Authors: Andrew Solomon
338
L. Lamison-White’s
U.S. Bureau of the Census: Current Populations Report
indicates that 13.7 percent of Americans are below the poverty line, as taken from Jeanne Miranda and Bonnie L. Green, “Poverty and Mental Health Services Research,” page 4.
338
The study showing that 42 percent of heads of households receiving AFDC meet the criteria for clinical depression is K. Moore et al., “The JOBS Evaluation: How Well Are They Faring? AFDC Families with Preschool-Aged Children in Atlanta at the Outset of the JOBS Evaluation,” published by the U.S. Department of Health and Human Services, 1995.
338
The study showing that 53 percent of pregnant welfare mothers meet the criteria for major depression is J. C. Quint et al., “New Chance: Interim Findings on a Comprehensive Program for Disadvantaged Young Mothers and Their Children,” published by Manpower Demonstration Research Corporation, 1994.
338
That those with psychiatric disorders are 38 percent more likely to receive welfare than those without is shown in R. Jayakody and H. Pollack, “Barriers to Self-Sufficiency among Low-Income, Single Mothers: Substance Use, Mental Health Problems, and Welfare Reform.” This paper was presented at the Association for Public Policy Analysis and Management in Washington, D.C., November 1997.
338
That the state and federal governments spend roughly $20 billion on cash transfers to poor nonelderly adults and their children, and roughly the same amount for food stamps for such families, is taken from the the U.S. House of Representatives
Committee on Ways and Means’
Green Book,
1998. It cites, on page 411, government expenditures of $11.1 billion and state expenditures of $9.3 billion on Aid to Families with Dependent Children (AFDC) benefits. This does not count an additional $1.6 billion in federal administrative costs and $1.6 billion in state administrative costs. The federal costs for Temporary Assistance for Needy Families (TANF) benefits are cited as $23.5 billion on food stamp benefits and $2 billion on administration. State and local governments spent $1.8 billion on administration. TANF statistics are from page 927.
339
On the woes of the welfare system, in this example, the child welfare system, see Alvin Rosenfeld et al., “Psychiatry and Children in the Child Welfare System,”
Child and Adolescent Psychiatric Clinics of North America
7, no. 3 (1998). They write, “In contrast to the mental health system, nonmedical personnel usually run child welfare. . . . Most foster children probably need a psychiatric evaluation; few get one.” Page 527.
339
Jeanne Miranda has been a real pioneer in this area. Her most notable publications include Kenneth Wells et al., “Impact of disseminating quality improvement programs for depression in managed primary care: A randomized controlled trial,”
Journal of the American Medical Association
283, no. 2 (2000); Jeanne Miranda et al., “Unmet mental health needs of women in public-sector gynecologic clinics,”
American Journal of Obstetrics and Gynecology
178, no. 2 (1998); “Introduction to the special section on recruiting and retaining minorities in psychotherapy research,”
Journal of Consulting Clinical Psychologists
64, no. 5 (1996); and Jeanne Miranda et al., “Recruiting and retaining low-income Latinos in psychotherapy research,”
Journal of Consulting Clinical Psychologists
64, no. 5 (1996).
340
That total costs per patient for all the mentioned treatment programs are under $1,000 a year was discussed in much correspondence with the researchers. The exact figures for such programs are of course extremely difficult to calculate and compare because of differences in treatment programs, protocol, and services. Jeanne Miranda estimated her costs at under $100 per patient; Emily Hauenstein provided total costs of $638 per person for treatment regimens that include approximately thirty-six therapeutic meetings. Costing for Glenn Treisman’s work is based on figures he sent me in an E-mail of October 30, 2000. He estimated his operating costs at between $250,000 and $350,000 per year for an outreach service that provides care for twenty-five hundred to three thousand patients. Average cost per patient is therefore around $109.
343
That depression among the poor is not usually manifest in the cognitive arena of personal failure and guilt, but rather in somaticization, is indicated in Marvin Opler and S. Mouchly Small, “Cultural Variables Affecting Somatic Complaints and Depression,”
Psychosomatics
9, no. 5 (1968).
347
The article in
The New England Journal of Medicine
on economic hardship and depression is John Lynch et al., “Cumulative Impact of Sustained Economic Hardship on Physical, Cognitive, Psychological, and Social Functioning,” vol. 337 (1997).
348
On the phenomenon of learned helplessness, see Martin Seligman’s
Learned Optimism.
353
The rate of schizophrenia among low-income populations is in Carl Cohen, “Poverty and the Course of Schizophrenia: Implications for Research and Policy,”
Hospital and Community Psychology
44, no. 10 (1993).
360
The antarctic ozone “hole” is defined as an “area having less than 220 dobson units
(DU) of ozone in the overhead column (i.e., between the ground and space).” As the Environmental Protection Agency’s Web site points out, “The word
hole
is a misnomer; the hole is really a significant thinning, or reduction in ozone concentrations, which results in the destruction of up to 70 percent of the ozone normally found over Antarctica.” I take from
One Earth, One Future: Our Changing Global Environment,
page 135: “The first unmistakable sign of human-induced change in the global environment arrived in 1985 when a team of British scientists published findings that stunned the world community of atmospheric chemists. Joseph Farman, of the British Meteorological Survey, and colleagues reported in the scientific journal
Nature
that concentrations of stratospheric ozone above Antarctica had plunged more than 40 percent from 1960s baseline levels during October, the first month of spring in the Southern Hemisphere, between 1977 and 1984. Most scientists greeted the news with disbelief.” See the EPA’s Web site dedicated to the ozone hole at
www.epa.gov/ozone/science/hole/holehome.html
. The British Antarctic Survey publishes yearly updates on the state of the antarctic ozone. For current information, see
www.nbs.ac.uk//files/10/51/42/f105142/public/icd/jds/ozone/index.html
.
