Disabled Parking Placard for Depression and Anxiety

Disabled placards should not be denied to people with depression and anxiety. Depression is the number one cause of disability in America. That means it's more crippling than any other ailment, including cancer, arthritis, and heart disease. Anxiety, including panic attacks, PTSD, GAD, and Social Phobia, can be just as crippling. Yet, I was denied a disabled placard for Anxiety by my PCP, which is discrimination against people with mental illnesses.

For example, when I had depression, I often worried that I will get a ticket. I once parked near a fire hydrant at night without any warning signs or a red curb, and got a ticket which caused significant distress. I filed a dispute, which, after a half-year "evaluation" period, was rejected. Dealing with parking tickets is anxiety-provoking and energy-depleting.

Walking through a busy parking lot can trigger anxiety. Sometimes I felt the need to run and get away, like I'm being chased by an unknown predator or like I'm falling down from a ten-story building. It's an awful, emotionally-draining feeling, and should not be endured by people with anxiety disorders.

I also worried about hitting other cars and people as I was looking for a parking space. I'd feel much safer to know where I'm going to park.

The anxiety made it significantly harder for me to function, just as if I had a broken leg. This anxiety is excessive and much more intense then what most people feel.

Anxiety is a disability; and a frighteningly real one. Therefore, we need to give disabled placards to people who have depression and anxiety.


How To Talk About Mental Illness

Just like saying "that's gay" is insensitive to the gay community, saying "that's crazy" is insensitive to people with mental illness. A simple way to advocate for mental health and help alleviate mental illness prejudice is by changing such language when talking about mental illness as well as correcting others when they misuse this language.

Appropriate language focuses on people’s abilities instead of their limitations. It always puts the person first before the mental illness to demonstrate his dignity and worth. We talk about a person’s illness only if necessary. Here are some guidelines to keep in mind when talking or writing about mental illness:
  • Avoid using adjectives that label people as "schizophrenics" or "a schizophrenic". Instead, use first-person language and name the illness, such as “he has schizophrenia” or “a person with schizophrenia”. This change distinguishes the person from the illness and treats him as an individual rather than defining him by his illness. 
  • Avoid the article "the" and thereby avoid, "the mentally ill". Use first-person language, such as, "people with mental illnesses". 
  • Avoid the abstract, "mental illness," whenever you can, use the fully informative specific diagnosis. 
  • Avoid saying “committed suicide” or "failed/successful suicide attempt”. “Commit” connotes a crime, and suicide is not a crime. "Failed" and "successful" are ridiculous to use in this context. Instead, say “died by suicide” or “killed himself”.
  • Don’t joke about mental illness, such as “I'd rather shoot myself”, “I’m OCD”, or “he must be bipolar”, to describe daily situations. Suicide and OCD are serious affliction, and talking about them casually is ignorant, insensitive, and minimizes their gravity. If you hear somebody say something like “Taking that class is suicide”, say that you know somebody who died by suicide (if you do) and that you’d like that this subject be treated with respect.

Labels / Outdated LanguagePreferred / First-Person Language
• Crazy
• Psycho
• Insane
• Lunatic
• A person with a mental health condition
• A person with experience of [a mental health condition]
• Normal
• Sane
• A person without a mental illness
• Healthy
• Paranoid schizophrenic
• Anorexic
• Depressive
• Obsessive-compulsive
• A person with paranoid schizophrenia / Anorexia nervosa / Major depression / Obsessive-compulsive disorder (OCD)
• Emotionally disturbed• A person with an emotional disturbance
• Special education student• A student receiving
special education services
• Addict
• Substance abuser
• Alcoholic
• A person with a substance abuse disorder / experience of substance abuse
•  A person with alcohol abuse
• Mentally ill / The mentally ill• A person with mental illness
• People with mental illnesses
• People with experience of mental illness
• Patient
• Client
• Case
• Individual
• Service recipient
• Consumer
• Survivor
• Successful suicide
• Unsuccessful / failed suicide
• Committed suicide
• Died by suicide / killed oneself
• Attempted suicide
• Performed suicide
• That drives me crazy / nuts
• That party was crazy
• My schedule is crazy
• He is nuts / mental
• That bothers / annoys me
• That party was sweet / off the hook / totally badass / hella fuckin’ balls-to-the-wall awesome
• My schedule is chaotic / hectic / busy
• He is weird / interesting / wild / funny


Union Tribune Contributes to Stigma... Again

The San Diego Union-Tribune editorial cartoonist, Steve Breen, has once again created a graphic that stigmatizes against all individuals who seek mental health treatment. The cartoon depicts an individual laying on a chaise with a therapist taking notes on a chair nearby. The patient's head is a grenade and the caption above the cartoon says 'Lawyers: James Holmes was psychiatric patient prior to shooting'.


