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Expanding Use of Technology for Mental Health

More than half of people with mental illness are not receiving the care they need, but technology is offering those in need more ways to access mental health help.  While using technology is not new, it is rapidly changing and expanding.  A June 2015 World Health Organization report notes that 6 six percent of all mobile health apps relate to mental health.

A look at a few examples of the ways technology is improving mental health care:

Assess/ Track Symptoms
Technology is being used to help individuals and their physicians track depression symptoms. For example, one app helps monitor mental health by tracking in real time responses to depression screening questions. Many emergency rooms are now using remote access to psychiatrists to provide psychiatric services  that would not otherwise have been available.

Access to Therapy Remotely
Cognitive behavior therapy (CBT) and other talk therapies are increasingly being provided remotely.  A recent study looking at computer and Internet based CBT found it to be a promising treatment for youth with depression and anxiety.

Connect
Technology allows people to connect to others for sharing, understanding, support and community.  For example, the Love is Louder campaign, a collaboration of The Jed Foundation, MTV and Brittany Snow, has hundreds of thousands of participants in its efforts to address issues such as bullying, discrimination, loneliness and depression. The National Alliance on Mental Illness (NAMI) has developed a support app, NAMIAir (Anonymous, Inspiring, and Relatable), for people looking to connect and talk about mental health. It is designed for use by individuals with mental illines and their families and allows people to share experiences and receive encouragement.



Communicate
Numerous apps are available to help people who have difficulty with communication, such as many people with autism, to express themselves.  The apps are changing the lives of many children and adults with autism.

But experts offer a word of caution when considering using technology to aid in mental health. One recent review of smartphone uses for mental health concluded that “mobile apps for mental health have the potential to be effective in reducing depression, anxiety, stress and possibly substance use.” However, the authors caution that few have been tested and found effective and they call for further research and possibly regulation.(1) Another group of researchers looking at smartphone apps for anxiety concluded that the apps can be useful for self-help and can complement existing treatment. However, they also cautioned that patients should be wary about security, privacy, and effectiveness.(2)


References
(1) Donker T, Petrie K, Proudfoot J, et al. Smartphones for Smarter Delivery of Mental Health Programs: A Systematic Review
(2) Chan S, Torous J, Misra S, et al. Smartphone apps for anxiety: A Review of Commercially Available Apps Using a Heuristic Review Framework. Poster presentation at Annual Meeting of the American Psychiatric Association, 2015.


By Deborah Cohen, Senior Writer, APA

Celebrating the Progress and Promise of the ADA

Twenty-five years ago, on July 26, 1990, President George H.W. Bush signed into law the Americans with Disabilities Act (ADA). The ADA and the subsequent ADA Amendments Act, signed in 2008 by President George W. Bush, expanded opportunities for Americans with disabilities by reducing barriers and changing perceptions.  As a result, our society is more open and accessible to people with disabilities today than it was just a generation ago.

The ADA prohibits discrimination based on disability in employment, services rendered by state and local governments, places of public accommodation, transportation, and telecommunication services.

While the ADA mandates equal access to employment for people with a physical or mental impairment, two-thirds of Americans with disabilities are still unemployed or underemployed, a number that has not changed since the ADA became law. Truly, employment remains the unfulfilled promise of the ADA.

In a recent Catholic News Service article, Marian Vessels, director of the Mid-Atlantic ADA Center in Rockville, Md., suggested the need to address disabilities that may not be apparent or obvious, noting: “accommodations need to be made for people with psychiatric issues, people with PTSD, people with a variety of different learning disabilities.” Addressing these concerns is critical to expanding opportunity for those with mental or intellectual disabilities, as well as those with physical disabilities.

The Interfaith Disability Advocacy Coalition (IDAC), a program of the American Association of People with Disabilities (AAPD), partnered with the ADA Legacy Project, the Collaborative on Faith and Disability, and the ADA National Network to celebrate the progress and recommit to the promise of the ADA. We developed worship and education resources, a proclamation for faith communities to commit to full implementation of the ADA, and hosted an interfaith worship service celebrating 25 years of the ADA, July 26 in Washington, D.C.

While the 25th anniversary of the signing of the ADA has passed, the opportunity to recommit ourselves to expanding access and opportunity for Americans with disabilities remains, whether those disabilities are apparent or not.


By Curtis Ramsey-Lucas, Director of Interfaith Engagement
American Association of People with Disabilities

Why People Don’t Get Help for Alcohol Use

Alcohol misuse is common – more than 16 million US adults (about seven percent) have alcohol use disorder. Yet many people don’t get help.  Less than one in 10 people with alcohol use disorder receiving treatment, according to the 2013 National Survey on Drug Use and Health.

Many people with alcohol use disorder don’t think they need treatment, yet even among people who believe they need treatment, only 15-30 percent receive treatment.  Researchers looking into why people don’t get treatment found barriers related to beliefs and attitude the biggest obstacle.

Among people who believe they need treatment, their attitudes are the most commonly reported barriers, according to research reported  in Psychiatric Services in Advance on August 3, 2015  Financial barriers (e.g., couldn’t afford it) and structural barriers (e.g., didn’t have time, didn’t know where to go) were cited much less frequently.

The top barriers to seeking help for alcohol problems were
• I should be strong enough to handle it alone -  42%
• The problem would get better by itself - 33%
• Not serious enough to seek treatment  - 21%
• Too embarrassed to discuss it - 19%

Previous research has identified some characteristics that make if more or less likely that people will seek treatment: unmarried people are more likely to get treatment than married people and men are more likely to get treatment than women.

