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Roger Murray

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  1. When someone makes the critical decision to start therapy, it can provoke a great deal of nervousness—beyond the underlying anxiety, depression, or other mental health issues that are prompting them to seek therapy in the first place. This is especially true if they've never been in a setting where they've been expected to focus solely on themselves and the sensitive aspects of their lives for a fixed period of time. As a new therapy client, preparation is key to help calm the nerves. Here are the top six tips for how to prepare for a first therapy session. 1. Have a Quick Reference for Health-Related Information Psychological and physical health are intricately connected, and during a first therapy session, it'll be important to come prepared to discuss health history details. People should make sure to have a readily accessible list of the medications they are currently taking, including supplements. This can be especially helpful if a person would like to start a new medication in conjunction with their first therapy session. Beyond current medications, being prepared with a list of medications one has taken in the past can be helpful, especially if certain medications caused adverse side effects or were otherwise ineffective. Be ready to discuss other health conditions, too, as many medical conditions can influence mental health or stress levels—including endocrine conditions (such as thyroid disorders), chronic pain syndromes, or chronic illnesses. Having these health details written down in a single place can serve as a handy reference and reduce stress during a first therapy session. 2. Think About the Functional Goals of Therapy Often when starting therapy, the broad goal is to feel better overall. While this is certainly a realistic and achievable goal, it can be helpful to break this goal down into smaller pieces. This way, it's easier to assess progress during a therapeutic journey. Before a first therapy session, people need to take some time to reflect on what they're looking to get out of therapy. If a person is experiencing depression and hoping that therapy will help their condition improve, they should reflect on the most challenging aspects of their current condition. For example, depression-related sleep challenges are very common. If sleep has been difficult, a goal of therapy could be to increase the number of nights per week that they get quality, uninterrupted sleep. Or, if a person is experiencing tearfulness with their depression, a practical goal of therapy would be to see a reduction in crying episodes per week. Tracking these symptoms can help a person measure the impact of their therapy and make sure they're recognizing improvement in their condition. It's important to ask one's therapist during a first therapy session about how they view and measure progress, as well. 3. Prepare First Therapy Session Questions Thinking too much about a first therapy session can make it difficult to open up and start a conversation and relationship with one's new therapist. However, going into a first therapy session with a completely blank slate can also make it difficult to know where to start. It can help to prepare a few questions to ask during the first therapy session. Examples include: What to expect from therapy? What is the therapist's counseling style? How do practical issues like billing work? A good way to come up with questions is for people to think about what details about the first session are nagging at them the most—and then reframe those as a question. For example, if a person is worried about what they should be doing during a therapy session (i.e., should they be sitting at their computer desk, or is it okay for them to be lying on their couch), they should simply ask. Or, if a person is concerned about the billing or financing aspect of a session, they should feel free to get those questions out in the open as well. 4. Focus on Creating a Supportive Environment for the Session Virtual mental health counseling sessions can help people fit therapy into their busy lives in a way that was never possible before. However, people need to think about where in their living space they will want a session to occur. Being strategic about this can ensure that a first therapy session is as productive and beneficial as possible. Some factors to consider include the following: Selecting what to wear. Choosing comfortable clothing can be a great way to feel at ease during a therapy session. People shouldn't worry about dressing to make an impression or to appear professional. Instead, they should wear clothing that makes them feel as relaxed as possible. Choosing where to have the session. If possible, people should choose to have a first therapy session in an area of their home where they're free from mental distractions. If having a therapy session in the kitchen means staring at a to-do list on the fridge, or a sink full of dishes, this can introduce more stress into the session. Instead, choose a peaceful, meditative space with as few distractions as possible. Ensuring that this is free from disruption (i.e., by locking the door to prevent roommates from wandering in) can also help one feel more comfortable during a first session. Being intentional about the physical space and nearby items. Once a person has chosen what to wear and where to set up their device for a first therapy session, it can also help to have a few items nearby to make the setting as calm and supportive as possible. Think about keeping a candle, a favorite scent, a comfort item, a framed picture, or a cozy blanket nearby. Practical items, like a box of tissues, may be helpful to have on hand, too. 5. Think Ahead of Time About Conversation Starters or Jumping Off Points One of the most intimidating aspects of a first therapy session may be the initial ice breaker or conversation starter that answers the question: "What brings you here today?" This question can feel so big that it becomes difficult to answer or even to know how to start answering. However, instead of thinking of a first therapy session as this giant, inaugural jump into a new frontier, it's helpful to realize that each therapy session is simply a resource for whatever a person may be needed at the moment. Here are some potential topics for jumping-off points people can use when it comes to talking to their therapist during a first therapy session: When was a period in their life, or a specific moment, that they felt truly happy or joyful? What factors contributed to that moment—who was there, and what was the context? Comparing that moment to the present moment, what factors are different or the same? When was a period in their life that they felt the lowest, and what factors contributed to this? How quickly did they come out of this lowest moment, or what feelings or emotions are residual from this moment and continuing into the present day? What relationships in the past have they considered to be the most nourishing and constructive? On the flip side, what relationships in the past have been the most toxic or difficult? What present hardship or situation would they want to change first if they could? What worries them the most about the future? What are they hoping will happen in the future? What small, annoying thing happened yesterday? What choice did they make recently that they regret? 6. Congratulate Oneself on the Reality of a First Therapy Session It takes a lot of courage to be vulnerable and to go through the process of seeking therapy and showing up to a first session. A final tip for preparing for a first therapy session is simply acknowledging the groundwork that a person has laid to get themselves into the position of attending a first therapy session. Showing up for oneself is often more than half the battle, as practicing true self-care takes enormous bravery. Before a first therapy session, people should take a moment to pat themselves on the back for taking this big, important next step forward. How to Learn More About First Therapy Sessions The above tips about how to prepare for therapy consultation can make it easier to leap into this rewarding journey. At Telemynd, our mental health professionals view therapy sessions as a resource for clients, and each session can serve whatever purpose is needed at the moment. Telemynd providers understand the dynamics that go into embarking upon a therapeutic journey, and they excel at easing clients into a first session. For more information about Telemynd's personalized approach to therapy, contact us to get started with an appointment today.
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    Quality mental health care should be available to everyone, no matter where they live. That’s why we built Telemynd, an easy-to-use telebehavioral health platform where you can see therapists and prescribers virtually so that you can always feel confident about the future of your mental health.
