September is National Suicide Awareness Month. This is a pretty toughened lengthy post for me to write but I think it’s an important and I hope you take the time to read it. So here it goes:

The video in the link below is a great message from the wife and sister of Chester Bennington- lead singer of Linkin Park- who passed away last year from suicide. It is a pretty powerful video whether you like the band or not. Although we have gotten much better as a society, there is still an unfortunate stigma and judgment around mental illness, particularly around suicide. We always hear the “how could he/she do that to their family? they were so successful and had everything? Money. Fame. Talent. etc etc. So selfish” These questions are exact proof that our understanding of mental health is poor. Although there are options for treatment and support, the access to these options leaves much to be desired- whether it be shortage of therapists, psychiatrists, or poor access to meds.

I had a case that helped me understand mental health so much better than anything I learned in medical training. He has given me permission to tell his story. He was a 20 something year old male that had just graduated college and was contemplating going to grad school. He was living at home with his parents and working while applying to grad school. He was educated, outgoing, caring and did not come from a “broken, unloving household” etc. He had suffered some significant losses in his life prior to this but always just kept plugging along not realizing that he had been depressed for years. He was just very good at hiding it from close friends and compartmentalized it very well. That is until the dam broke in his 20’s and the terrible symptoms and thoughts that go along with this illness reared their ugly head. He told me he tried to reach out to therapists/psychiatrists on his own but no one could see him for weeks and most were cash only which at the time he could not afford since he was trying to keep this from his family out of shame and embarrassment. So much for easy access. The process to find help alone was enough to increase the depression and make the thoughts worse. Shouldn’t getting help be easier? Especially when it is for a condition that it’s hard enough to admit you need help? And maybe that one moment could be what saves the person?

So the help came when his parents found him at home after leaving work early because the depression and anxiety were at an all-time high. He figured his parents would be at work midday but that wasn’t the case. It is a good thing they were home because he was brought to his primary care doctor- yes I believe that mental health care starts with good primary care- and he was referred to a therapist who saw him immediately. Things got better, but over the years therapy became a must and medication became a must as the disease would rear its ugly head many more times over. Was there trial and error with meds and luck finding the right fit for a therapist? Of course. It took work, patience, help, and understanding that this is a disease. Sometimes it is a day to day battle, but a majority of the time there is happiness now thanks to medication and help. Yet it still requires a lot of maintenance and self awareness.

So if you have never experienced mental illness in yourself or your loved ones, I hope you take from this that this disease often lives in hiding….in secrecy. It can live behind a visage of smiles and happiness and laughs. It can live behind anyone at any given time. It can present as isolation, irritability, sadness, anger, etc. There is no blood test or scan that makes the diagnosis. As Chesters sister says in the video the key is to bring this issue out of the shadows and into the light. So that’s what I thought I should do.

The patient is me and it is my story, but the illness doesn’t own me. I own it. Physicians, along with veterinarians, have the highest suicide rate of any profession in the country right now. Many of patients know this because I have spoken to them about it in privacy when they are struggling. I have been there and lived it. I have felt hopeless, ashamed, embarrassed, scared, anxious, guilty, etc. However, for a long time now I have felt happy, secure, unashamed, calm(er), and most importantly…alive to experience the love of my two children and so much other joy. Please do not crap on meds and or therapy. They can save peoples lives…or their doctors 🙂

If you are a colleague and feel you need help do not ever hesitate to reach out to me. Same goes for any other human being that reads this. Thanks for reading and know that there are people out there that get it and really do want to help, especially a local primary care doc 🙂 Thanks to Delicia M Haynes for giving me the courage to put this out there. You are an inspiration in many ways.I now hope I can do the same for others. We all have “mental health” and we need to take care of it every day. Without it, physical health means nothing. This one of my favorite Linkin Park songs. So sad that he wrote these words years ago.

Leave Out All the Rest by Linkin Park

https://nowthisnews.com/videos/news/family-of-linkin-parks-chester-bennington-on-mental-health

Todays Boston Globe has an article regarding physician prescribing of opiates to patients that have already experienced an overdose Opiate Prescribing to Patients With OD History. Between the documentary that HBO aired last night regarding the opiate crisis on Cape Cod and this article from today, I felt that as a primary care physician and as a resident of a seemingly “white-picket fence” suburb of Boston that has experienced its own opiate epidemic with the loss of too many good people- many of them kids-to this illness, it was worth commenting on. Many of these kids and young adults I knew and even played street hockey with as a kid. Others I did not know at all, but I can feel the loss when something like this happens.

I am not an Addiction Specialist or a Psychiatrist but as a Family Physician we do often deal with these issues and are usually the front door to the healthcare system. I have treated many patients that struggle with the disease of addiction and it is an extremely complex disease that is extremely difficult to cure and it usually coexists with other mental health diagnoses whether it be ADHD, major depression, anxiety disorders, bipolar disorder etc etc that add to the challenge. The hardest part of the disease to address initially is the denial. As a key cog in the wheels of this disease, denial is the toughest nut to crack. Just like any other chronic disease we treat, patients have to come to some degree of acceptance to move forward, and with addiction denial prevents this from happening easily. Sadly, we have no idea when that bridge of denial will be crossed and what the outlook on the other side looks like, but it needs to be crossed nonetheless.

I may be an idealist at heart and obviously have my biases, but I think one key solution to this epidemic is better primary care. People that struggle with the disease of addiction obviously need a multidisciplinary approach- one that includes doctors, nurses, social workers, counselors, addiction specialists etc- but they also need a primary care doctor that can help them navigate this messed up system, be the teams quarterback, and most importantly know them and treat them as a human being rather than just a “disease”. We need to ask the hard questions such as “with all the stories and news out there on this issue, what drove you to take that pill that started it all? what support system if any do you have? how can WE help YOU get healed? How do we as a community band together to educate and support our kids in a nonjudgmental supportive way? What are WE as a community doing wrong?” It isn’t all about the actual drug or the patient and the choices they have made. Its an US issue because it could be any of our friends, family members, or children that can succumb to this disease. And I don’t know about you but aren’t you tired of reading these obituaries week after week?

Our primary care system and mental health system need an overhaul for many reasons, but this epidemic is a big one. All patients of all socioeconomic backgrounds that struggle with this awful illness deserve better than 15 minute visits. They deserve better than more pills thrown at them. They deserve a relationship that is based on trust, care, and respect. What if the doctors that were studied in the aforementioned article had time to research records and databases during these visits? What if they actually had time to call other members of the patients care team? What if they had time to discuss the risks, benefits, and alternative options for pain management with their patients with appropriate, close followup and communication? I can personally attest to the fact working in the Direct Primary Care model has allowed me to treat patients with addiction 100% better. I have the time to listen, call other resources if needed, and followup frequently by phone or email. I am by no means perfect and do not always have success sadly. Yet there is one thing that DPC has allowed me to show the patient who struggles with addiction that all the Continuing Medical Education and seminars in the world do not even touch on and that is……that I too am an imperfect human being, that I do care, and that there is hope. I know this idealistic view will not solve the whole crisis, but maybe infusing some humanity towards these patients is a good start towards helping them heal and live a healthy life? What we are doing certainly is not enough and to me that is unacceptable.