By APRIL BOYKIN
As we have seen recently with athletes and celebrities, the stigma around mental illness is shifting, but it is still one of the most significant reasons people don't get the help they need.
Public and self-stigma refer to how society judges and holds negative attitudes about those in need of mental health support and how we internalize shame about our conditions.
People have long believed that mental illness represents a weakness of the mind or a fundamental character flaw. These beliefs have created long-standing obstacles that prevent people from seeking the help they need to overcome suffering and improve their condition. Today, the ultimate goal is to move away from the idea of “illness” and embrace the concept of “wellness.” While we strive to take care of ourselves physically, seek medical care, take supplements, exercise, or even rest, it is just as important to place the same emphasis on mental and emotional wellness. The shift in terminology from "mental illness" toward "Behavioral Health" can offer a more accessible pathway for people to reach out for support
Behavioral health services, obstacles to care and increasing wellness
The words "mental illness" reflect the idea that one must be unstable before getting help. Behavioral Health describes the connection between the health and well-being of the body and mind. It encompasses actions, coping skills, daily living skills, and their impact on one's ability to function, emotional and mental state, relationships, life satisfaction, achievement of goals, and overall wellness. While mental health is part of this model, the Behavioral Health model is more comprehensive and focuses on more aspects of overall wellness.
The statistics vary, but approximately 25 percent of all adults experience some form of mental illness in their lifetime, and we also know that many more suffer without ever having a diagnosis. However, 100 percent of all people can benefit from Behavioral Health Services. These services include counseling, coaching, support groups, psychotherapy, psychiatry, mentoring, mindfulness, spiritual support, testing and diagnosis, and so much more. The human condition is both complicated and straightforward. We all have similar experiences that create stress, loss, joy, anger, excitement, etc. We all have biological needs and want some level of connection. But how we navigate the challenges and disappointments that show up in our lives depends on our genetics and what skills we learn. Behavioral Health services can help strengthen everyone’s' resiliency, help us understand where our struggles originate, help build new coping skills, and help mitigate suffering.
So, what gets in the way?
- Knowledge/Education-Many people misunderstand the meaning, process, and benefit of Behavioral Health Services. We all must talk about the benefits of these services to our patients whenever we can and before it is evident that the services are needed.
- Medication Equation – When prescribing medications for patients struggling with depression or anxiety, it is essential to remember they often reject any Behavioral Health Support once they start feeling better. However, if they do not learn new coping skills, then they never truly learn to manage stress in their lives and will likely be back for more mediation. So, when prescribing also refer for counseling.
- Culturally Competent Care – Many cultures perpetuate the stigmas associated with seeking help. Individuals who consider seeking help often have to overcome those beliefs and want to relate to a counselor who can understand their struggles from a cultural, racial, ethnic, religious, etc. perspective. Diversity exists in the Behavioral Health field, encourage people to keep searching for the right counselor, but also discuss that people outside of their background may have exactly what they need too.
- Ageism – Sometimes, we overlook people struggling with declining mood, fatigue, or worry because these symptoms are a side effects of health conditions or aging. However, in 80 percent of cases, these symptoms can resolve through Behavioral Health support, and our patients should be encouraged to enroll in services.
- Missing the Signs – Patient frequently underreport their symptoms and conditions to appear better than they are. This phenomenon can cause us not to offer support until our patients are in crisis. If they have a condition or experience that can impact emotional well-being refer the for counseling.
- Service Delivery/Transportation – Today Behavioral Health services are provided through telehealth, in-person/in-home, or traditional office-based settings. Lack of transportation or being home-bound should never be a reason to prevent participation.
- Affordability/Policy Limitations – While some insurances do not cover Behavioral Health Services; most do, thanks to the Mental Health Parity Act. Refer your patients to community health programs if they do not have insurance that covers these services.
The benefits of Behavioral Health services are innumerous and include resolving symptoms of depression, anxiety, worry, and panic, regulating emotions, and improving functioning. It can decrease demanding and high need patient distress and improve communication and self-care skills. Additional treatment components include helping patients with processing and learning to live with grief and loss, developing coping skills, developing wellness routines, and overcoming obstacles to navigate challenges better. We all must discuss the importance of mental and emotional wellness with our patients and normalize Behavioral Health Services.
How do we start the conversation? The best way to overcome the stigma is to talk about Behavioral Health Services and normalize society's need and prevalence. The following are a few ideas of how to talk to our patients about getting engaged.
Someone to Talk To: “It seems like you have a lot going on. It is often helpful to have someone to talk to, I am going to refer you to a psychologist.”
Impact of Stress: “Stress, worry, and anxiety negatively impact your (heart condition), and I want you to learn skills to manage stress. I am going to refer you to Behavioral Health Services.”
Caregivers Help: “Caregivers don't have time to focus on their own needs. It's essential to have someone who can listen to you, so I will refer you to a support group.”
Medical Condition: “Did you know people with (diabetes) are more likely to feel depressed sometimes? I like my patients to talk to someone about those feelings to promote overall wellness. I am going to refer you to counseling.”
Isolation: A lot of people feel isolated when they are experiencing (chronic pain); it is helpful to have someone you can connect to and share your challenges with. I am going to refer you to a counselor.
Prescribing Psychotropics: When I prescribe (psychotropic medication), I always ask my patients to participate in counseling to help them learn coping skills to get the best effects.
April Boykin is a Licensed Clinical Social Worker and cofounder of Counseling Resource Services (CRS). Established in 2013, CRS is a community-based in-home integrated behavioral health agency serving the aged and disabled population in Central Florida. As a mental health counselor, she has provided individual, family and caregiver counseling to children, teens and adults. She can be reached at firstname.lastname@example.org