Mental Health Matters: Back to mental health basics

AUGUSTA, Ga. (WJBF) – Mental health matters because you matter. It is a month-long initiative on The Means Report to bring you everything you need to know about mental health; not only mental health awareness and what it is, but the resources that are out there in case you, or a loved one, needs help.

• The first challenge that everyone faces when it comes to this topic is it’s not fun to admit that you’re having those thoughts, those feelings, those challenges.

• We always talk about in crisis. Let’s talk about before you get to crisis.

• There’s not a day that doesn’t go by that I don’t receive multiple calls from families with individuals who are struggling with these issues that need help. They need access to care.

• I asked myself, “Do I need help?” How should I know? Each night I wondered what was wrong. And in hindsight, it is terrifying to know that I was physically harming myself and still unsure if I needed support.

• My brother was overdosing on fentanyl and almost died in our hallway.

• It is absolutely critical that we are discussing mental health in schools, that we are building into our curriculum social-emotional competence. We have the tools to build kids’ resilience.

• They see things on a regular basis that don’t always make the news. They’re not always a widely-known situation, but it happens. Child abuse, domestic violence situations. ‘Cause then over time, that can take a toll on those who are serving our community.

• I do have friends who view it as stigmatized and who are more hesitant to reach out. And so it made me realize now is the time to act.

• There’s a tremendous amount of distrust that is rightly deserved in the Black community as it relates to seeking mental health care.

• We think of therapy, we think of a couch and somebody who looks like Sigmund Freud. That’s not necessarily the truth. It’s usually somebody who looks like me. Somebody that looks like even you, you know, who’s sitting there who honestly wants to unpack some of that baggage you’ve been carrying.

• The ability for us to deal with folks who are in crisis and figure out a way to triage them instead of just the hospital room or crisis intervention. Somebody shouldn’t have to be in crisis to access help. I mean, ultimately that should be the last phase of somebody going out to seek help.

• You cannot believe your child if they say they’re okay. You have to pursue.

• Now, when we start getting a crisis moment, we gotta start being wanting to ask for help. We’re told not to talk about things. So that’s the first thing, having the conversation when we’re starting to feel overwhelmed.

• This thing is gonna lead that child to comparison and feeling feelings of inadequacy so draw that child away from that digital dependency.

• We’re at the breaking point. It’s time that we start to, as a state, as local communities, and as a nation begin to be able to address these issues of mental illness. Stop putting ’em in the shadows.

• No one is immune. No one is untouchable when it comes to mental health.

Brad Means: May is Mental Health Awareness Month. I suspect we will re-air this series later in the year, but I can tell you that it’s beginning right here as we kick off the month of May. And I can’t think of a better person to help us kick off Mental Health Awareness Month and our mental health series than Dr. Vaughn McCall. He’s going to help us answer several questions and tackle these topics, the basics of mental health. What it is, the stigma of mental illness. We’re constantly trying to get rid of that, aren’t we? I wonder if it still exists. We’ll ask the doctor. And how to know if something isn’t right. How to tell the difference between just perhaps a mood swing or something that might require professional attention. Dr. McCall is the chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Augusta University, and he is so kind to rejoin us. Thanks for coming back to “The Means Report.” You’ve been a frequent guest because this is a topic that affects so many people. Thanks for coming back.

Dr. Vaughn McCall: Thank you, Brad. It’s great to be here again.

Brad Means: Did I get all the Medical College of Georgia at Augusta University part right?

Dr. Vaughn McCall: You did perfectly.

Brad Means: It’s a lot.

Dr. Vaughn McCall: It is a lot.

Brad Means: We can’t just say MCG like we did back in the day.

Dr. Vaughn McCall: No, but thank goodness MCG remains at the heart of it.

Brad Means: Yeah, it does. And you and your team do an incredible job over there.

Dr. Vaughn McCall: Thank you.

Brad Means: All right, we told the viewers we were gonna talk about the mental health basics, and I really would like to spend the better part of this broadcast talking about just the basics so we all understand what it is and how it impacts all of us. Is this a general definition? You can agree or disagree. Mental health is how we think, feel, and act. Does that cover it all?

Dr. Vaughn McCall: That covers it. And it would encompass both mental wellness as well as mental illness. And the difference between the wellness and the illness, of course, comes down to basically two factors. The first would be the presence of suffering. And obviously suffering would be a part of the mental illness definition. And if I can even parse that out a little bit further, we could talk about who is suffering. And as in the rest of medicine, psychiatry and psychology are interested in the suffering of the patient themselves, but oftentimes other people around the patient are the ones who are suffering, and sometimes society suffers. So the suffering that goes along with mental illness affects the patient, the people that live with them and love them and also society. And I would say the second component of mental illness would be if there is some loss of functioning related to how people think, feel, and act. And by functioning, I’m thinking pretty simply in terms of how people fulfill their major role in life. Whether they see themselves as a student or a homemaker or a breadwinner or a grandparent. Presumably we all have some sense what our role is, and mental illness often interferes with that role.

