Author: Jeannette Porter

Mental health Monday: Orange County gets dementia-friendly

Dementia friendly logoNovember is Alzheimer’s Disease Awareness Month and Family Caregivers Month, and both are being marked in Orange County by the rollout of the Orange County Dementia-Friendly Business Campaign.

That doesn’t mean that Orange County businesses want to drive you to dementia. Rather, participating businesses have committed to their consumer-facing employees taking a two-hour training in how to interact with people who may have dementia. Those businesses will also display the program’s logo near their entrances.

The idea is to recognize that more than 5 million Americans—more than 1 in 9 older people—are living with Alzheimer’s disease or another dementia. They have unique needs, especially when they interact with the community at large. Participating businesses are signaling that they are sensitive to those needs.

DeWana Anderson, a Carrboro veterinarian, said in a Chapel Hill News article that she found the training useful in working with some of the older people who bring their pets in for help.

“They may know what they want to say and they may know how they want to say it,” she said, “but when stuff hits them too fast, it can flabbergast them.”

The article said the staff at The Animal Hospital “learned through the training to ask simple questions and provide clear instructions to someone who has trouble understanding.”

The Dementia-Friendly Orange County site has more information on how to participate in the program, including a 19-minute training video. It’s aimed at teaching businesses how to be dementia-friendly, but which contains a lot of good tips for anybody who interacts with folks with dementia.

Mental health Mondays: signs of Alzheimer’s

Nurse_in_geriatryLast week, in honor of National Alzheimer’s Disease Awareness Month and Family Caregivers Month, I mentioned some strategies that could help a family member with a dementia be integrated into holiday festivities. But what if the family member has memory loss but hasn’t been diagnosed with a dementia? What are the signs of Alzheimer’s, and how do they differ from those of an ordinarily aging mind?

The Alzheimer’s Association website (a terrific resource) suggests that your level of worry should partly be determined by the person’s degree of incapacity. For instance, missing a monthly credit card or other bill payment could happen to anyone. A persistent inability to manage a budget, on the other hand, could be a warning of a developing dementia.

Forgetting words for specific things happens all the time. Difficulty having a conversation might be a warning. Losing things periodically? Totally normal. Misplacing things and being unable to retrace steps to find them? Could be trouble. At our house we have a joke: it’s OK to lose the car keys, but you’re in trouble if you don’t know what the car keys are for. There’s some truth in that.

The holidays are a time to see family you haven’t seen in a while, and we notice aging more when we don’t see it every day. If you think you have a relative who’s becoming impaired, don’t panic. But, check out the Alzheimer’s Association website, and then you might want to check with your relative’s doctor. Be aware that one in three American seniors dies with Alzheimer’s or another dementia, and many people with dementia don’t know that they have it. The earlier you come to grips with it, the better you can plan for it. And the better you plan, the better things will be for you, your relative and his or her caregivers.

Mental health Monday: Alzheimer’s at the holidays

end of family dinnerPeople all across America are looking forward to going home for Thanksgiving. We’re making lists, shopping, cooking, packing, baking and getting in the holiday mood. And we’re mentally girding ourselves for our relatives. Going home often means seeing relatives. And depending on the relatives you’ve got, that might be terrific—or maybe not.

November is both Alzheimer’s Disease Awareness Month and Family Caregivers Month.  If you have a family member with one of the dementias (which we often lump together under the term “Alzheimer’s disease”), the reunion can be bittersweet. You love this person, but his or her behavior can cause real hardship for the people around him or her, especially at the holidays. However, according to the Alzheimer’s Association, there are ways to make holidays better for the whole family:

1) Adjust expectations. A family conference call before folks arrive for the big day can let everyone know in advance how Uncle Charlie is doing and what he needs to stay on an even keel. And do you need turkey and ham and venison and Cornish game hens? Keep it simple.

2) Involve the person with dementia. Focus on what s/he can do, not what s/he can’t. If it’s not a good idea to give Aunt Carla a knife to chop onions, maybe she can mix dough, or dry dishes, or tell stories to younger kids.

3) Don’t forget family members. Even if Grandpa doesn’t talk, don’t assume he doesn’t see and hear. The person you love is in there, even if his neurons are keeping him from expressing himself the way he used to. Consider switching the big dinner to a big lunch or brunch, because lots of folks with dementias do better earlier in the day. And remember that caregiving is a huge responsibility—take advantage of family members being around to give Grandpa’s caregiver some respite.

For more detail about the suggestions above, and a lot of other very useful information about dementia, visit the Alzheimer’s Association page at

Mental health Monday: Learning to live well in low light



Dark comes early these days, since we turned our clocks back.

For some folks, that’s just an opportunity to rock reflective accessories—but for others, the shortage of sunshine is associated with depression.

