Lynn Bonner, Staff Writer
Weeks after setting aside more money than ever to care for North Carolina's mentally ill, the state is cutting $6 million used to help emotionally disturbed children so it can pay local administrative costs.
The money provides short-term care that keeps children out of group homes and helps parents who need advice on getting cooperation among social workers, school officials and other government agencies, said Connie Hawkins, executive director of the Exceptional Children's Assistance Center, based in Mecklenburg County.
"These kinds of silent cuts are just eroding the ability to do what we need to do," she said.
Legislators this summer approved an additional $80 million to treat mentally ill people and drug addicts, pay for housing for the disabled and expand community mental health services. It was the largest single-year increase for mental health programs since the state started overhauling the mental health system in 2001.
But the $6 million increase that was to go to severely emotionally disturbed children not eligible for Medicaid will be diverted. The state will spend $24.5 million instead of $30.5 million.
Community groups statewide are struggling to scale back plans to fit budgets that are suddenly smaller.
"It makes no sense," said Mark Sullivan, executive director of the Mental Health Association in Orange County. He said that the state knew it had to pay these administrative bills and should have devised a way to do it other than cutting money that was intended to help children.
Sullivan works with other agencies to develop programs for adolescent drug abusers, summer activities for emotionally disturbed children and other projects. Those plans are in question because of the cut.
"It's really frustrating for us who are working in the field," he said.
In Cleveland County, a planned support group for parents could be in jeopardy. Lori Oates, who works with the Cleveland community group, said she was surprised to learn of the budget cut so soon after cheering historic increases in the state's mental health budget.
"Where the heck did it go," Oates asked. "Why are we being cut?"
Beth Nelson, who heads children's mental health services in Wake County, said she had not heard about the cut.
State officials say they needed to find $18.9 million for local mental health offices because legislators ordered them to preserve certain services. Leza Wainwright, deputy director of the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services, described the money being used to pay the offices as coming from "emergency reserves" and said no service will get less money than last year.
Offices, agency at odds
The budget cut is rooted in a dispute between local mental health offices and the state agency about how much should be spent on administrative work, such as coordinating who gets care where after business hours.
The state tried last year to cut local administrative expenses, but counties and local offices resisted. For the past two years, state officials used money from the Medicaid office to help cover the local administrative bill but could not take Medicaid money this year because of cuts in the Medicaid budget, Wainwright said. Legislators understood that the department would have to look for money in other accounts if it came up short, she said.
Rep. Verla Insko, a Chapel Hill Democrat who helped write the state mental health budget, said she didn't know that money for services would be cut.
"I was shocked," she said.
Legislators did not know, she said, that the division had money in accounts that it did not plan to spend.
"I didn't know they had money over there to pad their budget," Insko said.
The division expects administrative costs to drop as more local offices merge and as the state continues to rewrite its plans for mental health, Wainwright said. Local offices' administrative costs are based on the jobs they were doing in 2003 and 2004, she said, and their roles have changed. Money now being used for administration can go back to mental health services if office costs go down, she said.
"We hope this is not a recurring need," Wainwright said.
Staff writer Lynn Bonner can be reached at 829-4821 or email@example.com.
Saturday, September 30, 2006
Lynn Bonner, Staff Writer
Posted by John at 1:06 PM Permalink
Friday, September 29, 2006
Coming out of the medicine cabinet
Celebate Mental Health Awarness Week by eliminating the stigma
By Sean Cunnison Scott
September 29, 2006
I remember the day, several years ago, when a co-worker I didn't know very well told me that Zoloft saved her life. It came as a shock. I thought that she was, well, crazy, that she must have been way off the deep end to have needed that kind of help, let alone to bring it up in conversation like that.
Attitudes like this are fostered by a society that until recently just didn't talk about such things unless to ridicule or pity the freaks afflicted with such problems. Even I, as an educated and compassionate person, shared in such thinking to some degree. Is it any wonder, then, that when I started taking antidepressants I was loath to tell anyone? What would people think? Would it ruin my chances of getting a job?
The gay community has long had the "closet" as a metaphor of secrecy and shame. In recent years, more and more people have had the courage to "come out of the closet." I propose a parallel metaphor for another group that has too long, and too often, felt the need for secrecy and shame. Yes, folks, it's time to come out of the medicine cabinet.
Part of me is hesitant to draw an analogy between the stigma of homosexuality and the stigma of mental illness. After all, within my lifetime, homosexuality was still officially classified as a mental illness by the psychiatric profession. I would never say that gayness is a disease, and I'm disgusted by the "ex-gay" movement that seeks to cure sodomites of their sinful ways. That said, there are relevant parallels. Both sexuality and mental health can color and pervade all facets of our lives, and in both cases, little good can come of people denying the truth about themselves or the people they love. Both issues need to be dealt with honestly and openly for people to have healthy emotional lives and positive relationships.
Another big topic also shows the power of openness. "Cancer" used to be a word that many people were afraid to speak aloud. If anything, it was to be whispered, or cut to "C," as though the disease were a dog or child who knew words but didn't know how to spell, and would spin out of control unless one discreetly referred to C-A-N-D-Y or a W-A-L-K. People responded to the "C word" with a mixture of shame and magical thinking, as if merely to talk about the disease would encourage its spread, or even its transmission to others. Cancer was like Beetlejuice â€” say it too many times and it would appear in your life, with no way to get rid of it. Cancer is still scary, and still takes too many lives, but thanks to advances in medical technology â€” and, unfortunately, the appearance of deadlier diseases â€” cancer is now a problem to be dealt with, attacked, talked about, and even laughed at.
Because topics like homosexuality and cancer were not openly discussed, there was an emphasis on the negative consequences and the exceptional nature of those affected. You often didn't know that someone had cancer until it killed them, and people often weren't known to be gay unless they died of AIDS or their sexuality was revealed as part of a legal scandal. Even the few public figures who flaunted their sexuality, merely underlined the exceptionality and otherness of people with the disease. As more people came out of the closet, it started a virtuous, as opposed to a vicious, cycle. The more people came out, the less stigma there was, and as the stigma receded, more people worked up the courage to come out. Of course, gays are still the victims of discrimination and ignorance, but now gays and the people who love them can openly engage the critics and bigots rather than fearing guilt by association. As a society, we have come to see that gays and lesbians are not just flamboyant societal outsiders or tragic figures wasting away on deathbeds as a result of their own behavior. They are friends, loved ones, teachers, family members, professionals, working men and women. Hell, some of them are even downright boring! Because some people were brave enough to speak openly about their sexual identities, it has become easier for everyone to understand each other and live honestly.
The time is right for people suffering from depression, anxiety, obsessive-compulsive disorder, bipolar disorder, attention-deficit disorder and other mental health issues to come out of the medicine cabinet. In the last 10 years, very successful movies, memoirs, television shows and even children's books have treated mental illness openly, respectfully, compassionately, and even hilariously. Jack Nicholson's poignant and funny performance in As Good as it Gets, for example, raised awareness of OCD and even inspired many people to seek treatment so they could take control of a condition that had so long controlled them.
It has been said that fresh air and sunlight are the best disinfectants. In 1990, Congress designated the first week in October as Mental Illness Awareness Week. People struggling with mental illness have the opportunity to share the truth of their lives rather than live in fear. Those who know people affected by mental illness â€” i.e., all of us â€” have the opportunity to learn more about mental health issues. For more information on Mental Illness Awareness Week, visit http://www.nami.org/miaw. You have nothing to lose but your stigma. Read more!
Posted by david at 6:50 PM Permalink
Friday, September 29, 2006
State drafting plan to house mentally ill
They need somewhere besides rest homes for the elderly, experts say
THE ASSOCIATED PRESS
Responding to problems in the state's adult-care homes, North Carolina health officials have announced a plan to house aggressive mentally ill patients in a place separate from rest homes designed for senior citizens.
Plans for the new type of care center are being drafted, Health and Human Services Secretary Carmen Hooker Odom announced Wednesday. The move comes after a series of high-profile cases involving adult-care residents who wandered away from their centers. One resident died.
The practice of placing the mentally ill in rest homes has long been criticized. Critics say that the rules endanger frail geriatric residents and place mentally ill people where staff cannot properly care for them.
Rest homes have been a convenient place to house mentally ill patients when they move out of large mental hospitals under a state mental-health reform plan.
In the past two months, two residents have wandered away from the Unique Living home in Cleveland County. The first resident, who had dementia, was found dead in nearby woods. The second, who has schizophrenia, was found alive but hungry 100 miles away in Maggie Valley.
Hooker Odom has made finding a solution a priority, said Jackie Sheppard, the assistant Health and Human Services Secretary.
"Given the critical nature of this issue, and what we see day after day about people (wandering) and other issues, she decided it was too important not to take on," Sheppard said during a meeting of the N.C. Study Commission on Aging in Raleigh.
Sheppard said that the state health department has "cobbled together" the $600,000 expected to be the minimum needed for a long-range study on housing for mentally ill patients, including those who have a high potential for aggression.
Health-department officials also told commissioners that they have made progress toward improving screening of patients who are entering rest homes.
Legislators on the study commission said that they were pleased with the effort but noted that it has been 10 years since the General Assembly, the health department and rest-home industry officials started debating how to help mental-health patients who need long-term care.
Rep. Jennifer Weiss, D-Wake, asked why the state has been moving people out of mental hospitals with no plan on where to put them.
"I'm kind of distressed, shocked and appalled that now, in 2006, we're being told we need a study to figure out where we need to put these folks," Weiss said.
