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May 2023

May 15

New certification program encourages Indiana employers to develop more robust mental health initiatives

By Feature, Mental Health

Executive for Mental Health of America of Indiana discusses recent developments in efforts to advocate for mental wellness

by Shari Finnell, editor/writer, Not-for-profit News

With the recent approval of a $100 million Senate bill, Indiana is making inroads in providing much needed mental health resources to residents. But the funds still fall significantly short of what’s needed to address the state’s mental health needs, according to Stephanie Anderson, chief operating officer of Mental Health America of Indiana.

Anderson, who has been among the advocates championing for more attention to the state’s mental health needs, noted that Indiana continues to rank among the last in the nation when it comes to providing adequate mental health services to residents. Currently, Indiana ranks 42nd in the nation when it comes to mental health, according to the State of Mental Health in America 2023 report.

Anderson said the mental health bill is unprecedented in addressing mental health at this level in Indiana, but it has its limitations because of the two-year period of coverage. “For the caucus to consider mental health their No. 1 priority is a huge deal,” she said. “We have mixed emotions about it. I’m glad we’re paying attention to it and glad we passed the bill, but the funds do not support a sustainable program.”

Mental Health America is among the nonprofit organizations targeting gaps in mental health awareness and resources through various educational programs, toolkits, research, and advocacy. One of its most recent initiatives is the Bell Seal for Mental Health certification program, which encourages employers to develop more robust mental health programs in the workplace.

The concept of the Bell Seal certification predates the pandemic, Anderson said.

“The original thought behind it was multifaceted,” she said. “MHA national was really hoping to highlight organizations that are doing right by their employees in terms of mental health and supporting mental health from several different angles.”

The designation also provides a resource or technical assistance for employers that want to do more, said Anderson, who noted that since the program is fairly new, many employers, including those in Indiana, are unaware of the certification.

“We’ve been discussing ways to bring it to Indiana on a bigger level, including adding it as an invaluable resource to Indiana employers,” she said. “This recent session was huge for mental health, and we need to keep that momentum going.”

Insights from Bell Seal recipients

As part of the annual, national Bell Seal certification process, employers seeking to be recognized for creating mentally healthy workplaces undergo a comprehensive 58-criteria application. The process requires teams to evaluate organizational policies and practices that improve employee mental health outcomes, including workplace culture, benefits, compliance, and wellness programs. 

Of the 92 recipients of the 2022 Bell Seal certification, 20 percent represented the nonprofit sector, the second largest group of recipients. Healthcare organizations represented the leading group of recipients at 28 percent.

Some areas that the Bell Seal recipients focused on as part of their efforts to support the mental wellness of their employees included the following:

  • Increased or improved mental health benefits and additional resource support.
  • Provided full coverage of mental health counseling visits, regardless of provider or network
  • Covered in- and out-of-network benefits at the same co-pay or co-insurance rates
  • Implemented $0 co-pay for unlimited mental health therapy sessions
  • Reimbursed 50% of mental health therapy session costs
  • Increased telehealth options
  • Increased number of EAP sessions to 6, 10, or 12 counseling sessions
  • Offered a free virtual 1:1 counseling program
  • Evaluated compensation equity and role structure.
  • Increased compensation transparency and equity
  • Increased minimum wage to reflect the current costs of living
  • Restructured roles to fit employees’ needs
  • Implemented permanent flexible work schedules and enhanced leave policies.
  • Implemented a permanent hybrid work environment
  • Offered paid family leave to care for family members with health conditions
  • Implemented floating and organization-wide “Mental Health Days”
  • Suggested “No Meeting Wednesdays” to focus on other work responsibilities
  • Suggested two-hour blocks on calendars for no meetings
  • Designated a team or individual to identify and address mental health concerns in the workplace.
  • Educated new employees about mental health benefits and support during orientation or onboarding processes.
  • Provided mental health training for supervisors or employees. According to MHA’s 2022 Mind the Workplace report findings, only 46% of companies provide mental health training. 

