Self-Care in the Mental Health World

             Today I would like to revisit self-care. I wrote about it last June (Self-Care Ideas for When You Are Struggling with Depression) but I think it is worth revisiting. At its very core self-care is doing things to take care of yourself. We all need to take care of ourselves. Unfortunately, in the hustle and bustle of life, caring for ourselves often gets lost. Self- care is important for everyone. Today I would like to focus on two groups of people. First, individuals with depression and other mental illnesses. Second, I will address the need for mental healthcare professionals to ensure that they are engaging in self-care.

According to the National Institute of Mental Health, “self-care means taking the time to do things that help you live well and improve both your physical health and mental health.” On the surface this seems like a simple task, but for many of us it is difficult to prioritize self-care. Living with mental illness can make engaging in self-care even more difficult. The depression tells us not to get out of bed. It tells us that self-care is not worth the energy it requires. Depression and other mental illnesses tell us that we are not going to get better even if we engage in self-care activities. We are up against a mountain of reasons not to take care of ourselves. But mental illness is a liar. If we can just get ourselves to start, we would find that we will do so much better. 

What does self-care include? Really there are no limits to what can be considered self-care. It depends on the individual. In general, self-care includes getting enough sleep, but not too much, regular exercise, eating healthily, engaging in relaxing activities, setting goals and priorities, thinking positively, and staying connected. Sounds easy, right? I wish it was. When you struggle with mental illness, these basic routines can become difficult. Try focusing on one to start with. 

There are times when I can only focus on one aspect of self-care. Those are the times when my depression is bad. At these times I need to pick one self-care routine to focus on. Maybe it is exercising regularly. For me that looks like taking walks several times a week. It can be difficult to drag myself onto the sidewalk when I am feeling down. I need to remind myself that I will feel better, even if only slightly, afterwards. This helps me get my feet going. I have found that linking exercise with goalsetting helps me. So, I use the notes app on my phone to track how many times I walk each week. This allows me to see that I am really doing it, which builds my self-esteem. That in turn helps lift my depression.

Self-care is important when you live with mental illness. It helps you climb out of the pit that so often we fall into. It allows us to feel positives. Sleep, healthy eating habits, exercise, and regular engagement are all things that can help us when we are struggling. Start small. Don’t pressure yourself to jump in and do everything. That is likely to result in failure. Starting small allows us to see the positives and experience the successes. Whatever self-care looks like to you, make an effort to do it for your mental health. 

What about mental healthcare professionals? Why is self-care so important for these individuals? According to an article by Posluns and Gall, there is a prevalence of stress, burnout, and professional impairment among mental healthcare professionals. These authors found that self-care is important for mental healthcare professionals. Think about it. Psychiatrists, psychologists, and therapists (and other mental healthcare professionals) work with people who are often struggling. They see people at their lowest and help them cope with or overcome their mental illnesses. These professionals see a lot of struggle. They are expected to express caring in a relationship where the client is often not capable, or at least not expected to, return that care. That can take a toll on someone. 

According to Posluns and Gall a mental health practitioner must be well themselves in order to provide care to patients/clients. This obviously requires engaging in self-care. Posluns and Gall cite the Canadian Code of Ethics for Psychologists, which states that psychologists should “engage in self-care activities that help to avoid conditions (e.g., burnout, addictions) that could result in impaired judgment and interfere with their ability to benefit and not harm others”.

The same guidelines I provided above for self-care apply to mental healthcare professionals. Self-care may look different for mental healthcare professionals because they are not dealing with the difficulties of mental illness. The important thing is that the professional carves out time in their day for themselves. They need to make an active attempt to engage in self-care. Likely they are encouraging their patients/clients to engage in self-care. The mental healthcare professional needs to lead by example. This doesn’t mean they need to share what they are doing with their patients. The fact that they are engaging in self-care will be evident from their overall well-being and lack of burnout. 

Self-care is part of healthy living for everyone. People with mental illness may need more support to engage in self-care. We can all take small steps to improve our lives through self-care. Take a moment to examine what you are doing. Can you take a step to engage in a self-care activity?  If you are already engaging in self-care activities, can you add to what you are already doing? 

