The 10 by 10 Campaign - Wellness Update
Volume 7
July 6, 2009
Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA)
Greetings! This is the summer 2009 update on the 10 by 10 Campaign to promote wellness for people with mental illnesses and reduce early mortality by 10 years over the next 10 year time period.
Please forward to others who are interested in promoting wellness for people with mental illnesses!
In This Issue:
Guest Columnist
The truth about madness
Wellness: What You Need to Know
Risk: Fatal illness more likely in bipolar patients
Mood disorders common in polycystic ovary syndrome
Moving nation from sick care toward wellness care
General exercise guidelines for people with disabilities
Depression in cancer patients: inquire or don’t, but be concerned
Studies try to tease apart the links between depression and hearth disease
Social rejection linked with pain in depresses patients
Poor mental health, asthma risk linked?
Loneliness as harmful as smoking and obesity, say scientist
Happenings All Over the Country
Spread the Word
An active campaigner for the Pledge for Wellness
Quotes-of-the-Month
Guest Columnist
Meghan Caughey
On that final evening, after helping a friend celebrate her birthday, my friend David Romprey started to drive off in high spirits, on his way to a date at the movies. He was excited about the future. Over the years, he had successfully dealt with his bipolar disorder, had been recognized for his determined efforts as a mental health advocate, and would soon be starting a wonderful new position as coordinator of the Peer Bridgers program at the Oregon State Hospital.
But then something went terribly wrong: his car backed out and struck an electrical box on the curb. People rushed to the scene but it was too late: David was dead. His friends would later speculate that he had had a massive stroke or aneurysm. We mourned: we had lost our friend, the state of Oregon had lost a national mental health champion, and his family had lost a son and father.
The fact that David had longstanding mental health challenges and was only 42 years old points to a stunning problem that is a stubborn part of the landscape of madness in our contemporary culture: those of us who have serious mental health issues tend to die younger than other people. A study by the National Association of State Mental Health Program Directors in 2006 found that persons with serious mental illness die, on average, 25 years earlier than the general population. The fact that it is worse today than it was 10 years ago suggests that the trend is going in the wrong direction. The leading causes of death include cardiovascular disease, smoking, diabetes, suicide, and obesity. Some of the same medications that allow these persons to live relatively normal lives also contribute to heart disease and diabetes.
I know about this firsthand: when I was 19 years old I was diagnosed with schizophrenia. For years, my self-identity was “the Mental Patient.” I lived up to this “truth” by my frequent hospitalizations, some of which were involuntary, some voluntary because I knew no other way to cope with my pain. There were electroshock treatments, insulin shock treatments, seclusion rooms, even four-point restraints on my ankles and wrists when the emotional pain grew so intense that I could not contain it.
There have been years of medications, which have had devastating side effects. The weight gain that is so common to many of the medications has been a real blow to my self-esteem. I still struggle with it: despite having lost over a hundred pounds, I worry about getting diabetes. With the medications, for many of us, it is a trade-off. I do not feel that I have the option of completely going without the medications, but I know that there is a cost to my physical health. With exercise and a healthful diet, I do everything that I can to minimize that cost.
The miracle of all of this is that I have emerged from the painful “war” of my life despite attempts to end my life, and the life force in me cried out and has found expression. Over time, I have healed and created a way of being that is well and whole. Slowly, I discovered that my true identity was not “The Schizophrenic,” and I fashioned a new sense of self. I am living proof that even a very deeply disturbed soul can be resurrected from the despairing depths of a pained condition, and that pain can be a fertile source of creativity. Through my drawings and paintings, I celebrate the rich soil of both the dark and light aspects of myself. My “shadow self” is a part of me that I firmly value.
Today, at 53, I have a full-time job; for the first time in my life, I am no longer supported by government entitlements. My title, Peer Wellness Coordinator, is a bureaucratic term for my passion, which is to find ways to help those of us who know madness to live the lives we want to live, with greater health and without dying early. As we have struggled so hard to recover from our mental maladies, it seems beyond cruel that we should not have the opportunity to live a normal life span and enjoy our hard-won freedom. We want to live. We want to live well.
So, now, there is work for all of us together. Those of us who have been through the mental health system or who are still going through it must learn to demand that our providers give us recovery- and wellness-based programs that we ourselves are the force behind, not some other driver. We call these programs “consumer-driven” or “person-driven” services. Such services give us the voice that we need to help shape our present and future. Next, we need to support each other in the expectation that we can and will be healthy. I call this “creating a culture of wellness.” People with serious mental health issues often understandably focus on their emotional pain, with the result that even after their mental condition improves, they have forgotten, or never learned, the art of taking care of their bodies: eating right, exercising, a spiritual practice, maintaining connections with others. Every choice that we make for ourselves will have a ripple effect throughout our world; when we choose something good for ourselves, we are lifting up everybody else at the same time.
