All of us have had good and bad experiences when visiting the mechanic. If you are like me, and know little about engines to begin with, it is a very vulnerable situation. You do not know whether the mechanic is taking advantage of you, or if he has your best interest in mind.
I often find myself trying to relate things to analogies. I have lots of time to do this on my 1-2 hours of driving each day. Today, I found myself particularly discouraged when looking at our patient registry (list) sorted by highest to lowest on the Patient Health Questionnaire-9 (PHQ-9). If you do not know, the PHQ-9 is rating scale with a possible range of 0-27 (severity of symptoms represented by scores from low to high). The PHQ-9 is often used to detect and monitor patients with depressive symptoms. When I examined the numbers and looked at the charts, I noticed that patients' depressive symptoms were not improving. The absence of progress was not due to a lack of effort or lack of care by the health center's providers. We all wanted the patients to experience life to its fullest. Most of the organization's behavioral health clinicians put forth a lot effort, primary care providers tried many options, and I even pitched in a few treatment options as board certified psychiatric pharmacist to address the depressive symptoms many of our patients experienced.
As I looked closer at some of our more severe and younger patients who still struggled despite our team's best efforts, I became even more discouraged. It became clear that the health center's providers did not have the necessary tools due to the lack of resources available to a clinic in rural Montana. Nearly all the patients who struggled the most to manage their depressive symptoms shared one all too common thread found in many rural communities. Childhood trauma of some sort. In my experience as a clinical pharmacist specializing in behavioral health medications I have yet to find the magic pharmacological agent to treat childhood trauma. Nor I have seen any perfect behavioral health intervention that is magic remedy.
This brings me to my somewhat sad and revealing analogy. Our patients are like automobiles and healthcare professionals are mechanics. A well-maintained automobile can run for years with basic maintenance, my Tundra is approaching 300,000 miles. An automobile neglected is another story. Imagine you never knew a thing about a vehicle, and you were given a brand-new car to drive for the rest of your life. Imagine that automobile came with no oil and you did not know any better before you started driving. That engine will be in bad shape almost immediately. It might be fixable; it will probably be towable. It is going to take lots of time, lots of effort, and lots of resources to fix it. Now imagine if before you started that car, someone intervened and prevented all the damage. They taught you how to care for the car and taught you about routine maintenance. That car might be a 300,000-mile Tundra.
So, what is the point of the analogy? As mental health mechanics we want nothing more than to help anyone with engine trouble. We could not be happier to get your automobile running and get you moving along in this journey of life, but as mental health clinicians we wish your engines would have never had issues to begin with. Is it possible as mental health mechanics that we can somehow help this population or new automobiles; educate, protect, and provide preventive mechanical work? Are we overwhelmed and short on resources because we are not able prevent the preventable? Can we somehow find the resources and unite in preventing childhood trauma?
Shawn Patrick PharmD is a clinical pharmacist with a specialization in behavioral health medications. As a colleague I have learned a considerable amount from him, and he has profoundly shaped my approach to treating mental illness as an individual and family therapist. I am lucky to have him contribute his unique perspective to The Bitter Pill.-Jay