WASHINGTON, D.C. – The National Association of Social Workers (NASW) applauds Sen. Debbie Stabenow (D-MI) and Sen. John Barrasso (R-WY) for introducing the bipartisan Improving Access to Mental Health Act (S.2613), legislation that would increase public access to the vital mental health services that clinical social workers provide and offer clinical social workers more adequate Medicare reimbursement rates.
Their Senate bill is a companion to H.R. 1290, which was introduced in the House by Rep. Barbara Lee (D-CA). Stabenow and Lee are social workers and Barrasso is a physician. “Mental illness is an issue that touches so many families in some way and seniors are no exception,” said Senator Stabenow.
“Michigan seniors should be able to get quality care from the provider of their choice and this bill ensures that clinical social workers are among those essential providers.”
“Our nation’s share of people who are aging is growing rapidly and older Americans are in dire need of improved mental health services so they can enjoy a better quality of life and live as independently as possible,” said NASW CEO Angelo McClain, PhD, LICSW. “NASW congratulates Sen. Stabenow and Sen. Barrasso and Rep. Lee for using their combined expertise in social work, health care and legislative leadership to craft bipartisan legislation to address this issue.”
Clinical social workers are one of the nation’s largest groups of providers of mental health services. Currently, there are more than 300,000 social workers in the United States working in health care, mental health and substance use disorder treatment, according to the Bureau of Labor Statistics.
The House and Senate versions of the “Improving Access to Mental Health Act” would increase access to mental health services for residents of skilled nursing facilities and provide access to the complete set of clinical services that help Medicare beneficiaries cope with medical conditions.
In addition, the bill would align Medicare payment for clinical social workers with that of other non-physician providers by increasing the reimbursement rate from 75 percent to 85 percent of the physician fee schedule.
There are already 14 co-sponsors for the House bill, which was released in March 2017. Sens. Stabenow and Barrasso introduced the Senate version of the bill on March 22.
“It is fitting that this legislation was introduced in March, which is Social Work Month,” McClain said. “There is no better way to recognize the contributions of the nation’s more than 650,000 social workers than to put forward a bill that would support the clients who social workers serve, improve our nation’s mental health delivery system, and give social workers the reimbursement they need to do their critically important work.”
Self-Regulation Significant to Overcoming Early Adversity in Drug and Alcohol Abuse
Self-regulation may hold the key to helping young adults overcome their risk for developing alcohol and drug problems, according to recent research from the University of Georgia.
The study looked at 225 non-college-educated adults aged 18-25 from lower socioeconomic backgrounds who grew up in rural areas in Northeast Georgia. Led by Assaf Oshri, an associate professor in the UGA College of Family and Consumer Sciences, the research team found that young adults who experience abuse as children have a higher risk for developing alcohol and drug problems. These same young adults also have a decreased ability to self-regulate, or avoid impulsive decision-making in socially stressful situations.
Oshri pointed to the results as evidence of the need for family-focused preventive intervention programs for adolescents that target self-regulation, in hopes of better identifying factors that promote resilience among youth.
“If we use delayed gratification, we can do well in life, but it seems like those who have specific early life experiences are less able to perform this optimal decision-making, and that can affect their risk of substance abuse,” said Oshri, who is housed in the department of human development and family science.
Protective factors at the biological and psychosocial levels offer hope that interventions targeting decision-making can help at-risk youth, he explained.
“The goal is to try to identify mechanisms that will help youth who experience adversity in life,” he said
During the study, the young adults were assessed twice over two years. In addition to completing surveys measuring their drug and alcohol use and experiences with child maltreatment, participants completed a decision-making task that evaluated their tendency to make impulsive decisions and ability to self-regulate and delay gratification.
To accomplish this, researchers used a tool called “delayed reward discounting.” The young adults answered questions such as “Would you rather have $14 today or $25 in 19 days?” They also agreed to have their heart rates measured while they completed a series of increasingly difficult math-related tasks in front of an audience of research assistants. These measurements allowed researchers to record stress levels and assess self-regulatory capacities.
Study results found that as participants’ maltreatment experiences as children increased, the higher their inclination toward impulsive decision-making and problems delaying gratification.
