http://azstarnet.com/news/opinion/editorial/article_a1372367-3bd9-5f49-8ea7-91fb0d25e4df.html

Local pyschiatric beds are commonly filled, but I wasn’t aware that psychiatric beds in our prison system are also filled.  Hummmmmm, I wonder what’s going on? Is it possible that we’re starting to see the results of continued budget slashes to mental health care in our state?  Or, is it because more people are becoming mentally ill? I think it’s the former.

Let’s look at some statistics.  One in four families are effected by mental illness in a given year and at least 10% of the population lives with a serious mental illness like schizophrenia or bi-polar disorder.  If Tucson’s population is one million, then that’s 100,000 people right here in the Old Pueblo.  Some are being successfully treated and some are not.  Many are in denial about their illnesses and don’t know about the high success rates of treatment – sometimes as high as 90%  do achieve mental health recovery.  But, not without proper treatment that can include medication, therapy and a strong support system.

Last time I checked there weren’t that many psychiatric beds in Tucson.  Even with the new psychiatric crisis hospital opening soon there won’t be new beds as it will only replace the currently existing beds at UPH.  Without more funding I don’t see any growth for new tratment facilites, but unfortuanately I do see growth in the prison facilities.  It seems like that’s one of the few areas of growth in our state.  Some legislators in Phoenix have stated that it’s time for families and loved ones to “step up” and take care of those struggling with menta illness. I wish it were that simple.

But, I’m glad to see that the Arizona Daily Star is initiating this dialogue.  Hopefully some inovative solutions will come about…….and they won’t cost anything!

So, even if President Reagan was a great man, it was during his presidency that treatment for our nations most vulnerable went from bad to worse.  The following article is a reprint because I found it expresses my concerns adequately and one month after the horrible shootings in Tucson, people seem to be more receptive to learning about this issue.

Ronald Reagan, Mental Health, and Spin . . .

Man Behind the Myth

By Phyllis Vine

For the next twelve months, the Ronald Reagan image machine will be turning out countless vignettes of the nation’s 40th president, the man neighbors called “Dutch.” He will be described as no-nonsense yet kindly, remote but avuncular, a movies-star-turned-politician, and remembered as a local lifeguard rescuing people in troubled waters. With dashing good looks, a sonorous tone that became the voice of General Electric, and an affable smile, even those who disagreed with his policies will say he was genuinely kind-hearted.

So what did this mean practically for policies about mental health? Here we need to  ask how the image departs from the reality.

Contrary to the spin about trimming government, which he called “the problem,” we all know he oversaw increases in federal spending that exploded the national debt, and grew the size of the government he impugned. Another part of the reality, rarely the image, is how he attempted to savage the  entitlement system and roll back supports for people with a mental illness.

When Ronald Reagan arrived in Washington, he inherited the Mental Health Systems Act of 1980. One of the last achievements of Pres. Jimmy Carter, this was passed by the House 277 to 15, in the Senate, 93 to 3. With as many critics as there were special interests, it was far from perfect. Yet it expanded the federal government’s commitment to services, to research, to training professionals, and to patient rights. It identified stigma as an impediment to seeking and receiving services.  It established parity in Medicaid and Medicare. It recognized the link between physical health and mental health. And it dedicated $800 million over 4 years to redress the gross neglect of the commitment to mental health in earlier administrations.  In short, it moved an agenda that minimized homelessness, the reliance on expensive nursing homes, jails and prisons, and one that to more hopeful choices for those who needed help.

The Mental Health Systems Act was a milestone. It came on the heels of four years of hearings and a presidential task force benefiting from First Lady Rosalynn Carter’s active involvement.  Philosophically it affirmed Pres. John F. Kennedy’s Community Mental Health Centers, an attempt to thwart hospitalizations. It fit into the safety-net values championed by Pres. Lyndon B. Johnson with the passage of Medicaid and Medicare.

Still, by 1980 the nation needed more for those with a chronic illness. Many failures accompanied the attempts to close the miserable hospitals, often little more than warehouses, to help patients succeed in the community. The neglect of government support conspired to form a patchwork system with notable gaping holes. A 1977 GAO report said, “Government needs to do more.”  Congressional hearings in 1979 re-affirmed the need to strengthen impoverished services and the failed policies.

