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Another New Face!

I am excited to welcome Kate Patterson, MSEd, BCBA, LBA to the Treehouse family! You can find Kate’s full bio on our “Clinicians” page, but Kate is a wonderful behavioral analyst who works with kids and families on behavioral strategies to help with autism, ADHD, problematic behaviors, and other issues. Kate and I go way back, having been in marching band together at Albemarle High School, and she remains as hard working and committed as she was back then. When I saw she was working in mental health, I knew I wanted her at Treehouse. If anyone reading this has a child with any difficulties managing behaviors, family relationships, life skills, sensory issues, or anything else, I strongly suggest booking at least a consultation visit with Kate to see how she might be able to help.

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Exciting News

We are excited to welcome a new mental healthcare pracitioner to the Treehouse family!  Julie Roebuck is a Psychiatric Nurse Practitioner with many years of experience caring for children and adults with a wide variety of mental illnesses. She currently teaches at the UVA Psychiatric Nurse Practitioner program, but will be a valued member of our team, working part-time at Treehouse!

In further exciting news, the Treehouse office is likely to be moving very shortly to a nice, new space! It’s not far from the current office, located in an office building at the corner of Branchlands Blvd and Incarnation Drive, essentially right behind what used to be Toys R Us (now Big Lots). Treehouse is purchasing this space, and the mortgage process is moving along, but not done yet, but at this point we’re not expecting to hit any snags and will hopefully be in the new space by June or July at the latest.

In the meantime, we are continuing with COVID-19 precautions and doing all appointments from home via telemedicine for the time being. We appreciate everyone’s patience with all the new systems and processes that have been required for this to work, but I think it’s gone pretty smoothly!

If anyone has any questions or concerns, as always feel free to email me at drheck@treehousechildpsychiatry.com

 

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Coronavirus Update

As you’ve all probably heard, there’s a pandemic going on. It’s pretty serious, actually. The single best thing we can do is to practice physical/social distancing in real life, to try and limit the spread of the virus as much as possible. Doing this will hopefully help keep our medical system from getting overwhelmed so when people DO get sick (with anything) we can help them. If the system gets overwhelmed with coronavirus patients, there won’t be enough resources or staff to save everyone, regardless of what brings them to the hospital. So it is of upmost importance that everyone engage is pretty extreme isolation by modern standards for the time being.

To that end, for the time being, Treehouse Child Psychiatry is moving to telemedicine visits for all in-person visits. At the same time, we are starting the process of migrating from Luminello to a different electronic medical record system, CharmEHR. Charm has built in telemedicine capabilities, which was one big reason for the switch.

Another reason for the changeover is that in the next few months, we are very likely adding a new member to our team, a nurse practitioner with many years of experience. She is wonderful, and I may be asking if some of you might want to transfer to her care (especially adult patients, anyone who would prefer a female provider, anyone who needs a slightly more affordable alternative, or anyone who is just tired of seeing me and wants to see someone else haha.)  It’s not official yet, but we’re hoping to have that in place by June or so, and CharmEHR allows us to share the practice records across the board.

Finally, if all current patients could take a second and fill out this quick form to update your contact info/emails that’d be fantastic:  https://drive.google.com/open?id=1sxY4_h2crZ7JGEgzaYGDJDI08UB0nsisRS4DPv-z9lc

 

 

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All About ADHD (aka “Brain Asthma”)

Imagine a world in which you have asthma (a disease where the lungs don’t work well, making it difficult to breathe), and in this world, asthma is not well understood by most people or even most doctors, and is not commonly diagnosed or treated.

In this world, school consists of nothing but gym class. All day. Just gym class where you have to exercise all day…with asthma. You come home from school and have to do “exercise homework” (with asthma). Your parents ask you to do “exercise chores.” They tell you that when you grow up you have to be able to do exercise if you want to be successful and not homeless. Society, in all it’s subtle ways, tells you that you have to be athletic to be well liked and successful. Everyone on TV shows and commercials are good at exercising and happy when they do it. The kids on TV are happy when they get into the best “Exercise Ivy League Universities” and sad if they don’t.

