The Need for Medical and Mental Health Care Providers to Collaborate

In a recent online survey of physicians from several countries, 27% or respondents answered “no” to this question.

The US Preventive Services Task Force recommends that all adults be screened for depression. Do you feel comfortable discussing mental health issues with all of your adult patients?

This is concerning because many people who are experiencing behavioral health problems seek help first from their physician. The Centers for Disease Control and Prevention noted in a 2015 press release that about half of the people who visit a physician for mental health problems see someone other than a psychiatrist.

In another finding by the same organization, the results were even more discouraging. 

I believe most of my patients are honest with me when discussing…

• 23% – Tobacco use
• 19% – Eating & exercise habits
• 13% – Alcohol use
• 13% – Sexual history
• 10% – Drug use
• 4% – Domestic abuse
• 18% – None of the above

These problems involve choices people are making that negatively impact their physical and emotional lives. And the results suggest that these important issues are not being discussed, or are not being discussed honestly, by a sizable portion of patients.

Polls sometimes fail to reflect reality for a variety of reasons. Even if twice as many people are honest when talking to their doctors about issues, that still means fewer than half are being honest about tobacco use, and fewer than 10% about domestic abuse.

Both of these survey items point to the need for better communication – between doctors and patients, and between doctors and providers who specialize in mental health treatment. I work hard to keep in touch with the other people who provide care to my clients. Many of them appreciate these efforts, and many of them reciprocate.

Although it sometimes appears that members of different health care disciplines work hard to protect “territory”, our clients and patients are always better served when we collaborate.

Looking for Common Ground

Most of my social media exposure is through Facebook. I know, I know, I’m behind the times. So be it. Through Facebook I see postings from other social media sites. And I read the letters to the editor, a kind of old school social media. Regardless of the source, I’m not very happy with what I see.

We seem to have created an atmosphere in which discord and denigration are valued more than civility and communication. I suppose this is nothing new, except perhaps in the depth to which it has penetrated our “interactions.” And it goes beyond politics and comedy, which have always been fertile ground for putdowns, shout-downs, and sometimes knockdowns. According to my Facebook feed, if I like/dislike the Dallas Cowboys/Greenpeace/Wall St. Journal/John Steward/Taylor Swift; if I agree/disagree that children should wear/not wear bicycle helmets or play/not play video games; if I can/can’t recognize that picture of an ice cube tray/rotary phone/air raid shelter sign; then I am worse than worthless and am wasting valuable oxygen meant for someone more deserving. Doesn’t it seem a bit ridiculous?

I have been guilty of contributing to this trend at times. I have posted a comment to try to get a laugh, not thinking about how it might hurt someone’s feelings until after clicking POST. I have added my two cents unnecessarily to a stream that already had too much heat and not enough light. I have LIKEd harsh putdowns disguised as seemingly clever comments, hoping that someone will see me as clever, too. Maybe I have scored meaningless “points” by these actions, but at the expense of a useful exchange of ideas.

This isn’t helping.

I am not advocating an end to social media. It could be – and is - such a powerful tool that it would be senseless to let it go to waste. What I would love to see is people reading comments thoughtfully, responding to them with questions rather than attacks, and looking for common ground. I believe that common ground is there, but we have stopped seeking it.

I have tried this approach. It is not easy. Sometimes I become preachy and self-righteous, or Pollyanna-ish and naïve, or just plain irritating. Sometimes I expose my ignorance, which is not much fun. In spite of that, if I am open to understanding what the other person really means, I often learn something. One of the biggest things I learn is that the other person and I are more similar than different. When that happens, we both score points that are really worth something.

Other people are doing this. I’m going to keep trying. I’ve got nothing to lose, and a better world to gain. I'd love to hear what you think.

Psychology and Torture?

In recent weeks it has come to light that two psychologists allegedly assisted in “enhanced interrogation” (aka torture) conducted by the CIA in Afghanistan. I have seen articles on newspaper websites and on the website of the American Psychological Association (APA) discussing this issue. Recently the topic was featured in a Doonesbury comic strip.

Am I shocked that psychologists may have been involved in such activities? No. Psychologists are human beings, and human beings come in all varieties, good and bad.

Am I dismayed that this might give psychologists a black eye? Yes. It is unfortunate that the times when we remember hearing about psychologists – in the news, on television, in the movies – tend to be when psychologists have engaged in inappropriate activities, or when they have been presented negatively. This happens despite efforts by the APA and other organizations to use the science of psychology to improve our lives. The APA is conducting an investigation to determine if the organization was in some way complicit in the actions of these two psychologists (who are not APA members).

Yes, among psychologists there are some bad actors, as there are in all occupations. I hope that people do not conclude that because some psychologists - or ministers, or law enforcement officers or politicians – have acted inappropriately, unethically or criminally, that all of them do. I believe most of us (the big “us”, not just psychologists) try to do the right thing most of the time.

I’d love to hear your comments and concerns and answer your questions.

Misunderstanding violence and mental illness

The September 2014 issue of Monitor on Psychology (the American Psychological Association’s monthly magazine) includes a column on violence and mental illness. Norman Anderson, the APA’s Chief Executive officer, tries to dispel various misconceptions about the perceived connection between violence and mental illness.

