Category: Health

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Talking about Death May Prevent End-Of-Life Suffering

80Anxiety, Decision-Making, Featured news, Grief, Health, Psychopathy December, 17
Source: Marica Villeneuve, Trauma and Mental Health Report artist, used with permission

Death comes unexpectedly. As City University of New York professor Massimo Pigliuccionce said, “You can evade taxes. But so far, you can’t evade death.” Just what is it, though, that we are trying to evade?

“We don’t know how or when we will die – even as we are actually dying,” wrote Joan Halifax, medical anthropologist and Zen teacher. “Death, in all its aspects, is a mystery.”

But we can talk. In conversation, we are able to clarify our wishes for end-of-life care, express our fear of the unknown, and grieve the loss of a loved one.

The “Death Café”, or “café mortel”, is a movement in which strangers meet to talk about death over tea and cake. The first “café mortel” was hosted in 2004 by Swiss sociologist and anthropologist Bernard Crettaz. In 2011, the movement migrated to the UK and took on the name “Death Café”. Their website states:

“Our aim is to increase awareness of death to help people make the most of their (finite) lives.”

In an article for Aeon magazine, freelance essayist Clare Davies described the kinds of topics explored at Death Café:

“The guests take turns to voice their thoughts and feelings across a wide range of subjects. How does it feel to lose a parent? What is existence? What matters most to us in life? The point is to talk. What is death like? What exactly are we afraid of? To what degree do our ideas on death influence how we live?”

But death isn’t an easy topic… even some doctors avoid it.

A 2015 study led by Vyjeyanthi Periyakoli at the Stanford University School of Medicine found that 86% of 1040 doctors said that they find it “very challenging” to talk to patients about death.

Yet, conversations that explore patient values are essential to end-of-life care. Many prefer to forgo aggressive treatments that are unlikely to prolong life, or improve its quality. Conversations ensure that patients are protected from unwanted treatments and excessive rescue measures that may lead to distress.

End-of-life distress can take many forms. Medications and surgeries often leave the body frail and vulnerable to other illnesses, or dependent on a ventilator or intravenous nutrition.

In a 2010 New Yorker article entitled “Letting Go”, medical doctor and public health researcher Atul Gawande wrote:

“Spending one’s final days in an intensive care unit because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place.”

End-of-life decisions can be stressful for both the patient and doctor. But talking about them does help.

In the New Yorker article, Gawande describes a 2008 Coping with Cancer study in which only one third of patients reported talking with their doctors about goals for end-of-life care, even though they were, on average, four months from death. Those who did have end-of-life conversations were significantly less likely to undergo cardiopulmonary resuscitation, be put on a ventilator, or end up in an intensive care unit. Gawande wrote:

“These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others. In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation, and to spare their family anguish.”

Audrey Pellicano hosts the New York Death Café, and works as a grief counsellor. She told the New York Times:

“Death and grief are topics avoided at all costs in our society. If we talk about them, maybe we won’t fear them as much.”

This sentiment is echoed by palliative care specialist Susan Block, who was interviewed by Gawande for the New Yorker article. Regarding end-of-life conversations, she said:

“A large part of the task is helping people negotiate the overwhelming anxiety—anxiety about death, anxiety about suffering, anxiety about loved ones, anxiety about finances.”

Fear surrounding life’s end is immense and varied. But death comes regardless. Perhaps what is needed is an ideological shift, supported by movements like the Death Café, which provides opportunities for people to discuss death from a safe distance. By facing death, a greater appreciation of life’s preciousness may emerge, clarifying what we want most from both living and dying.

–Rebecca Abavi, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Talking About Death May Prevent End-Of-Life Suffering

00Anxiety, Decision-Making, Featured news, Grief, Health, Psychopathy December, 17
Source: Marica Villeneuve, Trauma and Mental Health Report artist, used with permission

Death comes unexpectedly. As City University of New York professor Massimo Pigliuccionce said, “You can evade taxes. But so far, you can’t evade death.” Just what is it, though, that we are trying to evade?

