What can we do if a loved one doesn’t want medical help?

A Helping Hand - Cristian BernalBlog post by Colin Hung

On Monday August 11th the world lost a great entertainer – Robin Williams.

As the details of his death became clearer, his battles with depression and addiction became headline news. Williams’ mental health issues and his suicide were analyzed and re-analyzed by the media with an army of clinical experts.  His death put the spotlight on “Brain Health”. [Thank you #InnoPsy for this much more positive term vs mental health. Speaking of #InnoPsy, their last tweetchat was an intelligent conversation around the issues that Williams’ death had raised. I recommend the transcript]

On the morning of Tuesday August 12th, Bernadette Keefe (@nxtstop1) and I briefly considered changing the topic of the #hcldr chat from “Ending patient-provider relationships” to Brain Health. However, after a brief discussion, Bernadette convinced me to stick with the plan and wait to discuss Williams this week instead.

I’m glad we waited because this week on #hcldr we’re going to explore a very difficult ethical/emotional issue that emerged in the days that followed Williams’ death – how to help a friend (or family member) seek help when they don’t want it or feel they need it.

This isn’t what happened in Williams’ case. According to the media it appears that he was getting help of some sort throughout the years. However, in the aftermath of Williams’ death, there were many pleas of “just talk to someone” from celebrities and medical experts alike. These pleas were usually accompanied by statements of “don’t let your friends suffer in silence”. These are the statements that are the inspiration for our #hcldr chat this week.

The outpouring of tributes from Williams’ fans via social media was astounding. There was one tweet in particular that spread quickly around the world (over 330,000 retweets to date):

When I saw it I retweeted it too. At the time I thought it was a fitting tribute to the fallen actor. But the day after that tweet caught fire, I started seeing stories about how harmful that tweet could be to people who suffer from depression and are contemplating suicide.

A Sydney Morning Herald article had this stark statement about the imagery and wording of the tweet:

The starry sky from Disney’s Aladdin, and the written implication that suicide is somehow a liberating option, presents suicide in too celebratory a light

This statement came from Christine Moutier, Chief Medical Officer at the American Foundation for Suicide Prevention who added:

If it doesn’t cross the line, it comes very, very close to it. Suicide should never be presented as an option. That’s a formula for potential contagion.

The potential contagion that Moutier is referring to is “copycat suicides” – where media coverage encourages vulnerable people to commit suicide in a similar way.

When I read this, I was shocked and dismayed. By retweeting that message had I inadvertently contributed to the contagion? I started to think about my friends who have brain health issues. What would they think of that tweet? Would they think I was being insensitive?

A second eye-opening article came from NBC News. Despite the sensationalist headline, “The Robin Williams Effect: Could Suicides Follow Star’s Death?” had a very poignant quote from Dr. J. Raymond DePaulo Jr, Henry Phipps Professor and Director of the department of psychiatry & behavioral sciences at the Johns Hopkins University School of Medicine:

One very important thing to keep in mind is that a good 75 percent of clinically depressed people don’t get diagnosed or treated for it. And most don’t come for care because they don’t think of themselves as having something they need to go to the doctor for. They figure we all have good days and bad days, so there is this reservoir of people out there who are clinically depressed and also having bad days on top of that and sometimes they see a suicide and it will have an effect.

75% of clinically depressed people don’t get diagnosed! Wow. I was floored. I started to think about my own family and friends – did any of them fall into this category? Did any of them have a brain health issue that they were hiding? For that matter, did anyone have a general medical condition that they believed they could just “deal with”?

I’m willing to bet that many of you have friends or know people who actively avoid seeking medical help. Some are the type that pride themselves on being able to power through any ailment or ill-feeling. They are the ones that see going to the doctor or hospital as an admission of weakness. Some are the type that remain silent, who “turtle” when the conversation turns to health issues or when you are remembering someone who has passed away. They are the ones that are too embarrassed to say something yet you get this feeling that they really want to.

If you do have friends or family like this, you aren’t alone. A recent study published by the Kaiser Family Foundation showed how many men and women avoid getting the care they need:

MtnStar_WhyWomenDontGoToTheDoctor01Revamp

Why do people refuse to seek medical help? There are many reasons and not all of them are financial [see Resources for the sources of these reasons]:

  • Couldn’t find time to go to doctor
  • Couldn’t take time off work
  • Problems getting child care
  • Transportation problems
  • Lack of insurance or means to pay for care
  • No easy access to the care they require
  • Embarrassment
  • Reluctance to admit there is a problem

So what can we do member to encourage our friends or family members who we believe are suffering in silence from a medical condition yet aren’t seeking help? Should we even try? And if we do how far should we push?

