Not even a week after the tragic events in Newtown, CT, and the conversation is already moving towards finding solutions- as it should. From gun control to violence to video games to parenting to mental illness to safety protocols in schools and public locales, the conversations are flowing. And as a mental health professional, I’d like to add my concerns and thoughts to the mix.
A few years after I began my career working with children and families, my state embarked on mental health reform. As a huge believer in change and finding better solutions to age-old problems, I was excited about the opportunities that were ahead for our state, our profession, and more importantly, those we worked with. But as I was about to learn, big systems, and in particular mental health, moves on a pendulum. We swing back and forth from one model to another, and tend to vascilate between the two options. But as I share with my clients on a daily basis, life is not divided into two options, two viewpoints, or two solutions. And sticking with a black and white mentality doesn’t necessarily make things better. The only guarantee is to make things different. We need to move away from opposites and towards new, innovative solutions.
I’m not sure what the role of access to mental health played in this recent tragedy. And I certainly don’t blame asperger’s as the cause for such an act. That simply isn’t true. But being as the conversation on mental health reform has been opened, I wanted to take advantage of that interest and join the conversation. As we move forward, here are some things we as individuals, families, work places, professionals, and government leaders should consider as we begin making and implementing changes.
1. In a society that dennounces stereotypes, labels, and profiling, mental health is a profession that frequently gives you a label at the door. Once diagnosed with a condition, it’s nearly impossible to remove that label from your records. If we really do what we say we do, many of the most common conditions we treat are “curable” or are able to be changed from one condition to another as our clients make advances, changes and feel the effects of healing in their lives. I’ve had so many clients come to me and say they’ve been told they’ll have depression for the rest of their life. REALLY? THAT is depressing to me! Mental health needs to get better at not mandating scary terms and labels just to start getting help and support.
2. As we move forward in health care reform, I hope that the need to give clients earth-shattering diagnoses just so their insurance carrier will pay for their treatment will come to a halt. The most common things that clients need help with are considered “V” codes by insurance, and thus are not reimbursible for any visits to a provider. So clients must be diagnosed with what can seem like the mental health equivalent to a heart attack, just to have a therapy session. These clients are wonderful people who are trying their hardest in life, and are facing issues that most of us face at one point or the other. They are people who wouldn’t consider themselves “sick” or “broken” or “mentally ill.” They simply want some insight, guidance, and help with situations they are facing. But yet, their insurance makes it hard to even qualify for help. And if you’re wondering what these V codes are:
- V61.1 Partner Relational Problems (AKA: Marriage/Relationship Counseling)
- V61.1 Physical Abuse of Adult (Think elder abuse or domestic violence)
- V61.1 Sexual Abuse of Adult
- V61.20 Parent-Child Relationship Problem (Getting your child to listen or open up to you, discipline, the list goes on)
- V61.21 Neglect of Child
- V61.21 Physical Abuse of Child
- V61.21 Sexual Abuse of Child
- V61.8 Sibling Relational Problem
- V71.01 Adult Antisocial Behavior
- V71.02 Child or Adolescent Antisocial Behavior
I hope you’re as appalled about those conditions not being accepted by insurance companies as I am. How many of these codes could have helped many individuals and families to not progress into severe depression, have huge bouts of PTSD, or have a divorce?
3. We as mental health providers need to believe in what we do. I see so many of us who are scared of our own abilities. Truth be told, the knowledge we have can actually change and save the world. We know the art and science of love. We know how to heal pain beyond description. We know how to give hope to those who have experienced horror. That is a sacred gift and an honor. And we don’t need to keep those abilities hidden. As part of that, we also need to be comfortable with not having the exact answers, and be able to convey that reality in a kind and supportive way. In the words of Forrest Gump, “Sometimes there aren’t enough words.”
4. Having said that, we also need helpful and proper trainings. Yes, we are required to have CEUs each year to renew our licenses. But many of the trainings I have attended have been a letdown. I go with high hopes of learning something new and taking my knowledge to the next level, only to come away hearing the same things I’ve heard since Sunday School and undergrad. Give me some REAL stuff. Yes, research is a vital part of helping us learn and move forward. But research needs to be paired, taught, and presented in ways that integrate clinical applications and not just reflections of ANOVAS and other statistical analyses.
5. Mental health professionals also need to monitor our knee-jerk reactions. Often, certain words evoke an automatic response without taking time to gather more information. Our clients learn what those words are, and instead of opening up and sharing so they can process, discuss, heal, and learn new ways of coping, they instead learn to keep those things to themselves to prevent being involuntarily committed to the nearest psych ward or having social services investigate them. I’m not in any way saying those services aren’t needed and aren’t necessary at times. But they shouldn’t be threatened nor should they be our first response. We need to take the time to hear and understand what our clients are saying. They don’t learn to not hit their children. They don’t stop feeling like they want to die. They instead learn to remain silent and not ask for help.
