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Greater Nashua Mental Health Center at Community Council

May is Mental Health Month

7 Prospect Street ● 15 Prospect Street ● 100 West Pearl Street ● 440 Amherst Street Nashua, NH ● 603-889-6147 ● Emergency 800-762-8191 ● VP 603-821-0240

www.gnmhc.org

Serving Amherst, Brookline, Hollis, Hudson, Litchfield, Mason, Merrimack, Milford, Mont Vernon and Nashua

Cover design by Jeanne Maestranzi

Trauma: Healing

America's Invisible Wounds

May 2012

Greater Nashua Mental Health Center

at Community Council

With increasing economic troubles piled upon the stress of work and family demands, Americans continue to report struggling in their lives. Locally, requests for Greater Nashua Mental Health Center’s Assessment and Brief Treatment Program services are increasing as family stressors mount.

Our Assessment & Brief Treatment Program provides care to adults in need of short-term mental health services. Their problems might include depression, anxiety, losing a job, losing a spouse through death or divorce, serious illness of a loved one – all of which are not only emotionally painful, but can also take their toll on family stability and diminish productivity.

Fees for counseling, group therapy, medication, and other treatment services are determined individually on a sliding scale based upon income and family size. It is only through the support of the towns we serve and donations such as those businesses and individuals who appear in this insert that we are able provide essential mental health care to all our neighbors in need, regardless of their insurance and financial status. Thank you.

2012 Board of Directors

President: H. Scott Flegal, Esq. First Vice President: James S. Fasoli Second Vice President: Earle Rosse Secretary: Jone LaBombard Treasurer: Marie Tule, C.P.A. Assistant Treasurer Edmund Sylvia Executive Director & Chief Medical Officer : Hisham Hafez, M.D.

Pamela Burns M. Patricia Jewett Timothy J. McMahon, Jr. Donald L. Mousseau, Jr. Kathie Rice Orshak, MA Richard L. Sharkey Mary Ann Somerville

PAGE 2 MAY 2012 Greater Nashua Mental Health Center at Community Council

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Hisham Hafez, MDExecutive Director & Chief Medical Off icer

Over the past several years, despite – and because of – these challenging economic times, Greater Nashua Mental Health Center has responded to emerging needs and gaps in the delivery system by taking the lead in developing novel programs and strengthening existing ones.

Nearly six years ago, we began a collaborative endeavor with the Nashua District Court, estab-lishing the Community Connections Mental Health Court in order to better address the needs of individuals suffering from mental illness who are involved in the legal system by providing psychiatric services in the community and divert-ing them away from more costly interventions in the county jail. Over the past three years, we have collaborated with the Mental Health Center of Greater Manchester, courts throughout the county, public defenders, prosecutors and the Hillsborough County Department of Corrections to expand Community Connections into a county-wide program that has received national recognition. Our patients benefited and societal resources were used more efficiently. We saw demonstrable reductions in the time such individ-uals spent in jail and rates of recidivism while the patients received timely community-based care.

Our SAMHSA-funded Healthy Connections – Integrated Primary and Behavioral Healthcare Program was developed to address a very seri-ous public health problem – the appallingly poor health outcomes for people suffering from serious mental illness. We have partnered with Lamprey Health Care and HEARTS Peer Support in the creation of this innovative project. At the mental health center, we now provide primary health services and an array of wellness activities as we gradually change the nature of the work we do at the Center. We based our approach on empow-ering our patients through knowledge, access to timely care, and developed needed educational and wellness programs. Much work remains, but the process of transformation of the mental health system into a comprehensive health home has begun. In a short three years, progress has been made, and our program is seen as a model for others to implement.

Substance abuse disorders are prevalent, often co-existing with mental health problems, nega-tively impacting the outcome of physical illnesses. The public health recognition of the magnitude of the problem and its societal cost unfortunately does not translate in appropriate resource alloca-tion and accessible services. Emotional suffering, family disruption, tragic early death, and lost lives are all too familiar to people who have to deal with the disease in their lives or their loved ones. We were keenly aware of limited resources, and that what is available does not meet the needs of our population or address the core need of a chronic relapsing condition. Recognizing this, we decided to act and began a small substance

abuse program with one clini-cian. Over the past five years, this program has grown to include a wide array of community-based services that include consultation, brief treatment, an intensive out-patient program,

and outpatient detoxification for both adults and adolescents. We are now offering services to peo-ple who suffer severe and persistent mental illness who are disproportionately affected by substance abuse problems.

We always envision the mental health center as a community resource. Our success is dependent on how we can demonstrate this in action. Our Child and Adolescent Services Program collabo-rates with school systems providing mental health service and consultation in area schools. We expanded our Assessment and Brief Treatment services, added to our medical staff, and we are grateful that many graduate students, the clini-cal leaders of tomorrow, choose to spend part of their internship with us. We chose to weather the funding problems facing our Supervised Visitation Center, keeping our doors open while we worked tirelessly on a long-term plan. I am grateful to add, because of staff commitment, we are now on more firm footing.

Our Research Department provides state-of-the-art treatments and collaborates in multicenter research projects to bring novel therapies to our community. We are determined not only to be consumers of knowledge but leaders who partici-pate in its development.

We accomplished this in a time of uncertainty, societal change, economic strain and increasing appreciation that the cost of health care is out-stripping society’s ability to pay for it. We firmly believe that a responsive mental health system should address quality and value of its services in order to alleviate suffering, empower people, and enhance recovery while controlling cost and strengthening our institution.

As we look forward, we are determined to meet the challenges by reaffirming our commitment to our patients, advocating for their needs, taking responsibility for demonstrating the value of our services, joining debates regarding policy deci-sions, continuing to develop ways to improve the delivery of essential services, and seeking funds to ensure their stability.

As a mental health center and as medical pro-fessionals, we are engaged in the raging debate as to how to bring escalating health care costs under control while meeting our responsibility to the people we serve.

Greater Nashua Mental Health Center at Community Council MAY 2012 PAGE 3

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CONTINUED ON PAGE 4

MAY 2012 Greater Nashua Mental Health Center at Community Council

Tom Doucette, Assistant Executive DirectorH.E.A.R.T.S. Peer Support Agency

My story begins at the age of ten – that is when my Bipolar began. Although there were mental health issues throughout my family, in my generation it was still not spoken about. I know now that my struggles began at age ten because of the highs and lows that I had. I did not see them then and evidently no one else did either or ignored the obvious. I would stay in my room for days while my friends would come over and ask me to come out and play. Then after those few days I would come out and just throw caution to the wind by doing jumps with my bike or grabbing onto the back bumper of a city bus and sliding along on my shoes on the snow-covered street while the bus went on its route. Of course that would come to a sudden stop when I hit the bare pavement where the snow had melted away.

As I grew older my mood swings kept coming and going. Looking back, I now realize I had more highs than lows, and that would be the pattern for my life until it all caught up with me.

Because of my being manic most of the time, I was a great employee because when you’re manic there is no job that you can’t do and nearly all the time that was the case for me. I worked for a research and development corporation for about ten years. Like I said, I was a great employee but not a team player kind of employee. Everything I did was my idea, even if someone else had given me the idea – without them knowing it, of course.

My life stayed pretty much the same until my mania just took over and I began a downward slide that would see me losing everything. I was about thirty-five years old. I left my research and development job less than six months shy of being fully vested in my 401. I walked away from a secure well-paying job with unbelievable benefits to go camping for seven weeks. I had no job, did not care to look for a job, nor did I care about getting one. It was then that I came up with this great idea to move to another state where I knew absolutely no one and open my own business. Well, start a new business I did, four of them. In the last business, I lost everything and had to move back to the state that I had left and move into my parents’ home, because I had nowhere else to go and no funds to do anything else.

At the age of fifty-six I was finally diagnosed as having Bipolar I. I experienced the usual sort of realizations that comes with such a diagnosis later in life – at last I knew why I did all those dangerous things, ruined personal and business relationships – and the list goes on. Then came the denial, stopping medication, re-starting medication, attempts at harming myself and the rest. Finally, I came to accept that I had this disease for life and that I was not Bipolar but I have Bipolar and that Bipolar does not define who I am. As soon as I recognized that fact I started my journey of forgiving myself for all of the harm and wrong that I had done to others and myself. I always say that I was born at the age of fifty-six and it’s true.

I have repaired my life by staying on my medication, having been blessed with great psychia-trists and therapists, using coping skills that I have learned using WRAP©, and, most impor-tantly, using peer support, and having a wife ( Judy) who stood by me when most would have walked out the door. We have now been married for eighteen years and I have always said that she married two different men and has stuck with the best one of the two.

I started the Depression and Bipolar Support Alliance (DBSA) Nashua peer support group nine years ago and we still open the door every Thursday evening. I now have the greatest job anyone could have working with people who have mental health issues at H.E.A.R.T.S. Peer Support Center in Nashua. It’s like when they interview a baseball player or a musician and they say I do what I love and live to do it. I am making a difference in people’s lives and my own. I learn new things about myself everyday by talking with my peers.

I would not change any part of my life because it has gotten me to the best years of my life. I am now sixty-eight and intend to do what I love for many more years to come.

My Two Lives

While we have serious concerns as to some of the decisions that our elected officials have recently made, we appreciate their attempt to balance multiple priorities and finite budgets. However, walking away from our core mission, turning our back on the most vulnerable of our citizens, or causing them undue anxiety about their care is never an option for a responsible health care system. The simple truth is that good care saves lives, conserves resources, and con-trols budgets. Enlightened policy makers need to be aware of that if they are to discharge the responsibilities they were privileged to accept when they asked for our votes.

We plan to tackle the current challenges with the same set of priorities that have guided our actions: a commitment to our patients to treat each one with the respect they deserve, respect-ing their choices and utilizing their resources wisely.

Keeping the Promise… CONTINUED FROM PG 3


Rebecca K. Sartor, LICSWDirector, Community Support Services

Domestic violence is a prevalent social prob-lem that is best addressed through a coordina-tion of community stakeholders including law enforcement, victim-witness advocates, judges, prosecutors, service providers for victims, as well as providers for perpetrators. As part of the collaborative community response to domestic violence, Greater Nashua Mental Health Center offers a Batterer’s Intervention Program with the ultimate goal of increasing victim safety and perpetrator accountability.

