MENTAL DISORDERS COMMON, U.S. SAYS; MANY NOT TREATED

WASHINGTON -- One in every five Americans experiences a mental disorder in
any given year, and half of all Americans have such disorders at some time
in their lives, but most of them never seek treatment, the surgeon general
of the United States says in a comprehensive new report.

Many people with mental disorders do not realize that effective treatments
exist, or they fear discrimination because of the stigma attached to mental
illness, the study found. And, it said, many people cannot afford treatment
because they lack insurance that would cover it. After reviewing hundreds of
studies, the report concludes that "a range of effective treatments exist
for nearly all mental disorders," including the most severe. The report's
principal recommendation is to "seek help if you experience symptoms of
mental illness."

The report is to be issued at the White House on Monday by the surgeon
general, Dr. David Satcher, the government's leading spokesman on matters of
public health.

Dr. Satcher finds a huge gap between the need for mental health services and
their availability.

A major theme of the report is that mental health must be part of mainstream
health care, not an afterthought or an offshoot.

The report says that "22 percent of the population has a diagnosable mental
disorder," as suggested by several recent studies. It also says that "mental
illness, including suicide, is the second leading cause of disability,"
after heart disease.

But, it says, "nearly two-thirds of all people with diagnosable mental
disorders do not seek treatment."

The statistics, derived from studies published in the last few years, will
probably not surprise psychiatrists, psychologists or other specialists in
mental health. But the report is significant because it meticulously
analyzes huge amounts of data and puts the imprimatur of the government on
the findings, just as the surgeon general's report on smoking and health did
in 1964.

Mental disorders are defined in the report as health conditions marked by
alterations in thinking, mood or behavior that cause distress or impair a
person's ability to function. They include Alzheimer's disease, depression,
attention-deficit or hyperactivity disorder and phobias.

The report says people are deterred from seeking treatment for mental
disorders because they have no health insurance, their insurance does not
adequately cover the costs or they have an "unwarranted sense of
hopelessness" about the prospects for recovery from mental illness.

The document declares that "mental disorders are not character flaws, but
are legitimate illnesses that respond to specific treatments." It says that
the "cruel and unfair stigma attached to mental illness" is "inexcusably
outmoded" and must no longer be tolerated.

"Why is the stigma so strong despite better public understanding of mental
illness?" the report asks. "The answer appears to be fear of violence.
People with mental illness, especially those with psychosis, are perceived
to be more violent than in the past."

While research suggests that some people with mental disorders and drug
abuse problems do indeed pose a risk of violence, the report says, the
danger is not great. "In fact," it says, "there is very little risk of
violence or harm to a stranger from casual contact with an individual who
has a mental disorder."

In issuing the report, federal officials said, the Clinton administration
will emphasize its efforts to fight mental illness.

Copies of the report and related documents were obtained today from a civil
servant who fears that the scientific significance of the report may be
overshadowed by its "political manipulation," consumer advocates who advised
the government on the study and mental health experts close to the office of
Tipper Gore. Over the last two decades, Mrs. Gore, the wife of Vice
President Al Gore, has been a champion for the rights of people with mental
illness, and she was once treated for depression herself.

Michael M. Faenza, president of the National Mental Health Association, who
served as a member of the planning board for the report, said: "This is a
historic day. It's wonderful that we have a surgeon general talking about
mental health and mental illness, in a voice that has not been used in
Washington before."

Faenza said the report could be a turning point, if it improves access to
services, or "it could be meaningless, if Congress and state legislators do
not have the backbone and the political will to act on it."

The report endorses efforts by some states and members of Congress to
eliminate the disparities in insurance coverage for mental disorders and
other illnesses. Equality between mental health coverage and that for other
illnesses -- a concept known as parity -- is "an affordable and effective
objective," it says. When mental health care is properly coordinated by a
health maintenance organization or a firm specializing in such care, parity
causes "negligible cost increases," it says.

But, the study says, techniques used by H.M.O.'s to cut costs, by reducing
hospital stays and encouraging short-term outpatient therapy, have not
worked well for emotionally disturbed children from low-income families on
Medicaid. Indeed, it says, Medicaid may be simply shifting costs to child
welfare and juvenile justice agencies.

Among other recommendations, the study says "it is imperative to expand the
supply" of mental health services, and to increase the number of mental
health professionals caring for children and adolescents. The study does not
specify the cost of such initiatives, but health officials said the
administration was not seeking a big budget increase. Researchers have made
immense gains in the treatment of mental disorders, with powerful new drugs
and various methods of psychotherapy, but they need to focus more on how to
prevent such illnesses, the report said.

Progress in preventing mental illness has been slow, because scientists do
not understand enough about the causes of such illness, the report said.
Mental disorders are usually not defined by laboratory tests or physiologic
abnormalities of the brain, and "for the most part, their causes remain
unknown," it said.

The split between mind and body, proposed by Descartes in the 17th century,
is artificial and antiquated and has hampered mental health research, the
report says.

"The roots of most mental disorders lie in some combination of biological
and environmental factors," the report says. "No single gene appears to be
responsible for any mental disorder. Rather, small variations in multiple
genes contribute to a disruption in healthy brain function." Under certain
environmental conditions, it says, this disruption can result in mental
illness.

The report says "the mental health system is highly fragmented," so that
people who need help must often navigate a bewildering maze to get
treatment. Moreover, it says, health care practitioners are often unaware of
research identifying the most effective treatments.

The surgeon general's report also makes these points:

a.. Psychiatric disorders appear in all types of families, of all social
classes and of all backgrounds.

b.. Treatment of mental disorders cost $69 billion in 1996, the last year
for which figures are available. In addition, the nation spent $17.7 billion
on Alzheimer's disease and $12.6 billion on treatment for drug and alcohol
abuse that year. The figures do not include indirect costs, like days of
work lost because of mental illness.

c.. One in five children experiences the signs and symptoms of a diagnosable
mental disorder in the course of a year, but only about 5 percent of all
children suffer "extreme functional impairment."

d.. Among Americans age 18 to 54, 14.9 have anxiety disorders, 7.1 percent
have mood disorders and 1.3 percent have schizophrenia.

e.. Among elderly people, depression takes an "inordinate toll," but often
goes undiagnosed and untreated. Eight percent to 15 percent of older people
have symptoms of depression. "Suicidal thoughts are sometimes considered a
normal facet of old age." People 65 and older have the highest suicide rates
of any age group. In addition, the report says that Alzheimer's disease
strikes 8 percent to 15 percent of people over the age of 65. But it insists
that "normal aging is not characterized by mental disorders."