Normal holiday stressors can be compounded when we miss someone we have lost or are impacted by other hardships. This year, the sense of loss – of a loved one, financial security and a sense of “normal” – has touched many of us due to the COVID-19 pandemic. As we’re making plans to celebrate the holidays in unprecedented times, let’s take a break with Magellan’s Dr. Shareh Ghani as he discusses ways to address feelings of loss, practice self-care and make the most of this holiday season.

Magellan: Dr. Ghani, thank you so much for being here with us to share your many years of expertise in helping patients with behavioral health needs. Our first question: Is it possible to enjoy the holidays when we are experiencing the pain of losing a loved one to COVID-19 or something else?

Dr. Ghani: Thank you for having me. The pandemic has taken a toll on our community as we have lost loved ones prematurely, and we continue to experience sustained emotional pressure as COVID continues to spread. It is vitally important that we celebrate the holidays, exchange gifts and cards, gather virtually, and celebrate life. Spreading love and joy in these trying times will bring much-needed respite to the brain and body and boost our immune systems.

Magellan: How can we overcome feelings of worry and anxiety due to a job loss or other financial insecurity during this holiday season?

Dr. Ghani: Losing a job obviously leads to worry, anxiety and even questioning one’s own competence. The pandemic has helped many people shift focus to the “must haves” and not worry about the “nice-to-have” luxuries in life. Some are paying more attention to their health and fitness, minimizing spend, and planning for the future. Having a good strategy will help reduce the anxiety of uncertainty. If need be, talk to a therapist.

Magellan: Do you have any tips for people experiencing distress over not being able to celebrate the holidays in the way they may have in the past?

Dr. Ghani: One needs to evaluate the reason why we are changing our lifestyle. Social distancing helps stop the spread of the virus. Those who take this threat to our lives lightly may experience distress. Understanding the gravity of the situation alleviates it. We are celebrating in smaller groups so we can defeat the virus and return to our old ways of celebrating holidays safely. Think of it as a form of delaying gratification for better outcomes.

Magellan: What is your general advice for anyone who is experiencing loss to feel better and be able to experience joy this holiday season?

Dr. Ghani: Losing loved ones is a part of our life cycle. Human beings are resilient beings. Remember – those that we have lost would have wanted us to be happy. We should think about the happy moments we shared with those that are not here today and celebrate life.

Magellan: Why is it important to practice self-care and be an advocate for one’s own mental health?

Dr. Ghani: Good eating habits and physical exercise are key to physical and emotional wellness. Sleeping at least eight hours a day, hydrating well and experiencing joy and happiness are also important. All these things help with mental health. Relationships, family, helping others and being grateful add to a joyous life experience.

Untreated mental illness costs the United States up to $300 billion every year.[1] It is the leading cause of disability and the third most expensive medical condition in terms of total health spending, behind cancer and traumatic injury.

Given that one in five Americans suffers from a mental illness in a given year[3], and that the average delay between the onset of mental illness symptoms and treatment is 11 years[4], mental health screening should be considered just as important as regular medical exams.

Many physicians integrate screening to diagnose mental health conditions as part of primary care. It gives a PCP a picture of the patient’s emotional state and helps determine if symptoms they are experiencing are an indication of a mental health condition or an underlying physical health condition. Magellan Healthcare supports primary care screening and treatment with our Behavioral Health Toolkit at MagellanPCPtoolkit.com

Online screening and digital screening are two of the quickest and easiest ways to determine if a patient is experiencing symptoms of a mental health condition. A PCP may ask a patient to complete a questionnaire online before a visit, or a PCP may ask a patient to answer a few questions on a tablet or form while you they are at the office.

Based on the results, the PCP can recommend treatment options, such as digital or in-person therapy, a referral to a psychiatrist or psychologist, or a referral to the patient’s health plan’s case management team.

Early identification and intervention lead to better outcomes and can reduce long-term disabilities and prevent years of suffering.

To learn more, visit magellanhealthcare.com/mental-health. You’ll find information about mental health conditions and links to evidence-based screening tools you can do yourself. If any screener indicates a problem, consult a healthcare professional immediately.