Reversing the statistics so that people with serious mental health issues do not die young from co-occurring physical ailments will not be easy. For me, it took nature, meditation, therapy, the right medication, art, and persistence to help create my healing, and the process took years. But what was possible for me is possible for others--one person and one life at a time. The human spirit strives to find a way to be well, and there is hope for everyone because the life force resides deeply within us all. By creating our culture of wellness, we will turn around the awful trend that seeks to take our lives prematurely, and replace it with a new expectation of vibrancy and wholeness.
My friend David Romprey died much too young. Let us not be content with a reality that says this is how things are. Instead, let us work for a world where recovery and health—both mental and physical—is possible for all of us who walk the land of madness. Our very lives depend on it.
What You Need to Know
Stay up-to-date on the latest wellness news!
Risk: Fatal Illness More Likely In Bipolar Patients
By Nicholas Bakalar
http://www.nytimes.com/2009/03/03/health/03risk.html?_r=2
People with bipolar disorder are at risk for an array of fatal illnesses, according to a review of 17 studies involving more than 331,000 patients. The researchers, writing in the February issue of Psychiatric Services, looked at studies of patients whose bipolar illness was severe enough to require hospitalization. Mortality in those patients ranged from 35 percent to 200 percent higher than in comparison groups.
In the larger studies, almost every cause of death was higher among bipolar patients: cardiovascular, respiratory, cerebrovascular (including strokes), and endocrine (like diabetes). In the smaller studies, mortality from cerebrovascular disease was higher among those with bipolar illness, but they showed inconsistent results, probably because they used smaller samples or less representative populations.
Several markers of inflammation — often precursors of heart attack and strokes — are higher among bipolar patients than others. The chronic stress of bipolar illness may lead to metabolic syndrome and atherosclerosis, or to insulin resistance, which increase the risk for sudden cardiac death. And psychiatric medications, because many lead to weight gain, may increase the risk for diabetes and cardiovascular disorders.
Dr. Wayne Katon, a professor of psychiatry at the University of Washington and a co-author of the study, said psychiatric patients and their families should try to make sure they are getting good medical care. “Good medicine,” he said, “means integrated mental health and primary care.”
http://www.reuters.com/article/healthNews/idUSTRE5155EE20090206
The prevalence of depression and anxiety among patients with polycystic ovary syndrome is high and warrants routine screening and aggressive treatment, investigators report in the journal Fertility and Sterility. In a previous study, Dr. Anuja Dokras, at the University of Pennsylvania and colleagues identified high rates of depression (35 percent) among women with PCOS, substantially higher than the 10.7 percent rate among the comparison subjects.
The current report is a follow-up to that study to determine the persistence of mood disorders and the incidence of new mood disorders.
Sixty of the original 103 women participated in the second survey, conducted an average of 22 months after the first survey. "The high prevalence rate of depression and persistence of new cases in this population suggests that initial evaluation of all women with PCOS should also include assessment of mental health disorders," Dokras and associates advise.
They recommend that physicians administer the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD PHQ) to their PCOS `patients because it screens for eating disorders and anxiety, as well as depression. They also suggest that patients be referred to dermatology and for weight loss counseling, since hirsutism, acne, and excess weight associated with PCOS may contribute to the emotional problems.
http://abcnews.go.com/Health/wireStory?id=6940761
Popping a pill can cut your cholesterol. But did the doctor also prescribe cutting the stress that's eroding your immune system? Or teach you how to exercise without worsening painful joints?
Think 3 Ps: Good health care is preventive, predictive and personalized, a rarity today in a crisis-oriented care system far better at treating disease than keeping it at bay. To help change that, one of the nation's top medical groups starts a major push this week for what patients might call whole-body wellness care.
"Health is more than the absence of disease," says Dr. Ralph Snyderman, who heads a three-day meeting of the prestigious Institute of Medicine to get onto Congress' radar this health-promotion approach, what jargon-loving doctors call "integrative medicine."
Medicare funded a Duke study of 154 middle-aged people at high risk of heart disease. In 10 months, people who received health coaching were exercising 3.7 days a week — two days a week more than when they started — and had an average 10-point drop in cholesterol. That equaled a small but significant drop in their overall heart risk, while people who got standard checkups barely budged.
