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013. Sometimes, What You Need is Someone to Listen

Our conversation today is with Dr. Dipo Masha. Dr. Masha is a family practice provider. In Family Practice, you’ll be surprised to learn that a large proportion of his weekly consultations involve mental health issues.

Dr. Masha shares his approach to managing mental health issues. You’ll be surprised to find out that sometimes what you need is someone to listen.

Episode Highlights with Dr. Dipo Masha:

  • The state of mental health
  • The influence of culture in mental health
  • What to look for in someone willing to listen

Show Transcript

Introduction: [00:00:00] Welcome to the Wellness Surge podcast with Dr. Adeola Oke. Each week we discuss our wellness journey with real people like you and me. We have conversations about food, fitness, mental health, financial wellness, and much more so you can get back to the real you. To make sure that you’re up to date with this and other wellness topics, visit wellnesssurge.com. Information presented here is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of the information presented here without first speaking with your primary care provider. Now let’s head on to the show.

Dr. Adeola Oke: [00:00:40] Hello, everybody. Welcome to the wellness such podcast. My name is Dr. Adeola Oke. And today I have Dr. Dipo Masha. And today we’re going to be talking about:  sometimes what you need is someone to listen to. So hello Dipo!. Say hello to everybody,

Dr. Dipo Masha: [00:00:57] Hello everybody.

Dr. Adeola Oke: [00:00:58] Alrighty. So Dr. Dipo. Masha is a family practice provider in the United Kingdom.

A large proportion of his weekly consultations involve mental health issues. Right. So as a primary care practitioner. To be able to manage the physical symptoms, he also needs to be able to manage the mental aspect of things. All right. So  I kind of introduced you right.

When you, when people come to you most of the time they come with a physical ailment, right?

Dr. Dipo Masha: [00:01:26] Yes.

Dr. Adeola Oke: [00:01:26] But sometimes the main thing is mental. So based on your experience, what is the state of mental health in the world?

Dr. Dipo Masha: [00:01:34] So I think one of the most important thing is to define health. And when you define health and you use the WHO’s (World Health Oreganization) .Which I think is one of the best definitions of health is that it’s a complete physical, social, mental wellbeing of an individual and not just the absence of infirmity.

Most people think that if you don’t have high blood pressure, you don’t have diabetes. You don’t have a malignancy, you’re healthy.  But if you don’t have a very good mental wellbeing or social wellbeing, you’re not very healthy and that can affect your physical wellbeing. One of the ways, certainly in primary care, for us to understand and completely appreciate people’s health is not just by asking them, you know, What the physical problem is, but understand what their ideas, what their concerns, and what their expectations are.

And when you ask an individual, what their ideas, concerns, and expectations are, you’ll be amazed and surprised as to the other things that they come up with. So someone telling you that “I have a headache”. It may turn out that the problem is they don’t have enough support for at home. They’ve been feeding low. They’re feeling anxious. Work is a bit overwhelming. Those things come into play from a social and mental aspect to impact on their health care. So attention headache, for example, it’s usually due to stress. And the stress may be coming from depression or anxiety. So you at mental health and physical health is certainly very much intertwined.

You asked me a question that I think I went through very long way.

Dr. Adeola Oke: [00:03:00] Okay. Because he gave us a better understanding of health. Because you’re absolutely right. People think you don’t have high blood pressure. You don’t have diabetes. I don’t want to listen to anything else again.

Dr. Dipo Masha: [00:03:11] I’m fine. Yeah. But when we talk about. You know, the state of mental health in the world. I can’t answer that. But what I can do is give anecdote stories about mental health in places that I have experienced. And so in Nigeria, in Ghana, and certainly the United Kingdom, when it comes to places like. The United Kingdom, certainly, and most countries are actually mental health is not giving us much credit.

Well, unfortunately the asset box, because any  social care is also affected, which affects mental health. If you don’t have good housing or you don’t have that recreational facility, there are a lot of people with mental health problems that depend on that. Now, you take that away. It affects mental health.

So they are good there. The pros and cons with the United Kingdom perspective, mental health, when it comes to countries like. And Ghana, Nigeria, certainly maybe a lot West Africa or African and whole, and maybe parts of the middle East mental health is certainly not as advanced as, um, places like the United Kingdom.

Um, in Nigeria, for example, you still have Victoria laws whereby committing suicide is a crime. And you wonder how that makes any sense, but. It’s the same thing in Ghana. Most of the mental health in the United Kingdom is as you said, practiced in primary care or , at a more local level. In Nigeria, Ghana it is practiced in secondary care… tertiary care.

