Mental Health America Indiana Blog

Mental Health America Indiana Blog. Keeping your mental health informed.

Don't Make That New Year's Resolution - submitted by Lisa Hutcheson

Don't Make That New Year's Resolution - submitted by Lisa Hutcheson

Ok, maybe I should be more clear - don't make the same old new year's resolutions that we all do to lose weight, eat better, exercise more or stop smoking.  All of those are great goals and very important, of course, but I would encourage us to think as much about our MENTAL health as we do our physical health. Mental wellness and physical wellness are so intertwined that it's hard to separate them and we know that one impacts the other.  So in this new year, when we are given a fresh start and while we are motivated (hopefully beyond this month!), let think about how we can ensure that we are paying attention to our mental health.  

The following article excerpts are found on the Empower website and you can read the entire article here:

 http://www.empowher.com/mental-health/content/11-mental-health-new-years-resolutions

 

1.  Resolve to treat yourself nicely and write out a list of 10 positive things you like about yourself and look at that list often

2.  Resolve to seek help if you need it - help reduce the stigma!

3.  Resolve to be physically active and mentally active every day

4.  Resolve to ACT and not REACT to negative situations and people around you

5.  Resolve to RELAX - at least 15 minutes a day do something that helps you feel calm and something that you enjoy

6.  Resolve to put yourself before your illness - we are NOT defined by our mental or physical illnesses (don't say "I'm depressed", say instead "I HAVE depression")

7.  Resolve to be mindful and present NOW - we can't change the past or control tomorrow, but we can live in the moment today

8.  Resolve to be the person you want to be and know you can be - you may have seen the saying "God, please help me be the person my dog thinks I am"?  Well this is like that, you have goals and aspirations and you need to take steps, no matter how tiny, to become that person. 

9.  Resolve to forgive yourself and others - we all have great intentions and we really do want to keep our promises and resolutions to ourselves and others but sometimes we will fail and it feels like we are going backwards and not moving ahead.  That's ok - the great thing about new years is that there are also new months and new days and you can choose to "start over" any time...the calendar has no control over our making better choices!

 

So happy 2015 to you and remember:

"Your present circumstances don't determine where you can go; they merely determine where you start."  Nido Qubein

 

 

 

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Study Finds Mental Health Providers Not Well Prepared for Military Veterans - from Medical News Today -

Study Finds Mental Health Providers Not Well Prepared for Military Veterans - from Medical News Today -

Most community-based mental health providers are not well prepared to take care of the special needs of military veterans and their families, according to a new study by the RAND Corporation that was commissioned by United Health Foundation in collaboration with the Military Officers Association of America.

The exploratory report, based on a survey of mental health providers nationally, found few community-based providers met criteria for military cultural competency or used evidence-based approaches to treat problems commonly seen among veterans.

"Our findings suggest that community-based mental health providers are not as well prepared as they need to be to address the needs of veterans and their families," said Terri Tanielian, the study's lead author and a senior social research analyst at RAND, a nonprofit research organization. "There is a need for increased training among community-based providers in high quality treatment techniques for PTSD and other disorders that are more common among veterans."

Although the Department of Defense and Veterans Health Administration in recent years have increased employment of mental health professionals, many veterans may seek services from practitioners in the civilian sector, often because they are located closer to their homes. In addition, policymakers have expanded veterans' access to community-based health providers as a way to meet demands, given capacity constraints in the VA health system.

"Our veterans have served and sacrificed for our nation and deserve the very best care," said Kate Rubin, president of United Health Foundation. "We hope this study will focus attention on the opportunity that exists to better prepare our mental health workforce to meet the unique needs of veterans and their families."

Recent military veterans are more likely than the general population to suffer from major depressive disorder and posttraumatic stress disorders, two conditions prevalent among those who have deployed to battle zones.

RAND researchers surveyed a convenience sample of 522 psychiatrists, psychologists, licensed clinical social workers and licensed counselors to determine whether they used evidence-based methods to treat major depressive disorder and PTSD, and whether they had the training needed to be sensitive to the needs of veterans.

Just 13 percent of the mental health providers surveyed met the study's readiness criteria for both cultural competency and delivering evidence-based care. Providers who worked in community settings were less prepared than providers who are affiliated with the VA or military health system.

Only one-third of psychotherapists reported receiving the training and supervision necessary to deliver at least one evidence-based psychotherapy for PTSD and at least one for depression.

While 70 percent of those providers working in a military or VA setting had high military cultural competency, only 24 percent of those participating in the TRICARE network, the Department of Defense's health insurance program, and 8 percent of those without VA or TRICARE affiliation met the threshold for cultural competency.

"Veterans and their family members face unique challenges, and addressing their needs requires understanding military culture as well as their mental health challenges," said retired Navy Vice Adm. Norb Ryan, president of the Military Officers Association of America. "It's crucial that our civilian mental health providers acquire the training and perspective they need to guide their practice in the care of our military and veteran population."

The study recommends that organizations that maintain registries or provider networks include information about mental health practitioners' ability to properly treat the special needs of military and veteran populations.

In addition, researchers encourage policymakers to expand access to effective training in evidence-based treatment approaches and to create incentives to encourage providers to use these strategies in their routine practice.

 

If you are a veteran or would like resources for veterans, please check out these sites:

http://www.archives.gov/veterans/employment-resources.html (employment resources)

http://www.va.gov/homeless/resources.asp (resources for homeless vets)

http://www.nami.org (resources for mental health)

http://www.veteranscrisisline.net/GetHelp/ResourceLocator.aspx (veterans crisis line  1-800-273-8255 press#1)

 

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Suicide - what can you do to prevent it?

Suicide - what can you do to prevent it?

At the Indiana Collegiate Action Network (ICAN) conference today, Colleen Carpenter, who is an expert on suicide prevention spoke about the issue of suicide  and how it can be prevented.  The following are excerpts from her presentation:

*90% of those who die by suicide showed warning signs, 2 weeks before their death

*nearly everyone who is thinking about suicide is ambivalent about ending their life

*showing them that you care and offering help builds hope and can prevent suicide

There are risk factors associated with suicide:

1.  family history of mental illness and suicide

2. lack of parental support and a history of violence and abuse

3.  feelings of hopelessness, loneliness, anger/hostility, poor problems solving skills, feeling like a burden

4.  school or work problems, financial problems, abuse, chronic disability or illness

5.  lack of access to care, stigma about seeking help, access to lethal means, negative social environment

WARNING SIGNS

F - Feelings

A - Actions

C- Changes

T- Threats

S-Situations

How do we PREVENT suicide?  Don't be afraid to start a conversation with someone by saying something like....

"I have been feeling concerned about you lately."

"It sounds like you're going through a lot right now - do you want to talk about it?"

"It seems like you're really (down, depressed, angry etc) - can we talk about it?"

WHAT YOU SHOULD NOT DO:

1.  NEVER leave the person alone

2.  Don't think they're "just talking" and don't mean it if they make suicidal threats and don't imply their thoughts are silly or unimportant

3.  Don't make promises to them including that you will keep their secret

4.  Don't try to convince them that things are not "all that bad"

5.  Don't act alone - try to get someone else, preferably a professional, involved

FOLLOW UP AND GET THEM RESOURCES AND HELP

Call 9-1-1 if they're actively threatening or become secluded while actively threatening

The Jed Foundation www.thejedfoundation.com

National Suicide Prevention Lifeline 1-800-273-TALK (8255)

Suicide Prevention Resource Center - www.sprc.org

American Association of Suicidology - www.suicidology.org 

 

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Mental Health First Aid

Mental Health First Aid

Let's make 'Mental Health First Aid' a mental illness game changer

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FILE -- July 16, 2014: Rep. Lynn Jenkins, R-Kansas and David Johnson discuss Mental Health First Aid at a National Council for Behavioral Health briefing. (Courtesy National Council for Behavioral Health)

From time to time something triggers a nearly universal reaction across the country. Sadly, this collective experience is often prompted by a tragedy, one that induces a wave of gasps soon followed by the unanswerable question -- “Why?” 

Whether it’s the death of a universally beloved actor by suicide, or an act of horrific, seemingly arbitrary and unexplainable violence, all too often the national conversation evolves to include a discussion of mental illness.

Indeed, recent reports suggest that approximately one in four adults experience a diagnosable mental health disorder today. And sadly, in almost all acts of horrific mass violence over the past couple years from Newtown, to Tucson, to Aurora, mental illness has been a common denominator.

Mental Health First Aid is an eight-hour course that uses an approach similar to first aid, teaching participants to identify, understand, and respond to early signs of mental illness. 

By default, teachers, first responders, law enforcement officers, and other public servants, are more and more often on the front lines of dealing with persons living with mental illness. Until recently, these agencies had little or no training on how to adequately respond to mental health crises.

