Mental Health

HealthCare

How can we create an environment where students feel comfortable seeking out mental health services?

Breaking Stigma: Sharing Stories to Support Student Mental Health

How does anybody become comfortable with anything exposure? Every time a parent, a loved one, a brother, a sister, a friend shares a story of their suffering or a story of their triumph, that makes students feel more comfortable sharing theirs. I think stigma is the biggest thing that gets in the way of comfortability. So I encourage everyone to share their roses and their thorns. You quickly realize that while there's no equity in suffering, there is a shared human experience that we all have. And if we were a little less afraid of being vulnerable, I think people would feel a lot more comfortable talking about mental health care problems. So I encourage you to share everything or a lot of the good things that happened in your life and a lot of the bad ones, too. They're all important and they all decrease stigma.

To become comfortable with exposure, it's important to share stories of both suffering and triumph to reduce stigma, allowing people to be more open and vulnerable about their mental health.

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To create an environment where students feel comfortable seeking out mental health services, it's important to address stigma and encourage open dialogue. One way to do this is through exposure. When parents, loved ones, siblings, or friends share their own stories of suffering or triumph, it helps students feel more comfortable sharing their own experiences.

Stigma is a major barrier to comfortability. By encouraging everyone to share both the positive and negative aspects of their lives, we can break down the stigma surrounding mental health. It's important to recognize that while suffering may not be equal, there is a shared human experience that connects us all. If we can be less afraid of vulnerability, people will feel more at ease discussing mental health concerns.

I encourage individuals to share their personal stories, both the good and the bad. By doing so, we can decrease stigma and create a more supportive environment for students to seek out mental health services.

What values should be prioritized when treating someone with a mental illness?

Prioritizing Patient Values: Creating Space for What Matters

Great question. I think it's the provider's job to elicit as much as we can from the patient about what's important to them, but also it's our job to leave space for them to tell you what's important. Some of the ways we elicit what's important are by the way we interview and the way we invite information from the patient. I start every interview asking someone what they want to be called, how they want to be addressed. I always introduce myself as Dr. Cruz or Andy, and I say my pronouns to invite them to say theirs if they want to. I always ask are there any spiritual, religious, cultural considerations that I should take into account. And then at the end of the encounter, humbling myself, knowing that I couldn't have possibly asked every permutation of every question about what could be important to someone, I always say is there anything important to you that we didn't talk about? And if they offer something that should have been obvious to me or something very special that I didn't ask about, I always apologize. I say oh my gosh, that sounds like that's really important to you. I'm so sorry I didn't ask you about that. I think that humans are infinitely complex, so we both obtain what is a priority for a patient by what we say, but also what they give us, and it has to be two-sided or else we'll miss something, because every patient is infinitely unique.

As providers it's our job to elicit as much information from the patient as we can about what's important to them. We do this by the way we interview and invite information from the patient, always asking questions such as "Are there any spiritual, religious, or cultural considerations that I should take into account?" and humbly leaving space for the patient to tell us what is important to them.

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When treating someone with a mental illness, it is important to prioritize the values of patient-centered care and creating a safe and inclusive environment. As a provider, it is crucial to elicit information from the patient about what is important to them and to leave space for them to express their needs and preferences.

One way to do this is by conducting interviews in a way that invites open communication. Starting the interview by asking how the patient wants to be addressed and introducing oneself with pronouns sets a respectful tone. Additionally, inquiring about any spiritual, religious, or cultural considerations shows an understanding and respect for the patient's background.

At the end of the encounter, it is important to humbly acknowledge that it may not have been possible to cover every aspect of what is important to the patient. Asking if there is anything important that was not discussed allows the patient to bring up any additional concerns or values. If the patient shares something that should have been obvious or something unique that was not addressed, it is important to apologize and acknowledge the significance of their input.