Remember, in this world, you have asthma, and exercise is very difficult for you.  How difficult? Well, that depends on how severe your asthma is and how demanding the exercise is. For the purposes of this thought exercise, for now, let’s say you have moderate asthma.

You start Kindergarten. It goes ok. They make you exercise a tiny bit, but it’s mostly playing, learning some rules of the various sports, and just sort of trying to build some basic skills more than truly testing your endurance or fitness. No one, not teachers or parents, is concerned about your performance. 1st and 2nd grade go ok too. The exercise still isn’t too hard for your moderate asthma, and you do alright. 3rd to 5th grade go mostly ok, and although your grades are still good, you have started to notice that you’re not quite the same as the other kids, and they’ve started to notice too, and maybe one or two kids have started to tease you about being slow or different. But you push yourself, and your grades are still fine, so still teachers and parents don’t really notice, except that you tell your parents that you “hate” doing exercise chores and homework at home, but every kid hates those things, it’s normal…right?

Middle school starts and now the exercise work gets difficult. You’re having to run farther and faster each year, and even when you push yourself, you can’t quite keep up. Your grades start to drop and the stress starts to show to your parents, teachers, and friends. You start to become a perfectionist about your school work, overanalyzing every aspect of your stride, trying to maximize efficiency and squeeze every drop of performance you can out of your poorly performing body, because you want to succeed, and almost can, but despite all your efforts, can’t quite live up to your own expectations. Your self esteem begins to decline further, adding more failure to the already-present sense of being different or not good enough from elementary school. You begin to feel even more judged by others, especially your peers (other kids). You begin to be anxious in social situations (which, of course, involve exercise in this horrible world), worrying that they’ll notice that you’re different.

The years go by, the exercise getting harder and harder each year, your performance getting worse and worse, and your self-esteem getting lower and lower. You begin to get depressed, as someone with asthma would do if they were forced to run every day with untreated asthma. You are visibly anxious about attending school, and sometimes might beg to stay home. Your parents might take you to a doctor who thinks you have depression and anxiety and starts you on an antidepressant (the proper treatment for these conditions), but it doesn’t work. You get more hopeless. You go to therapy but that doesn’t work either. Everyone is at a loss for how to help you. “Maybe you’re just lazy? You just need to try harder,” your parents say. Teachers say, “She has so much potential…”

Sounds pretty awful huh? This is what everyday life is like for the average person with moderate ADHD living in our world. Now, let’s make a couple adjustments to the analogy to fit a few common variants of ADHD.

In our earlier version, we had “moderate” asthma.  Let’s imagine a child with SEVERE asthma. His parents don’t believe in medicine. “I ran just fine as a boy,” dad says. “If I didn’t my daddy would whoop my behind. That was all the motivation I needed to run. I don’t want my kid to have to depend on medicine to function.” This child, with severe untreated asthma, would do poorly in school nearly from the beginning. They’d probably hate school early on. They’d have tantrums to get out of going to school. They’d have tantrums when asked to do their exercise chores or their exercise homework. They’d get grounded often for this behavior at school and at home. They’d quickly begin to resent their parents for forcing them to do this thing that feels like torture to them, then grounding them for not wanting to do it. They’d begin to get oppositional to everything their parents ask of them. As school goes on and gets harder, at some point (if their asthma was bad enough) they might just quit school and refuse to go back, becoming high school drop outs and essentially dropping out of society. If their asthma isn’t quite THAT bad (more moderate-severe asthma), they might finish high school and find some specialized niche field that doesn’t require much exercise (or much school), some trade like being a plumber, in which they could function with minimal school/exercise.  But they’d look back and say “I wasn’t too good at school and hated it. College wasn’t for me.”

