Mental Health
cALL 800-273-8255 or text "sos" to 741741 Don't let anyone
tell you how you feel! Don't let anyone say they know
how you feel!
Mental Illness Types, Symptoms, and Diagnosis
#MentalHealth4ALl social graphics
Mind Your Language Best Practices and Recommendations for Reporting on Suicide (2 page PDF)
Beyond the ACE Score: Perspectives from the NCTSN on Child Trauma and Adversity Screening and Impact
Bring ‘It’s Real: College Students and Mental Health’ to a Campus Near You AFSP
How the U.S. Is Addressing the Youth Mental Health Crisis - 3/21/24
Men’s Mental Health Challenges in the Covid-19 Era 4/3/20
Addiction Ketamine
Best LGBTQ+ Online Therapy and Counseling - 8/22/22
What Is Mental
Health? Over the course of your life, if you experience mental health problems, your thinking, mood, and behavior could be affected. Many factors contribute to mental health problems, including:
Mental health problems are common but help is available. People with mental health problems can get better and many recover completely. Early Warning Signs Not sure if you or someone you know is living with mental health problems? Experiencing one or more of the following feelings or behaviors can be an early warning sign of a problem:
Learn more about specific mental health problems and where to find help. Mental Health and Wellness Positive mental health allows people to:
Ways to maintain positive mental health include:
Learn More About Mental
Health: The
importance of prevention and wellness Frequently asked
questions (and questions to ask!) about referral to mental
health services What is a mental health evaluation? A “mental health evaluation” means an assessment provided by a mental health professional to determine whether or not your child has an issue or problem that would benefit from mental health treatment. This evaluation can take the form of an interview with you and your child (both separately and together), as well some paper and pencil testing for your child. This assessment can sometimes begin as soon as you call to make an appointment. You will probably be asked the reason for your call as well as for basic information about your child. During the initial evaluation session, the therapist will generally ask questions of both you and your child. You may also be asked to sign a paper (called a “Release of Information”) to give the counselor permission to speak to someone at your child’s school. This is usually a very important component of the assessment since your child’s behavior at school may be very different than it is at home. This release will give the school permission to share their observations about your child but, unless you specifically indicate it, the counselor is not allowed by law to disclose information back to the school. All information accumulated by the therapist is confidential. Once the necessary information has been collected and reviewed, this counselor will make a recommendation as to whether there is an issue or problem that might get better with counseling or therapy. In some cases, the counselor might recommend an additional evaluation for medication. This evaluation is done by a psychiatrist or other mental health professional who is licensed to write prescriptions. Who are the mental health professionals who provide this evaluation? There are several kinds of mental health professionals:
How do I decide which mental health professional is best for my child? Your first step is to check with your insurance provider to find out the extent of your mental health coverage, if you need preauthorization, and whether or not you have provisions for out-of-network coverage. If you have out-of-network coverage, your choice of providers will greatly increase. If you have to stay within your network, ask the insurance representative for a list of approved providers who work with children and youth within your geographic area. Another good place to start looking for help is through your pediatrician or family doctor. The American Academy of Pediatricians says, “Pediatricians are, and will continue to be an important first source for parents who are worried about their child’s behavioral problems.” If I don’t have coverage or choose to go out of network, how do I get the names of mental health professionals who would be appropriate for my child? At your child’s school, good referral sources can include the guidance staff or school nurse. They usually have a lot of experience making similar referrals. If you’re school doesn’t have staff in any of these positions, there may be an administrator who is in charge of making these types of recommendations. Other good referral sources can include your pediatrician or primary care physician, clergy members, or other parents whose children are in counseling. This last source can be very helpful, since you can get a personal feel for the practitioner. Even if a professional comes highly recommended, I’m still not sure I’d be comfortable sending my child for counseling without talking to the person myself. Is that allowed with medical privacy policies? Absolutely! Remember, you are technically a consumer who will be purchasing an important service for your child. It helps, of course, to frame your request in a courteous way, for example, “I don’t know much about mental health counseling, and I’m trying to approach this process as an educated consumer. I’d like to ask you a few questions to help me better understand how you work.” While you probably already have a list of questions in your head, here are a few more that you may want to include:
What kind of treatment do mental health professionals provide? Mental health treatment for children can include talk therapy, play therapy, or activity therapy. One of the most effective types of ‘talk therapy’ is called cognitive behavior therapy. This type of treatment focuses not just on feelings but on specific behavior changes, usually related to the problem your child is experiencing. Some children also benefit from group treatment where they interact with peers who have similar problems or concerns. There may also be a recommendation for family treatment, which involves not only the child but also the parents or caregivers and siblings. When the benefits of treatment with medication outweigh the risks, psychotropic medication might also be recommended. I have heard about something called a “black box” warning related to the use of these psychotropic medications for children. What does this mean? In 2004, the U.S. Food and Drug Administration (FDA) mandated that all antidepressant medication prescribed to children and adolescents indicate that use of this medication could result in an increase in suicidal ideation or suicide attempts. This warning was based on studies that showed 2 to 3 percent of pediatric patients that had taken this medication had experienced an increase in suicidal thoughts during the first four weeks of drug use. While there was not a single suicide in the studies, the “black box” warning does call attention to the importance of making sure that children or adolescents who are taking antidepressant medication be closely monitored by the prescribing physician early in the course of treatment or when medication is adjusted or changed. If this type of medication can be so dangerous, why would anyone use it? While medication isn’t usually necessary for milder forms of depression, it can be a very important and effective component in treatment for children and teens who are moderately to severely depressed. Untreated clinical depression can be incapacitating for kids, creating symptoms that interfere with their ability to perform in school and athletics, maintain friendships, interact at home…the list goes on. As a parent, you’re not in a position to make the medical diagnosis of depression, which is why it’s so important to consult with a physician. If your physician recommends the use of antidepressant medication for your child, ask for the following:
It is important to remember that when the benefits of medication outweigh the risks and the prescription is accompanied by talk therapy, antidepressants that are carefully monitored by the patient, family, and physician have proven to be effective in the treatment of depression. So if medication is effective, do I need to do anything else? Yes! Medication is only one piece of the treatment equation. Several studies have shown that a combination of medication and talk therapy (counseling) is really the most successful form of treatment. As a parent, you want to remain an advocate for your child. Continue to monitor the effects of the medication, be alert for side effects, and if you’re concerned about the progress of treatment, consider getting a second opinion. These questions only touch the surface
of the things that are important for you as a parent to
understand when initiating a mental health referral for your
child. They are a start, but here are other places you may
want to check for additional information: Myths and
facts about mental health Myth: People with mental health conditions never get better Fact: Treatment works for more than 8 in 10 people who get help for depression, and as many as 9 in 10 people who get help for panic attacks.† †Source: Mental Health America Myth: People with mental health conditions are just weak Fact: Many factors can impact mental health — including biology, environment, and challenging life events. Anyone can develop a mental health condition — there’s no single cause, and it isn’t anyone’s fault. Myth: If I get treatment, my employer will find out Fact: You decide who you want to tell — and not tell — about your care. Your medical record is confidential, and you can’t lose your job or your health insurance for getting treatment for a mental health or addiction issue. Myth: If I get treatment, I’ll have to take medication Fact: There are many types of
treatment. Medication is just one of them — and
it’s typically combined with therapy, self-care
resources, and other types of support. We don’t
automatically recommend medication to everyone —
it’s a personal decision members and providers make
together. Mind Your
Language Avoid using:
Instead try:
Other common mistakes
Read this blog from one mental health professional who explains why he decided to challenge the BBC over its use of language. If you want to read more about any
particular mental health condition have a look at the
information from Mind
or Rethink
Mental Illness Nearly 1 in 5
Americans Suffers From Mental Illness Each Year Every year, about 42.5 million American adults (or 18.2 percent of the total adult population in the United States) suffers from some mental illness, enduring conditions such as depression, bipolar disorder or schizophrenia, statistics released Friday reveal. The data, compiled by the Substance Abuse and Mental Health Services Administration (SAMHSA), also indicate that approximately 9.3 million adults, or about 4 percent of those Americans ages 18 and up, experience “serious mental illness” – that is, their condition impedes day-to-day activities, such as going to work. This data does not diverge greatly from the last SAMHSA report, released in 2012, which found that 45.9 million American adults, 20 percent of this demographic, experienced mental illness at least once annually. (Though there is a 1.8 percent difference, the statistics do have margins of error, and methods of compiling them are often revised, so this dip does not necessarily mean there has been a long-term decline in mental illness.) The SAMHSA paper comes amid increasing scrutiny of the ability of America’s health care system to handle issues of mental illness. For example, the American Mental Health Counselors Association released a study earlier this week claiming that adults with mental illness who live in those states electing against expanding Medicaid under Obamacare will be denied insurance. According to the study, care could be denied to up to 4 million patients. The SAMHSA study breaks down mental illness rates by state. Perhaps surprisingly, New Jersey had the lowest national rates of overall and severe mental illness – 14.7 percent and 3.1 percent, respectively. The states with the most mental illness? In Utah, 22.3 percent of the adult population experienced mental illness, and in West Virginia had the most cases of severe mental illness among adults, at 5.5 percent. It may be tempting to look at the map that accompanies the study and try to make guesses at why, say, the Pacific Northwest and the Midwest seem to suffer more from mental illness than other regions. However, because there is so much mental health illness in all the states – and lots of uncontrolled variables – it would be hard to draw any real conclusions. According to the study, “factors that potentially contribute to the variation are not well understood and need further study.” Not all psychiatric statisticians are satisfied with SAMHSA’s findings, with some alleging that the agency grossly understates the prevalence of mental illness. Ronald Kessler, McNeil Family Professor of Health Care at Harvard and expert in large scale mental illness surveys, tells Newsweek that SAMHSA’s assessment of serious mental illness is “pretty good” but that he believes that the “prevalence for any mental illness is too low.” Kessler, who is familiar with SAMHSA’s computational methods, said that the agency did not measure all of the ailments in the Diagnostic and Statistical Manual of Mental Disorders -- including some major ones like attention deficit disorder. “I find it objectionable that they use this term ‘any mental illness,’” he says. “What they really mean is any mental illness that they decided to measure. What they ask about is anxiety and depression and drinking and drugs, but there are many things beside that they totally ignored.”’ Kessler estimates that the prevalence of mental illness might range from 25 to 30 percent of American adults. A 2011 report published by the U.S. Centers for Disease Control and Prevention pegs the number at 25 percent. SAMHSA’s statistics division disagrees with Kessler’s assessment. “This captures the majority of people suffering from mental illness in the country,” Dr. Kevin Hennessy, deputy director of the Center for Behavioral Health and Statistics and Quality, tells Newsweek. According to the report, the state-level estimates are based on data collected from 92,400 adults 18 and over from the 2011 and 2012 National Surveys on Drug Use and Health. The survey itself was built around the DSM, but also includes an “improved prediction model” developed based on previous survey attempts. Ultimately, the experts might be splitting hairs; even the state with the lowest rate of mental illness still nears 15 percent. Perhaps more importantly, only 62.9 percent of adults nationwide with serious mental illness received mental health treatment in the year they reported this illness. Dr. Peter Delany – director of the “the government’s lead agency for behavioral health statistics,” the Center for Behavioral Health and Statistics and Quality, according to SAMHSA’s website – tells Newsweek that the information shows policymakers, in black and white terms, that mental illness impacts a large portion of the population, regardless of statistical caveats. “These are real people that have
very serious problems,“ he says. “The data should
be helping us think through how we want to approach helping
them get services that they need.” Talk
with your kids about Mental Health In order to talk with a child about mental illnesses, you must be knowledgeable and reasonably comfortable with the subject. You should have a basic understanding and answers to questions such as, what are mental illnesses, who can get them, what causes them, how are diagnoses made, and what treatments are available. Some parents may have to do a little homework to be better informed. Parents can help children understand that these are real illnesses that can be treated. In order to talk with a child about mental illnesses, you must be knowledgeable and reasonably comfortable with the subject. You should have a basic understanding and answers to questions such as, what are mental illnesses, who can get them, what causes them, how are diagnoses made, and what treatments are available. Some parents may have to do a little homework to be better informed. Because children often can’t understand difficult situations on their own, you should pay particular attention if they experience: 1. Loss of a loved one Parents should be aware of their child's needs, concerns, knowledge, and experience with mental illnesses. When talking about mental illnesses, parents should: 1. Communicate in a straightforward
