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Mental Health Awareness Month in the United States: How Are We Doing?

Did you know that May is Mental Health Awareness Month? This is an opportunity to look at the state of mental healthcare in the United States to identify trends and areas for improvement.

Despite Increased Demand, Behavioral Health Services Cut Back

Demand for behavioral health services has skyrocketed during the COVID-19 pandemic. A new report from the Government Accountability Office (GAO), however, has found that some provider groups laid off staff or cut back on programs.

The GAO report referred to a 2020 survey by the National Council for Behavioral Health that found that 27 percent of 343 behavioral healthcare organizations cut back employees. Forty-five percent of the organizations cut some of their programs. The majority (65 percent) of organizations reported having to cancel, reschedule, or turn away patients in the summer of 2020, even as 52 percent reported an increase in demand.

Some providers have had to reduce inpatient beds to follow social distancing requirements. Others have had difficulty getting insurers to cover inpatient stays for patients with both physical and behavioral health diagnoses. While providers have tried to address these issues through telehealth visits or partnering with digital health resources that provide self-directed mental health resources to clients, it has not completely offset demand, especially for those who need in-person care.

Time to Rethink Physical and Behavioral Health Integration

Integrating primary care with behavioral health has been a goal and a challenge in healthcare for years. However, Ed Jones, PhD, senior vice president for the Institute for Health and Productivity Management, notes that the movement so far has not met the high expectations. In many cases, “integration” has been interchangeable with “coordination,” which doesn’t lead to much change. The same goes for collaboration and the patient-centered health home.

Instead, Jones suggests a model that leads to fundamental, transformational changes in primary or behavioral care. That model should target the failure of primary care to address health behaviors that affect chronic medical conditions associated with a majority of healthcare costs, along with the continued stigma of seeking help for mental health concerns. A new type of provider, which Jones calls the “primary care therapist,” can help address both the issue of behavior change and stigma. Therapists may work within primary care settings to help screen, counsel, and refer patients. The full article can be found at Behavioral Health Executive.

How Has Telehealth Affected Therapy During the Pandemic?

During the COVID-19 pandemic, infection control measures and the increased demand for mental health services has led many behavioral health providers to move to telehealth. Clinicians are attempting to address a backlog of appointments, while patients deal with long waitlists to see a provider. At Aspirus Wausau Hospital, the waiting period to see a psychiatrist is 8-12 weeks, and referrals have doubled over the last year. As more providers resume in-person services, there is hope that the backlogs will decline.

Increased demand and complex client needs have created challenges for behavioral health providers. Make your practice more efficient and improve client outcomes with BestNotes’ EHR solutions, customized to your unique needs. Contact BestNotes today to learn more and schedule a free demo.

date:  May 25, 2021
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Social Determinants of Health: What Behavioral Health Providers Should Know

Physical and mental health depends on a lot of different factors. Behaviors like diet and smoking status can affect our health, as well as uncontrollable factors, like genetics.

Even our environments and income levels can affect health outcomes. That’s the idea behind social determinants of health (SDOH), which include conditions related to where we live and work.

What are social determinants of health (SDOH)?

Healthy People 2030, an initiative by the U.S. Department of Health and Human Services, groups SDOH into five general areas:

Economic Stability
Education Access and Quality
Health Care Access and Quality
Neighborhood and Built Environment
Social and Community Context

These SDOH include factors such as:

Access to safe housing
Experiences of violence or discrimination
Job opportunities and income level
Opportunities for physical activity
Exposure to pollution

These factors can have a significant impact on health and quality of life. For example, lack of access to healthy foods and few opportunities to exercise can increase a person’s risk of cardiovascular disease. Individuals who live in urban areas with high levels of air pollution tend to have higher rates of asthma.

And those are just physical health concerns. SDOH can also affect mental health.

How do social determinants affect mental health?

For example, a person who experiences frequent violence in their neighborhood or home can experience chronic stress and anxiety. This, in turn, can affect physical health in ways that may include disturbed sleep and increased inflammation. When these negative experiences occur in childhood, they can also impact mental health in adulthood.

Certain neighborhood details can also influence mental health. A team of British researchers found statistically significant associations between the prevalence of depression and residential characteristics, such as “abundant graffiti” and lack of private outdoor space.

Research from the World Health Organization in 2014 found that certain populations around the globe are at higher risk of mental disorders due to exposure to unfavorable circumstances. These include war and other armed conflict, neglect in early childhood, and lack of access to clean water. (Download a PDF of the full report here.)

In the United States, researchers examined the health effects of the severe drought in California in 2015. Many affected households reported that the drought negatively affected their peace of mind. Those households who reported that the drought affected their finances or property were more likely to report that it impacted their peace of mind and stress levels.

By understanding how these factors impact a person’s health, behavioral health providers can gain a more complete picture of their clients’ needs and concerns. This can help guide treatment and may lead to better client outcomes. Social workers and other types of behavioral health providers also will be better prepared to advocate for their clients, when necessary.