Finally, let’s imagine someone with mild asthma, who is also “gifted” with very long legs. This person still has asthma, but is able to do the work and get by. Their academic struggles go unnoticed much longer due to the combination of mild asthma and long legs. They still feel some low self-esteem because they can tell that it’s harder for them than for others and that they have to push themselves pretty hard to not mess up in gym school, but in the end they can do it if they push themselves. They mostly fit in with others, so there may be less social anxiety (though there can still be some). Still, at some point, if they continue in school, the demand of the work might eventually overcome their symptoms and they might begin to struggle, but this might not occur until 11th grade, or college, or even graduate school, or even adulthood (which can itself be quite difficult). They might begin to develop some rather extreme coping strategies to deal with their struggles: they might start to train constantly, trying to improve their performance. They might (like our moderate example did) become perfectionists, over-analyzing their every movement to find and correct an inefficiency. They might become super stressed “Type A” individuals, driven but very neurotic.

Hopefully you can now see what life is like for many people with ADHD and how much it can vary from person to person. The more severe the symptoms are, the more obvious and great the struggles. But mild to moderate symptoms often go completely undetected and people just try to live with it, at the cost of high stress and anxiety. This is not to say that ALL people with ADHD fit these molds, but these patterns are evident in the vast majority of cases that I see, and are widely misunderstood and under-recognized.

Now that you understand the concepts, we need to talk about a few things that are specific to ADHD and don’t really fit my asthma analogy very well.

First, a quick note on naming.  The formal name is “Attention-Deficit/Hyperactivity Disorder.” (Yes, with the dash and slash in those places.) There are three types: hyperactive, inattentive, and combined. ADHD, inattentive type is what laypeople commonly call “ADD” (though this is no longer a technical term for the illness). It’s basically ADHD without the H (hyperactivity), and hence “ADD”. Personally, I actually prefer ADD to the mouthful “ADHD, inattentive type” and you’ll hear me use both ADD and ADHD somewhat interchangeable. But yes, technically a person with just the inattentive type and no hyperactivity still technically has “ADHD.”

I’ve always said doctors are terrible at naming things, and psychiatrists are the WORST at naming things. We have a condition called “DISruptive Mood DYSregulation DISorder.” OMG. In my opinion, ADHD should actually be called “Executive Function Disorder”, because really, what it affects, is what we call “executive function.”

There is a whole checklist of symptoms, which you can easily google, so I won’t bore you with it here. If you’re my patient, we’ve gone through these in the visit. But the big ones are disorganization, poor attention/focus, procrastination on tasks that require attention, poor planning skills, forgetfulness, losing or misplacing items, impulsiveness, hyperactivity, etc. Interestingly (and most egregiously to me) you won’t find “low self-esteem” or “social anxiety” anywhere on the ADHD checklist, but these are BY FAR the two most common symptoms I see in ADHD patients, especially the self-esteem damage that comes from making little mistakes often.

Actually, in some ways, it’s almost like many patients with ADHD are “traumatized” by mistakes and failures. If they have a mistake, setback, or failure, it’s like they become “triggered” by it, in the same way people with PTSD are triggered by their more “typical” traumas. They can become angry or very sad, often very quickly. They might try to avoid thinking about the mistake, sometimes by lying about it, even if caught red-handed! They might refuse to do something that they’re afraid they’re going to mess up (a new task for example, or an old task they feel they’ve messed up before), or they might procrastinate on a task to avoid messing it up. Psychologically it hurts less to get an F on a paper you didn’t even try to do than to get a C on a paper that you tried you HARDEST on. So this type of failure/mistake avoidance is pretty common.

