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Behavioral Health Reform By CORI URBAN
Special To The Republican
Data from the Massachusetts Department of Public Health’s COVID-19 Community Impact Survey shows that the four counties of Western Massachusetts had the highest reported number of “poor mental health” days in the early months of the pandemic. “The toll overtime has been significant,” said Katherine C. Mague, Behavioral Health Network senior vice president. One way that toll is being addressed is a plan for new community behavioral health centers that are to open in the area. Beginning in January, designated Roadmap for Behavioral Health Reform will provide expanded access to behavioral health evaluation and treatment in communities across Massachusetts. They will serve as an entry point for timely, high-quality and evidence-based treatment for mental health conditions and substance use disorders including routine appointments, urgent visits, and 24/7 community-based crisis intervention as an alternative to hospital emergency departments. The centers will receive enhanced state funding through alternative payment models to support flexible, person-centered treatment. These services are covered by medical insurance for individuals covered by MassHealth. The Commonwealth Executive Office of Health and Human Services has been planning the Roadmap for Behavioral Health Reform for a few years; and the community behavioral health centers are “designed to address significant and longstanding gaps and problems in the system of care,” Mague said. “Turns out the timing couldn’t be better because of the increase in need related to pandemic and societal stress/ distress.” The Roadmap for Behavioral Health Reform ensures the right treatment when and where people need it. It is a multi-year blueprint, based on listening sessions and feedback from nearly 700 individuals, fam-
ilies, providers and other stakeholders who identified the need for expanded access to treatment, more effective treatment and improved health equity. “The challenge with the pandemic restrictions is that we all lost access to the universal foundational supports on which we create and maintain optimal behavioral health functioning,” Mague said. “These supports are things like church/synagogue/mosque, school (for youth), hobby groups (choir, soccer team, knitting club, book club), dinner out, etc.” Many more people needed targeted or intensive therapeutic supports; emergency services department data reflects that. “More people presented for crisis assessments and with much higher acuity than pre-pandemic,” she explained. “However, the mental health system was not resourced to provide specialty care for the high numbers of people who were needing them. So the wait lists were long to get into care, and that forced people to need higher levels of care because they didn’t get the help they needed sooner.” The situation has improved as people return to more pre-pandemic activities. “As they are able to re-establish connection with their universal supports — faith community, book club, school, etc. — the rates of people needing intensive intervention is trending slightly downward,” she continued. However, it is likely that the lasting impact of the pandemic on mental health will be present for a long time. “The prevailing ethos in our culture and communities is one of fear and uncertainty. By nature, when we feel a loss of control or when our world is unpredictable, it triggers a fear response,” Mague said. “The pandemic and resulting restrictions/isolation created conditions where we felt a loss of control, a loss of predictability and isolation which removed our normal sources of support and stability. Although the sources of support are coming back, we are not seeing a reduction in the sense of fear and foreboding that pervades the culture right now.
We need to address that in order to see large-scale improvement in behavioral health functioning.” The new community behavioral health centers will provide the following services in person and via telehealth:
ed to operate a single community behavioral health center in its assigned area. These facilities will provide services to the entire community in their area, not just the city/town housing the facility. The agencies are currently working with the Executive Office of Health and Human Services to identify their designated • Integrated mental health and addiction treatment. facility and the cities and towns that will house them. “The goal of the center is to con• Extended hours, including evenings and weekends. duct an assessment to determine the nature of the problem and appropriate treatment and to support the • Same-day access to intake and brief assessment, urgent and crisis individual in accessing appropriate treatment including medications treatment either in the (community behavioral health center) or and drop-in treatment and another local mental health clinic,” support (e.g., group sessions, Mague said. Conditions include peer supports). anxiety, depression, bipolar disor• 24/7 mobile and community crisis der, post-traumatic stress disorder, autism spectrum and alcohol and response with Community Crisis Stabilization for youth and adults. other substance use and misuse. “At Behavioral Health Network we • Telehealth and flexible service are very excited about the potential delivery locations (e.g., home, for the community behavioral health school, etc.). center service model to make a significant difference in the expe• Peer supports. rience of clients seeking care with community behavioral health cen• Care coordination. ters,” Mague said. “The community • Ability to serve all ages, including behavioral health center intentionalchild and family-specific treatment ly integrates screening for medical, substance use and mental health models and models for older needs when clients present for care. adults. Identification of needs in any area leads to recommendations either for • Ability to meet a variety of treatment at the community behavlanguage needs and serve ioral health center or other appropriindividuals from diverse ate area providers.” cultural backgrounds. The community behavioral health • Evidence-based and evidence-in centers will be staffed by a mulformed treatments to meet tidisciplinary team of providers individual needs, including including therapists, certified peer interventions and close specialists, psychiatric providers and coordination for individuals with navigators who help connect people behavioral health needs who are to needed resources. involved with other systems For example, if initial screening including the justice system or identifies someone with opioid use children in the care and as well as trauma symptoms, houscustody of the commonwealth. ing and food instability, the center will offer a multidisciplinary team Serving clients in Western Massa- approach, including enrollment in chusetts will be Clinical Support Op- medication assisted treatment for tions, Behavioral Health Network, opioid use, therapy for the trauma Center for Human Development symptoms, a peer to share his or her and The Brien Center. own journey and provide a sense of Each contracted agency is expect- hope and a navigator who will help
Above: Katherine Mague, senior vice president at Behavioral Health Network, Inc. (PHOTO COURTESY OF BEHAVIORAL HEALTH NETWORK)
the client access food pantries and safe housing. “As the individual stabilizes, the team will support them in self-sufficiency efforts such as employment preparation or job search,” Mague said. The goal of the community behavioral health centers is to deliver the right type and amount of care at the right time in a culturally and linguistically accessible manner so that the client sees measurable improvement and to make this care easy to find and easy to access. “The commonwealth is providing increased financial support as well as technical assistance to ensure a system of care across Massachusetts that delivers on these goals,” Mague said. “If these goals are realized as designed, community members will find it easier to seek and receive care and to experience improvement in functioning. The more successful we are, the more people will benefit.”
