Mental Health is Medicine’s Second Fiddle

Why does mental health always play second fiddle to health concerns?

From ERs to health insurance reimbursement, mental health concerns always seem to get the short shrift. Nobody cares, nobody pays them much attention. Mainstream family physicians and medical doctors nearly always look at a mental health concern as something akin to a rare STD or skin condition, and always seem somewhat uncomfortable talking about them (“It’s all in your head!”).

And yet, the facts remain the same — mental health concerns affect more than 1 in 10 Americans in any given year. This is no small number. There is no other condition that is so prevalent and yet is so widely scorned. Ignored. Lost. Forgotten.

Year after year, little changes. When I speak to my medical brethren, I often feel like the token mental health professional on the panel or in the group. Something akin to, “Oh yeah, John, he represents mental illness, you know, that stuff that isn’t really a medical problem.”

This could be all me and my own insecurities. It would have nothing to do with the comments I’ve listened to over the years from medical colleagues…

• “ADHD isn’t real, just parents who don’t know how to parent.”
• “Are you kidding me about so many people feeling depressed? That’s not a disorder, that’s just life.”
• “Isn’t that all just genetics now?”
• “We’re making such great advances with neuroimaging, it’s just a matter of time…”
• “I just prescribe an antidepressant and usually that seems to work.”
• “They still reimburse for psychotherapy? Huh.”

Yeah, they do. They still reimburse for psychotherapy, one of those empirically proven methods for treating mental disorders. While psychiatric medications can be an important treatment component for many, any doctor who stops there should lose their license. Neuroimaging is just pretty pictures at this point that has told us little of real-world value. No, mental disorders are complex, biopsychosocial disorders that are not caused by genes. Genes may be part of that complex equation, much like a single college class helps you score higher on the final exam — but sitting in a single class out of 36 classes won’t really help you pass it. Depression is a real condition and isn’t just “life.” And yes, so is ADHD, even though some parents really are just bad parents (watch any episode of SuperNanny to see that; parenting manuals should be required reading before breeding).

There are no easy answers here — mental health is the awkward stepchild you sent away to the state hospital in the country and visited once a year. When you did visit, you brought some generic gift that could’ve been for anyone, and when you left, you didn’t think about her again for another year. That’s how the health care industry and medicine in general treats the behavioral health professional and people with mental health concerns. We’re the awkward profession that doesn’t really “fit” with the traditional medical model.

And that’s really just fine with mental health professionals. We know our stuff, we know mental disorders are real and professionals on the front line treat this every day. Millions of Americans deal with these very real disorders every single day of their lives. And the best thing that the medical profession can do is recognize the importance of mental health concerns in all of our lives, refer when needed, and remember that it is all very, very real.