CPMH's Opinion on the 21st Century Cures Act

A Message on the 21st Century Cures Act from James A. Smith, III, MD,
Medical Director of Carolina Partners in Mental HealthCare, PLLC

The 21st Century Cures Act was recently signed by President Obama, to both praise and scrutiny. Most think this act is related to cancer and Alzheimer’s disease, but deep into the 1000-page bill Congress went after the dilapidated state of our mental health system, allowing for many benefits to improve the current state of mental health treatment and research.

The first big change is that Congress accepted the fact that SAMHSA (Substance Abuse and Mental Health Services Administration) has failed individuals with serious mental health illnesses; wherefore, the bill establishes an assistant secretary for Mental Health and Substance Abuse to oversee SAMHSA. Many, including the National Alliance on Mental Illness, view this as a step in the right direction.

The act designates a new Interdepartmental Serious Mental Illness Coordinating Committee, which will be charged with summarizing advances in diagnosing and treating serious mental illness, and reporting to Congress; this group will also evaluate the impact of federal programs on public and private mental health services. The act specifically allows grants to local governments, which will provide funding to improve crisis intervention services and to build a registry of available inpatient psychiatric beds. The act increases training programs to foster “integrated care” as the most efficient model of health care — embedding mental health providers into the broader landscape of primary care. The act also includes funding for a nationwide hotline and an online tool for accessing mental health providers with greater ease. Crucially, the act will offer grants to address mental health accessibility for the homeless and those trapped in the criminal justice system, who have both been egregiously overlooked by the mental health system at large.

An inmate in the La Crosse County men's jail has little to do but rest in his cell in a jail-issued uniform. PETER THOMSON photo

This act does not amend HIPAA, but it does improve a clinician’s ability to share information with a patient’s family. It also promises to go after insurers who skirt around the Mental Health Parity Act to avoid covering mental health care services. The act also will improve and enforce information interoperability within electronic health systems, improving patient care nationwide.

Carolina Partners stands ready to move forward as one of the few private practices that accept insurance, assisting thousands of patients each year who would otherwise have very limited access to quality mental health services. While the 21st Century Cures Act contains no magic within its pages, it is an important step in reforming a broken system that has excluded so many with a serious mental illness — shunting people out onto the streets and into our prison system — while closing hospitals and withholding much needed funding from our communities. We stand in full support of this act — let’s give it a year!

January Focus: Mental Wellness in the New Year

It's a new year, and a new chance to intentionally care for your mental health!

First thing's first. Remember that with the beginning of the new year, it is normal to feel tired from the holidays. The holiday season is a time of lots of joy, but also lots of busy-ness and stress. Often people feel societal pressure to jump back into work with boundless energy in the new year. But pace yourself! And be kind to yourself. Remember that just because we all are returning from a holiday "break" doesn't mean that we actually got a break. Many of us will return to work in the new year feeling tired and unprepared to start back at work. Be aware of your own expectations entering the new year. And be aware of the expectations of others. Practice self-loving and give yourself time to achieve small tasks and rest as you ease into 2017.

The end of a year is a great time to take stock of where we are and to set goals for what we next want to achieve. As you think about possibilities for your own new year's resolutions, remember to consider your mental health! Here are some tips for factoring mental healthcare into your coming year.

1. Set specific, measurable goals.
When working towards a goal it is important that we facilitate our ability to see change and to see the results of our efforts. By setting specific goals, you will be more likely to reach them. By setting measurable goals, you'll be more likely to congratulate yourself for your progress. So, for example, instead of setting a goal to, "Exercise more," consider making that goal more specific. You could, "exercise for 30 minutes three times a week, doing any activity." And then you could put a chart on your fridge where you mark each day that you complete your goal. Achieving your goals and congratulating yourself on your progress are two ways to dramatically benefit your mental wellness.

2. Have realistic expectations.Another important aspect to mental wellness in the new year involves setting realistic expectations. For example, if you've never before successfully run a mile, then it's unrealistic to expect that you'll be able to run a marathon this year. Instead, you could set a goal to run a mile within two months, two miles within four months, etc. Then, you can further break down your goal into weekly and even daily goals. Setting realistic expectations likewise benefits your mental wellness by allowing you to work towards a goal that is possible to achieve without hurting or overextending yourself.

