Another person has joined the campaign to end discrimination against people with mental illness.  Glenn Close, whose sister has bi-polar, is speaking out about removing stigma and creating hope for people living with these illnesses.

Close has appeared on numerous television talk shows with her sister, Jessie, who lives in Montana.  Jessie’s son is also living with schizophrenia and they credit NAMI with giving them the strength to speak out.

They star in a new public service announcement that is airing on several major market television stations.  Ron Howard, who made the movie “A Beautiful Mind”, directed the PSA “film shoot” in New York’s Grand Central Station.  The campaign has received broad support from the mental health community.

Earlier this year, Close helped lead Maine’s NAMI Walks near her home. The campaign Web site, www.bringChange2Mind.com  has had over 80,000 visitors to date and its Facebook community has over 3,000 friends.

see the video here:  “http://blip.tv/play/hMYXgafJfwI“

It’s already starting…..including right here on the Tucson Citizen site……..the man, Major Nadil Malik Hasan was “crazy.”  If you have read any of my blogs before, you know how important it is to me to try and create a world where people living with mental illnesses do not feel stigmatized and one of the first steps is to stop using horribly discrimating terms like “crazy” or “crazed.”  Yes, I agree that someone who goes on a rampage killing 12 people and wounding at least 31 others is not of sound mind, but why don’t we take a look at why this happened? 

If you believe, as I do, that mental illnesses are illness just like any other, than why was this man, who supposedly treated other people with brain disorders, not receiving treatment himself?  Did  anyone not notice how he was struggling?  According to the “God Blogging” post on this site, NPR interviewed others at Walter Reed who said he was. 

Which brings us back to the same problem, the same issues that continue to plague people with mental illness and their families.  Because of the stigma, because of the inattention by our health care system that doesn’t think the mind is part of one’s physical health, because of an overburdened mental healthcare system, because people suffering from a mental illness can feel isoloated and abandoned by their support structure, people with diagnosable brain disorders are falling through the cracks.  One again, as President Obama called this tragedy, “a horrific” catastrophe has occured in this country.

Who knows what was going on in Hasan’s head……Certainly listening to war stories from our returning Veterans experiencing Post Traumatic Stress Disorder was not an easy thing to do, but why is it that no one saw the signs, especially when he was set to deploy at the end of the month? Maybe Major Hasan will be able to shed some light on our questions.

Established by Congress and now in its 19^th year, MIAW takes place the first week of October each year, and recognizes the National Alliance on Mental Illness’ (NAMI) efforts to raise mental illness awareness through early detection and accurate diagnosis and to reduce the associated stigma and create awareness though outreach, support and educational programs focused on brain disorders. 

Several activities are scheduled for the week beginning with the Daniel Moreno Recovery Award Event at Skyline Country Club on Friday, October 2nd.  It’s open to the public and tickets may be purchased for $55 per person by calling NAMI Southern Arizona at 622-5582.

Sunday, October 4th

PBS Station KUAT Channel 6 will air the first in the Fred Friendly series on mental illness called “Minds on the Edge” (www.mindsontheedge.org) about current issues in the mental health care system. It will be aired four times that day at 5am, 11am, 6pm, and 10pm.

October 6-8, 2009

10th Annual Community Mental Health Arts Show – Community Partnership of Southern Arizona – 2502 N. Dodge Blvd.         For information, call (520) 318-6994                   Website: www.cpsa-rbha.org

An article in the New York Times today motivated me to talk about housing.  A Federal Judge has ruled that the state has discriminated against people with mental illness.

http://www.nytimes.com/2009/09/09/nyregion/09mental.html

Above is the link to the New York Times article about discrimination against people with mental illness in poorly run adult “care” homes.  I put the word in quotes because I don’t think “care” is appropriate in many cases.  Evidently in New York privately run adult homes aren’t much better than many of the facilities in Tucson. The article states that the residents are essentially warehoused and in the case of New York, unlike some in  Arizona, their facilities are licensed!

My son spent less than 2 months in one 3 bedroom apartment that his provider had arranged for him.  It was a nightmare.  Without going into too many details, suffice it to say that street drugs are rampant, nutritional meals don’t exist, personal safety and privacy is not garanteed and in his case the house manager who was supposed to be on-site would disappear for days on end leaving the 6 residents to fend for themselves.

