A Diagnosis: Mental Health in

America
By: Justin Mecca

Depression, anxiety, anorexia, schizophrenia, dissociative identity disorder. All of these

are what most people will immediately think about when discussing mental illness. Whether

people know someone with a disorder like this or not, the general mindset is that these types of

issues exist. At times, however, the mental health debate gets caught up with other issues,

muddying the waters surrounding the central issue. Adam Lanza, more commonly referred to as

the Sandy Hook Shooter visited with therapists, yet they were not able to predict a violent

outburst, and he refused to take the prescribed medication for his issues.1 Nikolas Cruz’s mother,

two years before her son’s shooting in Parkland of this year, said that her son suffered from

ADHD, OCD, and anger issues, and despite all this, was not admitted for a mental health

evaluation.2 While mental health debates get caught in the crossfire with mass shootings and gun

control, the discussions about how to address and fix a potentially broken system stay in the

spotlight for a brief time, then quickly fall to the wayside. By looking at how America

specifically handles mental health issues, finding the broken aspects of this, solutions can be

offered up and hopes of a better future could be found.

Mental Health: Defined and Understood

Mental health is a delicate issue to discuss because it’s not as easily seen due to a majority of it

having to do with more personal issues. Consider how relatively easy it is to look at someone and

say that they are ‘physically unhealthy’, as there are many warning signs for that. Warning signs
for mental health however, tend to be more hidden and not as easily recognizable. Some of the

most common early signs are a lack of energy, sleeping or eating either too much or too little,

and pulling away from people or usual activities.3 With these types of warning symptoms, it’s

easy to see why approximately 26% of people over the age of 18 in America had a mental

disorder in 2012, ranging from mood disorders, eating disorders, or substance abuse.4

Image 1:

Image 2
In the above graphs, ‘any mental illness’ is used for mental illness with the consequences ranging

from none to moderate.5 The ‘serious mental illness’ category is a subset of any but focuses on

those whose disability actively and severely impacts people in their daily lives.6

Mental Health: Current State of Treatment

As of 2015, there were around 13,000 mental health treatment facilities, with over 9,000 of them

being less than 24-hours for outpatients, meaning no overnight stay required.7 With these types

of resources available, most people should be able to receive the help they require to fix their

problems. As said earlier, sometimes people just don’t listen to the professionals about their

issues and don’t take the prescribed medicine or treatments. However, that is not the only reason

for a kind of stigma amongst mental health patients.

Image 3
From this image, it’s clear that people simply not taking their prescribed medicine is an outlier

on the issue. Looking at each reason given, they can be grouped into 3 groups: One being

personal feelings, a second being outside feelings, and the final being financial issues. Each of

these lead to a lack of good treatment, for one reason or another.

Personal Barriers and Public Stigma

The two reasons that an individual doesn’t receive treatment for their mental issues is either they

feel it wouldn’t help them, or they don’t think they need it. There are many perceived reasons for

this, ranging from individual feelings to broader scale societal issues. Looking at both reasons,

the individual probably doesn’t have enough information about either the treatment or what

problem they think they might have to accurately make a decision about whether or not treatment

is the correct option for them. All of this can come down to a lack of proper education and

understanding of how mental health can impact people, especially younger generations. Being

that New York is set to be the first state in the entire U.S to require all their schools to have

mental health education8, there’s a clear barrier right away for why people don’t know anything

about their mental problems. Currently, most information people have to look up on their own

from online resources or going to make appointments with therapists to discuss. However, seeing

as therapists could classify as a type of treatment in its own right, it leads back to the issue of

people not accurately knowing what is right for them. Alongside these types of educational and

personal barriers, there’s also the obvious stigma against people with mental issues. The mental

health stigma is the general mindset of the public that leads to a negative viewpoint on those with

mental illnesses, and leads most people to generally avoid, and to a more extreme extent fear and

even discriminate those with mental illness. While in general this type of viewpoint is toxic to
have when thinking about other social issues, it gets an even worse affect when referring to those

with mental issues. With around only 20% of adults with mental health issues going out to see a

therapist9, the other 80% had to have a reason not to. As shown in Image 3, the two relatively

middle options involve structural barriers and discrimination that leads people to not go and

receive the proper treatment. This type of stigma against mentally ill people leads them to not get

the proper treatment, and potentially makes things much worse. While it might seem like a small

issue, since most people would be quick to support anyone with mental illness if they knew, only

one-fourth of U.S adults in 2010 believed that people were sympathetic and caring towards

others with mental illnesses.10 There is then a cycle that goes on for people seeking help. If an

individual has a disorder, like depression or anxiety, it can be difficult to share that with others

just generally, stigma or not. A lack of good education for these types of disorders leads said

person to having to conduct their own research, and maybe learning that most people wouldn’t

accept them with their own problems. This in turn makes them keep their problems, and when

asked about any potential issues by doctors or others, they don’t share anything out of fear,

which contributes to the stigma not only against people with mental illness, but for people with

mental illness to talk with other people about their issues. This type of cycle just makes it more

difficult to educate and try to help those in need.

