Out of Hiding

Mental health awareness paves the way for better diagnosis and treatment
Niki Stojnic  |   Seattle Health Fall/Winter 2013-2014   |  FROM THE PRINT EDITION

Depression also is also often linked with PTSD, which falls under the umbrella of anxiety disorders. Though PTSD is not solely limited to veterans, Seattle’s proximity to Joint Base Lewis-McChord and the high number of veterans returning from military action abroad make it loom especially large here. According to the U.S. Department of Veterans Affairs, depression is nearly three to five times more likely in those with PTSD than those without PTSD. Both tracking down veterans who suffer from PTSD, and getting them to admit a problem are a huge challenges for mental health professionals. “In the military we’re trained to be tough; it’s one thing if you break a leg, but mental illness is seen as a weakness. Before somebody can get help, they have to admit they’re dealing with it,” says Kevin St. Jacques of Sound Mental Health, a PTSD expert who speaks about the disorder nationwide and is himself a veteran. “We’re getting vets through the criminal justice system, and the judges finally say, ‘You need to get treatment.’”

Mental health practitioners in Seattle are also participating in a nationwide initiative called Mental Health First Aid USA, a program that works a bit like CPR training, but for mental health: Mental health professionals volunteer to teach laypeople, in 12-hour sessions, how to identify and handle a mental health crisis, such as suicide. “The goal is to reach out to the community; they go and train the community on what it means to recognize that someone in your neighborhood, on the street, on the bus, might be having a mental health issue. They’re really talking to people about how talk to them,” says Egner.

Researchers are now looking at how early intervention can help curb depression, anxiety disorders and other mental health issues in adulthood, as well as learning how early childhood trauma can manifest itself in adulthood. “Early intervention is key; we also do ‘trauma-informed care’ in the sense that you treat everyone as if they’ve experienced trauma,” says Winston. “What we know now is that trauma can occur in many different forms, and children grow up stuck in fight-or-flight mode.”

Says Egner, “People are resilient by nature and trauma manifests in lots of different ways—some people push it down for years, some people get PTSD. The goal is to destigmatize all of that and let people know that it’s OK and there’s resources for you.”

Another champion for early intervention is Seattle Children’s, which has been studying mental health in children and adolescents from several aspects. In one recent study, published in April in the Journal of Clinical Child & Adolescent Psychology, researchers found that among 11- to 15-year-olds, those who received group intervention with a positive approach experienced more of a reduction in depressive symptoms compared to those who received one-on-one support that did not emphasize positivity. The medical center also is currently conducting a study for kids and teens to learn more about behavioral activation therapy and whether it can help them cope with depression.

Last year, University of Washington researchers published a study in Nature in which they identified a neurological link between stress and depression: a peptide that would bind to receptors in an area of the brain that is involved with motivation, pleasure and social behavior. In an experiment using mice, the scientists found that when good things happened, the peptide binds to a receptor that releases dopamine, which helps give the feeling of reward or excitement. When the mice were stressed, the peptide failed to cause the dopamine to release, and over a longer term, the effect was to cause the mice to avoid the area where would receive doses of the peptide.

All of the recent research and community initiatives on both a local and national scale are heartening for bringing mental health issues out into the open.

According to Sound Mental Health’s Winston and Egner, in recognizing mental health problems, the first circle of support is your personal support system. After that, medical providers, churches and other community groups can help recognize when it might be time to seek help. “Being aware of everyday worries getting out of hand; periods of highs and lows, starting to be super irritable, confused, you can’t think things through—these all suggest you might be having mental or emotional problems; certainly suicidal thoughts are also a big indicator, as well as substance abuse,” says Winston.

Everyone agrees that destigmatizing depression comes down to education and conversation. Egner says, “There are education and brain studies offering proof that it’s not that you aren’t strong enough—it’s not a character flaw.” ✚