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December 2020
In This Month's Newsletter:
Thoughts about Flourishing & Living an Optimal Life During
Challenging Times

Although our worst days of the Covid pandemic are still ahead, the availability of effective vaccines has given us hope and enabled us to envision the possibility that eventually things will return to normal. As welcome as that would be, should we stop there? Consistent with the messaging from our incoming administration, this may be an opportunity to “build back better,” not only in relation to our economy but in relation to our personal lives as well. 

In this vein, in considering how psychotherapy provides more than just relief from symptoms, I’ve been thinking lately about how “mental health” may be more than just the absence of “mental illness.” Just as mental illness can be conceptualized on a continuum of severity, perhaps mental health can similarly be described on a continuum. What does it mean to not only be free of symptoms, but to actually flourish? Is it possible to define what an “optimal life” consists of? Perhaps thinking about such things will not only be useful for our patients but may benefit us personally as well.

Flourishing
I think of flourishing as a state, in contrast to the totality of experiences that constitute a life (optimal or not) as a whole. In thinking about flourishing, which can be a state that lasts days, weeks, months or even years, I’d elaborate on Freud’s dictum of mental health involving the ability to love and work by also including play. So I address each of these three categories below. It’s important to note, however, that for particular people in their unique circumstances, thriving in all three contexts may not be possible and may not be necessary.

I also appreciate that it would be desirable to have definitions that are independent of socio-economic status or level of intellectual achievement. It seems possible to flourish if one is in a state of poverty if one has the right mindset, e.g. a Buddhist monk with no personal possessions can flourish with adequate food and shelter. It depends a lot on one’s value system and social context. 

In general, the distinction between hedonic and eudaimonic happiness is important here. Hedonic pleasure derives from sensory experiences and can be fleeting. These are pleasurable experiences of the self. Eudaimonic happiness, however, involves the gratification or pleasure derived from having a sense of purpose or meaning in one’s life, and often involves activities that benefit others. Both are desirable if not essential for flourishing.

Work: Ideally this involves having an occupation where a person uses their unique talents and skills, for which there is an appreciative audience, for the benefit of others (e.g. enhancing their well-being in broad terms) as well as oneself. Flourishing involves feeling successful in relation to one’s own goals and ideals. In the optimal scenario, most of the time one’s occupation should not feel like work but rather, “Wow, I actually get paid to do this?!” An important element of flourishing is self-actualization in the sense that one’s skills and abilities are being utilized to their fullest and are not significantly limited by environmental constraints.

Love: The goal here is to experience connection and intimacy in at least three domains: romantic, family, and friendships (which all involve different varieties of love). Ideally one experiences secure attachment in all three domains. Flourishing in a romantic relationship involves a stable relationship where both parties (assuming a dyad) feel that they are “in love” and where each person feels that by virtue of their relationship they can each be the best version of themselves. Family ideally involves a kinship group with a shared history and a commitment to each other’s material and instrumental security who collectively provide feelings of closeness, warmth, support and, when needed, unconditional love. Friendships should consist of multiple long-standing relationships characterized by reliable enjoyment, shared interests and activities, acceptance, affection and mutual respect. Note, however, that while having all three might be considered ideal, it might still be possible to flourish with none of these. Consider the devout Buddhist monk who may be part of a spiritual community but engages in silent meditation retreats for extended time periods. 

Living an Optimal Life
Unlike flourishing, which is an ideal state, living an optimal life involves making the most of the circumstances in which one finds oneself. An optimal life involves experiencing flourishing as much as possible. It also includes the following characteristics.

  • Finding a way to use one’s strengths and talents in ways that are rewarding and fulfilling, while rarely or infrequently being limited or confronted by one’s deficits, unresolved conflicts, or liabilities, whatever they might be.
  • Having romantic, family, and friendship relationships that are satisfying and come as close as possible to approximating the ideal described above.
  • Living in a context whereby one’s personality traits are appreciated and valued, knowing that every personality profile fits poorly in certain contexts. 
  • Having enough money to feel comfortable and not worry about having enough, i.e. financial security.
  • Similarly, having sufficiently good health that does not significantly compromise opportunities for enjoyment.
  • Able to balance work and play as desired, being sufficiently stimulated while having ample opportunities for restorative experiences.
  • Discovering that disappointments, failures, and losses make what one does have all the more precious.
  • Occasionally having a sense of wonder and awe at all that life has to offer, both natural and man-made.
  • Living in a “savoring” mode – experiencing and appreciating the good things in life as much as possible.
As we ring in the new year, this is a time to plan and perhaps think about resolutions (which are notoriously difficult to adhere to). Are there ways that we can draw on these ideas for our own personal well-being? Are there some ideas here that we can share with our patients?