“We don’t know how or when we will die – even as we are actually dying,” wrote Joan Halifax, medical anthropologist and Zen teacher. “Death, in all its aspects, is a mystery.”

But we can talk. In conversation, we are able to clarify our wishes for end-of-life care, express our fear of the unknown, and grieve the loss of a loved one.

The “Death Café”, or “café mortel”, is a movement in which strangers meet to talk about death over tea and cake. The first “café mortel” was hosted in 2004 by Swiss sociologist and anthropologist Bernard Crettaz. In 2011, the movement migrated to the UK and took on the name “Death Café”. Their website states:

“Our aim is to increase awareness of death to help people make the most of their (finite) lives.”

In an article for Aeon, freelance essayist Clare Davies described the kinds of topics explored at Death Café:

“The guests take turns to voice their thoughts and feelings across a wide range of subjects. How does it feel to lose a parent? What is existence? What matters most to us in life? The point is to talk. What is death like? What exactly are we afraid of? To what degree do our ideas on death influence how we live?”

But death isn’t an easy topic… even some doctors avoid it.

A 2015 study led by Vyjeyanthi Periyakoli at the Stanford University School of Medicine found that 86 percent of 1040 doctors said that they find it “very challenging” to talk to patients about death.

Yet, conversations that explore patient values are essential to end-of-life care. Many prefer to forgo aggressive treatments that are unlikely to prolong life, or improve its quality. Conversations ensure that patients are protected from unwanted treatments and excessive rescue measures that may lead to distress.

End-of-life distress can take many forms. Medications and surgeries often leave the body frail and vulnerable to other illnesses, or dependent on a ventilator or intravenous nutrition.

In a 2010 New Yorker article entitled “Letting Go”, medical doctor and public health researcher Atul Gawande wrote:

“Spending one’s final days in an intensive care unit because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place.”

End-of-life decisions can be stressful for both the patient and doctor. But talking about them does help.

In the New Yorker article, Gawande describes a 2008 Coping with Cancer study in which only one-third of patients reported talking with their doctors about goals for end-of-life care, even though they were, on average, four months from death. Those who did have end-of-life conversations were significantly less likely to undergo cardiopulmonary resuscitation, be put on a ventilator, or end up in an intensive care unit. Gawande wrote:

“These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others. In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation, and to spare their family anguish.”

Audrey Pellicano hosts the New York Death Café, and works as a grief counsellor. She told the New York Times:

“Death and grief are topics avoided at all costs in our society. If we talk about them, maybe we won’t fear them as much.”

This sentiment is echoed by palliative care specialist Susan Block, who was interviewed by Gawande for the New Yorker article. Regarding end-of-life conversations, she said:

“A large part of the task is helping people negotiate the overwhelming anxiety—anxiety about death, anxiety about suffering, anxiety about loved ones, anxiety about finances.”

Fear surrounding life’s end is immense and varied. But death comes regardless. Perhaps what is needed is an ideological shift, supported by movements like the Death Café, which provides opportunities for people to discuss death from a safe distance. By facing death, a greater appreciation of life’s preciousness may emerge, clarifying what we want most from both living and dying.

–Rebecca Abavi, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Climate Change Affecting Farmer’s Mental Health

60Depression, Environment, Featured news, Health, Suicide, Work December, 17

Source: CIAT at flickr, Creative Commons

The cutoff for irreversible climate change has long been accepted as two or more degrees in global temperature compared to pre-industrial records. Reports show that, in early March 2016, this cutoff was crossed for the first time in recorded history.

January and February of 2016 broke all previous monthly records for high temperatures. Accompanying this trend are regular reports of melting ice caps and changes to animal migratory patterns. But the link between climate change and mental health is less visible.

One effect has been observed in farmers who are closely connected to the land. For some, environmental problems stem from insufficient water supply. For others, too much rainfall is a detriment to crop growth. Not surprisingly, farmers are anxious.

Matthew Russell is an Iowan farmer whose family has tended to their land for five generations. In an interview with Medical Daily, he recounts the physical and psychological toll brought on by extreme climate conditions:

“Psychologically, in the last few years, there’s a lot of anxiety that I don’t remember having 10 years ago. In the last three or four years, there’s this tremendous anxiety around the weather because windows of time for quality crop growth are very narrow.”

