Most of us have been touched by cancer in one way or another. The mere word causes us to shudder.
Though it is a physical illness, cancer certainly affects mental health as well. A diagnosis and the treatment options available can be overwhelming. When suddenly faced with an illness that has the potential to cause death, our emotional well-being can absolutely be threatened.
October is Breast Cancer Awareness month, and one area that often receives too little awareness is the intersection of cancer and mental health, and how treatment of the two might work together.
Cancer and mental health
A cancer diagnosis can affect mental health in all sorts of ways, not all of them obvious.
The many fears a person with cancer faces — fears of pain, death and leaving loved ones behind — can cause anxiety and depression even in people who have never had mental health issues before. And, certain cancer treatments can exacerbate symptoms of depression in those who already struggle with the condition, as Dr. Susan Noonan explained in a recent video for the Psychiatric Times.
Surprisingly, even recovering from cancer can take an emotional toll. As Noonan explains, anxiety and depression can appear “at the end of treatment, when the intense therapy is completed and the high level of support diminishes, causing fears of abandonment and being alone in many people.”
While these issues might affect anyone with cancer, they can be particularly acute in those with severe mental health issues who may not have access to mental health treatment.
Research tells us that people with severe mental illness (SMI) die an average of 10 to 25 years earlier than the general population, largely due to undiagnosed or untreated medical problems, including cancer. The reasons for these health problems vary, ranging from excessive tobacco use to diabetes and poor eating habits. People with conditions like schizophrenia and bipolar disorder often take medications that increase the chances of cardiovascular disease and cause weight gain, which can lead to diabetes.
These conditions are largely treatable, but people in this population often do not get preventive care such as cancer screenings. For a person with severe mental illness, intrusive thoughts — Why do I need this? Who is watching? What will they find out about me? What’s in this medicine? — can create a barrier to treatment.
The challenge for mental health care providers is to make sure these people have an advocate to help them get medical care on a regular basis. Treating issues as they arise is much more difficult when a person has not been seeing a health care provider as part of a regular routine.
Community Behavioral Health Clinics offer whole-person care
Since the late 1970s, the safety net for providing services for the severely and chronically mentally ill in Oklahoma has been supported by community mental health centers, a designation decreed by the Oklahoma Department of Mental Health and Substance Abuse Services.
These centers were created in 1963 to ensure that low-income and indigent people have access to comprehensive mental health and substance use care within their communities. The way these centers are structured and funded, however, limits the array and access to care they can offer.
In the past five or six years, all of the CMHCs in the state have achieved specialized certification and have been designated as certified community behavioral health clinics (CCBHCs). These clinics were started as part of the Protecting Access to Medicare Act of 2014 and their goal is to provide access to high quality care that integrates physical and mental health.
CCBHCs are designed to provide a large continuum of care, with crisis services available 24/7. These centers also arrange for integrated health care through partnerships with federally qualified health centers and maintain collaborative relationships with local schools, law enforcement and hospitals. The goal is to give patients access to providers who are highly skilled in a wide range of evidence-based practice models.
As part of their work, these centers are required to provide access to primary care, dental care and mental health care, either directly or through a formal relationship with another agency.
By offering a safe and comprehensive “medical home,” FQHCs can be particularly valuable for individuals with serious mental illness, substance use disorders or co-occurring physical health disorders. And coordinating different kinds of care is the linchpin of the system.
The purpose of integrating mental and physical health care is to ensure that we provide care for the whole person, rather than simply one disconnected aspect of the individual. This can be particularly important when someone gets a cancer diagnosis.
We know that cancer can cause even the most stable person to have new emotional needs along with new physical and practical needs. The CCBHC system enables us to wrap a team around that person and provide as much or as little support as they want.
As we celebrate the lives saved through preventative screenings and new research and treatments, we can also make a positive difference in the emotional and mental side of having cancer. The CCBHC model of care allows those of us in the field the honor of walking alongside people through this journey.