Batterer’s Intervention Programs were first developed over 30 years ago as legal systems reformed to criminalize domestic violence and prosecute perpetrators. These programs are rooted in both feminist and sociological theo-ries that reinforce that intimate partner vio-lence is not the result of mental illness, anger, dysfunctional upbringings, or substance abuse. Rather, abuse is a learned behavior that is pri-marily motivated by a conscious or unconscious desire by the abuser to control the victim.

The Batterer’s Intervention Program at GNMHC includes an intake and 36-group sessions divided into nine (9) themes that

are the basis of healthy, egalitarian relation-ships: non-violence, respect, support and trust, accountability and hon-esty, sexual respect, part-nership, negotiation, and fairness. Additionally, one theme is devoted to the impact of domestic violence on children and an overview of equality and partnership in a par-enting relationship. The vast majority of men in group are mandated to be there, although voluntary referrals are accepted. Referral sources include local district and supe-rior courts, Probation & Parole, and Division of Children, Youth, and Families (DCYF).

Objectives of the program not only include victim safety and perpetrator accountability but also to help the participant understand that his acts of

violence are a means of controlling the victim’s actions, thoughts, and feelings; to increase the participant’s willingness to change his actions by examining the negative effects of his behavior on his relationship, his partner, his children, his friends, and himself; to increase the participant’s understanding of the causes of his violence; to provide the participant with practical informa-tion on how to change abusive behavior by exploring non-control-ling and non-violent ways of relating to women; and to encour-age the participant to become accountable to those he has hurt

through his use of violence. Interventions in the program follow a gen-

der-based, cognitive-behavioral approach with

a focus on delving into underlying thought patterns and belief systems related to abuse and violence, restructuring those patterns, and developing alternative, non-abusive, thoughts and beliefs. Specific intervention strategies include handouts, group discussions, videos and “vignettes” to exemplify abusive behavior, edu-cational, as well as more didactic approaches.

Most of the men initially start the program with great disdain, reservation, and denial. Most, over the course of the 36 weeks, begin to open up and identify their own abusive patterns of operating in relationships. The experience of watching the group elders address abusive behaviors, confront peers on minimization, denial, and blame, and address colluding amongst group members head on is a testimony that a change process is occurring. With each small obstacle that is surpassed, it is apparent that this program is a core component of the coordinated community response, which is still in many ways in its infancy in New Hampshire. The hope is with more commu-nity knowledge of programs such as Batterer’s Intervention, we can build more effective strat-egies to address the social problem of Domestic Violence, protect victims, and create a safe infrastructure that produces positive outcomes.

A Coordinated Community Response to Domestic Violence:Working with Male Perpetrators

...programs are rooted in both feminist and

sociological theories that reinforce that intimate partner violence is not the result of mental ill-

ness, anger, dysfunc-tional upbringings, or

substance abuse. Rather, abuse is a learned

behavior that is pri-marily motivated by a

conscious or unconscious desire by the abuser to

control the victim.


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Kate Bernier, LICSWFamily TherapistCoordinator of Outreach Services Child and Adolescent Services

I’ll often hear a parent say, “My child doesn’t have an attachment problem. He/she is attached to me constantly. I can’t even go to the bathroom by myself.” Attachment can be a confusing word because it has many meanings, but this article will focus on the term as it is used in child psychology. In texts on child development, attachment refers to a process by which a child gains a healthy sense of self and an ability to enjoy and participate in healthy reciprocal relationships. The child that is described above, that cannot leave his mom’s side, is anxiously attached; unable to explore and enjoy his wider world with confidence. Another problematic style of attachment is avoidant attachment. The avoidantly attached child might appear quite independent, denying any need for help. She interacts with others primarily when it appears she has something to gain. Children (and adults) with these difficult styles of attachment are often described as “manipulative,” treating others as if they were vending machines; and their affection often feels wooden or superficial. Parents and others complain of them that they don’t show empathy or remorse. They don’t seem to experience real joy and seem to lack the ability to engage in relationships simply for the pleasure of being together.

What is this process of attachment and what are the factors that cause it to go well or not so well? Most people are familiar with the scene of a mother and her new infant and the interactions that take place many times a day over the first months and years of the child’s life. When things are going well and the caregiver is emotionally available, the pair are looking into each others’ eyes, holding each others’ gaze, making soft and comforting sounds back and forth. The caregiver mirrors the infant’s facial expressions, often with an exaggerated face; smiling or looking surprised or delighted; sometimes showing concern for hurts, etc. Researchers and developmental psy-chologists have discovered that a powerful process is taking place in the small child’s brain during these interactions. The neural center for emotion regulation and emotional intelligence is active

during these intense experiences. Neurons fire and neural pathways are being built; as the brain is developing at a rapid rate. This same part of the brain goes quiet when the child is left alone. During the first three years of a child’s life this kind of interaction will typically take place over and over, many times a day, week in and week out. The child will typically seek out the mother’s face, show delight when he recognizes her and eagerly take part in this primal “dance.” At the same time, the parent is rewarded by the child’s delight and experiences him or herself as competent and gratified in the role of caregiver.

When care giving is reliable and the primary caregiver (usually, though not always, the mother) is emotionally available, the child is learning that relationships can be fun and pleasurable and that he, the child is lovable and special, and worthy of his mother’s attention. This relationship becomes the first model upon which later relationships will be based. It is also during this interaction that a small child is learning to manage strong emo-tions, to self soothe, to read social and emotional cues, and to begin to interpret his own emotional states. In these early years we can also see the beginnings of reciprocity, as when a toddler tries to feed his mother or to comfort her if she is hurt. This is where empathy is born in exact imitation of what the child experiences from his caregiver. The child is also learning that he can have an effect on the world, can make things happen, as adults respond to his social overtures. This sense of efficacy becomes integral to one’s self confi-dence and sense of self.

This is the process called “attachment;” and the multiple repetitions of an infant and toddlers’ needs being met by a loving, responsive, reliable caregiver is called “the cycle of attachment.” It is an important process that can have profound effects on the way we feel about ourselves and

the way we interact with others later in life. Although parents virtually always want what is best for their children, parents are never perfect; and therefore no one’s attachment experience is perfect. We all have insecurities, moments of self-doubt, and occasional problems in relation-ships that can stem from this first experience

with relation-ship. Child psy-chologists have a term, “good enough” parent-ing to describe a relatively healthy parent that raises a relatively healthy child.

Attachment disorders occur when there is a significant dis-turbance in the

attachment cycle in the first three years of life. This can happen for a broad variety of reasons and understanding the reason is never about blame or finding fault. As was said earlier, virtu-ally all parents want what is best for their chil-dren, but as we all know, other things sometime intervene. Some examples are: prolonged illness or absence of a parent; depression or other mental illness in a parent; changes in caregivers; parents who are preoccupied with their adult relation-ships, such as those in a conflictual relationship or going through a divorce; a predisposing medical condition in the child that makes him particularly difficult to parent; substance abuse; and abuse and neglect. These conditions do not always produce attachment disorders, as even under difficult cir-cumstances parents will strive to meet their chil-dren’s needs; but parents are often unaware of the powerful and far reaching learning that is going on in that tiny little head.

Infants only have a few ways to let their needs be known. When reliable care is disrupted, a negative attachment cycle can be set into motion. This happens when a child makes a signal for pleasurable interaction (seeking, smiling) or for help (crying, whimpering, fussing, clinging) and the child’s signals are not answered. The child increases his efforts (screaming, hitting). These

attempts to communicate become increasingly unpleasant to the parent who may respond in anger or want to spend less time with the child. This will prompt the child to even more desper-ate measures. If this is repeated regularly the child learns that only persistent and aggressive behavior will be responded to; or he may give up and respond indifferently to the parent. In either case, both the parent and child begin to experi-ence the relationship as unrewarding and possibly fraught with unpleasant feelings. In many cases, the parent has some good moments when the child gets a glimpse of how wonderful a lov-ing relationship can be, but when other things intervene, that wonderful aspect of the adult may disappear and the child has no way of eliciting it. This leads to the most common style of attach-ment: the ambivalent, or approach-avoidant style. This is seen in a child who persistently intrudes into the adult’s attention, but does not trust that it will be given and so ensures that he or she will be rejected on his own terms by provoking dis-pleasure.

When the negative cycle is repeated, the child develops a sense of the world as unsafe and unpredictable, a sense of adults as inconsistent and therefore untrustworthy, and a sense of self as defective, shameful and unlovable. At the same time, the young child is learning a set of coping skills to manage and survive in what feels like a hostile world. And because of the life and death nature of survival, these skills become instinctive and are held tenaciously into older childhood and even adulthood. These can include an array of problematic social behaviors, but they are all generally driven by fear of the shame and vulner-ability being exposed, an instinctive distrust of adults, and a need to always be in control.

By school age, children with attachment disor-der are typically showing a disturbance in related-ness to others. An example might be intense but unstable relationships in which the child tries desperately to get attention but does not seem to enjoy it and it is never enough. In other cases this is shown by indiscriminate superficial affec-tion that seems only designed to get the child’s needs met; treating others as if they were vending machines. Hugs may seem wooden and artificial.

Attachment and Attachment Disorder

CONTINUED ON PAGE 11


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Kate Bernier, LICSWChild and Adolescent Services

For several years now the Child and Adolescent Department at GNMHC has offered an expres-sive group therapy program to treat clients who have experienced trauma or who have anxiety or other mood disorders. The name has changed a number of times, but the groups have always included a component of yoga as well as other expressive therapies; and the groups have always included the social aspect of growth in relation to others. The central idea from the beginning was to provide an experience for the group members that would begin to integrate their sense of them-selves and would develop a respectful and accepting view of their bodies and emotional experiences.

A common experience in the big Traumas and little traumas of life is that the sense of self becomes fragmented. The parts of self that are associated with an overwhelming or unpleasant experience become compartmentalized and dis-sociated or avoided and our perception of some aspects of self may become negative. An example might be when one is exposed to domestic vio-lence and the effect of extreme anger between individuals. One might fear the power of one’s own anger and keep it stuffed down. The fact that it eventually explodes out of proportion to the event that finally triggers it only confirms to us that it is a thing to be feared and must be kept under wraps. The effect is a blunted emotional state where one is not fully present with what one is feeling.

Another example might be when the body is a reminder of an abuse or trauma, one might dis-sociate from the body and see it as loathsome. When this happens, a person is less likely to take good care of the body, practice good habits and monitor risks. To one degree or another, and from time to time, we all experience some form of dissociation or not being fully present and aware of our own experience. A typical example would be suddenly realizing that you have been walk-ing or driving on “autopilot” and don’t remember the last few moments. When this happens fre-quently and to a considerable degree, it is anxiety provoking. One is never sure when one will be blindsided or hijacked by a part of one’s self that one is not fully aware of. It becomes difficult to concentrate, to be successful in school, to carry on friendships and other pleasurable pursuits.

