Now that I’ve practiced long term care and palliative/hospice medicine for over 10 years, I have come to believe that we must stop pretending that mental health is something we can keep at bay by simply painting around it…. as if no one can see the crooked white line on our nice, flat, dark pavement.
We know from personal experience and research that mental disorders are omnipresent and interrelated with many other physical disorders. Plus, they can be very costly and damaging when left untreated. The mind is unlike any other human element.
Yet, I propose we must regard the mind at least as important as any other organ system – prone to illness or injury. Therefore, it deserves equal placement among the medical disciplines, as well as our earnest efforts at screening, prevention, and treatment. Imagine our chagrin if primary care practitioners were to ignore our chest pain, jaundice, or unexplained anemia. Or imagine our response if our third-party payers were to decide that colon cancer screening is not worth the effort because most patients tend to deny or minimize their gastrointestinal symptoms. Would you agree the outcry would cause a knee-jerk correction to our system? I maintain that mental health has been slow to gain traction as a critical ingredient to excellent care in our greater health care delivery system.
At ASC (Advanced Senior Care), our providers serve patients who are elderly, chronically ill, and terminally ill. In treating the whole patient with “Just Better Care”, we continue to learn valuable lessons with each encounter as it relates the mental health of our patients. In fact, during the past decade as a nursing home and hospice physician, I have learned countless valuable lessons from my patients… here is my list in no particular order: (Please notice how many of the lessons effect the mind/mental clarity of the patient)
- The patient’s debility and their decreased control over life represents an assault on their mental health.
- Aside from physical decline and varying degrees of cognitive “slipping”, these patients are suffering from depression, anxiety, and other mental illnesses.Their circumstances often unmask symptoms and conditions for which they could previously compensate.
- Despite the regulatory codes and the mislead expectations of our culture, the tacit understanding among those of us who care for these patients is that they are constantly declining by some measure (strength, balance, renal, cardiac, or pulmonary function)… and there is very little we can do about it.
- They are constantly downsizing, continuously giving up space, and watching their world shrink.With each move or transition of care, personal belongings simply evaporate.
- Somehow, listening to and hearing our patients is the hardest part of delivering medical care. While these patients have the most expansive problem lists in healthcare and more medications than any other subset, what they require most is time with others – something that healthcare professionals possess in short supply.
- Regardless of complaint or ailment, patients usually need me to remove a medication rather than to add one.
- Warm hands are immeasurably more effective than vitamin supplementation.
- Their new (and cramped) living space must become their homes and residents become new family to each other.
- They become family to the staff charged with their medical care and oversight.
- Lest we forget: These are the people who built our homes and infrastructure, created institutions, fed & clothed us, defended us, and represented us to the world. Yet, their later years are filled with a struggle for relevance and meaning.
Are we just a nation of pretenders? We like to pretend that we can cruise, meander, or muddle through our days without much hindrance from those things we would consider to be weaknesses. I speak of those things that would, if we acknowledged them, reveal us to be human… complete with imperfections, scars, and emotional hang-ups. Such things as: Depression, anxiety, grief, bipolar disorder, personality disorder, obsessive compulsive disorder, substance abuse, schizophrenia, even dementia.
These are topics we read about, talk about, unfortunately even joke about while we keep them at arms’ length so as not to become too uncomfortable with ourselves. These things make us uncomfortable. If we were to let down our guard for more than a moment, we would see one or more of them in ourselves, and we would certainly see them in our families or inner circle. Yet we feel compelled to suppress them, hide them, and put them in the vault. In other words, we pretend to be free from these weaknesses.
This approach to mental health has a cascade of consequences affecting our personal lives and relationships, limiting our own abilities to cope with the fallout from mental illness, and reducing our capacity to care for others. This can be particularly costly for those of us working in American healthcare.
Our team 
at ASC (Advanced Senior Care) is proud to participate in Mental Health Awareness Month as a means to communicate the renewal of our commitment to mental health as it affects our patients, associates, and loved ones. Thank you for allowing this blog to alert your senses and to perhaps encourage you to join in the conversation in your own way. Our current health care system has passively allowed our personal attitudes and fears to influence the way we regard, deliver, and reimburse for the mental health portion of medical care. I hope these days are numbered.
Jerry Bruggeman, MD, MBA, CMD