15 Dec Preventative Health Care: Changing the Paradigm
By Bart Magee, Ph.D.
Among the 8.9 million Americans who reported experiencing a mental health problem in the past year, 56% of them got NO mental health treatment. That’s almost 5 million people not getting the care they need. This troubling statistic indicates that we have a long way to go to ensure that people can get needed mental health support. In past posts, I’ve discussed some of the barriers to accessing care (lack of finances, limitations on insurance coverage, etc), but today I’d like to address some of the commonly held ideas and culturally-based myths that keep people from seeking treatment when they need it, that is, before problems become crises.
To this day, many people continue to believe, consciously or unconsciously, that seeking help for a problem of the mind means that one is weak, broken, or crazy. When people encounter emotional problems they can feel tremendous shame associated with the vulnerability and dependency that comes as they realize they can’t handle it all on their own. Shame associated with vulnerability is embedded in our culture and reinforced from when we are children (weakness is teased and bullied) all the way through adulthood. The ideal of the independent, strong, resilient, self-made individual remains powerful in our western culture and is an ideal with a related myth that people should just be born that way. That myth not only makes people feel ashamed when they experience weakness or vulnerability – “What’s wrong with me, why am I so weak, needy, and messy? Why can’t I just pull it together?” – but also negates all the work, help, struggle, and even failure that goes into achieving autonomy. Nobody does it alone.
This also means that many people wait too long to get help. They wait until symptoms and problems become so severe that their functioning is significantly impaired which only makes the recovery process longer and more difficult.
Another way our culture keeps people from seeking mental health care on a more preemptive basis is the way the western medical system has focused its attention on disease and cure rather than on prevention and wellness and hasn’t integrated clinical psychology into general practice. Insurance companies only reimburse for diagnosable conditions and don’t pay for prevention, even when the research shows that prevention pays huge dividends. And people are looking for help. An average of one out of five visits to a primary care doctor is related to a mental health problem and 40 to 50 percent of frequent users of primary care had a diagnosable mental condition and yet mental health services are not integrated into medical practices. Primary care doctors lack the training and expertise to provide treatment. The biological model that western medicine is based on isn’t well suited to addressing mental health problems where the causes of difficulties are a complex interaction of biological, psychological, and social factors.
At Access Institute, we work to address these challenges. In our model of care, anyone can access treatment; a diagnosis is not necessary. For example, we provide care to individuals who may not have a diagnosis of depression, but may be experiencing some signs, or who may be grieving a loss and want to make sure their grief doesn’t turn into depression. Our model is holistic, as we work to understand the complexity of an individual’s experience and we listen for the shame associated with seeking help and work to address it, thereby facilitating the treatment process.
But we can’t do it alone. We are all part of the social fabric and all of us can help to chip away at some of the myths embedded in society that keep people from seeking help. First and foremost, we all can model behavior to those around us that doesn’t shame vulnerability, that recognizes our own weaknesses and encourages reaching out for help. We can speak out and promote the value of personal growth, which is a way of underscoring that we are all imperfect, that at any point in our lives we are fully capable of change, but to do that we all need help from others. Help may come from a friend or a trusted colleague, or from a trained mental health professional. Changing these attitudes can help to change people’s approach to mental health care so that they can become more open to appreciating the wisdom of seeking help early and with prevention in mind.