Posts Tagged mental health
As you may or may not know, May is National Mental Health Awareness month in the United States. Here at MINES improving services, knowledge, and awareness around mental health issues, and providing solutions to these issues is our business, our specialty, and our passion. Therefore, it’s safe to say that Mental Health Awareness Month is important to us as it allows us an opportunity to jump into the national conversation around critical behavioral health topics on a national level and help the fight to increase awareness and decrease stigma around mental health.
To shed some light on why this is so critical, consider the following statistics:
US General Stats:
- 1 in 25 adults are currently diagnosed with a serious mental illness; 1 in 5 are currently diagnosed with some sort mental illness
- There are a wide variety of anxiety disorders, including Post-Traumatic Stress Disorder, Obsessive-Compulsive Disorder, and specific phobias to name a few. Collectively they are among the most common mental disorders experienced by Americans.
- Approximately 10.2 million adults in the U.S. have co-occurring mental health and addiction disorders.
- Serious mental health illnesses cost people $193.2 billion in lost earnings every year in the U.S.
- Nearly 60% of adults with a mental illness did not receive care in the previous year.
- 3% are currently diagnosed with a serious mental illness; 14.3% are currently diagnosed with some sort mental illness.
- Men die from suicide at twice the rate as women.
- 6 milling men are affected by depression per year in the U.S.
- The Top 5 major mental health problems affecting men in the U.S. include: Depression, Anxiety, Bipolar Disorder, Psychosis and Schizophrenia, and Eating Disorders.
- Men are significantly less likely to seek help for mental health issues than women. Causes for this include reluctance to talk, social norms, and downplaying symptoms.
- 5% are currently diagnosed with a serious mental illness; 21.2% are currently diagnosed with some sort mental illness.
- 12 million women in the U.S. experience clinical depression each year. Roughly twice the rate of men.
- Although men are more likely than women to die by suicide, women report attempting suicide approximately twice as often as men.
- Many factors in women may contribute to depression, such as developmental, reproductive, hormonal, genetic and other biological differences (e.g. premenstrual syndrome, childbirth, infertility, and menopause).
- Fewer than half of the women who experience clinical depression will ever seek care. And Depression in women is misdiagnosed approximately 30 to 50 percent of the time.
- 50% of all chronic mental illness begins by the age of 14; 75% by the age of 24.
- 20% of 8 to 13 year of age in the U.S. will be diagnosed with some sort of mental illness in their lifetime.
- Girls 14-18 years of age have consistently higher rates of depression than boys in this age group.
- Nearly 50% of kids with a mental illness did not receive care in the previous year.
- LGBTQ adolescents are twice as likely to attempt suicide than non-LGBTQ youths.
- More than 90% of children who die by suicide have a mental health condition.
This month from MINES
All throughout this Mental Health Awareness Month, MINES will be tweeting out stats to stoke the conversation and resources to help those that may not know where to go. We will also be sharing thoughts, resources, and insight from different members of the MINES team around some of today’s important behavioral health issues right here on MINESblog. So please follow if you are not already, and feel free to share with anyone you think may benefit from the information. And if you or someone you know is struggling with a mental health issue, please encourage them to reach out to one of the resources above to find the help they need. And as always, if MINES is your Employee Assistance Program and you need help, information or just need to talk, call us 24 hours a day at 1-800-873-7138.
- Substance Abuse and Mental Health Services Administration Treatment Referral Helpline –
- National Institute for Mental Health – nimh.nih.gov
- NAMI (National Alliance on Mental Illness) – nami.org
- Mental Health America – mentalhealthamerica.net
- Mental Health America of Colorado http://www.mhacolorado.org/gethelp
- Anxiety and Depression Association of America – adaa.org
- Depression and Bipolar Support Alliance – dbsalliance.org
- National Suicide Prevention Lifeline – suicidepreventionlifeline.org
- Veterans Crisis Line – veteranscrisisline.net
- National Action Alliance for Suicide Prevention – actionallianceforsuicideprevention.org
- United Way- unitedway.org/local/united-states/
Keep the conversation going
As always we ask that you don’t let the conversation end with the end of the month. We don’t have to wait until next year to keep talking about Mental Health especially when there are so many people out there in need of help and information. Keep good track of your own health and wellbeing, don’t be afraid to seek help if you need to, and assist others by talking to them and sharing information and directing them towards care providers that can help them.
To your wellbeing,
The MINES Team
What is grief?
Grief is a natural reaction to loss. It can be a loved one, friend, co-worker, pet, and even sometimes objects such as a house or car. It’s important to understand that grief is a way in which our minds and bodies cope and that grief can be a healthy, even necessary, process. Everyone experiences grief at some point in their lives and works through it on their own terms. In fact, 1 in 5 people will experience the death of someone close to them by the time they are 18. Grief can be an extremely personal time where people may reach out to others or isolate themselves. We will discuss the difference between healthy and unhealthy grieving, along with the common stages of grief.
The stages of grief
Depending on where you look you can find anywhere from 5 to 7 stages of grief. For sake of brevity, we will focus on the core 5 stages. The stages are:
While these stages represent an overall progression, it is important to note that it is possible to move back and forth between stages, skip stages and even begin the stages again once you’ve reached acceptance. For instance, you may skip the bargaining stage and go straight into the depression stage but then fall back into the anger stage before finally reaching the acceptance stage. The healing process will be painful and depending on the level of grief you are experiencing can often take a long time. Sometimes it may take weeks, other times it can years to reach some form of resolution to the grieving process. It is important to focus on happy memories and positive thoughts when working through a loss. In 2008 psychologist Dale Lund of California State University surveyed 292 recently bereaved men and women age 50 and older and found that 75 percent reported finding humor and laughter in their daily lives and at levels much higher than they had expected. Other research has shown that being able to draw on happy memories of the deceased helps you heal — those who are able to smile when describing their relationship to their husband or wife six months after the loss were happier and healthier 14 months out than those who could only speak of the deceased with sadness, fear, and anger. Everyone works through grief their own way and in their own time but it is important to recognize when the grieving process has stagnated and is not progressing toward acceptance in a healthy way. This may be a sign that professional help is needed.
