Common warning signs for suicide include:

• Making suicidal statements.
• Being preoccupied with death in conversation, writing, or drawing.
• Giving away belongings.
• Withdrawing from friends and family.
• Having aggressive or hostile behavior.

It is extremely important that you take all threats of suicide seriously and seek immediate treatment for your child or teenager. If you are a child or teen and have these feelings, talk with your parents, an adult friend, or your doctor right away to get some help.

Other warning signs can include:

• Neglecting personal appearance.
• Running away from home.
• Risk-taking behavior, such as reckless driving or being sexually promiscuous.
• A change in personality (such as from upbeat to quiet).

Suicidal thoughts and suicide attempts

Certain circumstances increase the chances of suicidal thoughts in children and teens. Other situations may trigger a suicide attempt.

Circumstances that increase the chances of suicidal thoughts include having:

• Depression or another mental health problem, such as bipolar disorder (manic-depressive illness) or schizophrenia.
• A parent with depression or substance abuse problems.
• Tried suicide before.
• A friend, peer, family member, or hero (such as a sports figure or musician) who recently attempted or died by suicide.
• A disruptive or abusive family life.
• A history of sexual abuse.
• A history of being bullied.

Circumstances that may trigger a suicide attempt in children and teens include:

• Possession or purchase of a weapon, pills, or other means of inflicting self-harm.
• Drug or alcohol use problems.
• Witnessing the suicide of a family member.
• Problems at school, such as falling grades, disruptive behavior, or frequent absences.
• Loss of a parent or close family member through death or divorce.
• Legal or discipline problems.
• Stress caused by physical changes related to puberty, chronic illness, and/or sexually transmitted infections.
• Withdrawing from others and keeping thoughts to themselves.
• Uncertainty surrounding sexual orientation.

Depression

Signs of depression, which can lead to suicidal behavior, include:

• Feeling sad, empty, or tearful nearly every day.
• Loss of interest in activities that were enjoyed in the past.
• Changes in eating and sleeping habits.
• Difficulty thinking and concentrating.
• Complaints of continued boredom.
• Complaints of headaches, stomachaches, or fatigue with no actual physical problems.
• Expressions of guilt and/or not allowing anyone to give him or her praise or rewards.

Take any mention of suicide seriously. If someone you know is threatening suicide, get help right away.

Help is available. For additional information, visit MagellanHealth.com/MYMH

Source: Healthwise

Myth: It’s best not to plant the idea of suicide by talking about it with someone who seems depressed.

Fact: Talking about suicide provides the opportunity for communication. Fears that are shared are more likely to diminish. The first step in encouraging a suicidal person to live comes from talking about those feelings. The first step can be the simple inquiry about whether or not the person is intending to end their life.

Myth: Only crazy people commit suicide.

Fact: Everyone has the potential for suicide. While many people who kill themselves are clinically depressed, most are in touch with reality and not psychotic.

Myth: Suicide happens more often during the holidays, such as Christmas and Thanksgiving.

Fact: Suicide rates are lowest in December and peak during the spring.

Myth: If a person is determined to commit suicide, nothing will stop them.

Fact: Suicides can be prevented. People can be helped. Suicidal crises can be relatively short-lived. Suicide is a permanent solution to what is usually a temporary problem. Most suicidal people feel ambivalent and are torn between the desire to live and the desire to die. They just want the emotional pain to stop and see no other way out.

Myth: If a person attempts suicide and survives, they will never make a further attempt.

Fact: A suicide attempt is regarded as an indicator of further attempts. It is likely that the level of danger will increase with each further suicide attempt.

Myth: Teens are the greatest risk to commit suicide.

Fact: Adults are more likely to take their own life. At particularly high risk are adults between 45 and 54, who had a suicide rate of 19.72 deaths per 100,000 people, compared with about 19 per 100,000 in people over 85, and 13 per 100,000 in the general population. Still, teenagers remain a high-risk group. The percentage of emergency room visits related to suicidal thoughts or attempts among children and teens more than doubled from 2008 to 2015. (The suicide rate for 15- to 24-year-olds is 13.15 per 100,000.)

Help is available. For additional information, visit www.magellanhealth.com/mymh

Sources: American Foundation for Suicide Prevention; CDC.gov; Nevada Division of Public and Behavioral Health Office of Suicide Prevention

Magellan Rx Management hosted the 15^th annual Specialty Summit on August 21-23 in New York City with a day-and-a-half of sessions on the industry’s most complex pharmacy challenges and a focus on breakthrough treatments like CAR-T and gene therapy.

