Friday, May 9, 2014

Putting the "Health" Back in "Mental Health"

You'd think with this week being Mental Health Week in Canada (and Mental Health Month south of the border), next week being Nurse's Week (this week being such in the US) and Sunday being Mother's Day, that I'd have no problems coming up with a post.  "Slam dunk" I thought to myself, since I'm a Mom of a very interesting brood and a Mental Health RN and know a surprising amount about each of these things... and more importantly know where to find the stuff I don't know.

But, no. It wasn't that easy.

The Mom part is pretty self explanatory, as it is the part that I write about the most.  I love my little urchins and all the little things that they do, even the stuff that turns my hair grey and when I find myself fantasizing about running off to join the circus.  Hey, I clean up after twins.  Elephants could be a piece of cake and probably make less noise.  Probably...

The Mental Health Nurse bits I should write about more, but don't as there are always things like confidentiality and certain legalities to consider.  I do have a unique perspective from my side of the glass as it were.  And there is glass... I work in an acute psychiatric emergency department.  Many of my patients are very unwell, or are on drugs, or both.  The glass is there for safety reasons.  Everyone's safety.  There are also restraints, both physical, chemical and environmental;  again, for everyone's safety, not just mine.  I also seem have a knack for the most difficult cases, and by knack, I mean they seem to seek me out.  One of our prominent psychiatrists was telling me to write a book about the fascinating people I have helped along the years and I may do that one day, in James Herriot style, switching this name for that and blending stories to protect the innocent.  But that time is not now.  Today is not the day and this is not the place to start.

The stigma of mental illness permeates everything I do, from the amount of health teaching that I do with my patients, their families and the general public, to the way that my colleagues in other specialties regard us MH folk.  I've had palliative nurses come to our floor in bunches to protect themselves as they borrow supplies or access drugs.  I've had medical nurses refuse to sit near us... at a nursing gala.  Although ER tends to be slightly better with these things, I still feel like Severus Snape swooping in when I help out or drop by to say hi.  It's like the air changes somehow; even police tend to take a step back.  It's an unspoken whisper:  The Mental Health Nurse is Here.  Of course it might help if I stop wearing all black, but I digress...  It's there.  I can't tell you how many times I've been in a social setting, meeting new people and the inevitable "what do you do?" comes up.  I usually say I'm a nurse, and sometimes it's just left there.  Most of the time tho', people want to know what kind of nurse I am.  I'm not sure what people are expecting me to say, but every time, you can watch the smile fade and see the involuntary step back when I say "Mental Health" (or if I feel particularly scary "Psychiatry").  We feel it, this difference, this prejudice, and it's only a fraction of what our patients feel.   It is annoying when you are well.  When you are depressed or psychotic... well, if you didn't already feel like dirt, being looked at like some sort of exotic bug will certainly put you there.

A lot of the inter-disciplinary stuff, I would imagine, comes from the same place as the stigma in the general public:  lack of knowledge.  We hear all the time that we would all "have to be crazy" to work with a mentally ill population, or it is wondered aloud if we have someone in our close family with a mental illness that would cause us to have a vested interest.  There is so much wrong with these notions that it is difficult to know where to start, but here are some fast statistics from the Canadian Mental Health Association:

  • Mental illness indirectly affects all Canadians at some time through a family member, friend or colleague.
  • 20% of Canadians will personally experience a mental illness in their lifetime.
  • Mental illness affects people of all ages, educational and income levels, and cultures.
  • Approximately 8% of adults will experience major depression at some time in their lives.
  • About 1% of Canadians will experience bipolar disorder (or “manic depression”)
  • Schizophrenia affects 1% of the Canadian population.
  • Anxiety disorders affect 5% of the household population, causing mild to severe impairment.
  • Suicide accounts for 24% of all deaths among 15-24 year olds and 16% among 25-44 year olds.
  • Suicide is one of the leading causes of death in both men and women from adolescence to middle age.
  • The mortality rate due to suicide among men is four times the rate among women. 
  • It is estimated that 10-20% of Canadian youth are affected by a mental illness or disorder – the single most disabling group of disorders worldwide.
  • Today, approximately 5% of male youth and 12% of female youth, age 12 to 19, have experienced a major depressive episode.
  • The total number of 12-19 year olds in Canada at risk for developing depression is a staggering 3.2 million.
  • Mental illness is increasingly threatening the lives of our children; with Canada’s youth suicide rate the third highest in the industrialized world.
  • Suicide is among the leading causes of death in 15-24 year old Canadians, second only to accidents; 4,000 people die prematurely each year by suicide.
  • Schizophrenia is youth’s greatest disabler as it strikes most often in the 16 to 30 year age group, affecting an estimated one person in 100. 
  • Surpassed only by injuries, mental disorders in youth are ranked as the second highest hospital care expenditure in Canada. 
  • In 1999, 3.8% of all admissions in general hospitals (1.5 million hospital days) were due to anxiety disorders, bipolar disorders, schizophrenia, major depression, personality disorders, eating disorders and suicidal behavior.Sources: The Report on Mental Illness in Canada, October 2002. EBIC 1998 (Health Canada 2002), Stephens et al., 2001
  • The economic cost of mental illnesses in Canada for the health care system was estimated to be at least $7.9 billion in 1998 – $4.7 billion in care, and $3.2 billion in disability and early death.
  • An additional $6.3 billion was spent on uninsured mental health services and time off work for depression and distress that was not treated by the health care system.
(Courtesy of  "Fast Facts about Mental Illness." Canadian Mental Health Association.) 

