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Office of the Surgeon General (US). Surgeon General's Workshop on Women's Mental Health: November 30-December 1, 2005, Denver, Colorado. Rockville (MD): Office of the Surgeon General (US); 2006.

Cover of Surgeon General's Workshop on Women's Mental Health

Surgeon General's Workshop on Women's Mental Health: November 30-December 1, 2005, Denver, Colorado.

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Day 2 – Final Session

Overview of Themes and Recommendations from the Breakout Workgroup Presentations

Rear Admiral Kenneth Moritsugu, M.D., M.P.H., Deputy Surgeon General, greeted the workshop participants and thanked them for their hard work and generosity in sharing their perspectives and personal experiences for this effort. Dr. Moritsugu also thanked the American Psychiatric Association, the American Psychological Association, the National Association of Social Workers, and the Society for Women’s Health Research for sponsoring the workshop reception.

Dr. Moritsugu expressed Dr. Carmona’s regrets regarding not being able to stay for both days of the workshop due to a mission assignment from the White House in celebration of World AIDS Day. The Surgeon General reported that he was very excited and energized by this workshop. He reiterated his commitment to the issue of women’s and girls’ mental health and to the goals of the workshop.

In his role as Deputy Surgeon General, Dr. Moritsugu explained that he provides oversight and direction for the development of Surgeon General’s documents. Dr. Moritsugu assured the workshop participants that he would be recording and considering the outcomes of their discussions carefully – and bringing these back to the Surgeon General.

In honor of the fact that it was World AIDS Day, the Deputy Surgeon General took a few minutes to acknowledge the heavy toll that HIV/AIDS takes on women and girls and how it relates to issues of women’s mental health.

He reminded the audience that an estimated 39.4 million people worldwide were living with HIV at the end of 2004 and more than 20 million had died of AIDS since 1981. December 1, noted Dr. Moritsugu, serves as a reminder that action makes a difference in the fight against HIV/AIDS. He added that across our own Nation, African-American and Latina women are at particular risk for HIV/AIDS, and no one is immune to HIV. He noted that the percentage of women being infected with HIV has increased sharply to 27 percent of new cases.

As was discussed within some of the workgroups, Dr. Moritsugu commented that mental health issues can put women at risk for engaging in health risk behaviors – such as injection drug use or sexual contact – that can put them at risk for acquiring HIV. Thus, he said, it is very timely that we have come together to develop messages and communication strategies to better address the mental health issues of women and girls, which also may help protect them from developing other health problems, including HIV/AIDS.

Dr. Moritsugu reminded the workshop participants that the President’s Emergency Plan for HIV/AIDS Relief is a $15 billion global initiative to provide HIV/AIDS prevention and treatment services in 15 countries. He added that domestically, the President is working with Congress to reauthorize the Ryan White Comprehensive AIDS Resources Emergency Act, which funds primary health care and support services for individuals living with HIV/AIDS.

However, the battle against HIV/AIDS cannot be won by political leadership alone, warned Dr. Moritsugu. Individuals hold the most important keys to eradicating HIV – prevention and early diagnosis are vitally important.

Similarly, individuals hold the key, both alone and in united forums, for addressing and promoting the mental health of women and girls.

Dr. Moritsugu concluded by saying that he looked forward to hearing the recommendations of the workgroups and working together to set the direction of how to proceed with Surgeon General’s communiqués to address the important issues of women’s and girls’ mental health.

“The work you have been doing at this workshop and the ideas and recommendations you have generated will be very helpful in setting the direction for how we will proceed with the development of Surgeon General communiqués to address the mental health of our Nation’s women and girls.”

– Kenneth Moritsugu

Deputy Surgeon General

Wanda K. Jones, Dr.P.H., Deputy Assistant Secretary for Health, OWH, invited the facilitators from the eight working groups to present their groups’ recommendations. These were offered in the form of PowerPoint slides, which highlighted the three priority issues identified by each workgroup as well as the corresponding major messages, audiences, suggested formats, dissemination strategies, challenges and resources, and cross-cutting cultural concerns described in the previous chapter of this report.

Comments from the Workshop Participants

Following the workgroup presentations, Dr. Jones invited the workshop participants to share questions and comments with the larger group. The following highlights major themes and issues raised in those comments:

Prevention

  • If we want to build prevention and resilience, it is important to identify what good mental health looks like (e.g., positive relationships, autonomy). There are plenty of images in the media about bad mental health, but we do not have the picture of good mental health. We need more data on this. It also would be helpful to explore how better to harness innovative technologies that can help boost resiliency.
  • We need to pay more attention to the theme of prevention. The mental health challenges of trauma and violence are preventable. We must prevent the intergenerational cycle of abuse. Los Angeles has billboards and other public campaigns designed to address this topic. We also need to educate State legislators about prevention and mental health.
  • We need to focus on self-care for the caregivers and nurture the deficit disorder that women face who care for others.
  • Prevention needs to include issues such as eating disorders. We see disorders such as anorexia, which affects 2.5 million people in the United States, in children as young as 9 years. Binge eating disorders are not even on the table.

Families

  • Families are critical, and they are the first place we learn to heal.
  • We need to acknowledge and support the role women play in holding families together in the face of immigration to this country and the traumas that may precipitate or follow that change. Many carry the burden of trauma silently, face language and other barriers, and do not know that they have a right to access services.

