Ask the Expert Articles

AUTHORS & EDITORS

Tessa Garrow and Stephanie Woodcox,
Purdue Extension
Health & Human Sciences,
Purdue University

Andrew Airey,
Lindsey Daoust,
Jaime Escobedo,
Jimmy Hamrick,
Nate Payton,
Kira Siepman,
Julie Smith,
Jenn Whitney,
School of Nursing,
Purdue University

National conversations about health are no longer limited to a person’s physical well-being. Today, conversations recognize the importance of balancing physical and mental health needs. As we continue to talk about mental health more openly, it is helpful to understand what “mental health” means. Mental health includes a person’s thoughts, emotions, and how they experience the world around them. When a person’s mental health negatively affects their functioning, their symptoms can indicate the presence of a mental health disorder.

Estimates suggest that 21% of adults in the United States experience a mental health issue in a given year, meaning around 50 million people experience mental health struggles annually. However, only 41% of those adults receive professional mental health care annually.

This means fewer than half of all individuals living with a diagnosable mental health condition actually access treatment.

Many people do not seek mental health treatment because of negative attitudes and assumptions about mental health, also known as stigma. Stigma can particularly influence whether members of marginalized groups, young people, men, military professionals, and health professionals seek treatment. Stigma contributes to inaccurate perceptions that mental health struggles indicate mental weakness and permanent dysfunction. With proper resources and support, people can manage mental health issues and improve their symptoms. Increased understanding about mental health can help lessen fears and stigma. Reducing stigma makes people more likely to seek support and proper care.

In the same way a person can develop habits to maintain their physical health, they can also develop habits to maintain their mental health. Engaging in regular self-care, maintaining self-awareness about one’s emotions, and fostering supportive relationships all benefit someone’s mental health. These habits can help someone shift away from using harmful coping behaviors. Mental health disorders appear differently in people, but symptoms typically improve with professional treatment. Importantly, mental health treatments must be customized to the individual to be most effective.

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heather reister, MS

The Development of Living Skills (DLS) program, housed within the Family and Consumer Sciences division of Ohio State University Extension, has been collaborating with parents in Butler County for over 35 years. Via the program’s long standing relationship with the Ohio Department of Job & Family Services, the DLS program receives client referrals from child services workers in the county. In the case of many of these referrals, the children have been removed from their home due to allegations of abuse and neglect or are at high risk of being removed.

The DLS program has four pillars: parenting, health and wellness, home and safety, and resource management. With these four pillars as a guide, DLS educators develop lessons to strengthen protective factors in parents’ lives and build up life skills they had not previously been taught. These lessons are personalized to the client’s goals, developed in consultation with their child services worker. At the core of the lessons is the concept of Active Parenting coupled with hands-on learning. Some of the tools DLS educators use include Positive Parenting Program strategies, USDA MyPlate, CDC Parenting curriculum, and other cooperative Extension models.

Illinois Statewide Recovery Oriented System of Care (ROSC) Councils

Mark Sanders, LCSW, CADC

The concept of Recovery Oriented System of Care (ROSC) Councils is encapsulated in the African proverb, “If spiderwebs are united, they can carry a lion.” This unity mobilizes entire communities to reduce overdoses and increase recovery rates.”

Mark is the author of five books on behavioral health recovery. Recent writings include Slipping Through the Cracks: Intervention Strategies For Clients With Multiple Addictions Disorders and Relationship Detox: A Counselors Guide To Helping Clients Develop Healthy Relationships In Recovery. He was lead writer on a trauma informed gun violence prevention curriculum which is being implemented in several large cities in the United States. His groundbreaking monograph Recovery Management co-authored with historians William White and Earnest Kurtz helped shift substance use disorders treatment and recovery from the acute care model solely towards a Recovery Oriented System of Care. Mark has had two stories published in the New York Times bestselling book series, Chicken Soup for The Soul.