When is grieving good/bad?
As we mentioned above grief is a very natural, human reaction to tragedy and necessary to our healing process. Grieving is healthy when we are able to use it to process our thoughts and emotions in a way that lets us heal and eventually reach a state of acceptance that lets us move on from the tragedy. This does not mean forgetting about the people we may have lost or the events that might have happened, but simply reaching a place emotionally that allows us to live our lives normally. Grief is unhealthy when we stop progressing through the stages and get stuck. This may happen in any one of the stages and you may even switch between a couple but are never able to reach the acceptance stage. This can happen for any number of reasons. Depression, isolation, and compounding life sources of stress and grief are just a few factors that could lead to obstacles in the grieving process. If this becomes the case, it is often best to seek professional help. Contacting a professional grief counselor is the best first step in assessing where you are in the grieving process and to determine if there are other areas of concern that need attention. To get in touch with a qualified counselor you can talk to your primary care doctor and they can often make a referral. You may also have direct lines to behavioral health benefits through your employer’s health plan or Employee Assistance Program. Check with your Human Resources Department if you are not sure.
How to grieve in a healthy way
As we said, there is no right or wrong way to grieve, but there is healthy and unhealthy grieving. In order to help yourself stay positive and productive in the healing process it is helpful to keep in mind:
- You are not alone – Friends, family, co-workers, neighbors, church groups, and others you know socially can help. Think about whom you know that can support you.
- Don’t let others tell you how you should feel – Only you know what’s right for you. What someone else went through when they dealt with grief may not be what you experience.
- Let others know how they can help – What you need while navigating the grieving process may be different from moment to moment, day to day, and week to week. Let others know how your needs are changing.
- Everyone’s grief is unique – There is no guide to tell you when to start and stop grieving or when to move from one stage of the process to the next. However, if you feel that your grief is getting worse and that you are not progressing, there is help. Contact a grief counselor or EAP to get in touch with help. If your EAP is MINES our contact information is below.
Of course, this is not a comprehensive list and as you navigate through the healing process you may find that certain things help and others don’t. Find what works best for you.
How to help others grieve
At this point, you should see that grief is personal and can be a sensitive topic to some people. It can be hard to find ways to talk about grief or offer help if you know someone is grieving or struggling with a loss. There are things you can do, however, that offer support without being intrusive or overbearing. Things you might try include:
- Just being around – Sometimes there is nothing you can say that will make a person feel better. But just the fact that you are around can help. By being present and ready should they need something, the grieving person will feel supported even if you or they don’t know exactly what to say at the moment.
- Food – When someone is grieving, sometimes food is the last thing on their mind. They may not feel up to cooking or going out to get something. Or they may be suffering from lack of appetite which is common during grief. Being handy with quick, nutritious, easy to eat items such as fruit, veggies, or simple dishes can be a great help. As well as helping them remember when they ate last and ensuring they are getting enough sustenance.
- Support for decisions – When depressed, people’s decision-making ability can suffer. Try to help the griever put off big decisions until they are in a better state of mind. If necessary be there to act as a voice of reason and clear thought should important choices come up that need to be addressed.
- Listening – If and when the grieving person is ready to open up and talk, be there to listen. Offer simple understanding and words of support. Try and keep them talking so that they can vent their emotions when they have a chance. Steer away from any judgment and instead offer encouragement as much as possible. Talking is healing.
- Let them cry – Seeing our loved one’s cry can be painful, but don’t let that make you discourage them from doing so. Crying can be an important part of emotional processing. Instead, comfort them, offer them tissues, and even cry with them.
Be there for the person in need but allow them the chance to choose to open up to you on their own terms and in their own time. Trust that if you are there for them they will let you know when they need you. Intervene only if you sense that they are getting worse and not taking care of themselves in a way that will help them get better in time.
If you are currently grieving, supporting someone who is, or have grieved in the past but have reached acceptance, continue to focus on and preserve the good memories you have. You may always feel the sting of the loss to some extent but as you remember your passed loved one, lost relationship, or even a lost pet, the pain will slowly disappear over time and the fond memories and times that made you laugh and smile will be all that remain. If you are struggling and having trouble reaching the point of acceptance and do not feel as if you are healing, please reach out to someone. Find a close friend or family member you can confide in, seek out a grief counselor to talk to, and again if your employer has an Employee Assistance Program use that resource to find the help you need. If you have MINES as your EAP, we are always here to talk 24/7, please reach out to us anytime at 1-800-873-7138.
To Your Wellbeing,
The MINES Team
Children’s Grief Awareness Day. (n.d.). Retrieved March 24, 2017, from https://www.childrensgriefawarenessday.org/cgad2/index.shtml
Konigsberg, R. D. (2011, March 14). Grief, Bereavement, Mourning Death of Spouse. Retrieved March 24, 2017, from http://www.aarp.org/relationships/grief-loss/info-03-2011/truth-about-grief.html
There are many areas of life where body image and being thin are associated with performance. Certainly, more for women (a significantly higher percentage) than men, body image and eating disorders continue to be issues. Weight loss strategies, such as those used by individuals with eating disorders (anorexia, bulimia, body dysmorphic disorder, compulsive overeating, and others), can detract from performance, by adding undue suffering on a psychological level and negatively impacting so many areas of their lives, their families’ lives, their employers’ and co-workers’ lives.
