Dr. Nick Dewan discusses mental wellness and how to lead a healthy lifestyle.
Learn more about mental wellness and BayCare's behavioral health services.
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Mental Wellness
Featured Speaker:
He is a member of the physician leadership team within the BayCare Health System providing input to the hospitals, medical group, accountable care organization, and insurance-based initiatives. He has the respect of national hospital, managed behavioral health, community mental health, and consumer advocacy groups, and sits on the Council of Healthcare Systems and Finance of the American Psychiatric Association. Dr. Dewan is also a member of the Board of the Positive Coaching Alliance of Tampa Bay. He is a graduate of the Medical College of Ohio, and completed his residency in psychiatry at Los Angeles County-USC Medical Center and UCSD School of Medicine. He is a Diplomate of the American Board of Psychiatry and Neurology and the American Board of Addiction Medicine. He is also a board certified physician executive and a former collegiate tennis player and coach.
Nick Dewan, MD
Dr. Nick Dewan is a pioneer and an accomplished physician leader and sports psychiatrist with a nationally respected track record in health care value improvement and information technology. Currently, he serves as Chief Medical Officer for the Behavioral Health Division of the BayCare Health System. In 2015, he published his third book on information technology “Mental Health Practice in a Digital World: A Clinicians Guide”. His clinical experience includes work in emergency, hospital, outpatient, addiction medicine, and sports medicine settings. He is a sought after speaker and is interviewed by local and national media on behavioral health issues and sports performance topics. His work on clinical guidelines, performance bonuses for quality, efficient use of healthcare, best practice adoption, and patient empowerment and technology positions him as a leading expert in an era of accountable healthcare.He is a member of the physician leadership team within the BayCare Health System providing input to the hospitals, medical group, accountable care organization, and insurance-based initiatives. He has the respect of national hospital, managed behavioral health, community mental health, and consumer advocacy groups, and sits on the Council of Healthcare Systems and Finance of the American Psychiatric Association. Dr. Dewan is also a member of the Board of the Positive Coaching Alliance of Tampa Bay. He is a graduate of the Medical College of Ohio, and completed his residency in psychiatry at Los Angeles County-USC Medical Center and UCSD School of Medicine. He is a Diplomate of the American Board of Psychiatry and Neurology and the American Board of Addiction Medicine. He is also a board certified physician executive and a former collegiate tennis player and coach.
Transcription:
Mental Wellness
Melanie Cole (Host): Millions of people in the United States are affected by mental illnesses and mental health disorders each year. But there are so many treatment options available and here to tell us ways to help yourself with mental wellness is my guest Dr. Nick Dewan. He's the Chief Medical Officer in the Behavioral Health Division of BayCare. Dr. Dewan, always a pleasure to have you on. You give us such great advice. In your opinion, does there seem to be an uptick in mental health issues lately and if so, to what do you attribute that?
Nick Dewan, MD (Guest): That's a great question. When you look at the data around the country, there has been a slight uptick in stress based disorders, anxiety based disorders. So, yeah, we are seeing a little uptick in that area. And obviously, there are always two reasons or three reasons for these kinds of rates to go up. Number one, there's just less stigma, so people are more open to saying I need help.
The other thing is, there's just greater stress around and I think that the third thing is we may have not developed the skillsets to contend with the new stressors. We are in a brand new world and we haven't come up with the skills that we need to sort of cope and deal with the stressors in life. So, I think those are the three reasons.
Host: So, you mentioned the stigma, Dr. Dewan, do you feel that there is still a stigma around mental health issues so, people are sometimes more reluctant to seek help for depression or other mental health issues? And do you feel that there is a lack of mental health resources for all of these changes you mentioned?
Dr. Dewan: I have seen significant progress in the stigma issue. I really have. And when you look at whether it's media or social media; people are able to share their pain and suffering. You see more open conversations about whether it's depression, anxiety, bipolar disorder, substance use. So, I think people are more willing to share but it's not a common thing. You remember back 40 or 50 years ago; people didn't talk about cancer. And now, we have walks, we have people in remission and it's okay to say you know what, I got diagnosed with this, but I'm getting treatment.
We still have not reached the point where everybody can be comfortable with yeah, I'm in treatment for depression or I'm in treatment for anxiety. So, there is still a stigma remaining. And there's a stigma remaining not only when you are in treatment but there's a stigma remaining when you try to access treatment.
Now with respect to the issue of are there enough resources; there are hundreds of thousands of therapists in the United States. Hundreds of thousands of psychologists in the United States. But there's a small number of what I would call medical experts in psychiatry.
