Supporting a friend with mental illness

Some of the most common concerns teen patients have when discussing going back to school and reconnecting with their friends are often surrounded around their social relationships. Things such as, what will my friends think? What will my friends say? What will my friends do?

In our clinical service, we spend a lot of time helping young people determine the best way to mention their living with a mental illness to their friends, teachers and other social networks. As much as we try to help, the transition can sometimes not go as smooth as planned. Sometimes friends won’t fully understand.

One thing that we often tend to not pay enough attention to is helping people understand what they can do to be supportive. It now occurs to me that some of the people we complained about not being helpful and supportive may actually have wanted to be, but didn’t know how. 

Maybe it wasn't always the friends avoidance or apprehensive behaviour that was the result of stigma. Maybe some of that could be been due to awkwardness and not knowing what to say or do – something like what happens when you go to a funeral.  You know, what do you say to someone who has just lost a parent?  It’s never easy.

So, maybe it’s the same thing when supporting a friend who has a mental illness.  What do you say? What should you do?  It’s not always easy.

The recent edition of Moods Magazine has an article that can help people who have a friend living with a mental disorder.  It’s called, “Ten ways you can support a friend with a mental illness”.  For example, here’s the list of ten – in the order they appear in the article, not necessarily in order of importance.

1. Get in touch with your friends
2. Understand that its not your fault, in fact it’s no one’s fault
3. Don’t task yourself with changing your friend
4. Listen, listen, listen!
5. Get our of the house
6. Put yourself first
7. Be positive
8. Be a resource
9. Be respectful
10. A list of web resources is provided in the article

So there you have it.  A few practical and helpful hints on how you can help be more supportive to your friend or loved ones.  Give them a try and create some of your own.

-Stan

Mental health and back to school

Over the past week, I've had conversations with people who have this idea that upon a young person’s return to school, it can cause mental health problems – due to the increase in stress. We've seen this scenario discussed in the paper, in the news and on the radio this past month. Friends have told me that some schools are getting ready to deal with a “tsunami” of counseling needs when students return.  

A parent recently raised (to me) the implausible specter of creating a support group for junior high students to help them go back to school successfully. If Chicken Little were around, she would say that going back to school is causing the sky to fall.

Why is it that we’re beginning to think like this? Like there is this need to make normal like, pathological. Why are we beginning to merge positive stress (leads to improved performance and positive adaptation) with negative stress (leads to poor outcomes and leads to non-adaptation)? Why is it that we seem to continue to think that everyday stress leads to mental illness?

Is going back to school a stressor for young people? Of course it is, but so is getting up in the morning!  This does not mean that going back to school is a bad thing or something that will lead to a disaster.  What happened to the view that going back to school was a positive thing? For most young people, school is an exciting step in the journey of life.  Going back to school should cause anticipation, enjoyment and be fun – even in the presence of some “butterflies”.

The reality is that going back to school is a regular and expected part of normal life. The anxieties that most young people feel are appropriate and signaling that adaptation will need to happen.  And most already know exactly how to adapt –buy some new books and pencils, get a new school bag, link up with their friends, ride their bikes to the school yard and have a look.

Sure, there will be some who will have difficulty with that transition. Either because they may have a mental disorder or because the transition is greater than their adaptive capacity, they may struggle. Schools need to prepare for these students, while at the same time – not buy into the hype that the usual positive stress of going back to school can cause mental health problems.

So here we have it – going back to school is something that most look forward to. As parents and educators, we need to take a deep breath and stop focusing on the negative and start focusing on the positive. Don’t put your head in the sand because their will always be some young people who need help - but don’t make a mountain out of a molehill. Let’s stop this tendency to create pathology out of normal, everyday experience.  We help our youth become resilient by facing and successfully adapting to life stresses - not by seeking to protect them from it.

-Stan

Depression in young people can lead to early death

While we have know for many years about the varied negative impacts that clinical Depression can have on the lives of young people (including its negative long term impacts on personal, social and economic outcomes and increased risk for suicide), some new research is showing that it may also shorten life – specifically by increasing the risk of dying earlier from physical illnesses.  In a recent study published in the Annals of Epidemiology (July 26, 2012) both males and females who had experienced an episode of Depression in their youth had much higher rates of early death from physical causes than those who had not.  Death due to heart disease was mostly to blame!