Kathleen Hoffman (@drkdhoffman), made a few suggestions in her recent blog post about mental health that I believe can be applied to any chronic disease or health issue:

  1. Increase Awareness
  2. More Research
  3. Access to Medication and Treatment
  4. Understanding
  5. End the Stigma

#5 is precisely what Bell Canada (one of Canada’s top wireless and telecommunications providers) is trying to do with the “Let’s Talk” initiative. Every January they bring awareness to and reduce the stigma of mental health. This past January they raised over $5.5M for mental health research and generated over 109M tweets, texts and likes from people who wanted to bring attention to this important issue. You can watch more about this incredible initiative here:

The Movember movement has similar goals of awareness and fundraising for men’s health. Their story is equally powerful.

Join us Tuesday August 19th 2014 at 8:30pm Eastern Time (for your local time click here) for the weekly #hcldr tweetchat where we will be discussing:

  • T1 How did you/can we successfully convince someone to seek medical help? Why did you try?
  • T2 How far would you push to get someone to seek help? Would you jeopardize your relationship?
  • T3 What ideas do you have for eliminating the stigmas around seeking medical help?
  • CT One thing you learned tonight that you can take back & use to help a patient or your organization tomorrow?

Resources

“Losing The Man Who Helped Us Laugh”, Kathleen Hoffman, Medivizor, August 14 2014, http://medivizor.com/blog/2014/08/14/robin-williams-suicide-change-mental-healthcare/, accessed August 16 2014

“Robin Williams’ death: ‘Genie, you’re free’ tweet worries suicide prevention experts”, Caitlin Dewey, Sydney Morning Herald, August 13 2014,  http://www.smh.com.au/entertainment/movies/robin-williams-death-genie-youre-free-tweet-worries-suicide-prevention-experts-20140813-103h1t.html, August 16 2014

“The Robin Williams Effect: Could Suicides Follow Star’s Death?”, Linda Carroll, NBC News, August 12 2014, http://www.nbcnews.com/storyline/robin-williams-death/robin-williams-effect-could-suicides-follow-stars-death-n178961, August 16 2014

“Parkinson’s Disease And Depression Can Make Each Other Worse”, Sarah Klein, Huffington Post, August 14 2014, http://www.huffingtonpost.com/2014/08/14/robin-williams-parkinsons-depression_n_5679472.html, accessed August 17 2014

“Treating Depression in Patients With Chronic Disease”, Gregory E Simon, The Western Journal of Medicine, November 2001, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071593/, accessed August 17 2014

“Embarrassment is one reason why men don’t see the doctor”, Joel Sherman MD, KevinMD.com, November 7 2011, http://www.kevinmd.com/blog/2011/11/embarrassment-reason-men-doctor.html, accessed August 16 2014

“Why Women Don’t Go to the Doctor and How It’s Affecting Women’s Health”, N. Miller, Eastern Idaho Regional Medical Center Blog, July 8 2014, http://blog.eirmc.com/blog/2014/07/08/why-women-don%E2%80%99t-go-to-the-doctor-and-how-it%E2%80%99s-affecting-women%E2%80%99s-health/, accessed August 16 2014

“What Prevents People From Seeking Mental Health Treatment?”, Margarita Tartakovsky M.S., World of Psychology, January 14 2013, http://psychcentral.com/blog/archives/2013/01/14/what-prevents-people-from-seeking-mental-health-treatment/, accessed August 16 2014

“Why are men reluctant to seek medical help?”, Tom Geoghegan, BBC News Magazine, July 17 2009, http://news.bbc.co.uk/2/hi/uk_news/magazine/8154200.stm, accessed August 16 2014

“Bell Let’s Talk Day – Fight the Mental Health stigma”, February 18 2014, https://www.youtube.com/watch?v=yCg1ERSzND8, accessed August 16 2014

“Bell Let’s Talk: Suffering in Silence”, January 9 2014, https://www.youtube.com/watch?v=tri5ZQaiM7M, accessed August 16 2014

“Bell Let’s Talk: Missing Work”, January 9 2014, https://www.youtube.com/watch?v=w_B2Jn35L28, accessed August 16 2014

“Movember Impact on Awareness & Education – 2012”, September 20 2013,  https://www.youtube.com/watch?v=UMFSfwXoFsI&list=PL20AB03890A903B7E, accessed August 16 2014

Image Credit

A Helping Hand – Cristian Bernal

https://www.flickr.com/photos/townhero/5557220801/in/photolist-9t5d8K-5Q5ZaQ-3S39pB-6WmzQX-5HR1jR-8dPibx-mnpRV-9WVYyp-7BDYTP-58fK7i-bC94Qg-7Pzozk-8C6AUS-8C6AVh-4EuwBg-EVbu-9rUYSt-2T6K14-rbLxf-3eku72-5Rjzem-8hEVmX-6rUPaH-3jdhFK-69QRUc-A1tPF-8kXESm-bf2GB-cJ8B2y-gFZDZL-5F3w7r-3hPdJh-8C6AV5-2JmUJ-bE23ee-8C6AVb-dbjHFa-9Fsc9u-7Lvaqu-7s1SKA-9EAcw3-Yt2BL-6PmtSU-4Vn3XZ-YnsTV-ibPXg-8aCRkF-4ptwuj-dYzoJt-ckmQg

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