The field of mental health is a constant stream of new information which makes what we do as mental health practitioners all the more exciting and innovative. We are constantly growing, contributing, and sharing ideas. In this blog, I share some of my ideas and insights and welcome any comments, questions, or friendly debates. Thanks for reading!
  
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Posted By Suzanne Taluy LCSW, CCTP, Embrace Psychotherapy, LLC,
Wednesday, July 8, 2020
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As a mental health professional, I often critique myself and the kind of service I provide to my clients. I always wonder if I’m actually helping my clients achieve their goals, and I am constantly looking for new ways to help them. I'm passionate about helping others which is what motivated me to become a therapist. I also like being a part of the mental health community; working with people can be a very rewarding and fulfilling experience but it can also be frustrating. Specifically, when I’m not able to help clients move past certain barriers, when the services they need just aren’t accessible, and when there is little to no support available to them. Evidently, there are flaws and cracks in the mental health system; statistically few people actually recover or enter into remission, and I would like explore why that is.
We can all agree that mental health awareness has gained more attention in the past couple of years. Society realizes that helping professionals have a vital role in preventing and addressing trauma, substance abuse, and serious mental illnesses. There has been a push for people to seek professional help with a variety of services available. Here’s the catch. These services are sometimes not accessible to certain populations, some of them are time-limited, and most services are expensive even with insurance coverage. In many cases, the quality and how much help a person is able to receive depends on how much they can afford to spend. A person with severe mental illness can easily get lost in this system, especially if they don’t have the means to access long term mental health treatment.
During the mid- late 20th century large psychiatric facilities started to close; this is widely known as deinstitutionalization- “A process of replacing long-stay psychiatric hospitals with less isolated community health services” (Wikipedia.org). Programs proposed to help with recovery following the closure of these facilities never followed through, and as a result people with severe mental illnesses are comprised of 25% of the homeless population, and an estimated 1.2 million of the prison population (APA.org). Deinstitutionalization was also made possible by the discovery of psychiatric drugs in the mid-20th century; there were financial imperatives with the government viewing it as a way to save costs (Kales, Pierce, & Greenblatt, 2012). Maintaining mental illness with medication is a benefit for pharmaceutical companies, and It’s not unheard of for hospitals to release a patient before they are completely stabilized in the community with little support in order to free a bed for an incoming patient. Many facilities within the system aren’t designed for long term care, and many insurance companies only cover time limited services. A major barrier to improving this flaw is advocacy. People with severe mental illness are not able to advocate for themselves, and people who are put in place to advocate for these patients are faced with the ethical barrier of self-determination.
If there is a price tag on the quality and longevity of mental health services then it shouldn’t be surprising that there are cracks in the system, and unfortunately some of the clients and patients we serve are falling through them. Disadvantaged and poor communities where services are needed the most often have limited resources, and the resources that are available don’t have the capacity to service all the individuals that need the support. This causes agencies, organizations, and facilities to enforce limitations on who are eligible for services and those who don’t meet the criteria are excluded. Again, services in these communities are time limited in order for the agencies to service a larger portion of the population. Because long term care is not accessible, providers are managing symptoms with medications instead of focusing on symptom relief, which contributes to the problem of the “revolving door”.
In many facilities, rehabs, and hospitals bureaucracy has become a barrier to quality and effectiveness of services. In these organizations, the board of directors and administrators make most decision on how services are delivered to the patients. Customer service is a primary concern and customer care is secondary. Another limitation is the lack of autonomy and flexibility to provide individualized treatment to each patient which causes a “one size fits all” approach. The problem with this approach is mental illness is complex and diverse; many underlying behaviors can easily be overlooked and left unresolved. The programs in these organizations are not designed to address deep rooted issues that contribute to the disorder. The idea is to stabilize and then connect the client to other resources. Even if a person can afford long term treatment, they are in and out of multiple facilities. Each facility is designed differently causing inconsistencies in treatment. Inconsistency is another barrier to effective recovery leading clients to regress or drop out of services.
Ways to Improve
I have spent some time talking to people and researching what can be done to resolve the issues discussed. Let me just say that any system will always have flaws, and it’s impossible to satisfy everyone involved. However, the system can improve in the sense that mental health practitioners move from the idea of symptom management to symptom relief. Here are some ways we can work to accomplish this:
1. Make mental health services more affordable and accessible to people who need it. This means outreach in communities that have a need which include education and advocacy services. More investment in mental health in these communities from the local and state level. Better matches for people who aren’t using private insurances to ensure they are receiving services suited for their specific need; and reducing the costs of some co-pays and deductibles for those with private insurance.
