By Hannah Furfaro #SeattleTimes staff reporter
The #MentalHealthProject is a #SeattleTimes initiative focused on covering #mental and #behavioralhealthissues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The #SeattleTimes maintains editorial control over work produced by this team.
The #pandemic has shone a bright light on a stark reality. #Mentalhealth concerns are pervasive, and access to quality care — or any care at all — is incredibly unequal.
In #Washington, more than one in five #adults has a diagnosable #mentalillness. And all signs suggest #mentalhealthissues became more prevalent — and more extreme — over the past 18 months. In the spring, Gov. Jay Inslee declared a #youth #mentalhealthcrisis. National data shows 40% of #adults have experienced a mental or #behavioralhealth condition during the #pandemic.
But #mentalhealth concerns have always been common, and the way treatment is researched, funded and provided has long been plagued by #racial and economic inequities — and slowed by bureaucracy. Failure to get help can bring dire consequences: People with severe #mentalillness die, on average, 10 to 25 years earlier than those without a #mentalhealthcondition.
“These are life-stunting conditions,” said Dr. Larry Wissow, director of child and #adolescent #psychiatry and #behavioral medicine at Seattle Children’s.
There’s much we can do to help.
#TheSeattleTimes is launching a new reporting team dedicated to enhancing the public’s understanding of #mentalillness, holding agencies accountable and finding solutions that can help people get the care they need. As we begin, we turned to local clinicians such as Wissow, researchers and policy experts to answer some pressing questions about the state of #mentalhealth in #Washington.
What do we mean by #mentalhealth, #behavioralhealth and #mentalillness?
The words people use to describe #mentalhealth vary and can depend on a person’s cultural, family or religious background. In general, “#mentalhealth” includes a broad spectrum of social, psychological, emotional and #behavioral traits. It’s part of how we think, feel and act on a daily basis, and includes how we respond to #stress or other life events. And like physical health, it can vary from day to day, and from one stage of life to the next.
“#Behavioralhealth” is closely related to #mentalhealth. There’s no single definition of #behavioralhealth, and its definition has changed over time. Some in the #mentalhealthcommunity use the term to broadly describe the relationship between #behaviors and overall health and well-being, and the treatment and support of those with mental and substance-use conditions. Some use it interchangeably with “#mentalhealth.” Others believe the term is misleading or stigmatizing, and implies a person’s problems are mostly voluntary, or within the bounds of their control.
“#Mentalillness” is distinct from both of these terms. Having a #mentalillness signals that a person’s pattern of thinking, their mood or their #behavior has changed in a way that negatively affects their well-being or typical functioning. #Mentalillness is also distinct from developmental conditions such as autism and intellectual disability, which arise early in a child’s development and last the course of their lifetime. #Mentalillness and neurodevelopmental conditions can co-occur, however.
#Depression and #anxiety are among the most common #mentalhealthconditions. Eating disorders and #schizophrenia are other examples of #mentalillness. Substance use disorders are closely tied to #mentalillness. They can lead to, or be exacerbated by, #mentalillness. As with #mentalhealth, the severity of these disorders and the traits that accompany them occur on a spectrum.
How common are #mentalhealthconditions among #Washington children and #adults?
Unfortunately, #Washington ranks poorly on several national markers of #mentalhealth.
About 22% of #adults here are experiencing a #mentalillness, according to data from the national nonprofit #MentalHealth America’s 2021 report, compared to 19% nationally. Only five other states — Oregon, Indiana, West Virginia, Idaho and Utah — have a higher prevalence of #mentalillness than #Washington. Among children, Washington ranks among the 10 states with the highest prevalence of severe depressive episodes and substance use disorders.
This likely underestimates the extent of #mentalhealth concerns. The 2021 report includes data through 2018, before the #COVID-19 #pandemic and national uprisings over #racial injustice. Early data from the #CentersforDiseaseControlandPrevention suggests #mentalhealthissues skyrocketed after the #pandemic hit.
What common signs of #mentalillness should people look out for?
Symptoms of #mentaldistress can come in many forms, experts say. In general, though, people should start to have concerns about themselves or their loved ones when their everyday functioning becomes impaired.
Common signs of #mentalhealthissues include persistent trouble focusing on work, taking care of physical hygiene or fulfilling a role as a caregiver, said Jane Simoni, a professor and director of clinical training in the University of Washington’s #psychology department. Symptoms in children might be more subtle, or look different: Children might complain about headaches or refuse to go to school instead of saying in words that they feel anxious or stressed out.
What causes #mental or #behavioralhealth problems?
A person’s #mental well-being is influenced by many things, including their experiences, genetics and family history of #mentalillness. Some people are born with difficulties managing their emotions that could make them prone to developing #mentalhealthissues early on. Others grow up without serious concerns until #adolescence or adulthood.
