Beverly’s bipolar disorder began early, and successive crises built up from there. As her mental stability worsened, she saw no other option for relief than using—and eventually abusing—prescription narcotics, which resulted in the loss of her nursing license and led to a cycle of unemployment and poverty. On top of this, her illness meant she had frequent fights with her romantic partners, leaving her unable to keep up a steady relationship or provide stability to her children. All these misfortunes drove her to nearly take her own life in a car accident and overdosing several times. Beverly’s story is all too common in the modern era, and even though people hesitate to address it, too often, it has the same root cause: mental illness.
Mental health has been on the decline in rural low-income America, leading to rising rates of suicides, alcohol poisonings, and drug overdoses, especially in poor white communities. About 1 in 4 Americans with a mental illness now have a substance use disorder, and suicide rates have increased by 25% since 1999. State governments must focus on community-oriented mental health care in order to fight back against this epidemic of “deaths of despair.”
These deaths of despair have single-handedly caused U.S. life expectancy to decline for two years in a row, according to the CDC. Whether one looks at suicide, drug deaths, or alcohol poisoning, all can be attributed to mental health conditions such as depression, bipolar disorders, or post-traumatic stress disorder (PTSD). When it comes to increasing America’s average lifespan, most people tend to think of battling physical conditions such as cancer or diabetes, but it’s mental health that is causing premature deaths now. What is worse, this dark trend is poised to continue. Unfortunately, Americans are still uneasy discussing mental health at all and often try to look for something else to blame.
For example, within the broad category of deaths of despair lies the much-discussed opioid crisis, which now claims 115 lives a day. The public often blames excessive opioid prescriptions for the epidemic, but those don’t tell the whole story. After all, total opioid prescriptions have fallen 25% since 2012, and yet opioid overdoses continue to rise unabated. The mental health side of this crisis has often been overlooked.
The effects of declining mental health are clear, but its causes are more up for debate. A lack of job opportunities and income inequality might be a contributing factor, although these problems are specifically growing within the white population, which tends to have higher income and more access to opportunities than racial minorities. The link between economic prosperity and mental health is still tenuous at best.
Other social causes might be to blame, such as the decline in stable marriages or disappearing community support networks like churches. One could also look at the rising costs of tuition and medical care, or falling social mobility. Beverly experienced all of these hardships, but no matter which one played the largest role, the result was her mental illness and all the crises that came with it.
There are several solutions state governments can—and must—implement to improve the mental health of their poorer populations, health care coverage, education, and outreach programs. The most immediate and practical policy solution is expanding Medicaid, which, among other things, covers mental health and substance abuse treatments for low-income people. So far, 17 states have not expanded Medicaid, meaning a childless adult below the poverty line in those states has no way of paying for a psychiatrist or addiction treatment, even though they’re statistically more likely to need it. Citizens of some states, in particular, need the extra coverage: Alabama has not expanded Medicaid, and currently ranks among the worst in the nation in terms of access to mental health.
In terms of education, any trained therapist knows that the roots of mental illness can go back to one’s childhood. Accordingly, states need to ensure that schools screen children and teenagers for mental health conditions, just like they check for sight and vision problems. This simple measure could have vast ripple effects for communities, making sure that those who need help get it before simple malaise becomes substance abuse. Unfortunately, Beverly only started seeing a psychiatrist after addiction had taken hold of her, but more proactive policies might have prevented her from turning to drugs and alcohol in the first place.
Outside of the public sector, primary care doctors have a role to play as well; including mental health screenings in physical checkups that would result in more diagnoses and hopefully more treatments. The National Alliance on Mental Illness recommends short 10-question depression screenings in every doctor’s visit and ready pathways from primary care to behavioral health treatment. If your doctor checks your blood pressure, why shouldn’t they check your mental health as well?
Finally, state governments simply need to provide more money for mental illness treatment programs, especially in rural, low-income communities. After all, 65% of rural areas currently lack access to a psychiatrist. If we can guarantee that anyone with a mental illness has access to therapy or psychiatric services in their town, these rates of despair deaths may yet turn around. In Beverly’s case, she had fortunately moved from rural Appalachia to a decent-sized town while young, but if she hadn’t, she might have been shut off from the psychiatric help and addiction rehabilitation that eventually saved her life.
State initiatives like the above have already been seen to work. California’s Full-Service Partnerships program, created by referendum in 2004, has made the 150,000 people it serves half as likely to end up in the emergency room. But the responsibility lies with state and local governments because only they can provide the specific services that the mentally ill of their region need.
Treating mental diseases like Beverly’s are the new frontier of lifesaving in America. After all, mental illness is exactly that—illness, just as serious and just as treatable as hypertension or diabetes. When poor mental health reaches epidemic proportions among low-income communities, it’s no surprise that deaths by drugs, alcohol, and suicide follow close behind. These mounting tragedies must be addressed by our governments before they come to define us as a nation. The way we treat the mentally ill speaks to the way America takes care of its own.
Image: “man, depression, dark”