3. Practice self-compassion.Practicing regular self compassion is one of the most impactful strategies for mental wellness. Pay attention to the way you talk to yourself. You could, for example, take ten minutes a day to check in with yourself and bring awareness to your internal dialogue. Often we walk around all day with a very mean, very harsh inner voice--a voice who says things we'd never dream of voicing to a loved one. And yet we say these things to ourselves often. Statements like:
"You're lazy."
"No one really loves you."
"You're lame and stupid and everyone else sees it but you."

Once we take the time to intentionally bring awareness to our inner dialogue, we then have the option of countering this hurtful inner dialogue with statements of self-compassion. For example, if your inner critic says, "You don't work hard enough," you can counter that with a statement of self-compassion such as, "You're tired after the holidays. Give yourself some space to recover from a busy time." Or, if your inner critic says, "No one really loves you," you might counter that with a statement of self-compassion such as, "Wow, you are really scared that no one loves you and that you'll end up alone. I hear you and that sounds hard."
By practicing even small acts of self-compassion, we can dramatically benefit our own mental wellness.

4. Engage in activities that you know make you feel good.
Sometimes in the new year, people can get too focused on re-inventing the wheel. New Year's resolutions don't need to be original or new to you in order to improve your life. We are each the incomparable expert on ourselves. No one knows you better than you do. So what do you know makes you feel good? For example, maybe every time you go on a walk that's 20 minutes or longer you notice that your mood improves, even if only slightly. By noticing this pattern you can incorporate more walks into your new year. Be honest with yourself. Set goals from a place of honesty and alliance with yourself. If, for example, you know that you dislike the taste of kale, then don't set a nutrition goal to eat more kale. Why force yourself to do something you know you don't enjoy? Instead, think about other foods you could eat to get the same nutritional value as you do from kale. Or, if you know you love swimming, then why set a goal to learn a new sport? Instead, focus on refining and encouraging what you already know you enjoy. New Year's resolutions don't have to be hard; they can be fun!

Good luck! And let us know how you do! We would love to hear from you on how you're approaching the new year.

We want to hear from you! Please comment below.

What are your New Year's resolutions?
What are your strategies for setting goals?
How do you practice self-compassion?
Which types of goals feel the best to you and why?
When have you been most successful with your New Year's resolutions?

December Focus: Holidays & Mental Health

For many people, the holiday season can be a difficult time to maintain and care for their mental health. There's often financial, family and travel stress, not to mention the stress that can result from disruptions in routine. People are often busier during the holiday stress and their feelings of love, happiness and joy are often counterbalanced by stress and fatigue. This year's holiday season may be particularly stressful, since voters from all political parties report higher levels of stress and anxiety during the recent election.

So, what can we all do to take care of ourselves this holiday season? Here are some simple suggestions that will help you ensure you have the best holiday season you can. By taking care of your mental health in December, you can also set yourself up to have a better January and beginning to 2017.

Tips for Mental Wellness during the Holidays:

1. Examine your expectations and make adjustments so they are more realistic.
Thinking of cooking for 12 people? Trying to stuff stockings for your kids and all the cousins? Offering your house as the hub for all out-of-town relatives? Planning to spend more than you can afford? Take a second to look at your expectations for this holiday. Often, without even realizing it, many of us have ideas about what we should do this holiday. We often set up equations in our minds where "an enjoyable holiday = some form of backbreaking work." Ask yourself, "Do I honestly want to do these things?" Another good question to ask is, "Do I feel relieved when I think about not doing this thing?" If the answer to either or both of these is yes, then figure out where you can cut back on your task and can rework your's and others' expectations.

CPMH's Anti-Stigma Initiative collaborator, Dawn K. Dreyer, has another good suggestion on how to think about holiday expectations, which she discusses in her blog post, "How to Have a Good Enough Family Gathering."

In short, adjusting expectations can make the whole family happier!

