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Mental Health

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By Daniel Dunaief

Daniel Dunaief

While for now, the pandemic is officially in the rearview mirror, according to the World Health Organization, it’s worth considering what we can and can’t blame on COVID-19. For starters, here are a few things that aren’t the fault of the pandemic.

— A favorite sports team’s defeat. Every team had to deal with COVID-19. The pandemic didn’t affect my team’s best athletes any more than any other team’s stars.

— The weather. It’s going to rain, and it’s going to be too hot and too cold. That happened before the pandemic, and it’s going to happen afterward. Global warming, if anything, might have slowed slightly as more people stayed home each day.

— Unrequited love. Authors throughout history have found this topic particularly appealing. A would-be romantic goes out into the world with a proverbial heart filled with affection and admiration. Cupid hits that person with an arrow, creating a wellspring of dedication and devotion toward someone who doesn’t return the favor. The pandemic might have made it harder to know where we stood with each other, but unrequited love will continue to cause problems and lead to sad-but-relatable romantic comedies.

— Bad grades. We all have moments when we don’t study enough, the right way, or even the right material. The pandemic might have made it harder to focus or to care about theorems or memorizing dates, but it’s not the fault of the virus. It might have been tougher to concentrate in those early days, with dogs barking, parents yelling into Zoom calls, and people dropping off food at our front door.

— Anger in Washington. This is one of the easiest to dispel. Did you pay any attention to the vitriol coming out of the nation’s capital before 2019? It’s not as if the parties suddenly decided fighting each other was more valuable than getting anything done or compromising. The words under the Washington DC license plate shouldn’t read “taxation without representation,” which refers to the fact that residents pay taxes but don’t have federal representation. Instead, it should read: “Grrrrrrrrrrr!”

— Biased journalism. As a member of the media, I understand the frustration with the written and spoken words on TV and in print. The left hates Trump; the right hates Biden and ne’er the ‘twain shall meet. The pandemic didn’t pour gasoline on that dumpster fire. Media organizations staked out their territory prior to the pandemic and have remained more faithful to their talking points than many people do to their own marriage vows.

Okay, now, what about the things we can blame on the pandemic.

— Mental health strain. While the pandemic may be gone, we haven’t wrapped our arms around the mental health impact. We spent way too much time on our phones, making us feel simultaneously connected and disconnected while the pool of frustration continues to get deeper.

— Educational gaps. Students will never get back those days and the lessons they missed during the pandemic. Classes condensed their syllabi, lowering requirements and expectations for each class and for graduation. Students of all ages missed lessons and assignments that might have inspired them and that would have helped them reach previous educational requirements.

— Social graces. A first-grade teacher recently told me that their school still can’t bring all the first-grade classes together. When they do, the students argue about resources and space. Prior to the pandemic, students from several classes could easily play together. Hopefully, that will change as the students age and fill in gaps in their ability to interact.

Even as we hope to move past the pandemic, we can’t ignore the difficult reality, forcing parents, teachers, children and members of society to relearn lessons about acting and interacting. No, we can’t take cues from Washington, but maybe we can overcome deficiencies exacerbated by the pandemic.

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By Fr. Francis Pizzarelli

Father Frank Pizzarelli

What will it take for the country to push the pause button and then reset? We are a nation that is out of control. The pandemic has only underscored how out of control we are.

We are losing hundreds of young people every day due to fentanyl, heroin and suicide. The nation has declared that we have a national heroin epidemic but what is being done to address this tragic health concern that is killing more than 100,000 lives a year?

Yes, we are making Narcan more available but what about holistic residential treatment beds? There are no beds anywhere. Yes, a few for-profit programs have emerged in the midst of this crisis but what about the working class and working poor? How do they pay for evidence-based treatment for their children?

No one wants to challenge the insurance empire that is sentencing so many of our at- risk people to death. It is scandalous that an insurance gatekeeper with no training decides whether or not your son or daughter gets treatment! So many of these gatekeepers are clueless about addiction; our silence in this regard is deafening

How many more young people have to die before we say enough? If human life is such a priority, then challenge our paralyzed leadership to work together for systematic change in the treatment of substance use disorder and mental health.

Our social welfare system in Suffolk County needs to be overhauled department by department. Instead of empowering the broken and wounded to healing and change, our system is setting people up for failure. Your tax dollars are being wasted on a system that is inept and incapable of breaking the cycle of poverty and dependence among the people they are supposed to serve.

For more than 40 years in the trenches I have seen firsthand our destructive system at work I have seen countless homeless men set up for failure because we have no real transitional housing for them. We do not have enough case managers and social workers to assist them for so many of them are mentally ill and dependent.

The state is once again using fancy rhetoric to trick us with their new initiative to keep troubled youth at home. These troubled youth are young people between the ages of 12 and 17 who already have stolen cars, assaulted people and some are even in dangerous gangs. We have few to no mental health services in our local communities to support these young people and their families.

The few programs that do exist are being forced to close; soon we will have no help and no resources for families in need.

We are blessed to have a dynamic commissioner of social services in Suffolk County in the person of Frances Pierre. She is a talented and gifted professional who is being shackled by a legislature that lack the vision and commitment to the most vulnerable and broken among us. Our commissioner needs to be free to do her job. We need to raise our voices in support of her!

Father Francis Pizzarelli, SMM, LCSW-R, ACSW, DCSW, is the director of Hope House Ministries in Port Jefferson.

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The holiday season can be a difficult time for many people, especially for those who lost a loved one recently. Stock photo

An important gift people can give each other this holiday season is a check-in call or visit.

That’s the advice of area mental health professionals, who say that the holidays in general can be stressful and that several factors, including grieving over the loss of family or friends, fear about ongoing health concerns, and uncertainty and overall anxiety, have created stressors to mental health.

