My Plan, My Life, My Psychiatric Advance Directive

Similar to a medical advance directive or a health care power of attorney, a psychiatric advance directive is a legal document completed in a time of wellness that provides instructions regarding treatment or services one wishes to have or not have during a mental health crisis, and may help influence his or her care. A mental health crisis is when a person is unable to make or communicate rational decisions.

A psychiatric advance directive allows you to specify considerations about your mental health care treatment and appoint an agent who may make decisions about your treatment in the event of a mental health crisis. In some cases, you may also give further background information about how you have reacted to past treatment.

Despite these benefits, a survey of mental health experts concluded the underuse of psychiatric advance directives in the United States; this study surveyed 1,011 people with serious mental illness receiving public-sector treatment in 5 cities.

On the My Plan, My Life Web site, you will find comprehensive and easy-to-understand information for individuals with mental illness, their families and health care professionals. On the site you can learn about the importance of psychiatric advance directives as a tool for communicating specifics about one’s care during a mental health crisis and how to prepare your own directive.

My Plan, My Life: My Psychiatric Advance Directive is brought to you by Mental Health America and sponsored by Novartis Pharmaceuticals Corporation. http://www.myplanmylife.com/mylife.cfm

Reposted at darkestcloset.bloggerspot

Risk for Mental Health Conditions Vary by Gender

Women are more likely to develop anxiety and mood disorders such as depression, while men's mental health issues are more likely to involve antisocial personality and substance use disorders, a new study says. Researchers, whose findings are reported in the Journal of Abnormal Psychology, say the differences are due to the fact that women are more likely to internalize their emotions, which can bring on withdrawal, loneliness and depression, whereas men externalize them, becoming aggressive and impulsive. 

Researchers analyzed the answers to interview questions from 43,093 U.S. adults during a 2001 National Institutes of Health survey. For depression, 22.9 percent of women said they had had the condition during their lifetime; 13.1 percent of men said they had. The study showed 7.2 percent of women had panic disorder, and 5.8 percent had generalized anxiety disorder, while just 3.7 and 3.1 percent of men had those conditions, respectively. Among conditions more common in men were alcohol dependence and antisocial personality. (HealthDay News, 8/23/11) 

Reposted at darkestcloset.blogspot.com

Indonesians with Mental Illness Placed in Cages, Chained

An estimated 30,000 Indonesians with mental illness are placed in cages and chained because of stigma and lack of access to treatment. Last year, the government’s department of mental health announced “Meuju Bebas Pasung,” a roadmap to free people in chains. Although officials have worked to reach communities and raise awareness, the task is difficult because mental health remains low on the government’s list of priorities. (Globalpost, 9/12/11)

Reposted at darkestcloset.bloggerspot.com

People with Depression Don’t Reveal Symptoms to Physicians

People suffering from depression may not bring it up with their doctor for a number of reasons, a study finds. One of the most common reasons is that they are afraid of getting a recommendation for antidepressants.

The study, reported in the journal Annals of Family Medicine, surveyed 1,054 adults about why they wouldn't tell their primary care physician about depression symptoms, as well as their beliefs about the condition. The common reasons reported by participants was the fear of being put on medication, a belief that a doctor isn’t the person to handle such issues, and worries over privacy. At least 10 percent of the participants said that fear of being referred to a counselor or psychiatrist and being branded a psychiatric patient were stumbling blocks. Those who had more barriers to talking to their doctors about depression were likely to be female, Hispanic, with less education and lower income. (Los Angeles Times, 9/12/11)

Reposted at darkestcloset.bloggerspot.com

Study: Suicidal Teens Rarely Receive Treatment

Few suicidal teens receive the treatment and care they need, a new study reports. The researchers found only 13 percent of teenagers with suicidal thoughts visited a mental health professional through their health care network, and only 16 percent received treatment during the year, even though they were eligible for mental health visits without a referral and with relatively low co-payments. In the study, reported in the journal Academic Pediatrics, researchers analyzed the use of health care services among 198 teens ranging in age from 13 to 18 years. Half of the teenagers had had suicidal thoughts; the other half did not. The researchers found mental health services were underused among all of the teens studied. Although 86 percent of the teens with suicidal thoughts had seen a health care provider, only 13 percent had seen a mental health specialist. Just 7 percent received antidepressants, the study found. (HealthDay News, 9/16/11)

Reposted at darkestcloset.blogspot.com

Madness in the NFL - The Greg Montgomery Story

“Madness in the NFL - The Greg Montgomery Story” documentary takes us on Greg's journey from All-Pro NFL punter to his diagnosis with bipolar disorder in 1997 while playing with the Baltimore Ravens. Ultimately, his journey towards recovery from bipolar disorder has been a positive and successful one. Now almost 14 years after his diagnosis of bipolar disorder, Greg is a powerful advocate in the field of mental health. He recognizes that help is desperately needed for the millions living with mental illness and is making a difference by speaking out.

Greg is also an avid writer and blogger. Through his blog, Zen In The Art of Living Bipolar, Greg openly shares his experiences of anxiety, depression and bipolar disorder with educational, honest, and engaging content. You can also follow Greg on Twitter @ZenPunter.

We commend Greg for his advocacy efforts and for working with numerous mental health organizations on raising awareness and fighting the stigma that surrounds mental illness. DBSA looks forward to partnering with him on these upcoming DBSA initiatives:

• The October eUpdate will feature an empowering article written by Greg.
• In November, DBSA will host a live Telechat with Greg. Stay tuned for more information and how you can submit your questions in advance.

http://www.dbsalliance.org/site/PageServer?pagename=eupdate0911#1
Reposted at darkestcloset.blogspot.com

Laughter Really Is the Best Medicine, Study Suggests

Having a good laugh with friends helps people deal with pain, a new study suggests. An international research team, led by Oxford University, found that real laughter triggers the release of protective endorphins, which manage pain and promote feelings of well being.

