We tend to mark the passage of time with the changes of the seasons; seemingly endless when we’re young, passing quickly as we age. From winter to spring, from spring to summer, we pause and take note first externally: more obvious for those of us who live with clear changes of the seasons, with melting snow making room for expanses of green. Even for those of us who live in milder climates, we still notice the rise of the temperature, the new foliage and vegetation, the lengthening of the days.
We may also associate these seasonal changes with actions and activity level, such as slowing down, “hibernating” or staying close to home, drawing inward during the colder and shorter days of winter, and shedding the unnecessary “extras” during Spring Cleaning, while itching to stretch and expand outward.
However, in this fast-paced, internet driven world, in which we spend more time “on line” than out-doors, and can control lighting, temperature, and even the foods we buy and eat, regardless of the seasons, we may become less in tune with the natural rhythms of the seasons as they transition.
I suggest that if we are mindful of the changing seasons, and incorporate these shifts, both obvious and more subtle, then we may experience being more in balance and at ease, both with our surroundings and with ourselves.
At Vista Hill SmartCare, we encourage our patients and community partners to embrace a diet of “real” foods: foods that are as free from additives as possible, minimally processed, locally grown and organic if available, and “in season”! Now that it is summer, you may not want to spend much time cooking, and you may naturally crave those foods that are most available this time of year, including seasonal fresh fruits and vegetables. This will likely be the opposite of what you crave in the colder, darker months of winter, when soups, stews and other warm comfort foods are your priorities.
This is the basis of Ayurveda (Ayu = life, Veda = knowledge), which also teaches us that summer is the Pitta season (fire and water), and emphasizes the importance of eating whole, seasonal and fresh foods.
As SmartCare is an integrated behavioral health care program, we also encourage and promote physical activity, particularly those types of activities that connect us with nature. Summer, with longer days and perhaps a bit of freedom from school and/or work, is a perfect time to also incorporate a mindful practice with your outdoor activities, such as gardening, walking/hiking, swimming, (and consider “grounding” , or going bare-foot for added benefit!). Even your yoga practice can be adjusted for the summer months, to a more fluid and cool practice.
As we welcome these next summer months, I suggest we pause to mindfully embrace our favorite warm weather rituals, whether foods, events, practices, or other, and reap the healthful benefits of all!
Pamela Sachs, LCSW
May is Mental Health Awareness Month. Over the course of the past several years, our Vista Hill SmartCare teams have been utilizing the National health, behavioral health and social issue topics of each month as a best practice of promoting awareness of wellness topics and supporting healthy live-style choices. One of the primary missions of our integrative behavioral health care program, partnered with rural health care clinics, is to help with eradicating the stigma of mental illness. By providing information on these various topics, and encouraging conversations at our clinic sites, local schools, senior centers, libraries and other venues, we hope to break down barriers for those that might not normally seek out support for mental health services.
Topics are wide spread and diverse: Suicide Prevention Month, Blood Pressure Screening Month, Depression Screening Month, Autism Awareness Month, Heart Health Month, Domestic Violence Prevention Month, AIDS and HIV Awareness Month, Alcohol Awareness Month and Safe Driving Month, Bullying Prevention Month and numerous others.
As we prepared for Mental Health Awareness Month this year, possibly the most significant awareness topic of each year, I began to ponder about our approach. “Awareness” is defined as ‘the ability to directly know and perceive, to feel, or to be conscious of events, objects, thoughts, emotions or sensory patterns. In this level of consciousness, data can be confirmed by an observer without necessarily implying understanding’.
Clearly, most of us are already very “aware” of mental health, as well as of mental illness. And so I wondered if we are addressing “stigma” as best as we could, stigma being defined as “a mark of disgrace or infamy associated with a particular circumstance, quality or person”. We hope that by providing education on various behavioral health topics, and providing interventions for patients within their health care settings, in a holistic and integrative approach, that we are beginning to eradicate the stigma of mental health and behavioral health issues for our patients and the members of the communities that we serve.
Our reality is that between 42.5 to 46 million adults in the U.S. have some type of mental illness, or one in four adults experience mental illness in a given year. Mental health conditions are as common as other health conditions. Just as someone afflicted with cancer wouldn’t say, “I’m cancer”, someone with a bi-polar disorder wouldn’t say, “I’m bi-polar”. Neither person is their illness. Part of eradicating the stigma of mental health issues is in the language and verbiage we choose. Mental illnesses may be “brain disorders”, but they affect the body as well, which is why we choose our integrative approach to interventions, including sleep hygiene, pain management, nutrition, exercise and others.
