Roger Rivera Of Mente Suave Psychiatry & Medicine On The Benefits of Using a Family Approach for Treating Bipolar Disorder
An Interview with Stephanie Greer
Educating on treatment options and ensuring that treatment decisions are made in partnership with healthcare providers, patients, and the broader supper system can help patients do well long term.
Bipolar Disorder, a condition that affects millions around the world, not only impacts the individual diagnosed but also their surrounding family. It’s becoming increasingly clear that the journey towards mental wellness is not solely an individual pursuit but a collective one. Incorporating family perspectives and integrating a family approach in treatment methodologies can be pivotal in achieving holistic healing and stability. As a part of this interview series, I had the pleasure of interviewing Roger Rivera.
Roger Rivera, DNP, is a board-certified family nurse practitioner (FNP), psychiatric–mental health nurse practitioner (PMHNP) and Trauma Surgery First Assist. His areas of expertise include psychiatry, critical care, emergency medicine, and trauma surgery. He holds a Nurse Educator Certification from the University of Florida and completed his MSN training as a Family Nurse Practitioner at the University of Puerto Rico. He is enthused with teaching the art and science of integrative psychiatric care, and practicing Brazilian jiu jitsu in his free time.
Thank you so much for joining us in this interview series! Before we start, our readers would love to “get to know you” a bit better. Can you tell us a bit about your background and your childhood backstory?
When I was younger, I was a part of a group home, then ended up joining the Marine Corps at the age of 17. When I joined the infantry, I felt a desire to help people, which eventually led to my career and a private practice in psychiatry. Long story short, my backstory has the basis of a difficult upbringing, which made me want to help others out.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My favorite “Life Lesson Quote” is, “Fight for the things that you care about, but do it in a way that will lead others to join you,” by Ruth Bader Ginsburg. My experience in the Marine Corps did a good job of making us into leaders and incubating us into civilians. Now being in the mental health space, I think it’s important to practice what I preach and be an example to my patients and colleagues as well as continue teaching and giving back to the community.
Let’s now shift to the main part of our discussion. Can you tell us a bit about your background and your professional career treating patients with bipolar disorder diagnoses?
When I was working in trauma surgery, I saw the needs of those that had psychiatric conditions and what happens when they go untreated. Some of the worst cases I saw went untreated, and in a community setting, I can’t tell you how many people I see where traits of a possible mental health condition, such as bipolar 1, are already there.
When you work with patients, I understand that you often integrate family or friends into the treatment process. What do you consider the 3 primary benefits of including family?
Three primary benefits of including family in a patient’s bipolar 1 diagnosis and treatment journey include:
1. Reducing stigma or the misconception of the diagnosis, which come from offering empathy and support.
2. Helping support a patient in taking their medication as prescribed, as family members can better understand the importance of the medication.
3. Collaborative care, meaning, if a family member is involved in early detection of the diagnosis, then they are able to prompt intervention and prevent other negative things from happening.
What are some of the challenges you run into when working with families? How do you balance responding to the needs of the family with the needs of the patient?
There is sometimes a lack of awareness and stigma within families. I have seen–often in the Latin community–a lot of patients who say they can’t tell their family they are getting help or that they will call them “crazy.” Another issue is conflict and dysfunction in the household. This includes stigma, and other family members having mental health conditions that never got treated. I have seen privacy concerns, as they may feel uncomfortable sharing information about their diagnosis with their family, or families experiencing burnout or resentment if the patient has had many hospitalizations or relapses month in and month out, as well as constant caregiving and switching of emotions, which may start issues. Differing opinions between family members, and boundary issues like how involved they should be can also be a cause for concern. Lack of awareness and stigma can be part of cultural or religious views as well.
Family dynamics can greatly vary depending on the sociocultural backgrounds of the individuals involved. How do you tailor your family approach to respect and incorporate different sociocultural perspectives and values?”
I would say that breaking it down as much as possible so they understand their needs, whether it’s cultural, religious, or education-based, and taking it from there. Before I break down what bipolar 1 is, maybe I need to break down what mental disorders are and what to expect and they start to feel more comfortable and understanding. Sometimes they may need visuals, or apart from individual therapy, we might need social services or other systems involved. Each case is unique.
Likewise, inter-generational dynamics can sometimes play a significant role in the therapy process. Can you share any insights or experiences on how inter-generational understanding and communication facilitate the healing process?
You have to be communicative and open with them, and receptive as to why they are feeling that way. It’s important to be sensitive and tailor both education and support dependent upon factors like age, cultural background, etc. Additionally, breaking the basics of mental health disorders down intergenerationally is crucial to meet patients and their family members where they are at and ensure everyone is able to understand the diagnosis, treatment, etc. in a way they can conceptualize based on their lived experience.
Many mental health professionals don’t have training in working with families. How did you learn the techniques you use and what would you recommend to professionals that want to learn more about this approach?
