Healing A Broken Mental Health System: Cheryl Brown Merriwether Of International Center for Addiction and Recovery Education (ICARE) On 5 Things That Can Be Done To Fix Our Broken Mental Health System
An Interview With Stephanie Greer
Technological Advancements: I mentioned previously that there is a shortage of workers in the behavioral healthcare industry. The same is true in many other industries as well. As a result, there is a recognition nationwide that employers must do more to support their employees’ mental health needs. And because we have already established that the traditional treatment system is overburdened, employers are working more closely with their EAP, and other benefit service providers to pursue innovative solutions for both treatment and prevention, many of which utilize technology solutions. I’ll talk more about some of these later.
The current state of the mental health system is a conversation that echoes in the halls of policy-making, the corners of social advocacy, and within the private struggles of individuals and families. As we continue to witness an unprecedented need for robust mental health support, the shortcomings of the existing system become more glaring. It is within this backdrop that we seek the insight of those who are at the forefront of behavioral health. In this interview series, we are talking to behavioral health leaders, policymakers, mental health practitioners, advocates, and reformers to share their perspectives on healing our broken mental health system. As a part of this interview series, we had the pleasure of interviewing Cheryl Brown Merriwether.
Cheryl Brown Merriwether brings over two decades of experience in corporate HR management at AT&T, addiction recovery awareness, and adult education to the International Center for Addiction and Recovery Education (ICARE). As VP and Executive Director, she oversees and directs the administration, operations, and student support services for ICARE’s three divisions, Strategic Sobriety Workforce Solutions™, International Association of Professional Recovery Coaches (IAPRC) and NET Institute. Additionally, Cheryl is the Immediate Past President of Greater Orlando Society of Human Resource Management (GOSHRM), an active Board Member of Project Opioid, and a former adjunct faculty member at the University of Phoenix.
Thank you so much for joining us in this interview series. Before we start, our readers would love to “get to know you” a bit better. Can you tell us a bit about your background and your childhood backstory?
I am bi-racial and was put up for adoption because of the circumstances of my birth and the nature of interracial relationships in the South at that time. I was adopted by a black family and grew up an only child in a small town in Kentucky. My adopted father owned his own business, which afforded us a comfortable middle-class lifestyle. Sadly, he struggled with a severe alcohol use disorder, which led to his death ultimately decades later. My adopted mother was often hospitalized because she suffered from what was referred to at the time as a “nervous breakdown”. We now refer to her condition as a mental health disorder. My family-of-origin and the resulting “lived experiences” that I have had to learn to navigate throughout the decades of my life have prepared and positioned me to now be a voice for people who also have overcome similar challenges. My diverse career experiences have equipped me well for my current role as Vice President and Executive Director for ICARE, which is an amazing opportunity to serve others in a leadership capacity. My professional background includes management, HR, adult education, coaching and recovery support. In today’s post-pandemic era much of what was familiar has been totally disrupted. The workplace is now on the frontline in the battle for employee mental health and wellbeing and is perfectly positioned to serve as an incubator of innovative behavioral healthcare solutions.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
I use the following quote by Stephen Grellet as part of my email signature: “I expect to pass through this world but once. Any good thing, therefore, that I can do or any kindness I can show to any fellow human being, let me do it now. Let me not defer nor neglect it, for I shall not pass this way again.” This quote speaks to me because I am personally and intimately aware of what it feels like to struggle and suffer through the hardship, pain, and loss that results from mental health and substance use disorders (SUD). I’ve always felt everyone I meet is facing some challenge or difficulty in their life. Whatever is within my ability to alleviate suffering or make it easier for them to endure and ideally overcome, I want to do.
Let’s now shift to the main part of our discussion. It is often said that “the mental health system in America is broken”. What does that statement mean to you? From your perspective what is “broken” today?
