Why Don’t Teachers Get Mental Health Disorder Training

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Why Don’t Teachers Get Mental Health Disorder Training

I love teaching writing; it’s where revelations happen, where children plumb the dark corners, nudge the sleeping dogs, and work out solutions to their most convoluted dilemmas. As much as I adore reading student work, I still get a little nervous about what I’ll find there. Among the stories of what my teenage students did last summer and what they want to be when they grow up are the more emotionally loaded accounts: firsts (periods, kisses, or failures), transitions (moves, their parents’ divorces, or custody disputes), and departures (dropouts, graduations, or suicide attempts).

Over the years, my students have entrusted me with their most harrowing moments: psychotic hallucinations, sexual molestation, physical abuse, substance abuse, HIV exposures, and all sorts of self-injurious behavior ranging from cutting to starvation to trichotillomania. When students write about delicate and dangerous experiences, there are decisions to be made and judgments to be called. And yet, for much of my career, I have been horribly unprepared and have failed to secure the services my students needed as a result.

Teachers are often the first person children turn to when they are in crisis, and yet they are, as a profession, woefully unprepared to identify students’ mental-health issues and connect them with the services they need—even when those services are provided by schools. Aside from the obligatory professional-development session on mandatory reporting laws for child abuse and neglect we have to attend during new faculty orientation, teachers receive little or no education in evidence-based mental-health interventions. According to Darcy Gruttadaro, Director of Advocacy and Public Policy at the National Alliance on Mental Illness, “Most teachers are not trained about mental health in their formal education and degree programs, and yet an unidentified mental-health condition often interferes with a student’s ability to learn and reach their full academic potential.”

According to the National Institute of Mental Health, approximately one in five children currently have or will experience a severe mental disorder. For some disorders, such as anxiety, the rates are even higher. For people who do experience mental-health disorders, most experienced their first symptoms before young adulthood. Half of all people with mental disorders experienced the onset of symptoms by age of 14; 75 percent by age 24. Half of these students will drop out of school. As suicide is the second-leading cause of death among adolescents and young adults, lack of appropriate mental-health interventions and treatment can mean the difference between life and death. Given the amount of time children spend at school, teachers are likely be the ones to identify and refer children for mental-health services. For children fortunate enough to be identified and given access to those services, treatment will mostly likely take place at school, as schools serve as the primary providers of mental services for children in this country.

However, all the mental-health services in the world won’t help if teachers don’t understand the nature of the services available in school and can’t identify the students in need of intervention.

In 2011, researchers at the University of Missouri looked at whether teachers understood the 10 evidence-based mental-health interventions or resources their schools employed. The results were disheartening, to say the least. While two-thirds of the surveyed teachers held graduate degrees, and the remaining third had earned undergraduate degrees, more than 80 percent had never heard of some of the interventions or strategies their own school utilized. Half of the teachers surveyed did not know if their schools provided functional behavioral assessment or intervention planning at all. Given that the response rate for this study was only 50 percent—and it’s likely that teachers with a heightened interest in student mental health would be more likely to respond to the survey—these results probably overstate teachers’ understanding of the tools their own school districts use to support students’ mental and emotional health.

As an increasing number of schools roll out evidence-based mental-health programs such as Positive Behavioral Interventions and Supports (PBIS), teaching that promotes appropriate student behavior by proactively defining, teaching, and supporting positive student conduct, and Trauma-Sensitive Schools, programs aimed at reducing the effects of trauma on children’s emotional and academic well-being, educators need to be at least minimally conversant in the terminology, methods, and thinking behind these strategies. These programs provide strategies that can be highly effective, but only if the teachers tasked with implementing them are sufficiently trained in the basics of mental-health interventions and treatment.

Teachers routinely receive first-aid training in CPR, EpiPen use, and safe body fluid cleanup, but it’s rare for schools to offer training in mental health, said Todd Giszack, Academic Dean of Fork Union Military Academy in Fork Union, Virginia. Recognizing that schools are responsible for their students’ mental, as well as physical health, Fork Union Military Academy designed and implemented its own curriculum with the help of two mental-health professionals, and now offers eight-hour certification programs in Mental Health First Aid. “It has taken two years, but nearly all of our faculty and staff has become certified in Mental Health First Aid. This has allowed our school community to become familiar with trends and warning signs associated with adolescent emotional and mental health” Giszack said.

Dr. Michael Hollander, Assistant Professor in Psychology at Harvard Medical School and director of Training and Consultations on the 3East Dialectical Behavioral Therapy program at McLean Hospital in Belmont, Massachusetts, urges teachers to use caution when intervening in students’ mental-health crises. “In my experience, teacher response tends to be bi-modal; either they get solicitous, over-involved, and in over their head, or they mistake mental health issues for behavioral problems that require in-class discipline.”

Programs such as NAMI’s Parents and Teachers as Allies presentation are beneficial, Dr. Hollander said, because they help teachers understand both the benefits and limitations of in-class interventions. Despite his worries about teacher-facilitated mental health interventions, he’s grateful for the trend toward a greater understanding of students’ mental health. “We have arrived at a place where we finally understand that teaching is not just about educating someone’s rational mind, but also educating their heart,” he said.

Children with untreated mental-health issues can get by. They can limp along toward adulthood until an inevitable, eventual mental-health crisis lands them in the hospital, in jail, or even at an inpatient drug and alcohol rehabilitation facility for adolescents, where I teach. But by then, a lot of damage has been done to their young minds and hearts—damage that could have been prevented if they had received support when their symptoms first appeared.

As I read their essays about crippling childhood anxiety, alcoholic parents, and/or domestic violence, I can’t help but mourn for all the lost opportunities and squandered potential that was wasted on the way.

