The Blonde Vegan, aka Jordan Younger, found her blogging masked an eating disorder. Photo: The Blonde Vegan Facebook Page
Jordan Younger wasn't just any old vegan.
She was 'The Blonde Vegan', whose blog and Instagram account detailed her meals and recipes to tens of thousands of followers.
As someone obsessed with healthy eating, it came as a surprise to Younger when, just over a year into her public journey with veganism, the 23-year-old began to feel tired all the time, suffered skin breakouts and stopped getting her period.
Jordan Younger has turned away from veganism and is recovering from orthorexia nervosa. Photo: The Blonde Vegan Facebook Page
She recently told People magazine she had been diagnosed with orthorexia nervosa, a condition characterised by an overwhelming focus on a limited diet with elaborate rules that can evolve from an obsessive approach to diet, health and well being.
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"I was spending the entire day obsessing about eating only vegetables, green juices, fruits and occasionally nuts and grains," said Ms Younger, adding food was no longer enjoyable. "I was following thousands of rules in my head that were making me sick."
The term orthorexia nervosa was coined in 1997 by Californian doctor Steve Bratman in a book titled Health Food Junkies. He defined the condition as a fixation on healthy eating or pure food such as vegetables. The rigid approach to healthy eating usually includes extensive and even punitive exercise regimes.
While the condition isn’t officially recognised by the Diagnostic and Statistical Manual of Mental Disorders, Australia’s peak body for body image illnesses said it conforms to the behaviours that define eating disorders, which affect more than 900,000 Australians.
There are four broad types of eating disorders, including anorexia nervosa, bulimia nervosa and binge eating. According to the Butterfly Foundation, Orthorexia fits into the fourth category: identifiable sets of behaviours that make up a condition not otherwise specified.
Chief executive Christine Morgan told Fairfax Media eating disorders have a genetic predeterminant that is triggered by a nutritional deprivation.
“Nutritional deprivation is one of the key behavioural elements of an eating disorder. This can manifest in many forms, either by excluding whole foods groups or food types and then obsessively managing the consumption of these foods. Other behaviours include excessive exercise, withdrawal from social settings where food is involved, secrecy and covert behaviours.”
Jordan Younger launched The Blonde Vegan in early 2013, accumulating more than 70,000 Instagram followers, sharing photos, tips and recipes.
In a recent blog post explaining why she was transitioning away from veganism - she has since renamed herself The Balanced Blonde - Ms Younger said her online persona had obscured her understanding of what she was going through.
"My blog made it hard for me to see that I had an eating disorder. If I wasn't so closely tied to the vegan identity I'd given myself, I would have realised it a lot sooner," Ms Younger said.
Amanda Benham, a practising nutritionist with a masters in health science, said
veganism was an ethical position rather than a fad diet.
“It would be a bit of a stretch to blame veganism for an eating disorder,” Ms Benham said. “My guess is she had a predisposition for this, so whether she went on a vegan or a paleo or a low-carb diet, the outcome might have been the same.”
She said that provided vegans followed a few basic principles, they could maintain a healthy diet and life. If you are concerned that you or someone close to you is grappling with an eating disorder, seek help. The Butterfly Foundation: 1800 334 673; Lifeline Australia: 13 11 14; Kids Helpline: 1800 551 800.
In a few weeks, clinical psychologist Robert Franks will take over leadership of the Judge Baker Children’s Center, a century-old Harvard affiliated center that addresses children’s mental health. There’s a lot more that can be done to support children’s mental health, said Franks, currently an assistant clinical professor at the schools of medicine at both Yale University and the University of Connecticut.
Q. What do you think are the most important issues facing children’s mental health today? A. Ensuring that children and families have access to quality care. There tends to be a gap between what we know works and what’s actually done. I’ve tried to narrow that gap. The other issue that is really important to me is engaging parents and families in care.
Q. Are the mental health needs of children different than the needs of adults? A. As adults, if we struggle with mental health, it might interfere with work, relationships, leisure. For children, it really disrupts their ability to play, to engage in appropriate social relationships, to live harmoniously in a family environment. It has a huge impact on school performance. It affects their lives, but it also affects their future.
Q. You’ve said that childhood trauma is far more common than most of us realize. A. About 70 percent of kids, by the time they reach adulthood, have experienced some kind of significant, scary event — abuse, neglect, loss of a loved one. There just hasn’t been quality care for these kids.
Q. Is there effective help?
A. There are proven treatments that really help kids. We have 30 centers in Connecticut that deliver quality care. What we’re seeing is 80 percent of kids who go through [our centers] are having full remission of their PTSD diagnosis, which is just tremendous.
Q. And addressing these problems early helps keep the problems from getting worse later? A. When bad things happen to kids when they’re very young children, if they go untreated, they can turn into lifelong mental health and health problems: things like cancer, heart, disease and other chronic illnesses as adults. Children who are victimized or struggle with untreated mental health [can] end up later in the juvenile justice system.
Q. How many children need mental health services? A. In the general population, 20 to 40 percent of kids will need some mental health treatment at some time, particularly if they have a loss or an accident or something terrible happens to them.
Q. Do social norms exacerbate childhood violence? A. Our children are faced with a lot of violent content; if you look at the video games kids play, the movies and TV shows they watch, we’re feeding them a constant diet of violence. You are what you eat. That’s going to have an effect on young people’s development, particularly people who may have problems to begin with.
