National Wraparound Implementation Academy

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Okay all you wraparound devotees, put this one on your calendar! 

nwi
The National Wraparound Implementation Center (the implementation support wing of the National Wraparound Initiative) is hosting a NATIONAL WRAPAROUND IMPLEMENTATION ACADEMY July 14-15 in beautiful Portland, Oregon. The Academy will focus on implementation of high-quality, research-based Wraparound care coordination and have tracks for program administrators, supervisors of parent peer support partners and wraparound facilitators, and research and evaluation staff. The Academy will also have a particularly cutting edge track on youth and young adult peer su
pport. Space is VERY limited, so be sure to save these dates and be on the lookout for additional announcements about how to register in the new year.

nwi

Maryland pushing for new outpatient civil commitment law

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The state Department of Health and Mental Hygiene has outlined legislation that could ease Anne Arundel County's mental health needs.

The DHMH report, released Wednesday, has a proposal for an outpatient civil commitment law that would allow judges to order individuals with dangerous mental illness to undergo treatment while remaining in the community.

Maryland is one of five states that doesn't already have such a law, although states apply these laws in varying ways.

"It is very important for people with mental illness to recover and live productive lives," said DHMH secretary Dr. Joshua Sharfstein. "We are talking about a critical missing component in Maryland law that needs to be fixed in order to support certain people in Maryland getting the services they need."

  • "Groups such as the National Alliance on Mental Illness have said more hospital beds are needed for the treatment of serious mental illnesses, and also for voluntary services such as counseling... But the Maryland Disability Law Center, the Mental Health Association of Maryland and On Our Own of Maryland submitted a response to the DHMH report in which they criticized the drive for civil commitment."
  • Continue reading on the Capital Gazette website

National Data Collection project needs to hear from families

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Over the past 25 years, the number of family-run organizations has steadily increased across the country. Throughout this time, very little data has been collected nationally about the types of services, numbers of families and the impact and outcomes achieved by family-run organizations.

The Family Run Executive Director Leadership Association (FREDLA) established the National Data Collection project to establish standardized data collection elements and to build a body of evidence for the services and supports family-run organizations provide. A group of researchers, policy makers and family leaders have provided expertise and guidance to the project.

Family organizations are asking to complete this brief survey about their organization and the services provided. Participation in this survey will help to strengthen the voices of family-run organizations and build a case for support. 

TO COMPLETE THE SURVEY

'I ask members of Congress to look those Newtown families in the eye'

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murphyBy Wayne Drash, CNN, December 11, 2014 -- 

Tim Murphy was fascinated with trains at the age of 9. Every morning and evening, he went outside to watch an iron horse roar by on the railroad line that cut through Northfield, Ohio.

He placed pennies on the tracks. He waved at the engineer and watched the caboose disappear into the distance.

But one time, the train didn't come. A patient from the nearby state psychiatric hospital had escaped and laid down on the tracks.

Murphy didn't see the body, but news of the suicide hit hard.

He calls it his "first encounter" with mental illness.

"It was frightening to me, and I didn't quite know how to comprehend this. But I remember being very shook up for a number of days."

Now Murphy is a psychologist -- the only one serving in Congress. And as the nation marks the second anniversary of the school massacre in Newtown, Connecticut, the representative from Pennsylvania is shook up.

The mantle he accepted and embraced in the aftermath of Newtown haunts him: to fundamentally change America's mental health system.

"It's two years and nothing's happened. Period," says Neil Heslin, whose 6-year-old boy, Jesse, was killed that day. "It is what it is."

Murphy met with Newtown families whose children were killed in the massacre and pledged to dedicate his career to fixing a broken system. As a reminder, he keeps photographs of the children on a table in his office.

He traversed the nation, holding dozens of public forums on mental illness and meeting with hundreds of families affected by a system that too often fails their mentally ill children. The Republican congressman held multiple hearings looking into the state of the nation's mental health care system.

Even with his years of training, Murphy still gets taken aback when he hears stories from families. He marvels at the love of traumatized parents and ponders tough questions: Why has mental health care abandoned those it is meant to help the most?

