It should surprise no one that mental illness represents a significant threat to public health. Broadly defined, mental illness refers to a group of disorders that involves thinking, feeling and relating to others, and result in a greatly diminished capacity for coping with the ordinary demands of life. These disorders may reveal themselves in learning or work disturbances; disruptions in satisfactory relationships with family, friends or employers; inappropriate behaviors; unexplained physical symptoms; or a pervasive mood of unhappiness.
At any one time, about 30 percent of the nation's population are afflicted to some degree by a mental disorder such as mild, temporary anxiety or depression, and 15 percent suffer from persistent, severe and incapacitating mental illness.
One of the most prevalent mental illnesses in the United States is depression, which annually affects 10-million Americans. According to the National Mental Health Association, 25 percent of all women and 11.5 percent of all men in the United States will experience a depressive episode during their lifetimes. Only one in three, however, will ever seek treatment. Perhaps Thoreau alluded to depression and other mental diseases with his dark description of the mass of mankind who ". . . lead lives of quiet desperation."
For the over-55 age group various mental disorders are associated with increased physical illness, loss of significant social supports, isolation, poor nutrition and inadequate income. Particularly among the elderly population, malnutrition is often associated with bone fractures, osteoporosis, dental disease, physical inactivity, social isolation and depression. Studies have shown that between 15 percent and 25 percent of the elderly exhibit some serious signs of mental disorder. For those in nursing homes, of whom 10 percent to 20 percent suffer from major depression that often goes untreated, there is a 59 percent greater chance of non-suicidal death within one year.
Described as "one of the great masqueraders of medicine," depression is one of the most treatable conditions doctors encounter when it is correctly diagnosed.
Mental disease in the older population may be associated with and complicated by physical changes in brain tissue. It is conservatively estimated that 4-million Americans are afflicted with organic brain disease resulting from dementias of the Alzheimer's type, multiple mini-strokes causing reduced blood supply and oxygen to the brain, arteriosclerosis, brain injury and similar conditions associated with alcohol and other substance abuse. Diseases of the heart and lungs, liver, kidneys or thyroid, and the presence of a brain tumor also can produce symptoms of mental disorder.
The overuse or interactions of prescription or non-prescription drugs my also prompt dementialike symptoms.
The usual signs observed in patients with organic brain disease are impairments of memory, concentration and orientation; intellectual functioning such as comprehension, learning and doing simple calculations; judgment evidenced by understanding and evaluating options and making informed decisions; and unpredictable, inappropriate or shallow emotional responses. At times, the patient my be aggressive, hostile, hyperactive, withdrawn, delusional and have vivid visual hallucinations.
It is obvious that comprehensive diagnosis, which may include electrocardiogram (EKG), electroencephalogram (EEG), brain scan, and psychological testing, followed by individualized treatment are essential.
The management of severe and chronic mental illness in recent years has been characterized by attempts to provide support, care and treatment under conditions of everyday life that are as close as possible to the norm and patterns of society's mainstream. Guided by the principle of the least restrictive alternative, attention (and funding) has been turned away from institutional settings and toward community-based therapeutic initiatives.
The Alternative Family Program (AFP) sponsored by Gulf Coast Jewish Family Service (GCJFS), is designed to provide an individual with a permanent, secure family environment. Private host families are paid up to $900 monthly per client and act as caregivers for elderly people with serious and persistent mental illness. AFP is the newest expression of the least restrictive form of care available. In contrast to $175 per day to care for a mentally ill person in the state hospital, AFP provides a nurturing residential placement at a daily cost of $55 per client. Preplacement and ongoing training are provided to the caregiver, who is assisted by professional case-management support. Each client is provided with psychosocial rehabilitation and wrap-around community supportive services. While a tragically small number of clients currently can be served by AFP, it is anticipated that the project will expand in the coming years.
"Lord save us all from old age and broken health," lamented Mark Twain, "and a hope tree that has lost the faculty of putting out blossoms." AFP is one hope tree that is blossoming and will mercifully survive the state's budget pruning. For more information on AFP, please contact GCJFS at 541-7441.
Dale J. Hyland has been in social services for 15 years, and is a human services consultant in Pinellas County.