What To Do If You Need to See Patients In Office?

If you are a mental health professional who continues to see (some) patients in the office because of patient needs, the following chart may be helpful.  

To protect my patients, I imagine I am a carrier, even though I have no way of knowing because our government lacks the capacity for adequate COVID-19 testing.

Decision-Making Competence: More Than Intelligence?

Bruine de Bruin, W., Parker, A. M., & Fischhoff, B.
(2020). Current Directions in Psychological Science.
https://doi.org/10.1177/0963721420901592

Abstract

Decision-making competence refers to the ability to make better decisions, as defined by decision-making principles posited by models of rational choice. Historically, psychological research on decision-making has examined how well people follow these principles under carefully manipulated experimental conditions. When individual differences received attention, researchers often assumed that individuals with higher fluid intelligence would perform better. Here, we describe the development and validation of individual-differences measures of decision-making competence. Emerging findings suggest that decision-making competence may tap not only into fluid intelligence but also into motivation, emotion regulation, and experience (or crystallized intelligence). Although fluid intelligence tends to decline with age, older adults may be able to maintain decision-making competence by leveraging age-related improvements in these other skills. We discuss implications for interventions and future research.

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Implications for Interventions

Better understanding of how fluid intelligence and other skills support decision-making competence should facilitate the design of interventions. Below, we briefly consider directions for future research into potential cognitive, motivational, emotional, and experiential interventions for promoting decision-making competence.

In one intervention that aimed to provide cognitive support, Zwilling and colleagues (2019) found that training in core cognitive abilities improved decision-making competence, compared to an active control group (in which participants practiced to process visual information faster.) Effects of cognitive training can be enhanced by high-intensity cardioresistance fitness training, which improves connectivity in the brain (Zwilling et al., 2019).  Rosi, Vecchi, & Cavallini (2019) found that prompting older people to ask ‘metacognitive’ questions (e.g., what is the main information?) was more effective than general memory training for improving performance on Applying Decision Rules. This finding is in line with suggestions that older adults perform better when they are asked to explain their choices (Kim, Goldstein, Hasher, & Zachs, 2005). Additional intervention approaches have aimed to reduce the need to rely on fluid intelligence. Using simple instead of complex decision rules may decrease cognitive demands, and cause fewer errors (Payne et al., 1993). Reducing the number of options also reduces cognitive demands, and may help especially older adults to improve their choices (Tanius, Wood, Hanoch, & Rice, 2009).

Burnout as an ethical issue in psychotherapy.

Simionato, G., Simpson, S., & Reid, C.
Psychotherapy, 56(4), 470–482.

Abstract

Recent studies highlight a range of factors that place psychotherapists at risk of burnout. The aim of this study was to investigate the ethics issues linked to burnout among psychotherapists and to describe potentially effective ways of reducing vulnerability and preventing collateral damage. A purposive critical review of the literature was conducted to inform a narrative analysis. Differing burnout presentations elicit a wide range of ethics issues. High rates of burnout in the sector suggest systemic factors and the need for an ethics review of standard workplace practice. Burnout costs employers and taxpayers billions of dollars annually in heightened presenteeism and absenteeism. At a personal level, burnout has been linked to poorer physical and mental health outcomes for psychotherapists. Burnout has also been shown to interfere with clinical effectiveness and even contribute to misconduct. Hence, the ethical impact of burnout extends to our duty of care to clients and responsibilities to employers. A range of occupational and personal variables have been identified as vulnerability factors. A new 5-P model of prevention is proposed, which combines systemic and individually tailored responses as a means of offering the greatest potential for effective prevention, identification, and remediation. In addition to the significant economic impact and the impact on personal well-being, burnout in psychotherapists has the potential to directly and indirectly affect client care and standards of professional practice. Attending to the ethical risks associated with burnout is a priority for the profession, for service managers, and for each individual psychotherapist.

