www.mcw.edu

Mental HealthCarol I-PingTsao, MD, JD

Associate ProfessorDepartment of Psychiatry & Behavioral Medicine

Medical College of Wisconsin

www.mcw.edu

Mental Health, Mental Stress & Mental Illness

MaintainingMental Health

ProfessionalTreatment

Stress Management Techniques

www.mcw.edu

Health Maintenance• Diet ( about 1800 cal/day)• Exercise (30 minutes 3-4x/week)• Sleep (8-10 hours/night)• Reduce/cease alcohol, caffeine, tobacco,

illicit/licit drugs with abuse potential• Spend quality time (talking and playing -

undivided attention) with spouse/significant other and children every day

• Think quietly/meditate/pray every day

www.mcw.edu

Mental Stress

• Definition:Stress can be defined as the harmful physical and emotional responses that occur when external requirements outmatch individual capabilities and resources.

• Stress precipitants can be negative or positive

www.mcw.edu

Situational Factor(s)

Individual Factor(s)

STRESS

www.mcw.edu

Stress And Illness• Short-lived, infrequent, milder episodes of stress

pose little health risk• Sustained, high levels of stress can result in

symptoms such as headache, upset stomach, difficulty concentrating, sleep disturbances, irritability and low morale

• Increased risk for cardiovascular disease, musculoskeletal disorders, and depression

www.mcw.edu

Two Forms of Coping• Problem-focused (Adaptive Coping)

– Focus is on the problem – attempt to solve the problem, master the situation, or expand resources to deal with the situation.

• Emotion-focused (Palliative Coping) – Focus is on managing the emotional response to a

situation in order to attenuate the emotional impact.

www.mcw.edu

Stress Management Techniques

• Can control, reduce, sometimes even eliminate stress symptoms

• These techniques are readily learned, can be individually tailored and improved upon by practice

• Many draw from the theory and practice of cognitive and behavioral therapy

www.mcw.edu

Easy-To-Do Stress Management Techniques

• Deep breathing• Stretching• Mindful Awareness• Visual imagery• Thought stopping• Scheduling worrying• Positive affirmations

www.mcw.edu

• How to Talk So Kids Will Listen & Listen So Kids Will Talkby: Adele Faber and Elaine Mazlish (Feb 7, 2012)

• Become a Better You by: Joel Osteen (Oct 15, 2007)

• Women Food and God: An Unexpected Path to Almost Everythingby Geneen Roth (Feb 8, 2011)

• The Not So Big Life: Making Room for What Really Matters by: Sarah Susanka (Dec 26, 2007)

My Four Favorite Self Help Books

www.mcw.edu

Mental Illness: Scope and Impact• Psychiatric disorders affect all ages, genders, and cultures

• The vast majority of all illnesses and deaths in the world have behavioral components:– Heart disease– Obesity– Addiction– Infectious disease

• Psychiatric disorders are the:– #2 cause of disability in the world– #1 cause of disability in economically established countries

www.mcw.edu

• 1 in 2 physically ill persons have a coexisting mental illness/addiction

• Depression co-occurs in:– 33% people who have had a heart attack– 40% people with cancer– 50% people who have had a stroke

Mental and Physical Illness

www.mcw.edu

Mental Health Treatment

• Depressive disorders• Anxiety disorders• Psychotic disorders• Eating disorders• Trauma disorders• Attention deficit

disorders• Dementias

• Bipolar disorder• Substance Abuse• Sexual dysfunctions• Childhood disorders• Chronic pain• Personality disorders• Others

www.mcw.edu

Affordable Care Act• In 2014, health insurance plans must cover mental

health and addiction services as part of the essential benefits

• Mental Health Parity and Addictions Equity Act of 2008 required insurance coverage for mental health and addictions be equal to coverage of other illnesses.

