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Bonus: When hormones are missed in mental health · The Dr Louise Newson Podcast

0:03
So today on my podcast, I've got 2 lovely ladies.
0:06
They're both work in mental health and they've personally
0:11
had a experience, but they've also witnessed a lot.
0:14
And once you see hormonal changes, you can't Unsee them.
0:19
And once you have knowledge, you want to share it because you
0:22
want other people to learn from other people's experiences.
0:25
And actually, that's what we do as women, isn't it?
0:27
We just share and then we make decisions ourselves.
0:31
So Jane and Diane, I just welcome you to the podcast
0:34
studio and thanks for both of you giving up your time to come
0:37
today. Thank you, Louise.
0:38
Thanks so much for having us. Yeah, I'm a mental health nurse
0:43
and I'm also 49 and experiencing this wonderful time of life and
0:48
had my own struggles with that. But more importantly, I think
0:51
it's made me recognize how the hormonal, the hormonal impact on
0:56
mental health for women when women come into our service.
1:01
And yeah, and I, I, it's something that I'm struggling
1:03
with. It's something that I struggle
1:04
to advocate for because there just isn't enough knowledge and
1:08
it's just not spoken about. Yeah, what about you, Diane?
1:12
Yeah, so I'm also a mental health nurse.
1:14
I'm a CBT therapist and I've just recently finished my
1:18
master's degree in mental health specialising and the menopause
1:22
and the efficacy of CBT for basic motor symptoms.
1:28
And like yourself and Jane, you know, I've experienced so many
1:33
women coming into mental health services being, you know, with
1:37
diagnostic overshadowing, being misdiagnosed, being put on
1:42
antipsychotics, anti anxiety medications.
1:47
And so, yeah, we've, we see it all the time.
1:51
So my kind of hope is that I can bring a standard menopause
1:57
questionnaire and to make health services at the point of
2:01
referral for any women over 45. I think it's.
2:04
Really, I think it should be any woman though, actually, because
2:07
you know, one in 30 women underage of 40 have an early
2:10
menopause and a lot of women who are young have PNDD for
2:15
menstrual disorder. So I often think there are sort
2:20
of three questions that I think every woman, but especially
2:24
mental health services should be asked.
2:27
And one of them is do you think any of your symptoms could be
2:30
due to your hormones? Because actually once you ask
2:33
the question, people start to think, but also do you have
2:37
changes in your mental health throughout your menstrual cycle,
2:40
when you're having periods? And then the other thing is,
2:44
have you ever had post Natal depression?
2:48
Because that would unmask a lot that's going on in mental health
2:53
at the minute. Because I see a lot of women who
2:55
have been under psychiatrist, they've been under mental health
2:58
teams. I do see quite extreme cases.
3:01
But I think back to my psychiatry training and a lot of
3:05
the inpatients were women. A lot of them were, you know,
3:08
40, fifties, 60s. But I wasn't taught to ask these
3:12
questions. And then, like you say, if you
3:14
have a symptom questionnaire that you give to people and you
3:17
don't have to give it to them when they're in crisis the first
3:19
day they come in. But giving it just focuses
3:23
people to think more about the role of hormones in the brain
3:27
doesn't. It absolutely.
3:29
Yeah. And I think it Diane and I have
3:33
worked together. So we both worked on the same
3:34
service. So, so I know, well, I don't
3:37
think anything has changed, but the questions are just never
3:41
asked. It's never, there's never been
3:42
any consideration. We used to suggest it and we
3:44
dine in the MDT. If somebody came in and they
3:46
were kind of mid to late 30s, early 40s and they'd never
3:49
presented before, we'd then start asking the questions
3:52
around their menstrual cycles. And I don't think it was ever
3:56
really taken seriously. Most of the women were diagnosed
4:00
with bipolar type 2, which I have to say I'd never heard of
4:03
until I worked in Scotland. And then when you, when you
4:07
actually worked with these women, because that that was our
4:09
role as, as the nurses, as the kind of community mental health
4:12
nurse and asked the questions and, and dug a little bit deeper
4:16
into their, into their life. You started to see the pattern.
4:20
So why do you think people aren't asking the questions?
4:24
Because they're not. It doesn't cost any money.
4:25
It doesn't take much time to ask those questions.
4:30
There's a lot of reasons, but I think fundamentally a lot of the
4:38
psychiatry treats are misogynistic in nature.
