Tuesday, May 14, 2019

Your Authority as a Counseling Center Director

We all know that our work as directors comes with a lot of pressures and expectations. It sometimes seems that everyone, from students to parents to administrators, have ideas about how we should do our work, and they do not hesitate to express them. This is of course also true about those to whom we report. When we are in agreement with such opinions life can go on swimmingly. But many times we may not agree. Managing this disagreement can be quite stressful but is also crucial to the leadership of our centers.

It can help to have a frame of reference for our expertise, a baseline to turn to when conflicts emerge. Here is a list of areas about which you can reasonably assume authority, at least to some degree:

• The point person on campus for mental health expertise in late adolescents and young adults
• Defining the mission, scope, and philosophical orientation of the center
• Similarly, identifying and implementing the specific services of the center
• A significant amount of autonomy over the budget needed to carry out the center mission
• Custodian of center records and authority over access to them
• Preserving client rights to privilege and confidentiality
• Decisions concerning staffing, recruitment, hiring, termination
• Center operations such that there is adherence to ethical codes

This list is not exhaustive, nor does it imply that everyone will always agree with you. They will not. But it does provide a benchmark for conversations that can and should take place when disagreements occur. We encourage you to seek consultative support when this process becomes difficult for you, and to develop the communication and other skills necessary to advocate effectively for your role and the center’s mission.

Tuesday, April 30, 2019

A Raging Debate Invisible to Many

In talking with family members, friends, colleagues (especially early in their careers), and consumers of psychological services, most seem unaware of paradigmatic issues in the field and how these affect how they are viewed and treated in the consulting room. There is in fact a vigorous debate about such things but one has to do a little digging to access it, I think because the service industry is not particularly motivated to support it. This debate is quite advanced in the UK compared to America.

The most basic argument, in my view, centers around views of "mental disorders" as diseases, contrasted with perspectives of "symptoms" resulting from adversity, stress, and the natural consequences of problems in living. Some in the industry, particularly vendors and advocates for serious mental illness push for disease concepts, I think at east partly due the scale of unmet need in that community. Others argue that "The mind is not a physical organ; it cannot have a disease. While one can have a diseased brain, one cannot have a diseased mind." There is nothing inherent in the facts which says both things can't be true at the same time; the problem has more to do with what believers feel needs emphasis and attention. (If mental health services were plentiful and awash in support perhaps this conflict wouldn't even exist.) However, disease models inevitably lead to reductionism to cellular functioning and efficient delivery of the "intervention", mostly medication, and mostly in seven- to 15-minute encounters. Which too often leads to dissatisfaction and ultimately discontinuation of the medicine.

This is because humans are not just bags of symptoms. We now know too much about the prevalence and outcomes of trauma, bullying, harassment, discrimination, and stress that its reality cannot and should not be overlooked, but that is exactly what happens in many service settings. Further, the misery that Americans are experiencing appears to be getting worse. We can all expect that symptoms will follow. On this side of the argument, one can find views that it isn't so much that people are "diseased", it's that our society is, and this is the pathogen that needs our attention.

This is admittedly not an easy or simple task, not as simple as a prescription anyway. But it is possible to address social ills. There is now more dialog, for example, of later start times for schools and time for play, as data clearly reveal effectiveness for improving sleep times and attention span. Universities are beginning to address perfectionism and anxiety by defining learning as a trial and error process, which is not only acceptable but expected. There are efforts in California to make evaluation of trauma an essential part of every health screening. So yes, such things are possible, if we raise awareness of the paradigm from which we are operating and open our minds to other possibilities.

Monday, March 18, 2019

Q&A about Mental Health in the Workplace

From an interview by The Undercover Recruiter. Check this out soon as well as other material at https://theundercoverrecruiter.com/.

How can an employer help an employee deal with mental health in the workplace?

Employers can work to secure good mental health coverage in insurance policies for employees, especially parity with physical health coverage. They can also continuously scan existing policies, benefits, and structures which may present barriers to accessing mental health care.

What kind of mental health policies work, in your opinion?