Mark has also had a 30-year career as a university educator having taught at The University of Chicago, Loyola University of Chicago and Illinois State University Schools of Social Work. He is co-founder of Serenity Academy Chicago, a program which sponsors recovery-oriented peer groups in local high schools.

Here, Mark provides insights on the Illinois statewide effort to build Recovery Oriented System of Care (ROSC) Councils.

What is the underlying concept behind the Illinois Statewide ROSC project?

Who is typically involved in a ROSC Council?

“Each council has a lead organization that is supported by IDHS/SUPR. Involving people with lived experiences and those in recovery is key in the ROSC Councils. The councils bring together diverse individuals from the community, including representatives from social services, faith-based organizations, hospitals, employers, families, librarians, law enforcement, and individuals from justice systems. Employers also play a crucial role, as studies show that hiring individuals in recovery reduces overdose rates and recidivism.

Including law enforcement has been effective in reducing incarceration, increasing treatment rates for people who have drug-related offenses, and reducing stigma. Including medical professionals who work in hospital emergency departments has also been key to getting people into treatment as soon as possible after an overdose or other substance use related medical emergency. Bringing in librarians has been a way to engage with people who are homeless, who often seek shelter in public libraries.”

What are unique aspects of ROSC Councils in small towns and rural areas?

“ROSC Councils in rural areas have been able to quickly set up supports that can be harder to arrange in metropolitan areas, such as engaging local transit authorities to provide individuals in recovery with transportation to treatment and employment.”

How could other states replicate the Illinois ROSC Council model?

“The project started small in the first year and a great deal of learning occurred. In the beginning, eight providers selected to develop one ROSC Council in the county they served. Each provider worked with a coach who helped them develop the council. The providers participated in a monthly collaborative call where they learned from each other how to mobilize a community to work together to promote recovery. Each year more providers were added – leading to the 52 ROSC Councils we have today.”

For more information on the Illinois Statewide ROSC Initiative, contact

Learn more at the upcoming Great Lakes ROTA-RC training:

Nutrition as Harm Reduction

SUSIE WEST, MPH

Health & Nutrition Extension Educator, Department of Family, Health and Wellbeing, University of Minnesota Extension

Nutrition can play a really key role in harm reduction for those actively using substances and for those who are in recovery. For those who are using substances, access to food in general, let alone nutritious options, may be limited or not a priority. Consistent food access could help counter the effects of the substances or behaviors associated with substance use that could negatively impact their health. For those in recovery, being appropriately nourished could help reduce the likelihood of recurrence of use and keep them on track for long term recovery. Nutrition in recovery stages is also essential for rebuilding brain, gut and immune health that may have been impacted by previous substance use.

Substances, like food, influence all of our bodily systems so I see nutrition as a really powerful tool in supporting the whole-person healing of folks with SUD. Food has the ability to reconnect us with others, with our sense of self, with our culture, and our community which has benefits beyond just the nutrient content of what we’re eating. Nutrition as harm reduction certainly entails focusing on nutrient-dense food but we can’t overlook the healing that people get from cooking a family recipe, enjoying a treat or the sense of self-efficacy that comes from making health-supporting decisions on their own.

I would encourage them to become familiar with food access in their communities, learn about the food shelves in your area, the farmers’ market, mobile markets or mobile food shelves, community gardens and other resources. If we want folks to eat nutritious food, they’ve got to have access to it! I would also encourage them to consider framing nutrition as flexible when talking to their clients. I think so many people get turned off from healthy eating because it can be too rigid or dichotomous–it really isn’t! Celebrate small victories with nutrition like adding fruit as a snack or picking a side salad instead of fries. Practitioners may also look into what nutrition education is available for their clients in their communities, like SNAP-Ed or EFNEP community classes! These can help provide practical tips for meal planning, nutrition and cooking skills, often at no cost.

Sources of Strength – Ohio’s Approach to Youth Mental Health

AMANDA CONN STARNER, MS, CHES, OCPS

Chief Program Officer, PreventionFIRST! 