A chronically stressed brain orders release of hormones and other chemicals that tamp down the immune system so it can't fight off disease or speed healing, says Dr. Esther Sternberg of the National Institute of Mental Health. Too much stress even ages us faster. But regular exercise, a healthy diet and stress-relieving techniques such as meditation or yoga have been shown in scientific studies to help battle stress' bad effects.
“If I didn’t have coaching, I would have given up,” says Roberta Cutbill, 68, of Cary, N.C. With the coach's help, Cutbill started gentle yoga and weight training, building up to heart-healthier exercises. When her joints hurt, she heads for acupuncture. Cutbill has switched to heart-healthy olive oil; takes omega-3 fatty acids and some other heart-targeting nutrients that her cardiologist agreed couldn't hurt; sneaks fiber into meals; and learned that protein snacks level her blood sugar so she doesn't crave high-fat sweets.
General Exercise Guidelines for People with Disabilities
http://www.ncpad.org/exercise/fact_sheet.php?sheet=15
Exercise is for EVERY body. This slogan appears in a number of places on the CDC-funded NCPAD Web site, and for a very good reason. Exercise is a key factor in maintaining and improving overall health. In 1996, the Surgeon General of the United States reported that "significant health benefits can be obtained with a moderate amount of physical activity, preferably daily." These benefits are even more important if you have a disability, since people with disabilities have a tendency to live less active lifestyles. Yet, it is just as important for your body to get exercise. This fact sheet provides some general exercise guidelines you should review. Throughout this site are resources on physical activity and exercise programs of all sorts: indoor and outdoor, sports or recreational, solitary or team. It doesn't matter what you choose, so long as you choose to get a moderate amount of physical activity each day.
Depression in Cancer Patients: Inquire or Don't, but Be Concerned
By Robert H. Carlson
Mental health experts have spent years coaxing oncologists to be concerned about depression in their cancer patients. There are still only a few who do, so perhaps it's time for a new tack. One idea is to keep the oncologist's involvement as short as possible by listening for key words from the patient that can flag depression. That saves time, and at least opens the subject up for more doctor-patient discussion or a referral.
A more novel idea is to relieve the oncologist of the task entirely by making depression detection the job of other clinic staff members. As in cancer pain, cancer depression could be tackled by a psychiatrist or a team of palliative care specialists who keep the oncologist informed but not directly involved.
There is no question cancer patients are at risk for depression, with estimates that 20 to 30 percent of patients become clinically depressed. As with anyone, it can ruin the quality of their lives. And some studies, albeit controversial, suggest that oncology patients with untreated depression have worse outcomes after cancer therapy. All in all, diagnosing and dealing with depression can only be a good thing.
But as usual, it's a matter of time. Managing a life-threatening disease, its treatments, and their side effects, not to mention insurance, compliance, and comorbid conditions, all take up the physician's face-to-face time with patients.
If ask about depression is on the to-do list, it's likely at the bottom, with a good chance of not happening.
We've been at this game of encouraging oncologists to ask about depression, and it's not been terribly successful, said Andrew H. Miller, MD, Professor of Psychiatry and Behavioral Sciences at Emory and Director of Molecular and Clinical Psycho-Oncology at Winship.
It is miserable how much depression is tolerated, and this has not changed in 10 or 20 years.
Dr. Miller is Director of a program in development to make depression values a vital sign for cancer patients. Nurses or social workers will administer questionnaires regarding patient mood just as they take vital signs and monitor hematocrit or white blood cell counts. If depression is indicated, the staff will refer patients to psychological services and notify the oncologist. It may be enough for oncologists just to know about the depression and to know someone is on top of it, Dr. Miller said, noting that oncologists are supporting the nascent program because it takes something off instead of adding more to the oncologist's tasks.
Depression starting after a diagnosis of cancer doesn't necessarily resolve when the cancer is successfully treated, said David Spiegel, MD. When acute treatment stops, many patients feel worse because now they're not doing anything to fight the illness, and they feel more vulnerable. Even after treatment is over and there is no evidence of relapse, depressed patients tend to see the worst in their future, and they need help with that perspective.
Studies Try to Tease Apart the Links between Depression and Heart Disease
By Nicholas Bakalar
http://www.nytimes.com/2008/12/16/health/research/16depr.html
People who are depressed are literally sick at heart: they have a significantly increased risk for cardiovascular disease, and no one knows exactly why. Now three new studies have tried to explain this, and they arrive at subtly different conclusions.
The first study found an association of depression with heart disease, yet when researchers statistically corrected for other medical conditions, disease severity and physical inactivity, the association disappeared. They concluded with a relatively straightforward explanation: depression leads to physical inactivity and lack of exercise increases the risk for heart disease.