Q. Is the stigma around childhood mental illness changing? A. Stigma is still a big issue. We see stigma issues differ depending on people’s ethnic and cultural backgrounds. [But] we’ve come a long way.
Q. There has been a lot of discussion lately about whether we’re overmedicating kids for mental health issues: 4-year-olds treated with multiple heavy-duty medications, etc. A. We tend to remember those extreme cases. It’s important to remind people that there are many, many children treated successfully every year — more than not. In any medical field we have to make sure there are checks and balances in place to make sure quality care is being delivered.
Q. What do you see as the biggest issues for parents of children in the mental health system? A. I’ve talked to a lot of parents who struggle because they can’t take time off work to get to the appointment with their child. They can’t afford to get across town to get to the appointment. These are very practical barriers. And as a result, we are not adequately meeting the needs of our kids.
Q. How does Massachusetts, which is known for its conservative medical care, compare with other states in terms of mental health care for children and young adults? A. I see Massachusetts as a great seeding ground for innovative and best practices. Compared with other states there’s a much higher density of providers here. There are many providers who were trained originally in very traditional models. It takes time to steer that ship.
Q. Presumably, funding issues are affecting mental health care? A. It is challenging to make sure many of our community-based providers and practitioners make ends meet. Working in the mental health field is not a lucrative profession, so it’s sometimes difficult to have a stable workforce that is well trained.
Q. What is your vision for Judge Baker? What do you hope to accomplish there? A. I’ve spent a lot of time in my career focused on implementation. That’s the knowledge I want to bring to the Baker. I’d like to establish the Baker as a resource for the state so we can work to improve the quality of care.
Q. What motivates you to do what you do? A. As long as I can remember, I’ve loved children.
Q. Is it depressing to care for children who are suffering, who’ve experienced trauma? A. It’s actually the most hopeful profession there is. When people come to seek help, they want to have change in their lives. And change is possible. They can recover. It’s very gratifying.Interview was edited and condensed. Karen Weintraub can be reached at weintraubkaren@gmail.com.
No, really, you are what you eat. Photo: Crafty Cook Nook/Google CC
In a national survey administered by the Harvard School of Public Health, the Robert Wood Johnson Foundation, and NPR found that more than one-third of participants change their diets during times of stress. More often than not, those changes are not good.
Stress causes many to turn to comfort foods, such as sugary foods or refined carbohydrates, which actually led to discomfort and more stress in the form of a tighter waistband.
In a separate study by researchers at Harvard University published in the journal Pediatrics, breakfasts high in protein, high in fiber, and high on the glycemic index were pitted against one another to see which type caused participants to become hungry again quickly. Researchers found that foods high on the glycemic index cause a spike in blood sugar and a hunger-inducing crash, plus a surge in the stress hormone adrenaline.
Although a cookie or plate of pasta may seem like a quick fix to a stressful situation, the connection between what you eat and your mood should make you reach for foods that can make your body more resilient to its stress responses. Joe Hibbeln, a researcher at the National Institutes of Health, points at sources of omega-3 fatty acids and nutrient-rich foods as best to beat stress.
"One of the most basic ways that omega-3s help to regulate mood is by quieting down the [body's] response to inflammation," Hibbeln told NPR.
Fish (even canned), Swiss chard, eggs, chia seeds, leafy greens, and dark chocolate are all chock-full of nutrients such as zinc, magnesium, potassium, and vitamins that can help strengthen immune response, boost your mood, and, most important, satisfy hunger.
So next time you are feeling like you are going to crack from the pressure, crack a few eggs and whip yourself up a stress-busting breakfast.
High blood pressure may protect elderly against dementia
In the extreme elderly those with the highest blood pressure were the least likely to have dementia, according to new research.
New research suggests high blood pressure may not be all bad. Elevated levels might help to stave off mental decline among the extreme elderly, the study suggests.
The finding follows a decade spent tracking high blood pressure and dementia among 625 men and women aged 90 and up.
Those with the highest blood pressure levels were the least likely to have dementia, the researchers found. But that doesn't mean older people shouldn't try to control elevated blood pressure, they said.
"On the basis of this work we are absolutely not recommending that high blood pressure not be treated among the elderly," said study co-author Maria Corrada, an associate adjunct professor in the department of neurology at the University of California, Irvine.
"What we are saying is that from observing a group of very old people we now have some evidence that developing high blood pressure at a late age may be helpful in terms of maintaining intact thinking abilities," she said.
The reason behind this association isn't clear, Corrada said. "It could be that high blood pressure improves the blood flow to their brain... But we don't know. It will certainly require more study to better understand the mechanism behind this."
The study didn't prove that high blood pressure leads to improved mental acuity among the very old, it just found a link between the two.
Read: Improved treatment for high blood pressure
Corrada and her colleagues are scheduled to discuss their findings this week in Copenhagen, Denmark at an international meeting of the Alzheimer's Association. Research presented at meetings is considered preliminary until published in a peer-reviewed medical journal. Battery of tests
For the study, the study authors focused on men and women aged 90 to 103 – the "oldest old."
Almost seven in 10 participants were women, and at the start of the study none had dementia. All underwent an initial battery of mental health and neurological testing, as well as blood pressure assessments.
Then, for up to 10 years, all participants were re-evaluated every six months.
