“Our obligation to act is not just medical—it’s moral.”
Vivek H. Murthy, M.D., M.B.A. Vice Admiral, U.S. Public Health Service, Surgeon General of the United States

 
To support the Surgeon General’s recent advisory related to protecting youth mental health issues exposed by the COVID-19 pandemic, Magellan Federal offers best practices for professionals specializing in behavioral issues to foster the wellbeing of our military families.

Magellan Federal directly supports the mental health and resiliency of military youth and families, serving over 4.5 million service members and families a year. Read more about risk factors and recommendations in our whitepaper here.

It was hard enough for kids without social media. Many of our older readers will remember… We compared ourselves to others, but it happened mostly in-person at school or events, or when we consumed one-way media like TV or magazines. While it could be hurtful, we still got a break at home, while riding in a car, or for much of the rest of the day, as we didn’t have smartphones. We became the subject of gossip, but we had the benefit of an imperfect “grapevine” that took longer to spread information, and likely, we didn’t even always hear about it. And we played the popularity contest, but we could never be sure just who were the winners and losers.

We’ll dive into these issues in this post and you can learn more by watching a recording of our webinar, “Addressing the impacts of social media on kids,” here.

Kids’ self-image and social media

Social media makes it easy—and even entertaining—to endlessly scroll through the latest and greatest images of our friends, celebrities, and perfect strangers. We get to see the best of everyone all the time. If any one of our friends isn’t posting their best on any given day, we’re seeing someone else who is posting their best. This can put undue pressure on our kids to attain perfection, as they are developing their self-image and self-esteem.

For kids, and us all, there is tremendous value in limiting the time we spend on social media and understanding that what we see there isn’t usually the full picture. Social media can provide a great sense of connection with others, along with many other positive impacts, but life outside of it can be refreshing and cleansing when we focus on all that we have and want to do.

Social media and cyberbullying

It’s a lot easier to be mean to someone when you’re not doing it to their face. With social media, not only is it easy for a bully to target another child from behind the protection of their screen, but they can do so publicly for classmates and the world to see and weigh in with opinions, or even just a “like,” on the matter. This ruthlessness can be humiliating and overwhelming for the victim, and lead to serious mental health concerns.

As our kids’ gossip and squabbles naturally pervade and have the potential to be broadcasted instantaneously on social media for all to see, let’s talk to them about leaving the negativity off of social media and focusing on positive messages that will ultimately reflect better on us all. If your child is a victim of cyberbullying, find resources at https://www.stopbullying.gov/cyberbullying/prevention and learn more in our webinar on May 11.

Our kids’ popularity, quantified

Our kids’ popularity is now quantified and displayed on social media. They have a number of followers, and every time they post, it’s assigned a number of likes and comments. Is this environment creating additional pressure for our kids to be liked and drive up their social stats at the risk of harming their mental health in the process?

While we can’t make a direct correlation with kids’ use of social media, we know the prevalence of depression among adolescents aged 12–17 has steadily increased–and more than doubled–from 8% in 2010 to 17% in 2020, and that certain demographic groups have been disproportionately affected, including girls, of which the prevalence of depression has increased from 11.9% in 2010 (4.4% among boys) to 25.2% in 2020 (9.2% among boys).[1]

We know our kids are much more than the number of likes they receive on a social media post. It’s important that we talk to our kids about what is really important and build up their self-worth through meaningful activities that stimulate their learning and interests, and help others.

On May 11 Magellan Healthcare hosted a webinar, “Addressing the effects of social media on kids,” for Mental Health Month with former Magellan child psychiatrists, Dr. Keith Brown and Dr. LaShondra Washington, and Senior Director Children’s Healthcare Barbara Dunn, and Creator of Magellan Youth Leaders Inspiring Future Empowerment Greg Dicharry. Watch a recording of the webinar at https://www.magellanhealthcare.com/event/addressing-the-effects-of-social-media-on-kids/.

