For the Love of Health

Mental Health is Health with Dr. Mustafa Mufti

• ChristianaCare • Season 3 • Episode 1

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Mental illness isn't always obvious. Someone suffering with anxiety or depression can still wear a smile, crack a joke and be successful. On this episode of For the Love of Health, Dr. Mustafa Mufti, Chair of the ChristianaCare Department of Psychiatry, explains how mental health should be treated the same as physical health. 

Mustafa Mufti, M.D., is the chair of the ChristianaCare Department of Psychiatry. In this role, Dr. Mufti focuses on fostering and maintaining a vibrant, successful psychiatry department, including physician performance, quality, research and scholarly activity as well as the administration of all departmental educational, clinical and academic programming.

 

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Speaker 1:

I think one of the core things is people don't understand that mental illness is a medical condition.

Speaker 2:

You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by Christiana Care. Hello everyone, I'm Jason Tokarski.

Speaker 3:

And I'm Megan McGerman. Welcome to For the Love of Health brought to you by Christiana Care.

Speaker 2:

We've all heard the phrase it's okay to not be okay. But what does that really mean?

Speaker 3:

According to the National Institute of Mental Health, it is estimated that more than one in five US adults live with a mental illness.

Speaker 2:

Joining us for a deeper look into mental health is Mustafa Mufti, chair of the Christiana Care Department of Psychiatry.

Speaker 3:

Mustafa, thank you for being here today.

Speaker 1:

Good morning. Thank you for having me join you to discuss this very important topic.

Speaker 3:

We mentioned in the intro one in five US adults dealing with mental illness. In your professional opinion, how accurate is that number?

Speaker 1:

So one in five is what the data has told us, which equates to about 53 million people annually. I think that the true number is probably actually much higher. What I can tell you is that, clinically, we have seen that this does equate to that, but we also know that there's a fair number of people that either don't understand that they're struggling with mental illness or, if they do, they're afraid to seek out care for a multitude of different reasons, be that stigma, their personal stigma, or what people may think of them.

Speaker 2:

What are some of the most common misconceptions that you've seen in regards to needing and actually seeking out that mental health?

Speaker 1:

I think one of the core things is people don't understand that mental illness is a medical condition. You know it's very similar to diabetes, hypertension. These are all medical illnesses. A lot of times people feel that mental illness is some sort of a moral failing or a personal failure and as such, they think they can just work through it. So they don't appreciate that it is a medical condition that does require experts. It requires a diagnosis and then perhaps different treatment options.

Speaker 3:

If someone is listening to this and is personally thinking I'm fine, I'm working through, whatever that may be, or has a loved one who they think is kind of in that boat, what are those telltale signs that say maybe I'm not doing as okay as I thought I was?

Speaker 1:

There's a phrase that we often hear now and it's if you see something, say something. And I think for mental illness we need to expand that a little further that if you see something or feel something, say something, but also listen and stay. So if you're thinking about a loved one or someone who you think is struggling, so it's just not that you have to go into action and do something about it. I think it's more about being present in the moment and then hearing what's wrong. And if you think about it from a personal perspective, what does mental illness look like?

Speaker 1:

And a lot of times I think part of the stigma, part of the media that's created this image that you think of someone that is really out of sorts, struggling, disheveled, not able to take care of themselves. But what we do know is mental illness, what it looks like. It can wear a smile, it can laugh, it can crack a joke, it can be extremely professionally successful and it can be extremely wealthy, but that's sort of surviving, it's not thriving. So I think that's really when you have to think about things If you're doing very well from every aspect of your life, but you still feel that there's something missing, that you're able to do better and you're not able to thrive. I think that would be an opportunity for either yourself or for your loved one that just stop and listen.

Speaker 2:

What you just said there about people being successful with it reminded me very much of Robin Williams, who was very successful, constantly cracking jokes but internally constantly working through his depression and obviously not able to get the help he needed. So, as far as people on the outside looking in, what do you suggest to help them break through, to make them understand that they need help and that they're there for you or that they can help them? Find somebody to help them with it?

Speaker 1:

Yeah, so you bring up Robin Williams, and that was really. It was heartbreaking, that was a tragedy. He was, for all intents and purposes, a comedic genius, right, he made millions of people happy, laugh and just enjoy life. But none of us knew that this is what, internally, he was struggling with. And I think that you bring up a very valid point that the pain is internal. Right, but it's not any less.

Speaker 1:

You know, if someone breaks a leg, I like using analogies to, and I do it a lot in my clinical practice as well. So if you break a leg, what we would do is we're not going to tell that individual to walk it off right, we're going to say, hey, something wrong here, let's go get an x-ray, go to the ER, you may get a cast, you may get crutches, you may get medications and you may get even physical therapy. But since that pain is outward, we are very empathetic about it and we communicate about it. The pain with mental illness is internal, like it was for Robin Williams. It was not external, but it does not mean that it is any less and it does not mean that we should provide any less form of empathy or compassion for those individuals.

