Breaking the Stigma: Why Mental Health Conversations Matter

Mental health is important not only to discuss but also to de-stigmatize, so we sat down with Jennifer Rutledge, FNP-C, a WakeMed primary care provider to learn more.

Please explain why it is important to normalize mental health discussions with a primary care provider.

Emotional health plays a role in our physical well-being. Depression significantly impacts both mental and physical health and is the leading cause of disability. As primary care providers, we must normalize mental health discussions with our patients to provide the best care and promote healthy outcomes.

How can primary care providers support mental health?

It's critical to let patients know that they're not alone and that mental health challenges are a normal part of the human experience. The CDC reported in 2020 that 18.4 percent of adults in the United States reported having been diagnosed with depression. That's approximately one in five adults. Additionally, depression is most common among younger adults, ages 18 to 25.

That in mind, I aim to validate the condition, the prevalence and the concern. I then listen to my patients to understand how best to treat them.

Support is then dependent upon whether counseling or pharmacological interventions are preferred. By using shared decision-making, we collaborate to figure out what is best suited for individual patient outcomes and goals.

What mental health symptoms indicate a need to seek support?

Depression and anxiety are two different conditions, but often go hand-in-hand since, typically, patients suffer from both anxiety and depression. 

Specifically with depression, patients can often complain of the following:

• Losing interest in activities
• Feeling down or hopeless
• Experiencing problems with sleep
• Feeling tired
• Experiencing appetite changes
• Having difficulties concentrating

On the other hand, people with anxiety may often report these symptoms:

• Feeling nervous
• Worrying
• Having trouble relaxing at night
• Experiencing irritability and annoyance
• Having an internal sensation of impending doom or that something awful may happen

It can become trickier when we start to have physical symptoms of anxiety and depression. The combination can involve the following symptoms:

• Feeling dizzy 
• Having heart palpitations
• Experiencing sudden sweating
• Becoming short of breath
• Having tremors 
• Shaking
• Experiencing tingling in our extremities 
• Experiencing diarrhea
• Having chest pain

With that combination of symptoms, it's particularly hard to know what's going on. That's when we need to seek medical advice from our primary care providers because it takes the expert to dive in to see if this is something more serious going on physically, or if is this equally serious regarding mental health.

Can you overview the types of mental health screenings that a primary care provider may offer?

At WakeMed, since 2021, we have consistently screened for depression. This came out of increasing depression data that we retrieved as a result of the COVID-19 pandemic. A lot of compelling evidence showcased significantly increasing depression rates across the nation. 

We started screening patients in our primary care offices using a two-question screening to determine if they were having symptoms of depression that required action. 

We encourage patients to fill them out independently, when possible, to obtain honest answers. Those questions are as follows: 

1. Over the last two weeks, how often have you been bothered by little interest and pleasure in activities?
2. Have you been feeling down, depressed or hopeless?

This is called the PHQ-2 questionnaire. The answer options are "not at all," "several days," "more than half of the day" or "nearly every day." 

We gather a quantitative score. A value of greater than or equal to three is positive. A high score means patients answer additional questions to evaluate the best next steps for individualized treatment goals.

Can you speak on the connection between physical and mental health?

I like to use the analogy of getting in a vehicle collision. In a collision, automatically at impact, we feel tense, our body goes into fight or flight mode, our heart rate and blood pressure start to increase, we start to sweat and we start to worry/panic. These symptoms can last during that acute event for anywhere from five minutes to an hour.

Compare this to an acute psychological event happening every day for months or years. This physiologically damages the body. It puts stress on our heart. As such, anxiety and depression can lead to high blood pressure, heart disease and chronic illnesses. It's important for the safety of our physical health to seek treatment and get help.

What are barriers to mental health care?

• The first barrier is the stigma of mental health issues. One way we can overcome that barrier is by providing awareness and opportunities to educate the population. 
• Another barrier is the patient's perception that the problem isn't that serious.
• Yet another barrier is access to health care. 
• Fear of negative outcomes or expressing our concerns is also an issue. 
• High demand combined with low availability of mental health providers is also a challenge.

If patients have any of these barriers or concerns, it's critical to be honest and speak to health care providers and others with whom the patient feels comfortable sharing candid conversations.

How can providers help overcome them?

Our barriers are often financial, fragmented health care. Thankfully, at WakeMed, we have social workers who are able to provide one-on-one counseling via virtual patient appointments. We also have a psychiatrist we can call on, specifically, if we have a more complex case that we need to work out.

When it comes to high demand for support, but low availability, WakeMed has done an excellent job offering a variety of options to speed up access to care.

 

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About WakeMed Primary Care

WakeMed Physician Practices features board-certified primary care, internal medicine and family medicine physicians conveniently located throughout the Triangle.

Our exceptional, compassionate providers and care teams pride themselves on developing long-term relationships with our patients and families.

We look forward to caring for you and your family and to being your family’s medical home. Call or schedule online for an in-person or virtual visit with one of our primary care providers.

About Jennifer Rutledge, FNP-C

Jennifer Rutledge is a certified nurse practitioner through the American Academy of Nurse Practitioners (AANP) and specializes in adult primary care. Her clinical interests include health promotion and education, chronic disease management, women’s health and preventative care. She enjoys meeting with her patients and developing a partnership toward healthier lifestyles. Her previous experience serving as an emergency department nurse and traveling nurse helped her mature into a seasoned nurse practitioner with a wealth of clinical expertise.

Rutledge earned her bachelor’s degree in nursing from East Carolina University and her master’s degree in nursing through the University of North Carolina at Chapel Hill. She was inducted into the Sigma Theta Tau International Honor Society of Nursing in 2011 and is a member of the American Association of Nurse Practitioners. In her spare time, Rutledge likes spending time with her husband and two children, traveling, outdoor activities and live music.