Lisa Schlein
July 14, 2015 11:57 AM

GENEVA—
Hundreds of millions of people worldwide who suffer from mental disorders get little or no treatment, the World Health Organization reports. Its Mental Health Atlas 2014 finds that though mental illness constitutes 10 percent of the global health burden, it draws just 1 percent of the financial and human resources needed.

The Atlas provides the most comprehensive look to date at the global state of mental health. It contains data from 171 countries, representing 95 percent of the world’s population.

The report finds every country, region, age group and strata of society suffers significantly from mental disorders. Yet, it says the mental health field attracts very few nurses and other health care professionals and draws minimal spending.

A wide health-care gap separates poor and rich countries. The ratio of mental health care providers in low- and middle-income countries is one per 100,000 people compared to one per 2,000 in wealthy countries, the report said.

The financial gap also is broad. Poor countries spend less than $2 per capita each year on mental health, compared to more than $50 in high-income countries, according to the report.

Stigma interferes

Communities and countries do not pay enough attention to mental health problems because of stigma, Shekhar Saxena, director of WHO’s Department of Mental Health and Substance Abuse, told VOA. He said people shrink from speaking about their problems for fear of losing status in their societies or losing their jobs and relationships.

“There is a misconception that once a person is mentally ill … nothing much can be done about it, which is far from the truth,” Saxena said. “WHO’s documents have very clearly highlighted the fact that largely mental disorders are treatable. People can become all right – completely all right or partially all right – can go back to their job[s], can look after their normal roles and functioning in a very satisfactory way.”

Mental health disorders are continuing to increase, WHO said, with one in four people affected at some point over a lifetime. But three out of four people with severe disorders receive no treatment.

Serious consequences

Health systems’ inadequate responses are having serious consequences, it said, warning that depression will be the leading cause of disease burden by 2030.

Data from the Atlas show 900,000 people a year commit suicide, which also is the second most-common cause of death among young people.

The report also said people with mental health ailments suffer a wide range of human rights violations.

It’s much better to treat people with mental disorders in community-based settings than in institutions, WHO’s report said. Unfortunately, it noted the majority of spending – 82 percent – goes to mental hospitals, which serve a small proportion of those who need care.

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Time spent on smartphone and GPS location sensor data detect depression

NORTHWESTERN UNIVERSITY

CHICAGO — You can fake a smile, but your phone knows the truth. Depression can be detected from your smartphone sensor data by tracking the number of minutes you use the phone and your daily geographical locations, reports a small Northwestern Medicine study.

The more time you spend using your phone, the more likely you are depressed. The average daily usage for depressed individuals was about 68 minutes, while for non-depressed individuals it was about 17 minutes.

Spending most of your time at home and most of your time in fewer locations — as measured by GPS tracking — also are linked to depression. And, having a less regular day-to-day schedule, leaving your house and going to work at different times each day, for example, also is linked to depression.

Based on the phone sensor data, Northwestern scientists could identify people with depressive symptoms with 87 percent accuracy.

“The significance of this is we can detect if a person has depressive symptoms and the severity of those symptoms without asking them any questions,” said senior author David Mohr, director of the Center for Behavioral Intervention Technologies at Northwestern University Feinberg School of Medicine. “We now have an objective measure of behavior related to depression. And we’re detecting it passively. Phones can provide data unobtrusively and with no effort on the part of the user.”

The research could ultimately lead to monitoring people at risk of depression and enabling health care providers to intervene more quickly.

The study will be published July 15 in the Journal of Medical Internet Research.

The smart phone data was more reliable in detecting depression than daily questions participants answered about how sad they were feeling on a scale of 1 to 10. Their answers may be rote and often are not reliable, said lead author Sohrob Saeb, a postdoctoral fellow and computer scientist in preventive medicine at Feinberg.

“The data showing depressed people tended not to go many places reflects the loss of motivation seen in depression,” said Mohr, who is a clinical psychologist and professor of preventive medicine at Feinberg. “When people are depressed, they tend to withdraw and don’t have the motivation or energy to go out and do things.”

