Practice Guidelines

Surgeon General Releases Mental Health Report



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Am Fam Physician. 2000 Jun 15;61(12):3739-3740.

The surgeon general of the Department of Health and Human Services, U.S. Public Health Service, has issued the first report on mental health and mental illness. The report takes a lifespan approach to its consideration of mental health and mental illness by discussing in detail the periods of childhood, adolescence, adulthood and later life.

In this report, the coverage of mental health and mental illness is comprehensive but not exhaustive. While the report considers mental health facets of some conditions that are not always associated with the mental disorders, it does not consider all conditions that are found in classifications of mental disorders such as the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV).

Mental Health: A Report of the Surgeon General (ISBN 0-16-050300-0) is available from the U.S. Government Printing Office, Superintendent of Documents, Mail Stop: SSOP, Washington, DC 20402-9328.

Purpose of the Report

The purpose of the report is to convey several messages. First, mental health is fundamental to health. According to the report, Americans view the prevention of disease and promotion of personal well-being and public health as high-priority issues; the surgeon general stresses that we must also assign high priority to the promotion of mental health and the prevention of mental disorders. The second message of the report is that mental disorders are real health conditions that have a tremendous impact on persons and families throughout the world.

Definitions

The report defines the term “mental health” as: “the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity; from early childhood until late life, mental health is the springboard of thinking and communication skills, learning, emotional growth, resilience and self-esteem.”

The report defines “mental illness” as: “the term that refers collectively to all mental disorders. Mental disorders are health conditions that are characterized by alterations in thinking, mood or behavior (or some combination thereof) associated with distress and/or impaired functioning.”

Research Methods

The body of the report summarizes an extensive review of the scientific literature and consultations with mental health care professionals and consumers. More than 3,000 research articles and other materials, including first-person accounts from persons who have experienced mental disorders, were examined. The review of the research revealed two main findings: (1) the efficacy of mental health treatments is well documented and (2) a range of treatments exists for most mental disorders. Based on the strength of these findings, the main recommendation of the report is “to seek help if you have a mental health problem or think you have symptoms of a mental disorder.”

Scope of the Report and General Conclusions

The surgeon general's report is divided into eight chapters. The following is a summary of each chapter and the surgeon general's recommendations:

Chapter One: Introduction and Themes. This chapter gives an introduction to the report and lists the key conclusions drawn from each of the succeeding chapters.

Chapter Two: The Fundamentals of Mental Health and Mental Illness. Chapter two discusses several defining trends in the mental health field during the past 25 years. These include the following:

  • The impressive pace and productivity of scientific research on human behavior and the brain.

  • The introduction of a range of effective treatments for most mental disorders.

  • The transformation of society's approaches to the organization and financing of mental health care.

  • The emergence of powerful consumer and family movements.

This chapter was written to provide background information to help persons outside the field of mental health to better understand this report.

Chapter Three: Children and Mental Health. According to chapter three, childhood is characterized by periods of transition, making it necessary to assess the mental health of children and adolescents in the context of familial, social and cultural expectations about age-appropriate thoughts, emotions and behavior. Young persons can and do develop mental disorders that are more severe than the typical “ups and downs” of development.

About 20 percent of young persons experience the signs and symptoms of a DSM-IV disorder during any given year, but only about 5 percent of all children experience “extreme functional impairment.”

Mental health problems and disorders can affect persons of any social class or background. The children at greatest risk are those with physical problems, intellectual disabilities, low birth weight, family history of mental and addictive disorders, multigenerational poverty and care-giver separation or abuse and neglect.

Preventive interventions have been effective in reducing the impact of risk factors for mental disorders, and improving social and emotional development. A range of psychosocial and pharmacologic treatments also exist for many mental disorders in children, including attention-deficit/hyperactivity disorder, depression and disruptive disorders.

Primary care and schools are ideal settings for the potential recognition of mental disorders in young persons, but trained staff are limited. Family members have also become essential partners in the recognition and delivery of mental health services for children and adolescents.

Chapter Four: Adults and Mental Health. As persons move into adulthood, untreated mental disorders can lead to lost productivity, unsuccessful relationships and significant distress and dysfunction. Mental illness in adults can have a significant impact on children in their care. Also, stressful life events or the manifestation of mental illness can disrupt life balance and result in distress and dysfunction.

Research has improved our understanding of mental disorders in the adult stage of life. It has also contributed to our ability to recognize, diagnose and treat each of these conditions effectively in terms of symptom control and behavior management.

Certain common events in midlife, such as divorce or other stressful life events, can cause mental health problems that may be addressed through a range of interventions. Substance abuse is a common co-occurring problem for adults with mental disorders.

The report also emphasizes that sensitivity to culture, race, gender, disability, poverty and the need for patient involvement are important considerations for treatment and care.

Chapter Five: Older Adults and Mental Health. Chapter five states that continued intellectual, social and physical activity throughout life are important for maintaining mental health in late life.

Stressful life events, such as declining health or the loss of mates, family members or friends, will often increase with age. Persistent bereavement or serious depression is not “normal” and should be treated. Normal aging is not characterized by mental or cognitive disorders. Mental or substance use disorders that present alone or co-occur should be recognized and treated as illnesses.

Disability caused by mental illness in persons older than 65 years will become a major public health problem in the near future. Particularly, dementia, depression and schizophrenia, among other conditions, will present special problems in this age group.

There are effective interventions for most mental disorders and many mental health problems, such as bereavement, that affect older persons. The treatment of older adults with mental disorders can improve the interest and ability of persons to care for themselves and follow their physician's directions and advice. The report states that primary care physicians are a critical link in identifying and addressing mental disorders in older adults.

Chapter Six: Organization and Financing of Mental Health Services. Chapter six gives an overview of the current system of mental health services. It describes where persons receive care and how they use mental health services. The chapter also provides information on the costs of care and trends in mental health spending.

Chapter Seven: Confidentiality of Mental Health Information: Ethical, Legal and Policy Issues. This chapter emphasizes the critical need for confidentiality in the treatment of mental health conditions because of the extremely personal nature of the material shared. If patients trust that their condition not be disclosed without their consent, they are more likely to seek treatment for mental health problems.

Chapter Eight: A Vision for the Future—Actions for Mental Health in the New Millennium. The final chapter of the report recommends the following courses of action:

  • Continue to build the science base for new treatment opportunities and the prevention of mental illness.

  • Overcome stigma that prevents persons from acknowledging their own mental health problems.

  • Improve public awareness of effective treatment.

  • Ensure the supply of mental health services and providers.

  • Ensure delivery of state-of-the-art treatments.

  • Tailor treatment to age, gender, race and culture.

  • Facilitate entry into treatment.

  • Reduce financial barriers to treatment.



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