MENTAL HEALTH NEWSTM YOUR SOURCE OF INFORMATION, EDUCATION, ADVOCACY AND RESOURCES SPRING 2002 FROM THE LOCAL, STATE, AND NATIONAL NEWS SCENE VOL. 4 NO. 2 Out of the Abyss of Anger

mor, regulating one’s environ- end up being turned against ment, psychotherapy, medica- themselves in depression, or can tion, etc.). So, you have to be lead to problems with impulse wondering why I am writing control and end up contributing about anger. to legal problems. It seems to me that since Sep- Legal and illegal substances tember 11th, anger, as Emerald are often used to control anger. Lagasse might say, “has been Some people choose opioids as a kicked up a notch.” For the first drug because it helps push away time in all of our lives we have angry feelings, which has re- witnessed terrorism of a monu- sulted in an increase in opioid mental proportion in our own addiction in recent years which backyard. While it is true that may have been further effected we have experienced terrorism in by events of September 11th. Al- our country before, even at the cohol may also suppress and fa- World Trade Center, we have cilitate outbursts of anger, and

never seen anything like we have many alcoholics are opioid ad- Anger: The Choice is Yours this past fall. Think of the words Anger: A Candid Discussion dicts as well. Those who are By that have been used since that By addicted to sedative hypnotics date to describe our reactions: are using these drugs as a Richard J. Frances, M.D. Harris B. Stratyner, Ph.D., CASAC shock, disbelief, fear, anxiety, means of anger management

uncertainty, insecurity, outrage, which may very well be ineffec- th sychologists have been and of course, anger. ince September 11 tive. The other substances of researching and writing Now, I have no intention of many of us have been abuse, including use of cocaine about the emotion of an- writing about September 11th -- struggling with a variety and crack, can also contribute to ger for many years. so if you were anticipating that of emotional reactions poor impulse control, increased PThere is probably very little that I S was the direction I was heading, including numbness, pain, be- rage attacks, anger and crime. could add to the discussion. We I can assure you it is not. I men- reavement, sadness and anger. Fifty percent or more of homi- have all read articles, seen seg- tion it because I believe it Those of us in the mental cides are drug related. For the ments on television, heard inter- brought all of our emotions to health profession sometimes are most part, psychiatric patients views and discussions on the ra- the edge -- anger being one of concerned about analyzing every- are not at much higher risk for dio, etc., which explain anger in them. It was fascinating to me one’s anger too easily because it crime than the general popula- psychological and physiological as an observer of human nature, may need to be channeled pro- tion. However, psychiatric pa- terms. These same articles dis- to see how many New Yorkers, in ductively into a war effort, a tients who abuse substances and cuss “healthy” versus somewhat of an exaggerated homeland defense and an appro- have a history of violent behavior “unhealthy” forms of anger, view manner, went from a period of priate response to terrorism. can have impulsive outbursts, the triggers of anger (i.e., reac- tremendous love and caring, to a However, in times of stress and especially when intoxicated. tions to external events versus return to rushing around and war, anger can also be destruc- Sixty percent of patients with internal ruminations), and review having that angry edge to them tive. Anger can lead to a height- schizophrenia have substance the multitude of ways one can once again. Granted, I am ening of crime and substance problems and 60-80% of patients deal with anger (e.g., cognitive speaking in extreme terms, and abuse. Psychiatric patients may with bipolar disorder have sub- restructuring, relaxation tech- am myself a New Yorker through especially have difficulty dealing stance problems. niques, developing a sense of hu- with angry feelings which may see The Choice on page 8 see A Candid on page 10

• Evidenced-Based Practices -- The New Frontier ? Inside This Issue Of • Budget Bomb -- Parity Puzzle -- Sopranos Soliloquy MENTAL HEALTH NEWS • Autism - the Challenge and the Hope: A Special Report • Four Winds Hospital Education Series Supplement

PRESORTED MENTAL HEALTH NEWS STANDARD 65 Waller Avenue U.S. POSTAGE PAID White Plains, NY 10605 WHITE PLAINS, NY PERMIT NO. 153 PAGE 2 MENTAL HEALTH NEWS ~ SPRING 2001 MENTAL HEALTH NEWS ADVISORY COUNCIL

Hon. Tom Abinanti Toni Downs, Executive Director Carolyn S. Hedlund, Ph.D., Executive Director Westchester County Legislature - 12th District Westchester Residential Opportunities Mental Health Association of Westchester

Neil Aisonson, Ph.D., President Douglas Drew, Consumer Link Advocate Richard S. Hobish, Esq., Executive Director Westchester County Psychological Association Mental Health Association of Nassau County Pro Bono Partnership

Nadia Allen, Executive Director Mary Grace Ferone, Esq. Marsha Hurst, Ph.D., Director, Health Advocacy Program Mental Health Association in Orange County Westchester - Putnam Legal Services Sarah Lawrence College

Richard Altesman, M.D., Representative Marcia Z. Feuer, Esq., Director of Public Policy Doug Hovey, Executive Director American Psychiatric Association National Assembly Mental Health Association of Nassau County Independent Living Center of Orange County

Peter C. Ashenden, Executive Director Barbara Finkelstein, Esq., Executive Director Keith M. Johnson, M.A., Clubhouse Director Mental Health Empowerment Project Westchester - Putnam Legal Services Hope House

Hon. Chris Ashman, M.S., Commissioner Rena Finkelstein, President D.A. Johnson, RAS, Director of Recipient Affairs NYC Orange County Department of Community Mental Health NAMI-FAMILYA of Rockland County New York State Office of Mental Health

Jeannine Baart, M.S. Donald M. Fitch, MS., Executive Director Sabrina L. Johnson, B.A., Recipient Affairs Liaison Mental Health Education Consultant The Center For Career Freedom Westchester County Department of Community Mental Health

Alfred Bergman, Chief Executive Officer Pam Forde, Director David Kamchi Supervised Lifestyles Putnam Family Support and Advocacy, Inc. Disabilities Rights Advocate

Sheldon Blitstein, C.S.W. Richard J. Frances, M.D., Medical Director Rami P. Kaminski, M.D., Medical Director of Operations NY United Hospital - Behavioral Health Services Silver Hill Hospital New York State Office of Mental Health

Hon. Symra D. Brandon, C.S.W., Minority Leader Maurice J. Friedman, Director John M. Kane, M.D., Chief of Psychiatry Yonkers City Council Westchester Library System Hillside Hospital

Joe Bravo, Executive Director Michael B. Friedman, C.S.W. Sylvia Kaufman, C.S.W., Executive Director Westchester Independent Living Center Public Policy Consultant Jewish Family Service of Rockland County

Linda Breton, C.S.W., Assistant Executive Director Steven J. Friedman, Commissioner James J. Killoran, Executive Director Westchester Jewish Community Services Westchester County Department of Community Mental Health Habitat For Humanity - Westchester

Jacqueline Brownstein, Executive Director Kenneth M. Glatt, Ph.D., Commissioner Samuel C. Klagsbrun, M.D., Executive Medical Director Mental Health Association in Dutchess County Dutchess County Department of Mental Hygiene Four Winds Hospitals

John F. Butler, Manager of Community Affairs Joseph A. Glazer, President & CEO Marge Klein, Executive Director Verizon - New York Mental Health Association In New York State The Guidance Center

Ann Camerone-Moccio, R.N., Mental Health Program Manager Juliet Goldsmith, Director Public Information Lee-Ann Klein, M.S., R.D., Nutritionist Visiting Nurse Services in Westchester New York-Presbyterian Hospital Westchester Division Albert Einstein College of Medicine

Alison Carroll, C.S.W., Director of Day Treatment J.B. Goss, R.Ph., Ph.D. Easy Klein, Media Coordinator Putnam Family & Community Services Janssen Pharmaceutica NAMI - New York Metro Division

George M. Colabella, President Cora Greenberg, Executive Director Andrea Kocsis, C.S.W., Executive Director Colabella & Associates Westchester Children’s Association Human Development Services of Westchester

Robert S. and Susan W. Cole Steven Greenfield, Executive Director Joshua Koerner, Executive Director Cole Communications Mental Health Association of Nassau County Choice

Marianne Coughlin, Administrator Ralph A. Gregory, President & CPO Alan Kraus, CSW, CAC, Division Chief, Mental Health Services New York-Presbyterian Hospital Westchester Division United Way Of Westchester & Putnam Dutchess County Department of Mental Hygiene

Anthony A. Cupaiuolo, Director Mary Hanrahan, Director, Treatment Services Lois Kroplick, M.D., Founder & Chairwoman Michaelian Institute - PACE University New York-Presbyterian Hospital Mental Health Coalition of Rockland County

