Mental Health and the COVID-19 Pandemic
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
Climate Change, Climate Disaster, and Mental Health
Climate change and mental health are connected, and we need to be prepared to respond.
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
The history of psychiatry with women
It is time recognize and repair the injury American psychiatry has caused to 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 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:
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:
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:
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
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:
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.
Learn what local resources are available to aid those affected by the tragedy and be prepared to share this information.
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.
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.
Feelings of anxiety and depression following a traumatic event are natural. You may want to seek psychiatric care if:
you are having increasing problems at home or work
you are using more alcohol
your symptoms don’t get better after a few days (or are getting worse)
you just don’t feel right
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
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
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!
Psychiatric drugs save lives and promote healing
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.