What emerged from his work was legislation that seeks to make the most sweeping change in the system in more than two decades.

But it's almost as though Murphy's Law got in the way of Murphy's law: Everything that could go wrong did.

A Democratic bill introduced this spring scuttled bipartisanship and undercut his hard work. House leaders raised budgetary concerns. International crises in Iraq and Syria diverted attention over the summer. And a fickle public moved on.

Two years after Newtown, the nearly 14 million Americans with serious mental illness must navigate the same patchwork system that failed the nation on December 14, 2012.

Says Murphy: "I ask members of Congress to look those Newtown families in the eye."

A message of hope
From the beginning, Murphy was emphatic about what drove Adam Lanza to kill 26 people, including 20 children inside Sandy Hook Elementary School. In a closed-door meeting -- what he called Psychology 101 -- with House Republicans two years ago, he told fellow lawmakers to stop turning a blind eye to mental illness.

"I see it as the center of the issue," he said. "Get mental illness out of the shadows."

On an appearance on CBS's "Face The Nation," the congressman blasted those who blamed violent video games as the genesis for the shooting spree. "We're chasing the wrong rabbit down the wrong hole," Murphy said. "We need to be addressing mental illness, and we're not."

If 20-year-old Lanza and 26-year-old Jared Loughner had been forced into treatment, Murphy says, the tragedies in Newtown and Tucson could have been averted.

Loughner pleaded guilty in the January 8, 2011, attack that killed six and wounded Arizona Rep. Gabby Giffords and 12 others -- and was diagnosed paranoid schizophrenic only after he went to prison.

Patient advocacy groups always say, " 'Well, you couldn't have predicted that.' Yes, you can," Murphy says, his voice rising. "In each of those cases, the family knew that their son had a serious mental illness, and they couldn't get them help."

Laws prevent parents and caregivers from being involved in children's health care decisions once they turn 18 -- even for the most seriously mentally ill who have cycled in and out of psychiatric care for years.

His bill -- introduced this time last year -- would allow more parental involvement in a young adult's care, create a new assistant secretary for mental health and make it easier to commit people to court-ordered treatment against their will.

The issue of forced treatment is highly contentious among civil libertarians and patient rights advocates. It ignited a civil war inside the mental health community. The key argument: Should a seriously mentally ill patient be medicated over their objections as a last resort, or does that approach violate their civil liberties?

Murphy's bill would also gut more than $400 million from the Substance Abuse and Mental Health Services Administration (SAMHSA) and move the money to the National Institutes of Mental Health for effective programs with evidence-based research to get people better. As Murphy puts it, treatment should be "led by a doctor, not a lawyer."

"We need to bring mental health treatment into the 21st century," he says.

Patient rights groups wholeheartedly reject his approach. They see his bill as a two-pronged attack: They lose funding, and the mentally ill lose rights.

Murphy's supporters consider him a savior of the mentally ill. His critics call him a bully trampling individuals' rights.

Though his bill will die in this lame-duck session, he will reintroduce the legislation, possibly with some tweaks, next year to a GOP-controlled Congress. He has 115 co-sponsors, including nearly 40 Democrats onboard.

To the families he has met over the past two years, he has a message of hope: "Their voice is being heard, and it will not be simply dismissed."

"Our bill really pushes for solutions to help address the unique needs of not only those with serious mental illness, but families and communities and caregivers."

A lifelong commitment to the mentally ill
Murphy grew up one of 11 children, the fourth from the oldest in his family. His father was a podiatrist, and his mother was a nurse. His first paying job, at 10, was cleaning horse stables at a nearby farm.

"We mucked up the stalls for 50 cents, and I could ride horses," he says. "I like to say that sometimes the difference between that and Congress is: I don't get to ride horses."

Living in a large household helped shape his views. Siblings, cousins, aunts and uncles crammed the home for family events. There were things every family member knew, Murphy says, but no one ever talked about.

