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From The Blog

All Hands On Deck

All Hands On Deck

 

Bell Let’s Talk has come, with all it’s social media fanfare and buzz, then gone taking with it the conversation that hardly ever happens. In a few days, the social media world falls quiet again.

The awareness raising campaigns do their thing and for a brief window, it is hip and popular to pay lip service to mental health problems… meanwhile, people living with mental health disorders continue to live with these disorders, quietly, privately, knowing full well the reality of living with mental disorders does not go away after a day or two of token buzz.

At first, I wanted to try and get on board with the bandwagon, jump in when the chatter was hot but something didn’t feel quite right about it so I did not push it.

Maybe it is my own mental disorders I live with getting in the way, maybe it is an as-yet unarticulated sense of “this isn’t the way I want to do it” thing. Whatever it is, I did not write a blog, a series of blogs or long-winded post on social media about mental health and mental disorders.

Probably because it is so damn important to me; if I am going to write about it at all, I MUST do it justice.

You see, I’ve been wrestling with this thing for years, this feeling, this itch, in my career.

When I first chose this path, I couldn’t quite articulate it, but now, I can. I became a Massage Therapist because I want to comfort people when the shit hits the fan. I wanted to provide a space where a person could arrive with armfuls of pain, gritted teeth and hunched shoulders and just put that down for a minute or 90, have a moment where they could just… breathe.

No hard questions, no pushing for deep thinking, no demands for change or healing, only kindness, compassion, acceptance and attention. I wanted to help people find a sense of peace and safety in their bodies. I wanted to help people learn that their bodies could be nice places to be, that it was possible to feel good being in a body. To me it seemed obvious; that’s what Massage Therapists do.

Our scope of practice is clear; we treat the soft tissues of the body to relieve and prevent pain.

We now know that pain and mental health problems can and do travel together [1,3], that childhood traumas (ACEs) are a strong predictor of negative adult health outcomes [2]. And while I may be extrapolating a little bit here, I think it is fair to say that trauma can be an outcome of severe pain experiences, especially those that persist.  

Taking all of this into account, I can’t help but feel certain in my firm adoption of the idea that all healthcare providers, and especially those who choose to work within an evidence-based, biopsychosocial framework, need to learn how to navigate the therapeutic alliance with awareness for managing the intersections of psychological and somatic health problems.

Canadian Mental Health Stats

When I look at the numbers, I wish I could say my heart breaks but the fact is, I see myself in the stats. I see my friends and my family members.  

In any given year, ⅕ Canadians are living with a mental health problem [5], it could be anxiety or depression, it could be an addiction, bipolar disorder or schizophrenia, it could be PTSD.

Regardless of the diagnosis, it’s COMMON; 3.5 million Canadians seek services from hospitals and physicians for mood and anxiety disorders annually [4]. Mood and anxiety disorders are the most common mental illnesses in Canada and worldwide. The highest prevalence is among men and women aged 30-54, with the 55+ group bringing up a close second. Youth and adolescents are the most rapidly growing group of people affected by these disorders. Possibly most painful of all is the fact that an average of almost 11 people dies from suicide PER DAY.

After accidents, it is the 2nd leading cause of death among young people aged 15-24 [5].

Our Role In Human Health Care

So what is a Massage Therapist doing talking about these things, seemingly drifting from out of her lane?

I firmly believe that, currently, the mental illness crises our communities have been living with for decades (upon decades) demand an all hands on deck approach. We can no longer afford the luxury of letting it be someone else’s problem.

It’s a problem that affects us all.

1/5 Canadians will experience a mental disorder, including addiction, in their lifetimes. That means every single one of us knows someone who is presently – RIGHT NOW – dealing with something that can make everything else that much more difficult. And they are often trying to do it privately because either they don’t want to burden you OR they are afraid you will drop them.

Stigma prevents 40% of Canadians living with a mood disorder from seeking medical help [6] risking unnecessary consequences to their mental health. As an RMT, I am a front line health care provider. As a member of those professionals governed by the RHPA, I have a responsibility to care about all of the health of my patients.

As an RMT I may even have a better opportunity to note changes in the health presentations of my patients, including changes in mental health. This reality behooves us, all RMTs and other health care providers, to learn about mental disorders, pursue mental health first aid training, and to destigmatize our practices.

