Improving Public Mental Health: Four Secrets in Plain Sight
We read about 40 million Americans affected by mental health problems every year. That means if you walk into a room with five or more people, on average one of them will have an active mental condition impacting their functioning and eroding the quality of their life and that of their family.
We know too that more than half of people in “psychological distress” (a term used in public health surveys) do not seek care, and of those who do try to access a psychiatrist or mental health clinician, they find that it is daunting, difficult, and often too expensive in terms of money and time. Concerns about being labeled mentally ill and the discrimination that ensues further impede seeking help.
What might be a public mental health approach to improving the emotional status of this country? What population-based approach could address broad groups of people and provide prevention, disease mitigation, and even healing (or recovery)?
There are four ways we can do so, hiding in plain sight. They are universal in their application: they are not just for people with serious mental conditions (including bipolar disorder, major depression, and posttraumatic stress disorder [PTSD]—though they are for these conditions as well). In fact, these four secrets are actions that the vast majority of people in emotional distress as well as those with a variety of illnesses (mental, substance use, and chronic physical illnesses) can take—with no new money from state or federal treasuries or out of pocket either. These are ways to serve those who will not and cannot seek professional services—or to guide them if they do. These foundational ideas and actions stand to reduce disease incidence, social and economic burden, and suffering. These are the four secrets:
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Behavior serves a purpose. Often behaviors we see as self-defeating, as destructive, as “crazy,” or as simply inexplicable are the result of our not understanding that these behaviors serve a purpose—not very well, but the best a person has developed so far.
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The power of attachment. We know that human relationships and support are among the greatest protective factors against human distress and disease development. Relationships are the royal road to remedying human suffering—both individual and collective.
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As a rule, less is more. Primum non nocere—first, do no harm—is the first law of medicine. With this secret in mind, we can reduce treatment complications and mitigate the progression of some diseases in behavioral health care because good treatment will have had its chance.
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Chronic stress is the enemy. This is perhaps the most important and universal secret of all. From adverse childhood experiences (such as trauma and neglect) to depression, diabetes, autoimmune diseases, and PTSD, chronic stress can be an underlying and powerful factor in the development and worsening of many mental (and physical) disorders.
As a public health doctor for over 14 years, these “secrets” became clear to me when I started to ask the right questions about what we all can do now that will make a difference. We have at our command four secrets to improving public mental health. They are there for us to see and to use. They don’t require prior approval from an insurance company. They don’t require a prescription. And yet they are all ways to better manage our lives, our health, and our health care. ■
Biographies
Lloyd I. Sederer, M.D., is an adjunct professor at the Columbia University Mailman School of Public Health, chief medical officer of the New York State Office of Mental Health, and medical editor for mental health for the Huffington Post. He is the author of Improving Mental Health: Four Secrets in Plain Sight from APA Publishing. Members can purchase the book at a discount.
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Published online: 13 December 2016
Published in print: December 3, 2016 – December 16, 2016
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