• Studies have shown that every dollar spent on mental health care results in a savings of $12.

www.mcw.edu

How Employers Can Help

• Talk openly about mental diseases in public forums– especially the major ones for employers

(stress/anxiety, depression, substance abuse)

• Provide mental health benefits including Employee Assistance Programs and access to external referrals

• Maintain confidentiality

www.mcw.edu

Employee Assistance Programs• Complete a thorough assessment of their organizational

culture

• Suggest (even incentivize) employees complete anonymous health risk assessment

• Tailor programs targeting the areas of greatest need (likely stress, depression, obesity, substance abuse)

www.mcw.edu

Employer Benefits

• Employers who provide mental health benefits have lower incidents of job burnout, workplace injury, and onsite violence

www.mcw.edu

Preventing Job-Related Stress• Ensure work type and work volume is in

line with employee capabilities and resources

• Design jobs to provide meaning, stimulation, and opportunities for employees to use and develop their skills

• Clearly define employees’ roles and responsibilities

www.mcw.edu

(Continued)• Provide opportunities for employees to participate in

decision making that affects their jobs• Clear, consistent communication• Provide opportunities for social interaction among

employees• Establish work schedules that are compatible with

responsibilities outside the job

www.mcw.edu

Summary• Practice health maintenance• When stress increases, choose one technique –

commit to using it daily• Read (and apply) a pertinent self-help book • If symptoms (such as interpersonal irritability,

withdrawal from activities, physical fatigue, etc…) worsen, seek professional care

www.mcw.edu

QUESTIONS?

Carol I-Ping Tsao, MD, JDMedical College of Wisconsin

Associate Professor of Psychiatry and Behavioral Medicine

ctsao@mcw.edu

THANK YOU

www.mcw.edu

Taking Charge of your Fertility

Options for Delaying Parenthood

Sabina Diehr, MD

Associate Professor

Department of Family & Community Medicine

Medical College of Wisconsin

www.mcw.edu

Declining # of Children / Couple

www.mcw.edu

www.mcw.edu

www.mcw.edu

Aging and Fertility in Women

www.mcw.edu

Women are born with ALL of their eggs

www.mcw.edu

Men are able to make fresh sperm daily

www.mcw.edu

Infertility Treatments

www.mcw.edu

% of Egg Transfers Resulting in Live Births

www.mcw.edu

What is Important to YOU?

• Duration• Efficacy• Convenience• Not “messy”• Also helps acne, or menstrual flow• Little to no side-effects• No medical contraindications

www.mcw.edu

Contraceptive Choices

www.mcw.edu

Barrier Methods

– Condoms– Diaphragm– Today’s Sponge

www.mcw.edu

Short-Acting Reversible

– Pill– Patch– Nuva Ring

www.mcw.edu

Long-Acting Reversible

–Depo-Provera– IUD– Implanon

www.mcw.edu

Non-Reversible

–Tubal ligation–Vasectomy

www.mcw.edu

Natural Family Planning

www.mcw.edu

Failure Rates of Contraceptives

Typical Use Perfect Use

NFP / Withdrawal 18.4% 5%

Condom 15% 5%

Pill, Patch, Ring 8 % 0.3%

Depo-Provera Shot 6.7% 0.3%

IUD 0.2% 0.2%

Implanon 0.05% 0.05%

www.mcw.edu

www.mcw.edu

Questions?

Thank you!

www.mcw.edu

Navigating the Changing Health Care System: Tips for Business and Personal

Planning

Sheila G Moore, MD, FACR

Professor and Chief, Pediatric Imaging

Medical College of Wisconsin

www.mcw.edu

Early Healthcare in the US

• Barbers and Physicks• First Reform: 1854

Bill for the Benefit of the Indigent Insane

• Freedman’s Hospitals• The New Deal

www.mcw.edu

Medicare and the Expansion of Health Insurance

• 1920’s: Dallas teachers have first employer sponsored health care. Blue Cross is established

• WWII: Employer Health Insurance offered to offset freeze in wages

• 1965 Lyndon Johnson Signs Medicare Legislation

www.mcw.edu

Financial Impact of Health Care

www.mcw.edu

2010 Affordable Care Act (ACA)• Quality, Affordable Health Care for All

– No pre-existing exclusion– State Health Insurance Exchanges/

Lower rates– Children Covered to 26– No Maximum Lifetime/ Annual

Benefit • Enhanced Enrollment Public Programs

– Medicaid open to all low income individuals

• Improving Quality and Efficiency of Health Care– The “Medicare Provision”– Will “save” $450B in Medicare

costs

www.mcw.edu

Provisions of the ACA• Prevention• National Healthcare

Workforce Commission• Fraud and Abuse• Pharmaceutical Reform• Long Term Care• Revenue Provisions• Manager’s Amendment

www.mcw.edu

2010 Implementation• Ban on lifetime

limits on benefits• Dependent coverage

until age 26

www.mcw.edu

Act II: 2014• Tax Credits For Health Insurance

Premiums– “Middle Class” Benefit– Can be applied to Premium

Payments monthly (Advanceable)

– Income between 100% and 400% of the poverty line who are not eligible for other affordable coverage

• In 2013 400% of Poverty line for family of 4 is $92,200.

