Skip to main content

America has to tackle its suicide problem

By Namratha Kandula, Special to CNN
updated 9:18 AM EDT, Mon June 3, 2013
A psychiatrist talks to a patient in Peshawar, Pakistan. The country is also trying community-based approaches on mental health.
A psychiatrist talks to a patient in Peshawar, Pakistan. The country is also trying community-based approaches on mental health.
STORY HIGHLIGHTS
  • Namratha Kandula: CDC says suicide kills more Americans than car accidents
  • Depression is leading disability in U.S., which lags on treatment, she says
  • She says nations like Uganda, Pakistan, India find training community to help is effective
  • Kandula: The U.S. must get ahead of depression epidemic

Editor's note: Namratha Kandula is a physician and an assistant professor of medicine at Northwestern University's Feinberg School of Medicine and a Public Voices Fellow with The Op-Ed Project.

(CNN) -- Many Americans were stunned when the Centers for Disease Control and Prevention released a study last month showing that suicide now kills more Americans than car accidents. But as a primary care doctor, I am not surprised.

Over the past decade, the period in which suicide deaths spiked, I have witnessed how the U.S. health care system approaches the treatment of depression. It is outdated and ineffective, and it too often fails at protecting Americans from the consequences of mental illness. With each passing year, the U.S. falls further behind other countries in finding cost-effective ways to care for our citizens' mental health.

On Monday, President Barack Obama and Vice President Joe Biden are holding a conference at the White House aimed at broadening access to mental health care and removing the stigma from seeking treatment. They have their work cut out for them.

Namratha Kandula
Namratha Kandula

Depression is a leading cause of disability in the U.S. Most people with depression will see a primary care doctor before they see anyone else. We physicians are supposed to identify depression, help patients get the right treatment, and prevent suicide. But every time I see a patient with depression, I feel my hands are tied.

Yes, I can prescribe an antidepressant and adjust the dose, but many depressed patients also need psychotherapy, more intensive medication management, and close follow-up. I cannot get them all the treatments they need.

In the U.S., mental health treatment is largely delivered by specialists who are not integrated into primary care clinics. It is reimbursed separately, often with restrictions on the number of visits and at a high cost to patients. The best I can do with a depressed patient who is not responding to initial treatment is to say, "I can give you a referral, but you need to check with your insurance company to see if it will pay for this." Often the patients do not follow through -- either because the wait time to see a mental health provider is too long, they cannot afford the treatment, or they are simply too depressed to act on the referral.

The World Health Organization projects that by 2030, depression will be the leading cause of disability in the world, with huge economic and social costs. Even some developing countries are surpassing the U.S. in creating innovative and effective ways to deal with this coming tide.

The U.S. Mental Health Parity Act, passed in 2010, requires insurance companies to provide equal coverage for mental health and may improve depression care for Americans. The Affordable Care Act will also expand mental health benefits to 62 million more Americans by including mental health as an Essential Health Benefit and by mandating mental health parity within the health insurance exchanges.

Darkness descends over returning vets
Reporter reveals mental illness
Link between prejudice and depression

However, in light of ongoing state budget and sequestration cuts, mental health services continue to erode. In April, for example, the Democratic governor of Maryland revoked $7.2 million in funding for mental health.

As shocking as this was to mental health advocates, policymakers across the country -- even in comparatively liberal states like Maryland -- are arguing that in the face of other urgent and competing priorities, strengthening the mental health system is too expensive for states to pursue. But that wouldn't be true if we consider alternative, more cost-effective delivery models.

In a rigorous study in Uganda, which has very scarce resources, researchers trained community members to deliver group interpersonal therapy to depressed men and women in 30 villages. The groups met weekly for four months. During the meetings, participants shared their experiences, and the group leader facilitated support and suggestions for change from other group members. This approach dramatically reduced the percent of people in the study with depression, from 80% to 28%, and improved people's ability to do the things that matter most, such as taking care of their children and themselves, going to work, and socializing.

