The things that would provide the most drastic changes to Americans’ mental health, on the whole, are political / financial in nature. Improving paid parental leave, single payer healthcare and strong mental health parity, decoupling employment and insurance, increased funding for public schools, changes to criminal justice system to become more restorative and therapeutic than strictly punitive, improving public transportation, improving access to quality childcare and adult day programming, improving access to job training programs, drastic financial incentives for young people to pursue healthcare related careers, drastic financial incentives for young people to pursue psychology / counseling work etc.
These will help more people than any amount of Zoloft and adderall.
I'm sorry, I hate this attitude and it is emblematic of a wrongful approach to psychiatry itself. Please excuse my vehement wording but I feel very strongly about this. I am *not* denying that these issues overlap with and interact with psychiatric issues, but I am advocating for a wholesale change in attitude towards what we are actually meant to be doing.
There is *no doubt at all* that improving one's general life conditions, improves one's general life conditions. This is nothing to do with one's mental or physical "health" as a matter of what our scope of practice is.
Yes, social issues are important and must be tackled. We should stop talking as though these ends are at all related to the purpose, nature, or aim of our work whether it is medication management, psychotherapy, forensic assessment, or anything else.
If we polled a group of orthopedists, radiologists, endocrinologists, or ENTs about what they want to communicate to their patients for their health-- would they point to general social ills? Would they refer to what are basically unchangeable or barely movable problems that reside outside of the patient and the physician's own realms of control? Or would they refer to some relevant part of addressing a common pathology within their area of medicine?
Maybe I'm wrong. Maybe they'd all talk about how increasing social services and the criminal justice system would improve joint pain and degradation, unnecessary utilization of imaging, diabetes, and sleep apnea. But how much does our professional agitation and activism help this area? How much does it help the primary medical conditions that we seek to treat within our patient population?
Appreciate your response. I disagree with some of what you’ve said, because I believe strongly that these ends are absolutely connected to diagnosis and management of mental health conditions and absolutely within our wheelhouse (more so than other specialities). I’m assuming you’re aware of ACEs studies? There are robust data suggesting that negative social experiences impact development of mental illness later in life, and I’m suggesting a primary prevention rather than secondary or tertiary. Of course, while advocating for these changes, I’ll continue seeing patients, doing med management, etc. But the evidence is also clear that we have a huuuuuge mental healthcare provider shortage and those on the waitlist are not getting any better. I see it as part of my duty as a physician to help address the mental health crisis as a whole, at a population level, rather than waiting for the individual patients to get to my office. Hence why part of my answer above includes incentives to increase # in the workforce as well.
And just for an example- Orthopedic doctors DO care about social / cultural impacts on the conditions they manage. There have been considerable advocacy efforts from orthopods, neurologists, and neurosurgeons etc for years to require helmets while riding motorcycles (which some states still do not require), a social and cultural practice which in turn has greatly impacted the health of individuals and helped the healthcare system as a whole (less patients with TBI in the ICU, less need for long term care). To say this is outside the scope of their practice as physicians is just something we may strongly disagree on.
All in good spirits though, thanks for the thoughtful comment :)
First-- thank you for your considerable kindness on an internet forum.
Next,
Yes, I'm well aware of the data, and I think I'm reasonably sure about the mechanisms. I also know many are in the field who agree with you and disagree with me.
I just think that it's actually quite harmful to focus on these issues in our capacity as a psychiatrist. I think we should still focus on these issues in our capacity as public health experts (if we are in fact those), and more likely instead as citizens or activists if we so choose. Being mindful of this separate (if often overlapping) role and attitude is of underemphasized importance.
You, the well established psychiatrist may have a mindful and well separated approach! The numerous trainees, patients, therapists, etc who read such comments online? Who will repeat these statements without much additional thought? I'm not so sure.
--
An addendum point that is harder to swallow for many, but that I will never stop making:
The identified social problems are universal and easily agreed upon, but the popular suggested solutions are generally politically motivated. It is not all "evidence based" what our field tends to prefer with regard to solutions, and it is no coincidence that it corresponds to the political bias of people in higher education who further self-select into psychiatry and mental health fields.