One ongoing problem, the researchers note, is that many doctors are still uncomfortable asking about alcohol use.

Concerned about your own drinking?  See an online assessment from NIAAA and learn more problem drinking and getting help in Rethinking Drinking. Find help with SAMHSA’s Behavioral Health Treatment Locator or 24-hour toll-free Referral Helpline at 1-800-662-HELP (1-800-662-4357).


By Deborah Cohen, Senior Writer, American Psychiatric Association

Celebrities Take on Roles as Mental Health Advocates

Actor Jared Padalecki, known for his roles in “Supernatural” and “Gilmore Girls,” has become the latest in a long list of celebrities who are speaking out about mental illness. These famous people are talking about their personal experiences and using their popularity to help raise awareness, fight stigma, and encourage people who are struggling to reach out and get help. Padelecki has talked about his struggles with depression and initiated the #AlwaysKeepFighting campaign to raise awareness and support.

Musician Demi Lovato has been outspoken and public about her experience with bipolar disorder and has become an outspoken advocate for mental health.  She recently joined with several organizations, including the Depression and Bipolar Support Alliance, the Jed Foundation, and others, as part of the  Be Vocal: Speak Up for Mental Health initiative. The campaign encourages individuals to speak up for themselves in asking for help and to learn how to speak out for others in the community.

Actress Glenn Close has been outspoken and active in bringing national attention to the issue of mental illness. After seeing her sister cope with a mental illness and the stigma associated with it, Close founded the nonprofit advocacy organization of Bring Change 2 Mind.  

Actor Joey Pantoliano, has also been active in talking about his personal struggles with depression and substance use. He is raising awareness and fighting stigma through his No Kidding, Me Too! foundation.  Among its many activities, NKM2 promotes messages of empowerments and acceptance through an award-winning documentary of the same name and a series of public service announcements.

Brooke Shields has publicly shared her experience with postpartum depression and written her story of despair and recovery in a memoir, “Down Came the Rain: My Journey Through Postpartum Depression.” Carrie Fisher (Princess Leia of “Star Wars” fame) has taken her advocacy to the stage with her autobiographical one-woman play “Wishful Drinking,” where she tells her story of bipolar disorder and substance use with openness and humor.

As Jeffrey Borenstein, M.D., president and CEO of the Brain and Behavior Research Foundation, noted in a recent interview with CNN, "When celebrities speak publicly about their own experiences with depression or other psychiatric conditions, it's very helpful. It opens up a conversation about these issues. If someone you admire is going through the same thing you might be going through, it makes a difference with people, it causes people to seek help."

Borenstein is also host of a PBS series on mental health issues called Healthy Minds.  You can view past episodes on topics such as bipolar disorder, autism, schizophrenia, and more online at WLIW – Healthy Minds.

By Deborah Cohen, senior writer, American Psychiatric Association

Mental Illness Alone is Not a Risk for Gun Violence

While media coverage of gun violence often leaves us with the perception of close link between violence and mental illness, extensive research tells us that many other factors are associated with a greater risk of gun violence. Most people with mental illness are not violent, and most violent acts are committed by people without mental illness.

New research adds to the wealth of evidence that mental illness is not a risk for gun violence. Research published in June in Psychiatric Services in Advance  found that prior violence, substance abuse, and early trauma are more likely to contribute to future violence than mental illness. The study authors conclude that public safety will not be improved by policies “shaped by highly publicized but infrequent instances of gun violence toward strangers.”

A 2006 report from the Institute of Medicine concludes that "… the contribution of people with mental illnesses to overall rates of violence is small, and further, the magnitude of the relationship is greatly exaggerated in the minds of the general population."

People with mental illness are far more likely to be victims of violence—people with serious mental illness are more than 10 times more likely to be
victims of violence than the general public.

And while mental illness is not a major risk factor for gun violence, mental illness is a significant risk factor for suicide.  Some 39,000 people die by suicide in the United States each year—more than 50 percent by firearm (56 percent of men and 31 percent of women), according to the Centers for Disease Control and Prevention.  Among the major risk factors for suicide are a prior suicide attempt, substance misuse, mood disorders (depression or bipolar disorder), and access to lethal means.  However, research has also identified key protective factors—factors that make it less likely that a person will attempt or die by suicide.  Protective factors include effective mental health care and connection to family, friends and community.

By Deborah Cohen, senior writer, American Psychiatric Association

Diversity, Culture, and Mental Health

Diverse Populations and Mental Health

July is the American Psychiatric Association’s Diversity Mental Health Month, a time to appreciate the diversity among us and to focus on the unique mental health issues of diverse populations and efforts to reduce mental health disparities.  It’s clear we live in an increasingly diverse society, but how does that diversity relate to mental health and receiving quality mental health services?

Cultural background, including race/ethnicity and other aspects, can greatly influence how we think and feel about mental health and illness, how we experience symptoms, how we communicate about mental illness, and how and where we seek help.  Some people may be reluctant to talk about mental health concerns out of fear or shame, some people may seek help from faith leaders, while others may turn to a family doctor or a mental health professional.  (See the infographic from APA:  Mental Health and Diverse Populations.)