manner Considering these points will help any child be more relaxed and understand more of the conversation. Pre-School Age Children Young children need less information and fewer details because of their more limited ability to understand. Preschool children focus primarily on things they can see, for example, they may have questions about a person who has an unusual physical appearance, or is behaving strangely. They would also be very aware of people who are crying and obviously sad, or yelling and angry. School-Age Children Older children may want more specifics. They may ask more questions, especially about friends or family with emotional or behavioral problems. Their concerns and questions are usually very straightforward. "Why is that person crying? Why does Mommy drink and get so mad? Why is that person talking to himself?" They may worry about their safety or the safety of their family and friends. It is important to answer their questions directly and honestly and to reassure them about their concerns and feelings. Teenagers Teenagers are generally capable of handling much more information and asking more specific and difficult questions. Teenagers often talk more openly with their friends and peers than with their parents. As a result, some teens may already have misinformation about mental illnesses. Teenagers respond more positively to an open dialogue which includes give and take. They are not as open or responsive when a conversation feels one-sided or like a lecture. Talking to children about mental illnesses can be an opportunity for parents to provide their children with information, support, and guidance. Learning about mental illnesses can lead to improved recognition, earlier treatment, greater understanding and compassion, as well as decreased stigma. Do you need help starting a conversation with your child about mental health? Try leading with these questions. Make sure you actively listen to your child’s response. 1. Can you tell me more about what is
happening? How you are feeling. Seek immediate assistance if you think your child is in danger of harming themselves or others. You can call a crisis line or the National Suicide Prevention Line at 1.800.273.TALK (8255) or teach your children the to text "SOS" to the Crisis Text Line 741741 since they probably prefer to text about emotional issues than talk about them. If your child is in need of community
mental health services, check out your local school health
center. Talking
To Kids About Mental Illnesses
Parents can help children understand that these are real illnesses that can be treated. In order to talk with a child about mental illnesses, you must be knowledgeable and reasonably comfortable with the subject. You should have a basic understanding and answers to questions such as, what are mental illnesses, who can get them, what causes them, how are diagnoses made, and what treatments are available. Some parents may have to do a little homework to be better informed. When explaining to a child about how a mental illness affects a person, it may be helpful to make a comparison to a physical illness. For example, many people get sick with a cold or the flu, but only a few get really sick with something serious like pneumonia. People who have a cold are usually able to do their normal activities. However, if they get pneumonia, they will have to take medicine and may have to go to the hospital. Similarly, feelings of sadness, anxiety, worry, irritability, or sleep problems are common for most people. However, when these feelings get very intense, last for a long period of time and begin to interfere with school, work, and relationships, it may be a sign of a mental illness that requires treatment. Because children often can’t understand difficult situations on their own, you should pay particular attention if they experience: 1. Loss of a loved one 1. Communicate in a straightforward
manner Considering these points will help any child be more relaxed and understand more of the conversation. Do you need help starting a conversation with your child about mental health? Try leading with these questions. Make sure you actively listen to your child’s response. 1. Can you tell me more about what is
happening? How you are feeling. Seek immediate assistance if you think your child is in danger of harming themselves or others. You can call a crisis line or the National Suicide Prevention Line at 1.800.273.TALK (8255) or text "SOS" to the Crisis Text Line at 741741. If your child is in need of community mental health services, check out your local school health center. Pre-School Age Children Young children need less information and fewer details because of their more limited ability to understand. Preschool children focus primarily on things they can see, for example, they may have questions about a person who has an unusual physical appearance, or is behaving strangely. They would also be very aware of people who are crying and obviously sad, or yelling and angry. School-Age Children Older children may want more specifics. They may ask more questions, especially about friends or family with emotional or behavioral problems. Their concerns and questions are usually very straightforward. "Why is that person crying? Why does Daddy drink and get so mad? Why is that person talking to herself?" They may worry about their safety or the safety of their family and friends. It is important to answer their questions directly and honestly and to reassure them about their concerns and feelings. Teenagers Teenagers are generally capable of handling much more information and asking more specific and difficult questions. Teenagers often talk more openly with their friends and peers than with their parents. As a result, some teens may have already have misinformation about mental illnesses. Teenagers respond more positively to an open dialogue which includes give and take. They are not as open or responsive when a conversation feels one-sided or like a lecture. Talking to children about mental
illnesses can be an opportunity for parents to provide their
children with information, support, and guidance. Learning
about mental illnesses can lead to improved recognition,
earlier treatment, greater understanding and compassion, as
well as decreased stigma. 800/969-6642 www.nmha.org
How
to Talk About Mental Health
When talking about mental health problems with your child you should:
Related Video YouTube embedded video: www.youtube-nocookie.com/embed/zMdFj4e0Q18 Glenn Close talks about her family's experience with mental health problems, and the importance of talking and learning about mental health issues. "I challenge every American family to no longer whisper about mental illness behind closed doors," she said. Learn More about Supporting Your Children There are many resources for parents and caregivers who want to know more about children’s mental health. Learn more about:
Get Help for Your Child Seek immediate assistance if you think your child is in danger of harming themselves or others. You can call a crisis line or the National Suicide Prevention Line at 1.800.273.TALK (8255) or text "SOS" to the Crisis Text Line at 741741. If your child is in need of community
mental health services, find help in your area and possibly
from your school health center. Mental
health of children and young people ‘at risk in digital
age’ Violent video games, the sharing of indecent images on mobile phones, and other types of digital communications, are harming young people’s mental health, MPs warned on Wednesday, amid evidence of big increases in self-harm and serious psychological problems among the under-18s. Cyberbullying and websites advocating anorexia and self-harm are also posing a danger to the mental wellbeing of children and young people, the Commons health select committee says in its report. Sarah Wollaston, chair of the committee, who was a GP for 24 years before becoming a Tory MP in 2010, said: “In the past if you were being bullied it might just be in the classroom. Now it follows [you] way beyond the walk home from school. It is there all the time. Voluntary bodies have not suggested stopping young people using the internet. But for some young people it’s clearly a new source of stress.” However, the MPs said they had found no evidence that the emerging digital culture was behind the worrying rise, of up to 25% to 30% a year, in numbers of children and young people seeking treatment for mental health problems. The cross-party group acknowledges that forms of online and social communication are now central to the lives of under-18s, but says that a government inquiry into the effects is needed because of the potential for harm. “For today’s children and young people, digital culture and social media are an integral part of life … this has the potential to significantly increase stress and to amplify the effects of bullying,” the committee’s report says. Some young people experience “bullying, harassment and threats of violence” when online, the MPs say. While they did not look into internet regulation in depth during their six-month inquiry, they concluded: “In our view sufficient concern has been raised to warrant a more detailed consideration of the impact of the internet on children’s and young people’s mental health, and in particular the use of social media and impact of pro-anorexia, self-harm and other inappropriate websites.” It calls on the Department of Health and NHS England’s joint taskforce, now investigating, alongside bodies such as the UK Council for Child Internet Safety, the mental health of under-18s, to assess the impact of social media. The MPs appreciate the move for e-safety to be taught at all four education key-stages in England. But they also want the Department for Education, as part of a review of mental health education in schools, to “ensure that links between online safety, cyberbullying, and maintaining and protecting emotional wellbeing and mental health are fully articulated”. Wollaston voiced concern that “sexting” (sharing indecent photographs) could be traumatic for vulnerable young women persuaded to pose for intimate pictures then finding the shots shared widely. Some would end up being harassed, she said. Sexting had “become normalised in some school environments”, she said. “We need much better education about the dangers of sexting.” She also expressed unease about the impact of violent video games played by young people. Parents, she said, should do more to check what their offspring were doing online in their free time and talk to them because “if they are spending two hours a night doing that, is that harming their child?” Lucie Russell, director of campaigns and media at the charity Young Minds, said: “The 24/7 online world has the potential to massively increase young people’s stress levels and multiplies the opportunities for them to connect with others in similar distress. Websites like Tumblr, where there has been recent media focus on self-harm blogs, must do all they can to limit triggering content and that which encourages self-harming behaviour.” Russell backed the committee’s view that the internet could also be “a valuable source of support for children and young people with mental health problems”. But, she added that “many professionals feel completely out of touch with, even intimidated by, social media and the net”. The report paints a grim picture of the growing number of under-18s needing care, often struggling to access it, or becoming an inpatient hundreds of miles from home, as children’s and adolescents’ mental health services tried to cope with budget cuts, lack of staff and too few beds. “Major problems” in accessing services ends with “children and young people’s safety being compromised while they wait for a bed to become available”, say the MPs. Services are under such pressure that in some parts of England children only get seen by a psychiatrist if they have already tried to take their own lives at least once. Despite growing need, criteria for being referred for NHS treatment have been tightened in most of England, the MPs say. Liz Myers, a consultant psychiatrist with the Cornwall Partnership NHS foundation trust, told the inquiry that its services for the young were receiving 4,000 referrals a year, though were only commissioned by the NHS to do 2,000. “This has meant that we are necessarily having to prioritise those who have the most urgent and pressing need, and we have no capacity for earlier intervention and very little capacity for seeing those perhaps with the less life-threatening or urgent risky presentations. “There are increasing waits. It is not okay. We do not want that for our children and young people, but we have to just keep prioritising.” Hilary Cass, president of the Royal
College of Paediatrics and Child Health, said failure to
tackle emerging problems with young people’s mental
health meant the issue was now “a hidden
epidemic”. 5 ways to support
student mental health during the end of the semester 2. Encourage healthy coping: Model effective coping: be open about the ways you deal with the stress in your own life. Give students a space (private or public) to share their personal methods. 3. Make room for creativity: Extra credit for humorous poems/clever illustrations related to class subject matter. Hold a funny caption contest on your department's social media. Whatever your role, bring a touch of goofiness to it in the coming weeks. 4. Be aware and available: Keep an eye out for warning signs: isolation, change in academic performance, change in concentration or focus, new and unusual physical habits, and extreme emotional responses. No matter what your role is in your school, you can make a difference just by being there. Let students know your doors are open. 5. Share Crisis Text Line: Through
fliers, social media, little notes on the back of the
mid-term/final study guide, an
email home to parents, or just
telling someone who looks like they could use it: make sure
students know they can text SOS to 741741 for free
confidential support, 24/7. Men and Mental
Health Our goal in the Men’s Mental Health Campaign is to challenge some of the common yet false beliefs that men hold about mental health, particularly the beliefs that might prevent them from getting the help they need. Let’s start the conversation. Common Belief: “I don’t need help. I got this.” Research shows that, often, the men who need mental health services most – stressed out, successful, athletic, family men – are also the least interested in getting help. The traditional male role encourages a preoccupation with success, power and competition. And yet these types of men are at higher risk of negative psychological consequences, such as depression, anxiety, and relationship problems. Common Belief: “Talking about my problems is not going to change anything.” The term “normative male alexithymia” has been used to describe men’s problems with expressing their emotions, a possible contributor to depression and barrier to treatment. Men are geared towards problem solving, but sometimes holding in how you feel is part of the problem. When you start talking about things that bother you or are causing stress, the problem solving can begin. Athletes will “huddle up” on the court or field to make a plan or a game strategy and make adjustments as they go along. This is similar to what happens in counseling or therapy. Common Belief: “It’s not that bad, it’s the way I’ve always been.” Most likely, you don’t like to go to the doctor when you have a fever, sore throat, and cough. You probably want to ride it out and see if you can just get better on your own. But then you realize the cough has now turned into bronchitis and you aren’t able to work. Mental health issues can be similar. It can be hard to know when it’s time. Sometimes, you just need to talk. And, other times, it’s pretty bad. You can’t get out of bed or function. Untreated depression and other psychiatric problems can result in personal, family, and financial problems, even suicide. According to NIMH, four times as many men as women die by suicide in the United States, which may result from a higher prevalence of untreated depression. Yet eight out of 10 cases of depression respond to treatment. Common Belief: “People will think I am crazy if I see a psychologist.” Our brains are sensitive organs that respond to our genetics, traumatic life events, and stress. Many of these factors are not in our direct control. Men may express their depression in terms of increases in fatigue, irritability and anger, loss of interest in work, and sleep disturbances. It has also been shown that men use more drugs and alcohol, perhaps to self-medicate. This can mask the signs of depression, making it harder to detect and treat effectively. A diagnosis is not a life sentence. A diagnosis can be a name of a condition that provides a road-map for proper treatment and improvement in your mood, relationships, and life. Start the conversation. With someone you trust. With someone who is trained. With someone who cares. Ask questions. Start the conversation. Conversation Guide Some tips to start a conversation with someone about concerns around mental health. DO: OBSERVE, COMMUNICATE, RESPECT DON’T: ASSUME, ALIENATE, LABEL Start a Conversation
Listen Without Judgment
Encourage Action
Follow Up
Dealing with Denial?
Is Their Life in Danger?
Get immediate crisis help by calling 1-800-273-TALK (8255) or Texting "SOS" to 741741..
