mental health

January Physician Focus: Mindfulness

Posted in behavioral health, Health, mental health, Physician Focus on January 15th, 2016 by MMS Communications – Comments Off on January Physician Focus: Mindfulness

The stresses of daily life – financial pressures, family demands, professional or occupational stress – can Mindfulness1produce fatigue, sleeplessness, and other physical conditions that can harm our mental and physical health.

Mindfulness is an emerging approach that can help patients deal with these concerns by helping them participate in their own health care. Proponents of mindfulness say the practice can reduce stress, improve health, help to manage chronic illnesses such as heart disease or diabetes, and even be useful in treating addiction, substance abuse, and even pain. An approach that came into practice more than 30 years ago, mindfulness is now reaching mainstream medicine, considered to be a way to complement and enhance individual health for people of any age.

The January edition of Physician Focus provides an introduction to mindfulness — how it is practiced, whom it can help, and how it can improve our mental and physical health and overall well-being. Guests are Michael Guidi, D.O. and Jefferson Prince, M.D.

Dr. Guidi (right, photo), is a family physician in Haverhill and Chair of the MMS Committee on Student Health and Sports Medicine. He is engaged in efforts to reduce youth substance abuse by introducing mindfulness to students, parents, and teachers. Dr. Prince (center, photo) is Director of Child Psychiatry and Vice Chair of the Department of Psychiatry at MassGeneral for Children at North Shore Medical Center in Salem, Mass. and is an instructor in the Medical Center’s Mindfulness-Based Stress Reduction Program. Hosting this edition is primary care physician Bruce Karlin, M.D. (photo, left).

Physician Focus, now in its 11th consecutive year of production, is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.physicianfocus.org, www.massmed.org/physicianfocus, and on YouTube.

December Physician Focus: Violence and Mental Illness

Posted in behavioral health, Health, mental health, Physician Focus, Public Health, violence on December 2nd, 2013 by MMS Communications – Comments Off on December Physician Focus: Violence and Mental Illness

Mass killings such as those at the Washington Navy Yard earlier this year and in Aurora, Colorado and Newtown, Connecticut last year continue to raise alarms about the link between violence and mental illness. A recent Gallup poll found that nearly half of Americans – 48 percent – blame the mental health system “a great deal” for mass shootings and for failing to identify individuals who are a danger to others.

The December episode of Physician Focus offers a perspective on the topics of violence and mental illness and explores the link between them.

Guests are John Bradley, M.D. (center, photo), Chief of Psychiatry and Deputy Director of Mental Health for the Veterans Administration Boston Healthcare System and former Chief of Psychiatry at Walter Reed National Military Medical Center, and Michael Tang, D.O., M.P.H. (right), psychiatry resident at Harvard South Shore Psychiatry, a program of Harvard Medical School. Hosting this program is John Fromson, M.D. (left), Vice Chairman for Clinical Affairs of the Department of Psychiatry at Brigham and Women’s Hospital and Chief of Psychiatry at Brigham and Women’s Faulkner Hospital.

Among the topics of conversation are the definitions of violence and mental illness, predictors and risk factors for violent behavior, the pervasiveness of violence in daily life, the role and impact of the media in covering violent acts, the relationship of violence to firearm access, and whether, as public opinion polls suggest, the mental health system has failed in identifying individuals who may commit violent acts.

Physician Focus is available for viewing on public access television stations throughout Massachusetts and online at www.massmed.org/physicianfocus and www.physicianfocus.org.

August Physician Focus: Complicated Grief

Posted in behavioral health, mental health, Physician Focus, Uncategorized on August 2nd, 2013 by MMS Communications – Comments Off on August Physician Focus: Complicated Grief

Grief is a universal phenomenon, reaching all of us at one time or another following the loss of a loved one. Most people, after a period of mourning, adapt successfully to the loss and begin to move forward. Some, however, find it much harder to accept the loss and develop what is called complicated grief.