And so, the real challenge for us is how do we utilize those hundreds of thousands of say non-psychiatrists to contend with the demand for mental health problems and reserve what I would call the specialty care for the psychiatrists. So, I think there are a large number of resources out there. I don't think people know how to navigate those resources, how to get in, how to make sure that they reach the right person for the right condition. So, what I really think is we have to become more efficient with what I would call the navigation and coaching versions of what's going on. And then we can utilize those existing resources throughout the country.
Host: What a great point that you made Dr. Dewan, so, what are some red flags? If someone feels anxious all the time. I mean we all worry about stuff and we worry about finances and our kids and all these things; but what are some signs in you or a loved one that would signal you know what, this is more than just your average worry. When do you seek help?
Dr. Dewan: Let me backtrack a little bit because I really want to highlight this whole area of mental wellness and then I'm going to answer your question about, how do tell the difference between say this is just normal life stuff versus I've got something potentially that I need treatment for.
So, when we talk about regular wellbeing, it's basically are you able to reach your old potential. Are you able to cope with the normal stressors in life? Can you work productively and fruitfully? Are you making a contribution to your community? That's sort of the WHO definition of just mental health, wellbeing.
Now if you are not able to cope with normal stress, if your emotional state is severe anxiety where it affects your body, your heart races, your blood pressure goes up, you can't go to work, you are not able to converse with people, you are not able to function in what we call your normal roles in life. And your roles can be multiple roles in life. Your role can be somebody who is at work. Your role can be as a parent. Your role can be as a spouse. But if you're falling short and you're not able to function; that's when you know, you know what, it's time to get some help. Because I'm not – my wellbeing, my mental wellness is now going into this sort of across the spectrum of this is normal worry. It's when you can't function in your multiple roles in life is when you need help.
Host: So, what types of treatments. People hear about things like antidepressants and they worry about just that and side effects from those types of medications and myths surrounding them. But there are so many types of therapy; behavioral therapy and cognitive therapy and psychotherapy. There's so many different ways that people can seek help. Tell us about briefly, because there are so many, some of the different treatment options and then I'd like to get into some of the things that we can do for our own mental wellness. Things that we can work on at home and every day.
Dr. Dewan: Absolutely. So, obviously, what you just mentioned the cognitive, behavioral; there are many types of what I would call psychotherapies meaning therapies that allow you to figure out heh why do I think the way I think. Why do I feel the way I feel? And why do I behave the way I behave? And can I develop some skillsets, some patterns of thinking, some patterns of behavior and patterns of what I would call regulating my emotions? Most mental health issues do not require medication intervention.
Seventy to eighty percent don't require any medicine at all. But it's a matter of going to a professional whether the professional's strategy is let's just work on your thoughts, let's work on how you handle relations, let's look at how you develop your patterns of behavior over your lifespan. That's therapy. And 80%, like I said, 70 to 80% do just fine. Now for you, practice at home; there is an emerging science that there are four or five things people can do to really make themselves what I would call mentally strong. And that is, number one, there's this issue of or there's this practice of mindfulness, which is stilling the mind, absorbing the present. There's yoga-based meditation and breathing exercises which actually can lower your blood pressure, actually can lower your what I would call baseline anxiety.
And then not only that, there's – you can actually use better food, moving, exercise and then introduce the concept of what I would call gratitude and compassion in your daily life. Any opportunity to give thanks, any opportunity to show positive emotion; take advantage of that. Because just imagine, if somebody spent three to five minutes a day just being mindful or doing some slow relaxation breathing exercises, took the time to say one nice thing to somebody else every day and then took the time to look at how they are doing in their role as whether they are a parent or spouse or work and say what can I tweak a little bit today. Just doing that, will make people feel better and of course, the one thing that people don't do that we know in the literature is very supportive of mental wellness; is this whole concept of spirituality.
And some people do have a spiritual focus, some people don't. But the literature says that involvement in spiritual activities really does help one's mental wellness. So, the old concept of mind, body, spirit; there's science to back it up.
Host: Wow, what a great explanation and really good useable tips. I mean I'm listening because as I said, we are all suffering from various forms of anxiety and it feels like a fever pitch. So, as we wrap up, what would you like us to know about sleep quality and doing this mindfulness and then really when you feel Dr. Dewan, it's time, you've tried these things. You are going to continue to try these things but also maybe talking to somebody would really help settle you down.
Dr. Dewan: So, sleep; first of all, don't watch TV in your bed. That's number one. If you are going to be in your bed, shut off the lights, don't watch the TV, don't look at your phone and text people right before you go to sleep. And if you can't sleep for 15 minutes when you are in bed, go to a different room. So, that's number – that's the most important thing people can do for making sure they sleep well.