No where does it say "of mental health staff only" or "of families with established patterns of mental illness".  Everyone is affected.  Let me say this again:  Everyone is or will be affected at some point in their lives.  That means everyone from shopkeepers to bank tellers to police officers to EMS to lawyers to construction workers to even social workers, psychologists, doctors and nurses.  Everyone. 

  • Almost one half (49%) of those who feel they have suffered from depression or anxiety have never gone to see a doctor about this problem.
  • Stigma or discrimination attached to mental illnesses presents a serious barrier, not only to diagnosis and treatment but also to acceptance in the community.
  •  In Canada, only 1 out of 5 children who need mental health services receives them.
(Courtesy of  "Fast Facts about Mental Illness." Canadian Mental Health Association.)

 Even though:
  • Mental illnesses can be treated effectively. 
  • Once depression is recognized, help can make a difference for 80% of people who are affected, allowing them to get back to their regular activities.
(Courtesy of  "Fast Facts about Mental Illness." Canadian Mental Health Association.)

And, I'm not kidding.  Just like any other illness, mental illnesses can be treated very successfully and in some cases, resolve.

But, you need treatment.  Which means you need to go and get it.

There have been a lot of inroads lately that I am pleased to see.  Something as complex as Post Traumatic Stress Disorder (PTSD) has received a great deal of both awareness AND acceptance in certain communities.  I added the last bit as I don't think there would be many people that would bat an eye if a soldier or a police officer or an EMS or a survivor of physical violence, rape, war or accident came forward to talk about their experiences.  But, there are other groups that are at risk as well;  I have spoken before of parents whose children have required a NICU stay, for example.  Healthcare workers are also at high risk for PTSD, those very doctors and nurses that are treating people for their symptoms do often have them themselves.  This story:  Physician Suicide Letters was passed along to me by a physician friend and talks about some common experiences.  Numerous studies have been done on the prevalence of PTSD and burnout syndrome in nurses, especially in acute and critical care areas. 

So, this Mother's Day, I want you to not only appreciate those who gave us life.  I want you to also appreciate those Mothers who are caring for your loved ones.  I also want you to pay particular attention to those of us in Mental Health, who would rather spend our time providing mental and spiritual comfort to those who need it.  I also want you to think of the 49% of the population, many of which are mothers, that do not seek help due to stigma.  I also want you to think of the Nurses and health care workers that are experiencing mental health issues yet are even more fearful of seeking treatment as we are supposed to be tough and know everything and set an example.

No one needs to feel that they are suffering alone.  Tell somebody.  Help often comes in the most surprising of places... and if it doesn't, well, a little spring cleaning of the friends list may be in order as well.  If you need to seek medical attention, please do so.  If you are at risk of harming yourself or others, go.  Now.  It is not a contest, as mental illnesses, just like any other illness, are subjective.  Just because you don't "have it as bad as..." or "feel as bad as..." doesn't mean it is not impacting your life.  Go.  Now.

This Mental Health Nurse did.  This Mother did... and is glad of it.   She did that for the little urchins that she mentioned earlier.  Because seeking help when you need it (and not being ashamed about it) is a better example to set for them and everyone else, don't you think?

Happy Mental Health Week.  Happy Nurse's Week.  Happy Mother's Day.  For me at least, thankfully, they will be just that.  I hope they are for you as well.

1 comment :

  1. Thank you for speaking frankly about this.

    I truly wish help would be more easily available to those who desperate;y need it. And I wish they'd seek it, I do.


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