Healthcare, Mental Health, & Chronic Illnesses

What are the care gaps or frequently asked questions I have noticed as a BC Clinical Counsellor?

Over the last few years, there has been an increase in chronic illnesses. And a care gap through the lack of understanding of the intersectionality of chronic illness and mental health. This can be seen through the lack of mental health support providers that treat chronic illnesses. As well as a lack of primary doctors who refer to mental health counsellors for consultation and coordinated care as a part of treatment (Steffler et al., 2022; Roberts et al., 2022). This gap can be seen through the general lack of understanding, mainly in how mental health impacts chronic illnesses and vis versa. This could be solved with more education on mental health in medical programs. As well as aided through the way we speak about mental health with patients that hold chronic illness diagnoses. And in a lack of judgement towards those who have both mental illness and chronic disease conditions. Often a Dr. holding or displaying judgements towards patients is the main harm I hear about from patients in chronic disease counselling.

Mental Health Data that answers these topics

Often a problem is that patients feel shame and guilt about their illness and then that affects their perception of both themselves and their disorder. And then due to the judgements Dr’s imply when they do refer to mental health, the patients may incorrectly view themselves as having the symptoms all in their head. An important part of chronic illness counselling referrals is simply, the language used to promote this recommendation to patients. As chronic illness therapists are understanding of a wide range of chronic disease conditions and respect that the patients pain and symptoms are what they say they are. They are not in their head.

The Impact of Mental Health on Chronic Illness

As mental health impacts biology through stress, due to being linked to all conditions which are not genetically passed down (Mate, 2019). Stress then is a trigger in predisposing conditions such as chronic illnesses, caregiver fatigue. or central sensitization syndromes (Arseneau, 2008). Thus, mental health factors like stress and trauma can have a direct impact on our physical health, through our genetics and may cause these disorders. This is where courses on energy pacing, a Chronic Disease Self-Management Program, and chronic illness counselling can help to lower the stress in the patients life.

The Impact of Chronic Illness on Mental Health

Alternatively, the impact of having chronic disease conditions can also be seen in the effect on a patient’s mental health, through three primary areas such as internal body responses like the autonomic nervous system and hormones which are well understood by the medical community. And also, through maybe lesser understood areas such as external stressors and internal perception. External stressors being through limited abilities causing financial hardships, relationship issues, lack of social support, and limited work depending on mobility. And internal stressors seen through patients’ adjustment to a loss of capability to fulfill the roles or responsibilities they once enjoyed, due to these conditions. And from the psychological perspective, the patients’ chronic illnesses are then compounded by depression or anxiety which are comorbid with many chronic illnesses.

These fundamental areas that impact the mental health of a patient, can also be seen as causing flares in conditions. As the impact of diagnosis and onset of symptoms can deeply affect a patient’s internal perceptions of themselves and their self-worth. And emotions can be triggered by the losses associated with disorders and then their health can be worse through an inability to cope with the adjustments of slowing down or learning to manage energy and pain. Chronic illness is also often compounded by past traumas that have not been addressed as Mate (2019) points out. Which can cause another large impact on the mental health of patients and caregivers.

When we think of trauma it is not about what happens to you, rather it’s what happens inside of you, it’s how you perceive it.

Best described by Mate (2019), “It’s a restriction of your capacity to respond from your authentic self in a present moment.” (Mate, 2019). Therefore, “What happens to humans on a physiological level can be impacted by and even determined by what happens to them on a social level." (Mate, 2019).

This can effect the whole family of someone diagnosed young with a chronic illness as trauma can happen as siblings and parents are in the hospital seeing outcomes of surgery and procedures, and lack control. How these events are processed can be defining for trauma not just in patients but also in siblings and parents. that why its important to also get counselling support for family members.

Thus, chronic illnesses have this intersectionality and consequences due to the impact on their mental health. And both parents of kids with significant medical/developmental issues, and patients themselves often don’t access to the psychological care that they need due to the shame associated with their illness.

My concern is that this gap in care causes a slippery slope that will end up worsening their illness, and cause stress on families causing more stress induced chronic illnesses which further worsens their mental health.

What I recommend

1.      I would recommend that mental health resources be given out to patients at diagnosis or when stress symptoms are noticed by their care team. Or that they enroll in a Chronic Disease Self-Management Program.

2.      As well as incorporating routine mental health consultation into the treatment of those with chronic illnesses. As a way of ensuring that they receive the support that they need as these large lifestyle adjustments are happening in their lives. This will further help patients to learn tools to create lasting behavioral and psychological changes and set them up for success as they adjust to life with a chronic illness.