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space. #http://bit.ly/JamesMentalHealthArticle
Although a few #mentalhealthconditions are highly heritable, researchers and clinicians also point to environmental influences — a person’s income, how they were raised, work or school stressors, their connectedness to community — on individuals’ #mentalhealth outcomes. Personal and intergenerational trauma also have clear links to mental well-being.
“There’s always a biological and social component,” said Jonathan Kanter, who directs UW’s Center for the Science of Social Connection. “We’re getting better at recognizing that many #mentalhealth problems are a function of what’s going wrong in people’s context, in people’s community, in people’s social world.”
How are #mentalhealthconditions diagnosed?
Unlike many physical conditions, #mentalillness isn’t diagnosed using biological tests. Although genetic research and brain scanning studies continue to pick up differences between those with and without #mentalillness, in general, scientists haven’t found biological markers that can be reliably be used to predict or diagnose #mentalhealthconditions.
Instead, #mentalhealthprofessionals use behavioral diagnostic tools and clinical observation. They look for conditions as defined by the Diagnostic and Statistical Manual of #MentalDisorders or the International Classification of Diseases, standardized manuals that aim to make diagnosing #mentaldisorders consistent.
In recent years, the federal #NationalInstituteofMentalHealth has made a push to drop the diagnostic labels we’ve used for decades, and instead, has prioritized studies that focus on individuals’ traits or symptoms. This new framework for studying #mentalhealthconditions recognizes that many traits and their underlying biology map across various DSM-defined diagnoses. The reality is, many people have characteristics of several diagnoses — and even receive several diagnoses over their lifetime — because symptoms overlap between conditions and can evolve over time. This is one example of the many ways that diagnosing and treating #mentalillness is complex.https://projects.seattletimes.com/2021/local/mental-health-faq-lab/access.html
What types of treatment exist?
#Mentalhealthtreatment falls into two big buckets: #behavioral interventions or talk therapy — and #pharmaceutical drugs.
Both forms of treatment continue to advance through medical research. But each faces significant challenges. Talk therapy is effective but, practically, it’s difficult and expensive to scale up. And the #pharmaceutical industry, for all its years and research investment, hasn’t discovered “silver bullet” drugs for most people with #mentaldisorders.
What systemic barriers exist to receiving care?
The list is long. But here are several examples:
- Ability to pay: Many people are uninsured or underinsured — and some #therapists don’t accept insurance from those who have it because enough people are willing to pay out of pocket.
- Pipeline issues: Not enough professionals graduate each year to meet demand.
- #Racial disparities: Like the rest of the health care system, #mentalhealth care lacks Black and brown providers. Culturally competent care can be hard to come by.
- Rural vs. urban living: Finding a #therapist is nearly impossible in many #ruralcommunities — and still very difficult in urban areas.
- Stigma: Some communities consider #mentalillness a weakness; others don’t talk about #mentalhealth at all.
- Lack of coordination between primary and #mentalhealthcare. For instance, a person in #mentaldistress seeking help at an emergency room might find the #physician on duty isn’t trained to screen for — or treat — #mentalhealthconditions.
Most of these barriers are interrelated. For example, because of a lack of availability or coordination of care, #schools and child welfare agencies have become the de facto system of care for many #children and #adolescents. Prisons and jails have played the same role for some adults with serious #mentalillness.
One persistent tension in the effort to break barriers is the competing need to fund long-term, high-intensity inpatient and community-based care for those with severe #mentalillness — an expensive endeavor — and the need to scale up and pay for treatment for the many more people living with significant, but less debilitating conditions.
In an ideal world, we’d adequately fund both, said Dr. Jürgen Unützer, chair of UW’s Psychiatry and #Behavioral Sciences Department.
What prevents #mentalhealth concerns from emerging or escalating?
The universality of the #pandemic has opened doors for people to talk about their #mentalhealth.
Talking about #mentalhealth, teaching about mindfulness and helping people recognize signs of problems as they arise are all starting points to prevent #mentalillness from emerging or worsening, Simoni said; these efforts can happen in classrooms, workplaces, families and churches. “We’ll never have enough #mentalhealththerapists for those who need them, so we need to do more to focus on prevention,” she said.
Experts also point to the role of society, and inequities baked into our systems. #Peopleofcolor, in particular, face systemic discrimination that has clear ties to a negative impact on their #mentalhealth, said Pamela Collins, professor of psychiatry and #behavioralsciences and global health at the #UniversityofWashington. Another example: A weak social safety net might force someone with severe #mentalillness into #homelessness.
Alternatively, being involved in community activism can be an important form of #mentalhealth coping, Kanter said. Likewise, having a place to sleep, food to eat and support from family or friends might be the difference between someone’s ascent or descent through a #mentalhealthcondition.