Michael Dowling: When it comes to health disparities, gaps in mental health treatment are the worst

One in 5 adults experience a mental illness, ranging from mild to severe. Of those 46.6 million adults, only 43 percent received care for their mental health over the course of a year, according to the National Institute of Mental Health. For those who do seek care, there's often a long delay between the onset of symptoms and the healthcare they receive — 11 years on average, to be precise.

There's an alarming gap between the number of people who experience mental illness and those who receive care. It's especially troubling when you consider that the health disparity between people with mental illness and those without is larger than disparities attributable to race, ethnicity, geography or socioeconomic status.

Research shows people with mental illness have a higher relative risk of death than the general population and die 15 to 30 years younger than their counterparts. Most die of the same natural causes that are leading causes of death nationwide, including heart disease, cancer, and cerebrovascular, respiratory and lung diseases.

Combined, these statistics and findings underscore the need for health system leaders to embrace mental and behavioral health as part of their primary care delivery, rather than a distinct or separate service.

As health system leaders, we have a big responsibility to change perceptions. Most people, even the most highly educated, receive little exposure to mental, behavioral and emotional issues in our education system. Even among clinicians, there is great risk in assuming that a doctor or nurse knows much about mental health — it's not traditionally a focal point of their education.

We have lived in a split world, with physical health on one side and mental on the other. This is true for health systems, educational curriculum and our public discourse. We have to embrace both.

Last summer, New York became the first U.S. state to require mental health be taught as part of health education in elementary, middle and high schools. The landmark change was made to decrease stigma, change attitudes and empower students with practical knowledge they can use when it comes to mental health problems they or others face. One of the state advisory council's nine recommendations for school curriculum is an emphasis on the concept that mental health is part of wellness.

Isn't it noteworthy that elementary schoolers are learning a concept that is still not fully embraced and reflected in their healthcare system? It's time to catch up. We have managed to redesign care for joint replacements, yet little attention has been paid to redesigning care for those with mental illness. Patients are promptly seen for follow-up appointments within one week of discharge from hospitalization, whereas psychiatric patients can wait weeks or months before seeing a mental health professional. 

We're trying to close the gap at Northwell Health. As one of the largest providers of behavioral and mental health services in New York state, we operate two hospitals that specialize in behavioral health, addiction treatment, and behavioral consultations for students, schools and families. 

Like many other health systems around the country, we take an inclusive approach to health as the culmination of physical, mental, emotional and behavioral wellbeing. We are working to break the archaic, siloed approach in which physical health is addressed at one facility and mental health at another by incorporating mental health capabilities into primary care offices. We employ more than 3,000 behavioral health social workers, nurses and other staff who help patients tend to their health holistically.

I have grown more mindful of how we treat mental health, not only as part of our overall health system strategy, but also in my daily interactions and communication with staff, colleagues and the community.

Northwell's last two leadership retreats have included a major focus on clinician burnout and the opioid crisis, and how we can best address the community's mental health needs and integrate behavioral health with physical health. Internally, we continue to look for new and better ways of reducing depression, burnout and higher levels of anxiety among our staff.

We tackle these issues in open discussion with all of our leadership, and that inclusivity is important. The opportunity to learn from our peers, both personally and professionally, is life-changing. Like many large health systems, we have professionals who have devoted their careers to mental health, but there are undoubtedly many on the leadership team who have the same misconceptions as the general public. At last year's leadership retreat, one of our senior executives opened up about his son's opioid addiction and the emotional distress it caused his family. Experiences like his are not uncommon, but only when we talk openly about them can we change perceptions about what mental illness looks like.

Hearing a colleague's experience is important for interpersonal reasons, of course, but it's also critical for us to remember as we develop a holistic approach to treating mental illness, including effective ambulatory strategies, community education and awareness initiatives, and other outreach efforts aimed at combating outdated stigmas, assumptions or discriminatory attitudes toward those who are struggling.  

While our nation has made progress in recent years, we have a long way to go to build mental health awareness and acceptance. Health system leaders must do their part. As we begin a new decade, I encourage you to completely fully integrate mental health into your understanding of "healthcare."

I'm proud that children in my state are learning that mental health is part of wellness. We should all do our part to embrace that same understanding and build health systems that reflect it.

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