Fortunately, this is changing. They are increasingly working with behavioral health centers to better equip their personnel to fill this critically important role. Through an innovative program called Mental Health First Aid, they learn valuable lessons on how to work both compassionately and efficiently with those in need of mental health care.

Mental Health First Aid is an eight-hour course that uses an approach similar to first aid, teaching participants to identify, understand, and respond to early signs of mental illness. 

We are proud that Lawrence, Kansas has positioned itself as a leader in mental health care.  From captains to cadets, the entire officer and civilian staff at the Lawrence Police Department has been trained in Mental Health First Aid.  However, it is vital that this training is also highlighted at our universities and that is why the campus police, the law school faculty and staff, business school student advisors, and residential advisors at KU have also all been trained.

Earlier this year, the U.S. House of Representatives passed the bipartisan Consolidated Appropriations Act, an omnibus spending bill that provides discretionary funding for the entire federal government. 

Due to our requests and work to bring awareness to this issue the legislation contained $15 million that will be devoted to new mental health training programs like those administered by the Bert Nash Community Health Center in Lawrence and the Family Service & Guidance Center in Topeka.

Toward that end, we both spoke about this critically important program at a recent briefing in Washington, D.C.; one as the lead sponsor of the bipartisan Mental Health First Aid Act and someone who has been an advocate for mental health over the past decade, and the other as a mental health care professional and one of the first certified Mental Health First Aid trainers in the country.

Together we spoke of the many success stories generated by the mental health first aid course, and the urgent need to make it available throughout the country. Not only does the training lead to safer and healthier communities, but also to safer situations for those on the front lines.

There is still more work to be done with the bipartisan Mental Health First Aid Act – which currently has 83 cosponsors in the House – but we are glad that direct action has been taken this year. 

Mental Health First Aid is and will continue to make a real difference in our community and we look forward to continuing our lead to ensure that everyone has access to mental health resources and that more communities have the knowledge and tools needed to help folks and prevent another senseless crisis.

 

Republican Lynn Jenkins represents the second congressional district of Kansas in the U.S. House of Representatives. She  is the Vice Chairwoman of the House Republican Conference and is the lead Republican for H.R. 274, the Mental Health First Aid Act. Jenkins first started working on mental health initiatives nearly a decade ago through her involvement with the Family Service and Guidance Center and the National Council for Community Behavioral Healthcare.

 

 

David Johnson has been the CEO of the Bert Nash Community Mental Health Center in Lawrence, Kansas since 2001. He was one of the first 14 Certified Mental Health First Aid Instructors in the United States. Previously, Mr. Johnson has served as the President/Chief Executive Officer, Behavioral Health Resources of Central Iowa, Westminster House, Inc. and Eyerly Ball Community Mental Health Services, Des Moines, Iowa from 1979 to 2001

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What is Good Mental Health? original article published on ABC Health and Wellbeing, Sept. 11, 2014

What is Good Mental Health? original article published on ABC Health and Wellbeing, Sept. 11, 2014

Think of mental health and a list of mental illness often springs to mind – there's depression and anxiety, eating disorders and addictions, schizophrenia and bipolar disorder to name just a few.

Efforts to raise awareness of mental illness mean most of us are now somewhat familiar with the more common mental disorders, even if we've never had the personal experience of one.

But in recent years, both researchers and clinicians have been moving away from viewing mental health in terms of the presence or absence of symptoms. Instead, they have been seeking to discover what it means to be in good mental health, and what we can do to foster our own mental wellbeing.

According to Tim Sharp, founder and Chief Happiness Officer at The Happiness Institute, the shift has been an important one. Rather than spending most of his time stopping people from being at their worst, he now devotes much of his working life to ensuring people are at their best.

What is good mental health?

Psychologist Martin Seligman has been raising the profile of positive psychology over the past two decades.

Seligman's notion of good mental health boils down to five key domains that together form the acronym PERMA: positive emotions, engagement, relationships, meaning and purpose, and accomplishments. However, other researchers believe additional factors also play a role.

Felicia Huppert, director of the WellBeing Institute at the University of Cambridge and Professor of Psychology at the Institute for Positive Psychology and Education at the Australian Catholic University, has been studying mental wellbeing for more than two decades. She describes mental health as being a spectrum.

"At one end are the common mental disorders [of anxiety and depression] and at the other end is positive mental health, or flourishing," she says.

To define what it means to flourish, Huppert reasoned that attributes of positive mental health would be opposite those that define poor mental health. By looking at internationally agreed measures of depression and anxiety and defining the opposite of each symptom, Huppert distilled a list of 10 features of positive wellbeing.

This list includes the five PERMA attributes, as well as emotional stability, optimism, resilience, self-esteem and vitality.

What defines positive mental health?

The following attributes have been found to be important for good mental health

  • Positive emotions: all things considered, how happy do I feel?
  • Engagement: taking an interest in your work and activities
  • Relationships: having people in your life that you care for and who care about you
  • Meaning and purpose: feeling that what you do in life is valuable and worthwhile
  • Accomplishment: feeling that what you do gives you a sense of accomplishment and makes you feel competent
  • Emotional stability: feeling calm and peaceful
  • Optimism: feeling positive about your life and your future
  • Resilience: being able to bounce back in the face of adversity
  • Self-esteem: feeling positive about yourself
  • Vitality: feeling energetic

Why is good mental health important?

Regardless of the definitions, evidence shows that a healthy mental state is something to strive for.

"We know that when you have a high level of wellbeing, all sorts of other things go along with that that are really great, like better learning, better relationships, greater productivity, and better health," says Huppert.

Although positive mental attributes and symptoms of common mental illness fall at the opposite ends of the mental health spectrum, they are not merely different sides of the same coin. Having good mental health is not the same as being without poor mental health.

This is perhaps best illustrated by another of Huppert's studies. In the study, over 6000 people living in the UK completed surveys on their general wellbeing, and on whether or not they experienced psychological symptoms. When participants were followed up after seven years, Huppert found that lacking a positive mental state was a better predictor of mortality than the presence of psychological symptoms.

Huppert's study is backed by an analysis of 150 studies of wellbeing that comes to the same conclusion: good mental health can affect your health in ways that isn't explained by a simple lack of poor mental health.

But the analysis also found that some aspects of your health are more likely to be influenced by wellbeing. While wellbeing appeared to have a positive impact on measures of immune system function and tolerance to pain, no effect was seen in people with cardiovascular conditions. Although another study found that positive psychological wellbeing can reduce the risk of developing cardiovascular disease in the first place.

But it's not just you who is likely to benefit if you have positive mental health, there are also benefits for the community.

"When we have high levels of wellbeing, we are more pro-social," says Huppert. "People who feel happier and more satisfied are much more likely to be kind, to be tolerant, to be inclusive. So that's a direct way in which society benefits."

There also appear to be economic benefits as well. Sharp, who works with organisations to promote a culture of optimism and mental wellbeing in their employees, says that these businesses outperform comparable businesses that don't deliberately foster employee wellbeing.

Fostering good mental health

A number of practices have been shown to improve our mental health.

MindfulnessMindfulness, which emerged out of the Buddhist tradition of meditation, is a practice of drawing one's attention to the present moment, focusing on emotions, thoughts and sensations in a non-judgemental way. Mindfulness has been shown to be effective at improving mental wellbeing, behaviour regulation, and interpersonal relationships.

According to Huppert, who studies mindfulness, a key to mindfulness practice is awareness. If we are aware that we are becoming angry, for instance, we have a greater ability to make a choice of how to behave in response to that emotion.

Sharp also considers awareness of our emotions and thoughts as being crucial to fostering an optimistic outlook on life.

"Most people operate most of their time on automatic pilot," he says. "Most of their thoughts and beliefs are unconscious and automatic."

By learning to deliberately notice what thoughts we are having, and then being able to question whether or not they are helpful to the situation at hand, Sharp believes we can learn how to be more optimistic over time.

Gratitude diary: Another useful exercise for fostering optimism is a gratitude diary. Listing three things to be appreciative or thankful for at the end of each day can help us to view life from the glass-half-full perspective more often.

Optimism: Sharp draws a clear distinction between fostering optimism and simple positive thinking.

"Real optimism is about focusing on the positive, but it's also important that it's grounded in reality. It's not about pretending everything's fantastic if it's not."

The idea behind Sharp's brand of optimism is to promote thoughts that will help to make the most of a bad situation or find a realistic solution to a problem, rather than just sweeping a problem under the carpet.

Realistic expectations: These are also important, according to Sharp. "No-one's happy all of the time, and no-one will have a positive attitude all of the time."

