Friday, April 7, 2023

After the birth of my third child, I found myself bursting into tears for no reason and I had no energy. I was diagnosed with postpartum depression and responded well to medication. When I told one of my fellow family practice physicians how much better I was feeling, he quickly hushed me and told me I shouldn’t let people know I had been treated for depression. I was stunned. As physicians, we know depression is caused by a chemical imbalance in the brain and is treatable with medication.

Depression is common in America. I have prescribed medication to many patients with good results. Why shouldn’t I be as matter of fact about my own health as I was about my patients’? Why couldn’t I talk about it as easily and openly as I talk about treating high blood pressure or diabetes?

That was nearly 30 years ago, but stigma surrounding mental health remains. About 1 in 5 Americans experience mental health concerns every year, according to the National Alliance for Mental Illness (NAMI), including eating disorders, anxiety, depression, bipolar disorder, substance abuse disorders, obsessive compulsive disorder, PTSD, and schizophrenia. Unfortunately, fewer than half of the people with mental health concerns receives treatment. Sometimes due to lack of access or resources but often it is due to mental health stigma.

Healthcare workers seem to be particularly concerned about stigma. Many fear that admitting they sought treatment for mental health could affect their licensing or certification. Seeking treatment is a sign of wisdom and self-care, not weakness. It’s important to treat problems early, before the quality of care a health care worker can provides is affected.  Rules regarding reporting to licensing and certification boards should be changed to promote, not inhibit, seeking treatment.

Concerns about confidentiality also can be a barrier, but HIPAA rules protect patient privacy. One excellent source of help for University of Iowa employees is our Employee Assistance program, UI Employee Assistance Program | University Human Resources - The University of Iowa ( EAP provides free, confidential counseling services for employees and its record-keeping is strictly confidential.

It can be hard to find the time to get to appointments with therapists or physicians, but it’s important to make mental health a priority. Flexible clinic schedules and telehealth services are expanding to make mental health care more accessible.

To overcome stigma, we need to be comfortable talking about mental health. It can start with simply asking, “How are you, really?” and then listening with an open, accepting attitude. If you are concerned about a friend or co-worker, begin by mentioning a change you have observed in their behavior. Explain that you care about their well-being, and you are wondering how they are feeling. If the person is ready to talk, ask open-ended questions and listen without judgment. Work together to identify trusted sources of help and offer to help them set up appointments or to go with them.  If the person is not ready to talk, tell them that’s okay, and remind them you are available if they want to talk later. Check back later to see how they’re doing.  For more ideas on how to talk about mental health, go to the American Foundation for Suicide Prevention website: How to Start (and Continue!) a Conversation About Mental Health: A #RealConvo Guide from AFSP.

Training and information can help overcome stigma and we have excellent resources available at the University of Iowa. The University offers QPR (Question, Persuade, Refer) training to interested groups to explain how to help people with suicidal ideation and offers Kognito Training, an online interactive role-play simulation which lets you practice responding to students who present with various mental health concerns. The national Crisis and Suicide Prevention line, 988, is available 24/7 and can connect callers with local resources.

In the 30 years since I was treated for postpartum depression, I changed careers and became a hospital chaplain. I no longer diagnose and treat disease, but I still care about the well-being of individuals. Open, honest discussions of how we really feel is vital to understanding one another, getting help, and healing.  

Cover image by Kelly Sikkema