Showing posts with label mental health. Show all posts
Showing posts with label mental health. Show all posts

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Study highlights lack of access to mental health care

By Arshya Vahabzadeh,MD 

 @VahabzadehMD



A new study from the CDC’s National Center for Health Statistics once again highlights that too many people living with mental health conditions are not getting needed care.



Study authors Laura A. Pratt, PhD, and Debra J. Brody, MPH, found that nearly 8% of Americans aged 12 and up had depression (moderate or severe depressive symptoms in the past 2 weeks). The rate of depression was twice as high among people living below the poverty level, 15%.



 Far more alarming, the study showed yet again that people with depression are going untreated. While nearly 90% of people with severe depressive symptoms reported difficulty with work, home, or social activities related to their symptoms, only about one-third (35.3%) had seen a mental health professional in the past year, according to the study. Among those with moderate depressive symptoms, only 1 in 5 had seen a mental health professional.



While there are many reasons people don’t get needed mental health care, including mental health stigma and lack of access, discrimination in mental health coverage by insurance companies shouldn’t be among the reasons. Federal law now requires that insurers cover mental health illnesses the same as physical ailments, such as heart disease, diabetes and cancer.





However, many people don’t know their rights when it comes to getting mental health treatment. To address this glaring problem, the American Psychiatric Association has released a new poster --

available to mental health professionals -- that explains in simple terms your rights under the law and what to do if you think your rights are being denied. Download a copy at www.psychiatry.org/parity.


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World AIDS Day





By Annelle Primm, MD, MPH



World AIDS Day

December 1, 2014


Focus, Partner, Achieve:  An AIDS-Free Generation




World AIDS Day is a key opportunity to raise awareness and to commemorate those who lost their lives to this often deadly disease. But, today, we can also be hopeful about achieving an AIDS-free generation.  Increased access to treatment, new and better prevention services and care, and advances in treatment are all reasons for hopefulness.  And that amounts to greater peace of mind.

 


An estimated 35 million people worldwide have HIV and more than 39 million people have died from the virus since the first cases in 1981. In the U.S., more than 1.2 million people live with HIV, but nearly 1 in 7 of those don’t know they have the virus.


An estimated 50,000 people in the U.S. are newly infected each year.  It’s why I continue to tell people the importance of getting tested.  There’s no shame, just a need for information.




What is the Connection Between HIV and Mental Health?



Mental and neurological disorders have an intertwined and often complex relationship with HIV and AIDS. Yet mental health issues are often overlooked in HIV interventions and treatment.







  • About 60% of people with HIV also have depression.  Sometimes one may be tempted to “blame” depression on their HIV status, but the reality is that depression can happen to anyone and treatment works

  • Pre-existing mental disorders (including substance use) can complicate HIV-related illness.  It’s important for physicians to know all they need to know about your health, and for you to be comfortable sharing  

  • Nearly 50% of people with HIV experience impaired motor skills, trouble with memory and poor concentration.  If you experience such changes, those are important to inform your doctor about

  • Mental illness can make it more difficult for people to adhere to HIV-medication regimens

  • New antiretroviral treatments and combination therapies can affect the central nervous system and/or have psychiatric side effects

  • Mental illnesses can be especially challenging to recognize and diagnose in people with HIV/AIDS.  That’s why the APA works to educate and provide tools and training to physicians.





Unfortunately, both HIV and mental illness still carry a significant burden of stigma and discrimination.



As HIV/AIDS increasingly becomes a chronic disorder with the improvement of treatments, the need for mental health care and services is rising.  World AIDS Day is also a day to recognize the many psychiatrists and other mental health clinicians working with HIV patients who also have complicated psychiatric or substance use comorbidities.





Looking for ways to take action?  Here are a few simple, powerful, and engaging ways you can take action:







Annelle Primm, MD, MPH is the Deputy Medical Director of the American Psychiatric Association







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Native Americans and Suicide



By Arshya
Vahabzadeh, MD & Brad Zehring, DO





 Mental illness does not discriminate - it affects every age, sex, religion, and ethnic group.




The Indian Health Service conducted a study in 2008 that noted that the rate of suicide for American Indians and Alaska Natives is higher than any ethnic group within the United States. The study reported that suicide in these populations is up to 70% higher, especially in ages 10 to 24. Sadly, this statistic is not decreasing. Mental health professionals and society need to recognize the etiology of the despair that leads to suicide so that treatment and appropriate allocation of resources can be made.



