Vital Views

Joe Gaccione 0:02

Welcome to Vital Views, podcast for UNLV School of Nursing. I'm Joe Gaccione, communications director for the School of Nursing. Mental Health Awareness came to the forefront during the COVID-19 pandemic. There was no shortage of concerns from all walks of life, from professional burnout to personal isolation to general feelings of hopelessness. But even though COVID-19 is a more manageable pandemic now, and society is back in this new normal, mental health is just as relevant now as it's ever been. Yet it still faces scrutiny and lack of true understanding. One of our nursing faculty provides mental health training both locally and internationally in his home country in the Philippines. Dr. Jay Tan is an assistant professor here at UNLV. His specialties include advanced nurse practice, psychiatric and mental health nursing, and geriatric nursing. He also previously served as president of the Nevada State Board of Nursing. Dr. Tan, thanks for coming by.

Jay Tan 0:56

Thank you so much for inviting, Joe.

Joe Gaccione 0:58

Your mental health education in the Philippines, who and what do you specifically teach?

Jay Tan 1:03

Well, in the advent of COVID, I opened up some programs there in collaboration with the Department of Health in the Philippines and some local government. So basically, what I did, and my reach-out to them has three folds. One is mental health awareness, focusing on depression and anxiety and then two is stress debriefing, especially during the advent of a pandemic. This educational program is actually a non-formal program, which my aim is directed to the community and not only the community as the people who are consumers, but they are a community per se, and I look at them in different sects. Aside from the common people, the lay people, I also target the educators because I really believe you know, the elementary school teachers there, that's why I collaborated with the Department of Education, because I reach out to them, educating them, what are the telltale signs and symptoms that a child might be suffering from emotional problem, such as depression or anxiety, because I do believe, you know, as a child is in school, they spend more time in school, and who else is best to identify it early? It won't be the parents anymore, it would be the teachers, you know, so I educate the educators, and what are the telltale signs of signs and symptoms of depression and anxiety so that early identification, and perhaps intervention can be done. Also, I reach out to the teachers because they can influence this kid as well as their family, in decreasing social stigma. And that's another fold there that I focus on as an ultimate goal then, is to decrease social stigma, especially in the international level. I also spoke before in Indonesia, but both Asian countries has a very high stigma attached to mental health. It's a taboo, it's something that they don't talk about, and it's something also that no one talks about. Yet, in the Philippines, about 44.5 million, according to WHO are suffering from depression. That's highest in the Asian western country. And it's sad to say, you know, the reason why I do that education and initiative because 1/3 of that don't know they have mental health illness, 1/3 of that know they have mental illness, but they're so ashamed to seek help, and then only 1/3 seek help.

Joe Gaccione 3:36

And I feel like that's the same here. Why is there still this mountain to climb when it comes to mental health? Why is there a stigma? Why should I feel ashamed if I have these feelings?

Jay Tan 3:46

I think it's cultural over time because in the field of medicine, physiological was the main focus, the heart, the lungs, and all those things, you know, example. But mental health is viewed as a strength, it is something that you can, you know, control or if not, you lack of something in your character or in your personality that you can just learn along the way. But studies show it's not. Mental health is as true as physical health. So over time, and certain generation believes that mental health is not a priority, and if it affects you, it's something that you did to yourself, and that's probably where the stigma comes in, you know? So over time, perhaps the next generation is more informed, more informed, more knowledgeable, that there is now start to accumulate that need of mental health. And it's very interesting because even COVID, you know, I think helped. I think COVID, in a way I said, help, you know, that COVID had helped in mental awareness, because then previous generation view it as what you've said, with the stigma on it, that you'd something that you should just pray, something you could just train yourself, but then COVID comes in, that anxiety, depression comes in also, and the awareness becomes more necessitated. In fact, study shows that about 88%, or 9 out of 10 Americans think that access to mental health now is important. That's post COVID, so that's something that's probably brewing and that's interesting, some change of paradigm from lay people.

Joe Gaccione 5:23

And we saw pandemic specific mental health issues that we had not seen before, at least not seen as much, I mean, on the, you know, on the low end of the spectrum, you could argue zoom fatigue, you know, constantly on the computer, constantly in these virtual meetings. Older generations, I mean, older populations, stuck in their homes with little to no interaction with anybody, so there's that isolation that they previously hadn't experienced to that extent. Even though the pandemic’s waned, we still have mental health issues. Are there more COVID specific red flags these days or are they, are they still general, that could apply to any situation?