Although not perfect, the Mental Health Systems Act responded to these problems. For the first time since the National Institute of Mental Health became part of NIH in 1949, mental health was front and center in federal policy.

Then came Ronald Reagan. Within a month, the Office of Management Budget announced it would curtail the budget of the National Institute of Mental Health (NIMH), phase out training of clinicians, interrupt research, and eliminate services.  Cutbacks to staff followed; chaos ensued. Experienced people left, others remained in government service but were forced into menial jobs. Trained professionals were reassigned to labs to dissect dead rats; science writers were reassigned to typing pools. The Mental Health Systems Act would disappear. Instead, the Omnibus Budget Reconciliation Act (1982) would merge money for mental health programs into block grants, and with fewer dollars going to the states.  They had the discretion to use them however they saw fit, often to perpetuate programs already deemed problematic. The pretense for all this was the president’s concept of a “new federalism.”

“Many of our dreams were gone,” wrote Rosalynn Carter in Helping Someone with Mental Illness. “It was a bitter loss.”

This could have been enough, but it was not. Pres. Reagan attempted to restrict criteria for determining eligibility for SSI, thought to be a safety-net. Nearly 2.6 million people were receiving insurance because their disability prevented them from working. New evaluations for eligibility led to widespread terminations. Of those who were terminated, about half appealed, and in two-thirds of the cases, administrative law judges reversed the decision. The process took nearly a year, during which time they, and their families, were deprived of promised help.

About 340,000 people would lose their insurance before public outcry and courts halted the process. Sen. John Heinz, a liberal Republican from Pennsylvania, told the New York Times the policy was a “meat grinder.” Sen. Carl Levin, Michigan Democrat, said the reviews caused “unconscionable suffering.” In June 1983 HHS Secretary Margaret Heckler announced she would halt suspending about 135,000 people until the government could improve standards for “functional psychotic disorders.”

By then, however, the nation was doubting the president’s kindness. A1982 Louis Harris survey found nearly three-quarters of the respondents said the president was hard-hearted toward the poor.

These are the facts. And they add up to a roll-back of opportunities for people already struggling with a psychiatric illness.  Whatever spin accompanies the birthday celebrations for Ronald Reagan, we should not create yet another mythic figure, larger than life, more pure than Ivory soap, or with qualities he did not have.  He may have portrayed himself as everybody’s lifeguard, but he seemed willing to let people with a psychiatric illness sink.

Originally appeared in MIWatch.org

In response to this public discussion and request for education, Community Partnership of Southern Arizona (CPSA) has partnered with the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS) and the National Council for Community Behavioral Healthcare (National Council) to launch a statewide, extensive training campaign in Mental Health First Aid.

“People in our community want to take positive action after this tragedy,” said Neal Cash, President and CEO of CPSA. “Learning more about mental health and how to recognize and respond to possible problems is one way of doing that, one that could be of long term benefit to everyone in our community.”

Mental Health First Aid is a novel, evidence-based public education program. The program teaches average people a five-step process to assess a situation, select and implement appropriate interventions, and help a person in crisis or who may be developing the signs and symptoms of mental illness. The groundbreaking training equips people to provide initial help until appropriate professional, peer or family support can be engaged. Participants also learn about risk factors and warning signs of specific illnesses such as anxiety, depression, psychosis and addiction.

“None of us should underestimate the importance of early identification and intervention with an emerging mental health or substance abuse problem,” said Laura Nelson, M.D., Deputy Director at ADHS/DBHS. “Just as with diabetes or high blood pressure, the earlier the problem is recognized and addressed, the better the outcomes can be. It is also true that people who know the individual best can recognize the early signs and symptoms and can help that person get the treatment and support they may need.”

CPSA has been involved with Mental Health First Aid since 2009 and is now working to expand program offerings in the state.

CPSA will host an Instructor Training, conducted by the National Council, to increase the number of certified instructors who can offer the program throughout Arizona. The Instructor Training takes place the week of February 28-March 4, 2011. CPSA and the other Tribal and Regional Behavioral Health Authorities from around the state will identify thirty (30) future instructors to participate in this event.

The National Council has worked closely with CPSA and ADHS/DBHS to quickly mobilize its nationwide resources to support the Arizona trainings.

