A National Problem
In 1999, Dr. David Satcher, the Surgeon General published a report
Mental Health: A Report of the Surgeon General. This was a
collaborative effort by two federal agencies: the Substance Abuse
and Mental Health Services Administration and the National
Institutes for Health. The report reviews the prevalence, new
treatments, costs to society, stigma, and future research related to
According to the Surgeon General, approximately 20% of the US adult
population have a mental illness. These illnesses include anxiety
disorders, mood disorders, somatization, anorexia nervosa, and
severe cognitive impairment. More serious mental illnesses include
bipolar disorder and schizophrenia. Mental illness accounts for 15%
of overall burden of disease - more than malignant cancer and
respiratory diseases - and in 1996 direct cost of mental illness to
Americans was $69 billion.
In April 2002, President George W. Bush established the
President's New Freedom Commission on Mental Health. The Commission was charged to identify innovative Federal, State and local government mental health service provision models and policies. Specifically they searched for programs that had a track record of maximizing existing resources, improving treatment and service coordination, and supporting successful community integration for adults and children with a serious mental illness/ emotional disturbance.
Twenty-two Commissioners met monthly from June of 2002 through April of 2003 to analyze current public and private mental health systems. In addition, members of the Commission visited many innovative model programs, while testimony was obtained from representatives of the vast array of mental health stakeholders. The Commission received feedback from about 2,500 people from across the country and invited nationally recognized mental health professionals to participate. Fifteen subcommittees were formed to review aspects of mental health services and to offer recommendations for improvement.
The documents available in pdf download format on the right represent the highlights of the Commission's Report. For the entire report and for more information about this initiative, visit:
Differences in Life Expectancies -
The General Population and Persons with Mental Illness
With the advances in medicine during the 20th century, many people
are able to lead longer, fuller, and richer lives. New medical
technologies provide a mechanism to prolong life. By 1995, life
expectancy increased to approximately 76 years of age, a 52%
increase from 50 years of age in 1900.
Advances in medicine allowed us to live longer with chronic and
terminal illnesses. Traditionally, the medical profession
aggressively fights illness and seeks care. As a result, many people
living with chronic or terminal illness endure extended pain and
suffering. Dying all too often occurs in the hospital, resulting in
patients' dying alone instead of at home with family. For example,
in a Gallup survey conducted in 1996, a majority (90%) of Americans
expressed a desire to die at home, however, 74% died in hospitals
and nursing homes.
Persons with Mental Illness
Persons with mental illness die younger compared to the general
population. For example, in the Massachusetts Department of Mental
Health, Metro Suburban Area life expectancies are 8-14 years
shorter than expected...
Despite the higher relative mortality among the mentally ill, few
reports or research studies regarding advance care planning (ACP) or
end-of-life (EOL) services for persons with mental illness are
available. Basic information about their circumstances of death,
preferences for care, or the availability of hospice/palliative care
services has not been gathered for this population. Such
information is important for developing sensible practices,
procedures, and guidelines to provide quality end-of-life care for people with mental illness.
On this page:
President's New Freedom Commission on Mental Health: Vision Statement, Goals, and Recommendations