We seem to have a code of silence surrounding the topic of mental health. Simply put, mental health is our emotional well-being that affects how we think, feel and act.

We all desire to live full, happy lives with good mental health. However, according to the World Health Organization, only 17% of American adults are considered to be in a state of optimal mental health. The Centers for Disease Control reports that depression is the most common type of mental illness, affecting 26% of the U.S. adult population. By the year 2020, depression will be the second leading cause of disability throughout the world.
Undetected and poorly treated depression can place individuals at risk for suicide. Suicide is a scary word and nobody likes to talk about it either. However, suicide remains a leading cause of death in the U.S., claiming 40,600 lives in 2012. In 2013, 958 Missourians lost their lives to suicide, outnumbering lives lost to homicide and motor vehicle accidents that year.

The good news is that depression can be treated successfully. Unfortunately, many people don’t recognize the symptoms, nor do they seek treatment. We can avert the tragedy of suicide if we can bring ourselves to simply talk about it, recognize the warning signs and learn what resources are available so that life-saving help can be provided when it is needed most.

Warning signs that indicate a need to seek help include:

• Withdrawing from life
• Displaying extreme mood swings
• Sleeping too little or too much
• Increasing the use of alcohol or drugs
• Experiencing any significant losses
• Feeling hopeless
• Feeling one has no reason to live
• Feeling trapped
• Having unbearable emotional pain
• Wanting to die or kill oneself

If you recognize these warning signs, break the code of silence by talking directly and openly about your concerns. Then, connect your loved one, friend or coworker to the support he or she needs to stay safe and get back to traveling on the road of emotional well-being. 

Nationally, the National Suicide Prevention Lifeline is available 24 hours per day at 800.273.8255. Ozark Center, the behavioral health division of Freeman Health System, is a great local resource. Visit ozarkcenter.com to learn about services offered. Additionally, Ozark Center crisis services are available 24 hours per day and are staffed by highly trained mental health professionals. You can reach the Crisis Helpline at 417.347.7720 or 800.247.0661. Ozark Center’s TxtAboutIt program is a secure, anonymous communication service that anyone can begin using by texting REGISTER to 720-7-TXTOZK. The Ozark Center crisis services team offers free depression screenings to adults, youths and children daily – call 417.347.7600 for more information.

Help is readily available. Remember that people do recover from emotional setbacks and depression.  

Many of us tend to wait until the new year to think about getting fit or starting a fitness program. Why not get a jump start this year instead and fall into fitness? Fall is the perfect time of year to begin a fitness regimen – the weather is cooler and the beauty of the changing leaves is the perfect setting for an outdoor workout. Additionally, you’ll enjoy the holidays even more knowing you are going to have additional calorie burned to help offset those holiday treats. It takes approximately one month for a new behavior to become a habit, so follow the tips below to get started moving now.

Determine why you want to get fit
Determine why you want to get fit – your reason will help your decision stick. Maybe you want to lose weight, prepare for a 5K or have more energy. Your “why” will motivate you to stay on track with your plan for the next 30 days.

Enjoy fall weather
The cooler temperatures are a nice change from the heat of the summer. Fall is a perfect time for a hike, bike ride, walk or run. Check out the many local trails in the four state area by visiting livesmartswmo.com/move-more/trails. Let your kids take turns picking out a new trail to visit on the weekends.

Exercise safely 
With the days getting shorter, take precautions to exercise safely in the evenings. Wear reflective clothing, carrying a flashlight and use areas free of traffic such as a trail or school track. 

Dress appropriately
Wear a couple of layers of clothing when exercising during chilly mornings. Also, choose wicking clothing that pulls moisture away from your skin.

Team up for fitness
Accountability helps us follow through on a commitment to exercise. So, get a workout partner and put the dates on your calendar. Treat these appointments like any other daily commitment. Plan outdoor activities on the weekend with your kids or family members that you can look forward to during the week. 

Make a change this fall and start your fitness journey instead of making excuses, such as “I will get fit in the new year.” The 30 days will be up before you know it, and you will have developed some great habits for 2016!

