Treatment for Substance Use Disorder at Cerebral

Even in the face of its seriousness, suicidal ideation often goes undiscussed because of the stigma that can surround it. But, as we're talking more and more openly about mental health, it's essential that we approach the subject of suicidal thoughts with as much empathy, openness, and support as possible. If you find yourself grappling with these thoughts, or if you're trying to understand and support someone you care about who is, this guide is for you.  Suicide prevention support If you're thinking about acting on suicidal thoughts, reach out for help immediately.  Call 911 if you’re having a mental health emergency. Text HOME to 741-741 if you're emotionally distressed and need immediate support. Call or text 988 Suicide & Crisis Lifeline. Chat service is available at 988lifeline.org. What is suicidal ideation? Suicidal ideation transcends mere fleeting thoughts about death; it's a whole range of thinking that might start with not wanting to wake up and can go all the way to planning how to end one's life. Often accompanied by a sense of hopelessness, these intrusive thoughts can be potentially dangerous. Despite the severity, feeling this way doesn't have to be permanent. Instead, these thoughts can be a signal that indicates deeper psychological distress and emotional pain that need to be addressed.  The prevalence of intrusive thoughts  While it can feel isolating to experience, this mental health condition affects many. Every year, millions of people report these thoughts to medical professionals. Between 2015 and 2019, the CDC found that an estimated annual average of 10.6 million U.S. adults had thoughts of suicide in the past year, which accounted for about 4.3% of the adult population. Intrusive thoughts don't discriminate — depression can affect individuals of any age, gender, education level, socioeconomic status, or background. Suicidal ideation is part of a broader mental health landscape; it’s not a ‘character flaw.’  What causes suicidal thoughts? The causes of suicidal ideation are as varied as the individuals who experience it. They often stem from life circumstances, mental health disorders, or personal resilience levels. Common underlying conditions can include:  Major depressive disorder Bipolar disorder Posttraumatic stress disorder (PTSD) Social isolation Chronic pain Substance use disorder Understanding the warning signs of suicidal ideation in others For friends and family, recognizing the warning signs for suicide is paramount for timely intervention. The signals can look similar to the signs of depression and anxiety, but are typically more severe. Look for these behaviors: Withdrawal from social circles  Giving away possessions Sudden calmness after a period of depression Statements of feeling hopeless or having no purpose  Remember: Not everyone exhibits clear ‘red flags,’ and a person at risk might go to great lengths to hide their pain. How is suicidal ideation diagnosed? Identifying suicidal ideation typically occurs during a supportive conversation with a mental health expert. These caring professionals will talk with a patient, sometimes using questionnaires, to better understand their feelings and the severity of the thoughts they're facing.  They will also look for any underlying mental health conditions or life experiences that may be contributing to or exacerbating the intrusive thoughts. The recognition of suicidal ideation is less about certainty and more about concern. The presence of suicidal ideation often prompts an immediate need for intervention, regardless of other diagnoses. It's about recognizing that these feelings are a call for help and responding with the urgent care and support needed. What to do if you are experiencing suicidal ideation When you’re experiencing suicidal ideation, seeking help and taking action are crucial. Getting urgent help Seek help immediately if you're thinking about acting on suicidal thoughts. The 988 Lifeline provides 24/7, free, confidential support and crisis resources. Your options also include calling 911 or going to the nearest emergency room. No matter what course of urgent help is seen as the best fit at the moment, you will want to seek the support of a mental health professional as soon as possible. That also can be your first step when experiencing distress. Steps to take when it isn’t an emergency If you’re not in immediate danger, these are the first steps you could take toward getting the judgment-free help you deserve. 1. Make an appointment with a mental health professional Professional intervention is crucial in managing the risk of suicide or self harm. A mental health professional will provide a safe space to explore the thoughts and feelings you are experiencing. They can guide you to understanding the factors and strategies to manage your mental well-being effectively. 2. Identify and remove triggers Start by identifying the triggers that lead to these intrusive thoughts. They might be certain places, people, or events that consistently lead to distress. It might not necessarily mean avoiding them permanently, but it can allow for a safer environment while you address this mental health condition. 3. Reach out to a close friend or loved one  You’ll need a strong support system. You may be nervous about opening up, but doing so with a trusted, supportive connection can be a critical step in alleviating the burden, finding relief, and embarking on recovery. 4. Call a suicide hotline If you don’t feel comfortable talking to someone close to you at the time, a suicide hotline can be an invaluable mental health resource. Specialists on these hotlines are trained to support and assist those in crisis.  Managing suicidal ideation is a process; there will be ups and downs. The most crucial thing is to keep moving forward and continue seeking help from mental health resources. Treatment options for suicidal ideation There is no one-size-fits-all approach to treating suicidal ideation. Treatment will vary based on the individual’s needs but may include psychotherapy, medication, or a combination of the two. Hospitalization or intensive outpatient programs may be necessary for those at immediate risk of self-harm.  Additionally, new approaches to reducing suicidal ideation are continually being explored and implemented, often creating expanded access to care.  