Pop Up Mental Health Clinics

Pop Up Mental Health Clinic
Pop Up Mental Health Care Clinics

A pop up mental health clinic? Never heard of it? Nor had I until recently when I read an article on how pharmacies are getting into the game of mental health care. Soon, it seems, we will all be able to roll up to our local pharmacy and not only pick up our prescriptions, but see a therapist on site as well.

As a therapist myself I wondered what does this mean for not only me as a provider, but also for the patient. Certainly the pandemic over this past year has taught all of us that access to mental health care is not only necessary for everyone, but also needs to be accessible with few barriers to receiving treatment. In terms of access, rolling up to your pharmacy and having access to a therapist on the spot feels like this need is being met.

However, I have my questions. Therapy is broad with many therapists offering a range of different types of care for many different types of symptoms and upset. From anxiety to depression to severe illness such as schizophrenia, therapists treat people suffering from all of these and much much more. Given this broad range of mental health ailments, most therapists specialize in an area. The specialization comes from study, their experiences, and their interests. When someone is looking for a therapist, they are often trying to find someone who matches what their needs are.

Walking into a pharmacy, I wonder how people will be matched up. Will it run like a crisis line where whomever walks in gets the next available therapist and the meeting is for the therapy hour (45 to 50 minutes) and then the person gets up and walks away and hopefully feels better with no charge or is it going to operate like a low fee clinic, charging a low fee, and patients have a choice of whom they see and have the option of returning and seeing the therapist on a regular basis?

I also wonder will pharmacies tie people to a therapist based on their prescriptions. Let’s say someone is picking up an anti-anxiety medication and the pharmacy staff not only gives the patients their script, but also the names of therapists in their clinic that they encourage you to see alongside taking your medication. The flip side of this is a therapist who sees someone for anxiety and then sends them to an in-house medical doctor who then prescribes anti-anxiety meds that get filled right at the counter. Convenient one-stop mental health help.

Those two points, i.e. that therapists seeing patients in such pop up mental health clinics, actually have the experience to support whom they are seeing in the pharmacy and that this is not just a grab to prescribe more meds to the public, are the places where I feel concern. This article does not disclose the details of these plans, just to say this fad is coming our way.

The article lists out questions that patients should hold in mind when they meet a therapist, but, truth be told, when people want to talk to somebody such questions often go out the window as their distress is so keen, it is difficult to hold in mind who is this therapist and do I feel comfortable with her? It is then on the therapist to hold on to their minds to decide if they can serve a potential patient or not. If a therapist does not think she can, does she have the ability to not take someone on? In community mental health, that choice is often not there for the clinicians, but will it be in corporate America?

Mental health is serious and corporate America is seeing it as its own power play and grab. Ethically one needs to safe guard themselves from a fast food approach to mental health care. Yes, something is better than nothing, but sometimes fast therapy does little to change anything.

As a practicing therapist in Capitol Hill, Seattle, I believe mental health care should be available to all, but in a responsible way. There are low-cost clinics and websites where Clinicians offer their services at a deep sliding scale. Finding this type of therapist for a long-term relationship feels important as the therapist can then track alongside you your progress, setbacks, and provide a containing space that is ongoing and built on trust. I believe in this type of approach for the work we do together.

Yet! I won’t be surprised to walk into a pharmacy next time and see a line of therapists waiting to see you and me.

A Time to Languish

A Time To Languish
Languishing

Is this a time to languish?

According to the New York Times, it is! Last week, I was perusing the paper and there it was — an article on languishing. First off, this is a very old fashioned word. I had originally thought it meant to take one’s time, but the more I read the article, I knew I was wrong. When I looked the word up in the dictionary, it means “To grow weak or feeble and (2) to suffer from being forced to remain in an unpleasant place or situation.”

Aha! Now I had something to think about. Given we all seem to be stuck in the pandemic that just won’t take her leave, we are stuck in a situation that is joyless and aimless. The article points out we still have energy, but it’s just being used in mindless, unenergetic, stuck, and listless ways.

