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Making Sure the Kids Are Alright

March 10, 2023 | IBX Insights Team

It’s a question parents, teachers, and researchers alike are asking. The COVID-19 pandemic robbed many teens and young adults of precious learning and socializing time. Add to that the challenge of not having enough mental health providers to meet the demand for counseling, and you’ve got a serious problem.

According to the Harvard T.H. Chan School of Public Health, the pandemic led to a decline in kids’ overall mental health. But that impact varies, depending on factors including age, family circumstances, and preexisting conditions.

Results from a 2021 National Survey on Drug Use and Health showed that nearly half of kids ages 12 to 17 who had a major depressive episode (MDE) in the past year said the pandemic negatively impacted their mental health either “quite a bit or a lot.” That’s concerning because only 12.4 percent of their peers without an MDE reported similar levels of impact.

Not a New Problem

Although the pandemic may have put a spotlight on teen mental health, rates of depression and anxiety in children have risen steadily in the last ten years. Many experts think this trend is unlikely to improve without rethinking how we approach teen mental health care. As a result, the U.S. Preventive Services Task Force now recommends regular anxiety screenings for children ages 8 to 18 and regular depression screenings for adolescents ages 12 to 18.

The Power of School Connection

According to the Centers for Disease Control and Prevention, one of the most important factors in boosting students’ emotional resilience is “school connectedness.” This is the feeling of being supported and belonging at school. Students who felt connected to adults and peers at school were significantly less likely to report feelings of sadness or hopelessness.

Experts believe that students can benefit from multiple support systems in school. But given the shortage of available counselors, only about half of U.S. public schools offer mental health assessments, and even fewer offer treatment services.

In Philadelphia’s public schools, the STEP Program provides mental and behavioral health and social services to students and families. The school district works with the Mayor’s Office of Education, Community Behavioral Health, Drexel Community Partners, and the Department of Human Services to provide this support.

At the state level, Pennsylvania recently made $190 million available for school mental health and safety programs for the 2022‒23 school year. Districts that applied by August could receive a base grant of $100,000 for safety and security improvements, with another $100,000 for mental health programs and training. Additional funding may be available based on population.

“What we need is to build capacity through all of the systems that are part of children’s lives — in families, in schools, in the education of everybody who interacts with children,” says psychologist Ann Masten, Ph.D., a professor of child development at the University of Minnesota.

Focusing on Student Mental Health at Girard College

Youth from underserved communities are less likely to receive mental health care services. To address this disparity, the Independence Blue Cross Foundation is funding a multi-year pilot initiative to provide access to mental health care for every student at Girard College. Girard College is an independent, five-day boarding school in Philadelphia. It serves approximately 300 students in first through twelfth grades from families with limited financial resources. More than 80 percent of the student population identifies as African-American.

This innovative care model integrates school support with telehealth services provided by Children’s Hospital of Philadelphia. “The pandemic amplified the urgent need for access to mental health care as young people were faced with additional difficulties such as school closures, family stress, social isolation, and economic challenges,” said Foundation Executive Director Heather Major. “A key goal of this collaboration is to create a replicable model for bringing mental health services into schools in a sustainable way.”

The pandemic showed us students of all ages need greater access to mental health care. “The focus needs to shift up toward preventive care and secondary and early intervention,” says Archana Basu, research scientist and clinical psychologist at Massachusetts General Hospital. Independence Blue Cross will continue to support efforts to improve access to mental health care for youth in the community.

If you or someone you know may be experiencing anxiety or depression, please seek help. If you don’t know where to begin, visit ibx.com/knowyourmind. If you are having suicidal thoughts, please call the National Suicide Prevention Lifeline by dialing 988.

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Loneliness is a Serious Condition Among Seniors

February 14, 2023 | IBX Insights Team

In Japan, 65 percent of seniors live with their children, and in Italy, about 39 percent do. But in the United States, the figure is only about 20 percent, despite a rise in multi-generational households in recent years.

It’s just one of many factors that cause approximately one-quarter of Americans aged 65 and older to be socially isolated. People over age 50 are more likely to experience the risk factors for social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and reduced vision and hearing abilities.

It’s not surprising that being lonely is associated with higher rates of anxiety, depression, and suicide. However, a substantial body of evidence shows that social isolation also poses a major risk for physical problems including premature death — a risk level that’s comparable to having high blood pressure, smoking, or being obese.

Social isolation — a lack of social connections — is associated with a 50 percent increased risk for dementia. And loneliness among heart failure patients was associated with higher risks of death, hospitalization, and emergency department visits.

