Missoula Measures - Mental Health

Why this topic
How are we doing
Depression
Eating disorders
Attention Deficit Hyperactivity Disorder (ADHD)
Substance addiction
Post Traumatic Stress Disorder (PTSD)
Additional information
Protective factors
Progress
Goals
Related Measures
Related Websites

Why this topic?

Mental disorders are among the most common causes of disability.
The resulting disease burden of mental illness is among the highest of all diseases.

According to the National Institute of Mental Health (NIMH), in any given year, an estimated 13 million American adults (approximately 1 in 17) have a seriously debilitating mental illness. Mental health disorders are the leading cause of disability in the United States and Canada, accounting for 25 percent of all years of life lost to disability and premature mortality. Moreover, suicide is the 11th leading cause of death in the United States, accounting for the deaths of approximately 30,000 Americans each year.

Mental health and physical health are closely connected. Mental health plays a major role in people’s ability to maintain good physical health. Mental illnesses, such as depression and anxiety, affect people’s ability to participate in health-promoting behaviors. In turn, problems with physical health, such as chronic diseases, can have a serious impact on mental health and decrease a person’s ability to participate in treatment and recovery.

The National Alliance to End Homelessness reports (2009) that about half of homeless people have a mental health issue. Of those, 25% have a chronic, serious mental illness.

How are we doing?

ALMOST 6% OF AMERICAN ADULTS HAVE A MENTAL HEALTH ISSUE.

Treatment and control of mental health issues is challenging:

Due to the stigma attached to mental health treatment, many people don’t seek help.
Due to the rural nature of Montana, mental health treatment professionals are often not available locally.
Many health insurance companies don’t cover mental health care at the same rate as physical health care, so diagnosis and treatment can be expensive. (The Insurance Parity law before congress in 2011 may change this for the better.)

According to a 2011 report from Substance Abuse and Mental Health Services Administration (SAMSHA):

Only about 39% of those with a mental illness received mental health services.
Nearly 61% of those with severe mental illness received services.
8.7 million Americans had suicidal thoughts in the last year.
2.5 million made plans to kill themselves.
1.1 million attempted suicide.
People who abuse drugs or alcohol had higher rates of mental illness than others (20 percent vs. about 6 percent).
One-fourth of those with serious mental illness are substance abusers.
1.9 million 12- to 17-year-olds had a major depression episode in the past year.
Teens suffering depression were twice as likely to have a drug problem as teens who did not have a major depression (roughly 37 percent vs. 18 percent).

Local and state statistics on mental health issues is not readily available.

The most common forms of mental illness:

Depression

Affects about 16.5% of Americans; women are 70% more likely to suffer from depression than men. Depression is a common mental disorder with symptoms that include depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. These problems can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities. At its worst, depression can lead to suicide. World Health Organization

Eating disorders

Affects about 10-15% of Americans; women are 10 times more likely to have an eating disorder than men. "Eating disorder" is when a person eats, or refuses to eat, in order to satisfy a psychic need and not a physical need. The person doesn't listen to body signals or perhaps is not even aware of them. A normal person eats when hungry and stops eating when the body doesn't need more, when he feels the signal of satisfaction. Eating disorders are usually classified as anorexia nervosa, bulimia nervosa or binge eating disorder. However, a person may have an eating disorder without belonging exactly to any of these categories. Depression is a common co-illness; eating disorders have the highest mortality rate of any mental illness Nat’l Assn Anorexia

Attention Deficit Hyperactivity Disorder (ADHD)

Affects about 9% of Americans; males are twice as likely to have ADHA as women. Attention-deficit/hyperactivity disorder is a chronic condition that affects millions of children and often persists into adulthood. ADHD includes some combination of problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior. Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school. While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. A diagnosis of ADHD can be scary, and symptoms can be a challenge for parents and children alike. However, treatment can make a big difference, and most children with ADHD grow up to be normal adults. Mayo Clinic

Substance addiction

Substance abuse is defined as continued use of a substance (alcohol, prescription drugs, illegal drugs) regardless of the problems it causes. (One in 4 deaths of Americans is attributed to alcohol, tobacco or illicit drug use.) Substance abuse can cause problems with school, work, family responsibilities and social relationships. Addiction is often characterized by a craving for the substance, needing more of it to achieve the effect that a lesser amount of the substance induced in the past, or feeling that you can’t perform without it. The dependent user can also experience withdrawal symptoms such as increased heart rate, shaking, insomnia, fatigue, and irritability when the substance is not used. Robert Woods Johnson Foundation

Post Traumatic Stress Disorder (PTSD)

Affects about 8% of Americans sometime during their life. Women are twice as likely to suffer from PTSD as men. Post-traumatic stress disorder is a type of anxiety disorder that can occur after seeing or experiencing a traumatic event that involved the threat of injury or death. PTSD can occur at any age and can follow a natural disaster such as a flood or fire, or events such as assault, domestic abuse, a prison stay, rape, terrorism, war, etc. National Library of Medicine

Additional information

In Montana, on March 31, 2009, there were 3602 people in treatment for substance abuse at 60 facilities:

55% were being treated for both drug and alcohol abuse
7% for drug abuse only
28% for alcohol abuse only

National Survey of Substance Abuse Treatment Services

PROTECTIVE FACTORS

Factors that help protect CHILDREN against mental health disorders:

Good nutrition
Doing well in school
Positive values
Supportive, caring parents
Family harmony
Stable family
Strong family norms
Sense of belonging

Factors that help protect ADULTS against mental health disorders:

Economic security
Good physical health
Sense of connectedness to community
Strong cultural identity
Access to support services

PROGRESS

Over the past 20 years, research on the prevention of mental disorders has progressed. The understanding of how the brain functions under normal conditions and in response to stressors, combined with knowledge of how the brain develops over time, has been essential to that progress. The major areas of progress include evidence that:

Mental health disorders are common and begin early in life.
The greatest opportunity for prevention is among young people.
There are multiyear effects of multiple preventive interventions on reducing substance abuse, conduct disorder, antisocial behavior, aggression, and child maltreatment.
The incidence of depression among pregnant women and adolescents can be reduced.
School-based violence prevention can reduce the base rate of aggressive problems in an average school by 25 to 33 percent.
There are potential indicated preventive interventions for schizophrenia.
Improving family functioning and positive parenting can have positive outcomes on mental health and can reduce poverty-related risk.
School-based preventive interventions aimed at improving social and emotional outcomes can also improve academic outcomes.
Interventions targeting families dealing with adversities, such as parental depression or divorce, can be effective in reducing risk for depression among children and increasing effective parenting.
Some preventive interventions have benefits that exceed costs, with the available evidence strongest for early childhood interventions.

Goals

National Healthy People 2020 Target	Local statistics
Reduce suicide rate per 100,000 from 11.3 to 10.2.	2009 MT rate: 22
Increase the proportion of primary care facilities that provide mental health treatment onsite or by paid referral – from 79% to 87%.	In 2012, Missoula has 1 mental health inpatient treatment center which accepts referrals from our 2 hospitals.
Increase depression screening among primary care providers – currently, in the US, 2.2% screen.	In Missoula there are no primary care providers that screen for depression.
Increase the proportion of juvenile residential facilities that screen admissions for mental health problems - from 58% to 64%	In Missoula: Youth Court screens on a case-by-case basis if needed; Juvenile Detention uses Massachusetts Adolescent Youth Screening Instrument; Youth Homes conducts broad scope screening on intake and updates monthly.