The Mental Health Minute

Articles and news about mental health issues

Groups cast doubt on validity of state hospital’s electrotherapy consent forms

Here’s an article I found on the Austin American-Statesman that talks about the efficacy of the consent forms for controversial treatments on mentally ill patients.  I have often wondered about the use of consent forms on the floridly psychotic and the legalities of such use.  It seems others are wondering also.  Please read this article and tell me what you think.

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By Andrea Ball
AMERICAN-STATESMAN STAFF
Updated: 11:25 p.m. Thursday, May 31, 2012
Published: 8:05 p.m. Thursday, May 31, 2012

Texas’ public psychiatric hospitals never should have used a controversial treatment on more than 120 aggressive patients because the consent forms they signed did not spell out potential side effects and other information required under state rules, mental health watchdogs said this week.

Patients who received cranial electrotherapy stimulation at North Texas State Hospital in Vernon were not told in writing that the treatment can cause headaches, nausea, dizziness and skin irritation, said Beth Mitchell, a lawyer with Disability Rights Texas, a federally funded mental health advocacy group. The consent form — a copy of which was obtained by the Austin American-Statesman — also fails to mention alternative treatments and the condition that is being targeted.

But state officials say the form was adequate and is just one piece of the informed consent process.

“The form alone may not be the full picture,” said Carrie Williams, spokeswoman for the Department of State Health Services, which oversees the 10 public psychiatric hospitals. “Risks, benefits and alternatives could have been laid out verbally and documented in the progress notes.”

Challenges to the validity of the consent forms come several weeks after health department officials said they learned that a North Texas State Hospital psychiatrist had conducted unauthorized research on the use of cranial electrotherapy stimulation on violent, mentally ill patients.

The consent forms go to the heart of the questions advocates have posed on the issue: Did the patients understand and willingly agree to the treatment? Or were they being used as research subjects without regard to their civil rights?

“Honestly, I just don’t understand how this could happen,” Mitchell said. “I think there was a breakdown across the board here.”

State officials say they are still trying to determine whether …[read more]

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June 1, 2012 Posted by | Mental Health | , , , , , , | Leave a comment

A story about Peer Specialists

The use of Peer Specialists is controversial at best, but studies are finding that using peer specialists in patient  care gives hope and a message of possibilities.  The fact that there are real mental health consumers who have lives and are productive is a very powerful message.  Too often, the messages we send to our patients is that they are “broken” and cannot be fixed.  We don’t do that on purpose, but we still do that.  When you introduce a peer specialist into your program, you get someone who relates to your patients in a completely different way and who understands what they face daily.  You get  someone who inspires and brings hope back into their lives.

Peer Specialists must undergo significant training and certification to be allowed onto mental health units, but even that is not enough to prevent these wonderful people from “giving back” and staying healthy.

Please read this article entirely at the site, The New York Times.  You won’t regret reading it and you will learn quite a bit about who a peer specialist is.
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After Drugs and Dark Times, Helping Others to Stand Back Up

Dual Diagnosis: Antonio Lambert, diagnosed with a mood disorder and addiction, manages through faith, medication and companionship – leaning the same “peer specialist” skills he teaches.

By
Published: December 19, 2011

SMYRNA, Del. — The taste of cocaine and the slow-motion sensation of breaking the law were all too familiar, but the thrill was long gone.

Antonio Lambert was not a young hoodlum anymore but a family man with a career, and here he was last fall, high as any street user, sneaking into his workplace at 9 o’clock at night, looking for — what, exactly? He didn’t really know.

He left the building with a few cellphones (which he threw away) and a feeling that he was slipping, falling back down into a hole. He walked in the darkness, walked with no place to go, and then he began to do what he has taught others in similar circumstances to do: turn, face the problem, and stand back up.

“I started talking to myself, out loud; that’s one of my coping strategies, and one reason I relapsed is I had forgotten to use those,” said Mr. Lambert, 41, a mental health educator who has a combined diagnosis — mood disorder with drug addiction — that is among the scariest in psychiatry.

He texted a friend, someone who knew his history and could help talk him back down. And he checked himself into a hospital. “I know when it’s time to reach out for help.”

The mental health care system has long made use of former patients as counselors and the practice has been controversial, in part because doctors and caseworkers have questioned their effectiveness. But recent research suggests that peer support can reduce costs, and in 2007, federal health officials ruled that states could bill for the services under Medicaid — if the state had a system in place to train and certify peer providers.

In the years since, “peer support has just exploded; I have been in this field for 25 years, and I have never seen anything happen so quickly,” said Larry Davidson, a mental health researcher at Yale. “Peers are living, breathing proof that recovery is possible, that it is real.”

Exhibit A is Mr. Lambert, a self-taught ex-convict who is becoming a prominent peer trainer, giving classes in Delaware and across the country. He is one of a small number of people who have chosen to describe publicly how difficult it is to manage such a severe dual diagnosis, including the sudden setbacks that often come with it.

