Health File: Mental Health July 2018

health file A supplement to The Daily Reflector

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Mental Health

Anxiety, resilience & mental hygiene Mental health & your eyes Phototherapy

Spirituality Integrated Pediatric Care Just one conversation can help save a life How to help socially isolated seniors Intimate Partner Violence July 2018

MENTAL HEALTH

Anxiety, resilience

& mental hygiene

By Dr. Francisco Limon Behavioral Health Director, Greene County Health Care

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e have no reported evidence that the rate of anxiety disorders has changed in recent years. We do know we can prevent or easily and effectively treat most forms of anxiety.

Anxiety symptoms can be mild and very manageable. In fact, most people with mild anxiety never seek treatment and get well or manage on their own. People with more severe and persistent symptoms might have issues with daily functioning, both at work and at home.

People with clinical symptoms of anxiety often report severe difficulty sleeping, excessive worry, high irritability, and the sense that something is really wrong with their health.

Anxiety symptoms can easily become physical. People with more severe anxiety might experience random pain that is medically unexplained - chest discomfort, muscle tension and headaches, among others. Because anxiety becomes physical, people begin to believe they have a medical condition. When health care professionals can’t find the reason for the physical symptoms, people start believing they might have a serious, possibly fatal, illness. That belief and fear then increases the intensity of the symptoms.

When a person’s anxiety symptoms go untreated, those symptoms affect how the person interacts with his or her family, close friends and co-workers. People with anxiety may become easily irritable, resulting in a hostile environment and leading family members, friends and co-workers to dis-

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tance themselves. Families may begin to experience more frequent, severe and unresolved conflict. Once established, these family dynamics may last for years or even generations.

Anxiety can be very costly to the individual, their families and their employers.

Besides the immediate cost of treating the symptoms, individuals with anxiety may be more distracted, tired, or careless, resulting in work accidents and the destruction of property, personal injury and lost productivity. Highly anxious people tend to miss more work days than non-anxious people.

The cause could be that they don’t feel well enough to perform their duties, they attend more doctors’ appointments, or both.

The good news is that resilient people can successfully adapt to life stressors and either prevent stress from turning into anxiety or recover from anxiety. Sometimes they can recover on their own and sometimes they might require adequate and timely treatment.

HERE ARE SOME FACTORS THAT MAKE PEOPLE RESILIENT: • Good mental functioning - the ability to make sense of what happens to them and stop or change irrational thoughts • The ability to regulate their emotions, or calm themselves when distressed • The ability to seek and secure positive support from people who are important to them • A positive concept of themselves

• Optimism • Selfless concern for the well-being of others, called altruism • The ability to transform a traumatic experience into productive action • Effective strategies to manage stress

What is particularly important about these resilience factors is that we can learn them. You can practice these skills on your own or you can do it with the guidance of a skilled professional.

– Dr. Francisco Limon is the Behavioral Health director at Greene County Health Care (GCHC), which includes James D. Bernstein Community Health Center in Greenville. Dr. Limon holds a PhD in Medical Family Therapy from East Carolina University.

GC HC

THE NUMBERS RELATED TO ANXIETY DISORDERS ARE STAGGERING: • Costs the U.S. more than $42 billion a year, says The Economic Burden of Anxiety Disorders • $42 billion a year is almost a third of the $148 billion total costs for mental health in the U.S • Estimates show that nearly 34% of the adult population is affected by a type of anxiety disorder during their lifetime • Nearly 25% of adolescents may suffer from an anxiety disorder in a 24-month period

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Health File: Mental Health — July 2018

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MENTAL HEALTH

& your eyes

Mental health

By Dr. Jennifer Fishel

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here is a well-established link between poor eye health and mental health. It is important that those involved with eye care be aware of this. Poor health in general can be a detrimental factor to the health and vision of your eyes. Starting at birth, nutrition and vitamin supplements coupled with pediatric care will give your child the best possible outcome for healthy eyes.

Pediatricians and Optometrists working with pediatric patients work well together to discover abnormalities early and find solutions to correct eye tracking and strength. Eye turns or weak eyes may be discovered and corrective measures can be taken. Other, more serious, eye health issues such as cancerous moles and tumors as well as even glaucoma can also be detected and treated. Through programs like InfantSEE, your baby can be given an exam around 6 months. Most children by age 5 should have an exam; certainly earlier if parents notice problems or have concerns.

