Mental Health Diagnoses & the ICD-10

October 1 looms large for us mental health and medical professionals in the US. From that date on we’re required to switch from using the DSM V or ICD-9 codes for illness to the International Codes for Disease tenth edition (ICD-10 for short).

This is already feeling like too much for a blog post so I’ll try to make my point fast.

If you are a consumer of mental health services the switch doesn’t change much of anything. Your treatment, therapy, medication and general care doesn’t change one bit. The ICD-10, like the DSM V, is a code that is primarily used for third party payment claims, like for insurance or medicare. That’s it really, but if you have questions ask your behavioral healthcare professional.

If you’re a mental health professional I suggest you start by referring to your specific local, state or national professional organization for guidance, the American Psychological Association, American Psychiatric Association, National Association of Social Workers, the American Mental Health Counselors Association to name a few. The good news is that the DSM V did most of the heavy lifting for us so that conversion from DSM V to ICD-10 for mental illness diagnoses is fairly seamless.

The good health care professional makes sure everyone from the direct care provider to the billing manager is up to date on stuff like this. Even if it is a pain in the patootie.

The Shooting at Fort Hood & Mental Illness: “Please God, Not Again!”


Photo courtesy of Steven V

As soon as I saw the “Breaking News” my heart sank. Another shooting. Another gunman. More dead, injured, traumatized.

Then I brace myself for those two little words that always accompany these disastrous gun-related events: “mental illness.”

In a story on NPR, reporter Melissa Block spoke with Counselor Annie Powers, a military veteran herself,  who specializes in treating PTSD. Ms. Powers sees military patients at the Adult, Child and Family Counseling Center in Killeen, Texas, the town where Fort Hood is located.

Ms. Block reports, “All the patients [Annie Powers] talked to since the shooting have been talking about it.”

Ms. Powers states, “I can see where they might be concerned about, oh great, everybody thinks that if you have PTSD, anger, anxiety and depression issues that you’re crazy! There’s a lot of people who are afraid to come get the help. They don’t want it on their military record. They don’t want to go on medication because somebody might know, ‘I couldn’t handle it. I wasn’t strong enough.’ I have to explain to them that PTSD is not about strength.”


Sleep sweeps away the garbage in the brain


Eiko Ojala

Owning your own business can mean working 24/7. I really felt it last week. Even though I thought I was doing a good job with self-care, last night was the first time I was really able to sleep deeply, well and for as long as I wanted. This morning I woke up so happy, loose and serene I almost talked myself out of it! Almost!

It started with, “Remember the back up of emails you need to get to, that conversation you have to have you’re not looking forward to, that report you have to write…” I could feel the good mood start to dissolve like sugar dropped in boiling water. Thank God I stopped myself.

Instead I stretched and told myself, “Today I am happy. I can get to that stuff and still be happy right now!” And I smiled.

As I sipped my morning coffee, basking in my sleep fulfilled afterglow, I read the front page article in the New York Times Sunday Review section: Goodnight, Sleep Clean and it sighted studies that explained exactly what I had just experienced. That’s pretty cool.

We’ve had a lot of articles here on the EWN blog about the importance of sleep such as “7 Tips to Improve Your Sleep!” and without a doubt we’ll probably have more in the future. Sleep is that important to our mental, emotional and physical health!

So go to bed, relax and remember that sleeping is not a waste of time. It is actually allowing a second shift of biochemical workers to get busy taking out the trash! Wishing you all a refreshing good night’s sleep!

Remember the Basics! Sleep!


Editor’s Note: Nicole reminds us that we often forget about basic human needs such as proper sleep, nutrition and exercise. Deficits in these areas can have significant repercussions on our mind and body.

Sometimes I feel like there is not enough time in a day. I will stretch my bed-time to accommodate all of the projects that I want to finish. At the end of the day I am exhausted and feel accomplished but may be only left with 4 or 5 hours of sleep.

With all of the demands of this fast-paced, driven society I feel compelled to produce. The consequence however is less productivity, more anxiety and more body aches. With only 5 hours of sleep and over-stretching my mind and body’s capabilities every day, I cannot possibly be as productive a person as I think I am.

The next day I am tired. As weeks go by I might have more sick days because my immune system is compromised and overall I have more anxiety due to frustration from my decreased stress tolerance. These can all be relieved by maintaining healthy sleep habits.

The most powerful sleep habit that I have adopted has been to fall asleep and wake at the same time every day, yes even on weekends! As a result, I have been clearer headed, focused and energized. For me that was well worth waking up at 8am on Saturday mornings! If your interested in reenergizing and healthy sleep tips click here!

Blues or Depression? 8 Ways To Tell

380747916_5cdc54b030My senior year of college my Dad suggested I go to a therapist. He thought it might help me find some direction. During a hard college career that was interrupted by chronic illness, I changed majors three times, and still wasn’t sure what I wanted to be when I grew up. So I thought what the heck, I’d give therapy a go.