I started doing research and psychotherapy with individuals with eating disorders in 1980 when there were six articles on the treatment of bulimia. Since that time, research on treatment has evolved significantly. Unfortunately, societal pressures have not changed much; the incidence level has not changed and countless people continue to suffer. Each generation gets to cope with a misogynistic and sexually oriented culture, filled with distorted imagines in the media and body shaming on social media. However, with weeks like eating disorder awareness week, we can bring these disorders to the forefront. The good news is that there is help. People do recover from eating disorders. If you know someone or have an eating disorder yourself, please either encourage them to seek help (they may not be ready so don’t get discouraged) or get help for yourself.
There are several national resources and helplines, including:
Have a day filled with loving kindness and compassion!
Robert A. Mines, Ph.D., Chairman and Psychologist
— MINES & Associates (@MINES_bh) March 2, 2017
Student Assistance Programs (SAP) go a long way in addressing the concerns mentioned in Meg Bryant’s excellent article: Survey: Colleges struggling to meet mental health needs of students based on a recent report from STAT titled “A dangerous wait: Colleges can’t meet soaring student needs for mental health care.” Ms. Bryant brought up many issues: access, limited sessions, stigma concerns inadvertently setting students up not to be seen in a timely manner, high demand for service and limited resources, and finally the role telehealth may play in the future.
A growing problem
While the needs of university students have been recognized and provided for for years, the increased demand with a decreased stigma in accessing services and asking for help has led to a need for increased capacity for these services. There are many opportunities that moving to a larger, external network could afford.
Many of the schools highlighted in the report had student:provider ratios that were quite high – ranging from the low end of 400:1 to over 1,500:1. While provider ratio alone does not determine quality or even capacity, it’s an indicator of potential. Given the average university size of approximately 4,200 students, MINES’ average student to provider ratio would be under 5:1.
Additionally, this breadth of coverage means increased specialization available to those students. MINES’ network can be searched based on type of provider, populations they work with, modalities of treatment, languages that they speak, and much more. This results in a better match in the provider/patient relationship from the beginning.
Utilizing an external network also creates the ability to respond to increased demand on the university counseling staff for times when there is increased stress or pressure on the students, for example when there is a critical incident or even during midterms or finals when the added stress of accomplishment for the students may increase.
Using an external network also adds to capacity and expertise for referral after initial services are completed when a short-term therapy model will not resolve the issue the student is dealing with. Because MINES works with groups all across the country, with different health plans in place, our Case Management staff is adept at making referrals into those plans.
Student Health Plans
For some students with a university health plan, MINES can work directly with the plan to provide integrated care, supporting the other providers on the medical side of the plan with coordinated care planning and treatment adherence support.
Following the passage of the Affordable Care Act in 2009, coverage for children under their parent’s plan up to age 26 means that a student’s health plan may be more difficult to access given a student’s school of choice when that school is in a different state from where their parent is employed. With MINES national presence, we can work with these students to help them access those services on their behalf.
The SAP model
Student Assistance Programs are based on an Employee Assistance Program (EAP) platform. These programs are cost effective; however, they do have session limits similar to college/university counseling center programs. The advantage of a SAP program is that it can be a service extender of the counseling center under ideal budget circumstances. A SAP could replace a campus-based counseling center similar to EAPs replacing internal company programs. Why would this happen? It can bring greater access to the students with lower costs for the organization. Additional services are also provided in a SAP that many counseling centers do not provide such as legal/financial services, 24/7 access, sessions offered outside regular counseling center hours, and online access to resources. Telehealth services are also available in a SAP, further improving access to care. Most SAPs built on an EAP platform have much lower counselor to student population ratios. This allows for faster access for most of the issues or concerns for which a student may be calling. Finally, as the student does not have to go to the counseling center for the appointment, where other students may see them and make inferences as to their mental health, they can go to a therapist or counselor off campus and have greater privacy. This reduces the stigma reluctance some students may have.
Cost as a barrier to entry
While many of the programs listed in the report have some number of sessions covered for the students, most of them were limited to only a very limited number of sessions being free with a nominal cost thereafter. Even such a nominal cost, however, could be a barrier to continued treatment, especially as the costs of access to higher education continue to outpace the cost of living here in the United States.
Engaged students starts with engaged clients
MINES believes that, as is true for engaged employees, engaged students need to be engaged clients. This means approaching all of the elements to engaging in total wellbeing. We use the SAMHSA model for approaching this subject and even coordinate our regular communications with our employers around this model.
Using this as a starting point, we can tailor our interactions with individuals to help increase their capacity for creating healthier lives from each of these perspectives. With a holistic approach to therapy and coaching, we can work with an individual on many layers, increasing their health and wellbeing. This also allows us to begin engaging with an individual from one element and build trust to engage in other elements.
Millennials now make up the majority of students in higher learning institutions and there is a different set of expectations in working with this generation compared to generations before. Part of that change has to do with the use of technology, but what might be even more important than the technology itself is the way that technology can be applied to change entire models. There are examples of national suicide lines using texting to successfully intervene. Of course there are clinical limitations that need to be understood before SAP programs incorporate them to improve access.
Telehealth (which comes in many forms from texting a dedicated provider, requesting a prescription, or even videoconferencing!) has taken a major leap in recent years with legislative changes from state-to-state and technology companies attempting to pick up the slack in the emerging market. Millennials, in particular, want these solutions to improve communications with providers, for both qualitative and quantitative reasons.
And telehealth also means new opportunities to change the traditional treatment model. With improved security (especially identity management) and mobile data capacity, these telehealth solutions could result in a greater reliance on asynchronous communications with students. Relying on higher frequency of communication with lower time needs per communication, the traditional 50-minute model no longer has to be the default for treatment, allowing the provider to engage in treatment at episodic highs and without needing to rely on waiting for the next appointment.
Further, while most mental health centers provide access to counseling, a Student Assistance Program can also have an expanded role for those students including financial coaching and legal assistance, which are typically included in an Employee Assistance Program. This is an even broader set of problem resolution options that could be made available to students.