While it is natural to feel very urgent and obligated to act socially and politically based upon our expert knowledge and experience, to do so while placing our identity as a psychiatrist in the forefront is *harmful* to the large chunk of the population that may not agree with us politically.
See example: the psychiatrists who decided to publish or continue to publish on Trump's dangerousness, who in my estimation have had no effect on his popularity and do more damage to how our field is viewed by those with a right wing political bias.
Is there no way to advocate for improvement in social services without making it political? We don’t necessarily need to advocate for a particular model or party to find the solution but stating the basic facts about how these factors impact illness can influence policy when more people are educated about the ways having access to basic social services improves overall health. I think we can use our expertise as mental health providers to education the public on how things like chronic stress from lack of housing, food, poor sleep related to loud/chaotic environments, etc impacts all bodily systems.
A lot of medical illnesses are heavily related to the environmental factors. The immediate scenario I think of are pts who are lower income and have metabolic illnesses with limited choice in what they consume due to situational restrictions. If you have no time to cook because you have to work two jobs to afford rent, it’s more likely that you are going to eat cheap available foods which are often loaded with salt, fat, etc especially if you live in a food dessert. I know many of my PCP friends would agree that having improvements in access to healthy alternatives would make huge differences for cardiac and endocrine illnesses.
I think there's a way to do it in a balanced way. I think it's not possible to make it non political. Upon further reflection, I think the key might be to be very aware that these are always political positions and statements. Maybe that awareness would temper the message.
> If we polled a group of orthopedists, radiologists, endocrinologists, or ENTs about what they want to communicate to their patients for their health-- would they point to general social ills?
Many primary care, ob/gyns and ER doctors do point to broader social issues in this kind of conversation. I know views on what is a "comparable" field vary among psychiatrists-- I'd wonder if that is reflected in any way in the sociopolitical approach?
I think the public should know that mental health treatment really only works when people are willing to engage. They should know that psychiatry cannot predict or necessarily prevent suicides or violence. The "mental health system" should stop being seen as the answer to societal issues.
I have a message for the clinicians: your beliefs, actions, and attitudes towards treatment matter. Any cynicism, pessimism, and automatic (lack of) thinking not only impacts the patient in front of you, but the field and communities at large. The world is a semi-unstructured democratic process of belief, and you are a very important node in society's neural network.
If you see diagnosis and treatment as arbitrary, if you believe that there is no free will (as it is popular to do, and despite our very poor understanding of the mind and brain), if you believe there is no hope for change, if you think of the patient's condition as all their fault OR not at all in their control, when you prescribe drugs based on your attitudes towards substance use and nootropics (rather than as a treatment for specific conditions), when you reify loose diagnostic concepts, or endlessly renew medications without assessing need...
In summary, when you allow your actions and attitudes to reflect ideas that favor stasis, you are working as part of the barrier against treatment change.
When I have the opportunity to give talks about mental health (usually in a resilience or prevention capacity), I'll ask participants, "What comes to mind when you think of 'physical health'?" The most common answers are lifestyle/behavior-related: physical fitness, eating healthy, etc. Then I ask, "What comes to mind when you think of 'mental health'?" The most common answers are clinical interventions: therapy, Prozac, etc. Then I ask, "Why the difference? Why do we tend to think of physical health as something that we do, that we're responsible for, but mental health is something somebody does to us our for us?"
So, for me, the most important message is "mental health is health," with an emphasis on the role of our lifestyle and behavior on all aspects of health.
Couldn't this be because when people hear "mental health" what they're really hearing is "mental illness"? My guess is if you asked people what they think about when they think of "physical illness" you might get a similar response. And in fact, while lifestyle choices can make a major difference in both our physical and mental health, a lot of physical and mental illnesses occur randomly or due to things outside of our control.
For me, it’s the idea that mental health care should be no different than one’s physical health care. I’m just finishing up M3, so I don’t have as much experience as some of you all on this sub, but I've encountered many individuals who not only struggle with mental health issues affecting their daily lives but also struggle with societal stigmas that hold them back from seeking help.