Speaker 2:

I feel like we've started to reach a point where therapy isn't necessarily as stigmatized as it once was, that people are a little more open to the idea of going to therapy, but they seem to do it a lot of times based on a specific issue or they're in crisis, or they're having some specific thing they're dealing with at this time. Is that necessary, or do you think literally anybody, for any reason, should or could have a therapist in their life?

Speaker 1:

I think that anybody could or should if they feel that that's what they need. And, like I said, I love analogy, right? So I'm going to give you the analogy of a personal trainer. I mean, if I go to the gym, I don't go that much, I should, but you know, if I were to go to the gym, anyone would. We see a treadmill. But if I were to go to the gym, anyone would. We see a treadmill. We see a stair strapper. We generally know what to do with that, right, turn it on, you walk, you run, you incline it, et cetera.

Speaker 1:

But if anyone has gone to that same environment with a personal trainer, an expert, what you do with that expert in 15 minutes is probably going to be more impactful than what you do an hour by yourself. Right? And that's what I think about psychotherapy is, these are very highly trained, educated individuals in their field. By and large. I don't think they're going to tell you or anybody something you don't already know, right? We all know generally what we're supposed to do for our health Eat healthy, we're supposed to exercise, stay well hydrated, etc. But it's really about when to do those things, at what times and how to do those, and I think that's where therapy really comes into play, is you have an expert that you discuss your issues with and, based on their knowledge, experience and expertise, they allow you to be able to shuffle through that and then also give you the tools that you can then utilize at different times. Life is hard and challenging for everybody, right, and we're all going to come across different personal, social, financial struggles. We're all going to face that Health struggle, but what tools are going to be in our tool chest to utilize is, I think, really what a therapist is going to face that the health struggle, but what tools are going to be in our tool chest to utilize is, I think, really what a therapist is going to help you with Stigma is reducing. There's a lot of work to do there. There's a lot of things that we need to learn more about. I'm also very excited as a clinician to see where we are and how much we've grown with the medications, the different treatment modalities. I'm also very excited to see how many employers are out now looking at wellness and really speaking about this.

Speaker 1:

I think an important step in kind of reducing stigma is normalizing these conversations. I think it's also important for folks who are in leadership or in positions of authority, be that, you know, in kind of acting or music, where people are now speaking about these things, and I think that really helps people normalize it. We also are now seeing that people who are getting care are seeing a positive impact. You know what studies are showing is if you start an antidepressant, you know it may work up to 50% of the time. That's a good statistic, right Statistics in healthcare. I will add, they're a little tough. When I remember I was studying from one of my boards, I think one of the individuals said that you know, even if something is 99% effective, if you're that 1%, that it didn't help. Really unfortunate for you. But you know generally, when I go into it, 50%. We also know that people who do a combination of psychotherapy and medications, there's over a 70% reduction in relapse rate. So some of the numbers are very promising. So I think these are all positive things.

Speaker 3:

You mentioned those impressive statistics about when medication is paired with a therapy, how well people are doing. What about those people who are not interested in the medication aspect of it? What is available to them?

Speaker 1:

One thing about medications, before I answer that question, is the misconceptions that some people have that it's going to change your personality, it's going to change who you are, and that is absolutely not true. Right, medications are just going to help you to be able to deal with life and the things that it throws at you. It's going to help with your sleep, it's going to help with your energy, your concentration, et cetera. So I think that those are important things to understand To your point, like what about the people who are not interested in medications? I guess, as a psychiatrist, the first thing I want to ask them is why? And I want to get more information as to why they're not interested, and I will respect whatever their decision If they don't want to choose that medication or take a medication. I definitely want to do my job of discussing different alternatives. What are the benefits? What are the risks?

Speaker 1:

But then you said there are other treatment modalities which are now in play. We have therapy, which is a thing. We do have some neuromodulation opportunities that have now come up. There's repetitive transcranial magnetic stimulation for the treatment of depression, which basically entails it's sort of like you sit, almost something looks like a dental chair, and it's a magnet that sits over a certain area of your brain and we stimulate that area. It's an outpatient procedure. It is virtually not painful. It takes about 30, 35 minutes.

Speaker 1:

There's esketamine that's now available through an intranasal formulation to help with more. These are more for treatment refractory. But again, I'm going to look at this from a lens of optimism. These are different modalities that we did not have available to us a number of years ago and I'm confident in my colleagues who are actively involved in research and R&D that there's more things on the horizon. So, for those people who are afraid of medications, I would really encourage you to speak to a professional and understand why it is that they're, and perhaps you're right in your concerns, but we're really not going to know until we have a conversation about it.

Speaker 3:

Do you see that age groups handle this differently as well? There, I know, is a kind of stigma that millennials are extra anxious compared to, you know, the generations before them. Are you seeing that in your practice that different generations present their mental wellness differently?

Speaker 1:

So I always I'm really bad with that whole millennial X. I get those things all messed up.

Speaker 3:

The millennial. We're in our 30s, if that's helpful. Yeah, I'm a little older, right.

