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How should we talk about mental health?

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Mental health suffers from a major image problem. One in every four people experiences mental health issues — yet more than 40 percent of countries worldwide have no mental health policy. Across the board it seems like we have no idea how to talk about it respectfully and responsibly.

Stigma and discrimination are the two biggest obstacles to a productive public dialogue about mental health; indeed, the problem seems to be largely one of communication. So we asked seven mental health experts: How should we talk about mental health? How can informed and sensitive people do it right – and how can the media do it responsibly?

End the stigma

Easier said than done, of course. Says journalist  Andrew Solomon : “People still think that it’s shameful if they have a mental illness. They think it shows personal weakness. They think it shows a failing. If it’s their children who have mental illness, they think it reflects their failure as parents.” This self-inflicted stigma can make it difficult for people to speak about even their own mental health problems. According to neuroscientist  Sarah Caddick , this is because when someone points to his wrist to tell you it’s broken, you can easily understand the problem, but that’s not the case when the issue is with the three-pound mass hidden inside someone’s skull. “The minute you start talking about your mind, people get very anxious, because we associate that with being who we are, fundamentally with ‘us’ — us as a person, us as an individual, our thoughts, our fears, our hopes, our aspirations, our everything.” Says mental health care advocate  Vikram Patel , “Feeling miserable could in fact be seen as part of you or an extension of your social world, and applying a biomedical label is not always something that everyone with depression, for example, is comfortable with.” Banishing the stigma attached to mental health issues can go a long way to facilitating genuinely useful conversations.

Avoid correlations between criminality and mental illness

People are too quick to dole out judgments on people who experience mental health problems, grouping them together when isolated incidents of violence or crime occur. Says  Caddick , “You get a major incident like Columbine or Virginia Tech and then the media asks, ‘Why didn’t people know that he was bipolar?’ ‘Was he schizophrenic?’ From there, some people think, ‘Well, everybody with bipolar disease is likely to go out and shoot down a whole bunch of people in a school,’ or, ‘People who are schizophrenics shouldn’t be out on the street.’”  Solomon  agrees that this correlation works against a productive conversation about mental health: “The tendency to connect people’s crimes to mental illness diagnoses that are not in fact associated with criminality needs to go away. ‘This person murdered everyone because he was depressed.’ You think, yes, you could sort of indicate here this person was depressed and he murdered everyone, but most people who are depressed do not murder everyone.”

But do correlate more between mental illness and suicide

According to the National Institute for Mental Health (NIMH), 90 percent of people who die by suicide have depression or other mental disorders, or substance-abuse disorders in conjunction with other mental disorders. Yet we don’t give this link its due. Says  Solomon , “Just as the association between mental illness and crime is too strong, the connection between mental illness and suicide is too weak. So I feel like what I constantly read in the articles is that ‘so-and-so killed himself because his business had gone bankrupt and his wife had left him.’ And I think, okay, those were the triggering circumstances, but he killed himself because he suffered from a mental illness that drove him to kill himself. He was terribly depressed.”

Avoid words like “crazy” or “psycho”

Not surprisingly, nearly all the mental health experts we consulted were quick to decry playground slang like “mental,” “schizo,” “crazy,” “loonie,” or “nutter,” stigmatizing words that become embedded in people’s minds from a young age. NIMH Director  Thomas Insel  takes that one step further — he doesn’t like the category of “mental health problems” in general. He says, “Should we call cancer a ‘cell cycle problem’? Calling serious mental illness a ‘behavioral health problem’ is like calling cancer a ‘pain problem.’” Comedian  Ruby Wax , however, has a different point of view: “I call people that are mentally disturbed, you know, I say they’re crazy. I think in the right tone, that’s not the problem. Let’s not get caught in the minutiae of it.”

If you feel comfortable talking about your own experience with mental health, by all means, do so

Self-advocacy can be very powerful. It reaches people who are going through similar experiences as well as the general public.  Solomon  believes that people equipped to share their experiences should do so: “The most moving letter I ever received in a way was one that was only a sentence long, and it came from someone who didn’t sign his name. He just wrote me a postcard and said, ‘I was going to kill myself, but I read your book and changed my mind.’ And really, I thought, okay, if nobody else ever reads anything I’ve written, I’ve done some good in the world. It’s very important just to keep writing about these things, because I think there’s a trickle-down effect, and that the vocabulary that goes into serious books actually makes its way into the common experience — at least a little bit of it does — and makes it easier to talk about all of these things.”  Solomon ,  Wax , as well as  Temple Grandin , below, have all become public figures for mental health advocacy through sharing their own experiences.

Don’t define a person by his/her mental illnesses

Just as a tumor need not define a person, the same goes for mental illness. Although the line between mental health and the “rest” of a person is somewhat blurry, experts say the distinction is necessary. Says  Insel : “We need to talk about mental disorders the way we talk about other medical disorders. We generally don’t let having a medical illness define a person’s identity, yet we are very cautious about revealing mental illness because it will somehow define a person’s competence or even suggest dangerousness.”  Caddick  agrees: “There’s a lot of things that go on in the brain, and just because one thing goes wrong doesn’t mean that everything’s going wrong.”

Separate the person from the problem

Continuing from the last,  Insel  and  Patel  both recommend avoiding language that identifies people only by their mental health problems. Says  Insel , speak of “someone with schizophrenia,” not “the schizophrenic.” (Although, he points out, people with autism do often ask to be referred to as “autistic.”) Making this distinction clear, says  Patel , honors and respects the individual. “What you’re really saying is, this is something that’s not part of a person; it’s something the person is suffering from or is living with, and it’s a different thing from the person.”

Sometimes the problem isn’t that we’re using the wrong words, but that we’re not talking at all

Sometimes it just starts with speaking up. In  Solomon’s  words: “Wittgenstein said, ‘All I know is what I have words for.’ And I think that if you don’t have the words for it, you can’t explain to somebody else what your need is. To some degree, you can’t even explain to yourself what your need is. And so you can’t get better.” But, as suicide prevention advocate  Chris Le  knows well, there are challenges to talking about suicide and depression. Organizations aiming to raise awareness about depression and suicide have to wrangle with suicide contagion, or copycat suicides that can be sparked by media attention, especially in young people. Le, though, feels strongly that promoting dialogue ultimately helps. One simple solution, he says, is to keep it personal: “Reach out to your friends. If you’re down, talk to somebody, because remember that one time that your friend was down, and you talked to them, and they felt a little better? So reach out, support people, talk about your emotions and get comfortable with them.”

Recognize the amazing contributions of people with mental health differences

Says autism activist  Temple Grandin : “If it weren’t for a little bit of autism, we wouldn’t have any phones to talk on.” She describes the tech community as filled with autistic pioneers. “Einstein definitely was; he had no language until age three. How about Steve Jobs? I’ll only mention the dead ones by name. The live ones, you’ll have to look them up on the Internet.” Of depression, Grandin says: “The organizations involved with depression need to be emphasizing how many really creative people, people whose books we love, whose movies we love, their arts, have had a lot of problems with depression. See, a little bit of those genetics makes you sensitive, makes you emotional, makes you sensitive — and that makes you creative in a certain way.”

Humor helps

Humor, some say, is the best medicine for your brain. Says comedian  Wax : “If you surround [your message] with comedy, you have an entrée into their psyche. People love novelty, so for me it’s sort of foreplay: I’m softening them up, and then you can deliver as dark as you want. But if you whine, if you whine about being a woman or being black, good luck. Everybody smells it. But it’s true. People are liberated by laughing at themselves.”

Featured illustration via iStockphoto.

About the author

Thu-Huong Ha is a freelance writer. Previously she was the books and culture reporter for Quartz and the context editor at TED. Her writing has also appeared on Slate and in The New York Times Book Review. Her debut novel, Hail Caesar, was published in 2007 by PUSH, a YA imprint of Scholastic, and was named an NYPL Book for the Teen Age. Follow her at twitter.com/thu

• Andrew Solomon
• Editor's picks
• How should we talk about?
• mental health
• mental illness
• questions worth asking
• Sarah Caddick
• Temple Grandin
• Thomas Insel
• Vikram Patel

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Mental Health Awareness Month

May is Mental Health Awareness Month. Since its inception in 1949, Mental Health Awareness Month has been a cornerstone of addressing the challenges faced by millions of Americans living with mental health conditions. Throughout the month, NAMI actively participates in this national movement, dedicated to eradicating stigma, extending support, fostering public education and advocating for policies that prioritize the well-being of individuals and families affected by mental illness.

Take the Moment

Download the toolkit, share on social media, sharing is caring, nami helplines, more ways to get involved this mental health awareness month.

This year, NAMI is celebrating Mental Health Awareness Month with the Take the Moment campaign. We encourage you to join us in fostering open dialogues, cultivating empathy and understanding. We also urge you to share our resources to support individuals and families on their journey towards mental wellness. Through "Take the Moment," we shine a spotlight on NAMI's array of signature programs including: NAMI Basics , NAMI Family-to-Family , NAMI Family & Friends , NAMI Homefront , NAMI In Our Own Voice , NAMI Peer-to-Peer , NAMI Support Groups and our invaluable NAMI HelpLine , which is a free, nationwide peer-support service providing information, resource referrals and support to people living with a mental health condition, their family members and caregivers, mental health providers and the public.

This campaign also champions the importance of destigmatizing mental health by normalizing the practice of taking moments to prioritize mental health care without guilt or shame.

We at NAMI National have created this in order to support NAMI State Organizations, NAMI Aliates, partners and ambassadors in efforts to promote Mental Health Awareness Month.

Join us, take the moment and let's make a difference together. Download our toolkit for more insights on this campaign, downloadable graphics, and more!

Throughout May, we invite you to share with us on social media why or how you are taking moments to prioritize your mental health. Please use the hashtag #TakeAMentalHealthMoment in your posts.

Also, this page will be updated with more resources and ways to get involved during the months of April and May. You can bookmark this webpage, so you can easily access this information.

To help get you get started, we have provided sample posts and graphics below you can use on social media. Don’t forget to tag us at @NAMICommunicate on Instagram, Threads and X and @NAMI on LinkedIn, TikTok and Facebook.

Sample Captions

Take the Moment: Join NAMI's Mental Health Awareness Month campaign as we spotlight our signature programs! Let's break the stigma together! nami.org/mham #TakeAMentalHealthMoment #MentalHealthMonth

Our mental health journey starts with a single moment. Take it! NAMI's 2024 campaign is here to empower you with resources like NAMI Family-to-Family. Let's prioritize mental well-being together. nami.org/mham #TakeAMentalHealthMoment #MentalHealthMonth

Seeking mental health support? Look no further than NAMI's comprehensive suite of programs! Join us in making a difference today! nami.org/mham #TakeAMentalHealthMoment #MentalHealthMonth

Join us and NAMI this month in normalizing the practice of taking moments to prioritize mental health care without guilt or shame. Programs. nami.org/mham #TakeAMentalHealthMoment #MentalHealthMonth

Share some of our graphics below ( access our full set of graphics here ). Don’t forget to tag us at @NAMICommunicate on Instagram and Twitter and @NAMI on TikTok and Facebook and use our hashtag #TakeAMentalHealthMoment #MentalHealthMonth!

NAMI’s signature programs are where people and communities can find help, hope and healing. We encourage you to share or sign up for these programs if you or someone you know needs mental health support.

• NAMI Basics : A six-session education program for parents, caregivers and other family members who provide care for youth (ages 22 and younger) who are experiencing mental health symptoms.
• NAMI Family-to-Family : A free, eight-session educational program for family, significant others and friends of people with mental health conditions.
• NAMI Family & Friends: A free 90-minute or four-hour seminar that informs people who have loved ones with a mental health condition how to best support them.
• NAMI Homefront : A free, six-session program for families, caregivers and friends of military members and veterans with mental health conditions. Plus, find free online resources available 24/7.
• NAMI In Our Own Voice : Free presentations that provide a personal perspective of mental health conditions, as leaders with lived experience talk openly about what it's like to have a mental health condition.
• NAMI Peer-to-Peer : A free, eight-session educational program for adults with mental health conditions who are looking to better understand themselves and their recovery.
• NAMI Support Groups : NAMI support groups are peer-led and offer participants an opportunity to share their experiences and gain support from other attendees.

In Need of Help or Support?

You are not alone! If you are struggling with your mental health, the NAMI HelpLine is here for you. Connect with a NAMI HelpLine specialist or Teen & Young Adult HelpLine specialist today.

The NAMI HelpLine is a free, nationwide peer-support service providing information, resource referrals and support to people living with a mental health condition, their family members and caregivers, mental health providers and the public.

The NAMI Teen & Young Adult (T&YA) HelpLine offers a direct connection with another young person who shares similar experiences and is prepared to offer information, resources, and support to help you move through difficult times to a better place.

Available Monday Through Friday, 10 A.M. – 10 P.M. ET

Call 1-800-950-NAMI (6264) , text "HelpLine" to 62640 or chat with us at nami.org/help .

