Sweeping Stigma Under The Rug

Some 60 years later, people with mental illness are still overcoming the stigma that their physiological condition is more than a character flaw. It’s absurd to expect patients to overcome diabetes or heart disease by pulling themselves up by their bootstraps, and yet according to WHO, the vast majority of the 450 million people affected by mental disorders are not receiving treatment due to stigma, discrimination or neglect. 

Dr. Vikram Patel, co-director of the Centre of Global Mental Health, reported that “over 50 percent of people in developed countries with mental illness won’t receive appropriate help, and in developing countries, the treatment gap rockets to 90 percent.”

Closer to home, the prevalence of mental illness looks the same as global trends and surpasses national averages. In a recent in-depth community health assessment in the St. George area conducted by Intermountain Healthcare in conjunction with the Utah Public Health Department, 14 percent of adults reported poor mental health for a week or more in the last 30 days, and nearly 20 percent of adults in our community were dealing with depression. In Utah, 10 percent of our youth experienced a major depressive episode in 2016, and pediatric admissions for depression have tripled in the last 6 years.  

One tragic outcome directly tied to this mental health crisis is the increase in suicidal thoughts, attempts, and deaths. In our community the adult suicide rate (per 100,000 people) is 22.8. The national average is 12.5. According to the Utah Department of Health, suicide is the leading cause of death among teens, and the state suicide rate has been higher than the national rate for more than a decade. In addition, more than 37,000 Utah secondary students reported suicidal thoughts in the past year according to SHARPS data. 

This overwhelming evidence has prompted Intermountain Dixie Regional Medical Center to focus on clinical and community efforts to prevent depression and sweep the stigma of mental illness under the rug. Dixie Regional’s efforts align with system-wide initiatives that include integrating mental health services into routine doctor visits. It ensures mental health and physical health are routinely evaluated and cared for together. 

“Mental health providers such as therapists, counselors, nurse practitioners, and psychiatrists are available a few days a week in almost every Intermountain primary care practice,” said Dr. Marty Nygaard, the Intermountain Southwest Region Medical Group Medical Director. “There has been some stigma associated with mental health. Visiting a mental health provider alongside your primary care doctor takes away some of that stigma and makes it more routine.”

This approach of treating the mind and body has received far-reaching attention. Intermountain was recently awarded the National 2017 Hearst Health Prize. Now, Intermountain is paying it forward by offering free training to community clinics and other health groups interested in adopting the treatment model. 

In further community collaboration, Intermountain established a Behavioral Health Network in Washington County with the Doctor’s Volunteer Clinic and in Iron County with the Family Healthcare Clinic. Southwest Behavioral Health Center is also a valuable and important part of the process in both areas. The overall goal of the network and funding is to allow uninsured patients to get an appointment for affordable mental health services within seven days.

“Many people lack adequate insurance and income, and when they’re in a crisis, they need help right away,” said Lisa Nichols, Intermountain Community Benefit Director, who oversees the Behavioral Health Network. “Annually the network provides more than 8,000 patient visits statewide. Prior to the network, only 23 percent of uninsured patients had a follow-up appointment within a week. Now over 80 percent receive care with seven days.”

The impact on local communities has been threefold. It has created a safety net for those needing mental health service and allows them to be more self-sufficient. Routine care helps patients regulate their conditions, and reduces the number of acute hospitalizations. Finally, it is creating better coordination of care between organizations and allows these partners to stretch their resources farther. The end result is more access for more people for less cost. 

Intermountain Dixie Regional is dedicated to the mission of helping people live the healthiest lives possible, and there is no ranking of the body over the mind.  When it comes to healthy lives, both are integral and interdependent, and both should be addressed without stigma or shame.