Mental Health and Primary Health Care
How is it that we still don’t have mental health screenings at general checkups?
When one of my closest friends was eight years old, her mom took her to the doctor because she was complaining of stomach pains. The doctor did some tests, and they were inconclusive, so my friend was sent off to take some more tests, which were also inconclusive. This pattern ended up turning into a year of her being in and out of hospitals and doctor’s offices without any conclusive results. Finally, she was given the diagnosis of generalized anxiety disorder. This whole experience, besides being extremely stressful and scary for eight-year-old her, contributed to her developing hypochondriasis. Basically, she had a pretty awful year.
This sort of experience is all too common. Obviously, when a child is presented with stomach pains, their doctor is going to have to run some tests. However, a full year of testing for increasingly unlikely diagnoses without anyone considering the possibility of mental illness seems less like a precaution and more like the neglection of a major class of health problems. This story and many more like it highlight how ridiculous it is that mental health screening tests aren’t included in yearly checkups.
A 2011 Canadian study found that of patients that met the criteria for major depressive disorder, 65.9% had never been diagnosed. This rate was even higher for other disorders — 92.7% for bipolar disorder, 85.8% for panic disorder, 71.0% for generalized anxiety disorder, and 97.8% for social anxiety disorder (Vermani, Marcus, & Katzman). Basically, too many people are going undiagnosed, which means that too many people are not receiving the treatment that they need.
This under-diagnosing is due to a variety of reasons — stigma, lack of understanding of one’s symptoms, uncertainty about treatment options or where to go for help, never being asked about it, denial, and many more. A main underlying reason for why many of these are a problem for diagnosis is that in Canada, as is the case in many other societies, you need to seek out a mental health diagnosis, whereas many other health problems are detected during routine screenings and checkups.
In addition to helping to detect mental health issues in people who are not speaking up or have no idea what is wrong with them, this system will also help all of those people who use random websites to self-diagnose and who in turn often cause themselves undue stress or depend on shotty or unhealthy self-treatment methods. It is clear to see how the negative outcomes from these tendencies would be significantly decreased by ensuring that people are screened at least once a year in order to determine whether they need to be referred to a mental health professional.
I’m sure that we all agree that mental health screening should be a part of primary health care, I just think it is crazy that it hasn’t really happened yet. As mental health awareness grows and the discussion of mental health is becoming more and more prevalent in the media, somehow our health care systems are falling behind. We know that it is a problem, and I realize that you can’t just snap your fingers and make things happen, but we currently seem to be pretty far from implementing an effective screening process. I mean, I don’t remember my GP ever asking me anything relating to my mental health — excepting queries about drug and alcohol use. Maybe that is just my GP, but the lack of even a “have you been happy recently?” just shows the extent of the absurd separation that currently exists between primary health care and mental health assessment. Just to clarify, I am not saying that GPs should be diagnosing mental illness, but they should be looking out for when a patient should be referred to someone who can. This is a something that can change, needs to change, and definitely should have already changed.
Vermani, M., Marcus, M., & Katzman, M. A. (2011). Rates of Detection of Mood and Anxiety Disorders in Primary Care: A Descriptive, Cross-Sectional Study.The Primary Care Companion to CNS Disorders, 13(2), PCC.10m01013. doi:10.4088/PCC.10m01013
