Month: March 2019

Today I want to point out another resource that is available for another group of people – this is for all of us in the workplace.  It is called “Beautiful Brains: A mental health manual for the modern workforce”, and can be downloaded by using the following link: https://mailchi.mp/bb2523b6a45f/beautiful-brains-mental-health-guide  This manual is promoted by the Made of Millions Foundation, which is an advocacy platform with the goal of changing mental health survivors into mental health advocates.  This project was also made possible by Ready Set Rocket, a creative agency.

The guidebook is around 40 pages long, but there are a lot of illustrations, so it can be read fairly quickly and easily.  Topics covered include statistics on mental health in the workplace, a program for implementing supportive services and fighting stigma, sample wellness initiatives, and educational resources.

Like other resources mentioned in my previous posts, I think it is great to have a guide like this available.  I assume a lot of us in the workplace would appreciate having help in knowing what they can do if a mental health issue affects them or someone they know.  I also think it is important that we let employees and employers know that it is ok to talk about their mental health and any struggles they may be having.  Everyone needs to know they can get support, and although it might be hard for employees to ask for help, I feel that the more employees and employers hear about it the more they will be willing to get assistance when they need it.

How about you?  What are your thoughts on this manual?  Does it give you some helpful information?  Is it missing important pieces that would be helpful for you to know?  I hope you will take some time to download and review the manual to see if it can be helpful to you or someone you know.

This post is solely going to be based on my opinion, but I wanted to share some of my thoughts on health care, including care for mental health.

In the United States, there has been a lot of conversation about “health care for all” or “Medicare for all”, and, although I don’t know all of the details surrounding all of those ideas, I believe that health care is a right for everyone, regardless of a person’s ability to pay.  Now, having made that general statement, there are some caveats that I would include, and that makes this a lot harder.  While I think everyone has a right to health care, in my mind that includes certain services and not the extras.  For example, everyone should be treated for a broken bone.  However, I do not think that a breast enlargement should be counted as health care.  But therein lies the difficulty – what I consider essential and nonessential no doubt varies from many others.  How would we ever agree on what services everyone gets no matter what the circumstances?  Definitely not an easy road to travel.

When it comes to mental health care, I no doubt would be a lot more generous on what is considered essential, because I have seen first-hand how the current health care system can fail so many people with mental illness.  Mental health is just as important as physical health, and it needs to be considered essential care for anyone in my opinion.  But, again, how do we decide what is available to everyone? 

Overall, health care is not an easy topic, but in general my opinion is that to some extent it is a basic human right.  Although money will most likely always be an issue, from a moral and human standpoint I do not see how we can refuse to help our other fellow humans stay healthy.  We need to think about what is the right thing to do, and taking care of others is very high on the list. 

Today I want to touch on a topic that you may or may not have heard about – it is called trauma-informed care, and much of the information in today’s post comes from a great article from Harvard that can be found here: https://www.health.harvard.edu/blog/trauma-informed-care-what-it-is-and-why-its-important-2018101613562

Trauma-informed care is being described in the healthcare setting as a way to consider how a patient’s history of trauma may impact their interactions in the healthcare system.  Trauma-informed care includes practices of safety, empowerment, and healing, and considers the sobering reality that many patients have experienced trauma in their lives.  Realizing that trauma is common is a big part of integrating trauma-informed care into hospitals and clinics.

Another aspect is to recognize that there are many forms of trauma, which can translate into showing more open-mindedness and compassion with patients.  Some practices of trauma-informed care include: explaining why you are asking potentially sensitive questions, explaining why you need to perform a physical exam, and letting the patient know they can stop or refuse a test or procedure.  Overall, it may be best to assume that every patient has some trauma in their history, and act accordingly.  This does not mean a provider needs to ask every patient for details about their trauma history, but to be aware that it might have an effect on their interaction with a patient.

I think the concept of trauma-informed care is important, and I am glad to see that the healthcare system is working on including it.  I also think that this idea can be applied to other areas outside of healthcare, because a history of trauma can show up in many different places. 

How do you feel about trauma-informed care?  Have you heard of this concept before?  Have you experienced trauma-informed care in action?  My hope is that we will continue to see more of this type of care and consideration.

Today I want to point out a resource that is available for everyone, as we never know when this situation may happen to any of us.  It is called “Navigating a Mental Health Crisis”, and it can be downloaded for free on NAMI’s website at https://www.nami.org/About-NAMI/Publications-Reports/Guides/Navigating-a-Mental-Health-Crisis/Navigating-A-Mental-Health-Crisis.pdf?utm_source=website&utm_medium=cta&utm_campaign=crisisguide 

The guidebook is a little over 30 pages long, but it has many different sections, so you can pick and choose what is important to you if you don’t want to read the entire guide.  Topics covered include understanding mental illness, understanding mental health crises, what to do in a mental health crisis, what to expect from mental health treatment, advocating for treatment, other types of crises, preparing for a crisis, and NAMI resources.

Personally, I think it is great to have a guide like this available.  I assume most of us would appreciate having help in navigating a mental health crisis and having some assistance in knowing what to do.  As a lot of us have come to realize, understanding the healthcare system and insurance can be challenging, even if you are not faced with a mental health condition.  Also, there are challenges in understanding the criminal justice system and how to navigate that area should it come into play.  Finally, I like how the guide encourages us to consider the before, during, and after of a crisis, because these are all important parts of a mental health event.

How about you?  What are your thoughts on this guide?  Does it give you some helpful information?  Is it missing important pieces that would be helpful for you to know?  I hope you will take some time to download and review the guide to see if it can be helpful to you or someone you know.  Also consider sharing it with everyone you know, because a mental health crisis can affect anyone.

