Minding the gaps in mental health care
By Robert C. Smith, MD, MACP, University Distinguished Professor Emeritus of Medicine and Psychiatry, Michigan State University College of Human Medicine; Author
Why U.S. mental health care remains broken (and how people can demand change)
The public does not understand how abysmal U.S. mental health care is, that medicine refuses to improve it, or that it can direct its politicians to demand change. The book Has Medicine Lost Its Mind? details what Americans need to know to take control of the issue.
While mental illness is the most common health condition in the U.S., most people do not realize that only 25% of patients receive any care—compared to 70% of those with physical diseases.
The inadequacy of mental health care stems from medicine’s failure to train enough mental health professionals. Psychiatrists conduct only 12% of care, while over 75% falls to primary care clinicians, who receive almost no mental health training. U.S. citizens will be shocked to learn that only 2% of physician training is devoted to mental health care. This points to an often-overlooked solution to the crisis: properly train the doctors who provide care and increase the number of mental health professionals.
“Mind-body split”
Few people understand why medicine resists such obvious solutions. Since the Scientific Revolution of the 16th and 17th centuries, medicine has followed the theory of the “mind-body split,” which assigned the mind, soul, and spirit to the church while claiming the physical body and its diseases as medicine’s domain. As a result, mental disorders and other psychological issues, such as emotions, were historically deemed outside medicine’s scope.
Even though mental health care has long been medicine’s responsibility, the field has never prioritized it. Medicine, still shaped by the mind-body duality, sees no need to train physicians in mental health care—training only a limited number of psychiatrists as an afterthought. While this approach contributed to massive advances in physical health care over the last 75 years—doubling life expectancy—it now renders medicine obsolete in addressing the country’s most common health issue: mental illness.
“Missing” science in medicine
Finally, the public does not realize that medicine disregards modern scientific principles. Among all sciences, only medicine fails to follow the modern systems view of life, which requires considering all parts of a problem and their interactions rather than isolating a single aspect. Worse, medicine has repeatedly ignored the systems-based biopsychosocial model proposed in the 1970s. This research-backed model integrates mental health care with medical care by linking a patient’s biological condition with their psychological and social factors. Implementing this model would ensure that mental health care matches the accessibility and quality of physical health care.
Has Medicine Lost Its Mind? then outlines how an informed, outraged public can pressure politicians to demand change and details the steps needed once policymakers and the medical field commit to the necessary paradigm shift. For more information, visit https://www.robertcsmithmd.com/
Category: Education
