Today, we’re witnessing a change in how the world views mental health. As society changes its views on mental health, we’re learning more about how to address stigma, choose treatments, and decide what’s best for children. Ladeana Bell, a licensed psychological examiner and AFMC outreach specialist, discusses the latest trends in mental health and what we can learn from the newest discussions and hot topics.
Mental Health Stigma is Fading. Good Riddance.
The public stigma of mental health has greatly influenced how people view others who struggle with mental health. The negative or shame-based public perception has led many individuals to feel ashamed of seeking help or avoid seeking help altogether. Over the last 10 to 15 years, however, the stigma has begun to fade. While some still express negative opinions about therapy and counseling, a focus on addressing mental health, particularly in patients with depression and anxiety, has highlighted mental health.
“I think the public service campaigns to target why help-seeking is needed and how it can save lives has helped, especially in cases of suicide and bullying prevention,” Ladeana said. “Both of those areas have developed a lot of traction for mental health care over the last 10 years, which has had a ripple effect on the realization that mental health conditions need to be addressed now and in the open.”
While mental health and general health care are often separate from one another, many general practitioners are beginning to understand that mental health is a piece of a patient’s overall healthcare puzzle. “This increased comfort and awareness has helped promote our changing and evolving attitudes toward therapy. You may go to the doctor for a lingering cough but end up getting a brief depression screening and a conversation about a referral for additional support.”
Use of Online Mental Health Has Increased.
The use of online mental health services, such as teletherapy, has also increased rapidly over the last decade. “This is a positive in terms of access to help and access to specialty providers,” Ladeana said. Most of the therapists I know have been able to offer teletherapy services since March 2020 if the client is an appropriate candidate. Before this time, I only knew a handful of therapists that offered teletherapy.”
Before the pandemic, most doctors used telehealth primarily for follow-up appointments or medication checks. Today, doctors use telehealth for various other purposes, including teletherapy, which numerous providers across the state currently offer for counseling and mental health services.
“I am a firm believer in the video element of teletherapy, though there are some online virtual therapy platforms that offer telephone and texting services, too,” Ladeana said.
Teletherapy has pros and cons, just like with any new technology or tool. “A huge pro of the expansion of teletherapy is that more people have access to the services and more choices than perhaps the one service provider available within a 50-mile radius,” Ladeana explained. In a rural state like Arkansas, some citizens have limited (if any) mental health services in their community.
“On the downside, as virtual therapy options have exploded, so too has the monetization of mental health services,” Ladeana added. “Some platforms and apps do not prioritize ethics, meaning that services are not being offered in a thoughtful or deliberate way that aligns with a client’s unique needs and conditions.” Researchers are still determining the privacy and security risks related to telehealth services. There is no firm body of evidence that confirms telehealth platforms’ ability to safeguard patient health data, which is a major healthcare priority.
Youth Mental Health Surveys Can Be Hard to Validate.
It is well within a parent or legal guardian’s right to fill out a survey on behalf of their child or teenager (depending on the teenager’s developmental level and other factors). However, some parents may not accurately fill out the survey due to a lack of knowledge of a child’s underlying conditions or struggles or a desire to protect their child’s sensitive health information.
“I think the Adverse Childhood Experiences questionnaire is a perfect example of this,” Ladeana said. “The ACEs questionnaire is designed to be answered by those over 18, so they self-report what happened from birth to 18. A practitioner should not use the form on someone who is under the age of 18. Instead, the practitioner should use an alternative ACEs screening tool, such as the Pediatric ACEs and Related Life-Events Screener (PEARLS), geared more toward those 19 and younger.”
If a practitioner uses due diligence, they will screen patients using multiple tools when possible. In the case of research, researchers would use whatever model and data they identified with the Institutional Review Board. “The key with researchers would be not to misinterpret findings. I often say in trainings or discussions with fellow concerned stakeholders that the self-report is only as accurate as the person’s ability to fill it out honestly and forthrightly,” Ladeana explained. “So, we have to understand there are limitations to self-screening tools.”