2. Provide long term support for people with severe mental illness in which they can continue to have access to services once they leave the facility. This includes in home support and access to other community resources. This type of support is already in place in some areas, however at times the responsibility falls on the client to follow up with the services. Client with severe mental illness may have low motivation or poor follow through; in this case advocates can be put in place to ensure the client is enrolled in services.
3. Increase the client’s confidence in their ability to manage their mental health. Many client’s feel that they don’t have much say in their treatment. Services can focus on giving clients the tools they need to advocate for themselves, allowing them to feel they have the freedom to choose the right treatment for themselves.
4. Using peer support by matching clients with people who have similar experiences with mental illness and addiction. These people can relate to the client and help them learn coping skills effective for recovery.
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Posted By Suzanne Taluy LCSW, CCTP, Embrace Psychotherapy, LLC,
Friday, April 24, 2020
Updated: Friday, April 24, 2020
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COVID-19 has presented us with a very unique situation, “social distancing”. Almost everyone worldwide if not everyone has been affected in some way, shape, or form by this very contagious virus. It has forced many countries to put in place restrictions, businesses to shut down, employers to lay off or furlough employees, and individuals to “shelter in place”. Through this unique experience we are learning a lot about ourselves, the people closest to us, and the world around us. I would like to share the things I’m learning while surviving this pandemic in hopes that others can relate and feel somewhat comforted about their situation.
1. The world is anxiety driven.
This Pandemic has exposed a lot about the way people react to uncertainty. From the very beginning there has been a rapid spread of misinformation. Experts on infectious diseases have been educating the public as they are learning more. However, what we already know is scary and it has only created more hysteria. There are myths about how the disease is contracted, promotions of “magical” cures, and government conspiracy theories. Not only is this kind of information ignorant, it’s dangerous and it has potentially damaging effects. Besides misinformation spreading just as fast as the virus, it seems people now have the perfect excuse to hoard food, toilet paper, cleaning supplies, and other essential products.
…Then there is the total disregard for human life in order to save the economy. Many big businesses, billionaires, and politicians are more concerned about the economy (which is fully capable of recovering from this pandemic) then they are about saving lives. Yes, this too is a form of anxiety. People are pushing to return to work because, let’s face it, everyone has bills to pay and America’s reputation has been largely based on how well the economy is doing. Many law makers and big businesses are very concerned about how this pandemic may impact America’s future and the ability to maintain business relations oversees, as well as the length of time it will take for the country to recover.
2. Society performs well under pressure.
People are not used to having so much time on their hands, and most aren’t sure what to do with it. We have been conditioned to maintain a routine. Routines allow us feel a sense of normalcy, helps us to feel productive, and provides structure. For many, the routine of life has been disrupted and we are struggling to maintain some sort of structure. For some people this causes anxiety or a nagging sensation that we should be doing more with this free time, BUT there is no pressure to get anything done. So, what do we do? We procrastinate find time to relax, and prioritize less. Some people have invested time in exploring new hobbies, spending time with their families, and self-improvement. I hear many benefits of having the free time from some of my clients as well as the disadvantages. Being at home has created somewhat of a lax attitude while we are starting to adjust to this “new normal”.
3. COVID-19 is taking a heavy toll on society psychologically.
Lay-offs, financial hardships, isolation, death, agoraphobia, and the mental effects of being sick. These are sudden and stressful changes that no one could have prepared to deal with in advance. Sudden change, uncertainty, fear, and isolation are the perfect storm for a host of many emotional and mental issues. People are experiencing a new level of anxiety, depression, and trauma and it’s affecting adults and children alike. While many therapist, coaches, and counselors are still able to provide services online, some people don’t have the resources or the privacy to receive therapy. Even if talk therapy is not option, its important to know there are other resources available.
4. Quarantining is testing our patience and our relationships.
Although you love your family or significant other; spending so much time together can feel smothering, annoying, and frustrating at times. For most people school, work, and other obligations allowed some much-needed time away from our loved ones. These places also serve as outlets and allow people to distress. Parents throughout the country have stepped into the role of being educators in addition to working from home while still having to parent; it can be stressful trying to balance three hats at once. As far as intimate relationships, an extended amount of time with your partner can reveal some pretty annoying and disturbing traits you may have overlooked before. According to some researchers, there may be a spike in divorce rates once the pandemic has ended. However, for some families, the quarantine is creating stronger relationships while bringing people closer together which brings me to my final point…
5. This time can help us develop and attitude of gratitude.
Many of my clients share how grateful they are for their health, being able to work from home, and the increased support from friends and family. In general, the pandemic has created a great sense of appreciation for frontline workers such as doctors, nurses, techs, grocery store clerks, restaurant employees, pharmacies, mail and delivery services and many more. These are the people that are keeping society above float as well as risking their health and even their lives so we can have the essentials that we need. Although these individuals are the few that still go out to work every day, this time is just as hard for them as it is for anyone else; remember we’re all in this together. Not having access to some of the non-essential products and services that we took for granted prior to the pandemic has also created a new sense of appreciation. Although it is good to maintain a positive mindset throughout this time, remember to be self-forgiving if you feel frustrated, angry, or sad. This is a difficult experience for everyone.