Overall, 259 were diagnosed with dementia. And nearly three-quarters took some form of medication to control high blood pressure, which is linked to heart disease and stroke.
The research team found that those who had developed high blood pressure during their 80s faced a lower risk of developing dementia than those with normal blood pressure. And participants first diagnosed with high blood pressure during their 90s had an even lower dementia risk.
Even those whose blood pressure was slightly elevated – called "pre-hypertension" – had a lower risk for dementia than those with normal blood pressure, the study found.
The absolute lowest dementia risk was seen among those whose high blood pressure was the most advanced. The association held whether or not people took medication for their high blood pressure.
This led the research team to conclude that high blood pressure seems to be associated with a lower risk for dementia among the extreme elderly. Moreover, the worse a person's blood pressure status is, the better their thinking capacities, the researchers said.
"Now it should be said that people who survive to age 90 and above are, by definition, very different than people who survive to their 70s or 80s," said Corrada. "Obviously, they didn't have stroke or heart disease that took their lives. Or maybe they didn't have it at all. And more specifically, these may be people who have developed high blood pressure now, but did not struggle with it throughout their life."
Catherine Roe, an assistant professor of neurology at Washington University School of Medicine in St. Louis, said the findings seem to "fit with what we know about high blood pressure".
Read: Brain structure influences thinking
"High blood pressure during middle-age is a risk factor for later development of dementia," Roe said. "That's pretty clear from past research. But the study results have been mixed on whether high blood pressure for people in their 60s and 70s is related to cognition problems or not." Cognition refers to thinking and memory.
It appears that high blood pressure becomes less of a risk factor for mental decline in old age, Roe added. However, "high blood pressure is probably still bad for a lot of other reasons," she said.
Perhaps people who live to very advanced ages have a kind of "super health" that helps them withstand the impact of high blood pressure, she suggested.
By Nozia SayyedNozia Sayyed, Pune Mirror | Jul 14, 2014, 02.30 AM IST
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HEALING THROUGH DRUGS?
Many psychiatric patients as young as 14 years, have taken to self-medication with mind-altering substances to gain control over medical disorders
Ruhi, a resident of Vashi, was hit by an overpowering libido when she was barely 13-and-half years old. Not only did she take to unprotected sex with strangers, she even forced her 11-year-old brother into oral sex. She also had a sex clip made of herself in the act and let it go viral.
By 15, not knowing how to deal with her irrepressible nymphomaniac tendencies, she turned to methamphetamine and cocaine. Substance abuse gave her control over her personality disorder, but the minor's selfmedication brought her to the doorstep of a Pune-based NGO, a couple of weeks ago, to cure her of her new addiction.
It is a given that many junkies take to drugs to fight depression or other psychological issues. These were mostly people who have not recognised their state as a clinical condition but just drifted to substance abuse. But lately, de-addiction centres are noting that some cases, alarmingly many of them minors, coming to them are known clinical psychiatric patients who have turned to narcotics as a self-medication initiative.
Twenty-year-old Tejas, from Pune, in his final year of graduation in commerce, was diagnosed with schizophrenia. He had spiritual hallucinations about the deity Ram, perched atop a mountain. He was prescribed anti-depressants. But struggling with drug adherence, Tejas' condition worsened. Putting away his prescription, he sought solace in marijuana. The cannabis rid him of the apparition that haunted him, but also hooked him into a dependency he could do without.
Waking up to his conditions, his parents brought him to Practical Life Skills De-addiction and Rehabilitation Centre, Pashan. Pune's sixteen-year-old Aditya, in his junior college studying commerce, was on anti-depressants to cope with his clinical condition. But the medication was not helping, when his friends introduced him to the joy of sniffing glue. Aditya's depression drove him to masochistic behaviour and he often nicked or inflicted other physical abuse on himself. The glue came to his rescue.
After eight months of sniffing glue, his failing health caught his parents' attention, who dragged him to the deaddiction centre last month. "In past couple of months, we have admitted about six such cases, all aged between 15 and 24, who have indulged in self-medication with mind altering or mood changing substances.
More than alcohol, children as young as 15-16 are trying to take care of their psychiatric inconsistencies with substance abuse," noted Indrajit Deshmukh, project head at Practical Skills. "Our in-patient department (IPD) earlier dealt largely with people above 40 years in age. However, in the past eight to 10 months we are seeing a stream of young patients mostly in the age bracket of 14 to 20 years.
Many of them took to substances in the hope that they would be cured of their mental distress." said Dr Nitin Dalaya, director at the Nityanand Rehabilitation Centre, a 300 bedded facility at Katraj. Most of his patients come from Maharashtra, Madhya Pradesh, Gujarat and Goa. "Some of these kids have even graduated to multiple/poly-drug abuse.
The new thing going around is a combination of Vicks Action 500 along with Nitrazepam, Nitravet and Spazmo Proxyvon, These drugs taken in combination, yield a high far above what comes from cocaine or marijuana. Their physical impact is also equally exponential and prolonged use can use can lead to renal and liver failure or gastric ulcers.
We had two teenagers from Mumbai who had come with renal failures within four months of doing this permutation," Dr Dalaya said. "The age of people with diagnosed clinical psychiatric condition taking to self-medication in this manner, have certainly come down.
