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Medical Care Means Mental Health, Too

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Patients with depression, anxiety and more also often have chronic physical illnesses, and failing to integrate psychological treatment is costly

American society has historically segregated mental-health conditions from other health concerns. Doctors and laypeople alike often dismissed such problems as existing “just in people’s heads,” as if they lacked any real biological or genetic basis.

For decades, patients with serious mental-health conditions were shunted to isolated psychiatric hospitals, far from ordinary medical care. Americans with less severe mental-health conditions found that their insurance companies “carved out” mental-health benefits from basic coverage, and the benefits were skimpy compared with coverage for physical ailments.

As for clinical practice, mental-health professionals were kept separate from physicians treating patients for other medical conditions and rarely interacted with them. The rationale for this division was to avoid the stigma of mental disorders, but it only served to reinforce the stigma. At the cancer center where I trained, we had scores of oncologists and thousands of cancer patients—but just one psychiatrist.

Thankfully, this long era of separation and indifference seems to be coming to an end. In the decades ahead, there is every reason to expect that treatment for mental health will finally become integrated into mainstream medicine.

A key reason for the shift is the mounting evidence that depression, anxiety and substance abuse—as well as more severe conditions like schizophrenia and bipolar disorder—often occur alongside other chronic illnesses. A 2011 Robert Wood Johnson Foundation study suggests that some 30% of medical outpatients and patients admitted to general hospitals suffer from a range of mental illnesses, often undiagnosed and untreated.

The failure to address these problems in a more comprehensive way is costly. According to researchers at the University of Washington, mental-health conditions account for some $200 billion a year of U.S. health-care spending. But they also add to other medical expenses. When depression, anxiety and other conditions afflict patients with chronic illnesses, the costs shoot up. Consider patients with congestive heart failure. Their average monthly health care amounts to $1,846, according to a 2008 Milliman research report, but when these patients also suffer from depression, the average cost shoots up to $2,567 a month. Even for relatively simple chronic conditions such as hypertension, depression increases costs from $550 a month to $960.

These extra costs largely arise not from mental-health care but from extra dollars spent for medical services. Picture an anxious cancer patient, fearing some new twinge or bump, rushing to an emergency room or demanding a CT scan.

Some innovators are already working to integrate mental health into general care. For years, the 16-physician group Central Medical Clinic in Honolulu routinely screened its patients for depression, anxiety and similar conditions—but, like many small practices, it couldn’t provide proper mental-health treatment. A few years ago, the clinic invited psychologists in a separate practice to share their office space. Doctors can literally walk patients over to psychologists and get them same-day care if needed.

In Illinois, Advocate Health Care also uses “co-location” this way, employing 13 mental-health providers in eight of its busiest primary care practices in the Chicago area. Advocate now systematically screens all patients 65 and older who are in the emergency room or admitted to hospital for depression and anxiety. Those who screen positive are seen by behavioral-health specialists within 24 hours.

Such consultations are increasingly done via telemedicine, since psychiatrists can be in short supply. At Kaiser Permanente’s mid-Atlantic facilities, a psychotherapist is available 24/7 by video for patient consultations. This is especially useful for those needing urgent care for depression or suicidal thoughts.

Other pioneers are using technology to link physicians, patients and mental-health specialists in what they call “virtual collaborative care.” One young company, Manhattan-based Quartet Health, uses predictive modeling to review claims and other data to identify patients who might have undiagnosed or poorly managed mental-health issues, such as those who make frequent emergency room visits for chest pain without being admitted for heart attacks. Quartet then performs a comprehensive online mental-health assessment and offers tailored solutions, including virtual or in-person therapy.

This shift in care remains a work in progress, but physicians and companies are remaking what was long an isolated, ignored area of medicine. Integrating mental health into routine care will make our health-care system more humane and affordable—and make all of us healthier.

Appeared in the June 10, 2017, print edition as ‘medical care means Mental Health, too.’

MCAN founder to run for Don Young’s seat in Congress

Copy of Article in KTOO.

By Jeremy Hsieh, KTOO June 8, 2017

Greg Fitch, founder of the Juneau-based Mental Health Consumer Action Network, has filed to run for Republican Don Young’s seat in Congress.

Fitch, 47, is a Democrat. According to the Alaska Division of Elections, he’s the third person to file for the 2018 election.

Longtime incumbent Don Young and political newcomer Dimitri Shein of Anchorage are the other candidates.

Young, 83, has held Alaska’s sole seat in the U.S. House since 1973.

Shein, 36, is an Anchorage CPA and businessman running as a Democrat.

Fitch had resigned on May 24 as executive director of his fledgling nonprofit. At the time, he said he intended to run for Republican Dan Sullivan’s U.S. Senate seat in 2020, but says he is no longer pursuing that.

Juneau man Greg Fitch poses for a portrait in Juneau on June 8, 2017. Fitch filed paperwork to run for Republican Don Young's seat in Congress in 2018. (Photo by Jeremy Hsieh/KTOO)

Greg Fitch poses for a portrait in Juneau on Thursday. Fitch filed paperwork to run for Republican Don Young’s seat in Congress in 2018. (Photo by Jeremy Hsieh/KTOO)

Greg Fitch, founder of the Juneau-based Mental Health Consumer Action Network, has filed to run for Republican Don Young’s seat in Congress.

Fitch, 47, is a Democrat. According to the Alaska Division of Elections, he’s the third person to file for the 2018 election.

Longtime incumbent Don Young and political newcomer Dimitri Shein of Anchorage are the other candidates.