• In 2013 400% of Poverty line for an individual is $44,680

www.mcw.edu

ACT II: 2014• Required State “Health Insurance

Marketplace”• Individual Mandate

– Workplace– Individual/Health Insurance

Marketplace– Pay a fine

• Estimated 6M Affected• Average fine $1200/person

‘16• Expected to raise $6.9B

2016• Earn Less than 133% of poverty

level eligible for Medicaid

www.mcw.edu

Implementation: 2014• Reforms slated to start in 2014

apply to plans both inside and outside the exchange

• Guaranteed Coverage: Requires insurers to accept every individual and employer that applies for coverage

• Ban on Waiting Periods: Employers cannot impose waiting periods longer than 90 days before an employee can be eligible for coverage

• Rating Requirements: Insurers are restricted from using health status, gender, and other such factors in setting premiums

• Ban on Exclusion for Preexisting Condition: Insurers cannot exclude or limit coverage for people with preexisting health problems

• Essential Health Benefits: Requires insurers to cover a comprehensive set of health benefits.

• Out-of-Pocket Cost Limit: Holds out-of-pocket costs to the level established for high-deductible health plans that qualify for health savings accounts

• Actuarial Value: Requires insurers to

cover at least 60 percent of total costs

under each plan and sell plans that

meet new benefit tiers based on

average costs covered.

www.mcw.edu

Effect on Small Business: Self Employed

• Self Employed– Jan 2014: Individual

Shared Responsibility Provision

• Less than 25 Employees• 25-50 Employees• >50 Employees

• Individual Shared Provision – Essential Coverage– Qualify for Exemption– Pay When Filing Taxes

• Individual Insurance Marketplace

• Medicaid Expansion

www.mcw.edu

Effect on Small Business

www.mcw.edu

Effect on Large Business/Corporations

www.mcw.edu

Wisconsin• Under ACA: Regulation falls

to the states• 11 States and DC have passed

laws to implement ACA• Connecticut (7), California (6)

At least one: Arkansas, Maine, Maryland, New York, Oregon, Rhode Island, Utah, Vermont, Washington, District of Columbia

• Result: 2013 will be a critical time in State Legislatures to pass the bills needed

www.mcw.edu

Impact On Personal Taxes: 2013

• Limit on Flexible Spending Account: $2500 per year– Previously $5000

• Cadillac Health Insurance– 40 % Penalty for being

enrolled in a high-cost insurance plan

– $10,200 (I) and $27,500 (F)

• Medical Hospital Insurance (Part A) Tax • Medicare Payroll Tax of

2.35% on earnings >$200/$250K

• Imposed to keep Medicare funded

• Unearned Income Tax• Dividends/Rent/Interest• 3.8 % Surtax on Incomes

more than $200K/$250K

www.mcw.edu

Conclusion• 2010 Implementation is here• 2013 Tax Consequences are

here• 2014 Implementation is

– Sweeping– Here– Expensive– Goal: Quality and Access– Greater care for less

• Business– Learn the provisions– Plan for implementation– Educate employees– Plan recruitment/retention– Partner with Government,

Providers and Payers• You and Your Family

– Plan for implementation– Educate yourselves– Be healthy

www.mcw.edu

Thank You!

QUESTIONS?

Sheila G. Moore, MD, FACR

Children’s Hospital of Wisconsin

Professor and Chief of Pediatric Radiology

Medical College of Wisconsin

smoore@chw.org

www.mcw.edu

References• Commonwealth Fund

(2013, February 1). U.S. Healthcare: State action on Affordable Care

• http://www.healthcare.gov/law/timeline/index.html#event41-pane

• http://www.sba.gov/content/employers-with-fewer-50-employees

• http://www.sba.gov/content/employers-with-fewer-25-employees

• http://www.sba.gov/content/self-employed

• http://www.sba.gov/content/employers-with-50-or-more-employees

• H.R. 4872, Reconciliation Act of 2010 (Final Health Care Legislation: Analysis by the Congressional Budget Office; March 20 , 2010