The hope and promise of a new year brings with it many emotions as we look towards the future with anticipatory and optimistic resolutions, plans and goals. While 2016 was a year to remember, the clean slate that lies ahead encourages each of us to start anew in all aspects of our lives, as we work to better ourselves personally, emotionally, professionally and mentally.
The term “mental health” is commonly used in reference to mental illness. Addressing mental health, depending on the individual, can be a harsh reality. It is a taboo subject to some, an indirect part of life for many, and for others, it is a very real part of their lives, often buried by guilt, shame, embarrassment and denial. While there are many different perspectives on mental health, what it is, how it affects individuals and how it can be treated, many would agree that it is not given near enough time and attention, given that it is such a touchy and sensitive subject. This fact, though, is the very reason that the topic and our health and that of those we hold closest to our hearts needs to be brought to light and faced, head-on, with strength, perseverance and courage.
Many people choose to believe that mental health and mental illness are not a relevant issue in our society today, so it is vitally important that we work on education to help both ourselves and the ones we love. Some people will agree that, although mental health and mental illness are related, they represent different psychological states. “Mental health” often relates to a state of well-being in which one is self-aware, understands his/her own abilities, can effectively deal with the daily stressors life brings, is a productive worker and is able to contribute to his/her community. Studies show that only about 17 percent of U.S adults are in a state of optimal mental health, while emerging evidence shows that positive mental health is related to improved health outcomes. Mental illness represents all diagnosable mental disorders and/or health conditions described as alterations in thinking, mood or behavior. Currently, studies from the Center for Disease Control (CDC) show that depression is the most common type of mental illness, as it affects more than 26 percent of the U.S. adult population. Scientists and doctors estimate that, by the year 2020, depression will be the second leading cause of disability throughout the world, trailing only heart disease.
In addition to depression, there are many different types of mental illness like postpartum depression, post-traumatic stress disorder (PTSD), anxiety, bipolar disorder, eating disorders, addiction and schizophrenia, all of which are their own unique illnesses and require various treatments and knowledge bases. The more we know and understand about mental illness, the better equipped we are to recognize the signs and symptoms and to take care of those we love.
As researchers, doctors, counselors and other mental health professionals continually work toward the progression of the field, they are dealing daily with the many types of mental illness that affect the lives of those they treat. Not only does mental illness affect adults, but it also impacts the fragile lives of teens and children, too.
Robi Heath, a licensed professional counselor and registered play therapist supervisor at Kid Talk Counseling here in Frisco, wants parents to understand that children are complex, as they have not fully developed all parts of the brain, which means symptoms look different in every child. She says, “As a therapist, I look for behavior concerns such as shifts in a child’s behavior, which can be a sign that something else might be going on inside. I also look for changes in sleeping patterns. Teachers are a great resource for information, as they are with your child all day and can tell if a kid starts to struggle in their work, peer relationships or other areas.” Ms. Heath continues, “Communicate with your child’s teachers. If you see any shifts in your child, check in with them and gain further information to see if more might be going on. Kids often do not understand their feelings fully and might not have the words to explain how they feel on the inside.” While we work to understand the types and symptoms of mental illness, we must also keep in mind that mental illness does not affect everyone the same way.
Dr. Shaalon Joules, a Frisco-based licensed psychologist, has always been interested in how people think, personality types and how those factors combine to influence behavior and decision-making. She became a psychologist because she likes to listen to others and help them. Dr. Joules explains how mental illness can look different in various individuals. “The field of mental health recognizes that different mental disorders share symptoms, which can make diagnosis difficult. Also, there are typically multiple symptoms underlying a particular mental disorder and a specific number of these symptoms need to be present in order to make a clinical diagnosis,” she says. “There can be various combinations of these symptoms that can lead to a particular diagnosis. For example, two different people can both be diagnosed with depression, but have a different combination of symptoms and, therefore, the outward manifestation of these symptoms can appear different.”
