Article illustrations by Jon Sierra
Imagine waking up in a strange place, jarred by the overwhelming darkness and uncertainty of where you are. Eventually you realize you are trapped in a large brown paper bag—but the directions on how to get out are written on the outside. For many people, and maybe for you at some point—even right now—this illustration brings form to abstract feelings or complex, sometimes traumatic experiences.
The analogy is something Alice Nuttall learned in her early days of studying behavioral health. It has stuck with her, especially as she has played a pivotal role in assessing mental health needs and gaps in service for people in Polk County to ultimately bring much-needed resources and innovation to advance the well-being of youth and adults alike.
Nuttall is the AVP of Behavioral Health Services at Lakeland Regional Health, and helped author the comprehensive “Behavioral Health Strategic Plan Development & Sequential Intercept Mapping” in 2021 in partnership with Polk Vision. She also was instrumental in developing the plans for the brand new Harrell Family Center for Behavioral Wellness at LRH, which opened last October. She and her colleagues at LRH are passionately committed to leading the charge to change stigmas and outcomes related to mental health.
She says the analogy of the brown paper bag should remind people that reaching out for help is always a good place to start when you feel the darkness pressing in or are unsure how to get out of a difficult situation.
“Your tools and your insight and your thought process alone is not gonna be able to get you out of it,” she said. “So, at a minimum, you’re gonna need to talk to a friend or a loved one, or read a book or an article. But a lot of times if it’s something that’s really impacting your daily life, you need to talk to the next level provider.”
She said a person’s goal when evaluating their mental health or walking alongside a loved one experiencing mental health challenges should not be to figure out a comprehensive long-term solution right away, but to carefully look at first steps to better understand what help a person needs.
Leaders Are Working to Address the Most Prominent Struggles
Polk Vision is a local non-profit that brings together organizations, businesses, government and individuals to help bring positive change to Polk County. In 2021, Nuttall and Holly Vida, Director of Marketing and Community Relations for Central Florida Health Care, co-chaired a task force with Polk Vision to produce a comprehensive plan with the goal of improving the quality of life of Polk County residents by addressing behavioral health needs in the community.
The 261-page report, which can be viewed in full at polkvision.com, is a comprehensive survey and research analysis of the mental well being of people in Polk County, the needs that are present and the gaps that exist to meet those needs.
Diverse Data to Solve Complex Problems
“One of the things that was so cool about the Polk Vision study was all the different people we talked to that don’t work in behavioral health,” Nuttall said. “If you go and ask all the dentists in town… what do we need to do with dental care? They’re gonna have really good advice, but what about all the people that don’t brush their teeth? What if we went and talked to them?”
The study included the experiences and opinions of experts, but also included people who are struggling and a number of specialized, often underrepresented populations—including more than 300 incarcerated inmates.
They also tapped into data and anecdotes from the child welfare system. Nuttall said she can’t shake one specific comment that epitomizes why she is passionate about her work.
“One comment was from a homeless youth…and it was like, ‘I don’t have mental health concerns now, but I’m sure I will soon.’”
The Reality
The Top 8 Unmet Behavioral Health Needs in Polk County, According to 2021 Polk Vision Study
- Improved community awareness of available services
- Better collaboration among agencies
- Increased capacity of care coordinators, navigators and case workers
- More transitional care services for people being released from jail
- School-based behavioral health education
- An easily accessible centralized, fully updated, database of community providers and information
- More mobile crisis response teams
- An entity to work to reduce silos and contribute to more efficient, integrated behavioral health care
The Tangible Truth About Recovery
The numbers can appear grim and seem insurmountable, but there is always hope. Hope is intangible, it is often spiritual, and it can come and go. But Nuttall said one of the biggest revelations of her early career was that there is also a science to it.
“I just was transfixed by this concept of how chemistry and biology could translate into human emotion, and that through knowledge and understanding of the science behind it, and things as simple as eye movement, that you could influence and assist people to better cope with life and relationships,” she said. “A lot of what happens in the spaces of mental health, substance abuse and trauma, the real differing factor in recovery versus living in a place of darkness is hope.”
Nuttall gained a great deal of empathy and understanding about the role hope plays when she worked at a crisis center for survivors of rape and sexual abuse. She learned that even in the worst situations neuroscience provides pathways toward healing and restoration.
A Building Built on Research and Best Practices
Nuttall said traditionally behavioral health facilities have been underfunded, meaning professionals take the spaces that are most affordable and accessible and work to convert them to best meet patient’s needs.
With the Harrell Family Center for Behavioral Wellness—the $46 million facility spurred on by a transformative gift from Jack and Tina Harrell—this was not the case.
She says the 80,000 square foot building is a grand, cutting-edge facility staffed by professionals who are driven to change generational legacies in our community.
“It brought together all the best practices that we could find. We read them all, and then some of ’em we threw away and some of ’em we rewrote…” she said.
For example, nurses have unobstructed views to entire hallways of patients—rare for wings as large as in this facility—and features like telehealth technology and ability to contain infectious diseases are in place.
The facility incorporates a lot of natural light, high ceilings and open spaces for patients to enjoy tranquil settings.
Leading-edge Therapeutic Technology
The right prescribed medication can be a Godsend, but medicine is not always the answer, especially when it comes to effectively treating depression.
At its new facility, LRH offers Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS) as alternative options to traditional medication and therapies.