SOURCE

Holiday Tips

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I recently saw a meme on social media that said “It’s almost time for my normal anxiety to turn into my fancy holiday anxiety.” I had to chuckle when picturing anxiety showing up in a glittery ugly sweater or draped in all things sparkly. Humor aside, it shows that during the holidays, our existing anxiety (or depression) does not just “take a holiday” but rather increases due to stress and societal pressures.

This time of year can be an incredibly stressful and frustrating time. On one hand, we fill our days to the brim with spending time with family and friends, social events, potlucks, baking, preparing meals, finding the right present within your means, and many other tasks guised in the name of the holidays.  All of this “fun” can turn to chaotic quickly. Then on the other hand, some of us may have unwelcome reminders or memories associated with the holidays or feel more alone during this time as we watch others join together and celebrate. Whatever the reason for your distress, here are some helpful strategies to help manage the rise of our fancy anxiety (or depression) in finding ways to relax during the busy time of year or help with our perspective on the season.

  • Self-soothe – Using all 5 senses, focus on what you notice. Cast any judgments away and focus on the experience in the moment. Here are some examples.
    • Taste – slowly eat and notice different flavors in a favorite holiday treat or dish
    • Smell – light a candle or smell a pine tree or cup of tea
    • Sound – listen to your favorite holiday music, point our different instruments or lyrics you might have over looked
    • Sight – watch the fireplace flicker with light or notice the holiday lights all around
    • Touch – when baking or wrapping gifts, bring attention to the different textures you feel
  • Pay it forward – doing something kind for others or contributing can make us feel good about ourselves and give perspective. This could be anything from holding a door open for someone, greeting someone with a smile, adopting a family for the holiday, or volunteering. It does not need to be a large act to bring a sense of contribution to your holiday.
  • Be intentional about breaks – Set aside 15 minutes to check in with yourself and pause from all of the holiday excitement. Read a favorite book, do a meditation, sit in silence, or snuggle up with someone you love.
  • Simplify and slow down – With your to-do list growing, it may feel like you need to be in multiple places at once; however, what we know about the brain is that it cannot think 2 things at once. So, focus your entire attention to the task at hand rather than jumping from task to task (aka multitasking).
  • Follow traditions (or make your own new ones) – Partake in something that brings you meaning for the season, whether this be a family tradition, baking Grandma’s cookies, or finding something new to do this time of year (i.e., sledding, ice skating, driving around to see holiday lights, etc).
  • Put down the phones – I know, I said it. Just hear me out. Often times social media can impact our level of stress by comparing ourselves to others, especially when those others seem to have it all together. They have the catalog ready decorations, Martha Stewarts holiday food spread, or gifts we cannot afford. This can lead us into a down spiral. So, try to limit your access to your phone and engage with those around you.
  • Reach out to someone– The holidays can be a lonely time for some. Sometimes we can still feel lonely in a room full of people, feel so far away and disconnected from others, or feel forgotten. Use all of your willingness to reach out to someone or connect. Whether that be grabbing a cup of hot cocoa with a friend, attending a service, volunteering, or making a phone call to someone you have lost touch with in the past. We are social creatures and need human connection.
  • Be real with yourself – This includes preparing to spend time with family or friends. You likely already know who is going to be the Grinch, who is going to over indulge in the holiday punch, who is going to bring up politics, and who is going to ask about your love life. Just because it is the holidays, does not mean we are going to change who we are or the roles we play. Have an action plan for how you are going to deal with the likely interactions or dynamics.
  • Life in moderation – Life is about balance. Enjoy the holidays by partaking in the indulgences and socialization. Moderation is key. Listen to your body and the signals it is giving you.
  • Gratitude– Research is growing on the importance and efficacy of practicing gratitude in daily life. Our brains are inherently negative so being intentional about shifting out of the holiday stress (and negativity) can help bring perspective and renew our enjoyment of the season.
    • Write down things you are thankful for in life. Focus on the small things (i.e., clean water, fresh air, etc). Nothing is too small to be grateful for in life.
    • Reflect one thing you believe you did well over the past year.
    • Compare yourself to a time in your past when you might have handled the holiday stress less effectively.
  • Permission grant yourself – The holidays are not always candy canes and sprinkles. Often times we hold ourselves to high expectations and forget we are in control of our own actions. Grant yourself permission to: take time outs/breaks, have fun, do things “out of order”, celebrate differently than family/friends/the past, start a project and stop, be honest with people (and yourself), or have days that are “humbug” or just okay.

 

Feel free to make these tips your own by adding your own personal flair to them. It is important to find what works for you and your fancy holiday distress.

 

Happy holidays,

Dr. Alison Dolan

7 Ways Loneliness (and Connectedness) Affect Mental Health

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Loneliness is finally starting to get at least some of the attention it deserves—we may not be as “on it” as other countries, like the U.K. with its Minister for Loneliness, but we’re getting there. Like the push to dissolve the stigma around mental health issues, there’s been a similar increase in people’s honesty about their social connection, or lack thereof. And it turns out that people are pretty lonely these days. The percentage of people saying they have few or no confidants has risen precipitously in recent years. So if you’re feeling lonely, you’re…well, not alone.

As the research shows just how important social connection is for our health and mental health, and how detrimental loneliness can be, the value of speaking out—and changing our habits—becomes all the more clear. Here are some of the ways in which loneliness hurts us and social connectivity helps us, psychologically and physiologically. 

Loneliness is contagious

A fascinating study looked at how loneliness is present in communities, and found that it spreads through a contagious process in which people seemed to “catch” loneliness from one another. As people became lonelier, they moved to the edges of social networks, creating a kind of domino effect. For instance, when one person reported an increase of one day per week of loneliness, his or her close friends also reported an increase. As the authors write, “efforts to reduce loneliness in society may benefit by aggressively targeting the people in the periphery to help repair their social networks and to create a protective barrier against loneliness that can keep the whole network from unraveling.”

