New England Psychologist, Mar 2018

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AN INDEPENDENT VOICE FOR THE REGION’S PSYCHOLOGISTS

VOL. 26, NO. 2

Societal norms of masculinity still play a Vermont prison complex role in men’s reluctance to seek treatment meant to accommodate “Real Men. Real Depression,”

By Phyllis Hanlon multiple populations and the military’s increased ore than six million men are diagnosed with depression, according to the National Institute of Mental Health (NIMH). Left untreated, this condition can lead to a plethora of difficulties related to family, friends, and career. Psychologists around New England examined the complexity surrounding the issues of males seeking psychological help.

According to Michael E. Addis, Ph.D, professor in the department of psychology at Clark University in Worcester, Massachusetts, research has found that men utilize mental health services less frequently than women because of negative attitudes.

“There are individual differences in the degree to which men buy into the societal norms of masculine ideology,” he said. “It’s important to be

Mark Holbrook, Ph.D, LCPC, treats law enforcement and military personnel at his private practice in Maine.

they’ll think about seeking help,” Addis said.

In his book “Invisible Men,” Addis explores a male paradox. “On one hand men are highly visible,” he said, citing the prevalence of males in

“Therapy is not a quick fix. It’s harder with men to process difficulties at the level of emotion versus cognition.

They want practical steps.”

Rick Barnett, Ph.D, private practitioner in Stowe, Vermont and founder/president of Carter, Inc. self-reliant at all times and stay in control of emotions.

Number one is not doing anything perceived as feminine; seeking mental health services is seen as a more feminine act.

It produces a greater degree of fear and shame.”

Additionally, men have difficulty in recognizing personal emotional distress. “They appear to have a higher bar for considering mental health a problem. They think if they can get themselves to work, they’re okay. But when they can’t get out of bed, then

business, politics, entertainment, and other areas. “But they have personal vulnerability, which is related to the cost of ‘staying power.’ They keep their real selves hidden. This gives rise to untreated depression,” he said.

Addis feels that the situation has improved. He finds that male college students are somewhat more amenable to acknowledging and seeking counseling, most likely because of readily available on-campus resources.

Campaigns, such as NIMH’s

attention to mental health problems have also made some strides. “But whether that translates to greater use of mental health services remains to be seen,” Addis said.

“The longer I study, the more I’ve come to view this as less and less an individual issue. It’s a social and cultural issue. We need to head toward changing the message on a broad scale. We have to have day-to-day conversations with boys and de-emphasize gender, but focus on healthy living,” Addis said. “Men need to take the risk of being real.

When they do talk, they’re often met with relief and validation.”

While males in general are reluctant to seek help, those in the military and law enforcement are particularly disinclined, according to Mark Holbrook, Ph.D, LCPC, private practitioner in Brunswick, Maine, whose client base predominantly comprises this population.

Prior to opening his practice in 2003, Holbrook served as a police officer so he clearly understands the everyday stressors that can precipitate psychological and emotional difficulties.

He explained that men, in general, are not very comfortable with emotions and struggle to identify their own feelings. But for his clients, acknowledging emotions falls outside the traditional stoic nature of the military and law enforcement. “[Police officers] respond to crises and have to be effective dealing with whatever the situation is. Situational stoicism is crucial to success. The problem becomes--’what happens when they leave the crisis situation?’” he said. “They compartmentalize and to some degree are able to do this Continued on Page 11

By Janine Weisman ixing the mental health system is a key part of a plan Vermont Gov. Phil Scott’s administration introduced to the State Legislature in January to build a 925-bed prison complex in northwest part of the state over 10 years.

Fifty forensic beds — 20 reserved for hospital level care and 30 for outpatient or residential level care — are part of the $150 million corrections campus outlined in the Agency of Human Services (AHS) Report on Major Facilities.

AHS oversees both the Department of Corrections and the Department of Mental Health.

The plan to create the large complex in Franklin County by 2028 also calls for 457 beds for male inmates, 175 beds for female, 120 beds for federal offenders, and 50 Americans with Disabilities Act-compliant beds for aging/infirm men.

There also would be three booking and receiving beds and 18 infirmary beds, including two hospice and three quarantine.

An additional 25 beds for youth offenders is part of the plan if the state does not rebuild the Woodside Juvenile Rehabilitation Center adjacent to the current facility in Essex.

Vermont lost Medicaid funding for Woodside in October 2016 after federal regulators deemed it a correctional

facility and not an appropriate therapeutic setting for youth ages 10 to 18 in the custody of the Department of Children and Families.

HS Secretary Al Gobeille said funding for a replacement for Woodside would be included in a two-year capital bill Scott would present to the Legislature next January if reelected this year.

If not, the 25 adolescent beds would become a separate unit in the large prison campus.

“We’ve been clear in the report and with the Legislature that we don’t know if it’s the right size, we don’t know if they’ll agree with us on location, we don’t know if they think the timing’s right,” Gobeille said.

“It might need to be built in stages, so we’re really openminded and flexible because there are a lot of problems that this report identifies. Reasonably people could disagree on what the first, second, third, and fourth steps should be.”

All four of Vermont’s high acuity mental health treatment facilities have critical problems, the report states. In addition to the funding problems with Woodside, both the Vermont Psychiatric Care Hospital (VPCH) in Berlin and the Brattleboro Retreat are at risk of losing Medicaid funding in 2021.

The seven-bed Middlesex Continued on Page 11

INSIDE

In-service training to focus on police officers’ mental health....................Page 5 States await decision on Medicaid work requirements.....................................Page 6 CE listings.................................................Page 13

2

New England Psychologist

March 2018

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March 2018

New England Psychologist

3

Research looks at link between relationships, suicide ideation Katie Lewis, Ph.D., a research psychologist at the Austen Riggs Center in Stockbridge, Mass., is the recipient of the Robert S. Wallerstein Fellowship in Psychoanalytic Research.

The fellowship carries with it a minimum of five years.

The San Francisco Center for Psychoanalysis chose to support Lewis’ research on the impact of interpersonal relationships on suicidal ideation and urges.

The study will track up to 150 residents of Austen Riggs, a psychiatric hospital and residential treatment program, over a period of two weeks through a smart phone app designed by Lewis’ team. The purpose of the research is to understand how relationships can act as both a protective barrier to or a risk factor for suicidal behavior.

New England Psychologist’s Catherine Robertson Souter spoke with Lewis about the grant and the study it will help to fund.

First, congratulations on the Fellowship.

Robert Wallerstein was a huge proponent of empirical research in psychoanalysis. Suicide has become a major public health issue and it is a major clinical issue for our patients here at Austen Riggs so it feels wonderful to get the support to do this important work, in this setting, and to have it come from a figure in the field who was so important to promoting psychoanalytic research.

How will the grant help?

We are a small psychiatric hospital and our access to large samples of patients is limited because the care that we provide is so

focused. In order to collect enough participants to be able to run the kinds of statistical analysis that we would have to do will actually take three to four years.

Having grant funding for the duration helps us focus on the day-to-day practical work instead of having to worry about finding resources.

Tell us about the study.

In the field of suicide research, the majority of studies focus on the risk and protective factors of suicide, the broad things that are familiar to most people like depression, hopelessness, impulsivity.

While that research taught us what might lead a person to be vulnerable to acting on suicidal impulses, it doesn’t get at the level of immediate prediction, who might be at risk on more of a momentary level. Also, what sources of risk might interact with personality factors to really increase the immediacy of danger for a particular individual?

Relationships could be looked at as either a risk or a protective factor. A strong relationship could be a great buffer against stress but if relationships are going poorly, they can be a source of vulnerability for people who are feeling suicidal.

In our project, we are trying to take all of this into account.

Participants fill out questionnaires at the start and give information about levels of depression and any history of trauma they might have, so we have overview of what challenges they may be dealing with on a day to day basis.

During the study, we have them fill out brief questionnaires about their interpersonal interactions using their

smartphones. The questions take a minute or two and ask them to describe their experience of themselves in the interaction; whether they felt that they acted particularly friendly or unfriendly; if they felt like they were taking more of a leadership role in the interaction or if they were being a little bit more passive; if they felt hopeless or burdensome or more anxious.

Then, along the same dimensions, (we ask) how they experienced their interaction partner acting. We trace how those dynamics fluctuate and change over time and look at how this impacts mood and how these factors might translate to any presence of suicidal ideation or urges to either do self-harm or any other sort of externalizing behavior that would be problematic.

Our hope is to trace whether there are particular interpersonal dynamics that contribute to risk.

Are there plans to disseminate the information to clinicians?

Within our institution, I give regular feedback and updates to staff about the findings. This is useful not just to communicate to them but also to get their feedback about their impressions and their clinical wisdom about how to

interpret the results.

We are looking to continue doing conference presentations, getting out in front of broader professional audiences, and I am doing a single page presentation in a few months.

We are definitely planning on publishing our results and once we have a larger sample, I would like to find ways to bring it to our local community and different venues, school systems or other people who might be encountering suicidal individuals.

Personally, why did you get involved in this type of research?

I came to Austen Riggs after my first year of graduate school as a summer research intern and began working with Dr. Jane Tillman, [PhD, ABPP] and she inspired me to shift my focus and get involved in suicide research.

I find suicide really compelling as a research topic because it is such a significant public health issue. There has been a lot of research done and it is still not necessarily a well understood topic. There are models for prevention but there is still so much we have to learn.