The Cost of Therapy and Treatment

Naturally for people, the number 1 cause for concern over the ability to get help is the cost of it

all. Starting with just seeing a therapist, the prices range depending on location and other

variables like those. Sometimes it ranges from $75-$150 for a 45 minute session with a

therapist.11 Therapy is mainly structured around weekly meetings, so if one goes to a meeting
every week, it’s about a $3,200 investment, not counting any insurance policies or similar

practices.12 Having to pay even the weekly costs will be a major barrier, since a combination of

just the flat amount being too much, or people feeling like that amount of money isn’t worth just

going and talking to someone. Therapy is the relatively cheaper option for people, and its cost is

low compared to the real money sink for mental illness: medication and treatments. For people

with depression, the cost of their treatment can reach heights of about $9,700, and that’s for

people whose depression can be treated with basic anti-depressant medication.13 For people with

treatment-resistant forms of depression, their costs can reach upwards of $17,000,14 and even

then, with their form of depression not responding to normal treatments, this type of medication

might not even work. It takes a lot of courage to first talk with people that one might have a

mental illness, but the costs of accurately finding out, and treating this, leads to a scenario where

treatment isn’t a feasible option for people. The cost of treatment is large for people suffering,

but it is also a large detriment to America’s economy as a whole. Mental illnesses like depression

and anxiety overall cost America an average of about $193.2 billion in lost earnings per year.15

Lost earnings would be people with mental illnesses staying home from work and not earning

money, and things that fit that scenario. So not only is mental illness a large issue for people with

the illnesses, it’s a large detriment to the American economy as a whole. It’s in the best interest

of not only the public, but of larger corporations to find ways to combat the stigma around

mental health. It not only helps those suffering from them, but also would help reduce the overall

lost earnings from the impact of mental illness.

Past, Present, and Future Steps

The history of combatting mental illness has not been as effective as most would have hoped.

Starting in 1963 under John F. Kennedy, he released the Community Mental Health Act, which

looked to increase the number of community-based mental health centers in hopes of moving

patients out of mental hospitals and finding more effective ways to treat those with mental

issues.16 The major goal of the act was to move and make the mental health issue a more federal

issue than a state one. The Kennedy Administration gave $329 million in total to the states to

build the community centers, move patients out of institutions into those centers, and allow the

states to create awareness about mental illness.17 While this money was used for the start-up of

these centers, only half were actually built in long-term18, leaving money out in the air. During

the Reagan Administration, the previous funds the act gave was changed into a mental health

block grant, allowing the states to use the money in whatever way they saw fit to deal with the

issues.19 While this type of federal action is a good way to start a conversation on how to fix the

issues, it can easily change to simply being nothing more than a name. The real ways to combat

the mental health stigma in America is just with more education readily available to people who

need it most. Educating children still in school about warning signs and treatment options is the

first big step. In 2015, approximately 30% of high school students reported feeling sad or

hopeless in the past year.20 This type of feeling is a warning sign of mental illness, so letting the

youth know that something like this exists is a big step forward in getting rid of a stigma. The

second way to easily help is to combat the massive cost that patients have to shoulder. Payment

for other health issues, such as diabetes and hypertension, is based on the results of the

treatment.21 Creating a system that functions similarly to this for mental health will allow the

large burden of up-front costs to seem less of an issue. This will also benefit those for whom

normal treatment doesn’t work for, since they would normally have to pay large sums for the
treatment that didn’t work, then spend extra on new medication. Under a results-based system,

the first medication wouldn’t cost as much since it wouldn’t work.