The paper, “Child maltreatment, delayed reward discounting and alcohol and other drug use problems: The moderating role of heart rate variability,” was published online in August in the journal Alcoholism: Clinical and Experimental Research.
Co-authors are UGA graduate students Sihong Liu and Erinn Bernstein Duprey and James MacKillop from McMaster University in Canada. The work was supported by the UGA Owens Institute for Behavioral Research and the Sarah H. Moss Fellowship for UGA faculty.
The abstract can be found at https://onlinelibrary.wiley.
Get Comfortable With Not Knowing
How easy is it for you to be in a state of not knowing? Not knowing what will happen next? Not knowing your next step? Not knowing who you are as you’ve evolved into this present moment?
Not knowing can be an unsettling prospect. We like to know. We like to think that we know.
It is much more comfortable to feel like we have it all figured out ~ like we are guaranteed the outcome of our desires. And most of the time, we do feel like we are in the know when it comes to what our day will bring and what we can expect from each other.
The truth is though, that things can change on a dime. We find a sense of security with the thought that we can expect things to move along as they always have. Of course, we feel more secure when that expected direction is something that we want.
Alternatively, when we find ourselves stuck in situations that challenge us, we might pray for things to change while harbouring a suspicion that they never will because we know how these things have always played out in our lives before.
What if we got really cozy with the very real state of not knowing? What if we made friends with the reality that we could be surprised at any moment? And what if we began to anticipate that these surprises could be enriching and life-affirming as opposed to dark and threatening?
Recently on Serving Consciously, I interviewed Alexander Demetrius who has immersed himself in the vast expanse of the unknown and has discovered the rewards inherent in it.
Alexander Demetrius’ literary contributions have primarily been influenced by Joseph Campbell. During his lifetime, Campbell was one of the world’s foremost authorities on global mythology. Using Campbell’s monomyth or hero’s journey, Demetrius discovered that critical events from his past paralleled the typical sequence of events found in practically every narrative throughout the world.
The Reward of Not Knowing is an account of Demetrius’ memoirs, transformed into an epic journey that began in San Antonio, Texas, and spans across the Pacific Ocean to Honolulu, Hawaii, where he currently resides. What makes his journey unique is that much of it took place within, where so few ever voyage.
Through careful reflection and examination, he overcame some paralyzing characteristics that once constrained him to a life of insanity, orchestrated by his mother who suffers from dissociative identity disorder or multiple personalities.
Tap into All that You Do Know
It is easier said than done ~ this idea of being comfortable not knowing. Sure, we can acknowledge that we are lacking information in the moment or that we can’t see the next step on the path, but feeling comfortable with it? That’s another story.
To assist ourselves in this process, we can shift our focus to what we do know for sure.
Do you know that you can trust yourself?
Do you know that you can have faith in the process?
Do you know that you are capable of getting back up EVERY time you fall down?
Do you know that you are loved?
How connected are you to your resiliency?
How connected are you to your capacity to care for yourself?
How connected are you to your internal guidance system ~ your intuition?
How connected are you to a sense of self-love and self-worth?
If things go wrong, do you know that you can course correct?
If you feel unsupported, do you know you have your own back?
If you are frightened by what’s around the next corner, do you know that you can face whatever comes?
If you can’t see the forest for the trees, do you know that clarity resides within you and will eventually emerge?
Tune into all that you know to be true regardless of any evidence. Allow the unknown to exist without pressure from you to be different. Be patient as new information becomes available.
Learn to dance with the mystery.
Framing Mental Health from the Biopsychosocial Model
As someone who now works with people experiencing depression, anxiety, addiction and a range of other issues, and being a person who has experienced my own battle with depression, I have my own unique perspective.
Reflecting on his experience at a preview session from the Health Promotion Agency’s National Depression Initiative, Phillip shared his own common and unique experience of depression and anxiety.
Philip talked about his objections to the idea that depression is “an illness, not a weakness” because, in his view, the causes of depression and anxiety are often social factors – and that these problems (and other mental health concerns) need a “social model” rather than a medical one.
