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.

As winter approaches, efforts in many states across the country to control a second rise in COVID-19 infections also mean continued social isolation and hardship for millions of people. High, chronic levels of stress resulting from unemployment and economic insecurity, school closures, disruption to normal routines, illness, and loss have a negative impact on mental and physical health. In addition to the burden of the pandemic, simmering political and social tensions have left many people feeling distressed and threatened.[1]

As a nation, we face a challenging winter even as coronavirus vaccination news looks promising. It will be months before a vaccine can be widely distributed across the population, and even then, life may not be back to normal. In the meantime, it is important to monitor and care for your mental health as we move through this next phase.

People at Risk

A significant number of Americans report feeling depressed and anxious as a result of the pandemic. People who are already prone to mental health problems, people with low incomes, minorities, young people and isolated older adults (especially those living in facilities) are at higher risk of depression.

If you or a loved one are struggling with persistent feelings of sadness and hopelessness that last for two weeks or more, have lost interest in things you used to enjoy, have thoughts of self-harm and/or experience sleep disturbances and changes in appetite, it is important to see a doctor for an evaluation and possible treatment of your symptoms. There are effective treatments for depression, including medication and various therapies.

Building Resilience

There are several ways to build resilience and prepare emotionally for winter shutdowns. Research shows that resilience skills can be learned and include the following:

• Social connections. A strong social support network is one of the most important parts of building resilience. If face-to-face contact is not possible, stay in touch with family and friends by phone or video. Check in on friends and neighbors who are having a hard time.
• Pay attention to negative thoughts and practice gratitude. Resilient people tend to be optimistic and flexible in their thinking. If the constant negative bombardment of news and social media makes you anxious and unhappy, limit or take a break from your screen time.
• Assess what you can and cannot change. Focus on positive actions that you can take, even if the possibilities seem limited. Tap into your talents: revisit an old hobby or try something you’ve always wanted to do.
• Take care of yourself. Maintain routines, get enough sleep and exercise and eat a healthy diet. Avoid using alcohol or other drugs to combat sadness or boredom.

Having goals and a purpose can also increase resilience. The pandemic has led many to rediscover a new appreciation for their gifts, relationships and the values that give meaning to their lives. If you are doing all the right things to build your resilience and still feeling down, make an appointment with your doctor. You will get through this.

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

[1] Nancy Schimelpfening,“This COVID-19 Spike Will Also Hit our Mental Health with a ‘Second Wave,’” September 23, 2020, Healthline, https://www.healthline.com/health-news/this-covid-19-spike-will-also-hit-our-mental-health-with-a-second-wave#Why-is-the-pandemic-putting-our-mental-health-at-risk?

For November National Family Caregivers Month, we are pleased to share our e-interview with Pat Hunt, executive director of the Family Run Executive Director Leadership Association FREDLA, on family support organizations and how they help families who are dealing with mental health issues.

Magellan: Pat, so glad to have you with us today. Tell us a little about how you came to the work of family leadership.

Pat Hunt: It’s always a pleasure to spend time with folks at Magellan. Like family leaders across the nation, my lived experience has continued to shape the pathway. As a parent, I didn’t want anyone else’s child to struggle the way mine did – or for other parents to have a similar experience as mine. I was so fortunate to have the benefit of allies in my state – other parents, people in state government, providers – all willing to be courageous and develop solutions together. I worked with 16 families across my state to develop a statewide family network with a vision toward positive change. As a family leader, I applied what I had learned from my experience as an advocate – which may be a misunderstood word today – to help other families understand the impact of policy on service array, practice, access, quality, etc. and to have the information, opportunities, skills and resources to effectively participate. This foundation took me to national organizations, such as the Federation of Families, Magellan and FREDLA.

Magellan: You became the executive director at FREDLA almost two years ago. What are you passionate about in your work at FREDLA?

Pat Hunt: Family-run organizations across the nation are the bloodline of the family experience – flowing from the heart of every family they serve. THEY touch lives in amazing ways. FREDLA is here to nourish and support their work – to ensure they have the tools and support they need to be successful, viable and sustainable. That means we also help states, counties, practitioners, health plans and management organizations by providing consultation and training – because they are interdependent in achieving the positive outcomes for children, youth and their families.

Magellan: What should we be looking forward to in the next year on developments in the family support field?

Pat Hunt: 2020 has taught us that the efforts of peer family support partners have been nothing short of herculean during the most challenging of times. They are innovative, dedicated and resilient. The results of FREDLA’s recent national survey will be released soon and used to inform workforce development, technical assistance, national advocacy efforts and research programs. In March, we will be hosting a national event to respond to the needs of parent peer support providers, their supervisors and the funders and management of their programs. Stay tuned, and we hope your audience will as well.

