Finding solutions that allow individuals to improve their overall wellbeing has been Sara Pierce’s primary focus with the recent launch of eMbrace on April 1, 2022. As senior vice president of strategy and execution, Pierce has worked closely on the collaboration between Gallup and Magellan Health and the creation of the Magellan-Gallup Wellbeing Project. With over 10 years of experience working at Magellan, Pierce is a leader on the Growth Team where she’s responsible for the team’s Go-To Market strategy (GTM) and leads individuals on the sales operations, the sales training, and customer experience teams. Pierce, who is based in Connecticut, discusses her ongoing work with Gallup on projects including eMbrace, and how Magellan’s culture has been instrumental in its success.

What sort of innovative projects are you currently working on?

I think the most innovative and fun project I’m working on right now is related to our collaboration with Gallup. We’ve created the Magellan-Gallup Wellbeing Project, joining  forces to combine Magellan’s 50 years of behavioral health experience with Gallup’s industry-leading insights and research to understand how we can better meet the needs of individuals and improve their overall wellbeing. Gallup’s State of the Global Workplace Report tells us that roughly seven in 10 employees are struggling or suffering in their overall lives, with negative emotions at an all-time high. As an employer and a human this is deeply troubling to me.

eMbrace is a fully integrated, evidence-based solution for supporting members’ total wellbeing. We’re incorporating Gallup’s wellbeing assessment and then introducing different solutions or opportunities for employees to engage at all levels across the continuum depending on where they are in the six elements of wellbeing. In essence, we are breaking the silo that has until now separated employee assistance and clinical care, shifting an individual from coaching to employee assistance to clinical counseling based on what is happening in their life.

Do you have any other projects still in the planning phase?

We’re still in the thick of the recent eMbrace launch and it’s exciting that our own Magellan associates will be one of our first customers to utilize eMbrace. This provides us a valuable opportunity to “walk the walk” and to continuously learn from ourselves and our own team. At the same time, we are exploring how we can bring this important work to our health plan, public and Federals markets as well. This is only the beginning!

Why is Magellan Health the best place to do this project?

I think we are the perfect place to do this because of our over 50 years of deep clinical behavioral health experience. Our customers, whether they are employers, health plans, public or federal markets, all have one thing in common – they all have people who are struggling and suffering. The way I think about it, is if not us then who?

What are your thoughts on the culture here at Magellan Health? How has the culture at Magellan impacted your project?

I think one of the things that’s truly unique about Magellan’s culture is that everyone is singularly focused on our mission to help people. We take that very seriously. I think that’s a big part of who we are and why we do what we do and that it’s palpable. When you’re working on trying to solve big problems, it helps to bring it down to the individual level and understand that what we’re doing matters to a person, a family, and an employer. That culture informs everything we do.

What are some exciting trends you’ve noticed in the healthcare industry? What direction do you see healthcare going? What lessons are there to learn in other industries that can be applied to healthcare?

We are in unprecedented times in terms of the rise in unmet need. More and more, as an industry, we are coming up with unique ways to try and meet those needs. One example of that is by addressing people earlier on in the continuum so that we can intervene to prevent exacerbation of illness. Offering digital assessment tools and interventions is one way to try and address the unmet needs. But of course, we can’t make the mistake of letting the pendulum swing too far in any one direction. I believe that our customers want us to balance digital and in-person. The right tools to the right people at the right time.

I think one of the problems in healthcare is that the industry has not designed solutions with the user experience in mind. Meanwhile in all other aspects of our lives, our tolerance for bad experiences is getting smaller every day. Our cell phones are continuously upgraded to improve our user experience. Products and services are marketed directly to us based on knowledge of our preferences, and we have countless choices in entertainment, retail, and restaurants. User experience is king in everything other than healthcare. For too long consumers of healthcare have been trapped with few choices. The good news is that every day I see more evidence that this is changing but we have miles to go before we rest.

Learn more about the dimensions of wellness here.

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.

This article is part two of our discussion about the impacts on mental health and the war in Ukraine. Click here to read our tips for adults. 

