Thursday, March 31, 2011

Marijuana and the Risk of Schizophrenia

By Ken Duckworth, M.D., NAMI Medical Director

The ongoing link between use of marijuana in teens and the increased risk of developing schizophrenia has been further developed in a recent Dutch study published in the British Medical Journal (BMJ) and has re-ignited that area of interest. This study has important public health implications, because our capacity to prevent psychiatric illnesses is severely limited-although a recent small Omega-3 fatty acid study in the Archives of General Psychiatry suggests, in contrast, a protective impact.

The BMJ study looked at young adults who were at risk for psychosis and found that the rate of conversion to the illness was 51 percent with marijuana users-compared with 26 percent of nonusers. This study builds upon a growing body of literature that is making this causative link. This build upon other studies-one of the most interesting to me was a study that made a case for delaying all experimentation---the study found that users before age 15 were 4.5 times more likely to develop schizophrenia than nonsmokers, and those who delayed until age 18 had a risk of 1.6. This strongly suggests that, in addition to abstinence, delaying experimentation results in reduced risk.

Why do some people have no issues with this choice while another subset will never be the same after use? We do not know for sure, but interest has been growing on looking at generic variability. A gene variation in the metabolism of the neurochemicals dopamine may confer much of the risk. Unfortunately, there is not a test to determine if a group of teens will become symptomatic if they experiment. So all teens have an unknown but variable risk-a difficult area to impart wisdom in. It is very hard to be sure what the risk for use of marijuana is for any one teen, but use is clearly risky when you look at a population as a whole. This risk is even worse for kids with a family history of psychosis.

As a father of three teen girls (who also has a history of bipolar disorder with psychosis in my genes), I do my best to share with my kids that, in my view, all drug experiments need to be delayed-or denied. Teens are notorious for not listening to parents and for not delaying gratification, so I can't know what is actually getting through. I suspect it is less than I would like. Developing good decision-making skills is one of the key aspects of growing up, but there is no one way to get there. Learning by experimentation is one way, but as these studies show, the consequences can be much greater than anticipated.

Knowing your family risk (e.g. of schizophrenia or alcoholism or diabetes) is a good perspective to share with your kids so that they know that drugs, alcohol and sugar are even more worrisome for them. What they do with that kind of information is beyond parental control. Like teaching teens to drive a car, you hope to model and impart experience, and then you wait as they learn. I encourage my kids and the people who live with mental illness whom I treat as a doctor to wear seat belts and to avoid drugs. Then like all parents, I hope for the best and do my best to coach as more data comes in on their choices. But there are no guarantees. In neurobiology--just like with driving vehicles--all we can do is work to lower the chance of complications.

Thursday, March 24, 2011

Pat Quinn's Story

Many people report that sharing experiences is a vital aspect of therapy. In addition to some form of medication, talk therapy has been shown to increase the effectiveness and success of treatment. NAMI offers programs to individuals living with mental illness (NAMI Peer-to-Peer) and their families (NAMI Family-to-Family) to help provide a setting not only for education about mental illness but a place to share their thoughts and experiences.

Sometimes NAMI will ask its members to share stories about their lives and how they handle living with mental illness. Below is a story from Pat Quinn, who has lived with schizophrenia for more than 20 years. Pat tells a story a story of hope and recovery and how he was able to gain control of his illness and of his life.

Pat Quinn's Story

By Pat Quinn

I remember when I was about 14 or 15 years of age, I had the world by the tail. I was on the basketball team. My classmates were all my friends. I was enjoying my life because it was the way I thought life was supposed to be. The world was there for me to grab and I was going to grab it.

Flash forward a few years to a very disturbed young man who was suddenly hit with delusions, paranoia and hallucinations. My family and I had no idea what was going on with me. Following my disastrous first quarter at Ohio State University, my life revolved around hospitals, doctors, a search for a proper diagnosis and the medication that would allow me to function without the horrible side effects that the old antipsychotics caused for me. My former friends all abandoned me except one. My recovery began with the total support of my family. With a large family (three brothers and three sisters), that meant a lot of support.

Although there was a time when I never thought I would hear myself say this, I see my illness as a learning experience. It has given me a compassion for other people's pain and the gift of putting my own pain in perspective. It has enabled me to bring some joy into some lives that, otherwise, I would not have been able to touch.

