By Randal Terrell

Mental Health Exists on a Spectrum

One of the biggest changes in the way I think about mental health is realizing that mental well-being exists on a spectrum. Every human being experiences emotions such as anxiety, sadness, anger, fear, grief, stress, and emotional exhaustion at different points in life. However, having difficult emotions or occasional symptoms is not automatically the same as having a diagnosable mental disorder.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not say that everyone on the planet has a mental illness. Instead, it provides diagnostic criteria that mental health professionals use when evaluating mental disorders. At the same time, mental illness is extremely common. The National Institute of Mental Health reports that more than one in five U.S. adults lives with a mental illness.

To me, this reinforces an important distinction: everyone has mental health, but not everyone has a diagnosable mental illness. Mental health exists across a broad spectrum, and where a person falls on that spectrum can change throughout life.

The People We Never See in the Statistics

Statistics cannot completely capture everyone who is struggling. There are people who experience significant symptoms but never seek treatment. Some may not recognize what they are experiencing. Others may be embarrassed to discuss their symptoms, lack access to mental health services, or attempt to cope on their own.

Some people may also turn to alcohol or drugs as a way of coping with emotional distress or psychiatric symptoms. While substances may temporarily change how someone feels, self-medicating can create additional problems and can make it more difficult to identify and properly treat the underlying issues.

This is one reason I believe mental health screening and honest conversations about symptoms are so important. A person can appear functional on the outside while struggling tremendously internally. Mental health problems do not always announce themselves in an obvious or dramatic way.

Primary Care Can Be an Important Starting Point

For many people, a family doctor or primary-care provider is the first medical professional they tell about depression, anxiety, unusual thoughts, changes in sleep, mood changes, or other psychological symptoms. Primary-care clinicians therefore have an important role in recognizing and treating common mental health conditions.

However, screening is not the same thing as a complete psychiatric evaluation. When symptoms are complicated, unusual, severe, worsening, or not responding to treatment, I believe patients should feel comfortable asking whether evaluation by a psychiatrist, psychologist, or another qualified mental health professional would be appropriate.

The U.S. Preventive Services Task Force recommends screening adults for depression and recommends anxiety screening for adults age 64 and younger. Importantly, screening is supposed to be connected to appropriate evaluation, treatment, and follow-up rather than simply assigning someone a label.

What Happened to Me

This subject is particularly important to me because of what happened during my own mental health journey. When I began experiencing symptoms that concerned me, I attempted to explain what was happening to my primary doctor. In my experience, I was never referred to a psychiatrist at that point. Instead, additional medication continued to be prescribed in an attempt to address the problems I was describing.

From my perspective, my condition did not improve. It became worse and ultimately led to my hospitalization. Looking back, I wish the symptoms I was reporting had resulted in a specialized mental health evaluation much earlier.

I cannot know with certainty what would have happened if I had been evaluated by a psychiatrist sooner. I cannot say that an earlier referral would necessarily have prevented everything that followed. What I can say is that the experience changed the way I think about mental health treatment.

When someone’s psychological symptoms are becoming more severe, complicated, or difficult to understand, I believe it is reasonable to ask whether specialized mental health care should become part of the treatment plan. There is nothing wrong with asking your primary doctor, “Do you think I should see a psychiatrist or another mental health professional about this?”

More Diagnoses Do Not Necessarily Mean People Have Become Weaker

I sometimes hear people from older generations suggest that people today simply are not as mentally tough as people used to be. I do not think the issue is that simple.

An increase in recognized mental health conditions does not automatically mean people have become weaker. Part of what we are seeing may simply be greater awareness. When society becomes better at recognizing symptoms, more people are screened, more people understand what they are experiencing, and more people become willing to seek professional help.

Mental health stigma has historically prevented people from discussing what they were experiencing. Someone living with depression, anxiety, trauma, addiction, or another psychiatric condition decades ago might have suffered quietly rather than seeking treatment. Others may have turned to alcohol or drugs without recognizing that an underlying mental health condition could have been contributing to their behavior.

Today, mental health is discussed much more openly. That increased awareness can result in more people recognizing symptoms and seeking evaluation.

Finding More Because We Are Finally Looking

There is a simple principle that I believe is important when considering the apparent increase in mental health diagnoses: when we start looking for something more often, we are probably going to find more of it.

Imagine that very few people in a community are routinely screened for a particular condition. Some people could have symptoms for years without ever receiving a diagnosis. If doctors then begin screening thousands of people, the number of diagnoses could increase substantially even though the condition itself did not suddenly appear.

That does not mean increases in mental health diagnoses are entirely explained by better screening. It means there can be several explanations operating at the same time. Greater awareness, improved screening, changing diagnostic practices, better access to care, reduced stigma, and people’s increased willingness to discuss their symptoms can all influence how frequently conditions are identified.

Diagnosis Should Not Be a Label of Weakness

One of the most damaging ideas surrounding mental illness is that receiving a diagnosis somehow means someone is weak. I see it differently. A diagnosis should be a tool for understanding what someone is experiencing and helping determine what treatment or support may be appropriate.

Previous generations undoubtedly included people living with depression, anxiety, trauma, addiction, and serious psychiatric disorders. Some received treatment. Others may have suffered privately, self-medicated, been misunderstood, or simply never had a name for what they were experiencing.

Greater awareness does not necessarily create more mental illness. Sometimes awareness simply allows us to recognize suffering that previously remained hidden.

Mental Health Screening Should Be Taken Seriously

I believe mental health deserves a more consistent place in ordinary health care. We routinely talk about blood pressure, cholesterol, weight, blood sugar, medications, and other indicators of physical health. Mental and emotional health should also be part of the conversation.

Screening alone is not enough, however. A questionnaire cannot replace a comprehensive evaluation when one is necessary. If screening identifies concerning symptoms, there needs to be an appropriate next step. For some people that might involve continued care with a primary-care provider. For others, it could mean counseling, psychological evaluation, psychiatric care, substance-use treatment, or a combination of services.

The important thing is recognizing when additional expertise may be needed instead of assuming that every mental health problem can be addressed in exactly the same way.

What My Experience Taught Me

My experience has made me an advocate for taking mental health symptoms seriously. I believe primary-care providers play an important role in mental health care, but I also believe patients should feel empowered to ask questions, request further evaluation, seek a second opinion when appropriate, and ask for specialized mental health care when symptoms are persistent, unusual, worsening, or difficult to understand.

There is also no shame in admitting that something does not feel right. Seeking professional help does not mean someone is weak. It means they are trying to understand what is happening and determine what they can do about it.

The goal should not be to convince everyone that they have a mental illness. The goal should be to create a society where people understand that everyone has mental health, mental illness is common, and nobody should be ashamed to ask for help when something feels wrong.

The more willing we become to screen, listen, ask questions, seek qualified help, and talk openly about mental health, the greater our opportunity to identify problems earlier and help people before their lives reach a crisis point.