Employers who are interested in the program can review a pre-assessment tool to determine their preliminary level of recognition before moving forward with the full application. Of the 266 employers that completed the pre-assessment, 42 percent did not meet the qualifications for Bell Seal certification, and 58 percent fell in one of the four recognition levels: bronze, silver, gold, and platinum. 

Anderson noted that many Indiana employers may already have the qualifications to gain Bell Seal certification. “A lot of companies within Indiana are doing great things. They’re just not being highlighted at this point,” she said.

The Bell Seal certification can be effective in attracting and retaining employees in a highly competitive job market, Anderson said.

“The Indiana Chamber of Commerce has made it no secret that employers in general are saying that mental health or substance use disorders are among the leading barriers to a sustainable workforce,” she said. “In the nonprofit world, we struggle even more to compete with for-profit businesses in offering an equitable salary and benefits.” 

Future of mental wellness in Indiana

Anderson said she envisions advocates will continue efforts to restructure the mental health system in Indiana in the coming years. “We know we’re ranked 42nd in the United States, which is not a good number to be in terms of access and quality mental health care,” she said. “We have a system that has been largely untouched since the 1960s when President Kennedy signed into law the establishment of community mental health centers.”

She noted concerns remain because recommendations from the Behavioral Health Commission was for much greater and sustainable funding than what was provided by the $100 million under Senate Bill 1. 

“We’re thankful for the funding that was given and we know there will be supplemented with federal funds,” she said. “However, that doesn’t solve our problems after two years. Advocates will band together to figure out what would be an acceptable sustainable funding source, such as a cell phone surcharge, which is how we fund 911, or alcohol or tobacco taxes because they directly correlate with mental health.

“The ultimate goal is that we get our mental health system restructured so that people are sent to appropriate places for treatment for mental illness or substance use disorder as opposed to jail or the morgue,” Anderson said. “We’ve made some really great strides in this state. We have a long way to go but the momentum is good. I hope we can keep moving forward.”

May 08

‘The end of poverty is something to stand for’: Matthew Desmond urges audience to become ‘poverty abolitionists’

By Sponsor Insight

During United Way of Central Indiana event, author of “Evicted” says we’re doing a terrible job of connecting impoverished people with available resources

Growing up, Matthew Desmond’s family didn’t have a lot of money. His family’s gas got shut off all the time. The bank took their house. Seeing how his family was stressed by poverty drove Desmond to understand its dynamics and consequences. He has spent much of his life reporting and researching it.

“But even after all that, I felt I didn’t have this answer for: Why? Why is there so much poverty in America?” Desmond told a crowd of nearly 500 people during a recent event presented by the United Way of Central Indiana, alongside Glick Philanthropies, Indianapolis Neighborhood Housing Partnership and The Mind Trust.

“(Poverty’s) persistence in American life means that millions of families are denied safety and security and dignity in one of the richest nations in the history of the world. Why?” Desmond asked during his talk at the Indiana State Museum.

Desmond, the Pulitzer Prize-winning author of “Evicted,” said he sought to answer that question, which became the topic of his latest book released in March 2023, “Poverty, by America.”

United Way seeks to serve those living in or near poverty in the region. According to a new report released by United Way in April, more than 36 percent of Central Indiana households were either in poverty in 2021 or considered ALICE, an acronym for Asset Limited, Income Constrained, Employed, ALICE households earn above the Federal Poverty Level but not enough to afford a basic household budget.

That’s more than 244,400 households — more than one of three Central Indiana households. The number of households in this category has increased 11 percent since 2018, according to United Way data.

During his speech, Desmond, who also is a sociology professor at Princeton University and the principal investigator of The Eviction Lab, painted a picture of the landscape of American poverty: A third of U.S. households make $55,000 or less. More than 38 million Americans can’t afford basic necessities. If America’s poor founded a country, it would have a bigger population than Australia, he said.

While some have suggested there’s nothing to be done, that government programs don’t work, Desmond said that’s not true. Evidence shows programs such as housing assistance and food stamps are essential and effective — and anti-poverty spending has grown over the last several decades, he said. This makes America’s “stalled progress” on poverty even more baffling, as poverty has persisted despite an increase in federal relief.

Desmond offered several explanations for why poverty endures.

