Studies suggest primary care physicians often neglect to ask a patient about his or her mental health. They're missing a big opportunity.
Results of the Massachusetts Health Quality Partners 2015 patient experience survey indicate that physicians only ask patients about mental health problems about half the time.
But what’s more disturbing is the oversight is much broader than the confines of Massachusetts.
“It’s the same issue that I, as a psychologist, have seen for the past 30 years in practice,” says Richard Citrin, PhD, MBA, and author of the just-released “The Resilience Advantage.” “It’s difficult to talk about mental health issues.”
Citrin explains that there still exists a perception around mental illness, or lack of mental health, as being a type of character flaw rather than a medical condition. He believes it stems from the type of abnormal psychology that students study in a college intro to psychology course, where mental illness is viewed as an all-or-nothing condition.
“If you have a mental illness, you’re really sick,” says Citrin of the perception people have. “You must have schizophrenia or major depression. We haven’t done a good enough job educating people to the idea that things like depression can be mild, moderate, or severe.”
But even mild cases, left untreated, will almost always deepen and worsen, drawing individuals into a more isolated mode.
“Isolation around mental illness is like any disease,” he says. “If you don’t treat cancer, it’s not going to get better on its own. If you don’t treat diabetes, it’s not going to get better on its own.”
Citrin suggests that physicians engage in more conversations with their patients rather than looking at a computer screen and asking yes/no answers. For example, when asked a direct question by a physician, such as “Are you depressed, anxious, or using drugs?” a patient’s default position will be, “No way.”
Instead, physicians can better engage patients by having a discussion with them. Asking open-ended questions such as, “What’s going on in your life?” or “Tell me about some good things that are happening,” can help return that feeling of intimacy and make patients more comfortable opening up.
“By engaging in a dialogue, the physician kind of going in a side door,” Citrin says. “And even while taking blood pressure or checking reflexes, they will gain more insight using a conversational approach rather than checking a box by asking, ‘Are you depressed?’”
And if a patient responds with, “I’m fine,” or “Everything’s okay,” follow up by saying, “That’s great. Tell me about why you’re fine.” Doing so allows a patient more opportunity to fully express what’s going on in their life, and allows the physician to observe within a more normal conversation.
“My experience as a psychologist is people very much want to share what their problems are,” Citrin says.
Recognizing the Problem
A.J. Marsden, PhD, is a US Army veteran who now serves as an assistant professor of human services and psychology at Beacon College. She says that what has helped in better understanding mental health and its causes is the recognition that it has a strong genetic component.
“It has a tendency to run in families, especially depression, anxiety, and schizophrenia,” she says. “When we start to understand that it truly is a chemical imbalance in the brain, that’s when we can start to take action to change how people feel about mental health, and that includes physicians.”
Social media can also be used to help patients. Research conducted by the University of Pittsburgh School of Medicine indicates that the more time young adults use social media, the more likely they are to be depressed. If, through conversation, physicians determine a patient is an avid user of social media, they can use the information to their benefit.
“There are a lot of mental health therapists who use social media as a way to teach their patients different ways that they can cope with stress,” Marsden says. “There are groups they can join on Facebook, and different blogs they can read. It’s important for physicians to be aware of these online resources.”
Marsden suggests that physicians can educate their patients on the importance of mental health, and the importance of understanding that a health mind will help their body as well. Unfortunately, many physicians don’t have the time to educate their patients, but that’s where online resources and social media can help.
“Don’t be afraid to educate,” she says. “That negative stigma is still there. Physicians need to recognize that there is a mind-body connection. If they educate themselves on the importance of mental health, they can better understand their own patients.”