6 Intangible Tools
You Need to Take Charge of Your Mental Health With mental health, there are so many times where I’ve worked with clients who knew what tool to use just like this student did, yet had no idea how to use it effectively. Here are 6 intangible tools you can use to manage your mental health effectively: 1) READINESS Taking charge of your emotional well-being is a process that requires preparation and continual development. It's a great feeling to have an emotional wellness toolbox that you can use to handle and manage the problems that you face on a regular basis. Your overall wellness is a holistic concept. Not only is your physical and emotional wellness important, but there is also social, spiritual, intellectual, and financial wellness which contribute to your overall sense of being well. When considering emotional wellness, we’re often fooled into believing that either we have it together or we don’t. That could not be farther from the truth. Pro Tip: You can develop and train your emotional wellness just like you can train other areas of wellness. 2) WILLPOWER Willpower to grow and mature is an intangible ingredient needed to take charge of your mental health. Developing in this area of wellness requires courage and humility, both of which you need to have a high chance of success with your emotional well-being. Pro Tip: A will to break patterns in how we interpret, respond and cope with change during adverse times is a tool we need to possess. Are you willing? 3) SELF AWARENESS To increase your self-awareness on a regular basis, we have to be able to acknowledge our emotions and know what that really looks in our daily routine. With clients, I often share that I only have one rule during our sessions. That rule is: “ ‘I don’t know’ is not an answer.” This encourages them to really think through what they are feeling and learn how to express themselves effectively. “You have what it takes to take charge of your mental health. You can start today.” Pro Tip: You can often explain how you feel more effectively when you’re able to find the right words. Use a dictionary, thesaurus or list of emotions that can help you find the words to describe your feelings accurately. Pro Tip: Question to ask yourself: “What's making me feel this way?” Consider this question and go three steps beyond your initial answer. 4) HONEST REFLECTION Reflection is the process of serious thought and consideration. In every area of our life there will be times when situations don’t go your way and/or times when you don’t respond as well as you intended to in the middle of difficult situations. Reflection is an excellent tool available to all of us and can prove to be priceless if we use it well. In order to reflect well, we must dedicate necessary time to reflect and keep it real. Pro Tip: Here are two questions that you can use in moments of reflection: Was my response helpful towards the outcome that I wanted? What’s a healthy alternative response I could consider in the future that would have a higher chance of success for being understood or my feelings being acknowledged better? 5) LEVERAGE In order to navigate the general trials of life, we need to leverage positive support from friends and family that’s available to us. Developing genuine relationships is key. We benefit from deep meaningful relationships - there’s no app to create strength in relationships. It’s a slow, uncomfortable, and sometimes messy process, but it’s necessary. Pro Tip: For better conversations, ask better questions. You can Google great conversation starters and take your pick! 6) PROFESSIONAL HELP Professional help is oftentimes an integral step on the path towards personal development. Sometimes clients ask advice from others who seem to “have everything together” and yet they are unable to get an explanation on how they do it. Talking with a professional counselor can help you work through the “how to” that is often told to us as “just do.” You can do it! You have what it takes to take charge
of your mental health. You can start today. For
Parents and Caregivers
What to Look For It is important to be aware of warning signs that your child may be struggling. You can play a critical role in knowing when your child may need help. Consult with a school counselor, school nurse, mental health provider, or another health care professional if your child shows one or more of the following behaviors:
Because children often can’t understand difficult situations on their own, you should pay particular attention if they experience:
2:01 Former Senator Gordon Smith Sen. Gordon Smith shares his story about mental health problems, and encourages others to "bring mental health issues out of the shadows." What to Do If you are concerned your child’s behaviors, it is important to get appropriate care. You should:
Talking with Kids
about Mental Health
Data Highlights Children’s mental health problems are an important public health issue because of their prevalence, early onset and detrimental impacts on kids, families and communities. Half of all mental health disorders start by age 14 and, in any given year, up to 20% of US children have mental health problems. This translates to approximately 1.8 million California children that suffer from mental health problems each year. Left untreated, children with mental health problems are at greater risk of abusing drugs or alcohol, becoming involved with the criminal justice system, dropping out of school and dieing by suicide. Significant adversity experienced in early childhood, such as stress associated with persistent poverty or chronic neglect, can severely impact brain development and lead to decreased mental and physical well-being throughout a child’s lifetime. Even very young children can suffer from serious mental health disorders: over 10% of children, ages 2-5, are diagnosed with a mental health disorder. Parental well-being also directly impacts early childhood mental health, which is of particular importance given that postpartum depression affects 1 in 7 women. Annually, approximately 37% of California children who need mental health treatment or counseling do not receive services. Young children and those in poverty are even less likely to receive needed services. Despite the fact that early intervention is effective, 60% of California children under age 6 who needed mental health services did not receive them. Pro-Kid Policy Agenda To fight the growing, costly and potentially tragic epidemic of poor mental health among children, the state should promote children’s access to mental health care by requiring the health plans that it contracts with to make improvements in mental health service delivery and follow-up, including coordination with primary care networks and providers. California should also work expeditiously with counties to effectively leverage all funds generated by the Mental Health Services Act of 2004, and emphasize early intervention programs. Momentum Mental health programs in California have been drastically cut recently; the state’s spending on mental health was reduced by 21% between 2009 and 2012. Federal health care reform makes mental health services an “essential benefit” in children’s health coverage, which means that children’s access to mental health coverage and care will be substantially increased beginning in 2014. California’s Early Mental Health
Initiative has helped tens of thousands of young children
who suffer from mild to moderate mental health challenges
through proven school-based prevention and early
intervention programs; however, funding for the program was
eliminated in the 2012-13 budget and has not been restored
since, despite over 20 years of successful implementation
and its modest cost of $15 million per year. College
So often in the news, we hear about kids attempting suicide for a variety of reasons. The ages of these kids keeps getting younger & younger, it seems. As adults, we not only need to be honest with kids about our own mental health struggles, but also to let our kids know that getting help for themselves is also OK and no matter what they have questions about in regards to their mental health, asking those questions and seeking help is ALWAYS better than not saying anything. Talking to kids about this kind of stuff isn’t always easy though. Every child is going to respond to different things & different approaches. A few years back, I heard a speaker at a conference for the charter school my kids were going to attend. I wish I could remember his name because I really like what he had to say. He was talking about the differences in boys and girls and how if you were to take a look at high school during lunch time, a lot of the times, you would see a group of girls all huddled together talking. But, a group of boys would usually be standing side by side, sometimes leaning against a wall but usually not looking at each other eye to eye. He said that that is how he talks to his kids and I’ve started doing that too. When I need to talk to my son, who is 15, I find it best to do so as we’re driving somewhere in the van. This way, we’re side by side and he seems to respond better. With my daughter (who is 11), I find that it’s better to go somewhere, away from the house, where we can sit and talk to each other face-to-face, without any disruptions. Again, every child is different but that is what works for us. Also, if there is a certain subject I need to talk to my kids about and it’s a sensitive matter, I try to collect my thoughts and wait a little bit until I have thought it out. Trust me when I say I am FAR from perfect when it comes to this but I’ve noticed that when I have calmed down or have my thoughts all together, my kids react better too. In the past when I have gone to therapy or been on medication for depression & anxiety, I don’t hide it from my kids. Obviously, I won’t tell them everything I talk about in counseling but I don’t let depression & anxiety stay a family secret. When I am anxious about something, say an important doctor appointment, I’ve let them know that I am anxious and why. They can sense it, they’re smart kids…telling them “everything is fine” or not letting them know anything, is pretty much telling them to lie & not be honest about their own mental health. We can end the stigma of mental health issues, not only for ourselves but for our kids as well. If you head on over to the Each Mind Matters website, you can find an area to pledge to join the movement. “ Ending the stigma associated
with mental illness is a personal choice. We have to decide
for ourselves that each mind really does matter. Each one of
us must determine what we will do to make a difference. Helping
their college-age kids cope with the high stress of
undergraduate life
This week, The Checkup, our podcast on Slate, explores the mental health of college students. Here’s one sobering statistic: up to 50% of college-age kids have had or will have some kind of psychiatric disorder. That’s why we’re calling this episode “Meltdown U.” (To listen to The Checkup now, click on the arrow above; to download and listen later, press Download; and to get it through iTunes click here.) Consider some more scary numbers:
We asked Dr. Eugene Beresin, M.D., a child psychiatrist at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School, to offer some guidance on what parents should know about helping their college-age kids cope with the high stress of undergraduate life. Here’s his advice: 1. Be Prepared It is likely your kid will experience a mental health problem or encounter one in a roommate or classmate. Discuss this, and talk about what to do if it happens. You might say, “Talk with some adult to get advice. This could be me, a dorm advisor, or mental health counselor. Don’t think things will just pass. They could get worse.” Inform your kids about the mental health realities. 2. Get Information About Mental Health and Illness Some colleges have great websites on mental health services. They just don’t promote this nor do many educate parents or students about the signs and symptoms of psychiatric problems. Some colleges may have information online, or you can go to other sites for trusted resources about college student mental health, even other college sites (good examples include Cornell, MIT, University of Pittsburgh). For educational material about the disorders themselves go to your state psychiatric association website (branches of the American Psychiatric Association or the American Academy of Child and Adolescent Psychiatry). 3. Learn about College Mental Health Services Though no one will direct you, call the counseling center and ask about the kind of coverage, professional staff and the range of services for your kid. And talk with the highest staff member you can. The person answering the phone may know little or nothing about what really is available. It may be a student volunteer, or an administrator who does not know the answers you seek. 4. Find Out About Your Insurance Coverage This can be really hard. Think about your own coverage! The mental health system is very complicated. Call and ask about the number of office visits per year. Ask how many are just for medications, and how many are for therapy. Many insurance companies will say “we have unlimited visits for biological conditions.” But this means, “unlimited 15 minute visits for medication management.” If the coverage is obtained through the college, ask if it also covers visits off campus. 5. Learn About Local Mental Health Services Off Campus Many college mental health services will be limited so it’s important to see what may be available off campus at a local counseling center or hospital. If you need help in finding out which is really good, call a nearby medical school with an associated Department of Psychiatry, and ask what facilities are recommended. If there is not a Department of Psychiatry, call the nearest teaching hospital for a medical school in the state, even if it’s not right near your college. Another good resource is the local chapters of the National Alliance on Mental Illness (NAMI). 6. Don’t Worry About Stigma Of course there is stigma associated with psychiatric illness. Our culture will not change overnight. One in four people will have a psychiatric disorder during the course of life. Worrying that this will be a black mark on your child’s record is natural but there should be even greater worry if mental illness goes untreated. Many individuals who are highly successful have had psychiatric treatment and this does not interfere with success in their career or in relationships. Quite the contrary. Help may prove invaluable for functioning in life. 7. Talk With Your Kids About Mental Health and Illness It is one thing for us as parents to get the best information about psychiatric problems, relationship and drug issues. But your kids need this information too. They are living with this; they see their friends in trouble. Involve them in all of the tips described here. You will be surprised how much they want to know, what they have seen and their receptivity. Engage them. Let them know they’re not alone. Opening this door will serve them well, and is more likely to help them feel comfortable to talk about themselves and their experiences without feeling judged. 8. Get Help Early The earlier your kid gets services for any emotional, behavioral or learning problem the better. While mental illness is misunderstood and the system is very difficult to navigate even for the best educated (even by doctors), most psychiatric disorders can be successfully treated. The key is early intervention and prevention of complications. 9. Be Brave Colleges do their best, but are sorely lacking in resources, and frankly wary of putting such stigmatized problems on the front burner. You have to teach your child that it’s okay to ask for help and advocate for his or her own mental health needs. 10. Sleeping and Eating For Body & Mind This may seem banal and irrelevant but getting enough sleep and not living on ramen goes a long way in retaining sanity. Remind your kid that pulling frequent all-nighters to study may be harmful to their long-term well being. Getting into a daily exercise routine can also alleviate stress in a profound way. Readers, any specific questions
lingering in your minds? Please post questions below, or
tweet Dr. Beresin at @GeneBeresinMD. You can see his sources
for this post here, here, here and here. Help Bring
Good Samaritan Laws to Your State There are currently 35 states plus DC with Good Samaritan Overdose Laws. If your state has not yet adopted this life saving policy (see list below), you can send the following suggested letter to your Governor urging the state to do so.
Suggested Letter Dear Governor Kate Brown: Accidental drug overdoses are now the
leading cause of accidental death in the United States. Some
of these deaths could be prevented if the patient received
medical care in a timely manner. Good Samaritan laws, which
encourage people to call 911 when someone is overdosing,
help to ensure that there is not an unnecessary delay in
getting medical attention for the patient. Currently 35
states and the District of Colombia have such laws. I
encourage you to fight for this law in our state to provide
limited legal immunity for minor drug law violations for
those who call for help as well as the person who is
overdosing. Good Samaritan laws will save lives and prevent
countless families from the heartache of losing a loved
one. Mental Health
