In my home state of Oregon suicide rates have increased nearly 30 percent from 1999-2016 and suicide is now the second leading cause of death among children and young adults ages 10-24. Per Mental Health America, Oregon has the highest prevalence of mental illness in the nation.

Oregon can also claim the third worst high school graduation rate and the nation’s second highest number of unsheltered homeless persons. In many of Oregon’s rural counties, opioid prescriptions are also among the highest in the nation. There is a lot of hurt, a lot of desperation, and widespread feelings of being “stuck” in a system that allows little upward mobility.

Nearly 18 months ago I decided to make the shift to embracing functional medicine in my mental health practice. I have become convinced that functional medicine is not the latest trend, but simply common-sense medicine, I am a firm believer that functional medicine is the future of medicine.

That said, the reality is that functional medicine and frankly a lot worthwhile therapies are still a bit idealistic and inaccessible for many. Specialized labs are often not covered by insurance, supplements can be expensive, personalized nutrition approaches are not in the budget, and “stress management” may be a stretch for the many individuals existing in survival mode where relaxation, deep breathing, and self-reflection are luxuries.

And so, myself and many other healthcare providers are tasked with navigating the complexities of attempting to promote holistic, personalized care amid social realities that create immense barriers. Too many of our patients are stuck in the “fight or flight or freeze” mode where true healing becomes elusive. If we (as providers) are not careful and especially if we are being rushed into providing care for big problems, burn out can come quick.

Economic stability, physical environment, education, food, community and social supports, and access to healthcare are identified as the primary social determinants of health by the Centers for Disease Control. Many patients come my way seeking respite from understandable distress when one or more of these determinants are minimal or absent. And while counseling has often been suggested, so too has medication in many cases. The patient may be panicked, overwhelmed, depressed, hopeless, and isolated. Yes, they may meet “criteria” for a myriad of diagnoses; however, how often are we really medicating or even numbing symptoms that are not indicative of pathology, but of societal shortcomings?  I ponder the “what if’s” all the time…what if they had stable housing…enough food…a safe home? If only I had a magic wand.

Let’s go back to Psych 101 and revisit Maslow’s hierarchy of needs. Food, water, warmth, rest, security, and safety. It is in fact rare that I come across a patient that has all these basic needs met. Even in circles of affluence and privilege, there can certainly cases of unrest, insecurity, abuse, and a perception of feeling unsafe. Ultimately, when the body cannot be in a state of rest, healing is difficulty if not impossible. To expect favorable health outcomes in the context of desperation is simply irrational.

My opinions do not negate the potential value of pharmaceuticals and other mainstream therapies as tools to help regulate a person’s symptoms, but if we pretend that “the treatment” of mental illness and emotional distress is relegated to pharmaceuticals and counseling, we are being shortsighted and ignorant.

So where does this all leave us and how do we move forward? First and foremost, we cannot pretend that illness is happening in a vacuum. As a healthcare system, we know this intellectually, but in practice, as we silo care to different specialties, rush patients through appointments, and take away time for important communication, we can fail to address psycho-social, socioeconomic, and spiritual impacts. We cannot expect a pharmaceutical to solve homelessness, hunger, abuse, or poverty and we must prioritize trauma-centered care. This takes courage, radical responsibility, teamwork, and innovation. We must provide opportunities and space for discussion and emotional vulnerability in our families, schools, places of worship, and workplaces. The idea that mental health is a “personal problem” and therefore an individual burden, only increases secrecy, shame, and stigma. We must all be advocates. Your health and my health depend on it.

Thanks for listening everyone.

With gratitude,

Audry Van Houweling, Owner, She Soars Psychiatry, LLC

Sisters & Silverton, Oregon. www.shesoarspsych.com