After a few sessions, Dr. Greenbaum said I was depressed. Well blow me down! I wasn’t sad or crying all the time. How did he figure I was depressed?

He explained that you don’t have to feel sad to be depressed. Sometimes being depressed meant the stark, cold absence of happiness, feeling ‘flat’ or ‘empty’. There is a condition called dysthymia that is a sneaky form of depression. Not as imminently dangerous as major depression, dysthymia lasts longer, two years or more, is as serious and sometimes even more debilitating than major depression.

Eight potential signs (lasting longer than two weeks) of any kind of depression are:

  1. Feeling helpless, hopeless, stuck, “What’s the point?”
  2. Loss of interest in activities that were once pleasurable
  3. Appetite or weight changes
  4. Sleep changes. Insomnia or sleeping all the time
  5. Agitation or feeling slowed down
  6. Loss of energy, fatigue, easily exhausted
  7. Strong feelings of worthlessness or guilt
  8. Concentration problems, indecisiveness, lack of focus

Dr. Greenbaum taught me that being diagnosed with a chronic illness hit me harder than I wanted to admit, even to myself. He helped me get my head out of the sand and start living again. You might consider finding a good therapist for yourself.

More on: The symptoms of depression and types of depression

and How to Find a Good Therapist

Photo courtesy of Ozan Ozan

10 Ways to Find a Good Therapist

2558420993_6a732b1b72 When we want to improve our bodies we pretty much know where to find
help. This time of year the gyms are full and the meeting rooms at
Weight Watchers are packed. But what do we do when we want to improve
our inner selves, our relationships, to find help with depression or

I want to assist you to find the right therapist because making the decision to find help is hard enough. Why should you have to get even more stressed out hunting for the right therapist? I can only imagine it’s like searching for a needle in a haystack. So here are a few tips:

1) Forget the yellow pages. A yellow pages listing is expensive so a lot of good people aren’t there. I’m not. Plus there is no regulation of who can list.

2) Ask a professional you already work with and trust. Your accountant, lawyer, dentist, physician – any professional you have a relationship with who honors your confidentiality is a good resource. These people all run businesses as well as provide services, as do many psychotherapists in private practice. They are well connected in the community and refer to each other all the time.

By the way, when asking anyone for a referral to a mental health therapist you do not have to go into the details of why you’re looking for a someone unless you want to. It’s enough just to say, “I’m having some problems and I’d like to consult a therapist about it. Do you recommend anyone?”

3) Ask friends or family members if they can recommend someone.

4) Use a known therapist as a resource. If you have a friend or a friend’s friend who’s a therapist, ask them. Therapists refer to one another all the time. They will understand that you don’t want to see them (for whatever reason, you don’t have to say) but you want a recommendation from them. In other words, even if it doesn’t feel right going to your sister’s therapist, if your sister really likes her therapist he or she could probably give you a couple of names of good, qualified therapists in the community.

5) Use resources at work. Many places of employment have what’s called an Employee Assistance Program (EAP). These services might be in-house or out-sourced but the purpose of EAPs is to provide emotional support and counseling for employees in complete privacy and as part of the employee’s benefit package. EAPs are often part of the Human Resource department so ask there if your company has an EAP and how to access it. Usually you would see a counselor at the EAP for a set number of sessions (no charge to you) and if you want to continue they will refer to a therapist in the community who will take your insurance.


The Horror in Connecticutt

No words can describe the horror, anxiety and grief that devastates us upon hearing about the school shooting in Connecticut. Parents everywhere reach out to our children, no matter how old they are, hold them close and tell them how much we love them.

The DSM-5 & Me: 3 Reasons Why I’m a DSM Agnostic.

My first introduction to the Diagnostic Statistical Manual (DSM) published by the American Psychiatric Association (APA), was standing in the kitchen of my parent’s home and witnessing my father in full rant.

My Dad was a psychiatrist / psychoanalyst of the old school. Which is to say he was brilliant but also of his time. Which is to further say his fury was directed at the APA for taking homosexuality as a diagnosable mental illness out of the manual. It was 1973.

Hardly aware of what he was so upset about, I did hear him dramatically declare that he was withdrawing his membership to the APA. My Dad loved being a psychoanalyst / physician but he wasn’t that crazy (you should forgive the word) about being a psychiatrist. His prescription pad gathered dust as he focused on talk therapy. So his threat to quit the APA wasn’t idle but it wasn’t like he was giving up his beloved couch.

By the time I got to graduate school the DSM had gone through at least four more mutations. Partly because of my experience with my Dad but also because my Mom was addicted to the Merck Manual of Diagnosis and Treatment (in which every twinge or sore throat could become a sign of impending doom), I maintained a skeptic’s view of the DSM.

If the DSM really is the behavioral health professional’s Bible, then I was a doubting Thomas.