The article calls languishing the “middle child” of mental health — you aren’t thriving and you aren’t depressed. You are languishing on the vine of life going along at best. Is this you? Is this me? You may not even realize you are suffering from languishing as when you are in this state your mind is in a fog and cannot discern what you are feeling or not feeling. The article goes on to point out naming it may be a way to start normalizing this feeling. It even encourages people to answer the question, “How are you?” with the word — “I’m languishing.”

How would you respond?

Of course, the article goes on to giving some good tips — try to get into one’s flow, focus on small goals, and give yourself some uninterrupted time — all ideas that can help any number of mental health conditions that cause us to not be at our peak on any given day. So, the article is sound, but it is also general.

To languish now calls to mind rotten fruit withering on the vine of one’s life. That’s harsh, but it feels like the truth. One needs water and nourishment for growth — how can we gain this for ourselves when we are forced to continue in the pandemic. I know so many people who have booked travel for later this year to favorite destinations. Will they get to have the experience they desire or to return to those days do we have to wait longer?

Some of my own tips for dealing with the state of languishing includes:

Cultivating the long breath — the pandemic is not over yet. Being present to life and making it good in the here and now in the circumstances we are in is what we are each called to do. Figuring that out seems critical to growth at this time.

Pick up something new to do — that you can do without the pandemic constraints. Some people are tired of masks and social distancing. Give yourself activities that are safe to do without these constraints on you — i.e. a new exercise at home, a new hobby at home. I know you may be tired of home, but it is a place where freedom from these constraints can live.

Fully vaccinated? Get out and do old new things with the safety measures in place. Go out to eat, head to the local museum, take a weekend away — refresh yourself in ways that you haven’t touched since the pandemic began. Even little things can become big helping you to thrive.

Be in touch with your family and friends in new ways — perhaps that is once again being together as everyone is vaccinated or just remembering people through kind words and gestures. Holding others in mind can often get ourselves out of our own minds and languishing there.

It seems to me that straddling the middle to the end of the pandemic is about naming our mental state — are you thriving, languishing, anxious or depressed? Once one can name her feelings and actually feel them, one can act to lift the fog and take steps toward thriving.

May you not languish a moment longer than you need to!

A Pandemic Ending

Pandemic Ending

A pandemic ending. Can it even be possible?

Only a year ago, the entire world was going into lockdown. True lockdown days where the government actually counted cars on the road to see if we were doing a good job in WA State of staying home. Except for a trip to the grocery store every now and again, you were meant to stay inside.

Although life became strange, the lockdown provided many with a reprieve from having to be social. Many who feel pressure to live up to others’ expectations no longer need worry about it. Family occasions came and went and there was no need to make uneasy excuses as to why you didn’t want to attend.

The pandemic of course. It allowed for many to have breathing room to slow down, not care so much, and be true to themselves.

A pandemic ending? Now what?

All of a sudden, with everyone soon vaccinated, people are going to be out and about wanting to gather socially. All of a sudden the pressure to keep up, discuss post-pandemic plans, and be with others is on. Even before it actually is over, everyone is chomping at the bit to make plans. It’s no longer a long breath moment of silence and hunkering down. Now it is all about the other and getting out into life.

But what if you aren’t ready? What if you want to stay in lock down a little bit longer or even a lot longer. What to do? Perhaps all of us found a space that felt new and different that we don’t quite want to give up as the pandemic ends. Perhaps you love cooking more or family game nights have become a tradition or working on your creative projects deserve your time. These all feel like easier things to keep as a part of your life even as life resumes to normalcy.

How about drawing boundaries with friends and family? Now that everyone is going to be able to actually see their dear ones without a pandemic looming over us, what if you don’t feel like rushing out to be with everyone? How to handle? Being honest with one’s self seems to be the start. On your own, what did you learn about yourself as far as the others you share time with? Perhaps this is the time to put in motion how to be with others and be true to yourself. Perhaps that is not seeing people, perhaps it is not spending as much time, perhaps it is saying no, perhaps it is saying yes. Having courage to interact with others out of new knowledge garnered while in lockdown feels important as the pandemic ending is about to unfold.