This approach, and my thought process about May, brings me to Mindfulness: maintaining a moment to moment awareness of thoughts, feelings, bodily sensations and the surrounding environment. Even more significantly this month, Mindfulness involves an acceptance of a condition or situation, without judgment, without labeling them as right or wrong, good or bad.
I suggest then, that May be recognized as Mental Health Mindfulness Month: moving beyond awareness, and embracing an acceptance, without judgment.
And for a bit of an artistic and creative look at mental illness:
Pamela Sachs, LCSW
Our Vista Hill SmartCare team was recently asked to provide a Wellness event for parents of 4th-6th graders of an elementary school in one of the communities we serve, addressing concerns of parenting adolescents/teens. I must admit that I struggled with this topic for a bit: these are parents of nine to eleven year olds! Of course, we are a Prevention and Early Intervention Program, and I was grateful that this principal was being so responsive to the parents of her students, who were questioning what behaviors might constitute cause for concern in their children, and when and how they should seek assistance…. but teenagers?! At nine, ten, eleven years old?
I was even hesitant to title this event’s flyer as “Your Young Teen’s Emotional & Behavioral Well-Being” and send it home to these Elementary School parents, not sure that the parents were identifying themselves as such. The principal even re-titled the flyer, as “Your Adolescent’s Emotional & Behavioral Well-Being”, and the parents did attend.
Our kids are physically maturing at an earlier rate than even a generation ago. Many girls are entering puberty at nine years old or even younger; boys as young as ten or eleven. This doesn’t necessarily mean that they are also maturing emotionally and psychologically at a rate to manage these hormonal , physical and societal changes, and so creating the additional stress of this gap between physical maturity and emotional maturity.
For parents of teens, this can be one of the most trying and challenging times, as our kids bounce between striving toward independence, and needing and wanting to be cared for as children. One minute our kids crave our attention, presence and advice; the next they want nothing to do with us. I prefer to embrace this view of adolescence from Dan Siegel, Mindfulness expert: “Adolescence is not just a phase that needs to be grown out of, adolescence is actually a period of growth characterized by ‘emotional intensity, social engagement, and creativity’. So it’s not about surviving teenage-hood, but understanding and learning from these new desires and drives in ways that enable teens to thrive”.
But if we do see signs that concern us, how do we know if these are “normal”, or cause for concern?
These were some of the topics that our SmartCare team addressed with the parents:
*What is “normal” emotional development?
*How do we communicate?
*How do we encourage positive self-esteem and self-worth?
*When does “moodiness” become depression?
*What about body image concerns?
*When do “worries” become anxiety?
*What about self-injurious behaviors?
*What about drugs and alcohol?
*What are other signs of trouble?
*When should I ask for outside assistance, and where do I go?
The take-away from this event, and subsequent conversations, is that these are important dialogues for parents and caretakers of children of all ages, and become increasingly important as our children navigate their worlds of school, friendships and other activities and relationships. This is at the heart of prevention programs such as Vista Hill SmartCare. It is never too early, and our children are never too young, for us to be encouraging, supporting and nurturing their wellness.
Pamela Sachs, LCSW
“My heart hurts when I have strong feelings”, my teenage old son lamented, just the other day. I empathized, certainly, but also was thinking to myself, “how wonderful that he’s made the mind-body connection!” Who of us has not experienced the physical pain of a broken heart? And who doesn’t know someone who is certain they’ve experienced a heart attack, only to find out that their symptoms are of severe panic and anxiety? And, of course, the ultimate heartbreak of the spouse who dies of a broken heart, following the death of his partner?
Hopefully we can also share those times when we can say, “My heart sings!”, “My heart is full!” or “You touch my very heart!” Whose heart doesn’t actually skip a beat or two when we encounter someone we’d like to let into our heart?
Vista Hill SmartCare states in our brochure to aim to “help you bring body, mind and spirit together for a better life”. This is at the crux of our mission, and exactly why we are partnered with rural health clinics. We recognize and appreciate even more, after six years of our partnerships, how interconnected and inter-related physical and behavioral health issues are. In fact, almost nowhere is the mind-body connection more apparent than in the link between mental health and heart health.
February is American Heart Health Month, and so we use this opportunity to promote not only heart health, but also emotional heart health, through Random Acts of Kindness Day as well as celebrating Valentine’s Day.
If not encouraged by their primary care providers, many of our patients wouldn’t have sought out support for their issues and concerns. And whether seeking support for smoking cessation or alcohol use, diabetes or weight management, depression or anxiety, relationship issues, bereavement, cancer, or other issues, encouraging a “whole heart” approach is widely received and appreciated.
