Brain Science and Updates From the Field

Conference highlights important topics

Wednesday, June 21, 2017
Earlier this month, the expertise of an impressive collection of distinguished mental health professionals was on display for the benefit of their peers.

On June 22, Erie hosted the fourth annual Challenges & Innovations in Rural Psychiatry Conference at the Bayfront Convention Center. The conference is a way for professionals, students, consumers and family members to discuss important topics relating to mental health.

The keynote on the topic of the opioid epidemic was given by Dr. Donald S. Burke, Dean of the University of Pittsburgh Graduate school of Public Health. Burke was also part a roundtable panel discussion on the topic of the opioid epidemic that included County Executive Kathy Dahlkemper and drug and alcohol professionals from Stairways Behavioral Health.

In addition to the opioid epidemic, additional issues were discussed during the conference, including a case study examining the importance of art in recovery given by BLOOM Collaborative Director Lee Steadman, right, and Rochelle Youkers, director of Assertive Community Treatment at Stairways; best practices in Medication-Assisted Treatment (MAT); and a look at how peers have been effective in helping treat substance use.

Speakers who presented at the conference possessed diverse experience from clinical, academic and government backgrounds.

Stairways medical director Dr. Penny Chapman has spearheaded the annual event that made its debut in Erie. Dr. Chapman is also the Director of Rural Psychiatry Fellowship for the University of Pittsburgh’s Western Psychiatric Institute and Clinic, the main sponsor of the conference.

The conference was free of charge for individuals who use services and their families, as well as medical residents and students.

Occupational Therapy celebrates 100 years

Thursday, April 27, 2017

Each April is Occupational Therapy Month, but in 2017, the commemoration carries with it a little more significance.

That’s because this year marks the 100th anniversary since occupational therapy was established by the National Society for the Promotion of Occupational Therapy, now called the American Occupational Therapy Association.

Occupational therapists provide treatment to individuals through the therapeutic use of everyday activities, or occupations (AOTA).

It’s a charge at the forefront of Stairways’ Psychiatric Rehabilitation program’s mission, according to Christine Linkie, the program director.

“Both Psych Rehab and occupational therapy focus on skill-building and aim to develop fulfilling life goals,” Linkie said. “The idea behind OT is that people need meaningful activity. Every human being needs it and if you don’t have it, you start to falter.”

The modern version of occupational therapy traces its roots back to World War I, when soldiers suffering from physical and emotional trauma worked on handicrafts and vocational skills as a means of distraction as well as a way to increase physical activity and improve morale.

Since then, OT has developed into a science-driven, evidence-based profession whose goal is to help clients live meaningful lives. And a century later, the therapy is still predicated on the blending of physical and mental health.

“OT is a very holistic profession in that it’s not just physical but emotional and mental as well,” Linkie said, noting that low occupational activity is directly correlated with decreases quality of life.

“The holistic approach lends itself very well to the mental health population because it focuses on quality of life, which is a particularly important part especially since we know people with serious mental illness live, on average, shorter lives than average,” she said.

Stairways’ Psych Rehab makes this integrated approach a priority in its programming.

The clinical department holds group classes at BLOOM Collaborative year-round aimed at developing skills, increasing engagement and improving the quality of life for clients. These classes as well as all of Psych Rehab’s efforts help people develop skills for living, education, vocation and socialization in the home and in the community.

Linkie, who has made presentations on the topic of Psych Rehab and its relationship to occupational therapy at multiple events including this year’s AOTA national conference, said Psych Rehab’s focus on helping clients perform activities that allow them to reach their potential draws from the efficacy of occupation therapy.

“It’s really about providing the meaning that we all strive to achieve,” she said. “That is the piece that is most important.” 

March marks self-harm awareness month

Thursday, March 16, 2017

For millions of Americans, inflicting pain upon themselves seems like the only way to alleviate tension and gain some semblance of control over their lives.

Unfortunately, many of these people who engage in self-harm are often left unnoticed, misunderstood or neglected. The silence surrounding such self-harm makes increasing our understanding all the more vital to addressing the problem.

