The American Psychological Association (APA) defines trauma as a “an emotional response” to a terrible event like an accident, rape or natural disaster. You may have directly experienced a terrible event, learned about a terrible event happening to a close friend/ family member, or had a frightening experience in which there was actual or threatened death, injury, or violence.
Did you know that there are over 20 different LGBTQ flags?
Each has their own meaning and tell a story of individuals and groups within the LGBTQIA+ community, represented by the various colors in stripes, shapes, and symbols.
Supporting Teachers and The Work They are Doing. As a mental health therapist who has worked many years alongside teachers within the school system, I have a deep appreciate for the work that they do
Dr. Andrea Hutchinson’s drive to improve mental health providers’ lives has quickly established her as a leader
in the mental health community. Dr. Hutchinson’s practice, Care Counseling, fights for therapists by providing
support and training necessary to say things like CARE has 7x less clinician turnover than the national average.
When Cathy Moen’s son, Elijah, was in first grade, he was diagnosed with attention deficit hyperactivity disorder. She took him to the pediatrician, who put him on medication and suggested therapy.
The medication part was easy. But getting him therapy proved more difficult — not because Moen couldn’t find a therapist or didn’t have insurance, but because of logistics.
The appointments were always during the day, and between her work schedule and the traffic, it was nearly impossible for them to make it.
But she soon learned Elijah was able to see a therapist in his Bloomington school. More than 15 years ago, Minneapolis Public Schools helped pioneer a national model of bringing community mental health care directly to its students. Today, most of the public schools in Minneapolis — more than 50 of them — have a therapist on site, and many other districts, like Elijah’s, have followed suit.
These days, Elijah’s therapist simply walks down the hall and pulls him from class.
“This is like a godsend,” said Moen.
The family’s health insurance pays for the care the same way it would if the student were being seen in the clinic. The school program was designed so that no student in need will be turned away for lack of insurance.
The Minneapolis program has also provided a road map for schools across the country as more administrators realize that mental health is as important to students’ future success as academics. Studies have shown that students are more likely to show up for appointments when the therapists are on-site.
More and more states are making mental health care in schools a priority. At least two states have recently passed laws that require schools to teach mental health. And more are considering it.
But the benefit of having a therapist on-site goes beyond just getting students to see a therapist. In Minneapolis, it’s also helped make mental health a school-wide priority — and helped get counselors, teachers and others more involved, said Mark Sander, who helped start the district program.
“Those teachers start learning more and more [about mental health],” said Sander, who directs school mental health for the district and the county.
He said as they learn more about mental health, teachers are feeling like, “‘OK, I get it. And now, you know, I’ve got this other student who’s not diagnosed with anxiety but has some of those anxiety features. And now I know how to better support them.”
At South High School in Minneapolis, the therapists sit in the school clinic, the same one where students go if they feel sick during the day or to get a physical so they can play sports.
The issues the students bring to the therapist run the gamut from stress about grades and colleges to anxiety related to a bad situation at home.
Farah Hussein is a therapist at South. She said it’s hard being a teenager, and she tries to help.
“There’s a lot of conversations about, ‘Who am I? Where do I fit in the world? Where do I belong?’ and just a lot of distress in exploring that,” she said.
All of this has important implications for the students’ well-being beyond just their mental health.
Sharon Hoover, who co-directs the National Center for School Mental Health at the University of Maryland School of Medicine, said more schools are collecting data on outcomes of in-school mental health programs, and the results are clear.
“They are more likely to have good attendance and to graduate and to get improved grades. We even have documentation of having better standardized test scores when you put universal systems in place like classroom-wide social emotional learning,” she said, all of which makes for happier, better adjusted students.
Cathy Moen, the mother whose son, Elijah, is in therapy in school, said she doesn’t know if it’s the medicine, or the therapy, or just that he’s growing up, but she — and his teachers — are already seeing a difference.