The Tucson Weekly reported in their article, “Slums or Salvation,” that the local unlicensed “necessary evils” are finally beginning to draw some attention and the Pima County Human Rights Committee are starting to make visits to some of these homes.

The annual state audit of the mental health system’s performance that was released this year found it fails nearly all of its patients on key measures.  Among other things,  placing them in stable housing is at the top of the list.  For those who have not been in jail or hospitalized for their illness, the system failed 86 percent of the time. 

And, now with budget cuts who knows how much worse this system is going to get.  For some, living on the streets may be a better choice, but a stable environment is key to mental health recovery and I’m not sure the wash under a bridge qualifies.

 I just read an article in Psychology Today http://psychcentral.com/news/2009/08/20/physicians-avoid-mental-health-care/7875.html

It talks about a study done in the UK about doctors avoiding seeking advise for mental health issues.  A few different reasons are  cited…….most importantly were “career implications”,   ” personal integrity”  and STIGMA!”  That dirty little word that continues to pop up!  Almost half the doctors surveyed would seek informal advise, a small percentage would “self-medicate,” but almost 80% would seek inpatient treatment in either a private or distant facility rather than use the local NHS system because of the lack of confidence in the confidentiality of that system. (not, by the way, because of the quality of care)

Not having confidence in the confidentiality of the system is something that we can all relate to, but I want to talk about the impact of stigma for even those in the medical field!  According to the article doctors suffer depression and substance abuse as well as higher suicide rates than the general population.  And, these are the people that should understand that mental illnesses are  disorders of the brain………..just like diabetes can be caused by a disorder of the pancreas!

So, while we know that people do get better 80% of the time with proper treatment for brain disorders, even people that understand how medical  treatment can help someone may shy away from it.

I can’t wait for the new season of “House” on the Fox Network.  At the end of last season, Dr. House  checked himself into a psychiatric facility without telling any one. In the real world I’m sure he would be feeling stigmatized.  It will be interesting to see how it’s handled and if that dirty little word is addressed in any of the episodes. 

My sense is there are many medical doctors out there that are successfully living with mental illness……I know of a few, but don’t tell anyone!

As a person concerned about the increasing suicide risk and high incidence of post traumatic stress disorder in our nation’s returning war veterans, I am encouraged that the army is taking a pro-active stance on preparing them before they go to battle instead of dealing with the consequences once they return.

I’m talking about the Army’s plan to train 1.1 million of it’s soldiers in emotional resiliency and I think it’s a step in the right direction. Never tried before, the training is meant to improve performance in combat and (hopefully) deter mental health problems that affect at least 20% of returning troops from Iraq and Afghanistan.

Another pilot program currently planned for bases in Hawaii, Alaska and Washington removes a requirement that soldiers getting mental health treatment notify their commanders.  As discussed in previous posts, stigma surrounding mental illness is pervasive everywhere and the army is no different. 

Post Traumatic Stress Disorder resulting from combat has been linked to violent behavior including homicide and suicide. Naturally there is some resistance to this kind of therapy, but I think it’s a step in the right direction.

President Obama shared his vision for health care reform—and stressed his support of mental health parity—at a New Hampshire town hall meeting on Aug. 11.

Linda Becher, an audience member, specifically asked the president about access to mental health care and its impact on society. The president acknowledged the seriousness of mental illnesses and the reality that many existing insurance policies do not cover them on the same terms as physical illnesses. President Obama also expressed his desire to include mental health care as part of health care reform.

Watch President Obama speak about mental health care at 48:43 or read the transcript below.

QHello, Mr. President. My name is Linda Becher (ph). I’m from Portsmouth and I have proudly taught at this high school for 37 years…I’ve been lucky enough to have very good health care coverage and my concerns currently are for those who do not. And I guess my question is if every American who needed it has access to good mental health care, what do you think the impact would be on our society?

THE PRESIDENT: Well, you raise the — (applause) — you know, mental health has always been undervalued in the health insurance market. And what we now know is, is that somebody who has severe depression has a more debilitating and dangerous illness than somebody who’s got a broken leg. But a broken leg, nobody argues that’s covered. Severe depression, unfortunately, oftentimes isn’t even under existing insurance policies.