Expressive therapy is designed to treat the whole person, to bring together the fragmented parts. It helps to build a respectful and apprecia-tive awareness of the mind, the body, and the emotions. When this happens we become more aware of the connectedness and interdependence among the various parts that make up our sense of self.

When we become more integrated, we not only are more likely to have a kinder, more accepting

view of ourselves, but will also tend to have less anxiety. We lose the sense of the “enemy within.” We allow ourselves to feel our feelings because we are no longer afraid of them, and therefore are more present and aware of our immediate experi-ence; and are more available to life in general.

Expressive therapy can include a variety of interventions including visual art, movement, creativity, problem solving, and interaction. Each intervention is designed to assist the expression of some suppressed or silent or traumatized part of

the individual and integrate it into the experience of the whole. Because we are social animals, this experience of growth as a shared experi-ence is particularly powerful and healing. Generally social situations produce more anxiety, so the mastery of that anxiety in group is pro-found and the presence of

group members who challenge us and draw out different aspect of ourselves and bear witness to our experience, enhance it and make it feel more real.

Yoga was the original inspiration for the groups because of its effect on joining body, mind and spirit—or emotions. It contains contemplation, a stilling of the mind to allow one to become aware of the present moment. It teaches radical accep-tance of one’s experience--noticing the experi-ence without our constant tendency to evaluate whether it is good or bad. It teaches us to know our body’s abilities and limitations and to respect them. It teaches us to be strong and balanced and a useful container for the visceral aspect of our emotions. So for instance when we are angry, we notice the pulsing in our temples, the clench of our jaw, the tautness of our muscles; without deciding if these sensations are good or bad; without fearing the emotion and the sensations of it; and without feeling the need to either act on it or push it away.

One definition of yoga is “organizing the organ-ism.” It is called a practice because one can never complete it. One can’t fail or succeed at it; and since the practice amounts to knowing ones self, one can’t compare one’s practice to that of another person. There is no competition. But we can learn from one another.

The groups have always ended with what we call “Final Relaxation” which involves lying on a yoga mat in stillness and silence and hopefully completely relaxed while we listen to soothing music or have a guided relaxation. Because of the quiet and the close proximity of the group mem-bers, it has always been the most anxiety provok-ing part of the group, but year in and year out it has also always been the group members’ favorite activity. In that shared quiet it becomes difficult to push any part of one’s experience away; but week after week that shared experience becomes the vehicle of self acceptance and acceptance of others as we learn to sit with and tolerate and not fear our anxiety. And then it almost disappears.

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Coordinator, Mental Health In Schools Program

Imagine watching your child struggle and not being able to help. For some families it has been a challenge to seek and maintain mental health treatment for their children due to work, lack of childcare, disabilities or transportation issues. The Greater Nashua Mental Health Center has partnered with 8 of the Nashua Schools and 3 in the Hudson School district to provide confiden-tial, consistent therapeutic treatment to children that may otherwise be unable to regularly access our services.

There are several benefits to having access to therapy in school while overcoming the obstacles mentioned above. It can facilitate the development of functional coping skills in the environment they find challenging. It also can enhance communication and collaboration between providers ensuring consistency in your child’s care. However, being seen in a school can make it challenging for a parent to remain consistently, actively engaged in their child’s treatment. It is important to maintain open communication with families and family therapy appointments are encouraged at least monthly.

In addition to receiving individual therapy in their school building, these children may have access to any adjunct services through our agency as appropriate, such as Functional Support Services, Medication Management or group therapy.

Parents should see the school’s guidance counselor to make a referral. We are currently in the following schools in Nashua: Dr. Crisp Elementary, Fairgrounds Elementary, Mount Pleasant Elementary, Ledge St School, Amherst St. School, Elm St Middle School, Fairgrounds Middle School and Pennichuck Middle School. In Hudson, we are in Library St. School, Dr HO Smith School and Hudson Memorial Middle School.

Busy Parents and Struggling

Children

When you’ve got diabetes, it’s understand-able to feel stressed out or even be depressed at times. In fact, depression occurs more in people with diabetes than in the general population, according to the American Diabetes Association.

Across all age groups, ethnicities and income levels, depression is more common than many people realize. More than 20 mil-lion people in the United States suffer from depression.

Depression responds well to treatment. But if not treated, it can be a serious danger to your health.

How does depression feel?Occasional feelings of sadness are part of

life, of course. But if you feel sad for more than a few days, have lost interest in activi-ties that you usually enjoy and feel tired or hopeless, you may be dealing with depres-sion.

If you live with diabetes, depression can make it harder to cope with its challenges. It can cause more physical discomfort. Sticking to your diabetes management plan can seem more difficult. For example, things like managing blood glucose levels, taking medi-cations as prescribed and following healthy lifestyle habits can seem overwhelming when you’re depressed.

What to watch forSymptoms associated with depression vary

from person to person. They also may be difficult to recognize at first. The two most common symptoms of depression are:

• Feeling hopeless or sad nearly every day for at least two weeks

• Losing interest in or not enjoying usual daily activities nearly every day for at least two weeks

Other symptoms include:• Changes in appetite; weight loss or gain• Changes in sleep patterns• Difficulty making decisions• Trouble focusing and concentrating• Feeling very slow or lazy• Feeling very anxious or agitated• Feeling isolated from the world• Crying for no reason• Thoughts of suicideWhat to doIf you think you may be depressed, speak

with your doctor right away. There are many ways to treat depression. A combination of individual therapy and medication is a com-mon and effective treatment for depression. Lifestyle changes, such as getting more exer-cise, can also make a big difference.

Knowing the symptoms can put treatment to work for you or a loved one sooner. And when you feel better, it's easier to take better control of your diabetes and your health.

Reprinted with permission from Harvard Pilgrim Health Care of New England

Depression and Diabetes


Daniel P. Morin, MS, ARNP Director, Child & Adolescent Services

The decision to use psychiatric medication for a child is one of the most difficult that a parent will ever need to make. Prescribing psychiatric medication to a child is one of the most daunt-ing tasks facing medical professionals. In 2008, I wrote an article on this topic. I attempted to address the very valid concerns regarding medi-cating children by describing the point of view of professionals with the goal of showing how good practice takes into account the concerns of parents. I believe that the need is just as great today, so I am presenting a revised and updated version of the previous article.

While holding a personal view that psychiat-ric medication, used correctly, is safe and can be effective in relieving the debilitating symptoms of mental illness for many children, I under-stand the anxiety faced by parents who may need to make the decision. I believe that there are three significant take home messages that sum up the provider’s point of view:

1 Medications are used to help patients.2. Great effort is being made to develop

evidence-based practice in child psychiatry.3. Non-medical interventions should always be considered.

To discuss each of these points indi-vidually: Medications receive FDA approval based on scientific research, the final step being placebo-controlled trials using human sub-jects. Historically, doing research with children has been problematic. For good reason, parents were reluctant to enroll their children in trials and researchers were hesitant to accept the liability of working with children. Fortunately, there is a trend to correct this insufficiency and today more decisions can be made based on careful analysis of the “evidence” obtained through research than ever before. The number of medications officially indicated by the FDA for treatment of childhood disorders continues to increase at a slow but steady pace and more importantly, the commitment to continue the work necessary to provide scientifically proven answers to the real life questions of parents and

children is as strong as ever.

While advancement in science remains a goal for the future, there are millions of children who need help and treatment today. The most unfor-tunate aspect of some negative media cover-age is the implication psychiatric medication is carelessly prescribed for children and that the people who prescribe the medication are not con-cerned about the safety of their patients. In

my view, the reality is much different: doctors and nurse practitioners use the treatments that are currently available, including medications that are approved by the FDA to treat mental disorders in adults, because it would be unfair to withhold treatment until all of the studies are in. Medical providers are confronted with patients and families who may be suffering from devastating illnesses and feel obligated to use all of the tools at their disposal to relieve

that suffering.Additionally, I think that it is important to

mention that even though there has been much progress made in the field of psychopharmacol-ogy for children, medication is never the first or only option. Other forms of treatment, includ-ing therapy, need to be presented to families as part of the process of obtaining informed consent for medication. In fact, just as there is more evidence based practice available to sup-port treatment with medication the same is also true for various forms of therapy. In other words, medication alone is rarely the treatment of choice. This is the philosophy that governs practice at the Greater Nashua Mental Health Center’s Child and Adolescent Department.

In conclusion, I realize that the parents of children with mental illness can never be neu-tral observers. I recognize the unfortunate real-ity that the use of medication does not always result in good outcomes. Being concerned and asking questions can only improve care. My goal in writing these articles was to provide a perspective that practitioners who prescribe psy-chiatric medication to children share the same concerns and that they are highly motivated to use medication in a safe and meaningful way to help children and families.

Medicating Children: Challenges for Providers & Parents

Terry Gupta, MSW, E-RYT

May is National Mental Health Month.

May also heralds the Spring; season of hope, renewal, and validation of the cycles of life. It’s a time to shake off the winter season, open the win-dows, clean the house and roll out the yoga mat.

Roll out the yoga mat?When we think about yoga,

most often an image of a very flexible person in a compli-cated physical contortion of the body immediately comes to mind. Headstands, balanc-ing on the arms, and splits are what we tend to see in the magazines and on TV.

What if seasoned teach-ers were to share, from their very real experience, that yoga is for every body and every mind? Yes, just about any age, and with any range of abil-ity can do yoga. Those who exercise several times each week can enjoy yoga, as well as those who have not exercised in many years. Would that surprise you? Would you still have doubts?

In reality, those bendable physical move-ments, called asan, are only one of the many aspects of yoga. Yoga is as simple as:

1. conscious patterns of breathing (pranayam),

2. gentle movements done seated, standing or on an exercise mat that free the body from stress and circulate freshly oxygenated blood (asan),

3. clearing the mind using simple techniques

(pratyahar, dharana, dhyan), and 4. living in harmony with self and others

(yam/niyam). The “science” of yoga attends not only to the

physical body and mind, but also the deeper layers of our being. The clinical research on the benefits of yoga is beginning to catch up

with this. Yoga is being stud-ied as a therapeutic application for hypertension, depression, complex post-traumatic stress, anxiety, insomnia, ADHD, pain, fatigue, enhanced daily functioning, and so much more.