Complicated grief, which can affect a person’s physical and mental health, has just been recognized as a new diagnosis (called “persistent complex bereavement disorder”) in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM-5. It is the subject of discussion in the August edition of Physician Focus.

Naomi Simon, M.D., (photo, right) Director of the Complicated Grief Program and Director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital in Boston, joins colleague and program host John Fromson, M.D., (photo, left) Associate Director of the Center, to discuss complicated grief, how it affects individuals, and how it is treated.

The conversation includes such areas as the prevalence of the condition; its characteristics; the differences among complicated grief, depression, and post-traumatic stress disorder; the roles of “avoidance” and “isolation” in extending complicated grief; the influence of religious and cultural traditions in dealing with grief; how the diagnosis of complicated grief came to be recognized; and how it is treated.

Physician Focus is available for viewing on public access television stations throughout Massachusetts and also available online at www.massmed.org/physicianfocus , www.physicianfocus.org  and on iTunes at www.massmed.org/itunes.

 

Physicians Take Notice: Suicide Rates are Increasing Dramatically

Posted in behavioral health, Medicine, mental health, Steve Adelman on May 23rd, 2013 by MMS – Comments Off on Physicians Take Notice: Suicide Rates are Increasing Dramatically

By Steve Adelman, MD

Earlier this month, the CDC’s Morbidity and Mortality Weekly Report (MMWR) presented alarming data comparing age-adjusted suicide rates between 1999 and 2010.

Historically, the two major causes of death of younger people have been motor vehicle accidents and suicide. As motor vehicle accident deaths have gone down, suicides have gone up: 2009 was the first year in which the number of people who put an end to their lives themselves was greater than the number who lost their lives in car accidents.

Overall, the suicide rate jumped by 28.4% among persons aged 35-64. The rate of increase was even greater for whites, American Indian/Alaska Natives, older women (60-64), and people living in the West. As usual, in most successful suicides the cause of death is firearms.

To put the numbers in perspective, let’s think about a busy, multispecialty ambulatory adult primary care practice that employs a group of 4 internists, 2 nurse practitioners and a physician assistant. In the course of a year, perhaps 12,000 unique patients are seen in the office. A practice of this sort in Massachusetts, New York or New Jersey is likely to see one patient die by suicide per year. In Midwestern practices of this size, a second patient suicide would be predicted.

Suicide, not murder, is the most prevalent form of firearm death in this country. What is the role of primary care physicians in addressing this worrisome, growing public health problem?

Provide an opening: Give patients in the office enough time and space to talk about the things that worry them and weigh on them. A question like, “Is there anything else going on that you’d like to share with me? “ may give permission for a suicidal person to open up. A comment like, “Sometimes the most important stuff is the hardest to talk about….I’m all ears,” followed by enough time for the patient to think and open up, can make a difference.

Know your patient’s psychiatric history: Many elements in a patient’s history elevate the risk of suicide: a history of previous suicide attempts, a known mood disorder, a history of a substance use disorder, recent losses, and family history of suicide. Take the time to know your patients, and get help from mental professionals, as appropriate.

Clarify access to firearms: As firearms are the commonest proximate cause of violent deaths, physicians should understand whether or not their patients have access to firearms. It is appropriate to be worrying about high-risk patients with access to firearms, and to address this risk factor with the help of the patient’s family, mental health professionals, and, in some cases, the police.

Let patients know that the channels of communication are always open: People who know that they can always call and reach a health care professional have a place to turn when all else fails. Make sure that your practice has accessible 24/7 coverage, and that those covering know what to do when somebody suicidal calls for help.

In my next  post, I plan to discuss an important related topic: physician suicide. We have always been a high risk group, and this is especially worrisome in view of the recent overall increase in suicide.

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit www.physicianhealth.org. Opinions expressed here are his own, and do not necessarily reflect those of the Massachusetts Medical Society or Physician Health Services.

 

Listening First Aid

Posted in Boston Marathon, mental health, Physician Health, Steve Adelman, violence on April 23rd, 2013 by MMS – 1 Comment

By Steve Adelman, MD

In the past two days, I have had the privilege of participating in two large support sessions for volunteers who witnessed the horrors at the Boston Marathon finish line. The sessions were organized by the Boston Athletic Association, in conjunction with the Massachusetts Department of Public Health.

