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The last few years have been challenging for everyone. As more time passes, the continued uncertainty of the future, combined with the disillusionment surrounding the political environment, is affecting the mental health of many. A Harris Poll survey reported the majority of adults are unsettled by government and political actions, apprehensive about inflation levels, and distressed by boundless violence. The poll also found respondents hold a pessimistic view of the future. Over 60% disagreed with these statements: “I feel our country is on the path to being stronger than ever.” “Our children are going to inherit a better world than we did.” More than 75% of respondents said the future of our nation is a significant source of stress in their lives. And almost 70% said the current political climate is a significant source of stress in their lives. The stress caused by this uncertainty, disillusionment and fear plays a toll on mental health. This stress and pessimistic view of the future leads many Americans to consider moving to another country. Over 50% of Americans aged 18-44 said the state of this country has made them consider moving to another country. And 59% of LGBTQIA+ said the same. Stress and Health Consequences Over 75% of people polled said that stress had impacted their health. They reported headaches, fatigue, nervousness, anxiety, sadness and depression. Those with higher stress levels were more likely than those with a lower average stress level to report experiencing these symptoms. What’s more, over 70% also reported other impacts on their mental health, including feeling overwhelmed, changes in sleep and constant worrying. These changes in mental health have caused 15% of these people to turn to alcohol and drugs. How to Improve Your Mental Health During Times of Uncertainty Some people are better at dealing with uncertainties than others. It might take time for the situation to be resolved or improved. If you find yourself feeling stressed, you can take steps to build resilience. Accepting that there will be uncertainty in our lives is the first step. Being in this frame helps us focus on what we can control. Here are a few ways you can improve your mental health in times of uncertainty: Disrupt negative thinking and ruminating. Stop and take a breath when you find yourself spiraling into negative thoughts. Instead, try to imagine the best possible scenarios and figure out what you can do to experience that outcome. Do something new. You can train yourself to be more comfortable with uncertainty. Stepping outside of our routine and trying new things can help us become more comfortable with the unknown. Take control where you can. Taking action over aspects of life that are within our control can be empowering and help reduce stress over things that are out of our control. Surround yourself with supportive people. Seek out emotionally supportive friends and family who will be there for you when you need them. Talk with a mental health professional. Sometimes, despite our best efforts, we need help working through our problems. A mental health therapist can listen to your concerns and work with you on a plan to address your situation and help you move forward. It’s clear that more people than ever are dealing with mental health issues. Mental healthcare professionals can offer a non-judgemental and safe place to confront their fears and concerns and get the help they need.

The Mental Health Connection Independent of the weather, Fall has arrived and with it comes the beginning of the holidays. This month, Halloween is front and center. Halloween has been evolving to become less about kids trick-or-treating and more about adults partying. It’s also a time of anxiety for many suffering from a mental illness. These individuals can greatly benefit from talking with a therapist to uncover the underlying causes that trigger anxiety and learn coping strategies. Medicare Fall Enrollment begins October 15 and runs through December 7. This is the time Medicare recipients can change from Medicare Advantage plans to Medicare Original, or Medicare Original to Advantage plans, and also change prescription plans. Researching options and considering the consequences to changing plans is recommended; otherwise Medicare recipients will be re-enrolled in their current plan the first of the year. As mentioned in last month’s newsletter, Help Therapy is participating in the annual Navy SEAL Foundation Impact Forum taking place this month in La Jolla, CA. There’s still time to register. If you’d like to attend in person or virtually, register here. Help Therapy providers, if your patient tells you that they are switching their insurance, please email us so we can update their file at billing@helptherapy.com. Annette Conway, PsyD President Help Therapy October is National Depression and Mental Health Screening Month and Bullying Prevention Month National Depression and Mental Health Screening October is the perfect time to increase awareness and understanding of the signs and symptoms of mental health issues. It’s been reported that: One in five adults in the U.S. experiences mental illness each year One in six youths ages 6-17 experience a mental health disorder each year Bullying Prevention October is also the time to bring awareness to the fact that bullying is an ongoing concern and there is a need to address and prevent childhood bullying. The United States Justice Department's statistics show that one in every four kids will be bullied sometime in adolescence. Students ages 12–18 who reported being bullied said they thought those who bullied them: Had the ability to influence other students’ perception of them Were physically stronger or larger Had more money Have you ever been Denied? Claim denials are a pain for everyone involved. A few things can happen when a claim is submitted to an insurance provider or other payer. It can be: Accepted after the first submission, making it a clean claim Denied with no chance for resubmission Denied due to an error and can be resubmitted In the past, claims were reviewed, processed and paid by individual claim processors—real people. Today, much of that work is being determined by computers. Payers have increased the sophistication of their computer systems so they can define different payment algorithms which match the contract requirements. Unfortunately, it may appear that some algorithms are set to follow the rule: "When in doubt, deny.” After all, denying your claims saves the insurance provider money. Plus, payers are aware that many healthcare providers will not follow up on claim denials. In fact, The Healthcare Financial Management Association estimates that 65% of all denials are not resubmitted. But we all know that when you reduce your denial rate, you bring more money to your practice's bottom line. This process includes benefits verification, claim auditing and denial follow-up. Benefits Verification If a patient’s insurance isn’t up to date, any claim submitted to a payer may automatically be denied. That’s why each patient’s insurance coverage needs to be verified in advance. Claims Auditing Claims auditing is a step taken prior to the claim's submission. A billing team member will audit each of your claims to identify potential red flags, such as missing information, billing code errors and more. If an error is found, it’s corrected prior to submission. This step leads to higher rates of clean claims and increased revenue for you. Denial Follow-up Even with much diligence, denials still happen. But having a process in place ensures that every denied claim is corrected and resubmitted within the required time frame. You can trust Help Therapy has the knowledge and resources to handle your billing efficiently. Is it Just a ”Senior Moment” or Something More Serious Alzheimer's, dementia and other forms of cognitive impairment are conditions causing much fear because of their growing prevalence, incurability and life-changing consequences. According to Alzheimer's Disease International, someone develops dementia every 3 seconds. As of 2020, 55 million people worldwide are living with dementia. This number is expected to reach 78 million by 2030. Mild changes in memory and other thinking skills are common as we age. We’ve all experienced an older relative or friend forgetting someone’s name or misplacing their glasses or keys. These occasional lapses in memory or attention are not typically a cause for concern. But, regularly forgetting to turn off the stove, being unable to recall recent conversations or getting lost in familiar places could be signs of a more significant problem. Although cognitive decline is common with age, certain forms can indicate a more severe condition. There are particular memory loss and thinking issues seen in mild cognitive impairment (MCI) or dementia that are not part of normal aging. As we age, subtle changes in our memory occur naturally as part of the aging process. Unfortunately, these changes can happen sooner than anticipated or faster than expected. Researchers believe that MCI is the precursor to dementia for some individuals. It’s the stage between normal age-related mental changes and early-stage dementia. However, not all individuals diagnosed with mild cognitive impairment are destined to develop dementia. When memory loss prevents someone from performing daily tasks and continuing established roles in life, it becomes a health concern that needs further evaluation by a healthcare professional. [READ MORE] This Month’s Tip 7 Fun Family-Friendly Fall Outdoor Activities Fall is a beautiful time to enjoy nature and experience the mind and body benefits of being outdoors. No matter your age, Fall offers many fun activities for the whole family. Here are just a few ideas to get you outside. 