So I think — I’ve been a strong believer in mental health parity, recognizing that those are serious illnesses. (Applause.) And I would like to see a mental health component as part of a package that people are covered under, under our plan. Okay? (Applause.)

This all sounds good, but I don’t know if  we will see any kind of health care reform if some of the fear mongering doesn’t subside. Terms like “death panels” certainly don’t help to move the legislation, in any form, forward.  Personally, I like what I hear about Switzerland’s health care system…..A basic plan is provided and they have the option to “upgrade” at their own expense if they choose.  That’s all I want……basic coverage for everyone!

Here’s what healthcare reform will do:

* Health care reform will stop insurance company abuses like  refusing to pay a claim or give you coverage because of “pre-existing” conditions. (Been there)
– Your out-of-pocket expenses will be capped. (Methinks bankruptcies will decrease!)
– Insurance companies won’t be allowed to charge women higher rates than men (been there) or drop you if you get sick.
– Insurance companies will have to cover your children until age 26 instead of dumping them at 19. (been there – they should at least  be covered under family plans while they are in  college!)

* Health care reform will hold down rising costs. (been there – I now have less than adequate coverage because I can no longer afford my old plan)
– A public health insurance option will force private insurers to compete and will lower costs for everyone. (yeah!)
– By requiring companies to pay their fair share, we’ll stop them from dumping their health care costs on the rest of us. (when I owned a small business I offered health insurance to my employees……it helped keep my personal premium cost down!  Now I understand that’s not necessarily the case if there is one employee with expensive health issues – that’s wrong, too!)

* Health reform means affordable health care will be there for you, no matter what. If you lose your job, or your children lose their coverage. (  we have all heard stories about kids moving back in as adults!) 

- When you retire affordable health care will be there for you. (it’s called Medicare and it was vehemently debated and accused of being “socialism”  when passed)

THE REALITY:   health care costs are spiraling out of control, and we all deserve quality and affordable care. Health care reform simply can’t wait.

When it comes to state dollars it certainly seems that way!

I attended a screening Monday night with some local mental health advocates of a film in the Fred Friendly series called “Minds on the Edge.”  See info at www.mindsontheedge.org  The film is a very comprehensive panel discussion on facing the issues of severe mental illness.  It will be aired on PBS during Mental Illness Awareness week the first part of October.  Afterward NAMI Southern Arizona hosted the discussion on how to help promote not only the film, but how to use the series as a catalyst to increase dialogue and education in our community surrounding this topic. Stay tuned for more information regarding the series!

We are passionate about creating awareness about mental illness, but we invariably end up talking about the inadequacies of the public mental health system and the overall frustration  with the continuing decline in the meager  funding. Then we factor in the state’s formula to give us (Tucson) less support per patient and it’s a wonder Pima County is able to provide any mental health services! 

In Arnold vs Sarn,

a lawsuit filed alleging the state and Maricopa County did not fund a comprehensive mental health system, new services called Assertive Community Treatment Programs were instituted. Case managers in Maricopa County saw the number of patients they see decreased to around 30 per person while Pima County Case managers, who are paid just enough to get by,  continue to have as many as 100 active patients in their files! Imagine what it’s like for that person when several of her patients are in crisis and need focused, immediate attention!

Sometimes I feel like the little baby bird in the nest outside my window, just waiting for my Mama bird to bring me some little morsel to help me grow and be on  my own.  The problem with our public mental health system, is that the little birdies in Pima are struggling to get just enough nourishment from the Big Birds in Phoenix to learn how to fly.

And, as we all know, it’s just getting worse.  In fact, “state only” dollars for programs for the seriously mentally ill have decreased by more than 10 million since fiscal 2001. And, funding levels have never been adjusted for inflation. What is going to happen to these people?

Our legislators need to stop turning a blind eye to our most vulnerable population and increase funding for people living with brain disorders and they also need to start treating the citizens in Pima County as equal to those 100 miles up the freeway.

For more info on Arnold vs Sarn, see S.B. 1196

I watched this beautifully put together HBO documentary on Monday night.