The risk screening tools we have are still asking at a general level. The tools ask about depression and trauma history or hopelessness and these are things that are actually so common in patients seeking mental health treatment that it doesn’t necessarily do a great job at differentiating someone who might be at risk from someone who is not.

It is not that these questions are not important to ask but they are not enough. Research has an important role to play

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in how to refine what questions we are asking.

Is there a higher rate of suicide currently or are we hearing more about it?

It’s both, honestly. The CDC has a report that came out within the past year showing suicide rates have increased across almost all demographic groups in the last 15 years.

I think that there is also more public discussion about it, it is a slightly less taboo subject than it has been in the past. We had a whole blog series talking about how the Netflix production “13 Reasons Why” sparked a lot of discussion. The more the issue is raised the better, but definitely it is also reflective of the numbers rising.

There has also been a lot of controversy about how suicide is reported. There are inconsistent ways of reporting suicide as a cause of death from county to county depending on different coroner approaches. Even with national epidemiological studies of suicide prevalence, most will say up front that it is probably an underestimate.

What are your followup plans?

I would love to be able to do the study in other settings. University samples or outpatient mental health samples would tell us if our model holds outside a residential setting. Also, we are considering trying to integrate collecting physiological data for people who might have trouble identifying their own experiences of stress and anxiety. We could look at whether the self-report is matching up with physiological signals. n

Full time psychologist needed for a multi-disciplinary group practice with offices in Worcester, Westborough and Fitchburg, MA. We offer highly competitive reimbursements, collegial environment, comfortable offices and a varied, interesting case load. This is an employee position.

CV with letter of interest to: michaelcirillo@hotmail.com or contact Dr. Cirillo at 508-791-3677 www.cornerstonebehavioralhealth. com

4

New England Psychologist

In Person

March 2018

Editorial

You know you’re getting old when ... e’ve all heard it said that you’re only as old as you think you are, but I’m proud of my three score and ten. This milestone is a privilege denied to many and each new day is a gift to be used well, enjoyed, and savored.

I am also aware that 70 is not especially old.

According to gerontologists, it is threshold of our senior years, the midpoint of a stage of life beginning at 65 called the young old to be followed, if we are lucky, by the old beginning at 75, and the oldest old at 85.

Still, certain things have been happening to me since I retired, but especially since my last birthday, that I cannot help but think are related to my entry into this new territory. For now, I am taking them as signs that the years have piled up in spite of my efforts to cultivate a light heart and a playful spirit.

Here are some of them.

1) Pre-recorded telephone calls where the caller, usually a cheerful female voice or a threatening and animated male, warn you that you have or will have a serious agerelated problem you hadn’t ever considered.

Most of the time I can avoid these annoyances by screening my incoming calls but the other day, unsure of whether or not I might know the caller, I answered.

“Did you know, asked the cheerful woman, “that according to our statistics, you may be suffering from chronic pain and there is something you can do about it?” Well, no I didn’t and, thank goodness, I’m not. What I really want to know is who are you and who gave you the right to interrupt this day that I am trying to use well and savor with your so called statistically-informed ideas about my hypothetical pain. Of course, I couldn’t ask that question because she was a robot and, though I was annoyed, I was unable to curb my habit of responding politely with a no thank you when I ended the call.

The male version of this kind of call comes with two messages, both delivered in a tone of horror that you might expect from someone warn-

Alan Bodnar, Ph.D. ing you that your hair is on fire and it’s all your fault. Both messages begin with a Did You Know, move quickly to a You Could Be Next, and end with an Unless You Act Now and buy our remedy. Did you know how many people over the age of 60 suffer serious falls? Did you know that so many thousands of people over the age of 60 are victims of burglary? No, I didn’t. And, no thank you, I’ll be careful and take my chances.

2) Heightened awareness of television commercials for prescription medications to treat maladies of all kinds, especially those more common in our senior years.

In truth, it’s probably not that I am just more aware of these commercials. It’s likely that there are more of them to begin with. Advertisers are smart people and they’ve done their homework to know that people over 65 are the fastest growing segment of the US population.

According to statistics from the US Census Bureau, the over-65 crowd comprised 15.2% of the population in 2016 and, with the aging of the baby boom generation, this number is expected to grow to 20% by 2029.

Consequently, we are hearing more about medications to reduce blood sugar and cholesterol levels, to thin our blood to prevent heart attacks and strokes, and to ease muscle and joint pain.

In themselves, these are good things but how often do we need to be asked if it isn’t time to talk to our doctor about the wonder drug of the hour?

3) Sensitivity to the implied threat in drug commercials.

Call me hypersensitive on this one but, after all, I’m a psychologist trained to detect the subtle nuances of verbal and nonverbal communication. So, I naturally cringe when the guy with a clipboard asks the man in the street if he thinks his illness has anything to do with increased risk for cardiovascular disease and the man answers no, only to be told that he’s wrong and in for a lot more trouble than he is already expecting. Of course, there’s a pill for that and the clipboard guy, smiling now, is only too happy to remind him to talk to his doctor about it.

4) Talking to your doctor.

My doctor seems like a nice enough guy though we’ve only met once since his predecessor retired last year. Still, three chats per year is a bit more than I’m used to, especially with all the tests that come with them.

He tells me that I have to be careful because of a manageable condition of which I am in the “pre” stage. When I told an older friend about this, he wisely remarked that we are all “pre-something” unless we already have it. I get it and I’m not complaining. The idea is to remain “pre-dead” for as long as possible and that’s what doctors are for.

5) People doing more nice things for you than ever. Here are just a few of them: the city letting you ride on streetcars, subways, and buses for half price, people giving up their seats for you when there’s standing room only, merchants offering reduced ticket prices for movies, museums and restaurants, a neighbor using his snow blower to help to help you clear the snow from your driveway. It’s a relief that not all the signs of getting older are annoyances but it does make me wonder how the guy who offered me his seat on the streetcar knew my age.

6) A compulsion to write essays about growing older.

We all have a story to tell and there’s always another chapter. n Alan Bodnar, Ph.D. is a psychologist formerly at the Worcester Recovery Center and Hospital.

A proper introduction Many of you are familiar with Psych Central, and hopefully for those of you who are, you’re as happy as I am that we’re able to carry on the wonderful publishing tradition of New England Psychologist. But I suspect there are many professionals who are unfamiliar with us or our history.

The roots of Psych Central began while I attended Nova Southeastern University working on my doctorate. In my first year there in 1990, my childhood best friend took his own life back home. As anyone who’s been touched by suicide knows, it was a devastating loss.

It also drove me into a deep depression which I didn’t even recognize as such at the time. I turned for support not to the few fledgling friends I had just met at school, but rather to the Internet. Having been deeply ingrained in computing culture as a programmer since I was a teen, I regularly used email and other online services long before most of my peers.

It was online that I found support for my depressive feelings, through what we would call forums today. I didn’t even know such things existed until in my moment of need, I searched them out.

That was one of the largest problems at the time – before the web and everything we take for granted today (such as social networks and Google). Information and communities were extremely difficult to find.

Because of my own positive experiences and belief in the value of online communities, I set about solving this problem by collating and publishing indexes of mental health and psychology resources online at the time. This effort began in earnest in 1992.

In 1995, I put my collection of indexed links on the web on a site called Psych Central. Today, that collection has transformed into being one of the largest and most well-regarded mental health resources around the world.

When I was a teenager, I couldn’t imagine being anything but a good therapist, helping people overcome serious difficulties in their lives, one at a time. But sometimes life takes you on a different, unexpected path.

Today, I am both blessed and honored to oversee a collection of information and resources that help millions of people every month better understand and improve their mental health.

Thank you for being a part of this great journey. Together, I think we can continue to make significant strides in reducing stigma surrounding mental illness. It is because of clinicians like you that this progress is even possible.

John M. Grohol, Psy.D. Publisher

Publisher:

Editor-in-Chief:

Contributing Writers:

Graphic Designer:

John M. Grohol, Psy.D. Psych Central Susan Gonsalves Pamela Berard Alan Bodnar, Ph.D. Phyllis Hanlon Catherine Robertson Souter Eileen Weber Janine Weisman Karen H. Woodward

New England Psychologist is published 11 times a year (no August issue) by New England Psychologist, P.O. Box 5464, Bradford, MA 01835. It is mailed at no charge to all CT, ME, MA, NH, RI, and VT licensed psychologists. Distribution of this publication does not constitute an endorsement of products and services. The publisher reserves the right to reject any advertisement or listing considered inappropriate.

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New England Psychologist P.O. Box 5464 Bradford, MA 01835 Tel. 978-225-3082 www.nePsy.com

March 2018

New England Psychologist

5

Book Review

Insightful book looks at treatment of traumatized patients

By Stan Rockwell, Psy.D

about their life quality and emotional health,” she writes.

Rothschild addresses evidence-based practice in a way that I wish more would do. She points out that all research is biased, and that outcomes-based research may be the most biased of all.

She gives an example from her own experience with irritable bowel syndrome (IBS) and the very different advice she got from three different doctors – her primary care physician, her cardiologist, and her gastroenterologist.

She also cites the 2005 work of Ioannidis, which comprehensively deconstructs the accuracy of research. She points out that no one treatment in trauma stands out as superior to any other, and that it is important to have several tools in your tool box.

