Mental Health Coaching
How to Recognize? When to Screen? When to Refer?
Mental Health has come to the forefront over the past couple of years with the World Health Organization saying the pandemic triggered a 25% increase in depression and anxiety worldwide(1), while research from Boston University revealed that elevated rates of depression persisted into 2021 and continued to climb, affecting 1 in every 3 American adults(2). You could also hear comments from your own community and news outlets suggesting that mental health issues from lockdowns were worse than the virus itself.
Many clinicians experienced either anxiety and depression for the first time during Covid, or had family or colleagues whom we knew of who expressed feelings of being persistent "down" and in "a hole they couldn't seem to climb out of".
As clinicians, without a working background in mental health, we don't often know enough about depression first-hand to be 100% confident in recognizing it in patients, or even recognizing it in ourselves. So how can we recognize it with some sense of certainty? When should we screen our patients for it? When should we consider a mental health referral for a patient we're coaching or for ourselves?
According to the National Institute of Mental Health, depression affects how you feel, think, and manage activities of daily living, such as sleeping, eating or working. To be diagnosed with depression, symptoms must be present for two weeks(3). While there are several symptoms that are recognized as depression, some people may experience a few symptoms while others may have several.
These symptoms include(3):
- · Persistent sad, anxious, or “empty” mood
- · Feelings of hopelessness, or pessimism
- · Irritability
- · Feelings of guilt, worthlessness, or helplessness
- · Loss of interest or pleasure in hobbies and activities
- · Decreased energy or fatigue
- · Moving or talking more slowly
- · Feeling restless or having trouble sitting still
- · Difficulty concentrating, remembering, or making decisions
- · Difficulty sleeping, early-morning awakening, or oversleeping
- · Appetite and/or weight changes
- · Thoughts of death or suicide, or suicide attempts
- · Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
tHow to Recognize Depression
When coaching patients, be alert to the risk factors for depression. The Institute sums these up in three primary categories:
- 1. Personal or family history of depression
- 2. Major life changes, trauma, or stress
- 3. Certain physical illnesses and medications
Effective listening and use of motivational interviewing conversational skills within a coaching context can help you learn much about the following patient attributes and characteristics where risk factors can be elicited and followed up with a PQ-2 or PQ-10 depression screening questionnaire.
- · the patient's history,
- · aspects about the patient's health and daily life they think is most important,
- · any chronic conditions, and
- · medications that can have side affects contributing to depression symptoms.
The PQ-2 is the first two items of the PQ-9 questionnaire. The PQ-2 is quite brief and is often used in personal histories as part of the routine assessment. The American Psychological Assoication (APA) has the construct of the PQ-9 that is free to users. See: https://www.phqscreeners.com
Clinician Health Coaches by way of their licensure are generally trained when to recognize the need for referrals outside the areas of their professional expertise. It's also advisable to reach out to the mental health professionals in your locale or virtually to whom you might be referring patients, to confirm the types of patients they will see and treat. This develops professional working relationships and saves time, as behavioral health professionals are not always readily available.
If you or someone you know is in immediate distress or is thinking about hurting themselves,
National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255).
Starting July 16, 2022, everyone in the U.S. may dial 988 which goes directly to the Lifeline.
Text the Crisis Text Line (HELLO to 741741)
Melinda Huffman, BSN,MSN,CCNS,CHC
The National Society of Health Coaches