Understanding Mental Illness

How Gender Norms Affect Men’s Mental Health

In honor of National Men’s Health Month in June, we’re taking a closer look at how traditional gender norms negatively affect men’s mental health in the United States and especially in Maine—a phenomenon that, as therapists, many of our readers will have observed firsthand.

In the article, we’ll cover how our culturally created and reinforced ideas of how a man “should” act impact the rates and reporting of mental health issues, including depression and eating disorders, and, relatedly, how certain, more-traditional models of masculinity can contribute to stigma around mental health, with damaging consequences to men’s willingness to access mental health services.

Depression Symptoms in Men Versus Women

Partly due to gender norms perpetuated in our culture, men and women can present symptoms of mental and physical illnesses differently. This can lead to health-related problems going undiagnosed, and that lack of diagnosis (or late diagnosis) can alter the course of a person’s life.

For example, men are more likely to report symptoms of fatigue, irritability and/or rage, risk-taking, and loss of interest in work or hobbies when they are suffering from depression, according to Mental Health America. Women, in turn, are more likely to report feelings of sadness or worthlessness. One way of framing the difference is that men’s reported symptoms tend to be expressed as outwardly directed feelings and behaviors, while women’s reported symptoms tend to be more inwardly directed.

How to Assess Depression in Men

How we measure depression clinically, of course, changes how we treat it—or even if we treat it at all.

Officially, more than 6 million men in the U.S. report suffering from depression each year, but we know that many more cases go undiagnosed. It follows that the questions we ask as mental health providers and the use of gender-inclusive diagnostic scales can have a profound impact, as a 2013 study in JAMA Psychiatry found.

When a gender-inclusive scale is used, 30.6 percent of American males are found to have experienced a period of depression in their lifetimes, with no significant difference between sexes in rates of lifetime depression. However, when traditional depression scales are used, depression is found to be more common in women than in men.

It’s worth noting here that the State of Maine reports rates of diagnosed depression as higher in females, at 25.9%, than in males, at 16%. Because the State of Maine does not use a gender-inclusive scale when measuring depression, it is likely that many men who suffer from depression are not being counted, and we may be missing a large segment of the adult population in our diagnoses and treatments.

Men and Suicide Rates in Maine and the U.S.

The suicide rate among men in the United States is an unacceptable four times higher than it is for women, according to the Centers for Disease Control and Prevention, and it has been on the rise since 2000. Suicide deaths follow a similar trend in Maine, with significantly higher rates among men (24.3 per 100,000) than females (7.9 per 100,000). The suicide rate in our state is higher than the national rate (15.9 per 100,000, compared to 13.5), according to the 2019 Maine Shared Community Health Needs Assessment Report.

Given how far fewer men are diagnosed with depression when traditional depression scales are used, it is worth considering whether the suicide rate could be lowered simply by universally employing gender-inclusive depression scales in our field, thereby treating the depression before it can potentially manifest into suicidal ideation or suicide.

Masculinity and Access to Mental Health

One thing is clear, when we consider the underdiagnosed, under-cared-for rates of depression and national suicide rates for men in America: we need to improve accessibility to our services.

According to the National Health Interview Survey, only one in four men with depression has spoken to a mental health professional. This sobering statistic is likely due to influential social norms of masculinity, among which are the hyperinflation of emotional control and self-reliance, as measured in the widely used Conformity to Masculine Norms Inventory developed by James R. Mahalik and colleagues.

The net result of these influential social norms of masculinity is American men who are reluctant to talk and who downplay their symptoms when experiencing mental health issues, including depression, substance use, and stressful life events. Moreover, male minorities are even less likely than White men to seek assistance for mental health. The more we can reduce all barriers to mental health treatment across our field—and that includes stigma—the more we can be of service.

How Cultural Norms Affect Men with Eating Disorders

As we see with depression, men with eating disorders, such as muscle dysmorphia, are less likely to seek professional help than women, and once again gender expectations are the likely culprit. Men currently make up approximately 30 percent of eating disorder diagnoses, which is actually an uptick from previous years’ statistics, according to social psychologist Jaclyn A. Siegel, PhD. “Self-reliance is one characteristic of traditional masculinity,” Dr. Siegel said in a recent interview. “Because of this, men are less likely to seek help for medical and psychological conditions. … I suspect that every statistic we have about men with eating disorders is an underrepresentation of the actual number, because it’s not stereotypically masculine to admit to having these conditions, and it’s definitely not stereotypically masculine to go to a doctor or a specialist and get a diagnosis.”

Dr. Siegel goes on to note that men in the LGBTQ+ community are at an elevated risk for eating disorders, and that more research is needed on Black men’s experiences with body image, eating disorders, and other mental health issues.

Conclusion

When we have evidence of men feeling limited in their willingness and ability to access mental health treatment for issues like depression and eating disorders due to social stigma and traditional models of masculinity, it is time to reconsider how those models are serving us as a culture. What might the mental health of our nation’s men look like if we were to adopt more flexible gender norms that allowed for personal expression and authenticity?

Sign Up To Receive Our Latest Blog Posts!

Learn more tips on living well and understanding mental illness. Help to end the stigma, and hear inspiring stories of recovery. Sign up here!

