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More counselors needed to meet increasing demand for mental health support

Bullying, shaming and stigmatizing mental illness

Peter Sanderson is a licensed marriage and family therapist who practices in both Thurston and Mason Counties. He participates among other things in 3 of the state’s five Medicaid Managed Care plans. He was interviewed by Matt Crichton for Works in Progress in December 2021.

Matt (MC): How did you get into counseling?

Peter (PS): It was a pretty circuitous journey. When I was in high school, people said “you might be a good psychologist someday.” A few decades ago I enrolled in an undergraduate program for psychology, but I kind of dropped out. I was a construction worker for 15 years. Just after age 40, I went back to school as an undergrad and then went on to get a Masters Degree in psychology, in couple, child and family therapy.

MC: Give us a general sense of what is happening locally with the mental status of adults? Of youth?

PS: I hear stories about how the need for mental health services has hugely increased over the past two years. But this year, the people I encounter are largely coming to me for the same reasons they came before. People are anxious, depressed, dealing with the effects of trauma, things like that. Covid is just one more thing.

In contrast, in 2020, people would respond to me asking, “why are you here?” by putting on their intake form, “I’m really scared of covid….I don’t know how to deal with covid….I work in a medical environment and covid is heavily impacting my work and making me scared to go to work”. We live in very stressful times, and it’s just one more stressor to add to the mix that people deal with.

MC: What things do you hear from the youth in our area?

PS: I work with about 2/3 adults and 1/3 teenagers. Not many of my teenage clients have expressed a lot of stress about covid, unless it’s directly impacted a family member…someone has gotten sick or died. The top anxieties of teenagers are being bullied or shamed. Being trolled online is really huge.

Also school and school work and how to deal with that. Most of my teenage clients didn’t do very well when school was mostly online. That actually surprised some of them. They thought it would be their wildest dream—not have to go to school and just learn online. Then they discovered it wasn’t much fun and they missed human contact. This school year, some have stressed over having to re-learn how to interact with other human beings

MC: What have you found is a good way to engage with youth?

PS: Building trust. Many younger adolescents are dragged into counseling by a parent who wants somebody to fix them. It’s pretty understandable. Suddenly, your kid is acting differently. Their grades have gone down, and it seems like a mental health issue—and it may or may not be. Somebody, a parent, will schedule an appointment for their kid—often without telling them.

All of a sudden the youth is sitting in a counselor’s office. At that point, the main thing I have to do is gain some conditional level of trust. One strange thing about Washington state law is that once you’re 13 years old, you’re the one who contracts for therapy services. You control access to your records, with a few minor exceptions. Once my clients understand that, it usually helps build trust.

I can’t tell a 13-year old’s parent anything without a release of information, unless they describe danger to self, others, or abuse. I try to provide all my clients a safe, non-judgmental environment. That’s important in building the trust needed to make progress.

MC: What about people who feel they’re hooked on social media and worry that it’s causing them harm?

PS: That’s something I work with on an individual basis. Most of my teenage clients would list social media as a stressor. But at the same time, social media provides a lot of positive things for those same clients.

MC: Are there general similarities or differences in Mason County vs Thurston County clients?

PS: I see some clients in Mason County who are pretty poor, and some who have good jobs. The people who are pretty poor often have survival-related stressors in addition to issues experienced also by my clients who have good jobs. There’s more seasonal employment in Mason County; there’s a forest products industry that produces Christmas type stuff. People go to work and that’s their only potentially regular job for the year. Other than that, the stressors are pretty similar…people worry about and get depressed about the same things.

MC: Can you talk about major misconceptions of people with mental illness?

PS: People think about mental illness like it’s abnormal; like there’s something wrong with them. Most of the issues that people bring to counseling are actually their brains doing what they’re supposed to do, just not in the right way.

For instance, anxiety may arise from a response to a perceived threat in the environment. It’s your brain’s survival mechanism (limbic system) kicking in, going “warning warning you need to go into action!” People generate physiological symptoms as a result of a perceived threat, when there really might not be a threat in the environment. All of a sudden, the way they are thinking and acting is out of sync with their environment, which makes them look crazy.

