Mental health is not just about clinical terms

October 3-9 is Mental Health Awareness Week, but I think at this point we’re all pretty aware that our mental health is, collectively, not great. 

I by no means want to downplay the importance of recognizing and seeking help or support for mental illnesses such as clinical depression, anxiety, and the like. But rather, I hope we’ll all realize it doesn’t take a formal diagnosis to understand that our mental health, much like our physical health, has its ups and downs. What is going on in the world around us is taking a toll on our mental health in ways we may not be familiar with. 

We’re more than a year and a half into a global pandemic and it is taking a toll. As a parent, and an overthinker on a good day, I find myself questioning and analyzing every decision I make. Is this activity safe? Should I change what we’re planning? Should I add some precautions, or am I being too cautious? How is this going to affect my children, mentally and emotionally? It. Is. Exhausting. 

What is even more exhausting is that we can’t see a light at the end of the tunnel. There are still upticks in not just COVID cases, but in the number of arguments over what we should or should not be doing about the pandemic at this point. Everyone wants this to be over and to go back to “normal,” but we certainly don’t agree on how to get there. 

That mental exhaustion seeps throughout our lives. We allow too much screen time. We let messes go too long. We wait until the last minute to write something because we’re too fried to come up with a good idea. Our patience is shot. Our short-term memories are shot. Our communication skills go down the toilet.  

But what can we do about it? Even before the pandemic, our mental healthcare system was overloaded. Many people feel they can’t afford to seek help in the form of a therapist or medication. Some are able to find a level of relief on their own, through things like journaling, meditation, spirituality or a new hobby, but many are too mentally worn out to try to figure out something that will help them. 

I don’t really have a solution for all of this. My only suggestion – and hope – is that we can all adapt a stronger empathy for those around us and believe that we’re all doing our best. I came across a Facebook post the other day that really resonated on this front, and I’d like to share some lines from it for everyone to consider: 

“If someone is falling behind in life, you don’t have to remind them. Believe me, they already know…. It’s what consumes their thoughts each day. What you need to do for those who are struggling is not to reprimand, but encourage. Tell them what’s good about their lives, show them the potential that you see. Love them where they are. When we can’t see clearly for ourselves, we need others to speak greatness over us.  

“People don’t need you to tell them what’s wrong with their lives, they already know. They need you to reassure them that they can still make it right.” (credited to Brianna Wiest, who, according to Wikipedia, is a writer known for work on mindfulness and is a graduate of nearby Elizabethtown College) 

Maybe in our efforts to lift others, we’ll find ourselves uplifted. 


Capital BlueCross releases free mental wellness toolkit


Employers with health care coverage through Capital BlueCross now have access to a suite of mental health resources through the Harrisburg-based insurer’s new mental wellness toolkit.

Capital BlueCross announced on Wednesday that it is offering a free toolkit to help employers address mental wellness issues in the workplace.

The toolkit is downloadable through Capital BlueCross’ website and offers 50 customizable communications that can be used to engage employees both online and in-person. Employers with Capital BlueCross coverage will have access to the entire toolkit while those without access will see a portion of it.

Todd Shamash, president and CEO of Capital BlueCross, said that there continues to be a reluctance for individuals to seek help for mental health issues.

“The stress and anxiety caused by the pandemic only underscore the need to proactively help address mental wellness issues that impact so many of our friends, family, coworkers and members of our communities,” he said.

Through the communications in the toolkit, Capital BlueCross expects businesses to be able to promote a constructive dialogue about mental wellness issues, educate employees on available services and erode the stigma surrounding mental health issues.

Shamash said that he toolkit is part of a strategic decision by the company to help employers tackle mental wellness issues among employees before it impacts the workplace.

“Struggles with stress, anxiety or depression can sometimes be reflected in employee morale, absenteeism or productivity,” Shamash said. “If we can create a productive, ongoing discussion in the workplace around mental wellness, maybe we can help people recognize problems and seek help faster.”

Do’s and don’ts for employers confronted with employee mental health issues

Employers cannot afford to overlook the impact mental health may have on their business. The National Institute of Mental Health estimates that one in five people will experience a mental illness at some point in their life. Experts expect that number to increase due to the added pressures associated with the coronavirus pandemic.

Many common mental health conditions may qualify as protected disabilities under the Americans with Disabilities Act, or ADA. Under the ADA, applicants and employees with mental health conditions are entitled to privacy and reasonable accommodations unless this causes an undue hardship for an employer or poses a direct threat of harm to the individual or others.

Failing to comply with these requirements under the ADA could prove to be a costly, avoidable mistake. A jury in western Pennsylvania recently awarded an employee $285,000 in damages ($250,000 of which were punitive) for an employer’s failure to accommodate anxiety and PTSD after an employee sought two additional 10-minute breaks.