2. Remember the gray areas.
Life isn't black and white. Remember that most (if not all!) situations require compromise. When re-examining your expectations, you don't need to go from "doing everything" to "doing nothing." If, for example, you were planning to host both your sister's and your brother's families, could you instead only host one? Or, failing that, could you go stay at a hotel and take space you need? Or, failing that, can you go on a walk every morning with someone who relaxes you? This last suggestion brings us to the third tip....

3. Put your needs first. 
What do you need this holiday season? Alone time? Help in the kitchen? Someone else to wrap presents? Exercise? Help talking to a difficult family member? Be honest with yourself about what you need and then be vulnerable. Ask for help. Tell the ones you love and trust what you need and ask for their help. Maybe your partner can pay attention to times when you're cornered by your combative aunt and can come over to join the conversation. Maybe your nephew can babysit the toddler or your mother can finish the decorations. Whatever you need, first and foremost, give yourself permission to have those things and then stand your ground. Those who love you will respond positively to reasonable requests that you need to care for your mental health. You can even explain that by doing "blank" (for example, by going on a walk each day), you'll then have more energy during family time, which is better for everyone!

4. Think of small things you can do now that will help after the holiday. 
Many people consider the holidays to be a break from every routine. But often, counterintuitively, a complete break often isn't good for our mental health. For example, instead of taking a whole four days off from getting exercise, how about exercising at least one of those days? Even that one day of exercise (which can be as simple as a walk!) will ease the transition back into your normal exercise routine. Or perhaps you have a lingering anxiety about not checking work email for a week, knowing that you'll be inundated with messages, making your first day back exhausting. How about taking 15 min every other day to check in on your work email? By doing actions with intention, you can help separate your everyday routines from holiday celebrating, without ignoring them completely.

Mental health is always important! Pay attention to cultural messages that equate "ignoring mental health" with "holiday celebrating." Every day is a good day to prioritize your own mental wellness! And by doing this for yourself, you may also inspire your loved ones to do the same!

We want to hear from you! Please comment below and tell us:

How are you taking care of your mental health this holiday season?
Do the above suggestions resonate with you?
What are the most challenging aspects of the holidays?
What are the most enjoyable aspects of the holidays?
What do you most need this holiday season to stay mentally happy?


Carolina Partners in Mental Health wishes you a happy and healthy holiday season! 

October Focus: ADHD Awareness

October Focus: ADHD Awareness

Attention Deficit Hyperactivity Disorder is a huge issue in the US. Over ten percent of children aged 5-17 have been diagnosed with ADHD. And approximately five percent of adults also have it, though fewer adults are diagnosed and treated for it.

For starters, we want to clarify some confusing information about ADHD and ADD. ADHD used to be called ADD, but then it was changed to include the H, which stands for "Hyperactivity." (Some sources still use the term ADD to refer to ADHD.) Both adults and children can have ADHD; however, the disorder always begins in childhood. In other words, every adult who has ADHD also had it as a child. (But many adults may not have been diagnosed as children, and therefore don't realize that they have ADHD as adults.)

Adults can also have ADHD. 

Diagnosis of ADHD can be particularly tricky because the symptoms often overlap with other mental health issues. There are three main symptoms associated with ADHD: Inattention, Hyperactivity, and Impulsivity. Here are the definitions of those symptoms from the National Institute of Mental Health:

• Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.

 

• Hyperactivity means a person excessively fidgets, taps, moves about, or talks, even in situations in which such behavior is inappropriate. In adults, hyperactivity can be characterized as extreme restlessness, or a tendency to wear others out with constant activity.

 

• Impulsivity means a person acts on hastily-made decisions that occur in the moment, without much forethought, even when these actions may have high potential for harm. Impulsivity can also be identified by a desire for immediate rewards, or an inability to delay gratification. An impulsive person may be socially intrusive, excessively interrupting others. They may also tend to make important decisions without considering the long-term consequences.

There are three types of diagnosis that people with ADHD can receive: Inattentive ADHD, Hyperactivity-Impulsivity ADHD, or Combined ADHD. Each diagnosis specifies which aspects of ADHD are predominant for the person receiving the diagnosis.

