9/11 Mental Health: What We Now Know About Trauma

By Catherine Pearson, Huffington Post

In the days following 9/11, scores of mental health professionals and grief counselors rushed to directly-impacted areas, hoping to help people cope with the traumatic event.

Many gathered groups together -- asking survivors how they felt, what they thought and what the worst part of their experience was before providing them with basic stress management.

But in the 10 years since 9/11, many have abandoned the approach -- known as psychological or crisis debriefing -- in light of studies suggesting it does little to prevent post-traumatic stress. Instead, a growing number of psychologists support a new approach to helping children and adults who show signs of distress immediately after disasters: "Psychological First Aid."

In a new report published in a special 9/11 anniversary issue of the journal American Psychologist, Dr. Patricia Watson, a senior education specialist with the National Center for PTSD, and her co-authors explain the goal of the method is to reduce distress while linking survivors with key outside services. It is meant to be flexible -- highly specific and sensitive to factors including timing, age and an individual's personal preferences.

"Prior to PFA being routinely used, oftentimes providers would swoop in and try to 'help' everyone," Watson told HuffPost. "Implying that a disaster survivor 'needs' interventions in order to recover implies that they don't have the resources to recover on their own. They may accept this help, which actually removes an opportunity for them to work out their problems on their own."

The term Psychological First Aid has been used to describe a number of approaches over the years, but the National Child Traumatic Stress Network and National Center for PTSD (with which Watson works) codified a comprehensive model and operations guide, which can be used by all manner of providers including disaster response workers, in the years following 9/11 and other disasters like Hurricane Katrina.

That guide spells out eight areas of focus, including how to make initial contact and engage people in a non-intrusive way, how to calm disoriented survivors, how to help address their immediate concerns and how to point them towards services they might need down the road.

The method is highly adaptable, Watson explained. If providers only have a few minutes with an individual, they might focus on addressing immediate needs; if it is a week or two after a disaster and they have more time, they might run through all eight areas -- if they determine the individual needs them.

The real key to PFA, she said, is that it is not a one-size-fits-all approach to immediate post-disaster intervention.

"It is pretty common sense," said HuffPost blogger Dr. Lloyd Sederer, medical director of the New York State Office of Mental Health. In a blog post, he hailed the response to 9/11 as "the largest and most effective" mental health disaster responses in history, but explained that debriefing posed certain risks.

"There was this idea that you are supposed to talk about something in the immediate wake of it, but people process trauma differently," he said.

Indeed, Watson said providers should remember not to assume that everyone exposed to a disaster will actually be traumatized by it. In an essay introducing the special edition of American Psychologist, Roxanne Cohen Silver, a psychologist at the University of California at Irvine, explained that, while studies suggest the mental health impact of 9/11 may have been broader than anticipated, Americans also proved more resilient than many mental health professionals predicted.

"It became very clear after 9/11 that the impact of communal and collective trauma spilled over beyond the directly-impacted communities in New York City, Washington, D.C., and Pennsylvania," Silver said. "But in general, the message was one of resilience, rather than psychopathology. We saw normal reactions to an abnormal event."

Watson tweaked that message slightly, saying that what resulted were "understandable" or "expected" reactions to an abnormal event. PSA -- which she and her co-authors explain has not yet been systemically studied -- attempts to avoid labeling acute, immediate reactions as symptoms or disorders.

"It is not rocket science," said Watson. "It is trying to make a complete framework for intervening that is very conversational, very partner-oriented and very, very practical."

What is keeping us from treating mental health like physical health?

Mental health and addiction issues touch all of us.

This year, one in four Americans will experience a diagnosable mental illness -- disorders including depression, anxiety, bipolar disorder and addiction.
Unfortunately, only one in three of these people will seek the treatment and support they need, jeopardizing their physical health and quality of life.

May is Mental Health Month, a special annual commemoration that began
more than 60 years ago to raise awareness of mental health conditions
and mental wellness for all. It is an ideal time for us to reflect on how far we have come since the first Mental Health Month was celebrated and look toward the future.

Without a doubt, mental health care has changed dramatically in the last six decades. Where a mental health disorder was once a hopeless situation -- a source of shame that meant institutionalization -- people today have access to effective treatments and programs that allow them to get their lives back.