First, a “fair amount” of government aid earmarked for the poor never gets to them. Desmond said roughly 7 million people who could receive the Earned Income Tax Credit don’t, passing on $17 billion a year, for example.

“This is a picture of us doing a terrible job of connecting families to programs that they need and deserve,” he said.

The poor are exploited in the labor, housing and financial markets, Desmond said. Wages are falling and unions are weak in today’s labor market. Since 1985, rent prices have exceeded incomes by 325 percent, and every year poor Americans pay billions of dollars in overdraft fees, check cashing fees, and fees from payday loans. A hard pill to swallow, he said: Not only corporations but consumers, those invested directly or indirectly in the stock market, many homeowners and even those with free checking accounts all benefit from the exploitation of the poor.

Desmond argued the United States does more to subsidize affluence in American than to fight poverty. When considering all government spending from tax benefits to programs, he said, data shows that households in the bottom 20 percent — the poorest families — get about $26,000 a year from the government. By comparison, the richest ones — the top 20 percent — receive about $35,000 from the government.

“We give the most to those who have plenty already and then we have the audacity … to fabricate stories about poor people’s dependency on the government and shoot down proposals to reduce hardship because they would cost too much,” Desmond said.

“… There’s so much poverty here, not in spite of our wealth, but because of it.”
Affluent Americans also create poverty by building walls around prosperous communities, using municipal zoning ordinances to keep affordable housing out of their backyards, he said. It creates concentrated poverty.

Different anti-poverty investments are needed to fix the problem, not just deeper ones, Desmond said. He argued we need to create public policies that disrupt poverty and address exploitation by empowering the poor.

He suggested addressing labor exploitation, for example, by promoting worker empowerment and supporting the unionization of entire sectors as a way to level the playing field.

As for housing, Desmond said more can be done to expand the public housing infrastructure, to provide a path to homeownership for low-income families and to invest in community land trusts so tenants can build permanent, affordable housing.

He said we can end segregation of the poor by replacing exclusionary zoning policies with inclusionary ones — removing walls.

Desmond said the philanthropic sector has a role to play, too: Nonprofits can shift the conversation about poverty and advocate for more robust policy action.

Ending poverty requires all of us to become “poverty abolitionists,” he said.

“… The best hope we have of ending poverty is to bind ourselves together and demand this of our country. A mass movement for economic justice is necessary and a mass movement stirs,” Desmond said. “… The end of poverty is something to stand for.”

May 01

Is your nonprofit suffering the effects of secondary trauma?

By Feature, Mental Health

Local nonprofit leader stresses the importance of understanding mental wellness among employees

by Shari Finnell, editor/writer, Not-for-profit News

“Burnout.” “Compassion fatigue.” “Secondary traumatic stress.” “Vicarious trauma.” More than likely, you’re somewhat familiar with these terms, especially if you work or volunteer for an organization that supports individuals struggling with addiction, abuse, unemployment, food insecurity, homelessness, damaged relationships, or grief.

In the aftermath of the COVID-19 pandemic outbreak, the term “burnout,” in particular, gained increased attention as nonprofits disproportionately face an exodus of employees, along with an increased demand for services.

However, many people are using the terms interchangeably — which can make organizations vulnerable to other ways that various mental health conditions among their employees can undermine their mission, according to Dr. Cara Berg Raunick, the director of clinical quality at Health Care Education and Training (HCET), a nonprofit organization based in Indianapolis. Berg Raunick also is a former sexual assault nurse examiner (SANE) consultant for the Indiana Coalition to End Sexual Assault and Human Trafficking.

As leaders seek to support mental health programs, it’s important to gain a deeper understanding of each of the conditions and how they can impact an employee differently and, as a result, the organization, said Berg Raunick, who conducted extensive doctoral research on the vicarious trauma experienced among sexual assault nurse examiners.

Berg Raunick said the focus on “burnout” as a concept can be related to its perceived connection to a high voluntary turnover rate in the workforce. According to Nonprofit PR, 45 percent of nonprofit employees surveyed said that they would be seeking new employment by 2025 — which could further exacerbate disproportionately high voluntary turnover rates in the nonprofit sector.

