Why Women Need Mental Health to be a Part of Every Annual Exam | Opinion

The greatest threat to our health is not heart disease, nor is it cancer (the most common causes of death for women), but the insidious effects of women's declining mental health.

I make this claim not simply because women continue to be diagnosed with anxiety and depression at more than double the rate of men; nor do I assert this because providers are much more likely to write-off a female patient suffering from pain and mental illness than a male patient—though both these facts are true. I make this assertion because research has shown time and time again that how we perceive stress and internalize it in our bodies has a lasting impact on our physical health. And yet, our health care system has not responded to this evolving research and nuanced understanding of the way psycho-social stress implicates long-term health outcomes.

Mental health is defined as a productive way of adapting to psycho-social stress. When we fail to effectively deal with stressors, our bodies' proper functioning falters. At this point, clinical research has tied stress to the onset of cardiovascular disease, diabetes, Alzheimer's and dementia, and most autoimmune disorders including cancer. For these diseases it's time we consider: Did they start with faltering mental health? Could the life-altering outcome have been mitigated or even avoided by supplying the patient better access to stress management and mental health bolstering tools? It's time we reform our health care system to detect these faults early on, and it's time we normalize mental health checks as a fundamental part of the annual wellness check (commonly referred to as the "physical"—which obviously needs a rebrand if we're to follow this path).

For most of our history, mental health and emotional wellness has taken a back seat to physical conditions. Simply look at the traditional health care edifice for evidence: How much square footage is allocated to the floors addressing physical maladies? How much to a mental health wing (if one even exists)? Similarly, until the advent of COVID-19, dollars invested into mental health care paled in comparison to that put into company investments and research for physical-health issues.

In 2018, the total National Cancer Institute budget for cancer research alone was six times the entire budget awarded to National Institute of Mental Health's research—and that does not account for all the other areas of physical body research. This pattern is reflected in the global landscape, where only 2 percent of national health budgets globally are spent on mental health.

We're all familiar with the phenomenon of short-term (acute) stress triggering a physical response. Consider: Your teacher announces a pop quiz, an unexpected urgent request from your boss, an irritated text from your mother, disagreements with friends, anxiety induced by past trauma, the list goes on—you immediately start sweating bullets, heart thumps and your mouth goes dry.

A silhouette of a women running
A silhouette of a women running. Adam Pretty/AUS/Allsport/Getty Images

How stress works in the body on a longitudinal basis is in the process of being uncovered (it's highly complex)! Yet, a growing body of research indicates stress, anxiety and overall emotional unwellness can beget complex systemic dysregulation and cascade into disease. These new insights about the ways in which our mental wellness can influence our metabolism, cardiovascular system, pain sensitivity (and so much more!) cannot be ignored. They prove that mental health is central to our overall health—and prove the need to ensure secure and productive environments in order to ensure health.

Now that we know that mental health actually characterizes the performance of the physical body, this knowledge needs to penetrate our health care system fully. We need to drastically change the way that we evaluate patients and practice preventive health care.

Our health care of "old" is so anchored on the body that we colloquially refer to our annual visit with our doctor as the "physical". But, in order to build a system that is more effective at preventing long-term disease onset we must start at the origin, where cellular dysregulation begins (often a cell under chronic stress failing to properly copy itself or produce energy effectively). We must normalize mental health as part of the "whole person" health regime, just as we normalized nutrition and exercise over the last 30 years. We must give patients the tools to manage chronic stress and build resilience to our modern environments that are simply a battering ram of stressful events by the minute. And, lastly, we must hold our health systems (most notably payers) accountable to valuing the complexity and centricity of mental health's role in whole body health and longevity.

Here are three tactical ways we can begin this work:

—Start addressing physical health with mental health. By doing this we may be able to detect and prevent many of the downstream physical ailments and symptoms that derive from them.

—Support patients with tools and mechanisms to modulate chronic stress. This may be one of the best preventive tools in our "tool kit" to help create healthy behaviors to respond to stress before that stress starts to bear down on the body.

—Develop systems in our health care that can evaluate patients consistently. This includes annual mental health screenings baked into every woman's annual health exam, increased therapy offerings for women, integrated into her entire health care journey. At Tia we've moved toward this innovation by installing a mental health screening visit into every Well Woman preventive health visit. Women 18 and older are covered by the ACA for a cervical cancer screening; we believe the standard of care should be a mental health screening, too. Tactically, this means we stack a visit with a primary care and gynecology provider with a mental health specialist—we call this the "Tia Whole Health Exam." The result is cross specialty collaboration and share care plan development that ensures that both physical and emotional needs of the patient are addressed.

Felicity Yost is co-founder and chief product & operating officer of Tia.

The views expressed in this article are the writer's own.