WELL-BEING Resource Guide by Bozeman Daily Chronicle

WELL-BEING WELLBEING Resource Guide

STAYING CONNECTED IN A TIME OF UNCERTAINTY

A SPECIAL PUBLICATION WITH

OFFICIALS SEE RISE IN NEED FOR MENTAL HEALTH SERVICES IN BOZEMAN, GALLATIN COUNTY By FREDDY MONARES Chronicle Staff Writer

aren Patty typically spends the first hour of her workday reviewing police calls from the day before to see if she needs to follow up on any of them. After that she typically gets a call to provide on-scene care for people in a mental health crisis. She’s one of two crisis therapists contracted through the Western Montana Mental Health Center-Gallatin to respond to calls with Belgrade and Bozeman police departments, and the Gallatin County Sheriff’s Office. She said in 2019, the first year of the program, the number of calls she responded to spiked in the spring but calmed down during the summer. That didn’t happen this year. “It’s definitely on a very sharp trajectory up each month,” Patty said. The crisis response therapists aren’t alone in that observation. Mental health officials across Gallatin County said they’ve also seen a rise in needs for services amid the coronavirus pandemic and after the recent wildfire that burned more than two dozen homes. Help Center 211, which serves 13 counties, has seen its workload increase by 50% compared to last year. An official from Western Montana Mental Health Center said the facility has seen an increase in detention bed use of about 10 days per month since April. Bozeman Health’s behavioral health urgent care has treated more than 200 patients since March. The opening of the behavioral health urgent care center is one example of new responses to mental health needs during the pandemic. Several organizations are also working together to improve resources in the area. It’s the sort of work that many wanted to see even before the pandemic, and that they want to see continue. “That needs to happen — not just when it’s a crisis,” said Matt Kelley, Gallatin County health officer. 2

Mandy St. Aubyn, development and communications coordinator for Help Center 211, said the call center typically sees people calling about suicide, depression and anger or fear. She said the majority of the calls have been about suicide, depression and worries surrounding COVID-19. The help center was also tapped as an information hotline after the Bridger Foothills fire. She said there’s been an increase in calls in people looking for basic services like food, shelter and financial security since. Help Center 211 serves 13 counties including Park, Madison, Broadwater, Jefferson and Gallatin. When a call comes in, St. Aubyn said, a counselor works to connect the caller to the right resources. So far this year, the hotline has received 7,266 calls. From mid-March to September, 67% of those callers were female, 32% were male and 1% identified as non-binary.

Most of the callers, 45%, are between the ages of 25 and 44, and people 45 to 64 accounted for 40% of the help center’s calls during that period. People between 15 and 24 were 10% of the calls, and people 65 and older made up 5%. She said the pandemic has helped people realize that everyone has mental health needs, and that “it’s not just a subset of a population.” “They may be struggling more with their mental health, but they might also be recognizing that it’s OK to reach out and ask for help,” St. Aubyn said. Michael Foust, director of the Western Montana Mental Health Center, said we’re likely seeing the “tip of the iceberg” of what mental health issues are coming. “I don’t want to paint a grim picture,” Foust said. “It’s the realism of a pandemic. It’s just what happens in a pandemic or any kind of disaster.”

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Connections YOU ARE NOT ALONE WE ARE HERE TO HELP

LEARN MORE (406) 579-4984 | ProvidenceMH.com

MENTAL HEALTH SERVICES IN MONTANA The 211 Help Center (Crisis and suicide hotline, sexual assault counseling center): 406-586-3333 or 211 Montana Crisis Text Line: Text 741731 U.S. National Suicide Prevention Line: 1-800-273-TALK (8255) Crisis Intervention Team: 406-582-2100 MSU Counseling and Psychological Services (For students, staff and faculty): 406-994-4531 Hope House Crisis Stabilization: 406-585-113

OFFICIALS SEE RISE IN NEED FOR MENTAL HEALTH SERVICES IN BOZEMAN, GALLATIN COUNTY (CONT.) out. Alcohol sales, in a state that Foust said is already deemed the “booziest,” have increased. Kids are going back to school where reports of abuse and neglect are typically made. “I still think we have a long ways to go,” he said. Foust believes the county is headed in the right direction and that “it could have been a lot worse.” And, he said, resources have been able to keep up with demand — the food bank is still doling out food, residents continue to donate to relief accounts and nonprofits are still providing for those in need. He said the pandemic is an opportunity to look at the services the county has and reflect on what it could do better. And work on reaching people early in mental health crises started long before the pandemic arrived in Gallatin County. A number of organizations formed the Gallatin County crisis redesign committee to review and improve services. The committee includes Bozeman Health, the Gallatin County Sheriff’s Office, Western Montana Mental Health 4

Services, Community Health Partners and the Gallatin City-County Health Department. Maureen Womack, Bozeman Health’s system director of behavioral health, said the group had ideas percolating about how to improve services before the pandemic. Womack, the co-chair of the committee, said coronavirus placed a sense of urgency on rolling out those ideas to give people better access to mental health care. Since March, in addition to its behavioral health urgent care, Bozeman Health has placed a behavioral health crisis interventionist in the emergency department and launched a tele-psychiatry program for patients in Bozeman and Big Sky. “Necessity is the mother of invention,” Womack said. “When we were looking at the effects of the pandemic, we wanted to make sure that people who had a behavioral health crisis … did not have to co mingle with people that had physical conditions that may be infectious.” For Patty, the spike in calls started in June. She saw an increase in threats of suicide and involuntary commitments to psychiatric care. Patty tries to keep people in their home, WELL-BEING RESOURCE GUIDE

surround them with their own support system and get them connected to outpatient services — it’s cheaper and better for the person that way, she said. If that can’t happen, Patty said, therapists will petition the county attorney’s office to involuntarily commit someone. Patty said there are three thresholds when therapists decide to involuntarily commit someone. People are either actively suicidal or actively homicidal or unable to meet their basic needs due to a mental health diagnosis. In the past, she said, a majority of involuntary commitments happened because a person was actively suicidal. Patty said that has shifted to more people being committed because they’re unable to meet their own needs due to a mental health diagnosis. Because of the coronavirus pandemic, Patty said, there’s a significant absence of coping skills that people typically engage in. That includes checking in with a health care provider, being around friends and other things that offer support and comfort to someone in crisis. “As their support network falls apart, their acuity starts rising, and we need to do something different,” Patty said. bozemandailychronicle.com