“If you know someone is having a rough time, who will be without a loved one for the holidays, you can call and say, ‘I’m here,’” said Dr. Stacy Eagle, director of Psychiatry at Port Jefferson-based St. Charles Hospital. “Doing something that simple can be really helpful.”

Indeed, area mental health professionals said the health care system in general has been straining to meet the need for patients in a host of ages to provide timely services.

Signs

Dr. Adam Gonzalez, a licensed clinical psychologist, director of Behavioral Health at Stony Brook Medicine and founding director of the Stony Brook University Mind-Body Clinical Research Center at the Renaissance School of Medicine, suggested that people can look for signs among their friends, family members and coworkers.

“Be aware of behavioral and emotional changes like social withdrawal, increased alcohol or drug use, overeating/eating more unhealthy food, difficulty sleeping, difficulty concentrating or making decisions, difficulty with getting work done” irritability and sadness, Gonzalez explained in an email.

Broadly speaking, Eagle added that people should be aware of any change in normal functioning. An extrovert who is acting withdrawn can provide a clue about a daily struggle.

Solutions

When people notice these kinds of changes in themselves or others, doctors urged a host of responses, depending on the severity of the symptom.

People who are an imminent danger to themselves or to others can call 988, which is a suicide and crisis hotline phone number. They can also call 911 or go to an emergency room, where a psychiatrist can evaluate them and offer help.

Cari Faith Besserman, director in the Division of Community Mental Hygiene Services with the Suffolk County Department of Health, said residents can take classes such as Mental Health First Aid, which teaches laypeople to increase their awareness by recognizing signs of emotional and mental distress, how to respond safely, and educates on symptoms of illness to decrease the stigma and mystery of mental health and various stages of wellness.

Suffolk County residents also can turn to the Diagnostic Assessment and Stabilization Hub, also known as DASH, program, which provides 24/7 access to behavioral health professionals and provides somewhere to go for those experiencing a crisis. The DASH number is 631-952-3333.

For less severe but problematic or ongoing symptoms, doctors urged some restorative measures.

Eagle suggested getting proper rest, ensuring a sufficient and balanced diet and staying hydrated. Activities such as exercise, which helps increase the release of serotonin, can help reduce anxiety and improve mood.

She added that unplugging from social media, especially for adolescents and children, can improve overall mental health.

Gonzalez also urged those who are offering support to remain fully present and nonjudgmental, and listen actively when someone shares concerns or anxieties.

“Be sure to ask what they need from you,” Gonzalez urged. “For some, it may be just listening; for others, it may be advice/ feedback or helping to connect them to professional support services. It’s easy for many to slip into problem-solving mode; however, sometimes others just want to be heard and validated.”

Gonzalez added that group-based treatments are just as effective as individual therapy and encouraged patients to try skills-based groups to learn coping methods for managing stress, anxiety and depression symptoms.

Stony Brook offers a COVID-19 support group for people who have or have had COVID, especially those with long COVID symptoms. Stony Brook also offers a comprehensive mind-body treatment program called the Stress Management and Resilience Training program.

The SMART program is helpful for people who are managing co-occurring mental and physical health problems and for those who would like to enhance their overall resilience.

Overwhelming demand

On the whole, hospitals and mental health facilities are struggling to keep up with the need for help.

“Currently, the demand for psychotherapy services is overwhelming,” Gonzalez explained in an email.

Eagle added that the weeks leading up to the holidays have often been a stressful period.

This year, some groups in particular are struggling. Parents of children born in 2022 are especially concerned about respiratory syncytial virus, which is “higher than normal,” Eagle said.

Seasonal affective disorder, which occurs during the darker, colder winter months, also affects about 0.5 to 3% of the population, Eagle said.

SAD can be harder for people if they have depression or anxiety, Eagle said. “These things are definitely an issue.”

Doctors added that those who are grieving over a loss can find the holidays difficult.

“Grief can be more of an issue” around the holidays, Eagle said.

Eagle urges the continuation of traditions that families found meaningful and helpful.

Gonzalez added that people can cope with grief by keeping a picture of a person who is no longer present close by, offering a prayer in their honor, sharing positive memories, or writing them a note.

Grieving families can also consider starting new traditions that may help them move forward with their lives, Eagle suggested.

Good news

Even amid all the concerns this year, doctors said people can appreciate some good news.

“Happily, we are out of the severe hospitalizations for COVID,” Eagle said.

Communities can also celebrate resilience “as individuals and as a country,” she added.

In hospitals, visitors are able to offer comfort and spend quality time with their friends and family, which is a considerable improvement from the days when patients couldn’t have visitors.

Eagle said she is following her own advice with her friends and family.

She will try to reach out to those she knows have had a particularly bad time this year to “make sure that they are aware that someone is thinking about them,” she said.

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Dr. Farquharson suggests showing a person experiencing a mental health emergency your hands with the palms open to show you are not a threat to the person. Stock photo

Long Island residents have taken CPR classes and learned lifesaving basics to help others with injuries through programs like “Stop the Bleed.”

But what about mental health emergencies?

Those may be more difficult to diagnose or understand, particularly for people who may not know the person in emotional distress.

While Suffolk County Police Department officers with specialized training, support service organizations like Diagnostics, Assessment and Stabilization Hub (known as DASH) and Family Service League, and mental health care workers are available to help, doctors offered suggestions for people who would like to provide assistance for a friend, coworker or relative while awaiting professional assistance.

Dr. Wilfred Farquharson IV, a licensed psychologist and director of the Child and Adolescent Psychiatry Outpatient Clinic at Stony Brook Medicine, helped create a two-page patient education sheet titled “Mental Health Emergency Response Guidance Sheet — Knowing Your Options.”

The guide provides suggestions on how to respond to a variety of emergencies, starting with lower level crises, which could include a change in mood or side effects from a medication that is not dangerous to a person’s health.

The options in that case are to contact a mental health provider to schedule an appointment, to use a safety plan or to schedule an urgent visit with a primary doctor.

In situations in which a person is destroying property, is threatening physical injury and is not in a position for a safe transport, the guide suggests calling 911.

To ensure effective help from emergency responders, the guide urges people to go to Smart911 to complete a profile for the household.

Additionally, people who call 911 should indicate that there is a mental health emergency. The person making the call should be prepared to offer the person’s name and location, the reason for the call, the person’s diagnosis (if known), things that upset the person, such as yelling at them or getting too close, things that might help soothe the person, and special considerations.

While people are waiting for first responders, they can try to deescalate the situation, using tools similar to the ones professionals practice.

“A lot of what we do is give the person space,” Farquharson said. “We show them our hands, with open palms, and let them know we’re not trying to be a threat. We don’t say too much. We allow the person to talk, as long as they’re being safe. We allow them to yell.”

Neutral tone

Dr. Adnan Sarcevic, chairman of the Psychiatry Department at Huntington Hospital, also urges people to provide “as much privacy as possible” for someone in distress.

Sarcevic recommended that supportive family, friends or community members be empathetic without being judgmental.

“Keep your tone and your body language neutral,” Sarcevic said. He urges people to remain calm and friendly.

People can help deescalate situations by acknowledging that someone else’s feelings are important and indicating that crying or being angry is okay.

Taking a cue from the person in distress can also help. If a person stops talking, “let him or her be there in silence. Let them reflect,” Sarcevic said.

Additionally, the Huntington Hospital doctor urged people to respect the personal space of someone who is struggling.

As far as his list of “don’ts,” Sarcevic said people shouldn’t use judgmental language or wag their fingers.

“Don’t ask, ‘Why’ or ‘How could you do that?’” Sarcevic advised.

Other resources

The Suffolk County Police Department implemented a 911 call diversion pilot program in 2021 which allows Emergency Complaint Operators to divert crisis calls, when considered safe, to the Crisis Hotline at Family Service League.

The SCPD collaborates with Family Service League on a 24-hour crisis hotline as well as a mobile crisis team of mental health professionals that can be deployed 24/7, officials from the SCPD explained in an email.

Additionally, the department said about 20% of SCPD officers are Crisis Intervention Team trained. Someone with that training is always on patrol. 

In addition to 911, people can reach out to DASH, which is the Diagnostic, Assessment and Stabilization Hub. A community crisis program with a Mobile Crisis Team for Suffolk residents, DASH is open every hour of every day and offers services for people who have mental health and substance abuse disorders.

For situations in which there are no safety risks, Stony Brook Medicine suggested that DASH is a good option. Residents can call the hotline at 631-952-3333.

Additionally, residents can call the Suicide and Crisis Hotline at 988 at any time.

Dr. Stacy Eagle, director of Psychiatry at St. Charles Hospital, cautioned that what deescalates one person might be different from what helps someone else.

Offering physical comfort to some people may help, while others might prefer to have their own space.

All three mental health professionals said the pandemic has contributed to higher levels of anxiety and depression among the population.

“The pandemic has increased the level of distress for those patients,” Eagle said. The pandemic could be the “stressful hit” that triggers discomfort or a mental health episode.

Farquharson has noticed an increase in the acuity of symptoms for some residents.

The mental health practitioners said the response to a crisis depends on the person involved and the type of problem he or she
is experiencing.

“You have to use [your] judgment”
when dealing with various circumstances, Sarcevic said.

Mental health professionals urged people to develop a plan that includes having phone numbers nearby, for 911, 988, DASH and the Family Service League, among others.

Additionally, doctors suggested people can help by being supportive and being prepared.

Farquharson said people should learn what to do if someone is not feeling well emotionally or mentally when a doctor’s office might be closed.

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The second in a two-part series, this article highlights the strain COVID-19 has placed on a mental health care system that was already resource-constrained. Mental health care workers, from social workers to psychologists, psychiatrists and emergency medical teams, have responded to the increasing need for their services, cutting back on vacation times and dealing with patients who threaten violence against themselves and others. During the pandemic, health care workers who focused on the emotional well-being of patients also sought balance in their own lives. To borrow from the TV show “Law & Order,” these are their stories.

For some, running half marathons, spending time with family, meditating and communing with nature helps. For others, staying connected and reaching out to the kinds of services they themselves provide also offsets the growing strains in their work.

Health care workers have shouldered the burden of the COVID-19 pandemic for more than two years, reaching out well beyond their job description to help patients amid a period of intense uncertainty that threatened their physical and emotional health.

The cost to health care workers, including those who work in behavioral or mental health, has been considerable, as time at the hospital and speaking with patients remotely cut into their personal lives and threatened their own sense of balance.

“It was very difficult to be a doctor through the storms of COVID,” said Dr. Stacy Eagle, director of Psychiatry at Port Jefferson-based St. Charles Hospital. Health care workers had to “deal with a lot of mental health issues” during the last few years.

Indeed, hospitals throughout the area offered varying levels of support while their staff were on-site, including meditation rooms and aroma therapy. They also suggested personal health checks and provided on-call services for employees who might be struggling amid concerns about their health and the well-being of family members and their patients.

While the general public has tried to push COVID into the back of their minds, attending sporting events and movies, going to restaurants and returning to patterns and activities that are reminiscent of life in 2019, health care workers have increasingly needed mental health support.

Employee Assistance

Over the last several months, Stony Brook University, which has an Employee Assistance Program, has seen a rise in the number of staff reaching out for help.

During the pandemic, Stony Brook launched an employee helpline for those who need mental health support, including psychotherapy and/or medication management. Compared to last year, Stony Brook is seeing a two-folded increase, or triple, the number of employees reaching out for services, according to Dr. Adam Gonzalez, director of Behavioral Health and associate professor of Psychiatry & Behavioral Health at Stony University Renaissance School of Medicine.

“There are high concerns about employee burnout, resignations and departures from health care,” Gonzalez wrote in an email. “Most concerning is the risk for suicide — the ultimate consequence of burnout.”

Stony Brook has an employee support team that implements wellness initiatives, including daily mindfulness meditation sessions, yoga and stretching, and confidential one-on-one support by a faculty and staff care team and employee assistance program.

Dr. Poonamdeep Gill, director of the Comprehensive Psychiatric Emergency Program at Stony Brook Hospital, said the mental health team is “seeing more patients who are sicker from a mental health standpoint. People are really struggling. It does take a toll on you.”

Gill said Stony Brook is proactive with staff, making sure they can access services. The university also encourages staff to check in with their leadership team if they are feeling burned out or struggling.

Dr. Michel Khlat, director of St. Catherine of Siena in Smithtown, said he has seen some of the same health care fatigue that has beset hospitals and other health care facilities throughout the country.

“Staff members have gotten overwhelmed with the volumes,” Khlat said. “Some are altering their occupations to see more outpatients. Some are reverting to part-time and per diem work.” He has had a few friends in Florida who are seeing the same phenomenon, with health care workers quitting or cutting back on hospital time and going into private practices.

Bounce forward

The Northwell Health System has been working on the support of all health care workers, including in mental health, said Dr. Vera Feuer, associate vice president in School Mental Health. Northwell has adopted a stress first aid response, peer support, and a resilience model to recover from stress and trauma.

The military developed stress first aid to deal with situations like the pandemic, in which there is ongoing stress with an uncertain ending. That, Feuer said, differs from a single event, like 9/11, where something traumatic occurs and survivors build back from it.

The pandemic has involved over two years of continuous stress and this feeling of uncertainty, she added.

Stress first aid teaches people to support each other in resilience and to “bounce forward,” Feuer said. “It is difficult to maintain in a busy, stressful environment.”

Finding balance

Doctors suggested they engaged in a wide range of activities to help with their own mental health.

A believer in the value of nutraceuticals and supplements, Dr. Jeffrey Wheeler, the director of the Emergency Room at St. Charles Hospital said he also works on focused breathing.

Eagle, his colleague at St. Charles, urges people to pursue some of their hobbies, such as reading or painting. She also recommends staying off of or limiting social media, particularly for younger children who might find the information and the reaction to postings unnerving.

Stony Brook’s Gill believes in physical activity and exercise. She ran a half marathon a few weeks ago on Long Island.

“I make sure I stay active,” she said. “We need to take care of ourselves before we can take care of other people.”

Stony Brook’s Gonzalez stays closely connected to family, friends and work colleagues.

“I also try to stay active and explore nature,” Gonzalez said. “I regularly practice mindfulness [which is] tuning into the present moment in a nonjudgmental way.”

Gonzalez enjoys a good TV show or movie to disconnect and unwind as well.

Northwell’s Feuer said she’s worked harder than she ever had, but, at the same time, she feels fulfilled by the hope and meaning in her work.

For Feuer, the silver lining is the attention to mental health, which “we know has been a problem for a long time. I’m hoping the right resources and interventions” will help those who need it.

To read the first of this two-part series, “Mental health strain for Long Islanders,” visit tbrnewsmedia.com.

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The first in a two-part series, this article highlights the ways COVID-19 exacerbated an already difficult mental health landscape on Long Island, particularly for adolescents. Amid isolation and uncertainty, residents had an increase in anxiety-related and mental health crises. Additionally, residents in acute distress who arrived at the emergency room sometimes had to wait hours or days for an inpatient psychiatric bed. In the second feature, which will appear in a future edition, mental health workers describe the challenges of their work during the pandemic.

COVID-19 has taken its toll on mental health throughout Suffolk County, as people in a range of ages confront challenges related to isolation, depression, anxiety and grief.

Area hospitals report that inpatient psychiatric beds are rarely empty. Indeed, patients have had to receive treatment in the emergency room at times for a day or more as they wait for an available inpatient psychiatric bed.

“Our emergency room has two behavioral health beds, but often, we have more patients waiting for admission to [the] inpatient psychiatry unit,” said Dr. Adnan Sarcevic, chairman of the Psychiatry Department at Huntington Hospital. 

While patients receive the same treatment in the emergency room that they would in an inpatient unit, some types of intervention, like group psychotherapy “cannot be provided in an emergency room setting,” Sarcevic said.

COVID also exacerbated the shortage of beds when some units had to close after an outbreak of the virus.

“We had periods when some psychiatric inpatient units were closed for a variety of different reasons including COVID outbreaks” which created a shortage of beds, Sarcevic added.

At St. Catherine of Siena in Smithtown, beds filled up as soon as one opened, said Dr. Michel Khlat, chief medical officer.

Adolescent strains

The pandemic exacerbated trends that already reflected the mental health strain among youth and adolescents.

For the previous decade, youth presentations for mental health crises in the emergency room had been increasing.

During the pandemic, those numbers climbed nationally and on Long Island. Estimates of anxiety among youth increased to 20%, which is dramatically higher than the 12% prior to the pandemic, said Dr. Vera Feuer, associate vice president in the School Mental Health program at Northwell Health. Depression has also reached about 20%, which was previously below 10%.

Additionally, the pandemic caused a three-fold increase in children with eating disorders, which is consistent with new Centers for Disease Control and Prevention data, Feuer added.

“There’s a real big increase in presentation to the emergency room” with youth who are considering suicide, particularly for girls who are 10 to 13 years old.

Additionally, adolescents are showing an increase in tic disorders, which are involuntary movements of the neck, eye or facial movements, Feuer said. While some studies suggest a link between depression and these movements, other research has linked them to the increasing use of social media.

As for the availability of mental health services, adolescents are continuing to find it difficult to become outpatients for an overburdened mental health care system, which increases the need for emergency services.

Community services are often “saturated,” Feuer said. “There are not enough child psychiatrists” which means that children go without care for longer, she said.

On Long Island, the wait for inpatient beds is not as long as it reportedly has been in other areas of the country.

“We do have kids waiting at least a day or over the weekend,” said Feuer. She suggested that access to beds and to crisis programs in school have mitigated some of the adolescent demand.

Dr. Stacy Eagle, director of Psychiatry at St. Charles Hospital, cautioned that the potential for addiction and substance abuse is “concerning. Even marijuana is dangerous, because you don’t know what it’s laced with and it can become incredibly addicting.”

Broader challenges

The shortage of inpatient beds predated the arrival of COVID, with mask mandates, social distancing, remote learning and at-home work altering routines and creating stressors that often increased anxiety and triggered the kind of self-medication that led to substance abuse.

“I’ve seen it step up on a daily, weekly, monthly basis” in terms of generalized anxiety disorders and panic attacks, said Dr. Jeffrey Wheeler, director of the Emergency Department at St. Charles Hospital in Port Jefferson.

Eagle said she has seen more anxiety, mood disorders and substance abuse, with more acute patients coming in from schools.

Doctors suggested that COVID itself can contribute to the worsening of a person’s emotional well-being.

“COVID certainly plays a role in mental health, both as a psychosocial stressor and due to the neurotropic nature” of the virus, said Sarcevic.

The types of treatment varies according to the severity of the symptoms, the underlying conditions, and any ongoing treatment plans.

“Some people come in who are in need of medication to be stabilized for depression,” said Khlat.

To accommodate the increasing need for non-acute psychiatric services, health care professionals have been offering telepsychiatry help.

In the last three months, St. Catherine of Siena expanded their telepsychiatry services, which had been offered primarily on the weekends, to seven days a week.

“Due to the influx of patients we’re having, with COVID depression we had to [expand that] to the rest of the week,” Khlat said. These services “helped us out a lot.”

Silver lining

Feuer suggested a few silver linings amidst the health care crisis.

“The attention to something we know has been a problem for a long time” will help the community, she said. “I’m hoping the right resources and interventions will come.”

Additionally, the increased vigilance of mental health challenges has enabled people to feel that asking for mental health resources is something they can, and should, do.

“It has normalized these conversations,” Dr. Feuer said.

Available resources

Dr. Gregson Pigott, commissioner of the Suffolk County Department of Health Services, urged people who think they need help to get it right away.

Those people seeking help for substance abuse or mental health can visit www.SuffolkStopAddiction.org to find a network of providers in the 2022 Suffolk County Directory of Behavioral Health Services guide.

The following are resources available to those in crisis:

— Family Services League’s Diagnostic, Assessment and Stability Hub (DASH) program. This is a 24-hour stabilization response program for children and adults in crisis due to substance abuse, mental illness and other life stressors. They are located at 90 Adams Avenue in Hauppauge. Their phone number is 631-952-3333.

— A free 24-hour hotline: 631-751-7500, or www.responsehotline.org.

— A Comprehensive Psychiatric Emergency Program (CPEP) at Stony Brook Hospital at 101 Nicolls Rd in Stony Brook is available at 631-444-6050. CPEP has voluntary and involuntary emergency psychiatric services for children and adults every day.

“It is important for individuals to engage in self-care,” Pigott wrote in an email. “Listening to each other and recognizing the signs of mental illness and substance use can help mitigate a developing crisis.”

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Sheriff Toulon said he intends to address mental health and substance abuse during his second term. Photo from Toulon’s office

This week, TBR News Media had an exclusive interview with Suffolk County Sheriff Errol Toulon Jr. (D). During our conversation with the sheriff, he addressed his battles with cancer, the challenges of steering the sheriff’s department through a pandemic and his surprising place in the history of the New York Yankees.

Sheriff, what is your professional background and how did you land in the Suffolk County Sheriff’s Office?

I started my career in 1982 as a New York City correction officer and I worked with the New York City Department of Corrections for 22 years on the uniform side. From 1982 until 2004, I worked on various assignments in numerous jails throughout the department. We had almost 25,000 inmates in our city system back then. I worked in our emergency services unit for almost 10 years. I was a captain there and also a captain in our detectives unit for almost three years before I retired. I also worked in the compliance division toward the end of my career.

I had to leave because I had some health issues. I’m a two-time cancer survivor. Uniquely, after I was able to recover from my illnesses, I went back to school to finish my bachelor’s, master’s and I received a doctorate in education. I worked with County Executive [Steve] Bellone [D] as his assistant deputy county executive for public safety for almost two years, where I tell people that I truly got an understanding of the landscape of Suffolk County. Then, I returned back to New York City as the deputy commissioner of operations, overseeing almost all of the operational aspects of the department from 2014 until 2017. I then decided to run for sheriff in September of 2017.

How has your battle with cancer impacted both your outlook on life and the work that you do for Suffolk County?

One of the things that I realized as a two-time cancer survivor is that you never know what the person next to you — whether you’re on the ball field watching kids play or you’re in the movie theater or the supermarket — you don’t know if someone has health issues, financial issues, relationship issues. I think I have become a lot more sympathetic and also empathetic to the plights that people are going through.

Earlier in your career, you worked at Rikers Island. How has that experience shaped your later approach as county sheriff?

My father was a warden on Rikers Island for 36 years, starting off as a correction officer. I remember during one of the early conversations I had with him, I asked him about his employment. He said, ‘We rehabilitate men and women who are in jail.’ That kind of resonated with me throughout my career. 

When I became sheriff, I noticed that almost 85% of the men and women that are in our custody are returning back to our communities. In order to help them and to have less victims in our communities, while we have them within our custody why not try to provide them with the resources so that they can be successful when they return back to our communities?

What are some of the struggles that your department had encountered due to the COVID-19 pandemic and how did you attempt to overcome them?

When I was the deputy commissioner, we had to deal with the H1N1 and Ebola viruses. When we learned about COVID-19 in Washington state in 2020, we started preparing for the possibility of there being an outbreak. By the end of February, we had our plans set. We implemented them around the second week of March because the first [confirmed] case of COVID in New York state was March 1 and the first case in Suffolk County was March 8. By that second week of March, we started implementing measures of social distancing; we had masks that were mandated to be worn; we started doing temperature checks; and we told our staff that if they were not feeling well or had any of the signs of identified symptoms for COVID-19, that they should seek out their health care professionals. 

With the jails, we cleaned our facilities three to four times per day. Inmates were required to wear masks. We were able to “cell skip’’ our inmates, so instead of inmates being in cells 1, 2, 3, 4 and 5, they were in cells 1, 3, 5, 7 and 9. We did stop visits because, if you remember, [former] Governor [Andrew] Cuomo [D] had said that if we shut down visits for two weeks, we’d be OK. We did shut down our visits for any individuals coming in and for any service providers entering our jails. It proved to be somewhat successful, but we had to do it for longer than we anticipated. 

From March, when we first implemented those measures, until the beginning of December, we only had five inmates that had tested positive — and I should say, three tested positive in the jails, two came into the jail positive. I think we were very successful.

What we also did was that every newly admitted inmate had to go into a quarantine for 14 days while our medical staff checked up on them three or four times a day. We wanted to make sure that our new admission inmates weren’t exposing any inmates that had been in our custody with any potential virus. 

You were recently sworn in for a second term as sheriff. What is your vision for the next four years at the department?

There are three things that I’m working on.

Mental health and substance abuse seem to be the primary traits for the majority of the men and women not only in our custody but throughout the nation’s prisons and jails. We’re working very hard to understand those two components because we want to be able to help those men and women, and even those that are not in jail — maybe there’s no criminal activity in their lifestyles, but they’re still suffering. 

We want to see what we can do, working with various community partners and service providers to look more holistically and see what’s going on. We do understand, even with some of our youth, who we are learning may have adverse childhood experiences, not only are they experiencing mental health and substance abuse in the home, but there are also traumatic issues, domestic violence issues and socioeconomic challenges. Those are the things we intend to focus on.

We’re also looking to create the first network of information sharing for jails and prisons throughout the United States. We think this will be very beneficial. We know that most police departments are sharing information with each other, but jails and prisons throughout the country are not. We want to tap into that resource because if we learn of different trends that are occurring, we can also alert our law enforcement partners to these things that are occurring, specifically in the jails and prisons throughout our region and our country. 

Your office has donated bulletproof vests to the people of Ukraine. What are some of the other philanthropic initiatives that your office has been part of to benefit both Suffolk County and the greater global community?

That was a start by donating those decommissioned vests, but one of the things we are embarking on is that the Suffolk County Sheriff’s Office is now an advisory component to a sheriff’s foundation. This is not run by the Sheriff’s Office, but by a group of individuals. They’re a 501(c)(3) and their goal is to have fundraising events. We do so much in the community that they want to assist us in really helping these kids that are having certain issues. Whether it is donating school supplies or the various community events that we want to do, we want to strengthen the bond between the community and the Suffolk County Sheriff’s Office.

Also, we really want to engage our youth because they are the ones that we want to make sure are on the right path, that they look at law enforcement as a positive role model, and that they maybe even want to come join our forces and work at the Suffolk County Sheriff’s Office.

You are the first African American elected as Suffolk County sheriff. What does that distinction mean to you?

To me, and I know that’s something that has been said to me a lot, my first goal is to be the best sheriff possible, regardless of my race. I do realize that being the first African American not only as sheriff, but the first African American elected to a nonjudicial county-wide position on Long Island, Nassau or Suffolk, it’s something that I’m very cognizant of wherever and whenever I go somewhere. 

I know there are a lot of people looking at me, some favorably and some unfavorably. I think I need to be who I am and not necessarily who people perceive due to the color of my skin. 

Baseball season is now underway and I have learned that you also occupy a place in the history of the New York Yankees. Could you elaborate on this?

Yes. I was fortunate enough in 1979 and 1980 to be a bat boy with the New York Yankees. They had just come off of back-to-back World Series championships in 1977 and 1978. Tragically, in 1979 our captain, Thurman Munson, was killed in a plane crash and we fell short of making the playoffs that year. Subsequently, in 1980 we did make the playoffs, but we lost three straight to the Kansas City Royals. In the third game, I was the ball boy down the right field line watching George Brett hit a three-run homer off of Goose Gossage, which went into the upper deck. I realized then that my career as a bat boy had quickly come to an end. 

What are your thoughts on Aaron Judge’s contract fiasco? 

I hope they do sign him. I think he’s proven to be not only a great ballplayer when he’s not injured, but more importantly a great role model. Mr. [Joe] DiMaggio and Mr. [George] Steinbrenner — both of whom I was fortunate enough to meet and speak with — would say that he is the type of person they would want to be a Yankee for his entire career, very similar to Derek Jeter.

Sheriff, thank you for taking this interview. Is there anything else that you would like to say to our local readers?

Yes. I firmly believe that the Suffolk County Sheriff’s Office is changing the paradigm of criminal justice, not just in Suffolk County but throughout New York state. We’re continuing to look for partners, both from the governmental side but also the community side, to make sure that we are not only able to engage but also help those that need us. That’s why we’re here. We’re really here to help our community.

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CVS Pharmacy

People might soon be able to grab their prescriptions, a bag of potato chips and pick up soap as they head into a new therapy service at their local CVS.

The nation’s pharmacy retail giant has started a new service at several of their stores across the U.S. — offering both walk-in and scheduled sessions for mental health treatment. These appointments are available beyond typical daytime hours, including nights and weekends.

According to a spokesperson with CVS Health, the company began adding licensed clinical social workers trained in cognitive behavioral therapy to 13 locations in the Houston, Philadelphia and Tampa metro areas in January of this year.

These providers will offer mental health assessments, referrals and personalized counseling either in person or via telehealth through MinuteClinics inside CVS HealthHUB store locations.

The spokesperson said the company is planning on expanding to 34 locations this spring. 

“We anticipate expanding mental health services into additional markets in the coming months,” the representative said in an email. “We expect to have more detailed information soon.”

Rite Aid and Walmart have started similar programs, too. 

Dr. Adam Gonzalez.
Photo from Stony Brook Medicine

And although MinuteClinics and the like are not available in New York state yet, Dr. Adam Gonzalez, director of behavioral health and founding director of the Mind-Body Clinical Research Center at the Stony Brook Renaissance School of Medicine, said this could potentially be a good day if such facilities were to come close to home. 

“The COVID-19 pandemic has brought about many challenges and disruptions to our way of life,” he said. “We have seen an increase in depression, anxiety, increased stress overall and grief responses. Recent mental health data from the CDC also highlights an increase in mental health problems, especially among young adults, and importantly, unmet mental health needs.”

According to Gonzalez, a recent CDC report indicates that during August 2020 through this February “the percentage of adults with recent symptoms of an anxiety or a depressive disorder increased from 36.4% to 41.5%, and the percentage of those reporting an unmet mental health care need increased from 9.2% to 11.7%. Increases were largest among adults aged 18–29 years and those with less than a high school education.” 

“There is a great need for mental health awareness and treatment at this time,” Gonzalez added. “A silver lining of the pandemic has been the expansion and use of telehealth as a platform for treatment, allowing patients to participate in mental health treatment from the comfort of their home. However, a limiting factor for accessing care is the availability of providers.”

He said throughout the pandemic, SBU’s Department of Psychiatry and Behavioral Health saw a great increase in the need for mental health care — so large, it developed a call center.

“Throughout the pandemic we have consistently been receiving over 7,000 calls per month,” the director said. “Evaluating our outpatient data for the three months before the pandemic and the current last three months, there has been a 50% increase in number of visits scheduled for outpatient mental health services. Of note, the number of visits scheduled is limited by the number of providers available to provide services.”

With the need for mental health providers continuing to grow, Gonzalez said additional services — like the ones at the CVS pharmacy chain — could be helpful.

“I think having services available at CVS could help with normalizing mental health treatment and increasing access to care,” he said. “The more mental health service options available to the community, the better. One consideration is the type and quality of care to be delivered. Although it is important to increase access, we also want to make sure that the quality of care being delivered is high.”

But if and when the retailers open up shop on Long Island, Stony Brook Medicine is working on finding ways to reduce feelings of hopelessness and distress. 

“We are actively working on investigating various methods of delivering care to help with increasing access to treatment and addressing the mental health needs of the community,” Gonzalez said. 

These methods include expanding group-based services, utilizing a collaborative care model that involves working closely with primary care physicians and behavioral health care managers for medication management, and utilizing skills-based single-session interventions. 

“We have been working with Dr. Jessica Schleider in the Department of Psychology at Stony Brook University to implement and study a problem-solving single-session intervention,” he added. “Initial data indicates that these sessions help with improving agency — motivation for change — and reduce feelings of hopelessness and distress.”

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Pixabay photo

By Leah S. Dunaief

Leah Dunaief

Probably because of COVID-19, there has been more discussion in the media about depression, anxiety and mental health in general. CVS, the nation’s largest retail pharmacy, and the one owned by the Melville Corporation, (the company started by local philanthropist Ward Melville by the way) is creating a new niche for its many stores. It has been hiring licensed clinical social workers for a pilot project in several cities and will offer walk-in sessions or by appointment. 

The social workers are trained in cognitive behavior therapy or CBT. I believe that is generally a form of short term therapy in which the immediate problem is discussed and treated using evidence-based techniques. According to an article in The New York Times, May 10, social workers will offer assessments, referrals and counseling. They will be available during the day and also on evenings and weekends, and also by telemedicine. They will partner with the company’s nurse practitioners and pharmacists for prescriptions when needed.  This will be yet another nonemergency health care service the chain is providing, as they have most recently offered coronavirus vaccines for the public.

Now others beside pharmacies like Rite Aid and Walgreens, who are also planning mental health care, are seeing opportunity in the health field. Albertsons, a grocery chain, offers injectable antipsychotic drugs as well as injectable medication to help treat substance abuse. And a while ago, I got my first shingles vaccine in a drug store.

What a change from the pharmacy of my childhood. I well remember walking down to the drug store five blocks away in New York City with my dad, before I was even of elementary school age, to buy ice cream. That was the only place with a freezer, and the selections were Breyer’s vanilla, or chocolate, or vanilla, chocolate and strawberry together in half gallon containers. They were in a freezer chest, like a foot locker, and when I leaned in to pick the selection, the cold took my breath away. The pharmacy also had a counter where we could sit and get sundaes and milkshakes. But most of the time, we carried the ice cream carton home, hurriedly so it wouldn’t melt, to eat together with the rest of the family.

Another recent focus in the mental health field is on food. And sadly the foods we typically turn to when we are stressed, inevitably sugar-laden and of high fat like ice cream, pastries, pizza and hamburgers, now are on the mental wellness bad list. Nutritional psychiatry is an emerging field which looks at the relationship between diet and mental health. The idea that what we eat can affect our physical health is an accepted one, and now the same concept is extended to our mental wellbeing with the following physiological specifics thanks to research. 

“A healthy diet promotes a healthy gut, which communicates with the brain through what is known as the gut-brain axis. Microbes in the gut produce neurotransmitters like serotonin and dopamine, which regulate our mood and emotions, and the gut microbiome has been implicated in mental health outcomes,” states The New York Times in a May 18 article by Anahad O’Connor.