 According to the team’s research, published online in Proceedings of the Royal Society B, watching just 15 minutes of comedy with others increased the pain threshold by an average of about 10 per cent. The fact that only hearty, rather than polite, laughter releases endorphins has probably evolved as a way of promoting socializing among humans, the researchers suggest. Many studies have already shown that laughter is 30 times more likely to occur if people are together rather than alone. The endorphin rush appears to be limited to a good belly laugh, shared with others. The paper distinguishes between unforced laughter and polite laughter. It concludes that when we laugh hard we produce a series of exhalations without drawing breath, an involuntary physical mechanism that is limited to humans and appears to trigger the release of endorphins.

Source: http://www.ox.ac.uk/media/news_stories/2011/111409_1.html

MacArthur “Genius” Awards Include Grant to Suicide and Self-Injury Researcher

Matthew Nock, a Harvard University psychology professor studying suicide prevention, has received a MacArthur Fellowship, which includes a no-strings-attached grant of $500,000 ($100,000 annually for five years). The fellowships, popularly known as the “genius” awards, were announced on September 20 by the John D. and Catherine T. MacArthur Foundation.

Most recently, Nock’s research has identified a behavioral marker that might help predict suicide attempts. His research indicates that individuals who are suicidal react differently than non-suicidal people when they see words such as “suicide” or “death” on the monitor during a computer game. Seeing these words “captures their thinking and slows down their response,” Nock told The Los Angeles Times. “It’s an objective marker. It doesn’t require them to tell you whether they are suicidal.” At the same time, a recent study – published in Academic Pediatrics – has found that suicidal teens are not likely to get the mental health care they need. Among other findings, the researchers found that when all types of mental health services were combined (including antidepressants and care received through outside sources), only 26 percent of teens with suicidal ideation in the study received services the previous year.

Sources: http://www.latimes.com/health/boostershots/la-heb-macarthur-suicide-20110920,0,2354849.story
http://www.eurekalert.org/pub_releases/2011-09/sc-sfo091311.php

Reposted at darkestcloset.blogspot.com

Mental Health Reporting Website Educates Journalists

The University of Washington offers a website to educate journalists on how to report on stories that involve mental health issues. The site, at the source below, provides information including a “Checklist for Reporting on Mental Illness.” The checklist urges journalists to “[w]rite with awareness that people with mental illness face prejudice and discrimination,” and “[a]void using language that implies people with mental illness are violent,” among other suggestions.

Source: http://depts.washington.edu/mhreport/ reposted at darkestcloset.bloggerspot.com
http://depts.washington.edu/mhreport/

Deadlines Approach for Four Webinars

Four webinars – on “Demystifying Trauma,” “Working with Voices,” Starting a Peer-Run Respite, and Coalition-Building, respectively – will take place next week! “Demystifying Trauma: Sharing Pathways to Healing and Wellness,” organized by SAMHSA’s ADS Center (Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health), will take place Sept. 26, 2011, 3 p.m. – 4:30 p.m. ET. Registration closes at 5 p.m. ET on Sept. 25. To register, click on the following link: http://promoteacceptance.samhsa.gov/teleconferences/archive/training/teleconference09262011.aspx.

“Working with Voices” will focus on the Hearing Voices Network and Hearing Voices Groups, which do not pathologize hearing voices or other altered experiences. It will take place Sept. 27, 1 p.m. – 2:30 p.m. ET. Space is limited; to register, click here: http://cts.vresp.com/c/?NationalMentalHealth/14baa0ba54/ac1ab23981/db99ce0be4. “So You Want to Start a Peer-Run Respite?” will take place on Sept. 28, 1 p.m. – 2:30 p.m. ET. It the first webinar in a peer-run respite series sponsored by the National Empowerment Center. Space is limited; registration will close on Sept. 27.

To register, click here: https://www3.gotomeeting.com/register/728369694.

“Coalition Building 101 for Mental Health Consumers and Psychiatric Survivors: Finding Common Ground with Each Other and Allies,” to be held Sept. 30, 2:00 p.m. – 3:30 p.m. ET, will include how to address obstacles to sustaining a coalition, action steps to build and/or sustain a coalition, what to do when groups may be competing for the same resources, and more!

To register, e-mail rsvppeerlink@gmail.com with “Coalition Building” in the subject line

 Sources: http://promoteacceptance.samhsa.gov
http://www.nyaprs.org
http://www.power2u.org
SAMHSA/CMHS Consumer Affairs E-News, September 20, 2011

Does cutting mental health care increase the prison population?

The Washington Post, Suzy Khimm, 06/02/2011 Reposted at darkestcloset.bloggerspot.com

State-supported mental health care, like many social services, has been especially vulnerable in the recent rounds of budget cuts. Over the past two years, some $1.6 billion has been slashed from non-Medicaid state spending on mental health, according to the National Alliance on Mental Illness. But a growing number of law enforcement officials - along with mental health advocates - are voicing concerns that such cutbacks not only hurt mental health beneficiaries but also overburden the country's prison system.

Mental illness often ignored by churches

Published: June 23, 2011 at 8:31 PM Reposted at darkestcloset.bloggerspot.com

WACO, Texas, June 23 (UPI) -- Mental illness is prevalent in church communities but is also accompanied by significant distress that is often ignored, U.S. researchers found.

