Chloe: Welcome to the BH WELL video blog I'm Chloe Robertson, your host. BH WELL stands for Behavioral Health Wellness Environments for Living and Learning. Today on the vlog we're excited to spotlight Dr. Zim Okoli who is a part of the BH WELL faculty team. Hi, Dr. Okoli.

Dr. Okoli: Hi, Chloe. How are you? 

Chloe: Good, how are you?

Dr. Okoli: Well, thank you. 

Chloe: Could you please tell me a little bit about you and your research interests? 

Dr. Okoli: Well, that's a good question, I have a lot of research interests but I'm a psychiatric nurse. I have most of my experience in nursing working with people with severe and persistent mental illnesses. So a lot of my research is about understanding factors that affect their health and well-being and finding ways to develop programs that can help them in their process of recovery. 

Chloe: That's very neat. Why are you passionate about this area? 

Dr. Okoli: Well, you know, mental illness is one of those things which a person doesn't ask for and we don't have as many resources in terms of funding or even a lot of evidence in how to help individuals living with mental illnesses. So I’m really passionate about this through my experience working in an inpatient hospital setting and observing people with mental illnesses just struggling to go through getting stabilized after a crisis and then after their stabilized they go back into community they go back into a lot of situations that may have perpetuated or caused their mental illnesses and they come back to the hospital. So just trying to shut that revolving door to find ways that we can help them not just get stabilized but maintain their lifestyle under quality of life and also achieve recovery. 

Chloe: What do you want the public to know about your research? 

Dr. Okoli: Our research is multi-dimensional, multi-faceted. It goes anywhere from health policy to very specific program planning program development. And our research is just really to find out ways to help individuals to stay well, particularly their behavior, and their mental wellness. It's an exciting journey to be on, learning not just from our expertise and our training, but also hearing from people living with mental illnesses, care providers who care for these individuals, and finding ways to create innovative and creative research processes they can ensure wellness in these populations. 

Chloe: What is the most challenging part of your job? 

Dr. Okoli: I think the most challenging part of our job is having a balance between doing good science, using what we know works the methods that we know can help us inform evidence, but also making sure that our work is relevant. I may have some ideas of what I think are important but if it's not coming from the people who need our services then I may be doing research that is really not relevant. So I think the hardest or the most challenging part of our work is making sure what we're doing remains relevant. 

Chloe: What is the most helpful advice that you've received?

Dr. Okoli: The most helpful advice I've received is we have a lot of passions and people always vie to get you with their passion, but you have to stick to what makes you passionate that advice was given when I was a doctoral student and I was trying to figure out the research topic to do but a mentor just told me you have to do what you're passionate about because that will sustain your research career. 

Chloe: Who or what has influenced you most in your work? 

Dr. Okoli: I have a lot of influences but the person I think he's influenced me the most is Dr. Ellen Hahn. She's a professor at the UK College of Nursing and she was my mentor. She taught me everything I know about research and health policy. I cannot speak enough about her. But what inspires me about her is her ability to continue doing really good research that has impacted so many people. Her research is about health policy, mostly about tobacco use. She was very instrumental in bringing a smoke free or tobacco free law into Lexington and that has had tremendous impact in the quality of life of people. 

Chloe: Well, thank you Dr. Okoli for sharing why you're passionate about your research. 

Dr. Okoli: Thank you Chloe. 

Dr. Okoli states that people are not born impoverished but born into societies where there is inequitable distributions of wealth. Many of these situations are modifiable with the addition of tailored policies to specific needs in order to eliminate these issues.

Obesity is of great concern for those with mental health issues. Many medicines cause weight gain. Part of the treatment plan needs to include good nutrition education, adequate exercise, and enough sleep.

Some medication side effects can cause heart problems, creating a need for other prescriptions to counteract those risks. It is important to advise patients to eat heart-healthy, low-cholesterol foods to maintain heart health.

Substance use such as alcohol and drugs can affect those with mental illness. The substance may mimic mental illness making the illness difficult to diagnose. Or people experiencing new mental health problems may try to self-medicate to help manage the illness, often making it worse.

A lack of access to resources such as no transportation or no healthcare providers in the area can cause significant problems to those with mental health issues. Telehealth and mailing medications has helped combat this. 

Welcome to the BH WELL video blog. I’m Chloe Robertson, your host. BH WELL stands for Behavioral Health Wellness Environments for Living and Learning. Today on the vlog we have with us Dr. Okoli to talk about the 6 modifiable risk factors for people with mental health and substance use disorders as identified by the Substance Abuse and Mental Health Services Administration also known as SAMHSA. 