A highlight for the audience of 500 was a session on CAR-T, an immunotherapy that is pushing the boundaries of cancer treatment in both children and adults. Dr. Bruce Levine, Professor in Cancer Gene Therapy at the University of Pennsylvania, is a pioneer in this field and presented successful results from the first pediatric patient treated with engineered T-cell therapy—including a surprise appearance from that patient.  Now 13-years-old, she walked across the stage with her parents and shared her dream of being a movie director when she grows up!

Dr. Andrew Scharenberg of Casebia Therapeutics talked through the complexity of gene therapies, including the incredible CRISPR/Cas9 molecular surgery technique that modifies the patient’s own genome to restore ‘normal’ function and, essentially, cure the disease. Colleagues Dr. Jeffrey Trent of TGen and Dr. Joseph Mikhael of TGen and the International Myeloma Foundation shared the stage to discuss mind-blowing advances in personalized medicine that are transforming the lives of children with rare, previously undiagnosed diseases.

Diving deeper into specific categories, Dr. Saira Jan of Horizon BCBS of New Jersey highlighted opportunities to improve quality of care, lower the total cost of care, and enhance member experience through an integrated model of managing autoimmune therapies. Michelle Rice from the Hemophilia Foundation discussed similar strategies for hemophilia treatment, including how advocacy groups, providers, and payers can work together to deliver more effective care.

Several lively panel discussions with industry experts from Amgen, SelectHealth, Mercer, IQVIA, AmerisourceBergen, Pfizer, Barclays, BCBS of Tennessee, Medica, Health New England and Security Health unpacked industry challenges and the continuing evolution of care delivery. Sessions focused on value-based partnerships, overcoming specialty barriers in Medicaid and managing medical pharmacy trend, as well as the impacts and lessons learned from the introduction of biosimilars; through expert insights and real-word examples, attendees walked away with action-oriented solutions for better management strategies and patient care.

Two standout speakers were Mark Johnston of Amazon Web Services (AWS) who reviewed the culture, philosophy, and vision that is driving Amazon’s incredible pace of innovation and how AWS is helping to reshape the foundation of the healthcare industry. An inspiring keynote by Dr. Victor Strecher gave the audience a crash-course on honing your individual life purpose to motivate you through your work, personal ambitions, and family/community goals.

At Magellan Rx, we are passionate about connecting our clients and industry partners to the people, tools, and information needed to make the best decisions for the populations they serve. Our purpose is to help people live more healthy, vibrant lives and take better control of their health. As pioneers in specialty pharmacy management, we are proud of this heritage and develop the Specialty Summit agenda each year with those values in mind. Mark your calendars and join us next year in NYC on August 26-28, 2019 as we host another exciting event packed with timely insights and emerging trends in the evolving specialty market.

What is depression in children and teens?

Depression is a serious mood disorder that can take the joy from a child’s life. It is normal for a child to be moody or sad from time to time. You can expect these feelings after the death of a pet or a move to a new city. But if these feelings last for weeks or months, they may be a sign of depression.

Experts used to think that only adults could get depression. Now we know that even a young child can have depression that needs treatment to improve. As many as 2 out of 100 young children and 8 out of 100 teens have serious depression.

Still, many children don’t get the treatment they need. This is partly because it can be hard to tell the difference between depression and normal moodiness. Also, depression may not look the same in a child as in an adult.

If you are worried about your child, learn more about the symptoms in children. Talk to your child to see how he or she is feeling. If you think your child is depressed, talk to your doctor or a counselor. The sooner a child gets treatment, the sooner he or she will start to feel better.

What are the symptoms?

A child may be depressed if he or she:

• Is irritable, sad, withdrawn, or bored most of the time.
• Does not take pleasure in things he or she used to enjoy.

A child who is depressed may also:

• Lose or gain weight.
• Sleep too much or too little.
• Feel hopeless, worthless, or guilty.
• Have trouble concentrating, thinking, or making decisions.
• Think about death or suicide a lot.

The symptoms of depression are often overlooked at first. It can be hard to see that symptoms are all part of the same problem.

Also, the symptoms may be different depending on how old the child is.

