Mental illness, violence, and guns: The importance of early intervention

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The International Bipolar Foundation is out with another timely webinar. Plan to join Dr. Mark Komrad as he underscores the importance of early intervention when discussing the link between mental illness and violence.

  • Webinar: Mental illness, violence, and guns: The importance of early intervention
  • When: October 1st, 2014 at 4:00 pm PDT 
  • Space is limited, reserve your Webinar seat now 

Recent horrendous incidents of mass shootings, often by people with obvious psychiatric illness or a documented history of mental illness, have focused attention on violence as a feature of some mental illnesses. In particular, the discussion has tied together guns and mental illness in the minds of the public and many policy makers and legislators.  This webinar will focus on some of the  actual data regarding mental illnesses and their link with  violence.  

About the presenter: 
markDr. Mark Komrad 
Recipient of the National Exemplary Psychiatrist Award and named Mental Health Professional of the Year in 2013 by the National Alliance on Mental Illness (NAMI) , Dr. Komrad is a psychiatrist on the clinical and teaching staff of Sheppard Pratt Hospital and the Johns Hopkins Hospital in Baltimore,  Clinical Assistant Professor of Psychiatry at the University of Maryland and on the teaching faculty of Oceania University of Medicine in Samoa. He earned his undergraduate degree in molecular biophysics at Yale University, his M.D. degree at Duke Medical School, and trained in internal medicine and psychiatry at Johns Hopkins.  Read more.

17th Annual Family Café seeking workshop proposals

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The Family Café is pleased to announce that Presentation Proposals for The 17th Annual Family Café, to be held June 5-7, 2015, are now being accepted!

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The Annual Family Café Conference is a unique, state-wide event that brings together persons with disabilities and their families with peers, commercial service providers, and public entities to find out what services are available to them, which best serve their needs, and how to go about securing those services. Highlights from last year’s conference included 160+ classroom size sessions, three keynote addresses, an outdoor adaptive sports demonstration and rubber duck race event sponsored by the Florida Disabled Outdoors Association, as well as The 16th Annual Governor’s Summit on Disability featuring Governor Rick Scott. The event attracted some 8,900 participants.

The Annual Family Café is truly remarkable in its depth and scope, and its success relies in large part on the participation of knowledgeable, engaged presenters. The Family Café Planning Committee is inviting all interested parties to apply to be one of those presenters!

Proposals should be submitted prior to December 19, 2014; decisions regarding acceptance will be made in January, with notification following soon after. (The presenter listed as the “primary presenter” on the application form will be the individual notified.)

Once again, The 17th Annual Family Café Conference is scheduled for June 5-7, 2015 and will take place at Caribe Royale in Orlando. All professionals will be charged a registration fee of $150 unless they are either persons with disabilities or parents of persons with disabilities. Presenters are also responsible for arranging their own transportation and accommodations.

Even if you are not interested in making a presentation, you likely know people in your community who may be, so please feel free to share this call for presentation proposals with other interested parties, or simply direct them to The Family Café’s website. For more information about the Annual Family Café, including pictures of last year’s event, visit www.FamilyCafe.net. If you have any questions regarding the presenter application process, you may contact The Family Café office at 850/224-4670 or toll free at 888/309-CAFE.

Text, Talk, Act is back!

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Text, Talk, Act is back by popular demand to focus on a NEW topic that is of utmost interest to our youth: how to help a friend in need.

On Monday, October 6th, the conversation will go nationwide. Anyone, anywhere in the country (and Canada!), at any time can join this important event. It's still super easy:

This time, you'll get discussion questions and information on the importance of taking care of your mental health and how to help a friend in need. 

Groups that can't join the nationwide discussion on Oct. 6th can still host a Text, Talk, Act event anytime from now through the end of October. Simply text START to 89800 anytime now through the end of October to begin. 

  • Learn more at: www.creatingcommunitysolutions.org/texttalkact 
  • Register to organize Text, Talk, Act events on Oct. 6th and you could win one of ten $500 prizes (or one of 3 $1,000 prizes for your high school, college or community organization)! Five lucky participants will also win a $200 gift card to Amazon! 
  • Learn more at: http://bit.ly/TTAContest and forward this information to all young people you know!

  

You too can learn how to love groups!

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The National Council for Behavioral Health wants you to learn how to love groups. This exciting initiative provides organizations an opportunity to strengthen group delivered services by improving the knowledge and skills of group facilitators and their supervisors. Now how do you turn away from a lead-in like that? Read the message below from Council President & CEO Linda Rosenberg and consider getting your organization involved!

rosenbergThe National Council's Centers of Excellence recent crowdsourcing project highlighted for us struggles among treatment organizations to improve quality. Prominent among their struggles is the delivery of group services and, importantly, skills for supervisors of staff running groups.  