  3. Controlled substances are used to treat many common mental health conditions, like anxiety, depression, sleep disorders, and more. Prior to the COVID-19 pandemic and national health emergency, federal rules regulated how these meds were prescribed and dispensed - including a requirement for an in-person health evaluation prior to a prescription being written. However, during the pandemic, federal regulators temporarily waived these regulations to permit patients the ability to manage their medication and access to prescriptions, including controlled substances via telehealth visits. With the national health emergency waivers expected to expire soon, some states have stepped in to draft their own medication management legislation; the result has been growing confusion over which rules apply and where. In this article, we attempt to answer all your questions about prescribing controlled substances, and have included resources to find out more. Why are Some Medications Deemed Controlled Substances? Controlled substances by definition are medications with a likelihood for physical or mental dependence. Many of the more common drugs for ADHD, anxiety, sleep disorders, depression, and more, such as Xanax, Klonopin, Lunesta, and Adderall are listed as ‘controlled substances”. The U.S. Controlled Substances Act (1970) puts all substances which were in some manner regulated under existing federal law into one of five schedules. This placement is based on the substance’s medical use, its potential for abuse, and safety or dependence liability. Medications listed as Schedule I have the tightest controls, and those listed as Schedule V have the least restrictive controls. These controls are mandated by the federal government. This may all sound complicated - but it boils down to prescribers and pharmacies taking extra precaution to ensure these medications are prescribed for and delivered to the right individuals, for the right reasons. What Are the Extra Steps Clinicians Must Take to Prescribe Meds that are Deemed Controlled Substances? In general, to prescribe a controlled substance, a clinician must have a DEA (Drug Enforcement Administration) license, and to fill a prescription, a pharmacist must also have a controlled substance license. Further, for a pharmacist to dispense a controlled substance, the prescription must include specific information such as date of issue, patient’s name, address, and DoB, clinician name, address and DEA number, drug strength, number of refills, and the signature of the prescriber. For these kinds of medications, there are also legal limits on the number of refills and the amount that a prescription may contain. Some drugs have zero refills, and the maximum quantity dispensed is 30 days - meaning patients must contact their clinician each month a refill is needed. In addition, the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 specified that “any practitioner issuing a prescription for a controlled substance must conduct an in-person medical evaluation. A conservative recommendation to support compliance with the act is to conduct an in-person exam at least once every 24 months.” How did the COVID-19 Pandemic Impact Prescriptions of Controlled Substances? The unprecedented public health emergency created by COVID-19 caused action by state and federal regulators to ensure greater access to health care, while simultaneously limiting the spread of the virus. Therefore, as of March 2020, the DEA declared that practitioners “may issue prescriptions for controlled substances to patients via telemedicine, even for patients for whom they have not conducted an in-person medical evaluation, provided the prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of their professional practice, the telemedicine communication is conducted using an audiovisual, real-time, two-way interactive communication system, and the practitioner is acting in accordance with applicable federal and state laws.” At that time, the DEA also ruled it was “permissible to write controlled substance prescriptions to cover a 90-day supply.” However, depending on where you live or who prescribes your meds, you may have had a different experience as certain states and practitioners elected to retain pre-COVID protocols of in-person evaluations given the sensitivity of the medication being administered. What is the Current Status of Controlled Substances Prescriptions? As we move through 2022 and the threat of COVID-19 has lessened, requirements for prescribing and dispensing controlled substances in some states have begun making permanent changes to expand policies implemented under the public health emergency, while others have passed laws restricting them. This website has made an attempt to track these ongoing changes - but to be safe, always check with your own state’s official website, or contact your state or federal representatives. The DEA at the federal level said in a March press release, that it “wants medication-assisted treatment to be readily and safely available to anyone in the country who needs it." However, in the end it is up to each state and provider to do what they feel is best for the safety of constituents and/or patients. Therefore, check with your provider or prescriber to find out if you will need an in-person visit to continue receiving prescriptions of controlled substances or if telehealth visits are an option for you. Telemynd operates as a national practice, meaning that our national network of licensed providers may prescribe many types of medications, they follow federal regulation which prevents the prescribing of controlled-substances via our virtual telemedicine environment. Sources DEA.gov: Rules for Control Substances NIH | National Library of Medicine: Pharmacy Prescription Requirements
  4. Erratic. Volatile. Complicated. These are the unfortunate words that people often think of when they think of someone with a diagnosis of schizophrenia - which in turn has caused a stigma that has lead to fear and isolation for those most vulnerable. A movement has developed, made up of scientists, medical professionals, mental health advocates, and those with the diagnosis, to change the name. In this week’s article, we’ll look at the pros and cons of the name change proposition as well as explain what led to the idea in the first place. What is Schizophrenia? Schizophrenia is a brain disorder that affects less than 1% of the population. When it’s in its ‘active phase’, symptoms can include delusions, hallucinations, disorganized speech, trouble with thinking, and lack of motivation. Research has shown that schizophrenia affects men and women fairly equally but may have an earlier onset in males. As with any illness, the severity, duration and frequency of symptoms can vary. The symptoms are why Dr. Eugen Bleuler named the disorder in 1908 - the term ‘schizophrenia’ derives from Greek words for “split mind” - because Dr. Bleuler thought the disease was characterized by a “splitting of psychological functions” where “the personality loses its unity.” But it turns out the condition was named erroneously. Researchers believe that a number of genetic and environmental factors contribute to the cause of schizophrenia, as well, life stress may also play a role in the start of symptoms. But since multiple factors may contribute, scientists aren’t yet sure of the exact cause in each individual case. Modern Treatment Means Symptoms are Very Manageable While there is no cure for schizophrenia, the good news is that research has led to innovative and safe treatments which means most symptoms will greatly improve and the likelihood of recurrence is diminished. A combination of pharmaceutical treatment and therapeutic treatments such as cognitive behavioral therapy or supportive psychotherapy may reduce symptoms and enhance functioning. Additional treatments are aimed at reducing stress, supporting employment, and improving social skills. Yet a Stigma Still Exists So even while treatment helps dissipate symptoms, the complexity of schizophrenia may help explain why there are misconceptions about the disease. Contrary to what Dr. Bleuler thought when he named the disease over one hundred years ago, schizophrenia does not result in split personalities or multiple personalities. Most people