3.      In addition to this recommendation, I would like to point out that not all therapy styles are appropriate for chronic illness and would suggest creating a chronic illness counseling referral network of mental health practitioners that are specifically trained in the therapy styles that have shown success in chronically ill patients. As a recommendation for chronic illness patients to mental health counsellors is supported by Cohen et al., (2021). They have further, gathered research on which therapy styles have been studied in patients with chronic illness and showed which had the greatest impact. Although all studies were small, behavioral therapy and mindfulness therapy had the best results in this patient type (Cohen et al., 2021). Suggesting that Dialectical Behavioral Therapy, which is a subgroup of Cognitive Behavioral Therapy, could have a favorable effect on chronic illness. This would be due to both CBT and DBT incorporating cognitive and behavioral therapy approaches. What I like about DBT is that it gives tangible skills and includes mindfulness therapy techniques this could be effective in patients that have memory issues or learn best with visualization and reminders.

While I would personally argue for an integrated approach to therapy, as that is what I use and have found that the integration allows for a better explanation of a client’s problems and for more targeted treatments (Sperry & Sperry, 2020). In working within an integrative model, I have found CBT and DBT to complement each other, as DBT is flexible enough to add skills from it’s four modules of mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance to the end of counseling sessions. And it helps CBT’s cognitive processing of chronic illness, through its use of the dialectic between change and acceptance. Linehan and Wilks (2015) also note that each module holds all that is needed for one specific portion of the chosen treatment. Thus, if patients are uncomfortable with mental health referrals it is easier for them to accept the idea of going and learning coping skills, rather than the anxiety that can come with cognitive processing. Therefore, DBT integrates well into the treatment strategies and interventions of therapy.

4.      Ultimately, encouraging patients towards these often free mental health resources will lower their stress levels and help them to learn skills to cope with chronic illness. This can help by teaching an understanding of emotions and thus lowering their perceived stress which Maleki et al., (2012), noted to be a top trigger in flaring pain (Maleki et al., 2012). Campbell (2022) also described online counseling as a way to aid chronic illness by giving patients a greater ability to manage depression and anxiety over simply medicating.

5.      Thus, if changes are made and mental health is recommended more often, it could take the strain off of the medical system by patients becoming better equipped to manage stress. As well as the possibility of slowing the progression of some chronic illnesses that are triggered by stress. My secondary recommendation would be advocating for MSP to cover mental health, as it could drastically reduce chronic illness’s effect on the health care system.

References

Arseneau, R., 2008. Chronic Fatigue Syndrome: Your patients' – Not You – So all we could do was to Sit!, Sit!, Sit!. BC Women's Hospital. (2021). Complex Chronic Diseases Program. Retrieved October 4, 2021, from https://mediasite.phsa.ca/Mediasite/Catalog/catalogs/mediasiteadmin-ccdp-introduction-course.

Mate, G. (2019, March 15). Dr. Gabor MATÉ - when the body says no in psychotherapy. YouTube. Retrieved September 19, 2021, from https://www.youtube.com/watch?v=7V5qn9dkzIU.

Maleki-Yazdi MR, Kelly SM, Lam SY, Marin M, Barbeau M, Walker V. The burden of illness in patients with moderate to severe chronic obstructive pulmonary disease in Canada. Can Respir J. 2012 Sep-Oct;19(5):319-24. doi: 10.1155/2012/328460. PMID: 23061077; PMCID: PMC3473007.

Cohen, S., Vase, L., & Hooten, W. (2022). Chronic pain: an update on burden, best practices, and new advances. Retrieved 17 June 2022, from https://www.cmaj.ca/content/193/8/E270

Roberts, K. C., Rao, D. P., Bennett, T. L., Loukine, L., & Jayaraman, G. C. (2015). Prevalence and patterns of chronic disease multimorbidity and associated determinants in Canada. Health promotion and chronic disease prevention in Canada: research, policy and practice, 35(6), 87–94. https://doi.org/10.24095/hpcdp.35.6.01

Borsook, D., Maleki, N., Becerra, L., & McE Borsook D, Maleki N, Becerra L, McEwen B. Understanding migraine through the lens of maladaptive stress responses: a model disease of allostatic load. Neuron. 2012 Jan 26;73(2):219-34. doi: 10.1016/j.neuron.2012.01.001. PMID: 22284178.

Campbell, B. (2022). Reducing Anxiety and Worry | ME/CFS & Fibromyalgia Self-Help. Retrieved 17 June 2022, from http://www.cfsselfhelp.org/library/reducing-anxiety-and-worry

Jason LA, Benton M. The impact of energy modulation on physical functioning and fatigue and severity among patients with ME/CFS. Patient Education Couns. 2009;77(2):237-241. doi: 10.1016/j.pec.2009.02.015

Linehan, M. and Wilks, C., (2015). The Course and Evolution of Dialectical Behavior Therapy. American Journal of Psychotherapy, 69(2), pp.97-110.

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