A comprehensive approach to mental health care research and practice:

This Friday on October 10 is Hat Day where Australian Rotary Health—the largest non-government funder of mental health research in Australia—has asked people throughout Australia to wear a hat and donate to mental health research. I personally am very grateful for the hard work of Rotarians to raise such funds; I have been awarded an Ian Scott scholarship. My own research would not be possible without it.

The aim of my PhD project is to understand women’s experiences of endometriosis, particularly the effect that living with this condition has on their mental health. Throughout my research I have seen evidence of the need to approach all aspects of health, particularly mental health, in a comprehensive manner. I use ‘comprehensive’ to mean an approach that takes into account the person in their social context, not just the biological aspects of their illness. In this blog post I explain why such an approach is important in mental health research and practice, and why it is an essential topic for the next generation of doctors in Australia to understand and consider.

People do not experience illness in a vacuum, void of social, cultural and political influences, nor is medical practice immune to such influences.  A well-known example is the entry of homosexuality as a disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM; version: DSM-I)—the US diagnostic reference for mental health—despite the lack of empirical data. It was removed in 1986 because of changing social norms and the emergence of a politically active lesbian, gay, bisexual, and transsexual (LGBT) community.

The impact of sociocultural influences on people’s experience of illness is most evident when we consider women and their mental health. While both women and men experience mental illness, women in general are more often diagnosed and each is more prone to certain diagnoses. For example, mood disorders (such as depression) and anxiety disorders (such as generalised anxiety, post-traumatic stress) are more likely to be experienced by women than by men (mood: 18% vs 12%; anxiety: 32% vs 20%).

There are many factors that contribute to such gendered differences, one of which is women’s social context. The 1997 United Nations Human Development Report concluded that “no society treats its women as well as its men.” Although this report was published over 10 years ago little has changed. Gendered inequalities within society have been reported to be a significant factor in increased rates of mental illness among women.

Ignoring social factors has led many to attribute poor mental health among women to personal deficits rather than identifying it as an understandable reaction to adverse social circumstances. (It is ironic that this oppression—which is enacted by men who predominantly benefit from it—also adversely affects the ability of men and boys to seek care for mental health problems because of fear that it is not masculine to do so.) By not acknowledging social circumstances and their relationship to mental illness within health research and practice, we not only overlook significant determinants of women’s health but also perpetuate inequality.

Failure to consider all aspects of mental health also contributes to the unnecessary pathologisation of people’s distress, much of which is understandable given their circumstances. This pathologisation can result in the misallocation of resources, for example, funding pharmaceutical interventions rather than psychosocial interventions such as domestic violence campaigns and improved social support for women experiencing endometriosis. It can also lead to increased pressure on medical professionals, including general practitioners (GPs), to ‘treat’ problems for which they have received little or no training, when this burden could be distributed across the community.

It can be difficult to incorporate these concepts of a comprehensive approach into medical practice, given the restraints inherent in the modern medical environment, such as short consultation times and minimal training for non-specialist mental health professionals. As the future of Australian medicine, you are well placed to revolutionise the system to ensure that all women receive the best possible care. You may choose to take time now to become informed about how your service will contribute to people’s experience of illness. I hope this blog post contributes at least in a small way to your conversation with your peers.

For more information on the topics mentioned in this post I recommend the following:

o   Gender and sex, and its relevance to medical practice: http://www.med.monash.edu.au/gendermed/sexandgender.html

o   A review of the evidence of the psychosocial effects of living with endometriosis: Young K, Fisher J, Kirkman M. (2014). Women’s experiences of endometriosis: A systematic review and synthesis of qualitative research. Journal of Family Planning and Reproductive Health Care. http://www.ncbi.nlm.nih.gov/pubmed/25183531; doi: 10.1136/jfprhc-2013-100853.

o   The risks of ‘too much medicine’: http://www.bmj.com/too-much-medicine

Kate Young

PhD Candidate

Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University

Blue Week: Mental Health Infographics

They say a picture is worth a thousand words, so we have included a variety of infographic that highlight important facts and statistics that society needs to be confronted with. 

Mental illness is not uncommon, it is not simple and certainly isn't something someone can just get over. Do not mistake a depressing day for depression, do not mistake anxiously waiting for exam results as anxiety, do not belittle mental health. Too often we generalise mental health as not a big deal, too often we do not see the true face of mental illness as many do not speak out about it. It is not only those that cry and fear who suffer a mental illness, but also those silent people, who hide in the shadows and seldom socialise, those who you may never see as sad but who you may never see as happy either. So please take the time to step back, re-evaluate and assess whether someone could be masking a mental illness, because early detection and treatment is key. Do not be afraid to ask people if they are ok, do not be afraid to tell a friend you are concerned about them, statistics show that so often people just need someone to talk to, someone to care.