Countries such as Pakistan and India, which have huge populations and many competing economic and social priorities, are also experimenting with task-shifting, in which mental health counseling can be delivered by lay health workers trained to provide scientifically sound counseling with supervision.

The benefits go beyond cost reduction. Studies in India show that lay health workers also help people to better accept mental illness and necessary treatments.

To be sure, some mental health innovation can also be found in parts of the U.S. Project ECHO, partly funded by the Department of Health and Human Services, is using telephone and Internet technology to link specialists at the University of New Mexico with primary care doctors, community health workers, and health educators in rural parts of the state. Through technology, specialists train and support nonspecialists in treating people with mental illness and addiction, a lethal combination that often leads to suicide.

Suicide is the culmination of many complex forces. But it is often preceded by mental illness that could have been treated. The dramatic spike in suicide deaths among Americans is a stark warning to those in charge of the U.S. health care system. If the U.S. ignores the innovation and alternative delivery models that are advancing mental health care in other parts of the world, the cost will continue to be measured in American lives.

Follow us on Twitter @CNNOpinion.

Join us on Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Namratha Kandula.

ADVERTISEMENT
Part of complete coverage on
updated 12:11 PM EDT, Fri August 29, 2014
Leon Aron says the U.S. and Europe can help get Russia out of Ukraine by helping Ukraine win its just war, sharing defense technologies and intelligence
updated 1:24 PM EDT, Fri August 29, 2014
Timothy Stanley the report on widespread child abuse in a British town reveals an institutional betrayal by police, social services and politicians. Negligent officials must face justice
updated 9:06 PM EDT, Fri August 29, 2014
Peter Bergen and David Sterman say a new video of an American suicide bomber shows how Turkey's militant networks are key to jihadists' movement into Syria and Iraq. Turkey must stem the flow
updated 11:16 AM EDT, Thu August 28, 2014
Whitney Barkley says many for-profit colleges deceive students, charge exorbitant tuitions and make false promises
updated 10:34 AM EDT, Fri August 29, 2014
Mark O'Mara says the time has come to decide whether we really want police empowered to shoot those they believe are 'fleeing felons'
updated 10:32 AM EDT, Thu August 28, 2014
Bill Frelick says a tool of rights workers is 'naming and shaming,' ensuring accountability for human rights crimes in conflicts. But what if wrongdoers know no shame?
updated 10:43 PM EDT, Thu August 28, 2014
Jay Parini says, no, a little girl shouldn't fire an Uzi, but none of should have easy access to guns: The Second Amendment was not written to give us such a 'right,' no matter what the NRA says
updated 9:40 AM EDT, Thu August 28, 2014
Terra Ziporyn Snider says many adolescents suffer chronic sleep deprivation, which can indeed lead to safety problems. Would starting school an hour later be so wrong?
updated 9:30 AM EDT, Fri August 29, 2014
Peggy Drexler says after all the celebrity divorces, it's tempting to ask the question. But there are still considerable benefits to getting hitched
updated 2:49 PM EDT, Fri August 29, 2014
The death of Douglas McAuthur McCain, the first American killed fighting for ISIS, highlights the pull of Syria's war for Western jihadists, writes Peter Bergen.
updated 6:42 PM EDT, Tue August 26, 2014
Former ambassador to Syria Robert Ford says the West should be helping moderates in the Syrian armed opposition end the al-Assad regime and form a government to focus on driving ISIS out
updated 9:21 AM EDT, Wed August 27, 2014
Ruben Navarrette says a great country does not deport thousands of vulnerable, unaccompanied minors who fled in fear for their lives
updated 9:19 AM EDT, Wed August 27, 2014
Robert McIntyre says Congress is the culprit for letting Burger King pay lower taxes after merging with Tim Hortons.
updated 7:35 PM EDT, Tue August 26, 2014