Conclusion

Mental health is a difficult issue to talk about and understand for most people, since it’s difficult

to tell anything unless you live with it. Removing the stigma surrounding this means making it

easier to talk about and realizing that people with mental illnesses are just normal people as well.
 Endnotes (text)
1 Lauren Fox “Report: Sandy Hook Shooter Adam Lanza Was Obsessed With Mass Shootings” available at
(https://www.usnews.com/news/articles/2013/11/25/report-sandy-hook-shooter-adam-lanza-was-obsessed-with-
mass-shootings) (last accessed April 2, 2018)

2 Maria Perez and Brett Murphey “A timeline of Nikolas Cruz's activities leading up to the mass school shooting in
Parkland, Florida” available at (https://www.naplesnews.com/story/news/crime/2018/02/27/timeline-nikolas-cruzs-
activities-leading-up-mass-school-shooting-broward-county/377021002/) (last accessed April 2, 2018)

3 Department of Health and Human Services “What is Mental Health” available at

(https://www.mentalhealth.gov/basics/what-is-mental-health) (last accessed April 2, 2018)

4 Centers for Disease Control and Prevention “Attitudes Toward Mental Health: Results from the Behavioral Risk
Factor Surveillance System” published in 2012

5 The National Institute of Mental Health Information Resource Center ‘Statistics-Mental Illness’ (available at
https://www.nimh.nih.gov/health/statistics/mental-illness.shtml) (last accessed April 2, 2018)

6 Ibid.

7 The Statistics Portal “Number of mental health treatment facilities in the U.S. in 2015, by service setting”
(available at https://www.statista.com/statistics/450277/mental-health-facilities-in-the-us-by-service-type/) (last
accessed April 2, 2018)

8 Mental Health Association in New York State “Mental Health Education in New York Schools: A REVIEW OF
LEGISLATIVE HISTORY, INTENT AND VISION FOR IMPLEMENTATION”

9 Centers for Disease Control and Prevention “Attitudes Toward Mental Health: Results from the Behavioral Risk
Factor Surveillance System

10 Ibid.

11 Nina Stoller-Lindsey “How Much Does Therapy Cost, and How Do You Pay For It?” (available at
https://www.learnvest.com/2017/05/how-much-does-therapy-cost-and-how-do-you-pay-for-it) (last accessed April
2, 2018)

12 Ibid.

13 Tony B. Amos and others, “Direct and Indirect Cost Burden and Change of Employment Status in Treatment-
Resistant Depression: A Matched-Cohort Study Using a US Commercial Claims Database” The Journal of Clinical
Psychology (available at
http://www.psychiatrist.com/JCP/article/_layouts/ppp.psych.controls/BinaryViewer.ashx?Article=/JCP/article/Pages
/2018/v79n02/17m11725.aspx&Type=Article) ; Steven Ross Johnson “Treatment-resistant depression doubles
patient healthcare costs” (available at http://www.modernhealthcare.com/article/20180221/NEWS/180229980) last
accessed April 2, 2018)

14 Ibid.

15 Insel, T.R. (2008). Assessing the Economic Costs of Serious Mental Illness. The American Journal of Psychiatry.
165(6), 663-665

16 PUBLIC LAW 88-164-OCT. 31, 1963 (available at https://history.nih.gov/research/downloads/PL88-164.pdf)

17 The Associated Press “Kennedy's vision for mental health never realized” (available at
https://www.usatoday.com/story/news/nation/2013/10/20/kennedys-vision-mental-health/3100001/) (last accessed
April 2, 2018)

18 Ibid.

19 Ibid.

20 Office of Adolescent Health “United States Adolescent Mental Health Facts” (available at
https://www.hhs.gov/ash/oah/facts-and-stats/national-and-state-data-sheets/adolescent-mental-health-fact-
sheets/united-states/index.html) (last accessed April 2, 2018)

21Jeffery A. Lieberman and others, “Improving Mental Health Care in America: An Opportunity for
Comprehensive Reform” Psychiatric Times Vol. 34, Issue 4 (available at http://www.psychiatrictimes.com/cultural-
psychiatry/improving-mental-health-care-america-opportunity-comprehensive-reform/page/0/2)
 Endnotes (Images)
1 The National Institute of Mental Health Information Resource Center ‘Statistics-Mental Illness’ (available at
https://www.nimh.nih.gov/health/statistics/mental-illness.shtml) (last accessed April 2, 2018)

2 Ibid.

3 Rabah Kamal “What are the current costs and outcomes related to mental health and substance abuse disorders?”
(available at https://www.healthsystemtracker.org/chart-collection/current-costs-outcomes-related-mental-health-
substance-abuse-disorders/#item-start) (last accessed April 2, 2018)