Pat Hunt is the executive director of FREDLA, the national Family Run Executive Director Leadership Association, a non-profit union of leaders of grassroots family-run organizations across the nation. Along with her lived experience as a parent, Pat brings over 25 years of experiences as an advocate for children with behavioral health needs and their caregivers. During this time, she had extensive experience overseeing both federal and state grants and served as the founding director of a family-run organization.

Pat’s experience includes over 10 years in a corporate leadership role at Magellan Healthcare to advance best practices for children, youth and their families, and to ensure that their experiences informed policies, practices and program development. She previously held a senior leadership position as a conduit for local grassroots experience to inform national policy decisions at the Federation of Families for Children’s Mental Health. She has served as a VISTA Volunteer, directed a federally funded rural substance abuse prevention project, managed a statewide family-run organization, served as president of the Maine’s mental health planning council, and was the only non-state employee member invited to the Governor’s Children’s Cabinet.

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

Depression is a disease. It’s caused by changes in chemicals in the brain that are called neurotransmitters. Depression isn’t a character flaw, and it doesn’t mean you are bad or weak. It doesn’t mean you are going crazy.

People who are very depressed can feel so bad that they think about suicide. They may feel hopeless, helpless, and worthless. But most people who think about suicide don’t want to die. They may see suicide as a way to solve a problem or end their pain.

What to watch for

It is hard to know if someone is thinking about suicide. But past history or events may make suicide more likely.

Things that can make suicide more likely for those suffering from depression include:

• Being male
• Having had a family member attempt suicide or kill himself or herself
• Having access to a firearm
• Having been sexually abused
• Drinking a lot of alcohol or using drugs
• Having attempted suicide before
• Feeling hopeless
• Other mental health problems, such as bipolar disorder or schizophrenia

Warning signs of suicide include someone:

• Planning to or saying he or she wants to hurt or kill himself or herself or someone else
• Talking, writing, reading, or drawing about death, including writing suicide notes and speaking of items that can cause physical harm, such as pills, guns, or knives, especially if this behavior is new
• Saying he or she has no hope, feels trapped, or sees no point in “going on”

Find additional information and resources on suicide prevention here.

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

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

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.

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.

As if 2020 wasn’t already difficult enough with the stressors caused by the COVID-19 pandemic and protests over social justice issues, the upcoming election adds another level of anxiety for many people. A study published by the American Psychological Association in 2019 found that 56% of Americans, regardless of party affiliation, felt stressed about the upcoming presidential election.[1]  If you are feeling overwhelmed by the current political climate, you are not alone.

These feelings can have a negative impact on your emotional and physical health. Symptoms such as low energy, insomnia, loss of appetite, mood swings and tension are signs that you should not ignore. It is important to recognize what you can and cannot control as the election approaches.

You cannot control other people’s opinions, beliefs, reactions or how they express themselves. Nor can you control others’ votes. There are, however, many things you can control during and after the election:

• The amount of time you spend on election news and discussions. While the 24-hour political news cycle on television, radio and the internet is almost impossible to escape, you can limit the amount of time you spend on media each day.
• The coverage, feeds and groups you follow. When you are watching or reading election coverage, avoid negative-leaning discussions, especially if you feel constantly frustrated or upset by them.
• How you interact on social media. Avoid giving angry or emotional responses to posts that do not align with your views. You are unlikely to change other people’s opinions; you are more likely to get unwanted and hostile feedback.
• The time you spend with people. Prioritize your relationships with positive family and friends. Strong social connections can reduce stress and help you feel happier and more energetic. If you and a friend or family member have differing political views, try not to discuss them.
• How much you talk about politics at work. A February 2020 Gartner survey found that 78 percent of employees talk about politics at work; a third of those employees find the conversations stressful or frustrating.[2] Limit or avoid political discussions at work. When you do engage, treat colleagues with kindness and respect, and be aware that political discussions can hamper teamwork and productivity.
• How you deal with stress. Whether it’s meditation, going out in nature, reading a book or working on a hobby, take time every day to do something that makes you feel good. Make sure you get enough sleep and exercise, eat a healthy diet, and avoid using alcohol or drugs to cope.
• How you use your time and talents. Give your time and skills to a cause you believe in. If you have a strong interest in a political cause or candidate, offer to help with a campaign or other event.

Remember that professional help is available through your EAP if stress and anxiety about the election start negatively impacting your quality of life.

[1] https://www.apa.org/news/press/releases/2019/11/americans-significant-stress

[2] https://www.cnbc.com/2020/02/18/47percent-of-workers-say-the-2020-election-has-impacted-their-work.html