Establishing a baseline early will serve a child well when they are school age. If a child enters the school years unable to see to their full potential, they may take on

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but it requires discipline for the care and use of them. The rewards of seeing properly enable your child to grow and thrive with sports interests, the arts, and in academics: All of which aids in the development of self esteem and promotes socialization as well as provides outlets to be creative or relieve frustrations. For most sporting activities, protective eyewear is recommended in general and in particular with contact lens usage. Protective eyewear can also shield eyes from UV and blue light.

Your eye doctor is a good starting point should you notice a change in your child’s mood, behavior or temperament. Since the eyes are a direct window to the brain, mental and behavioral concerns can be addressed via a holistic approach with an inclusionary partnership of pediatricians, sociologists, and behaviorists.

Children are not the only ones impacted by the mental aspect of poor vision. Adults can also go through bouts of depression and social anxiety. As a fully functioning adult that is suddenly hit with being less

than perfect or having serious eye disease, this change can result in changes in outlook and behavior. Ensuring that everyone has a team of advocates around them will often mitigate changes such as total or partial blindness, as well as a progressively degenerative issue. Finding support groups is a great way to see how others have dealt with the issue and assist in finding workarounds to the day to day activities that are feeling further removed from what was once normal.

There is more to an eye doctor’s office than an optical shop. And there is more to eye doctors than “better or worse” or “one or two”. Optometrists, like other professional physicians, have to look at the whole picture to adequately make an informed decision or plan. So the next time you pass by an eye doctors office, hopefully you will think of them when concerned with your own or a loved ones behavioral or mental condition.

– Dr. Jennifer Fishel, Owner, Jennifer Fishel, OD, PA

characteristics commonly associated with ADD, ADHD, Autism and other behavioral/ mental diagnoses. Understanding their vision and finding ways to correct it could be a quick and prudent remedy prior to behavior modification or pharmacological solutions. Labeling a child is tough on parents and children.

Having a child erroneously labeled for only having a vision issue can be traumatic as well.

However, if properly diagnosed and medication is part of their treatment, be aware that side effects of medication can cause dry eyes or blurred vision.

Leaving these issues unaddressed or wrongly diagnosed, could lead to social withdrawal and depression. While these are legitimate concerns, evaluating their vision will help to unmask symptoms and make it easier for mental health professionals to create a true diagnosis and a path forward.

Glasses are often stigmatized by adults and children. Parents can turn inward and take the need for glasses as a sign of personal weakness and children see it as a way to tease. Getting your child use to eyewear early will often allay such fears and help them cope with possibly being teased by other kids. Contacts can be worn by older kids,

Health File: Mental Health — July 2018

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MENTAL HEALTH

Phototherapy: A new mental health treatment option

By Alida Lee and Kellie Brown, Phototechnicians AdvantageTherapySolutions.com

oxide they cannot take in oxygen, and consequently cannot function properly.

Phototherapy stimulates the mitochondria to release nitric oxide. As a result, the cell can take in oxygen and produce ATP. ATP is cellular energy which allows the cell to function properly. When oxidative stress is relieved, the nitric oxide that is released from the cell floods the blood stream, causing dilation of blood vessels and increased circulation.

Phototherapy and Mental Health

Photons aimed at the brain relieve oxidative stress in the brain. When oxidative stress is relieved, a chain reaction of metabolic effects leads to an increase in reenville, NC has an exciting blood flow and a reduction in inflammanew mental health treatment tory cytokines. According to a 2006 Trends option with no risk, no pills, in Immunology article “Cytokines Sing the and no side effects. The Blues”, pro-inflammatory cytokines contreatment is called phototherapy. You tribute to the physiological state in the may have already heard of this therapy brain which fuels depression. In fact, when under a different name, such as light pro-inflammatory cytokines were admintherapy. It sounds too good to be true, istered to healthy patients, 50% developed doesn't it? Shine light on me and I feel symptoms of depression. It makes sense, better? Must be snake oil. Phototherapy therefore, that a treatment that increasproviders use specifically calibrated de- es blood flow and reduces inflammatory vices that deliver photons at wavelengths cytokines in the brain would also reduce proven to stimulate a biological cellular depression. change. Phototherapy has been extensively researched and is proven to be a safe and effective treatment for a multitude of mental and physical conditions.