I was reminded of the ongoing work of Scott Miller in looking at what works in therapy. He has been advocating similar ideas for years, and talks about “practice-based evidence” versus the standard “evidence-based practice.”

“The Body Remembers, Volume 2” includes an updated overview of the autonomic nervous system and includes

information on the polyvagal system and theory. There is a chart insert on physical signs to look for to help you monitor your client’s arousal state as well as your own.

I found this tool to be very useful, both conceptually and pragmatically.

There are also case studies and transcripts of therapy sessions to help guide readers in doing the work. Rothschild also shares what has worked and what has not worked for her in counseling clients, and I appreciate her candor.

She also emphasizes culture, and cites the work of Ethan Watters’ 2010 book Crazy Like Us, which is one of my favorites. We can actually do damage when we try to put our evidence-based practice theories into one-size-fits-all therapy. Watters gives good examples.

We do carry memories in our bodies, and it is important for both the client and therapist to be aware of that and understand it in the context of the way we work with the body in recovery from trauma.

For more about Babette Rothschild, visit her online at www.somatictraumatherapy. com. n

In-service training to focus on police officers’ mental health

type of education rather than treatment which could help to erase the stigma surrounding it.

It is an issue that has greater reach than just with the officer and his or her family.

“Public safety depends on the health and wellness of our police force,” said Barry Feldman, Ph.D, director of psychiatry programs in public safety and assistant professor of psychiatry in the University of Massachusetts Medical School Department of Psychiatry.

“We must be proactive and not reactive when an officer’s mental health is concerned.

“Police have one of the most toxic careers in the world,” he added. ”Officers get tactical training but the impact of the human elements can be devastating.”

The bill has been referred to the Committee on Health Care Financing and will then face another committee to await further action. n

ears ago, a friend of mine told me about a case that still haunted him. It involved a little girl who had been sexually abused whose parents felt she should tell all on the witness stand so that she could recover. When her testimony began, she started screaming and could not stop.

Often people come to therapy thinking they must relive the trauma in order to come to grips with it, and want to begin telling the story in detail almost as soon as they sit down.

As Babette Rothschild points out in “The Body Remembers, Volume Two,” when clients do that, they can become overwhelmed and re-traumatized and unlikely to return to therapy.

In fact, telling all may not be a requirement to get better for a person. At one of her workshops, Rothschild asked therapists to raise a hand if they had experienced trauma.

Many raised their hands.

She then asked how many were functioning well with-

By Catherine Robertson Souter here were 19 deaths of police officers by suicide in Massachusetts in 2016 and 2017, the fourth highest number of suicides in the country. That is not fourth highest rate per 1,000 but fourth highest total number overall. The state is the 15th largest by population.

According to Blue H.E.L.P., a non-profit law enforcement mental health awareness group based in Auburn, Mass., there were 286 deaths nationwide.

A bill currently before the state’s legislature looks to address the issue by mandating in-service training on mental health as well as annual mental wellness and suicide prevention courses for all current officers.

“This bill is critically

out having gone into detail in therapy about the trauma.

Most hands, usually about half to four fifths, stayed up.

“Trauma treatment does not need to be traumatizing,” writes Rothschild.

The work of Pierre Janet is central to Rothschild’s work.

At the end of the 19th century, Janet proposed a threephase treatment for trauma.

The first phase is establishing safety and stabilization. This process, which Rothschild identifies as essential, can take anywhere from hours to years.

Only after the first phase is established can phases two and three be addressed, but Rothschild says that phase one alone can also be enough for some clients.

Phase two is the processing and resolution of trauma memories, while phase three focuses on integrating the gains from phases one and two into everyday life. The ultimate goal is to help the person function better, so if the client chooses to address their traumatic memories, that is their choice, not the therapist’s.

The process of resolving trauma includes taking a good history, finding out what spe-

important to help police officers understand their own human frailties and know they are vulnerable to the effects of cumulative PTSD,” said Rep. Timothy Whelan, (R-Brewster), who co-sponsored the bill. “For every officer who loses their life in the line of duty, four to five officers take their own lives due to the cumulative effects of PTSD.” “This isn’t just a suicide prevention issue,” Whelan added, “although that is of critical importance, but also an effort to help improve lives for suffering officers and their families who suffer with them.

Not every case of PTSD ends in suicide. Many more afflicted officers carry on with their quality of life diminished by self-medication through alcohol and drugs or failing marriages.”

Whelan, a former sergeant with the Massachusetts State

“The Body Remembers, Volume 2: Revolutionizing Trauma Treatment”

By Babette Rothschild W. Norton and Company cific factors led the person to come in for therapy, and coming up with a good treatment plan. Importantly, the treatment plan is based on what the client wants to accomplish – not what someone else wants them to accomplish.

“It is never a good idea to follow a third party’s agenda,” write Rothschild.

But this can be difficult.

When I worked in public mental health, there was often pressure to have referring agents’ goals take precedence over clients’ goals.

At other times, it may be a family member or someone else in the client’s life who has an agenda separate from the client and is pushing them.

I appreciated Rothschild’s emphasis on the client being the expert on his or her life.

“The therapy should be

Police for 22 years, has seen the devastation that comes from an officer’s suicide and also the difficulty within the profession in addressing the problem of stress and trauma.

“The need has existed for decades,” he said. “I am the third of four generations as a police officer and, going back generations, this issue was never discussed in the police station or the barracks, period. It has been a deeply buried ‘family’ secret, so to speak, one that law enforcers (including me) buried our heads in the sand and pretended didn’t exist because it was too painful to face. We failed. I failed.”

While awareness around suicide by former active duty military personnel has risen in the past decade, there has been far less focus on the issue with police officers.

“The suicide rate for returning veterans is approximately

27 per 100,000, triple the normal rate in the general population,” said Jeffrey Zeizel, LICSW, a clinical social worker in Woburn, Mass., and the area clinician for the U.S. Drug Enforcement Administration.

“For law enforcement, it’s the same, 27 per 100,000. So, a guy who is a Boston cop has the same statistical liability towards suicide as a returning veteran.”

Just as returning vets are automatically de-briefed before returning home, Zeizel would like to see all police officers have mandatory debriefing following any traumatic event.

“They don’t always have a chance and sometimes they don’t want to,” Zeizel added, explaining that officers are afraid to lose their badge if they admit they are having problems. He sees an opportunity to use the debriefing as a

6

New England Psychologist

March 2018

States await decision on Medicaid work requirements

By Janine Weisman pproval came first for Kentucky on Jan. 12, followed by Indiana on Feb. 1. That leaves eight states — including Maine and New Hampshire — with applications for federal waivers to require able-bodied Medicaid beneficiaries to work still under review.

The Centers for Medicare and Medicaid Services (CMS) sent a letter to state governors last March announcing it would allow states to use Section 1115 authority to require so-called “community engagement” activities like employment, education, job skills training, and community service in order to receive Medicaid benefits.

The move reversed the policy of previous Democrat and Republican administrations which considered work requirements a violation of Medicaid program objectives.

In early February, Arkansas, Arizona, Kansas, Mississippi, Utah and Wisconsin also had pending waiver requests under Section 1115 of the Social Security Act. The law gives the Secretary of Health and Human Services authority to waive provisions of health and welfare programs, including certain Medicaid requirements.

Maine submitted its proposal to alter its Medicaid program called MaineCare last August; the public comment period was open from Aug. 17 to Sept. 16. Voters last November passed a ballot ini-

tiative for Medicaid expansion allowed under the Affordable Care Act after Gov. Paul LePage had vetoed five Medicaid expansion bills passed by the Legislature.

“Employment provides not only monetary compensation, but also daily structure and a sense of pride that no government program can replicate,” states the application by the Maine Department of Health and Human Services (DHHS) submitted by then-Acting Commissioner Ricker Hamilton. He was named commissioner in October.

The Maine Psychological Association (MePA) has not taken an official position on the state’s application.

But MePA Executive Director Sheila M. Comerford said many recipients of MaineCare are already working at lowpaying jobs.

“A requirement that MaineCare recipients work or volunteer would be a problem for individuals in a rural state like Maine, where there is little or no mass transportation available and the unemployment rate is already very low,” Comerford said.

Comerford said work requirements would especially impact northern Maine, where many psychologists who treat MaineCare clients are located.

“If a good number of patients are unable to comply with the requirement and lose their coverage, the consequences not only for them but for psychologists with MaineCare heavy practices would be devastating,” Comerford said.

Proposed MaineCare work requirements seek at least 20 hours per week of paid employment or, if selfemployed, earning weekly earnings at least equal to state or federal minimum wage, whichever is higher, multiplied by 20 hours.

Eligibility would also be met by participating in a stateapproved work program or

that no subsidies for child care or adult day care activities would be provided.

The waiver application for New Hampshire’s Health Protection Program Premium Assistance proposal was filed Oct. 24, 2017; the public comment period closed on Dec. 2.

The state proposes that able-bodied adults must engage in at least 20 hours

“If a good number of patients are unable to comply with the requirement and lose their coverage, the consequences not only for them but for psychologists with MaineCare heavy practices would be devastating.”

Sheila Comerford, Maine Psychological Association executive director

enrolling as a student at an academic institution for 20 hours per week. Community service, evidence of individual or group job search or job readiness assistance or receiving unemployment benefits would also be counted.