Sheppard agreed. "We share your frustration, and (we) don't take this issue lightly. People's lives are at stake," she said.
Serving the mentally ill requires larger staffs and specialized training for those who handle patients' drugs and outbursts, experts say. A state study finished two years ago estimated that as much as $198 million more in public dollars would be needed to train and staff care homes to meet the needs of all state residents.
Posted by John at 10:03 AM Permalink
By David Goldstein
WASHINGTON - The Department of Veterans Affairs failed to fully spend a promised $300 million since 2005 to fill critical gaps in mental health services for returning troops and others, congressional investigators said.
The money was supposed to be used to improve awareness of the VA's mental health programs and provide better access to them for troops who served in Iraq and Afghanistan, women and other veterans suffering from serious mental illnesses.
But a Government Accountability Office report released Thursday found that the agency underspent the money and that not all of what it did spend went to those programs.
"Veterans expect that wounds suffered in service, be they to mind or body, will be cared for by the nation they served," Rep. Henry Brown Jr., R-S.C., said during a hearing he chaired Thursday on mental health issues. "We will exercise greater oversight on this issue now to determine what VA is spending and how it is being spent, to ensure that funds allocated by the American people are used as intended."
The VA didn't respond to requests for comment on the report.
The hearing was before the health subcommittee of the House Veterans Affairs Committee. The GAO's findings became yet another broadside at the VA and the Bush administration, which veterans groups have criticized for cutting benefits and not anticipating how the Iraq war would stretch the capacity of programs to treat the wounded.
The Kansas City Star reported in May that the VA had dramatically underestimated the number of troops that would return from Iraq this year suffering from post-traumatic stress disorder. The GAO reached a similar conclusion in a separate report last week.
In Thursday's GAO report, investigators found that the VA spent only $53 million of the $100 million it planned to use in fiscal 2005 on gaps in care under a mental health strategic plan. It sent $35 million of the $100 million to a VA general fund, where the money could be spent on a variety of programs.
"It is likely that some of these funds were not used" as intended, the GAO said.
Investigators also said that the VA didn't tell its hospital and health care officials that the $35 million was available and they "were unaware that any specific portion of their general allocation was to be used for mental health strategic plan initiatives."
Some of the money was used to pay for routine mental health programs, the GAO said.
Meanwhile, the $12 million remaining from the $100 million allocation went unspent, the GAO said, because VA officials said the fiscal year was running out.
Similarly, the GAO said that in fiscal 2006, which ends Saturday, the VA budgeted $200 million for the strategic plan, but $42 million remains unspent.
"Gaps in mental health services remain," said Rep. Michael Michaud of Maine, the ranking Democrat on the health subcommittee. "The mental health strategic plan is good. However, without a real commitment to funding, the plan will not become a reality."
Besides the GAO report, the hearing dealt with the rising number of post-traumatic stress disorder cases and traumatic brain injuries among troops.
Rep. Bill Pascrell Jr., D-N.J., said the Walter Reed Army Medical Center in Washington has so far treated more than 650 troops from Iraq and Afghanistan for traumatic brain injuries - 40 percent of all the troops from those combat zones the hospital has seen.
Col. Charles Hoge, director of psychiatry and neuroscience at the Walter Reed Army Institute of Research, said 15 percent to 17 percent of troops who served in combat have screened positive for post-traumatic stress disorder.
``Please don't hide behind statistics and bureaucrat-ese," Rep. Bob Filner, D-Calif., told Hoge and other medical experts at the hearing. "Let us know you have some passion for solving this issue."
Dr. Gerald Cross, a top VA health official, replied, "I can assure you we do have passion, and we have the passion for caring for our veterans." Read more!
Posted by david at 5:30 AM Permalink
Thursday, September 28, 2006
Times-News Staff Writer
Facing a looming shutdown amid financial woes, the region's largest mental health care provider will sell nine buildings in Henderson and Transylvania counties to make ends meet in the next month.
When Hendersonville-based Mountain Laurel and Asheville-based New Vistas merged in July 2005, each carried something the other needed, the head of the combined agency said. Mountain Laurel owned buildings. New Vistas helped more patients.
But now that the combined agency plans to shut down by Oct. 31, the buildings will be sold and the patients helped by new mental health care providers.
"We're in the process of having (the buildings) appraised and getting buyers for them, primarily with the focus of generating enough cash to meet our obligations to staff and to certain vendors and financial institutions," said New Vistas-Mountain Laurel Chief Executive Officer Will Callison.
Callison said the agency owes about $2.3 million to banks, and must also cover bills in the next month, from utilities to liability insurance.
New Vistas-Mountain Laurel also is trying to cover the ongoing payroll and employees' accrued paid time off, he said. The agency has 700 employees and an annual payroll of $24 million, an average of $2 million a month. Western Highlands, which manages mental health care in the eight-county region, is working to bring new mental health care providers to pick up the agency's caseload of 10,000-plus patients.
When asked whether the sale would impact the new providers expected to take on the agency's cases, Callison said, "That's really going to be an issue that Western Highlands is going to need to deal with. And in some cases, the potential purchaser may be able to not only use the building themselves for mental health services, but also may be able to sublease it to other providers."
"Another thing to remember, with new service definitions the emphasis is on community-based services, taking services out to the client," Callison said. "With that new model, I think that having a brick and mortar location where clients come for services is going to become less and less important."
Legislators discuss crisis
Meanwhile, a mountain legislator said Thursday the state should ensure mental health care providers divvy up profitable and taxing caseloads so no lone agency shoulders the financial burden.
That's one recommendation that came out of a legislative caucus held in Asheville on Wednesday, when seven mountain legislators discussed concerns about the looming closure of the region's largest mental health care provider. Western Highlands CEO Arthur Carder updated lawmakers on the response to the news that New Vistas-Mountain Laurel would shut down by Oct. 31.
Lawmakers said the Wednesday session was closed to the public because it was a legislative caucus, an exception to state open meeting laws.
Patients, case workers, county leaders, police officers and homeless shelters fear the short timeframe for the massive transition will translate into the mentally ill falling through the cracks.
Mountain lawmakers say they want to ensure such a massive shutdown never happens again. Rep. Carolyn Justus, R-Dana, says one way to do that is by ensuring no lone provider carries the burden of caring for patients who rely on the state's help to pay medical bills. Callison says one reason the agency went under is it shouldered the burden alone, losing money each time a state-funded patient saw a therapist.
"We need to share that around," Justus said.
Lawmakers said they came out of the meeting with Carder more optimistic than before. Sen. Martin Nesbitt, D-Asheville, hoped "at the end of the day we'll have an even stronger system than what we had to start with, if we can just get from here to there."
"Everyone is concerned that we have some 10,000 consumers out there that get their service from New Vistas that have to be taken care of. We want to make sure that is being done," Nesbitt said. "It will probably be a bumpy road. I don't know how you make a transition with that many people without having bumps in the road."
Sen. Tom Apodaca, R-Hendersonville, said one of his main concerns revolved around whether patients would have difficulty finding medication.
"One major concern -- are we going to have the necessary services for those who need it the most," Apodaca said. "I'm really concerned about the ones who have to have medication handed out on a regular basis. (Western Highlands) had already prepared for that and had prescriptions issued for four to six weeks so we could make sure these folks have their medications available to them."
Overall, Apodaca said, "It sounded to me like there are some positive things happening, and I just hope we can make it by the end of October. (Carder) seems to think we can."
Justus and Apodaca said the meeting was closed to the public because it was a legislative caucus.
The state's open meetings law allows General Assembly members to hold caucuses behind closed doors so long as they do not meet in a caucus called to subvert or evade the open meetings law. Nesbitt said the public could have attended the meeting. Read more!
Posted by david at 4:19 PM Permalink
Split possible in adult homes
State health official says plans in the works to place aggressive mentally ill patients in new housing
RALEIGH - With problems mounting in N.C. adult-care homes, the state's top health and human services official announced plans Wednesday to create new housing for some of the centers' most physically aggressive residents.
N.C. Health and Human Services Secretary Carmen Hooker Odom's office is drafting plans for a new type of facility that would take in aggressive mentally ill people now housed in rest homes designed for the aged.
Concerns over mixing the mentally ill with the elderly have intensified in recent months because of high-profile cases involving adult-care residents who went missing from centers.
Critics for years have said the homes often lack proper staffing or training to care for the mentally ill, and that the mixture endangers frail geriatric residents.
But since state rules allow mentally ill people to be placed in rest homes, the centers have emerged as a convenient place to put those being moved out of large mental hospitals under the state's mental health reform plan.
Ten days ago, a second resident in two months wandered off from one troubled Cleveland County home. The first resident, a dementia sufferer, was found dead in nearby woods. The second, who has schizophrenia, was found alive but hungry in Maggie Valley, 100 miles away.
News of Hooker Odom's plans emerged Wednesday as a state legislative research group, the N.C. Study Commission on Aging, discussed the problem. One of Hooker Odom's deputies told them she had decided to step up the search for solutions.
"Given the critical nature of this issue and what we see day after day about people (wandering) and other issues, she decided it was too important not to take on," said Jackie Sheppard, an assistant secretary for DHHS.
Sheppard said the agency has begun drawing up specifications for new housing that would meet the needs of mentally ill people with high potential for aggression. In addition, DHHS will order a long-range study to map out a full array of housing options for the mentally ill.
Such a study, estimated to cost at least $600,000, had been recommended to lawmakers in 2005. The General Assembly didn't fund it. DHHS has "cobbled together" money to finance it, Sheppard said.