Russell explains that this narrow window is due to increasing levels of rain, which leave his land muddy and wet, decreasing crop quality.

Aside from droughts and flooding, extreme temperatures compound the problem, as do weeds, pests, and fungi that thrive better as a result of warmer temperatures and increased carbon dioxide levels.

For those like Russell who have farmed throughout their lives, the idea of uprooting and relocating or finding a new profession seems daunting. With the continuing effects of climate change, this threat may soon become reality.

Anxiety is not the only mental-health concern influenced by climate change. A reportfrom the US National Library of Medicine states:

“An association has been found between crop failures due to unexpected droughts and suicide attempts in the farmers. Failure of crop can lead to economic hardships. When dependent on low precipitation situations, the farmer might not be able to sustain the expenses of the family and may become a victim of the debt trap to meet the expenses.”

Although the report focuses on droughts in Australian and Indian populations, these experiences are echoed elsewhere, like in California. Drought there has contributed to failed crops for farmers, as well as increased food prices for consumers in North America. A 2012 report showed that the economic hardship associated with these problems has increased the risk of suicide in American farmers.

A study on suicide by Ryan Sturgeon at the University of Calgary examined the content of calls to a rural stress line from farmers in Manitoba, Canada. He found that farmers may not be using the mental health resources open to them:

“Multiple factors may negatively impact farmers’ help-seeking behaviour, including greater isolation due to a growing distance between farms, increased competition and less cooperation among farmers because of the changing global economy, and fragmentation of existing rural communities as more people are moving off farms and into urban areas.”

Problems brought on by climate change are exacerbated in vulnerable rural communities populated by farmers. But as a worldwide phenomenon, climate change is likely to affect mental health globally.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report. 

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

an5_feature-1-470x260-1.jpg

Climate Change Affecting Farmers' Mental Health

00Depression, Environment, Featured news, Health, Suicide, Work December, 17

Source: CIAT at flickr, Creative Commons

The cutoff for irreversible climate change has long been accepted as two or more degrees in global temperature compared to pre-industrial records. Reports show that, in early March 2016, this cutoff was crossed for the first time in recorded history.

January and February of 2016 broke all previous monthly records for high temperatures. Accompanying this trend are regular reports of melting ice caps and changes to animal migratory patterns. But the link between climate change and mental health is less visible.

One effect has been observed in farmers who are closely connected to the land. For some, environmental problems stem from an insufficient water supply. For others, too much rainfall is a detriment to crop growth. Not surprisingly, farmers are anxious.

Matthew Russell is an Iowan farmer whose family has tended to their land for five generations. In an interview with Medical Daily, he recounts the physical and psychological toll brought on by extreme climate conditions:

“Psychologically, in the last few years, there’s a lot of anxiety that I don’t remember having 10 years ago. In the last three or four years, there’s this tremendous anxiety around the weather because windows of time for quality crop growth are very narrow.”

Russell explains that this narrow window is due to increasing levels of rain, which leave his land muddy and wet, decreasing crop quality.

Aside from droughts and flooding, extreme temperatures compound the problem, as do weeds, pests, and fungi that thrive better as a result of warmer temperatures and increased carbon dioxide levels.

For those like Russell who have farmed throughout their lives, the idea of uprooting and relocating or finding a new profession seems daunting. With the continuing effects of climate change, this threat may soon become reality.

Anxiety is not the only mental-health concern influenced by climate change. A report from the US National Library of Medicine states:

“An association has been found between crop failures due to unexpected droughts and suicide attempts by the farmers. Failure of a crop can lead to economic hardships. When dependent on low precipitation situations, the farmer might not be able to sustain the expenses of the family and may become a victim of the debt trap to meet the expenses.”

Although the report focuses on droughts in Australian and Indian populations, these experiences are echoed elsewhere, like in California. Drought there has contributed to failed crops for farmers, as well as increased food prices for consumers in North America. A 2012 report showed that the economic hardship associated with these problems has increased the risk of suicide in American farmers.