Extensive research tells us that ethnic and racial disparities in mental health care exist. A new report from Substance Abuse and Mental Health Services Administration (SAMHSA) notes that among adults with mental illness, whites, American Indian/Alaska Natives, and adults reporting two or more races reported higher mental health service use than black, Asian, and Hispanic adults. (See chart.)
Being aware of differences in the use of mental health services among different ethnic/racial population groups is critical for mental health professionals. That is part of what Diversity Mental Health Month is about – increasing understanding among psychiatrists about the influences of cultural diversity in their practices.

The SAMHSA report also looked at why people don’t use mental health services.  Adults across all racial/ethnic groups cited the same reason most frequently for not using mental health services:  the cost of services cost or lack of insurance.  Other reasons included:  low perceived need; stigma; and structural barriers. Concern about whether mental health services would help was the least cited reason by all racial/ethnic groups.

The top barrier to care, cost, may at least be partly addressed as more people gain access to mental health care with the Affordable Care Act and the Mental Health Parity Act. Many organizations, including the APA, are working to improve cultural sensitivity and to reduce the stigma of mental health, particularly among racial and ethnic minority populations.

By Ranna Parekh, M.D., M.P.H., Director
APA Division of Diversity and Health Equity

This post is part of an ongoing series spotlighting diversity from APA’s Division of Diversity and Health Equity.

Marijuana: Legal Doesn’t Mean Safe

Twenty-three states and the District of Columbia have laws legalizing some form of marijuana use, and recreational use of marijuana is legal in four states and D.C.

Does this growing trend to legalize marijuana mean we don’t need to worry about it?  About one in 10 people who try marijuana will become addicted to it which means that they most likely will use it in increasing quantities, develop tolerance (less effect from it as time goes on), will have withdrawal symptoms if they try to stop, and will find that the marijuana use is causing them to neglect other important areas of their life like work, relationships and leisure activities. 

Even occasional use of marijuana can have negative effects.  hen someone has marijuana in his/her system, short term memory is impaired, reflexes are impaired and judgment is impaired.  These impairments can last 24 hours or longer after the use of the marijuana so it is certainly not safe to drive after using marijuana. Most people will not be able to perform other demanding tasks (work-related activities, childcare) at the level they are accustomed to after using marijuana. 

All the evidence that we now have indicates that marijuana is possibly permanently damaging to the developing adolescent brain. All children should be strongly discouraged from using it at all until they are at least 21 years of age. If marijuana is smoked there are also potential physical health risks, such as damage to the lungs or cardiovascular system.

For more information, see American Psychiatric Association’s  Resource Document on Marijuana as Medicine.

By Andrew Saxon, MD

Professor and Director, Addiction Psychiatry Residency Program

University of Washington

Director, Center of Excellence in Substance Abuse Treatment and Education

VA Puget Sound Health Care System

Seattle, WA

Transgender: A Diverse Group of Individuals

With the recent spotlight on people who identify as transgender, it’s important to keep in mind that transgender people are as diverse as the general population and express themselves in a number of ways.

On a very basic level, a transgender person is born as male or female, but identifies as either the opposite gender, both genders, or no gender at all.  Some who are labeled as transgender may also decide not to even use that term. There is plenty of evidence that transgender people have existed as long as there has been a concept of male and female. Only recently have they received enough support from society to express themselves in a more open way.  This new recognition and support has opened the door for transgender people to pursue life in a body that feels on the outside the way they have always felt inside.

People who identify as transgender usually start to notice their differences early in life. However people can identify and come to understand themselves to be transgender at any point during their life.  Along the lines of discovering one’s sexual orientation, there are no clear “rules,” and identifying as a transgender individual is a very personal and unique process.  This means that those who identify as transgender may decide to dress as the opposite gender, take hormones to change their bodies, and even have surgical procedures to change their appearance to fit how they feel on the inside. There are also many transgender people who decide that these options are not right for them and express themselves in other ways.

Because society has traditionally been unaccepting to those who identify as transgender, they are at higher risk of depression, anxiety, substance abuse and even suicide. Symptoms can generally improve once the person is in a more supportive and accepting environment. Being supportive can be as simple as using the person’s preferred name and pronoun. Traditionally, even this level of support has not been reached in the health care industry because lack of education and training. It’s important that health care providers become more educated about this diverse group of individuals so that all transgender people can receive appropriate health care for their minds and bodies.

For more information on the historical and psychological evolution of transgender Individuals, please see Association for Gay and Lesbian Psychiatrists (AGLP).
More information and medical guidelines can be found at World Professional Association for Transgender Health (WPATH), www.wpath.org/

By Eric Yarbrough, M.D.
President, Association of Gay and Lesbian Psychiatrists
Director of Psychiatric Services, Callen-Lorde Community Health Center
New York City

This post is part of an ongoing series spotlighting diversity from APA’s Division of Diversity and Health Equity.

Human Trafficking: Modern Day Slavery

Human trafficking is one of the fastest-growing global crimes according to the United Nations. No country is immune to this modern-day slavery. According to one estimate, some 15,000 people are trafficked each year in the U.S. for either forced labor or sexual exploitation. Though governments across the world have declared slavery illegal, more than 20 million people worldwide are victims of forced labor. Human trafficking is the second largest source of illegal income, second only to drug trafficking. This inhumane business cuts across gender, age and ethnicity.