Cannabis is the preferred substance for them. Since at Muktanagan we don't admit kids of that low age we cannot give the details, but yes, in the last seven-eight months we were approached by many cases aged between 15 and 18, who we redirected to centres that do pediatric admissions," said Sanjay Bhagat, project co-ordinator, Regional Resource and Training Center West Zone 1, and coordinator at Muktangan De-addiction and Rehabilitation Centre. He added that the rising numbers indicate an urgent need to educate children on the adverse effect of such abuse.
Apart from the de-addiction centres, even psychiatrists are aware of this rising number of patients switching to illegal stimulants as selfmedication. "Five years ago, I would barely get a teenager patient who had taken to narcotics despite being a clinically diagnosed psychiatric patient. In the last six months, however, I have seen over 20 such cases.
All the cases were aged between 15 and 25 years,"said Dr Amod Borkar, a psychiatrist with private practice at Karve Nagar. Dr Ulhas Luktuke, life fellow at the International Council of Sex Education and Parenthood and life fellow at Indian Psychiatrists Association, too acknowledging the increasing trend of self-medication with drugs, pointed out, "Easy accessibility to the drugs and the absence of watchful eyes in a nuclear family is engendering this situation.
More than medication, what is required here is sensitisation of parents through workshops, so they have a better understanding of their growing children and provide the necessary support to them."
►►► We are seeing a stream of young patients between 14 to 20 years who took to substances to be cured of mental distress
- DR NITIN DALAYA, Director, Nityanand Rehabilitation Centre
Patient-generated data will play a critical role in the future of medicine and will help shape the evidence base that physicians, patients and policymakers use to improve the quality of care, according to an analysis published in Health Affairs, Modern Healthcare's "Vital Signs" reports (Conn, "Vital Signs," Modern Healthcare, 7/9).
For the analysis, Duke University researchers examined the effect of collecting real-world data directly from
patients as opposed to gathering such data through randomized controlled trials (Dvorak, FierceHealthIT, 7/10).
The authors defined patient-generated data as patient-reported outcomes.
Report Findings
The report found that patient-generated data will be "critical to developing the evidence base that informs decisions made by patients, providers and policymakers in pursuit of high-value medical care."
Specifically, the researchers wrote that the "key to high-quality, patient-generated data is to have immediate and actionable data" that allows patients to realize the importance of the data for research, as well as their personal care.
They added, "The easier it is for patients and clinicians to navigate [personal data], the more relevant that information will be to patient care, the more invested patients and clinics will be in contributing high-quality data, and the better the data in the big-data ecosystem will be" ("Vital Signs," Modern Healthcare, 7/9).
The researchers noted that physicians are increasingly using data captured directly from patients to help understand patients' health outcomes. They added that the ability to capture such data is growing in part because of the widespread adoption and use of electronic health records and monitoring devices.
However, they noted that full EHR implementation and interoperability have yet to be achieved (FierceHealthIT, 7/10).
In the meantime, the researchers recommended that physicians take simple steps to better familiarize patients the data collection efforts, such as by physicians telling a patient that they have seen their "symptom report" ("Vital Signs," Modern Healthcare, 7/9).
The American Psychiatric Association only recently recognized binge eating disorder as a diagnosable condition. It defines binge eating as "recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances, with episodes marked by feelings of lack of control."
Binge eating is different from occasionally overeating: it is a systematic, recurrent pattern that is associated with significant physical and psychological problems. Its onset usually occurs later than that of other eating disorders, according to Leanne Thorndyke, head of communications at BEAT - UK’s leading charity organization supporting people affected by eating disorders:
“Binge eating disorder has over the years been a growing problem. Until the changes to the diagnostic criteria it was in sort of a residual group of a whole range of different things that didn’t really fit anywhere else. So now it is a recognized eating disorder in its own right. It affects people who are slightly older, maybe in their 30’s or 40’s. There is also an even split between the affected men and women, whereas sometimes some of the other eating disorders tend to affect more women.”
People with binge eating disorder often have a mental obsession with food, weight, diet or body image. The illness has a profound effect on a person's self-esteem, relationships, finances, daily activities, and quality of life. Sufferers often become depressed or anxious because of their eating patterns and then get stuck in a never-ending cycle, trying to “eat their grief away,” Leanne Thorndyke said.
For people with binge eating disorder, it’s important to pinpoint the exact feelings or thoughts that are getting suppressed by food, Theresa Kinsella, a New York-based registered dietitian specializing in eating disorders, noted:
“Most of the time emotional eating, or binge eating, is a red flag that someone is not getting their emotional needs met. But often someone is not aware of what those emotional needs are. So we try to use the symptomatic eating as a sign, a positive sign, that there is some potential learning about what emotional needs aren’t getting met,” Theresa Kinsella said.
Binge eating is a lot like drug addiction. For the successful treatment of the disorder it is critical to identify why a person is turning to food or to the obsessive thoughts of disordered eating. Many times there are unresolved traumas or a lifetime of abandoning their self, feelings or emotions. According to a study published in the Archives of General Psychiatry, treatment programs with cognitive behavioral therapy are significantly more effective in treating binge eating disorder than weight loss programs. To fully recover from binge eating a person must always deal with the underlying, internal causes of the disorder firs Read more: http://voiceofrussia.com/radio_broadcast/no_program/274505829/
BERLIN – Later this week, perhaps as early as today, Peter Bartlett, a mental health recovery specialist, will relocate — along other employees and the eight patients at a temporary 8-bed psychiatric hospital in Morrisville — to the new Vermont Psychiatric Care Hospital in Berlin.