In this blog post, the compassion continuum discussion continues using the pool metaphor. The pool refers to adults in children’s lives, i.e. adults are pools full of sources to share, or provide resources, to children. Hopefully, the water hoses coming into the swimming pool are keeping pace with the amount of water going out due to evaporation, splashing, and filters. High water levels are dependable under these conditions. Leaks in the pool will drain the water level, however. When water loss comes outside the healthy outlets, compassion fatigue is a likely result. While burnout is a work-overload issue, compassion fatigue is an emotion-overload issue. This place along the compassion continuum refers to all the usual routes of water loss and hoses being in operation, but holes are also in the pool. Like little punctures in the pool’s walls, these subtle leaks can be experienced as a constant stream of feelings such a feeling of being overwhelmed due to the emotional nature of the work.

Compassion fatigue occurs when coping skills are exhausted and/or dysfunctional. Coping skills involve mental effort to be aware, tolerate and effectively manage emotions involved with child-serving work. When internal capacity is compromised, the result for the helper is a wide variety of defensive emotional reactions. For example, if a person has difficulty with saying “no” to new requests for help, the workload is not the issue – the issue is emotional stress. A helper may experience feelings of hopelessness he or she applies more effort with little to no changes in circumstances due to situations beyond the helper’s control. 

Prolonged exposure to overwhelming situations can result in a helper adopting a defensive stance. In other words, he or she is in fight, flight or freeze mode in helping efforts. Fight mode can cause a person to be irritable and defensive about preserving the remaining resources available. An example may include a person who avoids situations or complains when receiving requests through the usual “hose out” venues. Yet, since the water is leaking through holes in the side of the pool, resentment may build against the typical giving activities. The helper resists swimming.

Flight mode can include feelings of disconnectedness and/or being “out-of-touch” with the usual helping activity. The helper is hesitant to approach activities out of fear of more water loss. He or she may feel that helping does not have a good cost-benefit ratio. The helper may ask him or herself, “Why bother?” The helper is reluctant to swim.

During freeze mode, a helper may be bogged down and thus not able to participate in the activities fully. An example may include a person who has difficulty actively listening, empathic highlights, case conceptualization or determining best-fit technologies or procedures. People who are experiencing compassion fatigue may also be identified by frequent absenteeism – or worse, presenteeism – in which they are physically present but emotionally absent. The helper is weary and paralyzed from swimming.

Regardless of the defensive posture above, the results are similar: the helper does not engage in the swim.

Signs of compassion fatigue:

• Physical ailments such increased sickness and/or exhaustion 
• Difficulty with concentration, morale, motivation
• Reduced ability to feel sympathy and empathy
• Angry, cynical, irritable or out-of-proportion reactions to events 
• Increased use of alcohol and drugs
• Loss of healthy client boundaries and motivation to help 
• Decreased sense of enjoyment
• Increased isolation
• Disruption to world view, heightened anxiety or irrational fears
• Intrusive imagery or dissociation
• Hypersensitivity or Insensitivity to emotional material
• Difficulty separating work life from personal life
• Impaired ability to make decisions and care for clients
• Contributing to a toxic interpersonal environment

Travelling when you have diabetes can pose some challenges; however with proper planning, your trips will be fun and worry-free.

A change in your normal routine may increase your risk of high or low blood sugar. Often, when you are traveling, you are walking more. On the other hand, you may be eating more unfamiliar foods that you are not able to count as easily into your meal plan. Keeping your meter and extra strips with you will help you closely monitor your blood sugar. Certainly, if you are not feeling well, you should check your blood sugar.

Make sure to bring nonperishable snacks, such as  glucose tablets and juice boxes, in case meals are delayed. Keeping these snacks close by will make it easier to treat low blood sugar. If your blood sugar has dropped to less than 70 mg/dL, you’ll need to consume a fast acting carbohydrate such as the glucose tablets or juice mentioned above.

If you are going to be gone on an overnight trip, make sure to bring extra medication or emergency prescriptions in case you are delayed getting back home. An insurance card and emergency contact phone numbers will help if you run into any medical emergency along the way. If traveling by air, ask your physician for a note to help you get diabetes supplies through security at the airport. Also, research where to find medical care in the area can be helpful. Other supplies that are helpful to have with you while traveling include: extra batteries, cell phone, medical alert bracelet, waterproof insulated bag or cooler for insulin, comfortable shoes and an extra pair of socks.