The phrase “the system is broken” to me means there are not enough treatment providers and services available within the behavioral healthcare system. The world at large is in a state of perpetual crisis. The pace of political, economic, social, technical, legal, and environmental change is unprecedented. Consequently, the number of people who need clinical services has increased exponentially in recent years. And for a wide variety of reasons, these services are not available for many individuals. I often refer to a letter written by the American Hospital Association (AHA) in December of 2022 and sent to both houses of Congress as the best source of documentation regarding what is broken in the behavioral healthcare system. In that letter, the AHA mentioned there is a crisis within the healthcare system in this country. This letter states specifically there is a severe shortage of health care providers, specifically mental and behavioral health providers…. The letter states that “the nation is ‘ill-prepared to respond to the needs due to severe shortages in the behavioral health workforce….There are more than 100 million Americans who live in areas with staff shortages.
What about any bright spots? Do you think there are any elements that we get right in today’s world that we wouldn’t want to reverse unintentionally?
Despite the terrible magnitude of death, destruction and despair that resulted from the COVID- 19 Pandemic and the subsequent disruption to normalcy, there is a silver lining. There is now a broad public realization and acknowledgement of a severe mental health crisis in this country. Consequently, there is now a willingness to break the silence and openly discuss these pervasive problems. Fortunately, there are also groups of committed individuals and organizations working together to explore new and innovative solutions. Historically there has been a terrible stigma associated with mental illness SUD, which perpetuates silence, fear, and misunderstanding. However, because we now have a spotlight on this public health emergency, we are beginning to look for ways to create psychologically safe environments to break the silence around these diseases. Only then can people be free to comfortably learn about these prevalent disorders and proactively get help for themselves or others versus seeking treatment services when critical care may be desperately needed, but not available.
In your opinion, what are the 5 most impactful things that could help heal the broken mental health system? These could be on any level including training, workforce, policy, culture, equity etc.
When thinking or speaking about mental healthcare services, most people focus primarily on treatment, but the behavioral health continuum of care also includes a focus on prevention services. The key element of prevention is awareness. This is where the greatest opportunity for impact lies. The good news is there is great momentum building in support of awareness & prevention efforts. Here are some of the most impactful initiatives:
1 . Federal Government Level: In October of 2022, Dr. Vivek Murthy, U.S. Surgeon General, released a “Framework for Mental Health & Well-Being in the Workplace.” This framework outlines “Five Essentials for Workplace Mental Health and Well-Being” designed to guide organizations on how to establish policies, processes, and best practices that, when implemented, will help to change workplace culture, and institutionalize support for mental and behavioral health in the workplace. Dr. Murthy followed the Framework with an “Advisory on Our Epidemic of Loneliness and Isolation” in May of 2023. That advisory describes the devastating impact of loneliness and isolation on the American public and serves as a ‘call for action’ to advance social connections. Dr. Murthy’s publications further serve to raise our national awareness that COVID-19 perpetuated isolation and social disconnection, creating a surge in mental health disorders.
2 . Federal and State Government Partnership: Recovery Ready and Recovery Friendly workplace initiatives. You’ve heard me mention behavioral healthcare systems several times. I do that because behavioral health is where mental health and SUDs meet. You may also have heard the term ‘dual diagnosis or co-morbidity.’ Before COVID-19 46% of individuals seeking mental health services also struggled with a SUD, but now the number of people with a dual diagnoses exceeds 70%. To help employers meet the needs of their employees who may be in recovery from mental illness or SUD, the Federal government published guidelines designed to encourage employers to adopt Recovery Ready Workforce initiatives. Likewise, many states have followed New Hampshire’s Recovery Friendly Workplace model that encourages the formation of state-level communities of practice. These communities are made up of representatives from government, business establishments and providers of treatment services. The Federal government Recovery Ready Workplace initiatives and the Recovery Friendly Workplace communities of practice are now coming together to form a National Recovery Friendly Workplace Institute, whose primary mission is to raise our collective awareness of the need to support employees in recovery from mental health and SUD in the workplace. The establishment of the National Recovery Friendly Workplace Institute initiative is guaranteed to have tremendous impact.
3 . Technological Advancements: I mentioned previously that there is a shortage of workers in the behavioral healthcare industry. The same is true in many other industries as well. As a result, there is a recognition nationwide that employers must do more to support their employees’ mental health needs. And because we have already established that the traditional treatment system is overburdened, employers are working more closely with their EAP, and other benefit service providers to pursue innovative solutions for both treatment and prevention, many of which utilize technology solutions. I’ll talk more about some of these later.
