For July Black, Indigenous and People of Color (BIPOC) Mental Health Awareness Month, we are pleased to share our e-interview with Dr. Tonicia Freeman-Foster, Ed.D, CDP, CHES®, PMP, co-founder and principal consultant at Kusudi Consulting Group, and change specialist at Change Matrix, on mental health for Black people and African Americans

Magellan: What are some sources of stigma related to mental health treatment in Black communities?

Dr. Freeman-Foster: One source of stigma stems from slavery where Blacks and African Americans were deemed to be strong so that they could do the work. There were adverse consequences, including death, for those who were deemed to be weak. Because of this, in so many ways we have internalized strength to mean that you have to be able to do the work. You must be able to always put on a smile, even when you are sad or not feeling well. We have internalized this to the point of when we are not feeling well, we feel the judgment of it as a weakness or being lazy. This is why the message “it’s okay not to be okay” is critical, and it’s critical that we as Blacks and African Americans say it, practice it, and live it. Mental health is health too.

Another huge factor is the intersection between mental wellness and faith. There is some belief that if you are feeling sad, then you probably did not pray enough, or you do not believe in God enough, or that you do not have enough faith. The belief that overall, you are weak spiritually. No one wants to be seen as weak, and so as a result we do not seek help. It’s important that we understand that we can do both simultaneously. We can seek earthly help for our mental wellness AND we can pray too.

Magellan: Tell us about your presentation Equity as an Expectation on August 30th at 2:00 p.m. ET.

Dr. Freeman-Foster: With Equity as an Expectation (information and free registration under Upcoming Events here), we will explore strategies to create an environment where people, no matter their demographics or life experiences, can expect that they will receive culturally responsive services in an equitable manner and have equitable outcomes.

The reason that equity is missing in a lot of our programs and services is because it has been allowed to be optional. I compare it to a grocery store. You have young adult services on aisle five, HIV services on aisle six, mental health services on aisle seven, substance use services on aisle eight, physical health on aisle nine, and then equity on aisle three. If we truly want to make a positive impact in all our interactions, then equity must be the shopping cart. It must be the first thing that you come in the door with, and the thing that everything builds on top of. It is about interweaving equity practices into everything that we do, versus having equity as an optional standalone practice. There must also be accountability measures in place for all team members, and a consistent process for reviewing progress, outcomes measures, and follow-up actions.

Dr. Tonicia Freeman-Foster has over 20 years of experience in cultivating hope, resiliency, and wellness through her work with underserved persons and marginalized communities. She is passionate about her work in assisting organizations and leaders in understanding how their beliefs and actions impact diversity, equity, inclusion, belonging, and justice for staff, clients, and communities. Dr. Freeman-Foster possesses extensive experience in matters related to mental health, substance use, child welfare, HIV/AIDS, and LGBTQ+, youth and young adult, women, Black, Indigenous, and People of color (BIPOC) populations. 

Dr. Freeman-Foster is the co-founder and principal consultant at Kusudi Consulting Group, and she also currently serves as a change specialist at Change Matrix. In these roles, she provides training, technical assistance, and coaching to individuals, communities, and organizations throughout the nation. In her previous role, Dr. Freeman-Foster served as project director of the Florida Healthy Transitions program and led the development of an innovative peer-to-peer behavioral health model for youth and young adults. Dr. Freeman-Foster possesses a Bachelor’s degree in Health Science Education (Community Health) from the University of Florida, a Master’s degree in Human Services (Organizational Management and Leadership) from Springfield College, and a Doctorate degree in Education (Organizational Leadership) from Argosy University. Dr. Freeman-Foster is a Certified Diversity Professional, Certified Health Education Specialist, Certified Courageous Conversations About Race™ Practitioner, and Certified Project Management Professional.

This is an excerpt from the Magellan Healthcare eMpowered for Wellness July 2021 newsletter. To read the full article, go here. For more information and resources to support BIPOC mental health, and to register for Dr. Freeman-Foster’s continuing education credits-eligible webinar, visit MagellanHealthcare.com/BIPOC-MH

Explore tips and information to protect your mental health and deal with grief and loss of loved ones due to the worldwide impacts of COVID-19.

When else in our lifetime can we say all people in all countries of the world have directly experienced grief and loss due to the same traumatic event? Now that we are living through the COVID-19 pandemic, this is the sad reality. Our very sense of normalcy has been turned upside down, we have lost loved ones, missed milestones and other life events, and faced social isolation. We all hear about the traumas that occur across our globe – 9/11, weather events, war – and we may be affected; but COVID-19 has profoundly touched and changed each of our lives in many similar ways. As our world is adjusting to a now improving, but still evolving, pandemic, here are some tips to protect our mental health.

Dealing with grief and loss from COVID-19

While it’s never easy when we lose a loved one, grief and loss during the pandemic has been exacerbated by the confusion, fear, and social isolation we have all experienced. The novel coronavirus, COVID-19, did not come with an instruction manual and we had to learn, very quickly, how it was spread, how it affected those who got infected, and how to avoid being infected. Confusion around all of these things, and how a family member or friend could have died from this virus, was inevitable. At the same time, fear of the unknown and for one’s own health and safety was inescapable. Due to the critical social distancing measures, we could not even visit our loved ones in the hospital, even if the worst was expected. We could not begin our grieving process by honoring those we lost with traditional funeral services. As we’re navigating the stages of grief during COVID-19, here are some things to remember:

• You may hear about the “stages of grief,” but it’s normal to bounce back and forth between the stages and not experience them in a linear way.
• No matter what you’re feeling, your feelings are valid, and you are entitled to them; avoid telling yourself you should be feeling one way or another.
• Grieving doesn’t mean you are forgetting or totally letting go.
• It’s important to build a support system.
• With grief comes growth.

Practicing self-care to cope with grief and loss

Grieving is an intensely personal process. We can start to feel better when we reach out to loved ones and professionals for support, but there is no one who knows us better than ourselves, and we can always be our own best advocate. Knowing that our lost loved ones surely would want us to be happy and not suffer, it’s important to prioritize our own self-care and compassion to unlock its immense healing power. Engaging in self-care activities – exercise, journaling, meditation, doing something creative, etc. – can help us build resiliency and mental strength, elevate our mood, process our feelings, and cope effectively. As we strive to take care of and make time for ourselves, the following are some tips to keep in mind:

• Understand that grief is an ongoing process; it requires our self-patience and kindness.
• Realize that helping yourself does not mean you are avoiding the experience, rather that you are embracing it.
• Treat yourself the way you would treat a close friend or family member who is going through the same thing.
• Be deliberate and purposeful in taking breaks to mentally check out and/or do something that makes you happy or laugh.
• Focus on the present to ease the burdens of, and make more palatable, all that must be done that day, week, month, etc.
• Grant yourself permission to feel, as it’s a natural part of the grieving process; understand it’s okay to be vulnerable.

We can find meaning in the losses we have endured through this ordeal. Our lost loved ones gave us many gifts, and we can pick up on those gifts in celebration of their memories. We can embrace life and do the things that make us happy. We can reflect on the changes and losses caused by the pandemic that forced us to reevaluate our priorities, taking with us the good and leaving behind the bad. And we must always remember to seek help when it’s needed.

By Dr. Paula Hensley and Sagar Makanji, PharmD

Think back to New Year’s Eve, Tuesday, December 31, 2019. Maybe you had big plans that night to ring in the new year, or maybe you were spending a quiet evening at home. In either case, you probably had expectations about 2020 and hopes that it would be happy, healthy and prosperous…

Fast forward a couple months to February, 2020 when we began hearing more about a new coronavirus, COVID-19, originating from Wuhan, China that had made its way into the United States and was beginning to spread.

Changes caused by COVID-19

We started to see our world and our lives drastically change, experiencing loss and grief in several forms. For many of us, there were no more commutes to work, as we began to work from home if we were lucky enough to keep our job. There was no more getting the kids off to the bus stop or waiting in the drop-off line, as schools closed and switched to a virtual learning environment.

Parents lost the luxury of being able to fully concentrate on their jobs, as they were forced to take on the roles of teacher or daycare worker and daytime entertainer for their kids. Kids missed out on receiving the first-class education they depended on to feel prepared for the next school year or even college.

Healthcare workers risked their lives and those of their family to care for the people who were getting sick from COVID-19, worried they had been infected and wanted to get tested, or needed regular healthcare. Essential workers in grocery stores, post offices, public transportation, and other industries also became heroes as they continued to come to work to keep the country running, despite fearing for their own health and lives.

And there wasn’t a roll of toilet paper or paper towels to be found.

Social isolation

Across the board, we didn’t get to spend precious in-person time with our extended family and friends because we were doing our part to bend the curve and stop the spread of COVID-19. We didn’t get to go to the gym and may have fallen behind in our physical fitness. Our kids didn’t get to participate in their beloved sporting or other extracurricular events. Medical procedures were cancelled. Vacations were cancelled. Weddings were cancelled. Graduations were cancelled. Everything was cancelled.

Our dreams and plans were put on hold.

COVID-19 mental health toll

We certainly couldn’t have imagined this would be how the year would start off and end. Spring, summer, fall and winter, and all that comes with each, did not happen the way we have all become accustomed to for our entire lives.

And while we have done our best to adapt, the grief and loss of loved ones, financial security and social normality we have experienced over the past year has taken its toll on our mental health.

Where to go from here

We encourage you to watch a recording of our webinar “Coping with grief and loss during COVID-19” with Paula Hensley, MD, Magellan Healthcare senior medical director; Sagar Makanji, PharmD, Magellan Rx vice president, clinical strategy and programs; and Mark Santilli, PharmD, Magellan Rx senior director, clinical strategy and programs, as they share knowledge and tips for persevering after grief and loss due to COVID-19 and answer audience questions.

For additional COVID-19 resources from Magellan Health, click here.

By: Linda Y. Evans and Greg Dicharry

Before the COVID-19 pandemic started wreaking havoc on various aspects of our “normal” lives, including our mental health, 1 in 6 children aged 2-8 years in the United States was diagnosed with a mental, behavioral or developmental disorder.[1] While these children have endured the impacts of drastic changes over the past year, so too have others who did not previously have a mental health diagnosis; some children have been newly diagnosed with a mental health condition as a result of COVID-19. When considering how to nurture the mental health of our children during a pandemic, we must understand their pre-pandemic mental state and monitor how they are coping.

Children diagnosed with a mental health condition before COVID-19

For children who experienced mental health challenges before COVID-19, the pandemic may have imposed new complications. In many cases, before COVID-19, families practiced a routine in their daily lives, which helped everyone manage their feelings and behaviors. When routines changed – kids were no longer going to school, adults were working from home, or not at all, and in-person interactions with friends, extended family, and even doctors were cut off – that familiarity and rhythm, and the associated therapeutic effects, were lost. Another part of the pre-pandemic routine for many children with a mental health diagnosis was the special help received by trained teachers and therapists in schools. While this support could be a vital lifeline, it was completely cut off for the kids who depended on it. Other treatment options, through primary care and other outpatient settings, also dwindled due to office closures caused by COVID-19. As a result, an increasing number of children were seen for mental health-related care in emergency departments (EDs). From mid-March to October 2020, the Centers for Disease Control and Prevention reported an increase in the proportion of mental health-related ED visits among children aged 5-11 years (24%) and 12-17 years (31%) compared with the same period in 2019.[2]

Serious mental health impacts for children as a result of COVID-19

Children and youth who started off 2020 without a mental health diagnosis may not have ended the year in the same way, as newly developed depression and other mental health conditions were caused by the pandemic. A CDC report on mental health, substance use, and suicidal ideation during the COVID-19 pandemic shows that while 11% of adults seriously contemplated suicide in June 2020, the same was disproportionately reported by young people aged 18 to 24 (26%).[3] The serious effects on younger children include delays in social and emotional development, as their brains are forming amidst irregular human activity. In some cases, when parents weren’t adjusting or handling the increased stress and uncertainty well, maltreatment in the form of child neglect or abuse has resulted.

Negative mental health consequences of COVID-19 for all children

Because of COVID-19, all children are coping with unprecedented change and loss. Children feel the family stress of economic hardships, health concerns, social isolation, exhaustion, bereavement, and worsening mental health and substance use. And children have stressors of their own. When healthy outlets, like school, sports, and social engagements, are lost, that energy may become more negative and unproductive. The impacts of missed once-in-a-lifetime childhood events, like birthdays, graduations, and family vacations, may not even be fully realized until later in life. Children and youth may also experience their own anxiety and stress about what the future looks like.

The state of mental healthcare for children

There have always been barriers for children to access mental healthcare. Among them are stigma, availability, misinformation, and lack of information. While these factors impact access to care for adults, as well, they may be more pronounced for children. Parents are afraid or do not want to accept that their child is affected by a mental illness. There is a shortage of child and adolescent psychiatrists and therapists trained to work with children in our country. In addition, many parents and caregivers are misinformed about child psychiatric services that are meant to improve a child’s mental state, and not necessarily their behavior, although the latter may be a secondary effect.

With the pandemic, parents may be so preoccupied that they cannot see potential conditions in their children. The advent of a pandemic has stretched an already thin system of specialized mental healthcare for children at a time when it may be needed the most. And misinformation continues to plague our news sources and social media.

Where to go from here

There are many things that parents and caregivers can do to support and nurture their child’s mental health. We encourage you to learn more in a recording of the webinar, “How are your kids doing?” where I was joined by Greg Dicharry, CPRP, youth empowerment director, to share knowledge and our years of experience working with children to improve mental health and wellness and answer audience questions.

[1] https://www.cdc.gov/childrensmentalhealth/data.html

[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6945a3.htm

[3] https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm

For our kids, disruptions caused by the COVID-19 pandemic are likely more than just that – temporary inconveniences, varying in severity, until life goes back to “normal.” Besides missing out on once-in-a-lifetime events, like graduations, birthdays and other milestones – at least in a way they would traditionally be observed – regular human interactions, part of social and emotional development, have changed. While adults may be experiencing a serious blip on the radar, children may be experiencing an interruption in brain development and/or lack the ability to fully cope in this unchartered territory.

In this post, we will contemplate these issues and draw on knowledge from Magellan Healthcare’s recently updated clinical monograph, Understanding and Meeting the Needs of Children and Adolescents at High Risk, which highlights evidence-based prevention and treatment approaches for problematic behaviors and various types of behavioral health challenges in children and adolescents.

As we think about the significance of childhood development, the following points from Magellan’s monograph provide insights:

A growing body of scientific information has confirmed the importance of the first five years of life, when the ongoing construction of brain architecture impacts youth social and emotional development, the ability to learn new behavior and skills, and how the youth evolves into adolescence.

Advances in neuroscience have contributed new understanding of adolescent development. During adolescence, the brain experiences a period of major development comparable to that of early childhood.

With much changing in our kids’ lives and environment – virtual schooling, modified in-person play arrangements with friends and reduced time with extended family – the responsibility falls on parents and caregivers, as it always does, to ensure their child’s wellbeing and adjustment. Magellan’s monograph offers the following to ponder:

While genes determine when specific brain circuits are formed, experiences actually shape their formation and are fueled by a self-initiated, inborn drive toward competence. This phenomenon depends on appropriate sensory input and stable, responsive relationships whereby adults respond to a child’s natural reaching out for interaction.

However, when parents are under unprecedented stress and often just trying to make ends meet, attending to their child’s increasing needs can understandably be overwhelming. In addition to the role of parent and full-time employee, many adults have taken on the additional roles of teacher, daycare worker and entertainer, to name a few. In some cases, however, a parent’s struggles may lead to neglect of their children. Magellan’s monograph highlights the following of child neglect:

While child abuse is more widely acknowledged and publicized, child neglect is, in fact, the most common type of child maltreatment, which frequently goes underreported. Expanding on the earlier discussion of impaired brain development, it is now understood that lack of stimulation and necessary care early in life may cause children to remain in a state of “hyperarousal” (i.e., constantly anticipating threats and/or experiencing dissociation) rather than a normal state of attentive calm. This phenomenon leads to a decreased ability to benefit from social, emotional and cognitive experiences and results in other psychosocial consequences. Together with insecure attachments, this state of hyperarousal can significantly affect normal growth and development.

Many parents are also managing their own mental health conditions and substance use disorder during the pandemic, which adds to the impact of what children and adolescents are experiencing themselves. The monograph outlines the risks for children of these parents:

There are many serious risks to children and adolescents who have a parent or both parents with mental illness. The American Academy of Child and Adolescent Psychiatry (AACAP) calls attention to the strong genetic predisposition in children for inheriting bipolar disorder, an anxiety disorder, attention deficit-hyperactivity disorder (ADHD), schizophrenia, alcoholism or other SUD, or depression. Recent studies have also demonstrated delayed brain development in young children of depressed mothers. Further, the AACAP notes the additional stress that mental illness places on a marriage and parenting abilities of the couple, and the risks that stem from an inconsistent, unpredictable family environment that can contribute to psychiatric illness and developmental delays in children.

It’s also appropriate to consider the older children and young adults who may lack the ability to cope with increased stress and instability. Magellan’s monograph calls attention to recent research:

A CDC report on mental health, substance use and suicidal ideation during the COVID-19 pandemic shows that while 11% of adults seriously contemplated suicide in June 2020, the same was disproportionately reported by young people aged 18 to 24 (26%).

During these difficult times, we’re all doing the best we can. And we know that brighter days are on the horizon. Until then, and always, as we’re helping ourselves and our children through, let’s remember that “information is power,” as they say. To that effect, we encourage you to learn more in our full children’s clinical monograph here.

As the new COVID-19 vaccine is being administered across the country, many people are feeling a mix of emotions. There is hope that the vaccine will normalize life and relief that the vaccine will save lives.  There is also anxiety about its potential side effects, long-term effectiveness and availability. For some, the stress and uncertainty caused by the pandemic are being exacerbated by vaccine concerns.

Vaccine safety

Although the two vaccines currently available were rapidly developed, they meet the safety and efficacy standards of the U.S. Food and Drug Administration (FDA). The data from the manufacturers and research from large clinical trials show that the benefits of the COVID-19 vaccines outweigh the risks of side effects and coronavirus infection. There are also other COVID-19 vaccines in development that must meet stringent safety standards before they can be released.

In addition, the Centers for Disease Control (CDC) and FDA have expanded safety monitoring systems to continue to track possible side effects of vaccines. A new easy-to-use, smartphone-based tool called V-safe enables vaccinated individuals to notify the CDC about any side effects. V-safe also texts reminders to get the second vaccine dose.

Anxiety about the COVID-19 vaccine

Anxiety can stem from fears about the vaccine’s safety, getting a shot or not having control over when it will be available.

Here are tips to help manage it:

• Stay informed and research credible sources. There is a lot of misinformation online about vaccinations in general. Follow credible news and information sources. Up-to-date information about the COVID-19 vaccines, side effects and benefits, and answers to frequently asked questions, are available on the CDC website.
• Follow recommended guidelines to keep yourself safe. It will likely take months for the COVID-19 vaccine to be available to anyone who wants it. In the meantime, take precautions to protect yourself and your family by wearing masks, maintaining social distance and washing your hands frequently. Minimize your risk of contracting the virus by following CDC guidelines on travel, gatherings and other activities that can spread the virus.
• Make self-care a priority and consistently practice ways to cope with stress. Anxiety can result from a feeling of lack of control and uncertainty, and the pandemic was the perfect storm of both. Get enough sleep, eat nutritious foods, exercise and take time every day for an activity you enjoy.

Finally, remember that feelings of stress and anxiety during difficult times are normal and will pass. If you find that anxiety continually affects your quality of life and you feel overwhelmed, consider talking to a mental health professional.

To learn more about Magellan Healthcare’s mental and behavioral health resources, click here. 

Source: Centers for Disease Control and Prevention

How we can comfort and support each other when grieving

Grieving the loss of a family member, friend or colleague is difficult. The pandemic has made it even harder for many people to cope. Those who have lost loved ones to COVID-19 or other illnesses may face additional grief and sadness. Infection control restrictions have left them unable to visit or say goodbye. Moreover, traditional wakes and funeral services have been modified or eliminated due to social distancing and limits on the size of gatherings, changing the way people can comfort and support each other.

Many people have experienced multiple losses. For example, the loss of a loved one at the same time as unemployment and social isolation.  The resulting grief may be prolonged and complicated with delays in the ability to heal and move forward.

Common Grief Reactions

Pain associated with grief is a normal response to loss and can be felt on emotional, physical and spiritual levels. Common reactions to grief are:

• Initial feelings of shock, denial, and disbelief, which can be heightened when the death is sudden and unexpected
• Feelings of worry, fear, frustration, anger or guilt
• Physical reactions such as headaches, fatigue, difficulty sleeping, loss of appetite, pain and other stress-related symptoms
• Spiritual expressions of grief, such as questioning the meaning and purpose of life, pain and suffering

There is no normal and expected time for mourning to end. Depending on the relationship with the individual and the circumstances of the loss, grief can last for weeks to years. Grief can ebb and flow at unexpected times, triggered by memories of the deceased person, holidays and anniversaries of loss.

Coping with Loss

It is important to find ways to express grief.

• Connect with other people, such as friends, relatives, support groups, and faith-based organizations if applicable, even if the contact must be virtual or by phone. Sharing your feelings with people who understand what you are going through is comforting and eases loneliness.
• Participate in an activity, such as planting a tree or creating a memory book, to honor the person you lost. Ask family and friends to contribute their memories and stories.
• Take good care of yourself. Maintain a balanced diet, moderate exercise and adequate sleep. Treat yourself to something you enjoy, such as a massage or a walk in nature.
• Avoid the use of alcohol, tobacco or other drugs to escape emotional pain.
• Don’t be afraid to ask others for help. Allow other people to assume some of your responsibilities when you are feeling overwhelmed.

When time has passed, if you are still having difficulty functioning, seek support through grief counseling, your EAP, support groups or hotlines. As writer Vicki Harrison said, “Grief is like the ocean; it comes in waves ebbing and flowing. Sometimes the water is calm and sometimes it’s overwhelming. All we can do is learn to swim.”

Find ways to deal with negative emotions

There is no question that the pandemic has affected the mental and emotional health of Americans of all ages. We have experienced months of social isolation, job changes and unemployment, school closures, and other disruptions. This has led to a surge in the number of people reporting high levels of stress, anxiety and depression. Given the uncertainty of when life will return to normal, finding ways to manage negative emotions and strengthen your mental health is important.

Building and exercising resilience skills can help protect your mental and emotional health. Try these tips:

• Stay in touch with positive and supportive people, even if you can’t see them in person. Strong social connections can reduce stress and help you feel happier and more energetic. If you haven’t already, learn to use video platforms like FaceTime and Zoom to stay in touch with friends and family.
• Practice ways to manage everyday stress. For some people, a daily walk eases the pressure of the day. Try meditation, reading, yoga, working on a hobby, listening to music or any other activity that you enjoy. Practice finding something you can be grateful for every day. You will feel more positive and recharged.
• Find what motivates you. Research shows that people who feel they have a purpose in life tend to be happier and live longer. For some, being creative, helping other people or devoting their time and energy to a cause can be the best motivators.
• Make self-care a priority. Physical and mental health are closely intertwined. In difficult times, it is important to get enough sleep, eat a healthy diet and exercise. Avoid using alcohol, tobacco or other drugs to cope with negative emotions; they can make sadness, depression and anxiety worse.
• Limit the amount of time you spend on social media and the news. If you are constantly frustrated and upset over what you see in the news or on social media, limit or take a break from both.
• Maintain your sense of humor and practice reframing negative thoughts. If you become aware that negative thoughts and images are invading your mind, draw your attention to your surroundings. Being present in the moment, or mindful, is one way to break a pattern of negative thinking. Humor is another way to defuse negative emotions.
• Give others the benefit of the doubt. Everyone is affected by the pandemic in one way or another, and others’ emotions may not be obvious. Be kind in any interaction with others.

If you find that your mental health symptoms are negatively impacting your quality of life, consider talking to a professional.

To learn more about Magellan Healthcare’s behavioral health resources, click here.