David Satcher, M.D., Ph.D.
Assistant Secretary for Health and Surgeon General
Office of Public Health and Science

Release of the Mental Health Report

Washington, DC

Monday, December 13, 1999

[This text is the basis for the Assistant Secretary for Health and Surgeon General's oral remarks. It should be used with the understanding that some material may be added or omitted during presentation.]

Thank you, Secretary Shalala. It's my distinct pleasure in being here for this historic event.

I want to begin by thanking Secretary Shalala for the support and leadership she has offered to this project and for being a bold change agent on complex issues like this one, to Mrs. Gore for lending so much time and dedication to shedding light on what has heretofore been a dark topic of pervasive silence, and to the scientists and specialists and the Report's Planning Board without whose skill and expertise this report would never have been possible, and to all of those who gave input on and who care passionately about this issue. Thank you.

I also want to salute the leadership of the National Institute of Mental Health (NIMH) and the Substance Abuse and Mental Health Services Administration (SAMSHA), and I want to express our special appreciation to our senior editor, Dr. Howard Goldman.

To our colleagues in Australia, who, during our recent trip there, shared so much of their experience with mental health programs and politics, I also want to offer gratitude.

And finally, I want to say thank you to the many people throughout the country who responded to the Surgeon General's Call to Action to Prevent Suicide, a document that was released this past June in this very room in the presence of Mrs. Gore. I am grateful for all of the responses we received, whether through letters, e-mails, books, or notes. Each correspondence, although it may not have said it in exact words, bespoke the fact that the time has come for addressing overall mental health problems in this nation.

Let me emphasize three important findings from the report.

First, mental health is fundamental to overall health and the public health of our nation. Mental health is indispensable to personal well-being and to leading a balanced and productive life.

Second, mental disorders are real. In this report, we have established the clear scientific base showing that brain chemistry affects behavior, and behavior can affect brain chemistry. There is no longer any scientific justification for distinguishing between mental illness and other forms of illness in terms of physical and chemical manifestations. Mental illnesses ARE physical illnesses.

In fact, 1 in 5 Americans suffers from a mental disorder. I hope that as more people become aware of this prevalence they are convinced once and for all that it is time we end the blame and stigma that have traditionally surrounded mental illness in this country.

Third, not only are mental disorders and mental health problems real, they are treatable. That's great news! A scientific revolution has taken place over the last 25 years in our understanding of mental health and mental illness that has resulted in a vast array of safe and effective options to treat mental disorders. These treatments will allow people with mental disorders to return to productive life.

But there is also unsettling news in this report. While mental illness strikes 1 in 5 Americans each year, more than half of those who need treatment do not get it, either because they do not seek it or they do not have access to it. Stigmas are major barriers to access. Only 27 states have enacted laws requiring even limited forms of parity between mental health benefits and other health benefits. And the lack of access to mental health care has driven far too many of our most vulnerable populations to our streets, jails and prisons.

Mental illness can affect anyone, and few Americans are untouched by mental health problems. The results can be devastating and lead to a diminished quality of life, poverty, unemployment and homelessness.

Mental health problems are not new, but discussing them on a national level is. As we stand on the eve of a new millennium, this landmark mental health report equips us with a scientific, 21st century approach to mental illness so that we do not have to enter the new millennium with 19th century ideas.

So what do we do with this new knowledge?

I believe we can use it to offer new hope to people with mental disorders and mental health problems and new impetus for research and mental health prevention.

In her book, Night Falls Fast, Kay Redfield Jamison said of suicide: "... the breach between what we know and what we do is lethal." That's just as true for mental health, in general. We know now more than we ever did before. What we do now with what we know is critical to the future of our nation's health. So, if you, or a loved one, are experiencing the symptoms of a mental disorder, seek effective treatment. To get more information, call 1-877-9-M-HEALTH.

Long before this report was published, we have been supporting the needs for a balanced community health system in this country one that ensures universal access to care, while balancing health promotion, disease prevention and early diagnosis. Mental health is no exception. A balanced community health system calls for strengthening our mental health system by applying a new paradigm, and it views mental health from a public health perspective that involves the entire community homes, schools, churches and businesses in sharing the responsibility for health. It calls for a balanced research agenda. And it calls for a partnership between public health and medicine, where attention is given both to the community and the individual.

So how does a balanced community health system "play out" with regard to mental health? Let me share just a few ways with you ...

  • We must continue to do the science, especially in the area of treatment and the investigation of prevention strategies an area where we still have a great deal to accomplish.

  • All of us together must work to overcome the stigma that surrounds mental illnesses by educating ourselves and each other.

  • Together, we must increase awareness of effective treatments so that no one is left to suffer needlessly from mental disorders.

  • As a nation, we must ensure that we have an adequate supply of mental health services and providers who are available to serve all Americans with quality care and the most advanced treatments.

  • These treatments must be tailored to meet the specific needs of Americans, with special attention to the elderly, to gender issues, to race and ethnic issues and to cultural issues.

  • But we cannot assume that everyone will willingly seek treatment. Many people who are most at risk and who need treatment the most are unlikely to seek it, either due to lack of will, ease or hope. Therefore, we must help them gain access to the services they so desperately need.

  • Finally, we must reduce the financial barriers to treatment, including ensuring parity.

When I was sworn in on February 13, 1998, I said that I wanted to be remembered as the Surgeon General who listened to the American people and who responded with effective programs. I hope today will bear evidence to that. I hope that today will show that we not only listened to the many people throughout the country and the world who communicated with us on this topic, but that we also responded in a way that is meaningful and that will advance the overall health of the nation.

In just a few days, millions of people will be celebrating the new year by making promises to correct past year's mistakes and by setting new goals to reach for the future. As a nation, there's one goal I hope all of us will commit to. I hope all of us will include ways to improve the quality and access to mental health services throughout our nation as part of our goals for the future.

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Last revised: January 5, 2007