Most of the dedicated and hardworking students set to graduate from medical school within the next few years identify as part of the millennial generation. These individuals, including myself, will soon enough be physicians. While this reality is exciting, it also bears an enormous amount of responsibility. We must embrace technological advances. We must continue to improve health care access to underserved communities. Most importantly, we must ask ourselves how we want to shape the health care of tomorrow and what positive changes we wish to see. Perhaps we can all agree that we hope to see more enthusiasm and support for mental health care. For the next generation of physicians, mental health care must be a priority.
My introduction to mental health care began when I was an undergraduate student at the University of California, Davis. I volunteered at Clinica Tepati, which is a free clinic in Sacramento. After my first year of volunteering, I met a physician assistant (P.A.) student who was developing a new mental health program in the clinic. Since the clinic’s opening in 1974, this student was the first to propose an improved program that expanded the care for patients with mental illnesses. Furthermore, she developed a position at the clinic that centered on assessing and following these patients. When she graduated, I assumed her role as the program’s leader. I subsequently trained more undergraduate students for the position she created and found new counseling options for patients.
Surprisingly, the new counseling services were underutilized by patients, as those scheduled to be seen by mental health professionals may not show up to the clinic for their appointments. Patients with co-morbid conditions usually were more reliable. Although I did not survey these patients to confirm my suspicions, this trend seemed to hold true. It is possible that transportation was too costly to outweigh the perceived potential benefit patients believed they would gain from attending a counseling session. Ultimately, while I was able to expand the mental health provisions at Clinica Tepati, I was not able to fully assess or address the barriers patients experienced when trying to utilize these offerings.
Until my clinical rotations, I had not realized the lack of mental health care provisions for both the uninsured and the insured. Patients usually have to do their own research to find mental health care providers within their networks. Sadly, even patients who are able to navigate the system encounter additional barriers when attempting to access care. Patients who seek mental health care services must have access to transportation and may have to take time off from work in order to attend an appointment with a counselor or psychiatrist. In the end, some patients may never be able to talk with a mental health professional even after all this.
On the contrary, some patients may not seek mental health care because their illnesses are never recognized by their providers. In the primary care setting, as many as one in four patients in the primary care setting have a mental illness, while primary care physicians only identify and diagnose thirty-one percent of these patients. Many patients who would benefit from mental health resources are never diagnosed. In order to rectify this situation, physicians should receive additional training on recognizing mental illnesses.
The mental health care dilemma demands attention because it can affect the physical health of patients. Mental illnesses are associated with other chronic diseases, like cardiovascular disease, diabetes mellitus and malignancy. Furthermore, appropriate treatment of mental illness is associated with improved health outcomes for chronic diseases. Therefore, all physicians should understand how to recognize mental illnesses by familiarizing themselves with the resources and mental health providers in their areas.
In order to be more efficient, we, as future health care providers, must recognize that patients affected by mental illnesses will need our support and advocacy. We must also understand that some patients might not have the time or financial stability to seek treatment or therapy. Regardless, we should explore other long-term treatment options and strive to make mental health care easily accessible nationally.