Misintent : Hazing Students | Mental Health

Notice:  This piece was selected for publishing as an open opinion piece by an unaffiliated contributor.


How is what YOU do, in any way similar to fraternity/sorority HAZING? Before you say “in NO way!”…stop and reflect a little.

I know, not all fraternity “hazing” ends in death, though it is now illegal in California. But no matter how benign it seems, having to jump a lot of hurdles in order to GAIN ACCESS, is a problem for people seeking mental health treatment…or even getting the listening ear of a friend or parent.

Can we prevent the emotional/social pain sometimes inflicted on someone SEEKING ACCESS? Getting access to faith-based or mental health services, to school counselors, to peers or even distracted parents, can sometimes feel like “hazing”…the things we are asked to do, the price we are asked to pay.

How bad does someone want or need access? To what extent are hurdles placed in the way to find out “how high they will jump”? Some people “do what they are told”…are they considered fools (even by those whose services they seek) for not knowing when to stop seeking?

This Atlantic story is sad, but thought provoking.

Checkout: UNAFFILIATED ARTICLE ON THE NEWS STORY

It brings to my mind, another old story about a woman seeking help for her ill daughter, which suggests that even caregivers can learn from care seekers. Her daughter dying, the woman bowed down before the healer (as required by custom) and begged him to help her. His first response was, “It’s not good to take the children’s bread and throw it to the dogs.”, meaning…he’s only going to heal the really sick people, and those who are in my neighborhood, so to speak. To that, she said, “Yes, but even the dogs feed on the crumbs which fall from their owners’ tables.”. Comparing herself with hungry dogs seemed to make a difference. With that, he said, “Your faith is great and it shall be done for you as you wish.” And he healed her daughter at once.

I know scripture readers might argue with my interpretation here, but my point is, even Jesus felt he was only there for certain people and she had to do a little cajoling to get what SHE BELIEVED HE COULD DO. Compassionate or convicted – either way you interpret it – the healer, healed.

But why did she have to beg first? Did he know before she even started the conversation that he was going to help her? Was he “hazing” her a little? Did she have to prove her faith in him first? Or did he have to find her “worthy” of his time? Or did the “hazing” actually show him that his “treatment” was going to work on her prepared/faithful soul? Maybe there was another way to get THAT information…

In the end, she had her daughter back, healthy and whole. I wonder how SHE felt after that conversation. Of course, she felt grateful to the healer for his work. But I wonder if SHE felt healthy and whole, too.

 

“Advocate for mental health. Work to end STIGMA of mental illness.”

 

Focusing on Mental Health Policy Issues

The recent spate of high-profile mass shootings has inspired yet another “national conversation” about mental illness, with everyone agreeing that the country has a problem. Unfortunately, isolated instances of violence are how the subject typically ends up in the news cycle. But the more mundane social repercussions of mental illness, while perhaps not as headline-worthy, are pervasive and acutely felt nonetheless.

On any given day, one in five people in jail or prison has a severe mental illness. This means that people with serious mental illness are ten times more likely to inhabit a jail cell than a hospital bed. Besides contributing to jail and prison over-crowding, mentally ill people are especially vulnerable to victimization by fellow prisoners, spend more time in solitary confinement, and become suicidal behind bars at higher rates than non-mentally ill inmates. They also cost the correctional system considerably more than otherwise healthy prisoners.

The challenge facing prisons is just one consequence of decades of de-institutionalization policies. From a nationwide peak of around 560,000 psychiatric beds in 1955, the census has been whittled down to about 35,000 today — about half of what experts estimate is actually needed. In the absence of such beds, patients will continue to be warehoused behind bars, lie on emergency-room gurneys for days, and languish in nursing homes. One-third of the nations homeless will still be comprised of the untreated mentally ill, who are at far greater risk of being preyed upon than of harming someone else.

The lesson of downsizing state psychiatric facilities — no less powerful for being familiar — is that good intentions are not enough. Too many sick people are now caught in a pernicious cycle, rotating in and out of emergency rooms, crisis hospitalization, incarceration, homelessness, and back again. Its no wonder some of the strongest supporters of mental-health reform are police, district attorneys, corrections officials, and emergency-room physicians.

These problems afflict roughly 10 million Americans, or just over 4% of the population. Mainly diagnosed with schizophrenia, bipolar (manic-depressive illness), or major depression, such individuals are chronically or periodically unable to care for themselves or are suicidal. At times, they may be dangerous to the public. Relative to other psychiatric patients, those with severe mental illness are far more likely to need medication, intensive supervision, and even involuntary treatment at some point in their lives. But they arent getting the help they need, and the governments good intentions are often the very thing preventing their getting appropriate treatment.

To understand a key source of the problem, we should compare severe mental illness to “mental health.” The Centers for Disease Control describes mental health as a composite of “emotional well-being,” “psychological well-being,” and “social well-being.” According to government statistics, only about 17% of adults are considered to be in a state of optimal mental health — the rest, apparently, need some kind of professional assistance to achieve optimal “wellness.”

Sandwiched between mental health and severe mental illness is a clinical category called mental illness. One recent national survey estimates that nearly 18% of those individuals older than 18, or about 43.7 million people annually, are mentally ill — meaning they fulfill diagnostic criteria for any condition listed in psychiatrys official diagnostic handbook, ranging from attention deficit disorder to panic attacks to anorexia. The severity and chronicity of these conditions varies dramatically, with most conditions resolving on their own, while others are best served with time-limited psychiatric care; some may require hospitalization and long-term medication and therapy.

The distinction between mental health, mental illness, and severe mental illness is crucial, because it leads us to different clinical and policy prescriptions. The vague boundaries of “mental health” enabled a variety of advocates whose true agenda is grievance and social reform to claim that their concerns fell under its rubric, as historian of psychiatry Gerald Grob has observed. As a result, he writes, “persons with serious and persistent mental illnesses…[are] forced to compete, often unsuccessfully, with other groups that now [define] their needs in terms of mental health.”

The problem we have today is that the system is geared more toward mental health than severe mental illness. In fact, the federal governments lead agency on mental health, the Substance Abuse and Mental Health Services Administration, part of the Department of Health and Human Services, has explicitly stated this as its goal. Rather than focusing on reducing homelessness, hospitalization, or incarceration among people with serious mental illness, it concentrates federal and state efforts on delivering amorphous “behavioral health” to everyone else.

This is profoundly misguided. But it may not be surprising after a half-century of inept leadership, Medicaids financial incentives gone awry, and clashing ideas about the nature of the forces (psychological, biological, and social) that lead to psychopathology — and that, in turn, point toward the best possible therapeutic strategies. Ours is a problem-ridden system that could be markedly improved with strong political leadership.

We need a mental-illness system in which care for the sickest of the sick is a priority. If the federal government intends to take mental illness seriously, Congress and the next administration must be keenly responsive to the most vulnerable patients.

a troubled legacy

To understand what should be done, a review of the dynamics that led to the current state of disarray is in order. Four key elements are to blame.

The first emerged in the late 1950s, as officials emptied state hospitals of even the most debilitated patients without adequately planning for their continued treatment. The second contributing factor came with the creation of Medicare and Medicaid in 1965, as new policies limited access to community hospital beds. The third factor is the growing complexity of competing ideas about the causal and remedial factors involved in mental illness, and the resulting complications in policymaking. And fourth is the disproportionate leverage wielded by anti-psychiatry forces in an era of victim politics. This last influence builds upon a longstanding debate regarding the civil liberties of individuals whose capacity to manage their freedom is badly compromised by dysfunction in their brains.