"The staff is excited about getting there," said Bartlett, who worked at the antiquated wards at the Vermont State Hospital in Waterbury from 2002 until floodwaters forced its closure on Aug. 30, 2011. "The old hospital just was not therapeutic."
Before opening the $28 million, 25-bed hospital, state officials invited the public for a ribbon-cutting ceremony and tours of the one-story facility. Nearly 150 people turned up for speeches by a clutch of the notables who had roles in achieving the longstanding goal of closing the former psychiatric hospital and reconstructing the state's mental health system to distribute treatment options to more locations across the state.
Ken Libertoff, former director of the Vermont Association for Mental Health, attended to see a wish come true that he voiced 30 years ago.
"I said close the hospital in 1984," Libertoff said, referring to the psychiatric state hospital in Waterbury. Opening a replacement hospital represents "another step toward real parity," Libertoff said. Mental health parity is a concept Libertoff championed during his years as a mental health advocate. It means mental and physical illnesses should be addressed in the same way.
"Continued vigilance is needed to ensure all the hopes are realized," Libertoff said.
"What a day," Gov. Peter Shumlin declared to the crowd sweltering outside the hospital's front door. "All the people who didn't think they would live long enough to see this day, raise your hands," he said, thrusting his arm high.
Several governors talked about the need to replace the state hospital in Waterbury, but the price tag always stymied action. In the wake of the Tropical Irene storm damage, however, Shumlin told his staff that he intended to replace, not rebuild the closed facility.
"If there is ever an example of how to take a tragedy and turn it into opportunity, this is a shining example," Shumlin said. Because of the flooding, Federal Emergency Management Agency funds and the state's insurance coverage helped the state pay for the new facility. The state's share of the $28 million price tag ended up being $12.4 million.
The governor and Doug Racine, secretary of human services, noted how the state's mental health system reeled then rallied to respond after the sudden loss of 54 acute care beds following the flood.
"It has been an ongoing crisis, but everybody stepped up," Racine said. The result has been "a stronger system. We should all be proud of ourselves."
Mental Health Commissioner Paul Dupre noted that the Legislature and administration responded to the crisis with a plan for a new model of care that offers Vermonters with mental illnesses more options. Instead of offering acute psychiatric care only at one location — the former state hospital in Waterbury — patients could receive the highest level of care at the new hospital or new units at the Brattleboro Retreat and Rutland Regional Medical Center. Also, the state opened a secure residential unit in Middlesex for patients who are stable, but require locked living quarters. And several long-term rehabilitation facilities have opened, providing step-down options from hospitalization.
"This great facility is part of a whole system of care," Dupre said. State of the art
Ann Moore of South Burlington, who has a family member with mental illness, served on the committee that made design recommendations for the new hospital over the past two years. "To me it has been empowering and fascinating."
She noted how so many features of the building ensure both safety and an environment conducive to recovery.
Sara Wengert, one of the architects with Architecture +, expanded on Moore's point about balancing safety and beauty. She pointed to the wall at the end of one of two courtyards that allows both views and protects privacy.
Choice of materials involved finding ways to use local materials and still that ensure durability, Wengert said. "The patients are going to be hard users of this facility," she said. "We don't want it to be good for a year. We want it to be good for 20 years."
As the crowd streamed through the hallways to peek in the rooms in the four patients units, people could be heard exclaiming repeatedly about the elegance and spaciousness.
"This is a beautiful building," said Jack McCullough, director of the mental health project of Vermont Legal Aid. "It is ironic the opening is on the same day the involuntary medication law takes effect."
McCullough battled unsuccessfully to stop lawmakers from rewriting the process by which patients who are hospitalized because they pose a danger to themselves or others could be forced to accept medication.
"The Legislature chose to go with increased use of force," McCullough said. "If that happens in this building, it would be a shame."
As he spoke, a piercing alarm sounded. People touring the building set off the alarm repeatedly. "I hope they can figure that out," McCullough said, noting the alarm created "not such as soothing atmosphere."
Rep. Anne Donahue, R-Northfield, was one of many lawmakers at the open house. She is a long-time mental health watchdog and a member of the design committee.
"It is wonderful to see the commitment to quality in patient care," she said. She noted the private bedrooms, which are the standard now for all kinds of hospitals, and the outdoor space. "The importance of access to outdoor space just can't be overstated." Getting underway
Jeff Rothenberg is the chief executive officer for the new hospital which is expected to cost $19 million a year to operate. Rothenberg has been director at the temporary hospital in Morristown.
He said the state has nearly completed hiring the 183 staff the hospital needs to operate. A few nursing positions remain to be filled, he said.
The state has a contract with Fletcher Allen Health Care to deliver physician services. Standing in the foyer, Dr. Isabelle Desjardins, who will serve as executive medical director, said, "We are given a great tool to work with."
The hospital will open in phases, starting with the transfer of the eight patients from the Morrisville hospital. "Then we plan to breathe," Rothenberg said. The hospital will admit more patients slowly until all four units are occupied.
John O'Brien, senior mental health specialist at the new hospital, agreed with visitors' praise of the space.