”People in the family or community often don’t connect a person with mental illness to care because they don’t know how,” said Linda Rosenberg, President and CEO of the National

Council. “Mental Health First Aid teaches people how to offer concrete help. This early intervention can prevent tragic consequences and save lives.”

CPSA will offer a Mental Health First Aid training in early March for organizations and individuals most affected by the events of January 8. CPSA and the National Council will provide instructors for these sessions.

CPSA also will schedule trainings that will be open to the general public. For information, see the CPSA Web site at www.cpsa-rbha.org, call (520) 618-8860 or e-mail Prevention@cpsa-rbha.org.

CPSA, founded and based in Tucson, has overseen publicly funded behavioral health services in Pima County since 1995 and currently serves close to 30,000 members. CPSA receives funding from ADHS/DBHS, the Arizona Health Care Cost Containment System (AHCCCS), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Resources for mental health and trauma issues
following the January 8 shootings

• Tucson Tragedy Support Line: (520) 284-3517, available at no cost to anyone in Pima County who is struggling to deal with these events, or who wants information on how to help themselves or others cope. Staff at this number also will provide referrals to community behavioral healthcare providers and other services such as help coping with trauma and help talking with children and teens about tragedy.
• CPSA Web site (www.cpsa-rbha.org), including links to information from trusted sources on how to talk with children and teens about a tragedy, self-care in the wake of trauma and related topics.
• Community-Wide Crisis Line: (520) 520-622-6000 or 1-800-796-6762. Available 24/7 for anyone having a behavioral health crisis. Hearing impaired individuals may call the Crisis TTY Line at 520-284-3500 or 1-888-248-5998.
• Walk-in behavioral health crisis services: SAMHC, 2502 N. Dodge Blvd. (enter from Flower Street, which is parallel with and just north of Grant Road). If possible, please call the Community-Wide Crisis Line before going to SAMHC.

ADHS/DBHS and Magellan Health Services of Arizona have established a hotline for people outside of Pima County who need help in dealing with this tragedy: 1-800-203-CARES (1-800-203-2273).

An additional resource for people who are concerned about their own or someone else’s mental health is the “Mental Health Checklist” on ADHS/DBHS’ Web site, www.azdhs.gov

Undiagnosed depression is the number one cause of suicide, yet few people know what the symtoms are and even fewer seek treatment.  Each year nearly 26,400 teens in Arizona attempt suicide…….and that number reflects only the attempts that end up in an emergency rooms and/or require treatment by a professional! Many times the family is able to do something to treat the effects of the attempt (induce vomiting, CPR, etc.) without anyone outside the home ever being notified.

Education and awareness is crucial and O.P.T.I.O.N.S. (Offering Parents and Teens Information on Needless Suicide) is a free depression education and suicide prevention program offered to Arizona high schools by Mental Health America of Arizona. The successful educational program has been operating in the Phoenix area for several years and it is now available in Southern Arizona. When evaluated, 85%  of the students said the program provided helpful information on clinical depression and were able to identify at least 5 of the symptoms, and 90% felt that schools need a program like this.

Mental Health America of Arizona (MHAAZ) is a 501(c)3 non-profit organization providing leadership to address the full range of mental health, illness and wellness issues in Arizona. We are dedicated to improving care, treatment and recovery for people with all types of mental illness through support services, education and advocacy.

For more information or to schedule presentations in your child’s school, please contact Susan Moreno at:  smoreno@mhaarizona.org

Recent articles on teen depression and suicide:

http://health.usnews.com/health-news/family-health/childrens-health/articles/2010/10/04/adhd-depression-and-suicide-how-parents-can-keep-children-safe.html

http://www.huffingtonpost.com/dr-harold-koplewicz/gay-teen-suicide_b_760093.html

According to recent press releases, Brewer’s involvement in state politics started with her activism pushing better treatment and care for our state’s seriously mentally ill population.  Her son is diagnosed with a serious mental illness and has spent time in-patient at the Arizona State Mental Hospital.  As a Mom with a son who had a serious mental illness, I certainly can understand her motivation to try and make a difference.  Stigma continues to be pervasive and some still believe it’s the Mother’s fault when a mental illness presents itself.  Character flaws, laziness, and violent behavior automatically get labeled as mental illnesses when medical science knows that these illnesses are actual biological brain disorders that are treatable.  With proper medical treatment and support people have and do live in recovery.

