A New Prescription: Giving Thanks

September 11, 2014 by Leave a Comment

Recently, we discussed current efforts to eliminate stigma against mental health, including the potential effects of the Affordable Care Act on mental healthcare in the United States. This week, we will see how gratitude, a deeply humanistic emotion, can improve your mental and physical health.

gratefulheartOn March 3, 2008, my father experienced a minor heart attack. My family rushed to the ICU and crowded around his bed. We feared that he would sustain lasting damage to his heart. Surprisingly, he was in great spirits, and thanked us for coming to visit him! As soon as he left the hospital, my dad started to perform daily ‘gratitude meditations,’ in which he reflected upon the things in his life for which he was grateful. This simple act helped to relieve him of the stress associated with recovery.

Physiological Effects of Gratitude
My father’s story illustrates that feeling grateful can influence not only our psychology, but also our physiology. In fact, just 2 minutes of intensive gratitude meditation can reduce heart rate and negate stress. Higher gratitude levels can also lead to:

  • Increased quality of life, even in patients with debilitating neuromuscular diseases
  • Improved immune function
  • Higher energy levels
  • Better quality and duration of sleep
  • Higher levels of happiness and optimism, which in turn have powerful effects on the chemical regulation of our brains. Happiness and optimism have been linked with a lower lifetime burden of disease and improved familial relationships.

Our emotions can pass on to our children
Increased gratitude levels may even carry over to our children. Recent research has focused on how epigenetic modification of DNA resulting from long term depression may be inherited. In essence, our emotions and grat checkexperiences, if strong enough, may be passed down to the next generation in the form of DNA modification. This offers a powerful explanation for why depression seems to run in some families, but happiness in others. Taken as a whole, these studies demonstrate the holistic effect of positive thinking on the human body and bring a new meaning to Descartes’ famous conclusion, “I think; therefore, I am.”

It is difficult to imagine how one can feel grateful in the face of adversity. However, as Dr. Robert Emmons, a positive psychology researcher at the UC Davis explains, “in the face of demoralization, gratitude has the power to energize. In the face of brokenness, gratitude has the power to heal. In the face of despair, gratitude has the power to bring hope.” Though it may not be easy to feel grateful during trying circumstances, focusing on the positive aspects of one’s life can help us through the worst of situations. See our Weekly Gratitude Activities Checklist for ideas on how to bring gratitude into your lifestyle.

Expressing one’s gratitude has been enumerated by the world’s major religions for thousands of years. Not only does it improve interpersonal relationships and bring out the best in others, it also provides us with numerous health benefits. There is never a better time than now to start reaping the benefits of thanking those who are important in our lives.

So, in the spirit of gratitude, the staff at Aarris Homecare thanks you for choosing our services!

Works Cited
Dunavold, P. “Happiness, Hope, and Optimism.” CSU Northridge, 1997 (http://www.csun.edu/~vcpsy00h/students/happy.html)

Emmons, R. “How Gratitude Can Help You Through Hard Times.” Greater Good: The Science of a Meaningful Life, UC Berkeley, 2013 (http://greatergood.berkeley.edu/article/item/how_gratitude_can_help_you_through_hard_times)

Emmons, R & McCullough, ME. “Counting Blessings Versus Burdens: An Experimental Investigation of Gratitude and Subjective Well-Being in Daily Life.” Journal of Personality and Social Psychology, 2003, Vol. 84, No. 2, 377–389

Emmons, R & Stern, R. “Gratitude as a Psychotherapeutic Intervention.” J. Clin. Psychol: In Session, 2013 Vol. 69, pg. 846–855

Braunstein, D. “Pass the Gratitude: Recipe for a Happy Thanksgiving.” Huffington Post (http://www.huffingtonpost.com/glenn-d-braunstein-md/gratitude-health_b_2131450.html)

Levinson, DF & Nichols, WE. “Major Depression and Genetics.” Stanford School of Medicine 2014 (http://depressiongenetics.stanford.edu/mddandgenes.html)

Nestler, EJ. “Epigenetic Inheritance: Fact or Fiction?” Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 2013

(https://www.dana.org/Publications/ReportOnProgress/Epigenetic_Inheritance_Fact_or_Fiction/)
Rimer, S & Drexler, M. “Happiness & Health.” Harvard School of Public Health, Winter 2011

(http://www.hsph.harvard.edu/news/magazine/happiness-stress-heart-disease/)

Scott, E. “Family Connection and Happiness—Fostering A Closer Relationship With Your Family.” Stress.about.com, 2007 (http://stress.about.com/od/familystress/qt/family.htm)

Heartmath Institute: http://www.heartmath.org/templates/ihm/e-newsletter/publication/2013/spring/appreciation-is-good-for-you.php
WebMD: http://www.webmd.com/women/features/gratitute-health-boost

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Silencing the Stigma

August 22, 2014 by Leave a Comment

Last month, we discussed the social, institutional, and self-stigmatization of mental illness in the elderly and their ramifications. This week, we will discuss current efforts to eradicate mental health stigma and improve access to care.

