This is a good link to an Australian website with most of the main definitions

Inspired by Christopher thread on "No child left unmedicated" thread, I had a quick look for information on the New Freedom Commission on Mental Health, but couldn't find any non-partisan links on Google (though the AD thread came in at number 7 - yay! ). Most of the links were to commentary, and most focused on the same medicalisation of drug-treatable conditions angle that christopher raised.

It did, however set me thinking on our how our attitudes to mental health differ from those we have on physical health. It seems to be a much lower priority for discussion, let alone for allocation of resources to treatment, study or research.

Even medical litigation hasn't given the same priority to mental health concerns. Fat people get to sue McDonald's, smokers can successfully sue Phillip Morris and Imperial Tobacco, but I've yet to hear of a violent person suing the makers of Scarface or the original Starsky & Hutch. (Oops. That's given someone the idea. It's only a matter of time now... )

To set the ball rolling, I suffered from reactive depression for several years in my early twenties (my dad died, among other things). By the time I sought treatment, I didn't really need it.

Plus I'd studied enough on my Pharmacy degree not to like the idea of the MAOI drugs I was offered - basically they react badly with many common foods containing something called tyramine (including cheese, preserved meats & fishes, and many many more). Had I been offered SSRIs like Prozac, which weren't around then, I'd probably have popped them like candy.

What is your assessment of the prioritisation of mental health services in your country?
Why do you think it gets that level of priority, and do you approve or disapprove?
What more could or should be done to treat mental illness?
What more could or should be done to promote mental wellness?

I think what we have done a poor job doing is defining what, exactly, "good" mental health is.

Is good mental health being free from all anxiety? Is it not allowing anxiety to affect our physical health? Is it an ability to concentrate fully and unconditionally on the task at hand? Is it related to the interactions with others? Is being shy a mental illness?

These are the types of questions which have not been answered (and perhaps cannot be answered). If we cannot define health, we cannot define illness.

So when my 5 year old's teacher is concerned that he does inconsistent work (is able to make good letters and numbers sometimes, but not at other times), is that a signal that he has ADD? Does he need some kind of treatment? Is it an illness, or is it the natural product of being five? Is it caused by the four medicines he takes for his allergies/asthma?

Mental health is a very complicated issue. Right now, there is no baseline to judge "normal" by.

What is your assessment of the prioritisation of mental health services in your country?
The United States has many resources in this area. At some times, it is overemphasized, at others it is underemphasized.
Why do you think it gets that level of priority, and do you approve or disapprove?
Priority wise, the level fluctuates. In some areas, 1/3 of the kids are medicated for ADD and related "conditions". This is obviously overboard. In other cases, obvious mental problems are overlooked and swept under the rug. The lack of a definitive standard hampers diagnosis and treatment, in my opinion.

What more could or should be done to treat mental illness?
Establish a baseline of mental health and behavioral standards.

My husband has bipolar disorder, and I'm going to focus on that in particular, because that's where my experiences have been.

What is your assessment of the prioritisation of mental health services in your country?

I think it varies, actually. It's very easy to go to a primary care physician and obtain a prescription for SSRIs to treat clinical depression. The problem with this approach is that physicians don't have the time that it takes to properly diagnose a person. In my husband's experience, his physician treated him as though he had a standard depression, and this led to an inappropriate prescription that actually exacerbated his manic episodes.

What should be happening is a referral from the primary care physician to a psychiatrist who has more time and expertise in the field, but most insurance plans provide a very limited amount of psychiatric coverage. Additionally, an insurance agent that I recently spoke with informed me that once a person is diagnosed with bipolar disorder, the only coverage available is through a group plan.

When I tried to obtain an individual insurance plan with better coverage, they informed me that my husband is an autodecline for any individual insurance plan. They won't even insure him for general medical concerns with an exclusion on his BP. The only coverage that he can receive outside of the awful coverage at his job is through a plan mandated by the state that covers the terminally ill. It's very expensive.

So...my husband does not have insurance. We pay cash for psychiatric care, and it does get expensive, but it's necessary.

I also think that sometimes people are looking for a magical pill to make their problems disappear, and the prescription of certain drugs should be much more carefully thought out. Some people need different kinds of therapy to work through their issues and a prescription is not going to help them. Others need a combination of drugs and therapy, because they have issues within their life to work through, but they have been depressed for so long that there is a reaction to the way that the chemicals in the brain are being produced, and then, of course, there are those who simply have a physiological problem, and drugs can be extremely helpful.

I think that people have a hard time accepting that mania and depression can be physiological. They try too hard to relate it to their own feelings of up and down that are so often event based, but that's not necessarily an accurate depiction.

Why do you think it gets that level of priority, and do you approve or disapprove?

It's partially because of the way that people try to relate to some of these disorders. As I mentioned before, they try to view them in the context of their own event based periods of depression that can be worked through, but it doesn't always work that way. The brain is incredibly complex and it shouldn't be difficult to understand that sometimes the chemicals can get out of whack. It's no different than the body itself.

Another part of the problem is that our knowledge of how the brain works is not as comprehensive as our knowledge of the human body. Because of that, the science of treating some of these problems is not exact, and it involves a little bit of experimentation and fluctuation. This leads insurance companies to the idea that mental health care is a sort of hoodoo voodoo, alternative healthcare, and it also adds a certain amount of mistrust to the field.