While those concerns can be legitimate from an institutional and workforce perspective, employers also need to address the various types of secondary trauma that nonprofit and healthcare workers often face, Berg Raunick said.

“Burnout can be the easiest one to figure out why it matters,” she said. “People quit when they experience burnout, which can cost us money in training time, staff deficits, and a loss of institutional knowledge and expertise. However, unlike secondary trauma, burnout isn’t strictly trauma related. It can be caused by any challenging work scenario.

“While it certainly can be linked to working with folks who have experienced trauma, it’s important to recognize that people who experience any kind of secondary trauma have an increased risk of burnout,” she added.

In many cases, symptoms of secondary trauma — which is an umbrella term that describes what happens to people who are peripherally impacted by another person’s direct trauma — amy not be readily addressed in the workplace because they may appear to only impact the employee, Berg Raunick said.

Yet, secondary trauma can result in disconnected employees who are ineffective in supporting the organization’s mission, she noted.  According to the U.S. Department of Health and Human Services, symptoms of secondary trauma can include isolation, depression, anxiety, physical ailments, disassociation.

Berg Raunick stressed the importance of recognizing and addressing secondary trauma symptoms among employees — both to support employees’ overall well-being and the organization’s mission.

“In nonprofit and healthcare environments, working as a unit and supporting each other matters immensely,” she said. “It can lead to a decreased connection to patients, clients, and other team members.

“We’re losing a lot of our leaders over time to burnout,” she added. “But those who are staying may be disconnecting and losing their ability to have compassion and empathy. There’s a prevailing attitude that we should be strong, and we should be able to just carry on. We must approach not only our patients and clients and from a trauma-informed lens, but our workforce as well.”

Addressing secondary trauma in the workplace

Based on Berg Raunick’s research on vicarious trauma, which includes cognitive changes that occur with prolonged exposure to trauma, employees supporting traumatized people are likely to experience the highest levels of detrimental effects if they also have a personal history of trauma. 

However, as the research revealed, nurses without a personal history of sexual trauma but who examined sexual assault victims scored similarly in cognitive changes as obstetrics nurses who did have a personal history of sexual trauma — but did not work with sexual trauma victims in their roles. 

It’s important to create trauma-informed organizations and practices, including opportunities for self-care, in the workplace without setting the expectation that lack of resilience is a personal failure, said Berg Raunick.

“A huge part of it is learning about it, prioritizing it, and trying to create space to address it,” she said. “In some ways COVID taught us the importance of addressing it. We experienced immense trauma on so many levels, and the world slowed down for a bit.” 

Since there are many terms that have been associated with secondary trauma, understanding of the differences among them can be confusing, she noted.

“For example, compassion fatigue originated as a less stigmatized term for secondary traumatic stress, but now it is defined as a combination of secondary traumatic stress and burnout,” she said. “Compassion fatigue (as a description) makes a lot of intuitive sense. When we say compassion fatigue to someone, anyone who does any caring or any work in nonprofits, health care, or education, intuitively understands what that means.”

“With vicarious trauma, the changes aren’t pathologic,” she said. “They are normal and expected with this type of work. But while the changes themselves are normal, the effects can be harmful. We need to stress, ‘There’s nothing wrong with you. This isn’t a deficit if you’re experiencing this.”

Employers also should consider increasing awareness around the varying secondary trauma concepts as part of the onboarding process and continual employee engagement, Berg Raunick said. “By nature, most people who head into these kinds of fields have great resilience,” she said. “But it’s important to create trauma-informed organizations and practices, including opportunities for self-care, without setting the expectation that lack of resilience is a personal failure.

“A huge part of it is learning about it, prioritizing it, and trying to create space to address it,” she added. “In some ways COVID taught us the importance of addressing it. We experienced immense trauma on so many levels, and the world slowed down for a bit so that we can focus on it.”  

Ideas for practicing self-care

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), self-care tips to prevent and mitigate the impact of secondary trauma, such as those experienced by teams responding to a natural disaster.