ISOLATED SENIORS FACE MENTAL HEALTH CONCERNS DURING PANDEMIC

VOLUNTEERS, ORGANIZATIONS BOOST EFFORTS TO HELP THEM STAY CONNECTED By BLAKE JONES grandkids Addison and August, who Though mental health was “a major topic of bjones@idahopress.com live in Washington. Miller’s grandchildren didn’t discussion” at a recent Kuna Senior Center meeting, members who don’t attend in-person events have dropped off some organizers’ radar, Senior Center board member Guy DiTorrice said. “We have seniors who haven’t interacted with people outside family gatherings since March,” he said. To counteract the communication gap, McDougall’s team, along with local senior centers, are calling clients they’re concerned about.

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ocial worker Tiffany Stees, who has worked with seniors throughout the coronavirus pandemic, said she is witnessing “an impending mental health crisis.” At the residential care center where she works, Orchards of Cascadia in Nampa, Stees has observed how the pandemic has amplified isolation and loneliness among older adults. Others who work with seniors have seen a concurrent blow to the mental health of people isolating at home. But after eight plus months of virus spread, it’s what caregivers and volunteers don’t see that sometimes worries them most. With in-person events canceled, some seniors resist using technology to stay connected to their support systems, and others don’t have the resources or the tech literacy to participate in things like video calls, AARP Idaho Director of Outreach Cathy McDougall said. That’s severed the connection between volunteers and some of the seniors they work with. “I just don’t know what’s going on with them,” she said. “We’re not hearing from people. They’re just gone.” bozemandailychronicle.com

The Southwest Idaho Area Agency on Aging handles a wide range of calls from seniors and adult protective services reporters. They’ve noticed an uptick in calls, especially as the holidays near, but they can’t quantify how much the situation has worsened. National research shows rates of anxiety and depression have increased in adults of all ages during the pandemic. In August, one in four adults ages 65 and older reported anxiety or depression — up from one in 10 in 2018, according to the Kaiser Family Foundation. “As we’ve been going along … I’ve heard of people experiencing the residual effects of being isolated — things like depression, anxiety and suicide,” said agency director Raul Enriquez. Stees emphasized that, although not everyone experiences symptoms of mental illness, the pandemic is impacting everyone, especially those who are isolated. Some seniors have found ways to stay connected, even as in-person events continue to be canceled. Nampa resident Dana Miller, 73, has weathered isolation with her husband Warren, 75, by video calling friends, spending time with her English springer spaniel, Pete, and reading over FaceTime to her

visit for Thanksgiving this year; she hasn’t seen them since December. “It’s hard for those of us who are well confined and (are) older,” she said. “We’re in that senior citizen community who are more at risk.” Miller is thankful she’s been able to spend time in McCall, do things outside and connect with her grandchildren. She said most of her friends have remained generally positive throughout the pandemic, but “it’s been hard for some of them, especially those who have not gotten out much at all.” Stees said a crucial way people can help seniors forced to isolate is by wearing masks so new case numbers go down, allowing older adults to safely leave their homes once again. “They’ve dedicated their whole lives to society,” she said. “They’ve done a great job of living, and I’d like to keep it that way for as long as possible.”

RESOURCES Resources are available for seniors experiencing symptoms of mental illness. Medicare covers free yearly depression screenings and pays 80% of the cost of visits to psychiatrists, clinical psychologists and social workers. The Southwest Idaho Area Agency on Aging recently expanded its services; now, operators are making and taking calls to and from seniors who are lonely and simply need someone to talk to, public phone line supervisor Rickie Sautebin said. Seniors can call the agency for that support, to seek mental health resources or to be connected with other resources at 208-898-7060. The Idaho Suicide Prevention Hotline can be texted or called at 208-398-4357. Although many local senior centers are closed and their events canceled because of the pandemic, seniors can still access free or discounted meals through their local center, many of which are partnering with Metro Meals on Wheels to provide delivery and curbside pickup.

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PEN PAL PROGRAM CONNECTS NURSING HOME RESIDENTS WITH THE COMMUNITY By JEANNE HUFF jhuff@idahopress.com

eparated from loved ones and isolated within their own living quarters, many seniors are facing an excruciatingly lonely holiday season this year. It gives ‘home for the holidays’ a bitter new meaning. COVID-19 has been hard on the senior population in our communities, especially those in senior living centers and assisted living facilities, and Idaho is no exception. The high contagion rate of the virus and its devastating death toll among the over-65 group has effectively necessitated the shuttering of those places where those most vulnerable live. In doing so, it has set them up for heartbreak. But thanks to some creative ‘elves’ working behind the scenes this holiday season, you can still reach out and make a big difference — and help ease the pain of a cloistered Christmas for seniors in our communities. You can write a letter, be a pen pal or make a window visit — and in doing so, lift someone’s spirits, put a smile on their face, make a connection … and give them hope.

HOW TO PARTICIPATE ORCHARDS OF CASCADIA Orchards of Cascadia welcomes window visits, pen pals and donations of used Alexas and iPads. • Orchards of Cascadia, 404 N. Horton St, Nampa, ID 83651; (208) 466-9292.

KARCHER ESTATES & AUTUMN WIND All ages are invited to send positive notes, warm wishes and fun artwork to residents, with the following recommendations: • Messages should be handwritten in large, easy-to-read print. • Keep messages positive. Make letters kind, heartfelt. • If including a drawing or painting by a child, consider having them sign their name and age. • Don’t date letters; items can take up to three days to disinfect. • Note: All letters and artwork will be sorted and disinfected prior to delivery. All items will be opened and screened except private messages from family or friends. Send or drop off in person (call to meet a staff member at the entrance). • Prestige Senior Living Karcher Estates, 1127 Caldwell Blvd., Nampa, ID 83651; (208) 465-4935. •Prestige Assisted Living at Autumn Wind, 200 W. Beech St., Caldwell, ID 83605; (208) 459-3335.