How can we influence the media’s depiction seniors with mental illnesses?

notebook2004While the media promulgates inaccurate and damaging stereotypes about mental illness, it can also be a source of positive change in the battle against social stigma. For example, the movie The Notebook (2004) provides a genuine portrayal of strain and heart-ache accompanied by dementia. The vast majority of mass media, however, reinforce social stigma through stereotypical presentations of mental illness.

Organizations such as the Center for Mental Health and Media and Mental Health Reporting have launched their own campaigns to counter prevailing stereotypes by educating the public. They have also posted tips for reporters and screen writers to avoid promoting stigmas. Writers should:

  • Ask, “Is mental illness relevant to the story?”
  • Verify statements that mental illness is a factor in a violent crime. A past history of mental illness is not necessarily a reliable indicator.massmedia
  • Avoid using language that implies people with mental illness are violent.
  • Double-check specific symptoms of diagnoses with valid mental health resources, as necessary.

Ultimately, these organizations hope to inform writers that meaningful stories do not need to peddle incorrect and damaging stereotypes about the mentally ill. They have also initiated their own media campaigns to bring awareness to mental health stigmas.

The biggest advances in combatting stigma against mental illness have come through public policy

The passages of the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA), also known as Obamacare, have profoundly improved access to resources for the mentally ill.

mhpThe MHPAEA (2008) ensures that financial requirements (ex. Co-pays, deductibles) and treatment limitations (time of stay in hospital) for mental health or substance abuse disorder benefits are no more restrictive than corresponding surgical or medical benefits.

The ACA (2013) builds upon the principles of the MHPAEA and expands access to mental health services for geriatric patients in a number of ways:

  1. Employer-based insurance for seniors no longer can deny coverage based on preexisting psychiatric acaconditions.
  2. The ACA contains provisions that will increase quality of care in nursing homes.
  3. Healthcare institutions that are categorized as “Health Homes” or “Medical Homes” will receive increased federal funding, which will make mental health treatment more accessible for the disabled and elderly.
  4. All states will be required to have some level of mental healthcare coverage, though specific services are decided on a state-by-state basis.
  5. Medicaid has been expanded in 27 states. Medicaid’s broad range of mental health and community support resources mean that millions more people will be able to obtain treatment for psychiatric disorders.

Collectively, this means that mental health services will be more accessible than ever before to the majority of Americans, including geriatric patients. Though these policies are an important step forward, it is important to remember that social and self-stigmas are powerful factors in care quality and access, especially for seniors. Furthermore, the ACA only mildly addresses the most pressing issue facing seniors—the lack of geriatrics-specialized physicians and healthcare workers.

Fortunately, numerous colleges offer stipends and scholarships to encourage medical and graduate students to pursue specialty training in geriatric care. The American Association for Geriatric Psychiatry (AAGP) and the Geriatric Mental Health Foundation (GMHF) also support yearly scholarships for students who hope to obtain training in geriatric-focused medical care. As the Baby Boomer generation ages, these scholarships and programs will likely become more common in the nation’s medical colleges and healthcare training institutions.

Next week, we will discuss how practicing gratefulness in your daily life can improve your mental health.

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Products of Prejudice

July 21, 2014 by Leave a Comment

Last week we examined the causes of commonly-held stigmas against geriatric mental illness, including self-stigma, social stigma, and institutional stigma.

How do these stigmas affect the ability of elders to seek care for mental illnesses?

1. Fewer doctors train in geriatric healthcare, which makes it difficult for seniors to find specialized medical doctorattention. Seniors must travel further distances to see doctors with a detailed understanding of mental illness in the elderly.

a. Many doctors believe that they can have a more meaningful impact as pediatric psychiatrists, rather than as geriatric psychiatrists because they can change a child’s future as opposed to alleviating just a few years of suffering in mentally ill seniors.While pediatric psychiatrists provide immeasurable services to mentally ill youths, this mindset devalues the mind of the senior with respect to other age groups.

b. Historically, major healthcare plans have not provided enough incentive for hospital to provide mental health services. This is changing as a result of the Affordable Care Act, which we will discuss more in detail next week.

2. Doctors without training in geriatric care often misdiagnose or directly discriminate and stigmatize patients with mental illnesses. This can have a profoundly negative effect on patients by reducing treatment efficacy. Discrimination from healthcare workers can even worsen treatment outcomes. While many doctors are not directly prejudiced against the elderly, they are just as susceptible to prevailing stereotypes as the next person.

3. Because of social and self-stigmas, patients may distrust the medical establishment’s ability to treat their illness or fear institutionalization in a psychiatric ward. As a result, patients would be less likely to seek treatment for psychiatric disorders.

