Nevada is among a handful of states to add a surcharge to all phone bills intended to help support the state's 988 mental health emergency hotline.

A new report by the mental health advocacy group Inseparable found if the surcharge were to increase from 35 cents to 98 cents, it would generate approximately $3 million annually for the Silver State.

Angela Kimball, chief advocacy officer for Inseparable, said the report is a tool to help policymakers and state leaders develop an equitable and sustainable crisis response system. They found Nevada's in-state answer rate sits at 68%, when it should be above 90%.

"We're still a long way from having the kind of system that everybody expects in every ZIP code, in every part of America," Kimball acknowledged.

Kimball pointed out with the implementation of 988, it also brought about changes in the way local jurisdictions respond to mental health crises. The report highlighted Nevada has convened a workgroup to build response processes for collaboration between 988 and 911. While it is a step in the right direction, the report showed Nevada could improve call center capacity, crisis response as well as system financing.

Nevada has the 39th highest suicide rate in the country and also ranks 50th in the nation for overall mental health, according to the Nevada Division of Public and Behavioral Health.

Kimball stressed the figures need to see improvement. She added not having an effective response system in place can make a difference between life and death for some.

"People going without help, being turned on to the streets, being in jail, being in emergency departments, being hospitalized -- voluntarily or involuntarily -- or, tragically, having their life end," Kimball noted.

Kimball added the report lays out policy examples for each of their policy recommendations which come from red and blue states moving the needle in the right direction. She hopes they can serve as inspiration for other states. If you or someone you know is experiencing a mental-health emergency, do not hesitate to call or text 988.

On this Election Day, Indiana residents may be feeling the effects of what some are calling election stress disorder, but there are several ways to cope.

If you're suffering with anxiety related to the biggest day of the year for politics, Dr. Jennifer Embree - chief wellness officer and clinical professor at the Indiana University School of Nursing in Indianapolis - encourages taking a moment to pause before reacting to election-related news, especially on social media, and focusing on what you can control.

"When we pause, it's easier to take the emotion out of that situation and then really thinking about what exactly are you afraid of," said Embree. "What's the worst thing that can happen? And then, what issue impacts you the most?"

Deep breathing exercises can lower heart rates and reduce anxiety. One popular technique is known as box breathing: inhale for four seconds, hold for four, exhale for four, and hold again for four.

Medical experts caution against using alcohol or drugs to cope, noting the substances often disrupt sleep and ultimately do little to alleviate stress.

Instead, clinicians prescribe seeking professional help if stress becomes unmanageable.

Embree suggested connecting with supportive people who help keep them calm. For those greatly stressed, she recommended meditation, exercise, or even dancing to manage emotions.

"Think about the people that keep you calm and really are your support peope," said Embree. "Those are the people you need to be connecting with - not people that are going to make you more anxious, more upset, that's one thing - is to keep the calm around you."

While election outcomes are beyond individual control, Embree said maintaining personal well-being is key to victory in navigating this high-stress period and future events.

By Deanna Pistono for MinnPost.
Broadcast version by Mike Moen for Minnesota News Connection reporting for the Rural News Network-Public News Service Collaboration

If Minneapolis therapist Emily Abeln could wave a magic wand, the political rhetoric flooding the airwaves this election season would likely look a lot different. 

“I would just have every single human mind on the planet actually humanize each other. If we see everyone as human, then we don’t tend to do all this hate, violence, discrimination and restriction,” said Abeln, MA, LP, who co-founded Transcend Psychotherapy with spouse Max Abeln, MA, LMFT.

For many in America, this year’s election rhetoric has felt dehumanizing as parts of their identity are being discussed, often negatively, as political talking points. 

“Anytime that we have people who have to justify their own existence, (we’re) creating an environment for mental health problems and mental illness to form and be sustained,” said Shonda Craft PhD, LMFT, who runs Craft Psychotherapy and Consultation in the Twin Cities. 

Abeln and Craft are among the many providers with clients in Minnesota and across the U.S. who have had their identities – race, gender, or immigration status – invoked in various ways during the election. How they are impacted, however, can vary greatly. 

“Some people are desensitized to what’s happening. The constant exposure has caused them to emotionally disconnect and experience emotional fatigue, which can be a good coping mechanism (and) buffer for psychological distress,” said Fathi Kofiro, MSW, LICSW, who owns and practices at Daryeel Therapy in the Twin Cities. “For others, they’re terrified. They’re afraid for their lives. They’re afraid for their family’s lives. They’re afraid for the people that they care about.” 