A number of factors—poverty, child abuse, adverse social conditions, gender inequality—make people susceptible to trafficking. Children and youth are among the most vulnerable. Long and short-term physical and mental torture endured by victims leads to many health consequences. Physical health consequences can include traumatic brain injuries and other physical injuries, gastrointestinal problems, infectious diseases, poor nutrition, and reproductive health problems. Psychological consequences can include shame, grief, fear, distrust, self-blame and self-hatred, drug and alcohol addiction, suicide, suicidal thoughts, and post-traumatic stress disorder (PTSD).

Though this business operates in our communities, we don’t see these victims in day-to-day life as they are often kept behind locked doors. However, there are things we can do to fight human trafficking—educate ourselves, spread the word, become involved with groups fighting human trafficking and, take a closer look in our communities. With little knowledge about the human trafficking indicators and few follow-up questions, one can identify incidences of victimization and report them to the relevant authorities. Below is a list of indicators and questions from the U.S. Department of State which may help spot a victim.

Human Trafficking Indicators

   • Living with employer
   • Poor living conditions
   • Multiple people in cramped space
   • Inability to speak to individual alone
   • Answers appear to be scripted and rehearsed
   • Employer is holding identity documents
   • Signs of physical abuse
   • Submissive or fearful
   • Unpaid or paid very little
   • Under 18 and in prostitution

Questions to Ask

Assuming you have the opportunity to speak with a potential victim privately and without jeopardizing the victim’s safety because the trafficker is watching, here are some sample questions to ask to follow up on concerns:
• Can you leave your job if you want to?
• Can you come and go as you please?
• Have you been hurt or threatened if you tried to leave?
• Has your family been threatened?
• Do you live with your employer?
• Where do you sleep and eat?
• Are you in debt to your employer?
• Do you have your passport/identification? Who has it?

For more information, visit Stop the Traffik, a global movement of activists working to stop human trafficking.


By
Sejal Petal, Sr. Program Coordinator, and
Ranna Parekh, M.D., M.P.H., Director
APA Division of Diversity and Health Equity

This post is part of an ongoing series spotlighting diversity from APA’s Division of Diversity and Health Equity.

Stigma: Changing the Conversation and Changing Lives

Renee Binder, MD
APA President

I was reminded recently of the death of an acquaintance who was at the top of her career when she died suddenly after complications from surgery, according to her obituary. I later learned that she had died from suicide, possibly in response to her struggle with chronic pain and resulting depression. 

Stigma serves as a barrier to seeking treatment often because of fears of discrimination. A few years ago, a patient requested that I not keep any records and wanted to pay me in cash. He was concerned that if his psychiatric records were ever discovered, his career could be negatively impacted. Were this man’s concerns legitimate? In a more public incident Sen. Tom Eagleton was forced to withdraw as a candidate for vice president in 1972 after it became public that he had suffered from depression and undergone ECT (electroconvulsive therapy). 

According to the Merriam-Webster Dictionary, the definition of stigma is a set of negative and unfair beliefs that a society or group of people has about something; it is a mark of shame or discredit. 

How can we begin to address mental health stigma? Here are several ideas: We need courageous spokespersons who are willing to come forward and talk about mental health issues that they or their families are experiencing. Former Rep. Patrick Kennedy is one such champion. He has openly discussed his struggles with mental illness and substance abuse and how treatment has helped him lead a productive and rewarding life.
We can learn from the LGBT community and their struggles with stigma and negative stereotypes. They have taught us that “coming out” by public figures and celebrities can decrease stigma.


Another way of combating stigma is for my fellow mental health professions, psychiatrists and others, to take responsibility for examining the language that is used by the media and in our society. Words such as “lunatic,” “crazy person,” or “maniac” convey images of people who are out of control and dangerous rather than people who are experiencing a mental illness and deserve our compassion and support in getting effective treatments. 

Mental health professionals and others can take an active role in drawing attention to language and advocating for more appropriate, compassionate and less stigmatizing language. Mental health care is an essential part of health care. Almost everyone will suffer from a mental health problem at some point in his or her lifetime.. But for people to be willing to access the mental health care they need, we have to continue the fight against stigma.

If we are successful in addressing stigma, and we must be, then not only will we change the conversation, we will also change people’s lives and change the culture. We will finally reach the point where all of us can openly talk about someone’s death by suicide and encourage people with mental health problems to seek the help they need without fear of judgment or harmful repercussions.

By Renée Binder, M.D., APA President 

Know Your Rights: Fair Insurance Coverage for Mental Health

Federal law is clear that health insurance companies cannot discriminate against people seeking care for mental illness or addiction. But how do you know if your insurance company is not complying with the law? What can you do if you suspect a violation?

The American Psychiatric Association (APA) created a tool to help answer these questions. The poster titled, “Fair Insurance Coverage: It’s the Law” (Spanish-language version), clearly and simply explains the law and the steps to take if you suspect a violation.

The poster is intended to help enforce federal law and end discrimination.  Print it out and share the link (www.psychiatry.org/parity).

By understanding your rights and taking action you can help ensure fair coverage for yourself and your family, and you can help others by holding insurance companies accountable.

What Federal Law Requires

The Mental Health Parity and Addiction Equity Act requires any group health plan that covers more than 50 employees and offers mental health and/or substance use disorders coverage to provide that coverage with no greater financial requirements (such as co-pays, deductibles, annual or life-time dollar limits) or treatment limitations than the requirements the plan applies to medical / surgical benefits. 