Posted on by Author Rachael Severancein Categories Understanding Mental IllnessTagged ,

Trauma-Specific Self-Care: Part 2

We know that self-care is important for everyone. But how do you practice self-compassion and personal wellness when you have been through trauma or are trying to help someone through a traumatic life event? In the first part of a two-part series on trauma-specific self-care, we looked at how your body responds to stress and trauma and what individuals can do to begin healing. Now, in part two, we’ll explore how mental health professionals can take care of themselves while they take care of their clients.

How Does Treating Clients with Traumatic Experiences Affect Me?

The reality is that treating clients who have experienced trauma can have impact. This “inevitable secondary stress,” as Trauma expert and Simmons College Graduate School of Social Work professor Julia Colpitts, MSW, calls it, is natural. We evolved to connect with our pack to survive. When we see or hear other people’s trauma, the areas in our brain that are activated are the same ones that would be activated if it was primary trauma—our own trauma. Mirror neurons are engaged in the trauma’s retelling, and our bodies respond to the story and mimic the survivor’s physiological response. Trauma is, in a sense, contagious. So, what can we do about it?

What Is Secondary Stress?

“Vicarious or secondary stress is empathy in action,” Colpitts states, and it is unavoidable. We are social animals, and we respond naturally to others. The impact ranges from mild to clinically symptomatic, but all responses on the continuum can have a long-term effect. We can get stuck in arousal mode from the continuous retelling of traumatic life events if we don’t actively manage our secondary stress and its impact on us as therapists and mental health providers. It doesn’t have to lead to professional burnout; viewed and managed differently, it can even become an invitation to grow personally and professionally.

Secondary traumatic stress often causes muted arousal responses, either hyper (flood of anxiety, fear, and anger) or hypo (distancing from emotion). Over time, cognitive distortions can develop, altering one’s focus, the content of their thoughts, and even their worldview. Unacknowledged vicarious stress also has a negativity bias, which can obscure our compassion satisfaction and real accomplishments. For therapists who hear traumatic stories that resonate with their own prior life trauma, the arousal response can deepen—and our professional dissociation and burnout, historical and/or cultural trauma, and traumatized organizations can serve to further deepen that response.

Some mental health professionals, like others in the population, cope with secondary stress and trauma by employing short-term relief strategies to manage their state of arousal, such as food and alcohol issues, inactivity or “mindless” (dissociative) activities, and overwork. These primitive defense mechanisms may appear to help for a few hours, but ultimately they all have long-term negative consequences.

Unhealthy coping behaviors such as substance use may have the same effect as ignoring the secondary stress altogether: illness, including serious chronic conditions such as heart disease. Women who are social workers, for instance, are 36% more likely to have heart problems than women in other professions (American Heart Association scientific session, November 2019). And “community and social services” is number one of the top ten professions correlated to cardiac arrest (gender-neutral) (CDC Morbidity and Mortality Weekly Report, 2016). It is therefore crucial that we develop positive coping methods for secondary traumatic stress.

A therapist’s self-care involves acknowledging the continuous stress you are under and allowing yourself a release. We need to proactively prepare for secondhand stress and its impact on us through daily doses of calm interspersed through our days.

Which Tools Should Therapists Use for Secondary Stress?

How do we turn off the arousal response? We activate the care system.

“Self-care is not just what we do after work. Self-care is how we do the work itself.” –Julia Colpitts, MSW

 

First of all, guard against the tendency to overcommit, to overwork in an effort to soothe. Like the proverbial oxygen mask on an airplane, you are ill equipped to help others if you’re not functioning well yourself.

Then, create a resilience menu. Choose from an array of simple, self-care actions to calm the body and calm the mind—a personal relaxation practice that can radically reframe how you go about your day. As though you are selecting a dish from a restaurant menu, choose the one(s) that sound best to you that day, at that time. And just as we are advised to “eat the rainbow” when it comes to dietary health, your resiliency menu or toolkit works best when you layer soothing actions across the spectrum, and use self-care well not just when there’s a personal crisis, but proactively and intentionally, every day. Some examples of what relaxing options might be on your resiliency menu [link “resiliency menu” to October blog] include:

  • Breathwork, such as box breathing
  • Being kind to yourself—kick out the inner critic
  • Muscle tension release using progressive relaxation techniques
  • Guided meditation, such as those offered by Kristen Neff
  • Sensory stimulation (e.g., aromatherapy, calming visuals, nature sounds, savory tastes, touch, water, sexual activity, massage, Reiki bodywork, and grounding strategies)
  • Acupressure and acupuncture
  • Yoga, tai chi, and other mind-body centering work
  • Conjuring up images of love and connection
  • Self-compassionate meditation and activities, such as bilateral stimulation like the butterfly hug, and affirmations
  • Interacting with animals, including equine-facilitated therapy
  • Mindfulness and related physical practices, such as walking meditation and forest bathing
  • Body scans
  • Expressing gratitude and love

Your resiliency tools not only help to heal the impact of secondary traumatic stress by releasing stored arousal responses and reestablishing a peaceful baseline, they also help strengthen your capacity for joy and presence and prepare you for future sources of stress.

How Can I Support Other Mental Health Professionals’ Well-being?