Information on the war is continually changing. The youngest viewers, children, are watching and may experience the fear and stress associated with images from the war in Ukraine.

To add to the stress and concern, this global crisis comes on the heels of being exhausted and socially isolated by the pandemic. The following are some tips to help children that are impacted or stressed by the Ukraine situation.

Listen to children. Children hear and see things. This can be especially frightening if they have a parent deployed. It is important not to force them to talk. Find alternative ways to communicate with children such as drawing or playing with toys.

Calm conversation. It is important for parents to be calm when talking to their children about Ukraine. Parents need to be careful not to be the source of a child’s anxiety. Parents are encouraged to check-in and ask their children how they are doing.

Answer children’s questions. Support and acknowledge what your child is saying and their potential fears. Reassure your child but do not make unrealistic promises. Answer questions and help in separating fact from fiction.

Provide support. Do not let children watch the images of violence on television. Children who have experienced trauma may need extra attention. Some children may not want to talk about the event. It is okay if they would rather play or be outside.

Limit exposure to media and social media. Limit the exposure to graphic violence on media. For older children, watch the news with the child and then talk about how the child is reacting to what they are seeing.

Maintain a normal routine. Encourage the daily routines such as homework, sports, activities to continue.

Watch for changes in mood. Some children show their reactions in nonverbal ways. Watch for anger, physical symptoms, mood changes, or withdrawing from usual activities and conversations.

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.

We made it through Thanksgiving – hopefully emotionally unscathed. But for many, managing mental health during the holidays is not easy. Whether you deal with anxiety for months leading up to the holiday, your family is plagued with arguments or more subtle discomfort during get-togethers, and/or you are mourning the loss of a loved one and have an empty seat at the table – the holidays can be tough. In fact, in a 2021 survey, 44% of Americans said that preparing for the holidays is stressful and 39% said that family gatherings during the holidays are stressful.[1]

Holiday anxiety

Anxiety is defined by the National Institutes of Health as “a feeling of fear, dread, and uneasiness.”[2] And why might we feel anxious leading up to what one might consider a wonderous and magical occasion, such as Thanksgiving or a December holiday, with our family? The reasons are endless. It could be a difficult family member we are not looking forward to seeing. It could be that we are not feeling particularly good about ourselves and want to face others. Maybe we are hosting a holiday gathering and worried about getting everything done in time, how much everything will cost and whether everyone will have a good time.

We are barraged with media images of what the perfect holiday looks like, and we may sometimes feel pressure to be happy and festive and live up to expectations.

When we dread an upcoming holiday, it puts a damper on more than merely just that day or specific gathering, but the days, weeks, or even months leading up to it. It is almost like the reverse of excitement or anticipation. But whether we are excited or anxious about something, the actual event often does not live up to our expectations. In the case of holiday anxiety, if we can remember that it may actually end up being better than we think and simply try not to care as much, our anxiety time may be reduced. We can let go of others’ expectations of us and do what truly makes us happy.

Family arguments during the holidays

Yes, most families argue – even during the shiny holidays and behind the scenes of the happy pictures we post on social media. And just when our typical bickering was not enough, our country has become increasingly divided, and it has seeped into our very own families. There are things we can do to prevent the arguments and deal with them in a healthier way when they occur.

You have probably heard the phrase “communication is key.” A lot has changed over the past couple of years and continues to change at a rapid pace. We may think we know how a loved one would like to celebrate the holidays, for example. But their preferences, and our own, may have changed just like so much else has changed.

It’s a good idea to initiate respectful conversations – early in the holiday planning process – with our family and friends to understand where they are coming from on certain issues. It can be a way to identify the topics that should be off-limits during the upcoming holiday gathering and prevent arguments.

During these early conversations and when we’re all together for the holidays, our family members may inevitably do or say something that rubs us the wrong way. At that moment, our reaction will set the course for what comes next. As our feelings come together to form that reaction, why not assume goodwill and the best intentions of the offending person. It may be that their actions and comments reflect the way they feel about themselves and not the way they feel about you.