Integrating mental health and overall health

  • We will never address the issue of parity between mental health and other health unless we have a workgroup specifically designed to address this issue.
  • We need to integrate mental health with primary care, but the payment systems do not match. We need to advocate for greater parity and integration with legislators and health care business representatives.

Target populations

  • Although aging was mentioned in some discussions and presentations, we need more dialogue on this issue, including with women themselves. We need to talk about conveying the message to older women that they should not give up taking care of themselves. We need to address issues of isolation. The Administration on Aging is in the process of developing a toolkit addressing depression in women over age 65.
  • The issues of trafficking and prostitution, which affect an estimated 30,000 to 50,000 women and girls in the United States, need to be addressed.
  • Incarcerated women and women with HIV face undue mental health needs.
  • Rural women and girls often have no place or no one to whom they can turn. In the past 40 years, there has been no progress in increasing the supply of providers. Moreover, 61 percent of people in rural areas are underserved for mental health. In Nebraska, there is only one provider for cognitive behaviors in the whole State.
  • Women in the military now constitute 15 percent of our overseas troops. Some are given only 4–6 weeks’ notice before being deployed. Some are four months postpartum. They face issues of trauma, abuse, and secrecy – the “don’t ask, don’t tell” policy affects these areas, too.
  • It is important to look at both sex and gender differences and similarities. Men can be our allies, too.

Developing products and sharing existing resources

The 1980s letter from the Surgeon General on HIV/AIDS is something that people still remember. It can be a very effective tool.

  • A document highlighting exemplary practices would be very useful for presenting to legislators; such as a compendium of consumer networks, State standards, and other such resources for mental health issues, such as trauma or eating disorders.
  • We need information for parents written at a sixth-grade level and readily available to families. Educate parents and children on why mental health is important and that there are resources out there to help with healing.
  • We need to train front-line staff to be mental health savvy and responsive. They well may determine whether a person speaks up or returns to a provider.
  • There is a new evidence-based report on eating disorders due to be released in the spring of 2006. Another report is focusing on feedback from focus group participants regarding the use and effectiveness of domestic violence hotlines.
  • California passed a tax for mental health services. The next phase will be on identifying innovations so that California counties can incorporate some into their mental health plans.

Closing Remarks

Rear Admiral Kenneth Moritsugu, M.D., M.P.H., Deputy Surgeon General, closed the meeting by reiterating the Surgeon General’s personal commitment to bringing hope to those suffering from mental disorders – directly or indirectly through individuals they love – and to a strategy of prevention so that fewer women and girls will suffer in the future.

The Deputy Surgeon General reviewed some of the major themes heard at this workshop that can help serve as a guide in the development of Surgeon General’s communiqués and toolkits. Those themes included the following:

  • Mental health is integrally important to overall health, or as one group put it, there is no health without mental health.
  • To address stigma, mental health needs to evolve, as cancer has, to be seen and accepted as another chronic condition.
  • We must recognize that many families have their “day stories” and their “night stories” hiding secrets of abuse, trauma, and pain.
  • Mental disorders touch all of us directly and through the people we love.
  • When it comes to mental health, sex matters – and so do gender differences in the causes, course, treatments, and prevention of mental disorders.
  • The importance of trauma, violence, and abuse needs to resonate more clearly with the general public, providers, researchers, and policymakers.
  • We must continue to spread the word that recovery is possible, and we must transform the mental health services system beyond treatment of acute symptoms to one that is focused on recovery.
  • We must look at mental health issues such as specific conditions, risk, resilience, and protective factors across the life spans of women, from childhood through the later years. Products should be designed to target different age groups and life stages.
  • Culture is clearly a priority that cuts across all of the areas of discussion related to the mental health of women and girls. Tools must be culturally competent and developed with the participation of diverse consumers and communities.
  • Culture also must be considered from a strengths-based perspective and as a source of protective factors and resilience.

“The Surgeon General communiqués and toolkits we develop will be a platform upon which we will build the awareness to move all of the stakeholders – consumers, providers, policymakers, researchers, and the media – to action.”

– Kenneth Moritsugu

Deputy Surgeon General

Dr. Moritsugu noted that the different breakout workgroups had generated some excellent and creative ideas for concrete products and toolkits, ranging from a letter from the Surgeon General to the American people, to iPod messages for teens, audio and low-vision materials, storytelling formats, PSAs, messages on commonly used products, assessment tools, profiles of model practices or best companies for mental health, and many more.

Everything we do will affect the lives of individuals, commented Dr. Moritsugu. He added that he would not forget the human aspect of the issue of women and girls’ mental health – as expressed by Rene Andersen, Dr. Carmona, and many others during the course of this workshop. Dr. Moritsugu also reminded workshop participants of lessons learned from Hurricane Katrina shared by Dr. Bowers-Stephens regarding the disproportionate effects of natural disaster on women and children. These must be taken into consideration, he noted, as we continue to develop our Nation’s disaster planning and emergency preparedness.

The Deputy Surgeon General concluded by assuring the workshop participants that the goal was not to produce just another Federal report that would collect dust on a shelf. He reminded the audience that Surgeon General’s publications through the years have been catalysts for action to improve the health of Americans. Dr. Carmona, he added, is passionate about the need for action, not just talk, and committed to seeing that the communiqués have a true impact on the lives of individuals. Dr. Moritsugu finished by thanking participants for their contributions and dedication, saying that everyone has a role to play in this endeavor and that the Office of the Surgeon General will rely on the continued input and work of the people gathered at this meeting.

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