A look at mental health
Nova Scotia health experts offer insight into the struggle for wellness of mind
Mental health can be looked at like a bucket of water.
When people are mentally healthy, their buckets are full. It means they can be effective in their lives. It doesn’t mean they don’t feel pain or discomfort, but they're able to manage those feelings effectively.
But circumstances or situations can cause that bucket to empty.
“Some people come into the world in environments that drain their bucket a little bit more than other people. Either with their genetics, family environment and then also the way they interpret the world,” says Tammy Kontuk, a clinical psychologist at RiverStone Psychology and Counselling, New Glasgow, with over 18 years experience.
To refill and or maintain one’s bucket, people can do things that help their mental health, like exercise, sleep or doing something that fulfills them. But if doing those things requires a little water to start, and people are already low, it can feel like an uphill battle.
It is not events that cause suffering, but how people interpret said events, says Kontuk.
That is why a number of people can all experience the same event but have vastly different responses. Kontuk gives the example of the pandemic. For some, the pandemic has provided a chance to slow down, recharge and positively reflect, but for others, it has deprived them of all things that bring them joy.
She says a good amount of the time, from a cognitive point of view, many of people’s interpretations of the world/events can be skewed or biased. They don’t line up with facts and these interpretations then cause emotions that can be challenging to deal with.
For example, take someone who gets anxious about making phone calls. They could fear that if they call someone, they’ll sound stupid or be met with disdain. This idea persists to a crippling degree, even though they might rationally know the chances of these things occurring are low, or that if they do, the repercussions will be more or less harmless.
“We actually have to face the thing that we fear in order to discover that the monster in the closet has no teeth, but so many times our anxiety prevents us from facing that.”
Mental illnesses or mental disorders are health conditions in which one’s poor mental health disrupts a significant part of their life and or their ability to function in important areas of their life like school, relationships and work.
“I think we all need to check-in. Maintaining our mental health is something we all need to do regularly just like maintaining our physical health,” says Kontuk.
These are just some questions people can ask themselves when contemplating their mental health.
• What is my ratio of positive to negative emotions?
• Do I have a reasonable level of self-compassion and self-acceptance instead of self-criticism or high standards that seem unattainable?
• Do I keep a daily routine that provides joy or satisfaction?
• Am I living my values? Kontuk says the opposite of depression is not happiness, it is vitality. “Happiness, meaning and purpose boil down to living your values. Not the standards and expectations that others set for you.”
HELPING OTHERS AND HOW WE GOT HERE
Other peoples’ emotions can be hard to deal with. When a loved one is suffering, in a way that can not be instantly fixed, it can make people feel helpless. This in turn can even make people feel angry.
It can be hard to sit with someone in their suffering, yet usually, that is the best thing you can do for someone, says Kontuk.
“Really taking that time to connect to a person and say like ‘I’m here for you. I don’t know how to fix it, but I am open and I can hold space for your pain’ that is the first step that allows somebody to not carry it by themselves and that in itself regulates emotion,” Kontuk says.
In these cases, when people’s emotions are rising to their crest it can be hard for them to think rationally and logically. Yet, if they can sit with someone and be comforted, their nervous systems can calm down.
From there they can be brought back to a space where they can deal with and process what is going on.
“It’s just like when a baby cries or when a child is upset, they bang their knee and run to their parent. Their parent soothes them.”
This concept of holding space for someone can seem foreign to those, of any age, who were never encouraged or permitted to express their emotions.
“I’ve often said to youth that I work with nowadays that ‘you’re really the first generation that’s been allowed to have emotions,” says Kontuk.
Growing up in the ‘60s, ‘70s, 80’s children’s expression of emotion had a tendency to be interpreted as poor behaviour and punished instead of soothed.
Youth of today, in general, are much better at expressing their emotions and admitting their suffering. Yet just because older generations aren’t vocalizing their pain doesn’t mean it is not there.
Learning to suppress your emotions and not dealing with them effectively doesn’t make someone OK, it just makes it hidden, says Kontuk.
Generational differences may make conversations about mental health hard, but something that unites everyone’s mental health is genetics.
Just like people can be predisposed to diabetes if
it runs in their families, people can be predisposed to mental illness and or addictions.
Yet, genetics aren’t destiny. Just because someone has a parent with anxiety doesn’t mean they have to have anxiety themselves.
“Genetics loads the gun, but the environment pulls the trigger,” says Kontuk.
People being aware of their mental health and talking about it is a great place to start, but it’s really just the first step.
HELPING YOURSELF AND THE WAY FORWARD
If someone finds that they are mentally unwell, Kontuk suggests starting with the basics, getting enough sleep, eating well, and exercising.