(left) Jackie Daniels is taking part in a pen pal program in east Skagit County in Washington. Local senior centers in Idaho are encouraging similar programs, including pen pals and window visits for isolated seniors. Submitted Photo (right) Loretta Byington poses for a photo with letters she received from pen pals at Madison Carriage Cove in Rexburg. Byington said it feels good to receive the letters. “It’s nice to know people care about someone they don’t know,” said Byington. jroark@postregister.com

MAKE A SAFE CONNECTION IN PERSON Although most centers have had virtual visitation with family since the beginning, many residents have not seen a face without a mask in months. That’s where window visits can come in and provide an ‘up close and personal’ experience that can go a long way in giving solace, said Tiffeny Stees, a social worker at Orchards of Cascadia, a rehabilitation and nursing care center in Nampa. “We have had a letter writing campaign before,” she said. “But we would appreciate more window visits — from anybody. You can have phone-tophone conversations. And we’re hoping for window caroling. Or, if a family likes to sing, they don’d need to be Christmas carols.” Other ideas include: “Pet window visits … anything for more interactive, safe experiences.” Stees said the staff at Orchards of

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Cascadia has done a lot of creative brainstorming. “We keep asking: ‘What can we do to keep this interesting?’” Other ideas for window visits include: dance groups, “square dancers out on the lawn — we could open the windows and let them see,” Stees said.

A TWO-WAY STREET In Stees’ experience, the interactive piece is key, whether it is from a window visit or a pen pal program, which invites communication from both ends. Both are preferred to the more one-sided letter writing, she said, which is more like “just getting things thrown at them.” Other interactive ideas delve into donating tech devices. “We’re hoping for more community outreach in the area of donations of old Alexas or iPads to communicate or provide entertainment — or face-to-face Zoom meetings,” Stees said. bozemandailychronicle.com

IN PANDEMIC ERA’S ISOLATION, MEANING OF ‘SELF-CARE’ EVOLVES By ANNE D’INNOCENZIO and SOPHIA ROSENBAUM Associated Press been more focused on yourself,” said Rod

hese days, with a pandemic raging, this is what life can look like:

Staring at your face on Zoom for hours instead of occasionally glimpsing it in the mirror. Living out the days in loungewear. Wearing minimal makeup because no one sees much of you. Considering an investment in home exercise equipment because gyms are closed or restricted. The pandemic has forced people to spend more time with themselves than ever. Along the way, it has reshaped and broadened the way many think about and prioritize how they treat themselves — what has come to be called self-care. The pandemic-era incarnation of selfcare isn’t about buying a signature outfit, wearing a trendy shade of lipstick or getting a perfect haircut. It has, for many, put the purpose and meaning of life front and center, reconfiguring priorities and needs as the virusinflected months drift by. No longer are worries about longevity and fears of mortality mere hypotheticals. They are 2020’s reality. It is that daunting reality that has skyrocketed the importance of “me” time: stress-baking the latest viral creation, tending to a garden, learning a new skill, getting dressed like you’re going out just to feel some semblance of normalcy.

Little, CEO of Edgewell Personal Care, which makes Schick and Bull Dog products. “It’s beautifying for longevity, as opposed to how I look in the office tomorrow.” It’s also a way to mitigate the feeling that life is careening forward haphazardly in so many ways. That’s true for Tonya Speaks, a 43-year-old wardrobe coach from Fort Mill, South Carolina. Before the pandemic, she was always zipping to and from business meetings. Now, the mother of two teenagers exercises regularly and opts for luxurious baths at night instead of quick showers in the morning. She’s happier doing so. “Taking care of myself,” Speaks said, “is one way for me to have control.”

BEYOND THE ‘LIPSTICK INDEX’ Self-care isn’t a new fad. The difference is that pre-pandemic, it could fall by the wayside if a to-do list got crowded. Now, eight months into the new reality, it is a priority. After all, the thinking goes: If we’re not taking care of ourselves, how can we do jobs, parent children, care for loved ones? For those who have the means — and that’s no small caveat during this pandemic — feeling good can mean looking good. And the widespread isolation has produced new trends in beauty and clothing.

Companies like Signet Jewelers and Blue Nile are seeing a surge in sales of earrings, which are visible on video calls and when people are out wearing face masks. Department stores like Kohl’s and Macy’s are expanding casual clothing offerings as BEING KIND TO ONE’S SELF FEELS ESPECIALLY more people stay close to IMPORTANT DURING THE PANDEMIC, WHERE home.

“People are social beings. And while the social fabric has been torn down, and you can’t be a normal social person, you have

EVERY ASPECT OF HUMAN LIFE HAS BEEN IMPACTED AND THERE IS LITTLE CONTROL OVER WHAT’S NEXT.

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But when it comes to consumer products, the pandemic is pushing makeup aside as people gravitate

towards skin care products. The virus is even turning the “lipstick index” upside down.

Tamia Prescott sanitizes a cosmetic display Nov. 19, 2020, at an Ulta beauty store on Chicago’s Magniﬁcent Mile. AP Photo Charles Rex Arbogast

Typically, lipstick sales skyrocket when the economy gets rough because it is an inexpensive way to feel good. But during the pandemic, makeup sales have been rocky, and sales of skincare products are up. In fact, 70% of consumers scaled back their use of makeup this year, according to the NPD Group Inc., a market research firm. As a result, skincare has eclipsed makeup as the top category in the beauty industry’s market share from January through August. “This is a wellness revolution,” said Esi Eggleston Bracey, chief operating officer of Unilever North America’s personal care and beauty division.