Young, 83, has held Alaska’s sole seat in the U.S. House since 1973.

Shein, 36, is an Anchorage CPA and businessman running as a Democrat.

Fitch had resigned on May 24 as executive director of his fledgling nonprofit. At the time, he said he intended to run for Republican Dan Sullivan’s U.S. Senate seat in 2020, but says he is no longer pursuing that.

Part of Fitch and MCAN’s ethos is to destigmatize mental illness. Fitch says he has schizoaffective disorder. Before founding MCAN last year, he’d worked as a community organizer with ACORN in the Lower 48.

Trump’s Pick for Mental Health ‘Czar’ Highlights Rift

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For decades, therapists, patient advocates and countless families have worked to elevate mental health care in the political conversation. Their cause recently received a big boost when a new law created a federal mental health “czar” to help overhaul the system and bridge more than 100 federal agencies concerned with mental health.

But the White House’s choice for the first person to fill that position has already been divisive, exposing longstanding rifts within the field that may be difficult to mend.

President Trump has announced his intention to nominate Elinore F. McCance-Katz for the new position, assistant secretary for mental health and substance use. Dr. McCance-Katz is a psychiatrist whose long career has been focused on treating drug addiction, in particular opioid abuse. She has the support of several prominent groups, including the American Psychiatric Association and the National Alliance on Mental Illness, but others, including the Foundation for Excellence in Mental Health Care, are skeptical.

A central tension in the debate is between the medical model of psychiatry, which emphasizes drug and hospital treatment and which Dr. McCance-Katz has promoted, and the so-called psychosocial, which puts more emphasis on community care and support from family and peers.

“I feel like I died and went to heaven,” a prominent backer of the medical approach, Dr. E. Fuller Torrey, associate director of the Stanley Research Institute, said of the new position and Dr. McCance-Katz as its nominee. “I honestly didn’t think I’d see something like this happen in my lifetime.” Dr. Torrey and an organization he co-founded, the Treatment Advocacy Center, has been pushing to expand medical psychiatric services for more than 20 years.

But Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, which is funded in small part by Samhsa, said he was concerned about the potential direction the appointment of Dr. McCance-Katz could signal. “I fear that in this political environment it could denigrate and unravel some of the great progress we’ve made in person-centered recovery and rehabilitation services and peer support.”

Dr. McCance-Katz declined to comment, citing the continuing confirmation process.

For partisans, this rift is tribal: Those on the medical side are appalled at the lack of hospital beds and aggressive court-ordered — i.e. involuntary — drug treatment for people most in need, particularly those with schizophrenia, many of whom do not believe they need treatment and end up in prison.

On the other side, advocates, former patients, and some doctors argue that medical treatment by itself — beds and meds, as they call it — is often not sufficient and, when forced, can alienate the people it is meant to help.

In practice, the two sides argue more over emphasis in care and agree on many points; in public, it is all black and white. The creation of the new mental health czar position, and the nominee, are seen broadly as a victory for the medical side. Dr. McCance-Katz, if she is confirmed, is expected to steer more funding toward assertive drug treatment of the seriously mentally ill, and less toward social supports.

Dr. McCance-Katz began her career at Yale, later moving to the Albert Einstein College of Medicine and the University of California, San Francisco, building an expertise in treating drug addiction with medications. She was medical director of California’s Department of Alcohol and Drug Programs, before becoming the first chief medical officer at the Substance Abuse and Mental Health Services Administration, or Samhsa, the primary federal agency overseeing substance abuse and mental health services, in 2013. The medical officer serves under the agency’s director.

The person most responsible for creating the czar position, Representative Tim Murphy, Republican of Pennsylvania, a practicing psychologist, also objects to Dr. McCance-Katz’s nomination, but for another reason. Mr. Murphy, as chairman of a congressional subcommittee, investigated federal mental health programs after a 20-year-old man with severe mental illness shot and killed 26 elementary school students and teachers at Sandy Hook school in Newtown, Conn., in 2012. He found fault with Samhsa for not sufficiently addressing the hardest-to-treat forms of mental illness, and for using some of its funds to support organizations and conferences where participants encouraged patients to go off their physician-prescribed psychiatric medicines.

Mr. Murphy said he was disturbed that Dr. McCance-Katz publicly defended the agency as efficient and effective during her two-year tenure as the leading physician at Samhsa. “She does not have my confidence,” Mr. Murphy said in an interview. “When she was there, she knew there was a problem, and she didn’t speak up,” he said. “We never heard from her.”

Samhsa, where Dr. McCance-Katz served as chief medical officer from 2013 to 2015, has itself become a lightning rod in the debate. In fact, Dr. McCance-Katz has sent mixed signals about her preferences. She defended the agency while there, but after leaving she wrote a sharp critique in Psychiatric Times concluding that its approach “includes a focus on activities that don’t directly assist those who have serious mental illness.”

Mr. Murphy and members of his staff said he had raised his concerns about the nominee directly with the secretary of health and human services, Dr. Tom Price, and Vice President Mike Pence.

Representative Murphy has also attacked the choice publicly, on Twitter and in interviews. Many people following the drama, both inside and outside Washington, believe that he is upset that the White House passed over his favored candidate. According to Mr. Murphy’s staff, that was Dr. Michael Welner, a prominent and controversial New York forensic psychiatrist who helped develop the legislation that created the position.