Anderson writes:

Today, the national dialogue on mental illness and gun violence continues based on reports of mental health problems among some mass violence perpetrators…. Unfortunately, the conversation in the media has focused in large measure on keeping guns out of the hands of what some have called the ‘dangerous mentally ill.

The vast majority of violent acts are not committed by people who are diagnosed with, or in treatment for, mental illness….Moreover, the focus on mental illness ignores the fact that most gun violence is committed by people in crisis, who are under the influence of drugs or alcohol, or in the context of domestic violence or other illegal activitie.

Given that most people with mental illness do not harm or threaten others, continuing to frame the conversation about gun violence solely in the context of mental illness does a disservice both to the victims of violence and those who suffer from mental illness. More important, it does not direct us to appropriate solutions.

It is easy for us to accept unquestioningly what we see on television or the Internet. I appreciate the APA’s efforts to set the record straight. They also continue to conduct research on the nature of violence of all kinds, and on our best, scientifically based efforts to prevent and respond to such violence.

A Natural Opportunity Close to Home

In a recent issue of the Winston-Salem Journal columnist David Bare highlights a development near downtown Winston-Salem that will provide environmental and psychological benefits. The Gateway Nature Center is a project to restore and preserve 19 acres of land that had been tarnished by years of industrial activity and the encroachment of nonnative species of plants.

The Center will provide educational programs and facilities for all ages. The Gateway Environmental Initiative, the organization responsible for the Center, hopes to counteract one negative impact of our growing dependence on technology: decreased interaction with the natural world.

Exposure to nature seems to be a balm for some of the irritations of modern life. Nature sounds, and silence (remember silence?), stimulate effects that counteract the negative impact of human-generated noise on attention and sleep. Immersion in nature appears to reduce the symptoms of stress, depression and ADHD.

One of the questions I typically ask new clients is about the time they spend in nature. Our busy schedules and urban environment sometimes make it difficult to get out in the backyard, let alone the back woods. Still, research suggests that the effort is worth it.

Do yourself a favor and take a hike!

An Unhappy Story That Gives Me Hope

A week ago I read an essay in the NY Times by a man working as a mentor for a teenager at risk for a lot of bad things. The author, Ron Berler, was focusing on academic underachievement and possible gang involvement. Of course, this child could have many other problems.

I've met many boys like this one. For several years I was the psychologist assigned to work with youth involved with juvenile court. Some of them committed very serious crimes. Fortunately, most did not. Many of them came from families beset by numerous challenges. At a time when the economy was fairly stable, many of the parents were unemployed or underemployed. Some parents had substance abuse problems. Some engaged in criminal behavior. Some were just not there. It was easy to become discouraged. What chance did these kids have?

Berler's essay described his teen's lack of motivation to succeed in school, his mother's lack of financial and emotional resources, his father's lack of participation in parenting. His father worked long hours to provide for the family, but he left the discipline to his wife. Even the school system had all but given up.

Berler encountered an incarcerated felon who wanted to help. This person, Orlando Mayorga, was serving a decades-long prison sentence for a crime he committed at age 17. Mayorga has plans for when he gets out; he hopes to become a counselor for at-risk individuals, as he was, as Berler's mentee is. Mayorga encouraged the teen (in a letter) to think not only of himself but also of his loved ones, who will be hurt if the teen is incarcerated, injured or killed. Mayorga's letter may have an impact; it's too soon to tell.

This could wind up as another tale with an unhappy ending. It gives me hope, however. It is a story of two people going in different directions. Orlando Mayorga, whose life got off to such a poor start, looks like he is turning things around, for himself and for others. Ron Berler's young friend seems to be making many poor choices. If Mayorga can change his course after going so far down the wrong road, then it is definitely possible for this teenaged boy to turn things around also.

The Benefits of Playing Video Games?

I’ve been catching up on some professional reading, and I came across an article in the January 2014 issue of American Psychologist with the above title (minus the question mark). I was pleased to see scholarly treatment of video games that does not focus exclusively on their problems. The authors acknowledge that such problems are real and are supported by research. However, they contend that the media’s treatment of these games has been one-sided and simplistic. Isn’t it possible that some of these games have some redeeming qualities?

According to the research (which is limited but growing), they do. Video games may help our children learn how to selectively attend to relevant information, how to process visual information more accurately, and how to solve problems more creatively and effectively. They can create the awareness that “persistence in the face of failure reaps valued rewards.” The social nature of many video games offers our children the opportunity to develop social skills. All of these benefits may be generalizable to their lives outside the video game environment.

It is worth noting that some types of violent video games can have cognitive and social benefits. One point of this article is that the world of video games is enormously complex and varied; simple conclusions about the impact of these games – the stuff we see in headlines – are probably unwarranted.

I believe that we can go too far with video game playing; I routinely talk to my clients and their parents about sensible limits. I also believe that video game play can have a negative impact on some people. It is refreshing, however, to glimpse the more positive aspects of playing these games.

I’d hate to have to log off completely.