Dr. Bernard Arons chats about World Health Day

(CNN) -- United Nations Secretary-General Kofi Annan is urging countries to devote more money and attention to mental health issues. World Health Day is dedicated this year to mental health. Some 400 million people suffer from mental or neurological disorders or problems related to substance abuse, according to the World Health Organization. WHO is dedicating April 7 to highlighting such disorders as depression, schizophrenia, Alzheimer's disease, alcoholism, epilepsy and mental retardation.

Dr. Bernard Arons is director of the Center for Mental Health Services, a private, nonprofit clinic in the District of Columbia. He also currently serves as a clinical professor of psychiatry on the faculty of the Georgetown University School of Medicine. He participated in our chat Friday, April 6, at 2:00 p.m. EDT.

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CNN Moderator: Good afternoon, Dr. Arons. Welcome to CNN.com Health Chat.

Arons: It's very good to be here to participate in this.

CNN Moderator: What is World Health Day all about?

Arons: World Health Day is set as a day, usually April 7th, and we spend one day in which every country of the world focuses on the health of the people on the globe. It's hoped that concern about health won't only be on that day, but every day, but it gives us a focus on one particular day. Each year, a topic is selected for the focus, and this year, mental health has been chosen as the topic. I'm a psychiatrist, and I'm the director of the federal agency in the United States concerned with mental health, the Center for Mental Health Services. It's part of the Department of Health and Human Services. It's been our pleasure to participate in helping to orchestrate World Health Day in the United States.

From the chat room: Dr. Arons, what is your view of U.S. mental health -- declining, or just more reporting?

Arons: There is a number of ways in which we become aware that we are not as mentally healthy a nation as we ought to be. I think we see it in the number of individuals who have symptoms of mental illness, but feel that it's inappropriate or unwise to seek treatment. We see it in the number of people who have visits with their regular physician, having symptoms that don't seem related to a particular physical illness, but the physician is reluctant to raise the issue of depression or anxiety. And unfortunately, we see it in the too large number of people who commit suicide, which, at about 30,000 a year, is a major public health concern.

From the chat room: My question would be, United Nations makes the problem visible, but, individual countries must pay for it, who could afford more prevention type strategies?

Arons: We believe that all nations, including our own, are actually paying more than they ought to in terms of failing to provide appropriate mental health treatment and prevention. For example, the economic costs of people who become homeless, who no longer contribute to the productivity of the nation, people in jails with mental illnesses, who may not have committed a crime if they'd had treatment. People in juvenile justice systems -- we all pay for this, for the jails and prisons, in a way that could be saved if we'd only provide some treatment in a timely manner, and some appropriate prevention.

From the chat room: It has been my observation that many people who need to see a psychologist or a psychiatrist simply refuse to make such a step. Maybe they do not want to be called "crazy" or something like that. Is this a major problem and if it is what can be done about it?

Arons: It is a major problem. The stigma associated with treatment for mental illness is far too great, and keeps people from being willing to seek service. People sometimes feel discriminated against if they seek treatment for mental illness, and causes people to undergo unnecessary stress. There are things we can do. On an individual level, we can each be more supportive and understanding of our family and friends who are seeking treatment for mental illnesses, and express that we respect their choice to get treatment. We can make sure the message gets to all people, and support anti-stigma activities, to try to make sure that people know there are a range of effective services for mental health disorders. People should be aware that one particular treatment may not be appropriate for them, but that there will be other approaches that will work. Changing attitudes is important, as well as increasing knowledge.

CNN Moderator: How has treatment for mental illnesses improved over the last ten years?

Arons: We've had tremendous improvements in treatment in the last ten years. We understand more about the function of the human brain, about the role of neurotransmitters, the chemicals that serve to send messages between nerve cells, and there have been tremendous improvements in treatments with medications, and also we know more about treatments with verbal therapies. There are also a number of different medications available, so that if one doesn't work, there are others to try. We also understand more about the possibility that it may take two or more medications to work together to enable someone to recover from their condition. That's the good news. The bad news that is in spite of these accomplishments, there are still many parts of the country and world where these effective treatments, whether medication or verbal treatments, aren't available to people.

From the chat room: What are your thoughts on the ever-increasing use of anti-depressants and drugs such as Ritalin for children?