with schizophrenia are no more dangerous than people in the general population. However, you’d never know this based on how people with the diagnosis are portrayed in TV, film, and other media. And as with most stigmas around mental health issues, stigmas perpetuate fear, make “others” out of those with the diagnosis, and in turn encourage isolation - all of which worsen the lives of already vulnerable individuals. Research has found that “public, anticipated, and self-stigma decrease healthcare seeking and treatment adherence, and create barriers to pursuing independent living” for those living with the condition.. Would a Name Change Help Reduce the Stigma? This is how the idea of renaming schizophrenia came about. Said a recent New York Times article, "The idea is that replacing the term ‘schizophrenia’ with something less frightening and more descriptive will not only change how the public perceives people with the diagnosis but also how people with the diagnosis see themselves." Japan and South Korea have already changed the name to “Integration Disorder '', which is the term for which many in the re-naming movement are advocating. Most of the mental health community is behind the name change. A survey by the World Psychiatric Association showed that approximately half of mental health professionals around the world believe schizophrenia needs a new label, and over half believe the term is stigmatizing. Another 2021 poll found that 74% of stakeholders (mental health professionals, family members, researchers, government officials, and more) found the name stigmatizing and favored a name change. In the Meantime, How Can We Help Reduce the Stigma? Regardless of where you stand on the name change, the most important thing is to understand that schizophrenia is a physical disease of the brain - and like other medical diseases - it is treatable today. Much research has been done on how to reduce the stigma around this diagnosis, and that research has found that if we commit to educating society about schizophrenia, promote accurate representations of schizophrenia, and prioritize advocacy, we may help reduce the stigma. Sources The New York Times: ‘Schizophrenia’ Still Carries a Stigma. Will Changing the Name Help? American Psychiatric Association: What is Schizophrenia? National Alliance for Mental Illness: The Consequences of Stigma Surrounding Schizophrenia Schizophrenia Bulletin: Reducing Stigma Toward Individuals With Schizophrenia Using a Brief Video: A Randomized Controlled Trial of Young Adults
  5. As a mental health professional, it's important to create a therapy space for yourself and your clients that is polished yet comfortable and conducive to the interactions needed for successful treatment. Much research has been done over the years on elements like comfort and privacy that can help inform the design of an effective therapy space. "A space should be something that supports you as you try to achieve specific goals…that means creating a calm and refreshing environment to balance the rigorous mental and emotional work of therapy," says Dr. Sally Augustin, an applied environmental and design psychologist. Conversely, therapy space that in any way puts your clients on edge or makes them feel uncomfortable can have an adverse impact on their progress. Creating the right space for online therapy is just as important to get the most out of your therapy sessions. In this week’s article, we provide 5 tips for creating a comfortable and effective virtual therapy space. Choosing the right technology. Investing in your virtual practice is critical to establishing confidence in your ability to deliver care, and to offer a clear environment for your clients to openly engage in the therapeutic process - even when they are far away. Start by ensuring your camera is enabled and the resolution is acceptable (we recommend 720p display resolution or higher). Make sure your internet connection can support a video session and that the audio quality is clear and concise without degradation. The best position for your camera is at face level and centered so you are able to maintain eye contact. That may mean purchasing a stand for your computer or laptop. In session, the goal is to establish a relationship with new clients, to do this we suggest minimizing the appearance of multi-tasking . In addition, if you provide virtual therapy, choose a platform that meets the needs of your clients like Telemynd. Make your online therapy space calm and comfortable for clients. Set up a designated private space that is conducive to critical conversations. Use ambient light, calming wall art, and soft-colored walls in the background to keep distractions to a minimum. If your space doesn’t have good lighting, consider buying a ring light which is specifically designed to provide lighting for cameras and computers. And keep your office clutter-free, as that can give the impression of focus, clarity, and skill in your relationship with clients. You can also utilize a virtual background during your sessions if your space cannot be augmented. Privacy is an important ingredient to the therapeutic process. Clients should always feel safe during your therapy sessions, and since they’ll be sharing thoughts they usually keep to themselves, feeling a sense of privacy is key. Even though it may be tempting, don't do your therapy sessions from the car, or with others in the background. Close doors and windows in your workspace so it feels private for your clients to open up. And make sure your phone is turned to silent as ringing phones or alarms can disrupt the session. Eliminate negative distractions from your therapy space. Keep personalization to a minimum in the background (i.e., family photos, personal mementos) to help clients feel “at home” within the space. Keep background artwork calming and neutral; if the colors or images are too loud, too specific, or evoke sadness or violence, they may be disruptive to the therapeutic process. Other distractions to avoid: open doors or views of other rooms in your residence if you are working from home, or doing your sessions in anything other than professional attire (for example, PJs definitely give the wrong impression). Make the space comfortable for you! Don’t forget to get the right chair - since you’ll likely be sitting for extended periods of time every day, it’s important to find one that is ergonomic and comfortable for you. Some therapists sit in an armchair during an online session, and some prefer to sit in a more typical “desk” chair in front of their computer. Try them out before buying and choose what works best. While there is no single right way to design an online therapy space, you can help ensure your clients have a comfortable therapeutic experience by creating a welcoming, private, and technologically-sound space for when they need to be emotionally vulnerable. What tips would you add to the list? Let us know in the comments. Sources Hospital Community Psychiatry: Design considerations for mental health facilities Healthcare: Telemedicine Workplace Environments: Designing for Success Psychiatry Advisor: Designing the Therapeutic Space: Using Layout, Color, and Other Elements to Get Patients in the Right Frame of Mind
