Health

HE A LTH • Fall 2020 13 system for a while that they must engage with certain treatments to receive a certain outcome. And our approach is very different." That housing-first, trust-building template can mean something as basic as helping a client install a lock on a bathroom door, or changing a lightbulb – whatever a person needs in the moment. From there, conversations can unfold naturally, and clients can be connected with mental health care and other services as needs are identified as clients grow more comfortable with the idea of receiving care. Intersection of addiction and mental health Spectrum Health Services in Worcester is known for its relatively new care model: integrated addiction and mental health treatment. Lisa Blanchard, vice president of clinical services at Spectrum, said historically the two were treated separately, even though substance use disorder and mental health issues are co-occurring the vast majority of the time. "Very large percentage of individuals with substance use disorder have a trauma history, and may carry a diagnosis of PTSD or other diagnoses related to their trauma history," Blanchard said. Blanchard said the two problems can become muddled and self- perpetuating. A person may use substances to help cope with their mental health issues, and sometimes the symptoms of a mental health issue may look very similar to symptoms of the withdrawal cycle. At Spectrum, she said, the issues almost always overlap. "That's what brings them in: Their need to stop that cycle of abuse and withdrawal, and that negative impact of their substance use," Blanchard said. "Often that is the reason they may come in the door, and then as we meet with them, do clinical assessments, engage and connect with individuals, then we can help uncover underlying mental health conditions and how to enter treatment for that." While many of their clients seek out Spectrum's help of their own volition, Blanchard said trust still often needs to be built. As is the case at Open Sky, that trust is built through engagement and contact. Normalizing and reducing stigma While it's become fairly normal to see depictions of therapy in television or movies, or off-handedly referenced on Twitter or TikTok, stigmas around mental health remain a significant barrier for many patients, particularly those outside of higher income brackets. In that regard, organizations like Spectrum and Open Sky work to not only connect people with mental healthcare providers, but to break down preconceived notions about how clients can benefit from that type of care. "It can feel more stigmatizing to access that care because they haven't been in environments… where it's accepted and normalized, especially if there's cultural differences, which often will happen," Blanchard said. Arrell from Open Sky said accessing therapy can be a privilege of its own, using her own socioeconomic position as a reference point. "We're sort of privileged in a way because we can worry about getting the best therapist because we have a home and we have food, and when I'm going to my therapist or you're going to your therapist, you're not necessarily worried about someone coming in and taking away your children," Arrell said, citing a fear clients might have. Similarly, she said, someone like her doesn't have to worry about being able to groom herself, or maintaining a certain immigration status, or even finding a therapist coming from the same demographics she does. "It's almost like a luxury that we can engage in it without fear," Arrell said. "It's not necessarily the same for the folks that we serve." Eliminating those fears and helping foster those relationships between clients and mental healthcare providers, she said, is at the crux of the work to connect those vulnerable populations with the mental health treatment they need. "That's why we need our staff out there making those connections," she said, " to make it safe to go to therapy." H Untreated mental illness, in New England Virginia-based nonprofit Mental Health America reports more than half of adults with mental illness do not receive treatment. Source: Mental Health America PHOTOS/COURTESY Lisa Blanchard, vice president of clinical services at Spectrum Health Services 0% 10% 20% 30% 40% 50% 60% 56% 52% 50% 46% 45% 41% Connecticut Massachusetts Maine Rhode Island New Hampshire Vermont % of adults with a mental health illness who have not received treatment "As we meet with them, do clinical assessments, engage and connect with individuals, then we can help uncover underlying mental health conditions and how to enter treatment for that." Lisa Blanchard, vice president of clinical services at Spectrum Health Services Open Sky Community Services helped an Adonis (far right) find housing as part of his treatment. Pictured with Adonis (from left) are Evis Terpollari from the City of Worcester, and from Open Sky, Acadia Silveira-Santos, Laurel Brazao, Dana Chavis, and Melissa Ingerson.

• Cover