Today I want to highlight another possible treatment option for depression – vagus nerve stimulation, or VNS.  The Mayo Clinic has a very good overview of VNS, which is my source of information and can be found here:  https://www.mayoclinic.org/tests-procedures/vagus-nerve-stimulation/about/pac-20384565

Vagus nerve stimulation is typically used for seizures and depression, but research is being done to determine if there is a benefit in other conditions.  And, while most vagus nerve stimulators are implanted, there are some noninvasive stimulators now available.  There are two vagus nerves – one on each side of the body, and they run from the brainstem through your neck and into the chest and abdomen.

When it comes to depression, vagus nerve stimulation has been used for treatment-resistant depression.  These are patients who have tried things like medications, counseling, and electroconvulsive therapy (ECT), and have still not experienced much or any relief.  From what I can see, it is not known how VNS works to treat depression, and the research is mixed on the benefits of using an implanatable VNS device in this population.  There may also be an issue with getting the procedure covered by insurance.  Overall, my interpretation is that this is currently a last ditch effort to try something when nothing else is working.  It may not be a great option, but it is an option when other traditional methods have failed. 

If someone is considering VNS for depression, it is important to remember that it will likely be an invasive procedure that comes with potential risks and side effects.  Some examples include infection, pain, difficulty swallowing, voice changes, and shortness of breath.  Although hopefully these are minimal, it is important to know risks, benefits, and potential side effects before the procedure.

What are your thoughts on VNS?  Does it seems worth trying if everything else has seemed a failure?  

Have you heard of the term “evidence based medicine”?  What exactly does that mean?  Is it important?  If so, why?

The term “evidence based medicine” is used in many settings, but definitions can vary.   Essentially the name pretty much gives away what it means.  Evidence based medicine is medicine that comes from some kind of research or study or observation.  Most practitioners believe that when they practice medicine, they should be using medications, techniques, procedures, etc. that have been proven to help.  Another important piece of evidence they like to use is safety, because obviously providers do not want to increase any pain or suffering for their patients. 

When it comes to evaluating all of the information, not all evidence is created equally.  Most practitioners will consider evidence from prospective randomized controlled clinical trials to be the “gold standard”, while retrospective and observational data are considered less credible.  However, over the years, a lot of questions have come into how research and study is done and reported.  When reporting results, a lot of bias can be presented, and sometimes there can be large conflicts of interest that might make things look better or worse than they really are. 

That being said, this makes trusting any information harder, but that is the main point I want to get across – all evidence, no matter where it comes from, should be questioned.  Sometimes prospective randomized controlled clinical trials are very beneficial, but sometimes observations found with just one patient can be beneficial too.  When facing depression, it’s important to think about what might work for you, from both a benefit and safety standpoint, regardless of where the information may be presented.  Ultimately, this is a discussion between you and your provider, but challenge your provider to consider all of the different types of evidence that may be out there.

While I was not going to originally discuss today’s topic, I feel like I need to share my opinion and process it while it seems to be on my mind.  Within the last week, it seems like I am constantly reminded that it is winter and being out can be scary and dangerous.  My understanding is that this comes from an urge to keep our fellow humans safe and protect life, but right now I am questioning how far that should go before we are terrified into doing nothing. 

Don’t get me wrong – I am just as susceptible to the fear of bad snowstorms and really cold temperatures, but on the other hand, haven’t we all been through these things before?  Did we not survive when we were less aware of these dangers and warnings?  Did we not prepare somewhat, but not go overboard with worry and fear?  I am all for safety and taking precautions, but I am not for scaring all of us into thinking we should stop living because of it.  I am also sitting here thinking, no wonder we have so much anxiety and depression in the world!  When something like cold temperatures becomes an overly dramatized life or death situation, how many other things have we overblown because of fear? 

There has to be a better way.  There has to be a better way of warning people about risks and discussing important precautions, but we need to stop short of the line that goes into scaring people unnecessarily.  What are we doing?  Why does it feel like everything has to be so dramatic?  Again, no wonder we see so much depression and anxiety in the world – there are way too many triggers out there that can play a role in its development.

What are your thoughts on fear?  Does it seem like a lot of things are way too dramatic in our world these days?  It is not really a fun topic, but it is important to understand that this could very well contribute to the depression and anxiety we see in others.

Today I want to touch on a questionnaire that you may have heard of or taken before – the PHQ-9, also known as the Patient Health Questionaire-9 item.  This questionnaire can be used to help determine the presence of depression, as the questions are based on the diagnostic criteria for depression.  The PHQ-9 is used widely in many types of health settings, and can be a quick and easy way to assess for depression in many individuals. 

The questions ask about what you have experienced in the last 2 weeks, and the questions ask about your eating, sleeping, energy, concentration, feelings, and interest in regular activities, among a few other items.  Responses can vary from not at all, to several days, to more than half of the days, to almost all of the days in the last 2 weeks.  The higher the score on the PHQ-9 indicates a greater need for follow-up and/or treatment, which could include repeating the PHQ-9, getting counseling, starting medications, or immediately seeking treatment.  A shorter version of the PHQ-9, known as the PHQ-2, is also used in the healthcare setting for an even quicker assessment for depression.

Although I assume you will not see the PHQ-9 or PHQ-2 in every health care setting, what is exciting to me is that I feel like I am hearing and seeing more of it.  Like all of the other forms you have to fill out at a provider’s office, the PHQ-9 or 2 is becoming a standard part of the paperwork, and that is important.  To me, this is a way to normalize mental illness and make it no different than any other illness.

What are your thoughts?  Have you seen the PHQ-9 or 2 before?  Have you taken it?  Do you feel it is important to have as part of the regular paperwork for any office visit?  My hope is that we continue to see the screening for depression increase.