The Intersection of Behavioral Health, Mental Health, and Health Literacy Proceedings of a Workshop (2019) / Chapter Skim
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2 The Personal Experience
2 The Personal Experience
Pages 5-16
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From page 5... ...
A PERSONAL PERSPECTIVE ON EFFECTIVE COMMUNICATION2 "I believe the start to good communication in health care is listening, hearing, and seeing a person as an individual," Lisa Morgan said. "For me, 1 At the workshop, speaker Wilson Compton defined "behavioral health" as an overarching term that includes mental health diagnoses, substance abuse and addictive disorders as well as behaviors that affect health, such as medication adherence (see Chapter 3)
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From page 6... ...
. "Communication in health care is extremely important to me as an autistic adult," Morgan said, "and in my experience the lack of understanding and huge gaps in communication between patients, doctors, and behavioral health care providers can cause harm and misdiagnoses, reduce the success of treatment plans, and ultimately not address my actual health care needs as a patient." Along with health care concerns, many autism diagnoses come with at least one, if not more, co-occurring mental health diagnoses that are often complicated by such behavioral health issues as social withdrawal and isolation, perseveration on negative thoughts, self-harm, pervasive aloneness, poor social skills, and high levels of anxiety.
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From page 7... ...
Unfortunately, when Morgan relocated to another state, she had to start again to find a new doctor. Although her previous psychiatrist tried to assist her, Morgan's insurance required her to see the behavioral health professional in the medical office of her new primary care physician.
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Morgan explained why she had not: As an autistic adult, change is very difficult for me and I had not been able to try the new medicine because it was a change, and I didn't trust her at that point. I had previously communicated to her that it would be difficult for me, although I understood medicine is a tool for me to use to process everything that has happened leading up to my husband's suicide and the aftermath.
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From page 9... ...
While her interactions with her psychiatrist have been fraught with fear and anxiety, her psychologist communicates with her respectfully as who she is, "an educated professional who has experienced multiple traumatic situations." The psychologist does not patronize Morgan or treat her as though she is unable to help herself. Her psychologist actively listens, offers guidance, and offers space for Morgan's autism.
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From page 10... ...
NAMI also operates from the belief that the most effective treatments for mental illnesses jointly address biological, psychological, and social elements and that the gold standard of care is collaborative. "Most importantly," she said, "we believe that the lived experience of people with mental illness and their families is absolutely essential in helping people in the world to understand and think about how they might change systems and programs and that our voice should be in the conversation about how programs might be changed." Farinholt said that like most people who become involved with NAMI, she joined the organization because she had a relative with a mental illness -- in her case a sister who developed schizophrenia at age 11.
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From page 11... ...
While it is not currently available in all states, NAMI offers a provider education class that is designed to expand providers' compassion for the affected individuals and their families and to promote a collaborative model of care. NAMI programs differ from one affiliate chapter to the next, but many of these chapters offer classes for families and individuals on topics such as the stages of adherence and recovery, empathy
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From page 12... ...
Someone with a psychiatric illness might So you need to • Have trouble with reality • Be simple and truthful • Be fearful • Stay calm • Be insecure • Be accepting • Have trouble concentrating • Be brief and repeat • Be overstimulated • Limit input • Easily become agitated • Recognize agitation • Have poor judgment • Not expect rational discussion • Be preoccupied • Get attention first • Be withdrawn • Initiate relevant conversation • Have changing emotions • Disregard • Have changing plans • Keep to one plan • Have little empathy for you • Recognize as a symptom • Believe delusions • Ignore and do not argue • Have low self-esteem and motivation • Stay positive SOURCE: Adapted from a presentation by Kate Farinholt at the workshop The Intersection of Behavioral Health, Mental Health, and Health Literacy, on July 11, 2018. and empathic guidelines, how to collaborate successfully with the health care system, advocacy, and communication strategies and skill building.
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From page 13... ...
Morgan said that she would create an interpretation book similar to a foreign language phrase book that would allow for free-flowing communication between her and her health care providers. Farinholt said that she wants to see all health care professionals trained in basic communication skills and taught about the various mental illnesses so that they communicate effectively with someone who is having a behavioral health issue.
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From page 14... ...
Michael McKee from the University of Michigan Medical School pointed out that the burden of mental illness is high among patients with various types of disabilities, and he called on medical schools to do a better job training physicians on basic communication principles, particularly regarding communication with populations that may need more clarity and openness from their health care providers. He then commented on the difficulty of finding providers who are good communicators and suggested that some organizations should consider developing tools or resources that would help patients with this difficult task.
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From page 15... ...
Noting that there are efforts to increase the patient's voice in medical practice, she asked the panelists if they had any ideas on how to more systematically include the patient voice in the process of delivering care, in addition to the personal experience in receiving care. Farinholt said that SAMHSA has funded a program on the integration of mental health and behavioral health into pediatric care that has a focus on patient and family involvement and engagement in system and program changes and design.
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From page 16... ...
Earnestine Willis added that health care professionals need to do more work on de-stigmatizing mental and behavioral health, both within their ranks and out in the community. Martinez said that, in her experience, medical educators are prepared to meet this challenge, but she added that physicians in training also need to learn that the social determinants of health and behavioral health, not biological factors, are probably the biggest predictors of health outcomes.
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