So you have to go to a hospital to get that. And if you’re seen to be going to hospital there, you become, become persona non grata. People know you’ve gone into a mental health facility. Yeah. You’re stigmatized. So, you know, these things are there. So the mental health in the world is not one thing. It depends on culture.

Depends on where you are. From a cultural  aspect. Then you would know if you’re  from an African point of view, people don’t like talking about these things, you know, it’s like it doesn’t affect me or they don’t think it affects them until it probably does. And if it does, people shun you.You become not part of society anymore. How can you be depressed? What are you depressed about? That does not match. Your life should be better! From a religious aspect, people also say the same thing. You clearly not religious enough. That’s why you’re depressed.

Dr. Adeola Oke: [00:05:20] That’s just ignorance!

Dr. Dipo Masha: [00:05:22] Exactly! So you have that. So culture, religion, what have you can affect, the way we perceive mental health.

Um, and that is certainly changing in places. It is changing in the world, but it depends on where you live. And I think that’s one thing you have to appreciate. That’s a cultural, national ,religious, it does depend on where you are for mental health to be perceived in whatever way it’s perceived. And I think that’s the most important thing.

Know the environment you’re in before you can apply whatever it is you want to use in that environment.

Dr. Adeola Oke: [00:05:56] Absolutely. Absolutely. You were talking about in places where people are like in denial, right. About mental health issues. And it just reminded me of even just the coronavirus, right. People are like, Oh, you have the Corona virus.

Dr. Dipo Masha: [00:06:10] . Yeah, exactly.

Dr. Adeola Oke: [00:06:12] And it’s just like, people don’t even want to go to the hospital. Dont Even want to acknowledge that there’s something wrong with them and then leads to detrimental health effects. And so if you can catch it early, like the coronavirus or whatever, if you can catch it early, you may change your luck.

Right. So it just, that’s what just came to mind when he was talking about stigmas and people say, Oh, you don’t have it. I’m just like, yeah, it happens with so many other things too. People and I’m sure high blood pressure.

Dr. Dipo Masha: [00:06:42] Absolutely. People will say stuff like I can’t have high blood pressure. I am that religious or yeah.

Dr. Adeola Oke: [00:06:49] I’m just stressed out today.

Dr. Dipo Masha: [00:06:51] You know, all my blood pressure, you know, pops up today and tomorrow is fine. You know, people have different ways that they look at things and unfortunately you just have to educate them to, for them to understand you can’t just force things on people. And I think that’s the most important thing. To educate people.

Dr. Adeola Oke: [00:07:09] And that’s why I thank you for being here because the  whole purpose of this is to educate people, to reduce the burden of chronic diseases that we’re facing around the world. So thank you. Thank you. So I appreciate that. Alrighty. So we now know what health is. We now know the state of mental health, right?

So what can we do about it? Right. How can we effectively manage this?

Well from a point and I, and I appreciate it from when you come from, it’s always about trying to use wellbeing and wellness to manage things on medication maybe last. And certainly with this. Cause I bet I’m certainly much with you on, as I said, my, my conversation with you is going to be very anecdotal.

So, so it was going to be a lot of conversation about different stories I’ve experienced. Now there are different ways to manage mental health. And, and I think one of the ways, one of the things you have to know is what kind of mental health problem the individual has. So it could be depression. It could be anxiety could be substance misuse.

I mean, mental health even goes to psychosis from schizophrenia.  What have you. But I think when we talk about mental health a lot, especially in this, in this day and age, a lot of it focuses on depression and anxiety, suicidal ideation or substance misuse. Um, from a point of, um, how you manage it, you can use medication, so different sorts of medication, SSRI, TCS.

I’m sure some of your, um, viewers may not get that, but their medication. So I’ll use that totally.

A pharmacist. Okay. Believe me, I’m a pharmacist. Oh for medication when you have to. But my only thing is though, it’s like, I feel so bad because side effects, you know, because…

Dr. Dipo Masha: [00:08:48] Absolutely so I’ll get there I’ll get there.

So that’s all I’m saying, I’m with you and this particular thing, and I’ll give you stories about my approach to managing mental health. So I’ve had different people come to me or doc, I feel know what doc, I don’t know what’s going on. So you, obviously, you, you explore there. The ideas, concerns and expectations.

