Supporting Mental Health

Loneliness doesn't feel the same for everyone. Some people call it an ache. Others describe it as feeling empty or sad, or feeling disconnected or misunderstood. You may feel like you don't fit in, or that people just don't "get" you. And if you're feeling lonely, you might also be feeling depressed or anxious.

Some people feel lonely for a while, but then the feeling goes away. Others feel lonely for long stretches of time, or all of the time. This is sometimes called chronic loneliness.

Anyone can feel lonely. But people are more likely to feel lonely if they:

• Live alone or lack a daily companion

• Have health problems

• Have few social connections in their community

• Are unemployed or work from home or where most communication is electronic

• Don't feel like the relationships they do have are meaningful

Loneliness can also be more likely during certain stages of life. For example, people in their late 20s often have a lot of life changes happen as they begin adulthood. People in mid-life may start to see changes in their own health and the health of their friends. And people in the late stages of life may experience changes in where they live, a decline in health, and the death of friends or family members. These times in life can be difficult and lonely.

Loneliness can cause higher amounts of stress hormones in your body. This can have negative physical effects on your body. It can make it hard for you to sleep well, think clearly, and avoid illness. Feeling lonely can also make it feel hard to take care of your health, or to get help when you're having problems.

If you're lonely for a long time, your risk for certain health conditions may increase. These conditions can include:

• Depression and/or anxiety
• Heart disease/stroke
• Type 2 diabetes
• Dementia

It might seem overwhelming to think about how to find ways to be social or make more meaningful connections. But taking small steps can make a big difference. Here are some ideas to think about.

• Try volunteering. Look for organizations you're interested in that have needs you can help with. For example, animal shelters often need people to walk dogs or play with cats. And local food banks may need people to organize shelves or help visitors find what they need.
  
  
• Consider a meet-up group. Many cities have meet-up groups organized around activities, interests, or hobbies. You may find groups for hikers, caregivers, people who enjoy board games, or for those who just like drinking coffee. Websites like www.meetup.com can help you find groups near you.
  
  
• Think about getting a pet. If you can care for one, a pet can be an excellent companion. The type of pet you choose is up to you. Your local animal shelter can help you find a pet that fits your lifestyle.
  
  
• Shift negative thinking. When you feel lonely, it's common to have negative thoughts and emotions. But if negative thinking becomes a pattern, it can make you start to believe that the positive changes you're looking for aren't possible. If you can learn to catch negative thinking, you can learn to shift it.
  
  
• Consider seeing a counselor or other mental health professional. It can be hard to make changes in your habits or thinking on your own. And it can be scary to think about putting yourself "out there" in social situations. In some cases, loneliness may be part of a mental health condition, such as depression. If you feel like you need some support getting started, or if loneliness is making it hard for you to function, a counselor or other mental health professional can help.

Causes

Anyone who has gone through or witnessed a traumatic event can get PTSD. These events can include:

• Combat or being sent to a combat zone
• Military sexual trauma
• Terrorist attacks
• Sexual or physical violence
• Serious accidents, like a car wreck
• Natural disasters, like a fire or tornado
• Serious illnesses, like cancer
• Being in the intensive care unit (ICU)
• Living in or near a conflict

Many people who go through a traumatic event don't get PTSD. It isn't clear why some people get PTSD and others don't. How likely you are to get PTSD depends on many things, including:

• How intense the trauma was
• If you lost a loved one or were hurt
• How close you were to the event
• How strong your reaction was
• How much you felt in control of events
• How much help and support you got after the event

Having a history of mental health problems, substance use disorder, or childhood trauma may also increase your risk.

Symptoms

PTSD symptoms usually start soon after the traumatic event, but they may not happen until months or years later. They also may come and go over many years.

Symptoms include:

• Feeling upset by things that remind you of what happened.
• Having nightmares, vivid memories, or flashbacks of the event - you may feel like it is happening all over again.
• Avoiding places or things that remind you of what happened. You may even avoid talking or thinking about the event.
• Often feeling bad about yourself and the world.
• Feeling numb or losing interest in the things you used to care about.
• Feeling that you're always in danger, or worrying that something bad is about to happen.
• Feeling anxious, jittery, or irritated.
• Having trouble sleeping or keeping your mind on one thing.

PTSD symptoms can change your behavior and how you live your life. You may pull away from other people, work all the time, or use drugs, marijuana, or alcohol. You may find it hard to be in relationships. And you may have problems with your spouse and family.

Children can have PTSD too. They may have symptoms listed above and symptoms that depend on how old they are. As children get older, their symptoms are more like those of adults.

