Emotional mental health in the United States

According to the World Health Organization in 2004, depression is the leading cause of disability in the United States of America for individuals ages 15 to 44.^[29] Absence from work in the U.S. due to depression is estimated to be in excess of $31 billion per year. Depression frequently co-occurs with a variety of medical illnesses such as heart disease, cancer, and chronic pain and is associated with poorer health status and prognosis.^[30] Each year, roughly 30,000 Americans take their lives, while hundreds of thousands make suicide attempts (Centers for Disease Control and Prevention).^[31] In 2004, suicide was the 11th leading cause of death in the United States of America (Centers for Disease Control and Prevention), third among individuals ages 15–24. Despite the increasingly availability of effectual depression treatment, the level of unmet need for treatment remains high.^{[citation needed]}

There are many factors that influence mental health including:

• Mental illness, disability, and suicide are ultimately the result of a combination of biology, environment, and access to and utilization of mental health treatment.

• Public health policies can influence access and utilization, which subsequently may improve mental health and help to progress the negative consequences of depression and its associated disability.

• Research conducted by Mental Health America found the following factors to be considerably allied with improved depression status and lower suicide rates:

Mental health resources	On average, the higher the number of psychiatrists, psychologists, and social workers per capita in a state, the lower the suicide rate.
Barriers to treatment	The lower the percentage of the population reporting that they could not obtain healthcare because of costs, the lower the suicide rate and the better the state's depression status.
Mental health treatment utilization	The lower the percentage of the population that reported unmet mental healthcare needs, the better the state's depression status. When mental health treatment is utilized more, while holding the baseline level of depression in the state constant, the higher the number of antidepressant prescriptions per capita in the state, and the lower the suicide rate.
Socioeconomic characteristics	The more educated the population and the greater the percentage with health insurance, the lower the suicide rate. The more educated the population, the better the state's depression status.
Mental health policy	The more generous a state's mental health parity coverage, the greater the number of people in the population that receive mental health services.

Emotional mental illnesses should be a particular concern in the United States of America since the U.S.A has the highest annual prevalence rates (26 percent) for mental illnesses among a comparison of 14 developing and developed countries.^[32] While approximately 80 percent of all people in the United States with a mental disorder eventually receive some form of treatment, on the average persons do not access care until nearly a decade following the development of their illness, and less than one-third of people who seek help receive minimally adequate care.^[33]

Mental health policies in the United States

The mental health policies in the United States have experienced four major reforms: the American asylum movement led by Dorothea Dix in 1843; the "mental hygiene" movement inspired by Clifford Beers in 1908; the deinstitutionalization started by Action for Mental Health in 1961; and the community support movement called for by The CMCH Act Amendments of 1975.^[34]

In 1843, Dorothea Dix submitted a Memorial to the Legislature of Massachusetts, describing the abusive treatment and horrible conditions received by the mentally ill patients in jails, cages, and almshouses. She revealed in her Memorial: "I proceed, gentlemen, briefly to call your attention to the present state of insane persons confined within this Commonwealth, in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience. . . ."^[35] Many asylums were built in that period, with high fences or walls separating the patients from other community members and strict rules regarding the entrance and exit. In those asylums, traditional treatments were well implemented: drugs were not used as a cure for a disease, but a way to reset equilibrium in a person's body, along with other essential elements such as healthy diets, fresh air, middle class culture, and the visits by their neighboring residents. In 1866, a recommendation came to the New York State Legislature to establish a separate asylum for chronic mentally ill patients. Some hospitals placed the chronic patients into separate wings or wards, or different buildings.^[36]

In A Mind That Found Itself (1908) Clifford Whittingham Beers described the humiliating treatment he received and the deplorable conditions in the mental hospital.^[37] One year later, the National Committee for Mental Hygiene (NCMH) was founded by a small group of reform-minded scholars and scientists – including Beer himself – which marked the beginning of the "mental hygiene" movement. The movement emphasized the importance of childhood prevention. World War I catalyzed this idea with an additional emphasis on the impact of maladjustment, which convinced the hygienists that prevention was the only practical approach to handle mental health issues.^[38] However, prevention was not successful, especially for chronic illness; the condemnable conditions in the hospitals were even more prevalent, especially under the pressure of the increasing number of chronically ill and the influence of the Depression.^[34]

In 1961, the Joint Commission on Mental Health published a report called Action for Mental Health, whose goal was for community clinic care to take on the burden of prevention and early intervention of the mental illness, therefore to leave space in the hospitals for severe and chronic patients. The court started to rule in favor of the patients' will on whether they should be forced to treatment. By 1977, 650 community mental health centers were built to cover 43 percent of the population and serve 1.9 million individuals a year, and the lengths of treatment decreased from 6 months to only 23 days.^[39] However, issues still existed. Due to inflation, especially in the 1970s, the community nursing homes received less money to support the care and treatment provided. Fewer than half of the planned centers were created, and new methods did not fully replace the old approaches to carry out its full capacity of treating power.^[39] Besides, the community helping system was not fully established to support the patients' housing, vocational opportunities, income supports, and other benefits.^[34] Many patients returned to welfare and criminal justice institutions, and more became homeless. The movement of deinstitutionalization was facing great challenges.

After realizing that simply changing the location of mental health care from the state hospitals to nursing houses was insufficient to implement the idea of deinstitutionalization, the National Institute of Mental Health in 1975 created the Community Support Program (CSP) to provide funds for communities to set up a comprehensive mental health service and supports to help the mentally ill patients integrate successfully in the society. The program stressed the importance of other supports in addition to medical care, including housing, living expenses, employment, transportation, and education; and set up new national priority for people with serious mental disorders. In addition, the Congress enacted the Mental Health Systems Act to prioritize the service to the mentally ill and emphasize the expansion of services beyond just clinical care alone.^[40] Later in the 1980s, under the influence from the Congress and the Supreme Court, many programs started to help the patients regain their benefits. A new Medicaid service was also established to serve people who were suffering from a "chronic mental illness." People who were temporally hospitalized were also provided aid and care and a pre-release program was created to enable people to apply for reinstatement prior to discharge.^[39] Not until 1990, around 35 years after the start of the deinstitutionalization, did the first state hospital begin to close. The number of hospitals dropped from around 300 by over 40 in the 1990s, and finally a Report on Mental Health showed the efficacy of mental health treatment, giving a range of treatments available for patients to choose.^[40]

The 2011 National Prevention Strategy included mental and emotional well-being, with recommendations including better parenting and early intervention programs, which increase the likelihood of prevention programs being included in future US mental health policies.^[41][42] The NIMH is researching only suicide and HIV/AIDS prevention, but the National Prevention Strategy could lead to it focusing more broadly on longitudinal prevention studies.^[43]