Mental Health, Mental Illness, on Block Island

advocating for services and support for those who are ill and education for mental health to all on Block Island

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Is doing the numbers enough?

TelemedicineA Post from Board Member Socha Cohen, published in the BI Times

Is Doing the Numbers Enough?

Since its inception, the Tele-Medicine program provided on Block Island has serviced 29 patients, three of whom were escorted off-island by the case worker, Tracy Fredericks. Butler Hospital and Brown University offer the services of a psychiatric intern free of charge under the condition that Block Island pay for the salary of a case worker who receives an hourly wage: the more patients she helps, the higher her wage. In conjunction with a large donor, and the financial support of the Town, NAMI-BI has been raising funds to support Tracy’s salary which ranges from year to year depending upon her case load. “We are providing services to a community where there had been none in the past,” says Gloria Redlich, coordinator of the Coalition for Seniors. “Inherent in mental illness is that for many there are obstacles to reaching out for care.”

National data support Dr. Brownstein, NAMI-BI largest donor, stating, “it’s estimated that 30% of people will have a mental health problem at some point in their lives.  In all populations studied, 1% suffer from schizophrenia, and 5% have major depression.  9.3% of people 12 and over needed treatment for illicit drug or alcohol use in 2009.  Things have gotten worse since then.  So whether they’re taking advantage of the telemedicine program or not, it seems likely that a significant fraction of folks on the island are likely to need it sooner or later, and when the population swells to 10,000 or more in the summer months, the need expands markedly.”

Elspeth Crawford, board member of NAMI-BI and leader in Emotional Education, adds, “Provision of health service of any kind is not about monetary capital, e.g. what you get when you re-model the pavilion, it is about social capital, what a healthy community looks like in the future. Not providing the service has hidden costs on the future that affect us all. There would more disruption and expenditure in relation to other community services, and also, each person who is ill is not a lone person, but may have family and others, all of whom, including the ill person, are less able to contribute to our community and economy if their energy has to be directed in countless ways keeping stability.”

“In short, the bad news is that we’re still not serving as many people as we probably should be”, continues Dr. Brownstein, “and we need to figure out how to “market” the program better. The good news is that we have a program to market–one that probably saves lives.  What’s a life worth?







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Cannabise Use and Psychosis

An article here on research regarding the link between cannabis use and psychosis. It is from a group of scientists working in UK who say that cannabis use can lead to psychosis in certain people. the risk may be greater if use begins early, during adolescence. It may not be a risk to other people, but it needs to be taken seriously.

More research is needed to clarify strength and vulnerability factors in individuals, but that there is a link for some, and a loss of life potential, is already clear.

[This study is from the Guardian and reflects UK statistics, but recognizes trends elsewhere. Far more teenagers seek treatment in the UK for cannabis use than for any other drug including alcohol.]

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Join in the conversation

As a community we can learn from each other, share experience. Any one of us might be a “first responder” to someone who lives here and suffers illness. If you have something to say, join in the Community Conversations. Look at “Can You Help“. Come to the BI NAMI events that are advertised in The Block Island Times and on the Block Island Bulletin Board. Make contact or comment in these community posts. Scroll down below. Write a post – please ask. You might have found an article of interest – please send.

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Community Conversations – Summer 2015

NAMI BI thanks Block Island Times for publishing the letter below as “Featured Letter” on 9/18/15.

In June I wrote to say that NAMI Block Island [National Alliance on Mental Illness] would be taking up the challenge from SAMSHA [the national Substance Abuse and Mental Health Services Administration of the US department of Health and Human Services] to create community conversations about Mental Health. We were aware that this is a frequently taboo topic that can affect anyone, anywhere, and that has impact of some kind on us all. I am writing now to say how wonderfully those to whom we have spoken so far have been responding, how much we appreciate their time and thoughtfulness, and also to let everyone know that we are learning a lot, how much we don’t know as well sharing together much that is already understood. As community conversations develop, we hope we will achieve our aim: That the various responses to behavioral health issues on the island issues can be addressed in ways that complement existing local activities, are better coordinated, consistent, and in the best interests of all.

We don’t know, yet. But, we are hopeful and invite everyone who wishes to join in. Briefly, an outline of what we have heard in talking with more than 20 people representing different island groups: the people here care, and are aware, and as might be expected, each of us sees a different bit of this elephant. We have raised some awareness of each other’s “bits”.

