Dartmouth Medicine HomeCurrent IssueAbout UsContact UsSearchPodcasts

Surgeon general and other policy experts speak at Dartmouth

Surgeon General David Satcher, M.D., Ph.D., topped the bill at a recent day-long gathering for physicians and mental health workers from throughout New Hampshire. The event was hosted by Dartmouth and sponsored by the state medical society.

The surgeon general spoke about the failure of the U.S. health-care system to adequately provide services for the mentally ill. "It's time for us to take on this issue," he declared. His of- fice had recently released Mental Health: A Report of the Surgeon General, the first surgeon general's report on this topic. He stressed that the report was not based on opinion or politics, but on "the best available science."

New Hampshire Medical Society President David Charlesworth, left, and DMS Dean John Baldwin, right, flank Surgeon General David Satcher during a well-received talk that Satcher recently made at Dartmouth.
Photo by Mark Austin-Washburn

Due to tremendous gains in scientific understanding of the brain, Satcher said, we can now conclude that "mental disorders are physical disorders. . . . These findings are significant in a society that often questions whether mental illness is real." He noted that one in four Americans suffers from some sort of mental illness each year. Furthermore, mental illness is second only to cardiovascular disease in the disability it causes and thus the burden it places on society.

Satcher also discussed the tragedy of suicide and its connection to mental illness. He pointed out gaps in mental health care at different stages of life, from childhood to old age. For instance, he said, many older people who commit suicide have seen a physician shortly before their death.

Stigma: The surgeon general noted that "research has improved our ability to recognize, diagnose, and treat mental illness." However, he added the "bad news" is that "less than 50% of these people seek treatment." He attributed some of this disparity to the stigma associated with mental illness. But, Satcher countered, "just as things go wrong in the heart and the lungs, things go wrong in the brain. . . . We don't see a person suffering from chest pain and hesitate to get them help, and that's the attitude we must take."

Access to mental health services is also hindered by limits on insurance coverage, Satcher said. But by order of President Clinton, he added, any health plan for federal employees must now provide the same coverage for mental health as for other medical services.

"That has to be a part of our vision for the future, to remove the barriers to mental health services," concluded Satcher, to a standing ovation.

Overview: Hugh Scully, M.D., president of the Canadian Medical Association, spoke next, providing an overview of the Canadian system's mental health capabilities. He singled out the paucity of caregivers as Canada's greatest barrier to mental health care, calling it a potential crisis for the country.

The afternoon session concentrated on the issue of prescription drug coverage under Medicare. Richard Frank, Ph.D., of the Department of Health- Care Policy at Harvard Medical School, described the key conflict in the present system as the effort to produce good drugs, produce them quickly, and produce them at low cost. He suggested that it is difficult to meet all three of these goals at the same time. Frank said the difficulty will be to provide protection for the elderly in a way that doesn't harm technological development. "There's going to have to be a careful balancing act," he concluded, "and everyone is going to be a little dissatisfied in the end."

Congress: U.S. Representative Charles Bass of New Hampshire followed with an insider's view of efforts in Congress to introduce prescription drug coverage to Medicare. Bass said the good news is that everyone agrees on the importance of adding this benefit; he was convinced it will happen soon. However, he saw "philosophical differences" underlying the Republican and Democratic plans. "I wish we could pass a bill one way or the other," Bass said, "because costs for seniors will go down."

Finally, the president of the New Hampshire State Senate, Beverly Hollingworth, spoke on the role of the states in national health-care issues. She admitted that states have less power in today's global economy, and she also said that it's difficult to pass any measure that the pharmaceutical industry opposes. She mentioned the New Hampshire Medication Bridge Program as a local effort to improve access to prescription drugs.

Hollingworth concluded that the federal government must take the most significant steps in addressing these issues, but added that states "can do more to lessen the impact of high prescription drug prices."

Jonathan Weisberg

If you would like to offer any feedback about this article, we would welcome getting your comments at DartMed@Dartmouth.edu.

Back to Vital Signs

Dartmouth Medical SchoolDartmouth-Hitchcock Medical CenterWhite River Junction VAMCNorris Cotton Cancer CenterDartmouth College