• Children who are younger than six may act our the details of trauma through play. Or they may have upsetting dreams and nightmares that may not be related to the details of the trauma. Parents may also notice behavioral and emotional changes, like extreme temper tantrums or avoiding people, places, and activities that remind them of the trauma.

• Older children and teens may view themselves in a negative way and engage in risky behaviors. And they may have behavioral problems that affect their performance at school and their relationships with friends.

If you think you or your child has PTSD, talk to your doctor or a counselor. Treatment can help.

There is no medical test that can diagnose PTSD. Your doctor will ask about symptoms, how long you've had them, and how much they affect your daily activities.

Your doctor may also ask about:

• The event or events that led to your symptoms.
• Traumatic events in your past, including those from childhood.
• Whether anyone in your family has a mental health problem.
• Whether you have any suicidal thoughts or thoughts of harming others.

You may also have a physical exam or lab tests to check for signs of injury or other medical problems that my be causing your symptoms. Your doctor will also check to see if you have any other mental health problems, like depression or substance abuse disorder.

Your doctor may want your spouse, partner, or close family member to come with you. This person can help your doctor understand what you've been going through.

Medicines and counseling are used to treat PTSD. Treatment can help you feel more in control of your emotions, have fewer symptoms, and enjoy life again.

Counseling—there are many types of therapy that focus on trauma to help you get better. Most therapies use cognitive-behavioral (CBT) techniques to help you understand your thoughts and learn ways to cope with your feelings.

• In prolonged exposure therapy, you talk about the traumatic event as if it were happening again. You may also be exposed to places or things that are related to the event. You do these things until you have less fear.

• With cognitive processing therapy, you learn to change negative emotions and thoughts related to the trauma.

Antidepressant Medicines—in particular, selective serotonin reuptake inhibitors (SSRIs). They can help with many PTSD symptoms. SSRIs include:

• Fluoxetine
• Paroxetine
• Sertraline

You may need to try different types of treatment before you find the one that helps you. Your doctor will help you with this. These treatments may include other types of medicines and other forms of counseling, such as group counseling. If you have other problems along with PTSD, such as overuse of alcohol or drugs, you may need treatment for those too.

PTSD Support

When you have PTSD, social situations can bring up a lot of emotions. For example, you may feel on edge, anxious, or angry. Because of this, you may withdraw from those who are closest to you to cope with your symptoms. This can make it hard to connect with your community or accept support from those who care about you. 

Here are things you can do to help yourself, your family, and your community better understand and deal with PTSD:

• Know when to get crisis help—Sometimes you need help right away. This may be the case when you've had thoughts about suicide or if anger turns to rage.

• Let your friends and family know how they can help—They play an important part in your recovery from PTSD, but you also have to help them. This means talking to your family and friends about PTSD and what it does to you, talking to your kids and being sure they know they aren't to blame, and talking about triggers (triggers are places, sounds, and sights that can cause symptoms. They can be locations, social events, or holidays).

Remember that life transitions (even positive ones such as getting married, having a baby, or starting a new job) can cause stress and result in more PTSD symptoms.

Self-Care

It's important to take care of yourself when you have PTSD. Here are some things that you can do.

• Learn about PTSD—This can help you better understand how and why it affects you.

• Accept and cope with your symptoms in a positive way—It may be tempting to avoid or ignore your symptoms. But when you accept what the traumatic event did to you, you can take steps to help you get better. And you may find that you feel even more in control.

• Develop and maintain healthy habits—Get regular exercise and enough sleep, reduce stress, and be sure to eat a balanced diet.

• Identify and talk about your triggers—Certain places, people, or experiences may remind you of the trauma. You may withdraw or avoid those things to prevent new or worse symptoms. Share these triggers with your doctor. Your doctor may be able to help.

• Recognize and accept your anxiety—When you are in a situation that makes you anxious, say to yourself: "This is not an emergency. I feel uncomfortable, but I am not in danger. I can keep going even if I feel anxious."

• Find things that help ease your memories and reactions—Consider channeling your emotions into activities or sports, painting or writing, or a rewarding job.

• Identify your beliefs to keep you balanced—PTSD can cause a spiritual crisis. You may start to question your own beliefs and values and ask yourself why war or disasters happen. If this happens to you, talk to a family member, friend, or spiritual adviser. Consider spiritual study, prayer, or meditation.

• Avoid negative coping skills—These are certain ways you may try to deal with your symptoms and problems that cause more harm than good. They're quick fixes that don't improve your situation in the long run. They include drinking too much, avoiding others, and lashing out.