Speaker 1:

The good thing is, I think with the younger generations, they are a little bit more receptive to understanding that this is an issue and seeking out care. Part of what I'll talk again the positivities that we've seen with mental awareness is now that there are individuals in schools getting diagnosed, getting checked, and what the data tells us is the earlier onset of diagnosing these issues has a better prognosis. I look at it positively. I think that the younger generations are more in tune with understanding that there may be a concern and kind of seeking out help and likewise, you know, the elder generation has done well.

Speaker 1:

What we did see, again a positive statistic, is access is always an issue for mental health and with the pandemic, while national and global data has shown us that there's about a 25% increase in depression, anxiety and mental illness, we also saw that there's a 400% increase in access of telehealth right, which really allowed a lot more people to be able to get care.

Speaker 1:

And when I thought about this, I was thinking about, you know, our individuals, the people we care for, that are beyond the age of 65, 70, even beyond the age of 80. How were they going to navigate that iPad, that email, that link, and I was pleasantly surprised to see how many people had done well with that and really utilized that access to care, and I was also very optimistic to see people within that age group who did come, who did grow up during the time when this was stigmatized a lot more than it is now right. It was really considered, like I said, either a moral failing or a personal flaw. They're more willing to seek out care. I think these are all positive things that we're seeing.

Speaker 2:

Megan asked about generation and age differences there. What about gender? It seems like there was a lot more stigma about men addressing this than women, and are you still seeing that, or are men starting to come to the table more?

Speaker 1:

I can see where that originated from, just from that concept of being kind of that strong person that you should deal with this, that analogy I gave of just walk it off. So it's kind of like it's depression, it's anxiety. You know, just suck it up, Go on with life. This happens to all of us. What's the big deal? The mental illness. It can affect and impact anyone and the reason being is there is a biological component. Right, it is a medical illness. It is a difference with. There's an imbalance in neurotransmitters. There's been imaging studies which have shown us that someone with any particular mental illnesses versus another, there are structural brain differences that are also we're now seeing. So it's very evident that this is a biological process.

Speaker 2:

From what you've said, it sounds like we're already miles ahead of where we were 10, 20, 30 years ago in as far as taking care of mental health. What's next? Where are we going into the future?

Speaker 1:

I'm very optimistic of the future. I think that there's a lot more. You know I was previously the presidency director. I'm seeing a lot more people have a lot of interest coming into mental health as a profession, so we're seeing a lot more people entering it. And there's a lot more people have a lot of interest coming into mental health as a profession, so we're seeing a lot more people entering it and there's a lot more demand. There's a lot more people seeking help.

Speaker 1:

We're also seeing now as technology it's growing so quickly, so expansively. It's like you think about something and you pick up your phone. It's available to you through an app, through anything. And I think about AI. You know AI is a very interesting thing and AI has a lot of implications and also in behavioral health, we're also seeing that this can help with kind of even preliminary diagnosing things. There's different apps on there that can help with your medications, with therapies, et cetera. So I look at all of these as very positive, impactful tools which can allow us to reach more people the way that they want to be reached.

Speaker 1:

I think that's also very important is that we really individualize care. I'm going to give you an example of you know you brought up how different generations are responding and you know when I've done telehealth visits the older generation if they have ambulatory difficulties, if they have transportation difficulties they may have a walker wheelchair I'm able to have a conversation with them when they're in the comfort of their own living Right. It also allows people to be a little bit more open in conversations. I've had telehealth visits with other younger individuals who chose to go sit on a park bench outside in the open air and kind of have that sort of thing. So this has all been through technology. I think technology has a huge impact Pharmacologically. There are new medications coming out all the time. We're constantly looking at different neurotransmitters, different pathways of how to manage, from just a basic neurochemical standpoint, how to manage the illness.

Speaker 3:

Before we let you go, what is your last general takeaway message about mental health? We've certainly all heard the it's okay to not be okay. What is kind of your version of that, or your message to those listening today?

Speaker 1:

I think it's important to realize that mental health is health, and your physical and mental health are very codependent on each other. They're intertwined. I think it's very, almost impossible to have one and not the other, so I think that's a very important aspect. So when I speak about mental health, it's just health, it's your health care, it's the opportunity for you to thrive. At Christiana Care, we're guided by our core values of love and excellence. I can tell you that that's exactly what you're going to get if you seek behavioral health care with us. I can't guarantee a cure right, but what I can promise you is that each and every caregiver within our service line will meet you where you are. They're going to teach you with empathy, compassion, respect and offer you a lending ear to see how it is that we can help.

Speaker 3:

Thank you so much for your time. We talked before this that this episode could have been two hours long, so I'm sure we'll have you back for more topics.

Speaker 1:

Thank you so much. It was a pleasure speaking to you.

Speaker 2:

Check out the show notes for this episode for more information on behavioral health services at ChristianaCare.

Speaker 3:

Also head to podcastchristianacareorg or wherever you get your podcasts to check out the first two seasons of For the Love of Health as we kick off season three.

Speaker 2:

We'll be back in two weeks with another great conversation.

Speaker 3:

Until then, thanks for joining us.

Speaker 2:

For the Love of.

Speaker 3:

Health.

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Megan McGuriman

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