Given all the positive news about the potential for recovery, why in the world has Govenor Brewer decided to not only distance herself from the issues, but supported drastic slashes to budgets that assist people with mental illness?  I understand that we need to cut our spending, but why cut spending for our state’s most vulnerable?  In the long run, as Gov. Brewer knows, we will end up spending more for emergency room visits, hospitalizations and incarcerations for ignored people living with a treatable mental illness.  With all the publicity and nation wide visability she has created over the last several months, it seems a shame to me that she hasn’t used the opportunity to advance anti-stigma and the value of  proper treatment to some of our states most vulnerable…….including her son.  Is the illegal immigraton bandwagon the only issue she can focus on now?

But when a person suffers from a psychotic break in the earlier stages of serious mental illness and needs to be hospitalized or even when a person who has been living successfully in mental health recovery and experiences a set back, the support system vanishes and the person can be left to climb out of the hole on their own.  No cards and flowers are sent.  No help with day to day chores  is offered.  Rarely are there concerned phone calls asking how the family is holding up.

Why is that?  Is it because mental illness is so frightening to some people that they don’t want to discuss it?  Is it because they still think mental illness and/or a mental health crisis is not as devastating as a chronic physical illness or physical health crisis?

When my son was diagnosed with schizophrenia, many of my “friends” seem to disappear.  While my daughter and I were dealing with the most intense period of our lives, many seemed to look the other way.  As a parent I experienced unbearable grief and pain.  Gone was the brilliant young man who had plans of attending Harvard.  Left in his place was a person that had delusional thoughts that kept him incapable of caring for himself.  His first hospitalization was a rude awakening for all of us.  Psychiatric care at the hospital was not effective and when he was discharged after a few weeks the only advise I got was to “buy him some earphones so he could listen to music and drown out the voices.”  He was literally drooling from being over-medicated and started experiencing tremors that continually ebbed and flowed over the next years.

Fortunately, after several weeks a medication “cocktail” was created to give him some balance and give us some optimism that he would get better.

He did get better and although he never went to Harvard, he began a new life as a forever changed young man.  His old friends never came back around……perhaps they were too scared, and all of my support system was there again for me.  Unfortunately my son died by suicide five years later.  My friends and family were there for us then and continue to lovingly support us today.

The moral of this blog?  When someone with a psychiatric illness needs to be  hospitalized, they need your care and support the same as they would if they had pneumonia or were injured in an accident.  Trauma is trauma, whether it be mental or physical and loving care and support are essential in the healing process.

Some have struggled for years to find the right medication “cocktail” and now the rug is being pulled out from under them. They won’t be able to afford the newer, more effective drugs that can cost thousands of dollars a month and they won’t have a therapist or case manager monitoring their changes.  Many are the “working poor” who make just a few too many dollars to qualify for the the state’s medicaid system, AHCCCS;  also  in jeopardy of loosing millions.

Yes, it looks like it could get even worse since  Congress may not extend the states Medicaid assistance. Medicaid assistance from the federal government was voted against by the U.S. Senate last week.  Without it, Arizona’s health care budget falls further into the red.  In a letter to Arizona members of Congress, Governor Brewer complained that “(I)t has become clear that Congress does not have the will to assist states in addressing the very problem that it created.” Based on her combative attitude displayed recently all over the media, I will be surprised if any “Fed” will pay attention.

I guess you can tell I’m angry, but instead of complaining, I wish she would use the same “take charge” attitude towards our state’s health care system as she does toward our illegal immigration issues where no expense spared is the mantra.  We’re soon to be using our local city and state law enforcement officers to enforce federal immigration laws.  Plus, there always seems to be more money to build more prisons to house the additional “illegal immigrants.”  What about using money to house and treat some of our state’s most vulnerable citizens?