Until half a century ago, the care of people with mental illness had been the responsibility of the states. This changed in 1963 when President John Kennedy ushered in the era of federal support by championing the Mental Retardation Facilities and Community Mental Health Centers Construction Act. The new law mandated the creation of a user-friendly archipelago of 1,500 federally funded community clinics nationwide to supplant the large state asylums and to allow patients to live in their communities while receiving treatment. “When carried out,” Kennedy said of the act, “reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability.” The presidents interest was personal, stemming from the tragic experience of his sister Rosemary, who was born with mild mental retardation and eventually underwent a frontal lobotomy for schizophrenia.

The nation was primed for the change the president sought. Two decades earlier, Life magazine had run “Bedlam 1946,” a searing photo-journalistic exposé of Pennsylvanias Philadelphia State Hospital at Byberry and Ohios Cleveland State Hospital. Books like Albert Deutschs The Shame of the States and popular entertainments like the movie The Snake Pit, both of which appeared in 1948, exposed shocking conditions of filth and abuse in state facilities.

State-initiated efforts improved the conditions at state hospitals in the mid-1950s, and, thanks to the availability of Thorazine, an anti-psychotic medication introduced in 1954, some patients were successfully moved into the community. But with Kennedys community centers under construction in the mid-60s, the campaign to empty out state facilities took on new urgency. Some patients did well upon discharge, but the sickest were caught in a revolving door: Without closely supervised treatment, many failed in the community and went back to whatever institutions were left. Others ended up in a kind of limbo, neither institutionalized nor embedded in a community.

The state-hospital population was further eroded by legal decisions issued in the 1960s and 70s that made it hard for judges to order necessary treatments for patients who were wildly psychotic or immobilized by depression but were refusing care. A convergence of strange bedfellows — fiscally conservative state officials, progressive reformers, former patients, and politically liberal civil-rights lawyers — formed a strong advocacy coalition for deinstitutionalization policies.

In 1965, as the exodus from state hospitals was well underway, Congress passed legislation establishing Medicare and Medicaid. The new law included a provision that unwittingly planted the seeds of the current shortage of public hospital beds. It did so by prohibiting Medicaid from paying for care delivered to patients between the ages of 22 and 64 if that care was provided in an “institution for the treatment of mental diseases,” or IMD. An IMD is defined as a treatment facility with more than 16 beds of which at least half are dedicated to mentally ill patients. The so-called “IMD exclusion” was intended to spur momentum for community treatment by barring the doors to the asylum, which Congress saw more as a warehouse than a treatment facility anyway.

The IMD exclusion did not affect general hospitals and nursing homes. They remained eligible for Medicaid reimbursement. Thus, states had a strong incentive to shift patients from state psychiatric hospitals to Medicaid-eligible institutions, even if those venues were more costly or less effective. With fewer and fewer psychiatric beds available, emergency rooms became holding areas for those who needed inpatient treatment; others spilled out onto the streets and into run-down, questionable boarding houses and jails.

It did not have to be this way, which is clear given how well Medicaid has worked for people with intellectual and developmental disabilities. They, too, could be found living in state hospitals in the mid-20th century, but Medicaid treated them differently. If they still needed residential or intermediate care, Medicaid reimbursed the state for their stay. Then when these patients were discharged into the community, Medicaid covered wraparound services such as vocational assessments, family counseling, medication management, and transportation. Today, these services are provided under a “community options” waiver that “swaps” a Medicaid-covered inpatient bed for a similarly covered, community-based slot.

Unfortunately, no such waiver exists for individuals with serious mental illness, because the IMD exclusion prohibits federal coverage for adults. The ensuing problem of fragmented services is formidable. Between orchestrating disability entitlements, housing, and treatment of medical problems, case management can require organizational skills that are beyond most of us, let alone people who are also overwhelmed by depression, difficulty concentrating, or jumbled thoughts. Even when there are quality services covered by Medicaid, such as nursing-home placement, funds are not always tailored to young or middle-aged able-bodied psychiatric patients. Meanwhile, entire subpopulations of poor, young men are not covered at all in many states.

Thus, as Harold Pollack of the School of Social Service Administration at the University of Chicago explains, “Deinstitutionalization has, on the whole, worked well for the intellectually disabled because they and their supporters could crank the political valves required to make it work. Equally worthy claimants who lacked the same political muscle or public embrace fared much worse. Thats one key lesson of the deinstitutionalization fight.”

The next major step toward our current dysfunctional approach to treating mental illness seems at first glance to have begun with a semantic, rather than a policy, decision. When Jimmy and Rosalynn Carter entered the White House in 1977, they already had an interest in mental illness. President Carter wasted no time in establishing the Commission on Mental Health. According to historian of psychiatry Gerald Grob, “the [commissions] decision in 1977 to use mental health rather than mental illness…was based on the application of a public health model that emphasized the role of the environment, social services, and prevention rather than the traditional psychiatric focus on the diagnosis and treatment of severe and persistent mental disorders.”

The dubious notion that external influences, such as stress, social problems, traumatic experiences, and even coercive psychiatric care itself are the primary causes of severe mental illness still thrives today in influential quarters, as we will see.

the recovery model

A quarter-century after the Carter commission, in 2002, President George W. Bush revisited the problem of public mental-health care by appointing a commission of his own, called the New Freedom Commission on Mental Health. The commission was charged with conducting a “comprehensive study” of the existing system and advising President Bush on improvements. The 2003 report issued some positive suggestions regarding, for example, the need for an increased number of psychiatric beds and better programs to help disabled patients participate in the workforce. But the Bush commission, like Carters before it, elided the distinction between mental health and mental illness and failed to grapple with approaches to patients with severe mental illness who refused to take medication and had a potential for violence.

Instead, the Bush commission promoted an overly optimistic treatment philosophy that came to be called the “recovery model.” It held that with sufficient therapy, housing options, and employment programs, patients with schizophrenia or manic-depressive illness would be able to take charge of their lives. To be sure, a lot of patients are indeed able to do this, especially young people with recent onset of illness. But the recovery models unrealistic one-size-fits-all approach ignored the toughest cases, which often require heavy doses of paternalism because the patients dont acknowledge their own illness — a symptom of being psychotic in and of itself, in many instances. In an un-medicated state, an individuals symptoms remain unabated, behavior remains menacing or erratic, and the risk of violence, particularly if alcohol or cocaine is involved, is increased.

The recovery agenda was inspired by the patients rights movement of the 1960s. This campaign for enlightened care, which included better quality of treatment, collaboration with physicians, and assurance of privacy of health information, was a sensible reaction to the heavy strain of paternalism that marked the medical field at one time. Psychiatry, in particular, attracted the animus of patients rights activists; after all, it is a field whose very nature requires professionals to make fraught judgments about the normal or abnormal thoughts, behaviors, and identities of their patients. Whats more, for better or worse, psychiatrists may impose tacit or actual control over their patients.

Consequently, the psychiatric patients rights movement took on a radical tenor. Spurred by a 1960s ethos of social justice, activists saw themselves as a class of social dissidents and psychiatry as an agent of social control. The Insane Liberation Front was founded in 1970 in Portland, Oregon. In 1971, the Mental Patients Liberation Project and the Mental Patients Liberation Front appeared in New York and Boston, respectively. The next year, former patients in San Francisco organized the Network Against Psychiatric Assault and the Madness News Network. They have championed the rights of severely ill patients to refuse treatment, representing the expressed wishes of their clients (patients) even when they are delusional, and they have campaigned against involuntary commitment, as well as electroshock therapy, which is one of the safest and most effective treatments for severe depression. So what do these activists prescribe as an alternative? Political empowerment.

