-Caveat Lector-

U.S. Issues Mental Health Report

By LAURA MECKLER
.c The Associated Press


WASHINGTON (AP) - In an exhaustive review of research on mental disorders,
Surgeon General David Satcher concludes shame and difficulty paying for care
are keeping millions of Americans from treatments that have been proved
effective.

The sweeping report, issued today, encourages Americans who suspect they have
a mental disorder to seek help.

``Mental disorders are not character flaws but are legitimate illnesses that
respond to specific treatments, just as other health conditions respond to
medical interventions,'' said the report. ``Society no longer can afford to
view mental health as separate and unequal to general health.''

All told, mental disorders affect nearly one in five Americans. Two-thirds of
them never seek treatment, including nearly half of those with a severe
mental illness.

The report, a scientific rather than political document, makes no specific
policy recommendations. But mental health advocates said they would seize it
in fighting for equal health insurance coverage of mental ailments, better
treatments in prisons and more accountability in public spending.

``We've got a health crisis here and the surgeon general has documented it,''
said Laurie Flynn, executive director of the National Alliance for the
Mentally Ill.

``Mental Health: A Report of the Surgeon General'' reviews 3,000 academic
studies on mental health and mental illness and has been in the works since
Satcher took office in early 1998.

``They are treatable. That's the great news of this report,'' Satcher said
today as he released the report with Tipper Gore, Vice President Al Gore's
wife and a longtime advocate for the mentally ill.

Mrs. Gore noted that suicide is the third-leading causing of death among
young people 18 to 24. When asked why they don't get help, she said on ABC's
``Good Morning America,'' ``The kids say to me, `Because they are afraid of
being labeled.'

``Kids in particular need to know if they are in trouble and they know
someone who is talking about violence or talking about suicide or is in a
severe depression, they need to come forward and get the treatment they need
because treatment works,'' Mrs. Gore said.

``The report's principal recommendation to the American people is to seek
help if you have a mental health problem or think you have symptoms of a
mental disorder,'' it says. And Satcher encourages friends, family, teachers,
ministers, coaches and others who may spot someone with a problem to
encourage them to seek help.

But even people who want treatment can't always afford it. Even those with
health insurance often find sharp limits on what their health plans will pay
for.

The report stops short of recommending that the law require insurance
companies to treat mental and physical health problems equally - as President
Clinton and some in Congress have proposed. But it does call this coverage
``an affordable and effective objective.''

The nearly 500-page document examines both mental health and mental illness,
calling them ``points on a continuum.''

Mental health involves the ability to engage in productive activities, to
fulfill relationships with others, adapt to change and cope with adversity.
Mental illness includes a variety of disorders characterized by alterations
in thinking, like Alzheimer's disease; in mood, like depression, or in
behavior, like hyperactivity.

Satcher argues that people with mental health problems and mental illnesses
can live happier, more productive lives with the help of therapy and
medication.

Without help, someone who begins sad can become clinically depressed, and
ultimately even suicidal. Untreated, the most severely ill can end up
homeless or criminal.

``To a great extent, we are dumping our mental health problems on the streets
of America,'' Satcher said in an interview. ``We are dumping them into our
jails and prisons - there's no question about that.''

The nearly 500-page report, written by a panel of experts, also:

Reviews scientific research into the operations of the brain, including
unprecedented new examinations of complex neurochemical activity inside
individual brain cells.

Identifies prospective and promising new treatments.

Examines the flaws in the system for providing mental health care, including
problems coordinating government agencies, private groups, schools, prisons
and other providers.

Explains that researchers know more about how to treat mental disorders than
what causes them. No single gene causes disorders, the report says, but
variations in several genes can contribute to unhealthy brain activity that,
under certain conditions, results in mental illness.

Satcher, who has also focused on racial disparities in health, noted that
black Americans are less likely to get outpatient mental health services but
more likely to end up institutionalized, suggesting they are missing
opportunities for important early care.

This is the 51st surgeon general's report in the nation's history; 28 of them
have dealt with smoking, including a seminal work in 1964 that detailed the
health risks of tobacco.

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