Part of what is tricky about diagnosis is that, as mentioned earlier, the symptoms of ADHD can overlap with other problems and/or normal reactions to everyday life. For that reason, doctors who diagnose ADHD are looking for several indicators:

•   Behavior that's not typical for the person’s age. (Most children can behave in those ways at some point or another, though.)

•   Behavior that has a negative impact on the person’s ability to function at home, in social environments, or at work.

•   A consistent display of at least six separate symptoms.

•   Symptoms that last for at least 6 months, and in at least two settings, such as at home and in school.

Kids with ADHD often find school frustrating and challenging.

Certain existing myths about ADHD often confuse people, leading to misunderstandings, and even preventing some people from seeking help. One common misunderstanding has to do with focus. It is true that, for many people, ADHD manifests through the inability to maintain focus. But ADHD can also mean that someone is hyper-focused:

”People who think ADD means having a short attention span misunderstand what ADD is," says Kathleen Nadeau, Ph.D., a psychologist in Silver Spring, Maryland, and the author of ADD-Friendly Ways to Organize Your Life. "A better way to look at it is that people with ADD have a disregulated attention system."

Children might display hyper focus through intensive video game playing, or through watching TV for long hours. Likewise for adults — but hyper focus can also show up in almost any activity. Whichever activity holds that person’s focus, it will fully monopolize their attention for hours at a time, often until something or someone interrupts the thought process.

ADHD can also manifest as hyper focus rather than inability to focus.

Another common misconception about ADHD is that mostly boys and men have it. It is true that a higher percentage of boys are currently diagnosed, but this is largely due to the fact that ADHD has only been recognized in girls and women for the last few decades. And while more boys than girls are currently diagnosed, by the time these children reach adulthood, the disparity between the genders equal out.

ADHD exists for both male and female genders. 

The main causes of ADHD include: genetics, brain injury, exposure to environmental toxins (e.g., lead) during pregnancy or at a young age, alcohol and tobacco use during pregnancy, premature delivery, and a low birth weight.

Luckily, treatment of ADHD is becoming increasingly advanced. Many people (both children and adults) who are diagnosed with ADHD can learn to manage it through medication and therapy.

If you or someone you know displays the symptoms above, it would be worthwhile to consider looking into ADHD, and to talk to your doctor.

We want to hear from you!

• What are your experiences with ADHD?

• Do you know anyone who has ADHD? What has their experience been like?

•   Have they received successful treatment?

•   Or do you have ADHD? What has your experience been?

• Did this article clarify any information for you about ADHD? What were your previous misconceptions about it?

• Do you still have questions about ADHD?

Please leave your thoughts and comments below! And thank you for sharing!

August Focus: Substance Abuse Awareness

Substance Abuse and Addiction are long-standing problems for both the United States, and the state of North Carolina. North Carolina has the 30th highest drug overdose mortality rate in the United States. Though North Carolina is doing much to counteract these problems, there is still so much to be done. 

Alcohol and tobacco abuse remain the largest drug use problems in the United States, with "two-thirds (66.6%) of people aged 12 or older reporting in 2014 that they drank alcohol in the past 12 months, with 6.4% meeting criteria for an alcohol use disorder. Each year, approximately 5,000 youth under the age of 21 die as a result of underage drinking. And an estimated 25.2% (66.9 million) of Americans aged 12 or older were current users of a tobacco product. While tobacco use has declined since 2002 for the general population, this has not been the case for people with serious mental illness where tobacco use remains a major cause of morbidity and early death" (SAMHSA).

Also, "among Americans aged 12 or older, the use of illicit drugs has increased over the last decade from 8.3% of the population using illicit drugs in the past month in 2002 to 10.2% (27 million people) in 2014." Following alcohol and tobacco, marijuana abuse is the third largest, followed by prescription drugs (SAMHSA). 

