Daily Healthy: suicide prevention

Native Americans and Suicide

By Arshya Vahabzadeh, MD & Brad Zehring, DO <o:p></o:p>  Mental illness does not discriminate - it affects every age, sex, religion, and ethnic group. <o:p></o:p> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> <span style="color: black; font-family: "Calibri","sans-serif"; font-size: 11pt; mso-ascii-theme-font: major-latin; mso-bidi-theme-font: major-latin; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;">The Indian Health Service conducted a study in 2008 that noted that the rate of <a href="http://www.psychiatry.org/mental-health/key-topics/suicide">suicide</a> for <a href="http://www.psychiatry.org/mental-health/people/american-indians-">American Indians and Alaska Natives</a> is higher than any ethnic group within the United States. The study reported that suicide in these populations is up to 70% higher, especially in ages 10 to 24. Sadly, this statistic is not decreasing. Mental health professionals and society need to recognize the etiology of the despair that leads to suicide so that treatment and appropriate allocation of resources can be made.<o:p></o:p></div> The statistics are alarming, but possibly more alarming is the silence around this tragedy. Since suicide is taboo on most reservations - there are reports that a death by suicide often is not reported or legal authorities classify it as an accident. Due to the silence and misrepresentation, the numbers could be even greater. <o:p></o:p> It is important to break the silence on the troubling trends within Native American reservations. <a href="http://www.psychiatry.org/File%20Library/Practice/Diversity/Diversity%20Resources/Fact-Sheet---Native-Americans.pdf">Native Americans</a> must be willing to discuss their stressors and be open to getting education necessary to cope, deal, and treat their stressors. Mental Health professionals must be willing to understand their culture and adapt. Alex Crosby, MD, MPH, medical epidemiologist of the CDC has been recorded as saying that Native American suicide is so prevalent that it has become acceptable practice when tensions build up. Suicide should never be an acceptable option.<o:p></o:p> Reasons for troubling trends among Native Americans<o:p></o:p> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhx0NgKpvr_PJochoXZyWx2GWAgARxnTTmroNlbyfMJ3F7vvrpgeP2WKH6qq2IjaXJsuKsotS2ZrzyeB_03A23lZx7iZcsVAMkIVpaZbtHZt_gsTTmhKWsifIgddgOtLJIZQsmhpcgiwLM/s1600/Native+Amer+lets+talk+facts.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhx0NgKpvr_PJochoXZyWx2GWAgARxnTTmroNlbyfMJ3F7vvrpgeP2WKH6qq2IjaXJsuKsotS2ZrzyeB_03A23lZx7iZcsVAMkIVpaZbtHZt_gsTTmhKWsifIgddgOtLJIZQsmhpcgiwLM/s1600/Native+Amer+lets+talk+facts.JPG" width="82" /></a></div> There are a lot of thoughts on why mental illness and suicide have increased in the <a href="http://www.psychiatry.org/File%20Library/Mental%20IIlness/Lets%20Talk%20Facts/APA_American-Indians.pdf">Native American population</a>. There has been a lot of discussion of generational trauma due to the disempowerment and oppression of Native Americans and Alaska Natives. It has been discussed that this has caused adverse childhood experiences that lead to high rates of depression and other mental illness that are precursors to suicide. <span style="font-family: "Calibri","sans-serif"; font-size: 11pt; mso-ascii-theme-font: major-latin; mso-bidi-theme-font: major-latin; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;"><o:p></o:p> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> While disempowerment and oppression could very well be contributing factors - poverty seems to be a growing problem on reservations. Poverty tends to put stress on educational standards decreasing the educational opportunities for those on the reservation – leading to a viscous cycle. There are few jobs on the reservation causing adolescents and young adults to leave their families and move to where there are jobs. However, parents age and get ill causing tension between the traditional Native American family structures where youth takes care of the elderly and providing for the immediate family. <o:p></o:p></div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> In addition to poverty, substance abuse is a big problem on the reservation. Substance abuse can affect mood, often negatively, which increases the tension and is a risk factor for suicide. Domestic violence and sexual assault are also known problems on the reservation. These stressors have led to unstable environments for children growing up. Add untreated mental illness to the mix and it is easy to see how hopelessness and despair thrive often leading to the belief that suicide is the only way out.<o:p></o:p></div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> The Way Forward<o:p></o:p></div> Recently, the American Foundation for Suicide Prevention joined a Native American Mental Health panel sponsored by Congressional Native American Caucus and Center for Native American Youth. The panel focused on ways of improving mental health resources and suicide prevention. The IHS and the Substance Abuse and Mental Health Services Administration (SAMHSA) collaborated on targeted suicide prevention programs. The IHS established the <span style="font-family: "Calibri","sans-serif"; font-size: 11pt; mso-ansi-language: EN-US; mso-ascii-theme-font: major-latin; mso-bidi-language: AR-SA; mso-bidi-theme-font: major-latin; mso-fareast-font-family: "MS Mincho"; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: major-latin;">Suicide Prevention Initiative and SAMHSA provided funding to the IHS to address youth suicide and provide suicide prevention for high-risk populations. <o:p></o:p> <div class="MsoNormal" style="margin: 0in 0in 6.75pt;"> As we move forward as Mental Health professionals, it will be important to continue to collaborate with the Native American population, especially with Mental Health professionals with experience with the population and their culture. Understanding their culture and etiology of stressors will go a long way in providing the appropriate resources and treatment.<o:p></o:p></div> Resources for Help<o:p></o:p> In the US: <o:p></o:p> ·         <a href="http://www.helpguide.org/articles/suicide-prevention/suicide-help-dealing-with-your-suicidal-thoughts-and-feelings.htm">Suicide help</a> <o:p></o:p> ·         1-800-273-TALK <o:p></o:p> Outside the US:<o:p></o:p> ·         <a href="http://www.iasp.info/resources/Crisis_Centres/">International Association of Suicide Prevention (IASP)</a> <o:p></o:p>

