By MELISSA MARES

    On February 14, 2008, a gunman entered a lecture hall at Northern Illinois University and opened fire, killing 5 people and wounding 16 more before taking his own life. The shooter was later identified as Steven Kazmierczak, a 27-year-old graduate student with a history of psychiatric problems. By many accounts, Kazmierczak had seemed to have his mental illness under control and was living a normal life leading up to his death, and his actions came as a shock to his family, teachers and friends.

    It is easy to be unaware of how widespread mental illness is until an event like the NIU shootings receives extensive news coverage. But millions of Americans suffer from mental illness every day, and millions more watch a loved one suffer from a debilitating condition. 

    The National Institute of Mental Health estimates that 26.2 percent of Americans ages 18 and older (more than 57 million people) suffer from a diagnosable mental disorder in a given year. Mental disorders are the leading cause of disability in the United States and Canada for people aged 15 to 44. According to data from the Global Burden of Disease study completed by the World Health Organization, the World Bank and Harvard University, mental illness accounts for more than 15 percent of the burden of disease in the world’s market economies, which is more than that caused by all cancers.

    People living with mental illness can face very different realities depending on where they live.  An individual’s environment does have an impact on the ways they may suffer with mental illness. 

    It is easy for someone who is severely mentally ill to “hide out” in a large city because of the volume of people and the anonymity that urban living can provide, says Thomas Kinley, program director for the Thresholds Dincin Center in the Lincoln Park neighborhood of Chicago. Kinley started at Thresholds in 1981 and has been program director since 1990. Thresholds is the oldest and largest mental health non-profit orgnization in Illinois.

    The mentally ill in cities may have more ready access to services and care for their disease. While more rural areas can often be more community-oriented and people might band together to get help for someone who is clearly suffering, the same resources might not be available in a rural community. For these reasons, experts say it’s hard to say whether the mentally ill or those with mental health issues fare better in an urban or rural setting.

    Whether living a rural or urban lifestyle, experts seem to agree that the state of Illinois is not a particularly good place for someone who suffers from mental illness. 

    The University of Illinois Institute of Government and Public Affairs (IGPA) published a report in March 2007 to the Illinois General Assembly entitled “State Funding of Community Agencies for Services Provided to Illinois with Mental Illness and/or Developmental Disabilities.”

    In it the researchers write, “Illinois’ funding of [mental health] and [developmental disability] services is low compared to other states, as indicated by the relatively few people who are served, and as measured at the community agency level by the share of program costs reimbursed with dedicated state funds.”

    The report states that Illinois’ funding is inadequate for services for the mentally ill and developmentally disabled. 

    “In fiscal year 2002, Illinois ranked 31st among the states in total per capita spending on mental health services….A far lower proportion of Illinois residents receive mental health services than nationally (1.2 percent in Illinois compared with 2 percent nationally).”

    Even more jarring is the National Alliance on Mental Illness’ (NAMI) most recent nationwide “report card” on America’s health care system for serious mental illness. The 2006 NAMI “report card” gave the state of Illinois an “F” as an overall grade.

    “Illinois’ grade of ‘F’ was well-deserved,” says Suzanne M. Andriukaitis, executive director of NAMI of Greater Chicago, in an interview conducted via email. “The problem with our mental health service delivery system in Illinois is that it is not funded well enough. The demand is greater than the supply in every area of treatment services. As one of the richest states in terms of per-capita income, it is disgraceful that Illinois ranks at the bottom when it comes to caring for some of the most vulnerable of our citizens—the mentally ill.”

    Thresholds says it hopes it’s one place to which the mentally ill in Illinois can turn. The organization serves 6,000 people per year, with 30 service locations and 75 housing developments in the Chicagoland area. Mental illnesses, such as schizophrenia, severe depression, bipolar disorder among others, often render people unable to hold a job and secure housing, which can start them down a path that leads to substance abuse, prison or homelessness—and sometimes all three. Because they often lack health coverage and a support system, many do not get care. These are the challenges Thresholds’ members grapple with every day. 

    Thresholds has several hundred beds for members who do not have housing or need more extensive monitoring and treatment. But all of those beds are full, and there can be a two-year waiting list for a bed, Kinley says. 

    While severe mental illness is quite common, even more people suffer from an array of less serious mental health issues, including more moderate depressions, stress-related issues, anxiety and other ailments. Depending on their severity, these conditions may not turn an individual’s life upside down like a more severe illness would, but these do cause problems for many Americans in both rural and urban areas. 

    In his work as founding director of the Roosevelt University Stress Institute, Dr. Jonathan C. Smith begins with patients by evaluating the environmental issues that cause stress in his patients. Noise, pollution, traffic—all of these things can cause stress in urban dwellers. 

    “Urban living is complex,” says Smith. 

    He emphasizes that the deciding factor for the amount of stress urban living causes is how comfortable the individual is living in an urban area. 

    “People who like urban living…will hate living on a farm,” Smith says. “Stick a farmer in a city, they will be stressed.” So it’s not the urban environment itself as much as how comfortable the individual is in that environment, Smith says. 

    Smith says that stress is at least half-created by the individual, and his patients work to make changes in their lives to reduce the stressors at the same time that they learn relaxation techniques and coping skills. ..Smith says most stress can be reduced or erased by doing one of three things: “relax, change it, rethink it.” He teaches patients to “catch themselves in the act” of having thoughts that contribute to feeling highly stressed. 

    Stress-related problems can seem minor compared to schizophrenia and other severe disorders, but experts agree that stress can have very serious consequences for both mental and physical well-being.

    “Stress makes your body more vulnerable to and slower to recover from basically every illness,” Smith says. 

    Doctors used to discuss certain ailments as especially “stress-related”, such as ulcers, Smith says. “Now we know that stress wears your body down and hurts recovery.”

    Studies have found that stress causes wounds to heal more slowly than they would under less stressful conditions. One example of this is a study by researchers at Ohio State University, published in Psychosomatic Medicine in 1998.  This study found that wounds healed an average of three days slower in students stressed from taking examinations than they did during summer vacation. There are many examples of other studies that have had similar findings.  

    In the same way, Dr. Smith says that people who practice relaxation techniques can reverse some of the effects of stress. The Roosevelt University Stress Institute teaches yoga, meditation, breathing, visualization, progressive muscle relaxation and autogenic training, or the thinking of repeated hypnotic thoughts. 

    Even with these techniques, Smith says the first and most important part of managing mental health and especially stress is to remain mindful of stress levels and be aware of the times when things begin to feel unmanageable so individuals can seek help.

    “People become numb to their own stress in the way we tune out subways, air conditioners” and other white noise aspects of our environments, Smith says.

On the Web:

www.mentalhealthamerica.net