Yoga: More than Exercise - Greater Nashua Mental Health Center

Transcription

Greater Nashua Mental Health Center
at Community Council
Trauma:
Healing
America's
Invisible
Wounds
May is Mental Health Month
7 Prospect Street ● 15 Prospect Street ● 100 West Pearl Street ● 440 Amherst Street
Nashua, NH ● 603-889-6147 ● Emergency 800-762-8191 ● VP 603-821-0240
www.gnmhc.org
Serving Amherst, Brookline, Hollis, Hudson, Litchfield, Mason, Merrimack, Milford,
Mont Vernon and Nashua
May 2012
Cover design by Jeanne Maestranzi
PAGE 2

MAY 2012
Greater Nashua Mental Health Center at Community Council
With increasing economic troubles piled upon the stress of work and family demands,
Americans continue to report struggling in their lives. Locally, requests for Greater Nashua
Mental Health Center’s Assessment and Brief Treatment Program services are increasing as
family stressors mount.
Our Assessment & Brief Treatment Program provides care to adults in need of short-term
mental health services. Their problems might include depression, anxiety, losing a job,
losing a spouse through death or divorce, serious illness of a loved one – all of which are not
only emotionally painful, but can also take their toll on family stability and diminish
productivity.
Fees for counseling, group therapy, medication, and other treatment services are determined
individually on a sliding scale based upon income and family size. It is only through the
support of the towns we serve and donations such as those businesses and individuals who
appear in this insert that we are able provide essential mental health care to all our neighbors
in need, regardless of their insurance and financial status. Thank you.
Find a Medical Provider
Visit the Online Provider Directory
at www.stjosephhospital.com
or call (800) 210-9000
2012 Board of Directors
President:
First Vice President:
Second Vice President:
Secretary:
Treasurer:
Assistant Treasurer
Executive Director &
Chief Medical Officer:
H. Scott Flegal, Esq.
James S. Fasoli
Earle Rosse
Jone LaBombard
Marie Tule, C.P.A.
Edmund Sylvia
172 Kinsley Street, Nashua, NH 03060 • (603) 882-3000
Hisham Hafez, M.D.
Pamela Burns
M. Patricia Jewett
Timothy J. McMahon, Jr.
Donald L. Mousseau, Jr.
Kathie Rice Orshak, MA
Richard L. Sharkey
Mary Ann Somerville
Dare
to
m
a
e
r
D
Dare
to
Dream
Helping families cope with autism, including
people with disabilities in our community,
and keeping elders safe at home.
144 Canal Street, Nashua, NH
(603) 882-6333
www.gatewayscs.org
Greater Nashua Mental Health Center at Community Council Keeping the Promise:
Serving our Community with
Commitment and Collaboration
Hisham Hafez, MD
Executive Director & Chief Medical Off icer
Over the past several years, despite – and
because of – these challenging economic times,
Greater Nashua Mental Health Center has
responded to emerging needs and gaps in the
delivery system by taking the lead in developing
novel programs and strengthening existing ones.
Nearly six years ago, we began a collaborative
endeavor with the Nashua District Court, establishing the Community Connections Mental
Health Court in order to better address the
needs of individuals suffering from mental illness
who are involved in the legal system by providing
psychiatric services in the community and diverting them away from more costly interventions
in the county jail. Over the past three years, we
have collaborated with the Mental Health Center
of Greater Manchester, courts throughout the
county, public defenders, prosecutors and the
Hillsborough County Department of Corrections
to expand Community Connections into a
county-wide program that has received national
recognition. Our patients benefited and societal
resources were used more efficiently. We saw
demonstrable reductions in the time such individuals spent in jail and rates of recidivism while the
patients received timely community-based care.
Our SAMHSA-funded Healthy Connections
– Integrated Primary and Behavioral Healthcare
Program was developed to address a very serious public health problem – the appallingly poor
health outcomes for people suffering from serious
mental illness. We have partnered with Lamprey
Health Care and HEARTS Peer Support in the
creation of this innovative project. At the mental
health center, we now provide primary health
services and an array of wellness activities as we
gradually change the nature of the work we do at
the Center. We based our approach on empowering our patients through knowledge, access to
timely care, and developed needed educational
and wellness programs. Much work remains,
but the process of transformation of the mental
health system into a comprehensive health home
has begun. In a short three years, progress has
been made, and our program is seen as a model
for others to implement.
Substance abuse disorders are prevalent, often
co-existing with mental health problems, negatively impacting the outcome of physical illnesses.
The public health recognition of the magnitude
of the problem and its societal cost unfortunately
does not translate in appropriate resource allocation and accessible services. Emotional suffering,
family disruption, tragic early death, and lost lives
are all too familiar to people who have to deal
with the disease in their lives or their loved ones.
We were keenly aware of limited resources, and
that what is available does not meet the needs
of our population or address the core need of a
chronic relapsing condition. Recognizing this,
we decided to act and began a small substance
abuse program
with one clinician. Over the
past five years,
this program has
grown to include
a wide array of
communitybased services
that include
consultation,
brief treatment,
Hisham Hafez, MD
an intensive outpatient program,
and outpatient detoxification for both adults and
adolescents. We are now offering services to people who suffer severe and persistent mental illness
who are disproportionately affected by substance
abuse problems.
We always envision the mental health center as
a community resource. Our success is dependent
on how we can demonstrate this in action. Our
Child and Adolescent Services Program collaborates with school systems providing mental health
service and consultation in area schools. We
expanded our Assessment and Brief Treatment
services, added to our medical staff, and we are
grateful that many graduate students, the clinical leaders of tomorrow, choose to spend part of
their internship with us. We chose to weather
the funding problems facing our Supervised
Visitation Center, keeping our doors open while
we worked tirelessly on a long-term plan. I am
grateful to add, because of staff commitment, we
are now on more firm footing.
Our Research Department provides state-ofthe-art treatments and collaborates in multicenter
research projects to bring novel therapies to our
community. We are determined not only to be
consumers of knowledge but leaders who participate in its development.
We accomplished this in a time of uncertainty,
societal change, economic strain and increasing
appreciation that the cost of health care is outstripping society’s ability to pay for it. We firmly
believe that a responsive mental health system
should address quality and value of its services
in order to alleviate suffering, empower people,
and enhance recovery while controlling cost and
strengthening our institution.
As we look forward, we are determined to meet
the challenges by reaffirming our commitment
to our patients, advocating for their needs, taking
responsibility for demonstrating the value of our
services, joining debates regarding policy decisions, continuing to develop ways to improve the
delivery of essential services, and seeking funds to
ensure their stability.
As a mental health center and as medical professionals, we are engaged in the raging debate as
to how to bring escalating health care costs under
control while meeting our responsibility to the
people we serve.
CONTINUED ON PAGE 4
MAY 2012

PAGE 3
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
MAY 2012
My Two Lives
Tom Doucette, Assistant Executive Director
H.E.A.R.T.S. Peer Support Agency
My story begins at the age of ten – that is when my Bipolar began. Although there were
mental health issues throughout my family, in my generation it was still not spoken about. I
know now that my struggles began at age ten because of the highs and lows that I had. I did
not see them then and evidently no one else did either or ignored the obvious. I would stay in
my room for days while my friends would come over and ask me to come out and play. Then
after those few days I would come out and just throw caution to the wind by doing jumps with
my bike or grabbing onto the back bumper of a city bus and sliding along on my shoes on the
snow-covered street while the bus went on its route. Of course that would come to a sudden
stop when I hit the bare pavement where the snow had melted away.
As I grew older my mood swings kept coming and going. Looking back, I now realize I had
more highs than lows, and that would be the pattern for my life until it all caught up with me.
Because of my being manic most of the time, I was a great employee because when you’re
manic there is no job that you can’t do and nearly all the time that was the case for me. I
worked for a research and development corporation for about ten years. Like I said, I was a
great employee but not a team player kind of employee. Everything I did was my idea, even if
someone else had given me the idea – without them knowing it, of course.
My life stayed pretty much the same until my mania just took over and I began a downward
slide that would see me losing everything. I was about thirty-five years old. I left my research
and development job less than six months shy of being fully vested in my 401. I walked away
from a secure well-paying job with unbelievable benefits to go camping for seven weeks. I had
no job, did not care to look for a job, nor did I care about getting one. It was then that I came
up with this great idea to move to another state where I knew absolutely no one and open
my own business. Well, start a new business I did, four of them. In the last business, I lost
everything and had to move back to the state that I had left and move into my parents’ home,
because I had nowhere else to go and no funds to do anything else.
At the age of fifty-six I was finally diagnosed as having Bipolar I. I experienced the usual
sort of realizations that comes with such a diagnosis later in life – at last I knew why I did all
those dangerous things, ruined personal and business relationships – and the list goes on. Then
came the denial, stopping medication, re-starting medication, attempts at harming myself and
the rest. Finally, I came to accept that I had this disease for life and that I was not Bipolar but
I have Bipolar and that Bipolar does not define who I am. As soon as I recognized that fact I
started my journey of forgiving myself for all of the harm and wrong that I had done to others
and myself. I always say that I was born at the age of fifty-six and it’s true.
I have repaired my life by staying on my medication, having been blessed with great psychiatrists and therapists, using coping skills that I have learned using WRAP©, and, most importantly, using peer support, and having a wife (Judy) who stood by me when most would have
walked out the door. We have now been married for eighteen years and I have always said that
she married two different men and has stuck with the best one of the two.
I started the Depression and Bipolar Support Alliance (DBSA) Nashua peer support group
nine years ago and we still open the door every Thursday evening. I now have the greatest job
anyone could have working with people who have mental health issues at H.E.A.R.T.S. Peer
Support Center in Nashua. It’s like when they interview a baseball player or a musician and
they say I do what I love and live to do it. I am making a difference in people’s lives and my
own. I learn new things about myself everyday by talking with my peers.
I would not change any part of my life because it has gotten me to the best years of my life. I
am now sixty-eight and intend to do what I love for many more years to come.
Keeping the Promise… CONTINUED FROM PG 3
While we have serious concerns as to some of the decisions that our elected officials have
recently made, we appreciate their attempt to balance multiple priorities and finite budgets.
However, walking away from our core mission, turning our back on the most vulnerable of our
citizens, or causing them undue anxiety about their care is never an option for a responsible
health care system. The simple truth is that good care saves lives, conserves resources, and controls budgets. Enlightened policy makers need to be aware of that if they are to discharge the
responsibilities they were privileged to accept when they asked for our votes.
We plan to tackle the current challenges with the same set of priorities that have guided our
actions: a commitment to our patients to treat each one with the respect they deserve, respecting their choices and utilizing their resources wisely.
Greater Nashua Mental Health Center at Community Council MAY 2012

