Student Spotlight: ESL student Serife Gulmus
From ESL professor Mariya Petkova: “As part of their EAP Reading and Writing class, ESL student have to write an essay based on a previously researched academic topic of their choice. The purpose is to argue a point and try to convince the reader, supporting their view with academic sources. Being aware of Serife’s solid educational background and experience in the medical field, I was not surprised when she decided to write about mental health. Her essay provides an interesting explanation of why many people struggling with mental health issues do not seek medical help and offers practical solutions for this problem.”
Hello, my name is Serife Gulmuz. I am an International Medical Graduate from Turkey with more than 7 years of experience in different hospitals and research departments. I have been living in Canada for more than three years, with my husband and two children. I like reading and exploring new places.
I am currently preparing myself for employment in the Canadian Healthcare System by improving my language and communication skills. I have always been interested in the topic of Mental Health and would like to work towards improving mental health globally. This is why I chose Mental Health as a topic for my research paper.
Saving Lives by Changing Minds
By Serife Gulmus
Do you know anyone around you who has mental illnesses? The answer to this question is expected to be ‘yes’ because, according to the Mental Health Commission of Canada, almost 50% of the population will have or have had a mental disorder by the age of 40. Moreover, 10-20% of Canadian adolescents suffer from a mental illness while only 1 out of 5 children receives the appropriate mental health services. Consequently, 4000 youth die each year by suicide which is the second leading cause of death after accidents (Canada, 2013). The data illustrates the immense importance of raising awareness of and providing treatment for mental health problems. Besides this epidemic scene, the Canadian economy has been significantly affected by the total cost of mental illnesses or disorders, which costs at least $50 billion per year to the economy (Canada, Making the Case for Investing in Mental Health in Canada). Those results are similar throughout the world, which makes the problem a global issue, so it is time to have a close look at why mental problems spread gradually despite the incredible achievements in science and drug development. Psychotropic drug treatment is preferred by many healthcare providers as the initial way of treatment since it is considered time saving and available to everyone (Disorders, 2016), (Abdullah Al Maruf, 2019). However, this should be curtailed by effective regulations and the money spent for medication should be directed to providing psychotherapy and support centers as the initial step in the treatment of mental illnesses.
One reason for the funding of psychotherapy and support centers is that people who have mental disorders do not only suffer from their illnesses but also from the side effects of the drug treatments. Side effects vary from sedation, sexual disfunction, obesity, type 2 diabetes, mellitus to postural hypotension, cardiac arrhythmia, sudden cardiac death, and suicide (Muench, 2010). Those problems could be missed during initial clinical practice because their reflection is different for the patient and the doctor; thus, the doctor might think that the patient’s complaints are due to his/her mental illness but not the side effects of the drug. Moreover, because of long wait times and short visit durations, the patient might not be able to explain his condition clearly. Unfortunately, the current healthcare system is not able to help those people and this brings harmful consequences. For example, after the frightening reports of suicide events in the country, the UK Committee on the Safety of Medicines set up an expert work group to consider the safety of SSRIs, a group of antidepressant drugs, in April 2003. After a detailed study of all available evidence, in December 2003, the expert group declared that “the risk of treating depressive illness in under 18s with certain SSRIs outweighs the benefits of treatment” (Green, 2004). One year after the inspection, the UK’s Medicine and Healthcare Regulatory Agency (MHRA) sent a ‘strong signal’ saying that “the majority of SSRIs, the most commonly prescribed type of antidepressants, are not suitable to be used under age 18” and luckily this has been treated as an effective ban by healthcare providers and doctors have become more sensitive when they are prescribing antidepressants to their patients. A similar investigation was done by the US Food and Drug Administration; however, they only issued a “black box warning” on supplements rather than a restrictive action (Green, 2004). To establish the association between SSRIs and suicide attempts, researchers immediately started to evaluate drug trials, and the results were alarming: according to a systematic review study conducted by Fergusson et al.,there was a significant relation between the use of SSRI and suicide attempts. Additionally, researchers claimed that the investigators of the trials did not fully disclose all events and they noted that there were limitations in the methodology of the published trials, which makes the study results questionable (Fergusson, 2005).
Along with issues related to the drugs’ significant side effects, the study results mentioned above arose another concern among the research and healthcare community about bias in the drug trials. According to Dr. Jonathan Green from the University of Manchester, UK, positive results are released from trials and a lot of important information hidden in the drawers. Moreover, some studies used the term ‘emotional liability’ to describe ‘suicidality’, which does not reflect the importance of the event (Green, 2004). This report was compatible with another study that showed that placebos, a substance that is not medicine, were as effective as antidepressants (Bostwick, 2006). While physicians depended on the evidence-based healthcare, this led them to question their right action in prescribing: should they still rely on the ‘evidence’ or what will be the second option if the drugs are questionable? Even though doctors wish to help patients with other options, there are limited centers where they can refer individuals; furthermore, the care is costlier and insurance usually does not cover that type of services but medications.