To avoid the potential cost of a violation, employers must have a plan to balance the needs of their business with their duties under the ADA. This article will provide the basic do’s and don’ts for employee mental health matters.


When confronted with an employee who may have a mental health condition, an employer should not require an employee to disclose a mental health condition, unless it falls within an exception. In most cases an employer cannot require applicants or employees to disclose a mental health condition. An employer can only ask medical questions, including those relating to mental health, if the situation meets one of four exceptions:

  • An employee asks for a reasonable accommodation
  •  After a job offer has been made but before employment begins, so long as all employees entering the job category are asked the same questions
  • When engaging in affirmative action for people with disabilities
  • If there is objective evidence that the employee is unable to do his or her job or poses a safety risk because of a condition

Withdraw a job offer if a medical exam reveals a mental health condition, unless the exclusion is job-related. If a medical exam reveals the existence of a disability, the employer may only withdraw the offer if it is job-related and consistent with business necessity. The employer must also be able to show that no reasonable accommodation is available.

Share medical information disclosed to the employer, unless it falls within an exception. The ADA requires all medical information concerning psychiatric disabilities to be kept confidential. Employers may only disclose this information in three situations:

  •  Supervisors and managers can be told about necessary restrictions or accommodations.
  • First aid and safety personnel may be told if the disability requires emergency treatment.
  • Government officials investigating ADA compliance may be given relevant information.

Fire an employee because they have a mental health condition. An employer cannot discriminate against an employee simply because they have a mental health condition. However, an employer does not have to hire or retain an individual if there is evidence that even with a reasonable accommodation, the individual cannot perform the functions of the job or poses a safety risk.

Allow others to harass or bully an employee with a mental health condition. Harassment on the basis of having a disability is a form of discrimination under the ADA. If an employee reports the harassment to an employer, the employer is legally required to take prompt steps to end the harassment and prevent it from occurring in

the future.


When confronted with an employee who may have a mental health condition, an employer should:

Build trust with employees. Having an environment that is accepting and understanding of mental health conditions will lead to more employees disclosing conditions and reasonable accommodations being made to obtain the best performance from each employee. An effective Employee Assistance Program and/or Disability

Employee Resource Group can go a long way toward creating a positive climate. Developing a capacity to effectively respond to mental health conditions in the workplace transcends mere legal compliance—it is a key management practice to best utilize your talent.

Carefully examine the job duties to determine what functions are essential before taking an employment action. An employer does not have to hire or retain an employee who cannot perform the essential functions of the position, even with a reasonable accommodation. Whether a particular function is essential can be determined by looking at whether the reason the position exists is to perform that among other functions. Clearly identifying the essential functions of a job, especially before taking actions like hiring, firing, promoting, or recruiting, is crucial to determine the rights of an employee or applicant under the ADA.

Do your best to reasonably accommodate an employee’s mental health conditions, while remembering not every request must be met. Employees with psychiatric disabilities can ask an employer to provide a reasonable accommodation in the form of an adjustment to the job or the work environment. While the employer can take

into consideration an employee’s preferred accommodation, the employer ultimately gets to choose among the effective options. Examples of reasonable accommodations that may be made for employees with mental health conditions include:

  • More frequent reminders of tasks and due dates
  • Quiet office space or use of devices that create a quieter work environment
  • Altered break schedules, time off from work or shift changes
  • Change in management style of the supervisor
  • Attend meetings remotely or work from home
  • Exchange non-essential job duties with another employee
  • Simple physical changes to the workplace
  • Modification of workplace policy

To show a proposed accommodation poses an undue hardship an employer must show it would be unduly expensive, disruptive, or would fundamentally alter the nature of the operation. If a particular accommodation presents an undue hardship, the employer must try to find another accommodation.

Not all employees with mental health issues need accommodations to perform their jobs. For those who do, it is important to keep in mind that the process of developing and implementing accommodations is individualized and should begin with input from the employee. Effective accommodations vary, just as employees’ strengths and job duties vary.

Remember that you can always act when there is a clear safety concern; however, make sure actions taken are grounded in evidence. An employer cannot disregard credible evidence of an employee posing a threat to another employee or the public. The risk to health or safety must be a significant risk of substantial harm and cannot be based on myths or stereotypes. An employer may take a credible safety concern into consideration when deciding whether to hire or retain an employee with a mental health condition.

Require a mental exam if the employee is a clear safety concern. When an employer has an objective reason to believe that an employee poses a clear safety concern, the employer can require the employee to undergo a mental health exam. However, the employer needs to be able to show evidence that is job-related and consistent with business necessity, which should be documented. This standard is met when an employer observes performance issues connected with a known medical condition, has been given reliable information from a credible third party, or observes symptoms indicating an immediate threat to safety.

