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Better Health D
A TIME OF CHALLENGES: knowing when help is needed, D2 SUICIDE RATES ON THE INCREASE: stats tell a tragic story, D3 STRESS: healthy ways to relieve it throughout the day, D4
| SUNDAY, SEPTEMBER 22, 2019
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Physical and behavioral health conditions often occur hand-in-hand. Today, over two-thirds of adults with a behavioral health condition also have a medical condition - but the country’s fragmented health care system makes it difficult for these individuals to receive treatment that takes both areas of their health into account.
By Gillian I. Follett
Special to The Republican
Having the different aspects of their health care scattered among various medical providers can reduce the effectiveness of an individual’s overall care and significantly raise their medical costs. For over a decade, linking individuals’ physical and behavioral health* care has been at the heart of Behavioral Health Network’s mission. For the past two decades, the rate of co-occurring medical and behavioral health conditions has increased dramatically around the globe, especially among children, teens, and the elderly. In order to more effectively treat individuals with co-occurring conditions, BHN is among a growing number of nonprofits working to implement a “whole health” model by partnering with primary care providers to ensure that all of an individual’s conditions, medical or behavioral, are considered when creating a treatment plan. This approach largely centers on integrating behavioral health services into primary care locations to make it easier for doctors to connect patients to these services. “For the past ten years, we’ve been looking at how to be an integral part of health care as a system,” said Kathy Wilson, the chief executive officer and president of BHN. “Now, we work with health care providers as partners. Doctors need us, and we need them. We make sure we focus on the whole person, and not just the disease.” The whole health care model is based on the Institute for Health Care Improvement’s “Triple Aim” framework, which proposes a threepronged solution to modify the current health care system: 1) improving patient experience in terms of quality and satisfaction;
2) improving the population’s overall health; and 3) reducing individual health care costs. The Institute also promotes the expansion of primary care to include behavioral health care and social services to ensure individuals’ needs are effectively met at the lowest possible out-of-pocket cost. For the past few years, Massachusetts has been supporting an initiative to incorporate the Institute’s ideas into the state’s health-
developed several programs that involve medical organizations, such as Baystate Health and Holyoke Health Center, in individuals’ care. At each partner site, BHN employees are available to help patients who share concerns about their mental health or substance use with their doctor. “A doctor may determine that their patient needs a behavioral health specialist to work on things that are contributing to the patient’s challenges managing their physical
sistants depending on the patient’s needs. BHN’s behavioral health specialists can assist individuals in managing a variety of behavioral conditions, including substance use disorders or mental illnesses such as depression or anxiety. When a doctor at one of the sites— Baystate Health, for instance— decides that their patient needs additional behavioral health care, they direct them to one of BHN’s on-site behavioral health specialists,
“Sometimes it’s as simple as having a therapist at the doctor’s office for a couple of days each week so the doctor can refer patients to them,” DeFlumer-Trapp said. “And sometimes it’s as intensive as having the behavioral health specialist serve as a member of the doctor’s team and work directly with the primary care provider in a patient’s treatment.” BHN has also developed a range of programs outside of these primary care sites that blend together patients’ physical and mental health care. Behavioral health specialists, such as outpatient clinicians, home health aides and care managers, work together to act as a “wraparound” support system for individuals that addresses any gaps in their treatment plans. For individuals with substance use disorders, BHN offers detox programs and residential recovery homes. BHN has also implemented services based on the state’s Children’s Behavioral Health Initiative that address children’s behavioral health needs at all ages, both at home and at school. According to DeFlumer-Trapp, BHN’s increasing focus on integrating behavioral health care with physical wellness has developed in response to changes in how health care is viewed in the professional world. Assistant Program Director Sophia Barker, LCSW, and clinician Maria Leger, LMHC, of Behavioral Health “Behavioral health has been Network work on a case consultation with Family Nurse Practitioner Robbie S. Lauter, MSN, RN-C, of evolving over a long period of time,” Holyoke Health Center. (HOANG ‘LEON’ NGUYEN / THE REPUBLICAN) she said. “BHN decided about ten years ago to focus its energies on how it could integrate services and care system, which has helped health,” Wilson said. “So we begin said BHN Vice President Jessica help people care for their whole BHN secure support and funding to wrap a team of people around DeFlumer-Trapp. The specialist to develop programs and services them to try and treat the whole indi- then conducts a brief evaluation and selves, long before most other agencies were thinking about that idea. that embrace a more effective and vidual rather than just one aspect of decides what course of action will So, we strategically began to identify worthwhile structure of health care, their health.” be most helpful in improving the Wilson said. Care teams involve staff members patient’s behavioral health, whether partners and work with primary care Under Wilson’s direction, BHN from both the primary care providit’s providing them with a referral to sites to see how we could do things has focused its efforts on impleer and from BHN, and can include one of BHN’s programs or supplying differently together.” menting the Triple Aim framework clinicians, recovery coaches, care them with community resources into its services. The agency has coordinators, nurses or medical asand self-therapeutic techniques. SEE PHYSICAL, PAGE D2
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D2 | SUNDAY, SEPTEMBER 22, 2019
THE REPUBLICAN | MASSLIVE.COM
Physical
A Time of Challenges
- Megan O’Brien, FNP
Parents play an important role in knowing when adolescents might need help. Adolescence is a time when bodies and minds are changing rapidly. When you add the social challenges that come with school and peer groups, it can be a perfect storm of crisis for young people.
