Whenever there is a mass shooting, two questions are repeated in the news and social media: Did the shooter have a history of mental illness? And why weren’t warning signs identified earlier?
These questions reflect the barriers to better mental health care. Questioning whether the shooter ever had mental illness reinforces the false idea that some people experience mental illness while the rest do not, which is the foundation of stigma. Questioning why the shooter didn’t have an earlier intervention highlights the lack of prevention in our current mental health system, which focuses on identifying existing illnesses. If we want to reduce the stigma of getting mental health care and prevent mental health crises, an updated approach to mental health care is needed.
Primary mental health providers is an approach that addresses stigma and prevention in which general practitioner psychologists, like primary care physicians, would be primary care providers for people to receive regular mental health checkups and prevention, and would be the first stop for mental health care.
Since stigma is formed when only a subgroup of individuals is thought to need mental health treatment, this universal approach will counteract stigma. People do not feel stigmatized by getting a back-to-school physical because everyone does it. Similarly, stigma would be reduced with general practitioner psychologists because care would be universal.
Since, in reality, mental health is like physical health — no one stays mentally healthy throughout their entire lives — nonuniversal approaches leave a majority of society without beneficial mental health strategies. With general practitioner psychologists providing primary care, all people would have access to mental health care at each stage their lives and would receive preventive interventions for risk factors that could lead to more significant illness. Additionally, those who are at risk of violence would already have a psychologist screening and intervening on risk factors.
As doctoral-level clinicians trained in the human mind, behaviors and mental illness, psychologists are uniquely qualified to serve as primary mental health providers. Like primary care physicians, general practitioner psychologists could refer to clinicians with specialized training in treating mental illness, such as other psychologists, psychiatrists and licensed clinical social workers, when in-depth treatment is needed.
Imagine if psychologists could screen all children for developmental and learning disorders so they could be detected and addressed earlier.
Imagine if childhood bullies already had access to psychologists to address the underlying causes of the bullying and anger; and those being bullied already had access to a psychologist for coping and self-esteem building; and all children received interventions on communication and peer support as part of prevention.
Imagine if each person had a psychologist during every major life transition for guidance and situation-specific counseling, from starting a new school or job, to experiencing a pregnancy, to suffering the death of loved ones.
Imagine if all people were receiving regular screening and assessment for both common and rare mental health concerns so that conditions did not go undiagnosed for years, and those who experience precursors for mental health conditions could be educated on ways to diminish risk and to recognize warning signs of worsening symptoms.
It is time that we build on health care approaches that integrate mental health into primary care because mental health cannot have parity with physical health until we have a system in which all people can get primary care for mental health. To achieve parity, insurance companies would need to provide coverage for preventive mental health, which could save money because prevention is less expensive than treatment.
The general practitioner psychologist approach offers a solution in which mental health care is for all rather than just some, prevents crises rather than reacts to them, is expected rather than stigmatized and helps improve lives not just fix problems.
Adrienne A. Williams, Ph.D., is an associate professor at University of Illinois at Chicago College of Medicine.