After the public comment period ended, Maine DHHS indicated it would allow exemptions for caregivers of incapacitated adults and for parents with dependent children under the age of six. The application, however, notes

per week of one or a combination of specific employment and job training activities.

Between 12 and 24 months of Medicaid enrollment, the requirement would increase to 25 hours per week and, after two years, to a minimum of 30 hours.

New Hampshire’s application would exempt parents taking care of a child under six, caregivers for incapacitated adults and participants in a state-certified drug court program. The application speci-

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fies an exemption for a person temporarily unable to work because of illness or incapacity as certified by a licensed health care professional, including a psychologist.

Medicaid work requirements can make for a challenging conversational topic.

Just ask Kenneth Norton, LICSW, executive director of the New Hampshire chapter of the National Alliance on Mental Health, who worries that talk of work requirements only further stigmatizes those living with mental illness who seek to better their lives and job prospects.

“While NAMI New Hampshire is very concerned about the challenges presented for some people by this type of work requirement for Medicaid, we are much more concerned by the high rates of unemployment for people who have mental illness who are discriminated against and who are unable to find work,” Norton said.

Low-income, non-disabled adults receiving Medicaid benefits in New Hampshire totaled 10,839 as of Dec. 31, 2017, according to the state Department of Health and Human Services.

Maine’s waiver application estimates that 15,000 to 20,000 able-bodied adult MaineCare recipients, approximately 7 percent of the state’s Medicaid beneficiaries, would be subject to the work requirements In December 2017, New Hampshire had an unemployment rate of 2.6 percent, tied with North Dakota for the nation’s second lowest after Hawaii at 2 percent, according to the Bureau of Labor Statistics at the U.S. Department of Labor. The national unemployment rate was 4.1 percent. Maine’s jobless rate was 3.0 percent.

After CMS granted Kentucky’s waiver, several groups filed suit against the federal government to overturn the Medicaid changes. n

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March 2018

New England Psychologist

7

Lawsuit against Bristol County jail officials claims segregation practices are harmful for prisoners with mental health problems

By Pamela Berard hree prisoners with mental illness filed a lawsuit against officials at the Bristol County (Massachusetts) Sheriff’s Office (BCSO) in January that seeks to stop the practice of holding prisoners with serious mental illness in segregation. The lawsuit also aims to implement new disciplinary practices and ensure appropriate mental health evaluation and treatment for that population.

The lawsuit was filed against Sheriff Thomas M. Hodgson and other jail officials. The plaintiffs are represented by Prisoners’ Legal Services of Massachusetts and the Mental Health Legal Advisors Committee.

The lawsuit asserts that the plaintiffs have been held in tiny cells in segregation units “for substantial periods of time under extremely harsh conditions.” The lawsuit also claims that exposing prisoners with serious mental disorders to segregation for more than a brief period of time and not providing them with adequate treatment places them at risk of harm, including mental deterioration, aggravation of symptoms, and suicide.

Bonnie Tenneriello, staff attorney at Prisoners’ Legal Services, said her organization was in touch with many prisoners held by BCSO over the years and was told of problems involving the segregation of prisoners with mental illness and the denial of adequate mental health care.

Staff from both Prisoners’ Legal Services of Massachusetts and the Mental Health Legal Advisors Committee began interviewing prisoners.

“We undertook a very extensive investigation interviewing many prisoners over the course of a few years before we filed suit,” Tenneriello said.

“There’s a very clear constitutional claim that prisoners with serious mental illness cannot be held in solitary confinement for any substantial period of time because it puts them at unreasonable and serious risk of harm,” Tenneriello said.

“That’s well-established.

Your correctional facility cannot put people with serious mental illness in a position

where they face serious risk of harm and it’s well established that solitary confinement causes that risk for inmates with serious mental illness.”

Tenneriello said that the treatment violates the American with Disabilities Act. “The Eighth Amendment also requires prisons cannot be deliberately indifferent to the serious medical needs of their prisoners and serious mental health needs clearly fall within that,” Tenneriello said.

“We’re saying Bristol County has been deliberately indifferent to the serious mental health needs of these inmates, in a number of ways.”

The suit also alleges that the defendants failed to adequately assess prisoners before they enter segregation to determine whether such placement is clinically contraindicated or otherwise dangerous.

“The relief we want, is that prisoners who are really at risk in segregation be identified, and that they be kept out of segregation,” Tenneriello said.

“We’re not saying they can’t put anybody in segregation.”

Tenneriello said there are alternatives to segregation for prisoners who are posing a threat. “You can keep someone secure and still give them treatment and opportunities for social interaction,” Tenneriello said. “You don’t have to isolate them to keep them safe.”

Jonathan Darling, public

information officer for the Bristol County Sheriff’s Office, said the lawsuit is frivolous.

“There are a lot of statements in the lawsuit that are untrue and misrepresented, that are exaggerated. It’s full of lies,” Darling said.

“We’re looking forward to having it be seen by a judge.

passed them all.”

It is also accredited by the National Commission on Correctional Health Care. Darling said the provider of its facilities mental health services, Correctional Psychiatric Services of Braintree, does well on its inspections and audits.

“We work really closely with

“There’s a very clear constitutional claim that prisoners with serious mental illness cannot be held in solitary confinement for any substantial period of time because it puts them at unreasonable and serious risk of harm.”

Bonnie Tenneriello, staff attorney at Prisoners’ Legal Services

We have no doubt in our mind that it will be thrown out.”

Darling said, “We see it as a headline grab by Prisoners’ Legal Services.” He noted that there is currently legislation regarding segregation being debated by lawmakers.

The Bristol County House of Correction and Jail earned national accreditation by the American Correctional Association in 2016. “We scored 100 percent,” Darling said.

“Of over 362 indicators, we

them,” Darling said. “They’ve been great partners with us.”

The facility is also inspected every year by the state, through the Massachusetts Department of Corrections, Darling said.

“In all these inspections and audits, we’ve never gotten a derogatory remark about our health care, physical and mental health,” he said. “Our records speak for themselves.”

Tenneriello said she is hoping legislation to reform soli-

tary confinement that is currently at the State House will bring some changes.

“Nationally, we have a tremendous problem with the overuse of solitary confinement and resources everywhere need to be channeled away from punishing people and toward treatment and rehabilitation,” Tenneriello said. “Many jurisdictions are moving in that direction because it makes sense.”

Jennifer Honig, senior attorney at Mental Health Legal Advisors Committee, said, “One thing that is worth looking at is the duration of time people spend in segregation. And I don’t think it’s the same everywhere.”

She said, “We can see from the people we talked to (at BCSO facilities) that it’s very long periods of time they were in segregation and they are worsening because they are there so long.”

Honig said there is also concern over the number of suicides at BCSO facilities.

The lawsuit states that the suicide rate at BCSO facilities is twice as high as other county correctional facilities in Massachusetts and three times higher than the national rate in jails.

As of late January, Tenneriello said her organization was trying to get the suit against BCSO class-action certified.

The defendants’ deadline to respond to the complaint is in early April. n

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New England Psychologist

March 2018

Lawmakers seek to strengthen parity in Rhode Island

By Pamela Berard hode Island lawmakers are considering several proposals to strengthen mental healthcare and substance use disorder treatment in their state.

Among budget items Gov. Gina M. Raimondo included in her proposal to the state General Assembly in mid-January, are: • The creation of an acute mental health crisis center to help people navigate urgent mental health and substance use disorder crises and facilitate better connections to ongoing mental healthcare resources; • The development of a benchmarking study under the leadership of the state Office of the Health Insurance Commissioner (OHIC), to benchmark

underinvestment in mental healthcare and provide recommendations about investments/policies for improving mental health provided by commercial insurers and Medicaid; • Funds for a supported employment program that combines job training through a supported employment model with substance use disorder counseling; and • The creation of a competitive pool of graduate medical education funds that support research and training related to substance abuse and mental health disorders. “The Governor and her team are working with members of the legislature to craft legislation that will strengthen existing laws ensuring health insurance companies cover

addiction and mental health treatment just like they cover diabetes or other chronic conditions,� said Catherine Rolfe, deputy press secretary for the governor’s office.

The legislation will be submitted sometime during the current legislative session, which typically runs from January-June, Rolfe said.

Health Insurance Commissioner Marie L. Ganim, Ph.D, said OHIC has been working hand-in-hand with the governor’s office and other state agencies on policies aimed at making sure the healthcare system is meeting Rhode Island’s needs. OHIC issued a report in November looking at the status of behavioral health parity. “We have parity laws at the state level and the federal level, and over the years, there has been a progression of compli-

Report: Massachusetts is healthiest state

By Susan Gonsalves assachusetts jumped up a spot and is now designated as the healthiest state, according to a report from America’s Health Rankings.

The 171-page report from the United Health Foundation and American Public Health Association takes into consideration 35 measures for policy,

clinical care, behaviors, community and environment.

The overall rankings for the other New England states are as follows: Vermont, third; Connecticut, fifth; New Hampshire, eighth; Rhode Island, eleventh; and Maine, twenty-third.

Massachusetts achieved the slot based on high marks for having the highest concentration of mental health

providers (547.3 per 100,000 population), more than 200 primary care physicians and more than 80 dentists per 100,000 people.

It also scored high for reduced smoking prevalence 25 percent in the past five years--from 18.2 percent in 2012 to 13.6 percent in 2017.

Other laudable factors included having the lowest percentage of uninsured resi-

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ance, interpretation, and full implementation,� Ganim said.