ECT uses electrical current to stimulate brain activity and essentially redefine healthy pathways of neurological activity that may have been impacted by trauma or illness.
“It’s very much the leading edge of where psychiatry is,” Nuttall said. “We can intervene on that specific part of the brain and people have remarkable recoveries. But in order to engage in those treatments, you really need to be close to home.”
Patients come in three mornings a week for several weeks to several months, with medical professionals closely monitoring the results and progress.
TMS involves short sessions where an electromagnet is used to deliver magnetic pulses to specific areas of the brain. It can treat depression, obsessive-compulsive disorder and other brain-related conditions.
The Power of Being Present
It’s cliche but true: whenever someone commits suicide there were likely dozens, if not hundreds, of warning signs and points where someone could have intercepted those signals and had a life-changing conversation with that person.
Nuttall said oftentimes people who love a person the most are shielded from those warning signs, so it’s up to others, all of us included, to recognize harmful behaviors—like coming to work drunk or being noticeably more aggressive or withdrawn for prolonged periods of time—and then thoughtfully and carefully talk to the person.
“It’s not like you need to go in full blazing and throw a manual at them or say come on, ‘I’m calling 9-1-1,’” Nuttall said. “It’s very simple, it’s ‘If you ever need anything, I’m here. Don’t be afraid to ask for help.”
Push Against the “Rock Bottom” Mentality
“So often…like with people with substance abuse…if you wait for someone to hit rock bottom, it could be lethal, right?” Nuttall said. “The term is kind of a nebulous term. It could be very destructive to property or communities of families.”
Often times rock bottom is the point where people contemplate or even attempt suicide. Nuttall noted that statistically just 1 in 25 suicide attempts are successful, leaving a wake of hurting, vulnerable individuals in our community.
Nuttall said being human means at times we’re not going to feel perfect and our emotions constantly fluctuate. It’s at the point where your feelings and thoughts start to impact your day-to-day life or you feel unable to find joy that you need to make the courageous and wise decision to find resources, make a phone call or talk with someone you can confide in.
“You don’t have to drop out of school or lose your job or housing, or lose your marriage or family,” Nuttall implores. “Your whole life doesn’t have to explode for you to put it back together again.
One way to help ensure the people you care about don’t hit “rock bottom” is by saying something as simple as “Are you OK?” or “Would you like to talk?” if you notice that someone is obviously in distress or seems to be in a pattern of abnormal or self-destructive behaviors.
Embrace Telehealth
One positive coming out of the pandemic is the technology for telehealth has improved and people’s trust in it has increased.
Nuttall said about 60 percent of LRH’s behavioral and mental wellness services are currently done via telehealth, and it’s an incredible way to get more people help quicker, often from the comforts of their own home.
“It’s also very streamlined and simple. If you can put in a DoorDash order, you can do a telehealth appointment,” Nuttall said.
Telehealth can be a great option as a starting point for mental healthcare because people don’t have to be “seen” going in and out of a facility and can easily attend an appointment in their car during a lunch break. It has also been incredibly powerful in helping some children breakthrough who traditionally struggle to respond well in a traditional therapy environment. Nuttall mentioned an example of an autistic child who had a successful evaluation on their iPad from underneath their bed.
Helping HANDS
Helping HANDS is an innovative jail transition program that provides extensive support for inmates returning to the community who have a psychiatric need or concern.
It is an example of removing silos and working collaboratively, as entities such as Polk County Sheriff’s Office, Polk County Fire Rescue, LRH, Tri-County Services, Peace River Center and others share data and information to best serve individuals.
“They have paramedics actually see them in the field after their release to help them make sure that they’re staying on their medications and getting to their appointments. And through that they have case management type services,” Nuttall said.
Participation is voluntary, but Nuttall said most people who qualify for the services enroll in them, and they have proven to be successful from keeping people out of the hospital and staying out of legal trouble in the future.
Peer Recovery Specialists
The idea of peer recovery specialists is an ancient concept—and is very comparable to someone having a “sponsor” as they fight substance abuse—that essentially entrusts people who have gone through tough, usually life-altering, experiences to help others navigate those same hardships.
Peer recovery specialists have overcome challenges and also been certified through special training that gives them the tools to be peer counselors to others. At LRH, peer recovery specialists work with nearly 200 unique patients per month.
Many mental health organizations are looking for people willing to share their positive outcomes and be trained to help supplement the medical professionals, chaplains and other programs aimed to provide holistic care to people seeking help.
Nuttall said not only are peer recovery specialists “some of the most inspiring people she’s met” they also are also making a statistically significant impact.
“Sometimes it’s as simple as connecting with someone who understands what it’s like to accidentally overdose on fentanyl,” she said ”If you connect with a peer before you leave, you’re less likely to overdose again, you’re less likely to die and you’re more likely to get into treatment. Those are profound outcomes.”
See Something, Say Something
Nuttall said it takes millions of micro conversations and recalibrating the community one person at a time to better understand their role in addressing mental health and wellness.
“The main bullet point is if you see something, say something,” she said. “There’s no wrong door at Lakeland Regional Health if you need behavioral health. We are available 24/7, 365 days a year…and we can help get you on a path and start the process of healing.”
If you’re a Lakelander, do yourself and our community a favor by saving the number to Lakeland Regional Health in your phone: 863-687-1222.
Sometimes it’s a short call or simple conversation that literally changes the course of your future or someone else’s future—strengthening our community in the process.
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