A nurse wearing blue scrubs holds a binder and talks with a patient, who is sitting down on an exam table.Despite long-lasting stigmas, Americans’ attitudes toward mental health are shifting. In a survey from the American Psychological Association, 87% of respondents believe that having a mental health condition is nothing to be ashamed of. While the results of this survey suggest that more people in the United States are becoming more open about mental health, data from the National Institute of Mental Health shows that less than half of U.S. adults with any kind of mental illness received treatment for their condition.

In other words, though public perceptions have changed, mental health services remain inaccessible for many people. With mental health issues becoming more prevalent, it’s crucial to make treatment more accessible to a greater number of people. In order to provide your patients with the best possible care, it may be time to start incorporating mental health checkups into your physical health exams.

This greater inclusivity of services isn’t just limited to doctors and nurses; all healthcare providers can work to incorporate mental health checkups into their appointments. Even providers who are focused on physical health, such as physical or occupational therapists, already have the skills and knowledge necessary to offer more holistic care for patients who need mental health treatment. Not only is this a simple way to grow your healthcare practice, but it also breaks down some of the barriers that make mental health services difficult to access for so many people.

How Mental and Physical Health Are Connected

It’s only natural to include mental health assessments in physical examinations. There is a strong connection between physical and mental health — mental health may affect physical health, and physical health can impact mental health. There are many different ways the mind and body can influence each other. For instance, someone experiencing stress may have physical and mental symptoms that need to be addressed to overcome both the root issue and its consequences. In other words, it’s difficult to effectively assess the health of the body without also doing the same for the mind.

Why Don’t We Already Have Mental Health Checkups?

Mental illness and its treatment options have a complex — and sometimes dark — history in the U.S. that has paved the way for the present landscape. There is no single reason why mental health checkups are not already included in annual physicals, examinations, or other health screenings and assessments. Here are some of the major contributing factors to the lack of mental health checkups in the U.S.:

Stigmatization of Mental Health

Mental illness has long been stigmatized, and people who experience mental health issues have been treated or viewed negatively because of these beliefs. Though public perceptions have been changing, these attitudes persist and work to shape others’ understanding of mental illnesses.

Though it may seem innocuous, mental health stigma can have devastating consequences for individuals experiencing mental illness. Both public and self-stigma can discourage people from seeking treatment, or create barriers that make accessing care impossible or unrealistic. Further, mental health stigma is deeply ingrained in the healthcare system, making it more difficult to receive effective and judgment-free treatment even when patients are willing to seek it out. Mental health service providers can work to improve their cultural competence, but truly overcoming this stigma is a long and slow process.

Lack of Government Funding

Historically, mental health services and programs have not received much funding from federal or state governments. This lack of funding has made it increasingly difficult for healthcare providers to offer high-quality mental health services (if they’re able to offer them at all). It also makes treatment more costly and places the burden of payment on patients — something that not all patients can afford. For instance, though living in poverty can be highly damaging, impoverished individuals are more likely to forego treatment because it is too expensive.

Under the original Community Mental Health Center Act, the federal government provided funding for improved mental health services in the public sector. In 1980, President Reagan allowed these funds to be reallocated to public projects, such as infrastructure improvements, and left the decision of how to spend those funds to the states. Though there were existing issues with government funding, this led to many states greatly reducing their mental health services, the effects of which the U.S. still feels to this day.

For-Profit Healthcare

The healthcare system in the United States caters to for-profit organizations, including private insurance agencies and treatment settings. One study of the disparity between physical and mental health services in the U.S. discovered that insurance agencies pay primary care providers more than mental health professionals for the same services. Further, mental health services are more likely to be excluded from insurance networks than physical health services; this means that providers can earn more money, while patients have to pay more for treatment.

Because they aren’t paid as much and are less likely to get reimbursed from insurance companies, it isn’t financially feasible for healthcare providers to offer thorough and easily-accessible mental health services. Because treatment is more expensive, fewer patients can access these services. Because fewer people can afford the high cost of out-of-pocket expenses, providers must charge more to offer mental health services.

Additionally, when providers do offer more affordable and accessible mental health services, patients may flock to them. This can result in overwhelming or overworking providers, to the point where they can no longer accept more patients. These other patients, then, face the same obstacles discussed above when trying to find treatment.

Healthcare Reform

Under the current system, it falls to individual healthcare providers to decide how and when to do mental health screenings. With both providers and seekers of mental health services being disadvantaged by the current system, there have been calls to reform the U.S. healthcare system so it better prioritizes mental health and wellbeing.

Passed in 2010, the Patient Protection and Affordable Care Act (ACA) has made great strides to integrate mental and behavioral health services into the traditional healthcare system. Under the ACA, insurance companies are required to cover certain mental health screenings, including behavioral health assessments for children and depression screenings for adults. Additionally, the ACA guarantees that patients cannot be turned down or charged more for having or getting diagnosed with a mental health condition.

However, not all mental health screenings are covered by the ACA. What’s more, they still aren’t a normal part of preventative health appointments. Patients may only seek them out when they’re experiencing behavioral or emotional distress. Under the current framework, mental health screenings are a reactive tool, rather than a preventative one. With more work on destigmatizing mental health and greater emphasis on preventative mental health care, mental health checkups might become as standard fare, as routine and typical as an annual eye exam or dental cleaning.

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