[1] National Alliance on Mental Illness. (n.d.) FY 2018 Funding for mental health. Retrieved October 7, 2020 from https://www.nami.org/getattachment/Get-Involved/NAMI-National-Convention/Convention-Program-Schedule/Hill-Day-2017/FINAL-Hill-Day-17-Leave-Behind-Appropriations.pdf

[2] Soni, A. (2015). Top five most cCostly conditions among adults age 18 and older, 2012: Estimates for the U.S. civilian noninstitutionalized population. Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. Retrieved September 18, 2020 from https://meps.ahrq.gov/data_files/publications/st471/stat471.shtml.

[3] Centers for Disease Control and Prevention (2018). Learn about mental health. Retrieved September 18, 2020 from https://www.cdc.gov/mentalhealth/learn/index.htm.

[4] National Alliance on Mental Illness. Mental health by the numbers. (2019, September). Retrieved September 22, 2020 from https://www.nami.org/mhstats.

This month, we are sharing thoughts and insights on the importance of peer support services in healthcare, as well as other systems where peer supporters can be integrated. As the impact of the COVID-19 pandemic continues to be felt across the U.S. and around the world and folks struggle with the fallout, we are seeing an increased need for mental health and substance use disorder services and supports.

COVID-19 mental health impacts  

For many, the virus has taken a terrible toll. Family and friends have been lost. Millions of jobs have been lost. Our collective and individual sense of what is “normal” has been lost.

In a May 14, 2020 news release, the United Nations called for a substantial investment in mental health services to avoid a “massive increase in mental health conditions in the coming months.”

World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus said this:

“It is now crystal clear that mental health needs must be treated as a core element of our response to and recovery from the COVID-19 pandemic. This is a collective responsibility of governments and civil society, with the support of the whole United Nations System. A failure to take people’s emotional well-being seriously will lead to long-term social and economic costs to society.”

Focus on prevention

Public health experts, media and a growing number of policy makers are urgently emphasizing the critical necessity to take a preventive approach to this crisis, urging people to wear masks in public, practice physical distancing and increase testing. If we don’t embrace prevention, we will not beat this disease.

It’s not just infectious diseases like COVID-19 that require a robust, full court press preventive public health response. We need to get serious about prevention in mental health. A 2015 research article, Preventing Mental Illness: Closing the Evidence-Practice Gap Through Workforce and Service Planning stated:

Despite advances in treatment, there is little evidence that prevalence rates of mental illness are falling. While the prevention of cardiovascular disease and cancers are common in policy dialogue and service delivery, the prevention of mental illness remains a neglected area.

Note the reference to “evidence-practice gap” in the article title. What does that mean? Here’s a great, succinct description from a 2014 article published in PLOS Medicine.

Health research promises societal benefit by making better health possible. However, there has always been a gap between research findings (what is known) and health care practice (what is done), described as the “evidence-practice” or “know-do” gap.

Peer support contributions

So, what are the implications to the peer support workforce I mentioned at the beginning of this article? How does prevention apply to this discussion? Why is there still an “evidence-practice” gap with regard to peer support?

There are 200+ articles published in the literature on peer support. Peer support has long been recognized as an evidence-based practice. In fact, there are several peer-developed, peer-delivered models grounded firmly in the principles of recovery and resiliency, choice and self-determination, and an understanding of a holistic approach to wellness. And these models have been shown to have a positive impact on traditional outcomes, predominantly measured in behavioral health, including significant reductions in hospital admissions, fewer re-admissions and decreased spending on high-cost, restrictive settings like psychiatric inpatient. While peer support is not a clinical service, it has been shown to impact clinical outcomes. Beyond this, folks receiving peer support services express very high degrees of satisfaction with those services and report improved quality of life.

This is an excerpt from the Magellan Healthcare eMpowered for Wellness July newsletter. To read the full article, go here.

Telehealth services have been available for years to help remove geographical and other boundaries for people in rural and medically under-served areas; however, use has been limited. Driven by the COVID-19 pandemic, including shelter-in-place orders, social distancing, and federal agencies mandating use for certain programs, telehealth has grown exponentially since March.

