Thursday, August 25, 2011

Behind Bars Without Help: The Mental Health Controversy in Michigan

By Ron Honberg, NAMI Director of Policy and Legal Affairs

The 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.

Thursday, August 11, 2011

Off to College

by Bianca Ruffin, Policy and Legal Affairs and CAAC Program Assistant

When I was an incoming freshman at Virginia Tech, now more than a decade ago, I remember feeling a mix of extreme fear and complete elation over the impending move from home to pursue a higher education. Academically, I had always thrived and I even received a scholarship. To me, this signified I was prepared for college. Unfortunately, it became rather clear-and quite quickly-that this was not the case.

As a teen, I dealt with mental health conditions that culminated in moments where I came close to suicide. I didn't understand what I was feeling and I was unaware of how to ask for the appropriate help. I lived with extreme anxieties that led me to fear the scrutiny of my peers, whether real or merely perceived. To safeguard myself, I became increasingly more reclusive-even avoiding eating in the school cafeteria for two years. I turned all of my focus to my school work and did so well that most people didn't even realize I had a problem. It was a charade that I could only keep up for so long.

When I was 17, I began making doctor's appointments for myself. I snuck in an appointment to speak to someone about my mental health. Whatever was going on in my head, I must've worried my doctor enough because she prescribed medication within 40 minutes of meeting me. It frightened me and I vowed to never reach out to a mental health professional again.

Unfortunately, this thought process did not help me in college one bit. I still had all these feelings to deal with. I was in unfamiliar territory and suddenly more responsible for myself than ever before. College became so overwhelming that my difficulties with anxiety and depression took over and my academics bore the brunt of my struggles. I went from having a scholarship to facing academic probation-almost every semester for three years.

The Cook Counseling Center staff at Virginia Tech took notice and reached out to me, urging me to seek out a type of group therapy the university provided that would teach me study skills and time management. As it turned out, it was much more in-depth than that. For the first time in ages, I didn't feel so alone because I was sitting and conversing amongst a group of peers in similar situations to mine. I also sought out individual therapy provided by the university and the combination helped turn my life around. I will always be grateful to my alma mater for that.

The problems I faced are not mine alone. Other young adults may be facing feelings similar to what I did when I began at Virginia Tech. It doesn't matter if a person is going to college, taking online classes, going on a break after high school, joining the military or pursuing work immediately-if someone is transitioning from a teenager into adulthood and they feel like they need or want mental health treatment, they should. I hope people do not discourage themselves from accessing services the way that I did. It cost me three extremely valuable years of college in which I missed out on internship opportunities, studying abroad and other extracurricular activities that could've helped shape my career.

Sites like StrengthOfUs.org enable young adults to connect and share their stories online by joining a social networking community. StrengthOfUs.org offers a variety of resources on issues important to young adults, including independent living, campus life, employment, mental health issues and much more.

It is important for students, friends and families to know that many colleges and universities provide mental health services or partner with communities to offer adequate mental health care to students. Check to see if the school in question has a student health department and if they include mental health services. If a college or university doesn't cover such services, or a different career path is being taken, try checking with the nearest NAMI State Organization or NAMI Affiliate as they may be able to help locate community mental health services. These days, continuing education has many faces-from online universities to private colleges to vocational schools-and finding what's most appropriate for an individual's situation is key.

I'm glad that I finally took the initiative to seek help. I hit a few speed bumps along the way but I realized there really was hope and I've carried that hope with me ever since. The day that I graduated from Virginia Tech still ranks as one of my highest accomplishments, considering how very close I came to not realizing that goal.

Don't give up on mental health treatment if you're faced with difficulties. Not all doctors or group therapies are the same and not every one will be right for you. I always compared trying to find the right doctor and the right treatment to trying on a pair of pants; it may take several pairs before you find the right fit.

Friday, August 5, 2011

The Voice and Ears of NAMI

by Martha Brick, Manager NAMI HelpLine

I first started at NAMI as a volunteer nine years ago. I was so moved by working on the HelpLine that I stayed to become a staff member. There are now seven staff and 27 dedicated volunteers who are ready to listen and provide help and support to the many thousands of individuals, family members and others whose lives are affected by mental illness.

Almost all of the people working on the HelpLine, myself included, have been touched in some way by mental illness. This ability to form a connection to the people who contact us helps create a bond that gives power to our mission that we advocate here at NAMI. Whether our stories are joyful or sad, our ability to understand the stigma so often strongly associated with mental illness is an important skill we all want to share.

By suggesting ideas from their own experience that have worked for themselves, HelpLine members can connect with callers and change the entire tone of a call. One NAMI HelpLine member used her own personal experience of living with depression by suggesting that the caller might want to try volunteering in her community to help keep from isolating herself. She had been leery at first, but near the end of the phone call, she sounded much more hopeful than she had when the call began.

At times it can be emotionally draining to hear some of the tragic situations people are in. Hearing the struggle of many people sometimes feels as if a weight is being placed on our shoulders, especially when the call has no easy answer. Sometimes something terrible has happened and they ask, "Who should I talk to?," "Who should I go to for help?" or "What's the best thing I can do?" Sometimes, there is no straightforward answer; there is no one right answer. Those are the toughest times: When the desire to help is so strong but you find yourself limited by either your own knowledge and abilities or the situation is merely out of your hands.

At times an event has transpired that cannot be undone. Providing reactive measures can help, but telling people these ideas often doesn't feel like enough; I can't, after all, undo the tragic event and completely fix the situation. But even when I don't feel I have necessarily provided a foolproof solution, I'm surprised. One time I sympathized with a caller, gave him some possible ways of finding legal help and told him to how to contact his local NAMI where he might find people who had been through similar situations. Although I knew I couldn't change what had happened, my help still provided hope and I received the following reply from the person:

I can't thank you enough for responding to my email. I will take your advice- it means a lot to me that someone understands.

Whether he took all my advice or merely benefited from a friendly ear, I was still able to lend help in some manner. Luckily though, even with the occasional positive endings, those hard-to-answer calls are few and far between. The majority of the time we can provide concrete help to callers, and sometimes that help comes when they feel they have nowhere else to turn. Knowing that your support can be life-saving for some individuals makes the emotional struggle of difficult calls much easier to bear.

The temporary strain of stressful calls pales in comparison to the joy I feel when I receive an email, a letter or even a simple "thank you" on the telephone after I've helped someone. Even the thank you from a simple request, such as sending out a packet of information on bipolar disorder or schizophrenia, is cherished because you know that, with your help, that person is one step closer to recovery.

Providing help gives me a sense of purpose, a sense of fulfillment. Knowing that for even a moment I was able to help make that caller feel less alone is invaluable. A few years ago, I directed someone with a missing relative who lived with mental illness to the missing persons section of our website. After several days, I received an email thanking me for my advice and letting me know that the missing relative had been located.

Stories like these keep me passionate about my work here at NAMI. The opportunity to lend a helping hand or listening ear to those in need is what inspires me to come to work every day-and hopefully help make at least one person's day a little less difficult.

If you need help concerning you or your loved one's mental illness don't hesitate to call the NAMI HelpLine at (800) 950-NAMI (6264).