Join us for our next Mind Matters meeting!

Eyal Shemesh, MD will be speaking about mental health screenings in pediatric primary and specialty care at our next Mind Matters meeting on May 8, 2024.

Participants will learn about evidence for and against screening for depression in non-mental health settings and how to interpret USPSTF recommendations into their practice.

Dr. Shemesh is the chief of the Division of Behavioral and Developmental Pediatrics at the Kravis Children’s Hospital and Professor in the Departments of Pediatrics and Psychiatry at the Icahn School of Medicine at Mount Sinai.

If you have a case you'd like to share for consultation and support at this or a future Mind Matters meeting, please email Anitha Iyer, PhD, Course Director.

Remember that you can view recordings and slides of previous meetings on our website. Past meetings have covered treating depression and anxiety in primary care, substance use disorders, and more.

Most recently, Dr. Sidney Hankerson spoke about advancing mental health equity in communities of color. 

All health care providers should be prepared for patients of all genders to disclosure sexual trauma in the exam room, and it is crucial that they are ready to respond with compassion and empowerment.

The American Association of Family Physicians (AAFP) offers some tips for having supportive conversations about sexual trauma with patients:

• Listen non-judgmentally, make eye contact, and use a gentle tone
• Convey to the patient that you appreciate them sharing this information, that you empathize with them, and they are not at fault
• Acknowledge the pain, burden, and reality of their experience(s)
• While it’s okay to ask whether the patient has already or wants to report the event to police, it is more important to empower them to make their own decisions and understand that there are a number of reasons victims choose not to report
• Avoid using touch to comfort the patient; while well-intentioned, non-consensual touch may be particularly distressing and traumatizing to survivors of sexual assault

Trauma-informed care and physical exams

• Before performing a physical exam, explain to the patient what you plan to do and why
• Ask them if there’s anything you can do to support them during the exam and offer them an option to signal the need for a break if they feel overwhelmed or uncomfortable
• Gain explicit permission before touching them and check in with them during the exam.

Consider screening for a history of sexual assault

• Patients are more likely to disclose when directly asked
• “I'm going to ask a few questions that will help me provide the best care for you. Many of my patients have experienced sexual violence. Has anything like that ever been done to you?” 
• Incorporate questions about sexual assault history and intimate partner violence in pre-visit paperwork

Share follow-up resources if appropriate

• Safe Horizon operates a 24/7 Rape and Sexual Assault Hotline and can assist in any language; call 212-227-3000
• SafeChat is currently available Monday-Friday from 9:00am - 6:00pm to assist English speakers with advocacy and support regarding crime, violence, and/or abuse
• Share this Safe Horizon tip sheet (in English and Spanish) and this Recovery Guide for Survivors with your patients

Using trauma-informed care to address sexual assault and intimate partner violence in primary care

Sexual assault (SA) and intimate partner violence (IPV) can have lasting impacts on a person’s mental and physical health throughout their life. Routine screening of all patients for SA/IPV normalizes disclosure, reassures survivors that it is safe and appropriate to discuss with their care provider, and allows providers to connect survivors to further care and resources as appropriate for their recovery.

For providers, barriers to screening for SA/IPV include low comfort level, perceived time restraints, lack of protocols, and not knowing how to respond to a disclosure. Providers can facilitate disclosures by building rapport with their patients and creating a feeling of safety, as well as acknowledging their trauma and reassuring them that they are not at fault. Disclosures can be retraumatizing for survivors, especially when met with (perceived or real) disbelief, skepticism, and/or blame.

Trauma-informed care offers providers a holistic approach to evaluating and addressing trauma and empowering survivors in their recovery. Instead of asking for symptoms or what is wrong, trauma-informed care seeks to understand what has happened in the patient’s life that has influenced their health and behavior. Four key principles are trauma-informed care are to realize that trauma is pervasive and affects not just survivors, but families, communities, health care systems, and providers; recognize signs of trauma and screen routinely; respond with understanding and sensitivity; and resist retraumatization by collaborating with patients to provide a safe environment. 

Learn more

Don't miss this recent Carr Talk on the new behavioral health center on Rivington Street on the Lower East Side.

Dr. Carr calls the center "one of the most revolutionary and game-changing behavioral health facilities in the nation." Providing comprehensive integrated care in one facility, providers holistically evaluate and treat patients' entire continuum of health care needs.

Ensure your patients are aware that their insurance provider must cover behavioral health benefits with no session caps. This quick guide explains how to find treatment and services and includes information about understanding insurance coverage and benefits.

Epic users can include this information as part of the After Visit Summary by using dot phrase .behavioralhealthresourceguide.

It's no secret that there is high stigma surrounding mental health which can be incredibly harmful to people living with mental health conditions and interfere with their treatment and recovery.

The CDC offers a variety of provider resources on mental health literacy, including a CME course from the University of Texas at Austin on stigma-free communication about mental health.

Spanish language resources from the National Institute of Mental Health (NIMH)

NIMH has patient-friendly information about a variety of mental health topics in Spanish. Share this information with Spanish-speaking patients to help them understand any relevant topics or diagnoses.

Information to share with your patients: sexual assault

Well-being and mental health resources for Mount Sinai Health System faculty, staff, students, trainees, and co-insured family members

MSHS offers a variety of support services to all faculty, staff, students, and trainees. To learn more, view this flyer.

This flowchart highlights available options for therapy and medication management.