While the phone usage data didn’t identify how people were using their phones, Mohr suspects people who spent the most time on them were surfing the web or playing games, rather than talking to friends.

“People are likely, when on their phones, to avoid thinking about things that are troubling, painful feelings or difficult relationships,” Mohr said. “It’s an avoidance behavior we see in depression.”

Saeb analyzed the GPS locations and phone usage for 28 individuals (20 females and eight males, average age of 29) over two weeks. The sensor tracked GPS locations every five minutes.

To determine the relationship between phone usage and geographical location and depression, the subjects took a widely used standardized questionnaire measuring depression, the PHQ-9, at the beginning of the two-week study. The PHQ-9 asks about symptoms used to diagnose depression such as sadness, loss of pleasure, hopelessness, disturbances in sleep and appetite, and difficulty concentrating. Then, Saeb developed algorithms using the GPS and phone usage data collected from the phone, and correlated the results of those GPS and phone usage algorithms with the subjects’ depression test results.

Of the participants, 14 did not have any signs of depression and 14 had symptoms ranging from mild to severe depression.

The goal of the research is to passively detect depression and different levels of emotional states related to depression, Saeb said.

The information ultimately could be used to monitor people who are at risk of depression to, perhaps, offer them interventions if the sensor detected depression or to deliver the information to their clinicians.

Future Northwestern research will look at whether getting people to change those behaviors linked to depression improves their mood.

“We will see if we can reduce symptoms of depression by encouraging people to visit more locations throughout the day, have a more regular routine, spend more time in a variety of places or reduce mobile phone use,” Saeb said.

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This research was funded by research grants P20 MH090318 and K08 MH 102336 from the National Institute of Mental Health of the National Institutes of Health.

February is American Heart Month. People with heart disease are at a higher risk for depression. In fact, up to 33 percent of heart attack patients end up developing some degree of depression – three times the rate compared to the general population.

How are depression and heart disease linked? People with heart disease are more likely to suffer from depression than otherwise healthy people. Angina and heart attacks are closely linked with depression. Researchers are unsure exactly why this occurs. They do know that some symptoms of depression may reduce a person’s overall physical and mental health, increasing the risk for heart disease or making symptoms of heart disease worse. Fatigue or feelings of worthlessness may cause a person to ignore their medication plan and avoid treatment for heart disease. Having depression increases the risk of death after a heart attack.

What are the signs and symptoms of depression? Not everyone will experience the same symptoms of depression, but symptoms may include:

• Ongoing sad, anxious, or empty feelings
• Feeling hopeless
• Feeling guilty, worthless, or helpless
• Feeling irritable or restless
• Loss of interest in activities or hobbies once enjoyable, including sex
• Feeling tired all the time
• Difficulty concentrating, remembering details, or making decisions
• Difficulty falling asleep or staying asleep, a condition called insomnia, or sleeping all the time
• Overeating or loss of appetite
• Thoughts of death and suicide or suicide attempts
• Ongoing aches and pains, headaches, cramps, or digestive problems that do not ease with treatment

Treating depression can help a person manage their heart disease and improve their overall health. Common treatments for depression are psychotherapy, medication, or combination of both.

Visit the National Institute of Mental Health website for more information on depression and heart disease.

To take a free, anonymous mental health self-assessment that screens for depression and other common mental health conditions visit our online screening.

The Centers for Disease Control and Prevention’s November 28, 2014, Morbidity and Mortality Weekly Report (MMWR), highlighted that in 2010, 20% of all visits to primary care physicians included at least one of the following mental health indicators: depression screening, counseling, a mental health diagnosis or reason for visit, psychotherapy, or provision of a psychotropic drug. The percentage of mental health–related visits to primary care physicians increased with age through age 59 years and then stabilized. Approximately 6% of visits were for children that were 11 years old or younger and approximately 31% of visits were for adults aged 75 years or older were associated with mental health care. The data was obtained from the 2010 National Ambulatory Medical Care Survey, which can be found at http://www.cdc.gov/nchs/ahcd.htm

* A mental health visit was defined by at least one of the following: ordering or provision of depression screening, psychotherapy, or other mental health counseling; a mental health diagnosis or reason for visit; or a psychotropic medication that was ordered, supplied, administered, or continued at the visit. Mental health diagnosis, reason for visit, and psychotropic medications were based on certain categories. Source: Olfson M, Kroenke K, Wang S, Blanco C. Trends in office-based mental health care provided by psychiatrists and primary care physicians. J Clin Psychiatry 2014;75:247–53.

