Psychiatrists can get compassion fatigue

This article comes from www.dallasnews.com website, posted on November 8, 2009. It was written by Gregg Jones and Lee Hancock

Maj. Nidal Malik Hasan had never set foot in Afghanistan or Iraq when he allegedly pulled out a semiautomatic pistol and began shooting his comrades at Fort Hood.

But as an Army psychiatrist, caring for soldiers scarred by both wars, Hasan had experienced the conflict almost as if he had been in the combat zone for the past six years, psychiatrists and traumatic stress experts said.

“Many of the soldiers you evaluate and treat talk to you about horrific events,” said Dr. Daniel Amen, a former Army psychiatrist who, like Hasan, once worked at Walter Reed Army Medical Center. “Psychiatrists can develop something called compassion fatigue. You just get worn out by the trauma.”

At its worst, compassion fatigue becomes secondary trauma – a condition similar to post-traumatic stress, mental health experts said.

“They may not see combat themselves … but they see the outcome of it and they hear the stories of it day in and day out,” said Rep. Tim Murphy, R-Pa., a psychologist in the Navy Reserves. “It can be very real when you are dealing with people’s difficulties every day.”

An uncle of the 39-year-old shooter said Saturday that the work clearly weighed on Hasan.

‘Tears in his eyes’

“I think I saw him with tears in his eyes when he was talking about some of [the] patients, when they came overseas from the battlefield,” Rafik Hamad told The Associated Press from his home near the West Bank town of Ramallah.

Hasan also was torn between his religion and his military service, officials and acquaintances have said, and stressed about his imminent deployment to Afghanistan – a place “where all these terrible things he had heard about had taken place,” Amen said.

While it’s not yet clear what might have factored into Hasan’s alleged attack on fellow soldiers Thursday, secondary trauma has been sparingly addressed in the military and civilian worlds, experts said.

“There have been a lot of cases and stories of those who just couldn’t take it any longer and were transferred,” said Charles Figley, a traumatic stress expert and former Marine who consults on the subject for the Pentagon. “And for those who are active duty, your career is over in that area if you transfer.”

Emotionally drained

An acute shortage of trained mental health workers in the military has left these therapists emotionally drained and overworked, with limited time to prepare for their own war deployments.

A military mental health task force in 2007 expressed concern about the stress on nondeployed mental health personnel because of the shortage, which it said was leading to high attrition rates. “A vicious cycle has formed that will probably continue to worsen before it improves,” the report said.

Dr. Layton McCurdy, a psychiatrist and dean emeritus at the Medical University of South Carolina who served on the task force, said the shortage is compounded by the thousands of troops suffering combat-related stress. “The psychiatrists are working with more people than they have time to work with,” McCurdy said.

Post-traumatic stress is in essence a memory-management problem – an “inability to effectively manage the frightening experiences they’ve had,” said Figley, who has conducted pioneering research on secondary traumatic stress at Tulane University. “It comes out in flashbacks, sleeping problems, being on edge.”

Secondary trauma causes similar symptoms: sleep disruptions, nightmares, depression and jumpiness. Sufferers may avoid situations that remind them of past stresses. A mental health practitioner also may feel guilty about not having done more to help a patient or may obsess about individual patients – particularly those with whom they identify.

One noted study found that social workers who treated survivors, victims’ families and first responders at the World Trade Center after 9/11 were most susceptible to secondary trauma if they lacked social support.

Suicide risk

Doctors generally have relatively high suicide rates, with psychiatrists having the highest rates.

Both male and female physicians are significantly more likely to commit suicide than the rest of the population, according to a 2004 article in the American Journal of Psychiatry. Among all physicians. Psychiatrists are considered to be at greatest risk for suicide, according to the 2007 version of Kaplan and Sadock’s Synopsis of Psychiatry.

Secondary stress poses more potential risks for military personnel – especially psychiatrists, said the study’s principal investigator, public health researcher Joseph Boscarino of the Geisinger Health System in Danville, Pa.

“They are at high risk,” said Boscarino, a Vietnam veteran and defense consultant.

No pleas for help

In 2008, the trend of military suicide rates being historically lower than the civilian population reversed, according to the National Institutes of Mental Health. In the first nine months of 2009, the Army reported 117 confirmed or suspected cases of suicide among active-duty personnel, compared with 103 over the same period in 2008.

If Hasan was suffering from the stress of secondary trauma, he told no one, military officials said. That would not be unusual for the medical profession, according to the experts.

“Doctors are the No. 1 profession for suicide,” Amen said, but “doctors don’t ask for help.”

The Associated Press contributed to this report.

gjones@dallasnews.com;

lhancock@dallasnews.com

What is Normal in Mental Health?

by Deborah Mitchell at emaxhealth.com on Oct. 28.

Approximately 26.2 percent of Americans age 18 and older suffer from a diagnosable mental disorder in a given year, but how do you decide what’s normal or not normal when it comes to mental health? How do you know if your feelings of sadness or anxiety or occasional panic are signs of mental illness or that your state of mental health is normal?

