The U.S. Preventive Services Task Force recommends that all people, starting at age 12, be screened for depression. Screening for depression helps find depression early. And early treatment may help you get better faster.

Depression is a disease. It’s not caused by personal weakness and is not a character flaw. When you have depression, chemicals in your brain called neurotransmitters are out of balance.

Depression causes adults and children to feel sad or hopeless much of the time. It’s different from normal feelings of sadness, grief, or low energy. Always tell your doctor if you feel sad or have other symptoms of depression. Many times, people are embarrassed by these feelings and say nothing. Depression can be treated, and the sooner you get treatment, the better your chance for a quick and full recovery. Untreated depression can get worse, cause other health problems, and may last for years or even a lifetime. It can have a serious impact on both you and the people you care about.

Adults

To find out if you are depressed, your doctor may do a physical exam and ask you questions about your health and your feelings. Some questions may not seem related to your mood. But your honest answers can help give the doctor clues about how depression may be affecting you. Your doctor may ask you about feelings of sadness, changes in hunger or weight, energy level, concentration, guilt, thoughts of death and suicide, sleep, general interest in everyday activities, and more.

Some diseases can cause symptoms that look like depression. So your doctor may do blood tests to help rule out physical problems, such as a low thyroid level or anemia.

Children and teens

Symptoms of depression in children and teens can be different from adult symptoms.

To find out if your child is depressed, the doctor may do a physical exam and ask your child about his or her health and about how he or she thinks, acts, and feels. The doctor may ask your child about grouchiness, temper tantrums, headaches, stomachaches, social withdrawal, and more. It is common for children with depression to have other problems, such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder. The doctor may ask questions about these problems too.

The doctor may also ask you or a teacher to fill out a form about your child’s symptoms.

Some diseases can cause symptoms that look like depression. So the doctor may do blood tests to help rule out physical problems, such as a low thyroid level or anemia.

For information about Magellan events during National Depression and Mental Health Awareness and Screening Month, downloadable materials and more free resources, visit our website here.

Adapted with permission from copyrighted materials here from Healthwise, Incorporated.  Healthwise, Incorporated disclaims any warranty and all liability for your use of this information.

This month we are sharing an earlier Thought Leaders interview with Patricia Smith about compassion fatigue, given the significant impact COVID-19 continues to have on caregivers across the spectrum, from hospital staff to family caregivers. We are reminded of Patricia’s interview and wanted to share it at a time when it could be so helpful to so many.

Patricia graciously agreed to us re-running her 2017 feature article, and was kind enough to write a new introduction. Many thanks to Patricia for her continued contributions to the field and in caregiver communities! Now, let’s hear from Patricia about compassion fatigue in today’s caregiver climate.

As I write this addition to the 2017 interview on compassion fatigue and caregivers, our world is in the grips of COVID-19. This pandemic has created worldwide confusion, anger, pain and suffering. My work over the past 20 years has been focused on caregivers in all of the helping professions, and family caregivers, as well. Now, with the trauma created by the virus, I consider all of us caregivers. Who hasn’t run errands for their elderly parents? Who hasn’t shopped and delivered the groceries to their elderly, ill or disabled neighbors? Who hasn’t sewn masks to be given out to their community members? Who hasn’t worked diligently in lockdown to prepare nutritious meals for themselves and their family members? Who hasn’t advocated what’s right and life-affirming on Facebook, Twitter and other social media? These, and many more actions and behaviors, define care-giving. It is more important than ever that each one of us begin our healing process. As difficult as that is in the eye of the hurricane, it is imperative if we hope to return to a healthy level of wellness, happiness and good health. Find time in each day for authentic self-care. Take a walk in nature, paint a picture, meditate, practice yoga, listen to music that stirs your soul, bake a cake and give half to someone who is weathering the storm alone, plant a vegetable garden, or sit in silence and be thankful for the good that remains in your life. All of these strategies define and promote healing.

Stay safe. Patricia

2017 Thought Leaders Interview with Patricia Smith on Compassion Fatigue

Magellan: Thank you for taking the time to participate in our virtual interview. Can you share with our readers some background regarding your interest and leadership in the area of compassion fatigue and burnout in the mental health and wellness field?