Pandemic Fallout

“Senior isolation was a tremendous problem during the pandemic,” notes geriatrician Heidi J. Syropoulos, MD, medical director of Government Markets at Independence Blue Cross (Independence). “It affected people who would never have considered themselves socially isolated before — whose children visited them all the time, or who perhaps had a caregiver that took care of their finances, or brought them a meal once a week, or went grocery shopping for them.”

“During the pandemic, some of those things still happened, but the affected individuals did not see those caregivers. They just dropped off the groceries or a meal at the front door and then left. So social isolation definitely increased during the pandemic. I think it’s gone back down a little bit now, but not to where it was before.”

Technology has helped bridge the loneliness gap to some degree, as seniors have become accustomed to using computers and other devices to keep in touch with family, friends, and health care providers. However, there’s no substitute for face-to-face social contact. For this reason, many local houses of worship and community service organizations are working to fill the gap to help seniors build relationships and maintain their quality of life.

Local Supports Deliver Connection

If you’re feeling socially isolated, the World Health Organization offers three key pieces of advice:

Get in touch with friends by either meeting them in person or contacting them by phone or through social media.
Do the things you enjoy, like engaging in a hobby or spending time outdoors.
Reach out to local services that can connect you to new people, communities, or professional help.

The Philadelphia Corporation for Aging, for one, provides Community & Connection programs at 28 PCA-supported senior centers in the City of Philadelphia. They also offer health and wellness programs, volunteer support, and job training services that keep seniors active and engaged. To learn more, call the PCA Helpline at 215-765-9040 Monday through Friday, 8:30 a.m. to 5 p.m., except for major holidays.

In Montgomery County, the Senior Adult Activities Center helps seniors continue to be active, creative, healthy, and engaged in the community. Other resources include three Meals on Wheels programs, two senior centers, and an inter-generational art center — the Ambler Senior Adult Activity Center.

Similar organizations and services exist in Bucks, Chester, and Delaware counties.

Isolation can take a devastating emotional, cognitive, and physical toll over time. If you are an older adult, any steps you can take to maximize your social interactions will have a huge benefit.

If you or someone you know may be experiencing anxiety or depression, depression, please seek help. If you don’t know where to begin, visit ibx.com/knowyourmind. If you are having suicidal thoughts, please call the National Suicide Prevention Lifeline by dialing 988.

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Channeling Climate Anxiety Into Action

January 25, 2023 | IBX Insights Team

Intense heat waves. Severe weather damage. As dramatic events like floods, hurricanes, fires, and droughts have become frequent occurrences, it’s only natural to be concerned about what climate change may mean for our future. But for some of us, climate anxiety becomes overwhelming, leading to low moods or a sense of dread or hopelessness.

There is a difference of opinion about whether climate anxiety is a clinical condition, but both the United Nations and the American Psychological Association (APA) have found that people are increasingly at risk of climate change-induced mental health issues, especially young people.

The Prevalence of Climate Anxiety

In a 2021 global study published in The Lancet Planetary Health of 10,000 young people ages 16 – 25 in ten countries (Australia, Brazil, Finland, France, India, Nigeria, Philippines, Portugal, the UK, and the USA):

45 percent of respondents said climate anxiety was affecting their daily lives.
More than 50 percent reported feeling sad, anxious, angry, powerless, helpless, and guilty.

“We were disturbed by the scale of emotional and psychological effects of climate change upon the children of the world, and the number who reported feeling hopeless and frightened about the future of humanity,” the research team wrote. “It underscores an urgent need for greater responsiveness to children and young people’s concerns, more in-depth research, and immediate action on climate change.”

Finding Satisfaction in Climate Action

Beyond the self-care strategies we may use to reduce other sources of anxiety — such as exercise, meditation, walking outdoors — taking specific actions to address climate change can help support our mental well-being.

In her TED Talk, “How to find joy in climate action,” marine biologist and policy expert Ayana Elizabeth Johnson, Ph.D., encourages us to create our own Climate Action Venn Diagram in which we ask ourselves, “What am I good at? What is the work that needs doing? What brings me joy and satisfaction?”

The point at which the three answers come together is a great place to start, Johnson says. Whether through protecting forests or oceans, building a bicycle infrastructure in our neighborhood, or promoting family planning and education, there are many ways we can reduce stress by using our interests and skills to develop solutions.

Even if we’re not experiencing climate anxiety, that’s no cause for complacency, as Greta Thunberg reminds us. Climate change is real and is affecting the health of our population. Climate change demands urgent action from all of us.

