Language And Health: Bringing Mental Health Into The Culture Of Health

39097145815dd9f6c076ede586561362-huge-miFor all the strides we make, mental health and physical health continue to be viewed by many as two separate issues, though the two are inextricably linked. As a result, the quality of mental health care suffers. Today on the blog, clinical psychologist Benjamin Miller urges us to adopt language and actions that reflect the "oneness" of mental and physical health in order to begin to better address them. 

By Benjamin Miller, PsyD

What is health? Depending on who you ask the definition can be quite broad.

Our understanding of health is often tied to our experience in health care despite the two being quite distinct and different. Research is clear that what impacts our health has little to do with health care, which begs the question – what is health?

Health is the foundation for achievement. Without it, we cannot achieve our fullest potential and goals. We need health to make sure that we can be successful in life. While we must never ignore major issues like social determinants on our health, we also need a functional health care system that can adequately address our health needs when we are sick. 

But do we have this system? Do we have language to describe what we want? Language is important in our understanding of culture. And language has divided us in health care. Consider the wonderful breakdown of terms according to Moses et al.:

Current taxonomy is frequently misleading and fails to describe the complexity of the entirety of the US health care system. Health is a misnomer, because most activity involves illness. Health care and medical care are not synonymous. Prevention requires tools that are often unfamiliar because educational, behavioral, and social interventions, not usually considered to be part of medicine, may be most effective for many diseases. Provider does not accurately describe the dozens of different professions and organizations required for a patient’s care. Payers are paid not to pay too easily; insurers do only modest amounts of insuring because government and employers accept most risk. Economic concepts of cost and value are ambiguous, as measurement is elusive and because one segment’s cost is another’s value. Market is a misnomer because few prices are transparent and many are controlled. Above all, US health care is not a system, as it is neither coordinated by a central entity nor governed by individuals and institutions that interact in predictable ways.”

Having more precise language to describe health may actually help change health care. Consider the issue of mental health. Yes, we use this term to describe what we think of as a mental condition or need; however, science and evidence simply refute this notion concluding that our mental health is inextricably linked to our physical health. It’s really just about health.  It’s about the whole and not the part.   

Our health care system, taking a page from this limited understanding, created an entirely separate system to manage mental health. In fact, legislation passed under JFK over 50 years ago still haunts us today as Kennedy’s promise to better address mental illness was never fully realized. Then, as now, the health care system isolates mental health from whole-person health. We see a piece when we need to see a whole. Kennedy’s legislation, while undoubtedly filled with good intentions, only widened the divide between mental health and the rest of health care because the science was simply not where it is now to inform the policy decisions. Deinstitutionalizing mental health was the right move, but what happened next was a series of unintended consequences that we are still addressing today. For example, consider that there were really no mental health benefits at the time- these had to be created, and in their creation a division emerged of having two separate benefits (one for mental health and one for medical). These decisions are why the battle over mental health parity has been so critical – so that all benefits are treated as equal.

Concurrent mental health and physical health problems are quite common and often go untreated, leading to high health care utilization. Said differently, when both behavioral and physical health problems are treated in a medical setting simultaneously, improper utilization of the health care system decreases, patient outcomes improve, and money is saved. We know what needs to be done, but we are constantly running up against a culture of fragmentation and a history of fractured delivery that presents a substantial barrier for change.
Language changes culture.

While mental health is undoubtedly a critical piece to our health, it is a piece. If we want to decrease stigma around mental illness, perhaps we need to begin to think about our language. If we want our community to begin to demand and expect something different in health care for their health, maybe it’s time we begin to shift our language to be more inclusive of mental health.

To accomplish this, we need to be less afraid to talk about mental health in all settings. We need to be willing and able to have teams that include mental health clinicians. We need to recognize that every time in health care we refer or say “I don’t do mental health,” we further fragmentation and stigma. It is on us, all of us, to begin to reassess our language in service to a much more whole and complete vision of health.  

To help begin to better address mental health perhaps we should consider, at a minimum, the following:
  1. Be careful of using language that furthers the artificial divide between mind and body (e.g. that’s so mental, he/she is crazy)
  2. Provide educational materials that speak to the whole of health (e.g. brochures in a primary care practice, videos or public education efforts on the role of “mental health” in health)
  3. Advocate for payment models that are inclusive of mental health (e.g. global payments that include the cost of mental health clinicians, bundling mental health services into larger medical services)
Health is health is health, and until our health care system reflects that, we must keep pushing for our broadest understanding of health to include mental health. Together we can begin to change culture to make mental health just another facet of health. This will change practice, policy, payment, and most important people’s minds.  

Benjamin Miller, PsyD, is an associate professor in the Department of Family Medicine at the University of Colorado School of Medicine where he is director of Eugene S. Farley, Jr., Health Policy Center. Under his leadership, the Farley Center has worked on four main areas: behavioral health and primary care integration, payment reform, workforce, and prevention. A clinical psychologist by training, Miller has focused his career on creating innovative solutions to fragmentation in health care.
Read more about integrating mental and physical health. 
Posted by Sonya Collins on Nov 10, 2016 11:03 AM America/New_York
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