To journey to wellness together, we need to support positive attachments to ourselves, to others, and to community coregulation. As mental health providers, we can:

  • Talk openly about secondary trauma and its impact.
  • Add moments to meetings that emphasize compassion satisfaction.
  • Practice personal relaxation techniques openly, as appropriate, to model calm.
  • Notice and address when organizations are traumatized.
  • Support setting realistic workloads.

Thank you to Julia Colpitts, MSW, for sharing her keynote presentation and ideas on this subject.

Sign Up To Receive Our Latest Blog Posts!

Learn more tips on living well and understanding mental illness. Help to end the stigma, and hear inspiring stories of recovery. Sign up here!

Posted on by Author Rachael Severancein Categories Tips for Healthy Living, Understanding Mental Illness, WellnessTagged ,

How to Identify and Treat Summer Depression

Summertime… and the living isn’t easy for everyone. Depression in the summer is more common than you might guess. While many equate summer with school vacation, outdoor camps, water fun, and blooming gardens, others can and do feel depressed during the sunny season—and the social expectation that you’re supposed to have fun can make that depression feel even lonelier and more isolating.

How to Identify Summer Depression

While summer depression shares common symptoms with depression (feeling depressed most of the day, having low energy levels, losing interest in activities you used to enjoy, difficulty concentrating on tasks, and feeling hopeless or worthless), summer depression has specific symptoms that include:

  • agitation and restlessness
  • loss of appetite
  • trouble sleeping (insomnia)
  • weight loss
  • anxiety

If you feel depressed come June each year and it seems to improve around September, you may be experiencing summer depression. The National Institute of Mental Health indicates a patient may be diagnosed with summertime seasonal affective disorder if they have symptoms of major depression, have lived with depressive episodes in the summer months for two consecutive years, and have a tendency to have depressive periods more frequently in the summer than in than in other times of the year.

Symptoms of summertime blues, by contrast, are similar (low mood and a lack of energy) but less debilitating.

Where Does Summer Depression Come From?

Like all forms of depression, summertime depression can have biological, psychological, and/or environmental causes. Summer schedules are often disruptive to our usual schedules, and this sudden, big change can be hard to handle, especially for people who are vulnerable to depression.

Biologically, some studies suggest that, like other forms of major depressive disorder (MDD), summer depression may be linked to the brain chemical serotonin. The risk of developing summer depression is higher for women, those with relatives with a mental illness, or those who have major depressive disorder, bipolar disorder, or another mental illness.

More than 3 million American adults experience seasonal affective disorder, or SAD. Of those, about 10% of people who have a MDD with a seasonal pattern, such as SAD, have their depression symptoms begin at the onset of summer, not winter. It’s unclear why this happens to a subset of those with MDD or SAD. Some experts point to too much sunlight, heat, and humidity as possible culprits.

How to Help Your Clients Cope with Summertime Depression

A number of tools and strategies can be employed by mental health practitioners to help their clients cope with summer depression.

  • Change dosage. If you are licensed to prescribe medications, consider temporarily increasing the dosage of your client’s medication for depression. Or, if you are not, encourage your client to speak to their medication prescriber about gradually increasing their dosage in late spring and easing off slowly in the fall.
  • Respect the worry your client may be feeling. With summer depression in particular, people who are struggling with their mental health are apt to feel something is wrong with them: Why does it seem like everyone else is having fun and I’m not? What’s wrong with me? While this is a typical response, it is not helpful to compare how we’re feeling with how we think we’re supposed to feel. Instead, gently encourage your client to focus on the causes of their summertime depression and how it can be resolved.
  • Evaluate triggers. Consider what past experiences your client may be associating with summer, whether it’s the death of a loved one, an important anniversary, or another traumatic event. Working through triggers may lessen or release some of these associations.
  • Experiment with darkened rooms. Following some mental health professionals’ theory that too much sunlight could be causing summer-onset MDD, spending more time in darkened rooms—the opposite of light therapy—may be advisable. For similar reasons, wearing sunglasses may help.
  • Advocate for regular exercise. Numerous studies demonstrate that regular physical activity can help depression and mood disorders.
  • Recommend a good night’s sleep. Insufficient sleep can trigger depression. Rule out this cause by ensuring your client is getting enough ZZZs (generally 7 to 9 hours a night for adults).
  • Engage in mindfulness. Yes, there’s that oft-mentioned recommendation to develop a meditation and mindfulness practice again! Evidence shows mindfulness has a significant impact on mental wellbeing, combating fatigue and naturally bolstering one’s defenses against depression.

Get Help

If you or someone you know thinks they might be depressed, regardless of the time of year, please get help. Do not take summer depression lightly or downplay its symptoms. Talk to a mental health practitioner. We are here to help, and there are effective treatments available. You do not need to suffer in the summer.

Sign Up To Receive Our Latest Blog Posts!

Learn more tips on living well and understanding mental illness. Help to end the stigma, and hear inspiring stories of recovery. Sign up here!