We are all worthy of care. It starts with us. We need to take steps to care for ourselves. That is how we all can become healthier. 

For tips on self-care activities see my previous post, (Self-Care Ideas for When You Are Struggling with Depression).

 

Source: Posluns, K., & Gall, T. L. (2020). Dear Mental Health Practitioners, Take Care of Yourselves: a Literature Review on Self-Care. International journal for the advancement of counseling, 42(1), 1–20. https://doi.org/10.1007/s10447-019-09382-w

 

 

                  

A Winding Road

                  Struggling with depression is difficult. I have been through a rough section of the road that is depression recently. Often during the last few weeks, I have found myself headed downhill. At times I have been stuck in the road. I have not known where to turn. The GPS in my head has been confused about which way to turn and how to find my way back to my baseline mood. This is depression.

                  I think a road is an apt description because with depression we are often in different places. The darkness feels different depending on our mental location. I have lived with this monster for almost 40 years now. Despite the length of time I have known depression, it still has the ability to sneak up on me and the ability to confuse me. At times I don’t know where the depression is taking me. I know I am in the darkness, and I still frequently find myself on unfamiliar roads. 

                  Right now I know I am headed towards healing, but still I struggle. It takes time and patience to get through a depressive episode. When I don’t know where to turn or where I am headed, I need maps. I need to be able to rely on an outside guide to lead me through darkened roads. Luckily, as I have mentioned many times, I have a mental health team to support me through the depression. They talk to me; give me advice. Their support provides a map to guide me on my road to healing. Even with their help, it takes time to maneuver along the winding road of depression. Despite this, a part of me knows I will make it. That is what keeps me going.

                  Depression is a road. We are never in one place for long. Our tires may get stuck in a muddy patch, but we eventually move on if we don’t give up. Sometimes we need a psychiatrist, psychologist, or therapist to give us a push in the right direction. That is okay. It is the reason they are there for us. 

                  For me the last few weeks have been a struggle and there have been moments when I wondered if I would find the right road. I wondered if the depression was too much this time. Fortunately, I know from experience that I will get through these times. Actually, I’m not sure “fortunately” is the right word. I wish I had never been through those times, but they are my reality. I have gotten through them. I am still on the road. I am still traveling toward healing. The road of depression is difficult. It is part of an illness that tries to tear us down. I know I am not on the road I need to be on yet, but I am nearing it. With a little help, I will make the correct turn and head toward the light. My wish is that if you find yourself lost in depression that you will reach out to mental health care professionals and allow them to direct you onto the right road. 

 

Finding the Right Psychiatrist for You

                  Last July I wrote about finding the right therapist.  As I was going through my posts a question entered my mind. How do you find the right psychiatrist?  I have had a few psychiatrists over the years.  It took a long time to find the right one. I spent a lot of time seeing psychiatrists that were not the right fit for me.  This is not to say they were not good at their profession.  I just did not click the right way with them.  

I spent over ten years with one of those wrong psychiatrists.  That shows It can be difficult to build a true psychiatrist/patient relationship.  It took a primary care physician’s assistant to show me how fractured the relationship with my psychiatrist at that time was.  I am sure this psychiatrist was good for many of her patients. Unfortunately, she either didn’t see what I needed, or she overlooked it to remain in her comfort zone.

I am sure I could do a Google search for what to look for in a good psychiatrist. You could to.  I think it is more important to speak from my own experience. As many of you know I have lived with depression and anxiety since I was a young teenager.  That is over about 37 years of living with mental illness.  During that time my illness has presented itself in ways that have needed the care of a psychiatrist.  I actually didn’t see a psychiatrist until I was well into my 20s.  Before that I either dealt with it on my own or therapists and general practitioners provided my care.  

I didn’t feel comfortable with my first psychiatrist, but she connected me with the psychologist who has guided me through therapy since.  I am grateful for that. Other psychiatrists were what I would refer to as pill-pushers.  The answer to every issue my mental illness created was a new pill or an increased dosage of one I was already taking.  This didn’t work for me. 