The statistics are alarming, but possibly more alarming is the silence around this tragedy. Since suicide is taboo on most reservations - there are reports that a death by suicide often is not reported or legal authorities classify it as an accident. Due to the silence and misrepresentation, the numbers could be even greater.



It is important to break the silence on the troubling trends within Native American reservations. Native Americans must be willing to discuss their stressors and be open to getting education necessary to cope, deal, and treat their stressors. Mental Health professionals must be willing to understand their culture and adapt. Alex Crosby, MD, MPH, medical epidemiologist of the CDC has been recorded as saying that Native American suicide is so prevalent that it has become acceptable practice when tensions build up. Suicide should never be an acceptable option.



Reasons for troubling trends among Native Americans



There are a lot of thoughts on why mental illness and suicide have increased in the Native American population. There has been a lot of discussion of generational trauma due to the disempowerment and oppression of Native Americans and Alaska Natives. It has been discussed that this has caused adverse childhood experiences that lead to high rates of depression and other mental illness that are precursors to suicide.




While disempowerment and oppression could very well be contributing factors - poverty seems to be a growing problem on reservations. Poverty tends to put stress on educational standards decreasing the educational opportunities for those on the reservation – leading to a viscous cycle. There are few jobs on the reservation causing adolescents and young adults to leave their families and move to where there are jobs. However, parents age and get ill causing tension between the traditional Native American family structures where youth takes care of the elderly and providing for the immediate family.




In addition to poverty, substance abuse is a big problem on the reservation. Substance abuse can affect mood, often negatively, which increases the tension and is a risk factor for suicide. Domestic violence and sexual assault are also known problems on the reservation. These stressors have led to unstable environments for children growing up. Add untreated mental illness to the mix and it is easy to see how hopelessness and despair thrive often leading to the belief that suicide is the only way out.




The Way Forward

Recently, the American Foundation for Suicide Prevention joined a Native American Mental Health panel sponsored by Congressional Native American Caucus and Center for Native American Youth. The panel focused on ways of improving mental health resources and suicide prevention. The IHS and the Substance Abuse and Mental Health Services Administration (SAMHSA) collaborated on targeted suicide prevention programs. The IHS established the Suicide Prevention Initiative and SAMHSA provided funding to the IHS to address youth suicide and provide suicide prevention for high-risk populations.




As we move forward as Mental Health professionals, it will be important to continue to collaborate with the Native American population, especially with Mental Health professionals with experience with the population and their culture. Understanding their culture and etiology of stressors will go a long way in providing the appropriate resources and treatment.

Resources for Help

In the US:

·         Suicide help

·         1-800-273-TALK



Outside the US:

·         International Association of Suicide Prevention (IASP)

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How does your primary care doctor coordinate with your psychiatrist?

By Pierre
Gingerich-Boberg, Medical Student

Reviewed by Claudia
Reardon, MD



I’m stuck in behaviors
that are making me unhealthy.  My smoking
makes my asthma worse, and I don’t want to end up with emphysema like my dad.  I smoke when I’m anxious, and my finances, my
teenager, my boss, and my increasing weight all make me anxious.  Now to top it off, my chronic headaches are
getting worse.  My problems are physical,
but I know they’re also mental.  But the
idea of seeing a psychiatrist makes me even more anxious!  What should I do?



Patients need primary care doctors who can comprehensively
address the varied aspects of their physical and mental health. Health systems
are starting to recognize that multi-disciplinary teams (sometimes called patient-centered medical homes) can be
an effective way to provide integrated
care.  How might this look for our example
patient?




First, it’s worth noting that traditional primary care doctors
already spend a lot of effort helping patients with a wide spectrum of behavior
issues.  We saw this for our example patient.
 Her anxiety is an example of a classic mental health problem—others
might be depression, panic attacks, and addictions. Primary care docs refer some
of these patients to psychiatrists, but primary care docs are treating the
majority directly.  Our patient’s
headaches are likely a functional
ailment. Like irritable bowel syndrome and general aches and pains,
headaches are real problems that often defy simple solutions.  Standard treatments focus on limiting symptoms
while helping patients cope with the stressors and psychological distress that often
contribute.  Finally, our patient faces
problems with health-related behaviors including
tobacco use, diet, and stress management. 
These and other common behaviors are hugely important for the development
of chronic diseases.  



