Episode 40: Mental health and young people: two personal stories

Dr. Caroline West:

Hello and welcome. I'm Dr. Caroline West, I'm a GP with a special interest in mental health, and I'm an NPS MedicineWise Medical Advisor. Increasing numbers of young Australians are experiencing psychological distress. And the last couple of years with COVID, lockdowns, disruptions to work, education, and socialising haven't made it any easier, particularly for those under 25. So, it's timely that today we are focusing on young people and their mental health. At the core of this is the need for engagement and empowerment of young people because this can profoundly affect the trajectory of someone's journey.  I'm a GP. I enjoy working with young people, but there's always so much to learn. And I'm curious to know what engagement and empowerment looks like from a young person's perspective. Joining us today to take us through these issues and more are two young people with lived experience. Welcome, Rebecca Langman and Nic Juniper.

Rebecca Langman:

Hi, nice to be here.

Dr. Caroline West:

Nice to have you on the show. Can I start by checking the pronouns that you'd like us to use during the show? Rebecca?

Rebecca Langman: 

Yeah, so Rebecca she/her.

Dr. Caroline West:

Yeah, and Nic

Nic Juniper:

Nic, I use they/them pronouns.

Dr. Caroline West: 

They/them. Fantastic. Great. And if, at any time through this podcast, there's something that you don't feel comfortable talking about, then please let us know. Because obviously, this is an important area for you in terms of taking us through your journey with mental health. And we are very mindful that if at any time you wish to change the narrative, you can do so. But can I start off by just asking you to tell us a bit about your story? Rebecca, to you?

Rebecca Langman:

I live in Adelaide, and my journey with mental health started around when I was in high school, around 15 or 16 years old. Really classic stuff of not wanting to go to school, sleeping a lot, not interested in my school work, very sort of classic depression symptoms. And it didn't really get picked up at the time because this was over 10 years ago now, and mental health wasn't on the agenda as much. So it kind of went untreated, and I didn't go and see anyone about it because I still felt a lot of stigma and fear as a young person with all these feelings that I didn't know what to do with. So I started university in 2014. Everything got a lot worse. It was a bit of a pressure cooker moving out of home when I was 18 and starting uni, trying to find work. It was all just a bit much, which is really common for most young people in their first couple years of uni. So yeah, I was experiencing a lot of really like depressed, sad feelings, some suicidal ideation, substance use, lots of different things. I didn't have a regular GP. I didn't have a psychologist. I'd never seen anything like that for more than a cold or something like that. So I didn't really know where to start. And I eventually sought out a psychologist and got a referral there, and started seeing a psychologist in my first year of uni, which was really helpful for me.  Then after that, I started on some medication when I found a regular GP that I really got along with. And after that, it was a long journey of going on and off medications, side effects, trying different things. And it wasn't until sort of towards the end of my university, when I got a job in mental health, that I started to see a lot of my symptoms improving, and I started to see that it wasn't really just a chemical imbalance in my head that, I was really struggling with things going on in my life like not feeling connected to my community, not feeling I had a purpose, not having healthy relationships in my life. So, I spent a lot of time going back and forth on medications. When really I needed someone to talk to me about my life and my needs and what needs weren't being met. So, yeah. And so, after I started working in mental health and really found that purpose and community, things started to get a lot better. And it's been up and down since then, but I've really figured out the strategies and the routine and the things I need to stay well.

Dr. Caroline West: 

Well, thanks for that. There's so much to explore there, but I guess what I'm hearing is that really, it was a holistic approach to your mental health that really made the difference and including all those other aspects of your life, including what you were doing in terms of your work and your focus and all of those things made a tremendous difference. And over to you, Nic, does Rebecca's story resonate? Are there parallels to your own experience?

