“Julia’’ is a 38-year-old patient of the Family Medicine clinic at Boston Medical Center. Originally from Puerto Rico, she married young and was in an abusive spousal relationship for years. Both of her children were born without an important but not essential part of their brain. Now ages 4 and 6, they have spent their lives going from one specialist to the next. Having finally left her abusive marriage, Julia takes care of them without the support of family or friends. Julia is morbidly obese and suffers from diabetes, high blood pressure, high cholesterol, and chronic pain. She also suffers from debilitating depression, anxiety, and panic attacks. Despite our intensive outreach, she rarely makes her scheduled appointments and when she does, her depression and anxiety are overwhelming and it is hard to address her health issues and needed lifestyle modifications. She has been referred multiple times to psychiatry and counseling, been admitted for her depression, and cycled though multiple medications and behavioral health providers. But she, like her children, is trapped in a fragmented system where her care is being held up by many hands. Hands that do not touch. And though we have tried everything, our system is failing her.
This month marks the 50th anniversary of President Kennedy’s signing of the Community Mental Health Act — a bill that aimed to bring greater awareness and acceptance for mental health disorders. Though perhaps the scope and depth of mental disorders is better understood today, our medical system’s approach to caring for those who suffer remains fractured. With the political rancor over the Affordable Care Act and the recent government shut down, many have lost sight of the fact that the ACA offers a real solution to the mental health care crisis: the integration of mental health and primary care.