Friday, December 19, 2014

Depression: A Scientific Approach

By Marisa Balades

“Of all the major illnesses, mental or physical, depression has been one of the toughest to subdue.” – Dr. Richard A. Friedman.

Millions of teens and adults all over the world are affected by depression every year and it may be a more complex problem than we thought.

With over 350 million people affected by depression worldwide, it’s no doubt an incredibly real and serious problem, but what exactly is going on inside a depressed person?

“There might be something genetic about it”, Beverly Lehr, health sciences clinical professor and staff psychologist from the University of San Francisco. She talks about how depression might actually be hereditary and is usually misconstrued as a disease “you can just get.”

In the past, depression was often described as simply a chemical imbalance in the brain. In recent years, scientists began to notice that the brain cell growth and connections actually may play a larger roll. The hippocampus region in particular controls memory and emotion and the longer a person has been depressed, the smaller the hippocampus becomes. The cells and networks literally deteriorate.

Stress may actually be a main trigger in the increase of new neurons in this area of the brain. Interestingly, many modern drugs have an indirect effect on the growth of brain cells. This is likely why serotonin-based drugs seem to help some patients, but not for the reasons we once thought. Instead, they promote the release of other chemicals which ultimately stimulate neurogenesis.

Some scientists now believe the focus should be on drugs which directly affect neurogenesis. However, while your neurons and chemicals may be the direct influencers, many genetic factors have been discovered as well. Every part of your body is controlled by genes. “If the genes get it wrong, they can alter your biology in a way that results in your mood becoming unstable.” Harvard Health Publications explains. Knowing this, we are informed how genes make biological processes and how they can alter your biology.

Obviously, more research needs to be conducted in order to prove that depression could have be hereditary.  

“They are considered usually to be vulnerable to depression because of family history,” Lehr said.  She explains how depression is a disease involving genetics. This is imperative because you can see if your parents or grandparents had depression and be better prepared. One particular study found that in a variation in the serotonin transporter gene leaves individuals more vulnerable to depression.

So while the true cause or causes of depression are yet to be identified, it is important to remember that depression is a disease with a biological basis along with psychological social implications. It is not simply a weakness that somebody should get over or even something we have a say in. Just like heart disease or cancer, shedding light onto the subject is of the utmost importance in order to bring funding and proper research.

Psychologist David Burns is quoted as saying, “Depression can seem worse than terminal cancer.” He tells us this because most people with cancer feel loved, have hope, and have self-esteem.
Jan Silver Maguire, who lives with depression, shares, “I’ve come to understand that recurrent depression is my Achilles’s heel. There is also a strong biological component in my family; my mother and sister both struggled with severe postpartum depression. I know that medication alone is not the cure-all so I’ve expanded my arsenal of coping skills. I exercise, try to eat healthfully, volunteer, set boundaries like saying “no” when I need to, work on turning negative to positive self-talk, and cultivate an attitude of gratitude whenever possible. Some days are better than others, but that’s OK.”

Jan shares her depression story on Anxiety and Depression Association of America (AADA) and explains her journey through her recurrent depression. Jan’s story helps truly understand some important information. She talks about how there is a strong biological component in her family which goes to show that depression stands on a biological basis.

“It pains me that there are still so many misconceptions about mental illness because it prevents so many people from seeking treatment,” she writes. “It’s your life and you absolutely matter.” Jan provides hope for people suffering with depression, stating that they can get help. This lets us know, that even Jan, knows that there is hope for anyone who has depression. People shouldn’t stop when there is a better way to solve the issue.
Although depression cannot actually be cured without medicine and more research, studies do show that just by saying ‘hi’ to a depressed person can make their day better.  Try to say hi to someone who you know is not feeling the happiest in their lives. It is hard for people struggling with depression. Every aspect of life can be impacted.

