Being “green” has become the newest fad, which few could argue is a bad thing. The part that many aren’t aware of, even the greenest environmentalists, is that the benefits of the green movement aren’t only about clean air, water and soil. Availability of and access to plentiful green space is also strongly linked to increased mental health. As prevention and wellness programming becomes more prominent in the provision of mental health services, it’s important to conserve and increase the availability of and access to green space, as well as incorporate the use of it into mental health programming.
Time spent in nature, whether it’s camping in a forest, hiking in the mountains, or sitting in an urban park makes people feel happy, peaceful, rejuvenated, connected to something bigger than oneself. Green space is directly linked to decreased stress, decreased aggression, improved concentration, spiritual connectedness, and enhanced physical health. The reasons for this can be at least partially explained by the Attention Restoration Theory (ART), which asserts that directed attention plays an important role in information processing.
Fatigue leads to negative consequences such as stress which is its resulting effects. Urban environments require significant directed attention due to larger amounts of stimulus, whereas natural settings have been found to be highly restorative to this process, reducing directed attention fatigue and stress levels. There are also many social benefits including reduced crime and road rage, economic stimulation, and increased social networks. All of these are factors that contribute to our mental well-being.
With more and more people living in urban environments and the availability of green space decreasing worldwide, it is becoming increasingly difficult to access the nature that provides these benefits. Those who live in more rural areas-where forests, meadows, rivers, and lakes are right outside their front door or minutes away, don’t have to put extra effort into accessing such green space because they’re enveloped by it. For those living in urban environments, not only do they not have immediate access to such green space, but they must also put in considerably more effort to reach comparable natural areas.
Once these areas are reached, the green space is frequently packed with other urban dwellers seeking similar benefits, disturbing the serenity nature it is supposed to provide. Of course, there’s green space closer to home in the form of urban parks. Some of which are fairly amazing as far as parks go, but there can be challenges to overcome in accessing those as well. There often aren’t enough quality parks so they too can become packed with visitors, not allowing for the same restorative experience one would have in the more rural natural settings. This is particularly problematic for those living in low-income areas who are already at higher risk for poorer mental and physical health because overall there are fewer parks in such areas, they aren’t as well maintained, and some aren’t entirely safe to be in.
While many of us are at least partially aware of the benefits we receive from nature, less accessible green space is a reality for many. The importance of conserving our natural surroundings and creating more where they don’t exist is out of our realm of consciousness. It’s easy to get caught up in day-to-day routines and neglect the big picture not fully noticing what we’re feeling and how we’re living. With rapid advances in technology and people not interacting with nature on a regular basis, we often forget our intimate connection to it. Even when we’re aware that something needs to be done, it’s difficult to know what to do and taking action on any issue can sometimes feel so overwhelming that we don’t do anything.
The World Health Organization (WHO) estimates that approximately 1 in 4 people worldwide have or will develop a mental illness in their lifetime and that the global cost of mental illness was 2.5 trillion dollars in 2010 with a projected increase to 6 trillion dollars by 2030. In addition to those with a diagnosable mental illness, the National Health Interview Survey found that 75% of the population experiences some stress every two weeks and approximately half of those individuals experience moderate to high levels of stress during those same two-weeks. Stress is linked directly to depression and anxiety as well as most, if not all physical diseases; therefore, decreasing stress levels would increase overall well-being. It would also reduce our society’s economic burden, which we know for the policy makers is often a higher priority than their constituents’ health.
Aside from the cost benefits of utilizing green space as a preventative measure for mental health treatment, there are also numerous other economic benefits that could also positively affect mental well-being. Increased physical health would further reduce the cost of health care services. Housing prices are higher in areas with easy access to parks and other outdoor areas as was demonstrated by Boston’s Big Dig project. Boston significantly increased its green space over a 15 year span and as a result the value of those properties located in close proximity to the green space increased. Green space also attracts economic development which in turn creates employment opportunities. Proximity to green space is also linked to worker satisfaction which increases productivity. Reducing the economic burden could also reduce stress as stated previously would improve mental health.