Anna Danoy, Deputy Director Dean B. Harlam, M.D., Associate Medical Director Mental Health Association of Westchester Saint Vincent’s Behavioral Health Center - Westchester Mental Health News Advisory Council continued on page 39

Mental Health News Send All Inquiries To: MENTAL HEALTH NEWS TM does not endorse the views, Mental Health News For Advertisement And products, or services contained herein. No part of this publication may be Ira H. Minot, C.S.W. 65 Waller Avenue Subscription Information reproduced in any form Publisher & Editor White Plains, NY 10605 without written permission. See Page 30 Mental Health News is not (914) 948-6699 responsible for omissions or errors. It is Illegal under Federal Copyright Law or call us between the hours of To Reproduce This Publication or Any Portion of it (914) 948-6677 fax Copyright © 2002 9 am & 5 pm Without the Publisher’s Permission Mental Health News, Inc. [email protected] All rights reserved. MENTAL HEALTH NEWS ~ SPRING 2002 PAGE 3 The Editor’s Desk

practice theory want to design a “experts” that would decide what new system grounded in scien- facts and practices are really the A Better tific research and measured on best? Would consumers be in- quality and accountability. volved in designing the new sys- Safety Net Discrepancies in care and tem? How long would this effort professional judgment can and take to implement, and how do occur in treatment. A case in would we pay the costs associ- Mental Health Consumers Need point comes from a consumer ated with accomplishing this Evidence-Based Practices To who wrote to me the following task? Ensure Effective Outcomes From account. As it is, funding for mental Treatment And They Need Help I went to my doctor for his sig- health is a battlefield right now in Developing Self-Management nature on an application for sup- New York State due to 9/11 ex- ported housing. Once filed, it penditures and curtailment of the Skills To Best Utilize The Care would help me live a little easier Community Reinvestment Fund. Available To Them on the few dollars a month I re- However, we must not lose faith ceive from my social security dis- that funding cut-backs last for- By Ira Minot, Publisher ability payment. Instead of under- ever and let’s remember that Re- Mental Health News standing my request for his help, investment had great success in he was indignant about signing providing millions of dollars for A major factor in surviving a the form and said I should get a innovative and effective commu- mental illness involves negotiat- full time job, “get with it” and stop nity mental health services. ing the maze of programs and draining the system. Ira Minot We must focus on why we therapeutic interventions which How this made the consumer need a better safety net. make up the mental health care feel? I find these notes from con- We need a better safety net, system. This can often be more I felt betrayed...it was awful. I sumers invaluable in helping me because people need to respond difficult for consumers (patients) had been in the hospital for al- pose the following question: Don’t to treatment much more rapidly than the system or the clinician most an entire year following a we deserve A Better Safety Net? then they do now. It should not would probably care to acknowl- major breakdown and was trying When a person falls ill to take years of a persons life spent edge. However, change is in the to get my life back...but I still mental illness, they aren’t given a in programs and on dozens of wind. needed time and a safety net to road map to understand what medications to find the help they Mental health care in America keep me from being re- has happened, what they should need to become productive mem- today relies on a system of prom- hospitalized. The doctor acted as know about their illness, and bers of the community again. ise and peril that evolved from an if he didn’t care that I was spend- where the programs and re- Both consumers and providers institutional care model to mod- ing so much money on my meds sources available to help them make critical mistakes that often ern day community mental that I barely had enough to eat are located. That was why I prolong recovery time. health, a system based primarily each week. He didn’t understand started Mental Health News—to On an even broader level, the on bringing mental health care that the supported housing would give people that road map. facts remain that large numbers into the community. allow me to stretch my budget. I By the same token, consum- of people with mental illness still Current research studies didn’t want to challenge my doc- ers are not given a handbook on exist and are not being reached point out that although reforms tor’s attitude for fear that I would what to expect from their treat- in New York State. We still have did occur as a result of the com- be seen as crazy or non- ment, the programs they attend many homeless people with munity mental health movement, compliant. The entire situation and how interactions between mental illness, and people with it has had limited impact on im- had me scared, worried, more de- them and their caregivers should mental illness continue to live proving the lives of persons with pressed and fearful that I was be taking place. Such a hand- under harsh or unsafe living con- mental illness. Howard H. Gold- heading for a relapse...all over book would be welcomed and ditions. In addition, many chil- man, M.D., Ph.D., et al, this simple request for his help. highly useful to help consumers dren and adolescents with signifi- (Psychiatric Services, December I received another compelling functioning well in their recovery cant emotional problems are not 2001, Vol. 52, No. 12) points to account from one other consumer process to become advocates for receiving the services they need the need for mental health care which I would like to share with their own treatment, care and in communities throughout New to shift to one of content and you. recovery through a process of York State. quality of services, the bulwark of I was in a day program follow- day- to-day self-management. Will a new scientific approach a push for a new mental health ing a recent hospitalization for This notion is not to be con- to mental health care address system based on evidenced-based depression, and I wanted desper- fused with Advanced Directives, these broader concerns as well? I practices. ately to get my life back…I was which have been developed as pray they will, and I believe that Robert E. Drake, M.D., Ph.D., highly motivated, but the other highly useful directives for con- people throughout the state will et al, (Psychiatric Services, Febru- patients in the program seemed sumer care in the event they are be working hard to see that we ary 2001, Vol. 52, No. 2) defines satisfied to stay where they were unable to make informed deci- weave a stronger and more com- evidence-based practices as inter- and not get better. Because of sions on their own. prehensive safety net. ventions for which there is scien- this, I was seen by the other pa- Helping consumers develop In that spirit I believe that tific evidence consistently showing tients as an outcast and a ’goody- daily self-management and em- Mental Health News can play an that they improve client outcomes. two-shoes.’ If I wasn’t willing to powerment skills needs to be- important role in bringing evi- The time is right for bringing stay at the same level as the other come a mainstream of ongoing denced-based practices informa- evidenced-based (EVP) practices patients, they didn’t want me treatment and one that is re- tion and education to communi- into our mental health system. around and resented my high as- spected, acknowledged and en- ties throughout New York State. It is undeniable that a system pirations. It was very depressing. couraged by providers of services Should the New York State that lacks uniformity in its prac- I felt the staff had the same im- throughout the care giving sys- Office of Mental Health support tices invites harmful outcomes in pression of me and when I went to tem. this idea, Mental Health News client care and invites unneces- them pleading to help me move on Could a new evidenced-based stands ready to serve. sarily prolonged illness. with my life, they would tell me to system, built on quality and ac- I would like to thank you all Mental health care today is ‘go back into group and talk about countability, really be designed for your participation and sup- somewhat based on best inten- it.’ I ended up quitting the pro- and implemented unifmormly port, which fuels our commit- tions, historical assumptions and gram and found a consumer-run throughout our entire mental ment to mental health education. clinical opinion for such critical drop-in center where I felt re- health system? Please continue to E-mail your aspects of client care as diagno- spected for who I was. It was How would this sweeping ref- comments and suggestions. sis, therapies, medication selec- there that I got my life back on ormation take place? Would eve- tion and course of treatments. track, and I’m now back in school rybody have to go back to the Best Wishes The architects of evidence-based finishing my degree in business. classroom? Who would be the Ira Minot, Publisher PAGE 4 MENTAL HEALTH NEWS ~ SPRING 2002 Letters to the Editor

Stigma and September 11th the typical person who is men- Profits over People the losses of a productive em-