Posted on by Author Rachael Severancein Categories #EndTheStigma, Understanding Mental Illness, WellnessTagged , , ,

Together for Mental Health

More than 52 million American adults—or one in five—live with a mental health issue. Despite its prevalence, we hold an unhealthy stigma of mental illness. As a result, some individuals who live with mental health issues experience challenges accessing quality care and coverage, a challenge that can be exacerbated by their backgrounds and identities. This needs to change.

Reducing the stigma associated with mental illness is central to Health Affiliates Maine’s vision. By recognizing that we are all affected by mental health and substance issues, we reduce the stigma associated with accessing care, and in doing so, we increase the opportunity for everyone to participate in their own journey to wellness.

That’s why we’re proud to raise awareness for the Bebe Moore Campbell National Minority Mental Health Awareness Month this July. “Together for Mental Health,” we proudly stand up for a shared vision of a nation where anyone affected by mental illness—no matter their class, culture, ethnicity, or identity—can get the appropriate, quality care and support they need to live healthy lives.

“We need a national campaign to destigmatize mental illness, especially one targeted toward African Americans…It’s not shameful to have a mental illness. Get treatment. Recovery is possible.” –Bebe Moore Campbell, 2005

 

Anyone can experience the challenges of mental illness. Mental health conditions do not discriminate based on race, color, gender, class, sexual orientation, or any other elements of our identity. While BIPOC have rates of mental health disorders similar to white people, people in the BIPOC community are disproportionately affected by a lack of access to quality healthcare and cultural stigma, according to US News.

Of the 52 million+ Americans who live with a mental health condition, nearly 5 million are black people—and yet only 33% of those seek appropriate treatment, such as regularly meeting with a mental health professional, compared to nearly half of white people. As writer and policy analyst Brakeyshia R. Samms describes, there are many factors that contribute to whether or not a person with a mental illness receives treatment, including under/misdiagnosis, lack of access to quality care, and community stigma. We all experience these factors, but some communities experience them to a disproportionate degree—and suffer as a result. Bebe Moore Campbell summarized the issue: “No one wants to say, ‘I’m not in control of my mind.’ But people of color really don’t want to say it because we already feel stigmatized by virtue of skin color or eye shape or accent, and we don’t want any more reasons for anyone to say, ‘You’re not good enough.’”

How to Help

Samms suggests four activities we can all engage in to take action against the stigma around mental illness: gather information to counter “negative preconceived notions,” speak up, remain open, and believe people. “Stigma stems from a lack of knowledge,” Samms writes, “and the best way to fight a gap in information is by educating others in our community.” To this end, understanding and then communicating the complex issues at play helps spread acceptance and inclusivity, which in turn fights the inequities and stigma we have developed and now need to unlearn as a culture.

 

Sources: www.nimh.nih.gov, nami.org, rtor.org, mhanational.org

Sign Up To Receive Our Latest Blog Posts!

Learn more tips on living well and understanding mental illness. Help to end the stigma, and hear inspiring stories of recovery. Sign up here!

Posted on by Author Rachael Severancein Categories #EndTheStigma, Understanding Mental IllnessTagged , ,

Motivational Interviewing for Substance Use Treatment

As a compassionate behavioral and mental health care provider, you incorporate many modalities to treat your clients. For those clients seeking recovery from addiction or substance use, one lesser-known, relatively new model is Motivational Interviewing (MI). Developed in the early 1980s, MI requires an approach based on collaboration, understanding, and empathy. 

What is Motivational Interviewing?
Motivational Interviewing (MI) is a technique commonly used in the treatment of clients with addiction or substance use. This style of treatment can be thought of as an evidence-based conversation that truly encourages behavior change from within and guides clients toward a specific end goal (in this case recovery from addition). 

Motivational Interviewing is highly collaborative. Through approachable dialogue, the client is encouraged to explore their desire for change, receiving kindness, compassion, and acceptance both from their counselor and from themselves. 

This style of treatment is not meant to manipulate, coerce, or “get people to change” as in an intervention. Motivational Interviewing is an on-going conversation between clinician and client that takes time, practice, and the client’s own self-awareness.

Essential Processes of Motivational Interviewing
There are four main processes to successful Motivational Interviewing or “keeping the conversation going.” During the “conversation” (Motivational Interviewing treatment), the clinician must always be: 

  • Engaging. The foundation to MI: actively listening, reflecting on, and affirming a client’s experience and perspective. 
  • Focusing. Steering dialogue toward the end goal of positive change.
  • Evoking. Helping clients build on their “why.”
  • Planning. The “how” to the process of change for a client.

Signs Motivational Interviewing May Benefit a Client 
Although not an exhaustive list, a client may benefit from MI if the following is present:

  • Ambivalence: having mixed feelings about change
  • Low confidence: doubting their ability to change
  • Apathy: low desire or uncertain if they want to change 

Is this tool aligned with my treatment style and will it be beneficial to my clients?
Be honest with yourself if this tool may be right for you, your clients, and your practice. Not every clinician or behavioral health provider is a good fit for motivational interviewing, just like not every client will be a good fit for this type of treatment.

