Mental Health

Although primary care doctors frequently see patients with depression, they typically do less to help those patients manage it than they do for patients with other chronic conditions such as diabetes, asthma or congestive heart failure, a recent study found.

That is important because research has found that it can be good for patients’ health when physician practices have procedures in place to identify and provide targeted services to patients with chronic conditions and to encourage patients to get involved in actively managing their own care.

But physicians were less likely to use those “care-management processes” with patients who have depression than with those who had other chronic conditions, according to the study in the March edition of the journal Health Affairs.

The study analyzed data from the three largest national surveys of physician practices to determine the extent to which they employed five care-management processes between 2006 and 2013. The five processes studied were patient education; patient reminders about preventive care; nurse care managers to coordinate care; feedback on care quality to providers; and disease registries that identify patients with chronic conditions, enabling practices to be proactive about their care.

The results were particularly dismal for depression. In the 2012 to 2013 time frame, physician groups on average used fewer than one (0.8) of the care-management processes for their patients with depression, and that level of use hadn’t changed since the 2006 to 2007 period, according to the study. In contrast, practices used 1.7 diabetes care-management processes on average overall with their patients between 2012 and 2013. Among only large practices, the use of diabetes care-management processes grew significantly over time, to 3.2 in 2012-2013.

The use of care-management processes for patients with congestive heart failure and asthma was 1.1, a statistically significant difference compared with their use in patients with depression. Still, Dr. Tara F. Bishop, the lead author of the study and an associate professor in the department of health care policy and research at Weill Cornell Medical College in New York City, said those measures were also considered low.

The depression results were not surprising, said Bishop. 

“There’s a growing understanding that depression and mental illness generally are being undermanaged [in primary care settings] and we’re not using the tools that are available,” she said.

It may be that physicians are less comfortable managing psychological illnesses than they are physical ones, but size may also matter, she said. Primary care practices that are part of academic medical centers or integrated health care systems may be better equipped to adopt care-management processes, while smaller, independent practices have trouble marshaling the staff and other resources necessary to put comprehensive care-management techniques to use.

Read original article – March 25, 2016
Study: Primary Care Doctors Often Don’t Help Patients Manage Depression

The Bering Strait School District has joined a nationwide effort to encourage healthy relationships and end dating violence among Native youth.

The NativeLove Project raises awareness through social media and school programs. Students in White Mountain are producing a video with local interviews to add to the conversation.

More than 40 percent of Native children experience multiple acts of violence by age 18. That’s according to the National Indigenous Women’s Resource Center in Montana. The organization launched the NativeLove Project to get young, indigenous people talking about healthy relationships.

Kelly Rae Martin is a teacher in White Mountain. She said it’s important her students join the discussion, given Alaska’s high rate of domestic violence.

“It doesn’t get talked about very much,” said Martin. “It doesn’t get shared or discussed, so I think it’s really important people start seeing that it is OK to talk about it. It is OK to address it and try to work through it, so that some healing can happen.”

To promote that healing, her students are producing a video. Anna Prentice is a high school senior, and she interviewed classmates and community members for the project.

“We asked a lot of questions like: What to you is Native love? How do you know that people are showing you love? And then, what do you think an ideal world would be?” said Prentice.

For the young students she interviewed, Prentice said love means helping clean up around the house or taking their siblings out four-wheeling. For elders, she said cooking and sharing food is a favorite way to express their love.

“Everyone thinks it’s happiness, respect for one other, and just family things to do with love,” she said.

Prentice also participated on the other side of the camera. She said she was happy to share her experience with dating violence, even though it was hard.

“For me, the topic is personal,” she said. “I feel like everybody needs to know how we can prevent that from happening, especially with the younger generation. I’ve been through it all, I’ve seen it and to me, it’s very important they know what love is and what isn’t.”