Call 1-800-950-NAMI (6264) , text "HelpLine" to 62640 or chat with us at nami.org/talktous .

Need Immediate Help in A Crisis?

988 Suicide & Crisis Lifeline – Dial or text 988 if you or someone you know is having thoughts of suicide or experiencing a mental health crisis and get connected to a trained crisis counselor 24 hours a day, 7 days a week. Crisis counselors listen empathetically and without judgment. Your crisis counselor will work to ensure that you feel safe and help identify options and information about mental health services in your area.

Attend An Event

NAMIWalks : Is more than just a walk—it's a powerful movement for change in mental health. Bringing together individuals, families, and communities, NAMIWalks raises funds, spreads awareness, and fights stigma surrounding mental illness. By participating, you join a nationwide effort to value mental health and promote compassion and understanding for those affected by mental illness.

Partner With Us

Become an advocate : NAMI advocates with elected officials to ensure people get help early, people get the best possible care, and people get diverted from justice system involvement. But, we can’t do this without you. Your voice makes a difference.

Volunteer: Get involved with your local NAMI and make a difference in your community or apply to be a volunteer with our national HelpLine.

Know the warning signs of mental illness

Learn more about common mental health conditions

NAMI HelpLine is available M-F, 10 a.m. – 10 p.m. ET. Call 800-950-6264 , text “helpline” to 62640 , or chat online. In a crisis, call or text 988 (24/7).

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Resources for Students and Educators

The National Institute of Mental Health (NIMH) offers a variety of learning resources for students and teachers about mental health and the brain. Whether you want to understand mental health challenges, promote emotional well-being in the classroom, or simply learn how to take care of your own mental health, our resources cover a wide range of topics to foster a supportive and informed learning environment. Explore videos, coloring books, and hands-on quizzes and activities to empower yourself and others on the journey to mental well-being.

You can also find additional educational resources about mental health and other topics on NIH’s STEM Teaching Resources website  .

Childhood Irritability : Learn about symptoms of irritability, why it's important to study irritability, NIMH-supported research in this area, and new treatments for severe irritability in youth.

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Getting to Know Your Brain: Dealing with Stress: Test your knowledge about stress and the brain. Also learn how to create and use a “ stress catcher ” to practice strategies to deal with stress.

Coloring and activity books

Print or order these coloring and activity books to help teach kids about mental health, stress, and the brain. These are available in English and Spanish. 

Get Excited About Mental Health Research!

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Stand Up to Stress!

This free coloring and activity book teaches children about stress and anxiety and offers tips for coping in a healthy way.

Get Excited About the Brain!

This free coloring and activity book for children ages 8-12 features exciting facts about the human brain and mental health.

Quizzes and activities

Use these fun, hands-on activities in the classroom or at home to teach kids about mental health.

Teen Depression Kahoot! Quiz  

Engage students in fun and interactive competition as they learn about depression, stress and anxiety, self-care, and how to get help for themselves or others.

Stress Catcher

Life can get challenging sometimes, and it’s important for kids (and adults!) to develop strategies for coping with stress or anxiety. This printable stress catcher “fortune teller” offers some strategies children can practice and use to help manage stress and other difficult emotions.

Brochures and fact sheets

Below is a selection of NIMH brochures and fact sheets to help teach kids and parents about mental health and the brain. Additional publications are available for download or ordering in English and Spanish.

Children and Mental Health: Is This Just a Stage?

This fact sheet presents information on children’s mental health including assessing your child’s behavior, when to seek help, first steps for parents, treatment options, and factors to consider when choosing a mental health professional.

The Teen Brain: 7 Things to Know

Learn about how the teen brain grows, matures, and adapts to the world.

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A Whole-Person Approach to Mental Health

More than half of adults with mental illness go untreated. Christina Mainelli ’11, CEO of Quartet Health, says a value-based approach can help to expand access, standardize treatment, and create incentives for better coordination between physical and mental healthcare.

• Christina Mainelli Chief Executive Officer, Quartet Health

Q: What is the scale of the mental health need in the U.S.?

It’s estimated that more than one in five adults live with a mental illness. And if you add addiction—substance use disorder—that number gets much larger. It’s also pretty alarming that 55% of adults with mental illness go untreated. That’s devastating for those individuals and their families and friends. There are impacts on productivity, employment, even lifespan, and for society there’s lost economic vitality.

For adults with serious mental illness—think bipolar, schizophrenia, PTSD, major depressive disorder—there are even greater impacts. These individuals often have multiple comorbid conditions and worse health outcomes. Forty to fifty percent of this population also has a substance use disorder.

Additionally, the impact of mental illness on kids is staggering. Over half of adolescents have had a mental health issue or mental illness. Kids with a mental illness are two times more likely to drop out of school. Suicide is the second leading cause of death for adolescents as a whole and the leading cause of death for 14- and 15-year-olds.

Q: What’s keeping people from getting the care they need?

I think of three major issues that need to be addressed: access, quality, and the fragmentation of the delivery system.

This is a business opportunity because, in a value-based context, we can deliver higher quality care that lowers overall costs and provides better patient outcomes.

One way to think of access is simply getting an appointment. You hear about wait times of weeks or months for people struggling with high acuity concerns—meaning their condition may be serious and could benefit from immediate care. The average wait time to see a psychiatrist is 25 days, and it can be up to 90 days. That’s a huge issue. Generally accepted standards include speed to care within 10 days for routine needs, within 48 hours for urgent needs, and within 6 hours for those in non-life-threatening crisis.

From a business perspective, access is largely a supply and a matching issue. Almost half of the U.S. population, 164 million people, live in designated mental health professional shortage areas. To bring this to life, in Massachusetts, there’s one behavioral health clinician for every 150 people. In Alabama, there’s one behavioral health clinician for every 920 people. Essentially, in Alabama, there’s simply not enough supply, while in Massachusetts access challenges have more to do with matching the right provider to the patient.

It’s a very personal experience to obtain mental health care; we want a clinician who understands our circumstances. We may feel more comfortable with someone who “looks like us” in terms of age, race, religion, language, or gender. To fully address access, we need to support patients in getting connected or “matched” to the right behavioral healthcare clinician, and we need clinicians that reflect the complexion of our population as part of addressing health equity issues.

Q: What about quality?

Delivering high quality care that achieves the best outcomes for patients is critical, but significant variation remains in adherence to evidenced based care and in treatment outcomes across care settings, providers, and geographies. There are multiple contributing factors, including training, reimbursement models, and impact of health disparities which need to be addressed both on the healthcare delivery side as well as from a policy perspective.

Q: The third issue you noted was fragmentation.

Fragmentation between physical and behavioral healthcare is a huge problem—the more we learn about mental health care, the clearer it is that physical health can be a large determinant of mental health and vice versa.

There has been progress addressing fragmentation as demonstrated by collaborative care models and related codes, and most recently a Centers for Medicare & Medicaid Services announcement around Integrated Health Models aimed at advancing holistic care. However, there is still a huge need for a formalized structure that not just enables but also incentivizes primary care doctors to connect with behavioral health specialists.

Imagine you’re a primary care physician in a practice seeing patients every 12 to 15 minutes, and someone presents with a mental health issue. It may not be clear how acute the patient is or how serious the issue is. What’s the appropriate treatment pathway? Who should you refer the patient to? It’s not obvious—or efficient to act on—in today’s clinical world.

I often hear that physical health providers are reticent to treat individuals with serious mental illness. Why? Because patients with these conditions often have a complex combination of physical, behavioral, and social health needs.

There’s a lack of aligned incentives that would enable physical health providers to take on these patients, work with the mental health provider on a treatment plan that addresses all health needs, and engage in an ongoing exchange of information with the patient and the mental health provider about how the patient is progressing.

All of these things combined contribute to a lack of connectivity between the physical and behavioral health provider. It also creates a confusing and fragmented experience for the patient.

Q: How does Quartet Health work?

Quartet is both a technology platform and a direct provider of patient care. On our digital platform, we are connected to over 10,000 behavioral health providers that service up to 21 million patients. We also have a medical group that directly employs over 250 behavioral health clinicians who see over 500,000 patients a year.

Here’s a real-life example: a 71-year-old female patient in Michigan used her phone to access our digital platform where she answered a few questions and selected what was most important to her in her care. She requested a female provider for virtual and in-person services to help address her anxiety. Within two hours, we reached out to the patient in Michigan and matched her to a provider. The provider contacted her within the hour, and she had her first appointment three days later.

The patient in Michigan is what we’d consider a good patient experience—within three hours the patient had an appointment set for within three days. This is using technology to help solve the access problem. We triage, match, and then provide care. At every step, we’re measuring outcomes to ensure quality.

While this patient used the self-service option, primary care providers on our platform can also make a referral or have someone in the front office go through the initial matching process with a patient. Whether it’s the patient or the provider making the query, it passes right through our algorithms which help match the best behavioral health provider. That’s the connectivity between physical and behavioral health reducing fragmentation.

The name Quartet refers to what we see as the foundation of the physical health provider, the behavioral health provider, the payer, and the patient all working together.

Q: Why not just operate a digital platform to connect patients to existing providers?

Many behavioral healthcare companies were born out of the pandemic. A lot of them offer point solutions—they’re addressing one specific need. We’re starting to see consolidation in that part of the industry. We’re also seeing some of those companies fail due to lack of a robust business model. The ones that are surviving aren’t just offering point solutions, they’re taking on bigger industry-wide problems.

At Quartet, we felt that the digital platform alone wasn’t solving a big enough problem, so we made a strategic decision to deliver care ourselves. Quartet Medical Group delivers care in 30+ markets. We practice measurement-based care (MBC) to ensure our clinicians are using evidence-based medicine; we have close to 80% adherence to MBC, which is well above industry best practice. We also offer appointments within 48 hours for high acuity patients, and our outcomes are strong. Our data shows over 40% improvement in total cost of care for patients in our clinic. I don’t know of another company that connects physical health to behavioral health the way we do.

I have absolute conviction that we must address the whole person in healthcare.

Using that integrated approach, we’ve just launched a new product. For patients with serious mental illness, we’re building a behavioral health home that delivers whole-person treatment—physical health, behavioral health, and social care, which is reimbursed in a value-based model. I worked closely with two of my classmates from Yale SOM to develop this solution: Tom Dow, who leads our medical economics team, and Michael Lipp, our chief medical officer. Getting to collaborate and innovate with Michael and Tom at Quartet has been one of the greatest gifts from the program.

Q: Why did Quartet choose to focus its new offering on the seriously mentally ill population?

In the last few years, we’ve seen lots of new entrants in behavioral health—think Talkspace, Headspace, Calm. Most new entrants focus on those with mild mental illness. There are very few programs directed at the moderate to seriously mentally ill.

This is a patient population that really struggles. Their average lifespan is 15 to 17 years shorter. Often, they do not have access to physical or behavioral healthcare. And from an economic perspective, these are incredibly expensive patients because they require a lot of services and, if they don’t get those services, they end up in situations that require an emergency room or inpatient facility.

I have absolute conviction that we must address the “whole person” in healthcare. I’ve spent over two decades in the field. I’ve worked on the physical health side. I’ve seen the difficulties and complexities of delivering care to patients. I’ve also done work focused on the social determinants of health. That’s why I know Quartet’s approach is an opportunity to improve experience and outcomes for these patients. This is a business opportunity because, in a value-based context, we can deliver higher quality care that lowers overall costs and provides better patient outcomes.

Q: How does the program work?

We take total cost-of-care accountability. Our primary care and behavioral health clinicians provide care virtually and in person. We meet the patient where they are: in the hospital, in the home, in the community. We provide whatever service the patient needs, whether it’s physical health, behavioral health, or social services. We’re not saying, “Oh, this or that’s not covered.” We’re doing what we think is clinically appropriate for each patient because, at the end of the day, we are rewarded based on our clinical outcomes: Did we reduce cost of care? Did the patient’s health improve?

Value-based care is a very impactful reimbursement model for this population because it aligns incentives. This population has complex needs, with nearly three comorbid conditions on average, and thus requires a payment model that reimburses for not just mental health services but treatment for the whole person. By treating all aspects of health, we can prevent acute events such as hospital admissions by ensuring access, quality, and continuity of care, which in turn lowers overall costs. And we can do this successfully because it’s one care delivery team working together.

This isn’t a short-term program; we stay with patients for as long as they need us. That could be 12 months or 18 months or it could be three years. We see up to a 30% to 40% total cost-of-care reduction while improving quality and patient experience. It’s early, but we’re seeing very good results to start. For example, we are seeing over 25% patient engagement in a tough to reach population, and over 95% are coming back for follow on appointments and visits. That is an early indicator of success.

Q: How is mental health care usually paid for?

Today, mental health is still primarily a fee-for-service game. If you’re fortunate enough to find a provider that’s in your network, you have a co-pay, but the lion’s share of individuals are using cash pay in order to get access to the mental health provider that they want on the timeline that they want.

A lot of work has been done on mental health parity, which would ensure mental health issues are covered by insurance and that providers are available, but more work needs to be done to fully implement these programs with payers across the country.