Still he reminded the crowd, "A hospital is not only walls and rooms, gardens and glass. It is people. And Vermont can proud of the knowledge and skill that my coworkers bring to this new place of healing." Contact Nancy Remsen at 578-5685 or nremsen@freepressmedia.com. Follow Nancy on Twitter at www.twitter.com/nancybfp State psychiatric hospital history • 1891: First 25 patients moved into wing of new Vermont State Hospital in Waterbury. • 1960s: Patient population peaks at 1,200 during this decade. • 1990s: New drugs and changed treatment philosophies shrink state psychiatric hospital population to as low as 42. Hospital consolidated to three wards in the midst of state government's largest office complex. • 2003: Federal inspectors cite hospital for deficiencies, including too few nurses. After two patient suicides, federal inspectors terminate the hospital's certification and federal funding. • 2004: Under new leadership, the hospital regains federal certification and funding, but the U.S. Department of Justice initiates an investigation of possible violations of patients' rights. • 2005: Federal regulators yank certification and funding again after back-to-back incidents in which patients escaped. Gov. Jim Douglas wants to speed up process to replace and close the Waterbury facility. • 2006: Vergennes and Greensboro reject plans to locate long-term residential treatment facilities in their towns, slowing state's process to replace and close Waterbury hospital. State begins formally exploring options for a new acute care hospital, including locating such a facility at Fletcher Allen Health Care in Burlington. • 2007: Second Spring, a long-term rehabilitation residence, opens in Williamstown, serving 11 patients. • 2008-2009: State tries repeatedly to regain federal certification and funding, before giving up permanently. U.S. Justice Department ends four-years of oversight saying the facility achieved and maintained all the benchmarks it set for treatment and safety. • 2010: Douglas administration approves construction of 15-bed secure residential unit for the back side of the Waterbury Office Complex, another step toward replacing the acute care hospital. • 2011: Shumlin administration cancels 15-bed secure residential project say it would be too big and faced too much opposition from mental health advocates over its location. • Aug. 29, 2011: Tropical Storm Irene floods Waterbury Office Complex. State hospital patients evacuated the following morning and relocated to facilities across the state. The hospital is closed permanently. • 2012: Legislature approves plan to address the crisis created by the closing of the Vermont State Hospital. The plan is to construct a new 16-25 bed psychiatric hospital in Berlin, expand the psychiatric capacity at Brattleboro Retreat and Rutland Regional Medical Center, rely on Fletcher Allen Health Care to continue to provide acute psychiatric care for state patients until a new hospital opens, develop additional residential rehabilitation facilities, build a secure residence in Middlesex, open a temporary acute care facility in a former nursing home in Morrisville and bolster an array of community mental health services. • 2013: The six-bed secure residential home opens in Middlesex and the temporary, 8-bed hospital opens in Morrisville. • July 1, 2014: State holds open house at 25-bed Vermont Psychiatric Care Hospital.
Published: 09:20 GMT, 9 July 2014 | Updated: 11:45 GMT, 9 July 2014
Schoolgirls who ask their parents for healthy meals may be showing early signs of an eating disorder, a leading headmistress has warned.
Jayne Triffitt, who is head of the Catholic girls boarding school Woldingham in Surrey, was speaking at an end of term assembly about mental health and eating disorders among teens.
She said, due to social pressure, young girls feel they must look a certain way - and so may reduce their food intake in a bid to be thin.
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Warning: Jayne Triffitt, head of Woldingham School in Surrey, has warned that schoolgirls who ask their parents for healthy meals may be showing early signs of an eating disorder
The head of the £10,000-a-term institution warned parents to be wary of their daughters asking to follow a 'healthy diet' - as the request could be a 'euphemism' for eating very little.
Mrs Triffit said: 'The biggest pressure is to be thin.
'But, of course, the catch is that if they reduce their food intake they will not have the energy to cope with a packed life here at school.
'All too quickly they could head for some type of eating disorder.'
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Pressure: Mrs Triffit said exam stress and heavy workloads - particularly in female pupils aged between 14 and 18 - can trigger mental illness, which in turn may lead to an eating disorder (library image)
According to The Times, she added: 'Just a hint to parents, do not be caught out by your daughter's wish to eat a 'healthy' diet. This is often a euphemism for eating very little indeed.'
Later in her speech, Mrs Triffit said exam stress and heavy workloads - particularly in female pupils aged between 14 and 18 - can trigger mental illness, which in turn may lead to an eating disorder.
Mrs Triffit said pupils in this age range are under particular pressure as Universities demand 'ridiculously high grades' from applicants.
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Worry: The head said young girls feel pressured to look a certain way - so drop their food intake in a bid to be thin
The headmistress said: 'Some will become over-anxious and display particular mental health issues connected with this.'
Mrs Triffit's warning comes as research indicates teenage girls could be more prone to depression and anxiety as they experience greater blood flow to the brain.
Hormone oestrogen drives more blood to the heads of young women compared to men - and that could explain disparities in psychiatric disorders, scientists at the University of Pennsylvania claim.
Blood flow is known to be higher in adult women than men, but the study now shows it is markedly different during adolescence when teenagers are going through puberty.
According to the NHS Choices website, eating disorders are most commonly blamed on social pressures to be thin.
However, those with a family history of depression are also more likely to develop the three main types of eating disorder - anorexia nervosa, bulimia or a binge eating. Eating disorders can affect people of any age - but often develop in teenagers.
According to the NHS, around one in 250 women will experience anorexia at some point - with the condition usually developing around the age of 16 or 17.
One in 2,000 men will also experience such disorder.