The following are important characteristics in clinicians for the success of Motivational Interviewing:

  • Partnership and collaboration. Clinicians guide toward change, not force it.
  • Acceptance. Clinicians are non-judgmental and actively seek to understand their client’s perspective and life experiences. 
  • Compassion. Clinicians express unending empathy and promote their client’s wellbeing in a selfless way.
  • Patience and understanding. Clinicians actively listen, ask meaningful questions, and provide affirmations to build up client confidence

Behavioral and mental health providers should consider if Motivational Interviewing would be an impactful approach for those clients who are willing and wanting to change. It is proven to be a successful, client-centered approach to encouraging change, promoting resilience, and building confidence particularly in those seeking recovery. 

Sign Up To Receive Our Latest Blog Posts!

Learn more tips on living well and understanding mental illness. Help to end the stigma, and hear inspiring stories of recovery. Sign up here!

Posted on by Author Kayla Quesnelin Categories #EndTheStigma, Advice for Affiliates, Understanding Mental Illness

moral injury

Moral Injury Part Two: Self-care Strategies for Clinicians (and their clients)

In a previous blog, Moral Injury Part One, we discussed the differences between workplace burnout and moral injury. While often used interchangeably, the two are markedly different and require a differing approach to addressing and coping with them.

Burnout is the result of chronic workplace stress. It’s not a medical diagnosis, but if left unaddressed could potentially lead to physical and mental health concerns. For more information on burnout including common symptoms read Moral Injury Part One: Are You Experiencing Burnout or Moral Injury?

Moral injury, on the other hand, refers to psychological, behavioral, social and/or spiritual distress that is experienced by individuals who are performing, asked to perform, or exposed to actions that contradict their moral values and personal ethics. Moral injury is being recognized in frontline and healthcare workers of the COVID-19 pandemic.

Symptoms of moral injury could be acute or appear slowly months or years after the event. Symptoms can include:
• Feelings of guilt, shame, disgust, anger
• Self-blame, self-sabotage
• Feeling unworthy
• Feeling detached from sense of self

Note: If you’re feeling severe symptoms such as those related to PTSD, depression, anxiety or substance use issues, it’s important to see a behavioral healthcare provider as soon as you can.

Everyone has individual experiences and may require different strategies to cope with moral injury. What may work for one person may not work for another, and that’s okay. Consider the following:

Lean on existing support systems. Seek support from family, friends, colleagues, and spiritual leaders. Be vulnerable and express your feelings. Often, having a listener is helpful in relieving the burden of our feelings. Also consider reaching out to other support groups locally or even virtually for a place to share your thoughts, feelings, and help others by supporting them.

Create a stress management system. You know yourself best and know what strategies work for you. Common techniques include focusing on proper sleep, a consistent exercise routine, incorporating healthy foods, and a mindfulness practice. Would it be helpful to have an accountability partner? Ask someone from your support system if they will walk around the neighborhood with you a couple times a week. Or discover a new recipe with nutritious ingredients. Consider cooking the meal as a form of mindfulness and allow yourself to get lost in the process.

Slow down. Recognize that you may be in a vulnerable and raw emotional and spiritual place. Remind yourself that this is okay. We all go through traumatic events, witness unethical practices, or are asked to perform duties that go against our very nature. Allow yourself to slow down, feel and process your feelings. Take all the time you need. Healing yourself isn’t a race.

Attend therapy. If you don’t yet attend, we suggest that you start. As a behavioral healthcare provider, you know first-hand the benefits of scheduled therapy sessions. Additionally, it’s likely that your provider will be sympathetic to the effects of moral injury as they may have experienced it before themselves.

Take action. Experiencing moral injury has the potential to detract us from our sense of self. What we believe in, our ethics, our values. Reunite with your inner self by remembering what it is that you believe in. Take time to reflect inwardly on what strengthens your sense of self, your morals and your beliefs. Then take action! Maybe it’s in the form of activism for a cause you care deeply about or volunteering in your community. Determine what’s important to your deepest self, what reinforces your core beliefs, and then, reconnect with it.

 

 

 

Sources: hhs.gov, ncbi.nlm.nih.gov, drpaularedmond.com, mentalhealthfirstaid.com

Sign Up To Receive Our Latest Blog Posts!

Learn more tips on living well and understanding mental illness. Help to end the stigma, and hear inspiring stories of recovery. Sign up here!

Posted on by Author Kayla Quesnelin Categories Understanding Mental Illness

Moral Injury Part One: Are You Experiencing Burnout or Moral Injury?

Your mental and emotional health directly affects your ability to provide quality care to your clients. Healthcare professionals in various industries—and mostly due to factors of the coronavirus pandemic—are feeling guilt, shame and exhaustion, all symptoms of burnout. But are you experiencing something more complicated?

What is Burnout?

First, let’s discuss what burnout is. Burnout is a non-medical diagnosis characterized as a specific type of work-related stress. Burnout causes physical or emotional exhaustion (or both) that typically includes a feeling that you’ve lost your personal identity and sense of accomplishment.
Experts don’t know the cause of burnout, but some believe that depression and other individual factors may be involved.