Improving access to mental health care is about removing barriers and promoting communication without forcing or “outing” employees. Common barriers include lack of insurance coverage, distance to providers (thus causing interruptions to life and work routines), limiting or discouraging leave time, working parent programs, etc.

Which company do you think offers the best mental health policies?

The American Psychological Association (APA) has recognized psychologically healthy workplaces for many years. Nearly two dozen companies were recognized in 2018: https://www.apa.org/news/press/releases/2018/09/healthy-workplace-honors.

How can employers spot the signs of an employee suffering from mental health in the workplace?

The most noticeable early signs will include stress reactions: “A stressful work environment can contribute to problems such as headache, stomachache, sleep disturbances, short temper and difficulty concentrating. Chronic stress can result in anxiety, insomnia, high blood pressure and a weakened immune system. It can also contribute to health conditions such as depression, obesity and heart disease. Compounding the problem, people who experience excessive stress often deal with it in unhealthy ways such as overeating, eating unhealthy foods, smoking cigarettes or abusing drugs and alcohol.” (From https://www.apa.org/helpcenter/work-stress.)

What is the worst thing an employer can do when it comes to tackling mental health in the workplace?

Creating or worsening barriers, creating stigma, forcing unnecessary disclosures by or about the employee. Also failing to advocate for good mental health coverage in insurance.

What can employees do to help their own mental health in the workplace?

Employees should be informed about their insurance coverage including copays and deductibles, covered providers in their network, and navigating access to care. They should also be informed about leave policies including Family and Medical Leave in America, for example. They need to know about the minimum amount of information their employer (usually Human Resources) needs to know in order to process leave requests, and their own rights to privilege and privacy. Accessing good mental health care often involves self-advocacy by the employee, so they need to be assertive about their needs and rights when that is appropriate.

What is the minimum a company should have when it comes to mental health policies?

Good mental health care coverage in insurance policies, especially parity. Well-articulated, managed, and reasonable benefits and leave policies.

How can a manager approach an employee they feel may be suffering from mental health in the workplace?

They can raise their awareness of basic helping skills that any layperson can utilize. The skills represent a balance between sensitivity for the employee, expectations for the work environment, positive views of mental health care, and the encouragement of the employee. Such skills are noted at this link which is focused on the college environment, but may be extrapolated to other settings: https://counseling.sa.ua.edu/helpingstudents/%EF%BB%BFconsultation-resources/helping-skills-faculty-staff-others/.

How do you maintain your own mental health at work?

For me, being very clear about what I am and what I am not responsible for in employment is a key. Being continuously aware of these boundaries helps me know what I need to do, what I can delegate to others, and when I can walk away from the office and focus on other parts of my life and identity. 

What tips can you give to an employer who doesn’t have a mental health policy in place?

The main thing is awareness of the costs associated with unaddressed mental health issues. Research by the APA has clearly shown that missing or ineffective policies lead to losses in productivity, revenue, employee retention, morale, and more. It is clearly in the interests of employers to establish and maintain effective policies and benefits.

Wednesday, February 20, 2019

The Central Role of Social Factors in Well-being

In other writing I have argued that life is difficult and getting more so. The observation that life is difficult is nothing new of course; others have said this long before me. Why is it, then, that mental health systems focus on intrapersonal origins of psychopathology and tend to "treat" those? Specifically and most often, with medication? There is no shortage of other factors on which we could spend our investigative energies, especially in the post-modern era in which we live. Poverty, trauma, hunger, under-employment, wage stagnation, and much more all have a significant role in our mental health.

Bracken (2001) argued that we cannot understand PTSD, for example, without grasping the global social context in which trauma is occurring:

"The advent of post-modernity has witnessed an undermining of social stability and coherence and a systematic weakening of those cultural institutions that provide meaning and order for individuals. Following trauma, the development of the characteristic symptoms of PTSD is currently understood to arise from a breakdown of meaning within the victim's world."