At a time when mental health wellness for our youth remains front and center, we invite you to consider the Sources of Strength curriculum to aid your school or community’s efforts to improve the mental well-being of kids and reduce youth suicide rates.

Sources is an evidence-based, upstream prevention program that employs a strength-based approach to improving the health and wellbeing of individuals. Implemented in schools and communities, this program works to give students tools to develop their strength, resilience, and help-seeking behaviors. The primary mission of Sources is to move further upstream in the prevention cycle.

A few of the components of the elementary curriculum include Talking Circles, Active Learning Activities, Calming Activities and Guided Reflection. In addition, Celebrations of Growth are an integral part providing opportunities for students and staff to apply and celebrate a growth mindset, while Everyday Application and Extension activities allow students to practice their new skills and provide touch points for instructors and classroom teachers to integrate the concepts being learned in the classroom.

Some key steps in the secondary program include utilizing connected adult advisors and student peer leaders to enhance protective factors associated with reducing suicide through strategic messaging campaigns. Using a peer led model, students are empowered to leverage their social influence as agents of change in their school.

Other structure elements of the curriculum are:

· The program is available K-12 but does not have to be implemented at every grade level.

· The cost of training and implementation is currently covered by grant funding. There is no cost for implementation.

· The secondary program is listed as an approved program for the SAVE Students Act.

Three Steps to Restore Your Humanity

MIKE BLASER, MS, OCLPM

Mercyhealth System Trauma Preparedness Center

During the past 25 years, I saw my share of sad, bad, and traumatic. Don’t get me wrong it wasn’t all doom and gloom. There were plenty of silly, funny, and you just can’t make this stuff up incidents. Like the night an intoxicated person looked at me with a huge grin and said, “what’s wrong with your nose.” Those who know me would understand.  I hope as my retirement looms, I remember the latter more than the prior. Over these years I experienced depression and a loss of humanity.

The definition of a first responder has expanded beyond that of the traditional public safety role. We now understand this to include police officers, paramedics, EMT’s, firefighters, nurses, doctors, counselors, dispatchers, social workers, and probably many more that I may have overlooked. Every one of these jobs requires that you experience trauma and vicarious trauma, much as our clerical staff do every day as they type reports. 

Recently there has been an ongoing conversation around the country regarding mental health and the wellness of those serving as first responders. This is because suicide is taking the lives of first responders more often than being killed in the line of duty. For example, EMS providers are 1.39 times more likely to die by suicide than the public. [1] Studies have found that between 17% and 24% of public safety telecommunicators have symptoms of post-traumatic stress disorder (PTSD) and 24% have symptoms of depression[2]. Between 2007 and 2018, nurses were 18 percent more likely to die from suicide than the general population.[3]

This constant reaction to trauma causes a numbing of the senses. This numbness that all responders feel is often joked about, and eventually turns in to a loss of humanity.

When you see trauma, you know the sad, the bad, and the awful. You become jaded, numb, and are forced to stop feeling. If you felt it all, as you eventually will, it becomes overwhelming. Seeing these events are not what solely drives depression. It’s not what drives the feeling of darkness and bitterness. It’s the loss of humanity that causes so much grief.

It’s when you recognize that you lost your own humanity that depression really sets in. Your focus on the icky bad awful day took away the spirit you had when you applied for the job. Do you remember, during the interview for this job, you answered a question with the following phrase, “Because I want to help people.” What happened to that feeling? Now you’ve reached a point where you do the job everyday, but without emotion or feeling. You begin to feel robotic and one day you wake up and think your humanity has been stripped from you.  Without humanity, how can one serve humanely?

There are three tools I focus on when restoring humanity to my role and my job. By focusing on these three tools, you can restore your own humanity, as well as serve humanely; driving better connections and a happier work life.