And the idea is: I feel low. Someone thinks I’m depressed. Okay. Well, my concern is:  well it is affecting my family and my relations. My expectations,: well I want a medication to make me feel better. Perfect. Now we know where you start from. We know where you want to end. How can I manage this?

Um, ifI would do an assessment, I think you are, you may be depressed. Okay. How depressed are you? Moderate. Mild. Severe. Okay. What do you need Ms. Becca?  Is Medication required or not? My first point of call when it comes to management. Is usually self CBT. So cognitive mirror therapy. How do you think, and how does that thinking affect how you’re going to manage yourself?

If you appreciate your depressed .Great! It means that you’re already insightful. So you, you know, you already want. Step in managing yourself. What can you do about it? When a lot of my patients, what I do is I, we write down, unfortunately, because of COVID. I don’t see a lot of people face to face, but when I did, I’ll have sticky notes on my table and I used to divide things into you, workplace, maybe family and friends.

What can you do about yourself? What can you do about work or whatever, social activities and family and friends, what can they do for you? How can you appreciate that? With you, it’ll probably be, how can I exercise more? How can I stop feeling negative about myself? Things like that.  With work. Can I take a break?

Can I take another leave? Can I take study leave? Can I get occupational health to, you know, get me some sort of therapy with family and friends? Who do I talk to? When do I talk to them? Who can support me? If I can use all the resources around me to manage myself, then I may not need medication. And I’ve had a patient with similar situations whereby this individual is able to use these things I provided for her to avoid medication.

On the opposite where I had another individual was like, I was like, let’s try this. And it was like, nah, I prefer medication. And I’m like, absolutely, that’s fine. I don’t. And I don’t, but what I do is I tell them, you see if I put you on medication, I’m always worried. And I say this that you may not get off it.

And I would prefer if you weren’t started on medication, but if you want it, that’s fine. We can look at it later and maybe avoid you. Having to be on medication for the rest of your life. And one of the doctors said that if you ever want to get a patient off medication, never take them off in the winter.

It’s just great. You just going to get back. Cause as you know, if it. Places like Scotland it’s really, really dark and went. So also that’s how you manage people. You manage them based on what they want. You manage them based on what you know. You manage them on, you know, it has to be a two way street. Bothof you have to manage it together.

If it’s a doctor centered approach? I mean like a specialty mental health, if it’s patient oriented only, it may not work because. They may put them some danger if they say only one medication and they don’t want to talk about there. So I think from a management point of view, that there’s also, um, you know, we talked about medications, so, um, electroconvulsive therapy, which I’ve seen once.

So. Another story. This was in Ghana and there was a lady. Um, and this is what I’m talking about, about how we perceive mental health. Cause there was a Muslim lady and the reason why this is important. Cause she, um, she did n’twant… she was very depressed, but she did a want to commit suicide. I E by taking a poison or killing herself directly, she decided that she was going to go on journeys whereby she thought that the route were dangerous.

So just in case something happens, she can get into an accident and potentially die. This was the way she went out to kill herself because in her mind, you know, as a Muslim, if I commit suicide, I go to hell. So that’s. She basically said, I don’t want to. Affect my religious aspect, but at the same time, I don’t want to be in this world.

So because it was so severe, she acquired electroconvulsive shock therapy because I mean, she’s very severe. You can’t, you can’t do anything. A lot of people that, you know,… your brain is a bit shocked. And the guide there is to release some, some hormones to help you feel a bit better. And this is where I talk about culture and religion affecting the way  you may act. One of the things that actually- and… this is probably an example, is that religion and culture sometimes can be protective, not from mental health problems, but from suicide. So you seem less likely to commit suicide because I’m worried that I will go to hell because I’m a Muslim. You see. So these are… this is how people perceive things. So these things, family, religion, a good working environment, these things can be very protective.

Having children. What have you can be very protective because when we speak to patient, especially suicidal patients, we ask them a question. What are your protective factors? And they’ll usually say, well, maybe my job, or maybe my children, or maybe my wife, or maybe my husband, maybe my mom, you know, what have you.

Um, so it’s very important that we explore this and just talking about suicide, I think is just important to bring up. So the Samaritans, the group that sends the helplines that help people when they feel very low, they came up with a study in 2019 saying that the, um, the most common cause of death, which is quite interesting in men under  forty five it’s suicide.