MC: Society tends to stigmatize those with mental illness. What would you say to someone who may not know much about mental illness and sees a person on the street acting “differently?”

PS: Part of that goes back to people perceiving threat. We’re all wired to notice things that might hurt us. We pick out difference. If someone is acting in a way that seems strange, many of us go “oh, maybe that person is dangerous.” The fact that they’re acting weirdly or speaking weirdly doesn’t necessarily make them dangerous. It could mean a lot of things. A person who has a manic episode and doesn’t sleep for five days can hallucinate and walk around talking to people who don’t appear to be there. That can be scary to somebody encountering them.

MC: Does the occurrence of mental illness have a bias towards a certain economic, social, geographic, political, class, race or gender affiliation?

PS: In one sense, no. But in another, people who have more means, people at a higher socioeconomic status, have more ability to insulate themselves from some of the stressors that can aggravate or lead to mental illness. They are also able to avail themselves of help better and faster. Stress does come to everybody, but if you’re food insecure, or housing insecure, or in another situation based on not having money or resources, those are very big stressors that will impact your mental health.

MC: What do you say to someone who thinks homelessness is caused by mental illness or drug addiction?

PS: As a therapist, I don’t hold myself out to be an expert on homelessness. Many things can contribute to homelessness. We live in a time when a lot of people are just a few hundred dollars away from getting kicked out of their housing. It’s pretty scary.

MC: What would you say to someone who wants help but doesn’t know how to take the first step?

PS: Simply asking for help is huge. There’s still the perception that “there is something wrong with me.” Most people get counseling at some point. It’s not an abnormal thing. So part of it is deciding to take the first step.

How do you take that first step? There are multiple ways people look for therapists—like doing an internet search. It partly depends on whether people have insurance or not. People who are on Medicaid can use Community Mental Health. Places like BHR, Sea Mar, and Community Youth Services will provide counseling to some people depending on their income level. People with insurance can access lists of therapists through their insurer.

MC: Can you explain different kinds of counseling or mental health options?

PS: People who haven’t had counseling don’t really know who to go to. Who counsels you? People think it’s a psychologist or psychiatrist or someone like that but for the most part, they’re not the ones who do counseling. In this state, counseling is done mostly by masters level practitioners who are licensed either as mental health counselors, marriage and family therapists or clinical social workers. There are also peer counselors.

Some psychologists do counseling, although they also do other things like specialized testing and court testimony. Psychiatrists write prescriptions for medication and only rarely do anything like counseling.

MC: How could Thurston and Mason counties improve how we deal with mental illness?

PS: Find a way to create more therapists and provide better reimbursements. People below a certain income level can qualify for Apple Health (AH). Reimbursement levels for AH are really bad and the result is that not enough providers see clients with AH plans. A huge amount of people spend months searching for a therapist, sometimes calling 40 or 50 places. Even regular insurance plans, for the most part, don’t reimburse at a decent level.

Some therapists don’t even take insurance because of the hassle of billing and the level of reimbursement. But most people pay for counseling with insurance, so that shrinks the pool.

There aren’t enough people doing counseling. The demand is greater than the supply. So better reimbursement that would enable more people to stay in the business of counseling would improve the situation. Most of us don’t do this primarily for the money, but most of us rely on insurance for reimbursement and insurance simply doesn’t pay enough.

MC: Winter can be hard for some people. Can you offer suggestions to help?

PS: I have a few things I try to get some clients to do. Full spectrum light, if you have access to that. Exercise. Getting out—getting outside. When you get outside, the nasty gray you see through the window that looks so depressing is really not quite so bad. Light does filter down through the clouds. The process of getting outside and walking if you can is hugely beneficial to your mental health. Being around people helps some people.

MC: What can the community do to be helpful to people with mental illness?

PS: Support legislation that would expand mental health services. Donate to mental health related nonprofits like Community Youth Services or BHR foundation. Become a volunteer at the Crisis Clinic of Thurston/Mason counties.

Contact numbers for the Crisis Clinic: 360-586-2800 – adults; 360-586-2777 – Youth Help Line


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