Parity and Addiction Equity Act The lack of enforcement has left too many families with inadequate health coverage for their child’s substance abuse treatment. We think this is unacceptable and are calling for the HHS and DOL agencies to sufficiently implement this law. Please write your Congressman and urge them to sign on to the below letter demanding action to enforce MHPAEA. From: The Honorable Paul Tonko Dear Colleague, We all know the statistics that are staggering. Over 41,000 Americans died from suicide in 2013 and suicide is the third leading cause of death for 15-24 year olds. 120 Americans a day are dying from drug overdoses, and overdose now exceeds vehicular accidents as a leading cause of death. Sadly, only 10 percent of individuals diagnosed with a substance use disorder receive any help for their illness and only 20 percent of children with a mental illness diagnosis receive care. Our system is broken. The Mental Health Parity and Addiction Equity Act (MHPAEA) was passed with overwhelming bipartisan majorities in the House and Senate and signed into law in 2008 by President George W. Bush. Seven years have elapsed and final regulations are still not fully implemented. Unfortunately, the Departments of Health and Human Services and Labor have provided only limited guidance on how states must comply with MHPAEA and enforcement has been inconsistent. Not fully using MHPAEA to combat the twin public health crises of untreated mental illness and substance use disorders has led to a lack of access to care and the nearly 50,000 Americans annually who lose their lives because of untreated mental illness and addiction. These are needless tragedies that are creating devastating effects on individuals, families and communities. In April 2015, a National Alliance on Mental Illness report showed that consumers are unable to access provider lists before buying a health plan and are unable to access information they need to make informed decisions about which plan best serves their needs. As a result, we are circulating a letter to Department of Health and Human Services Secretary Sylvia Burwell and Department of Labor Secretary Thomas Perez asking them to take immediate action to implement and enforce the Mental Health Parity and Addiction Equity Act. Specifically, our letter urges HHS and DOL to report back to Congress on the following: 1. How many audits has your Department conducted to determine compliance with MHPAEA? What were the results of those audits? Will de-identified results of the audits be made available on your website? If audits have not been conducted, will your agencies be conducting them in the future? 2. Does your Department plan to issue additional parity guidance to health plans and issuers on what documents and analyses they must conduct and disclose in order to demonstrate compliance with MHPAEA? If so, by what date? 3. When will Medicaid parity final regulations be released? When will enforcement for parity under Medicaid and the Children’s Health Insurance Program begin? For more information or to sign on, contact Scott Dziengelski with Rep. Murphy at scott.dziengelski@mail.house.gov or Jeff Morgan with Rep. Tonko at jeff.morgan@mail.house.gov. Please have your staff contact our staff with any questions. Thank you for your attention to this important issue. Sincerely, Tim Murphy Paul Tonko Source: drugfree.org/mental-health-parity/
The stigma that
goes along with mental illness issues So often in the news, we hear about kids attempting suicide for a variety of reasons. The ages of these kids keeps getting younger & younger, it seems. As adults, we not only need to be honest with kids about our own mental health struggles, but also to let our kids know that getting help for themselves is also OK and no matter what they have questions about in regards to their mental health, asking those questions and seeking help is ALWAYS better than not saying anything. Talking to kids about this kind of stuff isn’t always easy though. Every child is going to respond to different things & different approaches. A few years back, I heard a speaker at a conference for the charter school my kids were going to attend. I wish I could remember his name because I really like what he had to say. He was talking about the differences in boys and girls and how if you were to take a look at high school during lunch time, a lot of the times, you would see a group of girls all huddled together talking. But, a group of boys would usually be standing side by side, sometimes leaning against a wall but usually not looking at each other eye to eye. He said that that is how he talks to his kids and I’ve started doing that too. When I need to talk to my son, who is 15, I find it best to do so as we’re driving somewhere in the van. This way, we’re side by side and he seems to respond better. With my daughter (who is 11), I find that it’s better to go somewhere, away from the house, where we can sit and talk to each other face-to-face, without any disruptions. Again, every child is different but that is what works for us. Also, if there is a certain subject I need to talk to my kids about & it’s a sensitive matter, I try to collect my thoughts and wait a little bit until I have thought it out. Trust me when I say I am FAR from perfect when it comes to this but I’ve noticed that when I have calmed down or have my thoughts all together, my kids react better too. In the past when I have gone to therapy or been on medication for depression & anxiety, I don’t hide it from my kids. Obviously, I won’t tell them everything I talk about in counseling but I don’t let depression & anxiety stay a family secret. When I am anxious about something, say an important doctor appointment, I’ve let them know that I am anxious and why. They can sense it, they’re smart kids…telling them “everything is fine” or not letting them know anything, is pretty much telling them to lie & not be honest about their own mental health. We can end the stigma of mental health issues, not only for ourselves but for our kids as well. If you head on over to the Each Mind Matters website, you can find an area to pledge to join the movement. “Ending the stigma associated
with mental illness is a personal choice. We have to decide
for ourselves that each mind really does matter. Each one of
us must determine what we will do to make a difference. No proof that 85% of
mental health apps accredited by the NHS actually work It’s an inconvenient reality that while demand for psychological services seems to be forever increasing, NHS resources designated for the treatment of mental health problems are going the other way. The unfortunate, but inevitable result is that unmet need for NHS mental health services has reached an unprecedented level (Cooper, 2014). To illustrate the situation, monthly referrals to community mental health teams increased over 13% in 2013, and 16% in the case of crisis services (The Mental Health Policy Group, 2015), yet roughly 200 full-time NHS mental health doctors, and 3,600 nurses were lost over the same period (Cooper, 2014). This has meant that despite the ‘new NHS standard’ whereby 95% of those with a mental health issue are to be seen within 18 weeks (NHS England, 2015), 1 in 10 are waiting over a year before receiving any form of treatment, with 1 in 2 waiting over 3 months (We Need To Talk Coalition, 2013). While this is a problem in itself, a seemingly much bigger problem is the reality that 1 in 6 of those on waiting lists for mental-health services are expected to attempt suicide, 4 in 10 are expected to self-harm and 6 in 10 will likely to see their condition deteriorate before having the opportunity to see a mental health professional (Cooper, 2014). So how should the NHS and its patients respond? With the widespread availability and increased reliance upon smart phones, one increasingly popular suggestion is the use of apps. Our own experiences can tell us that apps are relatively inexpensive and widely available, but probably most importantly, the use of an app by one person won’t prevent another using the same service at the same time. Given the history of long waiting lists for mental health services this is a highly desirable trait for future NHS services, which could result in flexible, user-led healthcare delivery. MIND have reported that just 50% and 13% of people currently have a choice as to when and where they receive therapy respectively (We Need To Talk Coalition, 2011), and as such, it’s also possible that the wider-spread use of apps could extend the reach of traditional mental-health services to those who, for one reason or another, are not currently able to engage with treatment. Examples may include the teenager who is too anxious or stigmatised to discuss his condition face-to-face, the armed forces serviceman for whom a desire for anonymity is paramount (Murphy & Busuttil, 2014), or the single-mother who struggles to schedule an appointment around her childcare and work commitments. With 1 in 10 people with a mental health problem waiting over a year for treatment, perhaps apps can help cut the queues? Depression Apps: in practice Regrettably, the reality is that there’s currently a considerable gap between the benefits that apps may provide in theory, and what they are likely to deliver in practice. Taking a look at the NHS Apps Library, there are currently 27 mental health apps accredited for use by patients, with a total of 14 designated for the treatment/management of the symptoms of depression and anxiety. Upon close inspection, terms such as ‘control stress’, ‘increase wellbeing’, ‘beat depression’ and ‘improve mood’ are frequently listed benefits from downloading, and often purchasing these apps. Worryingly though, just 4/14 are able to provide any tangible evidence of outcomes, as reported by real-world users, to substantiate their claims, while just 2/14 make use of NHS-validated performance measures including the Generalised Anxiety Disorder 7 (GAD-7) questionnaire, which is routinely used to assess the effectiveness of other NHS-accredited treatments, including counselling and cognitive-behavioural therapy. As a result, we are currently facing an open question regarding the true-effectiveness of the remaining 85% (12/14) of NHS-accredited mental health apps. The majority of depression and anxiety apps accredited by the NHS Apps Library have no tangible evidence of outcomes to substantiate their claims. Room for concern? In 2013, a review of mHealth apps found that from 2003-2013 just 32 articles were published regarding depression apps, compared with a total of 1,536 available for download (Martínez-Pérez et al, 2013). While this finding of a high availability, but low underlying evidence-base is concerning, it could arguably be expected from the open and largely unregulated free-markets that are the app stores. In contrast, the apps under consideration here are the beneficiaries of a ‘seal of approval’ from a world-leading healthcare system, and as a result, the expectation is that they are of significantly greater quality. This is a worrying situation. Most of us would acknowledge that there is a perceived implicit level of quality that comes with accreditation or association with the NHS, with reputation and legitimacy of sources known to be highly correlated with app downloads (Dennison et al, 2013). Considering that 3 in 10 individuals with an untreated mental health issue currently opt to pay for treatments privately (We Need To Talk Coalition, 2011), the recommendation of, purchase and use of apps that are yet to demonstrate any objectively measurable benefits to users, is not only a potential waste of money, but could also potentially have a compounding and devastating effect on levels of anxiety in those with the greatest need and the least access to effective NHS-led mental health services. The NHS Apps Library has closed after just 2 years. Moving forward On the large part, the National Health Service provides a regulatory framework that is second to none, with the attention to detail, rigour and emphasis on safety, clinical quality and cost-effectiveness, seeing NICE tokened as the ‘4th hurdle’ to market access. Unfortunately it would appear that this same level of rigour has not been applied to the apps that the NHS has, until now, recommended to patients. Although the NHS is pushing for a 21st century approach to healthcare, it’s important that this isn’t achieved through a dilution of quality, and fortunately it would appear that the NHS are now taking this subject more seriously. As of October 16th, the NHS Choices Health Apps Library will officially cease to exist, with the National Information Board considering how alternative models for assessing and regulating health apps may be put in place, and ultimately how quality control can be improved. In the meantime, until such a framework exists, it’s imperative that those considering downloading mental health apps take a moment to weigh up the available evidence, in order to ensure that apps don’t result in more harm than good. Whilst the app store is often slim on technical information, and sifting through medical publications is far from ideal, there are some clear indications of quality to look out for: Firstly, apps supported by a mental health practitioner are on average more than twice as effective as those from non-practitioner led developers (Richards & Richardson, 2012) Secondly, apps with approval from other well-established regulatory bodies including the US Food and Drug Administration (FDA), can act as an intermediary quality control and help separate those apps which offer users hope, and those which offer real proven solutions Thirdly, are apps forthcoming with the information they provide? It’s easy enough to say ‘this app beats depression’ but do they offer any proof to turn this from what is essentially marketing into evidence of clinical effectiveness? Finally, it’s worth re-enforcing, that not all mental-health apps are created equally, and that some, designed with clinical quality and effectiveness in mind, are providing real solutions and support to their users. One such app, ‘Big White Wall’ boasts recovery rates of 58%, which contrasts with the 44% exhibited by the NHS’s flagship ‘Increasing Access to Psychological Therapies’ (IAPT) initiative over the same period, demonstrating that if done properly, apps really can improve people’s mental health, at a low cost and from the comfort of their own home. Primary paper Leigh S, Flatt S. App-based psychological interventions: friend or foe? Evidence Based Mental Health 2015 doi:10.1136/eb-2023-102203 Other references Cooper, C. (2014) Thousands attempt suicide while on NHS waiting list for psychological help. Independent, 16 Sep 2014. Guidance to support the introduction of access and waiting time standards for mental health services in 2015/16 (29 page PDF). NHS England, 2015. We still need to talk A report on access to talking therapies (40 page PDF). We Need To Talk Coalition, 2013. We need to talk: getting the right therapy at the right time (32 page PDF). We Need To Talk Coalition, 2011. Murphy D, Busuttil W. (2014) PTSD, stigma and barriers to help-seeking within the UK Armed Forces (6 ppage PDF). J R Army Med Corps 2014;0:1–5. doi:10.1136/jramc-2023-000344 Generalised Anxiety Disorder Assessment (GAD 7). Patient website, last accessed 12 Oct 2015. Martínez-Pérez B, de la Torre-Díez I, López-Coronado M. (2013) Mobile Health Applications for the Most Prevalent Conditions by the World Health Organization: Review and Analysis. J Med Internet Res 2013;15(6):e120 DOI: 10.2196/jmir.2600 Dennison L, Morrison L, Conway G, Yardley L. (2013) Opportunities and Challenges for Smartphone Applications in Supporting Health Behavior Change: Qualitative Study. J Med Internet Res 2013;15(4):e86 DOI: 10.2196/jmir.2583 Richards D, Richardson T. (2012)
Computer-based psychological treatments for depression: a
systematic review and meta-analysis. Clin Psychol Rev. 2012
Jun;32(4):329-42. doi: 10.1016/j.cpr.2012.02.004. Epub 2012
Feb 28. [PubMed
abstract] “Are you sure? You tend to have a bad memory.” “It’s all in your head.” Does your partner repeatedly say things like this to you? Do you often start questioning your own perception of reality, even your own sanity, within your relationship? If so, your partner may be using what mental health professionals call “gaslighting.” This term comes from the 1938 stage play Gas Light, in which a husband attempts to drive his wife crazy by dimming the lights (which were powered by gas) in their home, and then he denies that the light changed when his wife points it out. It is an extremely effective form of emotional abuse that causes a victim to question their own feelings, instincts, and sanity, which gives the abusive partner a lot of power (and we know that abuse is about power and control). Once an abusive partner has broken down the victim’s ability to trust their own perceptions, the victim is more likely to stay in the abusive relationship. There are a variety of gaslighting techniques that an abusive partner might use: Withholding: the abusive partner pretends not to understand or refuses to listen. Ex. “I don’t want to hear this again,” or “You’re trying to confuse me.” Countering: the abusive partner questions the victim’s memory of events, even when the victim remembers them accurately. Ex. “You’re wrong, you never remember things correctly.” Blocking/Diverting: the abusive partner changes the subject and/or questions the victim’s thoughts. Ex. “Is that another crazy idea you got from [friend/family member]?” or “You’re imagining things.” Trivializing: the abusive partner makes the victim’s needs or feelings seem unimportant. Ex. “You’re going to get angry over a little thing like that?” or “You’re too sensitive.” Forgetting/Denial: the abusive partner pretends to have forgotten what actually occurred or denies things like promises made to the victim. Ex. “I don’t know what you’re talking about,” or “You’re just making stuff up.” Gaslighting typically happens very gradually in a relationship; in fact, the abusive partner’s actions may seem harmless at first. Over time, however, these abusive patterns continue and a victim can become confused, anxious, isolated, and depressed, and they can lose all sense of what is actually happening. Then they start relying on the abusive partner more and more to define reality, which creates a very difficult situation to escape. In order to overcome this type of abuse, it’s important to start recognizing the signs and eventually learn to trust yourself again. According to author and psychoanalyst Robin Stern, Ph.D., the signs of being a victim of gaslighting include:
If any of these signs ring true for
you, give us a call at 1-800-799-7233 or chat with us online
from 7 a.m.-2 a.m. CT. Our advocates are here to support and
listen to you. Tags: emotional abuse, When
the Hospital Fires the Bullet When doctors and nurses arrived at Room 834 just after 11 a.m., a college student admitted to the hospital hours earlier lay motionless on the floor, breathing shallowly, a sheet draped over his body. A Houston police officer with a cut on his head was being helped onto a stretcher, while another hovered over the student. Blood smeared the floor and walls. “What happened?” asked Dr. Daniel Arango, a surgical resident at the hospital, St. Joseph Medical Center. The student, 26-year-old Alan Pean,
had come to the hospital for treatment of possible
bipolar
disorder Soon, from inside the room, there was shouting, sounds of a scuffle and a loud pop. During an altercation, two off-duty Houston police officers, moonlighting as security guards, had shocked Mr. Pean with a Taser, fired a bullet into his chest, then handcuffed him.
FEB. 12, 2016 “I thought of the hospital as a beacon, a safe haven,” said Mr. Pean, who survived the wound just millimeters from his heart last Aug. 27. “I can’t quite believe that I ended up shot.” Like Mr. Pean, patients seeking help at hospitals across the country have instead been injured or killed by those guarding the institutions. Medical centers are not required to report such encounters, so little data is available and health experts suspect that some cases go unnoticed. Police blotters, court documents and government health reports have identified more than a dozen in recent years. They have occurred as more and more American hospitals are arming guards with guns and Tasers, setting off a fierce debate among health care officials about whether such steps — along with greater reliance on law enforcement or military veterans — improve safety or endanger patients. The same day Mr. Pean was shot, a
patient with mental
health problems Hospitals can be dangerous places.