[1] SAMHSA 2020 National Survey of Drug Use and Health, Youth Mental Health Trend Tables

Total wellbeing means that you feel fulfilled in all aspects of your life. Your mental health is a big part of your wellbeing. It is important to be aware of the signs or symptoms of mental stress so you can seek help or recognize when someone you care about may need help.

5 reasons why it is important to pay attention to your mental health and wellbeing

1. Mental illness is more common than you think. Mental illness does not discriminate, it affects people of all ages, genders, and ethnicities. One in five U.S. adults experience mental illness, 1 in 20 U.S. adults experience serious mental illness, and 17% of youth aged 6 – 17 experience a mental health condition. Unfortunately, too many don’t seek help.
2. Mental illness affects your physical health. Your brain is part of your body. Mental and physical health are connected. In fact, mental illness can be the root of many physical symptoms. For example, if you are suffering from insomnia, heart palpitations, or fatigue, your doctor may want to rule out depression, anxiety, or other mental health conditions as a potential cause.
3. Diseases or injuries can increase your risk. Just as mental illness can cause physical symptoms in your body, physical diseases, like cancer, multiple sclerosis, diabetes, and trauma such as head injuries, can raise your risk of mental illness. It is important that you are honest about your experiences when speaking with your doctor.
4. It runs in families. Mental illnesses tend to run in families due to both genetic factors and family cultural issues. Remember to include things like depression, bipolar disorder, and attention deficit hyperactivity disorder in your family health history along with information about heart disease, cancer, and other conditions.
5. Early detection makes a difference. Like medical conditions, getting diagnosed early generally leads to better outcomes. Getting the help you need can prevent symptoms of mental illness from getting worse and causing negative effects on your life, including strained relationships and difficulty managing work and finances.

Visit our 2022 Mental Health Month web page to discover more tools to address and spread awareness about mental health, wellbeing, and specific conditions as we recover from the pandemic and deal with civil, economic, and global unrest.

Sources: health.clevelandclinic.org, nami.org, nih.org

Obstructive sleep apnea (OSA) has been linked to an increased risk of physical health problems, including high blood pressure, heart disease, stroke, and diabetes. But how does OSA affect your ability to think clearly, learn and remember, and your emotional psychological, and social wellbeing?

If you have ever worked a 24-hour shift or experienced back-to-back days of poor sleep, it probably comes as no surprise to hear that OSA has been linked to cognitive and mental health issues. OSA causes frequent breathing interruptions, or apneas, while you sleep—as many as 30 per hour. OSA is associated with:

1. Trouble concentrating—OSA can lead to significant changes in two important brain chemicals, gamma-aminobutyric acid (known as GABA) and glutamate. Together, these two chemicals help maintain balance. People with OSA may have decreased levels of GABA and elevated levels of glutamate. GABA is a chemical messenger that acts as an inhibitor in the brain. It slows things down and helps you remain calm. Glutamate, on the other hand, speeds things up. When your glutamate levels are high, your brain is working in a state of stress and does not function as effectively.[1] Glutamate in high amounts has also been shown to contribute to brain damage.
2. Memory problems—Throughout the night your body fluctuates through different sleep stages, allowing your brain to process and sort out all the information it has gathered throughout the day. OSA stops the flow of oxygen to your brain or completely cuts it off multiple times during the night, robbing your ability to reach deep and restorative sleep These frequent disruptions can contribute to memory loss and have a negative impact on overall brain performance.[2]
3. Poor decision-making—Sleep is essential in maintaining brain health and contributes to your ability to learn and recall information. A lack of sleep caused by OSA can cause frequent problems with attention and concentration. If you suffer from OSA, you may have trouble focusing at work or school, being creative, solving problems, and making decisions.[3]
4. Depression and stress—OSA can cause hundreds of interruptions in your breathing during the night, which can set off a constant fight-or-flight response. You may wake up suddenly with your heart racing, sweating, and a feeling of doom. This can carry over into the daytime, causing you to feel run-down and sleepy and your body to be without the energy it needs to protect you against depression and stress.[4]

The good news about obstructive sleep apnea’s impacts on cognitive and mental health

While OSA can negatively impact your day-to-day life, there is hope. The harmful cognitive and mental health effects of OSA can be reversed with treatment. For some, this may mean lifestyle changes. For others, it may mean continuous positive airway pressure, or CPAP—a machine that helps you sleep easier.

