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Has Medicine Lost Its Mind?

Your physician is not trained to treat your mental health problems.

Since 1985, I’ve focused on patient-centered communication and mental health care in medical settings. That’s right—medical settings—not psychiatric settings. That’s because primary health care physicians are typically the first person a patient goes to for help with their mental health problems. And these physicians are rarely trained to recognize, diagnose, or treat those mental health disorders.

Trained as an internist, I teach medicine at Michigan State University where I work with students, residents, and colleagues to study the vast array of mental health disorders in our clinics. We’ve had to address mental health because help from psychiatry is terribly scarce. My job keeps me busy teaching, supervising, publishing, traveling to present papers and, of course, attending lots of meetings.

So if I’m that busy, why start a blog?

To sound an alarm.

I’m worried, scared really. I love medicine, but over the years I’ve seen that the profession has a frightful problem. Worse, it doesn’t recognize the problem.

“Mania and Melancholia”/ Wellcome Library, London/CC BY 4.0
Source: “Mania and Melancholia”/ Wellcome Library, London/CC BY 4.0

The problem: by restricting its interest to physical diseases, medicine fails its patients who come to them with mental health disorders. According to the Healthy People initiatives, only twenty-five percent of patients with mental illness receive any care, while sixty to eighty percent of those with heart disease and other medical problems receive care. Further, although physicians are well prepared to provide your heart the care it needs, care for mental health patients mostly falls below standards.

Why? Because, according to research from the National Institute of Mental Health, eighty-five percent of all mental health care is provided by medical clinicians. And, as I’ve said, they have not been trained to provide mental health care.

That’s right, your doctor is not trained to provide care if you (or your family and friends) happen to become depressed, have an alcohol problem, develop a panic disorder, are suicidal, are painfully shy around people, or have chronic pain. Sure, I know, for chronic pain, they might give you a narcotic, like oxycodone. But that’s the wrong treatment—and can lead to addiction.

You’re probably as worried as I am by now. But my concern goes beyond the individual patient to society’s needs. According to the National Alliance for Mental Illness, mental disorders are the most common condition physicians face in practice, more common than heart disease and cancer combined.

Here’s what’s really bizarre. First, understand that everyone in the medical profession recognizes there has never been—and never will be—enough psychiatrists. Second, to correct the mental health crisis, all the medical profession would need to do is train all graduates to be as competent with mental health problems as they are for medical problems. Medicine knows this—but has not changed educational practices for mental health care in over 100 years. That’s right—when it comes to mental health care, we haven’t changed our standards of training in over a century! To illustrate, for four years of medical school and three years of a primary care residency, medicine devotes no more than one or two percent of total teaching to mental health care, despite it being the most common problem its graduates will face in practice.

Medicine seems not to understand what, to me, is a simple concept: train the people who provide the care. I’m sure you understand the need to do so, so why doesn’t medicine? In future posts, I’ll explore the many reasons the medical profession has failed us—and discuss current events that touch on the many intersections between our mental and our physical health.

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