Thursday, December 18, 2014

Congressional Budget Bill a Mixed Bag

By Andrew Sperling, NAMI Director of Federal Legislative Advocacy

This past weekend Congress passed the “Continuing Resolution – Omnibus” spending bill (HR 83) for the remaining months of fiscal year 2015 which runs through Sept. 30, 2015. The measure is now waiting for the President’s signature. This bill contains good news and bad news for mental health. The good news: HR 83 provides a small increase in funding for mental illness research. Bad news: the bill includes a small reduction for mental health services.

Mental Illness Research Funding

The omnibus bill prevents any further cuts to funding at the National Institute of Mental Health (NIMH). Overall the National Institutes of Health (NIH) budget for 2015 will be increased by almost $150 million. NIMH received a budget increase of almost $17 million for a total budget of $1.463 billion for 2015. The bill also allocates funding to the NIMH as part of the President’s Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative. Multiple federal agencies and a number of foundations collaborate in the BRAIN Initiative designed to release new technologies and undertake basic mapping of circuits and neurons in the brain.

Mental Health Services Funding

The Substance Abuse and Mental Health Services Administration (SAMHSA) will receive a $39 million increase over fiscal year 2014 levels, for a total budget of $3.62 billion. However, most of this increase is directed to the Center for Substance Abuse Treatment to address the growing crisis of opiate addiction in America. Funding at the SAMHSA Center for Mental Health Services (CMHS) will actually be reduced for 2015 – a reduction of $9.4 million out of total CMHS funding level of $1.079 billion. Almost every line item in the CMHS budget endures a small reduction, in most cases, less than 0.5%. Among the highlights of the final CMHS budget for 2015 are:

  • $481.5 million for the Mental Health Block Grant (MHBG) – a $1.2 million reduction. The MHBG is dedicated to building and supporting the community-based public mental health system across the country. Despite this reduction the bill does continue the 5% set aside for early intervention in first break psychosis that Congress put in place last year. This requires each state and territory to direct 5% of the block grant funds for evidence-based programs that address the needs of young adults experiencing first break psychosis. NIMH will continue its role of validating evidence-based approaches for early intervention and psychosis.
  • $64.6 million is allocated for the PATH program, a $100,000 reduction from its 2014 level. The PATH program is a state grant program for outreach and engagement for individuals with serious mental illness who are homeless.
  • $117 million is allocated for the Children’s Mental Health program, $300,000 below the current level.

Most programs under the CMHS “Programs of Regional and National Significance” (PRNS) would continue at levels slightly below their 2014 level. The total amount for 2015 for PRNS is $366.6 million which is a $7.7 million reduction. Among these line items are:

  • $49.8 million for the Primary-Behavioral Health Care Integration (PBHCI) program, which supports the co-location of services in behavioral health and primary care settings.
  • $54.9 million for suicide prevention activities, including the Garrett Lee Smith state and campus grant programs.
  • $39.9 million for new Project AWARE (Advancing Wellness and Resilience in Education) grants.
  • $14.9 million for Mental Health First Aid training.
  • $30.7 million for homelessness prevention programs.

Supportive Housing Funding

This bill regrettably does not include the increases put forward in President Obama’s 2015 budget proposal for supportive housing programs. Back in February, the President proposed $301 million in additional funding for development of new permanent supportive housing (PSH). These new funds were projected to continue the program on a trajectory to end chronic homelessness by 2017. The President’s budget also called for a $25 million increase for the HUD Section 811 Project-Based Rental Assistance (PRA) program which supports the lowest income people with long-term disabilities to live independently in the community. The spending bill did not include either of these requests and instead provides only enough funding to renew the operating subsidies associated with existing PSH units in both programs. The bill does include an additional $75 million in funding for new rental vouchers for supportive housing for veterans experiencing homelessness under the Veterans Affairs Supportive Housing (VASH) program.

Veterans Funding

The U.S. Department of Veterans Affairs (VA) medical services are funded for 2015 at $45.2 billion – which will provide care and treatment for about 6.7 million veterans.

