Lemaire: A Sense of Urgency for Mental Health

By Dr. Chad Lemaire – Originally Published in the Houston Chronicle on 10/21

Mental health concerns too often get swept under the rug and ignored.

Yet 44 million Americans, and half a million in Harris County, have experienced some sort of mental illness such as depression or an anxiety disorder in any given year. (And those are the ones we know about.) The Houston area has an alarmingly higher rate than the national average of people experiencing Serious Psychological Distress (SPD). A small fraction of folks actually get treatment.

It’s not that Houston, with the largest medical center in the world, doesn’t have the right treatment options. We do. The problem is a lack of resources to get people the care they need. The severe shortage of behavioral health professionals, for instance, is dire, with 185 of Texas’ 254 counties not having a psychiatrist. Wait lists for children, students at Texas universities, veterans, and the underserved are a mile long.

But perhaps more than these resource factors is a larger challenge: Our collective mindset is – still, after many years of ringing this bell – off the mark. The way we as a city and as a nation typically think about behavioral health – somewhat negatively, laden with stigma – makes it difficult to treat, even if we had all the money and psychiatrists in the world.

For patients, 9 of out 10 Texans say it’s harder for them to talk about a mental health condition than a physical one, according to the Meadows Mental Health Policy Institute. We don’t need Freud to tell us that when you don’t talk about something, it only gets worse. Or often goes unnoticed and untreated. For physicians, it is imperative they throw out the old model learned in medical school that considered mental health less urgent than physical health. The mind must be given the same attention as the body. Depression and anxiety are just as important to treat as diabetes or any chronic disease.

One promising approach is Integrated Behavioral Health (IBH), which combines physical and mental health services instead of the standard separation between them. What began as a two-year pilot program in IBH at Legacy Community Health’s Baytown clinic will now be permanent, and replicated at our flagship Montrose location. Bringing a behavioral health consultant into primary care patient visits in real time allows us to better identify, de-stigmatize, and treat conditions like depression and anxiety. Many, if not most, of the 80 percent of patients we screened under the pilot would have gone untreated.

While there’s a long way to go for full integration at Legacy, we wanted to start somewhere and hope other providers in Houston to follow suit. One estimate shows a savings of $26 billion-$48 billion annually through successful integration of physical and behavioral health.

Policymakers also have a leadership role, one that can be bipartisan, constructive, and deliver immediate benefit to millions of Texans. Mental health is expected to be a priority when the Texas Legislature convenes in January, and we’re hopeful telemedicine, strengthening the state’s Medicaid program in some fashion so patients can better afford treatment, and, yes, more funding are considered. Even in a tight budget year, the Legislature should continue to increase funding as it has done in the two previous sessions. Let’s not take our foot off the gas now.

We get a lot thrown at us with work, school, family, finances, social media (“Facebook depression”) and even by a presidential election. A recent poll by the American Psychological Association shows more than half of the country, almost equally divided between Republicans and Democrats, is stressed out over the campaign. All of this is to say the day-to-day stresses of life affect our mental condition, sometimes more than physical ailments. It’s time our medical and political priorities reflect that reality.

Dr. Lemaire is medical director of behavioral health at Legacy Community Health.