A DEEPER IMPORTANCE How deep does this run? Is all the pandemic self-care working, or are people are just going through haphazard motions? One psychologist compares it to a roller coaster — up on some days, down on others. “Some days, you have a great day when you did all the things you wanted to do. You got up on time, you made a salad. And then the next day, it’s Cheetos for lunch,” said Dr. Vaile Wright, a senior director at the American Psychological Association. Being kind to one’s self feels especially important during the pandemic, where every aspect of human life has been impacted and there is little control over what’s next. That level of uncertainty is unnerving, Wright said, and further depletes already limited energy levels. Self-care, of course, is only one dimension of coping during stressful times. Surveys have shown a sharp increase in anxiety disorders. Many therapists are reporting upticks in referrals and increases in caseloads. Virtual mental health services are booming — another form of self-care, in a more medical sense.

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“Having a toolbox of coping skills is really critical,” Wright said. She highlights other types of self-care like meditation, journaling and organizing — each of which has its own culture and committed practitioners. “We have a tendency to isolate emotionally,” Wright said. “It is really important that people don’t do that.” Ultimately, “self-care” contains as many definitions as there are people who take care of themselves — a Google search of the term will show you that. The World Health Organization takes an expansive view, describing it as a “broad concept” that includes hygiene, lifestyle, social habits, income levels and cultural beliefs — and, in the best cases, can “strengthen national institutions” to encourage a society’s overall health. As the world navigates a web of unknowns that sometimes feels like the Upside Down in “Stranger Things,” there is one thing that people can do something about: themselves. For all the horror the pandemic has brought, it has also revealed things that matter. And from the way people have reacted through this year, it seems clear that, in all the forms it takes, self-care matters — particularly right now, particularly with so many unknowns still ahead.

COOLING STRESS TIPS:

HOW TO FILL UP YOUR

EMOTIONAL BANK ACCOUNT By JUDI LIGHT HOPSON Tribune News Service (TNS)

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Do you feel anxious when your checking account gets low? Most of us do. Our bank statements and incoming bills can cause a rise in anxiety. But, do you realize your emotional “bank account” can plunge as well? Too much stress, too many problems, too many demands on you can drain the life right out of you. When we’re stressed out, many of us tend to overeat. We might also overspend, watch too much TV, and stay on social media for hours. We’re trying to fill our spirit because the emptiness gets to be too much. That’s why it pays to guard your emotional bank account. How? You’ll need to make some “deposits.” Every person has his or her way of doing that. But, it’s better to choose actions that are healthy in the long run. Also, choose actions that are relatively easy to do. Once you get the idea, you can keep adding to the list.

HERE ARE SOME STRATEGIES TO FILL UP YOUR BRAIN AND SPIRIT WITH GOOD FEELINGS: •

Do what feels soothing to your senses. You might read a few pages in a good book, soak in a tub, or listen to music when you cook dinner.

•

Take a long nap when you get a chance. You might want to stretch out and relax on a Saturday afternoon. If you’re sleep deprived, this will feel like a gift to yourself.

•

Watch a few of your favorite movies. This is a healthy form of escape. You might select a movie you enjoyed in high school. Or, you might choose a Disney movie you loved as a child.

•

Forgive a couple of people who’ve hurt you. This really paves the way to let go of negative emotions. The purpose of forgiveness is to clear your own brain from psychological pain.

“I recently got on a ‘forgiveness’ kick,” says a financial adviser we’ll call Anna. “I decided to focus on tackling big goals I want to reach. For instance, I need to lose 25 pounds. So, to add energy to my get-in-shape willpower, I decided to let go of all bad thoughts.” Anna says she forgave her ex-husband, the woman he cheated with, and her ex-business partner who flubbed a couple of great financial opportunities for their company. “I’m a financial adviser, and I know my divorce and past business partner cost me a lot of money,” says Anna. “But, I’m making up for it all. I’ve got a good business sense of how to invest, and I’ll eventually be back on top!” Imagine going out to seize the day by having good emotions literally pouring out of you. These days happen when we’re dwelling on what’s right in our lives. “I have clients who are still grieving over lost love that died 10 years ago,” says a psychologist we’ll call Jack. “They are literally buried alive in bad thoughts. These thoughts all produce bad feelings. They can easily cause physical illness.” Jack helps those he counsels by helping them plan their good experiences. Each client is asked to keep a journal. “We spend a lot of time focusing on what memories and activities felt good in the past,” says Jack. “Some people bury all their past joy when one bad thing happens. I go in and help excavate their buried happy memories, hopes, and dreams. I help them slowly bring them back to life.” Jack concludes: “We each can easily make deposits into our emotional reserves. And, it usually costs little, if any, money.”

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HOW YOU CAN HELP VETERANS EVERY DAY By SHELLEY MACDERMID WADSWORTH Guest Columnist As the nation celebrates our 17 million living veterans, it is also important to know that the number of these heroes who are ending their own lives prematurely is rising. In the general population, suicide is the 10th most common cause of death, but among veterans with PTSD, it’s fourth. Among veterans younger than 35, it’s second. Suicide rates are also rising among members of the military. Since 2017, rates for active-duty service members have been above those of civilians. The same is true for National Guard

serious relationship difficulty with an intimate partner or someone else within the previous 90 days.

feel isolated. Families, friends, neighbors and colleagues all may have opportunities to make these catches.

And more than half of service members who attempt or complete suicide had been seen within those 90 days by a medical, mental health or social service professional. Almost one-third communicated a potential for self-harm.

Peer support programs may also help. Alcoholics Anonymous and Narcotics Anonymous are effective alone or in combination with clinical treatment for substance use disorders. Results regarding mental health problems such as depression are more mixed, but a consistent finding is that peer support can help promote compliance with treatment, communication with clinicians, improved coping and self-care, and increased feelings of hope and self-efficacy. Studies suggest that peer support can also help people during transition times, particularly when they are leaving military service to return to civilian life.

It’s not only medical professionals who can help a veteran who is dealing with despair and contemplating death by suicide. You can also help.