Our patient’s picture might seem complex, but primary care
doctors face such complexity (and more) every day! Frankly, patients often are
dealing with too much for their doctors to address optimally in a 15-20 minute
time slot. One approach is to triage—to ask what’s treatable and doable, and
what can wait until the next appointment. The limited time
available for counseling tends to push primary care doctors toward relying on
treatment with psych meds. A second approach is to refer the patient to
a psychiatrist.  But psychiatrists in
many communities are spread too thin, so patients often wait weeks or months
for an appointment. Then there’s stigma--our example patient’s anxiety around
psychiatric care is actually pretty typical. 
This helps push up no-show rates for first visits with a psychiatrist to
30 or 40%.  It’s no wonder that careful
studies show that only a fraction of the mental health problems in our
communities are ever diagnosed, and fewer still are adequately treated.




A third option returns us to the medical
home concept.  At the VA and increasingly
in federally qualified health centers (FQHCs), mental health services are being
brought into the primary care setting. 
Here, behavioral health consultants
(BHCs) share space with primary care doctors. 
These are generally psychologists or social workers, that is,
non-physicians. BHCs’ schedules are intentionally left mostly open, so that they’re
available to see patients immediately after a non-threatening ‘warm handoff’
from the primary care doc.  The BHC can offer
expert counseling for the patient, and advise the primary care provider on
diagnosis and treatment.  BHCs arrange
for a small subset of their patients to get a subsequent visit with a psychiatrist
(a specialist physician), who is also in-house. 
 All the BHC patients get
systematic evaluation and follow-up by phone or with visits to make sure their
needs don’t fall through the cracks.







When a behavioral health consultation system is in place,
problems of waiting times, missed appointments, and incomplete records are
eliminated for most behavioral health visits. 
Primary care docs have more time to focus on medical issues, while
getting the expert consultation they need to optimize behavioral health care
for their patients. Finally, because most behavioral issues can be addressed efficiently
by BHCs, specialty psychiatrists are not so swamped, and waiting times can be
greatly shortened for the small group of patients needing psychiatric care beyond
what can be managed in the primary care setting.

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Diversity Mental Health Month: Why It is Needed and How It Came to Be




By Steve Koh, MD, MPH, MBA


July of 2014 is the very first APA Diversity Mental Health Month. This
emphasis on mental health needs of diverse populations is much needed. While we
have diversity oriented month observances for specific population groups like
the Black History Month (February), National Women’s History Month (March),
Asian Pacific American Heritage Month (May), Gay and Lesbian Pride Month
(June), American Indian Heritage Month (August), and Hispanic Heritage Month
(September), we have not had a dedicated month more broadly addressing diverse
populations and mental health issues.




I cannot overemphasize the importance of this month. For the first
time, together, we will bring attention to the unique and challenging needs of
the diverse populations with mental illness and substance use disorders, work
to decrease mental health disparities, and engage with diverse populations to
help promote and grow future mental health champions in the communities.




The concept for Diversity Mental Health Month came from a group of
participants in APA’s Minority Fellowship program.  The program’s goal is to eliminate racial and
ethnic disparities in mental health and substance abuse care by providing
specialized training and mentorship. The fellowship fosters those with diverse
backgrounds who have chosen to become physicians specializing in mental health
and to do this work with the diverse populations.  



But what happens when we go home? What then? We felt that it was easy to get
lost when we left our APA meetings in Washington DC. How do we galvanize our
colleagues at home to look at the importance of minority mental health issues?
To recognize the stigma of being an ethnic and cultural minority and also
suffering mental illness? To understand that many minority students do not
consider going into field of medicine let alone mental health profession? To
appreciate the importance of cultural competency and humility in working with
diverse patient population?




Without
involvement a coordinated effort by the APA, it was our belief that while we
personally benefited from the fellowship experience, our impact would be
limited. There needed to be a designated time for all of APA to bring attention
to this important patient population.  So
the idea was born to create a Diversity Mental Health Month. The APA Assembly asked
APA staff to help create a month designated to minority mental health issues
and for the APA to actively promote the month.




