APA Webinar regarding Stimulant Shortage

The APA, along with the American Community Pharmacists Association will be hosting a webinar on the stimulant shortage on Thursday, February 15, 2024 at 9:00 am PST. Psychiatrists across the country, including in Utah, have been seeing the effects of this shortage in their practices and the lives of their patients for multiple years at this point. From the APA:

This webinar will share the many factors that impact the stimulant supply, the impact the shortage has had on patients, prescribers, and pharmacies, and how prescribers and pharmacists can work together during this challenging time.

Those interested in attending will need to register, which they can do here (link).

Climate change, psychiatry, and politics

One of our members, Dr. Michael Kalm, recently drew my attention to a review and an editorial published in Current Psychiatry: Climate Change and Mental Illness: What Psychiatrists can do; a Toxic and Fractured Political System can Breed Angst and PTSD; and to his letter to the editor (the second letter at this link) regarding these articles.

Access to those articles may require readers to be logged into an account with the publisher, but those articles, or portions of them are reproduced here, with permission from the publisher.

In Climate Change and Mental Illness: What Psychiatrists can do, the authors (Oliver Freudenreich, MD, FACLP; Katherine A. Koh, MD, MSc; and Elizabeth K. Haase, MD) begin my posing the question:

Why should psychiatrists care about climate change and try to mitigate its effects?"

They answer their question first by stating that we, as psychiatrists, are “tasked by society with managing the psychological and neuropsychiatric sequelae from disasters, which include climate change,” and reference the American Psychiatric Association’s position statement on climate change. The authors also assort that our moral obligation to do no harm requires us to look at the practices of the health care industry that contribute to climate change and take steps to manage them. Finally, the authors write, psychiatrists have skills that help them address fear, disagreement, and ambivalence around climate change and its associated harms. Psychiatrists, they say, can “help communities not only endure the emotional impact of climate change but become more psychologically resilient.”

The authors discuss the impact of climate change on human health, and divide their discussion between the direct impacts (e.g., air pollutions, heat, infections, and hunger) and indirect impacts (e.g., increased stress from living through disasters, loss of friends and family members, and being displaced from homes and communities), which are often intertwined. The authors discuss the research associating these changes with specific anatomical and physiological changes in animal and human study populations and associated health outcomes, including increased associations with depression, suicide, anxiety, psychotic disorders, increasing transmission of infectious disease, agriculture and associated hunger. Including the striking statistic that “each degree Celsius increase in ambient temperature may increase suicide rates by approximately 1%.” If climate change (or other stimuli) drive large-scale migrations, there are concerns related to the loss of support and resources that come along with being displaced from one’s home and community and from the strain on the communities that receive large numbers of immigrants. The authors also discuss the evolving language around distress related to climate change, including with terms such as “ecoanxiety”, “ecogrief”, “solastalgia”, and “terrafuria” or “ecorage”, and discuss the nihilism and pessimism about the future that may accompany individuals’ consideration of the future.

The article relates that individuals with severe mental illness are particularly vulnerable to many of these concerns due to decreased physical and emotional resiliency, more limited socioeconomic means, and limited social support. The authors use impaired heat regulation due to medications, mental illness and its sequelae as an example of one concern psychiatrists should keep in mind. The coronavirus pandemic highlighted many ways that our conventional systems of care needed to adapt to keep patients engaged in care.

The authors propose “three Ps” of taking climate action as they apply to psychiatrists. Psychiatrists can take Personal action by “overcoming paralysis from the enormity of the problem,” shifting away from an “expanding consumption” model to a a more environmentally sustainable model. Psychiatrists can also learn how to discuss these issues effectively in both their professional and personal lives by pairing “constructive hope” and “constructive doubt” to motivate people to action. They point out that well-meaning campaigns to change behavior can fail if not communicated with skill. Good messages, they authors write, “are targeted to a concrete concern and where action would pay off now and not in some distant future.” This is all in addition to the obvious personal steps of moving toward carbon neutrality and learning about disaster preparedness and crisis communication. Psychiatrists may take Patient-oriented steps by helping patients understand their own climate-related anxieties around uncertain futures, identify barriers in their own lives to taking climate action, and emphasizing the immediate health benefits to them and their communities from taking climate action. Patient-oriented actions also including developing disaster plans to prevent disruption of psychiatric care that includes the provision of medications. Finally, supporting refugees by connecting them to services and providing appropriate trauma-informed care. Psychiatrists may take Politically-oriented action by advocating for changes within the health care system, joining climate and other relevant committees of special interest groups in their professional organizations, promoting psychiatric voices in these public forums.