Most of all, remember that getting away from your day-to-day routine should be fun and enjoyable!

As soon as a body lands in the pool, water is pushed out to make room for the plunging object. Since the water has no other place to go, it shoots upward and outward. A precision dive might produce a slight splash, but a cannonball splatters and leaves a ripple effect. Within the compassion continuum, similar risk exists for caring child-serving adults who help children during intense emotional situations. Calm waters can be disturbed by unfortunate events. Without an awareness and after-care plan for the possible cannonball, the helper may be vulnerable to significant water loss of their own.

Vicarious trauma and secondary traumatic stress can impact the helper’s own emotional state. These two terms are similar because the starting point of the water splatter is not due to the helper’s own events in the moment – rather, the helper intends to be a resource and knows that being authentic is crucial to build rapport. The helping alliance brings a person-to-person connection, with the helper serving as a resource. The helper must keep his or her heart open to let their sources pour in the direction of children. During the helping relationship, however, an event that acts like a cannonball can happen. After the cannonball, the helper may be experiencing waves of emotional distress, challenging the helper’s strength.

Vicarious Trauma
When vicarious trauma occurs, it’s as if two swimming pools are next to each other. The helper is one pool. In this place, the helper is empathetic and sensitive to the needs of the children. The helper is aware and ready to respond to the children’s needs. Openness is necessary for the relationship to be beneficial.

However, exposure to someone else’s trauma can disrupt the calm pool of the helper. In the second pool, when the person being helped experiences an unfortunate event, the situation could catapult like a cannonball into his or her swimming pool – leaving water to splatter across and begins to ripple the water in the helper’s pool. A swell of emotions impacts the helper due to empathy. The helper may be keenly able to identify with the other person’s pain and loss – so much so that the helper is now flooded with the intense emotions of the other pool. The unfortunate event did not happen for the helper, but he or she may react as if it did. The helper may be exposed to pictures, sounds or other sensory input that is overwhelming. He or she is able to imagine the pain and loss of the other to the point that it feels so real. At the vicarious trauma point along the continuum, the helper is underwater due to waves of empathy.

Secondary Traumatic Stress
Secondary traumatic stress happens when the cannonball splats into the helper’s pool! During secondary traumatic stress, sensory immersion takes place: heart racing, sweating and confusion. A helper may experience secondary traumatic stress if his/her own history is similar to the child’s. The helper may be reminded of his or her own challenges, and this realization can activate the threat mode and produce a defensive reaction. If the helper is not self-aware and using self-care strategies, unanticipated events can burst in like a waterfall as if the helper had no warning signal. This surprise can bring disorientation and survival reactions. Additionally, the helper may be exposed to elements of the cannonball through another person but internalize possibilities for him or herself. For example, if child is in a crisis situation that has a lot of similarities to characteristics of the helper’s own life (e.g., same kind of car in an accident, same age of child, or the “that could have been me” realization), a helper may feel the weight of fear. Similar to the first hand experiences of those who are helped, the helper may then proceed to his or her own first hand experiences with intrusive memories, second guessing, and other avoidance and alarm reactions. At the secondary traumatic stress point along the continuum, the helper feels as if he or she is sitting empty and frightened.

Vicarious trauma and secondary traumatic stress prevention and intervention strategies:

• Use checklists to frequently evaluate stress levels
• Participate in healthy self-care in the areas of thinking, feeling and doing
• Utilize mindfulness practices
• Engage in reflective supervision

The health insurance marketplace opens for enrollment on November 1. According to the Affordable Care Act, most Missourians are required to have health insurance or pay a penalty. 
 
To date, nearly 254,000 Missourians have obtained coverage through the Missouri Health Insurance Marketplace, according to the U.S. Department of Health and Human Services. In the past enrollment period, 90 percent of Missouri Marketplace enrollees qualified for premium tax credits to lower their costs, which lowered the average premium payment from $363 to $85 per month. 
 
Additionally, the United States Supreme Court voted to uphold subsidies for health insurance purchased through federally-run marketplaces like the Missouri Marketplace in June. Thanks to this ruling, Missourians who rely on this financial help don’t have to worry about choosing between health insurance and other basic needs – vital health services will continue to be available at an affordable cost.
 