PAGE 5
A Coordinated Community Response to Domestic Violence:
Working with Male Perpetrators
Rebecca K. Sartor, LICSW
Director, Community Support Services
Domestic violence is a prevalent social problem that is best addressed through a coordination of community stakeholders including law
enforcement, victim-witness advocates, judges,
prosecutors, service providers for victims, as
well as providers for perpetrators. As part
of the collaborative community response to
domestic violence, Greater Nashua Mental
Health Center offers a Batterer’s Intervention
Program with the ultimate goal of increasing
victim safety and perpetrator accountability.
Batterer’s Intervention Programs were first
developed over 30 years ago as legal systems
reformed to criminalize domestic violence and
prosecute perpetrators. These programs are
rooted in both feminist and sociological theories that reinforce that intimate partner violence is not the result of mental illness, anger,
dysfunctional upbringings, or substance abuse.
Rather, abuse is a learned behavior that is primarily motivated by a conscious or unconscious
desire by the abuser to control the victim.
The Batterer’s Intervention Program at
GNMHC includes an intake and 36-group
sessions divided into nine (9) themes that
are the basis of healthy,
violence are a means of
egalitarian relationcontrolling the victim’s
...programs are rooted
ships: non-violence,
actions, thoughts, and
in both feminist and
respect, support and trust,
feelings; to increase the
accountability and honwillingness
sociological theories that participant’s
esty, sexual respect, partto change his actions by
reinforce that intimate
nership, negotiation, and
examining the negative
fairness. Additionally,
effects of his behavior
partner violence is not
one theme is devoted to
on his relationship, his
the result of mental illthe impact of domestic
partner, his children, his
violence on children and
friends, and himself; to
ness, anger, dysfuncan overview of equality
increase the participant’s
tional upbringings, or
and partnership in a parunderstanding of the
enting relationship. The
substance abuse. Rather, causes of his violence; to
vast majority of men in
provide the participant
abuse is a learned
group are mandated to be
with practical informathere, although voluntary
tion on how to change
behavior that is prireferrals are accepted.
abusive behavior by
marily motivated by a
Referral sources include
exploring non-controllocal district and supeconscious or unconscious ling and non-violent
rior courts, Probation
ways of relating to
desire by the abuser to
& Parole, and Division
women; and to encourcontrol the victim.
of Children, Youth, and
age the participant to
Families (DCYF).
become accountable
Objectives of the
to those he has hurt
program not only include victim safety and
through his use of violence.
perpetrator accountability but also to help
Interventions in the program follow a genthe participant understand that his acts of
der-based, cognitive-behavioral approach with
a focus on delving into underlying thought
patterns and belief systems related to abuse
and violence, restructuring those patterns, and
developing alternative, non-abusive, thoughts
and beliefs. Specific intervention strategies
include handouts, group discussions, videos and
“vignettes” to exemplify abusive behavior, educational, as well as more didactic approaches.
Most of the men initially start the program
with great disdain, reservation, and denial.
Most, over the course of the 36 weeks, begin
to open up and identify their own abusive
patterns of operating in relationships. The
experience of watching the group elders
address abusive behaviors, confront peers on
minimization, denial, and blame, and address
colluding amongst group members head on is
a testimony that a change process is occurring.
With each small obstacle that is surpassed, it is
apparent that this program is a core component
of the coordinated community response, which
is still in many ways in its infancy in New
Hampshire. The hope is with more community knowledge of programs such as Batterer’s
Intervention, we can build more effective strategies to address the social problem of Domestic
Violence, protect victims, and create a safe
infrastructure that produces positive outcomes.
PAGE 6

MAY 2012
Attachment and Attachment Disorder
Kate Bernier, LICSW
Family Therapist
Coordinator of Outreach Services
Child and Adolescent Services
I’ll often hear a parent say, “My child doesn’t
have an attachment problem. He/she is attached
to me constantly. I can’t even go to the bathroom
by myself.” Attachment can be a confusing word
because it has many meanings, but this article will
focus on the term as it is used in child psychology.
In texts on child development, attachment refers
to a process by which a child gains a healthy sense
of self and an ability to enjoy and participate in
healthy reciprocal relationships. The child that
is described above, that cannot leave his mom’s
side, is anxiously attached; unable to explore and
enjoy his wider world with confidence. Another
problematic style of attachment is avoidant
attachment. The avoidantly attached child might
appear quite independent, denying any need for
help. She interacts with others primarily when it
appears she has something to gain. Children (and
adults) with these difficult styles of attachment
are often described as “manipulative,” treating
others as if they were vending machines; and
their affection often feels wooden or superficial.
Parents and others complain of them that they
don’t show empathy or remorse. They don’t seem
to experience real joy and seem to lack the ability
to engage in relationships simply for the pleasure
of being together.
What is this process of attachment and what
are the factors that cause it to go well or not so
well? Most people are familiar with the scene of
a mother and her new infant and the interactions
that take place many times a day over the first
months and years of the child’s life. When things
are going well and the caregiver is emotionally
available, the pair are looking into each others’
eyes, holding each others’ gaze, making soft and
comforting sounds back and forth. The caregiver
mirrors the infant’s facial expressions, often with
an exaggerated face; smiling or looking surprised
or delighted; sometimes showing concern for
hurts, etc. Researchers and developmental psychologists have discovered that a powerful process
is taking place in the small child’s brain during
these interactions. The neural center for emotion
regulation and emotional intelligence is active
during these intense experiences. Neurons fire
and neural pathways are being built; as the brain
is developing at a rapid rate. This same part of
the brain goes quiet when the child is left alone.
During the first three years of a child’s life this
kind of interaction will typically take place over
and over, many times a day, week in and week
out. The child
will typically seek
out the mother’s
face, show
delight when
he recognizes
her and eagerly
take part in this
primal “dance.”
At the same
time, the parent
is rewarded by
the child’s delight
and experiences
him or herself as
competent and gratified in the role of caregiver.
When care giving is reliable and the primary
caregiver (usually, though not always, the mother)
is emotionally available, the child is learning that
relationships can be fun and pleasurable and that
he, the child is lovable and special, and worthy of
his mother’s attention. This relationship becomes
the first model upon which later relationships will
be based. It is also during this interaction that
a small child is learning to manage strong emotions, to self soothe, to read social and emotional
cues, and to begin to interpret his own emotional
states. In these early years we can also see the
beginnings of reciprocity, as when a toddler tries
to feed his mother or to comfort her if she is hurt.
This is where empathy is born in exact imitation
of what the child experiences from his caregiver.
The child is also learning that he can have an
effect on the world, can make things happen, as
adults respond to his social overtures. This sense
of efficacy becomes integral to one’s self confidence and sense of self.
This is the process called “attachment;” and the
multiple repetitions of an infant and toddlers’
needs being met by a loving, responsive, reliable
caregiver is called “the cycle of attachment.” It
is an important process that can have profound
effects on the way we feel about ourselves and
the way we interact with others later in life.
Although parents virtually always want what is
best for their children, parents are never perfect;
and therefore no one’s attachment experience
is perfect. We all have insecurities, moments of
self-doubt, and occasional problems in relationships that can stem from this first experience
with relationship. Child psychologists have
a term, “good
enough” parenting to describe a
relatively healthy
parent that
raises a relatively
healthy child.
Attachment
disorders occur
when there is a
significant disturbance in the
attachment cycle in the first three years of life.
This can happen for a broad variety of reasons
and understanding the reason is never about
blame or finding fault. As was said earlier, virtually all parents want what is best for their children, but as we all know, other things sometime
intervene. Some examples are: prolonged illness
or absence of a parent; depression or other mental
illness in a parent; changes in caregivers; parents
who are preoccupied with their adult relationships, such as those in a conflictual relationship or
going through a divorce; a predisposing medical
condition in the child that makes him particularly
difficult to parent; substance abuse; and abuse and
neglect. These conditions do not always produce
attachment disorders, as even under difficult circumstances parents will strive to meet their children’s needs; but parents are often unaware of the
powerful and far reaching learning that is going
on in that tiny little head.
Infants only have a few ways to let their needs
be known. When reliable care is disrupted, a
negative attachment cycle can be set into motion.
This happens when a child makes a signal for
pleasurable interaction (seeking, smiling) or for
help (crying, whimpering, fussing, clinging) and
the child’s signals are not answered. The child
increases his efforts (screaming, hitting). These
attempts to communicate become increasingly
unpleasant to the parent who may respond in
anger or want to spend less time with the child.
This will prompt the child to even more desperate measures. If this is repeated regularly the
child learns that only persistent and aggressive
behavior will be responded to; or he may give up
and respond indifferently to the parent. In either
case, both the parent and child begin to experience the relationship as unrewarding and possibly
fraught with unpleasant feelings. In many cases,
the parent has some good moments when the
child gets a glimpse of how wonderful a loving relationship can be, but when other things
intervene, that wonderful aspect of the adult may
disappear and the child has no way of eliciting it.