If you are grieving the end of the pandemic, it is perfectly normal. For over a year, we have found a new way to live life that was quite different than life before. Taking some time to think about the losses that you will endure as life resumes also feels important at this time. As we went into lockdown, I don’t think anyone saw that this was going to go on for over a year. We lived into it as it unfolded.

As we have more notice of the pandemic ending, grieving what is over and lost, preparing how you want to engage with the other, and determining what parts of your lockdown life you want to keep are all ways to prepare for coming out of lockdown and engaging in normal life over the next few months.

Puppy Love

Puppy Love

Puppy Love — it’s real!

It seems everywhere I look around my neighborhood there are puppies. During this COVID pandemic I have heard it’s a thing – getting a puppy – and now I know it is true. I walk anywhere and there is a six month old puppy walking along her happy owner. Perhaps you are one of these people who got a pup at the beginning of quarantine.

And what lucky puppies they are. Everyone is at home with hardly a thing to do. What could be a better time to enjoy a puppy and give time to play, walk, train, and be with puppy. I think our little animal friends can provide a calming effect on people as we deal with these odd times. Instead of focusing on all that feels blocked and off this year, puppy gives us something to focus on and enjoy in the here and now — allowing us to be in the present moment rather than getting into thoughts of an anxious future.

Only thing — puppy costs quite a bit these days. Specialized diet, toys, training, vet bills, possibly insurance, and more — it is a significant expense to undertake a puppy who becomes a dog for the long term. So, keep this in mind. Second, keep in mind your schedule. If you are working from home for the foreseeable future, this may not be a problem, but it’s important to note your schedule and how it may change. And when it does, what will happen to puppy? Keep this in mind too.

Outside of the considerations, pets help regulate us and our own emotions, help us remain in the present, and ease our anxiety as they grow into this fun world. For them, it is fun. Keep the puppy love going and take some advice from our little furry friends.

Everything is going to be alright!

Are You Still At Home?

Are you still at home?

I read an interesting article in the NY Times recently titled What Does it Mean “To Be at Home” These Days? The title intrigued me so I clicked on through as I think I am wondering what does it mean as well.

When the quarantine lock down happened back in the spring it felt serious. My state and immediate community felt locked down. I remember I was at home, except for a Thursday grocery shopping trip. I worked from home, took care of my home, and lived at home for weeks into months. I did not have anyone in and, except for walking the dog, did not go out myself.

Home for me became everything. Where I worked out, met friends and family (on-line), met my patients, cooked, watched movies and plays, and more. It was the only place I had that felt safe and where I was told to be. Now, all of that is changing as restrictions have been lifting, the economy opening up, and my own sense of feeling freedom to move again.

However, there is still the recommendation in place to stay at home if at all possible. What does that mean? Is it quarantine time again or something else? I find myself at home and being there a lot of the time, but I also find I am working from office more — even if alone and using tele-health — I am doing more errands and my personal rituals of self care are back. I may still be doing a lot from home, but it is certainly not everything. It feels good.

Yet, others I know are not only as out there as I am, but also traveling, sharing significant time with groups of friends, and generally not home that much. Others are still in lock down. Wow! Everyone is making their way in what they feel is good for them. No longer consistent in staying at home or going out, people are up to their own thing based on their level of comfort given what is unfolding.

What does it mean for you to be home these days? How has it changed since it all started? How will you sustain this life into the future? Are you able to respect the choices people are making in regard to how often they are in or out of their homes? Taking stock of what home means to you as well as how it continues to shift as the pandemic sticks around is a space to hold all of our feelings and care well for ourselves.

A Return to Routine

Return to Routine
Back to Your Routine?

A return to your routine — or not?

