Mental health experts say this winter may be especially difficult for people who have lost homes or loved ones in the eastern Kentucky floods, and those who are rebuilding after last year's deadly tornadoes in the western part of the state.

Marcie Timmerman, executive director of Mental Health America of Kentucky, said the increased stress on families during the holidays and winter blues could set the stage for seasonal depression.

"We've been through pandemics, tornadoes and flooding, right? We've lost homes, we've lost things. We may have lost people we love. We lost places that we love."

The University of Kentucky reports more students seeking help for mental health issues on campus.

Timmerman noted Mental Health America has an online screening tool, which can be used at home to gauge depression risk.

She pointed out screening for depression increases the chance of getting treatment. Research shows many primary care physicians fail to recognize depression, especially in patients of color.

If you, or someone you know, are experiencing a mental health crisis, call or text the Suicide and Crisis Lifeline at 988, 24 hours a day, seven days a week.

Timmerman explained seasonal affective disorder is often affiliated with a lack of sunlight and decreased vitamin D levels. She emphasized it is important to pay attention to warning signs, including sadness, lack of energy and oversleeping.

"If you're crying every day for say, seven to 14 days, and it's impacting your work, or your school or your everyday life, that's really an indicator that you need to get some help," Timmerman advised.

According to the Cleveland Clinic, up to 3% of Americans suffer from seasonal affective disorder, but the number jumps to around 10% in parts of the country with longer winters.

Most South Dakotans live in federally designated mental-health professional shortage areas, and a new report recommended steps Congress and other decision-makers can take to help states close gaps within the behavioral health workforce, amid a growing demand for mental-health services and a shortage of licensed providers.

Kendall Strong, senior policy analyst for the health project at the Bipartisan Policy Center, said one solution is to enhance the role of those with mental-health training who do not have the full credentials. She argued behavioral-health support specialists are certainly up to the task.

"These people are underutilized," Strong contended. "They have a lot to offer because part of the folks that we're talking about are folks like peer-support specialists, who have lived experiences and can really connect with folks who are struggling."

Others in the group are community health workers and paraprofessionals. The report recommends reducing barriers for them to take on bigger roles in behavioral health, including adopting a certification framework to promote flexibility but still protect patients.

Strong acknowledged a divided Congress might provide obstacles but added there is optimism with both parties recognizing the provider shortage.

The report advised pulling in more help can free up licensed providers who are dealing with patient backlogs. Strong added behavioral health support specialists are embedded in the community and can meet in a nonclinical setting. She suggested it can be especially helpful in rural areas where mental-health stigma still might exist.

"In areas where there is just less infrastructure visibility as compared to urban areas, it's really clear if you're going into a health care facility," Strong noted.

The report also called on federal officials to explore expanding Medicaid and Medicare coverage of services provided by behavioral-health support specialists.

The Kaiser Family Foundation said South Dakota has nearly 60 areas with provider shortage designations, which affects nearly 800,000 residents.

One in 11 Missouri children, and one in 13 nationally, will lose a parent or sibling by age 18.

Childhood grief that is not dealt with can have short and long-term negative effects, including school problems, mental health issues and even a shortened life span.

Becky Byrne, founder and executive director of Annie's Hope, The Center for Grieving Kids in Glendale, explained kids grieve differently than adults, so it is not always obvious when they are struggling. She emphasized anyone can help a grieving child if they can overcome their fear and discomfort.

"And if you can't figure out what to say, just simply say, 'I want to be able to help you, I do not know what to say.' You don't have to be a trained professional," Byrne explained. "All you have to be is human, and willing to open up yourself to hear somebody else's pain."

During eight-session family support groups, she noted Annie's Hope pairs children with their peers and adults with adults. Byrne pointed out death affects the whole family system, and adults can learn about ways to best help their children at home.

Cindy Izzo, school support and education coordinator for the organization who facilitates the six-week school-based program, said it is especially important for kids who are not attending a grief support group outside of school, and it provides additional training for school professionals.

"We are showing the kids in the school that they are not the only one who is grieving," Izzo stressed. "Really, our group of participants is just the tip of the iceberg. So then, we're also connecting the students to the adults in the school who will provide that ongoing support for them."

Byrne added peers who are experiencing the death of a loved one can be immensely helpful to each other.

"When you find somebody who's your contemporary -- who this makes total sense to, and they can validate you -- that makes it like, 'Oh well, if that person can do it, maybe I can do it.' You immediately get this head start if it's a peer," Byrne stated.

For grieving families unable to attend an in-person support group, Byrne suggested virtual groups can also be helpful.

A recently proposed plan has been devised to better fund Virginia's mental-health programs.

The new Right Help, Right Now plan calls for $230 million in funding for upgrades to the state's mental-health system.

Some elements of the plan include expanding mental-health programs in schools, growing tele-behavioral health operations in high schools and college campuses, and creating more than 30 mobile crisis centers.

However, some feel the plan is a good start with more to be done.

Bruce Cruser - executive director of Mental Health America in Virginia - said in the past, more money has been put toward hospital care than community care. Although this plan changes that dynamic, he outlined what else needs to be addressed in the state's mental-health landscape.

"What we don't see there is funding for the Community Services Board's employees," said Cruser, "and they're really the front line of care in the community to help prevent people from having to go into the hospital. And so, what we'd really like to see is some additional funding to make up the ground for the Community Services Board, the direct care staff."

The plan finds 106 of Virginia's 133 counties are classified as having a mental-health professional shortage.

Cruser said the COVID-19 pandemic only exacerbated existing flaws in Virginia's mental-health system. This resulted in less people being able to get the help they needed.

While he said it's fortunate to see the attention this plan is creating, he noted that it's a shame it took years of crisis to reach this turning point.

Although the plan has great support, Cruser also noted that there will be challenges to implementing this plan. Specifically, he noted that the pay rate from insurance or Medicaid needs to be increased.

But, Cruser said he feels there are two elements of this plan which ensure people won't always end up in hospitals for behavioral-health issues.

"The mobile crisis and the crisis receiving centers would help build up that continuum of care in the community so that people don't have to end up going to the hospital," said Cruser, "They can get the care they need, they can get the crisis resolved, they can find the services that they need in the community with much better outcomes."

He added that this would boost the state's mental-health system a lot.

Over the Virginia General Assembly's next legislative session, Cruser said he is eager to see this proposed plan become a package of legislation that'll advance the state's mental-health system.