It may be best to seek feedback from a child, teacher, therapist, foster parent, or attorney ad litem to validate the data. If it is not possible to validate reported data from a screening tool, we can only go with what we have, being mindful that it may not accurately reflect the whole picture.
“Many times, parents over-report psychiatric behavioral symptoms, such as inattention, lack of concentration, and disruptive behaviors,” Ladeana said. “They may under-report abuse, neglect, stress in the home, marital tensions, or trauma history. The bottom line is to try to talk to the child or teenager to verify the information when possible, but know that self-reporting tools are often full of validity concerns due to the respondent trying to answer favorably or not fully understanding the question. Use multiple sources of collateral information at your disposal.”
We're Learning More about Mental Health's Correlation to Other Health Conditions.
Many other health conditions, symptoms, and environmental factors play into the mental health status of an individual. Healthcare professionals have begun to realize that mental health is intricately related to overall health and that some conditions, such as chronic pain, heart conditions, diabetes, and cancer, affect an individual’s emotional and mental well-being.
“One thing the medical community is still learning to practice is not to be dismissive of patients, especially women, who report pain,” Ladeana said. “This does not mean we encourage prescribing a strong narcotic. It just means not assuming that someone is attention-seeking, lying, or drug-seeking when they want answers about ongoing symptoms.”
Medical personnel are busy. They face constant workforce demands and immense pressure to see as many patients as possible and be adequately reimbursed for their services. “This focus is a reality and a barrier at odds with taking time to fully assess the presenting problem,” Ladeana said. “Questions like ‘what has been tried, when is your pain worse, when is it better, what have you tried historically, and what are the side effects’ might provide a fuller picture and make the patient feel like they are part of the team.”
“Taking time to ask clarifying questions may help the patient feel that the provider is truly trying to understand rather than get them out of the office and move on to the next patient,” Ladeana said.
What we say and how we respond to our patient’s health concerns matters. Often, we don’t realize the mental impact this has on our patients. “If you tell an anxious patient with a heart condition to go discuss their concerning feelings with their psychiatrist without exploring more about what the patient is worried about from a medical standpoint, you are missing an opportunity,” Ladeana said.
Referring a patient to a mental health specialist isn’t wrong, but we should be addressing their physical health concerns while they’re in our care before referring them. Physical and mental health are connected; quickly sending patients to another professional conveys the wrong idea and may sometimes make the patient feel worse.
“The approach should fit the patient, so get to know your patients,” Ladeana suggested. “It may be a good idea to kindly ask the patient what they need from you.” No two patients are the same, even if they share similar symptoms or diagnoses. What works well for one patient with chronic pain may make the other feel discounted.
“Telling a patient you understand that they are in pain, but that a new medication may not be the answer and suggesting a stress-management technique is much kinder than telling a patient, ‘I’ll see you in six months. Follow up with your psychiatrist about your pain.”
As many of us have begun to embrace the intersection of mental health and general well-being, it is crucial to stay informed. By leveraging innovative approaches, challenging stigmas, and prioritizing whole-person care, we can help enhance access to mental health services and advocate for our patients, regardless of their concerns.
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{slider title="Meet Ladeana Bell"}
Ladeana Bell, MS, LPE-I is an independently licensed psychological examiner who has been practicing psychology for 29 years. She has a wide range of clinical experience in inpatient and outpatient mental health settings in private, non-profit, and academic institutions with ages 2 to adult. Ladeana works closely with the ACEs coalition at the Arkansas Foundation for Medical Care (AFMC). Ladeana is a frequent presenter on ACEs, trauma, and various other mental health topics. In addition, Ladeana works with the IOC quality assurance team at AFMC with a focus on behavioral health. She has a small private practice providing therapy to adults with a particular emphasis on mental health professionals and couples’ counseling. Ladeana is a passionate advocate for mental health awareness, policy change, education, and systemic change related to the delivery of mental healthcare. She has one 24-year-old daughter, an Australian shepherd “grand dog,” and two special cats.
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