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May 2013
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Mental Health
Mental health and physical health are inextricably linked. Evidence has shown that mental health disorders—especially depression—are strongly associated with the risk, occurrence, management, progression, and outcome of serious chronic diseases and health conditions, including diabetes, hypertension, stroke, heart disease, and cancer.1 Depression, other mental disorders, and substance abuse disorders are major risk factors for suicide.
Suicide is a serious public health problem that affects individuals in various life stages. For children and young adults between the ages of 10 and 24, suicide was the third leading cause of death in 2010, behind unintentional injuries and homicide. Suicide and suicide-related behaviors have a profound impact on American Indian and Alaska Native individuals and communities, particularly among their youth. In 2010, the suicide rate among American Indian or Alaska Native adolescents and young adults aged 15 to 34 was about 50 percent higher than the national rate for that age group.
Evidence-based prevention efforts and access to appropriate, quality mental health services can help to address mental illness in our communities and homes.
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Mental Health and the Affordable Care Act
The Affordable Care Act will provide one of the largest expansions of mental health and substance use disorder coverage in a generation by building on the Mental Health Parity and Addiction Equity Act of 2008 and extending Federal parity protections to 62 million Americans. Beginning in 2014, under the law, all new small-group and individual-market plans—offered both inside and outside of the Health Insurance Marketplace—will be required to cover a comprehensive set of benefits and services in 10 categories. These are known as “Essential Health Benefits” and include mental health and substance use disorder services. By applying Federal parity protections to these benefits, the law also requires that coverage for mental health and substance use disorder services is comparable to the general medical and surgical coverage. Also in 2014, insurers will no longer be able to deny anyone coverage because of a pre-existing behavioral health condition. The Affordable Care Act has already ensured that new health plans cover recommended preventive benefits without cost-sharing, including depression screening for adults and adolescents and behavioral assessments for children.2
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Leading Health Indicators
Leading Health Indicators (LHI) are critical health issues that—if tackled appropriately—will dramatically reduce the leading causes of death and preventable illnesses. The LHIs for Mental Health are:
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Where We’ve Been and Where We’re Going
Over the past decade, the suicide rate increased 16.3%, from 10.4 per 100,000 population (age adjusted) in 2000 to 12.1 in 2010. Suicide rates varied by factors such as race/ethnicity and age; for example, the rate for the American Indian or Alaska Native population was twice as high as that for the black non-Hispanic population, the racial/ethnic group with the lowest suicide rate. In 2011, 8.2% of adolescents aged 12 to 17 reported having had a major depressive episode (MDE) in the past 12 months. The rate of MDE for females was more than 2½ times that for males.
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Who’s Leading the Leading Health Indicators?
Addressing Teen Suicide Through Evidence-Based Interventions
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Suicide has been a grave concern to the White Mountain Apache Tribe. During 2001 and 2006, the average suicide rate for the whole tribe was nearly four times the national suicide rate. The suicide rate for individuals aged 15 to 24 was over 7 times the national American Indian or Alaska Native rate for the same age group, and over 13 times the suicide rate for individuals aged 15 to 24 nationally.3 To address this issue, tribal leadership, in collaboration with the Johns Hopkins Center for American Indian Health (CAIH), developed the Empowering Our Spirits initiative to prevent suicide. This community-wide effort was developed by a coalition comprised of representatives from different tribal agencies including mental health, foster care, schools, justice system/tribal police force, and community leaders and organizations, such as traditional healers and churches, in collaboration with CAIH.
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