Study co-author Dr. Matthew Stanford -- a professor of psychology and neuroscience at Baylor University, and an expert in mental illness and the church -- says families with a member who is mentally ill would like their congregation to provide assistance.

The study surveyed nearly 6,000 participants in 24 churches representing four Protestant denominations about their family's stresses, strengths, faith practices and desires for congregational assistance.

The study, published in the journal Mental Health, Religion and Culture, found help from the church with depression and mental illness was the second priority of families with mental illness, but ranked 42nd on the list of requests from families that did not have a family member with mental illness.

"The difference in response is staggering, especially given the picture of distress painted by the data: families with mental illness reported twice as many problems and tended to ask for assistance with more immediate or crisis needs compared to other families," Stanford said in a statement. "The data give the impression that mental illness, while prevalent within a congregation, is also nearly invisible."

As a result, mental illness of a family member frequently destroys the family's connection with the religious community, Stanford said.

Read more: http://www.upi.com/Health_News/2011/06/23/Mental-illness-often-ignored-by-churches/UPI-23821308875519/#ixzz1XfQVjlyv

Time Magazine Zeroes In on Horrific Abuse in Residential Care

An investigative reporter at a major news weekly recently published a blueprint for preventing the terrible abuse and neglect that routinely occur in institutions that are supposed to serve individuals with disabilities. Citing investigations by The New York Times and the Miami Herald, which uncovered ongoing violations – including those leading to deaths – in such institutions, Time magazine’s Maia Szalavitz came up with a template for putting an end to such abuse. Her suggestions include intensive oversight and “redundant checks on power,” frequent and unannounced inspections, a reduction in stigma, and adequate funding. “If we want the elderly, disabled and others living in institutions to be safe and well cared for, we need to value them both emotionally and financially,” Szalavitz writes. “That’s not what’s going on now.”

Source: http://healthland.time.com/2011/06/07/why-so-much-abuse-is-allowed-to-continue-in-residential-care/ Reposted at darkestcloset.bloggerspot.com

Study Notes High Prevalence of Alcohol Dependency Among Adults with Psychiatric Disabilities

A new nationwide survey has revealed that adults diagnosed with mental illnesses are four times more likely to develop alcohol dependency than adults who do not have such a diagnosis (9.6 percent compared to 2.2 percent), according to the Substance Abuse and Mental Health Services Administration (SAMHSA). The rate of alcohol dependency increases as the severity of the mental illness increases, the report found. “This SAMHSA study adds to the evidence” of the connection between mental health and substance use disorders, said SAMHSA administrator Pam Hyde. The full report is available at http://oas.samhsa.gov/spotlight/Spotlight027AlcoholDependence.pdf. For related publications and information, visit http://www.samhsa.gov/.

Source: http://www.samhsa.gov

What mom thinks matters

Fred Markowitz

Attitudes of family members can impede recovery from mental illness
DeKalb, Ill. – A new study led by a Northern Illinois University sociologist shows that while family members often provide critical support, they also can sometimes be the source of stigmatizing attitudes that impede the recovery of mentally ill relatives.

“Negative attitudes of family members have the potential to affect the ways that mentally ill persons view themselves, adversely influencing the likelihood of recovery from the illness,” said lead researcher Fred Markowitz, an NIU professor of sociology.

Markowitz and his colleagues, Beth Angell from Rutgers and Jan Greenberg from the University of Wisconsin-Madison, published their findings in the June issue of Social Psychology Quarterly, a peer-reviewed journal of the American Sociological Association.

Over an 18-month period, the researchers studied 129 mothers of adult children with schizophrenia.
“In short, what mom thinks matters,” Markowitz said. “It’s a chain of effects that unfolds.

“We found that when those with mental illness exhibited greater levels of initial symptoms, lower self-confidence and quality of life, their mothers tended to view them in more stigmatized terms—for example, seeing them as ‘incompetent,’ ‘unpredictable’ and ‘unreliable,’ ” Markowitz said. “When mothers held these views, their sons and daughters with mental illness were more likely to come to see themselves in similar terms—what social psychologists call ‘the reflected appraisals process.’ Importantly, when the individuals with mental illness took on these stigmatizing views of themselves, their symptoms became somewhat greater and levels of self-confidence and quality of life lower.”

A long line of research has shown that the stigma associated with mental illness can be a major impediment to recovery, affecting self-esteem and even job prospects. But research has not historically examined the links between stigma, reflected appraisals, identity formation and recovery, Markowitz said.

“Our study is part of research that is starting to more fully examine how stigma affects the self-concept and identity of those with mental illness,” he said.

Markowitz and his colleagues believe it is important to acknowledge that many of the sentiments conveyed toward ill relatives grow out of positive intentions and reflect attempts to cope with the difficulties of having a relative with serious mental illness. Yet, stigmatizing attitudes are of concern because of their potential adverse effects.

“This study highlights the notion that recovery from mental illness is not simply a matter of controlling symptoms as indicated by a strictly ‘psychiatric’ perspective,” Markowitz said. “It is, to a certain extent, a social-psychological process.

“The ways in which people, including family members and service providers, think about persons with mental illness affect the beliefs and actions of the individuals with mental illness, in turn shaping the trajectory of recovery.”

National Wellness Week/Recovery Month

Mark your calendars! The first National Wellness Week will be held as part of SAMHSA’s Recovery Month from September 19‒25, 2011. The inaugural theme is: Living Wellness.

People with mental health and substance use disorders die decades earlier than the general population, mostly due to preventable medical conditions. That is why SAMHSA – in partnership with the Food and Drug Administration’s Office of Women’s Health – have created the 10x10 Wellness Campaign to promote wellness and increase life expectancies for people with mental health and substance use problems by 10 years in 10 years.   

