People with Mental Health Conditions More Likely to Use E-Cigarettes

 People with mental health conditions were twice as likely to use electronic cigarettes, according to a new study. They were also three times more likely to be current users of e-cigarettes than people without mental health conditions. About 15 percent of people with mental health conditions had tried e-cigarettes and about 3 percent were currently using them, compared with 6.6 percent and about 1 percent, respectively, among those without mental health conditions. More than 10,000 Americans were surveyed by the study authors, who found that nearly 28 percent of current smokers said they had mental health conditions, compared with about 13 percent of nonsmokers. More than 60 percent of smokers with mental health disorders said they were likely or very likely to try e-cigarettes in the future, compared with about 45 percent of smokers without mental health conditions, according to the findings published online in the journal Tobacco Control. (HealthDay News, 5/13/14)

Prescribing Exercise before Medication

Depression is the most common mental illness—affecting a staggering 25 percent of Americans—but a growing body of research suggests that one of its best cures is cheap and ubiquitous. In 1999, a randomized controlled trial showed that depressed adults who took part in aerobic exercise improved as much as those treated with Zoloft. A 2006 meta-analysis of 11 studies bolstered those findings and recommended that physicians counsel their depressed patients to try it. A 2011 study took this conclusion even further: It looked at 127 depressed people who hadn’t experienced relief from SSRIs, a common type of antidepressant, and found that exercise led 30 percent of them into remission—a result that was as good as, or better than, drugs alone.

Percent of patients in each condition six months after treatment. (Psychosomatic Medicine)

Though we don’t know exactly how any antidepressant works, we think exercise combats depression by enhancing endorphins: natural chemicals that act like morphine and other painkillers. There’s also a theory that aerobic activity boosts norepinephrine, a neurotransmitter that plays a role in mood. And like antidepressants, exercise helps the brain grow new neurons.

But this powerful, non-drug treatment hasn’t yet become a mainstream remedy. In a 2009 study, only 40 percent of patients reported being counseled to try exercise at their last physician visit.

Instead, Americans are awash in pills. The use of antidepressants has increased 400 percent between 1988 and 2008. They’re now one of the three most-prescribed categories of drugs, coming in right after painkillers and cholesterol medications.

After 15 years of research on the depression-relieving effects of exercise, why are there still so many people on pills? The answer speaks volumes about our mental-health infrastructure and physician reimbursement system, as well as about how difficult it remains to decipher the nature of depression and what patients want from their doctors.

Jogging as medicine

“I am only a doctor, not a dictator,” insists Madhukar H. Trivedi, a professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas. “I don't tell patients what to do.”

Trivedi is one of the forefathers of the movement to combat melancholy with physical exertion. He’s authored multiple studies on the exercise-depression connection, and workouts are now one of the many weapons in his psychiatric arsenal. But whether any given treatment is right for a particular person is entirely up to that patient, he said.

“I talk about the pros and cons about all the treatment options available—exercise, therapy, and pills,” he said. “If a patient says, ‘I'm not really keen on medication and therapy, I want to use exercise,’ then if it's appropriate, they can try it. But I give them caveats about how they should be monitoring it. I don't say, ‘Go exercise and call me if it doesn't work.’”

Here’s how he goes about this unconventional type of prescription: “People will take the disease and treatment lightly if they know Paxil is coming.”

First, Trivedi must gently raise the idea of exercise as a treatment option—patients often don’t know to ask. (There are no televised pharmaceutical ads for running, he notes.) He then tells patients about the studies, the amount of exercise that would be required, and the heart rate they’d need to reach. Based on a recent study by Trivedi and others, he recommends three to five sessions per week. Each one should last 45 to 60 minutes, and patients should reach 50 to 85 percent of their maximum heart rates.

He and the patient then blueprint a weekly workout schedule together. Not doing enough sessions, he warns, would be like a diabetic person “using insulin only occasionally.” He encourages patients to use FitBits or other monitoring gadgets to track their progress—and to guilt them off the couch.
Trivedi says this approach rests on three key elements. “One, you have to be very clear with patients that just because exercise has been shown to be efficacious, it doesn't work for everyone. Two, the dose of the treatment is very important; you can't just go for a stroll in the park. And three, there has to be a constant vigilance about the monitoring of symptoms. If the treatment is not working, you need to do something.”

That “something” could be adding antidepressants back into the mix—but only if the workouts have truly failed. “People will take the disease and treatment lightly,” he said, “if they know Paxil is coming.” For more of this article go to
http://www.theatlantic.com/health/archive/2014/03/for-depression-prescribing-exercise-before-medication/284587/

Clinical Issues in Working with Lesbian, Gay, Bisexual, and Transgender and Questioning Youth

Developed by Dr. Gerald Mallon, Executive Director of the National Center for Child Welfare Excellence (NCCWE) and the National Resource Center for Permanency and Family Connections (NRCPFC), this PowerPoint presentation provides an overview of significant developmental issues for LGBTQ youth, explores various clinical issues for LGBTQ youth, and shares intervention strategies and implications for practice.  This presentation was delivered at Grand Rounds for Psychiatric Interns at the Tulane Medical School, New Orleans, Louisiana. (May 2014)
http://www.nrcpfc.org/is/downloads/Tulane.grandrounds.clinicalissues.pdf