While companies like Teladoc and MD Live have been operating telehealth platforms for nearly two decades, many platforms are dedicated only to physical health. Magellan Healthcare has maintained a telehealth network for behavioral health since 2014 and helps:

• Health plans offer a cost-effective alternative to traditional doctor visits, urgent care and the emergency room; provide access to valuable care that is convenient and available anytime and anywhere; expand existing programs and services focused on health and wellness; and attract new members by offering the modern convenience of an on-demand service.
• Employers improve employee access to healthcare; reduce tardiness and absenteeism; increase employee productivity; offer a competitive benefits package; improve employee satisfaction; and retain and attract the best employees.
• Members have more privacy; access a deep and specialized network; receive treatment before work, after work or on weekends; have more frequent touch points to improve compliance with treatment and avoid unnecessary hospitalizations; and avoid travel, lost time from work and weeks of waiting for an appointment.
• Providers reach out to members in remote areas or where specialties are needed; provide care to homebound members; provide behavioral health services from home, office or while traveling; reduce no-shows and cancellations; offer additional and/or non-standard appointment times; and expand the patient base and improve relationships with existing patients.

Although the benefits of telehealth are many, people may feel uncomfortable using services. That’s why Magellan Healthcare created a video called Telehealth: Get Care and Treatment Wherever You Are. This video can help people understand:

• How to schedule a telehealth visit
• What to do once a telehealth visit is scheduled
• How to get the most from telehealth

The more comfortable people are using telehealth for their behavioral healthcare, the more options they have available to them. This can lead to improved compliance and better health outcomes.

Watch the video here.

Anyone who has gone through a traumatic event can develop symptoms of stress disorders such as post-traumatic stress disorder (PTSD).  Although the COVID-19 pandemic in general would not meet the criteria for formally causing a stress disorder, many of the same issues can result from such a widespread and overwhelming event.

The pandemic could be viewed as a long-term stress event.  It has become life-changing for the whole world.  As COVID-19 spreads across the globe, people may experience increased anxiety and fear triggered by the pandemic and constant news. In addition, the pandemic can be traumatizing for others: healthcare workers, people who have lost friends and loved ones, and people whose lives have drastically changed.

What are stress-related disorders?

Stress-related disorders can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening. These symptoms can change your behavior and how you live your life.

How can reaction to the COVID pandemic be similar to a stress disorder?

When you struggle with a stress disorder, it can be hard to anticipate when anxiety or depressive symptoms may flare up. Although it may appear that symptoms come out of nowhere, in most cases they are cued by factors called triggers. Internal triggers are the feelings, thoughts, memories, emotions, and bodily sensations that you feel or experience. External triggers are the people, places, and situations that can bring back memories of the traumatic event.  In the current environment this could be caused by news reports, social media or discussion with friends or family.

The first thing to realize is that many fears are unwarranted; anxiety may arise when you are in a completely safe environment. When you begin to despair or your fears consumer you, try to remember that your worries and fears may be extreme because of previous experiences and not current facts. Once you’ve realized what may trigger these fears and anxiety, you can begin to try to deal with them.

How to cope with stress-related symptoms amid COVID-19

• Cultivate ways to be calmer. It’s understandable to feel anxious and worried about what may happen. While circumstances may be stressful and beyond your control, you can try to offset them with positive, calming activities. Practice slow, steady breathing and muscle relaxation, as well as any other actions that are calming for you (yoga, exercise, music, keeping the mind occupied).
• Understand what is within your control. Accept circumstances that cannot be changed and focus on what you can do. Evaluate your risk of contracting the virus, practice social distancing and follow clinical guidance on other practices. If you are in quarantine or isolation, do things that can support your mental health.¹ Focusing on what you can control and do can help you deal with the unknown.
• Remain hopeful. Keep a long-term perspective. Look for opportunities to practice being more patient or kind with yourself, or to see the situation as an opportunity to learn or build strengths. Celebrate successes, find things to be grateful about, and take satisfaction in completing tasks, even small ones. Remember that this will not last forever.
• Lean on your network. Make the most of technology and stay in touch with colleagues, friends and family via phone calls, texts, social media and video conferencing. Consider joining a free support group online to stay connected.² If you have a therapist, try to continue your treatment by phone or online.
• Focus on the potential positives. Try and focus on the things that can be viewed positively such as spending more time with family and a experiencing a potential to grow. Many times, going through a stressful time like this can lead to post-traumatic growth. This growth can be seen as though the stressful event was a trial or challenge that you conquered, something you learned from and became more resilient through. Sometimes stress can stimulate personal growth and improved overall coping.