Firstly, like Philip, I can see why someone would classify anxiety or depression as “an illness, not a weakness”. I agree that no mental health problem comes about as the result of a weakness of character and that anyone, anywhere, at any time, can experience these kinds of problems (and indeed, one in five New Zealand’s do in their lifetime).
I think that experiences like depression and anxiety get called “illnesses” as a way of signaling the vast difference between someone when they feel mentally “well”, compared to when they don’t. Indeed, most of the diagnostic criteria for mental “illnesses” include the fact that the symptoms either cause significant distress to a person, or significant impairment in their day-to-day functioning.
So my take is that “illness” is perhaps used as an inadequate shorthand for “not functioning in the way that I do when I’m feeling whole, connected, supported, complete and satisfied with my life – I’m struggling, help!”
But I agree too, that “illness” also does not feel like quite the right term. Philip suggests that depression, anxiety, and other mental health concerns can be valid emotional responses when a person is struggling with the state of their life. As both a therapist and a person who has experienced significant depression, I completely agree.
Philip goes on to suggest that rather than a medical model, we need a “social model” of mental illness. The thing is, that is exactly what we have and use in mainstream mental health. We base most modern, evidence-based mental health intervention on what is called the “bio-psycho-social” model of mental illness. I’ll break this down briefly, with examples.
The Biopsychosocial Perspective
The “bio” part of the model refers to the fact that we are pretty sure that some mental health problems have a genetic component. Now, this doesn’t mean that if you have a particular gene you are guaranteed to get a particular disorder, rather than your brain chemistry might just be a little bit more vulnerable to developing one, given the right life circumstances. It’s a bit like heart disease. Two people can have the same healthy (or not so healthy) diet. One, who has a particular genetic marker in their family, may have a heart attack; while the other goes on to live a long life with no heart problems.
It’s a bit like heart disease. Two people can have the same healthy (or not so healthy) diet. One, who has a particular genetic marker in their family, may have a heart attack; while the other goes on to live a long life with no heart problems.
“Bio” also refers to the fact that experiences like anxiety and depression do affect your physical body just as much as your mental health. In terms of treatment, many people will find that particular medications help (others don’t, and that’s okay too). We also know things, like getting enough sleep and exercising a little, can help people manage these problems too.
The “psycho” part refers to your internal functioning – your mind, mental and emotional experience. When I was growing up, I learned particular ways to think about and manage my emotional experiences, that didn’t really serve me so well as an adult. For example, thinking “negative” emotions like sadness or anger are a bad thing and should not be experienced or expressed…that’s a pretty common right across Kiwi culture, I think.
Part of my recovery involved learning a different way of understanding and managing my emotions. This is generally where therapy can be the most helpful and can heap other benefits as well.
The last is the “social” part of the model. This is the acknowledgment of the idea that crappy life experiences or a not-so-great situation can significantly contribute to mental health concerns.
Again, treatment often involves helping someone to get themselves into a better or more stable environment, and connecting to good support. I’ve had many clients realize they needed to do things like end relationships, quit a job or move house, as I did myself, to help improve their mental health.
Now, our mental health system is far from perfect. There is a massive shortage of resource and funding, as well as an ongoing battle with stigma and discrimination, amongst other issues. But, for better or worse, that’s a super short summary of the model that the majority of mainstream mental health support services are based on.
So given that we are supposed to be acknowledging, integrating and working with all the parts of a person and their situation – why is it that the message is still out there in the media that mental health problems are a medical, not a social issue? Is it short-hand, a simplified way of raising awareness that mental health problems are common, and not a character flaw?
Or is it is lack of understanding as to how mental health problems develop, and how we treat them? I’m really not sure on this one – but I’d love to find out.
7 Tips for Staying Strong During Your Recovery from Addiction
When you’re overcoming addiction, the road to recovery can be tough to walk at times. However, recovering is one of the most worthwhile things you’ll ever do, and beating addiction will make you a stronger person. Here are seven things you can do to stick to your goals and have a successful recovery.
Take care of your health.
Addiction can take a toll on your physical health, so it’s important to take especially good care of yourself now. Get some exercise every day, eat right, and get at least eight hours of sleep every night. Even small positive changes, like eating fruit instead of candy, can make you feel a lot better. When you’re healthy, you’ll have an easier time maintaining a positive mindset and saying to temptations.
