Credit: (Rudy and Peter Skitterians from Pixabay)NJ Spotlight News recently hosted a panel of experts to discuss mental health, access to treatments and concerns both in the medical community and in the community at large. The interactive roundtable also sought to engage the audience, some of whom submitted questions before or during the event. We selected several of these audience questions that were not addressed during the forum and asked panelists to respond in writing. Below are their answers.
Mental health and mental illness are complex topics. The following remarks are for informational purposes only and should not be viewed as a substitute for seeking clinical care.
Carolyn Beauchamp, president and CEO, Mental Health Association in New Jersey
Question: How do we deal with the lack of mental health services available to families as need has increased?
Answer: There is more awareness than ever of the need for mental health services in response to COVID. For instance, school systems are increasingly looking to place counselors within their systems to help students in real time. Telehealth services have cropped up and made many more counselors available where there is private insurance. Many churches have pastors with counseling degrees who can offer guidance.
Question: What are strategies for reaching and addressing mental health challenges among hard-to-reach populations?
Answer: For those without insurance or with Medicaid, some of our Federally Qualified Health Centers have counselors as part of their services. These are generally located in urban areas. This administration is looking at how to enhance the workforce-related mental health services to help create more long-term solutions to building our practitioner ranks. For more specific help for those with limited resources, information and referral are provided through the Mental Health Association’s statewide call center, NJ Mental Health Cares at 866-202-4357. Staff is available from 8 a.m. to 8 p.m. daily.
Frank A. Ghinassi, Ph.D, ABPP, president and CEO, Rutgers Health University Behavioral Health Care; senior vice president, Behavioral Health and Addictions Service Line, RWJBarnabas Health
Question: Are provider shortages exacerbating access issues and what strategies could assist in increasing interest in this field?
Answer: Yes. To an extent, shortages are due to competition for providers from new players in the marketplace, which are often virtual-only, for-profit startups. Many often are cash-only and do not take health insurance. They can often offer providers higher salaries and at-home work arrangements. RWJBarnabas Health is examining incentive alternatives including salary adjustments, hybrid work options and tuition reimbursement.
Question: How can everyone in need get mental health services when many providers are not accepting new patients and many do not accept insurance?
Answer: Continue to write to your congresspeople and senators about taking action. Also, petition your employer to request better provider networks from your insurer. Finally, contact the call centers of the larger providers’ systems and get on their access lists.
Margaret Swarbrick, Ph.D, FAOTA, associate director, Rutgers Center of Alcohol & Substance Use Studies; research professor, Rutgers Graduate School of Applied and Professional Psychology; behavioral health peer leader, Collaborative Support Programs of New Jersey
Question: How can we educate people on seeing mental health as part of our well-being?
Answer: The World Health Organization defines “mental health” as a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her (their) community. Well-being includes the presence of positive emotions and moods (e.g., contentment, happiness), the absence of negative emotions (e.g., depression, anxiety), satisfaction with life, fulfillment and positive functioning. Well-being can be described as judging life positively and feeling good. Stress, disappointment, and trauma can all impact emotional satisfaction and one’s ability to be productive and contribute to community.
From an early age through one’s life, it is important to build skills needed to bounce back when faced with stress, disappointment and trauma and also gain access to supportive figures who might include family, friends, co-workers or professional support when needed.
As people talk about mental health more openly in non-stigmatizing ways and talk about the non-pharmacological ways people maintain and strengthen their mental health, many more people may be able to improve their well-being.
Question: What can employers do to address mental health issues in the workplace before they might escalate?
Answer: Prioritize that full- and part-time employees have good benefits for medical substance use. Be open to talking about mental-health-related challenges in a productive non-stigmatizing manner. Create and sustain workflow processes that allow for balanced productivity with ways for employees to gain and give support to one another. Make sure supervisors and managers have the proper attitudes to build workplace wellness cultures and help support employees in distress. Link to available resources (EAP, peer-support programs or local mental health or substance-use facilities). Pay a living wage and have opportunities for career growth since financial stressors are prompts for distress and even suicide. Offer education on wellness-focused strategies to promote work-life balance. Consider peer-support programs and ECPR training for staff.