  6. Mental health care is critical to maintaining overall wellness - just as important as caring for your physical health. And as we noted in a recent article, 1 in 5 of us live with mental health issues on a daily basis. As many as 30% of those with a mental health issue don’t seek treatment, and a common obstacle to that care is cost. The good news is that you can pay for some mental health treatments and services with your Flexible Spending Account (FSA) or your Health Savings Account (HSA), to offset out-of-pocket expenses. This week’s article summarizes what mental health services qualify for coverage with FSA and HSA funds and how to use these accounts for mental health care. Be sure to click on the links included in this article, as we’ve referenced the original IRS and government sources for further information. What’s the difference between an FSA and an HSA? FSAs are an arrangement through your employer that lets you pay for many out-of-pocket medical expenses with tax-free dollars. You decide how much to put in an FSA, up to a limit set by your employer. Employers may make contributions to your FSA, but aren’t required to. An HSA is a type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses. HSA funds generally may not be used to pay premiums. While you can use the funds in an HSA at any time to pay for qualified medical expenses, you may contribute to an HSA only if you have a High Deductible Health Plan (HDHP) — generally a health plan that only covers preventive services before the deductible. It may sound complicated - but FSAs and HSAs are often a win-win for many people, as they allow you to reduce your tax liability and pay for your mental health care expenses, using pre-tax funds. Is mental health treatment eligible for HSA or FSA funds? According to the IRS, mental health therapy and treatment that is deemed ‘medically necessary’ is eligible for reimbursement with an FSA or an HSA - things like psychiatric care, and treatment for drug or alcohol addiction. So therapy such as marriage or family counseling - that is not required for a medical or mental purpose - may not qualify. The actual wording from the IRS is this: “treatment provided by a psychologist or psychiatrist is eligible for FSA or HSA reimbursement if the purpose of the treatment is for medical care and not for the general improvement of mental health”. Sound a bit murky? The best thing to do is to speak with your your health insurance directly to understand how to approach the situation first. Regardless of the kind of health care services you are getting, an administrator may require you to get a ‘Letter of Medical Necessity’ in order to get coverage. This is a letter written by your doctor that verifies the services you are purchasing are for the diagnosis, treatment or prevention of a disease or medical condition. Make the most of your HSA to cover mental health expenses The IRS-approved list of mental health care expenses on which you can use your HSA includes services like psychologist visits (including online therapy), psychiatric care, alcoholism and drug treatment, and prescription drugs related to psychiatric care. You can pay for these with an HSA card or by getting reimbursed, but either way, always save your receipts. You’ll need these when you file your tax return each year. You can ask your health care provider for itemized receipts after each service, or a total record of all services at the end of the year. If you have health insurance (and remember, it must be a High Deductible Health Plan in order to be allowed to contribute to an HSA), you can use your HSA funds for any qualified expense that’s not paid directly to the provider or for which you’re not reimbursed by your insurance company. This includes co-pays and expenses to meet your deductible, as well as any uncovered medical expense. Using an FSA to cover mental health expenses Eligible mental health care expenses for which you can use your FSA account include alcoholism and drug treatment, psychiatric care (including online therapy), and prescription drugs related to psychiatric care. You use your FSA by submitting a claim to the FSA (through your employer) with proof of the medical expense and a statement that it has not been covered by your plan. You will then receive reimbursement for your costs. In addition, according to the IRS, you can use FSA funds to pay deductibles and copayments, but not for insurance premiums. In summary, understanding how to use FSAs and HSAs to help offset the cost of behavioral health may feel confusing or overwhelming - but it's worth digging into, as these accounts may save you money. For more help, you can ask your employer, an accountant, reference IRS Publication 969, or research online yourself. Here’s a good article that goes into more detail - in an understandable way - about the differences between HSAs and FSAs.
  7. A growing number of Americans are struggling with mental health every year. In fact, 1 in 5 Americans live with mental health issues on a daily basis. We know this from Mental Health America’s 2022 State of Mental Health in America Report. For the 8th year in a row, MHA released its annual report, which looks at our mental health based on 15 prevalence and access measures for youth and adults. The report confirms the trend that mental health in the US continued to worsen leading into the pandemic and remains problematic. In this article, we summarize key findings and highlight a few policies that can improve access to mental health resources. Key findings from the 2022 report: Overall mental health Suicidal ideation continues to increase among adults in the US: 4.6% of adults report having serious thoughts of suicide, an increase over prior years. Rates of substance use are increasing for youth and adults: 7.5% of adults and 4.1% of young people had a substance use disorder in the past year - an increase over the prior year. A growing percentage of young people in the US live with generalized depression. In fact, 15.1% of young people experienced a major depressive episode in the past year, a 1.3% increase over last year. Another 10.6% of young people in the US have severe depression (depression that severely affects the ability to function), and multiracial youth are at greatest risk for severe depression. These statistics indicate that mental illness is a common problem for many. Most of us will be impacted by it at some point in our lives - or know a loved one who struggles. And if untreated, mental health issues lead to other health problems like insomnia, eating disorders, heart disease, diabetes, arthritis, and other chronic disorders. Key findings from the 2022 report: Access to mental health treatment Over 50% of adults with a mental illness do not receive treatment - often because in-person treatment is not offered locally, because they do not know how to access treatment, or due to stigma around treatment. The percentage of adults with a mental illness who report unmet need for treatment has increased every year since 2011. Over 60% of young people with major depression do not receive mental health treatment. Even in states with the greatest access to treatment, nearly 33% go without treatment, and in states where access is the most difficult, nearly 75% did not receive mental health treatment. Some adults and young people continue to lack adequate insurance coverage for mental health treatment. Are there policies and programs that can help address the state of mental health in America? The MHA report also suggests policies that may improve access to mental health resources in the US - and one has just been implemented. The 988 Suicide and Crisis Lifeline is a national network of more than 200 crisis centers around the country. The 988 Lifeline provides 24/7, confidential support to people in suicidal crisis or mental health-related distress - which they can reach just by dialing 988. The report’s second recommendation is to increase mental health education and support in schools to address disparities in access to mental health treatment for youth of color. The report found that students of color disproportionately access their mental health care at school, often because they don’t have access to mental health services elsewhere. Given this data, the report recommends that “increasing access to school-based mental health services can promote equity and reduce disparities in access to care”. Read more about the Report’s findings and recommendations here. Sources Mental Health America (MHA): 2022 State of Mental Health in America Report
