Caitlin Whyte (Host): Mental health is so, so important to not only discuss, but de-stigmatize. And here today to help us start that conversation is family nurse practitioner, Jennifer Rutledge.

 This is WakeMed Voices, a podcast brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. I'm your host, Caitlin Whyte. Well, Jennifer, I am so glad that we are talking about this today. So to start off our conversation, can you tell us more about the importance of normalizing mental health discussions with a primary care provider?

Jennifer Rutledge: Yeah. I definitely want to focus this conversation on emphasizing the importance of mental well-being and how emotional health really plays a huge role in our physical well-being. Depression significantly impacts both mental and physical health and is the leading cause of disability. I think as primary care providers, we must first normalize mental health discussions with our patients to provide the best care we can and really promote healthy outcomes.

Host: Absolutely. And how can those primary care providers support mental health?

Jennifer Rutledge: I think, first, letting patients know that they're not alone, right? That this is normal. The CDC reported in 2020 that 18.4% of U.S. adults reported ever having been diagnosed with depression. So, that's approximately one in five adults. And that's most commonly in our younger adults, ages 18 to 25.

The first thing I really like to do is let the patient know that, "Hey, you're not alone. This is very normal." Validate the condition, the prevalence, and their concern. And then, listen, right? If we're not listening to our patients, then we can't even begin to understand how to best treat them.

And finally, I would say we've got to offer support, whether it be counseling or pharmacological support. But that is discussion that I have individually with my patients by using shared decision-making to figure out what is going to best suit the patient and their outcome goals.

Host: Some great points there. So, what are some common mental health symptoms that may be an indicator you need to talk to someone and seek out that support?

Jennifer Rutledge: Yeah, Caitlin. So, depression and anxiety are actually two different conditions, but often can go hand in hand. Typically, patients suffer from both anxiety and depression. Occasionally, it is just one or the other. Specifically with depression, patients can often complain of little interest in doing things, feeling down or hopeless, problems with sleep, feeling tired, maybe some appetite changes, and even some concentration deficit. On the other hand, people with anxiety may often report feeling nervous, feeling anxious, constantly worrying. Maybe having trouble relaxing at nighttime, irritability, becoming annoyed and that internal sensation of impending doom or just afraid that something awful may happen.

So, those are really like the common health symptoms. And then, sometimes it can become even more trickier when we start to have physical symptoms of anxiety and depression, and that can be feeling dizzy or having palpitations, sweating, becoming short of breath, having tremors or shaking, tingling in our extremities and diarrhea, having chest pain. And I think with those, it's particularly hard to know what's going on. So, really, that's when you need to seek out medical advice from your primary care provider first and foremost, because it really takes the expert to dive in to see, you know, is this something more serious going on physically, or is this equally serious with your mental health?

Host: Of course. Well, can you then give us an overview of the types of mental health screenings that a primary care provider may offer?

Jennifer Rutledge: Absolutely. So fortunately, in the primary care setting at WakeMed, we've been consistently screening for depression since 2021. And this really came out of the increasing depression data that we retrieved out of COVID. There was a lot of compelling evidence that our numbers were significantly increasing nationally for depression.

So, we started screening, again, primary care offices on almost every patient that walks through our door. They get a two-question screening to determine if they are having some symptoms of depression, and do we need to take action on it? And those are just two simple questions that they can fill out in the lobby or that they can fill out in the exam room. We really encourage these patients to fill them out independently when possible, just to get honest answers. And those questions are: Over the last two weeks, how often have you been bothered by... Question one is little interest and pleasure doing things. And question two is feeling down, depressed, or hopeless. And this is called the PHQ-2 questions. And the answers are not at all several days, more than half days, or nearly every day. And we get a quantitative score and a value of greater than or equal to three is positive. And so, that really means that then we have our patients answer additional questions to evaluate the best next steps and individualized treatment goals.

Host: Gotcha. And as we wrap up here, Jennifer, can you speak more on that connection between physical health and mental health?

Jennifer Rutledge: Yeah, absolutely. I really like to use the analogy of getting in a car accident, right? So if you're in a motor vehicle accident, automatically at that impact, you feel tense, your body is kind of in that fight or flight mode where your heart rate starts to increase. Your blood pressure starts to increase, you start to sweat, you start to worry. And remember, that's just one accident, and that can last during that acute event for anywhere from five to 10 minutes to 30 minutes an hour. So, think about that acute event happening every day for months or years and what that does physiologically on the body. It puts stress on your heart. And so, certainly anxiety and depression can lead to high blood pressure, heart disease. And more chronic diseases that we continue to learn about over time. So, it's really important for your physical health to seek treatment and get help.

Host: Great. Well, Jennifer, my last question today is what are some common barriers to mental health care and how can providers help overcome them?

Jennifer Rutledge: Yes, Caitlin. So, I think this is a two-part question here. I think, firstly, for patients, I think the barriers are the stigma, right? One way that we can overcome that barrier is providing awareness, and providing opportunities to educate the population. I think another barrier is maybe sometimes as patients we perceive that our problem maybe isn't as serious enough as we think it might be. Another barrier is access to healthcare. And so, that can definitely be a problem. And then, fear of negative outcomes or expressing your concerns. And I think the biggest thing I would tell patients is if you're having any of these barriers or concerns, to be honest with yourself and to speak to your health care provider about this. And if you don't feel comfortable talking to your health care provider, then maybe find someone who you do feel comfortable having those candid conversations with.

And then, Caitlin, for providers, I think some of our barriers are financial barriers and fragmented health care. It's really nice at WakeMed, particularly we have social workers that are able to provide one-on-one counseling via virtual appointments with our patients. And we also have a psychiatrist that we can call on specifically if we're having a more of a complex case that we need to work out.

Another barrier can be the lack of mental health care professionals, right? There's a high demand with very low supply of trained professionals and access. You know, if I put in a referral to Psychiatry, it could take three to six months when that patient needs help in my office today. There's limited availability of those appointments. So, again, I think WakeMed has done an excellent job with having support at our office for primary care providers to best suit our patients and care for their mental health needs.

Host: Well, it is really just so critical to take care of our mental health. Just as much as our physical health, like you said. Thank you so much, Jennifer, for everything that you do. Visit wakemed.org to learn more about WakeMed Primary Care. And thank you for listening. I'm Caitlin Whyte with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina.