Chat transcript: U.S. surgeon general on mental health

June 8, 1999
Web posted at: 11:57 a.m. EDT (1557 GMT)

The following is an edited transcript of a chat with U.S. Surgeon General David Satcher about the White House's first conference on mental health. Dr. Satcher joined our chat over the phone from the Carter Center in Atlanta on Monday, June 7, 1999.

Chat Moderator: Welcome, Dr. Satcher. Please tell us about the conference going on at the White House today.

Dr. David Satcher: This is the White House Mental Health Conference. It is the first White House Mental Health Conference, and I think perhaps the most important goal is to move towards changing attitudes towards mental health problems, or, if you will, to destigmatize mental health problems; to try to make the point that there are a lot of people in this country who suffer mental health problems. They are as common as any other kind of health problems. And just as things can go wrong with the heart, the lungs, the kidneys, the livers, things go wrong with the brain. And we would like to think that there would be no shame in that, but that people would feel comfortable coming forward and seeking help for depressions, anxiety, impulsiveness in terms of behavior, or any other mental health problems. But we are also hoping that out of this conference today there will come a new commitment on the part of communities to not only respond when there is a tragedy like the bombing in Oklahoma City, or the floods in Iowa, or the tragedy in Littleton, Colorado, but even before a tragedy for communities to focus on mental health programs at the community level -- programs that involve not only health professionals, but parents and teachers and coaches, scoutmasters and others -- community-based mental health programs. Today we hope to move toward a new understanding behind the science of mental health problems -- the fact that chemical and physical abnormalities in the brain are associated with and can explain most of the mental health problems that we see. By the same token, as we learn more about these physical and chemical abnormalities, we’re better able to treat them.

Chat Participant: What is your opinion on the reasons why mental diseases are stigmatized that much?

Dr. David Satcher: I think that we have not done a good enough job of educating people about mental health problems. You know, there was a time when having cancer was looked upon in a very similar manner. And it has taken time for us to better educate people about cancer, and especially about the fact that it can be diagnosed and treated, and often with good treatment it can be cured or at least controlled so that people can live normal lives. We have the same issue facing us with mental health in terms of the lack of awareness. Some people still believe that mental health problems represent character disorders, that there's something wrong with the person, bad people, as opposed to seeing mental health problems as real problems that in most cases can be successfully treated and controlled.

Chat Participant: Dr. Satcher, is today's conference focusing on mental health problems like depression, or on the needs of Americans who have mental retardation or educational impairments? Are there any plans to focus on these needs?

Dr. David Satcher: Well, I think today's program focuses on all kinds of mental health problems. I think we are not limiting it to one area. Obviously, we are not going to go into detail in any area, but the idea is to point out that mental health problems are real, are common, there is treatment and support and care available, there needs to be more, and we're going to work to develop better programs, better support systems, and generally better treatment. But yes, we are concerned with all types of mental health problems.

Chat Participant (Susie): Seems to me that things like the Oklahoma bombing and the Littleton shootings were CAUSED by mental health problems, while floods in Iowa and other natural disasters were the cause OF mental health problems.

Dr. David Satcher: Susie is absolutely right, right on target. Which is why we use the Iowa example, is that they are natural, and they are manmade, if you will, disasters. Natural disasters are not caused by man, if you will, but can cause mental health problems in a community. So Susie is correct.

Chat Participant: Do you think Mrs. Gore's recent initiative on mental health is a political move?

Dr. David Satcher: I have known Tipper Gore a long time, long before I came into government, and I can tell you this is not a political move. When I was president at Meharry Medical College, we started an institute on health care for the poor and underserved. And I remember that Mrs. Gore became involved because of her interest in the mental health of children, and she later joined our board, voluntarily, no pay, certainly no political benefit. She joined the board at Meharry because of her interests in what we were doing, especially her interest in mental health. I think that was 10 years ago. That was long before Al Gore became vice president. Everything in Washington has a political flavor to it, because people have to be elected, that's the nature of our system, but that doesn't mean that a person like Tipper Gore, who has a master's degree in psychology, is leading an effort in this area for political reasons.

Chat Moderator: Could this issue become a major issue in the presidential race in 2000? Will it since Tipper Gore has come forward and acknowledged that she suffered from depression?

Dr. David Satcher: I don't know. I certainly don't think it will become an issue of the kind that we experienced with Tom Eagleton, who was the vice presidential candidate with George McGovern in 1972. And when it was discovered that he had had mental health problems, he actually had to withdraw from the race. And I think that was because of the extreme stigmatization associated with mental health problems at that time. I think we have made much progress since then. But we still have work to do. I don't think, personally, that it will be a major issue in this campaign.

Chat Participant: Dr. Satcher, I think Mrs. Carter is very active in mental health issues. Is she a part of this conference?

Dr. David Satcher: Yes and no. We're here at the Carter Center. President and Mrs. Carter are out of the country, which is why I am here. I believe they are monitoring elections in Nicaragua. But there will be a tape from Mrs. Carter, and a letter read from her later. So even though they are not here, they are involved.

Chat Participant: What view on mental health has the medical community embraced?

Dr. David Satcher: I will respond in two ways. I think those who are knowledgeable in the mental health field have embraced the problem as a biomedical problem that has a basic biomedical cause, can be diagnosed and treated. There are people in the medical profession who still often don't think of mental health problems or don't remember to ask their patients about problems such as depression and anxiety. Perhaps the best example is the fact that we estimate that of the elderly who commit suicide, that 70 percent of them would have seen at least a primary care provider at least 30 days before suicide. But at least most of them will not have been asked about depressions. We're going to change that. We're going to work with medical schools and continuing education for physicians to significantly improve their knowledge and sensitivity relative to mental health problems.

Chat Moderator: Please tell us about the legislation being proposed by the White House on mental health treatment.

Dr. David Satcher: Let me just say, one of the most important concerns which we have is the historic lack of parity in the coverage for mental health treatment. So many insurance companies will not provide the same kind of coverage for mental health problems as they do for other health problems. And we already have the health parity act for programs like Medicare and, I guess, Medicaid. What President Clinton is proposing now for private insurance companies, and there are many of them who are involved in the care of federal employees, for those insurance companies to be able to participate in these federal programs, even though they are private insurance companies, they would have to provide parity of coverage for mental health services. That's one. There are several new programs that will be announced in terms of funding today. Increasing the budget of the mental health block grant will be one of them. New strategies for enhancing access. But also the idea of mental health as a disability and how it affects the workplace is one of the major topics of discussion today. And President Clinton announced on Saturday in his weekly radio program that there will be a national anti-stigmatization campaign, where Mrs. Gore will serve as the honorary chairperson, and I as surgeon general will be responsible for leading the program.

Chat Participant: Why are you only proposing to enforce parity with health plans doing business with the government? Why not plans affecting all Americans?

Dr. David Satcher: That's a very good question. Because that would be under the states. Insurance companies that are not doing business with the federal government are regulated by the states, not by the federal government. The good news is that there are a number of states that are in the process of passing legislation to require parity. Some states already have it. But let me just say one other thing. Many private businesses and some insurance companies have voluntarily embarked upon the parity strategy, and the interesting thing is that they have found that in the long run it does not add significantly to their cost. In some cases, it can even reduce costs. I think we're going to have to wrap it up here.

Chat Moderator: Any final comments?

Dr. David Satcher: It is a very important conference. It's the first ever. Later this year, there will be the first ever surgeon general's report on mental health. Hopefully, we are on the path to changing the environment for mental health in this country.

Chat Moderator: Thank you, Dr. Satcher, for joining us today.

Dr. David Satcher: It was great. Thank you very much.