"And those things take a toll on a family," he says. "And maybe it was the sum of those many experiences that certainly drove me to, instead of being afraid of mental illness, to be compassionate and driven towards saying, 'I'm going to walk into this and dedicate my life to changing things so that other people don't have to feel the pain.' "

Pressed about his devotion to the mentally ill, Murphy, 62, says he watched "things erode and decay" during his formative years with friends and family. But he stops there, saying only that there was a great deal of sadness involved.

"Some day I'll disclose," Murphy says, "but I'm not comfortable with that yet."

His interest in psychology grew as he went off to college. He earned his bachelor degree from Wheeling Jesuit University in West Virginia in 1970, before seeking a master's in clinical psychology from Cleveland State University and working at a community mental health center.

"I found the field of psychology fascinating," he says. "The more I got into it, the more I felt this is where I could make some difference."

He earned his PhD in psychology from the University of Pittsburgh and worked in various Pennsylvania hospitals. He became an assistant professor of psychology at the University of Pittsburgh and was known as "Dr. Tim" from appearances on local television.

He opened his private practice around 1987.

He came along at a time when the main psychiatric hospital in Pennsylvania, even in the early 1980s, still used archaic treatment practices, such as dunking patients suffering from depression into ice water, thinking it would snap them out of it. "The asylums of yesteryear needed to be torn down," he says.

As a young psychologist, he heard horrific stories of sexual abuse of children and "physical beatings that were awful." He counseled those children and fought for their well-being.

More recently, he joined the Naval Reserve in 2009, and every month spends two days at Walter Reed hospital counseling war veterans suffering from traumatic brain injuries and post-traumatic stress disorder. "I thought if I'm going to be voting to send them over to war, then I have a responsibility to help them when they return," Murphy says.

When he informed a wife of the extent of her husband's war wounds, she left him; the spouse of another had the opposite reaction: "If it takes me 50 years, I'll teach him to laugh and love again."

In the stories and struggles of his patients, Murphy finds resolve. "You develop a lot of what they call 'compassion fatigue,' " he says. "But then, I'd say, 'That's nothing compared to what people face.' And it just gives you strength."

Dennis Roddy, a long-time journalist in Pittsburgh who went on to become an aide to Pennsylvania Gov. Tom Corbett, says it was considered an oddity when Murphy became a state senator in 1996. The stigma of mental illness was so prevalent, Roddy says, that some constituents had a hard time with the thought of a psychologist in office and wondered: "Should we feel comfortable about it?"

"He was at the forefront of the politicians who recognized the dilemma" of mental illness, Roddy adds. "When he got into Congress, he waited and worked his way until he was in a position to do something about it."

Politics PA, a buzzy blog tracking the state's political scene from Erie to Philadelphia, once dubbed Murphy one of the smartest lawmakers in the state.

"He has the capacity to pay attention and the talent to listen," Roddy says. "This psychologist doesn't look at the clock and say, 'I see our time is up.' "

Opponent: 'Back to the Dark Ages'
Curt Decker, executive director of the National Disability Rights Network, doesn't buy it. He believes Murphy used his position as a psychologist to curry favor among GOP leadership, "bootstrapped onto Newtown" and was sold a bill of goods by those who believe medication over objection is the answer to treating the seriously mentally ill.

"I would say he puts out there that he cares about this population, and he really doesn't," Decker says. "In the meantime, it adds to the stigma."

The Murphy bill, he says, focuses on a "coercive lock-them-up and throw-away-the-key kind of approach and ignores the whole movement that's been going on in the mental health community for the last couple decades" -- one based on recovery and support systems within communities.

Decker agrees with Murphy that the mental health system must be revamped to repair "this really dangerous patchwork of services." He just doesn't like Murphy's approach.

To be clear, Decker has a beef with Murphy. He says his Disability Rights Network would see its federal funding shrink from $38 million a year to $5 million under Murphy's plan. He says Murphy puts on this public persona that he's willing to work with his opponents, but then "he brings them in and yells at them."

"What he's trying to do is kind of scary," she says. "If he takes away Protection and Advocacy for Individuals with Mental Illness, then we do go back to the Dark Ages where we can be involuntarily committed someplace and abused and neglected."

On that point, Murphy pushes back. And hard.