From the Conclusion:

Burnout is a common feature of unintentional misconduct among psychotherapists, often at the expense of client well-being, therapeutic progress, and successful client outcomes. Clinicians working in spite of burnout also incur personal and economic costs that compromise the principles of competence and beneficence outlined in ethical guidelines. This article has focused on a communitarian approach to identifying, understanding, and responding to the signs, symptoms, and risk factors in an attempt to harness ethical practice and foster successful careers in psychotherapy. The 5-P strength-based model illuminates the positive potential of workplaces that support wellbeing and prioritize ethical practice through providing an individualized responsiveness to the training, professional development, and support needs of staff. Further, in contrast to the majority of the literature that explores organizational factors leading to burnout and ethical missteps, the 5-P model also considers the personal characteristics that may contribute to burnout and the personal action that
psychotherapists can take to avoid burnout and unintentional misconduct.

The info is here.

Examining clinician burnout in health industries

Cynda Hylton Rushton

Danielle Kress
Johns Hopkins Magazine
Originally posted 26 Dec 19


Here is an excerpt from the interview with Cynda Hylton Rushton:

How much is burnout really affecting clinicians?

Among nurses, 35-45% experience some form of burnout, with comparable rates among other providers and higher rates among physicians. It's important to note that burnout has been viewed as an occupational hazard rather than a mental health diagnosis. It is not a few days or even weeks of depletion or exhaustion. It is the cumulative, long-term distress and suffering that is slowly eroding the workforce and leading to significant job dissatisfaction and many leaving their professions. In some instances, serious health concerns and suicide can result.

What about the impact on patients?

Patient care can suffer when clinicians withdraw or are not fully engaged in their work. Moral distress, long hours, negative work environments, or organizational inefficiencies can all impact a clinician's ability to provide what they feel is quality, safe patient care. Likewise, patients are impacted when health care organizations are unable to attract and retain competent and compassionate clinicians.

What does this mean for nurses?

As the largest sector of the health care professions, nurses have the most patient interaction and are at the center of the health care team. Nurses are integral to helping patients to holistically respond to their health conditions, illness, or injury. If nurses are suffering from burnout and moral distress, the whole care team and the patient will experience serious consequences when nurses' capacities to adapt to the organizational and external pressures are eventually exceeded.

The info is here.

Veterans Must Also Heal From Moral Injury After War

Camillo Mac Bica
truthout.org
Originally published Nov 11, 2019

Here are two excerpts:

Humankind has identified and internalized a set of values and norms through which we define ourselves as persons, structure our world and render our relationship to it — and to other human beings — comprehensible. These values and norms provide the parameters of our being: our moral identity. Consequently, we now have the need and the means to weigh concrete situations to determine acceptable (right) and unacceptable (wrong) behavior.

Whether an individual chooses to act rightly or wrongly, according to or in violation of her moral identity, will affect whether she perceives herself as true to her personal convictions and to others in the moral community who share her values and ideals. As the moral gravity of one’s actions and experiences on the battlefield becomes apparent, a warrior may suffer profound moral confusion and distress at having transgressed her moral foundations, her moral identity.

Guilt is, simply speaking, the awareness of having transgressed one’s moral convictions and the anxiety precipitated by a perceived breakdown of one’s ethical cohesion — one’s integrity — and an alienation from the moral community. Shame is the loss of self-esteem consequent to a failure to live up to personal and communal expectations.

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Having completed the necessary philosophical and psychological groundwork, veterans can now begin the very difficult task of confronting the experience. That is, of remembering, reassessing and morally reevaluating their responsibility and culpability for their perceived transgressions on the battlefield.

Reassessing their behavior in combat within the parameters of their increased philosophical and psychological awareness, veterans realize that the programming to which they were subjected and the experience of war as a survival situation are causally connected to those specific battlefield incidents and behaviors, theirs and/or others’, that weigh heavily on their consciences — their moral injury. As a consequence, they understand these influences as extenuating circumstances.

Finally, as they morally reevaluate their actions in war, they see these incidents and behaviors in combat not as justifiable, but as understandable, perhaps even excusable, and their culpability mitigated by the fact that those who determined policy, sent them to war, issued the orders, and allowed the war to occur and/or to continue unchallenged must share responsibility for the crimes and horror that inevitably characterize war.

The info is here.

