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

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

Book Review: "A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness" by Nassir Ghaemi, M.D.

The Penguin Press (2011), $27.95 (hardcover)

By Bob Carolla, NAMI Director of Media Relations

One of the best books to document and discuss in detail the link between mental illness—specifically depression—and great leadership is Lincoln's Melancholy by Joshua Wolf Shenk. Dr. Ghaemi, the director of the Mood Disorders Program at Tufts University, now takes the discussion of mental illness and leaders further by including bipolar disorder and expanding the scope to several other historical and contemporary leaders, including Civil War general William Sherman, Winston Churchill and Ted Turner. Also included are Mahatma Gandhi and Martin Luther King, whose names are new to "famous people" lists that provide inspiration to many people who live with mental illness.

The book makes the case that four elements are essential to leadership in times of crisis: realism, empathy, creativity and resilience. Living with depression can enhance the first two traits and mania can enrich the third. Both can help instill resiliency. At the same time, some conditions such as psychosis can prove disastrous.

Leadership can be exercised for good or evil— independent from mental illness. In other words, free will and moral values remain part of the equation. The book includes a chilling discussion of Adolf Hitler, who presided as the leader of Germany during World War II and the Holocaust; Ghaemi makes a case that Hitler lived with untreated bipolar disorder which gave him charisma, resilience and political creativity in his rise to power. On the other hand, by the time the war began, he was being treated with barbiturates and amphetamines (including meth) for insomnia and fatigue, a combination that only worsened his mental illness. Essentially, his mind spun out of control—possibly into some form of psychosis. In that respect, impairment of his leadership abilities because of heavy drug use was a stroke of good fortune for civilization. “In his final two years, Hitler probably never experienced a day of normal mood,” Ghaemi writes. “His world was collapsing; his mind already had.”

The book also includes discussion of other leaders such as John F. Kennedy, Richard Nixon and George W. Bush, arguing that “homoclite” leaders who “want to be liked” can be dangerous in times of crisis. “Normal” mental health may actually be a drawback. This section, as well a chapter on stigma and politics, are not the books strongest but they raise issues that are worth thinking about carefully. Would our country ever elect a president who acknowledges living with bipolar disorder—and perhaps even campaigns on it as a qualification suited for the times? In some cases, personal experience with mental illness may be a strength, providing vision and a foundation for brilliant leadership, but the stigma surrounding mental illness still prevents a completely open discussion.

Posted at NAMI Advocate. NAMI Bookshelf August 2011. http://www.nami.org/ADVTemplate.cfm?Section=20111&Template=/ContentManagement/ContentDisplay.cfm&ContentID=126353

Reposted at darkestcloset.blogspot.com

Does cutting mental health care increase the prison population?

By Suzy Khimm

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.

In Illinois, where mental health spending has dropped 15 percent since 2009, the Cook County sheriff may file a lawsuit against the state for allow the county jail to “essentially become a dumping ground for people with serious mental health programs,” reports a local ABC affiliate, WLS-TV. The details:

Sheriff Tom Dart says it has gotten so bad Cook County Jail is now the largest provider of mental health treatment in the state. … As much as 20 percent of the jail's population has been diagnosed with some type of mental illness. That's 1,300 to 1,400 people receiving psychiatric care while behind bars.

“What ends up happening is, there’s no safety net to catch them, so they end up committing crimes, getting swept up by the police and coming to jail,” said jail psychiatrist Dr. Jonathan Howard.

The head of Illinois’ mental health department says that the state is trying to make do with limited resources — but acknowledges that it still can’t afford treatment programs such as community-based care that might be more effective, as WLS-TV points out.

Similarly, the Los Angeles Times has examined a public safety program in Nevada that’s also under threat because of mental health budget cuts. The effort pairs police officers in Reno with mental health counselors to reach out to the mentally ill, whether they’ve committed crime, are a threat to themselves, or could be in the future. “Already starved for services, troubled citizens sometimes tumble into homelessness and alcoholism and tussle violently with police, who are usually ill-equipped to help them,” the story explains.

In Nevada and Illinois, as in states across the country, mental health services will continue to be vulnerable to budget cuts. According to University of Chicago Professor Harold Pollack, states deliver many mental health and behavioral services outside of Medicaid and are thus freed from federal coverage requirements — as well as matching dollars — making these services a more tempting target for legislators committed to fiscal austerity.