Other work has shown that people who become lonelier over time also begin to trust others less, which creates a vicious cycle of loneliness and social isolation. These types of studies suggest that social connection is precarious, and vulnerable to different forces, making it all the more important to do what we can to keep our networks together and oneself involved.

SOURCE

How a Toxic Work Environment Affects Your Mental Health

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Not only is incivility in the workplace on the rise, but according to a recent study, it is compromising one of our most critical assets—our mental health.

The authors of the study, published in the Journal of Occupational Health Psychology, looked at the correlation between toxicity in the workplace and symptoms of insomnia, a common symptom of clinical depression. They wanted to know how, or via which mechanism, incivility in the workplace negatively affected employees’ sleep quality, as there has been limited research into this factor.

What Is Workplace Incivility?

Workplace civility, as described by McKinsey and Company, is “the accumulation of thoughtless actions that leave employees feeling disrespected—intentionally ignored, undermined by colleagues, or publicly belittled by an insensitive manager.” It has also been defined as “low-intensity deviant behavior with ambiguous intent to harm the target, in violation of workplace norms for mutual respect.”

Why Quality of Sleep Matters

Sleep is a critical factor in our overall well-being, including our work performance. It has long been established that poor quality of sleep has significant implications for both our physical and psychological well-being.

For example, insufficient sleep increases a person’s risk of developing serious medical conditions, including obesity, diabetes, and cardiovascular disease. Additionally, lack of sleep over time has been associated with a shortened lifespan.

Effects of Negative Rumination

In examining the indirect effects of workplace incivility on symptoms of insomnia and thus overall health, the determining mechanism was found to be negative rumination, or the mentally replaying of an event or disturbing interaction with a co-worker long after the workday has ended.

“Workplace toxicity leads to adverse effects in part by stimulating people to ruminate on their negative work experiences.” according to the authors. “Negative rumination represents an active cognitive preoccupation with work events, either in an attempt to solve work problems or anticipate future work problems.”

Given that most of us spend the better part of our days and our energy at work, increasing hostility in the workplace doesn’t bode well for our emotional or physical well-being. Research over the past 20 years has associated toxic work environments with increased depression, substance use, and health issues among employees. Further research has shown that organizations are suffering as well. Some of these adverse effects include decreased productivity, lower levels of employee commitment and increased turnover.

Coping Techniques to Reduce Effects of Workplace Incivility

The good news is that sufficient recovery or coping techniques may be able to mitigate the negative effects of a toxic work environment on employee well-being. In particular, relaxation and psychological detachment. The ability to psychologically detach from work during non-work hours and relaxation were shown to be the two mitigating factors that determined how workers were affected or not by a negative work environment.

Employees who were better able to detach psychologically are able to relax after work and sleep better even in the face of workplace incivility. Below are descriptions of these recovery experiences and how they were shown to reduce the negative effects and enable employees to thrive in the most toxic of work environments.

Psychological Detachment

Psychological detachment represents an avoidance of work-related thoughts, actions or emotions. Some of the items used in the study to measure employees’ levels of psychological detachment in the evenings including the following: “I didn’t think about work at all” and “I distanced myself from my work.” Those who were able to detach themselves mentally from this cycle do not suffer as much sleep disruption as those who are less capable of detachment.

Detachment can be fostered through a variety of specific activities, including exercise. Planning future events such as vacations or weekend outings with family or friends are examples of positive distractions outside of work.

Relaxation

It should come as no surprise that prioritizing work-life balance was shown to be another effective buffer against the detrimental effects of workplace incivility. Relaxation has long been associated with fewer health complaints and less exhaustion and need for recovery.

As hypothesized by the authors of the study, relaxation during non-work time served as an important moderator of the relationship between negative work rumination and insomnia symptoms. Additionally, it has been identified as a moderator between work characteristics and occupational well-being, between time demands and exhaustion, and between job insecurity and need for recovery from work. Relaxation provides an opportunity for individuals to halt work-related demands, which is critical for restoring individuals to their pre-stressor state.

Some activities outside of the office that can foster recovery include volunteering, meditation, taking a walk, listening to music, and spending time with friends and other positive social supports.

How Organizations Can Address Workplace Incivility 

Based on the results of the study, the authors suggest the following interventions that companies can address to reduce workplace incivility.

  • Raise awareness
  • Ensure protection for employees
  • Ensure accountability
  • Train and model appropriate behavior
  • Train supervisors on aggression-prevention behaviors
  •  Improve emotional resilience skills
  • Offer training on recovery from work, mindfulness practices, emotional/social intelligence skills

A Word From Verywell

You may not be able to control certain events during work hours or the characteristics of your workplace environment. However, what you do have control over is how you choose to cope. Most importantly, finding time to relax, spending time with friends and family, and engaging in activities that will shift your focus away from work during non-work hours.

If you find that you are still experiencing distressful symptoms and that they are interfering with your functioning, it may be a good idea to speak to a therapist who can help you learn additional strategies for coping.

If despite having done all you can still nothing has changed, it might be time to consider the possibility of removing yourself from the toxic environment and looking for a new, more fulfilling and less distressful job. Your health may depend on it.

SOURCE

In Minnesota, 4 out of 5 gun deaths are suicide

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Juanita Jensen grew up in a gun family. She doesn’t hunt, but believes in the sport and is used to having guns around.

And as the parents of five children, Juanita and her husband were careful to follow all the rules for firearm safety: Keep the guns separate from the bullets. Lock up everything. Enroll their teen boys in gun-safety classes so they could learn to hunt responsibly.

But despite all of their precautions, they realized just how tough it is to keep guns away from someone who shouldn’t have one.

Most Americans are unaware that suicides — not mass shootings, other murders or accidental gun discharges — account for the majority of gun deaths in the United States, according to a recent survey from APM Research Lab. As many as three-fifths of gun deaths in the U.S. are the result of people intentionally killing themselves.

And in Minnesota, the statistics are even worse: 4 out of 5 deaths by firearms are suicides.

