Kristof on Mental Illness

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New York Times Op Ed Columnist Nicholas Kristof Comments on mental illness. Jan. 5, 2014, Sunday Review Section SundayReview

First Up, Mental Illness. Next Topic Is Up to You.

THOSE of us in the pundit world tend to blather on about what happened yesterday, while often ignoring what happens every day. We stir up topics already on the agenda, but we falter at calling attention to crucial-but-neglected issues.

So here’s your chance to tell us what we’re missing. I invite readers to suggest issues that deserve more attention in 2014. Make your suggestions on my blog, nytimes.com/ontheground. I hope to quote from some of your ideas in a future column.

My own suggestion for a systematically neglected issue: mental health. One-quarter of American adults suffer from a diagnosable mental disorder, including depression, anorexia, post-traumatic stress disorder and more, according to the National Institutes of Health. Such disorders are the leading cause of disability in the United States and Canada, the N.I.H. says.

A parent with depression. A lover who is bipolar. A child with an eating disorder. A brother who returned from war with P.T.S.D. A sister who is suicidal.

All across America and the world, families struggle with these issues, but people are more likely to cry quietly in bed than speak out. These mental health issues pose a greater risk to our well-being than, say, the Afghan Taliban or Al Qaeda terrorists, yet in polite society there is still something of a code of silence around these topics.

We in the news business have devoted vast coverage to political battles over health care, deservedly, but we don’t delve enough into underlying mental health issues that are crucial to national well-being.

Indeed, when the news media do cover mental health, we do so mostly in extreme situations such as a mass shooting. That leads the public to think of mental disorders as dangerous, stigmatizing those who are mentally ill and making it harder for them to find friends or get family support.

In fact, says an Institute of Medicine report, the danger is “greatly exaggerated” in the public mind. The report concluded: “although findings of many studies suggest a link between mental illnesses and violence, the contribution of people with mental illnesses to overall rates of violence is small.”

Put simply, the great majority of people who are mentally ill are not violent and do not constitute a threat — except, sometimes, to themselves. Every year, 38,000 Americans commit suicide, and 90 percent of them are said to suffer from mental illness.

One study found that anorexia is by far the most deadly psychiatric disorder, partly because of greatly elevated suicide risk.

Mental illness is also linked to narcotics and alcoholism, homelessness, parenting problems and cycles of poverty. One study found that 55 percent of American infants in poverty are raised by mothers with symptoms of depression, which impairs child rearing.

So if we want to tackle a broad range of social pathologies and inequities, we as a society have to break taboos about mental health. There has been progress, and news organizations can help accelerate it. But too often our coverage just aggravates the stigma and thereby encourages more silence.

The truth is that mental illness is not hopeless, and people recover all the time. Consider John Nash, the Princeton University mathematics genius who after a brilliant early career then tumbled into delusions and involuntary hospitalization — captured by the book and movie “A Beautiful Mind.” Nash spent decades as an obscure, mumbling presence on the Princeton campus before regaining his mental health and winning the Nobel Prize for economics.

Although treatments are available, we often don’t provide care, so the mentally ill disproportionately end up in prison or on the streets.

One example of a cost-effective approach employs a case worker to help mentally ill people leaving a hospital or shelter as they adjust to life in the outside world. Randomized trials have found that this support dramatically reduces subsequent homelessness and hospitalization.

Researchers found that the $6,300 cost per person in the program was offset by $24,000 in savings because of reduced hospitalization. In short, the program more than paid for itself. But we as a society hugely underinvest in mental health services.

Children in particular don’t get treated nearly often enough. The American Journal of Psychiatry reports that of children ages 6 to 17 who need mental health services, 80 percent don’t get help. Racial and ethnic minorities are even more underserved.

So mental health gets my vote as a major neglected issue meriting more attention. It’s not sexy, and it doesn’t involve Democrats and Republicans screaming at each other, but it is a source of incalculable suffering that can be remedied.

Now it’s your turn to suggest neglected issues for coverage in 2014. I’ll be back with a report.