There’s a link with depression with that. And one of the problems with men. Especially at that age in any it’s just men. We don’t like talking because we don’t like talking. We keep everything in. And when you know, the canister decides to explode, it really does explode. So that was the fact that under forty fives have a higher rate of suicide amongst men is it’s telling and then women are more likely to maybe attempt suicide, but they are very unlikely to complete suicide. So these are the things that we need to know from a mental health point of view, how we protect ourselves, how we protect our family, knowing the signs, knowing the, the risk factors for, for suicide. Because the ultimate reason why we talk about mental health a lot is we’re worried that people will harm themselves, even if it’s not to commit suicide, but certainly harm themselves, and harm themselves in a- can be quite brutal way. So it’s important that we remember that.

Dr. Adeola Oke: [00:15:24] Okay. So you’ve said a lot, so thank you. Alrighty. So what I’m getting from this is this, it all depends on the severity, but a good place to start is let’s like with a qualified person, try to evaluate the different aspects of your life that could be protective or could be contributing. Is that right? Right.

Dr. Dipo Masha: [00:15:43] Yes. Aboslutely.

Dr. Adeola Oke: [00:15:44] Like work, family. What do you want from them? What can they do for me? I never thought about that. Like, man, I really appreciate that because yeah. When I actually work with patients too, bottom line is: what do you want? Are you ready to go the easy route or the longer lasting route.

Right? So you’re ready to do like the work and try to work on your diet and exercise and stuff. Or do you just want a pill? So if you want a pill. Full stop. It’s all good. It’s all good.

Dr. Dipo Masha: [00:16:13] Well, you have to, you have to remember that everybody wants the easy way. Obviously, if I can feel good by taking their pill. Then it’s great.

But I have to give you some information to let you know, as you said, side effects. I have to give information to know that. And a lot of people eventually say, you know what, maybe I can come off the pill. Maybe I can come off. Uh, maybe I don’t want to get on it. I don’t want to be addicted. You know, they use all sorts of words and you have to give them information that they need.

And I think that’s why the ideas, the concerns, the expectations is very important to know so that you guys can meet somewhere halfway quarterly. Yeah.

Dr. Adeola Oke: [00:16:47] They say thank you.  After a whil they’re like, you were so hard on me . Thank you. Like, because they finally achieved that goal. That seemed so impossible.

So yes, that’s exactly what I’m getting from here. So that’s a lot. Right. And so. In this day and age, right? Everybody…around the corner is popping up with, um, I’m a certified, this I’m a certified that. Okay. So…

Dr. Dipo Masha: [00:17:09] Yeah.

Dr. Adeola Oke: [00:17:10] What should we look for, in somebody willing to help manage your mental health?

I think, I think when you’re looking to manage your mental health, you have to look at somebody that is able to listen to you and talks less.

They need to hear you. They need to understand where you are, what you’re about. They need to be nonjudgmental. And it’s very important that someone is perceived as no judgment. So you can say I’m not judgemental, but you have to be perceived as not judgmental. So when someone tells you, you know, um, I think about, I don’t know, smoking this substance.

So I use this drug or what have you people look at them in a funny way. Or I abused this or I I’ve tried to self harm them. You have to be willing to appreciate that this individual is suffering. And I remember I had a – there’s uh, a condition of being bi- not bipolar, um, borderline personality disorder.

Now, if you’ve ever met anyone, a borderline personality disorder, they are very, very. They have a very, very chaotic life, very, very dependent on people, but they’re also very chaotic and they’re always wanting to sort of say “Ahh”. Conversating with someone with borderline personality can be quite frustrating to me…. because sometimes it doesn’t make sense too much.

So told me, we’ll see if you appreciate something about people born with borderline personality disorder, you won’t gets frustrated as you do. They’re suffering. Think of them as suffering. And if you think of them that way, your judgment of them, your irritation, your judging, all that stuff goes away because you look at them as.

Well, this is a condition they’re not, it’s not an act. Yeah, sure. They come to me every week with something. .But you think honestly, they would want to be doing this if they were well, Clearly there’s something going on. So look at them in that way. And that’s where the nonjudgmental it’s very difficult.

Even. I was doctors difficult, not to judge people. When someone walks into your consulting room, the first thing you’re doing is judging them. You’re looking at their parents. Did they look clean? Do they look well shaved? And they look well dressed. Did they smell well? Did they? You’re judging them. You’re always judging, but to be perceived as nonjudgmental as what the act is, is very difficult.

