Rise in Mental Disorders Seen as Boomers Age

As the nation’s baby-boomer generation ages and life expectancy grows, the number of Americans with mental disorders--ranging from substance abuse to depression to schizophrenia--likely will rise, “confronting our society with unprecedented challenges,” a landmark U.S. surgeon general’s report has concluded.

Those challenges will stress a system of mental health care delivery that is already creaking: Although one in five Americans suffers from some form of mental illness in any given year, fewer than half of them receive the right kind of treatment, according to the study released Monday. Those who fail to get good care are held back by enduring stigma, a fragmented system of mental health care delivery and financial strains.

On Capitol Hill, the report is expected to spur movement on a “parity” measure that would require health care insurers to cover mental health treatment on a par with treatment for physical disorders. Vice President Al Gore, whose wife, Tipper, has been a powerful advocate for the mentally ill, called the report “a call to action.”

In California, as well, the report is expected to provide powerful impetus to reformers.

Stephen Mayberg, California’s director of mental health, called the report “a blueprint for the future” that will be very helpful in legislative and policy discussions in many states. The coming year “should be a very busy year” for mental health reforms in California, he said.

More than two years in the making, the surgeon general’s treatise was hailed by some advocates and politicians as a crucial step toward placing mental health in the mainstream of health care issues. “Mental health,” the report says simply, “is fundamental to health.” But in spite of growing scientific evidence that mental and physical health are inseparable, psychological afflictions “continue too frequently to be spoken of in whispers and shame,” wrote Surgeon General David Satcher in his preface to the study.

In a reflection of the Clinton administration’s reluctance to back parity legislation and more sweeping reform proposals, however, Satcher appeared to give great weight to the report’s call for social changes surrounding mental illness. Satcher did not, by contrast, emphasize the report’s repeated criticisms of the patchwork system currently in place to help Americans cope with mental illness.

“Promoting mental health for all Americans will require . . . a societal resolve that we will need to make the needed investment,” Satcher wrote. But, he added, “the investment does not call for massive budgets.” Rather, it calls for greater willingness “to confront the attitudes, fear and misunderstanding that remain as barriers before us.”

But some advocates complained Monday that the surgeon general’s report does not go far enough in calling for a dramatic overhaul of the mental health care delivery system.

To them, current treatment practices for the mentally ill represent a national crisis that should be fought with the same vigor as the campaign against smoking.

“It’s wonderful that the surgeon general has raised the visibility of this issue and has stated that mental health is just as important as physical health,” said Laurie Flynn, director of the National Alliance for the Mentally Ill. But, she added, “I would wish there was a greater sense of urgency around this public health crisis we are facing. . . . My fear is this will be [received as] just another report from Washington.”

In its carefully annotated 458 pages, however, “Mental Health: A Report of the Surgeon General” makes clear that the current system of mental health care delivery may not hold up under the strains it is likely to face in the future. Those strains are likely to come from two swelling segments of the population, which appear to be at particular risk of psychological problems: older Americans and children and adolescents.

Among Americans 55 and older, for instance, almost 20% experience mental disorders that are not a normal part of aging. With about 75 million baby boomers on the threshold of those years, a larger-than-ever proportion of the American population will become particularly vulnerable to depression, substance abuse, Alzheimer’s disease, anxiety disorders and late-onset schizophrenia.

Studies suggest that among aging baby boomers, alcohol and illicit drug abuse or dependence will increase--rather than decrease, as it has among earlier generations of older Americans--because boomers have a greater history of alcohol and drug consumption than do earlier generations.

The report notes that in addition to stereotypes about what level of mental impairment is “normal” among the aging, the current health care system may contribute to the under-diagnosis of such mental disorders in older Americans. By restricting the time that doctors can spend with patients, health insurers may be contributing to doctors’ failure to detect emerging mental problems amid the welter of an aging patient’s more evident physical problems.

Among children 9 to 17, almost 21% suffer from diagnosable mental or addictive disorders, the report found. This “baby boom echo” generation, which is currently crowding schools beyond capacity, could be the beneficiaries of a vast amount of research on what kinds of intervention programs work to protect a child from social dysfunction and mental illness, the report said.

But a mental health care system that is “complex, sometimes to the point of inscrutability--a patchwork of providers, interventions and payers”--means that many of the estimated 6 million to 9 million American children with serious emotional disturbances do not get the kind of effective treatment that is available. The problem is particularly acute among children from low-income and minority homes, the study added.

In a series earlier this year, The Times described how California has reneged on its 30-year-old promise to provide adequate community care for its sickest mentally ill people. As a result, many end up incarcerated, in acute care hospitals or locked private wards, homeless or dead.

The surgeon general’s report underscored that the problem is a national one. “An alarming number of children and adults with mental illness are in the criminal justice system inappropriately,” it said.

Healy reported from Washington and Marquis from Los Angeles.