Monday, June 10, 2013

Thoughts on Mental Health Care

Immediately after the events of Newtown and Aurora, there was a national call for better mental health care. It was a part of the healing process for Americans dealing with grief from the loss of children and the idea that even public places like a movie theater are no longer 100 percent safe. It’s a natural reaction, and I think for those across the entire spectrum of experience with mental health service, it was a deeply held conviction.

Now, with a little space between the tragedies that call has diminished. There are some who will still continue to push for reform. There are others who await the next catastrophe to jump on another bandwagon. But for me, I just want to talk about the reason I don't care for the specific language "better mental health care."

First, I lay this on the table: I work in mental health care service. I work for the federal government studying PTSD in military veterans. Our scope is not limited to veterans suffering from war-related illnesses, we also have patients with sexual trauma, from tornado related trauma, accidents, shootings, murders, etc. So, though we have a limited scope of the population we engage, we still hear many voices of PTSD.

Also, since what I do is research based I meet patients interested in our services with other diagnoses like depression, anxiety, bipolar, schizophrenia, schizoaffective, personality disorders. My life is basically a living DSM-IV manual. And I will be frank on this point: the care that I see given to veterans by the providers I work for is amazing. These women (because they are all women) astound me. They are able to disarm these men and women, see through liars, call out malingerers, point families to great resources and help veterans understand their illness.

I know there are a lot of other providers across our hospital that are just as amazing. I also know there are certain providers who give diagnoses or prescriptions that are quite suspect. I also know that some are doing so because they are dealing with, to go biblical for a second, persistent widows; these are vets that beat the path looking for a prescription. I also know that some of these doctors have pet diagnoses; if you go see Dr. So and So, you will eventually be diagnosed as Bi-Polar II. So, I understand that there is a need for better, more accurate mental health treatment.

Another thing I understand is that mental health care is expensive and a lot of people do not have insurance that will cover the costs. Or just as bad, are afraid to seek out mental health coverage because a permanent diagnosis will be added to their medical record that could cause them to lose their job, or prevent them from getting future jobs. So, I know that access to health care is problematic as well.

But I think that beyond those things the bigger issue is a misconception of mental health care. We think that certain people should be locked away. We think that certain people should be given a pill. We think that certain people should be given intensive therapy. We think that some people should be medically induced into a coma the rest of their lives. In other words we have all of these theories based on our experience with a homeless guy who freaked us out once, or an aunt who has seasonal depression, or this teenager who shot up an elementary school. In other words, we just aren't fully informed. So to call for an overhaul of a system without full understanding is scary to me.

I think the overall state of mental health care provision in America is pretty great. I think, just as there are good teachers and bad teachers, good bankers and bad bankers, we have good providers and bad providers. I think many people aren't educated enough to really know the difference. I know that there are many wastes in care partly because of inefficiency on our part, and partly because there are people who either don't have words to explain what they are feeling, are faking symptoms, or who think we need a pill immediately any time there is something wrong with them.

One of the doctors I work for recently relayed the story of a social worker who did a house visit and asked for X,Y&Z to occur. She reported back to the social worker the history of treatment for this particular patient and ended by saying, "They are just dulling their pain, and sometimes pain is the indicator that we need to do something different. I will not do X,Y&Z because this patient does not want to change...they want an excuse."

What can come across as callous was really a simple statement saying, some people don't understand the purpose or the point. Some people do not want to be better. I think this is a relatively small part of the population, but it needs to be acknowledged.

But on the flip side of things we also have a large part of the population like your Uncle Joe. Joe probably has been depressed or anxious for decades. He has never let anyone know as such and has been compensating for a long time. Some of his dealings could be greatly helped by one or two trips to a mental health provider, but fear, skepticism, lack of funds, or whatever the reason keeps him from getting help. It's just the reality of things. Doctors cannot heal the things they don't see.

And there are the rest of us. Sometimes we have things that we can’t sort out. Sometimes there is something wrong with our pituitary gland. Sometimes anniversaries mess with our mind. Sometimes Christmas is sad…every year. There are all of these things, and sometimes what we need is a listening ear. Sometimes we need medicine. Sometimes we need to work out and change our diet. Sometimes we need to just be honest.

In other words, we need good providers who can call us out on something…and we need to be able to believe them. And that is where I think we are at with this thing we call mental health provision.

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