Zach Irwin: So getting somebody to come to treatment is
only half the battle, it's a matter of applying those things outside of
treatment too.

Caitlin Whyte (Host): The environments that adolescents
surround themselves with can shape their habits and tendencies, therefore
influencing their mental health. Zach Irwin is a counselor at Oakview
Behavioral Health Services at Southwest General and joins us today to
understand how adolescents' mental health is shaped by their environment. This
is Southwest General Health Talk. I'm Caitlin Whyte.

Host: So to start us off today, what are some
commonalities that you see as to why patients struggle with their mental
health?

Zach Irwin: So, there's the whole nature versus nurture
conversation. The nurture side of this would be the socioeconomic factors that
play in people's environments, the settings that they're in, the households
that they live in, the people who they're around, and the relationships they
have. The nature part of this being that there is a lot of genetic links that
we've discovered to a lot of different mental health disorders, such as mood
disorders, depression, anxiety, bipolar disorder; schizophrenia has genetic
links as well as many others. So, it really is a combination of that whole
nature versus nurture argument. And both of them play a pretty significant role
into different commonalities that we see people struggling with.

Host: You know, some people may be listening and
thinking, "Well, I have a supportive family and we're a good base, so
maybe we don't need a professional." But how can a healthcare professional
and that family work together to better address the patient or loved one's
issues at hand.

Zach Irwin: Yeah. So when it comes to these kind of
things, social support is a huge role in mental health treatment and recovery,
and we definitely are glad to hear when that's the case. However, that's not
the only role that you know is happening when people are going through
treatment. When we talk about addressing these needs and the healthcare
professionals aligning with the family, it's important to get on the same page
about what these needs are that need to be met. Nobody knows the patient better
than the patient themselves. They know themselves, their families know them.
And so, it's up to us as healthcare providers to be receptive to what we're
hearing the needs are, as well as implementing our experience and knowledge in
a way that compliments each other as to what the family is identifying and what
we're seeing as clinical impairments as well.

Host: Kind of that third party outside perspective,
right?

Zach Irwin: Absolutely.

Host: So, let's focus on the environment again. So, the
environment in which one puts themselves can shape their character and
behaviors. Now, what specifically is looked at to determine the degree of
healthiness a patient is in? What is taken into consideration?

Zach Irwin: This is a fantastic question and it's
something that really doesn't have enough light shined on it. So when we talk
about mental health disorders, the biggest criteria that needs to be met is
there has to be an impairment. So for somebody that may have symptoms of
depression or symptoms of anxiety, but as far as being diagnosed with a
disorder, that primary criteria of impairment needs to be met. You may struggle
with something like low moods, or maybe you have a loss of interest in certain
things, that doesn't mean you necessarily meet full criteria to be diagnosed
with major depressive disorder. Or maybe you struggle with feeling nervous or
on edge, that doesn't mean you meet full criteria for generalized anxiety
disorders, so on and so on.

So to determine healthiness, we're looking at all these
different domains. So, we have our social domain and what that looks like with
people's healthiness of relationships. What is the quality of their
relationships? Are they able to maintain these relationships, make new
relationships, so on and so on and so on.

We also have what might be referred to as like the work domain.
So, do the symptoms you're experiencing cause an impairment in your
professional life that's going on? Are you missing days from work because of
how you're feeling? Is it affecting your job performance even while you are
there?

Along with that, we also of course take physical condition into
consideration. As a matter of fact, one of the kind of rules of thumb for
mental health disorders is that we rule out the possibility of a physical
explanation as to what's going on as well as there's different disorders that
can be induced by substances. So, we really look at those criteria first and
make sure, just as an example, somebody could be having a side effect to a
medication, let's say hallucinating, for example. If we were to jump to
conclusions and say, "Oh, that person's hallucinating. They must be suffering
from something along the lines of schizophrenia or severe depression or X, Y,
Z." Step one is making sure, "Okay. Well, you say you started this
new medication two months ago and the hallucinations didn't start until after
that medication. Let's have you checked out by a medical professional prior to
pursuing the mental health route and making sure that it may not be due to
something like that." So really, we're looking at the physical domain, the
social domain, the professional domain, all these different areas to determine
what kind of impairment is happening.

Host: Now, if we're looking at an adolescent, of course,
schooling comes up in the conversation. So, how can a healthcare institution
include schools in the process of assisting an adolescent struggling with a
mental health disorder?

Zach Irwin: Absolutely. So, this is one of the things
that I really love about Southwest, is they really make an effort to get into
the community and get engaged in the community, especially as a nonprofit
organization. There's so many resources that are supplied, whether that be-- I
personally have gone to some of the local schools, Berea-Midpark, Highland,
Columbia Station, a few others and provided whether it be staff trainings,
whether it just be letting them know about our resources that we have
available, so schools, getting engaged in that sense. And it is a mutual
partnership of we have to be willing to get out there to provide this
information. And also, schools have to be willing to accept us. Alongside that,
schools also do a fairly good job to some extent with having mental health
professionals in the schools. You'll find that a lot of schools will have
contracts with community-based agencies to have different therapists or
different providers that provide school-based therapy. That's a whole other
conversation, but it does have its place.

Host: Well, let's talk about what happens at home. Once
we're away from the providers and these resources, what recommendations can be
made to parents or loved ones on how to handle a home life with a patient
struggling with a mental health disorder?

