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Wednesday, 22 February 2012

DSM 5 - Expects that 'One in five have a mental health problem.' - Baloney!!

The phrase "one in five have a mental illness (or issue or problem)" has been used extensively for quite some time. From a public relations point of view, I can (or did) appreciate why: to demonstrate what an extensive issue mental illness is. Even if you are not the one in five, chances are you know of a friend or relative who is.

I first heard the term over 10 years ago when reporting on a psychiatrist lecturing doctors whom I was covering for the Medical Post newspaper. The psychiatrist asked how many in the audience had any experience with mental illness -- either themselves or amongst friends and relatives. When almost no one raised a hand, he called them dishonest and pointed out that since one in five do, it was statistically unlikely that so few of the audience would not have some personal knowledge of mental illness.

Today, that phrase is so hackneyed it's become almost meaningless. In fact, one of the editors of the Medical Post just wrote in her blog about how confusing it is. She wondered if it was even correct.

This statistic does not, in my opinion, tell us anything. It is of as much value as saying that four out of five people have stomach problems, which could range from over indulging at the all-you-can-eat buffet and being bloated for days, to having incurable stomach cancer.

In fact, cancer statistics are a good model for us to use when talking about mental illness statistics. Each type of cancer is not only different but there are differences within each type and they are thus classified internally by stages. The discovery of stage one cancer would have a better outcome than the discovery of stage four cancer. Developing a basal cell carcinoma (a simple skin cancer) and having it treated will only result in a potential return of the condition about one per cent of the time. There are no statistics on death.

Compare that to pancreatic cancer which has a five year survival rate of 5.5 per cent. By stages, pancreatic cancer found early has a five-year survival of 21.5 per cent compared to only 1.8 per cent for that which has metastasized or spread. It does not make sense to talk about all cancers as if they are just one disease.

And the same goes for mental illnesses. So yes, maybe one in five of us does suffer at some point in our lives, but like cancer, those illnesses and the suffering they produce are not all the same.

I am one of the five. A few years ago, my car was struck on the highway by a wheel that had flown off a pickup. I suddenly went into a panic when the tow truck driver told me I could have been killed if the wheel had hit my windshield rather than my fender.

I developed a mild form of post-traumatic stress which I treated with a short course of anti-anxiety meds and by forcing myself to drive on that stretch of highway the very next day. My PTSD was nothing compared to the PTSD that an Afghan war vet my doctor was treating suffered from.

Without violating confidentiality, my doctor told me that his other patient had seen some horrendous things done to civilians in the Afghan war zone and was suffering from violent nightmares.

As bad as PTSD might be for some, it cannot compare to the horrors of untreated psychosis from schizophrenia, or the ravages of bipolar mania or depression -- the two most severe forms of mental illness.

Both Health Canada and the National Institute of Mental Illness in the U.S. recognize that it is not helpful to lump all mental health illnesses/problems together. Page 31 of the Health Canada report shows that 11 per cent have a mood or anxiety disorder or substance dependence. They then devote an entire chapter to mood disorders and an entire chapter to schizophrenia. While schizophrenia only impacts 1 per cent, it is such a serious illness that it accounts for about $5 billion annually in both direct and indirect costs. Lumping my mild PTSD in with schizophrenia is not particularly valid.

The National Institute of Mental Health in the U.S. provides some even more revealing numbers. For each category, they list total percentage, severity level, and how many are receiving treatment. So, while 26.2 per cent of Americans have a mental illness in a given year, only 5.8 per cent are severe. Of those who have a problem, only 36 per cent of them are receiving treatment. Bipolar disorder accounts for 2.6 per cent of the population, 2.2 per cent of the cases are considered severe, and while 48.8 per cent are receiving treatment, only 18.8 per cent of those with the disorder are getting minimally adequate service.

What I find concerning in these numbers (and I suspect they are the same in Canada as well) is how few are receiving adequate treatment. Each of the conditions is reported separately so take a look for yourselves. We really do need to stop talking about one in five and start emphasizing other aspects of mental illness and the lack of care.

We need to find mental illness statistics that are more meaningful than one in five. In fact, thinking about one in five may detract us from establishing a very clear focus on the people who really need help. And those people are the ones with the very serious illnesses.

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