Brad Means: All right, one of the things I love about talking to you is because you say these things and you make me picture real-life situations, and then I start asking you about those situations and then our time is up. But that’s the great part about this broadcast on “The Means Report” is we don’t have to talk in soundbites. We can have this conversation. So let me try to envision what you just said and picture somebody with a mental illness who’s not mentally well.

Dr. Vaughn McCall: Right.

Brad Means: A lot of times they don’t know they’re suffering, right? What they’re doing doesn’t bother them so is that when you start to think about, well, it’s impacting your family or others because they’re tired of the way you’re acting?

Dr. Vaughn McCall: Exactly, and a few quick examples which don’t exhaust the entire list of how a person might think or behave in a way that leads other people to suffer would include things such as paranoid behavior almost always impacts the people that are around you. Sometimes obsessive compulsive behavior. Certainly addictions affect other people. And then we think about how society can suffer as a result of mental illness. I’ll again use the example of, say, paranoid behavior. We sometimes hear about these tragedies of people who are suffering under the influence of a delusion, and they feel that other people are out to get them or to harm them in some way. And in reacting to that belief, they may hurt somebody else. So that’s an example where the designated patient may not feel like they have a problem, and yet there’s suffering nonetheless on the part of somebody else.

Brad Means: Can you have periods where you’re not mentally well? A week, a month, six months, but you’re not mentally ill? Are we allowed to, for lack of a better way to put it, go through phases without being officially ill?

Dr. Vaughn McCall: Oh, yes. So there are some classic examples. There’s some illnesses such as, to give a contrary example, there’s some illnesses which tend to persist over long periods of time without a break. And an example would be one of the schizophrenic-type illnesses. Those tend to go on for long periods. In contrast, people with severe mood disorders, either major depressive disorder or bipolar disorder can have spontaneous periods of wellness. And I always like to hold this out to my patients. I’d like to think that I and my professional colleagues can help patients, but sometimes even our best efforts don’t seem to make a difference. But I’ll tell the patient, you know, the nature of your illness is such, it could go into a spontaneous remission pretty soon. We just don’t know so hang in there. So to your point, Brad, yeah, sometimes the illness will kind of go away on its own for a period of time and then it may come back later so waxing and waning.

Brad Means: Are some people less prone to mental illness? Or I guess a better way to ask the question is, are some people more prone to mental illness? If my mom and dad and grandparents all had some sort of issue, I’m gonna definitely get one too?

Dr. Vaughn McCall: Well, thankfully you won’t definitely get one. But they do tend to be heritable problems. And one way that we know this, there were some studies done decades ago where children from parents who were affected, let’s say a parent who either had a schizophrenic illness or a bipolar illness, they were unable to care for their child by virtue of their illness or some other factor. And the children were adopted away into a family where the parents did not have mental illness. And the question became, well, if you are now in a healthy family, does that mitigate or remove the risk that you came from a parent that had a mental illness?

Brad Means: Right.

Dr. Vaughn McCall: And the finding was is that the child who was adopted still was at risk for mental illness. So it’s like a lot of things, whether it’s lung disease or heart disease where illnesses are a product both of what we were born with and what we do. And this is often true with mental illnesses. Some of it is, in fact, an inborn risk.

Brad Means: You can’t outrun it.

Dr. Vaughn McCall: In many cases, not.

Brad Means: Let me ask you this. Is there a typical age range where somebody might begin to have mental health issues? I don’t think you would be able to tell it in an infant, but after that, what might you see?

Dr. Vaughn McCall: You know, there are some disorders seen in childhood that go by names like oppositional disorder, which you can probably guess from the name implies children that are just not gonna go along to get along.

Brad Means: Right.

Dr. Vaughn McCall: And conduct disorders. It’s a little bit later in childhood, which include things like truancy and disobeying the law and so forth. So you can see behavioral problems in children and adolescents. Most of the more severe disorders that are present in adults don’t really begin until puberty or the middle of high school years. For example, schizophrenic illness, which can often be devastating, typically starts between the ages of about 12 to 25, between early adolescence to the first decade of young adult life is a period of risk for schizophrenia and also for bipolar disorder, which interestingly, you know, we’d like to think we’re all grown up when we’re 18 or 19 and yet our brains are still developing. We’re not-

Brad Means: Wait, till 25, right?