"The Value of Peer and Family Support"

In order to increase awareness and help educate Americans about mental health, SAMHSA/CMHS Director Paolo del Vecchio, M.S.W., is releasing a series of blogs that discuss important issues for the behavioral health community and the nation. Mr. del Vecchio's latest post focuses on "The Value of Peer and Family Support":

 

There are many studies that demonstrate the effectiveness of peer support. For example, research has demonstrated that peer support helps improve the mental health of veterans, makes people reduces hospital visits for those with co-occurring disorders, and increases coping skills of families with a family member who has a mental illness. Because of studies like these, SAMHSA, the Department of Veterans Affairs, and over 40 states consider peer and family support an evidence-based practice.

Beyond the numbers, stories from real people who have had their lives changed for the better show how critical it can be. Here’s what one man in recovery named Jeff had to say:

In my adult life, I’ve had about nine serious suicide attempts, and I’ve been hospitalized 15 times (two of which were long-term stays). It wasn’t until the mid-80s that I found really positive treatment after I became involved with a peer support group. I learned a lot from my fellow consumers about medications and therapy that could improve the treatment I’d had….I want to share my story in hopes of giving others with psychiatric disabilities the knowledge that they are not alone and there is hope for the future.

SAMHSA supports the development of peer and family support efforts through National Technical Assistance Centers, Consumer and Family Network Grants, Recovery Community Services Program, and the Alternatives Conference, which is a place where individuals with serious mental illnesses from all over the nation can meet, exchange information and ideas, and provide and receive technical assistance. Peer support services usually operate in conjunction with clinical services which amplify the benefit of treatment by engaging peers in services they might otherwise not accept, offering ongoing support and psychosocial rehabilitation, and encouraging peers to stay in treatment and services by sharing their stories of recovery.

Many peer support services require that they be part of a treatment plan authorized by a “licensed practitioner of the healing arts” such as a psychiatrist, psychologist, or physician in order to be reimbursed by Medicaid under Centers for Medicare and Medicaid Services (CMS) rules. Peer support services are a valuable adjunct to traditional care that are known to contribute to improved outcomes in employment, education, housing stability, satisfaction, self-esteem, medication adherence, and decrease in the need for more costly services, such as hospitalizations. Peer-provided services help to foster recovery, increase treatment and service engagement, reduce acute care use, and improve quality of life.

 

Click on the following link to read more from Mr. del Vecchio's latest blog post: http://blog.samhsa.gov/2014/05/26/the-value-of-peer-and-family-support/#.U4YRXi_gWYV. Please feel free to share this – along with the others in the series that will be published during May - with your networks and help continue the conversation.

People with Mental Illness More Likely to Use E-Cigarettes

New research from the University of California San Diego indicates that people with mental health conditions are twice as likely to have tried e-cigarettes and three times as likely to be current users of the devices, as people without mental health disorders. The frequently debated and highly controversial devices have not been approved by the FDA as smoking cessation aids and have not been demonstrated as effective harm reduction tools. The FDA has released proposed regulations for e-cigarettes, but critical loopholes still exist. Visit the Tobacco Control Legal Consortium’s FDA Action Center to learn more about these issues.

Diverse Leaders Scholarship Program for Executive Directors of Family-Run Organizations

The Family-Run Executive Director Leadership Association (FREDLA) has announced a new Diverse Leaders Scholarship Program for Executive Directors of family-run organizations and authorized leaders of American Indian and Alaskan Native communities. Family leaders from four eligible racial/ethnic communities are invited to apply: American Indian or Alaskan Native, Asian and Pacific Islander, African American/Black, and Hispanic/Latino.

The family-run organizations must be focused on the well-being of children and youth with mental health, emotional or behavioral challenges and their families. One $2,000 scholarship will be awarded to an applicant who belongs to one or more of the four racial/ethnic communities. Deadline to apply is Friday, May 16, 2014.

The FREDLA Diverse Leaders Scholarship Program is a racial/ethnic minority scholarship program to promote diverse leadership within family-run organizations focused on the well-being of children and youth with mental health, emotional or behavioral challenges and their families. The Program seeks to lower financial barriers to training and to highlight the accomplishments of a diverse group of family run leaders. The Diverse Leaders Scholarship Program advances FREDLA's commitment to diversity and cultural competence.

Read more about the program. Read instructions for applying (pdf).

Café TA Center Releases the Second Video in Its Recovery Series

The Café TA Center has announced release of the second video in its ongoing series, Recovery Stories. This series of videos, all of which were assembled from interviews of people with lived experience of mental health challenges at Alternatives 2013, provides a platform for people to share their individual experience of mental health recovery. 

This installment, The Road to Recovery, features individuals sharing their stories of how they first encountered mental health issues, and the fears, hopes and assumptions with which they began their recovery journeys. For Episode 2, click here, https://www.youtube.com/watch?v=rQD6V1wPHQ0&feature=youtu.be.

 For more information and for Episode 1, click here, http://cafetacenter.net/recovery-stories/