Be gentle with yourself.
Don’t dwell on the time you spent addicted. It’s easy to feel bad about wasted time, money, and opportunities once you start recovery, but there’s no point in beating yourself up. The past is over, and everybody makes mistakes. The important thing is that you’re making the effort to get better right now. Shift your focus to your successes instead of your failures.
Focus on one day at a time.
It can be overwhelming to think about spending your entire future sober. Instead of worrying about how you’ll get through the next month, year, or decade, just focus on today. If thinking about the whole day is still overwhelming, focus on the next hour or even the next minute. After all, a sober future is built one minute at a time.
Reach out to your support network.
Stay in touch with your family members and friends who support your recovery. When you’re struggling, don’t be afraid to call or text someone you trust and tell them how you’re feeling. Therapists and recovery programs can also make great additions to your support network. If you’re still looking at your options for recovery programs, there are plenty of options to choose from, like Addiction Treatment Riverdale Utah or Long Island Center for Recovery. You can find the best one for you online. The important thing is to surround yourself with people who want to help you get better.
Build new habits and routines.
A daily schedule can help you stay on track and fill your time with constructive activities. In addition to scheduling your work and other daily responsibilities, set aside some time to exercise, work on your hobbies, see your friends, and pray or meditate every day. Avoid activities and people that might trigger a relapse.
Make a plan for dealing with temptation.
You’ll probably have to deal with temptation at some point. Maybe someone who doesn’t know you’re in recovery will offer you a drink, or maybe you’ll start craving a drink or a hit when you’re feeling stressed. It will be easier to get past feelings of temptation if you make a plan for how you’ll cope. Practice saying no to offers of drugs or alcohol ahead of time, and come up with some emotional coping strategies as well. For instance, if you want to relapse, you could plan to call your sponsor or go for a walk instead.
Focus on your goals.
If you’re struggling to stay strong in the moment, your long-term goals can help you stay on track. Take a deep breath and think about why you want to stay sober for the long haul. Maybe you want to spend more time with your kids, start your own business, go back to school, or just stay healthy as you get older. Learning to prioritize your long-term goals over your immediate feelings is key to staying strong during your recovery.
Recovering from addiction is an attainable goal. Millions of other people have done it, and you can do it too. Use these tips to help you stay strong and focused throughout your recovery. You’ll probably find that sobriety is more meaningful and fulfilling than you ever imagined.
Mental Fitness: We Can Actually Train to Become Resilient Leaders!
What if I told you that mental fitness is something you can develop in the same way you build your physical fitness?
We hear a lot these days about stress and when we do, the conversation often focuses on avoiding it or managing it. What if that isn’t actually useful?
The best illustration I’ve read highlighting the direct link between mental toughness and performance comes out of a research lab. A team of researchers wanted to look at what made subjects mentally fit or resilient and took some baby chicks into the lab to study their theory. Painting the chicks and grouping them in separate pens, the first group was left alone to interact happily and normally.
The second group was periodically picked up and stressed in a confined space. After the stress, the chick was given time back in their group pen to recuperate. The third group was continually stressed in the confined space, with no recovery time or play opportunity with other chickens. The researchers created three distinct populations with different experiences.
After raising them for a time in this manner, all the painted chicks were placed in buckets of water, with researchers timing their struggle until drowning. I know, this sounds just awful.
The chicks that had been continually stressed drowned almost immediately; they just had no hope in the face of hardship that they could swim. The second group to succumb was comprised of those “happy innocents” in group one who had never been confined and stressed. They didn’t know how to withstand this watery hardship and folded in the face of it. The last swimmers fighting to make it were the chicks from the stress adaptation group.
Somehow, the confinement stressors followed by time to recover had rendered them stronger and able to swim and survive much longer than their peers. This group was resilient; they had experienced hardship before and believed they had a chance to make it and recover. They had those past mastery experiences to rely on, and they just fought to keep swimming.
Stress has a purpose. Stress is opportunity. It’s meant to teach us to swim!