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Posted By Suzanne Taluy LCSW, CCTP, Embrace Psychotherapy, LLC,
Tuesday, March 31, 2020
Updated: Friday, April 24, 2020
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Anxious thinking is based on assuming the worst outcome; most often these thoughts starts off with two words “what if…”, and what comes after is our own interpretations. Mankind has never been comfortable with the unknown, not having all of the facts and not being able to fully understand what we don’t know is perceived as a threat. Someone once said “What we don’t understand, we fear. What we fear, we judge as evil. What we judge as evil, we attempt to control. And what we cannot control we attack.” In this case the attack is on ourselves; it comes in the form of anxiety and panic attacks. We lose control of our response to what we don't know because we allow ourselves to get caught up in our anxious “what if” thinking.
Humans are blessed with intelligence which allows us to be creative and imaginative. This blessing can also be a curse. When people don’t know all of the facts, they often use their imaginations to conclude what will happen. With anxiety, people imagine the worst possible outcome; these scenarios are vivid and very detailed. Almost like a dream that feels real. Unconsciously and quickly or imagination becomes our reality; this “reality” poses a threat. Our sympathetic nervous system (SNS) aka “the reacting brain” is responsible for the threat response. Often times anxiety is based on misinterpretations, missing information, and assumptions. These threats mobilize our bodies to react but because the threats aren't real we don't quite know what to do with the anxiety; leaving us to sit with our reaction without any outlet.
We must consider that if our anxiety is based on assumption; we not only assume and expect the worst from the situation but we assume and expect the worst from ourselves. In the worst case scenario we create, we imagine that we are not capable of taking on the challenge; this is self-doubt. We devote much of our time to negative self-criticism and self-doubt that it hardly occurs to us that we actually have the capacity to handle many of the situations we fear. This kind of thinking can be paralyzing causing people to avoid “the unknown”. When you break it down it seems silly, but an estimated 40 million Americans who suffer with anxiety engage in this kind of thinking on a daily basis.
Anxious thinking causes individuals to live their lives in fear. Avoidance is a common defense mechanism for most people but the reason it doesn’t work is because change is constant and almost guaranteed. Anxiety is a survival response meant to motivate people so they can plan for these changes. When faced with sudden changes or challenges, a person who avoids will feel too overwhelmed to adequately deal with it.
Exposure therapy is an effective way to help individuals prepare and plan for changes, allowing people to better control the SNS response. Gaining insight into negative thinking patterns is also an effective way to reduce anxiety. This can be achieved through mindfulness techniques and self-awareness exercises. Many thoughts run through our minds unchecked and unchallenged. What we think is based on our belief system which is so embedded into our identity that it’s hard for us to consider other perspectives. There are many different ways of looking at a problem, and most of the time we are only looking at it from one angle. The first step to increasing self-awareness is to start paying attention to negative and unhelpful thoughts, and challenge them by looking at the facts vs. assumptions.
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Posted By Suzanne Taluy LCSW, CCTP, Embrace Psychotherapy, LLC,
Saturday, February 29, 2020
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Ever heard the saying “you are what you eat”? Well it's true. If you eat crap, 9 times out of 10 you will feel like crap. If you eat natural whole foods then you most likely will feel good. This is common sense and easy to access knowledge. We have seen it time and time again; headlines about fast food leading to obesity and bad health. News articles and documentaries warning about the dangers of carbonated soft drinks, processed foods, and sugars. Another recent article reported an adolescent boy who lost his eyesight as a result of a diet of mostly potato chips and French fries.
