Help for Mental Health: What We’re Doing Wrong

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I was recently reading about an online treatment for depression called “Deprexis” summarized by Dr. John Grohol, over at the Psych Central site. Dr. Grohol discusses the study that was done to investigate the effectiveness of this online treatment program, that doesn’t involve any contact with a therapist.

Results of the study were very promising, suggesting that those who completed the treatment improved in terms of their scores on the Beck Depression Inventory.

Surprisingly, however, even participants who did not complete the entire 10-module program still improved. Those who only completed 4 or fewer of the 10 sessions still received a positive benefit. In addition, there was a very large dropout rate (almost half) in the study, which is consistent with most online interventions.

Dr. Grohol discusses some of the issues surrounding these findings — namely, why do people drop out of online treatment? Is it because they are depressed? Or because they have improved enough in the first half of the program that they don’t need to continue? Or that they just lost motivation, possibly due to the depression itself?

These are all fascinating issues, and relevant to those who wish to create online treatment programs for social anxiety disorder as well. I would like to return to this discussion, but first, I have a little story to tell.

I recently went to see my doctor for a physical issue that had been giving me problems for a couple of months. When I arrived at the office, I was told that there was a medical student who would be sitting in on the appointment, if that was okay with me. I don’t mind that sort of thing, so agreed that it was fine.

Prior to the doctor arriving, the medical student took my history. And by history, I mean an extensive list of questions about my medical background. As I answered the questions, in the back of my mind I was thinking, “When will I be asked about my mental health history?” I kept waiting, and waiting, and waiting. The questions never came.

I left that day bewildered. If our primary physicians are not the entry point into mental health discussions, then who is? Is it up to the person with depression, social anxiety, obsessive-compulsive habits or post-traumatic flashbacks to say, “Hey doc, I’ve been having these mental health issues. Do you think you could help with that?” Perhaps it is, but I don’t think it should have to be that way.

People shouldn’t have to jump through hoops to get mental health diagnoses and treatment. The process needs to be made as easy as possible for those struggling with mental health issues. Asking someone with social anxiety or depression to proactively bring up mental health issues during a routine doctor’s appointment is akin to asking a person who just had a heart attack to drive himself to the hospital. We have procedures like 911 and ambulances because we recognize the handicap that those in physical distress face. Why don’t we recognize the same handicap among those under extreme mental stress?

Bringing the discussion back around full circle — I would like to think that somehow the online treatment revolution might bring some relief. However, if nearly half of those who start an online program end up dropping out, then we still aren’t doing a good enough job.

How can we fix this problem? Here would be a few of my suggestions:

1. Train primary physicians to watch for and ask about mental health symptoms. And to ask about them even when it seems irrelevant.

2. To take the burden off of the patient with mental health issues to push for treatment. Once symptoms have been identified, the burden should be on the attending physician to start a course of action that leads to a resolution — that does not require the patient to be proactive or make follow-up phone calls. The simplest road block could discourage someone with depression or social anxiety from continuing to seek help. All of those road blocks need to be removed.

3. Follow through. In the case of those in the online treatment programs I described, I suspect that some form of accountability might have kept them in the program longer. For those with social anxiety, facing fears can be daunting. Having someone (anyone) to whom they are accountable for completing the program could make a huge difference.

As Dr. Grohol states, however, we still don’t know the reason for those dropout rates — so this is the next avenue that research needs to address.

In the meantime, what can you do?

1. Start an online treatment program for SAD that has been validated with some form of scientific study.

2. Try to complete the whole program, even if you feel like dropping out.

3. If your doctor isn’t good about asking about mental health symptoms, bring a written summary with you. Doctors still need to do a better job with mental health issues, but in the meantime you can help them out.