In considerable detail, we found many frustrations, often systemic in origin (rather than negativity). That is, organizations, local or national, may enable individuals to act in their own sphere of authority, but because the nature of mental illness crosses so many boundaries the right kind of action can be difficult to find, and frustration follows. Important matters such as confidentiality, trust, and rights of both family and ill person have to be protected. There were many suggestions about the right kind of “go-to” person or facility that we all know our island does not have, or cannot afford. We heard imaginative ideas for addressing the gaps. We will soon be talking with our community organizations for help in finding ways to develop protocols, say for emergency responses, or prevention of fragmented care, as are appropriate to each organization’s first area of responsibility. We also ask individuals to think about taking part in the programs and trainings that hope to continue bringing to the island, for example our mental health discussion meetings and possibly a repeat of the praised Mental Health First Aid course brought by the school and the library last winter?

Can we improve communication and co-ordination, so that we all feel more competent, whether we should happen to be the “first responder”, or whether we have a particular duty of care? We think that we can, but it will be a developing process. There is work to do in factual research and sharing of information, and finding how lines of communication will work with accountability and confidentiality dilemmas.

Another discovery has been that there is even more confusion and difference in perceptions than we knew. We ourselves in NAMI BI are equally unsure, e.g. there is no accepted definition of Mental Health, and no consensus on “best treatment”. Or, what is the difference between NAMI BI and Block Island Wellness Coalition (working to prevent of substance abuse and create wellness)? We know there is overlap, but what is it? Is NAMI BI a Harbor Church group? [No, it is not, it is a separate 501c organization that is grateful to the church for providing a meeting place.]

We plan a series of communications on specific topics that have arisen as well as more meetings. In the meantime, remember that there is a free telemedicine service provided by psychiatrist residents from Butler Hospital. Phone the Case Manager, Tracy Fredericks [CSP certified], 207 229 6349. Also, see some summaries of issues and suggestions, and previous articles in the BI Times on

We found a very clear sense that Community Conversations are worthwhile and should be continued. We do have a very special place here, thank you Block Island people.

Yours sincerely, Elspeth Crawford

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Compassion and Our Selves

Please let us know the URL to any websites/articles/blogs/stories/videos/books etc you think visitors would find interesting or useful. A brief review of what the contribution is about would be useful too. We will add a post – others are found by scrolling down here. Hopefully this will grow into a resource for us all. However, NAMI BI cannot monitor all the information on other sites and we are not responsible for it. Please let us know if any link or articles suggested seem inappropriate or unhelpful.

bodyscoreA book was recommended by Arietta Slade – it is well worth reading: The Body Keeps the Score, by Bessell van der Kolk.

I am impressed by the integration of neuroscience (in a way I could understand) with a variety of therapies, experience of talk, body, and mind.

A great book.

And, a great article:

Self-Compassion in Kids from, August 19, 2015 By Shilagh Mirgain, PhD

It turns out psychologists may have gotten it wrong. compassionkidOver the years, there has been a tremendous emphasis in our society on building kids’ self-esteem. Psychologists now think we should be teaching children how to develop self-compassion instead.

The problem is that self-esteem is often developed by social comparison, meaning it requires a person to feel special and superior to others on a variety of dimensions. Kids feel good about themselves when they get the A, win the game, receive the trophy and sometimes even by putting other kids down to make themselves feel better. But this constant comparison needing to be better than other kids instills a belief that it is not ok to be average.  When things don’t go well, feelings of superiority slip and self-esteem takes a nose dive, leaving kids vulnerable to anxiety, insecurity and depression.

What’s the solution?

Teach children how to develop self-compassion. Self-compassion is learning to extend understanding, compassion and encouragement to yourself when things don’t go your way, treating yourself the way you would a close and treasured friend.  Research shows increasing self-compassion has all the benefits of self-esteem but without the downsides. Unlike self-esteem, self-compassion reduces anxiety, lowers feelings of embarrassment when you mess up, and is associated with steadier and more consistent feelings of self-worth.

