When it comes to America’s escalating epidemic of psychological disorders, odds are you either know someone or you are someone.

One in five adults have a mental health condition — which can range from post-traumatic stress to chronic anxiety to bipolar disorder — equivalent to more than 46 million Americans — spanning all ethnicities, geographies and economic classes.

Suicide rates have risen steadily throughout the century and now stand at the highest levels in 78 years — levels not seen since suicides spiked during the Great Depression and World War II, according to the U.S. Centers for Disease Control and Prevention. Suicide has become the nation’s second leading cause of death between the ages 10-34 (behind “unintentional injury” and ahead of homicide).

Among the nation’s youth population, rates of severe depression have increased to 8.7 percent from 5.9 percent in the latest available five-year period, according to the nonprofit advocacy group Mental Health America. Of the 50 states, Wisconsin ranks 47th highest in the share of youth with at least one major depressive episode in the past year.

That data is getting particular attention as Wisconsin has ramped up its efforts to address neurological trauma, which has emerged as a leading cause of mental illness, depression, suicide and post-traumatic stress disorders. Those involved in trauma-responsive care, or trying to advance it, are confronting this question:

Why do potentially fatal afflictions that affect so many people consistently fail to attract government or philanthropic funding that comes anywhere close to addressing the scale of the crisis?

The question gets more urgent as cases of mental illness proliferate.

“Mental health care continues to be severely underfunded,” said Jon Lehrmann, chair of psychiatry and behavioral medicine at the Medical College of Wisconsin.

Government reimbursements for mental and behavioral health services are 19 percent to 22 percent below payments for conventional medical or surgical care, according to the Seattle-based Milliman Inc. research group. That makes it a struggle for health care providers to justify offering those services even as the same funding imbalance also puts downward pressure on salaries for mental health practitioners.

“I struggle to hire psychiatrists,” Lehrmann said.

The shortfalls are glaring in Wisconsin. Of Wisconsin’s 72 counties, 48 lack even one practicing child psychiatrist, according to the American Academy of Child & Adolescent Psychiatry. In 2017, Wisconsin ranked 49th out of 50 in the share of youth with at least one major depressive episode who did not receive mental health services, ahead only of Tennessee, according to Mental Health America, which relies on the government’s best and most recent surveys.

“Nationally, we see mental health trends worsening,” said Michele Hellebuyck, a public policy adviser at Mental Health America.

Trying to explain the chronic funding shortfalls, many point out that the epidemic by its nature is invisible.

Much of the data showing the prevalence of mental illness is relatively new — and the data itself is so extreme that they might defy credibility if the numbers weren’t as consistent as they are staggering. The National Institutes of Health, for instance, estimates that 14.4 million Americans will be diagnosed in their lifetimes with post-traumatic stress disorder — nearly all inflicted by nonmilitary violence and abuse — more than twice the population of Wisconsin and more than all but four of the 50 U.S. states.

What’s more, mental illness comes with its own stigma and shame that silence many who suffer. “Stigma is an oft-cited reason for why mental illness does not draw as much attention as other health conditions,” according to the Chronicle of Philanthropy, a magazine that covers the nonprofit world,

“As a society, we don’t value these services as much as we value services that help people recover from physical illnesses despite the fact that very few families don’t have some sort of mental illness or substance abuse problems. It’s a paradox,” said Pete Carlson, president of the Psychiatric Hospital and Behavioral Health division of Aurora Health Care.

Devoted to mental health

Both Carlson and Lehrmann sit on the scientific advisory board for the Charles E. Kubly Foundation, Wisconsin’s only philanthropic nonprofit dedicated to mental illness, suicide prevention, access to treatment and projects meant to reduce stigma.

The Kubly Foundation is small by almost any measure although it’s incessant activism has given it the prominence of better-funded nonprofits. In the 15 years since its founding, a skeleton crew has raised and disbursed $2.3 million to 273 community-based projects, many for training efforts and community groups.

“I can’t find any other foundation in the state that’s strictly devoted to funding mental health initiatives,” said Ann Homstad, the foundation’s executive director. “If there are others, I want to meet them right away. They would be my new best friend.”

The genesis of the Kubly Foundation, in its current form, began at the University of Wisconsin-Madison in the 1950s when four undergrad students began a lifelong friendship — Michael Kubly and his wife-to-be Billie Wenger, and Michael Schmitz and his wife-to-be Jeanne Berry.

Fast-forward to 2003 when 28-year-old Charlie Kubly took his own life after struggling with depression. His parents threw themselves into a philanthropic mission, helped by funds from the Kubly family’s cheese business in Monroe, Wisconsin.

In addition to the foundation, the Kubly’s separately created an endowed academic position at the Medical College of Wisconsin, currently held by Lehrmann. They gave $5 million to Marquette University to establish the Charles E. Kubly Mental Health Research Center. They funded counselling programs at Rogers Memorial Hospital in Oconomowoc and Mount Mary University in Milwaukee.

Michael Kubly, an orthopedic surgeon, died in January at age 82.

The Schmitz family, meanwhile, had been living with its own grief. In 1981, their son Joey took his own life at age 19 as a college freshman. This year, 37 years after Joey’s death, his parents gave $500,000 to the Kubly Foundation. Rather than turn around and disburse it with a quick pop of philanthropy, the foundation will create an endowment to generate just enough annual interest income to stabilize operations from year to year in a sector known for volatility, Homstad said.

Following the lead of the Kublys, the Schmitz family separately endowed a $1 million Depression Research Fund at Marquette University. With the Marquette donation, they issued a statement: “Research for cures for depression is woefully underfunded as compared to other serious illnesses.”

Generation to generation

The economic costs of the epidemic are nearly incalculable because widespread mental illness creates widespread workplace disability. Chronic depression weakens the ability to focus in school, work, sleep, maintain self esteem or manage relationships. According to the World Health Organization, mental illness accounts for more disability in developed countries than any other group of illnesses, including cancer and heart disease.

Economics frequently are cited among the factors that drive the worsening epidemic, which in turn undermines the economy further as the epidemic widens.

Data collected around the world show that financial distress and economic disruption are closely linked to suicides of working-age adults. Because depressive symptoms are most common among those with chronic financial stress, “those with a greater need for treatment cannot afford it,” according to the 2018 Mental Health America report.

The downward spiral of financial distress and mental illness often perpetuates from generation to generation. That dynamic is documented in surveys called “adverse childhood experience” questionnaires, which ask about exposure to traumatic violence, neglect, abuse, drugs and alcohol while growing up.

The results of the ACE surveys, as they’re known, are consistent: childhood trauma leads with statistical predictability to mental illness as well as a cycle of poverty.

A report last year by researchers from the Centers for Disease Control, which has collected ACE data for the last ten years, summed up the findings:

“Exposure to childhood adversity has an impact on adult mental health, increasing the risk for depression and suicide.”

The National Suicide Prevention Lifeline is a free confidential support network if you or someone you know is having suicidal thoughts call: 1-800-273-8255.

This article originally appeared in the Milwaukee Journal Sentinel written by John Schmid.