Negative life events can strike anyone. The death of a loved one, loss of a job, or onset of serious illness can all take their toll on mental wellbeing. This is one reason that it's important to focus on aspects of our life that are within out control, according to Kaarin Anstey, Director of the Centre for Research on Ageing, Health and Wellbeing at the Australian National University.

"There's a lot you can do to improve your happiness and your sense of mental wellbeing," she says.

Social engagement: Anstey points to social engagement and activities such as volunteering as factors that can help to promote good mental health. She also says a healthy diet, exercise and getting adequate sleep play a role.

Many of these same factors protect our cognitive health, something that Anstey also considers central to mental wellbeing.

Huppert, who is studying the impact of a mindfulness program in schools, would like to see mental wellbeing and practices such as mindfulness encouraged as early as possible so that people can reap the benefits as they mature into adulthood.

"Anyone can learn at any stage, at any age," she says. "But the earlier the better."

 

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Inadequate Mental Health Treatment for African Americans - from the Source for Advancing Health, July 25, 2014

Inadequate Mental Health Treatment for African Americans - from the Source for Advancing Health, July 25, 2014

Blacks with depression and diabetes receive inadequate mental health treatment

Published on July 25, 2014 at 4:04 AM · No Comments

A new study in General Hospital Psychiatry confirms that Blacks with depression plus another chronic medical condition, such as Type 2 diabetes or high blood pressure, do not receive adequate mental health treatment.

Those who do seek treatment for depression often receive medications from a primary care provider, the authors said, and are less likely to have care from specialized mental health providers. Consequently, those patients are less likely to receive mental health treatment recommended by American Psychiatric Association (APA) guidelines. Primary care is rarely adequately resourced to provide long-term mental health treatment.

"People who have depression are more likely to develop type 2 diabetes and vice versa," said lead study author Amma A. Agyemang, M.S., M.P.H. of Virginia Commonwealth University's psychology department. "We found depression treatment below par for minorities, even those with co-morbid diabetes or hypertension. Having a mental illness and a medical illness makes both more complex to treat, and the rate of obtaining depression treatment remains low for this population."

The research team utilized cross-sectional data obtained between 2001 and 2003 from the National Survey of American Life. They were particularly interested in two opposing hypotheses: exposure or crowd-out effects. The former occurs when a person has both a mental and medical illness, said Agyemang. A provider helps manage the medical illness, and will be more likely to inquire about mental health. In contrast, crowd-out effects occur when a medical illness like type 2 diabetes demands more focus, resulting in inadequate mental health care.

Overall, they found that only 19.2 percent of Black Americans with major depression alone, 7.8 percent with depression plus type 2 diabetes and 22.3 percent with depression plus hypertension reported receiving psychotherapy or antidepressant treatment in accordance with APA guidelines. Compared to respondents with major depression alone, respondents with two health conditions, either major depression and type 2 diabetes or major depression and hypertension, were no more likely to receive depression care. Respondents with all three health concerns: depression, type 2 diabetes and hypertension were, however, three times more likely to report any guideline-concordant care

"Depression has lower rates of detection and treatment among Blacks compared to Whites—a well- known health disparity—and we know depression is more disabling and chronic among Blacks," said Shervin Assari, M.D., M.P.H., a research fellow at the Department of Psychiatry and Center for Research on Ethnicity, Culture, and Health at the University of Michigan School of Public Health. "The good news for treatment of depression among Blacks is a higher chance of treatment of depression in the presence of medical multi-morbidity. The bad news for depression treatment among Blacks is lower quality of depression treatment in this case. They do not receive the most effective, evidence- and guideline-based treatment."

Mental health conditions in general and depression in particular are associated with high stigma among Blacks, keeping them away from psychiatric services, Assari added. "African Americans may also have lower trust in the health care system. Black patients who have multiple medical conditions may have a higher likelihood of treatment, however, the treatment may not be based on standard guidelines. Diagnostic tools are designed based on White patients and are not sensitive to patients' cultures. Physicians also do not receive enough training for detection and diagnosis of mental health illnesses among minority groups."

Hopefully, that will change, observed Agyemang. "As the discipline of psychology continues moving closer to really integrating mental health services into broader medical settings, perhaps we can close the gap in mental health treatment and health disparities for minority populations.

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Thoughts on Freedom

Thoughts on Freedom

As we celebrate the 4th of July tomorrow and all of the freedoms we enjoy, my thoughts turn to those friends and family who are fighting their own battles for freedom from mental illness and addiction.  And how many families and friends still hide their illness or addiction because of the stigma, guilt, and shame they still feel.  It is estimated that more than 12,000 adults in Indiana have serious mental illness and 70% of them are not being treated either because they can't afford it, don't have access to treatment, or are in denial that they need help.

Thankfully we have made a lot of progress is the way we diagnose and treat mental illness and addiction, and we understand much more about the neurology of the disease.  Now we have much more sophisticated medications available and other therapies that are much more effective, making living in successful recovery a possibility.  Unfortunately, the stigma and stereotypes surrounding mental illness are still alive and well.   The word "stigma" is a Greek word that means "a mark or token of disgrace".  The stigma around mental illness can often be as bad or even worse than the illness itself, causing the person to live in shame and secrecy with feelings of guilt and responsibility.  Only 25% of adults with mental illness believe that people are caring and sympathetic  to other people with mental illness. Because of stigma, many people with mental illness and addiction may not seek treatment.  Federal law has prohibited discrimination for more than five decades. People with other illnesses like diabetes aren't routinely discriminated against - why is a brain illness any different?

How do we "break the chains" of stigma? As with most stereotypes, much of it is rooted in ignorance and lack of understanding. Education and awareness is key.  There are also steps that consumers can take to cope with the stigma they may feel:

1.  Find and Get Treatment - don't let your fear of being labeled or stereotyped stop you from seeking the help that you need to recover.

2.  Find Support - don't live in isolation, but find the support you need through groups, programs, or other networks that offer friendship and support

3.   Define Yourself, Not Your Illness - your mental illness or addiction is not who you are, its doesn't define you or make you who you are.  Don't say "Im bipolar" but instead, "I have bipolar".  I have learned working in this field, that the person is always first, not the illness.

4.  Stand Up and Speak Out - It's important that people with mental illness and addiction become their own best advocates. Friends and family members can also become advocates and help to educate and raise awareness.  

Is freedom from mental illness, addiction, and stigma possible?  Yes!  We all can have a role in the recovery of a friend or family member with mental illness by showing our support, love, and care and ensuring that they are getting the medical and emotional care and treatment that they need. Former President Bill Clinton once said, "Mental illness is nothing to be ashamed of, but stigma and bias shame us all".

 

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Competing Mental Health Bills Introduced in Congress - article written by Liz Szabo, USA Today (May 8, 2014)

Competing Mental Health Bills Introduced in Congress  - article written by Liz Szabo, USA Today (May 8, 2014)

 

In the weeks after the shootings in Newtown, Conn., many mental health advocates hoped that the tragedy would lead Congress to address problems in the country's fragmented mental health system.

Nearly a year and a half later — and in spite of several additional shootings — Congress has yet to pass major mental health reforms.

Now, some mental health advocates wonder if competing bills introduced in the House of Representatives will improve the chances of passing new legislation or hinder it.

In December, Rep. Tim Murphy, R-Pa., introduced the Helping Families in Mental Health Crisis Act. About two-thirds of its 77 co-sponsors are Republicans.

The issue took a partisan turn Tuesday when Rep. Ron Barber, D-Ariz., introduced his own, more limited bill, supported by a handful of Democrats, called theStrengthening Mental Health in Our Communities Act of 2014. While the two bills have some elements in common, Barber's bill is far less sweeping than Murphy's, which proposes an overhaul of the way federal mental health programs are organized and funded.

Murphy and Barber both have worked in the mental health field for decades, and they agree that patients and their families need help. "We've lost billions of dollars in funding over the past few years" for mental health services, Barber says. "We've really got a crisis on our hands."

Yet mental health advocates say the bills are also in competition. Some worry that partisanship could doom any chance of passing a bill.

"In the best-case scenario, you've got two proposals addressing the same problems, and a framework for the parties to come together," says Ron Honberg, of the National Alliance on Mental Illness. "In the worst case, the partisan divide prevents them from ever reaching agreement."

Barber, who was shot alongside Rep. Gabrielle Giffords when Jared Loughner opened fire on a crowd in Tucson in 2011, says his bill makes "serious and sustained investments in existing programs" proven to work.

Barber's bill would increase mental health funding for veterans and active-duty service members; create "mental health first aid" programs in schools and communities; and create a White House Office for Mental Health Policy, similar to the White House's Office of National Drug Control Policy. The bill aims to make hospital care more accessible to seniors with mental illness, by requiring Medicare to treat mental health hospitalizations the same way as other hospitalizations. Today, Medicare sets a 190-day lifetime cap on inpatient psychiatric care.

