Guest editorial: Are we fooling ourselves about mental health progress?
Are we living in an era of enlightenment about mental health — or are we fooling ourselves?
We might have to answer in the negative when we consider the progress other health professions have made. Unlike most other health fields, we are usually in crisis when we contact a mental health professional. Yet, many mental health risks provide ample warning: 50 percent of all lifetime mental health disorders start by age 14. The average diagnosis of a mental health disorder usually occurs 10 years or more after the onset of first symptoms.
Why is mental health treatment nearly always a rescue operation?
Medical and dental wellness are well-integrated into professional practice and insurance policies. Early detection through routine checkups is a cornerstone of cancer medicine. A routine blood test is chock full of checkpoints for early detection of disease. The six-month dental checkup is an icon of American culture.
Why is mental health missing the wellness boat? Most people think of going to a mental health professional only when things get “really bad.” One of the main fallacies about mental health is that only negative events cause risk. Another is that we should be able to cure ourselves. Despite major contrary evidence, people and institutions still tend to believe these things, and attitude change is happening slowly.
Life is a roller coaster of positive and negative changes, all of which cause stress: children are born, children grow up and leave home, parents get older and sometimes ill, friends move and new friends arrive, jobs are lost and found, bank accounts rise and fall. The concept of a periodic “mental health checkup” is a powerful recognition that mental health issues are unpredictable, often escalate slowly, and need professional expertise.
Checking in with a mental health professional once a year, even if nothing is “wrong,” is a way to gain new coping strategies, identify coping strategies that no longer work well, and prevent the suffering that mental illness entails. Regular screening would also help identify periods when we are “stuck” and don’t understand why, would help set goals and keep us moving forward in our sense of ourselves and our happiness.
Insurance may not pay for this service currently, but remember that insurance in the not-too-distant past did not pay for physical therapy, chiropractic treatments or acupuncture for example. Patients saw value in these treatments, paid out-of-pocket for the services and over time the insurance companies came to see the benefit of preventing problems rather paying for them later.
There have been small advances in establishing a mental health checkup practice. Some physicians and networks use the PHQ-2 and PHQ-9 self-administered depression screenings. The Medicaid Early and Periodic Screening Diagnosis and Treatment Law and The Mental Health in Schools Act of 2015 include screening, early identification and treatment for young people, but these received limited state adoption and are currently the target of cutbacks. Bottom-up demand from patients seems to be more effective than government action in establishing medical convention.
My recommendation to readers: If you’ve had helpful treatment from a mental health specialist in the past, check with them about the possibility of doing periodic checkups, whether covered by insurance or not. If you’ve never had treatment, ask for a referral from your physician or health network to a professional, and have the same discussion.
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