Mental health providers use therapeutic techniques and practices while validating clients’ emotions and giving them a space to share their feelings. Providers working with clients from these communities also emphasize the importance of connection with a community that affirms their client’s identity and supports them.

“The gap between (a person’s ideal life and the life they live right now) is oftentimes where mental illness lives. That gap between what I expect life to be and what I experience life (to) actually (be) can be filled in with depression. It can be filled in with anxiety, it can be filled in with hopelessness (and) loneliness,” Craft said, adding that she works with clients to close the gap. “How can we build connections with people who are affirming of who you are? How can we help you to understand your own value and identify what makes you unique, and how that uniqueness is actually very needed in this world?” 

In addition to individual therapy, some providers host support groups for members of targeted communities. But providers also acknowledge their own limitations: While they can help clients deal with their identities being part of political discussion, they cannot stop these identities from being part of the conversation.

“We can support people in gaining insight and we can support people in restructuring the way that they’re thinking. But we cannot get rid of the fact that (stress and trauma) continue to happen over and over and over,” said Candace Hanson, LPCC, and executive director of Canopy Mental Health & Counseling in Minnesota.

Ghazel Tellawi, who has therapy clients in Minnesota, Kentucky and Wisconsin, hopes those whose identities are not subject to political attacks will understand that “the things that are said have a real-life impact on people’s lives and people’s wellbeing. It’s not just locker room talk.” 

Here are three examples of political rhetoric affecting marginalized communities this election:

Mental health providers working with the Black community and other communities of color have noticed how right-wing backlash against diversity, equity and inclusion initiatives has been used to question Vice President Harris’s competency.

“When you add in this political environment, where we’re labeling certain types of people as inherently not qualified for a job that they hold, that starts being something that plays out in workplaces. It reinforces that pressure to perform that a lot of BIPOC folks have in the workplace (and) dials up the pressure and the stress,” Hanson, of Canopy Mental Health & Counseling, said. 

This stress can go on to negatively impact a person’s mental health, leading to a loss of self-confidence, along with signs of anxiety and depression. All the microaggressions in the workplace, along with “DEI hire” rhetoric, said Hanson, builds up to a “cumulative effect that can amount to racial trauma.”

Adriana Ines Quiñones Peña, a mental health practitioner and advocate based in Minnesota, also referenced a statement by Trump that immigrants were stealing “Black jobs” as something that was evocative of a history of colonization and racist perceptions of Black people. 

“There’s Black people in tech, there’s Black people in STEM, there’s Black doctors (and) there’s black people that are artists, so when it comes to (the) idea (of) ‘Black people jobs,’ it feels as (if) we are supposed to go back to those days when we (were) doing hard labor (and were) severely underpaid or not getting paid,” she said. 

Having one’s identity othered can also lead to distrust and isolation. 

“There is this withdrawal that happens (in communities of color) because they don’t know who they can trust and they don’t know who’s safe,” said Hanson, who noted that even while former President Barack Obama was running, clients would indicate that they were unsure of what their white neighbors were saying about them when they weren’t around, or what they thought of racist rhetoric. 

“It is sort of like this daily reminder that this hostility against who you are as a person exists and there’s nothing you can do about it.”

What has also been concerning and harmful to communities of color, specifically mixed-race people, has been the periodic questioning of Harris’ racial identity. Harris is multiracial, a group that comprises the fastest growing part of the U.S. population, according to the most recent U.S. census in 2020. But just because the numbers of mixed-race people are growing does not mean that there is a greater understanding of mixed identities. 

The struggle for determining one’s identity as a mixed-race person remains “a really complicated dynamic,” said Hanson, who noted that people from different groups may not “claim” individuals who are mixed race as part of their group. 

“Having that become this public and ugly kind of discussion and criticism can be very difficult to cope with for some folks,” Hanson added. 

Craft said the rhetoric “does cause some anxiety because it’s almost like telling them, ‘You’re not allowed to know who you think you are.”

When speaking about the mental toll on the trans community during the election cycle, Christine Kerno, LICSW, a trans mental health provider who also serves trans clients, referenced the quote above, noting that it was clearly a reference to trans and nonbinary people using they/them pronouns. 

“There’s a lot of fear of what will happen if Trump wins the presidency,” Kerno said, adding there’s also concern about what a Republican-controlled Congress would do. State legislation in Minnesota protecting trans rights, “will help, but it won’t protect us completely,” Kerno said.

“The rights of trans folks are very much being used as this political tool (and) talking point to sway certain people,” Tellawi said. “(They) use fear-based tactics to make people afraid of trans people.”

While coping with anxiety, fear and depression ahead of the election, some members of the trans community are trying to prepare for how the election results could affect them, Max Abeln of Transcend Psychotherapy said. 