This funding includes:

  • $7.2 billion in mental health care services.
  • $133 million in suicide prevention activities.
  • $229 million for traumatic brain injury treatment.
  • $7.4 billion in homeless veterans’ treatment, services, housing and job training.
  • $250 million in rural health initiatives.

The bill also includes $209 million to help address new costs related to the Veterans Access, Choice, and Accountability Act of 2014 (VACAA) – such as hiring medical staff and expanding facility capacity – and to implement the Caregivers Act, which provides stipends and other assistance to families of seriously wounded veterans.

To assist the VA in meeting its goal of ending the disability compensation claims backlog by the end of 2015, the bill includes $2.5 billion for the costs of processing disability claims. This level is a $69 million increase from last year. Language is also included directing that $40 million of the increase should be used to support digital scanning of claims, to hire additional claims processors in regional offices, and for the centralized mail initiative. Funding for the Board of Veterans Appeals is increased by $11 million for a total of $99 million to address the looming appeals backlog.

Finally, the bill contains $58.7 billion in advance fiscal year 2016 funding for the VA – the same level provided in the House budget resolution. This funding will provide for medical services, medical support and compliance, and medical facilities, and ensure that our veterans have continued, full access to their medical care.

Want to become a NAMI Advocate? Sign-up for alerts so that you can raise your voice and help NAMI make mental health a priority in the halls of Congress and beyond!

People with Mental Illness in the Criminal Justice System: A Cry for Help

By Jackie Feldman, M.D.

Several years ago, in partnership with Dear Abby, a request was sent out in her newspaper column asking those with mental illness or family members with mental illness who had “interfaced” with the criminal justice system.  I was part of a committee called Psychiatry and the Community, with the Group for the Advancement of Psychiatry, and received almost 3,000 letters.

Each one was read and we decided a practical response was to develop a monograph entitled: “People with Mental Illness in the Criminal Justice System: A Cry for Help,” hopefully to be published soon with the help of the American Psychiatric Foundation (and available to the public, providers, and purveyors of care in the criminal justice system).

The demographics of the criminal justice system are devastating. In a year’s time:

  • 2 million arrests in the U.S. involve persons with serious mental illness
  • 550,000 people with serious mental illness are in jails and prisons
  • 900,000 are in some kind of community control

The system is woefully understaffed and often poorly educated about the needs of those with mental illness.

However, a few things about the criminal justice system became apparent as I read the letters.

  1. It can be ignorant and insensitive, usually not because providers are evil, but because they are tired and lack resources like time, money, training, space and manpower.
  2. It often lacks innovation in response to crises and focuses on safety and boundary setting via restraint and seclusion.
  3. It uses short-term fixes and “efficiencies” to save money, but lacks a commitment to assessing long-term consequences of these fixes.
  4. And importantly, it can and will respond to advice and training.

The document that was developed after reading this letters will hopefully offer guidance to mental health care providers on how to interact with the criminal justice system to advocate for skills development, provide training opportunities, develop partnerships and enhance care.

In addition, the final product will provide practical advice for individuals with serious mental illness and their families on how to be prepared for an interaction with the criminal justice system.

  • Carry the name and contact information of your psychiatrist/mental health care provider (they can be contacted to advocate and educate law enforcement, jail and court personnel). Sign and carry a pre-emptive release form allowing communication with your mental health provider and law enforcement.
  • Carry a sheet with your diagnosis and list of medicines (some of my patients have taken to wearing medical alert bracelets).
  • Keep the lines of communication open.  Family members should ask to speak with local leadership such as a police chief, sheriff or patient advocate if care isn’t being provided in a timely fashion. Insist on treatment, but also understand that jails and prisons have very limited formularies that often contain the cheapest medications. You will need to lobby hard to get formularies to expand, or more practically, negotiate with the jail to use your family member’s own medication supply (there may be barriers to this tactic). Require adequate transition/discharge planning (a call at 11 p.m. telling you that your son is being discharged at midnight with no medication and no follow-up is basically a guarantee for failure).
  • If law enforcement has been trained, develop and share your WRAP (Wellness Recovery Action Plan) in advance.
  • Advocate for crisis intervention training of local law enforcement. Make sure to participate and offer your viewpoint as an individual with mental illness or as a family member.  Personal stories carry incredible weight, especially if delivered face-to-face.
  • Support/advocate/demand the development of mental health courts and drug courts.