From 2012 to 2014, health care institutions reported a 40
percent increase in violent crime, with more than 10,000
incidents mostly directed at employees, according
to a survey To protect their corridors, 52 percent
of medical centers reported that their security personnel
carried handguns and 47 percent said they used Tasers,
according to a 2014
national survey Massachusetts General Hospital in Boston, for example, sends some of its security officers through the state police academy, but the strongest weapon they carry is pepper spray, which has been used only 11 times in 10 years. In New York City’s public hospital system, which runs several of the 20 busiest emergency rooms in the country, security personnel carry nothing more than plastic wrist restraints. (Like many other hospitals, the system coordinates with the local police for crises its staff cannot handle.) “Tasers and guns send a bad message in a health care facility,” said Antonio D. Martin, the system’s executive vice president for security. “I have some concerns about even having uniforms because I think that could agitate some patients.” But many hospitals say that with proper safeguards — some restrict armed officers to high-risk areas like emergency rooms and parking areas — and supervision, weapons save lives and defuse threatening situations. The Cleveland Clinic, which has placed metal detectors in its emergency room, has its own fully armed police force and hires off-duty officers as well. The University of California medical centers at Irvine and San Diego and small community hospitals are among the more than 200 facilities that use stun guns produced by Taser International, which has courted hospitals as a lucrative new market. “I’ve worked in systems where everyone has a firearm and an intermediate weapon, and I’ve worked in systems where a call to security meant the plumber and every able-bodied man would respond,” said David LaRose, past president of the health care security association. “How much has your system thought about safety and security? In some places that’s a 2 or 3; in some places it’s a 10.” After Mr. Pean’s shooting, St. Joseph’s chief executive, Mark Bernard, said the officers were “justified.” The hospital said it was reviewing its practices but declined to respond to questions. The Houston Police Department, citing an internal investigation, declined to comment or to make the officers available for interviews, and released only a heavily redacted version of its report on the shooting. This account is drawn from a review by federal health investigators, medical records, criminal complaints and interviews with medical personnel and family members. Mr. Pean had expected an apology after the shooting. Instead, during four days in intensive care, prosecutors charged him with two counts of felony assault on a police officer. They accused him of attacking with four “deadly weapons” — an unspecified piece of furniture, a wall fixture, a tray table and his hands. James Kennedy, a lawyer representing Mr. Pean, says his client disputes that he was the aggressor and other allegations by the police, but cannot discuss specifics until the charges are resolved. His family has filed complaints with the Justice Department and health care regulators, including the Centers for Medicare and Medicaid Services, which provides funding to most American hospitals. After an emergency investigation, the Medicare agency faulted St. Joseph for the shooting, saying it had created “immediate jeopardy to the health and safety of its patients.” Threatening to withdraw federal money, the agency demanded restrictions on the use of weapons. A family with Haitian and Mexican roots who settled in McAllen, Tex., the Peans were shocked that Mr. Pean’s effort to get medical aid ended so badly. Though his father, Harold Pean, and a half-dozen other relatives are physicians, they said they had no idea that guns could be used against patients. After watching the nation roiled by the shootings of unarmed black men by police officers over the last year or so, the family now wonders whether race contributed to Alan’s near-fatal encounter. “We never thought that would happen to us,” Dr. Pean said. ‘I’m Manic!’ In his family of high-achievers, Alan Pean (pronounced PAY-on) is the soft-spoken and mellow middle sibling, into yoga, video games and pickup football. Christian, 28, now a medical student at Mount Sinai in New York, is the Type A leader; Dominique, 24, is following his path, applying to medical school while pursuing a master’s degree. Alan, who had never been in any sort of trouble, is “probably the nicest of us three,” Dominique said. Like many people with mental health issues, he did not get a clear-cut diagnosis. After a brief delusional episode in 2008, he was hospitalized for a more severe recurrence the next year, at the end of his second year at the University of Texas. He was kept for a week and told that he had possible bipolar disorder, though his symptoms did not reappear for years even after he tapered off medication. He was prone to bouts of sadness and anxiety, he recalled in an interview, but had attended college, taking breaks from time to time, and worked for a while as a medical assistant back home in McAllen, near the Mexican border. Though he had smoked marijuana regularly to help tame his symptoms, he said in an interview, he quit last summer when he enrolled at the University of Houston to complete his bachelor’s degree. Just days into the semester, though, he barely slept and found himself increasingly agitated and delusional. On Aug. 26, he talked repeatedly on the phone with his parents and brothers, who tried to calm him but worried that he sounded disoriented. Christian had been concerned enough that he called the Houston police to do a “welfare check” on his brother at his apartment, though no one answered the door when officers arrived. When Mr. Pean sounded worse in the evening, his family summoned a fraternity brother in Houston to take him to an emergency room; his parents would fly in the next morning. But Mr. Pean did not wait. His mind vacillating between the knowledge that he needed psychiatric medication and encroaching delusions that he was a Barack Obama impersonator or a “Cyborg robot agent” who was being pursued by assassins, he said, he got into his white Lexus and drove at high speed to St. Joseph Medical Center, the only major hospital in downtown Houston. Turning into the parking lot just before midnight, he crashed, nearly totaling his vehicle. As Mr. Pean was helped into the emergency room and onto a stretcher by paramedics and nurses, he recalled, he yelled: “I’m manic! I’m manic!” Alan Pean’s white Lexus. He struck several cars after driving himself to St. Joseph Medical Center for treatment of possible bipolar disorder. Prosecutors later charged him with reckless driving. He was seen immediately by a doctor from the trauma team to assess his injuries (scans and exams showed none). The physician’s initial note, minutes after arrival, lists the young man’s history of bipolar disorder. His father and brother, in separate phone calls to the emergency room, and a family friend who came to the hospital, alerted the staff about his psychiatric issues, they recalled. Nonetheless, Mr. Pean was admitted for
observation to Room 834 on a surgical floor. The diagnoses:
hand abrasion, substance
abuse While St. Joseph does have a
psychiatric ward, Mr. Pean was never seen by a psychiatrist
or prescribed any psychiatric medicines before the shooting.
Because he had complained of back pain, he was given
Flexeril, a muscle relaxant, which can exacerbate
psychotic
In interviews with the Medicare investigators and notations in medical records, the nurses who cared for Mr. Pean describe a man who had flashes of lucidity, but was increasingly restless and bizarre. He pulled out the IV in his arm. He thought it was 1989. He could not remember the car crash or why he was in a hospital. But even in the throes of his illness, he was polite. When a nurse told him to return to his room after he repeatedly emerged naked into the hall, he complied, she told investigators, with a “Yes ma’am, righty-o, O.K. ma’am.” ‘No Clear Guidance’ Though the trauma team had planned to discharge Mr. Pean that morning, his parents were so alarmed when they arrived about 10 a.m. that they insisted a psychiatrist see him. As they waited for doctors to discuss their concerns, the Peans went to their nearby hotel to try to rent a car and drive their son to a psychiatric facility. In their 30-minute absence, a nurse made the call to security. At St. Joseph Medical Center, the security force included armed off-duty police officers as well as unarmed civilian officers. Who responded to a call depended only on availability, according to the investigators’ interview with the chief nursing officer. The two men who arrived were Houston police officers. Roggie V. Law, 53, who is white, and Oscar Ortega, 44, who is Latino, each had decades on the force. They supplemented their base salaries of about $64,000 by moonlighting at the hospital. Their records were unremarkable. Both had some commendations, and Officer Ortega had one distant four-day suspension for failing to submit an accident report. Houston police officers get 40 hours of crisis intervention training, according to the department. The N.A.A.C.P. and the Greater Houston Coalition for Justice, a civil rights group, have complained that local officers too often use their weapons, and repeatedly requested the appointment of an independent police review board. From 2008 to 2012, there were 121 police shootings, in which a quarter of the victims were unarmed, according to an investigation by The Houston Chronicle. The two off-duty officers had signed on with Criterion Healthcare Security, a four-year-old staffing agency based in Tennessee whose executives had previously managed prisons and owned gyms. Their training at St. Joseph consisted of an orientation and online instruction, which investigators found inadequate. “The facility had no clear guidance for the role, duties and responsibilities of the police officers they employ to provide security services,” the Medicare investigators’ report said. Like many other security firms, Criterion encourages applications from those with law enforcement or military backgrounds, who are trained to use weapons and to deal with volatile situations. But working in health care settings requires a different mind-set, security experts emphasize. “If they come from law enforcement or the military, I ask them directly, ‘How would you respond differently here than if you encountered a criminal on a street in L.A. or when you are kicking down a door in Iraq?’” said Scott Martin, the security director at the University of California, Irvine, Medical Center. “You have to send the message that these are patients, they’re sick, the mental health population has rights — and you need to be sensitive to that.” Many mental health professionals
strongly object to weapons in hospitals, saying they have
numerous other means — from talk therapy to cloth
restraints and seclusion rooms to quick-acting shots of
sedatives
Uniforms and weapons may, in fact, exacerbate delusions, since many psychotic patients are paranoid and, like Alan Pean, believe they are being pursued. Anthony O’Brien, a researcher at the University of Auckland, in New Zealand, said, “That’s not a good thing, pointing something that looks like a gun at a patient with mental health issues.” When the two Houston officers arrived on St. Joseph’s eighth floor, they headed for Room 834. Unannounced, and unaccompanied by doctors, nurses or social workers, they went in, the door closing behind them. Anxious Patient to Felony Suspect Racing upstairs to a Code Blue in Room 834, Dr. Arango found a cluster of about 20 Houston police officers in the hall, according to his interview with investigators. When he pulled back the sheet covering Mr. Pean, he saw that the patient was in handcuffs, his torso dotted with Taser probes and a bloody wound on his upper chest. It was only after the doctor noted the blood pooling around the young man, who began shouting that he was Superman as the physician tried to examine the wound, that someone mentioned he had not only been hit with the Taser, but also shot. Mr. Pean’s X-ray, taken several days after he was shot, showing bruised lungs and bullet fragments scattered through his chest. Initially combative and flailing, Mr. Pean allowed a staff member to start an IV as she told him: “It’s O.K., Alan, I’m a nurse. We’re here to help.” Within minutes, doctors placed him on a ventilator, inserted a tube into his chest and whisked him away for a scan, which showed that the bullet had fractured his fifth and sixth ribs, scattering metal fragments and causing extensive bleeding as it ripped through his chest. According to a statement on the Police Department’s website, Alan struck one officer in the head, causing a laceration, when they arrived in the room. Officer Law shocked the patient with a Taser, to no apparent effect, and then Officer Ortega, fearing for their safety, shot Mr. Pean. After the shooting, his father said officers asked over and over if Alan had a criminal record. The next day, Christian Pean asked Sgt. Steve Murdock, a Houston police investigator, why the officers had to shoot his brother. In a phone conversation, Christian recalled, the sergeant replied, “Let’s just say the term ‘Tasmanian devil’ comes to mind.” “It was like a big whirlwind,” he went on. “Everything was fair game. Objects, chairs, eating trays, everything was being thrown.” An ambiguity in Medicare rules allowed Alan Pean’s conversion from delusional patient to felony suspect. If a patient throws a tray at a nurse and the staff responds with restraints, it can be considered a health care incident. If the same patient throws the same tray at a police officer, even one off-duty, who shoots in response, the encounter is subject to a criminal investigation. While Mr. Pean was in the intensive care unit, he was handcuffed to his bed, even though he was heavily sedated, with a Houston police officer standing guard. His family had to post $60,000 bail days later so he could be discharged from the hospital. Mr. Pean’s felony case is likely to go before a grand jury in the coming months. Under the care of a psychiatrist and on medication, Mr. Pean left Texas behind. Living with his brother in New York, he is finishing his degree at Hunter College and planning to go to graduate school in public health. But the day before Christmas, Mr. Pean learned that prosecutors had brought a new charge — reckless driving — against him, referring to his race to the hospital. Accompanied by his father, he flew to Houston. In five hours of processing at the Harris County Detention Center, Mr. Pean was interviewed by a detention officer, photographed for a mug shot and fingerprinted. “Being paraded around was really stressful,” he said. “Did they not understand what I’d gone through? I’d been shot in a hospital room by an officer.” A version of this article appears in
print on February 14, 2016, on Page A1 of the New York
edition with the headline: When the Hospital Fires the
Bullet. Order Reprints| Today's Paper|Subscribe 5 ways to support
student mental health during the end of the semester Letter
to Parents Dear students, parents, and community, We know that you put your trust in us every day to keep students safe, and we take that trust seriously. Student suicide is a public health issue that has affected communities like ours, and it’s crucial that we continue to take action to prevent further tragedies. One way that we’re working to keep students safe is by sharing resources with a proven track record, like Crisis Text Line. Crisis Text Line is the free, nationwide, 24/7 text message service for people in crisis. Anyone in the United States can text 741741 to reach a trained Crisis Counselor. More information on how the service works can be found on the organization’s website at crisistextline.org/how-it-works. We recognize that a new service may raise a lot of questions, and welcome you to learn more at crisistextline.org/faqs, where you’ll find answers to the most common questions. Confidentiality is a key tenet of Crisis Text Line’s work: conversations are kept between the texter, the Crisis Counselor, and the staff supervisor monitoring it. The Terms of Service at crisistextline.org/terms further explain confidentiality policy, as well as how and when exceptions are made to protect texters in imminent risk. While we encourage students to use this resource when they need it, we hope it will be only one part of a holistic suicide prevention effort. Another crucial part of this effort is having tough, but necessary, conversations about suicide as soon as you have reason to be concerned. More information about the warning signs and risk factors of suicide, as well as how to talk to a loved one who may be at risk, can be found at afsp.org. It’s understandable to prefer that someone you care about would come to you rather than an anonymous service. For many young people, Crisis Text Line can serve as a stepping stone to telling a parent or other trusted adult about what they’re feeling. We hope you’ll encourage the students in your life to seek help in whatever form they’re comfortable with, including but not limited to Crisis Text Line. Please don’t hesitate to be in touch with any questions you have about suicide prevention efforts in the Brookings-Harbor School District. Warm regards, If a person is drowning would you try to save them? If a person begins choking next to you at a restaurant, would you try to save their life with a Heimlich maneuver? Dr. Campbell discusses the new use of the old anesthesia drug Ketamine that has been shown to decrease suicidal tendencies in severely depressed patients. He explains the use of this drug to provide a pharmaceutical lifeboat that may other treatment modalities time to take effect. Dr. Joe Campbell is an anesthesiologist, medical director of the surgery suite, and a chief medical officer of Forrest General Hospital in Hattiesburg, MS. He has been a practicing board certified anesthesiologist for almost 30 years and has broad experience with all aspects of anesthesia which include pediatric, cardiovascular, vascular, neuro, and orthopedics. He holds a Medical Degree from the University of Mississippi and completed a residency at the University of Texas Medical Branch. This talk was given at a TEDx event
using the TED conference format but independently organized
by a local community. Learn more at http://ted.com/tedx Mental Health
Medications Medications can play a role in treating several mental disorders and conditions. Treatment may also include psychotherapy (also called “talk therapy”) and brain stimulation therapies (less common). In some cases, psychotherapy alone may be the best treatment option. Choosing the right treatment plan should be based on a person's individual needs and medical situation, and under a mental health professional’s care. The National Institute of Mental Health (NIMH), a Federal research agency, does not provide medical advice or referrals. Resources that may help you find treatment services in your area are listed on our Help for Mental Illnesses web page. NIMH also does not endorse or recommend any particular drug, herb, or supplement. Results from NIMH-supported clinical research trials (What are Clinical Research Trials?) that examine the effectiveness of treatments, including medications, are reported in the medical literature. This health topic webpage is intended to provide basic information about mental health medications. It is not a complete source for all medications available and should not be used as a guide for making medical decisions. Information about medications changes frequently. Check the U.S. Food and Drug Administration (FDA) website for the latest warnings, patient medication guides, or newly approved medications. Brand names are not referenced on this page, but you can search by brand name on MedlinePlus Drugs, Herbs and Supplements Drugs website. The MedlinePlus website also provides additional information about each medication, including side effects and FDA warnings. Understanding Your Medications If you are prescribed a medication, be sure that you:
Antidepressants What are antidepressants? Antidepressants are medications commonly used to treat depression. Antidepressants are also used for other health conditions, such as anxiety, pain and insomnia. Although antidepressants are not FDA-approved specifically to treat ADHD, antidepressants are sometimes used to treat ADHD in adults. The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Examples of SSRIs include:
Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are similar to SSRIs and include venlafaxine and duloxetine. Another antidepressant that is commonly used is bupropion. Bupropion is a third type of antidepressant which works differently than either SSRIs or SNRIs. Bupropion is also used to treat seasonal affective disorder and to help people stop smoking. SSRIs, SNRIs, and bupropion are popular because they do not cause as many side effects as older classes of antidepressants, and seem to help a broader group of depressive and anxiety disorders. Older antidepressant medications include tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs). For some people, tricyclics, tetracyclics, or MAOIs may be the best medications. How do people respond to antidepressants? According to a research review by the Agency for Healthcare Research and Quality, all antidepressant medications work about as well as each other to improve symptoms of depression and to keep depression symptoms from coming back. For reasons not yet well understood, some people respond better to some antidepressant medications than to others. Therefore, it is important to know that some people may not feel better with the first medicine they try and may need to try several medicines to find the one that works for them. Others may find that a medicine helped for a while, but their symptoms came back. It is important to carefully follow your doctor’s directions for taking your medicine at an adequate dose and over an extended period of time (often 4 to 6 weeks) for it to work. Once a person begins taking antidepressants, it is important to not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and stop taking the medication too soon, and the depression may return. When it is time to stop the medication, the doctor will help the person slowly and safely decrease the dose. It's important to give the body time to adjust to the change. People don't get addicted (or "hooked") on these medications, but stopping them abruptly may also cause withdrawal symptoms What are the possible side effects of antidepressants? Some antidepressants may cause more side effects than others. You may need to try several different antidepressant medications before finding the one that improves your symptoms and that causes side effects that you can manage. The most common side effects listed by the FDA include:
Call your doctor right away if you have any of the following symptoms, especially if they are new, worsening, or worry you(U.S. Food and Drug Administration, 2011):
Combining the newer SSRI or SNRI antidepressants with one of the commonly-used "triptan" medications used to treat migraine headaches could cause a life-threatening illness called "serotonin syndrome." A person with serotonin syndrome may be agitated, have hallucinations (see or hear things that are not real), have a high temperature, or have unusual blood pressure changes. Serotonin syndrome is usually associated with the older antidepressants called MAOIs, but it can happen with the newer antidepressants as well, if they are mixed with the wrong medications. For more information, please see the FDA Medication Guide on Antidepressant Medicines (Broken) Antidepressants may cause other side effects that were not included in this list. To report any serious adverse effects associated with the use of antidepressant medicines, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects for each medication, please see Drugs@FDA. Anti-Anxiety Medications What are anti-anxiety medications? Anti-anxiety medications help reduce the symptoms of anxiety, such as panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Benzodiazepines can treat generalized anxiety disorder. In the case of panic disorder or social phobia (social anxiety disorder), benzodiazepines are usually second-line treatments, behind SSRIs or other antidepressants. Benzodiazepines used to treat anxiety disorders include:
Short half-life (or short-acting) benzodiazepines (such as Lorazepam) and beta-blockers are used to treat the short-term symptoms of anxiety. Beta-blockers help manage physical symptoms of anxiety, such as trembling, rapid heartbeat, and sweating that people with phobias (an overwhelming and unreasonable fear of an object or situation, such as public speaking) experience in difficult situations. Taking these medications for a short period of time can help the person keep physical symptoms under control and can be used “as needed” to reduce acute anxiety. Buspirone (which is unrelated to the benzodiazepines) is sometimes used for the long-term treatment of chronic anxiety. In contrast to the benzodiazepines, buspirone must be taken every day for a few weeks to reach its full effect. It is not useful on an “as-needed” basis. How do people respond to anti-anxiety medications? Anti-anxiety medications such as benzodiazepines are effective in relieving anxiety and take effect more quickly than the antidepressant medications (or buspirone) often prescribed for anxiety. However, people can build up a tolerance to benzodiazepines if they are taken over a long period of time and may need higher and higher doses to get the same effect. Some people may even become dependent on them. To avoid these problems, doctors usually prescribe benzodiazepines for short periods, a practice that is especially helpful for older adults (read the NIMH article: Despite Risks, Benzodiazepine Use Highest in Older People), people who have substance abuse problems and people who become dependent on medication easily. If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly. What are the possible side effects of anti-anxiety medications? Like other medications, anti-anxiety medications may cause side effects. Some of these side effects and risks are serious. The most common side effects for benzodiazepines are drowsiness and dizziness. Other possible side effects include:
Tell your doctor if any of these symptoms are severe or do not go away:
If you experience any of the symptoms below, call your doctor immediately:
Common side effects of beta-blockers include:
Beta-blockers generally are not recommended for people with asthma or diabetes because they may worsen symptoms related to both. Possible side effects from buspirone include:
Anti-anxiety medications may cause other side effects that are not included in the lists above. To report any serious adverse effects associated with the use of these medicines, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects for each medication, please see Drugs@FDA. Stimulants What are Stimulants? As the name suggests, stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration (National Institute on Drug Abuse, 2014). Stimulant medications are often prescribed to treat children, adolescents, or adults diagnosed with ADHD. Stimulants used to treat ADHD include:
Note: In 2002, the FDA approved the non-stimulant medication atomoxetine for use as a treatment for ADHD. Two other non-stimulant antihypertensive medications, clonidine and guanfacine, are also approved for treatment of ADHD in children and adolescents. One of these non-stimulant medications is often tried first in a young person with ADHD, and if response is insufficient, then a stimulant is prescribed. Stimulants are also prescribed to treat other health conditions, including narcolepsy, and occasionally depression (especially in older or chronically medically ill people and in those who have not responded to other treatments). How do people respond to stimulants? Prescription stimulants have a calming and “focusing” effect on individuals with ADHD. Stimulant medications are safe when given under a doctor's supervision. Some children taking them may feel slightly different or "funny." Some parents worry that stimulant medications may lead to drug abuse or dependence, but there is little evidence of this when they are used properly as prescribed. Additionally, research shows that teens with ADHD who took stimulant medications were less likely to abuse drugs than those who did not take stimulant medications. What are the possible side effects of stimulants? Stimulants may cause side effects. Most side effects are minor and disappear when dosage levels are lowered. The most common side effects include:
Less common side effects include:
Call your doctor right away if you have any of these symptoms, especially if they are new, become worse, or worry you. Stimulants may cause other side effects that are not included in the list above. To report any serious adverse effects associated with the use of stimulants, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects for each medication, please see Drugs@FDA. Antipsychotics What are antipsychotics? Antipsychotic medicines are primarily used to manage psychosis. The word “psychosis” is used to describe conditions that affect the mind, and in which there has been some loss of contact with reality, often including delusions (false, fixed beliefs) or hallucinations (hearing or seeing things that are not really there). It can be a symptom of a physical condition such as drug abuse or a mental disorder such as schizophrenia, bipolar disorder, or very severe depression (also known as “psychotic depression”). Antipsychotic medications are often used in combination with other medications to treat delirium, dementia, and mental health conditions, including:
Antipsychotic medicines do not cure these conditions. They are used to help relieve symptoms and improve quality of life. Older or first-generation antipsychotic medications are also called conventional "typical" antipsychotics or “neuroleptics”. Some of the common typical antipsychotics include:
Newer or second generation medications are also called "atypical" antipsychotics. Some of the common atypical antipsychotics include:
According to a 2013 research review by the Agency for Healthcare Research and Quality, typical and atypical antipsychotics both work to treat symptoms of schizophrenia and the manic phase of bipolar disorder. Several atypical antipsychotics have a “broader spectrum” of action than the older medications, and are used for treating bipolar depression or depression that has not responded to an antidepressant medication alone. To find additional antipsychotics and other medications used to manage psychoses and current warnings and advisories, please visit the FDA website. How do people respond to antipsychotics? Certain symptoms, such as feeling agitated and having hallucinations, usually go away within days of starting an antipsychotic medication. Symptoms like delusions usually go away within a few weeks, but the full effects of the medication may not be seen for up to six weeks. Every patient responds differently, so it may take several trials of different antipsychotic medications to find the one that works best. Some people may have a relapse—meaning their symptoms come back or get worse. Usually relapses happen when people stop taking their medication, or when they only take it sometimes. Some people stop taking the medication because they feel better or they may feel that they don't need it anymore, but no one should stop taking an antipsychotic medication without talking to his or her doctor.When a doctor says it is okay to stop taking a medication, it should be gradually tapered off— never stopped suddenly. Many people must stay on an antipsychotic continuously for months or years in order to stay well; treatment should be personalized for each individual. What are the possible side effects of antipsychotics? Antipsychotics have many side effects (or adverse events) and risks. The FDA lists the following side effects of antipsychotic medicines:
Typical antipsychotic medications can also cause additional side effects related to physical movement, such as:
Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements, commonly around the mouth, that a person can't control. TD can range from mild to severe, and in some people, the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking typical antipsychotic medication. People who think that they might have TD should check with their doctor before stopping their medication. TD rarely occurs while taking atypical antipsychotics. Antipsychotics may cause other side effects that are not included in this list above. To report any serious adverse effects associated with the use of these medicines, please contact the FDA MedWatch program. For more information about the risks and side effects for antipsychotic medications, please visit Drugs@FDA. Mood Stabilizers What are mood stabilizers? Mood stabilizers are used primarily to treat bipolar disorder, mood swings associated with other mental disorders, and in some cases, to augment the effect of other medications used to treat depression. Lithium, which is aneffective mood stabilizer, is approved for the treatment of mania and the maintenance treatment of bipolar disorder. A number of cohort studies describe anti-suicide benefits of lithium for individuals on long-term maintenance. Mood stabilizers work by decreasing abnormal activity in the brain and are also sometimes used to treat:
Anticonvulsant medications are also used as mood stabilizers. They were originally developed to treat seizures, but they were found to help control unstable moods as well. One anticonvulsant commonly used as a mood stabilizer is valproic acid (also called divalproex sodium). For some people, especially those with “mixed” symptoms of mania and depression or those with rapid-cycling bipolar disorder, valproic acid may work better than lithium. Other anticonvulsants used as mood stabilizers include:
What are the possible side effects of mood stabilizers? Mood stabilizers can cause several side effects, and some of them may become serious, especially at excessively high blood levels. These side effects include:
If a person with bipolar disorder is being treated with lithium, he or she should visit the doctor regularly to check the lithium levels his or her blood, and make sure the kidneys and the thyroid are working normally. Lithium is eliminated from the body through the kidney, so the dose may need to be lowered in older people with reduced kidney function. Also, loss of water from the body, such as through sweating or diarrhea, can cause the lithium level to rise, requiring a temporary lowering of the daily dose. Although kidney functions are checked periodically during lithium treatment, actual damage of the kidney is uncommon in people whose blood levels of lithium have stayed within the therapeutic range. Mood stabilizers may cause other side effects that are not included in this list. To report any serious adverse effects associated with the use of these medicines, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects for each individual medication, please see Drugs@FDA. For more information on the side effects of Carbamazepine, Lamotrigine, and Oxcarbazepine, please visit MedlinePlus Drugs, Herbs and Supplements. Some possible side effects linked anticonvulsants (such as valproic acid) include:
These medications may also:
For more information about the risks and side effects for each medication, please see Drugs@FDA Special Groups: Children, Older Adults, Pregnant Women All types of people take psychiatric medications, but some groups have special needs, including:
Many medications used to treat children and adolescents with mental illness are safe and effective. However, some medications have not been studied or approved for use with children or adolescents. Still, a doctor can give a young person an FDA-approved medication on an "off-label" basis. This means that the doctor prescribes the medication to help the patient even though the medicine is not approved for the specific mental disorder that is being treated or for use by patients under a certain age. Remember:
In addition to medications, other treatments for children and adolescents should be considered, either to be tried first, with medication added later if necessary, or to be provided along with medication. Psychotherapy, family therapy, educational courses, and behavior management techniques can help everyone involved cope with disorders that affect a child’s mental health. Read more about child and adolescent mental health research. Older Adults People over 65 have to be careful when taking medications, especially when they’re taking many different drugs. Older adults have a higher risk for experiencing bad drug interactions, missing doses, or overdosing. Older adults also tend to be more sensitive to medications. Even healthy older people react to medications differently than younger people because older people's bodies process and eliminate medications more slowly. Therefore, lower or less frequent doses may be needed for older adults. Before starting a medication, older people and their family members should talk carefully with a physician about whether a medication can affect alertness, memory, or coordination, and how to help ensure that prescribed medications do not increase the risk of falls. Sometimes memory problems affect older people who take medications for mental disorders. An older adult may forget his or her regular dose and take too much or not enough. A good way to keep track of medicine is to use a seven-day pill box, which can be bought at any pharmacy. At the beginning of each week, older adults and their caregivers fill the box so that it is easy to remember what medicine to take. Many pharmacies also have pill boxes with sections for medications that must be taken more than once a day. For more information and practical tips to help older people take their medicines safely, please see National Institute on Aging’s Safe Use of Medicines booklet and Taking Medicines on NIHSeniorHealth.gov. Women who are pregnant or who may become pregnant The research on the use of psychiatric medications during pregnancy is limited. The risks are different depending on which medication is taken, and at what point during the pregnancy the medication is taken. Decisions on treatments for all conditions during pregnancy should be based on each woman's needs and circumstances, and based on a careful weighing of the likely benefits and risks of all available options, including psychotherapy (or “watchful waiting” during part or all of the pregnancy), medication, or a combination of the two. While no medication is considered perfectly safe for all women at all stages of pregnancy, this must be balanced for each woman against the fact that untreated serious mental disorders themselves can pose a risk to a pregnant woman and her developing fetus. Medications should be selected based on available scientific research, and they should be taken at the lowest possible dose. Pregnant women should have a medical professional who will watch them closely throughout their pregnancy and after delivery. Most women should avoid certain medications during pregnancy. For example: Mood stabilizers are known to cause birth defects. Benzodiazepines and lithium have been shown to cause "floppy baby syndrome," in which a baby is drowsy and limp, and cannot breathe or feed well. Benzodiazepines may cause birth defects or other infant problems, especially if taken during the first trimester. According to research, taking antipsychotic medications during pregnancy can lead to birth defects, especially if they are taken during the first trimester and in combination with other drugs, but the risks vary widely and depend on the type of antipsychotic taken. The conventional antipsychotic haloperidol has been studied more than others, and has been found not to cause birth defects. Research on the newer atypical antipsychotics is ongoing. Antidepressants, especially SSRIs, are considered to be safe during pregnancy. However, antidepressant medications do cross the placental barrier and may reach the fetus. Birth defects or other problems are possible, but they are very rare. The effects of antidepressants on childhood development remain under study. Studies have also found that fetuses exposed to SSRIs during the third trimester may be born with "withdrawal" symptoms such as breathing problems, jitteriness, irritability, trouble feeding, or hypoglycemia (low blood sugar). Most studies have found that these symptoms in babies are generally mild and short-lived, and no deaths have been reported. Risks from the use of antidepressants need to be balanced with the risks of stopping medication; if a mother is too depressed to care for herself and her child, both may be at risk for problems. In 2004, the FDA issued a warning against the use of certain antidepressants in the late third trimester. The warning said that doctors may want to gradually taper pregnant women off antidepressants in the third trimester so that the baby is not affected. After a woman delivers, she should consult with her doctor to decide whether to return to a full dose during the period when she is most vulnerable to postpartum depression. After the baby is born, women and their doctors should watch for postpartum depression, especially if a mother stopped taking her medication during pregnancy. In addition, women who nurse while taking psychiatric medications should know that a small amount of the medication passes into the breast milk. However, the medication may or may not affect the baby depending s on the medication and when it is taken. Women taking psychiatric medications and who intend to breastfeed should discuss the potential risks and benefits with their doctors. About the FDA The FDA is responsible for protecting the public health by ensuring the safety, efficacy and security of drugs (medications), biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation. FDA is also responsible for advancing public health by helping to speed innovations that make medicines more effective, safer, and more affordable and by helping the public get accurate science-based information they need to use medicines and foods to maintain and improve their health. Reporting Serious Problems to the FDA Visit FDA’s MedWatch to voluntarily report a serious adverse effect, product quality problem, product use error or product failure that you suspect is associated with the use of an FDA-regulated drug, biologic, medical device, dietary supplement or cosmetic. You can also report suspected counterfeit medical products to the FDA through MedWatch. You can also use the contact information provided below: 1-800-332-1088 Resources American Psychiatric Association
(APA) Federation of Families National Alliance for the Mentally Ill
(NAMI) National Mental Health Association
(NMHA) Mental Health
By The Numbers Download the following flyers: You are not alone | Mental Health Matters | Common Warning Signs of Mental Illness | It's okay to talk about suicide The information on these infographics and this page comes from studies conducted by organizations like Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Disease Control and Prevention (CDC) and the U.S. Department of Justice. The terminology used reflects what is used in original studies. Terms like “serious mental illness,” “mental illness” or “mental health disorders” may all seem like they’re referring to the same thing, but in fact refer to specific diagnostic groups for that particular study. If you have questions about a statistic or term that’s being used, please visit the original study by clicking the link provided.