4:43
And and unfortunately it gets poo pooed at that level.
4:52
Unless you have, you know, people who feel really strongly,
4:56
there's no education on hormones even from, you know, childhood
5:02
up, you know, as as children, we don't get taught about hormones.
5:08
Women don't know what's happening to their bodies.
5:11
And so if if women were perhaps educated and mental health
5:16
services about it, I mean, any kind of education on this has
5:21
been self education for myself and I think for Jane as well,
5:25
because, you know, in the NHS you're not you're not taught
5:30
about the impact of hormones in your body.
5:33
But it seems so wrong because we've known for decades about
5:39
the role of hormones in our brain.
5:42
We've got evidence showing that all three hormones,
5:45
progesterone, testosterone, estadiol, have effects on mental
5:49
health, even in men. We know that testosterone can
5:53
have an effect on mental health and low testosterone can cause
5:57
depression, but it's just been ignored.
6:03
I don't know if it's easier to just to prescribe the
6:06
medications that they're used to prescribing, if it's easier, if
6:11
it's like an easier box to tick to say that somebody had
6:14
depression as an example. I mean, it's I've, I'm recently
6:20
working with a, with a, with a woman that's been in services
6:23
for a hell of a long time. And there are lots of factors
6:26
that contribute to her mental health status.
6:31
But I recently recognized that she came into service with post
6:33
Natal depression and she's now on like heavy antipsychotic,
6:39
she's on clozapine. And I just wonder what that
6:42
journey actually looked like for her.
6:44
It like I can imagine nobody asked any questions around her,
6:48
her, you know, her hormonal health around her menstrual
6:51
cycle, you know, recognize that she had post sexual depression,
6:54
what that then meant. And as a result of that, she's
6:58
now been in services for 30 years.
7:00
And I doubt very much that she'll ever get out.
7:04
So I find that incredibly distressing that we're we are
7:08
literally diagnosing these people incorrectly and ruining
7:13
their lives. Yeah, so you might have heard my
7:17
podcast for Jay and Haley, who Haley was in in and out
7:21
psychiatric hospitals for 30 years.
7:24
And when you talk to her, which is quite nice, isn't it, talk to
7:28
the patient and ask those questions.
7:32
Do you think it could be related to a hormone?
7:34
So maybe. And then I said, do you have,
7:37
did you ever have changing mood symptoms for the old menstrual
7:40
cycle? She said, oh, yeah, the days
7:42
before my period were awful. That was when I was
7:44
argumentative. I was irritable.
7:46
I just literally was terrible. And then my period would come
7:50
and I would feel so different. It was like night and day.
7:54
And then she's had three children.
7:56
So again, I asked the question, did you have postnatal
7:58
depression? Well, she did, she have
7:59
postnatal psychosis and was sectioned and that was when she
8:02
had her first ECT round. But I said to her, how did you
8:07
feel when you were pregnant? And that was the first time I
8:10
met her and she grinned from ear to ear.
8:14
She said I I just felt amazing, best I've ever felt.
8:19
Now, I think if you just asked all your inpatients who had been
8:22
pregnant before, how did you feel when you were pregnant?
8:27
And it's not because they were pregnant.
8:28
It's not because, you know, whatever.
8:30
Usually it's because they've got hormones in their body, often
8:33
for the first time. And it's often more related to
8:35
progesterone as well. And I feel just, I feel cheated
8:41
as a doctor that no one taught me for so long.
8:46
And but I feel sad because the psychiatrist still pushed back.
8:50
I spoke to someone the other day and he said I can't even talk to
8:54
this. She was a mental health.
8:55
And then she said, I can't even talk to the psychiatrist.
8:57
They wouldn't even entertain. And my pushback's always, you
9:02
know, I think I'm sure you agree.
9:05
Mental health issues are multifactorial.
9:09
It's not just one thing. So I was taught quite early on
9:14
as a doctor that means you can't change people's homes and their
9:18
circumstances as much as you'd like to, that you can't do it.
9:21
But you can change the way that they think about it and the way
9:25
maybe their future life's going to be.
9:27
And it's the same with mental health.
9:29
There's things we can help and a lot of things are associated
9:33
together that often until you balance hormones, they can't
9:37
think better and then they can't then address their alcohol and
9:40
their drugs and whatever else is going on.