Nic Juniper: 

Definitely, I relate to a lot of Rebecca's story. Yeah. I mean, it's very difficult to condense 10 years of service use into a little tiny introduction to my story, but I started really experiencing mental health issues in high school. I found that transition from primary school to high school to be very, very difficult. And I was initially a very engaged student. I was very active and interested in learning more but started to withdraw. I started to isolate myself and not show up to class, and teachers started to notice that, so I was sent to a school counselor, and that was the first time somebody realized that I was self-harming. So from there, my parents came involved. I was referred to a Headspace center, and I've been in and out of different services. I've been in youth services and adult services. I've been in public and private, and there were periods where I was seeing a psychologist weekly. When I was really, really struggling, I ended up dropping out of high school, and there was a period of time where I really wasn't doing anything, and I felt like that was kind of it. I felt like a failure, and I wouldn't get anywhere in life. But I ended up seeking vocational support. I ended up getting into study, getting into work, getting into volunteering a lot, which has driven me quite a bit, and it was never the plan, but I ended up working, getting a job in the mental health field where I use my lived experience as expertise. And that is something that, at this point, really drives me. Something that I'm very, very passionate about: I love to share my story and work with other young people, and it keeps me very, very active, and I love it. It's just something that's really important to me.

Dr. Caroline West: 

Something that we've heard from both of you is there's a lot of complexity there with that story that you're sharing, and you're both sorts of describing how those transitions into school and beyond are often pretty difficult. And that experience of sort of withdrawing, I guess, from attending school, being interested, perhaps getting up in the morning for some young people. All of those things can be warning signs that somebody's disengaging and not traveling so well.

Rebecca Langman: 

Yeah, definitely.

Dr. Caroline West:

How do you know when something is sort of crossed the line between being a normal response to being a young person or an adolescent and something that's actually beyond that, that it's actually a mental health issue as opposed to an adaptive adjustment to a new life phase? How does somebody know when they're not traveling so well, do you think? What recommendations would you give as things for people to look out for?

Rebecca Langman: 

I think for me, when I was in school, no one ever really asked why are you finding it so hard to get to school? Why are you finding it so hard to do your work? Those sorts of questions and just diving a bit deeper, and I'm sure I would've given some compelling answers. I don't think I would've just gone, "Ah, I don't know." Because I was really, really struggling at that point. So I think it can be as simple as just digging a bit deeper and finding out what's going on in their life. It could be family, relationships, anything like that. I think it's just about digging a bit deeper, and for some young people, it will be, "Oh, I'm just tired. I'm just bored. I'm just not interested." But there is a big majority of people who will be struggling with mental health issues.

Dr. Caroline West: 

So what you're describing is really this level of engagement, that's so important, which is really the focus of what we're talking about today, and from a young person's perspective, Nic, what does good engagement look like?

Nic Juniper:

For me, I had a lot of people who really got to know me as a person, and I think that building relationships and really connecting with somebody made me feel like I could trust them and that I could be very open with them. I had one clinician that I saw who knew that I really loved dogs. So we would always share pictures of our dogs together, and that was something to look forward to in sessions, but it was also something that really made me feel comfortable with her. And I knew that she actually cared and wanted to know about me as a person with interests and dreams and goals in life because we could just talk about stuff that wasn't the brain mental health stuff that was going on.

Rebecca Langman:

Yeah I think that the power of self-disclosure is so big, and it applies for psychologists, GPs, teachers, anyone really. It doesn't have to be groundbreaking stuff, but it's that stuff talking about your pets or your hobbies that just make you feel more like a person and less like a doctor or a psychologist, or it helps break down those power imbalances because when you're a young person walking into a GP or a psychologist for the first time you feel quite small, you feel quite uneducated and very overwhelmed. So I think anything that can make you seem more human and create a connection is helpful.

Dr. Caroline West: 

Yeah. And some of those things are so simple, but as you say, they worked to form a great connection. I remember a patient of mine was besotted with her two cats, and she reckoned that one of them used to play games on the iPad with these fish, and I thought that's not possible. And so then she decided to film it on her phone. And it was fantastic looking at the footage of the cat actually playing with this fish app on the phone, seeing the footage, and just also sharing photos of her cats and just by sharing those photographs of the things she was passionate about. And she was also very, very much into knitting. And just if we could share some of those creative things she was doing and some of those passions she had around her pets, it allowed me to get an understanding about her life in a more complete sense. And so, can you think of things that may be a barrier to engagement? I mean, what are some of the turnoffs for young people when it comes to navigating the health system?

