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University Gazette

The University of North Carolina at Chapel Hill

School reaches out through research to serve the state’s mental health providers

No one speaks as openly about depression as they do high blood pressure, or about alcoholism as freely as diabetes.

But more than a quarter of individuals will face a mental illness or substance abuse issue in the course of a year, said Tara Bohley, clinical assistant professor and program coordinator of the Behavioral Healthcare Resource Program (BHRP) at the School of Social Work.

The BHRP helps increase the state’s capacity to treat a population that is often misunderstood or overlooked.

“The odds are, if you aren’t experiencing it, you know someone who is,” said Bohley.

For two decades, BHRP, which contracts with the state through the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services, has provided training and technical assistance, consulting, online models and face-to-face outreach to mental illness and substance abuse providers in North Carolina.

Bringing to them the latest research and evidence-based practices can help them guide patients to long-lasting recovery, said Kim Strom-Gottfried, principal investigator at BHRP and Smith P. Theimann, Jr. Distinguished Professor for Ethical and Professional Practice.

What was once a confrontational, punitive model of treatment has changed over the years, and BHRP has worked to communicate that sea change in care, she said.

“The confrontational model engendered defensiveness, where a motivational approach recognizes that there is ambivalence in all change, and it helps people come to that change through empathy and reflective communication,” said Strom-Gottfried.

BHRP’s trainers have worked with all of North Carolina’s 100 counties, especially those in the eastern and western parts of the state, which have historically had the fewest resources to meet their needs.

“People in those areas will drive for hours to get to the training,” Bohley said. “They want to help people in their communities, and it’s important to match them with the proper resources.”

The impact is reciprocal, said Strom-Gottfried.

“The feedback we get from the state informs our notion of what the challenges are for providers and how we can make curricular changes at the School of Social Work to reflect that,” she said.

Reach one, teach one

BHRP’s training programs expand the capacity for individuals to receive mental health and substance abuse services, Bohley said. A recent report from BHRP estimated that the programs touch 14,000 North Carolinians each year.

“It has a real ‘reach one, teach one,’ effect,” said Strom-Gottfried.

One model is SBIRT, which stands for Screening, Brief Intervention and Referral to Treatment. General practitioners are encouraged to use SBIRT to screen for behaviors that could affect the physical health of their patients.  

“When doctors and nurses recognize that substance abuse and mental health issues are part of someone’s life, and ask related questions, they may find someone who hasn’t had an opportunity to talk about it in a secure way,” said Bohley. “We’re not asking them to be therapists, just to connect that patient to someone who can help.”

BHRP not only enlists caregivers, it also uses a peer network of people who are in recovery to help others with mental health and substance abuse issues. The program coordinates the certification for the division’s Peer-Support Specialist program, which has placed more than 800 peer-support specialists throughout the state.

The specialists, who are screened by the school, complete 40-hour training programs and they work in treatment settings along with clinicians and other support staff to help people struggling with recovery.

“This is someone who has walked the walk, who can relate to someone on their level, but also communicate with clinicians and family members,” Bohley said. “And, this is an opportunity for them to make something out of their experiences.”

Mental Health First Aid

Most people have a basic idea of how to help someone in physical distress, but not mental distress. They might not recognize the signs of depression or anxiety, or an eating disorder, or know the difference between self-injury and a suicide attempt.

That’s where the worldwide curriculum Mental Health First Aid comes in, Bohley said.

“The training provides education around the main categories of mental illness and substance abuse to laypeople, to people who are not providing treatment, but who are likely to come in contact with someone who has an emerging mental illness,” she said.

BHRP will sponsor its first official training and certification later this month in Chapel Hill. The 12-hour curriculum will certify an individual to provide mental health first aid to anyone they believe needs help, much like CPR training, and the school’s hope is one day to have as many people trained in that model as they are in CPR.

“This is about empowering people to know how to respond to someone and not be afraid, to not turn away or make fun of someone in a crisis. You may be the person who can intervene and stop something terrible from happening,” said Strom-Gottfried.

Positioned to help

The fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders is forthcoming, and BHRP is working on a podcast that can help users navigate the text’s changes.

Knowing about the latest research and innovations in effective treatment is key, Strom-Gottfried said, but saving lives is all about connecting with the end user and influencing the uptake of research.

“We’re fortunate that we have this wealth of knowledge at the school,” she said. “We also have these links out into the world to help others understand that knowledge and use it.”