Good psychiatrists listen to patients before writing prescriptions.  Throwing medication at a mental illness without listening to the patient is not good practice.  I have had psychiatrists who would start writing on their prescription pad or pharmacy app before I had even taken a seat. That is not good practice.  In my case it resulted in me becoming overmedicated and addicted to one medication.  That psychiatrist never even noticed.  

I am not saying that medication is not an important part of the treatment of mental illness.  I just believe that medications that are prescribe must serve to heal the patient and help that patient live with the illness.  All patients deserve time from their provider.  The best psychiatrists understand this.  They treat their patients with respect and empathy.  There should be clear, open conversations about medications that include the purpose of the medication, how it works, and what the benefits and side effects are.  

I believe a psychiatrist needs to have a conversation with the patient in order to know the right medication to prescribe.  As I look back on my experience with one of my former psychiatrists I wonder if she was just prescribing whatever pharmaceutical reps brought to her that week.  She would prescribe a new medication before I even said how I was feeling or what I was experiencing.  

I had another psychiatrist who wouldn’t even look up at me.  I would walk in, and he would say, “what do you need refilled?” Then would say he’d see me in month.  Appointment over and I hadn’t said a word. I hope he was an extreme case.  

Sometimes I think I should have known better.  Neither one of these psychiatrists were good for me.  I need to know why I am taking a medication.  I need my psychiatrist to know what I am experiencing because of my mental illness.  I need to be heard.  I need a psychiatrist who understands medications don’t really work for me.  Luckily, several years ago, I found that psychiatrist.  Finding her was life changing.  I am in better place with my mental illness than I have ever been.  That doesn’t mean I am healed or beyond my mental illness.  I still battle depression and anxiety, but I have a psychiatrist who listens to me and understands what works for me as an individual.  

Here are some traits that I believe make a great psychiatrist.  Here’s a short list:

 

·      Listens first.

·      Doesn’t jump to the prescription pad.

·      Asks questions about how mental illness is affecting the person.

·      Engages in conversation with eye contact.

·      Includes the patient in the treatment plan.

·      Shows genuine interest in the patient and their healing.

·      Remembers previous conversations and follows up.

 

These are just some of the qualities that make a psychiatrist great.  As I said I could

have searched for these traits on Google.  I didn’t need to.  I described my psychiatrist.  After years of floundering with the wrong psychiatrists, I am now with a psychiatrist who sees me for who I am. She understands me and treats me with respect.  Her support has allowed me to grow even though I live with mental illness.  She supports my efforts to heal.  I think she has read every one of my blog posts, which encourages me to keep writing even when my blog isn’t getting the number of readers I want.

As a patient it is important to feel comfortable with your psychiatrist.  It is just as important to be confident in your psychiatrist.  There must be trust.  I trust my psychiatrist to make the right decisions for me because I know she is valuing my input on those decisions.  

A great psychiatrist also is able work as part of a team.  When it was time for me to try transcranial magnetic stimulation (TMS) and when I tried ketamine treatment, my psychiatrist welcomed the providers who oversee that treatment.  This gives me a team overseeing my mental health.  Likewise, when I was diagnosed with cancer, my psychiatrist spoke with my oncologist so that they were on the same page with understanding how my mental health affected my physical health.  A great psychiatrist is willing to be a part of a team. 

You may wonder where I found my psychiatrist.  I found her name on the list provided by my health insurance company of psychiatrists in their network. I scanned the names and marked a few whose names jumped out at me.  Then I looked for those psychiatrists on-line.  Something about the description of my psychiatrist jumped out at me.  I couldn’t tell you what that was because it was just a sense I had.  I picked up the phone and asked if she was taking on new patients.  Luckily, for me, she was. I felt comfortable from appointment one. Several years later, I am doing my best as I live with depression and anxiety.  Having the right psychiatrist makes a difference.

If you are seeing a psychiatrist, I would encourage you to evaluate your relationship with that person.  If there are things you would like changed, voice your concerns.  You may find that is not enough.  In that case, start looking for someone who will meet your needs.  It takes effort.  Sadly, that is difficult when you live with mental illness, but it can be done.  Consider asking a loved one or friend for help.  Ask your therapist or primary care provider to recommend someone.  Remember you are worthy of having a psychiatrist who meets your needs and who sees you as a whole person. Those psychiatrists are out there.  

