Category Archives: Media

Medical Care Means Mental Health, Too

Copy of Article

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.

Reformers seek alternatives to putting mentally ill behind bars in Alaska

Link to Full Article & Video

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

JUNEAU –

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.

Mental Health Consumer Action Network