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

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

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

Williams’ death reminds us that a patient’s relief might be a warning sign

By
H. Steven Moffic, MD

One
of my favorite movie moments is when Robin Williams signs on as an edgy D.J. by
exclaiming "Good Morning, Vietnam" from the 1987 movie of the same name.
Sometimes, I played the audio over and over, as if it could promise a good day.
As he did so often, he found a way to not only lighten the sadness, but to do
it in such a way that might be constructively critical.

Surely,
the real life mornings were not often happy ones, as so many of our troops died
or ended up with post-traumatic stress disorder (PTSD) from that war. It is a
lesson we are still learning, so that movie and his role is worth seeing again
soon.

Now,
after his reported suicide, that good morning seems more like a final good
night.

Although
he is probably best known for his manic comedy, he also played many serious
roles. Most ironically now, he won an academy award in 1997 for playing an
empathic therapist in the film “Good Will Hunting.”

Indeed,
beloved entertainers like Robin Williams have a therapeutic role of sorts for
society in the sense that they provide some relief—even if briefly—for the
grief and stress of everyday life. For playing that societal role, such people
become a repository for our hopes, dreams and demons. As we know for so many
famous entertainers, it is not easy for them to have a successful private
life—a private life that the public also tries to invade, as if they were
related to us.

What
we do know publicly is that Williams suffered from chronic depression and
intermittent substance abuse. It is reported that he received treatment,
including entering rehab just last month. Obviously, money to get the best
treatment was not an issue, though how good the treatment was will remain
unknown. We do know, however, that wealthy VIPs often receive treatment just as
poor as low-income folks without resources. We also know that occasionally
depression is a terminal illness, though that ending is not predictable.

Beyond
the public information, and despite the understandable curiosity, this is not
the time, nor should it ever be the time, to speculate about his diagnosis and
reasons for committing suicide. In fact, the so-called "Goldwater
Rule," called that for the inappropriate professional speculation about
presidential candidate Barry Goldwater, ethically prohibits such speculations
on the part of psychiatrists like myself.


Given
this professional ethical principle, as well as the family's request for
privacy, is there anything we can still learn from this apparent tragedy? The
most intriguing detail that caught my attention was his last tweet and
Instagram on July 31. Reportedly, he had wished his daughter a happy 25th
birthday.

Why
might this positive communication be of importance to us?

It
reminded me of the only patient I ever had who committed suicide, long ago,
when I was a resident in training. In the second session, the depression of
this elderly man seemed to be less severe, but after that session he walked
into Lake Michigan and drown. In the psychological autopsy, I never forgot the
warning that when a depressed patient starts to seem better, they actually can
be at higher risk for suicide.

Risky
time

Why
is that time of apparent improvement a risky time? The person can have more
energy, then plan and complete a suicide. They may also feel relief at their
decision, causing others to paradoxically feel relief. That is one of the
reasons why it is so common to hear of the genuine surprise that the suicide
occurred, as the person seemed to be happier.

What
this means, not only for professionals, but for the public, is not to take at
face value if a depressed person seems better. Be sure there is a sound
explanation for the apparent improvement. 

Our
only consolation must be that entertainers like Robin Williams keep on living
in the form of their life’s work, like the movie “Good Morning, Vietnam,” that
is so ubiquitously available nowadays. Even so, it would not be surprising if
at the times we laugh once again at Robin William's humor, that the laughter
will also be accompanied by some tears of grief.

Bio

H. Steven Moffic, MD, is a Life Fellow of the APA. Currently, he blogs regularly for Psychiatric Times, Behavioral
Healthcare, and The Hastings Center's Over 65.



This blog was originally published in Behavioral Healthcare.
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