There are still barriers to mental health care, in both the medical and outside worlds, noted Debra Delaney, MSN, FNP-BC, primary care nurse practitioner at ChristianaCare’s Helen F. Graham Cancer Center & Research Institute.
In some ways, there are still barriers to mental health care, in both the medical and outside worlds, noted Debra Delaney, MSN, FNP-BC, primary care nurse practitioner at ChristianaCare’s Helen F. Graham Cancer Center & Research Institute; the more it is talked about, acceptance will grow, she added.
Why is it important to address barriers to mental health, as highlighted by the COVID-19 pandemic, and can you discuss how stress and mental health overlap with oncology care?
There still are barriers in some ways. I look at the world—the medical world and outside world—and there is a stigma attached to it, even though we're talking more about it than we ever have. Even patients who come to me and they tell me that they're crying intermittently, and I say, “Well, you know, that seems to be one of the signs of depression.” And we talk about supportive care, journaling. We talk about communicating with friends and family and surrounding each other with support. And when I bring up the topic of medications, patients will shut me down immediately and say, “I do not want to medication.” And I'm fine with that. That's fine. What I say is, “We do need to talk about this because crying every day is interfering with your activity of daily living, and it's not supposed to happen.
The stigma is still there, and we're trying to work with it. The more we talk about it, I think the more it will be accepted. It's slow, and patients don't like to take medications to begin with. There are a lot of patients who [say], “I'm going to get my blood pressure under control with exercise and weight loss,” and that's great and I support that 100%—and I support patients who want supportive care first. Also, counseling can be beneficial for patients who are struggling mentally.
In the oncology world, the oncology diagnosis is such a heavy, heavy diagnosis to hear. Immediately, I think people go to a really dark area when somebody says, “This looks like it's cancer.” That plays on the mental health issues that may already be there, it brings them to the forefront. I see that a lot in my practice, and I talk to patients. Again, I go over supportive care mechanisms: “Let's do journaling, surround yourself with friends, it's okay to sit and cry for a few minutes, and then we have to try to work our way through this.” I can refer them to psycho-oncology, I can refer them to outside counseling if they want for cognitive behavioral therapy, and we can discuss medications at some point when they're ready.