Rebecca Langman:

I think for me, so when I first became unwell, that was sort of the early days of Headspace and living in Adelaide, which is not one of the bigger capital cities. There wasn't a Headspace around, there wasn't a lot of private psychologists, and my journey is that I, because of all the stigma and shame and fear that I felt, I didn't tell anyone that I was trying to seek help. So as a 16 to 18-year-old, I didn't have a whole lot of money to be seeing different health professionals. And I was seeking out things on my own. I didn't know where to go. There wasn't bulk billing services, just things like that when you're a young person. If it's not easy to catch the bus there or walk there, things like that can really get in the way. And it's a lot better these days with the amount of youth services we have. But for me, that was a really big deal, just purely access. It was really hard for me to access anywhere.

Dr. Caroline West:

Yeah. I'm hearing you and Nic. What was your experience there with some of the things that may have been turnoffs?

Nic Juniper: 

Yeah, I think that the big thing for me was, was stigma and self-stigma. Being pulled out of class to go see a school counselor was really, really embarrassing. And I didn't know what my peers would be thinking. And I was afraid that if people knew that I was seeing a psychologist, that they would be judging me. I was very lucky in terms of access. I had a Headspace centre that was quite local, and I always had my mum there who was able to drive me. But that was another thing, having my mum very involved in my care. I was also embarrassed about that. I didn't want her to be worrying all the time. I was very protective and quite secretive. I was hiding a lot of my experiences because I was afraid that people would treat me differently or be afraid of what I was experiencing and be really, really scared on my behalf.

Dr. Caroline West: 

So you've mentioned the family and involvement there, and I guess that for many people, their family or friends are going to provide a great support network, and some people don't have that refuge. What are your thoughts on the importance of having other people on the team, so to speak, that know about your condition and are there to support you? Rebecca, what do you think we need to think about there?

Rebecca Langman: 

In my situation, it was that no one else in the world knew except me, my GP, and my psychologist. And at that point, I still withheld a lot from my GP and I sort of saved all the intense stuff for the psychologist, which is not how you want it to be because when I felt that I was in distress or crisis, I didn't really know where to turn. I might have to wait two to four weeks to see my GP or psychologist. So it just creates a really isolating sort of chamber where you don't know where to go. Even if that young person comes in on their own talking about what family do you have, what friends do you have? Who do you live with? Sort of identifying those supports can really help.

Dr. Caroline West:

And I guess that could be part of safety planning, too, because one of the things that we're doing at NPS MedicineWise is running a program on engagement and empowerment of young people with their mental health. And one of the things we're focusing on is safety planning and for GPs to be aware of this as a tool to work with, with young people in terms of having a framework and having a sense of, "Well, this is what you can do to remind yourself of what some of the warning signs may be." Things that you still love doing, reasons to live, what are your support networks, and what to do if you're in crisis. I suppose that brings us to that delicate subject of what should we be doing in terms of discussing frankly the risk of suicidal thoughts and what's going on for a young person there because I know that a lot of doctors and other health professionals are a little awkward around this area because they don't want to be seen to be in any way increasing risk. And they sometimes feel uncertain about whether talking about it will actually do that. But I think the evidence is very clear that it doesn't. Rebecca, do you have some input on that?

Rebecca Langman:

Yeah. And I think I definitely grew up around that time where it was you don't talk about suicide or self-harm, and I often had experiences with health professionals where they didn't sort of dive a bit deeper and sort of ask the why, how of the self-harm or the suicidal ideation and just normalizing it in the sense that it's okay to talk about. I'm not going to be punished, or I'm not going to be spoken down to. I think you can acknowledge it in a way, saying, "This isn't an ideal coping mechanism but let's work on creating some other ways you can cope and let's stop you from getting to that point where you're really distressed, and you don't know what else to do." So I think just taking the fear away from it and just empowering that person to talk about it, knowing it's a safe place.

Dr. Caroline West:

Nic, I can see you're nodding your head for the podcast listeners. They can't actually see you visually, but I can. What's going through your mind.

Nic Juniper:

Yeah. I think that openness is the key thing. I know for me, I wouldn't tell people if I felt like I was in risk. It's just not something that I felt comfortable with. And the times that I did it took so much courage. And it was very, very difficult. There were times when I had to tell people that I didn't feel safe and that I might need to go into hospital. And I hated having to do that, that there were other times where people would ask me if they noticed that I was struggling. Or if things seemed like they were getting worse, they would ask things like, "Are you feeling suicidal? Do you think that you are at a higher risk," and that meant that I didn't have to broach the topic myself because it was just something that felt so unnatural to have to bring up? So I would say that really opening up that space and making it something that's okay to talk about, something that's normal to talk about and actually a very good thing to talk about.

