Normal holiday stressors can be compounded when we miss someone we have lost or are impacted by other hardships. This year, the sense of loss – of a loved one, financial security and a sense of “normal” – has touched many of us due to the COVID-19 pandemic. As we’re making plans to celebrate the holidays in unprecedented times, let’s take a break with Magellan’s Dr. Shareh Ghani as he discusses ways to address feelings of loss, practice self-care and make the most of this holiday season.

Magellan: Dr. Ghani, thank you so much for being here with us to share your many years of expertise in helping patients with behavioral health needs. Our first question: Is it possible to enjoy the holidays when we are experiencing the pain of losing a loved one to COVID-19 or something else?

Dr. Ghani: Thank you for having me. The pandemic has taken a toll on our community as we have lost loved ones prematurely, and we continue to experience sustained emotional pressure as COVID continues to spread. It is vitally important that we celebrate the holidays, exchange gifts and cards, gather virtually, and celebrate life. Spreading love and joy in these trying times will bring much-needed respite to the brain and body and boost our immune systems.

Magellan: How can we overcome feelings of worry and anxiety due to a job loss or other financial insecurity during this holiday season?

Dr. Ghani: Losing a job obviously leads to worry, anxiety and even questioning one’s own competence. The pandemic has helped many people shift focus to the “must haves” and not worry about the “nice-to-have” luxuries in life. Some are paying more attention to their health and fitness, minimizing spend, and planning for the future. Having a good strategy will help reduce the anxiety of uncertainty. If need be, talk to a therapist.

Magellan: Do you have any tips for people experiencing distress over not being able to celebrate the holidays in the way they may have in the past?

Dr. Ghani: One needs to evaluate the reason why we are changing our lifestyle. Social distancing helps stop the spread of the virus. Those who take this threat to our lives lightly may experience distress. Understanding the gravity of the situation alleviates it. We are celebrating in smaller groups so we can defeat the virus and return to our old ways of celebrating holidays safely. Think of it as a form of delaying gratification for better outcomes.

Magellan: What is your general advice for anyone who is experiencing loss to feel better and be able to experience joy this holiday season?

Dr. Ghani: Losing loved ones is a part of our life cycle. Human beings are resilient beings. Remember – those that we have lost would have wanted us to be happy. We should think about the happy moments we shared with those that are not here today and celebrate life.

Magellan: Why is it important to practice self-care and be an advocate for one’s own mental health?

Dr. Ghani: Good eating habits and physical exercise are key to physical and emotional wellness. Sleeping at least eight hours a day, hydrating well and experiencing joy and happiness are also important. All these things help with mental health. Relationships, family, helping others and being grateful add to a joyous life experience.

We all need to be cautious as COVID-19 continues to spread across the United States. However, people with type 1 or type 2 diabetes need to be extra careful. According to the CDC, the risk of catching the virus isn’t greater for those with diabetes, but the symptoms could be worse. That’s especially true if diabetes is not well managed or controlled. Here are some ways to reduce your chance of contracting COVID-19 if you have diabetes.

• Keep your distance
  The best way to avoid getting sick is to stay home. However, we know that is not always possible. If you do go out, stay 6 feet away from other people and wear a face mask.
• Use good hygiene
  It’s important to wash your hands often to prevent the spread of infection. Be vigilant about washing your hands before you give yourself a finger stick or insulin shot. Also, remember to clean each area first with soap and water or rubbing alcohol.
• Keep your blood sugar under control
  When you have diabetes, your blood sugar levels may be consistently high. Many parts of your body can be affected or damaged by too much sugar including your immune system, which puts you at greater risk of infection.
• Keep moving
  Your lifestyle may have changed since the COVID-19 pandemic. You may be working remote, going out less, or avoiding the gym. However, moderate activity is still very important to your overall health and management of diabetes. Yard work, brisk walking, cycling, or in-home workouts are all safe ways to get exercise.
• Supportive family and friends
  To protect you, your friends and family should take extra precautions. Some of these may include washing their hands more often, not sharing personal items, and wearing a face mask if you’re in the same room.
• Stay positive
  Staying positive and focusing on those circumstances you can control is always a good foundation for health. Mindfulness activities and gratitude will go a long way to maintaining wellness.

If you do start feeling sick and have COVID-19 symptoms such as a dry cough, fever, or shortness of breath, call your doctor.