Leaders of treatment organizations and their staff understand the positive impact of group treatments, including the group as a community of support, a safe place to learn and refine new skills. Groups are highly valued as a sound clinical and financial investment, worthy of attention, time and energy, but hard to deliver.   

We believe that the National Council policy work is most effective when aligned with efforts to improve quality, and "Learning to Love Groups" is a new training and technical assistance offering consistent with our commitment to quality. As a former clinician, supervisor and program director, I've experienced both success and failure in delivering group treatment and so this newest offering is near and dear to my heart. We've recruited excellent trainers and tried to make the training affordable.

Please take a moment to learn more about Learning to Love Groups. You won't be sorry. If you decide to go forward and participate in the learning community, please be in touch with me and let me know if it's helpful.

Integrating behavioral and physical health care: State strategies

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commonwealthlogoStates across the country are embracing integrated care delivery models as part of their efforts to deliver high-quality, cost-effective care to Medicaid beneficiaries with both physical and behavioral health needs. The Medicaid expansion authorized by the Affordable Care Act brings greater import to these efforts, as millions of previously uninsured low-income adults—many at increased risk of having behavioral health conditions—gain coverage.

Drawing on a review of the literature and interviews with consumers, providers, payers, and policymakers, Deborah Bachrach and colleagues from Manatt, Phelps & Phillips explore strategies states are deploying to promote integrated care for this medically complex and high-cost Medicaid population in a new Commonwealth Fund report.

Dr. Thomas Jensen speaks on childhood bipolar disorder

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The International Bipolar Foundation is offering another great webinar - this one focusing on children with Bipolar disorder. Dr. Thomas Jensen provide an overview of  the diagnosis of Bipolar Disorder in Children and adolescents as well as treatment strategies for Bipolar disorder and comorbid conditions. Dr. Jensen serves as the medical director of the International Bipolar Foundation. Treatment resistant mood disorders are his specialty and he has treated several thousand people with mood disorders. Also, he teaches on the faculty of the UCSD school of medicine, and lectures extensively in the San Diego community.  

Trevor Project launches Ask for Help 2014

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“Whatever it is, Ask for Help.” That's the message The Trevor Project is sharing this September during National Suicide Prevention Month.

  • For the month of September, the Children's Mental Health Network will be promoting the Trevor Project's life campaign during National Suicide Prevention Month. Get involved, Network faithful. The Trevor Project does amazing work on behalf of LGBTQ young people!

Ask for Help is a PSA campaign that features empowering, first-person accounts of youth reaching out to friends, teachers, parents or counselors to promote the idea that it’s ok to ask for help when you need it. Through these diverse videos, Ask for Help helps reduce the stigma surrounding help-seeking behavior and directly refers LGBTQ young people to The Trevor Project’s life-affirming resources. 

Too often, we're afraid to ask for help when we really need it. After all, asking for help isn’t always easy. When a young person is lesbian, gay, bisexual, transgender or questioning, this can be even tougher, especially if they face family rejection, discrimination, or barriers to accessing help. The truth is that no problem is too big or too small. It’s ok to ask for help.

There are many ways you can support LGBTQ youth and join the Ask for Help campaign:

  • SHARE THE MESSAGE:
    • Share Ask for Help videos and graphics: OktoAsk.org.
    • Take a Supportive Selfie with our Ask for Help sign.
    • Change your profile picture on World Suicide Prevention Say (Sept. 10).
  • HELP OTHERS:
    • Become a Trevor volunteer and support LGBTQ youth.
    • Learn the warning signs of suicide and discover the facts.
    • Connect a young person in crisis to Trevor’s nationwide programs.
    • Bring the Trevor Lifeguard Workshop to your classroom.

The Ask for Help campaign also includes print ads, web banners, display ads, broadcast and radio spots. Contact Tobias.Rodriguez@TheTrevorProject.org to request more information.

“Ask for Help” Talking Points 
The Trevor Project’s Ask for Help campaign runs throughout National Suicide Prevention Month, and encourages young people to ask for support when they need it.