Dr. Caroline West: 

Yeah. And ideally, GPs and health professionals will be checking in with young people at every visit to just assess how they're going and to update a safety plan if that's what's needed. But it's also good to know that there are apps and other resources that can be used with safety planning, like Beyond Now, so that you've always got your safety plan on your phone, for example, and I've found with my patients that they've found that really handy. So if they get into the doldrums and they're really experiencing suicidal thoughts or not feeling particular, or they're feeling particularly vulnerable, they can go to that app and just remind themselves of the steps and what needs to be done to settle their thoughts and give them a framework for managing those times. Because when somebody's seriously depressed, those thoughts may pop up. And I think you are saying it's good to be quite direct about it and to actually be open with a young person and discuss it.

Rebecca Langman:

I think it's important that if you ask that question about self-harm and suicidal thoughts, that if that young person says yes, or maybe, or anything that is a no, that, that conversation continues and goes, "Okay, well, what are we going to do about that?" Because I think often people can disclose that and the conversation sort of stalls, but I think it's a good opportunity for the safety planning and for connecting with the person and showing them that it's okay to say that and that there are options.

Dr. Caroline West:

I guess we've talked about trust and open communication, and it's not just about safety planning, but it's also about assessing other risks and having frank discussions about things like drugs and alcohol. There's sometimes awkward areas for practitioners to delve into. And sometimes, I guess young people may not want to talk about it in case there are any leaks with the confidentiality that they're concerned about. What should we think about as health professionals when it comes to talking about areas like drugs and alcohol?

Rebecca Langman: 

I think that so many young people experiment with drugs and alcohol, I don't know the statistics, but I think it's a lot. So I think it's safe to assume that when you're working with young people, it is a question worth asking, especially when some drugs can interact with mental health medications that we take. I remember just sort of being in that party phase when I was in uni and not really having the information or any of the science around how the medications work, how they interact with things. Things like serotonin syndrome, and things like that. So I think it's an opportunity to empower and educate the young person, and even with substances like alcohol, I know a lot of people that would take anti antidepressants and drink alcohol and then suddenly find themselves really, really intoxicated. So I think even issues like that are not spoken about enough and can really help to educate that young person for when they go out and inevitably experiment with things.

Dr. Caroline West: 

What I’ve observed with some of my young patients is that they stop their medications for a while because they think, "Oh, I'm going to have a pretty big party weekend," then all medications stop. And then they get sort of certain symptoms off the back of that and make them feel worse. And then they hit the doldrums midweek after a big weekend, and it can actually lead to a lot more undulations, which are difficult to manage. And a lot of people are self-medicating with drugs and alcohol. That's the other thing to remember that they're self-soothing with these substances. And we need to sort of explore whether it's crossed that line to be part of their coping strategies. And this is what they're using to cover up feelings that they're experiencing, which are really difficult. In terms of you've mentioned medication and the sort of interactions there, both of you have mentioned being on medications. What about that exploration of side effects and sort of bringing young people into that conversation around, "This is what this medication does. These are some of the benefits, but these are the costs or the side effects." Is that happening much, do you think?

Rebecca Langman:

I can very clearly remember my initial appointment where I got my first antidepressant. I don't know why that memory's so clear to me, but it is. And I had a good GP, but it was very much sort of a chemical imbalance in your brain, these medications can help, and you'll probably feel a bit worse before you feel better. Here you go. And while some of that information is good, it wasn't detailed enough, and I didn't understand the science of it. I didn't understand neurotransmitters and how the medication worked and side effects, and I did end up feeling a lot worse before I felt better. My first two weeks, I experienced that quite intense suicidal ideation when starting a new medication that I wasn't really prepared for. I ended up with one of those more rare side effects, like yawning all the time, which sounds not significant, but it really impacted me at work and uni and stuff coming across, like, I was really, really exhausted all the time. So yeah, I sort of had the bare amount of info, but it wasn't enough, and it wasn't explained in a way that was really practical. And I think young people, we can explain it in a way that's really accessible, and you can draw a diagram. There are ways that we can explain the medication options in a way that young people can understand.