Also, under the Affordable Care Act, new individual and small group plans in and outside of the mandated health insurance exchanges are required to offer mental and substance use disorder coverage similar to medical/surgical benefits.

In addition to federal law, 49 states and D.C. currently have laws relating to insurance coverage for mental health and substance use.  More information, including a summary table of state laws, is available from the National Conference of State Legislators.

By Deborah Cohen, senior writer, American Psychiatric Association

Racism, Discrimination, and Microaggressions: Effects on Mental Health

We know from extensive research that racism can cause significant harmful effects to the victim’s physical and mental health. In 2006, the American Psychiatric Association (APA) established a formal position against racism and discrimination, which partly states that the APA “recognizes that racism and racial discrimination adversely affect mental health by diminishing the victim’s self-image, confidence and optimal mental functioning…. APA believes that attempts should be made to eliminate racism and racial discrimination by fostering a respectful appreciation of multiculturalism and diversity.”

However, racism—prejudice or discrimination directed against someone of a different race based on a belief that one’s own race is superior—is not a mental disorder (it is not included in APA’s diagnostic manual*).

Racism may not appear in the form of clear and obvious acts, it may be in the form of less obvious, “every day” racism.  These acts, termed “microaggressions,” by psychiatrist Chester Pierce, M.D. in 1970, are subtle, often automatic, and nonverbal exchanges with negative overtones. Originally the concept referred to put-downs of blacks by whites in the post-Civil Rights era, but it has since evolved to include people with many differences.  

These subtle and even unintentional acts, can none-the-less be harmful. The effects of this on children are especially pronounced. Victims of racism often display signs of physical and emotional stress. Some victims even start behaving in self-destructive ways that conform to the negative stereotypes they are facing.

Even perceived discrimination can affect health and mental health in several ways, according to an analysis of more than 130 medical studies.** For example, the stress of ongoing perceived discrimination can lead to an increase in unhealthy behaviors, such as smoking or drinking, and decrease in healthy behaviors, such as exercising and healthy eating. If a person has a sense of hopelessness, and low self-esteem, they may be more likely to engage in risky behaviors.  

So how can people protect themselves?  Research suggests several ways to help protect yourself, including having a supportive network of friends and family you can talk to about problems; taking action to address a situation of discrimination, rather than ignoring or avoiding it; and having strong ties to the group(s) with which you identify.

We can all be more mindful of the existence and impact of even subtle and unintentional racism and racial discrimination in the lives of patients and their families and in their everyday practice.

Read more on the Microaggressions Project blog which provides many examples of everyday microaggressions from people across the country.

By Ranna Parekh, M.D.
Director, Division of Diversity and Health Equity\
American Psychiatric Association

References:

*American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.) 2013. Washington, DC:  Author.
**Pascoe EA, Richman LS. (2009). Perceived Discrimination and Health:  A Meta-Analytic Review. Pscyhol Bull; 135(4):531-554.

Nutrition and Mental Health: Dr. Ramsey’s 5 Rules for Eating for Happiness

Dr. Drew Ramsey

A growing body of research is confirming the relationship between a good, quality diet and better mental health outcomes. Poor diet (generally defined as greater consumption of saturated fats and refined and processed foods and lower consumption of fruits, vegetables, fish and nutrient-dense foods) has been associated with depression, anxiety and ADHD. A recent review of studies focused on children and adolescents found a consistent trend in the relationship between a healthy diet and better mental health.(1)

So how do you go about improving your diet and your mental health without overly complicated or restrictive regimes? Drew Ramsey, M.D., psychiatrist, assistant clinical professor of psychiatry at Columbia University, and author, has identified a simple set of 5 rules to eat for happiness—advice he gives to patients and others who want to simplify meal choices and maximize brain health.

1. Skip the processed foods. Processed foods are filled with empty calories; whole grains, lentils, nuts, leafy greens, and seafood contain brain-healthy nutrients.

2. Don’t fear fats. “Good fats,” omega-3 fats DHA and EPA found in whole foods like fish, , dairy products and pasture-raised eggs, are great for your brain. Trans fats, however, are among the unhealthiest substances and are still found in many packaged baked goods.

3. Mind your meat. While a plant-based diet is important, the right meat is an important source of protein, zinc and vitamin B12. “Grass-fed” or “pasture-raised” beef and chicken and “farm fresh” eggs are more nutritionally beneficial.

4. Go organic. Organic choices, increasingly available at most supermarkets, avoid the potential risks of insecticides and pesticides. And summer is great time to check out your local farmers’ market.

5. Make friends with farmers. Shopping at your local farmers’ market can give you added motivation to stay away from a pre-packaged processed-food diet. Getting to know the people who grow your food also offers you the opportunity to gain a better understanding of what you’re eating.

As Dr. Ramsey notes: “The goal is not to become a food snob, but to make that vital connection between your fork and your feelings and choose foods that support your emotional well-being and enhance your sense of vitality.”

Follow Dr. Ramsey @DrewRamseyMD.


By Deborah Cohen, senior writer, American Psychiatric Association

(1) O’Neil A, Quirk S, Housden S, et al. 2014. Relationship between Diet and Mental Health in Children and Adolescents: A Systematic Review. American Journal of Public Health, 104:10, e31-41. www.ncbi.nlm.nih.gov/pmc/articles/PMC4167107/

From Secrets and Shame to an Authentic Self: How Caitlyn Jenner Could Reduce Stigma for Transgender People

When Caitlyn (formerly Bruce) Jenner revealed her new identity as a transgender woman this week, it sparked many news articles and conversations about what it means to be transgender.