  • Whatever it is, Ask for Help.
  • Ask for help – it’s the first step to getting the support you need.
  • Asking for help can be scary, but it’s one of the bravest things you can do.
  • Let your friends and family know you’re here if they ever need to ask for help.
  • Reaching out for help isn’t always easy. In fact, the stigma surrounding mental health can seem paralyzing, especially for young people.
  • When a young person is lesbian, gay, bisexual, transgender or questioning, the stigma of asking for help can be even bigger, especially if they face family rejection, discrimination, or barriers to accessing support.
  • Too often, we’re afraid to ask for help when we really need it. After all, figuring out what to do, or who to ask, can be overwhelming. Still, taking this first step can be life-saving.
  • Sometimes it’s easy to keep our struggles inside, and not want to bother anyone with our worries or fears. The truth is that no problem is too big or too small. It’s ok to ask for help.
  • There are helpers everywhere, like friends, parents, teachers, counselors, faith leaders, youth group leaders, and Trevor counselors, who are there to listen whenever you need help.
  • When a young person has at least one supportive person to turn to, they are more likely to ask for help when they need it. This increases their chance of finding supportive resources like The Trevor Project, and that can be life-saving.
  • World Suicide Prevention Day is September 10, 2014. Change your profile picture to encourage your friends and family to Ask for Help when they need support!
  • If you or someone you care about it thinking about suicide, call The Trevor Lifeline at 866-488-7386. It’s free, confidential and there is always someone to talk to, 24/7.

National Suicide Prevention Week - September 8 - 14

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The theme for this year’s suicide prevention week is Suicide Prevention: One World Connected. The Suicide Prevention Resource Center (SPRC) has compiled materials and information to help raise awareness and support the worldwide effort to end suicide. 

Suicide prevention for Alaska Native communities

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The National Institute of Mental Health (NIMH), in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), announces a webinar on effective practices in suicide prevention for Alaska Native communities. Suicide is a national concern, with approximately 38,000 suicides occurring in the United States each year. Alaska Native and American Indian populations bear a disproportionately high burden from suicide and, as such, merit special attention. The geographic isolation of many Alaska Native communities appears to contribute to suicide risk. Conversely, access to income, social connectedness, and a link to strong traditional culture appear to be protective against suicide. The speakers will provide an overview of what is known about suicide in Alaska and will present specific effective strategies currently being used to promote mental wellness and reduce suicide among Alaska Natives. 

  • Webinar: Alaska Suicide Prevention
    Tuesday, September 23, 2014 • 2:00 pm – 3:30 pm EST 
  • Download the flyer 

Wrestling with a Texas county’s mental health system

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SAN ANTONIO -- Some people here just call Leon Evans “The Bear.” He is a massive man with a shock of white hair on both his head and face and wrists the size of a child’s thighs. The former All-Star wrestler earned his nickname after wrestling two living, breathing bears. “

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San Antonio's program is the brainchild of Leon Evans, director of the community mental health system in Bexar County, Texas. Evans stands in front of a mural across the street from the Restoration Center in San Antonio.

“This is Bexar County” (pronounced “bear”), Evans says, “so my wife teases me about this being my third bear.”

Evans is the director of the Center for Health Care Services, the community mental health system in San Antonio and  Bexar County. 

Texas ranks 49th out of 50 states in how much funding it commits to mental health.  But under Evans’ leadership, Bexar County has built a mental health system considered a model for other cities across the country -- one that has saved $50 million over the past five  years.

“In my entire career I’ve always understood the people who are the least valued, the people who society thinks the least of, are the people who have the most potential,” says Evans. “You reach out to them, they’ll do amazing things and nobody expects them to.”

Evans came to Texas in 1972 as a social worker, to help set up some of the very first community mental health systems, and he’s been in the state ever since. When he took over the Bexar county system 14 years ago, the county jail was so overcrowded -- packed with people in various states of psychoses -- that the state was getting ready to levy fines.

That’s not unusual. Across the country, about 20 percent of inmates and prisoners have a serious mental illness that includes psychosis, according to a study from the Justice Department’s Bureau of Justice Statistics.

Evans’ idea for reform was simple: for people with mental illness, treatment works. Andjaildoes not.

“Even here in Texas, which is very conservative, we learned some time ago that nonviolent mentally ill offenders shouldn’t be in prison. They don’t make good prisoners, ” he says, Ina state of psychosis, a prisoner is hearing voices and can’t follow rules, and that means he gets no time off for good behavior, Evans explains.  “They take up space for violent offenders.”

It’s also an expensive revolving door. When people with a serious mental illness are released from jail, many end up living on the street, sick and often addicted. And then almost invariably, they end up back in jail for a minor nuisance crime, like panhandling (which is illegal in San Antonio), urinating in public, digging in dumpsters or sleeping on someone’s porch.

That all sounds very familiar to Samuel Lott. For decades, he was a white collar worker,  most recently for the BNSF railway in Fort Worth. But in 2006, he lost his job.

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Samuel Lott stands in the courtyard of the homeless shelter across the street from the Restoration Center in San Antonio, Texas (Photo by Jenny Gold/KHN).

“Whatever diagnosis I had – depression, alcoholism, that sort of thing kicked into high gear back then, and I spiraled down pretty quick and became homeless,” says Lott.