A study on suicide by Ryan Sturgeon at the University of Calgary examined the content of calls to a rural stress line from farmers in Manitoba, Canada. He found that farmers may not be using the mental health resources open to them:

“Multiple factors may negatively impact farmers’ help-seeking behavior, including greater isolation due to a growing distance between farms, increased competition, and less cooperation among farmers because of the changing global economy, and fragmentation of existing rural communities as more people are moving off farms and into urban areas.”

Problems brought on by climate change are exacerbated in vulnerable rural communities populated by farmers. But as a worldwide phenomenon, climate change is likely to affect mental health globally.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report. 

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

This article was originally published on Psychology Today

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Pregnant Women Struggle with Managing Psychiatric Medication

60Anxiety, Featured news, Health, Pregnancy, Psychiatry, Psychopharmacology, Suicide November, 17

Source: Lauren Fritts at flickr, Creative Commons

It is often portrayed as a happy and exciting time but the experience of pregnancy can be mixed, with physical and mental complications dampening the experience.

In a recently released documentary, Moms and Meds, director Dina Fiasconaro addresses the challenges that she and other women with psychiatric disorders face during pregnancy.

Fiasconaro’s goal in making the documentary was to investigate women’s experiences with psychotropic drugs at this life stage. She became pregnant while on anti-anxiety medication and had difficulty obtaining clear information from healthcare professionals.

In an interview with the Trauma and Mental Health Report, Fiasconaro explained:

“I received very conflicting information on what medications were safe from my psychiatrist, therapist, and high-risk obstetrician. Even with non-psychiatric medication, I couldn’t get a clear answer, or from the pharmaceutical companies that manufactured them. No one wanted to say ‘that’s okay’ and be liable if something were to go awry.”

When she spoke to her maternal/fetal specialist, she was provided with a stack of research abstracts regarding the use of certain psychotropic medications during pregnancy. Although the information was helpful, it didn’t adequately inform her about the risks and benefits of medication use versus non-use.

One of the main questions Fiasconaro had was, should she continue using medication and risk harming her baby, or should she discontinue use and risk harming herself?

One of the women featured in Moms and Meds, Kelly Ford, contemplated suicide several times during pregnancy. When her feelings began to intensify, she admitted herself to a hospital. There, she was steered away from taking medication which led her to feel significant distress and an inability to cope with her declining mental health.

Elizabeth Fitelson, director of the Women’s Program at Columbia University, also featured in the documentary, believes there is a tendency for healthcare professionals to dismiss mental illness in pregnant women.

In the film, Fitelson said:

“If a pregnant woman falls and breaks her leg, for example, we don’t say, ‘Oh, we can’t give you anything for pain because there may be some potential risk for the baby.’ We say, ‘Of course we have to treat your pain. That’s excruciating. We’ll give you this. There are some risks, but the risks are low and, of course, we have to treat the pain. ‘”

This lack of validation for mental health issues was echoed by Fiasconaro when she visited her doctor:

“I was referred to a high-risk obstetrician by my therapist. Although I was given the proper advice, that high-risk doctor ended up being very insensitive to my mental illness. She told me that everybody’s anxious and brushed it off like it was a non-issue. I understand that in the larger context of what she does and who she treats, my anxiety probably seemed like a low priority in the face of other, seemingly more threatening, physical illnesses.”

The ambiguous information provided by health professionals is representative of a lack of research on the risks of using medication during pregnancy.

Mary Blehar and colleagues, at the National Institutes of Health (NIH), state in the Journal of Women and Health that data are lacking on the subject. In a review of clinical research on pregnant women, they found that data obtained over the last 30 years, about which medications are harmful and which can be used safely, are incomplete. These gaps are largely due to the majority of information being based on case reports of congenital abnormalities, which are rare and difficult to follow.

During her pregnancy, Fiasconaro was able to slowly stop taking her anxiety medication. But halting treatment is sometimes not an option for women who suffer from severe, debilitating psychiatric conditions such as bipolar disorder, major depression, or schizophrenia.