The authors emphasize planning for the future, recognizing our duty and opportunity to create and maintain a health care system that addresses the needs of our patients and their communities. They say, “We must grapple wit ha sense of an ‘extended period of insecurity and instability’ (permacrisis) and must better prepare for and prevent the polycrisis (many simultaneous crises) or the metacrisis of our ‘age of turmoil’ in which we must limit global warming, mitigate its damage, and increase community resilience to adapt… it may be better for both our world and a clinician’s own sanity to be engaged in professional and private hopeful action to address climate change. Without ecological or planetary health, there can be no mental health.”

Dr. Nasrallah, in his editorial, wrote (quoted in its entirety)

As psychiatrists know, many of our severely traumatized adult patients were victims of abuse during childhood. We routinely ask every new patient about physical, emotional, or sexual abuse when they were growing up because of the well-established, serious neurobiological and mental repercussions.1,2

Perhaps one of the worst experiences for a child is to witness bitterly adversarial parents (their vital role models) who argue viciously, despise each other, and hurl insults (and even punches) at each other. Such a chronically and emotionally traumatic upbringing can haunt kids well into adulthood, disrupting their hypothalamic-pituitary-adrenal axis and triggering anxiety, depression, and even psychosis due to epigenetic changes that ultimately lead to abnormal brain development.3

It often feels that the governance of our country, or the national “political family,” is seriously fractured like a hopelessly dysfunctional family. Could that be negatively impacting the mental health of the citizenry? Having 2 antagonistic political parties expressing visceral hatred and undisguised contempt for each other 24/7 (thanks to the enabling era of cable TV, the internet, and social media) has transformed each party’s fanatic followers from fellow citizens to ideological combatants. In this poisonous societal zeitgeist of bidirectional acrimony and mutual detestation, the opposing parties and their “intellectual militias” label each other as “extremists” or “radicals.” They become completely blind to any redeeming social value in the ideas or principles of their political opponents. They spend enormous time and energy on undermining each other instead of attending to the myriad vital issues involved in the governance of a massive and complex country.

Winston Churchill said, “Democracy is the worst form of government, except for all the others that have been tried.”4 The current toxic cloud of intense “hyperpartisanship” is emblematic of the dark Machiavellian side of democracy. But those who lament the current distorted version of democracy should contemplate living in a dictatorship or totalitarian regime, where a despot would execute any dissenter or invade and destroy an adjacent country at a whim.

Churchill made that statement in 1947. The internet, social media, and smartphones were science fiction back then. Those technological advances have added fuel to the political process and significantly stoked the flames of hyperpartisanship. It’s now democracy on steroids, where freedom of expression goes to extremes, highlighting the warts and pitfalls of the democratic system. Political rivals can now communicate their ferocious disagreements to millions of their disciples instantaneously, triggering immediate rebuttals and counterattacks by their adversaries. This “virtual guerilla warfare” is mentally and emotionally exhausting to all involved, especially to the subset of neutral bystanders who are unaffiliated with either political party, which, due to the “religification” of politics, have become like secular religions.5 Chronic, unremitting, inescapable stress is a sure pathway for anxiety, depression, posttraumatic stress disorder, and even brain atrophy.

Optimists may point out that the United States has weathered and emerged stronger from many serious traumas, including the Civil War (with its lethal divisiveness), World War I, the deadly 1918 influenza pandemic, the Great Depression, Pearl Harbor, World War II, the Cold War, the Vietnam War, the Watergate political scandal, the 9/11 terrorist attacks, the banking collapse and recession, and most recently the COVID-19 pandemic, which brought society to a standstill and induced so much anxiety and uncertainty.

On the other hand, pessimists would insist those sequential crises left indelible scars that cumulatively altered the mindset of political rivals, predisposing them to extreme views of each other. Alienation inevitably leads to fanaticism. It’s perplexing but fascinating how the fierce bidirectional missives of weaponized ideas can be as virulent and destructive as a traditional physical war. Perhaps in this era, the pen is mightier than the sword after all.