Four years ago, when Jensen’s second oldest was 19, he had a psychotic break and ended up in the hospital. (He didn’t want to talk to MPR News for this story and asked that we not use his name. We agreed to respect his privacy.)

The hospital kept him for three days — what’s known as a 72-hour hold — to see if he might hurt himself or somebody else. Hospital staff didn’t say anything to him or his parents about guns when they sent him home. And with the family’s emphasis on gun safety, and Jensen’s worries about their son’s health, it didn’t occur to her.

“They don’t send you home with … a packet, you know, that said, ‘Listen, the hold is over. We’re gonna discharge him. Here are some meds, just things are good,’” she said.

That was in the spring. By the beginning of the summer, Jensen’s son was worse. Her husband was so concerned that he quietly took the guns — and the ammunition — to her brother’s house in another city.

Then one night in June of 2015, one of their sons woke them up with a gun. “Please do something with this,” she says he told them. He told his parents his brother was upstairs “trying to take his life.”

The 19-year-old had gone to Walmart and bought a shotgun, they learned. His brother had found him just in time.

Red flag laws
Seventeen states have passed red flag laws, which let families petition to have peoples’ guns taken away if there’s reason to believe that they would hurt somebody. In Minnesota, red flag bills have come up in the Legislature a few times, but none have gone through. Some states have seen a drop in suicides as a result of red flag laws.

The night he tried to kill himself, Jensen’s son ended up in the hospital and eventually was committed. That means he was under a court order to follow certain rules, including one that barred him from having firearms. In his case, it was the first time any kind of oversight about guns kicked in.

Commitments are handled at the county level; they require an elaborate set of rules that guarantee the person due process, including medical exams and a judge.

The problem is even though the statute says clearly that a person who is committed may not have guns, it doesn’t say how to get the guns away from the person. So, people like Theresa Couri, who helps handle commitments at the Hennepin County Attorney’s Office, are left trying to figure out what to do.

During the commitment process, her office sometimes finds out that the person has a gun or has access to a gun.

When that happens, Couri said, it’s important to get it away from the person. But doing that can be complicated.

“So, what my staff attorneys often do,” she said, “is contact a family member, they will contact a spouse, if it’s a young person, a roommate,” and ask them to go to the house — or wherever the weapon is — to retrieve it.

If they can’t find somebody close to the person, then attorneys call the local police and have them take the weapons.

“I don’t feel that doing nothing is appropriate, so our lawyers engage in activities that I think are consistent with the statute,” said Couri, who was not involved in the case of Jensen’s son. “The statute says a person committed is ineligible [to have a gun]. If we know there’s a gun, we should be taking some action, in concert with law enforcement, to do our best to effect that part of the statute.”

The other thing that happens when a person is committed, whether they are known to have access to a gun or not, is that the person’s name gets reported to the FBI. It’s then added to a confidential list that licensed gun dealers have to check before they sell somebody a gun.

Who can buy a gun?
Kory Krause, who owns the Frontiersman Sports gun shop in St. Louis Park, said would-be gun buyers are required to fill out a form that asks for the person’s identifying information. It seeks not just the basics like name, birth date and address, but also things like height, weight and race. And it includes a checklist of potential disqualifiers, including whether the person has been convicted of a felony or committed to a “mental institution.”

The gun shop submits the form to the FBI, which then has three days to respond, either giving permission for the person to buy, denying it, or asking for more time. The list is confidential so when a person is denied, neither the seller nor the buyer are told why. Krause said it’s rare that a person who knows he’ll be denied bothers to try buying a gun.

What does happen, though, is people who want to hurt themselves will occasionally come in to buy a weapon. And if they’re not on the list, then it’s up to Krause and his employees to recognize the potential danger and stop the sale.

Krause said he’s never gotten any official training to identify somebody in a mental health crisis, and that he and his employees rely on experience and intuition. They might get suspicious if, say, an old man comes in and wants a revolver and only one or two bullets, or if the person physically can’t operate the gun.

He said if he thinks a person might try to hurt himself, he’ll refuse to sell and call the police to check on the person. But he knows a person who is suicidal will at times slip through.

“We know that when they walk out that door, what they do with it could be good or bad,” he said. “It’s an unfortunate component of the business.”

There are other loopholes or gaps that let people get guns when they shouldn’t, including private sales, which aren’t subject to background checks.

Juanita Jensen’s son is doing better, following the rules of his treatment and living on his own. He could eventually petition the state to be allowed to have guns again.
This reporting is part of Call to Mind, our MPR initiative to foster new conversations about mental health.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to SpeakingofSuicide.com/resources for a list of additional resources.

If you or someone you know has had guns taken away because of mental health concerns or if you have tried unsuccessfully to get guns taken away from somebody because of mental health concerns, we’d like to hear from you: aroth@mpr.org or 651-290-1061.

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Three Simple Ways to Enhance Mental Health Resilience

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Cultivating resilience can lead to greater confidence, autonomy and mastery.

There is a consensus among professionals that ‘mental health’ is a positive state where an individual is flourishing, thriving and meeting their full potential in life. There are many cognate terms for ‘mental health’ including subjective well-being, quality of life or simply happiness.

Another term commonly used in relation to positive mental health is ‘resilience’. This phrase is actually borrowed from engineering, where it refers to the ability of a physical material to withhold external stress. A resilient material thus has hardiness, flexibility and strength.

What is Mental Health Resilience?

In psychiatry, the phrase is used similarly, referring to the ability of an individual to handle stress and adversity. It is sometimes referred to as ‘bouncing back’ and can be particularly important after people have experienced difficult circumstances such as losing a job, divorce or bereavement.

Research on resilience indicates that it is not a fixed attribute, but can change over time. Indeed, individuals can cultivate resilience, though this can require time and effort.

