Wednesday, September 3, 2014

Notes from Mental Health Community Conversation on 8/26/14


Notes from meeting on 8/26/14  How can we both reduce the stigma and address the unmet mental health needs of so many among us?
http://metro.co.uk/2014/02/06/time-to-talk-day-shaking-off-the-stigma-of-mental-health-4265834/


First, some statistics:

One in five children birth to 18 has a diagnosable mental disorder.
One in 10 youth has serious mental health problems that are severe enough to impair how they function at home, in school, or in the community.
About 18 percent of children and adults — more than 1 million people in Massachusetts — suffer from behavior problems, depression, bipolar disorder, schizophrenia, or other psychiatric illnesses, and about 9 percent have substance abuse disorders, according to a report last month from the state Department of Public Health.

 Untreated population with schizophrenia: 37,284   
Untreated population with severe bipolar disorder: 58,486  
Estimated number of homeless with with severe mental illness: 4,999 (30% of 16,664 )
Prisons:
7.26% of the male inmate population identified as having serious mental illness
24% of men in prison have open mental health cases; 18% on psychotropic medication
24.9% of the female inmate population identified as having serious mental
59% of women in prison have open mental health cases; 49% on psychotropic predication

http://www.bostonglobe.com/lifestyle/health-wellness/2014/06/26/change-proposed-inmates-health-coverage/xfY7PeWbX1U0gzCtMwUlBN/story.html
Forty percent of inmates in [Middlesex County Sherriff] Koutoujian’s charge suffer from a mental illness, and 80 to 90 percent report drug or alcohol addiction, he said, making it urgent for them to connect with caregivers shortly after release.






We had 7 people show up at the Waltham Public Library for this discussion.  These are my somewhat cryptic notes, in order of how they came up in the discussions and to the best of my recollection.

·      Waverly Place in Belmont is a day program that helps adults work on their goals.  It  is run by McLean Hospital and grant funded.
·      Mental health issues and substance use is common and can have undesirable consequences.  As hard as it is for most to avoid using  substances, it is even more difficult for kids with MH needs.
·      It is sometimes difficult to differentiate between MH issues and issues related to substance use, and sometimes they are so intertwined there is no difference
·      Stigma gets in the way of admitting there is an issue or a need
·      Not necessarily the same level of stigma associated with MH issues in other countries as there is here in the US.  All cultures are diffrent, here in the US we tend to hide our family members with MH issues.  Parents often feel as though their children are shunned and sometimes the family is shunned by the community
·      MH issues need to be identified early on in families, noticing and dealing with issues, differentiating between typical behavior and non-typical.  Hard to know what to look for and then know what to do.  Parents are not trained MH experts
·      ‘Back in the day’, people lived with their extended families and there was a place for an uncle with MH issues or an aunt that could not go out on her own.  They were accepted as part of the family.
·      Two different people heard someone with MH issues speak at their places of worship.  Very brave act and helpful for the community to understand that this is just one facet of the person and to understand how it impacts the person’s life and that they can still be productive contributing citizens
·      We in the US are getting a little better but we do not know how to talk about MH, about race, about oppression
·      We do have the freedom in the US to explore new ideas and try to implement them
·      Education system needs attention
o   Need to put more effort into helping our educators identify, understand and help our children
o   Need more alternative educational options to help our children be succcssful
o   Massachusetts implementation of No Child Left Behind by the requirement to pass MCAS is in fact leaving many children behind.
o   Students that need MH services often do well academically so they are not identified as children in need.  The law requires that they make adequate progress not just academically but also socially and emotionally.  Educators and parents are often not aware of this requirement and the only recourse for families is to hire a Special Education lawyer of an educational advocate.  Costs lots of money to get the students their legal right
o   It can be difficult to measure social emotional growth but there are tests just for this
o   There is much more awareness now and some of the stigma is going away in the schools.  One person said his daughter is not at all afraid to say she is going to the Disability Office at her college
·      Mental Health Parity - http://www.healthlawadvocates.org/priority-areas?id=0016  Adults and children who need mental health treatment or substance abuse treatment should have access to the care they need.  Both Massachusetts law and federal law require health plans to cover diagnosis and treatment of these conditions at equal levels to coverage for medical and surgical services.  The federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) prevents health plans from placing higher costs or stricter treatment limitations on consumers who need mental health and substance abuse services.  Under the Massachusetts Mental Health Parity Law, insurers may not establish dollar or service amount limits that are more restrictive for biologically-based mental health conditions than for other types of medical conditions and requires a minimum level of coverage for non-biologically based conditions.
o   Yet we continue to have to re-qualify for services
o   Very difficult to find quality providers and then to find quality providers that will take your insurance is another battle

·      What are we doing as a community?
o   Roz Rubin, Director of GWarc in Waltham is an advocate for change at the legislative level – would be a good contact
o   Need a community center or some place for people to connect, find support and resources
o   Need educational advocacy
o   Need housing.  There is some limited housing through the Department of Mental Health but there is not nearly enough housing and many people fall through the cracks
o   People with MH issues are not always their own best advocates
o   After a person turns 18 parents often cannot gain access to information because their child is now considered an adult
We all have responsibility for MH

·      De-institutionalization
http://en.wikipedia.org/wiki/Deinstitutionalisation According to psychiatrist and author Thomas Szasz, deinstitutionalisation is the policy and practice of transferring homeless, involuntarily hospitalised mental patients from state mental hospitals into many different kinds of de facto psychiatric institutions funded largely by the federal government. These federally subsidised institutions began in the United States and were quickly adopted by most Western governments. The plan was set in motion by the Community Mental Health Act as a part of John F. Kennedy's legislation [clarification needed] and passed by the U.S. Congress in 1963, mandating the appointment of a commission to make recommendations for "combating mental illness in the United States".[4]
Although deinstitutionalisation has been positive for the majority of patients, it also has severe shortcomings.[22] Expectations that community care would lead to fuller social integration have not been achieved; many remain without work, have limited social contacts, and often live in sheltered environments.[23]
o   ‘We’ have a moral obligation, and some might argue a legal obligation to take care of these citizens.
o   There is little lobbying done on behalf of people with MH issues.  NAMI (http://www.namimass.org) does good work but not nearly enough
o   Police are often the first line of defense in communities and they are not trained mental health providers
o   Here is a report from NAMI on the state of mental health services in MA http://www.namimass.org/wp-content/uploads/Report-on-State-of-Mental-Health-in-2014.pdf  It is appalling.
o   We need to find a way to stimulate the community to take an interest in this important topic
§  Maybe something like the ‘ice bucket challenge’, or the Pink for Breast Cancer awareness, we need to find our own ‘thing’
§  NAMI has a mental heath walk and the OCD community has a fund raiser walk - we need more than these to raise awareness

·      What can we do?
o   Look at other countries for models of MH care
o   Consider implementing a local community mental health center modeled on the Council on Aging
o   Advocate for more and better community based services
o   More advocacy

·      Why should me/we/you care?
o   Health care industry is a big job generator
o   Massachusetts could and should be the mental health care innovation center
o   Look at all the mass shootings and suicides.  Many could be prevented with better health care services
o   Impact on community of under-educating or under-serving our children has financial repercussions for all of us

Next up, the Story of Oscar.

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