Kate Spade’s apparent suicide demonstrates US needs a mental health care overhaul

Kate Spade’s apparent suicide demonstrates US needs a mental health care overhaul
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The apparent suicide of fashion designer Kate Spade shows that untreated mental illness can affect anyone — regardless of their gender, the color of their skin, or the size of their bank account.

Many news reports found that Spade had been suffering with her mental health for a long time. According to the Kansas City Star, Spade’s older sister said that her suicide was, “was not unexpected by me.”

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As a practicing psychologist, I find that most people with mental health disorders do not seek out or receive effective health-care services and treatments.

 

Most people who meet criteria for a mental disorder or have significant related difficulties do not actively try to find specialty mental health care. More typically, they are seen in general practice medical settings, like primary care. Indeed, primary care has been called the de facto behavioral health system in our country because there are simply not enough behavioral health providers.

That doesn’t mean that going to a general practitioner for a mental health evaluation isn’t a good thing. It just means that this is the state of our current medical system and culture when confronted with mental health problems.

In many cases, people don’t recognize that they are in psychological distress — they don’t understand that their symptoms are largely treatable and can be managed.  Or they want to handle the problem on their own. And in some cases, they may be concerned about being viewed as crazy, lazy, weak or bad. The stigma of having a mental health disorder in our society is still great.

Most people with emotional or substance abuse struggles don’t tell their physicians that the have problems. Rather, they exhibit psychological issues that are part of other acute medical conditions. For example, they come in with complaints of sleeping problems, headache or gastrointestinal problems, when the underlying cause is depression or anxiety.

Untreated or inadequately treated mental health problems are a tremendous strain on individuals, societies and health-care systems. At its most extreme, there can be a loss of life through suicide and the carry-over effects of bereavement on that person’s loved ones.

In the majority of cases, however, the effects are more subtle, such as family discord or missed days at work. In these cases, though the effects may be less obvious, they are very costly, particularly if they lead to poor job performance and unemployment.

If health-care providers aren’t getting to the underlying cause of a patient’s problems in general medical settings, that patient is not likely to get better, and quite possibly will get worse. This lack of recognition or misattribution of a patient’s mental health symptoms, on the part of the patient or the health-care provider, may lead to inadequate treatment plans or the administration of poorly focused or inappropriate treatments.

How do we get patients with mental health difficulties properly diagnosed? How do we get them properly treated? Where do we begin to fix this severely broken system? Of course, proper diagnosis and receipt of care still depends on one’s wealth and access to insurance.

This ongoing systemic issue needs addressing, for sure. But, in addition, a group of national experts recently explained that improving the quality of mental health care is a team sport. We need better coordination across medical and mental health providers, incentives and coordinated efforts among employers and healthcare systems, and involvement of patients and their families.

Kate Spade’s death by suicide is a reminder that we need to ensure access to mental health treatment and improve the quality of such treatment. Early intervention and prevention of mental health problems needs to be a priority in this country.

Joan Cook PhD is an associate professor at Yale School of Medicine. Cook has worked clinically with a range of trauma survivors, including combat veterans and former prisoners of war, men and women who have been physically and sexually assaulted in childhood and adulthood, and survivors of the 2001 World Trade Center bombing. She is a member of the American Psychological Association (APA) Guideline Development Panel for PTSD and the 2016 president of APA’s Division of Trauma Psychology.