In fact, the road to resilience often involves pain and struggle, as does the mastery of any new life-skill. For example, learning to ride a bike often involves falls, cuts and bruises, but results in a new-found ability and autonomy. The same can be said for the resilience-enhancing strategies described below.

Skill Acquisition

Evidence suggests that the acquisition of new skills can play a key role in enhancing resilience. Skill-acquisition helps develop a sense of competency and mastery, which can be deployed in the face of other challenges. This can also increase self-esteem and problem-solving ability.

Skills to be learnt depends very much on individual circumstances. For some, this will mean learning cognitive and emotional skills that may help everyday functioning, for example active listening. For others it may involve pursuits, hobbies, or activities that involve the mastery of new competencies.

This is explored in the insightful documentary below, detailing how the acquisition of art skills enhanced resiliency among a group of people with mental illness. Interestingly, skill-acquisition in a group setting maybe especially effective, as this gives an added benefit of social support, which also fosters resiliency.

<iframe width=”560″ height=”315″ src=”https://www.youtube.com/embed/4p3gSaJU1Mg” frameborder=”0″ allow=”accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture” allowfullscreen></iframe>

Goal setting

Much research indicates that the setting and meeting of goals facilitates the development of resilience. This helps develop will-power, as well as the ability to create and execute an action plan. Goals may vary in size, depending on individual circumstances, but often involve a series of short achievable steps.

For one person, it may be related to physical health, for example exercising more regularly. For another, it may be related to social or emotional goals, such as visiting family and friends more frequently. Goal setting that involves skill-acquisition, for example learning a new language, will have a double benefit.

Interestingly, some research indicates that goal-setting involving a sense of purpose and meaning beyond the individual self (e.g. volunteering or religious involvement) can be particularly useful for resiliency. This may give a deeper sense of coherence and connection, valuable in times of trouble.

Controlled exposure

This involves the slow and gradual exposure to anxiety-provoking situations, thus helping individuals overcome debilitating fears. Numerous studies indicate that controlled exposure can foster resilience. Controlled exposure can offer a triple benefit when it involves skill-acquisition and goal-setting.

For example, public speaking is a valued skill that can help people advance in life. People who are fearful of public speaking can acquire this skill through setting small goals involving controlled exposure. They can start with an audience of one or two friends, progressively expanding their audience over time.

A controlled exposure action-plan can be self-initiated, or developed in tandem with a therapist trained in Cognitive Behavioral Therapy. Again, successful efforts will result in increased self-esteem, as well as an enhanced sense of mastery and autonomy. This can be harnessed to surmount future challenges.

Conclusion

An amassed body of research suggests that resilience can be developed and cultivated over the life course through simple (though challenging) self-initiated activities. This often involves discipline, will-power and hard-work, but the results will be bountiful: greater autonomy, mastery and confidence.

Try it and see for yourself.

 

SOURCE

Telehealth Training Day

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Here at CARE we are dedicated to making sure that our staff members are properly trained. Telehealth allows therapy to be provided to a much larger community of people. Ensuring that our staff members are appropriately trained is important to us. We want to make sure your time spent together with your clinician is private, secure, and safe. Zoom is our new video conferencing system that we are using to conduct our Telehealth sessions. Zoom is HIPPA compliant and super easy to use!

Click here to watch our telehealth training day for our clinicians! 

Learn more about Zoom by clicking the link below:

https://care-clinics.com/about/telehealth/

Improving Treatment Adherence for Type 1 Diabetes

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Despite all the advances in medical science and technology, there is still no cure for diabetes. A person with diabetes has to live with it and manage it all their life. The challenge, of course, is being diligent and consistent with diabetes management. Type 1 diabetes is challenging to manage because it is so comprehensive. Research shows that the adherence rate for chronic conditions is about 50%. Despite extensive studies and research, that number has not changed significantly over the past 3 decades.

What is adherence? How does it apply to people with type 1 diabetes? How can a person with type 1 diabetes improve their adherence? And how can mental health professionals help? These questions were answered by Dr. Katherine Fan, a psychiatrist and pediatrician, at the 2016 Asian Outreach Day. Dr. Fan spoke with attendees about the factors that affect a person’s short and long-term dedication and commitment to managing their diabetes. Here’s a recap of her talk:

 

What is Treatment Adherence?

Adherence is the active, responsible, and flexible process of self care and self management with a goal of overall health and wellness. An adherent patient strives to achieve good health by working in close collaboration with health care staff, instead of simply following rigidly prescribed rules.

In the context of type 1 diabetes, adherence can also be known as “collaborative diabetes management”, “patient empowerment”, or “self care behavior management”.  It can be useful to break down diabetes adherence into a number of areas:

  • Glucose monitoring
  • Administration of medication / insulin
  • Dietary intake / carb counting
  • Physical activity
  • Follow up visits

This may help the patient, medical care providers, and support system prioritize and focus on which parts to work on.

Also, it is important to distinguish between Adherence and Compliance. Compliance implies a paternalistic relationship between and patient and his/her doctor. The patient takes a passive role in diabetes management, simply following doctor’s orders and doing what they say. On the other hand, adherence is more of a partnership between a patient and his/her doctor, as well as his/her support network. In fact, the patient is an active participant in planning and management.

 

Factors Impacting Adherence

What makes a person with diabetes more or less likely to adhere to their diabetes management plan?  There are 4 main types of factors that diabetes adherence:

Treatment and Disease Characteristics

Complexity of treatment: The more complex the regimen, the lower the adherence rate. For example, if a patient has to take 10 different kinds of medication, 4 times per day, it is difficult to integrate this routine into daily life.

Duration of disease: The more chronic the illness, the lower the adherence rate. This may seem counterintuitive, but patients who have been diagnosed longer actually tend to have lower adherence rates than those recently diagnosed. Managing a condition over long periods of time may lead to a more casual attitude, or it may lead to burnout.