What School Shooters Have in Common

Jillian Peterson & James Densley
edweek.org
Originally posted October 8, 2019

Here is an excerpt:

However, school shooters are almost always a student at the school, and they typically have four things in common:

They suffered early-childhood trauma and exposure to violence at a young age. They were angry or despondent over a recent event, resulting in feelings of suicidality. They studied other school shootings, notably Columbine, often online, and found inspiration. And they possessed the means to carry out an attack.

By understanding the traits that school shooters share, schools can do more than just upgrade security or have students rehearse for their near-deaths. They can instead plan to prevent the violence.

To mitigate childhood trauma, for example, school-based mental-health services such as counselors and social workers are needed. Schools can also adopt curriculum focused on teaching positive coping skills, resilience, and social-emotional learning, especially to young boys (According to our data, 98 percent of mass shooters are men.)

A crisis is a moment, an inflection point, when things will either become very bad or begin to get better. In 80 percent of cases, school shooters communicated to others that they were in crisis, whether through a marked change in behavior, an expression of suicidal thoughts or plans, or specific threats of violence. For this reason, all adults in schools, from the principal to the custodian, need high-quality training in crisis intervention and suicide prevention and the time and space to connect with a student. At the same time, schools need formal systems in place for students and staff to (anonymously) report a student in crisis.

The info is here.

Are We Causing Moral Injury to Our Physician Workforce?

Carolyn Meltzer
theneuroethicsblog.com
Originally posted November 5, 2019

Here is an excerpt:

The term moral injury was coined by psychiatrist Jonathan Shay, MD PhD, who, while working at a Veterans Affairs hospital, noted that moral injury is present when 1) there is a betrayal of what is considered morally correct, 2) by someone who holds legitimate authority (conceptualized by Shay as “leadership malpractice”), and 3) in a high-stakes situation (Shay and Monroe 1998). Nash and Little (2013) went on to propose a model that identified the types of war-zone events that contributed to moral injury as witnessing events that are morally wrong (or strongly contradicted one’s own moral code), acting in ways that violate moral values, or feeling betrayed by those who were once trusted. In a fascinating study using the Moral Injury Event Scale and resting-state functional magnetic resonance imaging (fMRI), Sun and colleagues (2019) were able to discern a distinct pattern of altered functional neural connectivity in soldiers exposed to morally injurious events. In fact, functional connectivity between the left inferior parietal lobule and bilateral precuneus was positively related with the soldiers’ post-traumatic stress disorder (PTSD) symptoms and negatively related with scores on the Moral Injury Event Scale.

Moral injury has been recently applied as a construct for physician burnout. Those who argue for this framework propose that structural and cultural factors have contributed to physician burden by undervaluing physicians and over-relying on financial metrics (such as relative value units, RVUs) as the primary surrogate of physician productivity (Nurok and Gewertz 2019). Turner (2019) recently compared the military experience to that of physician providers. While one may draw similarities between the front line of healthcare delivery and that experienced by soldiers, Turner argues that a fundamental tenet of military leadership - that leaders eat last – provides effective support for the health of the workforce. In increasingly large healthcare organizations managed by administrators who may be distant from the front line and reliant on metrics of productivity, the necessary sense of empathy and support from leadership can seem lacking.

The info is here.

Burnout in healthcare: the case for organisational change

A Montgomery, E Panagopoulou, A Esmail,
T Richards, & C Maslach
BMJ 2019; 366
doi: https://doi.org/10.1136/bmj.l4774
(Published 30 July 2019)

Burnout has become a big concern within healthcare. It is a response to prolonged exposure to occupational stressors, and it has serious consequences for healthcare professionals and the organisations in which they work. Burnout is associated with sleep deprivation, medical errors, poor quality of care, and low ratings of patient satisfaction. Yet often initiatives to tackle burnout are focused on individuals rather than taking a systems approach to the problem.

Evidence on the association of burnout with objective indicators of performance (as opposed to self report) is scarce in all occupations, including healthcare. But the few examples of studies using objective indicators of patient safety at a system level confirm the association between burnout and suboptimal care. For example, in a recent study, intensive care units in which staff had high emotional exhaustion had higher patient standardised mortality ratios, even after objective unit characteristics such as workload had been controlled for.