Dr. Caroline West:

One of the side effects of some antidepressant medication, of course, is it can interrupt sexual function, so it can make it more difficult to achieve orgasm, or it can affect arousal or interest in sex, for example. That's possibly an area too, which may be not fully explored prior to medication being initiated. Nic, do you have any thoughts about that particular area and what we could do if it's not being addressed?

Nic Juniper:

I think that again, it's about openness and making it okay to talk about these things because definitely, it's very uncomfy for a young person, but it is also very uncomfy for a clinician to talk about. So it's okay to say that like, "Hey, this might be a little bit weird to talk about, but I think that it's really, really important that we do talk about this." Because it is important to a lot of people, it's something that we have to weigh up our mental health, our sexual health, our physical health. And sometimes it's very difficult to make those choices, but we need to know everything that could happen in order to actually be able to make an informed choice.

Dr. Caroline West: 

Yeah. And in terms of sexual health and other elements of a person's health, young people who are experiencing psychological distress are more likely to be taking risks with their sexual health. And it is relevant to also think going back to your initial point, Rebecca of thinking holistically about a person that it's important to include those other elements of physical health in consultations as part [00:27:30] of the approach, Nic.

Nic Juniper: 

Yeah. I think that, for me, it was, again, I struggled with cognition a lot, and I couldn't take in a lot of information. And I was given that big old booklet about the medications that I was going on, but I didn't have the capacity to actually read through that and understand what it was actually telling me. I never had a conversation about a lot of the side effects that could come from medications. And now, I live with a lot of long-term side effects that I have to deal with. And you can never really pull out which medication might have done it. I always wonder, is this just chronic health? Is this medication? Is this just because of my lifestyle? And I feel like there are some things that I experience now that if I'd known it was a possibility, I might have said no to certain medications.

Dr. Caroline West: 

Yeah. And Rebecca.

Rebecca Langman:

Those side effects aren't really explained in detail. And I think it's safe to assume that the majority of not even just young people, but the majority of people are not going to read that pamphlet in the box thoroughly. It's just what we do as humans. We scroll past the terms and conditions we just don't read unless it's very accessible, very straightforward. So, it's an issue that I've seen with a lot of young men I know taking medications that it's really impacted their lives and sexuality, and relationships. And I think yeah, it's definitely not discussed enough and openly. I think it's just all in that initial conversation that you just put everything on the table. There's no judgment. And for each person, it's about weighing up the side effects and weighing up the benefits, and that's going to be different for everyone. Yeah, it's really individual.

Dr. Caroline West: 

It is very individual. And I guess, guess on the back of that discussion about medications, with the benefits that people may have, but also, and initiating a drug, but also discontinuing it. What does the other end look like? Because hopefully, people will be on them for a shorter amount of time as possible, often six to 12 months, but often people will stay on them for years. And if they do come off a medication, what does that feel like? What are people going to experience? So that they're forewarned that it's not necessarily their condition getting worse, but their symptoms may be just a discontinuation experience.

Rebecca Langman: 

That was a key issue for me. They often explain that when you start taking it, you'll feel worse, then you'll feel better. Which is often true, but no one said at the end, it can be really rough coming off of some of these medications, and you can have all sorts of symptoms like fatigue and head spins and brain fog, and the list is endless. And no one ever really explained that to me. So I had a really rough time coming off of medications. And one, in particular, took me, I think, about six months to lower my dose on. And that it was just never clearly explained. And I ended up doing a lot of research online, like in forums and Facebook groups which can often not be the most helpful places in the world because whenever someone has a bad experience, that's the place they go. So I did a lot of that kind of research. And I tried lots of different medications and would often get to a point where I felt like they weren't working anymore. But now, I can see with retrospect that it was actually my life and the situations I was in that I needed to work through. And being on a sort of a hamster wheel of different medications wasn't ultimately helpful. And I needed to look at my life situation.

Dr. Caroline West:

I guess when a health professional is doing an assessment with a young person and really trying to get a sense of that person's life, a sense of that person's relationships, gender identity, sexual orientation, all of those elements can be really important, especially to a young person. And how is that particular area dealt with?

