Straight TeleTalk: Mental Health

Judy:

Hello, everyone and welcome to the SCAN health plan TeleTalk. My name is Judy Velarde and I'm a Senior Advocate. So not only do I work part time for SCAN, I'm also a member.

Now, today I'm here to host this TeleTalk, which basically means that I need to make sure we have time to get to some of your questions. So let me introduce the other three people with me today. Suzette Abend is our Behavioral Health Specialist with SCAN. Hi, Suzette. Please say hello to everyone.

Suzette:

Hi, everyone. As Judy just said, I'm Suzette and I've been with SCAN for 10 years, I am a Case Manager with SCAN in the Department of Health Care Services and I assist members with managing their emotional and physical health, as well as their medications.

Judy:

Thanks, Suzette.

Our other speaker today is Jim McDermott. Jim is also a Behavioral Health Specialist at SCAN. Jim, please tell the listeners what you do at SCAN.

Jim:

Thanks, Judy. Hello, I'm Jim and my work in SCAN is to assist members with obtaining the behavioral health services that they need. I've been with SCAN for about a year.

Judy:

Great.

Now, finally, we have Doug Buseck and Doug is a Process Improvement Manager in our Health Care Services Support Department. Doug, please tell us about yourself.

Doug:

Will do, Judy. Hey, thanks a lot. I've been with SCAN for 20 years. I do work in the Health Care Services Department where we support members. And I kind of work behind the scenes doing process improvement, trying to make things work good behind the scenes.

Judy:

Great.

Now that we've introduced ourselves, let's go ahead and get started. Are you ready, Doug? I'm going to turn it over to you.

Doug:

All right, Judy. Well, first of all, we'd like to start by thanking our listeners for taking part in this TeleTalk.

Mental health is such an important issue but there is a lot of misinformation and stigma about mental health. Some people don't really understand it and think of it as something else.

Maybe like a sign of weakness?

No!

Or a lack of character?

No!

Or something that you can just will yourself out of.

We want to say right up front that none of that is true!

It's also not unusual for people dealing with mental health issues to feel embarrassed or ashamed and choose to ignore it in the hope that it just goes away.

Suzette:

You're absolutely right about that, Doug. When you are dealing with mental health concerns, there's really nothing wrong with you other than the fact that you just don't feel well. And that's why we're doing this TeleTalk. We want people to get used to talking about these things, so that they can get the care they need and feel better.

Doug:

You know, I think it would be helpful if we started today by defining what we're talking about. Suzette what exactly do we mean when we say “mental health” and why is mental health so important?

Suzette:

Well, mental health refers to our cognitive and emotional well-being. So our thinking and reasoning and emotions. Maintaining our mental health is vital because mental health affects every aspect of our lives. When we're free of sadness and worry, we can better tackle life's challenges. When our mental health is good and in good shape, our physical health, our relationships, our jobs, our whole quality of life tends to also be in in very good shape

Doug:

Wow.

Suzette:

Unfortunately, there are several conditions that can have a negative impact on our mental well-being and today we're going to be focusing on the most common ones, which are depression and anxiety.

Doug:

You know, I think we can all relate to feeling down or stressed from time to time. Maybe we have a case of the blues because we've had a bad day or we're not able to get around as well as we once did. And there are all kinds of things in our lives that cause stress, like traffic or paying bills. Here's a big one: having chronic pain. Brief periods of sadness and stress are a normal part of life and everyone goes through them. But that's not what we're talking about when we're talking about depression and anxiety – is it, Jim?

Jim:

That's right, Doug. As you said, we all have to go through difficult situations. We all have difficult days but there is a difference between having a bad day and being clinically depressed, between being stressed and suffering from anxiety and between being emotional and having mood imbalances. The difference is when these things start impacting your life in a negative way. That's when it becomes what we consider a mental health problem.

Doug:

I see. Let's talk about depression for a few minutes. How can you tell when it's more than just a case of the blues?

Suzette:

Well, Doug, it's really important to know the difference between blues and depression, especially in older adults. Depression is often overlooked in older adults and untreated because the symptoms of depression can coincide with other problems older adults experience.

Now, we've mentioned sadness and that's definitely one of the key symptoms. But there are others. Some of the symptoms of depression include feeling empty or anxious, a sense of hopelessness, experiencing less interest in things you used to enjoy and having less energy.

Jim:

Hm. I see. Again, those are things that each of us experienced from time to time. When does feeling one or a combination of what you just mentioned start to really become a problem?

Suzette:

The two-week mark is really essential. If these feelings last more than two weeks, you may be experiencing a clinical depression. As we get older, we experience more losses in life and that can bring feelings of grief, which are also very normal.