Delivery of care: Diabetes care can be delivered a number of ways: via a multidisciplinary team, a single general-care provider, or community treatment, to name a few. Research has shown that patients with diabetes seen specifically for their diabetes received more counselling on diet and adherence than patients with diabetes seen for an acute illness.

Intra-personal factors

Age: The teenage years tend to be hardest time to stick to a diabetes management plan. In contrast, parents of young children with diabetes are more likely to be adherent.

Self-esteem: Research has shown that high levels of self-esteem are related to high levels of adherence to physical activity regimens, adjustment of insulin doses and dental self-care

Self efficacy: Self-efficacy is defined as an individual’s belief in their ability to succeed specific or accomplish a task. A healthy sense of self-efficacy can play a major role in approaching goals, tasks, and challenges. The more a patient is able to advocate for him and herself, the better the outcome.

Stress: Stress and emotional state is also correlated with treatment adherence. The less stresses a person experiences, the more likely he or she will adhere to diabetes management.

Comorbid conditions: A comorbid condition is one that occurs at the same time as another illness or condition. Comorbid conditions such as depression, alcohol abuse, eating disorders, and others can adversely affect diabetes adherence. This effect is not limited to mental conditions: physical comorbidities also tend to lower the adherence rate of diabetes.

Inter-personal factors

Patient-provider relationship: The better the relationship between a patient and his or her provider, the higher the patient’s adherence rate will be. Patients and providers who communicate with each other tend to have improved relationships.

Social support: The benefits to have a social network for a person with type 1 diabetes are well known. Greater social support means better levels of adherence. For children and teens with type 1 diabetes, great parental involvement also means better levels of adherence.

Environmental factors

Stressors:The more stress a person has in their life, the harder it is to prioritize and manage diabetes

Conflicts: People with diabetes are as multifaceted as everyone else. Frequently, they are called upon to choose between giving attention to diabetes self-management or to some other life priority. They can face time pressures and social pressures during school events, work events, family events, holidays, and more.

Lifestyle factors: A person’s lifestyle can directly affect their diabetes adherence levels. Are they sedentary or active at work? Do they work long hours? Do they travel a lot? How much time do they spend in front of the television? Do they have a hobby?  Different circumstances require individuals to adjust and maintain their diabetes management.

Socio-economic status: The economically disadvantaged and ethnic minorities may find it particularly challenging to visit healthcare providers or to live a healthy lifestyle. They may have limited access to fresh fruits and vegetables, small living spaces. Their schools may not provide opportunities for physical activity. What’s more, financial constraints may prevent them from going to a gym. Those factors, combined with their local climate, may make regular exercise challenging.

 

The Diabetes Adherence Team: What can we do?

There are four kinds of players on any diabetes management team: the Patient, the Parents (or family/friends), the Physician, and the Environment. All players have a role to play in diabetes adherence. When each “player” contributes in a positive way, it leads to better adherence and better outcomes. Here are tips on how each team player can work to enhance adherence and wellness:

The Patient

It takes a team to manage diabetes, but adherence starts with the patient. As the person with diabetes, you’re going to be living with your body for a long time, so take care of it! Here are some things the patient can do to make diabetes adherence easier:

  • Be informed and understand your condition. Understand what it does to your body, and understand the complications that can occur if one does not manage the condition and stick to the plan.
  • Identify your strengths and future goals. Don’t see diabetes as something that defines you, but something that is a part of you. You cannot change it but you can manage it.
  • Stress proof your life. Work on areas such as sleep, nutrition, exercise, hobbies, mind-body exercise, healthy coping strategies, and more. Also, develop a support network of family, peers, school, religion, and/or support groups.

The Parents

Parents (and family) play a huge role in enhancing adherence. Here are some things parents can do to help their child with T1D:

  • Understand the developmental needs of your child and recognize where they are. Remember, each child is different! At any given age, a child may be a different levels with respect to cognitive, motor, social-emotional, and physical skills.
  • Be informed and stay involved. Invest in your relationship with your child! Additionally, help your child be informed and involved. Help educate your child’s school, as well as caretakers, friends, and family.
  • Balance “take control” and “letting go”. We all want to be there for our kids, but we want our kids to take responsibility and be independent so that when they leave home, they can take care of themselves.
  • Create a supportive home environment. Avoid judgement words such as “good” or “bad” sugar/A1C. Instead, use phrases like “in or out of range”.
  • Foster a positive attitude about the condition.
  • Model self care. Kids learn by watching!
  • Focus on incentives, not threats or fear tactics. Consequences are for behaviors that you want to stop, while incentives are for behaviors that you want to foster.
  • Don’t be shy about asking for professional help!

The Physician

Physicians play an important role. A physician who can help enhance adherence is one who:

  • Keeps it simple and simplifies treatment regiments as much as possible
  • Makes sure patients understand the consequences of non-adherence
  • Connects with the patient in a way they understant
  • Enhances patient communication via phone, text, etc..
  • Leaves bias out of the relationship and avoids judgement. Patients already feel shame and guilt, and when they feel judged, it negatively affects the doctor-patient relationship.

The Environment

Some environmental factors are difficult, if not impossible, to control, so focus on things that you can control. For example, you may not be able to enhance access to health care, but you can provide diabetes awareness and education. You can educate not only yourself and your family, but also the broader community. Parents can help educate their children’s school teachers and friends. Adult patients can start support groups online and in real life. Technology can also improve diabetes awareness and education.

 

The role of Mental Health Clinicians

How can mental health clinicians help patients achieve overall wellness?

  • They can support the patient and the patient’s family, not just during diagnosis, but throughout their journey.
  • Acceptance is the first step towards adherence. Mental health clinicians can help patients work on accepting their condition and coping with it.
  • Mental Health Clinicians can help the patient process some of the emotional factors that come with diabetes: anger, fear, guilt, shame, stress, sadness
  • They can facilitate communication and conflict resolution, between you and parents and friends, between doctor and patient
  • They can help identify other emotional disorders that can complicate diabetes management, such as depression, anxiety, eating disorders, or substance abuse.

