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

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.

Sleepless in Ithaca

Instead of falling asleep at 10 p.m., Daniel, a junior psychology major at Ithaca College, has just woken up. He was too tired to stay awake in the afternoon, but now he won’t be able to get back to sleep until 2 or 3 a.m. Because he won’t get enough sleep at night, tomorrow he’ll be tired again in the afternoon.

The Fountains at Ithaca College

College students are notorious for their unconventional sleep schedules. The transition to online classes during the Covid-19 pandemic has merged school and personal time, meaning even more students are having difficulty getting enough sleep at night and staying awake during the day. The Ithaca College Center for Health Promotion hosts the THRIVE @ IC Wellness Coaching program, which includes one-on-one sessions and group workshops for building resiliency to help students address these sleep difficulties and other health concerns. According to Program Director Nancy Reynolds, a Health Education Specialist and National Board-certified health and wellness coach, anyone can start taking steps today to improve their sleep cycle and overall wellness.

A good night’s sleep might be hard to get for some, experts agree, but it’s easy to define. According to the Centers for Disease Control and Prevention, adults college-aged and up need seven to nine hours of sleep every night. Sleep is generally better without frequent awakenings and when you keep a consistent routine, waking up and going to bed at similar times every day.

Reynolds points out signs of a poor sleep schedule that may sound familiar to college students.

“Do you feel well-rested in the morning?” Reynolds asks. “What’s your fatigue level during the day? Because that’s another marker of if you’re not getting enough sleep or a good quality of sleep. You’re going to notice during the day that you’re feeling groggy, maybe you’re falling asleep in class, you’re having to take naps every day because you’re so tired.”

It’s a stereotype that college students choose to stay up past midnight and sleep into the afternoon, but many students like Daniel, who requested that his full name not be published, really do have difficulty getting up and staying awake.

According to Reynolds, various aspects of student culture contribute to unhealthy sleep schedules. When students spend time on phones and laptops late into the night, she noted, blue light from these devices prevents the brain from releasing sleep chemicals. Reynolds said that many students also struggle with time management, especially when they’re juggling a lot of responsibilities. That can force students to stay up late to complete all their tasks or assignments, she said. Reynolds also points to a strange element of college culture in which students “compete” to be the busiest or the most sleep deprived—which some students dub the “Sleep Olympics.”

The switch to online learning has further complicated student sleep problems, Reynolds said. Students face even more hours of screen time, and the line between schoolwork and rest of life is blurred. It’s not unusual for students to log in to a class on Zoom and see several classmates attending from their beds. Reynolds explained that taking online classes from the same room all day may be another reason students are struggling with sleep.

“We’re not getting variety in our day in terms of social connections and moving around to different environments—walking around campus, going to the library, hanging out in different students’ rooms,” she said. “We’re not getting the same amount of stimulation that our brains need to make our bodies ready for sleep at night.”

Along with lack of stimulation, Covid-19 has introduced new stressors, such as social, financial, and health-related worries, that may keep students up at night, Reynolds said. She noted that many people are coping with feelings of grief for those they have lost to Covid-19.

Reynolds said that sleep and mental health are strongly interconnected. Bad moods, low energy, and difficulty in focusing due to lack of sleep take a toll on mental health.

Reynolds explained that sleep cycles necessary to maintaining mental wellness can be interrupted for many reasons, one of which is substance use.

“Some students are self-medicating with cannabis,” she said, explaining how students use marijuana to help them fall asleep at night. “The downside is we know scientifically that THC and cannabis prevent us from going into REM sleep, which is dream sleep. If you don’t get dream sleep on a continual basis, your mood may suffer.”

Struggling with mental health can cause poor sleep, and in turn poor sleep can make it difficult to focus on one’s mental health, Reynolds said. Anxiety specifically feeds into this cycle, as racing thoughts keep people awake, and the resulting poor sleep causes them to feel like they can’t handle challenges in their lives, she added.

Daniel agreed that the two were related, saying, “When my sleep schedule is off, I’m often anxious about class work, since I don’t have time or energy to get it done.”

It can seem like an endless cycle. At Wellness Coaching, Reynolds focuses on finding a first step that can help students move forward. This may be anything from mindfulness to a new exercise routine.

