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Facebook's New Suicide Prevention Tool

Facebook's New Suicide Prevention Tool

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Coping with Depression in the New Year

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.

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Study Finds Mental Health Providers Not Well Prepared for Military Veterans - from Medical News Today

Study Finds Mental Health Providers Not Well Prepared for Military Veterans - from Medical News Today

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: (employment resources) (resources for homeless vets) (resources for mental health) (veterans crisis line  1-800-273-8255 press#1)

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Managing chronic pain and its consequences

I thought others may find this article from the Mayo Clinic helpful.

More information at:

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.

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Bipolar Survey

DBSA wants to hear from you. Take the parent/caregiver survey.

Depression and Bipolar Support Alliance
Greg Simon, MD, MPH

Ask the Doc: Do I Have Bipolar Disorder?

Q. Question: I have severe depression, but I've often wondered if I have bipolar. My mood constantly changes. One minute I'm fine, the next I'm crying my eyes out. I snap over things I shouldn't get mad over.

A. : Your question is a very important one, but it’s not an easy one to answer.

As you may know, surveys of people living with bipolar disorder find that many people experience severe symptoms for 10 years or more before receiving a diagnosis of bipolar disorder. In many cases, people receive years of treatment for depression before someone realizes that depression is really part of bipolar disorder.

The “textbook” picture of bipolar disorder includes clear manic episodes with euphoria or elevated mood. That kind of bipolar disorder is easier to recognize. But most people with bipolar disorder don’t experience that “textbook” picture. It’s more common to experience mixtures of symptoms (feeling depressed while also feeling increased energy, racing thoughts, decreased need for sleep). Or people may experience more rapid mood shifts between feeling depressed and slowed down to feeling irritated and speeded up. Those more mixed or rapidly changing types of bipolar disorder are not as easy to recognize.

There are some things that should make us think more about bipolar disorder (instead of just unipolar depression): a family history of bipolar disorder, experiencing rapid mood shifts, and not seeing benefit from several different antidepressant medications. Information from family members or friends is often helpful. They may be able to see patterns over time: periods of increased energy, decreased sleep, or appearing speeded up.

DBSA has online tools that can be helpful. Our Wellness Tracker can help you to keep track of things that might indicate bipolar disorder: not needing to sleep, feeling irritable or speeded up, doing impulsive things (like over-spending or driving too aggressively). Using that tool—and bringing it with you when you visit your doctor or therapist—can really help you to make better decisions about next steps.

Greg Simon, MD, MPH, is a psychiatrist and researcher at Group Health Cooperative at the Center for Health Studies in Seattle. His research focuses on improving the quality and availability of mental health services for people living with mood disorders, and he has a specific interest in activating consumers to expect and demand more effective mental health care.

Got a nagging question you want to ask a doc? Submit your questions online for a chance to get the answer. Check the next DBSA eUpdate to see if your question was chosen.

In the meantime, take a look through our Ask the Doc feature page, a comprehensive archive of past Ask the Doc features which may already be home to the answers you seek.

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Family Rights vs. Patient Rights

Balancing Family Rights to Know with Patient Rights to Privacy

CounselingFamily members are an inescapable fact of life for most of us—good and bad. So how do peers navigate personal decisions about their own treatment options and living a life of recovery with their family members? Today we continue our series on HIPAA with peers sharing their thoughts on the role of family members vs the right to direct their own treatment and recovery.

Balancing Family Rights to Know with Patient Rights to Privacy
It can be difficult for family members, who often have the best interest of their loved ones at heart, to provide enough space for their loved one to accept their disorder, seek treatment and build a life of recovery based on personal choice. But when speaking with individuals living with a mood disorder, many state that this is exactly what needs to happen. While it can be tempting to place oneself in a position of “knowing what’s best,” loved ones may need to recognize that they are on their own separate journey with an unknown destination.

Creating space for recovery to take root
Contributors to today’s post stated that their journey to recovery, began with a personal acceptance of a need for help. Providing space for that journey to evolve is often at odds with a loved-ones desire for things to “just get back to normal”.

Choosing the course treatment takes may also require family members to keep a comfortable distance. For many people, making the step to embark on treatment is the apex for developing feelings of empowerment, embracing an attitude that they are capable of rebuilding their lives, and believing that they have some control over their own destiny.

