Access to Mental Health Care or the Jackson Pollock of It All

by Monica A. Ross, LPC

Problem-solving. Why would the ability to problem solve be a core component of resilience? My first thought on that one is that people who are struggling just to survive, for those who face steep obstacles in life, the ability to problem solve is critical in order to figure a way out of the crisis(es). 

Take a look at this clip, for instance, from the Center on the Developing Child at Harvard University called “How Resilience is Built.” It talks about the importance of relationships and the importance for the developing child of the ability to both monitor and problem solve. 

At the time of this posting, what comes up in a Google search on “How to problem solve” is this method:

1.     Identify the issues.
2.     Understand everyone's interests.
3.     List the possible solutions (options).
4.     Evaluate the options.
5.     Select an option or options.
6.     Document the agreement(s).
7.     Agree on contingencies, monitoring, and evaluation.

This is, of course, geared towards problem-solving in the workplace. That sounds about right, but we also know that people who find themselves in crisis at work or at home can’t even begin to complete number 1, let alone move smoothly along to 2, 3, 4, etc. The reason for this perhaps is because those living in crisis are living life from a scarcity mind-set. 

Mullainathan and Shafir in their book Scarcity: Why Having Too Little Means So Much explain that the focus on what we lack, or approaching life from a scarcity mind-set forces a type of preoccupation in life. When we are preoccupied we do not have the cognitive bandwidth to begin to address other problems. Or at the very least, addressing other problems becomes a daunting task.

The scarcity mind-set, as the authors point out, is not about lacking the capacity to process, but it is about lacking the mental resources. With the scarcity mind-set we tend to do things like incorporate tunnel vision, which is good when something deserves our sole focus and concentration, but towards how many singular things in life do we have the luxury of dedicating all of our attention? 

Scarcity also affects our executive control, making it hard to have self-control.

A lack of self-control can then interfere with problem-solving. Lack of self-control more often than not can exacerbate a problem. It is these types of psychological biases affecting those living with a scarcity mind-set that fuel sometimes poor choices despite the fact that the consequences of those choices can be extreme.

This lends itself to doing impulsive things despite the fact that the stakes are higher. Not only do those who are operating at the survival level (e.g., the poor) have less room to fail because they have fewer resources, but they also have a compromised ability to make good decisions. This, in turn, increases the likelihood of failure.

As clinicians, one of the modules we are typically called upon to utilize in working with clients and in conducting psychoeducation is the module on problem-solving. Why? Because people with severe mental health issues sometimes forget to take their medication, and when that happens they may stop taking medication altogether. They may act on impulse and find themselves running up gambling debts or maxing out credit cards in an impulsive spree, or making hasty, major life decisions like moving cross-country.

It’s important, then, both to gain some level of stability as a consumer or client either on or off medication and from there to work towards maintaining that stability. Stabilizing itself takes a certain amount of problem-solving ability and that problem-solving ability may never be reached if a person finds themselves in a constant state of making both impulsive and poor decisions.

Now let’s compound the issue for the person struggling with mental health issues by making access to help in and of itself confusing. If I were to describe the process of finding a psychotherapist from the consumer or client’s side, well it’s a bit like this:

Some Issues for Consumers

To me the current marketplace is like…..my own artistic interpretation:

scribble

 

Or

Like a Pollock Painting:

Pollock Painting

Or

Like my friend Yoon Lee’s paintings

Yoon Lee

It’s like a kindergartener took a piece of paper and did this:

kindergarten

To put it metaphorically. . .

It’s like a city wanted to build a new roadway system and they let everyone decide where they wanted to put the pavement, stoplights, lane markers, and highway signs.

Book Reference

Mullainathan, S., & Shafir, E. (2013). Scarcity: Why having too little means so much. London: Allen Lane.

What is a DSW exactly? What Else are We Learning?--And My Faculty Advisor

What Is a DSW Exactly? What Else Are We Learning?—And My Faculty Advisor

by Monica A. Ross, LPC

I’ve been assigned an advisor for my thesis. Her name is Dr. Amanda Stylianou. She’s an LCSW practicing out of New York and the Associate Vice President for Quality and Program Development at an organization called Safe Horizon

Safe Horizon is the largest nonprofit victim services agency in the United States. They work with victims of domestic violence, child abuse, sexual assault, and human trafficking. I’m very much looking forward to working with Dr. Stylianou.

