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Treating the Whole Patient Key to De-Stigmatizing Mental Health, Say Experts

In the effort to treat the whole patient, doctors must grapple with one section of care still stigmatized by society, patients and even sometimes providers themselves: mental health.

A group of six professionals discussed the topic during a panel at the Utah Business Healthcare Solutions Summit, held at the Grand America Hotel Tuesday. The initial consensus between the doctors and insurance providers on the panel was that, because work stress can create or exacerbate many symptoms of depression, anxiety or other mental ailments, the best place to treat and ease those is at the workplace.

An Employee Assistance Program, or EAP, can help bring mental health services into the office, said Sean Morris, CEO of Blomquist Hale. The EAP providers can work with employers to make sure employees are getting cared for early and with targeted approaches.

Dr. B. Todd Thatcher, chief medical officer for Valley Behavioral Health described the relationship as more coach-like than medical, and in the case of symptoms or disorders caused or spurred by work stress, EAPs can help employees decide whether they can do something to better cope with the stress or find another means of work to keep them well and productive.

The trick, however, is to give employees an environment to talk about their struggles that feels safer to them than telling HR professionals, for example, or their boss, he said.

“How do we make this more accessible to the employee who is just not going to tell his supervisor? You can do all the public relations you want…but how can we make this accessible?” Thatcher said.

Some people who are struggling can avoid care because they’re afraid of receiving a diagnosis of depression or other disorders, Morris said. With an EAP, employees can get help for symptoms caused by work stress without necessarily walking out of the visit with a diagnosis, he said, as not all symptoms are part of mental disorders but do still benefit with some treatment.

Additionally, Thatcher said, having regular screenings for employees can benefit employers by helping make employees well and more productive, as well as weeding out any unscrupulous employees who try to get out of doing certain tasks by claiming to have a mental disorder they don’t have or exaggerating symptoms.

And while part of that aspect of mental health is in the way care is presented, said Thatcher, the overall stigma against mental health also needs to be addressed. In much the same way a person’s family members would urge them to see a doctor for a cough that just won’t go away, so should people go to a mental health provider for symptoms of a possible mental disorder that persist, he said. He said he feels the stigma has lightened, at least for disorders like depression and bipolar disorder, but still persists with others, such as schizophrenia. Even people who have sought care tend to feel shame for their need of it, he said.

“I think there’s obviously a stigma. … I think it’s [improving], but we don’t have the data to show it,” he said. “I think there is still a difference in the different psychiatric disorders.”

Dr. Edward Wyne, chief medical officer for DMBA, said in his days as a primary care physician, he found the acceptability for having depression soared after the introduction of Prozac, which allowed doctors to treat depression as they would physical ailments.

“I think there’s a long way to go, and [in knowing] mental illness doesn’t have to be schizophrenia,” he said. “Depression and anxiety are real medical conditions that need to be correctly treated.”

Dr. Donna Milavetz, CEO and chief medical officer for Onsite Care, said she feels the stigma against mental health disorders has improved greatly in recent years, especially among younger people. There is still much to be done, though.

“You get some of these older patients in, and I can’t even get them to undress for a physical exam, let alone tell me some of these really personal things,” she said.

In addition to a persistent stigma against mental health services, another barrier for patients needing or seeking care is the relatively low number of practicing psychiatrists, and the fact that more of them are over the age of 60. Panelists discussed the strengths and drawbacks of utilizing telehealth for mental health services. Among the challenges are, with texting, messaging or even video conferencing, a lack of the seeing the kind of nonverbal cues an in-person discussion would give, as well as, for doctors, difficulty in coding those visits for reimbursement, and, for insurance providers, an inability to tell how well the therapy is benefitting patients.

However, panelists said, telehealth would make mental health services significantly more accessible for people in rural areas—of which Utah has many—and some might feel more comfortable opening up over text or an instant messaging service than they would going to a provider’s office. The variable length of appointments, with some patients needing only a quick check-in and others needing more time to delve into deeper issues, would work well with the instant capabilities of telehealth.

Milavetz said she believed all of the challenges could be solved or addressed in time. Thatcher said he thought that, eventually, telehealth would find its place in the scale of degrees of medical attention, from a friendly chat with a healthcare provider to hospitalization.

By adopting the philosophy of treating the whole patient—and having social workers and therapists located in the same area as other clinicians—stereotypes and stigma can be broken down, said Janelle Robinson, director of outpatient clinics at the University Neuropsychiatric Institute at the University of Utah, which has introduced co-location of those services. And stigmas aren’t just for patients—doctors can have them, too.

“It takes us being advocates, saying it’s around us, to open the conversation,” she said. “We bring to the table our own biases that we, as a medical community, need to explore and push against.”