To the Editor: tally ill and the terrorist, when To the Editor: ployee are held to a minimum. the only connection is in the Then there is the destructive loss Since September 11, 2001, mind of the speaker. The re- The House Republican denial to the family system and the everyone’s attention has been sponse I got was that I was too of the Senate’s proposal to elimi- community at large when access riveted on the Attack at the sensitive, and there was no prob- nate the insurance disparities to health care is denied. Should World Trade Center and all its lem in using that expression, be- between those who suffer from these far reaching repercussions implications. We hardly remem- cause “everyone knew what was mental illness to that of physical be predicated by a corporation or ber what we were concerned meant.” illnesses displays their ignorance congressman’s worry about the about before September 10, and Unfortunately, I think, on the nature of the various in- bottom line? we even question if any of the “everyone did know what was flictions that affect the mentally I didn’t know values our trivial problems we had in the meant.” What it seemed to mean ill community. country was founded on were past are even related to the after- was that people can give the im- The cost to the individual only based on dollars and cents. math of the “incident.” pression that participating in should override corporate cost. Only those who have mental For many years, I have been carefully planned violence and Insurance parity will increase the illness and their families that concerned about doing away with destruction is somehow related potential for acclimating society must endure the pain, hardships the stigma of mental illness. I to mental illness. I do not re- to treating mental illness—as the and losses imposed by the ill- try to understand how to create member being taught to diagnose choice of care and treatment op- ness, should be given the final an environment in which the mental illness according to this portunities increases. Productiv- word on passing parity legisla- mentally ill are accepted and un- standard. I am not able to find ity gained by addressing mental tion. This is evidenced even more derstood, as valuable, contribut- terrorism in the DSM-IV. illness issues would outweigh in that both Sens. Wellstone and ing members of society. I try to The attack on the World bottom line corporate cost. The Domenici, who championed pas- understand how to use language Trade Center has brought to- issue should be judged as the sage of parity legislation both to include the mentally ill in the gether people of good will from benefit to society as a whole, not have family members with men- life experience of the community, every walk of life and every eth- profits. Should corporate profits tal illness. and not use it to alienate and nic group. People who are dis- supersede family care concerns? Let’s not wait until others be- isolate the mentally ill. abled by mental illness feel in- The increased costs required come ill for us to better under- Several times since the at- cluded in this effort. Mental to place mental illness on par stand the need for parity legisla- tack, I have heard or read mate- health services are being ex- with other medical illnesses is tion to be passed. rial in which the behavior of the panded to people who have suf- certainly out-weighed by the tan- Let’s not allow the greedy fi- terrorists was referred to as fered from the disaster. To fur- gible and intangible gains. By nancial needs of an inanimate “crazy” or “mentally ill.” For ex- ther erode the stigma of mental not offering increased access to corporate mentality and bottom ample, on the evening after the illness, let us speak up when mental illness care, our society line legislative thinking decide Attack, I attended a prayer ser- anyone uses language which continues to lose the potential of the basic rights of individuals vice for those who were missing. equates terrorism, or even vio- people who are lost to illness be- and families in pain. Two of the speakers, who hap- lence, with mental illness. Let us cause intervention is not avail- pened to be leaders in the com- help those with mental disabili- able. When better care and Glenn Slaby munity, referred to the actions of ties feel more accepted in society treatment are available early on, New Rochelle, New York the terrorists as “crazy.” I ap- by spreading the idea that men- proached one of the speakers, tal illness is treatable and under- after the program, and explained standable and does not interfere why I thought it was discrimina- with a persons ability to be a To the Editor: tory to use a word usually valuable member of the commu- Ira, we applaud your extraordinary efforts in providing support, thought to mean “mentally ill,” nity. education and advocacy for families of persons with serious mental when talking about the terror- illness. ists. It gives the impression that Pauline L. Kuyler, M.D., F.A.P.A. NAMI Families and Friends of the there is some similarity between Fresh Meadows, New York Nathan Kline Institute for Psychiatric Research “Hope and Recovery Through Research” Thoughts on Anger gle. It was wonderful having all Orangeburg, New York 10962 - www.rfmh.org/nki

To the Editor: my energy (that I usually use for the “struggle”) to simply enjoy, to When I think of anger, I think laugh regularly and easily. I to feel the way a “normal” person just to name a few. of several things. I think of the never knew what it was to feel feels. It felt wonderful to laugh, I grew up in a family where anger I grew up with and the an- this way. My mind was without to feel light, to be able to think anger was an outgrowth of alco- ger generated by my illness -- depression and anger. and see clearly. holism passed on from past gen- major depression, bi-polar disor- Does this mean I think every- Medications are wonderful. erations. Growing up with anger der II. I also think of when my one should go for ECT? No. But when they work, I work. And isn’t fun. And if one was to do medications aren’t right, and I when necessary, it works; it when they don’t work, I get irri- geneology research of their fam- get nasty, irritable, and angry. works well. And it made me real- table, nasty and angry. I don’t ily, they would probably find it Generally, I am a good person, ize how stimulating the brain feel like a nice person nor am I a way back there, too. Is it inher- but sometimes my illness inter- could allow someone to have the nice person when my medication ited through the genes? Or is it feres with my “normalcy,” and potential to feel happy. Because is off. So, since ECT, it has been inherited through the emotional my mind becomes noisy, unset- those of us who have low sera- important to have my medication cycle being handed down, and tled, and not at peace. tonin levels, need a chance to balanced periodically. down, to what I experienced in Anger turned inward equals experience good feelings. Once the brain chemistry is my life today. And, will my life depression. The only time I re- If used effectively and cau- regulated, talk therapy helps as repeat the same cycles as those member feeling life without de- tiously, ECT is an effective treat- well. I attended a DBT (dialectic before me? That’s a frightening pression or anger was following ment for depression. ECT behavior program) that helped a thought. Can I break the cycle? Electroconvulsive Therapy (ECT). brought me back from the dark- lot. I learned coping skills I I know I must continually I was 41, and it was the first ness, when medications proved never knew existed and had sup- work at managing my illness on time in my life that I felt what I ineffective. Yes, I didn’t appreci- port at least a few hours of my a daily basis, and continue every guess the “normal” person has ate losing my memory for nearly day. Great support! effort towards recovery and heal- always felt -- nothing. No heavy, a year and a half, but depression The skills I learned taught me ing. dark cloud, no noise, no struggle can do that on its own. how to deal with my anger, how to feel and stay normal. It was But ECT gave me, for the first to deal with conflict, how to ask Jane E. McCarty the only time it was not a strug- time in my life, the opportunity for what I wanted or needed -- Harrison, New York MENTAL HEALTH NEWS ~ SPRING 2002 PAGE 5 PAGE 6 MENTAL HEALTH NEWS ~ SPRING 2002

of View Conscience and Cowards

By Marty Luster mittee on the Labor-Health and indicated their support for the demonstrated by these members New York State Assembly Human Services-Education Ap- amendment by co-sponsoring of Congress, it now falls to those propriations bill in Washington parity legislation or signing let- states that do not have compre- on December 18th. The amend- ters urging the inclusion of the hensive parity legislation in place ment championed in the Senate Senate amendment in the final to enact such measures as soon by Senators Domenici (R-NM) appropriations bill. Clearly, the as possible. In the 2001 legisla- and Wellstone (D-MN). The ten House Republicans who scut- tive session, I introduced the Fair amendment would have elimi- tled this effort, which enjoys Insurance Treatment Act of 2001 nated discriminatory and un- enormous support by the Ameri- (A.4506). This bill, if enacted equal insurance coverage for can public, were under great into law, will completely eliminate mental health services by prohib- pressure from the House Repub- discriminatory insurance cover- iting the practice by insurance lican leadership who, in turn, age for mental health and sub- companies of imposing one set of caved in to the demands of the stance abuse services. It man- deductibles, co-payment, days-of- insurance industry and big busi- dates coverage for those illnesses coverage and scope of treatment ness. For those who think that and requires that the coverage be provisions for those with there is no difference between the provided on the same basis as “physical ailments,” and another, political parties, think again. coverage for physical ailments. It more restrictive, set for those After the vote, all that was left passed the Assembly in June and who have mental illness. It standing was a one-year exten- is now pending in the Senate, would have been a giant step to- sion of the current ineffectual sponsored by Republican Senator ward the elimination of the federal parity legislation that was John Marchi. Marty Luster stigma attached to mental illness passed in 1996. Shame on the Many of the same bogus argu- and a recognition that many who Republican leadership in the ments that were made to defeat If “conscience (meaning reflec- are mentally ill can be treated House, and shame on those the federal Domenici-Wellstone tion) doth make cowards of us and often cured and should be members who lacked the courage amendment were also used in all,” those who only reflect on treated no differently than those to enact a measure that provides Albany during the pendency of their own political security are with broken bones, cancer or fairness and equity to the 20% of the parity bill in the Assembly. cowards of the first class. I refer other “physical” ailments. Americans who, at one time or We were regaled with claims that to the display of cowardice by ten This vote occurred even another, will suffer from serious the cost of insurance coverage Republican members of the though 244 members of the mental illness. would skyrocket, ultimately House-Senate Conference Com- House of Representatives had Given the lack of backbone see Conscience page 14