With all these obvious benefits, it’s time for us as individuals and the collective to take action and really become “green.” Who wouldn’t want increased mental and physical health and more money in their pockets? Who wouldn’t want to leave a healthier environment and society all the way around for generations to come? It is our responsibility as citizens to educate ourselves and once we’ve done that, educate those around us. Talk to family, friends, and neighbors about the benefits of availability of and access to green space. Communicate with professional organizations and policy makers so that even if they’re educated on the issue they realize that it’s important to others. Lobby, advocate, storm Capital Hill if necessary. Most importantly utilize and encourage the utilization of green spaces to physically demonstrate the value of such spaces. It sounds so simple, yet it’s often the simplest acts that make the biggest difference.
Parental Medicaid Expansion Translates into Preventive Care for their Children
When low-income parents enroll in Medicaid through the Affordable Care Act (ACA) state expansion program, their children have considerably better odds of receiving annual preventive care pediatrician visits, according to a new analysis by the University of Pittsburgh Graduate School of Public Health and Johns Hopkins University.
This “spillover effect,” explained in a study published online today and scheduled for the December issue of the journal Pediatrics, demonstrates that the potential benefits of Medicaid expansion extend beyond the newly covered adults.
“These findings are of great significance given the current uncertainty surrounding the future of the ACA and Medicaid expansions authorized by the law,” said senior author Eric T. Roberts, Ph.D., assistant professor in Pitt Public Health’s Department of Health Policy and Management. “Lawmakers crafting policy proposals that could curtail Medicaid benefits or eligibility should recognize that such efforts would not just limit the receipt of health care services by low-income adults, but also by their children.”
The ACA provided states the opportunity to expand Medicaid coverage to all low-income people at or below 138 percent of the federal poverty level. So far, 31 states and the District of Columbia have expanded Medicaid coverage.
Roberts and his colleagues identified 50,622 parent-child pairs from data collected in the 2001 through 2013 Medical Expenditure Panel Surveys, a nationally representative survey administered by the U.S. Department of Health & Human Services that includes detailed information on family structure and demographics, including health insurance status and health care use.
They discovered that children of parents who had recently enrolled in Medicaid had a 29 percent higher probability than children of unenrolled parents of receiving their well child visit, which is recommended annually for children age 3 and older, and more frequently for infants and toddlers.
During the visits, the children are examined for growth and development and given immunizations, and their caregivers are guided on proper nutrition and child behaviors. Studies have shown that children who get well child visits are more likely to receive all their immunizations and less likely to have avoidable hospitalizations. The U.S. has persistently low rates of well child visits, particularly in low-income families.
“There are many reasons that parental Medicaid coverage increases the likelihood of well child visits for their children,” said Roberts. “It could be that insurance enhances the parents’ ability to navigate the health care system for themselves and their children, increasing their comfort in scheduling well child visits. Medicaid enrollment could be a sort of ‘welcome mat,’ in which eligible but previously uninsured children are enrolled after their parents gain coverage. It also could be that parental Medicaid coverage frees up more money to provide preventive services to their children, because even copays can be a deterrent to medical care among low-income people.”
Maya Venkataramani, M.D., is lead author on this research, and Craig Evan Pollack, M.D., M.H.S., is a coauthor. Both are from the Johns Hopkins University School of Medicine.
How to Develop an Individual Grief Plan
My Mother always said that my Daddy was “a fool born on April fools”. This was the running joke all of my life. April 1 came along this year and it was not a joking matter. I was heartbroken and devastated that I could not hear my father’s voice or see his smiling face on his birthday.
Earl, My Pearl, was diagnosed with pancreatic cancer June 20, 2016, after suffering several months of abdominal pain, significant weight loss and limited mobility. He passed away peacefully on September 9, 2016, 4:30 am. This process was very difficult for all of us to watch, yet, we were there every step of the way and handled it a gracefully as possible.
I worked as a hospice social worker for several years prior to my father’s diagnosis. Our journey was still difficult but I was familiar with the language and processes pertaining to the end of life which afforded me the opportunity to assist my mother in talking with our team of doctors and making decisions. She found comfort and security in that and this made me proud. I saw this as an attempt to make this living nightmare a little less scary and slightly bearable.
My hospice experience also somewhat prepared me for being around death. I spent time with my Daddy after he passed away and I combed his hair prior to his wake with an unusual calm. These were tender moments that I will forever cherish.
I faced a dilemma as my Daddy’s birthday approached. My 8th wedding anniversary was a few days prior to Daddy’s birthday. My husband wanted us to go away to celebrate the weekend of April 1st. My plan had been to spend the morning at the cemetery with my mother.
