Annual Town Meeting 2022 will be remote; what we learned from local data at this year’s Mental Health Summit

About the Mental Health Task Force: Lexington’s Mental Health Task Force was established as a municipal-school partnership following the town’s suicide prevention symposium in 2017. The group was formed with the goal of establishing a “sustainable structure for addressing mental health in a coordinated way across school and town departments” by “creating alignment” on approaches to mental health-related identification/evaluation; prevention activities; services and interventions; and critical incident responses. 

Funding: The group received a one-year planning grant and a three-year implementation grant from Community Health Network Area (CHNA). The Task Force paused grant work for a full year, from March 2020 to March 2021, to meet more immediate pandemic-related needs in school and town spheres, Director of Human Services Melissa Interess noted; the target end date of the grant was shifted to Fall 2022, with some work expected to continue into the winter of 2023, she added. 

How the money is being used: Using the CHNA funding, the town focused on identifying unmet needs and underserved populations by creating and distributing a Community Mental Health Assessment among adults, as well as creating an “inventory and repository” of mental health programs and services in school, municipal and other community groups. Initiatives still in various stages of progress include: Establishing a protocol for responding to critical incidents aligning school and municipal departments when applicable; establishing evaluation and measurement tools for impact and outcome data; and creating a communication and outreach plan for promoting available programs and services. 

About the Community Mental Health Assessment: In 2020, the Mental Health Task Force began collaborating with the Center for Social Research at Framingham State University on developing and administering a survey about adult mental health in Lexington. Lexington Public Schools already have detailed data about self-reported student mental health challenges for middle and high schoolers in the form of the biennial Youth Risk Behavior Survey (YRBS); the Task Force wanted to gather a detailed data set about adults as well. The survey results were published in an August 2021 report. 

Who responded to the survey? Center for Social Research Directors Marian Cohen and Ruth Remington surveyed 1,016 Lexington community members over six weeks. Respondents generally represented a cross-section of the adult Lexington population, but skewed older and more educated than the recorded population, with a higher percentage of white respondents and a lower percentage of Asian and South Asian respondents relative to recorded proportions of Lexington residents. These discrepancies could mean that health challenges among younger community members were underrepresented in survey results, Cohen noted. Additionally, other studies and literature have repeatedly indicated that conceptions of and attitudes toward mental health are “much more restrictive in Asian cultures,” Cohen said, which can mean that problems occurring are less commonly identified as having a mental health component. The vocabulary for describing mental health challenges “is either very limited or completely lacking,” Cohen added, which increases the likelihood that such challenges are “somaticized” – interpreted as physical problems. Consequently, the lower rate of respondents could indicate a possible underreporting of mental health challenges among members of Lexington’s Asian and South Asian communities as well, Cohen cautioned.

Key Findings:

• Most respondents identified anywhere from mild to moderate stress as a significant concern, Cohen said. The greatest sources of stress for community members were current social/political events (and this was before the invasion of Ukraine…); concerns about the future; and effects of the COVID-19 pandemic on their lives. We acknowledge that this might be the least surprising piece of news you have read in the past five years. Additionally, mental health, experiences with social or racial justice or injustice, simply being too busy, difficulty getting adequate sleep, and problems with family members were also identified as sources of stress by respondents. Factors causing less stress included having health insurance (since nearly all respondents indicated they have health insurance); feeding their families; and cultural barriers/language differences.

• Among COVID-19 specific stresses, respondents expressed the most concern about reduced social interactions and restricted movement from a socio-personal standpoint, and about anxiety and depression from a health standpoint.

• Respondents tend to cope with stress by: Talking with others; exercising; “employing stress management techniques”; participating in personal or individualized activities, e.g. just reading or surfing the internet; and “ignoring it” (17.7%).  

• The most common barriers to help-seeking were: long waits for a provider; affordability of care; issues with insurance; accessibility of care; and transportation. For all of these areas except transportation, the barriers to mental health issues were greater than for physical health issues.

• Challenges to physical health help-seeking primarily included long waits; transportation; finding time to seek help; and locating a provider. For mental health, challenges “tended to be more personal, philosophical, or cultural in nature,” Cohen said, included embarrassment; fear of stigma; and lack of knowledge about how to seek help.

• Almost all respondents have health insurance.

• Self-assessments of physical and mental health were generally good.

• There was a strong correlation between physical and mental health assessments.

• A total of 66% of respondents said their physical health was either excellent or very good, with higher income and professional degrees slightly correlated with better self-assessments of health.

