Do No Harm Vs. Saving Everyone
Do No Harm
The mental health field is well-known for high burn-out, high turn-over, and low pay. I’ve met amazing therapists that have been practicing for over a decade who love their job and could never imagine working in another field. I’ve also met many more terrible therapists who have stayed complacent in the field despite their own burn out who do much more harm to their patients than good. I’ve had the pleasure of working with and hiring newly graduated enthusiastic mental health interns who are so passionate and excited to heal everyone that their energy is almost infectious. I’ve only been in the field 5 years total so we’ll see how I fare five years down the road. Patients have yet to burn me out or exhaust me or disgust me. I see them as people trying to get their needs met. Trying to get through the day. Trying to solve problems the only way they know how. They are resourceful and resilient and incredible survivors. Doctors on the other hand-well they’ve done a pretty decent job at disgusting me.
According to Mental Health America in 2022, 19.86% of adults are experiencing a mental illness. Equivalent to nearly 50 million Americans. 4.91% are experiencing a severe mental illness. The U.S population in 2021 was 331.9 million. These aren’t small numbers. I think when people graduate school or complete their first internship, they have the mentality that they will save/heal/cure/fix everyone. It’s always good to have hope. Everyone is worth saving. But you cannot save everyone.
The Story In Your Head
To think that one human-doctor or otherwise-is fully capable of solving every patient’s problem that they come across and that this patient will truly want their help and follow through with it is a laughable concept. And if this is your belief, I guarantee you will do much more harm than good. Thinking that you can solve everyone’s problem is narcissistic and dangerous and small. I have yet to meet a patient who isn’t a survivor in some way. I have yet to meet a patient who has had a problem that they didn’t try to solve in some way. People try to solve problems in various healthy and unhealthy ways and they’ve usually learned how to do so long before they were brought into your office/hospital/facility. They have a story in their head that matches their behavior. And some people are not ready to change these stories. Change is difficult. And most people have been telling themselves the same story for a very long time.
When I think about psychiatrists that I work with who have told themselves this story that they can heal every person-I imagine that they too have been telling themselves this story for a very long time. I imagine that when they were in medical school, they were told a story that mental illness-now, not prior to the development of psychiatric medications-is chronic, lifelong, and will require (and be cured by) medications. I genuinely don’t believe anyone goes into this field with a full understanding of the history of mental illness in the United States, the history of pharmaceutical advertising, how clinical trials work and how they are funded, the development of the DSM, or the roles that racism and sexism and homophobia has played in diagnosis. All of these things have shaped how mental illness is diagnosed and treated today. Students aren’t taught this. Instead, doctors are taught to look for symptoms, check the boxes, choose a diagnosis, and medicate accordingly. And if two medication trials don’t “work,” well then the patient is treatment-resistant. Have we ever stopped to consider that perhaps our medications are treatment-failures?
Something else that strikes me as concerning in mental health is the lack of training on psychopharmacology. Of course, us social workers and therapists are in no way doctors, but most of our patients are being prescribed psychotropic medications. Shouldn’t we have a solid understanding of what our patients are taking? Short and long-term side effects to look out for, what medications are prescribed for which diagnosis, what is generally used as off-label for patients and for what reasons, what medications interact poorly with others, etc.? It seems to me that this would be pretty important. But I have never received any training or class or any education about psychopharmacology that I did not pursue on my own. I wanted to know and have a full understanding of what it was that my patients were signing up for.
The majority of my co-workers believe in how we treat mental illness in the United States and that it is effective, but if our treatments are so effective, why does the data look like this?
According to the National Alliance on Mental Illness:
47.2% of U.S. adults with mental illness received treatment in 2021
65.4% of U.S. adults with serious mental illness received treatment in 2021
50.6% of U.S. youth aged 6-17 with a mental health disorder received treatment in 2016
Suicide is the 2nd leading cause of death among people aged 10-14 and the 3rd leading cause of death among those aged 15-24 in the U.S.
Suicide is the 12th leading cause of death overall in the U.S.
46% of people who die by suicide had a diagnosed mental health condition
We are certainly not saving everyone. Not even close.
Reference
https://mhanational.org/issues/2022/mental-health-america-adult-data
