Mental Health

Background

Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships, and the ability to adapt and cope with life situations [1]. Mental health disorders are a variety of conditions that affect mood, thinking and behavior. One in five American adults, or 46.6 million people, suffer from mental illness in a given year [2]. Among youth aged 13-18, approximately one in five experience a severe mental disorder in some point in their lives [2]. Studies estimate that, in a given year, more than half of people living with mental illness do not receive care.

In the 2019 DC Community Health Needs Assessment Survey, 37% of respondents identified mental health and mental disorders as one of the top five most important issues in their community that impact community health [10]. When asked to think about an ideal community, 40% of respondents identified access to mental health and substance abuse treatment services as one of the top five most important assets a community would need to reach its full potential [10].

Mental and physical health are intertwined; for example, those living with mental illness face more barriers to healthy living, while physical illnesses such as chronic disease can negatively affect a person’s mental health and likelihood for treatment adherence and/or recovery.

While there is no single cause of mental illness, a number of factors can contribute to risk of mental illness including:
     • Early adverse life experiences, such as trauma or history of abuse
     • Chronic medical conditions
     • Biological factors
     • Substance abuse
     • Isolation, feelings of loneliness, and having few friends

It’s critical to note how the stigma surrounding mental illnesses and treatment can be a barrier to diagnosing and receiving appropriate care [1]. 

The DC Healthy People 2020 goals related to mental health include:

1) Those experiencing mental disorders have access to accurate and timely diagnosis and treatment;
2) Mental health is supported through trauma prevention;
3) All have access to appropriate and high quality mental health services. 

In the past decade, the prevalence of District adults who report being diagnosed with depression has dropped to a recent low of 14.3% [3]. In 2017, nearly 63% of adults did not have any poor mental health days in the past month. But among the 37% of District adults who did have poor mental health days in the past month, there were differences in these experiences by age, race/ethnicity and ward. 

Mental illness is often co-occurring with substance use, and both are critical risk factors for suicide. The District-wide suicide rate has not changed much in the last decade, but among youth, the prevalence of middle school and high school students who have attempted suicide has increased [4]. Nearly 1 out of 4 high school students who are bullied at school reported having attempted suicide. In 2017, 33% of Lesbian, Gay and/or Bisexual (LGB) high school students and 56.2% of LGB middle school students seriously considered attempting suicide compared to 12% and 21.1% of their heterosexual peers respectively [4].  

It’s important to understand that a person’s mental health can change over time, depending on many factors. When the demands placed on a person exceed their resources and coping abilities, their mental health could be impacted [5]. For example, if someone is working long hours, caring for an ill relative, or experiencing economic hardship they may experience poor mental health.

There are also many socioeconomic factors that affect mental health, including racism and poverty. In the 2017, District high school students who had experienced homelessness in the past month were 4.2 times more likely to report attempting suicide [4]. More than 1 in every 3 high school students who had gone hungry in the past month reported having seriously considered suicide [4]. 

These risk factors can be observed even within the same racial/ethnic groups, for example Black Americans living below the poverty level, as compared to Black Americans living at over twice the poverty level, are 3 times more likely to report psychological distress [6]. Recent studies have found that even when Black Americans seek professional help, psychotherapists are less likely to actually offer assistance [7]. 

Mental Illness & Substance Use

...dealing with trauma and behavioral health and emotional health that a lot of folks from communities that we work with have…to deal with trauma and that impacts every aspect of their lives and not having adequate access to that behavioral health that they need to cope with trauma and to just also deal with mental health issues that I think are pervasive across any community, but particularly communities that have lived in trauma

-Key Informant Interviewee

Individuals in the District Who Received Mental Health and Substance Use Treatment in Fiscal Year 2018 [11]

Many individuals who develop substance use disorders (SUD) are also diagnosed with mental disorders, and vice versa. Multiple national population surveys have found that about half of those who experience a mental illness during their lives will also experience a substance use disorder and vice versa [8]. In the US, an estimated 8.2 million adults, 3.4% of all adults, had both a mental illness and substance use disorder in the past year. About half of the adults with co-occurring mental illness and substance use disorder in the past year did not receive either mental health care or specialty substance use treatment [9].

Newer mental health issues have emerged among some special populations, including:

    • Veterans who have experienced physical and mental trauma;
    • People in communities with large-scale psychological trauma caused by natural disasters; and
    • Older adults, as the understanding and treatment of dementia and mood disorders continues to improve. 

Assets & Resources

Department of Behavioral Health Adult Services

Department of Behavioral Health Community Based Children, Youth and Family Services

Emergency Psychiatric Services

Homeless Services

Peer Specialist Certification Program

Recovery Support Services

School Behavioral Health Program

Treatment Services

Child & Adolescent Mobile Psychiatric Services (ChAMPS) 202-481-1440

DC Department of Behavioral Health Helpline 866-245-6350

DPR Roving Leaders

National Suicide Prevention Lifeline 800-273-TALK (8255)

The Trevor Project 866-488-7386

Sasha Bruce Youthwork 202-547-7777

Fair Girls 855-900-3274

Latin American Youth Center 202-319-2225 


Promising Practices & Policies:

MHMD-I Improve policies and procedures to identify workplace/school bullying and establish clear guidelines for steps of resolution.

MHMD-II Screen for and improve surveillance around childhood trauma.*

MHMD-III Increase the proportion of primary care physician office visits where patients are screened for depression. 

Citations & Additional Data Resources

1. Healthy People 2020. Mental Health and Mental Disorders

2. National Alliance on Mental Illness. Mental Health by the Numbers. 2019

3. DC BRFSS 2017

4. DC YRBS 2017

5. CDC. Mental Health Basics. 2018

6. U.S Department of Health and Human Services Office of Minority Health. Mental Health and African Americans. 2017

7. Kugelmass, H. (2016). “Sorry, I’m Not Accepting New Patients”: An Audit Study of Access to Mental Health Care. Journal of Health and Social Behavior, 57(2), 168–183.

8. National Institute of Health. Common Comorbidities with Substance Use Disorders. 2018

9. SAMHSHA National Survey on Drug Use and Health. Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. 2017

10. DC Community Health Needs Assessment Survey. DC Health. 2019.

11. DC Department of Behavioral Health. Mental Health and Substance Use Report on Expenditures and Services.  2019.

Photo Credits

Courtesy of Allison Shelley/The Verbatim Agency for American Education: Images of Teachers and Students in Action