“He is an extreme example of how much difference passion and commitment can make, given where he’s come from,” said Steve Harrington, the chief executive of the National Association of Peer Specialists, a group devoted to promoting peer support in mental health care.

Mr. Lambert, who has climbed out of a deep hole with the help of religious faith, medication and his own forms of self-expression, puts it this way: “There are a lot of people dealing with mental illness, drugs, abandonment, abuse, and they don’t think there’s a way out. I didn’t. I didn’t.”

Bean Bean in Spider City

His grandmother was the first person to call him Bean Bean, and the boy was so skinny that he couldn’t shake it.

He couldn’t avoid the older toughs in the Brighton section of Portsmouth, Va., either, and he spent some of his school-age years taking beatings. That was Brighton back in the day, and at least those fights taught survival skills. Not everything did: He remembers being sexually abused at age 6, by an older boy in the neighborhood — brutally.

He had no one to tell, even if he had known what to say. His mother and father were split, living blocks apart, each a fixture in the neighborhood’s social swirl of house parties, moonshine “shot shops,” card games and other attractions. His mother, called Chucky, was often out, sometimes leaving the boy at a friend’s house for “a few hours” that turned into an entire weekend. For much of that time, he waited on the porch.

He idolized his father, a truck driver and warehouse worker who lived nearby but spent his free time out, too, drinking and playing cards.

“During that time I was an alcoholic, but I would go out and try to find him when I heard he was out,” said his father, Edward Lambert, in a recent interview at his house in Brighton. He gave up drinking years ago for God, and father and son would eventually become close…[read more]

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December 20, 2011 Posted by | Mental Health | , , , , | 4 Comments

Childhood disorder prompts study of infection link to mental illness

Here’s yet another article from the Los Angeles Times about mental health.  Is California just more aware of the problem we have in society with mental disorders, or do they have a higher number of mentally ill people?  Just a question.

I thought this article was interesting and felt it needed to be posted here for your perusal.  Won’t you read this article and then let me know what you think?  Is there a connection between infection and mental illness?

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By Shari Roan, Los Angeles TimesDecember 5, 2011

Brody Kennedy was a typical sixth-grader who loved to hang out with friends in Castaic and play video games. A strep-throat infection in October caused him to miss a couple of days of school, but he was eager to rejoin his classmates, recalls his mother, Tracy.

Then, a week after Brody became ill, he awoke one morning to find his world was no longer safe. Paranoid about germs and obsessed with cleanliness, he refused to touch things and showered several times a day. His fear prevented him from attending school, and he insisted on wearing nothing but a sheet or demanding that his mother microwave his clothes or heat them in the dryer before dressing.

So began a horrific battle with a sudden-onset mental illness that was diagnosed as pediatric autoimmune neuropsychiatric disorder associated with streptococcus, or PANDAS. The puzzling name describes children who have obsessive-compulsive disorder that occurs suddenly — and often dramatically — within days or weeks of a simple infection, such as strep throat.

“He washed his hands over and over and was using hand-sanitizer nonstop,” said Tracy Kennedy, who has home-schooled her 11-year-old son since early November. “He had never been like this before. Ever. He just woke up with it.”

The bizarre illness, first recognized in the mid-1990s, has been cloaked in controversy. Now, however, studies are reinforcing the belief that some psychiatric illnesses can be triggered by ordinary infections and the body’s immune response. While the theory remains unproved, the research raises the possibility that some cases of mental illness might be cured by treating the immune system dysfunction.

“Some people get sick with whatever infection, and they recover and they’re fine,” says M. Karen Newell Rogers, an immunologist at Texas A&M Health Science Center College of Medicine in Temple, Texas, who studies such illnesses. “Other people get sick and recover, but they are not the same.”

PANDAS is thought to be caused by antibodies generated as a result of an infection, usually strep. Normally, an infection causes the body to generate antibodies that fight the infection and promote healing. But in PANDAS, the antibody response is thought to go awry, attacking brain cells and resulting in OCD symptoms.

A greater understanding of the link between strep and OCD has opened the door to the study of other psychiatric or neurological illnesses that may be linked to improper immune response, including cases of autism, schizophrenia and anorexia.

“The whole area of mental illness caused by infections is being looked at more closely because of PANDAS,” says Dr. Michael A. Jenike, a professor of psychiatry at Harvard Medical School and chairman of the International OCD Foundation’s scientific advisory board. “If you can prevent lifelong suffering by using antibiotics or some acute intervention, that would be huge.”

Little understood disorder

PANDAS is generally poorly understood in the medical field, said Dr. Margo Thienemann, a Palo Alto child psychiatrist who has treated several cases. There is no test to help doctors diagnose it, although the National Institute of Mental Health says that PANDAS can be identified after two or three episodes of OCD or tics that occur in conjunction with strep infection — a vague guideline that results in much confusion.

