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.

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.

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.”

New group activity adds color to therapy

Monday, January 25, 2016

Depending on one’s frame of mind, a blank canvas can represent unlimited potential or feel incredibly intimidating.

Properly framing that mindset is the function of Counseling in Colors, an activity that integrates painting with group therapy at Stairways Behavioral Health’s Residential Treatment Facility for Adults.

“I had been to a Cocktails and Colors event and thought about how I could put a CBT twist on it,” Jennifer LaRoche, a therapist at RTFA, said.

CBT — Cognitive Behavioral Therapy — is a form of psychotherapy predicated on the idea that thoughts, or cognitions, have a direct effect on feelings and behaviors and that if negative and distorted thoughts can be changed, so too can the effects that accompany them.

LaRoche consulted Josh Staszewski, rehabilitation coordinator at RTFA and amateur artist who studied art in college. He determined that the process of painting could help the clients challenge negative thoughts that occur automatically.

“It was a method to apply CBT to real life situations and address thought distortions in a way that we can use painting to practice proper cognitive techniques,” LaRoche said.

LaRoche and Staszewski came up with a format in which they could elicit distorted thoughts by setting up paint stations for clients before they arrive for group therapy. When 15 clients enter the room, so too do their feelings of insecurity about sitting at an easel and applying paint to a canvas.

“Everything is set up when they walk in and you instantly can see the fear in their eyes and we ask ‘how do you feel?’” Staszewski said.

Clients typically respond with thoughts of doubt and fear about their ability to complete a painting. These voiced thoughts are written on the board.

Staszewski then shows a scene as an example and prompts the clients on what object to paint. The group painted a pumpkin in November and a snowman for December.

The caveat? Each client is given free rein on how their work is depicted.

“I’ll set some guidelines as what to paint but that is the only criteria,” Staszewski said. “They ask questions and I’ll give guidance but I won’t touch the painting because that’s theirs.”

Both sessions have lasted between two to three hours, giving everyone the chance to put the desired touch and detail on their works.

And although clients typically have minimal or no experience, whatever struggles they experience behind the easels become reason to connect and share ideas with the other new artists, who include a handful of staff members with a brush in hand.

“Staff are much in the same boat as the clients who haven’t painted before and it makes them appear vulnerable and allows us to connect and be supportive of each other,” she said. “That opens up connections because we talk about how everyone has distortions.”

After everyone has finished painting, the group revisits the automatic thoughts that were posted to the board before the class and identifies how they were distorted and misleading.

At the end of the session, clients have not only completed an exercise in how to adjust their thought processes, but also have a visual representation of the work they have completed, which they display or give as gifts. In addition, they will also walk away having learned a valuable coping skill to use in moments of need, according to Staszewski.

“It opens up other discussions about ‘this is how you can step away from stress for a short period and put your effort into something else,” he said. “When they’re getting stressed, it gives them an idea that ‘hey, I can get a cheap camera and start taking photographs or use a coloring book to relax.'”

LaRoche and Staszewski plan to hold the next Counseling in Colors session sometime in February, though the lessons the session promotes can be applied to any canvas in life.

“We use this in a way to let them see how they can do this with their thoughts all of the time,” LaRoche said.


May is Mental Health Month: Addressing Mental Health B4Stage4

Friday, May 29, 2015

When we think about cancer, heart disease, or diabetes, we don’t wait years to treat them.

When people are in the first stages of those diseases, and are beginning to show signs of symptoms like a persistent cough, high blood pressure, or high blood sugar, we try immediately to treat these symptoms.

We don’t ignore them. In fact, we develop a plan of action to reverse and sometimes stop the progression of the disease.

So why aren’t we doing the same for individuals who are dealing with potentially serious mental illness?

May marks Mental Health Awareness month, a time when millions of Americans across the country become mindful of the prevalence of mental illness and its many means of treatment. This May, the theme has been B4Stage4, focusing on how people can address their mental health in its beginning stages, rather than waiting until symptoms are more severe and recovery is made a longer process.

When you or someone close to you starts to experience the early warning signs of mental illness, knowing what the risk factors and symptoms are will help to catch them early. Often times, family and friends are the first to step in to support a person through these early stages. Experiencing symptoms such as loss of sleep, feeling tired for no reason, feeling low, feeling anxious, or hearing voices shouldn’t be ignored or brushed aside in the hopes that they go away.

Like other diseases, we need to address these symptoms early, identify the underlying disease, and plan an appropriate course of action on a path towards overall health. Mental health conditions should be addressed long before they reach the most critical points in the disease process.

Many people do not seek treatment in the early stages of mental illnesses because they don’t recognize the symptoms. Up to 84% of the time between the first signs of mental illness and first treatment is spent not recognizing the symptoms.