To get started, consider learning which SDOH most affect your practice’s client population or geographic location. You may be working with local, county, or state health departments in this area. If your clients mention particular SDOH concerns, document it in their health record, if appropriate. When possible, work with your client to take action or point them toward specific resources to help mitigate some SDOH.

At BestNotes, we’re big fans of helping behavioral health providers and their clients achieve the best outcomes. Our OutcomeTools feature helps you gather, track, and report outcome data, saving you time and reducing frustration. Whether you’re following one client or many, it’s never been easier to gather outcome data. Contact BestNotes today to learn more.

date:  May 12, 2021
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What Should Behavioral Health Providers Know About Polyvagal Theory?

“Polyvagal Theory” describes a group of ideas related to the role of the vagus nerve in human psychology. According to this theory, the vagus nerve serves an important role in emotional regulation, social behavior, and fear response. Stephen Porges, director of the Brain-Body Center at the University of Illinois at Chicago, first introduced Polyvagal Theory in 1994.

What is the vagus nerve?

The vagus nerve, also called the pneumogastric nerve, is a cranial nerve made up of sensory and motor fibers. It is also the longest nerve of the human autonomic nervous system (ANS). The ANS controls and regulates many bodily functions, usually unconsciously. Such functions include heart rate, digestion, respiratory rate, and urination.

The ANS is important for the human body’s stress response and defense mechanisms. One branch of the ANS, the sympathetic nervous system, is connected to the “fight-or-flight” response. Another branch, the parasympathetic nervous system, controls what is sometimes called the “freeze-or-faint” response. In stressful situations, these systems may work together, or one may inhibit the other.

What is Polyvagal Theory?

Under Polyvagal Theory, human beings can immediately, even unconsciously decide if an environment is safe or threatening because of information sent via the vagus nerve.

When responding to their environment, Polyvagal Theory proposes that humans use not only the fight-or-flight and freeze-or-faint responses, but another division of the ANS. This third division includes a social communication and engagement system, which includes facial muscles, middle ear function, and vocalizing.

According to Polyvagal Theory, a person who, with the information sent via their vagus nerve, has determined that an environment is secure can feel safe in using their social engagement system. This includes a calm heart and respiratory rate, and the free use of vocal and facial expressions.

However, if the environment is not safe, it will trigger the fight-or-flight response. If that system somehow fails, then the freeze-or-faint response kicks in, and the affected person is less able to relate to the world socially. Porges also suggests that the body can remember a traumatic experience and become “stuck” in one of these trauma response states.

Polyvagal Theory in Mental Health

Psychologists and therapists who are interested in Polyvagal Theory often use it to inform decisions about anxiety, fear, and trauma.

According to Bessel van der Kolk, professor of psychiatry at the Boston University School of Medicine and author of The Body Keeps the Score, the Polyvagal Theory “makes us look beyond the effects of fight or flight and put social relationships front and centre in our understanding of trauma. It also suggested new approaches to healing that focus on strengthening the body’s system for regulating arousal.”

Because Polyvagal Theory is a relatively recent idea, supporting evidence remains limited. While it has been used to help inform trauma treatment, Polyvagal Theory has also been criticized for this lack of research. Additional research may be necessary before the theory is more widely incorporated into behavioral health clinical practice.

Trauma recovery is just one of many challenging areas for behavioral health providers. In particular, mental health and addiction treatment professionals can prepare to see an increased demand for services related to trauma connected to the COVID-19 pandemic.

You use different treatment approaches for different clients, so it’s important to make sure your EHR solution is just as flexible. BestNotes EHR solutions can be customized to your unique needs to help you save time, reduce frustration, improve profitability, and meet documentation and reporting requirements. Contact us today to learn more or schedule a demo.

date:  Apr 16, 2021
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This Spring, Consider the Link Between Green Space and Mental Health

Spring is finally here, bringing longer days, warmer temperatures, and new growth. As a behavioral health provider, this is the perfect time for you to encourage your clients to enjoy the benefits of green space.

Green Health Benefits

An increasing body of research shows that green spaces and nature can be a vital part of mental and physical health. For example, a World Health Organization report in 2016-17 noted that greenery and natural features can specifically help counteract the stress, lack of physical activity, and environmental hazards associated with urban living.

Experts have not yet determined exactly why we benefit from green space, but the effects are fairly obvious. Health benefits include:

Encouraging physical movement
Space to socialize (a notable benefit during the era of COVID-19, when people still need social interaction but many places have limited indoor gatherings)
Lower air and noise pollution
Exposure to beneficial microbes that can improve immune function
Reduced stimulation, leading to a more relaxed mind and increased ability to concentrate, remember, and learn

A Danish study published in 2019 suggests that, among those with behavioral health disorders, the benefits of green space may be greatest for individuals with mood disorders, depression, neurotic behavior, and stress-related concerns.

