Notes on the social crisis in America

One in five US adults suffering mental illness


Twenty percent of American adults—over 45 million people—grappled with some form of mental illness in 2010, a federal survey suggests.


The Substance Abuse and Mental Health Services Administration (SAMHSA) found especially high rates of mental illness among young adults, with 30 percent of those aged 18 to 25 suffering from a diagnosable mental, emotional, or behavioral disorder.


Five percent of the adult population, or 11.4 million people, were found to have a serious mental illness, a disorder that greatly hinders one’s ability to function in daily life.


The survey found a significantly higher rate of mental illness for those living in poverty than among higher income groups.


Only 39 percent of those with any diagnosable mental illness, and 61 percent of those with severe mental illness, received mental health services. Many people who went untreated for mental disorders cited lack of insurance as the main reason for lack of care.


SAMHSA also reported that 8.7 million Americans seriously considered committing suicide in 2010, and 2.5 million made plans to do so. Some 1.1 million adults attempted suicide. Among college-age adults particularly, suicide ideation is on the rise.


Major depression is likewise increasing, especially among adults under age 26. This group is least likely to receive treatment for depression. In children and teenagers between the ages of 12 and 17, 8 percent (2 million people) were found to have suffered a major depressive episode in 2010. The majority of these children did not receive any treatment, SAMHSA reported.


Core funding cut for half of US public health departments since 2008


Between 2008 and 2010, 53 percent of local health departments across the US saw cuts to their base funding levels, a series published in the Journal of Public Health Management and Practice reports.


The departments are critical in maintaining public health, including providing vaccinations and help for pregnant women, and responding to disease outbreaks or other emergencies.


In 2009, public health departments eliminated 23,000 jobs—15 percent of the total workforce—and tens of thousands of other health workers were furloughed or had hours cut. More than half of all departments reduced or eliminated at least one program area. These cuts come atop years of stagnating or declining funding; between 1993 and 2005, 35 percent of departments reduced per capita spending. Between 2001 and 2006, federal public health funding decreased in almost every program.


More cuts are anticipated. Calling the budgetary outlook “gloomy,” the report notes that “under the terms of the Budget Control Act of 2011, discretionary grant programs, which include most public health programs, must be cut by $900 billion over the decade beginning in fiscal year 2012. Because the Super Committee was unable to decide on further reductions, there will be automatic budget cuts (or sequestrations) totaling another $1.2 trillion beginning in fiscal year 2013. It is expected that these sequestrations will reduce all grant programs by 7.8 percent in 2013 alone, with continuing cuts in subsequent years.” Coinciding with federal cuts, at least 25 states have slashed health programs for 2012.


Louisville, Kentucky social workers “buckling under overwhelming caseloads”


Social workers in greater Louisville’s Jefferson County service area are so overworked that the Cabinet for Health and Family Services has been paralyzed by resignations, breakdowns, and exhaustion.


“We are in an emergency situation,” Patricia Pregliasco, a 13-year Jefferson County social worker, said in a January 9 open letter to Health and Family Services Secretary Janie Miller. “Frontline workers are breaking down. My co-workers are having mental health and physical health issues because of the overwhelming stress of this job.”


In the past four years, Health and Family Services’ budget has been cut by $80 million. Statewide, there are 600 fewer social service workers than the workforce of 2,000 a decade ago.


Over the same period, Kentucky child deaths from abuse or neglect have soared, with more than 80 fatal or near-fatal cases in 2009-10. Last year, the state investigated 76,500 suspected cases of abuse or neglect. Kentucky, one of the poorest states in the country, ranks the worst for child abuse.


In an interview with the Louisville Courier-Journal published January 11, Pregliasco said, “It is a desperate situation. It is very difficult to see my friends having breakdowns, crying on the job.” Jefferson County’s child abuse unit has been cut in half, to 30 workers, while reports of suspected abuse and neglect have risen.


Some workers now manage 50 or 60 cases—many times over the 17 cases per worker recommended under professional standards. Pregliasco said these workers were being “written up” for missing paperwork deadlines. “On my unit, only four or five of us have experience doing investigations,” she said, explaining that the process required time and care in recognizing signs of abuse or neglect.


Child abuse caseworker Laurie Jones told the Courier-Journal that she had been suffering chest pains from stress. “I am so overwhelmed I can’t see straight,” she said. “My kids tell me they wish I could quit my job.”


Indebted Illinois residents jailed


According to the Illinois Department of Financial and Professional Regulation secretary, Brent Adams, increasing numbers of debtors in the state are being sued by creditors and jailed on the basis of failure to appear in court. Adams told the Southern Illinoisan January 12 that often residents were not even aware of the lawsuits when they were arrested.


A public hearing in the town of Marion January 11 took testimony from residents who had been victimized by the practice. Several said that the amount of their bond was the same as their debts, and that the bonds were immediately turned over by the jails to the creditors.


Lisa Lindsay, a Herrin resident who was recovering from breast cancer, was thrown into jail over an unpaid medical bill of $280. Living on a low income, Lindsay testified that she had taken on a second job to try to manage the medical costs, but the creditor filed a complaint and she was summoned to appear in court. State troopers arrested her on her doorstep.


“I see a lot of crime happen all the time,” Lindsay told the hearing. “You see a lot of things happen. And you’re always wondering if everything is justified. Then you get arrested for a medical bill, for having cancer, and you go to jail. It’s just crazy. In this day and age and in this state and county, I don’t think that should happen.”


Sandi Gordon, a Land of Lincoln Legal Assistance Foundation attorney in Carbondale, said that 30 to 40 percent of people who are jailed on such grounds owe less than $1,000.


Debt collection agencies target indebted Illinoisans at a higher rate than those who owe money in neighboring states because of aggressive state laws, debt collection agency CFS II president Bill Bartmann told the hearing.