The approach to healthcare in the US

In continuing my recent post about my son, I thought I would write on another issue regarding those impacted by suicide. I was greatly disappointed at the care (or lack thereof) during my recent annual physical. I decided to provide my feedback to the clinic system and, here's the response I got - it's the classic 'thank you for your feedback, we have no actual intention to do anything about it". So, as we continue to see the rising numbers of Millennial men completing suicide, and parents, family, friends and colleagues being impacted by it, the medical community shows a surprising lack of concern. My original email to them is below their response:

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Good afternoon,

Your concern has been forwarded to the practice leadership of Family Medical at [medical practice name] for review. If you would like to discuss further please contact (phone number).

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And, my original email message to them:

Recently, I attended my appointment for my routine annual physical at the [specific clinic name and location]. I wanted to bring to your attention a concern I have about how the staff approach the mental health questionnaire that seems to be a routine check-box exercise at the beginning of every appointment. The list of questions are quite straightforward and I am assuming are designed to ‘check-in’ and tick a box as far as recognizing mental health as an aspect of physical health.

The concern I have is that the staff seem unprepared (uneducated?) on what to do if someone says ‘yes’ to the question that a mentally health person would say ‘no’ to. As a case in point, I recently lost my son to suicide. When the question came up ‘have you been sad or depressed in the last month?’ (Forgive me if that isn’t verbatim); I decided in the moment to be honest and said, “Yes, my son died last month, so I have been sad and unhappy.” The nurse looked up briefly, said “Oh, that’s sad” and continued with the next question. When the NP came in to do my actual physical, she first asked me to verify I have two children which caused me to pause, because I am still new to this and am uncertain how to respond (do I say “I HAD two children, now I have one” or do I say, “Yes, I have two children, though one is now in heaven” Or, do I just continue to say I have two adult children?). I finally ended up saying, “Two, but my son died, so one?” She asked me how he died. I can be somewhat blunt, and so I said, “He killed himself.” She raised her eyebrows, commented that she had a friend or relative whose nephew had done likewise, and carried on with the appointment. Also note that I told both that I live alone (e.g. I am dealing with a traumatic event by myself, and neither would have known whether I have any friends or family nearby since that was not in the questionnaire, and they did not ask).

This response, or lack thereof, frustrated me. In my case, I am very fortunate to have received incredible support from the local coroner’s office in Frisco, Texas where my son lived. They have provided my contact details to two local charities that support parents whose children have died by suicide. I’ve already received several mailings and a phone call to talk through the services they can provide to me virtually since I live in PA. I also have a great network of friends and family (albeit not in the Delaware Valley) who are checking in with me frequently and offering all kinds of support. So, my concern is with the ‘what if’ – what if I didn’t have support? What if I had no close friends or family? What if I am not ok? I expected that one of them at minimum would have asked, “Do you need help? Are you ok? You live alone, do you have friends or family nearby?” Of course, my health insurance plan offers mental health benefits, but there was no question about whether I knew how to access those benefits or if I needed a referral to a mental health provider. No, it felt like their attitude was ‘let’s get through these mandatory questions and move on so we can stay on schedule.’

I do not think there is any value whatsoever in asking questions about a patient’s mental health if there is no intention to do anything with the answer. It makes me wonder if someone says ‘no’ to the ‘do you feel safe at home?’ question whether the response is the same, ‘Oh, that’s too bad,’ and we carry on with what we’re actually here to do (weight, blood pressure, check your lungs and go over vaccinations or blood work that needs to be done). At minimum, there should be brochures about mental health topics that can be readily provided, or a list of resources, or a ‘cheat sheet’ on how to take advantage of free or health insurance provided mental health benefits. Instead, I left the office wondering what the point is to these questions; is it truly a check-box exercise where you can say that you verify that patients are mentally healthy without actually doing anything? Maybe if I had broken down crying the response would have been different, but I’m not entirely sure that would be the case.

I am not interested in ‘getting people in trouble,’ and am not asking for any kind of ‘slap on the wrist’ or disciplinary action to be taken. What I am asking is that you evaluate how you ensure a patient who actually decides to be honest and answers those questions indicating that they are dealing with a crisis, trauma or other mental health issue get some kind of follow up. I understand that ‘physical’ health professionals often know about as much about dealing with mental health as the average ‘man on the street,’ but it doesn’t mean that it is helpful or valuable that you give them a list of questions to ask that they are unequipped to deal with when the answer is not ‘everything is great!’ As a career Human Resources executive, I caution companies about having managers asking questions about an employee’s mental health for this exact reason – they are unequipped to deal with the answer, unless you provide specific training. Given my profession, I am educated on a variety of topics and know how to advise employees, whatever their mental health challenge is (though I am not trained to ‘do’ anything about it, I have a wealth of information at my fingertips for when I find out through a manager, coworker, or the employee themselves that they need help). My EAP can help managers on how to broach the topic, but I find most of them just encourage employees to come see me. Fortunately, I have good relationships with employees and most of them trust me enough, they seek my counsel. However, not everyone is so fortunate to have competent HR people at their fingertips.

I am hoping that this letter will lead to some internal changes where you can at least have a standard list of ‘resources’ to give to a patient when they indicate they might possibly need help. There are so many charities, local organizations and agencies that offer support on mental health issues, I am certain you can find a low-cost, no-cost way to at least do something with a negative answer to the mental health related questions being asked. Even in the case of someone like me, where I appear to be ‘fine’ and would likely say I have enough support, how can they know for sure it’s true? Maybe, I’m just biting my tongue and telling them what they want to hear. So, providing a list of resources could allow me to go home, process the need and ultimately reach out if/when I need help.

Sincerely,

Jeannine Stearns