“I miss the staff, they were all really friendly and welcoming. Putting myself in treatment was the best decision I have made for myself.”

Jaylen G.


What if “Behavioral Health” Was a Good Thing?

Moving towards integrated behavioral health will help us be healthier people and reduce the cost of healthcare.

Earlier this month, someone asked me to describe what I do for a living. Depending on the day, I would describe my job as herding feral cats with un-medicated ADHD; an exercise in futility; or the opportunity to be humbled at how vulnerable and empowered people can be. I am a mental health counselor; a substance use disorder counselor; a teacher; and mentor. Being the consummate professional that I am, I answered the person with “I am a behavioral health provider.” She looked at me as if I said I was an underwater-basket-weaver living on Mars. “What is that?” she asked. I wasn’t sure exactly how to respond. I had to think. What is behavioral health? What/who is a behavioral health care provider?

Just in the last few years, the licensure board that governs two of my licenses changed its name from “Board of Social Work Examiners and Professional Counselors” to the “Board of Behavioral Health.” But, again, what is “behavioral health?” Historically, “behavioral health” was considered to be behaviors that lead to a healthier lifestyle or behaviors that prevented illness. Now, behavioral health tends to be more negative and connotes an unhealthy mental health status. If you’re seeing a behavioral health professional, chances are that there are some things in your life that have gone awry. Rarely do people sit in my office and tell me that life is full of roses and puppies and rainbows—there is a reason I buy Kleenex in bulk for my office. But… what if that wasn’t the case? What if “behavioral health” was a good thing?

SAMHSA (Substance Abuse and Mental Health Services Administration) states that Behavioral Health means “The promotion of mental health, resilience and wellbeing; the treatment of mental and substance use disorder; and the support of those who experience and/or are in recovery from these conditions along with their families and communities.” Okay… that was a mouthful, but sounds much better than “Well, life isn’t going very well, so deal with it. Here are the Kleenex.”

Our current healthcare system tends to focus on the physical health over the emotional health of individuals. In part, that is because “physical” issues are often more measurable and quantifiable. I can easily identify someone as having hypertension because their blood pressure is outside normal limits or that they have diabetes because their blood sugar is outside normal limits. Emotional health, on the other hand, is much more subjective. Despite the DSM (Diagnostic Statistical Manual—the manual published by the American Psychiatric Association that lists all of the mental health diagnosis a person could have) attempting objectivity by describing specific criteria, it is also somewhat open to the interpretation of the clinician or the perspective and situation of the patient. At some point, we’ll be better able to quantify emotional health and it will truly get the credit it deserves, but we’re not there yet. We are getting better. We are getting better at identifying and quantifying the connection between physical and emotional health. According to the Center for Medicaid and Medicare Services (CMS), 50% of Medicaid enrollees have a mental health diagnosis and people with mental health concerns and chronic health conditions (like diabetes or hypertension) have health care costs that are 75% higher than those without both mental and physical health conditions. Specifically, those with diabetes who also have a mental health diagnosis cost 2-3 times more to care for than those with only one condition. People with significant mental health issues die on average 20 years earlier than those without co-occurring disorders.

According to the National Survey on Drug Use and Health Report, people with mental health issues (anxiety, depression, and post-traumatic stress disorder to name a few) are more likely to have chronic conditions such as hypertension, asthma, diabetes and heart disease. If you really want to see how our emotions impact physical health, just take a look at the ACE (Adverse Childhood Experiences) study or read The Deepest Well by Dr. Nadine Burke-Harris. For every ten people in a doctor’s office, seven are there for behavioral health issues. I personally can attest to the connection between emotional health and physical health. I have anxiety disorder (card carrying member since 1996). When my anxiety flares outside of its normal limits, I tend to stop sleeping well, grind my teeth (I will be the first person to chew through my bite guard) and my stomach gets mad at me. If I went to a doctor with those symptoms, they’d tell me to take some antacids, prescribe a benzodiazepine and a sleeping pill. All of those things might help me, but they do not address the underlying issue (my anxiety). What we want to strive for is integrated behavioral health — truly providing holistic care that takes into account the mental and physical health of each patient.

Right now, the United States is moving towards what is called “value-based” reimbursement for healthcare services. This means that, rather than getting paid by the volume of clients I (or any other provider) see, I would get paid based on the value of the care I provide — the more improvement made for my patients, the better I would get paid. This means that, thankfully, as a society we will have to participate in truly integrated behavioral health. If a provider wants to get a better rate of reimbursement for services, they will have to demonstrate that their clients are getting better. As a behavioral health care provider, I will need to be taking into consideration the whole person, addressing mental and physical health in an integrated way if I want to get paid better.