This graphic stigmatizes against all individuals who seek mental health treatment.

"the overall contribution of mental disorders to the total level of violence in society is exceptionally small." --U. S. Surgeon General

There are a lot of reasons why violence occurs in our society, most of which have nothing to do with mental illness.


How to Think About Depression

There is a lot of misunderstanding and stigma associated with clinical depression, not to mention that the feelings experienced by someone with depression are inaccessible to someone who has not suffered from it - in the same way as none of us will truly understand what someone in a concentration camp during WWII was going through - so I don't blame anyone for not understanding the extent of the illness - only for not trying.

If you'd like to understand what suffering from clinical depression is really like, I suggest starting with the Wikipedia article on major depressive disorder and to read up on people's experiences from memoir (e.g., Darkness Visible) or online (e.g, www.ihaveamentalillness.com).

The truth is that more people kill themselves from going through this illness than die in traffic accidents. A person with depression cannot control how he feels, and he feels guilty and ashamed of this fact. So saying that feeling bad is no use only exacerbates that blame and reminds the person of his own inadequacy.

I had depression and the experience is a humbling one - the world is not always a positive place we'd like it to be. Depression is as insidious as cancer, and a person can't cure depression by simply changing his thinking, just like he can't cure his cancer by changing his thoughts. Sometimes - but less often then not - a person cannot ever feel better and death is the only solution. Sad but true.


What Not To Say To Someone With Mental Illness

If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather. Try to understand the blackness, lethargy, hopelessness, and loneliness they’re going through. Be there for them when they come through the other side. It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.
- Stephen Fry
Many people don’t know how to approach a friend or a family member who has a mental illness. Many feel uncomfortable by this thought. Our society is partly in denial of death and does not accept that a person can suffer despite his best efforts. This discomfort and confusion may lead those around the person—despite their best intentions—to be “walking on eggshells”. This is very noticeable to the suffering person and alienates him further.

I compiled a list of the top six worst things and one best thing to say to a person with depression, with explanations.

What Not To Say:

1. "I know just how you feel."

Possibly the most harmful characteristic of clinical depression is its inaccessibility to those who have not suffered from it. The feeling of isolation that the person with clinical depression feels is compounded by others’ inability to relate and sometimes even to merely accept that they have an illness. Unless you have tried to kill yourself or have actually been formally diagnosed with major depressive disorder, you don't, and this will only minimize the person's pain.

2. "Why are you depressed?"

Can be interpreted as a challenge (“are you really depressed?”). The person is depressed because he has clinical depression. And feeling depressed is only one out of dozens devastating symptoms of clinical depression. Just by asking this question you are demonstrating your ignorance of the very nature of clinical depression. The cause of depression is a mystery even in the medical field. Besides, why does it matter? Would you ask a cancer patient, why did you get cancer (bad mattress)? it’s a stupid question. Unless you care about the etiology of depression, this question will be perceived as a challenge. Only a clinically depressed person know what it's like to be clinically depressed.

3. “You are more fortunate than some people.”

If you could just see the good in your life you wouldn’t be so miserable. The person with depression cannot control how he or she feels, just like a cancer patient cannot heal his cancer simply by thinking. Depression is the result of complex interaction of biopsychosocial factors continuously in flux. The person has no say in when or how it will lift. Saying this will make the person with depression feel guilty about his inability to feel pleasure despite having more food, money, and a better shelter than many others. Physical possessions do not determine happiness. Besides, the inability to feel pleasure is a hallmark symptom of depression. Not only does it invalidate their feelings, but also chides them for feeling this way, not to mention serving as a reminder of their inability to feel even a drop of pleasure. It’s like asking a quadriplegic person to pick up a rock. Saying, "others' problems are worse than yours", will only make the person feel even more guilty about feeling bad.

4. "snap out of it" / "just shake it off" / “get over it” / ”pull yourself by the straps” / "it's just a phase, you'll get over it" / "man up" / “It's all in your head.”