This is a new area of thought and exploration for me. I’d welcome hearing everyone’s thoughts and ideas.

Warmest wishes for a healthy and productive 2021!

Richard D. Lane, MD, with appreciation for helpful comments, suggestions and encouragement from Jordan Karp and Karen Weihs.

 
Winter Competitions:
The Winners Are…
Our colleagues are not only intelligent, dedicated, and compassionate, they are also super creative! We had 11 holly-jolly entries for the door decorating contest, and the top three winners were chosen by popular vote (power to the people!).
 
Coming in third place is the Emergency Department! Their 3D Christmas tree is adorned by the faces of future healers, with presents at its trunk, and topped by caduceus.

In second place is 5NE with their richly festooned, symbol of the Southwest, the mighty saguaro! Flanked at its base are the Sonoran Desert’s ubiquitous barrel cactus and prickly pear, also delightfully decorated.


And in first place, with Santa’s helpers shooting the COVID Grinch with their peppermint canes is the – both traditional and timely – door décor by the Whole Health Clinic’s MAs. Their door’s thought bubble is sassy and resilient:
“COVID-19 won’t kill our holiday spirit!”
DEI Corner
The next meeting of the Department of Psychiatry Diversity Committee (PsyDAC) is on Thursday, Jan. 28 at 3 p.m. Please reach out to me if you would like to join and let me know if you have specific issues you would like to see the committee address. The committee is open to all, and everyone's comments and suggestions are always welcome!

Events
Jan. 21, 2021, 10 a.m.: Examining the Causes and Consequences of Poverty in Tucson through Experiential Learning at the University of Arizona

Jan. 21, 2021, 3 p.m.: Anti-Racism in Medicine Town Hall

Keep an eye on Diversity.UAHS.arizona.edu and Diversity.Medicine.arizona.edu for future events.
 - Patricia Harrison-Monroe, Vice Chair
Awards & Laudatory Notes
Kudos to Karen Weihs, MD, for signing up the most patients to participate in the “Collaborative Oncology Program to Enhance Depression care (COPE-D)” study (funded by the Merck Foundation). Dr. Weihs leads the accrual of participants with 48 in 2020!
Faculty in the Public Spotlight
Dr Grandner was interviewed on the Sleep Well, Stay Well podcast to talk about how a good night's sleep can help smokers quit.

Dr Killgore and his team’s research on loneliness continuing to rise during the lockdowns was covered by HealthDay, with syndication in U.S. News & World Report, Drugs.com, Doctors Lounge, and MedicalXpress. He was also interviewed by KTAR, where he talks about going “old school.” Read the press release here.
COVID-19 Updates
For up-to-date information on COVID-19 and Banner’s response, please access the Banner COVID-19 toolkit on the Banner Intranet.
Guidelines 
  • Banner’s Emergency Operations Center are at “red level,’’  based on distinct increases in the number of COVID-19 cases in our communities. Visitors are no longer allowed in Banner entities. Clinic patients are allowed a helper to attend their appointment, if they are a:
    • Child under 18 years of age.  They may have one parent or guardian with them. 
    • Adult who, because of a disability, requires assistance from someone else to engage in care.
  • Elective surgeries – Each facility adjusted its elective surgery schedules and volume based on facility-specific data.    
  • Universal eye protection – Please wear eye protection for all patient care and use N95 for all aerosol-generating procedures.

Banner has extensive resources for its employees – from COVID testing and help lines to housing and childcare! Check out the list here (opens a Word document).
Inpatient Clothing Drive
Call for Donations
Do you have a spare pair of jeans, or slip-on shoes? How about some long-sleeved shirts or sweats without ties? Bring ‘em on down for the inpatient clothing closets! There is a tremendous need, as many patients come in without much more than the clothes on their backs.
 