First of all, the 26.2 percent statistic provided by the National Institute of Mental Health, which translates into 57.7 million people, can be shaved down significantly when you consider that the proportion that suffer from a serious mental illness is only 6 percent—still a substantial number but significantly less than 26.2 percent.

Second, determining whether what you are feeling is considered normal mental health or an indication that you should seek advice from a mental health professional is not always easy. Unfortunately, some people still believe it is a sign of weakness or a stigma to have or admit having a mental illness. This belief prevents them from seeking and getting advice or treatment that could benefit them greatly. Many people also do not know where to turn to get the information they need to make a decision about whether they should seek further help.

People who try to diagnose themselves and determine if their feelings and behaviors are normal will likely only become more frustrated and confused. It is not easy to distinguish normal mental health from a diagnosable mental illness because there is no one easy test anyone, even mental health professionals, can use to make that determination. Mental health providers gather much of the information they need by talking with the individual who is experiencing some mental health issues.

To help them make a diagnose, mental health providers use the Diagnostic and Statistical Manual of Mental Disorders (DSM), which defines mental disorders as “behavioral or psychological syndromes or patterns that cause distress, disability in functioning, or a significantly increased risk of death, pain or disability. And that syndrome or pattern can’t just be an expected and culturally accepted response to a particular event, such as grieving the death of a loved one.” As you can see, this definition still does not provide a precise idea of what normal mental health is.

So what can you do to help you decide what’s normal? You can begin by turning to various mental health individuals, agencies, organizations, and groups to get information and guidance to determine whether what you (or a loved one) are experiencing is something that requires or would benefit from treatment, be it support groups, counseling, some type of psychotherapy, alternative therapies (e.g., biofeedback, guided visualization, meditation), medication, or a combination of these and other approaches.

The best place to begin is by consulting your family physician or another physician you trust. If you know any counselors, therapists, or other mental health professionals, including religious or spiritual counselors, you can contact them for a consultation. You might also contact any one or more of the following organizations. This is only a representative list; there are other organizations that focus on mental health issues that can provide professional information and guidance.

Looking Ahead to 2010

Mental Health America of Northeast Georgia will soon finalize its calendar for 2010. We’re looking now at the projects we will take on in the new year and the work to bring these projects to fruition.

Typically, we have the following events:

The Mental Health Benefit, which is held the last week of January;

Mental Health Day at the Capitol, which takes place in February;

Mental Health Month in May;

The Mental Health Banquet, near the end of June;

Mental Illness Awareness Week, which is in October; and,

Mental Health Wellness Week, which is in November.

In addition, we will have monthly presentations on a variety of topics. These presentations are scheduled for the auditorium at Athens Technical College.

I am scheduling our participation in local events, such as The Human Rights Festival and AthFest. I am talking with folks at Advantage Behavioral Health Services about doing some social events for clients.

If you have suggestions for other projects, please contact us.

Colleges see rise in Mental Health Issues

by Deborah Franklin

They may not tell their roommates or even close friends, but on college campuses all across the United States, more students than ever before are seeking psychiatric help, according to recent national surveys of campus therapists.

And it’s not just for homesickness and relationship problems, says the University of Michigan’s Daniel Eisenberg. He directs the Healthy Minds Study, a multicenter study that queries counselors about, among other things, the prevalence of clinical depression, anxiety and eating disorders on campus.

“One of the questions is whether they’re seeing an increase in the number and severity of students with mental health problems,” Eisenberg says. “And over 90 percent [of college counseling services] are saying yes to that question.” Just one example: In 2007, around 15 percent of students reported having been diagnosed with depression at some point in their lives; that’s up from 10 percent in 2000.

Read the whole story here:

From NPR: http://www.npr.org/templates/story/story.php?storyId=113835383

Smoking by Pregnant Mom Linked to Psychosis in Children

from US NEWS & WORLD REPORT
If women need yet another reason to avoid smoking during pregnancy, researchers now say that tobacco use by expectant mothers may raise the risk that their children will develop psychotic symptoms.

Go here to read the whole article: http://health.usnews.com/articles/health/healthday/2009/10/01/smoking-in-pregnancy-linked-to-psychotic-symptoms.html

Making Mental Health Part of “the Physical”

New Movements Seek to Introduce Preventive, Mental Health Care in New Settings

This article comes from the Kaiser Health News website.

A nationwide effort to coordinate mental health with primary care is underway, The Philadelphia Inquirer reports. “The idea is to give simple interventions in 15- to 30-minute visits that will address behavioral issues ranging from stress to traumatic reactions that often go untreated.” Some clinics have coupled licensed social workers with their other clinical staff; the mental health experts provide services while patients and family members receive physical care. “Insurers, however, have been slow to pay even for brief visits, so the model is catching on mostly in settings where the same entity provides insurance and medical care: Kaiser Permanente in Northern California, federally funded health centers such as 11th Street, and Veterans Affairs medical centers” (Sapatkin, 9/28).

A separate “growing movement supported by key lawmakers and health industry leaders” is meant to turn “health care upside down” by “keeping people well … in the first place,” The Florida Times-Union reports. The president of one Jacksonville, Fla., company says, “Everyone’s talking about prevention, but a year ago it was one line in the Republican Party platform and three in the Democratic Party’s.” However, experts are still on the fence about whether or not the efforts will lower costs. The company, Preventive Medicine, offers packages that cover screening, telephone consultations with nurses, and online information for $60 to $450 per year, per person. The costs are often paid by employers (Cox, 9/28).