4 . Strategic Collaborations and New Partnerships: Clinical and nonclinical (counselors and therapists) are beginning to work more closely and in partnership with credentialed non-clinical practitioners such as certified professional recovery coaches, and certified addiction awareness facilitators. In addition, certified health and wellness coaches are also expanding their skillset to incorporate information on mental health and SUD into their wellness programs. Working together as a team, these clinical and non-clinical professionals cover both sides of the mental and behavioral healthcare continuum. Collectively they help people learn about the disorders, access available resources, achieve treatment services, while also supporting others to achieve and maintain long-term recovery. The impact is significant.
5 . Peer Support Group Expansion: This is the most impactful initiative of all. Peers are defined as people with “lived experience” with either mental health or SUD. If they have not personally utilized mental or behavioral healthcare services, they may have helped family members or friends do so. Peer recovery groups have supported individuals with alcohol use disorders since Alcoholics Anonymous was formed in the 1930s. Peer support for mental health disorders likewise continues to increase in number and popularity. While many peers work in partnership with clinical practitioners, companies are starting to explore ways to identify their employees who may be peers and encourage them to lead groups and initiatives in the workplace. This model can be easily adopted in the workplace because companies have long supported the establishment of employee resource and/or affinity groups. These groups are sanctioned by the company, but led by employees. And when the employees who lead these groups have a) lived experience with mental health or SUD and b) successfully completed a credible training program from a reputable institution, like ICARE, NAMI, Mental Health America, or the Copeland Center, then they become a workforce of individuals willing and able to add capacity to the otherwise overburdened traditional systems of care.
If all of the items on your list were magically implemented tomorrow what change might we see in the world? What are the signs (big and small) that would show us that the system is being healed?
If all the items on this list are implemented, then the number of individuals qualified and capable of raising awareness and guiding safe conversations about mental health and SUD would rapidly expand. And, because behavioral healthcare is healthcare, we have indisputable evidence that by delivering high quality education programs, health care screenings and other related services, we will raise public awareness, facilitate early detection, prevent disease progression, and saves lives.
What is a project you or others are working on today that gives you hope? How can our readers learn more about this work?
Since 2013, ICARE has trained and certified non-clinical professional recovery coaches from 41 nations. These individuals come from a wide variety of backgrounds. Their training and credentials qualify them to work with both individual and corporate clients. Because many of these coaches work in corporations and have corporate clients, they asked us to help them create a facilitator training program that would provide them with the knowledge, skills and resources needed to deliver awareness education programs both in the community and in the workplace. To meet this need, ICARE developed the Certified Facilitator in Addiction Awareness (CFAA) train-the-trainer program. This program has been expanded to provide training to HR practitioners desiring to make long-term sustainable culture change within their organizations relating to mental health, substance misuse, addiction, and recovery. Human Resources Managers, Mental Health practitioners, Health, Wellness and Recovery Coaches, EAP counselors, and others have successfully completed this online training program and earned the Certified Facilitator in Addiction Awareness for Human Resources (CFAA-HR) credential that qualifies them to raise awareness, break the silence and guide safe conversations in community and/or workplace settings. This program was the recipient of the “Pinnacle Award”, the highest-level national award presented by the Society for Human Resource Management (SHRM).
How do you see technology shaping the future of mental health care and its accessibility?
Clearly face-to-face, heart-to-heart human connection will always be a preeminent and preferred method of addressing mental and behavioral health disorders. Nevertheless, given the mental and behavioral healthcare workforce shortage, technological solutions are necessary to help meet the ever-growing critical need for services. They are particularly helpful as part of awareness and prevention interventions. In many ways, providers of workplace wellness programs are taking the lead in incorporating technology to help meet employee mental health needs. For example, wearable health devices can provide real time data on things like an individual’s heart rate, hours of sleep, and activity level. Researchers are increasing validating these leading indicators are connected with and predictive of mental health disorders. I previously mentioned the role of peers and coaches to bridge the service delivery gaps that limit or restrict one’s access to services. One-on-one or group sessions can be conducted online when in-person interactions may be difficult to arrange. In addition, there is now a wide selection of health, wellness, mental and behavioral health apps available that are readily accessible, affordable, and easy to use.