As mental health professionals one of our goals ought to be helping others navigate this "breakdown in meaning". This is hard to do, perhaps impossible, when our focus is solely on, say, cognition or cells. Even focusing on income alone will not lead to the improvements we seek. In Barrington-Leigh and Galbraith's 2019 article reference at the link, "The authors warn that the greatest benefits to be made potentially over the next decades, as well as the most dangerous pitfalls to be avoided, lie in the domain of social fabric."

Given the complexity of our current world and the stresses it produces, it's way past time to help others by creating new narratives that promote healthy adaptation and functioning in the chaos that surrounds us. On a very basic level we can begin by communicating that "you" are not always the problem. "It" is the problem. Then we can say "Now, what can we do about this?"

Thursday, January 10, 2019

Constructing Counseling Services from the Ground Up

It seems odd, if not incredulous, but college counseling practitioners and the upper administrators to whom they report receive little to no training on how to build a center. In most mental health and higher education training programs there may be an overview of the business and financial aspects of practice, but even this is cursory at best. Less available is information concerning such profoundly important details of service construction. From what paradigm should the center operate? What type of model will guide the day-to-day operations of the center? How should the center be oriented in order to match a specific campus culture and the needs of its students? What does such an orientation have to say about the rising demand for services? What are the strengths and limitations of this orientation?

These are profound in their importance because the work that is done with developing adults will flow from these details. They affect how we see, define, and approach the advancement of their well-being, thus potentially affecting the rest of their lives.

A road map, or guidebook, which seeks to offer a foundation for this aspect of training is now available. Delivering Effective College Mental Health Services, published by Johns Hopkins University Press, can be ordered at the link below. The book also: 

"• poses questions and offers practical advice to help college counseling centers form a consistent philosophical model

• lays out conceptual groundwork for constructing college counseling services, from training activities to counseling/psychotherapy processes

• takes into account the pressures (time related, economic, political, cultural) that strain universities

• explains how to cultivate an accurate and empathic response to each individual, their entire history and context, and their possible life trajectory"

Order your copy today at http://bit.ly/2SNmEMD. The book will ship in April.

Friday, February 16, 2018

Delusions About Violence

You have to understand the scale of mental health problems. The total burden is estimated to be up to 40% of any community. Mental health service providers reach only a fraction of that number. Even if you focused on those who have been identified as a safety risk, and you reasonably forbade them access to guns, you would get only a small percentage in overall harm reduction. All it takes to harm others is a delusion, and most people with delusions of some kind walk freely and have no history of formal mental health treatment. A great many of these would also test out as "normal" even if they did see a mental health professional, because one can harbor a circumscribed delusion and otherwise lead an apparently normal life. (This has in fact repeatedly happened.) What we have in this country is an epidemic of sorts, one caused by extreme stress and meanness in the world in my opinion. To address that effectively but quickly you would have to have a mental health equivalent of fluoride in the water, which does not exist, or reduce/eliminate access to the most harmful implements of destruction. But the "non-delusional" among us can't agree to do that for the sake of the entire community. Which may itself be a delusion.

Thursday, September 28, 2017

An American Story of Pain

He could not have known that bishops and kings had a hand in this. That they set the stage for the paranoia, the violence, the stoicism that were handed down to him through a dozen generations since leaving Ulster. He lived like an island and felt no longing for comrades or even blood kinship. As he lived this out he was blind to its source: privation, famine, religious persecution, stern resolve. And no time for beauty and kindness. They had hidden in the woods to worship and marry. They hid and ran and changed their identities in whatever way worked. They sold their labor in order to secure escape on a ship crossing the disastrous Atlantic. This ship carried orphans without a family name, still in hiding even then. Down, down through generations scattering down, down the spine of the Appalachians, looking for a peaceful hearth on a plot of land where they might be unmolested. Only, then, to recreate their circumstances over and over with too much drink, too much violence displaced on the women, children, natives, slaves. An anger boring down into their DNA, through the bishops and kings who toyed with the planted for land, greed, and power. He did not know this until right before he died. The family story, resurrected, reverberated around him but by then he was unable to to take its full measure. Or learn. Or seek forgiveness. He passed on never knowing why he did what he did, nor how descendants carried on the legacy still. Or that the young knew the story long before he did.