There is also the issue of mental illness being taboo, although this is improving over time, I think.

What more could or should be done to treat mental illness?
What more could or should be done to promote mental wellness?

Well, obviously, I would like to see some better insurance options.

I also think that it's important to provide care to the indigent, because many adults end up in that situation because they haven't been able to receive treatment for their mental disorders. We could have a lot more productive members of society if we improved our assistance programs in that area.

I actually appreciate the New Freedom Commission on Mental Health. It's a bit vague at the moment, but it opens the door for discussion of new ways to help deal with this issue, and as I stated in the No Child Left Unmedicated thread, I support the idea of preliminary screening in schools.

Catching mental issues when people are young can sometimes make the process of working through them much less difficult. Some things are not as diagnosable at that age, but there are some issues like sensory integration problems and asperger's that can be improved with therapy.

Working on providing information is a good step, and chiseling away that taboo would be extremely helpful.

Having spent over 10 years married to a person (now an ex) with bipolar disorder, I can echo much of what Cyan relates in her excellent post. To a relationship and a family, it can be pure hell and the insurance problems that Cyan cites only make it worse. I think much of the problem stems from a term Cyan used in dealing with something like this - "work through it". One will notice that she didn't say "cure it" because "it" can't really be cured, only controlled if one's fortunate and it's an on-going process. I think that's what scares off the insurance companies. The medications are very expensive and the therapy that goes along with them isn't cheap either and near as I can tell, it's something that has to continue throughout a person's life. So insurance companies are looking at hundreds of thousands of dollars they are going to have to pay out for this one person.

What is your assessment of the prioritisation of mental health services in your country?



Up until now, it's been pretty poor I think, but it is getting a little better. Like Cyan, I like the new plan as a step in the right direction. It seems to me that mental health issues on a national scale were first addressed specifically by Tipper Gore during the Clinton years and I'm glad the Bush administration is following through on them. At least it's a start.


What more could or should be done to treat mental illness?
What more could or should be done to promote mental wellness?



As Cyan stated in her post, so little is known in this area really. I think we should begin to treat mental disorders with the same kind of aggressive research that we treat other illnesses. It seems to me that before you can begin to fix a problem, you first have to understand the problem and I don't think we're anywhere close to that yet.

What is your assessment of the prioritisation of mental health services in your country?
Pitiful. I think it has a very low priority unless you are wealthy, well insured (or both). During Reagan's 8 years in the White House, ruthless budget cuts (HUD being the most well-known) and overhaul of tax codes led to an explosion of homelessness and release of mental patients in the US.

Why do you think it gets that level of priority, and do you approve or disapprove?

Because it is largely a social issue, and most politicians, especially conservative politicians, care little for social programs. Mentally ill and/or homeless people do not vote, and are truly a forgotten population to the powers that be. I disapprove, because without proper funding for care of the severely mentally disabled, they become everyone’s problem.

Another reason is that a lot of mental illness isn’t immediately detectable or obvious; not like a double amputee in a wheelchair. But a mentally ill person can be just as disabled as the person in the wheelchair. Just watch the reaction whenever someone "normal-looking" is arrested for a gruesome crime..."he seemed so 'nice'". Mentally ill people don't have a red "I" tattoed on their foreheads, just as psycopaths look like Joe Blow-everyman. And the mere idea of mental illness makes many people uncomfortable.

What more could or should be done to treat mental illness?

A true effort to eliminate the stigma associated with it would be a good start. How sad is it that there is an agency devoted to rooting out stigmatizing those with mental illnesses?

What more could or should be done to promote mental wellness?

I'm not sure how to answer this. Each mental illness presents its own problems; some are genetic and some are as a result of environment or abuse, or the like. Some are severe; some are not so.

OK, now for the personal side note. My mother is diagnosed as clinically depressed with anxiety disorder, and it has crippled her life. About 6 years ago, I went through a particularly rough patch in my life, and was slowly, inexorably falling apart. Only a physical ailment that led me to my doctor forced me to realize that I, too, was suffering from depression. I bless the day my doctor was astute enough to see what was wrong with me. But I remember recoiling in horror at the idea of taking anti-depressant medication, because I didn’t want to become dependant, and worse, become like my mom. I can laugh about it now, but that day I was shaking, crying and so jumbled up in my thoughts I could barely function, and still maintained that I didn’t need a pill!!

I was so wrong. The medication has given me back my sanity and allows me to function at a much higher level than I ever would have been able to if I hadn’t relented and swallowed that first pill. I cannot say that I am "happy", but I am not desperately "UNhappy" either. I am one of those people who HATE to take medicine, but in my case, it was literally a lifesaver. I am an advocate of whatever works well for a person – within limits. Drugging people to the eyeballs isn’t what I’m talking about. My mother has such a high tolerance for nearly all the psychotropic drugs that she takes a monster dose just to maintain the poor level of relief she gets. And I detest the overmedication of children. I do not believe the medication would have worked so well on me if I had taken a pharmacopoeia of other drugs.

Therapy and meds. Thats all that can really be done. I have ADHD and there is nothing aside from meds that can help people with this disorder.