Phototherapy improves neurogenesis, while decreasing oxidative stress and inflammation in the brain. It should come as no surprise, then, that phototherapy improves cognitive function. In 2013, neuroscience researchers at the University of Phototherapy is the use of light emit- Texas at Austin administered transcranial ting diodes (LED) to stimulate cells with infrared laser phototherapy to healthy subwavelength-specific photons to heal the jects to see if it would improve their cogbody on the cellular level by relieving ox- nitive function. In this randomized, plaidative stress. Oxidative stress is a condi- cebo- controlled study, researchers found tion in which healthy cells become clogged that phototherapy improved reaction time, with nitric oxide due to injury, stress, and memory, and emotional functions in their aging. When cells are clogged with nitric test subjects.

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Cognitive Enhancement

How Does Phototherapy Work?

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Health File: Mental Health — July 2018

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Chronic Pain Management

Working with Mental Health Providers

Chronic pain and depression often go hand-in-hand. According to the American Pain Foundation, about 32 million people in the U.S. report chronic pain, and more than half of those patients also have depression. Phototherapy providers treat chronic pain in two ways: reducing inflammation, and inducing analgesia. In low doses, phototherapy relieves oxidative stress in cells, increases blood flow, and reduces inflammation. In high doses, phototherapy induces analgesia by disrupting axonal transport in nocireceptors. In other words, photons interrupt pain signals to the brain. This is temporary and reversible, however repeated treatments can lead to reduced central sensitization.

It is easy to incorporate this treatment option into your mental healthcare plan.

Phototherapy can be done in conjunction with any other mental health treatment modality already in place. That means a patient doesn't have to stop any medications or therapies to receive benefits from phototherapy.

A Healthy Brain These therapies have been proven to reduce brain inflammation, reduce depression symptoms, boost cognitive function, and manage chronic pain. By addressing biological changes or injuries to your brain with phototherapy, you can regain your mental clarity, reduce stress, eliminate pain and react more rationally to the stresses of aging and life in general. Finally there is an effective, non-invasive, safe solution to even the most severe mental health issues. From pain relief to depression, anxiety, panic attacks, brain injuries and more; phototherapy can be used to reverse your symptoms!

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Monday 6pm Alateen (Closed*) Room 202 Al-Anon Monday 6pm (Open*) Room 204 Covenant Church 4000 Corey Road, Winterville, NC Building B (Large White Building) Tuesday 12pm (Open*) Pitt County AFG Sheppard Memorial Library 530 S. Evans Street, Greenville, NC Meeting Room B

Thursday 12pm (Open*) Bookworms AFG Sheppard Memorial Library 530 S. Evans Street, Greenville, NC Group Study Room Saturday 10am (Closed*) Recovery 12 & 12 AFG First Christian Church 2810 14th Street, Greenville, NC Enter through center door & turn left

*Open meetings welcome visitors seeking information about Al-Anon as well as newcomers & members of Al-Anon. Students & members of the professional community are welcome at open meetings. *Closed meetings are for Al-Anon members and prospective members only. Anyone who has been affected by someone else’s drinking is welcome at closed meetings.

To find meetings in other places, call 1-888-4AL-ANON (1-888-425-2666) On the Web, visit http://al-anon.org/

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Health File: Mental Health — July 2018

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MENTAL HEALTH

SPIRITUALITY: An important dimension of well-being (and treatment)

By Janie Taylor, PhD, LMFT Regional Director, CareNet Counseling East

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isit a bookstore and examine self-help books.

Do an online search on the topic of health and wellness. Talk with professionals and “everyday folks” about how to live a healthy lifestyle.

It probably will not take long before the important role one’s spirituality “plays” in a person’s life is mentioned. In fact, religion and spirituality are often recognized as critical components of one’s health and well-being, especially in times of crisis.

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Why is spirituality viewed as being so important? In response, this writer would suggest it is because spirituality provides structure as well as purpose and meaning to life and daily activities. It yields an interpretation of morality, faith, love, and that which is existential. Spirituality offers an explanation for one’s purpose, and can even offer insight into suffering. More than that, it helps one gain understanding of God; and is seen by many as the source of hope. And when considering recovery, hope is often viewed as the most important of all factors. Without it, treatment may fail.