I know people who are paying up to $450 an hour to see a therapist in New York City. I don’t think that’s sustainable. It doesn’t solve the core issues at hand with respect to equitable access, quality, or fragmentation. For example, the fee-for-service world does not reimburse for treating the whole person. Services like transportation, wellness visits, or peer support are often not reimbursed, but they are critical to improving health outcomes and lowering overall costs. That’s why we’ve made the choice to work with both commercial and government payers, so the providers we make available to individuals are largely in-network choices, and why we’ve launched our value-based products to provide alternative payment models.

Q: Who is your customer?

We have a patient-first culture and mentality. We are accountable to our patients, but often we get access to them through a payer, so at the end of the day, our customers are health plans, health systems, community mental health centers, and government payers.

Q: Where do you see the field moving in the next five years?

I think that we are going to see a lot more movement toward value-based care for behavioral health. Traditional fee-for-service does not work for whole-person care or for higher acuity populations—whether its mental health or substance use.

I also absolutely think there’s a place for AI in behavioral healthcare. There’s work being done on patient intake, routine administrative tasks, and transcribing notes from sessions, all of which can help to tackle issues of supply by freeing up staff to focus on patient care.

AI can also analyze vast datasets far more efficiently than humans. This capability can lead to earlier detection of diseases, help develop personalized treatment plans, and lead to better patient outcomes. It’s worth noting that for these efforts to be successful, they rely on high quality data, a multi-disciplinary team to develop and validate recommendations, and the protection of patient data and privacy.

Q: Has your experience at Yale SOM shaped how you approach your work?

I got a tremendous amount out of my Yale SOM experience. Because I chose the healthcare focus, my classmates all worked in healthcare, too, but they had expertise in other disciplines such as law, technology, or medicine. Their different points of view gave me a broader understanding of the many constituents in healthcare and the challenges and opportunities each faces, as well as the importance of the entire healthcare delivery system working together. This broader view and experience have made me a better problem solver, strategist, partner, and leader of people and organizations.

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Blog Infographics

8 Mental Health Infographics to Raise Awareness [Templates and Examples]

By Jeilan Devanesan , Mar 10, 2021

Did you know that leading organizations like NAMI , MHA , and others educate people on mental health most frequently using mental health infographics?

Mental health infographics are simple and accessible visuals that help people (who aren’t mental health professionals) understand important and complex mental health information. When you communicate to staff, students, parents or entire communities, mental health infographics help you convey a lot of information clearly and effectively .

Take a look at these mental health infographic templates and examples to help you create your own.

Not a designer? No problem. Our easy-to-edit infographic templates and online Infographic Maker make it simple to create your own mental health infographics .

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NEW! Launching: The Authoritative Guide to Designing Infographics

Anyone can create professional infographics with this comprehensive and accessible guide. It’s packed with insights, best practices, examples, checklists and more—everything you need to make infographics that stand out above the cut.

Learn how to design professional infographics that help you reach your communication and business goals. Check out the book here:

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Click to jump ahead:

• Fact sheet mental health infographic template
• Fact sheet mental health infographic example
• Employee mental health checklist infographic template
• Workplace mental health chart infographic template
• Children’s mental health infographic template
• Tips mental health infographic example
• Disorders mental health infographic template
• Coping mental health infographic template

Mental health infographics FAQ

1. fact sheet mental health infographic template.

CREATE THIS INFOGRAPHIC TEMPLATE

This mental health infographic template breaks down something complex into manageable chunks of information. The bulk of the infographic consists of headings and vibrant illustrations that communicate singular ideas clearly. Any accompanying text provides context and examples.

Related : 7 Healthcare Infographic Templates for Healthcare Professionals

This template can easily be customized for other healthcare issues: diseases, syndromes, chronic illnesses and more. With our in-editor library of over 12,000 free icons and illustrations, you’ll find the right visuals to help convey your message. We also have 400+ diverse icons for better representation of everyone in our communities.

2. Fact sheet mental health infographic example

The National Alliance on Mental Illness (NAMI) created this amazing mental health fact sheet infographic to support people managing their own or others’ mental illness.

The messages are clear, the different icons engage our attention and help to break up the text. Not only does it provide advice, it also offers guidelines and examples of how to act on the information. This infographic is of practical value to anyone who needs this type of support.

Mental health infographics like these can be used to empower mental health workers and train healthcare staff. But it can be used in any professional or community setting as a resource to support people’s mental health journeys.

Related : 6 Types of Nonprofit Infographics to Boost Your Campaigns

3. Employee mental health checklist infographic template

CREATE THIS CHECKLIST TEMPLATE

This customizable employee mental health checklist infographic template is a simple tool for helping people mindfully manage their mental wellbeing.

To customize the template, swap out icons, add news sections and text and hyperlink to more in-depth resources. Sharing the checklist infographic as an Interactive PDF makes links clickable.

The rates at which people are experiencing anxiety and depression have spiked severely over the past year. At the same time, professionals are increasingly working remotely, while engaging with their colleagues, friends and people in general less frequently.

Connecting with your staff and team in person can be challenging, but providing visual resources is the easiest way to do so.

4. Workplace mental health chart infographic template

CREATE THIS CHART TEMPLATE

We’ve often heard that mental health illnesses, or mental health in general, exists on a spectrum. This mental health chart infographic template depicts one context in which that applies.

Using simple icons that convey varying emotions, and a matching color palette, this chart infographic depicts a range of emotions and conditions that people may be experiencing at any given time (with relation to employment).

Infographics like these are valuable because they provide an emotional context for our interactions with people at different stages of their career or employment status.

5. Children’s mental health infographic template

Sharing information is not quite the same as informing and educating people . To effectively inform someone, they’ll need to retain the key points.

This children’s mental health infographic template is an easy-to-read guide for identifying mental health illnesses among children. The icons and headings work together to help information sink in, while the explanations/examples in each tile provide needed context.

To customize the design, sections can be added or taken away, the length of the infographic changed under the settings   tab in the editor and a new color palette can be applied for a unique look.

6. Tips mental health infographic example

The Anxiety and Disorder Association of America  created a great mental health infographic for dealing with anxiety.

The super large icons and bold text really support the scan-ability of the infographic. It makes reading through the infographic less intimidating and also ensures a hassle-free mobile experience. It’s important to remember, many things we share with our audiences today may be viewed on a large monitor, a laptop, a tablet or a mobile phone screen.

Finally, the infographic is longer in length than some other mental health infographics we may have come across. But spacing the text out and not overwhelming the reader is a great approach.

Related : How to Create Accessible Infographics With Venngage

7. Disorders mental health infographic template

This mental health comparison infographic template is a great way to provide clarification to any topic shrouded in misconceptions. By comparing myths to the corresponding facts of a mental health illness (bipolar disorder, in this case) you provide accurate information and undermine falsely-held ideas at once.

You can reinforce the comparisons you’re making through design. Bold headings, lining up sections head-to-head and a distinct color palette for each myth and truth effectively draws out the individual points in this comparison infographic template. The icons establish a line down the middle to establish the two sides of the topic.

This mental health comparison infographic template can be used for any topic, mental health illnesses or something else entirely.

8. Coping mental health infographic template

Messaging within your health infographic design is important. Acknowledging a time period as a crisis is an important step to take as an organization. It allows employees to feel that experiencing stress, burnout and other intense emotions is normal.

This mental health infographic template also uses icon illustrations effectively, by helping readers visualize each outcome.

Being able to visualize an outcome is key to bringing it about. For people dealing with overwhelming amounts of stress, they can benefit from visual cues to take care of themselves and do something that they will enjoy.

The Venngage editor makes it easy to capture a range of activities, ideas and feelings with a library of over 12,000 icons. They’re all free and you can replace any icon in our templates by clicking it, clicking the Replace button and selecting a new icon from the library.

1. What is a mental health infographic? 

A mental health infographic is a visual that provides information related to mental health wellness and illnesses using text and visual cues.

2. How do I add mental health information into an infographic?

Every Venngage infographic template is completely customizable and can be edited online. It’s free to sign up and edit templates, there is no software to download and your changes save as you go.

3. Why do I need to use infographics to communicate about mental health?

Mental health is a very broad, complex and constantly evolving topic. But the audience who need information about mental health are the general public who are not experts in mental health. Mental health infographics help to make complex mental health information easy to understand and act on.

Need to make an infographic? Start creating in seconds with our professional templates and simple online editor.

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5 Strategies for Improving Mental Health at Work

• Morra Aarons-Mele

Benefits and conversations around mental health evolved during the pandemic. Workplace cultures are starting to catch up.

Companies are investing in — and talking about — mental health more often these days. But employees aren’t reporting a corresponding rise in well-being. Why? The author, who wrote a book on mental health and work last year, explores several key ways organizations haven’t gone far enough in implementing a culture of well-being. She also makes five key suggestions on what they can do to improve the mental health of their employees.

“I have never felt so seen.”

• Morra Aarons-Mele is a workplace mental health consultant and author of  The Anxious Achiever: Turn Your Biggest Fears Into Your Leadership Superpower (Harvard Business Review Press, 2023). She has written for The New York Times, The Wall Street Journal, O the Oprah Magazine, TED, among others, and is the host of the Anxious Achiever podcast from LinkedIn Presents. morraam

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Helpful Presentations for Short Mental Health Discussions

Choose to stay suicide prevention, church resources on emotional resilience, get to know your classmates (connection), journaling (discussion questions), professor life experience, professors sharing experience - discussion questions, therapy stigma, panic disorder, social anxiety disorder, best possible self - self care tips, classical music, mindfulness, paced breathing, self-compassion, support system, emotional resilience, biofeedback lab, case manager, couples therapy, crisis services, group therapy, individual therapy, qpr training, silvercloud, university accessibility center.

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• Types of Therapy
• Best Online Therapy
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• Managing Stress
• Sleep and Dreaming
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The Importance of Mental Health

Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities.

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Risk Factors for Poor Mental Health

Signs of mental health problems, benefits of good mental health, how to maintain mental health and well-being.

Your mental health is an important part of your well-being. This aspect of your welfare determines how you’re able to operate psychologically, emotionally, and socially among others.

Considering how much of a role your mental health plays in each aspect of your life, it's important to guard and improve psychological wellness using appropriate measures.

Because different circumstances can affect your mental health, we’ll be highlighting risk factors and signs that may indicate mental distress. But most importantly, we’ll dive into all of the benefits of having your mental health in its best shape.

Mental health is described as a state of well-being where a person is able to cope with the normal stresses of life. This state permits productive work output and allows for meaningful contributions to society.

However, different circumstances exist that may affect the ability to handle life’s curveballs. These factors may also disrupt daily activities, and the capacity to manage these changes. 

The following factors, listed below, may affect mental well-being and could increase the risk of developing psychological disorders .

Childhood Abuse

When a child is subjected to physical assault, sexual violence, emotional abuse, or neglect while growing up, it can lead to severe mental and emotional distress.

Abuse increases the risk of developing mental disorders like depression, anxiety, post-traumatic stress disorder, or personality disorders.

Children who have been abused may eventually deal with alcohol and substance use issues. But beyond mental health challenges, child abuse may also lead to medical complications such as diabetes, stroke, and other forms of heart disease.

The Environment

A strong contributor to mental well-being is the state of a person’s usual environment . Adverse environmental circumstances can cause negative effects on psychological wellness.

For instance, weather conditions may influence an increase in suicide cases. Likewise, experiencing natural disasters firsthand can increase the chances of developing PTSD. In certain cases, air pollution may produce negative effects on depression symptoms.  

In contrast, living in a positive social environment can provide protection against mental challenges.

Your biological makeup could determine the state of your well-being. A number of mental health disorders have been found to run in families and may be passed down to members.

These include conditions such as autism , attention deficit hyperactivity disorder , bipolar disorder , depression , and schizophrenia .

Your lifestyle can also impact your mental health. Smoking, a poor diet , alcohol consumption , substance use , and risky sexual behavior may cause psychological harm. These behaviors have been linked to depression.

When mental health is compromised, it isn’t always apparent to the individual or those around them. However, there are certain warning signs to look out for, that may signify negative changes for the well-being. These include:

• A switch in eating habits, whether over or undereating
• A noticeable reduction in energy levels
• Being more reclusive and shying away from others
• Feeling persistent despair
• Indulging in alcohol, tobacco, or other substances more than usual
• Experiencing unexplained confusion, anger, guilt, or worry
• Severe mood swings
• Picking fights with family and friends
• Hearing voices with no identifiable source
• Thinking of self-harm or causing harm to others
• Being unable to perform daily tasks with ease

Whether young or old, the importance of mental health for total well-being cannot be overstated. When psychological wellness is affected, it can cause negative behaviors that may not only affect personal health but can also compromise relationships with others. 

Below are some of the benefits of good mental health.

A Stronger Ability to Cope With Life’s Stressors

When mental and emotional states are at peak levels, the challenges of life can be easier to overcome.