“We prefer that patients wear their own clothing, rather than just a hospital gown,” inpatient nurse Teri Hess shares. “When people are cleaning themselves up, by showering, shaving, it is a positive thing for people to take pride in how they look, and want to get better. If we can help our patients do that with donated clothing items, that’s a good thing.”
 
They especially need men’s clothing of all sizes but women’s clothing will also be appreciated. Long sleeved shirts are particularly popular this time of year. Please, no tank tops, spaghetti straps, short shorts, socks underwear or bras with wires. Please drop them off at the BHP Lobby security desk. Thank you!
Education Updates

The Psychiatry Residency Program continues its longstanding history of 100% Board Passage Rate!
All 2020 graduates who sat for the boards have passed:

Brian Bayze, Michael Broukhim, Matthew Dinovitz, Philip Lam, Alison Moritz, Michelle O’Brien, Terry Platto, Sandhya Masih, Sneha Venkatraman, Morgan Zingsheim

The Residency Program is also pleased to report that their virtual recruitment is going extremely well.

Clinical Updates
Express eVisit: immediate Support is available via the resources below.
  • Clinic support staff: Call Banner Helpdesk at 602-747-4444, option 3
  • Providers: Call Banner Provider STAT line at 602-747-7828
  • Patients: Call eVisit at 480-739-9252 or email btnsupport@evisit.com

Cultivating Happiness in Medicine (CHIM) is Banner’s commitment and multi-year strategy to improve physician and APP well-being by preventing and reducing burnout. Learn more at the website and from this PDF.
      

South Campus Adult & Child Clinics 
Both clinics continue to be steady in completed appointments. Adult had 1,856 patient visits with a large decrease in the no-show rate - 11.2% in October to 9.3% in November. Additionally, 98% of our clinic visits continue to be scheduled as telehealth until it is safe to bring patients and providers back into the clinic setting. I want to give a special shout out to all our wonderful residents, faculty and front desk staff who continue to provide excellent customer service to our patients. Happy Holidays!!
- Leslie Armenta

As Whole Health Clinic wraps up 2020, I have found myself doing a lot of reflection on this past year. The Whole Health Clinic team stepped up without missing a beat when COVID-19 first entered our community. Everyone came together to adjust, and we have become one of the largest clinics (along with South Campus outpatient) to utilize telehealth services within Banner. We have seen our members suffer as a result of this pandemic and while we have found ourselves dealing with an increase in stress and anxiety, we put our best foot forward and come to work every day present and available to meet the needs of our community. It is an honor to work with such a wonderful group of compassionate people. I so look forward to 2021!
- Lori Wellman
A huge thank you to the MAs at Whole Health for working extra hard while I’ve spent a majority of my time at our Child/Adolescent Psychiatry Clinic to support them (while they have been without a dedicated MA) also big thanks to Chris for holding down the fort in our Adult Psychiatry Clinic!
- Rebekah Lopez

Pam Mirsky, MD, is accepting patients for her mindfulness-based therapies. Dr. Mirksy offers individual appointments using mindfulness-based psychotherapy (medication supplementation available as needed), as well as a Mindfulness-Based Cognitive Therapy (MBCT) group for depression. More details are here. Please send referrals her way!
Kudos to BHP team members who were nominated by their colleagues as Employees of the Month for November! 

Grant Hull is appreciated for doing a great job stepping into his new role with the case management team and working well with the patients. “He is kind and easy to work with. Grant is always available and able to handle any daily task! He has a positive attitude and communicates well with patients.”

Nurse Glenda (Bessie) Mount is praised for being “a wonderful additional to 2W night shift. She consistently strives to provide exceptional patient care and she is always supportive of the other team members not only on 2W but whatever unit she is working. She is definitely a favorite.”

Tech Chhatra Tiwari is lauded for having “a great attitude. He is caring towards patients, and makes the unit feel safer when he is working.”
Research Updates
During University Closure from December 24 to January 1, the IRB closes and IRB staff will be unavailable. If an urgent situation arises for a research project, Bryan Clines will be monitoring email occasionally, please contact him at bclines@arizona.edu, or email the IRB directly at VPR-IRB@email.arizona.edu and copy bclines@arizona.edu.

