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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When Divorce Happens

By Gariane Gunter, M.D. 



A recent study was published in Health Day that discusses the mental health of children of divorced parents. While I am not in the position to support or deny the findings, the topic of divorce when children are involved is often a difficult one. Every family is different, but the following are some general tips for divorcing parents that can be helpful.



1. Attempt to keep a positive attitude during the point of separation. This is often a very trying time for the family. Stick to a routine and embrace the activities your children have always enjoyed.

2. Don’t forget to nurture yourself. Going for a walk, having coffee with a friend, or reading a good book are ways to rest and regain energy. It’s normal to feel exhausted when separating; and possibly for many months to follow.

3. Encourage kids to openly discuss their feelings, positive or negative, about what's happening.

It's important for divorcing, as well as already divorced parents, to sit down with their kids and encourage them to say what they're thinking and feeling. But you'll need to keep this separate from your own feelings. Most often, children experience a sense of loss of family and may blame you, the other parent, or both of you for what is going on in their lives. You really need to be prepared to answer questions your kids might raise. They might feel guilty and imagine that they "caused" the problem. Kids and teenagers may feel angry or frightened, or worried about their future. Counselors can assist with this difficult conversation and provide a safe environment if safety is a concern.

4. Although very tempting, try not to speak negatively about your former spouse when your children are present. This issue, often called “parental alienation” can be a problem. Doing things such as putting your child in the middle, saying negative things about the other parent, and using your child as a messenger puts your child in a “no win” situation and creates lifelong relationship issues for all involved. The reasons include the following:



• The comments may confuse and frighten children.

• Many of your concerns about your former spouse are difficult for you to express. It is very important that you keep these concerns to yourself. Children just do not have the emotional maturity to withstand information/situations that adults find stressful.

• Your child’s identity and self concept is based on parental behavior. Even if it is next to impossible to say anything good about your former spouse, try to do so. If this is impossible then don’t say anything.

• Children love to eavesdrop. Telephone conversations are their favorite snooping ground. Make all effort to not discuss your divorce-related difficulties on the telephone when your children are around.

5. During the crisis point of separation try to remember that your children need you both parents more than ever. This is not a time to deny access unless a professional deems it necessary to do so for safety related reasons.

6. It is important to accept the fact that a separation involves feelings of loss for children. Try not to panic if the following behaviors occur during the first few months of separation:

• Sleep difficulties like disrupted sleep, an inability to sleep, exhaustion etc.

• Social isolation

• Anger, intolerance, grumpiness

• Avoidance of divorce related conversations

• Obsessing about the divorce

• Appetite changes

• Feelings of worthlessness

• Tears and feelings of overwhelming sadness

7. Although many children do not ask to see a counselor when their parents separate, they usually find counseling very helpful.

8. It is important to acknowledge that children are very loyal and protective of their parents. If children are placed in loyalty binds they can experience anxiety. Try to alleviate their anxiety if they decided to “pick a side.” This is a coping skill which teens in particular use. If your child engages in “picking a side” try not to feel rejected.



9. Think of yourself as a survivor not a victim. And be patient. Everyone takes different times to heal.

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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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Supporting Gay Youth as a Way to Prevent Suicide

By Tristan Gorrindo, MD



Coming out of the closet is one of the hardest things that a gay, lesbian, or bisexual person will do.

“Coming out,” is the process of revealing to friends, parents, family members, and acquaintances that he or she is gay. It is more that just a simple act or decision to announce that a person is gay, but rather a process that unfolds overtime, usually in small steps. For many people, it involves telling one person, then a group of friends or family members, then classmates or co-workers, and finally the world at large. But for each person, the journey is different and often filled with emotional ups and downs.

Recent events in the national media have highlighted the issues surrounding coming out and youth suicide. By some estimates, as many as nine gay youth died by suicide since September 1, 2010. Government officials and celebrities have publicly referred to this as a national crisis.



Many population scientists have tried to understand why gay teens are at such high risk for suicide -- by some estimates 7 times the national average for their age. And although there are many possible contributors to what might make a gay teen suicidal, we must first remember that all teens, gay and straight alike, are struggling with basic questions about self-identity.



A friend of mine once described being a teenager is like, “being at a costume ball where the costumes and guests are constantly changing.” As part of normal teenage development, teens are “trying on” different roles, different groups of friends, and even different kinds of dress. It is a time when teens are first experimenting with the idea of romantic relationships and at the same time trying to separate from their parents. Gay teens have the added burden of sorting out the confusing, often negative messages from the culture about what it means to be gay. When these ingredients mix -- unsure sense of self-identify, novice experience with romance, trying to separate from one’s parents, and fear of what it means to be gay -- gay teens run the risk of feeling quite isolated and alone.