By Arshya Vahabzadeh, MD & Brad Zehring, DO Mental illness does not discriminate - it affects every age, sex, religion, and ethnic gro...

Adult Bullying in the Workplace

1:26 AM Meme Art Studio 0 Comment

<div class="MsoNormal" style="margin: 0in 0in 0pt;"> By Brad Zehring, DO </div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> </div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> I would rather be a little nobody, then to be an evil somebody - Abraham Lincoln <o:p></o:p></div> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> Typically, when bullying is talked about it is in the context of children or adolescents during some level of schooling. Rarely do we think about<a href="http://www.nxtbook.com/nxtbooks/apf/mentalhealthworks_2012q2/#/6" target="_blank"> bullying as an adult issue.</a> However, much more attention has been focused on adult bullying – more specifically, adult bullying in the <a href="http://www.nxtbook.com/nxtbooks/apf/mentalhealthworks_2012q2/#/6" target="_blank">workplace.<o:p></o:p></a></div> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6gbkoJjXtispBE11miJABZcf2lJICFyFl3vkXW4M5q70a-fH5meOIm8jM-MrogpRoNJWRJ1JhsWU0Re0EgoUFPBC-u1hWlMvFujsT5W6VdOl2aY4qO1cCyy3X2Bv7IEUT0ceIVuqR6U9I/s1600/Unity+Day_Bully.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6gbkoJjXtispBE11miJABZcf2lJICFyFl3vkXW4M5q70a-fH5meOIm8jM-MrogpRoNJWRJ1JhsWU0Re0EgoUFPBC-u1hWlMvFujsT5W6VdOl2aY4qO1cCyy3X2Bv7IEUT0ceIVuqR6U9I/s1600/Unity+Day_Bully.jpg" width="214" /></a></div> According to various sources, citing research and survey’s, it has been reported that as many as 1 in 4 adults will face some form of bullying in their career.  It is important to point out the differences between constructive criticism, workplace conflict, and bullying. Workplace bullying focuses on the person rather than the performance or task being completed by the person. In addition, the person being targeted feels powerless to stop it. Making the situation worse, is when the adult being bullied goes to management to report the offense and the abuse is minimized or discounted altogether. Complicating the issue further is the difficulty verbalizing what is taking place or being unaware that what is occurring is bullying, leading to worsening suffering.<o:p></o:p> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> What are some forms of workplace bullying?<o:p></o:p></div> As discussed earlier, workplace bullying can be described as an extreme pattern where the person is isolated apart from his/her performance or task. Some examples of <a href="http://www.nxtbook.com/nxtbooks/apf/mentalhealthworks_2012q2/#/6" target="_blank">workplace bullying</a> are: being left-out of work-related social events, coworkers refusing to help when asked, coworkers leaving the room when you enter or routinely arriving to meetings late that when you call them, being yelled at, put down, or disciplined in front of your coworkers. These are some of the ways that workplace bullying presents, but it is not an exhaustive list.<o:p></o:p> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> How workplace bullying is harmful<o:p></o:p></div> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWW2khCUHbZEJaXeZvTJqMszw500RgDY2__K6bneUuzKjL4aBO0OvsPYT72G6ClM3EuZO6D0j4V6T_CzzjbzHjWjJ1i_R3IQ34vg5Oo22L3KR1aNGsj_UGaGx488WrRiS6YAbgR6xyNFFx/s1600/Suicide-Prevention-Graphic-FB-Cox.