 

Barber's bill has the support of the American Foundation for Suicide Prevention, theNational Association for Rural Mental Health, the Bazelon Center for Mental Health Law and the National Association of County Behavioral Health and Developmental Disability Directors.

The bill from Murphy, a child psychologist, would create a new Assistant Secretary of Mental Health and Substance Abuse Disorders, who would control mental health funding and report annually to Congress.

That would shift power away the Substance Abuse and Mental Health Services Administration, which currently administers mental health grants to states. Murphy says some of these grants are wasteful and aren't supported by good medical evidence.

The bill would require states that get federal mental health grants to change their standards for involuntary psychiatric commitment, allowing people to be hospitalized against their will when they need treatment, not simply when they pose a danger to themselves or others – the standard in about half of states. That change could allow patients to get care sooner, Murphy says.

Murphy's bill also aims to provide family caregivers with more information about their loved ones' care, by clarifying privacy rules set out in the Health Insurance Portability and Accountability Act. Today, Murphy says, privacy rules lead families to be shut out of their children's care, when kids are as young as 14.

Murphy's bill would also make changes to Medicaid funding, allowing psychiatric hospitals to be reimbursed for short-term care. Today, psychiatric hospitals with more than 16 beds aren't eligible for Medicaid funding for most adult patients, which has propelled the closing of many hospitals, Murphy says. Those closures have left many mentally ill patients without a place to go when they're in serious crisis. Many end up homeless or in jail, he says.

Murphy's bill has been endorsed by the American College of Emergency Physicians and American Academy of Child & Adolescent Psychiatry.

The National Disability Leadership Alliance has criticized Murphy's bill, charging that it would strip people with mental illness of critical privacy rights. And allowing psychiatric hospitals to bill Medicaid for services could lead patients to be institutionalized, rather than treated in the community.

Yet Honberg applauds Murphy's focus on increasing access to psychiatric beds and clarifying privacy rules.

"The assumption should be that health care providers can and should communicate with families," Honberg says. "There needs to be clarity in the law. That's the only way we are ever going to change providers' behavior."

The two bills reflect not just political divisions, but deep philosophical divides in the mental health community, says Ron Manderscheid, executive director of the National Association of County Behavioral Health and Developmental Disability Directors.

Mental health advocates disagree about the balance between respecting patient privacy and helping people who don't realize they're sick; whether scarce financial resources are better spent providing community care or hospital beds; and whether to promote general mental health or concentrate resources on those with the most severe mental illnesses, such as schizophrenia, says D.J. Jaffe, executive director ofMentalIllnessPolicy.org. And some people with mental illness reject all treatment, viewing psychiatry as the problem, rather than the solution.

 

Jeffrey Lieberman, past president of the American Psychiatric Association, says he hopes members of Congress can work together. Failing to act on the momentum provided by tragedies such as those at Newtown, the Washington Navy Yard and Fort Hood, he says, "would be a terrible misfortune and missed opportunity."

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Who Will Not Be Covered? Indiana's response to ACA

Indiana is one of the 25 states that has chosen to not expand Medicaid as an option under the Affordable Care Act.  It is estimated that almost 250,000 adults with serious mental illness and substance abuse will be without coverage if Indiana doesn't expand Medicaid.  
There was a call from some legislators last week for a full and complete report from Governor Pence on his recent meeting with Kathleen Sebelius, Health and Human Services Secretary, on where Indiana stands with the ACA.  Currently. the administration plans to expand HIP (the Healthy Indiana Plan) to provide coverage to adults and children.
What are your thoughts on Indiana's response to ACA and not expanding Medicaid?  Do you think this will create a health care crisis, specifically a mental health care crisis?  Leave us a comment.
 

Report: Almost 4 million with mental illness won’t be covered in states that don’t expand Medicaid

Source: American Mental Health Counselors Association

Source: American Mental Health Counselors Association

States that decide not to expand Medicaid under the Affordable Care Act will leave more than 3.7 million Americans with mental illness without health-care coverage, according to a new report from an organization that represents mental health professionals.

Almost one in five Americans between the ages of 18-34 who live without health insurance and make less than 138 percent of the federal poverty level suffer from serious psychological distress, the report by the American Mental Health Counselors Association says. In states that opt to expand Medicaid under the ACA, those people would be eligible for coverage that includes mental health treatment.

But 25 states have not expanded Medicaid yet, meaning those residents with mental illness won’t be eligible for coverage. The problem is most acute in Florida and Texas, both home to more than half a million uninsured adults with serious mental health and substance use conditions.The 11 southern states that are not moving toward Medicaid expansion are home to 2.7 million people with mental illness. Virginia, North Carolina, Tennessee, South Carolina, Oklahoma, Louisiana, Missouri and Mississippi each have between 100,000 and 200,000 such uninsured adults. Georgia has 233,000 residents who suffer from mental illness, according to data compiled through the Substance Abuse and Mental Health Services Administration.

Several Mountain West states have yet to move toward expanding Medicaid. Republican-dominated legislatures in Montana, Wyoming and Idaho have not taken up Medicaid expansion legislation. Utah, where Republicans control both legislative chambers and the governor’s mansion, will take up one of several proposals; Gov. Gary Herbert (R) has said doing nothing on Medicaid expansion is the only option he will rule out.

About 40 percent of all uninsured Americans with a mental illness are eligible for health insurance coverage under Medicaid as it stands now; under Medicaid expansion in states that have opted to accept federal money; or under state health insurance marketplaces.

Mental health care is included under what the ACA dubs the “Essential Health Benefits” package.

Nationwide, about 18 million Americans are eligible for coverage through Medicaid expansion. About 10 million live in states that have opted not to expand Medicaid. Nearly 800,000 of those residents have serious mental illness, while 1.5 million experience serious psychological distress and almost 1.4 million suffer from substance abuse disorders.

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Pentagon’s Efforts to Curb Mental-Health Woes Falling Short | Mark Thompson for Time

Pentagon’s Efforts to Curb Mental-Health Woes Falling Short | Mark Thompson for Time

In this article, published on February 21, 2014, the military is once again being scrutinized for their lack of providing effectual and evidence based services for those who need mental health services.  It's estimated that 12-18 veterans die from suicide every day, and hundreds of thousands are diagnosed every year with PTSD, depression, and other mental illness.  The federal government has much to do to improve the system for these men and women who need to be assessed, diagnosed, and treated.  What do you think about Indiana's response to this mental health crisis?  Is our system effectively providing services to our Hoosier service men and women?  Please leave us a comment

 

The Pentagon didn’t actually win the wars in Afghanistan and Iraq. Now a prestigious federal panel has concluded it’s also not winning its decade-long battle to shield troops’ brains and minds from mental-health woes stemming from those conflicts.

There is little evidence that the military’s so-called “resilience, prevention, and reintegration” programs, designed to beef up soldiers’ defenses against the mind-ravages of war, have had any beneficial effect, concluded the 291-page report released Thursday by an Institute of Medicine panel. Its members, a variety of mental-health experts with diverse backgrounds, said:

A majority of Department of Defense resilience, prevention, and reintegration programs are not consistently based on evidence and that programs are evaluated infrequently or inadequately. For example, on the basis of internal research data that show only very small effect sizes, Department of Defense concluded that Comprehensive Soldier Fitness, a broadly implemented program intended to foster resilience, is effective—despite external evaluations that dispute that conclusion. Among the small number of Department of Defense -sponsored reintegration programs that exist, none appears to be based on scientific evidence. The committee was unable to identify any Department of Defense evidence-based programs addressing the prevention of domestic abuse. More recently, the services have implemented a number of prevention interventions to address military sexual assault, yet a Department of Defense review found that critical evaluation components needed to measure their effectiveness are missing.

The meager results don’t come as a shock to Elspeth Ritchie, who retired as a colonel from the Army in 2010 after serving as the service’s top psychiatrist. “The military took the approach of `let’s throw everything at it and let’s see what works,’” she says, recalling the thinking of some of her Army colleagues: “You put enough steel on target, the target is going to go down.”

The report singled out the Army’s Comprehensive Soldier and Family Fitness program, a $125 million effort created in 2008 to fortify soldiers’ mental health. While the Army concluded it was working in 2012, Thursday’s report said its evidence was based on a too-small sample to reach such a conclusion. The panel said the Army efforts did little to reduce the chances of a soldier suffering from post-traumatic stress disorder or depression. It added that the current one-size-fits-all strategy for addressing mental-health issues may not work best and “can lead to the inefficient use or waste of scarce resources that could otherwise be used to address the enormous task of preventing psychological health problems.”

