In the U.S., we had a sad, embarrassing time in our recent history where a large swath of our nation treated one race as “separate but equal.” This was particularly true for African Americans in the South, where they were socially segregated — from lunch counters to riding the bus. At one time, most (white) Americans seemed perfectly okay with this form of discrimination, prejudice, and stigma.
It took a 42-year-old woman named Rosa Parks (and others like her) to change things in America. But it also took time; change didn’t occur overnight.
In some of the same ways, mental health care in America suffers from the same “separate but equal” in our healthcare system. Mental health treatment is conducted in a parallel system that is often disconnected from regular medical treatment.
Because of this, patient care suffers.
I believe it’s time to lead a revolution in mental health care in America.
When I began grad school in 1990, one of the first things that struck me about learning about mental disorders and their treatment was that we operated in a system cut-off from normal healthcare. Treatment teams and our training weren’t based in a hospital, but rather in “clinics,” where the only medical staffer was the psychiatrist.
Arguably, this is all just fine. Mental health care doesn’t involve a lot of traditional medical care, and the only medical treatment given is the prescription of psychiatric medications. Most mental health care in clinics revolves around psychological treatment — typically individual and group psychotherapy.
This disconnect hurts not only the mental health care system, but most importantly, the patient themselves. That’s because when doctors talk about a patient’s care, their mental, psychological and emotional health is so often just an afterthought. A psychiatric prescription may be written (most antidepressants are prescribed by family doctors and internists, not psychiatrists), but little effort is made to ensure the patient gets into that “other” treatment system — the mental health system.
For instance, physicians spend enormous amounts of time trying to impact patient behavior change, with little understanding of the psychological processes that are at work. Therefore, many physicians’ orders and prescriptions are ignored, or tried for a few days and then abandoned. Physician follow-up rates with such orders and prescriptions are embarrassingly low.
If we worked within an integrated care system, physicians would hand the patient off to the behavioral specialist, to tailor the physician’s orders to each individual’s lifestyle and personality.
Some healthcare systems are — in 2012 — only beginning to “get it.” They see that when behavioral specialists — like psychologists — are a core component of the treatment team, patient outcomes improve. Not just mental health outcomes, mind you, but physical outcomes as well.
America can and needs to do better. There’s little reason — outside of special interests — these two systems can’t be better integrated with a focus on holistic patient care. “Separate but equal” didn’t work in America’s history. So there’s no reason to accept that the future of mental health care has to remain isolated from the usual healthcare system in the U.S.