1.) Serve with empathy, 2.) Perspective seeking; seek to understand, 3.) Treat the trauma

Empathy is a difficult tool for many first responders.  It is also the first skill we tend to lose. First responders are problem solvers and look for solutions. Sometimes a solution is not needed, your presence is needed more than a solution. Empathy is very different than sympathy. Sympathy is a lack of understanding and places judgement, whereas empathy is supportive. For many first responders it’s hard to be supportive and empathetic when you have your own challenges to face during your effort to solve problems for others.

Empathic conversations take effort and practice. I cannot tell you to “be empathetic.” I encourage you, when you hear a problem, reflect to that person how you understand the frustration, or how sad this must be.  Tell them you can’t know how they feel, and you are there to help. Ask them what they need, not what you can provide. Practice listening to what the root of the problem is, not focusing on what your solution will be. Empathic listening helps people feel understood and cared for, even for a minute. Empathy is the first step to restoring your humanity by showing humanity to others.

One of the things I heard in police work for years is, “they had it coming, or they chose this.” This is one of the greatest indicators of a loss of humanity and brings me to the second tool, perspective seeking. It is easy to assume an outcome when you have no idea what precipitated the event. This is also the epitome of judgement and stereotyping.

Taking a few minutes to listen to a story, not just the words but what the environment around that story tells you. Your other senses can help you understand the perspective of the person and the problem you are asked to solve. The smells, the sounds, the appearance of the person and the environment, and the non-verbal cues that you are receiving. As an example, speaking to a person that smells unbathed may be unpleasant. Think for a second how embarrassing it must be for the person who is unbathed. What situations precipitated today that didn’t allow them to bath for a lengthy period?  What else could be contributing to today’s situation?

For the perspective taking tool, your goal is to ask yourself questions and be mindful of what could be the answer. Also notice that I said the person and the problem. After years in a role serving people, the person can become the problem for you. If you take just a few moments to think introspectively you may find that the situation is different than you judged it on first appearance. This tool also takes practice. The more you use it, you will find your connection to people will improve and you will be closer to restoring your own humanity through connection.

[1] https://blogs.cdc.gov/niosh-science-blog/2021/04/06/suicides-first-responders/, [2] [author to provide resource upon request], [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344804/

Rural Mental Health & Suicide Prevention Projects in Rural WI Communities

JOHN SHUTSKE, PhD

Professor and Agricultural Safety & Health Specialist

Rural mental health, suicide prevention, and well-being programs abound in Wisconsin thanks to partnerships and coordination efforts that have been led from the University of Wisconsin (UW) through Extension, agriculture, and other units.

The “Resilient Farms and Families” (RFF) project first took shape in 2018, led by Extension specialists Joy Kirkpatrick and John Shutske who both work in agriculture. RFF began by creating a web-based resource center and coordinating activities and check-ins for a statewide cohort of partners. These included the state’s agriculture department and many rural-serving organizations. Much of the success of RFF was to create new relationships and to help connect the dots through numerous communication channels.

Taking Action Against Substance Use in Communities (TASC)

Assistant Dean and Program Leader, Community and Economic Development, University of Illinois Extension

Taking Action to Address Substance Use in Communities has been developed by a team of health professionals and Extension professionals from Purdue University, the University of Illinois at Urbana-Champaign, and The Ohio State University to provide a theoretical framework for Extension professionals as they work with communities to create a collaborative approach to addressing substance use disorder. The waning and irregular access to treatment providers in rural areas, combined with a need to increase efforts to help individuals with SUD enter recovery, call for community-based approaches which increase collaboration among community organizations and individuals involved with substance use prevention, treatment, and recovery support.

The program was designed for communities which may not be using all their resources, have a shortage of treatment providers, experience significant barriers to recovery, or who wish to take a more proactive stance on substance use and develop an effective community-based intervention to augment and collaborate with existing recovery resources. Working with a facilitator, community coalitions create a map of their communities, identifying the gaps and barriers, along with the resources, that make up the community response to substance use. Using the map, the coalition members identify priority areas for projects, and then develop action plans to address those priority areas.