ADHD is strongly genetic. If one parent has it, there is around a 60%+ chance that their child will have it (I think this is a low estimate though). It is extremely common for it to run in families. If anyone is the family is diagnosed have a strong suspicion and keep a close eye on others. Untreated ADHD causes a lot of issues, but is so easily and effectively treated (especially compared to most other mental illnesses) and letting it go untreated is often tragic. I always mention that patients who do not get their ADHD treated as kids, by adulthood are at increased risk for car accidents, substance use, going to jail, and unplanned/early pregnancies (plus the low self-esteem, depression, anxiety, and social anxiety we already covered.) I tend to to have a high level of suspicion for the diagnosis when any of these things are present in families: family members in jail or on drugs, having children in high school or at 18-19 years old, etc.  Studies show that people with ADHD are likely to hang out with other people with ADHD, so friends and romantic partners of people with ADHD are also likely to have it. Studies also show that therapy is less likely to be effective if ADHD is untreated. People with ADHD have trouble paying attention to most everything, why would therapy be any different.

A quick word about screens/electronics/social media. One thing I often here, often on-line, but sometimes from parents is: “my kid doesn’t have ADHD, he can focus on that darn video game for hours!” This is a common misconception. ADHD brains WANT to focus, they just have trouble doing so and are easily bored. Give them something that is stimulating enough to keep their attention (and what is more stimulating than video games?) and they can HYPERfocus for hours.  It’s actually not a LACK of attention, it’s DISORDERED/broken attention.  When everything in your world is boring or hard for you, and you finally find ONE THING that you enjoy and want to do, wouldn’t that be all you’d want to do? Hence, ADHD people are more apt to become “addicted” to games and electronics. At the same time, we know that too much screen time also worsens ADHD symptoms, so it’s better if we can get ADHD people to be on screens less. Our current epidemic of screen use is probably making a lot of ADHD symptoms worse, even turning many people who were “sub-clinical” before screens, into “clinical” (it’s a problem for them) after screens.

ADHD actually has some advantages! There are some good things about having it. On average, people with ADHD have above average intelligence (these are the “long legs” in my asthma analogy above). They think FASTER than average (sometimes TOO fast). There is a famous saying: “The ADHD brain is a Ferrari engine with bicycle brakes.” It goes 0 to 100 instantly and has trouble stopping. This is evident in many ways, but most obvious with emotions, so it’s common for people with ADHD to have very quick mood swings, getting irritated or angry quickly if something sets them off, for example. Or getting extremely excited instantly.  Finally, people with ADHD almost universally have excellent creativity and outside-the-box thinking. They tend to excel in artistic or creative fields, or make excellent inventors or theoreticians. Many highly successful people have (or had) ADHD. A recent university study concluded a high likelihood that Leonardo DaVinci had ADHD. DaVinci was always late on his paintings, did many projects at once, was never happy doing just one thing (inventing, painting, sculpting, anatomy, etc). ADHD is a super-power. It affects around 10% of the human race (depending on whose estimates you believe) and without ADHD we probably never would’ve invented things like fire: “What happens if I rub these sticks together REALLY REALLY FAST?”  Such an ADHD thing to do!

I hope this gives anyone reading it a better understanding of what ADHD/ADD is like for those who have it, and for the myriad of different ways in which it presents clinically. The hyperactive version is readily diagnosed by parents and teachers because it is painfully obvious because they are bouncing off the walls. The less hyper, more inattentive type goes heavily UNDER-diagnosed because it is so poorly recognized, or mis-recognized or mis-diagnosed as pure depression or anxiety or “mood swings” or “just a teenager,” etc.  None of these things could be further from the truth.

 

 

 

 

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Important Announcements

Hello Treehouse Family! It’s been a while since my last blog and I wanted to update everyone with some exciting and important changes happening at the office.

First, the bad news: As of September 20th (tentatively) we will no longer be accepting insurance plans from Aetna or Optima. Unfortunately, the lost income, time, and expense of taking insurance is simply not sustainable for a small, one-person office, and the time I’ve had to spend dealing with insurance-based headaches is simply unsustainable. I realize this may impact some of you financially to the point that you are no longer able to see me due to the cost of private visits. If that is the case, let me know and I will endeavor to find you care, though if you must use your insurance, the only options in the Charlottesville area are likely UVA or your primary care doctor. The other option is to see me and file your own insurance as an “out of network” visit. Reimbursement for this can vary a LOT and depends on your deductible and out of network copay, so check with your insurance plans and see if you can determine whether the visits will be affordable if you go that route. Some patients I have who file for out of network visits get a substantial amount of money back. Please know I have agonized over this decision for months, but in the end, it has been made for me by the insurance industry.

