It’s no secret that there is a crisis in the healthcare system in America. This is old news. In fact, it’s not even news anymore. It’s starting to become just “the way it is”. Behavioral healthcare, as health insurance providers like to call it, is an even greater problem. What is behavioral healthcare? As one hospital staff member explained it to me, “If it doesn’t make you sick or require surgery, then it’s not really considered an illness by the hospital and we refuse to bill insurance for it.” This is where “behavioral health” comes in.
Behavioral health refers to biologically based mental health disorders and mental health in general. Any disorder that can be found in the DSM-5 falls under “behavioral health”. In my city, there is a Behavioral Health Emergency Room. If you or someone you know is experiencing suicidal ideation, then go to the Behavioral Health ER. When Grace stabbed herself with a fork, we took her there. If a person with a mood disorder were to suddenly begin rapid cycling, then they would go to the Behavioral Health ER. Anyone struggling with psychosis, mania, clinical depression not responding to treatment and in need of immediate care and the like would go to a Behavioral Health ER. These disorders are, in fact, all manifestations of neurological disorders that are treated under the psychiatric specialty rather than neurology. They are, however, still medical in nature and, therefore, require medical attention. Why is the opinion even in the medical community otherwise? Does it really matter?
When hospital staff so brazenly declare that mental health disorders are not medical in nature and, therefore, will not bill health insurance for them, they are perpetuating the stigma surrounding mental illness. Schizophrenia spectrum disorders are neurodegenerative and neurodevelopmental in nature. They are the definition of “medical”, and yet staff members in hospital billing departments still maintain a belief that this cluster of disorders represents something more like Dissociative Identity Disorder (DID) or just bad behavior brought on by a combination of stress and poor distress tolerance. What is the likelihood that a person experiencing psychosis will seek medical attention then if hospital staff are untrained and ignorant? What is the likelihood that hospital staff will show respect to patients struggling with psychosis, mania, or depressive symptoms if they believe that it’s “all in their head” and with some real effort these patients could simply heal themselves?
What perpetuates this stigma within the medical community itself? Let me give you an example from my own community. I’ve written a few posts on my ex-husband’s anxiety disorder. He has struggled most of his life with almost crippling anxiety. Persuading him to overcome his anxiety and see an internist just for a physical examination in which he could also inquire about anxiety treatment was a huge success. It took 16 years of convincing. When he asked for a list of psychiatrists from his internist, the clinic gave him a list of recommended psychiatrists all of whom were no longer taking patients due to either being retired or dead. This clinic had not bothered to keep their list of psychiatrists up to date! They certainly keep their other lists of recommended specialists up to date. Are they giving men and women lists of recommended oncologists who have died and/or retired? Doubtful. This is profoundly troubling since, on average, twice as many women die by suicide annually than they do from breast cancer. Three times as many men die by suicide annually than they do by prostate cancer. And, yet, we are surrounded by charities and reminders that breast cancer kills, and we should do something about it. I agree wholeheartedly. Men should get physical exams and take care of their bodies. But, a well-known clinic can’t be bothered to maintain a list of psychiatrists so that their patients can receive psychiatric care and follow-up? Why?
Another large and well-known mental healthcare service provider in my area sent out a letter two weeks ago stating that they would be discontinuing their psychiatric services. Period. There was no list of local treating psychiatrists who current patients could call in order to maintain their current level of care. Just a notice of “We’re closed for business. Good luck getting those meds filled.” This is shocking. Psychiatry is a medical speciality. Patients under the care of a psychiatrist are receiving specialized care, and it borders on unethical to suddenly stop care without transferring that care to another physician or, at a bare minimum, providing a list of physicians who are taking new patients. This attitude, however, is prevalent within the medical community itself, and this is what perpetuates the stigma within the medical community. If doctors, therapists, and administrators themselves believe that behavioral healthcare is simply optional and not vital to the health and well-being of their patients, then what does this say about the medical community’s view of mental health? A person receiving treatment for Multiple Sclerosis would not simply receive a letter from their neurologist stating, “I’ve decided to drop you as a patient. Good luck finding care elsewhere,” but patients with diagnosed mental health disorders are treated like this quite often by their own mental healthcare providers. Why?
I think that the medical community is caught between two views–the old and the new. Animal models are showing that most mental health disorders from depression and OCD to bipolar disorder and schizophrenia spectrum disorders are biologically based meaning caused by the enteric or primary nervous system. The research is consistently pointing to the gut or the brain. It is an exciting time to be a neuroscientist. Deficits in the function on a brain level often manifest behaviorally, however, and many people–even doctors–are very uncomfortable with unusual behaviors. It’s easy to blame trauma and shove someone out the door. Even trauma, however, becomes brain-based as the success of treatments like EMDR are showing.
We are socially conditioned to feel ashamed when we feel anything but happy and good about ourselves. If you don’t feel happy, then pull yourself up by your bootstraps! Exercise. Change your diet. Lose weight. Get a makeover. Go for a walk. This might work if you don’t have a biologically based mental disorder, but who, within the medical community, is willing to consider this? Furthermore, who is willing to consider that a child might have bipolar disorder or a schizophrenia spectrum disorder? What physician is willing to say that bipolar disorder, for example, is as serious as cancer and deserves the same amount of attention and care? The number one cause of premature death among those diagnosed with bipolar disorder is suicide with 15-17% taking their own life and up to 50% attempting suicide at least once due to the negative symptoms of the disorder. These are shocking statistics, and I don’t think most physicians consider this. Until the medical community at large is able to take mental health seriously–as seriously as it takes cancer and heart disease–there will be a lack of quality care and treatment for people struggling with mental health disorders. Perhaps then we’ll begin seeing sparkly new hospital wings dedicated to mental healthcare right next to the breast cancer and heart surgery wings.
That will be a good day.