Mental Health Awareness and Services for Veterans and Families Presenter Name and Subtopic Date 226123 ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information.

“I’m Good” When you ask how someone is doing and get the response “I’m good,” do you ever give it a second thought? The U.S. Department of Veterans Affairs and the U.S. Department of Defense have come together to create a video that addresses this question. “I’m Good” features actual Veterans and Service members talking about the conflicting feelings that sometimes underlie offhand responses like “I’m good.” It also highlights the important role that families, friends, co-workers, and other acquaintances can play in helping to prevent suicide. The video emphasizes the importance of being there for the people in our lives who, though they may not always show it, aren’t doing so well. ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information.

Mental health conditions are prevalent and have far-reaching health consequences Nearly 1 in 5 people in the U.S. have a mental health condition1 More than 50% of people with a mental health condition are not receiving treatment1 Mental health conditions are far more common in the U.S. today than either heart disease or diabetes, affecting approximately 1-in-5 individuals – or more than 40 million people each year. However, it’s estimated more than half of those impacted are not receiving treatment for their mental health condition. Its clear that the impact of mental health conditions on individuals, families, communities, government and the healthcare industry is tremendous. 226123 You are not alone 1. Prevention and early intervention B4stage4: The state of mental health in America 2016. Mental Health America Web site. http://mentalhealthamerica.net/sites/default/files/2016%20MH%20in%20America%20FINAL.pdf. Accessed April 12, 2016. ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information.

Mental health and chronic comorbid conditions have a significant correlation Mental health conditions, especially depression, are strongly related to the occurrence, successful treatment and course of many chronic diseases1 more likely for adults with depression to also have heart disease of chronic pain patients have major depression of cancer patients have major depression more likely for diabetes patients to also have depression 2x 50% 25% As these stats show, mental health conditions do not exist in a vacuum. Chronic conditions such as heart disease, pain, diabetes and cancer pose serious health and financial burdens on patients and the healthcare system by themselves. When they are accompanied by mental health conditions, the impact can increase exponentially. The way to truly achieve wellness is through good health in both body and mind, and, unfortunately, far too many people aren’t able to experience overall wellness due to gaps in our healthcare system today. 226123 1. Chapman DP, Perry GS, Strine TW. The vital link between chronic disease and depressive disorders. Prev Chronic Dis. 2005;2(1). http://www.cdc.gov/pcd/issues/2005/jan/04_0066.htm ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information.

Veterans have unique mental health needs Veterans aged 65 years and older that have a diagnosis of major depressive disorder2 Service members returning from Iraq or Afghanistan having post-traumatic stress disorder or depression Higher suicide risk among Veterans when compared to U.S. civilian adults3 Veterans deployed to Iraq and Afghanistan will requiring treatment for a mental health condition1 Of Veteran suicides are among people age 50 or older3 11% 18.5% 21% 30% 60% Depression in late life may be brought on by losses or serious challenges such as the death of a spouse, family member, or pet, medical problems, disability, or even retirement. Meeting the Mental Health Needs of Veterans, The National Council for Behavioral Health, 2012 VA National Registry for Depression Suicide Among Veterans and Other Americans 2001–2014, 2016 ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information.

The five signs of emotional suffering Personality changes May neglect self-care and engage in risky behavior. Uncharacteristically angry, anxious, agitated, or moody Overcome with hopelessness and overwhelmed by circumstances. Personality changes. You may notice sudden or gradual changes in the way that someone typically behaves. People in this situation may behave in ways that don't seem to fit their values, or the person may just seem different. Uncharacteristically angry, anxious, agitated, or moody. You may notice the person has more frequent problems controlling his or her temper and seems irritable or unable to calm down. People in more extreme situations of this kind may be unable to sleep or may explode in anger at a minor problem. Withdrawal or isolation from other people. Someone who used to be socially engaged may pull away from family and friends and stop taking part in activities that used to be enjoyable. In more severe cases the person may start failing to make it to work or school. Not to be confused with the behavior of someone who is more introverted, this sign is marked by a change in a person’s typical sociability, as when someone pulls away from the social support typically available. May neglect self-care and engage in risky behavior. You may notice a change in the person's level of personal care or an act of poor judgment. For instance, someone may let personal hygiene deteriorate, or the person may start abusing alcohol or illicit substances or engaging in other self-destructive behavior that may alienate loved ones. Overcome with hopelessness and overwhelmed by circumstances. Have you noticed someone who used to be optimistic and now can’t find anything to be hopeful about? That person may be suffering from extreme or prolonged grief, or feelings of worthlessness or guilt. People in this situation may say that the world would be better off without them, suggesting suicidal thinking. Withdrawal or isolation from other people If you see these signs, will you know what to do? Reference: Campaign to Change Direction, http://www.changedirection.org/, Retrieved 9/6/2016 ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information.