“You have to go at it from both aspects—improving the sleep and reducing anxiety,” Reynolds explained.

All aspects of health are related, which Wellness Coaching illustrates through a “Resilience Pyramid” graphic. The bottom building blocks of the pyramid are eating well, “balancing substance use,” moving your body, and getting good sleep. All of these elements are essential for building up personal health and moving up to higher goals on the pyramid such as connecting with others and adopting a growth mindset.

In a first visit with Wellness Coaching, students typically assess their own strengths and challenges on the pyramid. They can then start finding solutions. Wellness Coaching is currently available virtually at no cost for all Ithaca College students. Reynolds encourages students to reach out, even if they only need assistance for one session. (Email healthpromotion@ithaca.edu for more information.)

Reynolds said there are several first steps that a student can take today to getting their sleep cycle back on track. For example, she said, take the time to go for a walk outside, allow yourself breaks between classes, and stay connected with the important people in your life. Be mindful of activities that may be disrupting your sleep cycle, such as upsetting media, substance use, and long naps, Reynolds advised. She also recommends establishing a nightly wind-down routine, a period of 30 to 60 minutes before bed when you shut off your devices and do something quiet like stretching or listening to a podcast.

As the semester nears an end, Daniel is feeling hopeful. With three of his five classes now meeting in person, he’s having less difficulty separating work and leisure environments. He’s also monitoring his afternoon habits, trying to avoid  too-long naps. Daniel’s latest report: the sleep cycle is getting back on track.

—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.

Support Family & Children’s Service of Ithaca

Now more than ever, Family & Children’s Service of Ithaca needs the aid of the community to ensure that it can continue to be a place to turn when someone needs support for their mental health. Click here to donate to F&Cs’s Annual Cardboard Boat Race (Virtual Edition) fundraiser.

Scenes from the 2019 Cardboard Boat Race on Lake Cayuga

The Covid-19 pandemic prevented F&CS from hosting its fun-packed fundraiser on Cayuga Lake as usual. But boat “captains” are nonetheless flying their virtual flags high to collect funds to benefit F&CS.

This year’s goal is to raise $40,000 by September 13. Donations will support high quality mental health care that is affordable and accessible to anyone in Tompkins County.

More than 40 clinical therapists and psychiatrists at Family & Children’s Service help some 2,000 individuals and families every year by providing counseling and psychiatry services for depression, anxiety, and mental wellness.

F&CS also operates a range of social service programs, such as temporary housing for runaway and homeless youth and support for kinship foster families. F&CS’s Community Outreach Workers provide social worker support throughout downtown Ithaca.

Watch a short video to hear President and CEO Karen Schachere and board members discuss F&CS’s mission.

The Healing Power of Storytelling

“The Path to Recovery: One Story at a Time” is the theme of this year’s Annual Depression Conference being held at the Tompkins County Public Library from 9 a.m. to 3:30 p.m. on Tuesday, November 28. Open to the public, the conference includes a keynote talk, a panel discussion on mental health recovery, workshops focused on children/adolescents, adults, and older adults, and a book discussion.

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The keynote speaker is Regi Carpenter, an advocate for “narrative medicine,” a medical approach that utilizes patients’ personal stories as part of their healing. She is the author of Snap!, the story of her own severe mental illness as a teenager and her path to recovery, and a memoir, Where There’s Smoke, There’s Dinner: Stories of a Seared Childhood.

Carpenter was 16 years old when she first experienced severe mental illness and was committed to a New York State mental institution. According to the conference organizers:

“After being released she never spoke of it for over thirty years. As a professional storyteller, author and workshop leader, Regi knows the importance of telling one’s story to overcome trauma, ease anxiety, depression and shame. It wasn’t until she told her story of teenage trauma that Regi knew the healing power of stories to restore and heal the battered psyche. In this keynote you’ll hear stories of Regi’s experience as well as how stories can be used as a therapeutic tool to help clients become more resilient and resourceful.”

From Carpenter’s website bio:

“For over 20 years Regi Carpenter has been bringing songs and stories to audiences of all ages throughout the world in school, theaters, libraries, at festivals, conferences and in people’s back yards. An award winning performer, Regi has toured her solo shows and workshops in theaters, festivals and schools, nationally and internationally.

