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Mental Health
& Medical Professionals Need To Re-examine Customer Service Skills
By Kathleen Howe
It's a newly "recognized" population seeking mental health and medical services in today's world. The statistics say
it all when over 11.7% of the military are currently reacclimating themselves into everyday society with post traumatic stress
disorder, depression and other mental illnesses. Their families also affected need mental health support as well. Other types
of illnesses such as cancer patients, recovering victims of abuse, violent crimes and automobile accidents are all suffering
from mental illnesses as well and are suddenly finding themselves "admitting to their mental illnesses" despite the negative
stigma that mental illness has always entertained. Trusting in the belief that the medical and mental health workers are professional
and educated concerning mental illness - the vast number of patients in this dilemma are hoping they don't regret being so
candid concerning their diagnoses.
With so many people realizing the causes of their daily troubles to be centered
around their brain and how it is or isn't working correctly - isn't it time for the medical and mental health professions
to learn how to deal with these people in a professional, dignified manner? Isn't it time that their mental illness be recognized
as well as the symptoms that might escalate upon injury, loss, accidents, additional traumas and crises that happen to people
on a daily basis? The answer to both questions is clearly a resounding, "yes!" and the time is now for improvement.
Imagine this true story happening within your practice
or associated facilities. A woman who had dealt with abuse, domestic violence, severe trauma and crises her entire life beginning
in early childhood had finally escaped from the victimhood she had embraced for over forty years. Starting her life over after
relocating to a new city where she knew not a single soul, she was properly diagnosed with PTSD, depression and an eating
disorder. After establishing a treatment program of medication and counseling, she began her recovery. Spending an immense
amount of time in self study of mental illness, eating and sleep disorders and lifestyle factors that affect mental and physical
well being; she began to feel comfortable with admitting to others that she in fact experienced PTSD and depression.
Upon
a visit to her dentist office she visited with the office staff and had to overcome a phobia of dealing with financial matters
to speak about a balance which was overdue. She had been handling things so well until this moment when an unexpected repair
had to be made to her home and the money wasn't available for the dentist bill. In good spirits she carefully and slowly explained
the problems to the staff to ask for an extension. Being sure to speak slowly and clearly, being mindful of her breathing
techniques and monitoring her level of stress within her body; she admitted to having the PTSD and depression and reflected
the fact that on her medical chart within the office there were many medications that she was taking on the chart. She explained
that this was what they were for and that she was on a steady journey of personal growth and recovery. She spoke confidently
and announced to the staff how proud she was of herself for making so much positive forward progress.
Quickly the young
woman who was in charge of the billing processes spoke out sharply, stating, "You had better hope you're getting it together!
How can you expect to survive in today's world if you don't get a grip on yourself?"
The cutting tone of the young
woman's voice and the lack of knowledge and understanding concerning mental illness had surprised the patient. She had always
felt comfortable with the office staff, even surprising them with flowers for no special occassion in her quest to perform
random acts of kindness. She was always talking to people about how great her dentist office was tried to bring additional
customers to their practice.
Immediately the patient lost her breath as if someone had literally knocked the wind
out of her and she couldn't look at either of the office girls in her prescence. Quickly leaving the office, she could never
return. She lost track of her positive progress and regressed immediately. The cutting remarks had penetrated the newly formed
confidence of the patient and once again, she had felt herself falling into depression and panic. The exchange put her backwards
at least a year from the progress she had made.
In every avenue of today's life there are opportunities for the professional
community to come into contact with a person who is experiencing a mental illness. Perhaps it's time that employers, hospital
administrations, doctors' offices and even dentist, optometrist and counseling centers begin to teach their employees the
facts about mental illness. It's time that people were forced to become aware of what uneducated service workers might unknowingly
trigger in a mentally ill patient or patron. Even doctors' comments have been overheard by those experiencing mental illness
to be sharp, uncaring and uneducated thus, causing the triggering of additional symptoms to an already unhealthy situation.
Every person on this earth needs to begin to educate themselves if they intend on dealing with any type of public
affairs in their business, community or personal life. Just as we need to begin to educate ourselves on how to take care of
our planet, it's essential that we learn how to take care of each other. The numbers are staggering if you care to examine
them. You can realize the immensity of the problem by viewing any vital statistic material on the Internet concerning mental
health.
