Mental Health is a Physical Heath Issue

CAN I see another’s woe,
And not be in sorrow too?
Can I see another’s grief,
And not seek for kind relief?
~~ William Blake Songs of Innocence and Experience

I recently took a sabbatical from my private practice counseling to start work with a grant program.  Its intention is to explore integration of mental health services into family practice medicine.  What a great idea.

Studies show around 80% of people with anxiety and depression never see anyone about these issues except their PCPs (primary care medical folks).  Many persistent and "medically unexplained" physical symptoms are the result of trauma, stress and untreated depression and anxiety. Since most people see their PCP at least once a year, it makes a lot of sense to have a mental health professional at the ready and in their medical home.  My grant takes me to a clinic that serves over 10,000 adults and children.  Over half of them are on the Oregon health plan, meaning they live at or below the poverty line.

Most insurances now, including public health, are required by law to offer coverage for "mental" illnesses.  I have never understood the notion that the emotional and mental processes are somehow supposed to happen separately of the body.  All are contained within the same vehicle, right?  And by now, surely, most of us understand that what we translate as emotion and even thought has a physical corollary.

Short digression:  truth is that the previous statement is not true.  Not everybody gets this connection.

So imagine this:  You are readying to cross the street just as the "Don't Walk" light changes to "Walk".  Entering the crosswalk, an inattentive driver turning right enters, missing you by a few feet.  Inattentive driver speeds on, maybe not even having noticed you.  But you noticed, as did your body.  You've just had a brush with death.  In an instant, you've gone from calm to agitated.  Your heart races, your blood pressure skyrockets, your breathing increases.  Less noticeably, your pupils enlarge, the tiny blood vessels in your hands and feet contract.  Your hair may even be standing on end. You logically know you are safe-- the car is gone, and you are intact.  But it will be at least several minutes before your body catches up with your mind.

What's happened?

On sensing an imminent danger, your body releases a chemical cascade designed to help you survive the threat.  This cocktail contains numerous substances, the most commonly known being adrenaline.  The chemicals have many effects intended to increase your chances of living.  Your pupils enlarge to help you take in the visual field and see chances for escape or weapons for use.  Your hair is standing on end because of an evolutionary quirk that works for many mammals, though not so much for humans: to make you look bigger.  Think raccoon or freaked out cat.  Your increased heart rate, blood pressure and breathing is sending oxygen to your large muscles (thighs and biceps) to help you run and fight.  Your cold hands and feet are diverting the blood to the more important internal organs.  Even the capillaries on the surface of your skin are contracting, so you won't bleed to death as quickly.

In short, your body is doing what it needs to.  And your brain is interpreting all this as FEAR, and filing it away under THINGS TO AVOID.

But fear, in this case, is just your body's shorthand to describe that chemical cascade and its connection to threat.

OK, that was a long diversion.  Let's assume that between your previous knowledge or this new information, you  understand that what happens to the "mind" is also/really happening to the body.    One affects the other.  The software (thinking) affects the hardware (body).  Addressing only physical symptoms without addressing the underlying stresses that bring them, continue them or worsen them doesn't make sense in the long run.  Our state seems to agree with that, which is why I am now doing therapy work within the context of a Medical Home model.

But not everyone gets this.  There is still a lot of  stigma about emotional health issues, and misunderstanding about stress-related illnesses.  And there are still many people who would be completely offended to be referred to a mental health professional.

Many people think that when a doctor/PCP tells them their symptoms are stress related, they are being told they are making them up, or faking them, or can fix them by just relaxing a little.  I didn't quite understand this myself, until I heard a great interview with an immunologist on Krista Tippet's public radio show.  At the time the show was called "Speaking of Faith".  To not scare the unchurched, it's now called "On Being".  The doctor, Esther Sternberg, explained in very clear terms the effects of stress on the physical body and the life-endangering damage it can do.  Click the link to hear the whole show.  The short story:  trauma and stress can damage the immune system and worsen or cause real disease. These symptoms are not in your head, they are happening to and in your body.

In the last two months or so, I have been able to see people who would NEVER have come to my private practice office.  But when their doctors (thank you for trusting me, docs!) tell them, hey, we have someone here who knows a lot about X (helping you with your racing heart/worrisome thoughts/grief over your loss/high blood pressure) and let me come in and say hi during a visit, they welcome the opportunity to tell their story, be witnessed and heard.  They appreciate being offered practical tools for calming their physiology, and being told that a normal human reaction to suffering is not pathology.

Many of the people I have seen the last two months have had a great deal of trauma in their lives.  Trauma has a marked effect on the body, and kindles the brain in a way that can cause ongoing difficulty in regulating emotions and handling stress.  Many have never discussed this trauma with another person before, because of shame or because it happened long ago and they thought they were supposed to be over it as adults.  They had developing defenses and coping mechanisms that served for a while and then stopped working or had too many side effects (self-medicating through substances or other numbing mechanisms, self isolating, anger).

These are also people who, even if they WANTED to see a therapist, might not have been able to do so.  Most private practices in my town are full.  My own practice gets 5-10 inquiries a week. Most only accept a few insurances, either because the panels are closed for new providers (I DO NOT GET THIS!  THERE IS SUCH DEMAND!) or because they choose not to participate due to the bureaucracy involved and low reimbursement.  Even the so-called public services turn away clients regularly and create numerous barriers to care:  lengthy waiting periods, intimidatingly personal paperwork requested without creating trust, mandated length-of-service before even knowing what the problems are, and lack of any assurance of privacy.

I get the problems.  Money doesn't grow on trees, and demands exceed supplies.  But we are being very short-sighted if we think we are saving money by refusing people support in managing the incredible stress of being human, and then spend billions to treat the illnesses this stress causes.

I am so very grateful to the doctors of Samaritan Family Medicine Residents Clinic who have trusted

me to assist their patients.  It took a little convincing.  And I am not great at measuring the data to show it is making a difference. Obviously I can't share with you the details of specific patients for whom this is working. But I can tell you that people coming in with heart pains are learning to take time to appreciate what is good in the world and to soothe their worried souls, and people who have been afraid to connect with others are making friends, and people who were ashamed that they were sad and needed space to grieve are back at work.  I am grateful to them for sharing their stories, their pain and their trust with me.

A few years ago, I took advantage of my generous insurance program to visit a specialist in hopes of finding relief from my persistent allergic reaction to Everything Oregon.  20 minutes and $890 (insurance) dollars later, it was confirmed by Science that I'm indeed allergic to most major crops and native plants of Oregon.  I was advised I would likely remain so, but could take the same over-the-counter stuff that seems to make me cranky and depressed if I wanted to sniffle less.  At current insurance reimbursement rates for my services, I could have seen someone with anxiety and depression a dozen times and offered them some tools and support that may have lessened the chances of a $2000 ER visit, lost work time, a relationship crisis, etc.  Something is wrong here.

I see the value in what I can do.  I hope the future of medicine sees the same.  That feels unlikely, as long as mental health is seen as moral/willpower issue instead of a medical one.  I'm going to talk with my representative, Sara Acres Gesler, to see what we can do about that.  I hope that you will do what you can to promote increasing access to emotional and mental health services in the country.

Jana