Where alcohol/drugs, isolation, tantrums, or fighting may have been adopted to manage relationship disputes, financial woes, work challenges, and other life issues—a stable mental state can encourage healthier coping mechanisms.

A Positive Self-Image

Mental health greatly correlates with personal feelings about oneself. Overall mental wellness plays a part in your self-esteem . Confidence can often be a good indicator of a healthy mental state.

A person whose mental health is flourishing is more likely to focus on the good in themselves. They will hone in on these qualities, and will generally have ambitions that strive for a healthy, happy life.

Healthier Relationships

If your mental health is in good standing, you might be more capable of providing your friends and family with quality time , affection , and support. When you're not in emotional distress, it can be easier to show up and support the people you care about.

Better Productivity

Dealing with depression or other mental health disorders can impact your productivity levels. If you feel mentally strong , it's more likely that you will be able to work more efficiently and provide higher quality work.

Higher Quality of Life

When mental well-being thrives, your quality of life may improve. This can give room for greater participation in community building. For example, you may begin volunteering in soup kitchens, at food drives, shelters, etc.

You might also pick up new hobbies , and make new acquaintances , and travel to new cities.

Because mental health is so important to general wellness, it’s important that you take care of your mental health.

To keep mental health in shape, a few introductions to and changes to lifestyle practices may be required. These include:

• Taking up regular exercise
• Prioritizing rest and sleep on a daily basis
• Trying meditation
• Learning coping skills for life challenges
• Keeping in touch with loved ones
• Maintaining a positive outlook on life

Another proven way to improve and maintain mental well-being is through the guidance of a professional. Talk therapy can teach you healthier ways to interact with others and coping mechanisms to try during difficult times.

Therapy can also help you address some of your own negative behaviors and provide you with the tools to make some changes in your own life.

A Word From Verywell

Your mental health state can have a profound impact on all areas of your life. If you're finding it difficult to address mental health concerns on your own, don't hesitate to seek help from a licensed therapist .

World Health Organization. Mental Health: Strengthening our Response .

Lippard ETC, Nemeroff CB. The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders . Am J Psychiatry . 2020;177(1):20-36. doi:10.1176/appi.ajp.2019.19010020

 Helbich M. Mental Health and Environmental Exposures: An Editorial. Int J Environ Res Public Health . 2018;15(10):2207. Published 2018 Oct 10. doi:10.3390/ijerph15102207

Helbich M. Mental Health and Environmental Exposures: An Editorial. Int J Environ Res Public Health . 2018;15(10):2207. Published 2018 Oct 10. doi:10.3390/ijerph15102207

National Institutes of Health. Common Genetic Factors Found in 5 Mental Disorders .

Zaman R, Hankir A, Jemni M. Lifestyle Factors and Mental Health . Psychiatr Danub . 2019;31(Suppl 3):217-220.

Medline Plus. What Is mental health? .

National Alliance on Mental Health. Why Self-Esteem Is Important for Mental Health .

By Elizabeth Plumptre Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

The Mental Health Toolbox

-KNOWLEDGE TO THRIVE: Your resource to learn actionable coping skills for strengthening your mental health, gaining focus and succeeding at life.

How To Structure A Mental Health Intake Assessment

Table of Contents

The Clinical Loop: Part-1/3: How to Structure A Mental Health Intake Assessment.

How To Structure A Mental Health Intake Assessment I n this video, I discuss how to structure a mental health intake assessment.

– Gratitude Journal –

– Guided Meditatio ns –

TRANSCRIPTION

Hi, are you trying to figure out how to structure a mental health intake assessment while you’re in the right place? So stick around and I’m going to walk you through step by step how I structure and take assessments as a mental health professional. After a decade of experience and why it’s important to consider this as the first part of the clinical loop. OK, so let’s get to it!

Hi, my name is Patrick Martin and after meeting me for the first time I’m a mental health professional by trade. I am passionate about raising mental health awareness and teaching actionable coping skills and ways to be more productive. In this episode of the video podcast I’m going to teach you how to structure a mental health intake assessment. 

As I walk through this, I want you to keep in mind that this is the first part of the clinical loop and the clinical loop consists of three phases. The intake assessment, the treatment plan. 

And progress notes, and we’ll talk more about that in a bit, but I wanted to take an opportunity to create this episode for you. And if you’re listening on the podcast, you’ll still get value out of this. If you’re watching on the video, you can follow along. 

I don’t know about you, but I I like to toggle between both depending on what I’m doing. If I’m taking a walk, I like to have a podcast going. If I’m sitting and relaxing, I’d like to watch YouTube tutorials, so best of both worlds. 

In this episode of the video podcast, I’m going to walk you through how I structure mental health intake assessments and also why it’s the first step in the clinical loop. The clinical loop consists of three parts, the intake assessment, the treatment plan and progress notes, and as I walk through this, I’ll try to explain my thought process and how I ask questions why ask the questions but I’ll keep it as quick and simple as possible and you can always ask me to elaborate and I’ll be more than happy to do so in any future videos. OK, let’s go. 

Alright, so the first thing to consider when you’re conducting an take assessment is of course informed consent right? I usually start off the conversation by asking clients; Have you ever been through this process before trying to keep in mind what it’s like to be on the other side of the desk and get into? 

The mindset of the person that you are speaking to, because if it’s somebody who has a lot of treatment history in the mental health system. They’ve they’re probably very familiar with the intake process, the type of questions the rigamarole, but if they’ve never been through the intake process, it could be pretty scary.

They don’t know what to expect, so it’s always good to start off by just letting them know that a of course everything is confidential and private won’t be shared with anyone else without their informed consent. 

Explicit consent. Of course it falls under mandated mandated reporting laws right? And so it’s important to just keep in mind that it’s well worth your time to educate the person on the other side of the desk or the other side of the phone or the other side of the camera, depending on what your modality is, Tele health, face to face, and help demystify it for them, so I usually say something along the lines of:

Orient Them To The Process

“you know the intake assessment is just a process in which we’re gathering history in order to get a bird’s eye view so that we can figure out how to best help you, and also put together a plan to see how we can be of service and meeting your goals”; or something along those lines, and just let them know that there’s nothing behind the curtain.

This is mostly history gathering process, but also as a clinician, we’re looking for points of intervention for future implications in terms of how we can intervene, what their target behaviors are. 

Are there any compensatory behaviors, as well as any other clinical relevant information, such as grief, loss, strengths, weaknesses, environment, bio-psycho-social stuff. 

OK, so the first thing I want to bring your attention to is of course modality. So if this is something being done via Tele Health, which you know, given that this is the Covid-19 pandemic and pretty much all treatment is being done over the phone or over Tele health right now, it’s really important to consider the modality so that you can you can put into your assessment or at least assess for what the circumstance is. So, for example, if it’s being conducted by telephone, you definitely want to document that that this is being done by telephone and you’ve reviewed emergency protocols with your client in advance. 

And in the same vein, you want to be sure that you understand where they are. So you want to document their location. Very important in case of an emergency. So you want to know are they home or they have their car. If they’re in their car, where are they? And so forth. 

Referral Source

And other than that, the first question I’d like to start off with is the referral source. You know, how did you hear about us? Who? How did you you know who refer to you as a family? Was it a friend? Was it your primary care provider? Was it another mental health professional? ’cause that gives you a lot of information and also what the motivation is, is this? 

Um, a self identified problem that brings into treatment or is this? 

An issue that’s been brought to their attention by somebody else or even oftentimes mandated treatment through, like the court, children, Family Services and that’s equally important to know because that’s going to help prime your mind for how you’re going to what you’re going to be looking for during the assessment. In terms of how to best help this person and what their level of motivation and even insight is. 

Into what the whole mental health platform has to offer them in terms of their needs. ’cause a lot of people they look at mental health as just being sometimes about thoughts and feelings, but they don’t necessarily think about it as a resource you know to meet their other basic needs.

Help them problem solve barriers for those needs and so it’s a great opportunity, especially if it’s somebody’s first time getting to mental health. 

To educate them about exactly what mental health is and to address any underlying assumptions they might have about it.

Presentation

Alright, so presentation. This is basically something I I’m mindful of. You know you’re paying attention to their affect. Their stated mood. Is it congruent incongruent? Their age, ethnicity? Do they have children? Do they not have children? And oftentimes this is something I’ll come back to after I’ve asked the rest of the questions. 

And I’ll fill in once I have a better, better idea of what the whole picture looks like. It just helps me write the presentation. 

Later, after I’ve asked most of the other questions, it’s almost like a brief summary before I do the clinical summary. I don’t know if that makes sense, but it will OK, and then the primary complaint. This, in my opinion, should be the client’s own words, so this should come directly from the client or the horses mouth. If you were and. 

Primary Complaint

You can paraphrase. I paraphrase sometimes, but the idea here is that the primary complaint is going to speak directly to the goals when you’re formulating the treatment plan. OK, because oftentimes we have a certain idea. We make assumptions about what a client is going through based on their history, but nothing is more valuable. 

Then getting their own words.

Oftentimes. They all want to say something like. I just don’t want to be anxious anymore or I just want to be happy or I don’t want to be depressed. And it’s our job to really tease out what that means specifically in actionable terms, right? What does it mean to not be depressed? Well, if you’re anxious, how often are you anxious, you know? 

Frequency and intensity. How is this, more importantly, interfering with your life, your quality of life? Is it causing problems in your relationships? Is it causing problems at work? Is it causing problems in school, you know? 

The more specific we can get with the impairments, the easier it’s going to be to formulate a treatment plan, which is the second part of the clinical loop.

Being cognizant of how these things tie together, because the assessment should inform the treatment plan and the progress notes from therapy that the actual treatment should reflect progress toward the goals. The stated goal is the treatment plan, right? So that’s why it’s called the clinical loop. 

Religious Practice

Religious practice. I always like to start with this question after the initial complaint, because it’s important for us to be sensitive not just to someone’s spiritual beliefs, but also because how relevant is that? And that’s an easy one to miss. If if we just drive past it. 

And so they might say, oh, Catholic Christian, Jewish, Taoist or whatever, you know, or agnostic, and we can leave that alone. But I like to dig a little bit deeper and find out how does their value system inform their quality of life, maybe they used to be very involved in church and they’re not anymore. That’s important to know that’s something we want to pay attention to, OK? 

Now, in terms of symptoms, it helps me to list things out kind of break it apart. So what I’m asking about symptoms, I’ll drill down a little bit. More specifically, I’m looking for depression and anxiety and of course any psychotic symptoms. Try and parse all those out so they can be more specific. 

So somebody’s complaining of feeling depressed. 

It’s important to know, of course, how often they’re feeling depressed. How long-lasting is that depression? 

How intense is that depression, and specifically what symptoms surround the depression.

Somebody is not going to say I’m anhedonic or I suffer from hypersomnia, hypersomnolence or insomnia. Even sometimes they’ll just say like, well, I can’t sleep and when I try to sleep my mind is racing and then I worry about my future and….

You know they will use different language, so it’s our job to kind of tease out that language and then kind of wrap it back up into clinical terms, right? That makes sense to us and so this will help us distinguish and determine out clinical impression. 

Is this A major depressive disorder or is this indicative of a bipolar disorder. They start to drill down on what’s specifically going on and what that looks like for somebody; you will get a better idea from a recall of lived experience. 

The relevance when we’re looking at diagnosis are differential diagnosis, and so there’s no right or wrong here, absolutely. 

It is important though to consider. 

The details, yeah, because the duration of depression, the intensity of depression, and how that coincides with other other things like mania, hypomania. You know their complaints of panic disorder. Those are all relevant and oftentimes indicative one to another, OK. And when it comes to onset, you know oftentimes the client will complain about it; “oh, I’ve been struggling with this for years or as long as I can remember”.

But do try and challenge your client a little bit more on when did they first notice it, and what did life look like, and at the onset of anxiety may look different than the onset of depression, which may be different than the onset of psychosis; if they struggle with all three, you know. Their first experience of paranoia may differ from their first experience of a panic attack or their first experience of a major depressive episode. 

And so it’s kind of important to tease those things out and make sure you’re accounting for the timeline on each of those. And so I’ll apply, you know, under depression I might put a different onset or under onset all kind of list out onset of depression onto the anxiety instead of 1st psychotic episode. And if they do differ, kind of tease those out from each other because it’s relevant. 

OK, so sleep. You know when we’re assessing for mental health, it’s really, really important to get an idea of what somebody’s sleep looks like because. 

That’s really a big clue in terms of where their struggles are, and oftentimes is one of the biggest things that we used to help tease out symptoms of, say, a bipolar disorder, and then the kind of sleep patterns there, because yeah, insomnia might be a symptom of depression, and so is hypersomnolence.

It’s a symptom for anxiety too, right? And so it could also be indicative of, you know if there’s a pattern to the sleep cycle hypomania, or mania, not sleeping for four five nights at a time, feeling lots of energy. Those are things we want to pay a lot of attention to because we never know what’s going to be relevant, so we are sure to be careful not to drive past the subject of sleep hygiene too fast. 