Signs of Burnout

One person may experience burnout entirely differently from another. Take a few moments to consider these work scenarios to see if you’re experiencing burnout:

  • You feel pessimistic, critical and/or irritable
  • You feel unmotivated, easily distracted, and less productive
  • You don’t feel satisfied by your achievements or your work
  • Your sleep habits have changed (extreme fatigue, insomnia, sleep disturbances)
  • You’re experiencing headaches, stomach aches or other physical ailments
  • You’re using food, drugs or alcohol to feel better or to not feel at all
  • You no longer have energy for the people or things you enjoy

Possible Reasons You May Experience Burnout

Again, reasons of burnout will be different for each individual. Common factors include:

  • Lack of support
  • Unclear job expectations
  • Toxic or dysfunctional workplace environment
  • Lack of work/life balance

You may also be experiencing a heavy workload, excessive or long hours, or having little control over your work or schedule. Unfortunately, if you work in a helping profession, you may be more susceptible to burnout. If you suspect burnout, discuss your feelings and possible options with your supervisor or an HR resource.

You can also seek the advice of a healthcare professional to help address and alleviate any physical or emotional effects that are troubling you. Without intervention, burnout could lead to excessive stress, sleep issues, substance misuse, high blood pressure and higher risk of other health-related conditions.

Identifying with typical job burnout may not be sufficient for those in the helping professions, particularly in the years of the COVID-19 pandemic. This is where moral injury is increasingly getting brought into the conversation.

What is Moral Injury?

Moral injury involves the stressful social, psychological, and/or spiritual effects of having witnessed or participated in behaviors that go against a person’s core beliefs and values.

The term was developed in the 1990s to describe the moral conflicts military professionals were feeling after returning from war zones. Later, it was used to describe healthcare professionals facing similar distressing environments.

In a healthcare setting, burnout is described as a type of “chronic work stress” while moral injury is explained as the “suffering that occurs in response to moral adversity.” Having our beliefs or ethics repeatedly dishonored at our workplace can create undue psychological injury including disrupting how we feel about our individual selves and how we show up in the world.

What does moral injury look like in the helping professions?

Moral injury can occur in any profession but is on the rise in the healthcare industry. Here are some examples of what that may look like:

Feeling a sense of responsibility to make decisions that entail conflicting morals, ethics and values. For example, taking on more clients to meet the needs of your community, despite the caseload size exceeding your typical self-care standard.

Doing something that goes against your beliefs (referred to as an act of commission). Behavioral health care workers may be faced with situations where they need to decide how best to prioritize clients in need of a session (e.g., which clients receive less/more frequent sessions and how to best use limited time when multiple clients need help or when many are waiting for services).

Failing to do something in line with your beliefs (referred to as an act of omission). Moral injury can also develop in behavioral health care workers when they feel unable to provide the type of care requested by the client (e.g., in person session) for sake of their own safety or their families.

Witnessing or learning about an act that goes against your ethics and beliefs.Some may feel guilt and shame because they felt numb in the face of suffering and death. Behavioral health care workers may also witness what they perceive to be unjustifiable or unfair acts or policies that they feel powerless to confront.

Experiencing betrayal by someone you trust. A person who experiences betrayal may also feel anger, resentment, and/or diminished confidence in peers, leaders or organizations.

In behavioral health and mental health professions specifically, moral injury is a common occurrence. However, neither moral injury nor burnout is the fault of an individual, and self-care alone will not eliminate them. If you’re experiencing or have experienced moral injury, consider the following:

  • If you don’t already, attend therapy sessions regularly
  • Connect with colleagues who feel or have felt similarly
  • Take the time to self-reflect often (journal, prayer, meditation, etc.)
  • Stay connected to your true self, beliefs and values
  • Align your personal values with your business’ values
  • If you’re not self-employed, look for a workplace that prioritizes care over quotas and encourages a work/life balance

Clinicians, therapists, and other behavioral health workers are in their line of work because they truly want to help others—but remember that being an impactful, successful, and respected healthcare professional doesn’t need to come at a personal cost.

Self-care for moral injury can be particularly challenging for people working in behavioral health care given that those in the field strongly value caring for others and may prioritize the needs of others over their own. It is often only in conversations with others that we can hear a different, more helpful way to think about or make meaning from morally distressing situations.

On the positive side, there is also evidence that indicates after potentially morally injurious experiences some people develop a redefined meaning in life and, with time and support, begin to incorporate the experience into growth or helping others. Further, some develop new insights about how to help the systems in which they work or that can help them grow in their own work or lives.

Behavioral health care workers, their colleagues, and leaders can use strategies to take care of themselves and each other both during and after potential morally injurious situations, to support recovery and growth.

Sign Up To Receive Our Latest Blog Posts!

Learn more tips on living well and understanding mental illness. Help to end the stigma, and hear inspiring stories of recovery. Sign up here!

Posted on by Author Hanna Gilleyin Categories #EndTheStigma, Advice for Affiliates, Understanding Mental IllnessTagged , , , , , ,

What Does it Meant to Be in Recovery?

An estimated 22 million Americans among every gender, race, and social class are currently in recovery. For those in recovery, it is not a one-size-fits-all situation but one completely unique to one’s life experiences and circumstances.

What does “in recovery” mean?

It’s a common misconception that abstinence and sobriety alone equates to being in recovery. The definition provided by the Substance Abuse and Mental Health Services Administration (SAMHSA) is as follows: Recovery is “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach
their full potential.” While in recovery, it’s important to also recognize the significance of focusing on one’s physical and mental health. Continued success is more likely once an individual has gained insight regarding any unresolved trauma, or underlying emotional and mental health issues in order to better understand how these factors may have impact on their recovery process.