We have unprecedented tools to diagnose and treat even severe mental illnesses. Socially, we have come a long way as well. Legislators are more aware of how mental illness affects our communities, and the vital need for strong funding and infrastructure in mental health care.

More and more, we are seeing public figures coming forward to discuss their personal and familial battles with many mental health and addiction disorders. These stories inspire hope and promote early intervention and treatment.

We've advanced mental health care significantly, but we still have work to do to see that those who need help and support receive it. Data shows that mental health conditions are responsible for more disability than chronic diseases like arthritis and diabetes.

Two-thirds of all visits to family physicians are due to stress-related symptoms. High levels of stress have been found to predict heart
disease, the world's leading cause of death, more often than high cholesterol, cigarette smoking or obesity.

People with depression are more likely to develop diabetes than those without symptoms of depression. Serious mental illnesses can shorten a person's lifespan by up to 25 years.

With these staggering statistics in mind, we have to ask: Why do two-thirds of those in need of mental health support and treatment never seek help? We would never leave a broken limb unattended or allow a loved one to suffer with unmanaged diabetes. What is keeping us from treating our mental health in the same way that we treat our physical health?

The answers to these questions are rooted in our attitudes about mental health. Many in our society cling to long-held beliefs that mental health and addiction disorders are a result of socioeconomic status, character flaws, bad parenting, growing up or growing older. Others mistakenly believe that those who have mental health and addiction disorders can never recover.

We can correct these misperceptions.

This community has been a wonderful supporter of mental health providers and many residents have been advocates for their friends and family members who are working toward recovery in their lives. Let's take the opportunity that Mental Health Month provides to talk openly and honestly about mental health. Together, we can close the gap between those who need care and those who receive it.

Article by Suzanne Koesel is CEO of Centerstone of Indiana. She may be reached at suzanne.koesel@centerstone.org. The Centerstone crisis line is available 24 hours a day, 7 days a week at (800) 344-8802 for anyone seeking help.

Never Going Back: Memories of A Suicide Attempt by Amy Kiel

It’s a bit daunting to say the word “never”, especially when we are referring to depression. Depression has an element of surprise and the benefit of disguise in it’s arsenal, but there is a part of me that believes I never have to go back, that I never will experience the darkest depths of depression ever again.

My Most Trying Times With Depression

I look back on some of my most trying times with depression now and I see that I have come so far. Even though I still struggle with the daily challenges of living with chronic depression, the worst of times from my memory are behind me. It was almost 5 years ago that I lay in bed one summer day crying and tormented by my mental pain and anguish, struggling with the decision of whether or not to take my own life.

I had been recently diagnosed with fibromyalgia and the physical pain I was in daily was intense. I had become a person that I never wanted to be. I felt completely useless to my family, my friends and to the world. I believed in my mind that day that the world would be better served without me in it. Even though I believed this to be true, I was still scared and a bit uncertain. So, in my bed, in my own quiet world, my family in the living room beyond, I grappled with spiritual beliefs and weighed the pros and cons. As the pain in my mind became too great I picked up my prescription bottle and began swallowing pills. One pill at a time with a sip of water. I counted each one. I took them deliberately and a bit slowly. I wrote a letter to my family. I apologized for leaving them, but reassured them that life would be better without me.

My Saving Grace From Suicide

I swallowed the thirteenth pill and shortly after my daughter came into my room. She was seven years old at the time. She asked me what was wrong and I asked her if she could get me more water, I had just run out. Her appearance in my room perhaps saved me or perhaps I saved myself because of her appearance. I somehow realized, upon seeing her, that I had to stop taking those pills. She was, before that day, an angel to me and she has been one ever since. I asked my little girl to get my husband. When he came to the room I handed him the letter, I did not know what to say. He read the letter and looked at me, saw the pill bottle and went to call my mother who lived close by. Someone called 911.

The experience from there only became more chaotic. I can barely stand to think of it for it makes my stomach turn so much. The dark black color of the charcoal, the tube in my nose and throat, it was unwelcome and yet necessary to avoid any damage to my body from the pills I had swallowed.

The psychiatric unit I was taken to was cold. The bathroom tiles were icy and hard. I was crumpled on the floor, ill from the charcoal, now vomiting and cramping. It was an experience I will never forget and pray no one ever has to experience. I cried and moaned. No one heard me. The next day I awoke, alive and well, but very grumpy. I was definitely not happy to be there. I wanted to go home. I wanted the nightmare to be over. I just wanted the pain to stop.

