More Than Stigma: Shifting the Nature of the Conversation Around Mental Health and Suicide

Advocates for suicide prevention and mental health often talk broadly about “the stigma” which surrounds mental illness and suicide. Many of us – myself included – believe that if we can just get more people talking and thinking of mental illness, if we can have people discussing their issues with depression, anxiety, addiction and more without shame or fear, we can help to put an end to this epidemic. I firmly believe that this is the case.

I also know its not enough.

And that’s where the conversation around public policy, resources and taxation has to come into pay.

I happened to catch a fascinating column on mental health the other day – I obviously can’t find it now, that would be too easy, but the column made a great broad point: Ending mental health stigma is like cutting holes in a wall, but then there’s nowhere to go because our system of mental healthcare is so broken in this country.

Many of us concentrate our efforts on stigma for a couple of reasons. I think it’s one of the most important things that we can do. But let me expand on the second part of that sentence: That we can do. People do need to know it is okay to seek help and to treat themselves. They need to know that these issues are real, powerful and can kill you. But, as any studies have shown, individual conversations are the best way to break mental health stigma. A face to face talk can make a huge difference in that area. That means that, without question, the most important person to ending mental health stigma is you.

Second, it’s the easiest.

Making society-wide change is really hard, of course. Particularly in areas where colossal interest groups are at play. I’m an elected official – theoretically one of the people who makes state-wide decisions in Pennsylvania – and I fully understand just how difficult this can be.

And the simple truth is that we must make systemic changes to help reduce rates of mental illness and suicide.

From a mental health and suicide perspective, there’s an awful lot that needs to be done. This includes increasing access to mental health care, increasing the number of mental health care practitioners and addressing the mental health care practitioner shortage, reducing costs, enforcing parity in insurance care, reducing access to deadly means of suicide and more. And that’s to say nothing about the major societal problems that we face which contribute to mental illness and suicide, including improving housing options, strengthening the social safety net, increasing the minimum wage, making housing more affordable, etc.

Many of us tackle stigma because we can’t get at these issues. And stigma is something we can control.

So, what does that mean? Should you stop talking about mental health stigma? Hell no. Of course it’s vitally important, but it’s important in more ways than you think, because the more you discuss mental health, the more pressure you can bring on policy makers to address the fundamental inequities and gaps in our system which allow for mental illness to run so rampant. Keep fighting.

But make sure you fight in a public policy realm, in addition to addressing individual changes. Tell policy makers and elected officials that you expect them to do more to address rates of mental illness and reduce suicides. These issues require government intervention, and that requires public pressure. Please help make this happen.

 

Medication is Not Addiction: A response to a misinformed column

I spent way too much time on Sunday on Twitter, joining a chorus of voices who were yelling at David Lazarus, a columnist or the Los Angeles times. Lazarus wrote a column in which he discusses his own experience at trying to withdraw from anti-depressants. The title of the column? “Hi, I’m David. I’m a drug addict.”

Yep. Only went downhill from there.

Ironically, Lazarus discussed important issues like the over prescribing of medication, failure to adequately warn patients about side effects and discontinuation syndrome. These are real, important issues. They merit serious, thoughtful consideration. Instead, Lazarus decided to call millions of Americans (like me) drug addicts. He esoterically wondered “Who am I, really?” about taking anti-depressants. It’s a tragic, misguided view, one which reinforces stigma and will prevent people from getting help they need. And the language used by Lazarus is just appalling. If I’m a drug addict, so is everyone else who uses medication to survive for any other condition.

Really, this is just an ugly article.

I wrote a response which the Los Angeles Times did not accept, citing their policy to not run op-eds in response to other op-eds. Fair enough. My response, then, is below.

Don’t believe crap like what Lazarus decided to spew. Medication can be a vitally important part of any therapeutic regimen. It has saved thousands of lives.

Let’s say you are a diabetic and require insulin to live. One day, a friend tells you to quit insulin. Stunned, you ask why. Your friend responds: “Well, you can’t live without insulin. That makes you a drug addict.”