A “whole heart” approach encompasses both a healthy physical heart, by encouraging physical activity, healthy eating and other healthy lifestyle choices, as well as encouraging emotional self- care through increasing support networks and socialization, identifying strengths, and incorporating affirmations.
Additionally, as presented here previously, we encourage and promote mindfulness in numerous ways, as we have found that mindfulness activities support and improve both physical and emotional health, (true heart health) in ways that are easily incorporated in almost every setting, and by our patients of all ages and backgrounds. We incorporate mindfulness into wellness activities and events, including our Art and Yoga events and parenting curricula. And we continually find new ways to incorporate mindfulness into individual interventions, to include issues such as lowering blood pressure or weight, decreasing smoking, improving sleep, increasing mood and of course, decreasing stress and anxiety.
We wish you a healthy heart – mind, body and soul – this month and always.
Pamela Sachs, LCSW
There are very few of us anymore who will argue the point that smoking cigarettes is seriously bad for your health. Additionally, the odors that linger on your breath, your clothes, in your car and in your home, the burden on your weekly budget, the yellowing of your fingers and teeth can hardly compete with the glamorous image that cigarette smoking may have held previously for some of us.
Yet, it remains one of the most difficult habits to break. Those that still do smoke, and those that are trying to assist others to quit, will attest that trying to quit smoking is harder than any other addiction, including alcohol, pain killers or even heroin. In addition to the significant physical cravings, smoking becomes so integrated into a smoker’s daily routine, that there it seems that only a multi-layered, multi-dimensional approach to quitting has a chance of being successful.
As an integrated behavioral health care program, partnered with rural health care clinics, and with the ability and flexibility to provide a variety of wellness interventions and activities, Vista Hill SmartCare is finding that a multi-dimensional approach to smoking cessation indeed has possibilities for success.
When one of our partnering health care providers encourages a patient to quit smoking due to the various significant related health risks, and then provides a “warm hand-off” to a SmartCare provider, the SmartCare provider can then help that patient assess motivation, lifestyle, support networks, basic needs and other factors. There is no “one method fits all” approach. But as we currently have the benefit of offering free patches to our patients through a County program, many patients appreciate this as a starting point to their plan.
They may then choose to participate in a weekly Wellness group or meet 1:1 with a SmartCare provider to learn stress reduction techniques, improve their eating habits now that their taste buds are coming back, increase their physical activity now that their lung capacity is improving, and alter their other routines that previously supported their smoking habits. They may choose to also participate in other SmartCare Wellness events, such as Yoga, Art, Mindfulness or other Wellness topics to replace/add healthier habits to their routines and increase their positive social interactions, such as an Empowerment Group or Walking Group. Most also register for the California No Butts Website for additional support.
Our SmartCare teams have worked with many patients in the past few months who have successfully reduced their smoking or quit altogether. For example, there is the 65 year old gentleman from Boulevard who has been smoking for more than 50 years. He has COPD and uses a nebulizer. He has tried to quit smoking several times over the years. He had recently tried patches, but couldn’t afford to continue to purchase them. His daily habit had been as much as 2 ½ packs, and when he was referred to SmartCare was smoking at least a pack a day. With a combination of patches, registering on line with the County “No Butts” campaign and bi-weekly 1:1 meetings with a Behavioral Health Educator to help him identify his smoking patterns and triggers, the patient began to find activities to keep his hands busy (puzzles and crafts) and started walking daily. Within two weeks he was smoking 10 cigarettes a day, and within four weeks was smoking 2 cigarettes a day. His use of his inhaler and nebulizer has decreased significantly also. Most importantly, he expresses tremendous pride in his accomplishment and improved overall wellness, as well as motivation to continue.
SmartCare’s hope is to continue to partner with others who choose to breathe deeply, mindfully and freely.
Pamela Sachs, LCSW
As Jimmy Himmel informed Marty McFly and Doc Brown on their historic 10.21.15 “Back to the Future” visit, the smart phone is our greatest achievement of the past 30 years…. We don’t yet have flying cars or hoverboards, or self-lacing shoes, but we do have “tiny super computers” that provide a multitude of functions including driving directions, storing your favorite songs, the answers to trivia, giving you the weather report, saving your passwords and gift cards, connecting you to Facebook, Twitter and Instragram, depositing checks into your bank account, keeping track of your daily steps and heart rate, providing the daily stock report, taking photos and video clips, and – oh yes – making phone calls (your choice of voice or “face-time”)!
At the swipe of a finger or a touch of a button we can manage any number of tasks, connect to friends and family around the world and capture moments for posterity. We rely on our phones to wake us up in the morning and to keep track of our schedules and correspondence throughout the day, not to mention, keep track of the where-a bouts of our children. And yet, Marty and Doc do not seem impressed.