With so much to disagree about these days, there is also a lot we can agree on. Try to focus on the latter, agree to disagree when possible, and assume that others are coming from a place that is genuinely meaningful to them.

Grief and missing a loved one during the holidays

The pandemic has taken so much from us, including the lives of precious loved ones. The holidays have always been a difficult time to bear when we cannot share them with a lost family member or friend. During this holiday season, you can uphold and honor memories of those you have lost in many ways: Look through photographs of the person and reminisce about holidays of the past; do things you used to do with a lost loved one during the holidays, like cooking or baking a certain recipe, a craft, or decorating; and journaling or talking with others about your feelings.

It can be hard to move on without a person we love, but they would want you to be happy. We will always have their memories during the holidays and beyond, as we carry on with old and new traditions.

We can all agree that it has been another tough year. But we have endured, and it is time to let go of expectations and focus on our mental health during the holidays and how the holidays can be a time to do what makes us happy, spend quality time with those who are important to us and cherish the memories of those we have lost.

Visit MagellanHealthcare.com/Holidays for additional information and resources on holiday emotional wellbeing and how to find peace and moments of joy with family and friends this holiday season.

[1] Collage Group Holidays and Occasions Survey, May 2021

[2] https://medlineplus.gov/anxiety.html

Candice Tate, MD, MBA, serves as a medical director at Magellan Healthcare. Dr. Tate’s treatment philosophy includes a strong physician-patient therapeutic alliance and safe, responsible medication management. Dr. Tate joined Magellan in 2017. She has years of experience in psychotropic medication management for a variety of psychiatric conditions in inpatient and outpatient settings. During her graduate medical training, Dr. Tate was extensively trained in psychodynamic psychotherapy and was supervised by experienced psychoanalysts. She is also familiar with cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and dialectical behavior therapy (DBT). Dr. Tate graduated from the University of Tennessee Medical School in Memphis and completed her graduate medical education in General Psychiatry at Northwestern University’s Feinberg School of Medicine in Chicago, IL. Dr. Tate is a board-certified psychiatrist by the American Board of Psychiatry and Neurology.

The COVID-19 pandemic has had a profound affect on everyone, particularly children with emotional health concerns. Many support structures in place prior to the pandemic to help children thrive have disappeared or been changed significantly, resulting in increased pressure on caretakers and overwhelming stress for children. New and innovative solutions are needed to meet these challenges. Magellan Healthcare’s Emotional Health for Kids by Mightier is a clinically proven video game solution that helps children build emotion regulation skills through play and caregivers build emotionally healthy homes.

Developed at Boston Children’s Hospital and Harvard Medical School, Mightier helps children ages 6 to 14 who are struggling with emotional health concerns, such as irritability, aggression, and anger, as well as children diagnosed with oppositional defiant disorder, attention deficit-hyperactivity disorder, autism spectrum disorder (ASD) and general anxiety disorder.

Mightier’s impact on children’s emotional health

In a pilot program, Magellan provided members access to the Mightier program for a period of twelve weeks during the COVID-19 pandemic. Families were recruited and randomized into a group that received Mightier in addition to applied behavior analysis (ABA), or a group that received only ABA as a control.

• Children engaged with Mightier at a high rate. On average, Mightier families played for 30.4 minutes above the 30 minutes per week recommended to see clinical change.
• Clinical symptoms improved. Eighty percent of children with ASD who used Mightier showed an improvement on primary symptoms, compared to only 50% in the control group.
• Children showed twice as much decrease in aggressive behaviors. Adding Mightier to ABA resulted in a reduction in aggressive behavior in children with autism by twice as much compared to ABA alone.
• Families reported a less stressful and more supportive environment. Families using Mightier showed 50% improvement in family stress, 114% improvement in parent confidence, and 114% improvement in access to resources relative to control.

Visit  Magellanhealthcare.com/kids-emotions-mightier/ to learn more about the pilot and how Mightier helps children build self-regulation skills and supports caregivers in building emotionally healthy homes.