Each year there is a focus for wellness and health in America. This observance for 2012 is September 17-23, 2012 with a variety of issues addressing all areas of health, yet for the purposes of this post, is to promote Mental Wellness and address areas of national concern. Integrated Medical and Mental Health services are best provided by a clinician trained in such services incorporating appropriate screenings and assessments for depression, anxiety, mood disorder, alcohol use, assessment of ADHD, quality of life, abuse, suicide, bipolar disorder, and other areas which affect wellness in an individual’s, couple’s, or family’s life. This blog will provide some areas for focus from defining mental health or wellness, parenting, teen issues, abuse, alcohol use, and general guidelines for prevention, such as recognizing suicide, a concern for military and their families, teen, and seniors.

In my previous work settings and during education, training, and teaching opportunities as a counselor and preventionist, Integrated Medicine and Mental Health guidelines were followed as directed through my professional trainings in National educational experience supported and provided by the US Preventative Task Force. Through work in Primary Care, University Clinics, Veterans Administration Community Based Outreach Clinics (VA-CBOC), and in my own private practice, standardized screenings were and continue to be a routine part of each visit.  Mental health clinicians often state their use of the Integrated Model, yet have not had the formal education and training to truly be involved in this specialized approach of client/patient care.  Therefore, mental and medical wellness, often go hand in hand for the total care of the patient, including medical management (annual physicals, laboratory studies, wellness programs that are age specific, and communication with the medical provider) and if mental health issues are involved, collaborating effectively with routine communication between both medical and mental health providers.  Wellness and prevention are issues are key. Beyond the mental health screening tools, often other assessments are found useful and can be incorporated successfully in the counseling and consultation sessions.

From Medline Plus, with latest update 3/2012, defines “mental health is how we think, feel and act as
we cope with life. It also helps determine how we handle stress, relate to others and make choices.
Like physical health, mental health is important at every stage of life, from childhood and adolescence
through adulthood”. Furthermore, the article cites “Staying mentally healthy is not always easy,
especially during tough times”. The resource outlines some prevention and wellness approaches, such as:

• Get support from family and friends
• Find time to take care of yourself and relax
• Have a healthy lifestyle, with regular exercise

This brief governmental resource notes that “it is also important to recognize when you may need help from a professional. Mental disorders are common, but treatments are available”.

The US Preventative Task Force has encouraged in Primary Care and/or Family Medicine for screening of women to involve depression, risk of abuse, with regard to teens screening to Depression to prevent increased use of alcohol and drugs, yet most importantly reduce risk of suicide, and for adults screening for depression.

As noted from government resources, screening for “interpersonal and domestic violence screening and counseling  should be provided for all adolescent and adult women. An estimated 25% of women in the United States report being targets of intimate partner violence during their lifetimes. Screening is effective in the early detection and effectiveness of interventions to increase the safety of abused women”.

Depression screening needs to be addressed in adolescents also. The USPSTF recommends screening of adolescents (12-18 years of age) for major depressive disorder when systems are in place to ensure accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal), and follow-up.  March 2009 depression screening for adults was recommended by the USPSTF when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up.

Recent data cite that one in ten adults in the US have diagnosed depression.  Further data shows who tends to be most depressed meeting the criteria for major depression:

• persons 45-64 years of age
• women
• blacks, Hispanics, non-Hispanic persons of other races or multiple races
• persons with less than a high school education
• those previously married
• individuals unable to work or unemployed
• persons without health insurance coverage

Similar patterns were found among persons with “other depression” with the two following exceptions: adults aged 18-24 years were most likely to report “other depression” as were Hispanics (instead of other non-Hispanics).

Depression is the most common mental health disorder in the United States among teens and adults.

• About 20 percent of teens will experience teen depression before they reach adulthood.
• Between 10 to 15 percent of teenagers have some symptoms of teen depression at any one time.
• About 5 percent of teens are suffering from major depression at any one time
• As many as 8.3 percent of teens suffer depression for at least a year at a time, compared to about 5.3 percent of the general population.
• Most teens with depression will suffer from more than one episode. 20 to 40 percent will have more than one episode within two years, and 70 percent will have more than one episode before adulthood. Episodes of teen depression generally last about 8 months.
• Dysthymia, a type of mild, long-lasting depression, affects about 2 percent of teens, and about the same percentage of teens develop bipolar disorder in their late teenage years. 15 percent of teens with depression eventuallydevelop bipolar disorder.
• A small percent of teens also suffer from seasonal depression, usually during the winter months in higher latitudes.