Treatment goals Regardless of the course of treatment, the focus will be on achieving several key goals. Address the underlying factors contributing to the intrusive thoughts.  Build coping strategies for preventing suicide. Create a support network for the individual.  Individuals will be actively involved in their treatment plan, working collaboratively with their care team. The path to recovery Recovery from suicidal thoughts comes with its own challenges, but many individuals who have once experienced these thoughts have gone on to live fulfilling lives. Recovery often involves finding the right treatment, building a solid support system, and learning healthy coping mechanisms. We know that each person's road to recovery is unique, but it’s important to avoid projecting set timelines or expectations. Celebrating the small victories can make a world of difference. Whether it’s practicing a new coping skill or continuing to seek help, these concrete steps signify resilience and strength. Remember: Patience and consistency in support are key if you’re standing by someone in recovery.  The myth and reality of suicidal thoughts and creativity There is a common misconception that suicidal ideation is a byproduct of creativity. While individuals with artistic inclinations might be predisposed to deeper emotional experiences, it’s crucial not to romanticize or normalize the suffering that comes with suicidal thoughts. The art lies in expressing your emotions in a healthy manner that supports your well-being rather than harming it. Art, writing, and other creative outlets can be a powerful force in recovery. However, these outlets should be harnessed under the guidance of a mental health professional so their benefits can enhance structured therapy and/or medication like anti-depressants or mood stabilizers. The role of community in suicide prevention Support can take many forms, from suicide prevention organizations and support groups to simply being there for someone in need. By building a community that is educated on the warning signs of suicide and the steps to take to support someone in crisis, we can provide a safety net for those who are in need.  Engaging in open, honest conversations about mental health and suicide removes the stigma that often surrounds these topics. Creating a safe space to talk makes it easier for people to seek help and for those around them to provide support. If you or someone you know is struggling with suicidal thoughts, please know that there is hope and help available. Reach out to a mental health professional, call the national suicide prevention hotline at 988, or talk to someone you trust.  Remind yourself: You are not alone — there are people who care and want to help.  Working to stop suicidal thoughts Cerebral is continuing to make strides in improving clinical quality and safety for those experiencing suicidal ideation. With systems in place to connect you to care quickly in crisis situations, not only can unnecessary emergency room visits and hospitalizations be avoided, but meaningful improvements in symptoms can be made in a short period. Of the patients who come to Cerebral considering suicide, half of the individuals stopped having thoughts of suicide within an average of 6 months of treatment. This highlights the powerful impact of seeking support and the real possibility of regaining a sense of hope and purpose. Critical resources 988 Suicide & Crisis Lifeline offers free and confidential support via phone, text, or chat. Crisis Text Line allows one to text with a trained crisis counselor for free by texting TALK to 741-741. Veterans Crisis Line enables veterans to get help via text by sending one to 838255. Vets4Warriors provides free, 24/7 peer support for veterans via phone at 855-838-8255 or by email. The Trevor Project offers immediate crisis support for LGBTQ+ youth via phone at 1-866-488-7386 or by texting START to 678-678. Image by rawpixel.com on Freepik

The mental health care system is in crisis – overwhelmed in the pandemic’s wake, with patients nationwide suffering from rising cases of anxiety, depression and other disorders. As a result, they are frequently left unable to find psychiatric and behavioral care. Telehealth companies like Cerebral are leading the way in addressing that need, but like any new innovation in health care, there is resistance. Traditional mental health providers feel threatened by this new model, which exponentially improves access for patients across the U.S. The fact is that there’s room and need for both traditional in-person care and telemedicine. Without both modalities, there’s no way we will make a dent in the acute challenges facing people from every walk of life and across the country. Telehealth isn’t a panacea, but it undoubtedly improves access and reduces the stigma associated with services that are out of reach for far too many people. Americans do not have adequate access to mental health care. Nearly one-third of Americans live in an area that has a shortage of mental health care professionals and 60 percent of all U.S. counties – including 80 percent of all rural counties – do not have a single psychiatrist. If patients are lucky enough to secure an appointment, they often have to wait months before their first session.  However, it is typical for non-psychiatrists to treat mental illness. In conventional health care, 79 percent of antidepressants are prescribed by primary care doctors, so it’s a misconception to think that psychiatrists are prescribing the lion’s share in traditional settings. Nurse practitioners have a critical role to play. A key to improving access to care is to use experienced clinicians – often nurse practitioners – who play a vital role in the health care system, especially in underserved communities. As front-line clinicians, nurse practitioners are practiced hands in dealing with many aspects of mental health care, and Cerebral’s nurse practitioners are particularly well-equipped and supported to manage mental illnesses.  Besides being carefully screened and interviewed before joining the Cerebral team, our nurse practitioners receive additional training and clinical support for the treatment of the psychiatric conditions we see most frequently, including depression, anxiety, bipolar disorder, insomnia, and PTSD, among others. Should they want to discuss a challenging clinical situation, they can easily get in touch with a staff psychiatrist within minutes; this ‘second opinion’ line, which we call Curbside Consults, is an innovation that is available to our NPs 12 hours a day, 7 days a week  They are well positioned to monitor and counsel patients throughout the process of initial evaluation, treatment, and recovery.  