This just in from the feds -- the Agency for Healthcare Research and Quality (AHRQ)to be specific: mental disorders were one of the five costliest conditions in the US in 2006, with one in four adults suffering from some sort of mental disorder in any given year. 6% of adults suffer from a "serious" mental illness. I put "serious" in quotes because what may seem "not serious" to a psychiatrist usually feels VERY serious to the person suffering. What they mean here, though, is a mental illness that is extremely debilitating and does not ever fully go away. For example: schizophrenia, chronic depression, chronic bi-polar and other disorders that are resistant to treatment. Many people know what depression is like and how it differs from simply being in a bad mood. I think of depression as "the common cold of mental illness": most of it come down with it at some point, we suffer, we recover. OK, now: braid together a mental disorder (even a little one), trauma (you might be amazed at what counts as "traumatic" as far as the brain is concerned) and substance abuse. This is a common condition for women in treatment for substance abuse.

Is it awful? Yes. For the woman, it is until she gets a little recovery going. Is it treatable? Very. Does it constitute an issue that the public should care about and that our healthcare system (such as it is) address in a more informed and systematic way. Just listen to these statistics, sent to me today from AHRQ:

* Domestic violence victims have higher health care use and costs than other women, even long after the abuse has ended.

* Health care costs are significantly greater for women who were physically or sexually abused as children than for women who left childhood unscathed.

* Substance use is prevalent and problematic use is frequent among depressed adolescents.

* Substance abuse and psychiatric illness account for 80 percent of hospital admissions among homeless veterans.

* Patients with diabetes and depression tend to skip self-care behaviors that would help keep their diabetes in check.

* Up to one in four primary care patients suffer from depression; yet, primary care doctors identify less than one-third (31 percent) of these patients.

That's just a brief sampling. You can find the whole report at

http://www.ahrq.gov/research/mentalhth.htm#contents

Part of the "reform" we need in healthcare is, I'm afraid, something the congress cannot address in its current healthcare kerfuffle. I'm talking about de-fragmenting the systems that dole out treatment and health services based on single criteria when most peoples' conditions are multi-problematic and complex.

Personally, I can't think of a compelling excuse for why we as health care providers are not -- in the year 2009 -- proficient at treating primary health concerns, mental illness (including trauma symptoms) and addiction in a fashion that integrates the care plans and streamlines patient access to competent care.

The mental health and substance abuse parity legislation, when fully implemented, will help increase access to mental health and substance abuse treatment. But the kind of quality of integrated care I'm talking about will come about through changes in practice standards that are lead by providers and their respective agency administrators.

Which reminds me, I may have forgotten to tell you: Marin Services for Women is accredited by the Commission on the Accreditation of Rehabilitative Facilities (CARF), who recently changed our accreditation category from "Alcohol and Other Drug" treatment to Integrated Alochol and Other Drug/Mental Health" treatment.

INTEGRATED INTEGRATED INTEGRATED.

It's a start!