The idea of annual “mental health checkups” has been bandied about by various people in the field over the past year or so. My initial reaction to the idea was that of bemusement, because it strikes me as simply impossible to implement on a mass scale. It is already extremely difficult for people with mental health problems to find an appropriately-trained clinician. Most mental health providers go months each year during which they are unable to accept new patients. Many have stopped taking health insurance, which is one way the field participates in the rationing of care. So I cannot imagine how these already over-booked clinicians could possibly conduct annual psychological exams on millions of additional people, most of whom are presumably psychologically healthy.
And what would such an exam look like, anyway? Let’s assume that it won’t involve completing the 567 True or False items on the Minnesota Multiphasic Personality Inventory, or describing “What might this be” to a set of Rorschach inkblots — the administration and interpretation of both of those tests requires a doctoral-level clinical psychologist. Because there are only 106,500 clinical psychologists in the United States, to give annual exams to the approximately 270 million people over the age of 14 in this country each psychologist would have to see 2,535 people every year. If the exam (with testing) took two hours, they could just barely pull it off, but only by working 14 hour days, seven days a week, 365 days a year. (And, of course, by no longer being available to treat people who actually have mental health problems.)
In lieu of an in-person exam, perhaps some form of self-exam could be useful. An annual mental health self-exam might look something like this:
Can you answer YES, THIS DESCRIBES ME to each of the following?
1. Over the past year, I haven’t had a period of depressed mood that lasted more than two weeks and which negatively affected my work or relationships. I’m in a reasonably alright mood most of the time. I have my down days, sure, but so does everyone else. I feel like there’s enough going on in my life to keep me interested. There are at least a few activities or interests that I enjoy and engage in regularly.
2. I feel as if my alcohol and/or drug use is under control, and everyone else in my life seems to think so, too. Nobody nags me about my drinking or drug use. In the past year, my drinking and/or drug use hasn’t increased significantly, nor have I tried to cut down but failed. I haven’t suffered any negative effects from my substance use in the past year (e.g., arrests, fines, missed work, injury, relationship conflicts, etc.). I drink or use drugs on fewer days that I do not (i.e., I use three days a week or less). My physical health is not negatively affected by my substance use.
3. I have people who care about me and people for whom I care. I see these people in person several times a week. I express my love to the people closest to me. I have people whom I feel I can depend on if I ever needed help. I have at least one person in my life with whom I feel I can share my most personal thoughts and feelings. In the past year, I have never felt afraid of or hurt by anyone in my life. I do not feel guilty over anything I have done (or failed to do) with regard to significant people in my life. I do not harm other people (this includes belittling, embarrassing, or cruelly teasing others). If I have a significant other, we enjoy each other’s company far more than we argue or disagree.
4. I feel like a contributing member of society. I am either engaged in full-time work, provide care for children under 13, or I am retired but active in my community. I find the work I do interesting enough (not deathly dull and repetitious) and reasonably fulfilling. The conditions under which I work are not “toxic,” either physically or emotionally. I do not have more than $100,000 in debt (including mortgage), or, if I do, I have a plan that I follow to eventually pay off that debt. I do not feel panicked about my financial situation. I do not spend money recklessly.
5. I am glad to be alive. In the past year, I have not had more than a fleeting thought about suicide. I haven’t been thinking about how I might go about killing myself. I haven’t bought a new firearm in the past year, with the idea that I might need it one day to end my life. There are a lot of things that I look forward to and that I want to keep doing and experiencing. I know that there are people who care about me and that they and others would be worse off without me around.
6. My temper is usually under control. I don’t drive aggressively or honk my horn just because I think another driver is an idiot. I don’t use physical aggression to intimidate other people or to get what I want (unless doing so is part of my job, e.g., law enforcement). People don’t tell me to “calm down” a lot or think of me as “hot-headed.” I am rarely “happy one minute and ticked off the next.” I don’t hold grudges or plot revenge against people who have done me wrong. I don’t feel as if people are out to get me or to do me harm.
7. My physical health is okay. I take any required medications as prescribed and otherwise follow the advice of my physicians. I am not sedentary; I walk at least 30 minutes a day, four days a week. I eat mostly food that is healthy and limit my consumption of junk food. I don’t binge on food, nor do I unduly restrict my food intake. I use caffeine in moderation. I do not suffer from symptoms for which my doctors cannot find a cause. I do not suffer from chronic headaches, muscle tension, dizziness, shortness of breath, chest pains, or fatigue. I have had a physical exam (with blood work) within the past 12 months. I do not use tobacco in any form.
8. I sleep okay. I get at least 7 hours of sleep on more nights than not. I keep fairly regular sleep hours, given the requirements of my work and/or childcare responsibilities. I do not have difficulty falling asleep, staying asleep, or frequent nightmares. I do not wake up a few hours before dawn and find myself unable to return to sleep. If my bed partner or physician suspects sleep apnea, I have had a sleep study done and/or use a CPAP.
9. I feel as if there must be some sort of purpose to my life, even if I am not currently aware of what it might be. I am not frightened about what the future holds. I am not tortured by things that happened in the past. I am able to enjoy being with people and doing things in the present moment. I notice the beauty in the world. I feel like if there is a Controlling Power in the universe, it is most likely Good.
10. I am able to relax and take it easy. I know that family and friends are more important than work and career success, and my behavior shows it. I take an hour a day just to relax and do things I enjoy. I take a full day off work at least once a week. At least twice a year, I take a full week off work and do something memorable, usually with people I care about.
11. My “life clock” seems to be ticking along okay. I don’t feel as if my “time is running out” to do the things I want to do. If I wanted to, but haven’t already, committed to a life partner, had children, or launched a career, I feel that those goals are within reach. If I am married or have children, I doing my best to be a good spouse and parent. If my own parents are still alive, I am doing the best by them that I can.
12. In the past year, no one has suggested to me that I seek mental health treatment of any kind. My partner has not suggested entering couples counseling. I am not taking medications for depression, anxiety, or insomnia. I do not have a severe mental illness such as schizophrenia, bipolar illness, recurrent major depression, or OCD.
0 to 7 YES responses: Go ahead and call for an appointment with a mental health provider today.
8 to 11 YES responses: Discuss the results of your self-exam with someone you trust and decide whether or not to seek treatment.
12 YES responses=You’re good to go for another year.
PLEASE NOTE: THESE SELF-EXAM QUESTIONS ARE FOR ILLUSTRATIVE PURPOSES ONLY AND IN NO WAY CONSTITUTE A FORMAL MENTAL HEALTH EXAMINATION OR SCREENING. If you are at all concerned about your mental health, you should seek the care of a licensed mental health provider or mention your concerns to your primary care physician. The Crisis Textline (TEXT HOME to 741741) and the National Suicide Prevention Lifeline (1-800-273-8255) are also valuable sources of support that you can use immediately.