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A major effort to overhaul mental health care and substance use treatment in the U.S. is gaining traction as Congress and the Biden administration work on overlapping plans to address concerns across dividing lines of politics, geography and race. Top goals include responding to the mental health crisis among youth, increasing the supply of professional counselors and clinicians, narrowing a persistent gap between care for physical and mental health problems, and preserving access to telehealth services that proved their usefulness in the pandemic. COVID-19 has laid bare the need. “There is a very nonpartisan aspect to this — I wouldn’t even say it’s bipartisan,” said Hannah Wesolowski, NAMI CAO. “The need for a rapid scale-up of mental health services is one of the few issues where the parties can come together.”
If you’re working from home after spending months, or years, working in an office, you may find it hard to take breaks. “When working from home, it can be a little hard to figure out what a break looks like,” says Dr. Christine Crawford, associate medical director of NAMI. "In an office, breaks can be going to the water bubbler or stepping out of your cubicle to chitchat with a coworker.” These give you a chance to step away from what you’re doing and come back a little more focused. Another challenge is your day may seem to have endless hours, Crawford says. You end up working into the evening, and that can interfere with your sleep and make it hard to feel disconnected from work. Crawford has seen more anxiety and depression in her patients who feel too connected to work. “They don’t have enough time to do what they need to do, and at the same time, they feel there is time and feel guilty that they aren’t managing their time effectively,” she says.
Researchers have found variations in a small number of genes that appear to dramatically increase the likelihood of developing schizophrenia in some people. Ken Duckworth, NAMI CMO, a nationwide advocacy group, said the study is an important development in the neuroscience that underlies schizophrenia. But he said it is difficult to predict how soon such basic research would pay off for people living with the disease. “This is a big step forward for science that may pay a long-term return for people with schizophrenia and the people who live with them,” Duckworth said. But, he said, “if this is a 17-inning game and they’ve gotten us from the first to the second inning, how does this help someone today?”
A new survey reveals that girls in particular were affected by the social isolation of the pandemic. The stress and adversity of the pandemic were not limited to just adults; teens and children felt it too. "It's no secret that kids are going through a lot right now. Knowing how to spot the signs of something more serious is vital," says Barb Solish, director of youth and young adult initiatives at NAMI. Talking to your children about mental health topics is difficult. "All kids experience 'bad days' now and then, but if their negative emotions, thoughts or behaviors are getting in the way of their everyday functioning, it is important to take notice and take action," Solish says.
The long-term vision is that someone experiencing a mental health crisis or suicidal ideation can dial 988 to reach a local call center for support or to dispatch a mobile crisis team. Many of the 180 local call centers across the country struggle with funding. “Mental health has been underfunded for decades — we get pennies here, pennies there,” says Hannah Wesolowski, NAMI CAO. “The 911 system took decades to build but because of the pandemic, our need is high and we need to move as quickly as possible.” Congress did not mandate federal funding for 988, rather leaving it up to the states. Wesolowski says that due to the patchy funding, there won’t be a widespread marketing campaign for 988. “We don’t want people to call and not get connected,” she says. “The real fear is people losing trust in the system before the system is off the ground.”
Virtual health care has exploded during the COVID-19 pandemic, and new data indicates digital tools targeting the behavioral health needs of children and teenagers are no exception. While clinicians and health executives say these tools could offer some solutions for young people, they also come with challenges. It’s important to establish long-term relationships for children’s mental health care because it can be difficult for them to be “fully present and engaged” in treatment through a screen, said Dr. Christine Crawford, NAMI associate medical director. For particularly young children, “it may be really tough for the mental health provider to do a thorough assessment of the child if they’re frequently getting up and running around.” Crawford, for one, stressed that the advent of virtual care for pediatric mental health should mean patients have more options, not that digital care fully replaces in-person treatment. “For some people who may have more significant mental health-related concerns, it may be beneficial for them to meet with a therapist or meet with the psychiatrist in person,” Crawford said. And they shouldn’t “feel as though it’s any sort of failing or shortcoming on their part if they’re not able to get all of their needs met in one of these virtual apps.”
In advance of the July launch of 988, mental health experts worry about workforce capacity issues and the ability to provide 24/7 crisis care. "Fortunately, most [states] are taking this as an opportunity and are working towards increasing their Lifeline call centers within the network," said Hannah Wesolowski, NAMI CAO. "But when somebody calls in, and they wait, and they hang up — we have one chance to get this right for a person. Lives are literally at risk. These are people who are in crisis, might be having suicidal ideation. It's incredibly risky when those calls don't get through." Wesolowski explained that local call centers connect people to mental health care providers in their communities, as well as other resources, while the backup centers may not be able to provide that service. "We want to deescalate the immediate crisis, which is what those trained crisis counselors do, but we also want to connect them to resources so they stay well," Wesolowski said. "We don't want to just have them keep cycling into crises — crisis after crisis — it's really important that they get connected to needed care so they can get well and stay well beyond that crisis situation. So it's those local crisis counselors that can really make those connections. When there's not that local capacity. It's a huge concern."
The hope with 988 is that those who are in a mental health crisis will be able to be receive fast and safe help. "We believe strongly that people who are in a mental health crisis deserve a mental health response, not a criminal justice response," says Jennifer Snow, NAMI national director of government relations, policy, and advocacy. A survey conducted by NAMI found that 46% of people would not feel safe calling 911 for help if their loved one were experiencing a mental health or suicide crisis. The reason is likely in part due to police interactions have been dangerous and at times deadly. In fact, per NAMI, one in four fatal police shootings between 2015 – 2020 involved a person with mental illness. "Is it going to be perfect nationwide, come July? Absolutely not," Snow says. "But I'd like to say that it's getting better every day and more communities are expanding the ability to have that mobile crisis so that people can get the response they deserve." No. "It will never cost anybody to call the lifeline," Snow says.
Finding a therapist — let alone one who is a good fit — can take time and determination, especially during the pandemic, when many therapists report they cannot keep up with demand and must turn away patients. If there is a crisis, do not wait. The National Alliance on Mental Illness has information on various types of mental health crisis services, like mobile crisis teams and crisis stabilization units.
For an on-camera interview, Dr. Christine Crawford, associate medical director at NAMI, discusses the increased ER visits by young people or suicidal thoughts and behavior, and the lack of mental health providers to meet the increased demand for children in need of mental health care.
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