Mental Health Month is an important time to honor and raise awareness around mental illness and mental wellness. Correcting and combating stigma and discrimination, including with data, is one of the month’s major goals.
It’s hard to talk about mental health without also addressing substance use disorders (including opioids), homelessness and violence. These topics continue to become intertwined in public and private commentaries.
One of the things that drew me to a career in analytics (from direct care) is the power of data to challenge assumptions and accurately identify needs, strengths, opportunities for improvement and (perhaps most importantly) successes. Analytics can provide a more complete, accurate picture of community needs, drivers of problems and the impacts of interventions.
With that in mind, it might be useful to evaluate some myths about mental illness and uncover the reality based on what the data really says.
Myth 1: Mental illness is rare
First, it can be important to differentiate mental illness from mental health. They’re often used interchangeably, but the latter increasingly includes all forms of mental health, not just the presence of illness. A mental illness refers to meeting diagnostic criteria, and the statistic of 1 in 5 experiencing a mental illness is often cited.
The context that’s often missing is: That’s the number of people experiencing a mental illness in a given year. This is a good example of proper descriptions and labeling of data results, as well as pairing different metrics together for a more complete picture.
In fact, over a lifetime, closer to half of us will meet the criteria for a mental illness, though most don’t get diagnosed or treated. That doesn’t include all the other people with symptoms that may not rise to the level of a formal disorder.
In other words, mental illness is not rare. And analytics demonstrates that.
Myth 2: Substance misuse is caused by mental illness, or vice-versa
Having both mental illness and a substance use disorder (SUD) simultaneously is commonly referred to as co-occurring, and these rates can be high. Around 1 in 4 people with a serious mental illness have a SUD, and about 40% of people with SUD have a mental illness.
In other words, they often go together, and one can cause the other. Still, it’s also likely they are caused by other common factors, such as genetic predispositions, environmental factors, or other social drivers/determinants of health.
The ability to bring large disparate data sets together for more whole person analytics beyond the more basic prevalence rates not only can move us toward more causal analysis, but also empowers greater investigation of whole person treatment efficacy.
Myth 3: Mental illness and substance use disorders have to be treated separately
In the past, we often thought these problems needed to be differentiated entirely, and whichever was primary needed to be treated (and resolved) before moving to the other. The reality of full remission of symptoms (also recognizing the high relapse rate) makes this difficult.
Once again, analytics has been able to help us assess and challenge treatment assumptions. Whole person data has validated that the causes, triggers and resolutions are intertwined. Further, analyses have led us to recognize that in most cases, both mental illness and SUD should be treated together and in an integrated fashion.
However, mental health treatment is still far more common and accessible than SUD or SUD-integrated treatment. Part of this is an artifact of insurance historically not covering SUD treatment as frequently as it would cover mental health treatment. Now in the United States, mental health and SUD are part of the 10 essential health benefits of the Affordable Care Act, so all health insurance must provide coverage.
Accessing quality care is a different issue and is a primary focus of current analytics to clarify need, ensure adequate resources, and empower the best ways to connect people in need to the proper care.
Myth 4: Mental health and substance misuse are the cause of homelessness
Many homelessness policies and programs have been focused on behavioral health treatment (which refers to bothmental health and SUD). These efforts are often based on public opinion, so what does the data say? Analyses demonstrate that while people with behavioral health conditions are overrepresented in the homeless population, they are not the driver.
In fact, rates are consistently around one-fourth to one-third of homeless having a behavioral health condition (though different studies use varying definitions, making comparisons difficult). These numbers are higher in the chronically unsheltered homeless groups, but it’s still not a defining factor.
What would happen if we led our public policy conversations based more on the analytics, which show that poverty is the major driver of homelessness? How might interventions and prevention change (hint: psychiatric hospitals won’t solve homelessness)? Of course, it’s worth noting that while we can’t write homelessness off as “just” due to behavioral health, people experiencing homelessness need good behavioral health resources!
Myth 5: Mental health and substance misuse are the causes of violence
Mental health is regularly blamed for various forms of violence, along with calls for more treatment. As with homelessness, this is more connected to assumptions we popularly make than to actual analytics.
While I would always advocate for increased mental health treatment capacity, analytics demonstrates that’s neither the problem nor the solution to violence. Several years ago, Dr. Laura L. Hayes put together an important analysis in Slate, calling out that violence is a product of anger, not mental illness.
In fact, data consistently shows that people experiencing mental illness and homelessness are far more likely to be victims of violence than perpetrators.
Active intoxication or withdrawal can raise the risk of violence due to reductions in impulse control. However, the common contextual factors usually drive violence more than mental illness or SUD. Once again, whole person data and analytics is a critical component of providing the right support to people as early as possible!
Substantial research has been conducted on causes of violence, interventions and treatment models. It’s important to consider a public health approach to violence as well. In short, we need to continue collecting data on this critical issue and conduct further analytics to continue to save lives and improve quality of life.