Stairways Behavioral Health is raising awareness of the important role mental health plays in our lives and encouraging members of the community to learn more about their own mental health and to take action immediately if they are experiencing symptoms of a mental illness.

Mental illnesses are not only common, they are treatable. There is a wide variety of treatment options for mental illnesses ranging from talk therapy to medication to peer support, and it may take some time for a person to find the right treatment or combination of treatments that works best for them. But when they do, the results can be truly amazing and life changing.

Stairways wants to help people learn what they can do both to protect their mental health and know the signs of mental illness.

It’s up to all of us to know the signs and take action so that mental illnesses can be caught early and treated, and we can live up to our full potential. We know that intervening effectively during early stages of mental illness can save lives and change the trajectories of people living with mental illnesses.

If you or someone you know is struggling, talk about it! Call us at 453-5806.

Navigating College Emotions

Wednesday, April 29, 2015

The Prevalence of College Student Mental Health Concerns and Where to Find Help.

College years are filled with a constant ebb and flow of emotions, from hopefulness and exhilaration to frustration and chaos. As finals week approaches, these emotions become even more heightened. Thankfully, professional help stands at the ready. Awareness and recognition is the key for family, roommates and friends to encourage students to seek help.

The Research

Since 1920, the American College Health Association (ACHA) has linked the nation’s college health professionals, serving to advance the health and wellness of college students through advocacy, education and research.

The most recent (Spring 2014) ACHA-National College Health Assessment (NCHA)* surveyed 79,266 students from 140 college, universities and post-secondary institutions across the nation, revealing the following statistics:

The Top Five Health-Related Factors Which Affected Students’ Academic Performance, e.g. lowered grade on exam or project; course dropped or incomplete; significant disruption in thesis or practicum work:

Percentage of students reporting disruptive health factor:

30.3%   Stress
21.8%   Anxiety
21.0%   Sleep difficulties
15.1%   Cold/flu/sore throat
13.5%   Depression

While a full 91.2% of surveyed students described their over-all health as good, very good, or excellent, they also reported the following felt experiences in the previous year:

86.4%   Felt overwhelmed by all you had to do
82.1%   Felt exhausted (not from physical activity)
62.0%   Felt very sad
59.2%   Felt very lonely
54.0%   Felt overwhelming anxiety
46.4%   Felt things were hopeless
37.4%   Felt overwhelming anger
32.6%   Felt so depressed it was difficult to function

Where to Find Help

For students attending 4-year colleges and universities here in Northwestern Pennsylvania, help is as close as a phone call or a short walk across campus. Families, friends and roommates can use the following list to encourage students to the seek professional help available on campus:

Crawford County Crisis Hotline 814-724-2732
Erie County Crisis Services 814-456-2014
National Suicide Prevention Lifeline 1-800-273-TALK

Allegheny College Counseling Center
Phone number: 814-332-4368
Location: Reis Hall, 3rd Floor, room 304

Edinboro University Counseling and Psychological Services (CAPS)
Phone number: 814-732-2252
Location: Ghering Health and Wellness Center, McNerney Hall, 1st Floor

Gannon University Counseling Services
Phone number: 814-871-7622
Location: below Harborview House Apartments, 210 W. Sixth St.

Mercyhurst College Counseling Center
Erie Campus - Phone number: 814-824-3650
Location: Cohen Health Center, 4118 Briggs Avenue
North East Campus - Phone number 814-725-6136
Location: Miller Hall 7B

PSU Behrend Personal Counseling Office
Phone number: 814-898-6504
Location: Reed Union Building, First Floor, Room 1

* See the full data for the ACHA-National College Health Assessment survey here:

National Institute of Mental Health Releases Strategic Plan

Tuesday, March 31, 2015

The impact of mental health on the American society is often expressed through statistics which are sobering – if not staggering:

  • One in four adults will experience a mental illness in any given year
  • One in five children will experience a seriously debilitating mental disorder at some point in their life
  • Nearly two-thirds of state and federal inmates meet criteria for mental health problems in any given year
  • Suicide is the No. 4 cause of death for adults ages 18-25.
  • More people pay for care related to mental disorders than any other medical condition except for asthma – more than heart conditions and cancer combined.
  • Costs associated with serious mental illness in America exceed $300 billion per year, between direct (treatment and services) and indirect (public expenditure, lost wages and disability support).

At the same time, recent advancements in brain research and understanding about mental illness are just as dramatic, leading to more nuanced treatments and overwhelmingly improved outcomes.