361
For a general overview of changing government policies in the area of mental health, there are a number of informative Web sites focused on mental health advocacy, support, and education. I would particularly recommend the Web sites for the National Institute of Mental Health (
www.nimh.nih.gov
), the National Alliance for the Mentally Ill (
www.nami.org
), the Treatment Advocacy Center (
www.psychlaws.org
), the National Depressive & Manic-Depressive Association (
www.ndmda.org
), and the American Psychiatric Association (
www.psych.org
).
365
For Tipper Gore’s remarks on her own depression, see her interview published as “Strip Stigma from Mental Illness,”
USA Today,
May 7, 1999.
365
A plethora of articles have been published on Mike Wallace and his depression. See Jolie Solomon, “Breaking the Silence,”
Newsweek,
May 20, 1996; Walter Goodman, “In Confronting Depression the First Target Is Shame,”
New York Times,
January 6, 1998; and Jane Brody, “Despite the Despair of Depression, Few Men Seek Treatment,”
New York Times,
December 30, 1997.
365
For William Styron’s description of his depression, see his elegantly written first-person memoir
Darkness Visible,
which was one of the first open modern portraits of depressive illness.
366
The National Alliance for the Mentally Ill (NAMI) provides excellent information regarding the ADA, including summaries, consumer and advocate information, and contact information. This may be found at
http://www.nami.org/helpline/ada.htm
.
367
The Civil Aeromedical Institute (CAMI) is the medical certification, research, and education wing of the U.S. Department of Transportation Federal Aviation Administration. For the full FAA regulations, see the CAMI Web site at
www.cami.jccbi.gov/AAM-300/part67.html
.
368
The quotations from Richard Baron come from his unpublished manuscript “Employment Programs for Persons with Serious Mental Illness: Drawing the Fine Line Between Providing Necessary Financial Support and Promoting Lifetime Economic Dependence,” pages 5–6, 18, 21.
369
For information on the NIH, as well as its various departments and budgets, see its Web site at
www.nih.gov
.
369
The six Nobel winners who spoke before Congress in the testimony mentioned here appeared before an annual hearing of the House Subcommittee on Labor, Health and Human Services, and Education, in the early 1990s. Representative John Porter, among others, has described the event in several oral interviews.
369
The figure that over 75 percent of health plans in the United States offer less coverage for mental health than for any other kind of physical health is from Jeffrey Buck et al., “Behavioral Health Benefits in Employer-Sponsored Health Plans, 1997,”
Health Affairs
18, no. 2 (1999).
371
The numbers for my own illness break down as follows: sixteen visits to the psychopharmacologist at $250 per visit; fifty visits to the psychiatrist (approximately three hours per week) at $200 per hour; and bills for medications that add up to at least $3,500 per year.
371
The statistics regarding the financial costs of depression in the workplace come from Robert Hirschfeld et al., “The National Depressive and Manic-Depressive Association Consensus Statement on the Undertreatment of Depression,”
Journal of the American Medical Association
277, no. 4 (1997): 335.
371
The Mental Health Parity Act of 1996 took effect January 1, 1998.
372
The statistic that four hundred thousand people fall off the insurance registers for every 1 percent increase in the cost is quoted in a letter from John F. Sheils, Vice President of the Lewin Group, Inc. to Richard Smith, Vice President of Public Policy and Research, American Association of Health Plans, November 17, 1997. Naturally this estimate will vary depending upon “the health policy being analyzed.” The letter was provided to me by the Lewin Group, Inc.
372
The economic consequences of insurance parity are extremely complicated and rely on variables too diverse to be reflected in any one study. While many experts seem to agree that insurance parity will raise total insurance costs less than 1 percent—this statistic is quoted regularly in the professional and popular presses—various studies have found other numbers. The Rand Corporation Study found that equalizing annual limits would “increase costs by only about one dollar per employee.” A report by the National Advisory Mental Health Council’s Interim Report on Parity Costs found a number of possibilities—from decreases of 0.2 percent to increases of less than 1 percent. In a Lewin Group study of New Hampshire insurance providers, no cost increases were found. For more information on these various studies, see NAMI’s Web site at
www.nami.org/pressroom/costfact.html
.
372
The figure on overall added costs for first year of parity is in Robert Pear, “Insurance Plans Skirt Requirement on Mental Health,”
New York Times,
December 26, 1998.
373
That over a thousand homicides in 1998 were attributable to people with mental illness is stated in Dr. E. Fuller Torrey and Mary Zdanowicz, “Why Deinstitutionalization Turned Deadly,”
Wall Street Journal,
August 4, 1998.
373
The extent of the discrepancy between the proportion of the mentally ill who are dangerous and the media coverage of those people is reported in “Depression: The Spirit of the Age,”
The Economist,
December 19, 1998, page 116.
374
The recent study at MIT that showed that people who have major depression and lose work abilities can return to previous norms on medication is Ernst Berndt et al., “Workplace performance effects from chronic depression and its treatment,”
Journal of Health Economics
17, no. 5 (1998).
374
The two studies showing that supported employment for the mentally ill is the
most economically beneficial way of dealing with them are E. S. Rogers et al., “A benefit-cost analysis of a supported employment model for persons with psychiatric disabilities,”
Evaluation and Program Planning
18, no. 2 (1995), and R. E. Clark et al., “A cost-effectiveness comparison of supported employment and rehabilitation day treatment,”
Administration and Policy in Mental Health
24, no. 1 (1996).