For four years, Lott lived on the streets and camped in the woods. He was estranged from his family, got infected with hepatitis C, and his untreated depression started to take on signs of psychosis.  He had frequent run-ins with the police.

On his laptop, Lott, 51 pulls a picture of himself from 2010, the last time he was in jail. “This person is angry, unhealthy, there’s malnutrition, there’s no direction. You can see from the sunken cheekbones,” he says, pointing to the screen.

Getting treatment for any of his health problems felt hopeless, especially without transportation. “It meant having to walk from one side of town– I mean, miles and miles to the other side of town -- maybe to get a referral, and then you take your referral and walk clear back over to some other side of town, and then maybe you can go and get the help,” Lott explains.

In addition to scattered services,  Leon Evans says there was another problem for this population: none of the county or city agencies and nonprofits that deal with people with serious mental illness was talking to one another. The jails, hospitals, courts, police and mental health department all worked in separate silos.

“People who fund these services only look at their little small piece of the pie and whether there is a return on investment,” says Evans.

So with the help of the county judge, Evans worked to get the funders together to talk about the money they were all spending on mental health.  It turned out to be the most challenging – and the most important – piece of the puzzle.

“If you think law enforcement and mental health workers have anything in common, we don’t, except people with substance abuse and mental health problems. We speak a different language, we have different goals, there’s not a lot of trust there,” he says.

So he hired Gilbert Gonzalez to take a look at the money that they were all spending on mental health.

“You know Brad Pitt in the movie Moneyball?” asks Gonzalez. “Well, the success in that movie was based on the data and analytics. We needed to do the same thing.”

Once they stopped looking at mental health as an isolated expense in the city budget, the players realized they were spending enormous sums of money to take care of people. And they were doing a bad job of it.   Pooling their resources instead, Gonzalez found, would offer significant savings.

The courts, the jails, the hospitals, the county government and the police department agreed to work together on the issue. Everyone provided funding– the police even contributed their drug seizure money – to build a system where people with mental illnesses could get better. 

The result is one centralized complex which offers many services. The Restoration Center is conveniently located across the street from San Antonio’s state-of-the-art homeless shelter.

“One thing that’s really important about the San Antonio approach is that they’ve integrated services together for mental health and substance abuse and homeless services,  because most people have overlapping needs,” says Laura Usher, a program manager at the National Alliance on Mental Illness who helps set up collaborations between law enforcement agencies and mental health departments.

The center has a 48-hour inpatient psychiatric unit, sobering and detox centers, outpatient primary care and psychiatric services, a 90-day recovery program, housing for people with mental illnesses, and even job training and a program to help people transition to supported housing.

“San Antonio realized that it’s more cost effective to provide mental health services and supports to people on the front end, rather than pay for jail beds and prison time,” says Usher.

More than 18,000 people pass through the Restoration Center each year and officials say the coordinated approach is saving the city more than $10 million each year. “There’s no wrong door,” says Evans. Some patients walk in off the streets or with their families. Others are brought in by police or diverted here from programs inside the jails.

“San Antonio is ahead of what’s a growing trend across the country to try to build a non-hospital alternative for people who are experiencing a psychiatric emergency, often with co-occurring alcohol or other drug abuse,” says Dr. Mark Munetz, a psychiatrist and professor at Northeast Ohio Medical University who toured the Restoration Center last year.

But he says the San Antonio model might not work for everyone.  The Restoration Center and homeless shelter, he says, felt like “a psychiatric oasis, removing the people from the most central part of the city, it felt a little like segregating people in that part of the city, especially with the homeless shelter next door. I’m not sure how that would fly in other parts of the country.”

Nonetheless, the rest of the country has started to notice. Every state in the country has sent delegates to San Antonio to see if they can model their own mental health systems after this one.

Samuel Lott found his way there in  2010. He walked over to the Restoration Center from his jail cell a block away.  He went through the detox program, then a 90-day in-patient recovery program, followed by treatment for hepatitis C, and finally medication to help control his mental illness.  The center helped place him in an apartment of his own and provided him with additional job training.

He pulls up another photo on his laptop, this one taken Thanksgiving of 2012, two years after he arrived at the center. It’s a picture of Lott with his arms around his family – mother, father, brother, niece and nephew. He looks like a different man.

“I’ll start crying if I talk about it,” says Lott, who is now healthy and employed at the center. “It felt so good to be home, with my mother and my dad. And I had expected them to be angry and hurt, but it was the exact opposite. They were so happy for a member of the family to come home. Now I email with them every single day, text, Facebook, make plans for gatherings.”

He says he’s helping other people find the kind of hope and healing that he has. 

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BJenny GoldKHN Staff Writer, AUG 20, 2014. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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