This blog was originally published in December 2020. As this pandemic rages on, the message remains relevant, and so we’re sharing it with you again to mark the 2021 holiday season.
Content warning: This post discusses sensitive topics such as suicide and abuse.
In a year as strange and relentless as 2020, I needed a sense of normalcy more than ever this holiday season, and that came in the form of my annual viewing of “It’s a Wonderful Life.” In years’ past, the film’s theme of suicide prevention struck me most. But like a lot of things, the experience of 2020 placed a new filter over the movie for me, and I started noticing elements that, while always there, hadn’t been as noticeable to me before.
The crises of 2020 were relentless. And when the bad news just keeps coming and it feels there’s no end in sight, no clear solution or relief, it can be easy to fall into total despair. George Bailey experiences this very thing in “It’s a Wonderful Life.” George passed on his own dreams so the dreams of others could be realized and those he loved could be happy, and for awhile he appears okay with that. Then a series of crises compound, and old trauma and resentments quickly rise to the surface. George, completely devoid of hope and solutions, is now staring into the icy churning waters of a river flowing beneath him. For all his good deeds and sacrifices, look at how bad things are. What was it all for? He contemplates how the world might be better off if he wasn’t here, or if he never existed at all.
George’s scenario got me thinking about the exhaustive work so many people have been doing all throughout the COVID-19 pandemic, only to have things stay the same, or get worse, day in and day out, with no relief in sight. When there’s no clear impact or positive change to motivate you, to reassure you that your sacrifices and work matters, how do you keep going? How do you resist despair and hopelessness?
I think the answer is similar to what we see in “It’s a Wonderful Life.” George can’t see his positive impact until he’s shown a world without him in it. Perhaps we need to briefly imagine what the world would look like without those forces of good working hard to help others.
What would our world look like now if helplines, contact centers, and other community services didn’t exist?
Contact centers and Information and Referral services like 2-1-1 commonly act as their community’s primary source of information about COVID-19, providing information on everything from common symptoms to look for and where to go to get tested. In many cases 2-1-1 became the official state/provincial source of COVID-19 information. Without that centralized information delivery service, health departments, emergency rooms, and medical offices are overwhelmed with people seeking information. Phone lines jam and human resources are syphoned from direct care treating those who are ill. Fewer people know where to get tested. More people get sick, and more lives are lost as a result.
The economic fallout from the pandemic will be with us for some time. Some say the financial recovery may take longer than public health recovery. Thankfully, people looking for financial assistance for their very survival—help with utilities or food—had places to reach. Places where a compassionate and knowledgeable specialist could, in a single interaction, provide ideas and resources that may help with several needs. Without those contact centers, those in need are left feeling lost and overwhelmed. Already worn down by their situation, they must now spend time and effort navigating the network of community services on their own. They don’t know how the systems work. They are frustrated and even more overwhelmed. It takes longer to access assistance. They miss several meals. They only find out about a fraction of the services for which they were eligible.
Quarantines and stay-at-home orders kept people at home more, and for many the people they live with are a source of comfort. For others, it’s a source of conflict or even danger. Suddenly, vulnerable individuals suffering abuse at the hands of a parent or partner, or LGBTQIA youth living with unsupportive family members, were cut off from their daily escapes and support systems. Without services specializing in providing safety and emotional support, they become more isolated. Tensions in the household rise. Abused partners and Queer youth have no professional confidential counseling to access quietly and privately through chats or text messages. There’s no emergency shelter to escape to.
Viruses and physical health have taken center stage this year, but the mental health toll is undeniable. We’ve been going through a collective, worldwide trauma. Everything familiar was disrupted and the entire concept of “normal” disappeared overnight. Many people are experiencing emotions they aren’t sure what to do with, and they aren’t ready to talk to their friends or loved ones. Others lack those connections and are processing things all on their own. Imagine a world without an outlet to help one cope with those feelings. No warmlines or impartial empathetic listeners, no crisis or suicide prevention services. The emotional suffering deepens and spreads, and we lose even more people to a different type of pandemic—suicide—that was present long before COVID-19.
So yes, 2020 was the worst, filled with more crises happening all at once than many of us could have imagined. And in a seemingly never-ending string of challenges, it may feel at times like your contributions, all your exhaustive efforts, aren’t making a dent. If reassurance and evidence of your impact seems elusive, think back to George Bailey’s tour of seedy Pottersville, the bad place version of Bedford Falls. Close your eyes and take a stroll through that scary, imaginary world without organizations like yours, and see that things could actually be much worse. It’s because of the good work of those who care, like you, that it isn’t.