The Cover Missouri Coalition works to build awareness, facilitate enrollment, increase health insurance literacy and support Medicaid transformation. As part of Cover Missouri, Freeman participates in the coordinated statewide outreach effort during open enrollment to help our neighbors get covered.
 
Please contact the Freeman Marketplace Team at 417.347.8888 or toll-free, 855.355.PLAN (7526) to visit with one of our certified specialists. You can learn more about financial help and coverage options or schedule an appointment. For additional information, visit covermissouri.org or call 800.466.3213 for the Cover Missouri call center. Don’t delay – open enrollment ends January 31, 2016!

The American Academy of Pediatrics recommends exclusively breastfeeding for about the first six months of a baby's life, and then gradually adding solid foods while continuing breastfeeding until at least the baby's first birthday. The first few days after your baby’s birth are important for establishing a successful breastfeeding relationship. Try these tips to get the process started:

Breastfeed within the first hour after delivery. Tell your health care provider you would like to breastfeed as soon as possible after delivery. The best way to accomplish this and help your baby transition outside the womb is to place your baby skin-to-skin on your chest.

Keep your baby with you in your room at the hospital. Your baby can stay with you from delivery until discharge if both of you are stable. Rooming in allows you to get to know each other. Newborns are often sleepy in the early days and rooming in will help you learn early hunger cues. Additionally, families usually rest better knowing baby is safe and content beside them.

Breastfeed on demand. This means to breastfeed as long and as often as baby desires. Watching for these early hunger cues will help in getting frequent feedings:

• Starting to wake
• Smacking or licking lips
• Opening and closing mouth
• Sucking on lips, tongue or hands

Try to avoid artificial nipples, such as bottles and pacifiers, for the first few weeks. The American Academy of Pediatrics recommends waiting until breastfeeding is well established, about 3 weeks for most babies, before introducing a pacifier to a breastfeeding baby. Pacifiers can keep you from noticing early hunger cues and can interfere with a baby learning to breastfeed.

Breastfeed exclusively. Only offering breast milk to the baby encourages a better milk supply to be established. The first two weeks after delivery are when prolactin, a hormone that helps make breast milk, increases to produce adequate milk for the baby. Plenty of time spent with your baby breastfeeding and holding him or her will aid in stimulating prolactin levels.

Source: Missouri Show Me Five Hospital Initiative link: http://health.mo.gov/living/families/wic/breastfeeding

“The greatest healing therapy is friendship and love.” – Hubert H. Humphrey, Jr.

I recently received an invitation apply for an award to recognize Freeman WellBalance, our employee wellness program, for its social wellness offerings. I have been promoting wellness for over 10 years and have never been asked specifically about our social wellness initiatives. Typically, when we think of wellness or health promotion, we often reference or expect to see information on healthy eating or increasing our physical activity. Both of these areas of wellness have a social component, but you may be wondering, what is social wellness?

Social wellness has been described by the University of California as one's ability to interact with people around them. It involves using good communications skills, having meaningful relationships, respecting yourself and others, and creating a support system that includes family members and friends. It’s important to note that face-to-face interaction with friends and loved ones is crucial for social wellness. We may feel that we engage in social wellness on a regular basis through social networks such as Facebook and Twitter, but those interactions do not take place in person.

Research shows there is a direct correlation between the degree to which a person feels connected to others and mental and physical health. Individuals who don’t feel connected to others have a greater likelihood of developing chronic illness, such as diabetes and heart disease, than someone with strong social connections. They may suffer from more occurrences of cold and flu and/or take longer to recover from illness. These individuals may also be more likely to develop depression and to have lack of energy or interest in activities. It has also been noted that they may have shorter lifespans.

Here are a few ways you can help improve your own social wellness:

• Set a time to meet in-person with a family member or friend you haven’t seen in a while
• Volunteer your time at a local event or nonprofit
• Invite a friend for a walk or hike
• Make a habit of logging off social media when you are in a group setting
• Develop good listening skills and stay present when people are talking to you

Take time this week to try one of the ideas above and see if you have more energy or excitement for life. 

When the weather begins getting cooler, nothing is better than a bowl of delicious, hearty chili to warm you up! This recipe for garden harvest chili is chock-full of fall vegetables – and it’s diabetes-friendly.