The purpose of these events was to give stressed and  traumatized volunteers an opportunity to come together, share their experiences, and to commence the process of regaining a sense of emotional well-being after having served a sudden and unexpected tour of duty in an urban war zone.

Sunday’s session took place at the Boston Sheraton on Boylston Street, not far from the finish line. Monday’s session took place at the offices of the Massachusetts Medical Society and Physician Health Services, in Waltham.

Many affected volunteers at each session expressed feelings that they wish they had done more. Virtually everybody at the scene was thrust into a chaotic and unpredictable situation, one that nobody anticipated. In the minutes after the blasts, most everyone at the scene of carnage experienced serious challenges to their sense of being competent and effective.

Although the results speak for themselves – many, many lives and limbs were saved by a superlative team effort – the members of the team are all feeling pretty bad. It’s as if they were saying, “I have no idea how our team won on Monday, because I certainly could have played better.”

Many of the survivors described awkward conversations in the community and the workplace:  “People call me a hero, but I don’t feel like a hero.” It’s very difficult to feel incompetent and to be told that you are a hero.

Several survivors have learned that people out there “just don’t know what to say.” After the manhunt ended on Friday, a common comment they heard was, “You must feel better now.” But they didn’t feel better – many of them felt worse.

Question: How do we talk to people who have recently endured extreme trauma?

Answer: Very little – better to listen than to talk.

Listen very carefully, and try to put yourself in their shoes. Ask open-ended questions and respect their answers and wishes. Follow the lead of the person you are listening to. Here are a few questions and comments to consider utilizing if you undertake a conversation with a traumatized person:

  • Do you feel like talking?
  • What would you like to talk about?
  • Tell me more.
  • What was that like?

Don’t assume that you know how the other person feels, and don’t assume that their experience of the trauma is what you imagine it to be. By asking gentle, empathic questions, you can help the trauma survivor to unburden himself or herself, but only if he or she wants to.

As an empathic listener, your job is to follow the other person’s lead, never to take the lead. If the survivor you are with prefers to remain silent, that’s okay. Just let them know that you’re ready to listen if they ever feel like talking.

Gregorio Billikopf Encina of the University of California Berkeley has referred to this form of “empathic listening” as “listening first aid.”

Now that the acute trauma of the Marathon explosions is beginning to subside, let’s approach our conversations with the survivors – in our communities and throughout the health care system – in a low-key, respectful, and empathic way. By applying “Listening First Aid,” we can promote healing by helping them to feel understood, by trying, as best we can, to see the fractured world through their eyes.

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit www.physicianhealth.org.

The Next Focus: Mental Health

Posted in Boston Marathon, mental health, violence on April 19th, 2013 by MMS – Comments Off on The Next Focus: Mental Health

Following a week of terror and tragedy, there will likely be a greater focus on the mental health needs of the community: Victims, family members, medical clinicians, first responders, volunteers, and spectators.

Some of the most common symptoms of mental health issues are likely to be difficulty sleeping, becoming easily frustrated or angry, and a diminished ability to focus on daily tasks.

Physician Health Services is available to physicians, to provide support, and, when appropriate, referrals to mental health professionals and other resources. Support groups for physicians are also available. PHS can be reached at (781) 434-7404.

The Mass. Department of Public Health is coordinating mental health services for the public through its website.

The Massachusetts Department of Mental Health offers an excellent list of web resources on mental health issues.

The heroic work of physicians, first responders and other medical personnel was broadly documented in the news media. Here is a sample of the many reports:

Like all of you, we are grateful that this nightmare is over. Let us expend our energy and focus our resources to help all those involved recover from this ordeal – physically and emotionally.

