tive psychology orientation, the technique is used to help patients feel heard, and to gain a sense of self-efficacy over their own health behaviors and emotional states. The BATHE technique’s emphasis on deep listening is a way of formalizing what many effective primary care physicians and people with mental health issues have long known: Listen carefully, don’t discount what someone is telling you about their physical health just because they may have a mental health diagnosis. Open-minded listening with empathic understanding builds the relationship between practitioner and patient and ultimately, the relationship is the most critical tool at the doctor’s disposal. Kelechi Ubozoh, a young woman with a background in journalism who transitioned to the mental health research and activism field after her own experience recovering from mental health challenges, talks about the power of relationship: “When I was first diagnosed, I was too young to understand what it meant. I’ve had a label for longer than I haven’t. My mother, who is a primary care doctor, always looked at what I was going through as a health condition. She never shrugged off my problems. Sometimes, reaching someone with mental health challenges doesn’t require a bullet point list or years of training; it’s about connection and seeing the person first. I am not a diagnosis; I am a person.”
HOPE AND SUPPORT FOR PEOPLE WITH MENTAL HEALTH ISSUES AND THE HEALTH CARE PROFESSIONALS WHO TREAT THEM:
According to the National Alliance on Mental Illness (NAMI), with support and treatment, 70%-90% of people report reduced symptoms and improved quality of life from mental health conditions, even those considered “severe mental illness” such as bi-polar disorder and schizophrenia5, a statistic that often surprises many seasoned primary care and mental health care professionals. Changes in legislation, such as the Patient Protection and Affordable Care Act (PPACA), and the Mental Health Services Act (MHSA) are also supporting significant shifts in the way care is provided: promoting integrated approaches to behavioral and primary care, training and support for primary care physicians who are seeing more patients with behavioral health concerns in their practices, and tools to help lessen the impact of stigma as a barrier to treatment and support. Each Mind Matters, California’s Mental Health Movement, is one such project funded by the Mental Health Services Act. Created to unite all Californians who share a vision of improved mental health and equality, Each Mind Matters is starting conversations about what helps people feel safe to reach out, and connecting them to resources in the community. Example Question
Everyone experiencing a mental health challenge deserves the opportunity to live a healthy, happy, and meaningful life. People can and do get better, and by talking openly and honestly about mental health we take the first steps toward making that possible. To find out more about the Each Mind Matters campaign and the tools and resources available to primary care physicians, please visit www. eachmindmatters.org.
RESOURCES:
Below are some helpful, free resources and training materials for primary care physicians regarding suicide prevention, mental health screening tools, and integrated care. • http://resource-center.yourvoicecounts.org/content/trainingresource-guide-suicide-prevention-primary-care-settings • http://www.ibhp.org/uploads/file/IBHPIinteragency%20 Collaboration%20Tool%20Kit%202013%20.pdf • http://ibhp.org/uploads/file/IBHScreeningToolsRevFinal100313. pdf • http://www.namica.org/uploads/eng/pe_flier_jul2013.pdf
ABOUT THE AUTHOR
Lisa Smusz is a Licensed Professional Clinical Counselor with more than 15 years of experience operating large-scale mental health projects and has internationally published works on stigma reduction. Ms. Smusz currently serves as a consultant for the Each Mind Matters campaign.
REFERENCES
1. Care coordination for persons with complex mental health, substance use, and medical conditions: The case for providers. Available 3/10/15 online: http://www.ibhp.org/uploads/file/ BusinessCaseProvidersFinal.pdf 2. CDC Report: Mental Illness Surveillance Among Adults in the United States. Available 3/10/15 online: http://www.cdc.gov/ mentalhealthsurveillance/fact_sheet.html 3. California Primary Care Association, Integrated Behavioral Health Care: An Effective and Affordable Model. Available 3/10/15 online: http://www.cpca.org/cpca/assets/file/policy-andadvocacy/active-policy-issues/mhsa/integrationbrief.pdf 4. Effects of BATHE Interview Protocol on Patient Satisfaction. Available 3/10/15 online: http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3526719/ 5. National Alliance on Mental Illness (NAMI) Fact Sheet. Available 3/10/15 online: http://www2.nami.org/Content/ NavigationMenu/Inform_Yourself/About_Mental_Illness/ About_Mental_Illness.htm
Description
B
Background
“What is going on in your life?” This question helps elicit the context of the patient’s visit.
A
Affect
“How do you feel about that?” or “What is your mood?”
This question allows the patient to report on his/her current feeling state.
T
Trouble
“What about the situation troubles you the most?”
This question should be asked even when the patient’s affect is positive, as they may still be stressed about their current life circumstances.
H
Handling
“How are you handling that?” or “How could you handle that?”
This question is asked to evaluate what psychological stress the patient may be experiencing that may be contributing to their physical complaint or affective state.
E
Empathy
“That must be very difficult for you.”
Expressing empathy or sympathy conveys a sense of concern and of being understood, which affirms the patients and enhances positive feelings toward their health care provider. MARCH / APRIL 2015 | THE BULLETIN | 29