Mental health care in America has been a topic of discussion that has received varying levels of attention. Inadequacies in the current system are often seen as glaring. There is a tendency in this country for the diagnosis of a mental illness to be too readily available, while treatment remains elusive to many. Some experts in the field are now cautioning that this disparity will only get worse as conditions will favor a quick and easy diagnosis over an accurate one.
A person’s mental health is influenced by both situational and biological factors. It is not a matter of nature versus nurture, but one of nature and nurture. Our interactions with our environment clearly impact our physical and emotional lives, but when one person out of 10 responds to a situation with a severe depressive episode, more than the situation is at work. Therefore, it is often necessary to treat the biological factors with medication. However, in order to have comprehensive treatment of mental disorders, clinical interventions are essential and often life-saving.
DSM V and Diagnosis Rates
The major criticisms of the latest version of the Diagnostic and Statistical Manual (DSM V) is that it could pave the way for diagnostic rates to skyrocket. Critics of the DSM V have expressed concerns that the restructuring of many of the definitions and diagnostic criteria for many disorders will result in those loss of normal variation in human behavior. Dissenters insist that mild symptoms have been given too much weight in an effort to create a more encompassing manual for diagnoses for those who seek mental health assistance but present vague symptoms. There is fear that the rate of diagnosis could reflect epidemic proportions based on the lowered threshold for diagnostic qualifications. Many people who exhibit emotional or behavioral disturbances that are mild and would, with time, resolve themselves, would be given medication not necessary to them.
Pharmaceutical Companies Impact on Mental Health Diagnoses
One of the tenets of contention among professionals stems from the role that pharmaceutical companies play in diagnostic rates. Worry over profit-driven inflation effects is not limited to the mental health realm. However, with diagnosis made even easier by the DSM V, there is great concern that diagnoses will become too available and will present a more drastic picture than is reflective of the actual population while treatment for those who need it will remain elusive.
In the past, pharmaceutical marketing has resulted in education and awareness being brought to major health concerns, such as cholesterol’s link to heart disease. Dr. Allen Frances, a psychiatrist with 35 years of experience, explained in an interview that patients who ask for a medication specifically are 17 times more likely to receive it. Dr. Frances said that the majority of the prescriptions would come from primary care physicians who would not specialize in or treat any of the mental health diagnoses they prescribe medication for. He also explained that these diagnoses often come after as little as seven minutes of face time with the patient.
The Rates of Treatment Do Not Match Diagnostic Rates
Though medication is readily available to those with enough medical coverage to acquire it, the other elements of treatment for mental illness are much harder to come by. It is often difficult to find or maintain consistent access to dependable care. Treatment methods that are empirically supported are an essential element to the treatment of mental disorders and yet the people who need them the most are not gaining consistent access to them.
Media and Stigmatizing Hinder Progress in Mental Health Reform
One of the problems that arises from over-diagnosing people is the label of the diagnosis itself. Media portrayal of mental illness has been predominantly focused on the rare instances where untreated mental illness has resulted in violent outbursts. News outlets report quickly and sensationally on mass shootings and murder/suicides. Recently, this coverage has been instrumental in bringing mental health “awareness” into the conversation surrounding gun control. But this awareness is stigmatizing and only serves to impress a negative and inaccurate perception of those who suffer with mental illness as violently inclined upon the general public. This can reduce the rates of those who are willing to seek out treatment for fear of being associated with this flawed idea of what mental illness is.
An excellent example of the skewed media coverage regarding mental health can be found in the recent announcement of a massive bill meant to overhaul mental health care. Only eight reporters attended the press conference for the bill and of them, only two asked questions. Instead, most of the recent focus on mental health has been in regards to the tragic shooting that took place at Sandy Hook Elementary nearly a year ago. According to the Surgeon General, this constant linking of mental illness to violence has only served to misinform the public and fuel stigma based discrimination.
The reality of violent crimes is that only about three to five percent of them are the result of mental illness. Most crimes committed by the mentally ill are considered “nuisance” crimes and are largely preventable with proper treatment and housing. Yet, according to Dr. Frances. securing out-patient treatment is still harder than buying a gun.
As treatment remains elusive for people who need it and mental health diagnoses become even more available, many professionals caution that a picture of resource misallocation is presenting itself as a major hurdle to mental health care being effectively practiced. Hardly anyone appears to argue against the need for reform. The fact that professionals within the field are taking such active roles of advocation bodes well for the potential of the field to improve.
By Vanessa Blanchard