Well, the evidence is everywhere. People are emerging from the lock down, shelter-in-place state across the world and America. In Seattle, our lock down continues in many ways that have been lifted in other parts of the nation. However, certain areas have been opened including the hiking paths, parking, camping, medical appointments, dog walkers and more. When I am driving around these days, I am noticing more traffic on the roads, more people out and about, more freedom of movement.

As quickly as we were put into lockdown for several months and had to seek a new normal, we are now being invited back out into the world. The virus is still very much alive and active in society, but so too is man. However, the shelter in place orders allowed for a new routine to take hold for many of us.

Many people have been working from home in their comfortable clothes with more autonomy over how they are working. The rhythms are simply different. With all stores closed, except for grocery stores and pharmacies and a few other places, perhaps you found yourself consuming less over this time. Did you miss it? My guess is you have been spending your time with your family – this closest to you – and your pets. How has it been to slow down and be with your cherished family? Perhaps you are now playing board games and solving puzzles? Maybe you have explored cooking and perfected some new recipes.

Ah! Life has certainly been different, and there have been new pleasures we have been able to explore given the significant disruption to our routines. My guess is as we continue to open up, these new routines and ways of living will recede as we return to our lives and to one another.

However, are there parts of your new lockdown routine that you don’t want to give up, but want to be a part of your new post shelter in place routine? Maybe you don’t miss your gourmet coffee out or shopping? Perhaps you really appreciate not commuting and using that time to ground yourself in your home and garden and family? Has there been a new hobby you have picked up that you do not want to abandon?

This is the perfect moment to take a little time and reflect on how the past few months have been in totality for you. From there, determine what parts of your old routine you would like to restore and what parts you want to take from your new routine and keep. I believe we have all learned a great deal about ourselves and none of these learnings need to be abandoned because people are again moving and interacting.

Intention around how you want to live your life moving forward could be a major shift we feel across society as people renew their sense of what life and living is about based on the truths they learned from slowing down, being limited in movement, and spending significant time with self and close loved ones. Let this be a moment of choice of how you may return to your routine — or not.

Just as there has been something lost as we locked down this past spring, something again will be lost as we move back into society. Mark this moment and make it meaningful for you and yours.

Dear Therapist: Opening Envy

Opening Envy of People at Stores

Dear Therapist;
I live in a State that remains in lockdown. A few things are reopening, but the “shelter in place” order is still active and we are pretty much housebound in our community over 60 days at this point. I have family in other parts of the country that are enjoying dinner out with their friends, getting their hair and nails done, and living life somewhat back to the way it was just a few months ago. I am happy for them, but it also sort of ticks me off to not be able to have my freedom to move. It’s hard for me to be happy for them when I feel stuck. I guess I am envious. How do I keep it together?

Sincerely, Sick of It

I hear you. I think it’s wonderful you can admit to feeling envy for people in other areas gaining their freedom to move and get back to their lives. However, many people feel the risks they are undertaking is not worth it for their health or the health of others. Yet, it also is getting old to simply be indoors with take away, cooking, and watching movies and shows with the same people for months on end.

This pandemic is all about the other and the collective health of society and much less about ourselves as individuals. The problem in America is we are all about the individual and take very little care of the other. And this bears out in so many aspects of American life, but is now in full political mode as people exert their rights over the good of public health. So, continuing to shelter in place for the good of others as many Americans are given the freedom to live as we believe as Americans — for ourselves — makes it even more difficult.

Socialized nations, like Australia and New Zealand and countries in Europe, suffered with not being able to move as well, but believe that society and community comes first over themselves as individuals. In this way, it is easier to shelter in place because the entire nation has the ethos and is in it together.

There is not much we are in together as Americans anymore. The divide between the good of all v. our own personal good is on the line in a way that it has never been before. I hear in your question the desire to care for your community, and, at the same time, your envy of those who can move as we all believe we should. Being envious of this movement after months cooped up is completely understandable.