Prescription drugs, in particular, are an enormous problem in today's world, because they are the fastest growing drug problem in the US, with fifty Americans dying each day from prescription drug overdose and more than 6 million people suffering from prescription drug abuse disorders. Most likely, even more people abuse prescription drugs, but, since only overdoses are easily tracked, it is difficult to get accurate statistics. According to SAMHSA, "more than 50% of people aged 12 or older in 2011-2012 who used pain relievers for non-medical reasons in the past year got them from a friend or relative." In 2015, 15 million people used prescription drugs for non-medical reasons (SAMHSA). 

For many, prescription drug addiction starts with the drug being medically prescribed to them for legitimate medical reasons. WebMD states that often prescription drug addictions start with the young, citing a statistic that 8% of high school seniors used the painkiller hydrocodone for non-medical reasons. People with mental illness are also at risk, since anxiety and depression both increase the chances of someone using prescription drugs on a long-term basis. 

But prescription drug disorders aren't just suffered by the young or by those with anxiety or depression. NY Times reporter Constance Gustke discusses the abuse of prescription drugs in the elderly population in her article, "Prescription Drug Abuse Among Older Adults is Harder to Detect." As with most prescription drug addictions, most elderly adults who abuse the drugs first used them when they were prescribed for non-medical reasons.  "Even starting on low doses of opioids can quickly turn into abuse...There are two factors for aging adults: drug tolerance that builds with time, and the body’s slowing metabolism, which gives drugs a bigger effect" (Gustke). The article quotes the medical director of a NJ outpatient detox facility:

“By 10 days of usage, you can be addicted,” Dr. Cidambi said. “You don’t think of affluent, well-put-together women as addicts. But I see this happening constantly.”

Carol Waldman, 64, became addicted to Xanax, which was prescribed by a psychiatrist, and to pain pills for chronic back and knee problems. 

The truth is that anyone can become addicted to prescription drugs, and substance abuse of a wide variety of drugs abounds in the United States, causing serious detriment and many fatalities.

Carolina Partners in Mental Health is working hard to help those with substance abuse problems, offering many psychiatrists, psychologists, counselors and therapists in our Durham, Raleigh, Wilson, Concord, Asheville,Wake Forest, Cary and Chapel Hill offices who can diagnose and treat substance use/abuse disorders. For more information on these providers, as well as access to three informational videos on substance abuse, click here: https://www.carolinapartners.com/mental-illness-treatment/substance-abuse-disorder.php. 


We want to hear from you! Please comment below!

How has substance abuse affected your life? 
Do you know anyone who has a substance abuse problem? What are they doing to get help?
Have you ever had a substance abuse problem? What did you do to get help?
Which drug do you most often see abused in your own life?
What are the consequences of that abuse? 

July's Focus: Purposeful Parenting Month

Compassionate and comprehensive mental health care is an important part of any and every child’s overall health and well-being. Issues in a child’s mental health can dramatically affect every aspect of the child’s life, including performance in school, friendships and self-confidence, energy for and interest in extracurricular activities. As children we all form habits that stay with us for most of our lives. Childhood is an essential time to begin the beneficial habit of caring for our mental health!

As SAMHSA points out, “It’s more than just being moody,” and “it’s more than just a phase.” If your child is having a difficult time mentally or emotionally, it’s important to pay attention to this and take it seriously and not disregard it as “age-appropriate.” If a child thrives on the inside then he or she can also thrive on the outside. Approximately one in ten children aged 5-16 suffer from a mental health disorder in the US and the UK.

Start with how your child thinks about himself. Pay attention to their self-image, their anxiety, their body image, etc. One of the best ways to develop children’s mental health is to ask them regularly how they feel, how they think about themselves. Ask questions and really listen to the answers. Engage them in conversation. Work to create a safe environment where the child feels that he can share and discuss thoughts safely. Things like routine, structure and regular discussion and conversation can dramatically help a child understand and positively develop his mental health.

Another good discussion to have with children involves their expectations—for themselves and also for others. It’s good to discuss expectations with a child so that you, as the parent or adult in their life, can help him develop reasonable and realistic expectations for themselves. As this video from the Canadian Pediatric Society points out, a child will be stressed unnecessarily if she thinks that she must excel at every sport she plays, for example. Instead, you can help her understand the benefits of sports beyond excelling at goal scoring and can, for example, discuss the realistic expectation that sometimes she’ll score goals and sometimes she won’t, sometimes she’ll have a lot of fun and feel energized and sometimes she may not have fun or may feel tired while playing.