For more information about National Wellness Week 2011,  join the 10x10 Wellness Campaign’s listserv/electronic newsletter at

For the news release please visit http://www.samhsa.gov/newsroom/advisories/1106280601.aspxwww.10x10.samhsa.gov/.

Switching Antipsychotics May Reduce Metabolic Risks

NIMH-funded study examines whether switching to a different antipsychotic can reduce side effects while maintaining effectiveness

Patients experiencing cardiovascular or metabolic side effects while taking an antipsychotic medication may fare better if they switch to a different medication provided they are closely monitored, according to an NIMH-funded study. The study was published online ahead of print July 18, 2011, in the American Journal of Psychiatry.

Antipsychotic medications can effectively treat psychotic symptoms among people with schizophrenia or related disorders. However, the medications, especially some of those that are most commonly used, are associated with serious metabolic side effects that can lead to heart disease or diabetes. Even when patients do experience these side effects, doctors are often reluctant to change a patient’s medication regimen if the patient’s psychotic symptoms are controlled by the existing medication.

“Treating the symptoms of schizophrenia is a delicate balancing act between risks and benefits,” said National Institute of Mental Health Director Thomas R. Insel, M.D. “The possible benefits of switching medications to reduce metabolic risks must be carefully weighed against the potential risk of symptom relapse or medication failure.”

Scott Stroup, M.D., of Columbia University and colleagues aimed to determine if a medication switch could be made safely and without sacrificing clinical stability. For the Comparison of Antipsychotics for Metabolic Problems (CAMP) study, they enrolled 215 patients from 27 clinical sites whose psychotic symptoms were stabilized on one of three frequently used antipsychotics (olanzapine, quetiapine or risperidone) but were experiencing serious metabolic side effects such as weight gain and high cholesterol levels. Half of the patients were assigned to stay on their current medication, while the other half were switched to aripiprazole, another antipsychotic that is generally associated with fewer metabolic risks. All of the participants received a behavioral intervention that included a diet and exercise program designed to reduce the risk of cardiovascular disease.

After 24 weeks, the researchers found that those who switched to aripiprazole had improved cholesterol levels and other metabolic factors, and lost more weight (average of 8 lbs) than those who stayed on their original medication (average of 1.5 lbs). Those who switched also did not experience any more illness relapses or worsening of psychotic symptoms compared to those who stayed on their original medication. However, those who switched to aripiprazole were more likely to discontinue the new medication compared to those who stayed on their original medication. Almost 44 percent of those who switched discontinued the aripiprazole compared to 24.5 percent of those who were assigned to stay on their current medication.

The authors suggest that the high discontinuation rate for switchers may have been related to the fact that the study was open label, meaning both the patient and the clinician knew what drug the patient was taking. Some patients who were switched may have felt uncomfortable changing from a medication they knew worked for them, and therefore stopped the new medication. In addition, because clinicians were encouraged to closely monitor and intervene before a patient experienced severe problems, many may have discontinued aripiprazole when the clinician first determined that the patient was having difficulties, but before full-blown treatment failure occurred.

“For patients whose symptoms are stabilized but who are overweight or experiencing other metabolic problems, clinicians may want to consider switching to a medication that is less likely to cause metabolic problems. However, because switching is not always successful, clinicians must monitor patients carefully to avoid illness exacerbation,” said Dr. Stroup. “If switching medications is not an option, then adding a medication like metformin or a statin could help reduce cardiovascular risks while maintaining symptom stability,” he concluded. He also noted that the study’s behavioral intervention that focused on improved diet and exercise habits benefited even those who did not switch medications.

Reference

Stroup TS, McEvoy JP, Ring KD, Hamer RH, LaVange LM, Swartz MS, Rosenheck RA, Perkins DO, Nussbaum AM, Lieberman JA. Comparison of antipsychotics for metabolic problems (CAMP):a randomized trial examining the effectiveness of switching from olanzapine, quetiapine, or risperidone to aripiprazole to reduce metabolic risk. American Journal of Psychiatry. Online ahead of print July 18, 2011.

Shared Decision Making in Mental Health

“In July 2007, a meeting of approximately 50 experts and stakeholders in SDM and mental health was convened in Washington, DC by CMHS. Participants included researchers and SDM providers in general and mental health care, policymakers, and mental health consumers. The meeting provided an opportunity for participants to exchange perspectives on SDM, inform one another of the state of the science and practice of SDM in general and mental health care, and develop recommendations for advancing SDM within the U.S. mental health care field. Participants shared their experiences as consumers and providers of mental health care and offered insights and perspectives on a variety of aspects of SDM.

This report is intended to provide a general overview of SDM and the available research on its effects in both general and mental health care. It includes recommendations from the participants of the SDM meeting.”

To obtain a copy of the publication please visit SAMHSA Publications .

Reposted at darkestcloset.bloggerspot.com

Mental Illnesses Mistaken for Medical Conditions

An August article in The Wall Street Journal Online highlights the prevalence of psychological symptoms attributed to medical conditions. In "Confusing Medical Ailments with Mental Illness," Harvard psychiatrist Barbara Schildkrout says more than 100 medical illnesses can be masked as mental health disorders. According to the article, "untangling cause and effect can challenge even seasoned clinicians, and the potential for missed diagnoses is growing."
Read the story, which includes warning signs for problems that seem behavioral, but may be medical:
http://online.wsj.com/article/SB10001424053111904480904576496271983911668.html.