  • Focus on the four core components of resilience: adequate sleep, good nutrition, regular physical activity, and active relaxation (e.g., yoga or meditation).
  • Get enough sleep or at least rest. This is of great importance, as it affects all other aspects of your work—your physical strength, your decision making, your temperament.
  • Drink enough fluids to stay hydrated and eat the best quality food that you can access.
  • Complete basic hygiene tasks like combing your hair, brushing your teeth, and changing clothes when possible. Wearing clean clothes can make you feel better.
  • Try to wash up, even just your hands and face, after you leave your work shift. Think of it as a symbolic “washing away” of the hardness of the day.
  • Make time to learn about the people with whom you work. Taking time for conversations will help foster feelings of positive regard toward yourself and others.
  • Engage with your fellow workers to celebrate successes and mourn sorrows as a group.
  • Take time to be alone so you can think, meditate, and rest.
  • Practice your spiritual beliefs or reach out to a faith leader for support.
  • Take time away from the work when possible. Removing yourself from the disaster area can help you remember that not every place is so troubled.
  • Try to find things to look forward to.
  • Communicate with friends and family as best you can. If you do not have Internet or cell phone access or ways to mail letters, write to loved ones anyway and send the letters later.
  • Create individual ceremonies or rituals. For example, write down something that bothers you and then burn it as a symbolic goodbye.
  • Focus your thoughts on letting go of stress or anger or on honoring the memory, depending on the situation.
May 01

In ‘The Room’ where it happens: Setting the space for interpersonal communication

By Sponsor Insight

by Christy Shepard and Jan Frazier of Planning Plus, LLC

Before the recent days of remote and hybrid work models, work was conducted in very static and finite methods and places. The paradigm shifts from employer-driven to employee-driven decision making and work life integration has afforded today’s worker choices and options for work engagement, participation, and lifestyle.

Employers are competing for employees at record levels and remote and hybrid work models are very attractive to multiple generations of people. No longer do we need to be “in the room” where it happens, as we have access to people and information like never before. Technological tools have broken barriers and stigmas, allowing workplaces to build healthy and dynamic organizational cultures that support the goals of the business and people that work in them. But with information and decision making moving through organizations at the speed of light, how do we ensure we are still making “the room” for the necessary thought and decision making to effectively problem solve?

‘The Room Where it Happens’, sung by Hamilton’s Aaron Burr in the popular Broadway musical, expresses many of the downsides workers have faced in the great transition from work from ‘working from home.’ Recently we have been involved in several significant projects involving multiple people where the work was done via emailing, texting, phone calls, Zoom, etc. Rarely were all players “in the room” at the same time. This led to delays in creating consensus solutions and became quite inefficient. Email may be efficient, Zoom is a step above, but where is the “room” for creative thinking, brainstorming, back-and-forth discussions? We may get the work done, but is it the best work we could have done?

Well before the Internet, Zoom, and other technological tools we have today, in 1989 the textbook Organizational Behavior by Robert Kreitner and Angelo Kinicki was published (Richard D. Irwin, Inc.). Based on their research, a Contingency Model for Selecting Communication Media was created by Richard L. Daft and Robert H. Lengel. In this model, they compared the appropriate media to use for communication information based on the richness of the medium and the complexity of the problem or situation. Fast forward to 2023 and we recognize that their principles still hold true.

Richness of the medium refers to how a message may be received and the level of interaction that may follow. We know that emails, written reports, and other forms of mechanical communication are generally impersonal, may or may not be read, and may or may not elicit any observable responses. Communication that involves more face-to-face communication, whether in person or via Zoom, allows the speaker to observe nonverbal communication as well as receive immediate feedback.

Over the years, the original model by Daft and Lengel has been updated but its essence has not changed. The figure below illustrates the information richness of different information channels.

Principles of Management – Open Textbook (umn.edu).

As you think about communicating information with your team or throughout your organization, identify how complex the situation is and match it to a more appropriate forum for discussion.

In this post-COVID work world, employees have become quite comfortable working from home, and we have seen articles where in some cases productivity has not been affected. But productivity alone should not be the deciding factor. We continue to encourage our clients to bring folks into the workspace at least weekly, to allow for critical interpersonal communication and decision making to happen when everyone is in the room.