That’s absurd, right? Taking a prescribed medication in recommended doses doesn’t make you a drug addict. That makes you a responsible adult.

But the above scenario would never really happen, right? No one would ever claim that taking medication to treat diabetes, Parkinson’s or Alzheimer’s would make you a drug addict.

But, apparently, such an understanding does not apply to the millions of Americans who take medication to manage mental illnesses. To Americans like me.

For eighteen years, I’ve been diagnosed with a major depressive and generalized anxiety disorder. I’ve been suicidal. The medication which I take, in conjunction with therapy and lifestyle changes, has saved my life.

About five years ago, I made the decision, as a Pennsylvania State Representative, to start discussing my battles with depression, anxiety and suicidal ideation. I did so in response to the stigma which surrounds mental illness. Depression isn’t a weakness. It can’t be willed away. Taking medication doesn’t say anything about one’s character any more than having heart disease indicates a moral failure.

That’s why I was so disheartened to read Mr. Lazarus’ column: It took serious issues like over-prescribing  and discontinuation syndrome – issues which deserve thoughtful, reflective discussion – and conflated them with drug addiction. To be sure, medication is not a panacea. It often takes months, if not years, to find appropriate medication and dosage. Prescribers sometimes fail to appropriately monitor their patients. Side effects are real and dangerous. All of these issues demand thoughtful consideration and conversation.

However, such problems exist in virtually all areas of medicine, and no one would reasonably or seriously suggest that we should stop prescribing scientifically proven medication to people in need. Yet, that is exactly what some suggest when it comes to mental health.

Mr. Lazarus refers to himself as a “drug addict” for taking anti-depressants. Yet, he also discusses being a diabetic who takes medication for chronic Type 1 diabetes. Strangely, he declines to refer to himself as a “drug addict” for requiring insulin to manage his blood sugar levels. I wonder why.

We should never, ever be so foolish as to conflate appropriate use of anti-depressants with drug addiction. To do so makes people who take anti-depressants to live sound like sound like a caricature of a drug addict, desperate for their next hit of smack…or, as I like to call it, the pills which help me not want to kill myself every morning.

Contrary to what some believe, anti-depressants are not happy pills which whisk you away on a cotton-candy cloud, carrying you to Lollipop Island to float with gumdrops all day long. What they do is help you control symptoms, improve your mood and make other forms of change – like psychological therapy and lifestyle changes – easier to obtain.

Taking medication for mental illness doesn’t change who you are. It allows you to be who you are.

Far too many Americans have ignored their own minds and medical advice, choosing to try and “tough out” spells of depression, to “man up” or ignore these painful and rehabilitating symptoms. Too many Americans have powerful fears that taking anti-depressants makes you weak. This stigma must be crushed and rebutted in the same way intelligent society has pushed back on those who attack vaccines.

Anti-vaxxers and those who deny the positive impact of anti-depressants are flip sides of the same coin: They seek to use pseudoscience and stigma. Science has given us incredible tools which can be used to our great physical and emotional benefit. To ignore those tools, or to somehow wrap their use in shame, serves only to pull us into a darkness which we should have left behind decades ago.

The nearly 1 in 5 Americans who suffer from mental illness – including me – deserve to have our challenges discussed with respect and a comprehensive understanding of mental health treatment options. This discussion is simply incomplete without discussing the importance, effectiveness and risks of medication. No one who takes an anti-depressant is a drug addict, any more than a person who takes Prilosec for heartburn is addicted to not having their chest feel like is on fire.

The facts are stark. Depression rates are skyrocketing, rising sharpest among today’s youth, who have seen nearly 50% increases in rates of depression. 47,000 Americans – and 2,000 in my home state of Pennsylvania – died by suicide last year, an increase of 34% since 1999.

We need serious, sober conversations about mental illness and how to treat it. There are many concerns with anti-depressants. These are valid, serious concerns which must be addressed. But these conversations must occur using words and arguments which shatter stigma and support science. To do otherwise does an incredible disservice to those of us who suffer.

