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Mental Health

Top Five Barriers to Mental Health Treatment

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Today, one in five people in the United States experience a mental health condition which is equivalent to approximately 40 million Americans, but only 41% of adults with a mental health condition actually receive treatment. For Mental Health Awareness Month, King’s University and Social Work Helper are working together to help raise awareness on mental health barriers and challenges many individuals face when contemplating mental health treatment.

When increased concerns about a mental health condition arise, friends, family and/or Google are often the first to be consulted. Varying responses from getting counseling to hospitalization may be suggested as the potential solution, but what roadblocks may be encountered before an intervention can be decided? There are many things to consider on the journey to mental wellness, but there are also several pitfalls to look out for.

1. Stigma

The unfortunate truth is that most people are terrified of being discriminated against in their employment or unjustly targeted by the police because of their mental health status. According to current data, individuals with a mental health condition are more likely to encounter law enforcement than receive professional treatment. Too often, the public’s education on mental illness is learned from misrepresented portrayals of mentally ill individuals as violent criminals by the media.

2. Refusal

Adult patients have the right to refuse treatment. This may become a major barrier and challenge for parents with adult children who need treatment. Current laws require an individual to be a danger to themselves or third party in order to qualify for an involuntary committal. Typically, commitment of a mental ill individual is avoided unless a determination has been made declaring them to be dangerous. Unfortunately, loved ones of an individual struggling with mental illness who have refused treatment have very limited options available to them.

3. Financial

The rising cost of prescription drugs, high co-pays and deductibles in addition to limited and uncovered mental health services may be the deciding factor in whether someone seeks treatment. According to a 2011 study in the journal Health Affairs, the United States spent 113 billion dollars on mental health treatment which was only 5.6% of national physical health-care related spending. Most importantly, the majority of those dollars went to prescription drug costs as the primary treatment for the mental health condition. Even though the Affordable Care Act has pushed the uninsured rate to an all time low, approximately 27.3 million Americans still are without insurance. Also, in surveys measuring the effectiveness of the ACA, responses suggest high deductibles and out of pocket costs still remain the biggest barrier preventing individuals from seeking mental health treatment.

4. Intervention

Some people may give up on pursuing treatment because they don’t believe therapy is working for them. Could it be possible the right type of therapy was not introduced to improve their mental health needs? It could happen. There may be several therapists and/or several medications tried before finding the right combination to yield the best results. When it comes to mental health treatment, there is no one size fits all treatment, and any wellness plan must be tailored to fit the needs of the individual seeking treatment in order to help them achieve the best outcomes. Before choosing a counselor or therapist, there are many factors to consider before making a decision such as their cultural background, spiritual philosophy, and competencies in order to increase the odds of a better fit.

5. Access

Even if the four previous mentioned barriers could be prevented, individuals experiencing a mental health crisis may be wait listed before they can get access to a mental health provider. According to U.S. Health Resources & Services Administration, 60% of Americans live in a mental health provider shortage area because the mental healthcare system does not have enough providers to meet current demand. There are approximately 1,000 patients for every 1 provider, and the US needs to add approximately 10,000 providers by 2025 in order to make pace with the growing demand for services.

Licensed counselors, clinical social workers, psychologists, and psychiatrists are desperately needed to begin closing the treatment area shortage gap. According to the American Psychological Association (APA), “The APA Education Government Relations Office (GRO) continues to seek increased federal support for psychology education and training, particularly for psychologists who work with underserved populations” which includes a loan repayment option for early career psychologists. For more information on earning a psychology degree, visit King’s University Bachelor’s of Psychology Program.

Deona Hooper, MSW is the Founder and Editor-in-Chief of Social Work Helper, and she has experience in nonprofit communications, tech development and social media consulting. Deona has a Masters in Social Work with a concentration in Management and Community Practice as well as a Certificate in Nonprofit Management both from the University of North Carolina at Chapel Hill.

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Mental Health

APA Offers Resources for Coping with Mass Shootings, Understanding Gun Violence

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Constant news reports about the shooting in Las Vegas can cause stress and anxiety for people, leaving them with questions about the causes of and solutions to gun violence. Resources on the American Psychological Association’s website can help people with both issues.

One APA resource offers tips for managing feelings of distress in the aftermath of a shooting. “You may be struggling to understand how a shooting could occur and why such a terrible thing would happen. There may never be satisfactory answers to these questions,” it says. “Meanwhile, you may wonder how to go on living your daily life. You can strengthen your resilience – the ability to adapt well in the face of adversity – in the days and weeks ahead.”