Besides the side effects and the biased evidence, another argument why mental illnesses should be treated with psychotherapy and support programs is for long-term positive effects. Although medication helps to reduce the symptoms of the disease, it does not fully cure the illnesses because their mechanism of action is not fully understood yet (Health, n.d.). In order to get long-lasting outcomes from the mental treatment, it is better to figure out the underlying reason of the problem and help patients to learn how to cope with that. This is actually how psychotherapy works. Maroun et al. conducted a study recently which analyses the views and experiences from antidepressants and psychological therapies of minors who suffer from depression. A total of 12 young people aged between 13 to 18 participated in the study in which three of them refused to use drugs when offered and six took the medication (four of whom stopped afterwards). Researchers asked other three adolescents to share their views about drug therapy, but they have not been offered to take it. Results were dramatic! From one participant, Talia, “It’s annoying I have to take these pills every day…if I forget it could be bad(…)It’s unnerving when you’re feeling happy and having a side thought going yeah but are you happy or is it just added chemicals making you feel happy?” Natasha said, “Me having therapy has helped my life in so much ways, it’s gonna help my future in the long run. But if you gave me medication, I would still be battling with my past, my Dad’s relation, and I would just be kind of a neutral person, coping with pills.” Here is the reason why Steven stopped taking his pills; “we went through different antidepressants then I chose one I haven’t taken before (…) Dunno I hope they help but with every anti-depressant there’s a different side-effect…so interesting to see what the side-effects of these are (…)Oh [medication 1]…I just slept constantly(…) and the other ones I just felt completely numb that’s why I stopped taking them…” Nonetheless, drug therapy helped some participants. Kayleigh shared her view and said, “I was getting better but I needed a final push (…)it was a tough decision cause I didn’t like taking tablets but I think looking back now it was the right decision to go on it (…)I started crawling out of the hole but then once the medication kicked in it was just like I can actually see the light at the end.” Those are real life experiences from young people who suffers from moderate to severe depression. While sole usage of medication generally causes the patients to suffer from the side effects, initial psychotherapy has a positive result without any complaint.
The last but not the least rational why money should be invested in providing psychological support centers is their cost-effectiveness. Mental health costs do not only originate from the treatment of the disease but also from lost productivity in businesses which causes absenteeism, presenteeism, and turnover. According to the Mental Health Commission of Canada, mental health problems and illnesses hit especially the entry level employees; furthermore, approximately 21.4% Canadian workers have such problems which leads to drop productivity. By 10% reducing the number of people with a new diagnosed mental disorder, there could be more than $4 billion savings to the economy in a year (Canada, 2013). In fact, cost benefits to the economy and better mental outcomes would be seen in the process.
One might suggest that solution to suicidality events would be doctor’s clear explanations to the parents or other caregivers on those medications which cause rollback effects during early days and weeks of the treatment (Bostwick, 2006). This approach is giving the responsibility of dealing with side effects of drug treatment (suicidality) to the mentally ill- vulnerable- individuals and the caregivers- who may also be suffering from some degree of mental problem because of the conditions. Obviously, this will not resolve the dilemma while it is the healthcare professional’s responsibility to take care of his own decision and foresee the probable consequences of the drug treatment. Moreover, this advice is also against to the Hippocrates Oath, ‘First Do Not Harm!’, which is thought during very early years of the medical school.
In conclusion, urgent action is needed to change the treatment perspective before spending a fortune and feel the guilt. Due to the unwanted side effects, biased evidence, long-term influences to the community, and cost to the budget, drug treatment should not be the immediate solution to mental illnesses. Rather, preventive and supportive actions and psychotherapy might be the first preference, with or without medication, for better outcomes.
Abdullah Al Maruf, A. G. (2019). Antidepressant pharmacogenetics in children and young adults: A systematic review. Journal of Affective Disorders, 98-108.
Association, C. M. (n.d.). Retrieved from https://cmha.ca/fast-facts-about-mental-illness
Bostwick, J. M. (2006). Do SSRIs Cause Suicide in Children? The Evidence is Underwhelming. Journal of Clinical Psychology, 235-241.
Canada, M. H. (2013). Retrieved from https://www.mentalhealthcommission.ca/English/media/3179
Canada, M. H. (n.d.). Making the Case for Investing in Mental Health in Canada. Toronto: Mental Health Commission of Canada.
Disorders, t. c. (2016, June). Retrieved from https://centerforanxietydisorders.com/
Fergusson, D. (2005). Assiciation between suicide attempts and selective seratonin reuptake inhibitors: review of randomized controlled trials. BMJ.
Green, J. (2004). The SSRI debate and the evidence base in child and adolescent psychiatry. Current opinion in Psychiatry, 233-235.
Health, C. A. (n.d.). Retrieved from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/antidepressant-medications
Muench, J. (2010, March 1). Retrieved from https://www.aafp.org/afp/2010/0301/p617.html
Rita A. Maroun, L. A. (2018). Meaning and medication: a thematic analysis of depressed adolescents’ views and experience of SSRI antidepressants alongside psychological therapies. BMC Psychiatry.
Wykes, T. (2017). What side effects are problematic for patients prescribed antipsychotic medication? The Maudsley Side Effects (MSE) measure for antipsychotic medication. 2369-2378.