Winter 2008

Since 1991, First Lady Rosalynn Carter has worked to raise awareness and reduce the stigma of mental illness through The Carter Center’s public policy forums, outreach, and journalism fellowship.

Deborah Hakes/The Carter Center

Changing Life Courses

The Carter Center pushes for prevention of mental illness

By Elizabeth Elkins 95C

The adage that an ounce of prevention is worth a pound of cure has become central to our physical health care routine; in the world of mental health, however, prevention still gets short shrift.

Yet mental illnesses are the second-leading cause of disability in the United States, and mental disorders affect at least 20 percent of the population. Current research indicates a direct connection between mental health and physical health. Poor mental health is now believed to contribute to diseases as far-ranging as diabetes, heart disease, obesity, alcoholism, and sexually transmitted diseases.

Despite persuasive scientific data, health care providers have been slow to change. Mental health is often treated as a separate problem rather than integrated into a patient’s overall health program. While it has become commonplace to push prevention in terms of seatbelts and cigarettes, many providers do not view mental health problems as their responsibility, nor do they see the tie between mental and physical health.

“There are many myths and stigmas attached to mental illness,” says Thom Bornemann, director of The Carter Center Mental Health Program. “There is a fear of unpredictability and violence. There is the myth that mental health care costs more, that the problems are not treatable, and that treatments do not make people better. But we have learned from the work that has been done in general public health. People are becoming attracted to prevention, and the United States is slowly starting to look more at the total health of a person.”

Educating policy makers, insurance companies, and health practitioners about the importance of prevention is the top priority for The Carter Center Mental Health Program. At “The Time Is Now: Creating a Public Policy Action Agenda on Preventing Mental Illness,” the twenty-third-annual Rosalynn Carter Symposium on Mental Health Policy, more than two hundred participants gathered to hear experts from around the country discuss research on successful interventions and to address the policy barriers to the adoption of these techniques.

“If efforts are going to focus on prevention,” First Lady Rosalynn Carter said in her opening remarks, “it means that public health people and health professionals are going to have to play a leadership role, and we all know that our cornerstone of public health is promotion and prevention. We in the mental health community need to take these two issues just as seriously as public health takes tobacco control, cardiovascular disease prevention, and other health conditions.”

The keynote address by Vincent Felitti, an internist with Kaiser Permanente and coprincipal investigator of the Adverse Childhood Experience (ACE) study, provided the rationale behind Carter’s plea. The ACE study is one of the largest investigations ever conducted on the links between childhood emotional experiences and later-life health. As Felitti explained, the study strongly suggests that a childhood history of family dysfunction, neglect, and mental and physical abuse plays a major role in our adult emotional and physical health.

“Children are screened in school for hearing and for eyesight,” Bornemann says. “Children who are unable to learn because they have another kind of health condition that may be related to their brain or family functioning should have the same opportunity for early intervention. If mental health screening became a routine measure, I think stigma would lessen.”

“The evidence that prevention works is compelling,” agrees Benjamin Druss, Rosalynn Carter Endowed Chair in Mental Health at Rollins School of Public Health. “Many recent reports suggest that regular medical health strategies can and should be applied to mental health. It is a vital component of how we should improve the quality of mental health care in the United States.”

The adoption of this kind of primary care may one day alter the work of psychiatrists like Allison Nitsche, community and child/adolescent psychiatry fellow at Emory’s School of Medicine, who participated in the symposium.

“Every day I see kids with problems I cannot undo,” she says. “If we can institute programs and services that can keep these disorders from developing, we can change life courses.”

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