Wesley Clark says the U.S. can offer support to its Islamic friends in the region most threatened by ISIS, but it can't fight their war
updated 7:26 AM EDT, Wed August 27, 2014
Jeff Yang says the tech sector's diversity numbers are embarrassing and the big players need to do more.
updated 4:53 PM EDT, Tue August 26, 2014
America's painful struggle with racism has often brought great satisfaction to the country's rivals, critics, and foes. The killing of Michael Brown and its tumultuous aftermath has been a bonanza.
updated 4:19 PM EDT, Tue August 26, 2014
Ed Bark says in this Emmy year, broadcasters CBS, ABC and PBS can all say they matched or exceeded HBO. These days that's no small feat
updated 3:19 PM EDT, Tue August 26, 2014
Rick Martin says the death of Robin Williams brought back memories of his own battle facing down depression as a young man
updated 11:58 AM EDT, Tue August 26, 2014
David Perry asks: What's the best way for police officers to handle people with psychiatric disabilities?
updated 3:50 PM EDT, Mon August 25, 2014
Julian Zelizer says it's not crazy to think Mitt Romney would be able to end up at the top of the GOP ticket in 2016
updated 4:52 PM EDT, Mon August 25, 2014
Roxanne Jones and her girlfriends would cheer from the sidelines for the boys playing Little League. But they really wanted to play. Now Mo'ne Davis shows the world that girls really can throw.
updated 12:29 PM EDT, Mon August 25, 2014
Peter Bergen and Emily Schneider say a YouTube video apparently posted by ISIS seems to show that the group has a surveillance drone, highlighting a new reality: Terrorist groups have technology once only used by states
updated 5:04 PM EDT, Mon August 25, 2014
Kimberly Norwood is a black mom who lives in an affluent neighborhood not far from Ferguson, but she has the same fears for her children as people in that troubled town do
updated 5:45 PM EDT, Fri August 22, 2014
It apparently has worked for France, say Peter Bergen and Emily Schneider, but carries uncomfortable risks. When it comes to kidnappings, nations face grim options.
updated 1:27 PM EDT, Tue August 26, 2014
John Bare says the Ice Bucket Challenge signals a new kind of activism and peer-to-peer fund-raising.
updated 8:31 AM EDT, Fri August 22, 2014
James Dawes says calling ISIS evil over and over again could very well make it harder to stop them.
updated 9:05 PM EDT, Sat August 23, 2014
As the inquiry into the shooting of Michael Brown continues, critics question the prosecutor's impartiality.
updated 6:47 PM EDT, Fri August 22, 2014
Newt Gingrich says it's troubling that a vicious group like ISIS can recruit so many young men from Britain.
updated 10:50 AM EDT, Thu August 21, 2014
David Weinberger says Twitter and other social networks have been vested with a responsibility, and a trust, they did not ask for.
updated 7:03 AM EDT, Fri August 22, 2014
John Inazu says the slogan "We are Ferguson" is meant to express empathy and solidarity. It's not true: Not all of us live in those circumstances. But we all made them.
updated 8:23 AM EDT, Fri August 22, 2014
Retired Lt. Gen. Mark Hertling says he learned that the territory ISIS wants to control is amazingly complex.
updated 3:51 PM EDT, Wed August 20, 2014
Cerue Garlo says Liberia is desperate for help amid a Ebola outbreak that has touched every aspect of life.
updated 1:42 PM EDT, Thu August 21, 2014
Eric Liu says Republicans who want to restrict voting may win now, but the party will suffer in the long term.
updated 11:38 AM EDT, Thu August 21, 2014
Jay Parini: Jesus, Pope and now researchers agree: Wealth decreases our ability to sympathize with the poor.
updated 8:00 AM EDT, Thu August 21, 2014
Judy Melinek offers a medical examiner's perspective on what happens when police kill people like Michael Brown.
updated 6:03 PM EDT, Tue August 19, 2014
It used to be billy clubs, fire hoses and snarling German shepherds. Now it's armored personnel carriers and flash-bang grenades, writes Kara Dansky.
updated 1:27 PM EDT, Wed August 20, 2014
Maria Haberfeld: People who are unfamiliar with police work can reasonably ask, why was an unarmed man shot so many times, and why was deadly force used at all?
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT