Surgeon General Issues 'Landmark' Report on Mental Health

From the WebMD Archives

Dec. 13, 1999 (Washington) -- The U.S. Surgeon General's first-ever report on the nation's mental health urges those who need help to seek treatment, but the 500-page document also warns that much needs to be done to guarantee that insurance will cover the therapies that are available.

"As we stand of the eve of a new millennium, this landmark mental health report equips us with a scientific, 21st-century approach to mental illness," says U.S. Surgeon General David Satcher, MD.

Among the report's key findings: Mental disorders affect nearly one in five Americans in any given year. They are the second-leading cause of disability and premature death in the U.S., but new understanding of the brain is generating effective treatments for most of these conditions. Still, more than half of those who need treatment don't get it, according to the report.

"It's really a tragedy that so many people are suffering mental illness and not seeking treatment," Satcher tells WebMD. "I think that's because of the stigma that surrounds mental illness, but it's also because of our system, and we should admit that."

In a preface to the report, Health and Human Services Secretary Donna Shalala, PhD, says the report is a chance to end stereotypes about mental illness. "In fact, mental illnesses are just as real as other illnesses," says Shalala.

Mental disorders, says the report, are conditions that impair thinking, feeling, and behavior; left untreated, diseases like depression, schizophrenia, and eating disorders can be just as disabling as cancer or heart disease. The direct costs of mental illness in the U.S. are estimated at about $70 billion annually.

Satcher presented his report, based on more than 3,000 articles and first-person accounts, to Tipper Gore and Shalala at a news conference Monday. Gore has been a longtime advocate for the mentally ill and earlier this year revealed that she herself has undergone treatment for depression.

Gore praised the report as a "historic opportunity" but also noted that it spotlights the need for more tolerance of mental patients and better insurance coverage for their treatments. "For all the progress we have made on mental health, [mental illness] is still very much feared, and it's very much misunderstood," she said. "We certainly can uphold the virtue of opportunity for all by working for mental health coverage for everybody."

The solution, she said, is parity. Currently, 27 states have at least some kind of limited parity requirements, and while a federal mandate imposes the same lifetime benefits caps for all conditions, health plans vary widely in the mental health services they cover. In addition, 44 million Americans have no health insurance coverage at all.

"It is ironic that the central recommendation of this report is that if you have symptoms of a mental illness you should seek help, but at the same time, we live in a world where not everyone can afford help, or even if they have insurance, they might find the insurance really doesn't cover what they need," says Steven Hyman, MD, director of the National Institute of Mental Health, tells WebMD. NIMH was one of the agencies that helped prepare the report.

While the report says "there is little direct evidence of problems with quality in well-implemented managed care programs," Hyman believes behavioral treatments are still being hit hard by HMOs.

Jerry Vaccaro, MD, of the American Managed Behavioral Healthcare Association, says the report appears fair. "It's time for honest dialogue about the true experiences with managed care so that we can realize its full potential ... improving the state of mental health care," he says.

The American Psychiatric Association lauded the report as an effort that could raise awareness of mental health issues, much as the 1964 Surgeon General's report increased understanding of the perils of smoking.