By the 1980s, the movement had spawned a new identity known as the “consumer-survivor,” which persists to this day. In this iteration of the psychiatric patients rights movement, dynamics such as identity politics (with the mentally ill playing the role of minority population), disability status, and a sense of entitlement to public services play a larger role than they did in the 60s and 70s. Compared to their earlier counterparts who saw themselves as dissenters, not patients, these consumer-survivors actually do see themselves as ill. “Consumer” is the politically correct word for patient, and “survivor” refers to one who has survived psychiatric care. The most vocal anti-psychiatry consumer-survivor groups are the National Empowerment Center near Boston and the Nation Mental Health Consumers Self-Help Clearinghouse in southeastern Pennsylvania. Funded in part by the federal government and state mental-health agencies, these groups lobby against involuntary treatment and electroconvulsive therapy, and they discourage patients from taking medication.

As with the anti-vaccine movement, such trends always have the capacity to be damaging, but vocal, misguided fringe groups are not a rare occurrence in the United States, especially when it comes to health care. The difference is that these groups have the financial support of the U.S. government; thus, taxpayer money is being used to make things worse.

failing the most vulnerable

The Substance Abuse and Mental Health Services Administration, an agency within the Department of Health and Human Services known by its acronym, SAMHSA, bolsters the consumer-survivor agenda ideologically, programmatically, and financially. It is a striking example of government working at cross-purposes to the best interests of its most desperate constituents.

The agencys entire budget for mental health is around $1.1 billion. (The remainder of its full budget of $3.6 billion is earmarked for prevention and treatment of substance abuse.) Of the $1.1 billion mental-health budget, $482 million goes into block grants to the states for mental-health services, and the remainder goes to other programs for adults and children, the homeless, and Protection and Advocacy (described further below). Given that federal mental-health expenditures total $130 billion annually, mostly in the form of Medicaid, the SAMHSA budget seems modest. But the agency manages to leverage its funds in ways that not only shortchange but actively undermine the welfare of the sickest patients.

For one thing, SAMHSA claims to receive much of its policy input from groups of consumers that it occasionally convenes. These people may have psychiatric problems but generally need only low-levels of support, and many do not take medication. They do not represent the most impaired patients — the ones who are languishing in jails, in emergency rooms, or on the streets. Such people are too lost in their psychosis to show up for a focus group or to embrace the “recovery agenda.” Indeed, approximately half of all untreated people with a psychotic disorder do not acknowledge they are ill, which is itself a neurological condition called anosognosia.

There is a vital role for benign paternalism toward this highly vulnerable set of patients, but the culture of mental health as practiced by SAMHSA effectively denies their existence, let alone their needs. To be sure, the psychiatric profession was once dismissive and too pessimistic about many people who were indeed capable of greater independence, but there is no denying that now a subset of the mentally ill needs much more oversight and, at times, even benign coercion.

SAMHSAs worldview is reflected in the nature of its discretionary grants and programs, some of which completely undermine the best interests of patients with severe mental illness. For example, the agency is a major funder of groups that are overtly opposed to medically accepted psychiatric care. The National Empowerment Center, based in Lawrence, Massachusetts, is one beneficiary of SAMHSA funds. Its mission is “to carry a message of recovery, empowerment, hope and healing to people with lived experience with mental health issues, trauma, and/or extreme states.” The NECs Chief Operating Officer has been a long-time critic of the use of psychiatric medications.

The Washington, D.C.-based National Coalition for Mental Health Recovery is a trade group for recipients of agency largesse. Its mission is to ensure “consumer/survivors have a major voice in…policies at the state and national levels.” The coalition and its smaller, composite organizations oppose the type of services — civil commitment, increased hospital capacity — that target the most impaired. Another example is the Alternatives Conference, which is funded by SAMHSA each year. Among other things, attendees with mental illness are taught how to go off their psychiatric medications. In 2011, SAMHSA gave one of its annual “Voice Awards” to an activist who believes that “[p]sychiatry is not medical because it is not scientific. It does not diagnose or treat actual conditions. It is complete fiction. Voodoo witch doctors have a better cure rate.”

Apart from awarding grants, SAMHSA runs its own programs, perhaps the most painfully misguided of which is the Protection and Advocacy program. Established by Congress, the original, benign intent of the Protection and Advocacy for Individuals with Mental Illness Act of 1986, or P&A, was to investigate allegations of patient abuse, neglect, and rights violations in hospital wards or in residential facilities. Mission creep soon set in, however. As Rael Jean Isaac and Virginia Armat documented in their 1990 book Madness in the Streets, P&A quickly devolved into “playgrounds for anti-psychiatric activists.”

The P&A program operates with $39 million, distributed among the states. The local P&A agencies routinely flout congressional intent by lobbying state legislatures against adopting sensible treatment policies and against strengthening their civil-commitment laws. Making matters worse, they do so at the expense of conducting investigations into the mistreatment of patients. Amanda Peters of South Texas College of Law has closely examined P&A programs, and has found that their lawyers and personnel are so preoccupied with fighting civil-commitment policies and trying to liberate undeniably psychotic patients from hospitals that glaring violations of abuse and neglect go unchecked.

Many P&A lawyers are against hospitalization at any cost, to sometimes tragic result. Consider the story of Joe Bruce of Caratunk, Maine, whose psychotic son is now a murderer because of Maines P&A agency. In 2006, 24-year-old William Bruce was a patient at Riverview Psychiatric Center, where he had been committed after assaulting his father. His parents were afraid of their son and begged the hospital to medicate him with the antipsychotic that had previously quelled his paranoia and aggression. Williams psychiatrists, who had observed him for weeks as an inpatient, fought against Williams pleas for release because he remained paranoid and agitated. Nonetheless, the P&A legal advocates insisted that William was “competent” for discharge and openly coached him — as any lawyer would his client — on how to placate the doctors so theyd let him go. William and his lawyers somehow prevailed over his doctors and parents objections, and Riverview discharged him. Two months later, he killed his mother with a hatchet. The Bruce familys story is one of the most dramatic, but by no means one of the only, examples of the reckless “liberation” of dangerous or debilitated patients at the hands of a P&A agency.

For decades, HHS and SAMHSA have mismanaged the mental-illness resources of the federal government, focusing increasingly on “recovery agendas” instead of on the severely mentally ill. Our most vulnerable citizens are slipping through the cracks. It is long past time for a better, more serious mental-illness agenda.

prescriptions for mental health

Like Presidents Kennedy, Carter, and Bush, the next president could do a great deal to improve the nations mental-health system. The most radical, most effective approach might be to propose legislation to abolish SAMHSA altogether, holding on to those pieces worth saving, such as the collection of statistics, by assigning them to the Centers for Disease Control and Prevention, the National Institutes of Mental Health, or other appropriate government agencies. Charges of abuse (such as excessive use of physical restraints) and neglect could be handled by the Department of Justice. The block grants could be distributed by the Human Resources and Services Administration.