Talking to children about the shooting isn’t easy but parents or teachers shouldn’t completely shield them from violence or tragedies. APA offers a series of tips to parents and other caregivers on how to guide the conversation in a proactive and supportive way. “The conversation may not seem easy, but taking a proactive stance, discussing difficult events in age-appropriate language can help a child feel safer and more secure,” according to the resource available in the APA Help Center.

Parents should also watch for signs of stress, fear or anxiety.

For those who feel too overwhelmed to use the tips provided, APA suggests consulting a psychologist or other mental health professional.

“Turning to someone for guidance may help you strengthen your resilience and persevere through difficult times,” it says.

There is no single personality profile that can reliably predict who will use a gun in a violent act, according to a report issued by the APA in December 2013 entitled Gun Violence: Prediction, Prevention, and Policy. There is, however, psychological research that has helped develop evidence-based programs that can prevent violence through primary and secondary interventions.

Written by a task force composed of psychologists and other researchers, the report synthesized the available science on the complex underpinnings of gun violence, from gender and culture to gun policies and prevention strategies.

“The skills and knowledge of psychologists are needed to develop and evaluate programs and settings in schools, workplaces, prisons, neighborhoods, clinics, and other relevant contexts that aim to change gendered expectations for males that emphasize self-sufficiency, toughness and violence, including gun violence,” according to the report.

Gun violence is estimated to cost hundreds of billions of dollars a year in medical, legal and other expenses, not to mention the psychological toll. That is why the government needs to approach it as a public health problem, according to APA acting Executive Director for Public Interest Clinton Anderson, PhD, writing in a blog post entitled No Silver Bullet: Why We Need Research on Gun Violence Prevention.

“Some have argued that we need to focus on policies that prosecute criminals and prevent those individuals who have been found to be a danger to themselves or others from obtaining a firearm,” wrote Anderson. “While these policies have merit, they are clearly not fully effective, and do not address the roots of violence in our society.”

No one policy will prevent gun violence, writes Anderson. “It will take a multi-faceted approach. Funding research that explores these horrific, impulsive acts can help us all inform and adapt our policy approach.”

In another blog post, clinical psychologist Joel Dvoskin, PhD, warned against unfairly stigmatizing the mentally ill by immediately jumping to the conclusion that most shooters have a mental illness.

“Too often, even the most well-intentioned among us believe that most mass shootings are carried out by those with untreated mental illness,” he wrote. “What the perpetrators seem to have in common is the experience of extreme situational crisis.”

Additional resources:

Talking to Kids When They Need Help

7 Ways to Talk to Children and Youth about the Shootings in Orlando

Helping Children Manage Distress in the Aftermath of a Shooting

How Much News Coverage is OK for Children?

Gun Violence Prevention

APA Initiatives to Prevent Gun Violence

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Emergency Management

Rescue to Recovery Stages in a Red Cross Disaster Deployment

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Roy was my partner for most of our deployment with Red Cross on the Disaster Mental Health Team in Texas. We spent many hours on the road mostly on our own, with the exception of “ride to the office” or “back to the shelter” caravans, which could be quite crowded as there were few available cars to ferry us all from the staff shelter to Headquarters for the day.

Conversations stayed rooted mostly in the present, even with kids occasionally Face-timing us in the car when a signal would pop up. I know that he’s been a social worker since 1970 and that he has been married nearly as long. Getting to know each other on a disaster mental health deployment is a different way of knowing someone, but knowing them well regardless. Similar relationships are built with the people you sleep a couple of feet from in the staff shelter.

Roy: “Wasn’t there a band people used to like called the Dead Heads? People liked them but I think they’re dead.”

Roy, In response to a question about breakfast: “Right I’ll give you another rotten orange in the morning.

Kristie: “No thank you; that coffee was sufficient.”

Roy, just go ahead and get in the wrong lane again for this right turn.” (Texas “turnarounds” can be a nightmare).

There was the normalcy of the city center recovering, demonstrated through open shops and Home Depot’s parking lot was nearly at capacity. Starbucks opened, there was a carafe in HQ for one of the lucky teams.

Vulnerability and exploitation were visible not far from the city center. Compounding issues plague those who struggled prior to the disaster. Living paycheck to paycheck when there is suddenly no paycheck creates a domino effect of financial disaster. You can only call the companies to beg for mercy if your phone works, if there are enough bars available to connect you. The smell is rising in neighborhoods, and the question, “What is that smell?” was more frequent today. Mold grows rapidly, and you can smell it from the street.  Weeks have passed since the initial disaster, but it is just beginning to unfold for many people do not have flood insurance.

