What is B4Stage4 (Before Stage 4)?


Tom Starling, Ed.D.


April 24, 2020

When we think about cancer, heart disease, or diabetes, we don’t wait years to treat them. We start way before Stage 4. We begin with prevention in elementary school by stressing the importance of health, nutrition, and exercise. When people are in the first stages of those diseases with a persistent cough, high blood pressure, or high blood sugar, we move from prevention to early intervention. That is, we immediately try to reverse these initial symptoms.

This is what we should be doing when people have a mental health issue, too. We should begin with regular screenings, just like receiving immunizations and physicals before school or before playing sports. (In fact, half of all lifetime mental illnesses begin by age 14, so we should insist on screening children and youth.) Then, we should immediately act when people first begin to experience symptoms such as loss of sleep, feeling tired for no reason, consistently feeling low or feeling anxious, or hearing voices.

These early symptoms might not ever become serious. Like a cough, they often go away on their own, and are nothing to fear. Unfortunately, when they do not go away, research studies show it typically takes ten years from the time they first appear until someone gets a correct diagnosis and proper treatment. That’s ten years lost to depression, anxiety, psychosis, or something similar.

It’s important to act before stage 4 (B4Stage4)! During the years of initial symptoms, most people still have supports that allow them to succeed - home, family, friends, school, and work. People can often recover quickly, and live full and productive lives.

Even when we don’t intervene right away, and even when mental health declines and disrupts our lives, we can still act effectively. We can offer people choices and supports to help them recover. These include clinical services, drugs, peer supports, counseling, family supports, and alternative therapies that also help them manage their thoughts and emotions. Together, these all help to keep people connected to their families and their community. (Research shows that “connectedness” is a huge protective factor to sustain good mental health.) Intervening as early as possible preserves opportunities for education, employment, social supports, housing – and brain power! It also costs less than the all-too-common revolving door of incarceration, hospitalization, and homelessness, which are stage 4 indicators.

What’s the biggest barrier to getting help B4Stage4? Despite improved therapies and treatments, people choose to suffer in silence because of the stigma associated with mental health. People feel they are defective, “less than,” or “crazy,” if they choose to get help. They might attribute their situation to having sin in their lives, being raised wrong, or having weak character that can be self-corrected. This stigma doesn’t exist with cancer, heart disease, or diabetes. Having any disease or illness is not one’s fault, and the B4Stage4 philosophy encourages us to act now, be strong, get help, and start living the fulfilled and healthy life we were intended to lead.
Act B4Stage4!

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