9:44
And I feel like we're just letting these poor women down
9:47
more and more. Yeah, I think women are kind of
9:53
double disadvantaged because if they go to the GP, often the GP
10:00
is not educated on hormones and treatments that are available
10:06
for them. So then they come to us.
10:09
If they go straight to an outpatient psychiatrist, they
10:12
often get, as Jane said, they're diagnosed with, you know, late
10:17
onset bipolar fibromyalgia and chronic fatigue syndrome.
10:22
They get given a wacka medication.
10:25
There's still no further forward.
10:27
They're still having all these symptoms.
10:29
They think they're actually losing their mind.
10:32
And in fact, I had a lady last week who I had a, a really good
10:36
session with and she just said at the end of it, you've, you've
10:39
made me feel that I'm normal again because I just normalized
10:45
all her symptoms. And, you know, we've done a, a
10:49
really good piece of work. But unfortunately I had to kind
10:53
of educate her on what to go and say to the GP to try and get
10:57
what she needs to get. But not every woman gets that
10:59
opportunity. It's very, very difficult and a
11:04
lot of people can't advocate for themselves and they have no one
11:07
else to help them. And I also think once you've
11:11
been labeled with a mental health condition, that label
11:15
stays with you forever and it judges how people think of you.
11:20
So it's, you know, this 55 year old lady with schizophrenic
11:24
disorder, this 46 year old lady with clinical depression, and
11:28
that's it. They're locked into the system.
11:32
But the other thing is, so I actually, as I've said, it's
11:35
multifactorial. Some women absolutely need these
11:39
drugs. They need CBT, they need
11:41
hormones. There's lots of, lots of
11:43
treatments. That is really important.
11:45
The same that we do in anything in medicine, you know, we have
11:47
to look at nutrition and exercise and well-being and
11:50
mental health. It all works together.
11:52
That's just so good. Without saying really, but one
11:55
of the things about the drugs you mentioned about
11:57
antipsychotic medication is that we've known for many years that
12:02
people who take antipsychotics have an increased incidence of
12:06
raised blood pressure, metabolic syndrome, type 2 diabetes,
12:11
Alzheimer's, the way that the drugs work in the brain and body
12:14
and affect the metabolism. But we've also known for many
12:17
years that they affect our hormones.
12:20
So they give people often a chemical menopause.
12:23
So we know they reduce progesterone, estradiol and
12:26
testosterone levels. I recently contacted the Royal
12:30
College of Psychiatrists to ask them how they screen for this
12:33
because they know people have their cholesterol tested, they
12:36
know they have their blood pressure measured.
12:38
So he said, well, I can't find any guidelines, but I'm not a
12:41
psychiatrist so I'm probably missing them.
12:43
But where are the guidelines? Or can you point me to some
12:47
practical tips that you give to people about when people are on
12:52
antipsychotic screening for low hormones and I haven't had
12:57
anything back, she said. There isn't anything.
13:02
I recently have been challenging.
13:05
We have a young woman, I said young woman, she's 36, which is
13:09
obviously a young woman, but she could also be going through
13:12
perimenopause, like she's around that age.
13:15
And I've recently learned that lower levels of estrogen
13:21
increase the metabolism of the medication that she takes.
13:24
So therefore the medication is no longer effective.
13:28
So, so we have been concerned, but, and, and again, the
13:33
concerns are sporadic. It isn't, it isn't like an
13:36
ongoing psychosis. It just felt really odd to me.
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I didn't feel that she was necessarily deteriorating.
13:42
It felt that something was, was kind of changing in her that we
13:46
needed to address. And when I raised it, I, I was,
13:50
I was basically ignored. And there's a consideration
13:54
that, you know, perhaps we need to, you know, like consider
14:00
hospitalization and all kinds of things.
14:02
So I've, I've had to respond and say, you know, I've done my,
14:05
I've done some like a, I'm going to say research.
14:08
It's just, it was just Google, you just Googled it and, and
14:13
the, there are some studies that just show up immediately, you
14:16
know, and, and I, I felt really sad that we didn't know that,
14:20
that that isn't common knowledge.
14:22
That, and the medication is clozapine.
14:24
And, and there are lots of studies because lots of women
14:26
when they enter between the ages of 40 and 60, they noticed that
14:30
the effects of clozapine changed, but it didn't in men.
14:34
And then that's where they draw the do the link to kind of, and
14:37
it's lowered estrogen. But why?
14:39
Why is that not common knowledge?