Bulimia is around five times more common than anorexia, research shows, and 90 per cent of people with bulimia are female.
The condition usually develops around the age of 18 or 19.
Binge eating usually affects males and females equally and often appears later in life - between the ages of 30 and 40.
Research conducted last year by Health and Social Care Information Centre (HSCIC) suggested that one in ten individuals admitted to hospital with an eating disorder were female and aged 15.
A study based on 2008 prescription claims found that 11 percent of Arizona foster kids — 1,681 children — took at least one psychotropic drug, like anti-depressants, anti-psychotics and stimulants such as Ritalin for attention-deficit disorders.
More than 1 in 4 children ages 6 to 12 were taking the drugs, compared with one in 20 non-foster children that age.
Still, Arizona's overall rate was lower than rates in five U.S. states studied in a U.S. Government Accountability Office report, where 19 percent to nearly 40 percent of foster youth in 2008 were on at least one psychotropic drug.
"It is indeed concerning," said Dr. Kathy SmithKathy Smith, director of child and adolescent psychiatry at the University of Arizona."What’s causing that, is the question. Is it because we have people who don’t have enough expertise prescribing medication? Is it because of changes in caregivers? Is it because these kids are really complicated?"
Raised on Tucson’s east side by an abusive parent, Angela Luna entered foster care at age 14.
After being diagnosed with bipolar disorder, she was put on antidepressants and anti-anxiety medications and stayed on them for seven years. But she says her emotional problems were related to her childhood trauma, not mental illness. The medications numbed her pain and anger, she says, and prevented her from learning how to deal with her emotions — or even knowing how she felt.
“I constantly felt stoned and high,” says Luna, now 28, who has since been diagnosed with post-traumatic stress disorder. “You’re never given the chance to properly grow. ... Therapists ask, ‘How’s your medication?’ Not ‘How are you?’”
Arizona foster children were 4.4 times more likely than nonfoster children on Medicaid to be prescribed powerful psychotropic drugs, a report based on 2008 data found.
Arizona hasn’t updated that report, but the number of foster kids on psychotropic drugs likely has grown along with the state’s foster-care population: Between March 2008 and March 2014, the number of Arizona children in foster care soared by 62 percent from 9,721 to 15,750. Child-welfare advocates attribute the growth to deepening poverty leading to more cases of neglect.
When used appropriately, psychotropic drugs — which affect mood, thought or behavior — can be lifesaving, experts say. But some child-welfare advocates say the drugs can be prescribed more for the convenience of overwhelmed caregivers than for the benefit of the child.
“I see youth that are so overly medicated that they’re literally drooling,” said Christa Drake, former executive director of In My Shoes, a mentorship program for foster youth. “Sometimes it’s like, ‘Let’s just medicate him and subdue him so we don’t have to deal with the behavior.’”
This year the state implemented new oversight and heightened reporting requirements regarding prescriptions for foster kids, said Steven Dingle, chief medical officer of the Arizona Division of Behavioral Health. As of January, “regional behavioral health authorities” — organizations that coordinate behavioral health care for foster kids — must regularly submit data on medication utilization rates among foster kids. The behavioral health authorities will also monitor the prescribing habits of doctors in their region and identify outliers.
In addition, doctors must now get authorization — attesting they first tried psychosocial interventions like therapy — before prescribing the following:
•antipsychotic or ADHD medications for children under age 6;
•any psychotropic drug at a dosage level exceeding FDA recommendations;
•more than one antipsychotic or antidepressant simultaneously.
The state has also formed the Arizona Psychotropic Monitoring Oversight Team, a partnership between the Department of Child Safety, AHCCCS and the Division of Behavioral Health Services focused on ensuring appropriate prescribing, Dingle said. The team plans to replicate the study on psychotropic prescriptions among 2008 foster children with more recent data, likely within the next six months, he said.
Normal behaviors
Despite the new reporting requirements, some worry medication use could increase as Arizona’s child welfare system is stretched.
Last November, the Arizona Department of Economic Security admitted that its Child Protective Service division failed to investigate more than 6,500 reports of abuse or neglect, in part due to sky-high caseloads for CPS caseworkers. CPS oversight was taken from DES and given to the newly created Department of Child Safety in May.
Heavy caseloads leave caseworkers, caregivers and doctors with less time to concentrate on each child’s medication regimen. A foster family shortage also means more children are in group homes, with less individualized attention, increasing the risk of fragmented oversight of their care.
“The system remains ripe for medication misuse or overuse,” says Sen. David Bradley, D-Tucson, who worked in child welfare for 20 years.
Finding solutions other than medication takes resources, time and patience, said Drake, formerly of In My Shoes. Foster children need stability and a safe space to explore and express their emotions, she said.
Instead, lots of kids get a diagnosis of conditions like “oppositional defiance disorder” when they act out, she said. That diagnosis can sometimes medicalize normal behavior, she said.
“Most people would be upset if they were ripped away from their families and sent to live in a group home,” she said. “A lot of our youth are acting appropriately in their surroundings.”
Foster kids with complex needs are often bounced between therapeutic and regular foster homes as their behavior stabilizes, then deteriorates again, said Sarah Huntoon, foster program director for Intermountain Centers for Human Development, which trains and licenses therapeutic foster homes.
The more transitions, the more instability for the foster child — and the less likely he is to have a familiar caregiver who will notice and report concerns about medications.