No Vacancy for Suicide

Five years later, I am here tell you, that I will never go back to that emotional place again. I may struggle with severe depression in my lifetime, as depression seems quite fond of me. It is honestly difficult to say “never”, but I know in my heart that I will not allow myself to get that low again before I seek help and let someone know that I am thinking suicidal thoughts. It is not an option to consider. It has been wiped from any list I might have of solutions to despair. It has been a remarkable road to here and while I cannot say that I have all the power over depression, I can say that there is no room for it here. When it comes to suicidal thoughts, there is simply no vacancy.

If you or someone you care about is in crisis, please visit Visit the National Suicide Prevention Lifeline or call 800-273-TALK. There is help available.

Kennedy Launches Initiative to Promote Brain Research

APA has joined an impressive list of government officials, mental health advocacy groups and experts, scientists, and clinicians to launch former Congressman Patrick Kennedy's campaign to support the development of effective new treatments for neurological and mental disorders and dramatically increase funding for and coordination of brain research.

The American Psychiatric Foundation has stepped up with a $50,000 grant to support the conference that will launch the campaign, known as “The Next Frontier: One Mind for the Brain.” The conference will be hosted by the Massachusetts General Hospital Starr Center from May 23 to 25. Co-chairs Kennedy and Garen Staglin are referring to the Next Frontier campaign as a “moonshot to the mind,” and its goal is to map what Kennedy calls the “inner space of the mind” within the next decade…

During 16 years in the U.S. House of Representatives, Kennedy wrote and co-sponsored dozens of bills on issues related to mental illness and improving the lives of people with psychiatric disorders. Also, he used his position and profile to raise understanding of these disorders, including speaking openly about his own battles with mental illness and those of his family.

Read the full article by Richard Faust at Psychiatry Online
and learn more about The Next Frontier at Moonshot.org.

Seven graduate from the Center for Mental Health's Peer Employment Training Program

The Center for Mental Health celebrated a milestone on March 18 when seven people graduated from the Peer Employment Training Program.

Peer specialists use their life experiences with mental illness, as well as recovery knowledge and skills, to support other people recovering from serious mental illness, such as schizophrenia, bipolar disorder, major depression or PTSD.

PET program graduates, Sonja Letz, William Gange, Virginia Carnes, Joseph Olson, Kelli Jackson and Frans Swier, can apply for jobs and join other peer specialists already employed by the center.

Peer Employment Training is an 80-hour college level course that includes homework each night, a midterm and a final exam.

For many, severe and disabling mental illnesses have prevented them from working for many years, so the program also serves as a transition back to the world of work.

"The peer specialists have really enriched our services," said Center for Mental Health Foundation Director Heidi Gibson. "They can intercept people who walk in with a mental health crisis, and their expertise helps prevent the crisis from escalating. Early intervention means people need fewer services down the road."

All participants must first complete Wellness Recovery Action Plan training so that they can develop their own self-care strategy.

"Recovery doesn't mean they're 'cured,' " CMH interim CEO Sydney Blair said. "It means mental illness is no longer the biggest thing in their life. It means they can dream again about having a very full life. People can, and do, get better."

For information about graduation or opportunities for upcoming trainings, call Peer Support at 727-4315 or send an email to peersupport@center4mh.org.

How Depression Dulls the World—Literally

The condition seems to affect how our senses work, and researchers may one day use this to make an objective diagnosis of depression.

A sad person who says that the world looks dull and gray and that flowers no longer smell so sweet may not just be speaking figuratively. Two recent studies from Germany provide evidence that sensory perception is diminished in depressed individuals.

To determine if depression has an effect on vision, neuropsychiatrist Ludger Tebartz van Elst of the University of Freiburg hooked up depressed patients and control subjects to a pattern electroretinograph, a device that measures electrical signals in the retina. When viewing black-and-white checkerboard images, people with depression showed markedly reduced electrical responses.

The effect may originate in the retina’s amacrine cells, which feed sensory input to the neurons in the eye. Amacrine cells rely on the neurotransmitter dopamine to function, and mood disorders have been linked to dopamine dysfunctions in the brain. Tebartz van Elst believes the visual response test could serve as an objective measure for establishing a diagnosis of depression: “The patients don’t have to say anything at all—they just keep their eyes open,” he says.