It’s what makes March’s designation of Self-Harm Awareness Month all the more important.

What is self-harm?

Each year, two million cases of self-harm are reported among Americans, who often carry out the act by cutting and burning their skin and pulling out hair. But despite its destructive nature, self-harm is not necessarily suicidal behavior. On the contrary, the act of hurting oneself serves as a way to feel in control when they otherwise feel as though they possess no control in their lives. Although many people carry out the act at instant relief, self-harm is fueled by emotional distress that could lead to suicide attempts in the future. At a time of great emotional pain, the physical pain brought on by self-harm is often easier to deal with and might feel less acute by comparison.

Self-harm occurs nearly evenly among males and females. According to the Healthy Place, one-in-five females and one-in-seven males engage in the behavior. The practice often starts during adolescence, when a reported 90 percent of self-harm occurs, but can start and continue to occur later in life as well. Many young people feel encouraged to use self-harm as a coping method and learn techniques to do so from websites and peers.

Indeed, media portrayal of self-harm has had an effect on perceptions of the behavior. Not only has it influenced younger people to engage in it, but it has also led to generalizations that the act is commonplace among some social cultures and the assumption that those who self-injure are simply seeking attention.

While self-harm itself is not a mental illness, it is often an indication of underlying depression and personality disorders. Some signs can help shine a light on whether or not a loved one is engaging in self-harming behaviors. If you have noticed them often wearing bandages and bruises or if they insist on wearing long sleeves and pants even in hot weather, perhaps they are trying to hide scars and injuries. In addition, be aware of potential self-endangering behaviors and any sharp objects they might be concealing at unusual times.

But most of all, be sure to ask questions and listen. It is important to refrain from judgement and to remember that there is an underlying issue behind the self-harm that is causing the behavior.

Seek help by calling the national self-injury hotline, 1-800-DONTCUT, or contacting Stairways Behavioral Health at 814-453-5806.


Overdose drug gains attention, saves lives

Monday, January 30, 2017
For many people in the throes of an opioid-induced overdose, a chance at survival can come in the form of an injection or a spray to the nose.

Such is the philosophy of naloxone, an anti-overdose drug that has become widely used at hospitals, schools and treatment centers, including Stairways Behavioral Health.

“Having Narcan available at these locations is an important safety precaution in the event of an overdose”, said Erin Mrenek, Director of Stairways Dual Outpatient Clinic.

Naloxone, known by its trade name Narcan or referred to as a “save shot,” is a medication used the block the effects of an overdose that has enjoyed increased prominence as the nationwide opioid epidemic continues to escalate.

The emergency drug works by binding to the same receptors in the brain that are occupied by the chemical the individual has consumed, essentially overtaking the opioids and reversing its effects. For someone who has overdosed, this means the ability to begin breathing normally after a stoppage of respiration. Because of its mechanisms, naloxone causes those who have overdosed to go into withdrawal, prompting them to feel the classic symptoms associated with the condition.

“Narcan is a very effective and fast-acting medication for most types of opioids,” said Mrenak, who added that the drug’s effectiveness is at its peak during the time that follows an overdose and precedes medical attention.

“Our policy at Stairways is always to call 911 in addition to administering Narcan, as it is not a substitute for medical attention. It is a way to improve functioning until emergency medical personnel arrive,” she said

Mrenak noted that people should follow up with medical attention after receiving naloxone, as it is possible to have overdose symptoms resume once the medication wears off.

Deaths from opioids, a drug class that includes heroin and prescription pain medications like oxycodone, morphine and fentanyl, have climbed dramatically in recent years.

The epidemic can trace its roots to more than a decade ago, when pain medicines became more readily available, as opioid overdose deaths have increased from just over 9,000 in 2000 to more than 33,000 in 2015, according to the most recent statistics by the Center for Disease Control. The trend’s dramatic rise is reflected at a local level, as heroin and fentanyl were responsible for the vast majority of nearly 100 drug-related deaths – a number that nearly doubled 2015’s total — in Erie County in 2016, according to an Erie Times-News report.

