Mental Health Minute

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Achieving/Maintaining Good Mental Health

Can psychiatrists, psychologists or other mental healthcare workers read your mind?

No, absolutely not. Mental healthcare workers are regular people who have studied and trained to recognize symptoms people suffer from with mental health problems. They have learned to recognize the physical or emotional signs of mental health problems or unusual thought patterns. They do this by asking questions, looking at you and observing your mood, emotional state, thinking patterns and thought contents. With your permission, they may try to gather information by interviewing family or friends who know you, or ask you for school or workplace reports to try and pick up clues as to what’s going on. They are like detectives trying to figure out a puzzle which they are trained to solve. You can train to do this yourself if you’re willing to spend the time and have the ability. This is a skill it’s not magic. With experience, a mental health worker or professional can assess you relatively quickly and make it seem effortless, giving the impression they have read your mind. But don’t be scared. At no time can they read your mind to figure out what you are thinking. They’re there to help you. They do not have supernatural or telepathic mind reading abilities. Sometimes psychiatrists or psychologists joke that they wish they could read your mind because it would make their jobs a whole lot easier.

How can I get help without everyone knowing my problems?

Most mental healthcare providers follow ethical confidentiality rules so that when you go to see them and share your concerns they are obliged to keep them private. For physicians this is called doctor/patient confidentiality. Except in rare cases where a threat to safety of others is involved, they are not allowed to share any of the information they receive without your written consent. But ask and find out at the start of any visit to a mental health provider what their confidentiality guidelines are. Sometimes these rules are different. For example if you are being sent by your employer for an assessment or to a company doctor, nurse or counsellor, then you might be agreeing to let your employer or insurance company know the outcome of the visit. In this case you should be informed up front at the outset and provide your consent before you tell anyone your business. Most telephone hotlines, or emergency helplines are anonymous and you do not have to give your name to talk to someone. If you decide to go for help, it’s your choice whether you tell anyone. You don’t have to tell family, friends or co-workers why you have been off work or what you are being treated for. It’s your choice. One approach is to say that you have been away for medical reasons, or make up a white lie. You can say you have had a back problem or you are leaving work for some physiotherapy if it makes you feel more comfortable. No one else needs to know your personal business.

If people are still nosy then you can just repeat the same sentence as to why you’ve been off or where you’ve been. This is called the broken record (or broken CD) technique. Eventually others should back off and respect your privacy. But sharing what you are going through with trusted supportive others can be very helpful and help you feel less alone.

What will others think if they know my mental problems? Could I get fired?

Most mental health problems are bona fide medical illnesses. They are a valid reason to be excused from work, school or social engagements for medical reasons. Your fellow employees, boss, or teachers don’t need to know the exact details of your illness. You will probably be asked to provide a doctor’s note saying you need to be off work. If your terms of employment allow for appropriate sick leave then you should not be fired. Physical and mental health should be treated equally. If you feel you are being treated in an unfair or discriminatory manner try speaking to your human resources person, employee health provider, or insurance provider to try and clear up any misunderstandings. Ask a trusted and capable friend to help you navigate the necessary forms and paperwork. If you still can’t resolve things and feel you’ve been wronged then you may need to hire a lawyer to represent you. Once back working your coworkers or boss don’t need to know much more than you’ve had a medical problem. If people know you were suffering from a mental health problem then some might avoid you or treat you differently. This is out of fear or lack of understanding and knowledge about mental health. This can be trying and difficult. A good return to work plan can include preparing for others questions and reactions to you. With time people soon get back to treating you like normal. You might take the lead in talking to others about your illness. This makes it safer for them to ask how you are doing and gain understanding themselves. Don’t be surprised if suddenly others start confiding in you and telling you about their problems. Some jobs (e.g. pilots, military personnel, police) require perfect mental health as a precondition and ongoing requirement of employment. This is usually for public safety and to ensure you can cope with the demands of the job. With these types of work the employer will routinely send you for check ups and you must declare your mental health status. If mentally unwell you can be placed on reduced or alternate duties, sick leave, or terminated from employment when justified.

My loved one is not himself, I think they need some help but they refuse to talk about it or see someone.

Keep asking and keep offering help. It’s very common for people to avoid talking about their mental health. They mistakenly think it’s their fault, or a sign of weakness, embarrassed or are just plain scared. Providing information pamphlets, website addresses, helpline phone numbers or names of good health providers to educate them about where to get help or to better understand their problems is doing a lot for them. They may first need to recognize there is something wrong and that there is help available. Creating this awareness can be the first task. It might take them a while before they move from contemplating getting help to actually being prepared to do something about it. Suggest they talk to a neutral third party such as their healthcare provider or other trusted person. There might be things they do not want to share with you which are getting in the way of them talking to you or getting help. If they are very unwell and disturbed to the point that they are thinking of hurting themselves or someone else, then you need to speak to the appropriate authorities. Seek emergency assistance through a physician, justice of the peace, police or your local emergency response line (411 in some areas) to see what intervention will best help keep them and others safe.