Those with mental illnesses may even be experincing physical illnesses due to the fact that their mental illness
had gone unrecognized and untreated. If, in fact, you are not ready to deal with the population that is experiencing a mental
illness, you may want to stop all business affairs until you can learn more about dealing with people who need to be treated
with respect, care and dignity instead of hurting someone unintentionally that is already suffering.
If, in fact, you
are selling products to the public that might not be usuable by those with a mental illness; it's time to think about how
to qualify that population. Nothing is as embarrassing than to be dealing with someone that you would like to purchase a self
help product from and then find out that their product is ineffective if you have been diagnosed with an anxiety disorder
and/or depression. Not only is it embarrassing, it triggers those who aren't ready to recognize their own triggers when someone
is being humiliated or intimidated by an uneducated salesperson.
Believe me, this type of personal interaction is
detrimental to those trying desperately to recover from a mental illness. It's time the reigns of professionalism are pulled
in tighter to include a public that is experiencing a mental illness - a disability - into their considerations for quality
customer service. Look for more of these articles and answers as to how to educate your administrators and employees in their
communications with a very up and coming population!
Author's
Bio: Kathleen Howe, a mother,
wife and writer has a network of self help sites that include information for those working in personal growth and recovery.
Sites cover a variety of topics that include life traumas and crises that Kathleen has experienced and recovered from herself.
Look for her new site which is about to open that covers the same topic that the article above covers - Dealing with the Emergence
of Mentally Ill Patients in the Medical and Mental Health Fields. It's about time the stigma was set aside! Also, visit her
existing network of sites anytime~! emotionalfeelings.tripod.com/emotional_feelings/index.html
just a special note to all my visitors...
do you have children or transport children?
click here... it's an emotional feeling "you tube video" that'll
cause you to be more careful in how you transport your child(ren).
God
Bless...
welcome! to anxieties 101!
after looking things over here at anxieties 101,
try out "the layer down under," (part of the emotional feelings network of sites) & read a special "i
just gotta say it" column concerning porn addiction by clicking here! Be sure to scroll down towards the bottom of the right hand column to find it!
What is Operation Helmet?
Founded in 2003 by Dr. Robert H. Meaders whose grandson is an active duty Marine in Iraq, Operation Helmet is a nonpartisan 501(c)(3) organization dedicated
to providing safer helmet pad upgrade kits to the troops in Iraq & Afghanistan.
To date, more than 6,000 kits have been shipped to the troops in the field.
 
How this site works best for you!
You'll
notice that there are many underlined link words in each article below. The reason for this is that you have reached not only, "the
layer down under that," but the emotional feelings network of sites. There are many
sites included within the network that'll be visited by clicking on these underlined link words.
If you can't find what you came
here looking for, visit the homepage for the emotional feelings network of sites by clicking above & read the options on
the homepage for the networks index of sites. Try to be specific when looking for an emotion or feeling word & click on the site you need!
It's very simple & very
interesting to follow your way thru the layers of your buried or stuffed emotions & feelings that have accumulated throughout the years!
when you've reached this point, or this website, you know you're making
progress!!!! this part gets difficult because now is the time to look within & become emotionally honest with yourself!!!
Best of luck & if you're
still stuck, send me an e-mail anytime, by clicking
here & I'll be glad to send you an immediate personal response!
Sincerely,
Kathleen
  What Causes an Anxiety Disorder?
- By Deanne Repich
"What causes an anxiety disorder?
And which of these causes do I have control over?"
Here are answers to these important questions.
What Causes an Anxiety Disorder?
There are several factors that can contribute to an anxiety disorder.
An anxiety disorder is caused by a combination of several of these factors working together
over a period of time. Usually one factor alone doesn't result in an anxiety disorder.
Several of the contributing factors are:
Biological Factors
We
all have an inborn "fight or flight" response designed to protect us from harm. When our survival is threatened, the fight or flight response creates physical & psychological changes that encourage us to act & protect our survival. These changes include:
People suffering from anxiety
disorders often have a physical overreaction to stress. This overreaction occurs because your body perceives everyday events & situations as threats to survival. In an effort to protect you, your body triggers the fight or flight response even though no real danger exists.