Thienemann says patients tend to fall between the cracks of psychiatry and immunology. But early diagnosis is important.

“In psychiatry, we generally spend our time treating diseases without knowing the reason they happen,” she says. “With PANDAS we are able to see the cause of a problem rather than the downstream effects. This is the exciting part.”

OCD affects about 1% of people and can feature a fear of contamination by germs or other substances, hoarding, intense anxiety over one’s moral behavior, tics, compulsive skin-picking or body dysmorphic disorder (obsession with some perceived bodily imperfection). The disorder tends to run in families and usually appears around the ages of 10 to 12, with a later spike in rates from age 18 to 22.

No one knows what portion of obsessive-compulsive disorder cases may be tied to PANDAS — or even how prevalent the condition may be, Jenike says.

“I used to think it was exceedingly rare,” he says. “Now I think it’s exceedingly common.”

Recent research has strengthened support for PANDAS. For instance, one study demonstrated that in mice prone to autoimmune disorders (in which the immune system attacks healthy cells), exposure to strep led to OCD-like behavior. The study was published in 2009 in the journal Molecular Psychiatry.

A 2010 Yale study found that tic symptoms worsened somewhat in children with OCD following a strep infection. That study, published in Biological Psychiatry, suggests some children are vulnerable to flare-ups of OCD symptoms when stressed by infections.

Another paper, published online in August in the Journal of Pediatrics, found that, compared with children with typical OCD, children diagnosed with PANDAS were more likely to have biological evidence of a recent strep infection, a sudden onset of psychiatric symptoms and an easing of those symptoms while taking antibiotics…[read more]

 

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December 10, 2011 Posted by | Mental Health | , , , , | Leave a comment

Mentally ill behind bars

This was an article I found in the Springfield News-Leader.  It eloquently portrays the tasks facing the prison system in Missouri.  It is almost as if the prison system has become the “new” mental health system.

This trend is continuing at an alarming rate.  Prison is not equipped to help mentally ill people.  There is no treatment except medications there.  They have no one to help them hook up with services when they are released.  Granted, there are many mentally ill people in prison who need to be because they are too dangerous to leave unattended in the population.  But the majority of the mental patients in our jails have been unlucky enough to have fallen through the cracks of a seriously cracked mental health system.

Please read this entire article, even though it is long.  It is worth the time and effort and will give you some insight into what the prison employees are having to deal with daily without any prior or special education.

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Melissa Ussery, mental health coordinator at the Greene County Jail, interviews an inmate. / Bob Linder / News-Leader

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Written by
Jess Rollins
News-Leader
Missouri State Hospital No. 3 at Nevada, shown in May 1925, housed 1,200 at its peak. / File photo, 1925

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A slender young man in glasses sits at a small plastic table in the observation wing of the Greene County Jail.

Across from him, Melissa Ussery, mental health coordinator at the jail, asks if he is doing better.

Last week, he surprised Ussery by handing her something in a handkerchief. He had pulled out all 10 of his toenails.

“I’m actually content now. I’ve just been in there reading,” he says, pointing to his cell.

A few questions later, Ussery asks how often he thinks of harming himself or hurting guards. He says he wouldn’t but he sometimes has “the urge to do it all over again.”

This young man, who has borderline personality disorder, is one of about 50 inmates in the jail at any given time diagnosed with a serious mental illness like schizophrenia, bipolar or major depression.

Many involved in the area’s mental health system say the Greene County Jail has become the largest mental health care facility in southwest Missouri — the de facto mental hospital.

Meanwhile, the cost to house someone with a mental illness is nearly double the cost of housing a healthy inmate. According to officials and advocates, it’s an expensive, frustrating, dangerous problem.

Although mentally ill inmates receive some services in jail, they are often released without a path to continue treatment. With what many perceive as a lack of community resources, the cycle continues.

As cuts to programs for those most at risk persist, many see no end in sight.

Nowhere else to go

Every day, Ussery, the only licensed psychologist at the jail, makes her rounds.

In the female pod, Ussery talks to a young woman with straight blond hair.

“Have you thought of hurting yourself?”

“Are you seeing anything?”

“What year is it?”

At each question, the young woman pauses. She looks to the left, then to the ceiling, to the right, back to the left.

“We think she is hearing voices,” Ussery explains later.

The long pauses and wandering eyes are a type of screening of what the woman hears, according to Ussery; that’s common among those diagnosed with schizophrenia…[read more]

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October 21, 2011 Posted by | Mental Health | , , , , , | 1 Comment

Police training addresses suicide, domestic violence, road rage, DWI

Calgary police brutality cover-up?

