The possible outcomes for millions of American adults and children with mental health problems are far from bleak, as science continues to make significant inroads into understanding the risk factors for mental illness, defining mental disorders' characteristics and progression, and evaluating the available treatment options. Far too often, however, these individuals continue to face formidable barriers to the treatments that can help get their lives back.
And while we have come a long way, science still has much to learn about mental disorders and the best medical and social interventions to foster recovery for all. Right now, the best available research confirms that there are no universally effective treatments and no way to determine which treatments are best for each individual. While science is moving quickly to answer some of these questions, the lag time in applying what we know from science to actual treatment for real people is dramatic. Meanwhile, blatant insurance discrimination, workforce shortages, and stigma are denying individuals the potential to receive the best care available and exacerbating long-existing disparities in care. In the past several months, major reports have shed new light on treatments for depression and schizophrenia, and confirmed that the equitable provision of health and mental health is a wise investment for wellness and for the economic bottom line. These landmark reports confirm what we have known for decades: Treatment works best when tailored to the individual's needs and is accessible.
Phase II of STAR*D provides strong scientific support that treatment for depression works and that each medication studied works differently in each individual. The promise of STAR*D is to help redefine the way Americans view depression—as an illness that requires proper medical care, customized to the individual, without stigma and misunderstanding. Future phases of the study will examine the effectiveness of medications with other types of interventions, such as cognitive-behavioral therapy.
Similarly, the first two phases of CATIE take an important step toward better understanding the medications used to treat schizophrenia. Both phases show that no one treatment works for every person and that side effects play a considerable role in an individual's decision to continue taking a medication. Rather than concluding—as some have erroneously—that these results prove that the available treatments for schizophrenia are interchangeable, results highlight the individuality of the disorder and emphasize the need for access to all treatment options. This way, providers and the individuals they treat can find the best options that work for each individual.
CATIE and STAR*D, in tandem with emerging science, help inform patient-provider dialogue, assisting them in defining treatment strategies to achieve recovery. But a formidable barrier to ensuring that the best science translates into everyday care remains: a lack of real access to mental health services.
At every level in the public and private healthcare marketplace, America has not achieved the equitable provision of preventive and comprehensive mental health services. Yet a recent study commissioned by the U.S. Department of Health and Human Services shows that providing mental health and substance abuse coverage on par with other health coverage can achieve greater fairness and improved insurance protection without increasing healthcare costs. The study again confirms what advocates and some forward-thinking business leaders have said for years: Access to mental health benefits and better care management of mental disorders is cost-effective. Parity is no longer just a clarion call for advocates—it is a moral and economic imperative.
The National Mental Health Association and mental health advocates, providers, and consumers across the nation look forward to a time when barriers to care are no longer a daily reality for millions of Americans. Understanding and applying better science to the design and delivery of services is an important step toward that future. Equally important is the rapid and robust investment of government and research communities in both scientific and health services research that answers questions of the highest importance to an individual with a mental illness: Can I live in the community? Can I work? Can I build or get back meaningful relationships? But perhaps the most important first step toward this vision is a societal and political commitment to end discrimination in Americans' ability to access mental health services. It's already been far too long coming.
Cynthia Wainscott is Chair of the Board of the National Mental Health Association.