“At our D and A treatment programs, we have seen an increase in individuals with opioids as their primary drug of choice,” Mrenak said. “There has also been an increase in the use of heroin, specifically with IV use.”

Mrenak added that it has become more difficult to locate inpatient beds for clients in need of services, and Stairways has noticed an increase in individuals using medication-assisted treatment, such as methadone, suboxone or Vivitrol, to treat addictions.

As localities across the country take steps to respond to the opioid epidemic, many have turned to naloxone.

In 2014, Pennsylvania enacted legislation designed to make the drug more readily available when Gov. Tom Wolf signed a standing order making naloxone available to laypeople at pharmacies. In Erie County, overdose victims have benefitted from a new “warm handoff” program that ensures people who have overdosed are considered into substance abuse treatment. The warm handoff, a program run by Safe Harbor Behavioral Health and Gaudenzia covering local hospitals, was an initiative the county’s Heroin Overdose Community Awareness Task Force pursued.

Despite the measures, at least locally, overdoses continue and naloxone is being administered at an alarming rate.

According to the Times-News, naloxone usage among EmergyCare paramedics more than doubled in 2016 — from 39 in 2015 to more than 80 uses last year. First responders also have reported having to use more naloxone as opioid drugs continue to grow in strength. Sadly, many of those who have been saved using naloxone have been revived by the antidote before, underscoring the cruel and unrelenting nature of addiction.

“Opioid addiction is very challenging to overcome because the body becomes physically dependent on these substances and it creates significant changes in the functioning of the brain,” Mrenak said. “Individuals working toward recovery from opioid addiction often struggle with impulse control, recognizing and managing emotions, feelings of depression and managing pain.”

What is exposure therapy?

Thursday, December 22, 2016

While fear and anxiety can be useful tools that warn us when danger is imminent, they can also be debilitating forces.

And when they prevent us from carrying out necessary functions or have an adverse effect on our happiness, one’s natural instinct might be to avoid the experience at all costs.

Interestingly, a therapy based in doing the opposite has proven to be among the most effective treatments at confronting—and conquering—fears, anxieties and phobias.

For people who struggle with anxiety disorders and phobias, exposure therapy brings them face to face with their fears, helping them attain a sense of ease in the process.

The practice involves subjecting individuals to increasing amounts of the feared object or experience without any danger in order to help them overcome their anxiety. It is effective in the treatment of anxiety disorders such as Post-Traumatic Stress and Obsessive Compulsive disorders.

Donnelle Super has been using exposure therapy for about a decade as a therapist at Stairways Behavioral Health’s Erie Outpatient Clinic. While working with clients who have various phobias and fears, Super starts by identifying a fear, recognizing the irrational thought that causes it and confronting it.

“If you have a fear of spiders, we might start by showing you pictures of spiders as a way to challenge the irrational thoughts that are causing that fear,” she said.

Most exposure therapists use a graded approach in which they begin by targeting mildly feared stimuli and gradually move on to challenge greater ones. Super said she often tasks clients with assignments in which they confront their fears outside the office.

Using the example of a client who is fearful of going to the grocery store, Super described the steps they may take during exposure therapy.

“You might want to start by taking them to the parking lot just to see and visualize what the experience might be,” she said. “The next time you might go inside the store and buy one item and use the quick check-out line, and then the next time, you’ll buy a few more items.”

Super also stressed the importance of determining what triggers might elicit strong responses and to not put individuals in those positions where they would feel imminent danger.

“You would never want to take them past an anxiety point,” she said. “That’s why it is so important to establish a trigger hierarchy that you would know at what point the client feels some anxiety but they wouldn’t feel at risk of danger.”

However, there should always be some level of discomfort, she said.

“If there is no anxiety, you’re not going to perform much. At some point, there has to be fear, because if there isn’t, we aren’t working on anything.”

While the main mechanisms of exposure therapy have remained much the same since the treatment became widely recognized in the 1950s, the method has received renewed attention thanks to the introduction of virtual reality.

In particular, for those who have experienced trauma, virtual reality has proven to be an effective tool. Virtual Reality can transport users to a time and place where they can experience their fears in a seemingly authentic but controlled environment.