Whether or not SAMHSA is shut down, it is imperative that the next director of federal mental-health initiatives, perhaps working directly out of HHS, be a psychiatrist or psychologist with extensive experience treating and managing systems that target severely and persistently ill patients. (Currently, SAMHSA does not employ a single psychiatrist among its staff of 570, let alone in a leadership or key advisory position.) In 2013, an experienced psychiatrist joined as medical director, but she quit two years later because of what she described as “an open hostility toward psychiatric medicine by those at the helm of the agency. The concept of mental disorders as diseases was rejected.”

A SAMHSA leader who understands the clinical needs of the sickest patients and prioritizes these demands — and who is backed by the secretary of HHS — would instinctively make profound changes. He would cease grant-making to advocacy organizations whose members deliberately undermine the validity of professional help and medications and those who lobby against commitment policies at the state and federal levels. The medical-director slot would be filled by a psychiatrist who endorses mainstream views on the value of medication, the importance of promoting tested programs over a feel-good “wellness” and “empowerment” agenda, and the need for inpatient services. An enlightened agency leader would invest in research aimed at the sickest patients and accept the notion that paternalistic strategies are legitimate and necessary for some of them. Finally, such a leader would contain P&As mission creep and ensure that program funds go solely to the investigation of abuse and neglect, as was the programs original congressional mandate.

Medicaid needs improvements, too. To address the bed shortage, for example, Congress could base eligibility for Medicaid reimbursement solely upon an individuals need for care, rather than upon the location in which it is delivered. Another option is raising the limit on the number of psychiatric beds for which Medicaid will pay, to allow larger facilities already specializing in mental illness to fall outside of the scope of the IMD exclusion. Alternatively, more states could be allowed to use Medicaid Section 1115 waivers — as some already are — to draw down reimbursement for services provided in IMDs. Not surprisingly, some advocates argue against these ideas, concerned that they will re-open the door to institutionalization.

Some policymakers suggest simply expanding the number of psychiatric beds in general hospitals, but economies of scale (a benefit of larger psychiatric institutions) would be lost. Nor would general hospital units be able to reproduce the therapeutic milieu that characterizes a quality inpatient unit. Whats more, general hospitals are reluctant to admit the sickest psychiatric patients, who are often disruptive, sometimes violent, and difficult to treat and require additional nursing.

To inform lawmakers debating this complicated issue, the federal Centers for Medicare & Medicaid Services is funding the Medicaid Emergency Psychiatric Demonstration, mandated by the Affordable Care Act. Eleven states and the District of Columbia are using Medicaid funds to pay for inpatient emergency psychiatric care in psychiatric hospitals for patients aged 21 to 65 without the 16-bed restriction. By focusing on psychiatric emergencies, the three-year demonstration, which began in 2012, also attempts to explore a potential remedy to alleviate burdens placed on general-hospital emergency rooms by psychiatric patients for whom no bed is available.

Medicaid administrators also need more flexibility to cover the unique kinds of help, beyond standard fee-for-service visits for medication and therapy, which enable mentally ill individuals to thrive in the community. These may include Fountain House-type clubhouses (private, non-profit community centers that provide job training, socialization opportunities, and computer access) and various other types of assistance with staying in school or holding down a job. Assertive Community Treatment teams — intensive 24-hour outpatient supervision by clinical teams linking patients to needed medical and social services — would save money and reduce days in the hospital, but they currently have no reliable source of public funding. The same is true of Forensic Assertive Community Treatment, an adaptation of the ACT model that has been shown to reduce criminal recidivism through criminal-justice collaborations.

The good news is that there is active experimentation. In addition to emergency-room demonstrations now underway, Congress authorized a $1.1 billion, eight-state demonstration program in 2014 for a new type of community-based clinic focused on behavioral health. The Excellence in Mental Health Act, spearheaded by Democratic senator Debbie Stabenow of Michigan and signed into law in April 2014, created criteria for facilities to become “certified community behavioral health clinics.” (In 2016, Stabenow and Republican senator Roy Blunt of Missouri introduced a bill expanding the law to provide additional funding for 24 states to launch a demonstration program to tackle payment reform in behavioral health.)

These clinics are required to provide a wide range of services, such as the kinds provided by ACT teams. States will apply to develop a prospective-payment arrangement with clinics to cover all necessary treatment, a so-called flexible funding stream that supplants service-by-service reimbursement. After two years, these pilot programs may be replicated nationwide. Ultimately, certified clinics will be eligible for Medicaid reimbursement as the sole source of payment for patients.

Flexible funding streams will figure prominently in approaches to treating young people, generally in their late teens and early 20s, who are in the early stages of schizophrenia. Psychiatrists now know that the amount of time between the onset of psychotic symptoms and the beginning of treatment is very important in determining response to care. An especially promising study, Recovery After an Initial Schizophrenia Episode, just completed its first wave of trials in the fall of 2015 and attests to the value of aggressive intervention for first-episode psychosis. These data, derived from research funded by the National Institutes of Mental Health, show that a tightly coordinated team approach, including the patient, professionals, and family members, led to greater symptom control and more involvement in work and school than experienced by patients receiving treatment as usual. The team provides medication (at the lowest dose necessary), therapy for coping with stress, education for loved ones about the disease, supported employment or education for the patient once symptoms are under control, and personalized case management. Currently, these teams are in the research stage, but when they become standard practice, payment systems will need to accommodate wrap-around services en bloc instead of traditional fee-for-service arrangements.

Some additional relief has come with the Affordable Care Act of 2010, which included a provision to expand Medicaid. Currently, 31 states plus the District of Columbia have opted in to the Medicaid expansion, which means the federal government — rather than those states — will pay for the great bulk of the outpatient and hospital treatment of newly qualified low-income people. This has the potential to help individuals who are mentally ill or in the early stages of serious illness, especially young men, who are not yet designated disabled. (The IMD exclusion remains in place.) The laws requirement that young adults up to age 26 be able to stay on their parents insurance plans is also helpful in this regard, as it preserves access to psychiatric care right at the moment some will first be developing psychosis.

These encouraging developments are tempered, unfortunately, by a looming crisis in public-sector psychiatry, especially in inner-city and rural areas and especially for patients on Medicaid. While the number of all physicians in the United States rose by 45% from 1995 to today, the number of psychiatrists increased by only 12% — and over half are aged 55 or older and will soon retire. Medical students choosing the field of psychiatry are fewer in number than in decades past, in part because many graduates face huge debt burdens, and psychiatry is among the lowest-paid of the medical specialties — especially in clinics and public hospitals where psychiatrists are needed the most.

benign paternalism versus jail time

Even if these reforms were successfully undertaken and the mentally ill were granted broader access to care, however, it would not be enough to ensure that the sickest individuals received the care they needed. One of the hallmarks of severe mental illness is that patients often deny that anything is wrong with them. So for many patients with severe mental illness, a strong dose of paternalism is often required to keep them from descending further into psychosis, self-neglect, and disruptive behavior, which can range from public disturbance or destruction of property to outright violence.

Assisted outpatient treatment, or AOT, a cost-saving and effective form of civil-court-ordered community treatment, is aimed at individuals who have a well-established pattern of falling into a spiral of self-neglect, self-harm, or dangerousness when off medication. AOT allows judges to order these individuals into mandated and monitored treatment while they continue to live in the community. In some states, violation of the court-ordered conditions can result in the individual being hospitalized for further treatment. According to a review of studies by the Virginia-based Treatment Advocacy Center, AOT has reliably reduced homelessness, re-arrest, incarceration, hospitalization, and suicide by half to 74%, thereby cutting long-term health-care costs in half.