 

 

 

 

                  

Different Types of Mental Health Professionals

                  When you are first looking for help with a mental health disorder, the number of different mental health professionals can be confusing.  In today’s post I will try to make sense of some of the options.  I am not a mental health professional.  By no means is this list meant to be authoritative or exhaustive.  I am a person with lived mental illness experience who has seen several professionals about my illness.  My intent in sharing this information is to provide assistance to those trying to navigate the mental health system.  It can be an overwhelming process especially when a person is struggling.

                  You may need more than one of these professionals.  I have a team that includes four members.  That is not always necessary.  From my personal perspective, each member of my mental health team adds to my treatment and healing and are instrumental.  I believe a team approach is beneficial to living with mental illness. 

                  Let’s look at some different mental health professionals.

Psychiatrist

                  A psychiatrist is a licensed medical doctor.  They are either an MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine).  Psychiatrists have completed a residency training in psychiatry.  They address both the mental and physical aspects of mental illness.  Psychiatrists diagnose mental health conditions.  Once they have diagnosed a patient, psychiatrists prescribe and monitor medication.  They also can provide therapy.  Psychiatrist can also prescribe alternative treatments for mental illnesses including transcranial magnetic stimulation (TMS), ketamine, and electric convulsive treatment (ECT).  

 

Psychologist

                  A psychologist has a doctorate degree in clinical psychology.  This can be a Ph.D. or a Psy.D.  They are licensed by their state.  Psychologists evaluate a person’s mental health.  They use clinical interviews, psychological evaluations, and tests.  A psychologist uses the information they gain from these tools to make a diagnosis.  They provide individual and group therapy.  Psychologist often use psychotherapy (talk therapy) with patients.  Some types of therapy used by psychologists include cognitive behavioral therapy (CBT), dialectal behavior therapy (DBT), interpersonal therapy, humanistic therapy, and psychodynamic therapy. 

 

Psychiatric Nurse Practitioner

                  A psychiatric nurse practitioner has a Master of Science (MS) or Doctor of Philosophy (Ph.D.) in nursing with a specialized focus in psychiatry.  They have either PMHNP-BC, which is board certification in psychiatric nursing, or they have NCLEX, which is National Council Licensure Examination.  Psychiatric nurse practitioners provide assessment, diagnosis, and therapy for patients with mental illness or substance use disorders.   Depending on their state, they can prescribe and monitor medication.  A psychiatric nurse practitioner blends nursing and psychiatric expertise when treating patients.  

 

Therapists/Counselors

                  Therapists and counselors have a master’s degree (MS or MA).  They can evaluate a person’s mental health.  When working with individuals they use therapeutic techniques based on specific training programs.  There is different licensing for therapists and counselors.  LPC stands for Licensed Professional Counselor.  LMFT stands for Licensed Marriage and Family Therapist. LCADAC stands for Licensed Clinical Alcohol and Drug Abuse Counselor.   Therapists work with people on understanding their thoughts, feelings, and choices.  

 

Social Worker

                  A social worker has a Master of Social Work (MSW) degree.  These professionals can evaluate a person’s mental health.  They use therapeutic techniques based on specific programs. Social workers are trained in case management and advocacy services.  Their role is often to empower individuals with mental illness to lead lives that are fulfilling and independent.  

 

Primary Care Provider

                  A primary care provider (PCP) is a doctor (MD), physician’s assistant (PA), or nurse practitioner (NP).  This provider can prescribe medication.  They can refer a patient to providers who specialize in mental health.  In the best scenarios a primary care provider works with other mental health professionals to provide the quality care.

 

                  Often, the first line of defense against mental illness is the primary care provider.  They are usually the provider who is going to see the patient most often prior to diagnosis.  Primary care providers should screen for mental health disorders and refer patients to the appropriate mental health care provider.  Once the patient has a mental health care provider, the PCP should work collaboratively with that provider to ensure the patient’s care.  

                  I have seen all the above providers except a social worker.  In my experience the best mental health professionals are the ones who listen not only to what the patient is saying, but also to what the patient is not saying.  They are empathetic and patient centered.  High-quality mental health care professionals treat the whole patient by being aware of their needs.  They ask meaningful questions.  They are not quick to slap a label on a person.  Instead, they see the person as an individual with an illness that they can treat.  

