The state of mental healthcare in Westchester reflects progress — and ongoing challenges. “We’ll know we made it when we stop calling it mental health and just call it health,” says Wendy Wollner, CEO of Ossining-based Balancing Life’s Issues, a corporate training program provider.
Progress can be seen in the increased use of technology, such as teletherapy and virtual reality therapy, as well as the growing focus on prevention and early intervention. There has also been increased attention to the social determinants of mental health, such as poverty, racism, and discrimination and a growing recognition of the importance of self-care and mindfulness. New York State is also improving funding for housing, substance abuse, and mental health, says Steve Miccio, CEO of peer-run mental health nonprofit People USA.
But obstacles persist. Jennifer Spitz, director at St. Vincent’s Hospital in Harrison, says the private system is tapped out and many are unable to get services. Finding an adult psychiatrist is difficult, but identifying a child or adolescent one is harder. “Even in private practice, providers have waitlists,” says Dr. Shama Saqi, St. Vincent’s Behavioral Health Center in White Plains.
Dr. Alexa Whoriskey, Chief of Outpatient Services, St. Vincent’s Harrison, adds it’s a New York State problem and the hospital administration is developing models, services, and increased care coordination to hopefully lessen the fragmentation.
A New Landmark Rule
Nationally, 21% of adults have a mental illness, and 55% of adults with a mental illness haven’t received treatment. In July, President Biden announced a rule to strengthen mental and physical health parity requirements and improve access. This “incentivizes more practitioners to enter the field,” says Daniel Sexton, the Chappaqua-based outpatient program manager at Mountainside Treatment Center. Biden supports the model of behavioral healthcare — the Certified Community Behavioral Health Clinic (CCBHC) — which provides services and promotes access to care for underserved communities. Family Services of Westchester’s Karen Fink welcomes this policy change, as many health insurance companies found ways not to include this parity, and access to services suffers, or disappears. Also part of Biden’s plan is 988, the dialing code for the National Suicide Prevention Lifeline that went live last year, replacing the previous 10-digit number. “Having a crisis number just for mental health conditions reduces the stigma and barrier,” Dr. Whoriskey of St Vincent’s says.
Most experts agree that the pandemic changed the landscape of mental healthcare.
Residents across communities and age spans had to accept mental health issues could happen to anyone. “[They’re] experiencing stress, depression, and challenges with substance abuse,” says Shannon Catauro, senior director of development at the Mental Health Association of Westchester. Since the pandemic, few providers accept insurance in-network, creating additional stress for a population in need, psychologist Dr. Sarah Stern of Chappaqua says.
Children struggled re-entering in-person schooling and experienced social delays. Dr. Saqi of St. Vincent’s saw referrals increase in adolescent girls — specifically, a rise in eating disorders. The resources for eating disorders are private and don’t accept insurance. “Even they had a waitlist,” she says. “Even paying out of pocket, you couldn’t get into treatment facilities.” And immigrants suffered because they weren’t among those who could afford pods, referring to a social “bubble” families created to manage homeschooling with loosened pandemic safety protocols.
Many suffered trauma through loss; others sustained significant economic impact. “Many had a hard time coping with health, financial, and familial stressors; that’s how anxiety, depression, and substance abuse disorders activate,” Sexton of Mountainside says.
“The virus itself produced mental health and cognitive symptoms that appear to persist long term,” Dr. Stephen Ferrando of Westchester Medical Center (WMC) says. His team sees outpatients in a program for COVID’s post-acute conditions — including disabling fatigue and brain fog. “These individuals experience occupational challenges and feel misunderstood by the healthcare system,” he says. No definitive treatments for post-COVID syndrome exist.
Nationally, 21% of adults have a mental illness, and 55% of adults with a mental illness haven’t received treatment.