There's some indication that an overreaction to stress is caused by a chemical imbalance in the brain. However, we don't know what initially causes this chemical imbalance.
It hasn't been proven which occurs first - the overreaction to stress that causes the chemical imbalance, or the chemical imbalance that causes the overreaction to stress.
Can I change it?: Yes. What's important to realize is that if you overreact to stress, you can learn to change it, no matter how it began.
You can learn deep breathing techniques, relaxation
techniques & techniques such as the Anxiety Pyramid (all included in our course) to
train your body to react more calmly.
Stress Overload / Lifestyle Factors
When you experience excessive stress over time, your body can trigger the fight or flight response & start to react to daily
events as if they were dangers. Poor lifestyle habits such as overwork, lack of sleep, poor diet & lack of regular exercise
can cause unnecessary stress & promote anxiety.
Let's look at an example of how stress overload & lifestyle factors can contribute to anxiety.
Donna works 70 hours a week for several years. This
puts excessive stress on Donna's body. To make matters worse, Donna is so busy working that she only manages to get 5 or 6
hours of sleep a night, she doesn't exercise regularly & she eats mainly fast food. She
can't remember the last time she took time out for herself.
Do you see how Donna's
lifestyle creates stress in her life & produces a negative snowball effect?
Over time Donna's body starts perceiving these constant
stressors as a threat to her survival. Her body eventually gets "burned out" from repeated unnecessary stress reactions.
It's on a constant state of alert - contributing to
the physical & mental symptoms of anxiety.
Can I change it?: Yes. You have the power to reduce or eliminate many of the stressors in your life. You do this by integrating healthy lifestyle habits - by making choices that promote calmness, self-care & a balanced lifestyle.
For example
-
Sleep 8 hours a night instead of 6.
-
Eat well-balanced, healthy meals.
-
Work 40-50 hours a week instead of 70 & so on.
You can also learn to view stressors in a less anxious way so your body doesn't overreact to stressors when they occur.
Childhood Environment
Your childhood
environment affects how you think & act as an adult. Even though the adults around you meant well, as a child you
may have learned habits & beliefs that contribute to anxiety.
For example, you may not have been taught to have a sense of control over your world. You may have been expected to achieve as a way of gaining love & acceptance.
You may have been taught all or nothing thinking or weren't allowed to freely express your feelings or opinions.
You may have grown up in an environment that wasn't physically or emotionally safe. You may have been frequently judged or
criticized. Or you may have grown up watching & modeling adults around you that reacted to life in an anxious way.
Can I change it?: Yes. No matter what your childhood environment was, you can change the anxiety-producing thought patterns & habits you learned then thru knowledge & practice.
Thought Patterns
How you think affects how you view the world &
how you react to stress. Negative thought patterns like "what-if" thinking, perfectionism, all or nothing thinking & victim talk can contribute to an anxiety disorder. In fact, negative thoughts can actually create physical symptoms in your body.
Can I change it?: Yes. Research shows that you have the power to change your thoughts, which can in turn affect how you physically & mentally feel. Thru healther thoughts, you can learn to view the world in a less anxious way & feel better.
How do you change your thoughts? By using the three "R"s we discussed in the last newsletter: Recognize, Replace & Reinforce.
Genetic Factors
Research shows that panic disorder & obsessive-compulsive disorder tend to run in families. Although there's some debate, it appears that part of this family tendency is due to how you're
brought up (environment) & part is due to genetics. There is some indication that genetic
factors are also involved in social anxiety.
Can I change it?: No. We can't change our genes. That's the bad news. Now here's the good news. You can positively change all of the other factors we discussed that contribute to anxiety.
And like we mentioned earlier, usually one factor alone doesn't result in an anxiety disorder. This is exciting news! It means that if you learn to successfully address the other factors that contribute to anxiety, you can conquer your anxiety in spite of genetic factors.
Note: If you would like to learn skills to change how you react to stress, reduce the stress in your life, learn anxiety-fighting lifestyle habits & change your anxious thought patterns & behaviors, try our Conquer Your Anxiety Success Program, available at:
http://www.ConquerAnxiety.com.
The landmark study is described
in 4 papers that document the prevalence & severity of specific mental disorders. The
papers provide significant new data on the impairment - such as days lost from work - caused by specific disorders, including
mood, anxiety & substance abuse disorders.