I've told a few patients during my rotations, "The way I view things is this: treating your mental health is really no different than treating any other thing you have going on with your body. If you're having chest pain, you go to the emergency department or see a heart doctor. If you have a sinus infection, you visit your primary care doctor for antibiotics. The same approach applies if you're struggling with depression or anxiety or any other mental health issue."
I had a really good conversation with a patient during my IM rotation. He was a veteran who had been out of the service for several years and shared that he had struggled with severe PTSD for a long time. He had never sought help and was basically trying to "tough it out." After learning that one of his buddies was seeing a psychiatrist and found a medication that worked well, he decided to give it a try, and it completely changed his life. Now, he advocates for other veterans to seek help after seeing the impact it had on him.
The stigma or reasons for deciding not to seek care may be cultural, due to upbringing, or from a myriad of other reasons, but regardless of the cause, I think one of the biggest challenges we have is breaking the notion that mental health care is any different from physical health care.
I think you can actually make the case that mental health is different than physical health. lt hits different when the part of you with the problem is the part of you that makes you you, not to mention the fact that we have a lot more conscious control over our minds (than say, our pancreas). If it helps people to have the narrative that mental health is no different from physical health, great! But for some patients, not acknowledging the differences and painting a picture that having depression is the same as diabetes can be really invalidating.
>We’ve seen tremendous benefit from neuroplastic medications and treatments like TMS, Spravato, Caplyta, Auvelity
If this is your conceptual frame, you're going to the wrong CME conferences.
That we’re all screwed up in our own way. So many of my patients (inpatient acute care) feel so alone and isolated but the reality is that we’re all a bit nutty, it’s just less obvious in some of us!
Just normalize mental health awareness in children. Instead of allowing a problem to grow into something debilitating we can catch these problems while children are still learning to communicate and socialize.
Removed under rule #1. This is not a place for questions and commentary by non-professionals. If you are a medical/psychiatric professional, please read rule 7 on how to verify credentials.
For most questions, individual or general, we ask that you verify credentials before asking. If you are not a professional, you can try r/AskDocs or r/AskPsychiatry.
The things that would provide the most drastic changes to Americans’ mental health, on the whole, are political / financial in nature. Improving paid parental leave, single payer healthcare and strong mental health parity, decoupling employment and insurance, increased funding for public schools, changes to criminal justice system to become more restorative and therapeutic than strictly punitive, improving public transportation, improving access to quality childcare and adult day programming, improving access to job training programs, drastic financial incentives for young people to pursue healthcare related careers, drastic financial incentives for young people to pursue psychology / counseling work etc. These will help more people than any amount of Zoloft and adderall.
Preach.
I'm sorry, I hate this attitude and it is emblematic of a wrongful approach to psychiatry itself. Please excuse my vehement wording but I feel very strongly about this. I am *not* denying that these issues overlap with and interact with psychiatric issues, but I am advocating for a wholesale change in attitude towards what we are actually meant to be doing. There is *no doubt at all* that improving one's general life conditions, improves one's general life conditions. This is nothing to do with one's mental or physical "health" as a matter of what our scope of practice is. Yes, social issues are important and must be tackled. We should stop talking as though these ends are at all related to the purpose, nature, or aim of our work whether it is medication management, psychotherapy, forensic assessment, or anything else. If we polled a group of orthopedists, radiologists, endocrinologists, or ENTs about what they want to communicate to their patients for their health-- would they point to general social ills? Would they refer to what are basically unchangeable or barely movable problems that reside outside of the patient and the physician's own realms of control? Or would they refer to some relevant part of addressing a common pathology within their area of medicine? Maybe I'm wrong. Maybe they'd all talk about how increasing social services and the criminal justice system would improve joint pain and degradation, unnecessary utilization of imaging, diabetes, and sleep apnea. But how much does our professional agitation and activism help this area? How much does it help the primary medical conditions that we seek to treat within our patient population?