Want to learn more about obstructive sleep apnea?

Find the recording of our webinar, “Obstructive sleep apnea: Impacts, diagnosis and treatment,” to hear board-certified somnologist and neurologist, Dr. Karen Jablonski, physician clinical reviewer, Magellan Healthcare, and I discuss the mental and physical health impacts of OSA, and OSA diagnosis and treatment here.

[1] https://newsroom.ucla.edu/releases/sleep-apnea-takes-a-toll-on-brain-function#:~:text=They%20found%20that%20people%20with,calm%20%E2%80%94%20like%20a%20brake%20pedal.

[2] https://goodsomnia.com/blog/snoring-sleep-apnea/can-sleep-apnea-cause-memory-problems/

[3] https://www.sleephealthsolutionsohio.com/blog/sleep-apnea-and-brain-health/

[4] https://www.everydayhealth.com/sleep/sleep-apnea-link-depression-anxiety/

In the midst of a national children’s mental health crisis, families are doing the best they can to assess how well their children are coping with increased stressors from the pandemic and figure out what to do if it seems they are having difficulty. Psychotropic medication is among the options to consider when indicated. However, over the years, children and adolescents with behavioral health challenges have generally been prescribed an alarming number of medications. This high prescription rate, paired with questions about the appropriateness of the diagnoses used to justify the drugs’ use, has raised many concerns among families, practitioners, and youth advocates alike. Prescribing medication to treat children’s mental health conditions can be appropriate, but parents, caregivers, and practitioners need to fully understand the risks and monitor their use.

In this post, we will contemplate these issues and draw on knowledge from Magellan Healthcare’s recently updated clinical monograph, Appropriate Use of Psychotropic Drugs in Children and Adolescents, which highlights evidence-based research on the use of psychotherapeutic agents in children and principles for optimal children’s psychopharmacotherapy practice.

Considerations for treatment with medication for children’s mental health

When families consider medication as an option to treat a child’s mental health condition, Magellan’s monograph offers the following to contemplate:

The practice of evidence-based medicine for children and adolescents requires health professionals and child welfare advocates to engage in a careful assessment of the risks and benefits of using psychopharmacological treatments while addressing serious concerns of over-diagnosis and overtreatment in this vulnerable population. As attention to these issues has grown, a strong undercurrent of anxiety and confusion exists about whether the use of psychotropic agents to remove undesirable impulses and behaviors of children may affect their neurological development, personality, character, and temperament. Suspicions exist that over-diagnosis and overtreatment are driven by a supply-induced demand created by pharmaceutical companies and medical providers.

Addressing the shortage of children’s mental health professionals

Another consideration for parents and families is the shortage of professionals providing specialized mental healthcare services for children. Mental healthcare for children is often initiated at the pediatrician’s office, Magellan’s monograph provides the following insights:

Given the significant national shortage of child psychiatrists, there remains a realistic need to rely on primary care clinicians to perform screenings of children for mental health disorders and treat uncomplicated ADHD, anxiety, or depression. However, the problem of follow-up care and ongoing monitoring of mental health problems in pediatric primary care is a matter that must be addressed.

Principles for optimal use of medication to treat children’s mental health

The American Academy of Child and Adolescent Psychiatry published the Practice Parameter on the Use of Psychotropic Medication in Children and Adolescents to promote the appropriate and safe use of medication to treat children’s mental health by emphasizing the best practice principles that underlie medication prescribing. These principles, as highlighted in the monograph, are as follows:

Principle 1: Before initiating pharmacotherapy, a psychiatric evaluation is completed.

Principle 2: Before initiating pharmacotherapy, a medical history is obtained, and a medical evaluation is considered when appropriate.