Recovery varies by person, but may include:

  • 12-step programs such as Alcoholics Anonymous or Narcotics Anonymous
  • In-patient treatment, Medication Assisted Treatment (MAT) or an Intensive Outpatient Program (IOP)
  • Avoiding triggering situations
  • Meditation and prayer
  • Regular counseling sessions
  • Trying a new hobby or resuming an old one
  • Building strong + positive support systems
  • Being physically active on a regular basis
  • Developing structure and routines
  • Focusing on nutrition, sleep, and stress management

How do I support a loved one in recovery?

When you discover that a friend or loved one is in recovery, you may be nervous or unsure of how to act or speak around them. Remember, people in recovery are humans just like you! If someone discloses that they’re in recovery, you can say the following:

  • “How’s it going?”
  • “I’m proud of you!”
  • “That’s great! You deserve to live a happy and fulfilling life.”
  • “How can I support you in your recovery?”

The statements above show your genuine support of their health. A simple phrase of encouragement and recognition can go a long way for someone in recovery. If someone discloses that they’re in recovery, avoid the following statements:

  • “You don’t look like an addict.”
  • “How do you know you’re an addict?”
  • “When did you hit rock bottom?” or “How do you know you hit bottom?”
  • “If you were addicted to drugs, can you still drink alcohol?”

The statements have the potential to result in hurt or upset feelings for a person in recovery. While you may be curious about their recovery process, it’s essential to allow the person in recovery to share their perspective on their own terms.

Health Affiliates Maine continuously strives to address the stigma associated with mental health and substance use. We work to increase access to supportive services for all Mainers so that they have a successful journey to recovery. We have a network of counselors, LADCs, and community resources (such as our telehealth IOP) that aims to help anyone in need of treatment. While you can’t force anyone to get help (only they can make that decision), you can offer validation and encouragement. If you’re equipped with resources and education, you’re already supporting them in their journey to recovery.

Sign Up To Receive Our Latest Blog Posts!

Learn more tips on living well and understanding mental illness. Help to end the stigma, and hear inspiring stories of recovery. Sign up here!

Posted on by Author Hanna Gilleyin Categories Hope & Recovery, Tips for Healthy Living, Understanding Mental IllnessTagged , , , , , ,

Ask the Experts: What Questions to Ask When Looking For A Counselor

This article originally appeared in Macaroni Kid on July 1, 2021, by Lindsay McKeen, LCSW, CCS, Outpatient Therapy Supervisor, Health Affiliates Maine. 

Question: My husband and I divorced last year and while initially our daughter (11) was adjusting well to the big change in her life, she seems to be struggling more and more. We want to find a counselor for her to talk with. I’m wondering if you can suggest what types of questions are good ones to ask when trying to find the right counselor? My ex and I want to be sure it’s a good fit. Thank you so much.

Answer: It can be difficult to take that first step in getting yourself or a loved one into counseling, and even more so when you are navigating a new family dynamic and trying to find that support for your child. It is important that you and your ex-husband are on the same page here. In sharing this awareness of her needs and interest in finding a counselor that is a good fit for her, you are off to a good start.

Before looking at what to ask of the counselor, it is important to be sure the right questions have been asked within the family. While your child may not be hands-on in the search for a counselor, it will end up being her service and provider and so including her voice early on may help enhance her connection and engagement. What is her understanding of counseling? Is she agreeable to seeing a counselor? Are there any questions she would like answered before seeing the counselor? Does she have any questions for you? While parents are the decision makers, children value being heard and having a sense of control where appropriate. Giving her this voice before starting the counseling relationship can set a good tone for creating a trusting environment where she feels she can be open about the struggles she has been having.

Then, when it comes time to ask questions of the potential counselor, it may also be helpful to ensure you and your ex-husband have similar definitions of what a “good fit” would look like. You may have already had this dialogue, or you might try answering the questions below with one another to see if your definitions align. Many counselors also have online profiles and viewing these together could be another way to get a sense for what you both are looking for in a counselor for your daughter. Here are some topics and questions to consider when looking for a counselor:

Experience: While it is possible for counselors to work with people of all ages, many counselors find their niche in working with certain client populations. This niche may be developed around age group, diagnoses or presenting concerns, and/or specialized treatment approaches. Asking about the counselor’s experience may help you feel more comfortable with their ability to support your daughter with her needs.

  • Does the counselor have experience working with children or your child’s particular age group?
  • Does the counselor have experience working with families, especially those navigating divorce?
  • What is the counselor’s therapeutic modality or approach to working with children?

If you have spiritual beliefs or other cultural considerations you would like considered by the counselor:

  • What is the counselor’s understanding of that belief/culture?
  • How does the counselor manage differences in beliefs/culture and/or how does the counselor understand the ways in which the belief/culture may impact a child’s mental health care?