I’d be interested in hearing how y’all deal with these challenges and if these suggestions have been helpful.

This is Jackie Feldman’s inaugural blog since starting her volunteer position as Associate Medical Director. She is a family member of near and dear relatives who have experienced depression and psychosis, and the consequences of the stigma of hospitalization, side effects to medicine, and memory loss from ECT. 

She is also a psychiatrist. When she retired in mid-2014, she had spent the last 24 years in community psychiatry, running a public mental health center at the University of Alabama at Birmingham. In this position, she was privileged to work with thousands of individuals with serious mental illness and their family members.  She was a member of the NAMI state board, a federal court monitor for the Alabama women’s prison system, and helped the Department of Justice investigate state hospitals in Georgia.

Thursday, December 11, 2014

Mental Health Investment By States Slowed in 2014

By Jessica Hart, NAMI State Advocacy Manager

NAMI just released a report highlighting what went on in state legislatures in 2014 across the country when it comes to mental health issues. The report, State Mental Health Legislation 2014 shows that investment in mental health services slowed from last year and that when progress was made around specific policy issues much of the legislation felt like it only skimmed the surface.

This year, only 29 states and the District of Columbia increased funding for mental health services. Overall, the mental health care system still simply needs to recover lost ground from the state budget cuts of 2009-2012. But reinvestment is unsteady. See where your state fell in investment this year below.

There were some victories this year. Minnesota, Virginia and Wisconsin were leaders in the country by passing measures that can serve as models for other states in areas such as workforce shortage, children and youth, school-based mental health, employment and criminal justice.

Our policy recommendations for states in 2015 are:

  • Strengthen public mental health funding.
  • Hold public and private insurers and providers accountable for appropriate, high-quality services with measurement of outcomes.
  • Expand Medicaid with adequate coverage for mental health.
  • Implement effective practices such as first episode psychosis (FEP), assertive community treatment (ACT) and crisis intervention team (CIT) programs.

What can you do?

Write to your Governor and State Legislators to let them know that they need to make mental health care a priority.

Connect with your local NAMI to see how you can help advocate for mental health services and supports in your community.

Friday, December 5, 2014

NAMI Applauds Stay of Execution in Panetti Case

Ron Honberg, national director of public policy and legal affairs,
speaking on Democracy Now! (Photo: Screen Capture)

By Bob Carolla, NAMI Director of Media Relations

NAMI and other advocates won a victory—at least temporarily—when the Federal Fifth Circuit Court of Appeals stayed the scheduled execution of Scott Panetti in Texas on Dec. 3, with only seven hours to spare.

NAMI Executive Director Mary Gilberti expressed NAMI’s gratitude to the court, noting that Panetti has lived with severe schizophrenia for more than 30 years.

“The delusions and severe symptoms Mr.Panetti experiences every day have been unremitting since before his crime and have impacted profoundly on the course of this case. 

“In 2007, the U.S. Supreme Court ruled that Texas had applied too narrow a standard in assessing Panetti's competence to be executed and sent the case back for further consideration.  This year, despite no additional competency evaluation, Texas once again set a date for Mr. Panetti's execution. Now, the Fifth Circuit has intervened expressing concerns about the complicated legal questions raised in the rush to execute Mr. Panetti.

“After multiple rulings by courts and statements from individuals on all sides of the political spectrum that the execution of Panetti would offend all standards of modern decency, NAMI urges that the death penalty should be taken off the table once and for all in this tragic case,” Giliberti said.

Ron Honberg, NAMI Director of Public Policy and Legal Affairs has been an  advocate in the case for years, including the filing of an amicus brief with the Supreme Court, coordinating with NAMI Texas.