Local Opportunities for Making a Difference

In January 2021, the City of Philadelphia’s Office of Sustainability published a Philadelphia Climate Action Playbook (in English and Spanish) that details the climate actions the City is taking. Residents can sign up for the newsletter to stay informed and get involved. In addition, the region is home to dozens of local action organizations including 350philadelphia, the Clean Air Council, and ClimateActionPhilly.

What else can we do? The United Nations Environment Programme recommends:

Leave your car at home and walk, bike, or take public transportation whenever possible. Get a hybrid or electric vehicle if you can.
Rein in your power use by turning down your heating a degree or two, switching off appliances and lights when not using them, and use more energy-efficient appliances.
Eat more plant-based meals, which ultimately helps reduce the amount of agricultural land used for livestock grazing.
Shop locally for groceries, which reduces the energy used to transport foods.
Try to waste less food. Food waste contributes to global greenhouse gas emissions.
Buy fewer new clothes and wear them longer. The fashion industry accounts for 8 – 10 percent of global carbon emissions.
Plant trees.
Spread the word about the urgency of fighting climate change.
Encourage local politicians and businesses to cut their emissions and reduce their carbon footprint.

“The best way to cope…is to avoid dwelling on the terrifying scientific projections and instead pivot quickly to solutions,” Johnson says. “Choose the things that enliven you. The goal is to be at the heart of the Venn diagram for as many minutes of your life as you can.”

For more information about mental health, self-care strategies, and where to find help, visit ibx.com/knowyourmind.

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Finding the Right Type of Mental Health Provider

December 9, 2022 | IBX Team

The demand for mental health services has skyrocketed since the start of the COVID-19 pandemic. At the same time, the U.S. faces a chronic shortage of psychiatrists and other mental health professionals. As a result, 65 percent of mental health organizations reported having to cancel, reschedule, or turn away patients in 2020.

In order to fill the gap, some primary care offices have developed collaborative care models. With these models an affiliated psychologist or social worker provides therapy and patient management and consults with a psychiatrist on medications. Other health care providers are undertaking additional mental health training to meet patient needs.

Psychiatrist, Psychologist, Therapist: Which Do You Need?

Determining the right mental health provider can be confusing. Should you see a psychiatrist, a psychologist, or a therapist? What exactly is the difference? The first difference is whether a professional specializes in prescribing medication, providing therapy, or both.

Prescribers and therapists are both mental health professionals whose expertise is the mind and the way it affects behavior and well-being. They often work together to diagnose and treat a patient. For example, a patient might see a psychiatrist who prescribes medication for depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), or bipolar disorder, and also work with another mental health professional for psychotherapy, also known as talk therapy or counseling.

Prescribers

Psychiatrists are physicians (M.D. or D.O.) who specialize in the assessment and treatment of the biological, psychological, and social factors that lead to behavioral health conditions. A psychiatrist may prescribe medication and may provide therapy as well. Often, the psychiatrist prescribes medication and acts as the leader of a treatment team that may include other professionals who provide therapy.

Psychiatric mental health nurse practitioners are another kind of professional that can prescribe medication for behavioral health conditions. They have a master’s of science in nursing or doctor of nursing practice degree with specialized focus on psychiatry. They provide diagnosis and therapy for mental health conditions and can prescribe medications independently or under the supervision of a medical doctor, depending on the state.

Therapists

Psychotherapy (also known as talk therapy, or just “therapy”) helps people deal with various mental illnesses and emotional difficulties. Therapy can help eliminate or control troubling symptoms so a person can function better. Depending on the issue, therapy can be short-term (a few sessions), or long-term (months or years). Psychotherapy is often used in combination with medication to treat mental health conditions. Therapy can be provided by several different kinds of professionals:

Psychologists have a doctoral degree in psychology and know how to evaluate and treat behavioral health disorders, but generally are not licensed to prescribe medication. In order to receive their license, psychologists also complete an internship with specific training in behavioral therapy and other methods of treatment. Once licensed, a psychologist is qualified to provide psychotherapy, counseling, psychological testing, and mental health disorder treatment.

Master’s level professionals

Licensed clinical social workers have a master’s or doctoral degree in social work and also complete two years of postgraduate supervised clinical work to become licensed. They are trained to evaluate and treat mental health issues, provide individual and group counseling, and like other therapists have varied specializations.

Licensed professional counselors and licensed marriage and family therapists are qualified to provide counseling or psychotherapy for mental health treatment. They have a master’s degree in psychology, counseling, or a related field, plus at least two years of postgraduate training working alongside a qualified mental health professional.

