If you were to guess at the leading cause of injury deaths in the United States, chances are you might think of accidents—car crashes, for example, or falls. But while those accidental events are on the list (numbers two and four, respectively), it’s self-harm that has risen to the top in recent years—suicide.
During a nine-year study that was published online in September in The American Journal of Public Health, researchers found that the rate of suicides went up 15 percent, while car crashes, the previous leader, went down. And number three on the list, poisoning, might also include unreported suicide deaths, researchers speculate, since prescription drugs are the culprit in the majority of poison cases.
That grim finding highlights an aspect of health that so often goes unaddressed—mental health. Whereas a patient might be quick to call their doctor to check out that racing heart or persistent sore throat, that person freezes up when it comes to mental health, either brushing off a bout of depression as something to just get over, or being too embarrassed to ask for help. “When people think of mental health, people often think of the severe end—but it’s more common that an individual is suffering from everyday health, depression, anxiety, difficulty doing your job,” says Susie Winston, a counselor for child and family services at Seattle-based Sound Mental Health, a non-profit and one of the biggest mental health organizations serving King County. “Others are recovering from trauma.”
But doctors, mental health professionals, scientists and even politicians have recently been making a variety of efforts to curb the stigma and raise awareness of mental health issues, particularly depression and post-traumatic stress disorder (PTSD). The White House hosted a national conference on the topic in June and has launched Mentalhealth.gov with the slogan, “You Are Not Alone,” aimed at spurring conversation about mental health and educating the public on the subject. In Seattle, research at the University of Washington and Seattle Children’s is focused on learning more about issues such as depression, as well as how to better treat it.
“People are working hard to help it change,” says Katrina Egner, a Sound Mental Health crisis services manager, who adds that there are varying degrees of acceptance of talking about mental health problems; as the problem becomes more severe, communication becomes sparse. “It’s OK to see a therapist if you’re divorced and feeling down, and it’s harder to go to work; and if you start hearing voices, well then, God knows you don’t tell anyone about that!” says Egner.
Primary care doctors are often the first line of defense for people suffering from mental health issues and are trained to look for signs as part of routine exams, says Oren Townsend, M.D., a primary care doctor at The Polyclinic’s First Hill campus who includes depression and preventive wellness among his specialties. Depression is one of the three most common conditions that routinely come up at primary care clinics (the other two are diabetes and hypertension). “We’re always looking for it. If you’re not looking for it, you’re not doing your job as a doctor.”
But mental health is rarely as simple as zeroing in on the problem and making a diagnosis, especially when symptoms themselves work against patients’ abilities to help themselves. One of the symptoms of depression, for example, is loss of energy and an impaired ability to concentrate. “On any given day in primary care, as many as 10 percent of patients have depression,” says Townsend but primary care physicians are only diagnosing it about half of the time. Of the patients who are diagnosed with depression, he adds, few receive adequate medication or therapy, and many don’t follow through with referrals for care. Anxiety disorders follow a similar line: highly treatable and very common, it affects about 40 million adults 18 and older every year, according to the National Institute of Mental Health.
Mental health isn’t all in your head—it often correlates with physical illnesses. “We’re finding how many of our clients also have physical health problems, and are looking at the correlation between the two to bridge the gap,” says Egner. “There’s a lot of research right now about stressors in your life and relation to heart disease.” In children, says Winston, physical symptoms can manifest as asthma, chronic backache and the inability to cope with the usual demands of life.
Townsend agrees. “Patients with depression and multiple medical conditions are more likely to smoke, drink alcohol in excessive amounts, be physically inactive, have unhealthy eating habits and are at greater risk for obesity. Untreated or unrecognized depression is a barrier to effective treatment of other co-occurring illnesses.”
Depression also is also often linked with PTSD, which falls under the umbrella of anxiety disorders. Though PTSD is not solely limited to veterans, Seattle’s proximity to Joint Base Lewis-McChord and the high number of veterans returning from military action abroad make it loom especially large here. According to the U.S. Department of Veterans Affairs, depression is nearly three to five times more likely in those with PTSD than those without PTSD. Both tracking down veterans who suffer from PTSD, and getting them to admit a problem are a huge challenges for mental health professionals. “In the military we’re trained to be tough; it’s one thing if you break a leg, but mental illness is seen as a weakness. Before somebody can get help, they have to admit they’re dealing with it,” says Kevin St. Jacques of Sound Mental Health, a PTSD expert who speaks about the disorder nationwide and is himself a veteran. “We’re getting vets through the criminal justice system, and the judges finally say, ‘You need to get treatment.’”
Mental health practitioners in Seattle are also participating in a nationwide initiative called Mental Health First Aid USA, a program that works a bit like CPR training, but for mental health: Mental health professionals volunteer to teach laypeople, in 12-hour sessions, how to identify and handle a mental health crisis, such as suicide. “The goal is to reach out to the community; they go and train the community on what it means to recognize that someone in your neighborhood, on the street, on the bus, might be having a mental health issue. They’re really talking to people about how talk to them,” says Egner.
Researchers are now looking at how early intervention can help curb depression, anxiety disorders and other mental health issues in adulthood, as well as learning how early childhood trauma can manifest itself in adulthood. “Early intervention is key; we also do ‘trauma-informed care’ in the sense that you treat everyone as if they’ve experienced trauma,” says Winston. “What we know now is that trauma can occur in many different forms, and children grow up stuck in fight-or-flight mode.”
Says Egner, “People are resilient by nature and trauma manifests in lots of different ways—some people push it down for years, some people get PTSD. The goal is to destigmatize all of that and let people know that it’s OK and there’s resources for you.”
Another champion for early intervention is Seattle Children’s, which has been studying mental health in children and adolescents from several aspects. In one recent study, published in April in the Journal of Clinical Child & Adolescent Psychology, researchers found that among 11- to 15-year-olds, those who received group intervention with a positive approach experienced more of a reduction in depressive symptoms compared to those who received one-on-one support that did not emphasize positivity. The medical center also is currently conducting a study for kids and teens to learn more about behavioral activation therapy and whether it can help them cope with depression.
Last year, University of Washington researchers published a study in Nature in which they identified a neurological link between stress and depression: a peptide that would bind to receptors in an area of the brain that is involved with motivation, pleasure and social behavior. In an experiment using mice, the scientists found that when good things happened, the peptide binds to a receptor that releases dopamine, which helps give the feeling of reward or excitement. When the mice were stressed, the peptide failed to cause the dopamine to release, and over a longer term, the effect was to cause the mice to avoid the area where would receive doses of the peptide.
All of the recent research and community initiatives on both a local and national scale are heartening for bringing mental health issues out into the open.
According to Sound Mental Health’s Winston and Egner, in recognizing mental health problems, the first circle of support is your personal support system. After that, medical providers, churches and other community groups can help recognize when it might be time to seek help. “Being aware of everyday worries getting out of hand; periods of highs and lows, starting to be super irritable, confused, you can’t think things through—these all suggest you might be having mental or emotional problems; certainly suicidal thoughts are also a big indicator, as well as substance abuse,” says Winston.
Everyone agrees that destigmatizing depression comes down to education and conversation. Egner says, “There are education and brain studies offering proof that it’s not that you aren’t strong enough—it’s not a character flaw.” ✚