Depression (major depressive disorder or clinical depression) is a common, but serious, disorder that affects one’s mood. The illness can cause severe symptoms that affect how one feels, thinks and handles daily activities, such as sleeping, eating or working. This all-too-common mental illness can cause feelings of sadness and/or a loss of interest in activities once enjoyed and can lead to a variety of emotional and physical problems. Additionally, depression can cause one’s ability to function at work and at home to decrease. The signs and symptoms of depression can vary from mild to severe and often include feelings of sadness, loss of interest or pleasure in activities once enjoyed, changes in appetite (weight loss or gain unrelated to dieting), trouble sleeping or sleeping too much, loss of energy or increased fatigue, feeling worthless or guilty, difficulty thinking, concentrating or making decisions and even thoughts of death or suicide.
Gary Gabbard, a Frisco-based licensed professional counselor, hopes readers understand that even though some people seem to have it all, suicide is still a very real, relevant and dangerous possibility of depression. He explains, “Notice changes in behavior. Oftentimes, individuals are a little more withdrawn, stop texting and communicating with friends and family and even start giving treasured items to other people. Occasionally, the once depressed individual has a sudden change and appears really happy (as he has made the decision how he will end his life). If someone you love stops talking about the future, displays the above symptoms and talks about ending his life, take notice. Immediately take him to his primary care physician or a mental health counselor.”
Depression, like many illnesses, comes in many forms, two of which, bipolar disorder and postpartum depression, are more common than others. Dr. Joules explains that the essential difference in depression and bipolar disorder is the occurrence of a manic episode. She clarifies, “A manic episode may be characterized by a feeling of euphoria or irritability; engaging in multiple projects in which they have little or no knowledge of the topic; extremely high self-esteem; feeling rested or energetic, even after not sleeping or sleeping only a few hours; talking continuously and speech may be incoherent; being easily distracted by irrelevant stimuli; increased sexual drive or risky sexual behavior.” Postpartum depression can affect women after the birth of a child. Extreme sadness, anxiety and exhaustion make it increasingly hard for them to complete daily care activities. While postpartum depression does not have a single cause, it most likely results from a combination of physical and emotional factors. It is important to note that postpartum depression does not occur because of something a mother does or does not do.
Anxiety is a mental health condition that ranges from everyday worry to debilitating agoraphobia (an inability to leave home). The term “anxiety disorder” includes generalized anxiety disorder, panic disorder and panic attacks, agoraphobia, social anxiety disorder, selective mutism and separation anxiety. Mr. Gabbard explains, “Many emergency room visits for fear of a heart attack turn out to be anxiety ‘on steroids,’ called ‘a panic attack.’ Difficulty breathing, tightness in the neck and pressure on the chest often occur during a panic attack. Anxiety can also affect physical health issues. When we start ‘anxiety-ing’ ourselves, our endocrine system kicks into gear and our body increases endorphins and other hormones that put us into the fight or flight syndrome. Blood pressure can increase, heart rate may increase, sleep can be impacted, headaches may be experienced and a compromised immune system can occur because of the physiological changes in the body.”
Ms. Heath explains that anxiety is also a very real illness many children experience. “Anxiety presents itself differently with each person and especially with children,” Ms. Heath clarifies. “I tend to use the word ‘worry’ with kids. Does the child manage worries well and seek out support as needed, or is the child struggling to communicate those feelings? A child can express worries and anxiety through lots of different mediums. I believe that anxiety becomes troublesome when a child is not seeking out support and it begins to interfere with everyday tasks such as focus at school or home. Because everyone is different, symptoms are tough to identify and some signs might be that the worry or anxiety is disproportionate than the actual risk, parents might look for trouble sleeping, tiring easily, impaired concentration and irritability in children.” Bianca Mickan, a licensed professional counselor, elaborates on the physical symptoms that can manifest through anxiety that can include excessive and overwhelming worry, chronic sleep problems, muscle tension and body aches, chronic indigestion and even self-doubt. Ms. Mickan says, “Because anxiety comes in so many different forms, the distinction between an official diagnosis and ‘normal’ anxiety is not always clear.”