An interesting study was conducted by researchers at the University of Maryland School of Nursing. They found that “yoga actually out-performed aerobic exercise” in a range of health param-eters and in areas such as: improving balance, flexibility, strength, reducing pain levels, managing menopausal symp-toms, and enhancing daily energy level, as well as social and occupation functioning.

Jay Gupta, a pharmacist, yoga therapist and lifestyle coach, observes that “even the most gentle yoga practice can provide cardiovascular benefits by lowering resting heart rate, increasing endurance and improving oxygen uptake”. He continues that “yoga also helps in lowering levels of the stress hormone cortisol. This can lower blood pressure and

heart rate, improve digestion, and boost the immune system, and can bring relief to the symptoms of conditions like anxiety, depres-sion, fatigue, asthma and insomnia”.

Yoga: More than Exercise



The child can mimic happiness but never seems to experience real joy. The profound anxiety of being unattached in this world is managed with controlling behavior. This often manifests as oppositional behavior, argumentative behavior, and deliberately annoying behavior. Attachment disordered children keep others at a distance and off balance by controlling the emotional climate through constant chatter, nonsense questions, lying, sneaking, stealing, and seemingly cruel behavior. They feel safer when they know where they stand with people, and they know where they stand when people are angry with them. When things are going well and people are happy with them, they tend to get very anxious and need to create distance.

Because they are not trying to please their care-givers (except when it suits their purpose), attach-ment disordered children usually have difficulty learning cause and effect and therefore do not respond well to discipline. A common feature in the caregivers of these children is that the parents seem unusually angry. Small wonder, since the attachment disordered defense mechanisms oper-ate primarily when there is danger of closeness, the child is often “charming” to most adults while deliberately targeting the parents. Parents often feel isolated and misunderstood by other adults who don’t see the worst of the behavior. These caregivers are also usually worn out, having made heroic efforts to do all the things that would be effective for a child with a healthy attachment. Parents are left feeling ineffective and lacking even the simple reward of seeing pleasure in their child’s eyes.

Parents are most often disturbed by their child’s lack of remorse. “They don’t seem to care about other people’s feelings.” And indeed, they do not. They cannot because they do not know how, because that learning did not take place in those early interactions that give meaning and reciproc-ity to emotions. It is not a character flaw or a defect that the child could have done anything about, but it certainly feels like one when they hear “What’s wrong with you?” “How come you can’t be like other people?”

Early childhood is the ideal time for develop-ing attachment because the emotional brain is growing rapidly. The dependency of infancy with its close, intimate, repetitive interactions is the perfect environment in which to teach the child how to learn to accept nurture and structure and

to develop a model of a pleasurable rewarding relationship. Without this emotional intelligence a child becomes focused on survival needs and simply values relationships for getting needs and wants met. Her sense of self is based on shame—a feeling of being unworthy, unlovable, of being bad. This feeling is so painful and unendurable that a child will avoid any experience likely to tap into it. Therefore the one thing that the child wants most—intimacy—is also the thing that she is most resistant to because of its potential to make her feel ashamed. Any perception of criticism or anger is likely to trigger a powerful defense against shame: either rage out of all proportion to the event or a very bland “I don’t care” attitude, as the child cuts herself off from her feelings that are unmanageable. This makes it particularly difficult to provide the rewards and consequences that generally work well in shaping a healthy child’s behavior. The attachment disordered child’s need to be in control and to avoid being ashamed usually far outweighs the value of the rewards and consequences.

While it is true that the optimal time for devel-oping attachment is in infancy and toddlerhood, fortunately it is also true that humans can learn and change throughout the lifespan. The brain continues to grow new neural pathways and we as humans typically seek reparative experiences. In the last few decades much research and clinical practice has focused on understanding and treat-ing attachment disorders. There are treatments and interventions that have been successful in reducing the shame involved in attachment dis-orders and in increasing the capacity for healthy relationships. If the child and family are strug-gling, it is best to seek treatment with a therapist who has training in attachment disorders. While there are a number of different approaches to attachment treatment, there are some common features.

Attachment treatment usually addresses the younger needs of the child (or adult). This is based on the understanding that the disruption in attachment took place in the first three years of

life and so emotional development was arrested at an early age while physical and intellectual devel-opment continued. Thus an intelligent street wise teenager may have an emotional age that is much younger. The treatment may appear “babyish” or juvenile at times; but because it matches the child’s emotional age, the child is usually receptive.

Attachment treatment usually includes the child’s parents or primary care-giver. Because attachment is about a relationship, it is not something a child can resolve on his own. Parents need to learn how to inter-act with their child in a way that is more satisfying to both of them. A therapist can facilitate the interac-tions necessary to create the experiences an attachment disordered child needs.

Treatment usually seeks to provide the experiences that the child missed early in life that would help him feel safe and special and loved. This involves containing his negative behavior to protect him from repeating the negative cycle of attachment and to avoid confirming his sense of shame. Thus a parent is encouraged to keep the child close and to narrow his field of choices until he has shown that he can manage more. This is not done in a punitive way, but in a loving and protective way, as a caring par-ent would with a small child. The message to the child is that the adults are in control and will take good care of him and make good choices for him so that he can focus on age appropriate activities rather than survival needs. Rewards and conse-quences are consistent, without the expectation that the child will value them in the beginning; but to show the child that the world can be a pre-dictable place and that adults can be trustworthy.

Treatment also provides experiences that rep-licate the positive attachment cycle. These are close, intimate, pleasurable, fun, safe interactions that remind one of the playful affectionate games parents play with small children. This gives the experience of being intensely focused on and enjoyed. It begins the awareness that relationships can be rich and joyful and non-shaming. The give and take of play also begins the process of reci-procity and the recognition of comparable feelings

in the other. This is the beginning of empathy and the possibility of remorse.

A common theme that runs through most treatments for attachment disorder is the impor-tance of having a mindset that understands the cause of the disorder. The child did not cause it. The child’s interior life is probably excruciat-ingly painful. The child’s outrageous behavior is an attempt to stay safe; and stems from a fear of adult motives. Keeping these thoughts in mind helps one to have empathy for the emotionally young aspect of a child that appears much older and has developed smart, effective, anti-social coping skills. The way to approach this treatment is with an attitude of playfulness, love, acceptance, curiosity and most importantly, of empathy. It is by having empathy for the motives behind the behavior that the shame is reduced and the child can lower his defenses and begin learning about positive relationships.

A key aspect of attachment treatment is provid-ing support for the caregivers. Attachment disor-dered children have some of the most disturbing behaviors and at the same time do not usually provide parents with the typical rewards of par-enthood. Their faces do not light up with plea-sure. They don’t know how to accept affection. And because their disorder involves their primary relationships, they often present very well in pub-lic settings, while putting parents through a pri-vate hell. Caregivers need the understanding and support of the other adults involved in a child’s life: the school, church, coaches, scout leaders, mental and medical health professionals, etc.

This work takes patience and a strong com-mitment. It helps if the adult has had a good experience of attachment themselves. If they have not, it is important for them to get treatment for themselves. Parents, foster parents, adoptive par-ents, and residential staff that undertake this work need to be very good to themselves and seek sup-port from other adults so they can be calm and in control when challenged by the child’s defenses.

The good news is that a child’s hardened resistance will be warmed and disarmed by that patient, loving commitment. We are hardwired to want relationships. These challenging children are yearning for guides who are not put off by their fear driven defenses; and who will hang in there and provide the repetitive experiences of a loving relationship so they can experience the pleasure of healthy attachment.

Attachment and attachment disorder…CONTINUED FROM PG 6

When care giving is reliable and the pri-

mary caregiver (usually, though not always, the mother) is emotionally available, the child is

learning that relation-ships can be fun and

pleasurable...


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Christine Penta, LICSWCoordinator of Deaf Services

Intimate partner violence (IPV) is a wide-spread social problem that affects over one in three women and one in four men (Black, Basile, Breiding, Smith, Walters, Merrick, Chen & Stevens, 2011). IPV includes physical vio-lence, sexual violence, threatening, and emotion-al abuse between two people who are in a close relationship (CDC, 2012). While relationship violence does not discriminate against economic status, race, religious affiliation, sexual orienta-tion, or disability status, it is most prevalent in heterosexual relationships against women (Black et al, 2011).

In small communities like the Deaf com-munity, who primarily use American Sign Language and have their own distinct culture, the prevalence of IPV is even higher, and the risk of victimization to violence is even greater. A recent study compared the prevalence of IPV among deaf and hearing women. It indicated that deaf women were 1.74 times more likely to report an experience of physical violence by an intimate partner and 3.66 times more likely to report an experience of sexual violence by an intimate partner than a comparable sample of hearing women (Anderson, 2010). Considering that resources to eliminate violence through education, prevention and intervention are largely inaccessible to people who are deaf, this

illustrates an even more dangerous and critical situa-tion for deaf survi-vors of violence.

Many people who are deaf have experienced or been exposed to different types of violence through-out their lives. This could include witnessing or being the target of domestic violence at home, or being the victim of bul-lying at school, or experiencing “nor-malized” discrimi-nation and oppres-sion from the wider community on a frequent basis. Given that abusers are often acutely adept at selecting targets who may be vulnerable in one way or another, these experiences of discrimi-nation and violence increase vulnerability to additional violence, such as IPV. Please note, this is not to suggest in any way that all victim/survivors are vulnerable or impaired, or that it

is their fault that they were targeted. The only real dif-ference between an abused woman and a woman who is not abused is the abuser (Gilfus, 1991).

Intimate partner violence toward people who are deaf can include additional lay-ers of control and psychological abuse and are not neces-sarily experienced in the same way as IPV amongst peo-ple who are hear-ing. For example, if the abuser is hear-ing and the victim/survivor is deaf, the

abuser may withhold the deaf person’s means of calling for help (ex. technology, assistive devic-es), or even “speak for” the victim/survivor if the police or hospital become involved (National Domestic Violence Hotline, 2012). If both the abuser and victim/survivor are deaf, the abuser may threaten to publicly humiliate his partner

within their shared community, further isolating the victim/survivor and increasing vulnerability for control.

Those who have experienced IPV are often at greater risk for physical health problems, mental health problems, and time lost at work. Poly-victimization (the experience of multiple types of victimization) has been shown to con-tribute to increased risk of post traumatic stress and symptoms of depression (Sabina & Straus, 2008) as well. The longer violence continues, the more dangerous these risks become.

