The Big 5

Let's say you've decided to focus on your mental health.

Before you start anything, I recommend you take stock of these five aspects of your life:

1. Sleep
2. Diet and exercise
3. Recreational drugs and alcohol
4. Social Connectedness
5. Personal pursuits/hobbies

I call them the big 5 because they come up in all of my consultations with patients.  Often, difficulties in these areas make a significant contribution to a patient's overall suffering and symptoms.  I would go so far to say that making sure the big 5 are optimized could make equal or even more of a difference than a medication for many of my patients.  

I will elaborate a little more on each one to give you a sense of what I tell my patients as they embark on improving their mental health.

1. Sleep:  The number of hours of sleep a person needs can vary significantly.  Therefore it is not so much the number of hours slept, but if the sleep is restful and rejuvenating.  Certain points I emphasize with sleep is that the best shot at getting regular, good sleep is to wake up at the same time every morning and to avoid naps.  Keep other activities apart from sleep and sex out of the bedroom so that your body links sleep with the proper environment and will naturally feel sleepy once you are in bed.  I also recommend watching how much caffeine someone drinks and to limit this only to mornings.  These routines are known as sleep hygiene.  If you believe you have a sleep disorder, you will need your family doctor to refer you for a sleep study and to see a sleep specialist.  
2. a)  Diet: Eating healthy meals have been proven to improve mental health and reduce the risk for depression.  There is evidence available highlighting the Mediterranean and Japanese diets.  These diets are high in fish, fruits, vegetables, unprocessed grains and include smaller amounts of dairy and red meat.  It is best to avoid highly processed foods like potato chips and fast food and to also limit sugar.  

  b) Exercise is a natural antidepressant and anxiolytic.  It improves     alertness, energy levels and cognition.  Please try to exercise regularly.    Though there is evidence to say a specific amount would help most, I am   not emphasizing that here, mainly because just starting somewhere is     enough.  I would also want you to be attuned to what your own body can   handle before increasing the frequency or intensity of your workout.

3.  Limit or avoid recreational drugs and alcohol.  If drugs and alcohol are a significant part of maintaining your sense of wellbeing, this is telling you something important.  You may be unaware of healthier coping skills or you may be struggling and the drugs and alcohol are masking this.  If this is the case, please seek out addictions support.  There is a range of help available from intensive inpatient services to individual outpatient individual therapy to groups like Alcoholic or Narcotics anonymous.  In Ottawa, Ontario, the phone number for addictions services, called Service Access to Recovery (SAR) is 613-241-5202.

4.  Social Connectedness: For the most part, we are social beings and do best when we feel we are part of a community.  What I emphasize here is that it is not the quantity of social interactions that matter, but the quality.  And though I realize many interactions now are based online, I recommend a mix of interactions that include seeing someone in person.  Lately, I have had many assessments for patients who feel very alone in their experiences and who have for one reason or another isolated themselves from people.  As someone who talks to people for a living, I can tell you that you are not alone. Please seek out healthy, safe social interactions.  Avoid socials that revolve around substance use.   A therapist/psychiatrist or medication can not replace positive social interaction and community.

For those of you who do not feel you can enter into a "natural social setting" like a bar or a party, join the rest of us!  I recommend you seek out social settings with clear boundaries and that offer more structure for you to feel more comfortable.  These kinds of settings could be a group music lesson or a support group.  You could join a volunteer organization or advocacy group.  A religious or cultural community would also be a good place to start if this applies to you.

For people with mental illness specifically, here in Ottawa, we have a wonderful organization called "Psychiatric survivors of Ottawa" and they host many groups and social activities.  Their website is https://www.pso-ottawa.ca/

5.  I can not emphasize enough the importance of developing oneself, even better when done in a consistent and thoughtful way.  When you do this, you build perseverance, mastery and self-reliance, qualities necessary to become a resilient person.  More importantly, you become someone you actually find interesting and want to spend time with.  To nurture this relationship with yourself is both one of the biggest challenges, and the biggest joys to being alive.  The idea here is to pursue something, just for you, and to guard and protect this time for yourself no matter what.