For more information and tips, www.MagellanHealthcare.com/COVID-19.

More people are being exposed to infection as the number of COVID-19 cases continue to grow, resulting in an increased need for quarantines. The fear, stress and stigma associated with being quarantined can be damaging to one’s mental health.

The differences between isolation, quarantine and social distancing

The U.S. Centers for Disease Control and Prevention (CDC) defines medical isolation, quarantine and social distancing as follows:

Isolation – The separation of a person or group of people confirmed or suspected to be infected with COVID-19, and potentially infectious, from those who are not infected. This can prevent spread of the virus. Isolation for public health purposes may be voluntary or compelled by federal, state, or local public health order.

Quarantine – The separation of individuals who have had close contact with a COVID-19 case, but are not showing symptoms, to determine whether they develop symptoms of the disease. This keeps the person from potentially spreading the virus in the community. Quarantine for COVID-19 should last for a period of 14 days in a room with a door. If symptoms develop during the 14-day period, the individual should be placed under isolation and evaluated for COVID-19.

Social Distancing – The act of remaining out of congregate settings, avoiding mass gatherings and maintaining distance (approximately 6 feet, or 2 meters) from others when possible. Social distancing strategies can be applied on an individual level (e.g., avoiding physical contact), a group level (e.g., canceling group activities where individuals will be in close contact), and an operational level (e.g., rearranging desks in an office to increase distance between workers).

 Emotional impact of quarantine

The simple act of being quarantined can be distressing. When people are quarantined, they:

• Can be completely separated from loved ones
• Lose their freedom of movement
• Don’t know if they will show symptoms or not
• Don’t know how the disease may affect them
• Have no understanding of how long they will be separated
• Experience boredom and have too much time to worry about the situation

People who have been quarantined have reported or shown a high prevalence of symptoms of psychological distress and disorder. Symptoms reported include emotional disturbance, confusion, depression, stress, irritability, insomnia and post-traumatic stress symptoms. In addition, the stigma surrounding those in quarantine can lead people to feel rejected and/or avoid seeking help.

How to reduce the negative effects on mental health

• Seek trusted information sources. COVID-19 information and news is everywhere, and it’s hard to know what’s true. Follow news from the World Health Organization, the CDC and your state health department. Stay away from suspect information that well-intentioned people may share on social media. If you have specific questions about your situation, call your doctor.
• Make sure you have adequate supplies. Make your experience as tolerable as possible. Make sure you have basic supplies such as food, water and medicine for the duration of the quarantine period. Many communities have stores or services that will deliver essential items to your door, so keep a list in case you need anything.
• Make the most of your downtime. As noted above, isolation, boredom and stigma negatively impact mental health. Call old friends you haven’t talked to. Catch up on your reading, do crossword puzzles or play electronic games. Listen to music. Organize those piles of paper you haven’t gotten to. If you can, work remotely.
• Keep a journal, blog or vlog about your experience. Writing down your feelings and experiences, or talking about them, can be cathartic for some people. And if you are comfortable sharing it, your journal can be helpful for other people in the same situation.
• Don’t be afraid to reach out. Talk to a neighbor or two and let them know of your situation so they can help. Find others who are going through the same thing or have been in your shoes before. Talking to someone who knows what you’re going through can help you feel less alone.
• Focus on how you are helping. Remind yourself that your isolation, while difficult to bear, is truly helping contain the spread of disease and potentially saving lives.

If you find yourself feeling overly sad, angry or anxious, contact a behavioral health professional. They can conduct appointments over the phone and provide helpful advice.

After the quarantine

You’ve stayed away from everyone for 14 days, and you’re still healthy. When you are released from quarantine, remember that social distancing may still be in force.

You might have some residual stress from being alone for so long, or you might be angry that you had to stay separated from loved ones when you weren’t contagious. It’s OK to have those feelings. If they don’t subside after a few months, talk to a behavioral health provider.

For more information and tips, visit www.MagellanHealthcare.com/COVID-19.

