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Many depressed
fail to seek help

Stigma, insurance worries
and inertia keep people
from getting treatment

What to do if you see red flags
Where to get help
Part One

By Susan Kreifels
Star-Bulletin

Friends and family members can be the lifeline of depressed people who are contemplating suicide, mental health experts say, and they should not hesitate to interfere -- even if it means calling police to take someone by force to an emergency room.

"When you're wrong, it's not going to harm them," said Dr. Wayne Levy, a psychiatrist at Kaiser Permanente. "If you're right, it's life-saving. If you act in good faith, it's likely to go well."

Depression is one of the most treatable diseases. One to three months of medication and therapy will help 70 to 80 percent of depressed people, Levy said. For the rest, more aggressive therapy will normally work.

But only one-third of those with mental health problems seek treatment, often because of the stigma attached to mental illness. Or, when people reach desperately low points in their lives, "they don't feel worthwhile or worth saving," Levy said. "It's hard to advocate for themselves."

That's when friends and family must step in to help, mental health advocates say.

Even the uninsured can be treated. The state's mental health centers throughout the islands must immediately treat anyone, even an illegal alien, who is diagnosed to be suffering serious mental illness and is in a "crisis situation," said Linda Fox, chief of adult mental health services at the state Department of Health. Charges are determined by the patient's ability to pay, and the centers will also try to find insurance programs.

Studies show about one in five adults in the United States suffer from diagnosable mental illnesses. Approximately 21,500 adults in Hawaii suffer debilitating mental illnesses such as manic depression or schizophrenia, officials say. With only one-third seeking treatment, that means about 14,000 seriously ill people in Hawaii go without professional help.

"Most you don't see," said Greg Farstrup, executive director of the Mental Health Association in Hawai'i. "They're suffering in silence or on their own."

To complicate problems, even those receiving treatment can end their lives if they don't have good follow-up service.

"It's just as life-threatening as cancer and heart disease," Farstrup said. "If they're feeling so depressed that they can't move a muscle, and they're on the wrong medicine, they can kill themselves."

But quality follow-up services are lacking because of decades of inadequate funding for mental health services, Farstrup said. In the early 1990s, Hawaii was rated last among states in mental health services, he said, although he didn't agree with that assessment.

Levy added that low funding means "sometimes services leave something to be desired."

Fox agreed that funding has been inadequate, although Hawaii ranks about 20th in per capita government spending on mental health, not considering the high cost of living. The most urgent needs in public health: a more robust crisis-intervention system, more extensive rehabilitation programs, getting people into the work environment, and facilities to support independent living.

Nevertheless, Fox said state mental health services have improved significantly in recent years. Since 1994, all state facilities have earned national accreditation, and contracted services are doing the same.

Regarding insurance, Farstrup said he and others have worked to create equal benefits for mental health ailments -- they succeeded for treatment of schizophrenia, manic depression and schizo-affective disorder. But other types of mental illness still require bigger payments from patients and visits are limited.

Low funding, unequal insurance benefits and a low percentage of victims who seek treatment may be due partly to the stigma still attached to mental illness. Professionals and advocates for patients believe the stigma is stronger in Hawaii than elsewhere in the country.

Levy, who has worked in Washington, D.C., and Atlanta, said admitting mental health problems in some Asian cultures, or seeking help, can be considered a "blight on ancestry and an embarrassment to everyone they care about." Some cultures also see suicide as an acceptable solution to problems.

But more people are learning that depression is a treatable disease brought on by biological, psychological and social factors -- loss of a loved one or a feeling of abandonment, loss of income, or a family history of anxiety, mood swings or addiction.

"I've never seen anyone who caused their own depression or wanted it," Levy said.

Having food and a place to live are the front-line factors in preventing depression. After that, anyone can be struck. "Whether you are Bill Gates or working the graveyard shift cleaning schools, you have the same protection against depression," Levy said.

