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Category: Mental Health

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How Can We Be Happier?

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Americans today are emotionally distressed. Many are nervous about the economy, struggling to afford rent or buy a home, frustrated about the direction of the nation, feeling culturally and politically divided, socially isolated and most concerning of all, uncharacteristically unhappy.

We know Americans are feeling blue because they tell us so. According to a survey by the University of Chicago, the percentage of Americans saying they are “very happy” has nosedived since 2000 from 34% to 19% while the percentage who report they are not happy has more than doubled to 24%. That probably understates the issue because admitting this in a survey requires an individual first to admit it to themselves.

Before we bemoan our emotional state we need to determine what happiness is. Many efforts have been made to define it and they seem to coalesce around the idea that happiness isn’t so much an ephemeral state as a durable way of being. Happy humans are preternaturally happy or find ways to be; things and events don’t make us happy.

Indeed, a massive, longitudinal Harvard happiness study begun in 1938 and, still ongoing, has reached some counter-intuitive conclusions. Regardless of participants’ sex, age and other demographic attributes, even irrespective of their life experiences, the study found, genetics determine about half of happiness; some people are hard-wired to find the good or bad in everything. As for the rest, the markers of success in our country – money, health and possessions, for example – contribute little to happiness.

Poverty can inhibit happiness, but the link between income and joy frays once basic needs are met. A 2010 study by the Nobel Prize-winning psychologist Daniel Kahneman, the author of the bestseller Thinking Fast and Slow, found that income’s impact on our emotions flattens out around $75,000. Above that, an increase in income barely ripples on the happiness meter.

It is the relationships in our lives, it turns out, that have the greatest impact on our physical and emotional health, our lifespan and our happiness. “Taking care of your body is important, but tending to your relationships is a form of self-care too. That, I think, is the revelation,” said Robert Waldinger, a psychiatrist at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School, and director of the study.

As explained in this article by Gregg Vanourek, this all hints at the ultimate aim of happiness: we want to feel like we are living a meaningful life, one filled with daily pleasures, opportunities to do what we do best, and using our strengths to serve a higher purpose, like raising children, working for a cause that you’re passionate about, or simply doing good for others.

Consider this: marital satisfaction, a dynamic social life with a web of friends and family, and a strong sense of a greater purpose is the most powerful drug cocktail for achieving health and happiness. Loneliness, which affects a quarter of adults aged 65-plus, is as dangerous to health as smoking and alcoholism.

“When we gathered together everything we knew about (the participants in the Harvard study) at age 50, it wasn’t their middle-age cholesterol levels that predicted how they were going to grow old,” said Dr. Waldinger “It was how satisfied they were in their relationships. The people who were the most satisfied in their relationships at age 50 were the healthiest at age 80.”

The implications for all of us are simple but startling, and they offer a roadmap to happiness. Spend less time pursuing material advantages and more time nurturing strong human bonds with those around you. Reconnect with friends and family, curate nascent friendships, and intentionally develop or maintain a rich web of social connections.

By: Ronit Molko
Forbes Books Author
Forbes Books

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Addressing Student Mental Health Is Complex … And Critical

An image of a teen looking worried while sitting against a wall, with her right hand arm on her knee, supporting her head

Forbes Books Author
Ronit Molko
Sep 13, 2022,03:59pm EDT

In a previous blog on my website written for Radicle Health, I discussed the broad mental health issues facing students today in our schools and on-campuses across the country. The focus was primarily on current response procedures, and what certain schools and states are doing to implement more nuanced support systems for student mental health crises. As we dig a bit deeper, we find that our ongoing mental health epidemic is not evenly distributed among students.

While mental health issues in young people have spiked since the pandemic, the current landscape is truly a minefield for young women, Black and Latinx youth, and those with sexual identity issues. Marginalized groups are suffering now like never before with their emotional and behavioral health.

An Alarming Increase in Suicide Risk

The numbers suggest a new tsunami of pain and suffering across the country. Three quarters of college students reported enduring moderate or severe psychological distress, according to the American College Health Association’s fall 2021 National College Health Assessment. Rates of depression, anxiety and suicidal ideation are even higher for students with sexual identity issues. A staggering 42% reported seriously considering suicide in 2020.