• Seek support—You may want to learn more about PTSD or talk with others who have PTSD. You need people who understand what you're going through and will help you and care about you. This is your support network. Support takes many forms. You can find it in seminars and groups led by professionals, in groups made up of others with PTSD, and in your relationships with family and friends.

Get help right away if you or someone you know talks about suicide, self-harm, or feeling hopeless.

Post-traumatic stress disorder (PTSD) can be a challenge for you and your family. Your family may find it hard to accept some of the changes PTSD can bring to your life. By talking and supporting one another, you and your family will be better prepared for these changes.

Family Support

Your family is an important part of your recovery. They can be there to listen and to help you through rough times. It's also important that you help your family understand PTSD. They may not always know how to respond when they see you hurting. They may feel scared, sad, guilty, or even angry about your condition. Talking about PTSD can help you and your family cope. Talk about your symptoms and what triggers them. Discuss different treatments and how they can help you recover. When you open up, your family can better understand what you're going through. Family therapy can help. This is a type of counseling that involves your whole family. A therapist can teach you how to work through problems and communicate better.

Talking with Your Kids About PTSD

Teaching your kids about PTSD is important. They may not understand why you're feeling bad or why you get angry sometimes. This can be scary for kids at any age. They also may blame themselves for things that aren't their fault. Make sure your kids understand that they aren't to blame for your PTSD.

When talking with your kids about PTSD:

• Be honest and listen to what they have to say.
• Tell them it's okay to ask questions. Ask them how they're feeling and let them know that their concerns are important.
• Make sure they feel safe, secure, and loved. They may be afraid that something bad is going to happen.
• Provide information about PTSD. Let them know what it is, how you got it, and how you can recover.
• Encourage a good support system of friends outside your family. Get them involved in school activities or youth programs in the community.
• Don't promise that your PTSD is going to go away soon. Instead, talk about how treatment can help you feel better. It's okay if you don't have all the answers.
• Be as positive as you can. Your kids will notice how you react in difficult situations, which can influence their reactions.

Triggers

Things that suddenly remind you of your traumatic event are called triggers. Triggers can bring up stressful feelings or cause you to have flashbacks, which means you feel like you're reliving the event all over again.

Trying to avoid triggers is a common reaction. It's normal to stay away from things that cause you stress. Because of this, you may feel like you can't do the things you used to enjoy. This may be hard on you and your family.

Talk with your family about your triggers. They need to know what causes you stress. By being aware of your triggers, your family can help you find ways to cope with them.

Some common triggers include:

• Places, social events, or even smells and sounds. For example, smoke may trigger memories in someone who was hurt in a fire. Or a car that backfires may remind a veteran of gunfire.
• Being around others who were involved in your traumatic event. This may happen when veterans have a reunion.
• The anniversary of your traumatic event. Try to plan enjoyable activities on and around the anniversary date. It may help to be with friends or family.

Coping with the Holidays

Big holidays like Christmas and New Year's can be stressful. The holidays can be a painful reminder of past times when life seemed better. Big groups of family and friends are often part of the holidays. This may be stressful because:

• Groups tire you out or make you feel overwhelmed.
• You feel pressure to join family activities when you're not up for it.
• You feel like you have to act happy when you're not.

Your loved ones also might ask you questions about your life or about PTSD. You may not feel comfortable answering these questions. Keep in mind that your family may feel some of the same pressures.

You can cope with holiday stress by:

• Setting limits. Don't join activities for longer than you can handle. You can choose when you want to be a part of the group.
• Taking breaks. Go for walks or set aside a place where you can be alone for a while. This can keep you from feeling overwhelmed.
• Getting plenty of rest. Take naps if you feel like you're not getting enough sleep at night.
• Talking with your family about how you feel. Your family can help you. Be honest with them about your stress.
• Not drinking too much. Alcohol may make your symptoms worse or cause you to have problems with your family.

For Family Members

If you are the spouse or family member of someone with PTSD, here are some tips for helping your loved one during the holidays:

• Accept the mixed feelings your loved one may have about the holiday.
• Respect and support your loved one's choices about being involved in the celebration.
• Plan ahead for how you will cope with stress. This may mean talking about how your loved one will answer questions about PTSD, or deciding how long you will stay at a party.
• Remember to take care of yourself. Do things for yourself to relieve stress.
• Keep your expectations realistic.

Click here to view a video about PTSD Signs and Symptoms.

If you care about someone with PTSD, here's what you can do to help.

