Online Medication Plans: Your Rx for a Healthier You

Despite Medical Progress, Suicide Remains Difficult to Treat Even as medical care has progressed, one leading cause of death remains tragically high suicide. Despite persistent research over the past decades, suicide rates have only increased , and self-harm remains stigmatized for families and among caregivers.  In some ways, suicide is among the last of the medical taboos, and that makes sense: doctors don’t like to talk about ailments they can do little about. Even at the best hospitals in the world, psychiatrists fail to predict whether a depressed patient will take their own life after leaving the hospital. Studies show that they have just over a 50 percent probability of making an accurate assessment. Ineffective prognosis and treatments make medical professionals reluctant to take on these difficult cases, leaving patients and families even more isolated. A 2019 study found that willingness to treat was significantly lower and the likelihood of referring out was significantly higher among therapists for suicidal patients.”  To make matters worse, medications intended to alleviate depression and other mental health conditions can take weeks to take effect, leaving some patients especially vulnerable as they await the onset of effect. Overcoming Stigma and Developing Proactive Treatment We can and must do better. Suicide is a national emergency. Every 11 minutes in the United States, someone takes their own life, according to the Centers for Disease Control, and suicide rates increased 30 percent between 2010 and 2018. In 2020, suicide was the second leading cause of death for Americans aged 10 to 14 and 25 to 34. Rates of suicidal thinking are even higher. The CDC estimates that in 2020, 12.2 million adults seriously considered suicide and 1.2 million actually tried to take their own life.    Given the pervasiveness of suicidal ideation in the United States, mental health providers must adjust how we treat and think about suicide. In order to help these patients, we have to dismantle the stigma around talking about suicide. This starts with consistent screening for depression during routine physical exams. Removing stigmas starts with the clinician. If clinicians initiate the conversation, patients may feel more comfortable discussing topics they may have otherwise been too nervous to bring up.        In addition to clinicians, our medical system must broadly establish consistent screening for depression just as it’s done for blood pressure, high cholesterol, as well as much more intensive diagnostics like endoscopies and colonoscopies. Depression should be among the first things physicians and nurses ask about during physical exams - and yet often, it's the last. In fact, a panel of medical experts recently recommended anxiety screening for all adults under 65.        Fifty years ago, the diagnosis of cancer was similarly stigmatized, for the same reason that clinicians were not well-equipped to manage these conditions. The advent of new treatments, better outcomes, and advocacy efforts by medical professionals and patients alike changed perceptions about cancer completely. We can similarly change how we as a society think about suicide through a concerted effort to develop better treatments, improve outcomes, and increase awareness and acceptance.         In particular, telehealth offers a much-needed resource to address the current situation by providing access for patients who haven’t been able to seek mental health care in the past, were excluded in underserved communities, or didn’t feel comfortable seeking care. New Approaches Offer Promise As a first step in improving clinical care and outcomes, we need better measures of treatment for suicidal patients, something that is sorely lacking today. Better data, consistent measurement, and more widespread benchmarks would be a helpful first step. Then, we need to develop interventions that can decrease suicidal thinking.      Some developments are promising. New research indicates that even brief regular contacts with patients experiencing severe depression through post-cards, text messages, emails, phone calls or other communication can decrease suicidal ideation.        This approach helped inspire a new paper that I co-authored with colleagues at Harvard on Bibliotherapy. After suicidal patients read brief, first-person narratives about coping with suicidal ideation written by other people who overcame suicidal thinking, the readers themselves experienced lower rates of suicidal thinking. Bibliotherapy is cost-efficient, easy to scale, and a method of treatment Cerebral intends to launch in the next few months. How Cerebral is Making A Difference At Cerebral, we understand just how prevalent suicide is and how difficult it is to treat. And we are committed to taking on the toughest cases and making a real difference for suicidal patients and their families and utilize a comprehensive treatment plan.       Our organizational structure includes a comprehensive Clinical Safety department that includes crisis specialists, psychiatrists, and data scientists. With this crisis response capability in place, our goal is to make sure no one is neglected by the mental health care system and everyone receives consistent, measurable and high-touch interaction.      Cerebral’s data-driven approach is instrumental in improving clinical safety. Each day, Cerebral receives 5,000 to 10,000 patient messages via a chat system available on our website or mobile app. We are using machine-learning to analyze these messages, and we can correctly detect messages with suicidal content with 97% accuracy, and reach out to these patients within minutes.  This system can also serve as a way to connect with patients regularly and keep them close touch with their care team, as each patient message is reviewed and addressed by our patient support team.         Conclusion As the new research indicates, there are reasons to believe we can make progress in combating the scourge of suicide. As a psychiatrist and CEO of Cerebral, I have seen the devastating impact suicide has on individuals and their families firsthand. During medical training, medical students typically wore short white coats while more senior doctors were clad in longer ones, symbolizing that they had already completed the process of learning. At Massachusetts General Hospital, where I trained, all doctors wore short coats to emphasize that real learning never ends. We always practice medicine; we do not perfect medicine. That is the mentality which I bring to Cerebral. In order to improve care for our most vulnerable patients, we need to remain humble, data-driven, and committed to becoming life-long students of medicine. Too much is at stake for us not to try.  Resources: Suicide and Suicidal Behavior Prediction of Suicide Attempts Using Clinician Assessment, Patient Self-report, and Electronic Health Records | Electronic Health Records | JAMA Network Open | JAMA Network  To Treat or Not to Treat: The Effect of Hypothetical Patients’ Suicidal Severity on Therapists’ Willingness to Treat  Facts About Suicide | Suicide | CDC Advancing the Understanding of Suicide: The Need for Formal Theory and Rigorous Descriptive Research Taking care of suicidal patients with new technologies and reaching-out means in the post-discharge period