So how does this fit into mental health? Whatever we eat breaks down in our stomach and the nutrients then enter into our bloodstreams; blood flows into all our vital organs including the brain. Foods that are processed, full of preservatives, man-made sugars, and unhealthy fats are not only bad for your physical health but affect your mental health. Natural whole foods are rich in vitamins, minerals, and oxygen. Oxygen is a vital part of our survival; when the brain is not receiving enough oxygen, it can result in brain damage. Oxygen-rich blood helps your immune system function properly in order to fight off viruses and infections and provides you with the energy needed to function throughout the day. It's no secret that fatigue contributes to depression, and foods high in sugar can aggravate symptoms of anxiety. In the last twenty years, the relationship between diet, stress, and mood has been well documented… certain foods tend to create additional stress and anxiety. Certain natural substances have a direct calming effect, and others are known to have an antidepressant effect (Edmund J. Bourne, Ph.D., 2015).
The Problem.
Stress and bad eating habits go hand in hand. Just to be fair, it’s extremely difficult to maintain a well-balanced, nutritious diet when your life feels like chaos. Stress commonly contributes to overeating and/or loss of appetite. Perhaps, your schedule doesn’t allow you to incorporate healthy eating habits into your routine. I have heard this many times from my clients, and the solution is simple… you make time for what you want. Instead of drinking that extra cup of coffee, pop a multivitamin in the morning, or have a nice natural fruit smoothie. Keep some healthy snacks in your car, in your bag, or your desk if you are constantly on the go. There are solutions... if providers are promoting mental health then it’s imperative that we promote nutrition and healthy eating habits.
As a society, we look for convenience which causes us to take short cuts in how we self-care. I understand the complexities of mental illness, and in many situations, people need more than just a good diet to resolve their symptoms. However, better eating habits and more natural remedies can make a world of difference. Stress is a powerful hormone that has a significant impact on your body; it is widely known that during times of stress your body tends to rapidly deplete stores of B vitamins and C vitamins (Edmund J. Bourne, Ph.D., 2015). Vitamin B and C are part of the essential nutrients needed to maintain your nervous system which directly impacts anxiety. There is a list of vitamins, herbs, minerals that help with depression and anxiety; Omega 3 fatty acids are commonly used as an antidepressant and many herbs such as Kava, Valerian, and Saint Johns wort have calming and relaxing effects.
What can wellness professionals do?
If we are to achieve Wellness, it should be looked at from a whole-body perspective. Wellness professionals can help by incorporating self-care into the client’s treatment plan. The first phase of treatment is when the client’s self-care habits can be assessed. Self-care surveys are becoming popular assessment tools used to evaluate eating habits, sleep hygiene, exercise, substance, and stimulant use. These assessment tools can give both the client and provider insight into unhealthy habits affecting the client’s mental health. Providers can promote the importance of a well-balanced nutritious diet throughout treatment, and encourage clients to seek tests from their PCPs that can measure vitamin deficiencies. A balanced diet and nutrition regime can improve the client’s ability to achieve balance in their personal lives, and in turn, give them a sense of control and well-being.
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Posted By Suzanne Taluy LCSW, CCTP, Embrace Psychotherapy, LLC,
Wednesday, February 26, 2020
Updated: Wednesday, February 26, 2020
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Knowledge concerning trauma-informed care has increased substantially over the past decade or so. While this increased awareness has helped us understand the importance of trauma treatment, certain demographics and populations still go untreated for PTSD and other trauma-related disorders. People of color are less likely to be treated and have arguably been impacted by trauma more than any other race; from the Atlantic slave trade to public lynchings, to racial tensions that sparked the "black lives matter" movement, and beyond. Trauma in the African American community has been prevalent for generations. "Intergenerational trauma" is a term used to describe how events that target a group of people affect family members who have not directly experienced trauma. In addition, the stigma of mental illness has kept African Americans at a disadvantage when it comes to identifying mental illness and seeking treatment.
Intergenerational trauma and its impact on the African American community has helped shape stereotypes and commonly held beliefs African Americans have about themselves. According to the National Alliance on Mental Illness, African Americans are 13% less likely to seek mental health treatment compared to the national average, one reason is that seeking help is considered a "weakness"; the trauma that has been the experience of African Americans through generations of broken families, abuse, and disregard for human rights has been dealt with in silence and ultimately has become a norm. Trauma caused by centuries of oppression and discrimination has robbed people of color of their right to live successful lives for generations, and it has been a struggle for many to break the cycle.
How can we change this?
Treating people of color requires a culturally sensitive and socially aware therapist. Mental health professionals interested in treating trauma should be aware of the barriers to bringing mental health awareness to people of color such as mistaken beliefs about treatment, the stigma of having a mental illness, and distrust. Mental health treatment should be made more accessible in African American communities, and it should be normalized and discussed more frequently. Finally, Intergenerational trauma should be included when teaching black history in order to increase understanding and awareness of how and why the African American community has been impacted.
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