When nearly three of seven young people of any kind are thinking about suicide, that is a crisis. In one sense, it’s a shocking development, considering that our society has never been more accepting of teens and young adults with sexual identity issues. At the same time, it’s no surprise at all given the social isolation Covid imposed, combined with the health scare, recent racial and political tensions, the social pressures caused by online media and growing effects of climate change. It appears to be the greatest time in history to be young – and the worst.

Institutions that engage the mind must be alert to the emotional stressors that reduce cognitive ability. That puts schools on the front line of confronting this new crisis, especially as communities beyond the campus are so ill-equipped to do so.

Thoughtful Responses and Programs are Necessary

School districts and college campuses are working to address these emotional impacts as they provide education to parents’ most precious priority. They are employing several strategies to lower the temperature of psychological distress. Many school districts are leveraging social and emotional learning (SEL), which teaches managing emotions, developing healthy identities, feeling and showing empathy, and more. Research clearly demonstrates SEL “leads to beneficial outcomes related to social and emotional skills; attitudes about self, school, and civic engagement; social behaviors; conduct problems; emotional distress; and academic performance,” according to the Collaborative to Advance Social and Emotional Learning.

Also on the prevention side, districts are establishing positive behavior intervention and supports, a combination proactive and reactive system of individualized prevention and interventions for at-risk students. Districts are also moving away from the punitive reaction model for wayward behavior to restorative discipline practices, which focuses on accountability over punishment. Districts are creating formal partnerships with community agencies and other organizations that can provide behavioral crisis support and establishing crisis-response teams inside the schools to address mental health issues. Federal funding that was part of the Covid-inspired CARES Act is fueling many of the new programs to support primary school students’ mental health.

On college campuses, mental health is on the administrative radar like never before. Campus counselors are having to update their skills to provide for gender non-conforming students and change some of their practices to account for a whole new category of patients. This includes significant changes, like building more single dorm rooms for non-binary students, and small ones, like asking for gender rather than sex on forms.

Minority Students are More Deeply Impacted

For minority students, the challenges are analogous, but different. Black and Latinx families were more likely to work on the front lines during the pandemic, unable to work from home and avoid contamination. As a result, they endured higher infection, hospitalization, and death rates from Covid, exacerbated by “racial battle fatigue” following the George Floyd killing that exposed old wounds about police brutality against Black Americans. It is perhaps not surprising that 67% of Black adults reported in a July 2020 survey by the American Psychological Association that their experiences with racism are a significant source of stress in their lives.

For schools, this may also require a new sensitivity to the special needs of minority students, says Dr. Zainab Okolo, a family therapist. “For students to feel like they’re a part of campus, they have to be willing in some ways to divorce themselves from their [home] culture,” she tells DiverseEducation.com. “For some students, the campus culture and their home culture are so alike, maybe both parents went to the school, and they were born there, that there’s no divorcing. But for some students — students of color, first-generation students — they almost have to betray themselves to fit in.”

Educational institutions that aim to serve diverse student populations are having to pivot with the times and accommodate the mental health issues facing many minority student groups who have suffered because of, and since, Covid. Even if Covid recedes into the background, it is unlikely the emotional wellness of student populations will. The critical concern now is whether the efforts being made by institutions to address emotional wellness among students will persist as well.

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Providers Working with Communities to Address Student Mental Health

an image depicting children in a classroom, with a child raising his left arm to ask the teacher a question

Emotional wellness has become the elephant in the room in our schools today, as young people struggle like never before with their mental health.

A student at Long Beach State University in California called a friend in an emotional crisis, desperate for help and threatening to harm herself. The friend knew she had to act and in the absence of any on-campus crisis response strategy, she called campus security. To her shock, she discovered she had made the problem worse.

So goes the story told to Ashley Smith, a reporter for EdSource, an online publication highlighting strategies for student success.

After the call, armed police showed up at the student’s dorm room and dragged her off to a hospital psychiatric unit. At the time, the university lacked a comprehensive mental health response plan. 