Jay Tan 5:56

Well, there are, there are. In my review, I mean, and it might not be generalized in the population, but it's also felt and that COVID specific increase of mental health issues covered, one, healthcare workers, you know, frontliners, not only healthcare workers, but frontliners, because they've seen also a spike of a lot of COVID patients, and especially in the first part, PTSD and anxiety is how related to it, especially health workers, you know, because they've seen a surge of COVID into hospitalization, I mean, in hospital death that goes with it. So, a lot of healthcare workers suffer from anxiety and PTSD of caring for the COVID population. You know, that's one thing, but the general population too, has all those COVID specific, they feel the need, but they have also felt more anxious than before. And I've seen that in my practice, such as concerned about their physical health. About 70% of America now is concerned about their physical health, post COVID. About 90% of Americans concerned about their economy, post COVID, and 72% are concerned about their purchasing necessities, all this after post COVID, which would zeroed in into generalized anxiety in the community.

Joe Gaccione 7:14

You adjusted your own language to promote better mental health during the pandemic. Social distancing was the popular term, but you preferred to call it social spacing. Can you explain why?

Jay Tan 7:23

Yes, that change of paradigm where I use social spacing rather than social distancing comes from my background as a mental health practitioner. Well, in mental health, I deal with a lot of people who are already feeling isolated, because they're feeling depressed. So, the word of “social distancing,” for me, makes them feel more isolated than usual, even during COVID or, or before COVID, when before COVID, they felt already lonely and depressed, and then during COVID, then we put more context or concept of distancing, and people are distancing, some people view distancing as not only a matter of measurement. Some people view the word distancing as a means of isolating them, you know, “you're distant to me, you're away from me, you're neglecting me,” you know? And a lot of depressed individual are also very sensitive to those. So, using the word in my practice, even in my clinic, using the word, “maintain social distancing,” connotes that they will be more lonely than usual aside from the depressive symptoms. So instead, I use the word, “social spacing,” because I do support the six feet distance to prevent the infection, but I don't want to create a notion that you will be isolated than ever before on top of your depression. So then, I use the word social spacing, as a way of reminding them that it's not about being alone. You will be supported, there is support, but it's all about space and distance that you are going to maintain to prevent the physiological transfer of the virus. In that way, you don't feel like, “I'm already so sad, depressed, lonely, hopeless and worthless, and now I have to distance from people, which I don't have to start with.” So for me, it's very comforting and I have a lot of patient that I used that. And they said, “That makes sense. You know, that would not make me feel that I'm alone during this pandemic, which would make me more depressed, that I cannot reach out to others. And I do understand, and we do understand that it's not about, somebody's away from us, but it's the space that we need in between to prevent the surge of infection.”

Joe Gaccione 9:48

We talked about treating mental health, we've already discussed education, we've discussed awareness, pharmacology is another area to help treat mental health, but when it comes to medication treatment, it's not one size fits all, correct?

Jay Tan 10:00

Correct, yes. And I really love that you asked that question because that's one of my advocacy as a practicing nurse practitioner in mental health. One of my value and practice that I do in my clinic is the notion of personalized medicine, or precision medicine. And what does it entail? It entails us, what you've said, that not all medication is true to everyone and one size fits all, like a cookie cutter. What happened is that I use and I prescribe a lot of medication, antidepressant antianxiety, based on their symptoms, but before I treat each individual, and if they allow, I would do what we call this, pharmacogenetics. Pharmacogenetics actually allows us to know that this medication fits this patient by considering the uniqueness of the individual's genetic profile. And that is a science that's available right now, since 1950, and got FDA approval in 1990. So now it's available for clinic practice, most insurance covers it, and in general term, and how do we know that this is good science? I mean, if you remember, a lot of people, they may take one medication, that's the same medication, the same dose, two different individual, they may have two different reaction. One says, “I love it, that works for me.” The other one would say, “I hate it, it makes me drowsy, it makes me groggy, it has a lot of side effects.” We have the same medication, the same dose, but two individuals. Why? Because each individual has their own uniqueness, as indicated by the genes in the body that actually would process that medication and that's where the difference in reaction. Nowadays, there is a science now that will test what type of genes you have and would even suggest what are the medication of this class is appropriate for you, that your body knows how to process, that you will get the benefit, and minimize the side effects. So, it's no longer the guessing game, or, you know, the trial and error approach of the older medication practice. So, that's the beauty of it, you know, so that's why I always would go, you know, it's not a one size fits all, it's not a cookie cutter that all antidepressant can help everyone. Antidepressants can help, but genetic profile would also be a factor to make a difference between effectiveness and side effects.