From a psychiatric perspective, the intransigent groupthink of political partisanship eerily resembles folie en masse, a psychiatric syndrome for which there is no established treatment. It has become a serious threat to our modern democracy. So I decided to ask the “know-it-all” artificial intelligence ChatGPT, whom I previously had “invited” to write a “guest editorial” about myths surrounding psychiatry,6 to answer 3 burning questions:

1. Is there toxic hyperpartisanship in the USA today?

ChatGPT’s response: Yes, there is toxic hyperpartisanship in the United States today. Political polarization has been on the rise for several decades, and in recent years, it has become increasingly toxic and divisive. This toxic hyperpartisanship has contributed to a breakdown in civil discourse and a lack of cooperation and compromise in government.

The toxic hyperpartisanship is evident in many aspects of American society, including politics, media, and social media. Political leaders often engage in divisive rhetoric and focus on winning at all costs, rather than working towards solutions that benefit the country as a whole. Media outlets often present news in a partisan manner, further fueling political polarization. Social media platforms have also played a role in exacerbating toxic hyperpartisanship by allowing the spread of misinformation and creating echo chambers where people are only exposed to like-minded viewpoints.

The consequences of toxic hyperpartisanship are significant, as it can hinder progress on important issues and erode trust in institutions and government. It also makes it difficult for people to engage in productive dialogue and find common ground, leading to a lack of cooperation and compromise.

It is important for individuals to be aware of the impact of toxic hyperpartisanship and work towards finding ways to bridge the political divide and engage in constructive dialogue.

2. How can severe hyperpartisanship be corrected?

ChatGPT’s response: Severe hyperpartisanship, characterized by intense and entrenched divisions between political parties, can be a challenging issue to address, but there are several steps that can be taken to work towards correcting it. Here are some potential approaches:

1. Promote civil discourse: Encourage respectful and constructive conversations between individuals with differing political views. This can be achieved through education programs, media campaigns, and initiatives to foster open dialogue.

2. Electoral reforms: Consider implementing electoral reforms that can reduce the influence of extreme partisanship. For example, ranked-choice voting or nonpartisan primaries may encourage candidates to appeal to a broader base of voters rather than just their party’s base.

3. Campaign finance reform: Limit the influence of money in politics, as it can exacerbate hyperpartisanship by allowing wealthy donors to have undue influence over candidates and parties.

4. Independent redistricting: Ensure that electoral district boundaries are drawn in a fair and nonpartisan manner. Gerrymandering, the manipulation of district lines to favor one party, can contribute to hyperpartisanship by creating “safe” districts where extreme candidates are more likely to be elected.

5. Promote media literacy: Encourage media literacy education to help citizens critically evaluate information sources and avoid echo chambers. A well-informed electorate is less susceptible to extreme partisanship.

6. Encourage bipartisan collaboration: Highlight and support instances of successful bipartisan collaboration. Elected officials who work across the aisle can serve as positive examples and encourage others to follow suit.

7. Address economic inequality: Tackling economic disparities can alleviate some of the underlying factors that contribute to polarization. When people feel economically secure, they may be more willing to seek common ground.

8. Civics education: Improve civics education in schools to foster a deeper understanding of democratic values, the political process, and the importance of civic engagement.

9. Leadership example: Encourage political leaders to model cooperation and compromise rather than relying on divisive rhetoric. Voters often take cues from their leaders’ behavior.

10. Promote third parties: Support and encourage the emergence of viable thirdparty candidates. A more diverse political landscape can provide alternatives to extreme partisanship.

11. Focus on common ground: Identify and prioritize issues where there is potential for bipartisan consensus and progress. Building success on these issues can create momentum for further cooperation.

12. Encourage grassroots activism: Support grassroots movements that seek to bridge divides and foster understanding between individuals and communities with different political perspectives.

It’s essential to recognize that addressing severe hyperpartisanship is a complex and long-term process that requires collective effort from citizens, political leaders, educators, and institutions. It won’t be achieved overnight, but through sustained and committed actions, progress can be made toward a more collaborative and less divisive political climate.

3. What can cause the collapse of a democracy?

ChatGPT’s response: The collapse of a democracy can be a complex and multifaceted process, influenced by various factors and circumstances. Some of the common causes that can lead to the erosion or breakdown of a democratic system include:

1. Authoritarianism and power concentration: When leaders or institutions become increasingly authoritarian, centralizing power and weakening checks and balances, it can undermine democratic principles.