A ‘GOOD CATCH’ Some recent studies have suggested that a complex array of factors combine to lead a person to contemplate death by suicide. And many things contribute to the feelings of despair that veterans experience. In addition to post-traumatic stress disorder, other mental health problems and medical challenges, veterans also face unemployment, bereavement and parenting issues. It is easy to understand how veterans might feel overwhelmed and desperate.

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service members since 2015 and nonactive veterans for the past decade. I’m a researcher who studies risk and resilience in military and veteran families. I can tell you that the single most common stressor for those who attempt or complete suicide is a

Through my work, I’ve heard firsthand the stories of service members and veterans who had decided to take their own lives but did not. Often I’ve observed that it was a “good catch” that did it: a friend or family member answered a call at an odd hour; noticed the person seemed “off” and asked careful questions; stayed with them while summoning professional help; or checked in with them so they wouldn’t

Veterans themselves are taking action. In the Department of Veterans Affairs, peer facilitators are key to a new “whole health” approach. American Legion members also offer support aimed at preventing suicide. Across the country, veterans treatment courts routinely include mentors to boost the success of clients.

PEER SUPPORT IS OUT THERE Not all peers have to be veterans. Sometimes the strongest connections are with those who have had different challenges and who also can therefore relate — like a family member’s addiction, or one’s own disability or mental health problem. Many peer networks can help, including the National Alliance on Mental Illness, the

American Cancer Society and the Alzheimer’s Association. Even though they may not focus specifically on suicide, they help reduce isolation, increase social connections, and support coping and self-care.

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We can all help to prevent death by suicide. And joining a peer support program or training to make ourselves ready aren’t the only ways. Simply being more attentive as a friend, family member, neighbor or colleague can help. It is normal for a person to feel awkward when talking to someone contemplating death by suicide. Learning is a great way to prepare. For example, “Question, Persuade, Refer (QPR)” is evidence-based training that can help anyone recognize early warning signs of suicide, learn ways to offer hope and encouragement, and connect with help. If you or anyone of your loved ones are in need of help, call the National Suicide Prevention Lifeline at 800-273-8255 or text 838255. You can also get help at the Veterans Crisis Line and the Military Crisis Line.

PEOPLE WITH DEPRESSION FARE WORSE IN HEART HEALTH STUDY

AMERICAN HEART ASSOCIATION NEWS

eart disease and depression are interwoven, and a new study is helping unravel that connection by linking depression with poorer scores on seven important measures of heart health.

people with symptoms of severe depression were 3.1 times more likely to have worse cardiovascular health than people without depression. People with mild-to-moderate depression were 1.4 times more likely.

The research included more than 4,000 people taking part in a national survey who had been screened for depression using a basic questionnaire. Participants were evaluated for weight, smoking, diet, physical activity, blood sugar, cholesterol and high blood pressure — measures known as the American Heart Association’s Life Simple 7.

Lead researcher Dr. Brent Medoff said the study shows a clear link between depression and poor heart health, although it can’t explain what’s behind the connection.

After adjusting for factors such as age, race and income, the researchers found

“Whether it’s because they’re depressed and they don’t want to move around, or they’re not taking care of themselves, or they’re unable to get medication, (these) are things that we have to look for in other research,” said Medoff,

a resident physician at the University of Pittsburgh Medical Center. The research, presented this month at the AHA’s virtual Scientific Sessions conference, is considered preliminary until published in a peer-reviewed journal. Dr. Christopher Celano, associate director of the Cardiac Psychiatry Research Program at Massachusetts General Hospital, said zeroing in on the root causes of the relationship between depression and heart disease offers fresh details on a complicated interaction. He was not involved in the new research. It’s a two-way street, studies suggest. People with depression are more likely to develop heart disease. And people with heart

disease can experience depression. In fact, research suggests 15% to 30% of people with cardiovascular disease have depression — a rate two to three times higher than the general population. Celano said some of the connection is probably behavioral. People who are depressed are more likely to smoke, less likely to be active and tend to have a less healthy diet. But depression also has a physical side. It affects the nervous system in ways that can raise blood pressure and heart rate. It affects blood platelets, which can increase the risk of clotting. It’s also been associated with inflammation, which is linked to many diseases.

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“Depression and depressive symptoms are not just in the brain,” Celano said. “Your brain is connected to every other part of your body. We know more and more that these connections between the brain and the rest of the body go both ways. So things that happen in your body can affect how you think and feel. And changes in your brain can affect many different parts of your body, including your heart.” Debra Moser, a professor and assistant dean at the University of Kentucky College of Nursing in Lexington, said the new study shows that health care professionals need to do a better job of managing depression. “Basically, this evidence says we really need to start assessing people for depressive symptoms,” said Moser, who was not involved in the study. The U.S. Preventive Services Task Force in 2016 recommended depression screening for the general population, with an emphasis on people with cardiovascular disease. And an AHA advisory in 2008 recommended screening for depression in people with coronary heart disease. Screenings can be done easily with the same nine-item questionnaire used in the study, said Moser, who is actively researching depression in cardiac patients. People also

can watch for warning signs in themselves and loved ones. “People who really lose interest in what they used to do, and really kind of just feel down and depressed and don’t engage in anything they used to like, should begin to worry that they’re suffering from depressive symptoms that need to be managed,” she said. Medications, talk therapy and exercise can help, Moser and Celano said. People having depressive symptoms should speak with their primary care physician about getting a referral to a psychiatrist or other mental health professional, Celano said. That is “critical. And this is regardless of whether you have heart disease or not.” Medoff said with less stigma these days attached to mental health treatment, better communication can make for better overall health. “I think it’s going to be really important for patients to feel comfortable coming to their physicians and saying, ‘Hey, I feel I haven’t been able to do these things. I feel down,’ and for the physician to say, ‘OK, well, I think these are connected.’”

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“DEPRESSION AND DEPRESSIVE SYMPTOMS ARE NOT JUST IN THE BRAIN. YOUR BRAIN IS CONNECTED TO EVERY OTHER PART OF YOUR BODY. WE KNOW MORE AND MORE THAT THESE CONNECTIONS BETWEEN THE BRAIN AND THE REST OF THE BODY GO BOTH WAYS. SO THINGS THAT HAPPEN IN YOUR BODY CAN AFFECT HOW YOU THINK AND FEEL.”