Family dynamics as well as stigma can also play a role in making the decision to keep family members at bay. Inaccurate stereotypes based on outdated information or worse, lack of interest in becoming educated about mental health conditions can lead to disruptive and unsupportive behavior.

To quote SAMSHA, many peers tell their loved ones:
We are human beings and we can speak for ourselves. We have a voice and can learn to use it.

Supporting family members
An often expressed concern from family member is that they need to speak to their loved-one’s clinician because the loved one is not telling the truth. Although well-intended, these attitudes germinate and take root in a lack of trust and understanding that the road to recovery is one of personal self-discovery.

So what can a family member do when they believe that their input is vital? HIPAA does not stipulate that a family member is prohibited from reaching out. Family members can write a letter, send an email or leave a voice mail.

It is not uncommon for the desire to contact the provider to originate from a yearning to “speed up” the recovery process and get things “back to normal”.  Attending DBSA family support groups or family education programs from NAMI has helped many family members adjust to a “new” normal.

Ongoing communication
The peers contributing to this post, hold a common belief that family communication can mitigate the HIPAA debate. One person sent emails to his family telling them he was doing well and needed space to develop his recovery. If anything, he was a little put out that they respected his request too well. Another peer shared with her mother her personal WRAP®. It describes and outlines behaviors of a bipolar episode that would warrant an intervention from a family member. Yet, another peer interviewed for this post has a 5 Wishes document. This document is notarized, is on-file with her doctors and provides instructions for care in the event that she is incapacitated.

Studies have suggested that family involvement is important when recovering from a mental health episode and sustaining a life lived in wellness. Recognizing that recovery is a personal journey of self-growth can be difficult to accept when someone you love is hurting. It is a natural human instinct to want to help your loved one. As difficult as it might be, creating the space for a loved one to take that journey may result in open family communication that could make some of the controversial parts of the HIPAA discussion obsolete.


  • How do you involve your family, or how has your family involved you, in treatment and recovery?
  • Are their circumstances where privacy needs to be protected from family members?
  • What precautions have you taken to allow others to make treatment decisions for you should you be incapacitated?
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Mental Health Privacy

How Are States Addressing Patient Mental Health Privacy?

JenniferPhotoJennifer Bernstein, JD, MPH
Senior Attorney, The Network for Public Health Law—Mid-States Region
University of Michigan School of Public Health

We continue our series on the interplay between patient privacy and families’ interest in their loved one’s care. Here, Attorney Jennifer Bernstein covers what two states are doing to allow for increased family involvement.

How Are States Addressing Patient Mental Health Privacy?
Though HIPAA is not necessarily a bar to family members obtaining information about their loved ones with mental illness, the wishes of patients are usually paramount. Some states have adopted more innovative legal provisions to help assist families and patients in both protecting privacy while improving care.

New York
In New York, even in cases where the family members are unable to obtain permission to receive information about their relatives, New York State Mental Hygiene Law not only allows but requires the involvement of an authorized representative of the patient in treatment planning. Authorized representatives can include family members. The law presumes that such involvement has important therapeutic benefits to the patient and assists in the patient’s treatment and recovery. The law performs a balancing act.  It assists families by allowing the disclosure of limited information, but does not compromise or reveal confidential information that should be kept between therapist and patient. The goal of the law is to increase family involvement without obtaining the express permission of the patient and without violating confidentiality.

Information disclosed to family members can include information about:

  • programs available for the patient
  • rights and privileges of the patient and family members
  • family visits
  • legal status of the patient, and
  • discharge plans

Also, if not clinically contraindicated and appropriate, health care providers can share information provided by the family with the patient, such as relaying messages of support.

An innovative Minnesota law creates a new type of information release for family caregivers and clarifies the rights of families with respect to the care, treatment and monitoring of loved ones with a mental illness. The law, called the “family involvement law,” allows for limited but important information to be released to family caregivers of patients with mental illness.