When parity laws were first passed, there were different interpretations of, for example, what would constitute “comparable disease,� and the differences between qualitative and quantitative treatment limitations. “It’s been an evolution,�

Ganim said.

Ganim said insurance companies ultimately have the responsibility to comply with parity. “It’s really on their shoulders to do it,� she said.

Among complaints Ganim hears from constituents is that co-pays are high for some behavioral health services.

Prior authorizations are also of concern.

Ganim said originally, prior authorizations were a way for insurance companies to either

save money or ensure that the services that were being delivered really met evidencebased or medical necessity standards. “Over time, some of that criteria maybe should have changed,� Ganim said. “We are working with insurers to make sure that happens.�

Ganim said her office asked insurers to report on how often they are using prior authorizations. “And we saw that many of the prior authorizations that are in place are for behavioral health services,� Ganim said. “We need to look more closely at that to see if it’s parity or not.� Ganim is also looking into possible alternatives to prior authorizations to ensure a treatment is medically necessary.

She said insurers have been cooperative on this issue. “Our insurers want to do the right thing and they want to be in compliance.� n

dents at 2.7 percent, a low prevalence of obesity and a 38 percent decrease in the number of children living in poverty--from 17.6 percent to 11 percent--over the past two years.

The number of cancer deaths decreased in both Massachusetts and Connecticut.

However, Massachusetts is plagued by a high drug death rate which increased 69 percent or an additional 8.1 deaths per 100,000 population.

Other New England states also experienced jumps in the number of drug-related deaths with New Hampshire’s rate increasing by 118 percent (additional 13.2 deaths per 100,000 population) and Rhode Island having a rise by 56 percent (additional 8.9 deaths per 100,000 population).

Despite its number one status, Massachusetts was also challenged by a high preventable hospitalization rate and a large disparity between health status by educational attainment.

In terms of the number of mental health providers, the other New England states ranked well with Maine placing third, (442.1 per 100,000 population), Vermont in fourth (407.3), Rhode Island in sixth (375.0), Connecticut in ninth (354.8) and New Hampshire in fifteenth (273.8).

Authors of the report noted that 43 million people had a mental illness in 2015 and 10 million had a serious mental illness. In 2016, 44.7 percent of adults with mental illness and 64.8 percent of people with serious mental illness received treatment.

However, the report cited the fact that access to mental health care is limited in rural areas where 20 percent of the population lives but only 10 percent of psychologists and psychiatrists reside.

Across the nation, the report also cites disturbing trends in mortality. Since 2015, premature deaths (the number of years of potential life lost before age 75) increased by three percent or 217 years lost and cardiovascular deaths are up by two percent.

Over the past year, drug deaths have risen by seven percent.

In a statement, Governor Charlie Baker said, “This report highlights the notable progress that our state is making to improve the health and well-being of every individual living in the Commonwealth.�

Overall, Alabama has the lowest concentration of mental health care providers at 85 per 100,000 population.

Rounding out the top five are Hawaii, second place after five years at number one and Utah in fourth.

Nation-wide, Mississippi ranked last. n

March 2018

New England Psychologist

Causes of disenfranchised grief A reminder for therapists

By Marie HartwellWalker, Ed.D. ll never forget my first lesson in the meaning of disenfranchised grief.

While interning, I was assigned to a young woman who had been referred by her doctor for depression. In our first session, I heard her story.

She had miscarried her first pregnancy only a few months before.

“Everyone tells me to get over it,” she said. “When I was crying in the hospital, a nurse told me that miscarriage is nature’s way to end pregnancies that aren’t quite right and that I’m young so I will have other babies. But I wanted this baby I had already named.

Why don’t people understand?”

Why indeed? To this young woman, a miscarriage was not simply a medical event. It was a huge loss. Just about everyone she had talked to minimized it or explained it away.

The message to her was clear: This loss wasn’t legitimate.

She wasn’t depressed. She was grieving.

“Disenfranchised grief” is a term used to name grief and mourning that society as a whole and/or a person’s immediate family and friendship circle don’t recognize as legitimate. The relationship to the person they lost isn’t acknowledged or the impact of the loss is minimized.

As with the young woman in the story above, well-meaning people may actively try to rationalize the death or “talk sense” into the grieving person by offering platitudes. Not so well-meaning people may make harsh judgments on the relationship or on the impact of the loss.

One of our most valuable roles as therapists is to provide what the individual’s immediate social world either can’t or won’t. Regardless of the model of grief therapy we use, legitimizing and working through the patient’s feelings can help him or her come to terms with the loss.

The following list is a reminder of at least some of the types of disenfranchised grief that bring people to our door. It is not intended to be complete. People’s experience of loss can be as individual as they are.

1) A death that others think shouldn’t be mourned When a relationship has been misunderstood, minimized or marked by shame, grieving the loss is often equally misunderstood, disallowed or seen as shameful.

Miscarriage: When friends and family are firmly of the belief that miscarrying an early pregnancy “doesn’t count” or is “for the best,” the woman gets little to no support for her loss. They don’t understand that she is mourning the child and the future together she thought she would have.

Fathers, too, can profoundly feel the loss of a pregnancy.

A pet: This situation is perhaps the most common one where others provide limited support. Friends may feel the client’s grief is disproportional to the loss of a cat. But for that person, the cat was more than a cat. It was an important family member that gave him needed love and attention.

The loss of a child given up for adoption: Since the decision was voluntary, others may not sympathize with the grieving mother. If the mother managed to have a secret birth, she is alone with her feelings.

Death of an ex-spouse or lover (or even an estranged friend): Even when divorce or separation was bitter or angry or long ago, the person left behind may grieve. Any unresolved issues will never be resolved. The death is a marker of the final closing of that chapter in the survivor’s life.

An LGBT spouse or partner: There are families who never accepted their adult child’s sexual orientation and who therefore don’t permit the grieving partner to come

to the funeral. There are other families that allow participation but only if the relationship is kept secret. The loss of the LGBT partner may even be a relief to some survivors’ families.

A partner in a secret affair: Since the affair was secret, the person is unable to even acknowledge their relationship, much less mourn the death in public. He or she doesn’t exist to the deceased person’s family and can’t talk about it with friends.

A difficult family member or abuser: Other people may believe the deceased person’s actions were so hateful that the death is “good riddance to bad company.” But the patient may have memories of important positive moments between them as well. They need room to grieve the lost potential they saw in those moments.

2) Death of those who suffer A long good bye doesn’t necessarily protect people from grief. When others focus only on the end of suffering, a client may feel he isn’t entitled to grieve.

A person who has long suffered from disease or dementia: The client feels he should be relieved or grateful that the suffering is at an end.

A very old person: Especially when the deceased was active and engaging in their advanced age, relatives and friends may be unprepared for the death and may be shocked and devastated. People may encourage the survivors to only celebrate the long life, not understanding that they can still be saddened by the death.

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9 3) Stigmatized Death Sometimes the cause of the death is the basis for disenfranchisement. The griever feels he or she has to hide their grief because of shame or blame or feelings of guilt around the death.

A suicide: Some people often distance from mourners, because they have strong negative feelings about the morality of suicide. To others, a suicide is cause for anger, not grief. But for those who loved the individual, the emotions are often complicated, especially if the individual was visibly suffering for a long time. Sadness, anger and even relief that the suffering is over are often in the mix.

Drug overdose: There are those who focus on blame and shame instead of on the very legitimate grief of those who loved the person. Because

their predominant feeling is anger at the deceased, they believe everyone else should be angry too.

Death because of a car accident caused by driving drunk (or drug impaired): If an individual had a number of DUIs, if other people were injured or killed in the accident, if others believe that family members should have or could have held the keys, people may be dismissive of family grief.

Abortion: For some individuals, an abortion, even when freely chosen, is cause for protracted grieving. If friends and family believe it was the right thing to do and perhaps especially if they strongly believe it was not, the griever is unable to share her pain. This applies to the father of the fetus as well as the mother. n

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New England Psychologist

March 2018

NH looks to community-based solutions to address bed shortage

By Eileen Weber shortage of hospital bed space has reached a boiling point in New Hampshire.

Emergency rooms are backlogged. Hallways can be filled with more than 50 patients at a time. Admission can take as long as days, weeks, or even months. Known as “ER boarding,” patients with behavioral health issues like mental illness or substance abuse are left in limbo long after emergency work has been completed. These are people in crisis with no place to go.

“This is an immediate problem. We can’t have people waiting this long,” said David Hughes, Ph.D, president of the Human Services Research Institute (HSRI). “More beds are necessary, but there is clearly a need for communitybased opportunities for the future.”

The state’s Department of Health and Human Services (DHHS) issued a report in December from HSRI detailing the system’s ability to address behavior health needs. Following extensive review, HSRI suggested increasing community-based services like peer

support, urgent care, supportive community housing services, and inpatient to outpatient transitioning.

The report was done as a result of legislation signed

by Governor Christopher T. Sununu. That legislation came on the heels of a class-action lawsuit filed by the Disabilities Rights Center against the state aimed at the deficiencies in the mental health system.

The case was settled by 2014.

Nearly four years later, it is still a predicament.

“It’s not like nobody saw this coming,” said Ken Norton, executive director of the New Hampshire chapter of the National Alliance on Mental Illness. “It was a perfect storm—a combination of the workforce capacity, lack of parity, lack of budget, some hospitals closing their doors.