Patricia Smith: I first learned about compassion fatigue as the training and development manager at Humane Society Silicon Valley. After many years as a journalist, I decided I wanted to work with animals. Within the first two weeks in my new job, the executive director asked me to create a shelter-wide compassion fatigue training. I had never heard the term, and the only information I could find was the academic work of Dr. Charles Figley, who was then the director of the Traumatology Institute at Florida State University. I contacted Dr. Figley and he brought me through the process of understanding exactly what compassion fatigue is and how to address the symptoms. At that same time, I took the Professional Quality of Life Self-Test (https://www.proqol.org/ProQol_Test.html) created by Dr. Beth Hudnall Stamm, who also became a mentor. The test revealed that I suffered from very high levels of compassion fatigue. This started me on a journey that has lasted the past 20 years. After several years on my own personal healing journey, I created the Compassion Fatigue Awareness Project in hopes of helping others in the helping professions to understand compassion fatigue and how high levels can devastate a caregiver’s life. The scope of my work has grown beyond anything I could have imagined.

Magellan: You have done a great deal of work looking at aspects of compassion fatigue and burnout. What have you learned over the course of this work, and what recommendations would you make to peers to support their own wellness and to avoid compassion fatigue?

Patricia Smith: My own work has dovetailed with the amazing work being accomplished by professionals such as psychiatrists and psychologists in the field of traumatology and neuroscience. Powerful new information has come about from studies of the effect of trauma on our Wounded Warriors. Post-traumatic stress disorder is now a common phrase and the understanding of trauma on the human body, mind and spirit is widespread. These studies have branched out to include brain studies and how traumatic events impact our brains – and, more important, what we can do about it.

If, indeed, a caregiver suffers a high level of compassion fatigue, which is a secondary traumatic stress syndrome, the best path to take for healing is authentic, sustainable self care. The practices that promote wellness encompass the Standards of Self-Care: nutritious food, exercise, restful sleep, highly functional relationships and replacing toxic habits (smoking, alcohol, drugs, overeating, pornography, etc.) with healthy, life-affirming habits.

Magellan: Your studies/work around compassion fatigue and personal wellness are of particular interest to our readers, given their work in peer support. How can we influence modifiable lifestyle behaviors to improve individual well-being and battle compassion fatigue?

Patricia Smith: Re-wiring our brains to successfully improve the quality of our own lives takes work – lots of work. Healing is an inside job. We must go back in time to heal the wounds we have endured throughout our lives; one of the main causes of compassion fatigue is holding unresolved pain and suffering within. This takes a toll emotionally, but is well-worth the journey. The work involved in healing our wounds is nothing compared to the time, energy and emotional pain it takes to hold them at bay. Everything that has ever happened to us lives within. Pushing down the memories or ignoring them constantly elevates levels of compassion fatigue. Every time we experience additional trauma in our lives, which today is perpetrated everywhere – Facebook, TV news, newspapers— the new trauma hooks into the trauma that already exists. This pattern continues day after day in the helping professions and, eventually, a caregiver will become paralyzed with compassion fatigue. Businesses and organizations can do their part in helping caregivers to modify their lifestyles by educating their employees about compassion fatigue and putting healthy alternatives into place. This could include an edict wherein no business (emails, texts, phone calls) is conducted on weekends or evenings, encouraging mandatory vacations, providing healthy food alternatives in the cafeteria or vending machines, creating walking or biking groups, and other positive encouragement to promote wellness.

Patricia Smith is a certified compassion fatigue specialist with 20 years of training experience. As founder of the Compassion Fatigue Awareness Project©, she writes, speaks and facilitates trainings nationwide in service of those who care for others. She has presented to caregivers in numerous helping professions including social work, health care, law enforcement, chaplain services, suicide prevention and education, among many others. She has authored several books and training materials for caregivers, including the award-winning To Weep for a Stranger: Compassion Fatigue in Caregiving. She served as the caregiving expert for Spry magazine for several years. In September 2016, she presented a TEDx talk on the subject. Additionally, she was the 2012 and 2013 recipient of a writing fellowship at the Helen R. Whiteley Center, in Friday Harbor, Washington, a scholarly research center sponsored by the University of Washington in Seattle.

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

It’s hard to comprehend how much the world has changed since the beginning of the COVID-19 pandemic. It has turned our lives upside down in many ways, from school and business closures to quarantines and social isolation. With no clear end in sight, it is not surprising that many people are having difficulty getting used to the “new normal” that is far from what normal life once was.

Families face the challenges of online and home schooling, and the coming school year brings more uncertainty.  In addition, many people are experiencing financial strain from reduced working hours or job losses. Workers may have to work from home and adapt to an entirely new way of working, with little social interaction.  For some workers, juggling parental and domestic duties with the demands of work has been very stressful. Over time, chronic stress can lead to burnout.

