One of the most exciting developments of the 21st century is the increased ability to probe and understand the human mind. Advances in neuroscience and related fields are bringing about, almost weekly, new discoveries of the functioning of the brain. This is good news, because a race is on. The race is between our ability to understand, prevent, and treat mental illness and its increasing incidence and prevalence throughout the world. Here are some facts:
- The recent Global Burden of Disease Study conducted by the World Health Organization, the World Bank, and Harvard University found that mental illness, including suicide, accounts for over 15 percent of the burden of disease throughout established market development economies. This is more than the disease burden caused by all cancers combined.
- About 25 percent of American adults suffer from a diagnosable mental illness in a given year, and 6 percent suffer from a serious mental illness.
- Nearly half of those with any mental disorder have two or more disorders.
- The economic burden of depression alone in the United States is estimated at $83 billion, including both direct treatment costs and indirect lost workplace productivity costs.
- Depression is the leading comorbid condition for people suffering from other chronic illnesses such as diabetes, heart disease, and asthma.
I was first exposed to the human faces behind these numbers as a young college student working as an orderly in a 36-bed psychiatric unit of a community hospital. I worked the weekend graveyard shift from 11 p.m. to 7 a.m. I saw firsthand the pervasive economic and social impact of mental illness, not only on the patients, but on their families and friends. While the mental health professionals—psychiatrists and others—did their best with the medicines, shock therapy, and various counseling approaches, too often we saw “returnees.” I think this was the first time that I fully understood what was a “chronic” illness.
As our knowledge of the relationship between mind and body advances, we are becoming increasingly aware of the important role played by the underlying physical and social determinants of both mental and physical illness throughout the life cycle. In the pages that follow, you will read about the fascinating research being conducted by Darlene Francis and Ray Catalano on the role of early nurturing and stress in the neo-natal, infancy, and childhood period. Ron Dahl and Emily Ozer address their work covering the adolescent life stage. Joan Bloom and Lonnie Snowden turn their attention to the mental health systems in which most adults receive mental health services. These issues are also addressed by Richard Scheffler and several California mental health leaders. In examining the later stages of life, Bill Jagust discusses his work to identify early markers of Alzheimer’s disease, and Bill Satariano identifies the environmental factors that contribute to positive mental health and healthy aging. This issue also highlights the important work of several of our alumni and students to improve mental health in their communities.
The need for progress is great. A recent assessment of the mental health objectives in the Healthy People 2010 report found that only one of 14 of the established objectives was met or exceeded. If greater progress could be made in mental health, it would likely have a positive multiplier effect on physical health status indicators as well, due to the high interdependence of our mental health with our physical health. We also need better indicators to track our progress. What, for example, might be the mental health equivalent of clean water?
A major area for future research (and subsequent policy interventions) will be to examine and disentangle the likely reciprocal relationship between a given community’s level of mental health and its development of the social capital needed to create healthier communities in which all residents can thrive—throughout their lives. I have every expectation that Berkeley faculty, alumni, and students will, along with others, be at the forefront of developing this knowledge.
Stephen M. Shortell, PhD, MPH, MBA
Dean, School of Public Health
Blue Cross of California Distinguished
Professor of Health Policy & Management
Professor of Organization Behavior