Eighty-four days after Alex Smith suffered a compound leg fracture that jeopardized his life, he was able to talk about football again.
The National Football League quarterback went to the Center for the Intrepid, a state-of-the-art rehabilitation facility in the Brooke Army Medical Center near San Antonio, Texas, where he met soldiers recovering from an amputation or a mangled limb.
Speaking with veterans, including one who underwent more than 25 surgeries after a roadside bomb tore through his leg while the soldier served in Iraq, allowed Smith to confront his injury for the first time.
"I remember just staring at his leg and asking him, 'How do you get there?' I'm so far from where you're at mentally," Smith said. "He said, 'You're going to get a point where you're proud of your leg.' On that same trip, the words came out of my mouth, 'I am going to play football again.' I was scared to death when I said it, but that community and connection with other people who had gone through similar things helped me in so many ways."
Integrating mental health into the physical treatment of traumatic injuries, life-threatening diagnoses and obstetrics represents the next step in mental healthcare. Many hospitals have added mental health screening and referrals into primary-care visits. But those efforts are still in their infancy.
Similar to traumatic injuries, cancer diagnoses weigh heavily on patients who deal with the mental toll long after treatment ends. But most of the focus is on the physical care.
Billions of dollars are spent each year on developing new breakthrough cancer drugs. But physicians aren't adequately trained in how to broach or address patients' mental health, said Dr. Manish Agrawal, cancer center director at Aquilino Cancer Center in Rockville, Maryland.
There was no formal training about how to handle telling a patient that their cancer is progressing and how a patient copes, he said.
"Mental health is perhaps the thing that determines someone's quality of life more than everything. But so much of people's care is left unaddressed," Agrawal said. "If you don't die, a cancer diagnosis brings psychological issues associated with brushing with death."