I hope that others are excited about this new endeavor of the APA as I
am. The challenges are great but together we can bring the needed attention to
this area of our profession.




Many resources, including an infographic with basic data on mental
health disparities, and brochures and fact sheets on specific populations,
suggested activities, video messages, and more, are available at www.psychiatry.org/diversity-month.













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Depression & Cancer

By Brad Zehring, DO @DrZehringDO






“Cancer can take away all of my physical abilities. It
cannot touch my mind, it cannot touch my heart, and it cannot touch my
soul”  - Jim Valvano




But, what
happens when it does?



Depression
is a multifactorial disorder that requires acknowledgement of the biological,
psychological, and social aspects of a person’s life. Professionals in the
mental health community describe this as the biopsychosocial model. It provides
an understanding of the factors influencing a person’s mental and physical
state of being.




When mental health professionals talk about depression they
often do so in regards to Major Depressive Disorder (MDD). According to DSM 5
(Diagnostic and Statistical Manual of Mental Disorders), 5 out of 9 criteria
are needed to diagnose MDD. It requires a depressed mood or anhedonia (lack of
enjoying what was previously enjoyed) for greater than 2 weeks including:
disturbances in sleep, guilty/hopeless/worthless feelings, poor concentration,
low energy, changes in appetite (weight loss or weight gain), psychomotor
agitation or retardation, and suicidal ideation.



Depression affects your entire body. But, the physical
aspects of depression are often overlooked. It is common for people with
depression to experience weight changes, digestive problems, headaches, back
pain, muscle and joint pain, and disruptions in sleep cycle. Many symptoms that
are present in cancer.




Depression has been linked with many health problems,
including cancer. Cancer is a heavy word. The enormity of the word brings many
images to the forefront of our imagination: radiation, chemotherapy, losing
hair, sickness, weakness, and death - among others. There is so much symptom
overlap between cancer and depression it can be hard to recognize the etiology
of the symptoms.






It is important that health care professionals, family
members, and other caretakers
are vigilant with a person’s mental well being after they are diagnosed with
cancer. Even if a person has never experienced depression previously, their
risk of depression is increased when they find out they have cancer. Research
shows that the incidence of depression increases proportionately with the
cancer’s progression. It is believed those with depression have increased
likelihood of depression because of increased immune response (cytokines)
within the body.




It is important not to assume that someone with cancer has
an appropriate depressed mood due to his or her circumstances.  This is why it is important to screen for
depression in those diagnosed with cancer. Screening for depression can help
“tease out” symptoms related to depression and symptoms related to the cancer. Treating
depression in patients with cancer can help them focus on their treatment and
have the motivation to do everything needed to possibly achieve remission.
Proper treatment gives them the ability to focus on their future. Cancer alone
is enough, but when combined with untreated depression the results can be
deadly.




After recognizing depression in someone with cancer, there
are ways to treat depression in parallel with cancer treatment. There are two
forms of treatment. One involves medication and the other involves
psychotherapy, or talk therapy. The typical medications for depression are
antidepressants like Selective Serotonin Reuptake Inhibitors (SSRI) and
Serotonin and Norepinephrine Reuptake Inhibitors (SNRI). These medications have
been around for a long time and are generally well tolerated. They take
anywhere from 2-6 weeks for clinical efficacy. These medications should be
monitored with cancer treatment, as there can be drug interactions and side
effects that may not be present in someone taking these medications without
cancer. In addition to medications, psychotherapy can be effective. More
specifically, Cognitive Behavioral Therapy (CBT) can help people change their
negative thoughts about cancer and their future. For the most efficacious
treatment a combination of both should be implemented.




Cancer is a serious illness and a well-developed
multi-disciplinary approach is necessary to best treat the patient. Cancer can
cause a lot of different disturbances in physical and mental health. It is
important to have health professionals, like psychiatrists
and psychologists, part of the treatment team to ensure proper treatment of the
whole patient.





















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What does Archbishop Desmond Tutu say about Mental Illness Stigma?