“Consistency of care is an issue,” she said.
Trauma is a given
Experts say it makes sense that kids in foster care have a higher rate of psychotropic-drug use than other kids.
Between 60 and 80 percent of foster youth have at least one psychiatric diagnosis or developmental disability, compared with 15 to 20 percent of the general population, said Dr. Sandy Stein, associate medical director of Community Partnership of Southern Arizona, the Regional Behavioral Health Authority for Pima County. The authority coordinates and manages behavioral health care for children in the child welfare system.
Some of those diagnoses in foster children are related to lack of prenatal care, to parental substance abuse or to a family history of mental illness, Stein said.
Lengthy stays in foster care, or transitions between foster families and group homes, can add to a child’s sense of instability.
“These kids have been traumatized,” says Susie Huhn, executive director of Casa de los Niños, a social-service and foster-care agency in Tucson. “The very fact that they’re in the foster care system means they’ve been exposed to toxic stress and traumatic events — so why wouldn’t we expect they’ll have more social or emotional issues?”
But some worry about questionable prescribing practices. Among the 2008 psychotropic drug report’s findings:
•Foster kids were nine times more likely than nonfoster children to be prescribed five psychotropic medications at one time. Almost 800 children, or 5.4 percent of the foster population, were taking two or more drugs. Only limited evidence supports the use of even two psychotropic drug in children, and no evidence supports children — or even adults — taking five at once, according to the U.S. Government Accountability Office.
•Arizona foster children ages 5 and younger were 5.5 times more likely than nonfoster children to be prescribed at least one psychotropic medication. That year, 225 Arizona foster children 5 and younger were prescribed the drugs.
•The state’s foster kids were 7.4 times as likely to be prescribed the drugs in doses exceeding the maximum recommendation for their age group.
•Fifty-five foster children ages 1 and younger got a psychotropic prescription in 2008, though the report notes some drugs could have been prescribed to treat other conditions. The drugs can have serious side effects for infants, and the GAO points out that there is no established use for these drugs to treat mental-health conditions in infants.
Long-term harm
Even if kids improve with medication, powerful psychotropics may do a lifetime of harm.
Common side effects include paranoia, weight gain, extreme fatigue and reduced bone density.
Little research has been done on long-term impacts on brain development in children. And unlike in adults, side effects like weight gain can become permanent for children, even after they’re taken off the medication.
Proper diagnosis is often a challenge. Post-traumatic stress disorder can look a lot like ADHD, and the treatments for each are different, said Laurel Rettle, critical-care coordination administrator for Cenpatico, one of four Regional Behavioral Health Authorities in Arizona.
Although medications can help those who suffer from PTSD in the short term, long-term use of stimulants — like ADHD treatments — will not.
PTSD “is not, in and of itself, a serious mental illness,” she said. “These children are dealing with things they never should have to deal with. You can compare it to children of war.”
Geara Patten has been a therapeutic foster mom since 1998. Most of her foster children came to her already on medications, she said, and many stayed on them until they aged out of the system. She believes psychotropic medications were used generally only when necessary and helped many of her foster kids get through a difficult time.
Still, most of her foster kids ended up stopping their meds as soon as they gained independence, she said, and they seemed to thrive without the drugs.
“They’re at a calmer place,” she said. “I imagine 90 to 95 percent of them take themselves off the medicine.”
“Assent” sought
Bouncing between foster homes, group homes and behavioral-health facilities for foster youth, Luna learned to accept that the drugs were a necessary part of her life.
“You take the meds and shut up and deal with it, or you get in trouble,” she recalled of her time in a group home. “No one’s there to tell you that we all struggle. It makes you hopeless.”
A foster-care mentor was the first person to suggest her emotions and anger were understandable, and that she wasn’t destined to always need medication. Drake, of In My Shoes, encouraged Luna to question her medication protocol.
“Christa saved my life,” she said. “Christa told me, ‘You have a right to know about your medicine.’”
Starting this month, CPSA is formalizing an “assent” process for foster children under 18 to sign off on their treatment plan, said Stein of Community Partnership of Southern Arizona.
“Assent” is not legally binding, as the child’s caregiver has the final say on treatment, but the process will ensure children understand their diagnosis, treatment options and the goals of their medications, she said.
“It’s absolutely essential to engage kids in their overall health-care treatments,” she said.
Luna got off her medications at age 21 and earned her GED. She put herself through cosmetology school and as a hairstylist, client after client praised strengths she never realized she possessed: her compassion and listening skills.
Now in her work as a mentor to foster youth, Luna says she sees children on four or five different psychotropic medications at a time. Some may have serious mental illnesses and require medication, but she thinks many of them just need understanding.
Giving foster kids the emotional tools to cope with their trauma will have a far more positive effect on their lives, she said.
“You have to cherish all your broken pieces,” she says, “because it makes a beautiful mural.”
This video was created by a five UBC nursing students for client education surrounding medication adherence in mental health. It was produced as an assignment for Nursing 424 "Clinical Nursing Major: Individuals and families with mental health concerns" **It should not be substituted for the advice of medical
The Blonde Vegan, aka Jordan Younger, found her blogging masked an eating disorder. Photo: The Blonde Vegan Facebook Page
Jordan Younger has turned away from veganism and is recovering from orthorexia nervosa. Photo: The Blonde Vegan Facebook Page