  8. In case you missed it, the new national mental health crisis line launched in July. For those in any kind of mental health distress, including thoughts of suicide, dialing 988 (24/7) immediately connects you with trained mental health counselors who can help you figure out critical next steps. The national health hotline has been several years in the making. Read on to learn how the mental health version of 911 came about. What is the 988 Suicide and Crisis Lifeline? The 988 Suicide and Crisis Lifeline is a national network of more than 200 crisis centers that help thousands of people overcome crisis situations every day. These centers are supported by local and state resources, as well as the Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA). The 988 Lifeline provides 24/7, confidential support to people in suicidal crisis or mental health-related distress. Modeled after 911, the new three-digit 988 number is designed to be a memorable and quick number that connects people who feel they are in any kind of mental health crisis, with a trained mental health professional. Currently, the number automatically routes calls by area code to the nearest crisis center. Sources of federal funding for 988 are separate from those of the 911 system, so the new hotline is not pulling any funds away from 911. Note that veterans can press “1” after dialing 988 to connect directly to the Veterans Crisis Lifeline which serves our nation’s Veterans, service members, National Guard, and Reserve members. What’s behind the development of 988? In the past, the majority of people experiencing a mental health emergency ended up dialing 911. The problem is that 911 wasn't set up to address mental health needs, so callers may end up in long lines in an ER, or interacting with law enforcement who may not be trained to handle their specific mental health crisis. Mental health advocates pushed for the new 988 hotline in the hopes that it would become a widely known, safer, and more effective alternative. In mid-2020, the FCC adopted rules to establish 988 as the nationwide, 3-digit dialing code for people in crisis, and later that year, the National Suicide Hotline Designation Act of 2020 was signed into law. The FCC adopted additional rules in November 2021 to expand access to the hotline by establishing the ability to also text to 988. As a result, covered phone service and text providers in all of the US states and territories were required to direct all 988 calls and texts to the National Suicide Prevention Lifeline by July 16, 2022. There is significant government investment to back up the new service - Congress and the current administration have dedicated $432 million toward building the capacity of local and backup call centers, and providing associated services, including a subnetwork for Spanish speakers. "One of the goals of 988 is to ensure that people get the help that they need when they need it, where they need it. And so, when a person calls 988, they can expect to have a conversation with a trained, compassionate crisis counselor who will talk with them about what they're experiencing. If it's the case that they need further intervention, then likely the crisis counselor will connect with a local mobile crisis team," says Dr. Miriam Delphin-Rittmon, the administrator of SAMHSA. The National Suicide Prevention Lifeline's 10-digit number — 1-800-273-8255 — will remain active, but calls will be routed to 988. Sources Substance Abuse and Mental Health Services Administration (SAMHSA): How does the new 988 work?
  9. We all have a sense of the big things we should be doing to stay healthy in mind and body: things like eating well, exercising, and getting enough sleep. But sometimes life gets in the way, and as much as we want to add healthy behaviors to our routine, we just don’t. So how exactly do we form those good habits to improve wellness? In this article, we explain the steps. And we know that healthy habits are good for both physical and mental health, so as a bonus, we’ve included 6 top healthy behaviors to try today. How to form healthy habits Start by making it easy and simple. Research says we’re more likely to form new habits when we clear away the obstacles that stand in our way of doing them. And don’t try to completely change your life in one day. It’s easy to take on too much. For example, start by packing your gym bag and putting it by the door the night before, or walking for just 10 minutes at first, or choose an exercise that doesn’t require you to leave the house at all. Here are four additional tips to help you form healthy behaviors: Make a plan for the behaviors you want to change. Include small, reasonable goals and specific actions you’ll take to move toward them. Consider what you’ll need to be successful and get those things in place. For example, stock up on healthy foods, or plan a special spot to relax in advance. (And don't forget to plan for obstacles. Think ahead to what will happen when you're faced with extra stress or temptation.) Keep a record. Use a journal or mobile app - whatever makes most sense to you - to track things like diet, exercise, stress levels, or sleep patterns. Experts say that even if you think you’re about to ‘fall off the wagon,’ continue to track your behavior, as sometimes when you feel like you’re failing, you learn the most. Do the behavior every day. Research says the amount of time it can take for a behavior to become a habit ranges from 18 to 66 days, but they form faster when we do them more often, so start with something easy and simple, and do it often. Once the habit is formed, you can explore more complex or harder behavior changes. Reward yourself - early and often This is an important part of habit formation - especially as some results of habit changes take longer to show up. So, build in some immediate rewards to help you reinforce the habit, like listening to an audiobook while running, or watching a favorite Netflix series while on the treadmill. Lastly, be patient with yourself! Healthy habit-forming is hard work and even though the payoff is big, there may be missteps along the way - and that’s ok. How do you form healthy behaviors? Leave a comment below or tell us on social media. Experts say these are top behaviors for improved wellness Now that you know how to form a healthy habit, here’s how experts weigh in on some of the top healthy behaviors that benefit body and mind (besides the big ones - eating healthy, exercising, and getting enough sleep). Some may be familiar but others may be a surprise. Drink lots of water. Check with your doctor to find out how much is right for you. If it gets boring, add fresh mint, lemon, or cucumber slices to switch it up. Plan your meals. Experts recommend you get into this habit, as it reduces the chances for unhealthy eating, and also saves time and money (and who doesn’t need more of both?!) Train your muscles. Strength training helps replace body fat with muscle - so you burn more calories overall. And it’s really important for women - especially as they get older. Go offline. So hard to do! But this gives our eyes and brains a big break and frees up time for other healthy habits. Learn something new. New skills keep our brains really healthy and may even provide you with new free-time activities and friendships. Get outside in nature. More and more, researchers are learning the benefits of fresh air, sunshine (vitamin D), and the peace that comes from being in green spaces. Healthy habits ensure a better quality of life. Commit to forming healthier behaviors by starting with just one today. Sources The New York Times: How to Build Healthy Habits Harvard Business Review: Building Healthy Habits When You’re Exhausted NIH News in Health: Creating Healthy Habits
  10. Stress and burnout are concerning - especially regarding our work lives. A recent Deloitte study found that 91% of people say that having an unmanageable amount of stress negatively impacts the quality of their work. Additionally, 77% say they’ve experienced burnout at their current job, with more than half citing more than one occurrence. But is there a difference between stress and burnout? Is burnout a kind of stress? Is stress at work always bad? And what can be done about both? In this article, we look at what the research says about the difference between stress and burnout, and how to prevent chronic stress from becoming burnout. What is burnout? What is stress? In 1974, psychologist Herbert Freudenberger first coined the term “burnout” - which he said usually occurs within the context of work - to mean emotional exhaustion, depersonalization, and feelings of inefficiency or lack of accomplishment. His studies found that burnout diminishes productivity and ultimately leads to a lesser quality of work. Stress is a physical or mental response to any external cause. A stressor may be a one-time or short-term occurrence, or it can happen repeatedly over a long time (chronic stress). Stress can be a negative factor (scientists call this dysfunctional stress) or a positive one (called functional