Mindful practice

In many cases, mental illness doesn’t occur in the mind alone. It also produces physical symptoms like joint and limb pain, gastrointestinal distress and appetite changes. In chiropractic practice, mental illness can co-occur with any number of physical complaints. Understanding mental illness, then, can prove valuable in treating its physical symptoms – and with interdisciplinary approaches to medical problems gaining in popularity, chiropractors have much to gain by developing a basic understanding of mental illness.

The Centre for Addiction and Mental Health in Toronto says that one in every five Canadians will experience a mental illness or substance abuse problem in his or her lifetime. That means approximately seven million Canadians will suffer from mental illness at some point. Mental illnesses cost Canada’s economy a staggering $51 billion every year.

For this reason, medical professionals of all kinds, and the nation at large, have a vested interest in promoting mental health initiatives. In chiropractic, that involves knowing how to identify mental illness, knowing how to broach the subject of mental illness with patients and having a thorough grasp of the available solutions for this very real problem.

Mental health advocates maintain that if society is to effectively address mental illness, doctors and professionals of all medical disciplines will need to join the larger public health movement around this issue and create a space for interdisciplinary dialogue. Mental illness isn’t just a mental problem – it also creates physical symptoms that chiropractors may often see in their practices. This is why Canadian Chiropractor spoke to two of British Columbia’s leading experts on the issue – one an expert of the mind, the other an expert of the body.

Mental illness and chronic pain
Dr. Jay Robinson is a chiropractor in Burnaby, B.C. and the president of the British Columbia Chiropractic Association. He says mental illness is something chiropractors commonly see among chronic pain patients.

“There’s definitely a connection between mental illness and chronic pain,” Robinson says. “It’s common among chronic pain patients to feel depressed. These patients can get frustrated even though care may be working, so they abandon care for something else. It’s a big problem.”

Psychologist Dr. Susan Holtzman agrees with Robinson. Holtzman is the lead investigator of the Health Psychology Laboratory at the University of British Columbia’s satellite campus in Kelowna. She is a health psychologist who studies chronic pain.

“We now know, after decades of research, that there is a very close link between chronic pain and mental health difficulties. The strongest example of this link is the connection between chronic pain and depression. We see much higher rates of depression among chronic pain patients, and we see higher rates of chronic pain among depression patients,” Holtzman says.

Signs and symptoms
This increased prevalence of mental illness in chronic pain patients means it’s important for chiropractors to be able to recognize mental illness. According to Robinson, a patient may come in for an issue like back pain or neck pain, but might also have an underlying mental disorder that can go unnoticed.

“We can all recognize the severe cases,” he says, “but how many of us can recognize someone in the early stages of Alzheimer’s disease? How many of the patients who walk through your door might be suicidal?”

Holtzman says chiropractors who want to be able to recognize mental illness should be aware of common issues and should know which questions to ask.

“It’s important to be aware of the most common mental health issues in pain patients. But keep in mind that there’s a difference between someone who has a mental illness and someone who is dealing with a difficult life situation,” she says.

So how do you know when these challenges constitute a mental illness? Holtzman says it’s a great idea to ask patients to what extent their mood interferes with their life.

“We all have bad days, but most of us are able to keep functioning. It only becomes a mental illness when it starts to affect your quality of life… it’s important to ask not only what the patient’s mood has been like lately, but also to what extent their mood interferes with their life.”

For instance: Everyone experiences anxiety, but not everyone has an anxiety disorder. The difference lies in how much the experience of anxiety influences the patient’s quality of life. Anxiety may become a disorder if it causes the patient to miss work, abuse drugs or have severely strained relationships.

Collaboration
Holtzman says many health-care practitioners can be afraid to “open the Pandora’s Box” of mental illness. However, as a multifaceted and complex problem, mental illness is best dealt with by collaborating with other professionals.

Robinson also agrees that treating mental illnesses should involve collaboration.

“I saw a fair number of patients who, because of a car accident or something similar, had chronic neck pain and couldn’t work,” Robinson says. “Many of them would develop depression secondary to the neck pain about one or two years later. These are co-treat issues.”

As an insurance negotiator for B.C., Robinson says an interdisciplinary approach is something that stands to benefit patients, chiropractors and the government.

“It’s a significant enough issue that the Insurance Corporation of British Columbia has recognized it, and is looking into funding long-term mental health support for car accident patients,” he says.

Holtzman says chiropractors do indeed have a role to play in helping patients seek mental health treatment.

“The first step is to learn about what type of treatment appeals to the patient,” she says.

She also notes helping patients find appropriate mental health treatment can often improve their physical symptoms – given the intimate link between mind and body.

Talking to patients
Holtzman says it’s important to be open and non-judgmental when patients have mental health concerns. One great way to do this is to mirror the patient’s language rather than using clinical terms like “disorder.” She also notes although mental illness falls outside the scope of the chiropractic treatment mandate, there are several ways that chiropractors can help.

“For practitioners, having good self-help books or online resources on hand would be of great value in helping mentally ill patients,” Holtzman suggests.

Resources from the Canadian Mental Health Association, the Mood Disorders Society and the Anxiety Disorders Society are all great resources to have available in the clinic. It’s also useful to take stock of which mental health professionals are working in the community.

With mental illness becoming a larger public health problem every day, health-care professionals, like chiropractors, are starting to see it more and more in practice. Psychologists are now calling for an interdisciplinary approach to the management and treatment of mental illness in Canada.

Chiropractors can become part of this initiative in a variety of ways – even something like becoming more aware about mental health issues can have an impact.

Recognizing the signs of mental illness and responding appropriately can ultimately contribute to the larger public health movement and greatly improve a chiropractor’s standard of care.