The National Alliance on Mental Health reports that 20.6% of U.S. adults experienced mental illness in 2019 (51.5 million people). This represents 1 in 5 adults. Established in 1949, Mental Health Awareness Month is observed every May to raise awareness, fight stigma, provide support, and advocate for policy change on behalf of people living with mental illness and their loved ones.
Earlier this year, Perspectives in Biology and Medicine published a special issue dedicated to Mental Health and Illness, guest edited by Dr. Dominic Sisti. The entire issue has been made available subscription free for the duration of the month of May. JHU Press is grateful to Dr. Sisti for graciously answering some questions about this important issue.
How did this special issue on Mental Health and Illness come about?
In late 2019, Frank Miller reached out and asked if I’d be interested in editing an issue of PBM on mental health and illness. We discussed what to include— because mental health and illness is such a broad topic—and decided on a handful of ethics and policy topics that seemed particularly important, including euthanasia for mentally ill people and questions about the future of psychiatric nosology. This was of course just before the pandemic struck.
The issue covers a wide range of topics, including the very definition of mental illness, ethical issues about medical assistance in dying, legal arguments for mentally ill patients convicted of crimes, and the history of deinstitutionalization.Did the call for papers cast a wide net on the topic or ask for any specific focus?
We actually solicited papers on specific topics from several authors. We knew, for example, Steve Hyman probably had a lot to say about psychiatric nosology and so we invited him to contribute. Likewise, Scott Kim, who has been studying euthanasia in the Benelux countries, was an easy choice for a conceptual paper on the debates about euthanasia for serious mental illness.
This issue was put together during the onset of the Covid-19 pandemic. What was your biggest challenge as editor?
Simply finding the headspace to work on it! I was—like most parents last year—pulled in a lot directions juggling my career, my kids homeschooling needs, and other family obligations.
What do you think is the most pressing mental health issue in the U.S. today?
Easy, affordable access to quality, evidence based mental health care is and has been a pressing challenge. We are seeing now how telepsych can be leveraged to expand access for individuals struggling with mild and moderate symptoms, but for individuals with serious mental illness, we need more well trained clinicians and resources. We also need insurers to cover mental health services; despite parity laws many payers still don’t fully cover adequate long-term treatments and care making it difficult for people who really need continuous care. Lack of housing, jobs, and education are of course enormous structural issues that exacerbate mental health condition and make life in recovery so much more difficult.
What are you currently working on? Any upcoming research or book you'd like to tell us about?
I'm working on a paper on borderline personality, and how it is often misdiagnosed or not diagnosed at all b/c some clinicians don’t believe in it or think the diagnosis is too stigmatizing to use. Of course, this is a problem if a patient has BPD and isn’t told, only to bounce from therapist to therapist receiving inappropriate treatment or none at all.
Dominic Sisti, PhD, directs the Scattergood Program for the Applied Ethics of Behavioral Health Care and is an assistant professor in the Department of Medical Ethics & Health Policy at the University of Pennsylvania. Dr. Sisti examines ethical and policy challenges in mental health care, including long-term psychiatric care for individuals with serious mental illness, clinical ethics issues in correctional settings, and ethical issues in psychedelic research and clinical application. Dr. Sisti was an Edmund Pellegrino Fellow at the Center for Clinical Bioethics at Georgetown University. He received his bachelor's degree in biology from Villanova University, a master of bioethics from the University of Pennsylvania, and his doctorate in philosophy from Michigan State University.