Ask Nurse Jenn - Our Resident Mental Health Nurse!

[Sophie_M]

Hi everyone,

This is a thread for asking questions of our resident Mental Health Nurse, Nurse Jenn who pops into the forums regularly.

PLEASE NOTE as per our community rules, Nurse Jenn won't be able to answer questions about medications, these are best discussed offline directly with your mental health professional.

BEFORE YOU ASK NURSE JENN PLEASE CONSIDER THE FOLLOWING POINTS:

• Nurse Jenn’s time is limited! We cannot provide an ongoing dialogue with Nurse Jenn in this thread - one post/question per person please
• We'd recommend you have a look through the forums before posting here to see if your question has already been answered by Nurse Jenn, our other members, or if there's information about it already on the beyondblue website.
• If a question pops up that has already been answered previously, or if alternate resources are available, one of our moderators will reply and direct you to the link.
• When writing your question, imagine you are speaking to someone in person i.e. provide a clear and detailed post with enough information that outlines how Nurse Jenn can help you.

Background

From Nurse Jenn

Long ago I was struggling to find my way in my career. I was training to become a registered nurse and I didn’t seem to fit into the traditional ‘medical model’ of delivering care.  Then I started my mental health rotation and I found my place in helping others. I am now 45 years old and have been in the mental health field as a nurse, manager, educator, project officer, advocate… for over 22 years across several countries and cultures (Aus USA Canada NZ).  I have experience in a number of different child and youth mental health teams, early psychosis teams as well as adult and older adult hospital settings. I have also worked as the manager of the beyondblue NewAccess program and understand what it’s like to live regionally where services can be limited. 

Working with people around the globe has made me aware that worry and stress do not know age, culture or country. It is a phenomenon of being human. I have felt it myself in different periods of my life and seen struggle it in loved ones and people everywhere.  I have felt the traumatic loss of a close friends death by suicide (as so many have) and recently experienced the extreme joy of becoming a mother.  

I am thankful everyday that I can walk beside people who need some support to find their own balance and strength. I am very grateful to be here on the beyondblue forum with all of you.

I hope that my professional and personal experience can provide you with some support, direction or even just an acknowledgement that what you are going through is real, and tough, and that you can achieve more than you know.  

[Nurse_Jenn]

Hi Sueetties,

It’s great to see you reaching out across the forum. You have an incredible amount of insight into your own health and well-being plan and commend you on being so proactive in taking care of your health. This is tough to do through the lense of anxiety/depression.

I also appreciate the feedback on the program Mindspot as I recommend this as an option to many people but don’t always get to hear back about whether it has been effective. It is great to hear that you have found it helpful.

As far as your question goes in terms of keeping on with your psychologist I would suggest first a conversation with them about moving to a lower level or ‘step’ of care. They can work with you on where this might be. There may be group therapy options in your area or other programs available such as a support group or counselling service.

In the Australian mental health system, ‘stepped care’ is the new way the entire system is reforming. This means that people should be able to move down or up to the right level of care. This is fairly new as historically everyone (no matter how unwell) were referred to a psychologist. Now there are different options such as Mindspot and other types of lower intensity programs.

Why I am explaining this to you is that this ‘stepped care’ movement has created many new low intensity options which are popping up across the country. For example, NewAccess - a developed by beyondblue program, is a low intensity treatment option for people with anxiety/depression. Specifiaclly trained and skilled professionals deliver low intensity Cognitive Behaviour Therapy (CBT). You can read about it on the link below but it is only available in some parts of Australia.

https://www.beyondblue.org.au/get-support/newaccess

Another option you have already utilised is Mindspot. But in your local area there may be other options which your psychologist may be across and able to connect you with.

Explaining to your psychologist that you are feeling ready to stop seeing them and move on to a different level of support would be a good first step. If this doesn’t get you far (as not all psychologists are connected to different programs or supports) then you could certainly go back to your GP and revisit other options.

Another suggestion I have is to build a strong relationship with your GP and see them regularly regarding your mental health.

Wishing you the best possible outcome,

Nurse Jenn

[jessrobb]

Hi Jenny,
I need advice big time

I have been studying a degree in social work and have got my cert Iv and a diploma in youth work(had placement for both). I would love to get out and start work in the field but I am way to anxious to start, part of it is i'm so terrified I will mess up a clients life and everything will go wrong.

