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About The nugget. (Sisters, Or.) 1994-current | View Entire Issue (Jan. 30, 2019)
Wednesday, January 30, 2019 The Nugget Newspaper, Sisters, Oregon Your Story MATTERS Audry Van Houweling, PMHNP Columnist The shadow of desperation In Oregon, suicide rates have increased nearly 30 percent from 1999-2016 and suicide is now the second leading cause of death among children and young adults ages 10 to 24. Per Mental Health America, Oregon has the highest prevalence of mental illness in the nation. Oregon can also claim the third-worst high school grad- uation rate and the nation9s second-highest number of unsheltered homeless per- sons. In many of Oregon9s rural counties, opioid pre- scriptions are also among the highest in the nation. There is a lot of hurt, a lot of desperation, and wide- spread feelings of being <stuck= in a system that allows little upward mobility. Nearly 18 months ago I decided to make the shift to embracing functional medi- cine in my mental health practice. I have become con- vinced that functional medi- cine is not the latest trend, but simply common-sense medi- cine, I am a firm believer that functional medicine is the future of medicine. That said, the reality is that functional medicine and frankly a lot of worthwhile therapies are still a bit idealis- tic and inaccessible for many. Specialized labs are often not covered by insurance, supplements can be expen- sive, personalized nutrition approaches are not in the budget, and <stress manage- ment= may be a stretch for the many individuals existing in survival mode where relax- ation, deep breathing, and self-reflection are luxuries. And so, myself and many other healthcare providers are tasked with navigating the complexities of attempting to promote holistic, personal- ized care amid social realities that create immense barriers. Too many of our patients are stuck in the <fight or flight or freeze= mode where true healing becomes elusive. If we (as providers) are not careful and especially if we are being rushed into provid- ing care for big problems, burn out can come quick. Economic stability, physi- cal environment, educa- tion, food, community and social supports, and access to healthcare are identified as the primary social determi- nants of health by the Centers for Disease Control. Many patients come my way seek- ing respite from understand- able distress when one or more of these determinants are minimal or absent. And while counseling has often been suggested, so too has medication in many cases. The patient may be panicked, overwhelmed, depressed, hopeless, and isolated. Yes, they may meet <criteria= for a myriad of diagnoses; how- ever, how often are we really medicating or even numbing symptoms that are not indica- tive of pathology, but of soci- etal shortcomings? I ponder the <what ifs= all the time&what if they had stable housing&enough food&a safe home? If only I had a magic wand. Let9s go back to Psych 101 and revisit Maslow9s hier- archy of needs: food, water, warmth, rest, security, and safety. It is in fact rare that I come across a patient that has all these basic needs met. Even in circles of affluence and privilege, there can cer- tainly cases of unrest, insecu- rity, abuse, and a perception of feeling unsafe. Ultimately, when the body cannot be in a state of rest, healing is dif- ficult if not impossible. To expect favorable health out- comes in the context of des- peration is simply irrational. My opinions do not negate the potential value of phar- maceuticals and mainstream therapies as tools to help regulate a person9s symp- toms, but if we pretend that <the treatment= of mental ill- ness and emotional distress is relegated to pharmaceuticals and counseling, we are being shortsighted and ignorant. So where does this all leave us and how do we move forward? First and foremost, we cannot pretend that illness is happening in a vacuum. As a healthcare system, we know this intellectually, but in prac- tice, as we silo care to differ- ent specialties, rush patients through appointments, and take away time for impor- tant communication, we can fail to address psychosocial, socioeconomic, and spiritual impacts. We cannot expect a pharmaceutical to solve homelessness, hunger, abuse, or poverty and we must pri- oritize trauma-centered care. This takes courage, radi- cal responsibility, teamwork, and innovation. We must pro- vide opportunities and space for discussion and emotional vulnerability in our families, schools, places of worship, and workplaces. The idea that mental health is a <per- sonal problem= and therefore an individual burden, only increases secrecy, shame, and stigma. We must all be advo- cates. Your health and my health depend on it. 25 The Nugget Newspaper Crossword By Jacqueline E. 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