Going into a New Year is always associated with resolutions and fresh starts. However, it can be a struggle for people coping with depression at this time; "snapping out" of their condition is not as easy and quick as a burst of New Years Eve fireworks. Whether you are helping others or yourself cope with depression, here are some helpful tips
Helping Other Cope With Depression:
- Offer emotional support, understanding, patience, and encouragement.
- Talk to him or her, and listen carefully.
- Never dismiss feelings, but point out realities and offer hope.
- Never ignore comments about suicide, and report them to your loved one's therapist or doctor.
- Invite your loved one out for walks, outings and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon.
- Provide assistance in getting to the doctor's appointments.
- Remind your loved one that with time and treatment, the depression will lift.
Helping Yourself Cope With Depression:
- Do not wait too long to get evaluated or treated. There is research showing the longer one waits, the greater the impairment can be down the road. Try to see a professional as soon as possible.
- Try to be active and exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed.
- Set realistic goals for yourself.
- Break up large tasks into small ones, set some priorities and do what you can as you can.
- Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself, and let others help you.
- Expect your mood to improve gradually, not immediately. Do not expect to suddenly "snap out of" your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.
- Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
- Remember that positive thinking will replace negative thoughts as your depression responds to treatment.
- Continue to educate yourself about depression.
Most community-based mental health providers are not well prepared to take care of the special needs of military veterans and their families, according to a new study by the RAND Corporation that was commissioned by United Health Foundation in collaboration with the Military Officers Association of America.
The exploratory report, based on a survey of mental health providers nationally, found few community-based providers met criteria for military cultural competency or used evidence-based approaches to treat problems commonly seen among veterans.
"Our findings suggest that community-based mental health providers are not as well prepared as they need to be to address the needs of veterans and their families," said Terri Tanielian, the study's lead author and a senior social research analyst at RAND, a nonprofit research organization. "There is a need for increased training among community-based providers in high quality treatment techniques for PTSD and other disorders that are more common among veterans."
Although the Department of Defense and Veterans Health Administration in recent years have increased employment of mental health professionals, many veterans may seek services from practitioners in the civilian sector, often because they are located closer to their homes. In addition, policymakers have expanded veterans' access to community-based health providers as a way to meet demands, given capacity constraints in the VA health system.
"Our veterans have served and sacrificed for our nation and deserve the very best care," said Kate Rubin, president of United Health Foundation. "We hope this study will focus attention on the opportunity that exists to better prepare our mental health workforce to meet the unique needs of veterans and their families."
Recent military veterans are more likely than the general population to suffer from major depressive disorder and posttraumatic stress disorders, two conditions prevalent among those who have deployed to battle zones.
RAND researchers surveyed a convenience sample of 522 psychiatrists, psychologists, licensed clinical social workers and licensed counselors to determine whether they used evidence-based methods to treat major depressive disorder and PTSD, and whether they had the training needed to be sensitive to the needs of veterans.
Just 13 percent of the mental health providers surveyed met the study's readiness criteria for both cultural competency and delivering evidence-based care. Providers who worked in community settings were less prepared than providers who are affiliated with the VA or military health system.
Only one-third of psychotherapists reported receiving the training and supervision necessary to deliver at least one evidence-based psychotherapy for PTSD and at least one for depression.
While 70 percent of those providers working in a military or VA setting had high military cultural competency, only 24 percent of those participating in the TRICARE network, the Department of Defense's health insurance program, and 8 percent of those without VA or TRICARE affiliation met the threshold for cultural competency.
"Veterans and their family members face unique challenges, and addressing their needs requires understanding military culture as well as their mental health challenges," said retired Navy Vice Adm. Norb Ryan, president of the Military Officers Association of America. "It's crucial that our civilian mental health providers acquire the training and perspective they need to guide their practice in the care of our military and veteran population."
The study recommends that organizations that maintain registries or provider networks include information about mental health practitioners' ability to properly treat the special needs of military and veteran populations.
In addition, researchers encourage policymakers to expand access to effective training in evidence-based treatment approaches and to create incentives to encourage providers to use these strategies in their routine practice.
If you are a veteran or would like resources for veterans, please check out these sites:
http://www.archives.gov/veterans/employment-resources.html (employment resources)
http://www.va.gov/homeless/resources.asp (resources for homeless vets)
http://www.nami.org (resources for mental health)
http://www.veteranscrisisline.net/GetHelp/ResourceLocator.aspx (veterans crisis line 1-800-273-8255 press#1)
I thought others may find this article from the Mayo Clinic helpful.
Is there a link between pain and depression? Can depression cause physical pain?
Answers from Daniel K. Hall-Flavin, M.D.
Pain and depression are closely related. Depression can cause pain — and pain can cause depression. Sometimes pain and depression create a vicious cycle in which pain worsens symptoms of depression, and then the resulting depression worsens feelings of pain.
