At this time, about 63% of Americans are part of the labor force.  Many employers offer programs designed to promote wellness and connect individuals with treatment options.  In addition, they promote the ability to handle and reduce stress. 
 
The CDC (Centers for Disease Control) reports that 1 in 5 adults (18 and older) reported suffering from mental illness in 2016.  Additionally, 71% reported headaches, feelings of being overwhelmed, or anxiety, all overt symptoms of stress. 
 
Mental health disorders are also closely linked to other physical conditions like heart disease, diabetes, and muscular problems.  Treating the physical and mental disorders separately will cost two to three times more than treating those without combination issues.  By combining the treatment plans, the savings could amount to $37 billion to $67 billion each year.  This means employers can reduce health care costs across the board and have healthier employees.
 
Further, the CDC says that employees with a high risk of depression had the highest health cost during a three year period following the initial assessment.  This includes others at risk from smoking and obesity.  Depression will affect performance at least 20% and affects cognitive abilities about 35%.  However, of those who report moderate depression only 57% receive treatment and for those with severe depression only 40%.
 
Excess stress and other mental health issues translates to negatively affecting:

• Job performance
• Productivity
• Interactions with other employees
• Communication
• Physical issues
• Functionality

 
Especially when mental and physical treatment plans are combined, employer sponsored wellness programs have proven beneficial to both the company and the employees.  Through a combined plan:

• Communications can be combined using the structures already in place
• Social networks become available
• Programs and policies are united
• Offering incentives for healthy behaviors
• Employers can track progress

 
As an employer you have some options.

• Offer self-assessment mental health tools
• Establish clinical screenings by qualified mental health professionals with clinical referrals as appropriate.  These can be free to the employee or offered at a reduced cost.
• Reduce co pays on depression medications
• Programs for lifestyle changes
• Host in-office programs to discuss stress reduction techniques
  • Breathing exercises
  • Meditation
  • Mindfulness
  • Focus improvement
• Treat disrespectful comments or actions as you would any other form of prejudice or discrimination
• Provide managers and supervisors with the tools to identify signs of stress and depression
• Give employees the opportunity to voice opinions

 
There are a number of insurers who provide plans to help implement a mental health program.  This can include videos, emails, education and other initiatives to help management and employees deal with the issues in the workplace.

​The CDC (Centers for Disease Control) estimates that 20% of adults over the age of 55 will experience some form of mental health disorder.  This can include some sort of cognitive issue (forgetfulness all the way to some degree of dementia), mood swings (generally depression), and anxiety. 
 
With depression as the most common form of mental disorder in seniors, it can affect social interactions and impair the ongoing treatment of other chronic conditions.  It is often dismissed as a normal part of aging or under treated. 
 
In reality, depression or other mental illnesses are not a normal part of the aging process.  Left untreated, it will affect the person's ability to function, lead to a poorer quality of life, and can actually slow the healing from physical illnesses and surgeries.
 
Mental health can easily decline after a serious illness like stroke or chronic conditions like Parkinson’s, arthritis, or cancer.  Medication can often play a part with drug interactions between prescriptions that are overlooked.  Older adults have needs that change including loss of friendships, relocating to other parts of the country, and changes in living conditions.  All of this needs to be considered during the treatment of mental health issues.
 
The good news is that older adults can be helped with the same success as those who are younger.  With some psychotherapy and anti-depressant medication, it is reported that 80% will recover.
 
Some symptoms you may want to watch for include:

• Sadness that persists.  If the person remains depressed longer than two weeks, keep tabs to see if it is improving.  If not, consider help with a mental health professional.
• Consistent sleep issues
• Trouble concentrating
• Everyone forgets things.  However if it becomes consistent, occurs more frequently, or in familiar surroundings, start paying closer attention.
• Over use of alcohol
• Confusion with the medication regimen

If these indicators accumulate or become more serious, it is a sign that the individual may need some professional help.
 
Many older adults continue to thrive even on their own.  Some habits that seem to help are:

• Exercising to the best of their physical ability.  This can include gardening in raised beds, walking, dancing, etc.
• Reading.  Joining with others to discuss books is a good way to stimulate mental agility.  Reading as a group event allows for socializing and forces people to read something they would not normally pick up.  There are a number of websites that offer discussion questions.  Check with your local public library for suggestions.

 
The health system in the United States offers Medicare that covers 80% of a physical health issue but only 50% for a mental health condition.  Fear of overspending can often impact an older adult's reluctance to seek mental health assistance.  Studies have shown that over 60% of older adults with a mental health issue will not receive the help necessary to bring them back to a stable head space.

