Tackling mental health with therapy, support animals, deconstructed sandwiches

With more than 60% of college students meeting the criteria for at least one mental health issue during 2020-2021, being able to access mental health resources is crucial, according to a 2022 study.

With such a high percentage of students struggling, the stigmas surrounding mental healthcare can be even more damaging.

Care for mental health doesn’t just mean therapists, pills, prescriptions and cut-and-dry diagnoses. Pills likely won’t solve all — and sometimes neither will therapy, explained Clint Martineau, a psychiatric nurse practitioner who works at Mental Health and Wellness of Southern Utah. Martineau is also Louise Saw’s psychiatrist.

Louise has been working on her mental health for the past five years. That process has included various therapy treatments and medication. She also has a service dog named Piper, a 90 pound doodle who interrupts harmful behavior and detects spikes or drops in mood that might predict these behaviors.

Along this journey she has learned a lot about life and what it takes to maintain good mental health, Louise explained.

Louise’s therapist, Rochelle McLelland of Roots Counseling in Cedar City explained that a frequently circulated concept is being “true to oneself.” 

“I feel like we’re seeing a cultural shift of people feeling like they have to do what makes them happy at any expense and not prioritize relationships over self-satisfaction. Ironically, we also see the other side of people feeling like they have to give all of themselves to others and not focus on self-care,” she said.

These extremes are dangerous, and Louise said she has struggled with her natural tendency towards prioritizing and caring for others over herself, even those who have hurt her. This meant learning to advocate for herself, something she continues to work on.

“When I’m not (up to advocating, and) a friend wants to go hiking, I can say ‘Well, Piper can’t handle the heat’ when it’s really me that can’t handle it, but I’m not good enough at setting boundaries with myself,” Louise said.

Another strategy Louise frequently uses is eating while in a depressive episode. Depressive episodes look different for different people but can involve a lack of energy, motivation, struggle with apathy and a looming sense of failure before a task has even begun.

To combat this, she explained that the concept of a meal is somewhat contrived. We think of meals as prepared dishes, even if it is just a sandwich, she said. When making a sandwich feels like pushing a boulder up a steep hill, she doesn’t make a sandwich.

Instead, Louise collects all the ingredients, and eats them one at a time. This eliminates the need for preparation or doing dishes.

However, Louise said practices such as these can’t address everything. In addition to tactics such as having deconstructed sandwiches for dinner, her psychiatrist is a big help and part of her mental health care.

It’s important not to view medication as the end-all be-all: “Though I prescribe medications to treat mental health disorders, I consider them useful tools that can help an individual gain and/or maintain mental health,” Martineau said.

Among some patients there can be a fear of overprescription. Studies disagree on how prevalent overprescription really is. In a literature review published in 2019, overprescription is divided into different types: the length of time patients spend on antidepressants and the frequency with which patients are diagnosed without the required number of symptoms (five of nine symptoms for two weeks or longer).

Diagnoses that don’t meet the required number of symptoms are also referred to as “not otherwise specified” or “NOS” diagnosis. Between 1999 and 2010, one study reported a significant increase in NOS diagnosis. Two-thirds of the total NOS diagnosis were made by non-psychiatrists (family practitioners or other general specialties).

The danger of these diagnoses is a lack of evidence supporting the benefits of antidepressants for NOS patients and the costs of antidepressants. Long-term use of antidepressants increases risk of “impaired sexual function, agitation, weight gain, type 2 diabetes, hypertension and low bone density,” according to the 2019 literature review.

These negative effects are just some of the reasons that “(Medications are) not meant to be a lifestyle and should not be used as a crutch or a means for a person to avoid dealing with the root cause of their problems,” Martineau said.

He explained medication can still be a powerful option when other methods have failed to accomplish desired results. Still, the availability of medication doesn’t make mental health a walk in the park or remove the ever present stigma surrounding it, something that Martineau and Louise’s therapist, McLelland, spoke about.

Louise said she encounters stigmas as she navigates the world with a service animal. Piper isn’t always welcomed, taken seriously or is sometimes perceived as a liability, as illustrated when Louise attended a job interview a couple years ago with Piper. Piper had rolled through the dirt and Louise didn’t have time to wash her again, which meant the interviewers could see and smell Piper. Louise didn’t get the job, and largely attributed this to the negative attention Piper attracted during the interview.

Louise continues to put effort and time into her mental health, and said that if there was one thing she could tell people about mental health, it would be this: “Rest if you must, but don’t quit.”