What is Indiana Recovery Network?

HEATHER RODRIGUEZ, MSW, CAPRC II
Vice President of Recovery Advocacy and Programs & Director, Indiana Recovery Network

Heather Rodriguez began her career in 2018 as a student intern with Mental Health America-Indiana while pursuing her undergraduate degree in social work. Her first assignment was to work on creating Indiana Recovery Community Organizations (RCOs). Her internship led to permanent positions and her current role as Vice President of Recovery Advocacy and Programs and Director of the Indiana Recovery Network (IRN). “This was all possible due to my sustained recovery,” says Heather. She recently celebrated 16 years of recovery.

“Often people new to recovery don’t know where to start when they’re seeking help,” says Heather Rodriquez, Director of Indiana Recovery Network. “We created a website to make it easier for people seeking recovery support in Indiana to find out what resources were available.” The website includes a search function that people can use to look up resources by city or zip code to find organizations and service providers nearby.

The Indiana Recovery Network was created through a SAMHSA grant awarded to the Indiana Addictions Issues Coalition (IAIC), a program of Mental Health America Indiana, in 2017 to build a statewide network for Recovery Community Organizations (RCOs).

“IRN now includes more than 100 recovery-focused member organizations that provide wide a variety of services, including training on recovery services, recovery residences, RCOs, and recovery engagement centers,” says Heather. SAMHSA’s four dimensions of recovery provide the guiding framework for IRN: health, home, purpose, and community.

“We continually update the website with new resources as we believe that recovery support is sustained when all the dimensions are covered,” adds Heather. “People can go to our events page to see what member organization are doing through free trainings, group services, or fun pro-social events around the state,” she explains.

Recent updates include information on grant opportunities for RCOs and Medicaid changes affecting people who may lose coverage that was extended due to COVID-19. “We also offer trainings available at no cost with support from our partner at the state Division of Mental Health and Addiction.”

Another exciting development is the RCO certification program that the IRN launched in October 2022 in partnership with the DMHA Recovery Works Program. “We are now up to 11 certified RCOs in Indiana,” says Heather.

How Does Trauma Connect to Substance Use and How Can Healing Start?

BRIANA MATRIOUS, Tribal Community Facilitator

University of Minnesota Extension Educator and Extension’s American Indian Resource Resilience Team

I believe that addiction is just a symptom of historical trauma. Until we get to the root cause of our pain, we won’t ever figure out the opioid crisis, we will never figure out alcoholism or any other symptom of trauma for that matter. I believe we have to get to the root cause of our issues. When we start to heal, we heal the generations before us and we heal the generations [to come]. For many families, there have been multiple generations that have been forced to be in boarding school. When we understand the impact of historical trauma like boarding school, then we understand the intergenerational trauma that happens and why those cycles continue. We start to understand the correlation between trauma and addictions, and how we cope with the pain of it all.  I also think that it’s important that we talk about forgiveness and healing and what it means to us so we can understand where we need to go on our healing path.

What is the Importance of Providing Fentanyl Test Strip Education to Youth?

DR. BETH WEINSTOCK, founder of BirdieLght

We’ve reached a cultural pivot point; in 2021 alone, we lost over 108,000 lives due to a drug-related fatality, and that’s the highest number ever recorded on American soil. The overwhelming majority of these deaths are due to fentanyl. Young people today are sadly part of the ‘fentanyl generation’; the fastest rising age demographic for these fentanyl-related fatalities is age 15-25, as well as in communities of color. When BirdieLight speaks to young people at high schools and colleges across the country, we stress to them that, unfortunately, this IS the greatest public health crisis of their generation. 

And this rapid escalation of fatalities has hit every corner of American life. From the student who tries a presumed Adderall, to the young professional who tries a line of cocaine, to the teen who takes Xanax (which isn’t ‘Xanax’ at all, but rather a counterfeit pill pressed with fentanyl), our young people are dying.

