With widespread media coverage of mass shootings and other unthinkable acts of violence in our society, the call for “more mental health” is heard more than ever. This is a good thing; we do need more mental health. One of the main problems, however, is that the stigma associated with “mental health” is alive and well and so blended into the fabric of our concept of mental health that we’re ashamed to be associated with “mental” anything.
Of course, it’s not really “mental health” that people have a problem with. The problem is that when we hear “mental health,” we tend to think of mental illness and psychiatric disorders. If we walk through a door that says “PHYSICAL EDUCATION DEPARTMENT” we hold our heads up and whistle as we prance through. Walking through another door labeled “MENTAL HEALTH DEPARTMENT” we hang our heads, put on sunglasses and hope no one sees us. The word “health” has positive connotations. Put the word “mental” in front of it and it becomes a negative. How interesting.
Why the stigma?
The stigma comes from the model we’ve embraced to conduct the business—yes business—of mental health. This traditional medical model has two fundamental steps: assessment and treatment. Assessment means finding the proper diagnosis for the problem, disorder or disease process. Step two is the treatment or healing of the defect. With a system that requires a diagnosis and evidence of treatment of a disorder, it’s no wonder why people shy away from so called “mental health.” This is not to say that mental illnesses like schizophrenia and bipolar disorder don’t exist. But the improved mental health that we need applies to all of us, not just those with mental illnesses.
Why the medical model?
Sadly, it seems to boil down to politics and money. For mental health, the medical model is kept alive not so much because it’s the best theoretical model, but because, to date, it’s the most practical business model. It’s how mental health help is paid for at the marketplace. If you meet the subjectively created criteria for depression or anxiety, then you get a diagnosis of depression or anxiety and your insurance will pay for most or all of your bill. However, if you want to learn to live a happier and more relaxed life, then you won’t qualify for a diagnosis, treatment or insurance reimbursement and then you can’t get “mental health.” Let the word games begin.
The new “Mapquest” or GPS model of mental health
Before traveling you probably go to a website like Mapquest or to your GPS device and type in your current location and then your destination. Mapquest or the GPS will then tell you how to get from point A to point B. This is basically what you do when you meet with a physical trainer at the gym, a financial planner, or a career counselor at school. You talk about where you want to go, you collaborate on creating a plan to get there and then you get to work. This is goal oriented, not problem, defect or disease based. Theoretically, this model is simple, comfortable, logical and effective. But from a business perspective, this model dangles the nagging question: who’s supposed to pay for this? The more we see it as a medical condition, the more we expect insurance to pay for it. But if we regard mental health as a positive goal worth investing in, we might be willing to personally shoulder more of the cost.
Art Frenz, Ph.D.
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