One of the things I like most about Halloween is that it offers such a wide range of ways to participate and have fun. Horror movies not your thing? You can stick to fun activities like carving a jack-o-lantern and handing out candy to trick or treaters (in normal, non-pandemic years at least). And then there are the endless costume possibilities. You can be anything from a superhero to your favorite movie character to some very obscure cultural reference or the more traditional choice of ghost or vampire.
So with that range of costume possibilities and ways to have fun in mind, it’s always deeply upsetting to see Halloween become an event where mental illness is misrepresented and stigmatized. Some haunted house attractions are centered around “asylum” themes, or have a “haunted psych ward” component. Actors wearing straight jackets or wielding weapons chase visitors and shout lines about hearing voices. The message is very clear: Mental illness, and people who experience mental illness, are scary, violent, and to be feared.
In recent years, several costumes have been pulled from the shelves following pressure from mental health advocates. Unfortunately every year there are still a few new inappropriate and offensive costumes that pop up and make their way to stores and online retailers, and regrettably they are eventually seen out in public at bars and parties. And each time one is sold and then worn, it perpetuates the stigma and misconceptions around mental illness.
These interjections of mental illness into Halloween are neither fun nor harmless, but keep in place harmful stereotypes. These attractions and costumes continue pushing the idea that a person living with mental illness is violent and should be avoided. Discrimination is still a problem for people living with mental illness, and every day those who experience symptoms choose not to seek help for fear of mistreatment by the public, or that their relationships with family and friends will suffer. These depictions also hurt those who have experienced mental illness, especially those who have been hospitalized. Their deepest fears about what society thinks of them are realized when they see illness become a subject of fear-based entertainment.
It would never be acceptable to have haunted houses set in a hospice or cancer wing of a hospital, nor would we find cancer patient costumes to be appropriate. It’s important that we all speak up when we see mental illness being stigmatized, and stand up for those who have experience with illness and are negatively impacted by the perpetuation of stigma.
Even with increased awareness and understanding about mental health and mental illness, mental health care, particularly psychiatric care, can still be difficult to access. This often leaves Primary Care Physicians (PCPs), nurses, and other healthcare workers on the frontlines of mental health care in the United States.
However, in Utah PCPs can access specialized psychiatric consultations through the Consultation Access Link Line to Utah Psychiatry (CALL-UP) Program. This legislative funded program is designed to address the limited number of psychiatric services in Utah and improve access to them, and serves patients at no cost to providers or patients in the state of Utah.
iCarol is proud to play a role in the service delivery of CALL-UP, through CALL-UP’s use of iCarol for psychiatrist on-call shift sign up, CALL-UP program documentation to maintain state funding, and through iCarol’s Public Web Forms.
Here’s how iCarol fits into the service delivery workflow of the CALL-UP program in Utah:
The on-call service for psychiatry consultation is available Monday through Friday from 12:00pm to 4:30 pm. Participating psychiatrists are invited by the CALL-UP program administrators to sign into the iCarol system to sign up for shifts where they will be on-call for consultations.
Primary Care Physicians (PCPs) are instructed to contact the CALL-UP program to request a consultation. If the PCP calls in, CALL-UP staff collect basic demographic, needs, and other important data from the PCP in order to comply with state funding requirements, which is input by the phone specialist into iCarol, using an iCarol Contact Form. Then, they can forward the call to the on-call psychiatrist for the consultation to occur.
PCPs can also request a consultation online, using an iCarol Public Web Form. The form has a built-in screening element that first ensures the requestor is a physician, as this is a requirement for program access. If they are not a physician, a prompt instructs them to please contact their doctor.
If the requestor is a PCP then they continue to use the form to provide the information needed to obtain a consultation, including the demographic and other information required to maintain state funding.
Once the Public Web Form is received by CALL-UP staff, they have the information they need to contact the PCP requesting consultation, and connect them with the on-call psychiatrist. Because the iCarol Web Form is simply a publicly available iCarol Contact Form, they already have the data they need, automatically submitted to iCarol with the form, to meet their reporting requirements.
Each year during the first full week of October, mental health organizations draw attention to mental health conditions through Mental Illness Awareness Week.
Mental illnesses are medical conditions that effect millions of people, however they are still misunderstood and stigmatized, and those living with these conditions still face prejudice that those with other medical conditions don’t experience.
The aim of Mental Illness Awareness Week is to provide public education highlighting the fact that these illnesses are medical conditions and should be treated as such.
For more information on Mental Illness Awareness Week, and to participate with promoting the efforts around public information on mental illness, visit these resources:
Data shows that when specialists respond to mental health crises, everyone is safer and outcomes are better. That’s why communities everywhere are investing in crisis intervention teams as an alternative to 9-1-1 and law enforcement in response to crisis, suicide ideation, homelessness, substance abuse, and more.