In other news, I have always tried to make it a priority to provide excellent communication between myself and other care providers (primary care physicians, therapists, etc). I feel like that is not going as well as I would like, partially due to the time I’ve had to spend dealing with insurance-based problems, but also due to not having a good workflow for this. That is also changing now. It would help me greatly, if everyone could fill out the Google Form below (all info is HIPAA protected, I pay extra for that) with the names and contact info (phone, fax, and email) of everyone on your child’s care team. This will go into a spreadsheet on my end that I can use to coordinate communications, as several of my patients see the same doctors/therapists.

Contact Form Link:  Provider Contact Survey

There are also some relatively minor upcoming changes to office policies, which will be detailed further in a new “office policies” form, but the main change is that we will be requiring credit cards be kept on file and will begin charging for missed visits. Early on, I was able to waive missed visit fees because we could simply reschedule for the following week, but now my schedule is so full this is no longer possible and missed visits not only result in lost income, but more importantly, waste time that could have been used by someone else in need. We can also use the cards on file to pay any outstanding balances that weren’t taken care of during the visit (though this will be more rare once we move off insurance, which is the primary reason for not taking care of balances during visits).

Finally, we are continuing the search for more mental health clinicians to join Treehouse!  I have a couple therapists I’ve talked to that are thinking about joining, but if any of you could ask your therapists if they know anyone who would like to come work with me, that’d be great! I have 3 large office spaces in my office that I’d like to get filled! I would like at least one of those spaces to be filled by a Psychiatric Nurse Practitioner or a Psychiatrist, if anyone knows one of those as well!  Once I have at least one more provider joining the office I plan to hire a new front desk person as well.

I know this is a lot of change and change can be difficult and scary, but my hope is that these changes will improve care at Treehouse and will allow me to continue to care for my patients in a sustainable way. As always, I welcome any feedback or other ideas you may have! Thank you for allowing me to care for you or your child.

Dr. Heck

 

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Anniversary Reflections, Insurance, and Lack of Access to Mental Health Care

It has been a little over a year since Treehouse Child Psychiatry opened its doors, and I have to say that I’ve been blessed to have had a great year. I’ve met many fantastic patients and families, learned a lot about running a business, and feel like I have done some good in the world.  There were some headaches with the property association not approving of our sign and having to have a new one printed, and with figuring out how to just function as a solo doctor, but overall I feel like everything has turned out pretty well for the first year of business.

When I first opened, I had made it my goal to at least try to take some insurances. Now, some of you may not know (but I bet most of you do) that the shortage of psychiatrists, and especially CHILD psychiatrists is extreme.  Most practices in the area have wait times of over 6 months for a new patient to see a doctor. I’m told by friends that it’s similar in other areas of the country. Los Angeles, for example, has twice as bad a shortage as Charlottesville per capita.  As a result, few child psychiatrists want to deal with the headache of taking insurance. The payments typically pale in comparison to the average cash rates in the community, and it introduces several paperwork headaches and need to hire extra staff, which incurs extra costs. So, more work, most expense, and less money.  Why isn’t every doctor signing up for that?

The reality is that many patients simply can’t afford the cash rates of child psychiatrists. The going rate in Charlottesville is around $250-300 an hour, or $125/mo for monthly follow up visits.  That’s around $1500 per year.  It’s a lot of money for many families.  Now, for doctors, the shortage is so bad, that we are not hurting for patients even with the cash rates.  But it still leaves many families out in the cold.  So, I made the choice to try my hardest to take insurances.  I requested rates and contracts from all the major insurers when I first opened.  One insurer’s rates were simply too low to even be considered. They were so low that I even emailed them to ask if it was a typo or if I was reading it wrong.  They wouldn’t negotiate.  I had Creigh Deeds file a complaint on my behalf with the insurance board, because since the advent of the ACA (Obamacare), insurance companies are required to pay equal rates to mental health doctors as other medical doctors.  Still, they’ve found creative ways around this provision.