Responding well to stress requires high functional capacity of your brain’s frontal cortex. This area of our brain houses something called our working memory capacity, which helps us with both emotional regulation (being able to think and not just react) and upper-level cognition (focus). We can improve that capacity with the use of some well-studied, relatively simple exercises.
Think about the last time you experienced stress. I always think back to those really awkward years – for me it was 13 – and last week. Think about that age, standing in the middle of the school lunchroom with your meal tray. As you gaze over top of your sandwich, anemic vegetables, and cookie snack pack, you anxiously wonder who will make room for you at their table.
What happened in your body at that moment? Maybe your heart sped up, you started breathing fast, your face flushed – your body fires off a full-on stress response. As the stress is registered by your brain, wherever that stress comes from – a chain reaction fires.
Your body releases cortisol, adrenaline, and a host of other chemicals to help you cope. It also releases a hormone called DHEA into your bloodstream. DHEA’s entire role is to help your brain grow from the stressor you just survived. But there’s a catch – DHEA only does its job when you give yourself a post-stressor break.
You need that time to de-escalate your revved up nervous system in order for DHEA to do its brain-building work for you! The hormone increases synaptic firing and neural connectivity (you’ll think faster) and increases working memory capacity (emotional regulation and focus). DHEA is what makes stressful experiences worth your time, but you have to create the space for it to do its work.
Creating this space is the heavy lifting of mental fitness training, and it isn’t as easy as it sounds. If I say rest, self-care, nervous system regulation and you think taking a nap, you’re on the wrong track.
When we are asleep our brain waves are long and slow. We call these delta waves, and our brain is in delta state. When you’re awake and ambulatory, walking and talking in the world you’re in Bets state. What’s interesting for a lot of us in a hyper-stimulated environment is that we find ourselves often entirely on or entirely off, and the place in the middle where DHEA does its building work is theta state.
In this space, you’re at rest, but still aware. Also, your nervous system has space to rebuild and strengthen. So what does a drop in stress hormones and downshifting of the nervous system feel like? Think about the last time you enjoyed an activity or training – when you took a deep breath in and you just felt that “Ahhh!” feeling – even if you were working hard and running up and down trails.
You may find it while running, skiing, doing yoga, getting a deep tissue massage, taking a bubble bath, or even lifting weights. Some people call it a “click,” or a “shift.” Here is where you have to experiment a bit. That moment will look different for everyone, but when you find it, take note.
Do more of it – especially when you’re feeling stressed and overwhelmed. I find it often on a yoga mat. I have a friend who tells me she finds it swimming laps. Now for me, I’m trying not to drown while swimming laps, there is nothing theta state happening for me there! Dedicate the time to finding your practice. What down-shifts your nervous system? Then do it. Ritualize it. Make downshifted moments part of your training routine.
All of us face periods of adversity, and no one is going to ask us if we can swim before the crisis. We have to train for the hard times, and we can. Make a little time for your brain and watch yourself get sharper, smarter, more focused, kinder. You’ll also be ready for the bucket of water.
You need to know how to become mentally fit to be the best student, professional, parent, and friend that you can be. Be the chick that lived well! Train yourself to swim.
A wrote a book on this subject that’s brand new from Praeger – check it out here.
Factors Families Should Consider Before Employing A Drug Treatment Program for A Loved One [List]
What happens in drug rehab matters a lot, which is why we need to carefully select which one we end up enrolling ourselves, or our loved ones into. The first one that pops up may not necessarily be the best one for your situation which means browsing your options is an important part of the process. Unfortunately though, researching inpatient drug treatment programs for yourself or a loved one can lead you down an internet rabbit hole.
We’ve outlined 14 questions that are designed to give you more control over the decision process. Instead of being sold or coerced on the phone, you can use these questions to draw out the most important and relevant information from whichever drug rehab, addiction treatment, or detox facility you are considering. Remember, information is power, and these questions and explanations will equip you with the know-how to find the best rehab match for your unique situation.
1) How long have you been in business? Who is the founder, and who is the current owner? If the founder is no longer the owner, why did they leave?