Super noted this is a trend to keep an eye on as VR comes in the mainstream.

But whether it’s performed conventionally or using state-of-the-art technology, the research and results are clear when it comes to exposure therapy: for a number of problems, the best way out is often through.

Stairways engages in suicide prevention efforts

Wednesday, October 26, 2016

In observance of National Suicide Prevention Month, Stairways Behavioral Health participated in two local events in September that helped raise awareness and promote discussion on the topic of suicide.

Stairways served as a sponsor for the Erie County Suicide Task Force’s third annual conference Sept. 20 and the Out of the Darkness Walk at Presque Isle State Park on Sept. 25.

The Suicide Task Force, a consortium of professionals, survivors and families affected by suicide in the community, held its conference at the Bayfront Convention Center, where an audience of more than 300 was in attendance. Stairways Blended Case Managers Jana Zybowski and Kelly Roberts, both of whom are members of the community task force, attended the conference and represented Stairways.

The conference was broken into morning and afternoon workshops and included presentations and displays by expert speakers. Both the morning and afternoon sessions consisted of two-part lectures entitled “Social Media and Suicide Risks” and “The Ethics of Self-Harm.” The morning workshop also included presentations that examined the risks among those in the LGBTQI community and discussed correlations between criminal think and suicidal behaviors. Following the lunch break, attendees then heard presentations on self-injury and suicidal behaviors.

Participants of the conference also had the opportunity to receive education credit hours.

The task force began in 2010 when the Erie County Department of Health conducted a needs assessment that revealed Erie and its surrounding counties needed to build a comprehensive approach to suicide prevention, policy, awareness and education. The team now consists of more than 30 members, including professionals in the mental health field.

Less than a week later, Stairways was represented at the American Foundation for Suicide Prevention’s (AFSP) Out of the Darkness Walk.

The walk surpassed its $10,000 fundraising goal thanks more than 250 people completing the 5K course. Walk participants included mental health professionals, survivors, affected family members and other members of the community.

Those who attended the walk also had a chance to speak with area service providers on hand and gather information for those in need. Stairways and other organizations were on site inside the Rotary Pavilion.

Both the walk and conference addressed an issue that is reaching crisis-level proportions.

In Erie as well as statewide, the prevalence of suicide is staggering. According to AFSP, suicide is the 11th-leading cause of death in Pennsylvania. Among children ages 10-14, it is the leading cause of death and ranks as the second-leading cause for persons between the ages of 15 and 34.

In Pennsylvania, five people end their lives each day.

Clients at Stairways program find rhythm in class

Monday, July 25, 2016

Every other Sunday, clients at Stairways Behavioral Health’s Residential Treatment Facility for Adults are encouraged to march to the beat of their own drum.

In fact, finding one’s inner rhythm is the idea therapist Megan Paterson had in mind when she created RTFA’s Therapeutic Drumming class.

Even if it’s only for between an hour to 90 minutes every two weeks, the program provides a respite to the traditional forms of psychiatric care—something clients and clinicians welcome as beneficial.

“The definition of insanity is doing the same thing over again and expecting different results, so with this we are doing something different,” Paterson said of bringing drumming to RTFA. “A lot of people here have been treated for mental illness for so long and have had many of the same treatments for a long time.

“This is something different that has had a positive effect on them.”

Whether clients are able to find a tempo that suits them best or if they’re just talking out some frustration when they slap the drum, the class yields instant results. Paterson said clients report feeling less stressed at the end of a session and are less likely to negatively respond to in damaging ways.

One client, she said, rated her happiness at a zero prior to the session. But after taking part in the class, her assessment had increased to seven.

“The response from clients has been amazing.” Paterson said.

Lynn Johnson (above), who works as a behavior specialist for the Erie School District and is locally renowned for his work as a drum circle facilitator, leads the biweekly Sunday group sessions.

After hauling more than a dozen of his traditional African hand drums into the RTFA’s East 29th Street’s building, Johnson’s main focus in leading the group is to help clients to increase awareness by finding a natural and relaxing tempo.

