Every society and every life comes with one or two “elephants in the room” to politely tiptoe around. Some of these are so diplomatically disguised as to be completely invisible—especially to insiders.
Few of them, though, are either weightier or better-ignored than the elephant of mental health epidemics that quietly sweep through many modern cultures, including our own.
One out of every five Americans has been diagnosed with a mental health disorder.
Cumulatively, these conditions are costing the US more than $200 billion—over $50 billion more than the ‘silent killer’ of heart disease—and the personal toll in wrecked lives and ruined relationships, in many cases unnecessarily, is inestimable.
Much of this is manageable with adequate care but upwards of 50% of diagnosed adults aren’t getting proper treatment. Many refuse to seek it.
You see, polite society—and all of us in it—seem to have taken the policy of holding the problematic topic of mental health at arm’s length, where it vaguely rests only on the fringes of consciousness.
At least, that is, until it rudely invites itself in to touch the life of someone close to us—or our own—destroying short-term productivity and threatening long-term happiness.
Even then, many of us refuse to squarely confront hard realities, clinging to the hope of ‘fixing it ourselves’ rather than being the person who unveils the unpleasant pachyderm to public view.
I’ve touched briefly on this topic in the past as it relates to productivity, pointing out research suggesting that sleep, exercise, and cold showers; fasting; and learning to detach from work and reduce our dependence on smart devices can assist in holding depression and certain other forms of mental illness at bay.
Today, though, I’m going to dig much deeper.
In this post, I address what you should do if you struggle with mental illness—or suspect you do—to maintain a productive and happy lifestyle.
I address what you can do to understand and support those in your life who are struggling with mental illness if you do not.
And I lift the shroud our society has wrapped around the costliest and most devastating productivity killer in this nation, to examine why our entire healthcare system is geared against the treatment of mental health—and the one thing you and I must do if we want to see this change.
Because mental illness like virtually nothing else, has the power to destroy the productive life—even take life itself—if left unchecked, if untreated; whereas if these maladies of the mind are caught early and treated responsibly the harm they cause can be mitigated, and successful, productive life preserved.
For those who wrestle directly with mental illness:
Know, first of all, that you are not alone.
Behavioral illness—depression, anxiety, substance abuse, and other issues—is a dark place. Many—perhaps even most—of your friends and family members will not understand what you are going through. You must reach out anyway. Identify and rely on those within your immediate support network who do understand, who are committed to helping you through a long-term plan for coping and recovery.
If you ever find yourself on the brink of crisis, take courage and reach out for support immediately.
This is all especially crucial for men, who are more likely to hide behavioral health problems until they are tragically driven to the unthinkable.
Now: like most everything else I write about, good or bad behavioral health will almost never be entirely within your own control. And as with everything else, you must not allow that to stop you from shouldering responsibility and taking control of your health to the greatest extent possible:
1. Decide to do absolutely everything in your power to to improve your behavioral health. Commit to change what you can and work around what you can’t. Flatly refuse to let this challenge define you—either as a passive victim, or worse, by taking pride and entitlement in it—and you will find open doors to vast improvements in your quality of life, even if you are never fully ‘cured.’
2. Be willing to recognize and acknowledge what is going on. Monitor yourself. Know the warning signs or triggers for your condition, and get help early when you recognize them rather than ignoring them or trying to manage them yourself.
3. Get professional help. Find a credible, credentialed professional trained in psychiatric methods. If your socioeconomic circumstances or insurance prevent you from accessing care through a clinic, you can likely find free, subsidized, or reduced-cost psychiatric resources through local philanthropies or religious organizations (clergy in many faiths are often trained in therapeutic methods).
4. Never stop contributing to the world. If you are wrestling with mental health or substance abuse issues, your employment prospects may seem bleak. If your circumstances force you out of your chosen career path, resist the temptation to give up. If you are able, find a career pivot that will allow you to work around your challenges. Even if you are unable to ‘work,’ find ways to contribute meaningfully, even if they feel small at the moment. With every diligent act of productivity, you exercise control over your life and claim our common birthright of human dignity.
5. Let your story be heard. We exist in a culture that largely disavows mental illness. By appropriately sharing your story in positive, proactive ways, you not only take a crucial step toward management or recovery—you provide an essential ingredient in rewriting our cultural narrative of these issues—from the inside.
For those who do not personally wrestle with mental illness:
Recognize that the hand dealt each of us has a few handicaps, and refuse to believe that the Achilles’ heel of mental illness makes those who struggle with it somehow inferior to you.
Refuse to be part of the insensitive group naively perceives those who struggle against mental illness are simply ‘lazy,’ or that they could simply resolve their problems with an act of will.
Even when you happen to guess right that a particular individual could be doing more, your judgment probably won’t help.
The best way to lift someone in their fight with mental illness, as with anything else, is to meet them where they are:
6. Educate yourself. Invest some time into reading up on mental illness. Consider this facts sheet compiled by fellow HuffPost contributor Lindsay Holmes. Ensure that you can carry on an intelligent conversation on the subject.
7. To the degree possible, make an effort to empathize. Strive to truly understand the experience of those who must confront the reality of mental illness on a daily basis. Read accounts by individuals coping with mental illness and their family members online to get a sense for what their lives are really like. Tactfully reach out to affected friends and family for first-hand accounts to deepen your understanding of ‘a day in the life.’
