Mental health spending on the rise

From a recent article in Benefits Pro, which is a recurring newsletter for benefit professionals:

“Overall spending on mental health services increased from 6.8% to 8.2% between 2013 and 2020, according to a new study published by the Employee Benefit Research Institute (EBRI).

‘Approximately 1 in 5 adults and 1 in 6 youth experience mental illness each year, and these rates have been rising,’ Paul Fronstin, director of EBRI’s Health Benefits Research and co-author of the study, says in a statement. ‘Over 20 million Americans have a substance use disorder.

The COVID-19 pandemic has exacerbated mental health issues nationally and in the workplace. With increases in both the number of individuals diagnosed with mental health disorders and use of health care services, higher spending is of great concern to plan sponsors of health benefit programs.'”

This trend has been supported by other sources of information, especially as it relates to the impact from the pandemic. When I traveled around with a Behavioral Psychologist who would help our corporate clients set-up mental health programs around depression and obesity management, mental wellness help-lines, etc., she would cite a statistic that 1 in 5 adults would have some form of depression in their lifetime. That is now a dated statistic, as the above surveys cites 1 in 5 per year.

Her main thrust is people who are battling depression to any degree should get counseling. She hated to see anti-depression medicine prescribed by general practitioners, as that just helped with the depression not get at the cause and management. If you know of anyone who is experiencing depression, please encourage them to seek counseling.

There is no shame in getting help from someone qualified to give it. This also goes for other disorders that someone might be dealing with – substance abuse, anxiety, paranoia, OCD, schizoid personality disorder, PTSD, etc. It is not uncommon for someone to have multiple diagnoses. And, I include PTSD, as one need not be in battle to experience post-traumatic stress disorder, as homeless mothers and kids or victims of domestic violence will tend to have PTSD issues as well.

Mental Health is presenting unprecedented challenges

In a recent article in Benefits Pro, a piece on the rising mental health challenges caught my eye. An excerpt from the article follows:

“A new report from consulting firm McKinsey finds ‘unprecedented’ behavioral health challenges among Gen Z Americans. The age group, which ranges from middle-school students to younger members of the workforce, has significantly more issues with behavioral health than other age groups, the study found. Their conclusions are not unique: the U.S. Surgeon General recently issued a public advisory describing a ‘youth mental health crisis,’ which has been exacerbated by the COVID-19 pandemic.

The report pointed to consumer surveys that found Gen Z members more likely to report behavioral health issues, more likely to be diagnosed with mental health conditions, and more likely to contemplate suicide than other generations.”

Unfortunately, there remains a stigma attached to mental health that prevents too many from getting the needed help. With that said, a possible reason for the uptick is more younger folks are realizing the need than in previous demographic generations. Nonetheless, getting help is something that should be easily enabled. And, it is not just medicine that should be prescribed. Therapy paired with medicine is essential to getting the most productive level of help.

Before I retired as consultant, I used to travel with a behavioral psychologist who helped large companies set up mental health programs for its employees, including depression and obesity management ones. She would tell our clients that 1 in 5 people will have some level of mental health issue in their lifetime. She would add that if she looked at any prescription drug claims report, she would see 10% of the prescriptions be for mental health issues. What she was looking for is who prescribed the Rx, as she would prefer to see a psychiatrist rather a general practitioner.

I have a number of friends and relatives who have had mental health challenges, often multiple diagnoses – anxiety and paranoia are often paired together, eg. Therapy is the key. Having someone to help work through the problems is essential to managing them. The word management is critical as many of these problems don’t go away, so having tools to deal with them on a daily basis is utile.

Rather offer advice that I am not qualified to give, let me just say this simply. If you, a loved one or friend are having mental health issues, get or encourage them to get help from a therapist. Often, the therapy will come from a licensed clinical social worker LCSW. Your health plan or other networks will have several therapists to offer, so go through their bios and typical clients. They will suggest a psychiatrist if medicine is in order. Yet, if you or your relative or friend are having suicidal thoughts, call 911 or a suicide hotline (see below) and don’t wait on a therapist.