The main problem with AOT is that it is too rarely used. Forty-five states permit the use of AOT, also called “outpatient commitment,” but, due to a lack of funding and unfamiliarity with the AOT process or philosophy (which is constantly denounced by activist “consumers” in state houses), it is not applied as robustly as it should be.

In addition to AOT, which is a civil remedy, entities known as Mental Health Courts exist for those charged with criminal offenses. These courts embrace a therapeutic rather than a punitive approach, but use the power of the court to enforce ordered treatment. Defendants who agree to participate receive a treatment plan and other community-supervision conditions. Those who adhere to their treatment plan for the agreed-upon period of time see either their cases dismissed or their sentences greatly reduced. If the defendant does not comply with the conditions of the court, or decides to leave the program, his case returns to the original criminal calendar where prosecution proceeds as normal.

As a rule, most Mental Health Courts use a variety of intermediate sanctions in response to non-compliance before ending a defendants participation. At present, there is only a modest number of courts, but a 2012 Urban Institute evaluation yielded promising results: Participants in two New York City Mental Health Courts were significantly less likely to re-offend than similar offenders whose cases were handled in the traditional court system.

Law enforcement has a large role to play as well. Increasingly, emergency 911 calls for “mental disturbance” are being met by law-enforcement officials who have received crisis intervention training, or CIT. Not only do they learn how to defuse tense, potentially violent situations, but police are also taught to distinguish criminal acts from erratic behaviors due to psychosis. The first CIT program was established in Memphis in 1988, after a police officer shot a man with a serious mental illness. The program came to be known as the “Memphis Model,” and it is now a popular, 40-hour curriculum, developed in collaboration with local academics, family members of ill individuals, and the Memphis police department. It teaches police how to respond safely to a person in crisis, and includes information about the local mental-health system and laws, and about how to recognize mental illness and link people with appropriate treatment, as well as guidelines for interacting with disturbed people who are extremely agitated or aggressive. CIT can reduce arrests, injuries to police, and the need for SWAT intervention. Unfortunately, however, fewer than 20% of law-enforcement agencies train their officers, according to the National Alliance for the Mentally Ill, an advocacy group representing concerned family members.

Finally, individuals who are dangerous to others, suicidal, or unable to care for themselves may need to be hospitalized, regardless of their cooperation. Coerced care has long been a fraught issue. It pits an individuals liberty against societys safety. It also creates a tension between an ill persons “freedom” to act afoul of his own best interests and his potential to benefit from therapeutic intervention. Each case requires courts and lawyers to balance these interests as fairly and delicately as possible. The majority of states have a “grave disability” standard, an explicit and broad designation that focuses on a persons ability to feed, clothe, and protect himself. But the freedom to be psychotic and endangered is not a meaningful freedom at all. More states should adopt the “need for treatment” standard. This approach, which is in effect in about half the states, allows a court to intervene in a crisis. These standards are particularly relevant for individuals who lack insight into their illnesses.

These approaches — AOT, Mental Health Courts, crisis-trained law enforcement, and sensible commitment laws — can help divert mentally ill people from the correctional system. Though states determine their own investments in these options, the federal government could incentivize their use through extra resources or tie block-grant funding to the existence and smooth operation of AOT laws, Mental Health Courts, and need-for-treatment statutes.

the politics of mental-illness reform

Some of these solutions are currently under consideration on Capitol Hill, and constructive changes may be afoot. The furthest-reaching of the proposed mental-health bills introduced in the 114th Congress is the bipartisan Helping Families in Mental Health Crisis Act of 2015, championed by Pennsylvania congressman Tim Murphy, a child psychologist, and Texas congresswoman Eddie Bernice Johnson, a former psychiatric nurse. The cornerstone of the bill is new executive leadership in the form of an assistant secretary for Mental Health and Substance Abuse; this individual would be appointed by the secretary of HHS and subject to Senate confirmation. Funding and authority over SAMHSA would be brought under the assistant secretary who would be required to focus on both severe mental illness — thereby ensuring that adequate resources are targeted at reducing homelessness, arrest, incarceration, hospitalization, suicide, and violence among people with untreated illness — and coordinating the federal governments larger response.

The Murphy-Johnson bill would also rein in the Protection and Advocacy program, mandating an exclusive focus on safeguarding patients rights to be free from abuse and neglect. It also forbids P&A offices from lobbying federal, state, or local governmental entities and prohibits their efforts to secure discharge of patients “with a serious mental illness who [lack] insight into their condition on refusing medical treatment.” In addition, the bill encourages states to develop assisted outpatient treatment capacity and provides a financial bonus when they set up such programs. Murphy-Johnson also clarifies mental-health information privacy standards under the long-contested Health Insurance Portability and Accountability Act, known as “HIPAA,” so that medical personnel can communicate in detail with patients families in emergency situations.

Further, the legislation mandates that Medicaid cover inpatient care, no matter a facilitys bed count, as long as that facility or hospital has an average length of stay of fewer than 30 days. It also allows a Medicaid patient to visit more than one health-care provider in a given day, a boon for coordinated care. Notably, Murphy-Johnson increases the demonstration authority regarding “certified community behavioral health clinics” from eight states to 10 states and lengthens the time frame from two years to four years. The legislation also expands training and educational opportunities to ensure a sufficient number of providers.

The Murphy-Johnson bill has garnered considerable bipartisan support, and a similar companion bill has been introduced in the Senate, co-sponsored by Senators Chris Murphy and Bill Cassidy. But the legislation has met resistance on several fronts. The first stumbling blocks are basic legislative barriers such as the anticipated cost of the bill, crowded committee and floor schedules, and the fact that the bill falls into several different committee jurisdictions. As of mid-February, the Murphy-Johnson bill was wending its way through the House, having been marked up by the Health Subcommittee of the Energy and Commerce Committee.

Second, advocacy groups that receive funding from SAMHSA are protesting because their financial lifeblood is being threatened. More broadly, the mental-health consumer lobby fears that the bills provisions to increase bed space, strengthen commitment laws, and restrict the advocacy system will effectively send patients back to the asylum. According to the National Coalition for Mental Health Recovery — the trade organization representing SAMHSA-funded anti-psychiatry groups — the Murphy-Johnson bill “will set back community mental health care and undermine much of what our movement has worked so hard to achieve.”

Third, despite broad bipartisan support — 185 co-sponsors as of this writing — a cohort of Democrats has lined up against Murphy-Johnson. In a letter to the chairmen of the House Energy and Commerce Committee, the lawmakers expressed their “strong” opposition to elements of the bill that, they claim, “would restrict patients civil rights.” They refer specifically to the privacy-rule clarification (which supposedly “discriminates” against people with mental illness because no other medical conditions are singled out for special privacy considerations). The opponents decry AOT as being too restrictive because it targets patients who are not in immediate danger — the strict commitment standard they endorse — rather than merely at great risk of harm to self or others when untreated. They also reject the proposed limits on the activities of the Protection and Advocacy agencies.

Fourth, the recent, high-profile shootings in Roanoke, Virginia, and Roseburg, Oregon, have jeopardized prospects for mental-health reform. The incidents re-ignited the simmering tension between political parties as to whether such violence is more aptly attributable to the availability of high-powered guns or to the broken mental-health system, whose many fault lines allow ill people who are armed to slip into classrooms, movie theaters, and college campuses. This has resulted in a stalemate: Democrats refuse to move on mental-health legislation because Republicans refuse to pass gun-control legislation.

