Mental health is not always the easiest topic to discuss. You may be like many older adults who feel challenged to address the topic with your health care team, especially if you grew up in a time when mental health was stigmatized or not well understood.

You may be reluctant to reveal aspects of your personal life or you may worry that family members will probe into your affairs more than you’d like them to.

Despite these obstacles, starting conversations about mental health is vital for seeking support, improving your quality of life, and ensuring that you are not misdiagnosed. You can use some straightforward strategies to get the conversation going with your trusted health care team.

Doctor and patient: The importance of a trusting relationship

An essential component of maintaining our overall health involves how well we communicate with our health care team—and how well that team communicates with us. Ideally, you and your health care team will work in partnership to make sure that you receive the best care and that everyone on the team practices good medicine.

Making a good partnership with your doctors and nurses a reality will depend on three important factors:

1. Having a common goal
2. Working toward shared decision making
3. Establishing consistent and clear communication.

This means asking questions if you don’t understand your doctor’s instructions or explanations, bringing up problems even if the doctor doesn’t ask, and sharing concerns you may have about changes or treatments with your doctor. If none of this describes your current communication with your health care team, it might be time to explore other options or to try out some of the techniques below to improve the communication between you and your health care team.

Getting the most out of your health care visit

One way to get the most from your time with the doctor or nurse (or other members of your health care team such as a dietitian) is to prepare for the visit, take information with you, and take notes at the appointment.

Before visiting the doctor, think about the reasons for your visit and make a list of what you want to discuss. You may think that you’ll remember everything you want to say, but it can difficult in the moment to recall all of the questions that you have on your mind. Be specific. When does the symptom occur and how long does it last? How does it affect your daily activity? Every detail you give is a piece of a puzzle to help your doctor diagnose your condition and its severity. Filling out a worksheet ahead of time is hugely helpful.

You should also bring either a list of everything you take or put all of your prescription drugs, over-the-counter medicines, vitamins, and herbal remedies or supplements in a bag and bring them with you to your next doctor’s appointment.

During the visit, write down your diagnosis, the treatment, your follow-up plan, and what you can do at home. If you aren’t sure that you can talk, listen, and write at the same time, take a friend or family member along—if you feel comfortable doing this—to write down your doctor’s findings and suggestions. When it comes to treatment options, think about how each treatment or test will affect your life and your ability to do activities you enjoy. Share any apprehensions you might have so your doctor can work with you to develop a treatment plan that meets your needs.

How to address mental health concerns with your health care team

All of the above recommendations are good advice for any medical visit. But talking with your health care team about your mental health concerns might require a few additional steps.

First of all, some symptoms that you might not think about could be mental health related. For example, ongoing headaches, digestive issues, pain, difficulty concentrating, irritability, changes in appetite, and difficulty sleeping could all be signs of a mental health disorder. Other, more noticeable signs include sadness, changes in mood, engaging in high-risk activities, substance abuse, thoughts of death, anxiety, and obsessive thinking. If you are experiencing any of these symptoms, it’s worthwhile to bring them up with your health care team and explore them further so that you are not misdiagnosed. The cognitive changes that can accompany depression, for instance, are often mistaken for dementia in older adults leading to a misdiagnosis.¹

Second, you’ll want to know what types of doctor visits and treatments are covered by Medicare or your health insurance plan. As of January 2024, Medicare has greatly expanded its outpatient mental health benefits. Medicare Part B pays in part for various therapies—occupational, dance, individual, and group—in addition to substance use disorder treatment, laboratory tests, family counseling, and an annual depression screening. (Your plan’s deductible and copayments will apply.) Many medical providers—general practitioners, nurse practitioners, psychiatrists, etc.—are also covered. However, not all non-medical doctors, such as psychologists, are covered. You will want to know if your provider is Medicare-certified and takes assignment.²

Third, if you are in crisis and either do not yet trust your health care team or just do not know where to turn, get in touch with the 988 Suicide & Crisis Lifeline. You can dial or text 988 to be put in touch with a trained counselor from the existing Suicide Prevention Lifeline network. These counselors are experienced in responding to people in emotional distress, including those with suicidal intent. If you are a veteran, you can use the existing Veterans Crisis Line. Dial 988 and then press "1" to reach the Veterans Crisis Line, or dial 1-800-273-8255 and press "1.” Counselors can help you chart your next steps with your health care team.

Mental health is an extremely important part of your overall health and well-being at any age, and discussing any concerns with your health care team can help point you to a correct diagnosis.

As is true in other aspects of your life, honesty is the best policy. Tell your health care team the entire truth about how your are feeling and what symptoms you are having. Knowing your symptoms and habits will help your doctor to understand your medical conditions fully and recommend the best treatment choices for you. It may not feel natural, at first, to have these conversations with your medical team, but prioritizing your mental health will also help your overall health as you age.

Sources

1. National Institute of Mental Health (NIMH). Older Adults and Mental Health. Found on the Internet at https://www.nimh.nih.gov/health/topics/older-adults-and-mental-health

2. Medicare Interactive. Outpatient Mental Health Care. Found on the Internet at https://www.medicareinteractive.org/get-answers/medicare-covered-services/mental-health-services/outpatient-mental-health-care