As much as I would like to think that it’s not about the money (pretty sure that in graduate school I was informed that our purpose was to help people, not be making the big bucks…), it is all about the money. As much as I would like to think that my insurance company covers “preventative” care (like my annual gynecological exam) because it cares about my health and happiness, it is because insurance companies have finally learned that catching illness early is actually cheaper to treat (sorry if I popped anyone’s delusion with that last statement). Moving towards integrated behavioral health will not only save our society money, it will actually help us be healthier people.

Additional Sources:

https://online.alvernia.edu/program-resources/behavioral-health-vs-mental-health/

(E. Chesney et al., Risks of all-cause and suicide mortality in mental disorders: a meta-review, World Psychiatry; 2014: 13: 1153-160.)

https://www.samhsa.gov/sites/default/files/samhsa-behavioral-health-integration.pdf

Celebrate Connections During September, National Recovery Month

September is National Recovery Month during which new evidence-based treatment and recovery practices are highlighted. The strong and proud recovery community, including the dedicated service providers and community members across the nation who support the millions of individuals who are proudly living their lives in recovery, as well as their family members and loved ones, comes together to. This year’s Recovery Month theme is “Join the Voices for Recovery: Celebrating Connections.”

The 2020 National Recovery Month theme, “Join the Voices for Recovery: Celebrating Connections,” reminds people in recovery and those who support them, that we all have victories to celebrate and things we may wish we had done differently. This is true of everyone and, as in most cases, we cannot do it alone. Recovery Month will continue to educate others about substance use disorders and co-occurring disorders, the effectiveness of treatment and recovery services, and that recovery is possible.  All of us, from celebrities and sports figures to our co-workers, neighbors, friends, and family members, throughout our lives have experienced peaks and valleys, both big and small. But, with strength, support, and hope from the people we love, we are resilient.

National Addiction Professionals Day will be celebrated on September 20, 2020, as part of National Recovery Month. Started by NAADAC, the Association for Addiction Professionals in 1992, the day was established to commemorate the hard work that addiction professionals do on a daily basis. Addiction professionals provide people in need the support and tools necessary to address their addictions and move towards recovery. The need for addiction and mental health professionals has never been greater, and we can support their commitment to serving those in need by recognizing the vital role they play in the lives of our friends, our families and our community.

The addiction professionals at Rimrock are committed to helping those struggling with addiction and meeting them where they are. This means meeting individuals where they are in their journey towards recovery and meeting where they can receive treatment. Rimrock has greatly expanded the treatment we are able to provide through telehealth with the introduction of Rimrock Connect, allowing us to connect those in need with addiction and mental health professionals online or by phone.

Faces & Voices of Recovery has created a new Recovery Month website that will host all Recovery Month events and assets that make this celebration possible. Faces & Voices of Recovery works to hard to support individuals in long-term recovery from drug and alcohol addiction and their family members, friends and allies in a variety of ways, including, capacity building in support of the national recovery movement, fighting the stigma of addiction, creating groundbreaking recovery messaging trainings and more. Faces & Voices of Recovery is dedicated to organizing and mobilizing the over 23 million Americans in recovery from addiction to alcohol and other drugs and families, friends and allies into recovery community organizations and networks. They work to promote the right and resources to recover through advocacy, education and demonstrate the power and proof of long-term recovery.

If your organization is interested in learning more about mental health and substance use issues facing our community, Rimrock staff provides education and outreach presentations at no charge. Please call us at 406-248-3175 to learn more.

And, if you need help or know someone struggling with substance use or their mental health, we are here for you 24/7. Please call 800-227-3953 or complete our online request form to connect with our team of professionals. Rimrock Is Recovery.

Anxiety: How to Keep Your Gizmo from Becoming a Gremlin

Full disclosure….I have anxiety disorder. I come by it honestly—my mom has anxiety, and I’ve earned the right to follow in her ruminating footsteps. She has over-thought herself into such states that she thinks she’s having a heart attack. We both tend to lay in bed cogitating and marinating in a soup of fretting and pondering about anything and everything (How do we have prune juice?? Isn’t a prune a dehydrated plum? How do you have juice from something that is dehydrated? Shouldn’t it be plum juice?). I tend to worry and catastrophize about things that might happen. Sometimes I think my head has taken lessons from Dateline and Unsolved Mysteries the way it jumps to dramatic tragedy on the edge of absurd. Anxiety is an odd little critter… it lives inside, and I sometimes find myself nurturing it like Gizmo, occasionally feeding it after midnight and throwing water on it so that it becomes an all-consuming Gremlin. It causes me to grind my teeth at night to the point of cracking a tooth (I tell my dentist that I will be her first patient to chew through my bite guard).