• About 59% of respondents said their mental health was excellent or very good. Males, those 50 and older, those with professional and doctoral degrees, those with incomes of $300,000 or more, and whites, Asians and South Asians were most likely to rate their mental health as such. 

• The most common physical problems cited were cancer, endocrine disorders, heart disease and digestive issues. The most common mental health challenges included depression, anxiety and ADHD. Cohen, who presented the survey results, explained that she was providing this information because it offers “a picture of the distribution of major health issues in the community, and it provides a focus for concentrated efforts to help residents with their health issues.” The data also indicates that examining the interaction between physical and mental health is important, she added.

• About 67% of residents say they take prescription drugs, and 16% of those say they experience negative side effects. But, drug and substance use are generally low, with alcohol being the most commonly used substance, and recreational drugs the least commonly used.

• Physical health was assessed as better than mental health overall, but mental health was assessed as more stable – 34% of respondents said their physical health status had worsened in the last five years, whereas 27% said this about their mental health over the same period.

• Impediments to physical health tended to impact social and recreational activities, and participation in hobbies. Mental health impediments reportedly impacted self-care and completion of daily role obligations. 

• Respondents tended to seek help for physical health issues from health care professionals, and from family and friends for mental health. 

   

Recommendations from Cohen and Remington:

• Greater outreach is needed to more comprehensively understand community mental health challenges, especially among younger and middle-aged adults; Asian and South Asian populations in town; and community members with less education.

• There should be more education about mental health, including about how, when and from whom to seek help; interpreting medical information; making optimal use of insurance programs; navigating the health care system (e.g., how to deal with wait lists for providers); transportation options (many which are already identified by the Department of Human Services, but should be more widely promoted, Cohen said) and coping with stigma.

• It would be helpful to provide more programming about: Physical and mental health needs; stress and stigma reduction; and the link between physical and mental health.

• Integrating Town Departments and groups (as is already being done through the Mental Health Task Force, but to an even greater extent).
   

• Promoting the Mental Health Task Force website. Cohen said the work on this website was “particularly outstanding” relative to the resources offered by other communities, and that it should be more widely shared to better connect community members with its resources.

• Repeating this study in the future in order to track changes over time.

   

YRBS: K-12 Director of Counseling Val Viscosi also presented a brief overview of YRBS 2021 results. This data has been presented in multiple previous meetings, and LexObserver reported last October on student responses to questions about pandemic impacts. You can learn more about the full breakdown of this data in the presentation linked in the March 14 meeting agenda.

William James referrals over time: The William James College INTERFACE referral service began connecting Lexington students and residents to mental health providers free of charge beginning in 2018. Data on total referrals offers another window into fluctuating community mental health needs over time. From December 2019 to May 2020, there were 64 referrals, followed by a slight drop in referrals (51) from June to November 2020, according to Interess. Then, from December 2020 to May 2021, referrals almost doubled, rising to 94. They leveled out slightly from May to November 2021, the most recent reporting period with available data, to 84 referrals.

Mental health needs in the community, especially for young children, have been so widespread during the last several months of the pandemic that this referral service has struggled to fully meet community needs, Interess noted. Community members have experienced long waits to connect with a provider, especially due to more demand for in-person services and the sharp increase in demand for therapists specializing in supporting young children, LexObserver previously reported. Community members also specifically saw longer waits for INTERFACE follow-ups due to the higher call volume & acuity. It could take 3-4 days for an initial call return; another 4-5 days for the assignment of a referral counselor; and 2+ weeks for provider identification – totaling 3-4 weeks per provider. In fact, INTERFACE had to shut down completely for a month recently.

Since mid-February, the Town has offered some short-term supplementary counseling services via Human Services. The Town has seen about a dozen referrals through this program in this time, Interess said. Lexington is looking to contract a full-time mental health clinician through an agency this spring using American Rescue Plan Act (ARPA) funding, who they hope will have expertise in supporting young children due to the continued demand for this support, she added.