1. Take a hayride 2. Explore a pumpkin patch 3. Get lost in a corn maze 4. Attend a Fall festival 5. Pick apples 6. Enjoy the Fall displays at a botanical garden 7. Go on a nature scavenger hunt. Collect: Bird feathers Berries Seed pods Pinecones Acorns Colorful leaves After collecting your Fall icons, arrange them into a decorative Autumn display. Medicare Enrollment Medicare Fall Enrollment begins October 15 and runs through December 7. This is the time Medicare recipients can change from Medicare Original to Medicare Advantage plans, or Advantage plans to Medicare Original, and also change prescription plans. Beware of marketing pitches that offer Advantage manage care plans with low or zero premiums. In general, Medicare managed care plans require individuals to go through their limited network of health providers, can get hit with unexpected co-pays and deductibles, receive denials for services deemed not medically unnecessary, and often requires referrals from a PCP to see a specialist. Researching options and considering the consequences to changing plans is recommended; otherwise Medicare recipients will be re-enrolled in their current plan the first of the year. Welcome New Help Therapy Mental Health Provider Partners These mental healthcare partners are new to our network and offer evaluations and other types of therapy. They are accepting new patients and provide telehealth appointments. California Annie Merkel, LMFT Featured Practitioner Julie Jeffery, LCSW Julie helps her clients reach their goals through a primary focus on hope and forgiveness—of self and others—opening up additional avenues of healing. Over the years, she has provided counseling, case management and psychotherapy in a variety of settings, including outpatient behavioral health, home-based counseling, nursing homes & assisted living facilities, faith-based organizations and active duty military service organizations. Her specialties include solution-focused therapy, trauma modalities and dementia therapy. Julie has also added Cognitive Processing Therapy and Pain Reprocessing Therapy as her newest specialties. Julie is currently enrolled in advanced training for trauma and pain reprocessing. Having suffered from chronic pain for many years, she credits Pain Reprocessing Therapy for curing her chronic pain. She's excited to bring this relief to others! Events National Depression Screening Day October 6, 2022 See IABHP for more information. OCD Awareness Week October 9-15, 2022 SeeIOCDF for more information. World Mental Health Day October 10, 2022 See WHO for more information. National Coming Out Day Day October 11, 2022 See HRC for more information. National Pregnancy and Infant Loss Remembrance Day October 15, 2022 See SLF for more information. “You, yourself, as much as anybody in the universe, deserve your love and affection." -The Buddha Partner With Us Are you a psychologist, LCSW or LMFT? We’re always looking for exceptional mental healthcare providers. Visit helptherapy.com for more information and fill out the quick and easy application. Benefits: Stream of new patients Billing off your plate Flexibility and Freedom Credentialing assistance No hidden costs Do you have something to share? We’d love to hear about your successes and accomplishments! Have you: Written an article? Given a presentation? Been featured on a podcast? Contact us at info@helptherapy.com. We welcome your feedback. What would you like to see in this newsletter? Do you have a topic you would like discussed? Have questions? Want to learn more about Help Therapy? Visit helptherapy.com, call 855-449-0159 or email info@helptherapy.com

The Mental Health Connection With school back in session, mental health issues begin to surface or resurface. For students, low self-esteem, social comparisons, fear of not fitting in, stress about grades… can all lead to mental health challenges—even thoughts of suicide for some. For parents, just keeping up with their children’s demanding schedules can be pretty stressful. It’s essential that parents and students are aware of the resources available to them and feel comfortable seeking help when they need it. See Fitting in and Self-Esteem for Students further down in this newsletter for a few tips on addressing these issues. Another population in particular need of mental health resources is veterans. Help Therapy will again participate in the annual Navy Seal Impact Forum, held October 17 and 18 in La Jolla. This event highlights speakers with insights, strategies and treatments to help Navy Seals improve their mental health and well-being. We provide service to countless veterans and always look forward to this event. If you’d like to attend in person or virtually, you can register here. Stop by our booth and say hello! Annette Conway, PsyD President Help Therapy Annette Conway, PsyD President Help Therapy September is a Time to Promote Awareness of Four Special Issues Suicide Prevention Awareness Month (SPAM) There were nearly 46,000 suicides in 2020. And between 1999 and 2019, the suicide death rate increased by 33%. This National Alliance on Mental Illness (NAMI) encourages people to advocate for better mental health care. Past efforts have led to the creation of 988—a new nationwide contact number for mental health crises, including suicide. The theme for 2022 is “Together for Mental Health.” National Recovery Month Since 1989, September has been chosen to promote and support new evidence-based treatment and recovery practices. The Substance Abuse and Mental Health Services Administration (SAMHSA) collaborates with private and public entities to bring awareness to mental health treatments and addiction recovery. World Alzheimer's Month Experts estimate that the number of Americans living with Alzheimer’s will rise to 16 million by 2050. Many people believe developing Alzheimer’s or dementia is a normal part of aging. Alzheimer's Disease International aims to change this misperception and increase public knowledge about these diseases. This year’s campaign will highlight the importance of support for people with dementia and their families. National Hispanic Heritage Month Hispanic Heritage Month is a time to celebrate the achievements and contributions of Hispanic Americans who have inspired others. But it’s also an apt time to bring awareness to the need for accessible mental health treatment for this undertreated, diverse population. It’s estimated that more than half of Hispanic adults between 18-25 with a severe mental illness may not receive treatment. Only 35% of adults in this population with mental illness receive treatment each year compared to the U.S. average of 46%. Exploring the Hoffman Process The Hoffman Quadrinity Process®, founded by Bob Hoffman in 1967, is a week-long personal growth retreat that helps attendees identify negative behaviors, moods, and ways of thinking that developed unconsciously in childhood. The Hoffman Process aims to help participants become conscious of their negative thoughts and behavioral patterns on emotional, intellectual, and physical levels. Participants learn to remove habitual ways of thinking and behaving, align with their authentic selves and respond consciously to situations in their life. Then, to make significant changes in their life on a spiritual level to disconnect from these negative patterns. In the course of the retreat, participants are led through exercises and experiences to begin a journey to self-understanding. Along this journey, they learn new ways of thinking and being, allowing them to experience more awareness and positivity in life. One of Help Therapy's employees just returned from a Hoffman Process retreat. What he found the most surprising was the power of forgiveness—forgiving parents and others who have wronged us in the past. “During the retreat, it became very easy to forgive when I came to understand that behavioral patterns pass from generation to generation and that our parents were once young children whose parents had faults.” Visualization, letting go of vindictiveness and identifying negative behavioral patterns were all part of the process, leading to inner peace. At the end of the retreat, the Hoffman counselors send the attendees home with tools to continue using in their lives. But as the Help Therapy team member explains, “ What I found most remarkable is that the most change from the process comes from the process, not how often you use the tools. It’s hard to believe a week retreat can have such a lasting impact, but it has for me and many others in my group.” Grown-Ups Need Playtime Too When we’re kids, we can’t wait to grow up. We want more freedom. We want to do what grown-ups do. As kids, we see our lives revolving around school, friends and fun activities and don’t understand how good we have it. When we grow up, work often takes the place of school, friends take a back seat to family obligations and fun activities are often more like special events. As adults, we feel we always need to be responsible and productive and rarely make time for playful activities. We create conscious or unconscious boundaries around what is acceptable and unacceptable adult behavior. We view visiting the zoo or going to a carnival as something fun for the children to do and we just play the role of chaperone. We don’t think about actually having fun ourselves. Children play spontaneously. They can create playful activities