On-Campus Response Strategies Are Necessary

Following this incident, campus leaders recognized that mental health crises require a much more nuanced and humane response. Campus leaders devised a whole new strategy for student mental health. Implementation of this first-in-the-nation mental health strategic plan began last spring and will phase in its 60 action items over the next three years. Chief among them is a mobile crisis unit that responds to mental health emergencies with mental health professionals, not police.

Mental health has been a growing concern on campuses since 2013, according to a 2021 survey by the Association for University and College Counseling Center Directors. Ninety-five percent of the college counseling center directors said the number of students with significant psychological problems was increasing. First appointment visits at The University of Florida’s mental health clinic more than doubled between 2019 and 2020, and then increased again in 2021.

A Growing Crisis in Children’s Mental Health

The situation is similar for younger children. The Children’s Hospital Association reports that their member institutions recorded a nearly 38% increase in emergency department visits for mental health cases in the third quarter of 2021. They also reported nearly 54% more suicide and self-injury cases compared to 2020.

Though shocking, these numbers are not all that surprising. A pandemic that upended life for two years, mass shootings, racial tension, and angry political divisions have exacerbated the usual pressures that young people face. This is especially true for young people that are most susceptible to depression, eating disorders and other mental health issues. The rising mental health crisis among students has led to a bill presented to the California State Assembly, mandating that all public colleges in the state print a 24-hour hotline number on student identification cards for local mental health services.

There are many ways clinicians are responding to what many are calling a crisis. The Child Mind Institute this spring responded by embarking on a public awareness campaign anchored by the musician Pink, in which celebrities and ordinary people recount their stories of emotional struggle. 

How Can Schools Work With Mental Health Providers?

Because students spend more time during the week in school than with their parents, school psychologists, counselors and social workers are crucial to maintaining students’ emotional health. School staff are often the first to identify changes in student affect or behavior. School psychologists and other behavioral health professionals in the schools can hone the screening process by developing strong relationships with teachers, staff and parents. Identifying children with issues early can prevent mental health crises.It is important for schools to have a plan in place to connect students to support services, whether in-school or in the community. 

The Colorado Department of Education advises school districts to bring mental health professionals into the schools. “Utilizing mental health crisis teams can provide targeted and intensive mental health supports to students who require significant levels of support. These teams should include professionals, caregivers, community partners and stakeholders who understand robust approaches to mental health crisis management,” the department says on its website. 

Mental healthcare providers have an unprecedented opportunity to connect with in-school and out-of-school communities to address student mental health, now that schools and their surrounding communities are more amenable to that service than ever. There is so much these providers can offer. 

The Power of Telehealth to Expand Access

First, COVID has taught us the power of remote health services. Clinicians of all kinds can utilize telehealth to increase patient access to mental health services and minimize the stigma involved in seeking help by eliminating the public waiting room. Further, telehealth allows patients to receive care in the comforting surroundings and convenience of their own homes. Dropping the barriers to attending sessions boosts the likelihood of patient compliance and perseverance.

Patients have demonstrated a preference for telehealth services. The utilization of virtual appointments for mental health has hardly dropped off since COVID isolation, even as primary and secondary care patients are largely back in their doctors’ offices. 

Behavioral health providers can also expand patient access to mental health by co-locating with primary care providers to offer more comprehensive services in one place. Improved access has been shown to correlate with better outcomes.

Emotional wellness has become the elephant in the room in our schools today, as young people struggle like never before with their mental health. It is incumbent upon professionals in the field, school districts, and higher education institutions to make mental health services as accessible, available, convenient and comfortable to use as possible. 

By:
Ronit Molko
Radicle Health Advisory Board, Ph.D., BCBA-D
Aug 1, 2022

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Value-Based Healthcare

A patient desperate for pain relief opts for spinal fusion surgery, a procedure that typically costs between $80,000 and $150,000. Spinal fusion can offer benefits to healthcare patients but it has a woeful success rate often tabbed at 50%. We know that three of every seven patients who undergo the operation require further surgical intervention or experience disability, opiate use, and prolonged work loss, as well as low return-to-work status.

