More open talk about mental health disorders is long overdue, according to one local doctor.

Dr. Rachel Fiori, psychiatrist at Mercy Behavioral Health in Fort Smith, says the silence that often surrounds problems such as depression and anxiety has helped create a stigma about the issue.

"We don't have honest conversations about psychiatric illness, and yet, they're so common," Dr. Fiori said.

People may have difficulty finding help because they're uneasy about beginning the conversation with a primary care physician who may not be trained to deal with mental health issues. Dr. Fiori said she's had patients who felt stigmatized by some doctors or in emergency rooms because those people are not trained to assist with mental health disorders.

"I'm not saying those doctors are doing anything wrong, but the way a patient hears, 'I'm not an expert in mental health,' they think, 'OK, so who am I supposed to talk to about it?'" she said. "I think part of what drives the stigma is, there's just not the training out there in terms of people who are skilled to treat and identify mental illness, even among physicians and nurses."

Dr. Fiori said anxiety disorders are one of the most common psychiatric disorders; about 18 percent of the population will experience one in their lifetime. Signs of the disorder include a change in how someone functions in their everyday life and can include things like not wanting to leave their house. That's the point when a patient should begin speaking with his or her doctor or a counselor to discuss whether the stress being experienced is more of an anxiety disorder.

One thing a person can do on their own is watch for behavior changes — not just changes in mood. Family members also can be helpful in detecting the types of changes that are good indicators that a person may have a mental health issue, Dr. Fiori said.

"I think it's easier for families to comment on ... 'I've noticed you haven't been to church in three weeks,' or 'I've noticed you haven't brought the kids over to swim in several days; I've noticed it takes a lot longer to get a response from you when I text you,'" Dr. Fiori said. "Look for changes in behavior — withdrawing from friends and family, having trouble with work performance, getting to work on time, or you have a certain accuracy goal and you're not meeting it anymore, but previously you had no trouble with that."

Recent celebrity suicides — including designer Kate Spade and chef Anthony Bourdain — could have a negative impact on someone battling depression, anxiety or other mental disorder.

"When we talk about people who have it all, the first thing I remind people is that mental illness doesn't discriminate," Dr. Fiori said. "You can get severe depression, bipolar disorder, anxiety whether you are a well-loved, well-known celebrity ... or someone who's never had much of anything. I think it causes us to question more because we think, 'Gosh, if someone has all that and commits suicide, and I've got nothing, then what hope do I have?"

We don't always know what a person's home life or social connections are like, Dr. Fiori said, but it costs very little to find support, whether through talking with neighbors, finding a support group or attending church. Faith has proven to be a great avenue for many of Dr. Fiori's patients, but it can also be something like a bowling club or other group that provides those needed social connections.

Healthy habits

Dr. Fiori advocates a healthy daily routine for mental wellness that includes a balanced diet, proper rest and "exercise, exercise, exercise, exercise."

"We can't overstate the benefits of it — exercise is really important," she said. "The benefits are huge for depression or anxiety disorders."

For someone experiencing stress or anxiety, Dr. Fiori says it's important to continue an exercise routine rather than stopping it.

"Get that (stress) out. Work through it in a healthy way. ... Going for a walk once a week — even if it's once a week, it's more than you did last week," she said.

But setting reasonable expectations for yourself is key, Dr. Fiori said.

"We often have this idea that ... 'I need to excercise, so I'm going to be in a gym five days a week,'" she said. "Well, that's great, but maybe you work up to that, though, because if you set that as your initial goal, you're probably not going to do it the first week. You're going to do it the first two weeks, and then life is going to happen, you're going to miss it, and you're going to get discouraged, then you're going to feel stressed because you weren't doing the thing you were supposed to do to make you feel less stressed."

She also advocates for avoiding alcohol and other substances of abuse that could create a pattern of addiction. Maintaining connections with friends and family, especially during times of stress or depression, are essential, Dr. Fiori added.

"I don't mean — you're sad, so you should throw a dinner party for all your friends," she said. "(Instead), if you're invited somewhere, try to go, and try to do things that relax you, such as going to church. Those connections will help you handle the stress. Probably when we need those people most is when we're stressed."

Stress

People need a certain amount of stress in their lives to function; it's when that stress level becomes too much that people begin to experience problems.

"There's a healthy amount of stress," Dr. Fiori said. "What happens is, sometimes our stress levels, because of our environment, exceeds what we're able to handle.

"We all need a certain amount of stress or anxiety to function, so there is kind of an ideal amount of stress that we need to have. For instance, a high school student getting ready to take the ACT needs to be stressed enough about it that they take it seriously, prepare for it, get up on time, they get there on time, they have what they need. If they weren't stressed at all, that wouldn't be a good sign."

She gave the example of the sudden, tragic death of a loved one as being something people are not naturally set to cope with.

"It's kind of those unexpected, out-of-the-blue stressors or anything too extreme that you weren't expecting to deal with," she said. "Those things can certainly overwhelm our ability to handle stress."

However, not everyone who experiences stress has a mental disorder.

"For many of us, because stress is a normal part of our lives, there are ways that we can deal with it without turning to medication," Dr. Fiori said. "So, for many of us who have stress or are feeling stressed out or anxious, we don't necessarily have an anxiety disorder."

Anxiety disorders can affect how people deal with stress as well, Dr. Fiori said. People with anxiety disorders can get overwhelmed by certain stressors in their lives. It doesn't take as much to overwhelm your system as it used to, she said.

Social media

Dr. Fiori doesn't blame social media for a rise in suicide rates among younger people, but she feels being so connected to what others are doing can have a negative impact on someone's mental wellness.

"I do think it creates this amount of pressure," Dr. Fiori said. "This ability for them to be constantly connected to one another, and yet disconnected (at the same time), it creates this stress and pressure. I don't think that's directly responsibility for the increase in suicides, but it can create some unhealthy patterns in terms of comparing oneself to others always, always, always."

Social media can enhance our connections to people but shouldn't replace those connections, she said.

"We're always in this battle to compare ourselves," Dr. Fiori said. "We're not just having these nice conversations with one another in person. Yes, you can have a million friends and can work all these hours and then go home and do what you need to do at home, and never see one of your friends face-to-face."

All age groups can feel that impact as well — the need to measure up to friends and family. And, as Dr. Fiori says, mental health disorders don't discriminate.

"Certainly, in my practice, I see (mental disorders) cut across all age groups," Dr. Fiori said. "Some anxiety disorders will present differently or hit at different age. But in terms of stress, it can hit at all ages — it just might be different stressors. The things that are stressing a 20-year-old college student are going to be different than things that are stressing maybe someone in their 60s who is dealing with end-of-life issues with a parent. Those stressors are going to be there, they're just going to be different."