[Nurse_Jenn]

Hi jessrobb,

Great that you reaching out on the forum for support and also great to see that you starting a career working with young people and social issues as it is a much needed area of workforce in the country. The worry that you describe is quite normal. I remember when I was a nurse in training (long ago) I was thinking often to myself 'how am I going to be responsible for people who are so sick....what if I miss something...what if I make a medication mistake...what if... what if....'.

In reality, you are indeed accountable for your actions at work however when you are a junior, you are generally employed in a team environment to start with where there are others that you work along side with who have more experience. You learn through the experience in your role and in a first year social work job, I would expect that you would be asking a lot of questions and consulting with more senior staff until you get the hang of things. In fact, when I manage staff members, I really value a degree of worry in new or junior staff. Its healthy to want to do things right and it is more of a worry when a staff member thinks they know everything. The most important part is that you use good communication skills with your team members and supervisor. If you feel out of your depth on a case, talking with someone about it shows strength and safe practice.

Another element of working clinically is that you would usually find yourself a clinical supervisor or mentor. Sometimes employers have this as part of their standard operating procedure, but if it doesn't, you can ask someone you value who has lots of experience to be your supervisor. I had one of my previous nursing instructors be my clinical supervisor for the first few years where I could talk about work politics and big picture challenges that I felt my manager didn't have time to address.

If you would like some support to self manage your level of worry, you could try doing a program like Mindspot. It is a free course for people over 18 that uses cognitive behaviour therapy (CBT) done online with some telephone support. You can read about it here. www.mindspot.org.au

Having worry about starting a new job or career is common. Setting up support structures around you is good start as well as learning some skills to self manage your worry. Helping people is not done in isolation especially when you are new to the field. You are not alone.

Wishing you the best possible outcome,

Nurse Jenn

[Hannerilana]

Hi Nurse Jenn hope you’re well, just posted but I think something went wrong. Recently reduced an anti depressant with doctor with their permission with script for Lower dose. It has been 2 months since the reduction. Through that time I’ve had family support living at home. My family went away over the weekend and I found myself more vulnerable than usual. It was extra hard to travel long distances and could really manage a short walk . Not so much out of tiredness more a combination of tiredness and fear. I felt less able to travel far and go to busy areas. Is this normal after reducing?

[Nurse_Jenn]

Hi Hannerilana,

Thanks for your post and question regarding medication changes. Everyone responds differently when they reduce or cease mediation so it difficult to answer your question specifically. It is great to see that you are doing medication changes under the supervision of a GP. You are not alone in having challenges and questions when it comes to reducing medication. There are many posts on the forum with a similar topic.

When reducing medication, sometimes symptoms may feel like they are returning slightly but may not be as intense as they were previously. Some people don't have a return of their previous symptoms but can have withdrawal effects that feel new. There is a lot to read about 'Discontinuation Syndrome' on the internet and there are some posts on the forum where people discuss their experiences of withdrawal effects from reducing or ceasing antidepressants. That said, some people come off them with little to no problem. I agreed that there should be specific and reliable health information and resources that prepares people for what they could expect when reducing or coming off antidepressants.

In any case, my best suggestion to you is to start a journal that you you write each day on your any symptoms you are experiencing, you mood, what your energy level is and write down if there are any triggers to your feeling state ie. family away for the weekend. If you complete this journal each day for a week or two, then you can really see if there are any patterns to your symptoms. You could use a paper journal or calendar or there are some apps you could use such as Daylio https://daylio.webflow.io

Do you have an appointment booked with your GP? If not, it might be a good idea to have one in the near future and keep in close communication with them while you are reducing your medication. You can take in the information about your symptoms that you have collected so they understand exactly how you have been travelling.

You can use the search feature above and type in 'reducing medication' and read about others experience but it is safe to say that everyones experience is different. When changing or reducing medications, it is my advise to have a bit of extra support around you if possible and to keep in regular contact with your health professional. If you ever feel that your symptoms are significant or you feel unsafe, please reach out to a health professional immediately.