In the case of patient’s that do not elect for a full privacy release of information to family members, the law creates an alternative to signing a full privacy release. Under the law, patient’s may sign a partial information release that allows providers to disclose information about:

  • diagnosis, admission to or discharge from treatment
  • name and dosage of medications prescribed
  • side effects of medication
  • consequences of the failure to take prescribed medications, and
  • summary of the patient’s discharge plan

In the Minnesota law, any person can request mental health information about a person with a mental illness if they either

  • live with the person with a mental illness, or
  • cares for or helps obtain care for the person with a mental illness, or
  • directly involved with monitoring the well-being of the person with a mental illness

To ensure the rights and privacy of patients, the law requires that the caregiver’s involvement must be verified by someone such as a mental health or health care provider, the individual’s doctor, or anyone other than the caregiver putting in the request.

Family advocates for patients with mental illness were the driving force behind the laws in New York and Minnesota. Raising awareness about the benefits to family involvement in patient care, as well as the legal challenges families face in obtaining information about their loved ones can help spur change in other states.

Your Turn

  • In what ways are New York and Minnesota getting it right?  What’s wrong with their approach?
  • What’s happening in your state? Are you supporting it or not?

Do you want your state to make it easier for families to be involved in a loved one's mental health care?


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Youth Suicide Prevention

Speaking Out About Youth Suicide

alison_malmon_2_websiteAlison Malmon
Founder and executive director of Active Minds Inc.

Today we continue our five part series on youth suicide prevention. Guest perspectives come from National Network of Depression Centers and Active Minds Inc., as well as personal stories from both a peer and family member. In today’s post Alison Malmon writes about the role peers and others play in preventing youth suicide on college campuses.

Speaking Out About Youth Suicide

At first glance, the 1,100 backpacks spread out across the campus quad or in the student union look puzzling. Walking through them, you notice that most have stories attached. Some have pictures. Signs reading, “Don’t be afraid to ask for help”and “Stigma is shame, shame causes silence, silence hurts us all,” poke out among the packs. Students quietly mill around, picking up the bags and reading the stories.

At some point, it becomes clear: These aren’t just ordinary backpacks. They represent the number of college students who die by suicide each year.

This is what it’s like to experience Send Silence Packing, Active Minds’ traveling suicide prevention display currently touring campuses in the Midwest. The stunning visual depicts how many student lives are lost each year to suicide and gives important information to those on campus who most need it — students.

The statistics on college campus suicide are staggering, consider:

  • 1,100 students die by suicide each year
  • Suicide is the second-leading cause of death among students
  • Nearly one half of students say they felt so depressed that they found it difficult to function in the past school year
  • Roughly one in ten college students has considered suicide

It’s not enough to merely understand the statistics in order to prevent suicides on college campuses. We also need to understand the daily experiences of students who are struggling. Key in any campus suicide prevention effort is recognizing that college students turn to their friends for help before anyone else.

Research shows that two-thirds of all college students with suicidal ideation first report these feelings to a friend, roommate, or significant other. Because students spend the majority of their time in college surrounded by peers not just during weekdays, but also at night and on weekends, these peers are more likely to notice a change in their behavior or mood.

Students are more likely to talk to a friend before contacting the counseling center or reaching out to a parent or a professor. Fifty-two percent who confided in peers about their suicidal ideation reported the person was helpful or very helpful in their recovery. It’s pretty clear.Reaching out to students in distress isn’t enough. All students need the tools to safely and effectively help a peer that is struggling with suicidal ideation.

We need to educate the entire campus population.

This notion seems to be catching on. At more and more schools, we’re seeing mental health awareness included in freshman orientation. Resident Assistants are being trained in how to help students who are struggling. Our chapter at the University of Oregon is advocating to havemental health resource numbers printed on the back of every student I.D. There seems to be no limit to the creativity and innovation we find among our chapter members in finding ways to educate their peers about mental health and suicide.

Even so, we have much more work to do. Most of the students who approach a Send Silence Packing exhibit have no idea that suicide is so common on campuses. They aren’t sure what to say if a friend confides that they’re having suicidal thoughts. That’s OK. This is a scary subject to talk about. But it’s up to universities and colleges to start the conversation.

The answer to suicide prevention on our college campuses is simple: Involve the talented and intelligent students sitting in classrooms, eating in dining halls and sleeping in dorms. Talk to them. Teach them. Engage them. They are our best hope to truly send silence packing.

Your Turn

  • What would you want people to say to you if you were experiencing feelings of hopelessness?
  • How can campus administrators and college counseling centers create better awareness around the public health issue of student suicide?

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Is youth suicide a problem on your college campus?