The Army has said that these programs are not aimed at curbing depression or PRTD, but are focused on giving troops the tools they need to maintain a healthy mental outlook, which could reduce various mental-health ailments. The cost of such programs more than doubled between 2007 to 2012, to nearly $1 billion annually.

Mental-health problems skyrocketed in the U.S. military following troops’ repeated deployments to Afghanistan and Iraq. With a force too small to wage both conflicts, soldiers and Marines had to deploy repeatedly to the front lines. “As would be expected, there is a dose-dependent relationship between levels of combat experiences and well-being indices,” the Army’s recently-released ninth Mental Health Advisory Team report says. “This relationship is clearly demonstrated for the percentage of Soldiers meeting screening criteria for any psychological problem.”

The IOM report notes that mental illnesses among troops jumped by 62% between 2000 and 2011, with the suicide rate nearly doubling between 2005 and 2010. “In 2011 there was a total of 963,283 service members and former service members who had been diagnosed with at least 1 psychological disorder during their period of service,” the study found. “Nearly 49 percent of these service members had been diagnosed with multiple psychological disorders.” In recent years, mental-health diagnoses have eclipsed pregnancies as the source of most military hospitalizations.

Ritchie says the absence of proof that such programs aren’t working doesn’t mean they’re not; civilian efforts to achieve the same goals have similar “fuzzy” outcomes. “You try to add an hour or two of resilience training in basic training, but you really don’t know what [improvement] is related to that,” she says. “I remain skeptical, but at the same time I am sympathetic to the desire to do everything you can for the troops, even if the science isn’t there yet.”

 

 

 

 

 

 

 

Read more: Pentagon’s Efforts to Curb Mental-Health Woes Falling Short | TIME.com http://swampland.time.com/2014/02/21/pentagons-efforts-to-curb-mental-health-woes-apparently-falling-short/#ixzz2tyVyXH3p

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What is a Hero?

What is a Hero?

Webster's Dictionary defines hero as "a person who is admired for brave acts or fine qualities; a person who is greatly admired; an illustrious warrior".Some would say the world lost a hero last week with the passing of Neslon Mandela, the first black South African  president, great philanthropist, and political and social activist.   He fought for the rights of those who had no voice, engaged the world in a conversation about human rights, and showed forgiveness and mercy after being imprisoned.  Sounds pretty heroic to me.

To recognize Hoosier heroes,  Friday, December 13th, MHAI along with CHOICES, Inc.  will be hosting our annual "Heroes in the Fight" awards luncheon honoring those who are extraordinarily committed to improving the lives of persons with mental illness and addiction.   Why do we use the term "hero" when we talk about those in the mental health field?  They aren't literally fighting a battle, although sometimes they truly are when a client acts out physically.  Is there a "hero gene" that some people have that others don't?  What makes them "heroes"?

A recent article write by Kendra Cherry examined the characteristics of a hero and found that those who engage in "lifelong heroism" (choosing palliative care nursing, becoming a minister, becoming a firefighter etc) shared many similar qualities and characteristics.   According to the research cited in the article:

1.  People who become heroes tend to be concerned with the well-being of others.

Empathy and compassion for others were key characteristics that these people shared. A 2009 study found that people who have heroic tendencies also have a much higher degree of empathy.  They genuinely were concerned about others and the well being of others.  I have rarely met anyone in a "helping" profession that doesn't honestly care about the people they are trying to help.

2.  Heroes are good at seeing things from the perspective of others.

Having sympathy for someone is not enough - these people had true empathy and could "walk a mile" in someone else's shoes and really understand what that person was going through even if they had never gone through it themselves.  It is rare to find a nurse, counselor, or therapist who can't identify with their clients and what they are going through.  They understand that sometimes a person just needs to feel like they are being understood.

3.  Heroes are competent and confident.

These people have really good coping skills and are calm in a crisis.  If they are called upon to use their skills, they feel very confident and comfortable in their abilities in spite of any challenges or obstacles that may arise.  Most every position in the field of mental health and addiction is going to be filled with people in crisis a majority of the time.  These professionals must be able to successfully address multiple issues with many clients while maintaining their own mental and physical health…sure, they eat their Wheaties but they also feel confident and know they will be able to help.

4.  Heroes have a strong moral compass.

The article states that "according to heroism researchers Zimbardo and Franco, heroes have two essential qualities that set them apart from non-heroes: they live by their values and they are willing to endure personal risk to protect those values."  I think all people in the "helping" professions share the same values that everyone deserves to live as healthy a life as possible and to know that they are loved and valued.

5.  Having the right skills and training can make a difference.

Obviously, even though everyone would want to rush into a burning building to try to save someone, most of us don't know how to safely and effectively do that.  We have standards, certificates, degrees, and continuing education for a reason - to ensure that those who are helping people in crisis are able to do so with all of the skill, knowledge, and understanding that they can possibly have.  After all, we wouldn't go to a surgeon to take out our appendix if the only experience they had was dissecting a frog in high school biology class.

6.  Heroes persist, even if the face of fear.
 
This article suggests that these people are likely to be more "positive thinkers", risking themselves to help someone else.  In their daily work, therapists, counselors, and other mental health professionals may experience many kinds of fear:  physical fear, fear that a client may not recover, fear that services won't be available when clients need them, fear that stigma will never go away and people will continue to feel marginalized.  But they continue to go to work every day to overcome these fears and help their clients overcome, too.

7.  Heroes keep working on their goals, even after multiple setbacks.

Anyone who has worked in the mental health and addiction field understands that setbacks and relapse will happen, and happen often.  They are both part of the process of recovery and healing.  Undoubtedly, it can be frustrating when a client relapses in their addiction or refuses to follow their treatment plan and seems to make several steps backwards.  But these heroes are able to work through these setbacks and focus on the positives in the situation, even if they are seemingly small.  They are resistant and persistent!

So, as you reflect on the heroes in your life, take time to honor and thank them.  And as we give out our awards on Friday to a few deserving people, we are truly thanking all of the heroes who work daily and diligently to improve the lives of people with mental illness and addiction.

"The hero is one who kindles a great light in the world, who sets up blazing torches in the dark streets of life for men to see by.” –

Felix Adler

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Wounded Warriors

Wounded Warriors

As we remember our veterans, currently serving and those who have served in the past, we all should find some way to thank one (or many) of them today.  I have never been in the military so I don't know what it is like to have to leave friends and family, endure grueling and endless hours of training, and face fear on the battlefield.  I also don't know what it is like to experience PTSD (Post Traumatic Stress Disorder) or depression from witnessing and being a part of horrific events.

The U.S. Department of Veterans Affairs estimates that PTSD afflicts:

  • Almost 31 percent of Vietnam veterans
  • As many as 10 percent of Gulf War (Desert Storm) veterans
  • 11 percent of veterans of the war in Afghanistan
  • 20 percent of Iraqi war veterans
Traumatic Brain Injury (TBI), a jolt to the brain because of injury or repeated injuries to the brain, currently impacts more than 13,000 persons in the military, effecting every aspect of life.  Depression is the most common diagnosis after TBI, even mild PTSD.  How do you know if you, or someone you love, have PTSD?  Check these symptoms:
  • feeling upset by things that remind you of what happened
  • having nightmares or flashbacks, difficulty sleeping
  • feeling "cut off" from friends and family
  • feeling "numb" and losing interest in things that used to bring you joy and happiness
  • always feeling like you are "in danger"
  • feeling jittery or anxious, experiencing uncontrollable anger or other emotions
  • consider harming yourself or others
The good news is that there is  treatment available for PTSD, the most effective being counseling and medication.   So if you are a veteran and feel like you may be depressed or have PTSD, get help!  Below are some resources for you and your family:
If you are a veteran and want to help other veterans, go to:
If you would like to help our military by sending care packages, cards, letters or emails, or to volunteer, go to:
We thank all of you, those who have fought and continue to fight for our freedoms.  We also thank you, their families, who also sacrifice so much.  On this Veteran's Day, let's remember our warriors, our wounded warriors, who need our love, support, and help. So find a vet and thank them - I bet you won't have to go far.  Bring them cookies, take them out for coffee or lunch - or let them know there is help if they need it.  It's time for us to give back to those who gave and give so much to us.  Thank you, veterans!
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What's the Role of Primary Care Docs? By Dr. Suzann Koven

What's the Role of Primary Care Docs? By Dr. Suzann Koven

 

Patients occasionally ask me if I’ll be the doctor who’ll take out a gallbladder or deliver a baby. I tell them, “You deserve better.” I’m a primary-care internist, and my expertise is broader than it is deep. I manage high blood pressure and cholesterol but refer people with heart attacks to cardiologists; I perform Pap tests and prescribe birth-control pills but send pregnant women to obstetricians; and I often diagnose, but never treat, cancer.