Spinmasters, he says, have distorted his bill to scare away support. He is all for current comprehensive approaches -- peer support, medication, psychotherapy, group therapy, safe housing. Yet he ardently rejects the status quo -- $130 billion in federal funds, with what he says are millions upon millions being wasted on "feel-good" programs that don't work.

If patient advocacy programs were so effective, he says, then why over the past 20 years "have we seen an increase in incarcerations, suicides, substance abuse, suicide attempts, suicidal thoughts, homelessness, disability and unemployment among the mentally ill."

"On every metric," Murphy says, "this country is failing."

His opponents, he says, are perfectly fine with the mentally ill going untreated: "These groups push for a right to be sick, a right to be homeless, a right to be in jail, a right to be unemployed."

"If people want to defend that, then put that in front of the American public, because the American public does not agree with them. People have a right to get better."

There is no doubt that treatment works, Murphy says, even for the most seriously mentally ill. He knows that from counseling hundreds of patients over the years and from court-ordered programs that help the seriously mentally ill, but only after they have committed a major crime.

"Why not fight for what is right, what is appropriate, what is necessary?"

And so Murphy persists.

Despite critics. Despite a stalled Congress. Despite waning public interest.

Murphy: 'In this together'
At a hotel ballroom in the nation's capital, Murphy stands in front of more than 1,000 people for the keynote address of the annual conference of the National Alliance on Mental Illness, the largest nonprofit mental health advocacy group.

It's early September, and Murphy hopes to ignite these advocates to get their lawmakers to lend their support in advance of the midterm elections.

Moments earlier, Democratic Rep. Ron Barber of Arizona appeared via video to promote his own mental health bill -- one that was introduced this spring and has garnered little bipartisan support. As Murphy prepares to speak, murmurs bounce around the room:

If there are two bills, why can't they just work together and hammer out an agreement?

Barber was a key staffer for Giffords and was among the 13 wounded in the attack that nearly killed her. He knows first-hand the horrific effects of untreated mental illness.

Barber assumed Giffords' seat in June 2012. His bill avoids the controversial treatment provisions of Murphy's, instead focusing on creating a White House Office of Mental Health Policy, continuing to support the funding of SAMHSA and other initiatives.

"It is imperative that we find a way to establish common ground on provisions in each bill that we both support and move forward with a bipartisan bill that can pass the House and garner bipartisan support in the Senate," Barber says. (Barber is currently steeped in a recount in Arizona, and his staff would not make him available for an interview for this story but provided a written statement echoing his NAMI comments.)

But Murphy won't budge. He believes his bill is too critical in meeting the needs of the seriously mentally ill: "Why would I want to compromise when you hear these stories over and over?"

Murphy looks out over the crowd. He's met many of them over the past two years as he's traveled the country or hosted congressional hearings. He immediately sets the tone.

"I'm not interested in just passing a bill. I'm interested in making a fundamental change to America's abuse of the mentally ill," he says to raucous applause.

He speaks for 55 minutes, stepping the audience through the changes he has proposed and why he believes so adamantly about the most drastic portions of his bill. His speech is interrupted by applause 30 times.

He urges the crowd to tell their representatives to support the bill. "You are an army of soldiers with the biggest hearts and greatest love that is out there," Murphy says. "There'll be people out there who fire upon you slings and arrows of lies and stigmas and deceit and mistrust."

When those people attack, Murphy says to stand strong. "We are in this together."

Sorrow, stigma and heartache

A woman trembles: "My daughter Sarah died by suicide on July 16."

Says one man: "My brother got better treatment in 1957 than he would today."

On and on, the stories keep coming from people gathered in the Rayburn Office Building to talk with Murphy. Sons, daughters, brothers, sisters, husbands, wives. They're locked away in prisons; they're homeless; they're untreated; they're dead.

These families hail from California, Kentucky, New York, Oklahoma, Ohio and Pennsylvania. It doesn't matter where they're from: their stories are the same -- a mental health system laden with hurdles and bureaucracy that makes it difficult to get proper care.

Murphy agreed to meet with families in advance of his keynote speech at the NAMI conference. It was supposed to be a small gathering, but word spread among families, and the numbers swelled.