This list is not exhaustive and requirements often vary by state. It’s also important to note that your behavioral health is often best managed by a team that communicates well and uses each area of expertise to take care of you as a whole.

Getting Started

Your primary care provider is a great place to start discussing your mental health concerns. They are well-equipped to assess mental health needs and prescribe necessary medications, or to refer you to an appropriate specialist for counseling or psychotherapy.

In addition, many Employee Assistance Programs can be a source of mental health services to help employees with emotional and substance use issues, interpersonal relationships, legal problems, or financial difficulties. These services might be delivered in person, by telephone, or via online platforms.

There are also companies available, like Quartet*, that use specialized technology to help people more easily find and access care that’s right for them. Quartet does not provide direct mental health care. It works with health plans, like Independence Blue Cross, to match members with licensed mental health providers and programs that meet their needs and preferences, and accept their health insurance.

In summary, there are different types of support available to people seeking mental and behavioral support, and there are professionals skilled in getting you to the right provider. It all begins with that first call.

For more information about mental health, self-care strategies, and where to find help, visit ibx.com/knowyourmind.*Quartet is an independent company.

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Act to Curb Election Anxiety

October 28, 2022 | IBX Insights Team

Feeling anxious about the upcoming midterm elections? You’re not alone. Prior to the 2020 U.S. presidential election, more than two-thirds of Americans surveyed reported that the election was a significant source of tension in their lives. People across the political spectrum felt anxious, including 76 percent of Democrats, 67 percent of Republicans, and 64 percent of Independents.

Take Action and Vote!

“The best action to take for election anxiety? Volunteer, talk to people about the issues that matter most to you, and vote!” says clinical psychologist Tamar E. Chansky, Ph.D.

The American Psychological Association offers the following additional evidence-based advice:

Uncertainty is stressful, so don’t dwell on things you can’t control. Avoid imagining worst-case scenarios.
Focus on what you can control. Monitor your media consumption, and limit highly charged content.
Engage in activities or issues that are meaningful to you.
Stay socially connected. Spend time with friends and family.
Stay physically active.
Realize that you might not know the election results right away. Keep busy with other activities and social support, so you aren’t continually checking for “bad news.”

Recognizing Tension

Stress affects us in a variety of ways. “We notice it in our bodies, the tension in our shoulders,” said Robert Bright, MD, a psychiatrist at the Mayo Clinic, of the stress leading up to the October 2020 presidential election. “Sometimes people get GI [gastrointestinal] upset or headaches. People have trouble sleeping. There’s a lot of sleep disturbance going on right now — tossing, turning, and worrying, and not being able to get to sleep — or having bad dreams about the election.”

Dr. Bright added that television, radio, and social media ads flood us with catastrophic messages about the candidates that heighten our sense of anxiety and can feel overwhelming. “And it affects our emotions after a while. So, we start getting irritable and short, and snapping at people, not trusting people, seeing people as [either] the other or as the same. And that starts affecting our relationships at home. It starts affecting our work.”

“Our stress level is something we need to take seriously,” says Dr. Chansky. “Many of us never got that much-needed re-set from the earlier years of the pandemic. And we’re also still dealing with ongoing COVID cases, climate crises, war, and disruption. Even if these events don’t seem to be affecting us directly, we’re still processing them — and our emotional and physical resources are being strained.”

Check Your Facts and Have Hope

“Compartmentalization is a key skill for emotional well-being,” Dr. Chansky says. “Particularly when something is causing us ongoing stress, it doesn’t help to think about it all the time. But it does serve us to address it at designated times — what we may think of as ‘worry appointments.’

“At those times, write out your feelings about the election and fact-check them against what you know,” Dr. Chansky advises. Choose to have hope, she suggests, even if it’s not your natural inclination. Hope is not about imagining a particular election outcome. Rather, it’s a way of life and a continual commitment to not give up.

For more information about mental health, self-care strategies, and where to find help, visit ibx.com/knowyourmind.

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An Anxious Generation: Anxiety in Teens and Young Adults

October 24, 2022 | IBX Insights Team

Adults with jobs and family responsibilities may long for the carefree days of youth, but studies show that today’s young adults have plenty of worries of their own.

According to a University of California, San Francisco study of 2,809 young adults ages 18 to 25 nearly half (48 percent) reported symptoms of depression, anxiety, or other mental health concerns. Among those with symptoms, 39 percent reported using prescription medications and/or receiving counseling, and 36 percent reported unmet counseling needs.