Image by thivierr via Flickr

Here is an article from the Poughkeepsie Journal that illustrates the frustration felt by ill-equiped police when faced with a mentally ill person.  In the past, that person was either ignored or thrown in jail.  Current trends are to train the police in more “politically correct” treatment for the mentally ill.

While I wholeheartedly agree that police could stand to learn more about dealing with the mentally ill since they do it regularly, I doubt that the training is going to change anything in a major way.  The problem is that police have a totally different mindset than that of a social worker or psychiatric nurse.  They have no patience for hand-holding people who are endangering the lives and livelihood of others.  Their initial police training is in containment and arresting.

I applaud the Poughkeepsie police for their forward thinking and willingness to extend themselves.  I think there is some aspect of self-defense involved also, because, as this article states the police are frequently the first line in dealing with a mentally ill person; and with budget cut-backs, there doesn’t look to be any relief for quite some time.

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Written by
Shantal Parris Riley
Poughkeepsie Journal

They’re often the first to arrive on the scene in a mental health crisis.

Police and other law enforcement serve as public protectors — but, at a moment’s notice, when confronted with a situation involving a mentally disturbed person, they become social workers.

“Mental health issues are prevalent on the job,” Town of Poughkeepsie Police Chief Thomas Mauro said. “They occur with regular frequency.”

Regional police are preparing for an upcoming training series, titled “Responding to Situations Involving Emotionally Disturbed People: An In-Service Curriculum Orientation,” to be held in Orange County in February.

The curriculum, offered through the state Division of Criminal Justice Services and Office of Mental Health, will provide police with training on suicide assessment and intervention and a host of topics covering mental illness. The training course is designed to supplement the mandated training provided to police recruits.

From incidents of road rage and driving while intoxicated, to emotionally charged incidents of domestic abuse, police are faced with issues of mental health daily, Mauro said.

“Sometimes, there’s a conflict between our role as law-enforcement officers and the secondary social work aspect of law enforcement,” he said. “You’re trying to draw a balance between your responsibilities to maintain public safety and trying to do what is in the best interest of the person you’re dealing with.

“The difficulty can often be with communication.”

Mauro, who has decades of training in suicide intervention, crisis negotiation and stress management, said “talk tactics” often involve putting time into a conversation to calm or slow a person down.

Town of Poughkeepsie police had training in 2010 on “de-escalation techniques” to include listening with empathy and focusing on behavior, not the person.

This and other training was put to critical use in August 2010 when a 22-year-old man threatened to jump from a ledge of the sixth floor parking lot at Saint Francis Hospital after escaping from family members who drove him there for a mental health evaluation…[read more]

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October 19, 2011 Posted by | Mental Health | , , , , , , , , | 4 Comments

Global Study Tracks Pediatric Mental Illness Incidence, Treatment

The Lancet

Image via Wikipedia

Here is an article from Clinical Psychiatry News  showing that mental illness is a global concern and we, as a people, are doing miserably at attending to the needs of this population globally.  Children, especially, are vulnerable to in-utero exposure to toxins, and can end up with mental illness from that exposure.

Environmental toxins, major health outbreaks, poor nutrition all contribute to the number of mentally ill people across the globe.  But this article goes on to say that there are interventions that are effective if put in place early enough, but because some country is poor or moderately poor, they have no funds to implement these easy fixes.  Their citizens then are left unprotected and untreated, for the most part.

This article is an attempt to show that we are neglecting the needs of the mentally ill at an alarming rate.  Please go to the original site and read not only this article, but others similar to educate and enlighten yourself on the plight of the mentally ill globally.

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By: JENNIE SMITH, Clinical Psychiatry News Digital Network

 

Up to one in five children and adolescents worldwide has a mental health disorder, according to a broad-ranging new study, yet mental health interventions, and the research to support them, are neglected in low- and middle-income countries.

While 90% of the world’s 2.2 billion children and adolescents live in low- and middle-income countries, researchers found, only 10% of mental health trials for this population are conducted in these countries.

A dearth of research expertise in low- and middle-income countries is one contributing factor, said Atif Rahman, Ph.D., of the University of Liverpool and Alder Hey Children’s NHS Foundation Trust, in Liverpool, U.K., the corresponding author of the study.

“In most developing countries, the universities are not really geared up for research,” Dr. Rahman said in an interview. “If there’s not enough research infrastructure and no career structure for researchers, it’s not really going to be possible to do the research on the types of psychological and psychosocial interventions that work in these countries,” he said. And less than a third of low- and middle-income countries have a national policy that deals with mental health among children and adolescents.

The findings were published Oct 17 in the Lancet ([2011 [doi:10.1016/S0140-6736[11]60827-1]) as part of a global mental health series that explored disparities in mental health prevention and treatment worldwide.