stress or eustress). Surprised about that last part? Yes, stress can be good - in the right context. The American Psychological Association defines functional stress as “stress that involves optimal levels of stimulation resulting from challenging but attainable, enjoyable or worthwhile tasks. It has a beneficial effect by generating a sense of fulfillment or achievement and facilitating growth, mastery, and high levels of performance.” So for example, functional stress can help you perform better in an athletic event or get a job done more quickly at work. When too much stress becomes burnout However, if stress interferes with your everyday life, causes you to avoid doing things you normally like, or seems to be always present, you may have tipped the scales over into burnout. A recent research review suggests burnout is on the extreme far end of the stress continuum. When you are stressed, although it may feel miserable, you can still take steps to cope with pressures. But once burnout takes hold, you’re emotionally fatigued and have more than likely given up hope of overcoming obstacles. You have less ability to cope with regular stress. Your interests and motivation dry up, and you may fail to meet even the smallest obligations. Here are additional symptoms of burnout: Lowered immunity to illness Withdrawal from coworkers and social situations Job absenteeism and inefficiency Sleep deprivation Foggy thinking and trouble concentrating Lack of joy Recent research on the relationship between stress and burnout found that work stress and burnout are mutually reinforcing; however, the effect of work stress on burnout is smaller than the effect of burnout on work stress. This means that the more severe a person's burnout becomes, the more stressed they’ll feel at work. Try these tactics for keeping burnout in check Bottom line, don’t let negative stress tip over into burnout if you can help it. Experts suggest these self-care tips for keeping burnout in check: Focus on very short-term and realistic goals and wins Make time for yourself Take a break from the situation, if at all possible Exercise, and make sure you are eating healthy, regular meals Stick to a sleep routine, and make sure you are getting enough sleep Avoid drinking excess caffeine Identify and challenge negative and unhelpful thoughts Reach out to friends or family who help you cope in a positive way If none of these tactics work, speaking with a mental health professional is your next step before you experience severe burnout. They can help you develop new coping skills and provide a safe space to vent. They may suggest trying a combination of medication with your therapy. Each person is unique and will respond differently to each technique. Your therapist can help you find the right combination for you. Sources Journal Personality and Individual Differences: Stress and burnout: The significant difference NIH: Work Stress and Burnout Among Nurses: Role of the Work Environment and Working Conditions Frontiers in Psychology (Journal): Is Burnout Primarily Linked to Work-Situated Factors? A Relative Weight Analytic Study
  11. Summer is upon us and many of us are anticipating a return to travel. Whether staying stateside or going overseas, travel conjures up images of exciting new places, beautiful or unusual sights, visiting with family or friends, and in general, lots of relaxation and fun. But for many people, travel can also create feelings of discomfort and worry — a sensation psychologists refer to as "travel anxiety." If this describes you, you are not alone: feeling anxious about travel - before and during a trip - is very common. And of course, if you have a mental health diagnosis, you’ll want to check with your medical professional before your trip as they can make sure you are up-to-date on prescriptions, and even provide travel advice for your condition. In addition, this article offers 8 ways to cope with travel anxiety, from giving yourself extra time for transportation transitions to packing a calming item or book that provides comfort during stressful situations. Hopefully these suggestions will help reduce the anxiety and allow you to enjoy the journey! Alleviate potential anxiety before you go Experts suggest you start by thinking in advance about what situations on the trip might cause anxiety, recognize when your anxiety may be disproportionate, then challenge it with facts and planning. It’s a good idea for any traveler to do upfront research to make sure destinations and activities are safe. But if your fears about possible disaster get in the way of fully enjoying your experience, your anxieties may be at least partially unfounded. It may help to look at statistics to see how rare certain scary events really are. You can also find out in advance where to go or who to call if you do have an emergency. Often these upfront methods can provide a better sense of control and therefore alleviate some of the advance anxiety. Other Tips for coping with travel anxiety during your trip Build in extra time. This probably goes without saying. Almost every form of transportation - plane, train, even car rental - will almost certainly experience delays, lines, or schedule changes - causing even the most patient among us to feel overwhelmed. It makes sense to allow for extra time for each, as well as to plan what you’ll do in case of delays (bring a book, load up a movie on your phone, etc.), and learn to accept - rather than fight - these common inconveniences. Keep important documents handy. To reduce freak-outs at the airport or at border crossings, always keep your passport and ID in the exact same holder or bag while you travel (as well as in the same spot at home when not traveling!). Make paper copies of important documents just in case. Consider printing out copies of maps or have an up-to-date, hard copy guidebook in case GPS doesn’t work. Establish a routine that sets the tone for your trip. Familiarize yourself with your surroundings, and if you can, integrate activities that you’re used to doing at home (e.g., getting coffee at a local coffee shop each morning, reading before bed, etc.) to bring a sense of comfort and routine. Practice relaxing breathing exercises. Use these in traffic, in security lines, and whenever necessary. Also integrate physical activity like walking and stretching to relieve stress. Get the appropriate amount of sleep, eat a healthy diet, and stay hydrated. Try to stay positive — or at least neutral. Frustrating or disappointing situations are bound to happen while traveling. However, your attitude may make a difference. Boston University clinical psychologist and phobia expert, Dr. Todd Farchione, says, “A lot of times, by pulling from a mindfulness and acceptance-based approach, you can go into a situation in a way where you’re not judging it so negatively… To be calm, you have to act calm.” Know your mental and physical limits. Regularly reassess your original plans and change them to minimize stress levels. Let your fellow travelers know in advance that you will be prioritizing your mental health and that there may be activities along the way that you may not partake in. Finally, give yourself time on the back end of a trip. If possible, plan an extra day or two off after you return, to mentally and physically recover from your trip. This will help you get back into your daily routine with less stress. If you are still facing travel anxiety after trying these stress-reducing tips, a qualified mental health professional can help you work on further coping strategies for dealing with travel anxiety, or help you consider whether medication can help fulfill your wanderlust with as little stress as possible. Sources International Association for Medical Assistance to Travelers (IAMAT): Travel and Anxiety Conde Nast Traveler: What Does Travel Anxiety Look Like? CDC: Mental Health and Travel