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Do you believe your college or university is adequately addressing mental health and suicide issues for students?


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Can You Thrive with a Mood Disorder?

Gregory Simon, MD, MPH
Investigator, Center for Health Studies Group Health Cooperative

Can You Thrive with a Mood Disorder?

The Depression and Bipolar Support Alliance has designated 2014 as the Year of Thriving. Throughout the year, they are challenging the organization and the mental health community to set higher goals, to shift the conversation from “surviving” or “managing” a mood disorder to truly thriving.

In a recent DBSA podcast, Dr. Joseph Calabrese and I discuss the limitations of current treatment options for mood disorders and the need within the clinical and patient communities to shift expectations and raise treatment goals to complete remission of symptoms and sustained wellness.

We are challenging our entire field—clinicians, researchers, administrators, and policy makers—to set higher goals for mental health treatment. Our goal is not simply to control or reduce symptoms, but to eliminate them.

Is eliminating symptoms of depression or bipolar disorder a realistic goal? We think so. What we have now is not what we hope for, and we should not allow the inadequacies of our current treatments to diminish the importance of our long-term goals. Our current tools for treatment of mood disorders—medications, psychotherapies, and other treatments —often fall far short of eliminating symptoms and sometimes cause significant side effects or create long-term risks. With those far-from-perfect tools, patients may occasionally reach the target of zero symptoms. But most do not. If we hope to reach our target all of the time—or even most of the time—we clearly need more effective treatments.

In addition to better tools or treatments, we need a significant attitude adjustment at all levels of our treatment system. Our patients should expect—and even demand—better results of treatment. Sadly, consumers are, on average, quite satisfied with mental health treatment that is simply not very effective. Clinicians also need to re-orient toward higher goals. Our traditional metrics (like 50% reduction in symptoms or reducing symptoms to “subthreshold” levels) don’t help people to thrive. Most of us would prefer not to carry around a Hamilton Depression Rating Scale score of 12, even if it is 50% improved from what it used to be.

Thriving is, of course, about more than treatment to eliminate symptoms. Thriving is about total health—mental and physical. Thriving goes beyond eliminating the negative. It’s about developing the positive, and reaching personal goals in work and love and play.

In the podcast, Dr. Calabrese suggests that too much emphasis is placed on negative symptoms.  Dr. Calabrese states, “we almost never target positive symptoms of recovery… feelings of calm, rested or cheerfulness.”

DBSA’s Target Zero campaign to support the Year of Thriving suggests a paradigm shift from the traditional concept of remission in two ways:

  • First, it is a more ambitious goal: eliminating symptoms rather than reducing them to a tolerable level
  • Second, it is a verb. It is about action

Embracing research that broadens the definition of remission to include the presence of positive symptoms, not just the decrease of negative symptoms is a major attitude shift. As the mental health community explores attitude adjustments around the word “remission”, I challenge researchers, policy makers, and providers to broaden their perspective.

Your Turn

  • What can you tell your clinician as you aim to achieve zero symptoms?
  • Should researchers, policy makers and the medical community include positive symptoms as a marker for successful treatment?
  • How might policies change to re-orient treatment to achieve zero symptoms?
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Is “stability” the best we can do for wellness?

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:

  • relapse
  • functional impairment that increases the challenges of work, family, and day-to-day living
  • life-threatening co-occurring conditions such as heart disease, diabetes, hypertension
  • death by suicide

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

  • Spread the word and sign the petition
  • Post a selfie with the Target Zero logo on Facebook or Instagram
  • Request and wear a Target Zero pin
  • Nominate a professional who you believe embraces the ideas of the campaign

Your Turn

  • What should the research and medical community be doing to support people living with mood disorders to obtain a life lived with zero symptoms?
  • How do you support your friends or family members in attaining optimal health?


This entry was posted in Care for Your Mind and tagged , , by Care for Your Mind




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Better Alone and Happy, Than Together and Miserable

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White House Releases Long-Awaited Rules On Mental Health - original story on NPR

The Obama administration delivered on a long-delayed health care promise when it issued rules to ensure equal health insurance treatment for people who have problems with mental health or need treatment for substance abuse.

The rules, issued Friday, require that most health insurance plans offer the same amount of coverage for mental health and substance abuse claims as they do for medical and surgical coverage.

