It’s no great controversy to declare mental illness a genuine public health epidemic. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), mental disorders and drug addiction will surpass physical ailments to become the leading cause of disability worldwide by 2020.
Despite that alarming prediction, health care isn’t nearly as preoccupied with preventative medicine for mental health as it is for tangible illnesses. Patients are referred for routine colonoscopies, breast cancer screenings, and regular blood work, but comparatively few are screened for signs of psychological abnormalities that could have serious personal, financial, or even legal consequences. Primary care referrals to mental health professionals are often only performed after a patient begins to present with advanced symptoms.
Mental health detection falling short today
It’s clear that system isn’t working, with earlier intervention being ideal. For that to happen, more medical professionals will have to invest in the idea that mental health screenings are just as important as checking blood sugar and blood pressure.
“We’re not considering mental health part of health,” says Ruth C. White, Ph.D., a clinical associate professor in the Suzanne Dworak-Peck School of Social Work at the University of Southern California. “Why are we separating the body from the mind? Why is the brain going to be any different?”
An estimated 9.8 million adults have a mental illness, an often-chronic condition that could range in severity from anxiety to schizophrenia and beyond. Often, they seek help after a prolonged struggle that has allowed the condition to take root.
“With anxiety and depression, people don’t just wake up all of a sudden not wanting to get out of bed,” White says. “Feeling sad, feeling stressed, feeling underwhelmed, all of that happens before depression fully sets in. With anxiety, you don’t wind up in the emergency room with a panic attack on day one. When and if you do, you think back and go, ‘Okay, work has been crazy, the kids have been giving me problems.’ There are signs.”
Changing course for early intervention and preventative care
Despite the proliferation of symptom checkers and other online resources, people may not be able to recognize these symptoms as easily as they catch an obvious physical anomaly like being short of breath or experiencing pain. As a result, they miss a window of time when an early diagnosis could lead to more effective treatment. Or, a physician may take it upon themselves to prescribe a medication when more tailored treatment may be warranted. “Saying you’re depressed and getting pills doesn’t mean you’re good to go,” White says.
Logistically, people may not make time for a preventative mental health evaluation in the same way they do for annual physicals, which is why White and other advocates for screening are looking to primary care settings as the first line of defense. “There are some simple questions physicians can ask that take perhaps five minutes and can help detect warning signs,” she says. “Things like how a patient is sleeping, if they feel stressed, if they’re socializing, if they’re exercising. That can be done right in the office, and the physician can then refer the patient out if necessary.”
Those annual physician visits might not be perceived as frequent enough to catch signs of mental issues, but many disorders can take as long as two to four years to manifest before they suddenly become a life-altering interruption.
Moving in the right direction
Two major obstacles get in the way of that kind of preventative intervention, however. For the patient, mental health can often feel like a stigmatizing issue and one they’re reluctant to bring up on their own. For the physician, it’s the perpetual need to keep watching the clock. “Doctors have a lot to cover in the 15 or 20 minutes they get with a patient,” White says. “The way health insurance is billed and the time allotted, they don’t feel like they have time.”
Ironically, the same health care system that prioritizes efficiency and conserving money is the one paying the most. SAMHSA estimates that for every $1 spent on early intervention, $2 to $10 could be saved on more complex treatment, work absences, or even legal costs as a mental condition spins out of control. “It’s to their benefit,” White says. Medicare agrees: the policy allows for one annual depression screening to be covered every year.
Fortunately, things appear to be moving in the right direction. In 2016, the U.S. Preventative Services Task Force released a recommendation that all adults and children over 12 be screened for depression as part of their health care. Social media hubs like Facebook and Instagram recently instituted algorithms in their software that track keywords and are able to discern emotional changes in users that may be hinting at a desire to inflict self-harm. It’s no substitute for medical care, but the novel nature of the data leads to increased media scrutiny over mental health resources. Additionally, more employers are instituting programs that attempt to detect changes in productivity, offering help when indicated.
“I feel there’s a cultural shift taking place,” White says. “’Emotional resilience’ is a term that’s been coming into use. Mental wellness is a thing people want. And I think we’ll get there.”