In an email, Dr. Welner confirmed that Mr. Murphy had approached him about recommending him to the Trump administration for the position. He said he initially declined, because of the sacrifices involved, but later accepted because of the prospect of saving lives. He said he believed that federal mental health funding should be refocused on the most costly mental health challenges and on evidence-based treatments.

The agency devotes a small portion of its $3.7 billion annual budget to psychosocial supports, like guidance from so-called peers, the former patients who help those in need navigate the system. While proponents of a more medical approach have criticized this support, other mental health professionals believe there is not enough emphasis on this and other non-pharmacological programs. “Peers are not serving as mental health professionals, but peers are providing much needed support, because they have an understanding of what it’s like to struggle with mental health problems,” said Ellen Garrison, senior policy adviser at the American Psychological Association.

Whichever direction the new mental health czar chooses, most agree that the new position at least concentrates accountability for change in one place.

Senator Christopher Murphy of Connecticut, who co-sponsored the new mental health law, said he hoped that Dr. McCance-Katz would advocate full adoption of its most important provisions, which he said were “those pushing insurance companies to cover more mental health treatment.”

“There’s no choice to be made in treating mental illness through a purely medical model or through a more social and contextual program of support,” Senator Murphy said, adding: “Lots of people with mental illness have a disease of the brain that can be treated with medication, but also have major traumas in their life that need other kinds of therapies as well.”

Others agree.

“The federal agencies most responsible for the welfare of people with severe mental illness and substance problems have all failed them miserably,” said Dr. Allen Frances, a professor emeritus of psychiatry at Duke. “We should turn prisoners into patients, provide easy access to treatment in the community and ensure they have a decent place to live.”

Reformers seek alternatives to putting mentally ill behind bars in Alaska

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By Liz Raines Photojournalist: Cale Green – 8:54 PM April 5, 2017


There’s a will, but no clear way to solve a problem the Deptartment of Corrections (DOC) calls ‘unacceptable.’ Every year, Alaska prisons see thousands of cases of intoxicated, often mentally ill people who spend the night in prison cells instead of hospitals beds.

Greg Fitch is one of them.

“I have schizoaffective disorder. I have a personality disorder, very common in mental illness. I’m an ex-alcoholic and I do fall behind the wagon sometimes,” Fitch said during an interview outside of Juneau’s Lemon Creek Correctional Center Wednesday.

Fitch says he fell off the wagon Saturday, when he got drunk and became suicidal. He went to the hospital for help, but ended up in a jail cell instead.

“The people that brought me here, I knew one of them personally and I could tell he didn’t want to do it. Actually, I think he was confused too,” said Fitch.

Title 47 of Alaska law says intoxicated people can be held in prison for up to twelve hours if a hospital or family member won’t take them. While well-intentioned, Corrections Commissioner Dean Williams says the law needs reform.

(Data from Title 47 provided by the Alaska Dept. of Corrections)

“You’re not making them any better by putting them in a jail cell when they have serious psychiatric conditions,” Williams said.

He says the law was meant to provide a safe place to sober up for intoxicated people who may pose a threat to themselves or others. But in some cases, it’s kept them from getting the medical attention they need.

In 2015, Joseph Murphy died at the Lemon Creek Correctional Center while in a holding cell, under Title 47. After taking office last year, Williams has been advocating for sobering centers equipped with medical staff as alternatives to prison beds.

“I look at this as whether or not if it was my brother, my sister, a loved one, my daughter or son. Would it be acceptable to me where they were at? And in many of those cases, the answer is it’s not acceptable to me. I don’t think it’s acceptable to anyone else right now either. It’s just that what is the alternative,” said Williams.

Lawmakers are struggling to come up with a solution.

“Funding’s always going to be a problem. Even when we had a lot of money, this was hard to figure out,” Sen. John Coghill, Chair of the Judiciary Committee said. “How to get the people to do the service. What would that service look like?”

It’s a problem those in the mental health community, the state and local authorities all agree needs solving — but no one has an easy solution.

Fitch runs an organization that advocates on behalf of those with mental illness, Mental Health Consumer Action Network (MCAN). By sharing his own experience, he hopes to shine a light on the issue.

“We’re using the criminal justice system as a band-aid for mental health,” said Fitch. “It happens every day. We know that, there’s no doubt about that.”

A coalition in Fairbanks is taking the first steps toward opening a sobering center. The community has more than a thousand title 47 cases a year, according to DOC.

Williams says he’d like to put DOC money toward opening more sobering centers around the state.


Glenn Close and Patrick Kennedy on the Weight of Mental Illness

Copy of Article in New York Times

Glenn Close does not read her reviews. So the jumbo excerpt on the marquee where she is reprising her Tony Award-winning role in “Sunset Boulevard” (“One of the great stage performances of this century”), surrounded by flashing lights, may be a spoiler.

“You still have to go out the next night no matter what they write,” she said. Still, the actress, 69, who has won three Tony Awards and three Emmy Awards, and has been nominated for six Academy Awards for her work in films such as “Fatal Attraction,” “Dangerous Liaisons” and “Albert Nobbs,” would seem to have little to fear.

“But you work so tightly with people in theater,” she said. “Even if they say wonderful things about me, but something unkind about my incredible collaborators, that would be just as upsetting.”

That group ethos is also the essence of addiction recovery, according to Patrick Kennedy, who represented Rhode Island in Congress for eight terms before retiring from office in 2011. He subsequently founded the Kennedy Forum for equality in the treatment and insurance coverage of mental illness and addiction

“When you are emotionally connected to your peers in recovery,” he said, “you stand the best chance of being protected from the compulsion to use and do things that get you into trouble with your illness.”