14:41
But this is what surprises me because sometimes in medicine,
14:45
if I don't understand what's going on, I try and work it out
14:47
in my head and I go back to first principles.
14:50
And so we've known for a while that some of these drugs can
14:53
increase prolactin, which is another hormone.
14:55
And often people have their prolactin levels measured.
14:58
And we know that prolactin will affect the FSH, follicular
15:03
stimulating hormone, which will then reduce, which will then
15:07
switch off the ovaries, producing testosterone, estudiol
15:10
and testosterone. And a lot of these women will
15:13
have lower levels anyway, probably because that can
15:16
trigger their mental health symptoms.
15:19
And testosterone is just a blood test to measure even estradiol,
15:22
you can measure a blood test. These women are often having
15:26
blood tests anyway. And even the men actually like,
15:29
why aren't we measuring testosterone levels in men, in
15:32
these people? Because we know that when
15:35
hormones are replaced, we know mental health can improve, but
15:39
also those metabolic changes can improve.
15:41
So the type 2 diabetes, the raise blood pressure, the
15:44
Alzheimer's risk and so forth. So it it just doesn't really
15:49
seem very joined up, does it? No, and and I think from on a on
15:55
a personal level, Diane has a very similar story.
15:59
It's so as we were just talking about that, you know, our
16:02
patients often don't have anyone to advocate for them.
16:05
You know, as nurses, I think we're we're a little bit more
16:08
able to advocate for ourselves and we're happy to challenge
16:11
doctors, which people generally are great people.
16:15
People generally take the word of their doctor as as gospel.
16:18
Rich I I disagree with, but I when I was, I was 40 five and
16:23
I'd fallen, I'd gone for a run. I had fallen over and I broke
16:26
both my elbows. And that was the first time I
16:28
thought, oh, you know, mate, I'm 40-5, maybe I should consider.
16:33
And I spoke to three different doctors, all women, and they all
16:37
told me that I was far too young and they wouldn't consider with
16:40
one doctor basically suggesting I may well have ovarian cancer
16:44
due due to having kind of heavy periods which.
16:47
I you were held 45 he. Said yeah, yeah.
16:51
I quoted nice guidelines. I was told that I had to be, you
16:55
know, had I have all of these different referrals to like the
16:59
the things that I knew I didn't have for them to then come back
17:02
to me to two years later and say, Oh yeah, you were, yeah,
17:05
yeah, yeah, you're peri menopausal.
17:07
Yeah. It's such a waste of time and
17:10
money, isn't it? Yeah.
17:12
Thank you. You know, similar to Jean, you
17:16
know, I done my, my homework and, and approach the GP myself
17:21
and I had a really good experience and to do doing the
17:24
kind of research that I've been doing with us.
17:28
I've kind of had a bit of a specialist role at my own
17:32
private practice, Bot and my NHS post, and I've actually been met
17:38
with quite a lot of resistance from some GPS when all we're
17:44
trying to do is empower women to to love a bit of life.
17:50
And it's. It can be disheartening at times
17:53
because you know you're trying to work collaboratively with GP
17:57
practices to help you know, the shared care of our patients, but
18:03
often were met with resistance or what do they know you know
18:06
they're just enough that. Can.
18:08
Be disheartening, but you? See, I find I find this really
18:12
sad. So for two, well, lots of
18:14
reasons, but two main reasons. Firstly, as a doctor, I love
18:19
challenge. I love people say, why are you
18:22
doing this? What's this?
18:23
Why is the evidence? I think it's great.
18:26
I love working with nurses. I love like other healthcare
18:29
professionals to have a debate because you see different
18:32
things, you're trained in a different way.
18:35
And I find it really disrespectful.
18:37
It really triggers me when I hear that you're only a nurse.
18:40
How do you talk to a doctor? Because that is just wrong in so
18:43
many levels. And then the other thing is
18:48
like, it feels that it's like, even if hormones only made you
18:54
feel a little bit happier, and we know it, they do a lot more
18:57
than that. Why are people so worried about
19:00
people feeling happier? Someone was interviewing me this
19:04
morning about testosterone and it was a journalist and he said
19:09
something about when I hear you prescribe a lot of testosterone
19:13
and I hear that you'll say it can help people feel better.
19:17
And I said, well, yes, but I also do symptom questionnaire.