 

Yes, people really are this stupid about mental illness and suicide

Sometimes, I find myself falling victim to the availability heuristic, and if you read this blog on a regular basis, I bet you do too.

For those of you unaware, the availability heuristic is defined as: “A mental shortcut that relies on immediate examples that come to a given person’s mind when evaluating a specific topic, concept, method or decision. The availability heuristic operates on the notion that if something can be recalled, it must be important, or at least more important than alternative solutions which are not as readily recalled.”

Why am I mentioning this now? Well, if you read this blog, I’m guessing you have an interest in mental health and mental illness. It’s probably a subject you follow closely and in which you are are well educated. I bet you have more evolved views on the causes and symptoms of mental illness and understand it’s complexities. And, I’d bet that the vast majority of people you interact with feel the same way.

Ahhhh, dear reader, allow me to share portions of an Email I just received. Among it’s gems:

  • “People commit suicide because they lack hope. True hope comes from putting your trust in the Lord Jesus Christ.”
  • “A troubled person who believes in evolution and does not know anything about the Bible, may turn to suicide as an escape.”
  • “If you want to reduce suicide, introduce the Bible back into school and stop teaching the fairy tale of evolution.”

First, a disclaimer, and let me make it crystal clear: The purpose of this entry is not to mock anyone’s faith or sincerely held beliefs. Rather, it’s to point out an absolutely ridiculous example of thinking. Faith absolutely assists some in the fight against depression and hopelessness. That’s wonderful. If that’s something which may work for an individual, I highly, highly encourage them to find a method of counseling which fits their views on religion, God and spirituality.

But the notion that prayer, Jesus or teaching creationism will cure depression and suicide for everyone is absurd.

Mental illness is highly complex. It often requires time, resources and multiple, simultaneous methods of treatment and lifestyle changes in order to fully address and treat. There is no one size fits all bullet. But what absolutely will not help is judgmental statements like the above, or the adherence to a one-sized fits all approach.

I’d also challenge anyone who makes a statement about reducing depression, mental illness and suicide to make sure that their comments are backed up by research. As I’ve noted in previous entries, there is a complex relationship between religion and mental illness, but as best I could find, there is ZERO relationship between teaching evolution and mental illness. Someone correct me if I’m wrong.

We’ve made great strides in the area of mental illness of late, but we still have a long long way to go. And absolute statements like the ones made above will do nothing but drive people further into the shadows.

There are people this uneducated out there, and I hope this is something we can all remember.

Five ways YOU – yes, you – can help beat mental health stigma

One of the things I am most passionate about when it comes to mental health is trying to beat the stigma surrounding it. I was asked a very interesting question yesterday: What does that look like? What is a stigma free world?

The best answer I have for that very valid question is this: We treat and view physical and mental illness in the same light. And we don’t view mental illness as being anything other than what it is: A serious, dehabilitating and potentially deadly category of diseases which require time, resources and care to heal.

Unfortunately, we don’t live in a society where that is currently the case. We know that nearly one out of five American adults have some sort of mental illness, but only 30-40% seek treatment.  Stigma continues to play a role in this disconnect and in people’s assumptions of what it’s like to live with a mental illness.

So, rather than asking a broader question about what we can do, as a society, let me put the question to you in a more direct, personal terms: What can you do to help end mental health stigma?

Here are five suggestions. They are all relatively simple. You may have thought about them already. But I think it’s important that all of us realize we have a role to play in terms of ending mental health stigma.