Mr. Kennedy, 49, has publicly acknowledged his bipolar illness and addiction to alcohol and other drugs. He is the youngest child of Senator Edward M. Kennedy, who died in 2009, and is a nephew of President John F. Kennedy. His best-selling memoir, “A Common Struggle,” was published in 2015.

Over lunch at the Dutch in SoHo (burrata and pumpkin ravioli for Ms. Close, black sea bass for Mr. Kennedy), the pair discussed their work, especially their advocacy for mental illness awareness and treatment; their families, in which such illness flourished in silence; and the healing that comes with bringing truth to light.

Philip Galanes I saw your new “Sunset Boulevard.” Is it me — and 22 years of life kicking my butt — or is this Norma more heartbreaking than your first one?

Glenn Close Well, I’ve gotten kicked in the butt a few times, too. And I’ve learned a lot of craft in 22 years. So I came to her differently this time. Before, I played her as a woman whose delusion had stuck her in the 1920s. This time, she starts in the present and ends up retreating into the delusion of who she was.

PG It’s sadder. And it connects her with your other great roles: Patty Hewes in “Damages,” the Marquise in “Dangerous Liaisons.” Tough, powerful women who give us moving glimpses of how they got that way.

GC I think of those characters as brilliant survivors. They’ve built up powerful defenses to negotiate life. We’re all very good at survival. But many times, we sacrifice important parts of what it is to be human just to endure.

PG Like you, Patrick: a high-functioning congressman, but hiding your roller coaster of illness and addiction. What finally prompted you to speak up?

Patrick Kennedy I don’t get credit for coming out, so to speak. It was made possible when a guy I was in rehab with sold the story to the National Enquirer. And my face appeared on the cover with the headline “Patrick Kennedy, Cocaine Addict.”

GC Oh, my Lord!

PK It came out in 1991, during the Palm Beach rape trial of my cousin. It was an intense period of media scrutiny — and here’s this National Enquirer at every checkout counter. I wanted to run away from the fact that I’d been in treatment. I wanted to manage my surroundings. That’s what you do when you can’t manage your insides: You try to manage your outsides.

But my mentor in the district — this old-school, 87-year-old restaurateur — I was terrified that I’d let him down, but he managed to coalesce the community around me. The only thing worse than being an addict, I guess, is a rat who outs an addict. So I survived the next campaign.

PG Later, in 2006, you were in a car crash at the Capitol, and you came clean about being intoxicated when you had a chance to skate away. But you did so against the advice of your dad. He wanted you to play it off as a fender bender. Is that our generational edge: that we can admit our problems and not be destroyed by them?

GC Was your dad circling the wagons? Did he think that coming out would hurt you or the family?

PK That was his generational M.O. To shut down, not talk about it. But I knew that the accident was not a one-day story. The media was tracking my whereabouts for the previous week. I wanted to make it all public at once. I knew that would be better than the drip, drip, drip of slow reveals.

PG Is that when you came out as bipolar?

PK No, I only came out about my addiction to opiates and that I’d been to the Mayo Clinic a few months before. But I refused to go to the mental health ward there. I thought: “That’s where the crazy people go. I can’t afford to have people find out that I’m suffering from the same illnesses that I’m advocating for in Congress.” That’s how deranged my thinking was.

GC Had you been diagnosed as bipolar?

PK No, not until later. I went back and did the full complement of treatment. They peel away the onion and recognized that underlying my addiction to cocaine and stimulants and alcohol there was a huge mood disorder that, frankly, runs in my family. My mother suffered tremendously from mood disorder as well as alcoholism. Her mother died from it. But we never talked about it.

PG You’ve been a big advocate for mental illness too, Glenn.

GC Yes, for the importance of talking about it.

PG What was the catalyst?

GC My sister Jessie came to me and said: “I need your help because I can’t stop thinking about killing myself.”

PG That must have been terrible. My dad killed himself, but he never said a peep to anyone.

PK I’m sorry.

PG In a way, you were lucky. How great that your sister had you?

GC She was desperate. We’re lucky she’s still here because she wasn’t properly diagnosed with bipolar disorder until she was 50. We always thought she was just the “wild one,” leaving this path of houses and cars and husbands in her wake. Dragging her children from one place to another.

She’d been an alcoholic too, but I didn’t know any of that. I was in my career. I felt so bad when I learned what had gone on. She was an amazing kid, and the fact that she had gone through all this terrible stuff and no one from our family was there to protect her, it just kills me.

PG Families can be weird about this. I’ve spent half my life terrified that I’d end up like my dad. It can warp your thinking.

GC Sure, but the reality is that there’s a huge genetic component. That’s why genetic research is so important and needs to be better funded. My sister once said to me: “I guess I’m a sacrificial lamb.” We now know that my mom was what they call “mosaic,” she carried the possibility. She had depression but not bipolar disorder. But it was passed on to my sister and her son. None of the rest of us has it. But now there’s the next generation to think about.

PG Suddenly, the irony of “Fatal Attraction” hits: You became a superstar in a role about mental illness.

GC But she’s considered evil more than a person who needs help, which astounds me.

PG Boiling bunnies will do that.

PK Honestly, that character has probably contributed to the stigmatization of people with mental illness as much as anything. It’s such a seminal movie. And unfortunately, Glenn did such a good job.

GC But the strange thing is that the psychiatrist I took that script to — because I was interested in her specific behavior — never mentioned a possible mental illness. Never.