Dr. Vaughn McCall: Until about 25, and so it’s coincidental that it’s around age 25 that a lot of these more severe mental illnesses are demonstrating themselves. And once you get to 25, you’re not completely protected. I don’t want to give the implication that everything is gonna be rosy after 25, but a major period of risk has passed by age 25.

Brad Means: Wow, circling that age as we all bring our children up and watch them grow into young adults. When we come back, our conversation is going to continue with Dr. McCall. We’re going to take a look at the basics of mental illness and some of the resources that are out there. How you can get help and get healthy as “The Means Report” continues.

Part 2

Brad Means: Welcome back to “The Means Report.” We appreciate you staying with us as we continue to focus on mental health all month long, a special series. Dr. Vaughn McCall, our special guest with the Department of Psychiatry and Health Behavior at MCG at AU. Dr. McCall, what’s the most common illness that people have when they come in? You mentioned bipolar, OCD, schizophrenia in our first segment.

Dr. Vaughn McCall: Right, the most common illness we see in our clinic, and I think this is reflective of most clinics would be anxiety and depression problems. And that probably makes up at least 50% of all the problems that people bring to us. I’ll tell you as an aside because I think it’s sort of interesting, all mental illnesses are not catastrophic. And the analogy I would make is to infectious disease where you have things like a cold, which is annoying, but not deadly. And then you have other things like coronavirus or HIV, which are a big problem. So the same thing’s true with mental illness. And so interestingly, our version of the cold, if I can use that analogy for mental illness, might be phobias and so there are lots of people that have fear of flying, fear of elevators, fear of escalators, fear of closed spaces, fear of dogs, whatever. And they don’t necessarily ever go get treatment so we never see those people, but that is one of the most common psychological problems. And people solve it by just doing a workaround.

Brad Means: Yeah.

Dr. Vaughn McCall: But when people come for treatment, then we see a different sort of problem. And now it tends to be the anxieties and depressions at the top of the list.

Brad Means: A lot of people have phobias when it comes to going to the doctor, period. They’re afraid of you.

Dr. Vaughn McCall: That’s true.

Brad Means: Why shouldn’t they be?

Dr. Vaughn McCall: Well, you know, because they don’t know what’s coming so I don’t blame them. They just don’t know what to expect. So phobias are very common. We don’t always see them in our offices.

Brad Means: What should people expect when they do walk in? You know, we watch so much TV. We surf the internet so much. We think that all we have to do is walk in and you’ll give us a pill and heal us.

Dr. Vaughn McCall: Yeah, I wish it were that simple. There are some illnesses, mental illnesses where medication regimen and adhering to it may be absolutely primary in getting a good result. But Brad, I would say that irrespective of what someone’s problem is that they bring to our clinic, there’s almost always something the patient themselves can do to help themselves. It may be something very simple such as, maybe you shouldn’t drink so much caffeine which is making you nervous. It may be a very simple thing. But my point is when patients come to see a mental health provider, they should expect a fairly broad array of approaches, which might include self-help strategies. It may including teaching the patient some self-help strategies and maybe medications.

Brad Means: Dr. McCall, have you ever had a one and done where somebody walks in, you instantly can diagnose because you’ve seen it so many times and you do say, “Look, man, here’s a strategy. Go try it, see you later,” and it works?

Dr. Vaughn McCall: That happens occasionally, but I would tell you more often what happens is a patient will come in and I’ll have a great sense in the first 20 minutes on what needs to be done. But I also know the patient needs time to absorb the diagnosis and the treatment plan. And so even though I may know what needs to be done right away, it could take a couple or three visits or more before there’s complete buy-in, and I don’t blame them, that’s okay.

Brad Means: The Dean of the Medical College has been on many times. And a lot of times Dr. Hess talks about accessibility when it comes to healthcare, and I would presume that affects mental health as well. Are you seeing that people out there in the CSRA have a tough time getting to a clinic?

Dr. Vaughn McCall: Absolutely.

Brad Means: Yeah?

Dr. Vaughn McCall: It’s unfortunate. I think if I have my statistics correct, Georgia ranks near the bottom of states nationally with access to mental health. Very sad.

Brad Means: It is.

Dr. Vaughn McCall: And Augusta is unfortunately no better or worse than, I think, the rest of the state. We do have resources, though. I mean, it’s a matter of sometimes just pointing people in the right direction. Personally, I think that a major part of the formula, and this I think will be agreed upon by my colleagues in primary care, family medicine, internal medicine, pediatrics, is mental health providers like myself need to do a better job of teaching my primary care colleagues how they can take on some of this burden.

Brad Means: Right.

Dr. Vaughn McCall: Because there’s a lot that a family medicine doctor or internal medicine doctor, a pediatrician can do to help someone’s mental health without sending them to a psychiatrist. So we need to fully leverage our primary care resources to magnify and amplify what mental health services psychiatry can provide.