Rebecca Langman: 

I found going into a GP's psychologist's office when I was younger, and I identify as a queer woman. So, I never knew if it was going to be a safe space for me to say that I was in same-sex relationships. It was always quite scary and unknown, and often it can be simple as having a pride flag in your office or having a poster that welcomes different communities. And I think this applies outside the queer community to different cultures and religions, and identity. It's just about making it a safe place. Even my latest GP that I've seen, I picked her because, on her description, she said that she was an ally of the queer community, and I thought, "Okay, I'll give her a go." So it can really be as simple as that in creating a safe space, and it's not hard and educating yourself. There's so many resources out there about how we can support different communities and healthcare.

Dr. Caroline West:

Nic, do you think health professionals are getting more comfortable with this area?

Nic Juniper:

I hope so. I feel like I can talk about it a little bit more openly these days, and that is just because I'm more comfortable with it, but also, I do feel like seeing those posters around makes it a lot easier to talk about. It took me years to come out as transgender, and I was only able to do that because I saw a doctor who was queer himself. And even then, it took me several sessions to even be able to. I couldn't say the words; I had to write it down. And he was very, very receptive of that because I think that he understood how difficult some of this sort of stuff is and being in these spaces where it is very queer-friendly and queer-safe. I've been able to say, "Look, I'm seeing this health professional. I don't know how I feel about telling them about my identity. Can you support me in how to broach those conversations, or if it was really difficult, can you just give them a call and let them know? Because I literally can't say it." These days I've been to a lot of queer-specific health services because I'll make the assumption that it is safe. It can be quite difficult being in a service where you've got no idea if somebody's even worked with somebody who's queer before. And it's something that you just don't know if you can talk about it. You don't know if it's safe for one, and you don't know if it's something that you're going to tell somebody, and they're just going to sort of go, "Ah, I don't know how to approach that." So for me, specific places where it's understood and really advertised as, "Hey, this is a safe space for all communities," even a lot of places have aboriginal flags that are displayed in certain areas. I think that that's really important in terms of feeling comfortable and accepted because if you say one thing, you're hoping that there is that really intersectional view and that it is that really holistic view of an individual and that our identity is a huge part of our lives and does impact things like mental health and how we see the world.

Dr. Caroline West:

What I'm hearing is so important to be respected for who you are to have full acceptance. Yeah. And if we just go back to that original thread of the conversation, which was really around engagement, because what you're talking about here is trust and engagement, where you can disclose who you are without fearing judgment. What are your sort of top recommendations for health professionals? If we could somehow encapsulate that with what would be your top things. Rebecca.

Rebecca Langman: 

I think the core of it is building connection and finding that humanness in each other. And a lot of the research around psychological therapy says that one of the biggest predictors of how the effectiveness of the therapy is, is the relationship between the therapist and the person. And so much of it is based on relationship. And if someone feels comfortable and safe with you, then they're so much more likely to just tell you what's really going on and reach out when they're in a crisis as well. So I think building the humanness of it is really important to me and doing anything you can to break down those power imbalances. And as a 16-year-old, I had no idea what a mental health care plan was. No idea what an SSRI was. It was a complete mystery to me. I wasn't even sure how to get to the GP or how to see a psychologist. So explaining things in a way that's clear and makes sense because it's a complete labyrinth for young people when they're first stepping into the healthcare system. So I think just not assuming and explaining things as clearly as you can.

Dr. Caroline West:

Yeah. And I guess as part of that approach, having shared decision making that comes off the back of that, that then allows you to explore options that may be talk therapies, could be digital therapies. There are a whole range of initiatives that could be employed to really help you on the pathway to wellness or to recovery. Nic, what are your key recommendations here?

Nic Juniper:

Yeah, I think that my big one is connection, but I won't go into that again because Rebecca has summed it up really well.

Dr. Caroline West: 

Beautifully.

Nic Juniper:

I think that the other really important thing for me would be to say that it's important to get to know people as individuals and to really understand who they are and what they want to get out of any support or care that they receive. Not jumping to, " This person is experiencing psychological distress. Let's put them on medications." Maybe somebody is really struggling at school, and they need support in that. And that will really help with a lot of the stuff they're going with. We know that things like nutrition and physical activity, and sleep are all really big parts of well-being in general. And stress is a very normal experience that everybody goes through and it can be quite medicalized a lot of the time. I've gone to see a psychiatrist and said, "Hey," like, he's asked how I've been. And I said, "Hey, yeah, university is tough. Work is tough. I'm feeling a lot of stress," and he's gone. "Okay, well, here are the medications that you can go on for that," when really I'm experiencing everyday life. And I think that for me, things that help are socializing or working on eating well or getting out there into the sunlight and going for a walk. And sometimes, I need prompts for that. I need to know where I can access a social group, or is there a nutritionist or dietician that I can see because my life doesn't just revolve around my mental health issues. My life is holistic. To me, even work, study, it's so important to have things that you love and hreigfeeling like you're contributing and that you've got  pathways, a place to go. And it's very important for me to really highlight that it's not just brain stuff. A person is a whole person, and we need to understand who they are and what they want to get out of life to actually provide them with what they need. feeling like you are contributing and that you’ve got pathways, a place to go and its very important for me to really highlight not just the brain stuff. A person is a whole person and we need to understand who they are and what they want to get out of life to actually proved them what they need.

Dr. Caroline West: 

Yeah. So you're talking about scheduling in all of those other aspects of your life that make a difference. So sleep, nutrition, time with friends, getting into nature, perhaps as well. There are so many things that that can be done that are therapeutic tools in themselves that perhaps are overlooked, Rebecca.

Rebecca Langman: 

Yeah. I found that when I was a young person seeking help, I really wasn't provided with options. It was, "Here's the medication." And just take it, it wasn't, "We'll try this in the short term." The evidence around short-term and long-term effectiveness wasn't explained. So in my head and my friends and everyone I knew, it was, "Well, I've got this SSSRI for the chemical imbalance in my brain, and now I take it forever." We're setting up people to fail when we do that. And we don't look at the other parts of their life. We don't look at the social connections, the physical things going on in the body, relationships. So that was never explained to me. And I had to figure that out on my own, which I found quite difficult. I think it's a really big problem for a lot of young people. And we're not doing the work to find out those other domains of their life and the things that fill up their cup and the things that empty their cup and how we can balance those. And like Nic said, there is a normal amount of life stress, especially living in a pandemic now. It's a time of a lot of stress and anxiety, and increasing in medication dose, isn't going to solve those problems. They're still going to be there. And we need to figure out ways to work through those issues in our life. There are times when going up or down your medication is helpful. But in my experience, a lot of it was just lifestyle stress and normal stresses of growing up. And yeah, I find that we really need to communicate that these medications can be used as short-term support and that it's not a life sentence that you do have options. Yeah. There's lots of things you can try. And again, it's so individual. I love swimming and walking. I hate running and cardio. So, finding ways of moving my body that really spoke to me and filled my cup up was really important.

Dr. Caroline West:

If you were giving advice to young people who may be listening, who are experiencing mental health issues, what's important for them to take away from this. Nic.

Nic Juniper:

I would say stay informed, look out for information and keep track of the things that are offered to you. Sometimes it's difficult to know what questions to ask. Personally, if I have an appointment, I'll write down notes while we're talking so that I can remember, and I can follow up on things if I need to. I'll think about the questions I want to ask beforehand and afterward and bring that to the next session that I might have. And now I keep a lot of records about things like treatments that I've gone through medications that I've had because my brain just doesn't keep that stuff in there. I'm not going to remember it. So really take charge. Sometimes it's difficult if people don't want to give up that power, that it's important that we empower ourselves and really advocate for ourselves. If that's not something that we can do, it's really, really tough to do that. Talking to our support networks, talking to family or friends, or online forums, just being, getting out there and knowing what your options are, and really advocating for that and standing up for yourself and letting people know, "This is what [00:45:30] I need. I need you to listen to me. I need for us to make a decision together," because this is my life. You know, all of the theory, you've done all the study, but I know my body. I've lived in it for my whole life. And I want for people to be able to get the best care possible. And for them to really understand all the possibilities and all of the options.

Dr. Caroline West: 

Rebecca, what would you be saying to young people?

Rebecca Langman: 

Yeah, I was just thinking about the Choosing Wisely questions and thinking about how much they would've helped me as a young person. A simple question, like, what are the risks? What are the side effects? What happens if I don't take medication? What happens if I don't do anything? I think any young person can Google them. And I think it's a great place to start. And those questions often will have clear answers that your doctor or someone can give you. Yeah I just want young people to be empowered. And like Nic said, you are the expert in yourself. You know your mind and body. And that's why I think, the greatest knowledge that you can have. You know when something's wrong, you know when something's going well, and when you come into that doctor's office, you don't need to feel so small and uneducated, like I did, because this is your life. This is your body. And, you know about it, and you know it's your right to be there. It's your right to receive good healthcare. And yeah, there are so many things, but I think empowering young people and educating them is probably the most helpful thing we can do.