As Americans, we have a preconceived idea of recovery. When we are young, we fall off our bike and scrape our knee or elbow and what do we do? Run and tell Mom. Mom applies a little Neosporin and maybe a band-aid and pretty soon we are good as new. When we are teenagers we develop a headache from too much school work-what do we do? Take an aspirin, right? And pretty soon we are as good as new. When Dad falls and breaks an arm, there is a cast and maybe some surgery but within a relatively short amount of time, Dad is back running the farm.

One of the most difficult challenges faced by an individual living with mental illness and his family is to change this concept of recovery. Recovery from mental illness is a long and difficult process.

There were three essential elements to my journey of recovery: one, getting out of my bedroom and socializing, two, getting on the right medication and three, using my dad in helping with my faulty perception of reality. It is very important for someone with my illness to find a person they can trust, and believe, to give them a reality check.

I believe God plays an important role in my recovery. God says in Jeremiah 29, "I know well the plans I have in mind for you, plans for your welfare and not for your disaster, plans to give you a future full of hope. Then you will call to me. You will come and pray to Me and I will answer you .You will seek Me and you will find Me and I will restore your fortunes." He answers in Isaiah 30. "The Lord will make you go through hard times, but He Himself will be there to teach you, and you will not need to search for Him anymore, if you wander off the road to the right or the left, you will hear His voice behind you saying, here is the road, follow it." These words of scripture give me hope and strength. God has a plan for my life.

The caring professionals at a mental health services organization have been a great help to me. I have learned to have a sense of humor concerning my illness. I once asked a mental health professional, "Do you know which Christmas song is a schizophrenic's favorite?" The answer-"Do you hear what I hear?" I am a firm believer that work raises your self esteem and fattens your pocketbook. I lead a support group three times a week. This time I hope they don't keep me. I also work at Beacon Place, write articles for mental health newsletters and talk to law enforcement about NAMI's CIT programs.

Many people think when school is out, education ends. Not true! Education continues every moment you are alive! I have a degree in Social Work from Zane State College and a Specialized Study Degree from Ohio University, both associates. I help mom in my spare time, which gave me the incentive to move out! I have lived in my own apartment for 10 years.

Pearl S. Buck stated, "We learn as much from sorrow as from joy, as much from illness as from health, from handicap as from advantage-and, indeed, perhaps more."

I tell you today that there is hope. With new medications, therapy, the will to recover and the immense support of my family, I am reclaiming my life. It hasn't been easy and there is still a long bumpy road ahead, but I am determined to completely take control of this illness. I take my medication every day. I am certainly not healed, and my life is not perfect, but I run the illness, the illness does not run me.

Pat Quinn and his family have formed a band called the Quinn Family Singers. Every year they hold a concert, the Quinn Family Bash, to raise awareness of mental illness and the hope of recovery. This is its eleventh year. If you are in the Columbus, Ohio area, Pat and his family would like to extend an invitation to you to attend on Friday, April 8, in Zanesville, Ohio. For more information, check out the Quinn Family Bash Facebook page.

Thursday, March 17, 2011

NAMI’s Special Report: Mental Health Cuts

by Michael J. Fitzpatrick, Executive Director

We live in dangerous times.

That’s the message NAMI has delivered this month in a special report, State Mental Health Cuts: a National Crisis, which has received widespread media attention.

The report provides the first comprehensive look at how deep states have been cutting mental health budgets, based on tedious examination of public documents. For tens of thousands of people, the safety net for people living with mental illness is being shredded.

Two thirds of states have made cuts in mental health care in the last three years, even as need has increased because of the nation's economic distress and troops returning home from war. Nineteen states managed to increase mental health during the same period, but for 12 of them, increases totaled only four percent or less.

In all states, the budget squeeze is getting worse in part because of the expiration of enhanced federal Medicaid support in June 2011. Oregon, for example, increased mental health spending by $57.4 million from 2009 to 2011—23 percent. But it will lose $156 million because of the expiration. The report provides much data that helps to explain the crisis, how we got here and where we are headed.

Budget cuts aren’t just about data.

In real, human terms, lives are at risk.

Mental health cuts mean that clinics, crisis centers and hospitals close. Admissions are frozen. Emergency room visits increase. Where services remain, staff is cut, wait times for appointments are stretched and when people finally are seen, it's for shorter amounts of time.

People don't get the right help in the right place at the right time. Communities suffer and families break under the strain. Some people end up living on the street or dead.

Two months ago, the news media focused intensely on the nation’s mental health care system in the wake of the Arizona tragedy in which a young man with symptoms of mental illness killed six persons and wounded U.S. Representative Gabrielle Giffords and 12 others.