anytime, anywhere. As adults, we can lose this ability or bury it deep inside. At first, it may take a bit of time and creativity to think of playful activities and may need to be scheduled on the calendar. In time, playing may become more spontaneous. Although it’s often associated with games, the idea of play is much broader. Playing can be any fun, joyful activity where you forget about time. Playing can be a solo event, like riding a bike along the beach or engaging in a hobby. Or, it can involve others, like playing a sport or throwing a ball for your dog. Benefits of Play Playing offers an abundance of emotional and physical benefits. The more play, the more significant the benefits. Of course, it stands to reason that play involving movement (such as tennis) has more physical benefits than sedentary play (such as chess). [READ MORE] Who Says “Home Visits” are a Thing of the Past? By: Dr. Annette Conway My interest in specializing and working with the older adult and elderly population began as an undergraduate student at San Diego State University. It was there that I chose elective courses which focused on the sociology and psychology of the aging population. As well, I was fortunate enough to be mentored by two professors, who themselves were older adults. To gain clinical experience working with the older adult population, I contracted with a home-based organization in 1993, treating clients in their homes who would otherwise not be able to access mental health services, due to being bedbound, homebound, or unable to access transportation, among other reasons. In-home therapy was not only intrinsically rewarding in helping clients bring back purpose to their lives, but I also envisioned its value in helping improve the quality of mental healthcare in San Diego. [READ MORE] This Month’s Tip Fitting in and Self-Esteem for Students It’s easy to assume we know what someone else is thinking or feeling. A misinterpreted text message, a classmate who doesn’t acknowledge a wave as they pass by, etc. Assumptions about these types of occurrences can build up and cause a student to develop low self-esteem. Add to that, situations like not being chosen to be on a team, not getting invited to a party or giving the wrong answer in class and a student’s self-esteem can crumble. Here are a few tips to help children improve their self-esteem. Older children may understand and use these tips independently, while younger children may need help carrying out these activities. Start a conversation with a fellow student they want to get to know. Making one new friend can boost self-esteem and help maintain a feeling of self-worth. Make an effort to join or build a community with other students or peers having similar interests. Look into local clubs and volunteer opportunities to meet people with whom a child already has something in common. Be friendly to people you see frequently but don’t know—like a neighbor who walks his dog past your house every day. Brief interactions with people throughout the day can help children feel they are part of a local community. Learn to recognize negative thoughts when they occur and replace them with positive self-talk before these thoughts become persistent. Make a list of your best qualities. If the child has difficulty coming up with many, ask a friend or family member what they think your best qualities are to get you started. Keep adding to this list and keep it handy to refer to when you’re feeling insecure. A student’s low self-esteem and worries about not fitting in may not be apparent. They may feel embarrassed, hopeless and withdrawn. Talking to a compassionate, friendly therapist who listens without judgment and offers tools or methods to improve a child’s self-esteem and keep it healthy may be of great value to both child and parent. Welcome New Help Therapy Mental Health Provider Partners These mental healthcare partners are new to our network and offer evaluations and other types of therapy. They are accepting new patients and provide telehealth appointments. California Marisol Cendejas, LCSW Ryan McNeel, LCSW Susan Valoff, LCSW Jaazar Shalabi, LMFT Featured Practitioner Negar Nazari, Ph.D Dr. Nazari is passionate about providing services to a diverse community, specifically those who may struggle to access services. She provides a non-judgmental environment, utilizing a caring and collaborative approach to help her patients feel heard, supported and empowered. Her specialties include self-esteem building, racial & cultural identity, life transitions & adjustments, relationship concerns, academic & work challenges, trauma, family of origin issues, mood disorders and stress management. She also specializes in reproductive psychology—relating to infertility and the use of Assisted Reproductive Technology (ART). She focuses on working with individuals and couples who experience the emotional, physical and financial toll of infertility and loss. Dr. Nazari started working with Help Therapy in March 2019, conducting individual and couples therapy for veterans. She is a licensed clinical psychologist in private practice, dually licensed in California and Georgia. Events National Suicide Prevention Week September 4-10, 2022 See SP for more information. World Suicide Prevention Day September 10, 2022 See IASP for more information. National Assisted Living Week September 11-17, 2022 See AHCA for more information. World Alzheimer’s Day September 21, 2022 See Alzheimer's for more information. “Everything has beauty, but not everyone sees it" -Confucius Partner With Us Are you a psychologist, LCSW or LMFT? We’re always looking for exceptional mental healthcare providers. Visit helptherapy.com for more information and fill out the quick and easy application. Benefits: Stream of new patients Billing off your plate Flexibility and Freedom Credentialing assistance No hidden costs Do you have something to share? We’d love to hear about your successes and accomplishments! Have you: Written an article? Given a presentation? Been featured on a podcast? Contact us at info@helptherapy.com. We welcome your feedback. What would you like to see in this newsletter? Do you have a topic you would like discussed? Have questions? Want to learn more about Help Therapy? Visit helptherapy.com, call 855-449-0159 or email info@helptherapy.com

Alzheimer's, dementia and other forms of cognitive impairment are conditions causing much fear because of their growing prevalence, incurability and life-changing consequences. According to Alzheimer's Disease International, someone develops dementia every 3 seconds. As of 2020, 55 million people worldwide are living with dementia. This number is expected to reach 78 million by 2030. Mild changes in memory and other thinking skills are common as we age. We’ve all experienced an older relative or friend forgetting someone’s name or misplacing their glasses or keys. These occasional lapses in memory or attention are not typically a cause for concern. But, regularly forgetting to turn off the stove, being unable to recall recent conversations or getting lost in familiar places could be signs of a more significant problem. Although cognitive decline is common with age, certain forms can indicate a more severe condition. There are particular memory loss and thinking issues seen in mild cognitive impairment (MCI) or dementia that are not part of normal aging. As we age, subtle changes in our memory occur naturally as part of the aging process. Unfortunately, these changes can happen sooner than anticipated or faster than expected. Researchers believe that MCI is the precursor to dementia for some individuals. It’s the stage between normal age-related mental changes and early-stage dementia. However, not all individuals diagnosed with mild cognitive impairment are destined to develop dementia. When memory loss prevents someone from performing daily tasks and continuing established roles in life, it becomes a health concern that needs further evaluation by a healthcare professional. Several things can cause memory problems or make normal age-related memory changes worse. Possible causes include a medication side effect, a mental or physical health issue, sleep problems or a vitamin deficiency. Identifying and treating the underlying cause can improve memory. But if no underlying causes for changes in memory are found, it’s wise to look closely at the symptoms and have a professional cognitive assessment. Symptoms of Mild Cognitive Impairment (MCI) Forgetting recent events, planned events or appointments Forgetting conversations Forgetting names of friends and family members Misplacing items Difficulty coming up with the desired word Difficulty understanding written or verbal communication Easily distracted and loses focus May struggle with (but can complete) complex tasks such as paying bills, shopping, cooking and driving Experiences many memory impairments but can still function independently Symptoms of Dementia People with dementia endure many of the symptoms of MCI. But, as dementia progresses, more severe impairments develop, including: Inability to perform complex daily tasks such as shopping or driving Loss of awareness of their memory loss Using poor judgment Declining ability to solve problems Severe memory, language and cognition impairment requiring assistance with everyday self-care Some mental healthcare practitioners, such as neuropsychologists, have specialized training in assessing and treating memory and cognitive problems. Early detection of memory decline can be helpful in treating and managing declining cognitive functions to improve a person’s quality of life.

