Mental Health and Mental Illness

“I’ve never shared my story with anybody.” -- The first step toward recovery can be the most difficult. The ability to engage in productive activities, to find relationships with other people fulfilling, and to adapt to change and cope with adversity are each vital to enjoying a happy and healthy life. But each of these facilities can be significantly impaired by mental health disorders. A mental health diagnosis should not define who a person is, or what a person can achieve through treatment and support. Middle Tennessee nonprofit organizations are ready to help make that first step toward good health a little easier.

Mental disorders are common in the United States and internationally. An estimated 26.2% of Americans ages 18 and older have a diagnosable mental disorder in a given year, according to the U. S. National Institute of Mental Health. As 494,602 Davidson County residents are over age 18, that could be the equivalent to more than 129,000 Nashvillians.

A strong connection exists between physical and mental health, according to the U. S. Surgeon General. Health and illness are points along a continuum, with neither existing in isolation from the other. Poor mental health may reduce the likelihood that individuals will follow the prescribed advice/treatment regimen for the management of a physical health problem, for example. Additionally, individuals with mental health problems may be reluctant to come into contact with health care services for fear of being labeled. Both primary health care professionals and specialists treating chronic physical health problems may fail to detect mental health problems and vice versa.

The fact that 50% of mental health treatment in America is delivered in a primary care setting, coupled with findings suggesting roughly half the patients who visit a primary care physician also need behavioral health services, along with the abundance of research confirming that patients' mental wellbeing affects their physical wellbeing, and it becomes clear that integrated mental and physical care is needed in our communities.

Ben Middleton, Sr. VP for Core Services of Centerstone, says that their push for integrated care began when "it was clear to us that individuals we were seeing needed a medical home, and I'm talking here physical health, as much as they needed a place where they could come and receive mental health treatment. In fact, we became their medical home, and I think you can quickly see the challenge there for us." That challenge prompted Centerstone's integrated care initiative. Integrated care "puts behavioral healthcare providers in the medical setting, actually placing on the ground licensed, clinical social workers or master's-prepared individuals who have the abilities and expertise to diagnose and to work alongside the physician or nurse practitioner," Middleton explained.

During an economic downturn, people may need mental health services more often. With the unemployment rate higher during the past years than in previous decades, unemployed Americans are four times more likely than those with jobs to report symptoms of severe mental illness, including major depression. (Mental Health America, October 2009).


Depression and Suicide:

Depression: Psychosocial and environmental stressors are known risk factors contributing to depression. The National Institute of Mental Health (Grohol) research shows that stress in the form of loss, especially death of close family members or friends, can trigger depression in vulnerable individuals. Genetics research indicates that environmental stressors interact with depression vulnerability genes to increase the risk of developing depressive illness.

Suicide – in 2006, nationwide about 33,300 people died by suicide in the U.S. More than 90% of people who kill themselves have a diagnosable mental disorder (usually either a depressive disorder or a substance abuse disorder. Women attempt suicide two to three times as often as men, while four times as many men as women die by suicide. According to the Tennessee Suicide Prevention Network, someone dies by suicide once every 16 minutes in the United States. Suicide is the third leading cause of death for youth between the ages of 10 and 24. In 2007, suicide was the ninth-leading cause of death in Tennessee, claiming over 850 lives.


Types of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders, published in 1994 and revised in 2011, lists 297 mental disorders. Of the tens of millions of people affected by these disorders each year, only a fraction of those affected receive treatment. Youth are disproportionately affected by mental disorders.

26.2% of people experience a diagnosable mental disorder in a given year. The National Institute of Mental Health indicates that:

Mood Disorders affect about 9.5% of the U. S. population age 18 and over during any given year, with age 30 as the median onset, including:

  • Major Depressive Disorder – leading cause of disability in the U.S. for ages 15-44. Affects approximately 6.7% in a given year. More prevalent in women than in men.
  • Dysthymic Disorder – chronic, mild depression which persists for at least two years in adults (one year in children) to meet criteria for diagnosis. Affects about 1.5% in any given year.
  • Bipolar Disorder – affects approximately 2.6% of the population age 18 and older in a given year, with a median age of onset at age 25.