Life can be beautiful, but it is also hard. Sometimes it is harder than it needs to be. Just because you need help is nothing, I repeat nothing, to feel bad about whether you are the one in need or if it is your child. Get help. And, manage those challenges.

Five easy memory tricks

With two of our four parents succumbing to complications due to Alzheimer’s, memory maintenance is of interest to my wife and me. Readers’ Digest ran an article by Andrea Au Levitt called “5 Easy Memory Tricks.” Her intro paragraph follows:

“You know that eating healthy, staying active, and solving a few brain games can help keep you sharp. But these lesser known habits work wonders, too.”

1. Sit tall – when slouching it follows or promotes defeated, anxious and depressive thoughts, which hinder memory.

2. Exercise – once – gains in memory after one exercise are similar to gains after regular exercise (note still do the regular stuff).

3. Limit TV – including online versions of TV, too much screen time can harm cognitive development and maintenance.

4. Doodle – people can remember things better if they doodle or draw a picture of what they are thinking of. Writing the words of the thing is not as memorable as drawing a picture.

5. Walk backward – real, imagined or watched walking backward or even forward, can help remember something. So, in keeping with #2 above, take a walk (and walk backwards on occasion).

Let me take one of the above and break it down more. One of the examples from Malcom Gladwell’s book, “Talking to strangers,” notes that torture is a horrible way to gain information. Why? Under trauma, people remember less than they would normally. The comment about sitting tall in #1 above, notes if we slouch we increase anxiety or depressive thoughts, a mild form of trauma.

Outside of the walking backward, I do the above things. The sitting tall actually helps this tall person with his back. As for doodling, for some reason when I work the various puzzles in the newspaper, I blacken in the circular letters (O’s, D’s, P’s etc.) in the title of the advice section (sorry Dear Abby). Maybe it helps me with the puzzles (or advice).

As I leave you, think of Barbra Streisand walking backward singing “Memories light the corners of my mind, Misty water-colored memories of the way we were.”

When adults act like kids and kids like adults

I am so proud of the teens and young adults who are leading the charge for better gun governance. I have long been advocating for such and am in a constant state of disbelief that legislators fail to act.

The best quote came from a teen being interviewed on PBS Newshour when she said “When the adults act like kids and the kids like adults, then something is wrong.”

The sad truth is many of these adults are in the pockets of the NRA who dictate their response. It is largely a Republucan stance, but the NRA funds some Democrats as well.

What I also don’t care for are the conspiracy nuts like Alex Jones, Rush Limbbaugh et all who purposefully detract from genuine concerns calling these kids actors and staged. We should not lose sight of Jones’ continual claim that Sandy Hook is a hoax. This is an egregious misuse of a license to communicate online and both need to be called on the carpet.

The kids have to push for change as well as deal with these so called adults questioning their veracity. That is a shame, as these kids should be applauded. I must confess I am not one who would encourage applause for either Limbaugh, Jones and their ilk.

Right now, these kids are rightfully calling attention to the legislators’ conflict of interest. They are on the side of the Angels on this.

We should consider solutions that address the holistic nature of the problem. Rather than highlight what should be considered as I have done in multiple posts, I would like to simply say these kids should be heard and heeded.

If the politicians fail to do so or respond with window dressing, they do so at their peril.

Mental Health is one reason, but that means…

After the most recent mass shooting tragedy at Umpqua Community College, the new defense that it is not a gun problem, but is a mental health problem, have arisen. This is not an either/ or debate, as both are problems, but it is even more than that. But, let’s keep it simple and focus on mental health side for now, as there are some very telling things that need to be addressed.

Of course, someone killing people like this is indicative that there is likely a mental health issue. Even if the killer was aligned with a domestic terrorist group, wanted to commit a hate crime, or tried to start a race war as was the motivation in Charleston, SC, there is a sociopathic problem where the killer believes he is justified to do this.