Dr. Karp co-authored two papers that were placed in-press this month. One is a study of how gait and psychomotor speed may predict late-life anxiety and depression and the other is a study showing how often older adults engage in daily activities (but not their capacity to actually do the activities) that is linked with cognitive impairment.
  • Stahl ST, Altmann HM, Dew MA, Albert SM, Butters M, Gildengers A, Reynolds CF, Karp JF. The effects of gait speed and psychomotor speed on risk for depression and anxiety in older adults with medical comorbidities. Journal of the American Geriatrics Society. In press.
  • Wu C-W, Rodakowski J, Terhorst L, Dew MA, Butters M, Karp JF, Albert SM, Gildengers AG, Reynolds CF, Skidmore ER.  Frequency of but not Capacity for Participation in Everyday Activities is Associated with Cognitive Impairment in Late Life." Journal of Applied Gerontology. In Press.
Quality Updates
VOICE Survey Results
 
At least once a year, Banner Health solicits employee/faculty feedback through the VOICE Survey. Broadly, the survey asks whether Banner is a great place to work and a great place to receive care. Of those that replied from our Department, 63% said Banner is a great place to work, which is better than the overall system score of 56%. However, only 57% of Department respondents said Banner was a great place to receive care, below the system score of 62%.


When we look at more specific questions, including those related to culture and leadership, our Department usually scores higher. For example, 88% of our respondents said, “My work gives me a feeling of personal accomplishment” and 77% said “I know my contributions are valued at this organization.” Other questions score lower: “The amount of work I am expected to do is reasonable” at 56% and “People at Banner are rewarded according to their job performance” at 45%. A summary of the Department’s scores can be found here.

This year has been full of turmoil and uncertainty, and these scores may reflect that, but there are also opportunities to improve, specifically around culture and perceptions of fairness. Over the next month, supervisors and leaders will be soliciting additional feedback and developing plans. Please speak candidly with your supervisors about what’s going well and the areas where we can improve.
- Brad McKinney
Website: Updating Faculty Profiles
As we continuously work on the Department’s website for accuracy and consistency, one of the topics that has come up is the need to update the faculty profiles. We’ve been working on a form for faculty to complete and will be rolling that out early in 2021. We understand there are nuances to this, and we are working out the details with those in mind. We will keep you posted!
Mark Your Calendars!
Grand Rounds are weekly on Wednesdays, from noon to 1 p.m., but are on hiatus Dec. 23 and 30.
January presentations include:
Jan. 6: Trainee Presentations with PGY-4s Mehrban Goshtaseb pour parsi, DO, and Nikhil Raj Borra, MD
Jan. 13:
 Clarifying Neurodegenerative Features of Late Life Depression: Challenges and Opportunities with UCSF's Scott Mackin, PhD

Jan. 20: Trainee Presentation with PGY-4s Albert Shin, DO, and Kevin Sherman, DO
Jan. 27: QIPS (Quality Improvement/Patient Safety) with Kate Woods, DO, MS (only available to faculty and trainees)
Adieu & Bienvenidos!
Thank you to Naomi Park, MD, for her years of service to the Department. Her last day was on Friday, Dec. 11.    

We extend a warm welcome to:
  • Cristina Garcia, PhD, who is working as a therapist at WHC and the EPICenter, with a specialization in behavioral interventions for sleep disorders.
  • Medical Assistant Kristina Ahumada will be working in the Child/Adolescent Clinic and Medical Assistant Alejandra Mendoza will be working with our Adult Clinic.
  • The Whole Health Clinic brings onboard Recovery Coordinator Paul Hernandez, who has many years of experience in the field. Lauren Lieppman also joins WHC as a new therapist. She will be WHC’s sixth full time therapist, a testament to the clinic’s continued growth. 
Work Anniversaries
A big kudos to the following folks for their years of service!
Irene Laventure: 7 years
Jenna Summerfield: 5 years
Andrew Thomas: 3 years
Angela Romo: 3 years
Jeff Dixon: 3 years
Sunne Duray: 3 years
Elissa Salcido: 1 year
Happy December Birthdays!
Christopher Padilla
Diana Crocker
Gearrett Baker
Gustavo Perez
Jasmine Singh
Laurel Kukafka
Lindsey Collins
Lori Wellman
Matthew Habib
Michael Grandner
Michelle Singh
Mickie O'Brien
Nikhil Borra
Sarah Malcolm
Seth Studer
Soni Tiounoff
Sunne Duray
Yue Zong
Yvette Palma


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