Jim:

That's right, Suzette. But here's what I would tell our members: If you're wondering at all if you're depressed, I would suggest that you ask yourself the following five questions:

Have I had a hard time sleeping or am i sleeping too much?

Do I find myself lacking the energy or the will to do anything, even things that I used to enjoy?

Am I having a hard time concentrating, remembering things or making decisions?

Has my appetite changed dramatically? Either I've lost some appetite or I'm eating too much?

Am I crying or getting angry more than usual?

If you've answered yes to a few of these questions, that may be a sign that you have more than just the blues.

Doug:

Let's switch gears at this point and talk about the symptoms of anxiety.

Jim:

Thanks, Doug. Like depression, it's important for older adults to recognize the symptoms of anxiety because they can be mistaken with other problems older people go through and go untreated. Let's take a look at just a few of the symptoms quickly. If you experience any of these for longer than two weeks it may be a sign that you're suffering from anxiety.

Doug:

Hm.

Jim:

Panic

Uneasiness or fear

Trouble sleeping

Muscle tension

Heart palpitations

Or shortness of breath

Doug:

People can experience anxiety quite differently, isn't that right, Suzette? Can you talk about that briefly?

Suzette:

Sure, Doug. Anxiety can take different forms and the impact can also differ. It can be as mild as being unable to sit still or having vague feelings of anxiousness or you might experience a sudden fear that comes on repeatedly and without any warning. Or it can be severe, like being afraid to leave the house. And sometimes the cause of the fear is very difficult to even identify.

Doug:

Suzette, now that we have a better understanding about what depression and anxiety are and what symptoms to look for, can you talk about what caused those?

Suzette:

Sure. There are many possible causes but it is very important for anyone listening today to understand a few things. The first one we really want to emphasize again is that depression and anxiety are not signs of personal weakness. Did you guys know that Buzz Aldrin, Oprah Winfrey, Bob Dylan, Anthony Hopkins and Barbra Streisand all suffer from depression or anxiety?

Judy:

No.

Jim:

No.

Doug:

I did not know that.

Judy:

I didn’t either.

 

Suzette:

And these are very successful and very accomplished people. I don't think we’d call any of them “weak.”

Jim:

No.

Doug:

No, not at all.

Suzette:

Now, it's also important to know that depression and anxiety are not a normal part of aging. In fact, statistics show that incidence of depression actually decreased after age 59. However, it's important to know that due to some biological factors – like hormonal changes – older women are more vulnerable to depression and anxiety.

Jim:

Thanks, Suzette. Now, let's go to some causes of depression anxiety. They can come from many places, including past trauma; like an accident or sudden death of a parent; genetics, meaning you have a family history; brain structure or chemistry; life events, like the loss of friends family and independence; medication side effects – the side effects could be the result of medications that you're using as prescribed but they also could come from abusing prescriptions or illicit drugs or alcohol – chronic illnesses that leave us feeling despondent or afraid to seek further treatment, this is especially true for a senior population.

Doug:

Let's talk a little bit about grief and depression. Jim, now that we've said that if you've been experiencing symptoms for more than two weeks, you might be suffering from depression. But what about grief? The grieving process for most people can last for weeks, months, maybe even years. So, well, my question is, is there a set amount of time that you should be, well, maybe not done grieving but kind of over it? Let's say a year maybe? If you're mourning still after a year, should you go see the doctor?

Jim:

First, let's define grief. Any loss – and not just the death of a loved one – any loss contributes intense sadness, which we call grief. It can happen when you're diagnosed with a serious illness or when you're facing other traumatic changes. Unfortunately loss happens more often as we age.

Grief is not something that starts intensely and gradually lets up. It's more like a roller coaster. It goes up and down. Sometimes it'll hit you out of nowhere and other times you'll find yourself able to laugh again.

Doug:

Hm.

Suzette:

That's very true, Jim, and there's also no end point. The length of time that people experience grieving varies from person to person. The thing to keep in mind is that the intensity of the sadness, that's really the important part. And whether or not it's interfering with your regular activities.

If I may, I'd like to share a situation that I'm currently helping one of our members and her daughter's with. This member recently moved from her home of 25 years and decided to move in with her daughter. Her sadness over the loss of her home and what she is experiencing as the loss of her own independence has affected her ability to eat. She's having trouble sleeping, and she's not interested in bathing or changing her clothes.

Her daughter is very concerned and keeps saying, “This is not my mom.” So I'm working with both of them to schedule an appointment with the member’s new doctor and I'm certain he will be able to help her.

Doug:

Thank you so much for helping them.