Yet patients are charged the same fee whether they are wholly cured or can’t walk following the procedure. The disconnect between healthcare costs and health care outcomes has sparked a growing movement to price healthcare based on the results.

This is called Value-Based Healthcare.

In a nation whose healthcare costs exceed other similar countries’ per capita expenditures by whole number multiples, while producing inferior results, the United States may have the most to gain from this movement. Value-based healthcare, by definition, puts more emphasis on prevention, and on the treatment of chronic health issues, and places the patient at the center of the treatment regimen.

How Value-Based Healthcare Works

Dr. Christina Akerman, a professor of medicine at the University of Texas’s Dell Medical School, offers an example of value-based healthcare at work. She mentions a clinic in Germany that changed its treatment of localized prostate cancer to focus on incontinence and sexual performance, rather than simply on survival. This change was the result of asking patients what most concerned them about their treatment.

“Outcomes are the actual results of care, which does include clinical measures such as survival rates and the complications during treatments,” Dr. Ackerman said in a recent interview. “But, outcomes that matter most to patients are how care affects their quality of life.” The clinic’s survival rate is the same as those using fee-based metrics but its erectile dysfunction rate is close to half and its incontinence rate is 85% lower than its counterparts.

When patient engagement is at the center of the treatment plan and outcome measures, rather than volume, are the focus of care, the quality and value of health care increases.

Value-Based Care in Autism

Unfortunately, it’s not that simple. In the field of autism, each individual is unique and co-morbidities, from constipation to serious heart ailments, abound. That complicates diagnoses, treatment plans, and expected outcomes.

So how do we apply value-based reimbursement to the provision of care for autism? Some experts in the field believe the system would require dividing patients into age groups and determining the matrix of life skills they would need to develop.

For example, payment for services delivered to elementary-aged children would be determined by their development of social, communicative, and adaptive skills, while reimbursement for teenagers entering young adulthood would track with vocational skill acquisition. Other indicators might include quality of life, independent living skills, and self-determination.

The Many Benefits to Value-Based Healthcare

Better outcomes are just one benefit of value-based healthcare.  Because this model favors prevention, it has been found to require fewer hospital and doctor visits, fewer tests and procedures, and overall cost savings for the system. It also boosts patient satisfaction, as patient input is sought and incorporated into the treatment plan.

The value-based model would require providers to shift their service delivery to prevention, requiring more time per patient on the front end. It pays off in reduced time spent on managing chronic diseases. In the long run, the value is not just higher for patients, but for providers as well.

The long-run return also accrues to suppliers who will have the opportunity to realign their products and services with positive outcomes and long-term cost savings. The need for this is already critical as prescription drug prices continue to skyrocket and drain healthcare budgets of families and institutional payors like the U.S. government.

Are We Ready for Value-Based Healthcare?

The current system is so siloed among different types of providers, as if humans are simply the sum of their organ systems, each acting distinctly. A patient-centered approach could offer benefits on multiple fronts – notably good health and money saved – to individuals, corporate entities, and the system as a whole.

The fee-for-service model is highly entrenched, but its shortcomings are evident in ever-upward costs and desultory results. It will be interesting to see if proponents of value-based healthcare can overcome the barriers to change and overturn the status quo.

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Coping with Stress in Unprecedented Times Part 2

Coping-with-Stress-in-Unprecedented-Times-Part-2

In my previous post, I explored the tumult of unusual activity flowing into and out of our brains as a result of the novel Coronavirus and the worldwide response to it. The threat to lives and livelihoods, the near-total curtailment of social interaction and the departure from normalcy – all of these taken together are wreaking havoc with how we think and feel.

Worse yet might be the increased uncertainty that accompanies all this. 9/11 happened over the course of a morning. Pearl Harbor was a rallying point for action. While the devastating emotional and psychological trauma of these events can be lifelong, the events themselves were flashpoints—over in a matter of hours. We were able to begin picking up the pieces and take corrective action more immediately. With Covid-19, we’re stuck inside our homes living this new distanced reality, with serious economic impact for many, for who-knows-how-long.