I try to be very mindful of not being cut and dry with the questions, and so, oftentimes I will bounce around and that’s why I have this kind of written out on a Word document because I do jump around a lot because it’s more natural. That way you’re following the client, you’re letting them share, right? That free Association. 

So you can pick what’s relevant and circle back to those things ’cause everything is relevant. But oftentimes if we force a client into closed ended questions, we’re not really going to get a whole lot. You know, which can just lead to “yes” and “no”s, and very short statements. But if we allow clients to talk and share what’s most relevant to them we can kind of redirect the conversation if it gets off off topic too much, for the sake of time, but then we can also pick out things that we may not have otherwise considered, so it’s really important not to pigeonhole the client too much into answering specific questions in a specific order. 

But this is the general structure, just keep in mind I do like to jump around a lot depending on what what’s being expressed.

OK, dependence. This is a really, really big one, because when it comes to assessments, not just because of the family structure, but because of risk issues. 

We want to be mindful of whether somebody has children, how many children do they have? Always trying to assess for special needs. If there’s anything going on, so you can start to assess for any kind of support referrals they might need if they’re overwhelmed. If there’s a caretaker burden. Also, if there’s any custody issues. 

So definitely you want to assess for that you know somebody says they have Children.

I always like to ask if you know what the arrangement is. Oftentimes children can have different parents and there might be different situation there that might be history of abuse, domestic violence. There might be court orders, and so those are always things you want to kind of tease out. You don’t want to drive by that too quickly because you’ll end up having to assess for that later anyway, and you’ll end up maybe having to revisit that in more detail further on into treatment if you didn’t get enough information on the front end, OK. 

So loss, keep in mind that loss is not always death. Oftentimes loss can be loss of a job, loss of relationships, loss of identity, role transitions. So when we’re assessing for loss, I do try and start the question off with, you know, have you had any recent deaths or losses in the family? But then, if they, even if they say no, I’ll back out a little bit and say, well, what about other changes you know in your life, any major changes that you’ve been going through and so often times that’s when they’ll start to identify other forms of loss. “Oh yeah, you know I’ve been going, you know, I just broke up with my girlfriend of 18 years.” Well, that’s significant.

That’s a loss, but maybe they weren’t thinking of that as a loss because it wasn’t a death and so we need to be. Oftentimes careful to clarify what we’re asking, right? Because if we don’t, if we don’t elaborate, then clients will often just make assumptions like we all do, right, and they may not give you the details that really do matter when it comes to the assessment, OK? 

The other thing that is equally important is strength. So we definitely want to be assessing for strength, and this is really, really important. 

With the assessment is because this is what’s going to really move the needle because we want to be able to figure out what somebody has in terms of leveraging and their repertory, their coping skills. You know it’s going to help them move toward their goals and cope with future stress. 

So strengths might be art, music, creativity. I might be a skill set. It could be unbelief. System could be a lot of things. Maybe somebody who loves the outdoors. But since they’ve been depressed, they’ve neglected that part. Or maybe ’cause there’s been a life change, like the pandemic. They stopped going to the gym and that was really A big part of their life, so as as a clinician it’s our job to kind of tease out. OK well, how can we leverage those strengths in a different way that maybe they haven’t considered like if they used to love the gym. 

We want to ask have they been working out at home or are they caught up in that black and white thinking all or nothing thinking and so it’s part of our job to tease that out so that we can help them formulate ideas to start leveraging those strengths again, OK? 

Self-Harm and Violence

So it goes without saying that we want to assess for self harm and violence, right self harm such as self injurious behavior. 

Right? 

That could be superficial. History of like cutting. We want to find out where they’ve been cutting, if that’s if that’s a concern. That’s also indicative of potential diagnosis of other other conditions like borderline personality disorder.

Or if there’s been a self interest behavior as a form of suicidal ideations or testing themselves or even an expression of seeking help from others, or if there’s been any actual suicide attempts such as trying to end their own life, and if so, we want to definitely find out if you know if they did try and hurt themselves or they did try and their life. 

What stopped them? Was it a failed attempt? Did somebody intervene? It’s also relevant to future implications because it will advise us of any kind of red flags in the future of simply trying to overdose on pills in the past. That’s important to know because that’s something to watch for in the future, right? 

Equally, violence you know is really important to assess for because. 

Even if somebody doesn’t have a history of violence, we want to kind of find out what their relationship to violence is looked like, and also other propensity toward violence is. And if they have a history of anger or impulsive behavior, we want to find out a what’s triggered that behavior an be what helps mitigate that behavior. OK, again, we always want to be assessing for risk. 

And sometimes that won’t always be relevant until we start getting into other history of triggering situations, and then they’ll bring up something. Oh yeah, you asked me about violence. Well, there was this one time and so that’s why it’s important that you want to circle back with any added information, even if you’ve already kind of passed that question. You want to be sure to come back and kind of Plug that back in.

Contributing Factors

I always like to to tease out any contributing factors to stress right or tp their their primary complaint and so. 

This might seem a little repetitive regarding some things like loss, but it’s also real time issues like financial stress/debt. You know you want to drill down those things and find out well if they’re stressed financially. Is it just unemployment or is there more going on? Do they owe people money or are they in debt? 

Are they unemployed? How long have they been unemployed? You know, if it’s a relationship issue, we want to find out why that breakup was so difficult. So when it comes to contributing stressors, we really want to kind of look at in real time and history. 

As far as what’s kind of what weighs on them on a regular basis, right? 

Hospitalizations

OK, moving on. So now you know we’ll talk a little bit about hospitalizations. This is a quick can. Be a quick question, you know. Have you ever been admitted to a psychiatric hospital? Have you ever been on a 5150 yes or no? You know, but sometimes it’s. 

“Well, I was taken to the hospital. I was assessed but I wasn’t kept on a hold, you know or they didn’t keep me overnight.”

Those are things to assess for because it’s not just hospitalizations we want to tease out. It’s also like ER visits for panic attacks or suicidal thoughts, even if they weren’t didn’t meet criteria for 5150, it’s still relevant and important to kind of assess for any warranted concerns that led them to seek emergency assistance. 

If they have been in the hospital, it’s usually a good idea to get the dates right, the dates, times of visits, which hospitals they went to an, then how much they how much insight they have as to why they were there as well as what what followed up with in terms of their stay there where they discharged with medication, how much medication, what kind of medication were they given and discharged with? 

Did they have blood work done? If they have their blood work labs, that’s really important. And then if they’re if they’re open to it, you can always get a release from the, you know from the client for the hospital and then request the hospital records and so that can be very telling as well as discharge summaries lab results. That kind of stuff like drug screens can all be very relevant, especially if you’re working in coordination with a psychiatrist who’s going to want to know those things anyway, because psychiatrists will often order their own blood work, and if they have labs on file somewhere specially recently, it’s a good idea to have those OK. 

Mental Health Outpatient History

So mental health history in terms of outpatient services, that’s definitely something we want to assess for. You know where they had treatment? Have they ever been in counseling? Even if it was lay counseling with pastor or priest. 

Even in childhood where they any kind of services or programs you know, all of that is relevant and as much as possible, we want to be able to create a timeline of treatment and also trying to assess for you know what was helpful. So you’ve been in therapy in the past, what worked, what didn’t work.

What was thier experience like? That can be very telling as far as what their expectation is moving forward and also something was helpful. How we can leverage that? 

OK, if something really turned them off as far as treatment, we want to be sensitive to that as well, OK? 

Medication History

Medication support services. That’s a really a big thing. We want to assess for, you know, in terms of what medications have they tried. 

Were there any allergic reactions? 

Side effects what their experience has been like and what they’re currently taking, especially important to to find out if there’s been any reluctance to medication or any trouble with taking medication as prescribed, because that’s one of the biggest factors and people relapsing with mental health conditions is stopping medication because they don’t like the way it makes them feel or they it makes them feel like they have brain fog or they they feel they don’t feel motivated or they feel more blah. They lose their creativity.

There’s a lot of complaints with medication, libido and other things that can cause a person to stop taking their medication, but oftentimes people will stop but not talk to their psychiatrist or provider about it because they’re embarrassed. 

And so they’ll just stop and not say anything. And then we find out that’s why they ended up back in the hospital with a manic episode just because they stopped her medication. They had a valid complaint about it, but they didn’t expressed that for whatever reason, and that’s worth exploring, because treatment compliance is a major factor in recovery and for a client or consumer to feel safe talking about any apprehensions of their treatment is equally important to assess for OK. 

Substance Abuse

So in terms of substance abuse, you know we do want to find out, you know, do they drink alcohol? Do they smoke cigarettes? If so, how much and then any other drug history and. 

Also educate, you know if they if you tease out and you find out they do have a substance abuse disorder or some kind of dependence. This is your Golden opportunity to just offer. Ask if they’re willing for you to share some information on resources and then if they are, it is your Golden opportunity to really offer up some resources for inpatient outpatient treatment and also educate them about risk factors with alcohol and other substances so you can just kind of equip them, even if they’re not ready to make any changes right?

At that time you can start the conversation right there during the assessment and build that report early on. If it becomes a larger issue later on, you know at least you have that foundation and you might be surprised how open they are to intervention. Sometimes people are like, “yeah, you know, I’ve actually been thinking about that a lot and I would like to do something about it.”

You know, then you can equip them and even offer linkage if they need to. OK one example would be like the SASH hotline or refer them to the SBAT service locator tool. If you live in the LA County area, the SASH hotline will do a quick assessment screen over the phone with them and link him right to inpatient or outpatient services. So very helpful. 

So trauma. Keep in mind that when we’re assessing for trauma, it’s important to give them permission to not share everything. If they’re not ready. ’cause if you push too hard during the assessment for trauma, it can be a real turn off and they may not say anything, but then they may not come back because if you open something up that they’re not ready for, oftentimes they won’t say anything and they just won’t return for services. So it’s very important to. 

Give them permission to share as much as they like, but not anymore than they’re comfortable with. 

And then also understand that all trauma is not the same. So don’t just assess for physical or sexual trauma, but definitely also for witnessing violence growing up. What was it like growing up in their neighborhood? 

There’s a lot of different types of trauma. There is an emotional abuse, psychological abuse, neglect, trauma as an adult in relationships, domestic violence. So it’s just really important to keep an open mind when you’re asking about trauma and not just ask I’ve ever been abused. 

That won’t suffice, oftentimes, because they may not. 

It may not register with them. What you’re asking, OK? So take your time with this one.

Medical History

Medical, so it’s really important to a find out of course what kind of insurance they have and if you’re in California and for example they have medi-cal, it’s important to understand what kind of medi-cal, because you can oftentimes help link them to other services depending on what type of medical they have, what carve out. 

And if they have private insurance, you know it’s good to understand, kind of what they’re working with in terms of what their options are and also who their primary care provider is. You know if they don’t have a primary care provider, it’s our job to really make sure they’re linked, right? And they know where to go.

Did they get their their annual physical and blood work and all that good stuff because we can’t negate the General Medical and and talk about mental health issues only, because they’re married. We can’t separate them, and oftentimes General Medical issue have symptoms that mimic mental health issues and they also compound and aggravate mental health issues, and so talking about somebody’s General Medical care is really, really, really important part of their treatment. OK,

We always want to assess for their last physical. You know how long is it been, not just listening to their heart. 

When did they get blood work done? You know what did that blood work look like? Did the doctor review their labs with them? Was there anything flagged low vitamin D levels? Low vitamin B levels? High cholesterol? You know all of that stuff is relevant. 

We definitely want to assess for any medical history, so this would not just mean like. 

Diabetes, cancer, heart disease. This would be. 

Any history of surgeries? So did they have their Gallbladder removed? For example, we want to be very mindful of any any medical history that they’ve had in terms of treatment. OK ’cause again, we never know what’s going to be relevant and it’s really important that we take the time to kind of walk through this and not drive past it too fast.

OK, allergies. 

This is not just allergies to food and medication, but oftentimes seasonal allergies. We just want to be really sensitive and and thorough to make sure that we’re we’re capturing everything, because that is a risk factor. Allergies is a risk factor, and oftentimes clients will say well. When I took Abilify, you know I had this reaction as a medication that they. 

A doctor may try and prescribe them so we want to be aware of that, so that if we do refer them to a psychiatrist, we just remind them to let the psychiatrist know. Hey, I had a bad reaction to this medication, right? So that they don’t have a similar experience, which again could cause them to back out of treatment. 

OK, any sleep disorders? 

Sleep apnea right night terrors, sleep paralysis, sleepwalking. These are things we want to definitely be assessing for OK. 

Head trauma right? This could be a motor vehicle accident. This could be physical abuse in childhood, which one make sure you know, ask, have you ever had any lacerations? If you did have any head trauma, did you have a CAT scan? How long ago was the head trauma? These are all relevant issues. Any history of seizures and something I really like to kind of add on is diet so. 

Again, we can’t really separate physical health from mental health. If somebody is not eating properly and they’re not getting a proper diet, or hydrating that will have an impact on their mental health. So we definitely want to make sure that they are. 