We're going to move on to another part of our TeleTalk and this one is difficult to talk about. But I want to urge our listeners to stay with us even if they don't like the topic or if it does not apply to them. Suzette and Jim, can you talk about suicide for just a few minutes?

Suzette:

Sure, Doug. Thanks so much for raising the topic. It is a tough subject but one we should be talking about. The fact is 25 percent of all suicides are among people aged 65 and older. Sometimes when life becomes difficult for whatever reason, some people will start having thoughts of suicide and that can be very scary. It also happens gradually. Just like with a physical illness, the symptoms get worse and worse. That means the intensity or the frequency of the suicidal thoughts increases and then that thinking can just take over.

You might have thoughts like “I have no hope” or “It would be so much better for me and my family if I was gone” or “I wish I was dead” or even thinking about how you would actually take your own life.

Jim:

It's important to anyone having these types of thoughts should talk with his or her doctor as soon as possible. In fact, Judy’s going to give you some phone numbers to call so please have a pen and paper ready. It's important to remember that the thoughts – the hopelessness, the despair – they are all symptoms of a diagnosis and that when people get treatment these symptoms do go away.

 

 

Judy:

Thank you for explaining that, Jim.

I hope if any of our listeners are concerned about suicide, they’ll reach out. And it's so important to do that so let me give you the first phone number. Now, this is the number for the National Suicide Prevention lifeline and they are available 24 hours a day, seven days a week. That number is 1-800-273-8255. I’m going to read that to you again. It's 1-800-273-8255.

And now we have a second number and this is for Institute of Aging Friendship Line. Now, the Friendship Line is a crisis intervention center and it provides emotional support, medication reminders and well-being check-ins. It's also open 24 hours a day, every day. It has a toll-free number of 1-800-971-0016. Let me repeat that. Again, the toll-free number 1-800-971-0016.

Jim:

Thank you for that, Judy. We hope that if any of our members are having thoughts about suicide or know anyone who is will call one of those numbers. We also want to urge any caregivers who might be listening things right now and who might be needing help will call these numbers as well.

Doug:

Thanks, Jim, and thanks to everyone on the panel here for spending a few minutes on that subject.

We want to switch back to our main topic: Depression and anxiety. And we talk about a lot of problems; what are the solution, Suzette?

Suzette:

If you can relate to what we've talked about today, it's always a good idea to see your primary care doctor. Your doctor will ask you some questions about your symptoms, do a physical exam, maybe order lab work in order to rule out physical causes, like thyroid problems, which can mimic signs of depression.

Doug:

That's right, Suzette. I find that people often feel relieved when they get the diagnosis. That's when they realize these feelings are something that happened to them, not something they bought on themselves. They can stop thinking “It's all in my mind,” or “I'm just not trying hard enough.” And that could be a good first step toward getting better. If anyone else is saying those things to you, telling you snap out of it or that it’s your fault, they're wrong. So tune them out. Focus instead on getting better.

So let's say you see your doctor and she diagnoses you with depression or anxiety. What are some of the ways to ease the symptoms or to even make them go away entirely?

Judy:

Good question, Doug, because that's what we're here for: Letting our members know how they can stay happy and healthy.

Doug:

Yeah.

Suzette:

There are a lot of things we can do to help our mental health, like staying physically active, participating in prayer or meditation and maintaining contact with family and friends. But we also know that if you're depressed, it may be very, very hard to do these things even if you know they can help.

What I'd like to do now is share the circumstances of another member I am working with. This gentleman has experienced depression on and off through much of his adult life. He was very mindful of the fact that going to church was one way he was able to manage his depression. When he found himself, though, being a caregiver and taking the position of caring for his spouse, his depression resurfaced and he found himself feeling impatient and angry. Although he knew what to do to improve his mood, being depressed made it very, very difficult for him to help himself.

So if you find yourself unable to do the things that you normally do, please call someone and ask for help. Call a friend, a family member or your doctor.

Jim:

Thanks, Suzette. I would like to add that if you're experiencing the symptoms we talked about, don't wait until you feel so bad that you find it hard to take action. Just call your doctor. Discuss how you're feeling.

Doug:

We covered non-medical things we can do. Are there some medical options?

Jim:

Yes, Doug. Therapy is a big one, Doug, and helps millions of people every year. Talk therapy could be done on an individual basis with a trained professional or in a group setting. This can be a support group or a therapy group or even a community group, like a senior center or a church.

Doug:

What about medication?

