Our society suffers from many significant struggles that requires the efforts of all of us to combat. The recent suicides of celebrities Kate Spade and Anthony Bourdain highlight this plight as one of those chronic problems. There are no easy answers to this problem, but some resources exist and are available to you.
Unfortunately, the mental health care system in the United States is not structured to support the needs of the population. We have too few mental health providers who are too hard to access and with inconsistent insurance coverage. Rates of clinical mental illness, including substance abuse, have increased significantly in the last few decades, especially among adolescents. This has largely contributed to someone committing suicide every 12 minutes in our country. Utah has the highest percentage of adults with suicidal thoughts of any state and suicide is the leading cause of death in the 10-17 age group in our state.
There are many barriers that contribute to proper care, especially systemic structural and payment faults that could be improved in order to better address this issue. The time of visits is often not adequate to address all that is needed. The system treats mental health and physical health in isolation of one another, though the issues are often very intertwined. Social supports are lacking for many in this population, often resulting in homelessness or incarceration. Many times individuals fail to recognize their experience as anything severe enough to seek help until it is too late.
Despite the possible origins of this problem, one solution does stand out amongst the many suggested: primary care. Primary care physicians fill a needed gap even when an individual has access to a psychiatrist. The primary care physician has a relationship of trust, allowing one to discuss difficult struggles with someone they know and who knows them, often times for decades. This, added with the cultural stigma of seeing a “shrink,” can keep people from seeking help from other mental health professionals. Family physicians play a large role in filling this gap and often are a trusted guide into care from the mental health profession.
Family physicians are trained in screening for depression and other mental illnesses. This includes substance abuse, as well as for self-harm, suicidal thoughts and intent. We are trained to address the majority of these problems, and work closely with our mental health colleagues in more complicated, severe cases. This is a matter that we take very seriously and encounter often in our visits.
At least 20 percent of all health care interactions involve a mental health component. Nearly 50 percent of adults in the U.S. will have a mental health or substance abuse concern at some point in their lives, though only about one-third get the care they need. Individuals with symptoms of a mental illness wait on average of 8-10 years before seeking help. Individuals in a minority race or ethnicity receive help at about half the rate of caucasians. Each day an estimated 20 veterans commit suicide. Family physicians are involved in more patient visits than any other specialty, putting us in a prime position to assist.
The Centers for Medicare and Medicaid Services are trying to lead the way to better treatment with integration of mental health and primary care services through improved payment mechanisms. This supports greater assimilation of therapy and primary care for individuals with a mental illness. Its promise has yet to be fulfilled, but the momentum exists to improve this access and expertise in preventing suicide.
No single solution will solve our increasing number of suicides, but family medicine is poised to help in a big way. If you or a loved one have any concern about mental illness or suicidal thoughts, come our way, and we’ll take it from there.
Kyle Jones
Kyle Jones, M.D., is president-elect of the Utah Academy of Family Physicians.