Lawmakers on the study commission applauded the effort, but also expressed frustration. The General Assembly, DHHS and rest home industry officials have been debating for a decade or more about how best to meet the mental health needs of people in long-term care facilities.
One lawmaker asked why the state for years has been pushing people out of its mental hospitals if no one knows where they should stay. The state's mental health reform plan calls for moving mentally ill people out of hospitals and into the community.
"I'm kind of distressed, shocked and appalled that now, in 2006, we're being told we need a study to figure out where we need to put these folks," said Rep. Jennifer Weiss, D-Wake.
Sheppard responded: "We share your frustration, and (we) don't take this issue lightly. People's lives are at stake."
Cost likely daunting
DHHS is investigating the case of Kenneth Charles, a 45-year-old man who signed himself out of the Unique Living center in Cleveland County on Sept. 18. Charles, who suffers from schizophrenia, was going for a walk, but turned up in Maggie Valley a day later.More than 24 hours elapsed before the home alerted police and social services officials. Cleveland County DSS officials say that was too long. Unique Living officials have said Charles had the right to sign himself out, and that they didn't wait too long to give notice.
Charles is the second Unique Living resident in two months to wander away. Kelly "Buck" Whitesides, a 59-year-old former mill worker with dementia and diabetes, walked away July 30 and was found dead six days later in woods near the facility.
Those familiar with the problems of mentally ill people in rest homes say the solutions cost so much that authorities shy away from bold action. Serving the mentally ill requires larger staffs, as well as specialized training in handling residents' psychotropic drugs and possible emotional outbursts.
One 2004 state study looked at how much it would cost to fully train and staff the homes to meet the needs of all residents, mentally ill or not. The bottom line: As much as $198 million in additional local, state and federal dollars.
"We have been asking for (solutions) for 12 years," said Rep. Debbie Clary, R-Cleveland. "The problem with it is the money."
Fixes in the works
The state has been addressing some problems, though. DHHS officials told the study commission Wednesday about a three-year, $4.3 million contract they recently signed for production of a Web-based screening system for potential rest home clients.
It will give authorities more information on residents' problems and needs, helping them make wiser choices about which home a resident should stay in.
They also noted they are spending $1.4 million annually to add 20 staffers to special geriatric mental health teams that travel the state, training rest-home workers how to properly deal with mentally ill residents.
"We're not going to drag our feet on this issue," Sheppard said. "It's going to take a collective effort from the (rest home) providers and the state."
Posted by John at 3:48 PM Permalink
Man has schizophrenia, is found 100 miles away
ERIC FRAZIER AND KYTJA WEIR
Less than two months after a resident with dementia wandered away from a Cleveland County rest home and was found dead in the woods, investigators are looking into another disappearance at the same center.
Now the county's social services board wants the state to either change how it licenses Unique Living or shut it down.
Kenneth Charles, 45, signed himself out of the center near Fallston on Sept. 18 to go for a walk. He was found a day later in Maggie Valley, 100 miles away, dazed and hungry. The home didn't report him missing for more than 24 hours.
Charles suffers from schizophrenia and paranoia, DSS officials said.
"It just seems like a very dangerous situation when you have people checking themselves out and wandering all over the state, especially people with these diagnoses," said Steve Padgett, the DSS board's chairman.
State and local officials were already looking into problems at Unique Living. Now, they are investigating Charles' case, too.
"We are quite concerned," said Teala McSwain, program manager with Cleveland County DSS. "He was not in good shape when he was found."
The home said in a statement Tuesday it has created new policies restricting residents with "limited ability" from signing out. Charles, the home said, didn't fit that description.
"The resident in question is a competent individual who is capable of making decisions," wrote two of the home's owners, Dana Head and Shawn Kuhl.
Now all residents must get permission to leave, they said.
McSwain said Charles' doctor considered him well enough to sign himself out. Still, she said, the home is responsible for keeping him safe.
Charles left about 1:45 p.m., McSwain said, and the home didn't report him missing until about 5 p.m. the next day.
About 9 that night, he turned up at a closed restaurant near Maggie Valley and asked the staff to call police. DSS officials believe he had hitched a ride there.
Maggie Valley police Officer Jeff Mackey told the Observer he took the man to the police station. Charles told him he was starving and cold. It was clear to Mackey that the man couldn't take care of himself.
Charles ate a sandwich and drank some milk, then curled up on the floor with a blanket as police tried to find him help. A computer check revealed he had been reported as an "endangered" missing person out of Cleveland County.
Charles is back at Unique Living now.
This wasn't the first time he had disappeared. In May, he signed out and was arrested in Georgia for disorderly conduct, said Tom Ensley, Cleveland DSS adult services supervisor.
DSS officials said the home shouldn't have waited so long to notify authorities last week. They pointed to state rules requiring rest homes to immediately notify police and DSS if the person's safety is a concern and his whereabouts aren't known.
"If someone's walking and it's getting dark and they haven't called in, it would certainly be reasonable to start getting concerned," McSwain said.
But Unique Living's owners pointed to a different state rule that says if a person wanders away but doesn't require treatment for injuries, the home has as much as 48 hours to notify the resident's "responsible person."
However, that rule makes no reference to the timeframe for notifying police or DSS.
DSS officials have complained for years about problems involving mentally ill residents at Unique Living and Yelton's Health Care, a rest home that previously operated at the site. Two residents died there while it was Yelton's, and a convicted sex offender raped a fellow resident.
Scrutiny intensified after Kelly "Buck" Whitesides walked away from the center July 30. The 59-year-old former mill worker, who had dementia and diabetes, had a history of wandering. He was found dead six days later in woods near the facility.
DSS officials expect next month to ask the state for the maximum fine of $20,000 against the center in connection with Whitesides' death.
Several weeks ago, McSwain said, the state barred Unique Living from admitting new residents because the rest home hadn't submitted a budget report.
Ensley said DSS questions whether Unique Living has enough staff and training to care for so many mentally ill residents. An annual census this month found 96 percent of the home's 73 residents had been diagnosed with mental illnesses. The average age was 48.
In North Carolina, rest homes are designed primarily for the elderly. Experts say the licensing rules don't require enough training or staffing to meet the needs of the mentally ill, yet more and more mentally ill residents have flowed into them in recent years.
The Cleveland County DSS Board voted Monday to ask the state to either close Unique Living or relicense it as a mental health facility, which could upgrade training and staffing.
"The situation out there is unacceptable to the board and I would hope it's unacceptable to the people of Cleveland County," Padgett said.
Lawmakers are also looking into how such homes across the state treat the mentally ill. Today in Raleigh, the N.C. Study Commission on Aging plans to discuss possible solutions.
Posted by david at 5:43 AM Permalink
WASHINGTON D.C. -- As part of his effort to honor the legacy of his friend and colleague Senator Paul Wellstone, Senator Tom Harkin (D-IA) yesterday pressed for a resolution commemorating Wellstone’s tireless work on social issues and urging lawmakers to make mental health parity a priority for the 110th Congress.
“Paul was a champion of America’s underserved and fought hard for mental health parity,” Harkin said. “He fought for ordinary people, and always listened to the quiet voices that too often go unheard in Washington and across the country. It is long past do that we here in Congress rethink our priorities and continue the mission that Paul began.”
It is estimated that nearly 50 million Americans suffer from some sort of mental heath-related condition. But only one-third of those afflicted receive adequate treatment. Too many forgo medical treatment due to the high out-of-pocket cost of treatment, since private health insurance plans typically provide lower levels of coverage for treating mental illness than for treating other illnesses.
According to the Substance Abuse and Mental Health Services Administration, under-treated and untreated mental disorders cost the nation in excess of $200 billion annually – hurting the economy, the profitability of business, and government budgets.
“The good news is that millions of people with mental illness can recover and reclaim their lives, if provided treatment and support,” Harkin said. “To that end, it is time to do away with the discriminatory practice of treating mental and physical illness as two different things under insurance. I am proud to continue Paul’s fight and carry on this important work.”
In 1996, Congress passed the Mental Health Parity Act, which eliminated annual and lifetime dollar limits for mental healthcare for companies with more than 50 employees. This law was designed to be in effect for six years and it fell short of full parity. It also focused only on catastrophic benefits.
In 2001, with the end of this six year period approaching, The Mental Health Equitable Treatment Act was introduced for the first time by Senators Wellstone and Pete Domenici. In 2003 the legislation was reintroduced and renamed the Paul Wellstone Mental Health Equitable Treatment Act. The legislation that Harkin and others are urging Congress to consider next year would provide full parity, equalizing all treatment limitations and financial requirements for all physical and mental illnesses. Harkin has co-sponsored the same legislation for the past three sessions of Congress. Read more!
Posted by david at 5:12 AM Permalink
By Dawn Fallik and Alfred Lubrano
The Philadelphia Inquirer
PHILADELPHIA - As questions swirl around Terrell Owens' alleged suicide attempt, sports psychologists say stress that athletes need to pay as much attention to their mental health as they do their physical routines.
Professional sports teams typically employ doctors to care for everything from concussions to broken toes. But mental health is an issue often kept far behind locker room doors.
"The sports world is backwards and not very progressive regarding mental health," said Steven Berkowitz, a sports psychologist and former syndicated sports columnist for Copley News Service.
"Seeing a psychologist is still a taboo for some. And mental health is the last thing teams and athletes want to address."
When asked if the Eagles had a staff psychologist, spokesman Derek Boyko said he didn't know, adding that if something came up, a player would be referred to a professional.
On the other hand, the Philadelphia Flyers not only have a staff psychologist, he comes to practice every week.
"I'm just another part of the team to help them be the best they can be," said Joel H. Fish, director for the Center for Sports Psychology in Philadelphia.