Arons: The important thing to be concerned about is that an individual, whether adult or child, gets a full assessment and diagnosis. Then they should be made aware of the various interventions that are effective, whether medicine or others, and then make an informed choice. The reason these medications are known to be used increasingly is because of their effectiveness, as well as the low incidence of side effects. From one point of view, it's not surprising that we see a rise in the use of medications. On the other hand, it's important to also be aware that there may be other interventions that should be used along with medications, or sometimes on their own.

From the chat room: What online resources are there to evaluate specific psychiatrists?

Arons: There is quite a bit of information available online that should be useful to consumers. I'm not aware of any specific online service to evaluate particular providers. But let me mention some of the online resources that are available. There is www.mentalhealth.org, which is a resource for all kinds of information, written materials, materials put out by the government, lists of resources by community. They'll refer people to the mental health organization in their community, which can often be the source of good referral information. There are some increasingly interesting sites to help locate treatment resources. For example, if you go to samhsa.gov, there is a map of the USA, and you can locate the substance abuse facilities within five or ten miles of your home, and get information about the languages spoken, the insurance, or whether Medicare or Medicaid is accepted, and other information about the clinic.

From the chat room: Dr. Arons, it seems that there has been a fantastic rise in the number of cases of OCD and other anxiety disorders. Is this due to better diagnosis or our faster paced lifestyles?

Arons: That's a difficult question to answer. Sometimes, as information becomes available to people, they're more aware of their symptoms, and their physician or other provider may be quicker to diagnose when they're well known. We really don't have information about whether these conditions are really increasing in number, or if we're just diagnosing them more accurately. It's true -- it seems that we're in a faster-paced society, with 24-hour news, e-mail, shopping... it may very well be having an impact on our collective psyche.

From the chat room: Dr. Arons, mental illness can run in families. Is anything being done to help public awareness in this regard?

Arons: That is true, that mental illness can run in families. There seems to be some possibly genetic component for some mental illnesses. But it's also true that mental illness seems to not be limited only to families where there's a past illness. We certainly want to get the information public about accurate family connections, but that doesn't necessarily reassure someone who may be experiencing symptoms, and not be aware of any family history.

From the chat room: Is cost of such treatment upon diagnosis also a factor in whether or not someone will go to get diagnosed and, if so, is there anything being done about helping those who can't afford the proper care?

Arons: The cost of treatment and the availability of insurance coverage is an important barrier to receiving adequate assessment, diagnosis and treatment. Unfortunately, a number of insurance plans sometimes will provide mental health services that are at a lower level than for other health services. There is quite a bit being done to try to correct that, including passing state and sometimes local laws, and at the national level, making certain that we have the accurate information about how reasonable the costs are to fully cover mental health treatment.

From the chat room: Is mental health something our schools should be looking into, especially now that school shootings seem to have continued? And if so, where do you draw the line from being an educator to a clinician so to speak?

Arons: This is an important question. We certainly hear from teachers and principals that increasingly schools are asked to do more than teach students. But it is the place where students spend their time and energies. We do think that mental health issues and concepts should be part of schools and education. I think young people need to know as much about their emotions, about their mental health, as they learn about their intellectual health and functioning. Fortunately, schools are still in general safe places, and that's important to remember. Unfortunately, when there are incidents in schools, violent incidents, which should never really occur, but when they do occur, they seem to include more powerful and dangerous weapons, and a larger number of victims. Mental health concepts can be used to reduce bullying, to help identify young people in need of mental health intervention, and can also be the place where we begin to change attitudes about mental illness and its treatment.

CNN Moderator: Do you have any final thoughts for us today, Dr. Arons?

Arons: Using World Health Day to remember for at least one day, we'll remember that mental health disorders are becoming an increasing source of disability here and throughout the world. We can mobilize the energy and effort to improve the mental health of our nation, and other nations, as we recognize that mental health is fundamental to overall good health.

CNN Moderator: Thank you for joining our discussion today, Dr. Arons.

Arons: Thank you very much. Have a good day.

Knowledge Exchange Network (KEN): World Health Day

Center for Mental Health Services Knowledge Exchange Network (KEN)
Bernard S. Arons, M.D.

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