Treatments: Mindfulness-Based Therapies and Cognitive Behavioral Therapies
Mindfulness involves noticing thoughts and awareness of feelings and bodily sensations; it’s useful in treating anxiety. “The pandemic created and exacerbated feelings of isolation and loneliness. Mindfulness is a tool that helps us notice feelings and develop healthy ways to change patterns of behavior,” Scarsdale-based social worker Lauren A. Tetenbaum, who specializes in cognitive behavioral therapy and coaching for millenial and young women, says. Patients can practice on their own. “It’s helpful to connect exercises to a routine activity, such as drinking coffee or teeth brushing,” Chappaqua’s Dr. Stern says.
Congnitive Behavioral Therapy (CBT) encompasses a range of evidence-based psychotherapies targeting emotions, cognitions, and behaviors. “Shown to be effective across the lifespan across ages, genders, cultures, diagnoses, and settings, it prevents and treats not only the symptoms, it also works to reduce suffering and the impairment these conditions cause,” says White Plains-based psychologist Dr. Lata McGinn.
WMC’s Dr. Ferrando says “CBT has been effective in helping individuals cope with the stresses and manifestations of the pandemic.” His team provides it to those with COVID, diabetes, cardiovascular disease, even cancer. Dr. Stern reports CBT tends to be more concrete than other modalities. “During the pandemic and now, the idea of being able to write down your thoughts provides many with a sense of control when they didn’t feel they had much.”
“Teletherapy changed the mental health landscape for the better,” says social worker Tetenbaum. The advantages are its convenience and accessibiltiy. Plus being virtual allows some more comfort being vulnerable. Wollner of Balancing Life’s Issues says its anonymity makes it ideal for her suicide awareness and substance abuse classes. And when mental health needs were at an all-time high, the providers’ accessibility and patients’ extra time made treatment more attainable.
The pandemic lessened mental health’s stigma and highlighted providing care to underserved populations.
Some struggle connecting online, but ultimately, the same rules apply as in-person. “If someone’s open to change, whether it be perspective or behavior, they will benefit from therapy,” Mountainside’s Sexton says. Licensing laws pose challenges for providers and clients seeking teletherapy; individuals can only be treated in a state where providers are licensed — an issue for adolescents attending out-of-state colleges. “The stress of finding a new therapist adds to an already stressful time,” Dr. Stern says. Teletherapy was also difficult for senior citizens without access to devices.
According to St. Vincent’s Director Spitz, “Some said, ‘I’m so close to the end anyway. There’s no reason to continue if this is what the world will look like.’” She also remembers a crisis intervention call with somebody who’d stepped out of their Third Avenue office and that person, already in an adverse state of mind, was simultaneously hearing sirens blaring and cars honking. “I was anxious sitting at my desk,” she says.
Teletherapy has it limitations however. The socioeconomically disadvantaged may have difficulty with access. When technology malfunctions, it frustrates providers and patients. Miccio of People USA questions whether the interface allows the provider to “read” the patient enough to make a clinical decision. “Behavioral health treatment relies on relationships between helpers and people in need,” he says. “More research needs to be done to measure telehealth’s efficacy.”
Mental Health’s Changing Perception
The pandemic lessened mental health’s stigma and highlighted providing care to underserved populations. Struggling became normalized, for better or worse, says Lindsay March, director of Family Services of Westchester’s White Plains location.
In media, ads remind us about helplines and resources. “Athletes and celebrities going public with their own mental health issues inspire people,” Open Door Family Medical Center’s Andrea Ruggiero says. Media has a responsibility to show good care’s effectiveness — and outcomes.
According to New York-Presbyterian Westchester Behavioral Health’s Dr. Michael McIntosh there’s evidence that stigma toward some mental illnesses, such as depression, has decreased, but “research has shown the stigma of other mental illnesses — schizophrenia and alcohol disorders as examples — has not decreased.”
Yet certain perceptions are difficult to overcome. Society doesn’t yet recognize the possibility of recovery from mental illness, People USA’s Miccio says. “There’s also fear surrounding the ‘dangerousness’ of mental illness and the media is partly to blame, showing only heinous occurrences,” he says.