Comprehensive health care must include mental substance abuse treatments

Comprehensive health care must include mental substance abuse treatments
© Getty Images

As the Trump administration, Congress and insurance companies debate various future health-care plans for the American people, it’s important to remember that comprehensive coverage must include mental health and substance abuse treatment.

Perhaps if we increased public awareness of mental health issues and the effective preventions and interventions out there, they would be demanding such coverage too.


The estimated past-year prevalence of mental illness, excluding substance use disorders, is 18.3 percent of individuals aged 18 and older. If you add in the number of persons with alcohol or illicit drug use disorders, the number grows substantially. 


With the occurrence so high, we all likely know, and possibly love, someone with a mental illness or substance abuse disorder.

But most of us have limited understanding of mental disorders, and sometimes misguided or inaccurate knowledge. If we can improve the public’s understanding of mental health, this could help people better identify when they are in distress and get the help they need.

In addition, if we improve the public’s literacy regarding mental health and substance abuse issues, we can harness them as informal helpers and conduits to the formal mental health care system for their friends, family members, neighbors, and co-workers.

Health literacy is the degree to which individuals can obtain, process, and understand basic health information and services they need to make appropriate health decisions. This includes information from what constitutes a healthy diet to ways to engage in safe sex to prevent HIV.

The term mental health literacy was first coined in the mid-1990s by a group of Australian researchers who began a series of studies measuring the public’s knowledge about mental health — what are the symptoms, causes, and helpful interventions to ease the pain or cure disease.

These researchers also began a series of studies to tap into experts’ knowledge of strategies that could empower the public to better identify and provide initial support to someone who is developing a mental health problem, has worsening of an existing problem, or is in a mental health crisis.

Indeed, they developed free courses, called mental health first aid, to support some grassroots education. These courses also provide good help-seeking options and available treatments, self-help strategies for milder problems and skills for supporting others who have a mental disorder. Mental health literacy has spread across many countries and continents and courses are available in the U.S. as well.

Extensive research of mental health literacy has taken place in the US, Australia, Canada, the United Kingdom, India, and Japan among others. Typically, these surveys involve presenting participants with a case scenario describing a person with a mental disorder and asking the participant to identify what is wrong with the person.

Data from 16 studies conducted in industrialized first-world countries indicate two major trends in public attitudes about mental health. One, we’re making headway in terms of a greater mental health literacy, particularly in regards increased understanding of a biological component to mental illness.

The second is that there seems to be greater acceptance of professional help for mental health problems. Unfortunately, there seems to be no changes, or that things got even worse, in our attitudes towards those with mental illness.

Let’s face it. People are struggling, and if we open our eyes and our hearts, we see this in our homes, workplaces, and public places. Mental Health First Aid courses can increase mental health literacy in the community.

They provide basic information to enable individuals to develop the confidence to use safe "first aid" interventions in mental health related crises and refer people with mental health problems to appropriate professionals. It’s important for the public to gain knowledge, skills and confidence to help someone in distress and to increase empathy for people with mental illness.

Of course, while mental health is “everybody's business,” there are limits in the public’s efficacy as well as important boundaries of the person who is mentally distressed. Take the example of problem drinking. It’s one thing to be able to recognize your own or a friend or family members’ problem drinking. It is more delicate to approach someone if there is concern about their drinking and to support them in making changes in their drinking, if they are willing.

There are limits in how we can facilitate professional help seeking and respond if professional help is refused. There is a difference between encouragement and respecting people’s boundaries. And, of course, there are things to do regarding management of an alcohol-related medical emergency.

One of the biggest imperatives of mental health literacy is knowing that treatments have been developed and tested to successfully reduce the symptoms and disabilities of many mental illnesses. Access to and payment for these treatments should be included in any discussions of future health care coverage.

Joan Cook is a psychologist and associate professor at Yale University who researches traumatic stress and clinically treats combat veterans, interpersonal violence survivors and people who escaped the former World Trade Center towers on 9/11.