Annette Conway, Psy.D. My interest in specializing and working with the older adult and elderly population began as an undergraduate student at San Diego State University. It was there that I chose elective courses which focused on the sociology and psychology of the aging population. As well, I was fortunate enough to be mentored by two professors, who themselves were older adults. To gain clinical experience working with the older adult population, I contracted with a home-based organization in 1993, treating clients in their homes who would otherwise not be able to access mental health services, due to being bedbound, homebound, or unable to access transportation, among other reasons. In-home therapy was not only intrinsically rewarding in helping clients bring back purpose to their lives, but I also envisioned its value in helping improve the quality of mental healthcare in San Diego. The increasing need for “home visits”, changes in Medicare reimbursement, technology, and an interdisciplinary team approach influenced the decision to generate an organizational model around these services, known today as Help Therapy. For the past 29 years Help has been able to assist a large number of individuals, couples, and families who would otherwise have been unable to obtain treatment. Although lack of funding can be a major limitation in accessing mental health services, the issue of actually getting to an office is also a primary hindrance to treatment. As well, video visits require patients to have access to a computer, to be able to get on-line, and fix any technical problems that may arise. Help Therapy employs approximately 200 providers, including licensed Psychologists, licensed Social Workers, LMFT’s, Neuropsychologists, and Psychiatric Nurse Practitioners, all connecting to patients according to their expertise and geographical location. Help accepts Medicare, Medi-Cal, all PPO Insurances, some HMO’s, contracts with home resource organizations, private pay, and sliding scale fees. Historically, “home visits” aka “house calls” were not considered a valid clinical option for clinical transference reasons. Psychoanalytic-oriented practitioners and risk management experts were, and many still are, likely to frown upon treatment that departs from the office setting. With the Civil Rights movement of the 60’s and 70’s, and the Passage of Public Law 96-272, also known as the Adoption and Child Welfare Act, home-based family therapy became more common. The law was enacted to increase the safety of foster children and avoid their out-of-home placement. Thus, social workers routinely assessed child abuse and neglect, and domestic abuse in the home. Today’s elderly population is a special case, as they grew up in an era when psychological help was not only uncommon but was looked down upon. Needing mental help meant needing a locked room with padded walls. Therefore, the elderly tended to hold a more skeptical, stigmatized view of psychological services. Ironically however, the older adult and elderly population happens to be most affected by depression and therefore more often are in need of mental health services. Untreated depression has severe implications for older adults. It doubles the risk of developing cardiac disease, reduces the ability to rehabilitate, and increases the chances of dying from illnesses. Furthermore, it is more likely to lead to suicide than in any other age group. In 2020, suicide rates were highest among adults 75 to 84 years (18.43 per 100,000), with the highest among adults 85 years or older (20.86 per 100,000). Overall, depression affects nearly 7 million Americans over the age of 65, but only ten percent receive treatment. Information from the Cleveland Clinic Foundation cites both stigma and the belief that there is no help as reasons why many older adults and elderly do not seek treatment for depression. As well, too often older adults have physical disabilities that distract them from addressing their psychiatric needs. In-vivo treatment methods utilized at home capture the environment and the dynamics of the family firsthand. A “home visit” serves to support or question the hygiene, organizational abilities, cultural and religious customs, and daily rituals of a client. The “home visit” can help to establish treatment goals while utilizing client strengths and validating a client’s report about their perceptions and coping abilities. As the therapist crosses the threshold of the client’s home, it is important to realize the subtle and yet ever-present impact of the threshold as a therapeutic factor in the treatment process. The home environment may be reconstructed to a degree in the therapist’s office, however, upon entering the home, the therapist becomes a part of the family with boundaries and many other issues arising as a result. It is this arrangement that increases the likelihood for successful therapeutic contact with homebound individuals, and the benefits that results from a “home visit” intervention.

When we’re kids, we can’t wait to grow up. We want more freedom. We want to do what grown-ups do. As kids, we see our lives revolving around school, friends and fun activities and don’t understand how good we have it. When we grow up, work often takes the place of school, friends take a back seat to family obligations and fun activities are often more like special events. No Time for Play As adults, we feel we always need to be responsible and productive and rarely make time for playful activities. We create conscious or unconscious boundaries around what is acceptable and unacceptable adult behavior. We view visiting the zoo or going to a carnival as something fun for the children to do and we just play the role of chaperone. We don’t think about actually having fun ourselves. Children play spontaneously. They can create playful activities anytime, anywhere. As adults, we can lose this ability or bury it deep inside. At first, it may take a bit of time and creativity to think of playful activities and may need to be scheduled on the calendar. In time, playing may become more spontaneous. Although it’s often associated with games, the idea of play is much broader. Playing can be any fun, joyful activity where you forget about time. Playing can be a solo event, like riding a bike along the beach or engaging in a hobby. Or, it can involve others, like playing a sport or throwing a ball for your dog. Benefits of Play Playing offers an abundance of emotional and physical benefits. The more play, the more significant the benefits. Of course, it stands to reason that play involving movement (such as tennis) has more physical benefits than sedentary play (such as chess). Some of the mental health benefits of playing include: Reducing stress Uplifting mood Increasing energy Building a fun-loving attitude Fostering creativity Improving cognitive function Strengthening social bonds Some of the physical health benefits of physical play include: Reducing the risk of chronic disease Better cardiovascular health Better sleep Increasing endurance Increasing strength Increasing balance Weight management Categories of Play Stuart Brown, MD, has been studying neuroscience, biology, psychology and social science as it relates to play. In his book, Play: How it Shapes the Brain, Opens the Imagination, and Invigorates the Soul, he outlines five categories of playing. Rough-and-Tumble Play This type of play helps us with cognitive, emotional, and physical mastery and emotional regulation. Examples include: Scavenger hunts Softball Tug of war Ritual Play Ritual play involves set rules. It brings a group of people together to create, strategize and design for a common purpose or goal. Examples include: Board games Sports Paintball Imaginative Play This form of play involves fantasy, creativity and imagination. Examples include: Painting Acting Crafts Escape Room Body Play Body play involves putting our bodies in positions and activities that work against gravity. Examples include: Surfing Mountain Climbing Yoga Riding roller coasters Object Play This category of play involves manipulating objects and building. Examples include: Building with Legos Creating fortresses Having snowball fights Playing at Work More and more workplaces recognize the link between productivity and a fun work environment. Other benefits to the company and the employees include higher job satisfaction, fewer ”sick” days and less turnover. Some workplaces encourage play by offering “recess-type” breaks throughout the day with basketball hoops and yoga classes. Company picnics, parties and other group events are other ways companies promote a playful work environment. For people with mundane jobs, engaging in moments of play can help relieve boredom and uplift their mood. But even if a workplace doesn't specifically encourage play, there are many ways to sneak in playful moments throughout the day—especially during breaks. Sharing a funny story or playing a game with co-workers can be the highlight of the workday. By permitting yourself to play with the joyful abandon of childhood, you can reap the benefits throughout your life. As George Bernard Shaw said, “We don’t stop playing because we grow old; we grow old because we stop playing.”

The Mental Health Connection Many children and adults alike are going all out this month, determined to get the most out of it as back-to-school time approaches. Children may be disappointed that Summer is coming to an end, but parents may be relieved to send their kids back to school and back to a “normal” schedule. And speaking of schedules, we’ve realized that knowing which providers have openings at any particular time may be challenging, as availability opens and closes dynamically. We’d like to make it easier by providing regular updates. Some of the insurance carriers we can accommodate right away are: Aetna Cigna Community Health Group Medicare Optum / UHC We also want to express our appreciation to all of you who voted for Help Therapy in the San Diego Union Tribune’s Best Companies Poll. We’re listed as a Favorite Company in the non-medical healthcare services category. And, as President of the San Diego County Council on Aging (SDCCOA), I’d like to personally invite you to join Help Therapy at the San Diego County Council on Aging Health Fair on Sept 30th. More information can be found here. Enjoy the remainder of your Summer! Annette Conway, PsyD President Help Therapy August is National Breastfeeding Awareness Month Mothers often face a variety of barriers when starting and continuing breastfeeding. Some of these barriers relate to lactation issues, concerns about breastfeeding while taking medications, unsupportive hospital practices and access to resources and other support. Each August, the U.S. Breastfeeding Committee (USBC) hosts an advocacy and outreach campaign inviting organizations and individuals to take action and spread the word about changes to policies and practices needed to support babies and families. 2022 National Breastfeeding Month is divided into four weekly observances: Week 1: World Breastfeeding Week Week 2: Indigenous Milk Medicine Week Week 3: Asian American Native Hawaiian and Pacific Islander Breastfeeding Week Week 4: Black Breastfeeding Week Loneliness’s Effect on Mental and Physical Health Americans with mental health issues are more than twice as likely to be lonely than those without a mental health concern. According to a recent study by Cigna, 58% of U.S. adults are considered lonely. Health and Loneliness This study also found Individuals suffering from physical or mental health issues are approximately 50% more likely to be lonely than those with better health. Among individuals classified as lonely: 24% report sleep disorders 15% report weight-related problems or complications 9% report neurological disorders 9% report substance abuse 8% report kidney or urologic problems Likewise, a study reported by the CDC found loneliness to increase the risk of serious mental and physical health conditions and even death in older adults. Loneliness is associated with higher rates of depression, anxiety and suicide. Poor social relationships, characterized by social isolation or loneliness, are associated with a 29% increased risk of heart disease and a 32% increased risk of stroke. Lonely individuals with heart failure have nearly four times the risk of death, 68% increased risk of hospitalization and 57% increased risk of ER visits. [READ MORE] Using Pain Reprocessing Therapy When a person has chronic pain and becomes preoccupied with it, it reinforces the belief that the pain is dangerous and to be feared. This fear puts the brain on high alert, causing more pain. Then the pain elicits more fear, leading to more pain. It becomes a vicious circle. Pain Reprocessing Therapy (PRT) may help break the cycle. PRT is an approach for treating chronic pain based on neuroscience. This therapy aims to rewire neural pathways in the brain to deactivate pain. PRT is a system of psychological techniques that retrains the brain. The cycle of pain is broken by teaching the body to interpret and respond to pain signs differently—subsequently breaking the cycle. Pain Reprocessing Therapy has five main components: Educating the patient about the brain and the reversibility of pain Gathering personalized evidence reinforcing the fact that the pain is not caused by a structural or physical problem in the body Attending to and appraising pain sensations Addressing other emotional threats Replacing negative feelings and sensations with positive ones You can learn about this system here. Welcome New Help Therapy Mental Health Provider Partners These mental healthcare partners are new to our network and offer evaluations and other types of therapy. They are accepting new patients and provide telehealth appointments. California Veronica Gardner Mendoza Jane Bond Tiffany Ellerby Mimi DeGennaro LaShaunda Jethro Maria Belinsky Gina Woodford Texas Jacquelina Herrera Featured Practitioner Balaji Nettimi, PsyD After finishing his doctorate in clinical psychology, Dr. Nettimi completed his postdoctoral certification and residency in neuropsychology. He specializes in neuropsychological assessments for neurocognitive disorders—such as dementia and age-related cognitive decline— as well as pre-surgical psychological evaluations for bariatric surgery and spinal cord stimulator surgery. He offers a quick turnaround time of one to two days after an assessment for a report. Dr. Nettimi is also a pioneer in hypnotherapy and developed the Nettimi Hypnosis Model, which is taught to other therapists and practiced as a holistic therapy. Besides teaching fellow therapists his hypnosis model, he also performed live hypnotism shows in Las Vegas. Dr. Nettimi has been in private practice in Rancho Mirage, California for over ten years. Events World Breastfeeding Awareness Week August 1-6, 2022 See Awareness for more information. National Health Center Week August 8-12, 2022 See IAB for more information. World Humanitarian Day August 19, 2022 See UN for more information. International Day of the Disappeared August 30, 2022 See Awareness for more information. National Grief Awareness Day August 30, 2022 See HealGrief for more information. “There is hope even when your brain tells you there isn't." -John Green Partner With Us Are you a psychologist, LCSW or LMFT? We’re always looking for exceptional mental healthcare providers. Visit helptherapy.com for more information and fill out the quick and easy application. Benefits: Stream of new patients Billing off your plate Flexibility and Freedom Credentialing assistance No hidden costs Do you have something to share? We’d love to hear about your successes and accomplishments! Have you: Written an article? Given a presentation? Been featured on a podcast? Contact us at info@helptherapy.com. We welcome your feedback. What would you like to see in this newsletter? Do you have a topic you would like discussed? Have questions? Want to learn more about Help Therapy? Visit helptherapy.com, call 855-449-0159 or email info@helptherapy.com

Americans with mental health issues are more than twice as likely to be lonely than those without a mental health concern. According to a recent study by Cigna, 58% of U.S. adults are considered lonely. Health and Loneliness This study also found Individuals suffering from physical or mental health issues are approximately 50% more likely to be lonely than those with better health. Among individuals classified as lonely: 24% report sleep disorders 15% report weight-related problems or complications 9% report neurological disorders 9% report substance abuse 8% report kidney or urologic problems Likewise, a study reported by the CDC found loneliness to increase the risk of serious mental and physical health conditions and even death in older adults. Loneliness is associated with higher rates of depression, anxiety and suicide. Poor social relationships, characterized by social isolation or loneliness, are associated with a 29% increased risk of heart disease and a 32% increased risk of stroke. Lonely individuals with heart failure have nearly four times the risk of death, 68% increased risk of hospitalization and 57% increased risk of ER visits. Seniors vs. Young Adults It’s widely recognized that seniors living alone often experience loneliness, but it’s actually young adults who experience loneliness the most. The study revealed that 42% of young adults 18-34 report always feeling left out. Yet only 16% of older adults, 55+, report the same. It’s theorized that young adults may be vulnerable to loneliness because they feel disconnected from their peers and social groups after graduating or leaving school. College students may struggle to adapt to their new environment and academic challenges while trying to connect with fellow students. It’s during these times when these individuals are making important decisions, such as their desired career path and lifestyle. These life-changing decisions can be stressful and enforce a sense of isolation. Another interesting and counterintuitive finding is that individuals with children are likelier to be lonely than those without children. This fact further proves that loneliness is independent of being in the presence of other people. The Cigna study found: More than 77% of single parents struggle with loneliness. Parents and guardians are classified as lonely 10% more often than non-parents. 42% of lonely parents report feeling left out, compared to 24% of lonely non-parents. Mothers are 7% more likely to be considered lonely than fathers. Studies show the relationship between a parent’s loneliness and its effects on their child often depends on the sex of the parent and the child. One study found that a father’s loneliness is predictive of his son’s loneliness and a mother’s loneliness is predictive of her daughter’s. What's more, a mother’s loneliness is associated with her daughter’s problem-solving ability, tendency to internalize problems, social competence, fear of negative evaluation and social anxiety. Depression and Loneliness A UK study found loneliness and depression to be directly correlated. The study found that the higher an individual placed the loneliness score, the more severe the symptoms of depression. What’s more, the risk of depression persists for up to 12 years after experiencing loneliness. Each one-point increase on the study’s loneliness scale is linked with a 16% increase in an individual’s average depressive symptom severity score on the study’s scale. Depressive symptoms increase over time among individuals with higher loneliness scores, indicating that loneliness can cause future depression. Loneliness was linked to approximately one in five cases of depression one year later. The effect of loneliness decrease with time but is still associated with one in 10 cases after 12 years. These findings show that loneliness is not reserved for seniors or those living alone. Loneliness is experienced by people of all ages and can have lasting effects on the mind and the body. As more research examines the impact of loneliness on different populations, the seriousness of this far-reaching problem may be brought to light and addressed.

The Mental Health Connection Summer is here! Nothing says summer more than July 4th picnics and fireworks. But with Independence day now past, many of us are busy making plans for the next activities, road trips or extended vacations. Although Summer plans can be exciting, they can also be stressful and even intimidating. With this added stress and anxiety comes the need for individuals to seek help managing their mental health. We are happy to report that Help Therapy continues its efforts to meet this need by rapidly expanding its reach within California and also Arizona, Texas and Washington. Your contribution to this growth has been significant and very much appreciated. We are not just focused on expanding our reach, however. We want to provide value to our providers—to offer more services and resources. One way we do this is through our community of therapists. This community is a place Help Therapy providers connect with, share with and learn from one another through peer consult groups. Stay tuned for an announcement of the next consult, which will occur later this month. Annette Conway, PsyD President Help Therapy July is National Minority Mental Health Awareness Month National Minority Mental Health Awareness Month is observed to bring awareness to the obstacles minority populations often face pertaining to mental health. Recently, the pandemic has added even more challenges for people in these communities to find and receive needed treatment for mental health and substance use issues. The U.S. Department of Human Services Office of Minority Health (OMH) encourages state, local and community-based organizations, religious leaders and healthcare providers to educate people about the importance of treatment for substance use and mental health concerns and eliminate the stigma attached to such treatment. Self-Care While Coming off Medication International Self-Care Day is July 24th, making this the perfect time to discuss self-care for patients coming off medication. Like many prescribed for mental health conditions, coming off particular medications can be challenging—physically and emotionally. Patients must work closely with their psychiatrist or therapist to monitor how their bodies and minds are handling withdrawal from medication. One crucial factor that can help in this process is being prepared. Discussing what to expect and how it may affect a patient’s life while coming off a psychiatric medication is the first step. Self-care is critical to helping a patient get through this process. There are many things a patient can do to manage their physical and mental systems. One of these activities is making a self-care list in advance. It may be difficult for the patient to think of things that may help them feel better while they are going through withdrawal or unable to think clearly. Having a list of activities or items handy that may help can be beneficial. This very personal list of items and activities may include: Looking at a photo library of loved ones or experiences they’ve enjoyed Wearing a favorite sweater or pair of slippers Listing to music Watching a favorite movie Petting or playing with a pet Taking a bath Some other self-care ideas include: Trying alternative or complementary therapies such as art therapy or music therapy Having a daily routine Meditating or praying Keeping a journal to record thoughts, moods and feelings Practicing relaxation techniques Exercising Spending time in nature Eating healthy meals on a regular schedule Avoiding alcohol Adhering to a sleep schedule Avoiding stressful activities or situations Asking for help and support when needed Mental Health Assessments for Gun Ownership? The United States has by far the most firearms, both absolute and per capita, in the world. The statistics of the impact of guns in the United States are stark. Number of guns in the US: 393 million Number of people owning guns in the US: 81.4 million Number of injuries from guns in the US: 40,583 Number of deaths from guns in the US: 45,027 Number of accidental shootings in the US: 2,018 The recent tragic incidents in Uvalde, Texas and Buffalo, New York have again put mass shootings in the news. The question of whether mental health assessments should be a prerequisite to gun purchases has been renewed. Public outcry has prompted the US Congress to pass a bill that would expand background checks for prospective gun buyers between 18 and 21. The new process would incentivize states to provide access to previously sealed juvenile records and could add several days to the waiting period before a purchase can be completed. Could pre-purchase mental health assessments also help reduce the carnage? Would this Prerequisite Work? Currently, federal US law prohibits possession or receipt of firearms and ammunition if the firearms or ammunition were transported across state lines at any time and the person falls under any of the conditions below: Is a convicted felon (or awaiting trial on felony charges) or fugitive from justice Is a drug user or addict as defined in section 102 of the Controlled Substances Act Has been judged in court as being “a mental defective” or has been committed to a mental institution Immigrants who are not permanent residents, i.e., “green card” holders or visa holders with a special waiver from the US Attorney General Is subject to a domestic restraining order Has a prior conviction for domestic violence Was dishonorably discharged from the military Has renounced US citizenship Sales of firearms between private parties within a state who are not dealers with a Federal Firearms License (FFL) are not subject to background checks. Thus it’s primarily up to state and local governments to decide how (if at all) to limit access to firearms further. [READ MORE] Welcome New Help Therapy Mental Health Provider Partners These mental healthcare practitioners are new to our network and offer psychological evaluations and other types of therapy with a range of specialties. They are accepting new patients and provide telehealth appointments. California Patricia Jakobic, LCSW Lani Espinas, LMFT Philip Takakjian, PsyD Rosemary Donalson, PsyD Nancy Pereda, LCSW Alexis Valos, PsyD Roksana Sarrafan, LMFT Monica Flores, LMFT James McDermott, LMFT Erik Erickson, LCSW Alan Valdes, LMFT Claudia Franzosi, LMFT Featured Practitioner Nina Nehring, Psy.D Dr. Nina Nehring is a licensed Clinical Neuropsychologist practicing in California’s Bay Area. She specializes in neuropsychological, psychological and forensic assessments. In this capacity, she conducts cognitive, intellectual, and academic assessments on adults and children with various medical or mental health conditions such as traumatic brain injuries, cerebral vascular events, tumors, movement disorders and neurodegenerative disorders. She also performs assessments for ADHD, PTSD, learning disorders, sensory processing disorders, depression, and anxiety. In the forensic aspect of her work, she assists the court in examining specific mental health aspects within the legal context. Dr. Nehring started working with Help Therapy in March 2022, conducting pre-surgical psychological evaluations for individuals wanting to undergo Bariatric Surgery or Spinal Cord Stimulator Implantation. This Month's Tip Thinking About Vacationing with Your Pet? The summer is underway with many individuals, couples and families hitting the road for a much-needed vacation. To make the vacation as fun and relaxing as possible, planning is needed. If you have a pet, additional preparations are necessary. Some families prefer to board their pet when taking a road trip rather than dealing with the additional considerations and restricted freedom of bringing their pet along. In contrast, others look forward to including their pet in their travel plans. Whether vacationing for a few days or weeks, there are some essential things to be aware of when deciding if bringing the family pet is a good choice. When it comes to traveling with pets, most people take dogs on trips as opposed to cats or other types of pets. Before you plan on taking your dog (or another type of pet) with you, ensure they will be welcome and get the specifics about their pet policies. Check with the hotel you want to stay at, the relative or friend you plan to stay with, or the RV owner you’re renting an RV from. Another item to consider is your itinerary. Can you take your pet to all the places you plan to go? If not, where will you leave them? Even though a hotel may be “pet-friendly,” there are often rules against leaving your pet in the hotel unaccompanied, for example. And, of course, you must consider how leaving your pet behind or taking them with you will affect your mental health. Will boarding your pet cause you to feel guilt or worry? Or, would having your pet on vacation with you cause additional stress? If you do decide to bring your dog on your road trip, you want to make sure you pack everything your dog may need. These items may include: Pet Emergency Kit General health records and vaccination records Your veterinarian’s phone number 24-hour emergency clinic phone number in your vacation area Any prescriptions / medications Sterile saline solution (for cleaning cuts and rinsing eyes) Eye dropper Tweezers Small scissors Cotton balls Cotton swabs Gauze pads Pet-safe antiseptic Adhesive bandage tape Dog food Travel carrier Food and water dishes Harness and leash Cozy bed Favorite toys Pet stain remover Puppy pads (if your dog will use them) When you’re on the road, be sure to make frequent rest stops and take your dog out on a leash for some fun, exercise and of course, take care of their ” business.” Offer them water frequently and ensure the temperature in your car is comfortable. When traveling with your pet, some careful planning and preparation can make your trip as stress-free as possible for you and your dog. Events International Self-Care Day July 24, 2022 See Call to Mind for more information. World Against Trafficking Persons Day July 30, 2022 See UNDP for more information. “Being able to be your true self is one of the strongest components of good mental health." -Dr. Lauren Fogel Mersy Partner With Us Are you a psychologist, LCSW or LMFT? We’re always looking for exceptional mental healthcare providers. Visit helptherapy.com for more information and fill out the quick and easy application. Benefits: Stream of new patients Billing off your plate Flexibility and Freedom Credentialing assistance No hidden costs Do you have something to share? We’d love to hear about your successes and accomplishments! Have you: Written an article? Given a presentation? Been featured on a podcast? Contact us at info@helptherapy.com. We welcome your feedback. What would you like to see in this newsletter? Do you have a topic you would like discussed? Have questions? Want to learn more about Help Therapy? Visit helptherapy.com, call 855-449-0159 or email info@helptherapy.com