Why we think we can help
We have a robust psychological services platform that could be applied to Student Assistance Programs. Furthermore, we already serve many college students through our Employee Assistance Programs and managed mental healthcare services under their parent’s benefits. By working directly with universities, MINES is well-positioned to provide more robust support to these mental health centers in serving their populations.
Want to learn more?
Reach out to us to discuss how MINES can help support your organization by calling 800.873.7138 or emailing us at email@example.com
To your health,
Robert Mines, Ph.D.
Chairman & Psychologist
Psychology of Performance #55: The Role of ADA, FMLA, Mental Health Accommodations and Employee Performance
Employee work performance can be impacted and/or affected by numerous variables. This blog focuses specifically on the Americans with Disabilities Act and the implications for employer accommodations for those with mental health diagnoses. There is still stigma and urban myth regarding employees with mental health diagnoses which lead to a number of problems for employees and employers alike. Employers may not understand that an employee with a mental health diagnosis needs an accommodation, much less what that accommodation might be. Whether the employer understands this or not, the employer is legally obligated, unless it poses an undue hardship, to accommodate the employee so the employee can perform optimally. This blog does not address the myriad legal issues associated with the ADA and mental health accommodations. It focuses on providing a context for the complexity of mental health diagnoses and the need for understanding each employee’s needs and how the accommodation will enhance their work performance.
How does the employer determine what is a reasonable accommodation for a mental health ADA request?
This is particularly difficult given the variance in a diagnosis, much less across diagnoses. There are cognitive considerations, interpersonal considerations, physical space considerations, energy restoration elements, work group dynamics, HIPAA privacy concerns, employer limits on what can be requested and asked, threat to the individual’s health as well as to others.
In addition, how does the employer manage FMLA requests related to mental health illnesses?
- What amounts of time are appropriate to be out of work?
- What is the treatment plan to get back to work?
- Does the employer have the expertise to even begin to evaluate the requests?
Psychological Assessment of Functioning and Performance
The array of broad psychological diagnostic categories that may require accommodations is large. The following broad categories include: depressive disorders, bipolar disorders, anxiety, obsessive-compulsive spectrum, trauma and stressor-related disorders, sleep wake disorders, dissociative disorders, mood disorders, neurocognitive disorders, personality and personality disorders, schizophrenia spectrum and other psychotic disorders, eating disorders, substance related disorders, and a number of others. Each of these may have specific symptoms of a particular intensity, frequency, or duration that may require an accommodation. For the purpose of this blog, depressive disorders will be the focus of discussion.
- Depressive Disorders “include disruptive mood dysregulation disorder, major depressive disorder (including major depressive episode), persistent depressive disorder, (dysthymia), premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, and unspecified depressive disorder” (p. 155, DSM-5)
- The assessment must be related to job function. For example, in the case of depression, accommodations could be coming in later due to the impact of medication or because an early morning depressive feature gets better throughout the day; a nap that is medication related or sleep related; tools to improve cognitive functioning, which can be affected by depression (such as memory, concentration, complex problem solving) such as memory aids, quality assurance reviews. An accommodation may also be needed for time to see a psychologist, therapist, or psychiatrist.
- Second opinions for ADA accommodation requests. It may be the case that a mental health professional signs a letter asking for an accommodation without any idea of the specific job functions that the employee is asking to be accommodated for. An employer should send the accommodation request back to the mental health professional with the job description and ask what accommodations may allow the employee to do the essential functions of the job. Accommodations may need to be permanent or just temporary while the employee heals.
Intense and/or Complex Case Management for Absence Management
Human Resources and management in all likelihood do not have the time or expertise to manage these types of accommodation requests or absence requests. Providing case management expertise to support the employee in getting good care and returning to work can expedite the entire process. The following are considerations for case management.
- Intensive case management for all cases that have either a primary psychological diagnosis or co-morbid psychological diagnosis.
- Adherence and relapse considerations related to treatment and return to work are central to this approach.
- Communication among all providers, the employer, and the employee/employee’s family is essential for a timely return to work.
- When the employee returns to work, what, if any, accommodations will be needed? In the area of psychological diagnosis, each case stands on its own merits related to frequency, intensity, and duration of symptoms. For example, a diagnosis of depression can range from mild to severe/treatment resistant. There are no cookie cutter accommodations that can be applied across the board. This is where consultation with the case manager, the provider, and the employer is crucial for the success of the employee and the department the employee is returning to.
Psychological Considerations in ADA and FMLA Accommodation Requests
- What psychological functioning needs accommodation?
- How many ways can this accommodation occur?
- What is the impact of the accommodation on the work group/coworkers?
- How best can this be addressed with the work group so everyone understands and is on the same page without violating the employee’s privacy?
- Who best can assess the accommodation needs?
Psychologists, Psychiatrists & Other Mental Health Professionals
- What are their methods?
- What is the validity and reliability of their methods?
- Do they assess the workplace as well or just rely on employee self-report?
Common barriers to carrying out this type of intense/complex case management and accommodation process
- Timeliness of communication between the professional parties.
- Assessment methodology of treating professional.
- Adequacy of the treatment plan.
- Vested interest by the employee not to get better if it is possible with their condition. Getting the releases of information in a timely manner.
Ways to overcome barriers
- Have HR get the releases of information signed when the accommodation request or leave request comes in.
- The case manager needs to join with the provider in a collaborative manner rather than an adversarial manner with the best interests of the employee and employer in mind. This can be communicated up front with the provider to ensure timely communication.
- The case manager can ask for skill based assessment information. If the provider is not able to do so, second opinions should be sought out to allow for a more informed decision process related to the accommodation. The point of the accommodation is to optimize the employee’s success on the job.
