Committing to Psychiatric Ethics

A source of great personal suffering and societal burden, neuropsychiatric disease affects all people throughout the world. One hundred and fifty-one million individuals globally have depression, and nearly half (46%) of the people in the United States will experience an episode of mental illness during the course of their lives (WHO 2010). By 2020, mental illness will be the second leading cause of death and disability (Mitchell 2005), and by 2025, there will be roughly 34 million people living with Alzheimer’s disease and other forms of dementia (Alzheimer’s Society 2011; WHO 2010). Mental illness among young people is prevalent, and suicide is presently the third leading cause of death in adolescence and early adulthood (American Foundation for Suicide Prevention 2011; Centers for Disease Control and Prevention 2011). Co-occurring conditions, such as substance dependence, intellectual disability, and medically complex diseases, are becoming usual rather than rare (Conway et al. 2006; Regier et al. 1990; U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse 2010). All of these patterns are worrisomely heightened in specific subpopulations, such as among indigenous peoples, rural elders and adolescents, the incarcerated, some military personnel and veterans, recent immigrants, and the very old (National Institute of Mental Health 2002; 2004; 2010; Centers for Disease Control and Prevention 2011; Suicide Prevention Task Force 2010). And, by any measure, access to adequate health care services for neuropsychiatric diseases simply does not exist, even in economically established countries (The Commonwealth Fund 2011; World Health Organization 2011). Given the gravity of the consequences of neuropsychiatric disease, it is striking that these illnesses have been relatively neglected, whether considered from the perspective of public policy, science, or health systems. Clinically, neuropsychiatric disease is underrecognized, underdiagnosed, and undertreated (WHO 2010). The shortage of physicianscientists in psychiatry has reached a crisis (Coverdale et al. 2004; Fenton et al. 2004; Roane et al. 2009). From a bioethics point of view, on the other hand, ethical issues in health care and research involving people with neuropsychiatric diseases have been long, widely, and contentiously discussed. Conclusions remain elusive, though, despite the extensive