We also need to improve access to information on pharmacological and non-pharmacological treatment options, including psychotherapy for women with mental-health problems during pregnancy. Without adequate guidance, the management of psychiatric conditions can leave many feeling alone and overburdened. These women often feel stigmatized and neglected by healthcare professionals. The development of supportive and informative relationships is necessary to their wellbeing.

As Fiasconaro put it:

“I had to be pretty focused and tenacious in finding information and then making the most informed decision for myself. I’m grateful I was able to do so, but again, I know every woman might not be in that position, and it can be very scary and confusing.”

–Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Pregnant Women Struggle with Managing Psychiatric Medication

00Anxiety, Featured news, Health, Pregnancy, Psychiatry, Psychopharmacology, Suicide November, 17

Source: Lauren Fritts at flickr, Creative Commons

It is often portrayed as a happy and exciting time but the experience of pregnancy can be mixed, with physical and mental complications dampening the experience.

In a recently released documentary, Moms and Meds, director Dina Fiasconaro addresses the challenges that she and other women with psychiatric disorders face during pregnancy.

Fiasconaro’s goal in making the documentary was to investigate women’s experiences with psychotropic drugs at this life stage. She became pregnant while on anti-anxiety medication and had difficulty obtaining clear information from healthcare professionals.

In an interview with the Trauma and Mental Health Report, Fiasconaro explained:

“I received very conflicting information on what medications were safe from my psychiatrist, therapist, and high-risk obstetrician. Even with non-psychiatric medication, I couldn’t get a clear answer, or from the pharmaceutical companies that manufactured them. No one wanted to say ‘that’s okay’ and be liable if something were to go awry.”

When she spoke to her maternal/fetal specialist, she was provided with a stack of research abstracts regarding the use of certain psychotropic medications during pregnancy. Although the information was helpful, it didn’t adequately inform her about the risks and benefits of medication use versus non-use.

One of the main questions Fiasconaro had was, should she continue using medication and risk harming her baby, or should she discontinue use and risk harming herself?

One of the women featured in Moms and Meds, Kelly Ford, contemplated suicide several times during pregnancy. When her feelings began to intensify, she admitted herself to a hospital. There, she was steered away from taking medication which led her to feel significant distress and an inability to cope with her declining mental health.

Elizabeth Fitelson, director of the Women’s Program at Columbia University, also featured in the documentary, believes there is a tendency for healthcare professionals to dismiss mental illness in pregnant women.

In the film, Fitelson said:

“If a pregnant woman falls and breaks her leg, for example, we don’t say, ‘Oh, we can’t give you anything for pain because there may be some potential risk for the baby.’ We say, ‘Of course we have to treat your pain. That’s excruciating. We’ll give you this. There are some risks, but the risks are low and, of course, we have to treat the pain. ‘”

This lack of validation for mental health issues was echoed by Fiasconaro when she visited her doctor:

“I was referred to a high-risk obstetrician by my therapist. Although I was given the proper advice, that high-risk doctor ended up being very insensitive to my mental illness. She told me that everybody’s anxious and brushed it off like it was a non-issue. I understand that in the larger context of what she does and who she treats, my anxiety probably seemed like a low priority in the face of other, seemingly more threatening, physical illnesses.”

The ambiguous information provided by health professionals is representative of a lack of research on the risks of using medication during pregnancy.

Mary Blehar and colleagues, at the National Institutes of Health (NIH), state in the Journal of Women and Health that data are lacking on the subject. In a review of clinical research on pregnant women, they found that data obtained over the last 30 years, about which medications are harmful and which can be used safely, are incomplete. These gaps are largely due to the majority of information being based on case reports of congenital abnormalities, which are rare and difficult to follow.

During her pregnancy, Fiasconaro was able to slowly stop taking her anxiety medication. But halting treatment is sometimes not an option for women who suffer from severe, debilitating psychiatric conditions such as bipolar disorder, major depression, or schizophrenia.