A number of things contributed to this (problem).”

Steve Ahnen, MBA, president of the New Hampshire Hospital Association (NHHA), agreed it’s not one thing but everything that affected the current healthcare environment. That “perfect storm” expanded and there aren’t enough resources to turn it around.

“We started to see that wait list grow during the recession and the lack of budget that led to it,” he said of the economic downturn in 2008. “Now,

ages and frequent turnover.

Norton made that clear in a recent public radio podcast.

“People actually get sicker waiting for care,” he said.

“More beds are necessary, but there is clearly a need for community-based opportunities for the future.”

David Hughes, president of the Human Services Research Institution

there’s a problem on the front door with people coming in and the back door with people going out.”

Twenty years ago, New Hampshire’s system was considered one of the best in the country. The decline has since placed them at the bottom half of ranked systems, according to Mental Health America. Bed space and community-based services are necessary, but the state’s healthcare system has also experienced staff short-

“Unfortunately, there’s not enough people to fill the jobs to make an initiative successful.”

This simply compounds an already widespread issue.

Available staff then has to care for not just the immediate acute cases but also the cases needing longer-term care often with a co-occurring issue of mental illness and substance abuse.

Assertive Community Treatment (ACT), a team-

based model of psychiatric treatment on a 24/7 basis, is one of the urgent care community-based services highlighted in the HSRI report.

ACT is considered a potential solution to stabilizing the situation in processing behavioral health patients.

Hughes and Norton both noted that this situation is not unique to New Hampshire.

Hospitals all around the country have the same problem.

Norton believes we are in a national mental health crisis.

He said bed capacity is the lowest it’s ever been.

“In the mid-1950s, New Hampshire Hospital had 2,700 beds,” Norton said of the state’s only psychiatric facility when the population was a fraction of what it is now.

“Today, New Hampshire has 168 beds.”

This past summer, the DHHS and the NHHA proposed a $1 million 90-day pilot program to Governor Sununu to better streamline the behavioral health admissions process. While it pinpoints only four hospitals now, the goal is to include a due process plan for these patients in all 26 hospitals in the state. n

SAMHSA halts use of evidence-based intervention registry

By Phyllis Hanlon ince 1997, the Substance Abuse and Mental Health Services Administration (SAMHSA) has used the

National Registry of Evidencebased Programs and Practices (NREPP), which vetted practices and programs related to serious mental illness (SMI) and substance use disorders.

But SAMHSA recently decided to halt use of the registry.

Elinore F. McCance-Katz, MD, Ph.D, assistant secretary for Mental Health and Substance Use issued a written

statement that said the registry provided “…a skewed presentation of evidence-based interventions, which did not address the spectrum of needs of those living with serious

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mental illness and substance use disorders.”

She said that the registry in its current form often produced “few to no results” and offered “a poor approach to the determination of EBPs.” In its place, SAMHSA is providing $12 million to launch the Opioid State Targeted Response Technical Assistance (TA) Program. According to McCance-Katz, the American Academy of Addiction Psychiatry will provide technical assistance and training to local experts on evidence-based practices related to SMI and substance use issues.

Additionally, SAMHSA is funding a national Center of Excellence, focused on evidence-based treatments for SMI. The $14.5 million Clinical Support Services for SMI TA Center will train and educate providers to treat this population.

Emily Mohr, Ph.D, public education coordinator for the Continued on Page 12

March 2018

Societal norms Continued from Page 1 for a long time. But if you take an emotional experience and wall it off, over time it builds up. You find that it manifests as irritability, anger at home, excessive use of force on the job or alcohol abuse.”

For officers or military whose careers span two or three decades, a plethora of incidents left unprocessed can create psychological problems.

“If a police officer doesn’t process [an incident] at the time, it builds up and works to express itself in some way while the person struggles to contain it,” Holbrook said.

Holbrook pointed out that critical incident stress management (CISM) has become pervasive in many police departments in recent years.

Although well intentioned, this practice falls short of providing any real long-term benefit.

New England Psychologist He noted that police, fire or other emergency workers dispatched to distressful incidents are often mandated to attend a CISM session.

Unfortunately, many individuals believe a single session will adequately ameliorate any emotional repercussions.

“That is a gross over-simplification,” he said.

Rather than address male psychological health after a traumatic incident, Holbrook advocates for an “annual resiliency review.” He said, “If you get the officer to go to therapy once a year to check in, you build a relationship when he doesn’t need help. There is no pressure. Rather it’s a learning experience that removes stigma.”

Holbrook emphasized that law enforcement is a different type of work and the people who do the job require special support throughout their careers. “It needs to become more normal for administrators and supervisors to talk about psychological well-

Vermont prison complex Continued from Page 1 Therapeutic Community Residence was only designed to be temporary and is considered in “moderate/poor condition.”

The plan’s 20 additional hospital-level forensic beds would increase bed capacity throughout the state by 10 percent. That would relieve stress on emergency rooms.

Since the state had to close the 54-bed Vermont State Hospital in Waterbury in 2011 after it sustained heavy flooding damage during Tropical Storm Irene, spikes in mental health patients seeking treatment in hospital emergency departments can mean long waits for beds to open up at an appropriate treatment facility.

Gobeille said nearly half the 25 VPCH beds are used for court- involved people who could instead be treated in the proposed new forensic psychiatric facility, increasing capacity for the civilian population.

The state must decide whether to eliminate nine of the 25 beds at VPCH to maintain Medicaid funding, pay for all 25 beds with the state’s general fund or find a way for VPCH to become part of a hospital system, all options Gobeille said were “very tough.”

Under the plan, the state would close the Chittenden Regional Correctional Facility and the Northwest State Cor-

being of a police officer, to listen to the awful stuff and the emotional impact it has.”

Raising awareness, particularly through star power, is helping to reduce stigma, according to Rick Barnett,

He applauded a recent article in the New York Times by rapper Jay Z endorsing therapy, which he believes will prompt more men to come forward.

Other well-known figures,

“We have to have day-to-day conversations with boys and de-emphasize gender, but focus on healthy living.”

Michael E. Addis, Ph.D, professor of psychology at Clark University

Ph.D, private practitioner in Stowe, Vermont and founder/ president of Carter, Inc., a non-profit Center for Addiction Recognition Treatment Education Recovery.

such as former quarterback Terry Bradshaw and Prince Harry, have brought the subject of male depression out of the shadows through public advocacy for the benefits of

Any number at or above 215 would mean that no department jobs would be eliminated. The total inmates to staff ratio is estimated to be 3.37 to 1 according to cost summary assumptions outlined in the

has been talked about in a lot of rooms so that is a major concern of people and is something we’re going to have to work through,” Gobeille said.

The Vermont Psychological Association has so far taken no position on the prison complex proposal.

“I don’t think that we know enough about it yet,” said VPA Legislative Committee Chair Rick Barnett, Psy.D., M.S., LADC. “I’m not against it at all. I just don’t know how it’s going to play out.”

Barnett added he would be willing to provide information if asked to testify before the Legislature. He said the workforce capacity issues raised by the plan could help the VPA’s uphill battle to gain prescriptive authority for psychologists.

“People have said, ‘How are you going to staff this?’ That has been talked about in a lot of rooms so that is a major concern of people and is something we’re going to have to work through.”

Human Services Secretary Al Gobeille rectional Facility.

The project could eliminate the need to place offenders out of state while beds for federal detainees could generate revenue from the federal government.

The report outlines an estimated $117.5 million in cost savings over the next 20 years from shared administration and economy of scale, including consolidating specialized units state-wide. Health services staff would be concentrated in one place to address aging and infirm inmates and the correctional forensic population.

The staffing need at the new campus is estimated at 261.

11

report’s appendix.

Gobeille acknowledged the difficulty of finding adequate skilled staffing for a large prison complex in a state where the unemployment rate is one of the nation’s lowest.

Vermont’s unemployment rate was 2.8 percent for December 2017, the second lowest in New England after New Hampshire.

The presence of a large academic medical center and higher education institutions in the more populated northwest region of Vermont may help workforce recruiting efforts, Gobeille said.

“People have said, ‘How are you going to staff this?’ That

psychological intervention.

“The more people read and the more public figures talk and reveal their struggles, the more men will reach out for help,” Barnett said, but emphasized that making an appointment is a first step.

“Therapy is not a quick fix.

It’s harder with men to process difficulties at the level of emotion versus cognition. They want practical steps.”

Barnett helps his male clients become more aware of their inner feelings. “There is an art to sitting in an office and being able to detect nonverbal signs of emotion,” he said. Changes in body position or voice might warrant stopping the session to bring the client’s attention to the changes.

Barnett emphasized that male reluctance does not occur in all cases. “Some men are willing to talk and some have to work around emotional processing and think outside the box,” he said. n

A House bill proposing to allow the Board of Psychological Examiners to confer prescribing authority upon doctoral-level psychologists who have completed specific educational and training requirements was not taken up last year.

A Senate bill proposing the same thing was introduced in January.

“Any time that the state wants to open up more beds or things like this where mental health services are needed, there’s still a problem with access to psychiatrists and psychiatric nurse practitioners,” Barnett said. “So, you could argue if the state’s going to go forth with this, they might as well go forth with prescriptive authority because who’s going to staff this facility?” n

Recruit a PSYCHOLOGIST with your help wanted ad in

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March 2018

DMH initiative aims to expedite psychiatric inpatient admissions

By Phyllis Hanlon eople with mental health conditions routinely experience long wait times in hospital emergency departments.