at River Valley Counseling Center’s Teen Clinics. This is because the amygdala region of the brain, which is responsible for responding to threats in the environment, overwhelms the prefrontal cortex, the brain’s rational, thinking part. This reaction can become even more pronounced after the person experiences trauma. Adolescents can also occasionally:
• Abandonment of longtime friendships for a different group of friends • Regularly feeling “sick” • Self-harm or expressions of suicidal thoughts
If your teen displays any of these warning signs, help is available. The American Academy of Child and Ad• Engage in fights olescent Psychiatry (www. • Misinterpret social cues aacap.org) has details on and emotions the emotional and cognitive • Take part in risky development of children and behavior adolescents. In addition, the Anxiety and Depression Association of America (www. adaa.org) has information for “Parents play an important During this time, adolesparents and caregivers on disrole in determining whethcents will move toward indeorders and other challenges er their child is struggling pendence and may struggle adolescents are facing. with mental health issues,” with the mental, emotional River Valley Counseling said O’Brien. “Stay engaged and physical changes they are Center has multiple outwith your teen and watch for experiencing. Issues such as patient office locations in potentially harmful changes body image, gender identiHolyoke, Chicopee, Springin his or her behavior.” Be fication and bullying (espefield and Easthampton. on the alert for the following cially cyberbullying) have School-based behavioral changes: emerged on parents’ radar in health services are available recent years. These and other • Notable weight loss or throughout the Holyoke, weight gain issues can lead to anxiety for Chicopee, Easthampton and teens. So it’s important for Granby school systems, as • Prolonged moodiness parents to understand what is well as select schools in Hador irritability and isn’t normal. ley, Hatfield and Springfield.
WHAT’S NOT
• Withdrawal from activities your child once enjoyed
WHAT’S NORMAL
“It’s not unusual for teens to act impulsively as they try to figure out who they are,” says Megan O’Brien, FNP, who works with adolescents
To learn more or to schedule an appointment • Regular expressions of with a counselor at hostility, worries or fear, River Valley Counseling or crying Center, please call • Extended avoidance of 413.540.1234. parents
health care, there are support groups for them and they have access to anything and CONTINUED FROM PAGE D1 everything they might need Changes to the current in order to be able to get them health care system are espefurther up the hierarchy of cially critical for those with needs. co-occurring mental health “When a person shows up and medical conditions. for help, a primary care proStudies have shown that vider might bring in someone individuals with a behavioral who can help the person health condition die an aver- access community resources. age of 25 years earlier than That may involve giving peothe rest of the population, ple information about how to DeFlumer-Trapp said. access the local food bank, or “These deaths are typicalconnecting them to a housing ly because of their physical authority or a resource to help health conditions, and not them apply for subsidized because of the things that housing. When a person isn’t people would think,” she getting their basic needs met, said. “It’s not suicide, and it’s really hard for them to do they’re not necessarily dying things like eat healthy and because of their mental exercise, which can impact illness. Sometimes they are their physical health.” dying because of substance According to Steve Winn, use disorders—things like BHN’s Chief Operating Offioverdoses, or infections they cer, in addition to screening get as a result of being a long- for physical or behavioral term drug user. But the overarching piece is that many people have really significant chronic comorbid medical conditions with their behavioral health conditions.” In many cases, an individual’s mental illness or addiction contributes to the development of a medical condition such as diabetes, hypertension or heart disease, DeFlumillnesses, BHN now evaluates er-Trapp said. For example, individuals to determine the older medications once used impact that these societal to treat mental illnesses have factors may have on their been linked to the develophealth. “The social determiment of metabolic conditions nants of health include things such as diabetes. Other such as housing, employment individuals turn to smoking and nutrition,” Winn said. or alcohol as a coping mech- “If those kind of things are anism for their mental health a problem, a person isn’t condition, which can cause going to be able to focus their