Source: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

The Child and Adolescent Needs and Strengths (CANS) assessment is a multi-purpose tool developed for children’s services to support decision making, including level of care and service planning, to facilitate quality improvement initiatives, and to allow for the monitoring of outcomes of services. It is one of the tools in the Transformational Collaborative Outcomes Management (TCOM) framework, developed by Dr. John S. Lyons, consisting of a set of Guiding Values and Core Principles, all centered on how to provide the best and most support to all those in need.

I am often asked “How does managed care use the CANS?” Managed care organizations, like Magellan, are increasingly using clinical decision support tools and implementing value-based programs; the CANS offers a common language to look at resource needs and make the balancing of resources more transparent.

John Lyons frames the use of the CANS as part of “Five Key Decisions”: access, engagement, appropriateness, effectiveness and transitions. This framework on CANS use may be helpful for understanding how managed care uses decision support tools, and the CANS in particular, as the CANS has bonus options beyond the usual clinical decision support tools.

In this post, I provide an overview of each of the Five Key Decisions to shed light on how managed care uses the CANS. I invite you to explore the topics below and follow the links to learn more in my series on the TCOM Conversations blog.

Access

Access refers to screening for a target population, such as using CANS algorithms for matching needs to services. This identifies youth who will benefit from a certain level of care or service, as well as those who will not.

MCOs, with their advanced analytics capabilities, can provide valuable insights to state and local agencies to inform ongoing adjustments to algorithms to ensure that youth have access to the appropriate level of care.

Learn more

Engagement

Key Decision 2, Engagement, is about bringing people from access — opening the door — to becoming equal partners in the helping system. Engagement is built on respect and understanding that youth and family are experts in their own lives and need to captain their own ships. Engagement uses a fully person-centered discovery and planning process.

MCOs are tasked with operationalizing engagement, often taking the form of a checklist with time-frames and standards for everything from forms, consents, plans, child and family meetings, authorization, and even how often helpers and family are required to meet.

Proper operationalizing of engagement allows for family and youth to participate as fully as possible in using the CANS for reflection, self-advocacy and self-direction.

Learn more

Appropriateness and Effectiveness

An appropriate service should be effective. These two Key Decisions are inextricably linked and are often the basis of medical necessity. Evidence-based practices assign a defined appropriate population and a set of measures demonstrating effectiveness and provide a good example of how the community at large and managed care can agree.

Standardized assessment is an established best practice for measuring appropriateness and effectiveness. The CANS in practice excels at both. When the practice is done well, youth and families flourish and successfully complete their programs.

Learn more

Transitions

Using CANS algorithms for access and transition decision support is particularly helpful when celebrating successes. In behavioral healthcare, a discharge from a program can be seen as a success, but “success” may only be based on utilization or length of stay, and not on quality outcomes for the youth and family. The CANS is a functional outcomes measure, i.e., it measures how a youth and family is functioning in real life. As value-based programming expands, the CANS will be used for evidence of discharge success.

Learn more

Barbara Dunn, LCSW, ACSW, is director of program innovation and outcomes for Magellan Healthcare. She is the Conference Program Chair for the 16th annual TCOM Conference, A TCOM Cloud Gathering. Meeting Each Other Where We Are: Collaboration in a COVID-19 World. Learn more about the event here.

Depression is a disease. It’s caused by changes in chemicals in the brain that are called neurotransmitters. Depression isn’t a character flaw, and it doesn’t mean you are bad or weak. It doesn’t mean you are going crazy.

People who are very depressed can feel so bad that they think about suicide. They may feel hopeless, helpless, and worthless. But most people who think about suicide don’t want to die. They may see suicide as a way to solve a problem or end their pain.

What to watch for

It is hard to know if someone is thinking about suicide. But past history or events may make suicide more likely.

Things that can make suicide more likely for those suffering from depression include:

• Being male
• Having had a family member attempt suicide or kill himself or herself
• Having access to a firearm
• Having been sexually abused
• Drinking a lot of alcohol or using drugs
• Having attempted suicide before
• Feeling hopeless
• Other mental health problems, such as bipolar disorder or schizophrenia

Warning signs of suicide include someone:

• Planning to or saying he or she wants to hurt or kill himself or herself or someone else
• Talking, writing, reading, or drawing about death, including writing suicide notes and speaking of items that can cause physical harm, such as pills, guns, or knives, especially if this behavior is new
• Saying he or she has no hope, feels trapped, or sees no point in “going on”

Find additional information and resources on suicide prevention here.

For information about Magellan events during National Depression and Mental Health Awareness and Screening Month, downloadable materials and more, visit our website here.

Adapted with permission from copyrighted materials here from Healthwise, Incorporated.  Healthwise, Incorporated and Magellan Health disclaim any warranty and all liability for your use of this information.