1) You have to talk about it: One of the most difficult things which people can do in terms of mental health is also one of the simplest: You have to talk about it. If you are depressed, say it. If you are anxious, say it. According to research, anti-stigma campaigns which are most effective are those which feature real, “normal,” identifiable people discussing their mental illness. This means that the most effective person to attack mental health stigma is…well, you.
2) Encourage people to seek help: If you are one of the lucky ones who has avoided mental illness, that’s wonderful. You still have an important role to play: If someone you know is in pain and needs help, encourage them to get it. Be supportive and non-judgmental, but help them get the help that they need and deserve.
3) Encourage an equal perspective between physical & mental illness: I might be off here, but I believe ending stigma means that we take mental illness the same way we take physical illness. That, I believe, is important, because most people aren’t going to look at a broken arm and think, “Gee, I can just tough it out!” When someone gets physically sick, we usually don’t think twice about helping them get the help they need. I think this is a good model for breaking mental health stigma.
4) Watch your language: Here’s one that I must confess I sometimes violate, and I need to stop. Expressions like, “I’m crazy” or “You’re nuts” don’t help anything. All that does is reinforce a negative stigma about mental health. There has been an awesome campaign in the past couple of decades to eliminate use of the word “retard” as a negative description, and it’s fantastic. The campaign operates on the principle that we are a better society if we are more inclusive. This has to extend to how we discuss mental health as well.
5) Don’t just talk about failures and pain – talk about successes and joy. I think part of the problem with the way we discuss mental health is we discuss it. We talk about failures, about challenges, about struggles. When you discuss mental health, don’t just concentrate on the negatives. Talk about joys and victories. Talk about beating struggles, about thriving. Mental illness can, of course, be extraordinarily painful, but that makes our victories sweeter. Talk about thriving, not just the pain.
As always, I’d love to hear from you! Anything you want to add? Let us know in the comments below!

Want to tell your story? Great. Here’s how.

Last week, I wrote an entry about why telling your story – your own personal experience with mental illness (or anything, really) is so important. Study after study shows that the best way to reduce stigma is to put a human face on it. The power of saying, “Me too” cannot be underestimated – that’s why it is literally called the #MeToo movement.

That being said, telling your story can be absolutely terrifying. You may have no idea what to say, how to say it, or what the reaction is going to be. The fundamental truth is that once you put yourself out there, there’s a before and after in your life. As I’ve said repeatedly about my own life, I found the ability to tell my story in the courage of those who told there’s. To that end: Here are some tips about what to say, and how to say it:

Pick your medium. You don’t need an op-ed. You don’t need to stand on a chair and scream, “I HAVE DEPRESSION!” Telling your story may be as simple as opening up to a friend of colleague, or resolving yourself to do so in the future. It may be a long-winded Facebook post or blog entry (and I am the MASTER of those, with an emphasis on long-winded!). In all seriousness, understand that different medium will have different impacts. Pick the one that works best for you.

Read/watch others. Reading and watching what other people have said will give you a much better idea of how to say what you want to say. You’ll learn what works and what doesn’t. More importantly, paying attention to the stories of others will remind you of a fundamental and very important truth: You aren’t the first, and you aren’t alone.

Read from the experts. Related to the point above: Read what others say when discussing your particular issue. Know what words and phrases are good, and what don’t work as well.

Understand that most people will be overwhelmingly supportive. In a weird sort of way, one of the things that disoriented me the most was how kind people were. It never felt like something that was “so brave” or anything like that – it just felt like something that had to be done. And that became almost a source of anxiety – that now I had this standard to live up to. So, as strange as it may sound, brace yourself for the weird sensation of people being really, really nice and appreciative.

Understand that some will not. There will always be morons and unkind people. Just keep in mind that when someone inevitably says something ignorant, it says more about them than you.

If medium-appropriate, make it a story. Part of making in impact with your story is telling it as a story. When I discuss my own battles, I always begin with something like this: “On August 11, 2014, my life changed forever. That was the day that Robin Williams killed himself.” I think that’s a good hook and a good way to start. Anyone reading will think, “Huh. That’s interesting. Why did that have an impact on him?” And it goes from there. Tell your story as a story. Be specific. Use visuals. Give dates, times and locations. Don’t approach your personal story as an academic book report, replete with cold numbers that fail to convey passion – tell your story with the personal power it deserves.