A second study, found that behavioral issues like smoking and inactivity were the strongest factors in the increased risk for heart disease among people who are depressed or anxious. But they also found that depressed people had higher rates of hypertension and higher levels of C-reactive protein, and that these two physiological factors together accounted for about 19 percent of the increased risk.
While these two studies suggest that the mechanism by which depression exerts its effect is mostly or entirely through poor health behaviors, a third study, it found no difference in physical activity between those who were depressed and those who were not.
But it did find that depressive symptoms were associated with an increase in visceral fat accumulation — the pot belly that is a known risk factor for cardiovascular illness. This suggests that there is a biological mechanism that links depression with physiological changes independent of how much a person exercises.
Social Rejection Linked with Pain in Depressed Patients
By Andrew Czyzewski
The feeling of social rejection in patients with depression appears to be associated with physical pain, suggesting that the two characteristics share common neurobiologic circuits, say researchers. Approximately half of patients with depression suffer from physical pain including chest pain, headaches, and body aches.
"For most pain sufferers for whom an organic cause is not evident, the use of terms such as 'unexplained,' 'functional,' and 'psychosomatic' to describe painful symptoms generates frustration and distress, while offering few pointers towards appropriate treatment," explain Anna Ehnvall (Centre for Cognitive Psychotherapy and Education, Sweden) and colleagues.
Notably, a recent functional magnetic resonance imaging study found that the dorsal anterior cingulate cortex is activated during the distressing experience that accompanies physical pain and during the perception of social rejection.
"The nature of the link between pain and social support is not yet understood, but we propose that increased social support may be one means of decreasing the feeling of rejection during depression and thereby reducing the perception of pain," Ehnvall and colleagues conclude.
Poor Mental Health, Asthma Risk Linked?
http://www.webmd.com/asthma/news/20081204/poor-mental-health-asthma-risk-linked
A new study hints at a possible link between adults' poor mental health and their odds of having asthma. The study, a national survey of more than 300,000 U.S. adults, shows that those reporting more days of poor mental health in the previous month were more likely to also report having asthma.
In the survey, which was conducted in 2006, participants were asked how many days during the past month they had poor mental health, including stress, depression, and emotional problems. They were also asked if a doctor, nurse, or other health care provider had ever diagnosed them with asthma, and if so, whether they still had asthma.
Compared with people who reported no days of poor mental health in the previous month, people reporting up to a week of poor mental health in the previous month were 38% more likely to say they currently had asthma.
Those findings don't prove that poor mental health causes asthma or vice versa. That's partly because participants weren't followed over time and also because the data were self-reported since participants' medical records weren't checked. Also, the study only looked at adults; it didn't include children with asthma.
But Chun's team notes that other observational studies have shown a possible link between mental health problems and asthma. The exact nature of that connection needs further study, Chun and colleagues concluded.
Loneliness as Harmful as Smoking and Obesity, Say Scientists
By Richard Alleyne
Lack of connection with others not only makes us unhappy but it is also bad for the wellbeing of the body and mind, research finds. A sense of rejection or isolation increases blood pressure, stress levels and general wear and tear as well as increases your chances of developing Alzheimer's disease. It also reduces will power and perseverance, thus affecting the ability to follow a healthy lifestyle, according to scientists.
The findings were outlined by Professor John Cacioppo, of the University of Chicago, at the American Association for the Advancement of Science annual conference. Loneliness not only alters behaviour, but loneliness is related to greater resistance to blood flow through your cardiovascular system, Professor Cacioppo said. Loneliness leads to higher rises in morning levels of the stress hormone cortisol, affects the immune system, higher blood pressure and an increased level of depression. "The lonely have poor health. They exercise less, are more likely to quit. Eat more calories. They comfort eat more fats and sugars.
The problem of social isolation is likely to grow as conventional family structures die out, said Professor Cacioppo, the author of Loneliness: Human Nature and the Need for Social Connection. People are living longer, having fewer children later in life and increasingly mobile around the world. Surveys also show that people report significantly fewer close friends and confidants than those a generation ago.
Happenings all over the Country
A brief review of resources and other activities
If you have information or updates, please send to: paolo.delvecchio@samhsa.hhs.gov
RxAssist provides health care providers with information on accessing more than 100 pharmaceutical manufacturers’ patient assistance programs. These programs usually offer a limited supply of free prescription medication to eligible patients. Application forms are available on-line for the 40+ programs that allow their forms to be copied freely.