Yet, as tragic as these types of mass shootings are in the US, the most prevalent reason for gun death is clearly a mental health concern and that is suicide. Suicides account for two-thirds of all gun deaths and are the leading cause of death in nine of the top ten states for gun deaths. Also, homes with a gun have a much greater propensity toward suicide than homes without a gun. All it takes is one impulsive act and it is over.

So, yes improving access to mental health is important. Denying access or restricting access to guns for those who have mental health issues is also a concern. Yet, that means you should not advocate actions to the contrary. What do I mean by this?

The folks who are shouting the loudest that this is not a gun issue, but is a mental health issue, have taken steps to block the path to addressing the mental health aspects, sometimes overtly advocating a policy change to make it easier to kill with a gun. The easiest example is the NRA, through the conservative group ALEC, has been supportive of state legislation that will make it a crime if a doctor asks a patient if he or she owns a gun. These laws are being considered in several conservative led states and have passed in a few.

So, think about this. The NRA, who says gun deaths are a mental health issue, advocates that a doctor cannot ask a presumably depressed patient if he or she has a gun at home. Maybe this doctor is already prescribing Lexapro, Risperdal or Seroquel, but the NRA and ALEC want to say it is a criminal act that the doctor inquires whether the patient has access to a weapon. Again, two-thirds of gun deaths in the US are suicide. I think it is well within the domain of the doctor to ask these questions.

But, it goes further. The retiring US Speaker of the House struck language earlier this year to some funding of looking at health care data in the US. He felt it was not appropriate to track gun death data as that was not germane to health issues. Please reread this statement as it takes a second to sink in. A conservative leader, whose party is heavily influenced by the NRA who says gun deaths are a mental health issue, does not want to spend our money to track reasons for gun deaths.

Finally, access to mental health care is key to this process. How are you going to do it? A behavioral psychologist, I used to work with, who helps employers design mental health wellness programs cites the following two statistics. 1 out of 5 people will have some level of depression during their lifetime. She also says that you can pick up any large employer’s health claim data and 1 out of 10 plan participants would be on depression medication. So, the need for access to mental health care is critical. The beauty is the Affordable Care Act provides more people with access.

Yet, the people who say gun deaths are more of a mental health issue also want to repeal the Affordable Care Act. If this is done, what would they propose to make sure access to mental health care exists? The ACA is successful in getting uninsured people access to health care, including mental health care. My recommendation is if this is what they believe, then they should do what most Americans want and continue the ACA and improve it.

We obviously need better gun governance. Two keys are detailed background checks on all sales and elongated waiting periods. Per various surveys, there is a clear majority of Americans who want these, even conservative voters. The waiting period may help save a life, as if someone is depressive, the wait may allow the impulse to wane. Yet, both of these steps along with some others, could help make a difference in gun deaths.

Yet, mental health is a concern. But, that means we should not restrict doctors from having conversations with their patients about guns, especially if they are treating a patient for depression. That means we should track gun death data and use it to make informed decisions. And, that means we should promote the access to mental health care through the Affordable Care Act. To do otherwise on any of these three issues, is highly hypocritical. Saying mental health is a concern and then doing the opposite is antagonistic to solving the problem. It has to be more than words.

 

Unplugging for your health and sanity

On CBS Good Morning, a poll on New Year’s Resolutions noted the fifth most popular resolution is to “unplug.” I have written before about this topic, but with people sensing being too connected is a problem, I thought I would rehash a few things. My favorite quote comes from a communication consultant, of all people, who observed “you can be too connected.” He is right and more folks are agreeing with him.

Being too connected means you are constantly on alert status. You feel obligated to look and respond to any ping from your mobile device. When I first wrote this, my major focus was work texts and emails. If you never unplug, then you are constantly working or thinking about work. Checking emails at 10 pm does not impress me. It also means you will have only passed the baton and will get it back when you awake the next morning.