Principle 3: The prescriber is advised to communicate with other professionals involved with the child to obtain collateral history and set the stage for monitoring outcomes and side effects during the medication trial.

Principle 4: The prescriber develops a psychosocial and psychopharmacological treatment plan based on the best available evidence.

Principle 5: The prescriber develops a plan to monitor the patient, short and long-term. Clinicians should use standardized, objective measures to measure the efficacy of pharmacologic interventions.

Principle 6: Prescribers should be cautious when implementing a treatment plan that cannot be appropriately monitored.

Principle 7: The prescriber provides feedback about the diagnosis and educates the patient and family regarding the child’s disorder and the treatment and monitoring plan.

Principle 8: The child’s assent and parent’s consent are completed and documented before initiating, and at important points during, medication treatment

Principle 9: The assent and consent discussion is focused on the risks and benefits of the proposed and alternative treatments.

Principle 10: Medication trials are implemented using an adequate dose and for an adequate duration of treatment.

Principle 11: The prescriber reassesses the patient if the child does not respond to the initial medication trial as expected.

Principle 12: The prescriber needs a clear rationale for using medication combinations.

Principle 13: Discontinuing medication in children requires a specific plan.

We encourage you to learn more about medication to treat children’s mental health in the full clinical monograph and Understanding and Meeting the Needs of Children and Adolescents at High Risk: Foundations of a Model, which highlights evidence-based prevention and treatment approaches for problematic behaviors and various types of behavioral health challenges in children and adolescents, here. Both provide valuable insights and information to support the critical behavioral health needs of our nation’s children.

The war in Ukraine is continually changing with updates to the minute within the news cycle and social media. Constantly, there are reports and images flooding our electronic devices with images that are incomprehensible to see. Military families have intense stress as they look at the uncertainties of deployments and the impact on military families. To add to the stress and concern, this global crisis comes on the heels of being exhausted and socially isolated by a two-year pandemic. The following are some tips to take care of your mental health during the Ukraine situation.

Limit your exposure – disconnect from electronics and social media. Although it is important to understand what is happening in the world, it is important not to immerse oneself in the event every moment. Set time limits for yourself regarding how much News or social media you watch or follow.

Recognize that people will have different reactions. People respond and react to tragedy and stress in multiple ways. Personal circumstances, such as deployment, may have different responses than those that are not experiencing deployment.

Talk about it. Do not keep your reactions inside alone. Process your feelings by talking to family, friends, and colleagues about your experience. If the feelings are overwhelming, consider talking to Mental Health Professional that can offer personalized strategies for managing your anxiety about current events.

Engage in activities that provide meaning. Participate in activities that are healthy and you enjoy. Some ideas include exercising, cooking, taking a hike, or playing with a pet.

Engage in meditation and mindfulness. Relaxation, or breathing exercises can improve your state of mind and reduce stress. Taking a few moments just to be present can shift your body’s reaction from a stress response. Try a simple breathing exercise of breathing in for a count of 6 hold for a count of 2 and breathe out for a count of 6.

COVID fatigue. Acknowledge that after a two-year pandemic and many people are tired. The Ukraine situation is especially hard to absorb. It is normal to feel overwhelmed

Avoid catastrophizing. Avoid thinking about future scenarios and what the outcome might be. Focus on one day at a time for now.

Do psilocybin, MDMA, LSD, ketamine, and cannabis sound familiar as medication therapy to help treat mental illness? It goes without saying that the pandemic has intensified mental health symptoms in the United States (US), turning an urgent matter into a crisis. One in 5 American adults suffers from mental illness, with young adults ages 18 to 25 years reporting the highest prevalence. These numbers speak volumes. Some treatment options do not adequately treat patients with mental illness and are associated with significant side effects. This underscores the need for more effective treatments. Because of these factors, psychedelics and other psychoactive substances are gaining momentum as possible alternatives.