“For many people, it is difficult to understand how you can feel like a different person in your own body,” said Marshall Forstein, M.D., chair of the American Psychiatric Association’s LGBT Caucus, Associate Professor of Psychiatry at Harvard Medical School and Director of Adult Psychiatry Residency Training at the Cambridge Health Alliance. 

As celebrities like Jenner and Laverne Cox share their personal stories, they help reduce the stigma around being transgender, Forstein said. “The more that people get to know people who are living their authentic lives, the easier it is to understand.”

“I think any time there’s a sudden revelation of secrets there are different ways people metabolize that information,” said Forstein said. “Some people will say: ‘Wow, how brave.’ Others will doubt that someone could know they are transgender from such an early age.” Although research on transgender is limited, evidence shows that changes in the brain may occur even before people are born—leading to a disconnect between their outward appearance and how they feel.

Despite the limited research on transgender individuals, Forstein said: “One of the things we know is that, by and large, people who do transition begin to feel happier about this consistency of the internal and external experience.”

While many people who are transgender experience anxiety and depression, Forstein said that this is usually a result of keeping their authentic identity hidden: “It’s the pressure of stigma and shame from being other than what society wants you to be.” As defined by the DSM-5, gender dysphoria ends once an individual has transitioned to their authentic gender. “Put yourself in a situation where you’re not allowed to be you—like when left-handed children were forced to write with their right hands—what would that do to your mental health?”

As Jenner shared with more than a million Twitter followers on Monday: “I'm so happy after such a long struggle to be living my true self. Welcome to the world Caitlyn. Can’t wait for you to get to know her/me.”

By Amanda Davis, Deputy Director of Corporate Communications and Public Affairs, APA

Reducing the Stigma of Addiction

Nora Volkow, MD, Director, NIDA

Addiction is common – an estimated 1 in 11 people in the United States experiences a substance use disorder in a given year. Despite significant advances in understanding and treatment, stigma still prevents many people from seeking help.

Nora Volkow, M.D., director of the National Institute on Drug Abuse, speaking recently at the APA’s Annual Meeting in Toronto, talked about some of the recent advances in the understanding of addiction and called on psychiatrists to help reduce the stigma of addiction and “help to eliminate the shame and suffering that accompany the addict who experiences relapse after relapse after relapse.”

Volkow opened her speech with a moving and emotional story of how she learned of her grandfather’s alcoholism and suicide. He had died when she was a girl of 6 in Mexico, but Volkow’s mother did not reveal the truth of her grandfather’s addiction and death until many years later, when her mother was dying and after Volkow had already achieved distinction as an addiction expert.

It was a dramatic illustration of the despair experienced by people who have an addiction and continue to engage in a behavior that they may know is destroying them. She described how it was once believed that addiction was a disorder of hyperactive reward centers in the brain—that people with addiction s sought out drugs or alcohol because they were especially sensitive to the pleasure-inducing effects of dopamine.

But Volkow explained that in recent years research has revealed just the opposite: that those with addiction are actually less sensitive to the effects of dopamine. They seek out drugs because of the very potency with which they can increase dopamine in the brain, often at the expense of other pleasurable natural stimulants that do not increase dopamine so dramatically

Moreover, she emphasized that addiction to drugs disrupts multiple systems in the brain that govern the ability to plan, anticipate, and change behavior in response to changing circumstances. Volkow said it is this phenomenon that accounts for the “craving” experienced by addicts and alcoholics in response to environmental triggers—often leading to what she characterized in the account of her grandfather’s death as that “one last moment of self-hatred.”

Adapted from Psychiatric News

Resilience: How Do We Get It?

So what is resilience? We all want it, and we want to teach it to our children. But are there only a lucky few who inherit it?

Resilience is the ability to lead a healthy life, both physically and mentally, despite living through horrific circumstances, says Petros Levounis, M.D., M.A., chair of the Department of Psychiatry at Rutgers New Jersey Medical School. While there’s a genetic component, he said the thinking is changing around the idea that only some people are born with the ability to stay mentally strong in the face of war, natural disaster, rape, terrorism, chronic poverty and other traumas.

“Humans are far more resilient in general than we think, than we have assumed in the past,” Levounis said. “People who have been subjected to absolutely traumatic situations very frequently come out on other side and do quite well.”

There are some who may suffer more after a traumatic event -- people with depression or anxiety disorders are at a higher risk of developing posttraumatic stress disorder (PTSD). But PTSD is not the opposite of resilience, Levounis explained. “PTSD doesn’t mean you are weak. We now know that developing PTSD is associated with compassion and imagination and creativity.”

“Staying healthy both physically and mentally is paramount. Not only exercise and nutrition, which pretty much everybody knows, but also sleep hygiene. Sleep is the neglected stepchild of physical health. Keeping your mental health intact, your social life, your sexual life, your intellectual life, and for some your spiritual life—these build resilience,” Levounis said.

He added that parents who impart those healthy lifestyle habits to their kids will be helping their children be resilient, too.