SEASONAL AFFECTIVE DISORDER MARK SKRIEN Guest columnist Recently, people set their clocks back to Central Standard Time from Central Daylight Saving Time. This annual occurrence allows more daylight hours during the spring and summer. At about the same time, some sufferers of Seasonal Affective Disorder began to experience symptoms of depression that can last throughout the fall and winter months. Seasonal Affective Disorder (SAD) is a mood disorder associated with episodes of depression related to variations of light. The amount of sunlight that people experience during the spring and summer is greater than in the late fall and winter. It is thought that if sunlight affects the hibernation and other seasonal activities of animals, it may also affect humans. A theory is that when the daylight decreases, it may change our biological rhythms, causing an individual’s “biological clock” to be different than their daily schedules. Symptoms of SAD are: depression (including

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excessive eating and sleeping), weight gain, loss of energy, decreased activity, general sadness, and craving for sugary and starchy foods. Some sufferers are described as sluggish and lethargic. These symptoms can impact marriages, other relationships, and work-related activities. Most SAD symptoms subside in spring as daylight hours begin to stretch by a few minutes each day. The most difficult months for SAD sufferers are January and February. The most common theory about the cause of the disorder is the increased level of melatonin, a sleep-related hormone secreted by the brain. In the dark, it is produced at increased levels. When the days are shorter and darker, the production of the hormone increases, thus giving the body messages about sleeping, slowing down, i.e. messages that are similar to the symptoms of SAD. Seasonal Affective Disorder should not be confused with “holiday blues,” although they share

some of the same symptoms including sadness, weight gain, and lower energy. The latter is the result of increased stress during the holiday season. Phototherapy or bright light therapy suppresses the brain’s production of melatonin, thus informing the body not to go to a sleep mode. Many individuals respond well to phototherapy. A phototherapy light box uses white fluorescent lights and a metal reflector. The person turns the light on and sits in front of the light for a period of time (about a half hour) each day. Bright light therapy has proven to effectively reduce the intensity of the SAD symptoms. Antidepressant medication and brief therapy for support can also be effective treatments for some sufferers of SAD. A mental health professional can correctly diagnose and offer suggestions for treatment of Seasonal Affective Disorder.

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MAYO PSYCHOLOGIST DISCUSSES COVID-19, HOLIDAY STRESS By RYAN PATTERSON Leader-Telegram Staff

ith COVID-19 cases at an all-time high in the country, gatherings and celebrations in 2020 will look different than in previous years. Many will not happen, while others will take place over computers instead of in-person as public health precautions. With the holiday season underway, Craig Sawchuk, clinical psychologist and co-chair of the Integrated Behavioral Health Division at Mayo Clinic in Rochester, provided guidelines for navigating decisions and conversations with loved ones in the weeks and months ahead. Sawchuk laid out five tips to think about when determining travel plans for the holidays: make a decision based upon your values; have the conversation early about what you decided; don’t turn your decision into a debate; be flexible and open to doing holiday activities differently; and be realistically optimistic for the present and future. When informing people of your decision not to gather with them, for example, use simple, declarative messaging such as. “I love you, we want to spend time with you, and we’re choosing to stay at home,” Sawchuk said. Sawchuk said the best course of action is the “broken record routine” of a brief statement that clearly explains what you are doing without over-explaining why you are doing it. “If you’ve made this decision and it’s based upon your values, it really is not a debate,” Sawchuk said. Ideally, people can amicably agree to disagree. If that is not possible, suggest talking again after the holidays.

“TO AID ONE’S MENTAL HEALTH, HAVE SOME SENSE OF POSITIVITY WHILE STILL ACCEPTING THE SIGNIFICANT LOSSES FOR SO MANY PEOPLE THIS YEAR.”

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When talking about decisions with a spouse or partner that lives in the same household, people should communicate and be on the same page regarding what they decide. Sawchuk also said the only thing you can control is what you say and how you say it. You can’t control how others interpret what you say, so choosing words carefully is crucial. If conversations could result in you causing or receiving guilt, ask, “Is it more important to be right, or is the relationship more important?” Sawchuk said. Ideally, relationships have a strong enough history to overcome current difficulties. If you are physically separated, reach out early and try to figure out how to keep any traditions going virtually. Other options include sending care packages and writing letters to loved ones. “We’re adaptable; that’s the nature of being human,” Sawchuk said. To aid one’s mental health, have some sense of positivity while still accepting the significant losses for so many people this year. WELL-BEING RESOURCE GUIDE

“Be optimistic but not deluded,” Sawchuk said. If a person is grieving the death of a friend or family member, the first step is accepting how difficult this year has been. “It really is OK to not be OK,” Sawchuk said. “It’s normal to not really feel normal at this time … It’s been hard, and we have to acknowledge that it’s been hard, but maintain that optimism. Just imagine how good these get-togethers are going to be once we’re able to get back to living life normal.” There are fewer events to look forward to, like holiday celebrations, weddings and graduations, but some sense of optimism is vital in the months to come. “We will get to the other side of this, but we also are taking a lot of hits along the way,” Sawchuk said. “We will get through this. Sometimes we don’t actually know exactly how we will, but we’ve gotta trust that we are adaptable and we will get to the other side … Maybe we’ll celebrate twice as hard in 2021.” bozemandailychronicle.com