Another article in the series (Lancet 2011 [doi:10.1016/S0140-6736[11]61093-3]) found that trained mental health clinicians can be surprisingly scarce in developing countries, because of emigration: Sri Lanka, for example, had only 25 psychiatrists living there in 2007, while 142 who trained there had emigrated. A third paper, led by another group of international researchers (Lancet 2011 [doi:10.1016/S0140- 6736[11]60891-X]), found that children were not alone in getting inadequate mental health attention – that while 1 in 3 people with a mental health problem in wealthy nations receives treatment, in developing countries, it can be as few as 1 in 50.

For their research, Dr. Rahman and his colleagues analyzed epidemiologic studies to determine the prevalence of child and adolescent mental health problems in low- and middle-income countries. They also looked at randomized controlled trials evaluating preventative and treatment strategies.

They identified a number of effective interventions – particularly school- and community-based programs, in such diverse countries as China, Mauritius, and Iran – that were shown to successfully address behavioral problems, drug use initiation, and anxiety.

Maternal and child nutritional supplementation, immunization programs, reduction of exposure to toxins, maternal health interventions, malaria prevention, and early stimulation programs were all found to prevent cognitive deficits in low- and middle-income countries.

While there are a number of trials for preventative interventions in low- and middle-income countries, “There are only a handful of treatment trials,” Dr. Rahman said. Of the more than 670 treatment trials the investigators identified for the study, 58 came from middle-income countries and only 1 was from a low-income country.

The researchers decided to include in their analysis some treatment trials done in low-income populations in higher-income countries, such as those enrolling African-American children in the United States, noting that many mental health risk factors for children and adolescents were found to be similar across higher- and lower-income countries.

But Dr. Rahman noted that interventions developed in the West might not be feasible in lower-income settings where, for example, mental health specialists may be few and far between.

“Mental health problems in children in high- and low-income countries may share similar risk factors, especially in poor and disadvantaged communities. How you treat them will be very different depending on the health, social, and community-based systems available. There is the issue of who is there to deliver them – in a low-income setting you might have to adapt your interventions or develop new ones so that nonspecialists can deliver them,” he said.

“This is why the 90-10 research gap is so important,” Dr. Rahman continued. “You can’t just implement a strategy developed in the West. You have to find the right one, which is culturally appropriate and feasible, and requires research, trials, and cost-effectiveness analyses.”

In addition to calling for more randomized controlled trials, Dr. Rahman and his colleagues made several recommendations, based on their findings, for child and adolescent mental health programming in low- and middle-income countries.

Integration with existing, community-based systems is feasible, they wrote.

Early interventions and rehabilitative or curative interventions “need to develop side by side, which can be made efficient by task sharing,” they wrote, and advised partnering with physical health programs and agencies outside the health sector – in education, social care, and criminal justice. And finally, they wrote, “awareness programs and mobilization of potential stakeholders should be considered as part of any child and adolescent mental health service development.”

The researchers noted as a limitation of their study a heterogeneity in the prevalence studies that prevented either direct comparisons between countries or meta-analytic approaches. Two of Dr. Rahman’s coauthors reported disclosures: Dr. Christian Kieling took part in meetings sponsored by Novartis, Shire, and Deva. Dr. Luis Augusto Rohde acted as speaker or consultant for Eli Lilly, Janssen-Cilag, Novartis, and Shire, and received program funding and research support from those companies.

There was no external funding, and each of the researchers contributed their time to the study.

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October 17, 2011 Posted by | Mental Health | , , , , , | Leave a comment

Mental First Aid: How To Help In An Emotional Crisis

Werner Erhard and Associates v. Christopher Co...

Image via Wikipedia

Here is an article that denotes a personal struggle with OCD, an anxiety disorder.  She is one of the lucky ones who got help and then went out to find a way to help others.  OCD is a terrifying illness and I am so happy she was able to overcome it enough to participate in learning to help others with this and other mental illnesses.

Mental illness is an equal opportunity player.  No one is excused or exempt from playing in this game.

Learning the skills to help a mentally ill person is fairly easy to do.  What is hard is challenging your own beliefs about the mentally ill and making changes in your own behavior toward them.

I am reposting this article for NPR in its entirety because I believe the more people that are exposed to this message the better.  Please do click over and leave them a comment at the original site.

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by Kelley Weiss

October 10, 2011

When Nikki Perez was in her 20s, she had a job as a lab tech at a hospital in Sacramento, Calif. She said everything was going well until one day, when something changed.

“I worked in a very sterile environment, and so part of the procedure was to wash your hands,” she said. “I found myself washing my hands more and more, to the point where they were raw, and sometimes they would bleed.”

Perez went to the doctor and was diagnosed with something she had never even heard of — obsessive-compulsive disorder. At the time she was living with her parents. She quit her job and went on short-term disability.

Researchers say 1 in 4 adults has a mental disorder. But while many Americans are trained in first aid and CPR to respond to medical emergencies, few are prepared to help others experiencing a mental health crisis.