For more information go to:
Awards will be granted to nonprofit organizations to support grassroots efforts which increase awareness on critical health initiatives through health walks, health fairs and health education outreach. Grants up to $25,000 will be considered. Please provide all levels of event sponsorships on your application. Nonprofit organizations with evidence of IRS 501(c)(3) designation or de facto tax-exempt status may apply for a grant, with the following exceptions: advertising; capital campaigns; grants or scholarships to individuals; multiyear requests; political causes and events; or religious organizations in support of their sacramental or theological functions. Ongoing deadline.
For more information go to: http://www.aetna.com/foundation/grants_reg/guidelines.html
Build-A-Bear Workshop® guests often ask for help in supporting causes of great importance to their families. In 2003 the Build-A-Bear grant program began with support to children's cancer causes and quickly grew to include juvenile diabetes and autism. The Champ children's health and wellness grant program supports these important causes and many more! Champ is a special furry friend that gives back – examples of 501(c) (3) not for profit organizations that these grants support include: childhood disease research foundations; organizations that promote child safety; and charities that serve children with special needs. Letters of inquiry may be submitted any time. The Foundation’s staff will notify applicants within four weeks to discuss next steps in the grant process. Ongoing deadline.
For more information go to:
http://www.buildabear.com/aboutus/community/grants/
The HealthWell Foundation® is a 501(c)(3) non-profit, charitable organization that helps individuals afford prescription medications they are taking for specific illnesses. The Foundation provides financial assistance to eligible patients to cover certain out-of-pocket health care costs, including: prescription drug coinsurance, copayments, and deductibles; health insurance premiums; and other selected out-of-pocket health care costs. The HealthWell Foundation® takes into account an individual's financial, medical, and insurance situation when determining who is eligible for assistance. Financial criteria are based on multiples of the federal poverty level, which takes into account a family’s size. Families with incomes up to four times the federal poverty level may qualify. The foundation also considers the cost of living in a particular city or state. The Foundation asks for the patient's diagnosis, which must be verified by a physician signature, and the patient must receive treatment dispensed in the United States. Individuals covered by private insurance, employer-sponsored plans, Medicare or Medicaid may also be eligible. The Foundation grants assistance on a first-come, first-served basis to the extent that funding is available. Ongoing deadline.
For more information go to:
http://www.healthwellfoundation.org/index.aspx
Spread the Word
Learn and share ways to spread the word about Wellness and the 10 by 10 Campaign!
An Active Campaigner for the Pledge for Wellness
Peggy Moses is on a mission. Peggy, a busy consumer activist, has collected more than 150 signatures for the Pledge for Wellness, a commitment made by individuals and organizations to promote wellness and reduce early mortality for people with mental illnesses. The Pledge for Wellness was created in September 2007 at the National Wellness Summit sponsored by the Center for Mental Health Services (CMHS) of the U.S. Substance Abuse and Mental Health Services Administration (SAMSHA).
The summit was convened after the publication of compelling research which demonstrated that people with serious mental illnesses die 25 years earlier, on average, than people without mental illnesses from preventable health conditions; and 60 percent of people with serious mental illness live with a serious medical condition that contributes to this alarming loss of life. The vision and pledge developed at the summit has spurred concerted wellness efforts across the country including the DMH Healthy Changes Initiative which is designed to address the modifiable risk factors for chronic illness and premature death including smoking, obesity, and physical inactivity.
The vision and pledge has likewise inspired Peggy Moses. "We have to see this as a campaign. SAMHSA needs to see signatures." And indeed, Peggy works as an active campaigner. She has worked with DMH, the state Legislature, the Boston University Center for Psychiatric Rehabilitation, Massachusetts General Hospital, NAMI, Center Club, and other organizations to promote awareness of the Pledge and to collect signatures one by one.
"The one good thing about doing this project is meeting more dedicated people in our community," she said. "It gets you up in the morning. I wish I could pack up a few busloads of consumers, bring them to SAMHSA and let them get a sense of the scope of help and enthusiasm SAMHSA has for consumers and their families. SAMHSA has a very wide scope but it makes every individual it touches feel a very definite sense of respect and hope on an ongoing basis."
Peggy is training volunteers to collect signatures and educate the public and stakeholders about the alarming mortality crisis. More information about the Pledge for Wellness is available at http://www.bu.edu/cpr/resources/wellness-summit/.
Disclaimer
The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), SAMHSA, or HHS.
Quotes of the Month
We can all take steps to become healthier.
Barack Obama, 44th President of the United States
There is nothing wrong with us giving a little bit of a nudge in moving people in the direction of healthier lifestyles.
Barack Obama, 44th President of the United States
Paolo del Vecchio
CMHS Associate Director for Consumer Affairs
240-276-1946