As the primary conveners of the kidney community throughout the Pacific Northwest, the Northwest Kidney Council hosts a series of “Council Conversations” with our partners from Oregon and Washington that provide an opportunity to discuss the latest updates from our various organizations and hear from guest speakers.
Last week, the Northwest Kidney Council was pleased to host Dr. Felicia Speed, Vice President of Social Work Services for Fresenius Medical Care North America, and Lisa Hall (MSSW, LISCW), Patient Services Director for ESRD Network 16. Lisa brings extensive experience in patient services and an in-depth understanding of the needs and concerns of those affected by kidney disease. Dr. Speed has made significant contributions to enhancing holistic care provided to kidney patients.
Through their collective experiences we had an enlightening discussion and walked away with valuable knowledge and strategies to improve the mental well-being of individuals living with kidney disease.
Here is what they had to say. You can watch the full recording below.
What are some of the most common mental health challenges that are faced by kidney patients and how might they be addressed?
Dr. Felicia Speed – “I truly believe that living with chronic kidney disease can take a toll on a patient's mental and emotional health. The stress of medication burden, the strict dietary regiment, the treatment modality, whether it's hemodialysis or home dialysis. It really can just be extremely overwhelming. What I've seen the most of, that's most prominent, is depression.”
Lisa Hall – “I agree, mood disorders are the most common concerns... A recent study actually found, as a quality-of-life study, that 48 percent of patients on the study and on hemodialysis, with just hemodialysis patients, had high anxiety levels.”
What role do mental health professionals play in kidney treatment and how can the rest of the kidney care team work with them?
Lisa Hall – “Though each facility has a qualified social worker on site, caseloads and job burden limit the time that they are able to spend with each patient. They have to select patients that they might be able to help. They may be patients that are missing a lot of treatments or that want a transplant but there is interpersonal or emotional barriers to that.”
Dr. Felicia Speed – “Also, we don't have opportunities for our patients who may need inpatient treatment, a mental health treatment, because oftentimes psych hospitals don't [have space]. I know in the areas that I'm from, they don't take patients who are on dialysis, as for those patients who also don't have access to that in‑patient psych support that they actually could need. I think there's opportunity there.”
What tools or resources are available for kidney patients and their families to recognize some of these mental health signs before they enter a clinic? And do you have any tips for how patients can talk to their providers about mental health issues?
Lisa Hall – “When it comes to depression, there's a tool from Alliant Quality Improvement organizations called the "Zone Tool." You can just google Zone Tool. It's wonderful, it's got green, yellow, and red. You can see where you are. It has a description of each one of those. If you're in the red zone, then you're getting towards some of the crisis interventions stuff.”
Dr. Felicia Speed – “For our patient population, they really need the peer support. The more we encourage peer support and encouraging our patients to tap into that resource, the more we can begin to really create a network that could actually decrease their risk of mortality and hospitalization.”
Is there research being done to better understand the relationship between mental health and your kidney health? Are there implications for future treatment?
Dr. Felicia Speed – “It is time for us to dig a little deeper into the interventions. We've established, yes, they're experiencing these mood disorders. Now we need to take it a little bit further and create the toolkits. Create more of the tool boxes for our practitioners to be able to have those things to use.”
Lisa Hall – “Finding therapists who accept Medicare assignment is very challenging. I'm hoping some of the funding that's coming out of the NIH to the state is going to help to increase primary care offices integrating behavioral health into their practices.”
COVID hit the kidney community especially hard. We know that we have new kidney patients who have kidney disease because of COVID, and we are still trying to understand the effects of long COVID. Do you have any insight to share about the link between COVID, kidney disease and perhaps mental health?
Lisa Hall – “One of the problems that bubbled up during the pandemic that was a crisis before, but now it's full‑blown crisis, there's crisis down to the care in some states including in Oregon, is the staffing problem...”
Dr. Felicia Speed – “Even though it seems as though everybody else has moved on and COVID is over for them, we still feel like we're in the thick of it. We have not came up from this, we're still very impacted by COVID.”
If a patient came to either of you right now and said, "I'm experiencing this mental health problem." Where would you point them? What's their next step? Any practical advice?
Lisa Hall – “Talk to someone. But something I didn't mention, especially for patients that are therapy resistant, that everyone can do to feel better is changes in lifestyle to give yourself some more control, like considering a home modality, exercise, sleep, stress management, socialization.”
Dr. Felicia Speed – “All the things that Lisa mentioned, should always stay on the forefront. I think that that should be a part of the culture within our facilities, with our patients and with our staff. For the families, it's important that we encourage the families of those patients while they may not be ready to go into therapy, being there and listening… I always tell people, listen with the intent to understand, and not listening with the intent to reply. Encouraging people to take care of themselves, filling their own cup first and nourishing others with the overflow, that is so needed right now. Then still looking for things to be grateful for.”