In fact, the study also found that children who grew up with the least exposure to green space had up to 55 percent higher risk of developing a psychiatric disorder. This was independent of other known risk factors.

Not Just Any Green Space

But are all green spaces created equal? Not necessarily, some research suggests.

One study in the United Kingdom, published in Frontiers in Psychology in 2018, found that biodiversity in urban green spaces was best for mental health. Study participants reported significantly more “psychological restoration” from urban parks with more biodiversity. Where mental health is concerned, parks with a variety of plants and other natural features are more beneficial than cultivated landscapes and modern amenities.

Different people also may respond to green space differently. One 2014 study found that the relationship between urban green space and health can vary by age and sex. Researchers report in the Journal of Epidemiology and Community Health that the benefit of more green space was most apparent in early to mid-adulthood for men. Among older women, those with moderate access to green space had better mental health.

Other research has found that green space access can have specific benefits for children. In the Journal of Pediatric Nursing in 2017, researchers reported that access to green space was associated with better health and cognitive development for children. Green space access was linked to attention and memory restoration, stress moderation, improved behaviors, and even higher standardized test scores.

Behavioral health clinicians can use these findings to encourage green space exposure and outdoor activities in clients of all ages. Consider discussing these benefits with your clients and working with them to determine the best outdoor locations and activities for their particular mental and physical health needs.

With behavioral health services in greater demand than ever, you need to strike the right balance between improving client outcomes, keeping your practice profitable, and staying compliant with regulatory bodies. BestNotes EHR solutions, built and customized specifically for behavioral health clinicians, helps you accomplish all three. Contact us to learn more about how our solutions can help your practice.

date:  Apr 12, 2021
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Should You Discuss Nutritional Psychology With Your Behavioral Health Clients?

Do the foods we eat influence our mental health? That’s the idea behind nutritional psychology, also called nutritional psychiatry.

Support for Nutritional Psychology

Studies suggest there is, indeed, a connection between food and mental health. After all, our brains require food for fuel, just like any other organ. It makes sense that the kind of fuel is important.

Plus, the gastrointestinal tract is responsible for producing 95 percent of the body’s serotonin, a neurotransmitter involved in mood regulation. The condition of the gastrointestinal tract, including the presence of beneficial bacteria or harmful inflammation, could affect both digestion and emotions.

One systematic review, published in 2018 in Molecular Psychiatry, analyzed more than 40 studies that looked at the connection between following a healthy diet and depressive symptoms or clinical depression. Results indicated that a healthy diet may offer some protection against depression.

Stanford Medicine, the medical school at Stanford University, established the Metabolic Psychiatry Clinic, the first academic specialty clinic in the United States that evaluates and treats patients with psychiatric illness and metabolic abnormalities. Compared to the general population, people with psychiatric illness have a higher proportion of obesity, diabetes, and heart disease. Many patients also may experience metabolic abnormalities from taking certain medications for mental health conditions.

Behavioral health clinicians who encourage healthy lifestyle choices could help improve their clients’ outcomes. Positive lifestyle behaviors can also improve physical health, especially when encouraged in partnership with the rest of a client’s care team.

An Ideal Mental Health Diet?

There may not be a single, ideal diet that everyone should follow for their mental health. Each person is different, with different nutritional needs. However, some research offers insight that behavioral health providers and other clinicians might use to guide their clients’ nutritional decisions.

For example, the Molecular Psychiatry study found support for the use of a Mediterranean diet in treating depression. Generally, this diet includes relatively high consumption of olive oil, legumes, fruits and vegetables, and fish, with moderate consumption of dairy products and wine, and limited meat products.

Another 2018 study, published in the World Journal of Psychiatry, looked at the most nutrient-dense foods and how they might help prevent or mitigate depression. They found a connection between 12 “Antidepressant Nutrients” and the prevention and treatment of depressive disorders. These nutrients include:

Long-chain omega-3 fatty acids (EPA and DHA)
Vitamin A
Vitamins B6 and B12
Vitamin C

Foods with the highest concentrations of these nutrients were found to be:

Various seafoods (including oysters and mussels)
Organ meats
Leafy greens and lettuces
Cruciferous vegetables

The study authors recommended that further research examine these nutrients and foods, and that clinicians consider their dietary value in supporting clients with depression.

When you recommend a treatment for your client—whether that’s lifestyle changes, medications, or a type of psychotherapy—how do you know it’s working? Tracking outcomes is not only important for your clients, but is required in some form by various state and federal agencies. The right outcome tracking and documentation is vital for your practice’s success.

The OutcomeTools system by BestNotes helps reduce the hassle of recording and tracking outcome data. You can get OutcomeTools as a standalone tool, or as part of the BestNotes EHR solution. Contact us today to learn how OutcomeTools can help your behavioral health practice stay compliant, profitable, and effective.

date:  Mar 25, 2021
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