Some have tried to find common ground, though. Last fall, Republican senator John Cornyn promoted his NRA-endorsed Mental Health and Safe Communities Act of 2015, which tried to achieve consensus by revising the background-check system to help keep guns out of the hands of the mentally ill. But the measure falls far short of what Democrats have labeled “common-sense gun-control policies,” and so the legislation is likely to go nowhere. More encouraging, Democratic senator Al Franken’s measure that provides crisis-intervention training, funding for mental-health courts, veterans-treatment courts, and training for state and federal law-enforcement officers was approved by the Senate. And the omnibus bill passed last December provides funding for assisted outpatient treatment programs, the first time Congress has fully funded these programs. (Notably, separate grants for the same kind of AOT programs remain a major stumbling block in the debate over Representative Tim Murphys mental-health legislation in the House.) Finally, in early January, President Obama announced $500 million for expanding access to mental-health treatment as part of a series of executive actions aimed at curbing gun violence, but did not elaborate on how it would be spent.

treating the american psychosis

The right reforms can reduce the suffering of people with serious mental illness — and can protect them and improve their quality of life. That prescription entails forging better connections between institutions, and providing more quality care and community support and more psychiatric beds. We should not be afraid of creating benign asylums, especially residential psychiatric entities — ideally situated in rural areas so that patients can tend to animals and farms — that are true to the spirit of asylum: places of respite and safety. We should practice humane paternalism when needed.

This last point poses the greatest challenge to creating a system that is fully responsive to the needs of the sickest patients — that small fraction of people with severe mental illness who often require containment or intensive supervision against their will for brief periods of time and sometimes for long stretches. Some cast such intervention as an inexcusable encroachment on personal freedom. But when a persons thinking is warped by hallucination or delusion, he is not able to exercise meaningful freedom and might even endanger himself or others. The very point of involuntary intervention is to improve or restore the patients power of self-determination. Failure to recognize the need for this kind of action amounts to a refusal to face clinical reality.

What is the treatment for this American Psychosis, as it has been called? In the short term, we need more evidence that paternalistic strategies can be used humanely to produce positive results. The more effective they are, the more receptive localities will become to their use. Creating tighter community safety nets and opening up more beds will make these intrusive tactics less necessary in the first place, but the need will probably never disappear — precisely because a common feature of chronic psychosis is a lack of insight into one’s own impairment. Hopefully, over the long term, we might be able to narrow the pipeline of pathology by intervening when early signs of illness appear.

We must get rid of the distractions. We should not use government largesse to bolster opponents of benign paternalism. And we must not pit guns against patients. These are separate issues, each worthy of serious attention. Mental-health reform needs all the champions it can get. Strong political leadership could make a world of difference.

Sally Satel is a psychiatrist and a resident scholar at the American Enterprise Institute.

E. Fuller Torrey is a psychiatrist and founder of the Treatment Advocacy Center, a non-profit working to eliminate barriers to treatment for people with severe mental illnesses.

Suicide Attempts and Immune Response

Suicide kills more than 40,000 people in the United States every year, an estimated 90% of them with a diagnosable severe psychiatric disease. Yet little is known about what causes some individuals to take their own lives, limiting the ability to reduce the number of such deaths.
Findings from a new study published in the Journal of Psychiatric Research suggest that identifying blood-based antibodies may offer a route to more personalized assessment and treatment of suicide risk and, ultimately, to more effective suicide-attempt prevention. The study compared antibody levels to viruses known to attack and inflame the nervous system in psychiatric patients with a history of suicide attempt and patients who had not attempted suicide.
Findings
In the study by Faith Dickerson and colleagues, 162 patients with schizophrenia, bipolar disorder or major depression were assessed for suicide-attempt history and antibodies to neurotropic infectious agents including Toxoplasma gondii (T. gondii). All the patients were in psychiatric treatment and receiving medication during the study.
Among the participants, statistically significant correlations were found for:

  • Lifetime history of suicide attempt and the level of antibodies to T. gondii
  • Lifetime history of suicide attempt and the level of antibodies to a common herpes virus (cytomegalovirus or “CMV”)
  • Lifetime history of suicide attempt and current cigarette smoking.

Individuals with antibodies to both T. gondii and CMV were found to be at heightened risk of attempting suicide, suggesting that exposure to both viruses might be additive, according to the authors. Individuals with antibodies to both viruses were also more likely to have made multiple suicide attempts.
No statistical correlations were found for:

  • The deadliness of suicide attempt and the level of antibodies to either virus
  • Patient age at time of assessment, gender, race, diagnostic group, clinical care setting, cognitive score, psychiatric symptom score, or any of the medication variables

Implications
Suicide rates in the United States have been rising since the mid-2000s, with more individuals per 100,000 population killing themselves than previously. The 21stCentury Cures Act and other federal, state and local initiatives, as well as many national nonprofits, have focused on reducing suicide risk, but the task remains challenging without clarity about the underlying causes.
While “the mechanisms by which inflammation may be associated with increased suicide risk are not known with certainty,” the authors of this study wrote, “the successful identification of blood-based antibody markets would represent an advance in the prediction and prevention of suicide attempts” among psychiatric patients.
“Suicide, for which a previous suicide attempt is the greatest risk factor, is a major cause of death worldwide and is highly prevalent in patients with serious mental illness,” they conclude. “Unfortunately, the ability to predict suicide remains limited and no reliable biological markers are available. The identification of blood-based antibody markers should provide for more personalized methods for the assessment and treatment, and ultimately prevention, of suicide attempts in individuals with serious mental illnesses.”

Call To Action: ADDY Beverages Inc. “Addy Energy Drink”

Our Executive Director has launched a campaign to shed light on an Ohio Energy Drink manufacture, Addy Beverage Inc.

UPDATE: April 21, 2017 WLWT Interview by Hearst ft. our Founder

IMG_2740OUR STANCE

As an organization on the forefront of mental health advocacy in the collegiate setting,  we find it deeply disturbing to find an Ohio Energy Drink Manufacture using one of the most widely abused prescription medications to illicit buying behavior amongst the public. The can resembles in precise color and design the most commonly prescribed ADDERALL XR pill—in an appeal to buyers interested in having energy sourced in the same sense as what is commonly abused to gain rapid energy. It is a blatant correlation to the perceived benefits one gets from taking Adderall when abused to gain energy, speed, and altered minds and behavior.

Screen Shot 2017-04-18 at 12.15.17 PM
Store Shelves Addy Beverage Display in Retail Gas Station
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Addy Beverage Home Page Scan

Goal

Campuses nationwide, have experienced considerable growth in misuse of prescription stimulants. Several national studies have found that approximately one-third of college students misuse, and a recent survey of students confirmed this.

Prescription stimulants (specifically Adderall) have seen rising popularity, as demonstrated by their presence in popular TV shows (such as Pretty Little Liars) and Youtube videos.

Consider This:

  • What does the film for example highlight about the effects of Adderall? What does it say about pressures?
  • They take Adderall, presumably to study for their exam, but what do they do instead? How do they feel in the morning?
  • What symptoms do they show after taking Adderall?

There are Blatant Risks of Misuse of Adderall or Other Stimulants Without a Prescription

  • For what purposes do students misuse Adderall?
  • Do you know what risks are involved when taking Adderall or other stimulants without a prescription?

What are stimulants prescribed for?