19:20
We ask about libido. They have reduced libido, so we
19:23
prescribe it for that. But, but hang on, I said to him,
19:29
does it matter if women are feeling a bit better on
19:32
testosterone? Because actually lots of people
19:35
have prescribed antidepressants to feel a bit better and there's
19:39
far more risks of antidepressants than there is
19:43
with testosterone. So again, it goes back to my
19:47
thing that it's just allowing people a choice.
19:50
You know, if you both had low testosterone and you had
19:54
symptoms of testosterone deficiency and low mood, reduced
19:57
motivation, poor energy, muscle joint pains, reduced libido,
20:02
sure, you could be depressed with all those symptoms.
20:05
But most women say, I know I'm not depressed.
20:08
And then if you say that but I really want to try citalopram.
20:12
And I really don't want testosterone, despite my
20:15
testosterone level being 0 point nothing or whatever.
20:18
I would say, well, let's talk it through.
20:22
But somehow if you came and said, Oh my, you know,
20:25
everything's low and my testosterone is low and I've got
20:27
all these symptoms, I'd like to try testosterone.
20:29
You're treated like an imposter as a woman.
20:32
It's really weird. And that is another that's
20:35
that's another side to it. Is that because, because not
20:39
every Ave. is being explored because women are are not being
20:43
taken seriously when they're discussing their hormones or
20:46
their menstrual cycle. Young girls, especially young
20:48
girls have it have it really tough when they're, you know,
20:51
just just starting on their cycle and, and growing into
20:54
young women and dealing with life and going through schooling
20:57
and, you know, wondering what the future holds.
21:00
And then they're just labeled with a personality disorder if
21:02
they, if they decide to act, you know, in a way that that doesn't
21:06
fit, you know, not the normal criteria of young girls, but,
21:11
but having a conversation with someone who is listening to what
21:14
you're saying, who's trying to look at what, what might be
21:18
impacting your presentation. And then you get to choose.
21:22
It's informed consent. It's exactly that.
21:25
Do I want to try the hormone? Do I want to try the
21:27
antidepressant? Do I want to change my diet?
21:29
Do I want to reduce my stress? Do I want to do them all?
21:32
It's informed consent, which is what we should be working on.
21:36
Absolutely. And as healthcare professionals,
21:38
I feel our job is to help advocate for patients in the way
21:42
that they want. You know, I'm never going to
21:44
judge someone because they smoke.
21:48
I still treat them exactly the same way.
21:50
If they smoked or didn't smoke, I might add into the
21:52
conversation, it's probably not the healthiest habit, but I'm
21:55
not going to judge them. And it's the same if they didn't
21:58
want hormones. I'm not judging them if they
22:00
didn't. You know, it's, it's a choice
22:02
thing, but that choice has been taken away.
22:05
And, you know, somebody reached out to me last week on social
22:09
media and their daughter has gone to a psychiatric hospital.
22:14
She's in her 40s and they're convinced it's related to her
22:17
hormones. The family are, and she's got
22:20
psychosis, she's having heavy duty drugs and she's going to
22:24
have some ECT. And I said, could I speak to the
22:27
psychiatrist? They said no, they, I can't talk
22:29
to them about hormones. They're not interested at all.
22:33
So she's being transferred to another Hospital in London and
22:36
she must be quite severe. I'm not sure.
22:39
And they said we're really hoping that the new psychiatrist
22:43
might entertain a conversation. And it's really harrowing in my
22:48
mind, Like, it's not the Victorian times.
22:52
We don't have to give people chemical straight jackets for
22:54
everything. Of course, I'm not saying that
22:58
these drugs aren't important, but I am saying why are we so
23:02
resistant to thinking about hormones as well?
23:09
Yeah, I think from my experience, that whole, you
23:14
know, talking about it is the only place to start because like
23:19
Jane said, when we run the MDTS or when we have been, it's, it's
23:24
been kind of dismissed. But we won't stop challenging.
23:28
We'll continue to challenge. And the more we speak about it
23:31
and the more we put it out there, the more women will feel
23:34
empowered. I think it's about that.
23:35
It's about sharing and building and and continuing to challenge.
23:40
It's so wonderful that you said that because it's so true and
23:43
it's it's sharing so that actually relatives and partners
23:47
like with Jay and Hayley, it was Jay's 25, who's the 25 year old
23:51
son of Hayley. He's her biggest advocate and he
23:54
reached out to me. But that's what we need to do.