† Includes physicians in primary care specialties: general and family practice, internal medicine, pediatrics, and obstetrics/gynecology.

§ 95% confidence interval

In any given year, about 7% of the U.S. adult population experiences a major depressive episode (MDE). In a recent issue of The NSDUH Report from the Substance Abuse and Mental Health Services Administration looked at combined data from the 2008 to 2012 National Surveys on Drug Use and Health (NSDUH) that showed that more than one third of adults with past year MDE (38.3%) did not talk to a health professional or alternative service professional during the past 12 months. Of those who did seek help, 48% consulted with a health professional, 10.7% percent talked to both a health professional and an alternative service professional, and 2.9% talked to alternative service professional. The report suggests that primary care providers should consider using screening tools to identify patients that may be experiencing depression.

To view the The NSDUH Report: http://www.samhsa.gov/data/spotlight/spot133-major-depressive-episode-2014.pdf

For information on resources and the latest news and research on depression, please visit the MHAM website at https://mentalhealthmn.org/be-informed/mental-health-resources/depression

Antipsychotic medications can be effective in treating psychotic symptoms among people with schizophrenia or related disorders. Unfortunately, some commonly used antipsychotics are associated with serious metabolic side effects such as weight gain and heightened cholesterol levels. These health complications can lead to heart disease or diabetes.

In some circumstances, it may be possible for people experiencing metabolic side effects to switch to a different antipsychotic.  However, doctors are often reluctant to make changes in patient’s drug regimen when the current medication appears to keep the person’s psychotic symptoms under control.  When considering a switch to a new antipsychotic, doctors must perform a careful balancing act, weighing the possible benefit of reduced metabolic side effects against the possible risk of symptom relapse or medication failure.

In an effort to address such concerns, a National Institute of Mental Health (NIMH) has published research designed to determine if an antipsychotic medication switch could be made safely and without sacrificing the clinical stability of the participants.

The study enrolled people who were taking a commonly used antipsychotic and were experiencing serious metabolic side effects.  Half of the participants were assigned to continue taking their current medication and half of them were switched to an antipsychotic that was associated with fewer metabolic risks.  All participants were put on a diet and exercise program designed to reduce the risk of cardiovascular disease.

After 6 months, the researchers found that those who had switched antipsychotics had improved cholesterol levels and had lost more weight, on average, than those who had stayed with their original medication. In addition, those who had switched medication did not experience any more illness relapses or worsening of psychotic symptoms than those who stayed on their original medication.

However, participants who changed to a new antipsychotic were more likely to stop taking their medication compared to those who continued to take their original medication.  Almost 44 percent of those who switched antipsychotics discontinued their new medication, as compared to the 24.5 percent of those who were assigned to stay on their current medication. The study’s authors suggest that since both the participants and clinicians knew which drug the participant was taking, patients who switched antipsychotics may have felt uncomfortable about the change.  Participants also may have been more likely to discontinue their medication when doctors noticed the first signs of difficulties.

Among persons with serious mental illnesses such as schizophrenia, schizoaffective disorder, and bipolar affective disorder, the metabolic side effects associated with second-generation antipsychotics may contribute to early deaths.  As a 2006 report by the National Association of State Mental Health Program Directors notes, persons with serious mental illnesses die an average of 25 years earlier than members of the general population and are at an elevated risk of dying from diabetes and heart disease.  In response to the health crisis affecting those with serious mental illness, Minnesota has launched a branch of the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) 10 by 10 Wellness Campaign.  This program seeks to increase the life expectancy of persons with serious mental illness by 10 years in 10 years through developing measures by which to track the health of persons with mental illnesses, raising awareness among consumers and mental health professionals, and by encouraging psychiatrists and primary care physicians to talk with patients about health risks and tools for health management.