This leads to the most common style of attachment: the ambivalent, or approach-avoidant style.
This is seen in a child who persistently intrudes
into the adult’s attention, but does not trust that
it will be given and so ensures that he or she will
be rejected on his own terms by provoking displeasure.
When the negative cycle is repeated, the child
develops a sense of the world as unsafe and
unpredictable, a sense of adults as inconsistent
and therefore untrustworthy, and a sense of self
as defective, shameful and unlovable. At the same
time, the young child is learning a set of coping
skills to manage and survive in what feels like a
hostile world. And because of the life and death
nature of survival, these skills become instinctive
and are held tenaciously into older childhood
and even adulthood. These can include an array
of problematic social behaviors, but they are all
generally driven by fear of the shame and vulnerability being exposed, an instinctive distrust of
adults, and a need to always be in control.
By school age, children with attachment disorder are typically showing a disturbance in relatedness to others. An example might be intense but
unstable relationships in which the child tries
desperately to get attention but does not seem
to enjoy it and it is never enough. In other cases
this is shown by indiscriminate superficial affection that seems only designed to get the child’s
needs met; treating others as if they were vending
machines. Hugs may seem wooden and artificial.
CONTINUED ON PAGE 11
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view of ourselves, but will also tend to have less
anxiety. We lose the sense of the “enemy within.”
We allow ourselves to feel our feelings because
For several years now the Child and Adolescent we are no longer afraid of them, and therefore are
Department at GNMHC has offered an expresmore present and aware of our immediate experisive group therapy program to treat clients who
ence; and are more available to life in general.
have experienced trauma or who have anxiety or
Expressive therapy can include a variety of
other mood disorders. The name has changed
interventions including visual art, movement,
a number of times, but the groups have always
creativity, problem solving, and interaction. Each
included a component of yoga as well as other
intervention is designed to assist the expression of
expressive therapies; and the groups have always
some suppressed or silent or traumatized part of
included the social aspect of
the individual and integrate
growth in relation to others.
it into the experience of the
The central idea from the
whole. Because we are social
Expressive therapy
beginning was to provide
animals, this experience of
is designed to treat
an experience for the group
growth as a shared experithe whole person, to
members that would begin to
ence is particularly powerful
integrate their sense of themand healing. Generally social
bring together the
selves and would develop a
situations produce more
fragmented parts.
respectful and accepting view
anxiety, so the mastery of
of their bodies and emotional
that anxiety in group is proexperiences.
found and the presence of
A common experience in the big Traumas
group members who challenge us and draw out
and little traumas of life is that the sense of self
different aspect of ourselves and bear witness to
becomes fragmented. The parts of self that are
our experience, enhance it and make it feel more
associated with an overwhelming or unpleasant
real.
experience become compartmentalized and disYoga was the original inspiration for the groups
sociated or avoided and our perception of some
because of its effect on joining body, mind and
aspects of self may become negative. An example
spirit—or emotions. It contains contemplation, a
might be when one is exposed to domestic viostilling of the mind to allow one to become aware
lence and the effect of extreme anger between
of the present moment. It teaches radical accepindividuals. One might fear the power of one’s
tance of one’s experience--noticing the experiown anger and keep it stuffed down. The fact
ence without our constant tendency to evaluate
that it eventually explodes out of proportion to
whether it is good or bad. It teaches us to know
the event that finally triggers it only confirms to
our body’s abilities and limitations and to respect
us that it is a thing to be feared and must be kept them. It teaches us to be strong and balanced
under wraps. The effect is a blunted emotional
and a useful container for the visceral aspect of
state where one is not fully present with what one our emotions. So for instance when we are angry,
is feeling.
we notice the pulsing in our temples, the clench
Another example might be when the body is a
of our jaw, the tautness of our muscles; without
reminder of an abuse or trauma, one might disdeciding if these sensations are good or bad;
sociate from the body and see it as loathsome.
without fearing the emotion and the sensations of
When this happens, a person is less likely to take
it; and without feeling the need to either act on it
good care of the body, practice good habits and
or push it away.
monitor risks. To one degree or another, and
One definition of yoga is “organizing the organfrom time to time, we all experience some form of ism.” It is called a practice because one can never
dissociation or not being fully present and aware
complete it. One can’t fail or succeed at it; and
of our own experience. A typical example would
since the practice amounts to knowing ones self,
be suddenly realizing that you have been walkone can’t compare one’s practice to that of another
ing or driving on “autopilot” and don’t remember
person. There is no competition. But we can learn
the last few moments. When this happens frefrom one another.
quently and to a considerable degree, it is anxiety
The groups have always ended with what we
provoking. One is never sure when one will be
call “Final Relaxation” which involves lying on a
blindsided or hijacked by a part of one’s self that
yoga mat in stillness and silence and hopefully
one is not fully aware of. It becomes difficult to
completely relaxed while we listen to soothing
concentrate, to be successful in school, to carry on music or have a guided relaxation. Because of the
friendships and other pleasurable pursuits.
quiet and the close proximity of the group memExpressive therapy is designed to treat the
bers, it has always been the most anxiety provokwhole person, to bring together the fragmented
ing part of the group, but year in and year out it
parts. It helps to build a respectful and appreciahas also always been the group members’ favorite
tive awareness of the mind, the body, and the
activity. In that shared quiet it becomes difficult
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week after week that shared experience becomes
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MAY 2012
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Depression and Diabetes
When you’ve got diabetes, it’s understandable to feel stressed out or even be depressed
at times. In fact, depression occurs more in
people with diabetes than in the general
population, according to the American
Diabetes Association.
Across all age groups, ethnicities and
income levels, depression is more common
than many people realize. More than 20 million people in the United States suffer from
depression.
Depression responds well to treatment. But
if not treated, it can be a serious danger to
your health.
How does depression feel?
Occasional feelings of sadness are part of
life, of course. But if you feel sad for more
than a few days, have lost interest in activities that you usually enjoy and feel tired or
hopeless, you may be dealing with depression.
If you live with diabetes, depression can
make it harder to cope with its challenges. It
can cause more physical discomfort. Sticking
to your diabetes management plan can seem
more difficult. For example, things like
managing blood glucose levels, taking medications as prescribed and following healthy
lifestyle habits can seem overwhelming
when you’re depressed.
What to watch for
Symptoms associated with depression vary
from person to person. They also may be
difficult to recognize at first. The two most
common symptoms of depression are:
• Feeling hopeless or sad nearly every day
for at least two weeks
• Losing interest in or not enjoying usual
daily activities nearly every day for at least
two weeks
Other symptoms include:
• Changes in appetite; weight loss or gain
• Changes in sleep patterns
• Difficulty making decisions
• Trouble focusing and concentrating
• Feeling very slow or lazy
• Feeling very anxious or agitated
• Feeling isolated from the world
• Crying for no reason
• Thoughts of suicide
What to do
If you think you may be depressed, speak
with your doctor right away. There are many
ways to treat depression. A combination of
individual therapy and medication is a common and effective treatment for depression.
Lifestyle changes, such as getting more exercise, can also make a big difference.
Knowing the symptoms can put treatment
to work for you or a loved one sooner. And
when you feel better, it's easier to take better
control of your diabetes and your health.
Reprinted with permission from Harvard
Pilgrim Health Care of New England
Busy Parents
and Struggling
Children
Laura Morin, MA
Coordinator, Mental Health In Schools Program
Imagine watching your child struggle and not being able to help. For some families it has been
a challenge to seek and maintain mental health treatment for their children due to work, lack of
childcare, disabilities or transportation issues. The Greater Nashua Mental Health Center has
partnered with 8 of the Nashua Schools and 3 in the Hudson School district to provide confidential, consistent therapeutic treatment to children that may otherwise be unable to regularly access
our services.
There are several benefits to having access to therapy in school while overcoming the obstacles
mentioned above. It can facilitate the development of functional coping skills in the environment
they find challenging. It also can enhance communication and collaboration between providers
ensuring consistency in your child’s care. However, being seen in a school can make it challenging
for a parent to remain consistently, actively engaged in their child’s treatment. It is important to
maintain open communication with families and family therapy appointments are encouraged at
least monthly.
In addition to receiving individual therapy in their school building, these children may have access
to any adjunct services through our agency as appropriate, such as Functional Support Services,
Medication Management or group therapy.
Parents should see the school’s guidance counselor to make a referral. We are currently in the
following schools in Nashua: Dr. Crisp Elementary, Fairgrounds Elementary, Mount Pleasant
Elementary, Ledge St School, Amherst St. School, Elm St Middle School, Fairgrounds Middle
School and Pennichuck Middle School. In Hudson, we are in Library St. School, Dr HO Smith
School and Hudson Memorial Middle School.