Acknowledging this problem, Executive Office of Health and Human Services Secretary Marylou Sudders convened a task force last spring to develop appropriate interventions.

EOHHS, together with the Department of Mental Health (DMH), MassHealth and the Department of Public Health (DPH) created the Expedited Psychiatric Inpatient Admission Policy, a multi-pronged approach that launched on February 1.

Daniela Trammel, DMH director of communication and community engagement,

explained that the EOHHS chaired and partnered with the Division of Insurance (DOI) in convening a task force comprised of insurance carriers, psychiatric and medical hospital providers, hospital and carrier trade associations, professional associations and state agency representatives to develop a comprehensive plan to address the emergency department (ED) boarding problem.

The initiative is intended to benefit any patient in need of immediate inpatient psychiatric hospitalization, particularly individuals with complex behavioral health or co-morbid conditions.

To prepare healthcare facilities, insurers, practitioners and other mental health professionals and effectively implement the Expedited Admis-

SAMHSA halts registry Continued from Page 10 Massachusetts Psychological Association (MPA) and practitioner at Child & Family Psychological Services, PLLC, headquartered in Weymouth, Massachusetts, conducted an informal survey and discovered that many of her colleagues were unaware of the registry’s existence.

Her personal attempts to obtain information related to her specialties yielded no results. The programs she did find were not locally based or offered information she

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already knew. “The registry doesn’t appear to accomplish the goal of promoting effective evidence-based treatment,” she said. “It’s not widely recognized as being a first line tool.”

Mohr pointed out that practitioners in the Boston area are invested in evidence-based care and welcome any programs that would maximize experience and treatment for those who treat patients with mental health issues. “I will be interested in looking at the replacement programs and seeing how the proposed

sion Policy, DMH conducted a series of public presentations across the Commonwealth throughout January.

According to Trammel, all presentations have been open to the public, with the target audience being direct care providers. Representatives from MassHealth, the DPH and DOI have also been present at these meetings, she added.

The revised Expedited Admission Policy, which was previously referred to as the “no reject” policy, requires that inpatient psychiatric placements occur within a reasonable time period.

“Under these guidelines, inpatient psychiatric facilities will be expected to admit all patients who meet the criteria for an acute psychiatric hospitalization as long as they have

the capacity – an available bed – and capability, the ability to meet the clinical needs of the patient, to do so,” she said.

The initiative also notes that if placement is not achieved in a reasonable amount of time, “…senior clinical leadership at insurance carriers, inpatient psychiatric units and ultimately to DMH…” will be charged with resolving any issues, thus reducing the burden on the ED. Furthermore, insurance carriers are expected to have “…adequate networks of inpatient facilities…” and carriers should be able to “…facilitate admission of difficult-to-place patients seven days a week.”

DMH has also revised its licensing regulations, that were updated in February 2018, to require that

psychiatric facilities address the needs of the Commonwealth and have enhanced competencies to treat complex patients, Trammel added.

The new regulations should be of primary interest to psychologists who want their patients to receive timely treatment.

“Psychologists play a critical role in the diagnosis and treatment of individuals with mental illness, substance misuse and complex behavioral health conditions,” said Trammel. “By partnering with insurance carriers and hospitals to expedite the admission process, we are ensuring that behavioral health patients requiring inpatient hospitalization receive appropriate and effective care in a timely manner.” n

grants work out. We’ll have to just wait and see,” she said.

Ellen G. Garrison, Ph.D, senior policy advisor, executive office, American Psychological Association (APA), reported that APA is steadfastly committed to evidencebased practice as exemplified by its relevant Council policy and by its clinical practice guidelines initiative.

“We are therefore closely monitoring the SAMHSA developments involving NREPP. My understanding from recent communications with Dr. Elinore McCanceKatz, assistant secretary for Mental Health and Substance Use, is that she shares this commitment for SAMHSA,”

she said. “During a phone conversation with mental health and substance use disorder advocates, she read a statement that noted some limitations with the NREPP vetting process, which, in our view, are defensible.”

Additionally, the 21st Century Cures Act calls for the development of a new entity, the National Mental Health and Substance Use Policy Lab, to study and promote evidence-based practice, for which a director was recently appointed.

“We are hopeful that this will result in a new, more refined database with stronger criteria for program selection and broader applicability

across client service needs,” Garrison added.

According to Garrison, APA Chief Executive Officer Arthur Evans Jr., Ph.D., will meet with Dr. McCance-Katz later this month to discuss mutual interests, including APA’s commitment to evidence-based practice.

“We welcome the opportunity to work with SAMHSA to help shape the new Policy Lab, including through efforts to define program selection criteria and to promote dissemination and implementation of evidence-based programs at the community level to help to ensure program sustainability,” she said. n

Subscription/Change of Address Form

Psychologists licensed to practice in Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont automatically receive a free subscription to New England Psychologist. If you are licensed in a New England state and do not receive the publication, please mail or email (addresschange@nepsy.com) a copy of your license to us with the address you want the paper to be mailed to. Paid subscriptions for other professionals or agencies may be purchased by sending a subscription form with a check for $60 to: New England Psychologist, Subscriptions, P.O. Box 5464, Bradford, MA 01835 Please send me a subscription to New England Psychologist. 1 year — $60. Prepayment required.

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March 2018

March March 1-2, 22-23, April 26: Progressive Counting (PC).

East Aurora, NY. $790, 32 CEs. This is a hands-on clinical skills training for using Progressive Counting with clients of all ages who have been exposed to significant trauma or loss.

Sponsored by Trauma Institute & Child Trauma Institute and R. Cassidy Seminars. Contact www.childtrauma.com/training/ pc or 413-774-2340.

March 2: Connecticut Association for Behavior Analysis (CTABA) 14th Annual Conference. Hartford, CT. 8-5pm, $165, 7 CEs. Topics include: treatments and interventions for autism, developmental disabilities, and behavior problems for children and adolescents, as well as insurance, legislative issues, and schoolbases services. Contact 860413-9538, ext 304.

March 2-3: Treating the Addictions. Boston, MA. 7:455:15pm, $300, 14 CEs. Course will include an update on the clinical, theoretical, and research findings of addictive behaviors. Sponsored by Dept. of Psychiatry, Cambridge Health Alliance Physicians Organization. Contact 617-384-8600.

March 8: Movie + Dialogue Night showing the popular film The Big Sick. Watertown, MA. 7-10 pm, $55, 3 CEs. This film will be used to help us learn about the intricacies of cross cultural relationships.

Sponsored by Therapy Training Boston. Contact 617-9249255.

New England Psychologist

March 8-9, April 12-13, May 10: Progressive Counting (PC). Olean, NY. $790, 32 CEs. This is a hands-on clinical skills training for using Progressive Counting with clients of all ages who have been exposed to significant trauma or loss.

Sponsored by Trauma Institute & Child Trauma Institute and R. Cassidy Seminars. Contact www.childtrauma.com/training/ pc or 413-774-2340.

March 9: Cognitive Behavior Therapy and Anxiety. Marlborough, MA, 9-4pm, $169, 6 CEs. Treating social anxiety, OCD, panic disorders, phobias, and PTSD. Sponsored by The Bridge Training Institute.

Contact 508-755-0333.

March 12: Slaying the Dragon: PC & The Fairy Tale Model of Trauma Treatment.

Northampton, MA, $50, 6.5 CEs. A hands-on clinical skills training for working with clients who have been exposed to significant trauma or loss.

Sponsored by Trauma Institute & Child Trauma Institute and R. Cassidy Seminars. Contact http://www.childtrauma.com/ training/fairy-tale-model/ or 413-774-2340.

March 16: Narrative Therapy Course Spring 2018. Watertown, MA. 1-4:15 pm on four Fridays from March to June. $490, 12 CEs. This practical approach to working with problems focuses on thinking about what makes situations better or worse, and what people aspire toward, their goals and values.

Sponsored by Therapy Training Boston. Contact 617-9249255.

CONTINUING Education New England Psychologist prints as many continuing education conferences as space allows.

Listings with incomplete information will not be printed. CE credits listed are for psychologists. Deadline for submission is the 1st of each month for the following month’s issue. CE Listing correspondence to: New England Psychologist Attn: Continuing Education P.O. Box 5464 Bradford, MA 01835 ce@nepsy.com

March 16-17: Posttraumatic Stress and Related Disorders: The Latest From Neurobiology to Treatment. Boston, MA. 7-5pm, $495, 14.75 CEs. Topics include: developments in psychopharmacology; strategies to care for patients; patterns of trauma responses around the globe; develop strategies to treat trauma patients from a multicultural perspective. Sponsored by Harvard Medical School and McLean Hospital. Contact 617384-8600.

March 16-17: Sex as a Safe Adventure: Integrating Emotional and Physical Disconnection Through an Attachment Lens. Wellesley, MA, 9-5pm, $450, 12 CEs. This workshop will present the latest research on sexuality in couple relationships and the Emotional Focused Therapy (EFT) approach to helping couples address sexual issues. Sponsored by The New England Emotionally Focused Therapy Center. Contact 781-856-8727.