2. Corruption and lack of accountability: Rampant corruption among political leaders and institutions can erode public trust in the democratic system, leading to disillusionment and disengagement.

3. Economic instability: Prolonged economic crises or severe inequality can lead to social unrest, increasing the appeal of populist or extremist movements that may challenge democratic norms.

4. Weakening of rule of law: If the rule of law is weakened, and there is a lack of respect for judicial independence and constitutional principles, democratic institutions can become vulnerable to manipulation.

5. Erosion of civil liberties: Suppression of freedom of speech, media, assembly, and association can limit citizens’ ability to express their opinions and participate in the democratic process.

6. Polarization and divisive politics: Extreme political polarization and a breakdown of civil discourse can hinder cooperation and compromise essential for a functioning democracy.

7. External interference: Foreign intervention, propaganda, or cyberattacks can influence electoral processes and undermine democratic institutions.

8. Rise of populism and nationalism: Populist movements that challenge democratic norms, demonize minorities, or advocate for a strongman leadership can pose a threat to democracy.

9. Demographic and social shifts: Demographic changes and social tensions can exacerbate political divisions and weaken the fabric of democratic societies.

10. Lack of civic education and participation: A lack of civic education and low voter turnout can lead to reduced civic engagement and undermine the democratic process.

It is crucial to understand that no democracy is immune to these challenges, and the strength of a democratic system depends on the vigilance and engagement of its citizens, the integrity of its institutions, and the commitment to upholding democratic values. Safeguarding and strengthening democracy requires ongoing efforts to address these issues and protect the principles that underpin democratic governance.

Judge for yourself, but I believe the ChatGPT responses were spot-on.

The articles address difficult topics and phenomena about which there are a broad variety of opinions among the general public and among psychiatrists. Dr. Kalm writes:

I want to send my appreciation for publishing in the same issue your editorial “A toxic and fractured political system can breed angst and PTSD” and the article “Climate change and mental illness: What psychiatrists can do.” I believe the issues addressed are important and belong in the mainstream of current psychiatric discussion.

Regarding the differing views of optimists and pessimists, I agree that narrative is bound for destruction. Because of that, several months ago I decided to deliberately cultivate and maintain a sense of optimism while knowing the facts! I believe that stance is the only one that strategically can lead towards progress.

I also want to comment on the “religification” of politics. While I believe secular religions exist, I also believe what we are currently seeing in the United States is not the rise of secular religions, but instead an attempt to insert extreme religious beliefs into politics while using language to create the illusion that the Constitution’s barrier against the merging of church and state is not being breached. I don’t think we are seeing secular religion, but God-based religion masking as secular religion.

For those interested in more information, and more of the discourse, the relevant article sources are linked above.

Free APA Course on Fostering Community Resilience

The American Psychiatric Association has created a course on fostering community resilience in a world that frequently experiences a broad variety of disasters, pandemics, and violence. Living through such events can directly strain health and well-being and create an environment of ongoing and persistent stress long after a given event has happened. The APA course covers some fundamental concepts and interventions related to disaster response and preventative psychiatry.

The course is free to APA (and, thus, UPA) members, provides 8 CME credits, and can be found here.

The UPA encourages anyone interested to take the course.

Mental Health and the COVID-19 Pandemic

The following information is useful reading for understanding the effects the COVID-19 pandemic has had and continues to have on individuals’ mental health. A long list of resources can be found on our COVID-19 Resources page, here.

How Psychiatry can Help in the Present Crisis, by Michael Kalm

The Mental-Health Crises of the Coronavirus Pandemic

Psychiatrists deemed ‘essential’ in time of COVID-19

Is COVID-19 leading to a mental illness pandemic?

COVID-19: Be Ready for the Coming Mental Health Pandemic

The COVID-19 Pandemic has Shocked the Mental-Health System out of Complacency

Coronavirus on the Inpatient Unit: a new Challenge for Psychiatry

Pandemic is an Opportunity to Rethink Prisons

Climate Change, Climate Disaster, and Mental Health

Dr. Steve Sugden submitted a very interesting article on the growing profound mental health effects of climate disaster across our country and the world. The link for the article is here. It is well worth a read and serious consideration. As climate change gets worse, so will our mental illness pandemic. We have to be ready and we must be active on two fronts. We have to prepare to provide effective therapeutic care for those who are afflicted, and we also have to be active in preventing the worst changes of climate change by supporting global efforts to combat it.

