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?

The Child and Adolescent Needs and Strengths (CANS) assessment is a multi-purpose tool developed for children’s services to support decision making, including level of care and service planning, to facilitate quality improvement initiatives, and to allow for the monitoring of outcomes of services. It is one of the tools in the Transformational Collaborative Outcomes Management (TCOM) framework, developed by Dr. John S. Lyons, consisting of a set of Guiding Values and Core Principles, all centered on how to provide the best and most support to all those in need.

I am often asked “How does managed care use the CANS?” Managed care organizations, like Magellan, are increasingly using clinical decision support tools and implementing value-based programs; the CANS offers a common language to look at resource needs and make the balancing of resources more transparent.

John Lyons frames the use of the CANS as part of “Five Key Decisions”: access, engagement, appropriateness, effectiveness and transitions. This framework on CANS use may be helpful for understanding how managed care uses decision support tools, and the CANS in particular, as the CANS has bonus options beyond the usual clinical decision support tools.

In this post, I provide an overview of each of the Five Key Decisions to shed light on how managed care uses the CANS. I invite you to explore the topics below and follow the links to learn more in my series on the TCOM Conversations blog.

Access

Access refers to screening for a target population, such as using CANS algorithms for matching needs to services. This identifies youth who will benefit from a certain level of care or service, as well as those who will not.

MCOs, with their advanced analytics capabilities, can provide valuable insights to state and local agencies to inform ongoing adjustments to algorithms to ensure that youth have access to the appropriate level of care.

Learn more

Engagement

Key Decision 2, Engagement, is about bringing people from access — opening the door — to becoming equal partners in the helping system. Engagement is built on respect and understanding that youth and family are experts in their own lives and need to captain their own ships. Engagement uses a fully person-centered discovery and planning process.

MCOs are tasked with operationalizing engagement, often taking the form of a checklist with time-frames and standards for everything from forms, consents, plans, child and family meetings, authorization, and even how often helpers and family are required to meet.

Proper operationalizing of engagement allows for family and youth to participate as fully as possible in using the CANS for reflection, self-advocacy and self-direction.

Learn more

Appropriateness and Effectiveness

An appropriate service should be effective. These two Key Decisions are inextricably linked and are often the basis of medical necessity. Evidence-based practices assign a defined appropriate population and a set of measures demonstrating effectiveness and provide a good example of how the community at large and managed care can agree.

Standardized assessment is an established best practice for measuring appropriateness and effectiveness. The CANS in practice excels at both. When the practice is done well, youth and families flourish and successfully complete their programs.

Learn more

Transitions

Using CANS algorithms for access and transition decision support is particularly helpful when celebrating successes. In behavioral healthcare, a discharge from a program can be seen as a success, but “success” may only be based on utilization or length of stay, and not on quality outcomes for the youth and family. The CANS is a functional outcomes measure, i.e., it measures how a youth and family is functioning in real life. As value-based programming expands, the CANS will be used for evidence of discharge success.

Learn more

Barbara Dunn, LCSW, ACSW, is director of program innovation and outcomes for Magellan Healthcare. She is the Conference Program Chair for the 16th annual TCOM Conference, A TCOM Cloud Gathering. Meeting Each Other Where We Are: Collaboration in a COVID-19 World. Learn more about the event here.

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.

Stress and anxiety caused by the coronavirus pandemic pose a serious challenge for all age groups. A survey published by the American Psychiatric Association in March 2020 showed that more than one-third of Americans (36%) feel that the coronavirus pandemic is having a serious impact on their mental health. Most Americans (59%) report serious impacts on their daily lives.¹ Calls to crisis hotlines have increased exponentially. In recent studies, adults aged 18 to 44 report emotional and mental health problems associated with the pandemic.

Given that mental-health problems among young adults were on the rise even before the pandemic began, some experts believe that the country is on the verge of a mental-health crisis. Worse, quarantine and closures of medical practices have, in many cases, made access to personal treatment difficult or impossible. Fortunately, state and federal regulations have enabled the expansion of telemedicine services, including treatment for mental illness. Virtual therapies may well be the answer to the needs of millions of people in the mental-health field.

Proven efficacy

Research shows that online treatments can have positive results for a range of mental health problems, including depression, panic disorders, PTSD, eating disorders, anxiety disorders and substance use disorders. Telephone and video-based psychological care and evidence-based treatments such as online cognitive behavioral therapy (CBT) have proven to be as effective as face-to-face therapy.²

The benefits for patients go beyond making treatment more accessible. Virtual therapy offers convenient modalities including live chats, text messaging, video and telephone sessions. Appointments are easy to schedule at convenient times. Virtual therapy is an attractive alternative for people with transportation problems or time constraints. People who are worried about being seen in a therapist’s practice, and those who are reluctant to use traditional mental health services may benefit from increased privacy. In many cases, virtual therapy sessions are more affordable than face-to-face sessions.

Best practices

It is important that therapists have the clinical expertise, licenses and qualifications to virtually treat patients. Reliable technology and secure platforms to ensure customer confidentiality are also crucial. Virtual therapy can solve many mental health problems. However, it is not suitable for patients who are suicidal, psychotic, severely mentally ill or have other illnesses that call for in-person care.

Due to the pandemic, health care is developing rapidly. Magellan Healthcare recognizes the need for additional telemedicine options and is now offering BetterHelp, the world’s largest online counseling service, to help Employee Assistance Program members access convenient therapy options quickly and easily. Click here to learn more about how Magellan is helping our members their mental health, emotional well-being and quality of life.

[1] Psychiatry.org. 2020. New Poll: COVID-19 Impacting Mental Well-Being: Americans Feeling Anxious, Especially For Loved Ones; Older Adults Are Less Anxious. [online] Available at: <https://www.psychiatry.org/newsroom/news-releases/new-poll-covid-19-impacting-mental-well-being-americans-feeling-anxious-especially-for-loved-ones-older-adults-are-less-anxious> [Accessed 13 July 2020].

2 Gratzer, D. and Khalid-Khan, F., 2020. Internet-Delivered Cognitive Behavioural Therapy In The Treatment Of Psychiatric Illness

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.