Recognizing that every patient is infinitely complex, it is essential to actively listen and engage in a two-sided conversation. By valuing the patient's input and actively seeking to understand their priorities, a provider can ensure that the treatment approach is tailored to the individual needs of the patient.

For those with depression, what are effective treatment options that can be used?

Exercise: A Powerful Treatment Option for Depression

Depression like the humans, it affects is complex. My sense is that over time, we will come to discover that depression is actually multiple diseases caused by multiple things— that said there are options. Those include the common things you hear us talk about all the time, like medication and therapy. And it also includes the things we should probably talk about more like eating well and exercise. For the purpose of this explanation. I'm gonna put in a plug for exercise, severe depression aside for milder forms of depression, exercise can be as effective as medication. Now, what about getting started? This skill is framed as behavioral activation by some treaters. You can apply to exercise and to other things that are hard to do when feeling depressed. It's a common misconception that motivation comes before doing. But I'll challenge that.  For  me. When I wake up to go to the gym, I don't want to. When I'm driving to the gym, I don't want to, when I start at the gym, I don't want to, It's about 10 or 15 minutes into my workout that the motivation comes along and then I want to finish. Motivation comes after action. Sometimes we just need to do it.

Depression is complex and can be caused by multiple things. Options to combat depression include medication, therapy, eating well, and exercise. Behavioral activation is a skill that can help in starting to do the things that can be hard to do when feeling depressed. Motivation does not come before doing, it comes after action.

For effective treatment options for those with depression, there are a few approaches to consider. Medication and therapy are commonly discussed options. Additionally, lifestyle factors like maintaining a healthy diet and engaging in regular exercise can also play a significant role. Specifically, exercise can be as effective as medication for milder forms of depression. Getting started with exercise or any other activities when feeling depressed can be challenging. Some treaters refer to this as behavioral activation, which involves taking action despite lacking motivation. It's important to recognize that motivation often follows action, not the other way around. Personally, even when I don't feel like going to the gym, it's about 10 or 15 minutes into my workout that motivation kicks in and I want to finish. Sometimes we just need to take that first step and do it.

How do you engage with those who are resistant to seeking help?

How to engage with resistant individuals seeking help

I love, love this thoughtful question. How do you engage with those who are resistant to seeking help? I'm gonna speak to you as a psychiatrist who works with persons who struggle with substance use a lot and who often are resistant to seeking help. You know, first of all, it's not necessarily attacking the mental illness head on. It's getting to know the person. Who are you? Where do you come from? What makes you smile? What makes you mad? What TV shows do you watch? What do you like to be called? How do you identify as? It's building that rapport. A commonality of the people we treat is that a lot of people have trauma and don't trust easy. So you have to build that rapport. You have to build that foundation and then you can attack their suffering. You can't discount the human in order to treat the human condition. It just can't be done. Build rapport, put the mental health diagnoses aside, see the person and go from there.

Building rapport is key when engaging with those who are resistant to seeking help. Show genuine interest in the person, engage in conversation about their interests and identity, and build a foundation of trust before addressing their mental health struggles.

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Engaging with those who resist seeking help is a significant challenge. As a psychiatrist who often works with individuals struggling with substance use and resistance to assistance, I appreciate this question. Instead of directly addressing their mental illness, the key is to establish a connection with the person. Who are they? What are their experiences? What brings them joy or anger? What shows do they enjoy watching? How do they identify themselves? It's about building rapport and finding common ground. Many individuals we work with have experienced trauma and find it difficult to trust others. Therefore, building that foundation of trust is crucial before addressing their suffering. We cannot overlook the person in our attempt to treat their condition. It must begin with rapport-building and seeing them as individuals. From there, we can proceed in addressing their needs.

How might we work to break down the stigmas around addiction?