WORK THROUGH CHANGE THIS HOLIDAY SEABy CARRIE HADERLIE The Sheridan Press

or a healthy person under stress, for someone coping with the fallout from a worldwide pandemic and its impacts on day-to-day life, there is room for tears. “There is also room for laughter,” said Alicia Clark, a clinical psychologist and owner of Big Horn Psychological Services. “For some reason, in the day of 24/7 news that seems to want to draw people’s attention through gravitas, and in the era of political correctness, people are afraid to laugh anymore. Laughing at oneself or the overwhelming saga of life is a wonderful skill. Laughter is good, when it is about genuinely funny things that we can all appreciate about being human.” This holiday season, Clark recommended several ways to manage stress or feelings of sadness or disappointment. CONSIDER YOUR PERSONALITY in trying to find the best way forward. A one-sizefits-all approach for creating meaning will not work for everyone. Holiday music and decorations might be uplifting for some people, but others might struggle with outwardly-focused holiday trappings. “If people can embrace that this is going to be different and hard, that can help, because if they try to ignore it, it makes them depressed. They are not allowing themselves to grieve or get frustrated,” Clark said. CONSIDER RESILIENCE. It’s OK to be down about not seeing your family, but find intentionality and meaning by looking inward, Clark said. “I would encourage you to be very reflective,” Clark said. “Realistically, there isn’t going to be a year like this one again, so find a sense of the beauty in overcoming the struggle.” That could come from a hobby, or taking up painting or poetry. It may come from faith, or time spent in worship. It can come from honoring your friendships and family relationships, even from a distance. EMBRACE CHANGE, however hard.“If you can say, ‘Here is my challenging 2020 bozemandailychronicle.com

Christmas,’ you can begin to move forward,” Clark said. “Some people just really hate the change. I am one of those. It is not an easy thing to realize that change is a part of life, and definitely a part of this year.” PRACTICE GRATITUDE. Gratitude is not a feeling, but an attitude or a perspective. To practice gratitude, deliberately focus on the things you are grateful for, and then put weight or value into the thought by either expression or action. Following those actions, the feeling of appreciation occurs, which combats depression or self-pity. However, if someone around you feels hopeless, it’s not a good idea to say there is nothing to be hopeless about — a hopeless person can always think of discouraging things. The more helpful perspective is: “I may feel hopeless right now, but in the middle of this, I’m drawing to mind the things I’m so thankful for. I have this person in my life; I have this job; I have my health; I have these muscles; I get to enjoy this food; I can enjoy this painting; I love the look of the stars tonight,” Clark said. Even being grateful for life’s challenges can be healthy, Clark said, because sometimes they help you appreciate other things more. HELP OTHERS. “It is not an ideal year, but when you can do things for others and push yourself through, if you have that capacity, it is really going to help,” Clark said. Simple acts of kindness like standing on the street corner in your nuclear family and singing Christmas carols or leaving groceries outside for someone who is in quarantine are both examples. Helping others can get your mind off your own sadness. If you’re struggling with depression, anxiety, substance abuse or other mental health issues, get help. “I would not hesitate to get help,” Clark said. “The holiday season is a high-suicide time, and this year alcoholism and depression have gone significantly higher. It really does help to be proactive in saying, ‘This Christmas might be tougher than normal. I better get help, even if it is just a few sessions to have someone you really can talk to.’ That can be a real game changer for some people, and I would honestly do that now before the holidays.” WELL-BEING RESOURCE GUIDE

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“REALISTICALLY, THERE ISN’T GOING TO BE A YEAR LIKE THIS ONE AGAIN, SO FIND A SENSE OF THE BEAUTY IN OVERCOMING THE STRUGGLE.”

CONNECTING TO NATURE IS GOOD FOR KIDS — BUT THEY MAY NEED HELP COPING WITH A PLANET IN PERIL By LOUISE CHAWLA, University of Colorado Boulder

s an environmental psychologist who works to improve young people’s access to nature, I recently completed a review that brings two bodies of research together: one on connecting children and adolescents with nature, and the second on supporting healthy coping when they realize they are part of a planet in peril. My review shows that children and adolescents benefit from living near nature and having adults in their lives who encourage free play and outdoor discovery. When they feel connected to nature, they are more likely to report good health and a sense of well-being, more likely to get high scores for creative thinking, and more inclined to show cooperative, helping behaviors. They are also more likely to say they are

taking action to conserve nature, such as by feeding birds, saving energy and recycling. On the flip side, lack of access to nature has adverse effects. For example, COVID-19 restrictions on travel and social gathering led more people to visit parks to escape stress and move freely. But some families don’t have safe, attractive parks nearby, or their local parks are so heavily used that it’s hard to maintain safe distances. Under these conditions, city families stuck indoors reported mounting stress and deteriorating behavior in their children. My research literature review also shows that feeling connected with

1. CREATE SAFE OPPORTUNITIES TO SHARE EMOTIONS When family, friends and teachers listen sympathetically and offer support, young people are more likely to feel hopeful that people’s actions can make a positive difference. Opportunities to envision a promising future, plan pathways to get there and have hands-on experiences of working toward this goal also build hope.

2. ENCOURAGE TIME OUTDOORS IN NATURE Free time in nature and opportunities to develop comfort and confidence in nature are positive experiences in themselves; and by boosting well-being, providing time in nature can contribute to young people’s resilience.

3. BUILD COMMUNITY WITH OTHERS WHO CARE FOR NATURE Meeting other people who love and care for nature affirms young people’s own feelings of connection and shows them they’re not alone in working for a

nature can bring difficult emotions as well as happiness and well-being. When young people are asked about their hopes and fears for the future, many describe environmental breakdown. For example, when a doctoral student I supervised asked 50 10- to 11-year-olds in Denver what the future would be like, almost threequarters shared dystopic views: “Everything will die out, and there will be less trees and less plants, and there will be less nature. It just won’t be such a great Earth anymore.” “I feel sad because the animals are going to die.” “I feel sad because when I die I am probably gonna have a grandson or a great-grandson by then and maybe

them or their son or nephew is going to have to experience the end of the world.” Children who worry about the environment are likely to report that they are doing what they can to protect nature, but they almost always report individual actions like riding their bike to school or saving energy at home. Knowing that climate change and biodiversity loss are bigger problems than they can solve themselves can affect their mental health. Fortunately, the research also shows some key ways adults can help children and teens work through these feelings and maintain hope that they — in alliance with others — can address environmental problems constructively.

better world. Learning individual actions that add up to making a difference, or joining collective efforts to improve the environment, simultaneously demonstrate a sense of connection with nature and commitment to its care.