Achieving Mental Health Parity: 2013 MMS Public Health Leadership Forum

Posted in mental health, Public Health on April 4th, 2013 by Erica Noonan – Comments Off on Achieving Mental Health Parity: 2013 MMS Public Health Leadership Forum

Experts estimate that nearly half of Americans will experience and mental health or substance abuse issue in their lifetimes, yet mental health services remain far less accessible than medical and surgical care.

The pressing crisis in mental health care brought together more than 125 physicians, public officials, and patient advocates this week for the  Massachusetts Medical Society’s 2013 Annual Public Health Leadership Forum, “Mental Health: Achieving Parity in Principle and in Practice.”

“Since the passage of our health care insurance reform law in 2006, Massachusetts has been a national leader in health care access. But despite these gains, access to mental health care services has continued to lag. That should concern all of us,” said MMS President Richard Aghababian, MD, in his welcoming remarks.

The forum, now in its ninth year, featured faculty presentations from physicians, policymakers, economists and educators. It was moderated by Harold Cox, associate dean, Boston University School of Public Health.

Jeffrey Wisch, MD, acting chief of Hematology/Oncology at Newton- Wellesley Hospital, spoke about patient advocacy in the face of a mental health care system that is “unequivocably broken.”

“Triage systems don’t work. The confusion and isolation for family members is remarkable. There is no discharge planning of coordinated care,” said Dr. Wisch, describing his frustrated efforts to help a severely depressed 19-year-old family member. “We don’t see these problems with medical patients.”

Kathryn Power, Regional Administrator for the federal Substance Abuse and Mental Health Services Administration, offered historical  and political context on a mental health care systems that had evolved quote separately from  the modern medical infrastructure.

The Massachusetts health care reform law, passed in August, requires insurers to comply with federal laws to demonstrate federal mental health parity laws. Mental health is considered an “essential” condition that must be insured under new federal rules, set to go into effect in 2014. These changes, Power said, will have a dramatic impact on patients.

Suicide now kills more people annually than traffic accidents and HIV combined, Power said. “No other medical condition is so prevalent, yet lacking in resources,” she said.

The coverage expansion, expected next year, will affect more than 60 million Americans, said Harvard University Medical School Economist Richard G. Frank, another forum presenter. It has the potential to be the most significant public health development since the establishment of Medicare in 1965, he said.

Until then, the disproportionate burden of caring for mentally ill patients will continue to fall on hospital emergency departments, said Mark Pearlmutter, M.D., chair and vice president of Emergency Network Services at Steward Health Care.

Studies show that on average in Massachusetts, more than 100 patients are “boarding,” or waiting in a hospital emergency room at any given time, often for many hours or even days, for a mental health placement.

This is costly, inefficient, and poor care, Pearlmutter said.  “We call this boarders without doctors,” he said.

The forum also featured Peter Metz, MD, professor of psychiatry and pediatrics at University of Massachusetts Medical School, who spoke about advances in children’s mental health systems, and National Alliance on Mental Illness Medical Director Ken Duckworth, MD, who spoke about the mental health needs of teens.

At the start of the forum, MMS presented its Henry Ingersoll Bowditch Award for Excellence in Public Health to Linda Sagor, MD.  Dr. Sagor, director of the Division of General Pediatrics at UMass Memorial Health Care, was honored for her pioneering work in addressing the unmet medical needs of Massachusetts children in foster care.

Erica Noonan

March Physician Focus: Youth Violence and Child Abuse

Posted in gun control, mental health, Physician Focus, Public Health, violence on March 1st, 2013 by MMS Communications – Comments Off on March Physician Focus: Youth Violence and Child Abuse

As spectators, perpetrators, or victims, violence and abuse take a huge toll on our nation’s youth.  The numbers are stark and telling.

Homicide and suicide are the second and third leading causes of death of American children.  More than 707,000 youth ages 10-24 receive  emergency treatment for injuries from physical assaults, and more than three million reports of child abuse are filed each year – an average of nearly six every minute.

While the numbers show the size of the problem, news reports depict the tragedy.  The pictures and reports of such places as Columbine, Newtown, and Virginia Tech, and widespread abuse by clergy and coaches are now vivid and sad chapters in our nation’s history.  And they continue to make headlines.