  12. Are you one of the many people who have a hard time saying “no”? You’re not alone! There are many reasons experts say we don’t always set the boundaries that we need for good mental health - including wanting to people-please, playing the role of ‘rescuer’, feeling manipulated, or being put on the spot. In this week’s article, we explore ways to set healthy boundaries for better mental health, and why setting boundaries is important for self-care. What are boundaries and why set them? A boundary is a limit or space between you and another person, or persons; a clear place where you begin and the other person ends. Setting boundaries is an important part of establishing one’s identity and is a crucial aspect of well-being. Boundaries help us feel safer and more comfortable. Boundaries can be physical or emotional, and they can range from loose to rigid, with healthy boundaries often falling somewhere in between. When healthy boundaries are not present, people may feel angry or sad due to interactions that create a feeling of being taken advantage of, devalued, or unappreciated. In addition, we often feel exhausted by the responsibilities brought on by saying “yes” all the time - leading to what some experts call the “treadmill of over-commitment”. So why don’t we set boundaries more firmly and frequently? Sometimes we think that saying “yes” will make other people happy regardless of our own feelings. Sometimes, we think saying “yes” all the time confirms that we are needed. And sometimes we respond to the guilt that others may employ to try to break down our boundaries. When we say “yes” for these reasons, we’re out of balance - we’ve inadvertently placed more value on the needs of others than on ourselves. How to set healthy boundaries First, know the characteristics of effective boundaries: Limits are clear and decisive, yet reasonable Value is placed on your needs The focus is on authenticity and self-care, not on pleasing others or playing the rescuer Next, give yourself permission to set personal limits with people. If you feel that love and approval are tied to pleasing others, or that you’re somehow being selfish for setting boundaries, or if it feels “risky” to set boundaries, then consider consulting with a mental health professional who can help you see that it's not selfish to take care of your own needs. Next, define your boundaries. This might include things like: How you will and won’t spend your time and energy Who you will or won’t engage with and when What types of interactions you will or won’t engage in What activities and projects you will or won’t participate in You may find it helpful to practice communicating your boundaries beforehand. Practice staying calm in the face of others’ reactions to your boundary-setting. They may be surprised at first especially if they have come to believe you will always say “yes”, but don't let that stop you! It may feel uncomfortable in the short-term, but there’s definitely a long-term payoff. And finally, heed the warning signs - and stay away from those who repeatedly don’t respect boundaries you’ve set; who may be invading your space for their own end. If you find this all difficult to do, you’re not alone. It’s a big - but very positive step - to take for better mental health. Qualified behavioral health counselors can help with things like learning how to set and maintain boundaries, and recognizing when and what to do when others try to cross those boundaries. As part of improving self-care, consider getting guidance about this from a mental health professional. Sources Forbes: The Importance Of Setting Healthy Boundaries Harvard Business Review: Set Better Boundaries Psychology Today: 7 Tips to Create Healthy Boundaries
  13. Gaming is wildly popular. 60% of Americans say they play video games daily, and 75% of US households own a device they can play games on: phones, tablets, big screens, and other devices. Not unexpectedly, video games saw a 73% growth in sales during the pandemic, as people went online to socialize and escape. As popular as they are, games are also controversial; some believe they are addictive and others think they interrupt normal social interaction. However, recent scientific studies have found gaming can play a positive role in mental health, and in this article, we’ll tell you about those studies and debunk a few gaming myths along the way. Survey finds gaming can provide stress relief Video games can be a fun way to pass the time, and for those with challenges, they can provide a much-needed distraction from difficult situations. Games can be a low-stakes outlet for people to let off steam when they feel frustrated by school or work. Games which encourage exercise and socializing can even promote emotional wellness. Dr. Alok Kanojia who researches game addiction at Harvard Medical School says on the very positive side, “video games literally allow us to escape negative emotions and suppress them.” A 2019 survey found that almost 80% of gamers say video games provide them with mental stimulation, relaxation, and stress relief. The same survey found that some gamers - like competitive athletes who ‘live and breathe’ their sport - also report anxiety associated with game performance and expertise. The key here, like anything, is balance - and having tools and supports in place to manage mental health issues. Two studies find positive correlation between gaming and mental health Several research studies have found that some games can play a positive role in mental health. For example, a study at Oxford University which focused on those who play Nintendo’s Animal Crossing, found that people who played more games tend to report greater wellbeing. In fact, Animal Crossing is part of the ‘cozy game’ movement - a new genre of video games that rose in popularity during the pandemic, whose beautiful graphics, clever storylines, soaring soundtracks, and fluid end goals make them feel “approachable, stress-free and bite-sized.” Gamers who play cozy games say these games provide a way for them to “chill out with cute and colorful graphics, meditative tasks, and feel a sense of accomplishment” - all of which can contribute positively to mental health. Another study on location-based, mobile games like Pokémon GO (a game that lets players combine gameplay with real-world exercise), found that these games may be able to help alleviate depression symptoms in players, because they encourage exercise, contact with nature, community, and social connection. The researchers reported they were “able to connect use of Pokémon GO to a ‘significant short-term decrease in depression-related internet searches’, which is a common and reliable method of monitoring mental health, and therefore the game may help with mild, non-clinical forms of depression.” On a positive side note, the game maker community appears to be tackling the depiction of mental illness within games. Negative tropes about mental illness have existed in games since the beginning, but lately, creators have been trying to change that - even hiring psychologists to make sure there are no negative stereotypes in their games (even if inadvertently). If you or a loved one need help with mental health issues, consider contacting a telebehavioral health professional As with anything, if you or your loved one is a gamer and is experiencing symptoms of depression or anxiety, it's best to turn to a qualified mental health professional who can distinguish between everyday stress and something more serious. Sources Frontiers in Psychology: Gaming well: links between video games and flourishing mental health The Guardian: Video gaming can benefit mental health, find Oxford academics Journal of Management Information Systems: Location-Based Mobile Gaming and Local Depression Trends: A Study of Pokémon Go