In many people, depression causes unexplained physical symptoms such as back pain or headaches. This kind of pain may be the first or the only sign of depression.
Pain and the problems it causes can wear you down over time, and may begin to affect your mood. Chronic pain causes a number of problems that can lead to depression, such as trouble sleeping and stress. Disabling pain can cause low self-esteem due to work, legal or financial issues. Depression doesn't just occur with pain resulting from an injury. It's also common in people who have pain linked to a health condition such as diabetes or migraines.
To get symptoms of pain and depression under control, you may need separate treatment for each condition. However, some treatments may help with both:
Antidepressant medications may relieve both pain and depression because of shared chemical messengers in the brain.
Talk therapy, also called psychological counseling (psychotherapy), can be effective in treating both conditions.
Stress-reduction techniques, physical activity, exercise, meditation, journaling and other strategies also may help.
Pain rehabilitation programs, such as the Pain Rehabilitation Center at Mayo Clinic, typically provide a team approach to treatment, including medical and psychiatric aspects.
Treatment for co-occurring pain and depression may be most effective when it involves a combination of treatments.
If you have pain and depression, get help before your symptoms worsen. You don't have to be miserable. Getting the right treatment can help you start enjoying life again.
Cancer treatment is considered a success when all cancerous cells have been removed. So why is being stable considered to be successful treatment of mood disorders? Shouldn’t we insist on remission of all symptoms as the end goal? The Target Zero to Thrive Campaign raises expectations for outcomes and mental health treatment.
The first priority in treating a mood disorder is ensuring that the person is out of immediate crisis. But should this be the end goal? Too often researchers, providers, family members, and peers consider a stable mood as a measurement of a successful outcome.
On April 1, the Depression and Bipolar Support Alliance (DBSA) kicked off a month-long program challenging the mental health community to raise expectations from fewer symptoms to zero symptoms. “Target Zero to Thrive” is a campaign to insist on new standards for research and treatment that raise the bar from stability to lives of wellness.
Twenty-one million people in the U.S. live with mood disorders, and persisting symptoms increase the likelihood of:
According to Allen Doederlein, president of DBSA, “Living with a mood disorder can damage hope and lower expectations so a person may not expect or think they deserve a full life. We as peers, clinicians, researchers, and family need to help them expect and achieve more.”
Dr. John Greden, Executive Director of the University of Michigan Comprehensive Depression Center, wrote in a March 11, 2014 CFYM post that “We need policies that move away from short-term research grants and that support a change in approach in how we measure outcomes.”
In that same post, Greden further noted, “We treat mental health issues in an episodic way, even though we know that mood disorders are going to be with a patient for a lifetime and recur even with the best therapy.”
What is the flip-side of raised expectations? Certainly, not shame or guilt because one is experiencing residual symptoms. Rather, it is a call to the research and medical communities that we expect and demand more. Target Zero to Thrive points out how the system has failed people living with the mood disorders when they are not being given the opportunity to achieve zero symptoms—not the other way around.
Doederlein reiterates this point when he says “Believe me, I know—I know—that thriving can seem so elusive, even impossible at times. But we can’t get there if it’s not even part of the conversation.”
There are many ways to get involved in the campaign
Brown University student Okezie Nwoka experienced his first manic episode in the fall of his junior year.
After being hospitalized for a week, Nwoka spoke to administrators about remaining on campus to complete the semester.
"I was convinced very strongly to take a medical leave," said Nwoka, who had been president of his class. "I thought about it and decided I could take the medical leave and still graduate on time."
When Nwoka tried to return the next semester, his application for readmission was rejected.
"They said I had to be away at least a year," Nwoka said. "The rejection letters — it's almost like a slap in the heart."
While most universities offer support for students with mental health conditions, some who have taken psychological leave have found the process of returning to school difficult or impossible.
Brown's official medical leave policy mandates that a leave — for either physical or mental health — "is expected to last two full semesters."
Mental health problems are common on college campuses: Suicide is the second leading cause of death among college-age students, and a 2011 American College Health Association–National College Health Assessment survey found that 30% of undergraduates reported experiencing serious depression during their college careers.
Brown University's director of psychological services, Sherri Nelson, did not reply to an e-mail seeking comment. The former director, Belinda Johnson, has responded in the past to criticisms of the policy.
"The situation that arises is that as an institution we are trying to support students," Johnson said in an interview in 2010 interview with The Brown Daily Herald.
"Let us, as staff with experience, help you out."
While Brown University does occasionally make exceptions, Nwoka took several mandated medical leaves over the course of his education. He graduated from Brown five semesters late, in December 2012.
After six months of leave, Nwoka was required to start repaying his student loans, while his family struggled with a "ridiculous amount" of medical expenses. He tried to transfer to Howard University in Washington, D.C., which did not accept the majority of his credits.