"At the beginning of the season I'm introduced to the team, and I'm around informally on a regular basis so they know they have someone they can trust if they want to talk about their personal lives," said Fish, who works with the 76ers in the same way.
The American Psychological Association does not keep track of how many teams employ staff psychologists, but said many players work with a variety of mental health professionals, from "life coaches" to therapists to motivational specialists.
The same personality qualities that make athletes succeed on the field - high expectations, confidence, intensity - are the same ones that may make them more vulnerable to depression and substance abuse, said Eric Zillmer, a psychology professor and director of athletics at Drexel University.
"They don't talk things out, they act things out, that's why they're athletes," said Zillmer. "They tend to be a little more impulsive, and they take more risks, which is celebrated on the field but is maladaptive in their personal life."
Owens is going through an enormous amount of stress, psychologists pointed out. A new job and a new home are two of the top stressers, and would only exacerbate other problems.
Other football players have spoken openly about their struggles to cope.
In 2002, Owens' current teammate, Terry Glenn, sued the National Football League claiming it discriminated against him because he suffered from chronic depression. Glenn dropped the suit after he was traded to Green Bay.
And Terry Bradshaw, former star quarterback for the Pittsburgh Steelers, did not talk about his anxiety attacks and depression until well after his NFL career ended. Now he travels the country speaking out about how medication has helped him.
But although the stigma has lessened over the past two decades, many still believe in the macho dictate that anyone who needs a shrink is too weak to be playing the sport.
That may be more true of football than of other sports, said Deborah Graham, a Boerne, Texas, sports psychologist.
She said golfers probably seek help more than other athletes.
"I've worked with people from every sport, but golf is particularly difficult mentally," she said. "There's no guaranteed salary, there's too much time to think and it takes tremendous mental discipline to hit a ball that just sits there."
Jonathan Katz, director of sports psychology at Altheus, a Rye, N.Y., health and performance center for athletes, said Owens displayed "warning signs" that something might be wrong in his life.
"People who are confident in themselves don't feel a strong need to have to tell the world how great they are," as Owens has done, Katz said. "This is true if you're an athlete or a banker."
While everyone has problems, athletes face the additional indignity of being openly and, sometimes, roughly criticized. This can hurt even the most veteran performers.
"Criticism like Owens has endured wears down even the toughest athletes," said Berkowitz. "Being booed by 50,000 people all the time just doesn't work for anybody." Read more!
Posted by david at 4:13 AM Permalink
Wednesday, September 27, 2006
(IsraelNN.com) At their weekly meeting in Jerusalem, Cabinet ministers are expected to approve broad reforms in the mental health services, including changes in National Insurance coverage.
As a result of the change, 200,000 Israelis in need of psychiatric care will now be able to do so within the framework of the services provided by the regular health funds.
Currently, mental health services are mainly provided by the private sector. This change is due to be implemented from the beginning of next year.
One of the last obstacles to the passing of the reform was removed yesterday, making psychiatric care free within the health funds. The reform is expected to shorten the waiting lists at psychiatric clinics and double the number of recipients of such services in Israel.
Posted by david at 7:55 AM Permalink
Wednesday, September 27, 2006
Heed Portland's police chief on mental health
The death of James Philip Chasse Jr. in police custody demands a public inquest, and a new preventative strategy
T o some, it may have sounded like an excuse. The recent death of James Philip Chasse Jr., a 42-year-old mentally ill Portlander, while in police custody put Police Chief Rosie Sizer on the defensive, after all. She's at another disadvantage, too: She's not yet able to share all the facts surrounding Chasse's death.
Still, the chief was right Monday to remind us about the larger context surrounding this death: our broken mental health care system. Constantly dealing with the mentally ill is part of the "burden . . . police officers carry with them each and every day . . . to an extent unprecedented in my 21-year tenure in the Police Bureau," Sizer said.
But that's not an excuse, and Sizer wasn't wielding it that way.
Sizer has promised to make the police investigation into Chasse's death public as soon as possible. That's good, but as we've argued for years, any death at police hands or in police custody also demands a public inquest. Both Chasse's death in custody and another recent death in the area -- the police shooting of Lukus Glenn, 18, of Tigard -- underscore why a public inquest is always essential.
For the public, both of these deaths instinctively fall into the category of: "This shouldn't have happened." Both Glenn's and Chasse's families deserve a full public airing of the facts. And only a public inquest can elucidate the circumstances sufficiently to rebuild a foundation of public trust and confidence in the law enforcement agencies involved.
But invaluable as public inquests would be in these cases, Oregon needs a more proactive strategy for dealing with the mentally ill (Chasse) and those in crisis (Glenn). These two recent deaths strongly suggest that it's time to consider mandating intensive training in crisis intervention and in dealing with the mentally ill for patrol officers.
True, some get a few hours of training now, and some agencies provide more intensive training on a voluntary basis. (With 188 officers certified in crisis intervention, Portland is one of the leaders in this field.) It's also important to emphasize that no training program can eliminate such tragic deaths. At times, events spin out of control and police must act to protect themselves and the public.
But teaching police smarter, safer, low-key approaches to dealing with the mentally ill and people in crisis could save lives. And police careers, too. "The officers were devastated" by Chasse's death, the chief said Tuesday. "This is not the outcome they desired or expected."
Although it would be expensive to train all officers intensively to intervene with the mentally ill, Portland and other police agencies need to start calculating the cost, making the pitch and pushing for such intensive training, not just for new officers, but for police bureau veterans, too.
Police shouldn't shoulder so much of the burden of dealing with the mentally ill and those in crisis, but, as Sizer acknowledged this week, they often do. As long as they make up the front line in dealing with people in these situations, it would be better for everyone -- the officers, and the community -- if police really knew what to do. Read more!
Posted by david at 7:49 AM Permalink
Addressing the stigma of mental illness
09/26/2006 - Letter to the Editor
I had to bite my lip and cringe at my son's baseball game when I talked with another parent. He's a volunteer at a local rescue squad, and he proceeded to tell me about a call he received the night before.
He explained that they had responded to a late night call for some "mental guy who was off his medication." The man had fled the scene, and "he didn't want to go looking for him without a gun." I was floored. His sole rationale for needing a gun was that the man was mentally ill.
Mentally ill individuals do commit crimes. And they most often receive front-page, prime-time news coverage. But there is no evidence to support the case that mentally ill persons commit more crimes that the general public. The man was more likely to injure himself than the police or medical personnel.
Fortunately, most police officers receive training to deal with these situations and they can defuse them before they escalate to violence.
Unfortunately, this rescue squad volunteer's knee-jerk reaction is quite common and only accentuates the problem of stigma related to mental illnesses. Somewhere down the line, nobody educated this first responder about how to deal with this type of situation.
Many people still associate mental illness with the homeless or the institutionalized such as those seen in "One Flew Over the Cuckoo's Nest." In reality, many individuals with mental illness are part of our society and can go about their lives unnoticed.
And medications do remain an important piece of the medical treatment they receive. While it's true that individuals will sometimes go off their medication, it doesn't necessarily mean they will become a threat to society.
Mental illnesses are and will continue to be a part of the society in which we live. Reduced stigma and greater acceptance and understanding will only be reached through increased education.
Posted by david at 6:59 AM Permalink
In 1985, Steven Wikel, a senior in Carbondale Community High School, took his own life. He shot himself. He was only 18.
"It was one of those situations where it was a shock to everybody," recalls Judy Ashby, Steven's grieving mother, who is also a mental health counselor at Catholic Social Services, the executive director of LifeSavers Training Corporation and the chair of the community outreach workgroup at the Illinois Suicide Prevention Coalition.
"Part of me said, I'm a counselor, I should have known," says Ashby. "But parents are often the last to know in situations like these. It was a shock to everyone - to me, the school, the Church and the community. Of all people....not Steve Wikel, was the overwhelming reaction."
"It's a process to find a way through that kind of shock and grief; for our kids are our most important production. I will forever be haunted by the "If only...", "Why didn't I..." questions and how I failed as a mother," says Ashby. "To know that your own child, by his own hand, decided to stop living, changes your life irrevocably. This is just something you just cannot fix. You cannot bring your child back again."
"In retrospect, it was one of those situations where I could have gone crazy, slipped into depression, or followed him," says Ashby. "But I got busy. I wanted to desperately make sure this would never happen again."
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"In early 1987 maybe, I ran into a program featured at a conference in Springfield, IL. It was called LifeSavers. I thought to myself, gosh, this is what I'm looking for. I walked out into the lobby and connected with several people. Steven's teacher was there, trying to find answers too, just as I was."
Ashby ended up doing a lot of letter writing and connected with the department of mental health and disabilities. They gave her a $10,000 grant and she used the money to start a two day conference on suicide prevention, attended by cops, students and medical counselors.
With enough money left over from the grant to conduct the first ever suicide prevention training retreat in Carbondale, Ashby was soon approached by several schools, which had been affected by suicide. "They asked if we could train their students too," says Ashby.
Developing a suicide and crisis prevention training program specifically for high school kids, she started training students voluntarily from that point on. Not trained to be peer counselors, lifesavers are trained to be active listeners, who can responsibly help other students deal with the emotional crises of adolescence.
LifeSavers has now trained 26 other schools in Southern Illinois on suicide prevention. Close to 2,000 high school kids - sophomores, juniors, some mature freshmen form the first line of defense for high school communities.
Statistics show that suicidal incidents decreased by 50 percent in Southern Illinois schools that implemented the program and student referrals to counseling increased by 72 percent due to LifeSavers' awareness, interventions, and thoughtful referrals.