Spirituality is important in many models used in treating health conditions. The biopsychosocial-spiritual (BPS-S) model offers a framework which views individuals holistically. The interplay of the physical, psychological, social, and spiritual domains of the person are all assessed. Years ago, medical providers began to alter their focus from symptoms to a framework in which illness was seen to have social, psychological, and behavioral dimensions.

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Health File: Mental Health — July 2018

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Spirituality was included in the model nearly two decades later when it was recognized the human illness experience often includes and is interpreted by means of the beliefs and meanings ascribed to it by the patient.

The BPS-S model is not the only one which includes spirituality. Twelve-step programs, such as AA and NA, have been utilized for years in addiction treatment and are seen as effective. Acknowledging the existence of a Higher Power is a significant tenet in these programs.

SAMHSA, the Substance Abuse and Mental Health Services Administration (a branch of the US Department of Health and Human Services), also recognizes the important role spirituality plays in healthcare. Defined as that which “expands our sense of purpose and meaning in life,” spirituality is included as a dimension of wellness. SAMHSA acknowledges effective treatment incorporates it. The American Society of Addiction Medicine integrates spirituality in its multidimensional assessment model.

Many psychotherapists assess the client’s spirituality in their daily practices.

They understand individuals desire treatment which includes their faith and values. Spirituality is also seen to help many who suffer from depression, anxiety, and relationship issues. By gaining insight into what gives the individual meaning, treatment and recovery can be advanced.

Other practices and techniques, such as yoga and mindfulness, have also advanced interest in the important role spirituality plays.

It is the opinion of this writer that spirituality is an integral part of health, healing, and well-being. If it is important to you, it is recommended you assure its inclusion whenever you are seeking healthcare.

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Health File: Mental Health — July 2018

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MENTAL HEALTH

Integrated Pediatric Care

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hysical health impacts mental health and mental health impacts physical health. This is true for adults and children. Historically, these two sides of health care, physical and mental, have been treated separately. You may experience this when you take care yourself or your child to your primary care provider but are sent elsewhere for mental health services. This fragmentation in the health care system can be frustrating, costly, and can hinder positive outcomes for families. Addressing the whole person, through mental health integration, is a way to address the fragmentation that exists. Integrated care is designed to treat mental health conditions like any other medical condition a patient may experience.

For pediatric patients, the primary care setting is the ideal place for mental health integration. The pediatrician’s office is where families have established trusting relationships with pediatric providers and a place where children feel comfortable,

THE PEDIATRICIAN’S OFFICE IS WHERE FAMILIES HAVE ESTABLISHED TRUSTING RELATIONSHIPS WITH PEDIATRIC PROVIDERS AND A PLACE WHERE CHILDREN FEEL COMFORTABLE, FAMILIAR, AND SAFE.

familiar, and safe. According to the North Carolina Center for Excellence more than half of all common mental health conditions (ADHD, anxiety, and depression) are treated in primary care settings.

Pirate Pediatrics in Greenville, NC has had integrated mental health since 2016.

Dr. Page Klitzman Eaker is a pediatric psychologist seeing children for behavior and attention issues. She also helps patients with anxiety, depression, sleep and bathroom issues. “Dr. K� also leads group sessions where children of like age work on relaxation, social skills, study habits, and coping mechanisms.

At Pirate Pediatrics we believe that integrated mental health has many benefits for patients and families. Improved access to care, reduced stigma, increased collaboration between medical providers, decreased wait times for mental health appointments, greater convenience and satisfaction for families are just a few of the benefits Pirate Pediatrics has seen.

For further information on how Pirate Pe Pediatrics integrates mental health in a pe pediatric setting or to set up a consultation with Dr. K please call 252-364-8790 or go to piratepediatrics.com.

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Health File: Mental Health — July 2018

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MENTAL HEALTH

Just One Conversation Can Help Save a Life

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oday, mental health professionals are seeing record numbers of people suffering from substance abuse, anxiety, depression, PTSD, child trauma, risk for suicide, and countless other mental illnesses.

Unfortunately, not everyone receives the professional care they need, even though most conditions can be treated successfully. The key is early intervention.