With mental illness, though, the limits of my role are less clear. I’m comfortable helping people get through life’s more common emotional challenges, like divorce, retirement, disappointing children. If you’re hearing voices, or if you walk into my office and announce that you’ve decided to kill yourself, as someone did not long ago, I know exactly what to do: escort you to a psychiatrist. But what about the lawyer who’s having trouble meeting deadlines and wants medication for attention-deficit disorder? Or the businesswoman whose therapist told her to see me about starting an antidepressant? Or the civil servant trying to shake his Oxycontin addiction? They’ve all asked me to treat them because they don’t want or can’t easily access psychiatric care.

This winter, I’ll see more patients with seasonal-affective disorder than the flu, and the tissues in my exam room will dry tears more often than they muffle sneezes. The problem is, I lack the time or training to diagnose and manage many psychiatric disorders. And some studies, such as this one about low rates of detection of anxiety and depression by primary-care doctors, show that I’m probably not all that great at doing so. Still, over a third of all mental-health care in the U.S. is now provided by primary-care doctors, nurse practitioners, pediatricians, and family practitioners.

One reason is that there aren’t enough psychiatrists. I recall discussions, fifteen years ago, among members of my internal-medicine group about whether it was ethical for us to prescribe antidepressants when we practiced in a hospital with dozens of mental-health professionals on staff. We no longer have those discussions. Demand by patients for mental-health care has increased such that if primary-care doctors didn’t offer it, many people would go without it. It’s estimated that seventy per cent of a primary-care doctor’s practice now involves management of psychosocial issues ranging from marriage counselling to treatment of anxiety and depression.

Some argue that the increased demand is artificial, driven by overdiagnosis of mental illness and overuse of psychiatric medications. With one in four adults and one in five childrencurrently carrying a psychiatric diagnosis—and one in five Americans taking psychiatric medications regularly, such skepticism seems warranted. Regardless, access to psychiatric care is nowhere near large enough to meet the growing demand. Fewer medical students are going into psychiatry, partly because psychiatrists, like primary-care doctors, earn among the lowest salaries of all physicians. Those who do choose psychiatry often don’t accept insurance, including Medicare and Medicaid, requiring patients to pay out of pocket. Affordable psychiatric treatment is especially limited for children and in rural states. Wyoming, for example, which has one of the highest suicide rates in the nation, had,according to one count from a few years ago, a mere twenty-seven psychiatrists—just over five per hundred thousand residents. Massachusetts, by comparison, had around over two thousand psychiatrists, or around thirty-two per hundred thousand residents.

But even in Boston, where I practice, primary-care doctors are treating more mental illness. Some patients don’t have adequate insurance to obtain specialized mental-health care, despite legislative efforts, including the Affordable Care Act, to create parity between mental-health coverage and coverage for other medical conditions. Some people want psychiatric care without having to see a psychiatrist. Having finally confided a long-held secret of compulsive hand-washing or bulimia to me, some patients would rather not share it all over again with someone else. And some wish to avoid having, as one of my patients put it, “a psychiatric rap sheet”—a record that an insurance company, employer, or nosy family member might discover. They’d prefer to have their psychiatric diagnoses tucked discreetly between my notes about their heartburn and their eczema.

Harvard Medical School’s Center for Primary Care recently announced a new program to improve the quality of psychiatric care offered by primary-care doctors. In its initial phases, it will place mental-health workers in six Boston-area primary-care clinics and target the treatment of depression. It will also outfit the clinics with videoconferencing technology to enable consultations with psychiatrists and other specialists.

Programs like Harvard’s aren’t only responding to a shortage of psychiatrists, though. They’re part of a movement toward what’s called the “Patient-Centered Medical Home.” First conceived in the nineteen-sixties by pediatricians who were trying to provide better-coordinated care for chronically ill children, the medical-home model urges patients to receive most of their care in the offices of their primary-care doctors, with consultants coming and going. When a patient needs to see a specialist, the primary-care provider arranges and oversees the consultation. Often it occurs in the primary-care doctor’s office, or even in the patient’s actual home, via something like Skype; this modern medical home depends heavily on technology, such as electronic health records and video and digital communication between patients and their doctors—and between the primary-care team and consultants.

To get a sense of how this model differs from current norms, I told Dr. Russell Phillips, director of the Center for Primary Care, about the businesswoman whose therapist had recommended that I prescribe her an antidepressant. I mentioned that I’d prescribed it, arranged to meet with the patient frequently, and crossed my fingers that the drug would be effective and wouldn’t cause side effects. If the medication didn’t work, or if she didn’t tolerate it, I’d likely have to convince her to see a psychopharmacologist—if I could find one who accepted her insurance. How would things have been different if I practiced in one of the clinics participating in his new program?

Phillips said that first, my patient would fill out a PHQ-9 survey, a nine-question screener for depression. The survey isn’t perfect, but it might cut down on some of the antidepressant prescriptions written by primary-care doctors too busy to verify that a patient is clinically depressed. If she met the criteria for depression set by the PHQ-9, her name would be entered in a registry of patients in my practice who were assigned follow-up care with a psychiatric nurse, social worker, or other mental-health professional on my medical team. If appropriate, I’d prescribe an antidepressant, but with access to consultation by phone or videoconferencing with a psychopharmacologist paid to assist me.

While it sounds reasonable for a primary-care doctor to get an opinion about a rash or a chest X-ray via computer, it’s less obvious that a patient’s mental health could be assessed this way. But, it turns out, “telemental health” works surprisingly well. A 2013 review of several programs in which patients received psychiatric evaluation and counselling by phone, e-mail, or video showed that telemedicine can improve symptoms, reduce length of hospital stays, and help people adhere to medication as well as face-to-face psychiatric care. For children and adolescents, telemedicine often works better than face-to-face care.

Still, I confessed to Phillips that surveys, registries, and videoconferencing didn’t sound like the kind of patient interactions that made me choose primary care in the first place. He argued that, actually, the type of care he’s proposing is simply a modern version of what an old-fashioned general practitioner offered. A few generations ago, the family doctor was a one-stop resource for health care and emotional support. He might deliver you, take out your tonsils, write your college-recommendation letter, and, if he outlived you, preside over your deathbed. Phillips envisions twenty-first-century primary care as being no less inclusive. “Our patients are coming in to see us,” he told me. “They have needs. We should be able to address as many of those needs as possible. And we know behavioral-health disorders are front and center, so it should be something that primary-care doctors can manage.”

He also pointed out that in the current system, in which a doctor who cares for a patient’s body often has little contact with the doctor who cares for her mind, doesn’t make much sense. Psychiatric drugs and conditions can affect physical health, and drugs for medical conditions, as well as the medical conditions themselves, have psychological effects. And people with mental illness are two to four times as likely to die from their medical conditions as people without mental illness. Several studies have shown that when primary-care doctors team up with mental-health workers, their patients’ physical health improves.

The key to making team-based medical care work, Phillips said, is helping the patient feel that his or her relationship with the primary-care provider is at its center. “I’ve actually done some of this,” he told me. “And it’s very meaningful to patients to have a connection to a member of the team when they realize that the team is an extension of their physician. So it can’t be a faceless person who’s anonymous and is a robo-caller.”

Not long ago, a patient of mine came to my office, accompanied by his worried family. He’d been acting peculiarly, and it wasn’t clear whether his behavior was caused by some longstanding psychiatric issues or by his many medical problems and medications. I phoned a psychiatrist at my hospital to see if I might expedite an appointment for an evaluation to complement my medical work. “Is he with you now?” the psychiatrist asked. I said that he was, and she told me that she happened to be free, and would come to my office and meet with him there.

The patient and his family were greatly reassured by the psychiatrist’s visit. I have no doubt that much of that reassurance came from seeing the psychiatrist and me, even briefly, in the same room together—from a sense that I, the doctor who knows the patient best, was running the show.

I thought, Wouldn’t it be great if a psychiatrist appeared in my office every time a patient needed one? In the future, one will—most likely on a screen.

Suzanne Koven is a primary care doctor at Massachusetts General Hospital in Boston and writes the column "In Practice" at the Boston Globe.

 

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Removing The Mask

Removing The Mask

On Friday night I spent the evening with the Devil, villains, jesters, duck hunters, Honest Abe, a few pirates, and some royalty.  No, it wasn't just another day at the office.  It was Mental Health America of Indiana's annual "Removing the Mask" gala.  Kind of like a wedding, it took months to plan and coordinate, and was over in hours.  But it's always a lot of fun, the entertainment by Donovan and Rebecca was incredible, and the personal story of heroin addiction and recovery given by Jazzmin Brown was inspiring.