Symptoms of burnout include feeling physically depleted, emotionally exhausted and negative about work.[1]

The signs of burnout are similar to those of depression. If left untreated, burnout can lead to physical illness and mental health problems, such as depression and anxiety. Here are some practical tips to manage burnout:

• Set boundaries between work and private life. If you work from home, set clearly defined working hours and a specific work area.
• Take breaks during the day and build transitions in your life between the start of work and the end of the working day. For example, making a transition to work can be as easy as getting a cup of coffee each day and logging into your computer at the same time. To end the day, practice a daily routine such as checking your emails, reviewing priority tasks for the next day and logging off your computer.
• Take your well-earned time off. Even if the pandemic kept you from going somewhere for vacation, a planned “staycation” will allow you to enjoy the well-deserved rest and relaxation. It is important to recharge; you will feel refreshed when you return to work.
• Don’t forget to socialize. When your colleagues start working from home, you may miss the casual social interactions had throughout the day. Like any skill, use it or lose it. Socialization in a time of pandemic takes effort to maintain.
• Make self-care a part of your daily routine. A healthy diet, getting enough sleep and maintaining an exercise schedule can help you cope with and reduce stress.
• Maintain consistent family routines. A regular routine can help all family members feel more focused and productive. If your child is at home learning online either full or part-time or you’re home-schooling, set consistent times for meals, schoolwork, other activities and bedtime.

Help is available. Your program is completely confidential and here to help you and your household members 24/7/365. No situation is too big or too small. Give us a call or visit your program website to get started.

[1] https://www.who.int/mental_health/evidence/burn-out/en/

Technological and scientific advancements have dramatically altered the treatment landscape in several disease states. These include orphan diseases and conditions that previously had no disease-modifying treatment options. These innovative therapies have also come with unprecedented costs, with some agents introduced at a price exceeding one million dollars for a single patient. Value-based purchasing arrangements (VBPs) have attempted to manage the initial cost of these agents. In a VBP, which is sometimes referred to as an outcome-based arrangement, the ultimate price that is paid for the drug is dependent on the clinical outcome. In addition to a plan’s traditional utilization management initiatives to maintain sustainability, this strategy aims to hold pharmaceutical manufacturers responsible for the result of their product. This is similar to other healthcare environments, such as when readmissions impact hospital reimbursement. Under VBPs, a pharmaceutical manufacturer would issue a reimbursement if their product failed to produce the desired clinical outcome. In addition, this strategy incentivizes the development of unique therapies that are more likely to have a clinically significant impact. Novel medications that improve outcomes would provide a greater healthcare value and could be priced higher in the market. Currently, volume is a large driver of cost, with discounts from pharmaceutical manufacturers often tied to the number of units dispensed. This is less helpful for niche-area pharmaceuticals and genuinely innovative treatments used for uncommon conditions.

Practical considerations of VBPs, such as a higher administrative burden (e.g., paperwork, electronic database access, automated retrieval of data), limit their application to all products. Since it can be expensive to measure outcomes in order to assess the worth of a product to an individual patient or plan, VBP concepts are most commonly applied only to the costliest medications. For instance, VBPs can have a significant impact on the pricing of agents like gene therapy or select oncology agents. Some of these agents can have a large clinical impact on disease progression, survival, or quality of life, but a drug may not have the same results in all patients. However, value-based or outcome-based pricing may provide an increased incentive to payers by decreasing their initial risk and providing more sustainable treatment coverage.

While there has been an increase in the use of VBPs by states, manufacturers, and other payers in order to control drug spending and tie patient outcomes to cost, uncertainty remains in developing novel VBPs. The Medicaid Drug Rebate Program (MDRP) created by Congress under the Omnibus Budget Reconciliation Act of 1990 ensures that Medicaid receives the lowest net price for a single source drug or innovator multiple source drug during the rebate period charged to any payer. Simply put, pricing net of all discounts, must be reported to Medicaid, and the best price would have to be offered to Medicaid as well. It is critical that Medicaid programs continue to receive the lowest price available for a single source drug or innovator multiple source drug.

