It seems almost everyone in Hawai'i is hoping for big changes in 2010. There is hope for the economy to improve, for the unemployed to find work and for our brave servicemen and women to return home safely.

Next year, a decade after the surgeon general's report on mental health revealed that mental illnesses are as treatable as physical illnesses, there also appears to be hope for people with mental illnesses. The health care reform legislation being debated in Congress includes historic provisions to expand health coverage and significantly improve access to mental health and substance use disorder treatment services.

Health care reform in Hawai'i and across America is as much an economic issue as a moral one. The economic, social and human costs of mental health and addiction disorders in the U.S. are enormous.

Mental illness drains our economy of more than $80 billion every year, accounting for 15 percent of the total economic burden of all disease. Alcohol and drug abuse contribute to the death of more than 100,000 Americans and cost upwards of half a trillion dollars a year, while a quarter of all Social Security disability payments are for individuals with mental illness.

Demand for mental-health and substance-use treatment is up just as state budgets for these types of services are being severely reduced. Due in part to the current economic turmoil, community mental health and substance use treatment centers nationwide are experiencing a 20 percent increase in demand for services, according to a recent survey by the National Council for Community Behavioral Healthcare. At the same time demand is increasing, at least 32 states, including Hawai'i, are known to be enacting funding cuts — reducing services and closing programs.

One of the most crucial components of the health care reform legislation now being debated is the concept of parity. The bill includes the principles contained in the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, the federal law passed last year that prohibits unequal treatment limits and financial requirements for mental health and substance use treatment. The parity provisions are essential given that mental health and substance use treatment have traditionally been subject to blatantly discriminatory limits on coverage that restrict access to effective and, at times, lifesaving therapies.

Millions of Americans have mental health and substance use disorders and many still do not have access to treatment. Unlike most physical disorders, these conditions start at an early age and often go untreated until the illness becomes debilitating. The delay in treatment often interferes with a young person's ability to succeed in school and in the workplace. As a result, many people with mental health and substance use disorders are unemployed or work in low-paying jobs without health insurance and they will greatly benefit from expanded insurance coverage.

While health care reform is not a panacea for people with mental illnesses and substance use disorders, it takes groundbreaking steps in the right direction and may help stem the escalating death rates of people with serious mental illnesses. People in the U.S. with schizophrenia, bipolar disorder and other serious mental illnesses die years sooner than other Americans. Three out of every five people with these types of mental illnesses die from preventable, co-occurring chronic diseases such as asthma, diabetes, cancer, heart disease and cardiopulmonary conditions.

As we enter 2010, the tragic fact remains that a majority of Americans with mental illnesses and addictions do not get treatment. Health care reform holds the promise of greatly increasing access to mental health and substance-use services. Reform will finally open the treatment doors for some of the most vulnerable citizens in our society, and Aloha House, Maui Youth & Family Services and Malama Family Recovery Center will be ready to help them lead full and productive lives.