I mean, someone would say something and you react, or your eyebrow goes up. You have to, you have to challenge yourself and do that. And that’s one way people trust you by you not being judgemental. And you have to offer practical help. So saying, Oh, I’ve heard you. It’s all good. Yeah. Yeah. Fine. Okay. That’s all good.

Or I, you know, um, w I think it was a comedian that was talking about, and he was joking and he said, you know, a woman can call another woman as friend and say, well, I’m lonely. Can we hang out? And she’s like, great. Another man does. That’s another man. He’s like, no, leave me alone. I’m not hanging out with you.

That is what I mean by practical help. I’m not supposed to be why women are more likely to get support, because men don’t, you know. They’re not as emotional or intimate with each other, as women would be. And the practical help is that someone calls you out of the blue and says, you kno w, I’m struggling.

Maybe all you need to do is sit down with them. And this is from a, I mean, in France point of view, from a professional point of view, just telling somebody that and here. And because of COVID, I noticed a lot of things, yeah. Um, patients will call you when they are struggling. A lot of people are struggling. They don’t even appreciate that they can call you just to have a conversation about that. They’re struggling. Not for help, not for solution, just to say that.  Um, I had a conversation with a patient once and I think she was struggling and I said, okay. And I think she was asking about support at home and all of them. She’s like, well, it’s very difficult.

You know, my husband is working, I, you know, I’m having to be a teache at home.. This is new for a lot parents deciding to homeschool on half year. And I’m like, okay, so any support? Yeah, but it’s difficult because he’s working and, you know, and I can’t just keep asking him, like, why don’t you do this? Write a letter. Write him a whole letter, explain how you’re feeling. Sometimes when you say something, you might not be able to express yourself as well. So write a letter so he can read it. Now, maybe the first time, and don’t be, you know, don’t be very hard on him.  When you’re writing, just use it to express yourself.

So he understands how you’re struggling tips like that help people because they, as much as you mean. You may think it’s an .Easy thing to do. Just, you know, that’s, that’s quite logical. People don’t think that way because it’s a fog in their head and practical tips. It’s very, very good. Even from a medical point of view, just telling people, write a letter,  telling people go for a walk.

I don’t know, have a coffee somewhere, go outside your house, go for a run. These are practical tips, that house mental health, because if you’re stuck in your house doing absolutely nothing, sleeping, waking up, doing sleeping, or just having someone go for a walk, they may not realize if I go for a walk , I’ll feel better.

So practical tips helps. Um, and, and I think. You have to feel comfortable around the person that is giving you help or you’re talking to. If you don’t feel comfortable. Um, I mean, it’s very… so for example, people say I can’t go to religious leader with a, you know, to, to talk about this because they might judge me.

So go to a friend, go to a teacher, go to a classmate. But certainly if it’s somebody you need professional help. Go to somebody go to your doctor, go to your nurse, um, go to your social worker, go to your AA meeting if you know that something. So these are places you can seek help from from a professional point of view.

Alrighty. Well, thank you. That was very. That was thorough. I appreciate that. Okay. Alrighty. So you have said a lot today and we appreciate you. We appreciate your time. So what is one thing that you want to make sure that people take away from you today?Even if they did not even learn anything. I have learned a couple of things. So well, what do you want to make sure people learn and take away? One thing! 😀

Dr. Dipo Masha: [00:23:14] I’ll  say one thing, you’re not alone. I think that’s the one thing I would like you to take away. Um, and when I say you’re not alone, I mean, in the sense that it affects not just you, that affects a lot of people, but also you’re not alone in the fact that there are people that can help you.

So if you feel that way, that you’re not alone, you know, you’re not alone. I think you would appreciate that there are ways for you to seek out the other people in your shoes who have been able to get through this. And there are people that out there that are able to help you. I know you not being alone is.

It’s very, very important for you to know that there are people to help you and are people going through the same thing you are going through unable to survive.

Dr. Adeola Oke: [00:23:58] I absolutely love that. So listen people. You are not alone. Other people have gone through what you’re going through and there are other people that are willing and happy to help you.

All right. So thank you. That was good. You were not alone. You are not alone. I’m putting it on my wall. Adeola! You are not alone. You can totally do this. Alrighty Dipo! Well, thank you so much for coming all the way from Scotland!

Dr. Dipo Masha: [00:24:22] You are welcome! 😀

Dr. Adeola Oke: [00:24:23] Alrighty. I hope you all have a wonderful week and I’ll see you in the next show.

Take care. Bye bye!

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