5 Tips If You Love Someone Who Has a Mental Illness

The National Institute of Mental Health reports that one in every four adults – approximately 57.7 million Americans – experience a mental health disorder in a given year. One in four, and that’s just the US! And for every person in the world diagnosed with a mental disorder there is at least one, probably more, trying to help, cope and support that person any way they know how.

Mental illness is often a family issue. Parents, siblings, spouses and extended family provide housing, care and support, emotional and financial, sometimes to the point of  becoming proverbial case managers. It’s hard enough when the chronic illness is something everyone recognizes, like diabetes. It’s a whole other thing when the disease is a mental illness which is ripe for misunderstanding, misinformation and stigma.

By helping yourself you will help your loved one better. Care givers often have a hard time with this concept. Here are a few tips:

1) Be informed.  Go to the library or do a Google search to learn more about whatever diagnosis your loved one has. Be judicious, however. Go to reliable websites like Psych Central, the Mayo Clinic, National Institutes of Mental Health or WebMD. Remember that mental illness falls along a continuum of severity. One person’s depression, bipolar or borderline personality disorder may be quite different from another’s.

2) Join supportive organizations. Before you reject the idea of support groups because you are “not a joiner” or you “can’t relate to those people” go to at least two meetings. I’d bet my favorite pair of shoes that you will be surprised who is there and what you get from them. Mental illness and addictions touch people everywhere from all walks of life.

The National Alliance on Mental Illness: NAMI, provides thousands of families with much needed support. NAMI’s mission statement says: From its inception in 1979, NAMI has been dedicated to improving the lives of individuals and families affected by mental illness. They have a terrific website and local meetings.

Al-Anon also has a great tradition of fellowship and comfort. Al-Anon and Alateen are a fellowship of relatives and friends of alcoholics who share their experience, strength, and hope in order to solve their common problems. There are meetings everywhere, at all times of the day and night, all around the world.

3) Keep healthy boundaries. Boundaries are hard to maintain when you love someone with a mental illness, but it is crucial. Take time out for yourself. Nurture yourself by exercising, keeping involved in activities that bring you pleasure, getting respite and taking a trip. Such actions are not self-indulgent; they are your prescription for good health and resiliency like food, water and air.

4) Do not work harder than your loved one. It is their job to do what they can to get well. You cannot make them well. You cannot do their therapy homework. You cannot force them to go to sessions, groups or meetings. As much as you wish you could, you cannot take their medication for them.

Two good books to help you let go, even as you maintain a relationship with the person with mental illness, are Co-dependent No More by Melody Beattie and Stop Walking On Eggshells by Mason and Kreger.  It doesn’t matter whether or not your mentally ill loved is an addict or a borderline personality disorder. The insight and advice in these books is reassuring and practical and transcends diagnosis.

5) Find a therapist for yourself. Caregivers often get depressed themselves and could use a professional’s eyes and ears to help them gain perspective again. Please do not wait until you are down for the count before you give yourself this valuable gift.

Please share any other tips you have found helpful below in the comments.

Photo courtesy of Theoro via Flickr

Today is World Mental Health Day!

Today is World Mental Health Day!

It is easy to dismiss treatment for mental health problems as a luxury. Even in my typically American middle-class community in Western New York, people have to make hard decisions about what gets attention. Will it be renovations to an aging house, tuition for college or psychotherapy?

There is a tendency to put our mental health struggles on the back burner with the hope that things will get better by themselves. When they don’t, even educated, so-called sophisticated people take it as a personal failure. That causes us even more pain, more isolation, deeper mental illness.

Take that scenario and make it global, across cultures, across socio-economic strata, across all levels of industrial development. The same issues that prevent my neighbor (or me for that matter) from getting mental health treatment may be what keeps a young man in Sri Lanka from seeking help.

Mental illness is not just a first world problem. The Secretary General of the United Nations wrote:

“Poverty, unemployment, conflict and war all adversely affect mental health. In addition, the chronic, disabling nature of mental disorders often places a debilitating financial burden on individuals and households. Furthermore, individuals with mental health problems – and their families – endure stigma, discrimination and victimization, depriving them of their political and civil rights and constraining their ability to participate in the public life of their societies.”

What can we do to change things? By being part of the solution:

1. Let’s look at our own lives. Prioritize your and your family’s mental health by educating yourself and seeking the advice of a good mental health professional.

2. Let’s pay attention to how we may carelessly support stigmatizing, discrimination and bullying of those with mental health struggles.

3. Let law makers know you advocate adoption and promotion of mental health policies, laws and services that support comprehensive education, employment, housing and social services for people with mental disorders.

“If someone has a broken arm, you feel sorry for them. But when (the problem) is psychiatric, people don’t know how to react because they can’t see anything.

But just because you can’t see someone’s pain, it doesn’t mean they don’t need your care and support.”

~Samoan woman with bipolar disorder, 29 years old, Auckland, New Zealand

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