If your mood goes south when the birds do, you might have a condition known as Seasonal Affective Disorder, appropriately known as SAD. Traditional treatments include, logically enough, exposure to bright light. Light therapy typically means sitting under a bright light for 30 minutes right after waking, every day. For people who normally scramble out of the house (a lot of us) in the mornings, that can be a bit of a pain.

So SAD sufferers hailed an American Journal of Psychiatry article, just published November 5, suggesting that over the long term (two or more winters), cognitive behavioral therapy worked better for SAD than light therapy. Cognitive behavioral therapy looks and feels like counseling—the therapist teaches the patient new ways of thinking and acting to solve problems. Of course, you have to schedule the therapy and attend the sessions, usually weekly. But you may get to keep your eyes shut for an extra 30 minutes in the morning.

Kelly Rohan, a University of Vermont psychology professor who is the lead author of the American Journal of Psychiatry article, called light therapy “an effective treatment” in an Atlantic interview, but suggested that cognitive behavioral therapy provided “a sense of agency or control” that was useful in beating depression.

Local focus is key to health

Rose Hoban, founder and editor of North Carolina Health News.

Rose Hoban, founder and editor of North Carolina Health News.

One of North Carolina’s top health news practitioners Skyped into Upstream’s HQ in late October. Rose Hoban– the founder, editor and chief reporter of North Carolina Health News— spent 45 minutes putting the UNC-Chapel Hill students in the picture of the state’s health news.

Hoban founded the North Carolina Health News service in 2011 after a decade in nursing, a master’s degree from UC Berkeley in public health policy and six years on the health beat at WUNC (the Triangle’s public radio outlet).  Public service informs both her choice of stories and her approach to her craft.

“I’m an equal opportunity rabble-rouser,” she said, describing NCHN’s adherence to nonpartisan journalistic standards. “We follow the data.”

The financial pressures that decimated North Carolina’s once-robust health journalism corps have also taken their toll on local and statehouse reporting. Hoban says she’s seen this first hand on the two to three days a week she spends at the General Assembly when it’s in session.

“The trusted center voice has really eroded,” she said, describing local issues as “way less sexy” than national news, but far more impactful to citizens, especially in the health space.

“People aren’t paying attention,” Hoban said. “From both sides of the aisle, I hear two things: one, no one else is doing what you’re doing, and two: you end up driving the conversation.”

That’s a lot of work for 2.5 full time equivalents including Hoban herself, who described 60-hour workweeks. But that public service ethic is starting to be recognized by policy and funding types, she said.

Hoban wrapped up her session by urging Upstream’s public health students to “be acutely attuned to what is happening locally…. Now is the time to get your voice heard.”

Mental Health Monday: “ADHD Is Different for Women”

Look like your desk? Read on...

Look like your desk? Read on…

Are you feeling disorganized, scattered and forgetful?

If you’re a UNC-Chapel Hill student, that might be just the late-October vibe at a demanding academic institution. But if you’re a female student in her late teens or early 20s, it might be ADHD, or Attention Deficit Hyperactivity disorder.

Last week I wrote about Ty Pennington, who was bouncing off the walls in elementary school, a textbook case of ADHD. But according to a 2013 Atlantic article, “ADHD Is Different for Women.”

“ADHD does not look the same in boys and girls,” writes article author Maria Yagoda. “Women with the disorder tend to be less hyperactive and impulsive, more disorganized, scattered, forgetful and introverted. “

“They’ve alternately been anxious or depressed for years,” says Dr. Ellen Littman, author of Understanding Girls with ADHD, who is quoted in Yagoda’s article. “It’s this sense of not being able to hold everything together.”

Yagoda writes that she was diagnosed as a junior at Yale, and “initially perplexed by [her] diagnosis.” This may not be surprising, as she cites an estimate of around 4 million undiagnosed girls and women—half to three-quarters of all women with ADHD.

“Often, if girls are smart or in supportive homes, symptoms are masked,” says Sari Solden, therapist and author of Women and Attention Deficit Disorder, quoted in Yagoda’s article. “Because they’re not hyperactive or causing trouble for other people, they’re usually not diagnosed until they hit a wall, often at college, marriage, or pregnancy.”

If you’re feeling like you might have hit that wall, be reminded that neither this post nor anything else on the internet can function as a diagnosis. But if you want more information, check out the ADHD page at the National Institute of Mental Health. If you think your scatteredness might have roots in one of the attention deficit disorders, start with a visit to your doctor. And don’t worry that you’re not one of the boys.


Mental health Monday: Happy Birthday, Ty Pennington!

164px-Ty_Pennington_headshotGood morning and happy birthday, Ty Pennington!

The TV host, artist, author and carpenter turns either 50 or 51 today, depending on your sources. And we care because he’s been able to be a TV host, an artist, an author and a carpenter while living with a classic case of ADHD—attention deficit hyperactivity disorder.