I come from good academic institutions, including University of Cincinnati and the University of Florida, where I received my psychology training. I learned a lot during my training, including research on a precision medicine approach. I remember growing up and seeing how an interaction with a pediatric doctor was, where you felt you didn’t always get the right amount of information, so I decided to be the complete opposite once I went through my practicing. I also went through a lot of self-education even though I did a full year of psychotherapy and some of that had to do with family dynamics, but it was not quite enough and I continued to educate myself. The research component is the gold standard, but so is talking with colleagues and figuring out how we can bring our information together. I have my private practice, but if I have any questions I have several other psychiatrists I can call. Understanding that continuing to learn in life has helped me out a lot and the biggest thing is that what we do especially in any sort of specialty is ensuring there is a passion to do it from the heart and understanding. It is a science, but there’s also an art in bringing everything together.
Caring for a family member with bipolar disorder can sometimes be challenging and might lead to caregiver burnout. How does your approach incorporate strategies for self-care and support for family members who are involved in the caregiving process?
For family members, I like to make it a point that they need to take care of themselves as well. Patient’s family members have come up to me and said they have depression, can’t sleep, or have panic attacks, and I end up treating them as well. Just as I would do with patients, I give them as many resources as I can and stress the importance of the physical component of taking care of themselves like getting up and stretching. The approach is different, but at the same time, it is wanting the best for those individuals.
Preventive education is often seen as a powerful tool in managing bipolar disorder symptoms. How do you integrate education and awareness for family members within your family approach to treating bipolar disorder?
In my private practice, Spanish is spoken 99% of the time, so having the correct materials and not just explaining it in detail and encouraging the patient, if needed, to become advocates to their own healthcare is important. As is stating the importance of a treatment regimen, medication, education, and continuing compliance. Sometimes I’ll use visual aids, as I am also a nurse educator, and go back to the breakdown of their specific learning needs and being direct in that approach and addressing misconceptions. I’ve had patients where they don’t want the diagnosis because of that stigma.
As for treatment options, it must be initiated with the right chemical management and the right medication is the catalyst. Once you have the right chemical on board, you can start engaging and thinking about therapy. It’s imperative to understand that the disease is chronic and won’t go away, but getting on treatment that works for the patient is a critical first step in long-term management. Treatment also comes with a lot of secondary effects, with patients saying they don’t want to take medication anymore due to side effects such as weight gain, but it makes a world of difference. What we see with antipsychotic medications, especially newer generation options like LYBALVI, is that it keeps patients on board and the maintenance indication for bipolar 1 has been life-changing for a lot of patients.
Thank you. Here is the main question of our interview. What are 5 things you wish more people knew about people navigating life with bipolar disorder?
1 . Getting care early on is essential to the well-being of the patient.
2 . Understanding that lifestyle plays a significant role like sleep, diet, stress management, and education is critical.
3 . Involving family in the diagnosis and treatment journey is very important.
4 . Learning about the disease itself and what to expect can be beneficial in supporting people.
5 . Educating on treatment options and ensuring that treatment decisions are made in partnership with healthcare providers, patients, and the broader supper system can help patients do well long term.
There is a lot of misunderstanding when it comes to mental illnesses, especially involving psychosis. What do you wish more people were aware of either in the professional field or the general public?
I wish the general public had more awareness of bipolar 1 and knew that identifying symptoms earlier has been shown to improve that treatment as it is a difficult condition diagnose and treatment, especially because there aren’t clear biological markers. However, proper, early diagnosis and intervention has been shown to positively impact the progression of the disease and help patients lead happy, healthy, and productive lives. For my work colleagues, I think just really taking the time to understand the patient’s symptoms, experience, goals, etc. so they can work alongside their patients to find the right treatment and support.
We are very blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might just see this if we tag them. 🙂
Because of my background, interests, and what I am currently doing in my work, I would say Joe Rogan. He seems like an overall good guy, and it would be interesting to sit down and figure out how we can help other people out. Additionally, I practice Brazilian jiu jitsu and he is also a black belt, so we have that in common.
How can our readers further follow your work online?
Authority Magazine readers can follow my work at my private practice, Mente Suave Psychiatry & Medicine at its website https://mentesuavepsychiatry.com/ and on Instagram @mentesuave2023.
Thank you for your time and thoughtful answers. I know many people will gain so much from hearing this.
About The Interviewer: Stephanie Greer, PhD is the Co-founder and CEO of Akin Mental Health — a company dedicated to guiding families on their journey supporting a loved one with mental health challenges like bipolar disorder, schizophrenia and severe depression. Stephanie is passionate about this topic from her own personal experience growing up with a mother who struggled with bipolar 1 disorder and found a path forward to overcome the obstacles and live well. Stephanie’s professional experience includes a doctorate in neuroscience as well as design research roles at Hopelab and Apple. Stephanie brings this personal passion together with her world-class science and technology background to support families across the US in their personal journeys supporting loved ones with mental illness. To learn more about Akin Mental Health and join our community, visit us at akinmh.com.
Roger Rivera Of Mente Suave Psychiatry & Medicine On The Benefits of Using a Family Approach for… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.