Why Alaska Needs Medicaid Expansion

Alaska is a popular destination for many travelers who are looking to experience the outdoors in its most pure and intended state. The snow-capped mountains, breathtaking glaciers and extraordinary wildlife give the individual a glimpse into nature unparalleled any place else within the U.S. Yet, behind the beauty and splendor of this beautiful state lays unsettling facts concerning mental health and the access to care. Alaska has the highest rate of suicide per capita in the country. The rate of suicide in the United States was 11.5 suicides per 100,000 people in 2007 with Alaska’s rate of 21.8 per 100,000; Alaskan Natives were 35.1 per 100,000. The Suicide Prevention Resource Center reports that 78% of individuals who have suicided are men, 22% women. Alaskan Native men between the ages of 15-24 have the highest rate of suicide among any demographic in the country with an average of 141.6 suicides per 100,000 each year. Suicide deaths consistently outnumber homicide deaths three to two and 90% of people who die by suicide have depression, treatable mental health or substance abuse disorders according to the American Association of Suicidology.

On July 19, 2015 Alaskan Governor Bill Walker announced plans for Alaska to become the 30th state to expand Medicaid coverage which would provide benefits to hard-working families, young adults, veterans and more. Walker provided a 45-day notice of his intention to accept additional Federal and Mental Health Trust Fund Authority money to expand Alaska’s Medicaid. Expanding Medicaid would bring $146 million to the state in its first year and provide health care to more than 20,000 working Alaskans. DHSS reports that nearly 42,000 Alaskans will be eligible for expansion with approximately 21,000 expected to enroll in the first year. Additionally, Medicaid expansion would reduce state spending by $6.6 million in the first year with more savings to the state’s general fund. Governor Walker states, “Every day that we fail to act, Alaska loses out on $400,000. With a nearly $3 billion budget deficit it would be foolish for us to pass up that kind of boost to Alaska’s economy”. A major supporter of Alaskan Medicaid expansion is the Mat-Su Health Foundation that has a goal to help Mat-Su become the healthiest borough in the U.S. In an article published in the Mat-Su Valley Frontiersman on July 20th, Mat-SU Executive Director Elizabeth Ripley stresses the need for improved access to health care, managing chronic diseases and preventing unnecessary hospitalizations. Ripley points out that mortality rates in expansion states have declined compared to non-expansion states. Will Medicaid expansion reduce the suicide rate in Alaska? Only time will tell. But it is clear that the need and want for a mentally and financially secure Alaska is a top priority for its Governor, and, over 150 agencies that would be able to provide additional resources to our nation’s number one per capita suicide hot spot.

News Resources:

Office of Alaska Gov. Bill Walker www.gov.state.ak.us

Legislative Budget and Audit Committee Chairman Rep. Mike Hawker (R) www.housemajority.org

Department of Health and Social Services http://dhss.alaska.gov

Americans for Prosperity Alaska www.americansforprosperity.org Alaska Senate Majority www.akleg.gov

Alaska House Majority www.housemajority.org

“Thank you Gov. Walker, for expanding health for more Alaskans” www.frontiersman.com

Why do we have PRIDE Month?

June is a special time of year. For students, many are finally out of school for the summer and spending time with family and friends. For most, it’s a time for relaxation and enjoying the summer months. However, June has special significant for the LGBTQ community. Beginning in 1981, the month of June has been dedicated to the celebration of the lives of gay and lesbian people in the United States. A Pride Festival has taken place every year since which gives gay and lesbian people the opportunity to celebrate who they have become, and to be publicly proud without shame or discrimination. The goal of Pride Month is to foster an understanding and equality for the LGBTQ community in the general population by raising awareness through educational programs and events.

Pride Month exists to fight against the ideological system known as heterosexism. Heterosexism is commonly defined as an ideological system that denies, denigrates, and stigmatizes any non-heterosexual forms of behavior, identity, relationships, and community. Heterosexism should be noted because it advances the superiority of heterosexuality with the assumption that everyone is, or should be, heterosexual and abide by heteronormativity—the mundane, everyday ways that heterosexuality is privileged and taken for granted as normal and natural. Simply put, heterosexism is the belief that heterosexual relationships are the only acceptable form of sexual relationship. In fact, as of 1973, homosexuality remained listed as a mental disorder in the Diagnostic and Statistical Manual. Even with this change, many people still regard LBTQ as a social deviance.

