Mental health is an urgent public health concern

Mental health is an urgent public health concern

American Academy of Nursing on Policy Mental health is an urgent public health concern Nancy P. Hanrahan, PhD, RN, FAANa,*, Gail W. Stuart, PhD, RN, ...

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American Academy of Nursing on Policy

Mental health is an urgent public health concern Nancy P. Hanrahan, PhD, RN, FAANa,*, Gail W. Stuart, PhD, RN, FAANb, Kathleen R. Delaney, PhD, PMHNP, FAANc, Connie Wilson, EdD, PMHCNS-BC, LPCC, FAANd, on behalf of the members of Psychiatric/Mental Health Expert Panel a

University of Pennsylvania School of Nursing, Philadelphia, PA b Medical University of South Carolina, Charleston, SC c Department of Community, Mental Health and Systems, Rush College of Nursing, Chicago, IL d University of Cincinnati College of Nursing, Cincinnati, OH

The American Academy of Nursing endorses mental health parity and access to mental health and addiction assessment and treatment as an integrated component of health care. Furthermore, the Academy supports prevention of mental illness and substance use in our youth, very early identification and intervention when problems do occur, and easy access to care when needed. Finally, the stigma associated with mental illness must be replaced with the understanding that mental and physical health cannot be treated separately but as an integrated concern.

Background In any given year, one in four Americansd57.7 milliondhas a mental illness, and many more people and families experience the burden of suffering from untreated mental illness and addictions (Kessler et al., 2005). One in 10 children suffer from serious emotional and mental disorders that cause significant functional impairment in their day-to-day lives at home, in school, and with peers. Three quarters of all mental illnesses begin between the ages of 14 and 24 years. One in 17 adults lives with serious mental illness such as schizophrenia, major depression, or bipolar disorders (The National Household Survey on Drug Abuse Report, 2010). People with serious mental illness such as schizophrenia and mood disorders die 25 years earlier than the general population from treatable health conditions such as heart disease and diabetes. Also one in five older Americans suffer psychiatric problems that interfere with overall health and quality of life. Given the high prevalence of mental illness, it is stunning that less than one-third of adults and one-half of children with a diagnosable mental disorder receive mental health services in a given year. Stigma associated with mental illness explains reticence to seek treatment.

Most Americans have a personal story to tell about a mental illness they themselves have experienced or an episode a family member or friend has experienced. The story, in many cases, includes frustration about not finding appropriate treatment or fear of the consequences of being labeled as mentally ill. These conditions exist despite research that shows treatment for mental illness is available and highly effective. Between 70% and 90% of individuals have a significant reduction of symptoms and improved quality of life with a combination of medication and psychosocial treatments and supports (Institute of Medicine, 2006). Four years ago, the Mental Health Parity and Addiction Equity Act finally passed the U.S. Congress and entitled Americans with access to a full range of mental health and substance use disorder services equal to physical/medical health services. On February 25, 2013, the U.S. Department of Health and Human Services released the final rule that maps out how parity will be implemented under the Affordable Care Act (ACA). If the rules are applied according to the U.S. Department of Health and Human Services guidance, mental health and addiction care will become available to approximately 3.9 million Americans with individual health insurance plans and 1.2 million covered by small group plans. The ultimate outcome will be determined as each state implements the ACA. The Newtown Connecticut shooting tragedy that resulted in the death of 20 innocent children and six adults stimulated an important and long-overdue national dialogue about mental health, the occurrence of such violence, and access to services. Lack of appropriate access to integrated physical and mental health care is a fundamental and major health care issue for both children and adults in most of our American communities. Promotion of integrated health should replace the stigma associated with mental illness.

* Corresponding author: Nancy P. Hanrahan, Dr. Lenore H. Kurlowicz Memorial Term Assistant Professor in Psychiatric, Mental Health Nursing, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104. E-mail address: [email protected] (N.P. Hanrahan). 0029-6554/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved.