Try saying this to a person in a diabetic coma or with terminal cancer (the Burden of Disease for severe depression is the same as for terminal cancer). A person with depression, like with cancer, does not have control over his infliction. It’s like the person is in prison: it wouldn’t be helpful to say, “don’t worry, you’ll be free someday." The fact is that it hurts and he needs your support and understanding.  It's dismissive and can be interpreted as, "just accept that it sucks and don't whine", which leads me to number five. 

5. “Stop whining about life"

May be combined with “everybody has problems, but you don’t see them whining about them”, or “you’re being selfish”. Depression is not about whining.

6. "How are you?"

Bad to ask especially when you don't really want to know. Asking “how are you” may be done to appear caring, as if asking about your depression, but without the risk of breaching a boundary by asking about it directly. Actually responding by talking about your depression in detail would put the person off in such a casual setting, leaving you no other choice but to respond with the perfunctory “fine”. This may make the person with depression feel stigmatized and an outsider. So, only ask this question of somebody who knows you know about his or her depression or if you really want to know. Otherwise avoid it.

What To Say:

"It must be really bad for you to feel like this, please tell me more. Even though I can't imagine what you are going through, I am here to support you."

If you don’t know if something you say is appropriate, just say, “I don’t know what’s to say not to offend you, but I really want you to feel better. I’m sorry if anything I say hurts you. Let me know if it does so I can correct myself. Just know that I only mean the best.”


More American Soldiers Die By Suicide Than In Combat

For the second year in a row, more American soldiers—both enlisted men and women and veterans—took their own life than were killed in both the wars in Iraq and Afghanistan. Excluding accidents and illness, 462 soldiers died in combat, while 468 died by suicide. A difference of six isn't vast by any means, but the symbolism is significant and troubling. In 2009, there were 381 suicides by military personnel, a number that also exceeded the number of combat deaths.


The True Cost of Mental Illness

More than one in four American adults suffers from mental disorders in a given year.
Mental disorders are the leading cause of disability in the U.S.
60% of Americans with a mental disorder get no treatment for their ailment at all.
Only 6.2% of U.S. health care spending is devoted to the treatment of mental disorders. 
Too many people living with mental illness are ending up in our jails or homeless, often as a result of untreated or undertreated illness. How will you reduce the number of people living with mental illness in our streets and criminal justice systems?

Mental disorders cost the United States more than $150 billion each year for treatment, for lost productivity, for the costs of social service and disability payments made to patients, and premature mortality. And this is a conservative estimate. Reducing the costs and correcting the shortcomings of our health care system requires policies which acknowledge that mental illnesses can be diagnosed precisely and treated effectively.
Severe mental illnesses, which afflict about 6% of American adults, cost society $193.2 billion in lost earnings per year. Yet, corporate America has few employer-backed health plans offering any coverage for workers' mental conditions. 
One longtime barrier to psychiatric care has been reluctance by insurance companies to consider mental illnesses on par with physical ones and thus not pay as well to treat them. Mental illness and drug addiction are every bit as real and serious as physical illness, and by providing intervention and early treatment we may be able to prevent more serious and costly conditions as well as unimaginable suffering in the future.
Mental illness is every bit as serious as physical illness.
In a study comparing depression treatment costs to lost productivity costs, 45 to 98 percent of treatment costs were offset by increased productivity. Appropriate and timely treatment of severe mental disorders would decrease the use and cost of medical services by people with these illnesses, yielding savings greater than the cost of providing these treatment services.

Additional benefits of providing timely and sufficient treatments for mental illnesses include a decrease of the homeless and prison population.