Negative attitudes towards those who consider themselves homosexual have been common throughout history. From a sociological understanding, individuals go through ways of changing themselves in order to be more socially accepted. Ways in which this is commonly done include career successes, making a joke or mockery of transgressions, or propping up masculinity/femininity in other ways. In order to fit in with others and feel accepted by heterosexual peers, many LGBTQ individuals feel they must meet high expectations or prove themselves in some way. These high expectations cause many individuals to feel insecure about themselves, and as a result, are forced to pretend to be someone that they are not. Many LGBTQ individuals from a religious background have undergone “reparative therapy” which included the psychological and therapeutic interventions whose aim is to change the orientation of lesbian, gay, and bisexual individuals to that of an orientation which is primarily heterosexual. While the form of discrimination may vary, it sends a solid message that says: “there is something wrong with you- you are ‘less than.’

Pride Month is an opportunity for people in the United States to recognize, appreciate and celebrate those in the LGBTQ population. BHR Worldwide exists to support and assist individuals in crisis and seeks to celebrate the LBGTQ population for who they are, understand the trials that they have faced and support them in their fight for equality.

Author: Seth Showalter, MSW, LMSW

Are Traumatic Brain Injuries Increasing Veteran Suicides?

One of the greatest risks to returning service members in the United States is the lack of mental health care services. There is a far greater risk of becoming a psychological casualty of war than actually being killed on the battle field. Approximately 2.6 million American service members have fought in Iraq or Afghanistan alone adding 1.5 million veterans to the pool of those needing VA health care services since 2001. At least 20% of returning Iraq and Afghanistan veterans are experiencing PTSD, and the rate of veterans dying by suicide is estimated to be at 22 per day. During my lunch break today, which is not during a peak time as I work very early, I attempted to schedule a mental health appointment at my local VA Hospital. I waited an extensive amount of time before being transferred back to the operator and then finally being disconnected; deep breaths. Luckily for me I was not in need of crisis services and was just trying to gather research for this article. But, had I been in a place where the more “colorful” symptoms of my PTSD were present this could have gone another way. Yes, I am a veteran and am writing this from lived experiences acquired during my 6 year tenure of service, 1999-2005; when I was deployed in support of Operation Enduring Freedom.
An estimated 250,000 veterans living with Traumatic Brain Injuries (TBI) have been identified since 9/11; the VA began mandatory TBI screenings in 2007. The TBI is often called the “signature wound” of the Iraq and Afghanistan wars and occurs when a sudden trauma or head injury disrupts the functions of the brain. Often times these injuries are associated with explosives blasts (IEDs), falls or motor vehicle accidents. A TBI can happen at any point where the head has been struck hard enough by an object that would change consciousness resulting in disorientation and confusion. The vast majority of TBI’s are sustained by Army soldiers and are reported as MTBI’s (mild) which research is finding may lead to more suicidal thoughts that more severe TBI’s.

Many people are familiar with concussion related injuries suffered by NFL athletes, but little is known by the American public about the effects on the American soldier’s mental health after suffering a TBI. In fact, little is known to the public of the effect of TBI’s on athlete’s mental health. Last season, Ohio State football player Kosta Karageorge, 22, suicided after suffering a string of concussions that his family reported were “affecting his mind”. Karageorge was a college wrestler before joining the football team and had no known history of mental illness prior to taking his life. Many believe that the increase in veteran suicides are in direct correlation with the “signature wound” of today’s modern warfare; the TBI.

A study conducted by Craig Bryan, assistant professor of psychology at the University of Utah and associate director of the National Center for Veterans Studies found that military members with multiple TBI’s were more likely to be at risk for suicide ,not only in the short term but throughout their life. Many of these military members sustained early TBI’s from athletics and then compounded their injuries by entering military training or combat. Bryan studied active-duty soldiers in Iraq in 2009 finding that over one in five, 22%, who experienced more than one TBI in their life time reported thoughts or preoccupation with suicide. The rate for soldiers with only one TBI was 6%. The rate of suicide thought occurrence among military members with multiple TBI events was 267% higher than those with only one TBI event. Those with no history of TBI reported no suicidal thoughts. Some of the members that took part in this study had up to six reported TBI’s before joining the military with 20% sustaining concussions during basic training. Bryan states that theses earlier injuries can create a “preexisting vulnerability that gets activated” by another head injury sustained in combat. According to VA research, some service members have sustained as many as 15 traumatic brain injuries while per deployment deployed with the modern day service member completing three overseas tours of duty. Other opportunities for TBI exist between deployments due to excessive and rigorous training schedules and leadership academies.