At the intersection of mental health research and statistics lives the National Institute of Mental Health (NIMH), one of the 27 institutes or centers of the National Institute of Health, the nation’s medical research agency.

Charged with the mission of transforming the American landscape of mental health treatment and research, the NIMH recently issued a new five-year strategic plan for research designed to help balance urgent mental health care concerns with long-term research investments.

“A strategic plan can identify the most important problems and identify areas of traction,” said NIMH Director Thomas R. Insel, M.D., in the Institute’s March 26 release to the public. “This update of our strategic plan is a commitment to take a fresh look at our horizons so that we can refine priorities and energize our path of discovery.”

Incorporating input from more than 600 individuals, groups, organizations and national mental health councils, the new plan identifies four meta-level strategic objectives:

  1. Define the mechanisms of complex behaviors.
  2. Chart mental illness trajectories to determine when, where and how to intervene.
  3. Strive for prevention and cures.
  4. Strengthen the public health impact of NIMH-supported research.

These four objectives form a broad framework for the prioritization of the institute’s research focus – beginning with the fundamental science of the brain and behavior, and ending with public health impact.

Stay tuned as Stairways mental health professionals watch for new research trends which will help transform our friends, family and community members from statistical data points into stories of success and recovery.

The full NIMH Strategic Plan for Research is available online here:

Additional NIMH mental health statistics can be found here:

Treatment Court offers an alternative to offenders

Thursday, December 11, 2014

At a site where they might otherwise have been sentenced to incarceration, a group of individuals were recognized for making the most of a second chance Thursday, Dec. 18.

That’s when a handful ex-defendants stood before family, friends and support staff to mark their sobriety and advance to the next stage of recovery by graduating from Erie County Treatment Court.

“It’s usually an emotional time for therapists and families who have invested a great deal in seeing them graduate,” said Autumn McLellan, Stairways Behavioral Health Forensic clinical director.

Treatment court is a court-sponsored program that offers alternative treatment options for non-violent offenders struggling with mental health and substance abuse issues in lieu of jail time.

Treatment court is a model used in place of traditional prosecution for certain offenses in courts across the country and has gained popularity in recent years. In Erie, treatment court is broken down into drug, mental health and family dependency courts, all of which are presided over by Judge William Cunningham.

In March, Erie County President Judge Ernest J. DiSantis Jr. approved a veterans’ court—a program aimed at addressing veterans with addiction and mental health problems. DiSantis assigned Judge John Garhart to head up the court, which became the 18th such program in the state and will operate independently of the other three treatment court programs.

Since its inception in 2000, Erie County treatment court has graduated well over 200 individuals and witnessed on multiple occasions the benefits of using a more supportive and therapeutic approach in place of traditional punishments.

“The courts are more receptive to working with these offenders on issues that may arise because they recognize the mental health component,” said Wayne Sharrow, supervisor of Stairways Behavioral Health’s Drug and Alcohol Clinic.

Stairways has formed a close working partnership with the county in providing mental health services to those involved in treatment court. With the help of Stairways and other providers, treatment courts generally focus on treating the problems that cause the offenders to commit crimes.

Treatment court does have certain eligibility restrictions, Sharrow noted.

“If someone can’t be monitored that would be reason not to include them in treatment court,” he said. “The same is true for if there is a victim who is not welcome to the idea in the victim impact statement.”

Individuals who have applied for and are approved for treatment court attend weekly court hearings that track their adherence to the court’s conditions. Each defendant stands before Cunningham, who evaluates their progress and orders further discipline or treatment.

Staff from Stairways, the Erie County Probation and Parole Department, the district attorney’s office, Erie Office of Children and Youth, Erie County Care Management, Erie County Office of Drug and Alcohol, the Public Defender’s office, other service providers and Cunningham meet prior to the weekly hearings to review offenders’ progress and decide on the proper course of action. Should offenders violate the conditions of their treatment-court sentences, they can be sentenced to traditional penalties, such as jail time.

Offenders are monitored by probations and are subject to random drug testing. Additionally, they must comply with the conditions set forth by the court at the weekly hearings, including those relating to work and personal matters.

“If there is a bad living situation, we try to make arrangements to get them in better situations,” McLellan said. “And if the judge says you have to leave (your current living situation), then you have to leave.”

Treatment court’s pragmatic approach to justice has yielded positive results for courts utilizing the program, as national recidivism rates for graduates are regularly lower than offenders who don’t participate.

On Dec. 18, Erie County residents who completed the program’s three requisite phases and appeared before the court for graduation were the latest group to represent the efficiency of treatment court— a means of reintegration and rehabilitation McLellan endorses.

“I’d recommend (treatment court) to anyone because the need to be held accountable is so great and treatment court offers that,” she said. 

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