Poverty, Social Isolation, and Trauma

Can you first tell us why poverty, social isolation, and trauma is considered a modifiable risk factor? 

Some people might consider poverty a situation you are born into or social isolation is linked to location. So I don't think anybody is born poor. I think we are born into situations, governments, policy, or societies where there might be inequitable distribution of wealth. So if we call that poverty, then you could call that poverty. But I think a lot of issues related to poverty, social isolation, trauma, things like that are modifiable because they are things that can be changed if we put in good policy's understanding peoples specific situations, tailoring policy so that we can take away things that may cause unintended consequences, I think we can eliminate a lot of these issues. 

Obesity

Why is obesity of particular concern for individuals living with mental health issues? 

Obesity is a multifaceted problem which means there are several things that can cause obesity. One aspect of obesity is some of the medications that individuals take when they have mental illnesses which can cause weight gain it can cause certain things that can eventually lead to obesity. Another aspect is certain people living with mental illnesses don't have resources or the ability to exercise regularly. Their nutrition may not be as adequate as it could be, so these factors can also lead to obesity. So when we're treating people with mental illnesses part of our plan is to make sure that they have a lot of aspects beyond medications that can really help them to live a balanced, a well life, which could include things like good nutrition, education, adequate exercise, and making sure they get enough sleep. 

Medication Side Effects

Medication side effects are of particular concern for this population, especially cardiovascular disease, please share a bit about why this is true.

So people with mental illnesses may take medications for their mental illness that have side effects that can cause heart problems. Sometimes they have to take other medications to combat those side effects or we have to be careful to make sure that they don't have a history of heart problems in order to prescribe the right medications to them. So it is a complex issue but I think one way that we address it is to make sure that we advise our patients in eating heart healthy foods; You know, things with low cholesterol, low sugars, and just having adequate proper nutrition, eating the vegetables that are really good for the heart and things like that. So on the one hand medications can cause some of the heart side effects but if we can balance it with proper nutrition proper exercise we can combat some of these side effects. 

Substance Use

How does other substance use, alcohol, and drugs increase risk? 

So other substance use, alcohol, and drugs can affect individuals with mental illnesses in two ways, I would say. The first way is they may mimic symptoms of the mental illness which makes diagnosing them complicated. For example, if somebody is using some hallucinogenic drug, it may come out that they may have psychosis, but actually it's more of the drug induced psychosis. So we need to be able to help individuals stop the use of these drugs in order to enhance their mental health treatment. On the flip side a lot of people begin to use drugs who have mental illnesses because they're sort of self-medicating their problem. They know that they're uncomfortable emotionally and before they receive a diagnosis they may try several substances in order to see if they can manage the symptoms they are expressing. The good news is that we now have a lot of medication options that we know can help manage those symptoms. Part of the treatment plan when we we're working with individuals living with mental illnesses who have a substance use problem, we really help them to stop using the substances so that it can improve our ability to make a proper plan that can help them in their recovery and to stay well. 

Poor Access to Help

How does lack of access to quality healthcare affect individuals living with mental health and substance use disorders? 

Recently, I've been traveling through Kentucky. And you know Kentucky has a largely rural population. One of the challenges we've heard over and over is access to medical and mental health care access in terms of even having transportation or access in terms of having health care providers available. So access is a huge issue in terms of getting people the necessary treatments that we know work. And on the other hand, it's not just getting the treatments to the people, but also helping the people get to the treatments. So some modalities that are new and kind of innovative are using things like Telehealth, Telemedicine, and sometimes we can even mail medications to patients. So there are new opportunities in order to combat the issues surrounding access to health. 

SAMHSA

Do you have any final comments concerning SAMSHA? 

I think SAMHSA has done a really good job in promoting the need for taking care of substance use and mental health issues. They have a lot of evidence-based resources that help us in our practice and can guide our research. I'm glad to recommend anybody to go to SAMHSA to have a lot of the resources we need when taking care of people with mental illnesses, understanding mental illness and substance use disorders, and helping people live a life that enhances their recovery. 

Thank you Dr. Okoli for that thought-provoking insight. Interested in learning more? Check out our website at https://www.uky.edu/bhwell/. Thanks for tuning into the BH WELL vlog where behavioral health is our priority. See you next time.