Separately, otorhinolaryngologist Thomas Hummel of the University of Dresden Medical School explored odor perception in depressed patients. Compared with control subjects, he found, people suffering from depression were less able to detect weak smells; MRI scans revealed that they had smaller olfactory bulbs, the brain structures involved in odor perception. Both Hummel and Tebartz van Elst next plan to investigate whether the successful treatment of depression restores the richness of the senses.

Via Discover Magazine article by Eliza Strickland

Free Depression or Bipolar Disorder Monitoring Program Available to Consumers

Free Depression or Bipolar Disorder Monitoring Program Available to Consumers

Consumers with depression or bipolar disorder, being treated by a primary care physician, may benefit from additional monitoring by a trained pharmacist.

The program is seeking participation by consumers with depression or bipolar disorder. The program is funded by a grant funded by the Montana Department of Health and Human Services and is free to consumers. Patients receive a complete review of all of their medications, education brochures, and monitoring for the effects of their illness. All information collected is sent back to the primary care physician for review and interpretation.

To qualify, consumers must be on four or more medications, which can include over the counter or herbal medicines. Medications are not provided. Trained pharmacists are currently available in Billings, Roundup, Kalispell, and Lewistown or by Skype.

For more information please call Carla Cobb at 406-670-3722 or Dee Holley at 406-896-8805.

Innovative ways to move forward during budget cuts

A guest blog by Corinna West of CorinnaWest.com

At least 46 states have now cut budgets that help vulnerable low income people, especially those of us with mental illness. In times of struggle, it’s easy to hunker down and try to keep doing the same things we have always been doing, just with less money. I personally think we need to do more than just stick out our hands out and say, “Please don’t cut us… Please.” However, another way out of our difficulty is to find radically new ways of doing things that cost significantly less money while providing even higher quality results. Here are a couple of key suggestions for how we can keep high quality community health care even during budget cuts.

* Recognize the community mental health centers as sources of innovation and progress. In Kansas and Missouri, the states in which I work, they are the only providers of medicaid billable peer support, assertive community outreach, case management, and employment services. Although many people think that private health care is preferable, in the mental health system it might not be. The public care is the only place possible to get these evidence based treatments that help move people towards recovery. Innovation should be our primary response to economic difficulties, not stagnation.

* Recognize that the alternative to community based care is often hospitalization or jail, at up to 40 times the cost. It would be a significant cost savings to keep people treated in the community rather than re-institutionalizing us.

* For every dollar spent on rehabilitating a disabled person to be able to go back to work, $10 is returned to the economy. U.S. Census Bureau, 1986

* Increasing the amount of peer support would reduce overall mental health costs by increasing people’s recovery, helping people to get more involved in their community, and decreasing reliance on the mental health system. Peer support is an evidence based practice and often peer supporters can work at lower expense than professional with a higher educational requirement.

* Respite care centers cost 1/5 as much as psychiatric hospitalization and shift funding from large institutions to small community based mental health center or local consumer run organizations. Providing people in crisis with peer run centers would save large amounts of public funding. This would also increase people’s ability to stay closer to their local communities and keep their family and native supports involved. Respite care does less to delay peoples’ recovery than does institutionalization. There are quite a few existing models in the U.S.

* Trauma-informed care involves dealing with people’s primary experiences of loss of choice, voice, and control. Increasing the use of trauma informed care in the community mental health centers will greatly decrease costs by helping people to end the revolving cycle of becoming so strongly influenced by emotions brought on by past overwhelming experiences.

* Treat sex offenders in the criminal justice system instead of leaving them indefinitely in more expensive hospital situations that take away beds from people in crisis.

* Consumer run organizations promote well-being and recovery and are very cost-effective. One study found that the more people used these programs, the greater their increase in well-being.

* Some psychiatric medications may be less effective that previously reported and may in fact worsen long term outcomes. Keeping non-medication options like peer support, employment services, and respite care available is crucial to helping people who don’t respond to meds. For depression, this may be the majority of people according to a re-review of the data from the STAR-D trial, the biggest ever government funded clinical trial of antidepressants. This data shows that only 7.7% of participants did not relapse or drop out the end of the one year trial. If we were simply to admit the existence of a large percentage of people that aren’t helped by meds, then we could as a society make other treatments the primary option for up to 40% who have negative medication effects and not the positive benefits. This would drastically reduce medication expenditures and then we wouldn’t have to resort to using preferred drug lists that limit medication choice for the people that ARE being helped by their medications. This would free up vast amounts of funding for more recovery oriented approaches to mental health treatment.