Diet. You know that self Care piece is being attended to and that they’re educated about what’s going on, especially if they have co-morbid issue like diabetes who want to be sure that we’re linking them to valuable resources to help manage their diet. Maybe they don’t know how.

Asses if they are seeing a dietitian or if they have no idea what a diabetes educator is. You know we can help link them and help look those things up for them, even in real time. I do that. Oftentimes, I will help them find resources to well, well, it’s still top of mind while we’re talking about it that way. Again, it’s our job to help you quit people. 

To be their best selves, right? 

You also want to assess for if you know weight, height, BMI, that kind of thing, because you may be on the phone with someone for an hour, 2 hours, or doing an assessment that is not face to face and not even realize that they’re morbidly obese? Well, that’s good to know, right? We could have just completely missed that, because if somebody is not physically in front of us. 

It’s it’s an easy thing to miss if we don’t ask, right? And they may not feel like it’s relevant, or they may not even think to bring it up right? And then any medical history in the family you want to be sure that you’re paying attention to those things in terms of risk factors, so that could you know. Just ask, do you have any medical issues in the family that you’re aware of? Heart disease, diabetes? 

Cancer. 

And then usually if there is, people will know about it. 

And it’s again something that would be easy for them to forget to mention, unless you ask. 

And then, equally important, is history of mental illness in the family. So if there’s a history of bipolar in the family or a strong history of anxiety or depression, that’s a predisposing factor. We need to know about that so we can list that out as a risk factor, OK? 

Especially if they haven’t. If there’s a strong history, for example of bipolar disorder, and you’re talking to. 

An 18 or 19 year old who’s experiencing high anxiety and mood swings. You should in the back of your head be thinking you know this. This person could be looking at having their first manic break at you know 20 to 23. You know that’s something to look for because stress management is going to be really important. Part of the treatment plan. 

Alright education so not just did you finish high school or are you in college but we’re looking for things like where you ever diagnosed with a learning disability in school? Were you ever on an IEP? What did that look like for you? 

I also like to take an opportunity here and talk about goals. So if somebody has educational goals for college for example, but they didn’t get to that or they haven’t gotten to it, we want to find out why, because a big part of the assessment is identifying needs and goals, but also barriers. 

You know how can we help this person think through and problem solve their barriers? There’s probably resources they didn’t even know about. For example, disabled student services if they were, if they need help with accommodations, or if they can’t afford school thinking about things like Department of Rehabilitation that will help pay for their training and their higher education. 

Those are definite things we want to be assessing for OK. 

And then employment. You know if we don’t find out what obviously somebody’s employment status is, or the unemployed. Are they working? How many hours? What kind of job do they like their job? You know? Also what are they done in the past? So what you know? What are all the jobs you’ve had? And I always like to ask which one did you enjoy the most? 

Because. 

When it comes to our mental health and our quality of life. 

If we’re doing what we enjoy the most. 

It has a ripple effect on everything else, right? And so I I always try to encourage clients and we want to focus on jobs that speak to your strength and not your weaknesses, right? And oftentimes they will just look at a lived experience of a job they’ve had that didn’t go so well, and they’ll make assumptions about their ability to perform. And that’s not necessarily the case. 

It just wasn’t the best environment or a job for their skill set, their personality, their mental health, OK? 

So legal issues, of course. We want to find out if anybody has. 

You know illegal status, probation, parole. Those things are important, especially if they’re being referred by their probation officer or the court or diversion program. Any of those things, or if they do have a legal history but they didn’t want they had not brought it up yet and they have a probation officer, parole officer. 

They may, you know, it’s important to find out. “Do you want to sign a release of information so that if this person wants information about your treatment, we have permission to share that and so all of those things are relevant?” And also if somebody has a history of arrests and one of those arrests looked like what were the reasons? What were the circumstances? 

And so all of that is relevant because oftentimes people end up incarcerated because of their mental health issues, but they were never flagged as having a mental health problem. You know, in the forensic system, and so that’s also something worth teasing out. OK, and if they get arrested again, it’s important for them to know how you know to inform staff so they get proper treatment while incarcerated.

Right, the legal system of their mental health history so that that can be addressed in their incarceration and not just for their stigmatized right? OK, so housing, right? We definitely want to figure out, you know what somebody’s housing situation looks like. So do they live alone with family? The household constellation? So how many people are in the home? What ages are they? 

And drill down a little bit more and figure out what are those dynamics look like. Do you sleep on the couch or do you sleep in your own room? Do you have your own space? Do you share a room? How do you feel about your space? How much privacy do you have? All of those things are extremely relevant. You know we’re talking about an assessment in somebody’s mental health and quality of life. Because this is their day in. 

They out experience and you know between the times that you see them. This is their life and so. 

The better picture you can paint of somebody’s daily existence, the easier it’s going to be to kind of get inside their head and think about, well, if I’m this person. What are my needs? What would help me? 

You know thrive would help me improve my quality of life and so those are oftentimes things we can consider. And if they’re homeless, for example, they may not know what resources are available to them. They may not know about things like Volunteers of America or collaborative shared housing and things of that nature, or how to get into a Section 8. 

Waitlist or HUD housing there’s or even a family shelter right? If somebody’s in the streets with their kid and they’re escaping domestic violence, they may not even know about DV shelters for women. So there’s a lot of things that we want to be able to consider. 

When we’re talking about housing, it’s a big one. 

And homelessness is a huge issue right now and not just because of the pandemic, but in general OK. Family dynamics and structure. So this is definitely where you want to drill down on what somebody’s experience was like growing up, who raised them, where they raised by a single parent, where they raised in foster care Group home. 

Family History

Assess for family of origin and family of choice.

Where were they born, who raised them, what was their home life and childhood experience like, how many siblings do they have?

Were they raised by grandparents who you know have recently died, and that’s that’s a major loss for them. ’cause that was a parental figure. We want to find out if they have any siblings. Do they stay in touch with their siblings? And then of course, who are they closest to and their family? That’s really important. You know those attachments and trying to figure out what that looks like. If there’s any unresolved issues with their parents. 

See if they have ever been married, how many times they have been married? How long have they been divorced? Have they ever been widowed? 

How many kids do they have? What does their relationship with their kids look like? All of those things are extremely relevant. OK, and this is also where I would plug in if there’s any DCFS issues. You know custody issues, legal issues they’ve ever lost children to DCFS, you know custody and that kind of thing, so this is a big topic. 

And then I once you tease out some of that, you want to find out what their support system looks like. So I usually ask, you know, where do you get most of your moral emotional support from? Is that from family? Is that from friends? Is that from a particular group or your church? And what does that involvement look like? 

That could be an online forum that could be a Facebook group. Could be a number of things, but it’s again the better picture we get of what this person’s social network that looks like. The easier it’s going to be for us to kind of figure out where things can be leveraged, but also where we can plug some stuff in and help clients think through how to build out a better support system.

Clinical Summary

And then that brings us to this summary. So this is the clinical formulation, so it’s kind of taking all of that stuff and then packaging it in a way that makes quick, quick clinical kind of snapshot of what’s going on. And so this is often times where I look at the five P’s, you know, the pertinent history, the predisposing factors, the precipitating factors? 

Previous treatment and response and positive factors. In addition to their presentation and so taking all of the information and then kind of listing it out into these separate areas will give us a clinical snapshot of what we’re looking at, and especially if we have to do a case presentation or if you’re handing off this case to someone else. 

It’s a really helpful way to kind of paint a picture for somebody else so they whoever is picking up the case gets a quick idea of what the needs are, what the struggles are for the client, and that will help prime the other clinicians mind or the psychiatrist’s mind. 

Of how to proceed mindfully with this with this client right? And that’s really doing the client’s service, because we’re advocating for them even in the way that we document the assessment. OK, it’s not like somebody else has to start from scratch, right? 

Or dig through a body of text to kind of get a feel for what’s going on, right? 

So the presentation is kind of like we started off with at the top that we talked about. This is their their age, gender, orientation, ethnicity. 

Marital status. Do they have kids? And then of course, how do they present? Do they present somebody with a lot of insight? Do they present with somebody or as somebody who is a good historian? Do they have a linear thought process or are they very disorganized? Are they put together then well groomed, or they disheveled? You know, these are things to pay attention to. 

If there is any in congruence with their stated mood, and so a lot of the presentation ties into the mental health status exam, are they orientated to time person, place, situation? 

Are they having any internal stimuli? Are they? Does it look sound like there? It looks like they’re responding to any auditory hallucinations or visual hallucinations. These are definitely things you want to kind of tease out. And then of course their interaction styles. This person really easy to talk to, or are they very guarded? You know this person. 

Suspicious or paranoid? Or is this person love to talk a lot? Where? What is their style? Or are they storytellers is it? 

Does it take a lot of time to engage this person because they like to share a lot or is this somebody that you have to tease a lot of information out of? Those things are important. 

So again, this is not the history they’re presenting problem, right? There are predisposing factors, so this could be something like history of mental illness in the family. This could be in environmental situations, the way they’re raised, particular neighborhood, family dynamics was. 

Were they raised in families, heavily entrenched in gangs, those things are all relevant precipitating factors this is. 

Something that speaks to recent situations that lead them to mental health treatment. So oftentimes the question is why now? 

So you’re seeking mental health services, but why now? Why not before? Why not last year? Especially if this is the first time we really want to have a clear idea of what’s going on. 

That you’re now asking for help. What just happened to you? You know what was the hair that broke the camels back, right? Or or? Are they just being proactive, right? Maybe they’re really good with that, and they’re really good about asking for help before things become a big problem, right? That would also be a strength, and we also want to see in terms of perpetuating factors. 

Things that are currently contributing to their stress. Remember that section with the contributing stressors contributing factors? That’s what we’re talking about, so we want to find out what’s keeping them stuck. 

What’s keeping them unhappy? So this is often times where you would ask the miracle question. You know if you woke up tomorrow. 

And a miracle happened. How would you know what would be different so it’s that whole idea of solution focused therapy, right? Is that you’re trying to find the exception. So if life stinks right now, what would like what would life look like if it didn’t stink right? What would be different? And then that often will. 

Exactly what is weighing on the client, what the perpetuating factors are OK. 

And then positive factors. This is the strength, right? This is the strength and also things that maybe they didn’t identify your strengths that we see just and interacting with this person. And this person has really good insight or this person is really motivated to get help or this person is really well spoken, you know. Or this person hasn’t really solid goals in a clear plan about what they want to do. 

“This person is really artistic”. You know, these are things that we want to be able to list out in their own categories so that we can leverage them during treatment. OK.

Identified. Needs; you know, this is very, very tangible, so this is a very practical stuff, so I’m going to say like, oh, this person needs a primary doctor. 

This person has not had a physical in 10 years. It might be this person is homeless, right? They need housing or they need more appropriate housing or different housing environment, right? 

It could be something. 

This person needs to work on our communication skills. They bottled everything up. They contain everything and that’s why they explode. Or that’s why they get depressed is ’cause they’re not expressing themselves, so they don’t know how to communicate or they share too much right? They don’t know how to have good boundaries, and so these are things that we want to work on, right? Interpersonal effectiveness. 

Target behaviors; these are more specifically not just needs in terms of their quality of life, but the biggest red flags like this could be self interest behavior. This could be substance use. This could be anger outbursts. You know these are the target things that we’re most likely going to address in our treatment plan. 

All right, and so the DDX, the differential diagnosis is the last piece here, and this is really where we’re trying to use all of the information we just gathered, this is where we are really trying to determine what our clinical impression is.

This could be a few different things. This person could be going through an adjustment disorder, or maybe it’s an acute anxiety, or maybe as panic disorder. Or maybe it’s a major depressive disorder and maybe it’s a bipolar disorder. You know, this is where we’re trying to like say this versus this versus this, and based on all of the information presented. 

And all the information we have at hand, anything documented and our clinical impression. This is the provisional diagnosis that we’re giving them as our first impression. But keeping in mind that a diagnosis is not fixed, a diagnosis is nothing more than impression. It’s a compass that says, OK, this is what we think is going on, and so this is what we’re going to focus on right now in terms of the treatment plan and where where our head is at in terms of what we think the problem is. 

But that could change, right? Somebody could present as depressed, but we’ve you know they have a manic episode, you know, six months later and we found it, oh, so it’s not just depression as a bipolar disorder. Well, that changes things, especially with regard to medication, right? 

But understanding that a diagnosis is a living document, it’s not fixed and often times if you look at somebody’s history, they’ll have sometimes 10 different diagnosis because they present to different providers in a different way, different circumstances, and so that paints a very different clinical impression. Alright, OK? 

And so then, once you’ve got all that built out in the assessment, after you’ve done your formulation, this is where I like to list out the plan, because especially ’cause I don’t even know if I’m going to be keeping a case or if it’s going to go with someone else. 

But the plan is important in terms of case, So what happens next? So we’ve done the assessment. We’ve identified our clinical impression. We’ve got a background, got a diagnosis. 

This now we need to kind of think about. OK, So what happens next? And so who’s getting the case? Let’s say the case is being activated with, you know who is it going to? Am I going to keep the case? Is it going to another clinician? 