The March edition of Physician Focus attempts to put some perspective on the topic of youth violence and abuse with Robert Sege, M.D. (center, photo) and Elliot Pittel, M.D. (right)  joining program host Bruce Karlin, M.D. (left) for discussion.

Dr. Sege is Director of the Division of Family and Child Advocacy at Boston Medical Center, a member of the American Academy of Pediatrics’ Committee on Child Abuse and Neglect, and co-author of the AAP’s policy on guns.  Dr. Pittel is a child and adolescent psychiatrist at The Home for Little Wanderers in Boston and chair of the MMS Committee on Violence Intervention and Prevention.

Among the topics of conversation are the causes of youth violence, the influence of media on children, the importance of ‘being connected’ for both parents and children, and the role physicians can play in helping to prevent and reduce the violence.

Physician Focus is available for viewing on public access television stations throughout Massachusetts and also available online at www.physicianfocus.org. and on iTunes at www.massmed.org/itunes.

 

February Physician Focus: Understanding Depression

Posted in Health, mental health, Physician Focus on February 1st, 2013 by MMS Communications – Comments Off on February Physician Focus: Understanding Depression

The February edition of Physician Focus examines the chronic medical condition of depression – an illness that affects about one in ten adults each year and is a leading cause of disability for those 15-44 years old.

Marie Hobart, M.D., a psychiatrist and chief medical officer of Community Healthlink, a part of UMass Memorial Health Care that provides psychiatric, mental health, and substance abuse services for families and individual patients in Central Massachusetts, joins program host John Fromson, M.D., a fellow psychiatrist and associate director of graduate medical education at Massachusetts General Hospital, in lifting some of the mystery surrounding this often-stigmatizing illness.

The discussion between the physicians includes a description of the factors contributing to depression, how depression affects behavior and physical health, therapies used to treat the condition, preventive steps patients can take for their mental health, and the message that depression is a very treatable illness and that it need not be a lifelong condition.

Physician Focus is available for viewing on public access television stations throughout Massachusetts and also available online at www.physicianfocus.org. and on iTunes at www.massmed.org/itunes.

The Newtown School Shooting: A Call to Action

Posted in gun control, mental health, violence on December 21st, 2012 by MMS – Comments Off on The Newtown School Shooting: A Call to Action

By Richard V. Aghababian, MD
MMS President

As we all try to sort out our thoughts and emotions over the school shootings in Newtown, Conn., I believe that it’s imperative that physicians and the Massachusetts Medical Society take action.

As always, we must focus on the safety of our patients, children and communities. But we need to do more than that; it’s time for us to speak out. As part of our action, I have asked that the MMS focus on three areas:

  • Gun control  – We need to emphasize that this is a public health issue, not just a matter of civil liberty
  • Mental health – What should we do to ensure that those who need care get it?
  • Education – How do we educate medical personnel to respond to such incidents?

On Wednesday, President Obama announced the formation of a task force on gun violence, led by Vice President Biden. The task force has been charged with developing proposals on gun control. At MMS, we will begin a review of our gun policies to see where the gaps are, and we will support reforms that will limit access to guns and ammunition that are so often used in mass shooting scenarios.

At the same time, advocates are pushing for meaningful changes in the mental health care system. Meaningful change means that society as a whole must give the same attention to mental illness as we do to physical illness.  We stand in strong support of mental health parity laws and comprehensive access to mental health services, including screening and prevention.

Our annual Public Health Leadership Forum this coming April, which will focus on mental health, will address some of the successes and failures in the mental health system and how to work together to address patients’ needs.

Further, do we need additional education programs to prepare responders who must deal with mass casualty situations perpetrated on innocent, unsuspecting victims?

As always, we will be communicating with our health care partners across the state as we move forward with an advocacy and education plan in order to best protect our patients and our communities.

I urge you to stay connected on this issue. If you have suggestions on directions we should pursue, please contact me at president@massmed.org with your ideas and comments.