Depression is a common problem among older adults, but it is not a normal part of aging If you know someone with depression, simple interventions can make a difference Encourage him or her to see a doctor or mental health professional Offer support, understanding, patience, and encouragement Talk to him or her, and listen carefully Never ignore comments about suicide, and report them to your loved one’s therapist or doctor Invite him or her out for walks, outings, and other activities Remind him or her that with time and treatment, the symptoms will lift National Institutes of Health, Older Adults and Depression, http://www.nimh.nih.gov/health/publications/older-adults-and-depression/older-adults-and-depression_141998.pdf ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information.

Where to go for help - Resources for mental health Web http://www.mentalhealth.va.gov/ https://www.veteranscrisisline.net/ https://www.walgreens.com/health/mental-health/3200001 www.mentalhealthamerica.net (linked to Walgreens site) www.changedirection.org Telephonic Veterans Crisis Line (800-273-8255, Press 1) Apps PTSD Coach (VA) Moving Forward (VA/DoD) Web based resources include self screening tools, treatment information, and options for accessing treatment for mental health. These are for reference only ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information.

We can all do something Mental health conditions are common – don’t be afraid to seek help or discuss with a friend Be aware of the 5 signs of emotional suffering. Take action, if needed Simple acts of kindness or empathy are important to assist someone with getting the help they need Familiarize yourself with available mental health resources and know how to access them ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information.

Appendix ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information.

Depression Depression is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. Signs and Symptoms Treatment Options Persistent sad, anxious, or “empty” mood Feelings of hopelessness, or pessimism Irritability Feelings of guilt, worthlessness, or helplessness Loss of interest or pleasure in hobbies and activities Decreased energy or fatigue No “one size fits all” treatment solutions Medications Several options – many generic May take up to 4 weeks to begin working Psychotherapy Talk therapy Counselling Depression is an emotional state marked by persistent sadness, loss of interest in the things that once were pleasurable and a state of low energy for two weeks or more. Symptoms of depression include Changes in sleep patterns, trouble sleeping or sleep all the time. Changes in appetite: loss of appetite or over eating Lack of concentration: easily distracted Loss of energy: tired all the time Lack of interest: finds no enjoyment in what they used to love to do Low self esteem: feeling of worthlessness Hopelessness: Feeling of no desire to do anything Changes in movement - physical aches and pains. Evidence based treatment for depression includes a combination of psychotherapy and medication management. Antidepressants, mood stabilizers and antipsychotics are used Psychotherapy includes cognitive behavioral therapy, family-focused therapy and interpersonal therapy as well as brain stimulation therapies like electroconvulsive therapy (ECT). Alternative therapies include acupuncture, meditation/prayer and light therapy. National Institute of Mental Health, http://www.nimh.nih.gov/health/topics/depression/index.shtml ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information.

Post Traumatic Stress Disorder Post Traumatic Stress Disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event Signs and Symptoms Treatment Options To be diagnosed with PTSD, an adult must have all of the following for at least 1 month: At least one re-experiencing symptom Example: Flashbacks or bad dreams At least one avoidance symptom Example: Staying away from places that are reminders At least two arousal and reactivity symptoms Example: Easily startled or difficulty sleeping At least two cognition and mood symptoms Example: Trouble remembering key events Medications Several options – many generic Prazosin may be helpful for nightmares Psychotherapy Talk therapy Counselling Not every traumatized person develops ongoing or short-term PTSD. Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD. Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. To be diagnosed with PTSD, an adult must have all of the following for at least 1 month: At least one re-experiencing symptom At least one avoidance symptom At least two arousal and reactivity symptoms At least two cognition and mood symptoms Like depression, the main treatments for people with PTSD are medications, psychotherapy or both. It is important for anyone with PTSD to be treated by a mental health provider who is experienced with PTSD, and realize that some people with PTSD need to try different treatments to find what works for their symptoms. National Institute of Mental Health, http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information.

Heightening awareness of mental health issues Mental health “answers” page on Walgreens.com will feature: Informational resources and content Links to free online screening tools through MHA All 27,000 Walgreens pharmacists can access continuing education and training to better serve and counsel people living with mental health conditions We will be driving mental health awareness on multiple fronts: Our new mental health “answers” page on Walgreens.com will be an information-rich resource for people seeking this type of content. It will also include links to free screening tools provided by MHA, so patients can take action to determine if they need additional medical treatment. To ensure that patients with complex conditions have easy access to mental health information, patients visiting our heart health and diabetes “answers” pages on Walgreens.com will see links to the mental health “answers” page. Plus, we are empowering all our pharmacists with continuing mental health education and training so they can be valuable resources for diagnosed patients seeking counseling on prescriptions, side effects and more, as well as undiagnosed patients seeking information. 226123 ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information.

A strong commitment to improved mental health awareness and outcomes Walgreens has launched a comprehensive platform of services and strategic relationships with the goals of: Improving health outcomes through early mental health screening and intervention Heightening awareness of mental health issues and their effect on overall wellness Connecting more people with clinical resources in the community who can help Walgreens mission is to champion everyone’s right to be happy and healthy. Because mental health is such a significant factor in overall wellness, we’re making a strong commitment to the mental health community with a platform of services and relationships that aim to improve outcomes, raise awareness and connect those in need to clinical resources who can help. 226123 ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information.