Mental health is an important part of our overall health and well-being. While mental illness is incredibly common, two-thirds of Americans do not actively seek help or receive the proper treatment¹.

Plenty of treatment options are available to help patients with mental illnesses, but navigating care can be difficult. It is also important to consider the social and physical factors rather than focus only on mental health symptoms because mental health and physical health are directly related. This is why a behavioral health care manager’s role is essential. They provide care for the whole patient and ensure that treatment plans focus on health, wellness, and preventive care.

Here are five key ways care managers are helping guide patients to better mental health:

Coordinating Care
Care managers are typically nurses, clinical social workers, or licensed counselors who take a holistic approach to mental health. They work collaboratively and alongside physicians, nurses, providers, and other medical staff to ensure more continuity of care for patients. “Getting people to the right place is really our number one goal,” says Michael Adamson, LCSW, manager of clinical care services at Magellan Rx.

Preventing Escalation
If not treated properly, mental illnesses can lead to emergency room visits, hospitalization, or suicide. Care managers can help mitigate this risk by helping patients maximize their existing benefits for mental health and medical care. “If we can intervene before they think of suicide or before they need the hospital, that benefits everybody,” states Jordan Johnson, LMFT, senior care manager for Magellan Rx.

Checking In and Following Up
After a doctor visit or being discharged from a hospital, a patient may be feeling overwhelmed. Care managers check in on patients, make sure they understand their treatment plan, and eliminate gaps in care. “If I have a member who is discharged without a care plan, the member says, ‘I’m so glad you called, what do I do now?’” discloses Silvia Pantoja, senior care manager.

Supporting Parents and Caregivers
Depression and mental illness have increased over time in children and teens. Care managers not only help individual patients, but they can also support and provide resources for parents or their caregivers.

Education and Resources
Care managers help patients learn about all the resources and educational materials available to them. Especially during the COVID-19 outbreak, members need to rely on resources they are not normally used to. Care managers help find virtual care, online support groups, mail-order pharmacies, online resources, and more.

¹ National Network of Depression Centers. Get the Facts. Retrieved July 21, 2020 from https://nndc.org/facts/

Untreated mental illness costs the United States up to $300 billion every year.[1] It is the leading cause of disability and the third most expensive medical condition in terms of total health spending, behind cancer and traumatic injury.

Given that one in five Americans suffers from a mental illness in a given year[3], and that the average delay between the onset of mental illness symptoms and treatment is 11 years[4], mental health screening should be considered just as important as regular medical exams.

Many physicians integrate screening to diagnose mental health conditions as part of primary care. It gives a PCP a picture of the patient’s emotional state and helps determine if symptoms they are experiencing are an indication of a mental health condition or an underlying physical health condition. Magellan Healthcare supports primary care screening and treatment with our Behavioral Health Toolkit at MagellanPCPtoolkit.com

Online screening and digital screening are two of the quickest and easiest ways to determine if a patient is experiencing symptoms of a mental health condition. A PCP may ask a patient to complete a questionnaire online before a visit, or a PCP may ask a patient to answer a few questions on a tablet or form while you they are at the office.

Based on the results, the PCP can recommend treatment options, such as digital or in-person therapy, a referral to a psychiatrist or psychologist, or a referral to the patient’s health plan’s case management team.

Early identification and intervention lead to better outcomes and can reduce long-term disabilities and prevent years of suffering.

To learn more, visit magellanhealthcare.com/mental-health. You’ll find information about mental health conditions and links to evidence-based screening tools you can do yourself. If any screener indicates a problem, consult a healthcare professional immediately.

[1] National Alliance on Mental Illness. (n.d.) FY 2018 Funding for mental health. Retrieved October 7, 2020 from https://www.nami.org/getattachment/Get-Involved/NAMI-National-Convention/Convention-Program-Schedule/Hill-Day-2017/FINAL-Hill-Day-17-Leave-Behind-Appropriations.pdf

[2] Soni, A. (2015). Top five most cCostly conditions among adults age 18 and older, 2012: Estimates for the U.S. civilian noninstitutionalized population. Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. Retrieved September 18, 2020 from https://meps.ahrq.gov/data_files/publications/st471/stat471.shtml.

[3] Centers for Disease Control and Prevention (2018). Learn about mental health. Retrieved September 18, 2020 from https://www.cdc.gov/mentalhealth/learn/index.htm.

[4] National Alliance on Mental Illness. Mental health by the numbers. (2019, September). Retrieved September 22, 2020 from https://www.nami.org/mhstats.