them to develop a wide range attention on improving their of chronic physical illnesses. health. They aren’t going to Studies have also found that be going to therapy, they armental illness can increase en’t going to be keeping their an individual’s likelihood appointments and they aren’t of becoming obese, which going to be able to take care consequently boosts their of themselves. risk of developing additional An individual with diamedical conditions. betes needs to eat healthy For many individuals with foods, exercise regularly and a mental illness, poverty also take medication to remain contributes to medical condi- healthy; but if they are tions that they have difficulty homeless and struggling with managing. Social determiuntreated depression, it may nants of health, or economic be difficult for them to fulfill and social conditions that all of these requirements. affect an individual’s abil“Unfortunately, many of ity to manage their health, the people that we work with play a significant role in the don’t have the resources to lives of many low-income take control of their health. individuals with comorbid So we offer ways to help them conditions. According to overcome the social deterDeFlumer-Trapp, behavioral minants that may limit them. health conditions dispropor- We can help someone strugtionately occur in low-income gling to find housing, or conindividuals, and their limited nect someone to job training access to resources or the to help them get employed. environment they live in can For someone who needs to further complicate individu- exercise, we can help them als’ overall health. get a gym membership, or “We know that the founprovide them with bus passes dation of better health care to help them travel to a safe is making sure you can meet place to exercise, like a park. everybody’s needs,” DeFlum- We have lots of partners in er-Trapp said. “So we bring many different areas.” in additional programs and The current health care work collaboratively with model, which forces individcommunity organizations to uals to receive services for make sure that, when people different health conditions have issues beyond what at multiple care providers, you think when you think of is also needlessly expen-
sive for those with both a medical and behavioral health condition, Winn said. Studies show that medical costs are dramatically higher for individuals who have a behavioral illness in addition to a medical condition. One study found that the treatment of individuals with both behavioral and medical conditions cost Americans a total of $406 billion in additional health care costs in 2017. The high cost of receiving behavioral health care in addition to treatment for physical conditions can act as a barrier for individuals to seek treatment for their mental condition. The whole health model utilized by BHN helps to reduce these costs by focusing on treating the whole individual rather than treating their different health conditions in isolation. Wilson stated that whole health care is very empowering for individuals who may have traditionally felt helpless in their own health management. Introducing individuals to the resources and medical providers they need to improve their health allows them to take control of their health in ways they previously were denied. “Integrated care requires individuals to take a look at more than just taking a pill every day,” Wilson said. “It’s really trying to manage people’s behavior and give them some controls over their health. If you’ve never been taught what nutritious eating for diabetes looks like, we’ll come to your house and get you the information you need to know to make your eating healthier. It’s really about changing behaviors.” BHN’s work in whole health care over the past decade is only the beginning of the agency’s mission of playing a role in reshaping the state’s healthcare system, according to Wilson. Wilson plans to continue partnering with healthcare organizations in the future to ensure individuals receive the most effective and affordable treatment possible. BHN aims to improve as many individuals’ lives as it can — and the whole health care model makes that goal much more attainable. “It’s really all about working collaboratively on improving health care to help individuals change their lives in a way that gives them the kind of life that they deserve,” Wilson said. “Our vision is to create partnerships and secure funding that allow us to create opportunities for people to get the kind of treatment they need.”
“Unfortunately, many of the people that we work with don’t have the resources to take control of their health. So we offer ways to help them overcome the social determinants that may limit them...”
* Behavioral Health incorporates mental health, addictions and intellectual/ developmental disabilities.