- If the condition is one that should show improvement with treatment and the employee is not getting better, the case manager needs to address this with the provider and determine if it is the correct treatment. Are there secondary gains for the employee to maintain the accommodations (e.g., working from home rather than commuting in when everyone else in the work group works at the office)?
- If the case manager reviews the treatment plan and it does not look adequate, the case manager needs to confer with the provider to determine if the provider is able to enhance the treatment plans in a manner that more objectively show improvement and return the employee to work in a timely manner. The guideline is the longer employees are out of work, the lower the probability they will return to work.
The ADA allows employers to retain employees who work for them and can perform at high levels with some accommodations. There are several elements that need to be taken into account that when put into place help the employee to perform well, be self-sufficient, and contribute to the prosperity of the employer organization as well as their community.
Have a day filled with loving kindness and compassion,
Robert A. Mines, Ph.D., CEO & Psychologist
You may not know it, but November is the month to go purple! You will see buildings lit with the color purple and lots of publicity regarding Alzheimer’s disease, all to highlight November as National Alzheimer’s Disease Awareness and Caregiver Month. The tradition started back in 1983 when President Reagan (who died of Alzheimer’s disease) proclaimed the awareness month to call attention to this tragic disease. Back then, fewer than 2 million Americans had the disease, today that number is 5.4 million. Alzheimer’s is the 6th leading cause of death in the US and the only one in the top ten that cannot be prevented, treated, or cured. If the trajectory of the disease is not changed, by 2050, nearly 14 million Americans will be affected by Alzheimer’s.
So what exactly is Alzheimer’s disease? I have been working in the field of cognitive impairment for over 15 years and the number one question I am asked is “What’s the difference between Alzheimer’s and dementia?” The best answer I can give is that dementia is an “umbrella” term much like the term cancer. There are many types of cancer and there are many types of dementia as well. Perhaps the easiest explanation is this….everyone who has Alzheimer’s disease has dementia, but not everyone who has dementia has Alzheimer’s.
Alzheimer’s is, however, the most common type of dementia, accounting for around 70% of all cases. The hallmark symptom of Alzheimer’s disease is memory loss, particularly short-term memory loss in the early stages. Vascular dementia (strokes that impair the blood supply to the brain) accounts for around 10% of dementia cases, and then there are other forms of dementia you may have heard of like Lewy Body or Frontotemporal dementia. Dementia is defined by the Mayo Clinic as a group of symptoms affecting memory, thinking, and social abilities severe enough to interfere with daily functioning. It is important to note that Alzheimer’s disease is not a mental illness. It is a disease just as we know cardiovascular disease, diabetes, or cancer to be physical illnesses. And while there is a certain extent of memory loss that is a normal part of aging, the memory loss and other symptoms of Alzheimer’s disease are not a part of normal aging. Toward the end of this blog, I will list the ten warning signs for Alzheimer’s disease and attempt to differentiate between what is normal and what could be a red flag.
Why is this subject important to me? Aside from the huge public health and expense issue this presents for our country (and every other country in the world by the way), it affected my family personally. Three of our four parents in my immediate family were diagnosed with Alzheimer’s disease within a two year period. The disease changed everything for my parents, my family, and of course, for me and my priorities. My loved ones have now been gone for a few years, having lived for 16 years, 14 years, and 11 years with the disease. People ask me if I am relieved to be out from under the burdens of the disease. I tell them I am just warming up and will not rest until we find an end to Alzheimer’s. In the meantime, my quest is to help as many other families as possible who are dealing with this cruel disease.
A brief history of the disease
It might be a good time to switch gears and pause for a brief history lesson regarding Alzheimer’s. The disease was discovered in 1906 by a German doctor named Alois Alzheimer. He was presented with a 51 year old female we respectfully refer to simply as “Frau Auguste D.” Her husband brought her to Dr. Alzheimer’s clinic when she displayed irrational behaviors. Back then, it was usually, “off to Belleview for you” but Dr. Alzheimer was not buying it. He cared for her at his clinic until her death three years later and then discovered the disease during her autopsy. Without going into “Brain 101” too deeply in this blog, excess build-ups of two proteins (amyloid beta and tau) are present in Alzheimer’s patients. Now you may have the same reaction I have every time I tell the story of Frau August D…1906!!!!! What? It is 2015, why has this not been cured by now?
The disease is very complicated and it was only in the late 1980s that the scientific community realized that younger onset (diagnosis under 65) and regular onset (over 65) were the same disease. Several research and diagnosis breakthroughs have occurred in the past decade and while there is no treatment or cure that stops the disease as of today, I have never been more optimistic that a breakthrough is possible. Thousands of doctors and scientists around the world are working on the issue as we speak.
The high cost of the disease
You may not know that Alzheimer’s is the most expensive disease in our nation. This year, the cost of caring for Alzheimer’s patients will be $226 billion (yes, with a “b”). $153 billion of that will be Medicare and Medicaid costs for care of Alzheimer’s patients. With 10,000 Baby Boomers turning 65 everyday, we must put an end to Alzheimer’s. 1 in 9 of us will develop the disease past the age of 65. Nearly half of us will have the disease at age 85.
The workplace stats are equally disturbing. 85% of caregivers under 65 are employed. Alzheimer’s disease costs American business more than $60 billion annually, both in costs related to care and in lost productivity. 60% of working Alzheimer’s caregivers report that they have had to come in late, leave early, or take time off. 20% had to take a leave of absence. 13% had to go from full time to part time and 15% had to give up working entirely.
So I mentioned that November is Alzheimer’s Awareness and Caregiver month. Who are these caregivers exactly? There are over 15 million of us in the US. This year we will provide more than 17 billion hours of unpaid care. You History Channel buffs might think that ice road trucking is the most dangerous profession on earth, but I would submit that caring for a loved one with Alzheimer’s disease or another form of dementia is the most challenging. Caregivers must navigate between making sure their loved one is protected from a variety of dangers (60% of Alzheimer’s patients will wander during their journey with the disease) and preserving their dignity. These are our parents, our spouses, our friends, and treating them like children is never appropriate although their behaviors may certainly test our patience.
