By Mary Kay Clunies-Ross, executive director
I was participating in a forum on mental health policy earlier this month, and the organizer’s main message struck me at first as a sad statement on our healthcare system:
“We want mental health treatment to be treated just like any other chronic illness.”
A third to a half of all Americans are managing a chronic disease, so if it’s not you, it’s someone close to you. While there have certainly been a lot of improvements in treatment and payment, a chronic disease still takes effort to manage, sometimes as much effort as a second job.
Patients report:
- Multiple visits, sometimes years, before getting a diagnosis
- Struggle getting appropriate treatments
- Struggle getting prescribed treatments paid for by insurance
- Difficulties connecting to specialists
- Inflexible employers and managers
- Challenges getting other accommodations—even those guaranteed by law.
For those with a mental illness—an increasing amount of us, by the way—life is even harder.
Michelle Williams of Destiny’s Child kicked off Otsuka Pharmaceuticals’ 2022 Advancing Mental Health Policy Forum. She told of how she started to feel unwell as early as 7th grade. She knew something was off, but while she knew about diseases like lupus, cancer and some STDs, she didn’t know about depression. She didn’t know it was a diagnosable and treatable disease.
She managed and hid the condition for years. “I didn’t want to be the one walking in, all Debby Downer,” she said. The few times she tried to get help from others, they dismissed her. What did she have to be depressed about?
Which, of course, is not how depression works. Williams ultimately got the right help from the right people, and wrote “Checking In: How Getting Real about Depression Saved My Life---and Can Save Yours” to tell her story.
The Head is Part of the Body
One of the major frustrations for everyone involved in mental healthcare is the simple fact that it’s treated as something totally separate from overall health. Mental and physical health have different degrees of stigma, access to care, insurance coverage, provider reimbursement levels, research funding and more. Services are also often not even provided in the same building, with mental and behavioral health being cut off from the rest of the medical establishment.
This division hurts patients in a variety of ways, most especially by making it harder to treat conditions that are interrelated and interacting.
One of the speakers, Eduardo Colón, M.D., chief of psychiatry for Hennepin Healthcare, spoke about the interplay between depression and diabetes, which he has studied in Hispanic/Latino communities. The two conditions are circular, he said, and one can trigger the other. Other, more serious conditions such as bipolar disorder, may also act the same way.
Dr. Colón said that the separation of mental and physical health, even in terms of where the doctors’ offices are located, make it harder to treat both. This results in both conditions worsening over time, deepening the burden of chronic disease—especially on those patients who are also having to respond to social conditions such as racism and poverty.
The Canadian Mental Health Association succinctly summarizes the problem:
Nowhere is the relationship between mental and physical health more evident than in the area of chronic conditions. The associations between mental and physical health are:
- Poor mental health is a risk factor for chronic physical conditions.
- People with serious mental health conditions are at high risk of experiencing chronic physical conditions.
- People with chronic physical conditions are at risk of developing poor mental health.
The social determinants of health impact both chronic physical conditions and mental health.
Policy Implications
The good news is that there is an increasing effort to move toward mental health parity. Ideally this will manifest in multiple parts of the healthcare system at the same time: payment rates for providers, access to treatment, medication treatment, even preventive care.
It’s also a good reminder that the CDC’s policy platform addresses challenges for mental health treatment, such as step therapy, expanding access, lowering costs, and anti-discrimination work. If a patient must try and fail on a generic drug not prescribed by their own doctor, or if they can’t afford treatment because their third-party assistance doesn’t count toward their out-of-pocket costs, what does that do to their mental well-being?
While the Chronic Disease Coalition was started by those concerned about kidney patients, our policy focus has grown because almost all chronic disease patients have to navigate the same rocky terrain. This is true for those with mental/emotional/substance abuse issues as well. The commonalities in the stories are much greater than the differences.
Those managing conditions such as depression, bipolar disorder, eating disorders, anxiety, ADHD, or psychosis deserve better care from our system. As with many other diseases of the body, early intervention and consistent oversight and treatment can help people remain engaged in the world.
There is Hope
Glenn Liebman, CEO of the Mental Health Association in New York State remembered when the word “cancer” was only ever whispered.
The stigma around cancer was so huge because before there were good treatments and public awareness, cancer = death.
But since that time, as treatment and awareness improved, the stigma around cancer decreased. A diagnosis is still something to take seriously, but with improved surgical and pharmaceutical treatments, we know people can live through it. And because of the awareness and education campaigns, we also know how to support people who have cancer.
And in fact, there are other diseases which used to be death sentences and now can be managed as chronic diseases because pharmaceutical treatments improved. We are witnessing longer lifespans for cancer, kidney disease, HIV and other diseases.
Improving mental health awareness and treatments are the focus for many individuals, organizations and companies, and improvements are being made every day. May is Mental Health Awareness Month, and there are many free resources available to the public (See NAMI’s site here).
It’s a good time to check in with your primary care provider with any concerns, or reach out to a friend who is struggling. The treatment options are more numerous than ever before, enabling more of us to live our full lives.
Our many thanks go out to all the people working tirelessly to improve mental health. This is still an issue that takes a great deal of vulnerability, but the personal stories are crucial to advancing treatment and fair policies for all.