As is often the case, my anxiety has been made worse by events in my life and upbringing. Epigenetics (the study of changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself) tells us that we have an inherent genetic disposition for a disorder or condition (everything from mental health issues to physical diseases) and that our environment shapes that disorder or even determines if the disorder occurs at all. My parents were both high-functioning, intelligent, list-oriented administrators for the federal government… if I’d been raised by two hippies in a tent, perhaps I would be less anxious and more Zen, but that is not the case.

Anxiety isn’t all bad, however. My anxiety to do well and not let people down makes me a hard worker and accountable to my responsibilities. It allows me to be devoted to making good decisions ethically and ensures I work to treat people with respect. It makes me conscientious and reliable; dedicated and constantly striving to do things better. Anxiety is built on our primitive survival instincts: it makes us risk-adverse and often steers us away from experiences that could be life-threatening or uncomfortable emotionally. We all have anxiety related to survival tasks and this is not necessarily a bad thing.

Perhaps through my own rounds in therapists’ offices and perhaps because of my vocation, I have developed skills to be aware of and manage my anxiety. I am very aware of when it is prepping to run amok. I am aware of how things like sleep, exercise, and events in my environment impact my Gizmo and how to (hopefully) prevent a full-out Gremlin from emerging. I am also able to help my clients recognize and manage their own anxiety, as many are struggling with now.

When COVID-19 first hit, there was anxiety about getting sick, then about the economy, and then about the future (although, to be clear, these worries have not subsided, only modified and become more ripe with time). The first blog I wrote for Rimrock was at the beginning of the pandemic. Now we are several months in, and the anxiety has moved from an acute state to a chronic state and now is starting to move back to an acute stage as we ponder what the school year will bring. I recently had to complete a survey for each of my children for the school district about re-opening. My feelings are mixed: I want them back in school as they truly miss their friends and are really through with having to play (Oops —sorry! At 13 they no longer “play”… they “hang-out”) with each other. I know that they learn better and more when they are with their teachers and practicing social skills with others versus a couple hours of Zoom and mom and dad. The social interactions that they are missing are invaluable. However, I also want to be very aware that there is a deadly virus out there, and I want no part in making it worse and potentially harming another person (just watch how my Gizmo runs with that scenario!). We are fortunate in that we have the resources at home if we need to do school remotely, but not every family is as fortunate as we are. Gizmo has recently been catastrophizing about the children and families that have vulnerable immune systems or not enough computers for their children to really excel with remote learning; it is amazing how my Gizmo-to-Gremlin fires up with things that I cannot control.

I am not alone in experiencing the multiplication of these worries. There are many Gremlins running around right now in my own head and in the hearts and thoughts of nearly everyone in America. So: what do we do? One of the things that we teach our clients at Rimrock is to “take life on life’s terms.” We cannot control the world around us or the actions of others. Our true power lies in being able to manage our own impulses, responses, and cogitations. When I ask a client to move from being Powerless to Powerful, I am asking them to let go of things they cannot control (we call it “surrender” but that term somehow implies that they are giving up so I reframe it) and live a life of focusing on their own issues and engaging in behaviors of integrity. That is what I have to do with my Gizmo (anxiety): focus on my self-care and the things that keep it from staying up past midnight and feasting. We have to channel the anxiety into productivity instead of fear-based paralysis and reactivity. If you are experiencing situationally-based anxiety related to COVID, or if this is feeding your own Gizmo and throwing water on it, there are things you can do. You are not powerless.

Talk about it. We are only as sick as our secrets. When we talk about things, they lose their toxic power. Trust me, when I tell my husband about the Dateline scenario that is running around in my head, I realize how silly it is (“Well, yes, honey, I suppose lightening could strike the house, burn it down including the home owners insurance policy and all our valuable documents even though they’re in a fire-proof safe, and leave us homeless on the street…”). Whether it’s with your family or friends or a professional counselor, talking about what scares and worries us moves us from Powerless to Powerful.

Avoid triggers. I do not watch Dateline or any of those shows (which, sometimes, includes the evening news) because my Gizmo needs no help in finding fodder to play with.

Get enough sleep. When Gizmo is becoming a Gremlin, it is almost always related to feeling tired and overwhelmed.

Exercise. Exercise not only is good for us physically, it also stimulates endorphins and other neurochemicals that help keep us balanced and emotionally regulated. Exercise can be any physical activity — yoga, jogging, gardening, and walking are all great options.

Self-care. What makes you happy? What are the things that you do that make you feel happy and good? Any hobby from outdoor activities (which nicely multi-task as exercise) to knitting, baking, and crafts are all examples of self-care. Self-care is unique to all of us, so you need to find what works for you.

Escape. We all need to escape once in a while; a vacation, reading a book, or watching a movie are all temporary escapes from what is stressing us that can be healthy and proactive. But escape can be tricky if we are always escaping. If you find yourself constantly seeking escape, whether it is with alcohol/drugs, Netflix, sleeping, or simply tuning out, you would benefit from some professional help.

Regardless of what drives your Gizmo or how many Gizmos you may have, they do not have to turn into Gremlins. You are not alone in this crisis, no matter how isolated you may feel.

Rimrock’s Substance Use Specialists and Mental Health Professionals are available online or by phone to provide you the support you need, wherever you are. Connect yourself with the help you need today by completing our online request form or calling our 24/7 helpline at
800-227-3953.

Telehealth: Your Treatment Toolbox’s Newest Addition

Technology is something that we all have gotten more adept at using, whether we like it or not. “Zooming” is now a thing. I remember when I got a job after graduate school that required me to have a cell phone, I felt soooo sophisticated (it was a flip phone and there was an antenna that I pulled out for better reception). My relationship with tech goes back a little ways…

I can also remember when I was in elementary school and my dad really, really wanted a home computer for Christmas. My mom and I did get him a computer, but first we made him one out of cardboard with a drawn on keyboard. He was not impressed, but the look on his face was hilarious! As a high schooler, my dad insisted that I be proficient in typing; I had to practice typing more than I had to practice parallel parking (both of which I was pretty sure were ridiculous things to learn… no one would ever use typing as a skill and I was sure I’d be rich and famous and would have a driver. My dad did not buy either of my lines of reasoning). When I was in college, my parents wanted me to have my own laptop (not to date myself, but this was before it was normal to have your own computer). They had a “Gateway” (anyone else remember those cow-skin-black-and-white boxes???) delivered to me and I was the coolest kid in the dorm (until 11pm when I yelled at my dorm-mates to be quiet and go to bed).

My own kids (13-year old twin boys) are known as “digital natives.” Technology has been a part of their lives since the beginning. Using technology to connect, communicate and learn is not abnormal for them. Zoom, cell phones, tablets and computers are all integrated into their daily lives. Even before COVID-19, they used web-based programs in their school and knew how to use a tablet and laptop. Instead of an encyclopedia (or, God forbid, just not knowing something) we “Google” it. Where I used to play outside or read a book, they play X-box and want to be able to “game” with their friends. (Funny story: they really, really wanted an X-box for Christmas a couple years ago. I got a box and drew a huge “X” on it and gave it to them. The looks on their faces! Pretty sure they thought I was the dumbest mom on the planet. Even my husband, who is more anti-tech than I am, thought I was being cruel. We did get them a real X-box for Christmas that year, but I will forever remember the looks on their faces when I said, “You guys said you wanted an X-box! I thought that was what you wanted!” LOL. Priceless). They do not understand why I do not think they need iPhones; the argument “I didn’t have one when I was your age” only solicits them looking at me as if I am from Mars.

So, gung-ho technology! Maybe. Maybe not. Technology is a fabulous tool. It allows us to do many things easier, faster and (often) cheaper. But there is a price. It is often thought that technology impairs social growth and skills (my grandma used to say that TV “rots your brain”), but research has not born that out completely. Particularly for children with learning disabilities and autism, technology has actually provided useful tools to help children learn and communicate. I could argue that it may actually improve diversity and global awareness of issues: we are more aware of people on the other side of the world and even down our own street because we are all connected through the internet. We can connect with people that we’ve lost touch with via Facebook and buy our groceries without ever leaving our house. It has certainly made our lives more “normal” due to COVID-19. For the most part, we were still able to engage in work and school, even if it was in a modified way. It has allowed us to talk to our families since we cannot visit (although, I must say, after “Zooming” with patients all day, the very last thing I want to do is “Zoom” with my family… the only thing I want to do is “zoom” to bed and sleep!).