If you’re looking for a psychiatric provider or a behavioral therapist, you probably see all sorts of letters after people’s names. MD, NP, LPC, LPCC, LCSW — the list goes on and on.  But what do all those letters mean, and what do they say about the kind of care a clinician offers? Take a look at the reference list below for a quick view of degree types and certifications that mental health clinicians often have. And find out what they mean about the care you’ll receive. Prescribing provider degrees and titles Prescribing providers can prescribe medications, including psychiatric and mental health drugs. Without one of these medical degrees, a clinician cannot prescribe medications.  When people use the word “psychiatry,” they’re referring to medical care that includes the ability to prescribe medications. For more information on what “psychology” means, see the section below MD: Doctor of Medicine. This is the classic medical school degree. MDs can specialize in psychiatric care, family practice, and other specializations that can provide mental health care.  PA: Physician Assistant. According to the AAPA, PAs are medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal health care provider. NP: Nurse Practitioner. A NP is a certification for a nurse who has a graduate degree in advanced practice nursing. According to the AANP, NPs provide a full range of primary, acute and specialty health care services, such as prescribing medications and ordering tests. PMHNP: Psychiatric Mental Health Nurse Practitioner. A NP who specializes in psychiatry. FNP: Family Nurse Practitioner. A NP who specializes in family medicine. DNP: Doctor of Nursing Practice. This higher-education degree is for people who have reached a doctorate level of nursing practice.  Types of therapist degrees Psychotherapists use talk therapy and other behavioral health approaches to treat mental illnesses. Unlike medical practitioners like NPs or MDs, therapists do not prescribe medications.  This kind of care falls under the heading of “psychology,” which focuses on behavior and the mind. Cerebral therapists meet with members on a weekly basis. Our therapists are either fully licensed or are seeking their license and operate under the direct supervision of a clinical supervisor. LCSW: Licensed Clinical Social Worker. A LCSW is a master’s level social worker and mental health professional. LCSWs have extensive training and licensing in mental health and counseling. As a social worker, LCSWs also focus on societal and environmental impacts on mental health. LICSW: Licensed Independent Clinical Social Worker. The main differences between LICSWs and LCSWs is that only certain states have special licenses for the “independent” practice. LMFT: Licensed Marriage and Family Therapist. Similar to a LCSW, this is a master’s level counseling degree that provides extensive training and licensing in mental health, specifically couples and family counseling. Practitioners with this degree may focus on issues with and impacts of marriage and family interactions. Licensed Counselors: These licenses are similar to LCSWs and LMFTs in that they have master’s degrees and practitioners provide psychological therapy and counseling. The main difference is that these therapists may not have specific training and licensing in social work or familial aspects. The reason for the varying titles below is that different states call the licenses something slightly different. LMHC. Licensed Mental Health Counselor. LPC. Licensed Professional Counselor. LPCC. Licensed Professional Clinical Counselor. LCPC. Licensed Clinical Professional Counselor. LCMHC. Licensed Clinical Mental Health Counselor. Psy.D.: Doctor of Psychology. This is a doctorate degree in the field of psychology. Though it’s similar to Ph.D. in psychology, this degree is focused on the practice of psychology, such as diagnosing conditions. Psychologists vs. Mental Health Counselors Cerebral Care Counselors also offer behavioral health guidance. Meeting with members on a monthly basis, Care Counselors have a master’s degree at a minimum. Some Care Counselors are also licensed therapists. Below are the master’s degrees that Cerebral Care Counselors have at minimum. MA: Master of Arts. M.A. is an advanced degree that may be offered for any number of areas of study. Certain colleges, like a college for counseling or psychology, can offer a M.A. for advanced study in psychology. MS: Master of Science. Similar to M.A., a M.S. is an advanced degree. Certain schools may offer an M.S. in psychology, such as an M.S. in clinical psychology. MSW: Master of Social Work. Earning this master’s degree may be necessary in order to become a LCSW. Clinically reviewed by Tony Reigle, Ph.D., LPC, CCTP-II, CCFP

An important part of anyone’s mental healing is having access to the right resources at the right time. We grow by connecting, by being supported, by learning, and by putting what we learn into practice. As a way to connect Cerebral members with life-changing (and moment-changing) resources, we’re excited to launch Cognitive Behavioral Therapy (CBT) exercises in the Cerebral mobile app and website (Apple; Android). Now, Cerebral members get full access to CBT lessons, practical exercises, guided audio relaxation sessions, journaling, and a whole lot more. This all comes at no additional cost and is available to members today! One of the most critical parts of improving your mental health is that you actively work on it between sessions, since your therapist or counselor can’t always be there. Studies have shown that internet-based CBT exercises can reduce anxiety, depression, and insomnia, especially when combined with support from a mental health professional*. What is CBT? Cognitive behavioral therapy is a type of psychotherapy that places an emphasis on the connection between your thoughts and memories (cognition) and your emotions and feelings (behavior).  With CBT, you can recognize how to change negative, automatic thought patterns or beliefs that impact your behavior and emotions.  There’s a whole lot more to it than that, though. So download the app today to dive in! What’s included in the CBT feature? In short, quite a lot! But here are some highlights: Lessons for discovering how CBT can help with depression, anxiety, and insomnia Interactive worksheets that put CBT into action and help you explore your thoughts and behaviors Information and exercises on grounding techniques Calming and relaxing guided meditations Tips on using journaling, thought records and other techniques to understand yourself How do I start? If you’re a member, download or relaunch the Cerebral app and find the exercises in the bottom navigation tab. If you’re accessing Cerebral from a browser instead, click the three horizontal lines at the top of the page to find the exercises. If you aren't a member yet, sign up today! NOTE: Your therapist may tailor your therapy by assigning you specific exercises over time. If they do, we’ll send you a notification! *https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771536/