Schizophrenia – affects about 1.1% of the population age 18 and older in a given year. First appears in men in their late teens or early twenties and women in their twenties or early thirties.

Anxiety Disorders – include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and phobias (social phobia, agoraphobia, and specific phobia). Affect 18.1% of the population. Often exist with depressive disorders or substance abuse; most will have their first episode by around age 21.

  • Panic Disorder – affects 2.7%. Usually develops in early adulthood (median age of onset is 24) but onset could occur throughout adulthood. About one in three people with panic disorder develops agoraphobia, a condition in which the individual becomes afraid of being in any place or situation where escape might be difficult or help unavailable in the event of a panic attack.
  • Obsessive-Compulsive Disorder – Affects 1% of people. Median age of onset is 19 and first symptoms often begin during childhood or adolescence.
  • Post Traumatic Stress Disorder – affect 3.5%. Can develop at any age, including childhood. While most commonly discussed as being experienced after war, this can also occur after violent personal assaults such as rape, mugging, or domestic violence; terrorism; natural or human-caused disasters; and/or accidents.
  • Generalized Anxiety Disorder – affects 3.1%. Can begin across the life cycle. Median age of onset is 31 years old.
  • Social Phobia – experienced by 6.8%. Begins in childhood or adolescence, typically around 13 years of age.

Eating Disorders – three main types of eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder. Women more likely to experience than men. An estimated 0.6% of the population struggle with anorexia, 1% with bulimia, 2.8% with a binge eating disorder.

Attention Deficit Hyperactivity Disorder – usually becomes evident in preschool or early elementary years, with median age of onset age 7. Can persist into adolescence and occasionally into adulthood.

Autism – one of the autism spectrum disorders, also known as pervasive developmental disorders. ASDs range in severity, with autism being the most debilitating form while other disorders, such as Asperger syndrome, produce milder symptoms. Usually diagnosed by age 3. More common in boys than girls. Estimating the prevalence of autism is difficult due to differences in the ways that cases are identified and defined, differences in study methods, and changes in diagnostic criteria.

Personality Disorders – a “pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it.” Behavior is usually perceived to be appropriate by the individuals but it may significantly affect their lives in negative ways. Affect about 9.1%.

Antisocial Personality Disorder – characterized by an individual's disregard for social rules and cultural norms, impulsive behavior, and indifference to the rights and feelings of others. Affects about 1%.

Avoidant Personality Disorder – affects about 5.2%. Characterized by extreme social inhibition, sensitivity to negative evaluation, and feelings of inadequacy. Individuals with avoidant personality disorder frequently avoid social interaction for fear of being ridiculed, humiliated, or disliked.

Borderline Personality Disorder – affects 1.6%. Defined as a pervasive pattern of instability of interpersonal relationships, self-image, with marked impulsivity; usually beings in early adulthood.


Learn more:

Metro Nashville Community Needs Evaluation
HuffPost: Why is Mental Illness Still So Stigmatized?
National Alliance on Mental Illness (NAMI) Depression Resources

National Alliance on Mental Illness (NAMI) Veterans' Resources
Dr. Jorge Boero talks about emotional recovery after a disaster. Audio recording on 8-31-10 (Spanish only)

Local Nonprofit Resources:
Mental Health Cooperative
Mental Health Association of Middle Tennessee

Tennessee Mental Health Consumers' Association

If you are experiencing a crisis, please call the Crisis Intervention Center of the Mental Health Association of Middle Tennessee at 615-244-7444, or the Crisis Care Center of the Mental Health Cooperative at 615-726-0125, or 911.

Mental Health Association of Middle Tennessee
295 Plus Park Blvd., Suite 201
Nashville, TN 37217
Business Hours: Monday through Friday 8am – 5pm 615-269-5355 (office)

Tennessee Suicide Prevention Network (TSPN)
P.O. Box 40329
Nashville, TN 37204
615-297-1077 (office)