From Aaron Swartz's (hactivist who died by suicide) blogpost, Sick:
The economist Richard Layard, after advocating that the goal of public policy should be to maximize happiness, set out to learn what the greatest impediment to happiness was today. His conclusion: depression. Depression causes nearly half of all disability, it affects one in six, and explains more current unhappiness than poverty. And (important for public policy) Cognitive-Behavioral Therapy has a short-term success rate of 50%. Sadly, depression (like other mental illnesses, especially addiction) is not seen as “real” enough to deserve the investment and awareness of conditions like breast cancer (1 in 8) or AIDS (1 in 150). And there is, of course, the shame.
 From the article, Mental health care in U.S. questioned amid another tragedy:
Dr. Jeffrey Lieberman, chairman of psychiatry at Columbia University Medical Center in New York City, said shortcomings in mental health care are a very real problem. He told former assistant director of the FBI and CBS News senior correspondent John Miller on Monday that it's a societal problem because the U.S. has not taken on the treatment of mental illness as effectively as it could.
Only 5.6 percent of national health care spending goes towards mental health treatment, The Washington Post reported. Most of that money is spent on prescription drugs and outpatient treatment in a psychiatrist's office that some sufferers may not even choose to seek.
He added that the mental health care infrastructure just isn't there compared to care for other diseases. For example, a patient with cancer would be placed on a scientifically-backed comprehensive treatment plan with well-trained doctors for chemotherapy, radiation, etc., whereas people seeking mental health treatment need to do more work on their end not only find treatment but overcome these disincentives to get care. 
"Our society, with its stigma on mental illness and its broken healthcare system, does not provide us with other options," [Liza Long, the author of the post "I Am Adam Lanza's Mother"] wrote. "Then another tortured soul shoots up a fast food restaurant. A mall. A kindergarten classroom. And we wring our hands and say, 'Something must be done.' I agree that something must be done. It's time for a meaningful, nation-wide conversation about mental health."
But money should not have to be primary motivator. Because acting out of a purely financial motive is cold and soulless and is like a an insurance company deciding to not recall faulty vehicles because the total cost of the recall would be more then the cost of paying off lawsuits filed by the deceased victims' families.

Anyone who has experience serious mental illness knows that the suffering is inhuman, and no person should be allowed to experience it. Especially not when mental disorders are among the most treatable ones.

Sources: Tallying Mental Illness' CostsMental health care in U.S. questioned amid another tragedySick


The Mental Health Manifesto

The time has come when it is everyone’s duty to make their support for mental health known. We have lived in the shadows of shame and guilt for too long. It is criminally negligent to provide insufficient treatment knowing that mental illness is extremely treatable and considering the scope of the problem. And it is our duty to stand up and help those around us who suffer from mental illness today.

Wednesday, June 6, 2012


Dehumanization of People with Mental Illness

What is stigma? Stigma is a mark or a label, either physical, such as a tattoo, or psychological, such as stereotyping. In any case, it is believing that the other is less-than-human, an animal, and therefore his suffering is acceptable.

There are one million suicides worldwide annually. There are more suicides in the United States than both deaths from traffic accidents and homicides.

Why doesn't this bother the lay person? This is what may go on in his head: "wow, there are a lot of suicides in the world. Why would people want to end their lives? It must be because they deserve it. They are different and therefore deserve to die. So I guess it's just a fact of life, and since it doesn't affect me I'll go on living my life as I did a moment ago."

Why do I think people dehumanize those that kill themselves by suicide (or have mental illnesses)? Because if they really considered those people to be like themselves, they would surely be outraged.

Example: racism in present-day America.


Preventing Depression

“The health care system is set up to pay providers for treatment. It has not been set up to pay providers for prevention of mental disorders,” said Muñoz. “Without financial incentives for prevention few professionals will engage in preventive interventions. It’s a major structural obstacle.”


Causes of Depression (Etiology)

My own view is that depression arises out of an enormously complicated, constantly shifting, elusive concatenation of circumstance, temperament, and biochemistry.
–David Karp, An Unwelcome Career 

I shall never learn what “caused” my depression, as no one will ever learn about their own. To be able to do so will likely forever prove to be an impossibility, so complex are the intermingled factors of abnormal chemistry, behavior and genetics. Plainly, multiple components are involved—perhaps three of four, most probably more, in fathomless permutations.
–William Styron, Darkness Visible

Some causes (etiology) of depression

  • Stopping smoking or alcohol suddenly (William Styron, Les Murray)
  • Withdrawal from prescription or illicit drugs
  • Traumatic event or loss
  • Disease, such as cancer
  • Brain injury
  • Incomplete grief (ex: early loss of a mother)
There is no single consistent cause, but a combination of genes and the environment. There is usually a predisposition to depression (genes - family history of mental illness), and stressful events (environment), such as loss of a loved one, can trigger a depressive episode. 

Primary paradigm of contemporary mainstream Western psychiatry is said to be the biopsychosocial (BPS) model, incorporating biological, psychological and social factors.


