There is a growing mental health crisis today. Numerous people report being depressed or anxious due to Covid and its aftermath. As the Texas mall shooting illustrates there is a lot of untreated mental illness in the United States. Indeed visits to the emergency rooms (ER) for mental health problems are on the rise. A mental health issue such as a panic attack can mimic other problems. I met a cab driver who said he went to the ER for a heart attack but it turned out to be a panic attack. Purportedly, hundreds of thousands of Medicaid patients seek treatment in emergency rooms for mental health.
Mental illness, in addition to adverse childhood experiences and substance use, are risk factors for homelessness. Although estimates of the prevalence of mental illness vary, studies looking at mental illness in the homeless population have generally found a high prevalence of mental disorders. The most common disorders may be alcohol and drug dependence.
Moreover, drug misuse disorders are thought to (in many cases) be a form of self-treatment for mental health problems.
Many individuals who develop substance use disorders (SUD) are also diagnosed with mental disorders, and vice versa. Although there are fewer studies on comorbidity among youth, research suggests that adolescents with substance use disorders also have high rates of co-occurring mental illness; over 60 percent of adolescents in community-based substance use disorder treatment programs also meet diagnostic criteria for another mental illness.
Numerous studies have found people who are unhealthy mentally have higher costs for medical care that is seemingly unrelated to mental health. Mentally unhealthy workers take more sick days and use more health benefits, costing $48 billion annually.
A new study in JAMA found that people with depression have a much higher risk for numerous chronic diseases.
Depression is a common risk factor in the development of other physical heath issues, like diabetes, high blood pressure, and cardiovascular disease, that frequently lead to hospitalization, new research suggests.
The new study, published in JAMA Psychiatry Wednesday, evaluated the health data of over 130,000 people in the United Kingdom to determine if and how depression was associated with co-morbid illnesses that commonly require hospitalization.
People with depression have a 1.5 times greater risk of developing 29 health conditions, like poisoning and falls but also diabetes, back pain, and bronchitis, according to the findings.
Exactly what is mental illness and when does unhappiness turn into depression? Are negative people just annoying or are they clinically depressed and in need of pharmaceutical intervention? These are not just glib ideas. The New York Times talks about the role of misery in the mental health crisis.
How miserable are we supposed to be? It is extremely difficult to know when low mood trips over into depression or when people’s thoughts about their lives are distortions. When does emotional dysregulation become mania? When do idiosyncrasy and magical thinking become psychosis? This difficulty is what leads us to outsource such determinations to clinicians and other assorted experts. Those experts are then imbued with significant power. They assess and diagnose us and reflect for us a view of how maladjusted we are. Concerns about this power have made mental health such a fraught topic. We want clinicians to have some power, but we worry about it.
In recent years talk therapy has given way to drug therapy, such as selective serotonin reuptake inhibitors (SSRIs). Think Prozac. Few psychiatrists perform talk therapy due to time constraints. For most people it would probably be too expensive to talk to a psychiatrist for mental health therapy sessions. What a lot of people probably need is a sympathetic ear to talk to. Yet, most people probably can’t afford to spend, say, $125 to $160 a week for a 45-minute therapy session. There is also a shortage of therapists and most do not take insurance because reimbursements are too low.
There are online therapy sessions but one-on-one therapy is never cheap. There are even trials where ChatGPT provides therapy, which actually works pretty well but is unlikely to work as well once patients discover they are talking to a chatbot. I know people either meditate, do yoga, exercise or pick an activity that works for them. Occasionally I’ve heard of shopping therapy, which probably causes a relapse when you see your credit card statement.
Maybe what people need is group therapy. I talked in the past about the old Bob Newhart Show, where he played a psychologist with eccentric patients in group therapy. I wrote about the concept years ago. Or maybe this is just another example of the epidemic of loneliness. There are a lot of innovative ideas that would take hold if third-party payment did not interfere with the doctor/patient relationship.