That means insurers can't charge someone more for mental health services than for other services. It used to be that plans could — and would — pay 80 percent of the charge for medical care but only 50 percent of the claim for mental health care. But under these rules, plans can't cover fewer inpatient hospital days for mental health or substance abuse treatment than they do for a physical illness.

The law creating what's called mental health "parity" actually passed in 2008. Mental health advocates have been agitating for these rules ever since.

That's because once the Mental Health Parity and Addiction Equity Act barred insurance companies from imposing limits on the number of hospital days or copayments, insurance companies started looking for other ways to limit mental health and substance abuse care, like requiring preauthorizations that they don't demand for other types of medical care. That won't be allowed anymore. These rules also clarify coverage for rehabilitation or other intermediate types of care that don't fall neatly into inpatient or outpatient categories.

Until recently, the mental health parity law only applied to people covered by large group health plans — those with more than 100 workers.

That all changed when the Affordable Care Act was passed in 2010. It expands parity requirements to include the health insurance plans of smaller groups, as well as individual plans. And it also requires that those plans cover treatment for mental health, and substance abuse programs.

But that last requirement wasn't included in the 2008 law, and it still doesn't apply to larger plans under the Affordable Care Act. The 2008 law just says if the plan offers coverage, that coverage has to be the same for mental health and substance abuse as it is for other medical care.

So more people are covered, but there are still some people who are left out. While Medicare now has a mental health parity requirement, Medicaid and the Children's Health Insurance Program don't.

Go to the NPR health blog to listen to more of this story


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Policies hamper students' return from mental health leave - written by Carla Newton, USA Today College

Policies hamper students' return from mental health leave  - written by Carla Newton, USA Today College


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 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."

My sense is there's a tremendous variation among colleges and universities and how they handle these situations. Some do a really good job, some deal with it in just a frighteningly, appallingly prejudicial way.

— Ira Burnim, legal director of the D.C. Bazelon Center for Mental Health Law

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

"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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AZ proposed Mental Health Database

AZ proposed Mental Health Database

Legal groups propose mental health database

Published: Monday, October 28, 2013 2:54 AM MDT
PHOENIX (AP) — The State Bar of Arizona and state Criminal Justice Commission want a database to keep track of people who are under court-ordered mental health treatment.

The database known as the Mental-Health Registry is under construction and will be managed by the state Supreme Court, according to the Arizona Capitol Times.

It will tell police officers whether a person exhibiting possible signs of mental illness is undergoing treatment under the supervision of the court or deemed mentally incompetent by a court.

Proposed legislation also would close gaps in laws that prohibit certain people from possessing a firearm, such as those who are under indictment, under guardianship for mental incapacity or found to be mentally incompetent.
The state currently reports people who have been involuntarily committed to a mental institution to the National Instant Criminal Background Check System, the database used for checking the backgrounds of gun buyers.

However, only about 10 percent of them are reported because of an inadequate digital record-keeping system.

The state doesn’t report people who have been determined to be incompetent. Arizona also doesn’t report people under felony indictment, mostly because prosecutors aren’t set up to enter information into the various criminal databases from which NICS captures data.

The idea behind the legislation and the database is to improve the state’s reporting to NICS. The information in the Mental-Health Registry would be transmitted to the Arizona Department of Public Safety crime database and NICS.

“I really believe this is the start of a good solution,” said George Diaz, a spokesman for the Criminal Justice Commission.

The legislation is in its preliminary stage and has to be approved by the commission, which meets Nov. 14.

Eddie Sissons, a consultant with Mental Health America of Arizona, said any legislation is going to include a provision for deleting a person whose condition has improved from the mental health database.

Sissons said there has to be a balance reached between public safety and unnecessarily stigmatizing people with mental illness.

James McDougall, a retired judge who specializes in mental health legal issues, is drafting separate legislation that would spell out how the courts use the database.

He said there has been plenty of discussion about Sissons’ concerns and establishing a way to get people out of the registry, either through a separate court proceeding or more automatically with a separate order that supersedes the order for treatment.

“Nobody wants this register to fill up with orders that don’t need to be enforced,” said McDougall, who sits on a State Bar panel concerned with mental health law and legal practice.

McDougall said the legislation he’s working on is also very preliminary and hasn’t been approved by the State Bar.


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