The Obama administration launched a new health care reform website yesterday that provides information to the public on “the full range of public and private health insurance plans” that fits their specific circumstances. Mandated by the health reform law, the site will show users how their options “will change in coming years” as the law takes effect. – The Progress Report, July 1, 2010

Extension of the 2009 Poverty Guidelines Until at Least May 31, 2010

[ Federal Register Notice, January 22, 2010, (initial extension of guidelines until March 1) — Full text ]
[ Prior Poverty Guidelines and Federal Register References Since 1982 ]
[ Frequently Asked Questions (FAQs) ]
[ Further Resources on Poverty Measurement, Poverty Lines, and Their History ]

Congress has taken action to keep the 2009 poverty guidelines in effect until at least May 31, 2010.

Congressional actions on this matter have been in response to a decrease in the annual average Consumer Price Index (CPI-U) for 2009, projected during 2009 and announced on January 15, 2010 (see http://www.bls.gov/news.release/archives/cpi_01152010.pdf, Table 1A).  In the absence of legislative change, this decrease — the first since the poverty guidelines began to be issued in 1965 — would have required HHS to issue 2010 poverty guidelines that were lower than the 2009 poverty guidelines; that would have led to the “reduction in eligibility” referred to in the Congressional explanatory language quoted below.  Congress took several actions on this matter:

1.  On December 19, 2009, the Congress enacted and the President signed the Department of Defense Appropriations Act, 2010 (Pub. L. 111-118), which included a provision affecting the poverty guidelines.  Section 1012 of this law (as originally enacted, before subsequent amendment) stated that:

Notwithstanding any other provision of law, the Secretary of Health and Human Services shall not publish updated poverty guidelines for 2010 under section 673(2) of the Omnibus Budget Reconciliation Act of 1981 (42 U.S.C. 9902(2)) before March 1, 2010, and the poverty guidelines published under such section on January 23, 2009, shall remain in effect until updated poverty guidelines are published.

The Congressional Record (House) (December 16, 2009, p. H15370) provided the following explanation of this Congressional action in Pub. L. 111-118:

Section 1012 includes a provision to freeze the Department of Health and Human Services poverty guidelines at 2009 levels in order to prevent a reduction in eligibility for certain means-tested programs, including Medicaid, Supplemental Nutrition Assistance Program (SNAP), and child nutrition, through March 1, 2010.

A Federal Register notice about this initial extension of the 2009 poverty guidelines was published on January 22, 2010. (See Federal Register, Vol. 75, No. 14, January 22, 2010, pp. 3734-3735.)

2.  On March 2, 2010, the Congress enacted and the President signed the Temporary Extension Act of 2010 (Pub. L. 111-144), which included a provision affecting the poverty guidelines.  Section 7 of this law amended Section 1012 of the Department of Defense Appropriations Act, 2010, by replacing “March 1, 2010” with “March 31, 2010”.  The effect of this was to extend the 2009 poverty guidelines until at least March 31, 2010.

3.  On April 15, 2010, the Congress enacted and the President signed the Continuing Extension Act of 2010 (Pub. L. 111-157), which included a provision affecting the poverty guidelines.  Section 6 of this law amended Section 1012 of the Department of Defense Appropriations Act, 2010 (as amended by Pub. L. 111-144), by replacing “March 31, 2010” with “May 31, 2010”.  The effect of this was to extend the 2009 poverty guidelines until at least May 31, 2010.

We will provide updated information about the post-May-31 period when it becomes available.

The 2009 poverty guidelines figures that will remain in effect are given below.

NOTE:  The poverty guideline figures below are NOT the figures the Census Bureau uses to calculate the number of poor persons.
The figures that the Census Bureau uses are the poverty thresholds.

The 2009 Poverty Guidelines for the 48 Contiguous States and the District of Columbia
Persons in family	Poverty guideline
1	$10,830
2	14,570
3	18,310
4	22,050
5	25,790
6	29,530
7	33,270
8	37,010
For families with more than 8 persons, add $3,740 for each additional person.

2009 Poverty Guidelines for Alaska
Persons in family	Poverty guideline
1	$13,530
2	18,210
3	22,890
4	27,570
5	32,250
6	36,930
7	41,610
8	46,290
For families with more than 8 persons, add $4,680 for each additional person.

2009 Poverty Guidelines for Hawaii
Persons in family	Poverty guideline
1	$12,460
2	16,760
3	21,060
4	25,360
5	29,660
6	33,960
7	38,260
8	42,560
For families with more than 8 persons, add $4,300 for each additional person.

