People need a mental break from the anxieties and stresses inherent in daily living. In light of this, I would like to see businesses incorporate two or three "mental health days" a year into their benefits packages in addition to the usual sick days. Taking such a step would finally put us on the way toward establishing at least intellectual parity for mental health problems. This, in turn, would lessen the stigma associated with emotional disorders.
Dr. Robert T. London
Americans are clearly suffering. According to the National Comorbidity Survey Replication, about 26% of American adults aged 18 and older suffer from a diagnosable mental disorder in any given year.
Not only is feeling "down" or "anxious" cause for a mental health break. But often, emotional problems are a result of physical pain from problems such as headache and backache. That also is the case when it comes to gastrointestinal, cardiac, and skin problems. In medicine, we know that the sympathetic and parasympathetic innervations control GI disorders; cardiovascular problems; and skin disorders.
Over and over, we psychiatrists, psychologists and other mental health professionals hear people say "I can’t take another day of work," or "I’ll go crazy if I have to return to work tomorrow." The list of remarks illustrating the sense of dread that many people feel about their workplaces could go on and on. People certainly don’t want to quit their jobs – especially in these uncertain economic times. But some people do opt to use sick days when they need a break from the stress. Why not formalize such an action? After all, the ability to take a sick day because of extreme anxiety or stress is just as important as being able to do so because of a severe upper respiratory infection.
Speaking of physical ailments, I was pleased to see Dr. Amin A. Gadit’s commentary about the World Health Organization’s focus on the need for psychiatrists and primary care physicians to work together in its World Mental Health Day observance this year ("A Call for More Collaboration," Clinical Psychiatry News, October 2010, p. 8). The WHO estimates that 450 million people worldwide suffer mental health problems either directly or through physical illness that lead to mental disorders or mental disorders that lead to physical illnesses. Again, according to a WHO Health and Work Performance Questionnaire that assesses sick days, depression was cited as the No. 1 reason for absenteeism. According to the February 2010 issue of the Harvard Mental Health Letter, the top five reasons for absenteeism included depression, anxiety as well as back and neck pain. And because of the huge demands on the time of most nonpsychiatric physicians, coupled with the lack of depth they often bring to treating psychiatric illnesses, the mental health needs of patients they see often go unmet.
Perhaps our health care system would do a better job of meeting those needs if primary care physicians referred to us and our colleagues in mental health more often. Just as primary care physicians routinely recommend certain labs, EKGs, radiographic studies, or stress tests, they must make it routine to refer whenever they recognize an anxiety- or stress-related problem – including depression. One person I spoke with recently who is a chronic migraineur and subsequently misses days of work, told me that her primary care physician prescribes two medications for the migraines. In addition, he encourages the patient to eliminate the cause of her stress. And there it stops.
Therefore, I would propose an alternative system for handling the many mental health problems that the primary care physicians advise and treat. That would be a system in which mental health referrals would be routine – or even standard of care – for a suspected psychological problem or when psychotropic medications are prescribed. This approach would improve the quality of care for mental health problems.
Moving forward, one approach toward our larger goal might be to have primary care physicians hold a mental health day once a week or perhaps biweekly in their offices or clinics. On those days, patients with mental health problems could see a mental health expert – a psychiatrist, psychologist, psychiatric nurse practitioner, or mental health social worker. The point would be to have the mental health problem, whether one of the anxiety disorders, stress-related issues, depression, or the myriad of psychiatric disorders that are first seen by primary care physicians addressed by those experts trained to do this kind of intervention and care, as part of the general health care routine. In these sessions, a strategy would be put into place – whether short-term interventions, a cognitive-behavioral program, or a more dynamic approach.