With interviews complete, Prentice and her classmates are now editing footage for the video. They’ll screen the final product soon for the White Mountain community. Other BSSD schools are also joining the NativeLove Project. Students around the district are creating a quilt with artwork centered on healthy relationships.

The Alaska Network on Domestic Violence and Sexual Assault helped organize the training, which was taught by Gene Tagaban, a Tacoma, Washington resident originally from Juneau.

Tagaban said the class is meant to help stop the cycles of violence that are prevalent in many Alaska communities.

“It’s about teaching men to be mentors, and getting men involved to stop the violence, domestic abuse, the suicides, the hurts, the pain,” he said. “For so many years, women have been at the forefront of this movement, of wellness, of health. And as men, we need to be standing right beside the women together, to stop the violence, to stop this epidemic that’s going through Alaska.”

Compass is part of the Alaska Men Choose Respect effort. Participants talked about how to start conversations and lead healthy lives, both in their own homes and in the community.

Tagaban said the group discussed several topics, including respect for self and others, communication and conflict resolution.

“Ultimately, what does it mean to become a man, but even higher than that: what does it mean to become a human being,” he said. “… it’s about learning how to express ourselves in that way and share our stories, tell our stories, learning about where our stories came from. And learning about even, not only our empowerment but the pains, the hurts, the trauma and healing from that. It is about healing. But it’s about men working together to bring that healing together.”

Throughout the gathering, participants shared their own stories and learned how to facilitate those sorts of discussions. After the training, Tagaban hopes they’ll take what they’ve learned back out into the community, whether that’s doing presentations in schools or living a good life and leading by example.

“And I hope that they’ll go out and live a good life, a life of awareness, a life of empowerment, so that in their circles that they can influence those in a good way,” he said. “And maybe some of them will use it to start making presentations, talking about these things, and starting the conversations… that they’ll maybe go to schools and start talking about things, or just in the neighborhoods, in the stores that people would just see them living that powerful life that good life, and then passing it on in their own families, and teaching in their own families, or the schools.”

After Monday morning’s incident in which a Juneau woman took her own life at the entrance of the Dimond Courthouse, we talked to local specialists about suicide issues.

James Gallanos is a prevention program coordinator with the Alaska Department of Health and Social Services’ Division of Behavioral Health.

In an interview that aired in three parts on KTOO’s Morning Edition program, Gallanos talked about the Careline Alaska, safe messaging by the media during coverage of a public suicide, how to talk or comfort those who may have witnessed a suicide, and what to listen for if a family member or friend is contemplating suicide.

Safe messaging

Gallanos said safe messaging by the media includes avoiding images which show the method or location of a suicide.

“How can we cover a story while, at the same time, use words and phrases that are less harmful, more hopeful and helpful for people affected by the loss,” Gallanos said.

 

Making sense of suicide

Gallanos said it’s not uncommon for everyone to experience some degree of shock while responding to a suicide.

“The biggest question we have around suicide is ‘Why? Why would someone take their life?'” Gallanos said. “That makes it difficult because that’s why suicide is such a profound loss. We don’t always have the answers to why someone takes their life.”

(Since this interview with Gallanos on Tuesday, KTOO was able to determine that a group of children believed to be in the vicinity of the Dimond Courthouse during Monday morning’s incident was too far away to actually see what had happened.)

 

“Nobody cares about me. I won’t be around any longer to worry about it.”

Gallanos said many of those contemplating suicide are unlikely to say it directly, and many of the indications will come in coded language or messages.

“Maybe it’s important that I invite the question about if they’re experiencing suicidal thoughts or thinking about killing themselves,” Gallanos said. “Very difficult question to ask, but very critical and important question to ask.”

Update | 4:11 p.m.

Juneau police have identified the woman who shot herself this morning as 34-year-old Miranda Ellen Davison.

Davison was in the news last year after taking a hatchet to flat screen televisions at Juneau’s Wal-Mart.