The Ethics of Reporting Suspected Suicides

Counselors must have absolute and positive ethical and legal duty to report suicide threats just as they have a duty to report suspected child abuse in which any and all suspected situations are reported. Suicide is just too big of a threat to ignore and it overrides whatever obligations to privacy they have to the student. Ignoring a suicide threat is like ignoring claims of rape or child abuse by the victims.

The school also must be legally responsible for a student’s suicide. A counselor’s ethical obligation to a suicidal student has to extend beyond parental notification. And of course the student is going to deny that they said anything about attempting suicide - they are scared they will be locked up in a psychiatric ward. If a student isn’t helped after notifying parents or guardians, then the student’s counseling needs haven’t been met. School counselors must make every attempt to supply parents or guardians with counseling referrals until placement is secured for that student.



Suicide: Number One Killer of College Students

Suicide recently ranked as the leading cause of death among the university population, topping alcohol-related traffic deaths.

According to University of Virginia researchers, the leading cause of student deaths is suicide. James C. Turner, director of the Department of Student Health at the University of Virginia, asked more than 1,150 schools to share their student mortality rates.

Given this information, what does this say about the way major universities handle depression and mental illness?

According to the article:

It is becoming very difficult for colleges to push mental illness awareness and prevention to the forefront as economic times are getting tougher and endowments are taking hits, some schools don’t have the luxury to keep up with counseling and psychological services.
It claims that counseling and psychological services are a luxury. If the topic was concerning preventing alcohol-related traffic deaths, nobody would call traffic-safety education a luxury. Mental health services are not a luxury, but indispensable necessities and the responsibility of the university. Luxuries are the Universities' sports programs, new projectors, and remodeled buildings. The complacent tone the article's author conveys concerning the status quo is outrageous. For every suicide, there are twenty attempts, and 10% of America's college students have diagnosed depression. Does nobody care about the suffering going on before our eyes? 



Milestones In Mental Health

1932: Suicide rate reached 22 per 100000 people -- an all-time high in U.S. history. Thought to be the outcome of the Great Depression.
1946: The National Institute of Mental Health (NIMH) established within the National Institutes of Health. There, it launches a first-of-a-kind, comprehensive research program on mental illness and health.
1996: The Mental Health Parity Act (MHPA), a legislation signed into law by President Clinton, requires parity of mental health benefits with medical and surgical benefits, however, with limited scope and poor enforcement.
1999: The first White House Conference on Mental Health and the first Secretarial Initiative on Mental Health prepared under the aegis of the Department of Health and Human Services.
2004: globally, suicide tall exceeds lives taken by murder and war put together (WHO), expected to reach 1.5 million in 2020.

2009: U.S. military suicide deaths exceed combat fatalities in Iraq and Afghanistan
2009: Drugs exceeded motor vehicle accidents as a cause of death for the first time since the government started tracking drug-induced deaths in 1979, killing at least 37,485 people nationwide (U.S. Centers for Disease Control and Prevention). This is the first time that drugs have accounted for more fatalities than traffic accidents
2009: Suicides exceeded motor vehicle accidents as the cause of death for the first time since 1924 (16.4 suicides and 16.1 traffic deaths per 100k) killing 36,547 people nationwide in 2009, which is also the highest rate of suicide since 1993, 12.0 per 100,000. While car accidents had the lowest rate since 1920, 11.1 per 100k in 2009 vs. 11.4 in 1920.
2010: The Patient Protection and Affordable Care Act signed into law by President Obama, The biggest Civil Right legislature since the 1964 CRA. Expands insurance coverage to 30 million Americans.
2010: Army suicides hit all time high and continue to rise.
2010: Depression is the #1 cause of disability in the United States.
2020: Depression expected to reach #1 cause of disability in the world.

Suicide statistics grossly underestimate the actual rate of suicide. Many suicides are hidden among other causes of death, such as single car, single driver road traffic accidents, unwitnessed drownings, accidents, and other undetermined deaths. In addition, suicide is thought to be underreported for multiple reasons including stigma, religious concerns, and social attitudes. The psychological and social impact of suicide on the family and community is enormous.

Drugs Outnumber Traffic Deaths For The First Time Ever

Drugs exceeded motor vehicle accidents as a cause of death in 2009, killing at least 37,485 people nationwide (U.S. Centers for Disease Control and Prevention).
There were 33,808 traffic-related deaths in 2009.
This is the first time that drugs have accounted for more fatalities than traffic accidents since the government started tracking drug-induced deaths in 1979.