Just about one month has gone by in this program. The pace of working full-time and attending 4 hours of virtual class time a week in addition to the outside readings that we have to do has been challenging.

I feel like we’ve covered so much territory already. That would make sense because we’re doing things at a very fast pace. This program is only 24 months long. To those who would say, how can a doctoral program be only 24 months long?

I’d say this: The licensure that I have for my LPC took approximately 6 years to complete from start to finish. So in some sense, I feel as though my dues in terms of gaining an education at the graduate level and in time spent training for my profession have been paid.

These 2 years in the doctoral program will make it about 8 years of education and training post BA total. Most traditional PhD programs require about the same amount of time to complete coming straight from undergraduate school. So, in a way, I look it like I took the complicated route to a doctoral degree, which seems to be more in line with my style. 

Previous to even starting my master’s, I had accumulated over 20 years of work experience in a range of industries which gives me a wide perspective on office structures and organizational policies. Because the focus of this doctoral program is on social innovation and where systems in society overlap with social problems, that experience will help with the work that I’m doing as well. 

Academic programs that are online or remote come under scrutiny for not being as rigorous as brick and mortar academic programs. And there are some online academic programs out there that may not be. 

However, I can say that in this doctoral program, I’m meeting with a small group of up to 15 other students twice each week for a couple of hours each class. This doesn’t include time spent in group meetings that we have outside of class for group projects. We also have readings and assignments to complete consistent with more traditional academic programs.

The virtual environment as an educational tool is not going away and I’m excited to be participating in it with an academic institution that is on the leading edge of that front. Some might ask, what is a DSW anyway? It’s a doctorate, but it’s not the same as a PhD. 

The DSW is to social work as the PsyD is to psychology. A DSW degree is a bit like a PsyD in that it emphasizes professional practice over research. That’s not to say that I can’t conduct research or teach for that matter, but solely conducting research and teaching isn’t my current aim.

What else are we doing in this DSW program? We’re examining different organizational change models, we’re combing through databases from peer-reviewed journals, we’re creating annotated bibliographies for our separate projects, we’re applying the models we’re learning in class to case study examples on various social problems. 

And we’re doing all this from the standpoint that at some point the models we are learning will be applied to the separate projects that we are working on for our capstone thesis. We’re also hearing from thought leaders in a kind of a guest lecturer format who have taken the time to sit for recorded interviews specifically for our class on the topics we are covering—Freddy Mutanguha of the Holocaust Memorial Trust gave a lecture for our class recently, and Karen Freidt who is the Creativity and Innovation Program Manager for NASA’s Langley Research Center gave a lecture.

As I watch these leaders of industries with experience in anything from science and engineering to outreach and education programs in East Africa, I feel truly inspired by the lessons they are imparting from the work they are doing in their various fields. A couple of things stand out for me as lessons learned by these leaders of industry. 

Number one is the importance of not trying to solve a problem for someone else that you don’t yourself understand. I’m playing with the idea of using health disparities as my focus because it’s something that I intimately understand. When I use the term health disparities, I’m talking about group differences in physical health that are influenced by inequalities in society that are socially determined by such things as access to proper nutrition, education, employment, housing, and transportation. 

Both of my parents were chronically ill and social determinants in some sense affected both their access to care and the quality of care they received. But I don’t have to go there. I can stop with the fact that I myself am a member of more than one social grouping that often faces stigma and discrimination in society. I could look to my friends who themselves are in groups that are stigmatized and discriminated against. So, yes, a problem that I intimately understand, check mark.

Number two is that while it’s important to be passionate about your work, it’s also important to set the intensity of that passion so it’s not so high that your field of vision is narrowed. As far as dialing down the intensity goes, that’s hard to do. Because these issues for me are personal, as I mentioned, not just because my family members have been affected by these things, but my friends, myself.

My colleagues and I are doing this work doubtless because it feeds into our sense of purpose in life, but at the same time, a certain measure of detachment is needed in order to continue to learn and think critically and challenge long-held beliefs and presumptions, some of which might be our own. David Perkins from the Graduate School of Education at Harvard is attributed as having said that 90% of errors in thinking are not errors of logic but errors of perception. 

I’ll take it a step further. It’s our perception arguably from which we derive our logic. In other words, our perception or beliefs influence not only the way that we view ourselves but the way in which we view other people, and the way in which we view the very world we live in.