A caseworker, drug and alcohol counselor, a housing specialist and employment specialist. You know it’s important to know. 

Who’s going to be moving forward with the client? Medication support services? You know this may not be relevant. Maybe they they have no need for medication or no desire for medication. But if they do have a medication need that’s not being met, we definitely want to address that. So that might look something like, you know, the client is going to be scheduled with the psychiatrist and this is their appointment date. And in the meantime. 

I have encouraged the client to go to this mental health urgent care over here in order to get started on medication in the interim and so. 

We want to be sure that we’ve been very clear about what our plan is with the medication. If we’ve identified that as a need, OK, Now the PHQ-9 and the GAD-7 these are known as outcome questionnaires, right? They’re used as a way to get a baseline score. 

For specific symptoms, so the PHQ-9 is an outcome measure designed for depression is the Patient Health Questionnaire. This is used pretty regularly now in medical offices, primary care, mental health. 

And it’s a way to kind of flag potential, major depressive disorder, and it’s, you know, different symptoms. And it gives us a score out of 27 and generally anything North of #12 is a little concerning anything North of #18 is very concerning, and so this just kind of gives us a baseline of what to look for and also specifically what symptoms are the most distressing and then that can also really inform the treatment plan, which is why I use it a lot for something with add seven that stands for general anxiety disorder and so a lot of the questions are geared toward, you know, is this person have a general anxiety or not, or was specific symptoms of general anxiety disorder causing them the most distress? And that’s based out of #21 points, and so again, just like the PHQ-9, it’s more of a. 

A way to inform us of you know what to focus on and then overtime we want to see that score coming down OK and so. 

I know I’m I’m creating this tutorial. 

Parceled out you know in the clinical loop but in real time we would be doing the assessment in the treatment plan together, right? You want to do the treatment plan at the same time you’re doing the assessment, ideally, and not to let it tail behind too much, especially when it’s fresh in your mind and you have the client in front of you were on the phone or video and you really have them in that frame of mind. You want to say so. We talked about all these things so. 

What is it that you would like to see happen? And so the treatment plan will consist of, like a long term goal and short term objectives and we’ll talk more about that in Part 2 of the clinical loop when we discuss the treatment plan OK, and that will be the next episode. And then of course, you want to make sure that all of your consents are done, not just consent for treatment. 

But consents for any other relevant parties so primary care provider, family, anybody else that might be involved. DCFS probation officer? Anybody that might have? 

An interest with the client wants them to be involved in treatment, and you can specify of course the different levels of involvement, but it’s important to make sure those are all done ’cause it’s really a pain to get those later if you need to. Sometimes it just slows down the treatment process OK, and then of course any referrals you want to list out too. 

Identified needs. Like I said, this could be a mental health. Urgent care for medication, suicide hotlines, always a good one to give out any peer support hotlines. 

Substance abuse hotlines, that kind of thing. If you do give out any resources you want to be sure to kind of list those out. If for nothing else for a reminder an. 

This is often the way I do an assessment, I’m not writing the assessment just for it to look pretty. I’m I’m writing the assessment for myself because I want to be able to look back on my own notes, my own assessment, and be able to know exactly where my head was at. Because in the mental health world you know we see so many people, it’s it’s easy to kind of forget about the minutia of what was discussed, and so if you write a good assessment and it doesn’t have to be that way. 

You know, just lengthy for the sake of being lengthy, but if you have that vital information in there and it’s it’s summarized well it makes it a lot easier for you to reflect on your assessment when you’re about to see a client like, Oh yeah, that’s right. These things are really important. I want to make sure we put this into the treatment agenda so we don’t miss this because this was so important when they talked about it and you’re not the only one who’s going to forget about it. The client forgets also. 

The client will forget what they discussed week to week or session to session or the intake. You know, when you had opened everything up and so it’s really doing the client of service. If you’re able to reflect on those highlights and tease those things, back out, circle back to them. You know, during treatment, during progress notes or sessions and. 

Make sure that your documenting it, revisited these things because it will keep you on point as well. OK, so it’s a win win.

Well, I hope that was helpful. I know it was a lot. Certainly could have gone through this in more detail, but I am trying to keep this brief and write an helpful. 

So if you found it helpful, please do be sure to like and subscribe via YouTube, or if you are listening to this on the podcast and be sure to register with the MHT Newsletter to be notified of any new content as it is published.

Back to the MHT BLOG

Want to learn more? Check out my top picks for books on self-improvement and recovery HERE!

Learn more at www.thementalhealthtoolbox.com. 

NEED CRISIS HELP ? If you need immediate crisis help with your depression, you can call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741

OUTSIDE THE UNITED STATES: See International Suicide Hotlines

WHERE TO FIND MENTAL HEALTH HELP: -NAMI Referral Helpline: 1-800-950-6264

-California’s Statewide Mental Health Helpline: 1-855-845-7415

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ADHD Assessments For Adults: What To Expect

While attention-deficit/hyperactivity disorder (ADHD) is often diagnosed in childhood, this is not always the case. There are many potential reasons that an individual may receive an ADHD diagnosis for the first time in adulthood, some of which we’ll explore below. Regardless of the cause for the delay, seeking evaluation for symptoms of ADHD can be an important first step in the process of receiving treatment. Here, we’ll give an overview of what to expect when seeking an ADHD assessment as an adult.

Why do some people not get diagnosed with ADHD until adulthood?

It’s estimated that the prevalence of ADHD in children is between 5–7%, while the prevalence in adults is 3–5%. Many adults with ADHD may be undiagnosed, possibly because they’ve lived with their symptoms for so long without realizing they may indicate a treatable condition that they can seek help for. Plus, children typically interact more frequently with individuals who may be experienced in recognizing signs of this disorder, such as teachers. In other words, a lack of awareness around ADHD and its symptoms may be one cause of late diagnoses.

In addition, ADHD diagnoses have become more common in recent years as more individuals and providers alike become informed on the clinical signs, which have been clarified over time as well. Continually increasing awareness of this condition may mean that the diagnosis gap will close over time. 

Finally, it’s also worth noting that some people may engage in what’s known as “masking,” or the concealing of their symptoms in an effort to avoid judgment—which can make recognizing the signs of ADHD more difficult. This is suggested as one reason girls are less likely to receive a diagnosis in childhood than boys, as girls may be socialized to mask their symptoms more. Symptoms of co-occurring conditions, which are not uncommon in those with ADHD, could also make it more difficult to recognize signs of this condition.

What is the purpose of an ADHD assessment?

A mental health care provider will usually perform a thorough assessment to determine whether to diagnose an individual with ADHD. However, simply deciding whether ADHD is or is not present is only one of the reasons these assessments are performed. They may also:

• Help rule out other possible explanations for observed behaviors, such as medical conditions , learning disabilities, and sleep disturbances
• Be used to screen for comorbid mental disorders common in people with ADHD , such as anxiety and depression
• Help determine the specific ADHD presentation that best describes the individual's symptoms
• Determine symptom severity and the impact of symptoms on an individual's daily functioning—all critical information for developing intervention strategies and treatment planning
• Be used to monitor the individual's treatment progress over time 
• Be required for individuals seeking accommodations in educational or workplace settings, such as extended time on exams, modified assignments, or other adjustments to support optimal functioning

There’s no single "ADHD test," however. Instead, the adult ADHD assessment process typically involves a comprehensive evaluation and various types of testing conducted by a mental health professional such as a psychologist, psychiatrist, or clinical social worker. The stages and assessment tools used in the process typically depend on the individual's unique circumstances. Still, the goal is typically the same: to obtain a definitive, accurate diagnosis if applicable, develop an effective treatment plan, and achieve the best possible outcome for the client. 

Common components of an ADHD assessment

If you suspect you may have ADHD, seeking an assessment from a qualified mental health professional can have many benefits. Whether you receive a diagnosis or not, they may be able to help you develop coping mechanisms and get connected with resources that could support improved functioning in your daily life. Plus, undiagnosed and untreated ADHD can come with its own potential challenges , from ongoing trouble with daily functioning to an increased risk of depression and substance misuse. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

The following are components that might be included when receiving an ADHD assessment.

Initial interview

The assessment process usually begins with an interview to gather information about your current symptoms, family history, medical history, educational/occupational background, and any past experiences related to ADHD symptoms. The provider might also ask about any other physical and mental health concerns you may have. 

Symptom assessment

Next, standardized tools such as rating scales and questionnaires will often be used to assess any current symptoms of ADHD. These may include self-report measures, observer ratings, and/or interviews with people who know you well (such as family members or close friends) to obtain a comprehensive understanding of your symptoms. ADHD is considered to be a spectrum and symptoms can vary widely, so this portion of the assessment is likely to be detailed.

Adult ADHD symptoms are typically divided into categories that reflect the three core presentations outlined by the American Psychiatric Association. These are: a primarily inattentive presentation, a primarily hyperactive/impulsive presentation, and a combined presentation. Some of the most common symptoms of each include:

Primarily inattentive presentation

• Difficulty concentrating on tasks
• Being easily distracted by external stimuli
• Tending to "zone out" or appear like they aren't listening when directly engaged with others
• Forgetfulness in daily activities
• Problems with organizing tasks and activities
• Difficulty following instructions and completing tasks
• Tending to misplace items

Primarily hyperactive/impulsive presentation

• Restlessness or fidgeting
• Trouble staying seated or quiet in situations where it's expected
• Talking excessively
• Interrupting others in conversation
• Difficulty waiting one's turn
• Constantly moving from one activity to another
• Marked impatience

Combined presentation 

Some individuals may experience a combination of both inattention and hyperactivity/impulsivity symptoms. For example, they may have difficulty paying attention when completing a project and then quickly become impatient and abandon the task. 

Also note that emotional dysregulation in the form of mood swings, trouble coping with stressful situations, and self-esteem issues are common symptoms of all presentations of ADHD. 

Medical evaluation 

If you see a doctor or psychiatrist for your assessment, they may also conduct a medical evaluation to rule out any medical conditions that could mimic ADHD symptoms or contribute to them, like a seizure disorder or thyroid dysfunction . This step may involve reviewing your medical history, conducting physical exams, and ordering laboratory tests if necessary. The physician will also likely ask about any medical conditions that may run in your family.

Psychological testing 

In some cases, psychological testing may be performed to assess cognitive functioning, attentional abilities, and other relevant psychological factors. This process can provide additional information to help the clinician confirm or rule out an ADHD diagnosis. Psychological testing can also be used to determine the presence of any other mental health conditions with symptoms that may resemble ADHD, like some personality or mood disorders.

Functional assessment 

This step involves the provider identifying any difficulties with executive functioning that you might face in everyday life and learning about how they impact your ability to meet your goals and responsibilities.

Examples of such challenges include but aren't limited to:

• Difficulty planning, organizing, or breaking down tasks into manageable steps 
• Poor organization of work or personal spaces
• Difficulty estimating and managing time effectively
• Procrastination and difficulty starting or completing tasks
• Short- and/or long-term memory issues
• Difficulty mentally processing information
• Challenges sustaining effort over time, leading to unfinished projects
• Rigid thinking that makes it difficult to adapt to changes and transitions in plans
• Impaired or impulsive decision-making, especially when faced with multiple options
• Difficulty regulating emotions, managing frustration, and coping with stress
• Limited awareness of one's behavior and its impact on others
• Difficulty reflecting on and learning from past experiences
• Challenges with interpreting social cues and maintaining appropriate social behavior
• Impaired ability to listen actively and engage in reciprocal conversations

If you receive an ADHD diagnosis and work with a care provider like a coach or therapist, they may also measure your ability to meet these challenges repeatedly throughout your treatment to see how you’ve improved and what strategies are working.

Evaluation against diagnostic criteria 

Once all the necessary information is gathered, the clinician will use the guidelines for diagnosing ADHD from the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Adults must meet the following criteria as outlined in the DSM-5 to qualify for an ADHD diagnosis:

• Individuals 17 years and older must present five or more of the listed symptoms for at least six months. 
• Several of the symptoms must have been observed before 12 years old. 
• Symptoms should not occur exclusively during a schizophrenic episode or as effects of other psychotic disorders and cannot be better explained by another physical or mental disorder. 
• They must be present in two or more settings (work, social functions, home, school, or other activities).
• They must cause significant impairment in social, academic, or occupational functioning. 

Treatment recommendation 

Once the assessment is complete, the clinician will provide feedback on the findings and discuss whether it’s appropriate to diagnose ADHD given the information gathered. They may also offer treatment recommendations, which usually include therapy, medication, lifestyle changes, behavioral interventions, and/or accommodations to support your needs.

Seeking an ADHD assessment

Again, there are several different types of providers that may be able to offer an ADHD assessment and a diagnosis, if applicable. Examples include medical doctors and psychiatrists as well as therapists, psychologists, and social workers, in many cases. If you’re interested in being evaluated for ADHD, you can visit your primary care doctor, ask them for a referral, check with your insurance company for recommendations, or look for another type of provider in your area.