The Veterans Health Administration has a Polytrauma System of Care to treat and care for veterans with TBI alone or in in conjunction with other mental or physical health care needs. For more information on military TBI, please visit military.com at http://www.military.com/benefits/veterans-health-care/tbi-rehabilitation.html or check out the list or resources provided below. Please note these resources are not provided in lieu of medical advice and 911 should always be called for a medical emergency.

Follow on Twitter:@BartAndrews

#SPSM #zerosuicide

Veterans Crisis Line: Option 1: 1-800-273-8255

AMVETS (To get help with your VA Disability) : 877-726-8387

Request a free copy of your form DD 214 (Military Separation Papers) http://freedd214.com/reference/FreeDD214_SF180.pdf

Wounded Warrior Project: Clay Hunt Suicide Prevention Project: https://www.woundedwarriorproject.org/featured-campaign/president-obama-signs-into-law-


BHR Chosen to participate in Give STL Day 5/5/2015

On Tuesday, May 5 2015 , be part of Give STL Day and make a difference in St. Louis by donating to the BHR Crisis Lines.

Give STL Day is a 24-hour giving event with local impact. BHR is raising funds to support staff self-care and will sponsor a self-care week in July which will include a variety of resources supporting the well-being of BHR staff. BHR is manned 24/7 and does not close for inclement weather, holidays or other events because we know that a crisis is not limited to business hours. Our clinicians are always available to respond to crisis and work collaboratively with schools, parents, law enforcement and beyond to provide our customers with the level of care that they need and deserve. The management staff at BHR strives to work with clinicians and staff to support their needs and understands the emotional toll that helping others can have. Clinicians in the helping professions can experience compassion fatigue and burn out and we are constantly exploring new tools and approaches to remain emotionally and clinically healthy.

Recently, HBO created a documentary entitled Crisis Hotline: Veterans Push 1. This documentary gives powerful insight into the real emotions that call center clinicians face on a daily basis. Information on this documentary can be found at http://www.hbo.com/documentaries/crisis-hotline-veterans-press-1/synopsis.html#/.

With your help, we can provide our clinicians with additional tools to continue their engagements in selfcare so we can also continue to carry out our mission to care, listen, and respond 24 hours a day.


Author: Allison Alsop, MA, PLPC






Should Pro-Eating Disorder Websites Be Banned?

Eating disorders such as anorexia and bulimia are nothing new, but pro-eating disorder websites and blogs that promote anorexia (proAna) and bulimia (proMia) have flooded social media sites such as Tumblr, Twitter and Instagram with a fury. The premise for many of these blogs is to gain support from other individuals not to eat, to severely restrict their calories, or to share tips for binging and purging . The majority of the posters to these sites are adolescent females, but women of all ages and adolescent males are starting to post at alarming rates. Common pictures posted to “thinspiration” or “thinspro” sites include young, model-esque girls wearing next to nothing appearing emaciated, or disturbing quotes such as “I wish I was beautiful” or “When the bones start to show, it doesn’t mean you’re skinny, it means there’s more to lose.” Posters share their desires to have the coveted thigh gap (Google it), flat tummys, and protruding cheek bones. One of the most popular, and damaging, eating disorder sites I came across was theproanalifestyleforever.wordpress.com .The author disguises her eating disorder site as a religion & lifestyle site and is adamant that she does not encourage harmful behaviors. Upon reading through her “Thin Commandments” (posted below) and seeing advice to only eat Tums or drink apple cider vinegar if you are hungry I would have to respectfully disagree. You may think that her “Thin Commandments” are ridiculous, stupid or even childish, however the authors young readers are posting comments such as, “Inspirational, life changing, and motivational”. It is unfortunate, but many adolescents are learning about eating disorders through social media forums before we ever have the chance to reach them first.