These measures will allow
researchers to determine the degree of disability & the economic burden caused by mental illness,
as well as trends over time.
The papers are reported in
the June 6 issue of the Archives of General Psychiatry by Ronald Kessler, Ph.D. & colleagues. The study was
a collaborative project between Harvard Univ., the Univ. of Michigan & the NIMH Intramural Research Program.
This study, called the National
Comorbidity Survey Replication (NCS-R), is a household survey of 9,282 English-speaking
respondents, age 18 & older. It's an expanded replication of the 1990 National Comorbidity Survey, which was the 1st to
estimate the prevalence of mental disorders (using modern psychiatric
standards) in a nationally representative sample.
The expansion includes detailed
measures that will significantly improve estimates of the severity & persistence of mental
disorders & the degree to which they impair individuals & families & burden employers & the U.S.
economy.
"These studies confirm a growing
understanding about the nature of mental illness across the lifespan," says Thomas Insel, M.D., Director
of the National Institute of Mental Health.
"There are many important messages from this study, but perhaps none as important as the recognition that mental disorders are the chronic disorders
of young people in the U.S."
Prevalence & Age-of-Onset
of Mental Disorders
Unlike most disabling
physical diseases, mental illness begins very early in life.
1/2 of all lifetime
cases begin by age 14; 3/4 quarters have begun by age 24. Thus, mental disorders are really
the chronic diseases of the young.
For example, anxiety disorders often begin in late childhood, mood disorders in late adolescence & substance abuse in the early 20's. Unlike heart disease or most cancers, young people with mental disorders suffer disability when they're in the prime of
life, when they would normally be the most productive.
The risk of mental disorders
is substantially lower among people who have matured out of the high-risk age range. Prevalence increases from the youngest
group (age 18-29) to the next-oldest age group (age 30-44)
& then declines, sometimes substantially, in the oldest group (age 60 +).
Females have higher rates of mood & anxiety disorders. Males have higher rates of substance use disorders & impulse disorders.
The survey found that in the
U.S., mental disorders are quite common; 26% of the general population reported that they
had symptoms sufficient for diagnosing a mental disorder during the past 12 months. However, many of these cases are mild
or will resolve without formal interventions.
It's likely, however, that
the prevalence rates in this paper are underestimated, because the sample was drawn from listings of households & didn't
include homeless & institutionalized (nursing homes, group homes) populations.
In addition, the study didn't
assess some rare & clinically complex psychiatric disorders, such as schizophrenia & autism, because a household survey
isn't the most efficient study design to identify & evaluate those disorders.
Failure & Delay in Initial Treatment Contact
The study documents
the long delays between the onset of a mental disorder & the first treatment contact, as well as the accumulated burden
& hazards of untreated mental disorders.
These pervasive delays in getting treatment tend to occur for nearly all mental disorders, though they vary according
to specific diagnostic categories. The median delay across disorders is nearly a decade; the longest delays are 20-23
years, for social phobia & separation anxiety disorders. This is possibly due to the relatively early age of onset & fears of therapy that involve social interactions.
Shorter delays between onset
of disorder & treatment seeking - still a protracted 6 - 8 years - are seen for mood disorders & are likely attributable to public awareness campaigns, the marketing of newer therapies directly to consumers & expanded insurance coverage.
While approximately 80% of all people in the U.S. with a mental disorder eventually seek treatment, there
are public health implications from such long delays in treatment.
Untreated psychiatric disorders
can lead to more frequent & more severe episodes & are more likely to become resistant to treatment.
In addition, early-onset mental
disorders that are left untreated are associated with:
- school failure
- teenage childbearing
- unstable employment
- early marriage
- marital instability
- violence
"The
pattern appears to be that the earlier in life the disorder begins, the slower an individual is to seek therapy & the
more persistent the illness," said Dr. Kessler, a professor of health care policy at Harvard Medical School. "It's unfortunate that those who most need treatment are the least likely to get it."
Treating cases early could
prevent enormous disability, before the illness becomes more severe & before co-occurring mental illnesses develop, which
only become more difficult to treat as they accumulate, according to the researchers.