Mental health advocates have long banged the drum about the connection between mental health and crime, noting especially strong links between recidivism and mental illness. In a recent report on the phenomenon, “Cost-Shifting to Criminal Justice,” NAMI notes that as much as a quarter of prisoners in the United States suffer from a serious mental illness, citing a 2006 Department of Justice study. The group adds that 50 percent of previously incarcerated individuals with serious mental illnesses end up returning to jail — at times because untreated mental illness has led them to violate parole, citing the Council of State Governments.

Such findings may undercut the economic rationale for cutting mental health benefits if states are simply shifting — or increasing — costs to the prison system in doing so. As I've reported previously, many states are also battling to contain prison costs as well as health services. So budget-conscious legislators may be especially willing to think twice if research continues to support this argument.

Suzy Khimm is a staff reporter in the Washington bureau of Mother Jones.

Posted at http://www.washingtonpost.com/blogs/ezra-klein/post/does-cutting-mental-health-care-increase-the-prison-population/2011/06/02/AGzNdVHH_blog.html reposted at darkestcloset.blogspot.com

Proposals aim to improve safety in state mental hospitals

Reposted at darkestcloset.blogspot.com

A worsening safety trend at California's mental health facilities has spurred legislation to better screen and separate violent patients, increase surveillance and improve workers' disability insurance.

 

By Lee Romney, Los Angeles Times  May 16, 2011 Posted in LA Times, Reporting from San Francisco—

Nearly eight months after a Napa State Hospital patient strangled a psychiatric technician, lawmakers and employee groups are pushing proposals aimed at reversing a worsening safety trend at California's mental health facilities.

Among them are bills that would enable officials to better assess patients' potential for violence, speed up the process to involuntarily medicate certain individuals and punish those who funnel contraband — such as tobacco and cash — to patients, feeding a black market that goes hand-in-hand with assault and extortion.

FOR THE RECORD:
Mental hospital safety: In the March 16 LATExtra section, an article about efforts to curb violence in state mental hospitals erred in stating that Atascadero State Hospital psychologist Henry Ahlstrom said excessive paperwork demands from a federal monitor had pulled staff away from direct care to focus on patient records. Many of the paperwork demands are not imposed directly by the monitor, who oversees federal reforms, but by state hospital administrators seeking to satisfy the monitor. —

Legislators are working closely with California Health and Human Services Secretary Diana Dooley, who lifted a hiring freeze at the state's psychiatric hospitals last month. In a long-awaited report, the Department of Mental Health, which Dooley oversees, recently called for better alarm and surveillance systems at the facilities.

"We are maybe for the first time in a long time approaching critical mass for driving reform," said state Sen. Sam Blakeslee (R-San Luis Obispo), who wrote the contraband bill and whose district includes Atascadero State Hospital.

Meanwhile, the Select Committee on State Hospital Safety chaired by Assemblyman Michael Allen (D-Santa Rosa) is expected to convene in about a month to propose longer-term solutions. And a coalition of employee groups formed at Napa in the wake of Donna Gross' death has expanded statewide to demand safer conditions for staff and the more than 5,500 patients they treat.

"We're very close here to coming to a boiling point," said Eric Soto, a psychiatric technician at Metropolitan State Hospital who heads the Norwalk facility's chapter of the California Assn. of Psychiatric Technicians.

Soto said he understands that "there is an element of risk" in working with state hospital patients, most of whom have been accused or convicted of crimes related to their mental illnesses. However, he said, "We all expect our employer to take steps to minimize that as much as possible."

Violence is among the issues the U.S. Department of Justice sought to address when it filed suit in 2006 and imposed court-ordered reforms at four of the state's five mental hospitals. Yet data show that assaults against patients and staff have increased at most of the facilities.

A study obtained by Allen's committee shows that in 2010 there were 6,700 victims of aggressive incidents and 5,100 injuries at the state's mental hospitals — 1,000 of those to staff. That's a rate of 14 injuries a day.

On Wednesday night, a 49-year-old Napa patient described by staff as "frail" and "shy" was found unconscious and bloodied beyond recognition. Charged with attempted murder in the assault was 31-year-old Victor Hugo Mandujano. Mandujano was not responding to medication, often complained of hearing voices and suffered frequent bouts of violence, a fellow patient said.

"People would lend him headphones and radios just to drown out the voices so he could get some rest," said Tim Breckenridge, 35.

