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Grade C for Crisis

New Mexico gets a "C" in a new nationwide report card on treatment for schizophrenia and other mental-health problems.

By Margaret Markham

 

From coast to coast, officials recently applauded the welcome news of this nation's population topping the 300 million mark. But there's one brutal fact dimming such rejoicing: At least 3 million people among this burgeoning population are slated to eventually suffer from schizophrenia.

In terms of the local scene, that incidence rate translates into thousands of southern New Mexico residents earmarked for this ravaging mental illness.

Nor does it help their plight to learn from a recent state legislative audit that overall New Mexico spends less on behavioral health services than any other state. Among southern New Mexico residents recently testifying in favor of improving such services were Susie Trujillo of Silver City and Las Crucen Becky Beckett, vice-chairwoman of the Behavioral Health Planning Council.

But there's also reason for optimism about schizoprenia, as an overflow audience learned from a keynote speaker at a recent Las Cruces gathering of mental health caregivers, consumers and family members.

"While there is still no cure for schizophrenia, everyone should be aware of two important facts," said San Francisco psychiatrist Dr. Mary S. Hansen at the Choices in Recovery educational seminar, supported by Janssen Pharmaceutica. "With more than 2 million Americans already affected by schizophrenia in any given year, both patient and family members need to realize they are not alone in facing this medical problem. Nor are they without treatment options. In fact, I've never seen a patient with this mental disorder for whom therapy does not achieve some degree of improvement in the quality of life.

"It's particularly important to be aware that among any 100 schizophrenics you are apt to find 100 different symptoms and 100 different experiences," Hansen went on. "While medication is not an end in itself, it is the means to reaching the important goal of a more normal life and even of accomplishing delayed career plans and improved family and social activities."

Hansen, also a professor at the University of California, warned that the key to maintaining such recovery is staying on prescribed medication to avoid relapses. If there are unacceptable side effects, it's wiser to change to another therapy but not to lapse from treatment altogether. The more relapses there are, the harder it gets each time to achieve recovery, Hansen emphasized.

Dr. Jeffrey A. Lieberman of the Columbia University College of Physicians and Surgeons concurs with that cautionary note. From an ongoing National Institute of Mental Health study involving 71 scientists in 24 states, it's already evident there is still no ideal medication for all such patients. On the other hand, all available medications proved beneficial to some. As principal investigator in this longterm study, reported in the New England Journal of Medicine, Lieberman admits being shocked at learning "we are using essentially the same class of medications to treat schizophrenia in 2005 that we were using in 1955. . . . We urgently need better medications to treat this disorder."

Another deterrent to better outcomes in schizophrenia is the tendency to depression and eventual suicide. Because depression alone is estimated to crimp the national economy by some $83.1 billion annually, the National Alliance on Mental Illness (NAMI) is in the midst of surveying five key American cities on the overall impact of depression on families, health care systems and society as a whole. The project is also assessing challenges consumers face in obtaining effective treatment.

Such intensified focus on mental illnesses, including schizophrenia, appears long overdue. "We live in a time of great uncertainty for people with serious mental illness. States are making critical choices about mental health funding and their Medicaid programs," NAMI officials concede.

 

Perhaps nowhere is this more obvious than with mental health needs of children and teenagers. As New Mexico legislators tackle their 2007 session, they once again face the dilemma of lack of mental health services for the very young. Just last fall, the Children Youth and Families Department confronted the stark reality that the state code on this issue hasn't changed since 1996.

Based on recommendations from a recent 40-member task force, new guidelines would ensure that–regardless of setting–each child would receive individualized therapy. Moreover, parents would be involved in determining any plan for handling a child, without having to go through a judicial process.

Although schizophrenia, for instance, is relatively rare in young children, it may often be mistaken for autism. Therefore, the National Institute of Mental Health warns there may be good reason to suspect schizophrenia if a child age seven or older often claims to hear voices saying derogatory things about a parent, or "voices conversing with one another, talks to himself or herself, stares at scary things that are not really there, and shows no interest in friendships."

Fortunately, the institute notes, for childhood schizophrenia the outlook has taken a turn for the better due to the fact that "treatments for managing the illness have improved significantly in recent decades."

 

In response to the obvious need for an authoritative update on this country's mental health services, NAMI recently evaluated such care in each state. The outcome of the daunting task is the study, "Grading the States," a state-by-state report card on the adult mental-health care system. The document reveals deficiencies so serious in all 50 states that none received an A grade. New Mexico scored a C grade. Overall, the nationwide tally averaged a dismal D grading.

Not surprisingly, the study confirms that all states are experiencing increased pressures on emergency rooms, jails and prisons. As NAMI notes, the report is in accord with conclusions from President Bush's New Freedom Commission: "For too many Americans with mental illness, the mental health services and supports they need remain fragmented, disconnected and all too often inadequate, frustrating the opportunity for recovery."

It's not likely anyone will dispute, however, that we've come a long way in our attitude toward mental illness since the early days when Dorothea Dix chided the Massachusetts legislature for the prevalent inhumane treatment of the so-called insane. Nonetheless, the NAMI scorecard makes undeniably clear we still have a very long way to go.

 

For more information on the NAMI report, see www.nami.org/grades.

Longtime Las Cruces resident Margaret Markham is a freelance journalist and member of the National Association of Science Writers.

 

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