"We look for kids who are the carers; the listeners," says Ashby. "Whether they are preppies, jocks, nerds, geeks, Goths - doesn't matter. At the end of the training they each go back with a shifted attitude, to their own groups and help their friends and classmates."
"For example, they might see the weird kid in the corner who everyone's throwing dough at. In the past they would have avoided this kid. But after the training, they have a new perspective and realize the kid may be going through some issues like abuse at home or death of a parent," says Ashby.
"So the lifesaver then goes up to the kid and starts an authentic conversation. Hey man, you look like you're having a rough day. Wanna shoot some baskets? They find ways to talk to the kids and help them out."
Currently in the process of getting LifeSavers to college students now, Ashby says that what has worked at the High School level can be carried over and modified so that it works at the collegiate level. "We'll probably start at the dorms," she says.
A well respected public figure, Ashby is passionately working today to influence the government to provide more recognition, financial support and training for suicide prevention.
She says she's eternally grateful she went in this direction, for the death of her son, became a wakeup call for her and continues to be. "You slowly learn to laugh again. You learn to live again. But losing an adult child is a grieving experience you just cannot quite get over..."
Suicide: The Larger Picture
Often a last ditch effort to escape from unbearable stress and utter despair, suicide is recognized as a "chronic epidemic", with more than 30,000 deaths by suicide in the US alone, every year. The second leading cause of death among teens and children, nationally and statewide, experts say it is still vastly under reported.
Compared to the 18,000 who die from homicides and 17,000 from drunk driving every year, a person dies by suicide about every 18 minutes in the United States according to the American Association of Suicidology. Reliable estimates from the American Foundation for Suicide Prevention state that a suicide attempt is made about once every minute.
Multiple stressors - like marital and partner relationship difficulties, family issues, economic stress, adjustment disorders, anxiety disorders, schizophrenia and psychotic disorders, substance abuse, to name just a few - wear down the individual's inherent ability to cope on a psychological and physiological level resulting in depression and a feeling of utter hopelessness; which can trigger a suicide attempt.
"We see a lot of connections to the use of drugs and alcohol," says Laurie Schnider, director of mental health services, at Jefferson County Comprehensive Services (JCCS), in Mt. Vernon, Illinois. "Its not unusual for people who are under the influence to feel more distressed."
"There's also a link between domestic violence and suicide. More often than not the perpetrator kills himself or takes the poor victim with him. There are more deaths that are actually suicides than we can ever record. Many survive to tell the tale. Many don't. High risk behavior that leads to car accidents, driving off a bridge, driving into a tree - many of them are not really accidents, but intentional suicides."
"What worries us is when someone doesn't call and doesn't get the help they need," says Schnider. "If we don't know about it, we just can't help them out."
Contrary to popular belief, suicide attempts are generally not very high during the holiday season. "October and April tend to be the biggest months for suicidal attempts," says Schnider. "Seasonal changes, mid terms for students, tax time for families, whatever the reason; there are higher numbers around this time."
Statistics show that suicide rates are the highest among people aged 65 and older. Jim Novelli, adult crisis services manager at Southern Illinois Regional Social Services (SIRRS), in Carbondale, Illinois, says, "There's a misconception that anyone who is old is depressed. This is not true. The elderly can feel suicidal due to the loss of a loved one, innumerable medical problems, and the general feeling that life is just not what it used to be."
Being in school or college can be pretty traumatic too, with many attempting suicide over relationships gone bad. "You don't hear about it a lot," says Novelli. "But it happens all the time."
Prevention Services and Crisis Counseling
Managing a standalone crisis team of seven people who work together to provide crisis services to people 24/7, Novelli says they must have gone out to assess at least 500 adults-in-crisis, over the past year alone. "60 to 70 percent of those calls were suicidal or post a suicidal attempt that needed assessment," says Novelli.
While most people are uncomfortable talking about the subject, too often, victims are blamed and the surviving friends and family members are stigmatized states a brochure from the Centers for Disease Control and Prevention (CDC). Consequently, suicide is shrouded in secrecy.
Yet experts say that suicide is extremely preventable. In fact the American Foundation for Suicide Prevention reports that 75 percent of all people committing suicide give some warning of their intentions to a friend or family member. Hence all suicidal threats and attempts should be taken seriously.
"There is a national attempt to look at suicide prevention," reveals Schnider. "Within the last year there has been a federal move to look at suicide prevention in colleges. At present we're looking into how we can get the education out in places like Rend Lake College for example."
Harold Jones, assessment unit manager, Franklin-Williamson Human Services (FWHS), West Frankfort, Illinois says they have a prevention department that goes out into the community - usually targeting the school environment - and provides preventative services.
"We teach kids what to do if one of their friends approaches them with suicidal thoughts," says Jones. "We tell them they shouldn't leave their friend alone and to contact an authoritative person for help."
For adult consumers of the agency, FWHS has a psycho-social rehabilitation program.
Jones advises those in crisis to either call the National Suicide Hotline (1-800-273-TALK) or to go to the nearest emergency room or police station for help if it's late in the evening. "Our on-call crisis counselors will go there and see the individual," he says.
With services available in every community for the prevention, assessment and treatment of suicidal behaviors, experts verify that lives can be saved when suicidal behaviors are detected early.
Visiting jails, schools, nursing homes, emergency rooms and physician's offices, emergency crisis counselors play an important role in suicide prevention with the crisis intervention services they provide.
Novelli describes the evaluation process. "When we get a call from a person in crisis, it usually involves suicidal thoughts. We spend an hour or two evaluating the person. Do they have a suicidal plan in place? Can they manage with outpatient treatment? Do they need to be in the hospital?"
Counseling a lot of depressed, in-crisis individuals in rural areas, Shelly Wood, assertive community treatment (ACT) counselor, Egyptian Public and Mental Health Department, Eldorado, Illinois, says, "A lot of them have no jobs, no income, their families are falling apart."
Volunteering to carry the crisis beeper at night about 60 percent of the time, Wood determines what's going on when she meets an individual-in-crisis. "If they just need someone to talk to, we talk to them. If they are in danger to themselves or others, we evaluate them and make recommendations. In extreme cases, we work with officials to get them out of jail (if they are in jail) and move them to a hospital. But we try and handle most cases within the judicial system."
"We just listen with an open heart and open mind and allow them to tell their story from a safe place," says Ashby. "We provide education and gently nudge them along the way."
The executive director of Lifesavers Training Corporation (618-549-5578), Ashby says between 30 to 40 percent of teenagers think about suicide at some point. The Lifesavers program plays a vital role in suicide prevention, since it's a peer-supported, suicide and crisis-prevention training program for 9th through 12th graders.
The intense three-day training retreat teaches Southern Illinois high school students how to really listen with caring and respect to their troubled peers, how to recognize symptoms of an impending crisis, and when to seek professional help for their friend.
Student trainees gain a better understanding of the teenage concerns which can lead to a real crisis: alcohol and drug use, aggression and violence, sexuality and relationships, academic responsibilities, families, friends and peers, depression, stress, ineffective communication.
"Human beings can be incredibly resourceful," says Ashby. "With a lot of folks, if someone just listens to them with respect and caring, it helps them develop their own healing process. In most cases they have used up their entire repertoire of coping skills and just want the pain to stop. They don't really want to die."
Novelli says if someone is extremely suicidal and is certain to kill him/herself the minute they are left alone; the counselors do make every effort to help.
However if the individual cannot be trusted to be home alone or left on their own recognizance, since they are a danger to themselves, sometimes the only way out is to go through an emergency legal process where their civil rights are suspended and they are brought to a psychiatric unit for their own safety. "Others may choose to voluntarily enter an inpatient, lockdown facility on their own," says Novelli.
In-patient psychiatric facilities like the state operated Choate Mental Health and Developmental Center, in Anna and Chester Mental Health Center, in Chester; private in-patient psychiatric centers offered by Harrisburg Medical Center, Inc., in Harrisburg; St. Mary's Hospital, in Centralia; Richland Memorial Hospital, in Olney; and Lawrence County Memorial Hospital, in Lawrenceville; are just some of the facilities available in Southern Illinois.
"But the greater percentage of suicidal individuals are not hospitalized," clarifies Novelli. "We try to find the least restrictive options that will help them out immediately and in the long term."
How Can You Help a Suicidal Person?
"Unfortunately most people feel they shouldn't ask their friend or family member if they are feeling suicidal, since that may give them ideas," says Novelli, who recommends asking the person straight out if they feel like killing themselves. For if they are telling you they don't want to go on further, the thought of suicide has already entered their minds.
"Be there for the person," advices Novelli. "Be supportive. Listen to what their problems are in a non-judgmental fashion and then call a mental health professional for help. If it's an emergency, get them to the ER."
Sitting and listening attentively to the person and thinking of alternatives may open up new avenues for them, says Novelli. "People in crisis are not thinking straight. They are in such emotional pain that all they can think of is how to make the pain end and suicide seems like a solution."
"Hence parasuicidal attempts are really cries for help," says Novelli. Experts state that parasuicide, when defined broadly includes both suicide attempts and deliberate self-harm inflicted with no intent to die. The greatest predictor of eventual suicide, studies have consistently shown that females outnumber males in making parasuicidal attempts.
What the Future holds
Though more attention is being given to suicide prevention and treatment, those in the mental health field still face numerous problems and hurdles when dealing with suicidal patients.
"Plenty of substance abusers tend to be suicidal," says Wood. "But psychiatric hospitals won't take them in, since the individual has a substance abuse problem. Rehabilitation centers won't take them in since they are suicidal. It becomes a catch 22 situation."