Climate change has been associated with increases in anxiety.

Other relevant links and resources include:

The Ministry for the Future: Climate Change and the Human Psyche

Utah Psychiatric Association Website Changes

The Utah Psychiatric Association’s website was previously hosted by the American Psychiatric Association; however, the American Psychiatric Association will no longer be offering that service. The UPA is in the process of transferring the content from the old site to a new site managed directly by the UPA, in the process of the transition, we’ve been making some changes to how information was organized, condensing some pages with similar themes down to single pages, etc.

In particular, several of the pages previously posted that seemed to better fit blog posts have been moved here as such. In some cases, when the date the original page was posted, a blog entry with that date was created. In other cases, particularly where several pages were condensed, the date will reflect the date the information was moved to the new site.

Dr. Michael Kalm was the force behind our prior web presence, and particularly with the blog posts, I’ve attempted to clearly credit his work, as I cannot assign him as the author of those posts at this time.

We apologize for any confusion this has caused, but welcome you to join us at our new home on the web!

The history of psychiatry with women

In a year when APA has expended great effort in owning and repairing our past abuses in the area of racial injustice, it is also high time to make a similar effort regarding how American Psychiatry has treated women. This article makes an excellent beginning.

Link: Declared Insane for Speaking Up: The Dark American History of Silencing Women Through Psychiatry

Mental Health by the Numbers

Mental Health is important aspect of overall health. As we continue to struggle to support Utahns with mental illness, it is important to remember that mental illness causes ripples that spread to affect physical health, economic status, and social resources. Dr. Brock Chisholm, who was a psychiatrist and the first Director-General of the World Health Organization famously said, “Without mental health there can be no true physical health.” Yet, it is often easy to forget the scope and impact of mental illness on individuals and our populations.

In 2017, a study by Charles Roehrig found that mental disorders were among most costly conditions in the United States. This article was discussed in the Huffington Post here.

Further compounding the problem are difficulties with parity. Americans often have more difficulty getting treatment for mental illness than they do for other illnesses, even with insurance. Parity lows at federal and state levels have tried to remedy this situation, but the work has been slow. More information about parity can be found at paritytrack.org, including discussions of what parity is, and common parity violations.

Genine Babakian discussed the costs of healthcare in detail in a five part series of blog posts, the first of which can be found here.

The following information was compiled and written by Dr. Michael Kalm, a long-time member of our Utah psychiatric and medical communities.

1 in 5 U.S. adults experience mental illness each year
1 in 25 U.S. adults experience serious mental illness each year
1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
50% of all lifetime mental illness begins by age 14, and 75% by age 24
Suicide is the 2nd leading cause of death among people aged 10-34

You Are Not Alone

• 19.1% of U.S. adults experienced mental illness in 2018 (47.6 million people). This represents 1 in 5 adults.

• 4.6% of U.S. adults experienced serious mental illness in 2018 (11.4 million people). This represents 1 in 25 adults.

• 16.5% of U.S. youth aged 6-17 experienced a mental health disorder in 2016 (7.7 million people)

• 3.7% of U.S. adults experienced a co-occurring substance use disorder and mental illness in 2018 (9.2 million people)

• Annual prevalence of mental illness among U.S. adults, by demographic group:

  • Non-Hispanic Asian: 14.7%

  • Non-Hispanic white: 20.4%

  • Non-Hispanic black or African-American: 16.2%

  • Non-Hispanic mixed/multiracial: 26.8%

  • Hispanic or Latino: 16.9%

  • Lesbian, Gay or Bisexual: 37.4%

• Annual prevalence among U.S. adults, by condition:

  • Major Depressive Episode: 7.2% (17.7 million people)

  • Schizophrenia: <1% (estimated 1.5 million people)

  • Bipolar Disorder: 2.8% (estimated 7 million people)

  • Anxiety Disorders: 19.1% (estimated 48 million people)

  • Posttraumatic Stress Disorder: 3.6% (estimated 9 million people)

  • Obsessive Compulsive Disorder: 1.2% (estimated 3 million people)