By: Bridget Eickhoff, MA, Alison Dolan, Psy.D., LP, and Andrea Hutchinson, Psy.D., LP
Being a therapist can be a fulfilling and rewarding career. However, it can be hard to remember that therapists are humans who also experience anxiety, stress, and burnout. We took a survey of 30 clinicians at CARE Counseling asking what makes them feel successful and balanced at work. Here are the main points our amazing clinicians found that help them find balance when working with a full caseload.
- Create Boundaries and Stick to Them
- Let your clients know your boundaries for cancellations and follow through with the boundaries you’ve set or are set by your agency. Therapy should be a flexible time for the client to address topics that are important to them; however, aspects of structure are important in therapy to keep both your clients and yourself accountable.
- Start and end sessions on time so that you have time to complete documentation, grab something to eat or drink, use the restroom, consult with a colleague, and/or take a moment to regroup.
- Manage your Schedule Proactively
- Make your life easier by scheduling clients as recurring appointments and practice confirming the next appointment at the end of the session.
- You probably enjoy seeing clients and it can be heartbreaking to refer them out. However, back to that accountability point, close your clients who are not following the attendance policy (or use supervision and consultation if you need guidance) and give them referrals to help with barriers (e.g., closer to home, different hours, attending to a different piece of their difficulties, etc).
- Proactively reach out and ask for more clients if you start to notice your caseload looking low or you have inconsistent clients.
- Keep in mind, being proactive will help keep the number of intakes in the same week lower and documentation will likely feel more manageable.
- Take advantage of cancellations and catch up on documentation or check-in with a co-worker. If you are finding yourself racing towards burnout remember:
- You can use PTO and take a day or more to feel grounded again
- Ask if you can have a temporary block off time in your schedule to help you gain some extra time to feel like things are more manageable again
- Talk to management to see if there are ways to contribute to the team without as many client appointments.
- Try to NOT Take this Very Personal Job, Personally (easier said than done)
- For both you and your clients, use your intuition for goodness of fit. As you know, a healthy therapeutic alliance is a key factor for the overall success of therapy. At times, especially as a new clinician, it can be difficult to decipher between your intuition and anxiety. Clinicians should utilize supervision and consultation to explore types of clients who are and are not a good fit. Supervision and consultation are also helpful when you feel stuck.
- Sometimes, it can feel pretty personal when a client cancels often or ghosts us. Keep in mind, clients will cancel appointments for a multitude of reasons ranging from weather, illness, moving, and symptoms and this happens to the best of us.
- You’re Not Alone
- Consult with your peers and use supervision to feel balanced and confident with your caseload.
- While you are likely a compassionate person, remember you too may have times when you need to check-in on your own mental health. Remember everyone can benefit from therapy!
When Dr. Jeff Hardwig started his job as a psychiatrist in his hometown near the Canadian border, he wasn’t sure there was enough work for him.
Pretty soon, it became clear that there was, in fact, plenty of work in International Falls, Minn., a town of 6,000 people. He split his time between a group family practice and community mental health center and also saw patients in nearby communities.
“Within two or three years, it was clear I was too busy to go out of town anymore,” he said.
After nearly 30 years working as the town’s sole psychiatrist, Hardwig retired in September, leaving no psychiatrists for more than 100 miles around. His departure underscores a difficult reality: A national shortage of psychiatrists is much more acute in rural and remote areas, which leaves many people without access to the kind of services they need.
And the demand for Hardwig’s services has never let up.
Wendy Dougherty, the nurse who worked with him at the clinic, said his calendar was always full.
“He never ever … in the five years I worked with him, ever had an empty slot,” she said. “And one thing about his patients, if they called and canceled, that empty slot was filled by somebody that had been waiting two months to get in.”
But, she said, he was also the kind of doctor who would always find a way to squeeze in somebody in a crisis, even if it meant missing lunch or canceling his own meetings.
‘You take all comers’
The clinic where Hardwig worked is a primary care center on the outskirts of town, part of the Duluth-based Essentia Health system. It’s a low-slung building across the street from a Menards and a Dollar Tree that offers all the basic services, including annual checkups and mammograms.