Living with ADHD can make the simplest things tough. According to the National Institutes of Mental Health, adults with ADHD may not know they have it:

They may feel that it is impossible to get organized, stick to a job, or remember and keep appointments. Daily tasks such as getting up in the morning, preparing to leave the house for work, arriving at work on time, and being productive on the job can be especially challenging for adults with ADHD.

The average age of onset is 7, and Ty Pennington was a textbook case. He described his elementary school behavior in a 2007 interview in Ability magazine:

Within 30 minutes, I was wearing my desk. I swung to the blinds, I climbed out the windows, I ran around naked, I slapped Johnny in the back of the head. So I was what you call, ‘a classic distraction.’

Pennington was diagnosed with ADHD when he was starting college and it changed his life:

Once I tried out different meds that [the doctor] prescribed and then went back for the follow-up, there was a huge change in my behavior, which was phenomenal. I’d never even heard of ADHD. I knew that I had problems…. So to see such a change in my grades and in my class participation, not to mention the fact that I could actually communicate with other people, go on a date and not mumble the entire time… I think a lot of people don’t understand how much of an impact this condition has on a person, and what a struggle it can be in your life, not just your grades and your job, but with your relationships. Especially when you’re a teen, people are trying to understand what’s going on with you and you just don’t have a good way to really communicate it.

ADHD has three sub-types: predominantly hyperactive-impulsive; predominantly inattentive; and combined hyperactive-impulsive and inattentive. Check out the ADHD page at the National Institute of Mental Health for more information on symptoms, causes, treatments and tips for living with the disorder. According to that page, the disorder affects 9 percent of American kids aged 13 to 18 and boys are four times more at risk than girls.

The important thing to remember is that ADHD is treatable, and that people of all ages who have it can live productive lives. Just look at Ty Pennington.

Mental health Monday: Getting on your metals

Courtesy of

Courtesy of

Recent research into mechanisms of mental health indicates that zinc and a new way to process lithium may have promise in treating depression and bipolar disorder.

An August 2015 Scientific American article, “Metals and Mental Health,” explained that lithium, long considered the standard treatment for bipolar disorder, may be affected by insulinlike growth factor (IGF1). Lithium doesn’t always work with bipolar patients and doctors don’t know why. However, the fact that higher levels of IGF1 were found in the blood cells of those patients responsive to lithium treatment suggests that the hormone may be a key to how it works. When scientists added IGF1 to the cells of patients who didn’t originally respond to lithium, their cells showed increased lithium sensitivity. Researchers hope to get clinical trials of IGF1 for bipolar disorder underway “quickly.”

The same article described four studies on the role of zinc in brain operations. One study found that depressed people tended to have about 14 percent less zinc in their blood than most people do on average, and people with severe depression had even less. In the brain, zinc is concentrated in neurons that increase brain activity and play a role in neuroplasticity—the brain’s lifelong ability to adjust to changing circumstances. Another study (which was a double-blind, randomized, placebo-controlled trial) showed a steeper decline in depression symptoms when zinc was administered.

It’s important to note that “research indicates” and “may have promise” are not directives to start downing zinc by the handful or ask your doctor for an IGF1 prescription. For now, a well-balanced diet is your best bet. But in the future, publicly-available treatments for depression and bipolar disorder may be improved by this research.

Mental Health Mondays: Mental illness isn’t “It”

ROSEBURG, OR - OCTOBER 02:  A sign sits along the road to Umpqua Community College on October 2, 2015 in Roseburg, Oregon.  Yesterday 10 people were killed and another seven were wounded on the campus when 26-year-old Chris Harper Mercer went on a shooting rampage.  (Photo by Scott Olson/Getty Images)

A sign sits along the road to Umpqua Community College on October 2, 2015 in Roseburg, Oregon. Ten people were killed and another seven were wounded on the campus when 26-year-old Chris Harper Mercer went on a shooting rampage. (Photo by Scott Olson/Getty Images)

We’ve been here before: mass shooting, followed by thoughts and prayers sent to families, followed by calls for “something to be done.” Something usually takes one of two tacks, depending on your politics:

  1. Gun control or rights.
  2. Doing something about mental health.

Not touching number one in this post, but some things about number two bear repeating.

Mentally ill people are not automatically violent, any more than mentally healthy people. The mentally ill are more likely to be the victims of violence than the perps.

Metzl and MacLeish, in their literature review in the February 2015 issue of the American Journal of Public Health:

less than 3 to 5 percent of US crimes involve people with mental illness, and the percentages of crimes that involve guns are lower than the national average for persons not diagnosed with mental illness….A growing body of research suggests that mass shootings represent anecdotal distortions of, rather than representations of, the actions of ‘mentally ill’ people as an aggregate group.