Severity & Comorbidity of Mental Disorders
The second paper reports
that even though mental disorders are widespread throughout the population, the main burden of illness is concentrated in
those with a severe disorder - about 6%.
A "serious" disorder
involves a substantial limitation in daily activities or work disability, or a suicide attempt with serious lethal intent,
or psychosis. The serious group reported a mean of 88.3 days - nearly 3 months of the year - when they were unable to carry out their normal daily activities.
Unfortunately, say the researchers,
individuals with 1 mental disorder are at a high risk for also having a 2nd one (comorbidity).
Nearly 1/2 (45%) of those with one
mental disorder met criteria for two or more disorders, with severity strongly related to comorbidity. This finding
supports the suggestion by a growing portion of researchers that the boundaries between some diagnostic categories may be
less discrete than previously believed.
Use of Mental Health
Services
The study indicates that the U.S. mental health care system isn't keeping up with the needs of consumers & that improvements are needed to speed initiation of treatment as well as enhance the quality & duration of treatment.
For instance, over a 12-month period, 60% of those with a mental disorder got no treatment at all.
The good news is that the
proportion of people who reported 12-month mental health service use is higher now - at 17% - than a decade ago in the baseline
NCS survey, at 13%. The expansion was mainly in the general medical sector, with more primary care physicians providing psychiatric
services.
People with mental or substance abuse disorders were more likely to get treatment from:
- a primary care physician/nurse or other general medical doctor
(22.8%)
- from a non-psychiatrist mental health specialist (16%)
- a psychologist, social worker, or counselor, than from a psychiatrist
(12%)
though the survey did show that the adequacy of treatment -
measured by number of visits - is best when provided by mental health practitioners.
About 9.7% sought help from
a counselor or spiritual advisor outside of a mental health setting;
& 6.9% used a complementary-alternative source, such as a chiropractor or self-help group.
This held true even for those
with severe mood disorders. Traditionally underserved groups, such as the elderly, racial/ethnic minorities & those with low income or without insurance, had the greatest unmet need for treatment.
Future & Ongoing Efforts
The NIMH epidemiological
research portfolio contains several related projects that are focused on mental disorders among adolescents & ethnic subgroups. These include
1) an arm of the
NCS-R that is studying 10,000 youths
2) the National
Study of African American Life, with 6,000 participants
3) the National
Study of Latino & Asian Americans, with 5,000 participants
Each of these,
like the NCS-R, will provide information on diagnosis, medications, disability / impairment & service use, drawing from
nationally based samples.
An international perspective
on these findings is also becoming available, as the study is part of a global initiative on the epidemiology of mental disorders
in 28 countries, coordinated through the World Health Organization.
The Impact of Mental Illness on Society
"...the burden of psychiatric conditions has been heavily underestimated..."
The burden of mental illness
on health & productivity in the U. S. & throughout the world has long been underestimated. Data developed by the massive
Global Burden of Disease study conducted by the World Health Organization, the World Bank & Harvard University,
reveal that mental illness, including suicide, accounts for over 15% of the burden of disease in established market economies, such as the U.S.
This is more than the disease burden caused by
all cancers.
This Global
Burden of Disease study developed a single measure to allow comparison of the burden of disease across many
different disease conditions by including both death & disability.
This measure was called Disability
Adjusted Life Years (DALYs). DALYs measure lost years of healthy life regardless of whether the years were lost to
premature death or disability. The disability component of this measure is weighted for severity of the disability. i.e.,
disability caused by major depression was found to be equivalent to blindness or paraplegia whereas active psychosis seen in schizophrenia produces disability
equal to quadriplegia.
Using the DALYs measure, major
depression ranked second only to ischemic heart disease in magnitude of disease
burden in established market economies. Schizophrenia, bipolar disorder, obsessive-compulsive disorder, panic disorder & post-traumatic stress disorder also contributed significantly to the total burden of illness
attributable to mental disorders.
The projections show that
with the aging of the world population & the conquest of infectious diseases, psychiatric & neurological conditions
could increase their share of the total global disease burden by almost half, from 10.5% of the total burden to almost 15%
in 2020.
Facts
- Major depression is the leading cause of disability
(measured by the number of years lived with a disabling condition) worldwide among
persons age 5 and older.