Psychedelics are a “mind-manifesting” hallucinogenic class of psychoactive compounds that affect perception. They have been used by ancient civilizations for medicinal purposes and religious rituals for thousands of years. There is a renewed interest in using psychedelics to treat mental disorders driven by global research, influencers, education, and patient voices. Philanthropy has been the main funding source for psychedelics. However, a recent federal grant to Johns Hopkins Medicine to study psilocybin for tobacco addiction may signal a sea change in federal funding of psychedelic research.

While small-scale clinical trials have been promising, for psychedelics to become mainstream, large-scale randomized controlled trials are needed to fully evaluate their safety and efficacy. Studies are underway through several leading centers including MAPS – the Multidisciplinary Association for Psychedelic Studies – a non-profit dedicated to psychedelic research.

Psychedelics are not currently approved as prescription medications. Notably, the US Food and Drug Administration (FDA) has given Breakthrough Therapy designation to two psychedelics – MDMA-assisted psychotherapy for post-traumatic stress disorder (PTSD) and psilocybin-assisted therapy for treatment-resistant depression (TRD) and major depressive disorder (MDD). FDA’s Breakthrough Therapy is designed to “expedite the development and review of drugs which may demonstrate substantial improvement over available therapy.” As clinical trials progress, 2023 could bring regulatory approval for the MAPS’ MDMA-assisted psychotherapy for PTSD, a potential turning point in the mental health treatment paradigm.

Patients with mental health illnesses deserve to heal and restore balance to their lives without stigma and judgment and deserve treatments that are safe and efficacious. Step into Magellan’s Clinical Insights for the role of psychedelics in treating mental health conditions. This industry-first paper explores the current evidence, regulatory, and legislative landscape for psychedelics and shares Magellan’s four pillars on emerging therapeutic frontiers. We are guided by four principles:

• Education and thought leadership for patients, payers, providers, and stakeholders while addressing the stigma around mental health
• Evidence-based clinical recommendations and coverage
• Patient safety by advocating for quality standards
• Access that is responsible and sustainable

Disclaimer: The content in this blog article is not a substitute for professional medical advice. For questions regarding any medical condition or if you need medical advice, please contact your healthcare provider.

Twenty twenty-two is here, with all its possibilities and opportunities. You may be wondering how you will achieve all of your personal and professional goals this year. Your mental health in 2022 may hold the key to success. Read on for tips from Magellan Healthcare’s behavioral health experts to help you prioritize your mental health in the new year.