Often when discussing these ideas with my colleagues I encounter pushback; the worry about crossing a scope of practice line emerges, obstructing progress towards a health care system that is fully capable of addressing human health concerns. Our scope of practice is focused on the somatic experience. Given the relationship between mental health and physical health that is emerging, it is clear that, for some people, their ability to access care, follow through with home care plans and overcome the mental hurdles of dealing with a pain problem can be impeded by mental health problems.

Practitioners who work with the soma exclusively may need to consider these additional hurdles, ensuring that they are:

  1. not contributing to the fear of stigma or retraumatizing in their conduct and language and
  2. recognizing when a mental health problem may be a barrier or yellow flag to the patient’s ability to move forward with their pain management strategy, and when it might actually move them backward.

This is no easy task; stepping into a new level of discomfort, digging deep into your humanity to find compassion, understanding, and the ability to walk with your patient through the discomfort, fear, and shame that health problems, mental or physical, can bring requires a great deal of mental and emotional labour. It asks for empathy and boundaries held in close proximity and it asks us to be much better connected to the health care community we are oft surrounded by, but isolated from. And it asks us to address our own biases about mental health and pain and uncover the ugly heads of the stigma that exist within us and our practices.

The time for us to start giving a shit about these problems and SHOW UP to the table has come and gone, over and over again since the days of Freud. It’s time for All Hands On Deck, because we all, ALL of us, need each other if we’re gonna make it through this at all.

Resources

If you’re still with me here then thank you for reading. Below are resources I have been using to inform my own practice and dismantle the barriers of stigma and incompetence when working with mentally ill and traumatized populations. These resources are all free as of this writing.

Trauma + Trauma-Informed Practice:

Trauma Informed Practice Guide

Handbook on Sensitive Practice for Health Care Practitioners

Trauma and Recovery by Dr. Judith Herman M.D. (1992)

ACEs

Sexual Assault:

Addressing Past Sexual Assault in Clinical Settings

Recognizing and Responding to Commonly Misunderstood Reactions to Sexual Assault

Stigma:

Addressing Stigma – CAMH (scroll to the bottom)

References

  1. Currie, S. R., & Wang, J. (2004). Chronic back pain and major depression in the general Canadian population. Pain, 107(1), 54-60. doi:10.1016/j.pain.2003.09.015
  2. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., . . . Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14(4), 245-258. doi:10.1016/s0749-3797(98)00017-8
  3. Mcwilliams, L. A., Goodwin, R. D., & Cox, B. J. (2004). Depression and anxiety associated with three pain conditions: Results from a nationally representative sample. Pain, 111(1), 77-83. doi:10.1016/j.pain.2004.06.002
  4. Report from the Canadian Chronic Disease Surveillance System: Mood and Anxiety Disorders in Canada, 2016
  5. Mental Illness and Addiction: Facts and Statistics; Centre for Addiction and Mental Health. (https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics) accessed February 2, 2019
  6. Addressing Stigma; Centre for Addiction and Mental Health. (https://www.camh.ca/en/driving-change/addressing-stigma) accessed February 2, 2019

 

Jen Fleming is an RMT In hamilton Ontario serving populations living with pain and concurrent mental disorders. She is currently working towards obtaining her certificate in trauma through Wilfrid Laurier University via the Faculty of Social Work and developing curriculum for RMTs invested in working with trauma. She can be found at www.jenflemingrmt.com and reached by email at jenflemingrmt@gmail.com.

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Jennifer Fleming

Jen Fleming is an RMT In hamilton Ontario serving populations living with pain and concurrent mental disorders. She is currently working towards obtaining her certificate in trauma through Wilfrid Laurier University via the Faculty of Social Work and developing curriculum for RMTs invested in working with trauma. She can be found at www.jenflemingrmt.com and reached by email at jenflemingrmt@gmail.com.
Jennifer Fleming

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2 Comments

  1. Odette June 30, 2019

    Wonderful article Jennifer. As an RMT who has both experienced mental illness herself and worked in mental health before retraining as a Massage Therapist, I found your article spot on. The stats are the same here in New Zealand – 1 in 5 people have a mental health diagnosis, 10% at any one time and 20% in their lifetime. Our foundation training has to prepare us to work with the whole person, their mind as much as their body. This doesn’t mean working out of scope, what it means is understanding the individual, being informed about mental illness, identifying our own beliefs and being aware where we might be stigmatising or judging a person, understanding the differences between compassion and empowerment vs sympathy and disempowerment. We have to step up. Thank you for raising more awareness about this issue.

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