Regardless of one’s personal views of homosexuality, I think we can all agree on the importance of supporting our youth during difficult times. The American Psychiatric Association is committed to reducing the stigma around homosexuality and to promoting the psychological health of gay, straight, and bisexual individuals.



We owe it to our teens to make sure that they know that coming out is not a process that they have to go through alone. A wide variety of resources exist, from grass-roots YouTube videos which offer gay teens hope, as in The Make It Better Project, to 24-hour suicide hotline for gay teens offered through The Trevor Project. Additionally, The National Suicide Prevention Lifeline also is available 24/7 at 1-800-273-TALK (8255) to anyone struggling with suicidal thoughts. The Healthy Minds website is a source of clear factual information on sexual orientation. And let us not forget the parents that may also be struggling with how to help their gay child; for them there is support and advice offered through PFLAG.

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Getting Help Gets a Good Customer Review

By Molly McVoy, M.D.



A recent survey published in Consumer Reports, found that respondents reported the highest satisfaction for the combination of medication and talk therapy, when compared to talk therapy or medication alone.



The survey reported on over 1500 people treated for anxiety, depression or both. They also found that readers reported a higher satisfaction with treatment by a psychiatrist than by other mental health professionals (psychologists, social workers, and licensed professional counselors).

 

This is good news for psychiatrists and the mental health community in general. This is one indicator that the public feels treatment works and that psychiatrists help.





In addition, this consumer report supports the scientific evidence we already have – depression and anxiety treatment does work! In study after study, approximately 2/3 of patients respond to treatment for depression with an even higher percentage responding to treatment for anxiety disorders.



The bottom line is, treatment works and, it appears, most of the public knows it!

Getting Help: How to Start the Conversation and Find Professional Services

By Felicia Wong, M.D.

Many people don’t seek mental health care when they need it. This is particularly true for members of ethnic minorities, for whom physical illness is often considered more culturally acceptable than mental illness. Research has shown, for example, that Asian Americans are three times less likely than members of other ethnic groups to seek mental health services. This has more to do with lack of appropriate services, and barriers to services—including stigma, language and cultural differences—rather than the lack of need for services.

The important thing to remember is that with proper treatment, most symptoms of mental illness can be controlled. If the possibility of mental illness is a concern for you or someone you care about, please recognize there is no shame in seeking treatment and/or help.

Over the years, many people have asked me how to get help for themselves, a family member or a friend who is suffering. Navigating the mental health system is not easy, and the stigma and shame associated with mental illness make it even more difficult. Where someone may find it easy to ask a friend to recommend a family doctor or a dentist, people sometimes hesitate to ask about psychiatrists or therapists due to fears of being judged, or perhaps appearing "emotionally weak".

There are many places to go for help. A good place to start is by asking your family doctor or primary care doctor. In a crisis, emergency rooms can provide temporary relief for you or a loved one, and emergency room personnel may be able to guide you to further help.

Other potential resources include:

• mental health specialists such as psychiatrists, psychologists, social workers or mental health counselors;


• community mental health centers;


• hospital psychiatry departments, outpatient clinics and/or inpatient units;


• family services, social agencies, or clergy;


• peer support groups;


• private clinics and facilities;


• employee assistance program; or


• the phone book or web - search "mental health," "health," "social services," "hotlines," or "physicians" for phone numbers and addresses.

For more information on how to find and choose a psychiatrist and what to expect in treatment, read about Choosing a Psychiatrist on Healthyminds.org,

For Mental Health Month, Join a Former First Lady In Bringing Down Barriers to Mental Health Treatment.

By Roberto Blanco, M.D.



I was seeing a very depressed patient the other day and we were discussing how far he had fallen in his functioning since he had gotten ill. He said, “I used to be strong. I used to be able to provide for my family.” And yes, there was no doubt that he was unable to provide for his family now. Despite being relatively healthy physically, mental illness had made it so that he could not work, had difficulty leaving the house, or finding enjoyment in anything.



I try not to read too much into simple statements. But the phrase “I used to be strong” resonated with me because I think that it had something to do with why he waited until it was almost too late to seek treatment. While I think that he was trying to express the depths of his feelings of helplessness and need, his statement implied that he was now weak. Fatigue, lack of energy, and poor sleep from depression could make anybody weak. However, I don’t think that this is what he meant.



I often hear people stigmatizing mental illnesses like depression by saying that it only happens to “the weak”. One thing that I’ve learned from my experience practicing psychiatry is that it can affect anyone from CEOs to valedictorians to world-class athletes. Just like this patient indicated, it doesn’t matter how strong you are or think you are, mental illness can affect you if life and genetic predisposition put you in the wrong circumstances.