If you or someone you know has been the victim of relationship violence, please know that you are not alone and that there are people who care about your safety and are willing to help you during and after the abuse. •For Deaf and Hard of Hearing survivors

of relationship violence in NH, the Deaf Services Team at the Greater Nashua Mental Health Center provides confidential counsel-ing services in American Sign Language, and can provide support while addressing any emotional or mental health issues that arise due to experiencing or witnessing violence. For those who qualify, case management and community supports are available as well. Please contact Christine Penta, Coordinator of Deaf Services, for more information (603-889-6147x3479, [email protected]).

Relationship Violence in the Deaf Community



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Anonymous

My life has been interrupted three times. The first as a sibling, the second as a wife and the third and most importantly as a mother. The first two interruptions were silent. The third one was loud and painful. As a child fear is the emotion that comes to mind when I think of my brother. When I was about six years old he threatened to throw me in the fireplace and I believed him. it was not until just a few years ago when I was sharing this story with another sibling did I come to understand how I had held onto this unwar-ranted fear for so many years. My brother looked at me, smiled and stated "there was no fireplace in that house. " Now that was a light bulb explosion moment. Other childhood memories include vis-iting my brother in a psychiatric ward and the only memory I have is not how my brother was but silver ashtrays overflowing with cigarette butts and people sitting lifeless on the floor. My brother was an annoyance to the family. So much better when he was gone and on the road, and he had been on the road since the age of twelve. Did I forget to mention that my brother had schizophrenia?

As a young wife at the age of twenty one who would know my husbands rage after I burnt the rice. Doesn't every new cook burn things? Why would I ever question the reason he worked nights just so he could sleep the days away. He was pro-viding for his family. The perfect excuse not to ever attend a school or social event. Doesn't every-one arrange their furniture so they can always see the windows and the doors when they sit down?

When one enters a restaurant never taking a table that didn't let him have his back to the wall. I thought that was normal. If you think that post traumatic stress disorder commonly referred to as PTSD was ever openly discussed after the Viet Nam war you are wrong. It took over two decades and the death of my husband's father to realize that treatment was needed. Treatment was a good thing for my husband but it was much to late for us as a couple.

My son was diagnosed with schizophrenia when he was eighteen years old. I did not believe it. How could I? How could my cute handsome son turn into my brother? It was nothing more than a drug induced psychosis in my mind. What teen-ager who uses recreational drugs doesn't have a few hallucinations, odd behavior and extreme anger management issues. My son would always recover, be fine and move on to a new mission. One day though I found myself standing before a judge giv-ing the utmost private information about my son, knowing that it would tip the scales and commit him to the state hospital. I blind sided him that day in court. In his mind everything was fine. My son needed medical treatment at the time and had no insight into why. I sat there as they took him away wondering if our bond would be broken, but all along knowing treatment was needed at any cost. After a couple of weeks my son was released taking prescribed medications. He felt so good that he stopped taking all medications. Wouldn't you and I stop taking our medications if we felt

better? Soon after that depression took hold. It was not the kind that lifts in a couple of weeks. Thirty days and counting, not leaving the house, not moving off the couch. He was again in a dark place. He had no money, no friends, no job and had to live with his mother after being on his own for years. Can you imagine how he felt? How would you feel? My son then decided to try and commit suicide. He slit both wrists while taking a shower and stood frozen in time. Luckily for us all I came home early that day and found him. I can't imagine how sad and lonely he must have been that day.

Fast forward to an ad in the Telegraph for a Family To Family education course on mental illness offered by NAMI. What was NAMI? NAMI turned out to save my life. It changed the way I viewed the world. It opened my mind and heart to a new way of thinking. I was hooked. I can never feel guilty about what I didn't know but knowing what I do now with the education, I have received from NAMI and friends I wonder what a difference I could have made in my brothers life? With the education and support that is now being given to veterans maybe there might have been a chance to save our marriage. Those questions will never be answered. What I am sure of is that through the proper education I have been given the opportunity to support my son in his journey toward recovery. I will advocate on his behalf and on behalf of all other persons who have had the misfortune of being afflicted with a brain disorder. They did not ask for it. I know that you are not afraid of meeting me if I tell you that I have diabe-tes. If we meet and I tell you that I have a mental illness will you be so kind? My goal is to educate enough people in my lifetime so there will never be a wrong answer to that question.

My son was admitted to New Hampshire Hospital over a year ago. He was very sick and badly needed medical attention. I was very fortu-nate that his psychiatrist fought very hard on his behalf to get him admitted to the hospital. This is nothing different than the doctor that provides care for individuals having a stroke or heart attack. They are all medical emergencies. Mental illness is a roller coaster ride for individuals living with the illness and for their families as well. After six weeks in the state hospital my son was released on the proper medication that keeps his symptoms at bay. I can share with all of you that treatment works. At present time my son lives on his own and is working toward recovery.

My passion is fueled by witnessing how these illnesses rob people of their life everyday. In most cases it diminishes their ability to form and main-tain relationships with peers, family and potential partners. Careers and education are put on hold when they should just be beginning. I know mental illness is not a life sentence for all but life is so difficult for individuals living with severe and persistent mental illness. Imagine what it is like for most to have their careers taken away. To have to live in substandard housing with not enough money for clothes, food and medications.

Would you notice if your life was interrupted by mental illness?


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Whole person health is based on an under-standing that there is an undeniable connec-tion between our minds and bodies, between our mental health and physical health. As the recipient of a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), Greater Nashua Mental Health Center (GNMHC) has become a national leader in recognizing the importance of treat-ing the whole person. Through our Healthy Connections Program we have shifted how com-prehensive mental health services are delivered and how our center operates by providing accessible primary care within our center. Our Healthy Connections Program has brought primary care and other health and wellness oriented activities to patients of GNMHC and that has improved access to pri-mary care and resulted in better health outcomes. Likewise, there is mounting evidence that making mental health treatment available in primary care settings also has many positive outcomes.

Research has long suggested that many individuals bring mental health needs to their Primary Care Physician (PCP) rather than to a mental health professional. For example, fol-lowing a car accident many individuals might experience difficulties with sleeping and/or intrusive memories. These are common symptoms of Acute Stress Disorder. Over time, however, and especially if untreated in early stages, these symptoms can be indicative of Post Traumatic Stress Disorder (PTSD) and require specific evidence-based interven-tions. In addition, we all know that informa-tion alone does not bring about change, such that being told by your doctor to quit smoking, for example, is not enough to be successful in quitting. We require support and knowledge about the process of change in addition to the information about why we should change. Promoting behavior change is of primary importance to mental health clinicians. Thus, when they work alongside primary care pro-viders to provide behavior change treatments within the primary care setting, patients expe-rience more success with addressing problems (e.g., poor diet, lack of exercise, smoking, etc) that are often the root of other health issues. In general, providing mental health services in a primary care setting has been shown to lead to improved access to mental health care,

better physical health outcomes, and overall increased satisfaction for patients and providers for a large group of individuals.

The mission of GNMHC is to work with the community to meet the mental health needs of its residents by providing evaluation, treatment, resource development, education, and research. We are committed to providing services that address the needs of the greater Nashua community. As a result, GNMHC will soon be joining the growing movement toward integrated primary care, in which

primary care practitio-ners involve a behav-ioral health clinician in a patient’s total care. Starting next month, GNMHC will be pro-viding a mental health professional at the new Dartmouth-Hitchcock office, off Exit 8, to lead a patient-driven approach to screening, evaluation, and early intervention for behav-ioral healthcare issues that are commonly seen in primary healthcare settings. This col-laboration will result in positive changes for both patients and providers. Patients will be able to

access mental health services discreetly in their primary care office and benefit from a team of providers working together. The collaboration will also create a consultative relationship that will support medical professionals to manage mental health conditions within the medi-cal setting, prevent problems from escalating through the use of early intervention, promote positive health changes, and provide access to specialty mental health services when required.

GNMHC is committed to providing inte-grated care. We have successfully brought pri-mary care to our center through the Healthy Connections Program and are about to embark on bringing mental health services to primary care through collaboration with Dartmouth-Hitchcock. We believe that “integration” is not a set of services that are provided, but rather, involves starting with a patient’s unique needs and providing comprehensive services that are accessible, focused on meeting indi-vidual needs, and delivered by clinicians who understand the mind-body connection.

For more information about the Healthy Connections Program, please contact Mara Huberlie at 889-6147 x?3259

For more information about Integrated Primary Care, please contact Dr. Cynthia Whitaker at 889-6147 x3230.

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“The Body must be treated as a whole and not just a series of parts.”

Anyone familiar with current develop-ments in healthcare such as Accountable Care Organizations, Patient-Centered Medical Homes and Integrated Care programs would assume the above quote is part of the recent healthcare dialogue. Actually it is attributed to Hippocrates in 430 B.C. so it would seem that the concept of caring for the whole person is certainly not a new one. Yet in the thousands of years since the state-ment, there hasn’t been a whole lot of progress towards connecting the head with the body. For the most part we still haven’t rediscovered the “neck” as healthcare remains in “silos” with physi-cal health and mental health treated as unrelated experiences.

Since 2009, Greater Nashua Mental Health Center (GNMHC) has been working to change this paradigm of separate care through its Healthy Connections – Primary and Behavioral Healthcare Integration program. The program is funded through a grant from the Substance Abuse Mental Health Services Administration (SAMHSA) and has allowed GNMHC the opportunity to provide individuals with a serious mental illness (SMI) coordinated mental and physical health services, as well as access to a wide array of prevention and wellness programs.

The need for integrated healthcare is particu-larly acute for the SMI population which has on average a 53-year-lifespan – the same average lifespan as that of individuals living in sub-Saha-ran Africa. Adults who have SMI have dramati-cally increased rates of hypertension, asthma, dia-betes, heart disease and stroke. Most psychiatric medications, particularly anti-psychotic medica-tions, can cause weight gain, obesity and type 2 diabetes. In addition, up to 83% of people in the SMI population are overweight or obese and con-sume approximately 44% of all cigarettes sold in the United States. By anyone’s definition there is a huge public health crisis within this population, and SAMHSA was one of the first agencies to propose that integrated care for SMI individuals may best be centered in their Behavioral Health Home. The Healthy Connections program is aimed at reducing the disparity in lifespan by improving the “whole health” of those we serve. The program also focuses on empowering indi-viduals with the knowledge and confidence they need to actively participate in their healthcare decisions.

To date, over 600 individuals have participated in the Healthy Connections program, which includes twice-yearly free health screenings. Individuals receive a “Report Card” showing their height, weight, body mass index (BMI), waist circumference, blood pressure, pulse, cholesterol and H1AC results, intraocular pressure, and lung function.

