How mentally healthy is the United States? And how hard is it for people with mental problems to get help here?
These are some of the questions that advocates and practitioners of mental health have been asking in the week following the massacre at Sandy Hook Elementary School. While the definition of mental health and its disorders often differ across the globe, there are studies that can address the quality of care issue.
First off, the government estimates that one in five adult Americans suffered from some sort of diagnosable mental illness in the past year, according to the 2012 Survey of Mental Health by the Substance Abuse and Mental Health Services Administration.
Young people from 18 to 25 had the highest rate, nearly at 30 percent. But about 5 percent of the U.S. population suffered from a serious mental health problem that "resulted in serious functional impairment, which substantially interfered with or limited one or more major life activities."
Looking across the world, experts say that cross-cultural differences, social and religious stigmas, and income levels often make it difficult to compare mental health diagnoses rates from country to country. However, the World Health Organization (WHO) estimates that the five developed countries with the highest rates of any kind of diagnosed mental health problems (including substance abuse) are Colombia, France, the Ukraine, New Zealand and the United States, according to a 2009 report.
"We don't know why," said Magdalena Cerda, professor of epidemiology at Columbia University's Mailman School of Public Health. "There are different theories. It's still something people are trying to investigate. The next step is to investigate differences between countries."
Overall, 350 million people worldwide suffer from depression. More than half aren't getting the help they need, and that the problem is growing worse.
While diagnoses are harder to compare, counting the money spent on mental health is easier.
When it comes to caring for the mentally ill, it turns out that the United States spends 5.6 percent of its health care budget on mental health, or about $113 billion dollars. That's in line with other developed nations such as Australia and Italy. Egypt, in comparison, spends 9 percent of its health budget on mental health, according to a 2003 report by the World Health Organization http://www.who.int/mental_health/resources/en/Financing.pdf.
But recent trends inside the United States don't bode well. The recession hit mental health funding hard, as many states cut their budgets as federal dollars shrank.
The National Association for Mental Illness (NAMI) reported that states cut mental health budgets by $1.8 billion from 2009 to 2011, with the biggest cuts in Alaska, South Carolina, Arizona, the District of Columbia, Nevada, Kansas and California. Vermont closed its state-run psychiatric center after it couldn't afford to repair damage from Hurricane Irene, while Alabama closed two such hospitals, according to NAMI.
NAMI's medical director Ken Duckworth, a clinical psychiatrist, says that mental health cuts are making it more difficult for people to get the help they need, but isn't an explanation for the violent shooting sprees that have occurred in the past few years at Virginia Tech, Tucson, Aurora and Newtown.
"The world of violence in America and the mental health crisis are two Venn diagrams that have some overlap," Duckworth said. "But the vast majority of violence is caused by angry upset people, with access to guns. Does this (Sandy Hook school shooting) fall into that overlap? We don't know enough yet."
Duckworth notes past studies that have shown a connection between states with high suicide rates and high levels of gun ownership, for example.
One expert believes that the United States is about even with other Western industrialized nations when it comes to mental health problems, even though rates of suicide, for example, vary by country and usually spike during economic stress.
"I don't feel our system is inferior," said Todd Farchione, a clinical psychologist and professor at Boston University's Center for Anxiety and Related Disorders who studies the effectiveness of mental health treatment plans. "There's something else going on. It's not mental illness. It could be societal, or access to firearms. It could be the media."
Everyone points the finger at mental illness," Farchione continued. "That's unfortunate. People chasing after mental illness as a cause of these things - I feel they will be disappointed."