Unfortunately, I could not determine from the study if this included young people who had been successfully treated for their illness or not.  This of course is an important issue, as early and successful treatment of Depression may change the long-term outcomes for those who have experienced it.  It will be good to know if this also applies to early death from heart disease.

In any case, this information is very important to have.  For too long we have thought that the brain and the body are separate.  They are clearly are not!  The brain has a substantial and ongoing impact on all aspects of body function and vice versa.  The old Latin saying “mens sana in corpore sano” holds. Meaning "healthy mind in a healthy body" (or something like that - its been over 45 years since I took Latin in high school and was not so good at it then). Check it out the full meaning here.

So, let’s do whatever we can to help our brains get healthy and stay healthy.  That means eating properly, exercising vigorously and getting enough sleep.  It means moderate and parsimonious use of alcohol and avoiding substances that can cause brain damage.  It means taking the appropriate precautions to help decrease the risk of head injury.

If we do all that, can we be sure that Depression will not darken our doorstep?  Unfortunately not, but if Depression happens we need to make sure we recognize it early and get the best evidence supported help that we can, as soon as we can.  Overall, not dying early from having a heart attack is a good thing, don’t you think?

--Stan

Exercise as a treatment for Depression: Hot idea or hot air?

It is very fashionable to include exercise as a complementary treatment in Depression.  In fact there are many studies that show that exercise has positive impacts on the brain.  And, in such as way as to possibly help improve depressive symptoms.  In addition, there are lots of studies that show a positive effect of exercise on depressive symptoms and even some systematic reviews that suggest exercise is a good addition to the usual treatment of Depression.  So there we have it – or do we?

A recent excellent research study reported in the British Medical Journal (2012: June 6) suggests that some of our enthusiasm may have been a bit over-extended.

This was a randomized controlled trial in over 350 adults with depression treated in primary care in the UK.  Everyone got the usual care but half received additional exercise coaching to encourage exercise in addition to their usual care.  The exercise group did show much more exercise (that is a good thing) than the treatment as usual group.  However there was no difference in any outcome measure of depression or its treatment over a period of one year!  Ouch!

Now, what does this mean?  Well, like any study this one was not perfect and the participants in the exercise group did not all achieve the recommended 150 minutes of vigorous exercise per week (at 30 minute per day aliquots).  So there may be been a dosing problem – not enough of a dose of exercise.  Or it may mean that exercise may be helpful for mild depressive symptoms – for psychological distress, but not for clinical depression.  Or, it may mean that the model used (an exercise coaching model) is not the best one by which to help people with Depression get the exercise that they need to help them get better faster or to a greater extent.  Or it may mean other things, too many to list.

So, does this mean we should not exercise to help us feel better?  Totally not!  Does this support using exercise as an alternative treatment for best evidence based care for Depression?  Totally not!  Should we keep suggesting patients exercise?  Totally yes – there are lots of other health benefits to exercise as we know.  Should we engage in more systematic study of this before we write the final chapter?  For sure we should!.

Oh well.  Enough reading about research and writing a blog.  I am off to walk quickly for 30 minutes followed by a nice relaxing summer drink.  It’s hot outside!

-- Stan

School Mental Health: Teachers perspectives and what to do

A new study just reported in the Canadian Teachers Federation publication gives us some sobering information about what teachers think about mental health in young people and their ability to address that in the school setting.

As we would expect, teachers overwhelmingly reported that they think addressing mental health needs of students is very important and that poor mental health leads to many negative outcomes, including poor academic achievement.  But, there is much more!

About half the teachers surveyed (there were almost 4000 of them), noted that at least 10% of their students needed mental health services but were not receiving them.  They also identified a number of barriers to access of these needed services.  Here is what over 80% of them said: lack of staff training about mental health/mental illness; lack of school based mental health services; lack of community based mental health care providers.  Seventy percent also identified that stigma was a barrier.

About two-thirds of teachers had not received professional development on mental health, especially those who had been teaching for five years or less!  Ninety-seven percent of teachers wanted training in mental health.  I assume it was training that was relevant to their work.

So, what are we to make of this information?

First, it is not new news.  But it is really good to have it so well quantified, and kudos to the Mental Health Commission of Canada for funding the study.

Second, it is essential that addressing school mental health include training of teachers be widely available.  However we need to make sure that this is not done through one-off PD days or brainless general courses but in best evidence based and contextualized training programs that fit and make sense in the educational setting.  This is where some of our unique and validated work comes in – through the Mental Health Curriculum Guide and its related training programs we can ensure that teachers get the mental health literacy that they need and that this is provided in a sustainable and cost effective manner.  The models of Nova Scotia and the Ontario Shores lead initiative in Ontario are good examples of how to do this well.