• Both very young children and grade-school children may lack energy and become withdrawn. They may show little emotion, seem to feel hopeless, and have trouble sleeping. Often they will lose interest in friends and activities they liked before. They may complain of headaches or stomachaches. A child may be more anxious or clingy with caregivers.
• Teens may sleep a lot or move or speak more slowly than usual. Some teens and children with severe depression may see or hear things that aren’t there (hallucinate) or have false beliefs (delusions).

Depression can range from mild to severe. A child who feels a little “down” most of the time for a year or more may have a milder, ongoing form of depression called dysthymia (say “dis-THY-mee-uh”). In its most severe form, depression can cause a child to lose hope and want to die.

Whether depression is mild or severe, there are treatments that can help.

What causes depression?

Just what causes depression is not well understood. But it is linked to a problem with activity levels in certain parts of the brain as well as an imbalance of brain chemicals that affect mood. Things that may cause these problems include:

• Stressful events, such as changing schools, going through a divorce, or losing a close family member or friend.
• Some medicines, such as steroidsor opioids for pain relief.
• Family history. In some children, depression seems to be inherited.

How is depression diagnosed?

To diagnose depression, a doctor may do a physical exam and ask questions about your child’s past health. You and your child may be asked to fill out a form about your child’s symptoms. The doctor may ask your child questions to learn more about how he or she thinks, acts, and feels.

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

It is common for children with depression to have other problems too, such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder. The doctor may ask questions about these problems to help your child get the right diagnosis and treatment.

How is it treated?

Usually one of the first steps in treating depression is education for the child and his or her family. Teaching both the child and the family about depression can be a big help. It makes them less likely to blame themselves for the problem. Sometimes it can help other family members see that they are also depressed.

Counseling may help the child feel better. The type of counseling will depend on the age of the child. For young children, play therapy may be best. Older children and teens may benefit from cognitive-behavioral therapy. This type of counseling can help them change negative thoughts that make them feel bad.

Medicine may be an option if the child is very depressed. Combining antidepressant medicine with counseling often works best. A child with severe depression may need to be treated in the hospital.

There are some things you can do at home to help your child start to feel better.

• Encourage your child to get regular exercise, spend time with supportive friends, eat healthy foods, and get enough sleep.
• See that your child takes any medicine as prescribed and goes to all follow-up appointments.
• Make time to talk and listen to your child. Ask how he or she is feeling. Express your love and support.
• Remind your child that things will get better in time.

What should you know about antidepressant medicines?

Antidepressant medicines often work well for children who are depressed. But there are some important things you should know about these medicines.

• Children who take antidepressants should be watched closely. These medicines may increase the risk that a child will think about or try suicide, especially in the first few weeks of use. If your child takes an antidepressant, learn the warning signs of suicide, and get help right away if you see any of them. Common warning signs include:
  • Talking, drawing, or writing about death.
  • Giving away belongings.
  • Withdrawing from family and friends.
  • Having a plan, such as a gun or pills.
• Your child may start to feel better after 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. Make sure your child takes antidepressants as prescribed and keeps taking them so they have time to work.
• A child may need to try several different antidepressants to find one that works. If you notice any warning signs or have concerns about the medicine, or if you do not notice any improvement by 3 weeks, talk to your child’s doctor.
• Do not let a child suddenly stop taking antidepressants. This could be dangerous. Your doctor can help you taper off the dose slowly to prevent problems

Help is available. For additional information, visit MagellanHealth.com/MYMH

©Healthwise

A child’s mental health affects nearly every aspect of their overall health. Their physical health and their ability to become successful, contributing members of society depends on the state of mind they bring to every situation. Children’s mental health issues are real, common and treatable. An estimated 15 million of our nation’s young people can currently be diagnosed with a mental health disorder. Many more are at risk of developing a disorder due to genetic and environmental risk factors. However, it is estimated that only about 7 percent of youth who need services receive appropriate help from mental health professionals (Department of Health and Human Services, 2001 — Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda).

1) What should I do if I am concerned about mental, behavioral, or emotional symptoms in my child? Keep in mind that every child is different. Even normal development, such as when children develop language, motor, and social skills, varies from child to child. If you are concerned about changes in behavior or other symptoms, talk to your child’s doctor or health care provider. If your child is in school ask the teacher about observed changes in behavior and see if the school system can provide an evaluation. Share this with your provider as well. Be prepared to seek further evaluation by a specialist with experience in child mental health issues. Specialists may include psychiatrists, psychologists, social workers, psychiatric nurses, and behavioral therapists.