"A lot of times we've had to keep them in intensive care units or special care units of hospitals, until the substance is out of their system and they can then go into a psychiatric facility," says Wood. "These are things that need to be looked at and worked out."
Currently working on developing a local coalition that will focus on problems unique to Southern Illinois, Wood says she has never seen a field like this that doesn't have the resources to deal with a problem on this scale.
At the Rural Suicide Causes and Prevention conference held recently in Southern Illinois, clinical psychologist, Michael R. Rosmann, from Harlan, Iowa spoke about youth being more likely to attempt suicide out of anger and in retaliation, whereas utter hopelessness seemed to be the trigger for adults.
Speaking from clinical experience Rosmann is the executive director of AgriWellness, Inc., a nonprofit corporation that promotes accessible behavioral health services for under-served and at-risk populations who are affected by rural crisis in agricultural communities.
According to Rossman, from the individual perspective, hope is of outmost importance in preventing suicide. "The courage that one receives from others who understand how desperate the suicidal individual feels, professional or pastoral counseling, support from friends, acceptance that a higher power is in charge and personal integrity will go a long way in suicide prevention."
The Role of Bilingual Counselors in Suicide Prevention
With a high rate of reported suicides in the Spanish speaking community, public and mental health agencies are beginning to realize the importance and need for bi-lingual counselors in helping those who are in crisis.
The US Bureau of Census reports that more than one in four Hispanics lives in a "linguistically isolated household" in the United States. This reality added to the extremely low availability of bilingual mental health providers, paints a bleak picture of how hard basic access to mental health care can be for Latinos.
Irma Villadiego, a bi-lingual family counselor at Catholic Social Services in Carbondale, Illinois, treats those in the Latino community who are unable to speak English. The only bi-lingual counselor in Southern Illinois, she started the service in 2003, and has single handedly undertaken more than 200 sessions with Latinos.
Also offering counseling services at the Shawnee Health Center in Murphysboro, Villadiego says word of mouth is the best publicity in driving more Latino in-crisis patients to her. While Cobden, Illinois has a large Latino community, with over 60 Spanish-speaking families who have settled there, Latinos from St. Louis, Murphysboro, Herrin, West Frankfort, Harrisburg, Carbondale and Cobden; have all made use of Villadiego's help in times of crisis.
Many of their suicidal thoughts stem from being culturally, linguistically, socially and emotionally isolated; dealing with American life and values which can be very different from that of their home countries; and assimilating their own culture with that of their adopted country.
Emotional situations arise and women are often the most affected, says Villadiego, since they typically stay at home while the man goes out to work. Isolated within the four walls of their home, they have no friends and can't speak the language to make any new friends.
Most families have only one car and the man normally takes it to work, says Villadiego. The women feel impotent and diminished, being unable to even buy a jug of milk. More often than not, they are too poor to afford English classes or get to the class, even if it's free. The women fall deeper and deeper into depression, until suicide begins to look attractive.
"When we come here, it is most hard for us," says Villadiego. "When we smile here, no one smiles back. Here our neighbor is not our friend. Whereas back home we would say to our neighbor, mi casa es tu casa (My house is your house)."
The feelings of isolation heightened by the language and cultural barrier, dealing with growing children who are imbibing American values, which clash with the more traditional values of Latino parents, increase the feelings of helplessness and depression, until the individual reaches a point of utter crisis.
Latino teenagers also feel pressured on all sides. The Centers for Disease Control and Prevention (CDC) Youth Risk Survey found a 10.7 percent attempted suicide rate among Latino youth, compared with a 7.3 percent rate among African American youth and a 6.3 percent rate for White, non-Latino youth.
Surprisingly enough, research on suicidal ideation found that foreign-born Mexican Americans are at significantly lower risk of suicide and depression than those born in the United States.
Currently preparing a conference presentation on how Latino parents need to understand American culture better, Villadiego suggests that people who are in crisis and in need of a bi-lingual counselor call 618-351-0743 ext. 15 and leave a message for her.
Training Law Enforcement Officers
A member of the Illinois Suicide Prevention Coalition, Shelly Wood, ACT counselor, Egyptian Public and Mental Health Department, Eldorado, Illinois cannot stress enough the importance of getting law enforcement officials trained in suicide prevention. "They are the first responders to most crisis calls. While there are specially trained Crisis Intervention Teams (CIT) in Northern Illinois and other parts of the country, there are none in Southern Illinois."
A CIT program consists of a team of sworn officers who receive intensive specialized training in dealing with individuals in the community who have a mental illness. Statistics indicate that even in Northern Illinois there are only 12 primarily multi-jurisdictional crisis teams operating in 73 law enforcement agencies, with 860 state certified CIT officers.
"The plan is to secure some grant money from the IL Suicide Prevention Coalition to get officers in Southern Illinois trained as CIT trainers themselves, so that they can train others in Southern Illinois," says Wood. The 40 hour, one week long, Illinois Law Enforcement Training and Standards Board (ILETSB) CIT program trains officers on mental illness recognition, substance abuse and dual diagnosis, child and adolescent disorders, psychotropic medications, developmental disabilities, risk assessment and crisis intervention skills.
A collaboration between the Egyptian Health Department and the Illinois Suicide Prevention Coalition the training will be held during National Prevention Week, volunteers Camille Harris, crisis coordinator, Egyptian Health Department.
National Prevention Week, sponsored by the American Association of Suicidology (AAS), takes place on September 10 through September 16. Promoting collaboration, integration, and understanding, the week is all about promoting suicide awareness.
Harris says that National Prevention Week coincides with World Suicide Prevention Day, which is hosted by the International Association for Suicide Prevention (IASP) in collaboration with the World Health Organization (WHO).
Posted by david at 4:05 AM Permalink
Crisis intervention move is well-timed
published September 27, 2006 12:15 am
North Carolina’s move to treat mental health clients in community-based programs has hit a few well-publicized bumps in the road. One of the unfortunate byproducts of the move may be more of our mentally ill on our streets and in our jails.
Wake and a handful of other N.C. counties — including Buncombe — are to be congratulated for taking a pro-active step by training for law enforcement officers in mental health crisis intervention.
Two of the state’s largest psychiatric hospitals — Dorothea Dix Hospital in Raleigh and John Umstead Hospital in Butner — are closing as part of the reform. Crystal Farrow, director of Wake County’s Crisis and Assessment Center, said, “The streets of Raleigh will probably see a few more mentally ill than they do now.’
Streets from Asheville to Murphy probably will, too.
The 40-hour training program is designed to familiarize law officers with the symptoms of mental illness and teach them to handle situations before they become violent. Officers will undergo a course in psychiatric diagnoses, symptoms and medications; visit mental health facilities; and take part in role-playing sessions designed to teach them to defuse crises.
“It really extends the mental health services into the community and helps resolve the crisis earlier and with less struggle,’’ Farrow said.
Graduates of the training program receive Crisis Intervention Team pins, and the community has responded positively to the team. Some local families with family members in crisis call and ask for an intervention officer.
“They’re starting to recognize us and ask for us by name,’’ Wake County deputy Elliot Baker said. “It makes me feel better that we’re actually helping people.’’
The program is modeled on one that has worked in Memphis, Tenn., since 1988. Officials there credit the program with saving the agency time and money and leading to fewer officers injured on the job. Kudos to Wake for blazing the trail on this initiative, and we hope to see Buncombe County’s program up and running soon. Other counties would be wise to emulate them. The 40-hour training is a worthwhile investment of time and resources that will benefit law enforcement, the mentally ill and their families.
Posted by John at 12:15 AM Permalink
Tuesday, September 26, 2006
Score another one for the stigma of mental illness.
Football great Terry Bradshaw says going public about his struggles with depression brought him withering criticism from sports talk radio personalities and bloggers.
"People are mean, cruel and hateful," says the four-time Super Bowl quarterback scheduled to visit Charlotte for Sunday's game against New Orleans. "They love to take people who are successful and anything they can get on them, they like to wear them out."
Bradshaw went on a speaking tour in 2003, describing how he'd been plagued as an adult by anxiety attacks and persistent dark moods. He was paid as a spokesman for GlaxoSmithKline, maker of the antidepressant Paxil, which he was taking.
While many praised him for encouraging others to seek medical solutions for their depression, Bradshaw says some sports pundits used it as a way to heap scorn on him.
"I think the thing that hurt me the most was that people called me a phony and a liar," the Fox sports commentator said in a telephone interview with the Observer.
Bradshaw sought medical help while experiencing long-term anxiety after his third divorce in 1999. With therapy and Paxil (which he no longer takes because it interferes with another medication he takes for attention deficit disorder), he managed the symptoms.
Bradshaw, 58, is finished as an advocate for people with depression. "I got tired of people making fun of me. ... I decided I'm bringing this on myself and I don't need it."
Mental health authorities estimate that up to a quarter of the U.S. adult population will experience symptoms of serious depression sometime in their lives.
"There's just idiots out there who refuse to understand what it is -- it's a disease, you morons. You don't get it from bad food or a needle. It's the way I was made." Read more!
Posted by david at 5:37 PM Permalink
Wake County Commissioner Herb Council is right in his hesitation to go along with the only viable choice thus far presented to commissioners with regard to providing short-term care for mentally ill persons who are poor.
Council last week cautioned his fellow board members to make sure that advocates for those with mental illness had a chance to express all their views on a Tennessee company's proposal. The company, Psychiatric Solutions Inc., would provide the care by adding 44 beds to its Holly Hill facility and accommodating 16 patients in a nearby, county-built treatment center for those without insurance.