Fueling the surge in deaths are prescription painkiller and anti-anxiety drugs that are potent, highly addictive and especially dangerous when combined with one another or with other drugs or alcohol. Among the most commonly abused are OxyContin, Vicodin, Xanax and Soma, and Fentanyl.
  • There is a dramatic rise in prescription drug deaths in recent years, which now cause more deaths than heroin and cocaine combined.
"It's a wonderful medical advancement that we can treat pain," Bohnert said. "But we haven't figured out the safety belt yet."
Drug-induced deaths are mostly accidental overdoses but also include suicides and fatal diseases caused by drugs.
This is the only place the article mentions suicides. With depression affecting 6.7% of the population yearly (30% of these cases are severe), suicide is the obvious answer to the cause in the majority of overdose deaths.

Deaths from suicide outnumber traffic deaths as well.
  • Suicide vs. car accidents 
    • In the United States, suicide accounted for 36,547 deaths in 2009 (3/4 of them by males), while there were 33,808 automobile accident fatalities in 2009.
    • In Australia, 40 % more people lost their lives to suicide than car accidents. 
    • In the U.K., 100% more people die from suicide than road traffic accidents.
  • Suicide vs. homicide 
    • There were more than twice as many suicides (36,547) as homicides (16,591) in the United States in 2009. 
  • Suicide was the 10th leading cause of death in 2009.
    • 4th among 18-65 years (2007) 
  • Note: Mortality statistics are based on information from death certificates, and most suicides go unreported. 
    • The actual figure is 3 to 5 times higher (109,641 - 182,735), according to the book "Why Suicide". 
    • That puts suicide at 3rd to 6th cause of death in the U.S.
Other Suicide facts:
  • Men:
    • Die by suicide 4x more often then women (27,269 vs. 7,329 in 2009)
    • Chose more fatal methods, such as firearms.
  • Women:
    • Attempt suicide 4x more often then men. 
    • Choose less deforming methods, such as drug overdose.

Antidepressants: Most Prescribed Drug in the U.S.

About 11% of Americans aged 12 or older take antidepressant medications. The rate of antidepressant use in the U.S. has increased nearly 400% since 1988 (CDC: "NCHS Data Brief, No. 76," October 2011).

Antidepressants were the top most commonly prescribed drugs in America for all ages in the years 2006-2008, and (a very close) second in 2009 and 2010, with 253.6 million prescriptions in 2010 (Table 1). 

Two out of the top 10 most prescribed drugs are antipsychotics.
Appendix notes:
Therapy classes defined using ATC defined product groups and synthesized based on proprietary IMS Health definitions. Report reflects Prescription-bound products including Insulins (and excludes other products such as OTC). Includes all prescriptions dispensed through retail pharmacies - including independent and chain drug stores, food store pharmacies and mail order as well as long-term care facilities. Prescription counts are not adjusted for length of therapy. 90-day and 30-day prescriptions are both counted as one prescription. Updated April 7, 2011

Other findings:
  • 14% of non-Hispanic white persons take antidepressants compared with 4% of non-Hispanic black and 3% of Mexican-American persons.
  • Antidepressants were most frequently used from 2005 to 2008 by people between 18 and 44. 
  • Most people who take antidepressants do so to treat depression, but the drugs also are used for other disorders, such as anxiety (about 8% of people aged 12 and over who had no current depressive symptoms took antidepressant drugs). 
  • Females are 2.5 times more likely to take antidepressants than are males. 40% of females and 21% of males with severe depressive symptoms take antidepressants. 
  • 34% of severe, 28% of moderate, 19% of mild, and 7% of persons with no symptoms of depression take antidepressants.
  • More than 60% of Americans on antidepressants have taken the drugs for two or more years, with about 14% taking the medication for a decade or more. 
  • Less than 1/3 of people taking one antidepressant drug and less than 1/2 of those taking multiple antidepressant medications have seen a mental health professional in the past year. 
  • 23% of women between 40 and 59 take antidepressants, more than in any other age-sex group.
The Use of Medicines in the United States: Review of 2010: Report by the IMS Institute for Healthcare Informatics.
CDC: "NCHS Data Brief, No. 76," October 2011.


Are People With Mental Illness Violent?