For busy primary care physicians, this means they must not only treat each patient’s immediate need but should also step back and look at their overall well-being. Far too many people suffer from early warning signs that go ignored. In addition, many physicians feel uncomfortable discussing mental health concerns. But how difficult is it for a doctor to simply ask, “How is everything else going for you? Any stress or other concerns lately?”

Of course, it is also widely suggested that the patient start the conversation with their doctor.

When you get treated for the flu or some other physical concern, your physician will naturally focus on the issue at hand. They may or may not see the signs of stress, anxiety, or other issues you’ve also been suffering from in your daily life.

It’s often up to you to ask questions as to whether or not you might benefit from a conversation with a mental health professional. It’s not uncommon for a patient to ask, “One other thing … I’ve been feeling a lot of anxiety lately. Is that a concern?”

Your physician should take that as a cue to ask more questions and get to the heart of the problem.

If you end up perhaps needing help, the next step is easy. You’ll contact a mental health specialist like the professionals at PORT Health in Greenville. Dr. Gary Leonhardt, M.D., PORT medical director says, “Our mission is simple. We want

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to improve the quality of life, health, and well-being of every patient. Our number one job is helping people recover as quickly as possible, so they can move forward with normal life.”

ing subjected to more stress than any time in history. The intense impact of today’s fast-paced, high-pressure world is taking a toll on each of us.

Are you having more frequent arguments with your spouse? Have you noticed LESS THAN HALF OF AMERICANS any changes in behavior by your children?

WITH A MENTAL ILLNESS GET Could another member of your family be PROFESSIONAL TREATMENT.* showing signs of going through a difficult Dr. Leonhardt and other mental health time? In today’s world, it is far safer to have professionals also emphasize that while a simple, caring five-minute conversation treatment is easy to access, far too many than to simply assume all is well. The life people are never diagnosed.

According to a recent survey by the Substance Abuse and Mental Health Services Administration, only half of all Americans who experience a mental illness actually receive mental health care.* This puts millions of Americans at risk for potentially severe consequences, including suicide.

That’s why mental health professionals like those at PORT Health welcome your questions and concerns about mental well-being. There have been far too many cases where a five-minute conversation at an early stage could have not only changed a life, but perhaps also saved one.

you save may be a loved one closer than you imagine.

If you observe signs of any mental illness in a loved one or experience symptoms yourself, contact your primary care physician or a mental health professional such as PORT Health at 252-830-7540. *SAMHSA - Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, www.samhsa.gov, September 17, 2015

A FIVE-MINUTE CONVERSATION CAN SAVE A LIFE. It’s also important to remember that you not only need to look in the mirror, but also watch out for other members of your family. Now more than ever, we’re all be-

Health File: Mental Health — July 2018

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MENTAL HEALTH

How to help socially isolated seniors

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he elderly population is on the rise in many countries. Advancements in healthcare and a growing emphasis on healthy lifestyles means people are living longer than ever before.

Age is often accompanied by wisdom, but men and women may also find that feelings of isolation, loneliness and depression may also settle in as they grow older. The Journal of Primary Prevention published “A Review of Social Isolation,” which observed how social isolation has been linked to numerous detrimental health effects in older adults. Some of these ailments may include increased risk for mortality, rehospitalization, falls, and dementia.

Individuals looking to give back to their communities may want to consider helping seniors in their area. Although it can be difficult to see seniors with diminished physical or mental capabilities, the rewards of interacting and helping seniors can be immeasurable. There are plenty of ways to help seniors avoid isolation and continue to live fulfilling lives.

• Provide transportation. A Place for Mom, a senior

housing placement resource, notes that lack of adequate transportation is a main cause of social isolation among seniors. Voluntary or necessary cessation of driving makes getting to and from appointments or even recreational outings more difficult. Where public transportation is unavailable or challenging to come by, volunteers can help shuttle seniors to and from grocery stores, doctor’s offices and any other places they need to go. Getting out regularly and seeing new faces can help seniors overcome feelings of loneliness.

• Participate in hobbies together. Give seniors a sense of purpose by encouraging them to participate in hobbies or activities. Book clubs are one activity that can interest people of different age groups.

• Encourage exercise. Physical exercise keeps the

body fit and improves mental health. Seniors can benefit from physical activity because it promotes

strong bones and a healthy cardiovascular system.