In conclusion, although budgets are very lean in almost every state, now would be the time to radically rethink our approach to funding. We could fund approaches like the ones above that have been consistently shown to be effective while have significant cost savings. Many of in the consumer movement have appreciated the move towards recovery approaches, because we know recovery is possible. We are the evidence. We would love to help bring innovation into our states to help relieve the budget shortfall.

Follow Corrina on twitter or on the web at http://corinnawest.com/

Baucus working to reduce Guard, Reserve suicides

by Jennifer Donohue (Clark Fork Chronicle)

Montana's senior U.S. Senator Max Baucus expressed deep concern about military suicides after the Army released new data today showing suicides of Army Reserve and National Guard soldiers increased significantly to 145 in 2010, including two members of the Montana Army National Guard. Baucus is working with the Pentagon to implement the law he passed in 2009 to make sure troops get the care they need and deserve by requiring the military to conduct improved assessments to help identify signs of Post Traumatic Stress Disorder (PTSD) and suicidal tendencies.


“Montana is proud to have more brave men and women volunteering for service than almost any other state in the country – many of them as citizen soldiers in the Guard and Reserves. The news of increased suicides among our citizen soldiers is deeply troubling. This issue hits home in the worst way because we have already lost too many Montana heroes to suicide. We owe it to our troops, their families and their communities to tackle this problem head on,” Baucus said. “I will continue working with military leaders at the Pentagon until I am confident every Guard and Reserve unit across the country has the tools and resources it needs to keep our troops safe while deployed and here at home.”

In 2009, Baucus wrote and passed a law to establish a new assessment program to identify post-traumatic stress disorder, suicidal tendencies, and other behavioral health conditions both before troops deploy and after they come home – including troops serving in the Guard and Reserve. Baucus is working with the Pentagon to confirm that it is in full compliance with the law and identify any additional resources that would help implement it.

Baucus modeled the law after an innovative program used by the Montana National Guard. The law requires the military to provide mental health assessments for every soldier, Marine, airman, and sailor during the 60 day period before a deployment and six, twelve, and twenty-four months after they’ve returned home. The assessments are to be provided in a private, clinical setting by licensed mental-health professionals or troops trained and certified to perform the assessments.

A recent study released in the American Journal of Psychiatry found pre-screening, like that required by Baucus’ law, to be a very effective tool in reducing mental health problems in the military. The report said pre-deployment screening helped decrease the need for clinical care for combat stress, psychiatric and behavioral disorders, and suicidal tendencies.

Baucus also plans to reintroduce his VET Act this Congress to help veterans find good-paying jobs when they come home by making it easier for businesses to get tax credits for hiring troops returning home from service.

Health Care Reform Contains Major Expansion Of Access To Mental Health Services

By Amanda Terkel

WASHINGTON -- The health care law that Republicans are targeting for repeal provides significant assistance and options for people with mental illness, an issue that has received increased attention as details emerge about the alleged shooter in Arizona on Saturday.

"The shooter was a very disturbed individual and it appears there were so many warning signs that he was going to do something horrible," Rep. Allen West (R-Fla.) wrote on his Facebook page. "We should be focusing on the mental health crisis in our country, not politics."

As Igor Volsky of ThinkProgress points out, Rep. Mike Rogers (R-Mich.) similarly told MSNBC Tuesday, "A bad guy is going to get a gun. What we have to do is "intervene earlier in that cycle of violence when they have this kind of mental disability."

Lawmakers looking for a way to boost mental health services might want to start by checking out last year's Patient Protection and Affordable Care Act, which both West and Rogers support repealing. Mental health advocates have hailed the law for its expansion of access.

In 2008, President George W. Bush signed landmark "parity" legislation requiring employers to provide mental health insurance benefits comparable to traditional medical coverage. It also barred insurance companies from setting higher co-pays or deductibles for mental health services.

That law, however, applied only to people who already have insurance. Chris Koyanagi, policy director at the Judge David L. Bazelon Center for Mental Health Law, told The Huffington Post that the Obama administration's signature health care law is at least as key.