Three days prior to the Fifth Circuit stay. Honberg published a major op-ed in the Los Angeles Times stating: “Panetti’s execution— particularly as the product of an unreliable legal process—would be immoral and serve no purpose, either in retribution or to prevent similar crimes.”

National and international media interviewed Honberg about the case, including a joint TV interview on Democracy Now! with Panetti’s attorney, Kathryn Kase.

At least 100 people with mental illness have been put to death in the United States and hundreds more are awaiting execution. NAMI has previously published Double Tragedies, a report in conjunction with families of murder victims. The report gave voice to an "intersection" of concerns and made four recommendations:

  • Ban the death penalty for people with severe mental illness.
  • Reform the mental health care system to focus on treatment.
  • Recognize the needs of families of murder victims through rights to information and participation in criminal or mental health proceedings.
  • Families of executed persons also should be recognized as victims and given the assistance due to any victims of traumatic loss.

Proceedings in the Panetti case will continue. NAMI’s long-standing commitment to mental health care and criminal justice reforms will as well.


Tuesday, December 2, 2014

Inspiring Innovation through Connect4MentalHealth Partnerships

By Katrina Gay, NAMI Director of Communications

HUGS Program at NAMI Collier County.

As we celebrate the first anniversary of our Connect4MentalHealth (C4MH) alliance, we are energized in our commitment to work through this effort to help make mental health care a priority as today we announced the recipients of this year’s awards. By profiling and highlighting promising practices for those who live with mental illness, we are poised in our second year to expand and build on our early success as we continue efforts to elevate promising community practices that ensure the best possible care is available for individuals affected by mental illness.

Through the C4MH partnership, we were introduced this year to four outstanding programs, services and organizations that are going above and beyond to help individuals in their communities. 
Along with the other members of the alliance, The National Council for Behavioral Health (National Council), Otsuka America Pharmaceutical, Inc. and Lundbeck, we identified four pillars that we believe would provide the most comprehensive and innovative care to those in need:

  • Early intervention
  • Creative use of technology
  • Integration of services
  • Improved continuity of care

Expanding on the success of our initial effort, this fall we introduced the Community Innovation Awards process to honor four programs that embody those pillars of success. We focused our lens to recognizing programs that presented promise and ambition to advance us past our current understanding of mental health treatment and recovery.

More than one hundred applications were reviewed for the four awards, and today, the winners in each category were announced. As part of this recognition, they will receive a $10,000 award to continue their work and improve their services and will each be partnered with a mentor organization recognized by the C4MH initiative to support their work.

Four Innovators Receive This Year’s Connect4MentalHealth Recognition and Award

We join our C4MH partners in recognizing the winners of our Community Innovation Awards for their efforts and for their commitment. These four initiatives and organizations stand above as examples of innovation and integration as they strive to do whatever it takes to ensure successful lives for those with mental illness.

Early intervention: NAMI Collier County

NAMI of Collier County (Naples, Fla.) provides a comprehensive array of services to support individuals living with mental illness. The organization’s Health Under Guided Systems (HUGS) program, part of a broader mental health initiative known as “Beautiful Minds,” provides universal screenings to support the early identification of behavioral health problems in at-risk children up to age 18. The HUGS program has served more than 3,000 low-income, at-risk youth since 2010.

Creative Use of Technology: Crisis Text Line

Crisis Text Line (CTL) (New York) is the first free, nationwide, 24/7 text hotline for teens experiencing any type of crisis, including mental health-related issues like anxiety, depression and suicidal thoughts. In partnership with select crisis centers across the country, CTL hosts a network of 230 trained counselors (as of November 2014), who provide individualized support to teens using CTL’s software. CTL has exchanged more than 3.9 million messages with individuals in need since launching as a pilot program in August 2013.