Teen depression can affect a teen regardless of gender, social background, income level, race, or school or other achievements, though teenage girls report suffering from depression more often than teenage boys. Teenage boys are also less likely to seek help or recognize that they suffer from depression, probably due to different social expectations for boys and girls – girls are encouraged to express their feelings while boys are not. Teenage girls’ somewhat stronger dependence on social ties, however, can increase the chances of teen depression being triggered by social factors, such as loss of friends. Resources are provided by  Mental Health: A Report of the Surgeon General [online], Kidshealth.org from the Nemours Foundation, “Understanding Depression” [online], Center for Mental Health Services, SAMHSA, A Family Guide, Keeping Youth Mentally Healthy and Drug Free, “Depression Hurts” [online], U.S. National Library of Medicine and National Institutes of Health, MedlinePlus Medical Encyclopedia, “Depression signs in Teenagers” [online], Mental Health: A Report of the Surgeon General, “Depression and Suicide in children and adolescents” [online], WebMD.com : Depression in Childhood and Adolescence [online], WebMD/The Cleveland Clinic “Seasonal Depression” [online]

For assessing your teen for depression, visit this site:
http://healthfinder.gov/prevention/ViewTopic.aspx?topicId=85

Tips on raising today’s teens
http://www.cdc.gov/parents/teens/index.html

Domestic violence is an ongoing problem nationally with recent data showing:

• Every 9 seconds in the US a woman is assaulted or beaten.
• Around the world, at least one in every three women has been beaten, coerced into sex or otherwise abused during her lifetime. Most often, the abuser is a member of her own family.
• Domestic violence is the leading cause of injury to women—more than car accidents, muggings, and rapes combined.
• Studies suggest that up to 10 million children witness some form of domestic violence annually.
• Nearly 1 in 5 teenage girls who have been in a relationship said a boyfriend threatened violence or self-harm if presented with a breakup.
• Everyday in the US, more than three women are murdered by their husbands or boyfriends.
• Ninety-two percent of women surveyed listed reducing domestic violence and sexual assault as their top concern.
• Domestic violence victims lose nearly 8 million days of paid work per year in the US alone—the equivalent of 32,000 full-time jobs.
• Based on reports from 10 countries, between 55 percent and 95 percent of women who had been physically abused by their partners had never contacted non-governmental organizations, shelters, or the police for help.
• The costs of intimate partner violence in the US alone exceed $5.8 billion per year: $4.1 billion are for direct medical and health care services, while productivity losses account for nearly $1.8 billion.
• Men who as children witnessed their parents’ domestic violence were twice as likely to abuse their own wives than sons of nonviolent parents.

The following list presents some national domestic violence statistics as provided by the NationalCoalition Against Domestic Violence (NCADV) web site:

• One in every four women will experience domestic violence in her lifetime.
• An estimated 1.3 million women are victims of physical assault by an intimate partner each year.
• Almost one-third of female homicide victims that are reported in police records are killed by anintimate partner.

National and state resources show South Carolina now ranks #7 in the nation for the number of women murdered by men accordingto the Violence Policy Center’s September 2011 report, “When Men Murder Women: AnAnalysis of 2009 Homicide Data.” (SC ranked #9 in the September 2010 report.) South Carolina Attorney General Alan Wilson identified domestic violence as the number onecrime issue in the state. According to the State Attorney General’s web site, more than 36,000 victims report a domestic violence incident to law enforcement statewide.

Therefore, efforts to assess for such areas of challenge in a woman and family’s life, efforts for wellness are not available until the woman leaves and an opportunity for growth and change occurs. The USPTF encourages mental health and medical professionals to ask those very difficult questions when women are seen for care in an effort to prevent on-going areas of concern which can present with anxiety, depression, PTSD, medical problems, and other areas of life challenge.

Causes, types, signs, and effects of Domestic Violence

http://www.helpguide.org/mental/domestic_violence_abuse_types_signs_causes_effects.htm

About Domestic Violence:
Review this Video
http://www.healthyroadsmedia.org/titles/EngDomV/EngDomV.htm

Handout:
http://www.healthyroadsmedia.org/english/Files/pdf/EngDomV.pdf

Women and Domestic http://www.womenshealth.gov/violence-against-women/get-help-for-violence/how-to-help-a-friend-who-is-being-abused.cfmViolence

At every opportunity, wellness and prevention efforts need to be foremost in the lives of clinicians, friends, relatives, and co-workers to guide and help those in need for a truly positive effort at a healthy and happy life.