Suzette:

Thank you for bringing that up, Doug. Obviously anti-depression and anti-anxiety medications are something we see a lot of commercials about on TV these days. Sometimes chemicals in the brain may become imbalanced and cause the symptoms we talked about earlier. Medications can work by restoring the chemical balance in the brain. It is often the fastest way to start feeling better. People who start medication treatment could start seeing results with just within just a few weeks.

Doug:

I guess the flip side, like any medication anti-depressants and anti-anxiety medications, do come with some side effects, don't they?

Jim:

That's right, Doug, they do. Most of these side effects are short-term while your body adjusts the medications and will go away on their own in just a couple of weeks. One of the important things to remember is to tell your doctor about any side effects but do not stop taking the medication on your own. Your doctor will tell you how to do this safely.

Doug:

Mm.

Suzette:

Your doctor should monitor you closely during the adjustment period because finding the right medication or combination of medications might take more than just one try. So tell your doctor how you are doing with your treatment, how you are feeling. These medications are not like aspirin, something you take when you have a headache. These are more like medications for a chronic conditions, like diabetes or high blood pressure. They work by keeping a steady balance of your brains chemicals so you need to take them consistently as your doctor prescribed them.

Jim:

That's right, Suzette. A mistake a lot of people who have taken anti-depressant and anti-anxiety medications is thinking “I feel better, so I must not need to take my medication any longer” so they just stop.

Doug:

Mm.

Jim:

That's never a good idea. You feel better because your medications are working. You'll continue feeling better as long as you take a prescription as instructed and suddenly stopping and can cause very serious side effects. So again, if you decide at any point that you don't want to be on these medications any longer, talk to your doctor. He'll help you ease off the medications slowly and make sure you're not experiencing any negative side effects.

Doug:

I see.

Suzette:

Thank you for that, Jim. That's really, really important for our listeners to know

Doug:

And SCAN does provide coverage for mental healthcare services, don't we?

Suzette:

Yes, we do, Doug. And thank you for pointing that out. Again, these services would need to be directed by your primary care doctor or you can call SCAN Member Services to find out how to access them. It's important for members to know that different plans have different copays for mental health services, so be sure to be informed about your benefits.

Doug:

Thanks, Suzette. But again we encourage listeners to make the call and take those first few steps. If you run into any issues with copayments, give Member Services a call. They can help explain the benefits and they can even help you find other options, like community resources or support groups.

Judy:

Thank you, Suzette and Jim, for all of this great information. I feel like you we could just keep going but we do need to leave some time at the end to take questions from our listeners.

Jim:

I'll take the first one if that's okay. We have a question from Norma and Norma says, “I already take five medications every day and I don't want to take another one. Is medication for depression my only option?”

Doug:

Well I'm glad Norma talked to her doctor already – that's great! I would say that if your doctor knows all the medications you're already on and thinks another medication could benefit you, then it’s worth a try. Because you're taking other medications, be sure you know if there any other side effects to be aware of and to let your doctor know if you're feeling any of them.

Judy:

I have one. Hank called in to ask a question about his mother. Hank said his mom has lived alone for years but for the past few months, she hasn't been able to get her to do anything. Now he says his mom tells him that she's going to go out, she's got plans. And he finds out later she didn't leave the house. Is this a sign that Hank’s mom shouldn't be living alone?

Suzette:

That's a great question. It certainly sounds like Hank’s mom could be depressed. I can't answer whether she should live alone or not. Some people living alone is not the best thing but for other people, leaving their home would be a blow and can make them even more depressed, like the member that I'm helping now. In fact, some seniors don't want anyone to know they're having trouble for that very reason; they're afraid they won't be able to live alone anymore.

So, Hank, I recommend going to the doctor with your mother if you're able to and talking openly about it. See what her doctor has to say about the situation and what some possible treatments may be for her.

Judy:

Okay. Well, that's all the questions we have time for today and if you have a question that we didn't answer or maybe you think of something later, please remember Member Services is available until 8 p.m. tonight. Now I will tell you that Member Services is typically busiest in the mornings and at the beginning of the week, so if your call can wait, try calling later in the week or even in the evening. The phone number is on the back of your SCAN ID card. And if you're following online, it's also on the screen but I'll go ahead and give you that number now. It’s 1-800-559-3500. And don't forget that you can also email Member Services, so let me give you that address now. It's memberservices@scanhealthplan.com.

Also be sure to visit our website and you'll get more information about your benefits or you can even review our prescription Formulary. It's also an easy web address to remember. It's scanhealthplan.com.

I want to thank all of you for joining us today and especially for choosing SCAN as your health plan. I hope you have a great day.

Doug:

Bye-bye, everybody.

Suzette:

Bye.

Jim:

Good afternoon.

Judy:

Thank you for anticipating.