May is Mental Health Awareness month, and today is Child Mental Health Awareness Day. Our goal, as healthcare providers, family members, and people living with mental illness, is to spotlight the presence of mental illness in our communities and to spread the word that these are identifiable and treatable medical and neurodevelopmental conditions which are not cause for shame. About 1 in 5 people, including children, live with a mental health challenge in the United States. This is similar to the number of people living with some form of cardiovascular disease, including heart disease and stroke. The emotional and behavioral systems are just as vulnerable as our circulatory systems to disruption. And mental illness causes tremendous disability and can cause death, just as heart disease and strokes do.
The fact that symptoms of mental illness are emotions and behaviors leads many to assume that these symptoms are a matter of “weakness” or “not trying hard enough.” But this could not be farther from the truth. The people I know and work with who live with mental illness are the bravest and most hard working people I know. Getting through the day with the damaging pain and fatigue of depression, trying to overcome anxiety so that the day can begin, or starting over again each day at school in spite of feeling constantly corrected and criticized because of inattention and impulsive behavior — all of these require courage and enormous effort. Some days, people succeed and some (or most) days they don’t, because their condition is too active and too damaging. But this has nothing to do with lack of effort or motivation. It is because they are suffering.
The identification of these problems as medical and developmental does not in any way imply that medication is the only answer. This is the unfortunate conclusion that many people come to when the notion of mental health is brought under health. Like most other health challenges, such as cardiovascular disease, a wide range of interventions are needed to prevent onset of illness, to reduce illness severity, and to treat more advanced conditions. Managing stress and trauma in children’s lives — including the profound devastation wreaked by poverty — is part of preventing mental illness and heart disease later in life. We know these factors in childhood raise rates of mental illness and cardiovascular disease. Healthy and adequate nutrition and opportunities for moving and playing and exercising in childhood, and into adulthood, are critical to creating healthy minds and bodies.
Reducing a person to a patient number, a diagnosis, and a hastily written prescription to “fix it” is not good medical care for any human’s body and brain. Early intervention for risk factors, like reducing high blood pressure to help prevent heart disease, often starts with diet, exercise, and stress reduction before using medication, but sometimes the illness is acute and severe so medication is needed right away, as well. In mental illness, psychotherapy and other interventions, such as mindfulness and exercise should be first steps, unless the symptoms are more severe and require medication as part of the front line treatment. Treating a psychiatric illness as a medical condition does not reduce it to a medication problem. No health care should be reduced to this.
The stigma and shame around those who live with mental illness serve to make things far, far worse. People are afraid to speak up about symptoms, and they blame themselves and are afraid to seek help. Even in the world of health and mental healthcare, they may encounter prejudice and dismissive or judgmental responses. Mental healthcare is an essential part of all health care and until this is firmly and fully embraced in the worlds of medicine and education, the justice system, and public health policy, we will continue to continue to see significantly reduced well-being and function, disability, and death by suicide at alarming and unacceptable rates.