  • Borderline Personality Disorder: 1.4% (estimated 3.5 million people)

Mental Health Care Matters

• 43.3% of U.S. adults with mental illness received treatment in 2018

• 64.1% of U.S. adults with serious mental illness received treatment in 2018

• 50.6% of U.S. youth aged 6-17 with a mental health disorder received treatment in 2016

• The average delay between onset of mental illness symptoms and treatment is 11 years

• Annual treatment rates among U.S. adults with any mental illness, by demographic group:

  • Male: 34.9%

  • Female: 48.6%

  • Lesbian, Gay or Bisexual: 48.5%

  • Non-Hispanic Asian: 24.9%

  • Non-Hispanic white: 49.1%

  • Non-Hispanic black or African-American: 30.6%

  • Non-Hispanic mixed/multiracial: 31.8%

  • Hispanic or Latino: 32.9%

• 11.3% of U.S. adults with mental illness had no insurance coverage in 2018

• 13.4% of U.S. adults with serious mental illness had no insurance coverage in 2018

• 60% of U.S. counties do not have a single practicing psychiatrist

The Ripple Effect Of Mental Illness

PERSON

• People with depression have a 40% higher risk of developing cardiovascular and metabolic diseases than the general population. People with serious mental illness are nearly twice as likely to develop these conditions.

• 19.3% of U.S. adults with mental illness also experienced a substance use disorder in 2018 (9.2 million individuals)

• The rate of unemployment is higher among U.S. adults who have mental illness (5.8%) compared to those who do not (3.6%)

• High school students with significant symptoms of depression are more than twice as likely to drop out compared to their peers

FAMILY

• At least 8.4 million people in the U.S. provide care to an adult with a mental or emotional health issue

• Caregivers of adults with mental or emotional health issues spend an average of 32 hours per week providing unpaid care

COMMUNITY

• Mental illness and substance use disorders are involved in 1 out of every 8 emergency department visits by a U.S. adult (estimated 12 million visits)

• Mood disorders are the most common cause of hospitalization for all people in the U.S. under age 45 (after excluding hospitalization relating to pregnancy and birth)

• Across the U.S. economy, serious mental illness causes $193.2 billion in lost earnings each year

• 20.1% of people experiencing homelessness in the U.S. have a serious mental health condition

• 37% of adults incarcerated in the state and federal prison system have a diagnosed mental illness

• 70.4% of youth in the juvenile justice system have a diagnosed mental illness

• 41% of Veteran’s Health Administration patients have a diagnosed mental illness or substance use disorder

WORLD

• Depression and anxiety disorders cost the global economy $1 trillion in lost productivity each year

• Depression is the leading cause of disability worldwide

It’s Okay To Talk About Suicide

• Suicide is the 2nd leading cause of death among people aged 10-34 in the U.S.

• Suicide is the 10th leading cause of death in the U.S.

• The overall suicide rate in the U.S. has increased by 31% since 2001

• 46% of people who die by suicide had a diagnosed mental health condition

• 90% of people who die by suicide had shown symptoms of a mental health condition, according to interviews with family, friends and medical professionals (also known as psychological autopsy)

• Lesbian, gay and bisexual youth are 4x more likely to attempt suicide than straight youth

• 75% of people who die by suicide are male

• Transgender adults are nearly 12x more likely to attempt suicide than the general population

• Annual prevalence of serious thoughts of suicide, by U.S. demographic group:

  • 4.3% of all adults

  • 11.0% of young adults aged 18-25

  • 17.2% of high school students

  • 47.7% of lesbian, gay, and bisexual high school students

If you have questions about a statistic or term that’s being used, please visit the original study by following the link provided.

Mental Health Resources for Coping with Traumatic Events

Traumatic events can occur at any time, and can have large impacts on mental health both in individuals and in populations at large. The American Psychiatric Association (APA) offers tips and other mental health resources on how to minimize possible mental and emotional effects of trauma caused by a disaster.

Traumas and disasters can have tremendous psychological impacts on those who are affected directly and indirectly. Most people will do well after a traumatic event; some may emerge even stronger. Individuals who are affected may have various stress reactions that present psychological, as well as physical, symptoms.

However, there are steps that individuals can take for themselves and their families to lessen the psychosomatic impacts felt by the community at large and those involved in the event.