The link between burnout and performance in healthcare is probably underestimated: job performance can still be maintained even when burnt out staff lack mental or physical energy as they adopt “performance protection” strategies to maintain high priority clinical tasks and neglect low priority secondary tasks (such as reassuring patients). Thus, evidence that the system is broken is masked until critical points are reached. Measuring and assessing burnout within a system could act as a signal to stimulate intervention before it erodes quality of care and results in harm to patients.

Burnout does not just affect patient safety. Failing to deal with burnout results in higher staff turnover, lost revenue associated with decreased productivity, financial risk, and threats to the organisation’s long term viability because of the effects of burnout on quality of care, patient satisfaction, and safety. Given that roughly 10% of the active EU workforce is engaged in the health sector in its widest sense, the direct and indirect costs of burnout could be substantial.

The info is here.

Walking on Eggshells With Trainees in the Clinical Learning Environment—Avoiding the Eggshells Is Not the Answer.

Gold MA, Rosenthal SL, Wainberg ML.
JAMA Pediatr. 
Published online August 05, 2019.
doi:10.1001/jamapediatrics.2019.2501

Here is an excerpt:

Every trainee inevitably will encounter material or experiences that create discomfort. These situations are necessary for growth and faculty should be able to have the freedom in those situations to challenge the trainee’s assumptions.5 However, faculty have expressed concern that in the effort to manage the imbalance of power and protect trainees from the potential of abuse and harassment, we have labeled difficult conversations and discomfort as maltreatment. When faculty feel that the academic institution sides with trainees without considering the faculty member’s perspective and actions, they may feel as if their reputation and hard work as an educator has been challenged or ruined. For example, if a trainee reports a faculty member for creating a “sexually hostile” environment because the faculty has requested that the trainee take explicit sexual histories of adolescents, it may result in the faculty avoiding this type of difficult conversation and lead to a lack of skill development in trainees. Another unintended consequence is that trainees will not gain skills in having difficult conversations with their faculty, and without feedback they may not grow in their clinical expertise. As our workforce becomes increasingly diverse and we care for a range of populations, the likelihood of misunderstandings and the need to talk about sensitive topics and have difficult conversations increases.

There are several ways to create an environment that fosters the ability for trainees and faculty to walk across eggshells without fear. It is important to continue medical school training regarding unconscious bias, cultural sensitivity, and communication skills. This should include helping trainees not only apply these skills with each other and with their patients but also with their faculty. Trainees are likely to have as many unconscious biases toward their faculty as their faculty have toward them. For example, one study found that at one institution, female medical school faculty were given significantly lower teaching evaluations by third-year medical students in all clerkship rotations compared with male medical school faculty. Pediatrics showed the second largest difference, with surgery having the greatest difference.

The info is here.

Telehealth use jumps at inpatient settings

Shannon Muchmore
healthcaredive.com
Originally posted August 6, 2019

Here is an excerpt:

Hospital-owned outpatient facilities were more likely to use telehealth than those not owned by hospitals. Outpatient facilities tended to use patient portals or apps more than inpatient respondents but also had broad adoption of hub and spoke models.

Still, providers in a variety of settings keeping a close watch on possibilities and wanting to stay at the forefront of the technology, said Kate Shamsuddin, SVP of strategy at Definitive.

The results "show how telehealth continues to be one of the core linchpins" for providers, she told Healthcare Dive.

The inpatient report found telehealth use jumped from 54% when the survey was first taken in 2014 to 85% in 2019. The most common model is hub and spoke (65%), followed by patient portals or apps (40%), concierge services (29%) and clinical- and consumer-grade remote patient monitoring.

The tech most often used in that setting was two-way video between physician and patient. That is also the category respondents said they were most likely to invest in for the future.​ Shamsuddin said hospitals and health systems tend to have a broader mixture in the types of technologies they use due to their larger budgets and scale.

The info is here.

Physicians struggle with their own self-care, survey finds

Jeff Lagasse
Healthcare Finance
Originally published July 26, 2019

Despite believing that self-care is a vitally important part of health and overall well-being, many physicians overlook their own self-care, according to a new survey conducted by The Harris Poll on behalf of Samueli Integrative Health Programs. Lack of time, job demands, family demands, being too tired and burnout are the most common reasons for not practicing their desired amount of self-care.