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therapy approach -- with adults as well as children. Sponsored

by Trauma Institute & Child Trauma Institute and R. Cassidy Seminars. Contact www. childtrauma.com/emdr or 413774-2340.

PCFINE-sponsored programs exploring different models of couple therapy.

Sponsored

by Psychodynamic Couple & Family Institute of New England. Contact 781-433-0906 or pcfine1934@gmail.com.

March 17: A Contemporary Self Psychological Approach to Couple Therapy: An Overview and Comparison with Gottman and Emotionally Focused Couple Therapy (EFT) Models. Newton, MA. 9-4:30 pm.

Non-members: $170, 5.5 CEs. This workshop is part of an ongoing series of

March 19-20, April 16-19, May 14, June 11: EMDR. Northampton, MA. $1590, 49 CEs. A hands-on clinical skills training for using EMDR and integrating it with your psychotherapy approach -- with adults as well as children. Sponsored

by Trauma Institute & Child

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C March 16-17, April 18-19, May 4-5, June 15, July 13: EMDR. Fredonia, NY. $1550, 49 CEs. A hands-on clinical skills training for using EMDR and integrating it with your psycho-

Continued on Page 14

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New England Psychologist

Trauma Institute and R. Cassidy Seminars. Contact www. childtrauma.com/emdr or 413774-2340.

March 22: Internal Family Systems and Psychodynamic Therapy: Accelerating Access to the Unconscious Mind. Boston, MA. 8:45am5pm, $225, 6 CEs. Psychodynamic psychotherapy 2018 pre-conference institute. Sponsored by Beth Israel Deaconess Medical Center, Boston Psychoanalytic Society & Institute, and William James College. Contact 888-244-6843.

March 23: Transforming Vicarious Traumatization: Enhancing Self-Compassion, Resiliency, & Self-Care for Therapists. Exeter, NH. Join leading expert in psychologi-

cal trauma and therapist selfcare, Dr. Karen Saakvitne, in an experiential workshop that emphasizes how the work of psychotherapy can change practitioners and offers specific strategies to build therapist resilience. Sponsored by NHPA. Contact 603-415-0451.

March 23: Communication Strategies. Marlborough, MA. 9-4pm, $169, 6 CEs. Using DBT skills to work with emotionally sensitive or distressed youth. Sponsored by The Bridge Training Institute. Contact 508-755-0333.

March 23-24: Psychodynamic Psychotherapy 2018. Boston, MA. 8:15-5pm, $350, after 1/31: $395, 13 CEs. Overriding goal is to deepen understanding of the curative process,

with special attention to the contributions of both patient and therapist in the unfolding of the “cure.� Sponsored by Beth Israel Deaconess Medical Center, Boston Psychoanalytic Society & Institute, and William James College. Contact 888244-6843.

April April 5: Movie + Dialogue Night showing the popular film The Color Purple. Watertown, MA. 7-10pm, $55, 3 CEs. This Oscar-nominated adaptation of the novel by Alice will be used as a vehicle to help us understand the challenges for a black woman in finding her way in the world in the American South. Sponsored by Therapy Training Boston. Contact 617924-9255.

March 2018 cine and Psychology. Warwick, RI, 8:30am-4:30pm, $169. 6 CEs. Topics include: behavioral and psychological challenges for diabetics; interventions to improve medical and psychosocial outcomes.

Presented by Julie Wagner, PhD. Sponsored by RIPA. Contact 401-732-2400 or ripsych.org.

April 28-29: Honing your Hypnotic Voice: Delivering Strategic Interventions for Mind/Body Healing. Watertown, MA. 8:30-5pm, $399 members, $499 non-members. $30, 14 CEs. Registrants must have completed ASCH-approved basic hypnosis workshop. Sponsored by The New England Society of Clinical Hypnosis. Contact www.nesch. org or 617-734-5042.

May

Special Hospital Issue will publish in May the 26th annual directory on New England psychiatric hospitals and units.

978-225-3082 or advertising@nepsy.com

April 6-8: Intermediate Workshop in Hypnosis. Brookline, MA. 9-6pm. Total of 20 hours of lectures and small group practice. NESCH members by 3/9: $375; non-members $450.

After 3/9: members, $450; nonmembers, $525. 20 CEs available for $30. ASCH-approved basic hypnosis training a prerequisite. Sponsored by The New England Society of Clinical Hypnosis. Contact www.nesch.org or 617-734-5042.

April 10-11: Introduction to Internal Family Systems Therapy.

Auburndale, MA. 9-4:45 pm, $370, 12 CEs. This two day workshop will be an immersion in the basic premises of the model and their practice. Sponsored by Therapy Training Boston. Contact 617924-9255.

April 27: Diabetes Management: Intersection of Medi-

May 3: Movie + Dialogue Night showing the popular film Lady Bird. Watertown, MA. 7-10 pm, $55, 3 CEs. A mom works tirelessly to keep her family afloat after her husband loses his job. She also maintains a turbulent bond with her teenage daughter. This film will be a vehicle to help us learn about complexities in mother/daughter relationships.

Sponsored by Therapy Training Boston. Contact 617-9249255.

May 3-5: NHPA Three-Day Addictions Symposium. Topics include: Cybersex Use and Abuse, Key Elements in Chronic Pain and Addiction, and a Modern Perspective of Addiction. Hampton, NH. Sponsored by NHPA. Contact 603-415-0451.

May 15: The Crisis in Masculinity. Auburndale MA. 10-4:30 pm, $175, 5 CEs. This workshop will help work with the negative effects of patriarchy on men, women and relationships. This workshop introduces therapists to Relational Life Therapy, an approach that holds men accountably and empathically at the same time.

Sponsored by Therapy Training Boston. Contact 617-9249255.

June June 1-2: High Conflict Divorce: Legal Context and Family Work with Parent Child Relationship Problems. Watertown MA. 9-4:45pm, $320, 12 CEs. Two day workshop will address the significant dilemmas of working with children, adolescents and adults caught up in the drama of high conflict divorce. It will provide information and strategies to help individual and family therapists meet the challenges to support healthier relationships among all involved.

Sponsored by Therapy Training Boston. Contact 617-9249255.

June 8: Insurance Trust Program: Sequence VIII: Ethics and Risk Management in a Digital World 2.0. Warwick, RI. 8:30am-4:30pm, $195, 6.5 CEs. This workshop is a next-generation discussion of digital world issues, providing a review and update on the ethical, legal, and risk management dimensions of technology. Sponsored by the Rhode Island Psychological Association. Contact 401-732-2400.

Continued on Page 15

March 2018 July 17-18: Trauma and the Internal Family Systems Model: Releasing Personal and Legacy Burdens. Auburndale, MA. 9-4:45 pm, $370, 12 CEs. This presentation by the founder of the model will provide a brief introduction to the basics of the IFS Model followed by demonstrations of its use with attachment problems and trauma, including intergenerational and cultural burdens.

Sponsored by Therapy Training Boston. Contact 617-924-9255.

New England Psychologist June 25-29: New Frontiers in Mindfulness and Psychotherapy: A Retreat for the Heart and Mind with Ronald Siegel. Eastham, MA. $549 before 3/30; $599 after, 15 CEs. In addition to exploring new frontiers in the clinical application of mindfulness practices, this workshop will provide guided instruction in different techniques along with the opportunity for personal exploration in a supportive atmosphere. Sponsored by New England Education Institute.

Contact 413-499-1489 ext.1 or www.neei.org. n

For

comprehensive

CE listings check out

ARLINGTON: Full or parttime office sublet available in suite with waiting room, bathroom, WIFI. Shared playroom with toys, ideal for child therapist. Contact Lou at 781-6466306 or lou@eckart-phd.com BOSTON: Back Bay. Full-time (unfurnished) and part-time (furnished) offices available as of April in newly constructed office suite in beautiful Back Bay building, half-block from Public Garden. Amazing views of Boston. Shared waiting area, bathroom and kitchenette.

Many referrals available in collegial community of private practitioners. Private practice start-up and expansion consultation available. Assisting with billing-related administrative work also available as (completely optional) add-on service. Part-time sublets may be available prior to April as well. Contact 617-230-3002 or backbayalliance@gmail. com CAMBRIDGE, MA: Profes0sional psychotherapy office in a suite between Harvard and Central Square. Wheelchair accessible. Available M, Th, F anytime. Contact Debora at 617-661-5310.

MELROSE: Two offices for sublet FT or PT in a charming Victorian professional building in downtown Melrose, convenient to cafes and restaurants, parking, and convenient

to bus and trains. Additional work spaces include kitchenette, 1/2 bath, and conference room. Consultation on evidence-based treatment and support in building a private practice is available. Available January 1, 2018. Contact Lisa Coyne at dr.lisacoyne@gmail. com.

FALL RIVER, MA: Office available, 4th floor secure bank building, near government center. Shared waiting room, elevator, other amenities, parking. Contact Herb at 617-543-0094.

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NEW HAVEN, CT: Office space available for lease. All utilities + housekeeping included, off street parking, Yale/City bus line. Current tenants include therapist, social service staff, and Yale tenants. Contact Diane at 203789-7645 x112.

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WORCESTER, MA: Attractive office space for part-time mental health professional.

Includes consultation and waiting rooms. Located in professional building in downtown. Please contact Joyce at 508-795-1644.

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Deadline is 12th of every month (except for Aug./Sept. issue, which is Aug. 1).

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New England Psychologist

March 2018

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