In the wake of recent tragic events like the New Year’s Day attack in New Orleans, medical professionals are emphasizing the critical need to incorporate mental health assessments into routine medical care. As Rahn K. Bailey, MD chief of psychiatry at Louisiana State University, points out, “We should put more on the front end for prevention” when it comes to mental health and potential violence.
Expanding the Vital Signs
One key recommendation is to expand the traditional vital signs checked during medical visits. As Dr. Bailey explains:
“Early in my career… we were trained as physicians that there were four vital signs, temperature and breathing capacity and, whether you had any, heart rate, and any pulse. At some point in my career, we decided to add pain as the fifth vital sign. Now I earnestly believe that violence, a violent tendency, should be a sixth vital sign metaphorically.”
By routinely asking about potential violent thoughts or tendencies, doctors may uncover warning signs that would otherwise go unnoticed. Dr. Bailey notes, “You’d be surprised at how often, unbeknownst to you, a person will admit earnestly and honestly that they are having thoughts toward violence.”
Proactive Questioning
Beyond simply asking about violent thoughts, Dr. Bailey recommends probing deeper with hypothetical scenarios:
“If I give them a hypothetical and ask, what would you do if this situation occurred? Again, I remain very surprised in my current clinical practice how often individuals don’t have the so-called defense strategies or compensatory strategies to work through stresses and problems without resorting straight to violence.”
This approach can reveal gaps in coping skills that may put patients at risk for violent behavior under stress.
Overcoming Time Constraints
Michael LeNoir, MD, an allergist and pediatrician, as well as the host of African American Wellness Watch, acknowledges the challenges primary care physicians face: “We’re under a lot of pressure, we’re under a lot of stress, we know about the social determinants, we know about the psychiatric possibilities, yet we don’t seem to be able to incorporate effectively into our histories and physicals enough of the information about the mental status of patients.”
However, Dr. Bailey argues this needs to change: “We will be wise in our society to have an all hands on deck approach to decrease the risk and increase prevention of this kind of violent acts. More clinicians and all physicians should regularly be thoughtful and demonstrative of this concept…of a mental status exam.”
Expanding the Reach of Mental Health Screening
Importantly, non-psychiatric physicians are often in the best position to identify mental health concerns. Dr. Bailey points out:
“Of our 30,000+ suicides every year, almost 40,000…the data remains that over half have seen a professional within 30 days of committing suicide. Of the person who sees a professional, over half of those persons saw an individual that was not a psychiatrist, either a non-psychiatric mental health professional or a non-psychiatrist MD physician.”
This underscores the critical role all healthcare providers play in mental health screening and intervention.
A Call for Systemic Change
Dr. Bailey emphasizes that this shift requires a broader change in medical culture and training:
“We shouldn’t wait until there’s an initial consideration of a problem before we send someone to a psychiatrist for a formal assessment… We all should think [about] how a person thinks and engages, that’s important. And we all should recognize that we have an opportunity to have a blanket of an assessment strategy that is far-reaching.”
By expanding mental health screening across all medical specialties, the healthcare system can cast a wider net to identify individuals at risk and intervene earlier.
As society grapples with ongoing mental health challenges and incidents of violence, the medical community has a unique opportunity – and responsibility – to be proactive in addressing these issues. By incorporating mental health assessments into routine care, asking the right questions, and breaking down the silos between physical and mental healthcare, doctors can play a crucial role in early intervention and prevention. As Dr. Bailey concludes, “We must do that better in America going forward, or my unfortunate perspective is that these problems are likely to continue before they get better.”