Understand the impact. This is the one that I missed the most. Depending on who you are and how you choose to say your piece, you may wind up having a greater impact than you realize. When I told my best friend what I was going to do, he correctly noted that this would have a much greater impact on me or my career than I could have ever anticipated. When I told my mentor, she told me that she’d be surprised if the piece I wrote didn’t make state-wide news. Both were correct. Understand that people will look at you differently – and probably in a better light.

There. Hopefully, this post can serve as a guide to help you tell your story. As always, let me conclude with a question: What did I miss? What helped you tell your story? What didn’t? Please let us know in the comments!

The importance of sharing your story

You are all probably sick of me hearing me talk about my own depression/anxiety by now, and why I made the decision to tell the world about it. But, using my personal experience, let me pivot to another topic: Why I think you should tell your story.

I shared my story as a way of trying to make people realize that anyone, anywhere can suffer from mental illness, and in an effort to help destigmatize this terrible disease. As I thrust myself into the issue, I researched more and more ways to try and do just that. What I found, uniformly, was this: The most effect way to fight the stigma that surrounds mental illness is to engage in a contact strategy.

What is a contact strategy? Well, just what it sounds like: Make sure that more people have contact with someone with mental illness. Have those people – regular, ordinary people – discuss who they are, what they suffer from, and how they are able to live a successful and productive life despite their illness.

Does the same strategy work for fighting suicide? Absolutely, and this can come from family members who have lost or those who survived a suicide attempt. While there are guidelines and best practices for sharing those stories, doing so can be hugely beneficial:

Stories of suicide loss told from the heart are powerful. They promote healing for those who are newly bereaved, educate the public about how to support survivors of suicide loss, and increase awareness of suicide risk factors and warning signs.

As you have likely seen in the news lately, many celebrities and other prominent officials have discussed their own battles with mental illness or suicidal ideation. This is wonderful in that it can lower the overall effect of stigma. But, I’ll never forget one particular piece of research that I read: While it’s important, it is not as effective as a “normal, regular” person discussing their own pain and battles. That’s because celebrities are seen as “other” – they are different than normal people in that they occupy an elevated societal plane. Thus, while celebrities going public is great, it has to come from the heart and be a ordinary person who discusses their story.

And that’s where you come in. I’ve previously noted that the most important thing I felt I did when it comes to mental illness was share my story with the world. I want to take this opportunity to encourage you to do the same. Not only is it good for everyone else – mental illness needs a human face – but it’s good for you as well! I know that sounds strange, but trust me on that. There is something deeply freeing about letting lose your deepest, darkest secret in public – particularly when that “secret” is nothing you should be ashamed of.

In the coming weeks, I’ll discuss this concept further, including tips on the best way to share your story. But for now, please, if you are able, consider going public with your mental illness. It’s the best decision I ever made in my life, and I’d encourage you to do it if you can.

The dream scenario: How society should treat mental health

Many of us, including me, regularly talk about how important mental health is. We talk about how important it is that, as a society, we change the conversation around mental health. Something occurred to me as I was debating what to write: I had no idea what that specifically meant. I mean, I have some general ideas, but I want to take a minute to expand upon what I’m talking about – what I mean – when I say that we have to have better and more helpful conversations about mental health in this country.

What do I want? Easy.