To that end, we must equip them with knowledge and tools. Once we deliver the fentanyl facts to a young person, our hope is that they will never try a pill or powder, but we realistically can’t keep all young people from ever experimenting with substances.  Fentanyl test strips, a powerful tool in the fight to keep young people alive, allows the user to test a pill or powder for the presence of fentanyl, so that an informed decision can be made before ingestion. Fentanyl education and these test strips—up to 96% sensitive at detecting fentanyl in any pill or powder—empower youth to get as close to safe as possible. And as we all know, an empowered and educated generation is the first step toward a solution to this public health crisis.

Great Lakes ROTA-RC Specialist Profiles

Susie West, MPH, is a member of the Health and Nutrition team in Extension’s Department of Family, Health and Wellbeing. Her areas of focus are food access and mental wellbeing, with an emphasis on the experiences of those with Substance Use Disorder and those experiencing food insecurity.  A public health professional with a background in mental health, she is passionate about health equity and person-centered approaches for promoting wellness.

Amanda Conn Starner is a Certified Health Education Specialist (CHES) and Ohio Certified Prevention Specialist (OCPS). As Chief Program Officer, she is responsible for building, growing and sustaining substance use/misuse prevention coalitions across the Greater Cincinnati region. Amanda graduated from the University of Cincinnati with a BA in English Literature and a Journalism Writing Certificate along with a Master of Science in Health Promotion and Education with a concentration in community health. She is a graduate of the Community Anti-Drug Coalitions of America’s (CADCA) National Coalition Academy. Amanda worked for the public sector for several years including as a member of senior staff at the Ohio Department of Alcohol and Drug Addiction Services and the Ohio Senate. She began her professional career as a journalist including winning an Emmy Award. Amanda is currently an Advisory Council member for the Statewide Prevention Coalition Association through Prevention Action Alliance.  

Mike Blaser is a retired lieutenant from the Janesville Police Department where he was active in law enforcement for 25 years.  He is currently a certified Trauma Instructor and has been educating within the Mercyhealth system in Rock County, WI, for more than eight years. He he specializes in tactics, leadership, crisis intervention, patrol response, communication, de-escalation, CRASE, RTF and trauma intervention & preparedness. Mr. Blaser educates across the US, to home and international audiences, on crisis intervention and has been working with first responder communities to understand and address stress management, compassion fatigue and resilience.

John Shutske is Professor and Agricultural Safety & Health Specialist at UW Madison, at the College of Agricultural and Life Sciences through the Division of Extension. His Extension, research, and teaching activity focuses on safety, risk control, and health promotion in agriculture and other industries. His program leadership role allows him to develop research-based educational programs and curricula with colleagues across the state and across the country. The programs are intended to prevent injury, illness, and other types of loss and to mitigate the related negative impacts from farm stress. Historically, and in 2021, he worked across disciplines (farm management, animal science, bacteriology) in agriculture as well as veterinary medicine, public health, epidemiology, medicine, mental health, and program evaluation. He holds an affiliate Professor appointment in Family Medicine in the School of Medicine and Public Health and has worked to expand agriculture’s connections to the Wisconsin Academy of Rural Medicine and the Rural Health Equity program track.

Beth Weinstock is a physician, and also a mother of four whose eldest son Eli died in March 2021, when he unintentionally ingested fentanyl. In honor of Eli, she and her daughter Olivia Weinstock founded BirdieLight, an organization dedicated to ending the loss of young people due to the dangers of illicit fentanyl. She recently retired from Equitas Health in Columbus, OH, where she cared for individuals infected with HIV and Hepatitis C, to focus more exclusively on BirdieLightBirdieLight has been featured on multiple podcasts, news outlets, and on The Lead with Jake Tapper on CNN; her organization has spoken to 1000s of high-school and college students as well as public health and parent groups across the country and in her native Ohio.

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