As the person moves through Early, Middle, and Late Stage Alzheimer’s, behaviors can become more and more challenging. Just as we caregivers learn to handle one behavior, it disappears and another one emerges. Caregivers take lousy care of themselves due to stress and worry. They balance medical, legal, financial, and family dynamic issues that are complicated and emotional. 74% of caregivers report being somewhat to very concerned about their own health. So…if you know a caregiver of a person with dementia, give them a hug in November, better yet, offer to help them pick up groceries, rake leaves, or treat them to a spa day; they will be eternally grateful.
You also may not know that women are at the epicenter of Alzheimer’s disease. 2/3 of Alzheimer’s patients are women. The prevailing thought has been that this is because women live longer than men and the number one risk factor is age. New studies are underway to further investigate whether there are other factors that may make women more predisposed to the disease. Over 60% of Alzheimer’s caregivers are women as well. Perhaps the most startling statistic is that a woman over 60 is twice as likely to develop Alzheimer’s as breast cancer.
10 warning signs of Alzheimer’s
So now…as promised and if you are still reading this!… what are the common symptoms or early warning signs of Alzheimer’s? The Alzheimer’s Association lists ten of them. I will mention them all briefly and give a few examples from my own family experiences.
- Memory loss – not just forgetting the name of some movie star in an old film, but the type of memory loss that disrupts daily life and causes people to live in “sticky-note-ville.” Alzheimer’s erases short-term memory first so recently learned information may not be maintained like it was before.
- Changes in planning and problem solving – We all mess up a detail now and then but we are able to adjust and work through the issue. Many early-stage Alzheimer’s patients do very well as long as they stick to a routine. When problems arise, however, their ability to compensate is limited.
- Difficulty completing familiar tasks – We’re not talking about forgetting how to reprogram the thermostat and having to refer to the manual, we are talking about commonly performed tasks. An example would be my Mom who started taking 30 minutes to unload the dishwasher due to confusion.
- Confusion with time or place – We all forget what day it is occasionally but get ourselves back on track quickly. An Alzheimer’s symptom example might be someone who goes to the same activity each week but now cannot remember the route to take to get there.
- Trouble understanding visual images and spatial relationships – In other words, Alzheimer’s patients do not see things the way we do. They may suffer from a lack of peripheral vision (which is why driving becomes an issue) and may not be able to identify how close an object is to them.
- Problems with speaking or writing words – We all forget a word occasionally but we are quick to substitute another one that makes sense in the context of our conversation. My Dad, however, would become very frustrated when he couldn’t think of any words to describe his watch or wallet.
- Misplacing things and losing the ability to retrace steps – We all lose things and if you find your lost keys in the pocket of the jacket you wore two days ago, that makes sense. If you find them in the freezer, that could be a sign that something is wrong.
- Decreased or poor judgment – We all make stupid decisions from time to time – to err is human as they say. But Alzheimer’s patients may lose the basic judgment to know when a scammer is taking advantage of them or they may buy an expensive item they simply can’t afford.
- Withdrawal from work or social activities – The person may be “hiding out” to avoid family, friends or work associates from noticing that they are having cognitive issues. We all “check out” occasionally but a noticeable difference in someone’s social interaction may be a cause for concern.
- Changes in mood and personality – We are not talking about the typical “set in my ways” or “you kids get off my lawn” type crankiness. We are talking about changes in a person’s demeanor that are significantly different and unusual compared to their baseline behavior.
It’s time to lift the veil on Alzheimer’s
I could write for hours on this subject (in case you can’t tell by now) but I want to close by urging anyone reading this who has a friend or loved one with warning signs to see a doctor immediately to discuss symptoms in the context of their overall health. Many people are hesitant to discuss the subject but there are three reasons to do so. First, it might not be Alzheimer’s at all, there are many other conditions that present symptoms that may be similar. Secondly, if it is Alzheimer’s, perhaps a clinical trial would be appropriate; the care during these trials is excellent and the scientific community really needs participants. And finally, a diagnosis of Alzheimer’s allows the patient to express their wishes while they still can and it also allows family members to become knowledgeable about the disease, plan for the future, and learn the valuable caregiving skills they will need to maintain the highest quality of life for all involved throughout the journey. In other words, you want and need to know…no matter what.
I hope this information and my story helps draw attention to this disease and an appreciation for caregivers during the month of November. Please help spread the word during National Alzheimer’s Awareness and Caregiver month. And please know that we here at MINES and Associates recognize the family and workplace pressures of having a loved one with Alzheimer’s. Help, education, and coaching is available for employees who are balancing their responsibilities at home and at work.
And, oh yea, ski and snowboard season is upon us….be sure you and your friends and family wear helmets – your brain is your most precious and irreplaceable asset!
Associate, MINES and Associates
The World Health Organization estimates that approximately 1 million people die each year from suicide. Consider that number for a moment. Imagine someone asked you to count 1 million toothpicks. How long would it take? Most Americans have been impacted by suicide. The topic of suicide and the workplace is not frequently talked about and often gets overlooked.
A colleague or employee contemplating suicide can be overwhelming for HR representatives, supervisors, and managers. You may not know what your role is or how to offer support without overstepping professional and personal boundaries. One of the most difficult questions has to do with assessment. How does one determine if a person is really at risk for suicide, and if a risk is detected what is the most effective way to intervene?
This blog provides a brief reference, or starting point, for developing strategies to manage suicide in the work place. It addresses warning signs, prevention tips, and postvention tips. It also offers suggestions for what you can do to support those who have lost an employee or co-worker to suicide.