As a concerned family member or as part of the medical team, it is critical to review prescriptions and over-the-counter medications.  This has a two-fold importance:  to be sure the prescribed medication is taken as ordered and to review for any interactions.  

Older adults often visit more than one medical professional.  Most older adults are quite capable of managing their medical care and are conscientious about complying with the medication instructions. However, when multiple prescriptions are involved, medical staff should carefully review all of them. Overprescribing is rampant for older adults who are more vulnerable for adverse effects.

As one ages, the liver becomes less able to break down medications and toxins.  Side effects can become more common if medications are not initiated and titrated slowly.  Lower doses may be utilized compared to younger adults.

At some point, cognitive abilities will fail and it will be necessary for someone else to take responsibility for the medications.
​

The chance of dementia increases with age: 

• 5% of all adults over 65
• 30% in adults in the mid 80s
• over 50% for adults in their 90s. 

While Alzheimer's is the most common form, there are other types of dementia to be screened for.
​
Symptoms like depression, anxiety, and insomnia are often overlooked as changes in cognitive abilities. Wandering will occur in over 90% of patients diagnosed with dementia and is the primary concern for their caregivers.  With supportive guidance to the patients and families, this condition can be dealt with reasonably and safely.  Of primary concern is safe judgment and appropriate living arrangements.

If you know someone who may need some help, don't delay, book an appointment today. 
 ​

A psychiatrist is a medical doctor (M.D.) who becomes specialized to effectively treat mental health issues. If you're wondering how to become a psychiatrist, there are a few vital steps to take.

Psychiatrists diagnose, treat, and help prevent emotional and behavioral disorders. To do this they will use a number of techniques or methods including therapy, interventions, and medication.
​

​To become a psychiatrist, you must first have a bachelor’s degree from an accredited institution. These degrees are often in the pre-med area, psychology, sciences, or a combination.  The degree does not have to be science related though.  Any degree with the appropriate pre-requisites will suffice.  Academic advisors can help develop a program of classes to keep you on track.

Psychiatrists are medical doctors, so it is necessary to start with the MCAT (medical college admissions test), get admitted to a MD or DO Program.  After graduating medical school (4 years), begins years of clinical residency.  For psychiatry, the standard general residency is four years.  Many psychiatrists will work additional years to sub-specialize.  

In order to practice any type of medicine, physicians must be licensed in the state(s) in which they will work.  This includes psychiatrists.  This license must be maintained in good standing which will include continuing medical education credits and renewal.

While in college and during residency, the individual usually settles on a specialty in which he or she wishes to practice.  The classes and clinical work should focus on those areas.  The choices include:

• Behavioral Science – This focuses on human behavior involving emotions, personality, and social actions.  It involves biochemical, pharmacological, and physiological personality actions and traits.
• Cognitive, Affective, and Behavioral Neuroscience – This deals with neurological components that explain how people think, remember, make decisions, and deal with emotions.
• Psychopathology – This deals with serious disorders and how they can be treated.  It also explores the legal and ethical elements of the treatments.  Frequently it delves into multicultural influences

Psychiatrists work with patients either in private practice, in a hospital, or other institutional setting.  Away from the patient, they review and record notes and assure that treatment protocols are being followed.  They may meet with patients' families, support groups, or other interested parties.

Specialization can involve illnesses like anxiety or sociopathy, or with a demographic element like children, older adults, or veterans.  In some cases the working hours are very regular, but it is not unusual for psychiatrists to work extended hours in some settings.
  
There are a number of historical issues that influence the treatment and those who are seeking help.  Psychiatrists help dispel myths and stigmas and promote healthy mental and physical outlooks for their patients.

The psychiatrist will also need to understand the brain and how it works.  People perceive and process information in different ways and the interrelationship of the nervous system and behavior becomes critical in many cases.

Communication skills are particularly important in psychiatry.  How someone explains their symptoms and digging out the details can make a big difference when it comes to making the correct diagnosis.  Better care is often provided after a thorough evaluation.

Why do we have stress? How is stress different from anxiety?   

Our bodies have evolved over millennia to protect us from dangers. Our nervous system deploys the fight-flight or freeze responses in order to protect us. In fight-flight, we feel amped up with adrenaline and increased heart rate and blood flow to our limbs. More oxygen flows through our lungs as our body prepares us for action. You may feel the urge to run away, pace, or hide. The ability to rationalize or make good decisions lowers. Action, rather than reflection, is the order of the day. The freeze response is our body’s “play dead” response and is often tied to trauma. It can lead to tingling sensations, chest tightness, difficulty breathing, and feeling overwhelmed or incapable. According to Stephen Porges, the originator of Polyvagal theory, dangers can be real (like the saber tooth cat outside your cave) or perceived as such by our bodies (a slideshow in front of your boss). This means that in individuals prone to anxiety, bodies respond to perceived threats as though the threats are real.
   
