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People with chronic mental illness present complex challenges for the design of health care financing reforms. In this position statement from the committee on psychiatry and community of the Group for the Advancement of Psychiatry, the authors describe chronic and severe mental illnesses as psychiatric illnesses that require acute and ongoing psychiatric assessment and treatment, as chronic medical diseases that require ongoing rehabilitative services, and as persistent disabilities that need ongoing supportive care and social services. Any proposal for health care reform must ensure parity of chronic psychiatric illnesses with other psychiatric conditions. It must also reimburse psychiatric rehabilitation at parity with other medical rehabilitation and provide equal access to and reimbursement for broad ancillary health services that reduce costs and improve quality of life.

This study reports the results of a household survey and search of death certificates that show a relationship between depression, anxiety, and subsequent mortality. It is part of an effort to develop practical epidemiologic techniques for continuous assessment of community mental health. Use is made of the population attributable mortality rate, estimated from a comparison of the prevalence of a given factor in life and at death. The study estimated attributable mortality prospectively by following up participants in a mental health survey of Alachua County, Florida, for up to four years. Of eight mental scales examined, five (mood, depression, somatic symptoms of anxiety, the Health Opinion Survey, and selected psychopathologic symptoms) showed significant association of scores with community mortality. The data suggest linkages of mental factors to mortality of an order of magnitude sufficient to warrant consideration of these factors as leading causes of death.

The authors report data collected on 3674 subjects between 1970 and 1974 as part of an epidemiologic field survey of mental disorder in the southeastern United States, an area which was undergoing rapid sociocultural change. Rates of mental disorder, as measured by the Global Psychopathology Scale, are presented for various sociodemographic groups and are consistent with trends found in previous studies. Analysis of variance and multiple regression techniques are used to explore the relationships among awareness of social change, sociodemographic variables, and psychopathology. Low awareness of change is found to be consistently associated with low psychopathology scores across all socioeconomic groups. The authors postulate a "denial" or "filter" mechanism which may protect particularly vulnerable individuals from the psychic distress accompanying social change.