Van kills 12 on Toronto Street. 4 dead in shooting at Nashville Waffle House. Multiple gunshot wounds, 1 suicide at YouTube headquarters in San Bruno.

These grotesque acts are occurring almost daily and each has the hallmarks of a perpetrator suffering from a mental health disorder. It is not merely a coincidence that the males (and occasionally females) responsible for these tragedies are in their early 20s. The majority of mental health disorders begin in the teenage years, and it takes 8 years on average to make the diagnosis. Indeed, a surprising number of individuals who suffer from mental illness ( or “dis-ease” ) are not diagnosed nor properly treated. In 2009, 23.5 million Americans needed treatment for an illicit drug or alcohol problem (often self-medication for an underlying mental problem such as anxiety, depression or bi-polar illness). Only 4.3 million people received addiction treatment. Of the 9.8 million Americans who needed treatment for serious mental illness, only 4.1 million received it. The numbers have been steadily rising. A significant percentage of those with substance abuse and/or with mental health problems die prematurely, on average 37 years sooner. Their healthcare costs throughout their lives are substantially higher, compounding their hospital admissions for medical issues, prolonging their lengths of stay, not to mention the impact on unnecessary repeated admissions to emergency departments.

May is mental health awareness month. Statistics above are not meant to simply lead to head shaking or tongue clucking. Awareness of the rising tide of mental illness and the tremendous impact they create for individuals, families, and healthcare systems needs resolve and more concerted action, not just awareness. Even at Hoag, the statistics document the rapid increase in the number of mentally ill patients. Year over year, there has been a 47% increase in patients with psychiatric diagnoses visiting the emergency department compared to 14% increase in such visits for all other conditions. Up to 24% of our hospitalized inpatients for various medical conditions suffer from mental health comorbidities. Depression is the most common combined mental health condition, and is the number one cause of global burden of disease in the industrial world (outdistancing heart disease, cancer, diabetes, etc.). 1 out of 5 Americans (men, women and children) are now on a medication for some type of mental health disorder.

Hoag has been addressing addiction disorders for well over 20 years, seeing approximately 75 patients a day, and is now expanding its mental health efforts to address the tsunami described above. Particularly, given the onset of mental health in the teenage years, our after school program for resiliency education in troubled teenagers (ASPIRE) is starting both here and in Irvine, in cooperation with local school systems, parents, and other community leaders. Much, much, much more is needed. We are tactically focusing our efforts on the Hoag communities we serve. We are working with our partners at Providence St. Joseph Health on these issues on a more global scale. This is the toughest health struggle we face as a health system and, some would say, as a society. Let’s roll.

Michael N. Brant-Zawadzki, M.D., F.A.C.R.
The Ron and Sandi Simon Endowed Chair,
Executive Medical Director, Pickup Family Neurosciences Institute

Kambria Hittelman, PsyD
Director of Hoag Neurobehavioral Health