I eventually decided that the rates of two insurers were doable. Optima offered me very fair rates and I signed their contract without much hesitation. Aetna’s rates were less good, well below my cash rates, but I felt they were fair and I could make them work, so I signed the contract and waited.  And waited.  And waited.  It took around 6 months for the contracts to get processed.  I gave up hope that I would ever hear anything and accepted my fate as another cash psychiatrist.  Then in May, I found out that both insurers had processed my contracts and I was now in-network for both.

The Optima process was fairly simple. I made an online account with Optima and waited for the patients to come.  And waited.  And waited.  And…I’m still waiting.  The Aetna patients came. In droves. But we hit a snag. I filed my first claims and they all got rejected as out of network.  I called in early June.  The Aetna rep said that it was a computer glitch and they’d submit a “ticket” and get it sorted out within 10 days.  2 weeks later, I submitted more claims.  All rejected again.  I called again.  Each time I call it’s an hour on the phone. That’s an hour of patients who aren’t getting seen. Lost income for me, but more important lost care to our community. Fast forward to now. I have yet to be paid a dime by Aetna. There’s still a computer glitch showing me, like Schrodinger’s Cat, as both in and out of network simultaneously.  It’s honestly been a nightmare. It’s sometimes hard not to imagine that they’re doing this on purpose. A solution is still pending.

Needless to say, our system is broken. People who need mental health care cannot afford or access it. I am happy to announce that we are taking steps to fix this. My wife and daughter are founding a non-profit organization, Children’s Mental Health Fund (CMHF), to address this issue.  Our goal is to raise money from donations to pay for the care of needy children directly with cash pay psychiatrists.  If we can even pay for a year of care for one child ($1500) it would make all the difference in the world.  That’s 300 people giving $5 each.  I think we can do that.  I think we can do better.  Please note, I’m not asking for money…yet. The non-profit is not yet up and running. But don’t worry, we’ll let you know when it is.

In the meantime, the adventure continues.  I am looking to hire my first employee, a medical assistant or nurse to help with front desk duties and collecting patient vital signs.  If you know anyone with a medical certification who wants a part time job, send them my way.  I am hoping to hire a therapist or two, and possibly another doctor in the next year or so as well.  Maybe by next year, my issues with insurance will be sorted out too, we’ll see 🙂

Dr. Heck

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On Suicide

When I was 15 years old, Kurt Cobain killed himself.  His death was the first time I experienced suicide and the first time I experienced the death of an idol.  I wasn’t a huge Nirvana fan, but being a teenage musician in the early 90’s, it was impossible to ignore Nirvana and I did appreciate their work.  Still, when Kurt died, it rocked the world in a way their music did not.  I remember that most of my friends were essentially in mourning in the days that followed.

As the years passed, I watched as several other musical idols succumbed to suicide or substance use.  I watched as Shannon Hoon of Blind Melon (whose self-titled debut album is absolutely incredible), Layne Staley of Alice in Chains, Scott Weiland of Stone Temple Pilots, and more recently, Chris Cornell of Soundgarden (and possibly the best vocalist of his generation, in my opinion) all succumbed to their mental health issues.  And now we’ve lost another artist, Chester Bennington of Linkin Park (and, briefly, Stone Temple Pilots).  Like 1995, I’m not a big fan of Linkin Park, but I remember being struck by how unique their debut album sounded, and I appreciated some of their standout tracks.  And now, Chester Bennington has also committed suicide…on Chris Cornell’s birthday.

Which brings me to my next point.  So-called “copycat suicides” are fairly common.  It is not uncommon for people, especially young people, to copy the suicide of someone they look up to: a friend, acquaintance, pop-culture icon, etc.  In fact, exposure to the suicide of another person (friend, family member, or anyone you look up to, even someone you don’t actually know in real life) is a risk factor for suicide.