The U.S. Preventive Services Task Force recommends that all people, starting at age 12, be screened for depression. Screening for depression helps find depression early. And early treatment may help you get better faster.

Depression is a disease. It’s not caused by personal weakness and is not a character flaw. When you have depression, chemicals in your brain called neurotransmitters are out of balance.

Depression causes adults and children to feel sad or hopeless much of the time. It’s different from normal feelings of sadness, grief, or low energy. Always tell your doctor if you feel sad or have other symptoms of depression. Many times, people are embarrassed by these feelings and say nothing. Depression can be treated, and the sooner you get treatment, the better your chance for a quick and full recovery. Untreated depression can get worse, cause other health problems, and may last for years or even a lifetime. It can have a serious impact on both you and the people you care about.

Adults

To find out if you are depressed, your doctor may do a physical exam and ask you questions about your health and your feelings. Some questions may not seem related to your mood. But your honest answers can help give the doctor clues about how depression may be affecting you. Your doctor may ask you about feelings of sadness, changes in hunger or weight, energy level, concentration, guilt, thoughts of death and suicide, sleep, general interest in everyday activities, and more.

Some diseases can cause symptoms that look like depression. So your doctor may do blood tests to help rule out physical problems, such as a low thyroid level or anemia.

Children and teens

Symptoms of depression in children and teens can be different from adult symptoms.

To find out if your child is depressed, the doctor may do a physical exam and ask your child about his or her health and about how he or she thinks, acts, and feels. The doctor may ask your child about grouchiness, temper tantrums, headaches, stomachaches, social withdrawal, and more. It is common for children with depression to have other problems, such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder. The doctor may ask questions about these problems too.

The doctor may also ask you or a teacher to fill out a form about your child’s symptoms.

Some diseases can cause symptoms that look like depression. So the doctor may do blood tests to help rule out physical problems, such as a low thyroid level or anemia.

For information about Magellan events during National Depression and Mental Health Awareness and Screening Month, downloadable materials and more free resources, visit our website here.

Adapted with permission from copyrighted materials here from Healthwise, Incorporated.  Healthwise, Incorporated disclaims any warranty and all liability for your use of this information.

As if 2020 wasn’t already difficult enough with the stressors caused by the COVID-19 pandemic and protests over social justice issues, the upcoming election adds another level of anxiety for many people. A study published by the American Psychological Association in 2019 found that 56% of Americans, regardless of party affiliation, felt stressed about the upcoming presidential election.[1]  If you are feeling overwhelmed by the current political climate, you are not alone.

These feelings can have a negative impact on your emotional and physical health. Symptoms such as low energy, insomnia, loss of appetite, mood swings and tension are signs that you should not ignore. It is important to recognize what you can and cannot control as the election approaches.

You cannot control other people’s opinions, beliefs, reactions or how they express themselves. Nor can you control others’ votes. There are, however, many things you can control during and after the election:

• The amount of time you spend on election news and discussions. While the 24-hour political news cycle on television, radio and the internet is almost impossible to escape, you can limit the amount of time you spend on media each day.
• The coverage, feeds and groups you follow. When you are watching or reading election coverage, avoid negative-leaning discussions, especially if you feel constantly frustrated or upset by them.
• How you interact on social media. Avoid giving angry or emotional responses to posts that do not align with your views. You are unlikely to change other people’s opinions; you are more likely to get unwanted and hostile feedback.
• The time you spend with people. Prioritize your relationships with positive family and friends. Strong social connections can reduce stress and help you feel happier and more energetic. If you and a friend or family member have differing political views, try not to discuss them.
• How much you talk about politics at work. A February 2020 Gartner survey found that 78 percent of employees talk about politics at work; a third of those employees find the conversations stressful or frustrating.[2] Limit or avoid political discussions at work. When you do engage, treat colleagues with kindness and respect, and be aware that political discussions can hamper teamwork and productivity.
• How you deal with stress. Whether it’s meditation, going out in nature, reading a book or working on a hobby, take time every day to do something that makes you feel good. Make sure you get enough sleep and exercise, eat a healthy diet, and avoid using alcohol or drugs to cope.
• How you use your time and talents. Give your time and skills to a cause you believe in. If you have a strong interest in a political cause or candidate, offer to help with a campaign or other event.

Remember that professional help is available through your EAP if stress and anxiety about the election start negatively impacting your quality of life.

[1] https://www.apa.org/news/press/releases/2019/11/americans-significant-stress

[2] https://www.cnbc.com/2020/02/18/47percent-of-workers-say-the-2020-election-has-impacted-their-work.html