One way iCarol organizations are improving their workflows around Mobile Crisis Dispatch is by using Public Web Forms.
Our Public Web Forms are essentially a public-facing version of the same forms our customers use internally in the iCarol web application to log their contacts with clients, collect data, and provide resource and referral information. When placed on a website, these forms can be used for purposes such as intake and eligibility screening or service requests. Once a form is submitted by the web visitor, it arrives in the iCarol system as a completed Contact Form where it can be dispositioned as appropriate by contact center staff, and work with other elements of iCarol to take their purpose even further.
One example of how our customers use Public Web Forms is for Mobile Crisis Team dispatch. In a traditional workflow, someone in need of Mobile Crisis might call the contact center, and a specialist will process their request and complete an intake form over the phone, print it, and fax it to a team who will respond in person. In some centers using disparate systems for different departments, they may even encounter processes where paper or electronic forms are passed between departments requiring specialist to do manual data entry for their data collection.
A Crisis Team Dispatch workflow using a Public Web Form may look something like this:
A crisis services provider has a web page outlining their Mobile Crisis offerings, and places the link to a request form on the web page.
The person requesting response fills out the form, configured by the provider, requesting services and providing information about the situation.
If certain criteria must be met in order to request services via form, a pre-screening element can be built in which directs the person to call instead and speak to a specialist live, if they don’t meet the eligibility requirements to submit a form online.
Submitted forms arrive in the iCarol system and certain staff are notified of submission by email.
The specialist opens the form, contacts the requestor if necessary to fill in additional information, and explain to the requestor what will happen next.
The form is shared with the team providing the direct Mobile Crisis response. In iCarol, forms can sent in many ways: password protected and emailed within the system, sent to a secure Provider Portal for responders to access, transmitted electronically to another software system, are just a few examples.
The crisis team receives the necessary information, and responds.
The crisis team can then disposition the visit according to their protocols, and can add additional data to the form electronically to close the loop and provide the contact center with outcome data and more.
This is just one way Public Web Forms are being used, and we look forward to bringing you more of these stories in the coming days.
Want to learn more about Public Web Forms and talk through how they might be used for your program or partnership?
Around the nation there are conversations happening about public safety as it pertains to emergency response where it involves situations of mental health crisis. Who are the appropriate entities to respond to 911 calls for someone in a mental health crisis?
Legislation has been introduced in New York State, Daniel’s Law, that would establish both state and regional mental health response councils which would permit mental health professionals to respond to mental health and substance abuse emergencies.
This legislation is modeled after a program in Eugene, Oregon, CAHOOTS (Crisis Assistance Helping Out On The Streets), developed in 1989, that takes an innovative, community-based public safety approach to provide mental health first response for crises involving mental illness, homelessness, and addiction.
We believe 211s and Crisis Lines are an integral part of this conversation.
We are planning to host a conversation on this topic and would like to hear from you regarding what actions your organizations are currently taking and what kind of additional support iCarol could provide to assist you in responding to 911 calls in these situations.
email us if you are interested in sharing your ideas or plans related to this topic, or if you are simply interested in participating in these conversations.
Wednesday January 28th is a big day for Canadian mental health initiatives: It’s Bell Let’s Talk Day!
This annual event draws attention to the topic of mental health, particularly the stigma attached to mental illness that prevents many from seeking help. The idea is that if we all talk more openly about mental health and are open to conversations about it, it will lessen the shame attached to mental illness. Bell also champions access to care, workplace mental health, and research.
On Bell Let’s Talk Day, people are encouraged to take to social media and discuss the topics of mental health and mental illness. Certain social media activities, such as watching the official Bell Let’s Talk video, using their special profile photo frame in Facebook, or using their special Snapchat filter, will help raise funds for organizations that address Bell Let’s Talk’s initiatives. Bell donates 5¢ to mental health initiatives and programs across Canada (including many services that are part of the iCarol family!). Bell customers can also participate by texting or making calls. Find out more about how to take part.
Bell Let’s Talk has had a profound impact across Canada. Since the campaign began in 2011 there have been over 1 billion interactions around Bell Let’s Talk, with over $100 million donated to mental health initiatives. And 86% of Canadians say they are more aware of mental health issues since Bell Let’s Talk launched.
To learn more about Bell Let’s Talk, check out their website and toolkit that contains everything you need to participate. We hope you’ll follow us on Twitter and Facebook, to join us in raising funds and awareness so we can remove the stigma from the conversation about mental health!
October 10 is World Mental Health Day, and it’s a day every single person can and should participate in. Every person should be aware of the state of their own mental health, be able to recognize the signs that they are stressed or ill, and know what to do when that happens. And while this is important regardless of one’s age, this year the World Health Organization is placing a focus on child and adolescent mental health.