PAGE 9
PAGE 10

MAY 2012
Medicating Children: Challenges for Providers & Parents
Daniel P. Morin, MS, ARNP
Director, Child & Adolescent Services
The decision to use psychiatric medication for
a child is one of the most difficult that a parent
will ever need to make. Prescribing psychiatric
medication to a child is one of the most daunting tasks facing medical professionals. In 2008,
I wrote an article on this topic. I attempted to
address the very valid concerns regarding medicating children by describing the point of view
of professionals with the goal of showing how
good practice takes into account the concerns of
parents. I believe that the need is just as great
today, so I am presenting a revised and updated
version of the previous article.
While holding a personal view that psychiatric medication, used correctly, is safe and can be
effective in relieving the debilitating symptoms
of mental illness for many children, I understand the anxiety faced by parents who may
need to make the decision. I believe that there
are three significant take home messages that
sum up the provider’s point of view:
1 Medications are used to help patients.
2. Great effort is being made to develop
evidence-based practice in child psychiatry.
3. Non-medical interventions should
always be considered.
To discuss each of
these points individually: Medications
receive FDA approval
based on scientific
research, the final step
being placebo-controlled
trials using human subjects. Historically, doing
research with children
has been problematic.
For good reason, parents
were reluctant to enroll
their children in trials
and researchers were
hesitant to accept the
liability of working with
children. Fortunately,
there is a trend to correct this insufficiency
and today more decisions can be made based
on careful analysis of the “evidence” obtained
through research than ever before. The number
of medications officially indicated by the FDA
for treatment of childhood disorders continues
to increase at a slow but steady pace and more
importantly, the commitment to continue the
work necessary to provide scientifically proven
answers to the real life questions of parents and
children is as strong as
ever.
While advancement in
science remains a goal
for the future, there are
millions of children who
need help and treatment
today. The most unfortunate aspect of some
negative media coverage is the implication
psychiatric medication
is carelessly prescribed
for children and that the
people who prescribe the
medication are not concerned about the safety
of their patients. In
my view, the reality is much different: doctors
and nurse practitioners use the treatments that
are currently available, including medications
that are approved by the FDA to treat mental
disorders in adults, because it would be unfair
to withhold treatment until all of the studies
are in. Medical providers are confronted with
patients and families who may be suffering
from devastating illnesses and feel obligated to
use all of the tools at their disposal to relieve
Terry Gupta, MSW, E-RYT
May is National Mental
Health Month.
May also heralds the Spring;
season of hope, renewal, and
validation of the cycles of life.
It’s a time to shake off the
winter season, open the windows, clean the house and roll
out the yoga mat.
Roll out the yoga mat?
When we think about yoga,
most often an image of a very
flexible person in a complicated physical contortion of
the body immediately comes
to mind. Headstands, balancing on the arms, and splits are
what we tend to see in the
magazines and on TV.
What if seasoned teachers were to share, from their
very real experience, that yoga
is for every body and every
mind? Yes, just about any age,
and with any range of ability can do yoga. Those who
exercise several times each
week can enjoy yoga, as well as
those who have not exercised
in many years. Would that
surprise you? Would you still
have doubts?
In reality, those bendable physical movements, called asan, are only one of the many
aspects of yoga. Yoga is as simple as:
that suffering.
Additionally, I think that it is important to
mention that even though there has been much
progress made in the field of psychopharmacology for children, medication is never the first or
only option. Other forms of treatment, including therapy, need to be presented to families
as part of the process of obtaining informed
consent for medication. In fact, just as there is
more evidence based practice available to support treatment with medication the same is
also true for various forms of therapy. In other
words, medication alone is rarely the treatment
of choice. This is the philosophy that governs
practice at the Greater Nashua Mental Health
Center’s Child and Adolescent Department.
In conclusion, I realize that the parents of
children with mental illness can never be neutral observers. I recognize the unfortunate reality that the use of medication does not always
result in good outcomes. Being concerned and
asking questions can only improve care. My
goal in writing these articles was to provide a
perspective that practitioners who prescribe psychiatric medication to children share the same
concerns and that they are highly motivated to
use medication in a safe and meaningful way to
help children and families.
with this. Yoga is being studied as a therapeutic application
for hypertension, depression,
complex post-traumatic stress,
anxiety, insomnia, ADHD,
pain, fatigue, enhanced daily
functioning, and so much
more.
An interesting study was
conducted by researchers at
the University of Maryland
School of Nursing. They
found that “yoga actually outperformed aerobic exercise”
in a range of health parameters and in areas such as:
improving balance, flexibility,
strength, reducing pain levels,
managing menopausal symptoms, and enhancing daily
energy level, as well as social
and occupation functioning.
Jay Gupta, a pharmacist,
yoga therapist and lifestyle
coach, observes that “even the
most gentle yoga practice can
provide cardiovascular benefits
by lowering resting heart rate,
increasing endurance and
improving oxygen uptake”.
He continues that “yoga also
helps in lowering levels of the
stress hormone cortisol. This
can lower blood pressure and
heart rate, improve digestion, and boost the
immune system, and can bring relief to the
symptoms of conditions like anxiety, depression, fatigue, asthma and insomnia”.
Yoga: More than Exercise
1. conscious patterns of breathing
(pranayam),
2. gentle movements done seated, standing
or on an exercise mat that free the body from
stress and circulate freshly oxygenated blood
(asan),
3. clearing the mind using simple techniques
(pratyahar, dharana, dhyan), and
4. living in harmony with self and others
(yam/niyam).
The “science” of yoga attends not only to the
physical body and mind, but also the deeper
layers of our being. The clinical research on
the benefits of yoga is beginning to catch up
Greater Nashua Mental Health Center at Community Council Attachment and attachment disorder…CONTINUED FROM PG 6
The child can mimic happiness but never seems
to experience real joy. The profound anxiety of
being unattached in this world is managed with
controlling behavior. This often manifests as
oppositional behavior, argumentative behavior,
and deliberately annoying behavior. Attachment
disordered children keep others at a distance and
off balance by controlling the emotional climate
through constant chatter, nonsense questions,
lying, sneaking, stealing, and seemingly cruel
behavior. They feel safer when they know where
they stand with people, and they know where
they stand when people are angry with them.
When things are going well and people are happy
with them, they tend to get very anxious and need
to create distance.
Because they are not trying to please their caregivers (except when it suits their purpose), attachment disordered children usually have difficulty
learning cause and effect and therefore do not
respond well to discipline. A common feature in
the caregivers of these children is that the parents
seem unusually angry. Small wonder, since the
attachment disordered defense mechanisms operate primarily when there is danger of closeness,
the child is often “charming” to most adults while
deliberately targeting the parents. Parents often
feel isolated and misunderstood by other adults
who don’t see the worst of the behavior. These
caregivers are also usually worn out, having made
heroic efforts to do all the things that would be
effective for a child with a healthy attachment.
Parents are left feeling ineffective and lacking
even the simple reward of seeing pleasure in their
child’s eyes.
Parents are most often disturbed by their child’s
lack of remorse. “They don’t seem to care about
other people’s feelings.” And indeed, they do
not. They cannot because they do not know how,
because that learning did not take place in those
early interactions that give meaning and reciprocity to emotions. It is not a character flaw or a
defect that the child could have done anything
about, but it certainly feels like one when they
hear “What’s wrong with you?” “How come you
can’t be like other people?”
Early childhood is the ideal time for developing attachment because the emotional brain is
growing rapidly. The dependency of infancy with
its close, intimate, repetitive interactions is the
perfect environment in which to teach the child
how to learn to accept nurture and structure and
to develop a model of a pleasurable rewarding
life and so emotional development was arrested at
relationship. Without this emotional intelligence
an early age while physical and intellectual devela child becomes focused on survival needs and
opment continued. Thus an intelligent street wise
simply values relationships for getting needs and
teenager may have an emotional age that is much
wants met. Her sense of self is based on shame— younger. The treatment may appear “babyish”
a feeling of being unworthy, unlovable, of being
or juvenile at times; but because it matches the
bad. This feeling is so painful and unendurable
child’s emotional age, the child is usually receptive.
that a child will avoid any
Attachment treatment
experience likely to tap into
usually
includes the child’s
When care giving is
it. Therefore the one thing
parents or primary carereliable and the prithat the child wants most—
giver. Because attachment
intimacy—is also the thing
mary caregiver (usually, is about a relationship, it is
that she is most resistant
not something a child can
though not always, the resolve on his own. Parents
to because of its potential
to make her feel ashamed.
mother) is emotionally need to learn how to interAny perception of criticism
act with their child in a way
available, the child is
or anger is likely to trigger
that is more satisfying to
a powerful defense against
learning that relation- both of them. A therapist
shame: either rage out of all
can facilitate the interacships can be fun and
proportion to the event or
tions necessary to create the
a very bland “I don’t care”
experiences an attachment
pleasurable...
attitude, as the child cuts
disordered child needs.
herself off from her feelings
Treatment usually seeks
that are unmanageable. This makes it particularly to provide the experiences that the child missed
difficult to provide the rewards and consequences
early in life that would help him feel safe and
that generally work well in shaping a healthy
special and loved. This involves containing his
child’s behavior. The attachment disordered
negative behavior to protect him from repeating
child’s need to be in control and to avoid being
the negative cycle of attachment and to avoid
ashamed usually far outweighs the value of the
confirming his sense of shame. Thus a parent is
rewards and consequences.
encouraged to keep the child close and to narrow
While it is true that the optimal time for devel- his field of choices until he has shown that he can
oping attachment is in infancy and toddlerhood,
manage more. This is not done in a punitive way,
fortunately it is also true that humans can learn
but in a loving and protective way, as a caring parand change throughout the lifespan. The brain
ent would with a small child. The message to the
continues to grow new neural pathways and we as child is that the adults are in control and will take
humans typically seek reparative experiences. In
good care of him and make good choices for him
the last few decades much research and clinical
so that he can focus on age appropriate activities
practice has focused on understanding and treatrather than survival needs. Rewards and conseing attachment disorders. There are treatments
quences are consistent, without the expectation
and interventions that have been successful in
that the child will value them in the beginning;
reducing the shame involved in attachment disbut to show the child that the world can be a preorders and in increasing the capacity for healthy
dictable place and that adults can be trustworthy.
relationships. If the child and family are strugTreatment also provides experiences that repgling, it is best to seek treatment with a therapist
licate the positive attachment cycle. These are
who has training in attachment disorders. While
close, intimate, pleasurable, fun, safe interactions
there are a number of different approaches to
that remind one of the playful affectionate games
attachment treatment, there are some common
parents play with small children. This gives the
features.
experience of being intensely focused on and
Attachment treatment usually addresses the
enjoyed. It begins the awareness that relationships
younger needs of the child (or adult). This is
can be rich and joyful and non-shaming. The give
based on the understanding that the disruption in and take of play also begins the process of reciattachment took place in the first three years of
procity and the recognition of comparable feelings
MAY 2012

PAGE 11
in the other. This is the beginning of empathy
and the possibility of remorse.
A common theme that runs through most
treatments for attachment disorder is the importance of having a mindset that understands the
cause of the disorder. The child did not cause
it. The child’s interior life is probably excruciatingly painful. The child’s outrageous behavior is
an attempt to stay safe; and stems from a fear of
adult motives. Keeping these thoughts in mind
helps one to have empathy for the emotionally
young aspect of a child that appears much older
and has developed smart, effective, anti-social
coping skills. The way to approach this treatment
is with an attitude of playfulness, love, acceptance,
curiosity and most importantly, of empathy. It
is by having empathy for the motives behind the
behavior that the shame is reduced and the child
can lower his defenses and begin learning about
positive relationships.
A key aspect of attachment treatment is providing support for the caregivers. Attachment disordered children have some of the most disturbing
behaviors and at the same time do not usually
provide parents with the typical rewards of parenthood. Their faces do not light up with pleasure. They don’t know how to accept affection.
And because their disorder involves their primary
relationships, they often present very well in public settings, while putting parents through a private hell. Caregivers need the understanding and
support of the other adults involved in a child’s
life: the school, church, coaches, scout leaders,
mental and medical health professionals, etc.
This work takes patience and a strong commitment. It helps if the adult has had a good
experience of attachment themselves. If they have
not, it is important for them to get treatment for
themselves. Parents, foster parents, adoptive parents, and residential staff that undertake this work
need to be very good to themselves and seek support from other adults so they can be calm and in
control when challenged by the child’s defenses.
The good news is that a child’s hardened
resistance will be warmed and disarmed by that
patient, loving commitment. We are hardwired to
want relationships. These challenging children are
yearning for guides who are not put off by their
fear driven defenses; and who will hang in there
and provide the repetitive experiences of a loving
relationship so they can experience the pleasure of
healthy attachment.
PAGE 12

