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These are the main, and most troubling, findings of the first epidemiological study on the state of mental health in Puerto Ricans since 1985. (GFR Media)

Seven point three percent of Puerto Rican adults between the ages of 18 and 64 suffer from a serious mental illness. Two out of ten live with some kind of psychiatric ailment. One out of ten suffers from a severe depression disorder. Twenty-three point seven percent combine a mental illness with drug or alcohol abuse. Four out of ten people who suffer serious mental problems do not receive treatment of any kind.

These are the main, and most troubling, findings of the first epidemiological study on the state of mental health in Puerto Ricans since 1985. It was carried out by the Behavioral Sciences Research Institute in the Medical Sciences Campus of the University of Puerto Rico (UPR), for the Puerto Rico Administration of Mental Health and Anti-Addiction Services (ASSMCA, by its Spanish acronym), which needs it to justify the allocation of federal funds for addressing this problem.

The study confirms, to the surprise of some and horror of others, that thousands of Puerto Ricans battle with serious mental, emotional, or behavioral conditions on a daily basis, many of them in silence, without any kind of  treatment.

Some experts consider this to be the cause of the environment of tension, volatility, violence, and conflict that is engulfing the Puerto Rican society, especially since the study reveals that services are mostly available to those who suffer from serious and disabling conditions and not to those who, despite also suffering from mental illnesses, are still considered “functional.”

The main conditions affecting Puerto Ricans are anxiety disorders, like generalized anxiety and panic, and mood disorders, like depression, which—according to the study—affects one out of every ten Puerto Ricans.

Experts say these are the types of conditions that, unless treated in time, create situations of violence within families, communities, or workplaces, like the ones we see in the news on a daily basis.

“Mental illnesses cause a lot of suffering,” said Dr. Glorisa Canino, the principal researcher of the study, which was done through 3,062 interviews in all regions of the Island.

ASSMCA Administrator Suzanne Roig, newly appointed to the post, has already seen the report, but has not been able to study it in depth in order to plan a course of action regarding its findings.

This week, she will meet with Dr. Canino to answer questions and decide what to do about the seriousness of the findings. “This study is in keeping with the plan without improvisation that we want to implement,” said Roig.

165,497 Are Affected

Finding that 7.3% of Puerto Ricans have serious mental conditions is not a significant variation from the findings of the 1985 study, although Dr. Canino noted that, back then, the socioeconomic picture of the Island was even worse than it is now, with unemployment at around 20% and the povertylevel at 60%.

Currently, unemployment is slightly above 10%, and the level of poverty has gone down to 46%.

The 7.3% of the population with serious mental health conditions is equal to 165,497 people. The study does not include homeless people, which is a vast population thought to also have a large amount of people with mental illnesses or substance dependence. Of these 165,497 people with serious mental health conditions, 36.1% had not received specialized services in the past year, which shows that there are thousands of undiagnosed or untreated mentally ill people in the streets of the country.

The study defines a serious mental illness as a behavioral, emotional, or mental disorder lasting long enough to comply with the criteria of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, and which results in a substantial disability that interferes with, or limits, the functioning of a person in his or her family, work, relationships, or community.

Dr. Canino said the study did not measure the quality of services received by the 63.9% of people who are treated, but warned that in other studies done by herself in the past, they have found that very few people receive evidence-based treatments identified as adequate.

Latent Threats

The study warns of the danger that the critical fiscal situation Puerto Rico faces could end up affecting the services of mental health patients. The Health Insurance Administration (PRHIA)—which administers the Puerto Rico Government Health Plan, upon which almost two million Puerto Ricans rely—faces a fiscal insufficiency crisis that has forced it to incur millions of dollars of debt with their providers.

“The PRHIA debt represents a significant threat to maintaining an operational healthcare system. The debt has set off a chain reaction, with longer wait times for clinical and therapeutic procedures, overcrowded emergency rooms, attempts to directly charge patients for services, and an increasing exodus of physicians from Puerto Rico. According to the Puerto Rico College of Physicians and Surgeons, 364 physicians left Puerto Rico in 2014, and 500 in 2015,” says the study.

The analysis also cautions that the uncertainty and deterioration of the quality of life in Puerto Rico, due to the fiscal crisis, have the potential of increasing the prevalence of mental health conditions in the years to come.

“Since 2008, the Island has been affected by an economic recession. As a consequence, Puerto Rico has been facing greater chronic stressors that might have a negative impact on mental health: high levels of unemployment or underemployment, poverty, a drastic reduction of population, and higher levels of crime,” says the study.

The study does not measure how many people suffering from a mental illness, but are still functional, receive services. Dr. Canino explained that this wasn’t part of ASSMCA’s petition when hiring the UPR for the study, because the main purpose of the analysis is justifying the necessity of federal funds, and the United States government does not defray the costs of people who are not disabled.

“If you meet the criteria for mental illness, you should have services, even if you’re not disabled,” said Dr. Canino.

Puerto Rico is the third US jurisdiction with greater mental health issues, but not by a very wide margin.

The study indicates that another study done in 2011 by the Centers for Disease Control (CDC) found a 6% prevalence in mental health illnesses in Puerto Rico, which was only topped by Mississippi (6.6%) and Kentucky (6.5%).

Dr. Canino said that, since the United States is a developed country with a much higher standard of living than Puerto Rico, the prevalence of mental conditions should be much higher here.

But she insisted that other studies have revealed that there are informal support networks on the Island, composed by family members, friends, and communities, which help alleviate the stress that can cause severe mental health illnesses.

A Reflection of Reality

Dr. Julio Santana, director of the Clinical Psychology doctoral program of Albizu University, believes that the study adequately reflects the general situation of mental health deterioration that Puerto Rico is facing, and agreed that it could worsen due to economic uncertainty and social tensions.

“The socioeconomic situation Puerto Rico is going through significantly contributes to these conditions,” said Dr. Santana, who was intrigued by the finding that people between ages 45 and 64 are most affected by these illnesses, making up 8.5% of all the afflicted.

“This is the group that’s responsible for supporting families and societies. In an economic crisis, if the bases of labor stability are upset, these population groups suffer the emotional impact, the anguish, depression, and hopelessness,” said Santana.

Santana, who is the former President of the Puerto Rico Psychology Association, is sure that the violence problem overwhelming the country is directly tied to the deterioration of mental health. Above all, he is concerned that insurance companies put a limit on the amount of sessions with a psychologist a person could have, when this person is suffering from depression or one of the anxiety disorders so commonly reflected in the study.

“A humble, poor person, with a thousand everyday life problems, who has issues that have become chronic, isn’t cured in eight or ten sessions, which is what’s covered by health insurance,” said Dr. Santana.

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