However, given you have acknowledged your envy, perhaps now frame it for yourself in a new way. Each day you maintain shelter in place you seek to protect and care for your fellow members in society. Something sorely lacking in America today. The notion of kindness is extended in this way. Although difficult, it may make it a little more bearable to remain sheltered in place even as you see your friends and family move with freedom right now.

I feel your envy, your stagnation, and frustration. It’s becoming a lot, but keeping the bigger picture in perspective will hopefully help you hold the breath a little longer. I hope your friends and family in other parts of our nation remain healthy and safe too.

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Keeping Good Humor

Family Keeping Good Humor

A friend sent me an article about laughter during a pandemic. I think my friend knew I needed a lift and sent it along to me as a reminder to keep good humor during this uncertain time. Of course, I enthusiastically asked her to send me this article as I desperately needed to read it as I sometimes feel it is not OK to laugh or be light and funny during this time. Yet, it’s actually exactly what I need — i.e. to not take the whole thing so seriously and not get caught up in the abyss of the future that is more unknown than ever.

Are you keeping good humor these days? Are you the one sending around funny memes? Are you engaging in a deep belly laugh every now and again? Are you able to see the light side of the situation and make a joke? Or are you the person scouring when others engage in these ways? Whichever your reaction, my guess is that is says something about your mental state.

To be able to laugh is mentally healthy. Yes, even during a pandemic, it is important to give in to the lighter side of life and see that we can still hold on to this part of ourselves that is resilient, courageous, and has the ability to persevere in times of crisis and/or facing the unknown. Giving ourselves permission to give in and enjoy life during this time with good humor is really very important.

Have you noticed if nothing feels fun or funny or that people are annoying you who are embracing this these days? It may be an indicator of being very stressed, anxious, or depressed or a combination of all three states. One cannot embrace good humor – either our own or that of others – if we stay stuck in a serious, dire, anxious frame of mind. Living too far into the future or just looking around at reality in despair can truly lead to bad humor which can lead to low moods, physical ailments, or a general feeling of despair and inertia.

I want to encourage you to maintain some level of good humor during this time, especially if you feel anything but. Moving out of your comfort zone of being in misery, sadness, anxiousness, or hard-heartedness will not be easy, but I want you to open up and give it a try. See if some good humor can make it any better. And don’t do it for any great reason besides lifting your own spirits. Sometimes we feel guilty for putting ourselves above the collective situation and taking care of ourselves through something like laughter.

Good humor, laughter, optimism are all important components to being mentally healthy and resilient during this pandemic. Keep this in mind and laugh away!

Creativity Burst: Puzzle Time

Puzzle Time
Pandemic Puzzle Time!

Pandemic Puzzle Time!

It seems that these days all things old are new again. And this is true when it comes to puzzles. Remember the big jumbo 1000 piece puzzles you would do as a kid with other kids or your family. The pieces would be laid out on a large flat surface. There the puzzle pieces would sit beckoning to be put together.

It would often take hours to get it done over several days. Of course, starting at the corners, building the outside edge of the puzzle, and then filling it in — often by figuring out smaller puzzles that then fit into the big puzzle. It was quite something to see 1000 puzzle pieces be pieced together to find the picture on the front of the box.

With time on our hands and people in the house, puzzles offer us a place to ground ourselves in pieces that we can touch, creating a picture that is worth a 1000 pieces. There is something very satisfying to working a puzzle. I have seen puzzles in waiting rooms of therapy offices and often someone is in front of it working a piece of the puzzle. There are no apps, no screens, nothing bright and glitzy – just little pieces to put together. In this respect it feels really old fashioned.

It can also lead one to a sense of creativity as you are building picture of some sort as you work to solve the puzzle. Something that may be fun to do with your kids is to have them create their own puzzle. This doesn’t have to be 1000 pieces, but, using a thick piece of cardboard type paper, have them cut out different shapes that they seek to fit together to create their own picture. The can color in the picture once all of the blank pieces are pieced together. From there, pull it apart and solve their puzzle. Everyone in the family could do one and then hand it off to another family member to solve.