WakeMed has said it hasn't been able to figure a way to be a part of the effort, so the Psychiatric Solutions plan is the only one on the table. That's why some commissioners apparently want to go ahead with the deal.
Council, however, says he thinks pushing on would leave the impression that the commissioners rushed to a decision -- a decision made necessary by the planned closing of Dorothea Dix hospital in Raleigh late next year. Council is right. Oh, it's true there isn't a generous amount of time to figure out more alternatives, but there is some time. And there are definite differences of opinion in the community as to the best course to take.
There's no question that the county simply must provide some sort of center where those who are poor and having a psychiatric crisis can get help. To to that, commissioners say they need a private partner.
But providing this kind of care to people who can't afford it is a challenge for even the best hospitals and treatment centers. It may be that the proposal from Psychiatric Solutions will be the best, but it's too early for commissioners to foreclose all their options.
Posted by david at 5:27 PM Permalink
Training law enforcement officers in keeping the mentally ill out of jail is a healthy development for the Triangle
Unlike the case with other diseases, the symptoms of mental illness can land a person in jail. That's the community's fault, but one that is, at last, gaining recognition in North Carolina.
For too long, this state has nickel-and-dimed the treatment of the mentally ill. Worsening symptoms have led families, as a last resort, to call the police for help. Yet when police officers or sheriff's deputies are trained only to take crime suspects to jail, a family's desperate cry does next to nothing for the patient experiencing symptoms.
For the past year, as The N&O's Jean P. Fisher reports, Wake County has been training law enforcement officers a new way. Officers are taking a 40-hour crash course in psychiatric disorders, their symptoms and medications used to treat them. They are introduced to local facilities providing care for the mentally ill and given a chance to practice safe ways of resolving tense situations.
This is all to the good. The Wake Sheriff's Department can point to instances where deputies have put their new skills to good use, ending a threat and delivering a mentally ill person to the county's crisis center. After evaluation by specialists in psychiatric disorders, patients can be treated. Even those who still must answer criminal charges pose less risk to other prisoners or themselves following treatment.
In human terms, the cost of leaving psychiatric disorders untreated has been profound. In training, officers themselves are experiencing, through a "hallucination machine," the terror that an arrest can cause a patient with schizophrenia or other illness. Not only is that sort of experience unjust for the patient, the behavior leading up to it can be devastating for families -- over and over again.
It's high time North Carolina short-circuited the route that far too many sick people have taken to jail cells in favor of a route leading to treatment. Thanks to the advocacy of the National Alliance on Mental Illness, crisis intervention teams are lighting a new path in Wake County. In just one year, 150 officers have received the training, and many more eventually will.
Officers from other counties are learning crisis-intervention skills here and taking them home. What's more, officer training is beginning in other parts of the state, from Greenville in the east to Asheville in the west.
It would be a squandered opportunity if all this effort added up only to a temporary solution. The hope is that crisis intervention of the sort now finding favor in North Carolina will open doors to community care offering the mentally ill stability and independence. They deserve no less. Read more!
Posted by david at 5:02 PM Permalink
How teen broke free from shackles of social anxiety disorder
BY SHAWN RHEA
GANNETT NEW JERSEY
Kristen Silary was at a restaurant with her mother and grandmother the first time she became uncontrollably nervous about what other people might be thinking of her.
"When we got to the restaurant my stomach started hurting and I had to leave and go to the bathroom," Silary said.
Only 12 at the time, Silary, now 19, didn't realize she was having a panic attack.
"I had the whole racing heartbeat and I couldn't breathe and I was clinching my fists," said Silary, of Voorhees.
Even when the attack began to subside, Silary couldn't bring herself to leave the restroom. "I was fearful of what people were thinking about me and that everybody was looking at me," she said.
When Silary's mother learned of the episode, she wanted to take her daughter to the doctor. But she convinced her mom that it was a fluke occurrence.
However, the attacks worsened over the next four years and they were most intense when Silary found herself in social situations. "It got to the point where I couldn't leave the house," she said.
At her worst point, Silary found herself experiencing the attacks as often as twice daily. At school, she'd avoid being called on in class and had to sit next to the door in case she felt an attack coming on.
Finally, during her junior year of high school, Silary's mother insisted her daughter see a doctor. After running several tests that came back normal, Silary's pediatrician diagnosed the then 16-year-old with social anxiety disorder, a condition where individuals fear interacting with people due to an overwhelming feeling that they will be negatively scrutinized.
"They're terrified," said Rhona Brown, a Cherry Hill-based psychologist specializing in child and adolescent care. "In social situations they can experience heart palpitations, shakiness, blushing, nausea, headache and stomach-ache."
There are no definitive statistics on how many children and adolescents are living with social anxiety, but about 13 of every 100 youngsters ages 9 to 17 experience some type of anxiety disorder, according to the U.S. National Mental Health Information Center.
And, recent national surveys found about 5 percent of American children and teens have social anxiety disorder, according to the University of California, San Diego, Web site veryshy.org.
Young people with social anxiety are living with a real and debilitating condition that can be the root of a long list of problems, including poor school performance, isolation and depression, say experts.
For example, about 75 percent of children with social anxiety disorder have no or few friends, according to a paper written by Canadian pediatric psychiatrist Dr. Jim Chandler. Half of socially phobic children aren't involved in any after-school activities, half say they don't like school and 10 percent refuse to attend school, he reports.
"Social anxiety isn't shyness," explained Brown. "A shy kid is the one that's slow to warm up to a crowd, but once they get started, they may be the life of the party.
"Social anxiety is a marked condition. If you've got a kid who gets sick every time there's a birthday party or it's time for school and there's no (logical) reason for it, then that may be the child with social anxiety."
One of the baffling aspects of social anxiety is that it can appear to strike suddenly, say mental health experts. Kids who are perfectly comfortable and talkative around family and close friends may suddenly freeze and experience a host of physical ailments when placed in unfamiliar situations, such as eating at a restaurant or working on a group school project.
That's exactly what happened with Silary, who, before her first attack, hadn't experienced any direct fear associated with social situations. "I've always had the same group of friends from the neighborhood," she explained.
But, as her circle began to widen, so, too, did her anxiety about meeting new people or being put into the spotlight. "When friends would call and ask me to go out, I'd make excuses," she says.
When she turned 16, Silary finally began to get a grip on her fear with the help of medication. Her doctor prescribed a low dose of the anti-anxiety medication Lexapro, which Silary takes once daily. "I haven't experienced any side effects, which is lucky, because my doctor told me it usually takes people a long time to find a medication for something like this," she said.
The treatment has helped Silary take on a public job working as a waitress and assistant manager at an area International House of Pancakes. She also attends Camden County College and gives talks to teens about social anxiety.
"The funny thing with it, is I'm very much a people person," said Silary. "So, my mom and I were, like, how could I have social anxiety? But what I really focus on now is how I've changed, and that someone with a mental illness can have a successful life." Read more!
Posted by david at 4:51 PM Permalink
By Scott Sexton
Tuesday, September 26, 2006
Winston-Salem police officer Sharon Smith didn't hesitate when she saw that an obviously mentally disturbed woman had set herself on fire while sitting in a holding cell early in the morning of May 22.
Smelling smoke and seeing fire, Smith ran to the cell and struggled to get it open. Once she did, Smith beat the flames out with her bare hands and saved the woman from horrific injuries.
"She was resisting the whole time," Smith said in Forsyth County District Court a few weeks back, when Kellie Peterson was found guilty of assaulting a government official. "I got burns on my arms and permanent scarring on the backs of my hands."
Beyond those few words uttered to District Judge Denise Hartsfield, Smith didn't have much to say about her act of bravery.
Becky Zogry, a magistrate judge who was on duty that night, had plenty to say. Peterson was combative, fighting ferociously with Smith and another officer who had arrested her on a misdemeanor breaking-and-entering charge.
"The thing that impressed me the most was that as aggravating and as insulting as that woman had been, (Smith) charged in there and put the fire out with her bare hands irregardless of the danger to herself," Zogry said. "I just thought Sharon deserves some recognition for going in there like that."
Smith and Officer John Hocevar had a hard time even getting Peterson into the holding cell.
She cussed, kicked and fought as if her life hung in the balance. And somewhere on her person, she had hidden a lighter or a book of matches.
A few minutes after the cell door shut, flames became visible.
"You could see the smoke and actually see flames coming off the back of that lady," Zogry said. "And she was really slamming Sharon into that wall. You could tell she had some sort of mental problem."
Her attorney, Kelly Lee, didn't dispute that interpretation during the hearing Sept. 8.
"Clearly there was some sort of psychiatric incident that night," Lee said. "She is extremely bi-polar and had an incident with her medication.
"That said, I want to commend (Smith) for everything she did even though my client was not acting in the most graceful way."
Even though she didn't realize at the time what Smith was doing for her, Peterson eventually did come to grips with what had happened.
"I'm very sorry, so very sorry," she said, turning to face Smith before the judge gave her a 75-day suspended jail sentence and 12 months' probation and ordered her to write a letter of apology.
Zogry, a lawyer who has also worked in the Forsyth County Public Defender's Office and as a social worker at a state mental hospital, said she won't forget Smith's actions.
"I was just standing there dumbfounded," she said. "I'd never seen anything like that. I hope I never do again." Read more!
Lifetime of Caring: Judy Briggs knew as a teenager that she would be in health care
Keeping watch over a sick relative as a child helped Judy Briggs decide what she wanted to do with her life.