Continuity of Care:  Charleston Dorchester Mental Health Center (CDMHC)

Charleston Dorchester Mental Health Center (CDMHC) (Charleston and Summerville, S.C.) provides emergency services, case management, and evidence- based outpatient counseling and psychiatric treatment for children, adolescents, adults and families. CDMHC’s Assessment/Mobile Crisis Program (A/MC) offers the only 24/7 psychiatric emergency response and intake team in South Carolina, responding to critical mental health issues anywhere in the area that would otherwise go un-served. Between July 2013 and June 2014, the A/MC team helped to prevent 2,080 emergency department admissions, successfully diverting many of those patients to outpatient services.

Service Integration: Robert Young Center

The Robert Young Center (RYC) (Moline, Ill.) is a comprehensive community mental health center and a fully integrated corporation within UnityPoint Health – Trinity. The RYC has partnered with the local Federally Qualified Community Health Care (CHC) Center in Iowa and Illinois to provide bidirectional integration of primary and behavioral healthcare for individuals with serious mental illness. Through this model, the RYC has helped integrate health services for individuals with serious mental illness, and has saved the state of Illinois more than $8.2 million in Medicaid costs since 2009.

NAMI is thankful to the many organizations who applied for these awards. The work being done in communities across the country is inspirational  It is through these opportunities that we can continue to work together, to learn from each other and to strive every day to provide the best possible care for all individuals affected by mental illness.

Tuesday, November 25, 2014

What I’m Thankful for at NAMI

By Mary Giliberti, J.D., NAMI Executive Director

This Thanksgiving season, I am deeply grateful for those who share their stories and experiences to bring hope and help to others. I appreciate those who give time and talent so others may find the journey through mental illness a little less difficult.

This week, I worked on the NAMI HelpLine (1-800-950-6264) and gave thanks for all of our NAMI volunteers who answer calls, teach classes and lead support groups. I spoke to a mom in Texas who was exhausted by her daughter’s recent hospitalization and realized that she needed to get some support so she could be a better caregiver to her daughter. I was so thankful for the support group leaders in her community and in communities around the country.

At our Training of Trainers education event each year, I marvel at all of the ribbons that some of our volunteers wear, indicating that they teach and lead multiple NAMI programs. I ask them when they sleep and they invariably tell me that they get much more than they give. I hear the same from NAMI leaders and volunteers at state meetings and our national convention. And I am so deeply grateful for the transformational power of giving that brings healing and meaning to the experiences of individuals and families affected by mental illness.

I am thankful to prominent individuals who speak out at considerable cost to themselves. We appreciate State Senator Creigh Deeds of Virginia, who is advocating for better mental health care so no family will encounter the barriers that he did in seeking help for his son, Gus—barriers that led to Gus’ death late last year.

I am also grateful to Naomi Alexis, the sister of Aaron Alexis, the man who was sadly involved in the Washington Navy Yard tragedy in September 2013. She has spoken out in the national news media, noting that shame and lack of understanding of mental illness hurt her family’s efforts to seek help for her brother despite her requests. She urged families to contact NAMI for information and assistance.

I also deeply appreciate the inspirational stories that bring people hope for recovery and a passion for change. Noted psychologist and mental health advocate Dr. Patricia Deegan shared with NAMI convention-goers in September her personal journey and the critical role of her grandmother, who repeatedly urged her to go to the grocery store as Pat struggled with apathy and her diagnosis of schizophrenia. One day, Pat decided to go to the store and that small step led to another. Now Dr. Deegan develops tools to help people with mental illness communicate with their doctors about their goals and ensure that the treatment serves those goals.

NAMI’s good friend Patrick Kennedy uses his experience with mental illness and substance use to call us to advocate for equality and true parity, reminding us that discrimination against people with mental illness is the civil rights issue of our time.

As we begin the holiday season, I am grateful for the hope that starts with each of us when we bring light out of darkness and despair. I am thankful for all of the life experiences, difficult and inspirational, that have brought us to this place in life where we can be part of the NAMI movement—a movement that holds a hand, squeezes a shoulder, cries in solidarity, claps in celebration—a movement that cares and fights for a better tomorrow for all affected by mental illness. Happy Thanksgiving!