In your view, how do social factors like poverty, education, and culture affect mental health care and its effectiveness?
Poverty, education, and culture are social factors that can significantly impact the quality and effectiveness of the mental health care that individuals seek to access. For example, individuals living in poverty face numerous barriers and challenges as they seek to access mental health services. Treatment for mental and behavioral health care services can be expensive, and these individuals may not have the benefit of insurance to cover the costs. Furthermore, individuals living in poverty may struggle to meet their basic needs related to housing and employment stability, all of which create stressors that contribute to, or exacerbate mental health conditions. I’ve previously mentioned the numerous benefits of education as an essential element in the success of awareness and prevention initiatives. The goal is to normalize conversations about mental and behavioral health topics, which will create a sense of safety, eliminate fear, prevent misunderstanding, allow for the sharing of information, which reduces the stigma associated with these conditions. The more we can facilitate universal access to timely and accurate information proactively, before the need for critical clinical services becomes evident, the more capable and empowered individuals will be to make informed decisions about seeking help and obtaining appropriate treatment. And lastly, speaking of culture, cultural beliefs and attitudes about mental health and SUD, can dramatically influence an individual’s willingness to seek and obtain appropriate care. Both clinical and non-clinical mental and behavioral health care providers must be able to demonstrate cultural competence when seeking to address the needs of individuals who may come from widely varying cultural backgrounds.
In light of the growing mental health crisis among young people, what innovative approaches or interventions have proven most successful for children and adolescents?
Children and adolescents have always been susceptible to mental and behavioral health disorders. However, since 2020, groups like the National Alliance on Mental Illness (NAMI) and the Centers for Disease Control (CDC) report a dramatic and alarming increase in mental health problems among young people. In terms of innovative approaches or interventions that have proven most successful for young people, the Substance Abuse and Mental Health Services Administration (SAMHSA) encourages providers to consider implementing a multi-disciplinary collaborative and integrative care model. This concept of ‘team care’ has proven to be effective and reduces the cost of care in adults. Today there is optimism that teams of caring clinical professionals can similarly achieve positive outcomes when working together with a patient’s family, and with non-clinical practitioners. And while the ‘clinical’ teams of mental, behavioral, and physical health practitioners work to streamline and coordinate a more efficient continuum of care, the traditional best practices can also continue to evolve and expand to include things like digital platforms, peer-led groups, and training for family members and others to create safe spaces and guide constructive conversations to raise awareness and reduce stigma. Schools, faith, and cultural or community groups can also help by creating environments that are welcoming and inclusive for young people. To the extent that the pandemic greatly contributed to the mental health problem of young people in large part because of the resulting isolation and disconnection, solutions should emphasize and focus on the re-establishment of connections and community.
We are very blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might just see this if we tag them.
In response to your question about the prominent names of people with whom I would love to have a private breakfast or lunch with, I have really struggled to think of who that person, or those people might be. In the work that I do, I regularly meet, have met and have spoken with hundreds of the most incredible people with personal stories of resilience, determination, courage, and strength. I have been both humbled and honored to hear their stories and share in the celebration of their recovery journeys. So many of them have traveled literally from death’s door back to a place of vibrant possibilities and hopeful futures. While they may not be considered as ‘prominent’ by some, I know them as recovery heroes, champions, allies, colleagues, co-workers, and dear friends.
How can our readers further follow your work online?
Your readers can follow me online on LinkedIn here: https://www.linkedin.com/in/cherylbrownmerriwether/
Thank you for your time and thoughtful answers. I know many people will gain so much from hearing this.
About The Interviewer: Stephanie Greer, PhD is the Co-founder and CEO of Akin Mental Health — a company dedicated to guiding families on their journey supporting a loved one with mental health challenges like bipolar disorder, schizophrenia and severe depression. Stephanie is passionate about this topic from her own personal experience growing up with a mother who struggled with bipolar 1 disorder and found a path forward to overcome the obstacles and live well. Stephanie’s professional experience includes a doctorate in neuroscience as well as design research roles at Hopelab and Apple. Stephanie brings this personal passion together with her world-class science and technology background to support families across the US in their personal journeys supporting loved ones with mental illness. To learn more about Akin Mental Health and join our community, visit us at akinmh.com.