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SUNDAY, SEPTEMBER 22, 2019 | D3
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THE REPUBLICAN | MASSLIVE.COM
Suicide rates on
the increase
Statistics tell the tragic story By Keith O’Connor Special to The Republican
Dedicated to raising awareness of suicide and sharing information on how to recognize and help a suicidal person, Suicide Prevention Month in September may be crucial in preventing millions of Americans from ending their personal suffering. “Far too many individuals in our community have been lost to suicide. Many of the people who die from suicide have serious behavioral health conditions, including depression, which have never been diagnosed or treated. We still have an enormous amount of work to do to improve access to care for individuals suffering from depression, substance use disorders, post-traumatic stress disorder, and other conditions associated with suicide,” said Dr. Barry Sarvet, chair, Behavioral Health, Baystate Medical Center. Suicide rates in the United States have increased nearly 30 percent since 1999, according to the latest data from the Centers for Disease Control and Prevention (CDC). In Massachusetts, the suicide rate increased by 35.3 percent between 1999 and 2016, making it one of only 25 states where the suicide rate increased by more than 30 percent. “We don’t have clear answers regarding the cause of this increase. It is suspected that the opioid epidemic is a factor, but other possible
causes include increasing levels of stress and increased social isolation in contemporary society. Increased prevalence of economic hardship in the context of growing income disparity is also a likely factor,” said Dr. Sarvet. The statistics continue to tell a tragic story. In 2016, some 45,000 people lost their lives to suicide. It is the 10th leading cause of death for adults and the second leading cause of death in youth. While a major cause of suicide is mental illness, not all suicide deaths are the result of mental health conditions, noted Dr. Sarvet. “There can be many varying factors as to why someone takes his or her own life. It may be a relationship issue or financial problems due to job loss. Bullying is another reason, as well as deteriorating physical health or legal problems,” he said. Mental health conditions are often seen as the cause of suicide, but suicide is rarely caused by any single factor. In fact, many people who die by suicide are not known to have a diagnosed mental health condition at the time of death. Other problems often contribute to suicide, such as those related to relationships, substance use, physical health, and job, money, legal, or housing stress. The CDC lists 12 warning signs of suicide as feeling like a burden, being isolated, increased anxiety, feeling
trapped or in unbearable pain, increased substance use, looking for ways to access lethal means, increased anger or rage, extreme mood swings, expressing hopelessness, sleeping too little or too much, talking or posting about wanting to die, making plans for suicide. Because suicide is also a significant public health problem in the adolescent and young adult population, Dr. Sarvet noted that it is important for parents and caring adults to learn how to recognize depression in teenagers. “In teenagers, depression is often complicated by disciplinary problems, school underachievement, interpersonal conflict, and drug and alcohol problems. It takes a great deal of understanding and compassion to notice the depressed person in the middle of all of this, who may be at serious risk for suicide,” said Dr. Sarvet. The National Institute of Mental Health warns that people who threaten, talk or write about death, dying and suicide, or who seek access to a means to hurt or kill themselves, are exhibiting suicidal behaviors and are at risk of suicide. If you have a loved one exhibiting such behaviors or thoughts, you should ask them what you can do to help. You can point out your observation that they seem sad and can encourage them
to get help initially through their primary care doctor, who can assess the situation and prescribe medications or make a referral to a mental health professional. “People who attempt to take their own lives often are profoundly hopeless and need people around them to notice their suffering and to help them to seek treatment. It’s really important for people to learn about the signs of depression, substance use disorders, and other common behavioral health conditions. It’s time for us to let go of the stigma that has made it so difficult for people to talk about these things,” said Dr. Sarvet. He noted suicide touches everyone. The suicide death of a loved one or close friend can have a profound impact on survivors who often feel partly responsible for the tragedy. “Many times they are left feeling guilty and wondering what they could have done
differently and questioning how they could have missed the signs,” said Dr. Sarvet. Similar to high blood pressure, asthma, and diabetes, mental health conditions need treatment and ongoing follow up in order for them to be well-controlled. “Talking with your primary care provider is a great first step to getting help,” said Dr. Sarvet. Those looking for support in coping with a suicide loss can visit the American Foundation for Suicide Prevention website at www.afsp for a list
of nearby support groups. If you, or someone you know, is in suicidal crisis or emotional distress, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the Psychiatric Crisis Team at 413-733-6661 for Springfield residents or to learn where to call outside the Springfield area. You can also talk with your primary care physician for a referral to a mental health professional or visit your local emergency room.
For more information on behavioral health services at Baystate, visit www.BaystateHealth.org/ Behavioral-Health.