Robert Garza, a licensed chemical dependency counselor providing therapeutic services to combat addictions, explains, “Different substances affect the body and mind in different ways. People may use substances because of the effects on their person, which include decreased feelings of distress or increased feelings of pleasure and euphoria. Using alcohol or other drugs does not mean the person has a substance use, disorder or addiction.” Mr. Garza continues, “There are several warning signs a person may be developing an addiction to a single or multiple substances. Isolation and extreme preoccupation with a substance or multiple substances along with increased use and difficulty controlling use are signs of which to be vigilant. Abuse can occur when a person begins to use a substance that leads to work, school, health or legal problems. Dependence occurs when a person is unable to function without the aid of the foreign substance and experiences withdrawal when they are unable to consume the substance. Also, higher doses of the substance are needed to achieve the same desired effect. Substance abuse disorders often co-occur with other mental health disorders such as bipolar, anxiety and psychosis.”
Post Traumatic Stress Disorder
PTSD is a disorder that develops in people who have experienced a shocking, scary or dangerous event. Steven Scott, a licensed professional counselor at Frisco Counseling and Wellness, says it is natural to feel afraid during and after a traumatic situation. “Fear triggers many split-second changes in the body to help defend against danger,” he explains. “This fight or flight response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened, even when they are not in danger. Symptoms can include flashbacks (re-living trauma over and over, including physical symptoms like a racing heart or sweating, bad dreams and frightening thoughts.)” Dr. Joules adds that avoidance of people or places that trigger feelings or memories of the traumatic event, feeling that the world is a dangerous place, experiencing persistent feelings of anger, shame or guilt, outbursts and problems with sleep or concentration are also important effects of PTSD to know about and consider.
Treatment After Diagnosis
While the first step toward finding answers is the assessment of the symptoms one experiences, soon after such assessment, mental health professionals are able to diagnose mental illness and formulate a treatment plan. Dr. Joules explains, “Depending on the severity of the illness, inpatient psychiatric hospitalization may be required. With most cases that I see in the office, after a diagnosis is made, we are able to start therapy on an outpatient basis in an office setting.” Mr. Scott asserts that the most effective treatment for mental illness involves a combination of medication and cognitive behavioral therapy (CBT). He clarifies, “Research says that the most effective type of treatment for most of the mental health issues individuals face is CBT.” Dr. Joules elaborates, “There is no one particular tried and true way to treat mental illness. There are various theoretical orientations, solution-focused therapy, emotion-focused therapy or acceptance and commitment therapy, to name a few. CBT involves looking at a person’s thoughts, behavior and feelings. Rapport between the therapist and client is a considerable factor in determining effectiveness, along with the client’s willingness to work on their issues. With CBT, I look for maladaptive beliefs that contribute to emotional distress and behavioral problems. In other words, how does one’s beliefs about themselves or the world make them feel and how does that affect their behavior? In therapy, I help patients identify their beliefs and make changes in their negative thoughts. I also target problematic behaviors and help patients develop healthy behavioral responses.”
Ms. Heath says, “There are lots of great professionals to support your family, so finding the right fit that aligns with your beliefs and values is important. People are different and their bodies are wired a certain way. Treatment should be personalized to each client and kid’s needs.” Because her practice targets children’s mental health, Ms. Heath and her colleagues utilize various types of treatment that range from play therapy, sand tray therapy, expressive art, yoga and animal-assisted therapy. She continues, “All of our therapists are trained in play therapy, which is a form of mental health therapy that utilizes a child’s natural language to learn about their thoughts and feelings. These are all interventions that allow us to simultaneously engage the left and right hemisphere of the brain to help the child gain insight from both their thoughts and feelings, which are stored on different sides of the brain.”
Overwhelmingly, the mental health professionals who contributed to this article urged readers to seek treatment if you or someone you know is dealing with mental illness. “I have heard from countless patients, who were initially skeptical of therapy, who were glad they finally sought treatment,” Dr. Joules says. “Therapy is confidential. This frees many people to talk about things they may not typically feel comfortable discussing. Even if you do not feel completely comfortable at your first session, give it a few sessions. If after a few sessions, you still do not feel comfortable, consider finding a new therapist.”