Technology has allowed me to seamlessly continue to see my clients; telehealth has been used for decades (although it is more prevalent in traditional medicine versus mental health and substance use treatment). Even prior to COVID-19, technology has allowed me to see clients that do not live in Billings. It also allows me to provide quality treatment to individuals living in rural Montana that do not have local access to mental health and/or substance use counselors. Now that it is more mainstream, I foresee us continuing to use technology (in the form of “telehealth”) to provide services, even within the Billings city limits. Telehealth practices are allowing us to integrate people from outside Billings into our group therapy that previously required travel to Billings. Families that needed to take days off of work and pay for gas and hotels in order to participate in our “Family Week” can now do so virtually. I’ve also had clients that live in Billings ask to continue to use telehealth for various reasons including cutting down on having to take time away from work and drive to my office, reducing fear of embarrassment that someone they know will see them walk into my office (we’ll save stigma for a different blog post), and feeling it is “easier” to share difficult things over a camera versus face-to-face. Technology is a great tool with many benefits, and I’m glad we have it. I also want us to use caution: a hammer is also a tool, but it is not always the tool that you should or would use.

For some people, telehealth is not the best venue for receiving care. Face-to-face therapy can still happen during COVID-19 when we take the recommended precautions. For some, a blend of face-to-face and telehealth is the best fit. It is imperative that we, as clinicians and consumers, assess the needs and match it appropriately with provided services. While technology is a huge benefit in our lives, we also need to be aware that it is not always the best fit. When I work with my clients, I want them to have a lot of “tools in their toolbox” to deal with the stressors and boredom of everyday life, not just a hammer.

If you would like more information on how the available telehealth and in-person options Rimrock offers to address substance use and mental health needs can help you or someone you love, please call 800-227-3953 or complete our online request form and a member of our staff will reach out to you. Normal admission hours are between 8:00 am and 5:00 pm Mountain Time, Monday through Friday. However, we do have staff available anytime to take your call.

Time for a Change

Last weekend, my family and I put in our garden. I need to warn you that none of us are gardeners. We did one last year and it was obvious that it was our first try at doing a garden… this year we learned a few things and did it a little differently. As I churned the soil (next year I think I will rent or buy a tiller…although, I must say my arms got quite a workout!!) I noticed pieces of last year’s garden: some random leaves, a stem from one of hail storm-decimated tomato plants, a plastic GI Joe toy (ok, we didn’t plant that but I do have two sons) and the roots of part of a squash plant. As I noticed these items, I thought about the process of growth and change and how this year’s garden will be better because of what we learned (GI Joe toy aside) from last year’s garden. So often, our current state and trajectory is shaped by the past: we change from and because of our past.

One of my biggest pet peeves as a counselor is when a client tells me that people (often, other counselors) have told them that they should “be over” something that has happened to them.  My clients will tell me that they feel defective and ashamed that something that happened decades ago still impacts their daily life. One client in particular shared with me that he was to the point of suicide because he was so shamed and embarrassed about how he felt. I told him that, given his past and what was done to him, his feelings (anger, shame, hurt, fear, rejection) were normal results of surviving what he had been through. I told him I felt honored that he trusted me enough to talk to me about it. It wasn’t until he was able to accept (which took a lot of time in my office, tears, snot & Kleenex) his feelings and experiences that he was able to move on. He was able to gain understanding of what had happened to him and decide what he wanted the rest of his life to look like. I am humbled by the amount of trust and courage that it took him to be willing to be uncomfortable and walk through his past with me. He would not be the kind, gentle and talented man he is today if he hadn’t been through his experiences and conquered the uncomfortable feelings that resulted. He was able to transform trauma, adversity and addiction into compassion, gratitude and resilience.

I think that many of us have contemplated what “the future” will look like post COVID-19. And will it ever really be “post COVID-19?” Does the past ever really go away? Or does it just become better integrated into our present and future? People often assume that “change” means that you somehow discard the past or what is wrong and you do something new and different. But can we ever really do that? How do I know what direction I want to go in if I do not allow my history to remind me of what not to do or what lessons have been learned? If I do not remember the pain and discomfort of the past, I lose the motivation required to continue moving forward. Many people I’ve talked to are thinking of the “post COVID-19” world in terms of a “New Year’s Resolution” and that this is a time to leave what we didn’t like or need in our past and use this difficult time to evoke change. Take this time of separation from our normal routines to re-evaluate what you want to be different moving forward. More time with family? Less time being consumed by work? Fewer commercially-driven Target runs? Are there new habits you want to cultivate? Vices you want to let go of? What do you need to make that happen?

I think we’ve all heard those conversations about “when things go back to normal” and I honestly do not think we will “go back normal.” Just as the debris from last year’s garden will fertilize this year’s garden, we will use this time to assess what we want to take forward into our futures. I look forward to the rest of the summer and seeing what grows in my garden.

If you’re ready to reach out and make a change, Rimrock is here for you. Our Admissions Department can be reached at (406) 248-3175 or (800) 227-3953. Normal admission hours are between 8:00 am and 5:00 pm Mountain Time, Monday through Friday. However, we do have staff available anytime to take your call.