8. Commit to being non-judgmental. Decide that you will let the facts and personal stories about mental illness come together for you, and that you will work to form an accurate and compassionate view of how they work—and what it really takes for a person to take back their mental health.
9. Reach outside of yourself with a willingness to help. Find at least one way to meaningfully help someone suffering from depression, anxiety, or other issues along their path toward coping with or recovering. Tactfully reach out to friends or family who experience mental disorder and listen to their stories. Find ways, big or small, to lend a hand, brighten their day, and lighten the load they carry. Show them you see them.
And, finally, for everyone who reads this article:
Understand that our maladaptive approach to mental illness are systematically ingrained into out culture and our economy—and that you and I are the only ones who can change that.
A few conversations with those on the business side of mental health have helped put this into perspective for me.
Patrick Moallemian, a 30 year veteran administrator in the behavioral health industry who currently serves as the CEO of Signature Healthcare’s Massachusetts-based Westborough Behavioral Healthcare Hospital, put it this way:
“Our industry unfortunately suffers from not just the typical stigma, mostly based on misunderstanding,” he says, “but also, in my opinion, from lack of proper reimbursement levels for the intensity of the care that we provide.
“Our services are just as relevant, just as costly, [for maladies] just as debilitating as anything as it comes to population health—as it comes to employee health, as it comes to employee retention or productivity, to the cost to society, to individuals, to families, neighborhoods, towns, what have you—and it’s sort of a neglected or overlooked cost.”
To illustrate this point, Jesus Quiroga, one of Pat’s colleagues in charge of business development at Dallas Behavioral Health Hospital in DeSoto, TX, noted that insurance reimbursement allotments for behavioral health services range from $500 per day for Medicaid patients, to about $900 per day for holders of premium plans. In contrast, a typical MedSurge hospital will typically charge patients between $1,500 and $3,000 for a night’s stay, nationwide.
According Lana Foster-White at San Antonio Behavioral Healthcare Hospital in San Antonio, TX pointed out that, in an effort to escape the low-ROI insurance rat-race, many therapists are simply boycotting the game.
“[A lot of] psychiatrists are going straight-fee for service,” she says. “And that’s a huge problem we have: not enough psychiatric providers here will take insurance [or] Medicaid for aftercare.”
This means many patients—especially the less well-to-do—have no ready system in place for preventative care for managing mental health problems.
The question here, though, is why. And while we could point to the greater market power MedSurge hospitals command relative to behavioral health facilities, or perhaps to the sometimes tragic history of behavioral health institutions, I believe it ultimately boils down to something that is much more actionable:
Corey Blake, a marketing expert whose agency, MWI, works extensively with behavioral health professionals, believes that it boils down to what we as a society collectively value:
“Ultimately, the root problem in the behavioral health industry is the devaluing perception of mental health. Society in general still craves the comfort of not quite believing that mental illness exists, and as a consequence people don’t seek preventative help when they need it, and society doesn’t provide adequate resources to resolve inevitable crisis situations.”
The consequences of this undervaluing are felt socially and economically by everyone involved—both those who live with it, and those who treat it. As one veteran psychiatric doctor puts it:
“[T]he question I ask every interviewee for psychiatry residency is "Have your family gotten over it yet?"
And Neel Burton, a British author and psychiatrist says of his experience when he ultimately turned away from ‘more ambitious’ specialties as a medical doctor:
“It became very clear, first, that the stigma that people with a mental disorder are made to feel also extends to the doctors who look after them; and, second, that this stigma emanates most strongly from the medical profession itself[.]”
The secret, then, is that this becomes a vicious cycle: the medical profession treats psychiatry as a “second-rate” discipline, steering its resources—including some of its best talent—away from that field.
This in turn hurts public perception of psychiatry and the value placed on mental health, reducing demand psychiatric services, reducing prestige, driving down salaries, and further dissuading ‘ambitious’ doctors from entering the field.
Of course, professionals in this industry push back—Jesus Quiroga conducts trainings, for example; Lana Foster-White engages extensively in social media outreach, and Patrick Moallemian in his prior role at Chicago Lakeshore Hospital had his institution give back by participating in research—all with the objective of earning physicians’ respect and motivating a shift in public opinion.
As Corey Blake put it: “If we want to improve outcomes in behavioral health, we need to start by changing the value equation people are bringing to this. Once people put personal and social wellness ahead of traditional stigma norms, then behavior and policy will change. It’s the only way.”
But the most heroic efforts of these healthcare professionals won’t turn the tide alone. That’s where you and I come in:
10. We must work to change public perception of mental health and mental health issues. In addition to the proper self-care and empathy I suggest above, each of us can be an agent for change, simply by breaking our own link in the vicious cycle.
We can fight the stigma that holds people back from seeking early and proper care by speaking accurately and empathetically about mental health issues.
We can gently correct and educate others when we hear or read something that is false, derogatory, or stereotypical of those struggling wrestling with mental illness and the profession that serves them.
We can encourage political representatives to dig deep to craft sustainable improvements through innovative policy that goes beyond throwing money at the problems.
And when possible, we can contribute some of our time, talent, and resources to raising awareness in other ways.
When mental health crisis or substance abuse touches someone close to you, you’ll be glad you did.