I’ve talked to several artists who have reported that they look up to their idols because of the way they’ve successfully dealt with their mental health issues through their art.  Now imagine how that person feels when the idolized artist kills themselves.  They often feel hopeless, that if this person who they thought was dealing so well with their issues through their art couldn’t overcome it, how can they?   Chester Bennington and Chris Cornell were reportedly friends.  Chester was the right age to look up to Chris as an example, and both spoke openly several times about his own struggles with depression.  Chester’s choice of date and method of suicide (hanging, the same as Cornell) are not a coincidence.  He very likely painfully felt the loss of a friend and idol, and followed his lead.  And now the world has lost another great artist.

With that in mind, if you, or a loved one or friend, are feeling down, depressed, hopeless, or otherwise suffering, please seek help.  If you are thinking about taking your own life, call 911 and go to the hospital.  This is a MEDICAL EMERGENCY, just like a heart attack or stroke.

In the Charlottesville area, we have several other resources available:

  • Region Ten’s 24 hour crisis line (434-972-1800)
  • Madison House Help Line for UVA students (434-295-TALK)
  • National Suicide Hotline (1-800-273-8255)

I’ll add that people struggling with depression often feel hopeless, that things can’t get better.  If this describes you or a loved one, please seek treatment.  Treatment is effective and will almost always help once you find the right treatment(s).  If you’ve tried a few things, talk to your doctor and trying something different.  See a psychiatrist, if you haven’t.  Try therapy if you haven’t.  If you’ve tried one type of therapy and didn’t find it helpful, then try a different style of therapy (there are dozens or even hundreds of types of therapy).  There is a plethora of treatments available to modern mental health, DO NOT GIVE UP.

Check out the American Foundation of Suicide Prevention, and learn some of the risk factors for suicide: past suicide attempts, substance use, having guns at home, stressful life events (job loss, divorce, etc), family history of suicide, and exposure to another person’s suicide (which includes cultural idols, but also real life friends, family, and even acquaintances.

Finally, I can’t leave without mentioning some of the incorrect things I’ve seen said about suicide and mental illness on social media.  I’ve seen several people saying that people who kill themselves are weak and should’ve just “manned up” and “pulled themselves out of it.”  This is like telling an asthmatic to “just breathe” during an asthma attack.  Also, hearkening back to an earlier post about terminology, I would encourage people to learn the correct terminology for the various types of depression.  There is no such thing as a medical diagnosis of “depression.”  What people lump under “depression” is actually several totally different conditions such as Major Depressive Disorder, Adjustment Disorder with Depressed Mood, Bipolar Depression, Dysthymia, Depression due to a Medical Condition, Depression due to a Substance, and several others.  Each of these is separate condition with it’s own etiology and treatment.  We do patients and ourselves a disservice when we simplify this down to “depression.”

Remember, if you’re suffering, Seek Help.  Don’t Give Up.  

Psychiatry, Uncategorized

You Should Know Correct Mental Health Terminology (OCD and Bipolar are not what you think they are)

I am SO bipolar.

Everyone messes up basic mental health terminology. Why is this important? Well, I feel that using the terms in casual way only serves to further trivialize and stigmatize mental health disorders and people who suffer from them and impedes the education of others about appropriate mental health terminology. It trivializes the disease and those suffering from it to use these terms incorrectly.

With that being said, here are a few common mistakes:

I am so OCD.

Usually said in reference to being a “neat freak” or being really particular about the way you want something to be, such as wanting your desk or room organized a certain, specific way, color coding your closet, or alphabetizing your music collection.

This is not OCD

It’s actually closer to OCPD (Obsessive Compulsive Personality Disorder), but it’s not really that either. OCD is when you have an obsession (i.e. “There are germs on my hands, I have to wash them off”) and a compulsion (washing hands repeatedly) and act on these obsessions and compulsions repeatedly to the point that it interferes greatly with your life. Like, you can’t function at work because you’re too busy washing your hands all day. Common variations of OCD include washing, counting (even/odd numbers, stairs, switches, etc), and checking behaviors (have to check all the locks in the house 5 times, every time).