Family Mental History Shadows Children: an MSNBC report

by Melissa Schorr

Patrick Tracey watched helplessly as his two older sisters, mother and grandmother were all felled by the brutal blow of schizophrenia.

“It hits like a comet, the impact is so devastating,” says Tracey, who spent his 20s fearing inheriting the disease himself, and later, watching romantic relationships fizzle over his reluctance to pass that burden onto any children.

“Even though I could still have children, I won’t,” says the 51-year-old Boston-based author, whose book, “Stalking Irish Madness,” traces the roots of his family’s mental illness to the same town in Ireland where a genetic link to schizophrenia was first pinpointed. “The quest convinced me that I’d be insane — pardon the pun — to have kids.”

Go here to read the entire story:

MENTAL ILLNESS IN THE FAMILY

Stigma in Politics and Business: A Report from England

from the Guardian:
by Sarah Boseley

Gordon Brown may have emphatically denied he is taking prescription drugs, but the furore around Andrew Marr’s questioning of his health has underlined that there is still a stigma surrounding mental health conditions as well as widespread ignorance of their causes and effects.

Dr Peter Byrne, chair of the Royal College of Psychiatrists’ public education committee, says high-fliers, such as chief executives with jobs that put them under pressure, are not necessarily more prone to mental ill-health than others. “They are a very self-selecting group who choose that particular line of work,” he said. He also points out that the unemployed are more likely to suffer problems than the employed.

Stress also has positive and negative effects. Typically it triggers a “fight or flight” response. The pressure of deadlines or decision-making can concentrate the mind and bring out the best in an executive. Some people appear to be able to deal with continuous extreme stress – there are examples of those who have been in combat zones or taken hostage with apparently no ill effects. “There is a very small proportion of the population who can deal with anything, but most of us have a breaking point considerably short of that,” he said. “It is not only the stress itself, but what that person perceives the stress to be.”

Jonathan Naess, a successful corporate financier, came through mental illness and returned to work to carry on making hundreds of thousands of pounds for his employer. He now runs an organisation called Stand to Reason, which campaigns for more openness about the mental health of those at the top of the career ladder.

He deplores the tendency to turn the suggestion of mental ill-health into slur and gossip. “We would say that people’s mental health should be treated on an equal basis with their physical health,” he said.

One Sunday in 1998, Kjell Magne Bondevik found he could not get out of bed. He realised he was too depressed to go to work and needed a break. The problem was that he was Norway’s prime minister. Bondevik did something that is inconceivable in Britain today. He went public about his depression and took time off to recover. Not only was his return to his job welcomed by a sympathetic public, but he won another election.

Creative Consultants 2010

This week we will be joined by our team of public relations experts from the University of Georgia, Creative Consultants.

Last year’s team did a great job for us, but this year’s team faces new challenges as well as new opportunities.

We are going to be looking at increasing public awareness of our organization specifically and mental health generally.

In addition to print and broadcast media, Mental Health America of Northeast Georgia is looking to launch a Twitter project that will give positive mental health information daily to its subscribers.

If you would like to be part of this or any of our other efforts, please contact us.

Jewel Norman

I attended a meeting in Atlanta yesterday to discuss legislative priorities for the coming session of the General Assembly. Among those taking part was Jewel Norman. Here is the press release from July regarding her appointment as the disability ombudsman:

ATLANTA – Governor Sonny Perdue announced today that he has appointed Jewel Norman as the State Disability Services Ombudsman. Norman will assume the position on July 16.

“Along with creating a stand alone agency for developmental disabilities, the appointment of Jewel Norman as the mental health ombudsman is another step in improving the state’s care and delivery of services to the mental health community,” said Governor Perdue. “Ms. Norman has a wealth of public and private experience managing human services.”

The mental health ombudsman is a five year appointment. In January, the Governor organized a committee to nominate candidates for ombudsman. Member of the committee included Mary Burns, Nora Haynes, Tommy Hills, Vernon Keenan, Sharon McDaniel, Don Meck and Gwen Skinner.

“I look forward to working with the advocacy and provider community to promote system-wide improvements in mental health, developmental disabilities and addictive disease,” said Norman.

The ombudsman will investigate and make recommendations to the department and other agencies, establish a uniform state-wide complaint process, collect and record data relating to complaints with regard to service providers, recommend law and policy changes, and make a biennial written report documenting types of complaints reported by consumers.

“This is a great day for people with mental illness and co-occurring disorders and their families,” said Nora Haynes, President of the Georgia chapter of the National Alliance on Mental Illness.

Jewel Norman has served as Chief Operating Officer and Chief Executive Officer of a large private for profit residential treatment facility. She has also served as a regional vice president of a psychiatric hospital corporation and served as interim CEO for a number of larger comprehensive psychiatric hospitals. Norman received her undergraduate degree from the University of Mary Washington and master’s degree from the University of Virginia.