Mental health is not just a problem we will encounter with our future patients, but also a problem that will be encountered by our peers and maybe even ourselves, so stand up for your friends, stand up for your future patients, stand up for equality in health and raise awareness for mental health. Educate yourself, educate others and fight against the stigma that has plagued mental health.

An American source, but is still relevant to our society

What is the best time of day to exercise?

This has been a subject that has been researched and debated extensively amongst exercise physiologists. There are pro and cons regardless of the time of day that you choose to exercise but the most important fact is that you choose to exercise.

The Early Risers

While it generally requires a little bit of extra commitment and preparation, that is, waking up early and not slamming the “snooze” button or having your gym bag ready to go the night before; there have been many studies that have showed significant benefits of working up a sweat first thing in the morning. This has been especially so regarding those looking for fat loss as during the night your body has consumed all the available carbohydrates or sugars and hence has to resort to burning fat to fuel the early morning workouts. It is important to note for those looking to gain muscle that working out on an empty stomach is not recommended as you ultimately compromise performance leading to lighter lifts.

Furthermore, it has been shown that those who exercise first up are more likely to maintain exercise routines in the long term as they don’t let unexpected turns in the day compromise their routine. By exercising in the morning you also prevent yourself from using the “I’m too tired” excuse at the end of the day.

Importantly, exercise raises mood, alertness and energy levels and by doing so in the morning you will ultimately have a more productive day.

The Night Owls

Exercise in the evening also fair share of benefits. For those looking to build muscle, by exercising in the evening you are ensuring that (if you diet appropriately) that your body is optimally fueled for maximal performance and hence better gains.

Evening exercise can also help limit binge eating at dinner time – a cardinal sin as excess calories at this time of day tends to be stored as fat rather than burnt off due to the close temporal proximity to sleep.

There may also be stress relief benefits by exercising after a long day. This may result in improved sleep but this has been of much debate as some studies have shown that the increased body temperature and hormone levels may in fact interfere rather than aid sleep.

So, the best time is…

Whatever works for you! There are arguments for each side but overall all that matters is that you get at least 30 minutes of exercise – the rest is very secondary.

Fact from fiction - focus on self-harm

Recipe: Pumpkin Soup

Ingredients: (serves 4)

• 1/2 a medium-sized pumpkin or 2kg (peeled and chopped)
• 2 garlic cloves (crushed)
• 20g butter
• 2 cream delight potatoes (peeled and chopped)
• 1L chicken/vegetable stock
• 2 Tbsp natural/Greek yoghurt or cream
• Pepper & herbs to taste

Method:

1. Preheat oven to 180c fan-forced. Line a tray with baking paper, place pumpkin onto paper,drizzle with oil and sprinkle with salt and pepper. Bake for 40 minutes or until golden and soft.
2. While pumpkin is baking, prepare other ingredients
3. Then melt the butter in a saucepan over medium heat and add the garlic.
4. Add potatoes and cook for 5 minutes.
5. Add the stock, bring to boil and then reduce to a simmer until potatoes are fully cooked (15 minutes)
6. Stir in the roasted pumpkin and yoghurt/cream and keep on heat for a few more minutes.
7. Allow a few minutes for the soup to cool before blending.
8. Using a blender or food processor, blend the mixture in batches, then return to saucepan over low heat. If using a stick blender, blend in the saucepan over no heat and then return to low heat.
9. Serve and sprinkle with pepper, herbs, chives etc. to taste.

Credit goes to Taste.com for this recipe. For the original recipe go to:
http://www.taste.com.au/recipes/29499/roasted+pumpkin+soup

Recipe: Sweet Chilli & Soy Fish with Asian Greens

Ingredients: - Serves 4

For the fish:

• 1/4 cup soy sauce
• 2tbs sweet chilli sauce
• 2tbs lemon juice
• 3cm piece of ginger
• 1 clove garlic
• 4 pieces of white fish (~600g)*
• 2 green onions/shallots

Veggies:

• Broccoli
• Green beans/snow peas
• Pak choy or buk choy (Chinese cabbage)
• Asparagus
• Carrot (Not green ... I know)

Serve with:

• Brown/white rice 

Method

1. Preheat oven to 200°C. Put saucepan of water on stove and cook rice per packet instruction. 
2. Finely chop ginger and garlic and place in a bowl. Add soy sauce, sweet chilli sauce and lemon juice. Mix.
3. Place each piece of fish on a separate piece of foil. Top each piece with finely chopped green onion. Spoon 2 tbs of the sauce mixture over each piece of fish.
4. Fold up foil to form parcels. Place on a baking tray and bake for 10 to 15 minutes or until cooked through.
5. While fish is cooking, prepare the veggies. Cut broccoli into large florets and carrot into sticks. Roughly chop stalks of pak choy and keep the leaves separate. 
6. Place veggies except pak choy leaves in a pot with a small amount of water.
7. Cover with lid and steam over medium heat for 3-5mins until just soft. Add leaves and cover for a further 30secs. Drain.
8. Once fish is cooked, place rice and veggies on plate and open foil. Pour liquid from foil over rice and veggies. Place fish on top of rice. 

Notes:

* Basa is a very affordable fish. It’s from Vietnam and Thailand so it always comes frozen

and you can actually buy it from the frozen section at Aldi for super cheap. If you’re looking

for something a bit more fancy go for some Blue Grenadier.

Credit goes to Taste.com for this recipe. For the original recipe go to: http://www.taste.com.au/recipes/18487/chilli+soy+fish+with+egg+noodles

Yoga

The benefits of yoga transcend the physical realm and, in a classic Hassed manner, extends to the psycho-social facets of life. As an alternative therapy, yoga has been recommended as an adjunct to treatment for many medical conditions – and, unlike many other complementary therapies, has been proven to be of benefit. The physical aspects of yoga combined with the breathing exercises and mediation result in it being almost the perfect recipe for a wholesome healthy life.

Regular yoga practice will lead to visible improvements in the below aspects of bio-psycho-social wellbeing amongst others:

• Flexibility
• Strength and muscle tone
• Balance
• Breathing
• Stress reduction
• Body awareness
• Sleep
•  Posture
• Psychological – concentration, memory, attention, mood

There are many types of yoga, each with its own unique philosophy, and as a result it is important that you do some research on the class you’re planning to attend; firstly, to know what you’re getting yourself into, but also to make sure you pick the type of yoga that suits you the best. Some of the most popular styles you are likely to come across are:

• Hatha – movement tends to be slow and gentle and hence more relaxing
• Bikram – a progression through 26 poses in a hot room, take a towel
• Vinyasa – poses flow from one to another, tends to be the most popular type
•  Kundalini – a lot of spinal and core work
• Ashtanga – aka power yoga, physically intense and probably not for a beginner

If you are signed up to a health club, most should have a yoga class that you can involve yourself with. Otherwise, there are numerous dedicated yoga studios all around Melbourne that you can either participate in classes on a casual basis or join on a fixed contract if you fall in love. If the aforementioned options don’t suit you for one reason or another, you can practice at home with the help of some excellent YouTube classes or Apple apps (Yoga Studio would be a personal recommendation – it’s full of detailed instructions and videos – all for $4.99). If you’re an absolute beginner I would highly advise you to at least start with a couple of live classes with an instructor so that your basic technique can be corrected and will decrease the chance of you causing yourself injury.

Beyond the mat, yoga is a way of life that people from all walks of life “convert” to after really connecting with the physical side of it. The philosophies surrounding yoga are ancient and deeply meaningful. If you do a quick Google search you will find endless hits on individuals who have transformed their lives through yoga and its teachings. If you really want to connect with yoga and practice on a deeper level I would highly recommend you reading “Light on Yoga” by B. K. S. Iyengar; it is a great insight to yoga off-the-mat.

Overall, the best aspect of yoga is that it is totally inclusive in the sense that anybody can do it - regardless of fitness level – and further, regardless of your fitness goals, everybody can benefit. Each pose tends to have advancing variations that you can progress through to challenge yourself as your practice improves. I can’t stress the importance of practising as regularly as possible – even if its only for 15 minutes a day – as increased frequency of practice will lead to maximal benefit.

So grab a mat, open your mind and enjoy the journey – what are you waiting for?

Namaste.

If you have any questions regarding Yoga or any other fitness topic please ask us in the comments section.

Keep YOUR Grass Greener

Check out this guide on how to "Keep YOUR Grass Greener". A resource put together by AMSA and NZMSA to help us medical students not only survive, but thrive in medical school. Definitely worth a read!

http://media.amsa.org.au/publications/keeping_your_grass_greener_2011.pdf

NB: This resource and many others can be found in the resources tab at the top of the page.