PG What was his theory?

GC That she may have been incested at a young age. But of course, that can lead to mental disorder. A big percentage of young children who suffer incest end up suicidal.

PK We know this. There’s a terrific longitudinal study called the Adverse Childhood Experience that guides us on how to intervene with people who are at risk — from growing up in a home where there’s incest, violence, mental illness or addiction.

PG Do you think if you’d grown up in a less royal family — not a Kennedy — you might have gotten your illness under control easier? Without the risk of everything splashed in a headline?

PK Well, the theme of my book is that even though I came from a well-known family, the silence among my family members — about my mother’s profound alcoholism and my father’s profound PTSD — is all too common.

PG I’d never thought about your dad and PTSD before …

PK He watched his brothers violently murdered. Listen, my dad was the most important person in my world. I’ve spent my whole life trying to figure out how to protect him and love him. He suffered a lot. He was exposed as somebody who acted inappropriately; he was castigated for his behavior. But I always knew that bad behavior was the last thing my dad would choose. Like I knew that drinking was the last thing my mother would choose. It was their compulsion.

PG How would he feel about your book?

PK I think part of him would be happy for me that I’m coming into my own and getting the help I need. But there was a large part of him that was molded by my grandfather and that generation, which said: If it’s bad for the family, keep it under wraps.

PG You were estranged from your father, late in his life, when you and your siblings went to speak with him about his drinking. Did it get resolved between you?

PK Well, it’s like what Glenn was saying about survivors: We got through it. It was never resolved. We compartmentalized it, put it over there, and we all moved on.

PG Glenn was a different kind of survivor. When you were 7, your parents took you away from your life in Greenwich and joined a conservative religious cult, Moral Re-Armament. And you stayed in Switzerland, isolated from the world, until you broke away at 21. How did you find the strength to do that?

GC I’ve always felt that they never got to my core. I was a child of huge imagination. And even though I was a little foot soldier in that army — because as a child you want to please whoever the parent or authority figure is — there came a time when I felt disillusioned by it.

PG How so?

GC It was too painful: mouthing the same things, wearing the same things. They became [the singing group] Up With People. It’s not easy to talk about because it was such a profound experience. I’d been involved, in some iteration, since I was 7. I felt ignorant.

PG But you retained the intelligence to get out.

GC A lot of kids had their parents come and forcibly take them away. But of course, my parents were involved. Let me say: I have long forgiven my parents for any of this. They had their reasons for doing what they did, and I understand them. It had terrible effects on their kids, but that’s the way it is. We all try to survive, right? And I think what actually saved me more than anything was my desire to be an actress.

PG Did it make you a better actress?

GC It made me decide not to trust any of my instincts.

PG So, you had to learn to trust them all over again?

GC I suppose. But I will still say to a director: “I may have strong instincts. But question them, because they may not be right.”

PG Let’s turn to a subject you’ve both worked on: the stigma associated with mental illness. Where does it come from?

GC We’ve survived as a mammalian species because we established nests and then tribes. Anything outside of them can be considered a threat. There are probably evolutionary reasons for it. Now, you’d like to think that intellect can balance some of that away. But look at how we’re stigmatizing people in this country: Muslims, Jews. It’s all about “them” and “us.” And for whatever reason, the “them” is to be feared and reviled.

PK Beautifully said, Glenn! Her organization, BringChange2Mind, has done so much to help us understand what messages really work to break the stigma of mental illness.

PG But it’s been some time since we’ve known, medically, that mental illness is real illness — no different from lung cancer. So, why are they treated differently? Why am I still ashamed that my dad killed himself instead of dying of lung cancer?

PK First, denial. Our society is living in denial when so many of its members are dying from suicide and overdose that it’s affecting the life expectancy of huge demographics in our country. And if we can’t acknowledge this illness in our lives and our family’s lives, how in the world are we going to acknowledge it as a society?

There is a federal law to end discrimination in the treatment and coverage of mental illness and addiction. But too few people are willing to come out of the shadows and say: “I was denied my rights for equal coverage.” So I started the Parity Registry to get people to tell their stories. Until we push back against the insurance industry, this discrimination will never end. Frederick Douglass said: Power concedes nothing without demand. Never has, never will.

GC The thing that kills me is that one in four people are affected by this issue. Why isn’t everyone talking about it? Republicans, Democrats, it has nothing to do with that. It’s affecting our families, our friends, everyone.

PK President Trump lost his brother to alcoholism. And his voters represent the demographic that has the highest overdose and suicide rate in America: middle-age white men.

GC As far as I’m concerned, this (mental illness) is the last great frontier in civil rights.

PK No question. In President Kennedy’s address on civil rights, he said: Who among us would be content to trade the color of their skin and be content with those who counsel patience and delay? It’s the same with mental illness and addiction. Who would be content to take a “go slow” approach if mental illness affected them and their family? We’ve had two surgeons general come out and say that addiction is an illness, but we still treat addicts like pariahs. It’s incomprehensible.

GC We act like it’s their fault.

PK The answer is making everyone feel it’s their issue. And I think veterans are going to be the key. Most veterans who fought in Iraq and Afghanistan were civilian soldiers, guard reservists. And about 30 percent of them came back with PTSD and other invisible wounds of war. When those men and women go back to their employer-sponsored health care and learn that it doesn’t adequately cover mental illness like it does other health conditions, that’s going to be our jailbreak. When we put actual American heroes in front of insurance companies, and they deny them mental health coverage, I think we can see this situation change overnight.