Education is the best strategy to overcoming stigma

Education and Empowerment of the Mentally Ill
ageismIn order to effect long-lasting change of public sentiment, people afflicted by psychiatric diseases must dispel their own stereotypes against mental illness. These include the incorrect assumptions that:
• Mental illness is incurable
• Mental illness is a normal part of aging
• Elders with mental illnesses are not worth being treated

 

Education and Empowerment of the Public

The public must also be educated about mental health and aging. Today’s mass media often disseminates misleading and derogatory images concerning mental health and the aging process. Seniors are often portrayed as out of touch with reality, childish, and useless. Few films depict old age in a positive light, and many films focus on the dangerous aspects of mental illness, though only a small percentage of mentally ill patients are violent.

bedsideEducation of the next generation of doctors and medical professionals must be a priority for the future. A study conducted at the University of Calgary, Canada, showed that basic psychiatry education in a group of medical students helped to reduce common stigmas and misconceptions about mentally ill patients and improved student confidence when working with patients with psychiatric diseases. Geriatric healthcare must also become an integral part of medical education as America’s senior population (65+) is projected to double by the year 2030. Many of these efforts are currently underway.

Tune in next week to learn about current efforts to eliminate mental illness stigmas.

References

  • CDC.gov. “Depression is Not a Normal Part of Growing Older.” http://www.cdc.gov/aging/mentalhealth/depression.html
  • Mentally Healthy Aging: A Report on Overcoming Stigma for Older Americans. DHHS Pub. No. (SMA) 05-3988. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2005.
  • Neelgard, L. “Report: Too little mental health care for seniors.” Associated Press. http://usatoday30.usatoday.com/news/health/story/2012-07-10/aging-mental-health/56132426/1
  • Papish et al. “Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial.” BMC Medical Education 2013, 13:141
  • Persky, T. “Overlooked and Underserved: Elders in Need of Mental Health Care.” http://www.mhaging.org/info/olus.html
  • Thornicroft, G et al. “Discrimination against people with mental illness: what can psychiatrists do?” Advances in Psychiatric Treatment, 2010, 16: 53-59

 

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Mentally Ill Seniors—America’s Black Sheep

July 14, 2014 by Leave a Comment

Depression affects over 6.5 million of the 35 million Americans aged 65 and older, and yet only 10% of them are receiving treatment for the condition. This indicates a deep failure on the part of our healthcare system to recognize and treat mental health problems in older adults. While numerous problems contribute to this failure, underlying assumptions about elderly people cause social, self-, and institutionalized stigmas that complicate the ability of older people with mental illnesses to seek treatment for psychiatric diseases.
Let’s briefly discuss some of the different types of stigmas based around mental illness in the elderly:

Social Stigma
• Social stigma against mental illness in the elderly is closely related to ageism, or the idea that older people are not stigmaas able to contribute to society as younger people.
• Oftentimes, depression and related mental illnesses are seen as normal aspects of the aging process. Events such as retirement, the death of loved ones, medical problems, and increased isolation can evince feelings of sadness and grief, but do not directly cause depression. With strong support from one’s family or therapist, these distressing events may be successfully overcome. However, dismissing depression as an unavoidable side effect of aging drastically reduces the chances obtaining treatment for depression and related mental illnesses and can exacerbate the severity of the illness.
• The media commonly portrays elderly people with mental illnesses as childish, stubborn, and resistant to change. While this representation may stem from the self-stigma (discussed below), this portrayal only reinforces existing stereotypes of mental illnesses by imposing judgments on afflicted individuals rather than highlighting the need for change. In this sense, the media contributes to the problem.

Self-Stigma
cycle• Self-stigma occurs for a variety of reasons, including fear of financial repercussions, embarrassment, isolation, and/or distrust of mental health services. At worst, elderly patients fear being institutionalized in psychiatric wards or old-age homes and where they will be cut off from their families and friends.
• The baby boomers’ emphasis on self-reliance in the face of difficulty also contributes to self-stigma. As such, self-stigma is directly caused by and contributes to social stigma.

Institutional Stigma
• Assumptions about older people based on the above stigmas can lead to misguided policy that in effect punishes the mentally ill. For example, Medicaid does not cover services for those suffering from mental illnesses, which means that patients are often forced to find more expensive healthcare plans. To complicate the issue further, many states are cutting funding for mental health services in an effort to balance the budget even while 1 in 6 Americans suffer from some sort of mental illness.

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Each stigma is engendered by and reinforces the others.

Next week, we will discuss existing barriers to eliminating these stigmas and current efforts to bring awareness to the state of mental health services in America.

Sources

  • Depression in Older Adults & the Elderly—http://www.helpguide.org/mental/depression_elderly.htm
  • Goodell et al. “Health Policy Brief—Mental Health Parity.” Health Affairs, April 3, 2014. http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_112.pdf
  • Mentally Healthy Aging: A Report on Overcoming Stigma for Older Americans. DHHS Pub. No. (SMA) 05-3988. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2005.
  • Persky, T. “Overlooked and Underserved: Elders in Need of Mental Health Care.” http://www.mhaging.org/info/olus.html
  • Tomasky, M. “The Great GOP Mental Health Hypocrisy.” The Daily Beast, Politics, 9/20/2013. http://www.thedailybeast.com/articles/2013/09/20/the-great-gop-mental-health-hypocrisy.html
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