Mental Illness and Primary Care

      What happens when we deny our mental illness? The other day I had a conversation with my primary care provider, Cristina, that caused me to think about this. I always think about people with depression as not being listened to or taken seriously. Talking to Cristina I realized that the opposite could happen. A primary care provider can recognize the signs of depression and be met by resistance from the patient. What happens in that situation? It is not like the provider can use bloodwork or scans to show the patient that the depression exists. 

So, why would a person not want to hear that he or she has depression. The first thing that comes to my mind is stigma. Society doesn’t exactly make it easy to accept a mental health diagnosis. Often, we are taught to hide our emotions or tough it out. Mental illness is often joked about. People use mental health diagnoses in the wrong context. For example, someone who likes things neat and orderly might say they have OCD. That’s not OCD. I have a friend who suffers with OCD. I have seen her struggle. Believe me OCD is not just wanting things clean. It is much more involved and debilitating.  Unfortunately, it is a common perception in society that people with OCD are neat freaks. 

Likewise, depression is not just being sad. As I’ve discussed many times on this blog, depression is much more than being sad. There is a sense of hopelessness.  Often, people with depression fight a desire to escape life.  Depression is so much more than a passing sadness. I recently heard someone say, “I am so depressed. My favorite restaurant is closing.”  Trust me. That is not depression.  Depression is all-encompassing.  It affects every aspect of a person’s life. The word depression is used too casually, and it leads to a lack of understanding.  

Unfortunately, mental illnesses are often trivialized and misunderstood. It makes sense that some people would resist a mental health diagnosis. Who wants to be labeled with an illness that is misunderstood and even mocked?

Back to the primary care provider. They are often the first health care provider to recognize a mental illness. I don’t know the statistics, but I have read that primary care providers prescribe a significant amount of anti-depressant medications that are prescribed in the United States.  I am not an expert.  So, I don’t want to cite numbers or pass judgement on this.  However, it seems to me that if primary care providers are that involved in treating mental illness, we need to give them more education and support.   

How do primary care providers assist their patients in navigating their illness?  They are important in recognizing the signs of a mental illness.  Often, they use a paper and pencil screening tool to gauge how their patients are doing mentally.  They pick up on signs by talking to their patients.  Symptoms of depression sometimes surface as physical complaints.  These can include aches and pains, fatigue, sleep disturbances, gastrointestinal issues, and changes in appetite to name a few.  An astute primary care provider will investigate mental health causes along with looking at physical reasons for the symptoms.  This provider treats the whole patient.  He or she understands that there are many facets to a patient’s health.

Often, when a person is depressed, he or she feels alone. There is a darkness surrounding them. Life may seem hopeless. It is hard to talk about these feelings with others. You believe you are alone and that no one else understands. Reaching out for help is difficult, sometimes impossible. Add to this being aware of the stigma surrounding depression. It is possible for a person to go into denial and refuse to acknowledge the depression is impacting him or her. When someone else brings it up, even a primary care provider, different things can happen. The person may experience a sense of relief that there is a reason for how he or she is feeling. This is the person who will accept the diagnosis. He or she is more likely to accept therapy and/or medication. On the other hand, the person may go into denial. He or she knows something is not right but doesn’t believe it can be depression. This is the person who refuses therapy and medication. 

A doctor can’t force treatment on a person.  The patient in denial is likely to continue struggling. This is a tragic in a time when there are so many treatments for depression such as therapy, support groups, medication, TMS (transcranial magnetic stimulation), and ketamine. The provider can encourage the patient to accept treatment, but the patient needs to be willing to accept that treatment.  I would imagine it would be frustrating for the provider to recognize a mental illness, such as depression, and not be able to provide treatment.  

I believe we need to have more conversations about mental health.  Being open and honest about mental health is the only way we are going address this issue.  The stigma surrounding mental health needs to be significantly reduced.  Doctors, physician’s assistants, and nurse practitioners need to be able to address mental health openly.  This will allow them to start treatment and refer people to specialists.  People with mental illness deserve to be treated by psychiatrists, psychologists, and therapists.  The primary care provider is the link to these specialists.  That is why their role is so important. 

When a patient refuses to accept a mental health diagnosis he or she is refusing the treatment that can help.  I know from a lifetime of experience that treatment is vital to living with depression and anxiety.  The same is true of any mental health disorder. As a society we need to work to give primary care providers the education and support they need to address mental health issues.  We need to spread awareness of mental illness.  Hopefully, this will help people be more open to accepting a mental health diagnosis.  Supporting organizations like NAMI, (National Alliance on Mental Illness) is an important way to spread awareness and eliminate stigma.  

Continue following my blog.  I hope to address this issue in more depth in future posts.