Hardwig and others agree that the need for a psychiatrist in town was there, but until he arrived, people mostly counted on their primary care doctors to handle it.
His patients’ diagnoses over the years ran the spectrum of diseases, including anxiety, depression, bipolar disorder and schizophrenia.
“I had to take care of people of all ages — all the way through to the nursing home,” he said. “You can’t really specialize if you’re in a small town. You take all comers.”
And working in a small town, he also couldn’t avoid running into his patients frequently. It might have been hard for some doctors — psychiatry is a profession that particularly prizes its discretion — but Hardwig says he didn’t mind.
“I just had sort of an agreement with my patients if they say ‘hi’ to me, I’ll say ‘hi’ back, but I won’t otherwise out them. And my wife knew not to ask, ‘How do you know that person?’” he said.
He said his patients were respectful of him, too, and didn’t try to squeeze in consultations in line at the grocery store or when he was out to dinner.
One of his longtime patients was a man named Daniel Carr, whom I met at a clubhouse run by a community mental health center where people with serious mental illness can spend their time. The cozy house has battered couches and an armchair in the living room. A Christmas tree sparkles near the front window.
Carr, who has paranoid schizophrenia, was Hardwig’s patient for 25 years. He says he misses Hardwig.
“He knew exactly about how to treat me,” Carr said.
“I had some trouble with my medicine changing a little one way or the other, but he usually knew what was best. I’d tell him what I was experiencing and he knew what to do.”
Hardwig wouldn’t talk about specific patients, including Carr. Carr said his psychiatric care has been transferred back to his primary care doctor, and that it’s been going OK so far.
But Wendy Dougherty, the nurse who worked with Hardwig, said some of the primary care doctors have been less than enthusiastic about taking on the psychiatrist role.
“Jeff took care of the hard ones,” she said. “The schizophrenics, the bipolars … these docs kind of put up their hands and say, ‘Oh, my God, I don’t know what meds to give them.’”
The psychiatric nurse practitioner Hardwig worked with is still at the clinic and handles some of the harder cases, but she’s planning to retire soon, too.
A shortage in nearly every county
International Falls is hardly alone in not having a psychiatrist — particularly in remote areas.
More than 90 percent of psychiatrists only work in urban areas, even though more than 20 percent of Americans live in rural areas. In Minnesota, nearly every county — aside from the Twin Cities metro and Rochester area — is considered to have a shortage of mental-health professionals as determined by federal guidelines.
Hardwig said the hardest part of working in such a remote area was that he didn’t have a continuum of care to work with.
“There just isn’t that inpatient bed when you need it. We have only one crisis bed and we haven’t had that the whole time I’ve lived here. We don’t have residential treatment,” he said.
And International Falls is luckier than some places because there’s a community mental health clinic in town. (Hardwig partnered with it until his retirement, and the nurse practitioner still does.) The clinic is looking to expand in the near future. There’s also a mobile crisis team in town that can help with emergencies.
Still, recruiting mental-health care providers, even those who aren’t psychiatrists, to remote areas is challenging. Paul Mackie, a professor at Minnesota State University, Mankato, has studied the problem. And he said the only way to recruit and retain people in remote areas is to grow them from scratch. That is how Hardwig, who grew up in International Falls, ended up there.
Mackie said there are already physical medicine programs that train people for practice in rural areas. And he said now we need to do the same for mental health, too.
“We need to be a lot more thoughtful about who we’re recruiting and how we’re recruiting them,” he said. “We can have that conversation around what does a rural practitioner look like and look for that person and encourage them.”
But that takes time. People who graduated from high school this year won’t be done with medical school until 2027. And then they still have to complete their residency and any other specialty training.
So in the meantime, International Falls — and communities like it — are doing what they can. Hardwig’s old clinic has hired a child psychiatrist who sees her patients remotely over Skype-like technology.
Finding people to work on-site is proving much trickier, though. It was two years ago that Hardwig told the clinic he was planning to retire. It’s been looking for a replacement since then. But nobody has applied for the job.