Levy assumes a seriously depressed person suffers from a chemical imbalance in the brain, which develops in anyone who has suffered depression for more than three months. That imbalance can be corrected with medication.

More than 60 percent of all suicides are committed by people suffering major depression, according to the American Foundation for Suicide Prevention. For every successful suicide, there are 15 attempts. That's why Levy opposes television showing ways to commit suicide for the terminally ill who choose to die, because the depressed may find that option easier than treatment.

"One of the things that keeps suicide down is not having good information on how to be successful," Levy said.

Bud Bowles, executive director of United Self-Help, speaks to groups around the state about mental illness. His nonprofit organization, funded by the state, also offers support groups.

His advice to anyone suffering depression for longer than two weeks: seek professional help.

If there's no insurance, call a state community mental health center, which he called "dedicated but overworked."

His organization hands out free books listing where help can be found. However, "few take it because there's such a stigma," he said.

Sometimes a friend can be the key to recovery. It was a college roommate who got Bowles treatment when he suffered from depression. If depressed people can't help themselves, he said, "it's better if a friend pushes them."

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How to find help Star-Bulletin staff In addition to calling O or 911 for emergencies, here are other help lines: Hot lines: Oahu: Crisis Center, 521-4555 Big Island: Kahi Mohala, 935-3393 Maui, Molokai, Lanai: Help line, 244-7407/553-3311/ 1-800-887-7999 Maui Kokua Services: 244-7407 Service agency: Health & Human Services in Hawaii: 275-2000, or check http://www.ask2000.org Community Mental Health Centers Oahu: Central, 455-1051 Diamond Head, 733-9260 Kalihi-Palama, 832-5880 Waianae Coast, 696-4211 Windward, 233-3775 Big Island, 974-4300 Kauai, 274-3190 Maui/Molokai/Lanai, 984-2150 Mental Health Association in Hawai'i Oahu: 521-1846 or check www.mhahawaii.org Hawaii: 965-6601 Maui: 242-6461 Call the association for a free copy of "Finding Help: A Consumer Guide to Mental Health Services in Hawai'i" More Web sites National Mental Health Association: www.nmha.org American Foundation for Suicide Prevention: www.afsp.org

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What to do if you
see these red flags

Star-Bulletin staff

Here's how to recognize depression and what to do about it, according to Dr. Wayne Levy, Kaiser Permanente psychiatrist, and other mental health experts on Oahu.

Symptoms: Sadness, anxiety, empty feeling, lack of energy, loss of interest in usual or pleasurable activities, changes in sleep patterns and appetite, hopelessness or pessimism, feelings of guilt or worthlessness, difficulty concentrating, poor memory, thoughts and talk of death or suicide, writing wills, ordering/viewing/reading material on how to commit suicide, suicide attempts.

Don't be fooled if a person suddenly looks and feels better. That may be a red flag that a decision to commit suicide has been made.

Other clues to mental health problems: hallucinations, lots of energy but no sleep, thought disorders, manic behavior such as heavy spending or constant talking.

What to do: If symptoms persist for two weeks, get professional help through your insurance program, your regular health provider, or through the state's mental health centers.

If the depressed person doesn't seek help, family members and friends should get involved. Call a doctor, a clergy member, friends, family. With a patient's consent, you can also get information from a doctor. Be an advocate.

If suicidal, seek help immediately. Go to a hospital emergency room. Friends and family should take them if they don't go on their own.

For help, call 911. Police can make an evaluation and forcibly check a person into a hospital. If it's determined there's a threat of harm to self, psychiatric care will be set up, even without insurance.

Or call a state Crisis Center for an assessment at home.

"Tell them they're loved and deserve to feel better, and that they will feel better with appropriate treatment," Levy said.

Asking people if they are going to commit suicide does not prompt them to do it. "That's a common myth," Levy said. "No one should be afraid to talk about it. It may get them to share with you."