Nurs Outlook 61 (2013) 185e186

Recommendations 1. Monitor, analyze, and comment on state by state implementation of the ACA regarding the impact on the Mental Health Parity and Addiction Equity Act of 2008 to assure that full parity for mental health and substance abuse treatment is achieved. 2. Counteract the stigma surrounding mental illness by promoting hope-engendering models such as the Recovery model outlined by Substance Abuse and Mental Services Administration (2009). Integrate mental health and addiction specialist nurses and other mental health providers into primary care settings, schools, and other community locations in which people can access care without being labeled mentally ill. 3. Build the capacity of the national nurse workforce to detect and provide appropriate treatment and referral for individuals with mental health problems. Nurses can play a significant role in the integration of mental and physical health care. There are 3.1 million registered nurses in this country who are located in every place in which health care is delivered (HRSA, 2012). Providing all nurses with evidence-supported skills to detect individuals with mental health problems and guide them to treatment will have wide and immediate impact throughout the United States. 4. Advocate increased access to specialized mental health care for adults and children. Some mental health and addiction problems for children and adults are more severe than others. Access to mental health specialists is fraught with unnecessary barriers, such as limitations to full scope of practice, inadequate reimbursement for services from insurance plans, and a short supply of the mental health and addiction specialty trained providers including advanced-practice nurses (Hanrahan, Delaney, Stuart, 2012). Removal of these barriers and expansion of the mental health workforce who can effectively treat serious mental disorders in children, adolescents, and older adults will widen the margin between untreated mental illness and violent acts. 5. Promote initiatives to increase resources for mental health efforts that begin with children at an early age. Build evidence supported programs to educate primary care providers, other providers, teachers, and other professionals located in close proximity to children about prevention, recognition, early intervention, and effective treatment. Educate

parents, teachers, significant others, and communities to recognize the conditions that breed mental illness (e.g., bullying) and to make prompt referrals for assessment, crisis intervention, and ongoing treatment of distressed children and adolescents. 6. Support initiatives to reduce firearm violence. Support a ban on assault rifles and large magazine clips as proposed in the newly introduced Feinstein legislation. Today, there are 3 million assault rifles in the hands of Americansdone for every 100 people (Agresti & Smith, 2012). Assault rifles have been identified for decades as a major public health problem in the United States. Evidence supports that individuals with mental health conditions are no more violent than are people from the general public. To prevent a focus on mental health conditions, comprehensive and equitable screening procedures for gun purchases should focus on propensity to violence and past criminal records (The White House, 2013).


Agresti, J. D. & Smith, K. (2012). Gun Control Facts. Just Facts, September 13, 2010. Retrieved from guncontrol.asp. Hanrahan, N. P., Delaney, K., & Stuart, G. (2012). Blueprint for developing the advanced practice psychiatric nurse workforce. Nursing Outlook, 60(2), 91e104. Institute of Medicine. (2006). Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Washington, DC: National Academy Press. Kessler, R. C., Demler, O., Frank, R. G., Olfson, M., Pincus, H. A., & Walters, E. E. (2005). Prevalence and treatment of mental disorders, 1990-2003. New England Journal of Medicine, 352(24), 2515e2523. Substance Abuse and Mental Health Services Administration (SAMHSA, 2009). The Road to Recovery: Together We Learn, Together We Heal. Pub id: SMA09e4382. Retrieved from http:// The National Household Survey on Drug Abuse Report. (2010). The NHSDA Report. Retrieved from http://www.oas.samhsa. gov/2k2/SMI/SMI.htm. The White House (2013). Now is the time: The President’s plan to protect our children and our communities by reducing gun violence. Retrieved from default/files/docs/wh_now_is_the_time_full.pdf. U.S. Department of Health and Human Services, Health Resources and Services Administration (2012) . The registered nurse population. Findings from the 2008 National Sample Survey of Registered Nurses. Retrieved from http://bhpr.hrsa. gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf.