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Key points
- In addition to annual physical health checkups, we should have them for mental and emotional health too.
- Earlier detection improves outcomes, lessens collateral damage, and reduces stigma.
- Individuals and families historically tend to come in very late for mental health support.
The annual physical is a staple. Kids are required to do it for school and camp. And most of us have it as a yearly "to-do" throughout our adult life. After all, “an ounce of prevention is worth a pound of cure” or, if not actual prevention, then at least early detection. Most of us have experienced, or know someone who has experienced, the relief of finding an illness early so it can be treated more effectively and successfully. Though we may not always have our checkups quite as punctually as we should, most of us don’t question the logic of a regular checkup with a series of standard questions, physical reviews, and blood test results acting as generalized markers for health or the status of any number of physical health issues, and the ongoing process of aging. The point, as we all understand, is that, if there is something brewing, we should catch it early and therefore have a better chance of treating it while at its most treatable. Sometimes, we are urged to make a lifestyle change like a shift in diet or exercise as cholesterol or weight creeps up. Doctors will ask regular recurring questions about drinking, smoking, exercise, and other health benchmarks and can notice any upward or downward tick that should be underscored or taken notice of. Other times we are offered preventative medication or advice to stave off a potential problem. And then there are the patients who are given a clean bill of health and can skip off back to their lives with some confidence that there is nothing to worry about for another 12 months, hoping to be spared any unforeseen infections, diagnoses, or accidents.
How is it that this is not done for mental and emotional health? Largely, I think the answer is that it is not our habit, that we fear pathologizing normal behavior, and that stigma about mental illness is still an issue. Many of us are from a generation in which you needed to be seriously mentally ill to see a therapist or psychiatrist and, even then, there was shame attached to it. One common but erroneous view is that we should be capable of keeping an eye on our mental health status by ourselves—though this is not something that we say about physical health. And some believe we should rely on family and friends to let us know if there’s something amiss. In that case, we’re relying on the very people—ourselves and our families—who are most likely to normalize out-of-the-ordinary behavior and underestimate symptoms that may embarrass us. We would also be relying on the very people who have a vested interest for nothing to be wrong and, often, have little time to spare to contemplate tell-tale signs that there may be problems bubbling up. One of the reasons we go to our general practitioner is to set aside a specific time to review our health and to submit to a professional’s trained and objective eye. In my opinion, the same should be true for mental health.
All my professional career, I have worked with individuals and families coming in for help later than I would have wished — and most often, with hindsight, later than they themselves would have wished. Over and again, we are consulted when the symptoms are habitual, the behavioral patterns are hard to shift, and the diagnosis is entrenched. That’s not to say we don’t roll up our sleeves and get stuck in. When a client first makes a mental health appointment, it is because they see a problem and are motivated to get help and to change.
But I believe that often an individual and family’s outcomes could be so much better if they had an annual checkup, a yearly snapshot of mood and behaviors, issues, interactions and relationships and, maybe, brewing concerns. How much better when these things can be spoken about openly, addressed in their early stages with less intervention, or directed to the generalist or specialist most suitable for the issue at hand? We can hope also that there will be less of the collateral damage to close family and friends that often comes with festering problems.
Once we’ve discussed the origins of clients’ concerns, nine times out of 10, they look back and see markers they wish they had taken more notice of. Often, they saw them at the time, were concerned, but did not really know what they signified. Sometimes, in children, the issue is driven by inherited wiring or chemical makeup, by learning differences, or by unspoken individual or family trauma, and sometimes just by an unfortunate mismatch of temperaments and expectations. In many cases, there was a real belief that letting an issue or behavior run its course, or sort itself out, would resolve it. And, indeed, it can happen that way. Things do resolve. But sometimes they don’t. And I believe the effort and expense of a regular professional eye on these things would be invaluable to be able to differentiate those situations from the ones that are more serious and need intervention. Of course, there are already shortages of mental health professionals but, in the long run, the need would drop—that’s where the “ounce of prevention” and “pound of cure” ratio comes in.
Of course, therapists would need to change their practices to help make it possible for annual mental health checkups to become the norm. We will need to expand from the traditional weekly meetings with patients, and offer a service that enables clients to come in occasionally and prophylactically. We will also need to work on avoiding the dangers of over-pathologizing, just as GPs need to monitor the interventions offered on physical health issues.
In short, both patients and professionals will need to radically overhaul their demands, expectations of, and reactions to mental health care—but I believe we’ll be the better for it.
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