  • No one blinks about seeking treatment for mental health. There is no shame, no stigma. You say “I have depression” with the same breath that you say “I have the flu.” In my dream world, no one is afraid to talk about having an anxiety attack. No one is afraid to say they are having a bad day. In our current society, fear of being “discovered” creates more anxiety, more depression, more stress. That, in turns, has a dramatically negative impact on mental health and creates a vicious cycle. We shouldn’t be afraid about discussing who we are and the repercussions that may come with it.
  • There are no barriers to seeking treatment for mental illness in terms of finances or access, and I mean this in a few ways. First, like many areas of medicine, there is a major shortage of mental health care practitioners. This is a major problem and one that exists for many reason, but I’d argue that the chief problem is money. Physicians go into fields for many reasons, and those reasons are similar to decisions that the rest of us make: They are often financially based, and reimbursement rates for psychiatrists are far too low. This keeps doctors out of this vitally important field, and I’d argue that these rates are too low because we are too afraid of talking about mental health to begin with. Insurance companies often create plans that have different and lower levels of reimbursements for mental health care. That leads to worse mental health, and worse outcomes.
  • In my dream, as a society, we’ve stopped even hesitating about talking about mental illness. One of the things I learned quickly when I started talking about my own depression/anxiety? It’s everywhere and everyone. No, obviously every person in the world isn’t mentally ill. But just about every person in this country knows someone with mental illness. After all, one in five Americans suffer or will suffer from mental illness. We have to acknowledge this pain if we are ever going to cope with it.
  • There are no disparities in healthcare among various demographics. I’m lucky; I’m a relatively well-off white male with easy access to health care. While I’m grateful for my own circumstances, we have to acknowledge that other groups – including racial minorities and members of the LGBT community – lack the easy access that I and others like me are fortunate enough to have. This isn’t fair, and it isn’t right. A society is only just when everyone has the same access to life-saving resources.

There’s more – so much more – but these are the first things I’ve come up with. I’d love to hear from you – what else am I missing? Let me know in the comments below!

Talk to the kids: Why you should tell your mental health story

This past Friday, as part of the real job, I had the pleasure of attending career day at one of my local elementary schools. During that time, I spoke with about 70 5th graders about what it’s like to be a State Representative, what I do, what my issues are, etc. In doing so, did what I always did: I spoke about mental health. I also made sure to be very clear – no euphemisms, and no sugar-coating. I spoke about having depression and anxiety disorders – what that means – and how I see a therapist as needed and take medication on a daily basis.

I make this part of an overall anti-stigma conversation. If I’m talking to younger kids, I broach the subject like this:

“Okay, let’s say you’re riding you’re bike, and you fall off and your arm is hanging at a funny angle.” (imagine me holding my arm at a funny angle) “What’s the first thing you are going to do?”

“Cry!”

“Yes, well, there’s that, but AFTER that.”

“Call 911!”

“Right! Exactly! You’ll call 911! And you would’t even think about it, right? You wouldn’t be embarrassed. Well, imagine having a mental illness….”

And I take it from there.

Sometimes, the kids ask me questions about this stuff. Other times, they delve into other areas of my career. In two of the three classes I had, the mental illness did come up. I was asked questions about it, and they were strikingly perceptive. Two that stick out in my mind:

  • Is suicide a mental illness?
  • Is it a mental illness if you do drugs?

And then a few kids opened up and discussed their own experiences – or that of their family – with mental illness. I know no one would be able to identify them from this, but I’d still rather not say what they said. Suffice to say – it struck me. It left a mark. And it reminded me of one of the many reasons I always discuss my mental illness, but particularly with kids: It can give them a little bit of hope. As many of you unquestionably know, one of mental illness’ greatest challenges is the way it warps your mind, makes you feel like you are alone. I want all of these kids to know that they aren’t alone.

This leads me back to my main point: Tell your story. Please understand I say this not to toot my own horn, but the smartest decision I have ever made in my life was to publicly discuss my own struggles with depression and anxiety. The experience has become astonishingly positive, and has helped me help other people. According to research, a contact-oriented strategy, one in which regular people share their own struggles with mental illness, can be invaluable towards fighting the stigma that keeps people locked in shame and out of treatment. Telling your story can provide incalculable hope to others who need it.

As always, I’d love to hear your thoughts and perspective. Have you “gone public” with your struggles? What has your experience been like?

What anti-stigma really means

Call this one a brilliant thought that I had in the shower the other day.

There are plenty of anti-stigma campaigns related to mental health.  In many cases, the goal of these campaigns is simple, noble and necessary: to defeat “mental health challenges in the workplace and at home.”  This is vitally important work.

There’s good news related to that though.  In many areas, anti-stigma campaigns have already done their job.  For example, a poll taken in my home state of Pennsylvania (March 2017) shows high levels of comfort in terms of working with someone with a mental illness, a vast improvement over previous levels.  While there is still a long way to go, this poll shows significant movement in the area of mental illness.