- For women throughout the world as well as those in established
market economies, depression is the leading cause of DALYs. In established market economies, schizophrenia & bipolar disorder are also among the top 10 causes of DALYs for women.
click here to view chart
A Child's Death Increases Parents' Risk of Mental Illness
Bereaved parents, especially parents of children who die unexpectedly, are at increased risk of developing
a number of mental disorders, especially affective disorders.
Research suggests that mothers have a greater risk than fathers. Encourage both parents to seek professional help following the death of a child, but closely monitor mothers.
Review
LOS
ANGELES - When a child dies - especially when the death is unexpected - surviving parents
have a 67% higher risk of hospitalization for mental illness
than do parents who never experience the death of a child.
What's more, mothers are especially
vulnerable, Jørn Olsen, MD, PhD & colleagues reported in Thursday's New England Journal of Medicine.
The likelihood that grieving mothers will be hospitalized for affective disorders such as clinical depression, bipolar disorder or anxiety is almost twice that of mothers who don't experience the death of child, says Dr. Olsen, who is chairman of epidemiology
at the UCLA School of Public Health.
He says that for mothers this
increased risk was almost double (91% greater) than of mothers who didn't lose a child.
The risk is greatest during the first year after the child dies but remained significantly elevated 5 years or more after
the death.
"We also found a dose
effect - mothers who lose more than one child, have a greater risk," he says.
For fathers, the risk of a
mental health hospitalization is 61% higher than for fathers who don't lose a child, says
Dr. Olsen.
Coincidentally, the study
comes at a time when the nation is riveted by 2 news stories of struggling parents: Bob & Mary Schindler who continue
a legal crusade to keep their brain damaged daughter alive.
At the same time, there are
the grieving parents of 6 high school students who were killed Monday in a shooting incident at Red Lake High School in Red
Lake, Minn.
Dr. Olsen says
the study results suggest the need for close monitoring of parents of the slain high school students because parental bereavement risks are greatest when death
occurs suddenly.
Elizabeth Berger MD, speaking
for the American Psychiatric Association, says the study findings confirm her own observations from years of practice. "The
loss of a child is uniquely devastating," she said. "It is the worst thing."
Dr. Berger, who is the author
of "Raising Children With Character," says the "take home message for physicians is that the bereaved parents remain an at
risk group on all measures - psychiatric hospitalization is just one crude measure of this continuing risk."
The mental illness
study is the last in a series of studies by Dr. Olsen & a team researchers from Denmark, all of which investigated
the "the general hypothesis of whether stress could trigger mental or physical disorders."
He says they decided to investigate
bereaved parents because it was considered "the highest stress exposure."
In earlier papers they reported
increased risk of mortality - especially accidental death & suicide & increased risk of cardiovascular disease among bereaved parents. In both cases, Dr. Olsen says, the increased risk was greatest for mothers.
In this study, Dr. Olsen's
team identified 1,082,503 persons who were born in Denmark from 1952 to 1999 & who had a child 18 years old or younger
during the study period from 1970 to 1999. Birth & death registries as well as medical records were analyzed to confirm
childhood mortality & health status of parents.
Among the findings:
- Compared with
parents who didn't lose a child, parents who lost a child had an overall risk of first psychiatric hospitalization for any
disorder of 1.67 (95% CI 1.53-1.83).
- Bereaved mothers had a higher
risk for any psychiatric hospitalization: 1.78 compared with bereaved fathers 1.38.
- For bereaved mothers risk
of hospitalization for affective disorders is 1.91 (95% CI 1.59 to 2.30) vs. 1.61 (95% CI 1.15 to 2.27) for grieving fathers.
Dr. Olsen says the study has
a number of limitations that may over-estimate or underestimate the effect of a child's death: The authors couldn't adjust
for family history of psychiatric illness or socioeconomic status - both factors that could bias the results.
"Confounding might also be
possible it a shared genetic predisposition led to both the death of the child & psychiatric hospitalization in the parent…"
the authors write.
As the study included only
patients who were hospitalized, it's possible that it underestimated incidence rates for overall psychiatric illness.
The study was supported by grants form the Danish National
Research Foundation & the Danish Medical Research Council to the Danish Epidemiology Science Center & the National
Center for Register-Based Research.
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