Mental health clinicians can provide treatments such as cognitive behavioral therapy, motivational interviewing, behavior modification plans, or family therapy.  Diabetes affects the mind as well as the body. Mental health is an important step towards the journey to your best self. Never be afraid to ask for help from a mental health professional!

 

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The Most Important Things to Know About Diabetes and Alcohol

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BY SCOTT JOHNSON

We recently held our annual mySugr holiday celebration. What a good opportunity to talk about drinking alcohol with diabetes and the effect on blood sugar, right?

Party time!

You can probably imagine it. Some snacks to nibble on, a live DJ spinning the (digital) wheels of steel, and some tasty adult beverages. In a situation like that, It’s all too easy to get caught up in the atmosphere and not think about your blood sugar. That’s totally natural – who wants to think about diabetes when you’re having a good time? I certainly don’t. But does drinking alcohol affect your diabetes and blood sugar? Is it something to be concerned about?

Pay Respect!

Here’s the deal. If you don’t pay some attention to alcohol and learn how it interacts with your diabetes, it will stop your party in one way or another, either during the dance-off or perhaps more commonly, hours later when you’re sound asleep and dreaming about your fancy moves. Cruelly, that’s when you’re least expecting it and when you’re at your most vulnerable.

Having diabetes is no reason to avoid drinking if it’s something you’d like to do. But you should understand how it works so you can do so safely. I’m not personally a big drinker, but I’ve done some digging and hope to share a few bits of useful information to help keep you safe.

We’re all different, but basics are basic…

One of the most important things I can share is that we’re all different, especially when it comes to our diabetes. Many people also differ in how they respond to alcohol. So like everything – your mileage may vary.

In any case, there’s no harm in talking about some of the basic ways alcohol affects metabolism, and what it does to blood sugar. Ready?

Alcohol inhibits glucose release from the liver. So what?

The presence of alcohol in your system can cause low blood sugar. Why? Because it plays games with your liver. How? Your liver is a big reserve of sugar, and throughout the day and night, it normally releases glucose (sometimes even when we don’t want it to).

But when alcohol is present it switches focus to clearing alcohol from your bloodstream and forgets all about releasing glucose. That liver is no good at multitasking.

If there’s less sugar in the blood, you’ll need less insulin (or you’ll need to eat more). Aha! Makes sense, right?

And the time delay…

Each alcoholic beverage takes between 1 to 1.5 hours to process through the liver. During that entire time, your risk for lows is increased. So if you have two drinks, you’re looking at three hours. Three drinks and it could be more than four hours. Can you see how quickly the hours add up? If you’re not planning way ahead, this can easily sneak up and catch you off guard during the middle of the night.

Many alcoholic beverages (beer, wine, mixed drinks, etc.) contain carbohydrates, which will quickly increase your blood sugar and usually require a bolus. But the bolus should be calculated very carefully, because although your blood sugar may go up quickly, the alcohol is also setting the stage for a fall later on.

A tip from Gary Scheiner.

Gary Scheiner, award-winning Certified Diabetes Educator and author of “Think like a pancreas” offers a guideline for insulin pump users. He suggests that the basal rate should be reduced by 30-50% for 2 hours for each alcoholic drink. Meaning if you had three drinks, you’d set this temp basal rate for six hours.

Ok, at first glance this might sound a bit complicated. Actually, you’re right, dealing with diabetes and alcohol is a bit complicated. And as mentioned at the beginning, everyone reacts differently, which means it can be really hard to find clear and simple instructions on what to do. So like almost everything else with diabetes, you have to start with some basic knowledge (which I hope I’ve given you here) and experiment (safely).

Things to Remember:

  • Be very conservative and cautious if you use insulin to lower your blood sugar when drinking, and test often.
  • Have a meal or snack with carbohydrates when you consume alcohol.
  • Remember to keep glucose tabs or other fast-acting glucose with you at all times.
  • Dancing? Oh yeah! But remember, it counts as exercise, which also lowers blood sugar.
  • Consider going to bed with a blood sugar higher than normal if you’ve been drinking. Keep in mind that the drop in BG is often dramatically delayed and you’ll want to play it extra safe when sleeping.
  • Alcohol can make it hard to notice symptoms of a low. Check your blood sugar often. Check more often than you think you need to. Have I mentioned that you should check often?
  • Drunkenness and lows have similar symptoms. It makes sense for a few of your closest party buddies to know about your diabetes and how to help in case of trouble.
  • Wear your medical ID at all times (you do have a medical ID, right?).

A few more things that are good to know:

  • When you’ve been drinking, a glucagon rescue shot may not work!
  • I am going to repeat that – a glucagon shot may not work when your liver is busy clearing alcohol from your system!
  • You might need to hear that a third time… glucagon may not save you if you pass out from a low while drunk.
  • If you’re a woman, you typically process alcohol a bit slower than your male counterparts.

There is much more to know about diabetes and alcohol, but I hope that this has been a helpful start. There seems to be precious few community-based resources out there that cover drinking with diabetes. One I know of is drinkingwithdiabetes.com, and they even have a couple of nice infographics you can download.

Diabetes and Alcohol Infographic

I’d love to hear if you know of any other helpful resources. If so, please leave a comment.

Have fun out there, and stay safe!

And here is where I am also obliged to officially advise you to discuss your specific situation with your doctor.