“I definitely hear about the specifics of people getting legal documents in order and making sure they have their passports for fear of what might happen, or hurrying up their gender-affirming care, making sure they’re getting on hormones or stockpiling hormones,” they said.

For undocumented immigrants, being the subject of election discourse is nothing new. According to mental health provider Mayra Barragan-O’Brien, the mental health senior manager at Immigrants Rising, however, things are different from “the first time around,” during the 2016 election.

“The way that the past president was talking about the communities that we are a part of, the way he described our communities, described who we are was very violent,” Barragan-O’Brien said. “There is still a lot of fear, a lot of anxiety, a lot of sadness, frustration, rage that comes along (with) this election. But there’s also a lot of feeling numb – feeling like it’s the same thing, just a different year.” 

While some have become numb, others are afraid. 

For undocumented immigrants, talk of deportation “has definitely increased a fear and maybe some distrust in the system,” Quiñones Peña said. “They’re coming here thinking that they’re searching for that American dream – that they’re going to have a better quality of life for themselves and their family. And then when they come here, they have this reality check that not everyone’s going to be welcoming of them. That not everyone’s going to be accepting of them. And (even) if they’re accepted here, that doesn’t mean that they belong here.” 

An undocumented immigrant in Minnesota, who asked to be referenced using only their last name, Flores, said that they were, for their own mental health, trying to avoid hearing about the election cycle as much as possible while still keeping up to date. 

“(Growing up, the perception was that undocumented immigrants were) only older folks or folks who were smuggled in (and) they (were) here to take your jobs or get handouts or all these other things. That’s not the reality. Sometimes it just feels like we’re like still in the shadows because even if we did speak about coming out with our stories and sharing our experiences, I just feel so scared about people calling ICE, or feeling justified to let local authorities know my whereabouts,” said Flores, who described their life as one of “uncertainty.” 

Though Trump has often been criticized for his rhetoric regarding undocumented immigrants, Flores added that Harris’ response has also been lacking.

“Although (Harris) is receptive to listening to people’s stories and does hear them out, she just comes back to stricter borders. It’s disheartening to hear, but it’s nothing new,” Flores said. 

While they have coping mechanisms, such as nature walks, journaling and finding community with other undocumented immigrants online through Immigrant Risings’ wellness support groups, “sometimes I feel I’m drowning in the stress,” Flores said.

Barragan-O’Brien said she hopes more non-immigrants would empathize with those fleeing to the United States. 

“There’s this poem that says, ‘Nobody puts their children on the boat unless the water is safer than the land,’” she said. “I wish people could hear that and take it in and understand that if they were in a similar situation (as undocumented immigrants) they would try to survive (and do) whatever would be possible for themselves and for their children and their loved ones.”


This story was originally produced by Deanna Pistono of MinnPost as part of the Rural News Network, an initiative of the Institute for Nonprofit News (INN), supporting more than 475 independent, nonprofit news organizations.


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New data from the Centers for Disease Control and Prevention show three of every four high school students nationwide said they have experienced at least one adverse childhood experience, including witnessing domestic violence in the home, parental separation or physical and sexual abuse, among others.

Research has shown the experiences, called ACEs, can alter a child's brain chemistry and produce a prolonged, sometimes lifelong, toxic stress response.

Joe Bargione, a certified school psychologist and executive committee member of the Bounce Coalition, a Kentucky ACEs advocacy group, said the national data support the trends among youth in the Commonwealth.

"We're seeing some of the same kinds of patterns," Bargione outlined. "That increased sense of loneliness, isolation in our youth, increased levels of suicidal ideation, exposure to violence, exposure to other adverse childhood experiences."

Experiencing at least one ACE as a child is linked to having alcohol and substance use problems as an adult, as well as chronic diseases such as diabetes and obesity. Childhood trauma costs states. According to the National Governor's Associations, adults with ACEs can lead to billions of dollars in health care costs and lost productivity.

Bargione added schools can help address the youth mental health crisis by cultivating a sense of belonging and connectedness, as well as increasing suicide prevention programs.

"Promoting mental health awareness in schools," Bargione urged. "Teaching kids around social emotional learning and dealing with their emotions in an effective way, increased mental health services."

He pointed out recent changes to state law now require school districts to create trauma-informed plans.

"Creating those trauma-informed care plans and then reviewing those annually by the Kentucky Department of Education and also the General Assembly is really, I think, a great way to see what's working, what's not working," Bargione explained.

Statewide, one in five children has already experienced at least two ACEs, according to Kentucky Youth Advocates.


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