We also need to improve access to information on pharmacological and non-pharmacological treatment options, including psychotherapy for women with mental-health problems during pregnancy. Without adequate guidance, the management of psychiatric conditions can leave many feeling alone and overburdened. These women often feel stigmatized and neglected by healthcare professionals. The development of supportive and informative relationships is necessary to their wellbeing.

As Fiasconaro put it:

“I had to be pretty focused and tenacious in finding information and then making the most informed decision for myself. I’m grateful I was able to do so, but again, I know every woman might not be in that position, and it can be very scary and confusing.”

–Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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In Long-Term Care, Patient-on-Patient Violence on the Rise

00Aging, Anger, Cognition, Dementia, Featured news, Health, Trauma November, 17

Source: SpaceShoe at flickr, Creative Commons

A January 2016 Vancouver Sun article reported on 16 seniors in British Columbia (BC) killed in the last 4 years from violence in long-term care facilities.

While the mention of violence in nursing homes conjures images of support workers abusing patients, these altercations actually took place between patients. In each case, either one or both of the people involved suffered from a severe cognitive disability.

In one case, Karl Otessen, who suffered from dementia, had experienced multiple outbursts in which he would attack staff or rip off his clothes. He was on medication, and behavioral strategies had been implemented by the nurses, yet Otessen’s final attack resulted in a fractured hip, and he later died from related complications.

This sort of violence by a patient is rarely premeditated, making it difficult to prevent. The Alzheimer’s Society describes dementia patients as having difficulty describing their needs, leading to frustration and aggression. And dementia often causes decreased inhibition, resulting in violent and unpredictable outbursts.

In an interview with Global News, Sara Kaur, a support worker at a long-term care center in Mississauga, said that “Conflict can be prevented by understanding dementia and a senior’s inability to communicate simple needs.” By understanding the causes and symptoms of a mental-health disorder, a long-term care facility employee has a better chance of resolving potentially violent situations in a productive manner.

Many facilities have reported that they are under-staffed and under-equipped. But an article from Healthy Debate Canada, a publication focusing on the Canadian health care system, notes that:

“While we need more staff in long term care, just establishing an arbitrary number for staffing ratio isn’t the solution; it’s equally important to look at how much time staff are able to spend directly with residents, and whether they have the training they need to provide quality care.”

In Otessen’s case, although nurses tried to use a number of behavioural techniques to calm him, if a specific mental-health treatment plan had been in place, it’s possible that his violent behavior would have been reduced or eliminated entirely.

The Ontario Long Term Care Association, which examines progressive practices for long-term care homes, has suggested the use of specialized teams of nurses and support workers who are trained in identifying the triggers that lead to aggression in dementia patients. After identifying those triggers, the goal is to then create a solution to address the issue and protect other patients.

Using specialized teams may reduce the burden on regular support workers while also addressing the mental health needs of patients in an individualized manner. It is not enough to issue facility-wide policy changes to address behavioural issues when their causes vary from case to case.

The issue of patient-on-patient violence won’t be resolved without further attention. In Canada alone, there are currently over 750,000 individuals living with dementia, a number projected to double in 15 years. The growing elderly population must be considered when implementing budgetary and training changes to long-term care facilities.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

Copyright Robert T. Muller.
 

This article was originally published on Psychology Today

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In Long-Term Care, Patient-on-Patient Violence on the Rise

00Aging, Anger, Cognition, Dementia, Featured news, Health, Trauma November, 17

A January 2016 Vancouver Sun article reported on 16 seniors in British Columbia (BC) killed in the last 4 years from violence in long-term care facilities.

While the mention of violence in nursing homes conjures images of support workers abusing patients, these altercations actually took place between patients. In each case, either one or both of the people involved suffered from a severe cognitive disability.

In one case, Karl Otessen, who suffered from dementia, had experienced multiple outbursts in which he would attack staff or rip off his clothes. He was on medication, and behavioral strategies had been implemented by the nurses, yet Otessen’s final attack resulted in a fractured hip, and he later died from related complications.

This sort of violence by a patient is rarely premeditated, making it difficult to prevent. The Alzheimer’s Society describes dementia patients as having difficulty describing their needs, leading to frustration and aggression. And dementia often causes decreased inhibition, resulting in violent and unpredictable outbursts.