23:58
We need to recognize it and not be ashamed that we've missed it
24:01
in the past. Because I wonder, you know, I
24:04
think when I see the behaviours of some people and I think it's
24:07
because they feel embarrassed. And then when you, you know, I
24:12
know that when my children were younger, if they did something
24:14
wrong, they get crossed because they're crossed with themselves
24:18
that they've been found out. But that's just life.
24:22
Like we change and we should be saying as mental health nurses,
24:27
doctors, psychiatrists, you know, we should be saying, look,
24:31
guys, we've not thought about this before, let's embrace it.
24:34
Let's think about it. We're not saying it's replacing
24:37
all these other drugs, but we just need to think in the same
24:40
way. You know, we used to think that
24:43
the world was fat, and it's not. Yeah.
24:48
And I, I really feel for because I've worked on AI, worked on a
24:52
team before and this was many years before far really started
24:57
to think about hormones. And we had a woman and she, she
25:02
was 60. And you know, I do admit to
25:06
thinking that she was like kind of older and maybe it wasn't
25:10
necessary to consider it. But then as I started working
25:12
with her, she'd literally she, she had a really good job.
25:15
She really happy, happy family life.
25:18
And then it was kind of around the time she retired, she kind
25:22
of went in sunk into some deep depression and she just wouldn't
25:25
get get out of the bed. And that was her life.
25:28
And so she was tried on all different sorts of medications
25:31
that didn't work. And when I mentioned that, you
25:34
know, could we consider that it might be hormonal, again, it was
25:38
ignored. And the saddest thing for me was
25:40
that people were willing to just let this woman lay in her bed
25:45
every single day at 60 years old.
25:47
I did actually again, do some of my own research and spoke to her
25:52
husband and said, you know, I've tried to get this through our
25:55
team, but it's not working. And I referred him to, to kind
25:59
of a menopause specialist, which he said that he went, he went
26:02
and spoke with them and they did start on HRT.
26:04
And I don't know what happened because I left that role, but I
26:08
was just so, so angry really that somebody was happy to say,
26:12
well, there's nothing more we can do.
26:13
And that's that rather than, you know, I'd given other other
26:16
areas that we could explore and it just just didn't want to
26:19
happen. It's, I always find as a
26:22
clinician that I'm always giving choices to my patients.
26:27
So, you know, I don't give up very easily.
26:30
So if this doesn't work, we can try this.
26:32
If this works, we might carry on with it.
26:34
If it doesn't, then there's this or this or I can ask someone
26:37
else. I can, you know, because there's
26:39
a reason why something happens and just because I don't know
26:42
the reason, other people might. And I'm always keen to learn and
26:46
explore. And you know, it's just we've
26:49
got so much more to go, but I think the momentum is changing.
26:53
I think people are learning in different ways.
26:57
And I think us just doing this podcast is going to help a lot
27:01
of people. So very grateful that you both
27:04
came and reached out to me. And so before we end this, I
27:10
always ask for three take him tips, but I can't divide.
27:12
So I'm going to have to ask for two weeks.
27:15
So, so two things each so that you think we should do to make
27:22
these changes as in thinking about mental health and hormones
27:27
more what three things or four things, sorry, do you think
27:32
should happen quickly to reduce the suffering for some of these
27:36
women? So go with you first, Diane.
27:40
For, for, for me, standardized questionnaires as part of the
27:45
process, we do a genetic screening for people have the
27:49
questionnaire. It doesn't take any more time
27:52
and you're going to get so much more information, education for
28:00
GPS. That's that's my two things.
28:03
Very good. Very good.
28:05
Thank you. What about you, Jane?
28:07
I think education for nurses to be able to challenge doctors and
28:14
I think I think that's it. Just just just to continue to
28:17
challenge. If you if you are a nurse or, or
28:19
a patient and you don't feel that what is being said or the
28:24
treatment that's being given isn't correct, can just
28:26
challenge, just continue. Don't accept if it's if you're
28:30
not happy with the with the response.
28:33
Yeah, I think it's so important. It's a difficult thing to
28:36
challenge healthcare professionals, but sometimes we
28:39
have to all get a second opinion.
28:41
It's not always easy, especially if you're in a psychiatric
28:45
hospital. You can't just go to another
28:47
place, but just ask, keep asking and feel listened to and valued.
28:52
So thank you again so much for your time.
28:55
This has been a really interesting podcast.