Which is better, talk therapy or medications?

It depends on what type of talk therapy you’re talking about and for what condition. For example, in mild to moderate depression and anxiety disorders most studies show that talk therapy and medications do about the same with roughly equal chances of helping. For more moderate to severe disorders medications tend to be required and out-perform talk therapies. But the best outcomes are usually with a combination of the two. Sometimes medications are best at reducing symptoms while talk therapies and behavioural strategies might help change behaviour and get you back to full functioning and prevent further recurrences. Be very concerned if the healthcare provider you are seeing is exclusively a believer in one camp, either talk treatment or medication alone. They may be giving you biased or uninformed advice that prevents you from seeking out treatments that can improve your mental health and wellbeing. Educate yourself so you can make good personal health decisions.

Does using drugs and alcohol permanently damage your brain?

Not usually. The brain effects of most recreational drug and alcohol use or abuse is fully reversible on discontinuation of the drugs or alcohol. Most people’s brains remain entirely normal with no actual damage. But some drugs like cocaine or crack can permanently reset and lower the brain’s baseline chemical thermostat. Then when drug free the brain feels sluggish and craves the drug to get back to the previous thermostat levels just to feel normal. Coffee can do this to a mild degree but it’s reversible and after a few days off coffee the brain’s thermostat goes back to normal. In extreme cases of longstanding alcohol abuse some people get brain damage, develop cognitive thinking disorders or behavioural abnormalities even when sober. These need to be assessed medically to figure out the cause. Sometimes it’s a vitamin or nutrient deficiency caused by alcohol use or some other neurological or brain condition. Best to use responsibly. Don’t drink and drive. Don’t drug and drive.

Are antidepressants or anti-psychotic medications addictive?

No they are not. Despite popular belief these medications treat underlying conditions, reduce suffering and help people get back to their normal selves. They do not change your personality and do not turn you in to someone you are not. They do not control you and you do not get hooked on them. You don’t crave the drug or ruin your life trying to seek it out. In some cases regular use of an antidepressant can lead to physical tolerance and stopping them abruptly may cause symptoms. This is known as a discontinuation syndrome and can make you feel flu like, out of balance and dizzy, nausea, tingly, or weird. It’s not dangerous but very unpleasant Most physicians will have you gradually lower the dose of some antidepressants to avoid this syndrome. Be cautious who you believe when hearing stories about these medicines. There are some people who have a vested interest in irresponsibly misrepresenting the realities of these medications, or are just uninformed, and will lead you to believe they are addictive. Educate yourself. But medications like the Valium sedative family, some sleep agents, and stimulant medications can be habit forming or highly addictive and have to be used very properly and judiciously.

Aren’t mental health problems just a sign of weakness in people not trying hard enough to snap out of it?

No they are not a sign of weakness. This common misunderstanding can do great harm to people suffering from mental health conditions. Most problems are a result of a combination of factors including genetic and biological predisposition, stressful life events, difficult longstanding relationships or workplace problems. When a person’s heart is not working they get chest pain or shortness of breath. If their liver is not working they may get yellow skin or abdominal pain. And if a mental health disorder is affecting their brain they may have disturbances in their thoughts or their feelings. Blaming people for a mental health disorder is just not fair. Most people with mental health problems are trying extremely hard to keep their head above water and maintain some level of normalcy. They often suffer in silence and avoid telling anyone what they are going through and avoid treatment for fear of embarrassment and being stigmatized. It is important to give people who are suffering the permission and encouragement to seek help. Then they have the opportunity to find out what is going on so they can address their specific problem. Blaming or getting angry at them only worsens the problem.

Is stress bad for you?

Not always. A little bit of stress in our lives is actually a good thing. Our bodies and minds are made to cope with stress and respond to it. Sometimes it is the wake up call we need to get busy doing things. The stress of an upcoming test or examination gets us motivated to study for it. The stress of having to pay rent or a mortgage encourages us to go to work in the morning and not overspend. The threat of an upcoming bad weather storm gets us moving to stock up on supplies and find a safe place for shelter. Our bodies are wired to respond to life stress and have the “fight or flight” response to cope with emergencies. But when stress is ongoing, unremitting and intense it can wear us down and our emergency alert response systems will burn out and stop responding normally. At these times stress becomes very bad for us emotionally and physically. Signs of ongoing burnout and stress include constant fatigue, disturbed mood, trouble sleeping, being angry all the time or a change in the way you relate to other people at work or at home. Fortunately there are good coping strategies to deal with stress. Make the appropriate realistic changes that you can in your life to try to get stress back to a more manageable level. With today’s busy lives it is more important than ever to learn to recognize stress and to find out which coping strategies work best for you.

Are mental health problems just made up concerns of our modern western culture and society?