Half of all mental health conditions start by age 14, but most cases go undetected and untreated until many years later or often not at all. Suicide is the second leading cause of death among those aged 15-29. Depression and eating disorders are top concerns for youth, as is alcohol and drug use that can lead to unsafe behavior. Even under the best circumstances, adolescence and young adulthood are challenging times. Not only do youth experience physical, hormonal, and emotional changes that can be uncomfortable and confusing, but youth are also dealing with academic and societal expectations and challenges. Young adults are facing major life changes such as choosing how to begin their futures, starting university or their first jobs and beginning to navigate adulthood when they may very much still feel like a child. While all this is exciting, it’s also stressful. And, if these pressures aren’t managed well with healthy coping strategies, mental health conditions can and do develop. Besides all the expected challenges of adolescence, we mustn’t forget the number of youth worldwide living in areas affected by war, natural disaster, health epidemics, conflict, and humanitarian emergencies. Young people living in situations such as these are particularly vulnerable to mental distress and illness.
Thankfully, there is a growing focus on prevention and building resilience that could make a difference in the lifelong mental health of youth everywhere. The first step is greater awareness and understanding of mental health as a part of overall health and wellbeing, and knowing the first symptoms of mental illness. The removal of stigma associated with mental illness, and access to proper care are also a vital part of building a more mentally healthy world. And of course, parents, teachers, guidance counselors, and other adults who interact with youth have a role to play in helping children build life skills that help them cope with challenges in healthy and constructive ways so that serious mental health conditions are less likely to become an issue.
WHO encourages governments worldwide to invest in the social, health and education sectors and support comprehensive, integrated, evidence-based programs for the mental health of young people. In particular, programs that raise awareness among adolescents and young adults of ways to look after their mental health and programs that help peers, parents and teachers know how to support their friends, children and students.
The first full week in October is recognized as Mental Illness Awareness Week, and both Mental Health America and the National Alliance on Mental Illness (NAMI) are making stigma their topic to focus on for the week.
NAMI has launched CureStigma.org. The site provides a quiz that helps visitors assess their own stigma towards mental illness, and provides stories of hope and other resources.
Mental Health America similarly hopes to turn the focus on reducing the stigma that still surrounds mental illness. Their site encourages everyone to take a mental health screening and share the results with others to show that checking up on your mental health is nothing to be ashamed of, and that it’s okay not to be okay. They also encourage social media shares using #ThingsPeopleSaidAboutMyMentalIllness to spread awareness of the kinds of comments about mental illness that are hurtful.
While things are getting better, stigma remains a barrier standing in the way of more healthy discussions and solutions surrounding mental health. With 1 in 5 Americans affected by a mental health condition, stigma creates an environment of shame, fear and silence that prevents many people from seeking help and treatment.
Today marks the official start of National Suicide Prevention Week, with September 10th honored as World Suicide Prevention Day.
Suicide education, awareness, and prevention organizations worldwide are taking this opportunity to promote a few key themes and messages around suicide prevention, notably:
Every person has a role to play in suicide prevention. The Lifeline works to empower friends, family members, coworkers, and acquaintances to recognize the warning signs and know how best approach the topic of mental health or suicide, rather than simply encouraging people thinking of suicide to call the Lifeline. The #BeThe1To campaign campaign works to empower the public at large to recognize the warning signs of suicide, and know how to help someone who may be suicidal. This campaign also reminds us that suicide is a public health issue, and that we all can take responsibility for preventing suicide given the right knowledge and resources.
Smashing stigma continues to be the mission of the National Alliance on Mental Illness (NAMI). They take the opportunity of Suicide Prevention Week to encourage people to share their stories and experiences, and reject the stigma and prejudice that cause people to suffer in silence. Similarly, the American Foundation for Suicide Prevention is promoting the power of connection, and openly talking about mental health in everyday conversations.
Suicide prevention is a year-round effort. While it’s important to bring attention to the topic of suicide during special events and recognition dates, the American Association of Suicidology (AAS) has launched its #AAS365 initiative that focuses on suicide prevention each day of the year. They advocate continuously spreading awareness, advocating for research funding, developing innovative and effective treatment tools, being kind, and helping to educate others on things like resources and warning signs.
It is heartening to see how each year National Suicide Prevention Week grows in its reach and the number of people participating. It is clear that people are becoming more willing to talk about suicide, reach out to loved ones, and have conversations with others about it. One can see the initiatives outlined above in action and ultimately these conversations provide some of the best hope for reducing suicide rates.
To all the suicide prevention helpline volunteers and staff, researchers and doctors, advocates, people with lived experience, and suicide loss survivors — we thank you for your lifesaving work and for raising your voices this week and all year-round to help save lives.