Third, we need to ensure that schools are seamlessly linked to health systems that can offer mental health care to young people.  This means building the capacity for identification and interventions in the school itself as well as enhancement of primary care competencies in diagnosis and treatment.  We have the training programs and tools to do this.  In British Columbia, the Practice Support Program of the BCMA is doing excellent work in this regard. 

So, we know what the problem is.  We know what to do about it.  No excuses any more!

--Stan

Having courage: Talking to our kids

The instinct to protect our children from harmful ideas or influences is strong. Unfortunately, this parental instinct combined with cultural stigma about mental illness can create a perfect storm of silence around issues of suicide, depression and self-harm. In Canada approximately 500 youth between the ages of 15 and 24 years die by suicide. Suicide is not, in itself a mental disorder, but it is often the tragic result of untreated mental illness or disorder. Globally, suicide is among the top three causes of death for young people.Suicide is often the result of a complex set of factors. Not all young people who die by suicide have a mental illness or disorder.

For a parent, the very thought of losing a child in this way is excruciating. We pretend suicide doesn’t happen. Often families who have lost someone to suicide will keep the cause of death a secret. It is as if somewhere between the pressures of stigma and a fear of being responsible for ‘introducing’ the idea into someone else’s head, we become paralyzed. Suicide must be talked about in responsible ways, without the sensationalism that is often offered in the media. If a suicide happens at your child’s school or in the community, you must find a way to discuss this with your children. If we behave as if we are embarrassed or fearful, we shut down important lines of communication. If we send them the message that the topic is taboo, they may feel ashamed to come to us when they need our help.

Kids need to know that at some point in their life they are going to have really bad feelings. Sometimes these bad feelings may come as a result of something that happens, or sometimes because our brains, like our tummies, can get sick. They need to know that if they are scared and feeling hopeless, that they can talk to us. If they are too scared to talk to us, then there are people they can call such as Kids Help Phone. They need to know that if they have a friend who is feeling hopeless, a friend they are worried about, that adults are here to assist them to find the best possible help. They need to know that there is no shame in getting help, and no shame in finding professional help for a friend they are worried about. If a friend is talking about suicide, whether in person or on the internet, then it needs to be taken seriously and trusted adults need to be notified.

Despite our best efforts to reach out, children and teens often lead private lives. Whether it is through a secret facebook or formspring account, or use of a chat room on the family computer when we are not home, they may be exposed to influences or ideas that may worry us. That is why it is extremely important to keep resources such as the Kids Help Phone on the family fridge or message board so they have a place to go for help if they have stumbled upon something they are afraid to share with us.

Talking about suicide is no easy task. If you find yourself in a situation where your child is asking questions or is aware of a suicide in the community, rest easy knowing that there are resources out there if we feel like we are ‘in over our heads’ with the tough questions.  For more information please visit: Suicideinfo.ca or TeenMentalHealth.org . Kids Help Phone may be reached at: 1.800.668.6868.

--Ardath and Stan

Pay attention to your diet when you are depressed

One of the clinical symptoms of Major Depressive Disorder is loss of appetite.  Sometimes the appetite loss is so extreme that people loose significant amounts of weight.  A key feature of the loss of appetite is that food becomes less appealing, less tasty and therefore less of a motivator to eat.  For some teens who experience Major Depressive Disorder they even can’t be bothered eating their favorite foods, such as pizza or chicken wings.  However, one thing that we do not know very much about is whether this loss of appetite has an effect on nutrition. 

A recent study (Davidson and Kaplan, BMC Psychiatry, 2012) evaluated the nutritional status of self-reported diets in people who were Depressed.  The results showed some interesting differences compared to existing population information about diet.  People suffering from depression ate significantly fewer amounts of: grains, vegetables and fruit and some macronutrients.  They also ate significantly larger amounts of: processed meats; sugar; fat; salt. 

So what does this mean?  Actually I do not really know.  It likely does not mean that the diet caused or is perpetuating the Depression.  Is the diet helping the Depression?  That we can also not answer.  Does this mean that people who are experiencing a Depression should pay extra attention to their nutrition?  That seems to me to be a reasonable thing to do.

-Stan