And then finally, just I want to reiterate the point, if you've gone through a couple of weeks and you've embraced this concept of you know what, I'm going to try to be mindful, I'm going to take some breathing exercises a day, I'm going to reach out to friends; if that doesn't work for a couple of weeks; pick up the phone. Pick up the phone and if you work for a company that has an EAP; call the EAP. If you have a primary care doc, call your primary care doctor and say, I need to talk to you. I need you to send me to somebody because I've tried my best, I've gone to my friends, I've gone to my church, I've talked to people; I cannot figure out why things aren't working.
So, yeah, take those steps but then use the resources you have currently, and I think we're at a point where the professionals are sophisticated enough to say congratulations on asking for help. Thank you for asking for help. This is a courageous thing you are doing. Let me get you to the right place. So, I think that's the advice I would give people.
Host: And that is absolutely great advice. Dr. Dewan, a pleasure as always. Thank you so much for joining us and sharing your incredible expertise, giving us such great useable information. Thank you again. And that wraps up this episode of BayCare HealthChat. You can head on over to our website at www.baycarebehavioralhealth.org for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please share with friends and family members, share on social media. We all can learn from these experts together and we can help each other out. It's so important at this time and don't miss all the other really interesting podcasts in our library. Until next time, I'm Melanie Cole.
Mental Wellness
Melanie Cole (Host): Millions of people in the United States are affected by mental illnesses and mental health disorders each year. But there are so many treatment options available and here to tell us ways to help yourself with mental wellness is my guest Dr. Nick Dewan. He's the Chief Medical Officer in the Behavioral Health Division of BayCare. Dr. Dewan, always a pleasure to have you on. You give us such great advice. In your opinion, does there seem to be an uptick in mental health issues lately and if so, to what do you attribute that?
Nick Dewan, MD (Guest): That's a great question. When you look at the data around the country, there has been a slight uptick in stress based disorders, anxiety based disorders. So, yeah, we are seeing a little uptick in that area. And obviously, there are always two reasons or three reasons for these kinds of rates to go up. Number one, there's just less stigma, so people are more open to saying I need help.
The other thing is, there's just greater stress around and I think that the third thing is we may have not developed the skillsets to contend with the new stressors. We are in a brand new world and we haven't come up with the skills that we need to sort of cope and deal with the stressors in life. So, I think those are the three reasons.
Host: So, you mentioned the stigma, Dr. Dewan, do you feel that there is still a stigma around mental health issues so, people are sometimes more reluctant to seek help for depression or other mental health issues? And do you feel that there is a lack of mental health resources for all of these changes you mentioned?
Dr. Dewan: I have seen significant progress in the stigma issue. I really have. And when you look at whether it's media or social media; people are able to share their pain and suffering. You see more open conversations about whether it's depression, anxiety, bipolar disorder, substance use. So, I think people are more willing to share but it's not a common thing. You remember back 40 or 50 years ago; people didn't talk about cancer. And now, we have walks, we have people in remission and it's okay to say you know what, I got diagnosed with this, but I'm getting treatment.
We still have not reached the point where everybody can be comfortable with yeah, I'm in treatment for depression or I'm in treatment for anxiety. So, there is still a stigma remaining. And there's a stigma remaining not only when you are in treatment but there's a stigma remaining when you try to access treatment.
Now with respect to the issue of are there enough resources; there are hundreds of thousands of therapists in the United States. Hundreds of thousands of psychologists in the United States. But there's a small number of what I would call medical experts in psychiatry.
And so, the real challenge for us is how do we utilize those hundreds of thousands of say non-psychiatrists to contend with the demand for mental health problems and reserve what I would call the specialty care for the psychiatrists. So, I think there are a large number of resources out there. I don't think people know how to navigate those resources, how to get in, how to make sure that they reach the right person for the right condition. So, what I really think is we have to become more efficient with what I would call the navigation and coaching versions of what's going on. And then we can utilize those existing resources throughout the country.
Host: What a great point that you made Dr. Dewan, so, what are some red flags? If someone feels anxious all the time. I mean we all worry about stuff and we worry about finances and our kids and all these things; but what are some signs in you or a loved one that would signal you know what, this is more than just your average worry. When do you seek help?
Dr. Dewan: Let me backtrack a little bit because I really want to highlight this whole area of mental wellness and then I'm going to answer your question about, how do tell the difference between say this is just normal life stuff versus I've got something potentially that I need treatment for.
So, when we talk about regular wellbeing, it's basically are you able to reach your old potential. Are you able to cope with the normal stressors in life? Can you work productively and fruitfully? Are you making a contribution to your community? That's sort of the WHO definition of just mental health, wellbeing.
