When the Brain is Dis-eased, We Look the Other Way

Why do we hear so little about mental health issues, and when we do it’s only related to some bad news story? Truth is most mental health issues are not newsworthy. If there is a “story” to be told, it is about how hard it is for those with mental illness to find good care with supportive psychiatrists and counseling services. Statistics tell us each one of us knows someone suffering from depression or schizophrenia or bipolar disorder or other mental health issues.  Approximately one in five adult Americans meets the criteria for having a mental health disorder.

What we know about these friends or family members is that they are mostly peaceful individuals who can’t cope in our day-to-day world. Yet we know they suffer, and usually without the professional support of doctors, nurses, counselors or community. In fact, the majority of people suffering from mental health issues do not receive any treatment for their symptoms (Health Affairs, Measuring the Need for Mental Health Care). The reason for this is that no straightforward relationship exists between the presence of a mental disorder and help-seeking behavior, unlike say, a patient who has chest pain will seek help regarding their heart condition (Archive of General Psychiatry).

Perhaps some of the reason people with mental illness shy away from treatment is that they often report encountering negative attitudes among health care staff about their prognosis. Couple that with the accumulating evidence showing that in primary care there is a high degree of under-recognition, under-diagnosis, and under-treatment of conditions such as depression, anxiety disorders and alcoholism means we have an "opportunity for improvement" in this area. (Health Affairs, “Treating Depression and Anxiety in the Primary Care Setting”) 

I have a relative with mental health issues and I can tell you there are many “opportunities for improvement,” which is a euphemism for “C-“  health care.  A few years back, this relative was hospitalized in a very elite hospital for his mental health condition. I was hopeful that he would get good care, meaning, be placed in a well-resourced hospital unit, with smart and attentive professionals who would easily manage the complex issues of medication therapy, transition to a treatment center, and coordination and communication with those involved in his care.  However, when I got to this medical center the behavioral health unit was stuck in the 1960’s complete with a black and white small TV.  (Though in contrast the cardiac unit had the most amazing technology one could ever imagine.)  Additionally, this hospital failed to truly recognize the unique care needs of my relative, thus sending him home to an abusive partner.  In the end, nothing changed and nothing got better for my relative.  Sadly, the hospital under-recognize my relative’s need for ongoing and supportive therapy and failed to bring in appropriate family members to truly achieve care concordance.  

This population is at particular risk of disenfranchisement from the general community and within the health care community as well.  This is the saddest part of it all, since unlike someone with cancer, who’s mass can be measured, and who’s hair falls out with chemotherapy, you cannot see depression or bipolar disorder.  So we just “blame the patient” for their behavior in a way we would never do with someone with cancer or heart disease.

We all know someone who has depression or anxiety or substance abuse or bipolar disorder, or the like. Yet we don't talk enough about the difficulties or advocate harder to change the health care system. 

There is a problem in our midst, and it touches all of us. We need to demand better from our healthcare professionals and institutions.  And we need to not feel stigmatized by having someone in our lives with mental health issues. 

We need to do two things to truly change mental health care. First, become zealous advocates for improved mental health services and second, expect more from the health care community.  We would not accept this level of poor coordination and collaboration for someone diagnosed with cancer, why do we accept it when someone is plagued by an illness that affects the brain?