Out of Hiding

Mental health awareness paves the way for better diagnosis and treatment
Niki Stojnic  |   Seattle Health Fall/Winter 2013-2014   |  FROM THE PRINT EDITION

If you were to guess at the leading cause of injury deaths in the United States, chances are you might think of accidents—car crashes, for example, or falls. But while those accidental events are on the list (numbers two and four, respectively), it’s self-harm that has risen to the top in recent years—suicide.

During a nine-year study that was published online in September in The American Journal of Public Health, researchers found that the rate of suicides went up 15 percent, while car crashes, the previous leader, went down. And number three on the list, poisoning, might also include unreported suicide deaths, researchers speculate, since prescription drugs are the culprit in the majority of poison cases.

That grim finding highlights an aspect of health that so often goes unaddressed—mental health. Whereas a patient might be quick to call their doctor to check out that racing heart or persistent sore throat, that person freezes up when it comes to mental health, either brushing off a bout of depression as something to just get over, or being too embarrassed to ask for help. “When people think of mental health, people often think of the severe end—but it’s more common that an individual is suffering from everyday health, depression, anxiety, difficulty doing your job,” says Susie Winston, a counselor for child and family services at Seattle-based Sound Mental Health, a non-profit and one of the biggest mental health organizations serving King County. “Others are recovering from trauma.”

But doctors, mental health professionals, scientists and even politicians have recently been making a variety of efforts to curb the stigma and raise awareness of mental health issues, particularly depression and post-traumatic stress disorder (PTSD). The White House hosted a national conference on the topic in June and has launched Mentalhealth.gov with the slogan, “You Are Not Alone,” aimed at spurring conversation about mental health and educating the public on the subject. In Seattle, research at the University of Washington and Seattle Children’s is focused on learning more about issues such as depression, as well as how to better treat it.

“People are working hard to help it change,” says Katrina Egner, a Sound Mental Health crisis services manager, who adds that there are varying degrees of acceptance of talking about mental health problems; as the problem becomes more severe, communication becomes sparse. “It’s OK to see a therapist if you’re divorced and feeling down, and it’s harder to go to work; and if you start hearing voices, well then, God knows you don’t tell anyone about that!” says Egner.

Primary care doctors are often the first line of defense for people suffering from mental health issues and are trained to look for signs as part of routine exams, says Oren Townsend, M.D., a primary care doctor at The Polyclinic’s First Hill campus who includes depression and preventive wellness among his specialties. Depression is one of the three most common conditions that routinely come up at primary care clinics (the other two are diabetes and hypertension). “We’re always looking for it. If you’re not looking for it, you’re not doing your job as a doctor.”

But mental health is rarely as simple as zeroing in on the problem and making a diagnosis, especially when symptoms themselves work against patients’ abilities to help themselves. One of the symptoms of depression, for example, is loss of energy and an impaired ability to concentrate. “On any given day in primary care, as many as 10 percent of patients have depression,” says Townsend but primary care physicians are only diagnosing it about half of the time. Of the patients who are diagnosed with depression, he adds, few receive adequate medication or therapy, and many don’t follow through with referrals for care. Anxiety disorders follow a similar line: highly treatable and very common, it affects about 40 million adults 18 and older every year, according to the National Institute of Mental Health.

Mental health isn’t all in your head—it often correlates with physical illnesses. “We’re finding how many of our clients also have physical health problems, and are looking at the correlation between the two to bridge the gap,” says Egner. “There’s a lot of research right now about stressors in your life and relation to heart disease.” In children, says Winston, physical symptoms can manifest as asthma, chronic backache and the inability to cope with the usual demands of life.

Townsend agrees. “Patients with depression and multiple medical conditions are more likely to smoke, drink alcohol in excessive amounts, be physically inactive, have unhealthy eating habits and are at greater risk for obesity. Untreated or unrecognized depression is a barrier to effective treatment of other co-occurring illnesses.”