Healthy Connections: A Model for Integrated Care



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Since November 2011, Gupta has been teaching free yoga classes at Greater Nashua Mental Health Center (GNMHC) through YogaCaps, the nonprofit he co-founded. YogaCaps, Inc. is an all volunteer 501(c)3 nonprofit organization that builds a healthy community by making yoga more available and affordable. Students in the class have experienced the sense of peace associated with yoga, and self-reports also include reduction in distressing auditory hallucinations, decrease in pain (back, shoulder, joints), loss of weight, improved range of motion and better quality of sleep, to name a few.

Yoga offers us the hope and renewal of the Spring season every day of the year! It does so much more than make us more flexible. It acts as a silent witness to the seasons of our journey through life. As we become more aware of body and breath, we are able to observe our inner process. Gupta focuses on breath since “many people need coaching on how to breathe properly. I’ve seen firsthand that those who are reverse breathers, shallow breathers and mouth breathers are often experiencing chronic physi-cal and mental health issues.”

Research published in the Journal of Interpersonal Violence and Acta Psychiatrica Scandinavica indi-cates that yoga breath-based interventions offer promising results for symptom reduction and positive growth in complex trauma recovery. An article published in Traumatology discusses that applications like yoga “purportedly bring about, with unusual speed and precision, therapeutic shifts in affective, cog-nitive, and behavioral patterns that underlie a range of psychological concerns”.

So, consider adding yoga as a daily or weekly ‘Spring cleaning’ for the home that you live in: your own body and mind. Fortunately, you do not have to ‘roll out a yoga mat’ to participate in any of Gupta’s classes. He teaches Subtle Yoga for Rejuvenation which can be done in a seated or standing position with no special gear required. And, more good news! You do not need to choose between aerobic exer-cise and yoga. You can enjoy both! They enhance each other.

Clients of GNMHC are invited to join the yoga class on Fridays from 2:00-3:30 p.m. to experience all that yoga can be and bring to enrich your life.

YogaCaps shares free classes for special populations and donation-based events, like the Annual NH Yoga for Peace, and workshops for the public. For more information, visit www.yogacaps.org.

Yoga: more than exercise… CONTINUED FROM PG 10

Definitely not enough money for any entertainment, gas for their car or imagine this one, toilet paper, soap and razor blades. No wonder the person you see on the street corner looks dirty and disheveled. Individuals living with mental illness and family members fight stigma on a daily basis. We must all learn to see the individual first and not their symptoms. There is a real person inside who wants to be loved just like you and I. They want to work, have meaningful relationships and be productive members of society. They just need to be given the chance.

My son could be that bum on the street. He did not ask for his illness and definitely does not deserve this fate. I know that with access to treatment, which includes support from his psychiatrist and case manager, we can manage his illness together. Accessibility to treatment is paramount for my son and for all others afflicted with brain disorders. He has an amazing strength and the resiliency to keep on fighting daily. I am so proud of my son for allowing me to share in his amazing journey.

If your life was interrupted… CONTINUED FROM PG 12

We all share in the same human world. Cornelis Pieterse, MATherapist, Assessment & Grief Treatment

One of the most difficult things to do in life is to change our behaviors and attitudes. Most of us would rather avoid that work. I believe all of us have our demons – a kind of shadow-side that stops us from becoming more loving, more insightful, more emotionally stable, and more wholesome human beings with a moral compass.

In fact, what can happen when we are so incredibly busy with our daily responsibilities at home, at work or in school? We can then neglect the other tough job - to break a bad habit, to let go of a prejudice, to forgive another, to be less defensive, to control a temper or to make a sacrifice for the greater good.

Most of the people who walk through the doors of the Greater Nashua Mental Health Center (GNMHC) to seek help have taken on that work in one way or another. They work hard, very hard. They are willing to talk about what is often a deeply personal and private matter. They may have fears, phobias, impulse control issues, overpowering emotions, panic attacks or addictions. They may have thoughts that distort how they see themselves and the world around them. They may have terrifying memories of traumatic events. These memories force themselves so powerfully into their daily lives that the past and present cannot be separated.

Their courage and hard work is mostly unseen and unrecognized by the world. What we see instead are people who have accomplished much in our town, our country and in the world. These are the people we all recognize, celebrate and honor.

So I was thinking…. What if our buildings and roads, award shows, sport competitions, monu-ments, diplomas, books, works of art, music videos, wealth, careers, cars, the latest gadgets, or seats of government were all to disappear from sight? What if by some magic our world would become invisible and instead only show the hard work and courage of those who are changing themselves?

In that case the stigma and judgment around mental health impairments would disappear. We would see that the efforts of those who live and manage their mental health issues are as courageous as any who face other challenges. Then we would see people who have something important to offer the rest of us – namely that to work on ourselves is as important as anything else that can be achieved in life.

Making VisibleWhat Is Mostly Invisible


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Cynthia L Whitaker, PsyD and Kate Murphy, LCMHC, CGP

Dialectical Behavioral Therapy (DBT) is a behavior therapy approach that was originally developed by Marsha Linehan (1993) to treat patients with borderline personality disorder. It is considered an empirically validated treatment, which means that multiple research studies have shown that the treatment works. The core prob-lems that DBT targets are all-or-none thinking, confusion about oneself, impulsivity, emotional instability, and interpersonal problems. While these are all symptoms of borderline personality disorder, they are also problems faced by individu-als with other mental illnesses, such as eating disorders, trauma disorders, bipolar disorder, anxiety, and depression. Thus, the skills taught in DBT can be useful to people with almost any (or even no) diagnosis. DBT is also effective in treating symptoms related to suicidal thoughts or thoughts and behaviors related to self-harm. Researchers have also found that DBT decreases treatment dropout rates and hospital visits and leads to overall better treatment outcomes.

DBT treatment is based upon and teaches a “dialectical worldview.” This worldview acknowl-edges the inherent tensions of life and offers a way of thinking that allows for seemingly contra-dictory things to coexist. For example, one might be both anxious and excited about an event or

feel both love and frustration toward the same individual. In a relationship, two people might have conflicting wants and needs. DBT suggests that we can synthesize these seemingly contradic-tory things by balancing acceptance and change and avoiding all-or-none thinking. In other words, we observe and accept reality for what it is, in order to use skills to make the changes we can, while recognizing that things are not either all good or all bad and letting go of the need to be “right.”

In addition to teaching this worldview and meth-ods to combat all-or-none thinking, DBT skills training involves learning four groups of skills; core mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness. These skills correlate to the remaining problems that DBT targets, confusion about self, impulsivity, emotional instability, and interpersonal problems. Core mindfulness skills decrease confusion about oneself by promoting learning to go within one-self to learn and observe feelings and thoughts. It improves understanding of what one feels and why. Distress tolerance skills are skills that help someone get through a difficult moment by

decreasing impulsive reactions and learning how to tolerate stress and not engage in behavior that make a crisis worse. These two groups of skills are acceptance skills. That is, both core mindful-

ness and distress tolerance skills are focused on accu-rately understanding reality for what it is, not what it reminds us of from our past or what we fear will happen in our future. It is important to focus on the present moment, accurately assess what it includes, and learn skills to tolerate real-ity instead of avoiding or engaging in self-destructive behaviors.

The final two groups of skills, emotion regula-tion and interpersonal effectiveness, are change skills. Emotional regulation skills focus on ways to enhance control of emotions. Some strategies include reducing vulnerability to negative emo-tions, “acting opposite” to the emotion, “checking the facts” to determine if the emotional reaction is effective in the current situation, and building positive life experiences. Interpersonal effective-ness skills promote improved ability to deal with conflict, increased self-respect, and learning to set boundaries in relationships. This is achieved through careful examination of the objectives

of an interaction while also thinking about the importance of maintaining self-respect and rela-tionships with others.

DBT is a structured treatment that focuses on accepting things as they are while also encourag-ing personal change. It is different from other types of therapy that people may have experi-enced and, as a result, may cause discomfort at first and require a period of adjustment. Those who believe in the worldview promoted in DBT believe that everyone, regardless of biological makeup, childhood environment, or life circum-stances, can learn new behaviors. We can all learn to change the way we think about ourselves, our world, and our future by balancing acceptance and change and recognizing that both are needed for recovery and to have a “life worth living.”

Greater Nashua Mental Health Center currently offers three DBT skills groups. One, for women diag-nosed with borderline personality disorder, another for women with any diagnosis, and a third for men with any diagnosis. For more information about DBT offerings, please contact GNMHC at 603-889-6147.

References:Linehan, M. (1993). Cognitive-Behavioral

Treatment of Borderline Personality Disorder. The Guilford Press

Linehan, M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. The Guilford Press

DBT: Finding the Middle Path


Strengthening Individuals, Families & Our Community Since 1920!

2012 Advisory Council Members

Lisa Christie Thomas Doucette Mariellen Durso

Sheelu Joshi Flegal Robert Mack

Norma MacKinley-Smith Lt. Bryan Marshall

Jan Martin Kim Shottes

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provide mental health care to our community. ____$25 ____$50 ____$100 ____$200 ____Other

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Please return this form with your donation to: GNMHC, 100 W. Pearl Street, Nashua, NH 03060

Attn: Development Office Or give online at www.gnmhc.org!


Strengthening Individuals, Families and Our Community Since 1920!


Cullen Hardy, Doctoral Student and Cynthia L Whitaker, PsyD, DirectorAssessment & Brief Treatment

Greater Nashua Mental Health Center at Community Council is well known for meeting the needs of our region’s residents by providing mental health evaluation, treatment, resource development, education, and research. For the past year, we have expanded our ability to provide comprehensive evaluation by also offer-ing formal psychological assessments to both children and adults.

What exactly is a psychological assessment? Psychological assessments evaluate four areas of our mind: cognition, mood, personality, and behavior. Supervised by a licensed clini-cal psychologist, these assessments specialize in the interrelatedness of the brain & behavior. Psychological assess-ments generally include a formal interview, a thorough review of all available records, and psychological testing with multiple standard-ized instruments. This method of assessment is especially valuable because it addresses high-cortical function-ing including attention span, long- and short-term memory, informa-tion-processing speed, language & visuo-spatial abilities, and intelligence—to name just a few. This thorough assessment of brain functioning is helpful in detecting learning disabilities, pro-viding clarification about diagnosis, and provid-ing recommendations for ongoing treatment.