Governor’s Budget Gives Mental Heath Short Shrift

Coalition of Voluntary Mental cluding an annual staff turnover to other jobs. Ironically, these are with the State. Yet, with the way Health Agencies, New York City that is as high as 54%. often in the healthcare sector the budget is structured a flat Last year, the Governor and which pays better salaries. Un- mental health budget acts as a the Legislature walked away from addressed, the persistent and cut in community mental health promises to the mental health deliberate underfunding of the services because costs have esca- sector for 10% Medicaid fee in- community mental health system lated with annual inflation. State crease and 2.5% cost-of-living- will lead workers to find jobs mental health workers, who are increase. “We feel like we were elsewhere,” said Saperia. “This contracted to receive a 3% COLA jilted at the altar,” commented will have a deleterious effect, over each year, are paid approxi- Mr. Saperia. the long run, on the quality of mately $10,000 more than their “Throughout the heady years care and may limit access to peo- counterparts in the community of the 1990s, the mental health ple in need. In the meantime, who have the same job descrip- sector was told to wait for a bet- agencies are forced to increase tion. For each year that commu- ter time to get a Medicaid fee in- caseloads for caregivers, decrease nity mental health is left out of crease and cost of living increase time spent with each consumer, the budget, the disparity grows that would have begun to redress and raid contingency funds sim- even larger. the years of static reimbursement ply to stay afloat. Studies indi- Moreover, this is also a time and growing costs,” said Phillip cate that 2 of every 3 people who when community mental health A. Saperia, Executive Director of leave their job in mental health agencies are being asked to do The Coalition of Voluntary Mental programs have been with their even more as a result of Septem- Health Agencies. “Better times agency longer than a year. We ber 11. The crisis counseling ser- have never arrived and this sec- are losing the most experienced vices that are funded by FEMA Phillip A. Saperia tor is in greater need than ever staff at alarming rates. In mental require a stable base from which before. While we support the health, it means discontinuity to operate. Despite a strong Community-based mental governor’s initiative for increases and disruptions in the healing commitment to providing these health agencies were disap- for hospital workers who also relationship which is so neces- needed services, agencies are pointed to learn today that Gov- faced high turnover and staffing sary for recovery.” finding it difficult because the ernor Pataki’s 2002-03 budget shortages, mental health workers A model of public-private infrastructure is so badly frayed. proposal did not substantively should not be left out.” partnership, the non-profit com- “Since 1990,” said Saperia, “the address the problems besetting “Already, a significant portion munity mental health sector is Consumer Price Index has risen the mental health workforce, in- of our workforce has been driven largely funded through contracts see Short Shrift page 14 MENTAL HEALTH NEWS ~ SPRING 2002 PAGE 7 of View

Coming To Terms With Reality: The New York State Mental Health Budget For 2002-2003

By Michael B. Friedman, CSW agencies over the past decade yet once again--and the Reinvest- attract and retain the necessary has created a crisis in commu- ment Act lapsed on September staff. Given the fact that there nity mental health. 30, 2002. will be some new service develop- When wages for entry level This year the Governor's ment in the coming year as funds workers are lower than work in Budget Request includes funding for new programs that were fro- fast food restaurants, when cli- to increase wages for health care zen last year are released, it is ents breaking into work for the workers--including mental health hard to imagine that more devel- first time can get more per hour workers--in general hospitals. It opment will be feasible until we than the people helping them, includes funding to increase have addressed the crisis con- you know that something is wages for mental health workers fronting existing community wrong. And the consequence is in state facilities. It is important mental health services. that turnover in some agencies is and right that their wages will be I find these realities very dis- over 50% per year. That means raised. But sadly the Governor turbing. As I said at the begin- that people who need mental chose not to request funds for ning of this piece, I have devoted health care don't get continuity workers in community mental most of my professional career to in their relationships with the health agencies. "Not enough advocating for expansion of com- people hired to help them, and it money during an economic munity mental health. Further means that jobs go vacant for downturn," the Governor main- expansion is necessary, and to long periods of time. Workers tains. In other words, it's not at the very core of me I want to who remain in their jobs have the top of his list of priorities this push for it. But I have come to excessive workloads and cannot year. terms with the reality of this provide the time and attention So this is a year for political year. We must overcome the Michael B. Friedman their clients need. It is a recipe realism. That means focusing all workforce crisis in community for disaster, and it cannot be al- of our energies on a single prior- For over twenty years I have lowed to continue. ity and joining together to do it. mental health, and it will take all been an advocate for the progres- Last year the Governor recog- For most of us that priority is of us focusing exclusively on this sive development of a compre- nized that there is a crisis in wage stabilization--that is, paying one budget issue to get it done. hensive community mental community mental health and people enough so they will take It will take the advocates working health system. Year after year I proposed a multi-year approach jobs and stay in them. together. It will take the Senate have pushed for more housing, to increase funding for commu- It is possible to make a case and the Assembly forging a com- more rehabilitation services, nity mental health agencies. His that there is enough money both mon position. It will take the more outpatient services, more proposal called for replacing the to buttress the community men- Governor to sign on. We all most effective crisis services, and more Community Mental Health Rein- tal health systems and to expand put aside our differences this community supports for adults vestment Act, which was origi- it. But it seems extremely year to get this crisis behind us. with severe, long-term mental nally designed to use savings unlikely this year that the legisla- Only then will we be able to once illnesses and their families. I from reductions in State hospi- ture and the Governor would again pursue a vision of compre- have also pushed for more com- tals to expand services, with a agree to allocate money for both. hensive community mental munity services and better inte- new Reinvestment Act, designed That is why most of us are push- health. grated services for children and to use those savings to provide ing to extend the Reinvestment Michael B. Friedman is the adolescents with serious emo- increases for community mental Act and to use the savings from public policy consultant for The tional disturbances and their health agencies. Because his reductions in state hospitals for families. This year--for the first proposal included a plan to close increases for the existing system Mental Health Associations of time--I am not advocating for ser- several state hospitals and to rather than for the development New York City and Westchester vice expansion. I am advocating consolidate several state chil- of new services. County. The opinions expressed only for funding to buttress exist- dren's psychiatric centers with There is an enticing counter- in this essay are his own and do ing services. Why? Not because state psychiatric centers for argument--that there must be not necessarily reflect the opin- new services are no longer adults, it was politically unpopu- new services to meet the needs of ions of the Mental Health Associa- needed. They are needed. I am lar and collapsed in the state leg- the people who will no longer be tions. advocating only for funding to islature. And, because the Sen- served as inpatients in state fa- support existing services because ate and the Assembly were un- cilities. However, the sad reality Mental Health News wishes to the failure of the State to provide able to agree on an alternative is that it has become very diffi- thank the Mental Health Associa- adequate compensation for work- approach, community mental cult to develop new services now tion of Westchester for sponsoring ers in community mental health health agencies got no increase-- because salaries are too low to Mr. Friedman’s column.

Mental Health News Wants To Hear From You To Alert The Community Of Your Vital Programs & Services Support Mental Health Education & Give Hope To Individuals & Families Searching For Answers To Mental Illness PAGE 8 MENTAL HEALTH NEWS ~ SPRING 2002

Anger: The Choice from page 1 down to simply being a choice. gry, yet, we cannot change the deal with my anger by realizing Don’t we really choose whether or past. In the present moment we the difference between the first and through (and wouldn’t have not we will respond to a given encounter situations that make and second statements – which it any other way) but, if you have- situation with anger? Perhaps if us angry, for example, a particu- leads us to the last statement: n’t noticed, drivers are honking we practiced serenity a bit more lar individual, and yet we cannot “…the wisdom to know the differ- much faster again when the light the choice would be more obvious force others to change, but only ence.” changes, and even those old fa- than automatic. Ah, that word change how we react to others. Having the wisdom to distin- miliar hand gestures have “serenity” -- there lies the rub! Certainly getting angry because guish between what we cannot slipped back in. For that matter, I am sure that those of you one is anticipating a future event change and what we can is the it’s probably true in all fifty who have continued to read on to turn out a certain way is also a whole secret. This last statement states. and know that I am involved in futile exercise. addresses everything I stated in So, metaphorically speaking, working with addicted individuals Now let us turn to the second the first paragraph of this article. is it the world that’s spinning a might have guessed I would bring statement: “…the courage to It allows us to distinguish be- bit faster that causes us to lose up serenity. Certainly it is the change the things I can.” The one tween “healthy” and “unhealthy” our patience and flare up? Have cornerstone of addiction treat- thing that we all have the ability anger, it speaks to what we the internet and microwave made ment. But, I believe it is the key to change is ourselves. We can choose to view as “anger trig- us more intolerant of waiting? to all psychological treatment – change how we choose to react. gers,” it allows us the ability to (What I like to refer to as the including anger management. However, it does take courage. take the time and pause and “push a button” mentality.) Per- Think for a moment of the Think of Ghandi and King. They think, etc., etc. haps we have been saturated by “serenity prayer.” It is so simplis- had the courage to remain calm So, the next time you find our pagers and cell phones to the tic in what it instructs, yet it in the face of torment. This al- yourself stuck in “traffic” of the extent that our nervous systems represents an entire philosophy lowed them to influence millions street or of the mind, think about are constantly on edge from the of existence. Let us for just for a of individuals to think about choosing serenity. In the long run anticipatory call or message that moment focus on the three basic what they were doing. Would I you will feel a great deal better, beckons us, and anger is the only aspects of the prayer and for be naïve to think that they did and so will those around you. emotional direction we have to go those of you who have difficulty not feel outrage? Of course I Harris B. Stratyner, Ph.D., in. with the use of the word “God” or would, but they had the courage CASAC, is a licensed psycholo- I guess there really is no turn- even the word “prayer,” simply and conviction to practice peace. gist, and the Director of Addic- ing back the hands of technology. view the concepts independently. Allow me to tell you as a psy- tion/Recovery Services for New But don’t we still have the ability First of all, one is instructed chologist, but perhaps, more im- York Presbyterian Hospital – to choose how we respond to to “…accept the things I cannot portantly, as a human being, one Westchester Division, and the things? I know, “stimulus- change.” How freeing!!! I cannot must choose to practice being New York United Hospital Medical response,” it’s beyond our control change the traffic, so logically peaceful. It is hard work, but it Center. He is a member of the -- we are merely “operating” ac- why get angry with the traffic? is well worth the journey. Commissioner of Westchester cording to our environments. Why not simply accept the traffic For those of you who know me County Department of Community But certainly the cognitive thera- and move on mentally and emo- personally, you have to be saying Mental Health’s Community Ser- pists have taught us that we can tionally? Think of all the “traffic” at some point, “Come on Harris, vices Board, and can be heard alter our reactions. in our heads. We have road- you get angry;” Of course I do, I weekly on his own popular radio What I am arguing for in this blocks from the past that cause am a human being, but I can tell show, “Here’s to Your Good article is that anger really comes us to ruminate and become an- you that today I am better able to Health” on Am 1230, WFAS.

