The Clinician's Guide to Mental Health

The Clinician's Guide to Mental Health - featured image

Trigger warning: The following topic could be intense for certain readers. It recounts a motor vehicle accident resulting in a death. If you are sensitive to this topic, please do not continue reading.

It was the summer of 2001, and I was lying in a field in Lethlakarne, Botswana. I remember coming out of a mental fog and seeing the blue sky overhead. I could hear muffled screams and panic, as though it was coming from the other side of an invisible wall. I looked above my shoulder and noticed my friend's arms flailing and I wondered why he was so angry and fighting the people standing over him. Suddenly, as if a switch was flipped, the physical pain consumed me. I thought to myself, “this is how I die.” And then as if all at once, I grieved. I grieved for my mom and dad that I would never see again. I grieved over never seeing my grandmother again. The reality of what happened was sinking in. The car I was riding in, without a seatbelt, lost control and flipped several times. I was in the car and now I wasn’t. I can still hear the metal scrapping and crunching. I can feel the sand filling my hair, mouth, and eyes. 

It wasn’t until many hours later that I found out that a donkey jumped out in front of our vehicle as we were traveling between villages. Our driver swerved to miss the donkey, which caused the trailer attached to the back of the van to jack-knife, throwing all passengers out of the vehicle. My friend that I saw flailing and fighting was actually dying. He sustained a deadly brain injury and his body was shutting down. 

The next few days were a blur. I remember vacillating between relief and guilt. I was so thankful I would see my parents soon and then immediately guilt-ridden because my friend would not. I was afraid to sleep because I feared I wouldn’t wake up. After a 24-hour plane ride back to the states, with my friend’s lifeless body stored in the bottom of the plane, I was finally back on US soil. 

My story doesn’t stop there, as this was a beginning of sorts for me in understanding mental health. My experience in Africa ignited something in me and for the next 5 years I would struggle to make decisions, sleep, eat, and establish friendships.  Luckily for me, I started working as a medical assistant for a small family practice after I graduated from college. A few weeks after I started the doctor approached me and asked, “have you ever been diagnosed with anxiety?”   

For the next two decades I learned more about my brain and how it is wired, and during that journey I started to heal. I learned that while my personal experience was unique, my feelings and the way my neurons fired or didn’t fire was not unique. The more I talked about my experience the more I realized mental health disease was all around me. 

I’ve noticed that terms like “depression” and “anxiety” are often thrown around. Mental health disease is endemic in the US, with a whole month focused on bringing awareness. As a healthcare worker, it’s important that we know common mental health diagnoses and what signs to look for in others. And with the increase in workforce shortages, patient censuses, and cognitive overload, healthcare workers also need to know what signs to look for in ourselves. 

 

What is mental health? 

Mental health is simply how we think, feel, and behave, all of which influence how we perceive the world around us and respond to situations. So when our mental health is healthy we can encounter stressors and still make good decisions. We can separate our emotions about a situation from the reality of the situation. Good mental health allows people to make contributions to their communities, hold down a job, care for others and themselves, and cope with everyday stress. 

At times, life stressors may cause us to experience poor mental health for a period of time. This  doesn’t mean we have a mental health disorder. For example, when you get a cold or the flu, you cough (among many other symptoms). But when you’re coughing it doesn’t necessarily mean that you have lung cancer. Your immune system does it’s job and you eventually heal - the cough goes away. Mental health disorders don't heal independently. You can’t simply wait it out, because mental health disorders tend to fester and get worse when left untreated. We all experience symptoms of sadness, worry, and fear on a spectrum. But when we exist on one extreme end of the spectrum for too long, we may be experiencing a mental health disorder. 

So as a healthcare worker, do you know the difference between having a mental “cold” versus a mental health disorder? Current studies suggest many of us don’t. A recent study from the American Journal of Nursing discovered nurses are more likely to think about suicide than any other working group in the US. They are also less likely to seek help when they do. A post-COVID survey from the American Nurses Foundation found that nurses who are experiencing negative mental emotions do not seek help and feel they should be able to manage these emotions on their own. This is in stark contrast to the education and support we provide our patients and community. First, it starts with making sure you have an understanding of the common mental health disorders in the US, how each is diagnosed, and when to access specialized care. 

So let’s take a look at the two most common mental health disorders in the US and the diagnostic criteria for each. 

 

Depression

Depression, also known as Major Depressive Disorder or Clinical Depression, is the most common cause of disability in Americans aged 15-44, and typically affects women more than men. Depression exists on a spectrum, but it is more than just a bad day. It can be confused with sadness, the main symptom. Clinical depression is not situational. It’s not the sadness and grief associated with the loss of a loved one, divorce, or other traumatic life events. It’s sadness along with loss of pleasure in life not triggered by a life event. Often people with depression can’t tell you what’s making them sad, just simply that they’re sad. Depression sufferers also feel unexplained guilt and feelings of worthlessness and physical manifestations such as sleeping more or less than normal, weight gain or loss, and flat affect. 

The DSM-IV diagnostic criteria for depression  is:

  1. Five or more of the following symptoms during the same two-week period. One of the five symptoms must include depressed mood or loss of interest or pleasure. 
  2. Depressed mood
  3. Markedly diminished interest or pleasure 
  4. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite
  5. Insomnia or hypersomnia
  6. Psychomotor agitation or retardation
  7. Fatigue or loss of energy
  8. Feeling worthlessness or excessive or inappropriate guilt
  9. Diminished ability to think or concentrate
  10. Recurrent thoughts of death or suicide

If these signs and symptoms are all too familiar please consider reaching out to your primary care provider for help. Most physicians, physician assistants, and nurse practitioners are comfortable treating depression and will refer you to a psychiatrist for more specialized care, if needed. 

 

Anxiety

Anxiety disorders are the most common mental health disorder in the US. Nearly 40 million people suffer from anxiety, yet only 37% receive treatment despite the high success of treatment. Like sadness, feeling stress is a normal part of life. So how do you know when stress is no longer a response to an actual situation, but rather an emotional reaction to ongoing stress and which may be pathological?

When stress and worry start to interfere with daily functioning you should pay attention. The DSM-IV diagnostic criteria is:

  1. Excessive worry occurring more days than not for at least six months about a number of events, such as work or school performance
  2. Difficulty controlling the worry
  3. Anxiety and worry associated with three or more of the following symptoms:
    1. Restlessness
    2. Easily fatigued
    3. Difficulty concentrating 
    4. Irritability
    5. Muscle tension
    6. Sleep disturbance
  4. The focus on anxiety and worry is not associated with worrying about having a panic attack, being contaminated with certain pathogens, being away from home, gaining weight, or having a serious illness (these are signs that you may have an anxiety-related diagnosis like PTSD or OCD). 

If the above signs and symptoms are a huge part of your life, please consider reaching out to your primary care provider to find out more. Anxiety disorder is common and is the most treatable mental health disorder today. 

 

Conclusion

My journey with mental health started 20 years ago during a college trip to Africa. Like many naive young adults, I was going to another country to make a difference. Little did I know I would be the person forever changed. After years of struggling with fear, guilt, and confusion, I finally found my path. I had a doctor who provided me with medical treatment and a therapist that changed my life. Looking back, I am thankful for my experience because it’s made me who I am today; a better mom, wife, friend, and nurse. 

Although I am a Nurse Practitioner by training, I am not your Nurse Practitioner. This information is for educational purposes only and should not be used as medical advice, diagnosis, or treatment. Always seek the advice of your personal provider with any questions you may have regarding a medical condition or treatment or before beginning a new healthcare regimen. Never disregard medical advice or delay in treatment because of something you read in this or any article.