After an event has passed, the APA recommends following these steps to begin coping with the possible devastation and stress that follows:

1. Keep informed about new information and developments, but avoid overexposure to news rebroadcasts of the events. Be sure to use credible information sources to avoid speculation and rumors.

2. Learn what local resources are available to aid those affected by the tragedy and be prepared to share this information.

3. If you feel upset, you are not alone. Common reactions to trauma include anxiety, depression, irritability, difficulty sleeping, isolating yourself from others and increased use of alcohol and tobacco to manage your emotions. Talking with friends, family or colleagues who likely are experiencing the same feelings may help.

4. If you have contact with children, keep open dialogues with them regarding their fears of danger and the traumatic event. Let them know that in time, the tragedy will pass. Don’t minimize the danger, but talk about your ability to cope with tragedy and get through the ordeal.

5. Feelings of anxiety and depression following a traumatic event are natural. You may want to seek psychiatric care if:

   1. you are having increasing problems at home or work

   2. you are using more alcohol

   3. your symptoms don’t get better after a few days (or are getting worse)

   4. you just don’t feel right

   5. a loved one or colleague comments that you don’t seem like yourself

Your primary care provider or Employee Assistance Plan (EAP) can help connect you with mental health services.

For more information on coping with mental illnesses, visit the APA’s patient / public education website: www.psychiatry.org/mental-health

Information on coping after a disaster or tragedy is available at http://www.psychiatry.org/patients-families/coping-after-disaster-trauma

The APA Blog includes several posts about Coping After Tragedy and Talking to Children About Disasters.

Refugees

This is an educational video on the critical issue of promoting refugees’ mental health. Refugee children and families are at high risk for mental illness. This video highlights the story of a loving family escaping war. The video explain the challenges and trauma of being a refugee. It breaks down the walls of stigma surrounding seeking treatment and provides the viewer with resources. I developed this video as the Project Leader of the 2018 AACAP Advocacy and Collaboration grant awarded to St Louis ROCAP. Please feel free to share it with the refugees and those who work with them. I hope it will provide support for our refuges and for their families.

-Balkozar Adam, M.D.

English - https://vimeo.com/306501195/6748a91354
Arabic - https://vimeo.com/306501043/2aa5ab46af
Spanish - https://vimeo.com/306502562/4f5bb5361f
French - https://vimeo.com/306502434/f4d49f21b0
Swahili - https://vimeo.com/306502706/9453958bf6
Kinyarwanda - https://vimeo.com/306506774/a2bc2ac983
Burmese - https://vimeo.com/306506474/5eb49781d7

Advocacy for Psychiatrists

How to Contact your Legislator

How to Find Your Legislator

Go to vote.utah.gov and click on “find my voter registration info.” Enter your name, address and date of birth, and click “Submit.” In the right hand column that comes up, click on “Contact my Elected Officials.” A full list of your local, state and federal legislators will come up. Click on the arrow at the right of the representative you want to contact. Mailing address, email address and phone numbers will be provided.

How to Contact Your State Legislator or any other government official

A well-written concise letter under your letterhead (home or office) is almost always preferable to emails or phone calls, and certainly to form letters. Close your letter with a question asking the member what specific action he or she will take to follow-up on your request (i.e. cosponsoring, supporting, or opposing a specific bill) and thank him/her for considering your views. If time is of the essence…use email, fax, or the phone!

Address your letter correctly, i.e. place “Honorable” before the persons name in the address area, and then in the body of the letter begin with “Dear Senator , Representative, Governor, Attorney General or whichever is the appropriate title of whom you are writing to.

How to Meet In Person With Your Legislator

• Schedule the meeting in advance, whether you will meet in the district or in the Capitol. Be prepared to specify what the meeting will be about. Consult with UPA staff on issues.

• Be on time, be prepared. Take material with you as well as your business card. You will rarely have more than 15-20 minutes to state your case.

• Personalize the issue. Rather than stating that a bill is "unfair," explain how this would affect your patients and/or your practice.

• Wrap up the visit with a specific request, e.g. “I hope I can count on you to vote in favor of (or against) bill number and name.”

• Finally, volunteer to be a resource contact.

• Follow up with a thank you note and any additional information that may have been requested.

Tips

• Identify yourself as a psychiatric physician (legislators may be unaware that psychiatrists are physicians) and a constituent (if you live in the Legislator’s district).