Fight, Flight, and Freeze responses can be triggered not only by stimuli in the environment but also sensations in our bodies, thoughts or even memories.  Anxiety is fear without obvious danger. Anxiety differs from helpful stress that enables us to survive, stay safe, or get things done. Anxiety reactions can make dealing with situations more difficult and can affect relationships and our ability to live life on life’s terms.  
  
What are panic attacks? How do panic attacks differ from anxiety?  
Anxiety is taken to another level in panic attacks. Panic attacks include marked sensations like butterflies in the stomach, sweatiness, muscle tension, racing heartbeat, and breathing difficulties. Individuals may feel faint or dizzy, hot, or cold.  The sensations of the panic attack are overwhelming and the individual may feel disconnected from surroundings. Panic attacks also include worries that one is ‘losing it’ or that illness or death are imminent. Chest tightness may be perceived as evidence for a heart attack. This fear often brings individuals to emergency rooms.  

Sometimes panic attacks occur after specific triggers, like an individual with agoraphobia having a panic attack in a crowded public space. Other times, however, the panic attack comes on without a known cause. According to the Diagnostic and Statistical Manual 5 (DSM-5), some individuals will experience waking panic attacks, in which they wake from sleep in panic. Panic attacks lead to more “fear of fear” as the individual avoids contexts and environments in which panic attacks might happen. 
  
What causes panic attacks?   

According to the Cognitive Behavioral model for Panic Attacks, the normal effects of stress on the body (like increased heart rate) are misinterpreted as a serious problem. Put simply, symptoms of stress are catastrophized as indications of serious health issues or impending death.   

When the individual experiences symptoms like shortness of breath and chest tightness, worst case-scenario thoughts lead to more anxiety, which worsen symptoms and create a negative feedback loop of ever-increasing seriousness. Symptoms can lead to thoughts like: Am I having a heart attack? and Am I going to die? Am I Losing it? However, if the individual experiences the same symptoms but does not perceive the symptoms to mean something more than they are (symptoms of anxiety rather than a heart attack, for example), then the negative feedback loop will be lessened.   

The uncomfortable and overwhelming experience of a panic attack creates fear of more panic attacks. Body sensations like dizziness after standing up quickly or breathlessness during exercise are then understood to be something worse. Drinking caffeine can lead to bodily reactions that the individual associates with panic attacks. For example, increased heart rate or shakiness could lead one to associate the symptoms with a heart attack or a loss of control.   

Emotions like excitement or anger lead to bodily changes (increased heart rate or labored breathing) that could be misattributed as well.  The covid-19 pandemic has led many to worry about infection. Some symptoms of Covid-19 that are shared with panic attacks are the sensation of chest tightness as well as labored breathing. This can lead to some individuals perceiving symptoms due to the virus rather than anxiety, which leads to catastrophic What Ifs.   
  
What populations have panic attacks?  

According to the DSM-5, females are twice as likely to have panic attacks than males. Panic attack incidences tend to appear during adolescence and early adulthood, peak in adulthood, and then decline by age 65 (APA 2013).   
  
How are panic attacks treated?  

Medications and talk therapy combined are one way to treat Panic Attacks. Cognitive Behavioral Therapy (CBT) is to date the most tested therapeutic approach to panic disorders. In treatment, CBT challenges patients to test assumptions leading to more moderate viewpoints. Therapists may use exposures that mimic symptoms present in panic in order to enable clients to sit with the discomfort and learn from it. This could include spinning until dizzy as dizziness is one common symptom. As the sensations experienced are normalized, catastrophic thinking may be less likely to heighten anxiety into panic. In short, as the symptoms that lead to a panic attack are better understood, anxiety will be less likely to be interpreted as a worst-case scenario. Other treatment recommendations may include keeping a panic journal.
​   
While CBT is currently the most researched therapeutic approach to panic disorders, there is no significant data to suggest that it is the most effective approach. When considering your own treatment, work with a mental health professional to understand what type of treatment or therapy would best fit your needs and personality. For example, individuals who gravitate to rationalizing and reasoning may respond well to CBT. Artistic individuals may respond well to Psychodynamic Psychotherapy. Those who are interested in Mindfulness based therapies may be a good fit for ACT. ​