By Mary Brophy Marcus, health writer, APA

Helping Your Stressed-out Teen

School demands, sports commitments, body changes, confusing media messages. How can you help your kids manage life’s pressures as they hit the teen years – especially now at the end of the school year when exams and events pile up? Start by making sure the health basics are in place: good nutrition, solid sleep habits, and regular exercise. And don’t underestimate your teenager's need for downtime.By Mary Brophy Marcus, health writer, APA

These resources can help:

Nutrition: The USDA has a site for teens all about healthy eating with snack ideas, info on vitamins, weight and nutrition trackers, and more. There's nutrition advice for vegetarian teens and athletes, too.

Sleep: Teenagers need 8 - 10 hours a night, according to the National Sleep Foundation (NSF). However, almost 70% of high school students aren't logging that much, says the Centers for Disease Control and Prevention. Inadequate sleep can put them at risk for accidents, mood and behavior issues, and poor school performance. NSF shares tips like cutting out caffeinated sodas and setting a regular sleep routine.

Exercise and Relaxation: Physical activity helps increase "feel-good" endorphins in the brain, according to the Mayo Clinic. To relax, The American Academy of Child and Adolescent Psychiatry suggests practicing relaxation breathing and building a supportive circle of friends and family to cut stress, too.

If your tween or teen is still stressed and struggling, reach out to your child's doctor or a mental health professional who specializes in adolescents because a more serious health issue may be going on, such as depression or an anxiety disorder.

By Mary Brophy Marcus, health writer, APA

Even Young Children can Experience PTSD

When you think of PTSD (posttraumatic stress disorder), soldiers returning from combat may come to mind.  But years of research suggest many others experience PTSD, too, even young children, though their symptoms may differ from those of older children, adolescents and adults.

PTSD in adults and children can occur after exposure to a traumatic event — living through one, witnessing one in person, or learning about a traumatic event that involved a family member. A traumatic event can include a violent experience in the home or community, a fire, a natural disaster, a car accident, or the sudden death of a family member. The younger a child is, the greater the impact. The loss of a parent or being removed from a parent, for example, feels like a threat to a child, according to child psychiatrist Judith Cohen, M.D., medical director of the Center for Traumatic Stress in Children & Adolescents at Allegheny General Hospital in Pittsburgh.

Many children experience trauma — an estimated 14 to 43 percent, according to the National Center for PTSD. Of those, as many as 15 percent of girls and 6 percent of boys develop PTSD. Children with PTSD may experience distressful thoughts, ­and memories of the trauma may occur without warning. They may also have trouble sleeping and nightmares (though they may not seem clearly tied to the event). Traumatized children may try to avoid people or objects that are reminders of the event and they may act more irritable, have angry outbursts, or be easily startled. They may regress, wet the bed or talk baby-talk, and they may experience physical symptoms, such as headaches and stomachaches. The symptoms can cause major distress and can impact how a child behaves or relates to family members.

To help a child heal from PTSD, treatment involves working with the child and parents and caregivers, creating a feeling of safety, helping the child to understand the condition, and encouraging the youngster to talk about his or her feelings (through art and play), to help develop relaxation and coping skills. Rehabilitation begins with building trust and it needs to be fun and engaging for young children, according to Dr. Cohen. Several different types of treatment are available for children with symptoms of PTSD and early intervention can be important in helping little ones cope with and heal from the effects of trauma.

For more information on understanding and helping children of all ages heal from traumatic events visit the National Child Traumatic Stress Network.

By Debbie Cohen, health writer, APA

Don’t Over-Tax Yourself Over Tax Season!

With the April 15 tax deadline looming, it’s an anxious time for many people. Try these tips to keep your financial stress under control at tax time ­— and all year round.

Break It Up. A mountain of paperwork for your tax return or for any other financial responsibility, like applying for a college loan or mortgage, can seem overwhelming. Break up the process into smaller chunks, such as gathering pay stubs, finding your home mortgage interest statements, or organizing your receipts. Then tackle each task one by one. But before you do so…

Make a Plan. This is even more important when you’re on a tight deadline (like being just a few days away from April 15). Once you’ve broken down what you need to accomplish into pieces, put those steps in order and write down how and when you’re going to make each one happen. This will help you feel like you have control over the process. Being out of control is very stressful!

Keep Mentally Fit. Eat well, get a full night’s sleep, find a way to exercise every day, and connect with friends and loved ones. Financial deadlines may have you feeling like you need to lock yourself away and pull an all-nighter with a bag of potato chips and your 1040, but you’ll just raise your stress level, and you probably won’t accomplish your goal anyway.

Resist Unhealthy Temptations. When stress arises, it’s tempting to cope in unhealthy ways such as binge eating, smoking, or drinking alcohol. Avoid these negative coping strategies. Instead of a cigarette or a glass of wine, take a walk or call a friend to vent.

Don’t Go It Alone. It’s not too late to get help. Ask for help from a spouse, a trusted friend, or ideally, a financial professional like a certified public accountant. Some tax professionals will even save you the step of visiting their office and will review your documents and calculations online. Having too much on your shoulders and no help is a recipe for anxiety.

Request an Extension. If you’re utterly overwhelmed and you feel like there’s no way you’ll have it all together by April 15, talk to a tax professional about how to request an extension on filing. You’ll still have to pay your estimated taxes on time (or pay interest), but you’ll have an extra six months to get your paperwork in order.