"No one came in here saying what party they're in," Murphy tells the group. "I know that mental illness doesn't discriminate by party, by race, by age, by income."

The congressman listens to their stories and engages with each on a personal level. "I want to hear from you," he tells them. Dressed in a navy suit, he stands in front and points around the room to individuals who recite their travails.

"Every time you think your heart can't take any more," Murphy says later, "you hear more."

Rich Mandich and his wife, Joyce, sit in the front row. Like a shaken Coke bottle, Rich is about to burst, his emotions pent up for three years.

"I want to tell you about my son, Steven," he tells Murphy.

His son was 28 and suffered from schizophrenia. Police in Bedford, Ohio, knew him well. They'd responded to the home dozens of times during his meltdowns over the years.

Shortly before 6 p.m. on November 26, 2011, Steven called 911 to say his father had his medications. "They laughed at him," Mandich says. "They thought it was funny."

His wife moans, her body shakes.

Police came to the home. Mandich says he tried to intervene, but was Tasered and dragged out of the home by officers. His son had a knife in his hands and was Tasered multiple times, before being shot to death in his bedroom. Police said he lunged at them with a knife.

The family eventually filed suit against those involved. It was settled out of court for an undisclosed amount.

Mandich had always been his son's protector, but "that day, I couldn't save him because they got in the way." He breaks down, years of bottled-up pain welling over.

Murphy takes off his glasses and wipes his eyes. "He had rights and you had rights," Murphy tells the father. "He had a right to go and live a full life."

"He was a valuable person to us," Mandich says. "This kid had a kind heart."

The two agree that Steven Mandich deserved better treatment than being gunned down in his room. It is an important acknowledgment for a family still grieving -- to hear someone in power say that their son mattered.

When the session ends, Murphy strolls outside around the nation's Capitol, unable to shake the power of the Mandiches' story.

"They lost their loved one long ago," he says, "but they've never lost their hope that something can change."

The congressman is energized. In his view, the very least he can do is maintain that hope -- that changing the system is worth the fight.

Early Childhood Mental Health Partnership releases integration tool kit

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The Early Childhood Mental Health Partnership is pleased to release a new toolkit for programs and providers interested in integrating child mental health into pediatric primary care.

Available at ecmhmatters.org, the Early Childhood Mental Health Toolkit: Integrating Mental Health Services into the Pediatric Medical Home is a comprehensive collection of tools and tips for incorporating early childhood mental health personnel and practices into the pediatric primary care setting.

Topics addressed include:

In 2009, the Massachusetts Executive Office of Health and Human Services, the Massachusetts Department of Public Health, and the Boston Public Health Commission received funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) to create a model of early childhood mental health services integrated in the pediatric medical home.

The model is based on a partnership between a family partner and early childhood mental health clinician. Knowing many practices may not have the capacity to create or fill these positions in the current healthcare environment; BPHC has structured the toolkit to be used by primary care practices with or without dedicated early childhood mental health staff.

Building the Science and Practice of Implementation

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Hey Network faithful, this webinar is coming up fast, so pencil it in! 

  • Building the Science and Practice of Implementation
    Monday, December 15, 2014 2:00:00 PM EST - 3:30:00 PM EST
  • Register here

    This webinar will highlight current issues in implementation science with an eye towards future research and practice areas. The role of implementation science in achieving wide-scale social impact will be discussed. Allison Metz, PhD, will focus on the roles of key stakeholders in mainstreaming and sustaining the use of evidence in practice.
  • Allison Metz, Ph.D., is a developmental psychologist, Co-Director of the National Implementation Research Network (NIRN), and Senior Scientist at the Frank Porter Graham Child Development Institute at The University of North Carolina at Chapel Hill. Allison specializes in the implementation, mainstreaming, and scaling of evidence to achieve social impact for children and families in a range of human service and education areas, with an emphasis on child welfare and early childhood service contexts. Allison’s work focuses in several key areas including: the development of evidence-informed practice models; the use of effective implementation and scaling strategies to improve the application of evidence in service delivery systems; and the development of coaching, continuous quality improvement, and sustainability strategies.
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