Perez said her illness turned her life upside down. She would sit in her parents’ room watching TV on the floor, afraid to move. She didn’t want to get caught up in the obsessive routines around the house.

“You check locks, check the washer, check the doors, check the window — I did a lot of checking,” she said.

Overall, it was profoundly isolating. Her family, like many people, didn’t know how to handle mental illness.

Finally, she got treatment, but her experience made her want to learn more about mental health issues so she could help others in crisis.

Emotional Crises More Common Than Heart Attacks

She found just the right class, called Mental Health First Aid. Bryan Gibb is the director of public education for the National Council for Community Behavioral Healthcare, which runs the course.

“We often train to know CPR or the Heimlich maneuver or first aid. But the reality is, it’s much more likely that we’re going to come in contact with someone suffering from an emotional crisis than someone suffering a heart attack or choking in a restaurant,” he said.

In a 12-hour course, Gibb teaches people how to identify different types of mental illness: depression, anxiety disorders, psychosis, eating disorders and substance abuse.

Part of the learning process involves group exercises. Nikki Perez participated in one that simulated what it’s like for people who hear voices. She tried to have a conversation while someone whispered in her ear “don’t trust him,” “you’re a failure,” and “is he looking at you?”

After the class, members who get this firsthand perspective of the different symptoms of mental illness then learn how to approach someone who’s having a psychotic episode. They’re told to speak calmly and clearly, and not to dismiss or challenge the person about their hallucinations.

Direct Questions For The Suicidal

As with any first-aid course, there’s an Action Plan for what to do if someone’s in crisis: assess the person for risk of harm or suicide, listen non-judgmentally, give reassurance, and encourage the person to seek professional help.

Gibb says that for this to work, people need to force themselves to ask direct questions: Are you thinking of killing yourself? Do you have a plan? Do you have the things you need to complete that plan?

Gibb told the class to never leave an actively suicidal person alone and to call the police if the person has a weapon or is acting aggressively.

Longtime mental health advocates with the National Alliance on Mental Illness, or NAMI, say courses like this raise awareness about mental illness. Jessica Cruz, executive director of NAMI California, said this reduces the stigma around getting help.

“If people know that others are trained in how to deal with a crisis situation, they may even reach out for help before they even get to that crisis point,” she said.

Cruz is so impressed with the course, her own staff is going to be trained next month.

“It seems like it could be just universally applied, just like CPR,” Cruz said.

That’s already under way at schools, the workplace and churches. Since it started three years ago, more than 30,000 people have been trained around the country; another 20,000 are expected to get training by the end of the year.

Perez says she would recommend this course to anyone.

“I think it’s one of the best things that I’ve ever done for myself so far,” she said.

The National Council for Community Behavioral Healthcare said thousands of people like Perez now have the skills to help those experiencing a mental health crisis. But the group emphasized that this is first-aid training and should be used to keep someone safe and stabilized until the professional help arrives, just like if you’re responding to someone having a heart attack.

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October 12, 2011 Posted by | Mental Health | , , , , , | 2 Comments

Patients suffer when reimbursements for mental health care are reduced

Mental Health Awareness Ribbon

Image via Wikipedia

Here is an article written by a nurse about the way an insurance company manipulates the coverage and prevents payouts.  The targeted population for this tactic is the mentally ill, who cannot advocate for themselves and require nurses and mental health professionals to do so for them.

This article is from the OregonLive.com, and is a guest post by Susan King.  She speaks eloquently and obviously from her heart.  Please read this article and let your elected officials know that this type of behavior by insurance companies is totally unacceptable to you.

Please visit the site for other articles that may interest you, too.  Don’t forget to leave a comment!

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By Susan E. King

Your editorial “Sick, insured, and nowhere to turn” (Oct. 2) exposed tactics that Blue Cross Blue Shield of Massachusetts has used to decrease the financial impact of their insured customers with mental illness on the company’s bottom line. Such tactics clearly discriminate against people trying to maintain their health and further stigmatize those struggling with diagnoses of mental illness.

Unfortunately, Massachusetts isn’t the only state in which health insurance companies try to evade the intent of mental health parity laws. In 2009, many mental health professionals across Oregon received notice from Regence Blue Cross Blue Shield that their reimbursement rates for provision of mental health services would be reduced by 25 percent. Why? According to Regence, these providers were not physicians and, as a result, they were being paid “above the market” for their services. Nurse practitioners who had a large number of patients covered by Regence and who were treating the exact same diagnoses (and billing under the exact same codes as psychiatrists) were subjected to this arbitrary decrease in reimbursement rates.

The result? According to a recent survey of mental health nurse practitioners from across the state, the 25 percent reduction in reimbursement has had a serious impact on the financial viability of many NP practices. NPs report that the reduced reimbursements have led to reduced capacity to provide care to mental health clients, significantly longer wait times for appointments, limitations in the types of services available, and some have even reported they are considering clinic closure.