MAY 2012
Relationship Violence in the Deaf Community
Christine Penta, LICSW
Coordinator of Deaf Services
Intimate partner violence (IPV) is a widespread social problem that affects over one
in three women and one in four men (Black,
Basile, Breiding, Smith, Walters, Merrick, Chen
& Stevens, 2011). IPV includes physical violence, sexual violence, threatening, and emotional abuse between two people who are in a close
relationship (CDC, 2012). While relationship
violence does not discriminate against economic
status, race, religious affiliation, sexual orientation, or disability status, it is most prevalent
in heterosexual relationships against women
(Black et al, 2011).
In small communities like the Deaf community, who primarily use American Sign
Language and have their own distinct culture,
the prevalence of IPV is even higher, and the
risk of victimization to violence is even greater.
A recent study compared the prevalence of IPV
among deaf and hearing women. It indicated
that deaf women were 1.74 times more likely
to report an experience of physical violence by
an intimate partner and 3.66 times more likely
to report an experience of sexual violence by an
intimate partner than a comparable sample of
hearing women (Anderson, 2010). Considering
that resources to eliminate violence through
education, prevention and intervention are
largely inaccessible to people who are deaf, this
illustrates an even
more dangerous
and critical situation for deaf survivors of violence.
Many people
who are deaf have
experienced or
been exposed to
different types of
violence throughout their lives.
This could include
witnessing or
being the target of
domestic violence
at home, or being
the victim of bullying at school, or
experiencing “normalized” discrimination and oppression from the wider
community on
a frequent basis.
Given that abusers are often acutely adept at
selecting targets who may be vulnerable in one
way or another, these experiences of discrimination and violence increase vulnerability to
additional violence, such as IPV. Please note,
this is not to suggest in any way that all victim/
survivors are vulnerable or impaired, or that it
is their fault that
they were targeted.
The only real difference between
an abused woman
and a woman who
is not abused is
the abuser (Gilfus,
1991).
Intimate partner
violence toward
people who are
deaf can include
additional layers of control and
psychological abuse
and are not necessarily experienced
in the same way as
IPV amongst people who are hearing. For example, if
the abuser is hearing and the victim/
survivor is deaf, the
abuser may withhold the deaf person’s means of
calling for help (ex. technology, assistive devices), or even “speak for” the victim/survivor if the
police or hospital become involved (National
Domestic Violence Hotline, 2012). If both the
abuser and victim/survivor are deaf, the abuser
may threaten to publicly humiliate his partner
within their shared community, further isolating
the victim/survivor and increasing vulnerability
for control.
Those who have experienced IPV are often
at greater risk for physical health problems,
mental health problems, and time lost at work.
Poly-victimization (the experience of multiple
types of victimization) has been shown to contribute to increased risk of post traumatic stress
and symptoms of depression (Sabina & Straus,
2008) as well. The longer violence continues,
the more dangerous these risks become.
If you or someone you know has been the
victim of relationship violence, please know that
you are not alone and that there are people who
care about your safety and are willing to help
you during and after the abuse.
•For Deaf and Hard of Hearing survivors
of relationship violence in NH, the Deaf
Services Team at the Greater Nashua Mental
Health Center provides confidential counseling services in American Sign Language, and
can provide support while addressing any
emotional or mental health issues that arise
due to experiencing or witnessing violence.
For those who qualify, case management and
community supports are available as well.
Please contact Christine Penta, Coordinator
of Deaf Services, for more information (603889-6147x3479, deafservices@gnmhc.org).
What are you doing this weekend?
Become a leader in your community.
• Earnyourbachelor’sormaster’sdegreeinhumanservicesinaslittle
as16months
Bachelor’swithconcentrationsin:AddictionStudies,EarlyChildhoodEducation,
GeneralStudiesinHumanServices
Master’sconcentrationsin:OrganizationalManagementandLeadership,
MentalHealthCounseling
•
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Attendclassestwoweekendspermonth
Receiveundergraduatecreditforpriorcollege,life,andworkexperience
FinancialAidisavailableforqualifiedstudents
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Springfield
College
MANCHESTER CAMPUS
SCHOOL OF HUMAN SERVICES
500 Commercial Street, Manchester, NH 03101
(800) 727-0504 or (603) 666-5700
www.springfieldcollege.edu/shsmanchester • shsmanchester@springfieldcollege.edu
Founded in 1885, Springfield College is accredited by the New England Association of Schools and Colleges.
The Council for Standards in Human Services Education accredits the School of Human Services’ undergraduate program.
Greater Nashua Mental Health Center at Community Council Would you notice if your life was
interrupted by mental illness?
Anonymous
My life has been interrupted three times. The
first as a sibling, the second as a wife and the
third and most importantly as a mother. The first
two interruptions were silent. The third one was
loud and painful. As a child fear is the emotion
that comes to mind when I think of my brother.
When I was about six years old he threatened to
throw me in the fireplace and I believed him. it
was not until just a few years ago when I was
sharing this story with another sibling did I come
to understand how I had held onto this unwarranted fear for so many years. My brother looked
at me, smiled and stated "there was no fireplace in
that house. " Now that was a light bulb explosion
moment. Other childhood memories include visiting my brother in a psychiatric ward and the only
memory I have is not how my brother was but
silver ashtrays overflowing with cigarette butts and
people sitting lifeless on the floor. My brother was
an annoyance to the family. So much better when
he was gone and on the road, and he had been on
the road since the age of twelve. Did I forget to
mention that my brother had schizophrenia?
As a young wife at the age of twenty one who
would know my husbands rage after I burnt the
rice. Doesn't every new cook burn things? Why
would I ever question the reason he worked nights
just so he could sleep the days away. He was providing for his family. The perfect excuse not to
ever attend a school or social event. Doesn't everyone arrange their furniture so they can always see
the windows and the doors when they sit down?
When one enters a restaurant never taking a
table that didn't let him have his back to the wall.
I thought that was normal. If you think that post
traumatic stress disorder commonly referred to as
PTSD was ever openly discussed after the Viet
Nam war you are wrong. It took over two decades
and the death of my husband's father to realize
that treatment was needed. Treatment was a good
thing for my husband but it was much to late for
us as a couple.
My son was diagnosed with schizophrenia when
he was eighteen years old. I did not believe it.
How could I? How could my cute handsome son
turn into my brother? It was nothing more than a
drug induced psychosis in my mind. What teenager who uses recreational drugs doesn't have a few
hallucinations, odd behavior and extreme anger
management issues. My son would always recover,
be fine and move on to a new mission. One day
though I found myself standing before a judge giving the utmost private information about my son,
knowing that it would tip the scales and commit
him to the state hospital. I blind sided him that
day in court. In his mind everything was fine. My
son needed medical treatment at the time and had
no insight into why. I sat there as they took him
away wondering if our bond would be broken, but
all along knowing treatment was needed at any
cost. After a couple of weeks my son was released
taking prescribed medications. He felt so good
that he stopped taking all medications. Wouldn't
you and I stop taking our medications if we felt
better? Soon after that depression took hold. It
was not the kind that lifts in a couple of weeks.
Thirty days and counting, not leaving the house,
not moving off the couch. He was again in a dark
place. He had no money, no friends, no job and
had to live with his mother after being on his own
for years. Can you imagine how he felt? How
would you feel? My son then decided to try and
commit suicide. He slit both wrists while taking
a shower and stood frozen in time. Luckily for us
all I came home early that day and found him. I
can't imagine how sad and lonely he must have
been that day.
Fast forward to an ad in the Telegraph for a
Family To Family education course on mental
illness offered by NAMI. What was NAMI?
NAMI turned out to save my life. It changed the
way I viewed the world. It opened my mind and
heart to a new way of thinking. I was hooked. I
can never feel guilty about what I didn't know but
knowing what I do now with the education, I have
received from NAMI and friends I wonder what a
difference I could have made in my brothers life?
With the education and support that is now being
given to veterans maybe there might have been
a chance to save our marriage. Those questions
will never be answered. What I am sure of is that
through the proper education I have been given
the opportunity to support my son in his journey
toward recovery. I will advocate on his behalf and
on behalf of all other persons who have had the
misfortune of being afflicted with a brain disorder.
They did not ask for it. I know that you are not
afraid of meeting me if I tell you that I have diabetes. If we meet and I tell you that I have a mental
illness will you be so kind? My goal is to educate
enough people in my lifetime so there will never
be a wrong answer to that question.
My son was admitted to New Hampshire
Hospital over a year ago. He was very sick and
badly needed medical attention. I was very fortunate that his psychiatrist fought very hard on his
behalf to get him admitted to the hospital. This
is nothing different than the doctor that provides
care for individuals having a stroke or heart attack.
They are all medical emergencies. Mental illness
is a roller coaster ride for individuals living with
the illness and for their families as well. After six
weeks in the state hospital my son was released on
the proper medication that keeps his symptoms
at bay. I can share with all of you that treatment
works. At present time my son lives on his own
and is working toward recovery.
My passion is fueled by witnessing how these
illnesses rob people of their life everyday. In most
cases it diminishes their ability to form and maintain relationships with peers, family and potential
partners. Careers and education are put on hold
when they should just be beginning. I know
mental illness is not a life sentence for all but life
is so difficult for individuals living with severe and
persistent mental illness. Imagine what it is like
for most to have their careers taken away. To have
to live in substandard housing with not enough
money for clothes, food and medications.
MAY 2012

PAGE 13
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MAY 2012
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at Community Council.
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Bringing Integrated
Primary Care to Nashua
Cynthia L Whitaker, PsyD
Director, Assessment & Brief Treatment
Whole person health is based on an understanding that there is an undeniable connection between our minds and bodies, between
our mental health and physical health. As the
recipient of a grant from the Substance Abuse
and Mental Health Services Administration
(SAMHSA), Greater Nashua Mental Health
Center (GNMHC) has become a national
leader in recognizing the importance of treating the whole person.
Through our Healthy
Connections Program we
have shifted how comprehensive mental health
services are delivered and
how our center operates
by providing accessible
primary care within our
center. Our Healthy
Connections Program
has brought primary
care and other health
and wellness oriented
activities to patients of
GNMHC and that has
improved access to primary care and resulted in
better health outcomes.
Likewise, there is
mounting evidence that
making mental health
treatment available in primary care settings
also has many positive outcomes.
Research has long suggested that many
individuals bring mental health needs to their
Primary Care Physician (PCP) rather than to
a mental health professional. For example, following a car accident many individuals might
experience difficulties with sleeping and/
or intrusive memories. These are common
symptoms of Acute Stress Disorder. Over
time, however, and especially if untreated in
early stages, these symptoms can be indicative
of Post Traumatic Stress Disorder (PTSD)
and require specific evidence-based interventions. In addition, we all know that information alone does not bring about change, such
that being told by your doctor to quit smoking,
for example, is not enough to be successful in
quitting. We require support and knowledge
about the process of change in addition to
the information about why we should change.
Promoting behavior change is of primary
importance to mental health clinicians. Thus,
when they work alongside primary care providers to provide behavior change treatments
within the primary care setting, patients experience more success with addressing problems
(e.g., poor diet, lack of exercise, smoking, etc)
that are often the root of other health issues.
In general, providing mental health services
in a primary care setting has been shown to
lead to improved access to mental health care,
better physical health outcomes, and overall
increased satisfaction for patients and providers
for a large group of individuals.
The mission of GNMHC is to work with
the community to meet the mental health
needs of its residents by providing evaluation,
treatment, resource development, education,
and research. We are committed to providing
services that address the needs of the greater
Nashua community. As a result, GNMHC
will soon be joining the growing movement
toward integrated primary care, in which
primary care practitioners involve a behavioral health clinician
in a patient’s total care.
Starting next month,
GNMHC will be providing a mental health
professional at the new
Dartmouth-Hitchcock
office, off Exit 8, to
lead a patient-driven
approach to screening,
evaluation, and early
intervention for behavioral healthcare issues
that are commonly seen
in primary healthcare
settings. This collaboration will result in
positive changes for both
patients and providers.
Patients will be able to
access mental health services discreetly in their
primary care office and benefit from a team of
providers working together. The collaboration
will also create a consultative relationship that
will support medical professionals to manage
mental health conditions within the medical setting, prevent problems from escalating
through the use of early intervention, promote
positive health changes, and provide access to
specialty mental health services when required.
GNMHC is committed to providing integrated care. We have successfully brought primary care to our center through the Healthy
Connections Program and are about to embark
on bringing mental health services to primary
care through collaboration with DartmouthHitchcock. We believe that “integration” is
not a set of services that are provided, but
rather, involves starting with a patient’s unique
needs and providing comprehensive services
that are accessible, focused on meeting individual needs, and delivered by clinicians who
understand the mind-body connection.
Our Healthy
Connections
Program has
brought primary
care and other
health and wellness
oriented activities
to patients
of GNMHC...
For more information about the Healthy
Connections Program, please contact Mara
Huberlie at 889-6147 x?3259
For more information about Integrated Primary
Care, please contact Dr. Cynthia Whitaker at
889-6147 x3230.

PAGE 15
Healthy Connections: A Model for Integrated Care
Mara Huberlie, MA
Project Coordinator
“The Body must be treated as a whole and not
just a series of parts.”
Anyone familiar with current developments in healthcare such as Accountable Care
Organizations, Patient-Centered Medical Homes
and Integrated Care programs would assume
the above quote is part of the recent healthcare
dialogue. Actually it is attributed to Hippocrates
in 430 B.C. so it would seem that the concept of
caring for the whole person is certainly not a new
one. Yet in the thousands of years since the statement, there hasn’t been a whole lot of progress
towards connecting the head with the body. For
the most part we still haven’t rediscovered the
“neck” as healthcare remains in “silos” with physical health and mental health treated as unrelated
experiences.
Since 2009, Greater Nashua Mental Health
Center (GNMHC) has been working to change
this paradigm of separate care through its
Healthy Connections – Primary and Behavioral
Healthcare Integration program. The program
is funded through a grant from the Substance
Abuse Mental Health Services Administration
(SAMHSA) and has allowed GNMHC the
opportunity to provide individuals with a serious
mental illness (SMI) coordinated mental and
physical health services, as well as access to a wide
array of prevention and wellness programs.
The need for integrated healthcare is particularly acute for the SMI population which has on
average a 53-year-lifespan – the same average
lifespan as that of individuals living in sub-Saharan Africa. Adults who have SMI have dramatically increased rates of hypertension, asthma, diabetes, heart disease and stroke. Most psychiatric
medications, particularly anti-psychotic medications, can cause weight gain, obesity and type 2
diabetes. In addition, up to 83% of people in the
SMI population are overweight or obese and consume approximately 44% of all cigarettes sold in
the United States. By anyone’s definition there is
a huge public health crisis within this population,
and SAMHSA was one of the first agencies to
propose that integrated care for SMI individuals
may best be centered in their Behavioral Health
Home. The Healthy Connections program is
aimed at reducing the disparity in lifespan by
improving the “whole health” of those we serve.
The program also focuses on empowering individuals with the knowledge and confidence they
need to actively participate in their healthcare
decisions.
To date, over 600 individuals have participated
in the Healthy Connections program, which
includes twice-yearly free health screenings.
Individuals receive a “Report Card” showing their
height, weight, body mass index (BMI), waist
circumference, blood pressure, pulse, cholesterol
and H1AC results, intraocular pressure, and lung
function.
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PAGE 16