Wishing you the best possible outcome,

Nurse Jenn

[We_Can_Get_Through_It]

Hello,

I need some help regarding medication, I've taken ADHD meds for a very long time and have changed them too many times due to terrible side affects on all of them. I am starting to think that it's my fault and not the medication. I'm also not in a very happy place right now due to many reasons and want to get help but I'm scared to do so because I feel like they are just going to put me on more medications. Any suggestions on what I should do?

[Nurse_Jenn]

Hi there We Can Get Through It,

Thank you for reaching out. I am sorry to hear that you are going through a hard time. I wonder if you have a regular support person you could reach out to during this tough time? You are not alone. I hope you are finding some support on the forum.

It is difficult to offer specific medication advise as it is not something we do on the forum but I always recommend changing medication under supervision of a GP or prescribing Doctor. I hear that you are feeling that you may be to blame for taking different types of medications as you were experiencing side effects. This is likely not the case at all. Medications are tricky in that some people tolerate them really well and others do not. It is very unique to a persons biology. There may be other alternatives you might wish to explore. You could discuss these with a GP or with a specialist at an ADHD specific clinic or with a health provider that is well versed in treating the condition.

I wonder if you were able to bring a support person with you to a GP appointment? Or if you already have a psychiatrist or psychologist, perhaps you could arrange to have someone come with you there. Sometimes having a support person alongside you can be helpful. Another suggestion is writing down your specific health goals. You can take these with you going into any appointment which can help guide your care, for example - ‘not wanting to to medication’. This way you health provider has a clear understanding of what you want and don’t want and other options can be explored and your health care provider can work with you collaboratively on a plan.

Having a certain amount of fear is healthy and normal when you are struggling with an illness. By going into an appointment with a list of your treatment goals and having the right support around you can make some difference. And if the health care provider that is working with you isn’t in alignment with what you want to achieve, you could always source a second opinion on your care.

If you want to talk with someone I recommend the beyond blue support line on 1300 22 4636 where you can talk with someone anytime of the day.

Wishing you the best possible outcome,

Nurse Jenn

[Blusky]

Hi Nurse Jean,

I have been recently diagnosed with complicated migraines ( this explains a lot) I am about to start trialling a preventative.

In your experience and view, is it possible that my mental health issues ( anxiety, depression and panic attacks) are linked to this condition? Even partly?

Thanks in advance!

[Nurse_Jenn]

Hi Blusky,

I am so sorry for the late reply. I have been a bit under the weather but am back on track now. Thank you for you questions. I am sorry to hear that you are experiencing complicated migraines. This would be very distressing especially when you have anxiety with panic and depression. Be kind to yourself during this time and I hope that you are getting some support either through a health professional or trusted friend or family member.

In response to your question, I first must say that every individual is different. I am not sure if you have had any success in reducing your symptoms in anxiety and depression and seen a reduction in your migraines? This would important to track and I encourage you to keep a treatment/symptom/migraine diary to look for any correlation.

Migraines have been linked to mental health issues in some studies. I will let you do some research if you like and you can look up the term co-morbid (meaning 'related to') migraines and mental health. The fact that migraines can be brought on by stress and anxiety and depression can be brought on by the same reason indicates there is a possible link in the trigger of the two conditions.

In my experience, the mind and body are very connected. Stress (no matter what context) can impact many body systems and while the focus might be on relieving the symptoms of anxiety or migraine, it is important to get to the core issue of what the trigger is. Triggers could include environmental stressors such as work, or relationship stressors or to lifestyle choices such as diet and exercise. Many times people want relief from the symptoms of anxiety/depression and this is important. But it is also really important to look for the triggers to stress.

I am not sure I have answered your question clearly and I wish it was more straightforward for you. People get migraines for all types of reasons and sometimes the reasons are unknown. In any case, getting support for your mental health and wellbeing would be important for all conditions including finding ways to reduce your symptoms and establish what your main triggers are to your conditions. It is also important to find a trusting support team to help you on this journey.

For some further information on migraine management you could visit the headache Australia website where there is a lot of information about migraines. https://headacheaustralia.org.au

Wishing you the best possible outcome,

Nurse Jenn

[Blusky]

Thanks Nurse Jenn. You have given me a good place to start, I’ve downloaded a migraine tracking app as well as a food diary app to really identify the triggers. In a way I am just hoping that this will help to balance my mental health too.

Sorry to hear you were under the weather, I hope you are back to your self again.