Discussing Mental Health With Patients

The United States continually ranks among the countries with the highest rates of poor mental health and mental illness. For example, according to the Centers for Disease Control and Prevention (CDC), more than 50% of the U.S. population will be diagnosed with a mental illness or disorder at some point in their life, and one in five Americans will experience mental illness in a given year. Given the prevalence of these issues, it’s critical to discuss mental health during clinical interactions.  

Note that these interactions require great care, empathy and concern due to their sensitive nature. Following are tips to help physicians incorporate conversations about mental health into patient visits.

Beginning Conversations About Mental Health

When discussing mental health with patients, BJC Healthcare in St. Louis, Missouri, cautions that some patients may be hesitant to share their concerns due to underlying experiences and emotions. BJC Healthcare emphasizes that it’s key to remain neutral in these conversations and avoid expressing personal views or opinions.

To further support these conversations, BJC Healthcare suggests that physicians:

• Actively listen to patients. Aim to validate feelings while listening carefully to patient responses.
• Ask if events spark memories of previous events. This is important to note especially if these incidents trigger strong emotions or harmful behaviors such as withdrawal or hypervigilance. 
• Avoid language that is associated with diagnosis. Instead, express concern while validating feelings.
• Speak to your patient as simply as another person, rather than as a victim or someone who is seeking your expertise. Focus on conveying genuine interest in their wellbeing.
• Encourage patients to seek further assistance from a qualified professional.
• Provide patients with information about where to find additional resources.

Screening for Mental Health Conditions

The American Psychiatric Association (APA) emphasizes that early intervention is key to reducing the severity of mental illness and may even delay or prevent major concerns from developing. However, identifying mental health disorders can be complex and requires extensive knowledge. The following list is a starting point to help recognize key signs and behaviors that may require further exploration.

The APA advises asking about and watching for:

• Changes in sleep or appetite
• Decline in personal care
• Rapid or dramatic mood changes
• Social withdrawal
• Loss of interest in activities that were previously enjoyable
• Decline in function, such as poor performance at school or work
• Difficulty concentrating or focusing
• Increased sensitivity to surroundings, such as sights, sounds, smells or touch
• Feeling disconnected with the self or surroundings
• Thinking in a way that seems illogical or child-like
• Feelings of nervousness, including suspicion of others
• Uncharacteristic behavior

As a reminder, this list is not comprehensive and is, instead, a jumping-off point for identifying signs of mental illness. If you believe your patient may be at risk or would benefit from deeper mental health expertise, refer them to a qualified professional.

Supplemental Resources

In addition to the checklist previously described, the following resources are available to physicians and patients seeking further support.

• The National Suicide Prevention Lifeline is available 24/7 toll-free at 800.273.TALK (8255)
• The American Psychiatric Association’s “Find a Psychiatrist” tool
• The Anxiety and Depression Association of America’s “Find a Therapist Directory“
• The National Comprehensive Cancer Center “Distress Thermometer“

We also encourage our policyholders to explore our existing articles on providing inclusive care and discussing stigmatized topics.