PG You both seem so energized by this work.

GC Honestly, I wish I could do it 24/7. I have so many ideas. But the crazy thing is that no one would listen to me if I stopped acting.

PK I feel the same way. This cause is part of what keeps me ticking. It’s a great purpose in life, and I know I can make a difference. I’ve seen the difference in myself. When I left Congress, I felt demoralized and burned to the ground. I couldn’t imagine what I have going for me now: four kids, a beautiful wife. We all love each other. My 4-year-old fell asleep on my chest last night as I was reading him “Captain Underpants,” which he loved. And all because I went out and got the help I needed.

MCAN speaks up about downtown land sale

Copy of Article on Juneau Empire

Posted: January 16, 2017 – 12:00am



An organization devoted to supporting mental health is raising concerns about the pending sale of Mental Health Trust-owned land in downtown Juneau.

The Mental Health Consumers Action Network has issued a letter protesting the Trust’s sale of land to Develop Juneau Now LLC, which plans to build a heating plant, apartments and shops near Coast Guard Station Juneau on Egan Drive.

“We respectfully ask that this pending sale … be reconsidered,” the letter states.

Greg Fitch, director of MCAN, said he’s personally concerned that the sale won’t result in a better deal for the mentally ill, who are supposed to benefit from Trust actions.

The letter suggests the Trust should include sale conditions, such as affordable housing dedicated to “mental health consumers and trust beneficiaries” or employing “mental health consumers” in the construction that will follow the sale.

Fitch said MCAN isn’t opposed to Develop Juneau Now — whose backers are the same as those of the Sweetheart Lake hydroelectric plant — but MCAN wants to hold the Trust accountable to its core mission.

“That is exactly where we’re at with this,” he said.

The Trust was established after a scandal revealed improper treatment of the mentally ill at Morningside hospital in Oregon, where Alaskans were sent.

A land grant and financial grant were supposed to allow the Trust to provide services that meet Alaska’s needs, but a 2016 study by the Kaiser Family Foundation ranked Alaska’s mental health care 47th of 51 states and D.C.

“If we’re 47th in the country, my God, there’s no excuse for that,” Fitch said.

He pointed to the recent shooting by an Alaska man who was released from mental health treatment after four days, then flew to Florida and killed several people in Fort Lauderdale’s airport.

Fitch said MCAN intends to speak up for patients and press for the Trust to improve care.

“We’re a mental health consumer group,” he said. “We’re about better care for ourselves.”

Southeast Land exchange bill reintroduced in Congress

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By Leila Kheiry, KRBD January 14, 2017

With a new U.S. Congress convening, Alaska’s Congressional Delegation has reintroduced a bill that would trade federal land for land owned by Alaska Mental Health Trust – including Ketchikan’s Deer Mountain.

A joint statement Thursday from Sens. Lisa Murkowski and Dan Sullivan, and Rep. Don Young announced that companion bills to accelerate the exchange have been filed.

The House and Senate bills are pretty much identical, according to Matt Shuckerow of Rep. Young’s office. He said Sen. Murkowski, as the chair of the Senate Energy and Natural Resources Committee, is the main force behind the effort, which Rep. Young fully supports.

“This is something that’s been ongoing for a number of years and the Congressman has certainly been supportive of this effort,” Shuckerow said. “As has been detailed by others and the Congressman, this is an effort by all the stakeholders involved to come to some sort of resolution.”

The legislation would put Mental Health Trust land on Deer Mountain and above homes in Petersburg under U.S. Forest Service control. In exchange, the Trust would receive federal land on Prince of Wales Island and in Ketchikan’s Shelter Cove area for logging.

Last summer, the Alaska Mental Health Trust Land Office announced that it planned to move forward with logging Deer Mountain and the Petersburg site if the land exchange wasn’t approved by early this month. After public outcry and questions about the TLO’s decision-making process, a final decision on that plan was delayed.

Shuckerow said the legislation is the same bill that had been introduced in the previous Congress. He said the delegation hopes it will be approved fairly quickly.

“It is a model for governance where there is local support. It’s not a top-down approach; it’s really a bottom-up approach from the communities involved and the stakeholders involved,” he said. “That’s certainly a positive note in that regard, that it’s supported locally. That’s something we can relay to different members of Congress, that this is something that’s supported locally. Oftentimes that’s very helpful in moving legislation.”

Local governments in Ketchikan and Petersburg have approved resolutions in support of the land exchange, and there has been an effort to encourage individual residents to send letters of support.

In Thursday’s announcement, Murkowski states that the exchange will protect land that is valued by the communities while providing other land for timber harvest. She says logging the sites on POW and in Shelter Cove will assist the timber industry, and make money for mental health services in Alaska.

The U.S. Forest Service and the Trust already have agreed to the land exchange. The legislation would speed up the process.

The bill has just been introduced, which is the first step.

A Rampage in Florida Shines a Light on Alaska

Copy of Article Printed 1-13-2017

Kirk Johnson

ANCHORAGE — A deadly shooting rampage at Fort Lauderdale-Hollywood International Airport this month has focused attention on the interconnection of public safety and mental illness and raised questions, especially here in Alaska, about one of the thorniest questions of psychology: how to tell if someone is delusional and dangerous, or merely delusional.

There is no dispute, law enforcement officials said, that the suspect in the Florida case, Esteban Santiago, was disturbed. When he walked into the F.B.I. offices here in Alaska’s largest city in early November, he said his mind was being controlled by the government. After a voluntary four-day evaluation in a psychiatric hospital, he was released, and soon reclaimed the handgun that the police confiscated when he was admitted. He is now charged with killing five people and injuring six more at the airport on Jan. 6.