Watch exclusive interviews with Archbishop Desmond Tutu and actress Lorraine Bracco who attended this year's APA Annual Meeting in May.  Also included, video posts from HealthyMinds.org bloggers Dr. Claudia Reardon, Dr. Gariane Gunter, and Dr. Molly McVoy.  Have a mental health issue on your mind? Our Healthy Minds bloggers will anwser right here! Let us know what you want to know

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Make Mental Health Your Priority Every Month

By Felicia Wong, M.D



As the month of May comes to an end, make a promise to yourself that personal mental wellness will remain a daily priority.  Mental Health America has been working for 100 years to promote well-being for all Americans and recently developed a resource called 10 Tools to Live Your Life Well based on extensive scientific evidence.



Each day, we face all sorts of demands and drama which can lead to insomnia, lack of concentration, problems in our relationships, and other mental health issues. 
These "10 Tools" provide proven, healthy ways to cope with stress and boost your overall well-being.  Make a commitment to follow this list and feel more relaxed, fulfilled, and focused long after Mental Heath Month is over. . .  
1) Connect with Others. People who feel connected are happier and healthier--and may even live longer.
2) Stay Positive. People who regularly focus on the positive in their lives are less upset by painful memories.
3) Get Physically Active. Exercise can help relieve insomnia and reduce depression.
4) Help Others. People who consistently help others experience less depression, greater calm, and fewer pains.
5) Get Enough Sleep. Not getting enough rest increases risks of weight gain, accidents, reduced memory, and heart problems.
6) Create Joy and Satisfaction. Positive emotions can boost your ability to bounce back from stress.
7) Eat Well. Eating healthy food and regular meals can increase your energy, lower the risk of developing certain diseases, and influence your mood.
8) Take Care of Your Spirit. People who have strong spiritual lives may be healthier and live longer. Spirituality seems to cut the stress that can contribute to disease.
9) Deal Better with Hard Times. People who can tackle problems or get support in a tough situation tend to feel less depressed.
10) Get Professional Help if You Need It. More than 80 percent of people who are treated for depression improve.
So now you know the tools. . . Today is the perfect time to start incorporating this list into your day-to-day routine.  For more information, go to http://www.liveyourlifewell.org/ . 

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Lessons Learned in the Wake of Tragedy

By Gina Newsome Duncan, M.D.





Dr. Molly McVoy recently blogged about the horrific shootings of Representative Gabrielle Giffords and others on Saturday, January 8, 2011. This tragic incident has sparked widespread national debate about all aspects of the case, including mental health treatment in this country and links between violence and mental illness.



The fact is that most people with mental illness are not violent, and that violence is most often caused by those who are not mentally ill. However, this incident does provide an opportunity for us as a nation, to seriously consider the state of our mental health services. If we examine it carefully, we can possibly prevent further acts of violence, and also think about how we help those who are in need of mental health treatment.



It is an unfortunate reality that mental illness remains largely shrouded in stigma, and tragic events such as this often help to only deepen that stigma in the minds of the public. As a result of this stigma, many people live with unnecessary shame and suffering, not seeking the help that they need. Most often, the primary victim is the person living with the illness, and by extension, their loved ones. Very rarely, however, untreated illness can lead to tragic consequences that reach far beyond the person with the illness and his or her family.



Like physical illness, mental illness has the best outcome when recognized and treated early. We should let this tragedy be a call to become more proactive in addressing issues of mental illness in our communities.





There are several important steps that can be taken:



1) As a public, we can become more informed about the signs, symptoms and treatment of mental illness.



2) We can all work to  destigmatize mental illness. The American Psychiatric Association’s Council on Communications is actively involved using this blog and with other activities.



3) Educate yourself on how mental health is funded in your community and let your vote count when issues of mental health funding are on the ballot.





It is true that there are rare situations in which a person with a severe mental illness may become violent. In most cases, this violence will be self-directed in the form of suicidal acts, but in rare instances, it may be directed toward others as well. What can be done in those situations?



1) If you are personally experiencing a mental illness and are having thoughts of harming yourself or others, it is important that you seek help from a doctor, therapist, or 911 immediately.