In a state that is already experiencing serious challenges in the provision of mental health services, Regence’s unilateral decision to reduce reimbursement rates simply exacerbates this problem, putting even more pressure on an already stressed system.

Those of us who provide health know that if patients are unable to access care in a clinic or non-hospital setting, some of them will seek care when their illness is much more expensive to treat such as when they are in crisis or, in the case of mental illness, when their behavior intersects with law enforcement. Providing care in the ER or when a patient is in crisis is dramatically more expensive.

Insurers should help ensure that those they cover seek care in the most appropriate and most cost effective setting. Reducing reimbursement for nurse practitioners, creating more barriers to access for patients and refusing to pay the same fee for the same service, is not the way to support patients or to reduce costs.

Susan E. King is the director of the Oregon Nurses Association.

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October 9, 2011 Posted by | Mental Health | , , , , , , , , , , | 1 Comment

Singer Mental Health Center Hearing: Don’t Cut Patient Care

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Image by Ed Yourdon via Flickr

Here’s an article from MyStateLine.com that talks about how state budget cuts in Illinois are going to affect the mentally ill there.  It really is a shame to lose Mental Health Centers, because they provide on-going services to community based patients.  They have counseling, group therapy, medication management, etc. at the Center which then helps to keep these people out of the psychiatric hospitals.  Cutting these funds is not really a good idea, but for politicians who have no experience with the mentally ill, they feel it is wasted money.

Where will these people go?  To the streets, to the hospitals, into ambulances, to jail, to prison–because they are mentally ill and can not maintain on their own in the communities.  Shame on you, politicians!

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A debate rages in Rockford over whether to close Singer Mental Health Center.

Local leaders oppose Governor Quinn’s plan to shut it down. And tonight was the first public meeting on the issue.

The state agency responsible for running Illinois’ mental hospitals says it faces a 140 million dollar shortfall.

And that lawmakers have forced it to take drastic action.

Singer Mental Health Center is just one of nine mental health centers across Illinois. But the State wants to cut that number down to two. State’s Attorney Joe Bruscato says that’s a shortsighted decision.

“If you choose the mental health centers to save money, what you’re going to do is cause increased costs at other points in the system.”

Bruscato joined a rally with union workers and nurses against closing Singer. They want the state commission in charge of closing facilities to get one clear message, Singer provides care no one else can.

“We take people without insurance who are unable to be taken in private hospitals, we take people with criminal charges.”

Singer Psychologist Robert Izral says these patients often end up in jail without treatment.

“That’s the most inappropriate place for these patients to go.”

And County Sheriff Richard Meyers says the jail already has more inmates than planned. It can’t take over for state mental hospitals.

“The last thing we need as a unit of local government is to try to use our jail as a substitute for mental health facilities, we can’t match the quality of care.”

The state proposes transferring these patients to private hospitals. It has a number of incentive programs it can offer. Winnebago County Board chairman Scott Christiansen says that might be able to work, but it’s a decision the state can’t make quickly.

“We may have facilities that could be able to take over some of these responsibilities, but you got to give it some time, and when I say time, I’m saying two or three years.”

Tonight’s hearing is just the beginning of a very long process.

The state commission needs to hold hearings for the other mental health centers.

And lawmakers could still find more money for the centers in this falls legislative session.

Be sure to visit this site and read the  comments; maybe leave one of your own while your are there.

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October 7, 2011 Posted by | Mental Health | , , , , , | 6 Comments

Bill would require panic buttons at state mental health facilities

As a nurse who has been recently assaulted at work, I read this article with interest.  However, though it is a sad fact that this young women lost her life doing her job, many people won’t see the reason for making any changes.

I was at first confused because I have always worked in facilities that use “panic” buttons to call for help.  After reading this, I saw that she was not in a hospital but rather at a residential facility.

I know that these facilities are usually run on a shoestring budget and there may not be any alert system in place.  That said, if there are no other staff around, who will come when you sound the alarm? Staffing cuts due to budget cuts have placed more and more people who work with the mentally ill at risk of harm.

I agree that a mentally ill person is no more likely to assault than any one else, however when you add the possibility of substance abuse, the presence of hallucinations, and our lack of expectations for proper behavior of the chronically ill; then you have a recipe for violence.

My heart goes out to the family and friends of this young woman, Stephanie Moulton.  She did not have to die.  She did not deserve to be killed for trying to help someone in crisis.  She needed back-up and support, not death.

Please read this article from the Taunton Daily Gazette.  Let me know what you think about this, won’t you?

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By Michael Norton and Colleen Quinn
State House News Service
Posted Sep 26, 2011 @ 05:57 PM
Read more: http://www.tauntongazette.com/archive/x26168675/Bill-would-require-panic-buttons-at-state-mental-health-facilities#ixzz1Z9dbDXDX

Operators of residential mental health treatment facilities in Massachusetts would be required to have “panic buttons” available to employees under new legislation supported by high-ranking members of the House and Senate.