• Learn what you can about PTSD—The more you know, the better you can understand what your loved one is going through.

• Encourage contact with family and close friends—A support system will help your family member get through hard changes and stressful times.

• Learn how to deal with anger—Both you and your loved one may be angry at times.

• Learn the best way to talk with your loved one—When a loved one has PTSD, communication can be hard. These tips may help:'
  • Be clear and to the point
  • Be a good listener
  • Put your feelings into words
  • Don't give advice unless you are asked

   

• Offer to go to the doctor with your loved one—You can help keep track of appointments and you can be there for support.

• Be open to talking—Tell your loved one that you want to listen and that you also understand if they don't feel like talking. Give your loved one space, but let them know you're there to help.
  •  If the person doesn't want your help, keep in mind that withdrawal can be a symptom of PTSD.
  • A person who withdraws may not feel like talking, taking part in group activities, or being around other people.

   

• Stay active—Take a walk, go for a bike ride, or do some other physical activity together. Exercise is important for health and helps clear your mind.

• Take care of yourself—Take time for yourself, and have your own support system.

Martin’s Point Health Care contracts with Behavioral HealthCare Program (BHCP) to manage the behavioral health network and perform authorizations related to behavioral health care.

BHCP is a Maine-based benefits management program which is part of the MaineHealth Accountable Care Organization. They are dedicated to helping provide quality care. BHCP coordinates a network of mental health services in Maine, New Hampshire, Vermont, Pennsylvania and New York. Using their knowledge of our region and our providers, they can guide you to the most suitable provider at the most appropriate level of care. 

Their website, https://www.bhcp.org/, has many features including a current provider search function for members and providers and online treatment plan submission.

A hospitalization is a major and sometimes life-changing event in your life. The 30-day period following the discharge can be hard—physically and emotionally.  Studies have shown that, after hospitalization, nearly half of discharged patients will experience at least one issue that could lead to a readmission within 30 days. We want to prevent that from happening.

After you have been hospitalized, you may receive a call from the hospital, your provider’s office, or someone from the Martin’s Point Behavioral Health Care Management team. 

The Health Care Manager will ask questions about your stay, as well as: 

• Review your medications and discharge instructions

• Provide education on signs and symptoms of ongoing health problems

• Help you navigate the health care system

• Help connect you to community resources

• Confirm follow-up office visits with your provider(s)

Things you can do to prevent a re-admission: 

• Attend a follow-up visit with your provider(s) soon after discharge to review your treatment plan and your medications.

- If you have questions, create a list to ask at the appointment.

- If you are on several medications, either write down the names, dosages, and frequency or bring the medications with you to the appointment.

• Pick up all new medications at the pharmacy and take them as prescribed. Continue taking medications prescribed prior to your admission and continued after discharge. Discontinue medications no longer on your list.

• Be aware of warning signs and symptoms related to your health condition so that you can seek guidance from your provider(s) earlier rather than later.  Request additional education and guidance from your provider(s).

• If you have family or friends who are able and willing to help, accept their support until you begin to feel better.

• Pay close attention to how you feel and communicate anything concerning to your provider(s). 

If you need additional assistance coordinating your care after discharge, Martin’s Point offers a care management transitions of care program that can help! Feel free to call 1-877-659-2403.

A person who has a medical condition or needs may also have a behavioral condition or needs and vice versa.

Your primary care provider (PCP) and your behavioral health care provider have different areas of expertise and it is very important to maintain visits with both. Open communication among all your providers is important to be sure you are getting the best care and assistance you need and to avoid medical errors or misses.

To keep all your providers informed about your care, your provider may ask you to complete a medical release form for the purpose of sharing your records.

Monitoring

If your child or adolescent is aged 17 or under and is taking two or more antipsychotic medications listed below, they can have an increased risk for developing serious health complications associated with weight gain, diabetes, and high cholesterol.

Given these risks and the potential for lifelong consequences, they should have annual blood sugar and cholesterol testing to ensure appropriate health management.

Medications for the treatment of antipsychotic disorders include:

*Please contact the doctor who prescribes your child’s medication to request labs such as cholesterol and blood sugar levels if this is not already scheduled.

Monitoring

If your child is between 6-12 years old and has been newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication, they should have three follow-up care visits with the prescribing doctor within a 10-month period to assure the medication is working appropriately and there are no adjustments needed:

• One within 30 days of when the first ADHD medication was filled

• If the child remains on the following medication over six months, they should have at least two follow-up visits within nine months.

Medications for the treatment of ADHD include: