Month: May 2021

For Mental Health, Ithaca’s MindWell Offers Evidence-Based Care

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Mental health services in Tompkins County have been stretched to the limit for years. Demand for crisis support at local mental health clinics, as well as calls to Ithaca’s crisis hotline, spiked after the Covid-19 pandemic disrupted normal life in 2020. The number of people seeking non-crisis counseling in the county has also increased steadily since then.

MindWell Center Co-Founders Sarah Markowitz and Aaron Rakow

Into this breach last October stepped a new service provider promising cutting-edge approaches to mental health care: Mindwell Center LLP, located in the South Hill Business Campus.

MindWell is the brainchild of Aaron Rakow, a clinical psychiatry professor at Georgetown University who returned to his native Ithaca with a mission to upgrade the availability of services and standard of care in rural upstate New York. In short order, Rakow and co-founder Sarah Markowitz have hired 25 therapists and are adding another one-to-two a month; they plan to open a second clinic with 10 clinicians in September in Albany. MindWell is currently supporting 350 patients and counting.

“Across our society, we have more demand for mental health services than we have providers able to support that demand,” Rakow said. “In particular, within a category of the mental health field that we refer to as evidence-based care, or psychological intervention that is based on science, to be as effective as possible in treating a host of mental health challenges amongst individuals, there are even fewer practitioners that practice in that space. My hope is that through opening MindWell Center we will be able to address some of those needs.”

The Tompkins County Chamber of Commerce honored MindWell at its 2021 Annual Meeting and Celebration on May 20 with its Distinguished Business of the Year Award. Announcing the award, the Chamber said: “In response to a specific and substantial community need—access to effective, quality mental health care, and removing stigma regarding mental health concerns—MindWell founders Aaron Rakow and Sarah Markowitz have introduced a new model of treatment to our community and expanded their staff and services considerably in a short period of time.”

MindWell strives to provide the highest quality evidence-based mental health care to children, families, and adults for a spectrum of mental health conditions, including depression, anxiety, eating disorders, sleep disorders, substance use disorders, Post-Traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), and Attention-Deficit/Hyperactivity Disorder (ADHD).

Besides supporting individual patients, MindWell is ramping up population-level initiatives—for example, it offers contracted services for companies where clinicians implement programs fostering healthy workplaces through leadership training, wellness seminars, stress reduction classes, support groups, and individualized care for employees. MindWell is offering similar services to schools in the region, both K-12 and colleges. Rakow believes that the Ithaca community is aware of the need to address the “mental health pandemic” many experts believe accompanied the Covid crisis.

Rakow said that another key part of MindWell’s mission is to support the training and retention of high-quality evidence-based clinicians in upstate New York. To that end, MindWell has formed partnerships with the University at Albany and Binghamton University to provide training through externships for graduate programs in clinical psychology.

WATCH: Promotional video about the MindWell Center

Evidence-Based Care (EBC) is an evolving standard of care involving a variety of treatments endorsed by leading mental health associations. According to experts, it emphasizes integrating the best available research with clinical expertise in the context of a patient’s culture, individual characteristics, and personal preferences. Nonetheless, as a 2013 New York Times article pointed out, “surprisingly few patients actually get these kinds of evidence-based treatments” despite numerous trials demonstrating their effectiveness.

MindWell clinicians are trained to provide Cognitive Behavioral Therapy (CBT) and Measurement-Based Care (MBC) to carry out its evidence-based approach. According to the American Psychological Association, CBT encourages patients to recognize distortions in their thinking that are creating problems, and learn problem-solving skills to cope with difficult situations.

Any good therapist will utilize treatment elements such as reflective listening, validation, and empathy. As Rakow describes it, evidence-based treatment adds a roadmap for the client and the therapist to most efficiently decrease the symptoms of disorders through specific strategies and techniques that have been proven through science. In treating a patient with depression, Rakow explained, the therapist will assess the factors behind the patient’s negative thinking patterns. Then the treatment will focus on teaching coping skills that can change the patient’s cognitive narrative.

“The client gets a workbook to help their guidance and help their process at home,” said Rakow. “The clinician has a workbook to help guide the sessions. That is an evidence-based intervention in practice.”

Furthermore, MBC bases clinical care on data collected from patients throughout their treatment; experts say that MBC provides insight into treatment progress, highlights ongoing treatment targets, reduces symptom deterioration, and improves client outcomes.

“We are looking at every single session for the individual on how they are improving, if they are improving,” Rakow explained. “And if they are not, what can we be doing differently on an interventional level?”

To use an example, Rakow said that a clinician treating anxiety will have patients fill out screen tests during every therapy session to measure increases or decreases in symptoms. “So they can say, ‘It looks like you’ve had a difficult week. We’re seeing your anxiety go up. Let’s see how we can calibrate the treatment effectively to bring that level back down. Because we know you have that potential.’ If we are not practicing measurement-based care, we’re not practicing evidence-based care. Those two things must always go together,” Rakow said.

Some team members at MindWell are equipped to prescribe medications. That said, Rakow points out that many of the most evidence-based strategies involve the combination of psychotherapy and medication management, as opposed to a treatment regimen that involves medication management alone. Thus, MindWell’s team of multidisciplinary providers collaborate closely on cases to ensure that the treatments are optimally calibrated to each patient’s individual needs.

Population-level initiatives provide easier access to mental health treatment, Rakow explained. “There are far too many barriers to accessing high quality mental health care in our country,” Rakow said. “We will partner with hospitals, with school systems, with institutions of higher education, with businesses big and large, to provide integrated mental health solutions for their employees, for their pupils, for their staff, for their patients, to make the process of accessing mental health care that much easier.”

Rakow said that businesses are receptive to upstream mental health support for their employees, especially amid the Covid-19 pandemic, in part because they realize that decreased wellness can impact productivity and profits. He said that MindWell services for K-12 schools can focus on administrators, teachers, and staff as well as students and their parents.

School-integrated support helps parents avoid what can be a difficult challenge in navigating mental health services for their children on their own, Rakow said. “If you are a mom or dad, and your child needs mental health care, you have to locate a provider, wait for that provider to have an opening, take time off to drive across town and take that child to that appointment, wait while the child is seen, and follow up with the clinician,” Rakow said. “That could take weeks or months to treat, in the best-case circumstances.”

MindWell’s model for higher education similarly supports faculty and staff members while seeking to relieve the increasing burden on student counseling services.

“College student mental health is right now an extremely high need for our field,” said Rakow. “The institutions of higher ed in our region are taking this issue extremely seriously and have put an incredible amount of thought and commitment and resources towards it. But our need in our society from a mental health perspective continues to grow and the demand for it continues to increase. We need to really think innovatively about how we can provide support and access points for undergraduate and graduate populations of learners in our community to be able to effectively meet that demand.”

UPDATE: MindWell is working with regional insurance carriers to become in-network as soon as possible to increase access to its care model. In the meantime, MindWell offers a generous sliding scale for clients in need. MindWell also offers what it calls courtesy billing whereby the MindWell team submits the claim on the behalf of the client so they can focus on their care rather than dealing with paperwork.

Kid in College? Read This to Know the Mental Health Risks

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A letter of acceptance to college, which usually arrives in March or April before high school graduation, is a wonderful milestone for young people and their parents. Thus begins an exciting and sweet passage: commencement festivities, packing for life on a college campus, some goodbyes and hugs, moving into a dorm, making new friends, and beginning a promising academic journey into adulthood.

After more than a year of Covid-19 pandemic restrictions, the smiles will be wide when students arrive this fall for what is expected to be normal in-person classes at Cornell University, Ithaca College, and Tompkins Cortland Community College.

It is very easy to overlook—or even be clueless about—what for some students will become a dark side of leaving the family nest: anxiety, depression, sexual assault and hazing violence, misuse of alcohol and drugs, academic struggles, relationship problems, and more.

At Cornell, the proportion of undergraduates who reported that they were unable to function academically (missing classes, unable to study or complete homework) for at least a week in the past year due to depression, stress, or anxiety increased from 33 percent in 2015 to 42 percent in 2019. Many reports indicate that college students are struggling even more with their mental health during the pandemic.

College orientation materials usually provide some notice about the risks and the resources for staying safe and healthy, but they may have minimal impact amid the excitement of transitioning to college.

So, a word of advice for college students, particularly for incoming first-years:

Educate yourself about the mental health challenges that you may face, and learn about the ways that you can address those challenges if and when they arise.

The same advice goes for parents. Know what your college kid is getting into.

To help, Forefront Suicide Prevention, a center at the University of Washington, recently produced A Guide for Parents and Families: Supporting Your College Student Through Mental Health Challenges.

DOWNLOAD: A Guide for Parents and Families: Supporting Your College Student Through Mental Health Challenges

This essential booklet was written by Forefront’s Marny Lombard, who has gained a profound understanding of the challenges that college students may experience. Lombard’s son Sam struggled for many years with depression and died by suicide in 2013. He was 22 years old and a college senior majoring in architecture. Lombard wrote the Guide to provide parents and families with the knowledge that she needed but did not find.

“Mental health problems among young adults are more common than many families realize,” the Guide says. “In fact, one in three college students experiences a mental health issue, most commonly anxiety or depression. Major life changes such as adjusting to college life and experiencing added academic stress can set the stage for the onset of mental health issues.”

According to the Guide, parents and family members sometimes struggle to understand their student’s mental health concerns—or even to recognize that their student is in distress. Learning that their student is having suicidal thoughts can create extreme stress for the family.

Forefront’s Guide provides authoritative resources and recommended reading to help parents and families of students who are struggling with their mental health. It can help them to stay in touch with their students and know when and how to seek help if needed.

The Guide asks parents to gradually change the tenor of their conversations with their students, listening more and speaking less. Using compassion, setting aside judgment.

Guide sections include: “Ways to Keep Conversation Flowing”; “Ask about how things work at your college”; Finding the Right Therapist,” “What To Do When Your Student is Struggling”; “About Medications”; and “If Your Student Is Thinking About Suicide.”

“Suicidal urges, in particular, should always be taken seriously and never dismissed as a ploy to gain attention,” the Guide says, noting that “asking someone whether they are thinking about suicide will not plant the idea in their mind.” The Guide provides valuable information about engaging with a suicidal student and helping them get professional help. Suicide is preventable. “The vast majority of young people who consider suicide will move through this difficult time,” the Guide says. “Many will begin to learn how to manage their mental health.

Finally, the Guide advises parents to check in regularly about their students’ stress levels and warns against delaying treatment when the need is clear. It cites data showing that 75 percent of the time the onset of mental illness occurs by the age of 24.

“The longer the delay between the onset of mental illness and the start of treatment, the more difficult it can to successfully treat these issues,” the Guide says. “The good news is that you can learn how to support them and help them manage the underlying stressors.”

For more more resources, click here for the Student Mental Health page on The Sophie Fund Website

The Advocacy Center Steps Up

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Kristi Taylor sits at her computer and logs on to Zoom. The education director at the Advocacy Center of Tompkins County smiles about the technical difficulties using the software. She holds up the soft blanket that covers her lap, just one of the little rituals that get her through long video conferences in a changing work environment.

Kristi Taylor, education director at the Advocacy Center of Tompkins County

Putting in endless hours online hasn’t been the only change in Taylor’s routine at the Advocacy Center, an Ithaca nonprofit organization that supports victims of domestic violence. While the Covid-19 pandemic brought a suspected spike in cases of domestic violence, stay-at-home guidelines made it more difficult for victims to reach out for help. In March 2020, the Advocacy Center’s hotline went cold.

“We weren’t able to connect with survivors, and we weren’t hearing from people,” Taylor explained. “And that was really, really concerning for us, because what that told us is that people were trapped with their abusive partners.”

The center moved swiftly to address the new conditions, finding solutions in technology and social media as the center’s work went remote almost entirely (a notable exception being the center’s 24/7 shelter for abuse victims). First, the center significantly increased its use of Instagram to spread awareness and combat any impression that its activities had ceased. It launched an Instagram campaign with the hashtag #wearestillhere. Staff members posted pictures of themselves holding posters with the hashtag message, putting the center’s contact information in the caption. The center also added podcasts and blog posts to its education outreach mix.

By the summer, pandemic restrictions began to ease somewhat and the Advocacy Center’s hotline began buzzing again. The center upgraded its technology to handle multiple hotline calls simultaneously, and introduced a hybrid virtual platform for training additional hotline volunteers to manage the influx.

The Advocacy Center also moved its in-person support groups for domestic violence survivors online, the Survivor Empowerment group and Knowledge is Power group. The groups utilize secure video conferencing software during meetings to give a face-to-face connection while also protecting attendees’ privacy. Group numbers fluctuate due to the center’s “drop-in” policy, but usually seven to 10 people attend the once-a-week meetings lasting an hour or more.

Between July and October, hotline calls increased 55 percent over the same period in 2019. That aligns with a study published in December in the American Journal of Emergency Medicine, which indicates that cases of domestic abuse have significantly risen since the start of the pandemic in early 2020.

Pandemic conditions from stay-at-home orders to work-from-home practices meant that abuse victims became more isolated from their support systems, and as a result, more deeply trapped in their abusive relationships. “One of the most powerful tools that abusers have is creating isolation,” said Taylor.

Between July and October, the Advocacy Center provided support to 34 percent more domestic abuse survivors compared to the same period in 2019. Compared to the previous year, in 2020 the center also supported 44 percent more children and teens who had been sexually abused.

The Advocacy Center was founded in 1977 as the Task Force for Battered Women. At the time, its purpose was to provide women who had suffered from domestic abuse and their children a safe place to live. The organization also helps victims of sexual assault and rape, victims of child sexual abuse, family members of survivors, and people of any age and gender who have experienced domestic and sexual violence.

—By Margaret Kent

Margaret Kent, an intern at The Sophie Fund, is a senior at Ithaca College majoring in Communication Management and Design with a concentration in Corporate Communication and a minor in Writing.

Why This Professor Cares about Student Mental Health

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Ten to 15 students a day would come around to the Muller Faculty Center office of Derek Adams to discuss African American literature and ask questions about assignments. Then the Covid-19 pandemic forced Ithaca College classes online and turned the professor’s office hours into Zoom calls as well. Only a couple students a week showed up after office hours went virtual.

Adams regretted the lost mentoring time, but he had an even greater concern: his students’ mental health. A professor who cares deeply about student wellbeing, Adams uses office hours to keep an eye on how his students are doing.

“I don’t think it takes a license to actively listen, or to be open minded and listen to what somebody has to share,” said Adams, an associate professor of English who came to Ithaca College in 2012. “That’s something we should all be able to do. That’s just a very human thing that we do.”

Professors can often be the first to notice if a student is struggling with their mental health. On the first day of classes, Adams addresses students with three ice-breaker questions that demonstrate how he incorporates their wellbeing as a priority in his teaching: What is something you want to take from the class? What is something you’re willing to give to it? What is something we should know about you to get to a place where we can do the work that we need to do?

From there, Adams strives to create a classroom community with strong student connections that he believes benefits their mental health. For example, he requires students to learn each other’s names and encourages them to address each other as such in classroom discussions.

“I think, the better the state [my mental health] is in, the more I retain from what my students share with me, the more I retain from what I’m reading and what I’m conveying, the better I’m able to make connections between things,” Adams said. “And so, I just imagined that if that was true for me, it would be true for students as well, so I wanted to make that a core part of my pedagogy.”

A caring community in which students are allowed to feel vulnerable facilitates a greater understanding of literature, Adams believes. “I don’t know that we will ever get to the level of instruction and transmission of knowledge and the sharing of information that we want to get to without at least acknowledging that mental health is a core part of our experience,” he said.

But after the pandemic hit, Adams’s classroom community became more difficult to build in a Zoom gathering. The casual chatter before and after class—about things in the news, or popular culture—largely disappeared. “There’s just something about being in person that I think makes students feel more free to share those things,” he said. “Without those, it was harder to establish that kind of bond with my students.”

In response, Adams tried out some new ideas to rebuild his classroom community. He asked his students to address a letter to someone they trusted and cared about, exploring current events and how they felt about them. As they shared their letters with the Zoom class, Adams felt a better connection to his students and to the state of their mental health.

“Just giving students the platform to do that helped cultivate that sense of community that I’ve been able to hit on in my in-person classes for so many years,” Adams said. “I was learning to do this for the first time online.”

Adams also made clear that he is sensitive to obstacles in online learning and has adjusted expectations accordingly. He reminds students to prioritize their well-being and gives them pep talks. “Look at what you’re doing right now,” he tells his students. “How incredible is it that, in the middle of the pandemic, you can pick yourself up?”

Adams understands that many students struggle to be open with their professors, wary to admit they are having trouble keeping up. He believes that’s why it is essential for professors to pay attention to their students’ mental health. Although he is not a clinician, he can offer an empathetic ear. And, when he sees a cause for greater concern, he refers students to other resources such as Ithaca College’s Center for Counseling and Psychological Services (CAPS).

CAPS Director Brian Petersen agreed that everyone on campus can help improve the mental health climate.

“Mental health support for students is the responsibility of the entire campus community and Ithaca College is committed to creating a campus-wide culture that is focused on mental wellness,” Petersen explained.

Petersen believes that faculty members should be formally trained to recognize warning signs for distress and even suicide. Currently they are provided with a resource guide for directing students to support services on and off campus.

 “Our goal is to help faculty feel comfortable with this kind of intervention,” said Petersen. “We also talk with faculty about boundaries and how to be helpful without being too invested or psychologically or emotionally enmeshed with the student.”

Adams is looking forward to seeing students in his daily office hours again. But he doesn’t want to forget the lessons he’s learned about community building during the pandemic  “Whatever happens from this point forward, I would like there to be a continued focus—a renewed focus—on mental health and well being,” he said.

—By Lorelei Horrell

Lorelei Horrell, an intern at The Sophie Fund, is a second year Ithaca College student with a Writing major and double minor in Sociology and English.

Take a Mental Health Test

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May is Mental Health Month! Why not do a self-check to see how your mental health is doing right now? Mental Health America (MHA) provides a quick-and-easy-to-use online screening tool to test whether you are experiencing symptoms of a mental health condition. MHA says that 3 million Americans have taken a test during the Covid-19 pandemic in the past 12 months.

Click here to take MHA’s mental health tests

You can screen for anxiety, depression, postpartum depression, Post-Traumatic Stress Disorder, Bipolar Disorder, Eating Disorder, psychosis, and addiction. Parents can also take a test to understand whether their children may be experiencing emotional, attentional, or behavioral difficulties. There is also a similar test with youth-themed questions that young people can take to check on themselves.

Following screening, you will be provided with information, resources and tools to help you understand and improve your mental health.

MHA notes that online screening tools are meant to be a quick snapshot of your mental health. “If your results indicate you may be experiencing symptoms of a mental illness, consider sharing your results with someone,” MHA advises. “A mental health provider (such as a doctor or a therapist) can give you a full assessment and talk to you about options for how to feel better. Mental health conditions are real, common and treatable, and recovery is possible.”

“We at Mental Health America have witnessed an unprecedented increase in the numbers of people experiencing mental health problems,” said Paul Gionfriddo, MHA president and CEO. “In November 2020, the Centers for Disease Control and Prevention reported that 44 percent of us were dealing with either depression or anxiety. While historically data shows us that 1 in 5 adults will experience a mental health problem, these days it certainly feels like it’s 5 in 5.”

For Mental Health Month, MHA is providing a package of materials that can be used by healthcare providers, community organizations, schools, and social media users to encourage greater awareness and treatment for mental health conditions.

DOWNLOAD: MHA’s “Tools 2 Thrive” toolkit

The toolkit highlights six topcis:

Adapting After Trauma and Stress

Processing Big Changes

Getting Out of Thinking Traps

Radical Acceptance

Taking Time for Yourself

Dealing with Anger and Frustration

During Mental Health Month, follow and share The Sophie Fund’s education campaign on Instagram and Facebook to learn about screening tools, treatment methods, suicide safety plans, crisis hotlines, and mental health statistics.

The infographics relay expert information from sources such as Mental Health America, National Alliance on Mental Illness, American Foundation for Suicide Prevention, and Suicide Prevention Resource Center. The campaign was created by Margaret Kent, an Ithaca College student and intern at The Sophie Fund.