Many people with persistent mental illness find it difficult, or even impossible, to participate in common activities like work or friendships.
A unique clubhouse model at work in Greeley has been helping restore those lost social connections since 1990.
Ashlyn McMillan, a member of Frontier House Clubhouse, said when you have a mental illness, disconnecting is one of the easiest things to do but when you're all alone, she noted your mind can be your worst enemy.
"One of the things that we're always addressing is isolation," McMillan pointed out. "Isolation is a huge disconnect, one of the biggest disconnects. You're sitting at home alone, and don't have anything to distract yourself from what's going on in your mind. With the Clubhouse you do."
There is no cost to individuals for membership at the Frontier House Clubhouse, it never expires and it is open to anyone with a behavioral health diagnosis. Frontier House follows the evidence-based Clubhouse International Model of Psychosocial Rehabilitation. Participation is completely voluntary, some members drop in daily, others whenever they feel the need.
Renee Schell, director of Frontier House Clubhouse, said relationships at the Clubhouse are collegial. Staff and members work side by side to address challenges and reach life goals that are key to mental health, such as finding meaningful work and social relationships. In most institutional settings, people living with mental illness are clients or patients, but Schell explained you are first and foremost a person at the Clubhouse.
"A place that peels away labels and stigmas that people with mental illness may experience," Schell emphasized. "We do not focus on a person's diagnosis necessarily, we focus on a person's strengths, talents and abilities."
Clubhouses have helped reduce self-harm, hospitalization and incarceration often associated with mental illness by offering people opportunities for friendship, employment, housing, education and access to natural supports within a caring and safe environment. At the end of a therapy session or a doctor's visit, McMillan acknowledged it can feel like support stops when you leave their office.
"Then you're home, and that's where that support ends," McMillan observed. "At the Clubhouse, the support is always there. If a crisis happens outside those hours, if something happens where you need help now, the staff and the other members will come and help you."
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Gaps in mental health care are a common research topic right now and for Minnesota youth in rural areas, a new report showed their families face big obstacles in navigating the care system if their child displays symptoms.
In its analysis, the Center for Rural Policy and Development said long travel distances and a lack of information make it hard for parents in these settings to put a concrete plan together.
Marnie Werner, vice president of research and operations at the center, said other factors are at play.
"There's a desire for anonymity," Werner pointed out. "People don't necessarily want all their neighbors to know that their kids are seeing a therapist. And in rural areas, especially, there are just getting to be fewer and fewer people in the mental health field."
Because of a fragmented system, the authors say in a crisis, parents -- especially in rural areas -- often end up taking their child to the emergency room, which can create a host of other problems. As long-term solutions take shape, parents are encouraged to educate themselves about early warning signs and the basics of mental health. And if their child reaches a crisis point, the 988 Suicide and Crisis Lifeline is a resource to lean on.
Werner noted there is also an evolving approach to integrate mental health care with primary care.
"Having a therapist in the regular clinic," Werner explained. "Mental health has often been siloed off to the specialty clinic. And so, with behavioral health integration, the doctor can bring the therapist in to meet you and your child while you're there at your appointment."
The authors said it is not a perfect solution but school-linked mental health services are increasingly becoming more dynamic, which can make it easier to seek assessments and schedule treatment on campus.
Meanwhile, the American Heart Association is raising awareness about establishing healthy routines like physical activity, which help improve mental health while preventing such conditions as anxiety and depression.
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A U.S. Department of Justice investigation has found Kentucky is failing to provide access to community-based mental health services for people who need them, and instead relies too heavily on psychiatric hospitals.
The report says the state is potentially in violation of the Americans with Disabilities Act, or ADA.
Licensed Psychologist Sheila Shuster, who is part of the Advocacy Action Network, said years of budget cuts have reduced or eliminated the city's crisis centers - such as the Living Room, which opened its doors in 2018 and was shut down within a year due to lack of funding.
"Three to four hundred people a month coming in and using the services, and getting referrals," said Shuster. "And then boom, it's gone. So, that was May of 2019, and we don't have anything like it back in place."
The University of Louisville Hospital provides emergency psychiatric treatment to more than 2,200 adults with serious mental illness each year.
In a separate investigation last year, the Justice Department concluded the city and the Louisville Metro Police Department violated the ADA by subjecting people with mental illness to an unnecessary police response.
While the new report raises awareness about the needs of people living with mental illness, Shuster said it doesn't capture the full picture.
She cited recent changes the city has made, such its 911 call diversion program for mental health-related incidents, as well as families' view of the role of hospitalization.
"By and large, what I hear from the family members is not that their loved ones are being kept too long in the hospital, but that they're not being kept long enough," said Shuster, "which I think is what is leading to the revolving door."
Marcie Timmerman, executive director at Mental Health America of Kentucky, said the focus should be on early intervention and treatment, so folks don't end up being involved with the police.
"We would love to have more providers available," said Timmerman. "I'm not sure that pinpointing our psychiatric hospitals is really helpful."
She added that a mobile crisis response system, and Medicaid-funded housing and support programs, could help reduce the number of people who continue to cycle through hospitalization and the criminal legal system.
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Mental health experts have released a checklist for parents of students headed back to school in Montana.
Research shows kids who need services are often go without and substance abuse and mental health experts say half of students who are clinically depressed are not getting the mental health care they need.
Caitlin Hochul, vice president of public policy for the mental health advocacy organization Inseparable, said it is important services are available to students as they return to school.
"They help improve access to care and are really one of the most effective tools we have to help
improve children's mental health well-being," Hochul explained. "We are reaching kids where they spend most of their time, and that is in schools. "
The U.S. Department of Education said young people who get school-based services are six times more likely to complete treatment than those who get their services in community settings. A program at Montana State University has shown success in reducing the teen suicide rate by increasing mental health literacy among young students.
Hochul pointed out research showed increasing mental health literacy decreases symptoms of depression, and noted there are several steps to achieving the goal.
"One is making sure that kids understand what brain health is, what mental health is, similar to physical health education," Hochul outlined. "Then there's also training up staff and teachers, too, so they're understanding warning signs and can help with suicide prevention and substance use disorder prevention."
Hochul added regular mental health check-ins with kids, even if they are just informal, can help identify students who may need support.
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