The authors said that while most doctors acknowledge the physical, mental and social importance of self-care, many are falling short, perhaps contributing to the epidemic of physician burnout currently permating the nation's healthcare system.

What's The Impact

The survey -- involving more than 300 family medicine and internal medicine physicians as well as more than 1,000 U.S. adults ages 18 and older -- found that although 80 percent of physicians say practicing self-care is "very important" to them personally, only 57 percent practice it "often" and about one-third (36%) do so only "sometimes."

Lack of time is the primary reason physicians say they aren't able to practice their desired amount of self-care (72%). Other barriers include mounting job demands (59%) and burnout (25%). Additionally, almost half of physicians (45%) say family demands interfere with their ability to practice self-care, and 20 percent say they feel guilty taking time for themselves.

The info is here.

Challenges to capture the big five personality traits in non-WEIRD populations

Rachid Laajaj, Karen Macours, and others
Science Advances  10 Jul 2019:
Vol. 5, no. 7
DOI: 10.1126/sciadv.aaw5226

Abstract

Can personality traits be measured and interpreted reliably across the world? While the use of Big Five personality measures is increasingly common across social sciences, their validity outside of western, educated, industrialized, rich, and democratic (WEIRD) populations is unclear. Adopting a comprehensive psychometric approach to analyze 29 face-to-face surveys from 94,751 respondents in 23 low- and middle-income countries, we show that commonly used personality questions generally fail to measure the intended personality traits and show low validity. These findings contrast with the much higher validity of these measures attained in internet surveys of 198,356 self-selected respondents from the same countries. We discuss how systematic response patterns, enumerator interactions, and low education levels can collectively distort personality measures when assessed in large-scale surveys. Our results highlight the risk of misinterpreting Big Five survey data and provide a warning against naïve interpretations of personality traits without evidence of their validity.

The research is here.

Prediction Models for Suicide Attempts and Deaths: A Systematic Review and Simulation

Bradley Belsher, Derek Smolenski, Larry Pruitt, and others
JAMA Psychiatry. 2019;76(6):642-651.
doi:10.1001/jamapsychiatry.2019.0174

Abstract
Importance  Suicide prediction models have the potential to improve the identification of patients at heightened suicide risk by using predictive algorithms on large-scale data sources. Suicide prediction models are being developed for use across enterprise-level health care systems including the US Department of Defense, US Department of Veterans Affairs, and Kaiser Permanente.

Objectives
To evaluate the diagnostic accuracy of suicide prediction models in predicting suicide and suicide attempts and to simulate the effects of implementing suicide prediction models using population-level estimates of suicide rates.

Evidence Review
A systematic literature search was conducted in MEDLINE, PsycINFO, Embase, and the Cochrane Library to identify research evaluating the predictive accuracy of suicide prediction models in identifying patients at high risk for a suicide attempt or death by suicide. Each database was searched from inception to August 21, 2018. The search strategy included search terms for suicidal behavior, risk prediction, and predictive modeling. Reference lists of included studies were also screened. Two reviewers independently screened and evaluated eligible studies.

Findings
From a total of 7306 abstracts reviewed, 17 cohort studies met the inclusion criteria, representing 64 unique prediction models across 5 countries with more than 14 million participants. The research quality of the included studies was generally high. Global classification accuracy was good (≥0.80 in most models), while the predictive validity associated with a positive result for suicide mortality was extremely low (≤0.01 in most models). Simulations of the results suggest very low positive predictive values across a variety of population assessment characteristics.

Conclusions and Relevance
To date, suicide prediction models produce accurate overall classification models, but their accuracy of predicting a future event is near 0. Several critical concerns remain unaddressed, precluding their readiness for clinical applications across health systems.