Stuart’s 2008 review of violence and mental illness concludes: “mental disorders are neither necessary, nor sufficient causes of violence. The major determinants of violence continue to be socio-demographic and socio-economic factors such as being young, male, and of lower socio-economic status.”

One more time: mental illness does not equate with violence. Even if universal mental health could be achieved at the push of a button, that button wouldn’t solve the American plague of mass shootings. Mental illness is not “It.”

Back to the drawing board.

Mental Health Mondays: A different kind of recovery

(c) NPGCsoho/Wikimedia Commons/CC-BY-SA-3.0/GFDL

(c) NPGCsoho/Wikimedia Commons/CC-BY-SA-3.0/GFDL

In these last few days of September, which is National Recovery Month, learn about a recovery program you may not have heard of—SMART Recovery.

SMART stands for Self Management And Recovery Training. It’s been around since1994. It has a “4-Point Program,” not Twelve Steps. It’s based in part on the principles of cognitive behavioral therapy. And you don’t start the program by admitting powerlessness.

“That’s been a resonating point for a lot of people,” said Ted C., who attends both SMART Recovery and AA meetings to maintain his long-term sobriety. “People who have tried the Twelve Steps and said, ‘You know, I just can’t handle that telling me I’m powerless.’”

Mark T., who facilitates the SMART Recovery meeting in Chapel Hill, said that was one of the things that struck him about his first SMART Recovery meeting, facilitated by John B., an area psychologist who doesn’t have addictive issues but who does think SMART Recovery makes sense.

“I still remember the first thing [John] said was, ‘You are not powerless,’” Mark T. recalled.  “Which I’ve always felt I could do whatever I decided to do, so it resonated with me. So I kept coming back, and it worked.”

“The principles of SMART Recovery are in keeping with my understanding of what helps people,” said John, who still comes to the Chapel Hill meeting in a supportive role. “They’ve been found to be useful in empirical studies.”

SMART Recovery’s 4 points are:

1 – Building and Maintaining Motivation

2 – Coping with Urges

3 – Managing Thoughts, Feelings, and Behaviors

4 – Living a Balanced Life

Faith is not a requirement for SMART Recovery.

“A lot of people believe, and a lot of people don’t,” Mark T. said.

SMART “is for anyone who has behavior they want to change, basically,” Mark T. said.  “Everyone exhibits addictive traits. It’s just when it crosses the line and starts interfering with your life, you at least need to think about making changes.”

In addition to alcohol addiction, the Chapel Hill SMART Recovery meeting has hosted people with gambling, sex and computer gaming addictions, as well as eating disorders.

“[The SMART program] avoids terms like ‘alcoholic’ and ‘addict,’ because it holds that everyone exhibits addictive behavior,” Mark T. said. “And they also think the connotations of the alcoholic as a drunk sitting on the curb with a paper bag… A lot of people with addictive problems are very successful.”

“At first,” Ted said.


Mark T. said he runs the weekly Chapel Hill meetings, which run 60 to 90 minutes, according to the same basic pattern each week. People take 30 seconds to introduce themselves, then he lists the ground rules, which are: confidentiality; be open and honest, and don’t criticize when you’re giving feedback.

“Criticism makes most people defensive,” Mark T. points out.

Then generally there’s a handout focusing on one of the four points, and then the weekly check-in, where everybody takes turns saying what’s been going on in their life in the past week or two regarding recovery.

“We try to stress that we don’t care what happened 20 years ago, unless it’s impacting something that’s going on in your life today,” Mark T. said. “We’re about the present and going into the future.”

And then they pass the hat and adjourn.


While the SMART handbook says that attendees, “aren’t making a lifetime commitment to the program,” Mark T. and Ted both doubt that it will be possible for them to graduate—that is, stop attending meetings and become moderate drinkers.

“Of the people who’ve come to the SMART Recovery meetings, I only know one who successfully moderates,” Mark T. said. “But I will be open-minded on that subject,” he says of other people’s potential to graduate.

“We’re an abstinence-based program,” said Mark W., who facilitates the Carrboro program. “We welcome people whose goal is moderation
or ‘harm reduction,’ but our meetings focus on the techniques and challenges specific to abstinence.”

“I’m an evidence-based guy,” said Ted, who has three years sobriety now after a relapse. “And the evidence is pretty strong. I want to be very clear that I don’t have anything bad to say about AA,” he cautions. But, he concludes, SMART Recovery “works for me.”

“Meetings are open to anybody,” John said. “There’s no need to ask permission. We don’t pay dues, we don’t ask names. We’ll shake your hand.”

Mark W. clarified that meetings are open to anyone working on his or her own behavior.

“This restriction helps protect confidentiality,” Mark W. said, “and leaves attendees feeling they can be very open because everyone in attendance ‘has skin in the game.'”

“It really is welcoming,” Ted said.

For more information on the Chapel Hill meeting, go to For more information on SMART Recovery, go to