2) How do I know if my child’s problems are serious? Many everyday stressors can cause changes in a child’s behavior, however, not every problem is serious. For example, the birth of a sibling may cause a child to temporarily act much younger than he or she is. Behavior patterns that may indicate a more serious issue include:

• Problems across a variety of settings, such as at school, at home, or with peers
• Changes in appetite or sleep
• Social withdrawal, or fearful behavior toward things your child normally is not afraid of
• Returning to behaviors more common in younger children, such as bed-wetting, for a long time
• Signs of being upset, such as sadness or tearfulness
• Signs of self-destructive behavior, such as head-banging, or a tendency to get hurt often
• Repeated thoughts of death.

3) How are mental illnesses diagnosed in young children? Just like adults, children with mental illness are diagnosed after a doctor or mental health specialist carefully observes signs and symptoms. Some primary care physicians can diagnose a child themselves, but many will refer to a specialist for diagnosis and treatment.

• Before diagnosing a mental illness, the doctor or specialist tries to rule out other possible causes for a child’s behavior. The doctor will:
• Review the child’s medical history
• Discuss the issues you have observed
• Review the child’s developmental level
• Ask about any family history of mental health disorders
• Ask if the child has experienced physical or psychological traumas, such as a natural disaster, or situations that may cause stress, such as a death in the family
• Consider reports caretakers and/or teachers

Children are constantly changing and growing and diagnosis and treatment must be viewed with this in mind. While some problems are short-lived and don’t need treatment, others are ongoing and may be very serious. In either case, it is important to see more information so you can understand treatment options and make informed decisions.

3) What are the treatment options for children? The specialist will recommend specific treatment based on the diagnosis. Treatment options may include psychotherapy and/or medication. Talk about the options with the specialist and ask questions. Some treatment choices are a part of standard health care practice while others may be in the experimental stage.

4) Will my child get better with time? Some children get better with time and others children may need ongoing professional help, it all depends on the diagnosis. That is why it is important to consult with a health care providers as soon as possible because treatment may produce better results if started early.

5) How can families of children with mental illness get support? Like other serious illnesses, taking care of a child with mental illness is hard on the parents, family, and other caregivers. Support groups are available for many different types of issues and age groups. By sharing experiences in a safe and confidential setting encourages empathy and a sense of community.

Help is available. For additional information, visit MagellanHealth.com/MYMH

Sources: American Psychological Association, National Institute of Mental Health

If you’re raising children today, it can be easy to focus on the negative, especially with the constant media stream coming from all directions. Helping children see the positive in the world today is more important than ever. Research shows that optimists, who believe they can achieve success, are in fact more able to do so. They are less likely to get depressed, get fewer illnesses, have longer relationships, and live longer.

Here are 12 tips to help your children develop a positive outlook on life.

1. Quit complaining. Focusing on negative thoughts and frustrations is classic pessimism. The more you moan about troubles at work, money problems, etc. the more likely it is that your children will learn to do the same thing. Instead, try talking about things that go right.
2. Have high expectations. Kids won’t develop an optimistic, “can-do” attitude unless they have the opportunity to prove their worth.
3. Encourage reasonable risk-taking. Discouraging your children from doing activities because they might not be as skilled as other children can undermine their confidence.
4. Wait before reacting. Let your children try to solve things without your help. This will boost their sense of accomplishment and also make them more optimistic about what they can do in the future.
5. Be realistic and honest, even in difficult situations. For example, if your child is having a difficult time making friends at a new school, empathize with him/her, but explain that making friends takes time and he/she needs to take active steps to meet other kids and make friends.
6. Show your children you love them. Make time for them every day and use words and affection to show you care.
7. Be a positive role model. Your children will mimic your behaviors, so make sure you show them constructive ways of dealing with life’s challenges and misfortunes.
8. Allow your child to experience success. For example, give them age-appropriate tasks around the house and praise them for their efforts.
9. Teach practical skills with patience and humor. Help your child to keep up with peers – for example, tying shoelaces, using cutlery and managing the toilet.
10. Listen to their problems. Take concerns seriously and be supportive as they learn how to cope with life’s hurts and disappointments.
11. Point out the ‘silver lining’ in every cloud. Get your child into the habit of looking for the positives, even times where it may only seem like the chance to learn from a mistake.
12. Make happy events a regular part of your family life.