You Are Not Alone
Mental Health Care Matters
The Ripple Effect Of Mental Illness PERSON
FAMILY
COMMUNITY
WORLD
It’s Okay To Talk About Suicide
Source: www.nami.org/Learn-More/Mental-Health-By-the-Numbers Three
Ways to Get Mental Health Help Anonymously
In the United States, almost half of adults will experience a mental illness during their lifetime. Of the people who had a mental illness in the past year, only 41 percent received mental health services to address them. According to the National Alliance on Mental Illness, there are often “long delays – sometimes decades – between the first appearance of symptoms and when people get help.” There can be several reasons, including access to resources, cost and the stigma associated with mental health problems. Despite living in a time where people are more open about their thoughts and feelings, people are still often ashamed to discuss mental health concerns and might be hesitant to seek treatment and support because of what others will think. But treatment and support are still needed. As a loved one or friend of someone who may be struggling, your role is to provide support and resources when possible. If they aren’t ready to seek help in person, that’s okay. You can share other resources and #BeTheDifference today. These are just a few resources to reach out for mental health support anonymously.
Talkspace: Connect to affordable and convenient resources that will help you understand your symptoms. Source: www.mentalhealthfirstaid.org/2019/08/three-ways-to-get-mental-health-help-anonymously/
Talking about mental health can be hard. It can be hard to admit that you’re not feeling okay, and even harder to ask for help. This is especially true when you’re a young person facing the pressure to look, act and be a certain way. But, it’s important to know that asking for help is okay. You don’t need to tell everyone, but there are some things that you shouldn’t keep a secret. If you or someone you know is struggling with a mental health or substance use challenge, connect with a responsible and trusted adult. Use these tips from teen Mental Health First Aid to find an adult you trust and reach out for help.
These tips are just a place to start. You can also be trained in Mental Health First Aid and learn about other ways to talk about your mental health and get the support you need. teen Mental Health First Aid (tMHFA) teaches high school students about common mental health challenges and empowers them with an action plan to support each other in times of need. Learn
more about this exciting new
program, run by the National Council and supported by Lady
Gaga’s Born This Way Foundation. Right now, select
schools across the country are training students in tMHFA.
We’re looking forward to expanding to more schools
across the country in the coming
years. Talking
to Your Family About Mental Health Even though it can be difficult and uncomfortable, it’s important to talk to your family about mental health. You are the person closest to them and may even see them every day. By breaking down barriers and having uncomfortable conversations when you perceive problems, you can be their resource to mental health support and treatment. When talking about mental health, try to talk to your family member at a time when you won’t be rushed in a quiet, comfortable space. If you’re not sure how to start the conversation or what to say, the best thing you can do is be honest and ask if they’re okay. Let them know that you care about them and their safety, and that you are concerned. Your family member might not want to talk right away, and that’s okay. Don’t pressure them to discuss their mental health. Instead, remind them that you’ll be there to support them whenever they are ready. If they do want to talk about it, continue the conversation and do your best to listen to their concerns and needs in a nonjudgmental way. Provide emotional support and offer information on self-help strategies and professional help. But most importantly, be there for your loved one. This is a difficult conversation to have, and it might be the first time they are acknowledging their mental health challenges. Show them love, compassion and patience. This video from Mental Health First Aid provides additional insight on how to navigate awkward conversations about mental health. If you’re still not sure what to do, take Mental Health First Aid. The course will teach you a concrete action plan for starting or continuing a conversation about mental health or substance use, and steps to help your loved ones find appropriate support. Having an initial conversation about
mental health is hard. But with every uncomfortable
conversation, we can address stigma, break down barriers and
help those closest to us when they need it most. Five
Tips for Nonjudgmental Listening
When you’re trying to be there for your friend, neighbor or colleague, it’s important to maintain a positive attitude and open mind to truly be supportive. Use these Mental Health First Aid tips to be an effective nonjudgmental listener for those around you.
These tips are just a place to start.
You can also get trained in Mental Health First Aid and
learn about other ways to listen nonjudgmentally and support
those around you. The MHFA Action Plan – ALGEE –
will help you approach and talk to a person in distress and
respond in a safe and effective way to get them the help
they need. Get
trained today and
#BeTheDifference in the lives of your loved
ones. Is
the Mental Health System Yet Another Form of Institutional
Racism? What is not being discussed is how the mental health system contributes to the human rights violations of minorities every day. Is it possible that the mental institution is just another venue for imprisoning Blacks unjustly? Similar to the prison system, Blacks and other minorities make up a disproportionate percentage of the inpatient population in both the US and United Kingdom. Rates of admission are approximately three times higher in minorities than in White or Asian ethnic groups. Racism, sexism, oppression, and classism are argued to be inherent throughout the mental health system. The American Psychiatric Association has long ago acknowledged the stereotypes and misconceptions replete within the psychiatric literature. Drapetomania, known to medical authorities in the early 19th century as a disease that caused “negroes” to run away from their slave owners, was accepted as a true mental disease that explained why slaves might not wish to be the “submissive knee bender” that God declared him to be. More recently, schizophrenia, in its very definition, became symbolized by the angry Black man and is consistently applied more often to immigrants and African Americans throughout the Western world. The diagnosis is predicted by experiences of chronic discrimination, oppression, and marginalization, yet is asserted to be a genetic disease that has nothing to do with one’s life circumstances. Though likely unintentional and out of clinicians’ awareness, there is also clear racial bias in the diagnostic process itself. Minorities are more likely to have more defeatist prognoses and to be given less opportunity for meaning-making and recovery than their white counterparts. The “objective” psychological tests designed to aid in diagnosis are more likely to inflate pathology among minority subjects. And, when minorities’ explanatory models for their distress is in disagreement with the leading medical authorities, they are said to be victims of “stigma” and “underdiagnosis” rather than as having a viewpoint worth listening to. For instance, Native Americans have traditionally incorporated a holistic and spiritual approach to addressing emotional distress, but this has increasingly been usurped by a medical model that sends the message that they “lack awareness” and education which prevent them from obtaining “appropriate” services. Interestingly, stigma is actually directly associated with a medicalized understanding of emotional distress. Descriptive terms that are more likely to encapsulate the oppressed minority, such as “paranoia” or “delusions of persecution”, are experiences often difficult to understand for a highly educated privileged White person. Minorities develop within a world that teaches them to hate themselves, to internalize messages that they will never be good enough, and that no matter how successful they become, they will never be, well, White. This is particularly interesting considering that chronic experiences of persecution and relative poverty are both major risk factors for psychosis as a young adult. The only things more robustly related to “schizophrenia” are childhood emotional and sexual abuse and bullying. Yet, the public is inundated with messages that mental illness, particularly schizophrenia, is a hereditary disease unrelated to one’s life circumstances. In response, such individuals are most often given a cocktail of dangerous drugs that may or may not help them cope with the unjust world around them. And, although it is known that different ethnicities metabolize drugs differently, which can lead to toxicity or reactive psychoses and/or mania, they are actually given more of these drugs than their White counterparts. Further, they are more often injected with neuroleptics and involuntarily detained as compared to Whites. Instead of addressing issues of
poverty, discrimination, and ethnic disparities, public
funds are diverted to efforts to increasingly take away such
individuals’ rights, medicalize their suffering, and
quiet their rantings lest they disturb the illusion of
justice and peace. As it stands, current mental health
policy and diagnostic practices represent a form of
institutionalized
racism. In the ongoing efforts
to raise awareness and bring police and prison reform,
society must also consider the needed reform to mental
health laws, practices, and assumptions. Until it is
fundamentally understood that Black lives matter, in the
mental health system too, the importance of life more
generally will never be truly appreciated. Take
a Mental Health Test The Depression Test is for individuals who are feeling overwhelming sadness. The depression test is also available in Spanish. Prueba de Depresion The Postpartum Depression Test is for new and expecting mothers who began feeling overwhelming sadness after becoming pregnant or giving birth. The Anxiety Test is for people who feel that worry and fear are affecting their ability to function day-to-day. The anxiety test is also available in Spanish. Prueba de Ansiedad The Psychosis Test is for young people (age 12-35) who feel like their brain is playing tricks on them (seeing, hearing or believing things that don't seem real or quite right). The Bipolar Test is for individuals who have mood swings - or unusual or extreme shifts in mood and energy. The Eating Disorder Test can help explore eating related concerns that have an impact on your physical health and overall well-being. The PTSD (Post Traumatic Stress Disorder) Test is for those who are bothered by a traumatic life event. The Parent Test is for parents of young people to determine if their child’s emotions, attention, or behaviors might be signs of a problem. The Youth Test is for young people (age 11-17) who are concerned that their emotions, attention, or behaviors might be signs of a problem. The Addiction Test (Alcohol and substance use test) will help determine if your use of alcohol or drugs is an area to address. The Work Health Survey is not a mental health screening, but a survey meant to help us identify strategies to help companies do better. The survey is updated annually. You can find information about the results of last year's survey here. The Young People's Mental Health Survey is not a mental health screening, but a survey meant to help us understand and address the needs of young people, particularly during the COVID-19 pandemic. Following screening, you will be provided with information, resources and tools to help you understand and improve your mental health. Please note: Online screening tools are meant to be a quick snapshot of your mental health. If your results indicate you may be experiencing symptoms of a mental illness, consider sharing your results with someone. A mental health provider (such as a doctor or a therapist) can give you a full assessment and talk to you about options for how to feel better. If you provide us your information and are in need of support, we will do our best to respond. However, we are not a crisis support line. If you are in need of immediate assistance, please call the National Suicide Prevention Hotline at 1-800-273-TALK, or text "MHA" to 741-741 to talk to a trained counselor from the Crisis Text Line. Warmlines are also an excellent place for support. For all other screening-related
questions and non-emergency support, please contact
screening@mhanational.org. Can
an Algorithm Prevent Suicide? 11/23/20 At a recent visit to the Veterans Affairs clinic in the Bronx, Barry, a decorated Vietnam veteran, learned that he belonged to a very exclusive club. According to a new A.I.-assisted algorithm, he was one of several hundred V.A. patients nationwide, of six million total, deemed at imminent risk of suicide. The news did not take him entirely off guard. Barry, 69, who was badly wounded in the 1968 Tet offensive, had already made two previous attempts on his life. “I don’t like this idea of a list, to tell you the truth — a computer telling me something like this,” Barry, a retired postal worker, said in a phone interview. He asked that his surname be omitted for privacy. “But I thought about it,” Barry said. “I decided, you know, OK — if it’s going to get me more support that I need, then I’m OK with it.” For more than a decade, health officials have watched in vain as suicide rates climbed steadily — by 30 percent nationally since 2000 — and rates in the V.A. system have been higher than in the general population. The trends have defied easy explanation and driven investment in blind analysis: machine learning, or A.I.-assisted algorithms that search medical and other records for patterns historically associated with suicides or attempts in large clinical populations. Doctors have traditionally gauged patients’ risks by looking at past mental health diagnoses and incidents of substance abuse, and by drawing on experience and medical instinct. But these evaluations fall well short of predictive, and the artificially intelligent programs explore many more factors, like employment and marital status, physical ailments, prescription history and hospital visits. These algorithms are black boxes: They flag a person as at high risk of suicide, without providing any rationale. But human intelligence isn’t necessarily better at the task. “The fact is, we can’t rely on trained medical experts to identify people who are truly at high risk,” said Dr. Marianne S. Goodman, a psychiatrist at the Veterans Integrated Service Network in the Bronx, and a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai. “We’re no good at it.” Deploying A.I. in this way is not new; researchers have been gathering data on suicides through the National Health Service in Britain since 1996. The U.S. Army, Kaiser Permanente and Massachusetts General Hospital each has separately developed a algorithm intended to predict suicide risk. But the V.A.’s program, called Reach Vet, which identified Barry as at high risk, is the first of the new U.S. systems to be used in daily clinical practice, and it is being watched closely. How these systems perform — whether they save lives and at what cost, socially and financially — will help determine if digital medicine can deliver on its promise. “It is a critical test for these big-data systems,” said Alex John London, the director of the Center for Ethics and Policy at Carnegie Mellon University in Pittsburgh. “If these things have a high rate of false positives, for instance, that marks a lot people at high risk who are not — and the stigma associated with that could be harmful indeed downstream. We need to be sure these risk flags lead to people getting better or more help, not somehow being punished.” The V.A.’s algorithm updates continually, generating a new list of high-risk veterans each month. Some names stay on the list for months, others fall off. When a person is flagged, his or her name shows up on the computer dashboard of the local clinic’s Reach Vet coordinator, who calls to arrange an appointment. The veteran’s doctor explains what the high-risk designation means — it is a warning sign, not a prognosis — and makes sure the person has a suicide safety plan: that any guns and ammunition are stored separately; that photos of loved ones are visible; and that phone numbers of friends, social workers and suicide hotlines are on hand. Doctors who have worked with Reach Vet say that the system produces unexpected results, both in whom it flags and whom it does not. To some of his therapists, Chris, 36, who deployed to Iraq and Afghanistan, looked very much like someone who should be on the radar. He had been a Marine rifleman and saw combat in three of his four tours, taking and returning heavy fire in multiple skirmishes. In 2008, a roadside bomb injured several of his friends but left him unscathed. After the attack he had persistent nightmares about it and received a diagnosis of post-traumatic stress. In 2016, he had a suicidal episode; he asked that his last name be omitted to protect his privacy. “I remember going to the shower,
coming out and grabbing my gun,” he said in an
interview at his home near New York City. “I had a
Glock 9-millimeter. For me, I love guns, they’re like a
safety blanket. Next thing I know, I’m waking up in
cold water, sitting in the tub, the gun is sitting right
there, out of the holster. I blacked out. I mean, I have no
idea what happened. There were no bullets in the gun, it
turned out.” Therapy
