In proclaiming May as National Mental Health Awareness Month, President Obama called mental health problems a serious public health concern. We need to raise awareness about mental health while working to improve the standard of care for those with mental disorders.
I’m delighted that our work with the Social Innovation Fund will contribute to that overarching mission. The announcement of our five subgrantees marks the beginning of our initiative to increase the reach of the IMPACT model of depression treatment in Alaska and the Northwest, and to enable these community health centers to deliver effective care. For full details, please visit our special Social Innovation Fund page.
Our work has a distinctly human dimension which I was able to appreciate more fully during our site visits to the region last month. While the natural beauty of the land and the historic charms of the communities might be a welcome change from the hustle and bustle of life in New York City, at least to this out-of-towner, the residents of the communities—especially the middle-aged and the older adults—face an increased risk of depression and suicide.
The sources of stress and the disadvantages many confront are clear. Wherever you look, there’s evidence of economic hardship, unemployment, substance abuse, and the absence of vibrant social support systems—all of which conspire against vulnerable low-income populations.
How these factors play out across men and women, and particularly those who live in rural areas, might appear anomalous at first glance. We know that most suicides are the result of psychiatric illness, and the most frequent cause is depression. The five-State WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho) has some of the highest rates of suicide in the nation.
The three states that top the list are Wyoming, Alaska, and Montana: about 23 suicides per 100,000 population. Those rates are concentrated among White men and Native American men: about 27 per 100,000 vs. the national average of 12 per 100,000. By comparison, the rate for women is only about 8 per 100,000. Yet, we know that women as a group tend to suffer from depression more so than men.
So what could explain this? In part, social factors such as the stigma associated with mental illness make men less likely to seek help. Men and women also tend to cope differently with feelings of despair and isolation. But another salient factor is access to guns and other lethal weapons. This is true of rural communities in general, not just nationally but internationally, as well. Men are just more likely to shoot themselves. It’s this combination of more access to guns and less access to care that explains this apparent paradox.
The bottom line is that many people experiencing serious depression never receive care. Of those who do, the vast majority are diagnosed and treated by generalist providers in primary care settings. Unfortunately, most primary care practices are ill equipped to provide mental health care and, as a result, only a small percentage of patients treated for depression in primary care are significantly improved.
As we know from many scientific studies on collaborative care models such as IMPACT, improving the quality of care for depression can dramatically improve both mental and physical health outcomes, reduce health care costs, and improve the productivity and economic well-being of populations.
The beauty of the IMPACT model is that it achieves multiple goals at once: It improves the capacity of primary care-based teams; it brings together professionals with complementary skills who engage and support patients in treatment; and it allows the team to identify any patient who is at risk of “falling through the cracks” and intensify or change the patient’s treatment. Moreover, IMPACT is particularly well suited for rural areas because it allows remote access to the expertise of consulting psychiatrists who can help direct care, even if none are available locally.
And so, in keeping with the president’s proclamation, let’s raise awareness about mental health and lend strength and support to all who need it. The work of our five Social Innovation Fund subgrantees will certainly make a huge difference in the lives and health of rural low-income communities.