Separating from one’s parents and leaving home have always been anxiety-provoking experiences, but today’s young people have less privacy as they make these major transitions, learning and growing under the unforgiving eye of peers and even strangers on social media.

“It’s expected that adolescents test their social interactions,” says Dario V. LaRocca, MD, a board-certified psychiatrist and Independence Blue Cross Behavioral Health Medical Director. “Traditionally, it would be in a dorm with people you know. But with social media, you never really know who you’re talking to or where they’re coming from. Without body language or social cues, it’s easy to make a mistake that gets picked up and amplified,” says Dr. LaRocca, who is also the father of three daughters, ages 20 to 31.

Online Pressures

Having a presence on social media often forces people to pretend to be someone they’re not. Faith Attig, 21, a student at Penn State University’s Abington campus and an intern in Independence’s Corporate Communications department says, “There’s pressure to create a brand — to be somebody and to be perfect online even when you’re not.” At the same time, “there’s pressure to be authentic, because people are so quick to judge and call you out.”

As a result, “a lot of my generation likes to disappear [digitally],” Attig says. “We don’t like people to know where we are. Life gets to be too much.”

But social media is just one part of the conversation about rising rates of anxiety in teens and young adults. Researchers and social critics have proposed other potential contributors, from economic and environmental uncertainty and overprotective parents to poor diets and sedentary lifestyles.

Anxiety today is more prone to push people to isolate, LaRocca says, a trend that has been amplified by the pandemic. Fortunately, there is less stigma around depression and anxiety with this generation. “I’m surprised by how quickly people are ready to acknowledge it [mental health issues],” he says.

Ways to Cope

One important way to cope with anxiety and depression is to take a break from social media and create a life outside of the internet, Dr. LaRocca says. “Find friends you can talk to offline, whom you can trust. And if you feel overwhelmed, meet with a professional, ideally in person. Talk to people of different generations in person to get a different perspective.” You can keep in touch online, Dr. LaRocca says, “but being with people in person is still important, and can help reduce anxiety by reducing isolation.”

Other coping mechanisms include:

If You Need Help

If you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide and Crisis Lifeline toll-free at 1-800-273-TALK, (8255) or call or text the new 988.

For more information about depression, self-care strategies and where to find help, visit ibx.com/knowyourmind.

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Take a Minute to Breathe

June 29, 2022 | mindPHL

Ariana Grande’s popular song “breathin’” is an anthem to anxiety that speaks to a simple solution with a multitude of benefits. “Don’t know what else to try, but you tell me every time, just keep breathin’ and breathin’” chants the pop superstar.

Unfortunately, most of us weren’t taught the simple techniques and range of positive outcomes that come with—well—simply breathing.

It happens to all of us. Feelings like anxiety, stress, and fear cause our breathing to be shallow, irregular, or rapid. It’s entirely normal. Our body’s automatic response is to protect itself. The trick is to focus not on what’s happening around us, but to what is happening within us. We are breathing. It’s our most basic instinct.

Practicing steady, deep breathing delivers more oxygen to the body and brain, reduces your heart rate and decreases the release of cortisol—better known as the stress hormone. Deep breathing also releases endorphins. This in turn increases a sense of calm and can combat pain.

Other known benefits of deep breathing include:

Lower blood pressure –Relaxation opens the blood vessels and improves circulation
More energy—From increased oxygen to the circulatory system
Less headache pain – Due to reduced tension locked in the shoulders and neck (you’ll rest better, too!)

Practice Makes Perfect

Getting back to steadier breaths is within reach. All it takes is a few minutes of practice. The American Psychiatry Association (APA) created one solution called “Just Breathe.” For three to four minutes a day:

Think about your body. (Are you breathing rapidly, forgetting to take a breath altogether, or taking shallow gasps?)
Begin breathing slowly and deeply for a count of four
Hold that breath in for a count of four
Slowly let the breath out for a count of six

Why does this work? Our brains can tell when we have varying emotions. Taking a few minutes to exercise a large organ in our body – our lungs – refocuses precious energy and retrains the way our body responds to our feelings.

Self-Care is Good Care

Almost everyone can relate to Grande’s refrain, “Time goes by, and I can’t control my mind.”

When this does happen to you, remember to breathe. Better yet, be proactive and take a small step in self-care by scheduling 4 minutes of ‘me time’ on your iPhone or calendar. Devote that time to breathing exercises.

Then, the next time someone asks you “How are you,” it will ring true when you reply, “I am good!”