Sources:
Diabetes & Alcohol – UCSF
A Diabetic’s Guide to Drinking – University of Southern California
Understanding Alcohol’s Effects – University of Rochester Medical Center

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Anxiety + Diabetes

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WRITTEN BY: Kristi Caporoso, MSW, LSW

State(s) of Fear

Anxiety has become one of the most commonly diagnosed mental illnesses in the United States. It seems everywhere you turn, someone is talking about it. Whether it’s their child or themselves that are afflicted, everyone and their mother seems to suffer from some level of anxiety. There has been a particular uptick in the level of anxiety reported in children and adolescents. While mental health professionals are trying to put their finger on what exactly is contributing to this – technology, political climate, homework – you don’t have to dig deep to find a reason for increased levels of anxiety in those living with Type 1 diabetes. To begin unpacking this issue, first let’s take a look at what the “A” word actually means.

What is anxiety, exactly?

A certain level of anxiety is healthy – necessary, even. It is what prevents us from engaging in dangerous behaviors, and what keeps us motivated to accomplish the things we need to do. The dictionary definition of anxiety reads as follows: “distress or uneasiness of mind caused by fear of danger or misfortune.”1 When this distress gets too high, or is disproportionate to the situation provoking it, the person tends to suffer from anxiety instead of benefitting from it.

Some of the more common forms of anxiety disorders are:

Generalized Anxiety Disorder (GAD)

A prolonged state of worry or tendency to worry about any and everything. GAD can have physical manifestations, such as GI problems and difficulty sleeping.  Someone living with GAD will have a tendency to view everything through a lens of anxiety, and be bombarded with “what-ifs?”

Panic Disorder

Panic disorder can occur after a person experiences one or multiple panic attacks, and is living in constant fear of the next one occurring. Everyone experiences panic attacks in different ways, but the most common symptoms are shortness of breath, feelings of impending doom, de-personalization (that feeling when you are floating outside your body), and heart palpitations, to name a few.

Social Anxiety Disorder

Basically what it sounds like, social anxiety disorder is when people experience extreme discomfort and anxiety around other people. This anxiety is rooted in the fear of what others think of you, or of embarrassing yourself or looking foolish.

Diabetes & Anxiety

T1D and anxiety are made to exacerbate one another. The fears and thought patterns that fuel anxiety are inherent to managing diabetes. On the flip side, struggling with anxiety can wreak havoc on your blood sugars. The more time I’ve spent working with and trying to pick apart anxiety disorders, the more I’ve realized how counterintuitive diabetes management is to anxiety levels.

What ifs

Running through the back of every anxious mind is a pestering whisper of what if? “What if I die?” “What if I embarrass myself?” “What if I fail?” These persistent questions can be crippling. However, when managing diabetes, it is often necessary to ponder what if. For example, I am about to pre-bolus for my dinner on my way home, but what if I get stuck in traffic? I am preparing for a run by adjusting my dosage and snacking, but what if it rains?

At the forefront of diabetes management is planning. Unfortunately, planning often invites what ifs, and what ifs can easily manifest into anxiety. When you are living with anxiety, it is often difficult to differentiate between rational or helpful what ifs and irrational, detrimental ones. Considering the rain or traffic while planning your insulin dosage can be productive, while repetitively pondering the possibility of going low and passing out during your exercise routine is not.

Living in the present

Similarly, planning for diabetes care can interfere with being present in the current moment. In recent years there has been growing evidence of the efficacy of mindfulness-based stress reduction (MBSR) and meditation for treatment of anxiety2. Much of our worry is rooted in what may or may not happen in the future. But it is hard to focus on the present moment and often difficult to be spontaneous when you’ve got insulin on board (IOB), sensors with downward-pointing arrows, and a fixed amount of juice in your handbag. Even the actual practice of meditation can be interrupted by alerting insulin pumps and CGMs. As mentioned above, diabetes management involves a lot of planning. And a lot of planning means a lot of future-oriented thinking.

Checking

Much like planning, with diabetes checking is essential. Checking you blood sugar, checking your IOB, checking your low supplies. But for someone with anxiety, checking can spiral into an obsessive ritual. People suffering from obsessive-compulsive disorder (OCD) have certain rituals they perform to quiet obsessive thoughts that repeatedly run through their mind. Because checking is so essential for diabetes management, it’s easy for someone susceptible to anxiety to fall into a pattern of over-checking. Picture this: you feel anxious about going low, check your sensor data and see no downward arrows. You feel a temporary wave of relief. But moments later, those thoughts recur. They get louder and louder in your head, until you have to check your sensor again – still no downward arrows. You see how this can fall into a negative thought-behavior cycle.

Where do we go from here?

Fortunately, much like type one, anxiety is manageable. But it takes work. If you feel like anxiety is interfering with you or your child’s everyday life, consider seeing a therapist. There are many therapists who have experience working with people with chronic illness. And if they don’t, BT1 has a helpful guide to teach them about type 13.

Where to start: finding a therapist

Your primary care doctor or pediatrician may have some referrals. Or, if you feel comfortable, ask around. It’s more than likely that many people in your life see a therapist and you have no idea. Or, if you have private insurance, you can try calling the “Member Services” number on the back of the insurance card and asking for referrals to local in-network behavioral health providers. There are also many ways to locate a therapist online:

If you have Medicaid (or Medical, or your state’s equivalent), your state’s Division of Mental Health and Addiction Services should have resources for local community mental health centers that accept this insurance. Your therapist or primary care doctor will also be able to suggest if you should consult a psychiatrist. A psychiatrist can prescribe medications for behavioral health concerns.

While diabetes and anxiety may make a great pair, you don’t have to constantly live at their mercy. As you learn to accept and manage your anxiety, you’ll learn how to live well with it. It won’t be easy, and there’s a lot of trial and error. Of course, having type one means you’re used to that! And always remember, you’re not alone in this.

REFERENCES

  1. HTTP://WWW.DICTIONARY.COM/BROWSE/ANXIETY?S=T
  2. HTTPS://WWW.MINDFUL.ORG/JON-KABAT-ZINN-DEFINING-MINDFULNESS/
  3. HTTPS://BEYONDTYPE1.ORG/T1D-GUIDE-MENTAL-HEALTH-CARE-PROVIDERS/

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