I was thinking about this poll the other day, and it had me thinking: What does anti-stigma really mean?  Obviously we need to continue to work on critical areas like discrimination and access to healthcare, but I’d argue there’s more than that.

My argument is this: The most powerful sense of stigma is self-stigma.

Consider this 2012 article, which describes self-stigma as when “patients agree with and internalize social stereotypes,” resulting in:

•Patients often think that their illness is a sign of character weakness or incompetence.
•Patients develop feelings of low self-esteem and become less willing to seek or adhere to treatment.
• Patients anticipate that they will be discriminated against, and to protect themselves they limit their social interactions and fail to pursue work and housing opportunities.

As a result, patients find themselves less willing to seek treatment and social support, leading to lower rates of recovery.

This realization has had me rethinking how I approach the notion of anti-stigma campaigns.  Of course they should be focused on ensuring that all of society views people with mental illness not as sick freaks who are weak, but as real people suffering from real disorders that can be treated like any physical illness.  I want to push society to a place where all of us – those with mental illness and those without – view people who are suffering from a mental illness the same way that someone views a cancer patient.  No one who suffers from a mental illness should do so in fear, shame or silence.  They should talk about their therapy appointments the same way a cancer patient discusses chemo or someone with a broken leg discusses physical therapy.

I suppose, then, that what I am saying is this: Anti-stigma campaigns shouldn’t just address societal stigma.  They should address self-stigma as well.

As always, I welcome your thoughts – am I onto something here?  More importantly, have you found any anti-stigma campaigns that fulfill what I am describing?  Let me know what in the comments!

Google launches depression screening tool

I caught this over the weekend and found it to be very interesting: Apparently, Google has launched a tool that serves as a brief depression screening.

First, about the screening.  It is the PHQ-9, which is only nine statements.  It asks users to select the level of agreement with nine statements, ranging from “Not at all” to “Nearly every day.”  They include items like, “Little interest or pleasure in doing things” and “Feeling tired or having little energy.” The information can then be shared with the user’s health care provider and used to seek treatment.

This is noteworthy for many reasons.  The screening will pop up in the event that “depression related searches” are made, similar to the way that the number for the National Suicide Prevention Lifeline (1-800-273-8255) pops up for suicide related searches.  Given the prevalence of Google in modern life, this can, hopefully, help make people more aware of mental illness and steer them to treatment options.  This is also particularly important, given the spike in suicide-related Google searches.  That spike, incidentally, is tied to 13 Reasons Why on Netflix, a show I suspect I will be writing about in the future.

Indeed, I’d argue that the most significant reason that the availability of the depression questionnaire is important is because of the major rate of spikes in suicide that we are seeing.  Suicides are rising across the board, but particularly for young girls aged 15-24, who have seen suicide rates increase to 40 year highs.  Obviously, this is the generation that is the most technologically dependent, so increasing their awareness about mental illness and treatment options can be a very, very good and healthy thing.

As good of a thing as this is – and it really, really is a good thing – depression screenings are not without their problems.  There are some studies which report that versions of the PHQ can demonstrate “poor specificity in detecting major depression” or false positives.

That being said, for the sake of argument, let’s assume the absolute worst about the PHQ-9: That it leads to an unacceptably high amount of false positives for depression.  Google’s use of it is still a great:

  • First, false positives is very different than false negatives.  A single accurate, positive test about the PHQ-9 can steer people into treatment and give them the help that they so desperately need.
  • Second, it can help move positive views of mental illness in a positive direction.  Too many people still view mental illness as a weakness or something that can simply be conquered by willpower.  That, of course, isn’t the case anymore than a broken arm can be healed by well-wishes.  Having a source viewed as positively as Google advertise depression screenings can, hopefully, convince people of the importance of seeking treatment for mental health.

As always, I’d love to hear your thoughts.  Let us know in the comments!