Recipe: Yellow Chicken and Vegetable Curry

Ingredients

• 600g chicken breast, cut into 3cm cubes
• 2 tablespoons yellow curry paste
• 1 onion sliced
• 270ml light coconut milk 
• 80ml water
• 150g green beans or snowpeas
• 1 capsicum, thinly sliced
• 1 zucchini, thinly sliced
• Fresh coriander, to garnish

Method:

1. Heat oil in a wok (or frying pan) and add chicken to the pan. Cook for 2 minutes on medium heat or until the chicken is golden on the outside.*
2. Add curry paste and chopped onion to the chicken. Continue to cook for another 2 minutes or until the onion is soft.
3. Add the coconut milk and water to the pan. Heat until boiling and leave to simmer for 3 minutes. 
4. Add the capsicum, zucchini, beans/snowpeas to the pan, and cook for 2 minute. 
5. Serve with rice and coriander leaves

Notes

#You can use any vegetables you may have in your fridge already. Pumpkin, sweet potato, corn, broccoli, cauliflower and carrot are all great substitutes!

*Don’t cook the chicken the whole way through at this stage, as your chicken might dry out as you continue to cook the curry.

This recipe has been adapted from ‘Yellow Chicken & Vegetable Curry’ from taste.com http://www.taste.com.au/recipes/20037/yellow+chicken+vegetable+curry

Who doesn't like an infographic?

Or check out the video version:

Do Something Near You

Do Something Near You is an initiative created by the Do Something charity to help everyday Australians get involved in volunteering and give back to their community. So, if you are looking to for something to do that's both fun and rewarding in this semester break simply type in your suburb/postcode and select from the many categories of volunteering and charity work available such as community care, health, youth, animals and environment plus much more. Remember you can never have too much of a good thing, so get as involved as you can!

To find out more about the organisation follow the link below.
http://www.dosomethingnearyou.com.au/articles/page/about-us

Check Out This App: Smiling Mind

Smiling Mind is a unique web and App-based program developed by a team of psychologists with expertise in youth and adolescent therapy, Mindfulness Meditation and web-based wellness programs. Smiling Mind is a non-for-profit, free tool that will assist in improving to the lives of young Australians by providing clarity, calmness, contentment and balance. It is available online or as a smartphone app. 

For more information see: http://smilingmind.com.au/blog/#!/category/background/what-is-smiling-mind

Recipe: Chicken, Vegie and Barley Soup

Ingredients:

• 2tbs olive oil
• 1 medium brown onion
• 2tbs tomato paste
• 1tbs fresh thyme leaves
• ¾ cup pearl barley#
• 2L vegetable stock
• 1 chicken breast fillet
• Salt and pepper
• Paprika*
• 1 medium potato
• 1 carrot
• ½ frozen peas
• ½ pkt baby spinach

Method:

1. Heat oil in a large saucepan over high heat and add sliced onion. Cook for 2-3 mins until starting to soften. 
2. Add stock, tomato paste, pearl barley and thyme. Bring to the boil, then cover and reduce heat to low-medium heat. Simmer for 30mins.
3. While soup is simmering, lie the chicken breast flat and slice horizontally into two thinner halves. Season each side with salt, pepper and paprika.
4. Heat oil in a frypan over high heat and sear the chicken on both sides for 3-4mins or until brown and cooked through.
5. Add potato and carrot to soup and simmer for further 10mins, until tender.
6. Roughly pull apart/shred chicken and add to soup with, peas and spinach.
7. Stir, cover and remove from heat.

For extra delicious-ness serve with cheesy toasted pita bread:

1. Cut pita bread in half and fill each with ¼ cup grated cheese
2. Toast in toastie machine and serve

Notes:

# We used soup mix, which has a mix of pearl barley and green and yellow split peas. It is usually easy to find – even Aldi sells it.
* Don’t worry too much about paprika if you can’t be bothered, it will still be tasty. If you’d like a slightly different flavour, sprinkle some curry powder on instead or whichever spice takes your fancy. This recipe is adapted from ‘Chicken and barley soup with cheesy flatbread’ from Taste.com for a bigger vegie fix. Find the original recipe at http://www.taste.com.au/recipes/35167/chicken+and+barley+soup+with+cheesy+flatbreads

The easiest way to get healthy – without exercise!