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Seay New Director of NAMI-NYS

Staff Writer advocacy and government rela- Chatham, Columbia County, New Mental Health News tions. York. From 1979 to 2000 he was an NAMI-NYS is a grass-roots, The board of directors of the officer of the United Hospital self-help, support and advocacy National Alliance for the Mentally Fund of New York, a health organization dedicated to improv- Ill, New York State (NAMI-NYS) care philanthropic and research ing the lives of all people who are has announced the appointment organization, where he served as affected by mental illness. It of J. David Seay, J.D., as Execu- Vice President, Corporate Secre- strives to enable all individuals tive Director for the statewide tary, and General Counsel. with a mental illness and their mental health support, education He has also served with a families to live the best life possi- and advocacy organization. large national health insurer and ble. There are over 50 NAMI-NYS Mr. Seay, previously an attor- the Executive Office of the Presi- ney in private practice specializ- affiliates across New York state, dent of the United States in ing in exempt organizations, non- working together to provide sup- profit corporate law and health Washington, and has served on port groups, promote better treat- care, comes to NAMI-NYS with the boards of directors of numer- ment and support services, and over 20 years experience in ous local and national nonprofit advocate for research into the health policy, nonprofit manage- organizations. He and his wife causes and treatments of mental J. David Seay, J.D. ment and governance, education, Anita, and artist, reside in North illnesses. Luster Announces Retirement

Staff Writer Visiting Professor at Cornell Uni- trict. My experience has con- 1997 welfare reform efforts, legis- Mental Health News versity's Department of Govern- firmed my feeling that public ser- lative reform efforts in 2000, Leg- ment for the fall semester. vice is an honorable and worth- islation benefiting migrant labor- Assemblyman Marty Luster (D In 1988, Luster was the first while calling and that Oliver ers, and new laws establishing -125th) today announced his in- Democrat in 75 years to be Wendell Holmes was right when residential hospices, life-care tention to retire from the Assem- elected to represent the 125th he said: communities. bly at the end of his current term District. This followed a 5-year “As life is action and passion, According to NYAPRS Director in December 2002. Luster, a 14- tenure as Ulysses Town Supervi- it is required of a man that he Harvey Rosenthal: “Marty has year veteran of the Assembly, sor. share in the passion and action been a champion during his ten- said his decision to not seek re- "Serving in public office for 19 of his times, at the peril of being ure for the promotion of the re- election came largely from a de- years has been the highest honor judged not to have lived." covery, rehabilitation and rights sire to have more time to spend of my life," said Luster. "I thank In the Assembly, Luster, an of New Yorkers with psychiatric with his family, including two my constituents, supporters, unabashed liberal, authored disabilities” sentiments shared grandchildren, as well as an in- staff, and above all, my family, hundreds of bills, 150 of which throughout the mental health terest in pursuing other avenues for their encouragement and help have been signed into law includ- community. of involvement in political and throughout this time. It has ings: the creation of the Assembly Joining Luster at his an- civic affairs. Luster also recently been an extraordinary privilege to Standing Committee on Libraries, nouncement was Barbara Luster, accepted an appointment as a serve the people of the 125th Dis- of which he was the first Chair; his wife of 38 years.

Federal Court Decision on Mental Illness

NAMI E-News month limit in benefits. companies cannot arbitrarily ig- make public perceptions of men- February 28, 2002 Vol. 02-57 "The decision has symbolic nore the reality of the mind-body tal illness an evolving concept. importance in the ongoing Con- connection," Honberg said. There is no hard, fast rule to gov- Arlington, VA-The U.S. Dis- gressional debate over parity for The court's decision turned on ern the definition. trict Court for the District of Co- mental illnesses in health insur- an interpretation of an ambigu- In the case of Jane Fitts, an lumbia has opened a breach in ance," said Ron Honberg, legal ous definition of mental illness in attorney who began work for the artificial wall that has long director of the National Alliance Unum's contract with Fannie Fannie Mae in 1982 and was di- separated coverage of physical for the Mentally Ill (NAMI). "It will Mae. Noting that "courts are split agnosed with bipolar disorder in and mental illnesses in insurance have a practical impact on pre- over whether ailments like bipo- policies. cisely how the industry drafts lar disorder fall within the defini- 1995. In Fitts v. Federal National long-term disability insurance tion of mental illness contained "The court declared that the Mortgage Association (Civil Ac- contracts in the future. It also is in employee benefits plans," dispute was not over facts, but tion 98-00617), Judge Harold H. another step toward ending dis- Judge Kennedy identified "three definitions," Honberg said. "In the Kennedy ruled on February 26, crimination based on myths and basic approaches" which have 21st Century, there is better un- 2002 that Fannie Mae and Unum stigma." focused on symptoms, causes or derstanding of the physical na- Life Insurance Company of Amer- "What is most important is treatments. ture of mental illness. It's not ica (Unum) improperly classified that the court weighed science- The court found both cause- an employee's bipolar disorder based factors in reaching its deci- based and symptom-based ap- just scientists who understand (manic depression) as a mental sion. Mental illnesses are brain proaches to be "intuitively ap- this, but also, increasingly, the rather than physical illness, disorders. They have fundamen- pealing" and reasonable, but ob- average person. This decision is a which subjected her to a 24- tally physical causes. Insurance served that advances in science reflection of that reality." PAGE 10 MENTAL HEALTH NEWS ~ SPRING 2002 The Price We Pay For Our Anger

By Barbara Mazer-Turtenwald co-occurring disorder, i.e. substance ues and a cycle of dependence may de- It strikes me that stigma and peer Co-Occurring Disorders Coordinator, abuse. As a substance abuse counselor velop. Can a person “get rid of anger”? pressure are creations of our own minds. New York-Presbyterian Hospital, and the co-occurring disorders coordina- The answer is: “Yes,” with the right If I hurt, how can I stop the pain perma- Westchester Division tor at NYPH, my gut instinct tells me coping skills. nently? Treatment. The signs of early