Introduction The United States has by far the most firearms, both absolute and per capita, in the world. The statistics of the impact of guns in the United States are stark. Number of guns in the US: 393 million Number of people owning guns in the US: 81.4 million Number of injuries from guns in the US: 40,583 Number of deaths from guns in the US: 45,027 Number of accidental shootings in the US: 2,018 The recent tragic incidents in Uvalde, Texas and Buffalo, New York have again put mass shootings in the news. The question of whether mental health assessments should be a prerequisite to gun purchases has been renewed. Public outcry has prompted the US Congress to pass a bill that would expand background checks for prospective gun buyers between 18 and 21. The new process would incentivize states to provide access to previously sealed juvenile records and could add several days to the waiting period before a purchase can be completed. Could pre-purchase mental health assessments also help reduce the carnage? Would This Prerequisite Work? Currently, federal US law prohibits possession or receipt of firearms and ammunition if the firearms or ammunition were transported across state lines at any time and the person falls under any of the conditions below: Is a convicted felon (or awaiting trial on felony charges) or fugitive from justice Is a drug user or addict as defined in section 102 of the Controlled Substances Act Has been judged in court as being “a mental defective” or has been committed to a mental institution Immigrants who are not permanent residents, i.e., “green card” holders or visa holders with a special waiver from the US Attorney General Is subject to a domestic restraining order Has a prior conviction for domestic violence Was dishonorably discharged from the military Has renounced US citizenship Sales of firearms between private parties within a state who are not dealers with a Federal Firearms License (FFL) are not subject to background checks. Thus it’s primarily up to state and local governments to decide how (if at all) to limit access to firearms further. Many states have statutes on the books preventing some from possessing guns, but most parallel the federal restrictions: Persons who have been acquitted of crimes by reason of insanity Persons found incompetent to stand trial because of mental disorder Persons who have been committed to a mental hospital/institution or addiction treatment center Making a mental health assessment mandatory could well screen out some who would pose a danger to themselves or others if they obtained a gun. Consider the fact that of the 45,027 gun-related deaths in 2021, over 24,000 of these were by suicide. This number represents roughly half of all suicides committed, a grim toll. If mental health assessments could prevent a number of these, it would be a meaningful outcome. Would it be Supported? Support can be found for enacting a federal law requiring pre-purchase mental health assessments. A survey of 1.250 adult Americans found the following: 49% of all Americans say mental health assessments should be required for gun ownership. 4 in 10 Republicans support mental health tests before any gun purchases. 1 in 2 gun owners support annual mental health assessments for gun ownership. Mass shooters having a history of mental illness is the #1 reason why Americans say mental health assessments are necessary for gun ownership. 45% of people who object to mental health assessments cite the 2nd Amendment violation. There is also concern from mental health practitioners that the cost of malpractice insurance could increase—maybe substantially. How Would it Work? With the help of advanced technology, an interactive, standardized test could be developed as a starting point for the evaluation. Yet, a psychologist would still need to further evaluate a candidate for gun ownership. The Federal Bureau of Investigation (FBI) already maintains the National Instant Criminal Background Check System (NICS) database, established through the Brady Handgun Violence Prevention Act in 1993. The NICS is used when FFL dealers submit prospective buyers’ information as a prerequisite to a gun purchase. The NICS database might conceivably be adjusted to include individuals who have been assessed by a mental health professional and flagged. Much work would have to be done to establish standards for excluding those who should not purchase firearms. Also, gun rights advocates and defenders of the 2nd Amendment would surely work hard to prevent such protocols from being established. The process would be laborious, but establishing a screening system would help avoid needless gun deaths.

The Mental Health Connection As we look forward to the joys of Summer, we think of those with mental health concerns who don't have access to therapy. Are they welcoming Summer? Help Therapy started as one of the first providers of in-home therapy. Now we’re taking steps to address another need—the need to provide treatment to underserved populations. We want to continue this mission of Breaking Down Barriers to Exceptional Mental Healthcare. With this goal in mind, Help Therapy is giving additional support and opportunities to our provider partners. One way we support our providers is by offering insurance carrier credentialing. This new service will give patients access to therapy by various providers who accept their insurance, including Medicare. Annette Conway, PsyD President Help Therapy June is LGBT Pride, PTSD Awareness and Alzheimer’s and Brain Awareness Month LGBT Pride June celebrates sexual diversity. LGBT Pride Month promotes dignity, equal rights, and self-affirmation and is a way of increasing society’s awareness of the issues LGBTQ+ individuals face. Peaceful protests and parades are frequent awareness activities, displaying the iconic rainbow. Of course, San Francisco celebrates big with marches, parades and ceremonies throughout June, as do many communities elsewhere, including Help Therapy’s own Hillcrest neighborhood in San Diego! PTSD Many people may be familiar with PTSD as it relates to veterans. But many more are unaware that PTSD affects many others who have gone through a traumatic event —such as survivors of natural disasters, serious accidents and sexual assault. This month, help spread the word about PTSD and the availability of treatment. Pledge to raise awareness of PTSD Sign up for a 30-minute virtual walk Take a PTSD screening test Alzheimer’s and Brain Awareness An estimated 6.2 million Americans age 65 and older live with Alzheimer's. It’s predicted that the number could grow to 13.8 million by 2060. Although the entire month is an opportunity to spread awareness, June 21— is a special day. It’s referred to as “The Longest Day is the day with the most light”— the summer solstice. On June 21, thousands of participants from across the globe unite to fight the darkness of Alzheimer's. Together, they use their creativity and passion to raise funds and awareness for the care, support and research efforts of the Alzheimer’s Association. Rising Need, Rising Shortages According to a 2022 survey conducted by The Harris Poll on behalf of the American Psychological Association, stress is on the rise and the need for easier access to mental health services is consequently on the rise. More than half of Americans surveyed reported they could have used more emotional support since the start of the pandemic. Also, this year, the U.S. Census Bureau, along with other federal agencies, conducted a Household Pulse Survey to research the social and economic impacts of the pandemic. Overall, over 26% of respondents of this survey reported experiencing anxiety or depression—with the highest percentage of individuals (over 50%) belonging to one of the following populations: Disabled Transgender Bisexual As a comparison, in 2019, 10.8% of the individuals surveyed reported symptoms of anxiety disorder or depressive disorder, so the need has more than doubled. More than half a million people work in the mental health field in the U.S., according to a USAFacts report. Yet, 74% of the need for mental health services is NOT being met. The National Council of Behavioral Health reported that 77% of counties in the U.S. have a severe shortage of psychiatrists. And the National Center for Health Workforce projects there will be a need for 45,000 to 250,000 additional mental health professionals by 2025. A 2021 report shows the deficit of mental health care providers by state. Below are the statistics for the four states Help Therapy is currently focusing on: Arizona: 38.59% California: 27.34% Texas: 51.6% Washington: 36.87% It’s clear that there's a need for qualified mental healthcare providers in the U.S. Some universities and colleges, such as William James College, are addressing this need by offering scholarships for specific degrees related to mental health. William James College, for example, awards Behavioral Health Initiative Scholarships to students who demonstrate outstanding dedication and commitment to providing services in behavioral health. For those interested in advancing their education and career, now may be a great time to pursue this path. What to Know About Emotional Support Animals Emotional Support Animals are becoming more widely used to help individuals with mental health issues. They provide their partner assistance through constant companionship and connection. This relationship can help ease a person’s anxiety, depression or other