Got a question related to mental health? ASK DR KIM

[Chris_B]

Hi everyone,

This is a thread for asking questions of our resident GP and counsellor, Dr Kim, who pops into the forums regularly.

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

UPDATE - 01/03/2018
BEFORE YOU ASK DR.KIM PLEASE CONSIDER THE FOLLOWING POINTS:

• Dr Kim's time is limited! We cannot provide an ongoing dialogue with Dr Kim 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 Dr Kim, 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 Dr.Kim can help you.

Background

After 20 years of experience working as a GP, Dr Kim realised in 2003 the aspect of her work she enjoyed most was talking to people and understanding the way they think and behave – and so she underwent training in counselling and therapy, where she now solely works.

Her experience includes working with a wide range of mental health issues including anxiety, depression and adolescent mental health.

“Given my training I also see couples, siblings, parents with their children and entire family groups,” she says. “In this work I hope to give families the skills to understand one another and have the strategies to communicate and manage relationships that are distressing them. I believe strongly that best therapy is achieved when there is trust in the therapist's ability but also their genuine desire to understand and help.”

[Azurelies]

Hi Dr Kim

I have always coped with problems about self-worthlessness and thoughts about me being the problem in peoples' lives, but recently it has gotten worse with a lot of family issues and school pressures. I also don't have a very good relationship with my mum and we always get into fights, and its stressing me out a lot.

I don't know how to amend my relationship with my mum and sometimes I can't help but think mean thoughts such as "I hate her and I never want to see her again"sometimes even very violent and dark thoughts. But I know that she has done a lot for me and sacrificed a lot and I feel very bad afterwards.

I find myself feeling worthless more and more times nowadays and I sometimes feel that life isnt worth it anymore and just want to cry. I feel like I have no one to talk to, and my mum don't really get it, except by affirming my worthlessness.

I know it is very unhealthy but I can't help it. What should I do?

Thank you

[Dr_Kim]

Hi Azurelies,

I think it's really hard to sort out our feelings to our parents as they are often complicated. This is even more so when they are mean or abusive in some way . This is because we naturally want our parents approval and the security of their closeness but when they are also perceived as a threat , it's hard to attend to protecting ourselves and at the same time seek closeness and approval . 

Maybe this is why you can think dark thoughts about her and also want to be close to her.
I hope that you seek some guidance with this as it is really hard to find the right balance between looking after yourself and your self esteem AND also nurturing the relationship with your mum.

You might need some help with this from a counsellor at school or uni , or at a Headspace Centre , or via a GP. If you are unsure about these next steps you can look at the Beyond Blue or Headspace websites for help or call the helplines to talk about it.

It's really important that you feel your worth and know you are doing your best in what sounds like a really tough situation. I think most of us would struggle with it .. so please don't be hard on yourself. I feel the more you learn about your strengths , the better you will be able to withstand your mums comments or put some boundaries on them . 

[LeoVirgo]

Since there are no blood tests to ascertain depression, is a GP the best recommendation for a prescription - or should I contact a mental health professional? I have suffered depression for most of my life but now find current medication ineffective.

[Dr_Kim]

Hi LeoVirgo,

You are quite right that as things stand at the moment, depression is a clinical diagnosis. This means that you need to talk to someone trained in order to be assessed and see whether your history is consistent with the known criteria for the syndrome.

The people who are qualified to do this are GPs, Psychiatrists and Psychologists.

If you are finding that your medication is not effective there are a number of reasons. They include:
- There is a limited response rate to the medications (only about 60-70% of people will find any one anti-depressant effective)
- Sometimes the response to the medications changes over time, sometimes a different dose can help, but sometimes other courses of action are required
- The diagnosis might not be correct
- Sometimes the medications alone can’t manage the depression and one really needs all three strands of depression treatment - psychotherapy, lifestyle changes AND medication.

So .. I think the best option is to get a referral from your GP to a clinical psychologist or a psychiatrist to help sort this out for you so you can start to make decisions about how to proceed.

[Insomnia_Nights]

Hi Dr Kim
I have been suffering chronic anxiety/depression for over 10 years, I let go of my last psychiatrist a bit over a year ago as I did not find him at all helpful; after being referred to him by my previous psychiatrist (who's books are closed).

I am currently down to seeing my own GP only and he is getting edgy about prescribing some of my meds without a review by a psychiatrist. I am currently broke (last worked 2.5 years ago) and couldn't afford the $400 odd first visit fee or any corresponding costs. Do you know of any free psychiatric services in Perth?

