Consequences of delayed treatment of depression and other mental illnesses.

The medical community has advanced greatly in its understanding of neuroscience and biochemistry over the last decade, with a resulting increase in knowledge of successful treatment strategies for members of the population suffering from mental illnesses, including depression.

The recovery rates for mental illnesses can be as high as 80 percent when early diagnosis and proper medical treatment are provided. Because the public is not educated to recognize the symptoms of these illnesses early, the illnesses often go untreated. Even worse, for many people the symptoms predictably become more severe over time, the longer they remain untreated. What the medical community has observed, and what the remainder of the community needs to be informed of, is that the sooner proper medical help is sought, the greater the likelihood that the proper treatment will restore the person to health.

We have a tendency to disregard mental illness symptoms, often attributing them to being a "normal" part of life. For example, many older Americans simply attribute their not feeling well to being a "case of the blues," or what they assume to be normal aging. But when seniors believe the reason they have lost their energy, their interest in activities, and their ability to get a good night's sleep is based in the aging process and normal, they do not typically seek medical treatment. Such a misperception can result in delays in seeking treatment, which will then result in delays in recovery due to lack of treatment or inappropriate treatment. Time is of the essence in diagnosing and treating mental illnesses. The failure of our seniors to seek and receive appropriate psychiatric care results in a less positive prognosis, and is one major factor in the increase in geriatric alcoholism and suicides.

Among the entire population, as many as 50 percent of those with a mental illness turn to self-medication. The variety of substances used for self-medication can include legal options, such as alcohol and tobacco, through and including illegal drugs. Some people abusively use prescription medications. What these chemicals have in common is elevate the dopamine levels in the brain. Increasing dopamine works like an antidepressant or anti-anxiety medication for many people. Although the person feels some temporary relief, these abused substances can be expected to make things worse over time. Because the brain is not receiving proper medication, the mental illness symptoms worsen. The person may rapidly develop an addiction problem. Addiction creates additional medical and legal complications. Co-occurring disorders, that is having problems with both mental illness and substance abuse, are common.

Of those abusing illegal substances due to their failure to recognize their mental illness symptoms, many lose their jobs due to the mental illness and addiction problems. After losing their employment, coupled with the increasing expenses of a growing addiction habit, some turn to crime, such as theft or prostitution. Some find themselves incarcerated as a result of the crimes, when the underlying cause of the sequence may have been an untreated mental illness. In such cases, it is not adequate to merely punish the crime. However, finding the needed integrated treatment for both problems--untreated mental illness and substance abuse--is not common.

An educated bench and bar will consider the medical nature of behaviors, and seek proper treatment, structuring sentences to promote recovery and health. An educated justice system will assist with re-entry programs which afford former inmates the opportunity to maintain wellness and to become self-sufficient. This will cost our nation less than the expense of repeated incarcerations. Mental illness is not a crime. Nationally, however, many more people with mental illnesses are found in our jails and prisons than are found in our state mental hospitals and other residential treatment facilities.

Mental illness is a health problem with great legal, economic, and safety issues. Tragic and dangerous, mental illnesses are the preventable causes which lead thousands of people to suicide, or murder-suicides. The World Health Organization states that suicides cause more deaths every year than homicides or war.

Suicide is the third leading cause of death in America's teens, yet we are still not teaching our students about mental illnesses. One of the saddest facts is that studies show that 95 percent of all suicides are the result of untreated, or improperly treated, depression or bipolar disorder. If students were properly educated to recognize the symptoms of such mental illnesses, particularly depression and bipolar disorder, these statistics could be altered. Medical science has documented that an 80-90 percent recovery rate can be expected when such mental illnesses are diagnosed promptly and medicated properly and faithfully.

The statistics regarding the risk of suicide are staggering. The statistics on depression and bipolar combined indicate that 11 percent of the population will suffer from one of these illnesses at some point during their lifetime. An estimated 15 percent of those not properly treated for depression will kill themselves. It is thought that many more attempt suicide, and fall. Even in failure, many people do great damage to their property, their careers, their bodies, and their families. This places a great economic and emotional burden on our society. With bipolar it is estimated that 20 percent of those who are not properly medicated will take their lives. Accurate public education about these illnesses and about recovery is urgently needed.

Angela D. Vickers is a mental health advocate and educator, and a member of the Bar's Quality of Life and Career Committee. She also was named the national recipient of the 2004 Clifford Beers Award of the National Mental Health Association. This column is published under the sponsorship of the Quality of Life and Career Committee, The committee's Web site is at www.fla-lap.org/qlsm.