Being really neat or particular is closer to OCPD. OCPD is a “personality disorder” (terrible name, but that’s a different blog) in which people are SO particularly about the way something is that it interferes with their life. For example, someone spends so much time formatting a spreadsheet so the columns are exactly the right width and color that they never finish it and their boss gets mad. Repeatedly, so they get fired. Or someone is SO particular about the way their things are that they can’t keep friends or relationships because they’re constantly yelling at people for messing up their stuff.

If it’s not interfering with your life, it’s not OCD or OCPD. Lots of people do little things that are OCD or OCPD-like. I used to alphabetize my CD’s (when CD’s were a thing). Not OCPD, but maybe an OCPD trait. I tend to keep my thermostat set on even numbers. Not OCD, but maybe an OCD-like behavior. No big deal. Unless it takes over your life or causes you problems.

OMG, I am so bipolar!

“Bipolar” does not mean mood swings.

Say it again with me. “Bipolar” does not mean mood swings. Well, it kind of does, but not the kind of mood swings people usually talk about when they talk about bipolar disorder. What people generally mean when they say they’re “so bipolar” is that they get angry often and/or easily. But that’s not bipolar disorder. Bipolar disorder is a biologic mood disorder in which a person has experienced at least one manic episode at some point in their life.

What’s a manic episode?

Remember Charlie Sheen when he was “winning” (video)

I don’t know if Mr. Sheen was having a manic episode, or if he was on drugs, or was “acting” or doing a publicity stunt, but regardless, that is similar to what a manic episode LOOKS like. The person is very elevated, on top of the world, not needing to sleep, grandiose (I’m winning, I have tiger blood, etc), talking really fast or not letting other people get a word in edgewise, compared to their usual way of talking…and all of this goes on for at least 7 DAYS straight (often longer without treatment) and represents a marked change from their usual behavior.

The bipolar part comes from the fact that they have some of these “up” episodes, then they’ll have horrible depressive episodes. The textbook case is a manic episode, then a depressive episode 6 months later. The “rapid cycling” variant means 4 mood episodes in a year, not many episodes a week or a day. (Note: there is some professional debate about whether other “types” of bipolar might exist that last less than the 4 days required for Bipolar Type 2, but there is no official DSM diagnosis for manic episodes lasting less than 4 days.)

Anyways, I hope that next time you start to say you’re “so OCD” or “bipolar”, (at least without an accurate doctor’s diagnosis), that you will pause to consider using different terms and perhaps take a minute to educate those around you about the real diseases and terminology. Let’s stop mistaking OCD for OCPD, Anger for Bipolar Disorder, and move towards a society that is educated and compassionate about mental illness.

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Why I Founded Treehouse Child Psychiatry

There is currently a severe shortage of child psychiatrists nationwide.  Charlottesville is no exception.  Many patients are waiting months to years to see a doctor.  Take a look at this map:

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All the areas in dark blue have ZERO child psychiatrists.  As you can see, that’s most of the country.  Even areas in red, the best ranking, have severe shortages.  Los Angeles, for example, only has 7 child psychiatrists per 100,000 children, about half of Charlottesville’s 14 per 100,000.

Also, even the best count of child psychiatrists are not accurate. These are typically done by reviewing the number of active license holders in a state. Unfortunately, many doctors have moved or retired, but still hold active licenses.  Also, a very large percentage of child psychiatrists (possibly > 50%) work less than 40 hours a week.

My hope is that my practice, Treehouse Child Psychiatry, will help with this shortage.  Having grown up in Charlottesville, I care deeply about my community and want to help children in our area grow up free from the struggles of mental illness. I hope to do my small part to alleviate the severe shortage of mental health providers for children in our area and appreciate your support as we begin this journey.