Thanks

[Zoobee]

Hi Dr Kim, I need to know how to help my 9 yo son.
Over the past 4 years we noticed he started getting really angry, frustrated, anxious, can’t get to sleep (and therefore always tired), he can’t stop thinking about things, he worries and obsesses, has "bad thoughts" and he’s very sensory - sucks on sheets and his clothes and certain material/shoes are uncomfortable. He gets really frustrated and angry easily and will scratch his legs. He’s always itchy and often feels sick in the tummy, has regular mouth ulcers and often feels like he’s “not really here” and asks whether things are really happening or if he’s dreaming. He tells me he doesn’t want to act the way he does when he gets angry and silly and hates himself when in trouble. We have visited our GP and referred to pediatrician who we had a few visits. He then suggested we visit a psychologist which we have done and my son enjoys his time there but we’re not been given any strategies to help him cope and control emotions at home/school. I just don’t know where to turn next to help him. The psychologists say that he doesn’t “mean” what he does and he tells me the bad him does it. We haven't been given us any strategies for us to help him and have no idea where to turn next. Can you help?

[kanga_brumby]

Dr Kim my son was diagnosed with ADHD we have found out since it wasn’t . But instead he should have been diagnosed with Autism. I am wondering is that a physical or physiologic ability. ( I don’t see it as a disability as he has abilities. He has the ability to annoy his dad, sister cousins teachers) he is currently in main stream school struggling a little not in all things just some. From what I have heard this is normal for his type of Autism. The good people caring for him have been made aware of everything the school is next. Thanks
Kanga

[Dr_Kim]

Insomnia_Nights said:

Hi Dr Kim
I have been suffering chronic anxiety/depression for over 10 years, I let go of my last psychiatrist a bit over a year ago as I did not find him at all helpful; after being referred to him by my previous psychiatrist (who's books are closed).

Hi there,
 
It is true that private psychiatry is really expensive and unless one has reached the medicare safety net , it can be very pricy for that first assessment visit. I think to get a bulk billing ( free) service , you may have to go via a public mental health service which your GP can refer you to. 

In looking at the public mental health system in WA , I found this page which ay help you 
https://www.mhc.wa.gov.au/getting-help/public-mental-health-services/
Or this 
https://www.mhc.wa.gov.au/getting-help/community-support-services/

I know its not ideal as you don’t get to choose your specialist, but at least you are getting a trained eye on your situation to give you and your GP some guidance on your medications. It may be helpful and I suggest that you work hard with your GP to do a really good referral outlining all the questions that you want answered so you are more likely to get the most out of the consultation. 

Good Luck and good on you and your GP for working hard to get the best care possible for you. 

[Dr_Kim]

Zoobee said:Hi Dr Kim, I need to know how to help my 9 yo son.
Over the past 4 years we noticed he started getting really angry, frustrated, anxious, can’t get to sleep (and therefore always tired), he can’t stop thinking about things, he worries and obsesses, has "bad thoughts" and he’s very sensory - sucks on sheets and his clothes and certain material/shoes are uncomfortable.

It’s concerning that you don’t feel that you and your sons health team are all on the same page. 

I really am not sure what the issues are with your son. It could be he is just a lovely sensitive boy who needs a lot of support and nurturing, or he could be anxious, or have OCD or a learning disorder or ADD or be on the Autism Spectrum or be too young to diagnose…. I really don’t know and maybe your health professionals are not sure either . Maybe its not all that important at this stage to find a label, especially if the treatments are the the same.

However, I agree with you that you may need some guidelines with how to manage his emotional outbursts and his thinking.  Its important that you feel confident in what to say when he says things like he feels like he is "not really here”. This could be depersonalising which can be extreme anxiety .. but some grounding exercises might help…

I also would want you to feel ok about managing his bad thoughts and his emotional outbursts. 

I wonder if you could as a start maybe ask the GP to either
1. Call a community meeting with his Paediatrician and psychologist  (and possibly his teacher) so that there can be a consensus about what is and isn’t happening and helping, and  what you all can do together as a team.
OR 
2. Get a second opinion from a child psychiatrist to get a better idea of what might be going on for your son.

I would trust your gut here… Its great that you are trying so hard to make his world happier and healthier . It sounds like he is lucky to have you.
 

[james1]

Hello Dr Kim,

I think I've posted to you before, but I 'have' BPD and I'm currently in a relationship where I can feel things fraying. I know I have certain habits where I turn everything into a game or a story and if the other person doesn't play or listen along, I treat it as rejection. I can usually control it for a while, but it doesn't seem to like being put in a box and these behaviours are starting to creep back in.

I suppose my question is more about having my partner come to my therapy session. I don't know what I need to consider, or if it's even something I should do.

I suppose the aim is help her understand what is happening, but it feels like a big overreaction 4 months in, when nothing bad has even happened, barring one incident. We've talked through a few things well, but I also know that she's not sure if she can handle the full me-crazy mode I get. And nor should she, as I should be able to work on it with my psychologist.

So I suppose I'm worried that I'm trying to attract attention because the relationship is stable, yet at the same time I'm told that I don't take myself seriously enough.

In your experience, when would it be recommended to have a partner come to a session with you and what would/should be the goal of that?

Thank you

James