Joe Gaccione 12:36

And along the same lines, you could also say that mental health treatment is not one size fits all. If you have a friend that goes to a therapist or any other psych nurse, professional, and the results are working for them, you can go to the same person, but you might not gel, you might not agree with, you know, it's like it's still almost personalized, because everyone is unique.

Jay Tan 12:55

Exactly, Joe, and I do agree with that. I'm glad that you brought it up because aside from medication management, I also would advocate for a therapy, you know? It's not just chemicals in our body, it's actually learning things we haven't learned in the past or something that we could enhance what we need to in order to protect us and help us mentally, you know? So, therapists are very important, but I always tell this to my patient, you know, I always, “Let’s stabilize your mood with medication, but then the long term effect is to learn coping skills, learn techniques in life, that may lessen the impact of stress and anxiety in you on a day to day living.” So, talk to somebody like a therapist, but I gotta tell you, the therapist should be individualized. Not everyone, you might have a therapist who might have all the accolades and the titles and the training and the awards, but if it doesn't fit your needs, and it doesn't fit your personality, your approach, it's useless. You need to find that match to be personalized in approach in mental health. And that's when treatment is meaningful. And meaningful means with a biggest potential to help and succeed, help you mentally.

Joe Gaccione 14:11

How can we improve mental health awareness, specifically, mental health education? Is it just simply having more faculty who specialize in it?

Jay Tan 14:19

I think that's one factor, that more faculty specialize in it, but I think the biggest factor is make mental health issues, now my advocacy is make mental health a household discussion. You might have a very well trained faculty or specialists in mental health. It means nothing if people in the community is still not embracing it and is running away from it. You could just be preaching to somebody who's not ready to assimilate. That's what you've seen, there was a certain time when still, we still have stigma, different diverse community in our locality have their own culture, they have their own stigma attached to it, but so, so they might have different reaction, but if you bring mental health discussion in the household, I think it normalizes it. So then, one of my advocacy is to normalize the discussion of mental health of an individual. Just like we have, you know, “I have a stomachache, I have a fever, I'm sneezing, I have a flu.” The flu before, in the Spanish time, is very high mortality, but now it becomes a household discussion, that, “Oh, you have a flu, you need to seek help.” That's my hope. In order to permeate mental health awareness and mental health treatment coming from specialists, I think it should start from the household, where people are comfortable talking about mental health, talking, discussing without the strain of stigma, then people start to normalize it. And when they feel it, they seek help. And that could probably change the culture.

Joe Gaccione 16:00

What are some resources that you recommend people turn to if they feel like they need support, whether they're professional organizations, I mean, you have a practice here, if you want to plug that?

Jay Tan 16:09

Yeah, they could check into my website for my practice. It's called iCare Psychiatry, “i” like the iPhone, it's written, but it seems like, because my background is in nursing, so I have to still put that as the care of a nurse rather than the treatment, so that's my value, but I put actually the “i” there for many reasons: innovative care, that's why I do pharmacogenetic; informational care, because if they access my website, they could look at all, some layman's term explanation of what mental health, what are some common diagnosis and mental health and what to watch, so that's the ‘i” also is the informative care, and I also believe that “i” as an interdisciplinary care, and that's why if I write medications, I also have to refer you to appropriate professional in other disciplines, such as therapist, psychologist, because it should be viewed as a holistic approach. So, that's one thing and then they could also access the Southern Nevada Health District, they have a very good area there talking about mental health in the community and the resources where they could go, you know? And generally, you know, the CDC. And mental health is a very, by the way, mental health is a very big part also of Healthy People 2030. That's another site that you could check on, and there's a lot of support there.

Joe Gaccione 17:29

We will provide the links in this episode's page when it drops. Dr. Tan, thank you so much for coming by.

Jay Tan 17:34

Thank you so much, Joe. My pleasure.

Joe Gaccione 17:36

Thanks for listening out there. Hope you have a great day.