At a related court hearing in May, prosecuting attorney James Scott spoke to her state of mind. The Juneau Empire reported Scott said,

“The state feels as though it is highly likely that Ms. Davison’s … alleged actions were caused because she suffers from an emotional or psychiatric disorder.”

Court records show Davison’s public defender asked for a competency evaluation. That evaluation is confidential.

Davison eventually pleaded guilty to one misdemeanor charge in the case.

Her body will be sent to the State Medical Examiner Office in Anchorage for an autopsy.

Original story | 12:56 p.m.

A gunshot that rang outside the Dimond Courthouse late this morning has left one woman dead and rattled nerves in the heart of the Capital City.

Reports of the shooting came in just after 11 a.m. today. Police think the woman, who they’ve yet to identify beyond middle-aged and white, shot herself in the chest with a handgun. No one else was hurt.

Several first responders performed what appeared to be chest compressions on the woman.

At the scene this morning, Sgt. Chris Gifford said it appeared a single gunshot was fired.

“We don’t know who it is. And so we’re trying to talk to everybody that saw this and do as thorough an investigation as possible. … And we get more information out there as soon as we know,” Gifford said.

The courthouse, which has a security checkpoint and a metal detector at its public entrance, took additional security measures after the shooting. Across the street in the Capitol, lawmakers in the House cleared their chambers as the news spread. Several nearby schools also took additional security measures.

Authorities cordoned off Fourth Street between the Dimond Courthouse and the Alaska Capitol after reaching the scene. The street was reopened before noon.

After the woman was taken to the hospital, blood was visible just outside the main doors to the courthouse.

Police are seeking eyewitnesses to help with the investigation. Contact the Juneau Police Department at 586-0600.

Alaska’s Careline at 1-877-266-4357 provides round-the-clock crisis counseling.

Elizabeth Jenkins, Andrew Kitchenman, Jennifer Canfield, Matt Miller and Jeremy Hsieh contributed to this report. This is a developing story, check back for updates. 

Alaskans giving public testimony this week on the House’s budget proposal oppose cuts to many areas.

The Republican-led majority released a budget proposal this week that included $145 million more in cuts than Gov. Bill Walker’s budget. It would reduce spending on everything from public libraries to senior benefits.

Roughly 100 people testified Monday and Tuesday on the budget.

The cuts include reduced grants to mental health and addiction treatment programs.

Residents also opposed cuts to prekindergarten, public libraries and the University of Alaska. And they said they want the House to avoid cuts to senior benefits and public broadcasting.

Juneau resident Kara Nelson directs Haven House, a faith-based home for women leaving prison. She opposed cuts to behavioral health grants.

“There are over 120 people today alone that died from an accidental overdose in our nation,” Nelson said. “That is an Alaska Airlines flight that died every single day, and that was in 2015. And so I urge you that we are trying to lessen the beds in our prisons, but we have no supports already to support the well-being of our people.”

Elizabeth Ripley, executive director of the Mat-Su Health Foundation, shared her concerns over behavioral health cuts.

“Cutting behavioral health grants will only reinforce the current system that drives people to seek care in the emergency room,” Ripley said. “A 2013 data analysis shows that Mat-Su Regional Emergency Department had five times the number of visits than our community mental health center. These visits to one hospital cost Alaskans $23 million in 2013, not including doctor, EMS or police costs.”

Kodiak Public Library Director Katie Baxter urged House Finance Committee members to restore funding for the Online With Libraries, or OWL, program. It funds high-speed internet connections and receives federal funds — known as E-Rate — that match state contributions.

“I am here to urge you to restore the governor’s funding of $761,800 to restore the OWL internet connectivity program,” Baxter said. “This program is an intricate system that is cost efficient that involves local and federal funding. By eliminating the OWL program as the house subcommittee has done, now we are leaving federal E-Rate dollars on the table. And I for one really don’t want to do that.”

The House Finance Committee will hear more public testimony Wednesday and Thursday.