MAY 2012
Making Visible
What Is Mostly Invisible
We all share in the same human world.
Cornelis Pieterse, MA
Therapist, Assessment & Grief Treatment
One of the most difficult things to do in life is to change our behaviors and attitudes. Most of us
would rather avoid that work. I believe all of us have our demons – a kind of shadow-side that stops
us from becoming more loving, more insightful, more emotionally stable, and more wholesome
human beings with a moral compass.
In fact, what can happen when we are so incredibly busy with our daily responsibilities at home,
at work or in school? We can then neglect the other tough job - to break a bad habit, to let go of a
prejudice, to forgive another, to be less defensive, to control a temper or to make a sacrifice for the
greater good.
Most of the people who walk through the doors of the Greater Nashua Mental Health Center
(GNMHC) to seek help have taken on that work in one way or another. They work hard, very
hard. They are willing to talk about what is often a deeply personal and private matter. They may
have fears, phobias, impulse control issues, overpowering emotions, panic attacks or addictions. They
may have thoughts that distort how they see themselves and the world around them. They may
have terrifying memories of traumatic events. These memories force themselves so powerfully into
their daily lives that the past and present cannot be separated.
Their courage and hard work is mostly unseen and unrecognized by the world. What we see
instead are people who have accomplished much in our town, our country and in the world. These
are the people we all recognize, celebrate and honor.
So I was thinking…. What if our buildings and roads, award shows, sport competitions, monuments, diplomas, books, works of art, music videos, wealth, careers, cars, the latest gadgets, or seats
of government were all to disappear from sight? What if by some magic our world would become
invisible and instead only show the hard work and courage of those who are changing themselves?
In that case the stigma and judgment around mental health impairments would disappear. We
would see that the efforts of those who live and manage their mental health issues are as courageous
as any who face other challenges. Then we would see people who have something important to
offer the rest of us – namely that to work on ourselves is as important as anything else that can be
achieved in life.
If your life was interrupted… CONTINUED FROM PG 12
Definitely not enough money for any entertainment, gas for their car or imagine this one, toilet paper,
soap and razor blades. No wonder the person you see on the street corner looks dirty and disheveled.
Individuals living with mental illness and family members fight stigma on a daily basis. We must all
learn to see the individual first and not their symptoms. There is a real person inside who wants to be
loved just like you and I. They want to work, have meaningful relationships and be productive members
of society. They just need to be given the chance.
My son could be that bum on the street. He did not ask for his illness and definitely does not deserve
this fate. I know that with access to treatment, which includes support from his psychiatrist and case
manager, we can manage his illness together. Accessibility to treatment is paramount for my son and
for all others afflicted with brain disorders. He has an amazing strength and the resiliency to keep on
fighting daily. I am so proud of my son for allowing me to share in his amazing journey.
Yoga: more than exercise… CONTINUED FROM PG 10
Since November 2011, Gupta has been teaching free yoga classes at Greater Nashua Mental Health
Center (GNMHC) through YogaCaps, the nonprofit he co-founded. YogaCaps, Inc. is an all volunteer
501(c)3 nonprofit organization that builds a healthy community by making yoga more available and
affordable. Students in the class have experienced the sense of peace associated with yoga, and selfreports also include reduction in distressing auditory hallucinations, decrease in pain (back, shoulder,
joints), loss of weight, improved range of motion and better quality of sleep, to name a few.
Yoga offers us the hope and renewal of the Spring season every day of the year! It does so much
more than make us more flexible. It acts as a silent witness to the seasons of our journey through life.
As we become more aware of body and breath, we are able to observe our inner process. Gupta focuses
on breath since “many people need coaching on how to breathe properly. I’ve seen firsthand that those
who are reverse breathers, shallow breathers and mouth breathers are often experiencing chronic physical and mental health issues.”
Research published in the Journal of Interpersonal Violence and Acta Psychiatrica Scandinavica indicates that yoga breath-based interventions offer promising results for symptom reduction and positive
growth in complex trauma recovery. An article published in Traumatology discusses that applications
like yoga “purportedly bring about, with unusual speed and precision, therapeutic shifts in affective, cognitive, and behavioral patterns that underlie a range of psychological concerns”.
So, consider adding yoga as a daily or weekly ‘Spring cleaning’ for the home that you live in: your own
body and mind. Fortunately, you do not have to ‘roll out a yoga mat’ to participate in any of Gupta’s
classes. He teaches Subtle Yoga for Rejuvenation which can be done in a seated or standing position
with no special gear required. And, more good news! You do not need to choose between aerobic exercise and yoga. You can enjoy both! They enhance each other.
Clients of GNMHC are invited to join the yoga class on Fridays from 2:00-3:30 p.m. to experience
all that yoga can be and bring to enrich your life.
YogaCaps shares free classes for special populations and donation-based events, like the Annual NH
Yoga for Peace, and workshops for the public. For more information, visit www.yogacaps.org.
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PAGE 17
PAGE 18

MAY 2012
and Kate Murphy, LCMHC, CGP
DBT: Finding the Middle Path
Dialectical Behavioral Therapy (DBT) is a
behavior therapy approach that was originally
developed by Marsha Linehan (1993) to treat
patients with borderline personality disorder. It
is considered an empirically validated treatment,
which means that multiple research studies have
shown that the treatment works. The core problems that DBT targets are all-or-none thinking,
confusion about oneself, impulsivity, emotional
instability, and interpersonal problems. While
these are all symptoms of borderline personality
disorder, they are also problems faced by individuals with other mental illnesses, such as eating
disorders, trauma disorders, bipolar disorder,
anxiety, and depression. Thus, the skills taught
in DBT can be useful to people with almost any
(or even no) diagnosis. DBT is also effective in
treating symptoms related to suicidal thoughts
or thoughts and behaviors related to self-harm.
Researchers have also found that DBT decreases
treatment dropout rates and hospital visits and
leads to overall better treatment outcomes.
DBT treatment is based upon and teaches a
“dialectical worldview.” This worldview acknowledges the inherent tensions of life and offers a
way of thinking that allows for seemingly contradictory things to coexist. For example, one might
be both anxious and excited about an event or
feel both love and frustration toward the same
individual. In a relationship, two people might
have conflicting wants and needs. DBT suggests
that we can synthesize these seemingly contradictory things by balancing
acceptance and change
and avoiding all-or-none
thinking. In other words,
we observe and accept
reality for what it is, in
order to use skills to make
the changes we can, while
recognizing that things are
not either all good or all
bad and letting go of the
need to be “right.”
In addition to teaching
this worldview and methods to combat all-or-none thinking, DBT skills
training involves learning four groups of skills;
core mindfulness, distress tolerance, emotional
regulation and interpersonal effectiveness. These
skills correlate to the remaining problems that
DBT targets, confusion about self, impulsivity,
emotional instability, and interpersonal problems.
Core mindfulness skills decrease confusion about
oneself by promoting learning to go within oneself to learn and observe feelings and thoughts.
It improves understanding of what one feels
and why. Distress tolerance skills are skills that
help someone get through a difficult moment by
decreasing impulsive reactions and learning how
to tolerate stress and not engage in behavior that
make a crisis worse. These two groups of skills
are acceptance skills. That is, both core mindfulness and distress tolerance
skills are focused on accurately understanding reality
for what it is, not what it
reminds us of from our
past or what we fear will
happen in our future. It is
important to focus on the
present moment, accurately
assess what it includes, and
learn skills to tolerate reality instead of avoiding or
engaging in self-destructive
behaviors.
The final two groups of skills, emotion regulation and interpersonal effectiveness, are change
skills. Emotional regulation skills focus on ways
to enhance control of emotions. Some strategies
include reducing vulnerability to negative emotions, “acting opposite” to the emotion, “checking
the facts” to determine if the emotional reaction
is effective in the current situation, and building
positive life experiences. Interpersonal effectiveness skills promote improved ability to deal with
conflict, increased self-respect, and learning to
set boundaries in relationships. This is achieved
through careful examination of the objectives
of an interaction while also thinking about the
importance of maintaining self-respect and relationships with others.
DBT is a structured treatment that focuses on
accepting things as they are while also encouraging personal change. It is different from other
types of therapy that people may have experienced and, as a result, may cause discomfort at
first and require a period of adjustment. Those
who believe in the worldview promoted in DBT
believe that everyone, regardless of biological
makeup, childhood environment, or life circumstances, can learn new behaviors. We can all learn
to change the way we think about ourselves, our
world, and our future by balancing acceptance
and change and recognizing that both are needed
for recovery and to have a “life worth living.”
Greater Nashua Mental Health Center currently
offers three DBT skills groups. One, for women diagnosed with borderline personality disorder, another for
women with any diagnosis, and a third for men with
any diagnosis. For more information about DBT
offerings, please contact GNMHC at 603-889-6147.
References:
Linehan, M. (1993). Cognitive-Behavioral
Treatment of Borderline Personality Disorder.
The Guilford Press
Linehan, M. (1993). Skills Training Manual for
Treating Borderline Personality Disorder. The
Guilford Press
Greater Nashua Mental Health Center at Community Council The Many Advantages of
Psychological Assessment
Cullen Hardy, Doctoral Student and
Cynthia L Whitaker, PsyD, Director
Assessment & Brief Treatment
Greater Nashua Mental Health Center at
Community Council is well known for meeting
the needs of our region’s residents by providing
mental health evaluation, treatment, resource
development, education, and research. For
the past year, we have expanded our ability to
provide comprehensive evaluation by also offering formal psychological assessments to both
children and adults.
What exactly is a psychological assessment?
Psychological assessments evaluate four areas
of our mind: cognition,
mood, personality, and
behavior. Supervised
by a licensed clinical psychologist, these
assessments specialize
in the interrelatedness
of the brain & behavior.
Psychological assessments generally include
a formal interview, a
thorough review of all
available records, and
psychological testing
with multiple standardized instruments. This
method of assessment
is especially valuable
because it addresses
high-cortical functioning including attention
span, long- and short-term memory, information-processing speed, language & visuo-spatial
abilities, and intelligence—to name just a few.
This thorough assessment of brain functioning
is helpful in detecting learning disabilities, providing clarification about diagnosis, and providing recommendations for ongoing treatment.
Psychological assessments also take a holistic
approach to the mind-body relationship; we
recommend that assessments be conducted in
concert with a full medical evaluation, to ensure
that any worrisome symptoms are not, in fact,
caused by an underlying disease or other medical condition. In fact, a medical examination is
recommended prior to a formal psychological
assessment so that any relevant information can
be incorporated into the assessment.
What should
I expect?
A typical psychological assessment runs
from 4 to 8 hours,
although shorter, less
comprehensive tests are
also available depending upon the particular
problem into which
you are hoping to gain
insight. After the
assessment is completed,
the psychologist (or
psychologist in training) will take additional
time to go over your records, evaluate, score
and interpret tests, and prepare a report. This
report and the results will be shared with and
explained to both you and your providers.
Thankfully, many insurance companies cover
the cost of psychological assessments. It is
important to know, however that some insurance place limits on how many hours of testing
are covered and/or require preauthorization
(e.g., obtaining a referral from your primary
care physician or submitting forms to justify the
need for an assessment). Be sure to call your
insurer to confirm coverage.
There really are no reasons not to
schedule a psychological assessment
Psychological assessments can provide valuable insight into a person’s overall health. The
tests are non-invasive and gaining a clearer picture of your or your child’s condition will provide increased peace of mind and direction for
treatment. For Greater Nashua Mental Health
Center at Community Council, offering comprehensive psychological assessments was the
logical next-step in improving our community’s
overall mental health and providing our community with access to quality, evidence-based,
cost-effective treatment.
MAY 2012