Ingredients

• 1 medium sweet red pepper, chopped 
• 1 medium onion, chopped 
• 4 garlic cloves, minced 
• 2 tablespoons canola oil 
• 1 tablespoon chili powder 
• 1 teaspoon ground cumin 
• 1 teaspoon dried oregano 
• 2 cups cubed peeled butternut squash 
• 1 can (28 ounces) diced tomatoes, undrained 
• 2 cups diced zucchini 
• 1 can (15 ounces) black beans, rinsed and drained 
• 1 can (8-3/4 ounces) whole kernel corn, drained 
• 1/4 cup minced fresh parsley 

Cooking instructions
In a large saucepan, sauté the red pepper, onion and garlic in oil until tender. Stir in the chili powder, cumin, oregano, butternut squash and tomatoes; bring to a boil. Reduce heat; cover and simmer for 10-15 minutes or until squash is almost tender. 
Stir in remaining ingredients; cover and simmer 10 minutes longer or until heated through. 
Serves 7. Nutritional analysis per serving: 193 calories, 5 g fat, 0 g saturated fat, 0 mg cholesterol, 167 mg sodium, 33 g carbohydrates, 0 fiber, 8 g protein. 

Like many holidays, Christmas can be a challenge for those on the autism spectrum. Holidays often disrupt routines and bring an array of new foods, sounds and smells – all of which can be overwhelming or distressing for individuals with autism. By planning ahead, you can help your child have an enjoyable holiday.

Family gatherings
To prepare your child for a family gathering, start by telling a story with visual clues to let him or her know what to expect. He or she will want to know when the gathering will start, when it will end and the activities that are planned in between.

Bringing a reinforcing item can also help. For instance, if your child likes a particular video game, and you have a large and family gathering coming up, don’t allow the child to play the video game the day before the event. Then, during the gathering, make the game available to your child. Your child may also have specific food preferences for meals – pack a sack lunch if your child won’t enjoy some the foods that will be served.

Try talking with your family ahead of time to address your child’s needs. For instance, your family may want to arrive to the party a little early so your child can adjust, and you may need to leave early as well. Ask if there is a quiet place where your child can rest if needed. The party’s hosts may also want to make a few arrangements in their home before you arrive – for instance, if your child likes to open doors, they may want to lock all doors they do not want opened. If your child likes to tap on objects, it may be a good idea for glass and other breakables to be moved out of reach.

Your family members may ask you for ideas for appropriate gifts for your child. As with all children, receiving a lot of gifts can be overwhelming for your child. Let your family members know about your child’s individual interests, preferences and strengths. Gift certificates for activities that your child enjoys, such as a bounce house or roller-skating, make great gifts.

Decorating for the holidays
Holiday decorations around your home can be disruptive for your child. My best tip is for parents to remember that their vision for their home for Christmas may not quite match up with the reality of how your home will actually look – and that’s OK! Consider selecting decorations that are child friendly, non-breakable and interactive. Instead of worrying about what your family or neighbors might think of your decorations, try looking at Christmas through the eyes of your child. Your child will always have special memories of how you decorate your house. If your tree is decorated with toy cars only, that’s alright. If decorations have to be hung five feet or higher on the wall, that’s OK, too! 

Holiday travel
Whether traveling by plane or car, pack comforts of home for your child. Having familiar items can be comforting during stressful situations. For instance, if a special blanket or pillow would make your child more comfortable at night, bring that along. If your child uses a special bowl or spoon during breakfast, bring this item, too! Pack your child’s reinforcing items. Be sure to go over all the plans with your child so he or she knows what will happen in advance. Try not to cram too many activities in a short period of time, and schedule in rest time once you’ve arrived at your destination and in between activities.

Holiday family photos
Family photos are a wonderful holiday tradition. Whether planning for a large family photo at a gathering or a photo for your Christmas cards, it’s important to remember some children with autism have difficulties making eye contact with a camera. A photographer friend of mine had a great tip for photographing children with autism – try not to have the expectation that the child has to make eye contact with the camera. Instead of having everyone smiling and looking at the camera, have everyone interacting with each other in the photo and smiling. Mom or Dad can interact with the child. This will put less pressure on your child for the photo, and you’ll still get a wonderful family photo and great memories to look back on for years to come.