Brad Means: Are you trying to do that with these med students who come through to say, look, keep your radar cranked up at all times because you may, as a primary care doc, see some signs?

Dr. Vaughn McCall: Absolutely, in fact, with my first lecture to medical students at MCG every year, I tell them that in the, a primary care doctor, they call it their panel. How many patients they take care of. And the typical panel of a family medicine doctor, if he or she were to see, let’s say 25, 30 patients in a day, which is a lot, but not unheard of, they can count on maybe 1/3 of those people having a mental health difficulty. Now, it may not be why they came to see the doctor that day. Perhaps they came to see the family medicine doctor for high blood pressure, diabetes, and so forth. But in the background is this secondary layer of mental health concerns. And so I think family medicine doctors and internal medicine doctors and pediatricians for the most part are well prepared to handle that. And so we wanna partner with them so that psychiatry, if we’re doing our job, hopefully we’re taking on the more difficult cases and then sharing with family medicine and internal medicine, the cases which are more straightforward.

Brad Means: How can we get a family member or a friend to come see you if they don’t want to? How much power do we have to force ’em to go?

Dr. Vaughn McCall: Well, in the absence of imminent dangerousness, I think that’s the wording of the Georgia law. In the absence of imminent dangerousness, we really don’t have any powers other than persuasion. I think sometimes if the patients, we were talking about how patients can have suffering themselves, which is the paramount thing, but also others around them suffer. And if the family members are suffering so that, for example, a marriage or a family structure is endangered, then that, and I’m not encouraging that as a blackmail or a threat, but I’ve seen instances where the concern over dissolution of a marriage might finally bring someone into treatment.

Brad Means: Probably a couple more questions. The first one is, how long does it take to get better? I know you mentioned that some visits can be brief. Two, three sessions.

Dr. Vaughn McCall: Right, right.

Brad Means: If you had to average it out, before I’m comfortable again and I can function again.

Dr. Vaughn McCall: Sure, I’m gonna, in my mind, I’m imagining a person with a fairly average case, let’s say, of depression and anxiety. And we’re going to try to address that with a combination of advice and self-management and maybe a medication, maybe a couple months or so before we really get exactly where we want to be. And at that point, the person may not necessarily have to see the psychiatrist, but may continue to take, for example, a medication at home on their own.

Brad Means: Do y’all do group therapy ever? ‘Cause I think it would be reassuring to look around a room and go, “Oh, I’m not the only one who’s dealing with this.”

Dr. Vaughn McCall: You’re right, it’s very powerful and self-affirming for a patient to see someone else who’s struggling successfully, that’s the key, is you wanna see someone in your therapy group who is managing well and who is thriving. And I think that’s a terrific encouragement to a patient, perhaps, who’s just joined the group for the first time to see an old-timer who is succeeding.

Brad Means: Oh, I just can’t imagine. It’s gotta be a huge help. Last question is, what’s it feel like to see success, to take a patient from their darkest hour and send ’em back out into the world?

Dr. Vaughn McCall: Well, you know, I don’t know about you, but there are some days I go home from work and I think about my day and I think, “Did I accomplish anything today?”

Brad Means: Yeah.

Dr. Vaughn McCall: But the best days I have are when I go home and there’s been just one person that’s left my office and I can think, “Maybe I did a good thing today.” And that makes it all worthwhile.

Brad Means: Amen. Boy, it sure does. And you do such good work as does everybody on your team. We’re gonna continue to have you as our guest through Mental Heath Awareness Month here on “The Means Report.” Thanks for helping us get it kicked off

Dr. Vaughn McCall: Thank you, Brad.

Brad Means: Dr. Vaughn McCall, Medical College of Georgia at Augusta university. When we come back, what you can look forward to on future editions of “The Means Report.” Dr. Vaughn’s colleagues, Dr. McCall’s colleagues will join us as this month unfolds and how you can stay in touch with us here at “The Means Report” next.

Part 3

Brad Means: Well, I learned a lot about the basics of mental health during the last half hour. I hope you did, too. Dr. McCall was wonderful to explain it all to us.

Email us, let us know what you think about this edition of “The Means Report,” meansreport@wjbf.com is the email address. Just put “The Means Report” on the subject line. You can also find us on Facebook, Twitter, and Instagram. Our social media sites are always up and running, and you can watch previous episodes of “The Means Report” at wjbf.com/the-means-report.

Be sure to stay with us as we continue Mental Heath Awareness Month. Dr. McCall will rejoin us as will some of his colleagues to tackle specific mental health issues and how you can resolve them. For Levi, Marlena, and the entire “Means Report” family take care.