“Regi is the youngest daughter in a family that pulsates with contradictions: religious and raucous, tender but terrible, unfortunate yet irrepressible. These tales celebrate the glorious and gut-wrenching lives of four generations of Carpenter s raised on the Saint Lawrence River in Clayton, New York. Tales of underwater tea parties, drowning lessons and drives to the dump give voice to multi-generations of family life in a small river town with an undercurrent.”

Ithaca’s 24th Annual Depression Conference is sponsored by: the Alcohol and Drug Council of Tompkins County; Cayuga Addiction Recovery Services; Family and Children’s Service of Ithaca; Finger Lakes Independence Center; Ithaca College Gerontology Institute; The Mental Health Association in Tompkins County; Multicultural Resource Center; Suicide Prevention & Crisis Service; Tompkins County Mental Health Department; Tompkins County Office for the Aging; and the Tompkins County Public Library.

Photo Caption: Regi Carpenter

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Prince Harry’s Story

“Once you start talking about it, you realize that actually you’re part of quite a big club.” So says Prince Harry, 32, who has opened up in a British newspaper podcast interview about his mental health struggles and how he is dealing with them.

Harry spent 10 years in the British Armed Forces, including two operational tours in Afghanistan where he commanded Apache helicopters, and achieved the rank of captain. None of his military training and experiences, however, prepared him for the severe emotional challenges he faced due to the tragic death of his mother Princess Diana in 1997 when he was just 12 years of age.

In an interview with Britain’s Daily Telegraph, Harry revealed that he sought professional counseling after two years of “total chaos” in his late twenties. He described how he only began to address his grief at age 28 after feeling “on the verge of punching someone” and experiencing anxiety during royal engagements. He says he is now in a “good place.” He credits his elder brother, Prince William, for being a “huge support.”

Excerpts from the interview with Bryony Gordan’s “Mad World” podcast this week:

“I can safely say that losing my mum at the age of 12, and therefore shutting down all of my emotions for the last 20 years, has had a quite serious effect on not only my personal life but my work as well.

“I have probably been very close to a complete breakdown on numerous occasions when all sorts of grief and sort of lies and misconceptions and everything are coming to you from every angle.

“The experience I have had is that once you start talking about it, you realize that actually you’re part of quite a big club.

“My way of dealing with it was sticking my head in the sand, refusing to ever think about my mum, because why would that help?

“[I thought] it’s only going to make you sad, it’s not going to bring her back.

“So from an emotional side, I was like ‘right, don’t ever let your emotions be part of anything.’

“So I was a typical 20, 25, 28-year-old running around going ‘life is great,’ or ‘life is fine’ and that was exactly it.

“And then [I] started to have a few conversations and actually all of a sudden, all of this grief that I have never processed started to come to the 
forefront and I was like, there is actually a lot of stuff here that I need to deal with.

“It’s all about timing. And for me personally, my brother, you know, bless him, he was a huge support to me. He kept saying this is not right, this is not normal, you need to talk to [someone] about stuff, it’s OK.

“The timing wasn’t right. You need to feel it in yourself, you need to find the right person to talk to as well.

“I can’t encourage people enough to just have that conversation because you will be surprised firstly, how much support you get and secondly, how many people literally are longing for you to come out.”

British mental health experts praised Harry for speaking up so openly about seeking professional help for his mental health struggles. Sir Simon Wessely, the president of the Royal College of Psychiatrists, went so far as to say that the prince had achieved more in communicating mental health issues in the 25-minute podcast than Wessely had in a 25-year career.

Since retiring from the armed forces in 2015, Harry devotes much of his time to charity work. He is involved with Heads Together, which brings together The Royal Foundation of The Duke and Duchess of Cambridge and Prince Harry in partnership with charities tackling stigma, raising awareness, and providing help for people with mental health challenges. He also focuses on the welfare of servicemen and women, championing developmental opportunities for hard to reach children, and African conservation. In 2014, Harry created the Invictus Games, an international adaptive sporting event for wounded, injured and sick servicemen and women.