Another option to consider is speaking with a therapist virtually through an online therapy platform. This format can be convenient for those who have trouble locating a provider in their area. It can also be more comfortable for anyone who feels intimidated at the prospect of sharing information about their symptoms with a provider in person. Speaking with a licensed therapist remotely can help you learn more about your symptoms and get support in managing them—all from the comfort of home. A growing body of research suggests that online therapy can be a similarly effective alternative to in-person therapy for treating symptoms of ADHD as well as commonly comorbid conditions like anxiety and depression.

In order to receive a diagnosis of attention-deficit/hyperactivity disorder (ADHD), some type of clinical evaluation and assessment is typically required. An ADHD assessment for adults done by a qualified clinician may involve taking a medical history, evaluating ADHD symptoms, ruling out any other mental health disorders, and other components as described above. If you’re looking to be assessed for potential ADHD symptoms, you might consult with a medical doctor, psychiatrist, or therapist.

• How To Manage ADHD Difficulty Waking Up In The Morning Medically reviewed by April Justice , LICSW
• Understanding ADHD And Social Anxiety Medically reviewed by Nikki Ciletti , M.Ed, LPC
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Healthy Living with Diabetes

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How can I plan what to eat or drink when I have diabetes?

How can physical activity help manage my diabetes, what can i do to reach or maintain a healthy weight, should i quit smoking, how can i take care of my mental health, clinical trials for healthy living with diabetes.

Healthy living is a way to manage diabetes . To have a healthy lifestyle, take steps now to plan healthy meals and snacks, do physical activities, get enough sleep, and quit smoking or using tobacco products.

Healthy living may help keep your body’s blood pressure , cholesterol , and blood glucose level, also called blood sugar level, in the range your primary health care professional recommends. Your primary health care professional may be a doctor, a physician assistant, or a nurse practitioner. Healthy living may also help prevent or delay health problems  from diabetes that can affect your heart, kidneys, eyes, brain, and other parts of your body.

Making lifestyle changes can be hard, but starting with small changes and building from there may benefit your health. You may want to get help from family, loved ones, friends, and other trusted people in your community. You can also get information from your health care professionals.

What you choose to eat, how much you eat, and when you eat are parts of a meal plan. Having healthy foods and drinks can help keep your blood glucose, blood pressure, and cholesterol levels in the ranges your health care professional recommends. If you have overweight or obesity, a healthy meal plan—along with regular physical activity, getting enough sleep, and other healthy behaviors—may help you reach and maintain a healthy weight. In some cases, health care professionals may also recommend diabetes medicines that may help you lose weight, or weight-loss surgery, also called metabolic and bariatric surgery.

Choose healthy foods and drinks

There is no right or wrong way to choose healthy foods and drinks that may help manage your diabetes. Healthy meal plans for people who have diabetes may include

• dairy or plant-based dairy products
• nonstarchy vegetables
• protein foods
• whole grains

Try to choose foods that include nutrients such as vitamins, calcium , fiber , and healthy fats . Also try to choose drinks with little or no added sugar , such as tap or bottled water, low-fat or non-fat milk, and unsweetened tea, coffee, or sparkling water.

Try to plan meals and snacks that have fewer

• foods high in saturated fat
• foods high in sodium, a mineral found in salt
• sugary foods , such as cookies and cakes, and sweet drinks, such as soda, juice, flavored coffee, and sports drinks

Your body turns carbohydrates , or carbs, from food into glucose, which can raise your blood glucose level. Some fruits, beans, and starchy vegetables—such as potatoes and corn—have more carbs than other foods. Keep carbs in mind when planning your meals.

You should also limit how much alcohol you drink. If you take insulin  or certain diabetes medicines , drinking alcohol can make your blood glucose level drop too low, which is called hypoglycemia . If you do drink alcohol, be sure to eat food when you drink and remember to check your blood glucose level after drinking. Talk with your health care team about your alcohol-drinking habits.

Find the best times to eat or drink

Talk with your health care professional or health care team about when you should eat or drink. The best time to have meals and snacks may depend on

• what medicines you take for diabetes
• what your level of physical activity or your work schedule is
• whether you have other health conditions or diseases

Ask your health care team if you should eat before, during, or after physical activity. Some diabetes medicines, such as sulfonylureas  or insulin, may make your blood glucose level drop too low during exercise or if you skip or delay a meal.

Plan how much to eat or drink

You may worry that having diabetes means giving up foods and drinks you enjoy. The good news is you can still have your favorite foods and drinks, but you might need to have them in smaller portions  or enjoy them less often.

For people who have diabetes, carb counting and the plate method are two common ways to plan how much to eat or drink. Talk with your health care professional or health care team to find a method that works for you.

Carb counting

Carbohydrate counting , or carb counting, means planning and keeping track of the amount of carbs you eat and drink in each meal or snack. Not all people with diabetes need to count carbs. However, if you take insulin, counting carbs can help you know how much insulin to take.

Plate method

The plate method helps you control portion sizes  without counting and measuring. This method divides a 9-inch plate into the following three sections to help you choose the types and amounts of foods to eat for each meal.

• Nonstarchy vegetables—such as leafy greens, peppers, carrots, or green beans—should make up half of your plate.
• Carb foods that are high in fiber—such as brown rice, whole grains, beans, or fruits—should make up one-quarter of your plate.
• Protein foods—such as lean meats, fish, dairy, or tofu or other soy products—should make up one quarter of your plate.

If you are not taking insulin, you may not need to count carbs when using the plate method.

Work with your health care team to create a meal plan that works for you. You may want to have a diabetes educator  or a registered dietitian  on your team. A registered dietitian can provide medical nutrition therapy , which includes counseling to help you create and follow a meal plan. Your health care team may be able to recommend other resources, such as a healthy lifestyle coach, to help you with making changes. Ask your health care team or your insurance company if your benefits include medical nutrition therapy or other diabetes care resources.

Talk with your health care professional before taking dietary supplements

There is no clear proof that specific foods, herbs, spices, or dietary supplements —such as vitamins or minerals—can help manage diabetes. Your health care professional may ask you to take vitamins or minerals if you can’t get enough from foods. Talk with your health care professional before you take any supplements, because some may cause side effects or affect how well your diabetes medicines work.

Research shows that regular physical activity helps people manage their diabetes and stay healthy. Benefits of physical activity may include

• lower blood glucose, blood pressure, and cholesterol levels
• better heart health
• healthier weight
• better mood and sleep
• better balance and memory

Talk with your health care professional before starting a new physical activity or changing how much physical activity you do. They may suggest types of activities based on your ability, schedule, meal plan, interests, and diabetes medicines. Your health care professional may also tell you the best times of day to be active or what to do if your blood glucose level goes out of the range recommended for you.

Do different types of physical activity

People with diabetes can be active, even if they take insulin or use technology such as insulin pumps .

Try to do different kinds of activities . While being more active may have more health benefits, any physical activity is better than none. Start slowly with activities you enjoy. You may be able to change your level of effort and try other activities over time. Having a friend or family member join you may help you stick to your routine.

The physical activities you do may need to be different if you are age 65 or older , are pregnant , or have a disability or health condition . Physical activities may also need to be different for children and teens . Ask your health care professional or health care team about activities that are safe for you.

Aerobic activities

Aerobic activities make you breathe harder and make your heart beat faster. You can try walking, dancing, wheelchair rolling, or swimming. Most adults should try to get at least 150 minutes of moderate-intensity physical activity each week. Aim to do 30 minutes a day on most days of the week. You don’t have to do all 30 minutes at one time. You can break up physical activity into small amounts during your day and still get the benefit. 1

Strength training or resistance training

Strength training or resistance training may make your muscles and bones stronger. You can try lifting weights or doing other exercises such as wall pushups or arm raises. Try to do this kind of training two times a week. 1

Balance and stretching activities

Balance and stretching activities may help you move better and have stronger muscles and bones. You may want to try standing on one leg or stretching your legs when sitting on the floor. Try to do these kinds of activities two or three times a week. 1

Some activities that need balance may be unsafe for people with nerve damage or vision problems caused by diabetes. Ask your health care professional or health care team about activities that are safe for you.

Stay safe during physical activity

Staying safe during physical activity is important. Here are some tips to keep in mind.

Drink liquids

Drinking liquids helps prevent dehydration , or the loss of too much water in your body. Drinking water is a way to stay hydrated. Sports drinks often have a lot of sugar and calories , and you don’t need them for most moderate physical activities.

Avoid low blood glucose

Check your blood glucose level before, during, and right after physical activity. Physical activity often lowers the level of glucose in your blood. Low blood glucose levels may last for hours or days after physical activity. You are most likely to have low blood glucose if you take insulin or some other diabetes medicines, such as sulfonylureas.

Ask your health care professional if you should take less insulin or eat carbs before, during, or after physical activity. Low blood glucose can be a serious medical emergency that must be treated right away. Take steps to protect yourself. You can learn how to treat low blood glucose , let other people know what to do if you need help, and use a medical alert bracelet.

Avoid high blood glucose and ketoacidosis

Taking less insulin before physical activity may help prevent low blood glucose, but it may also make you more likely to have high blood glucose. If your body does not have enough insulin, it can’t use glucose as a source of energy and will use fat instead. When your body uses fat for energy, your body makes chemicals called ketones .

High levels of ketones in your blood can lead to a condition called diabetic ketoacidosis (DKA) . DKA is a medical emergency that should be treated right away. DKA is most common in people with type 1 diabetes . Occasionally, DKA may affect people with type 2 diabetes  who have lost their ability to produce insulin. Ask your health care professional how much insulin you should take before physical activity, whether you need to test your urine for ketones, and what level of ketones is dangerous for you.

Take care of your feet

People with diabetes may have problems with their feet because high blood glucose levels can damage blood vessels and nerves. To help prevent foot problems, wear comfortable and supportive shoes and take care of your feet  before, during, and after physical activity.

If you have diabetes, managing your weight  may bring you several health benefits. Ask your health care professional or health care team if you are at a healthy weight  or if you should try to lose weight.

If you are an adult with overweight or obesity, work with your health care team to create a weight-loss plan. Losing 5% to 7% of your current weight may help you prevent or improve some health problems  and manage your blood glucose, cholesterol, and blood pressure levels. 2 If you are worried about your child’s weight  and they have diabetes, talk with their health care professional before your child starts a new weight-loss plan.

You may be able to reach and maintain a healthy weight by

• following a healthy meal plan
• consuming fewer calories
• being physically active
• getting 7 to 8 hours of sleep each night 3

If you have type 2 diabetes, your health care professional may recommend diabetes medicines that may help you lose weight.

Online tools such as the Body Weight Planner  may help you create eating and physical activity plans. You may want to talk with your health care professional about other options for managing your weight, including joining a weight-loss program  that can provide helpful information, support, and behavioral or lifestyle counseling. These options may have a cost, so make sure to check the details of the programs.

Your health care professional may recommend weight-loss surgery  if you aren’t able to reach a healthy weight with meal planning, physical activity, and taking diabetes medicines that help with weight loss.

If you are pregnant , trying to lose weight may not be healthy. However, you should ask your health care professional whether it makes sense to monitor or limit your weight gain during pregnancy.

Both diabetes and smoking —including using tobacco products and e-cigarettes—cause your blood vessels to narrow. Both diabetes and smoking increase your risk of having a heart attack or stroke , nerve damage , kidney disease , eye disease , or amputation . Secondhand smoke can also affect the health of your family or others who live with you.

If you smoke or use other tobacco products, stop. Ask for help . You don’t have to do it alone.

Feeling stressed, sad, or angry can be common for people with diabetes. Managing diabetes or learning to cope with new information about your health can be hard. People with chronic illnesses such as diabetes may develop anxiety or other mental health conditions .

Learn healthy ways to lower your stress , and ask for help from your health care team or a mental health professional. While it may be uncomfortable to talk about your feelings, finding a health care professional whom you trust and want to talk with may help you

• lower your feelings of stress, depression, or anxiety
• manage problems sleeping or remembering things
• see how diabetes affects your family, school, work, or financial situation

Ask your health care team for mental health resources for people with diabetes.

Sleeping too much or too little may raise your blood glucose levels. Your sleep habits may also affect your mental health and vice versa. People with diabetes and overweight or obesity can also have other health conditions that affect sleep, such as sleep apnea , which can raise your blood pressure and risk of heart disease.

NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for healthy living with diabetes?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of healthy living for people with diabetes, such as

• how changing when you eat may affect body weight and metabolism
• how less access to healthy foods may affect diabetes management, other health problems, and risk of dying
• whether low-carbohydrate meal plans can help lower blood glucose levels
• which diabetes medicines are more likely to help people lose weight

Find out if clinical trials are right for you .

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for healthy living with diabetes are looking for participants?

You can view a filtered list of clinical studies on healthy living with diabetes that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe for you. Always talk with your primary health care professional before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Elizabeth M. Venditti, Ph.D., University of Pittsburgh School of Medicine.

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Mental Health in Teenagers

Mental health in teenagers presentation, free google slides theme and powerpoint template.

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