Reducing Stigma Associated with Mental health in Black Communities

According to a recent article in Behavioral Healthcare, statistics indicate that only one in three African Americans who need mental health care actually receive it, due to significant barriers in black communities such as racism, institutional mistrust, and lack of insurance. A new Web site, BlackMentalHealthNet.com, has been designed to empower the black community by promoting mental health and creating a private space for individuals to obtain information and resources. "Stigma often stifles the conversation regarding mental illness in the black community," says Harvard-trained psychiatrist Sarah Y. Vinson, the site's founder and chief editor. "Families too often base decisions on little information or misinformation. We hope to change that by providing facts and facilitating dialogue around mental illness in an environment of relative anonymity and acceptance." Posted at RECOVERe-works is an electronic circular of The Coalition of Behavioral Health Agencies' Center for Rehabilitation and Recovery.  Reposted at darkestcloset@blogspot.com

Start the Conversation

<b>National Suicide Prevention Week
</b>Kevin McHale for Trevor Project
http://www.thetrevorproject.org/talktome/index.html

Ruling may broaden insurance plans' coverage for mental illness

Judge says Blue Shield must cover woman's anorexia treatment at a residential facility. The Mental Health Parity Act requires insurers to provide equal coverage for severe mental illness and physical ailments.

The state Mental Health Parity Act obliges insurers to provide the same coverage for severe mental disorders as they do for physical ailments. (Mark Boster / Los Angeles Times)

By Carol J. Williams, Los Angeles Times  August 28, 2011

A Northern California woman's treatment for anorexia at a residential facility was medically necessary and must be covered by her healthcare plan, a federal appeals court has ruled in a case that could lead to more extensive benefits for those being treated for mental illnesses.

Jeanene Harlick's policy with Blue Shield of California specifically excluded coverage for residential care, the room and board expenses she incurred while at the Castlewood Treatment Center in Missouri for 10 months beginning in April 2006.

But the state Mental Health Parity Act obliges insurers to provide the same coverage for severe mental disorders as they do for physical ailments, a three-judge panel of the U.S. 9th Circuit Court of Appeals said Friday.

Harlick, 37, has struggled with anorexia for more than 20 years, the court noted. The judges said her doctors recommended the Missouri program when her body weight fell below 65% of ideal, a precarious condition that required insertion of a feeding tube within a month of her arrival at Castlewood.

Under the mental health parity law, insurance plans "must provide coverage of all 'medically necessary treatment' for nine enumerated 'severe mental illnesses,' " the court said, listing eating disorders as well as schizophrenia, schizoaffective disorder, bipolar disorder, major depression, obsessive-compulsive disorder, panic disorder, autism, and serious emotional disturbances in children and adolescents.

Steve Shivinsky, Blue Shield of California vice president for corporate communications, said the company was still reviewing the appeals court ruling and couldn't yet say what consequences it could have for Blue Shield or its 3.4 million policyholders in the state.

Harlick's attorney, Lisa Kantor of Northridge, said the ruling could have huge significance for those with eating disorders as well as emotional disturbances like Asperger syndrome and autism.

The ruling may not have immediate effect, though, because Blue Shield could petition the court for a full 11-judge rehearing of the case or ask the U.S. Supreme Court to review it.

carol.williams@latimes.com

http://www.latimes.com/health/la-me-mental-health-insurance-20110828,0,3394129.story

Obama: PTSD stigmatization must end

August 30, 2011 2:21 PM  By Lucy Madison

President Obama called on Tuesday for an end to the stigmatization of veterans with Post Traumatic Stress Disorder (PTSD), and affirmed his recent decision to send condolence letters to the families of service members who took their own lives while serving.

Mr. Obama, speaking at the annual American Legion Conference in Minneapolis, Minnesota, emphasized his commitment to providing improved support for veterans both during and after their service - particularly in regard to mental health services and job opportunities.

"We're working aggressively to address another signature wound of this war, which has led too many fine troops and veterans to take their own lives--Post Traumatic Stress Disorder," Mr. Obama said. "We're continuing to make major investments--improving outreach and suicide prevention, hiring and training more mental health counselors and treating more veterans than ever before."

The president also explained his recent decision, as reported in July by CBS News, to reverse a long-standing policy of not sending condolence letters to the families of service members who commit suicide while deployed to a combat zone.

"The days when depression and PTSD were stigmatized must end," said Mr. Obama. "That's why I made the decision to start sending condolence letters to the families of service members who take their lives while deployed in a combat zone."

He continued: "These American patriots did not die because they were weak. They were warriors. They deserve our respect. Every man and woman in uniform, and every veteran, needs to know that your nation will be there to help you stay strong. It's the right thing to do."

Mr. Obama first revealed the policy change in a July statement, in which he said he made the decision in consultation with then Defense Secretary Robert Gates and military leaders after a "difficult and exhaustive review" of the policy.

"Our men and women in uniform have borne the incredible burden of our wars, and we need to do everything in our power to honor their service, and to help them stay strong for themselves, for their families and for our nation," he said in that statement.

In his Tuesday remarks, Mr. Obama also lauded those who have served in what he described as the "9/11 Generation," and touted the funding of a post-9/11 GI Bill, which aims to send veterans and their family members to college, as well as provide vocational training and apprenticeships - "so veterans can develop the skills to succeed in today's economy."

"Today, as we near this solemn anniversary, it's fitting that we salute the extraordinary decade of service rendered by the 9/11 Generation-the more than five million Americans who have worn the uniform over the past ten years," he said. "They were there, on duty, that September morning, having enlisted in a time of peace, but they instantly transitioned to a war-footing. They're the millions of recruits who have stepped forward since, seeing their nation at war and saying 'send me.' They're every single soldier, sailor, airman, Marine and Coast Guardsman serving today, who has volunteered to serve in a time of war, knowing they could be sent into harm's way."