that these figures are probably higher. Anger is a normal human emotion, stage alcoholism are numerous and vary Anger is one of the basic human emo- So why is anger a topic of importance which can serve many purposes in our from person to person. For simplicity tions. Most people have developed, from a mental health perspective? It is psyches. The problems arise when our sake let me just say that if you think you through trial and error, effective coping important because it is often the nutri- anger or our coping skills become self- “may” have a problem with alcohol or skills to deal with their anger. Occasion- tional source which feeds the stress re- destructive. Alcoholism is self- drugs -- you probably do. Share your ally, we all get “stuck” in our anger, but sponse in our bodies. Unrelieved stress destructive. Drug abuse is self- concerns with someone…anyone, and we muddle through it somehow. As a acts like a physical, mental and spiritual destructive regardless of whether the seek professional help. mental health provider, I have been in- cancer. For people who suffer from drugs of abuse are prescribed or illicit. In the aftermath of our National Trag- volved in treating a disproportionate chemical addiction the solution is imme- The things that make me and the rest edy on September 11, 2001, I fear that amount of people who cannot effectively diate -- get high! What price do these of the human race angry could fill a there will be many people who will deal with their anger. individuals, their families, their friends book. The starting point for dealing with needlessly suffer because of their inabil- Mental illness carries a stigma, as and their employers pay? A very high any problem must be identifying that ity to cope effectively with their rage does alcoholism/drug addiction. Both of price, often ending in institutionaliza- there is a problem. Addiction and other (“anger” seems too mild a word to ex- these diseases are characterized by an tion, incarceration or death. It has been mental illnesses often start out slowly press the feelings for that abomination). inability to tolerate stress and by the estimated that for every alcoholic at least with few signs or symptoms. The slow- Addiction and other mental illnesses development of maladaptive coping five other people are directly affected by ness of this progression often leads the are highly treatable today and with ongo- skills. At the very least these skills are his/her disease -- hence the term “family inflicted to rationalize other reasons for ing research we are constantly improving ineffective; in the extreme they can be disease.” their behaviors. This is a defense modes of treatment. I hope this article lethal (e.g. alcoholism). Drug use (alcohol is a drug, too) mechanism. Rationalization defends our has you thinking about the coping strate- Depending on the source of statistics, masks anger, numbs anger, temporarily minds, our sense of self, from being la- gies that you use and has you re- it is estimated that between 40-60% of relieves anger, but it does not get rid of beled with the stigma of addiction and/or assessing what role pride takes in your individuals with a mental illness suffer a the anger. Therefore, the stress contin- the stigma of mental illness. choices.

Anger: A Candid from page 1 ally responsible for their violent diagnostic entities. In depression, sonality disorder may also be im- acts, or whether Addiction is a we often see anger turned against pulsive and commit aggressive It is likely to be the patient with brain disease which should the self. In addiction, anger may acts either directed at others or psychosis who has an additional therefore relinquish the person often be suppressed and released themselves. They may burn substance problem and is in a from responsibility for what they by the use of substances. A di- themselves with cigarettes or cut paranoid state that is likely to do. lemma often results where the themselves and they may also be strike out in a violent way. In the United States our legal person may be using substances destructive of other’s property at Another aspect of the problem system emphasizes that everyone to try to manage their anger only times. Patients with obsessive- of violence that affects everyone is responsible for acts they com- to further worsen their condition compulsive disorder are con- today is the enormous amount of mit even while intoxicated, and less control of their anger in stantly torn between their anger violence that youths are exposed unless there is no intent and the long run. and their fear and have difficulty to in film, TV and even on the they meet criteria for being crimi- In psychiatric illness such as managing both emotions and news. This American culture of nally insane—criteria which are psychotic conditions, the patient tend to displace this into hand- violence may have a particular held to a rigorous standard when may misperceive events around washing, rechecking things, and effect on that segment of the substance abuse is also involved. them in a paranoid way, which a general high level of anxiety. population who tend to either Most courts will hold someone can lead to defensive anger and The anger management which have vulnerability to anxiety, or guilty for acts committed while sometimes violence. For exam- is most dangerous is that which have impulse control problems. using alcohol and drugs. In fact, ple, an innocent friend’s gesture occurs in patients with so- One area of special concern is though addiction is as Alan Lesh- may be taken in some delusional ciopathic personalities who are teenage violence and suicidal be- ner of the National Institute of way as an attempt to hurt the truly likely to commit criminal havior. Drug Abuse says, a brain dis- patient, and the patient may re- acts when they are feeling angry, We have seen a 3 to 4 fold in- ease, it is a disease where there act in an angry or belligerent entitled or upset. crease in teenage suicide over the is a vorational component to use manner which seems uncalled Richard J. Frances, M.D., is last 30 years, and we have also substances that may lead to fur- for. Various psychiatric medica- President & Medical Director of seen children and young adults ther increase and impulsivity and tions may help patients with psy- Silver Hill Hospital in New Ca- who are increasingly liable to be violent acts. chiatric problems better cope naan, Connecticut. He was for- carrying guns and committing It is my feeling that once with or deal with angry feelings. merly chairman of the Dept. of violent acts. Episodes such as someone knows they have a diag- SSRI’s, antidepressants may help Psychiatry at Hackensack Univer- Columbine can have an epidemic nosis of addiction, they should be a depressed person who is sity Medical Center and professor impact as children with violent held more responsible for their chronically struggling with angry of clinical psychiatry at the Uni- fantasies may copy things that acts then at just a point in time and depressed thoughts to not versity of Medicine and Dentistry they see happen on the news. where they may not be aware of being as troubled by certain of New Jersey, New Jersey Medi- Inadequate national efforts in the how affected their behavior is by negative aspects of their lives. cal School. He is an international area of gun control and inade- substances of abuse. This knowl- Atypical antipsychotic agents are expert on addiction psychiatry, quate efforts at violence preven- edge could be used in a wise way helpful in reducing paranoia, in- and has published over 175 arti- tion is a national tragedy. In ad- in sentencing. For example, the creasing impulse control and cles, books, and reports, including dition, relatively little research on person who has a first DWI, has management for schizophrenic co-editing The Clinical Textbook of the nature of violent behavior is a strong family history of addic- patients. Bipolar patients who Addictive Disorders. He is also done. Whenever anyone at- tion, is in a high drinking envi- are stable on lithium or anticon- the founding president of the tempts to study violence, they are ronment and did not know that vulsive medications are much American Academy of Addiction sometimes stigmatized because they had a problem, should be better able to manage their im- Psychiatry. societal concerns that the study treated differently from the per- pulses and anger. Similarly, pa- To learn more about Dr. Rich- be done fairly and that results son who’s been through 4 rehabs tients who are taking Revia or ard J. Frances and the care and are accurate. and has had 3 DWI’s and is now Antabuse to help treat their alco- programs available at Silver Hill One significant debate regard- charged with manslaughter. holism may also indirectly man- Hospital, in New Canaan, Con- ing violent behavior is whether Anger may be manifested as a age their anger better. necticut, visit their website at the intoxicated person is person- dimension across many different Patients with borderline per- www.silverhillhospital.com. MENTAL HEALTH NEWS ~ SPRING 2002 PAGE 11 Finding a Balance in Therapeutic Relationships