2) If you are the friend or family member of a person experiencing a severe mental illness and you are concerned due to actions or statements they have made that they may be a danger to themselves or others, it is important that you seek help from a doctor, therapist, or by calling 911 immediately.



a. Be as detailed about your concerns as possible.



b. Do not let your concern go unheard, put it in writing.



c. Firearms and weapons should be kept sealed and locked, or ideally, removed from the home.



d. Unfortunately, many communities do not have adequate crisis prevention resources. Familiarize yourself with the procedures your community does have for involuntary hospitalization. You can get this information by calling your local health department, hospital department of psychiatry, emergency room, community mental health center, family physician, or police department.

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Coping with Stress in America

By Adair Parr, M.D.





A survey by the American Psychological Association highlighted the negative impact that stress can have on families and children. This is an extremely important topic that affects many family caregivers, who are under a great deal of stress taking care of loved ones. More and more Americans are affected by stress. The survey indicates that many Americans feel that they are experiencing unhealthy amounts of stress. The economy is one of the main reasons. Fewer are satisfied with the ways that their employer helps employees balance work and non-work demands and many are concerned about job stability.
In addition, stress impacts the entire family. Children recognize when their parents are stressed and that could make them feel sad and worried. Nevertheless, parents frequently underestimate the impact that their own stress has on their children.



Stress affects both our mental and physical health. Some people manage stress by smoking, drinking or over-eating. That can lead to bigger problems. The study shows that Americans understand the importance of healthy behaviors like getting enough sleep, exercising and eating healthy. However, lack of time and motivation gets in the way of following through on these goals. Willpower was identified as a barrier to many healthy behaviors, even when they are recommended by a health care provider.

Managing your stress is extremely important. Stress does affect the family members you care for. There are healthy ways to manage your stress. Some suggestions are: exercising or playing sports; listening to music; spending time with friends and family; going to religious services; journaling; and practicing yoga / meditation. 





If you find that you are overwhelmed or suffering physical symptoms from stress like headache, poor appetite and insomnia, or if you are feeling depressed or suffering from chronic irritability and crying spells, you may need to see a mental health provider. The Healthy Minds website has brochures about dozens of mental health issues including early warning signs of mental illness.

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Finding Meaning in Modern Life - Part 2



By Roberto Blanco, M.D.

Last month, I wrote about Viktor Frankl’s book “Man’s Search For Meaning” and how some of the principles in his book could be applied to modern life. In response to the blog, one of the readers, Mukesh Samani, asked what it was in Dr. Frankl’s book that touched me the most. I would like to take this opportunity to thank Mr. Samani for his question and to respond.




What touched me the most from Dr. Frankl’s work was his motivation to live, share his experience, and teach something positive. As a psychiatrist during a time when any type of self-revelation was taboo and frowned upon, he showed great courage in revealing some of the darkest, innermost details of his life to the entire world. He did this so others could learn from his experience.





As a Psychiatrist, I work with many people who may be down on their luck or are the victims of unfortunate situations. Like Dr. Frankl, the ones who are able to discuss their situation, find some meaning from it, and continue to move forward, generally do the best.




Mr. Samani also asked what is special or specific in Dr. Frankl’s model of psychotherapy known as Logotherapy. Mr. Samani, I would refer you back to Dr. Frankl’s book which has a nice summary on Logotherapy. I am not an expert on Logotherapy. However, in short, it is a therapy which focuses on man’s desire to find meaning as the main motivating force in life.




I see following role models, like Dr. Frankl, as a way to find meaning in life. Looking back on your own life, is it clear which people affected you the most in positive ways? What was it about these people that moved or affected you? Did they have some special characteristic that set them apart from others or allowed them to connect with you? If so, finding out what that is and trying to reproduce it with others can give your life more meaning.




I have a lot of admiration for Dr. Frankl’s work and I appreciate the comment from “Mary” about a new documentary coming out on his life titled “Viktor and I.” I’ll be interested to see how he used his experiences in his professional life and what he was like on a personal level from the perspective of his close friends, family and colleagues. Thank you for your comments and questions.

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National Family Caregivers Month: Self-Care for Caregivers

By Felicia Wong, MD



I love helping others. That is why I became a doctor, and why I love my job as a psychiatrist. But when I was a pre-medical student in college, my mom shared the following words of wisdom with me:  “In order to take care of others, you need to take care of yourself first.”