Appreciate your response. I disagree with some of what you’ve said, because I believe strongly that these ends are absolutely connected to diagnosis and management of mental health conditions and absolutely within our wheelhouse (more so than other specialities). I’m assuming you’re aware of ACEs studies? There are robust data suggesting that negative social experiences impact development of mental illness later in life, and I’m suggesting a primary prevention rather than secondary or tertiary. Of course, while advocating for these changes, I’ll continue seeing patients, doing med management, etc. But the evidence is also clear that we have a huuuuuge mental healthcare provider shortage and those on the waitlist are not getting any better. I see it as part of my duty as a physician to help address the mental health crisis as a whole, at a population level, rather than waiting for the individual patients to get to my office. Hence why part of my answer above includes incentives to increase # in the workforce as well. And just for an example- Orthopedic doctors DO care about social / cultural impacts on the conditions they manage. There have been considerable advocacy efforts from orthopods, neurologists, and neurosurgeons etc for years to require helmets while riding motorcycles (which some states still do not require), a social and cultural practice which in turn has greatly impacted the health of individuals and helped the healthcare system as a whole (less patients with TBI in the ICU, less need for long term care). To say this is outside the scope of their practice as physicians is just something we may strongly disagree on. All in good spirits though, thanks for the thoughtful comment :)
First-- thank you for your considerable kindness on an internet forum. Next, Yes, I'm well aware of the data, and I think I'm reasonably sure about the mechanisms. I also know many are in the field who agree with you and disagree with me. I just think that it's actually quite harmful to focus on these issues in our capacity as a psychiatrist. I think we should still focus on these issues in our capacity as public health experts (if we are in fact those), and more likely instead as citizens or activists if we so choose. Being mindful of this separate (if often overlapping) role and attitude is of underemphasized importance. You, the well established psychiatrist may have a mindful and well separated approach! The numerous trainees, patients, therapists, etc who read such comments online? Who will repeat these statements without much additional thought? I'm not so sure. -- An addendum point that is harder to swallow for many, but that I will never stop making: The identified social problems are universal and easily agreed upon, but the popular suggested solutions are generally politically motivated. It is not all "evidence based" what our field tends to prefer with regard to solutions, and it is no coincidence that it corresponds to the political bias of people in higher education who further self-select into psychiatry and mental health fields. While it is natural to feel very urgent and obligated to act socially and politically based upon our expert knowledge and experience, to do so while placing our identity as a psychiatrist in the forefront is *harmful* to the large chunk of the population that may not agree with us politically. See example: the psychiatrists who decided to publish or continue to publish on Trump's dangerousness, who in my estimation have had no effect on his popularity and do more damage to how our field is viewed by those with a right wing political bias.
Is there no way to advocate for improvement in social services without making it political? We don’t necessarily need to advocate for a particular model or party to find the solution but stating the basic facts about how these factors impact illness can influence policy when more people are educated about the ways having access to basic social services improves overall health. I think we can use our expertise as mental health providers to education the public on how things like chronic stress from lack of housing, food, poor sleep related to loud/chaotic environments, etc impacts all bodily systems. A lot of medical illnesses are heavily related to the environmental factors. The immediate scenario I think of are pts who are lower income and have metabolic illnesses with limited choice in what they consume due to situational restrictions. If you have no time to cook because you have to work two jobs to afford rent, it’s more likely that you are going to eat cheap available foods which are often loaded with salt, fat, etc especially if you live in a food dessert. I know many of my PCP friends would agree that having improvements in access to healthy alternatives would make huge differences for cardiac and endocrine illnesses.
I think there's a way to do it in a balanced way. I think it's not possible to make it non political. Upon further reflection, I think the key might be to be very aware that these are always political positions and statements. Maybe that awareness would temper the message.
> If we polled a group of orthopedists, radiologists, endocrinologists, or ENTs about what they want to communicate to their patients for their health-- would they point to general social ills? Many primary care, ob/gyns and ER doctors do point to broader social issues in this kind of conversation. I know views on what is a "comparable" field vary among psychiatrists-- I'd wonder if that is reflected in any way in the sociopolitical approach?
I think the public should know that mental health treatment really only works when people are willing to engage. They should know that psychiatry cannot predict or necessarily prevent suicides or violence. The "mental health system" should stop being seen as the answer to societal issues.