“Lynn emphasizes to find your own rhythm and begins by telling you to go back to your most basic beat, which is the heartbeat you feel from your mother,” Paterson said. “The No. 1 thing is to listen and find your own beat to be aware of. If you can’t do that you will struggle to get into a rhythm.”

Following each session, RTFA clients and staff convene to evaluate and discuss how the session affected each participant.

Sharing the experience creates sense of unity among those who take part, Paterson said.

“The whole idea is to make a connection,” Paterson said. “It’s making a connection through the drums that helps to form a sense of belonging and restore hope.”

Though it is currently in a temporary pilot stage, Paterson is hopeful to use the outcomes collected from the drumming program to help provide evidence of the program’s effectiveness to gain further sources of funds.

Could you be a Mental Health First Responder?

Tuesday, May 17, 2016

Ethan Call, a college student, was worried when he noticed that his friend—who normally attended church every Sunday—didn’t show up to teach Sunday School that day. He knew she had been struggling with depression and anxiety. So, he texted her and asked if she was okay. She wasn’t.

Gwen Cubit, a mother from Texas, was worried when her son texted her from Maryland asking her to call him—that it was urgent. She picked up the phone and found him in the throes of an emotional crisis—he wasn’t sure if he wanted to kill himself or someone else.

Think about the last time you worried about a friend, a family member or a neighbor. Many of us can sense when something isn’t quite right, but the fear of being intrusive, overstepping our bounds or saying the wrong thing can prevent us from acting. So, far too often, we do nothing to help.

Luckily, Ethan and Gwen knew exactly what to do. They had both recently been trained in Mental Health First Aid where they learned how to recognize when someone might be experiencing a mental health or substance use problem, and mastered an action plan to help.

Noticing the red flag, Ethan left church and drove to his friend’s house. Immediately, the Mental Health First Aid action plan kicked in. He sat with her and listened to her talk about her feelings—without judgment—over milk and cookies. He gave her information about where and how she could access professional help. He encouraged her to turn to her friends, family and faith community for support. Now, Ethan’s friend is working with a counselor and doing much better.  She got help.

Gwen immediately recalled an important strategy from her Mental Health First Aid training: stay calm. She kept her son talking, asked questions about what he was doing, where he was and where his family was. She took his risk of suicide seriously and encouraged him to go to the hospital with his father-in-law, who lived in the area. Her son agreed, and she stayed on the phone with him until she heard him check in with the administrative nurse at the ER. Her son was diagnosed with depression, and is doing much better today. He got help.

Each of these stories begins the same way: a person trained in Mental Health First Aid notices that something isn’t right. And each story ends with a person in distress getting the help they need.

But when people don’t know what they’re supposed to do when confronted with a difficult situation—when they don’t have an action plan for stepping in when someone is experiencing a mental health or substance use problem—the stories can end much differently.

Mental Health First Aid takes the fear and hesitation out of offering support to someone in an emotional crisis. It provides critical tools for helping people that can mean the difference between life and death.

Today, more than 550,000 Americans are trained in Mental Health First Aid. That’s 550,000 people who would know when and how to react to a person in crisis. And Stairways is proud to be a partner in that progress. But in a nation of more than 318 million, 550,000 is not enough.

All month, we have been celebrating Mental Health Month. We recognize the incredible strides we’ve made in promoting understanding, increasing opportunities and improving the lives of people living with mental health and substance use problems. Mental Health Month is an opportunity to reflect on how far we’ve come.

But Mental Health Month is also an opportunity to acknowledge how much more work there is to do.

In January, the National Council for Behavioral Health launched the Be 1 in a Million campaign—a national effort to train one million people in Mental Health First Aid. Since the launch of the campaign, more than 50,000 new first aiders have been trained.

This Mental Health Month, we encourage everyone to become part of the Be 1 in a Million movement. Get trained in Mental Health First Aid. Spread the word. Offer support to someone in need. Because—as Ethan, Gwen and so many like them know—recognizing how and when to step in and offer help can change, even save, a life.