To learn more about incorporating physical wellness in mental health recovery, please check out Steps to Wellness and Take Charge on the MHAM website.

This article was contributed by Claire Jamison, a volunteer for MHAM.  

From the Substance Abuse and Mental Health Services Administration (SAMHSA)

Excessive Heat Exposure Can Pose Higher Risks for Those on Psychotropic Medication or Other Substances

During this period when parts of the Nation are experiencing record high temperatures, SAMHSA is reminding everyone that these conditions can pose certain health risks to everyone—including people with mental and substance use disorders.

Exposure to excessive heat is dangerous and can lead to heatstroke, which is considered a medical emergency. Heatstroke occurs when an abnormally elevated body temperature is unable to cool itself. Internal body temperatures can rise to levels that may cause irreversible brain damage and death.

Individuals with behavioral health conditions who are taking psychotropic medications, or using certain substances such as illicit drugs and alcohol, may be at a higher risk for heatstroke and heat-related illnesses. These medications and substances can interfere with the body’s ability to regulate heat and an individual’s awareness that his or her body temperature is rising.

Visit the CDC’s Extreme Heat: A Prevention Guide To Promote Your Personal Health and Safety for information on how to prevent, recognize, and treat heat-related illnesses.

by Anna Raudenbush, Client Advocate

There has long been a gap in mental health services for folks who don’t need emergency room level care, but cannot wait a couple weeks to see a provider.  Now St. Paul has a new service to fill that gap, the Urgent Care for Adult Mental Health center.  Located at 402 University Avenue East, the center is meant for anyone in Ramsey, Dakota, and Washington Counties who need immediate non-emergency mental health support.

The center is operated by the Mental Health Crisis Alliance, formerly EMACs, and managed by Ramsey County.  While they offer on-site support and walk-ins, they also operate a mobile crisis team for Ramsey County.

Going to a new place for mental health care can be nerve-wracking; it’s hard to feel comfortable when you don’t know what to expect.  Fortunately, the Urgent Care center is hosting monthly open houses on the first Friday of each month at 1PM.  These open houses are free and anyone can come, no RSVP required.  At the open house visitors will get to tour the new center.  This is a great way to get familiar with mental health services in Ramsey County and to learn how Urgent Care can be a resource for you.

You can find more information about Urgent Care for Adult Mental Health here.   For more information about the monthly open houses, you can call their front desk at 651-266-4008.

People Incorporated Mental Health Services, the state’s largest nonprofit working exclusively in the adult mental health field, is expanding its care to children. The organization announced that it has acquired an array of programs supporting children’s mental health from St. Paul-based Children’s Home Society & Family Services (Children’s Home). The programs, which will continue without disruption, branch throughout a six-county metro area and currently serve about 1,000 clients.

The programs began operating as the new People Incorporated Children’s Services division on January 1. Services include individual and family counseling, early childhood mental health, school-linked counseling, day treatment for children, domestic abuse prevention, anger management, and parent support services.

For more information about the merger, please visit www.PeopleIncorporated.org.

Our recent newsletter included a Q and A on SNBC enrollment that incorrectly described the opt-out procedure.  To remain on Fee for Service Medical Assistance (Traditional MA), you must return an opt-out form.  Doing nothing will result in being placed in a managed care plan.

We apologize for the confusion, we based our report on information provided by the Department of Human Services. Please note that that “Guide to Special Needs BasicCare Enrollment” found on the SNBC main page of the DHS site describes benefits/regulations as they are now, but does not apply to the new expansion.

For more information, visit the “Expansion Outline” found here.  The Disability Linkage Line is a great resources for asking questions about this transition: 866-333-2466.