1.1 Mental Health and Mental Illness
Mental health refers to the successful performance of mental function, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity. Mental health provides people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem. People experiencing emotional well-being or mental health function comfortably in society and are satisfied with their achievements. Mental health is one of the leading health indicators that reflect the major public health concerns in the United States. Related indicators of interest to the mental health community include substance abuse, injury and violence, and access to healthcare.
The American Psychiatric Association (APA) defines mental illness as a clinically significant behavioral or psychological syndrome experienced by a person and marked by distress, disability, or the risk of suffering, disability, or loss of freedom. The symptoms of the disorder must be above and beyond expected reactions to an everyday event. The behavioral or psychological condition must result from brain functioning or malfunctioning, and it must cause the person distress, impairment, or both. It cannot be a cultural practice to which the majority culture in a society objects or that might cause distress to non-members of a cultural group. For example, some cultures believe that women should be subservient to men and expect the behavior of both sexes to reflect this idea. People of Western cultures might view such women as dependent or co-dependent, yet the behavior of these women is perfectly normal within the parameters of their own culture.
1.2 Incidence and Prevalence of Mental Illness
Psychiatric illnesses are common in the United States and internationally. The prominence of mental disorders in the total pattern of worldwide morbidity and mortality has been reported by the World Health Organization (WHO). According to their 2002 estimates, mental illnesses account for 25% of all disability across major industrialized countries. Mental illness ranks first in terms of causing disability in the US, Canada, and Western Europe.
In the US an estimated 26.2% of people (57.7 million) suffer from a diagnosable mental disorder in a given year. Data from the National Comorbidity Survey suggests that an estimated 13 million US adults (approximately 1 in 17) have a seriously debilitating mental illness. The main burden of illness is concentrated in this smaller population. Mental disorders are the leading cause of disability in the US and Canada for ages 15–44. Nearly half of people having any mental disorder meet the criteria for two or more disorders. In terms of mortality, suicide alone is the eleventh leading cause of death in the US, with approximately 30 000 deaths per year, and this is an issue of concern worldwide as well. Determining the costs associated with mental illness is challenging, but estimates suggest annual treatment costs in the US of $100 billion, with significantly more for indirect costs; $193 billion per year is estimated for lost earnings alone.
At least 20% of children in the United States have a diagnosable mental disorder; only 5% of these children have severely impaired functioning. In adults aged 18–54 years, 14.9% have anxiety disorders, 7.1% have mood disorders, and 1.3% have schizophrenia. Depression, a serious mental health problem in any age group, is particularly problematic in older adults. Between 8% and 15% of older adults have depression, but the condition is often undiagnosed and untreated in this age group because depression is mistakenly thought of as part of “normal aging.” People aged 65 years or older have the highest suicide rates of any age group. According to the Alzheimer’s Association, Alzheimer’s disease occurs in 8–15% of those older than 65 years (4.5 million cases) and that number is expected to increase to 11–16 million in the US by 2050. Approximately 125 000 people age 22–64 with mental illness live in nursing homes, 283 800 are incarcerated. Of 2 million individuals who are homeless over the course of a year, 50% have a mental illness and/or substance abuse disorder.
Table 1.1 contains National Institute of Mental Health statistics on the prevalence of some of the more common mental illnesses.
Table 1.1 Prevalence of mental illnesses in the United States.
Source: National Institute on Mental Health
| Disorder | Prevalence |
| Mood disorders (major depressive disorder, dysthymic disorder and bipolar disorder) | Approximately 20.9 million US adults, or about 9.5% of the population aged 18 and older, have a mood disorder in a given year |
| Major depressive disorder | Major depressive disorder affects approximately 14.8 million US adults, or about 6.7% of the population aged 18 and older in a given year |
| Dysthymic disorder | Dysthymic disorder affects approximately 1.5% of the US population aged 18 and older in a given year (this translates to about 3.3 million US adults) |
| Bipolar disorder | Bipolar disorder affects approximately 5.7 million US adults, or about 2.6% of the population aged 18 and older in a given year |
| Suicide | In 2006, 33 300 (approximately 11 per 100 000) people died by suicide in the US |
| Schizophrenia | Approximately 2.4 million US adults, or about 1.1% of the population aged 18 and older, have schizophrenia in a given year |
| Anxiety disorders | Approximately 40 million US adults aged 18 and older, or about 18.1% of people in this age group, have an anxiety disorder in a given year |
| Panic disorder | Approximately 6 million US adults aged 18 and older, or about 2.7% of people in this age group, have panic disorder in a given year |
| Obsessive–compulsive disorder (OCD) | Approximately 2.2 million US adults aged 18 and older, or about 1.0% of people in this age group, have OCD in a given year |
| Post-traumatic stress disorder (PTSD) | Approximately 7.7 million US adults aged 18 and older, or about 3.5% of people in this age group, have PTSD in a given year |
| Generalized anxiety disorder (GAD) | Approximately 6.8 million US adults, or about 3.1% of people aged 18 and over, have GAD in a given year |
| Social phobia |
