Hey, how are you? How you doing? What’s going on? We hear these conversational phrases all the time. And we say them to each other. Sometimes we’re asking the question. More often we are just extending a greeting. We might even be surprised if somebody genuinely tells us the answer.
If we’re not looking too good or if we’re dragging on a given day, then loved ones and people who care about us ask us about it. Maybe we’ve lost weight or started working out or are back from vacation. People gonna’ ask. In appointments with healthcare providers, we hear similar questions: “How have you been feeling?” When COVID hit, such inquiries carried urgent meaning. Back then those who managed public spaces needed to know if we were “symptomatic” or had had exposure that might put others at risk. Whether we realize it or not, our biological situation is a regular topic of our conversation.
But the “how are you” and “what’s going on” questions need not refer only to physical condition. We also use these same questions to express support, curiosity, love, solidarity, sympathy, concern, encouragement, and much more. We ask questions like these, because we want to learn about a person’s insides, their emotional or mental condition, their spirit.
Intuitively, we just seem to know that ‘wellbeing’ concerns the whole person: the physical body, the mind, that part of us which NH novelist John Irving called “the you in you.” The medical community appreciates this and recognizes that physical and mental health are elegantly interwoven. Physical malady can affect mental tranquility, as anyone who suffers from chronic pain knows. Mental distress shows up in multiple forms, some obvious and others less so.
Primary care medical practices are uniquely positioned to facilitate physical and mental wellness for a significant portion of the community. Studies point out that four out of five persons with a mental or behavioral health issue do interact with their primary care provider at least once a year.
But challenges exist. Reports suggest that when a referral gets made to an outside (i.e.: elsewhere) mental health provider, 30-50% of patients don’t show for their first appointment. For a number of reasons - - convenience, stigma, access, clinician scarcity - - 50% of all mental and behavioral health disorders end up being treated, not in mental health settings, but in a primary care office. John Todd, APRN, FNP, nurse practitioner with Putney Family Healthcare, part of the Brattleboro Memorial Hospital family practice network, notes that “more patients than ever depend on their primary care provider to help them cope with new or chronic mental health challenges.”
And two-thirds of primary care physicians say they cannot access appropriate mental health care for their patients. Studies indicate that eighty percent of patients who contend with a mental health disorder find their way to Emergency Departments but most leave without adequate mental health interventions.
One creative solution to this dilemma has involved embedding mental health services at the same location as the primary care. Such treatment integration is endorsed by the National Alliance on Mental Illness (NAMI) as a way to assist patients who have mental health concerns to be ableto navigate a “fragmented system” and to improve overall outcomes. The American Psychological Association (APA) points out that formal and informal collaboration between medical and psychological healthcare underscores the mind-body connection.
Johanna Murphy, APRN nurse practitioner at Brattleboro Family Medicine (BFM), “always considers a patient’s mental and emotional health… [since]… physical health conditions will improve when mental health is treated.” The Brattleboro Retreat champions the mental health care integration model at Brattleboro Memorial Hospital and provides a licensed psychologist for this purpose. According to Todd, access to the BMH Family Practices psychologist affords a “non-judgmental support network for the patient” to explore and enhance optimal healthy outcomes.
“Hey, tell me what’s going on – how are you?” These are words that can convey so much more than greeting. They can be the invitation to learn, encourage, repair, and heal. Not merely to fix bone or breath but also to enlist the mind and spirit in the service of bodily integrity. Ask yourself how you’re really doing. And answer honestly when someone asks you. It’ll be good for you.
John Halloran is a licensed psychologist in Vermont and Massachusetts, who integrates mental health treatment in the Brattleboro Memorial Hospital primary care practices. He received his Doctorate in Clinical Psychology from Immaculata University and completed his post-doctoral residency at the Brattleboro Retreat.