Breaking down addiction stigmas: Compassion and understanding

How might we work to break down the stigmas around addiction? Education. Understanding where addiction comes from, understanding where substance use comes from. So I'll walk you through one of my favorite frames. Shame. I'm not good enough. Something's wrong. I don't deserve a good life. Depending on the temperament of a kid, anything that happens during their life, in adolescence, in early childhood, can make them feel less than. That can be frank abuse, that can be being different, that can be mom or dad not being around, being out to work. It can mean a lot of things. That leads people to develop shame. That's an unbearable feeling. People cope by using substances, by using work, by using different addictions. Then while they're using those substances, they do more things to be ashamed about. And this goes round and around and around. It cannot be that the way we treat shame is by punitive actions. It has to be by compassion and love.

We can break down the stigma of addiction by educating people on where it comes from and understanding that addiction comes from a place of shame. We must treat those with addiction with compassion and love, rather than punitive actions.

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To break down the stigmas around addiction, one approach is through education. It's crucial to understand the origins of addiction and substance use. One perspective is to consider the role of shame. Many individuals with addiction may carry deep feelings of shame, believing they are not good enough or that something is inherently wrong with them. Childhood experiences, such as abuse or feeling different, can contribute to these feelings. Coping mechanisms like substance use or other addictions can develop as a result. However, these behaviors often lead to more things to feel ashamed about, creating a vicious cycle. Instead of punitive actions, addressing shame requires compassion and love. By fostering understanding and empathy, we can work towards breaking down the stigmas surrounding addiction.

How can people be encouraged to take ownership of their mental health?

Building Rapport: Encouraging Ownership of Mental Health

How can people be encouraged to take ownership of their mental health. Framing it is taking ownership can be a difficult concept for some patients to grasp it can bring up immediate defensiveness and even anger because some part of what you're saying, maybe tapping into the part of them that hasn't accepted that change needs to happen. So I will preface this by saying that building rapport and having a strong relationship before this conversation is super important. One technique I use is to first validate their suffering and pain. For instance, I may say something like you are not responsible for the horrible traumas you endured as a child. After validating the patient, I will often make the following statement and you are responsible for your wellness as an adult taken altogether. That is you are not responsible for the horrible traumas you endured as a child and you are responsible for your wellness as an adult. Then I may say something like how can I help you in your journey towards wellness? I am always careful to acknowledge that wellness is a journey and not a destination.

Building rapport and validating the patient is key when encouraging them to take ownership of their mental health. I use the technique of first validating their suffering and pain, then making the statement that they are responsible for their wellness as an adult. I then follow up by asking how can I help you in your journey towards wellness, acknowledging that it is a journey and not a destination.

Encouraging people to take ownership of their mental health can be a challenging task. The concept of taking ownership may initially trigger defensiveness or anger in some individuals who have not yet accepted the need for change. To approach this, it's crucial to first build rapport and establish a strong relationship with the person. One effective technique is to validate their suffering and pain, acknowledging that they are not responsible for the traumas they endured in the past. After validating their experiences, it can be helpful to convey that they are responsible for their wellness as adults. This can be done by saying something like, You are not responsible for the horrible traumas you endured as a child, but you are responsible for your wellness as an adult. Following this, it's important to ask how you can support them on their journey towards wellness, emphasizing that wellness is a continuous process rather than a destination.

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Dr. Andrew Cruz, MD is a psychiatry specialist in Belmont, MA. He currently practices at Mclean Hospital. He is also a pianist-turned-doctor who was inspired to pursue medicine after graduate school by the homeless, uninsured population in his hometown. He believes in the power of shared suffering and how medicine can help relieve it. He has participated in many extra-curricular activities and led organizations to give back to his community. As a gay Hispanic-American, he is also passionate about advocating for marginalized communities. Through his experiences, he has learned the importance of prioritizing and well-roundedness to become the best doctor. He encourages potential medical students to pursue what they are passionate about, as it will help them change the world.

Neither AnyQuestion nor its Experts provide medical advice, diagnosis or treatment or otherwise provide professional healthcare services.

Dr. Andy Cruz, MD