Some of the most pervasive and debilitating illnesses are mental illnesses. According to World Health Organization's (WHO's) The World Health Report 2001 — Mental Health: New Understanding, New Hope, approximately 450 million people worldwide have neuropsychiatric conditions; those conditions account for four of the top five leading causes of years of life lived with disability in people aged 15 to 44 in the Western world (1). Furthermore, Global Burden of Disease 2000 in Aging Populations estimates indicate that mental and neurological conditions account for 30.8% of all years lived with disability (1). Some of the more common mental conditions are depression, dysthamia, bipolar disorder, schizophrenia, and anxiety disorders. Depression causes the most disability, accounting for almost 12% of all disability (1).

Despite these statistics, mental health and mental illnesses remain issues of which the public is largely unaware. Many individuals with mental illnesses are not diagnosed or do not receive treatment for their illness. Annually, more than 26% of the U.S. population will be diagnosed with a mental disorder (2), and only about one third (8.6%) of those will receive treatment (3). If left untreated, these illnesses often have dire consequences. In fact, in 2002, suicide was the leading cause worldwide of intentional violent deaths (Figure), surpassing both homicide and war (4).

The cost of untreated mental illness is staggering and has a significant impact on the U.S. economy. A study conducted on the effects of depression in the workplace found that depression caused a loss of $44 billion each year in both presenteeism (the act of remaining on the job but not being as productive because of illness or stress) and absenteeism. This figure was approximately $31 billion more than the amount lost for nondepressed workers (5).

In 1999, Surgeon General David Satcher released Mental Health: A Report of the Surgeon General (2), which focused on mental illnesses and mental health issues in the United States and issued a call for action in the field of mental health care. According to the Surgeon General, the financial cost of mental illness to the nation is $63 billion in lost productivity because of illness and $12 billion because of premature death (2). The financial burden placed by mental illnesses on the United States points to the need for a concerted effort to focus on prevention and early identification of those illnesses.

Depression and mental disorders are also highly comorbid with other serious medical conditions: nearly 15% of individuals exhibiting a mental disorder in 1 year have a co-occurring disorder, compared with 3% of the general population (2). Major depression is correlated highly with diseases such as diabetes, coronary artery disease, chronic arthritis, and stroke (6). Smoking also is strongly correlated with depression. In any given month, people with mental illnesses (representing 28.3% of the U.S. population) consume approximately 44.3% of cigarettes smoked nationwide, based on a nationally representative sample, and people with mental illnesses are nearly twice as likely as individuals without mental illnesses to smoke (7). Treating an individual with multiple comorbid disorders can be costly, and it can be challenging to coordinate care among diverse medical providers.

Compounding those existing challenges, the age of onset for many major mental illnesses is young. Kessler et al (8) reported the following age-of-onset interquartile ranges: 8 years (age 7 to 15 years) for impulse-control disorders and anxiety disorders and 9 years (age 18 to 27 years) for substance use disorders. Based on their findings, Kessler et al noted that these patterns are opposite of those associated with chronic physical disorders, and risk increases into middle and late age. Prevention and early intervention of mental illnesses are crucial because they appear to have the strongest foothold during youth. By identifying and aggressively treating mental illnesses, particularly in children, disability could be lessened or prevented, thereby reducing the financial burden to society. 

Finding and obtaining effective medical treatment for mental illnesses, however, can be extremely difficult, particularly for racial and ethnic minorities. The disparities in care for racial and ethnic minority groups pose a significant public health crisis because racial minorities are continually underserved by mental health providers. Only 16% of African Americans with a diagnosable mood disorder seek care from a mental health specialist, and only approximately 29% seek care from any medical provider (9). African Americans and Latinos are substantially less likely to use some form of depression treatment than whites (9). For example, 70% of all children and adolescents who need treatment do not receive mental health services (2), but African American and Latino children have the lowest rates of service use, even when controlling for insurance status (10). If these children are left untreated, the persistence of these disorders may eventually lead to school failure, poor employment opportunities, and poverty in adulthood (11).

Many barriers keep people from seeking and obtaining care. Many racial and ethnic minorities live below the poverty line or do not have health insurance. Nearly one in four African Americans is uninsured (9), and few mental health care providers are minorities. For every 100,000 Hispanic individuals in the United States, there are only 29 Hispanic mental health care professionals (9). These two barriers are compounded by the stigma surrounding mental health issues in both minority and nonminority communities. In addition, some cultural and familial values do not support help-seeking behaviors; thus, many racial and ethnic minorities remain without care.

Former First Lady Rosalynn Carter has been a driving force in the field of mental health for more than 30 years, educating policy makers and the public about mental illnesses. During the Carter administration, she served as active honorary chairperson of the President's Commission on Mental Health, the first presidentially mandated commission examining the mental health needs and policies of the United States. Upon returning to their home state of Georgia after the presidency, President and Mrs Carter formed The Carter Center, an internationally recognized nongovernmental organization with the goal of advocating for human rights and alleviating human suffering. In her role as chairperson, Rosalynn Carter developed in 1991 The Carter Center Mental Health Task Force, consisting of a diverse group of professionals such as mental health experts, advocates, medical professionals, and two former Surgeons General. These professionals oversee The Carter Center's mental health initiatives and spearhead the annual Rosalynn Carter Symposium on Mental Health Policy.

The Carter Center Mental Health Program supports the implementation of policy change with the Mental Health Task Force, whose purpose is to identify major issues concerning mental health and mental illnesses and develop initiatives to reduce stigma and discrimination. The Carter Center Mental Health Program's approach to mental health policy is broad and includes activities to promote mental health, prevent mental illnesses, and support treatment through mental health services. Through its action-oriented agenda, The Carter Center Mental Health Program supports policies and services that better the lives of people with mental illnesses and their families. The goals of The Carter Center Mental Health Program are consistent with the principles of The Carter Center, which emphasize action, results, and the belief that people can improve their lives and the lives of others when provided with the necessary skills, knowledge, and access to resources.

The enormous burden of mental illnesses and the looming public health crisis of mental health care have a detrimental effect on society, and many barriers keep individuals with mental illnesses from seeking, obtaining, and maintaining treatment. The Carter Center Mental Health Program supports the implementation of lasting policy change by convening groups of mental health professionals, from consumer and advocacy groups to top government officials, and collaborating with them in their efforts.

By educating the public about mental illnesses, The Carter Center Mental Health Program attacks the greatest barrier, stigma. The Rosalynn Carter Fellowships for Mental Health Journalism are developing a group of committed journalists dedicated to portraying an accurate and balanced view of mental health issues, to educate the public about the illnesses that effect so many. With changing public perceptions about mental illnesses, the public health crisis can finally be addressed.