May 7, 1999

U.S. Surgeon General David Satcher, M.D., is distressed by the short shrift this country's health care system often gives to mental health issues and treatment. Far too few people are aware of the fact that "things go wrong with the brain, just like they do with the kidney or liver," he stated. To change perceptions about the importance of paying attention to mental health concerns, he delivers this message over and over as he speaks throughout the country.

Satcher spoke to psychiatrists last month at a breakfast meeting during APA's Federal Legislative Institute in Washington, D.C. He began by thanking APA for its help during his confirmation process two years ago and for the "important role it has played in advancing the mental health of the American people and the mental health agenda in this country."

"If any area has traditionally been given backdoor treatment, it's mental health," the Surgeon General emphasized. People become so uncomfortable thinking about mental illness that they "often respond to it with stigma and blame." But paradoxically, he noted that whenever he does talk about the need to pay more attention to mental health concerns, "invariably, people say 'thank you' for discussing it. The American people are clearly ready to move forward on issues related to mental health."

A mission he has put very high on the Public Health Service's agenda, he pointed out, is "targeting the most vulnerable in our population," which includes the mentally ill. One essential facet of this strategy is eliminating the racial and ethnic disparities that characterize the access to and quality of mental health care for Americans.

Another issue that Satcher has made a high priority is suicide prevention, especially among teenagers. The mental health system in the U.S. lacks "a sound strategy for preventing suicide," he said, a vacuum that must be filled now that suicide has become the eighth-leading cause of death in the U.S. A national strategy "would provide everyone in this country an opportunity to make a difference in preventing suicide."

Satcher went on to discuss his views on the Public Health Service's role in gun control in response to a question from Steven Sharfstein, M.D., vice chair of APA's joint commissions on government relations and public affairs. Satcher stated that he attributes much of the dramatic increase in youth suicides in recent decades-a 300 percent increase since 1950 and a 100 percent increase among black youths just since 1980-to the easy availability of guns. Suicide attempts are most likely to succeed when a gun is involved, he pointed out, and so easy access to them must be viewed as a "major public health problem."

He is hoping to increase the federal funds devoted to suicide prevention and all types of activities related to the prevention of mental illness.

The Federal Legislative Institute, held in the nation's capital every two years, is organized by APA's Division of Government Relations for members of its network of district branch legislative representatives and other APA leaders involved with federal legislative issues. These psychiatrists have the opportunity to hear from several members of Congress and the staff of committees responsible for crafting laws that affect health care and medical practice.

As a major component of the institute, psychiatrists meet in Capitol Hill offices with their senators or representative or with key health staff to educate them about issues critical to psychiatry or mental health in general. Such face-to-face meetings between lawmakers and their concerned constituents are among the most effective ways voters can influence the future course of legislation.