  • Attention Deficit/Hyperactivity Disorder (ADHD)
    • 7%-11% of children and adolescents are diagnosed with the disorder & two-thirds of them are prescribed stimulants
  • Narcolepsy
  • Obesity

How do stimulants work?

  • increase dopamine levels in the brain
    • neurotransmitter associated with pleasure, movement, and attention
    • creates a therapeutic effect with an increase in one’s ability to focus
  • prescribed in low dosages to increase dopamine in a manner similar to the natural release in the brain

Increasing Availability of Stimulants

  • ADHD diagnosis grew 17% between 2010 and 2011 and continues to rise
  • 19-25 year olds increased medicine use by 2% from 2010-2011
  • 2.7 million youth are prescribed the drug each year
  • 5.3% of college students prescribed stimulants

Public Perception

  • Little Risk
    • 40% of young adults believe that it is safer to abuse prescription stimulants than illicit ones
    • 30% of young adults believe that prescription stimulants are not addictive
  • High Reward
    • “Smart pill” that boosts GPA and academic performance
    • 65.2% use to improve alertness and concentration

Health Risks of Stimulant Abuse

  • Paranoia
  • Increased body temperature
  • Abnormal heartbeat
  • Hostility
  • Psychosis
  • Anxiety
  • …and even a drop in academic performance

Addiction and Withdrawal

  • High risk of addiction
    • Quick rise in dopamine can create sense of euphoria
    • Body becomes reliant on medication to produce dopamine
  • Withdrawal symptoms
    • fatigue, depression, disrupted sleep

Stimulants and Alcohol Use

  • Masks the depressant action of alcohol
    • Increases risk of alcohol overdose
  • May compound the stimulant health risks
    • higher risk of:
      • paranoia
      • hostility
      • anxiety

Prescription Stimulant Abuse at Vanderbilt

Anonymous Survey conducted on March 13-14, 2013

-242 students

-59% female

-88% greek life

-equal representation of all four classes

Survey Data: Prevalence on Campus

– 36% of students admitted to using prescription stimulants without a prescription

– 31% admitted to using prescription stimulants to help them focus on studying

-19% used prescription stimulants to pull an “all nighter”

-17% used prescription stimulants for recreational (for fun) use

-3% used prescription stimulants to lose weight or for athletic purposes

Survey Data: Supply

-How easy is it to obtain Adderall, Ritalin, Vyvanse, etc. from students on campus?

-0%: very difficult

-35.56%: somewhat easy

-35.15%: very easy

-8.37%: somewhat difficult

-20.92%: I’m not sure

Legal Consequences: Vanderbilt

The following are excerpts from the Vanderbilt Student Handbook at http://www.vanderbilt.edu/student_handbook/alcoholic-beverage-and-controlled-substances-policies/

Distribution or facilitation of distribution of illegal drugs (including unlawful distribution of prescription medication) may result in suspension or expulsion for a first offense; unlawful distribution includes incidents in which no money is exchanged. In addition, the possession of controlled substances or alcohol in such quantities as to create a presumption of possession with the intent to distribute on or off campus is a serious violation that may result in immediate suspension or expulsion. Evidence that a student has distributed drugs is grounds for interim suspension from the University and/or expulsion from University housing pending the findings of accountability proceedings. Students found to have distributed drugs to others may also be held responsible for personal injuries or property damages resulting from misconduct committed by the students under the influence of the distributed substances.

The presumptive sanction for a third violation of alcohol or controlled substances policies is suspension.

Violations involving behavior that injures persons, that damages property, or that injures or damages the community at-large, will increase the presumptive strength of the sanction given.

In addition, sanctions will be imposed for misconduct that results from the use of alcoholic beverages or other drugs. Students will also be held responsible for any damages that result from their misconduct. These sanctions will be imposed consistent with standards and procedures found in Chapter 3, “Student Accountability.”

Prescription Drugs:

Many medications and prescribed drugs have the potential for abuse. Those listed below are some of the most abused, addictive and dangerous.

  • Adderall, Concerta, Ritalin, etc. are stimulants and controlled by the Drug Enforcement Agency (DEA). These drugs are often prescribed for students who have been diagnosed with Attention Deficit Disorder (ADD) or ADHD. They are, however, used by some individuals who have do not have ADHD to increase alertness or recreationally for a “high.” Studies do not show improved academic performance when these stimulants are taken by students without ADHD. The risk from misuse of these drugs ranges from lack of sleep and weight loss to the more severe risk of psychosis with severely disorganized thinking. Individuals who develop psychosis have very poor insight and judgment and so continue to use the drugs in excess. For individuals abusing these stimulants, abrupt withdrawal may lead to significant mood changes including severe depression with a risk of self harm.
  • Codeine, Hydrocodone (Lortab and Vicodin), and Oxycodone (Percocet and OxyContin) are medications that are prescribed for severe pain. All these drugs can be addictive and may be abused for feeling anxious, sedation, falling asleep or to get a “buzz” or “high.” Addiction to pain medications is common and withdrawal can be very difficult to manage.
  • Xanax, Valium, and other benzodiazepine drugs are prescribed for acute anxiety and panic attacks. Use of all benzodiazepine compounds can lead to psychological and physiological dependence.  Symptoms associated with withdrawal from these drugs can be severe and include seizures. Barbiturates are also sedative medications that can be addictive. Barbiturates are no longer commonly prescribed, but are potentially addictive. As with all sedatives, withdrawal symptoms can be dangerous and severe. Combination of these drugs with other central nervous system depressants can be dangerous.

Warning Signs of Possible Substance Abuse

  • Withdrawal from social situations
  • Increased boredom or drowsiness
  • Change in personal appearance (increasingly unkempt or sloppy)
  • Change in friends
  • Easily discouraged; defeatist attitude
  • Low frustration tolerance (outbursts)
  • Violent behavior and vandalism
  • Terse replies to questions or conversation
  • Sad or forlorn expression
  • Lying
  • Poor classroom attendance
  • Dropping grades or poor work
  • Apathy or loss of interest
  • Change in sleep pattern ranging from excessive sleep to inability to sleep
  • Frequent excuses for absences from planned activities

When such signs appear in friends,

DO

  • Express your concern and caring
  • Be ready to listen
  • Communicate your desire to help
  • Make concrete suggestions as to where the student can find help or how he or she might cope with a given problem
  • Try to get the student to seek professional help
  • Ask for assistance from campus resources
  • Be persistent
  • Understand the definition of friendship to include making difficult decisions that may anger your friends

DON’T

  • Take the situation lightly or as a joke
  • Be offended if the student tries to “put you off”
  • Take “I don’t have a problem” as an answer
  • Try to handle the student alone-ask for assistance
  • Lecture about right and wrong
  • Promote guilt feelings about grades or anything else
  • Gossip: speak of it only to those who can help
  • Excuse behavior because “everybody does it”

References

Dear Teachers & Professors,

An open letter to those in education

Dear teacher(s)  professor(s),

TO WHOM IT MAY CONCERN:

I am a person living with mental illness. Odds are, I’m not the only person in your life who faces this — whether you know it or not. Your knowledge about mental illness may be limited to what the media says, or what society says. With the alarming amount of college students with mental illness these days, I would hope you’ve educated yourself on this topic.

I am a person living with mental illness. I’m also a good student. Yes, I may have missed class, not participated in a discussion or turned something in late, but if that’s all you see then you’re not seeing the whole picture. I’m not asking for excuses or looking for a way to get out of assignments or rules. I would love to be able to adhere to everything without a problem. But I can’t. I have a disability, and even the department that provides accommodations for disabilities doesn’t help much. Aside from the scars on my body and physical symptoms of panic attacks, my illnesses are invisible.