Now if you are not able to cope with normal stress, if your emotional state is severe anxiety where it affects your body, your heart races, your blood pressure goes up, you can't go to work, you are not able to converse with people, you are not able to function in what we call your normal roles in life. And your roles can be multiple roles in life. Your role can be somebody who is at work. Your role can be as a parent. Your role can be as a spouse. But if you're falling short and you're not able to function; that's when you know, you know what, it's time to get some help. Because I'm not – my wellbeing, my mental wellness is now going into this sort of across the spectrum of this is normal worry. It's when you can't function in your multiple roles in life is when you need help.
Host: So, what types of treatments. People hear about things like antidepressants and they worry about just that and side effects from those types of medications and myths surrounding them. But there are so many types of therapy; behavioral therapy and cognitive therapy and psychotherapy. There's so many different ways that people can seek help. Tell us about briefly, because there are so many, some of the different treatment options and then I'd like to get into some of the things that we can do for our own mental wellness. Things that we can work on at home and every day.
Dr. Dewan: Absolutely. So, obviously, what you just mentioned the cognitive, behavioral; there are many types of what I would call psychotherapies meaning therapies that allow you to figure out heh why do I think the way I think. Why do I feel the way I feel? And why do I behave the way I behave? And can I develop some skillsets, some patterns of thinking, some patterns of behavior and patterns of what I would call regulating my emotions? Most mental health issues do not require medication intervention.
Seventy to eighty percent don't require any medicine at all. But it's a matter of going to a professional whether the professional's strategy is let's just work on your thoughts, let's work on how you handle relations, let's look at how you develop your patterns of behavior over your lifespan. That's therapy. And 80%, like I said, 70 to 80% do just fine. Now for you, practice at home; there is an emerging science that there are four or five things people can do to really make themselves what I would call mentally strong. And that is, number one, there's this issue of or there's this practice of mindfulness, which is stilling the mind, absorbing the present. There's yoga-based meditation and breathing exercises which actually can lower your blood pressure, actually can lower your what I would call baseline anxiety.
And then not only that, there's – you can actually use better food, moving, exercise and then introduce the concept of what I would call gratitude and compassion in your daily life. Any opportunity to give thanks, any opportunity to show positive emotion; take advantage of that. Because just imagine, if somebody spent three to five minutes a day just being mindful or doing some slow relaxation breathing exercises, took the time to say one nice thing to somebody else every day and then took the time to look at how they are doing in their role as whether they are a parent or spouse or work and say what can I tweak a little bit today. Just doing that, will make people feel better and of course, the one thing that people don't do that we know in the literature is very supportive of mental wellness; is this whole concept of spirituality.
And some people do have a spiritual focus, some people don't. But the literature says that involvement in spiritual activities really does help one's mental wellness. So, the old concept of mind, body, spirit; there's science to back it up.
Host: Wow, what a great explanation and really good useable tips. I mean I'm listening because as I said, we are all suffering from various forms of anxiety and it feels like a fever pitch. So, as we wrap up, what would you like us to know about sleep quality and doing this mindfulness and then really when you feel Dr. Dewan, it's time, you've tried these things. You are going to continue to try these things but also maybe talking to somebody would really help settle you down.
Dr. Dewan: So, sleep; first of all, don't watch TV in your bed. That's number one. If you are going to be in your bed, shut off the lights, don't watch the TV, don't look at your phone and text people right before you go to sleep. And if you can't sleep for 15 minutes when you are in bed, go to a different room. So, that's number – that's the most important thing people can do for making sure they sleep well.
And then finally, just I want to reiterate the point, if you've gone through a couple of weeks and you've embraced this concept of you know what, I'm going to try to be mindful, I'm going to take some breathing exercises a day, I'm going to reach out to friends; if that doesn't work for a couple of weeks; pick up the phone. Pick up the phone and if you work for a company that has an EAP; call the EAP. If you have a primary care doc, call your primary care doctor and say, I need to talk to you. I need you to send me to somebody because I've tried my best, I've gone to my friends, I've gone to my church, I've talked to people; I cannot figure out why things aren't working.
So, yeah, take those steps but then use the resources you have currently, and I think we're at a point where the professionals are sophisticated enough to say congratulations on asking for help. Thank you for asking for help. This is a courageous thing you are doing. Let me get you to the right place. So, I think that's the advice I would give people.
Host: And that is absolutely great advice. Dr. Dewan, a pleasure as always. Thank you so much for joining us and sharing your incredible expertise, giving us such great useable information. Thank you again. And that wraps up this episode of BayCare HealthChat. You can head on over to our website at www.baycarebehavioralhealth.org for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please share with friends and family members, share on social media. We all can learn from these experts together and we can help each other out. It's so important at this time and don't miss all the other really interesting podcasts in our library. Until next time, I'm Melanie Cole.