It took me a moment to understand the importance of the point she was making. I had taken a break from my community service projects due to a sports injury, and was eager to return to them. However, at that time, I was not fully recovered and was often in pain, and would tire easily. My mom encouraged me to take some more time off in order to focus on my own recovery and healing. Initially, I felt guilty taking the time out for myself. But in the end, I realized mom was right. Once I became strong and well again, I had so much more to offer to others.
Caregivers tend to be selfless, and expect a lot of themselves without recognizing their own need for self-care. Studies have found that caregivers have higher levels of depression and stress than non-caregivers. Sometimes caregivers are so committed to helping others that they forget to take care of themselves. They fail to recognize that if they drive themselves to exhaustion or sickness, they may not be able to help at all.


Warning signs of caregiver burnout from the non-profit Helpguide.org include:
  • You have much less energy than you used to

  • It seems like you catch every cold or flu that’s going around

  • You’re constantly exhausted, even after sleeping or taking a break

  • You neglect your own needs, either because you’re too busy or you don’t care anymore

  • Your life revolves around caregiving, but it gives you little satisfaction

  • You have trouble relaxing, even when help is available

  • You’re increasingly impatient and irritable with the person you’re caring for

  • You feel overwhelmed, helpless, and hopeless

Key strategies to prevent burnout include getting the help you need, seeking emotional support, and taking time out to care for yourself.
  • Learn and use stress-reduction techniques.

  • Attend to your own healthcare needs.

  • Get proper rest and nutrition.

  • Exercise regularly.

  • Take time off without feeling guilty.

  • Participate in pleasant, nurturing activities.

  • Seek and accept the support of others.

  • Seek supportive counseling when you need it, or talk to a trusted counselor or friend.

  • Identify and acknowledge your feelings.

  • Change the negative ways you view situations.

  • Set goals.

For additional strategies for self-care for caregivers, visit the Family Caregiver Alliance, and watch for my next post on caring for someone with Alzheimer's. 

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Depression: Should I Tell the Boss?

By Gina Newsome Duncan, MD



Depression is the leading cause of disability among people ages 15-44, affecting nearly 7 percent of the adult population in a given year. That means that close to one in ten American adults is suffering from depression at any given point in time. A recent CNN Health article highlighted the dilemma one woman with depression faced when considering whether to tell her employer.







It may not be talked about much, but depression is most certainly present in the workplace. What are the effects? People suffering from depression can experience a decrease in concentration, difficulty making decisions, feelings of isolation, feeling slowed down in their thinking and mental processing, and poor sleep, which can lead to daytime fatigue. All of these factors can result in poor job performance. In fact,a decline in job performance is often the wake-up call that someone is experiencing depression and needs to do something.





If you feel that you may be suffering from major depressive disorder and are concerned about the effect on your work, what should you do?




  1. A good first step is to talk with a psychiatrist or your primary care physician about your symptoms and explore possible treatment options. Psychiatrists and primary care physicians are familiar with employment issues and should be able to get you started on a plan to address your concerns.

  2. Find out about your company’s Employee Assistance Program (EAP). It is in your company’s best interest for you to function at your optimal level, and most large companies offer some type of EAP. In most cases, confidentiality and privacy requirements apply to EAP services, and the employer does not usually know who is or is not using them, except in cases where the employer referred the worker to the EAP. Employee Assistance Programs offer a broad range of services, including psychological assessment, counseling, support and referrals.


Other things to keep in mind:



Depression is real, but it is not as visible as something like a broken leg. Depression can be difficult for others to accept as a true illness or valid reason for being excused from work. As a society, we can be stoic when it comes to issues of emotional distress; “Just suck it up and keep going,” we tell ourselves and others. It can be hard for others to understand or appreciate the effects of a major depressive episode or another mental illness unless they or a loved one have experienced it. Employers are beginning to understand that attending to their employees’ mental health is not just a nice thing to do, it makes good business sense.



Federal laws protect the rights of workers who become medically ill or disabled. This includes workers who are unable to work due to a mental illness such as major depression. However, employer sensitivity toward such employees can vary, particularly if the employee has not taken official medical leave but is frequently calling out sick or requesting time off for regular psychiatrist or therapist appointments during work hours.



