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

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.

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.

Study highlights lack of access to mental health care

By Arshya Vahabzadeh,MD 

 @VahabzadehMD



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



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



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



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





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

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

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:

• Know your HIV status. Use and share the HIV Testing Sites & Care Services Locator  


• Share your message on social media using #FacingAIDS or  in the Facing AIDS gallery


• Learn about HIV/AIDS with the HIV/AIDS Basics. Ask questions. Get help.


• Take a quiz:  Are you HIV Aware? 

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

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)

How does your primary care doctor coordinate with your psychiatrist?

By Pierre
Gingerich-Boberg, Medical Student

Reviewed by Claudia
Reardon, MD



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



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

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

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

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

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