WASHINGTON -- Millions of Americans are failing to get the treatment they need to combat mental illness, the surgeon general said Monday in an exhaustive report that blamed social stigmas and lack of money.
Mental disorders, ranging from clinical depression to schizophrenia, affect nearly one in five Americans, but two-thirds of those people never seek treatment, according to the first surgeon general's report on mental health.
"Mental disorders are not character flaws but are legitimate illnesses that respond to specific treatments, just as other health conditions respond to medical interventions," the report said.
"They are treatable," Surgeon General David Satcher added Monday. "That's the great news."
Research for treating these disorders has exploded in the past 25 years, and doctors say they now have powerful options -- including both therapy and new medications.
The report sets out to replace lingering myths about straightjackets and asylums with up-to-date data drawn from an exhaustive review of some 3,000 studies. It encourages Americans to seek help if they experience symptoms, and Satcher urged friends, family, teachers, ministers, coaches and others to speak up if they spot someone with a problem.
"For all the progress that we have made on mental health, mental illness is still very much feared, and it's very much misunderstood," said Tipper Gore, Vice President Al Gore's wife and a longtime advocate for the mentally ill.
"It's our responsibility to change those attitudes," Mrs. Gore said. "No law or government program is going to do that for us."
Her husband also spotlighted the report at a visit to a steel mill in Cleveland, calling it a "major milestone" and saying a lot of people haven't gotten help because of the stigma. Then he asked steelworkers to raise their hands if they had a family member with a problem. When only a handful did, Gore said he knew some people were probably embarrassed to pipe up. "We need to get past that," he said.
The report makes no policy recommendations. But Satcher hopes the high-profile release will reach everyday Americans, and advocates said they would use the report to fight for equal health insurance coverage of mental ailments, better treatment in prisons and more public funding.
"In many state legislatures, it's a very hard sell," said John Bryan, who runs Florida's mental health system. "Coming from the surgeon general, it carries some weight."
Advocates in Washington are hoping it will carry weight, too, in Congress, which has been considering legislation that would bar health insurers from paying less for mental disorders than for physical disorders.
And the report could inject mental health issues into next year's election and pressure Congress to act, said Rep. Marge Roukema, R-N.J. "The report has come at an opportune time," she said.
Insurers and businesses argue against government mandating any benefits, including mental health coverage. "Mandates, while well-intentioned, drive up the cost of coverage and increase the number of uninsured Americans," said Richard Coorsh of the Health Insurance Association of America.
The report stops short of recommending the so-called parity law, but calls equal coverage "an affordable and effective objective."
The document calls mental health and mental illness "points on a continuum."
Mental health involves the ability to engage in productive activities, to fulfill relationships with others, adapt to change and cope with adversity. Mental illness includes a variety of disorders characterized by alterations in thinking, like Alzheimer's disease, in mood, like depression, or in behavior, like hyperactivity.
Without help, someone who begins sad can become clinically depressed, and ultimately even suicidal. Untreated, the most severely ill can end up homeless or criminal. Half of those with severe mental illness don't seek treatment, the report said.
"To a great extent, we are dumping our mental health problems on the streets of America," Satcher said. "We are dumping them into our jails and prisons -- there's no question about that."
The report notes researchers know much more about how to treat these illnesses than what causes them or how to prevent them.
This is the 51st surgeon general's report in the nation's history; 28 of them have dealt with smoking, including a seminal work in 1964 that detailed the health risks of tobacco.
For more information, call 1-877-9-MHEALTH. The full report is available on the Internet at www.surgeongeneral.gov.