Has Medicine Lost Its Mind?

Modern health care wreaks havoc on patients with mental disorders. Sadly, only 25 percent of patients with a mental disorder, such as depression or drug abuse, receive any care at all. Worse yet, medical physicians conduct over three-fourths of this care, but it’s almost universally characterized as low quality because they have not been trained in mental illnesses. Contrast this to 60 to 80 percent of patients who receive high quality care for their physical diseases, such as diabetes and heart disease, from the same doctors.

One fact illustrates the societal impact of compromised mental health care: mental illnesses are the most common health condition in the US. Most don’t realize this, but the number of people with mental disorders exceed those of heart disease and cancer combined. And one in four Americans will have a major mental illness in any 12-month period, totaling some 90,000,000 individuals; twice that number, one in two, will suffer over their lifetime.

Why Society Should Take Note: Poor mental care reverberates throughout America. The familiar problems of unnecessary prescription overdose deaths and deaths by suicide pale before the more widespread but less-recognized effect on patients with undiagnosed and untreated mental illnesses—depression, anxiety, and substance abuse the most common. The disability from these illnesses harms not only individual patients but also their families, communities, and society; astronomical, unnecessary healthcare costs result, in the range of hundreds of billions, even trillions of dollars, and society picks up the tab.

Because medicine fails to recognize the problem, the author recommends that the public and its decision-makers take charge. Politicians and policy makers must exert strong pressure and insist that, via policy and funding leverage, medicine include mental disorders on an equal footing with physical diseases.

To operationalize this change, a Presidential Commission, a Congressional Commission, or the National Academies of Science, Engineering, and Medicine would analyze present medical education practices to determine how well they adhere to modern scientific understanding. The modern systems view of science is presented in Chapter 6. It integrates patients’ mental and social dimensions with their physical illnesses, thus correcting modern medicine’s isolated focus on physical disorders. Based on this evaluation, they would make recommendations to policy makers about the necessary changes needed to ensure a new direction in medicine that included training medical students and residents to be competent in mental health care and other psychological and social features of patients. That is, to return humanity to medicine. This high-level review mechanism to induce change was successful in changing medicine over 100 years ago in what was called the Flexner Report of 1910. Hence, the author calls for a “New Flexner Report.”