Town leadership wants to see more adult survey responses in the future: Almost all members of the Select Board and School Committee alike agreed that it will be very important to find ways to reach more community members and increase response rates among underrepresented groups in future iterations of the Community Mental Health Assessment. Newly elected School Committee member Larry Freeman, for instance, noted that response rates were too low to necessarily draw statistically significant conclusions about the experiences of Black community members in Lexington, even though proportionally, the number of respondents was roughly representative of Lexington’s population. He also commented that given the major mental health challenges identified among LGBTQ+ students in LPS data, it will be important to increase adult LGBTQ+ responses in the adult community so that this data can be broken down, explored and addressed. School Committee Vice Chair Eileen Jay also reflected that to reach Asian community members with culturally different attitudes toward mental health, different methods of and approaches to outreach may be required. Some Select Board members mused that perhaps offering treats, or free perks such as coffee or chocolate, could help increase overall participation in the adult survey in the future. Vice Chair Doug Lucente also stressed the importance of raising community awareness about existing mental health resources. 

Lexington students reflect on Ukrainian invasion, with one youth group fundraising for relief efforts
 

Thanks to LexObserver intern and Lexington High School junior Seiya Saneyoshi for interviewing LHS students and LexYouth volunteers about reacting to Russia’s invasion of Ukraine from afar. We have identified students, as minors, by their first names. In case you missed it two weeks ago, you can also read LexObserver’s conversation with George Gamota, a Lexingtonian and Ukrainian-American, about how the invasion is impacting him and some of his loved ones. 

When Russia began its invasion of Ukraine Feb. 24, LHS student Laila was totally disconnected from the news: It was an unassuming Thursday in the middle of February break, so she “was just watching Netflix all day,” she said. 

Laila’s dad was the first to tell her that Russia was mobilizing troops into Ukraine; she was shocked, and quickly did her best to catch up on the news via BBC and CNN. She checked her group chat for school debate, and realized everyone was talking about the invasion. 

Upon returning to school the following week, Laila noticed her classmates were “more worried about it than I expected,” she said. Still, she certainly understands why even those with no personal connection to Ukraine or Russia are worried: “It’s going to become a bigger issue if Ukraine and Russia don’t settle their own affairs, which I personally don’t think [is] going to happen anytime soon,” she said.
 

What’s more, Laila realized people in the immediate Lexington community were personally impacted: Her chemistry teacher, for instance, is Ukrainian. Superintendent Julie Hackett sent a message to the entire school community March 2 sharing resources for discussing the invasion with students, expressing support for all Ukrainian members of the community, and emphasizing that Ukrainian and Russian community members alike are all welcome in and belong in Lexington.

Students at LHS have indeed found themselves discussing the invasion in classes and clubs, and with friends, family and teachers. Laila, for instance, had to write a case for debate about Turkey and NATO, and she incorporated some of what she had learned about Ukraine into that case, she said. 

Danli, another LHS student, has been talking about the conflict with friends and in AP U.S. History (APUSH) and social studies classes, she said. Some teachers and students have been wearing pins supporting Ukraine with Ukrainian colors, she added. Her history class has debated whether or not the U.S. will join the war; “the consensus is that they probably won’t join” and will stick to continuing to supply military aid because Ukraine is not a member of NATO, she said.

One group of students has even worked to fundraise in support of Ukrainians.

LexYouth is a subsidiary of the local nonprofit CALex. CALex was one of multiple community organizations in town to start a fundraiser in late February to support Ukraine, raising about $3,000 total, according to volunteer Ally Wang. LexYouth high school and middle school students contributed to that total with their own fundraiser.

Athena, a 10th grade LexYouth volunteer, said the situation in Ukraine had caused “a lot of anxiety, and just worry for the soldiers and the citizens in Ukraine just because of how far they were pushed.” This motivated her and other students to donate and raise money, she explained, to try to “alleviate their suffering.” 

Over two days of in-person fundraising in early March, the students raised $806.46 of the $3,000 CALex total, Wang wrote in a follow-up email to LexObserver. 

Alex, another 10th grade LexYouth volunteer, said he had talked with teachers and peers about noticing a fair amount of misinformation and fake fundraisers on social media – so it was important for CALex and LexYouth to be careful to choose credible organizations which would take quick action as recipients of their funds. CALex and LexYouth considered three options, Wang explained, including Ukraine Humanitarian Fund, managed by the UN; Airbnb, which is providing some free, short-term housing to Ukrainian refugees; and Music, Arts and Fashion Productions, a Newton-based arts nonprofit founded by a Kyiv native which contributed to forming a volunteer team to purchase living and medical supplies for Ukrainians after the invasion began. CALex ultimately chose to donate $2,000 to Airbnb and $1,000 to the Newton team, Wang wrote.

COVID-19 Weekly Update: Town Dashboard to stop posting weekly case counts starting March 25; LPS case counts remain low following rescission of townwide mask mandate March 9