"While the 2008 law was very important in terms of people who have insurance through their employer, the great thing about the Affordable Care is that it's everybody," said Koyanagi, whose organization has produced a report on the 2010 law's impact. "If you have a serious mental illness, you have trouble staying employed. There's a whole group of people for whom parity would never have applied without this statute. We've had a lot of people just falling right through the cracks because they don't come with any way to pay, and they're the folks with the most serious problems."
Story continues below
Advertisement

Koyanagi highlighted two major elements of reform: More Americans are projected to be enrolled in private insurance under the 2010 law, which is required to provide coverage for mental health and substance abuse services, and it is also expected to significantly increase Medicaid availability.

"The expansion of Medicaid to people with incomes under 133 percent of poverty who would not otherwise have been able to get on the Medicaid program is going to include a lot of people with mental health needs," she said.

Before the Affordable Care Act, low-income childless adults with severe mental illnesses were not able to get Medicaid assistance, and therefore had no way to pay for mental health services. "Certainly the repeal of ACA would drastically hurt a lot of childless adults with serious mental illness who need treatment," Koyanagi said.

Acquaintances of Jared Lee Loughner, the man charged in Saturday's Arizona shootings, have described him as a troubled individual with worrisome behavior. One of his community college classmates wrote in an email about Loughner, "We have a mentally unstable person in the class that scares the living crap out of me. He is one of those whose picture you see on the news after he has come in to class with an automatic weapon."

Dr. Anthony Lehman, a professor at the University of Maryland School of Medicine, said that early reports on Loughner seem to follow a familiar pattern (with an atypical outcome) of the "failures of mental health systems to respond to young people with serious mental illness."

"As I understand, he began having problems as early as high school, dropped out of high school and was identified as someone who was having problems, and then proceeded in some of the history that we just heard about with involvement with the police and problems in college, but never received, I guess as best we know, any mental health treatment," Lehman said on PBS's "Newshour."

Despite the recent attempts to expand access and services, mental health is still woefully undertreated. In the past year, Arizona's Pima County, where Rep. Gabrielle Giffords (R-Ariz.) and 19 others were shot Saturday, has seen more than 45 percent of its mental health services recipients forced off the public rolls.

In response to the shooting, House Republican leadership postponed its vote on the Repealing the Job-Killing Health Care Law Act, which was supposed to take place Wednesday. The House is expected to pick it back up next week.

Neither West nor Rogers returned calls seeking comment.

Statement of Mental Health America on theTragedy in Arizona

Mental Health America joins Americans in mourning the loss of those killed in Saturday’s tragic and senseless attack and expressing our wishes for the full recovery of Congresswoman Gabrielle Giffords and fellow citizens who were injured. Our thoughts and prayers are with the families and loved ones of those who lost their lives and everyone who is affected by these horrific events. And we join in applauding the brave actions of individuals who prevented greater harm.

It will likely take many days to understand the reasons and motivations behind this national tragedy. Many have pointed to mental health as an issue.

It must first be emphasized that people with mental health conditions are no more likely to be violent than the rest of the population. And we have science-based methods to successfully treat persons with even the most severe mental illnesses. A very small group of individuals with a specific type of mental health symptoms are at greater risk for violence if their symptoms are untreated.

At the same time, we must recognize that the nation’s mental health system is drastically under-funded and fails to provide Americans living with mental health conditions with the effective community-based mental health services they need. Sadly, in the current environment of strained state budgets, mental health services have been cut drastically just as demand for these critical services has risen dramatically.

It is also important that, as a community, we assist persons with signs and symptoms of mental illnesses to seek treatment. Although rare, when a person becomes so ill that he/she is a danger to themselves or others state laws provide a way to get them help even if they don’t believe that they need it. The best strategy, however, is to have an accessible system of care that is easy to use.

Science has not developed tools to predict reliably individuals at risk for violence. But we can reduce the small risk of violence in those with certain mental health conditions by investing in proven intensive, coordinated community-based mental health services and making certain that they can access these services.

We do not know if the mental health system failed in this situation or if there were missed opportunities or if effective treatment might have averted this tragedy.

We do hope that we can find answers and create solutions that prevent this from ever happening again.

Mental Health America (www.mentalhealthamerica.net) is the country's leading nonprofit dedicated to helping all people live mentally healthier lives. With our century of service to America and our more than 300 affiliates nationwide, we represent a national movement that promotes mental wellness for the health and well-being of the nation— everyday and in times of crisis.