Why do we have this event every year?  It's a lot of fun for one thing - guests get to dress up in costumes, outbid each other on great auction items, enjoy a good meal and stellar entertainment.  And we raise money...which is what keeps our programs going throughout the rest of the year.  But the main reason we have this event every year is to remind people that mental illness doesn't have to be a death sentence and that recovery is possible.  We are trying to remove the stigma of mental illness symbolically by putting on and removing masks. And  people like Jazzmin who are willing to tell their personal story of recovery are an important part of that process.

At this time of year with Halloween fast approaching, as you help your kids with their costumes, hand out candy, and maybe even put on a mask of your own, take a minute to remember those you may know who are experiencing mental illness and may be afraid to "remove their mask" and get help.  We know recovery is possible and you can promote mental wellness by:

1.  Supporting people with mental illness and addiction - let them know you are there to offer support and help if they want it and understand that no one medication or treatment may be enough

2.  Reducing the stigma of mental illness - don't be afraid to share your own story or volunteer or support mental health organizations and services in your community with your time, talent, and financial support.

3.  Referring people to services - don't worry if you don't know what to do -  we do and we can help!  There are many organizations and agencies (in addition to Mental Health America of Indiana)  in Indiana that provide mental health services including direct services like counseling and treatment and family support.  You can find some of them here:

IN Council of Community Mental Health Centers

IN Division of Mental Health and Addiction

IN Suicide Prevention Resource Center

Key Consumer Organization

National Alliance on Mental Illness (NAMI)

Please view the photos from this year's event that are posted on our website and join us next year to help us remove the mask of stigma and ring out hope for recovery from mental illness!

 

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Change Is a Good Thing

It's official - Autumn has arrived.  I, for one, welcome the cooler days and chilly nights, changing leaves, and shorter days.  My husband and I love the "ber" months (September, October, November) and feel they give us the permission to watch Christmas movies and listen to Christmas music without embarrassment when we get strange looks from the neighbors who hear "Jingle Bells" coming out of the open windows.

Don't get me wrong, I really enjoyed summer and was glad for the hot days that helped my garden produce nice, juicy tomatoes and fragrant herbs. The long days were nice too, giving more time for my boys to play outside and for us to get projects done (although my "to do" list is still a mile long - how did that happen?).  But, sometime in August, I was over summer and ready for fall.  Acorns started falling off our giant oak tree, as well as pinecones from our fir, and I noticed the squirrels and chipmunks burying the acorns, of course in my newly mulched flower bed.  The neighbor across the street with the beautiful lawn, which I affectionately call "Central Park", started preparations to "winterize" his lawn.  We heard the high school football games being announced, and I could smell the fragrant bonfires of burning leaves and wood...fall was here, if I was ready for it or not.

Autumn is a time of transitions - plants transition from their growing season to their resting season as the save energy for spring, animals transition from growing their families to making sure there is enough food to feed them all as they sleep the winter away, and people transition too (and sometimes not as easily).  I have a friend who has SAD (Seasonal Affective Disorder) and she dreads the change of seasons, because she knows that her hours of sunlight will be limited.  She even purchased a special light for her office to use in the fall and winter months when its dark or dreary a lot of the time.  People with depression and other mental illnesses don't always know how to make the transition from the sunny, happy days of summer to the shorter, darker days of winter.  The weather, lack of sunlight, lack of mobility, and other factors may make depression or other mental illness symptoms worse.  So, here are some tips for all of us and we make the transition from summer:

1.  Stay Well -  talk to your health care provider if you think your depression might be getting worse or you just feel worse than usual.  You might need an adjustment to medication or a new therapy to help you through the fall and winter months.  Make sure you get regular physical check ups as well, and get a flu shot if you are able.

2. Eat Well - most of us are able to get fresh fruits and vegetables year round, even when it isn't summer, so don't stop eating salad or fruit just because you can't pick it off the tree or get it at the farmer's market.  And most of us tend to get less exercise in the fall and winter months so probably eating another cupcake like you did in July when you were running 5 miles a day outside, may not be the best choice now.

3.  Take Vitamins - even if you can't be in the sun for the few minutes it takes to get your daily dose of vitamin D, consider  using a light  box to make up for the lack of sun.  Vitamin D is easy to get through diary products or a supplement.  Ask your doctor what dose is best for you.

4. Stay Positive - I don't want much TV during the summer because I'm usually outside (and we don't have cable) but fall and winter is a great time to catch up on stuff you like to watch.  I personally like classic movies and musicals and always find that they make me feel happier.  With streaming sites like Netflix, or even free DVDs from your library, finding positive things to watch and listen to is easy to do.  Read that book you have been putting off, paint your bedroom a cheerful color. Make a list of all of things to be thankful for and look forward to (see #8).

5.  Get  Sleep, (but not too much) - I tend to want to hibernate in the winter, just like those squirrels and chipmunks in my yard.  But too much sleep can throw our internal clocks off just as much as not getting enough sleep, which can create problems.  Stick to your regular routine, even on the weekends or holidays (ok, maybe sleeping in after that big Thanksgiving meal or when you have snow day is ok).

6.  Stay Connected - don't forget about your friends or family just because you aren't able to have everyone over for a barbecue in the back yard.  You can still keep in touch all of the usual ways - phone, text, social media - and you can still have parties or get together with friends.  Don't hibernate indoors.  Keep your support system strong.

7.  Keep Moving (physically and mentally) - now's the time to take that exercise or yoga class you have been wanting to try.  It's also a great time to try a new hobby that would be fun and interesting - maybe you will be another Picasso or write the Great American Novel by spring!

8.  Plan Something - I like to plan my garden in the fall and winter.  Nothing makes me happier than looking through all of the beautiful bulb and plant catalogs, or books about gardens from the library.  Take this time to plan a vacation, make a plan to organize the closets, basement, or garage (might need to listen to uplifting music while doing that!), plan how you will rearrange your living room...plan something, anything.  Plans give us hope and a reason to look forward and are important to remind us that "this too shall pass".

So, put on your shorts and flip flops and plan your summer vacation while you drink your hot chocolate in front of the fireplace!  Change is a good thing.

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An Ounce of Prevention - Addressing Mental Illness in the DOC

With prison systems across the nation overfilled, many states are seeking ways to reduce the number of persons incarcerated.  In fact, California was federally mandated to reduce the size of their population by 10% at the end of this year.  They have asked for an extension to that deadline as they seek to remand inmates to other states and look at ways to increase the state's re-entry and rehabilitation services.  Los Angeles county is even considering building a new jail just for inmates with mental illness.  

Artist Name - 20130915_atc_01.mp3
   Clearly, many people who are incarcerated are in the criminal justice system because of their mental illness and the results of their not being compliant with medication or treatment plans, or other convening factors that contribute to their mental illness.  It's estimated that 16% of the population in the nations'  prison system have a mental illness, which is two to four times higher than the general population (and when you look at local and county systems, that number is likely to rise).  What why the increase? Research suggests that the largest contributing factor  was the closing of state mental hospitals over the past two decades and deinstitutionalization of those clients who went back to their community.  Some of those communities do not have the infrastructure needed to provide adequate housing, medical, and mental health services.  But we know that for many of those clients, living back in their communities is the best choice for their treatment.

In Indiana, it is estimated that 25% of the DOC population has a mental illness but the two units designed to work with inmates with mental illness can only handle about 250 persons.    Unfortunately, not every correctional system has the resources to provide the specialized treatment that these inmates need.  Many inmates with mental illness quickly find themselves on a downward spiral after they are arrested because they're not given the medications needed, are not medication compliant, and aren't getting the therapy and support they need. So what's the answer?  How do we make sure that our prison system does not remain the "largest mental health facility" in our state and nation?

Like Indiana, many states are engaging with other community stakeholders such as health professionals, mental health professionals, and non-profit consumer focused organizations to better serve these populations.  Evidence based practices such as Crisis Intervention Teams (CIT) and mental health courts can accommodate this population and provide needed services and community supports to prevent the person from entering the system to begin with, or returning to prison after another offense. Re-entry programs are also important, providing support and services for inmates going back to their communities.   Of course, all of these services are expensive and with state budgets stretched to the point of breaking, increased funding isn't likely...but it is necessary.

It seems that prevention is the key - as with most things, preventing something is much cheaper (and much better for the person) than treating it.  An ounce of prevention is truly worth a pound of cure.

 

 

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When Mental Health Is a Laughing Matter - written by David Granirer, Founder of Stand Up For Mental Health (originally posted on "Chiming In", MHA blog)

When Mental Health Is a Laughing Matter - written by David Granirer, Founder of Stand Up For Mental Health (originally posted on "Chiming In", MHA blog)

By David Granirer, Counselor, Stand-Up Comic, and Founder of Stand Up For Mental Health

Most people think you have to be nuts to do stand-up comedy. I offer it as a form of therapy. And it’s not as crazy as it seems. Stand Up For Mental Health is my program where I teach stand-up comedy to people with mental health issues as a way of building confidence, promoting recovery and fighting public stigma.