4. EMPOWER THEIR IDEAS It’s important to treat young people as partners in addressing environmental problems in their families, schools, communities and cities. A boy who was part of a group of children who created climate action proposals for his city in the Mountain West summarized the benefits. After they presented their ideas to their city council and got approval to launch a tree-planting campaign, he noted, “There’s something about it … getting together, creating projects, knowing each other, working together.” Research is clear: Children and young people need free time to connect with nature, but it’s also important to support them when they struggle with the consequences of feeling part of a natural world that is currently at risk. This article is republished from The Conversation under a Creative Commons license.

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MEMORIAL CHRISTMAS TREE WILL AGAIN HONOR THOSE LOST TO OVERDOSE By TYLER WOMBLES The Daily Times

hen his daughter passed away due to overdose in 2018, Tim Webb had no hope.

“I never thought I was going to recover,” Webb told The Daily Times. But two years later, he is part of an effort to use a seasonal staple to remember and honor his daughter and others that have lost their lives to overdose. This holiday season, the Blount County Justice Center will host a memorial Christmas tree for the second year in a row. The tree will sit just outside the center’s entrance and will be decorated with ornaments in remembrance of overdose deaths. The ornaments will be placed on the tree, and for those without ornaments, stars with loved ones’ names written on them will be used in their place to decorate the tree. “Just because our loved ones are gone, that doesn’t mean they have to be forgotten,” Webb said. The tree is the brainchild of Webb, fellow community member Jan McCoy and Blount County Sheriff James Berrong. McCoy, who lost her son to an overdose death, and Webb met with Berrong and Rob Talbott, who oversees the Fifth Judicial Drug Task Force, last year. Webb and McCoy wanted to do something to memorialize those lost to overdose, and the group brainstormed a Christmas tree. The original plan was to put it in the Blount County Courthouse, but Berrong later decided he wanted the tree to sit at the Justice Center, Webb said. The goal? To bring awareness to the overdose issue while allowing families a unique chance to remember those lost. “It would give some of these parents an opportunity to honor their child that they did not die in vain,” McCoy said. “And having it at

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the justice center with Sheriff Berrong’s blessing makes it all the better.” That awareness is especially crucial now, as overdoses rise amid the COVID-19 pandemic. McCoy cited the crisis’ negative effect on mental health, as social distancing can lead to isolation and thus a loss of the support and help needed to overcome addiction. “The opposite of addiction is community … We do have an epidemic in addition to the pandemic,” McCoy said. And the tree won’t put a damper on the community budget, according to McCoy. An area Home Depot is slated to donate the tree, and McCoy said she will work with the local parks and recreation department to attach lights to it. The tree will first be decorated in a basic way before its true attraction, then the ornaments are added. “That day is when it’s really emotional,” McCoy said. “But it’s also really, really neat.” The tree will also feature purple and silver colorings, as purple is the official color of Aug. 31’s International Overdose Awareness Day. McCoy estimated about 30 people attended last year’s tree decoration, and she’s hoping for many more this time around. She has worked to get the word out via Facebook, as has the Blount County Sheriff’s Office, which shared a promotional image for the tree decoration on its own Facebook page. McCoy and Webb also have the support of Berrong, who Webb said was enthusiastic about making the tree an annual fixture. The hope remains to honor those lost while bringing awareness to the horrors of drug addiction and overdose.

Jan McCoy, a local addiction activist, hangs an ornament on a memorial Christmas tree in 2019. Andrew Jones, The Daily Times

“THE OPPOSITE OF ADDICTION IS COMMUNITY … WE DO HAVE AN EPIDEMIC IN ADDITION TO THE PANDEMIC.”

“Every single day across the country, people are dying over this,” Webb said. “And they’re leaving behind mothers and fathers and children, sons, daughters.”

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O U R C O M M U N I T Y. O U R B U S I N E S S .

BEHAVIORAL HEALTH IN BIG SKY ADDRESSING THIS CRITICAL NEED On Wednesday, November 18th, in a COVID-safe event, the Big Sky Chamber convened a group of engaged local health care providers, nonprofit organizations and donors to speak to the critically important issue of Behavioral Health in Big Sky. In working to Create A Positive Business Climate for our members’ workforce, the Chamber believes that the issue of behavioral health is vital to our community’s sustainability. The presenters shared the work that their individual organizations are undertaking to address the fragmented delivery system in the continuum of care and announced the collective impact model to address this need.

KEY TAKE AWAYS FROM THE COMMUNITY HEALTH NEEDS ASSESSMENTS • MONTANA IS 40 IN ACCESS TO MENTAL HEALTH th

• ONLY 12% OF THE MENTAL HEALTH NEED IS MET We have social isolation, we have stigma, we have alcohol, we have access to lethal means, we have poverty, we have altitude, we have Vitamin D deficiencies, [and a lack of] access to resources. In the Rocky Mountains, we have a perfect storm of things... – KARL ROSSTON, SUICIDE PREVENTION COORDINATOR FOR THE STATE OF MONTANA

THERE IS HOPE CALL 211 to speak to a crisis counselor and receive immediate help Telehealth services are increasing with local partners offering digital options Bozeman Health Big Sky Medical Center has added two in-person behavioral health practitioners Bozeman Health and Madison Valley Medical Center have partnered together to increase their impact in the area A Big Sky Behavioral Health Coalition has been formed to create an integrated network of behavioral health services and preventative programs

THE BEHAVIORAL HEALTH COALITION The formation of the Behavioral Health Coalition, founded by Bozeman Health, Western Montana Mental Health Center and Yellowstone Club Community Foundation was announced at this meeting. Y.C.C.F. will lead the collaborative by hiring a dedicated Behavioral Health Coalition Director to support partner coordination, oversee community development of health and wellness programs, and direct community outreach from their new office in Big Sky Town Center. To learn more, visit their website yellowstoneclubfoundation.org/

This event can be viewed at BigSkyChamber.com/BehavioralHealth thanks to the generosity of our sponsors: