Tag Archives: Counselors Audience

Counselors Audience

Digging into the numbers

By Scott Rasmus February 9, 2017

It has been relatively well-publicized in the media that mental illness typically affects 20 percent of the U.S. population, or about 1 in 5 people, yet the source of this statistic is rarely disclosed. Furthermore, media sources typically discuss mental illness in general terms and don’t address its susceptibility by age or present statistics on the prevalence of mental illness over time. For instance, a basic comparison of mental illness prevalence statistics between children and adults, or in any given year versus over a person’s lifetime, is rarely offered.

Therefore, I wanted to offer a web-based meta-analysis of prevalence statistics for mental illness by including as many reputable sources of mental health information as I could identify. These sources include the Centers for Disease Control and Prevention, the National Alliance on Mental Illness, the American Psychological Association, the American Psychiatric Association, the National Institute of Mental Health (NIMH), the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the Surgeon General. The focus of my research was on the most current web research available, spanning the years 2011 to 2015.

Prevalence data

What are the generally accepted definitions of one-year prevalence and lifetime prevalence for mental illness? The NIMH defines one-year prevalence as the proportion of people who have experienced a mental illness in the past year, whereas lifetime prevalence reflects how many people have experienced an incidence of mental illness at any point in their lives up until the point of assessment. These numbers are typically reported as a percentage of the population. It is important to note that these statistics do not necessarily reflect new cases of mental illness, but rather those individuals who have experienced an instance of mental illness — new, ongoing or otherwise — in a given time period. With these definitions in mind, let’s look at the prevalence numbers.

In reviewing the prevalence statistics from various sources, my web research indicated that the average one-year prevalence for adults with mental illness was 22.2 percent (see Table 1), ranging from 14.5 to 26.2 percent over eight well-accepted sources. The average number trends higher than the general prevalence statistic that is often cited in the media, indicating that mental illness is somewhat more common than what is typically reported. With this in mind, one-year prevalence statistics should be revised and presented to the public to reflect that mental illness affects between 20 and 25 percent of adults in any given year.

For youths, I found data only for those ages 8-18. My research indicated that the average one-year prevalence number for mental illness among youths supported the number that is typically reported in the media — 20 percent (see Table 1). However, whereas I identified eight reputable sources of statistics for prevalence of mental illness among adults, I could identify no more than two such sources for youths. This discrepancy in viable sources suggests that a need exists for better research to identify the prevalence of mental illness among our children and adolescents.

I next refined the study to look at the one-year prevalence statistics for severe mental illness (see Table 2). When investigating this special population that is rarely reported in the media, my research indicated that the one-year prevalence average of severe mental illness among adults was 5.7 percent, ranging from 4 to 9.5 percent over seven sources. For youths ages 8-18, the one-year prevalence for severe mental illness averaged about 14 percent over just two sources, with a wide range from 9 to 20 percent.

Putting these numbers in the context of general mental illness, it implies that among adults, severe mental illness constitutes about a quarter of all cases, whereas among youths, severe mental illness makes up more than two-thirds of cases in any given year. This highlights an interesting difference, but we may infer from these numbers that the prevalence of severe mental illness can differ widely based on the definitions applied to it.

My experience suggests that these definitions tend to be more ambiguous and often are termed “severe mental illness,” “severe mental disorder” or “severe emotional disturbance,” to name a few. In my work over the past several years, I have noticed that the interpretation of the definition for severe mental illness can vary so greatly that it may include as few as five mental illness diagnoses or more than 100. SAMHSA’s National Registry of Evidence-based Programs and Practices identifies 17 related terms for severe mental illness. These terms can vary by state and with the inclusion or exclusion of childhood mental disorders and functional impairment criteria. On top of this variance, mental health professionals understand that there is some subjectivity involved in the diagnosis of mental disorders to begin with, even before the classification of the mental illness is determined as severe or not.

Next, I looked at the lifetime prevalence of mental illness for both adults and youths (see Table 3). Interestingly, I found the number of credible sources for these statistics much more limited than those for one-year prevalence, with only two sources apiece for both adults and youths. For adults, the lifetime prevalence statistics averaged 48.2 percent, with a range from 46.4 to 50 percent. For youths, the lifetime prevalence of mental illness ranged from 13 percent (ages 8-15) to 46 percent (ages 13-18), averaging about 30 percent over the full 8-18 age range. Given that youths have had fewer years to experience mental illness, it makes sense that their lifetime prevalence rates are lower than the lifetime prevalence rates of adults.

Finally, when considering the lifetime prevalence of severe mental illness (see Table 4), I could find reliable statistics only for youths, with an average prevalence of approximately 21 percent over two sources. I didn’t find enough credible information about the lifetime prevalence of severe mental illness in adults to even report here. Given the scarcity of statistics for both youths and adults related to lifetime prevalence of severe mental illness, this appears to represent a large gap in the research.

Concerning numbers

After reviewing the prevalence data for mental illness, it makes sense to me to consider current research statistics related to how many individuals with mental illness actually receive treatment for their disorders in a given year. My research indicates that the statistics for both youths and adults seem very consistent with age, averaging about 45 percent overall, and ranging over four sources from 39 to 50 percent.

These numbers shocked me somewhat and were very concerning. Such statistics indicate that regardless of age, less than half of the people who experience an episode of mental illness receive the mental health treatment that they need. This statistic begs the question: Why is this the case?

I can only hypothesize about the answer, which likely has many facets, including a general lack of awareness about mental illness, the need for education around it and the powerful influence of stigma related to mental illness. The media associates mental illness with a number of negative outcomes, particularly highlighting its relationship to violence, which in reality is very rare. To better address this misperception, the board for which I serve as the executive director — the Mental Health and Addiction Recovery Services Board in Butler County, Ohio — has adopted a position statement based on multiple sources indicating that only 3 to 5 percent of those with mental illness are violent. Still, let me offer a practical example of how the prevalence numbers and treatment statistics can be applied to the county where I live and work.

Based on the 2010 census numbers, Butler County has a population of about 370,000 residents. Applying the one-year prevalence statistics for mental illness of 20 to 25 percent, this implies that between 74,000 and 93,000 residents in our county experience an incidence of mental illness in a given year. Of those residents, upward of half don’t receive the mental health treatment services that they need. Potentially, that’s more than 46,000 county residents who may not be living their lives in as fulfilling and productive a manner as they otherwise could, especially when we know that mental health treatment largely works. People recover through modalities such as talk therapy, medications, lifestyle changes and other treatment approaches, which often are incorporated in an integrated way. What a challenge we face in addressing the mental health needs not only in my county but in our entire country and beyond. There are so many lives affected and so much productivity lost to what are very treatable illnesses.

Compiling the information I have shared in this article on the prevalence of mental illness related to time, age and treatment has really impressed on me how much work remains to be done to obtain better estimates of the general incidence of mental illness in our country and the world. We especially need more detailed statistics related to the cultural and demographic aspects of mental illness. The bible of mental illness, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, contains some valuable information related to prevalence and cultural data for specific diagnoses. There remains, however, a need for better research via large random studies that look at mental illness in general, including developmental disabilities and substance use disorders. I often wonder if the published mental health statistics that I review include these categories of mental illness.

Furthermore, as better statistics are researched and reported, mental health prevalence numbers need to be compared with those of well-known physical illnesses such as cancer, heart disease, diabetes, obesity and hypertension. In this way, I believe we can better demonstrate and publicize how common mental illness truly is in our society. Taking these actions will go a long way toward educating the public about its incidence, thus normalizing mental illness and, I hope, reducing the stigma with which it is often associated.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Scott Rasmus is the executive director of the Butler County (Ohio) Mental Health and Addiction Recovery Services Board. He received his doctorate in counselor education from the University of Central Florida. He is dually licensed in Ohio as a licensed professional clinical counselor-supervisor and as an independent marriage and family therapist. He has presented internationally on mental health topics. Contact him at RasmusSD@bcmhars.org.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

APA accepting feedback for DSM revision

By Bethany Bray February 6, 2017

The American Psychiatric Association has created an online portal for the public to submit suggested changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Launched this winter, the portal allows clinicians, scholars and members of the public to submit suggested additions, deletions or modifications to the DSM.

Often called the “psychiatric bible,” the DSM-5 is a go-to resource for many practitioners when it comes to the classification and diagnosis of mental disorders. APA released this most recent version of the DSM in May 2013, after more than a decade of planning, research and review.

The online portal creates a way to keep the DSM updated in a more timely manner and make changes incrementally, as new information and research is available, according to the APA website.

This new medium offers an important and much-needed chance to have counselors voices considered in what has traditionally been an arena dominated by psychiatrists, says Stephanie Dailey, who was involved with the American Counseling Association’s DSM-5 Task Force and co-author of the ACA-published book DSM-5 Learning Companion for Counselors.

However, Dailey, a licensed professional counselor and associate professor and director of counseling training programs at Argosy University, Washington, D.C., expresses some skepticism about which submissions might actually be considered for changes to the DSM. She contributed some thoughts, via email, to Counseling Today:

 

“The Diagnostic and Statistical Manual of Mental Disorders (DSM) has long been criticized, amongst other things, for poor utility; inadequate psychometric evidence for diagnostic categories and specifiers; comorbidity issues; overutilization of ‘catch all’ diagnoses (e.g., not otherwise specific [NOS] and generalized anxiety disorder [GAD]); and underutilization of emergent genetic, neuroscientific and behavioral research.

While APA’s DSM-5 Task Force attempted to rectify many of these issues, there are still considerable challenges in regard to validity, reliability and clinical utility within the DSM-5. Clarification of diagnostic descriptions, criteria, subtypes and specifiers is needed and there is a significant dearth of information regarding sociocultural, gender and familial patterns for diagnostic classifications. There is also a lack of rigorous psychometric validation for suggested dimensional and cross-cutting assessments (introduced in the DSM-5) and no consensus was made during the last revision to the DSM in terms of modifications needed for the personality disorders category. Thus, this diagnostic category has remained unchanged and clinicians (and clients) are facing the same challenges as they did 20 years ago when the DSM-IV was released.

In terms of the new portal, it is important for individuals to understand the revision process of previous iterations of the DSM to really appreciate the magnitude of an ‘open’ call for revisions. The revision process of the DSM-IV to DSM-5 was a 14-year process, beginning in 1999, which originated with a research agenda primarily developed by the American Psychiatric Association

Image via Flickr http://bit.ly/2lfWuka

(APA), the National Institute of Mental Health (NIMH) and the World Health Organization (WHO). In 2007, APA officially commissioned a DSM-5 Task Force which formed 13 work groups on specific disorders and/or diagnostic categories. While the scope was broad, the intent of the workgroups was to improve clinical utility, address comorbidity, eradicate the use of not otherwise specified (NOS), do away with functional impairments as necessary components of diagnostic criteria and use current research to further validate diagnostic classes and specifiers. Having released the draft proposed changes, three rounds of public comment and field trials were conducted between 2010 and 2012. During this time, numerous professional organizations, including ACA, voiced significant concerns (See ACA’s 2011 letter to APA: bit.ly/2kxJBVY).

Despite attempts to become involved, at no time has any professional counselor ever served on APA’s DSM Task Force. In regards to the new portal, our time to have a foothold in changes to current diagnostic classifications is now.

In looking at the portal which lists specific kinds of revisions sought, one can easily see that APA is looking to remedy the long-term critiques of the manual, specifically validity, reliability, utility and the need to capture emerging research.

However, what proposals (and by whom) that are selected for inclusion remains to be seen. While the portal allows anyone to submit a proposal, there is a long history of bias in the type of research which is deemed appropriate for consideration by APA. While there is no dispute in terms of the need for rigorous research designs and large scale studies to validate criterion, these studies are not likely going to be conducted by anyone outside of APA, NIMH, WHO and other large scale ‘think tanks.’

The problem, particularly for counselors, is both philosophical and practical. First, the psychiatric profession as a whole is trained in the medical model, while counselors tend to operate on a more humanistic, holistic perspective. Next, while Paul Appelbaum, chair of the DSM Steering Committee, stated that acceptance thresholds will be high, reports from Appelbaum and others have ensured scrutiny for submissions which don’t provide ‘clear evidence.’ This is not only vague, but likely slanted towards the psychiatric community.

No one is disputing the need for the best available scientific evidence or the ability of the counseling profession to produce substantive outcome research for the mental health community. The American Counseling Association has members who have significant, scientific-based expertise in areas relevant to the DSM and strong research agendas which can support evidence-based changes. However, our seat at the table in these discussions has been scant.

Thus, counselors are strongly urged to contribute to the revision process by submitting proposals and working towards serving as unique contributors to the next edition. This is particularly relevant to counselors whose focus is on marginalized populations and underserved groups. Outcome-based research is needed, specifically that which has been repeatedly shown to improve treatment outcomes.

This is the time for counselors to become involved and make our experience known, and more importantly, our clients’ voices heard.”

 

 

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Find out more

 

Visit APA’s DSM portal at https://psychiatry.org/psychiatrists/practice/dsm/submit-proposals

 

See Counseling Today’s Q+A with Dailey: “Behind the Book: DSM-5 Learning Companion for Counselors

 

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Hooah! Thoughts and musings on Operation Immersion

By Janet Fain Morgan January 3, 2017

Hooah: Military slang referring to or meaning “anything and everything except ‘no.’” Used predominantly by soldiers in the U.S. Army.

 

My father was in the U.S. Army for more than 30 years. I grew up as a military dependent, relocating every few years (and attending more than 20 schools) until I graduated high school. I joined the Army Reserve, later married my husband, a U.S. Navy submariner, and he eventually ended up retiring from the Army after 20 years. My eldest son joined the Army out of college and is currently on active duty.

I have been a licensed professional counselor in Augusta, Georgia; Bamberg, Germany; Lakewood, Washington; Fort Knox, Kentucky; Columbus, Georgia; and most recently, Somerset, Kentucky. As a member of the American Counseling Association and the Military and Government Counseling Association (a division of ACA), I am concerned about the rising number of suicides among our military veterans. On a related note, I am also concerned by the limited number of education and training opportunities available to counselors who are dedicated to the specific needs of military clients.

This past year, the Kentucky Counseling Association (KCA), a state branch of ACA, advertised a training program for counselors called Kentucky Operation Immersion. The program offered an immersion experience into military culture that aimed to help counselors become aware of the unique culture and specific needs of military clients. The training educated counselors on how better to help soldiers as they transition back from wartime environments overseas and reintegrate into a civilian society.

Only about 1 percent of the U.S. population actually serves in the military. Many people do not understand the difference between the military mindset and the civilian frame of mind. For that reason, I was impressed and excited to see that KCA was addressing a very important topic that can make a difference to our military members.

As a counseling professional and former soldier, I jumped at the opportunity to train with the Army National Guard at the Wendell H. Ford Regional Training Center. The Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID) and the Kentucky Army National Guard presented and sponsored the training, and many of their respective department members joined in the training. I had no idea what I had signed up for, but sometimes ignorance is bliss.

I arrived to join approximately 30 other participants from a variety of specialties, including drug and alcohol counselors, psychologists, school counselors and Kentucky Department of Veterans Affairs employees. The participants ranged in age from their 20s to their 70s.

Day One: Basic training

On the first day — basic training — we were introduced to the training leaders, department heads and Army National Guard soldiers who would mentor us throughout the training. We were issued our field equipment, including Kevlar helmets and flak jackets, which we would wear during our training for the next three days. Removing the metal plates that are normally part of the bulletproof garment decreased the flak jacket’s weight. Even so, the jacket was still heavy and served as a constant reminder of what soldiers wear to protect themselves during deployment.

Our first training exercise was an introduction to platoon formation and marching, but this version was much kinder than what I had experienced in my Army basic training days. Regardless, I found myself unable to maintain the pace of the platoon. This bruised my ego and provided a gentle indicator of the physical limitations I might encounter in the training exercises to come. And come they did …

The author, second from right in the back row, with fellow members of her Operation Immersion training squad.

The Field Leadership Reaction Course was a team-building exercise (obstacle course) that further introduced me to my counselor peers. We had fun coordinating our navigation of the ropes, walls and boards to achieve successful outcomes. Then Kentucky weather intervened, and we headed for shelter from tornadoes, storms and heavy rains. Chow took place in the mess hall with service members who invited us to ask them questions about the military and their military experience.

That evening we met Bobby Henline, an American hero, comedian and motivational speaker who served four tours of duty in Iraq. During his fourth tour, he was the sole survivor of a roadside bombing that left a third of his body burned. He shared his survival story and his outsize sense of humor with us. Bobby participated with us throughout the training and was an inspiration to us all. His humor helped lighten the serious moments, and his encouragement was invaluable. It was a true honor to meet him and a blessing to spend time with him.

Sleep was sweet after such a full first day.

Day One counseling takeaway: Military training is demanding physically and challenging mentally. Build relationships with military clients by asking about their training and work environments. Ask questions about any military-specific acronyms that they use. Many people know what an MRE (meal ready to eat) is, but fewer are familiar with what FOB (forward operations base) or TOC (tactical operations center) represent. Get to know these clients’ personal stories. This can shed light on what might be troubling them and why they are seeking counseling.

Day Two: Mobilization

Day Two arrived early — at 5 a.m. — and there we were, in formation, doing PT (physical training). Mobilization day started with breakfast in the chow hall, and then we had a class on sexual assault prevention. That morning we also heard personal stories of deployment from individual soldiers. Their stories spoke of bravery, tragedy, courage and, sometimes, boredom. All the stories touched our souls. In fact, when the program participants looked back over those days of classes, physical challenges and training, we decided the deployment stories were what we would remember most.

After a class on combat-related trauma, we headed to the SIM (Simulation) Center, where we ate MREs and enjoyed the virtual combat simulators in the forms of EST (Engagement Skills Training with Night Vision), IED (Improvised Explosive Device training instruction), HEAT (Humvee Egress Awareness Training Simulator) and CSF2 (Comprehensive Soldier and Family Fitness).

That evening, we were briefed by the commander, Capt. Michael Moynahan, and heard another personal deployment story from Maj. Amy Sutter, a licensed clinical social worker. Her mental health perspective on deployment was invaluable, and we also gained insight on deployment from a female viewpoint.

Day Two counseling takeaway: Deployment is rough, both mentally and physically. The living arrangements are complex, and soldiers have many challenges related to isolation and loneliness. At the same time, privacy is often limited. Build the therapeutic relationship by asking your military clients about any and all deployments. Each deployment offers military members challenges and unique perspectives. These could be explored through open-ended questions about their personal experiences. Be aware that some of these clients have seen or done things that they do not want to disclose or remember.

Day Three: Deployment

Deployment day again came early, with PT that included a warmup and running track. Classwork began with a briefing on substance abuse, posttraumatic stress disorder and traumatic brain injury. After listening to a suicide prevention panel, we headed out on a bus to the Gwynn City MOUT (Military Operations on Urban Terrain) site for our deployment training.

The Army National Guard launched a few simulated IED attacks in the direction of our bus and also created a machine gun simulation to get us “in the mood” for our urban warfare exercises. Command Sgt. Maj. Matthew Roberge led the military demonstrations and the exercises to prepare us for clearing a building of enemy personnel. The smooth, precise and sharp Army National Guard soldiers modeled the intricate procedure for us, and in teams of four, we attempted to reproduce the action with our military-style paintball weapons.

Our attempt was a less than perfect assault, with paintballs flying everywhere and Kentucky counselors doing their best to come out of the training exercise unscathed. That said, there was much laughter and excitement throughout, and everyone emerged feeling abundant respect for our U.S. military, and especially the group of professionals who worked with us during our training experience.

Dinner that evening was a relaxing outdoor cookout, during which we said goodbye to many of the soldiers who were leaving for their drill weekend. Awards were given, speeches were made and the treasured “challenge coins” — engraved with a unit’s or organization’s insignia or motto and given as a sign of respect — were secretly passed from palm to palm.

Day Three counseling takeaway: Military members face death often and rely on their training and peers to stay safe. Their training is precise and has to be executed perfectly every time, or the soldiers and their companions run the risk of becoming casualties. A high level of stress accompanies each operation, and sometimes that stress may last for days, weeks or even months, with little or no downtime for the soldier. The residual effects from this intense training and the soldier’s subsequent experiences can last a lifetime. Counselors should understand the deleterious effects of combat. Even if operations are carried out perfectly, casualties can occur, accidents can happen and the effects can be devastating.

Day Four: Demobilization

Demobilization day was early to rise — 4:50 a.m. — so we could clean the barracks, pack our bags and return the gear. Breakfast was quick, but then our first speaker arrived to awaken our senses. Capt. Phil Majcher spoke about his role as battalion chaplain and the duties that were part of the military chaplaincy. He didn’t sugarcoat anything, giving many of us moral points to ponder.

Linda Ringleka, military and national liaison from Lincoln Trail Behavioral Health System, joined Capt. Majcher. Together, they led a workshop on suicide prevention and ACE (Ask, Care, Escort) training. The counselors participated in small group activities that included role-plays and real-time suicide scenarios.

Sgt. Brooks, a female soldier, offered to speak with the female trainees about her experiences as a woman in the military with two deployments under her belt. Gathering together as women, we heard her personal story of courage, determination, struggling as a single mom and the challenges of being female in the Army. Her story was incredible and touched each of us. I must also mention that watching Sgt. Brooks throughout the entire training was like witnessing a master of all trades. She did everything that her male counterparts did, and with effortless perfection.

As we wrapped up the training, pictures were taken and awards were announced. Heath Dolen, DBHDID program administrator, presented each of us with a certificate, and a coveted challenge coin was passed secretly in a handshake.

As I drove home, I reflected on the immense amount of information and knowledge we had all gained as mental health professionals. This training was invaluable in providing us with skills to help soldiers as they return from difficult and sometimes horrific experiences. Many of these potential clients need to know that the counselors assisting them do actually understand some of the hardships they have endured. Counselors must gain the trust of hurting service members before many of them will disclose the horrors that they witnessed or even participated in during a deployment to a war zone.

The rules that we typically live by in our society do not always correspond to the experiences that soldiers see and live through. The camaraderie of this very tightknit community is exceptional, and counselors must understand the underlying military culture and gain the trust of these soldiers to be as effective as possible. Of that, I am certain.

I highly recommend that all mental health care professionals who take care of our soldiers undergo the type of training offered in Operation Immersion. Our heroes deserve the best that mental health professionals can give them, and this training definitely moved us in that direction.

 

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Janet Fain Morgan is a military family life counselor licensed in Kentucky and Georgia. She is a faculty member of William Glasser International and a member of the Military and Government Counseling Association, a division of ACA. She is also a former soldier. Contact her at JMFainMorgan@gmail.com.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having your article accepted for publication, go to ct.counseling.org/feedback

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Ask your doctor if nature is right for you

By Bethany Bray

Happy-looking people take a walk in the woods as small-print disclosures scroll across the bottom of the TV screen and a soothing voiceover explains possible side effects. As the scene closes, one of the actors looks squarely into the camera and says, “Ask your doctor if nature is right for you.”

The tongue-in-cheek NatureRx video campaign has the look and feel of the prescription drug commercials that inundate television in the U.S. The difference, however, is that they are “selling” something that is widely available and has proved to benefit mental health and overall well-being — without prescription drugs.

NatureRx is the brainchild of Justin Bogardus, a filmmaker and licensed professional counselor candidate in Boulder, Colorado. Everything seems to have a marketing campaign in this modern age, he says, so why not nature?

Rather than relying on a heavy-handed “you should” directive, the films use humor and a witty message to emphasize the benefits of getting outside, Bogardus explains.

“As a trained counselor myself [but primarily a filmmaker now],” he says, “I really wanted to create a message like NatureRx because I resonated with it so much personally. … I think people really resonate with the message and the humor because it’s fun, funny and inspiring to remember the little things that were always there, but sometimes we forgot about them, like nature and getting outdoors.”

NatureRx “commercials” have been screened at film festivals and shared widely online since the

Justin Bogardus, NatureRx filmmaker (Courtesy photo)

first video was released in the summer of 2015.

Bogardus has a film degree from Vassar College and has worked as an editor, writer and producer for several documentaries on wrongful conviction/incarceration. In 2013, he completed a master’s degree in Buddhist psychology and contemplative psychotherapy from Naropa University in Boulder. Although he primarily devotes his time to independent filmmaking and speaking engagements, he does occasionally see clients, lead group therapy and teach Buddhist psychology at Naropa.

 

 

Is NatureRx right for you? CT Online contacted Bogardus to learn more about the campaign and its connection to counseling and mental health.

 

The holiday season can be especially tough for people with anxiety and other mental health issues. At the same time, the weather is getting colder and the days are shorter and darker. Do you have suggestions on how to find “NatureRx” throughout the winter?

Research shows [that] as little as 10 minutes outdoors can reset the nervous system, especially if you can be mindful and present with nature for those 10 minutes. … Taking a walk and tasting the cold brisk air makes a big difference even in small doses.

I get asked about winter a lot in regards to NatureRx, and I love that question. I love winter. The outdoors seems particularly tranquil and quiet to me in the winter. There are no studies about this, but I actually think the positive impact of nature on our minds happens faster in winter. Something about a little temperature change and a change of scenery from the indoors in winter really resets my mind and body pretty quickly. Yes, it can be a little harder to motivate putting on jackets and boots when it’s cold and the sun sets so much earlier, but the colder air is more refreshing, I think. I also like to remember that our bodies were built for the outdoors, including the cold weather.

I also love this thing from Denmark called hygge (pronounced hoo-ga). Everyone knows how cold and dark winters in Denmark are, and the Danes have come up with a great word and lifestyle to make the most of it. It’s basically the idea of cultivating coziness, slowing down and taking in simple pleasures. It’s like NatureRx for the indoors.

I like that with the idea of hygge, you bring an overall sense of coziness to the winter and holiday season, which you bring with you both outdoors and inside. A 10-minute walk in the cold air, all bundled up in all the scarves, mittens, hats, puffy coats — whatever makes being outside a slowing down and cozy experience too. How great is a warm fire and hot cup of tea after a short dose of outdoors? How cozy and relaxing is that? So yes, back and forth with outdoors and the family, back and forth with getting warm and then getting refreshed outside with an overall sense of hygge. That’s a perfect recipe for the holiday season I think.

During holiday get-togethers, people and families can go stir crazy if no one is getting outside. Togetherness is great, but too much togetherness in an enclosed space is well … cue the commercial … “are you feeling tired, irritable [and] stressed out?” Who isn’t feeling tired, irritable and stressed out at some point during the holiday season? That’s the cue for a dose of nature, even a microdose. It really works and so does hygge.

NatureRx has been a lifesaver for me during the holidays. Now it’s fun because as I get outdoors for short breaks during each holiday season, the rest of my family has started doing it too. … Maybe they saw how happy and relaxed I was after a little time outside.

 

What do you want professional counselors to know about nature’s connection to wellness and mental health?

I like to remind even the most self-described “I would rather do anything besides camping” indoor people that it’s all about discovering the dose of nature that works for you. [Moving] more plants inside or gardening, or having a great view of the outdoors from a window, whatever brings nature into your life in a way you like, I think, can support our well-being [and] slowing down, which is incredibly helpful, especially in [the] busy, screen-time, information-overload, never-stop-world so many of us are meeting these days.

I once met this great group counselor in New York City — a real expert and guru of counseling. I was telling him how I like to get outside and to meditate. He told me, “Getting outside and meditation are like rocket fuel for healing in therapy.” I think that’s the best way to put it. NatureRx helps on its own and in conjunction with all the others things we need for rich, healthy lives.

Yes, there’s a new big study from big-name institutions almost every week it seems about the positive impacts of the outdoors and nature on all kinds of well-being metrics, especially mental health for all kinds of symptoms and challenges [and] for healthy development of kids. But really I think NatureRx got millions of views and has made such a splash because on a deep intuitive level, we already know this. The healing impact of nature is a story as old as humanity itself.

Being outside in nature supports our well-being. Of course it’s not a panacea. It’s not a cure-all. But who knows? For some people it might be. I think it’s like good rest. It’s something we all know on some level is needed and super helpful for whatever life throws at us. And like good rest, you don’t want to overdo it or go outside with too much of an agenda, expecting nature to fix everything. Nature doesn’t work that way, but if you can hang back a little in nature, let its beneficial impact come to you more and more … it works! I could go on and on. The magic always happens eventually.

Since the dawn of human civilization, we [have] lived increasingly in busier spaces. Every culture and every civilization from every time period has countless stories about the need for nature — a respite and restorative space to not only heal, but find your truer and deeper voice in. NatureRx is that same story, updated for our times. I think nature is a timeless space, a great place to discover your authenticity and who we really are — outside the din and distraction of culture and civilization.

 

Do you have suggestions for how counselors can bring nature into their work with clients?

Well, first have clients watch the NatureRx commercial. Self-promotion? Maybe, but really it’s true. First-time viewers love the humor and then love sharing the videos with other folks — it just resonates with so many people. That was certainly part of the goal with NatureRx and the humor behind it. I didn’t want to prescribe nature and getting outside as a “should.” I wanted to playfully invite people to look at getting outside and nature from a fresh perspective, and of course spoofing a prescription commercial was the way to do that.

So for counselors of all kinds, I say … find ways to invite people into thinking about nature and getting outdoors as a fun, healing space rather than imposing the idea on them in subtle or not so subtle ways. I think [it’s] always good to start with some curiosity, asking people questions about nature, [such as] plants or places they may like. It seems almost everyone has some memory or some animal or plant or some outdoor smell or nature activity they already remember or enjoy. I think that’s a great starting point. Later on, it can also be good to offer some of the evidence-based information about getting outdoors, which some people like to know because it can increase their time outdoors and their perceived benefit from nature. But some folks don’t even need that didactic information.

I’m amazed how many folks already have some NatureRx practice in their life without even realizing they’re intuitively getting benefit from nature — even smokers I meet. Many smokers talk about enjoying the break outdoors as part of their smoking habit. It’s interesting how many, when they quit, still like to get outside, but this time just for a short walk or to sip a cup of tea or something. What they didn’t think about was how smoking was a tool to take a break outside, even in the cold. Without the cigarette, they still get to benefit from getting outside with a lot more enjoyment.

I met a woman I’ll never forget who liked to check the weather for the sunset time. She rarely ever watched the sunset. She just found herself always checking in on what time the sun would set. She didn’t care too much for camping or the outdoors; she would never describe herself as a nature person. I worked with her some, and we talked about what she liked about the sunset and knowing the rhythms of the sunrise and sunset from season to season. Before long, she told me she had started to actually take the time, even if it was just five minutes toward the end of the workday, to not only check the sunset time, but take some time outside to really enjoy watching the sunset. Simple. Relaxing. Restorative. I’m pretty sure she still does that today and loves it.

 

Who is your target audience for the NatureRx campaign?

When first creating the NatureRx commercials and the NatureRx movement online, I intended to target millennials with the humor and the particular disconnection millennials might feel around nature. It’s the first generation that may not have been exposed to the outdoors readily as kids and, consequently, that millennial generation — which I’m a part of, but on the older side — may feel that lack of nature more acutely.

I grew up in the city myself. I was lucky to have a father who took the time to take us to national parks and [go] hiking. That’s probably how I first fell in love with nature. But I had a lot of city friends who didn’t get those experiences growing up, and I always imagined those lifelong friends and what might appeal to them when crafting this message and writing NatureRx content. The millennial generation is so used to getting tons of information on their laptops and phones all the time, so certainly it was an important goal of mine in creating NatureRx to craft a fun-filled message that could connect with them in short form and on social media in a way that they could really enjoy and consider.

It’s food for thought for any age — even kids love our G rated versions of the commercials. It’s something we can all relate to.

 

Do you think medical and mental health professionals sometimes overlook nature and its therapeutic benefits?

Yes and no. I think the medical and mental health professions as a whole have some real ambivalence about nature and the outdoors. [But] I think a lot of that’s changing now as we see the alternative — being inside, disconnected and sequestered, and how that is having terrible health and well-being impacts on our bodies and minds. I think there’s a big shift in medical and mental health professionals around embracing the benefits of nature and getting outdoors because of this.

I think all this research coming out about the benefits of getting outdoors reveals this movement and paradigm shift. For the last few decades in medicine, culture and in parenting, the view was [that] getting outside and in nature is how you get sick or hurt. I think lots of folks are seeing now how wrong that view is.

 

In a nutshell, what inspired you to start the NatureRx campaign?

Nutshell? I love nutshells. That was a big inspiration. That and climate change. I wondered, how could I speak about the human relationship to nature in a way that connected with people personally, whether they believe in human-caused climate change or not? I don’t say anything about climate change in the commercials, but I think it’s in there nonetheless.

I was inspired by how nature is something I need in my personal life. It’s helped me in countless ways, and nature is something we all need as a valuable space for all earthly inhabitants. I hoped the message and humor would convey that — both the personal and universal value of nature. It was a way of giving back for me.

 

What do you want professional counselors to know about why your campaign is needed?

As a trained counselor myself, I like this phrase: “Of all the paths you take in life, make sure some of them are dirt.” For professional counselors, I think NatureRx is needed because there are many paths to healing and recovery for clients. I think it’s also true to make sure some of those paths are made of dirt. A dirt path in the woods is the real-life metaphor we can experience at anytime. It’s a great ready-at-hand place where we can see that natural healing isn’t like a manicured superhighway to health. There are twists and turns.

Getting outside reminds me of my most human qualities. It reminds me that I have a body that likes to be in nature, to look at nature and be healthy. It reminds me to take time to just be. I think that’s the energizing trail mix we all need on whatever path we’re taking in life. That’s the need I hope NatureRx fills. It’s an empowering message about how you can take back your life at any point by simply stepping outdoors. I think healing and counseling works well when people feel empowered with real solutions, and getting outdoors is most certainly one of those solutions.

 

 

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Find out more about NatureRx and watch Bogardus’ TED Talk at Nature-Rx.org

The NatureRx “commercials” are available there as well as on the YouTube channel: bit.ly/2h1MCZp

 

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

CT Online’s most-read articles of 2016

December 27, 2016

What were professional counselors reading at CT Online in 2016? The year’s most popular new posts ran the gamut, from articles on attention-deficit/hyperactivity disorder to technology to issues surrounding multiculturalism and social justice. More than 150 articles, both online-exclusive pieces and articles that also appeared in Counseling Today’s print magazine, were posted at ct.counseling.org in 2016.

 

Most-viewed articles posted in 2016 at ct.counseling.org

  1. Why failing the NCMHCE felt so good” (Online exclusive; posted in January)
  2. Coping with college” (Cover story; April magazine)
  3. Multicultural and Social Justice Counseling Competencies: Practical applications in counseling” (Feature article; February magazine)
  4. Reconsidering ADHD” (Cover story; August magazine)
  5. The anxiety behind selective mutism” (Online exclusive; posted in January)
  6. License to deny services” (Cover story; July magazine)
  7. Immigration’s growing impact on counseling” (Cover story; February magazine)
  8. The counselor’s role in ensuring school safety” (Cover story; September magazine)
  9. Gut health and healthy brain function in children with ADHD and ASD” (Online exclusive; posted in February)
  10. Using ‘Inside Out’ to discuss emotions with children in therapy” (Online exclusive; posted in March)
  11. Why can’t we be friends?” (Knowledge Share; February magazine)
  12. Technology Tutor: Thinking about discussing clients online? Think twice” (Column; September magazine)
  13. Raising counselors’ awareness of microaggressions” (Member Insights; June magazine)
  14. Stepping across the poverty line” (Cover story; June magazine)
  15. Counseling ‘unlikeable’ clients” (Feature article; September magazine)
  16. Counseling babies” (Knowledge Share; August magazine)
  17. Addressing ethical issues in treating client self-injury” (Knowledge Share; August magazine)
  18. Grief: Going beyond death and stages” (Cover story; November magazine)
  19. ACA endorses animal-assisted therapy competencies” (Online exclusive; posted in August)
  20. Controversies in the evolving diagnosis of PTSD” (Knowledge Share; March magazine)

 

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What was your favorite article of 2016? What would you like to see Counseling Today and CT Online cover in 2017? Leave a reply in the comment section below, or email us at CT@counseling.org

 

 

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