Help is available. For additional information, visit MagellanHealth.com/MYMH

Sources: Parents.com, Better Health Channel

If you have, or believe you may have, a mental health problem, it can be helpful to talk about it with others. It can be scary to reach out for help, but it’s often the first step to helping you heal, grow, and recover.

Build your support system
Find someone—such as a parent, family member, teacher, faith leader, coworker or healthcare provider who:

• Gives good advice when you want and ask for it
• Assists you in taking action that will help and doesn’t escalate bad feelings
• Likes, respects and trusts you, and who you like, respect and trust, too
• Allows you the space to change, grow, make decisions, and even make mistakes
• Listens to you and shares with you, both the good and bad times
• Respects your need for confidentiality so you can tell him or her anything
• Lets you freely express your feelings and emotions without judging, teasing, or criticizing
• Works with you to figure out what to do the next time a difficult situation comes up
• Has your best interest in mind

Find a peer group
Find a group of people with mental health problems similar to yours who are taking care of the problems in a positive way. Peer support relationships can positively affect individual recovery because:

• People who have common life experiences have a unique ability to help each other based on a shared history and a deep understanding that may go beyond what exists in other relationships
• People offer their experiences, strengths, and hopes to peers, which allows for natural evolution of personal growth, wellness promotion, and recovery
• Peers can be very supportive since they have “been there” and serve as living examples that individuals can and do recover from mental health problems
• Peers also serve as advocates and support others who may experience discrimination and prejudice

You may want to start or join a self-help or peer support group. National organizations across the country have peer support networks and peer advocates. Find an organization that can help you connect with peer groups and other peer support.

Participate in your treatment decisions
It’s also important for you to be educated, informed, and engaged about your own mental health. Get involved in your treatment through shared decision making. Participate fully with your mental health provider and make informed treatment decisions together includes:

• Recognizing a decision needs to be made
• Identifying partners in the process as equals
• Stating options as equal
• Exploring understanding and expectations
• Identifying preferences
• Negotiating options/concordance
• Sharing decisions
• Arranging follow-up to evaluate decision-making outcomes

Develop a recovery plan
Recovery is a process of change where individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Studies show that most people with mental health problems get better, and many recover completely.

You may want to develop a written recovery plan. Recovery plans:

• Enable you to identify goals for achieving wellness
• Specify what you can do to reach those goals
• Can be daily activities as well as longer term goals
• Track your mental health problem
• Identify triggers or other stressful events that can make you feel worse, and help you learn how to manage them

Help is available. For additional information, visit MagellanHealth.com/MYMH

Source: MentalHealth.gov

This blog post is for your information only. It is not meant to give medical advice. It should not be used to replace a visit with a provider. Should you require specific help or feel that you are in crisis, you should seek the assistance of an appropriately trained professional.

If you have family, friends or colleagues who live with mental illnesses, you may be unsure of how to speak to them in a respectful way. You want to show you care, but don’t know how to express your concern and not hurt the person at the same time.

Just ask…

1. Can you help me understand what it’s like living with your condition?
2. Is there anything you need from me or something I can do to help you?
3. Can we do something together – get coffee, go for a walk or see a movie?
   Just because the person has mental illness doesn’t mean he/she won’t want to do regular activities
4. What is your diagnosis and how do you feel about it?
5. Do you need to talk?
   Sometimes talking can help make things feel a little better.
6.  What can I do to be there for you, and help you feel supported?
7. How can I support you – can I listen to you, leave you alone, give you a hug?
8.  How has living with this condition shaped who you are today?
9. How are you? You don’t seem like yourself, and I want to know how you’re really feeling because I care about you.

Find Help and More Information Regarding Mental Illness

Help is available. For additional information, visit MagellanHealth.com/MYMH.

For more information on treatment resources, contact:
National Institute of Mental Health
https://www.nimh.nih.gov/health/find-help/index.shtml

NAMI (National Alliance on Mental Illness)
http://www.nami.org/

Substance Abuse and Mental Health Services Administration (SAMHSA) https://findtreatment.samhsa.gov/https://www.mentalhealth.gov/

Mental Health.gov
https://www.mentalhealth.gov/
Help is available. For additional information, visit MagellanHealth.com/MYMH

Read more about Mental Illness from Magellan Health Insights