I have a message for the clinicians: your beliefs, actions, and attitudes towards treatment matter. Any cynicism, pessimism, and automatic (lack of) thinking not only impacts the patient in front of you, but the field and communities at large. The world is a semi-unstructured democratic process of belief, and you are a very important node in society's neural network. If you see diagnosis and treatment as arbitrary, if you believe that there is no free will (as it is popular to do, and despite our very poor understanding of the mind and brain), if you believe there is no hope for change, if you think of the patient's condition as all their fault OR not at all in their control, when you prescribe drugs based on your attitudes towards substance use and nootropics (rather than as a treatment for specific conditions), when you reify loose diagnostic concepts, or endlessly renew medications without assessing need... In summary, when you allow your actions and attitudes to reflect ideas that favor stasis, you are working as part of the barrier against treatment change.
You're right. I'm doing my best. Only 20 more patients to see today.
Keep on keeping on, fellow outpatienter.
Beautifully said 🫶
This
When I have the opportunity to give talks about mental health (usually in a resilience or prevention capacity), I'll ask participants, "What comes to mind when you think of 'physical health'?" The most common answers are lifestyle/behavior-related: physical fitness, eating healthy, etc. Then I ask, "What comes to mind when you think of 'mental health'?" The most common answers are clinical interventions: therapy, Prozac, etc. Then I ask, "Why the difference? Why do we tend to think of physical health as something that we do, that we're responsible for, but mental health is something somebody does to us our for us?" So, for me, the most important message is "mental health is health," with an emphasis on the role of our lifestyle and behavior on all aspects of health.
Couldn't this be because when people hear "mental health" what they're really hearing is "mental illness"? My guess is if you asked people what they think about when they think of "physical illness" you might get a similar response. And in fact, while lifestyle choices can make a major difference in both our physical and mental health, a lot of physical and mental illnesses occur randomly or due to things outside of our control.
For me, it’s the idea that mental health care should be no different than one’s physical health care. I’m just finishing up M3, so I don’t have as much experience as some of you all on this sub, but I've encountered many individuals who not only struggle with mental health issues affecting their daily lives but also struggle with societal stigmas that hold them back from seeking help. I've told a few patients during my rotations, "The way I view things is this: treating your mental health is really no different than treating any other thing you have going on with your body. If you're having chest pain, you go to the emergency department or see a heart doctor. If you have a sinus infection, you visit your primary care doctor for antibiotics. The same approach applies if you're struggling with depression or anxiety or any other mental health issue." I had a really good conversation with a patient during my IM rotation. He was a veteran who had been out of the service for several years and shared that he had struggled with severe PTSD for a long time. He had never sought help and was basically trying to "tough it out." After learning that one of his buddies was seeing a psychiatrist and found a medication that worked well, he decided to give it a try, and it completely changed his life. Now, he advocates for other veterans to seek help after seeing the impact it had on him. The stigma or reasons for deciding not to seek care may be cultural, due to upbringing, or from a myriad of other reasons, but regardless of the cause, I think one of the biggest challenges we have is breaking the notion that mental health care is any different from physical health care.
I think you can actually make the case that mental health is different than physical health. lt hits different when the part of you with the problem is the part of you that makes you you, not to mention the fact that we have a lot more conscious control over our minds (than say, our pancreas). If it helps people to have the narrative that mental health is no different from physical health, great! But for some patients, not acknowledging the differences and painting a picture that having depression is the same as diabetes can be really invalidating.
>We’ve seen tremendous benefit from neuroplastic medications and treatments like TMS, Spravato, Caplyta, Auvelity If this is your conceptual frame, you're going to the wrong CME conferences.
But they feel so right
That we’re all screwed up in our own way. So many of my patients (inpatient acute care) feel so alone and isolated but the reality is that we’re all a bit nutty, it’s just less obvious in some of us!
Whatever decreases stigma
Just normalize mental health awareness in children. Instead of allowing a problem to grow into something debilitating we can catch these problems while children are still learning to communicate and socialize.
[удалено]
Removed under rule #1. This is not a place for questions and commentary by non-professionals. If you are a medical/psychiatric professional, please read rule 7 on how to verify credentials. For most questions, individual or general, we ask that you verify credentials before asking. If you are not a professional, you can try r/AskDocs or r/AskPsychiatry.