Friday, December 5, 2014

Study highlights lack of access to mental health care

By Arshya Vahabzadeh,MD 

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

Tuesday, December 2, 2014

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

Monday, November 10, 2014

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)

Monday, October 20, 2014

15 Tips for Talking to Kids about Ebola

By David Fassler, M.D.
Child and adolescent psychiatrist 
Parents and teachers may find themselves faced with the challenge of discussing the evolving Ebola epidemic with children. Although these may be difficult conversations, they are also important. There are no “right” or “wrong” ways to talk with kids about Ebola, but here are some suggestions if you need help. 
1. Provide an open and supportive environment where children know they can ask questions. At the same time, it’s best not to force children to talk about Ebola unless and until they’re ready.
2. Answer questions honestly. Kids will usually know, or eventually find out, if you’re “making things up." It may affect their trust in you or your reassurances in the future.
3. Use words and ideas children can understand. Gear your explanations to the child’s age, language, and developmental level.
4. Help kids find accurate and up to date information. Print out Fact Sheets from the CDC, CNN, WHO and
5. Be ready to repeat information and explanations several times. Some information may be hard to accept or understand. Asking the same question over and over may also be a way for a child to ask for reassurance.
6. Acknowledge and validate the child’s thoughts, feelings, and reactions. Let them know that you think their questions and concerns are important and appropriate.
7. Remember that kids often personalize situations. For example, they may worry about their own safety and the safety of family members. They may also worry about friends or relatives who travel or live far away.
8. Be comforting, but don’t make unrealistic promises. It’s fine to let children know that they are safe in their home or at school. But you can’t promise that there will be no cases of Ebola in your state or community.
9. Let kids know that there are lots of people helping the families affected by Ebola. This time is a good opportunity to show children that when something scary or bad happens, there are people to help.
10. Children learn from watching their parents and teachers. They will be very interested in how you react to news about Ebola. They also learn from listening to your conversations with other adults.
11. Don’t let kids watch too much television with frightening images. The repetition of such scenes can be disturbing and confusing.
12. Children who have experienced serious illness, loss, or other traumatic events in the past are particularly vulnerable to graphic news reports or images of death. These children may need extra support and attention.
13. Watch for physical symptoms including headaches and stomachaches. Often times, kids express anxiety through physical aches and pains. An increase in such symptoms without apparent medical cause may be a sign that a child is feeling anxious or overwhelmed.
14. Children who are consumed with questions or worry about Ebola should be evaluated by a trained and qualified mental health professional. Other signs that a child may need additional care include: ongoing sleep problems, frequent fears about illness or death, or reluctance to leave parents or go to school. If such behaviors continue, ask your child’s pediatrician, family physician, or school counselor to help you contact a mental health professional. 
15. Although parents and teachers may follow the news and the daily updates with interest and attention, most kids just want to be kids. They may not want to think about what’s happening across the country or elsewhere in the world. They’d rather play ball, climb trees, or ride bikes.
Public health emergencies are not easy for anyone to comprehend or accept. Understandably, many young children feel frightened and confused.  As parents, teachers, and caring adults, we can best help by listening and responding honestly and comfortingly. Fortunately, most children, even those who have experienced loss or illness, are quite resilient.  However, by creating an open environment where they feel free to ask questions, we can help them cope with stressful events and experiences.

David Fassler, M.D., is a child and adolescent psychiatrist practicing in Burlington, Vermont. He is also a Clinical Professor of Psychiatry at the University of Vermont.

Tuesday, October 7, 2014

Adult Bullying in the Workplace

By Brad Zehring, DO
I would rather be a little nobody, then to be an evil somebody - Abraham Lincoln

Typically, when bullying is talked about it is in the context of children or adolescents during some level of schooling. Rarely do we think about bullying as an adult issue. However, much more attention has been focused on adult bullying – more specifically, adult bullying in the workplace.

According to various sources, citing research and survey’s, it has been reported that as many as 1 in 4 adults will face some form of bullying in their career.  It is important to point out the differences between constructive criticism, workplace conflict, and bullying. Workplace bullying focuses on the person rather than the performance or task being completed by the person. In addition, the person being targeted feels powerless to stop it. Making the situation worse, is when the adult being bullied goes to management to report the offense and the abuse is minimized or discounted altogether. Complicating the issue further is the difficulty verbalizing what is taking place or being unaware that what is occurring is bullying, leading to worsening suffering.

What are some forms of workplace bullying?
As discussed earlier, workplace bullying can be described as an extreme pattern where the person is isolated apart from his/her performance or task. Some examples of workplace bullying are: being left-out of work-related social events, coworkers refusing to help when asked, coworkers leaving the room when you enter or routinely arriving to meetings late that when you call them, being yelled at, put down, or disciplined in front of your coworkers. These are some of the ways that workplace bullying presents, but it is not an exhaustive list.

How workplace bullying is harmful
For individuals who are being bullied in the workplace, their desire to go into work day after day is diminished and their satisfaction in their performance and with their employer decreases.  Many reports discuss the loss of productivity when job satisfaction decreases. Beyond the psychological stress (depression, anxiety, PTSD, etc) – which should not be minimized, stress from bullying can lead to physical illness such as stroke, heart attacks, chronic fatigue or dissatisfaction in an person’s personal life – including leading to suicide. There are many reports documenting poor job satisfaction negatively affecting all areas on one’s life. Feeling accomplished and satisfied in a career can lead to a happier personal life and vice versa.

How to prevent or deal with workplace bullying
While recognizing or speaking up about workplace bullying can be a difficult task - it is important not to be silent about bullying experiences, whether personal attacks or witnessed attacks on colleagues, or isolate from those that may be able to help. Currently, states are working on anti-bullying bills to encourage healthy workplace environments, but fostering a workplace for your coworkers that doesn’t tolerate bullying is key. Many organizations provide or contract with mental health professionals willing to discuss, advise, and help an individual navigate the process. It is important to document your concerns and be specific and concise with the message you are trying to convey if you feel you are being bullied. Despite how difficult it may be, it is important to approach the bully or go to your supervisor with a calm demeanor and discuss your concerns rationally. Lastly, it is important to have an open mind about the situation. Sometimes it may be that the “bully” does not realize how his/her actions have affected you. Approaching them, or the situation, calmly will provide an environment for understanding and increase the probability for change.