One of my main concerns with the stigmatization of mental illness is that if it is seen as a weakness, then the solution is often seen as needing to “be stronger”, deny a physiologic problem, and not seek help. As many mental illnesses are quite treatable with medications, psychosocial interventions, and therapy, this can often have tragic and unintended consequences such as loss of close relationships, occupations and careers, or even death.



The other concern is that if mental illness is seen as a fault of character and not as a group of illnesses, then appropriate and necessary resources and medical services won’t be available. In North Carolina, where I work, acknowledging that you need help is not the biggest barrier to treatment. Actually, it is trying to find a provider or an inpatient bed.



With the demand for inpatient psychiatric services skyrocketing in North Carolina, the number of psychiatric beds available has decreased and the outpatient mental health system, which was once a model nationally, has crumbled. It’s hard to imagine that with greatly increasing rates of kidney disease in this country that dialysis clinics or transplant services would be closing down. However, this is exactly what is happening to psychiatric services in North Carolina. It is a complex issue but is due to the national trend of closing state psychiatric hospitals as well as to the privatization and decentralization of outpatient mental health services.



Some people are taking notice of this disturbing trend, including the former First Lady of the United States, Rosalynn Carter. She has written a book on the mental health crisis in the United States and is encouraging people to be vigilant in taking care of their mental health, to overcome challenges, and to get involved.



May is Mental Health Month. So, please take this opportunity to join our former First Lady in advocating for mental illness treatment. Go to your local legislatures or call your congressional representatives and ask that they support funding for mental health services.

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Women's Mental Health: The Facts

By Gariane Phillips Gunter, M.D.



We have all heard the saying; Women are from Mars and Men are from Venus. Well, when it comes to our mental health we may not be from separate planets but there are differences.



For example*:



• Depressive disorders account for close to 41.9% of the disability from neuropsychiatric disorders among women compared to 29.3% among men.



• Leading mental health problems of the elderly are depression, organic brain syndromes and dementias. A majority are women.



• An estimated 80% of 50 million people affected by violent conflicts, civil wars, disasters, and displacement are women and children.



• Lifetime prevalence rate of violence against women ranges from 16% to 50%.



• At least one in five women suffers rape or attempted rape in their lifetime.



• Mental disorders following childbirth, including post-partum depression, are estimated to affect about 13% of women within a year of delivery.



• Eating Disorders are more common in women however this is a growing concern for males as well.



• Suicide is the top cause of death globally for women aged 20-59 years of age.



So why are women more at risk? Well, it is known that our genes play a role in ones susceptibility to developing a mental illness. However, environment is also a huge factor. Pressures created by women’s multiple roles, gender discrimination and associated factors of poverty, hunger, malnutrition, overwork, domestic violence and sexual abuse, combine to account for a woman's poor mental health in many cases. There is a correlation between the frequency and severity of such poor social factors and the frequency and severity of mental health problems in women. In addition, the presence or lack of support during difficult times is also a factor.



Stigma surrounding mental illness is a huge barrier that keeps both men and women from seeking help in many cases. However, even in cases where stigma is not a concern, there are still differences in the way that men and women seek help for psychological difficulties. According to the World Health Organization, women are more likely to seek assistance from their primary care physician while men may seek a specialist or use the hospital system. Also, gender stereotypes of women’s proneness to emotional problems versus men may lead health care providers in discussing symptoms with women or prescribing medication.



So whether you are from Mars, Venus or somewhere in between, women are more susceptible to certain mental illnesses, our environment plays a role and treatment options vary. So women, take the time to take care of yourselves, you are worth it! And please ask for help if you should need it.





* Stats are from the World Health Organization

You are not Alone: Remembering the founder of NAMI, and Recognizing the importance of Support Systems

By Felicia K. Wong

I am a big fan of NAMI: National Alliance on Mental Illness. In honor of the late Harriet Shetler, co-founder of NAMI, who passed away last week, I would like to encourage you to learn more about this wonderful organization.

Since its inception in 1979, NAMI has been dedicated to improving the lives of individuals and families affected by mental illness. NAMI is a support, education, advocacy and research group. Over the past three decades, NAMI has established itself as the most formidable grassroots mental health advocacy organization in the country. NAMI recognizes that their greatest strength is the dedication of our grassroots leaders and members. On their  site, they state, “We are the families, friends and individuals that serve to strengthen communities across the country.”





If you, a friend, or family member, are affected by mental illness, please visit NAMI to learn more about the supports and services this organization offers. Support groups and organizations are important because they can provide emotional support, resources and helpful tools for people facing similar situations. Organizations like NAMI provide a voice for millions of Americans affected by mental illness and advocate to end discrimination, and to promote effective mental health services and supports.



