The way we treat mental health in the United States needs to change.
As many patients seek help from their primary care doctor, or more often end up in the Emergency Department (ED), it is not enough for those with mental health issues to be solely the responsibility of specialists in mental health hospitals.
It’s therefore vital that all healthcare workers hone their skills in mental health assessment so they can begin looking at the problem from a whole human perspective – taking a holistic approach – enabling patients to access the right care at the right time no matter where that may be.
What are the Barriers We Face?
Despite it being 2021, there is evidence that some still view those with mental health problems as “morally broken”1 rather than ill.
One plausible reason for this stigma is the perception that mental health conditions are less “real” than physical ailments. This societal stigma appears to hold true across the healthcare professional as well as within the general public.
For example, a study published in the Health Affairs journal found that doctors were less likely to follow up with their patients who have been diagnosed with depression than those with congestive heart failure, asthma, and diabetes.
This lower priority associated with mental health conditions can lead to substandard medical care2 with 44% of adults with mental illnesses reporting being discriminated against or dismissed by their physician when accessing treatment.
But stigma is not the only reason. Healthcare professionals are under enormous time pressures, frequently have a lack of adequate mental health training and, as such, often feel that mental health care is outside their scope of practice.
Many emergency departments and general clinicians are therefore ill-equipped to meet the needs of patients with mental health issues.
Obtaining treatment for mental health is also too difficult for patients in the US. Mental health care can be delayed by up to 23 years from first symptoms3 and it has been reported that 62% of people with mood disorders and 76% of those with anxiety do not receive treatment at all4.
According to a survey carried out by the National Council for Behavioral Health, 42% of respondents cited cost and poor insurance coverage as key barriers to accessing mental health care5 – with most insurance plans viewing mental illness and addiction as exceptions to standard care, rather than part of it.
Furthermore, Americans have reported saying they do not have the same access to mental health providers as they have for other medical providers. For example, 89.3 million Americans live in federally designated “mental health professional shortage areas”6, with 55% of US counties not having a single practicing psychiatrist7. Plus, even in states with the greatest access, more than 38% are not receiving the services they need8.
And this is only set to get worse, with the Health Resources and Services Administration reporting that by 2025, the US will be short on an estimated 250,000 mental health professionals9.
The Link Between Mental and Physical Health
Around 30% of all people with a long-term physical health condition also have a mental health problem10; Those with depression have a 40% higher risk of developing cardiovascular and metabolic disease than the general population11, and psychological stress can down-regulate various parts of the cellular immune response12.
This correlation between mental and physical health should encourage practitioners to take a holistic approach in looking after the whole human, and yet so often mental health is overlooked.
Take a clinician in emergency care for example. If a patient attends with a broken leg and then is also noted to have a chest infection, the clinician wouldn’t just treat the initial problem – they would also look after the infection.
Why should it be any different for those with mental health problems? We need to be attuned and sensitive to those with underlying mental health issues, to identify and manage conditions alongside other healthcare problems.
The coronavirus pandemic has had a major impact on people’s mental health. Before the pandemic, one in five US adults lived with a mental health issue13. Nine months in, 42% of people reported symptoms of anxiety or depression – an 11% increase from the previous years14.
The number of people looking for help with anxiety and depression skyrocketed between January and September 202015. It has also been reported that Covid-19 could result in a potential 50% increase in the prevalence of behavioral health conditions16.
If the country does not take action now, we will soon be dealing with another epidemic.
How Can VR Support Positive Mental Health Outcomes
Healthcare professionals do not need to be experts in mental health to have a huge impact.
Taking a whole-person perspective, communicating sensitively, coordinating care, and encouraging self-management and peer support will all help clinicians positively impact mental health care.
To help clinicians do this effectively, and to ensure it becomes second nature, Oxford Medical Simulation delivers immersive simulation scenarios in mental health care. These fully interactive, adaptive scenarios allow clinicians to practice interacting with artificial intelligence-controlled virtual patients as they would in real life. Learners are then given detailed feedback on performance and blended learning on one intuitive platform allowing clinicians to hone their skills to deliver optimal care in the real world.
We have just expanded our ever-growing mental health library, which contains a range of scenarios including anxiety, self-harm, bulimia nervosa, alcohol dependence, chronic pain, dementia with difficult behavior, gender transition, and suicidal ideation.
Each scenario has been created to help learners hone their skills in assessing psychological conditions, and – as in real life – contain physical health issues too. For example, Maria is an 80-year-old patient presenting with shortness of breath. Though she has a history of heart failure, her most prevalent issue is acute anxiety. The learner must balance these two issues to manage Maria successfully.
This involves establishing rapport, elucidating a medical and mental health history, assessing acute anxiety, use of scoring systems, investigating coping mechanisms and sources of support, involving the relevant teams for further assessment, and documenting as needed.
The virtual patients are designed to look and behave like real patients, from low mood and poor eye contact to confusion and agitation.
After each scenario, detailed feedback, evidence-based blended learning, and performance analytics allow the learner to repeat and improve their performance over time, and a guided debrief allows them to reflect and document their performance.
Healthcare professionals can access flexible, immersive, engaging simulation scenarios whenever they need to, achieving first-rate educational outcomes while saving organizations time, space, and money.
Bringing Mental and Physical Health Together
Mental and physical health are inextricably linked, and it is detrimental to a person’s overall wellbeing to regard these as two separate entities.
Covid-19 has had a major impact on US citizens’ mental health and it is important that access to specialist services across the states is broadened to cope with this impending epidemic.
It is not the sole responsibility of mental health specialists. Instead, all healthcare professionals should develop their skills to be able to recognize the symptoms and engage with their patients and ultimately deliver them the care they deserve.