In many ways, Mr. Santiago’s path through the mental health treatment system was unremarkable, similar to the one faced by people across the nation, the overwhelming majority of whom will never perform violent acts. Improved insurance coverage is now in place for many people — including an expansion of Medicaid for lower-income adults in Alaska — but a stigma about treatment, combined with a shortage of hospital beds and mental health professionals, keeps many people from getting or accepting care.

In Alaska, health care professionals and legal experts said the distinctive demographic, geographic and cultural stamp of the state also colors the often nuanced judgments that doctors, law enforcement officers and judges must make in deciding whether to hold a disturbed person against his or her will.

Alaska, they said, is ingrained with a deep tradition of tolerance — fueled by libertarian instincts holding that people should be able to believe what they want, however eccentric or irrational. And even when people are involuntarily committed for treatment, the median length of stay, at only five days, is shorter than in almost any other state. Only Wisconsin has a shorter median commitment time, at four days, according to the Treatment Advocacy Center, a national group that works to improve mental health laws and care. The national average is 75 days, with some states, like California, having a median of more than four months.

“Getting a commitment here is really hard,” said Merijeanne Moore, a psychiatrist in private practice in Anchorage.

The mental health needs are great here, too. Alaska has the nation’s second-highest suicide rate, after Wyoming, and some rural areas are by far the worst in America in rates of self-harm, federal figures say. Alaska also has among the highest rates of adult binge drinking, according to federal figures.

A study by the Kaiser Family Foundation ranked it 47th among states and territories in terms of the percentage of mental health care needs being met.

At the same time, the number of beds at the Alaska Psychiatric Institute in Anchorage, the state’s only long-term psychiatric hospital, is now half of what it was in the early 1990s, though many other states also cut their mental health treatment systems during the Great Recession.

“There’s a huge street problem, a huge drug problem and a lot of mentally ill people who don’t even have a finger grip on the lowest rungs of the ladder,” said Paul L. Craig, a neuropsychologist in private practice in Anchorage.

The state does have some mental health treatment strengths. The care system for Native Alaskans, paid for by the federal Indian Health Service, has an extensive mental health program for adolescents. The Department of Veterans Affairs and branches of the military treat tens of thousands of active-duty and retired military personnel.

Dr. Craig and other providers said, though, that those systems of care often function like autonomous empires, without coordination. “People fall through the cracks between them,” he said.

In part, the distinctively Alaskan way of thinking about mental illness may reach back to the era before statehood, which came in 1959. For decades up to that point, residents were committed and sent to a psychiatric hospital in Portland, Ore., from which some never returned. The grounds for commitment — effectively a kind of deportation — sound shocking by today’s standards, including a refusal to speak and excessive masturbation.

Partly in response to complaints about those past practices, Congress in the mid-1950s created the Alaska Mental Health Trust Authority, a unique land trust of one million acres, almost the size of Delaware, to produce income dedicated specifically to mental health. The Alaska Mental Health Trust Authority is still active, and has leverage through the millions of dollars it contributes to the state budget through its investments. The trust lobbied hard, in particular, for the expansion of Medicaid in the state.

Guns are also part of the fabric of Alaskan life. Ownership is widespread, and no permit is required for concealed carry. Until 2014, state officials were not required to report data on mental-illness diagnoses to the F.B.I.’s background check system, and Alaska is one of 17 states with no restrictions beyond federal law for keeping guns away from the mentally ill, said the Law Center to Prevent Gun Violence, a national legal research group in San Francisco.

Under federal law, a person who has been involuntarily committed is never again allowed to have firearms.

Mr. Santiago, who entered a no-contest plea last year on a misdemeanor domestic violence charge but has no record of being committed, told the F.B.I. and the Anchorage police in November that he did not want to harm anyone, F.B.I. officials said. He admitted himself to the hospital, so the federal law did not apply. It also meant, law enforcement officials said, that the gun he had in his car when he came into the F.B.I. offices had to be returned to him.

What this case illustrates, said John Snook, the executive director of the Treatment Advocacy Center, is that behavior somewhere short of dangerous may not count. “We use this outdated concept,” he said in a telephone interview. “Most people aren’t dangerous, so they don’t get care.”

And sometimes, establishing dangerousness is difficult.

Just before Christmas, a middle-aged woman who had been living in a 16-bed assisted-living home for the mentally ill in Anchorage began screaming and threatened other residents and the staff, said the home’s manager, Erin Terry. She called 911.

But when the police came, the patient refused to repeat her threats, so despite Ms. Terry’s pleas, the officers deemed the woman no danger and left. Several days later, Ms. Terry convinced a judge otherwise, and the woman was involuntarily committed and removed from the home.

“She was beyond our level of care,” Ms. Terry said. “We were terrified.”

Dr. Moore, the psychiatrist, said that in the last few years she has had two patients who, like Mr. Santiago, walked into F.B.I. offices to complain that the government was exerting control over them. Both were examined and released. One patient has since twice been involuntarily committed in other states, Dr. Moore said.

A version of this article appears in print on January 14, 2017, on Page A9 of the New York edition with the headline: Florida Airport Rampage Casts Stark Light on Alaska.