                  It is important to be comfortable with your mental health providers.  It is okay to try out professionals to ensure you have the right fit.  Being able to talk to your mental health care provider is crucial.  Even if you are not someone who is comfortable talking, there needs to be a comfort in the communication you have with your provider.  A good provider will support you in the communication aspects of treatment.  Don’t worry if you try a mental health provider and don’t feel there is a fit.  But make sure you try someone else. Don’t give up because a provider didn’t meet your needs.  We all deserve high-quality mental health care providers.  The right one for you is out there.  As an example, I have seen several psychiatrists over the years.  I had to learn that it was okay to change psychiatrists.  I have finally found the right one.  You will know when you have the right provider.  Trust yourself. 

                  There are a lot of great mental health providers out there.  If you are looking for one, ask your medical group for the names of providers.  You can ask your PCP to recommend someone.  There are also a lot of new ways to find a provider online, but that is for another post.  It is my hope that everyone can find the high-quality mental health providers like I have found.  It truly makes a difference.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I Could Only Laugh

            Recently, I wrote about my frustration with the health care system.  I had an experience last week that exemplifies the problems in the health care system.  It was so ridiculous that I couldn’t help but laugh.  

            You may remember that I had to fight to get care from the oncologist who is currently providing my care.  The first doctor, Dr. M, just wasn’t the right doctor for me.  I felt like the level of care was lacking.  The last time I had any contact with that doctor, or anyone in his practice was on August 14^th.  Remember that date.  I switched to Dr. St who has been providing my care and chemo since then.  Well, the other day I was laying down talking on the phone to my friend, Pam, after my chemo treatment.  Another call blinked on my phone screen.  The caller ID said it was from the first oncologist’s office.  After a moment’s hesitation, I answered it.  The man on the line said he was calling because Dr. M’s office was having difficulty getting my insurance company to authorize a blood draw.  I had to pause before I could respond.  What was he talking about?  It was October 4^th.  Remember I hadn’t had contact with this doctor or his office since August 14^th.  I had canceled a chemo appointment and an appointment with the doctor.  So, I told the man that I was no longer being treated by Dr. M because I had decided to go with a different doctor.  I pointed out that I had told someone in his office that I had changed doctors a few weeks prior.  The guy seemed clueless.  He asked me which doctor I had switched to.  My first thought was that he didn’t need to know.  Then I decided that I would tell him so Dr. M would know there were better doctors out there.  

            This whole situation left me laughing.  Where the hell did they think I had been for the last seven weeks?  I have stage 4 cancer.  Did they think I would just miss appointments?  Did they even notice that I hadn’t been there?  This proves that I made the right decision when I switched to Dr. St.  If a doctor lets a patient with stage 4 go missing for seven weeks, is he really interested in healing the patient?  Was anyone in his office really paying attention? 

            I understand that doctors have a lot of patients, and they depend on their staff who don’t always tell them everything.  This is ridiculous, though.  I made the right decision to go with Dr. St. 

            Health care baffles me.  There are good doctors out there.  Some are prevented from providing care the way they want because of the system and insurance companies.  Another example happened on Tuesday.  My psychiatrist made a change to how I take a medication, which required two different doses of the medication.  When I went to the pharmacy, they would only give me one.  I was told that I had to wait until the next day for the other one because my insurance said that is when it was due to be processed.  Never mind that my psychiatrist had made the decision to make the changes based on my health needs.  Evidently, the insurance company knows better than a psychiatrist!  I am frustrated.  Adding to the frustration was the fact that it was 4:00 in the afternoon.  Does it really make a difference if I pick the prescription up then as opposed to 9:00 the next morning.  Just an inconvenience for me.  

            Check back on Monday for a new post.  I am not sure what I will write about.  Perhaps another poem.  I have two poems that I have written during chemo treatment.  There is also a guest post on TMS treatment coming soon.   I wrote a lot in my journal yesterday.  Maybe there is a post in what I wrote.  Some of it is about the mental side of facing cancer.  Don’t miss Monday’s post.