Dr. Barry Sarvet, Chair, Behavioral Health, Baystate Medical Center
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D4 | SUNDAY, SEPTEMBER 22, 2019
THE REPUBLICAN | MASSLIVE.COM
What kids can do
in the face of bullying According to the U.S. Many adults Department of Health and may recall Human Services, bullying has been linked to various being bullied negative outcomes, mental health issues, substance or witnessing abuse and suicide. bullying when they When taking steps to combat bullying, parents were in school. and educators should not overlook the benefits of Despite that, it’s enlisting children in their efforts. Kids can be great allies important that in the fight against bullying, and the following are some adults, including ways adults can work with parents and youngsters who want to stop bullying. educators, not see bullying as an Teaching kids to respect others inevitable part of StopBullying.gov, the DHHS’ website devoted to growing up. stopping bullying once and The effects of bullying can be severe, affecting those involved - including the bullied, the bullies and those who merely witness bullying - long after their school days have ended.
for all, notes the importance of teaching kids to treat everyone, including other children, with respect. Parents can teach kids to pause before saying or doing
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something that can be harmful to someone else. Bullying inflicts physical and emotional pain on its victims, so teaching kids to recognize that words can be just as harmful as fists may encourage them to think twice before saying something mean to a classmate. The DHHS also recommends advising children to do something else if they feel an urge to say or do something mean. Walk away from a situation to watch television, play a video game or engage in another activity rather than saying or doing something hurtful.
What kids being bullied can do
Kids being bullied also can employ certain strategies to overcome bullying. The DHHS recommends teaching children to look at bullies and telling them to stop in a calm, clear voice. Laughing it off might also work for kids who find joking comes naturally to them. The DHHS advises against fighting back, instead suggesting kids walk away and stay away before finding an adult who can stop the bullying on the spot. Encouraging students to confide in adults they trust also can help them overcome bullying and the feelings of loneliness that bullying can elicit. Trusted adults can help children devise a plan to stop the bullying. The DHHS notes that most bullying happens when adults are not around, so staying near adults and other children can help kids avoid situations where they might be vulnerable to bullies.
What witnesses to bullying can do
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Bullying can have a negative impact on children who witness bullying, even if they aren’t the victims. Adults can encourage children to speak to trusted adults and to report instances of bullying. In addition, children should be encouraged to be kind to children who are being bullied, inviting them to sit with them on the bus or in the lunch room and engaging them in conversations about topics that interest them. Bullying affects children whether they’re being bullied, doing the bullying or witnessing it. But bullying can be overcome if adults and children work together and keep lines of communication open at all times.
Healthy ways to
relieve stress throughout the day
is to the body. Exercising to do something else, STRESS AFFECTS time several days per week is whether it’s to go for a brief especially beneficial to walk or converse with a PEOPLE FROM mind and body, but even coworker about something 20-minute exercise sessions, unrelated to the project. ALL WALKS including a walk around the Avoiding the stress entirely, OF LIFE, AND especially if it’s a work project grounds of an office complex or a quick swim during a or a bill that must be paid, is THE CAUSES lunch break, in the midst of not the answer. But a short stressful days can help people break from the stressor and OF STRESS ARE thinking about it can provide combat stress for several a new perspective and time to hours afterward. AS VARIED AS calm down. THE PEOPLE IT DELEGATE MORE DURING THE DAY. MEDITATE. AFFLICTS. In its 2017 Stress in AmericaTM survey, the American Psychological Association found that the three most common sources of stress were the future of the nation (63 percent), money (62 percent) and work (61 percent). According to the National Institute of Mental Health, routine stress that becomes chronic can result in a host of negative side effects. Such stress can suppress the immune system, disrupt digestion and have an adverse effect on sleep. But men and women who feel stressed at the end of each day need not resign themselves to sleepless nights and/or weakened immune systems. A proactive approach to alleviating stress during the day can help men and women reduce their stress levels and avoid the negative side effects associated with chronic stress.
WALK AWAY.
The APA notes that taking a break from a stressor is one of a handful of healthy techniques that research has indicated is a successful way to reduce stress, both in the short- and long-term. If a project at work is proving especially stressful, step away for a short period of
When stressed out, men and women should not discount the potential benefits of meditation. Researchers from Johns Hopkins University examined more than 19,000 meditation studies, ultimately concluding that mindful meditation can ease stresses like anxiety, depression and pain. The APA notes that such meditation has been found to reap immediate benefits, potentially helping people who can find time to meditate during the day to prevent their stress from accumulating throughout a hectic workday.
FIND TIME TO EXERCISE.
The APA notes that research continues to support the notion that exercise is as beneficial to the mind as it
Work is the third-leading source of stress among Americans. Men and women who feel overworked may benefit by delegating more tasks during their days or simply stepping back and taking on less work. The potential effects on your career of taking on less work will likely pale in comparison to the toll chronic stress, which can contribute to heart disease and stroke, takes on your body. Stress is a part of daily life for many people. But there are several simple and quick ways for stressed out men and women to reduce their stress during the day.