Yet, personal texts, instant messages and emails, can cause a similar level of angst. There is a feeling you will be “out of the loop” or unneeded should you forego answering a message. You feel less wanted when someone does not immediately respond to your message, even when you do not ask a question.

Since the urge to remain connected is a strong one, the best way I have found is to compartmentalize your check-ins. If you feel your job cannot let you relax and stay unconnected during off hours (that is a debatable point), I would suggest you allow fifteen to twenty minutes of check-in time for work after the kids are in bed and then set the device aside for the night.  The same holds true for personal messages. Set aside a focused amount of time and then turn the device off. You can even tell your friends that you are doing this, so they will not be offended by lack of response.

The above actions will be helpful to your mental health, but also to your physical health. You need to be unconnected from technology and especially from work to minimize stress. The same holds true when you go on vacation. If you need to check in, compartmentalize the time and then be done with it. It is unfair to you, your family and your co-workers. The co-worker unfairness part may sound strange, but if a boss keeps checking in, that sets the wrong example to the staff. And, I am citing a staff member who said this to her boss.

Unplugging will do wonders for your health. And, if someone comments to you about not returning a message immediately, tell them straight up what you are doing and encourage them to do the same. Finally, speaking of health, more states are passing laws banning texting while driving. Heed this law as it will save your life and that of others.

 

 

Gun Deaths and the Bigger Context

As a parent, I am both saddened and angry over the tragic gun related deaths at Sandy Hook Elementary. Any senseless death is troubling, but when kids are murdered at such a young age, it goes beyond belief and we can only look to the heavens and ask why Lord? Yet, as tragic as all of these deaths are, a greater tragedy occurs everyday in America that when added up dwarf these deaths. Due to the accessibility of guns in our country, coupled with humans who get angry, impulsive and depressive, gun related deaths occur that could have been avoided if the guns were not at hand.

In August, I wrote a post called “Another Day on America – 16-year old kills 13-year old friend.” This post was written after the Aurora and Wisconsin shootings that occurred earlier this year. This post has been getting more hits of late, as it attempts to speak to this broader context. I would encourage you to scroll back and read the earlier post as I have some statistics that might be of interest. I will cite some of them below.

I am writing this now for two reasons. First, we can no longer tolerate the number of gun deaths we have in America. We are beyond the tipping point and must act. Second, some of the ideas thrown out to remedy the Sandy Hook type massacres will actually not solve that problem and will create far greater problems down the road. We have to look at the greater context at what is happening everyday in America.

Let’s set the stage with a couple of statistics noted earlier. Per the Journal of Trauma and Acute Care Surgery and Medicine, the United States has:

– 80% of all gun related deaths when measuring deaths in the top 23 wealthiest nations;

– 87% of all gun related children deaths of these same 23 countries; and

– 14 gun related deaths per 100,000 people as compared to Mexico with 13, Canada with 4 and Great Britain with 1/2;

The comparison to Canada is very pertinent as Canadians love their guns like Americans. Yet, we have over 3x the gun related deaths that they do. There are many reasons noted in the earlier post – but Canada has better gun laws, less poverty and better access to mental health care as three of the reasons.

Quoting the NRA who likes to pontificate “guns don’t kill people – people kill people” I find this trivializes the point. The more true phrase is people who have access to guns kill people. And, generally, the converse is true – people who do not have access to guns don’t kill people. The greater context to this issue is humans are an impulsive, imperfect lot. As noted earlier, we get angry with family, friends, acquaintances, enemies and people who we perceive as treating us with disrespect. Every day in America, someone has killed another person as he or she has acted impulsively and was in close proximity to a weapon. Someone got mad in a Pizza parlor the other day, went out to his car, retrieved a gun, went back inside and killed the person who offended him.

