Did you know patients are most likely to consult with their family doctor about their mental health than any other healthcare professional? This episode features Dr. Nadia Alam a family physician and anesthetist practicing in Georgetown, Ontario. Dr. Alam explains the signs to look out for and recognizes the importance of Bell Let's Talk Day in raising awareness of the stigma surrounding mental health.
Did you know patients are most likely to consult with their family doctor about their mental health than any other healthcare professional? This episode features Dr. Nadia Alam a family physician and anesthetist practicing in Georgetown, Ontario. Dr. Alam explains the signs to look out for and recognizes the importance of Bell Let's Talk Day in raising awareness of the stigma surrounding mental health.
OMA Podcast Episode 9: Mental Health and Well-Being with Dr. Nadia Alam
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Voice-over: In this podcast, the Ontario Medical Association looks at current health issues that are on everyone’s mind. Spotlight on Health gives you the straight talk. We’re Ontario’s doctors and your health matters to us.
This episode explores mental health.
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Dr. Nadia Alam: My name is Dr. Nadia Alam. I am a family doctor and anesthetist working out of Georgetown, Ontario. As part of my practice, I try and provide "cradle to the grave" care.
Mental health is a more general term, a sense of psychological well-being, mental well-being, and the ability to function well in your life despite the hardships that life may throw at you.
Mental Illness refers to very specific diagnoses. People can have mental illness and still have that sense of mental well-being if their illness is controlled. People can have mental health and never be diagnosed with a mental illness. The two are not the same. The two can coexist. And the goal of ensuring psychological safety and well-being is one of the goals of medicine.
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Dr. Alam: Interestingly, while people, I find, are very comfortable talking about mental health and mental well-being—particularly from the preventive end, right? They want to control their stress, they want to make sure they sleep enough, they want to make sure that they're doing all of the things to manage the stresses in their lives—when it comes to mental illness, there is this wall. Particularly if they have it. They're very hesitant, they're worried about the repercussions, not just socially among their friends, but for jobs.
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Dr. Alam: I think one of the biggest things is for people to be aware, and this is where campaigns like Bell Let's Talk on January 29, come into play. While it's one day out of the year—and it's a fundraising campaign where Bell donates five cents for every conversation, every tweet using the hashtag "Bell Let's Talk" to community mental health initiatives—it has worked to raise some awareness.
Often people don't realize how common mental illness can be. Take depression, for example. By the age of 25, one in four kids will have experienced depression. By the age of 40, one in two adults will have experienced depression.
It is an incredibly common illness. And unfortunately, mental illness is not very well understood by the community at large. Often people will say "well just snap out of it," or "just deal with it" or "do some more yoga" or "do some more—take another bubble bath," or "read a book and everything will settle down."
Mental illness is more profound. It requires more systematic use of resources to help you. And even in people who do everything right—they exercise, they sleep well, they eat well, they have good social supports—they can still have mental illness.
So the first step is recognizing it, realizing that you're in trouble, you need to talk to your doctor.
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Dr. Alam: The signs of mental illness can be very insidious. I often find that people present in a couple of different ways.
One is, as a family doctor, I may see them in my office, and I may notice over time that they're struggling more and more. They seem more overwhelmed, their personality’s shifted, they’ve become quieter, they've become more withdrawn. I'll even have family members notice that and bring that up.
The other way people present, and this speaks to how insidious mental illness can be, there is such stigma around mental illness patients try to hide what they're feeling, or they're in a bit of denial. And often when people struggle, they tend to become very protective of themselves because everything hurts. They may present later on in their illness in crisis. They may present either in my office, or they may present in the emergency department, they may present to their paediatrician, or to a psychiatrist in crisis. So sometimes people can present early on in their illness, sometimes people don't present until they're in full blown crisis.
So what I tell patients is keep an open mind, right? Bring your concerns, all of them, whether you think they're true or not, or you think you're strange for asking. Bring up all of those questions, and talk about the uncertainties. 'Cause there are risks and benefits to treatment, whether it's counselling, whether it's medications.
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Dr. Alam: I was home reading to my kids at night, I was putting them to bed, and I got a phone call from the local emergency department at my hospital, who’s one of the emergency room physicians, and he said, "You know, something's bothering me about this. Can I run a case over with one of your patients who's come to the emergency department?" I said, "Sure, let's talk about it.”
The emergency room physician began, and he started telling me about this patient whom I had been treating for depression. We thought we'd been doing pretty well.
She had come to the emergency department with what he thought was probably an accidental overdose. She'd taken about three or four times her usual dose of antidepressants. She was medically stable, and he was trying to decide whether to keep her in hospital for the crisis nurse to see versus letting her go home.
And as he was talking about her, he started describing some of her mannerisms, and how she was holding herself, her body language, what she was saying. And one of the things he said was, "She said that she forgot she had taken the medications, and that's why she took them again."
And I thought about it, and I thought, that doesn't sound like her at all. How could she forget her medications? And I said, "I—I don't have a good feeling about this. Can you do me a favour? Can you just keep her and let the crisis nurse see her?"
That night, my patient tried to slit her wrists. Luckily, she was in the emergency department where they were able to stabilize her and save her.
That, too, speaks to that doctor-patient relationship. That sense of not just looking at the patient and seeing a bunch of diagnoses and a bunch of lab tests. It's knowing them as a person makes a huge difference in how you treat them, how you stabilize them, and whether or not you can get there in time when things go downhill.
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Dr. Alam: There is no magic pill that cures any illness, whether it's mental illness or physical illness. All illness requires patients to put in the time to take care of themselves.
And that's where the four fundamental blocks of eating well, sleeping well, exercising regularly, maintaining your stress management and coping mechanisms in place. That's where the work comes in.
Patients who focus on those four aspects go a long way towards controlling their illness, whether it's high blood pressure, whether it's heart disease, or whether it's depression.
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Dr. Alam: I think one of the most important things patients can take away from this is, regardless of the diagnosis, they still retain control over their lives. They still have a lot of power and influence over their own lives. They don't have to be overwhelmed by a number, or a lab test, or a diagnosis in my medical chart. They are more than that, and we see that. We see them.
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Voice-over: Don't miss our next episode on eating disorders.
This podcast is brought to you by the Ontario Medical Association. It is produced and edited by Jodi Crawford Productions. This podcast is not intended to provide medical advice for specific situations and is for general educational purposes only. Please consult your doctor if you have symptoms or questions about your health.
For more information, please visit our website at oma.org.
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