May is Mental Health Awareness Month. This is an opportunity to increase public awareness of mental health conditions.  We can break down the stigma by ending the silence. About 1 in 5 Americans experience mental illness. It is important to be able to talk openly about it to get people the help they need. It is particularly timely this year, as we are seeing stigma associated with COVID-19, and we must do what we can to stamp out stigma in all its forms.

Understanding mental illness

According to the National Alliance on Mental Illness (NAMI), a mental illness is a condition that affects a person’s thinking, feeling or mood. Such conditions may affect someone’s ability to relate to others and function each day. Each person will have different experiences, even people with the same diagnosis. If you have — or think you might have — a mental illness, the first thing you must know is that you are not alone. Mental health conditions are far more common than you think, mainly because people don’t like to, or are afraid to, talk about them.

Mental illness can affect anyone regardless of age, gender, income, social status, religion or race/ethnicity.

• 1 in 5 U.S. adults experience mental illness each year
• 1 in 25 U.S. adults experience serious mental illness each year
• 1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
• 50% of all lifetime mental illness begins by age 14, and 75% by age 24

Depression and anxiety disorders are the most common mental health disorders worldwide.

The exact causes of mental illness are not fully understood. However, factors that can contribute to mental health problems include:

• Genes and family history
• Biological factors such as brain chemistry and brain injury
• Serious medical conditions
• The use of alcohol or other drugs
• Traumatic life experiences
• Isolation and other social factors

Mental illness is not a character flaw or something that a person can just “snap out of.” For many people, recovery — including meaningful roles in social life, school and work — is possible, especially when you start treatment early and play a strong role in your own recovery process.

Sadly, many people never seek treatment out of fear and shame. The stigma of having a mental illness or substance use disorder is two-fold: people suffer needlessly even though effective treatments are available, and they’re also at higher risk of premature death. For example, people with depression have a higher risk of heart disease and cancer. Studies also show that people with severe mental illness have a higher incidence of chronic diseases and tend to die 10 – 25 years earlier than the general population.¹

Stamping Out Stigma

Everyone experiences the ups and downs of mental health. Many people have a mental illness or know a friend or family member who has struggled with one. To stamp out stigma and get people the help they need NAMI offers these practical tips:

• Talk openly and honestly about your own experiences with mental illness and addiction.
• Educate yourself and others about the facts of mental illness. Mental disorders are treatable just as physical diseases are, and people with mental illness are not to blame for their condition.
• Recognize the signs of mental illness and seek professional help when needed.
• Show empathy for those living with mental health and substance use disorders.
• Be aware of your attitudes and language used to describe mental illness and people with mental illness. Jokes and name-calling are hurtful and perpetuate demeaning stereotypes.

Let’s work together to Stamp Out Stigma!

Sources:

[1] Management Information Sheet. (n.d.). Retrieved from https://www.who.int/mental_health

²Social Stigma associated with COVID-19. (2020, February). Retrieved April 10, 2020, from https://www.unicef.org/media/65931/file/Social%20stigma%20associated%20with%20the%20coronavirus%20disease%202019%20(COVID-19).pdf

COVID-19 has disrupted our lives in many ways. The stress of social distancing and loss of routine, compounded with health and job concerns, has caused grief and anxiety levels to increase. What we thought of as “normal” is in transition, and we need to redefine how to cope with these changes.

Reasons people feel grief

Grief is a natural feeling accompanying any kind of loss. Typically, grief is associated with losing a loved one to death. With COVID-19, people are experiencing grief related to the loss of routines, livelihoods and relationships. While it is always good advice to be thankful for what we have, it is also important not to minimize the pandemic or its associated losses. Also challenging is that we do not know how long we’ll be impacted by COVID-19. With no clear end in sight, feelings of grief can intensify and make people feel less in control.

Grief shows itself in different ways

It’s perfectly normal to grieve when you can’t celebrate your child’s birthday, your friend’s graduation, your honeymoon or other important life events. It’s important to know that we all grieve differently. Some people may experience feelings more intensely than other people. We shouldn’t make judgments about how someone grieves. There is nothing wrong with having emotions; it is a common response to loss. When we don’t express our feelings, they can get stuck in our bodies, causing physical illness and/or depression.