PAGE 19
Strengthening Individuals, Families & Our Community Since 1920!
utilizing extensive measurements of cognition,
mood, personality, and behavior. However,
when the underlying condition is already
known (e.g., in people diagnosed with dementia) an assessment can give insights into the rate
of decline (or improvement) and provide other
insight and recommendations.
There are several benefits of a psychological
assessment. Many insights will be provided
into a person’s strengths and weaknesses.
Families can learn how to better support a family member. Patients and physicians can learn
how to assist their clients and treat and reduce
any symptoms more effectively. In short, a psychological assessment can be one of the most
valuable ways to gain insight and direction in
complex situations that
have presented as puzzling to providers and
family members.
For the past year,
we have expanded
our ability
to provide
comprehensive
evaluation by also
offering formal
psychological
assessments...
How will it benefit you or your child?
A thorough psychological assessment
will help provide a correct diagnosis of your
symptoms. Studies show that patients are
genuinely happy to receive accurate diagnosis
and prognosis, even when the condition is serious. Conversely, when the assessment shows
that the brain is not as impaired as originally
believed the diagnosis alone can help to jumpstart improved overall health. Furthermore,
psychological assessments can help provide a
clearer picture of a person’s overall health by
2012
Advisory Council Members
Lisa Christie
Thomas Doucette
Mariellen Durso
Sheelu Joshi Flegal
Robert Mack
Norma MacKinley-Smith
Lt. Bryan Marshall
Jan Martin
Kim Shottes
Strengthening Individuals, Families and Our Community Since 1920!
Yes, I want to help Greater Nashua Mental Health Center
provide mental health care to our community.
____$25
____$50
____$100
____$200 ____Other
I would like to make this donation in memory or honor of:
_____________________________________________________
______
I have enclosed my check made out to GNMHC
Please charge my: Visa_______ MasterCard_______ Discover______
Account number: __________________________Exp. Date: ________
Name: _____________________________________________________
Address: ____________________________________________________
City: _____________________ State: ___________ Zip: _____________
Signature: __________________________________________________
Please return this form with your donation to:
GNMHC, 100 W. Pearl Street, Nashua, NH 03060
Attn: Development Office
Or give online at www.gnmhc.org!
PAGE 20

MAY 2012
Signs of Depression Checklist
Everyone gets down
from time to time, but
sometimes it's more
than just "the blues."
Sometimes, it can be clinical depression. Clinical
depression affects more
than 19 million Americans each year. It is a real illness that can be
treated effectively. Unfortunately, fewer than half of the people who
have this illness seek treatment.
Too many people believe that it is a “normal” part of life and that
they can treat it themselves. Left untreated, depression poses a huge
burden on employees and employers. It causes unnecessary suffering
and disruption in one's life and work, and costs about $44 billion a
year in lost workdays, decreased productivity and other losses.
Know the Signs
The signs and symptoms of clinical depression are:
l Persistent sad, anxious or "empty" mood
l Changes in sleep patterns
l Reduced appetite and weight loss,
or increased appetite and weight gain
Loss of pleasure and interest in once-enjoyable
activities, including sex
l Restlessness, irritability
l Persistent physical symptoms that do not respond to treatment, such
as chronic pain or digestive disorders
l
Diff iculty concentrating at work or at school,
or diff iculty remembering things or making decisions
l Fatigue or loss of energy
l Feeling guilty, hopeless or worthless
l Thoughts of suicide or death
If you experience five or more of these symptoms for two weeks
or longer, you could have clinical depression. See a doctor or qualified mental health professional for help, right away.
If you are supervising an employee who exhibits any of these
symptoms and has frequent, unexcused absences, discuss the situation with the individual, but do not try to diagnose the problem.
Suggest that the employee seek help from his or her doctor or, if
you have one, the Employee Assistance Program (EAP). Make sure
the employee knows that seeking help is the healthy thing to do.
l
Lista de Vericación de las Señales de la Depresión
Todos nos ponemos tristes por algun tiempo,
pero a veces es más que eso. A veces puede ser
una depresión clínica. La depresión clínica afecta
a más de 19 millones de americanos cada año. Es
una enfermedad real que puede tratarse eficazmente.
Desgraciadamente, menos de la mitad de las
personas con esta enfermedad buscan tratamiento.
Demasiadas personas creen que es una parte
“normal” de la vida y que pueden tratarla por
cuenta propia. Si no se trata, la depresión significa
una enorme carga para empleados y empleadores.
Causa sufrimientos y trastornos innecesarios en
nuestra vida y trabajo y cuesta unos $44 miles
de millones por año en días de trabajo perdidos,
menor productividad y otras pérdidas.
Conozca Las Señales
Las señales y síntomas de la depresión clínica son:
l Persistente estado de ánimo triste,
pleno de ansiedad o “sin sentido”
l Cambios en los hábitos de sueño
l Reducción del apetito y pérdida de peso o
aumento del apetito y aumento de peso
l Insatisfacción y desinterés por actividades que
Strengthening Individuals, Families & Our Community Since 1920!
Program Statistics
In Fiscal Year 2011
2,288 people received 11,579 hours of Adult Assessment & Brief Treatment services;
1,170 children, adolescents and their families received 20,805 hours of service from
our Child and Adolescent Program;
296 persons were seen by our Older Adults Services staff for a total of 6,813 hours of
service;
475 people used our Emergency Services;
70 young people received 6,417 hours of service through the Young Adult Program;
1,052 consumers received 29,011 hours of Community Support Services;
64 consumers participated in our Vocational Services, receiving 527 hours of service;
105 people received Homeless Outreach Services;
356 individuals received 8,698 hours of Substance Abuse Treatment services;
609 parents participated in our Child Impact Seminars for Divorcing Parents;
77 deaf adults and children throughout New Hampshire received 2,598 hours of
service from our Deaf Services Team;
125 children and 95 families received 3,132 hours of supervised visits and a total of
196 monitored exchanges occurred at our Supervised Visitation Center.
Consumers Served By Town
Fiscal Year 2011 (7/1/10 – 6/30/11)
Amherst
72
Brookline
61
Hollis
89
Hudson
462
Litchfield
83
Merrimack
330
Milford
248
Mont Vernon
14
Nashua
3,468
Other
551
Total
5,378
antes disfrutaba, incluyendo el sexo
l Inquietud, irritabilidad
l Síntomas físicos persistentes que no responden
a tratamiento, tal como dolor crónico o trastornos
digestivos
l Dif icultad para concentrarse en el trabajo o la
escuela, o dif icultad para recordar cosas o tomar
decisions
l Fatiga o pérdida de energía
l Sentimientos de culpa, desesperanza o inutilidad
l Pensamientos de suicidio o muerte
Si usted padece de cinco o más de estos sín-
tomas durante dos semanas o más, podría tener
depresión clínica. Consulte a un médico o profesional de salud mental calificado inmediatamente.
Si está supervisando a un empleado que presenta cualquiera de estos síntomas y tiene ausencias frecuentes no justificadas, converse el tema
con la persona, pero no trate de diagnosticar el
problema. Sugiera que el empleado consiga ayuda
de su médico o, si lo hubiera, del Programa de
Asistencia al Empleado (EAP). Asegúrese de que
el empleado sepa que buscar ayuda es lo más saludable que puede hacer.
Greater Nashua Mental Health Center at Community Council Getting In SHAPE
Lenore Cortez, MSN, RNC
Healthier lifestyle options are a hot topic. Here at GNMHC we are gearing up to begin the
active phase of the In SHAPE program. Initially, we were chosen as a control site for this study
and for the past year had 30 clients participating in periodic assessments as they waited to actually begin working out at the gym. Studies show that people with severe mental illness live an
average of 10-20 years less than the general population (Barr, 2011). This program was developed in 2002 by Ken Jue of Monadnock Family Services after he noticed an increased percentage of their clients dying prematurely from physical illnesses related to the effects of isolation,
poor nutrition and sedentary lifestyles (Mondanock Family Services, 2009).
The program’s
acronym stands for
Individualized Self
Health Action Plan
for Empowerment.
The basis of this
program is to provide physical activity
support, nutritional
education, and community integration
to our clients with
severe mental illness. Participants
will work with a
health mentor who
will teach them
how to incorporate
physical activity and
good nutrition into
a healthy lifestyle.
Health Mentors
are an integral part
of this program as
they are Certified
Personal Trainers
who have received
education in promoting safe physical
activity for all levels
of people wishing to
improve their physical activity. We are partnering with the Nashua YMCA to provide gym memberships to participants. Flexibility is our key to planning exercise programs that will motivate and support the
needs of each of our clients. With this in mind, the health mentor will encourage participants to
develop individualized fitness plans.
Nutritional training will be provided to help clients develop healthier eating habits, learn about
portion control and eating on a budget. Daily food logs will be used to help participants track
their eating habits. The health mentor will provide weekly feedback on food and physical activity logs. Meetings between the health mentor and the participants will occur 1-2 times per week
as the participant begins the program and less frequently as a routine becomes established.
Another part of this program is the smoking cessation component. This online presentation
is available to all participants who are smokers, regardless of their desire to quit. Participants
can scroll through the screens at their own pace with the option of selecting links to additional
information. Those participants who then decide to pursue smoking cessation will have additional resources presented to them by the Health Mentor.
Our goal is to begin healthy changes that will become part of the daily routines of the individuals who participate in the In SHAPE program. Our success will come in the form of helping
our community to maintain healthier lifestyles. Further evidence of this success will be when we
see a client involve family members or friends in their exercise journey.
Resources:
Barr, B. (2011). Adults with severe mental illness get In SHAPE. Robert Wood Johnson
Foundation Grants Results Report #51433. Retrieved from http://www.rwjf.org/files/
research/51433.pdf
Monadnock Family Services (2009). In SHAPE: Shaping the future of mental health.
Monadnock Family Services and Dartmouth Center for Aging Research, 1-87.
MAY 2012

PAGE 21
Service Awards
Each year, Greater Nashua Mental Health Center at
Community Council recognizes employees who are marking
anniversary milestones in their service to the agency. In 2011,
we celebrated the dedication of the following individuals:
Five Years
Watila F. Burpee
Mary A. Chaput
Diane S. Cudworth
Patricia D. Gilbert
Barbara A. Merrill
Alicia R. McDermott
Richard S. Mansfield
Maureen L. Massmann
Cynthia L. Whitaker
Ten Years
Paul D. Lassins
Karen A. Lofstrom
Julie A. McIver
Fifteen Years
Patricia L. Butler
Twenty Years
Alice M. Cassidy
Twenty-Five Years
Susan W. Mead
Congratulations and Thank You All!
PAGE 22