I got the idea from watching students in a comedy course I was conducting. Even though it has nothing to do with mental health, I've had students overcome long-standing depressions and phobias, not to mention increasing their confidence and self-esteem. One student told me she had a fear of flying, but that the day after our showcase she got on a plane and her fear was gone. She said, “Once I’d done stand-up comedy I felt like I could do anything!” I was inspired by hers and other similar feedback to give this experience to my people, those who had some sort of psychiatric disorder, mental illness, mental health issue, or whatever we call it these days.

I myself have depression. And there’s no better medicine than laughter. One of my comics who has taken numerous drugs including crystal meth said it’s the best high she’s ever had – it’s free, legal, and has no side effects. Oh yeah, and it’s fun! It’s the best kind of wellness activity I can think of. As a matter of fact, I believe that a key component to wellness is the ability to see humor in adverse situations and the ability to laugh at yourself.

In mental health we talk a lot about restoring wellness by accessing people’s strengths, but nowhere do we say to someone, “You have a great sense of humor, let’s use it to build you up and give you confidence.” One of my comics who had schizophrenia found it extremely difficult to ride public transit. As she sat on the bus her voices would say things like, “Everyone knows that you’re a freak, they think you’re crazy.” After taking SMH she realized that she had a wicked sense of humor, and the next time she rode the bus she started joking with the other passengers. It was a great ride. She now had a skill that leveled the playing field between her and these so-called scary normal people. In other words she had achieved a state of wellness when it came to interacting with the outside world.

She also came to class one day wearing a striped shirt. She said that the voices hadn’t let her wear stripes for years but now that she was doing comedy she wasn’t so afraid of them. Another student who also had schizophrenia said that for about a week after we did a show his voices would either become quiet or actually tell him positive things. I’m not saying that comedy is the cure or magic bullet, but there certainly seem to be some interesting effects!

Almost as bad as having a mental illness is the shame that goes along with it. And shame is the opposite of wellness. But comedy helps people to achieve wellness because in comedy the more screwed up and dysfunctional you are, the better your act is going to be! This axiom creates a cognitive shift in the students. All of a sudden the very things they are ashamed of become wonderful resources that bring about a sense of wellness. They can’t wait to tell other people about the time they thought they were Jesus, or when they maxed out their Visa card and ran around naked!

All too often we see the process of achieving wellness as a serious and arduous task. But it doesn’t have to be. The folks at Mental Health America are devoting a whole conference to wellness—about the strategies and steps that promote well-being, including mine.

The truth is having a great sense of humor is good medicine. And that’s no joke.


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WHO says more mental health services are needed

WHO says more mental health services are needed

A new study was released today by the World Health Organization (WHO) stating that with most humanitarian crises there are non-existent or insufficient mental health services to assist those who need help.  When communities and populations are devastated by man made or natural disasters, the opportunity exists to rebuild the health system to include greater mental health services and supports.  Citing natural disasters like the tsunami in Sri Lanka, the WHO states that many countries have been able to greatly improve their mental health systems.  In Iraq, since 2004, half of their general practitioners have been trained in mental health.  Irag is a very large country and the limited mental health services that were available only existed in the large cities but now they're available to almost everyone across the country.

While there is still a lot of progress to be made in these tragic and infortunate circumstances, the opportunity to enhance, or in some places even create, an effective mental health system is great.

To read the entire WHO report, go here http://apps.who.int/iris/bitstream/10665/85761/2/9789240690837_eng.pdf

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How to Be More Open With Your Feelings - originally written by Katrina Miller, Demand Media



Sharing your feelings may make others like you more.

Sharing your feelings may make others like you more.You already have the tools you need to be more open with your feelings: awareness, a voice and the ability to write. The most difficult aspect of improving your ability to communicate openly may be motivational: overcoming a fear of rejection and exposing yourself. The rewards for expressing feelings openly are rich, including an increased liking and trust of others, suggests the August 2010 issue of the "Journal of Personality and Social Psychology." An article in "Science Daily" reports that talking or writing about your feelings can make sadness, anger or pain less intense.

Step 1

Use words to describe your feelings. "Science Daily" reports that people who said the word "angry" when observing an angry face kept themselves calmer and had brain images demonstrating less reactivity in the brain's emotional center as compared with those who did not say the word to themselves. There are many words to describe feelings and their intensity -- use them to label your feelings.

Step 2

Ask friends about their feelings. In April 2010, the Association for Psychological Science reported that people with greater well-being facilitated more substantive conversations with friends. Asking questions about your friend's feelings can help you reach deeper levels of communication.

Step 3

Express your feelings to people you like. The "Journal of Experimental Social Psychology" notes that your desire to belong motivates your desire to listen to a friend's feelings; your friend's desire to be a friend motivates the friend to listen to your feelings. As you rely on each other to discuss feelings openly, your feelings of connection are likely to increase.

Step 4

Write about your feelings in a journal. Writing about positive feelings can help you feel better about significant relationships, notes the March 2010 issue of the "Journal of Positive Psychology." Expressing positive feelings through writing can remind you that the world is good and that tomorrow will be a better day.

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Explaining Depression to a Friend - originally posted by Liana Scott

A couple of weeks ago, I wrote about talking to somebody about depression. Telling family and close friends has its challenges, but telling acquaintances can have its challenges too – especially when they are people you know from work.

Why would you even bother telling an acquaintance? What business is it of theirs? Good questions.

Recently, I saw an X-work friend I hadn’t seen in over a year. We bumped into each other at a local second-hand clothing store. An odd place to see a work friend, we laughed at having bumped into one another and asked the typical “what are you doing here?” and “do you come here often?” questions. I asked her where she was working now and asked after her kids and her health. She told me where she was working, her kids were doing well and her health was good.

Then, she asked me… “So, how have you been?”

After quickly weighing the options, I decided to perform an experiment in honesty.

Image courtesy of Stuart Miles, http://www.freedigitalphotos.net

I had never come out and just talked about my depression casually, as though it were the flu or a broken bone. Why not? Well, it’s obvious to anybody who suffers mental illness – you just don’t. In the name of ending the stigma (self-stigma in particular), I decided to just say it out loud.

“Well, I just got over a bit of a bad time. You see, I suffer from depression.”

She furrowed her bow, tilted her head and said, “Oh my, I’m sorry.”

“Thanks,” I responded, then just kept talking, deciding that I would be doing a disservice to my friend if I left it up to her to fill the inevitable silence that would have followed that “I’m sorry”.

I told her about how I suffer from chronic depression and how about six times a year, it rears its ugly head and I get very sad and fatigued and I have no energy… my motivation sucks and I can’t concentrate and I’m generally distant. Several times during my short diatribe, she furrowed her brow again and tilted her head and apologized. I did wonder what she was thinking while I talked but to her credit, I never felt judged or like less of a person.

The experiment was successful… this time.

Each time I say the words out loud – “I have depression” – it’s a little easier. It helps (I hope) to educate the people I tell. Mostly, it helps diffuse my own self-stigma and makes me stronger.

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Originally written by Suzanne Picerno | Depression is like nausea in my stomach

"Having depression is like having a knot of nausea in my stomach at all times and fighting personal negativity when an episode comes on. I'm generally the most successful depressed person I know as I fight it with meditation, affirmations, exercise , keeping moving (vs not getting out of bed ) and work. Medication helps, however it doesn't solve it completely.

Although it's difficult at times, I remind myself that I am not my depression. Perhaps, l should give my depression a name. Perhaps I'll call her 'Sandy.' She is gritty, she can find her way into small crevices and places that are deeply hidden. And then, seemingly without warning, she disappears. Perhaps she exits because I've nurtured her by paying attention to her, listened to her and attended to her esoteric longings? Perhaps, she realizes that despite all, the human need to aspire, to create, to laugh, and to love does not invalidate her and is, in fact, inclusive and richer because of her. These are questions and feelings that I reflect and ponder on. Doing so does my soul good as does sharing them with others."

Original writing by Suzanne Picerno, MA, MBA Suzanne is a consumer advocate living with depression, anxiety and cyclothymia. She is a hearing impaired mother, athlete, and a corporate professional in the healthcare environment.

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Join the Conversation!

This Blog is the next step in a larger public communication plan that includes social media and our redesigned web site.  We hope that you agree that the new site is more dynamic and interactive and will help us, help you, advocate for mental health and addiction recovery.  Please join us again as we continue to grow together.

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