He pledged to continue to work to create more jobs for former service members, and again called on Congress to enact tax credits for companies that hire unemployed veterans.

"We cannot, and we must not, balance the budget on the backs of our veterans," he said. "And as commander-in-chief, I won't allow it."

"America will never leave your side," he promised.

Political Hotsheet    http://www.cbsnews.com/8301-503544_162-20099337-503544.html Reposted at darkestcloset/bloggerspot.com

Army Suicides Rise to Record Levels in July

ROMEO GACAD/AFP/Getty Images

US soldier, Specialist Joshua Schonert from 1st Platoon, Charlie Company, 2-87 Infantry, 3d Brigade Combat Team under Afghanistan's International Security Assistance Force (ISAF) lights a cigarette as he prepares for the day following earlier attacks by Taliban insurgents on their checkpoint in Kandalay village, Kandahar province southern Afghanistan on August 5, 2011. US troops together with forces from Afghan National Army repelled Taliban insurgents attacks on the checkpoint protecting the western area of Kandalay village. Since the checkpoint was set up in August 3, 2011, Taliban have staged attacks on the outpost for two consecutive days. AFP PHOTO / ROMEO GACAD (Photo credit should read ROMEO GACAD/AFP/Getty Images)

By Yochi J. Dreazen  August 12, 2011

There were 32 Army suicides in July, the highest monthly toll ever recorded. The grim figure underscores the military’s continuing inability to find ways of preventing troubled soldiers from taking their own lives.

Military officials said 22 active-duty soldiers were thought to have taken their own lives last month, along with 10 reservists. The incidents are under investigation, and it'll be several weeks before the Army definitively rules on each case. If the numbers hold up, July will be the worst month for Army suicide in two years, since the Army first began releasing monthly suicide data. The previous record was June 2010, when 31 soldiers committed suicide.

Senior Army generals have devoted considerable resources towards suicide prevention in recent years, spending hundreds of millions of dollars to develop new military-wide training programs and to hire thousands of additional mental-health personnel. Top officials have also fought the stigma surrounding mental health in the military by encouraging soldiers to seek help, and stressing that psychological maladies like post-traumatic stress disorder should get the same respect as physical injuries like scars or lost limbs.

Still, the military’s suicide problem—fueled by the strains of repeat deployments to the wars in Iraq and Afghanistan—shows no signs of abating.  In 2010, 301 active-duty, reserve, and National Guard soldiers committed suicide, up from 242 in 2009. In 2008, the military’s suicide rate exceeded that of the general population for the first time ever.  All told, more than 1,000 military personnel have taken their own lives since the start of the two wars.

"Every suicide represents a tragic loss to our Army and the nation,” Gen. Peter W. Chiarelli, the Army’s vice chief of staff, said in a written release.  “While the high number of potential suicides in July is discouraging, we are confident our efforts … are having a positive impact.”

Still, Chiarelli said he and other top officials “absolutely recognize there is much work to be done.”

The ongoing rise in military suicide comes amid a broader debate about what it truly means to be a casualty of Iraq or Afghanistan. With troops serving repeat deployments, psychological maladies like post-traumatic stress disorder and hard-to-spot physical injuries like traumatic brain injury are emerging as the signature wounds of the long wars.

In 2008, for instance, the RAND Corporation estimated that one out of every five Iraq and Afghanistan veterans have symptoms of PTSD or major depression. Both are closely linked to suicide. But some suicides had little to do with deployment: Army studies have found 79 that percent of the suicides occurred within the first three years of service, whether soldiers had deployed or not.

Many within the military have been pushing senior commanders to treat troops who suffer invisible wounds like PTSD more like those with traditional injuries like lost limbs. In the summer of 2008, for instance, then-Defense Secretary Robert Gates said the military should consider awarding the Purple Heart, one of its highest honors, to veterans with PTSD. Supporters of the move argued that the change would reduce the stigma that surrounds the disorder and prevents troubled troops from seeking help; opponents argued that it would cheapen an award intended only for those with physical injuries. In the end, the Pentagon dropped the idea.

The Obama administration, for its part, has tried to remove the stigma surrounding military suicide by implementing new policies last month under which the president will send condolence letters to the families of troops who commit suicide in Iraq or Afghanistan. Previously, they received such letters from senior generals, but not from the president himself.

The move came after years of lobbying by the families of the hundreds of soldiers who have killed themselves since the wars began in late 2001. In a written statement last month, Obama said veterans of the conflicts suffered “unseen wounds of war.”

“This issue is emotional, painful, and complicated, but these Americans served our nation bravely,” Obama said at the time. “They didn’t die because they were weak. And the fact that they didn’t get the help they needed must change.” 

For now, though, the military’s suicide numbers continue to rise higher and higher.

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Posted at http://www.nationaljournal.com/army-suicides-rise-to-record-levels-in-july-20110812

reposted at darkestcloset.bloggerspot.com

Army silence and censors bring agony

posted at http://www.startribune.com/local/128130478.html?page=1&c=y , reposted at darkestcloset.bloggerspot.com

Army silence and censors bring agony

• Article by: MARK BRUNSWICK , Star Tribune Updated: August 24, 2011 - 3:52 PM

The aftermath of soldier suicides can entail a frustrating search for answers and endless anguish for the families.

For the families of soldiers who kill themselves, the anguish that accompanies the initial news is often only the beginning of their ordeal.

What frequently follows, survivors say, is a string of slights, stonewalling and misinformation that conveys a disturbing message: Their loved ones remain government property, even after their deaths.