6. Our treatment facilities need some help. When families bring a loved one there, it’s because they are at a crisis point and don’t know what to do next. I’ve heard first hand of their disappointment when the professionals there don’t know what to tell families about options once their loved one is discharged. They are left to go home and repeat the daily fear and pain all over again, with the only help available when their loved one makes ultimate threats to hurt themselves or others.
7. As mental health professionals, we don’t need to be so competitive or make promises we can’t keep. Like doctors and attorneys, we are taught the overall basics in our graduate education. But we need to be specific about what clients and areas we do our best work. Can a cardiologist deliver a baby on the side of the road if needed? Yes. But they don’t do that on a daily basis and it’s not their thing. It’s OK for us as mental health professionals to refer a client to the best person who can help them with their needs. There isn’t a scarcity of people who need our help and we need to stop acting that way in our practices. The therapist who has the most clients does not win. The therapist who helps people in the best way possible helps our clients, their families, our communities, and our society win. We will not take a hit in our pocketbook if we act this way. We will actually have more clients and will be able to truly do the work that we enjoy doing! Everyone wins!
8. Removing the stigma of mental health starts with us as professionals, and then moves across our society. Even amongst our colleagues, some of us treat them differently if they are open about seeking services themselves. I get calls weekly from people who really are interested in making changes in their lives, but they are terrified of professionals who are like what they see in the movies; who are distant, cold, and emotionless in sessions; and who seem totally unrelatable to them. There are ways to be ethical, professional, helpful, and authentic with our clients. It’s time we start acting that way and sharing that message with the community at large. Then more people will seek out the services they so earnestly desire.
9. Our society needs education about the issues we’re facing. From public service announcements, to stories in children’s basal readers where they can pick out topic sentences and main ideas while learning about sadness/change/being confident/bullying, to magazine articles and workplace lunch and learns- there are so many opportunities to learn ways to cope, things to look for, and ways to prevent these issues from blossoming. And there’s even an entire community of professionals who are trained and ready to do this: Certified Family Life Educators who are credentialed by the National Council on Family Relations. From schools to community organizations to government agencies to churches and more, Family Life Educators are begging for opportunities to help families.
10. Our communities need workplaces that are understanding and supportive of mental health treatment. Often, when managers suspect a mental health need, employees are treated poorly and are required to jump through hoops to come back to work or to keep their jobs. Their rights and privacy are infringed, and they don’t feel supported. They feel violated, embarrassed, and scared. Many times, this treatment stems from overzealous efforts to protect the company, instead of efforts to help support the employee. Workplace policies need to allow for appointments, too. Unlike the semi-annual dental cleanings and annual physicals, mental health care needs frequent appointments. In my practice, I offer late afternoon and evening sessions, but that often means I’m fitting someone in at 9:00pm, especially if it’s a last minute appointment triggered by a crisis. Employees need the ability and support to privately attend to their mental health needs.
11. As mental health professionals, we need to better understand the different disciplines within our field ourselves before we can expect the public and clients to understand the differences. The community needs to know that psychiatrists and psychologists are not the same thing. And even within therapists, counselors, and social workers there are differences. We need to be comfortable with understanding how each discipline is different and how we can all work together without a need to compete or battle for a client’s loyalty. Just like patients have a need to see dentists, optometrists, gynocologists, and dermatologists (and that’s not with any special health conditions), our clients may need to work with several of us to get the best care and to really make a difference in their mental health needs. It’s time to put aside our petty professional differences and lay aside claim as to which group “owns” which theory. Our clients could care less. They just want us to be give them our best so they can be their best.
12. Everyone, and I mean everyone, needs to understand that mental health is for all. Not just poor people. Not just children. Not just those who may have ADHD or depression or suicidal thoughts or substance abuse issues. So many of our community programs focus on specific groups. And while I am an advocate for mental health professionals to practice within a niche of their skillset, as a whole, our community programs are leaving a huge gap AND are sending a message that only certain issues and specific groups of people need treatment. That is simply untrue. And only by overcoming that stigma can any of us really begin to make mental health reform effective.
This list is by no means comprehensive. But instead of people talking about the need for mental health reform, we all need to get specific. And this conversation needs to include the viewpoints and insights of all of us- not just mental health providers, government leaders, or parents. The more specific we can be, the more helpful we can become.
May we all respectfully join the conversation as we share our experiences and views to find the best array of solutions that will help make our families, our relationships, and our communities the places they were meant to be.
Tammy Whitten is a Licensed Marriage & Family Therapist and Certified Family Life Educator who is passionate about providing services to women, couples, and families to help them manage the stress and anxiety in their lives in down-to-earth ways that allow for real solutions and real change. She believes that she provides the best therapy when she is barefoot with her feet curled up in her chair. Get her free e-book and weekly inspiring message in your inbox by signing up here.