No, not for the most part. Most studies by the World Health Organization and other international health agencies demonstrate that rates of many mental health disorders are fairly constant throughout the world. Illness rates for schizophrenia and many mood disorders are fairly consistent throughout the world. Sometimes researchers find different illness rates in different countries. There are several theories on how to explain this. In many countries people are not aware of mental illness or are not allowed to discuss emotional distress. Subsequently they do not get identified or included in statistical survey because people with mental health problems disorders are not offered or brought into treatment. In smaller rural and third world communities mentally ill people are often blended in as part of the village or town culture. They are referred to as strange “Mr.So and so” and thought of as odd, loners, or have a specific role that accommodates their mental health limitations. In other cultures mental health manifests as physical problems or as forces in the spirit or energy world. These cultures regard mentally unwell persons as visionary prophets or possessed by spirits. Our increased awareness, diagnosis and treatment of mental health in modern western culture is in many ways a reflection of the advances in our understanding and our humane concern for people. It’s not the existence of mental health problems but where we draw the line that is more often up for debate.

Isn’t it normal to get down and depressed or worried and anxious if you have good reason?

Yes absolutely. Feeling sad, down or depressed from time to time is a normal human emotion that we all feel. Similarly, being worried, nervous or anxious at times is also normal. These are part of the range of emotions that makes us human. But when mental healthcare providers talk about depression or anxiety they are usually talking about something very different that they have unfortunately given the same name. Doctors will talk be referring to a major depressive episode or clinical depression, not regular sad feelings. A clinical depression is a disorder that requires the presence of a number of physical and emotional symptoms most days for at least two weeks. It is more than being sad that your football team lost the game. It’s different than normal grief after the loss of a job or a loved one. Most mental healthcare providers understand these differences and should help to figure out whether your depressed or anxious feelings are within the range of normal response and emotion or if your emotions and feelings represent something altogether different such as a clinical depression or clinical worry disorder.

How do I know if I am clinically depressed?

Having a clinical depression or major depressive episodes requires experiencing five of the following nine symptoms for at least two weeks in duration. The symptoms include depressed or irritable mood, sleep disturbance (either too much or too little), lack of interest or pleasure in routine activities, feelings of guilt or worthlessness, decrease in energy, difficulty concentrating or remembering things, appetite disturbance (too much or too little) , physical fidgetiness, edginess or tension, and thoughts of death or suicide. There are a number of self test checklists and questionnaires you can fill out to give yourself a score and see if you might be depressed. Also you can go speak to a trained and accredited healthcare provider or your family doctor to help figure out if your depression may be more than just normal sadness. Sometimes checking with people close to you to see if they have noticed a change in you can also be an important clue.

Is it normal to be angry all the time?

No. Ongoing anger most of the time is often a symptom of a mood disorder such as clinical depression, an anxiety or worry disorder or sometimes even mania as part of a Bipolar or Manic Depressive Disorder. In other cases it is a feature of ongoing substance use or abuse or sleep disturbance where your body just is not getting the rest and restorative time it needs. Medical problems like thyroid disorders or diabetes can also cause you to feel angry and irritable much of the time. Ongoing anger and rage might be a symptom of these types of problems. If not addressed these can get you in trouble with other people at work, in your social life and sometimes even with the law. But if you have been an angry person most of your life and are not suffering from one of these clinical disorders, then anger can be a feature of your personality. In this case anger might be linked to having being hurt in past relationships. As a result you may not trust others or go around with a grudge against everyone even though they’ve done nothing to you. It is important to figure out more about a constant state of anger and go talk to someone. You don’t want to be blaming everyone including friends because someone in your past might have been an enemy or because you might have a treatable condition. Worst of all, being angry all the time feels awful and won’t make you any friends.

If I am unhappy with my treatment, how do I file a complaint?

If you feel your provider has been acting inappropriately, contact their regulatory body to file a complaint. Each registered health profession has a regulatory body, usually their professional college or board. The role of these colleges is to protect the public. If you and your provider are just not a good match, ask them to recommend someone else. You can also return to your family doctor and ask them for another referral.

Are mental health treatments covered by my provincial healthcare plan?

Not all mental health services are covered my provincial healthcare plans. Before starting any treatment plan it is important that you ask how much this may cost you. Fees may also be covered through an extended health care plan or private insurance. (You may have a benefits plan through your work.) Speak to a community organization in your province to find out which treatments are covered and which are not.

If I get diagnosed with a mental illness, will I have it for the rest of my life?

Many mental illnesses are completely treatable. With the appropriate medication or therapy you may recovery entirely from your illness. Other illnesses may require long-term medication. Talk to your provider to find out more about your specific illness.

My best friend confided in me that they think they have a mental illness, but they told me not to tell anyone. What should I do?

Encourage your friend to speak to a medical professional, perhaps starting with their family doctor. Mental illnesses don’t just go away on their own, but an appropriate treatment plan can help your friend to return to their old self. Remind your friend that you are there for them and will support them during their recovery phase. Offer to go to seek help with your friend.

How can I make sure my family member is getting the best available treatment?

As a caregiver it is important to understand the treatment options which are available. During medical visits, ask questions and follow up with any leads or suggestions the care provider discusses with you. Treatment guidelines exist for every mental health disorder. Contact a local community agency for specific treatment information.

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