As I noted in Part 1 (Blog Part 1), experts in the field of psychology and brain science  empathize with the challenges our brains are facing but also remind us that we can use our brains in an intentional way to manage our thoughts and emotions to some degree and create productive habits. We can accept that this is the new normal until it isn’t, remain positive, focus on the good things in our lives, and divert ourselves with creative and meaningful activities.

For individuals with autism individuals, the calculation is somewhat different. Most autistics thrive on predictability and structure, and struggle with change, even changes many would consider small and inconsequential. Having their lives turned upside down, as they are now, falls somewhere between extremely distressing and catastrophic.

For caregivers of children and adults with autism, the need to perform “social distancing” is incongruous. Their services are, by definition, one-on-one and in person. As Leann McQueen, a residential coordinator for the Young Adult Institute in Brooklyn, told ABC News about her organization’s services to young people with disabilities, “People need assistance with personal hygiene. Even being asked to wash your hands can be more challenging.”

Christine Motokane is an articulate self-advocate to whom I spoke when conducting research for my book, Autism Matters. In her blog, Redefining Normal: A Young Woman’s Journey with Autism, she outlines some of the challenges she faces in this extraordinary time. Everything that is familiar to her has closed – her workplace, her favorite restaurants, other non-essential business – even the weekly outings with her support person have suddenly ended.

“I had to spend and celebrate my 28th birthday at home. All of these sudden changes coupled with the fluidity and ever-changing nature of this situation, has caused my anxiety to skyrocket,” she writes.

This is particularly worrisome because anxiety is often a constant state of being for autistic individuals who are hyper-sensitive to stimuli like light and touch. While “social distancing” has relieved many of those with autism of the anxiety about shaking hands or otherwise engaging in unwanted physical contact with others, and may be comforted by the six foot barrier others are maintaining, they must also confront a degree of exacerbated uncertainty that we all find discomfiting but those with autism may be traumatized by.

Autistica, the UK’s leading autism research charity, notes that autistic individuals react to uncertainty by avoiding such situations, by over-preparing for them or by gathering information that might reduce the uncertainty. None of these strategies is well-suited to this crisis because it can’t be avoided, over-preparing can lead to hoarding and gathering information about an unknown can just result in heightened anxiety.

The strategies that I enunciated in the previous post to manage anxiety about COVID-19 probably apply to everyone, inadequate though they may seem. Keeping as much of the normalcy in our lives as possible, creating a routine and some structure to our days and engaging in activities that enable some type of social contact can ward off some of the avalanche of change in our lives.

This reminds me of a story I came across in my research about maintaining the positive therapy momentum for children with autism during COVID-19. One mother, in an effort to keep life as normal as possible for her son, wakes him up at the usual time, has him dress in school clothes, maintains the entire morning routine, ushers him into the car and drives him around the neighborhood for 20 minutes before returning home for “school”.

Unfortunately, many parents have neither the time nor the bandwidth for such an effective regimen, innovative though it is. They are struggling to keep it together themselves, juggling work at home with the intrusions of family and a lack of respite from 24-hour-a-day demands of caring for children and keeping them constructively busy.

For situations like that, it’s important not to let perfection be the enemy of good. There is no playbook for a circumstance none of us has ever encountered before. Any steps families take, even small ones, like maintaining wake-up and bedtime routines, creating regular family fun time (playing games, reading books, etc.), exercising and dedicating time to learning daily, will all help to maintain a sense of routine and normalcy which will accrue to the benefit of all of us, adults and children alike.

Published By:
Ronit Molko, Ph.D., BCBA-D
Advisor to Investors in Behavioral Health

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Coping with Stress in Unprecedented Times- Part 1

Hypochondriac Concept Disease Panic Of Outbreak Anxiety And Hypo
By Ronit Molko, Ph.D., BCBA-D

Pity your brain. This unprecedented epoch we are experiencing is playing havoc with our most vital organ, the one that is designed to act as the air traffic controller of our bodies during the impenetrable fog of a lockdown.

Our brain through our nervous system is constantly evaluating and detecting risk with the ultimate goal being safety. This occurs at a primitive level within our brain without our conscious awareness. The primary element that challenges safety and stability is uncertainty. The brain is wired to detect fear and we have an overwhelming amount of fear-generating information right now.