In an interview with Global News, Sara Kaur, a support worker at a long-term care center in Mississauga, said that “Conflict can be prevented by understanding dementia and a senior’s inability to communicate simple needs.” By understanding the causes and symptoms of a mental-health disorder, a long-term care facility employee has a better chance of resolving potentially violent situations in a productive manner.

Many facilities have reported that they are under-staffed and under-equipped. But an article from Healthy Debate Canada, a publication focusing on the Canadian health care system, notes that:

“While we need more staff in long term care, just establishing an arbitrary number for staffing ratio isn’t the solution; it’s equally important to look at how much time staff are able to spend directly with residents, and whether they have the training they need to provide quality care.”

In Otessen’s case, although nurses tried to use a number of behavioural techniques to calm him, if a specific mental-health treatment plan had been in place, it’s possible that his violent behavior would have been reduced or eliminated entirely.

The Ontario Long Term Care Association, which examines progressive practices for long-term care homes, has suggested the use of specialized teams of nurses and support workers who are trained in identifying the triggers that lead to aggression in dementia patients. After identifying those triggers, the goal is to then create a solution to address the issue and protect other patients.

Using specialized teams may reduce the burden on regular support workers while also addressing the mental health needs of patients in an individualized manner. It is not enough to issue facility-wide policy changes to address behavioural issues when their causes vary from case to case.

The issue of patient-on-patient violence won’t be resolved without further attention. In Canada alone, there are currently over 750,000 individuals living with dementia, a number projected to double in 15 years. The growing elderly population must be considered when implementing budgetary and training changes to long-term care facilities.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Expressing the Inner Voice May Bring Benefits

00Cognition, Featured news, Health, Optimism, Self-Help, Self-Talk November, 17

Source: geralt at Pixabay, Public Domain

An app called Dragon Anywhere allows people to talk to their smart phone with no word or time limits. Talking out loud with a piece of technology is socially acceptable these days, but what about when no one or no thing is listening?

Many associate hearing voices or talking to oneself with mental illnesses like schizophrenia. And because these behaviours deviate from the norm, they make people uncomfortable.

But might there be benefits to expressing inner voices out loud?

James McConnell, an American biologist and animal psychologist, has said that talking to oneself is psychologically healthy. And neuroscientist Jill Bolte Taylor, in her book My Stroke of Insight, argues that speaking out loud makes the mind more focused, and even calls it “a powerful instrument”.

In an article in The Quarterly Journal of Experimental Psychology, Gary Lupyan and Daniel Swingley discuss the functions of talking to oneself, also known as self-directed speech. Compared to thinking about a word (e.g., chair), hearing a word out loud can make us better visual detectors of that word in our surroundings. Speaking facilitates the search. This phenomenon is called the label feedback hypothesis.

It is unclear, however, whether the label feedback hypothesis can be applied to broader concepts like happiness. Can happiness literally be spoken into existence?

Proponents of positive affirmations think so, noting the benefits of repeating positive statements directed toward oneself. A study at the University of California, Los Angeles, showed that students who repeated positive affirmations produced fewer stress hormones. And another study published in the Personality and Social Psychology Bulletin by a team of researchers from Columbia, Berkeley, and Google found positive self-affirmations help those in low-power positions perform better.

Self-talk has other benefits as well. In a PsychCentral piece, Talking to Yourself: A Sign of Sanity, psychologist Linda Sapadin notes that giving voice to our goals focuses attention, controls emotions, and keeps distractions away.

In fact, this may be the best way for some individuals to get organized. While a number of people are visual learners, using calendars and to-do lists, it may be that others do better by simply speaking out loud.

Matt Duczeminski explains in his book 6 Benefits of Talking to Yourself (No, You’re Not Crazy) that talking through your thoughts helps distinguish big tasks from smaller ones, for example, getting organized by talking through a to-do list.