On June 19, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that is aimed at promoting VBP flexibility for a variety of payers, including Medicaid, with a goal of maintaining a best price for Medicaid. CMS notes that best price creates challenges related to the availability of VBP arrangements. For example, under existing best price rules, if an individual fails to achieve the specified clinical outcome under the VBP arrangement, the drug manufacturer may be required to provide a discount or otherwise may not be entitled to payment for that patient. Thus, the best price of that drug for purposes of the MDRP could become zero. This possibility has stunted the development and proliferation of VBPs. This new proposal from CMS, which includes other regulatory revisions as well (e.g., minimum standards for Drug Utilization Review [DUR] programs), could ultimately lower healthcare costs and potentially limit spending on treatments with limited value over time.

The ultimate goal of a VBP is for all parties to have a vested interest in the outcomes of drug therapy and to share the risk related to healthcare costs. Specifically, it calls on manufacturers to have more “skin in the game.” Moreover, the change to the Medicaid market could have potential savings applicable to a variety of market segments, impacting all Americans. Regardless of the final outcome or any changes made to the current draft prior to its possible rollout, the proposal demonstrates readiness from CMS to pivot prior strategies to mitigate rising drug prices.

As our country continues to navigate the coronavirus pandemic and social distancing, a new concern has emerged – avoiding and delaying medical help when necessary, also known as medical distancing. Maintaining physical and mental health during the current pandemic is essential. If you are feeling ill, need a routine medical check-up, or have severe feelings of anxiety or depression, please seek medical attention.

Stop Medical Distancing 

It’s important that you feel safe and get the care that you need, when you need it. Here are some helpful tips to safely receive medical attention while social distancing:

1.  Mask Up– The Centers for Disease Control and Prevention have asked all Americans to wear a cloth face covering to help prevent the spread of the coronavirus. Medical facilities require patients, staff, and providers to wear a mask to protect you and your community. Take part in the fight against the coronavirus by complying and wearing a mask, too.

2.  Distance Yourself– When you are waiting to be seen by your physician, ask if you can wait outside or in your car. If you have to stay inside, do your best to distance yourself from other patients, visitors, and staff. When returning home, avoid being in the presence of those most vulnerable to coronavirus.

3.  Sanitize– Medical facilities are regularly cleaning waiting areas and exam rooms between each patient. Hand washing and sanitizing your hands before and after your visit is a must to protect yourself and your family from getting sick. Keep hand sanitizer in easy-to-reach places so you don’t forget, such as your bag, purse, pocket, or in your car.

4.  Limit Visitors– To create a safe environment, many medical facilities have implemented restrictions and limitations on visitors. This helps protect you and other patients who are vulnerable to the coronavirus. Going to the doctor alone can be scary and intimidating – but it’s essential to limit friends of family members from going with you when it can be avoided.

5.  Go Digital– If you’re still not comfortable with face-to-face visits or don’t need to be physically seen by a doctor, you should optimize telemedicine or telehealth services. These are appropriate and efficient means of connecting with your provider in the comfort of your own home.

6.   Trust– Finally, trust your doctor and know that your safety is their number one priority. As the pandemic continues, medical facilities are adjusting the way they deliver health and enhancing their procedures and protocols.

Protecting yourself from the coronavirus does not need to get in the way of your overall health and well being. #Stopmedicaldistancing

There are an estimated 1.2 million people in the US living with HIV, and roughly 1 in 8 people are undiagnosed. The virus attacks your body’s immune system and weakens its ability to fight infections. When HIV is untreated, it can lead to acquired immunodeficiency syndrome (AIDS), and the body becomes even more at risk for opportunistic infections.

While antiretroviral therapy has been available to treat HIV-positive patients for some time now, certain antiretroviral medications are also FDA-approved to be taken daily to prevent the risk of becoming infected with HIV. This treatment, known as pre-exposure prophylaxis (PrEP), is intended for people who do not currently have HIV but are at risk for contracting HIV. Overall, PrEP has shown to reduce the risk of contracting HIV through sexual contact and injecting drugs by 99% and 74%.

The main goal of any PrEP treatment is to prevent the transmission of HIV to an uninfected person. There are multiple treatments available to help reduce the risk. Regardless of which medication a patient takes, these medications must be taken consistently every day as prescribed. It is also crucial to not skip or miss doses. Possible side effects from PrEP medications primarily include nausea, but in general, these medications are well-tolerated. Despite this, it is still important to tell a healthcare provider about any side effects experienced.

Advances in antiretroviral treatments have made it possible for patients to live healthy, vibrant lives. That said, patient management programs are very valuable to patients whose ability to take their medications as prescribed has direct impact on the long-term success of their treatment.

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.