This Thanksgiving, Be Mindful

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Mindfulness is increasingly popular within the mental health world. Mindful moments of observation are recommended for improved well-being. This is not necessarily mindfulness meditation, but a smaller type of everyday attention to each moment. If you can get out of your “mind’s eye” and stop replaying an argument from yesterday, or come back to this present moment and stop picturing a disastrous tomorrow, you can experience a calm feeling and alleviate of stress and worry. Mindfulness is being taught as a technique for treating depression and anxiety, and research suggests that it works.

Mindfulness gets you out of your head, and places you back into this moment. That’s helpful, even in small increments, to increase your sense of well-being.

Here are some tips to use mindfulness this holiday:

Cooking

Cooking can be stressful- planning and orchestrating the meal to hit the table on time, fully cooked, and still warm. A Thanksgiving kitchen can be chaotic.

Mindful tools: Stop and focus your attention on the food you are preparing. Mentally notice each step. Feel the textures and of the food, and see the vibrant colors. As food cooks, pause and take in the delicious smells. Be in your kitchen, not in your head.

Family and friends

Gathering, rushing around to get some place on time, or preparing to welcome guests can lead to anxieties.

Mindful tools: Greet each person with your mind fully present on him or her. Tune in and appreciate the presence of this family member, friend, or guest. Shake hands, hug, or otherwise connect with them one by one. Pause to appreciate them fully. Be with your loved one, instead of in your mind worrying about what you need to do next.

Food

Thanksgiving tradition involves mountains of food. Food can lead to stress when we feel pressured to overeat, or scrutinized for what food we select.

Mindful tools: Start by listening to your body, and your emotions. How much food do you want and need? Which foods do you prefer? Is there anything just outside your comfort zone that you’d like to try? And then, as you eat the food, notice mindfully how each bite smells, feels, and tastes. Place your mind fully on the experience of the food, while setting aside the other activities in the room. Let the food nourish your body, rather than using it as a tool to comfort you emotionally.

Posted on November 20, 2017 .

“He just stays up in his room watching Netflix. Is that depression?”

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I was asked this question (or some variation on the same theme) a half dozen times in the past week.

“He just stays up in his room watching Netflix. Is that depression?”

-Not necessarily.

While depressed people certainly tend to avoid things, not all vegging out in front of a bingeable TV series is depression.

People hide in their rooms and numb out with TV for other reasons:

  • Just relaxing
  • Needing more alone time, or time away from family
  • Avoiding responsibilities or unpleasant activities
  • Feeling lost, restless, or uncertain
  • As a tool for coping (albeit not always a healthy tool) 

But none of these are necessarily depression, or any illness for that matter. Even when your loved one uses a problematic coping skill, that doesn’t signify the presence of a mental health condition.

In our current world, questions like, “Is this depression?” can lead to excessive labeling and dangerous overtreatment. While families and friends are trying to understand and help a non-functional or distressed loved-one, we are at times too quick to jump to common illnesses like depression when we see someone who isn’t functioning.

Being lost isn’t depression, although it can be related. Wasting time in mindless activities is not depression (or else we are all depressed in the age of binge watching TV series).

More important, treating unhealthy coping as if it is depression doesn’t help. Medications (the most common treatment for depression) won't improve coping skills. 

To solve the mental health crisis, we have to direct people to the right places. That means providing reassurance, not medication, to folks who aren't truly ill. Otherwise, mental health clinics become overrun with the wrong folks and inaccessible to the ones in need of the most help. 

If your loved one isn't coping in healthy ways, try gentle confrontation, or schedule time with a counseling professional for advice. 

 

 

Posted on November 13, 2017 .

#MentalHealthAwareness is Great, But Where’s the Help?

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Imagine that your 12-year-old daughter cuts her arm superficially with a pair of scissors because she is having emotional turmoil that she doesn’t know how to handle. The school counselor calls you and says that your child showed the marks on her arm to her best friend in class, and the concerned friend notified the counselor’s office. The counselor tells you that you need to have your daughter assessed by a physician who specializes in mental health, and that she cannot come back to school without a letter from a doctor indicating that she is safe to be on campus. She says that as the counselors learn more about the importance of mental health issues in middle school kids, they have strict rules about ensuring kids get the help they need.

How long would you expect to wait for a child psychiatry appointment in these circumstances?

In many communities, unless your child needs to be in the hospital, you might not be able to get in to see a doctor for months.

You sit down and try to talk to your daughter, and quickly realize that you are in over your head. She sobs uncontrollably, and says she has been feeling terrible for weeks. She had seemed like her usual self, and you are stunned that this all happened right under your nose. Now you’re both overwhelmed, and you still don’t know how to get help.

You pull out the phone book, and start calling psychiatry clinics. Most of the offices don’t see children, and the few that do see children don’t take your insurance. Even if you pay cash, the first appointment you can secure is two months from now.

Your child can’t stay out of school for two months, and you don’t feel confident that you’re able to help her with her emotions right now. While your appreciate the school’s attention to your child’s safety, you don’t know how to do what the counselor asked you to do.

You call your pediatrician’s office, explain what happened, and ask if they can evaluate her. The nurse tells you that their clinic isn’t qualified to evaluate this issue, and further, they don’t know where you can go. The nurse says it has become impossible to find mental health help, and she thinks you might have to take your daughter to a hospital, where she would have to stay for up to a week.

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This scenario is common. It’s getting harder and harder to access mental healthcare services. This is true for adult patients as well as children and adolescents. Psychiatrists are aging out of the field, and too few young physicians are choosing this necessary specialty. Awareness is growing, and more and more people are asking for help. But then patients are finding that there is nowhere to get the help they need.

Primary care clinics are overwhelmed with the mental healthcare needs of their patients, and often do not feel qualified to handle the complex mental health needs of their patients.

In order to meet the needs for mental health care, things are going to have to change. What can be done?

1.     Prevention

Researching and educating families, communities, and schools about how to develop emotional skills, and open dialogues can decrease the risk of mental health crisis.

Prevention

2.     Collaboration

Primary care and specialist collaboration can increase available care.

3.     New Models of Care

Co-location by a mental health professional with primary care, and regular on site consultation have been shown to improve access to mental health care services. Integrating mental health into primary care is helping meet the need for care.

 

What other ideas do you have?

Posted on October 30, 2017 .