A new study out this month (September 2022) found that the ranks of psychiatric mental health nurse practitioners (PMHNPs) are surging as caseloads increase. Notably, the number of PMHNPs who care for Medicare patients jumped 162 percent between 2011 and 2019, compared to a 6 percent decline in psychiatrists, which further underscores how important nurse practitioners are to match the burgeoning demand for care.      By utilizing nurse practitioners and telehealth, we are democratizing access to care, and supporting patients who have historically been disenfranchised by the mental healthcare system.     .  Indeed, nearly 2/3 of Cerebral patients have never had the privilege of receiving mental health care prior to coming to Cerebral. We can only improve what we measure. The vast majority of mental health professionals do not measure clinical outcomes. This would be unacceptable in any other field of medicine: you wouldn’t trust a diabetes doctor who did not regularly check your labs in order to monitor the progression of the disease. Why should depression or anxiety disorders be treated so differently?  Telehealth allows us to measure clinical outcomes using  tools that are integrated within the care experience. By monitoring how patients are doing via surveys, we are able to better understand whether treatment plans are working, or whether adjustments need to be made. Overall, knowing how patients are doing helps us improve clinical quality and maintain patient safety. Collecting patient outcomes data at scale can also be a benefit. It can establish new baselines for what is most effective for different types of patients, paving the way for the kind of precision medicine approach that has transformed cancer care and other specialties.         The bottom line is that the current mental health care system can’t improve access for desperate patients who desperately need care. While there have been missteps and necessary learnings along the way, telehealth has a vital role to play in this process. For tens of millions of Americans who need our help, their well being, and their lives, are on the line. 

Millions of students are set to return to college campuses all over the country over the next few weeks. While this is an exciting time for many students, it can be a challenging one as well, and one that has only been complicated by the effects of the pandemic. According to the CDC, three out of four Americans between the ages of 18 and 24 now report poor mental health resulting from the pandemic. This is among a population that is already more prone to mental health issues, with significantly greater portions of young adults in college reporting struggling with conditions such as anxiety and depression than their unenrolled peers. For example, a recent survey conducted by Fortune found that 43% of college students report struggling with anxiety and 33% report struggling with depression, compared to 29% and 27%, respectively, of US adults in general. Suicide and suicidal ideation rates are also especially high in college students: according to the National College Health Risk Behavior Survey, 10.3% of respondents reported seriously considering attempting suicide, 6.7% had made a suicide plan, and 1.5% reported they had attempted suicide one or more times in the 12 months preceding the survey. The good news is that many students suffering from these conditions see the value in seeking support from mental health care providers. According to a recent survey, 60% of prospective college students now say that mental health services are a very important factor in their search for a university, a statistic that has jumped significantly in the wake of the pandemic. University presidents and leadership also recognize the need: according to the American Counsel on Education, 68% of university presidents view student body mental health as one of their most pressing issues. The bad news is that, despite that awareness, many universities struggled for years to adequately meet that demand, making access challenging for students and creating barriers to care for many. The reason for this gap is largely due to resourcing issues. Most schools only offer in-person counseling options, and there are simply not enough credentialed providers to go around. Colleges have attempted to address this in the past by triaging patients through a “stepped care” model, under which students initially receive the least resource-intensive form of care and are only allowed a more fulsome approach if it is deemed necessary. Other schools have capped the number of sessions an individual can schedule with a provider in an attempt to free up appointment time. Either way, it is clear that there are not enough traditional mental healthcare resources to meet the needs of America’s college students. This is where telehealth and Cerebral come in. As a telemental health care provider, Cerebral can help plug the resourcing gaps that many colleges are experiencing. Cerebral provides students suffering from mental health issues with the ability to book an appointment with a provider within days, alleviating some of the historically lengthy wait times for college counseling services. Cerebral is also able to quickly adapt to a patient’s needs, allowing students to increase or decrease their care as needed and without restrictions. Furthermore, students can now receive care in the comfort and privacy of their dorm, which will lower the threshold for seeking care. Some students find it intimidating or shameful to walk into the counseling centers. We already actively partner with a number of universities to offer this kind of hybrid approach to mental health care for students. For example, we partnered with Arkansas Colleges of Health Education (ACHE) to provide all students access to Cerebral’s telehealth services. A hybrid approach such as the one deployed by ACHE should be considered the future of mental health care on college campuses as university officials continue to look for ways to expand access and meet demand among their student populations. College is a stressful and intense time for many, and adequate mental health support can make navigating it all the more manageable.