Psychological assessments also take a holistic approach to the mind-body relationship; we recommend that assessments be conducted in concert with a full medical evaluation, to ensure that any worrisome symptoms are not, in fact, caused by an underlying disease or other medi-cal condition. In fact, a medical examination is recommended prior to a formal psychological assessment so that any relevant information can be incorporated into the assessment.

How will it benefit you or your child?A thorough psychological assessment

will help provide a correct diagnosis of your symptoms. Studies show that patients are genuinely happy to receive accurate diagnosis and prognosis, even when the condition is seri-ous. Conversely, when the assessment shows that the brain is not as impaired as originally believed the diagnosis alone can help to jump-start improved overall health. Furthermore, psychological assessments can help provide a clearer picture of a person’s overall health by

utilizing extensive measurements of cognition, mood, personality, and behavior. However, when the underlying condition is already known (e.g., in people diagnosed with demen-tia) an assessment can give insights into the rate of decline (or improvement) and provide other insight and recommendations.

There are several benefits of a psychological assessment. Many insights will be provided into a person’s strengths and weaknesses. Families can learn how to better support a fam-ily member. Patients and physicians can learn how to assist their clients and treat and reduce any symptoms more effectively. In short, a psy-chological assessment can be one of the most valuable ways to gain insight and direction in

complex situations that have presented as puz-zling to providers and family members.

What should I expect?A typical psycho-

logical assessment runs from 4 to 8 hours, although shorter, less comprehensive tests are also available depend-ing upon the particular problem into which you are hoping to gain insight. After the assessment is completed, the psychologist (or psychologist in train-ing) will take additional

time to go over your records, evaluate, score and interpret tests, and prepare a report. This report and the results will be shared with and explained to both you and your providers. Thankfully, many insurance companies cover the cost of psychological assessments. It is important to know, however that some insur-ance place limits on how many hours of testing are covered and/or require preauthorization (e.g., obtaining a referral from your primary care physician or submitting forms to justify the need for an assessment). Be sure to call your insurer to confirm coverage.

There really are no reasons not to schedule a psychological assessmentPsychological assessments can provide valu-

able insight into a person’s overall health. The tests are non-invasive and gaining a clearer pic-ture of your or your child’s condition will pro-vide increased peace of mind and direction for treatment. For Greater Nashua Mental Health Center at Community Council, offering com-prehensive psychological assessments was the logical next-step in improving our community’s overall mental health and providing our com-munity with access to quality, evidence-based, cost-effective treatment.

The Many Advantages of Psychological Assessment

For the past year, we have expanded

our abilityto provide

comprehensive evaluation by also

offering formalpsychologicalassessments...


Everyone gets down from time to time, but sometimes it's more than just "the blues." Sometimes, it can be clini-cal depression. Clinical depression affects more

than 19 million Americans each year. It is a real illness that can be treated effectively. Unfortunately, fewer than half of the people who have this illness seek treatment.

Too many people believe that it is a “normal” part of life and that they can treat it themselves. Left untreated, depression poses a huge burden on employees and employers. It causes unnecessary suffering and disruption in one's life and work, and costs about $44 billion a

year in lost workdays, decreased productivity and other losses.

Know the SignsThe signs and symptoms of clinical depression are:

l Persistent sad, anxious or "empty" moodl Changes in sleep patternsl Reduced appetite and weight loss, or increased appetite and weight gainl Loss of pleasure and interest in once-enjoyable activities, including sex l Restlessness, irritabilityl Persistent physical symptoms that do not respond to treatment, such as chronic pain or digestive disorders

l Diff iculty concentrating at work or at school, or diff iculty remembering things or making decisionsl Fatigue or loss of energyl Feeling guilty, hopeless or worthlessl Thoughts of suicide or death

If you experience five or more of these symptoms for two weeks or longer, you could have clinical depression. See a doctor or quali-fied mental health professional for help, right away.

If you are supervising an employee who exhibits any of these symptoms and has frequent, unexcused absences, discuss the situ-ation with the individual, but do not try to diagnose the problem. Suggest that the employee seek help from his or her doctor or, if you have one, the Employee Assistance Program (EAP). Make sure the employee knows that seeking help is the healthy thing to do.

Signs of Depression Checklist

Todos nos ponemos tristes por algun tiempo, pero a veces es más que eso. A veces puede ser una depresión clínica. La depresión clínica afecta a más de 19 millones de americanos cada año. Es una enfermedad real que puede tratarse eficaz-mente.

Desgraciadamente, menos de la mitad de las personas con esta enfermedad buscan tratamiento. Demasiadas personas creen que es una parte “normal” de la vida y que pueden tratarla por cuenta propia. Si no se trata, la depresión significa una enorme carga para empleados y empleadores. Causa sufrimientos y trastornos innecesarios en

nuestra vida y trabajo y cuesta unos $44 miles de millones por año en días de trabajo perdidos, menor productividad y otras pérdidas.

Conozca Las SeñalesLas señales y síntomas de la depresión clínica son:

l Persistente estado de ánimo triste, pleno de ansiedad o “sin sentido” l Cambios en los hábitos de sueño l Reducción del apetito y pérdida de peso o aumento del apetito y aumento de peso l Insatisfacción y desinterés por actividades que

antes disfrutaba, incluyendo el sexo l Inquietud, irritabilidad l Síntomas físicos persistentes que no responden a tratamiento, tal como dolor crónico o trastornos digestivos l Dif icultad para concentrarse en el trabajo o la escuela, o dif icultad para recordar cosas o tomar decisions l Fatiga o pérdida de energía l Sentimientos de culpa, desesperanza o inutilidad l Pensamientos de suicidio o muerte

Si usted padece de cinco o más de estos sín-

tomas durante dos semanas o más, podría tener depresión clínica. Consulte a un médico o profe-sional de salud mental calificado inmediatamente.

Si está supervisando a un empleado que pre-senta cualquiera de estos síntomas y tiene ausen-cias frecuentes no justificadas, converse el tema con la persona, pero no trate de diagnosticar el problema. Sugiera que el empleado consiga ayuda de su médico o, si lo hubiera, del Programa de Asistencia al Empleado (EAP). Asegúrese de que el empleado sepa que buscar ayuda es lo más salu-dable que puede hacer.

Lista de Vericación de las Señales de la Depresión


Strengthening Individuals, Families & Our Community Since 1920!

Program Statistics In Fiscal Year 2011

2,288 people received 11,579 hours of Adult Assessment & Brief Treatment services; 1,170 children, adolescents and their families received 20,805 hours of service from our Child and Adolescent Program; 296 persons were seen by our Older Adults Services staff for a total of 6,813 hours of service; 475 people used our Emergency Services; 70 young people received 6,417 hours of service through the Young Adult Program; 1,052 consumers received 29,011 hours of Community Support Services; 64 consumers participated in our Vocational Services, receiving 527 hours of service; 105 people received Homeless Outreach Services; 356 individuals received 8,698 hours of Substance Abuse Treatment services; 609 parents participated in our Child Impact Seminars for Divorcing Parents; 77 deaf adults and children throughout New Hampshire received 2,598 hours of service from our Deaf Services Team; 125 children and 95 families received 3,132 hours of supervised visits and a total of 196 monitored exchanges occurred at our Supervised Visitation Center.

Consumers Served By Town

Fiscal Year 2011 (7/1/10 – 6/30/11)

Amherst 72 Brookline 61 Hollis 89 Hudson 462 Litchfield 83 Merrimack 330 Milford 248 Mont Vernon 14 Nashua 3,468 Other 551 Total 5,378


Congratulations and Thank You All!

Service Awards Each year, Greater Nashua Mental Health Center at

Community Council recognizes employees who are marking anniversary milestones in their service to the agency. In 2011,

we celebrated the dedication of the following individuals:

Five Years Watila F. Burpee Mary A. Chaput

Diane S. Cudworth Patricia D. Gilbert Barbara A. Merrill

Alicia R. McDermott Richard S. Mansfield

Maureen L. Massmann Cynthia L. Whitaker

Ten Years

Paul D. Lassins Karen A. Lofstrom

Julie A. McIver

Fifteen Years Patricia L. Butler

Twenty Years Alice M. Cassidy

Twenty-Five Years Susan W. Mead

Getting In SHAPELenore Cortez, MSN, RNC

Healthier lifestyle options are a hot topic. Here at GNMHC we are gearing up to begin the active phase of the In SHAPE program. Initially, we were chosen as a control site for this study and for the past year had 30 clients participating in periodic assessments as they waited to actu-ally begin working out at the gym. Studies show that people with severe mental illness live an average of 10-20 years less than the general population (Barr, 2011). This program was devel-oped in 2002 by Ken Jue of Monadnock Family Services after he noticed an increased percent-age of their clients dying prematurely from physical illnesses related to the effects of isolation, poor nutrition and sedentary lifestyles (Mondanock Family Services, 2009).

The program’s acronym stands for Individualized Self Health Action Plan for Empowerment. The basis of this program is to pro-vide physical activity support, nutritional education, and com-munity integration to our clients with severe mental ill-ness. Participants will work with a health mentor who will teach them how to incorporate physical activity and good nutrition into a healthy lifestyle. Health Mentors are an integral part of this program as they are Certified Personal Trainers who have received education in pro-moting safe physical activity for all levels of people wishing to improve their physi-

cal activity. We are partnering with the Nashua YMCA to provide gym memberships to par-ticipants. Flexibility is our key to planning exercise programs that will motivate and support the needs of each of our clients. With this in mind, the health mentor will encourage participants to develop individualized fitness plans.

Nutritional training will be provided to help clients develop healthier eating habits, learn about portion control and eating on a budget. Daily food logs will be used to help participants track their eating habits. The health mentor will provide weekly feedback on food and physical activ-ity logs. Meetings between the health mentor and the participants will occur 1-2 times per week as the participant begins the program and less frequently as a routine becomes established.

Another part of this program is the smoking cessation component. This online presentation is available to all participants who are smokers, regardless of their desire to quit. Participants can scroll through the screens at their own pace with the option of selecting links to additional information. Those participants who then decide to pursue smoking cessation will have addi-tional resources presented to them by the Health Mentor.

Our goal is to begin healthy changes that will become part of the daily routines of the individ-uals who participate in the In SHAPE program. Our success will come in the form of helping our community to maintain healthier lifestyles. Further evidence of this success will be when we see a client involve family members or friends in their exercise journey.