Briggs, the chief executive of the Carolina Behavioral Health Alliance in Winston-Salem, was told as an eighth-grader to monitor the hospital intravenous unit attached to her mother, who had severe asthma. Briggs remembers counting each drop of fluid that drained into the IV bag.
"I thought I was doing something to help my mother," said Briggs, who eventually went on to nursing school. "That's when I decided that's what I wanted to do for the rest of my life. I never changed my mind. I remember that moment, very distinctly."
That introduction was the first step in a long career in health care for Briggs. From stops as a registered nurse and teacher to her current role as an administrator, Briggs has learned to use her passion for health care to help others, she said.
But it hasn't always been easy. Briggs said that she often struggles to help patients under the state's mental-health care system.
The negative image of people with mental-health problems can make it difficult for advocates to effectively help patients, she said.
"It's a huge problem. It's the thing that probably disturbs me the most, is how we do stigmatize mental illness, in that we don't recognize it as truly an illness."
She added: "I often say mental health is the stepchild in the industry."
Briggs' employer, Carolina Behavioral Health Alliance, provides mental health services for health-insurance plans in North Carolina. It is owned by three medical schools: East Carolina University, the University of North Carolina at Chapel Hill and Wake Forest University Health Services, which oversees the Wake Forest University School of Medicine.
The alliance has a long history in the region's mental-health system.
In 1996, Wake Forest University Baptist Medical Center created Wake Forest Behavioral Health Services, an organization that managed mental-health services for QualChoice, the managed-care company that the medical center had opened two years earlier.
East Carolina University and UNC-CH joined the program in 1999, and it became the Carolina Behavioral Health Alliance.
The combination of the three medical schools allows the alliance, a limited-liability company, to provide much-needed services without worrying about financial issues that could hamper for-profit companies, Briggs said.
The schools "didn't get into this business to make money off of health care," she said. "They got into this business to make sure health-care dollars are spent on health care and not Wall Street. It's the best of both worlds."
Briggs said that she primarily spends her day helping clients develop mental health-care programs, including programs that emphasize prevention and wellness services. One of her biggest challenges is convincing employers that proper mental-health services can improve a company's financial bottom line.
Workers suffering from depression or other mental-health problems can experience drops in productivity and increased absences - factors that can weaken a company's financial strength, Briggs said.
"I call it the elephant in the living room," Briggs said. "It impacts not only employers hugely, but it impacts our society hugely. We're paying for it in many ways in our society."
Briggs did not fall into the mental-health care industry by accident. The suicide of a close, teenage nephew and the death of a cousin motivated her to move into the field years ago, she said.
"Knowing the effects that it has on the family, and on people who love people that have mental illness, I finally realized that this is where I need to be," Briggs said. "This is what I need to be doing."
"It's kind of become my mission," she added. "It's been my calling."
Briggs said that she plans to continue helping workers and their employers combat mental-health problems. More prevention and wellness programs can help people identify and treat mental-health problems earlier, she said.
Many people with mental-health problems are simply not receiving adequate care, she said. "What I would love to see in my lifetime, is parity in mental illness," Briggs said.
• M. Paul Jackson can be reached at 727-7473 or at firstname.lastname@example.org. Read more!
Mental health care needs more funding
It’s appropriate that mental health service providers chose Municipal Correctional Institution as the site to announce a unified push for more state funding.
The city jail is now the second-largest inpatient facility for the mentally ill in western Missouri. The largest: the Jackson County Jail.
About 40 mental health professionals, judges and politicians gathered last week to announce they were forming the Northwest Missouri Regional Partners in Crisis. It will be part of a statewide group called Missouri Partners in Crisis.
The group will call upon Gov. Matt Blunt and state lawmakers to start meeting their responsibility to ensure appropriate care for persons with mental illnesses.
The state cut funding for mental health by $110 million between 1999 and 2005. One result: the new Western Missouri Mental Health center, due to staffing shortages, operates at only two-thirds capacity. For similar reasons, state psychiatric hospitals are serving 40 percent fewer patients than in 2002.
Those who need inpatient care have ended up in shelters, on the street and in jail. Community-based clinics and other resources can’t keep up with the needs.
“The mental health system is all about choice these days — choosing who gets services and who doesn’t,” said Bill Kyles, executive director of Comprehensive Mental Health Services in Independence.
Besides pressing for state funds, Partners in Crisis will educate people about mental illness and encourage excellence in treatment.
Members of the group are busy people, taking time from the extensive problems of their clients to embark on a lobbying effort. Blunt and Missouri lawmakers need to heed their pleas. Read more!
By Si Cantwell
Baby boomers like me fondly remember Patty Duke from a show where she played two teenagers, "identical cousins in every way" except that they had opposite personalities.
What we didn't know as we watched that show, first televised from 1963 to 1966 and endlessly rerun afterward, is that the early stardom had a profound effect on Duke's own personality.
It wasn't until the girl born as Anna Marie Duke began speaking out years later that we learned that she'd been diagnosed with bipolar disorder, then called manic depression. Her autobiography, Call Me Anna, was published in 1987 and she co-wrote A Brilliant Madness: Living With Manic Depression Illness in 1993. She has become a spokeswoman for mental health causes.
She'll discuss "Living With a Brilliant Madness" at 6:30 p.m. Wednesday at the Holiday Inn SunSpree Resort in Wrightsville Beach, part of the annual conference of the Mental Health Association in North Carolina (www.mha-nc.org).
Young Anna Marie fell under the influence of child-actor managers John and Ethel Ross, who renamed her Patty and in 1959 got her the role of Helen Keller in the Broadway version of The Miracle Worker. She was 12. The 1962 movie made her the youngest person to win an Oscar. At 16, she had her own television show.
"They had all the best of intentions to begin with," Duke told me by telephone recently. But "unlike the child actress who was handling success in stride, it really messed them up."
The domineering Rosses became involved in heavy alcohol and drug use, and led Duke down that path.
While mental illnesses have physical causes, Duke said, often there's a trigger that activates the disorder. In her case, she said, it was the pills.
Being diagnosed with manic depression in 1982 actually came as a relief after "years of feeling like I was the only one who ever felt this way," she said.
She'd swing from extreme highs to lows that left her "absolutely unable to get out of bed, except to use the bathroom, for months at a time." She spent those long days and nights crying.
Diagnosis and lithium restored the balance. After using the drug for a few weeks, she noticed "the absence of the running motor that would help my mania," and she'd stop short of descending into the abyss.
It took courage for Duke to go public with her story, which first surfaced in a TV Guide interview, she said. Her concern was for those still undiagnosed.
"I had a passion to tell other people who might be going through something like what I went through," she said.
As she travels the nation speaking about mental health, she's encouraged by the greater awareness she encounters.
But she believes the old stigma persists, she said. "It is born of fear, and the fear continues to exist."
She makes appearances like this week's speech to reach out to the undiagnosed and their families.
"I used to be tagged the 'everywoman' in TV movies. I'm hitching my wagon to that," she said. "I'm the everywoman. I have children, I have a past. I have needs, I have goals and I have my own brand of spirituality.
"I guess what I try to do is the Golden Rule," she said, "and that's what's been most successful for me in this little crusade I have."
Reach Si Cantwell at 343-2364 or si.cantwell@starnews online.com. Read more!
Posted by david at 4:34 PM Permalink
Depression can reach into the workplace, taking hold of corporate executives
by Andrea Kay, At Work Columnist
published September 26, 2006 12:15 am
The person I was talking to was not the confident, I-can-handle-anything, king-of-entrepreneurs I had known. His voice was cracking. He said he felt useless and empty inside. He was depressed.
It is hard to understand how those who seem to have it all can find life so empty. But “corporate executives, and especially entrepreneurs, may in fact be even more vulnerable to depression than others,” says Hara Estroff Marano in Psychology Today.
It’s not that times are suddenly tough for CEOs, who, as she says are at this moment enjoying “as much trust as a car salesman.” It’s a combination of forces from within and without that are particularly durable and deeply embedded in men.
“The very qualities that propel them to success can arise from an extremely dark place in the psyche,” Marano writes. “The tendency to build their identity on achievement makes a downturn unbearable.”
Calling the recent events of this man’s life “a downturn” is putting it mildly. He experienced four deaths in his immediate family, the closing of his business and loss of steady income. From the outside, he seemed to be coping.
This is partly what makes people like him such a distinguished species. They’re smart, charming and have extraordinary coping skills, says Marano.
“But the orientation to action that so distinguishes them can work spectacularly against them when problems arise, preventing them from getting help or even recognizing they need it, ultimately pulling them into a depression so subterranean it resists treatment.”
Other executives have come before him. In 2001, 59-year old entrepreneur Heinz Prechter, who struggled with depression for 30 years and sought treatment, committed suicide.
It’s a disease with a high level of treatment success, “if people only would recognize it and seek help,” said behavioral-health consultant Lynne DeGrande in Crain’s Detroit Business.
Executives are among the most difficult groups to reach, says the article. They’re used to being in control. They tend to think if they can’t solve their own problem, nobody else will. There’s also a stigma attached to admitting you have an emotional disorder, let alone any weakness.
I was relieved to find other executives who have depression talk openly about it — a key to getting better.
For resources in your community, contact the National Mental Health Association (www.nmha.org); the National Alliance on Mental Illness (www.nami.org) or the Depression Bipolar Support Alliance (DBSalliance.org).
This is the opinion of Andrea Kay. Send questions to her at 2692 Madison Road, No. 133, Cincinnati, Ohio 45208; www.andreakay.com. E-mail: email@example.com.
Posted by John at 12:15 AM Permalink