is Political. It’s High Time Therapists Acknowledge
This. Yet the people most impacted by this violence had a difficult time accessing therapy — and even when they did, inbuilt bias in the system often caused more harm than good. “Folks would tell me, ‘I’m terrified of therapists,’” Woodland said. He needed to know that the therapists he worked with would actually empathize with and be able to treat activists’ needs. “For five years, I was like ‘somebody should start a national network,’” said Woodland. “At a certain point, my ancestors and spirit were like, ‘That’s supposed to be you.’” So Woodland founded the National Queer and Trans Therapists of Color Network (NQTTCN), a database of dozens of queer and trans mental health workers of color that spans the entire United States. A Shift Toward Healing Justice Woodland’s group takes a healing justice view toward mental wellness. The framework was developed by Black feminists and other organizers of color in groups such as the Kindred Southern Healing Justice Collective. Healing justice emphasizes the historical violence — such as colonization and slavery — and contemporary oppression — such as the prison industrial complex — that shape collective well-being. “Our mental health is impacted by our entire ecosystem,” said Yolo Akili Robinson, Founder and Executive Director of Black Emotional and Mental Health Collective, a group of wellness workers dedicated to the healing of Black communities. “Healing justice really says in order for us to heal, we must transform the entire ecosystem.” Healing justice challenges everyone in the mental health field to acknowledge that wellness isn’t just individual: it is inherently political. That’s because our health is shaped by our identities and our access to resources. But that’s also because the mental health establishment itself has long been complicit in the criminalization and abuse of marginalized people in the United States, especially communities color and LGBTQ communities. In order to truly do no harm, therapists must acknowledge this history. They also must develop crucial skills to not just affirm marginalized clients, but to support the reality that healing goes beyond individualized treatment and encompasses the lived, political and economic conditions of our world. Who Defines Mental Illness? “Where I come from, social workers take the babies away,” said Woodland. Born and raised in Baltimore, Woodland went to social work school in his twenties, after encountering deep mental health needs among the justice system-involved, street economy-engaged, and HIV-positive people he was organizing with. Yet Woodland felt a deep tension in and with his new role. Even when he went to social work school, “Politically, I was very clear that I didn’t want to be a social worker,” Woodland said. Eventually, however, he had to come to terms with his new position, and find a way to practice social work that challenged the fraught history of the field. “I’m accountable for the harm even though I didn’t create the harm,” he said. Since its origins in the 1800s, social work — and the mental health field in general — has been intertwined with the systemic racism, sexism, ableism, and homo- and transphobia that have defined much of American history. Many of the so-called “diagnoses” used to classify mental illness throughout American history have been rooted in the desire of white, male landowners to control women and people of color. “Public health has historically been about public control,” said Robinson. Racism and fictitious mental illness Since the origination of American slavery in 1619, white enslavers invented stereotypes of Black people as “naturally” violent, restive, or unintelligent as a means of justifying their enslavement. In the 1850s, as abolition gained in popularity, supporters of slavery invented a new psychological diagnosis to justify white control of Black people: “Dysaesthesia aethiopica,” a fictitious, racist malady that they claimed struck Black people who sought freedom. After the Civil War, the migration of newly freed African Americans from the South to the Northeast and Midwest for work threatened white elites’ racist sense of “public order.” At the same time, an influx of immigrants from Southern and Eastern Europe, coupled with a lack of government poverty relief, led to overcrowded, deeply impoverished urban immigrant neighborhoods. The native-born upper classes labelled these communities as hotbeds of vice, and many of them founded “settlement houses,” university or charity-based organizations that championed new, scientific theories of population management and public health. Many of these groups provided concrete poverty relief and medical care to impoverished communities. Yet many were also sympathetic to eugenics, a racist and ableist ideology, which argues that some human beings and qualities (usually Europeans) are “naturally superior” to others. Aid workers often saw Black and Southern and Eastern European clients as “dirty” and in need of “civilizing,” and established social service systems that often controlled and punished poor clients more than they supported them. Black resistance continued to be pathologized well into the 20th century, with some white psychologists claiming that Black Power and Civil Rights activists suffered from “protest psychosis.” This racist pathologization of Black resistance, coupled with enduring racial trauma, has led to elevated rates of mental health diagnoses in Black communities to this day. Gender and sexual control The psychological establishment has long been hostile to women and LGBTQ people, as well. Many so-called mental illnesses, like “hysteria,” were historically defined to stigmatize women who didn’t adhere to social norms. Sigmund Freud first designated homosexuality as a sign of improper development in the late 19th century, and when the American Psychiatric Association published the first Diagnostic and Statistical Manuel in 1952, it characterized homosexuality as a disorder. Thanks to queer activism, the diagnosis was lifted from the DSM in 1973, but harmful and pseudoscientific practices like gay conversion therapy persist to this day. Transgender identity also remains highly medicalized, which Woodland says creates unfair barriers for trans people seeking care. “Gender dysphoria is still a diagnosis that is required to receive gender affirming care,” said Woodland. “Do cis women who are getting cosmetic surgery have to see a therapist before they alter their bodies? No.” Mental health and mass incarceration This history has translated to the modern-day criminal justice system. From childhood, Black people are far more likely to be perceived as having behavioral difficulties than their white counterparts, part of the school-to-prison pipeline. Today, prisons are the largest mental healthcare providers in the country, and people with mental illness are sixteen times more likely to be killed by police as those without. “A great proportion of black and brown people’s first engagement with the mental health industrial complex is through the prison industrial complex,” said Robinson. Numerous systems, like child protective services and ICE, actually feed Black and brown people into the prison system by criminalizing poverty, rather than providing families with needed resources. "She's been amazing. I feel like I won the jackpot with her. She always seemed to understand what I was going through and guided me through it." - Laura K, on her therapist Beyond Culturally Competent Care “Being QTBIPOC, you have to live with a pretty high level of fear around the community, the family, the state,” said Woodland. “You can’t really be an apolitical QTBIPOC person.” To address the health disparities resulting from these inequalities, mental health providers use a framework of “culturally competent care.” This emphasizes understanding and respecting the cultures and values of clients. But Robinson and Woodland say that providers need to go beyond simple cultural sensitivity, and instead address the ways in which mental health is inherently about power — and thus, inherently political. “A lot of therapists might talk about social justice, but fundamentally in the work that’s happening, in the therapeutic relationship, we don’t get a lot of training and support around the way those institutions and legacies live in our individual bodies and in our collective bodies,” said Woodland. To address this, Robinson’s and Woodland’s organizations both train mental health practitioners in a healing justice framework. Rather than considering racism and sexism individual ills, says Robinson, he assumes that all mental health practitioners have internalized racist and sexist ideas from our broader society, and supports them in addressing and shedding these attitudes so they can provide better care. Meanwhile, Woodland’s organization, the NQTTCN, focuses on connecting queer and trans people of color with the people most likely to empathize with their experiences: queer and trans therapists of color. Even the act of therapists listing themselves in the database is political. “We tell practitioners to out themselves as part of the directory,” said Woodland. “That itself, especially in this political moment, is putting us at risk.” Finally, healing justice groups like BEAM and NQTTCN help support forms of healing that fall outside of the conventional mental health system. “Therapy is really built on this kind of middle class model — this idea that someone can get away from their life for an hour a week and sit down with someone,” said Robinson. In contrast, communities have always had grassroots healing practices, from church to herbal remedies to rituals. “We fundamentally believe that therapy is a very important tool, but it’s only one tool for our healing,” said Woodland. “Our people have had traditions and cultural practices since the beginning of time to address violence, to address trauma, to address harm.” For many people of color, histories of colonization or enslavement have led to the banning or appropriation of these traditions — for example, through the criminalization of marijuana, which has sacred or healing properties in many cultures. Yet these care traditions, including food and spiritual traditions, have also sustained some of the most powerful movements for liberation.To encourage these grassroots healing practices, BEAM provides funds to Black Southern wellness workers, including doulas and community gardeners, and also hosts mental health training programs for community leaders like barbers, teachers, and activists. Healing for Liberation Mental health is expansive: it is shaped by all the histories and systems that shape how we experience the world. That’s why, according to healing justice practitioners, we can only achieve well-being through systemic change. “When we see folks fighting for clean water, that is a mental health intervention,” said Robinson. “When I see Black Lives Matter shutting down streets, that’s a mental health intervention.” Ideally, says Woodland, we would all have free, universal healthcare. But until that is a reality, he credits the daily work of community mental health practitioners with creating the kind of care communities deserve — now. From political violence to the death and economic fallout of the coronavirus pandemic, this year, more people than ever are experiencing the kind of deep harm that many people of color have endured since the United States’ founding. While he wishes it didn’t take so
much crisis to wake people up to the need for deep change,
Woodland also sees the collective response to our current
moment — including the rise of social movements and
mutual aid — as an example of the deep power
communities have to create wellness. “We don’t
have to look too far in the future to find examples that
point us towards what’s possible,” said Woodland.
“The reality is despite the despair of this moment, our
people are the antidote.” Child
Mental Health Crisis Needs Attention, AMA Delegates Say
- 6/15/21 The American Medical Association (AMA) must work with the federal government, as well as state and local governments, to expand access to psychiatric care for children, members of the AMA's House of Delegates said Monday. "This is a crisis," said Michael Simon, MD, a delegate from the American Society of Anesthesiologists, who was speaking for himself at the AMA's annual meeting. "Nearly every setting is seeing children suffering from lack of care. The pandemic exacerbated a problem we already had and made it a catastrophe ... We need to support our kids and the providers struggling to care for them." Simon was referring to resolutions being offered by the American Academy of Pediatrics (AAP) delegation to address the child mental health crisis. One resolution called for the AMA to "advocate at the state and national level for policies to prioritize children's mental, emotional, and behavioral health." Another urged the AMA to advocate for a system of prevention, management, and crisis care to address children's mental health needs, while a third called for the AMA to consider supporting mental health principles developed by the AAP and other children's healthcare groups. Delegates told stories of their own troubles getting help for pediatric patients. "At my emergency department in Boston, we have about 60 beds, about half of those right now are full of mental health boarders, with another 50-plus upstairs in our hospital as inpatient boarding, waiting for mental health beds," said Samantha Rosman, MD, a delegate from the AAP, who presented the resolutions. "For the community hospital I cover, we've had to convert the educational conference room into a place for 15 adolescents to board awaiting beds ... There just aren't resources to refer these kids to right now. We are simply overflowing at the seams." Raghuveer Puttagunta, MD, an alternate delegate for the AMA's Resident and Fellow Section, said that at the rural hospital he works at in central Pennsylvania, "it was not COVID-infected children overwhelming our ERs [emergency rooms] or inpatient beds, but pediatric patients waiting for psychiatric beds, with some of our patients waiting over 100 days." Ken Certa, MD, a delegate for the American Psychiatric Association, noted that although the crisis was bad before, it was worsened by COVID "and the need for many programs that treat children to reduce their census and go from double-bedded rooms to single rooms ... We in child psychiatry fight for this every single day; we would love to have the rest of medicine come with us to the statehouses." The delegates voted to approve the first two resolutions, but the resolution urging possible adoption of the AAP's mental health principles gave them pause. "I support the thought of this amendment but I don't know the specifics" of the principles, said Gregory Fuller, MD, a delegate from the Texas Medical Association who was speaking for himself. "And if this is changed in the future, we're going to be beholden to these same principles, so I'm speaking against this because I know none of the details." Floyd Buras Jr., MD, a delegate from
Louisiana, agreed. "As a matter of principle, we never want
someone else's policy built into AMA policy," he said. The
delegates voted to refer that resolution to the AMA Board of
Trustees for a decision. Seeking
Mental Health Services for the First Time: What You REALLY
Need to Know If so, they may not be sure if and how to seek help, including what kind of provider they may need, where to begin in looking for a provider, or what questions they should be asking prospective mental health providers. The following tips and recommendations may help: When should I seek services? If what you are experiencing feels like it’s more than a bad day, it may be time to consider talking to a professional. For example, if what you are experiencing is inhibiting your daily life, goals, or relationships, it is worth seeking a mental health check-up to find out if there are any strategies or resources available that can help. Learn more here. What kind of provider do I need? There are many options, and it’s important to know what they may be able to offer. A therapist may be able to help you manage triggers and symptoms. Primary care physicians may be able to rule out underlying medical conditions contributing to symptoms, as well. Psychiatrists and primary care physicians may also prescribe medication to help manage your mental health. Where can I find services? If this is your first time seeking care, it can be difficult to know where to begin. Below are a few suggestions:
What should I ask prospective providers? When you’ve found someone promising, request an informational phone call or a meet-and-greet before you dive into appointments. If it feels less intimidating, try sending an email to schedule a phone call. Here are a list of questions it may be worth asking: Functional:
Experience:
Other questions:
Those are a lot of questions worth asking, so pick the ones most important to you. Ideally, you will meet with a couple of providers and then pick the best fit. Most of all, it’s important that you can be open and honest with them and that they respect you. Finding a great provider who is a great fit for you is like trying to find any close confidant you trust. It might take a few tries to find the right one, so it’s important to go into this expecting that the first one may not work out. Important note: Therapy is not a catch-all solution to mental health. In fact, therapy isn’t for everyone and isn’t the only solution. As you try different treatment options, stay patient with yourself and make a list of people you can trust, including professionals, to help guide and be there for you through the process. In an emergency, call the National
Suicide Prevention Lifeline 1-800-273-TALK (8255) or text
SOS to 741-741. Full - See more
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