There are several ways to help foster self-compassion in kids, including:


In a world driven by distraction, teach your child how to be in the moment. Some ways to do so include:

  • Help them notice things around them, savoring positive experiences when they occur. Teach them how to be present with themselves.
  • Encourage them to take 3 deep breaths when feeling stressed, overwhelmed or distracted to return to the moment and back to their center.
  • Help them develop awareness of their thoughts and feelings, to not ignore them but to also not become overwhelmed by them either.
  • Help them learn how to observe non-judgmentally their internal experience, understanding that they don’t have to believe every thought they think, especially the negative ones, and that emotions, like ocean waves rise and fall if you just let them be.
  • Help your children identify those moments of struggle and difficulty as opportunities to practice self-compassion.

Validate their experience, such as saying, “oh this is a difficult moment,” or “that was really tough to go through,” make them aware of what they are feeling by labeling their emotions “oh you’re sad,” or mad, scared, hurt, etc. and talk through their reactions.


Kindness begins when we understand that we all struggle. Teach your children to talk kindly to themselves versus being critical. This builds a stable sense of self. Self-criticism isn’t helpful and only produces a variety of negative consequences, including feeling badly about oneself.  Next time your children start saying something critical, point this out to them and then teach them to reframe these thoughts into something positive and forgiving. The way we communicate with our children establishes a blue print for how they will eventually communicate with themselves. Talk to them in a non-critical way. Teach them how to self soothe during difficult times. Say to a small child, “Let’s practice hugging ourselves like mom and dad do to make you feel better. You can do this for yourself when you feel bad to remember how much you are loved.” Teach older children to put their hand on their heart to self-soothe when upset. These small gestures help them value and feel good about themselves just as they are no matter what is going on.

Teach kids how to be kind to others. Ask what they did in their day to make someone happy, find volunteer opportunities to do together as a family, encourage your kids to write thank you notes, recognize regularly when someone did something nice for another in the family.

Compassion for Others – Common Humanity

Remind your children that they are not alone in experiencing this difficult thing, other kids feels the exact same way. Everyone struggles, feels inadequate, does not get approved of, or fails at something in life. It’s part of our common humanity.  This helps normalize what a child is going through and reduces shame and embarrassment over mistakes made and not feeling good enough.

Encourage them when they see people throughout their day to offer them compassion. Teach them to wish others well, saying silently or verbally to others, “may you be happy, healthy and free from suffering.” . When our sense of self-worth is based on being a human being intrinsically worthy of respect, rather than on achieving certain ideals, our sense of self-worth is much less easily shaken. And that will make for a very good school year ahead.

This school year, instead of seeking to become extraordinary and special, encourage your children to find the wonder and marvel of the ordinary. How to sit with sadness in themselves and others, the comfort that a touch of a hand can provide, the warmth of compassion for themselves and others struggling. Teach them the simple pleasure of wishing someone else well, happiness and ease. Make these ordinary moments come alive for them. Then the extraordinary will take care of itself.


It’s so easy to focus on what’s wrong. Teach your children to focus on what’s right. Studies have shown that children who cultivate gratitude in their lives have better social relationships and do better in school. Make gratitude a part of your daily conversation. During dinner or as part of a bedtime ritual, ask children to share three things they’re grateful for about themselves and their lives. Ask them to reflect on why these things occurred to deepen their appreciation and understanding of the good things in their lives, including aspects of themselves, and not take it for granted.

As we talk about mindfulness, kindness, compassion and gratitude, what we’re really talking about is putting more love out in the world. And that can be one of the most meaningful gifts we can give our children.

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Current Need on Block Island

September 2015: Following from Community Conversations, and talks [e.g. Reed Cosper emphasized how Rhode Island has reduced spending on Mental Health] NAMI BI will prepare an Assessment of Needs. In the meantime – this is what we already know.

The only regular mental health service available on Block Island is that offered by NAMI BI. Emergency or more sporadic need to individuals who have not previously sought regular appointment is given as well as can be managed, depending on the point of access. This can come through the Block Island Medical Center (BIHS) or the Police Department as well as through NAMI BI Case manager, and can involve anything from advice or support to necessary escort off the island.

The island context also means there is variation in need depending on the time of year. The winter population of permanent residents is less than 1000 people. During the summer season, May – October, the need for services applies to island seasonal workers, as well as summer residents who return regularly each year. There are also visitors/tourists who might need a more temporary engagement with the program. Summer population estimate is about 10,000 people.

