The Unseen Epidemic

The world lost another light this week when the fashion designer Kate Spade was found dead of an apparent suicide inside her New York home.  This is what her sister told the Kansas City Star newspaper: “I will say this was not unexpected by me. She was always a very excitable little girl and I felt all the stress/pressure of her brand (KS) may have flipped the switch where she eventually became full-on manic depressive.”  Yet, her sister also reported that for years, Ms. Spade refused to seek the help she clearly needed. This latest incident is yet another high-profile reminder of the epidemic in our midst.

We are in the midst of a mental health crisis in this country, and we need to wake up and end the stigma of mental health. I know this is a big claim, so it is important to look at the numbers. For example, we have been devoting resources in treatment and research to ending cancer. While we are far from that goal, the mortality rate from cancer fell by 25% between 1990 and 2014. This shows that we are making progress in fighting this disease. In contrast, suicide rates increased by 24% between 1999 and 2014. To wit, there were more than twice as many suicides in 2016 as homicides. And yet, most adults with a serious mental health problem do not receive the help they so desperately need. Specifically, 56.5% of adults with mental illness received no past year treatment, and for those seeking treatment, 20.1% continue to report unmet treatment needs. The question bears asking: what gets between individuals and getting the care they need?

There are several reasons why people do not receive what can be life-saving mental health treatment. The biggest issue highlighted by the Kate Spade case is that of stigma. People generally treat mental illness diagnoses differently than those of physical health. For example, there has been a rising interest in the opioid epidemic that is raging across the country. We continue to struggle to define addiction as a disease rather than a moral failing. Too many people dismiss mental illness as somehow “not real” and a moral failing. This message is perpetuated in our very DNA of the American Dream–the ideal that every US citizen should have an equal opportunity to achieve success and prosperity through hard work, determination, and initiative. Inherent in this is the idea that if an individual works hard enough, they will be able to overcome and prosper. Thus, someone who is crippled by serious mental illness is seen as lazy, unmotivated, and undeserving of success. Our “rugged individualism” drills us with the idea that we need to pull ourselves up by the bootstraps and just try harder. But, mental illness is more than simply feeling bad. Depression is not just being “really sad.” Overcoming mental illness requires help, support, and most importantly community. But, instead of asking for help, far too many people languish in the shame of asking themselves, “what’s wrong with me? Why can’t I just try harder?” That message, and that perceived failure intensifies the shame that can lead to suicide.

And yet, even if someone wants to seek out treatment, our healthcare system discriminates against mental illness problems. The mental health parity and addiction equity act of 2008 was meant to put mental illness on the same playing field as physical health in terms of insurance coverage. However, insurance plans are not required to cover mental health services, they may exclude certain diagnoses, and many psychologists and other mental health providers opt out of the insurance system altogether. This is because many insurance plans have not raised their reimbursement rate in 10 or 20 years. Many well-trained mental health professionals simply cannot afford to participate in the insurance system.

Finally, while new immunotherapies and treatment approaches have been developed to battle cancer, mental health remains dominated by cognitive behavior therapy (CBT). While this approach clearly works for some people, some of the time, we urgently need to develop more effective approaches to treatment. As a field, we need to recognize that our current evidence-based treatment approaches, while extremely helpful, are not enough. Too many people die every year for us to throw in the towel and say, “our treatments are good enough.”

We here at CSI are fiercely committed to breaking down stigma and connecting people to the innovative treatments that can save their lives. We have a long history of breaking down stigma. While many clinics are content to offer office-based therapy, we go to people’s homes. We break through the stigma and shame of walking into a mental health clinic by meeting people on their turf. We constantly question what we do, and work to find alternative treatments that work. This has led us to offer neurofeedback or EEG biofeedback. This is an innovative modality of directly shaping an individual’s brainwaves in order to change how they feel. And finally, we fight to get people the services they need. We are not intimidated by insurance companies who want to limit clients’ access to services. To paraphrase John F. Kennedy, we are not mental health professionals because it is easy, but because it is hard.

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