One in 6 American Adults Say They Have Taken Psychiatric Drugs, Report Says

About one in six American adults reported taking at least one psychiatric drug, usually an antidepressant or an anti-anxiety medication, and most had been doing so for a year or more, according to a new analysis. The report is based on 2013 government survey data on some 37,421 adults and provides the finest-grained snapshot of prescription drug use for psychological and sleep problems to date.

“I follow this area, so I knew the numbers would be high,” said Thomas J. Moore, a researcher at the Institute for Safe Medication Practices, a nonprofit in Alexandria, Va., and the lead author of the analysis, which was published Monday in JAMA Internal Medicine. “But in some populations, the rates are extraordinary.”

Mr. Moore and his co-author, Donald R. Mattison of Risk Sciences International in Ottawa, combed household survey and insurance data compiled by the federal Agency for Healthcare Research and Quality. They found that one in five women had reported filling at least one prescription that year — about two times the number of men who had — and that whites were about twice as likely to have done so than blacks or Hispanics.

Nearly 85 percent of those who had gotten at least one drug had filled multiple prescriptions for that drug over the course of the year studied, which the authors considered long-term use. “To discover that eight in 10 adults who have taken psychiatric drugs are using them long term raises safety concerns, given that there’s reason to believe some of this continued use is due to dependence and withdrawal symptoms,” Mr. Moore said.

Dr. Mark Olfson, a professor of psychiatry at Columbia University, who was not involved in the study, said the new analysis provided a clear, detailed picture of current usage: “It reflects a growing acceptance of and reliance on prescription medications” to manage common emotional problems, he said.

The most commonly used type of drug was an antidepressant like Zoloft and Celexa, followed by an anti-anxiety or sleeping pill like Xanax and Ambien. All of these drugs can have withdrawal effects, including panic attacks and sleep problems, for many people on them long term. The prescribing of most anti-anxiety pills is strongly regulated in this and other countries because the drugs can be habit forming.

Usage rates were also higher with increased age, with one in four people of retirement age reporting at least one prescription. This is a growing concern among some doctors, as the incidence of diagnosable mental problems, with the exception of insomnia, tends to be much lower in elderly people than in young adults.

The increased rates in this group are most likely due in part to the fact that most elderly people get psychiatric drugs from their primary care doctor, who often prescribe for episodic conditions like mild depression and insomnia. “Particularly for this group, we need to be mindful of the trade-offs in prescribing,” Dr. Olfson said. “These are not benign drugs.”

The Mental Health Crisis in Trump’s America

A few days after Donald J. Trump was elected president, I started getting anxious phone calls from some of my patients. They were not just worried about the direction President-elect Trump might take the nation, but about how they were going to fare, given their longstanding and serious mental illnesses.

“Will I still have insurance and have my medications covered?” one depressed patient asked me.

As a psychiatrist, I wish that I could be more reassuring to my patients during a highly stressful political transition, but in truth, they have reason to worry.

Mr. Trump campaigned on a promise to “repeal and replace” the Affordable Care Act, and his pick for secretary of health and human services, Tom Price, is a staunch opponent of Obamacare. The 2010 law provides medical coverage to an estimated 20 million Americans and specifically included mental health and substance abuse treatment as one of 10 “essential benefits” that all private insurers and Medicaid have to cover.

For the 43.6 million American adults living with a psychiatric illness and the 16.3 million who have an alcohol use disorder, it is hard to exaggerate the importance of this. Until this law was passed, people with mental illness and substance abuse problems were subject to capricious annual or lifetime limits on coverage, higher deductibles or no coverage at all.

Obamacare changed all that and mandated that psychiatric disorders be treated on a par with non-psychiatric medical illnesses like cancer and heart disease.

It also prohibited the exclusion of people with pre-existing illness from medical coverage, which was an enormous boon for the mentally ill. Three-quarters of all serious mental disorders in adults — like major depression, schizophrenia and anxiety disorders — are present by age 25. So mental disorders are largely chronic illnesses that, while very treatable, are still characterized by relapses and recurrences.

Obamacare isn’t perfect. No legislative action can erase the stigma surrounding mental illness, which is a major barrier to getting good treatment. Nor can it solve the serious shortage of mental health specialists or the limited access to psychiatric treatment, especially in rural areas.

Still, if President-elect Trump makes good on his promise to repeal the law, he will effectively strip millions of Americans with mental illness overnight of the most medically rational and humane benefits they have ever had — without giving them any indication of what, if anything, will replace them.

The consequences would be quick and devastating. Psychiatrically ill Americans who lost their coverage would be forced to seek treatment in emergency rooms, causing a meteoric rise in health care costs. And untreated mental disorders like depression, bipolar illness and schizophrenia would almost certainly lead to higher suicide rates.

The current annual cost to society of treating depression alone is $210 billion — 60 percent of which represents reduced efficiency at work and costs related to suicide. With a reduction in mental health care, this bill will balloon. In other words, untreated mental illness is not just a source of individual morbidity, mortality and immense suffering; it is also a largely preventable drain on our economy.

There is at least one more reason to worry about mental health in the age of Trump. Mr. Trump has said that Congress should give each state a lump sum of federal money for Medicaid, the health insurance program for lower-income people. This would effectively roll back the expansion of Medicaid under Obamacare, which provided coverage to an additional 12 million people in 31 states. Since people with mental illness are far more likely to receive public insurance like Medicaid than private insurance, this will hurt them disproportionately.

America can’t be great if millions of our citizens with medical and psychiatric illnesses lose their insurance coverage. An anxious nation is rooting for Mr. Trump not to let that happen.

Mental Health Consumer Action Network