Listed below are some of the common emotions people experience when grieving, and they may be heightened because of the pandemic.

• Shock, disbelief and denial
• Anger
• Fear
• Guilt
• Helplessness
• Anxiety and depression
• Acceptance and hope
• Relief

Complicated grief

In the current environment, any losses experienced now have additional layers of complexity and depth. Likewise, if we’ve had previous traumas from earlier stages in our lives, the stress of the pandemic might bring up past life experiences that were painful. It’s important to be sensitive to those potential triggers.

COVID-19 has brought on many situations: not being able to say goodbye, to have a funeral service, to grieve because of taking care of others, dreams put on hold, etc. We don’t have the same levels of support due to the quarantine, such as being able to see loved ones and friends. For these reasons and others, it is important to develop coping skills to help get us through this difficult time.

Understanding grief

Part of what gives comfort during challenging times is understanding the healing process.

• Grief can be an ongoing process. It can take on different forms and meanings and with time; the intensity and feelings of grief do change.
• Grief doesn’t mean you obsessively think about what has happened. It is important to allow yourself to deal with the feelings, but obsessively thinking about the pain and fear will only make the feelings worse and can trigger anxiety.
• Grief does not mean “forgetting.” If you have experienced a significant loss or you have missed out on a long-planned event, it is okay to think about who or what you will miss. Part of the grieving process involves keeping your loved ones and/or cherished dreams with you emotionally, as they are still a part of you even if they are no longer a physical reality.
• Grief involves growth. Whether it is coping with the death of a loved one, going through a traumatic event or dealing with the loss of a job, no one chooses these experiences. Working through grief and sorting through intense emotions can help you learn new things about yourself and discover new strengths that can result in emotional growth and maturity. In this way, loss sometimes yields gifts.

How to help yourself

• Build a virtual support system. In the era of social distancing, be creative about how to give and receive support. It’s important to turn to friends, co-workers or family members for support. People like to be of service. Giving and receiving are part of the same equation and benefit all.
• Focus on hope. We all have times when we feel hopeless. Being hopeful helps you realize that we all have tough times and that those times will pass, as will the feelings associated with them.
• Take care of yourself. The mind and body are connected. When you feel good physically, you also feel better emotionally. When you feel sad, do not be influenced by how others think you should grieve. It’s important to feel whatever you feel without embarrassment or judgment. It’s okay to be angry, cry or not cry. It’s also okay to laugh, find moments of joy and let go when we’re ready.
• Practice gratitude. Sometimes when people are in the midst of loss, they have deep moments of gratitude for what they once had. Practicing gratitude trains our minds to change our thinking and to see the glass as half full.

How to help others

• What to say. It can feel awkward when conversing with someone going through grief. You may wonder what to say ornot say; however, don’t avoid the topic or be afraid to bring it up. Open the door for the grieving person to talk about their feelings. It’s not helpful to say things like, “There’s a reason for everything,” or ” “I know how you feel.” Instead, you can offer a simple expression of sorrow, such as “I’m sorry you’re going through this,” or “I don’t know how you feel, but I’d like to help in any way I can.”
• Sometimes the best thing to say is nothing. Or very little. A grieving person may need to tell their story again and again as part of the process. Be willing to listen without judgment. A good rule to follow is to listen 80 percent of the time and talk the other 20 percent. Your presence can be comforting to a grieving loved one, and you don’t have to do anything special. Often, grieving people just don’t want to be alone.
• Avoid giving advice. Unless someone specifically asks for your advice, it isn’t your place to give it. Grieving people need to do things in their own unique way.
• Don’t take things personally. When people are in profound emotional pain, they can cycle through a whole range of feelings, including irritability and anger. If a grieving person snaps at you, or doesn’t feel like engaging, don’t take it personally. It’s not about you.
• Offer to help. Grieving can make the demands of daily living feel overwhelming. Many times, the grieving person does not want to burden others by asking for help. Don’t wait for them to ask. Instead, offer to help by bringing over dinner, shopping, gardening, etc. During the quarantine, there might be a limit to what you can physically do to help, but you can still take on tasks for the individual to relieve some burdens.

For more information and tips, visit MagellanHealthcare.com/COVID-19.