Benjamin C. Dunlap, Jr. is managing partner at Nauman Smith, a Harrisburg-based law firm, and concentrates his practice on business and employment law.

Uncertainty and isolation trigger a spike in mental health treatments

Will a new normal develop for mental health care insurance coverage as a result of Covid-19?

Better insurance coverage for phone, text and video or telehealth appointments by those seeing mental health care could be driving a spike of calls to clinicians since the coronavirus pandemic. 

“In my opinion there is at least a 20 percent increase, compared to the same period last year, in both our mental health and wellness services,” said Eduardo Espiridion, chairman of the Department of Psychiatry at Reading Hospital Tower Health. Espiridion attributes the spike to fear of coronavirus, joblessness and isolation resulting from stay at home orders.

Health care professionals are connecting an increase in patients to the pandemic which has created a shift aided by health care insurance for services that were not previously covered. The shift has expanded care to more people with the hope at least some of the benefits will become permanent. 

Area clinicians are seeing increased medical insurance reimbursements for telehealth services, too, as well as payment breaks to patients including waived co-pays, co-insurance and deductible fees. 

Televideo and telephone visits, along with virtual appointments have caused an increase in patients attending scheduled visits, said Laura Campbell, interim clinical director of the outpatient behavioral health clinic at Geisinger Medical Center in Danville.

“Patients who might have been no-shows or cancelled their appointments pre-COVID are now able to engage with us and receive the services they need,” she said.

Virtual visits by phone or video link have removed barriers for many patients – from transportation to making childcare arrangements or coordinating work appointment times, she noted. 

According to a recent report by The Washington Post about 50 percent of Americans reported the crisis is impacting their mental health, and a federal emergency hotline handing emotional distress calls reported a 1,000 percent surge in contacts in April.

“I think people are anticipating a spike and the concern is being able to handle it,” said Stacy D. Martin, a licensed psychologist in Hellertown.

Prior to Covid-19, Martin was offering telehealth visits to patients. She said the transition was easy once the crisis began. Since the pandemic and shutdown order by Pennsylvania Gov. Tom Wolf, Martin has retained the majority of her clients and added new ones. 

Because many insurance carriers are waiving co-pays and co-insurance and deductible costs, financial stresses associated with seeking treatment in light of job uncertainty now – and in the future – are lessened, she said.

“Insurance is now all covering phone calls, which they never did before,” Martin said.

From losing family members or friends to the virus, being away from schools and routine and the inability to celebrate milestone occasions like weddings, graduations or significant birthdays, the pandemic was taking a significant toll. 

“It’s a really big loss,” she said.

While some insurance companies were already reimbursing telehealth visits for mental health appointments, the reimbursement amount was at a lower rate than face-to-face reimbursement to practitioners. 

“Now they are reimbursing at the same rate, and the other agencies that didn’t cover it pre-pandemic, there is a huge hope this will continue,” Martin said.

Beyond convenience and flexibility, some patients respond better to telehealth services than in-office visits. “I really think it’s a great model for providing mental health treatment,” she said.

Tripp Carey’s practice was already full and he was not taking new clients prior to the coronavirus outbreak. The licensed psychologist and operator of White Oak Counseling Center in Upper Saucon Township, said some of his colleagues’ practice loads were also full. But oncecoronavirus restrictions were put in place some treatment times opened up.

“Some patients dropped care or did not feel comfortable working electronically,” Carey said.

Some new patients were motivated by the extra stress caused by the pandemic to seek help, and nearly everyone is being treated online despite the state listing mental health care an essential sector for in-person treatment.

“A lot of therapists had never done this – it was a massive shift. Lots of people were learning how to set it up and get it going,” Carey said.

But virtual therapy isn’t a magic solution for everyone. Carey said there are non-verbal cues that are lost online, and some patients don’t have the space in their homes for private appointments right now, with children home from school.

Carey suggested a hybrid model for treatment could emerge after coronavirus, especially if insurance companies continue to pay the same reimbursement fees for telehealth as they do in office visits.

Espiridion said virtual visits at Reading have increased access to mental health services. “It will complement well with the face-to-face visits to increase patient and clinician options. In the era of a pandemic, it is also a very safe way of delivering healthcare services,” he said.

Tower Health started virtual care in ambulatory locations, and all outpatient providers are were furnishing mental health care to new and established patients. 

Telemedicine consultation services to reduce staff exposure to Covid-19 were a way to meet the needs of patients while keeping everyone safer, he said. 

Outreach as a result of virtual communication could also expand services in the region moving forward. 

“This is an additional way to provide mental health services at facilities that don’t have mental health providers on their staff,” Espiridion said.