Potential Scenarios: In learning about the counselor’s experience and approach in therapy, you may get a sense for how the clinician will interact with the child and family, or you may want to ask more questions to get a better understanding. You might try thinking ahead to potential scenarios that might arise using the questions below:

  • How will the counselor navigate confidentiality and privacy for the child in relation to parental involvement?
  • How will the counselor handle concerns that they themselves or the parent(s) have identified?
  • How does the counselor foresee handling differences in opinion that may arise between parent(s), child, and/or counselor?

Logistics: Though the counselor’s experience and approach are likely most influential in selecting the right provider, the logistics are important too. Having discussions about the logistics upfront can help clarify expectations of both parties and minimize disruptions to the counseling relationship once it has begun.

  • Does the counselor provide in-person or telehealth-based services?
  • Does the counselor have the availability to offer a standing appointment? Or is their scheduling flexible/varying depending on the week?

    • Does the counselor have any policies in place around attendance or payment?

  • What are the counselor’s practices for communicating information to parents?
  • Are there expectations for parental involvement?
  • What is the best way to communicate with the counselor?


Though this article presents many questions and considerations for finding the right counselor, know that this is not all-inclusive. Having conversations with your ex-husband and child may expand or narrow this list to what feels most relevant to her needs. Most important in this process is open communication, with one another and the counselor, keeping in mind that the common goal is to support your child, and that the search can continue if you find yourselves feeling like the counselor is not a good fit.

 

Lindsey McKeen, LCSW, CCS is a clinical social worker and Outpatient Therapy Supervisor at Health Affiliates Maine.

Sign Up To Receive Our Latest Blog Posts!

Learn more tips on living well and understanding mental illness. Help to end the stigma, and hear inspiring stories of recovery. Sign up here!

Posted on by Author Hanna Gilleyin Categories Journey, Macaroni Kid, Understanding Mental IllnessTagged , , , , , ,

9 Ways to Maintain Your Mental Health

Mental health can and should be a daily practice, taken into consideration more often than “when something is wrong” or when going through a particularly difficult time. Taking care of your mental health is a preventative form of care and by incorporating daily rituals and practices into your life, you can give your mental health the attention it deserves.

Here are nine things you can do to take care of yourself so you can take care of others:

Take a mental health day. You know yourself best. If you feel that you need a break, take one. If you don’t have vacation or paid time off, consider taking mini breaks throughout the day to renew your energy and spirit. It’s okay to slow down and not feel rushed to cross everything off the to-do list at once.

Switch up your evening routine. Try winding down in a different way than you typically do if you’re feeling particularly stressed or “off.” Think about what relaxes you and adopt that into your routine: reading a book, taking a long bath, chatting with a friend.

Adopt a vacation mentality. Put your phone setting on do not disturb between 9pm-7am. Go swimming instead of sweating at the gym. Walk in the park with a friend during lunch. Ignore emails after you’ve clocked out for the day/week. Whatever you do on vacation that feels relaxing and rejuvenating, try bringing some of that into your daily life.

Meditate for five minutes every day. Perhaps you’ve heard this advice before, but the science doesn’t lie! Meditation eases stress and anxiety, calms your nervous system, helps with memory and so much more. There’s no need to put pressure on yourself to gain some important insight or enlightenment. Sit quietly, focused on your breathing with no judgment of the thoughts in your head. With regular practice, you’ll begin to feel the benefits.

Be mindful of what you eat and drink. It’s a common coping mechanism to comfort our emotions with food, drink or other substances. We all have different nutritional and lifestyle choices, but we suggest being extra mindful when experiencing stress, anxiety or depression as sugar, junk foods and alcohol will make you feel worse (even if you feel better temporarily).

Consider reaching out for professional help. There is no barometer, specific feeling or event that warrants a person to “need” or want professional counseling. We all have varying life circumstances and coping strategies. If you feel like you “shouldn’t be this upset” or that “others have it worse” we suggest allowing yourself permission to seek help. We all deserve it.

Prioritize rest. Our culture values the “hustle” and though hustle has it’s time and place, we also need rest. You know your body and mind best—if you need a morning off work, take it. If you need a long weekend alone, take it. If you need to sleep in just a little bit longer, sleep in! The to-do list is not going anywhere and you’ll need your physical and emotional health in top shape to do your best.

Write down as many inspiring messages as you can. They can be lyrics, affirmations, reminders to move your body, drink water, have gratitude—any message that uplifts you. Keep them close by, such as in a desk drawer, a large jar or your phone’s notebook app. If you need a pick-me-up, reach for one. Alternatively, download an app that sends positive affirmations to your phone daily. It’s proven that we bring to life the thoughts that we tell ourselves (even unconsciously), so let yourself think positive thoughts!

When we feel that we are in control of our thoughts, feelings and emotions we’re bound to continue the work that allows us to feel that way. However, if you think you may need professional help, reach out. Everyone needs help at some point in life. It takes courage and strength to recognize when help is needed and seek it out.

Sign Up To Receive Our Latest Blog Posts!

Learn more tips on living well and understanding mental illness. Help to end the stigma, and hear inspiring stories of recovery. Sign up here!

Posted on by Author Hanna Gilleyin Categories Advice for Affiliates, Journey, Tips for Healthy Living, Understanding Mental Illness, WellnessTagged , , , ,

WE’RE HIRING! Explore our open positions and discover the support and flexibility you’ve been looking for.

Learn More