Plan Ahead for Next Year. If you’ve procrastinated about your taxes this year, use the stress you’re experiencing now as you try to get everything together at the last minute for a good cause: Keeping you on track to plan ahead for tax time 2016. Set a realistic budget and stick to it, and keep track of your finances as you go along. Having a plan and living within your means makes your life much less stressful.

by David Ginsberg, M.D., clinical associate professor and vice chair for clinical affairs, Department of Psychiatry, and chief of the Psychiatry Service, NYU Langone Medical Center in New York City.

Giving Kids a "Sip" of Alcohol Can Send the Wrong Message About Drinking

That little sip of wine or beer that some parents offer their kids at a wedding or on New Year’s Eve may muddle messages about alcohol, according to a new study by researchers at the Center for Alcohol and Addiction Studies at Brown University. The scientists surveyed middle school students for three years to learn whether even a taste in early childhood was a predictor of risky behavior in high school.

The Internet-based study, published in the April 1^st issue of the Journal of Studies on Alcohol and Drugs, included more than 500 Rhode Island school students. More than one-third of the kids surveyed reported trying their first sip of alcohol by the sixth grade, and most said that their first taste took place at home. Wine and beer were the most commonly tried beverages, usually at a special occasion, such as a wedding or a holiday, and adults were the primary source of the alcohol. Nearly three-quarters of the children were offered sips by their own mom or dad.

The study also showed that kids who sipped alcohol by the sixth grade were five times more likely to down a full alcoholic beverage by the time they reached 9^th grade—26% of sippers consumed a full drink versus 5.5% of non-sippers. The earlier sippers were also four times more likely to get drunk or binge drink by early high school, and trying alcoholic beverages earlier in life also raised a child’s risk for trying other substances.

Even when the researchers controlled for other factors, such as risk-taking behavior, the drinking habits of parents, and a history of alcoholism in a parent, kids who’d sipped before sixth grade had higher odds of alcohol use by their freshman year of high school.

The take-home message: Offering a child a sip of your beverage may send the wrong message, says study author Kristina Jackson, Ph.D., associate professor in the Department of Behavioral and Social Sciences at Brown School of Public Health.

"Parents should provide clear, consistent messages about the unacceptability of alcohol consumption for youth,” Jackson advises. “Younger teens and tweens may be unable to understand the difference between drinking a sip and drinking one or more drinks. Certainly there are exceptions, such as religious occasions, so the most important thing is to make sure that children know when drinking alcohol is acceptable and when it is not.”

The context of alcohol use is important, says Oscar G. Bukstein, M.D., M.P.H., medical director at DePelchin Children’s Center and a clinical professor of psychiatry at Baylor College of Medicine and the University of Texas Health Science Center-Houston, who was not involved in the research. “Often, by allowing children to sip or try alcohol on ‘special occasions’, the message delivered may be one of ‘this is how we celebrate’, we drink,” Buckstein says.

He says that sipping may be associated with increased access to alcohol, too, or more lax parent attitudes and that undermines any anti-drinking messages kids hear.

April 21^st is the national day to talk with your kids about alcohol. Visit Mothers Against Drunk Driving’s (MADD) Power of Parents page to learn more.

by Mary Brophy Marcus, health writer, APA

Autism Awareness Month: Learning more about a complex condition

You probably know someone with autism—in your neighborhood, in your workplace, in your school, in your family.   In fact, an estimated one in 68 children in the U.S. has been identified with autism spectrum disorder, according to the Centers for Disease Control and Prevention.   The data on adults is less clear, but the numbers are growing. 

April is Autism Awareness Month – a chance to raise awareness and learn a little more about this complex condition affecting so many.  Here are just a few sources that might help answer some questions.

Want a good quick overview of what autism is?  Check out the CDC’s main autism page.

Looking for a good app to help someone with autism function better?  There are many apps available to help people with autism with communication, behavior, organization, creative arts, and more. In fact, there are so many apps that it can be hard to know where to start or what might be useful for a particular person. Check out Autism Speaks’ searchable resource on autism apps – with information on function, device, target age, and the research data that’s been gathered to evaluate or inform the app.

 One resource you may be familiar with already is Siri, the personal assistant on the iPhone. See a New York Times column by a mom of a child with autism who has made good use of Siri, “To Siri, With Love: How One Boy With Autism Became BFF With Apple’s Siri.”  Siri is not only tirelessly patient in responding to repetitive questions (common among some with autism) but lets you know she doesn't understand (leading to practice with phrasing and enunciation) and will gently encourage polite language.

Want to know how to talk with parents of children with autism?  See a recent Today.com article on “11 things never to say to parents of a child with autism (and 11 you should).”

Want to know a little about what it’s like for some people with autism and sensory sensitivity issues to experience their environment? (Note of caution:  Every person with autism is different. No two experience sensory sensitivity in the same way.) View the short video from the UK-based National Autistic Society, Experience For 60 Seconds How The World Looks, Sounds, And Feels To Someone Who Has Autism.” Some people with autism have difficulty processing multiple sensory experiences at once. An animated video by the Interacting with Autism project gives a glimpse into sensory overload and how sensory experiences intertwine in everyday life.

Want to know more about the latest research on autism spectrum disorders or the latest clinical trials? Find out how your family can participate in research  or find out about clinical trials.

Have more questions? Visit national organizations, such as Autism Speaks and the Autism Society of America, or federal agencies, including the CDC and the National Institute of Mental Health.  Join the conversation #autismawareness, #autism, #mentalhealth.

by Deborah Cohen, senior writer, American Psychiatric Association

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