1. Spread out New Year’s resolutions over the year – At the beginning of the year, people usually try to accomplish too many resolutions all at once. They are quickly overwhelmed and give up. Instead, create a list of resolutions, or goals, to implement–one per month–over the year. Spreading out goals and focusing on one at a time will feel more consistent with lifestyle change than the usual New Year’s start and stop. – Candice Tate, MD, MBA
2. Plan things to look forward to – Having a daily routine is important for our mental health. It limits the chaos and helps us feel grounded. But it can get boring, especially during COVID-19 when we are closed in. Schedule things to look forward to for the upcoming weeks and months. Maybe schedule a day trip on a weekend, a few hours in the evening to watch a movie, or a phone/Zoom call with an old friend, make a reservation at your favorite restaurant or plan to place a delivery order. Choose things that make you feel good. – Linda Evans, MD, FAPA
3. Limit screen time and media exposure – Social media has been a much needed lifeline for so many of us during the pandemic, but it’s essential that we remember to limit our screen time and exposure to content that can be emotionally distressing or traumatizing. Make a habit of putting your mobile device down and stepping away from your computer to enjoy the people, plants or pets in your environment. Go outside, take a walk, and get some fresh air and sunlight. – Rakel Beall-Wilkins, MD, MPH
4. Learn that “no” is a complete sentence – You cannot pour from an empty cup. Saying yes to every request asked of you when you are already limited on time, energy or resources can increase stress levels. Putting your needs on the backburner is not healthy for you. Being a “yes” person sometimes equates to saying “no” to your own mental health. Recognize not only when to say no, but that you don’t have to feel guilty about it… It’s all about saying yes to you! – LaShondra Washington, MD, DFAPA
5. Measure something – Our perceptions often do not match the reality of a situation but picking something to measure that is related to a concern can help better align our perceptions to reality. And if the results of the measurements indicate that indeed perception and reality are aligned, then continued measurement, after an intervention, can determine the usefulness of the intervention on the measure. In other words, take steps to find out if what is bothering you is really a problem, and if it is, then make a change and reassess. – Louis Parrott, MD, PhD
6. Engage in journaling – Journaling is an effective way to manage stress and feelings. It can be cathartic to write about feelings and experiences. It is also a way to monitor your inner self and when it may be necessary to seek professional help. – Samuel Williams, MD, MBA, FAPA
7. Practice gratitude – Share gratitude with others and write three things you are grateful for every day. According to Jon Kabat-Zinn, PhD, an internationally known mindfulness advocate, we should ask ourselves three questions each day that relate to our relationships with family, friends, and co-workers: What have I received from __? What have I given to __? What troubles and difficulties have I caused? – Doris Lebischak, MD
8. Establish an attainable plan for regular physical activity and stick to it – Start with one or two days of exercise a week. Plan the days, times, and activities and commit to making it happen. Exercise is proven to reduce depression, anxiety, and negative mood.[1] – Greg Dicharry, CPRP
9. Consider expanding your exercise routine – As we age, our muscles must be challenged to maintain strength. Including strength training, stretching and physical activity that raises the heart rate in our workouts will have an immediate impact as well as long-term benefits for the body and mind. – Paula Hensley, MD
10. Eat a balanced diet with as many unprocessed foods as possible – Include colorful fruits and vegetables and prepare food in healthier ways like steaming and roasting rather than frying. If applicable, include children in meal selection and preparation, and eat at least one meal per day as a family. Try not to place food into strict bad and good categories, and understand that you are not–accordingly–bad or good depending on what you eat. It’s important to eat a balanced diet for your lifestyle. – Misty Tu, MD
11. Prioritize sleep – Push through busy schedules and life’s distractions to maintain eight hours of sleep each night and experience how it helps you think more clearly, feel better and be better able to creatively juggle the multiple demands of family, work, and beyond. – Barbara Dunn, LCSW, ACSW
12. Develop a cue that ends your workday – Whether it is pausing to watch the sunset, moving your body for 20 minutes, or ceremonially closing the door to your workspace, disconnecting from work to focus on rest, joy, or family responsibilities is a necessary way to prioritize mental health in 2022. – Dana Foglesong, MSW, NCPS, CRPS
13. Make sure to prioritize yourself – In a time when kids are home, work is piling up, and there is growing uncertainty in and outside of our homes, it’s unfortunately easy to get lost in all we have going on. But it’s vital we prioritize ourselves. Whether it’s going on a walk or other exercise, meditation, talk therapy, weekly dinner with friends or family… don’t ever forget to put yourself first because your mental health is wealth. – Yagnesh Vadgama, BCBA
14. Ask for help when you need it – Recognize that no one person can do everything. Family, friends, and neighbors can be great resources, so ask for what you need and offer help to them when you can. – Kathryn Kvederis, MD, DFAPA
15. Remember that you are not alone – One in five American adults has a mental illness and one in 18 American adults has a serious mental illness; one in six American youth has been diagnosed with depression.[2] Despite all of the glittery images we may see and our perceptions that others have it better, it’s likely that we have family members, friends, and co-workers who are right there with us when we aren’t feeling our best. – Keith Brown, MD

As we sail into a bright new year, with 2021 in the rear-view mirror, let’s remember to prioritize ourselves and our mental health. We have all experienced the trials and tribulations of a tumultuous previous two years. If we have learned anything, it’s that our mental health in 2022 is what will keep us strong and poised for happiness and success.

Visit MagellanHealthcare.com/BH-Resources for free information and tools to address mental/behavioral health needs and spread awareness to reduce stigma. Stay tuned here and on our calendar for updates on our virtual events throughout the year.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/

[2] https://www.samhsa.gov/data/release/2020-national-survey-drug-use-and-health-nsduh-releases