COVID-19 has brought the world to its knees. First, there is the physical threat of a virus that is undetectable and about which we are learning as it unfolds. Second, is the constant mental anguish caused by the uncertainty about the future, even about tomorrow.

As a result, we are seeing extreme levels of stress, anxiety, and incremental  increases in depression and addiction. The tidal wave of negative information and emotion creates a continuous brain hijack (as the brain works to manage this threat) and overwhelms our cognitive processing. This stress keeps us in a fight or flight state, affecting core brain capacities such as thinking and decision making. Hoarding of supplies and increased aggression in people are some observable results of these affected capacities.

So if you are feeling stressed, anxious, and exhausted, it’s completely normal under these circumstances.

Jump To Acceptance

In fact, Dr. David Kessler, who collaborated with Elisabeth Kübler-Ross on her treatise, On Grief and Grieving, says that what many Americans are feeling is grief. He says we have lost our normalcy, our future plans and our connection to others, ironically in a collective grief experience.

Worse yet is the uncertainty that imperils not just our health but our financial stability. We don’t know when this catastrophe will end – could this go on for six months, a year? – and that is flooding many of us with anxiety. Dr. Kessler calls this “anticipatory grief.”

Dr. Kessler recommends that we consider the six stages of grief that his co-author famously enumerated and jump as quickly as we can to acceptance. “We find control in acceptance: I can wash my hands. I can keep a safe distance. I can work virtually,” he told the Harvard Business Review.

Four Strategies to Tame Stress

Dr. David Whitehouse, the psychiatric medical director for Able To, a leading provider of virtual behavioral health care, told the Total Brain podcast of four keys to confronting the anxiety sparked by the COVID-19 crisis.

He recommends we identify what we are feeling; avoid catastrophizing, i.e., steer clear of talking ourselves into depression; focus on the positive; and engage our creative right brain.

We have about 50,000 thoughts a day, that’s 2,100 thoughts an hour.

Positive thinking has long been known to improve our overall outlook and boost our performance. Barbara Frederickson, a psychology professor and researcher at the University of North Carolina, has demonstrated that positive thinking opens us to more options than does negative or neutral thoughts. Rather than wallowing in negative thoughts and emotions, simply reminding ourselves that this situation is temporary can have significant salutary effects physiologically and emotionally.

“You can, in fact, drive that negative analytic off the table,” Dr. Whitehouse says.

Physical exercise is an elixir for stress as well. Pushing ourselves physically focuses our attention on the moment and boosts our depression-fighting endorphins. In fact, exercise is often prescribed for patients with mild to moderate clinical depression.

Deep breathing has a similar impact on us physically. It stimulates the vagus nerve, which acts as a crossing guard at the corner of flight and flight. By calming the fight or flight response, the vagus nerve allows our body to relax and our vital signs to settle back to normal. Research shows that our heart can synchronize with our breathing, so that reduced respirations produces a slower heart rate and lower blood pressure.

People who struggle with anxiety often feel that their lives are out of control. In fact, many who struggle with anxiety attempt to control every facet of their lives; when their plans fail, anxiety often comes back with a vengeance.

A relatively simple way to overcome this problem is to establish a routine. Setting a schedule and applying some self-discipline to stick with it allows us to control our daily activities to the extent possible. Adding this structure to daily living can also unlock additional free time to enjoy other things.

There is also one common sense measure we can all take to avoid driving ourselves crazy: limit our exposure to the news. At this point, there isn’t much new to learn about COVID-19 other than that we must isolate ourselves, wash our hands and practice social distancing. All the speculation about how much worse it will get or how long we must wait for normal life to resume, or for the new normal to unfold, produces anxiety without insight. So in this time, limiting exposure to news and information is self-preservation, and while I wouldn’t ordinarily recommend this, less information means more peace of mind.

What these prescriptions have in common is that they are under our control. If we commit to accepting the current circumstances, thinking positively, challenging our bodies and minds, avoiding the news and simply taking a deep breath, we can calm our brains and reduce our psychic pain.