Years ago in a biographical piece I read about former President Harry Truman, a woman was trying to describe the Missouri hometown of Truman's youth. "It's the kind of place where when you run into someone you know and ask them how they are, you really don't want to know."
I don't think the gist of this sentiment is meanness or lack of empathy, but reflects a view of life in which how someone is feeling or what important things are going on with their family or finances or health is their business, not ours. This theme of self-reliance is part of America: We come together to build schools, churches, and roads; but then we go home to live our lives how we darn choose.
But there is a dark side to this bifurcation. Many of us and our loved ones suffer from illnesses we lump together and describe as behavioral health disorders. While we might talk with a group of friends about a recent cholesterol test or a painful knee, we are much more reluctant to talk about spells of anxiety, a spouse's thoughts of suicide, apprehension that our party drinking has turned into something out-of-control, or concerns about a child's outbursts of anger.
Not many years ago, health insurance didn't cover mental health disorders very well, as if they were something separate from the body. Coverage is much better now, and treatments are much better, but many of us stigmatize ourselves as being faulty humans if we slide into a depression after having a beautiful new baby. Or while we are compassionate enough to know substance- and alcohol-use disorders can happen to anyone, we really didn't expect it to happen to our family. And do we really have enough confidence in our doctor's scheduler to respond honestly when she inquires as to the purpose of the visit, "I laid awake wondering if my family would be better off with me dead"?
Many Arkansans have chronic diseases like diabetes or heart ailments that require daily attention. The evidence is clear that undiagnosed or untreated behavioral health disorders make successful treatment of physical illnesses more difficult, but many of us are unsure how to improve the behavioral health part of life.
So what should we Arkansans do? First, confide in your doctor or nurse practitioner. Initially they will want to be sure that any symptoms you are having are not related to a medication or some underlying disease process. If a behavioral health diagnosis such as depression or substance-use disorder is made, together you can decide on the best treatment for you.
Second, providers, most of whom are plenty busy enough right now, must ensure that their patients are being appropriately screened for behavioral health illnesses. A substantial amount of screening can be done in the office by health-care workers other than physicians. Good brief screening tools, for example, are available for alcohol-use disorder and depression.
Some primary-care clinics now have behavioral health providers available in the clinic to help with evaluation and treatment. I recently talked with a family doctor in south Arkansas who believed that integrating these kinds of providers into his practice a year earlier was the best thing he'd ever done.
Third, Arkansas needs more behavioral health-care providers such as licensed clinical social workers trained in clinical care. It can be a challenge, particularly in more rural areas of the state, to find a behavioral health-care provider to see a patient in timely follow-up after hospital discharge for a behavioral health condition.
UAMS currently offers online tutorials for primary-care doctors in how to deal with complicated patients on multiple pain-related medications. And Dr. Mike Mancino's program at UAMS is available to train providers in how to treat opioid-use disorder with Medication Assisted Treatment using Suboxone.
Fourth, seek out information. The National Alliance on Mental Illness (NAMI.org) may be helpful. I liked the first message I saw on its website: "You Are Not Alone," which can resonate with both patients and family members. SAMHSA, the Substance Abuse and Mental Health Services Administration (samhsa.gov/find-treatment), is another online source.
And maybe that's a good way to end a brief discussion on behavioral health issues in Arkansas: You are not alone.
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Vic Snyder is the corporate medical director for external affairs at Arkansas Blue Cross Blue Shield.
Editorial on 01/20/2020