| |  |  State of Mind: America 2002: Where Are We Going? For the concluding panel discussion, we move back to Washington and Dr. Goodwin. He introduces audience member Pat Scoones from Florida, who tells the tragic story of how her son died by suicide after seeking help for his depression and encountering roadblocks at every turn due to staffing shortages and the bureaucracy of managed care. Dr. Goodwin comments that this story is a reminder that all practicioners need to recognize that mental illnesses can be as deadly as any other disease. Audience member Diane Engster, from Mount. Vernon, Virginia, speaks about how her congregation has a very active ministry to people with mental illnesses and includes them in their circle of caring and that this is very important. She comments that clergy are in a position to take the lead in combating the stigma around mental illness. Dr. Goodwin introduces the two members of State of Mind: America 2002's final panel, founder and honorary chair of the National Mental Health Awareness Campaign Tipper Gore and psychiatrist and author Dr. Peter Kramer. Their discussion begins with the issue of stigma, the stigma surrounding mental illness and those who experience it. Mrs. Gore explains how and why she chose to go public regarding her own depression a few years ago. She says that speaking to groups of children around the country she was shocked to find how many had considered or knew someone who was considering suicide. She then realized she could have a greater impact on people's lives if she went completely public about her own experiences. She talks about how we need to come together to eradicate stigma and improve access to treatment. Dr. Kramer talks about how our understanding of mental illness has changed in recent years. There is a much firmer grasp of the fact that mental illness has a biological basis, which isn't to say that the contributors to mental illness don't include various stressors like the traumatic events discussed earlier in the program. Those get translated into biology. Mental health treatment has been good at interrupting and muting what he calls "acute flare-ups" of mental illness, whether it be anxiety or depression or worse illnesses. There is a challenge in dealing with chronic mental illnesses that are taking place across the life cycle. Prevention is a wonderful area of promise in psychiatry. Dr. Goodwin and the panelists discuss the gap between what we can do, in terms of treatment for mental illness, and what we actually are doing. Mrs. Gore speaks about the gap in getting research results to care providers. There's a need for culturally sensitive mental health centers that people feel comfortable going to. Dr. Kramer says the gap between what can be done and what is done for people with inadequate or no health insurance is shameful. Audience member Yvette Sangster from Connecticut points out that treating people with mental illnesses as people is the most important thing. People with mental illnesses need more than pills and doctors; they need employment, friends, people who understand that they can and do recover. Dr. Kramer concurs that broadly-based social interventions are very important, along with medical intervention, in treating mental illness. Audience member Delfy Pena-Roach from New Mexico talks about how her husband, who had a dual diagnosis of manic depression and substance abuse, died fourteen years ago. The problems they had were in getting treatment for both halves of this diagnosis-they were being shunted from one provider to another and people were not looking at the full picture. Mrs. Gore concurs that we need an integrated, holistic mental health system similar to what is starting to emerge in other areas of medicine. Dr. Goodwin talks about federal programs forcing states to combine mental health and substance abuse services to positive effect. Mrs. Gore points out that there is a lot of activity on the state level, with some 31 states having passed parity legislation. | |