After discussing it with my spouse and my mother (my voices of reason) I came to the conclusion that my father would not want me weeping at his grave on his birthday. He would prefer me to go away, live life and celebrate with my husband whom he was very proud of and admired. So, we continued with our anniversary plans although I did not know what April 1st was going to be like.
I was committed to getting through my Daddy’s first birthday in Heaven without ruining this special weekend that my husband had so thoughtfully planned. So, I allotted uninterrupted time and space for my grief and I planned activities to pull me out of those dark places that have the ability to consume us if allowed. I planned for my grief. Sound weird; keep reading. I hope my experience assists you in your process.
On the morning of April 1st, I woke up, attempted to post a memorial birthday wish to My Pearl on my Facebook page and the tears began. I went into the bathroom and cried hard for at least an hour if not more. I wasn’t simply misty eyed or a little teary; this was the ugly cry that people try not to do in public.
My husband tried to console me but I asked him to allow me to handle this on my own. I allowed the tears and emotions to flow without beating myself up for crying like a 37-year-old baby. I did not attempt to suppress my feelings which is typically our natural response. I went through the sadness of being Daddy’s little girl without her Daddy. I experienced the “maybe I could have done more” routine that we wallow in sometimes. I felt the guilt of not choosing to be graveside on his 75th birthday.
I felt horrible for abandoning my mother in her grief even though I knew she wanted me to continue with my celebration. It went on and on and I allowed it until it ran its course naturally. Once I was completely done, I sat in silence for a while then cleaned myself up. I felt weak, somewhat limp yet refreshed. My husband and I went to a lovely breakfast at our hotel; we changed our clothes and went to the gym together.
After that, I took a long hot shower, allowed myself to air dry across the crisp white comforter on our king size fluffy bed. I then turned on some relaxing beautiful music. I did not sleep, I simply allowed myself to be in total and complete relaxation for the remainder of the afternoon. Our friends met us for cocktails and a show and it turned out to be an amazing and wonderful trip overall. I planned for my grief, I executed and came through my Daddy’s first birthday relatively unscathed and empowered.
Make an appointment to grieve.
When we go to the doctor, we have an appointment. You have called ahead, maybe weeks in advance, to make the appointment. You have your appointment time, you see the doctor to discuss your health, meds, etc within your allotted amount of time (usually not over an hour) you say your goodbyes and you leave. Think of your grief in that way.
I set my grief appointment for first thing in the morning because we were on vacation. We had nothing pressing planned that morning and we had guests meeting us in the evening. Whatever your day is going to look like, carve out space and time to be alone with your grief and make it happen.
This is important because if you allow the grief to have its way, it will show up throughout the day and consume you for the better part of that day and possibly beyond. Take control of your grief by making an appointment, letting it present as it may, then, as you do with other appointments, say your goodbyes and leave it.
Don’t take “walk-ins”.
It is very difficult to walk into your doctor’s office and see them without an appointment. Apply this to your grief. Say you had your appointment, you successfully followed all of the steps and are moving on with your day. If grief shows up outside of its appointment time, turn it away: “Look grief, your appointment was 8 am. We saw you and dealt with you then. I will see you at your next scheduled appointment.” Acknowledge your grief but do not allow it to consume you outside of your appointment. Commit to having power and control over the grief.
Plan to grieve alone.
Our family members and close friends mean well in trying to assist us in our grief, especially around holidays and special events that we would normally share with our deceased loved one. Unintentionally, they can often be a hindrance, sometimes a crutch in our process. Additionally, we may subconsciously modify our grief in order to accommodate them and their level of comfort.
This appointment is not the time for such modifications. Maybe we will cry but suck it up and move forward prematurely because they might feel like we have cried long enough. Or maybe they, meaning well, will say the cliché things that people say when one is grieving in an effort to help ease the pain and stop the flow of tears: “it will be ok” or “time heals all wounds” and my all-time favorite “he’s in a better place”. We know that those things are true.
However, do we want to hear those things in our time of grief? NO!!! We are thinking “it won’t be ok because I can’t live without him”, “nothing will heal these wounds” and “the best place is here with me”. None of those clichés are needed or welcomed for that matter, at this point in the process. Again, you have to allow space and time for this process without guidance from well-meaning family members and friends. It has to run its own natural course. Friends and family have a more appropriate role in the next steps of this process.