For more information, go to mass.gov/info-details/ community-behavioralhealth-centers
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D2 | SUNDAY, SEPTEMBER 18, 2022
THE REPUBLICAN | MASSLIVE.COM
What to know about
PTSD T
raumatic events and experiences can affect individuals for a long time. Though it’s often associated with combat veterans, post traumatic stress disorder, or PTSD, affects people from all walks of life. Because no one is immune to PTSD, it can benefit anyone to learn more about this potentially debilitating yet treatable condition.
What is PTSD?
The American Psychiatric Association defines PTSD as “a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event.” Some examples of events that can lead to PTSD include war/ combat, a terrorist attack, rape, or incidents in which people have been threatened with death, sexual violence or serious injury. PTSD also can occur after witnessing traumatic events, including natural disasters or serious accidents.
Is PTSD a recent phenomenon? PTSD has been around as long as there have been traumatic events, though its name is more recent. The APA notes that PTSD has been known by various names in the past, including “shell shock” and “combat fatigue.” These names are no longer used in part because they give the impression that post-traumatic stress is exclusive to combat
veterans. That’s a misperception, as the Sidran Institute, a nonprofit organization that helps people understand and recover from PTSD, notes PTSD will affect one in 13 people in the United States and 9 percent of Canadians at some point in their lives.
Who can get PTSD?
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Avoidance: People with PTSD may avoid reminders of the traumatic event. These reminders can include places, activities, objects, and even people. Individuals also may resist talking about the event and how they feel about it.
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Alterations in cognition and mood: PTSD can result in an inability to remember details of the The APA notes that exposure to an upsetting traumatic traumatic event. Individuals also may develop negative event is necessary before a thoughts and feelings that diagnosis of PTSD can be lead to ongoing and distorted made. However, that expobeliefs about themselves and sure can be indirect. For example, police officers who are others. Individuals may blame repeatedly exposed to details themselves for the event or of heinous crimes can develop experience ongoing fear, horror, anger, guilt, or shame. PTSD even though they are A sense of detachment or esnot victims of those crimes trangement from others also and did not witness them. may occur. But the U.S. Department of Veterans Affairs reports that Alterations in arousal individuals are more likely to develop PTSD if they are or reactivity: Symptoms in this category may include directly exposed to a trauma being irritable and having or injured. angry outbursts; reckless, and What are some potentially self-destructive behavior; being overly watchsymptoms of ful of surroundings; being easily startled; or experiencing PTSD? difficulty sleeping or concentrating. The APA places symptoms PTSD affects people from of PTSD into four categories: all walks of life. Individuals who are having difficulty Intrusion: Symptoms processing a traumatic event in this category include they were directly or indirectintrusive thoughts, such as ly involved with are urged repeated, involuntary memto contact their physicians ories; distressing dreams; or immediately. More informaflashbacks of the traumatic tion about PTSD is available event. at www.psychiatry.org.
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Foods that can
positively affect mood
No one is
immune to the occasional bad mood.
Whether it’s the weather, waking up on the wrong side of the bed or another variable, various factors can have an adverse affect on a per-
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son’s mood. Food is one factor that can have a positive effect on mood. Certain foods have been found to positively affect mood, so incorporating them into your diet may help you stay positive even on those days when you get up on the wrong side of the bed.
Fatty fish
A study from British researchers published in the Archives of General Psychiatry found that a daily dose of an omega-3 fatty acid called eicosapentaenoic acid, or EPA, helped patients with depression significantly reduce
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their feelings of sadness and pessimism. Hackensack Meridian Health notes that salmon, albacore tuna, sardines, trout, and anchovies are rich in omega-3 fatty acids.
Nuts and seeds
The minerals selenium, copper, magnesium, manganese, and zinc have all been linked to mental health, and nuts are rich in each of those minerals. Hackensack Meridian Health notes that almonds, sunflower seeds, pumpkin seeds, walnuts, and peanuts are particularly good sources of the immune system-boosting minerals zinc and magnesium.
Dark, leafy greens Dark, leafy greens like kale, spinach and collards are rich in iron and magnesium, both of which can increase serotonin levels and help reduce feelings of anxiety. Dark, leafy greens also help the body fight inflammation, which can have a positive effect on mood. A 2015 study published in the journal JAMA Psychiatry found that brain inflammation contributed to certain behaviors, including low mood, that appear during major depressive episodes.
Dark chocolate Chocolate lovers may be happy to learn that dark chocolate can improve mood. A 2009 study published in the Journal of Proteome Research found that dark chocolate helped to reduce levels of the hormone cortisol, which has been linked to stress. Hackensack Meridian Health notes that, when consumed in moderation, dark chocolate made of at least 70 percent cocoa can help people relax. Various foods can have a beneficial effect on mood, potentially helping people to stay positive when doing so proves challenging.