Zach Irwin: Again, another fantastic question. Treatment
is only part of the battle. I like to take our groups, for example. For our
adolescent program, we have a three-day a week group that runs for three hours
each day. So with that being said, in the grand scheme of things, that's only
5% roughly of their time that they're spending in the group receiving treatment
from a professional, that leaves 95% of their time, whether that be at home, at
school, with friends, so on and so on. So, getting somebody to come to
treatment is only half the battle. It's a matter of applying those things
outside of treatment too.

For parents and loved ones, the first thing that I always
recommend to people is learn the lingo. We want to be using common terms,
especially if you've not experienced depression, anxiety, other disorders. It
can be really, really hard to understand and relate to those if it's not
something you've been through. They're very experiential in nature, regardless
of whatever knowledge you may have about it. So, being open and being receptive
to understanding what the other person is going through as well as learning the
terminology or even, you don't have to use all the fancy clinical terms, we
call it speaking a common language. If you guys can come up with words that you
agree on, that you understand represent certain things, and then using those
words in practice to let each other know, "Hey, I'm really struggling with
this today," we just want to make sure we're on the same page as to what
we're saying.

There's something related to this called spoon theory, which
has been around for a little while right now, but it's in reference to how we
wake up each day with a finite amount of energy. And sometimes, or not
sometimes, depression actually can really cause that fatigue, cause that
tiredness, cause that feeling of being drained. And again, if you've not
experienced that, it's hard to relate to. So, there's this concept of spoon theory
introduced that relates to that finite energy. You have X number of spoons when
you wake up in the morning. And certain activities give spoons back to you,
certain activities use spoons up, certain activities have no net exchange
between them. And so, parents and children have started using this in some
places and saying, "Hey, you know, I'm running low on spoons today,"
and a parent will understand what that means. So, really just speaking that
same language is the number one thing to get on the same page about.

Host: I love that. I had a friend introduced me to that
recently and it really kind of opened my eyes to what she was going through.
So, thank you for providing that. Well, shifting the conversation now to
chemical substances. You mentioned this earlier. Why do people continue to
depend on chemical substances when according to Truth Initiative reports, users
are 2.4 times more likely to have a diagnosis of depression and furthermore
create other disorders such as ADHD and hinder the development of the body and
brain?

Zach Irwin: So when it comes to substance use, this is
something that's been evolving over time and especially in recent history. We
used to look at things through what might be called the 12-step model, which
those are all your A groups, the AA, the NA, the OA, so on and so on. More
recently, we've kind of transitioned the way that we looked at substance use as
far as a disorder. And what's been developed now is called the disease model of
addiction, which looks at addiction as an illness rather than the 12-step model
would be more indicative that it's a choice.

And so, through this, they've actually discovered that, again,
there is a genetic component to these things and they've been able to identify
the gene related to addiction. And so, there are people that, you know, if you
don't have this gene in your body, you don't have the ability to become
addicted to things versus where if you do, it's not about the substance or
behavioral addictions or process addictions as we call them too. It's not
specifically about anyone in particular. It's that you have the ability to
become addicted. And so, that can start really with anything. Like I said,
there's those behavioral or process addictions as some call them. So, things
like gambling, things like sex, things like shopping, things like eating where
there's no substance involved, but the way that it works in the brain is the
exact same, where you have neural pathways that lead to your reward center and
that kind of gets formed through this process of addiction.

So, alongside that, for those that don't fall into the category
of struggling with addiction, because you can abuse substances without being
addicted to substances, there's the other half of this that they are negative
coping skills. It'd be foolish not to acknowledge that people do identify
positives of using these negative coping skills. And when it helps a person
alleviate, whether it's certain emotions that they don't want to experience, or
maybe it helps them put off certain issues that they don't want to address,
human behavior, we do the same thing over and over if it's successful in doing
what we're trying to achieve. And so, using a substance or using a behavior as
a negative coping skill, if it works, then unfortunately your brain's going to
be more inclined to keep returning to that.

Host: No, that makes sense. Well, wrapping up here, my
last question, how can the mindsets and perspectives on life that patients
display be taken into consideration and shifted if it's considered poor or
ill-mannered?

Zach Irwin: So when it comes to perspective, this, in my
opinion, is everything. We've done groups on perspective in our treatment
programs that we offer. And when we talk about perspective, when you really
think about it, your entire reality is created by your perspective. Everything
you know to be true, everything you believe boils down to your perspective and
the way you look at things, which is great news because that means if we can
change your perspective, then we can change your subjective reality around you.

So when it comes to changing perspectives, there's a lot of
different ways to approach this. What we offer is primarily DBT, which is
dialectic behavioral therapy, and that's a very skills-based modality that we
use to teach new skills about emotion regulation, interpersonal effectiveness
skills, mindfulness, distress tolerance, and the like. We also incorporate
elements of CBT, which is cognitive behavioral therapy into our group. The
premise of that being if I can change the way that you perceive things, then as
a byproduct your behaviors are going to change as well. So, there's different
methods in those. There's things called thought challenging, you know, another
one's putting your thoughts on trial. There's all different interventions to
really address a person's perspective because it really is paramount when it
comes to treating mental health.

Host: Wonderful. Well, Zach, thank you so much for being
with us today and for all of this great information. If you believe you or a
loved one could benefit from mental health services, reach out to our team
today at Oakview Behavioral Health Services to schedule a free assessment.
Visit swgeneral.com to learn more. I'm Caitlin Whyte. And this has been
Southwest General Health Talk.