Perhaps the most important thing that support systems can provide is a feeling that you are not alone.





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Suicide Prevention – What You Should Know

By Jeffrey Borenstein, M.D.



More Americans die as a result of suicide than from homicide. What can you do to minimize the risk of suicide for your family and friends? I was recently interviewed by US News and World Report on this important topic.



The vast majority of people who die by suicide have depression, chemical dependency or another underlying psychiatric condition – all of which are treatable. My advice to people is not to suffer in silence, but to seek treatment.



And, if your loved one appears depressed, encourage him or her to get professional help. If someone expresses thoughts about hurting themselves, take this seriously. If a person has chest pain, you take them to an ER to be evaluated by a physician. If a person has suicidal thoughts – they should also receive a careful evaluation and treatment.



Over the years, I have had the opportunity to treat people who attempted suicide but fortunately were not successful. These people have an important perspective in common: with treatment, once their depression lifted or once they began to recover from chemical dependency, they were thankful to be alive and happy that their suicide attempt was unsuccessful. The key point is that with help, there’s hope. And with help we can prevent the tragedy of a suicide.



If You or Someone You Know Is in Crisis and Needs Immediate Help

• Call your physician’s office.


• Call 911 for emergency services.


• Go to the nearest hospital emergency room.


• Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).


• Ask a family member or friend to help you make these calls or take you to the hospital.

An Ounce of Prevention is Worth a Pound of Cure in Mental Health Treatment

By Roberto Blanco



Benjamin Franklin’s quote, “an ounce of prevention is worth a pound of cure,” can be applied to many arenas of life. From my experience in the mental health system, I believe that it is also quite an appropriate saying for mental health.



I work at a local crisis and assessment center in North Carolina and see many patients who come in with psychiatric emergencies. For a variety of reasons, a lot of these patients arrive in a dangerous state or have substance abuse problems that are out of control. They are in crisis and often need immediate action in order to assure their safety.





While many crises are an unfortunate result of untreated mental illness or painful circumstances, it is hard to ignore the great number of crises that could have been averted with some preventative mental hygiene. Many people become sick because they aren’t doing things that can keep them out of hospitals such as taking medicine regularly, going to therapy, or getting support from friends, family or community centers.



Just as you would not want to meet with your financial counselor to plan out retirement the day before you retire, you should be taking regular, proactive steps to take good care of your mental health before a crisis is at hand or, ideally, in order to prevent a crisis.



Here are some things you or your loved ones can do to help prevent mental health crises:



1. Engage in regularly scheduled therapy sessions.



2. Attend psychiatric appointments regularly and take medications as prescribed.



3. Create a Crisis Plan (a plan to follow in case of an emergency). These plans should include techniques to try to calm the situation (i.e. going for walks, deep breathing exercises, or listening to music are some favorites) along with the names and phone numbers of close supports, on-call mental health professionals, and emergency agencies. Keep this plan close at hand at all times.



4. If a significant portion of the problem is with a close relationship, consider going to family or couples counseling.



5. If you are running out of medication, call for refills at least 3-4 business days (7-9 business days for controlled substances or stimulants) before you will be out of medicine. This will assure that your doctor can supply you with the appropriate refill of medication in time.



6. Engage in regular, renewing self-care activities such as exercise, sleep, and fulfilling hobbies. Lack of sleep is often a cause and symptom of most mental illnesses.



7. Educate and advocate for yourself and your family. Learn as much as you can from many different perspectives about your illness. The National Institute of Mental Health has patient information available on a variety of diagnoses and topics. In addition, our very own APA Healthy Minds site has useful information on a variety of topics. Consider joining the National Alliance on Mental Illness and find your local chapter meeting location and time for support from other mental health consumers and families.

Am I Alone?

by Gariane Phillips Gunter, M.D.

















Am I Alone? by Megan Hance



I get a funny feeling, it comes from deep inside.



I get all mad and angry, wanting to go and hide.



My doctor calls it depression, my dad says it's just me.



But the thoughts and feelings, no one will ever be able to see.



Some say I'm psycho, some say I'm just weird.



It's like I'm a different person, and the old me just disappeared.



I get really edgy, I want to commit suicide real bad.



Then I get a headache, followed by feeling sad.



I wish I could get help, I wish it would go away.



Maybe if I keep praying real hard, it will some day.





I came across this poem and think that the author does a beautiful job of describing the stigma often experienced by those with mental illnesses. The holiday season can be a particularly difficult time as symptoms of depression and anxiety may flare, and feelings of hopelessness creep in.



If you feel yourself slipping away, please contact your doctor or a friend and get help right away. Receive the gift of treatment that everyone deserves. I wish you all a safe and Merry Christmas.