Resources:Barr, B. (2011). Adults with severe mental illness get In SHAPE. Robert Wood Johnson

Foundation Grants Results Report #51433. Retrieved from http://www.rwjf.org/files/research/51433.pdf

Monadnock Family Services (2009). In SHAPE: Shaping the future of mental health. Monadnock Family Services and Dartmouth Center for Aging Research, 1-87.


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The nurse care coordinator also speaks with them about their use of cigarettes, alcohol and reviews all of their cur-rent medications. Patients have plenty of time to ask questions and formulate personal health goals. At this time, they can also learn more about the various wellness activities which are available to all GNMHC clients. Programs include Smoking Reduction, Morning Stretch Group, Yoga for Sleep and Anxiety, Walking Groups, Healthy Cooking, Spanish Women’s Wellness, and Learning to Live Well with Diabetes. With their permission, this “Report Card” is also shared with the consumer’s primary care provider and mental health team.

Greater Nashua Mental Health Center has two critical community partners in the Healthy Connections project. The first is Lamprey HealthCare, the Nashua area’s Federally Qualified Health Center and our primary health care partner. Lamprey Healthcare provides a full range of onsite primary care services includ-ing: physical exams, immunizations, risk assessments, gynecological exams, reproductive healthcare and preventative care such as individual nutrition coun-seling and counseling for diabetes and other chronic diseases. Unlike many busy primary care offices, the program allows

the nurse practitioner to spend addi-tional time with patients to discuss their care and answers any questions. As the Healthy Connections program has grown, there are now two fully-equipped exam rooms on the first floor at the mental health center’s 7 Prospect Street facility.

GNMHC’s second partner is the H.E.A.R.T.S. Peer Support Center. The Healthy Connections project provides an excellent opportunity to expand the role of peers in the mental health system. There is a growing body of evidence that suggests peer-oriented recovery services produce outcomes that are as good or, in some cases, superior to services from non-peer professionals and in a much more cost-effective delivery system. The unique perspective and support offered by peers often is particularly effective at reducing isolation and increasing wellness program participation. Many of the well-ness activities take place at the peer sup-port center, including a specially designed SAMHSA-funded Whole Health Action Management program. The 13 week, peer-led program is a person-centered planning process that is strength-based and focuses on a person’s interests and natural supports. It stresses creating new health behaviors and strengthening one’s resiliency skills, as well as the promotion

of self-directed whole health. While improving the health of

GNMHC consumers is the most impor-tant benefit of the SAMHSA-funded project, there have been other significant advantages to being one of only 63 agen-cies in the country and the only one in New Hampshire to receive the grant. The program has allowed GNMHC to pro-vide high-level training to its staff as we work to retool the present workforce to meet the requirements of integrated care and health home programs. Over the last year, GNMHC staff has received “Health Navigator” training which expands the traditional case manager role to include assisting clients with managing chronic physical illness. Staff has also participated in certificate programs in Primary Care Behavioral Health at the University of Massachusetts Medical School. They have taken part in a two-day smoking cessation program, a dental-mental health pro-gram and there are many more additional opportunities on the horizon.

The project highlights the critical need for a clinically relevant electronic health record and the agency is in the process of implementing such a system. If inte-grated properly, electronic health records can play an integral role in providing clinicians with an efficient way to evalu-

ate the “big picture” and assist in decision making. This information should also be accessible and understandable to patients in order to empower them in the shared-decision making process.

One final benefit to the Healthy Connections project is that it has been a data and information driven project. From the beginning, GNMHC recognized the importance of collecting data, measur-ing outcomes and establishing value. GNMHC is working with the University of Connecticut to analyze and evaluate the data and present it to policy makers as we look to sustain the program after the completion of the grant. Such informa-tion and reports will also prove helpful in tracking and improving population-based health status and quality of care/life for consumers.

Implementing the Healthy Connections project has been challenging, forcing strangely disparate systems – behavioral health care and primary health care – to come together in order to “rediscover the neck” and provide whole health services in concert. Despite the obstacles, the project is demonstrating that it is possible to change the current paradigms of health care and cost-effectively provide better care that leads to better patient outcomes.

Healthy Connections: A Model for Integrated Care… CONTINUED FROM PG 14


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Cynthia L Whitaker, PsyDDirector, Assessment & Brief Treatment

Many people ask me, “Why do I feel this way?” or “Why do I do the things I do?” People ask because they don’t know why they get angry at someone who asks for help or who gives feedback. Or, they don’t understand why they avoid speaking up or expressing their opinions. Or, they don’t understand other things about their personality and behaviors.

For many people the reason why these feelings and behaviors happen, even when they don’t want them to, is because past experiences can affect today’s behavior. For example, if someone grows up being told they don’t do anything right or being yelled at for express-ing their opinion, then they learn to think their opinion is not right. As a result, they now might look like someone who is afraid to speak up or express an opinion. Another example is if some-one grows up in a home and school where they were picked on a lot, they may now have low self esteem and have strong reactions to feedback. There are many other examples of how someone’s past experiences affect the behaviors and feelings of today. The point is that we all learn to think, feel, and behave certain ways from our experi-ences, not just from our genes from our families.

Of course, all of our experiences are different. Some people have many positive experiences, but others are not so lucky. Negative experiences are also different and range from being alone or misunderstood to being abused again and again. These different experiences can affect different

people in different ways because our experi-ences interact with our genes. Some people act a bit shy or get nervous in new situations, others might get angry easily. These types of behaviors do not necessarily mean that a person has a dis-order and might be managed by learning what you are sensitive to and learning skills to change

your behavior. Other people can develop psy-chological disorders from negative experiences. The most common is Post Traumatic Stress Disorder (PTSD). PTSD is well known as a disorder in the military. Someone goes into the military, experi-ences negative things, and then has many symptoms of anxiety or anger after the negative experiences. Over the years, there has been a lot of research to prove that PTSD can also happen from negative childhood experiences, especially negative experi-ences that happen again and again. Someone with

PTSD is sensitive to any experience that reminds them of past negative experiences. For example, if you were picked on growing up, you might now be sensitive to feedback or any situation that makes you feel judged. People with PTSD also can react strongly to an experience that reminds them of past negative experiences. For example, you might react strongly to something that oth-ers think is no big deal because it reminds you of something negative from childhood.

Not all negative experiences lead to PTSD or a psychological disorder, but all negative experiences can affect our thoughts, feelings, and behaviors. If you need someone to talk to about your past negative experiences, feel free to contact Greater Nashua Mental Health Center at 603-889-6147.

Why Do I Feel This Way?How past experiences can affect

today’s behaviors and feelings

...if someone grows up being told they don’t do any-

thing right or being yelled at for express-

ing their opinion, then they learn to

think their opinion is not right.

Thank you...It is only through the support of the towns we serve anddonations such as those businesses and individuals whoappear in this insert that we are able provide essential

mental health care to all our neighbors in need, regardless of their insurance and financial status.



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319 East Dunstable Road

Nashua, NH 603.888.7878

We offer four levels of care with 24 hour nursing services. Speech, physical, occupational and pool therapy are available on site. Fine Dinning, spa services and a wide array of social activities are offered. Choose from assisted living suites, one, two bedroom or deluxe apartments. Short-term respite care is also available.

For more information call— 603.888.7878

or e-mail— [email protected]

At Langdon Place of Nashua, it’s all about choices

K.I.G. GroundMaintenance LLCNow Delivering Mulch, Stone and Soil

Donald M. Roy, CFP® of New England Wealth Advisors is an independent advisor who develops and implements solutions to comprehensive financial planning needs. He does this for individuals, business owners, private industry and nonprofit organizations. Please visit his website at newealthadvisors.com to view his qualifications and products and services offered.

Securities offered through Securities America, Inc, Member FINRA/SIPC, Donald M. Roy, Registered Representative Advisory Services offered through Securities America Advisors, Inc. Donald M. Roy, Investments Advisor Representative New England Wealth Advisors and the Securities America companies are unaffiliated

Donald M. Roy, CFP® of New England Wealth Advisors is an independent advisor who develops and implements solutions to comprehensive financial planning needs. He does this for individuals, business owners, private industry and nonprofit organizations. Please visit his website at newealthadvisors.com to view his qualifications and products and services offered.

Securities offered through Securities America, Inc, Member FINRA/SIPC, Donald M. Roy, Registered Representative Advisory Services offered through Securities America Advisors, Inc. Donald M. Roy, Investments Advisor Representative New England Wealth Advisors and the Securities America companies are unaffiliated

•Serving the Greater Nashua and Milford areas, Bridges is a domestic and sexual violence organization that provides crisis intervention, emergency shelter, court advocacy, support groups, and education and outreach to both women and men (www.bridgesnh.org, 24-hour support line 603-883-3044).

•For domestic and sexual violence resources throughout the country that specifically provide services to the Deaf community, please see the National Domestic Violence Hotline’s website: http://www.thehotline.org/deaf-deaf-blind-and-hard-of-hearing-outreach/.References:Anderson, M. L. (2010). Prevalence and preditors of intimate partner violence victimization in the

deaf community. Unpublished doctoral dissertation, Gallaudet University. Black, M. C., Basile, K. C., Breiding, M. J., Smith, S. G., Walters, M. L., Merrick, M. T., Chen,

J., & Stevens, M. R. (2011). The national intimate partner and sexual violence survey (NISVS): 2010 summary report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention (2012). Understanding intimate partner violence: Fact sheet. Retrieved on April 9, 2012 from http://www.cdc.gov/ViolencePrevention/pdf/

Relationship Violence in the Deaf Community… CONTINUED FROM PG 12

In Loving Memory OF

Richard James (Arjay) Sharkey

By his father, sister Erin & brother Patrick

PO Box 4387, Manchester , NH 03108

ABSOLUTE DATA DESTRUCTIONConfidential Record & Document Destruction

Mobile Shredding Service

www.absolutedatadestruction.com

Buzzy FrancisRegional Sales Manager

Bus: 1-800-797-0515Cell: 603-533-9369Fax: 603-625-1505

Printed on recycled paper

Harvard Pilgrim proudly salutes theGreater Nashua Mental Health Center,

making a difference to improve the lives of so many in the community.

Making health care work better


www.baesystems.com

SERVING OUR COMMUNITY — AND OUR NATION

For more than five decades, BAE Systems has remained as committed to supporting our surrounding communities as we are to developing advanced technology to protect our nation. We support those who go into harm’s way on America's behalf, from first responders to the men and women of the armed forces. As New Hampshire’s largest manufacturer, we’re proud to call the Granite State home — and even prouder to play a part in creating a safer tomorrow.

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