Mental illness suffers so much from stigma, that many people do not realize how many individuals suffer and their families and friends absorb consequences and also keep quiet. Given Rhode Island statistics* and the number of people in the local population, as the services become better known, it would seem that the number of individuals using the service will continue to increase as they have done each year they have been offered. At one time in 2014, there was a waiting time of four weeks for a client needing a first appointment. Now, in 2015, the current operating process for all activities is only funded for the limited number of hours used by the Case Manager in organizing the once weekly telemedicine appointments. The once every two weeks counselor visits are no longer available due to the retirement of the counselor and a replacement has not been found. The hours for which the manager, Tracy Fredericks, is employed are being used to the maximum, and indeed beyond as she responds willingly to emergency, to enabling referrals since the counselor retirement, and other issues that take more of her time. Extra time is not funded.

Educational meetings mostly take place during the summer season when it is hoped that a wider audience can be reached. The summer programs presented have been made possible by the generosity of the speakers who have given their time freely, and by the venue (Island Free Library) also free. Members of the NAMI BI Board give their time to organize the presentations. In the past, some possible speakers have had to refuse as travel and residence costs on the island could not be borne by either speaker or NAMI BI.

NAMI BI needs are threefold:

First the obvious one for any non-profit, we need donations in order to keep going. As described in more detail below, we want to offer more services and expand programs, both of which are indeed required. A generous donor will match any gift you make so that we can continue to provide psychiatric services and support on Block Island. Donate to NAMI Block Island, PO Box D2, BI RI 02807. All gifts are fully tax deductible.

Second, apart from the case manager, we work with volunteered time and effort. We deeply appreciate the partnerships of Butler Hospital and South Shore Center, the liaison with Block Island Health Services, the free venue for programs offered by the Island Free Library and the publicity from Block Island Times. Expenses are minimal.

For anyone wants to become involved and offer their time, as and when they can do so, there is no requirement for professional knowledge or past experience, just willingness.

Third, as we begin to work out what is meant by creating community conversations on mental health, to offer these and to offer support groups for families, we will be making contact with many other groups on the island. There may be a need to undertake training, or, to bring facilitators to the island. We look forward to interest and collaboration in the two-way discussions that help all of us with these initiatives.

Community opinion is valuable and experiences can be shared. 

More detail: In 2014 about $12,000 ensured the provision of help to residents. If the hours expand as we would like, we will need about $16,000 in 2015. Of course what would be wonderful would be sufficient donation that enabled us to set up an endowment fund, so that we can be more certain that services each year can be properly managed. All donations are helpful, and not just for the monetary value, they show us that the work is valued, that others find it worthwhile. Currently all donations have averaged $12,000 per year over the past three years. This does not allow for any effective increase in operating costs.

A generous donor has offered to match donations received.

Donate to NAMI Block Island, PO Box D2, BI RI 02807.

All gifts are fully tax deductible. 

Both nationally and in Rhode Island State, SAMSHA [The Substance Abuse and Mental Health Services Administration] are prioritizing initiatives that help provide treatment and services for people with mental and substance use disorders, support the families of people with mental and substance use disorders, build strong and supportive communities, prevent costly behavioral health problems, and promote better health for all Americans. “Now is the Time” is the President’s plan to increase access to mental health services. SAMHSA has played a key role in supporting a number of activities outlined in the plan to help build safer communities. NAMI BI is already planning to follow SAMSHA guidelines to launch Community Conversations on Mental Health to enable the Block Island Community. We have begun to build a Community Team (working collaboratively with other groups in the community). We also plan to offer a family series of group meetings.

To do this effectively we believe that at a minimum, we need access to funding for training group facilitators, and for travel, to training events. We think we are already using all the local expertise we have, given freely.

That is, our mission to provide Services, Support and Education, all need funding in the short term. In particular, the ongoing requirement to fund the Case Manager is a necessity for the services to continue even as they are now.

Donate to NAMI Block Island, PO Box D2, BI RI 02807.

*Trends Themes and Effective Practices in State legislation – NB Rhode Island has reduced its spending on Mental Health in past years, not because of less need. Maybe we need political influence too?