Whether or not to disclose your illness to your boss and/or your coworkers is an individual decision that depends on your company’s culture and your own preference. But here are a couple of thoughts to keep in mind: If your symptoms are not affecting your job performance in a visible way and if, with the help of your doctor, you have started a treatment plan that you are finding helpful, then disclosing your illness to your employer may not be necessary. If, on the other hand, your symptoms are severe, causing frequent missed days of work or other job performance issues that threaten your employment, and if you have not yet started treatment, then being proactive and addressing the issue with someone you trust, like a doctor, Employee Assistance Program or a boss, can be an important step.



Have you experienced firsthand the effects of depression in the workplace? If so, how was it addressed? How can we reduce the culture of stigma that surrounds mental illness in the workplace?

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Finding Meaning in Modern Life

By Roberto Blanco, M.D.






During recent travels, I visited the Yad Vashem Holocaust Museum in Jerusalem and came across Man’s Search for Meaning at the bookstore. It is written by Dr. Viktor Frankl, a Viennese professor and psychiatrist before World War II, who became a holocaust survivor. Dr. Frankl narrates his experiences and observations in different concentration camps and describes how, against all odds, he survived.



Dr. Frankl, however, did not intend the book to be solely a tale about survival. As he explained in his preface to the 1984 edition, he wrote the book so that others could see concretely that life, even in the most hopeless and miserable conditions, holds meaning. He wanted to show how having meaning in one’s life is the most important aspect to living fulfilling lives. In the book, Dr. Frankl proposed that he was able to survive because of luck and because his faith that his survival had some great meaning was unshakeable. During years spent in brutal conditions in concentration camps, Dr. Frankl was able to endure by finding some goodness to hold on to, even if sometimes this goodness could only be found in his head. He also observed how those who eventually lost motivation and hope usually did not survive much longer.



It is difficult not to be inspired by Dr. Frankl’s story, but it makes me think about how difficult it can be to feel fulfilled in our modern world. How can a man who had everything in his life taken away from him, find more meaning in his life than many who have all of the freedoms and material possessions they could want? I think that the answer lies in slowing down to appreciate the little things in life and to appreciate the meaning of it all. Every day should serve as a challenge to find a meaning, even if it is a small one.




The ways in which people find meaning depend on their age, current role in life, and developmental stage. Some people are motivated by special people in their lives; the relationships that provide meaning often change as people become independent of parents, find partners, and then have children of their own. Others develop a relationship with a higher power, which also can change as they grow and change themselves. And finally, having a mission, vocation, or cause often gives people meaning to their lives. These often change, as well, as people change careers, go back to school, or have other new experiences.





On a day-to-day basis, here are some things that you can do to answer the challenge of the day:





1. Be kind to another person.

2. Strike up a conversation with a friendly stranger.

3. Re-connect with an old friend.

4. Reminisce about that special memory that brings back positive feelings.

5. Further your cause or mission in some way.

6. Participate in a favorite hobby, sport, or special interest.

7. Pray.

8. Go for a walk.

9. Tell that special someone how you feel about them.

I’m interested to hear, what is it that brings meaning to your life?

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Talking about Mental Health

By R. Scott Benson, M.D.





In May a few years ago I was asked to give a talk to the seniors who exercised at the mall in the early morning hours. The timing was right for a mental health talk, since May is Mental Health Month.



The focus of my talk was new understanding of the brain and changing thoughts on the cause and treatment of mental illness. The audience was attentive but asked few questions. But after the talk an elderly man approached to clarify some comments I had made about schizophrenia. He called his wife over and they shared the painful story of their adult son’s deterioration as he developed unmistakable signs of this tragic disease.



This couple had been told by the treatment team that their parenting had caused their son’s condition and they needed to leave him alone so that he could recover. And they had carried a burden of guilt for years, viewing themselves as somehow toxic. I was able to answer a few of their questions and then I was encouraged them to join other families involved with our local chapters of Mental Health America and the National Alliance on Mental Illness.



The positive impact of these brave families sharing their stories was reinforced in a new survey from the American Psychiatric Association. And the results of this survey are a cause for celebration telling us how far we have come. More than a third said that stigma has declined, and openness about personal experiences by friends, family and public figures was influential.



The internet has become a valued source of information and was cited by 75% of those surveyed as at least moderately influential in reducing stigma associated with mental illness.



In addition to HealthyMinds, what are the reliable sources of information that have been useful to you? Where have you heard patient and family stories that have reduced stigma in your community?
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