Time to End Physician Sexual Abuse of Patients: Calling the U.S. Medical Community to Action

AbuDagga, A., Carome, M. & Wolfe, S.M.
J GEN INTERN MED (2019).
https://doi.org/10.1007/s11606-019-05014-6

Abstract

Despite the strict prohibition against all forms of sexual relations between physicians and their patients, some physicians cross this bright line and abuse their patients sexually. The true extent of sexual abuse of patients by physicians in the U.S. health care system is unknown. An analysis of National Practitioner Data Bank reports of adverse disciplinary actions taken by state medical boards, peer-review sanctions by institutions, and malpractice payments shows that a very small number of physicians have faced “reportable” consequences for this unethical behavior. However, physician self-reported data suggest that the problem occurs at a higher rate. We discuss the factors that can explain why such sexual abuse of patients is a persistent problem in the U.S. health care system. We implore the medical community to begin a candid discussion of this problem and call for an explicit zero-tolerance standard against sexual abuse of patients by physicians. This standard must be coupled with regulatory, institutional, and cultural changes to realize its promise. We propose initial recommendations toward that end.

Doctors are burning out twice as fast as other workers. The problem's costing the US $4.6 billion each year.

Lydia Ramsey
www.businessinsider.com
Originally posted May 31, 2019

Here is an excerpt:

To avoid burnout, some doctors have turned to alternative business models.

That includes new models like direct primary care, which charges a monthly fee and doesn't take insurance. Through direct primary care, doctors manage the healthcare of fewer patients than they might in a traditional model. That frees them up to spend more time with patients and ideally help them get healthier.

It's a model that has been adopted by independent doctors who would otherwise have left medicine, with insurers and even the government starting to take notes on the new approach.

Others have chosen to set their own hours by working for sites that virtually link up patients with doctors.

Even so, it'll take more to cut through the note-taking and other tedious tasks that preoccupy doctors, from primary-care visits to acute surgery. It has prompted some to look into ways to alleviate how much work they do on their computers for note-taking purposes by using new technology like artificial-intelligence voice assistants.

The info is here.

Why High-Class People Get Away With Incompetence

Heather Murphy
The New York Times
Originally posted May 20, 2019

Here are two excerpt:

The researchers suggest that part of the answer involves what they call “overconfidence.” In several experiments, they found that people who came from a higher social class were more likely to have an inflated sense of their skills — even when tests proved that they were average. This unmerited overconfidence, they found, was interpreted by strangers as competence.

The findings highlight yet another way that family wealth and parents’ education — two of a number of factors used to assess social class in the study — affect a person’s experience as they move through the world.

“With this research, we now have reason to think that coming from a higher social class confers yet another advantage,” said Jessica A. Kennedy, a professor of management at Vanderbilt University, who was not involved in the study.

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Researchers said they hoped that the takeaway was not to strive to be overconfident. Wars, stock market crashes and many other crises can be blamed on overconfidence, they said. So how do managers, employers, voters and customers avoid overvaluing social class and being duped by incompetent wealthy people? Dr. Kennedy said she had been encouraged to find that if you show people actual facts about a person, the elevated status that comes with overconfidence often fades away.

The info is here.

Promoting competent and flourishing life-long practice for psychologists: A communitarian perspective

Wise, E. H., & Reuman, L. (2019).
Professional Psychology: Research and Practice, 50(2), 129-135.

Abstract

Based on awareness of the challenges inherent in the practice of psychology there is a burgeoning interest in ensuring that psychologists who serve the public remain competent. These challenges include remaining current in our technical skills and maintaining sufficient personal wellness over the course of our careers. However, beyond merely maintaining competence, we encourage psychologists to envision flourishing lifelong practice that incorporates positive relationships, enhancement of meaning, and positive engagement. In this article we provide an overview of the foundational competencies related to professionalism including ethics, reflective practice, self-assessment, and self-care that underlie our ability to effectively apply technical skills in often complex and emotionally challenging relational contexts. Building on these foundational competencies that were initially defined and promulgated for academic training in health service psychology, we provide an initial framework for conceptualizing psychologist well-being and flourishing lifelong practice that incorporates tenets of applied positive psychology, values-based practice, and a communitarian-oriented approach into the following categories: fostering relationships, meaning making and value-based practice, and enhancing engagement. Finally, we propose broad strategies and specific examples intended to leverage current continuing education mandates into a broadly conceived vision of continuing professional development to support enhanced psychologist functioning for lifelong practice.