Sponsors of the bill say the goal is to ensure the safety of personnel in emergency situations and cite the death of Stephanie Moulton at a residential facility in January as an impetus for the filing of the bill. The 25-year-old mental health counselor was allegedly murdered by a resident of the residential home in Revere where she worked and the bill’s supporters are calling the legislation “Stephanie’s Law.”

The bill (S 2006) has already won the backing of the co-chairs of the Mental Health and Substance Abuse Committee, which plans a public hearing on the legislation Tuesday afternoon. Sen. Jon Keenan (D-Quincy) and Rep. Elizabeth Malia (D-Jamaica Plain) are cosponsors of Sen. Fred Berry’s legislation.

“The major goal is to provide for the safety of those who work in these environments,” Keenan told the News Service. He added, “The risk of dealing with mental health patients is relatively low. Not everybody is a risk and that seems to be kind of a mischaracterization that is somewhat out there.”

Rep. Theodore Speliotis (D-Danvers) said the bill was a direct reaction to the Moulton case.

“We lost a life at a DMH facility with somebody being alone on the job,” Speliotis said.

Speliotis said it would be “awful tough” to boost funding to increase staff at DMH residential facilities and called the panic button bill “the quickest thing that we can address” to assist workers.

“People put their lives on the line each and every day. It almost seems to me like a no-brainer,” he said.

Kimberly Flynn, Moulton’s mother, believes a panic button, intended to enable workers to quickly alert authorities, would have saved her daughter’s life. She plans to tell lawmakers during a hearing Tuesday that the buttons could be the first step in better protecting both mental health workers and patients.

“She walked into work on a Thursday morning, and she was brutally murdered,” Flynn said Monday in an interview with the News Service. “We still have a lot of unanswered questions.”

Deshawn Chappell, 27, allegedly stabbed Moulton multiple times, and then stole her car and drove her body to a church in Lynn, where he left her, her mother said. He was later found at his grandmother’s house in Roxbury. Chappell is being held in Bridgewater State Hospital, awaiting trial.

“I honestly believe my daughter walked in the door that day and knew nothing about what she was dealing with,” Flynn said, referring to the alleged killer’s violent past. “There were a lot of mistakes made that day, and I believe they have to be fixed and they have to be changed.”

Moulton, a social worker, was recently engaged to be married at the time of her death, Flynn said, and the night before her murder, she and her mother found a wedding dress she would have worn.

“This should have never happened. We have to protect these people,” Flynn said, adding that she supports the type of residential homes that her daughter worked at.

Flynn, a nurse who works with the elderly, said she uses similar emergency buttons when working with her patients. The elderly lifeline buttons are hooked to existing phone lines and able to directly dial a 911 operator. Flynn described the buttons used for the elderly as life-savers that could easily help mental health patients and staff.

Moulton’s death “staggered” the mental health community in Massachusetts, according to a Department of Mental Health task force on staff and client safety report released in June. The task force came up with 18 recommendations, including a call to dramatically increased funding for the Department of Mental Health over the next five years.

The task force report said “most individuals with mental illness pose no greater risk of violence than any other members of our society.” The report went on to say “We also know, however, that for a relatively small group of people, serious mental illness does have an association with aggressive behaviors. These individuals have past histories of violence occurring when their contact with reality has been distorted or lost due to untreated psychotic symptoms.”

Alcohol and substance abuse can significantly increase the likelihood of violence, the report said.

The task force report said years of budget cuts have negatively impacted delivery and safety issues surrounding mental health care, leading to an inadequate number of direct-care staff, a deficiency in the overall number of acute and intermediate hospital beds and community-based services, as well as a decreased role of psychiatrists and other professionals in the care of individuals with the most serious mental illnesses. The cuts require some staff to work under conditions that do not provide adequate safety and a lack of coordination of care across different components of the system, according to the report.

“The path to true safety requires adequate staffing and services,” the report said.

The task force said it was unable to identify any available funding by cutting other areas, and therefore any “recommendations that require new resources should be implemented only if additional funding becomes available.”

“Therefore, we do not recommend addressing the safety concerns that we identified through cuts in other areas. This would merely exchange one problem for another,” the report stated.

Keenan, committee co-chair, said there were several recommendations from the task force that could be implemented with little cost. Some standards, procedures and protocols could be put in place that could better protect mental health workers, he said.

The task force also recommended that DMH work to increase the number of beds available in hospitals.

Copyright 2011 The Taunton Gazette. Some rights reserved
Read more: http://www.tauntongazette.com/archive/x26168675/Bill-would-require-panic-buttons-at-state-mental-health-facilities#ixzz1Z9dST156
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September 27, 2011 Posted by | Mental Health | , , , , , , | 2 Comments