Plan activities that you enjoy.
I knew that if I had grieved and simply remained still, I would have wallowed in a sad, hurtful place all day. Therefore, I moved on to an enjoyable breakfast then a workout with my husband to take my mind to better places. It’s not that you’re getting busy to suppress your feelings. Because of your grief appointment, you have dealt with your feelings and emotions head on and very appropriately.
You’re merely creating a beautiful welcomed distraction in order to move on with your day. After the grief appointment, it is imperative to get up and get busy living. This has to be planned for and executed. At this point, your family and social support system could play a huge, meaningful role without hindering your process. Remember, do not take walk-ins!
Take some time for relaxation and self-care.
My self-care was a long hot shower followed by resting to nice music. Your self-care may look like a spa day, a long jog through your favorite park, a scenic hike, cooking an elaborate meal or a shopping trip. Whatever makes you feel well, do it! Think of this as a special gift from your loved one on this special day; it’s your reward for bravely facing your grief and taking control of your grief process. I firmly believe that the ones that we loved and lost enjoy seeing us live happy and well despite their absence.
My father was here for all of my major life events: all of my graduations and performances, he moved me into my first apartment, he walked me down the aisle at my wedding, he was there during my pregnancy and formed a sweet relationship with my daughter…with all of that being said, how can I wallow in sadness? I am so grateful for having a father that was present until he passed away.
Others have not been as fortunate and I acknowledge that. For that reason, I choose on his birthday, holidays and any day of the week to be grateful for him and his life rather than focus on his absence. I am also grateful that he did not suffer long after his diagnosis.
As a hospice social worker, I saw patients and families suffer months and months; having their hopes of recovery dashed with the horrible news that their cancer had spread and there were no further options. This was not our case. We had our ups and downs but God was merciful and ended my father’s battle 3 months after he was diagnosed. For that I am grateful. My gratitude list could go on and on. My point is that in our sadness and on those birthdays and holidays, we have to immerse ourselves in gratitude in order to make it through.
The preceding technique is not the catch all or fix all for your grief issues around holidays and special occasions. This is merely a formula that worked for me and I was compelled to share it with the hopes of helping others. If you are experiencing complicated, ongoing grief issues, please, seek help from a mental health professional.
Individual sessions, grief support groups, and other therapeutic interventions to deal with grief may be necessary depending on your individual needs. Remember, death is inevitable for all of us. However, being proactive in our grief process and planning for the same may assist and make facing holidays without your loved one bearable and beautiful. It happened for me; that’s my hope for you!
Social Workers Can Now Learn Medicare Online and Earn Continuing Education Hours
Social workers can now earn continuing education hours while they learn Medicare at their own pace, anytime and anywhere with Medicare Interactive (MI) Pro, an online Medicare curriculum powered by the Medicare Rights Center.
MI Pro provides the information that social workers and health professionals need to become “Medicare smart,” so they can help their clients navigate the Medicare maze. The online curriculum contains information on the rules and regulations regarding Medicare—from Medicare coverage options and coordination of benefits to the appeals process and assistance programs for clients with low incomes.
“For over 25 years, social workers have been turning to Medicare Rights’ helpline counselors for clear and concise information on how to help their clients access the affordable health care that they need,” said Joe Baker, president of the Medicare Rights Center. “Now social workers can enroll in MI Pro and learn—or enhance—their Medicare knowledge at their convenience while fulfilling their continuing education requirements.”
The Medicare Rights Center, a national nonprofit consumer service organization, is the largest and most reliable independent source of Medicare information and assistance in the United States.
Licensed Master Social Workers and Licensed Clinical Social Workers can earn continuing education hours when they successfully complete any of the four MI Pro programs: Medicare Basics; Medicare Coverage Rules; Medicare Appeals and Penalties; and Medicare, Other Insurance, and Assistance Programs. Each MI Pro program is comprised of four to five course modules.
All MI Pro programs are active for one year following registration.
MI Pro courses are nominally priced. Additionally, social workers who purchase all four programs at once will receive an automatic 20 percent discount.
Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives.
Available only through the Medicare Rights Center, Medicare Interactive (MI) is a free and independent online reference tool that provides easy-to-understand answers to questions posed by people with Medicare, their families and caregivers, and the professionals serving them. Find your Medicare answers at www.medicareinteractive.org.
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