  14. Over 12% of adults in the US meet the diagnostic criteria for a specific phobia. However, phobias come with much misunderstanding: some people believe they are just ‘overrated fears’ while others believe phobias can’t be overcome. On the contrary - phobias are a mental health issue. And they can be treated. In this article, we’re setting the record straight about common phobias - what they are, what they aren’t, how they are diagnosed, and how to get help. What is a phobia? Phobias are a kind of anxiety disorder; so they’re in the same diagnostic category as generalized anxiety disorder, but manifest differently. A phobia is defined as an overwhelming and debilitating fear of an object, place, situation, feeling or animal. But phobias are more pronounced than fears. They develop when a person has an exaggerated or unrealistic sense of danger about a situation or object. If a phobia becomes very severe, a person may organize their life around avoiding that thing that's causing them anxiety - so phobias can become debilitating. And in some cases, even thinking about the source of a phobia can make a person feel anxious or panicky (known as anticipatory anxiety). Types of phobias According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), there are three main types of phobias: Specific phobias. Refers to an intense, persistent, and marked fear of a specific object or situation (such as flying, insects, or heights). People with specific phobias may be aware that their anxiety is out of proportion but feel helpless to control it. Agoraphobia. Refers to a deep fear of being in an environment (often outside or with many other people) where escape might be difficult or help unavailable in the event of developing panic-like symptoms. Social phobia. Also called social anxiety disorder; involves acute fear and self-consciousness in social situations. Can lead people to avoid attending events, meeting new people, or even seeking employment. Studies indicate that specific phobias concerning heights and animals/insects are the most common, but here is a list of other common specific phobias for which people seek treatment: Acrophobia - fear of heights Aerophobia - fear of flying Aquaphobia - fear of water Astraphobia - fear of storms Claustrophobia - fear of confined or tight spaces Dentophobia - fear of dentists Hemophobia - fear of blood Nosocomephobia - fear of hospitals Zoophobia - fear of animals In all cases, these intense fears are real for the people experiencing them. They are not figments of imaginations nor deliberate exaggerations of fear. People with phobias feel very specific and often debilitating symptoms when they come into contact with the source of their fear. Symptoms may include the following if you find yourself around the phobia source: unsteadiness, dizziness, lightheadedness nausea sweating increased heart rate or palpitations shortness of breath trembling or shaking upset stomach Risk factors for phobias The causes of anxiety disorders like phobias are unknown but likely involve a combination of genetic, environmental, psychological, and developmental factors. Anxiety disorders can run in families, suggesting that a combination of genetics and environmental stresses can result in a diagnosed phobia. Help for phobias Mental health professionals can diagnose a phobia - and they can be treated successfully. Often treatment involves a combination of exposure, medication and coping strategies - all of which a qualified professional can provide. Scientists are finding that the phobias start out less intense and grow in acuteness over time - suggesting the possibility that interrupting the course of phobias with treatment early on could reduce their prevalence. A recent study, published in Lancet Psychiatry found that, “phobias can persist for several years, or even decades in 10-30% of cases, and are strongly predictive of the onset of other anxiety and mood disorders. Their high comorbidity with other mental disorders, especially after onset of the phobia, suggests that early treatment of phobias could also alter the risk of other disorders.” The key takeaway? Consult with a mental health professional as early as possible if you or a loved one believe you have symptoms of a phobia. Sources Lancet Psychiatry Current Topics in Behavioral Neuroscience National Institute of Mental Health
  15. Health care providers in the medical and behavioral health fields are increasingly recognizing that experiences of past trauma significantly influence our overall health, our relationships, school, work, and our ability to adopt healthy behaviors. And while we often associate trauma with things like soldiers in war settings, victims of crime, or the death of a loved one, it turns out that multiple life experiences clinically qualify as traumatic. In this article, we explore how the concept of holistic, trauma-informed care can improve the outcomes of mental health treatment. What is meant by ‘trauma’? Recent studies show that by the time they reach college, 66-85% of 18 year-olds report lifetime traumatic event exposure, with many reporting multiple exposures. That’s a lot. According to the American Psychological Association, trauma is an emotional response to a terrible event like an accident, rape, or natural disaster. But a person may experience trauma as a response to any event they find physically or emotionally threatening or harmful - for example, bullying and other character attacks; loss of a friend or loved one whether through death, moving, or a break-up; emotional, physical or sexual abuse; or even seeing something violent or disturbing. What matters is how the individual perceives an event, not how society judges how an individual should perceive an event. According to the Substance Abuse and Mental Health Services Administration, “the effects of traumatic events place a heavy burden on individuals, families and communities. Although many people who experience a traumatic event will go on without lasting negative effects, others will have more difficulty. Emerging research has documented the relationships among exposure to traumatic events, impaired neurodevelopmental and immune systems responses and subsequent health risk behaviors resulting in chronic physical or behavioral health disorders.” What is a trauma-informed approach to care? Trauma-informed care changes the opening question for those seeking mental health services from “what is wrong with you?” (i.e., patient or consumer) to “what has happened to you?” (i.e., survivor). Trauma-informed care is based on the assumption that every patient seeking services is a trauma survivor who can inform his or her own path to healing, facilitated by support and mentoring from a mental health provider. A trauma-informed approach to care acknowledges that providers “need to have a complete picture of a patient’s life situation — past and present — in order to provide effective health care services with a healing orientation.” The six key principles of a trauma-informed approach are: Safety Trustworthiness and transparency Peer support Collaboration and mutuality Empowerment, voice, and choice Humility and responsiveness In addition, potential biases and stereotypes based on race, ethnicity, sexual orientation, and age are recognized and addressed within the context of trauma-based care. Clinicians who train in trauma-based care also learn there are 10 domains of implementation of this approach, including governance and leadership, policy, physical environment, training and workforce development, progress monitoring and quality assurance, and more. Why is trauma-informed care important? It’s a win-win for everyone. For patients, trauma-informed care offers the opportunity to engage more fully in their own mental health care, develop a trusting relationship with their provider, and improve long-term outcomes. Studies have found that adopting trauma-informed practices can potentially improve overall patient engagement and adherence to treatment. It also reduces the need to relive experiences and retraumatize the patient. In addition, trauma-based care has been found to improve provider engagement. Overall, adopting a trauma-informed approach to care has the potential to improve patient health outcomes as well as the well-being of providers. If you feel you or a loved one could benefit from trauma-based care, consult your doctor or mental health provider. If you or a loved one need help with mental health issues, consider contacting a qualified telebehavioral health professional If you’re a client, request an appointment online or call our live support for assistance in scheduling care today. Our mental health professionals are trained in multiple mental health disorders and have experience treating them via online appointments - from the convenience and privacy of your home or wherever works for you. If you’re a behavioral health provider looking to join our network, see all the benefits and learn how to apply here. Sources Substance Abuse and Mental Health Services Administration (SAMSA) Center for Health Care Strategies National Council for Mental Wellbeing
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