Extra stress and the holiday season sometimes go hand in hand. But as Iowans gather for festivities, you're being reminded to take seriously any warnings that your mental wellbeing may be under duress.

From added time with family to expanding your budget, the holidays bring on a host of demands that can boost your stress level.

Emily Berry, research and referral manager for the Iowa chapter of NAMI, the National Alliance on Mental Illness, said there are red flags that what you're experiencing might be more than the typical holiday stress "if you're feeling so anxious that maybe you're nauseated or getting a headache, you're really feeling down about things - so, you're being withdrawn from things you wouldn't normally be withdrawn from."

If you're breaking typical holiday patterns, such as your normal food and alcohol consumption at festivities or money spent on gifts, she said, these also could be signs your mental wellbeing needs greater focus. NAMI recommends calling the Iowa Concern line, Iowa Warm line or COVID recovery line and ask for a specialist to talk with. These resources may be especially helpful over the holidays, with appointments with therapists harder to come by.

Berry said stress often can build up during a holiday gathering. In those situations, she recommends finding someone in the room you feel you can talk things out with to reduce the tension.

"Go into another room, or step outside with someone you trust - a loved one, a parent, friend, partner - anyone like that you can just take that breath with them," she said, "and just talk about how you're feeling."

She noted that a number of Iowans still might be reeling from losing a loved one to COVID. When it comes to feelings of grief during the holidays, NAMI suggests trying to offset them with experiencing joy in the relatives that are present. Part of that can include recalling fond memories of holidays past.

The U.S. Supreme Court is expected to announce its decision on a case, which could upend abortion access across the country. The topic is a source of fiery debate, and one reason could be because of our anxiety about death.

At a webinar hosted by the Seattle-based Ernest Becker Foundation, panelists discussed the link between the anthropologist's work on terror-management theory and the issue of abortion.

Dr. Emily Courtney, social psychologist at the University of South Florida, said people manage their anxiety about death by constructing worldviews, such as religions, ideologies and political orientations. But it also makes people defensive when their worldview is challenged, making topics such as abortion more divisive.

"The fact that we deal with the death anxiety by putting more of our own kind of personal stake in the ideologies that we've adopted as human beings," Courtney explained. "When those things are threatened, we take a step back and things get a little bit more intense when we do confront those issues."

A leaked Supreme Court opinion on the Mississippi abortion case showed justices could be preparing to overturn the 1973 Roe v. Wade case, which legalized abortion.

Regardless of the ruling, the option will remain legal in Washington state.

Courtney pointed out death is a large part of terror-management theory, but there are other components to our fear of death, including existential threats to our identity and autonomy. Courtney noted threats can present themselves when someone is not able to make the choice to get an abortion.

"So by limiting those choices, you're presenting more of an existential threat to specific groups of people," Courtney emphasized. "Women, people who may be marginalized in society, people who may be in different socio-economic tiers who could simply not support children."

Dr. Lindsey Harvell-Bowman, associate professor at James Madison University and director of the Terror Management Lab, explored more hopeful messages of empathy and trying to neutralize the terror-management defense which can come up on issues such as abortion.

She recommended humanizing people on the other side of this issue from you, and using communication as a way to get there.

"We're all humans," Harvell-Bowman stated. "We all end the same way, and so really in order to enact change we have to engage in meaningful conversations with each other without completely ruining the other side."

On a given day in Massachusetts, more than 100 children and teenagers are brought to hospital emergency rooms because they're facing a mental-health crisis and sometimes have to stay there for days or weeks.

Nonprofit Youth Villages is partnering with the Massachusetts Health and Human Services Department for a program called Intercept, to provide immediate in-home mental-health treatment for kids and teens.

Matt Stone, executive director of Youth Villages, hopes to see similar programs in other communities.

"The vast majority of the children and adolescents that we are serving in this program," Stone explained. "They don't need a bed in a facility. What they need is intensive in-home support, to help the parents and caregivers be able to manage the crisis."

Stone noted Youth Villages has served more than 100 families, referred by 20 different hospitals. Family intervention specialists meet with families two to three times a week; help address issues with schools, courts and children's services; and build and help families execute treatment plans. They're also on call 24/7 in case of an emergency.

Joy Rosen, vice president for systems behavioral and mental health at Mass General Brigham, said during the pandemic, hospitals have seen increased numbers of children and teens in mental distress. She pointed out there are a number of factors, from remote learning and feeling isolated, to potential loss of a friend or family member.

"Anyone is accepted, regardless of their insurance, whether they're documented or undocumented," Rosen stressed. "It's really a breath of fresh air, and particularly at a time when clinicians did not feel they had many resources at their fingertips for these suffering kids and families."

Angela is a parent of a teenager who went through the Intercept program. She emphasized the difference it makes to be able to take care of your kid at home. She recounted when her daughter was experiencing an eating disorder and self-harm, she was stuck in the emergency room for two full weeks because inpatient facilities wouldn't take her, until she was discharged with Youth Villages.

"Awareness of this program really needs to be heightened up a bit to help get kids home. An emergency room is not a place for mental illness with kids," Angela asserted. "She saw way too many things as a teenager that she should not have seen in that emergency room."

Virginia is home to more than 780,000 military veterans, and one organization is offering mental and emotional support.

The National Alliance on Mental Illness' (NAMI) Homefront program is a free, six-class course for veterans, active-duty military members and their families.

Mary Beth Walsh, director of programs for NAMI-Virginia, said military families often have their own unique mental and emotional needs, which the program aims to address.

"It's an educational course that helps lead family members through ways that they can not only help their loved ones, but also ways that they can focus on themselves and gain support for their own needs," Walsh explained.

In addition to NAMI's program, the Department of Veterans' Affairs (VA) also offers care via its mental-health specialty clinics, primary-care clinics, nursing homes and residential-care facilities. Walsh pointed out NAMI also partners with VA facilities to offer peer-to-peer support programs, which emphasize connecting veterans with folks who have shared experiences.

Walsh noted the peer-to-peer support model is used across NAMI's other mental-health programs, but is particularly important for veterans. As she explained, military veterans have a unique culture, language and experiences.

"Being able to talk to somebody who has been there and can really say, 'I've been through what you're going through,' it's such a huge aspect of what can really help somebody feel not so isolated and alone," Walsh emphasized.

Dr. Rhonda Randall, executive vice president and chief medical officer for UnitedHealthcare employer and individual, said there are a few signs people should keep an eye out for if they think someone is struggling with their mental health.

"Things that you really worry about are like loss of interest in things, a loss of feeling happiness or pleasure, really feeling helpless or hopeless," Randall advised. "Generally, we get concerned when those kinds of feelings persist for more than two weeks."

According to the federal government, more than 1.7 million veterans received mental-health counseling through a VA program in the 2018 fiscal year. The department also has a veterans' crisis phone line for emergency situations.