A psychiatric technician who responded to the attack said the hospital houses patients of various ages and violence levels in close quarters, with insufficient supervision.

The fears run systemwide. At Metropolitan last week, three female patients adorned their shirts with the slogans "Stop the Violence" and "Be Kind," said Denise Nicks, a rehabilitation therapist who is that hospital's union steward for AFSCME Local 2620.

Nicks, whose nose was broken by a patient last year, said it is upsetting that employees cannot keep patients safe, attributing the problem to inadequate staffing and excessive and redundant paperwork.

Yet consensus is building to place greater restrictions on the most violent patients. A bill by state Sen. Noreen Evans (D-Santa Rosa) would require thorough violence assessments, place the most aggressive patients in specialized units and, if secure housing cannot be found, send them to prison or jail. Patients who commit serious assaults would also be transferred.

Allen has also moved two bills through committee — one that makes it easier to involuntarily medicate certain patients deemed incompetent to stand trial, and another that enhances the disability insurance policies for all hospital staff.

Labor groups contend the Department of Mental Health has not moved with sufficient urgency to address the violence. But department spokeswoman Jennifer Turner said 50 employees have been hired since Dooley lifted the freeze and officials are working to expedite the process of sending violent patients to prison.

The department's recent safety report endorses the creation of special units to hold the most aggressive patients. They would have extra staff and on-site police officers, the rooms would have high-security doors and patients would be restrained when moved.

The most extensive reviews were conducted at Napa and Metropolitan, which have open campuses not designed for patients with violent criminal histories. Recommendations include more fencing and outside lighting and teams of psychiatric technicians and police officers to monitor the grounds as they do at Patton State Hospital in San Bernardino. The department's call for new video monitoring and upgraded alarm systems applies to all state hospitals.

While the price tag of these reforms would be high, the cost of doing nothing could be steeper. In 2010, Napa recorded 384 staff injuries resulting in 289 workers compensation claims and 10,724 missed work days, according to an analysis accompanying one of the bills. Systemwide, overtime costs in the last fiscal year ran up to $100 million, Allen said, in part due to injuries.

Psychologist Henry Ahlstrom, Atascadero's chief steward for AFSCME Local 2620, said he and other members of the statewide safety coalition applaud the legislation. But he stressed that underlying problems that feed the violence also need to be addressed.

The federal government's lawsuit brought about some positive changes, he said, including documentation and, to some extent, accountability through stricter protocols and audits. But excessive paperwork demands from the federal monitor have pulled staff away from direct care to focus on grooming patient records. The result is eroded therapeutic relationships, which are key to de-escalating violent situations, he said.

"We don't have sufficient time to help our patients develop healthy attachments and regulate their emotions better," Ahlstrom said.

Patient advocates say fear only worsens the equation. At Napa in particular, interactions with patients have become "guarded, tense, conveying orders or instructions, leaving patients feeling disrespected and disregarded," said Barbara Duncan, spokeswoman for Disability Rights California, which advocates on the patients' behalf. That atmosphere can cause patients to "back away, apologize for every request, avoid eye contact, close down," she said.

"When you have little positive human interaction, the result is hopelessness," she said, adding that the response "can be withdrawal and depression, but can also be anger and violence."

http://www.latimes.com/news/local/la-me-hospital-violence-20110516,0,7831085.story

Stem Cells of People who experience Schizophrenia Could Lead to Breakthrough in Treatment

A new method for recreating the brain cells of patients with schizophrenia is being described as a breakthrough in treating the condition. Scientists used a technique to reprogram the skin cells of schizophrenic patients to become stem cells and then coaxed them become neurons. These were then compared to brain cells derived from the skin cells of healthy volunteers. That would allow scientists to test the effects of antipsychotic drugs. (Voice of America, 4/13/11)

Guide for Advocacy Countering Criminalization of Mental Illness

The Urban Justice Center and the National Alliance on Mental Illness (NAMI) of New York State have published a guide for family and friends of people with mental illnesses who go to prison. The guide outlines services available for people with mental illnesses in prison and describes how family members can advocate for the person in prison while getting support for themselves. It also details how to become active in larger advocacy efforts countering the criminalization of mental illness.

The publication can be downloaded at: www.urbanjustice.org/pdf/publications/mhp_08sept10.pdf  Published in "National Association of Peer Specialist Newsletter—Fall 2010" reposted at http://darkestcloset.blogspot.com/