By Steve Miccio, Executive was a feeling we could all relate would tell Bob that the clinic he cal crisis for someone. Therapists Director, PEOPLe, Inc. to in the office. We may or may attends is very busy. I should and psychiatrists and case man- not have felt the exact intensity also mention that there are many agers also need to learn more that Bob felt, but we definitely amazing consumer friendly about complimentary therapies could relate to the feeling of lone- therapists that do take the time that teach individuals how to liness and sadness. We intro- to get to know their patients. cope and survive in recovery. duced him to advocacy and self However, this is a concern that Most people know what works help and naturally, he jumped we see consistently when talking well for their own recovery. They right into the work. We accepted to our peers. We have found oth- just need to be heard. his occasional absences and ers having the same problem Getting back to “Bob,” we of- would keep in touch through per- with their therapists when they ten discussed how we can go sonal visits to see if there was felt sad or happy on a particular about teaching someone how to anything that we could offer him. day. They consistently state that self advocate and demand ser- Bob would either accept our com- they are afraid at times to tell the vices that focus on that persons pany and support or he wouldn’t. Dr. or therapist what they are own recovery without ending up We respected his wishes. feeling for fear of some form of being forced into a hospital or Bob’s biggest problem was forced treatment. having a mobile team come to that whenever he saw his thera- Is it a learned behavior from their door because the therapist Steve Miccio pist and he was having a bad mo- their therapist or Dr.? Is it so in- has a feeling something is wrong ment, day or week, the therapist grained in people that if they be- with him/her. How are people supposed to immediately became alarmed and gin to exhibit an emotion which Bob didn’t always have good recover or stay well while thera- offered more medication, in- in many cases is very appropri- days. He continued to miss his pists and psychiatrists continue creased therapy, crisis housing ate, they actually begin to believe wife and was afraid to stay at to drive them crazy? or even hospitalization. This was that they are getting sick and home because of what his case We had a friend at our agency irritating to Bob, so he would they believe they may need to in- manager or therapist might that came in daily and volun- “act” happy and behave how he crease, change or decrease their think, Bob came to our drop-in teered his services any way he perceived the therapist would medication? Or, visit their thera- center and hang out. That should could. He was full of energy and expect a “normal” or recovered pist more often? Or, go into the be okay! Mental illness isn’t al- life! We’ll call him “Bob.” He had person to act while visiting his hospital? How can recovery be ways about reaching out. Some- been shut in his house for about therapist and then go back into possible if people are not empow- times we just need to be left three years and was very de- isolation until next time. Or, Bob ered to feel “normal” emotions? alone, however, in the mental pressed and lost after his wife would charge into my office and How can Dr.’s and therapists health system; self isolation can had died of cancer. Bob was so complain about this very subject. insure safety while taking a dig- often be viewed as a bad thing. devastated and missed her so He would say, “Don’t they nified risk that a patient is just We need to teach and learn much that he just could not cope (therapists) know that everyone having a bad day and that it is from one another. Therapists and with the world outside. can have a bad day sometimes not their illness talking? psychiatrists and case managers He was subsequently taken and that it isn’t necessarily a There is no easy answer to need to become advocates for re- out of his house and hospitalized mental illness?” this. I don’t claim to have the covery and understand us better. for quite a while until he showed Bob would talk about how perfect answer, but we do need to We need to learn from therapists signs of recovery. Once he was little his therapist really knew get to know each other in a and psychiatrists and case man- out of the hospital, he contacted him. You must understand that healthier manner. That’s easy to agers as to what they need to us and was intrigued with our Bob was a very energetic, open say, but does everyone have the help them do their job better. If mission at PEOPLe, Inc. We ac- and honest man and did not har- luxury of time to get to know we don’t have open dialogue and cepted him for who he was and bor any secrets that I know of. It each other? Ask any case man- if we can’t communicate in a safe we listened to him each and was not difficult to get to know ager, therapist or Dr. Most have environment, we will continue to every day. He would talk for Bob if you just took the time to very large caseloads and find it be scrutinized, stigmatized and hours about his wife and their listen. Bob would always com- difficult to spend the kind of time controlled by the system. And we life together. Before Bob became ment on how he felt he was on an two people need to really get to have all seen how that worked depressed, he and his wife did assembly line at his therapist as know each other. over the past hundred years. charity work in New York City. evidenced by the large amount of It does not mean that we PEOPLe, Inc. is a consumer We are fortunate that he brought people that were always in the shouldn’t try. Therapists and run organization, that provides that charity to our organization. waiting area. Bob could see the psychiatrists and case managers advocacy services to people with However, we consistently wit- anxiety and frustration on his need to become more educated in mental illness. Services include nessed the pain inside of him as therapists face often. He believed the social aspect of working with vocational case management, to how he missed his wife so that she was very overworked. individuals. They need to take supported housing, outreach and much. There were days when he In defense of therapists, there the time to understand and relate education. Offices are located in wouldn’t come to the office be- is often limited time to see so to people so that they do not Poughkeepsie and Kingston, NY, cause he was feeling so down. It many patients in a day and I jump the gun in creating a clini- reach them at (845) 452-2728.

Websites • The Committee for Children Website: www.cfchildren.org • National Coalition Against Domestic Violence Website: www.ncadv.org • Anger and Aggression Website: www.mentalhelp.net/psyhelp/chap7/ • PTSD & Anger: www.zoloft.com • American Psychological Association – Controlling Anger: www.apa.org/pubinfo/anger.html Books Wherever You Go There You Are: by Jon Kabat-Zinn Subject of Anger Subject of Resources on The Resources on Real Magic: by Dr. Wayne Dyer PAGE 12 MENTAL HEALTH NEWS ~ SPRING 2002 The Role of Advance Directives In Ensuring The Power of Self-Determination

By Dawn Casey fewer symptoms. ity; the Living Will, where wishes, cially those who may be most Central New York Regional The value and right of indi- choices, and preferences can be vulnerable to the threat of forced Educator, NYAPRS Advance Di- viduals to select health care of made known in writing, and Do or involuntary treatment, should rectives Training Project their own choosing is under- Not Resuscitate (DNR) Orders, consider creating an advance di- scored under New York State law. prescribed by physicians in end- rective. Tremendous feelings of pow- For example, providers of mental of-life situations. Advance directives have many erlessness, helplessness, or lack (and physical) health services are Most people recognize ad- benefits: they ensure that a per- of control are among the most required to afford their clients the vance directives as being used son’s wishes regarding health debilitating consequences of opportunity to give informed con- primarily for "end of life” deci- care treatment are known during seeking help for a psychiatric dis- sent to treatments that providers sions, such as specifying the periods of incapacity so that they ability. All too often, well- wish to offer them. Informed wishes of individuals to be with- may be honored to the greatest meaning providers may seem to consent occurs when consumers drawn from life supports when extent possible. They invite con- function as “pseudo-parents,” are properly informed about the there is no longer any reasonable sumers confidence that their engaging in decision making nature of the proposed treat- hope of survival. In recent years, knowledge of what works for about the treatment of those they ment, including its benefits, risks however, advance directives have them in time of crisis (and in serve without taking into consid- and alternatives. been recognized as being helpful general) will be respected and eration their own wishes, Consumers need to remember in empowering individuals suffer- utilized. choices, and preferences. Sadly, that they have the right to accept ing from psychiatric disabilities In the case of the health care this approach often results in or refuse treatment. Given what to communicate treatment pref- proxy document, conflict and people’s loss of faith in their own they learn in speaking with their erences in advance of periods of confusion in families about who judgment, and a resultant loss of treatment providers, each indi- incapacity. confidence, motivation and hope. vidual has the opportunity—and In New York State, a health makes treatment decisions is re- People in need come to look at the given right—to make the deci- care proxy is the only legally rec- duced. And finally, the docu- mental health professionals as sion about whether they wish to ognized means of protection of ments ensure that consumers experts on what is best for their engage in that treatment or not. treatment choice that is avail- can still be seen as the experts treatment and their lives, when Asking questions, making sure able. If a person is unable to cre- on their care, even during poten- really, the best expertise usually they fully understand, doing in- ate a health care proxy, perhaps tial incapacity. lies within themselves. dependent research to learn ad- because they have not found a A wise man once said, “If you The research is clear: taking ditional information about the satisfactory agent to appoint, don’t know you have a right, you control of one’s own treatment proposed treatment, and asking they may make their choices and don’t have a right.” As citizens, leads to increased recovery out- others who may be knowledge- preferences known in a written as members of a community, comes. Dr. Courtenay Harding’s able about the treatment are key document known as a living will. even as human beings we are landmark study on treatment elements in decision making In New York State, we do not afforded numerous rights—but if outcomes 25 years after individu- about what the best care for you have Living Will law in the same we don’t know what these rights als were released from Maine and may be. way we have Health Care Proxy are, how can we ever achieve Vermont state hospitals showed A powerful tool in ensuring law. However, courts in New what we are entitled to? that even in the most extreme that an individual’s health care York have honored Living Wills To ensure that New Yorkers cases of persons never expected choices are followed, even during that have established a person’s are adequately informed about to leave an institutional setting, times of difficulty, is an advance wishes by “clear and convincing” their rights under advance direc- healing and recovery can—and directive. evidence. tives, the NYS Office of Mental did—happen, despite the beliefs An advance directive is a type In the living will document, Health funds several training ini- and stigmatization of general so- of written or verbal instruction the principal states specifically tiatives. The New York Associa- ciety. Persons given the ability to about health care to be followed his wishes for the health care tion of Psychiatric Rehabilitation be engaged in their own treat- if a person is determined to be treatment he wants or does not Services operates an Advance ment planning and care were incapable of making decisions want to receive. This is another Directives Training Project aimed found to make significant ad- way that choice can be relayed to regarding her/his physical or at educating service providers vances in their own recovery, in mental health treatment. Ad- treatment providers at times of about their use. OMH Commis- contrast with those not granted vance directives are prepared incapacity. sioner James Stone has urged all such autonomy in choice mak- when a person is deemed compe- When an individual is found ing. tent and can set forth instruc- by their physician to be incapable provider agencies and programs Persons afforded the opportu- tions to be followed during peri- of making treatment decisions, to schedule such a training. Call nity to set goals for themselves, ods of time when the person may providers of health services must NYAPRS at 518-436-0008 for make choices, garner skills, and be considered to lack the capac- take into account the contents of more details. accept supports—but not ity to make medical treatment their advance directive, therefore OMH also has funds for an crutches—in the community were decisions. bringing the capability of having Advance Directives Training Pro- found to have achieved signifi- There are three types of ad- a voice and choice in treatment gram for consumers/survivors cant recovery outcomes including vance directives: the Health Care possible even when a person is that should be operational soon. having substantial relationships, Proxy, in which an agent is ap- not capable of speaking for him- Interested? Call OMH’s Bureau of living independently, working, pointed to represent the princi- self or herself. Every consumer Recipient Affairs at 518-473- decreased use of medication and ple’s wishes in times of incapac- of mental health services, espe- 6579 to learn more.

