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.

How I'm Currently Answering the Question: "What's the Book Going to Be About?"

by Monica Ross

Dorothea Lange-Migrant Mother

by Monica A. Ross, LPC

I’ve run into people lately who know my intent of writing a book and they’ve been asking me, “Well what's it about?” I say that I have a loose sketch. There are several themes that I want to tie in together. The general themes are poverty, stigma, mental health, physical health, behavioral economics, and therapeutic techniques like cognitive behavioral therapy. 

I’ve thought about going back to school to advance my studies even further. And recently, I applied to a couple of doctoral programs. Both of these programs are online and shorter in length than a traditional PhD track program, which would be geared more towards someone who wants to end up conducting research and teaching in academia. The one doctoral program that I am looking at in particular would place the emphasis on clinical practice.

I don’t know whether or not I’ll get into my program of choice or whether or not having gained the acceptance I’ll sign the piece of paper that commits myself to even more student loan debt. But I thought I’d use this post to explain some of my background or reasoning for wanting to pursue the idea of writing a book.

I made some of the following statements in my personal statement submitted to the doctoral program that elucidate my intent a little bit more:

Extreme economic inequality is a public health problem. As a health care provider, I want to advance well-being practices geared towards overcoming the unique psychological barriers that economic inequality perpetuates in order to stimulate behavioral and economic change. The government focuses on prevention and early intervention for “at risk” youth, and this leaves out our adult population, an even larger demographic.

Some of the adults I have treated were not able to get early interventions and therefore find themselves struggling later in life. I am intrigued by the work of Eldar Shafir and Johannes Haushofer, both from Princeton University, who are leading the conversation linking poverty to psychology and tracing this linkage to its economic impact.

In my early years, in Texas, I saw the struggles my parents had with chronic health impairments and economic inequality. This influenced my decision to go into psychology and sociology as an undergraduate student and to focus my studies on resilience and well-being later in life.

I did not see the burden of my parents’ health and financial issues, or my own issues for that matter, as resting solely on our shoulders. Instead, I had some sense there were environmental and societal factors affecting our overall health and well-being. I am an advocate of personal agency and responsibility, while at the same time acknowledging that we, all of us, live in systems.

After graduation I spent many years working in California at corporate, government, nonprofit, and academic institutions. I chose this path of work because I chased after the financial security that these roles provided. In 2010 I made the decision to come back to Texas to be with family and I came up with a plan to pursue my calling—to return to the study of psychology and to become a psychotherapist.

By August of 2011, I was enrolled full-time in a counseling program at St. Edward’s University. By May of 2014, I finished my counseling program and graduated with a 4.0 GPA. With my master’s degree and LPC-intern license in hand, I made the decision to relocate to rural East Texas because of the experience it offered.

I began working at Burke, a Federally Qualified Health Center headquartered in Lufkin. It serves a 12-county region and houses services for people across the life span, from children to adults, with mental health and medical issues. At Burke, I worked initially with the most severely mentally ill in vivo as a caseworker.

In that role as an in vivo caseworker, I came face-to-face with the devastating effects of poverty in America and its relationship to mental health. After a year as a caseworker, I transitioned to the office and provided psychotherapy at the clinic for our clients that included 50- to 90-minute individual counseling, group therapy, and psychoeducational sessions.

I discovered a wellness self-management personal workbook from the New York State Office of Mental Health and used that as a tool to lead a 12-week series of group therapy sessions. I also drove once a week an hour outside of Lufkin to Crockett, a town of less than 7,000, in order to provide therapy to the neediest in that community. Crockett has a 39.1% poverty rate.

In some ways, I had escaped the financial and cultural struggles of my early years for an interlude while in working California only to willingly come back to my home state and face those same struggles again, but from a different perspective. Once I finished the licensure process, I moved back to Austin to embark upon my own private practice.

Throughout my experience as a counselor, I have continued to work with clients of all ages in all levels of socioeconomic status. I have clients who have been in and out of prison, who have had Child Protective Services (CPS) involvement in their lives, and who are struggling to maintain independent housing, access to proper nutrition, and transportation.

I have also worked with top executives of well-known companies who are somewhat more economically privileged, but often face similar mental health challenges and have had to overcome sometimes similar childhood trauma.

By addressing the unique psychological barriers that people coming from a place of extreme economic inequality face, we can more adequately advance long and productive lives. This may come through a process of creating social responses that include therapeutic techniques to adapt to the changing social environment.

The experiences that I have had throughout life, the witnessing of the effects of extreme inequality, which are influenced by both societal factors and internalized psychological barriers, have taken on new meaning for me. These experiences were not random occurrences, but instead have prepared me for the work that I currently do and for the legacy that I hope to one day leave.