When a person is contemplating taking their own life, they often will not voluntarily tell anybody. They may, however, reach out in non-direct ways. Below are some warning signs that someone may be contemplating suicide:
- Talking, writing about suicide/death. The phrases, “I wish I were dead” or “the world would be better off without me” are common examples of things suicidal people might say.
- Someone might be suicidal if they begin actively seeking access to guns or other weapons, pills, etc.
- They begin putting their affairs in order. Things like making a will, or tying up loose ends as not to be a further burden on friends and family might be a sign that they are contemplating leaving for good.
- A person who appears down, depressed, or hopeless.
- Isolating themselves from others. Somebody who normally engages socially might become isolated or start to withdraw from co-workers, work engagements and other social obligations might be suffering from major depression.
- Increase in risky behavior. If a person significantly increases alcohol, or drug use, incidents of unsafe sex, calling into work, reckless driving, or a host of other harmful activities, they are demonstrating unsafe behaviors and may have given up.
If you witness one or more of the above behaviors the next step is to determine their risk. It is helpful to consider multiple factors that could increase ones risk. The brief list below is a place to start.
- Biopsychosocial factors: The individual is at higher risk if they have a history of trauma or abuse, alcohol or drug addiction, or mental health issues–especially those that have gone undiagnosed or untreated. If there have been previous attempts and/or a family history of suicide then this would increase the likelihood that someone would seriously complete suicide.
- Sociocultural factors: Being part of a stigmatized, non-dominate group in society like LBGTQ can cause a person to feel isolated especially if they do not have the support of friends and family. The person may have been in a social environment where suicide is normalized, they may have had friends or family complete suicide which makes suicide contemplative. Barriers to mental healthcare associated with socioeconomic issues prevent individuals obtaining the help and early intervention they need.
- Environmental factors: These might include a recent job loss, dropping out of school, or loss of a loved one or relationship. The person may live in an environment where access to guns or pills is readily available increasing their means–subsequently increasing risk.
- Does the person have a plan, intent or means to commit suicide? If somebody discloses that they have a specific plan to harm themselves, high motivation to do so, and a way to do it, they are at high risk for committing suicide.
If you have seen the warning signs in someone and determine that they are at high risk and you feel they are in imminent danger you should get them to a mental health professional, call 911, or take them to the nearest emergency room. For long-term suicide prevention tips in the workplace see the ideas below.
- Make help accessible by posting suicide prevention hotlines in lunchrooms, break rooms, and bathrooms.
- Raise awareness regarding resources; make sure employees know that they have an employee assistance program (EAP) and that using the benefit is confidential. Post flyers with numbers to the EAP so that number is accessible to everyone. Oftentimes EAP programs are accessible to human resource representatives, mangers, and supervisors; take advantage and seek advice. Have a list of community resources that offer mental health services. Let employees know that they can also talk with their human resources representative.
- Educate employees by destigmatizing mental health and substance abuse issues by offering lunch and learns or trainings on various topics such as suicide, healthy coping skills for managing stress, anxiety, depression, and substance abuse issues.
- Create a balanced work environment by allowing for “mental health” days or offering work from home days if it’s possible. Managers and supervisors can help by assisting in resolving work problems as they arise and managing conflict effectively between co-workers, managers, and supervisors.
If your company has experienced a suicide, the loss of a colleague or employee can be shocking and traumatic. Below are a series postvention tips that might be helpful in the event of a workplace suicide.
- Acknowledge that your employees may have strong emotions surrounding the suicide and will need opportunities to express their feelings.
- Supervisors and managers should be on alert for PTSD symptoms. A drastic change in behavior may be a sign that a person is having a hard time dealing with the incident.
- Encourage healthy grieving by providing a basic understanding of the stages of grief: Denial, Anger, Bargaining, Depression, Acceptance. The stages of grief affect individuals differently at various rates. Some employees may express their grief as sadness or anger over a long period of time, while others may get back to their normal lives rather quickly.
- Offering empathetic and compassionate listening will give employees permission to talk openly with their supervisors and managers and will give them the opportunity to ask for what they might need in their grief. Being accessible to employees lets them know that they are not alone and that they are supported
- Become a role model for healthy grieving by being open with your feelings surrounding the suicide.
The purpose of this blog is not only to help employers notice the warning signs of suicide and help them assess their employee’s risk for suicide, it also serves as a basic framework on how to instill awareness regarding suicide, prevention and postvention tips in the workplace. It is likely that if there is early recognition and intervention of a person who is contemplating suicide, that there can be a positive outcome. In honor of suicide prevention month remember, asking someone “how are you doing” or “are you ok” should reach farther than the project they’re working on. By asking and being open to talk, you can save a person’s life.
1-800-273-TALK (8255): This number will connect you with a mental health professional who will be able to assist you.
The Jason Foundation: http://jasonfoundation.com/get-involved/student/a-friend-asks-app/
Alea Makley, MA
MINES & Associates
Environmental and social stressors often negatively impact an individual’s work performance and mental wellbeing. It might seem as if these stressors are completely out of our control and that one must surrender to their impact. However, it is important to acknowledge that individuals do have control of how they respond to these stressors. Here, we take a look at some common examples of these types of stressors, and some ways in which we can choose to respond.
Environmental Stressors like weather, traffic, and the work environment represent a few examples of things that cannot always be controlled. The way humans respond to these situations can affect wellbeing. If there is no way to change one’s reality, there are likely ways to at least balance it. Consider taking possible measures to balance your own environmental stressors.
- Scheduling: Traffic, for example, can be a huge environmental stressor. Leaving the house late and speeding regularly adds to stress levels. Rather than cursing the freeways and inanity of one’s fellow drivers, a person can leave home in the morning 30 minutes early; they could put on their favorite music while sipping a nice hot beverage of their choice. This might make the commute more tolerable, possibly even enjoyable.
