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Mental Health

More than 50 years ago, the World Health Organization (WHO) defined mental health as a complete state of mental and physical well-being, and not simply the absence of disease. This definition emphasizes the positive features of mental well-being. Good mental health is associated with positive family, community, and school or work involvement, as well as with a supportive group of friends.

In contrast, mental illness usually is associated with the absence of one or more of these positive involvements. Mental illness can be characterized by problems in one's thinking, emotions, behaviors, or any combination of these three. The American Psychiatric Association (APA) has developed a classification system for mental disorders based on these characteristics, published as the Diagnostic and Statistical Manual of Mental Disorders (DSM).

The most common mental disorders among adults in the United States are depression and anxiety, each of which affects about 10% of the population. Much less common are bipolar disorder-a combination of depression and mania, which affects about 4% of adults-and schizophrenia, which affects about 1% of the adult population. Both can lead to disabilities, and both bipolar disorder and schizophrenia are known to have a genetic basis, at least in some population groups.

About 25% of adults have a mental disorder within a 1-year period, and about 50% will have a mental disorder in their lifetime. About 6% of adults become seriously disabled as a result of mental illness. Less is known about the rates of specific mental illnesses in children and adolescents. However, about 20% of youths suffer from one or more disorders, and 9% to 13% of them are seriously disabled. Soon, national data will be available on the rates of specific disorders in this population.

Historical Overview

Because mental illness has not been well understood in the past, the history of mental illness and care is characterized by misunderstanding and exclusion. These can lead to stigmatization, by which a person or a family is blamed for the mental illness and deliberately excluded from social groups, community activities, and work. Only recently has mental illness been truly recognized as a treatable illness from which one can recover.

In the American colonial period, people who had mental illness were called “the insane” and were cared for by their families or in local alms-houses. Around the time of the American Revolution, a system of state mental hospitals was constructed. The first of these facilities, Eastern State Hospital, was built near Williamsburg, Virginia, shortly before the Revolution. Usually, these facilities were located in rural areas because it was thought that persons with mental illness would benefit from good air and the quiet atmosphere of a rural setting.

After World War I, it became clear that a large number of potential recruits had been excluded from military service because of mental illness. It also became clear that battle fatigue, suffered by soldiers who had experienced combat, was a form of mental illness. As a result, in the early 1930s, the Veterans Administration created a system of general hospitals that also provided psychiatric care. In the early 1940s, a system of general hospitals in local communities was created, many of which offered psychiatric care, and in the 1950s, a large number of private psychiatric hospitals were founded, principally in urban areas.

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