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Kristof: First up, mental illness. Next topic is up to you

Those of us in the pundit world tend to blather on about what happened yesterday, while often ignoring what happens every day. We stir up topics already on the agenda, but we falter at calling attention to crucial-but-neglected issues. So here's your chance to tell us what we're missing. I invite readers to suggest issues that deserve more attention in 2014. Make your suggestions on my blog, nytimes.com/ontheground. I hope to quote from some of your ideas in a future column.

My own suggestion for a systematically neglected issue: mental health. One-quarter of American adults suffer from a diagnosable mental disorder, including depression, anorexia, post-traumatic stress disorder and more, according to the National Institutes of Health. Such disorders are the leading cause of disability in the United States and Canada, the NIH says.

A parent with depression. A lover who is bipolar. A child with an eating disorder. A brother who returned from war with PTSD. A sister who is suicidal.

All across America and the world, families struggle with these issues, but people are more likely to cry quietly in bed than speak out. These mental health issues pose a greater risk to our well-being than, say, the Afghan Taliban or al-Qaida terrorists, yet in polite society there is still something of a code of silence around these topics.

We in the news business have devoted vast coverage to political battles over health care, deservedly, but we don't delve enough into underlying mental health issues that are crucial to national well-being.

Indeed, when the news media do cover mental health, we do so mostly in extreme situations such as a mass shooting. That leads the public to think of mental disorders as dangerous, stigmatizing those who are mentally ill and making it harder for them to find friends or get family support.

In fact, says an Institute of Medicine report, the danger is "greatly exaggerated" in the public mind. The report concluded: "Although findings of many studies suggest a link between mental illnesses and violence, the contribution of people with mental illnesses to overall rates of violence is small." Put simply, the great majority of people who are mentally ill are not violent and do not constitute a threat -#8212; except, sometimes, to themselves. Every year, 38,000 Americans commit suicide, and 90 percent of them are said to suffer from mental illness.

Mental illness is also linked to narcotics and alcoholism, homelessness, parenting problems and cycles of poverty.

Although treatments are available, we often don't provide care, so the mentally ill disproportionately end up in prison or on the streets.

One example of a cost-effective approach employs a case worker to help mentally ill people leaving a hospital or shelter as they adjust to life in the outside world. Randomized trials have found that this support dramatically reduces subsequent homelessness and hospitalization. Researchers found that the $6,300 cost per person in the program was offset by $24,000 in savings because of reduced hospitalization. In short, the program more than paid for itself. But we as a society underinvest in mental health services.


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