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWW2khCUHbZEJaXeZvTJqMszw500RgDY2__K6bneUuzKjL4aBO0OvsPYT72G6ClM3EuZO6D0j4V6T_CzzjbzHjWjJ1i_R3IQ34vg5Oo22L3KR1aNGsj_UGaGx488WrRiS6YAbgR6xyNFFx/s1600/Suicide-Prevention-Graphic-FB-Cox.jpg" width="200" /></a>For individuals who are being bullied in the workplace, their desire to go into work day after day is diminished and their satisfaction in their performance and with their employer decreases.  Many reports discuss the loss of productivity when job satisfaction decreases. Beyond the psychological stress (<a href="http://www.psychiatry.org/mental-health/more-topics/warning-signs-of-mental-illness" target="_blank">depression</a>, anxiety, <a href="http://www.psychiatry.org/mental-health/people/military" target="_blank">PTSD</a>, etc) – which should not be minimized, stress from bullying can lead to physical illness such as stroke, heart attacks, chronic fatigue or dissatisfaction in an person’s personal life – including leading to <a href="http://suicide./">suicide.</a> There are many reports documenting poor job satisfaction negatively affecting all areas on one’s life. Feeling accomplished and satisfied in a career can lead to a happier personal life and vice versa.<o:p></o:p> How to prevent or deal with workplace bullying<o:p></o:p> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7H3gsvYWqdfX3q723HcxUnnWdjIP3XLjPsfjlz73wZ5hqd6Lncppc6MSAozbWglYH8LrnMbUptMYkhCtGdpS6y1MS3WOfm0ywn0ChIzK_k4dh04VvnYxBOaHhay3Uzt_N03IozmIM8OXH/s1600/2014-UD-banner-600px+unite+against+bullying.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="106" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7H3gsvYWqdfX3q723HcxUnnWdjIP3XLjPsfjlz73wZ5hqd6Lncppc6MSAozbWglYH8LrnMbUptMYkhCtGdpS6y1MS3WOfm0ywn0ChIzK_k4dh04VvnYxBOaHhay3Uzt_N03IozmIM8OXH/s1600/2014-UD-banner-600px+unite+against+bullying.jpg" width="200" /></a>While recognizing or speaking up about workplace bullying can be a difficult task - it is important not to be silent about bullying experiences, whether personal attacks or witnessed attacks on colleagues, or isolate from those that may be able to help. Currently, states are working on anti-bullying bills to encourage healthy workplace environments, but fostering a workplace for your coworkers that doesn’t tolerate bullying is key. Many organizations provide or contract with mental health professionals willing to discuss, advise, and help an individual navigate the process. It is important to document your concerns and be specific and concise with the message you are trying to convey if you feel you are being bullied. Despite how difficult it may be, it is important to approach the bully or go to your supervisor with a calm demeanor and discuss your concerns rationally. Lastly, it is important to have an open mind about the situation. Sometimes it may be that the “bully” does not realize how his/her actions have affected you. Approaching them, or the situation, calmly will provide an environment for understanding and increase the probability for change. <o:p></o:p> <div class="MsoNormal" style="margin: 0in 0in 0pt;"> <o:p><a href="http://apahealthyminds.blogspot.com/2011/12/how-to-bully-proof-kids.html" target="_blank">How to "Bully-Proof " Kids </a></o:p></div> <a class="twitter-share-button" data-count="horizontal" data-related="APAPsychiatric" data-via="APAHealthyMinds" href="http://twitter.com/share">Tweet</a><script src="http://platform.twitter.com/widgets.js" type="text/javascript"> </script>

adult bullying bullying depression PTSD suicide prevention workplace bullying Adult Bullying in the Workplace

By Brad Zehring, DO I would rather be a little nobody, then to be an evil somebody - Abraham Lincoln Typically, when bullying is talked ab...

