It starts with a conversation
The pandemic has taken a toll on most everyone and while some people are managing, others are facing significant struggles. A survey conducted by the Centre for Addiction and Mental Health (CAMH) and Delvinia found that one year into the pandemic, approximately one-in-five Canadians were reporting high levels of mental distress.
The effects of the pandemic are many — isolation, financial stresses, restrictions in activity, uncertainty and first-hand experiences with COVID-19, to name a few. Given the upheaval in the lives of so many, even individuals who have had no history of serious episodes of mental distress could be experiencing them now. In fact, during the first few months of the pandemic, patient visits at CAMH increased from 300 per month to 3,000.
While not all family physicians are equipped with the tools or expertise to counsel and treat their patients’ mental health issues, they can certainly help lessen these struggles and, when necessary, point their patients towards resources to seek the help they may need.
Dr. David Gratzer, an attending psychiatrist and the co-chief of the General Adult Psychiatry and Health Systems Division at CAMH, believes three simple words can open a door to patients who seem like they may be in distress.
How are you?
Patients often want to share with their doctors, but may be holding back due to stigma, shame or a fear of being vulnerable. In setting the stage for a conversation, physicians can create a safe environment for patients to open up and share when they may need it most.
“If a patient’s mental health has been affected or if their stress has taken on a life of its own — for example, if they’re so worried about paying rent next month that they are having difficulty getting out of bed — perhaps it’s time to start a conversation,” says Dr. Gratzer. “Physicians can provide that gentle nudge to help them get there. It’s important to listen and allow patients to be heard.”
Family physicians also have the added benefit of being familiar with their patients’ histories involving mental illness, as well as insight into their typical behaviours at lower levels of stress.
Dr. Gratzer noted it’s important for patients to understand that being stressed during times like this is a natural response. Being able to communicate how they’re feeling may help them realize they’re coping better than they believe. Feeling stress will inevitably lead to various coping strategies, but it’s important patients understand that some are better than others.
“Patients need to be careful about how they cope. It’s enormously tempting to look to alcohol and other substances — and it seems that many people do — but that’s a decision which could haunt them moving forward,” added Dr. Gratzer.
The CAMH and Delvinia survey examined alcohol as a proxy for all addictive substances and found 25.7 percent of people suggested that in the week prior to being surveyed, they had participated in binge drinking.
“When I speak with patients, I’m very careful to emphasize that we might all feel stressed, particularly people whose lives have been greatly affected by COVID, such as those in the hospitality industry or in small business,” said Dr. Gratzer. “But it’s important to choose ways of coping that are healthful and will not ultimately undermine us, such as healthy diet and regular exercise. If appropriate, I do make a point to bring up substance-use because patients often feel reluctant to speak about it.”
Dr. Gratzer highlights the need for an open, welcoming approach when providing patients with help and advice surrounding mental health issues.
“Tough talks with patients tend not to accomplish very much,” he said. “Motivational interviewing is a very powerful tool in communicating with patients. For example, instead of saying, “Don’t drink,” asking open-ended questions like, “How do you think alcohol is affecting your goals?” or “How could you be doing better?”, and allowing patients to explore the topic can be very helpful in clarifying things in their minds.”
Mental health affects us all
It’s not only patients who are managing mental health struggles during these unprecedented times, but physicians as well. Being a physician during a global public health crisis can take a heavy toll, even if they don’t appreciate it as such.
“Physicians are a tough group to talk to about these sorts of problems. Often, we like to believe we don’t get ill, and though there might be concepts like burnout and depression, they only apply to other people and not to ourselves.
“Physicians need to remember they’re human too. Doctors do get mental illness. It’s important for the sake of ourselves, our families and our patients to recognize when we might be struggling and seek appropriate help.”
This recognition can be internal, but it can also extend to fellow physicians, nurses and health-care workers. Just as one might help patients through mental health struggles, Dr. Gratzer stressed the need to create a safe environment and listen when reaching out to colleagues.
“Be respectful. Be thoughtful. Don’t do it on the way out the door. Create the time and the space to have that conversation. And just like patients, it’s important to remember physicians can get better.”
As COVID-19 cases go down, the availability of vaccines increases and vaccine hesitancy lowers, physicians should be hopeful and pass along that positivity to patients. But they must also remain vigilant and continue to be mindful of their patients’ mental well-being.
“When we examine the effects of SARS, long after the physical health issues abated, people struggled with mental health problems, particularly depression and PTSD in those who had a complicated course with the disease and survived it.
“Be cautiously optimistic, but don’t forget there is a mental health component to COVID-19. When the last patient is discharged from the ICU — hopefully in the not-too-distant future — there is still work ahead in caring for patients.”
Whether it’s with patients, fellow physicians or others, continue to start conversations. Continue to ask, “How are you?”
Resources to share with patients
- Website: The Centre for Addiction and Mental Health
- Resource: Coronavirus disease 2019: Achieving good mental health during social isolation
Resources for physicians
- Website: Physician Health Program: Ontario Medical Association
- Self-assessment: American Psychiatric Association: Well-being and Burnout
- Podcast: What all physicians need to know about cannabis use and how to talk to our patients about it
- Podcast: What all physicians need to know about physician burnout