Asking about the facility’s background is important because you want to choose a rehab that has experience, and also one that is run by a person who genuinely cares. If the founder has left, that doesn’t mean you should automatically rule out the rehab, but you should ask more questions about the new owner. What is their interest? What is their background? If the new owner is equally passionate about recovery, that’s a good sign, but if they are just a business person, you should be cautious.
2) What crimes, if any, in the United States and abroad, have your founder and/or partners been accused and/or convicted of? How many current lawsuits are pending against your center?
This is important information that you should be aware of before putting your time and resources on the line.
3) What is your staff to patient ratio? And how many patients does each primary therapist have on their caseload?
The more staff per patient, the better your odds of having more personalized care.
4) What is your daily rate for month one? Does it change for months 2 or 3?
Financial questions like these are important and ask the facility to clearly respond to you in writing.
5) Do you detox on-site or off-site?
Many small treatment centers operate an on-site detox, which is allowed by law but higher risk, to increase revenue. The Substance Abuse and Mental Health Services Administration recommends caution with rehabs offering on-site detox because these freestanding facilities may or may not be equipped to fully assess and treat complex cases. If the rehab you’re interested in does provide on-site detox, ask about the amount of medical staff on hand, the treatment protocol for yours, or your loved one’s drug of choice, and whether or not there will be help available 24/7. If the addiction is moderate, this may be appropriate.
For alcohol, benzodiazepine and “G” detox, please seek a hospital-based detox as these substances lead to more dangerous withdrawal.
6) What role do interns play in the delivery of clinical services to patients at your program? In regards to your clinical team, what percentage of them are full-time, and per-diem?
Many treatment centers will cut costs by bringing in clinical interns as their “counselors” who are required to “donate” thousands of hours in order to get licensed. While appropriate for a very low or no-cost program, a clinical team builds their wisdom and experience by practicing over years.
7) Are you an actual treatment center, with a building and staff? or are you a call center fronting for a lead generation company?
Do not sign up with a call center, continue searching and contact treatment centers directly. If you connect online with an unscrupulous phone center the odds of you being “sold” to the highest bidder as a piece of commerce is high. Which makes you wonder; If you are “sold” on the phone and send your loved one to a rehab that lacks clinical care, or has nobody else similar to your loved one present – will it really be the best match?
8) What is your smoking policy? What about Vaping? Do you offer a Nicotine Cessation Program?
Please consider choosing a no-smoking facility, and giving up smoking at the same time that you are treating your main addiction. You will have more support and guidance for smoking-cessation now, while you’re in rehab than when you go back.
10) What are your cell-phone, iPad, and laptop policy?
Treatment centers that allow the free or easy use of digital devices often have a low level of clinical care and a basic program. It’s best to participate in face-to-face interactions and real-world activities during treatment, rather than using your devices.
11) Given the recent wave of problems with rehab fraud around urine testing, and fraudulent lab billing, what is your UA policy, and what do you require the family to pay?
12) What is your refund policy if/when my loved one leaves treatment against clinical or medical advice?
This is known as an “ACA” or “AMA” exit. Many unscrupulous providers will often keep pre-paid fees due to the patient “storming off” or being “bad.” Addicted humans sometimes leave treatment, so a thoughtful refund policy is a necessity. This should be spelled out clearly in their Financial Agreement, but if not, get the refund policy in writing.
13) What is your policy on a patient who relapses? What do you do with him or her?
Different rehabs have different responses to relapse. Some rehabs offer ‘refresher’ courses where the addict can come back for a short time if they feel they’re approaching relapse, and some offer alumni support group meetings.
14) What is the male/female ratio of your community presently? What is the average age range of your community presently? Can you describe the current community members’ “drug of choice” at this time?
Since group work is very important. You need to make sure that your loved one will feel like they are part of the group, not alienated or labeled as ‘different.’ Try to find a rehab working with a group of similar people that you’re loved one can really connect with.
We hope you’ve found this resource helpful, and informative. Since the priority is getting yourself or your loved one into an appropriate, well-staffed, and safe treatment environment, it might be a good idea to consult with an experienced Interventionist if you’re still feeling uncertain. They can help you decide what services are necessary and which ones aren’t, and craft a personalized treatment plan to get your family going in the right direction.
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