But not all self-talk is useful. In fact, talking about our failures and putting ourselves down can be quite harmful. As Sapadin puts it, “That kind of self-talk is worse than no talk at all.” And it can lead to a self-fulfilling prophecy, where we view ourselves negatively and act accordingly, attracting others who reinforce those beliefs.

The link between negative self-talk and depression is also quite strong. In fact, those who engage in more negative self-talk experience more stress and inferior health, both psychologically and physically. Language and cognition expert, Steven Hayes, says negative thoughts are like passengers in the backseat of the car you’re driving. You hear them, but your focus should be on the task ahead.

Another way of coping with negative self-talk is by giving your negative voice a name. Brené Brown, author of the New York Times Bestsellers The Gifts of Imperfection and Daring Greatly, calls her inner critic ‘The Gremlin’, making light of the little voice inside her head.

So… if you’ll listen to yourself, keep talking.

But be kind to you.

–Marjan Khanjani, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Expressing the Inner Voice May Bring Benefits

00Cognition, Featured news, Health, Optimism, Self-Help, Self-Talk November, 17

Source: geralt at Pixabay, Public Domain

An app called Dragon Anywhere allows people to talk to their smart phone with no word or time limits. Talking out loud with a piece of technology is socially acceptable these days, but what about when nobody else is listening?

Many associate hearing voices or talking to oneself with mental illnesses like schizophrenia. And because these behaviours deviate from the norm, they make people uncomfortable. But might there be benefits to expressing inner thoughts out loud in this way?

James McConnell, an American biologist and animal psychologist, has said that talking to oneself is psychologically healthy. And neuroscientist Jill Bolte Taylor, in her book My Stroke of Insight, argues that speaking out loud makes the mind more focused, and even calls it “a powerful instrument.”

In an paper in The Quarterly Journal of Experimental Psychology, Gary Lupyan and Daniel Swingley discuss the functions of talking to oneself, also known as self-directed speech. Compared to thinking about a word (e.g., chair), hearing a word out loud can make us better at visually detecting that thing in our surroundings. Speaking facilitates the search. This phenomenon is called the label feedback hypothesis.

It is unclear, however, whether the label feedback hypothesis can be applied to broader concepts like happiness. Can happiness literally be spoken into existence?

Proponents of positive affirmations think so, noting the benefits of repeating positive statements directed toward oneself. A study at the University of California, Los Angeles, showed that students who repeated positive affirmations exhibited lower levels of stress hormones. And another study published in the Personality and Social Psychology Bulletin by a team of researchers from Columbia, Berkeley, and Google suggests that positive self-affirmations help those in low-power positions perform better.

Self-talk has other benefits as well. In a PsychCentral piece, “Talking to Yourself: A Sign of Sanity,” psychologist Linda Sapadin notes that giving voice to our goals focuses attention, controls emotions, and keeps distractions away.

In fact, this may be the best way for some individuals to get organized. While a number of people are visual learners, using calendars and to-do lists, it may be that others do better by simply speaking out loud.

Matt Duczeminski explains in his book 6 Benefits of Talking to Yourself (No, You’re Not Crazy) that talking through your thoughts helps distinguish big tasks from smaller ones, for example, getting organized by talking through a to-do list.

But not all self-talk is useful. In fact, talking about our failures and putting ourselves down can be quite harmful. As Sapadin puts it, “That kind of self-talk is worse than no talk at all.” And it can lead to a self-fulfilling prophecy, where we view ourselves negatively and act accordingly, attracting others who reinforce those beliefs.

The link between negative self-talk and depression is also quite strong. In fact, those who engage in more negative self-talk experience more stress and inferior health, both psychologically and physically. Language and cognition expert, Steven Hayes, says negative thoughts are like passengers in the backseat of the car you’re driving. You hear them, but your focus should be on the task ahead.

Another way of coping with negative self-talk is by giving your negative voice a name. Brené Brown, author of the New York Times Bestsellers The Gifts of Imperfection and Daring Greatly, calls her inner critic The Gremlin, making light of the little voice inside her head.

So… if you’ll listen to yourself, keep talking. But be kind.

–Marjan Khanjani, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller

This article was originally published on Psychology Today