Thin Commandments

1) If you aren’t thin, you aren’t attractive
2) Being thin is more important than being healthy
3) You must buy clothes, cut your hair, take laxatives, anything to make yourself look thinner
4) Thou shall not eat without feeling guilty
5) Thou shall not eat fattening food without punishing afterwards
6) Thou shall count calories and restrict intake accordingly
7) What the scale says is the most important thing
8) Losing weight is good, gaining weight is bad
9) You can never be too thin
10) Being thin and not eating are signs of true will power and success.

Why I starve myself

  • Because I can
  • Because I’m the hunger artist
  • Because I want to
  • Because if I can accomplish this, I can do anything!

If you are working with a client who is struggling with ED, or have a child with ED, ask them if they have ever spent any time on pro-eating disorder media sites! If you find pro Ana or Mia searches in your child’s search history, this could be an early warning sign of an eating disorder and a icebreaker to have this discussion. Common hash tags used by the thinspo community include #thinspo #proana #promia #thinspiration #proanorexia #probulimia #skinnyispretty #anorexiaprobs .These sites are packaged to be inspirational, motivating and encouraging. The colors are vibrant and attractive and more often than not created by a girl that many of us would have wanted to have been when we were younger. The sites are not getting hundreds of views they are getting MILLIONS. And what is worse, many of them have ad sponsorships on them which means the adolescents that are creating them are now getting monetary validation by adults to keep these pages up and running. Should these pages be allowed to exist? Are we doing enough as clinicians, parents and educators to educate the masses about the dangers of thinspro?



Author: Allison Alsop, MA, PLPC

What is a Crisis?

Have you ever lost your car key’s when you were short on time and being late was just not an option? Maybe you felt symptoms of anxiety to include racing heart, confusion and even panic. Would losing car keys qualify as a crisis? To answer this question we must first define the very term “crisis”. One definition of a crisis is “any situation that exceeds a person’s ability to cope.” For some people, losing their car keys can be a frustrating event that causes irritation, but for other’s this could be a very real and true crisis for them. Two people who are experiencing the very same scenario can react to the event in very differing ways depending on their abilities to cope and the tools they have in place to handle  a crisis. While losing car keys may cause intense frustration for one person, this same scenario could be the catalyst that leads to suicidal ideation or triggers a relapse in another. When contemplating the need for having a masters level clinician assisting your clientele picture the employee who has just missed their shift at work due to not having transportation as they could not find their car keys. They may be a single parent who needs every dollar to survive, or they may have already missed work and are on probation with their employer. Is this a crisis? Would having a trained counselor be optimal for this client?  The expertly trained  clinicians at BHR Worldwide are equipped and ready to respond to any situation or crisis in order to link client’s to the appropriate resources, or to respond at the level needed depending on the client’s individual needs. Clinician’s at BHR Worldwide are ready to assist your client’s with their current needs in order to de-escalate a crisis or to assist them with linking to you to minimize current and future crisis needs.  Client’s can take comfort that they are able to reach a highly skilled and educated clinician 24/7 as they understand that a crisis can happen at any hour and on any day of the year. Your client’s will benefit and take comfort in knowing that the clinicians at BHR Worldwide are ready to assist whenever they have exceeded their ability to cope.

Author: Allison Alsop, MA, PLPC

"I just need someone to listen."
“I didn’t know who else to call”.


Mental Health First Aid is a groundbreaking public education program that helps the public identify, understand, and respond to signs of mental illnesses and substance use disorders. Mental Health First Aid is offered in the form of an interactive 12-hour course that presents an overview of mental illness and substance use disorders in the U.S. and introduces participants to risk factors and warning signs of mental health problems, builds understanding of their impact, and overviews common treatments. Learn More about MHFA.

Interested in bringing Mental Health First Aid training to your organization or business?

As a service to the community, the Children’s Service Fund in partnership with BHR is offering this training FREEof charge to individuals who live in St. Louis County, work in St. Louis County, and/or serve/interact with St. Louis County children and youth on a regular basis. Email trainings@bhrworldwide.com to set one up.

CLICK HERE To view dates and availability for upcoming Mental Health First Aid Trainings.

MHFA Training Registration Form


Mental Health First Aid Flyer


Children’s Service Fund MHFA page