Puzzle time is back and in full force. I don’t think they ever went away — they just took our attention again when we had some time to solve them.

Mental Health Crisis in America

Mental Health Crisis in America
Mental Health Crisis Brews in America

I read an interesting article the other day in the Washington Post regarding how the current COVID-19 pandemic is pushing America to the brink of a mental health crisis. I cannot even believe it has taken a severe public health crisis like this one for the media to begin to pick up on how difficult it is for Americans to find and receive quality mental health care today.

Sitting from the vantage point of a therapist, I know this to be true for many reasons. While most articles, like the one in the Post above, focus on access to mental health care, there is something else one has to first realize. Access to mental health care starts with clinicians who are in training to work in the field and serve people in need of mental health services.

It is an unfortunate truth and one not often discussed in the media that to do the work of a therapist, or, as the traditional license is called, a Licensed Mental Health Counselor, is a costly and time-consuming journey. One cannot clinically practice one-on-one therapy with individuals without holding a Master’s Degree in counseling, social work, or marriage and family work. This type of degree takes 3-5 years to complete with significant amounts of debt taken on to complete the degree, upwards and over $100,000.

Along this journey, graduate students in training are called to do an internship with a significant number of clinical hours and supervision time spent in order to earn one’s degree. Although a person may have at least 2-3 years of training experience in school, one’s internship is unpaid. People must find paid jobs as they juggle their internship demands.

This is where it strikes me that the mental health system is failing at its core. Community Mental Health Agencies that serve the poor and mentally unwell, a segment of the population that would have very little access to mental health services, are staffed with interns from graduate schools who are seeing these people for free. The core of the mental health services offered to thousands of Americans is valued at an intern level who earn nothing.

From there, graduate students leave school and are permitted their first license. Where I live it is an Associate’s license, which means you have the ability to see patients, but you must be supervised for a set amount of hours as you work toward full licensure, which is additional hours. Often Associate Mental Health Counselors use this period of time to take clinician positions in mental health agencies. Now they are no longer serving for free, but for $17 to $23 per hour. The average case load for a new Clinician is upwards to 100 clients. Then add in the math of $100,000 of student loan debt.

It is from this vantage point that I see our mental health system failing in America. From the start, when people seek to train to become a mental health clinician, no value is given to the skills that they are learning and employing to help people with their mental health needs. From weighting people down with student loan debt, to not providing any value to the intern seeing clients, and then providing a very low income to the new clinician with a caseload that no one can keep up with — not only are the clinicians burned out, but the system is overwrought with little to no support for people who need tremendous care.

What happens after one has completed her Associate’s license requirements and you are now a fully licensed therapist? Unfortunately, most clinicians leave Community Mental Health and set up their own private practice. Even if the clinician charges a reduced fee, it is often three times the amount one was earning at the mental health agencies. It is unfortunate that the very poor and mentally unwell people in America are left to be churned through by clinicians who are in some training phase of their career burning out without proper care, support, or caseload numbers.

Insurance also plays a roll in the inequity of the Mental Health system in America. Are you in network and, if you are, your patients may benefit, but the Clinician will likely make very little money for their services when all is said and done. If you are out of network, then the Clinician works with the patient to determine the fee. A patient may submit a receipt to their insurance company which may provide them with a portion of the fee they have paid. In this way, the patient has to decide what can they afford given the insurance company will only be reimbursing some of the full fee and that is often after deductibles are met.

All of this to say that when we look at the mental health crisis in America, we need to critically think about how we value our clinicians in training as well as how we value the services provided to the mentally unwell, especially those accessing care through the community mental health agencies. It begins with both parties being valued and supported in terms of money and care.

Until this happens, the system is on crumbling crutches which is going to further lead to the black hole of inadequate care, funding, and a lack of people to serve during crisis such as the one we are in currently.