Mournful and emotional,  “Boy Interrupted” is about a mentally ill boy who committed suicide when he was only 15 years old. Having experienced the same tragedy, I really wanted to see how the story could be told without being exploitative or sensationalized. They couldn’t have done a better job……..the parents put the film together. Both of them are in the film industry, but a good part of the documentary was made from actual “home” movies that they and that Evan, their son had personally filmed. Some of the clips even give you a sense of how difficult life for Evan was when he was struggling with his bi-polar illness that wasn’t diagnosed until he was eight years old. Eight years old??? I’m sure you’re thinking that’s incredibly young…..and it is. But, it happens. And in Evan’s case, he started threatening suicide as early as age five.

His parents did everything they could to get Evan help. Finally by age 10 he was experiencing some normalcy in his life with the help of medication, therapy and family and academic support. Tragically, at age 15 when all seemed to be going well he ended his life by jumping from his bedroom window several floors up. He left a note explaining how disconnected he felt…….something many 15 year old boys will experience. But, for Evan his sadness was overwhelming and his bi-polar illness prevented him from facing another day. In my case, I always say, schizophrenia took my son. – I know he wouldn’t have purposely “ripped my heart out.”

According to the National Alliance on Mental Illness about one in ten children have a serious mental or emotional disorder, but fewer than half receive any mental health services in a given year. Over half of students with a mental disorder age 14 and older drop out of high school – the highest dropout rate of any disability group and many of the teenagers that have a mental disorder “self-medicate” with illegal drugs. Despite effective treatment, there are long delays, sometimes decades, before people seek and receive treatment.

These are pretty grim statistics, but I’m hopeful. As I have said before, I see people every day that have achieved mental health recovery. It’s something they have to work on- every day, and who knows, maybe one day we’ll find a cure or at least something to stop someone from wanting to end their life. Suicide causes unimaginable pain for those left behind.

I really don’t want to argue about health care. I don’t understand why the debate is all about economic issues instead of moral issues. I think a single payer plan with options to upgrade would be great, but hey, what do I know. I have paid for my own individual plan since I was 24 years old, and it has cost me dearly. I’m fortunate that I have been able to afford it. My insurance premium now is as much now as I used to pay for two children and myself back in the early 1990’s.  In an effort to save money, I changed insurance companies and now the two” pre-existing” conditions I have aren’t covered……including any kind of medication I might need to treat them!

 In my view, health care shouldn’t be based on profit margins.

It’s a complex problem. One that I certainly don’t know how to solve, but I am a fierce advocate for parity……..equal coverage and care for physical and mental illnesses. Something that mental health advocates have tirelessly promoted for many years. It is critical that mental illness treatment is included as part of any required basic benefit package AND is covered at parity relative to medical surgical benefits consistent with Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

The National Alliance on Mental Illness also urges that any health care reform package should include:

• Adequate financing in order to guarantee that health reform lives up to its promise of delivering comprehensive, affordable coverage;
  Income-based standards for premiums, co-payments, deductibles and all out-of-pocket health care costs;
  Premium subsidies on a sliding scale up to 400 percent of the Federal Poverty Level along with limits on cost sharing so health coverage is affordable for all American families;
  An expansion of Medicaid that strengthens and maintains Medicaid’s role as the base of coverage for current mandatory beneficiaries;
  Improvements to portability, enrollment, and renewal to maximize coverage, minimize red tape, and provide stability for all Americans;
  Regulations that prevent insurance companies from discriminating based on health status, gender, and occupation;
  Guarantees that quality, affordable health care coverage is available across the country and that individuals and families have options in selecting health plans;
  Financial support and incentives for primary community-based care — especially for children and adults living with serious mental illness;
  Adequate cost savings to improve long-range fiscal stability;
  A strong employer responsibility requirement with penalties for those employers who do not offer coverage based on total payroll rather than penalties tied only to employees who receive income subsidies;
  Sufficient assistance for states so that federal health reform does not impose an unnecessary burden on already strained state budgets, and that does not punish states that have chosen to expand Medicaid and SCHIP coverage above federal requirements.

And, please call your congressional representative  and tell them what you want!  They need to hear from us! Part of good mental  health is access to quality care…….for the body or the brain.