"The vast majority of the American public believes that persons suffering from depression, schizophrenia, alcohol dependence, and drug dependence pose a threat for violence toward self and others. (NMHA, 1999)"

According to Mental Health: A Report of the Surgeon General (1999), the discrimination and stigma associated with mental illnesses largely stem from the link between mental illness and violence in the minds of the general public. “For instance, 61 percent of Americans think that people with schizophrenia are likely to be dangerous to others,” notes the report of the President’s New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America (2003).

Many believe that education is the key to reducing the stigma associated with mental illness. Education does not reduce stigma. According to the paper Americans’ Views of Mental Health and Illness at Century’s End: Continuity and Change, "Between 1950 and 1996, the proportion of Americans who describe mental illness in terms consistent with violent or dangerous behavior nearly doubled." 

Why is this hurtful to society?
  • As a result of the fear of violence, preference for social distance in most social settings between the public and those with mental health problems remains distressingly high. 
  • Americans are hesitant to interact with people who have mental illnesses (Pescosolido, et.al., 1996): 
    • 38 percent are unwilling to be friends with someone having mental health difficulties
    • 64 percent do not want someone who has schizophrenia as a close coworker
    • 68 percent are unwilling to have someone with depression marry into their family
  • "The public is least willing to accept persons suffering from psychological problems as family members or coworkers."
“Most people who suffer from a mental disorder are not violent — there is no need to fear them. Embrace them for who they are — normal human beings experiencing a difficult time, who need your open mind, caring attitude, and helpful support.” (Grohol, 1998)

In fact, people with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime. (Appleby, et.al., 2001)

On functionality:
  • "Majority of Americans believe that persons suffering from a mental health problem (sans depression) are unable to manage finances or make treatment decisions."
  • "When asked to characterize the severity of the problem encountered by persons experiencing depression, schizophrenia, alcohol dependence, and drug dependence, the vast majority of the public views these conditions as representing “very serious” problems."
Most people with mental illness are high-functioning. 12-month incidence of mental illness in U.S. is 26.2% of adult population. Severe mental illness (resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities) is concentrated in only 1/5 of these cases (5.8% of adult population).
Women constituting twice as many severe cases as men. However, paradoxically, women with mental disorders are seen as significantly less likely to pose a threat for dangerous or violent behavior

Lifetime and 12-month incidence of mental illness in the U.S. adult population.1

The cases of mental illness in which violence does exist, the violence is not the result of inherent deviancy or a diabolical nature of those with mental illness, but because of severe distress. We, the public, are to blame for this, because we do not provide anywhere near the sufficient treatment to treat mental health problems.

Violence and Mental Illness — How Strong is the Link? 
Much can be done to diminish the risk of violence among the mentally ill. A study that compared the prevalence of violence in a group of psychiatric patients during the year after hospital discharge with the rate in the community in which the patients lived showed no difference in the risk of violence between treated patients and people without a psychiatric disorder.5 Thus, symptoms of psychiatric illness, rather than the diagnosis itself, appear to confer the risk of violent behavior. So patients with schizophrenia who are free of the acute psychotic symptoms that increase this risk, such as having paranoid thoughts or hearing voices that command them to hurt others (called command auditory hallucinations), may be no more likely to be violent than people without a mental disorder. The study did not specifically monitor the treatments, but it seems possible that treating psychiatric illness does not just make patients feel better; it may also drastically reduce the risk of violent behavior.
Of course, because serious mental illness is quite rare, it actually contributes very little to the overall rate of violence in the general population; the attributable risk has been estimated to be 3 to 5% — much lower than that associated with substance abuse, for example. One study involving 802 adults with a psychotic or major mood disorder showed that violence was independently correlated with several risk factors, including substance abuse, a history of having been a victim of violence, homelessness, and poor medical health.4 The 1-year rate of violent behavior for subjects with none or only one of these risk factors was 2% — a prevalence close to the ECA study's estimate for the general population. Thus, violence in people with serious mental illness probably results from multiple risk factors in several domains.
"Large numbers of the American public assign primary responsibility for the costs of mental health treatment to the affected individual and private insurance companies. If necessary, these individuals assign secondary responsibility to the families of those with mental health problems."
  • "Between 1957 and 1996 the percentage of the American public who indicated that they would seek informal support to deal with an anticipated nervous breakdown increased over 400 percent."
  • "Americans see the utility of a wide variety of potential sources of help for those suffering from mental health problems, but when asked to indicate whom they would turn to first, the majority indicated they would seek help from family and friends."
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