Williams’ death reminds us that a patient’s relief might be a warning sign

1:58 AM Meme Art Studio 0 Comment

<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> By H. Steven Moffic, MD <o:p></o:p></div> <div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> One of my favorite movie moments is when Robin Williams signs on as an edgy D.J. by exclaiming "Good Morning, Vietnam" from the 1987 movie of the same name. Sometimes, I played the audio over and over, as if it could promise a good day. As he did so often, he found a way to not only lighten the sadness, but to do it in such a way that might be constructively critical.<o:p></o:p></div> Surely, the real life mornings were not often happy ones, as so many of our troops died or ended up with <a href="http://www.psychiatry.org/ptsd" target="_blank">post-traumatic stress disorder (PTSD)</a> from that war. It is a lesson we are still learning, so that movie and his role is worth seeing again soon. <div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> Now, after his reported suicide, that good morning seems more like a final good night.<o:p></o:p></div> Although he is probably best known for his manic comedy, he also played many serious roles. Most ironically now, he won an academy award in 1997 for playing an empathic therapist in the film “Good Will Hunting.”<o:p></o:p> Indeed, beloved entertainers like Robin Williams have a therapeutic role of sorts for society in the sense that they provide some relief—even if briefly—for the grief and stress of everyday life. For playing that societal role, such people become a repository for our hopes, dreams and demons. As we know for so many famous entertainers, it is not easy for them to have a successful private life—a private life that the public also tries to invade, as if they were related to us.<o:p></o:p> <div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> What we do know publicly is that Williams suffered from chronic <a href="http://www.psychiatry.org/depression" target="_blank">depression</a> and intermittent <a href="http://www.psychiatry.org/addiction" target="_blank">substance abuse</a>. It is reported that he received treatment, including entering rehab just last month. Obviously, money to get the best treatment was not an issue, though how good the treatment was will remain unknown. We do know, however, that wealthy VIPs often receive treatment just as poor as low-income folks without resources. We also know that occasionally depression is a terminal illness, though that ending is not predictable.<o:p></o:p></div> Beyond the public information, and despite the understandable curiosity, this is not the time, nor should it ever be the time, to speculate about his diagnosis and reasons for committing suicide. In fact, the so-called "Goldwater Rule," called that for the inappropriate professional speculation about presidential candidate Barry Goldwater, ethically prohibits such speculations on the part of psychiatrists like myself.<o:p></o:p> Given this professional ethical principle, as well as the family's request for privacy, is there anything we can still learn from this apparent tragedy? The most intriguing detail that caught my attention was his last tweet and Instagram on July 31. Reportedly, he had wished his daughter a happy 25th birthday.<o:p></o:p> <div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> Why might this positive communication be of importance to us?<o:p></o:p></div> It reminded me of the only patient I ever had who committed suicide, long ago, when I was a resident in training. In the second session, the depression of this elderly man seemed to be less severe, but after that session he walked into Lake Michigan and drown. In the psychological autopsy, I never forgot the warning that when a depressed patient starts to seem better, they actually can be at higher risk for suicide.<o:p></o:p> <div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> Risky time<o:p></o:p></div> Why is that time of apparent improvement a risky time? The person can have more energy, then plan and complete a suicide. They may also feel relief at their decision, causing others to paradoxically feel relief. That is one of the reasons why it is so common to hear of the genuine surprise that the suicide occurred, as the person seemed to be happier.<o:p></o:p> <div class="MsoNormal" style="line-height: normal; margin: 0in 0in 10pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"> What this means, not only for professionals, but for the public, is not to take at face value if a depressed person seems better. Be sure there is a sound explanation for the apparent improvement. <o:p></o:p></div> Our only consolation must be that entertainers like Robin Williams keep on living in the form of their life’s work, like the movie “Good Morning, Vietnam,” that is so ubiquitously available nowadays. Even so, it would not be surprising if at the times we laugh once again at Robin William's humor, that the laughter will also be accompanied by some tears of grief.<o:p></o:p> <div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;"> Bio <o:p></o:p></div> H. Steven Moffic, MD, is a Life Fellow of the APA. Currently, he blogs regularly for Psychiatric Times, Behavioral Healthcare, and The Hastings Center's Over 65. This blog was originally published in <a href="http://www.behavioral.net/" target="_blank">Behavioral Healthcare</a>. <a class="twitter-share-button" data-count="horizontal" data-related="APAPsychiatric" data-via="APAHealthyMinds" href="http://twitter.com/share">Tweet</a><script src="http://platform.twitter.com/widgets.js" type="text/javascript"> </script>