In addition, seniors who enroll in exercise classes at gyms or local senior centers can meet like-minded adults, helping them overcome their feelings of isolation even further.

• Provide meals and companionship. Older adults

may not be getting all they need to maintain healthy weights and bodily functions. Cooking and shopping for healthy foods may be difficult. Provide seniors with healthy meals when possible, and take the time to share those meals. This can foster conversations that keep seniors’ minds sharp and also may help prevent social isolation.

Seniors can benefit from many different forms of support, and helping older adults is a worthy volunteer initiative.

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Health File: Mental Health — July 2018

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MENTAL HEALTH

Intimate Partner Violence

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ho could imagine meeting the seemingly perfect mate and having them transform into their worst nightmare —physically, emotionally, sexually, or financially endangering their life or livelihood! Unfortunately, too many people have this type experience known as “intimate partner violence.�

According to the Centers for Disease Control and Prevention, intimate partner violence (IPV) describes “physical violence, sexual violence, stalking and psychological aggression (including coercive acts) by a current or former intimate partner.â€? “Intimate partners are those with whom one has a close personal relationship that can be characterized by the following: • Emotional connectedness • Regular contact • Ongoing physical contact and/or sexual behavior • Identity as a couple • Familiarity and knowledge about each other’s lives.

These could be former spouses, boy or girlfriends, dating partners, or sexual partners—both heterosexual and samesex couples, not necessarily requiring sexual intimacy.� At the core of the violence is a desire for one of the partners (abuser) to have power and control over the partner.

It happens in all races, cultures, and socio-economic status groups. Unfortunately, we tend to think about it only when some major act of violence is perpetrated and it is publicized via the media.

Information collected over the past 30 years from the US Department of Justice document the cyclical nature of intimate partner violence. Many times these relationships go through a cycle of abuse be-

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ginning with a tension-building phase in which the abuser may be critical, moody, or threatening without actually becoming violent. The survivor responds in a nurturing or agreeable way, and feels as if walking on eggshells. The tension building phase is often followed by an acute explosion in which the violent partner hits, chokes, humiliates, beats, or uses a weapon on the survivor causing them to be protective of self and children (if there are any), trying to calm or reason with the violent partner. Survivors may even fight back, call the police, or leave.

After the explosion, the honeymoon phase may begin in which the violent partner is apologetic, begs for forgiveness, promises to never do it again, and even possibly go to counseling or church.

Many times the violent partner remains in denial about his/or her responsibility regarding their behavior. The abused partner becomes hopeful, may agree to stay or return, and sometimes drops legal proceedings if they have been initiated. Oftentimes, if the abuser has not received and accepted the appropriate help, the abuse continues and will most likely intensify.

Data from the Center for Disease Control (2015) indicate that “about 1 in 4 women and 1 in 10 men experienced contact sexual violence, physical violence, and/or stalking by an intimate partner and reported an IPV-related impact during their lifetime.� Intimate partner

violence survivors may find themselves in similar future relationships or find that their children are more prone to become violent or accept violence from a partner than those that have not been exposed to this type of behavior.

ABOUT 1 IN 4 WOMEN AND 1 IN 10 MEN EXPERIENCED CONTACT SEXUAL VIOLENCE, PHYSICAL VIOLENCE, AND/OR STALKING BY AN INTIMATE PARTNER So, why would anyone remain in a relationship in which they or their children are being abused or witnessing abuse?

There a number of reasons survivors remain in abusive relationships including not realizing they are being abused, low self-esteem, beliefs about marriage and family, threats by the abuser to harm them or others close to them, emotional feelings

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towards the abuser, health or financial concerns, threats to take their children or lack of options.

Overall, intimate partner violence is complicated. Therefore, it may take legal, social, emotional, and financial support (including housing) to begin the process of helping survivors overcome the challenges. The Center for Family Violence Prevention offers services related to each of these areas for clients including court services, children/adult counseling, a Safe House, parenting, supervised visitation, anger management, elder abuse program, abuser treatment, Hispanic outreach and counseling, and clothing/ home furnishings via two local retail stores. For assistance, please call 252-758-4400, 252-758-5021 or the 24 hr. crisis line at 252-752-3811.

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Health File: Mental Health — July 2018

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Health File: Mental Health — July 2018

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