However, it goes beyond this. In my previous job, I sometimes consulted with a Behavioral Psychologist who helped employers provide improved mental health benefits in their healthcare plans for employees. She often cited two statistics that resonated with me – 20% of people will at some point in their lives have mental health issues needing treatment. At any given time, 10% of an employer’s healthcare plan participants will be accessing mental healthcare treatment. This treatment may be as simple as being prescribed with antidepressants or it may include ongoing therapy. Her modus operandi was to get people with antidepressants prescribed by a medical doctor to also see a therapist. The meds help, but the care by a professional psycho-therapist is crucial.

With access to guns, people who have been or are subject to depression, could act on an impulse and take their own life. Or, if affronted, could possibly take the lives of others. This is a key reason letting kids have guns on college campuses is about the dumbest idea possible. You marry complex social circumstances with kids being away from home and without fully developed brains, the kids could more easily act out an impulse and their life is over.Without the gun, the suicide may be avoided. I know of one college close to where I live that has allowed guns on campus. So, the outside chance of preventing a rare Virginia Teach shooting, may lead to more gun related suicides and homicides.

So, our leaders need to focus on the bigger context. We know where the NRA stands – they want to sell more guns. Everything else said by the NRA is dwarfed by that mission. People wanting to arm everyone should be thanked for their comments and then quickly ignored as those ideas are ill-conceived. You give a teacher a gun and I can assure there will be more children deaths due to kids finding a loaded gun in the classroom. In Gun Ownership 101 it says keep loaded guns away from the kids.

At its simplest, getting a license for owning a weapon that kills, should be harder to obtain than other licenses. Gun licensing needs to have a longer waiting period and thorough background checks should occur. To do otherwise is irresponsible, end of story. If you are under psychiatric care on meds, you need to bring a note from a psychiatrist or psychologist or no gun for you. We won’t let people in the military for some mental health reasons, but they can get a gun here. And, no one in America should have an automatic assault weapon. If you do and are not in law enforcement, then I question your motivations. The Brady Law which was let to expire in 2004 will address some of these issues, if reinstated. Yet, law enforcement officers have suggested another item that will reduce guns deaths – register the sale of bullets. The police say encoded bullets will become traceable and help solve crimes, yet the NRA is against this practice. If I were a leader, I would listen to my police force who does not have a vested interest in any decision.

However, as noted above, this is only half of the story. The other half is we must encourage better access to mental health care. If you are on meds prescribed by a MD, please go see a psycho-therapist, as well. A Medical Doctor is not trained in psychiatry or psychology. Further, please take your meds. This could be said about any medicine, but people in need often stop taking their meds to save money. The Affordable Care Act will help in this regard extending healthcare coverage. Finally, referencing the 20% mental health prevalence statistic noted above, please help eliminate the stigma around mental healthcare issues. Every family has or knows someone who needs recurring mental healthcare help. Living with mental illness is something that is and can be dealt with.

Let me conclude with two final contextual points. First, poverty is rampant in America with almost 50 million people in poverty. As a result, the opportunities for gun related crime are increased in America. This issue is complex and deserves its own post, but the distance between the haves and have nots in our country is not healthy for many reasons. We have to afford opportunities to work for reasonable pay.

Second, we have a more violent culture in the US than in other countries. We have far more violence in movies and TV and we have greater access to violent video games. This prevalence of exposure to violence in entertainment is highly correlated with gun deaths. Is it causal? More than likely. To demonstrate a point for the younger readers, in the 1970’s TV crime shows rarely ended with the death of the criminal – the criminal was taken off to jail. Yet, toward the end of that decade, the trend changed where the shows concluded more and more with the good guy killing the bad guy. Now, we have video games, where your character is the bad guy killing others.

This is a complex issue and deserves concerted attention. Yet, it also requires a focus on the greater context. Who, where, why and how are the gun deaths occurring across America? As tragic as the events of Sandy Hook, Aurora, Wisconsin, and Virginia Tech are, they are dwarfed by the many gun related deaths which occur every day in America. That has to be the focus of our mission to reduce gun related deaths.