I ended up making a call to the Attorney General’s office regarding landlords who are refusing to remediate damage and demanding rent from those who cannot pay (or live in their home), with the threat of their things being sent to the dumpster. The police were empathetic but said that it’s a civil issue and in a disaster needs to go to the AGs office. So the wet carpet stays with children living inside, and they lack healthy food- maintaining on what looks like a vending machine diet.

There are contractor company scams that further exploit the exploited, and many workers are being brought in from surrounding areas without protective gear (notable lack of face masks) and clearly without reasonable hours or meal contracts.

On the other end of helplessness and anger, I felt in awe of all of the volunteers and what they do. They respond at the crack of dawn to Headquarters to work with a team using colored post it’s on the wall to map progress and hot spots for the day. Knowing that it’s likely that at the end of the day, they will have gotten sidetracked from the need that was directly in front of them, feeling regret for not making it back to the places they know are in desperate need but are now blocked by factors beyond their control.

Headquarters experienced an evacuation- someone screamed, “Get out! Get out of the building!” It turned out to be some off-gassing cones, but everyone went right back to work outside while standing outside the building waiting for clearance entirely unfazed.

Volunteers will talk it out with each other back at the shelter late at night, eating cold leftovers from the ERV (feeding) vehicles. Informal meetings run from their cots which will make a difference the next day in how resources are allocated because drivers are sleeping next to mental health, nurses, and those doing communications assessments. If you end up both eating and securing a space in line at the shower trailer behind the civic center before it’s too late, it’s something of a miracle. With a lot of contamination and illness going around, it’s best to just throw away the shoes on your way out.

As for the people we served, we realized the depth of desperation that is held for those in areas without good water. Your clothes were washed away or were contaminated, and even if you could wash them, you can’t because your washer and dryer is flooded (one family had some kind of snakes in theirs) as is the laundry mat down the road.

We brought restaurant workers wearing their last items of clothing and shoes serving people in the only community restaurant to open back up in Port Arthur in a certain radius, knowing that those clothes too, would soon be dirty. So what then? How long will this all take? While you may see signs of recovery in the city center, it’s clear that this is going to take so much longer for others, and the rural areas are barely touched by “helpers”.

The depth of this disaster isn’t something that we are used to covering, Katrina taught us a few things that are applicable, but each disaster is its own, and this scale is unimaginable. Puerto Rico is now unfolding as we watch on our screens, in some sort of mass denial of scale.

Most of us can sit comfortably behind our devices and all caps “GET TRUCK DRIVERS!” and while I can personally imagine the barriers that they have in distribution as we just experienced them in Harvey, you just can’t know unless you’re there and are using all of your five senses.

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Employment

Abusive Bosses Experience Short-Lived Benefits

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Being a jerk to your employees may actually improve your well-being, but only for a short while, suggests new research on abusive bosses co-authored by a Michigan State University business scholar.

Bullying and belittling employees starts to take its toll on a supervisor’s mental state after about a week, according to the study, which is published in the Academy of Management Journal.

“The moral of the story is that although abuse may be helpful and even mentally restorative for supervisors in the short-term, over the long haul it will come back to haunt them,” said Russell Johnson, MSU associate professor of management and an expert on workplace psychology.

While numerous studies have documented the negative effects of abusive supervision, some bosses nevertheless still act like jerks, meaning there must be some sort of benefit or reinforcement for them, Johnson said.

Indeed, the researchers found that supervisors who were abusive felt a sense of recovery because their boorish behavior helped replenish their mental energy and resources. Johnson said it requires mental effort to suppress abusive behavior – which can lead to mental fatigue – but supervisors who act on that impulse “save” the mental energy that would otherwise have been depleted by refraining from abuse.

Johnson and colleagues conducted multiple field and experiments on abusive bosses in the United States and China, verifying the results were not culture-specific. They collected daily survey data over a four-week period and studied workers and supervisors in a variety of industries including manufacturing, service and education.

The benefits of abusive supervision appeared to be short-lived, lasting a week or less. After that, abusive supervisors started to experience decreased trust, support and productivity from employees – and these are critical resources for the bosses’ recovery and engagement.

According to the study, although workers may not immediately confront their bosses following abusive behavior, over time they react in negative ways, such as engaging in counterproductive and aggressive behaviors and even quitting.

To prevent abusive behavior, the researchers suggest supervisors take well-timed breaks, reduce their workloads and communicate more with their employees. Communicating with workers may help supervisors by releasing negative emotions through sharing, receiving social support and gaining relational energy from their coworkers.

Co-authors are Xin Qin from Sun Yat-sen University, Mingpeng Huang from the University of International Business and Economics, Qiongjing Hu from Peking University and Dong Ju from Communication University of China.

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