Military authorities routinely promise that they will do all they can to help, but some families are left feeling that the military's real goal is to protect itself.

The Campbell family of Cloquet, Minn., came to that conclusion after Corinne Campbell, still grieving after the funeral of her son, Jeremy, her mind reduced to "scrambled eggs,'' started up his laptop. The Army, she discovered, had wiped its hard drive clean. Even his personal pictures from a trip to Germany were gone.

Jan Fairbanks of St. Paul spent months of frustration searching for answers about the death of her son, Jacob. Then one day, a thick stack of investigative files was left unannounced by military officials at her front door -- documents that only raised new questions.

Meanwhile, the Hervas family of Coon Rapids contends that the Army so zealously protected information about their son, Tad, a high-ranking intelligence officer who killed himself, that more than half of the documents the family asked for were edited to the point of being largely indecipherable. Even his parents' names were blacked out.

The Army has resisted acknowledging that other documents exist, the family says, and told them that it would take a court order to get further papers.

"It's not just that these folks are thoughtless in handling our requests, and forget that they're not moving papers but dealing with a life,'' said Kevin Hervas, Tad's brother. "The painful part is that they forget that the life belonged to a hero."

In an extensive report on suicide prevention last year, a Department of Defense task force found that there is no program for chaplains, first responders and casualty assistance officers on how best to work with next of kin.

"Family members explained that from their perception, some commanders and others in the military community believe that discussing the death of a service member by suicide with their families would be harmful or damaging to them," the report said.

Insular culture

The stigma attached to military suicides has long been reinforced by official policy.

Until this summer, the White House never sent letters of condolence to families of service members who killed themselves. The Obama administration, after a lengthy review, recently changed the policy -- but only for those who kill themselves in a combat zone.

Most military suicides occur before or after a deployment.

Earlier this month, the Army announced that its 32 suicides in July were the highest it has ever recorded since it began keeping track of monthly rates two years ago. The deaths, which included 22 active-duty soldiers and 10 from the reserves, put a damper on claims that the military was getting a handle on the problem. As soldier suicides have risen to record levels, the military has hired scores of mental health counselors to help families cope. Pentagon task forces also have recommended that military officials better inform families about how their loved ones died.

But the handling of several Minnesota cases suggests that the military, shielded by privacy laws and security concerns, can still leave grieving relatives frustrated.

Michelle Lindo McCleur, executive director of the National Institute of Military Justice at American University in Washington, said it's common for outsiders seeking information, including family members of fallen soldiers, to find the military blocking their way.

"The military has always been more insular than the rest of society," she said.

Lindo McCleur, who served for more than a decade in the Air Force's Judge Advocate General's office, said she suspects that some problems arise because military officials simply want to protect the privacy of individuals.

"But I'm certain,'' she said, "there are probably some individual cases where it's, 'We're not too proud of this, things fell through the cracks, there may have been signs, and we don't want to acknowledge that.' "

Military suicides are treated like criminal investigations. Final reports can take up to a year to complete, fostering suspicion among grieving relatives. Some families say that when records finally emerge, there is often no consistency in what documents get released. Some families have to wage long battles for every scrap of paperwork regarding a suicide; others are provided with volumes of investigative files.

Such was the case for Jan Fairbanks after her son, Specialist Jacob Fairbanks, killed himself while in Iraq with the Army's 101st Airborne.

During a retreat for families who have lost loved ones in the service, she met then-Gov. Tim Pawlenty and told him her concerns about her son's death. A few weeks later, she was surprised to find the military's investigative files left at her front door.

She has gone over them many times, making notes about when people arrived on the scene, that the service rifle he used was moved, that there was no gunpowder residue detected on his hands. It is still difficult for her to come to grips with the idea that Jake shot himself.

Fairbanks returns to the documents occasionally for solace, or to try to find a new clue. But reading them often only leaves her with more questions.

"I have to put it down and leave it where it lies for a while, sometimes for months,'' she said. "If I don't, it drives me crazy."

Desperate for 'why'

Last year, a Pentagon task force convened to create strategies for preventing soldier suicides released a 233-page report. It recommended that military criminal investigation agencies get staffed with family advocates who are trained in communicating with surviving family members.

The military survivors group known as Tragedy Assistance Program for Survivors, or TAPS, takes on about nine new cases a week of family members struggling with a suicide. Families are often tenacious pursuers of investigative files, poring over documents and discovering flaws in how cases were handled.

"They are desperately trying to answer the whole question of 'why,' " said Ami Neiberger-Miller, a TAPS spokeswoman.

The Hervas family has sought access to an investigative report detailing allegations that Tad Hervas had an inappropriate relationship with a subordinate enlisted soldier while with the Minnesota Guard in southern Iraq. The investigation, known as an AR 15-6, was the basis for discipline imposed on Hervas that included recommendations that he be kicked out of the Army.

When family members asked for the document, they say the Army referred them to the National Guard. When they went to the Guard, they say they were told to talk to the Army.

One investigator makes reference to a Guard general's sworn statement in his final report, but the statement can't be found anywhere in the files. Because Hervas was an intelligence officer with a high security clearance, one portion of the report on his death is redacted and referred to the Army's Intelligence and Security Command at Fort George Meade, Md., which said it had no such document.

Initially, the family says, the command there denied having any records, then acknowledged it had a document but blanked out every name and e-mail address.

The Army eventually produced several hundred pages of documents. Many were blacked out or had large sections omitted because of what the Army said were privacy and security concerns.