MAY 2012
Healthy Connections: A Model for Integrated Care… CONTINUED FROM PG 14
The nurse care coordinator also speaks
with them about their use of cigarettes,
alcohol and reviews all of their current medications. Patients have plenty
of time to ask questions and formulate
personal health goals. At this time, they
can also learn more about the various
wellness activities which are available to
all GNMHC clients. Programs include
Smoking Reduction, Morning Stretch
Group, Yoga for Sleep and Anxiety,
Walking Groups, Healthy Cooking,
Spanish Women’s Wellness, and Learning
to Live Well with Diabetes. With their
permission, this “Report Card” is also
shared with the consumer’s primary care
provider and mental health team.
has two critical community partners in
the Healthy Connections project. The
first is Lamprey HealthCare, the Nashua
area’s Federally Qualified Health Center
and our primary health care partner.
Lamprey Healthcare provides a full range
of onsite primary care services including: physical exams, immunizations,
risk assessments, gynecological exams,
reproductive healthcare and preventative
care such as individual nutrition counseling and counseling for diabetes and
other chronic diseases. Unlike many busy
primary care offices, the program allows
the nurse practitioner to spend additional time with patients to discuss their
care and answers any questions. As the
Healthy Connections program has grown,
there are now two fully-equipped exam
rooms on the first floor at the mental
health center’s 7 Prospect Street facility.
GNMHC’s second partner is the
H.E.A.R.T.S. Peer Support Center. The
Healthy Connections project provides
an excellent opportunity to expand the
role of peers in the mental health system.
There is a growing body of evidence that
suggests peer-oriented recovery services
produce outcomes that are as good or,
in some cases, superior to services from
non-peer professionals and in a much
more cost-effective delivery system. The
unique perspective and support offered
by peers often is particularly effective at
reducing isolation and increasing wellness
program participation. Many of the wellness activities take place at the peer support center, including a specially designed
SAMHSA-funded Whole Health Action
Management program. The 13 week,
peer-led program is a person-centered
planning process that is strength-based
and focuses on a person’s interests and
natural supports. It stresses creating new
health behaviors and strengthening one’s
resiliency skills, as well as the promotion
of self-directed whole health.
While improving the health of
GNMHC consumers is the most important benefit of the SAMHSA-funded
project, there have been other significant
advantages to being one of only 63 agencies in the country and the only one in
New Hampshire to receive the grant. The
program has allowed GNMHC to provide high-level training to its staff as we
work to retool the present workforce to
meet the requirements of integrated care
and health home programs. Over the last
year, GNMHC staff has received “Health
Navigator” training which expands the
traditional case manager role to include
assisting clients with managing chronic
physical illness. Staff has also participated
in certificate programs in Primary Care
Behavioral Health at the University of
Massachusetts Medical School. They have
taken part in a two-day smoking cessation
program, a dental-mental health program and there are many more additional
opportunities on the horizon.
The project highlights the critical need
for a clinically relevant electronic health
record and the agency is in the process
of implementing such a system. If integrated properly, electronic health records
can play an integral role in providing
clinicians with an efficient way to evalu-
ate the “big picture” and assist in decision
making. This information should also be
accessible and understandable to patients
in order to empower them in the shareddecision making process.
One final benefit to the Healthy
Connections project is that it has been a
data and information driven project. From
the beginning, GNMHC recognized the
importance of collecting data, measuring outcomes and establishing value.
GNMHC is working with the University
of Connecticut to analyze and evaluate
the data and present it to policy makers as
we look to sustain the program after the
completion of the grant. Such information and reports will also prove helpful in
tracking and improving population-based
health status and quality of care/life for
consumers.
Implementing the Healthy Connections
project has been challenging, forcing
strangely disparate systems – behavioral
health care and primary health care – to
come together in order to “rediscover the
neck” and provide whole health services
in concert. Despite the obstacles, the
project is demonstrating that it is possible
to change the current paradigms of health
care and cost-effectively provide better
care that leads to better patient outcomes.
Proud supporter of Greater Nashua Mental Health Center and its
commitment to meeting the mental health needs of our community.
Your business needs our vision.
BEDFORD
CONCORD
DOVER
MANCHESTER
MILFORD
centrixbank.com/cbeyond
NASHUA
PORTSMOUTH
Greater Nashua Mental Health Center at Community Council Why Do I Feel This Way?
MAY 2012

PAGE 23
How past experiences can affect
today’s behaviors and feelings
Director, Assessment & Brief Treatment
Many people ask me, “Why do I feel this way?”
or “Why do I do the things I do?” People ask
because they don’t know why they get angry at
someone who asks for help or who gives feedback.
Or, they don’t understand
why they avoid speaking
up or expressing their
opinions. Or, they don’t
understand other things
about their personality and
behaviors.
For many people the
reason why these feelings
and behaviors happen,
even when they don’t
want them to, is because
past experiences can
affect today’s behavior.
For example, if someone
grows up being told they
don’t do anything right or
being yelled at for expressing their opinion, then
they learn to think their
opinion is not right. As
a result, they now might
look like someone who is afraid to speak up or
express an opinion. Another example is if someone grows up in a home and school where they
were picked on a lot, they may now have low self
esteem and have strong reactions to feedback.
There are many other examples of how someone’s
past experiences affect the behaviors and feelings
of today. The point is that we all learn to think,
feel, and behave certain ways from our experiences, not just from our genes from our families.
Of course, all of our experiences are different.
Some people have many positive experiences,
but others are not so lucky. Negative experiences
are also different and range from being alone or
misunderstood to being abused again and again.
These different experiences can affect different
people in different ways because our experiences interact with our genes. Some people act
a bit shy or get nervous in new situations, others
might get angry easily. These types of behaviors
do not necessarily mean that a person has a disorder and might be managed by learning what
you are sensitive to and learning skills to change
your behavior. Other
people can develop psychological disorders from
negative experiences. The
most common is Post
Traumatic Stress Disorder
(PTSD). PTSD is well
known as a disorder in the
military. Someone goes
into the military, experiences negative things, and
then has many symptoms
of anxiety or anger after
the negative experiences.
Over the years, there has
been a lot of research to
prove that PTSD can also
happen from negative
childhood experiences,
especially negative experiences that happen again
and again. Someone with
PTSD is sensitive to any experience that reminds
them of past negative experiences. For example,
if you were picked on growing up, you might
now be sensitive to feedback or any situation that
makes you feel judged. People with PTSD also
can react strongly to an experience that reminds
them of past negative experiences. For example,
you might react strongly to something that others think is no big deal because it reminds you of
something negative from childhood.
Not all negative experiences lead to PTSD or a
psychological disorder, but all negative experiences
can affect our thoughts, feelings, and behaviors.
If you need someone to talk to about your past
negative experiences, feel free to contact Greater
Nashua Mental Health Center at 603-889-6147.
...if someone
grows up being told
they don’t do anything right or being
yelled at for expressing their opinion,
then they learn to
think their opinion
is not right.
Tel. 603-821-7567
(603) 566-6304
dwoolygraphics@yahoo.com
Tel.
In Loving Memory
OF
Rosa Maria Sharkey
By her husband and family
E-Mail: anthony@shp-seals.com • sales@shp-sealscom
Thank you...
It is only through the support of the towns we serve and
donations such as those businesses and individuals who
appear in this insert that we are able provide essential
mental health care to all our neighbors in need, regardless of
their insurance and financial status.
“Celebrating 100 Years in Business”
882•29757
PAGE 24

MAY 2012
We are proud to support the
Nobody delivers the
Nashua market better.
n 70,000 readers on Sunday
n 2 million page views per month
n Connect with us on
facebook.com/thetelegraph
(603) 594-6424
to subscribe
www.nashuatelegraph.com

PAGE 25
Relationship Violence in the Deaf Community…
CONTINUED FROM PG 12
STORM WINDOWS & DOORS
Printed on recycled paper
ABSOLUTE DATA DESTRUCTION
•Serving the Greater Nashua and Milford areas, Bridges is a domestic and sexual violence
organization that provides crisis intervention, emergency shelter, court advocacy, support
groups, and education and outreach to both women and men (www.bridgesnh.org, 24-hour
support line 603-883-3044).
•For domestic and sexual violence resources throughout the country that specifically provide
services to the Deaf community, please see the National Domestic Violence Hotline’s website:
http://www.thehotline.org/deaf-deaf-blind-and-hard-of-hearing-outreach/.
References:
Anderson, M. L. (2010). Prevalence and preditors of intimate partner violence victimization in the
deaf community. Unpublished doctoral dissertation, Gallaudet University.
Black, M. C., Basile, K. C., Breiding, M. J., Smith, S. G., Walters, M. L., Merrick, M. T., Chen,
J., & Stevens, M. R. (2011). The national intimate partner and sexual violence survey (NISVS):
2010 summary report. Atlanta, GA: National Center for Injury Prevention and Control, Centers
for Disease Control and Prevention.
Centers for Disease Control and Prevention (2012). Understanding intimate partner violence:
Fact sheet. Retrieved on April 9, 2012 from http://www.cdc.gov/ViolencePrevention/pdf/
Confidential Record & Document Destruction
Mobile Shredding Service
www.absolutedatadestruction.com
In Loving Memory
OF
Bus: 1-800-797-0515
Buzzy Francis
Cell: 603-533-9369
Regional Sales Manager
Fax: 603-625-1505
PO Box 4387, Manchester , NH 03108
Making health care work better
Harvard Pilgrim proudly salutes the
Greater Nashua Mental Health Center,
making a difference to improve
the lives of so many in the community.
Richard James (Arjay) Sharkey
By his father, sister Erin & brother Patrick
Donald M. Roy, CFP® of New England Wealth Advisors is an independent
advisor who develops and implements solutions to comprehensive financial
planning needs. He does this for individuals, business owners, private industry
and nonprofit
organizations.
Please
visitAdvisors
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newealthadvisors.com
Donald
M. Roy, CFP®
of New England
Wealth
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Securities
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through Securities America, Inc, Member FINRA/SIPC, Donald M. Roy, Registered Representative
Advisory Services offered through Securities America Advisors, Inc. Donald M. Roy, Investments Advisor Representative
New England Wealth Advisors and the Securities America companies are unaffiliated
Securities offered through Securities America, Inc, Member FINRA/SIPC, Donald M. Roy, Registered Representative Advisory Services offered thro
Securities America Advisors, Inc. Donald M. Roy, Investments Advisor Representative New England Wealth Advisors and the Securities America co
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PAGE 26

MAY 2012
SERVING OUR COMMUNITY —
AND OUR NATION
WORLD
PARTNER
www.baesystems.com
For more than five decades,
BAE Systems has remained as
committed to supporting our
surrounding communities as we are
to developing advanced technology
to protect our nation. We support
those who go into harm’s way
on America's behalf, from first
responders to the men and women
of the armed forces. As New
Hampshire’s largest manufacturer,
we’re proud to call the Granite State
home — and even prouder to play a
part in creating a safer tomorrow.

PAGE 27
PAGE 28

MAY 2012

Yoga: More than Exercise - Greater Nashua Mental Health Center

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