Mr. Scott shares, “I think it is important for people to realize that they have nothing to lose and that everyone experiences these issues from time to time. Sometimes, treatment can be as easy as managing stress in a more effective way. Make the call. Go in and chat with someone who may have ideas on how to help.”
In seeking treatment, it is important to remember that, in many cases, change takes time. Therapy involves a willingness to engage in the hard work that is required to experience positive life changes.
Kids/Teens and Suicide
Parents are often at a loss as to how to talk to and help their children and teens about mental illness and suicide prevention. Mr. Gomez says, “As difficult as it is to process these mental health struggles as a young person, it may be just as challenging, as a parent, to have difficult discussions with a young person regarding mental health or suicide.” He continues, “It can be emotionally difficult to speak to and accept that a child may need mental health care. It is common to feel responsible for a child’s mental health challenges, either because a parent may feel they could have prevented it or because of family history. Some young people may begin to isolate, become irritable, decline in personal hygiene or begin to give away possessions.”
Being aware of signs and symptoms helps with approaching the child. According to cdc.gov, suicide is the third leading cause of death of people ages 10-14 and is the second leading cause of death in people ages 15-34. Because suicidal thoughts and ideations are often closely-related to mental illness, parents need to know how to respond and how to ensure their child feels supported. Mr. Scott encourages parents to send the message that mental illness is not a choice and they should not feel bad about not feeling good. “The path to suicide is lethal but is a treatable condition that plagues many teens and adults. Generally, with intervention, even 10 minutes can make the difference in life and death.”
Ms. Heath also encourages parents to have ongoing discussions about their thoughts and feelings. “Creating an environment where these things can be discussed allows a child to feel safe in exploring these parts of them. Because children process through play, not talking, using this communication medium can allow a parent to connect with their child. Through this type of child-led play, a parent can also get a glimpse into how a child is doing on the inside.”
Mr. Gabbard says, “One of the most common complaints I hear from teens is that their parents do not listen to them. Encourage and build up their individual strengths. Take time to listen and validate their feelings. Implore them to continue to express their frustration and guide them into effective problem solving. Remember that you can validate what you hear without agreeing with them. Let them feel your respect and love for them.”
There are countless resources that can help families and individuals seeking help or knowledge about healthier habits. Websites such as nami.org, aamft.org, betterhelp.com and goodtherapy.org can help you to find a mental health specialist in your area by typing in the problematic situation you are seeking help for. Emergency rooms at all hospitals are now knowledgeable about providing face-to-face contact from a mental health specialist concerning anxiety, suicidal/homicidal ideas, unstable moods, medication management, psychosis, delusional episodes and more. The National Suicide Prevention Hotline is 1.800.273.8255 and is available 24 hours a day to provide help to those with feelings of helplessness and hopelessness. Mr. Gabbard adds, “If you have health insurance, there should be an ‘800’ number on the back of the insurance card. Trained, licensed counselors are available for triage and to help get you started on your road to recovery. There are twelve-step support groups that can provide support for many illnesses, including AA for alcoholism, ALANON for family members impacted by alcoholism, NARCON for help with drug addiction and CODA for co-dependency/people pleasing, to name a few.”
Mr. Gomez notes that other resources include Youth Mental Health First Aid classes that address and teach how to approach topics of mental health, suicide and substance abuse with children. Youth Mental Health First Aid is an eight-hour interactive class with national recognition and certification that helps empower discussions with youth and destigmatize mental health and the needs of youth. This practice provides mental health first aid training as well as other services to help create and maintain positive mental and emotional health for children.
While mental health and mental illness have long been topics of which many are not readily willing to speak of or acknowledge, they are very real and prevalent parts of our society and lives. As we welcome 2017 with open arms, so may we, too, welcome the possibilities of working toward better mental health and betterment in all areas of our lives. Whether it is you, your child, a family member or a friend, mental health is vital to anyone’s well-being, and dealing with it does not have to be a one-man job. Is today the day you will reach out for the help you or a loved one needs?