Adding to the family's suspicions, the general in command in Iraq when Tad Hervas killed himself, Rick Nash, was recently named head of the Minnesota National Guard. Hervas met with Nash shortly before he killed himself, and Nash signed off on the discipline that preceded Hervas' suicide.

A Minnesota National Guard spokesman said Nash played no role in what information was provided to the Hervas family.

"Major General Nash's position in command of the 34th Red Bull Infantry Division, and his subsequent selection as Adjutant General of the Minnesota National Guard, in no way had an impact on the dissemination of information of official documents to the family of Maj. Tad Hervas," said Lt. Col. Kevin Olson.

In April, after more than 10 months, the Hervas family finally got the final report it had been seeking -- the original investigation into the relationship between Tad Hervas and a female specialist.

The 119-page report has six pages completely blacked out and the rest with every name blacked out. It includes sworn statements from an investigator's file that detail concerns soldiers raised about the relationship Hervas had with a subordinate, and the fact that he had been counseled about the perception of impropriety.

But with the names blacked out, the family says it cannot assess the strength of the accusations, which included concerns that Hervas was flaunting his rank and that the relationship contributed to an environment in which soldiers perceived that commanders were not holding certain soldiers responsible for their actions.

"I was hoping the Army would be more open and transparent with the investigation that ultimately led to Tad making his fateful decision," said Paul Guelle, a boyhood friend of Hervas' who has spent more than two decades in the active Army. "But here we are 18 months after Tad's death, and we still don't have answers.''

Mark Brunswick • 612-673-4434

Behind Bars Without Help: The Mental Health Controversy in Michigan

Posted at NAMI blog Thursday, August 25, 2011 Reposted at darkestcloset.bloggerspot.com

By Ron Honberg, NAMI Director of Policy and Legal AffairsThe new head of Michigan's Department of Corrections recently made national news when he expressed concerns about the extent to which his department's resources are used to provide mental health to inmates.
On August 21, it was reported in the Detroit News that Dan Heyns, director of Michigan's Department of Corrections wanted to work with sheriffs, prosecutors and local officials to ensure that fewer people living with mental illnesses come to prison.

"I've got institutions that are just packed with people who are very, very seriously mentally ill", Heyns said. "These aren't stress cases. I can't exactly provide a therapeutic environment."

Jails and prisons are the worst possible environments for people struggling with the symptoms of severe mental illnesses. Prisons are ill-equipped to provide effective psychiatric treatment. Inmates with the most severe mental illnesses are too often isolated in administrative segregation, special housing units, super-max prisons and other forms of solitary confinement. The long term isolation of individuals experiencing delusions, hallucinations or other severe psychiatric symptoms has been characterized as being akin to torture.

Sadly, the problems highlighted by Director Heyns are not unique to Michigan. A recent study revealed that about 17.1 of male inmates and 34.3 percent of female inmates in local jails throughout the country live with a serious mental illness such as schizophrenia, bipolar disorder or PTSD. When compared to figures for the general population this is roughly a 470 percent increase in prevalence for both men and women.

So what can be done to achieve Director Heyns vision that fewer individuals living with mental illnesses come to prison to begin with?

Some would respond that we need to take a close look at our nation's treatment laws. Until the 1960s, people living with serious mental illnesses were virtually devoid of civil rights protections and were frequently institutionalized for long periods of time with no due process or right to appeal. Fortunately, these egregious civil rights abuses are a thing of the past.

There are many who believe that the laws have gone too far in the other direction, asserting that requiring proof of immediate or imminent danger to self or others means that certain people will not get help when they need it the most. Not everyone agrees. Many argue equally strenuously that the laws should remain as they are, citing continuing abuses and civil rights violations in hospitals, adult care homes, and other settings as evidence that we need to maintain strict, narrow civil commitment standards.

Irrespective of how you feel about these complex issues, the overall lack of mental health services and supports across the country is beyond dispute. Even during the best of economic times, the availability of good mental health services has been limited in the US, particularly for those who rely on the public mental health system for their care. In 2006 and 2009, before the full impact of the economic crisis, NAMI gave the nation's mental health system a grade of "D" in its Grading the States 2006 and 2009 reports.

Unfortunately, the economic recession has only made these problems worse. In March, 2011, NAMI released a report entitled State Mental Health Cuts: A National Crisis. This report revealed cuts to non-Medicaid state mental health spending of nearly $1.6 billion dollars between 2009 and 2011, with even deeper cuts projected for 2012. These cuts have led to the erosion of vital inpatient and community services for tens of thousands of youth and adults living with the most serious mental illnesses. Hospital beds have been eliminated and in many parts of the country, there are virtually no community services available either.
Not surprisingly, these cuts have added to already considerable burdens faced by law enforcement and correction centers. In Nevada, Judge Jackie Glass, who runs the Clark County (Las Vegas) Mental Health Court implored legislators not to impose further cuts on mental health services. She testified that "you will see … people [who lose mental health services] ending up in prisons, jails, emergency rooms, homeless…"
In Sacramento County, California, U.S. District Court Judge John A. Mendez went further, blocking the county from cutting mental health services as a way to balance the budget. He stated that the county's budget cutting plan would cause "catastrophic harm" and violate the Americans with Disabilities Act (ADA).
The U.S. is clearly at a pivotal moment in its history. Solutions to the budget crisis are not easy. However, one thing is clear: Indiscriminate cuts to mental health budgets will not save money, but cost more in the long run. Cuts of the magnitude that have occurred will continue to perpetuate the national disgrace of incarcerating people for the "crime" of having a serious mental illness. We should pay heed to Director Heyns, Judge Glass, Judge Mendez and others on the front lines responding to people in crisis. A civilized, advanced nation must do better for its most vulnerable citizens.