Dr. Caroline West: 

Just before we wrap up Nic, can I just ask you, what have you learned about yourself? That's helped you on this journey?

Nic Juniper:

I think that I just gone through a lot of self-discovery and really exploring my identity. And I have learned that there is nothing wrong with me. There's just been circumstantial things that I've experienced, and that has led to who I am today. I think for me, I still experience symptoms. I consider myself to have a living experience of mental health issues. And while I still experience psychological distress, I've learned the things that keep me going, so being able to study, being able to work in a field that I love and volunteer, but also just those little self-care things. For me, music is a really, really big thing. When I was really, really struggling with suicidal thoughts, I would book a concert for the future because I knew that I would have to live in order to see that concert. And that's something that I still do to this day. If I'm feeling a little bit not great, I'll put things in my diary so that I've got something to look forward to. I've just learned to do things that I love. So horror movies are really, really big for me. Art is really, really big for me. Seeing friends are really, really big for me, so just keeping myself busy but also so happy.

Dr. Caroline West: 

Fantastic. Yes. I relate to your interest in the creative arts, music, art. It brings me a lot of joy too. So learning an instrument mines the ukulele, but we don't need to go there with that. Rebecca, what is it in yourself that you've discovered in terms of your strengths through this process?

Rebecca Langman:

I think one of the biggest things for me was realizing that I am a very sensitive person, and that's not a bad thing, but, yeah, I'm just very sensitive. I'm very prone to tears. I'm very prone to emotions. They come very easily and quickly [00:50:00] to me, and that's okay. And that's part of who I am and to embrace that. That was really helpful for me. And I've personally moved away from a sort of diagnosis. I just sit with my sensitivity and how I am in the world. And I'm really comfortable with that at. As well as some really just building up support systems in your life. I have a partner who supports me a lot. I've seen a psychologist for many, many years, and that's a really strong, fulfilling relationship in my life. I have a best friend too who has supported me incredibly, and sort of building those communities in my life's been really important. And something as simple as I have a note in my phone where when I'm distressed, I just work through steps like doing some meditation, doing some stretching, writing out my feelings, talking to a trusted friend, I work through those steps. And if I get to the end that I'm still distressed, then I'll book an appointment to see someone. So just those strategies routine has been really important for me as well. And I enjoy creative things as well. I do film photography in my spare time, and a really important thing as well that we talked about was being in nature. I remember when I used to really struggle with depression and feeling low. I would go on hikes, or I would go out walking, and I would be puzzled. I'm like," Why do I feel so clearheaded? Why do I feel so much better?" And it was just that I really connect to being on country, being in nature. And it gets very spiritual for me. It's just very settling, and that was so important to me. And it can be simple things like just discovering what you like, what fills your cup. I think really important being gentle and kind with yourself. As humans, we can really be so hard on ourselves and expect so much but just moving through each day with kindness and knowing that you're trying your hardest is really important.

Dr. Caroline West:

I love that expression. What fills your cup. You've mentioned that a few times, and I think I'll take that away with me and think about that. It's a really great sort of metaphor, isn't it? And thank you both. I've learned so much during our conversation today. It's been really interesting, and I appreciate you taking the time to talk with us. It's such an important area for us to focus on young people and mental health, but particularly in this field of engagement and empowerment, because really without that, we have nothing, there's no therapeutic alliance, its progress is going to be so much harder. So, I appreciate you sharing your wisdom, and I think it's fantastic that you've infused creativity and a holistic plan into your mental health strategies. And I think that a lot of us will have to take away many messages around this in terms of what we could think about when we are working with young people. I know it's sometimes very difficult to talk about some of these issues to a big audience. And so, it's been incredibly helpful, and we really appreciate your time. So, with gratitude, say a big thank you to both of you. And for those of you who are listening, if you'd like any more information on this program, you can go to NPS MedicineWise at nps.org.au for more resources and also for information on CPD points. There have been no conflicts of interest declared for this podcast. And thanks once again, Nic and Rebecca, and to our audience. I look forward to you joining us next time. I'm Caroline West. Bye for now.