- Personal space: Another aspect of environment has to do with your physical environment. When you walk into your house after a long day of work how does it feel? When you sit at your desk at work all day how does it feel? What can you do to make your spaces feel better, healthier, and more supportive for you? Everyone is different. For some, having pictures of loved ones on your desk makes a big difference. For others, keeping your desk or home uncluttered and clean has a huge effect on their sense of control and wellbeing. Maybe others like to have lots of live green plants around to liven things up, or like to light incense or a candle to clear the air. Maybe you don’t have a window in your office, but is it possible to make sure you take a few small breaks during the day and go outside for a couple minutes to keep you grounded and feel some sunshine? Although these may seem like small efforts, they make a big difference in your emotional health and overall wellbeing.
- We can limit our exposure to environmental stressors. If you are someone who is agitated by listening to or reading the news, you can choose to limit your time doing that activity. We all know that the news tends to focus on negative stories and violence, and it may be beneficial to substitute an activity that is more calming. Limiting our exposure to unrealistic images of beauty that can be found on most magazine covers can lead to higher self-esteem. Perhaps bypassing the tabloid magazine for the bestseller at Barnes & Noble will give you a necessary break to develop self-compassion and inner peace. Things like pesticides, toxins, and pollutants are out of our control, but we can limit our exposure by eating more organic foods, drinking filtered water, and filtering our air with a HEPA filter. Things like noise pollution can be out of our control, but installing a white noise machine can drown out the unpleasant noise.
Social stressors can also weigh heavy in a person’s life. An ideal social environment would include meaningful relationships, positive support, and mutual respect. However, sometimes we are forced to learn how to best relate with individuals we encounter who may manipulate, try to exert control over us, or are emotionally or physically abusive.
- Boundaries: Create and maintain strong boundaries. It is okay to limit time with a problematic individual. It is also permissible to say “no” at times. It often feels difficult to set boundaries because the person may be angry or upset; however, in the long run boundaries actually help build much stronger relationships.
- Social support system: Although in some cases we don’t have control over the people in our lives, such as family and coworkers, we do have control over who we invite into our lives for a social support network. A person’s circle of friends has a strong influence on emotional health and overall wellbeing. If someone wants to think more positively and then they surround themselves with people who think negatively, they are likely not meeting their goal. Or take for example a person who wants to get healthier both physically and mentally by partying less. But that person’s friends put pressure on them to drink and go out during the weekends. The person in search of health might feel “out of control” or destined to constantly party. This furthers emotional and physical discomfort while simultaneously being held back from evolving and reaching your goals. You have a choice who to bring into your support system. You can bring people in who lift you up, inspire you, support you, and help you grow. Intimate relationships are another area you have choices in. If your partner is always putting you down or is abusive in any way, they may create a toxic environment that negatively influences your physical and emtional wellbeing.
- EAP and Counseling: Another way to get some support around social and environmental stressors is through counseling or your Employee Assistance Program (EAP). Counseling is a safe, non-judgemental place to get support around things you are struggling with in your life — whether they are related to work or not. Sometimes counseling is helpful just to gain another perspective or to attain some new coping skills. EAP is completely confidential and provides a great way to access free counseling services through your benefits. EAPs often offer telephonic or video sessions if you are too busy to go in for an appointment.
Remember: Our reactions to an environmental or social stressor can determine its impact. It’s always possible to reduce stress levels by consciously responding to these stressors in a way that can balance their effects. By practicing this skill often, you will begin to know yourself well enough to tell if an environmental or social stressor is negatively impacting your wellbeing, and you will be able to promptly take steps to improve your emotional and physical health.
To Your Wellbeing,
Alea Makley, MA – Clinical Case Manager
Alex Rothchild, MA, LPC – Clinical Case Manager
The MINES Clinical Case Management Team
When we meet a new person, the first question we ask is, “What’s your name?” Something I never consciously picked up on until recently, however, is that the second thing we say to a new person is almost as predictable.
“So, what do you do?”
And there it is: proof that we often form an initial understanding of who someone is largely based on what they’ve chosen as their occupation. In many ways, this assumption makes sense. We learn to make a lot of assumptions based on the answer to this question; How much money do you have? What are you interested in? What are your political views? What level of education have you reached? I can see how asking ‘The Second Question’ early on in the conversation can seem like an efficient way to get a lot of information about who a person is. “I’m a partner at a law firm,” “I’m a vegan chef,” and “I’m a stay-at-home parent” may each lead to very different conversations.
A potential pitfall here, of course, is that we are making assumptions, which by definition are not always true. Once we make a judgment or supposition and decide to believe that it is the truth, we may be closing a very important door. If I’ve already made up my mind about who someone is, I’m a lot less likely to hear anything else they may say to the contrary. I may become blind to the possibility of seeing my new acquaintance as anything other than one-dimensional, and miss an opportunity to know him or her more fully.
This phenomenon also causes me to think about how much of our identities are tied up in what we do for a living. We answer ‘The Second Question’ with the words “I am,” sometimes allowing the job title that follows to define us. Taking pride in one’s job, especially when it’s the result of hard work and passion, is certainly a good thing. The desire for achievement and recognition can motivate people to do amazing, important things. But it’s no secret that our society is obsessed with financial and professional success, and it’s easy to start to believe that those are the main components by which we should measure our own happiness and value as a human being. Our jobs are inevitably a part of our identity, after all, we spend a good amount of our lives working, but how big a part is too big?
Life is made up of moving pieces. Among all the ups and downs, though, we can find stability in a well-rounded identity. It’s helpful to remember that our value is not wholly reliant on any one job title, relationship, or number. Take a moment, if you choose, to consider: How could you answer “The Second Question in a different way? In addition to your job, what else makes you who you are, and how do you make sure those other parts are being equally nurtured and appreciated?
To Your Wellbeing,
The Health Psych Team