Follow this link to find a Mental Health First Aid course near you.


Do you know what mental illness feels like?

Wednesday, April 27, 2016

Do You Know What Mental Illness Feels Like?

We often hear the clinical terms used by doctors and other professionals to identify the symptoms of mental illnesses…but if someone hasn’t gone through it, would they know how to recognize it?

So often, clinical terms don’t do justice to what life with a mental illness feels like. We know that two people with the same diagnosis can experience the same symptom and describe it in very different ways. Understanding the signs of a mental illness and identifying how it can feel can be confusing—and sometimes can contribute to ongoing silence or hesitation to get help.

The 4 Stages of Mental Health Conditions

It’s important for people to talk about how it feels to live with a mental illness. We know that mental illnesses are common and treatable, and help is available. But not everyone knows what to look for when they are going through those early stages, and many simply experience symptoms differently. We all need to speak up early — 
Before Stage 4 (see the 4 stages of Mental Health Conditions graphic, left) — and in real, relatable terms so that people do not feel isolated and alone.

May is Mental Health Month

Next month is Mental Health Month. Stairways Behavioral Health is raising awareness of the importance of speaking up about mental health by joining Mental Health America in asking individuals to share what life with a mental illness feels like by tagging social media posts with #mentalillnessfeelslike. Posting with thishashtag is a way to speak up, to share your point of view with people who may be struggling to explain what they are going through—and to help others figure out if they too are showing signs of a mental illness.

Life with a Mental Illness is meant to help remove the shame and stigma of speaking out, so that more people can be comfortable coming out of the shadows and seeking the help they need. Whether you are in Stage 1 and just learning about those early symptoms, or are dealing with what it means to be in Stage 4, sharing how it feels can be part of your recovery.

Stairways wants everyone to know that mental illnesses are real, that recovery is always the goal, and that the best prospects for recovery come when we act Before Stage 4 (B4Stage4).

Addressing mental illnesses B4Stage4 means more than burying feelings and refusing to talk about them, and waiting for symptoms to clear up on their own. B4Stage4 means more than wishing that mental health problems aren’t real, and hoping that they will never get worse. B4Stage4 means more than thinking that someone on the edge of a crisis will always pull himself or herself back without our help, and praying that someone else will intervene before a crisis occurs.

B4Stage4 means, in part, talking about what mental illnesses feel like, and then acting on that information. It means giving voice to feelings and fears, and to hopes and dreams. It means empowering people as agents of their own recovery. And it means changing the trajectories of our own lives for the better, and helping those we love change theirs. So let’s talk about what life with a mental illness feels like, to voice what we are feeling, and so others can know they are not alone.

BLOOM hosts reintegration program graduation

Thursday, February 25, 2016
A group of individuals commemorated their next step of recovery and sobriety by graduating from the Community Reintegration of Offenders with Mental Illness and Substance Abuse (CROMISA) program during a ceremony at BLOOM Collaborative in February.

CROMISA is a reintegration program for people with mental illness and substance abuse problems who are incarcerated in the state system with at least one year of their sentence remaining.

Program graduates received recognition for their dedication in working with a team of professionals who provided necessary supports while keeping offenders on track.

One graduate praised his team by saying, “I was hesitant to do this at first but the team has become my family.”

Another said he learned a lot about himself from his work with his support team.

“I had isolated myself pretty well,” he said. “But through the team, I learned I didn’t have to think I was alone.”

The program brings together resources from mental health and substance abuse providers, such as the Erie County Office of Drug and Alcohol Abuse, Erie County Office of Mental Health/Mental Retardation, Gaudenzia Crossroads, Greater Erie Community Action Committee and the Probation and Parole Board of Pennsylvania.

As part of the graduation ceremony, professionals from these community partners joined staff from Stairways as well as the graduates themselves to share a meal and celebrate the occasion.

Graduates were quick to point out the commitment it takes and the satisfaction that results from having accomplished the program.

“Overall, CROMISA has been a rewarding experience,” one graduate said. “But you have to be dedicated to it. You can’t just sit back and expect benefits to be handed to you.”

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