Lancaster nonprofit provides funds to train future mental health providers

Health care providers in Lancaster County can receive funding to grow their mental health workforce through a new program by the Lancaster Osteopathic Health Foundation.

The Lancaster nonprofit announced on Friday it is accepting applications for up to five organizations that will agree to expand mental health programs with new providers.

The program is a direct response to a high demand for mental health care for youth and children in Lancaster County, the foundation wrote in a press release, noting some providers in the region schedule visits three to four months in advance.

Through the new Clinical Supervision Collaborative, participating organization’s will receive $20,000 to help provide graduates with master’s degrees in social work, psychology or nursing with 2,000 to 3,000 clinical hours they need to become Pennsylvania licensed mental health professionals.

That process can take much longer than expected for organizations that can’t afford to allocate time for supervision.

“There is no equivalent in mental health to a residency program,” said Anna Brendle Kennedy, the foundation’s executive director. “(The students) graduate with a masters, and they are on their own to find clinical supervision. Our goal is to speed up the time from when they graduate with their masters to when they get their license.”

Organization’s receiving funding from the Lancaster Osteopathic Health Foundation will be able to reimburse their supervisors, hire new providers and support the graduates as they earn the hours.

Over the next three years, the program is expected to greatly reduce the time it would take for 20 to 25 mental health care providers to receive their licensure.

“With $20,000 they may only be able to provide a little compensation but we are just trying to provide an incentive,” Kennedy said.

As a part of the collaborative, the organizations participating will also join in monthly webinars and in person meetings to discuss the project and how each organization is increasing their efforts in clinical supervision.

The Clinical Supervision Collaborative is being funded through a matching grant from the Lancaster-based Steinman Foundation, a nonprofit organization funding projects related to early childhood education and workforce development in STEM education.

Through the grant, the Lancaster Osteopathic Health Foundation will receive $50,000 for the next three years that it will match and put towards its new collaborative.

Retreat Behavioral Health to opens treatment center in Connecticut

Ephrata-based Retreat Behavioral Health will open a mental health and substance abuse treatment center in Connecticut next week.

The Lancaster County health care system operates inpatient treatment centers in Lancaster County and Palm Springs, Florida. The new center, opening Jan. 9, in New Haven, Connecticut, will be its third.

The new facility is approximately 53,000 square feet, has 80 beds and is Retreat’s first inpatient facility built with mental health services in mind.

Formerly known as Retreat Premier Addiction Treatment Centers, Retreat rebranded itself early last year after meeting the requirements to offer mental health services at its facilities.

Connecticut was chosen for its newest facility because of the state’s high death rates from opioids, which were at a rate of 27.7 deaths per 100,000 people in 2017,  twice the national average.

“We are prepared to hit the ground running in Connecticut to provide some relief to those who are suffering,” said Peter Schorr, Retreat Behavioral Health President and CEO. “With high-quality, affordable care, we aim to address the opioid epidemic, as well as all other growing substance abuse and mental health issues. By providing individualized care, a peaceful environment, and affordable treatment offerings, we aim to become the leading resource for this region.”

The new center will offer services such as rehabilitation, detox, intensive outpatient care and holistic therapy. Retreat’s new mental health services branch, Synergy Health Programs, will also offer services for mental health disorders like PTSD, depression and bipolar disorder from the center.

Hershey pediatric psychology practice focuses on mental health, movement disorders

Dr. Timothy Zeiger recently opened a pediatrics mental health practice in Derry Township, Dauphin County.

A former Penn State Health clinical psychologist opened a new practice in Derry Township focused on pediatric mental health.

Dr. Timothy Zeiger was a faculty member at the Milton S. Hershey Medical Center for seven years prior to leaving last year to pursue his own psychology practice.

Zeiger specializes in cognitive behavioral therapy for anxiety and depressive disorders in pediatric patients and recently opened his new office at 1512 East Caracas Avenue in Hershey.

Zeiger offers treatment to children and adolescents dealing with Obsessive Compulsive Disorder, tics, Tourette Syndrome, movement disorders, anxiety and depression. He said providers offering treatments for Tourette Syndrome and movement disorders are scarce and that he is already seeing interest from parents from as far as State College, Reading and western Pennsylvania.

“There is quite a large population of patients with tics and Tourette’s and nowhere to get this therapy, so I am proud and honored to provide this valuable and much needed service,” Zeiger said.

The new practice allows Zeiger to focus solely on clinical treatment, which he said wasn’t possible at the medical center where faculty must also provide research and train medical students.

Stigmas associated with mental health have declined in recent years, and Zeiger said he believes his practice will need to grow as more parents seek mental health care for their children.

“We are gradually overcoming those barriers and, as a result, people aren’t ashamed of mental health treatment,” he said. “More families are reaching out for help and, as a result, the number of patients outweigh the number of providers.”