Kontuk says getting 90 minutes of moderate level exercise a week has gone head-to-head with antidepressants for effectiveness for mild-moderate depression.
There are also apps and online services that are readily available. Kontuk gives the example of the YouTube channel Therapy in a Nutshell which has videos on anxiety skills, eating disorders and how to stop panic attacks. Or Feelinggood.com which has free anxiety and depression courses.
As for real-time personto-person care, there is a Community Mental Health and Addictions Clinic, as well as an Opiate Treatment Replacement Program, located at 690 East River Road in New Glasgow.
There are also a handful of local private clinics, that while pricey, can be made more accessible by certain health coverage.
When it comes to discussing mental health treatment methods it is important to understand that any singular or combination of methods is fine. All of them serve as tools that will or won’t work, or be needed, depending on the person.
“You do what you think is right for you,” says Michelle Stewart, a clinical pharmacist in New Glasgow.
One tool to improve mental health is medication. Medication of any kind can be intimidating, there is a lot of fear in the unknown.
This is why Stewart says it is important that people educate themselves by using trustworthy sources and if they want to start the conversation of trying medication, to talk to a trusted medical professional who can help you navigate. This can include family doctors, nurse practitioners and also your local pharmacists.
“Contrary to what some people might think, it’s not the opinion of pharmacists that medication is the answer necessarily,” she says.
Pharmacists can suggest different methods of treatment, can help people talk through their symptoms, can help tailor medication to each individual and or help them prepare for a conversation with their family doctor or a nurse practitioner.
They also have private spaces for these intimate conversations to take place.
When talking about mental health medication, while it is not a direct comparison, Stewart compares it to someone who was deficient in iron. It would make sense for someone who is iron deficient to feel tired, unmotivated, weak yet with a daily iron supplement this can be remedied.
“First-line medications for the most commonly reported mental health conditions like anxiety or depression, those medications are not addictive, that is a misconception. They do not change your personality, they don’t alter who you are, they don’t change your values or your ethics.”
They help to regulate the neurotransmitters in people’s brains to make them more parallel to people who aren’t experiencing anxiety or depression. It is an aid that helps balance things like serotonin, epinephrine and dopamine to where they are intended to be.
Stewart also wants people to understand that because the medication is not mindaltering, they are subtle, and they take time. People can think the medication isn’t helping and that they aren’t helpable, but it can take up to 12 weeks at the appropriate dose to see the maximum benefit.
People can also quit taking medication prescribed for their mental health at any time, stop taking it then resume, or continue to take it for long periods of time.
Whether medication is right for someone or not, Stewart doesn’t want people to be afraid to start the journey of getting help. Everyone is worthy of help and deserves to live their best life, she says.
A lot of dialogue around mental health is centered around how to help people who are hurting, but there are also more preventive measures that can be taken.
“Our mind has its own behaviour, and we are never taught how to effectively deal with the behaviour of our mind and our emotions,” Kontuk says. “We all know how to do CPR for a heart attack, but nobody knows how to help a friend with depression,” she says.
She continued that teaching mental health skills should be further implemented in schools as well as being taken on by all avenues, like popular media and the model of our workplaces.
Then when looking at root causes of mental health, much of it is beyond the individual. The social and structural determinants of mental health have a huge impact.
Social determinants are elements of people’s lived experiences like poverty, discrimination of all kinds, adverse early life experiences, food scarcity, job instability and access to housing.
“Looking at Nova Scotia
we really don’t fare that well, even within a national perspective in terms of the social determinants of health,” says Dr. Katie Aubrecht, Canada Research Chair in Health Equity and Social Justice and Assistant Professor in the Department of Sociology at St. Francis Xavier University.
From The Canadian Centre for Policy Alternatives, Nova Scotia has the highest rate of child poverty in Atlantic Canada and the third-highest provincial child poverty rate in Canada, which has been the case for several years.
In 2017-2018 according to Statistics Canada, Nova Scotia had the highest prevalence of food insecurity out of the ten provinces. Meanwhile, the province is also facing a housing crisis.
These things not only can contribute to poor mental health but also access to help.
“People may not seek care, they may be less likely to seek care, because they experience stigma and discrimination in the system or from the system,” says Aubrecht.
The structural determinants of health on the other hand include the governing process and economic and social policies and ideologies.
Aubrecht says when addressing structural determinants people with decision-making power need to listen and meaningfully involve people who have lived experience and expertise under these determinants.
This way they can better understand what the issues actually are on a personal and community level.
“First-line medications for the most commonly reported mental health conditions like anxiety or depression, those medications are not addictive, that is a misconception. They do not change your personality, they don’t alter who you are, they don’t change your values or your ethics.” Michelle Stewart Clinical pharmacist