• Identify clearly the specific issue or bill you are writing or meeting about. Contact the UPA office for talking points or other information.

• Be brief. Be sure to have the facts. State your reasons for support or opposition. Ask your Member for a specific action (i.e. cosponsoring, supporting, or opposing a specific bill) and thank him/her for considering your views.

• Recognize that Legislators are very busy and must weigh issues and assess competing interests. You may meet with staff in lieu of the Legislator—this is not a disappointment, but an opportunity to go into an issue with a bit more depth.

• Print your letter on letterhead if possible. Be sure to include your address on the letter itself—this is often overlooked on email letters (choose home or work address if it will locate you in a key district).

• Important: copy the Utah Psychiatric Association on your letter and mail, and email or fax a copy of any response received to the UPA office.

Physicians Day on the Hill

The Utah Medical Association (UMA) does an admirable job of speaking for all physicians in Utah, but our Psychiatric patients have unique needs, and the expertise of Utah’s psychiatrists is important in advocating for those needs. That is why it is so important that Psychiatrists attend the annual “Doctors’ Day at the Legislature,” a chance to informally meet with our legislators, get to know them, have them get to know us, and have a chance to educate them regarding the unique needs of our very vulnerable patient population.

Information regarding when the next Day at the Legislature will be can usually be found on the Utah Medical Association’s Events and CME Calendar.

Athletes and Mental Health

Wonderful article in the New York Times. The article is short. The five minute video about Olympian Alexi Pappas that accompanies it is terrific!

Link: I Achieved my Wildest Dreams. Then Depression Hit.

Psychiatric drugs save lives and promote healing

Note: The following is the text of an Op-Ed written by Dr. Michael Kalm for the Salt Lake Tribute on June 27, 2017 in response to a letter to the editor regarding the recent murders at the Mother Emanuel Church in Charleston, SC.

The Salt Lake Tribune published a letter to the editor titled, "Drugs, not guns, to blame for mass shootings."

It is tragically ironic that the writer of the letter was as misinformed about the realities of psychiatric medications, as the killer of the innocents at "Mother Emanuel" Church in Charleston was misinformed about "black men raping white women" and black people "taking over the country."

Perhaps the writer of the letter should be forgiven in that even the FDA has sometimes fallen victim to false scares. In 2004, the FDA issued a "black box" warning about suicidal ideation among adolescents taking antidepressant medications. This resulted in a decrease in the number of antidepressant prescriptions written.

This was a tragic error by the FDA. A study published in the prestigious "Archives of General Psychiatry" examined suicide rates in adolescents, aged 10-19, comparing 588 ZIP code regions across the United States. During the 10-year period of the study, whenever the prescriptions of antidepressant medication went up, the actual suicide rate went down. ZIP code by ZIP code. The FDA, cognizant of that study and mindful of the data that there were no documented completed suicides by adolescents taking antidepressant medications as prescribed, modified the "black box" warning in 2007 to remind the public that depression itself carried a high risk of suicide. Still, data shows that antidepressant prescriptions have remained lower than 2004 levels in the adolescent population.

Not only is there an inverse relationship between antidepressant usage and suicide, psychiatric medications have been shown to have a neuroprotective effect in brains, both animal and human. In bipolar disorder, it is very common for cognitive dysfunction to accompany the disease. But, as reported in a 2013 study, in the "The good news is that some of the medications, such as lithium, quetiapine (Seroquel), and valproate (Depakote, Depakene), have very positive effects on some of the things that may be deranged in bipolar disorder, such as abnormalities of brain-derived neurotrophic factor (BDNF) and the protein Bcl-2. Lithium enhances BDNF and Bcl-2. These are neuroprotective factors that may lead to neuronal health. Lithium may also reduce oxidative stress."

These neuroprotective effects have been noted since 2002, and further studies have replicated the findings. In 2009, a large review study published in "Dialogues in Clinical Neuroscience," showed the data supporting neuroprotective effects of medications, not only in bipolar disorder, but in depression and psychotic disorders.

It is a massive understatement to say that it is truly unfortunate that just as scurrilous websites can promote the kinds of lies that delude a young man like Dylann Roof to provoke him to mass murder, there are equally scurrilous websites that can frighten people who suffer from the genuine brain disease of mental illness away from the very treatments that can save their lives and promote healing.