When I don’t come to class, you may see a student who is lazy or didn’t feel like coming. But what you don’t see is the restless night I had tossing and turning with my insomnia. You don’t see the black mass encompassing my entire being some days. You don’t see the fight in my mind between staying alive or giving up. I’m not just lazy. It’s not because I didn’t finish the homework. I wasn’t in class because I couldn’t get out of bed today. I could not face the light of day because my depression had chained me to the darkness of my room.

I had a teacher tell me once it wouldn’t be fair to the people who always made it to class if my absences didn’t affect my grade. At the time, I understood. But looking back now, I realize that makes no sense. Accommodations exist for people with disabilities for a reason. By “understanding” but still penalizing me for something caused by my mental illness, you are keeping me at a disadvantage. It’s not fair to expect I be on par with other students who don’t have the added obstacle of an illness. I promise I’m giving it my all. I’m balancing my recovery and my education at the same time, and I shouldn’t feel like I have to choose. I shouldn’t feel like I can’t do both.

I’m not asking you to never expect me in class or constantly give me extensions. I’m not saying to just let it slide. I’m asking you to be empathetic, understand that I’m a student facing an illness and help me succeed. I’m asking you to not give me a low grade solely because my mental illness prevented me from having a perfect attendance. I’m asking that you look at me as a whole person. I’m asking that you care, and if you can, that you advocate for students like me. I’m a person living with mental illness, and there are so many of us who need your understanding.

-JACOB M. GRIFFIN
BALL STATE UNIVERSITY
FOUNDER OF GRIFFIN AMBITIONS LIMITED, A HOOSIER BASED 501c/3 NON-PROFIT
FOUNDER OF ACTIVE MINDS AT BALL STATE UNIVERSITY

 

A Pertinent Mental Health Agenda

The new President and a confident, conservative Congress will create grave threats to America’s mental health system—if they succeed in repealing the portions of the Affordable Care Act that increased access to mental health services, if they succeed in changing Medicaid from an entitlement to block grants, and if they succeed in changing Medicare to a voucher system.

Given these threats to the current, inadequate mental health system, this is clearly a time for unified action by all mental health advocates—action both to prevent erosion and to press for progress.

Why is it so important to protect current resources and to seek more?

• Of those who get treatment, less than 1/3 get minimally adequate treatment.

5-6% of American adults have a serious mental illness; about 2% have disorders that are long-term and disabling, contributing to very high rates of unemployment and poor living conditions.

30-40% of homeless adults and 15-20% of people in jails and prisonsin the United States have a serious mental illness. This is often accompanied by substance abuse problems in both these populations.

• As many as 10% of children have a serious emotional disturbance, contributing to school failure and other serious problems.

• There will also be massive growth of minority populations, and the mental health system already has a tremendous shortage of culturally competent personnel.

A 10-Point Agenda of Goals

1. Preserve Current Capacity: The Affordable Care Act has resulted in health and behavioral health insurance coverage for 20 million people who did not previously have health coverage at all and an additional 12 million people who did not have behavioral health coverage. We should demand that these people continue to be covered.

2. Increase Capacity and Improve Access: Since fewer than half of the people who could benefit from behavioral health service get it, there needs to be a multi-year commitment to increase service capacity, including rehabilitation services and a broad range of community supports—especially housing— for those with the most serious disorders as well as treatment interventions for the broader population of people with less severe disorders.

Proposals for growth must be based on realistic estimates of the scale of needed expansion. Given the fact that treatment for mental health and substance abuse services now costs over $220 billion per year, current behavioral health reform proposals barely scratch the surface of the need for expansion. Only Medicaid and Medicare are major sources of funding increases.

3. Preserve Medicaid and Medicare As Entitlements: Growth of the mental health system over several decades has come primarily from Medicaid. And over the past decade Medicare has grown as a funder of mental health services from paying 7% of all costs to 14%, an almost proportionate share. Loss of these programs as entitlements would virtually cut off increased funding for mental health and substance abuse services.

4. Remove barriers to access: In addition to increasing service capacity, efforts need to continue to remove barriers to treatment. Full implementation of parity requirements is essential as are increased efforts to overcome stigma.

Improving quality of care requires major changes in both the preparation of the behavioral health workforce and in the structure of service delivery. These changes include:

• Increased biomedical, clinical, epidemiological, and services research and the translation of research findings into practice and

• Enhanced integration of physical and behavioral health services.

Overall, improving quality will require continued modifications of practice, organization, and finance models.

Critically important are complex changes in the relationship between providers of service and those who use behavioral health services to make these services “person-centered” and “recovery oriented”.

6. Reduce the suicide rate: Although today’s mental health headlines are about rare instances in which a person with a serious mental illness commits a mass murder, in truth they commit only 4-6% of homicides, (about 800 per year). They are far more likely to be victims than perpetrators. And they are far more likely to kill themselves (about 40,000 per year). The nation must redouble its efforts to prevent suicide, including restricting access to lethal means.

7. Enhance substance abuse policy: Substance abuse, including the recent rise in opioid addiction, results in high rates of avoidable deaths, serious health conditions, incarceration, and lost human potential. Prevention and treatment must be at the center of the nation’s efforts to address substance abuse problems.

8. Enhance criminal justice policy: Sadly, encounters between people with serious mental illness and the criminal justice system sometimes result in avoidable deaths. In addition, hundreds of thousands of people with serious mental illness are unnecessarily incarcerated in jails and prisons, often for minor offenses. Improved police intervention, expansion of diversion programs—such as mental health courts—and a re-working of the American bail system are needed.

9. Build a hopeful future for children and adolescents with mental health problems: In addition to increasing service capacity and improving quality of care, there must be:

· Far greater attention to the social determinants of mental and/or substance use disorders—especially poverty and violence in families and neighborhoods

· Earlier identification and intervention

· Improved collaboration among child serving systems—behavioral health, health, education, child welfare, and juvenile justice.

10. Prepare for major demographic changes: Over the coming decades there will be two major demographic shifts in the United States. Minority and immigrant populations will gradually become the majority, and people 65 or older will grow to about 20% of the population, roughly equal to the population of children under 18.

For minority populations the critical need is to build a culturally competent behavioral health system. This includes culturally sensitive practice, efforts to address lingering racism and discrimination, and inclusion of more minorities as treatment providers, managers, planners, and policy makers.

For older adults, the critical need is to build a generationally competent behavioral health system with an emphasis on helping older adults to live in the community, despite physical and mental disabilities. Particularly important are appropriate residential settings, mobile services, integration of physical and behavioral health care, improved care for people with Alzheimer’s and other dementias, and support for family members, who provide 80% of the care for older adults with disabilities.

Avoid ideological disputes that paralyze change: This 10-point agenda to protect and improve America’s mental health system is challenging and complex. Efforts that have focused on constructing comprehensive behavioral health service delivery systems and financial models to support them have been stymied not just by stubborn divisions between the political parties, but also by vituperative ideological differences within the mental health community. Effective joint action will require putting aside debates fueled by ideological differences regarding coercive interventions, return to asylums, confidentiality, priority populations, and gun control so as to focus instead on the critical issues about which virtually all advocates agree.

We must put aside our differences and work together for preservation and improvement of our nation’s mental health system. The cost of failure is far too high.