As was the case with the Virginia Tech tragedy in 2007, national attention is too often fleeting, soon moving on to another topic. Less visible tragedies take place everyday in our communities—suicides, homelessness, arrests, incarcerations, school drop-outs and more. The service system in many communities is fractured and simply not accessible to all in need.

NAMI’s report focuses primarily on non-Medicaid mental health services, which are financed with state general funds and provided through state mental health agencies. It is the part of the mental health system that state legislatures have the most control over.

Medicaid funds many essential community treatment and rehabilitation services. Hard decisions will have to be made regarding general funds and Medicaid expenditures in legislative sessions that are happening now in your state and mine. Without your help it is unlikely that mental health will escape more of the budget ax.

The time is now to talk to your elected policymakers. These are dangerous times. We have not seen cuts like those outlines in this report in our lifetime. You have the power to move your elected officials. In fact, we have more power than we know. In the wake of the report, please be an advocate and speak out.

You can do so by clicking here to send a message to your elected officials. Write letters to the editors. Post media stories highlighting the mental health budget crisis on your Facebook page and on other social media.

Save mental health. No more cuts.

Give us back our lives. Give us back our futures. Tell everybody you know.

Friday, March 4, 2011

Coping Strategies for Grandparent Caregivers

By Sarah Heckenberg, HelpLine Staffer

In my work at the NAMI HelpLine, I have come to realize the important role that grandparents play when mental illness affects the family. Normally, grandparents play a special, dynamic and important role in the lives of their grandchildren, frequently providing unconditional love. They are often a link to the family’s history or act as a buddy, hero, mentor or role model. When serious mental illness occurs in the family, however, there are times when grandparents have to step into a new and unexpected role—raising their grandchildren while caring for their adult child living with a mental illness. In this case, grandparents can become the family anchor.

My conversations on the HelpLine have introduced me to grandparents who are juggling the needs of an ill child with the stability and structure their grandchildren require. At the same time, they must attend to their own emotions—the grief of losing the existing family structures as well as grief for the losses their child is experiencing.

Grandparents may not know where to turn for basic information, support, counseling and respite. They must confront privacy laws that keep them shielded from a loved one’s mental health care. These seniors are left to raise children in a world that is very different from the one that existed the first time around.

Grandparent caregivers should try to balance caregiving responsibilities with self-care strategies as outlined below.

  • Get legal advice about custody and financial planning. While having only an informal agreement with your child may feel more comfortable, in a crisis you may face challenges enrolling grandchildren in school, obtaining medical and mental health services or insurance. State laws vary, but often temporary custody or obtaining the status of a foster parent, will give you a measure of legal security that will help you maintain a balance of power between yourself and the child’s parents. Find more information about legal referrals on the NAMI website.
  • As they will allow, keep the lines of communication open with your child. Let him or her know that they are you are all partners in the grandchildren’s care and their own mental health care. However, stability for the grandchildren is the top priority. Bouncing back and forth between a grandparent’s house and that of an unstable, relapsing parent is very disruptive. When this happens children get confused about where they belong and fearful that their living routine will be disrupted.
  • Take care of yourself both physically and emotionally. Go to a support group or talk to a counselor to find coping strategies for the fatigue, anxiety, shame, fear and frustration that may come up from time to time. And—even with your new busy schedule—try to make time for regular exercise and health care. Keeping yourself in good health is imperative to the success of the family.
  • If your adult child is willing, ask him or her to prepare a psychiatric advance directive (PAD). This would allow them to have instructions in place regarding future mental health treatment or allow you to make decisions about their treatment should they become unable to do so.
  • If they will not prepare a PAD, be sure to have a plan for dealing with acute episodes of instability. Know where to find help, whether it be a crisis intervention team or by calling 911. Your local NAMI affiliate may be able to help you identify resources for managing a crisis.

As you face the challenges of this new role, remember to put together a network of support. You may have to educate those around you about what you are doing so that your efforts will be supported and respected. Be sure to stay informed about mental illness. Create a network of support that includes family, friends, church family and others who are going through similar situations and can truly relate. The NAMI HelpLine can help you identify resources in your community, such a support groups, as well as educational opportunities like NAMI’s Family-to-Family program.

Finally, several grandparents have mentioned that while this new family dynamic can be challenging, it can also be highly rewarding. HelpLine callers have shared that they receive comfort knowing that their grandchildren are safe with them. They learn over time that they have strength that they never knew they had and realize there is no greater gift than the love and respect of their grandchild as they watch him or her evolve into healthy, happy adults.