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Published November 18, 2012, 11:30 PM

Part 2 of 2: Overcoming the stigma of mental illness

While experts say treatment has improved, challenges remain
FARGO - Diabetes sufferers have access to nutrition counseling and frequent checkups to stay healthy, while a cancer diagnosis is met with comprehensive treatment plans and support to get better.

By: Ryan Johnson, INFORUM

FARGO - Diabetes sufferers have access to nutrition counseling and frequent checkups to stay healthy, while a cancer diagnosis is met with comprehensive treatment plans and support to get better.

That level of care isn’t the norm for many here who suffer from mental illness, including diseases that put them at risk of suicide, said Susan Rae Helgeland, executive director of Mental Health America of North Dakota.

“When a person is diagnosed with depression, they’re left on their own,” she said. “Insurance reimbursements are much better for prevention and for follow-up with heart disease or diabetes than they are for depression or bipolar disorder.”

Experts say the way we treat mental illness has improved. Still, it carries a stigma that affects everything from accessing help to research into the next generation of treatments.

Helgeland said her advocacy for better treatment of the mentally ill began in 1964, when she took a field trip to the State Hospital in Jamestown as a college student studying social work.

She said she was “shocked and traumatized” – more than 2,000 people were being held in the facility that had become a makeshift prison, its patients heavily medicated with little hope of release.

The hospital now has about 200 patients, and Helgeland said the state has made strides in treating the mentally ill in their own communities rather than institutionalizing them. But there’s still a long way to go.

“I thought by now, at 70 years old, I’d have worked myself out of a job, but that hasn’t happened,” she said. “That advocacy for better delivery of the services or parity is still needed.”

From ‘insane’ to ill

National mental health and suicide expert Dan Reidenberg said the mentally ill have been “demonized” throughout history.

“People were talked about as a ‘maniac’ and they were ‘insane’ and they were sent to asylums,” he said. “As a matter of fact, long ago in the 16th and 17th centuries, they used to think that if a woman who died by suicide was buried in a cemetery, if another woman walked on that grave, they would become barren.”

Reidenberg said things have improved in the past 50 years, something he attributed to more awareness. Television shows and movies often depict mental illness, and stories of sufferers’ experiences are easier than ever to find.

But the biggest changes have come from genetic research, chemical tests and a better understanding of how the brain works – knowledge that has dispelled many of the myths of what causes mental illness.

“It takes away from the character flaw or moral deficiency issue,” he said.

Paula Clayton, medical director for the American Foundation for Suicide Prevention, said about one in four Americans will have a mental health condition in their lifetimes. About 12 percent of women will get depression, while about 6 percent of men will face the illness.

She said numerous studies have found about 90 percent of people who die by suicide had a mental disorder at the time of their death. But most people with mental illness don’t die by suicide, and it’s not inevitable.

“That really is the outcome that we try to prevent when we’re treating people with mental illness,” Clayton said. “It’s the mortality that we want to prevent, just like cancer or heart disease.”

Like any other illness, not every person recovers, Clayton said. She said about 90 percent of people diagnosed with a mental illness can recover and be successfully treated.

The Centers for Disease Control and Prevention reported 38,364 suicide deaths in the U.S. in 2010, including 106 in North Dakota and 606 in Minnesota, making it the country’s 10th leading cause of death.

Suicide rates are highest for people ages 40 to 59. It’s the third leading cause of death for youths ages 10 to 24, claiming the lives of about 4,600 each year, and the CDC said about 157,000 teens and young adults get medical care at emergency rooms in a typical year for self-inflicted injuries.

The North Dakota State University Counseling Center has used an online screening program for the past three years to find these at-risk students and encourage them to get help, Director Bill Burns said.

NDSU was one of the first 15 schools to use the tool, which was developed by the AFSP. It has since spread across the country.

The center sends out 100 to 200 emails each week, working its way through the entire NDSU student body, and asks students to complete an anonymous survey ranking them based on risk level. Each student gets an email with results and how the school can help.

Burns said the program brings in 40 to 60 high-risk students each year who otherwise might not have sought help.

“It gets them when they’re feeling down, when they’re feeling at their worst,” he said. “What we know happens is they get these emails and they may not touch the email for weeks, and then sometime when they’re feeling down in the middle of the night or during the day, they’ll take it.”

Nearly all of the counseling center’s services are free to students. Burns said NDSU, as well as a similar center at the University of North Dakota, could always use more resources to keep up with the demand – NDSU helped about 1,100 students last year. The biggest shortages are at North Dakota’s other nine public colleges and universities.

“They really need more staff,” he said.

Getting help

When someone with mental illness is in crisis, they can still find help. Fargo-based FirstLink specializes in suicide prevention and runs a 24-hour helpline available by calling 1-800-273-TALK.

FirstLink took about 40,000 calls from across North Dakota and Clay County last year, said Information and Crisis Services Director Stacie Loegering. Of those, 1,021 were related to suicide, and specialists sought assistance from law enforcement 72 times.

“We can really help de-escalate people, but family members and friends should know that when it’s very severe, the next step should be to call 911,” she said.

FirstLink also runs the 211 helpline that connects people to local resources, such as support groups, places to volunteer and help with health issues.

Clayton said there are several treatments for mental illness, including antidepressants, counseling and electroconvulsive therapy, which puts an electrical current through the brain and provides temporary relief for many with severe depression.

But the medications haven’t changed in decades. One problem, she said, is that patients often have to try several drugs and wait weeks or months before they know if it will work.

“We don’t have any way to match the drug with the patient,” Clayton said. “If I’m depressed, I might not eat, and I might lose weight, and I can’t sleep, but the person next to me in the waiting room might be overweight because she’s eating too much and sleeping too much because we have different symptoms.”

Reidenberg said advances in screening and more effective treatment options are on the horizon, including a blood test for depression and an X-ray to diagnose bipolar disorder. Brain imaging could help break the stigma of mental illness, and also give experts a target for treatment because they’ll know where the illness has taken hold.

“The more we can get people to understand that the brain is an organ like any other organ in the body, and when that gets sick it needs help from a doctor, it takes away the stigma,” he said. “It takes away the shame around it just like it would if somebody needed to have insulin shots all the time.”

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Readers can reach Forum reporter Ryan Johnson at (701) 241-5587