The info is here.

Lost-in-the-mall: False memory or false defense?

Ruth A. Blizard & Morgan Shaw (2019)
Journal of Child Custody
DOI: 10.1080/15379418.2019.1590285

Abstract

False Memory Syndrome (FMS) and Parental Alienation Syndrome (PAS) were developed as defenses for parents accused of child abuse as part of a larger movement to undermine prosecution of child abuse. The lost-in-the-mall study by Dr. Elizabeth Loftus concludes that an entire false memory can be implanted by suggestion. It has since been used to discredit abuse survivors’ testimony by inferring that false memories for childhood abuse can be implanted by psychotherapists. Examination of the research methods and findings of the study shows that no full false memories were actually formed. Similarly, PAS, coined by Richard Gardner, is frequently used in custody cases to discredit children’s testimony by alleging that the protective parent coached them to have false memories of abuse. There is no scientific research demonstrating the existence of PAS, and, in fact, studies on the suggestibility of children show that they cannot easily be persuaded to provide detailed disclosures of abuse.

The info is here.

134 Activities to Add to Your Self-Care Plan

GoodTherapy.org Staff
www.goodtherapy.org
Originally posted June 13, 2015

At its most basic definition, self-care is any intentional action taken to meet an individual’s physical, mental, spiritual, or emotional needs. In short, it’s all the little ways we take care of ourselves to avoid a breakdown in those respective areas of health.

You may find that, at certain points, the world and the people in it place greater demands on your time, energy, and emotions than you might feel able to handle. This is precisely why self-care is so important. It is the routine maintenance you need do to function your best not only for others, but also for yourself.

GoodTherapy.org’s own business and administrative, web development, outreach and advertising, editorial and education, and support teams have compiled a massive list of some of their own personal self-care activities to offer some help for those struggling to come up with their own maintenance plan. Next time you find yourself saying, “I really need to do something for myself,” browse our list and pick something that speaks to you. Be silly, be caring to others, and make your self-care a priority! In most cases, taking care of yourself doesn’t even have to cost anything. And because self-care is as unique as the individual performing it, we’d love to invite you to comment and add any of your own personal self-care activities in the comments section below. Give back to your fellow readers and share some of the little ways you take care of yourself.

The list is here.

Note: Self-care enhances the possibility of competence practice.  Good self-care skills are important to promote ethical practice.

The Parking Lot Suicide

Emily Wax-Thibodeaux.
The Washington Post
Originally published February 11, 2019

Here is an excerpt:

Miller was suffering from post-traumatic stress disorder and suicidal thoughts when he checked into the Minneapolis Department of Veterans Affairs hospital in February 2018. After spending four days in the mental-health unit, Miller walked to his truck in VA’s parking lot and shot himself in the very place he went to find help.

“The fact that my brother, Justin, never left the VA parking lot — it’s infuriating,” said Harrington, 37. “He did the right thing; he went in for help. I just can’t get my head around it.”

A federal investigation into Miller’s death found that the Minneapolis VA made multiple errors: not scheduling a follow-up appointment, failing to communicate with his family about the treatment plan and inadequately assessing his access to firearms.

Several days after his death, Miller’s parents received a package from the Department of Veterans Affairs — bottles of antidepressants and sleep aids prescribed to Miller.

His death is among 19 suicides that occurred on VA campuses from October 2017 to November 2018, seven of them in parking lots, according to the Department of Veterans Affairs.

While studies show that every suicide is highly complex — influenced by genetics, financial uncertainty, relationship loss and other factors — mental-health experts worry that veterans taking their lives on VA property has become a desperate form of protest against a system that some veterans feel hasn’t helped them.

The most recent parking lot suicide occurred weeks before Christmas in St. Petersburg, Fla. Marine Col. Jim Turner, 55, dressed in his uniform blues and medals, sat on top of his military and VA records and killed himself with a rifle outside the Bay Pines Department of Veterans Affairs.

“I bet if you look at the 22 suicides a day you will see VA screwed up in 90%,” Turner wrote in a note investigators found near his body.

The info is here.