You can also begin this process by having open, compassionate conversations with your kids about what mental health and mental illness are. As this video points out, a lot of kids aren’t sure what mental health means and don’t understand that it is something that we all need to pay attention to for ourselves.

Lastly, here are some good tips on how to develop healthy habits within your family, habits that dramatically affect mental health. You can talk to your kids about the mental health benefits of these healthy habits.


We want to hear from you!

How do you think adults can help kids understand and develop mental health? 
What has worked or what hasn’t worked for you with your own kids or kids in your life? 
What worked or didn’t work for you when you were a child? 
Are there strategies your parents used that worked well? 

June Mental Health Focus: LGBTQ Pride Month

President Obama recently declared June 2016 as LGBT Pride Month, stating, "I call upon the people of the United States to eliminate prejudice everywhere it exists, and to celebrate the great diversity of the American people."

Last year's US Supreme Court ruling guarantees marriage equality for LGBT people in all 50 states--an important and landmark moment and one to celebrate this June! This month, let's focus on all the people who have fought for equality and change over the years. Let's acknowledge the progress that we've made and turn our focus towards the hurdles still left to conquer. As President Obama stated, "Despite the extraordinary progress of the past few years, LGBT Americans still face discrimination simply for being who they are.... love is love and that no person should be judged by anything but the content of their character."

The National Alliance on Mental Illness explains the impact that this discrimination has on the LGBTQ community. "LGBTQ individuals are almost 3 times more likely than others to experience a mental health condition such as major depression or generalized anxiety disorder. This fear of coming out and being discriminated against for sexual orientation and gender identities, can lead to depression, post-traumatic stress disorder, thoughts of suicide and substance abuse" (source). 

On a local level, one of the major moments of discrimination against the LGBTQ community is the recent House Bill 2, which NC Governor McCrory passed on March 23, 2016 and which, "bans individuals from using public bathrooms that do not correspond with their biological sex, as dictated by their birth certificates. It also bars cities from passing anti-discrimination ordinances to protect gay and transgender people (per Charlotte's act to protect the rights of the LGBT community)" (source). Additionally, "HB2 leaves in place language that strips North Carolina workers of the ability to sue under a state anti-discrimination law, a right that has been upheld in court since 1985."


J. Louise Newton, MSW, LCSW discusses CPMH’s stance on HB2:

We prioritize accessibility in all of our practices for all populations. Having All-Gender bathrooms makes the bathrooms safer for transgender folks as well as children and older adults who have a primary caregiver of a different gender with them in public (For example, a hypothetical 9 year-old son with developmental disabilities who comes to CPMH for his appointment with his mother who needs to help him in the restroom). Additionally, Carolina Partners in Mental Healthcare, PLLC has long partnered with LGBTQI identified providers and currently employs many staff and clinicians who are a part of the community. Recently, CPMH has doubled our efforts through the Gender and Sexual Diversity Spectrum (GSDS) Initiative to recruit and train competent providers in the healthcare provision of Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex patients. We are currently seeking fully licensed therapists who possess clinical competency in working with LGBTQI patients. In addition to the GSDS Initiative we also offer special programming for transgender patients, such as LGBTQ Affirmative therapy. Lastly, HB2 has caused an unnecessary increase in some mental health symptoms for some transgender people with regards to social phobias, body dysphoria, and trauma-related symptoms. Providing competent care requires us to take a stance!

Discrimination against the LGBTQ Community is real! This month let's celebrate all the progress that we, as Americans, have made towards equality and compassion for all. And let's remember and bring energy to the battles that we are still fighting!

If you're looking for some clever ways to support LGBTQ Pride Month, here are some LGBTQ Pride Fashion decisions that we love!

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Please share your comments below!

• How does LGBTQ Pride Month affect you? How does it encourage you?
• How do you show your LGBTQ Pride?
• What issue in the LGBTQ community do you most want to support?