One of the administrators, he claims, told him: "You should consider yourself lucky because Brown's better than other schools. At least you're not getting kicked out of Brown."
Medical leaves and the law
"I think universities do want to work with students to help them succeed," said civil rights attorney Karen Bower, who specializes disability discrimination cases in higher education. "There may be some sincere belief that in their experience, students need time to deal with emerging mental health problems."
Bower has litigated several cases involving undergraduate mental health, including a high-profile 2005 case at George Washington University.
The plaintiff, Jordan Nott, was a straight-A GW freshman. After his close friend and hallmate committed suicide in 2004, Nott sought treatment for depression from the University Counseling Center, according to court documents.
Under the influence of the prescription sleeping pill Ambien, Nott experienced suicidal thoughts. He told his roommate, who accompanied him to George Washington University Hospital.
Within 12 hours of his psychiatric hospitalization, Nott received a disciplinary letter barring his return to campus that semester. The university subsequently leveled disciplinary charges against Nott.
"He was charged with violation of the school code of conduct, which prohibited self-harm," said Bower. "He chose to withdraw from the school and matriculate elsewhere."
"I think GW would acknowledge that they mishandled the Jordan Nott situation and overreacted in ways that were less than helpful," said Dr. Victor Schwartz, medical director of the Jed Foundation, a leading college mental health organization.
"My sense is there's a tremendous variation among colleges and universities and how they handle these situations," said Ira Burnim, legal director of the D.C. Bazelon Center for Mental Health Law. "Some do a really good job; some deal with it in just a frighteningly, appallingly prejudicial way."
The Bazelon Center recently filed a discrimination complaint with the United States Department Office for Civil Rights against Princeton University.
The complaint claims that an undisclosed Princeton student was coerced to withdraw "voluntarily" from the university, which imposed "onerous and intrusive" conditions for his return.
"I was astounded to learn that Princeton has a mandatory one-year (medical leave)," Burnim said. "The law is clear — you can't deny people readmission if they meet the essential academic and behavioral standards of the school."
He claims policies that treat mental health leaves differently than physical health leaves are in violation of the American with Disabilities Act andSection 504 of the Rehabilitation Act, which forbids organizations from "excluding or denying individuals with disabilities an equal opportunity to receive program benefits and services."
"It's unfair, and illegal," said Burnim of the year-long requirement. "It's obviously not helpful to mental health."
Princeton officials declined to comment for this story.
"The policy needs to be clear and well-defined enough to be helpful for students and their families so they understand the parameters of the leave," said Schwartz. "At the same time, the policy needs to be flexible … the decision-making needs to be driven by some sense of medical necessity."
Schwartz said that some psychiatric problems—like "medication mismanagement"— can be treated within three or four weeks, and do not require year-long leaves. For other conditions, like eating disorders, longer treatments may be necessary.
"The student might be doing great academically but be in acute physical danger," said Schwartz. "The schools might use the leave of absence as leverage to get treatment. It can save people's lives."
Schwartz advocates equal policy for psychiatric and physical health leaves.
Jake Baggott, executive director of the University of Alabama-Birmingham's Student Health and Wellness Center, does not believe mental and physical health conditions can always be treated equally.
Baggott says he spoke as an administrator with almost 30 years of experience with campus wellness, not on behalf of UAB.
"I think that each condition, each situation, needs to be considered on its own merits," Baggott said. "It wouldn't be easy to compare the two ... I think it would be problematic to come up with one policy that applies to everyone the same. I'm going to be hesitant to be critical of anybody's particular practice."
Veronica Bland, 19, is a sophomore at Elon University who suffers from depression. Four years ago, while attending the Brooks School in Massachusetts, she overdosed in a suicide attempt.
"I immediately realized I couldn't do this to my family or my friends," Bland said. "I went and told a girl who lived on my hall. I was immediately brought to the hospital by the faculty member on duty that night."
While Bland was hospitalized, Brooks School made the decision to withdraw Bland without her knowledge — or her parents'.
"I guess they came to the conclusion, the deans and the president of the school, that I was dangerous to the community," Bland said. The school banned her from campus, even to visit friends.
In contrast, Elon has been accommodating to her needs.
"I don't think I could have asked for a better school. They would never involuntarily kick me out or put me on medical leave," Bland said.
Bland believes a network of university support is crucial in preventing other suicide attempts.
"It almost felt to me at the time, what was the point of getting help," says Bland of her expulsion. "I was just going to be kicked out anyway. The second time I attempted, I didn't really reach out."
"You didn't have to leave school in order to recover," said Bower, who also represents Bland. They are considering pursuing litigation. "Once you get the right people around you, recovery is that much better."
"Colleges need to accept that this isn't our fault," Bland said. "I will always be scarred by what happened. I will think about it for the rest of my life and how much it affected my recovery."
Cara Newlon is a senior at Brown University.
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