SOURCE: Federal Register, Vol. 74, No. 14, January 23, 2009, pp. 4199–4201

---

Go to Further Resources on Poverty Measurement, Poverty Lines, and Their History

Go to Frequently Asked Questions (FAQs).

Return to the main Poverty Guidelines, Research, and Measurement page.

Last Revised:  04/19/10

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“Thinking outside the box” was a phrase heard repeatedly and for many attending that answer was not enough to calm their fears. For a population accustomed to difficulties  finding appropriate mental health care that particular phrase has become a mantra.

One question about how the non-title XIX residents will be covered if they are currently in the Arizona State Hospital was never answered.

Of major concern to me is the misguided thought by some in Phoenix that people that are currently taking some of the more expensive, newer anti-psychotics, mood stabilizers and anti-depressants  can now be administered some of the older, less expensive drugs to save money.  What he forgot to say when talking about the older, less expensive medications is that they don’t work for some people.  Hence the reason for being prescribed the newer, more effective medications. Plus, the newer medications don’t have some of the debilitating side effects  that the older medications cause.  (Although, I must admit all of these medications do have some sort of negative side effect)

Even when a certain medication is successfully treating some of the symptoms today,  next week, next month or next year it may loose it’s efficacy and a new medication will need to be introduced; most likely a newer drug.

The state’s crisis system which had up until recently seen some positive advances is now experiencing limited funding as well.   It was suggested at the meeting that family members “step up” to the plate and do what they can to cover the shortages like manning all night crisis phone lines, etc.  on a volunteer basis.  Hum…….I guess that might work if their loved one isn’t in a crisis because their newly prescribed medication is working!

NOT… “just another walk”

As most of you know, we just had a very successful NAMIWalks in Tucson on March 27th. NAMIWalks Southern Arizona is the single biggest fundraising, awareness building event in this area promoting advocacy, support and education for people with mental illness and their families. A NAMI associate and friend of mine manages the Walk in San Diego that is scheduled for this weekend and was able to assist in coordinating a simultaneous walk in Iraq. Please read the following article from the NAMI website:

Army Troops in Iraq to Hold 5K Run to Promote PTSD Awareness and Ending Stigma of Mental Illness

April 14, 2010

Arlington, Va. — An Army platoon in Iraq will run five kilometers (5K) in full body armor on April 17 to raise awareness about posttraumatic stress disorder (PTSD) and the need to end stigma surrounding mental illness.

Forward Operating Base Echo in ad-Diwaniyah, Iraq will hold the event at the same time the National Alliance on Mental Illness (NAMI) affiliate in San Diego holds a NAMIWalk at a more leisurely pace.

NAMI San Diego will move out Saturday at 8:00 a.m. (PT) while 3rd Platoon, Baker Company of the 3rd Infantry Division’s 3rd Heavy Brigade Combat Team and others begin the 5K run at 19:00 hours (Iraq time).

“This is an incredible event,” said NAMI National Executive Director Mike Fitzpatrick. “NAMI is honored that Army soldiers in a war zone have synchronized their commitment to public education with our San Diego affiliate.”

“NAMIWalks across the country are about hope, recovery and community. They are fun events, but they support serious work.”

“As the U.S. Army has taught me, not all wounds are visible,” said Army specialist John Bell, who is organizing the Iraq event.

“As tough as a U.S. service member may be, many still suffer the effects of having endured life in a combat zone. The most prominent effect is PTSD. Not every combat-deployed soldier has been in a firefight, or had their vehicle struck by an IED, or even lost a friend by an enemy engagement. But the trauma they endure is nonetheless significant to them.”

* One in six veterans of Iraq and Afghanistan is affected by PTSD, depression or anxiety. Only about half seek treatment.

* One study has reported that 25 percent of Iraq veterans seen at veterans’ hospitals receive mental health diagnoses.

* Approximately 40 percent of homeless veterans have some form of mental illness.

For two years, NAMI San Diego development and events manager, Annie Dunlop told Bell, a friend, about NAMIWalks. Deployed in Iraq, he was unable to participate. This year he didn’t want to miss out. The 5K will honor NAMI San Diego’s work and NAMI efforts to help veterans nationwide through its on-line Veterans Resource Center and other programs.