Could it be that with our phones as an extension of our hands, our ears tuned into those “pings” for email and texts, our eyes locked onto our screens, that we are actually missing out on our very lives? It seems that our kids can’t take a drive in the car without having their phones charged, so that they can listen to music, text their friends or play their games. What happened to gazing out the window and enjoying the scenery, appreciating and learning from our surroundings? When was the last time you enjoyed a leisurely meal, engaging in delightful conversation, banning cell phones’ distractions? Or even took an invigorating hike or enjoyed a glorious sunset, without interrupting the peace and tranquility to capture the moment with a “selfie”?
With so many means to track, record and “save” each moment, are we actually missing the experience of living these moments, of truly being in the moment? Isn’t it possible to experience and truly appreciate each moment without tweeting, tagging or posting about it?
At Vista Hill SmartCare we encourage patients and community members to incorporate Mindfulness into to their daily lives to assist with decreasing depression and anxiety, to assist with managing ADHD and addictions, to ease the pain of grief and loss, and to integrate into self-care for many health care concerns. As I have written previously, a Mindfulness practice teaches us to live each moment as it unfolds, to focus attention on what is happening in the present and accept it without judgment. For some of us this may include a formal meditation practice, and for others this may include paying full and complete attention to our activity of the moment, utilizing all of our senses for complete attendance, involvement and enjoyment.
Yes, there are “apps” for mindfulness meditations that we can download onto our phones, and soothing music that we can incorporate into our yoga practice, or take with us on our mindful walks. I am not suggesting that to be truly mindful that we must discard our phones. But I am suggesting that to be fully present with those we care about and to thoroughly experience the wonders of those daily moments, precious and ordinary, and to truly appreciate what we have, these are the times to please, put down your phone!
Pamela Sachs, LCSW
“You’re forgiven!” was a private Facebook message I recently received. “Oh, no”, I thought. Did I inadvertently post something that offended one of my friends? I reached out to him quickly to inquire and to offer my apologies. He assured me I’d done nothing to offend him, he was just reminding me that it was Yom Kippur, the Jewish Day of Atonement, and the supreme day of forgiveness.
This sacred day, following the Jewish New Year, is a day of fasting, reflection and prayer, asking God for forgiveness, promising to do better in the coming year, and asking that our slates be wiped clear. Jews also seek forgiveness from those they have offended or hurt over the past year. It is a day of gratitude and of hope for the future.
Catholics have the sacrament of Confession, to obtain forgiveness of their sins and reconcile with God and the Church.
Those in recovery and in a 12 step program have Step 8: “Make a list of all persons we had harmed and become willing to make amends to them all”. One of the biggest obstacles to making amends, of course, is forgiveness – of those who have harmed, and also of ourselves.
As an integrated behavioral health program, working with individuals to improve overall wellness in mind, body and spirit, we at Vista Hill SmartCare know that the research now clearly shows that forgiveness improves our health. Holding on to the anger and resentment of past wrongs or injustices increases blood pressure and heart rate and compromises the immune system, as well as increases overall stress, anxiety and depression. It creates general physical stress on the body, accelerates the aging process, leads to over eating, poor sleep and other health issues.
Forgiveness not only improves these areas of health and well-being, it increases contentment, improves relationships and connectedness, and increases gratitude and kindness, not only for others, but for ourselves. It has also shown to extend our lifespan!
We have this misconception, however, that by forgiving, we are somehow condoning poor and abusive behaviors, or excusing undeniably terrible and even at times horrific acts. I suggest that forgiving the actions of others, and even our own actions that have caused pain is not about accepting or tolerating these behaviors. It is about letting go. We cannot undo the past. This is a gift that we can give ourselves, to our health and wellbeing, even if we don’t directly ask the other person for forgiveness, or even if that person is no longer alive.
Dr. Fred Luskin, Director of the Stanford University Forgiveness Projects, has written Nine Steps to Forgiveness. They include being able to articulate what happened to trusted people in our lives, make a commitment to yourself to your wellness, changing your “grievance story”, incorporating stress management techniques and looking within yourself for your health, wellness and joy. This process is about personal empowerment.
Other models of forgiveness include recognizing that one has suffered because of the injustice of another, and using that as a motivation for change – mourning and moving behind the hurt; developing an understanding that the perpetrator is human, and why the perpetrator may have done what he/she did (understanding their pain); and then moving beyond the past and embracing a story of hope for the present and the future.
This is a gift so worth giving, to ourselves, to our wellbeing.
Pamela Sachs, LCSW
“As I walked out the door toward my freedom I knew that if I did not leave all the anger, hatred and bitterness behind, I would still be in prison”. Nelson Mandela