mental health issues. Another benefit is that caring for an animal encourages a person struggling with depression or anxiety to maintain a schedule and participate in social activities. Emotional Support Animals vs. Service Animals However, Emotional Support Animals (ESAs) are not Service Animals. The Americans With Disabilities Act states that service animals are defined as “dogs that are individually trained to do work or perform tasks for people with disabilities.” A service dog, such as a guide dog, is trained for a specific job directly related to the person’s disability. Some of these specially trained dogs include: Psychiatric dogs: trained to detect and lessen the effects of psychiatric episodes Autism assistance dogs: trained to help those with autism identify important alerts, like a smoke alarm or overstimulation Guide dogs: trained to recognize seizures and stand guard or go for help during a seizure This specific training is the key difference between a service dog and an emotional support animal. This distinction is critical. [READ MORE] Welcome New Help Therapy Mental Health Provider Partners These mental healthcare partners are new to our network and offer evaluations and other types of therapy. They are accepting new patients and provide telehealth appointments. California Insha Rahman, LCSW Washington Elizabeth Soliday, PhD Lincoln Lim, PsyD Featured Practitioner Dr. Janelle Fisher Born and raised in Costa Rica, Dr. Fisher has experienced racism and discrimination firsthand. She aspired to become a mental health professional in high school. Then, in her sophomore year at California State University- Los Angeles, she decided to pursue a doctorate in psychology. She graduated from Alliant International University- Los Angeles and then received her Postdoctoral Master of Science in Clinical Psychopharmacology. Dr. Fisher has been a licensed psychologist in California for 11 years and recently secured licensing in Iowa and New Mexico. She started her private practice while in graduate school and recently began focusing on the growing needs of individuals during the pandemic. Her long-term goal is to make psychological testing readily available to underserved children and young adults by creating a non-profit organization to help this population. This Month's Tip Enjoy the Healing Benefits of Nature Our mental and physical well-being is constantly affected by our environment. Spending most of our time indoors—often in a stressful environment—can harm our health and well-being. The pressure to get more done—multitasking, working faster, working harder, meeting deadlines—causes constant stress. It even makes us feel guilty for taking some time for ourselves. This type of environment can lead to many mental health issues. Conversely, slowing down and spending time in nature is shown to have many physical and mental health benefits. These benefits include: Improved blood pressure levels Decreased anxiety Increased immune system function Decreased inflammation Improved ability to handle stress Improved mood A quote by Lao Tzu, ancient Chinese philosopher and author of the Tao Te Ching, provides an important message: “Nature does not hurry, yet everything is accomplished.” The medical community has long declared the psychological and physiological benefits of slowing down and connecting with nature. We can use nature as a catalyst for relaxation as well as mental and emotional healing. Just being in nature can make us more present, calm and joyful. When we incorporate exercise into this experience, the health benefits increase even more. When considering an outdoor space to exercise or just “be,” it’s important to find a place that’s not heavily populated or noisy. Walking or running on the beach may be enjoyable, but the calming benefits may not be as great if the beach is crowded. Exploring ways to integrate nature into our routine can significantly impact our health and well-being. A few minutes a day is all it takes to start experiencing the benefits of spending more time in nature. A few ideas include: Hiking on a nature trail Walking through a nature preserve Bike riding along the coast If you can’t find time to travel to a natural area, spending time in a quiet park or even your backyard can provide many of the same health benefits. Events Pet Appreciation Week June 5-11, 2022 See Hartz for more information. The Longest Day June 21, 2022 See Alzheimer's Association for more information. International Yoga Day June 21, 2022 See Yoga Day for more information. PTSD Awareness Day June 27, 2022 See PTSD Day for more information. “Self-care is how you take your power back." -Lalah Delia Partner With Us Are you a psychologist, LCSW or LMFT? We’re always looking for exceptional mental healthcare providers. Visit helptherapy.com for more information and fill out the quick and easy application. Benefits: Stream of new patients Billing off your plate Flexibility and Freedom Credentialing assistance No hidden costs Do you have something to share? We’d love to hear about your successes and accomplishments! Have you: Written an article? Given a presentation? Been featured on a podcast? Contact us at info@helptherapy.com. We welcome your feedback. What would you like to see in this newsletter? Do you have a topic you would like discussed? Have questions? Want to learn more about Help Therapy? Visit helptherapy.com, call 855-449-0159 or email info@helptherapy.com

Emotional Support Animals are becoming more widely used to help individuals with mental health issues. They provide their partner assistance through constant companionship and connection. This relationship can help ease a person’s anxiety, depression or other mental health issues. Another benefit is that caring for an animal encourages a person struggling with depression or anxiety to maintain a schedule and participate in social activities. Emotional Support Animals vs. Service Animals However, Emotional Support Animals (ESAs) are not Service Animals. The Americans With Disabilities Act states that service animals are defined as “dogs that are individually trained to do work or perform tasks for people with disabilities.” A service dog, such as a guide dog, is trained for a specific job directly related to the person’s disability. Some of these specially trained dogs include: Psychiatric dogs: trained to detect and lessen the effects of psychiatric episodes Autism assistance dogs: trained to help those with autism identify important alerts, like a smoke alarm or overstimulation Guide dogs: trained to recognize seizures and stand guard or go for help during a seizure This specific training is the key difference between a service dog and an emotional support animal. This distinction is critical. Where Can They Go? Service dogs are generally allowed in restaurants and the workplace, but emotional support animals are not automatically given access. ESAs are treated as pets, not service dogs, according to the Air Carrier Access Act. However, emotional support animals are given some of the rights service dogs receive. For example, ESAs are given the same rights as service dogs regarding housing under the Fair Housing Act. Housing policies such as pet restrictions and deposits are waived for those with an ESA prescription. Another distinction between Service Animals and Emotional support animals is that ESAs are not exclusively dogs. An ESA may be a cat, rabbit or even a duck or lizard. Stricter Regulations Unfortunately, many people have taken advantage of the opportunity to use these regulations to falsely identify their pets as emotional support animals and service animals. This has led to stricter criteria for ESA qualification. In 2021, California Governor Gavin Newson signed an ESA law that addresses this misrepresentation. ESA letters are subject to more stringent requirements under the new California emotional support animal law that took effect on January 1, 2022. To issue an ESA, the medical practitioner must: Hold an active license within the scope of the given treatment Complete a clinical evaluation Establish a patient-practitioner relationship at least 30 days before giving the patient an ESA letter How to Decide if an Emotional Support Animal Can Aid Treatment It’s been recommended that mental health professionals consider four separate components when considering a patient prescription for an emotional assistance animal. Patient Assessment: This evaluation determines whether or not a support animal will improve a patient’s mental health or help them live a better life not possible without the animal. Animal Assessment: This assessment aims to determine the animal's suitability as an ESA. Many types of animals may serve as ESAs, but some animals are more practical than others. A domestic cat or small dog may be more suitable than a horse or emu. Also, a patient may want their pet to qualify as an ESA but may have an ulterior motive for the request. Patient-Animal Interaction: The interaction between the patient and the prospective animal should also be evaluated. If the animal is well behaved and obeys the patient's commands showing a bond, it may be a good fit. In contrast, an animal that the patient has little control over would probably not make a good ESA candidate. Laws Pertaining to ESAs: It’s critical for the mental health practitioner and the patient to know the requirements for an ESA letter and the applicable laws and regulations. This knowledge can help in determining the suitability of a particular animal. If an emotional support animal is believed to positively impact a patient, a prescription for an ESA may be a valuable part of treatment. Suppose the patient doesn’t have a suitable pet. In that case, animal shelters and rescues are great resources for selecting a dog, cat or other emotional support animal that the patient can bond with and build a relationship with to improve the patient’s psychological health and daily life. But again, before deciding if an emotional support animal is a beneficial addition to an individual patient’s treatment plan, mental healthcare practitioners and patients must first understand the laws and policies that apply to their particular situation before moving forward.