Debra L. Wentz, Ph.D, president and CEO, New Jersey Association of Mental Health and Addiction Agencies (NJAMHAA); executive director, The New Jersey Mental Health Institute; chair, Governor’s Council on Mental Health Stigma, State of New Jersey
Question: How best to address mental illness with adults who refuse treatment?
Answer: For the general public, there are guidelines for encouraging others to seek mental health care. The first piece of advice is to not say “you need help” or “you need therapy.” Many people may take offense at this particular wording, as it may be interpreted as a statement about their inability to fix their problems. Also, the presence of stigma may prevent individuals from being receptive. However, there are tactics that can be effective. For example, Mental Health America recommends the following: “Keep trying, asking questions, listening, and reflecting. Help them feel heard and ask again. Continue to say things like, ‘I’m really worried about you. I’m thinking we should just go get checked out by a doctor to see what’s going on.’ Reassure them that you’ll stay with them and help them through the process.”
While we are all aware of individuals’ right to refuse treatment and are respectful of civil liberties, we also understand that the law allows for behavioral healthcare providers and the justice system to intervene when individuals who refuse treatment are a danger to themselves, others and property. We strongly believe that involuntary treatment should always be in the least restrictive environment possible. Trinitas Regional Medical Center operates one of New Jersey’s first Involuntary Outpatient Commitment (IOC) programs. They find it very successful with a portion of the population mandated for IOC. The encouragement of judges’ directions to follow the service plans leads to a significant number of individuals recovering. IOC, however, has not expanded since it was initially implemented and, as a result, it is difficult to serve everyone who is referred. We always have to keep in mind that individuals who “refuse” treatment may not be connected to empathic workers. Our members have seen many clients who resisted treatment improve from engaging with compassionate, skilled workers.
Question: From a primary prevention perspective, what is the most proactive thing we can do to prevent mental health issues?
Answer: Open conversations about mental health challenges in individuals’ personal lives and the workforce are essential for prevention of mental illness and substance-use disorders and, as noted earlier, to eliminate stigma so that everyone is comfortable seeking help when the need is recognized. Self-help and self-care can help prevent both the onset and progression of mental health and substance use disorders. Even small, daily acts of self-care can have a big impact by helping to manage stress, decrease risk of mental and physical illnesses, increase energy, improve mood and curb cravings for alcohol and other drugs. Strategies include exercising on a regular basis; eating a balanced diet and drinking plenty of water; following a schedule for sleep and not having phones or other devices nearby during sleep; doing breathing and other relaxation activities; setting goals and priorities; and focusing on positivity and what we value in our lives. These techniques can help prevent the urge to dilute emotions with alcohol and other drugs.
Additional self-care strategies for individuals in recovery from substance use are having mentors and taking classes tailored for individuals with substance use disorders and their families. While self-care can help individuals significantly cope with depression, anxiety and drug cravings, it is not a cure. It is equally important to understand what situations trigger depression, anxiety and the urge to take drugs, and to have positive coping techniques to use as needed. A behavioral or primary healthcare provider should be contacted if symptoms last for an extended period of time; interfere with daily life functioning (including difficulty sleeping, concentrating or getting out of bed; and losing interest in things that had been enjoyable); become more intense over time; and especially if alcohol or other drugs are being used or considered to reduce symptoms. Primary care and all other healthcare providers should screen every patient for depression, anxiety and substance use, and refer patients to behavioral healthcare specialists when needed.
Expecting and new parents should be given information about postpartum depression and other mental health challenges that they and their children may experience, so that if such difficulties are experienced, they can recognize what is happening and seek help.
Everyone needs to be educated. Mental health training, including the facts and how to de-escalate crises, must be provided to school staff, religious leaders and others in community roles and with families. In fact, the National Alliance on Mental Illness – New Jersey’s Family to Family program is extremely effective. This program provides information and emotional support for individuals who have family members with mental illnesses. It helps participants develop coping, self-care, empathy and communication skills.