Getting healthy without exercise, effort or money? Surely not. Until you discover the magic of drinking water. The significant benefit of drinking water is no secret, yet the vast majority of us do not consume enough H₂O each day. Dehydration, even in its mildest form, can have detrimental effect on our metabolism and bodily functions. In fact, your body needs to be adequately hydrated to reap the rewards of a hard workout. So in case you have forgotten or been living under a rock for your whole life, I thought I would give you a quick refresher on the benefits of H₂O:

• Vital to maintain bodily functions and metabolism: our bodies are roughly 60% water and thus is goes without saying that by not replenishing these stores we are adversely impacting its function. Water is also vital to speed up metabolism and clear toxins from our system.
• Suppresses hunger: over 75% of the time when we feel the need for a quick snack or meal we are actually not hungry, rather we are dehydrated. Thus, the calories we consume during this time is surplus and going straight to our waistline or thighs. By maintaining adequate hydration we would be saving our bodies from these excess, unwanted calories.
• Helps you stay alert and maintains energy levels: dehydration commonly leads to fatigue and lethargy, and hence, by staying hydrated we can avoid these feelings – especially during exercise.
• The healthiest drink: no sugar, no preservatives and nothing artificial. As long as its not brown and you can see through the glass, it’s the best liquid for you.
• Other benefits: decreases incidence of headaches, colon cancer, urinary tract cancer and kidney stones; also improves the appearance of your skin.

How much water do you need per day?

The general recommendation seems to be roughly around 6-8 glasses per day. But this variable depending on the water content of the food you are consuming and also the level of daily activity. So what is the perfect amount? Check your urine! If your urine is a lemonade or pale-straw colour you can pat your self on the back because your body is well hydrated. If it’s a distinct yellow or yellow-green colour you should grab your bottle and head straight to the tap. (If it’s any other colour you either need your eye checked or you should see a doctor).

Tips to stay hydrated:

• Get yourself a drink bottle and take it everywhere. Sip throughout the day rather than waiting for the thirst sensation.
• Go for a glass of water first thing in the morning – yes, that is, before (or, instead of) your morning coffee.
• Drink a glass of water before and after each meal.
• If you want to make things interesting, slice up a lemon and a few strawberries, put them in the bottle and throw it in the fridge overnight to let the flavours infuse. Experiment with other fruits or vegetables – acidic ones work best.
• Green tea is a great hot substitute instead of black tea or coffee, plus you get an added dose of antioxidants.

Why doctors hide their own illness...

There is a mountain of stigma associated with mental illness, but do we in the medical profession, cop it the most?

http://www.theguardian.com/society/2014/may/16/why-doctors-hide-their-own-illnesses 

HIIT – The Latest Buzz in Fitness

What is it?

HIIT – high intensity interval training – is method of training designed to maximize the benefits of exercise in the shortest time possible making it ideal for time-restrained individuals, for example, medical students. For those of us don’t want to – or don’t have the time to – spend 60 to 90 minutes on the treadmill or lifting weights then this is ideal. All you need is 20 minutes per day to see some real results!

How does it work?

HIIT combines alternating short periods of high-intensity exercise with less-intense recovery periods.

Does the compromise in time lead to compromised results?

NO! This is the best part about HIIT. The periods of high-intensity activity leads a increased number of calories burnt and also forces your body to adapt to a superior level of exercise than a mediocre-effort 60 minute workout. HIIT also increases the “after-burn” effect where your body will continue to burn calories even after you stop exercising.

A 2011 study that was presented at the American College of Sports Medicine Annual Meeting demonstrated that 2 weeks of HIIT increased an individual’s aerobic capacity by as much as 6-8 weeks of endurance training.

Will I lose muscle mass?

NO! The short, sharp bursts of exercise combined with the rest periods ensure that the body burns carbohydrates and fat preferentially to muscle

How do I do it?

It’s simple and requires no equipment at all. You can choose any activity – running, swimming, cycling, rowing or even weight lifting – and perform that activity at 90-100% effort for no more than 1 minute and then rest for an equal amount of time – we will call that one round – and then perform as many rounds as possible. If after 20 minutes you are not exhausted, lying on the floor, you haven’t worked hard enough.

For example: jump on a treadmill, set your incline at 2.0 or above and select a speed that is a sprint for you, e.g. 16.0kph. Then sprint at that speed for 30secs and then take a 30secs rest by either stepping off the treadmill or by having an active recovery at a very low speed, e.g. 6.0kph. It is vital that your recovery is a proper recovery – you need to remember that the benefits of this training is reaped during the active phase rather than the recovery phase and by pushing yourself too hard during the recovery, you are compromising your efforts in the active phase.

If you want to make the work out harder you can increase the incline, increase your running speed or – the best way – decrease your rest time.

Just a quick warning that when you first start this sort of training it might make you feel sick or dizzy during initial sessions so its important to know your physical limits and always stay hydrated.