People who eat a lot of nutrient-dense foods, like fruits and vegetables “report less depression and greater levels of happiness and mental well-being,” according to the NYT.

There is a bit of a chicken-egg conundrum here concerning which comes first? Do anxiety and depression drive people to eat unhealthy foods or are those who are happy and optimistic more likely to choose nutritious foods that further brighten their moods? Recent research has borne out that healthy foods do improve moods.

“Seafood, greens, nuts and beans — and a little dark chocolate” is the basic dietary advice of Dr. Drew Ramsey, a psychiatrist and assistant clinical professor at Columbia University College of Physicians and Surgeons. His jingle comes with the message that food can be empowering.

*This article was revised on June 1, 2021.

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Older folks are going to be struggling mentally this holiday season, as with current travel and gathering restrictions it will be harder to connect over long distances. Stock photo

Before, during and after major storms, state and local officials typically urge residents to check on elderly friends and neighbors to make sure they have what they need.

While the pandemic hasn’t torn up trees or left a physical mess strewn across impassable roadways, it has triggered the kind of problems residents might have during an ongoing storm.

Indeed, after a brutal spring that included school and business lockdowns followed by a summer respite when the number of infected people declined, the fall has proceeded the way many infectious disease experts had anticipated, with a resurgence in positive tests, steadily rising hospital bed occupancy and the possibility of renewed lockdowns.

Dr. Youssef Hassoun, the medical director at South Oaks Hospital, offers advice with connecting to the elderly over the holidays. Photo from Northwell Health

All of this is happening against the backdrop of a time when elderly residents typically welcome friends and extended family during Thanksgiving and through the December holidays. Many people have canceled or postponed seasonal rituals indefinitely, things that normally offer an opportunity to reconnect.

Holidays are a “needed process that are embedded in our culture and society and, for most, bring significant joy and purpose,” said Dr. Youssef Hassoun, Medical Director of South Oaks Hospital. “For the elderly, that is exaggerated, simply because that is their time to connect back with their loved ones.”

Elderly residents are managing, though they are feeling numerous stressors.

The mental health toll on elderly residents has increased since the pandemic began. In the first few months after the virus upended life on Long Island, the number of elderly residents seeking mental health support declined at Stony Brook, according to Nikhil Palekar, Associate Professor of Psychiatry and Director of Geriatric Psychiatry at Stony Brook University’s Renaissance School of Medicine.

In the last few months, “we have seen a significant increase in referrals our center has received for mental health services,” Palekar explained in an email.

Stony Brook has not had to increase their staffing yet, but if the demand for mental health services continues to be as high as it has been for the past couple of months, the university “will be hiring more clinical staff to provide care,” Palekar explained.

Elderly residents are trapped in a battle between the fear of contracting the virus and the impact of loneliness, which can increase the rate of depression, anxiety and cognitive impairment, Palekar added.

Indeed, the number of nursing home residents contracting the virus has increased in the country and in Suffolk County, according County Executive Steve Bellone (D) during a Tuesday call with reporters.

For people who are battling against the loneliness triggered by isolation, “our recommendation to our elderly patients is to use televideo conferencing to connect with their loved ones, peers and support groups,” Palekar wrote.

Ongoing Stress

For Baby Boomers, concerns about loneliness predated the pandemic, said Adam Gonzalez, Founding Director of the Mind-Body Clinical Research Center and Assistant Professor of Psychiatry at the Renaissance School of Medicine at Stony Brook University.

“COVID adds a whole ‘nother layer of barriers that might get in the way of people connecting,” Gonzalez said. “It’s definitely a high-stress and overwhelming time for many.”

Indeed, ongoing stress, including from concerns about COVID, can trigger cognitive stress.

“Stress can make it harder for people to think,” said Chris Christodoulou, Research Assistant Professor of Psychiatry & Behavioral Health and Neurology at Stony Brook University’s Renaissance School of Medicine. When people are thrown out of their habits, that can be “disorienting and stressful.”

‘For the elderly, [that need for holiday joy] is exaggerated, simply because that is their time to connect back with their loved ones.’

—Dr. Youssef Hassoun

A stressful situation can also reveal cognitive vulnerability for people who are suddenly unsure of themselves and their environment.

“Chronic stress changes our brains in ways that are not healthy and may contribute to lots of diseases, including those affecting the brain,” Christodoulou said.

As for what to pay close attention to when checking in on elderly residents, Palekar suggested that people listen for key words or phrases, such as “feel lonely,” “don’t like myself,” “poor sleep and appetite,” or “can’t stop worrying.” Additionally, members of a support network should pay close attention if others feel helpless, can’t concentrate, have lost interest in doing things or are tired all day.

Solutions

Christodoulou said activities like yoga and aerobic exercise can prevent and slow the decline in cognition.

Hassoun also urged residents to have an open conversation with elderly family members.

“We are very good at assuming that someone appreciates” the risks of larger or even medium-sized family gatherings, Hassoun said. People may understand those risks differently.

The South Oaks Hospital medical director suggested conversations begin not with the unknowns related to potential sicknesses or even new tests, treatments and vaccines, but rather with the knowns of what’s working. While residents may be tired of hearing it, the reality is that masks, social distancing and hand hygiene have reduced the spread of COVID-19, along with other pathogens and microbes that might spread through family contact during the holidays.

Doctors and mental health professionals urged people to be creative in their efforts to connect with others this year.

“How can we get dad, who has never enjoyed looking at an iPad, let alone using it, to find it more fun to have a zoom Thanksgiving together?” Hassoun asked.

He added that these unconventional Thanksgiving interactions could be a way to connect relatives and even children who may not participate as actively in group discussions during these holiday meals.

Residents can improve the holiday during this challenging year by making the most of each interaction, even if it’s not in the familiar personal setting.

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