Subscribe to Mental Health News Your Empowerment & Self Management Tool Kit Details On Page 30 MENTAL HEALTH NEWS ~ SPRING 2002 PAGE 13 The Trend Towards Evidence-Based Practices: Will It Promote Recovery For New Yorkers With Psychiatric Disabilities?

By Harvey Rosenthal of the strongest findings of the state this year. der treatment Executive Director, NYAPRS PORT study was, as Principal In- OMH has highlighted what is to the 6 evidence-based practices New York Association of Psy- vestigator Dr. Anthony Lehman being called the ‘quality chasm,’ already endorsed above. chiatric Rehabilitation Services noted, that less than half of all urging us to look at instances Americans receiving treatment where some services are being Further, OMH has supported for a diagnosis of schizophrenia overused, underused or misused the restructuring of the ‘illness received what research had and calling on service providers self-management’ practice into

shown to be the proper doses of to shift their practices to high- • wellness self-management psychiatric medications with the light consumer-centered, timely, education (featuring a strong right mix of ‘appropriate psycho- effective and efficient approaches. emphasis on approaches that social interventions,’ which they While most groups have well teach individuals to develop considered at the time to include appreciated the notion that the their own personalized recov- employment supports and case services people with psychiatric ery plan featuring a number management services. disabilities receive should be the of self-help and ‘alternative’ In 1999, the U.S. Surgeon best ones possible and ones with approaches, like Mary Ellen General's report on mental health clear evidence to back up their Copeland’s Wellness Recovery further emphasized the great gap effectiveness, the trend towards Action Plan. that existed between the kind of evidence-based practices has care the research found to be raised a number of provocative What’s next? Look for the fol- lowing over the next few months: most effective...and the kind of questions from the recovery and care that most Americans re- rehabilitation community. • OMH staff will be featuring ceived, concluding that “services Dr. William Anthony, the na- the ‘Winds of Change’ presen- and programs based on scientific tion’s leading proponent of psy- tation at a number of forums advances in treatment are not chiatric rehabilitation, has across the state. routinely available” to meet the pointed out that evidence-based • needs of individuals with psychi- practice research to date has not NYAPRS in conjunction with In recent years, national and atric disabilities. focused enough on “recovery- PEOPLe, Inc. will be hosting a state mental health agencies and Subsequently, prominent na- related process and outcomes (e. broad number of regional and organizations have come to make tional researchers like Dr. Robert g., having choices, feeling re- local presentations on the call the use of ‘evidence-based prac- Drake have focused national at- spected, positive changes in for quality and the nature tices’ one of their top priorities in tention on 6 particular evidence- meaningful work, self esteem, and use of evidence-based practices. the delivery of services to Ameri- based treatments, citing that empowerment, etc.).” Anthony cans with psychiatric disabilities. “...research strongly supports: has urged that “the concept of • The Mental Health Empower- Evidence-based practices, evidence-based practice must be • the use of specific medica- ment Project will be featuring which are considered to be ser- broadened to include tions prescribed in specific workshops on EBPs in each vices and supports that have ‘encouraging and promising but ways as well as the use of of their upcoming spring re- been consistently proven by re- not yet confirming’ evidence- psychosocial interventions gional conferences. search to help people in their re- based practices.” such as • covery, have been the theme of For example, a number of The NYS Council for Commu- several major recent studies, con- • supported employment, groups here in New York and nity Behavioral Healthcare will feature a track on evi- ferences and funding initiatives. • various approaches to illness across the country have advo- As such, their use represents a cated for the inclusion of increas- dence-based practices at its self-management, upcoming June conference. major national and state trend ingly popular and effective self- • family psycho-education, that will effect all of the stake- help approaches. In that spirit, And this year’s NYAPRS 20th holders in our mental health ser- • case management based on peer support services proponent Annual Conference will feature vice community, from consum- the principles of assertive Shery Mead M.S.W. has pressed both an ‘exemplary services’ ers/survivors to family members, community treatment, and for the inclusion of “research that track and a special September 10 from service providers to state is grounded in the outcomes • Institute Day program, “Making and local mental health agencies. substance abuse treatment of...alternative (peer support) the Case for Peer Support Ser- So, what is this trend towards that is integrated with mental practices,” adding that “it is cru- vices as an Evidence-based Prac- health treatment.” evidence-based practices cial that we teach and practice tice,’ that will feature national about...and what implications (I’ve adapted this quote into a approaches that allow us to figures like Dr. Edward Knight, can it have for proponents of re- bulleted format to highlight the 6 put..(these) values into action.” Dr. Daniel Fisher, Joseph Rogers, covery, rehabilitation and rights practices). NYAPRS has been encouraged Larry Belcher, Dr. Jean Camp- for New Yorkers with psychiatric Over the past year, the NYS by the NYS Office of Mental bell, Dr. Jean Dumont, Shery disabilities? Office of Mental Health has Health’s responsiveness to these Mead and Laura Prescott. From 1992-8, the National sought to put evidence-based concerns. Recently, OMH has NYAPRS is a statewide coali- Institute of Mental Health funded practices on the front burner issued its priority list of evidence- tion dedicated to promoting the a study, implemented by the Pa- here in New York, highlighted by based practices for adults that recovery, rehabilitation and rights tient Outcomes Research Team a special ‘Best Practices Confer- have added: of New Yorkers with psychiatric (PORT), to develop and distribute ence’ it hosted last June in • self-help and peer support disabilities. For further informa- recommendations for the treat- Brooklyn and a new special services and tion, please contact us at (518) ment of schizophrenia based on ‘Winds of Change’ presentation it 436-0008 or E-mail us at • ‘existing scientific evidence.” One will be rolling out this across the post-traumatic stress disor- [email protected]. Mental Health News - Your Trusted Newspaper For Information, Education, Advocacy & Resources PAGE 14 MENTAL HEALTH NEWS ~ SPRING 2002

Short Shrift from page 6 is more efficient and better able to help consumers reach their by more than 39%; at the same full potential in their own com- time, the community mental munities where they live. Mental Health Association health system has received ag- Because Reinvestment ex- gregate increases of less than pired in September, the commu- in Putnam County, Inc. 4%. This is a road to bankruptcy nity mental health sector stands of a crucial social safety net. to lose $9.2m in the current fis- 1620 Route 22 Agencies cannot continue to op- cal year alone. By failing to con- erate under these circumstances, tinue Reinvestment in the out Brewster, NY 10509 let alone continue to provide vital years, community mental health services.” stands to lose millions more. The Governor’s budget also “The recent funding for hospi- failed to reinstate the landmark tal and other health care workers Community Reinvestment Act is evidence of what we can do Promoting a vision of recovery for individuals which funneled savings from when we all work together to and families coping with mental health issues closed state psychiatric beds into solve an important problem,” the community mental health said Saperia. “High staff turn- sector. Passed in 1993, this leg- over, zooming caseloads and ● islation has funded more than quality work environments in Peer-Run Information and Referral Warmline $200m in new programs. Part of community mental health agen- ● Consumer-Drop-In-Center its appeal is that it costs the cies are clearly a problem of the ● State no additional dollars; same or greater magnitude, and Peer Bridging Program rather it redeploys the same dol- should garner the same attention ● Self-Help Groups lars to a community setting that and prompt resolution.” ● Education and Support for Family Members ● Community Outreach and Education Every Month Is

all of our services are available free of charge.. Mental Health Month At call us at Mental Health News !

Conscience from page 6 untreated mental illness and (845) 278-7600 substance abuse, which can resulting in fewer people being cause or contribute to accidents, able to afford insurance alto- job turnover, inter-personal con- gether. This claim is nothing but flict, disability, workers compen- a scare tactic by the insurance sation, involvement with the industry and is belied by all ob- criminal justice system, dis- jective proof. Maryland, Minne- rupted lives and families, and sota, North Carolina and Texas increased dependency on public have all enacted parity legisla- resources. With mental health tion. Maryland experienced an and substance abuse services initial increase and then a subse- readily available to all insured quent reduction to pre-parity lev- individuals, such ailments can els. In Minnesota, one of the be diagnosed and treated earlier, Opportunities to Heal Grow and Recover large insurance providers re- thus placing fewer burdens on ported that the requirement public resources, business and would add only 26 cents to the individuals themselves. Putnam Family & Community Services is: monthly premiums paid by the As stated earlier, the Fair In- 460,000 people enrolled with the surance Treatment Act of 2001 company. After implementation has already passed the State As- Welcoming Accessible of mental health parity for all sembly. With the failure of the Offering professional treatment Open Mon-Thurs 8am-9pm North Carolina state employees, effort to have parity legislation in a healing environment Fri. 8am-6pm - Sat 9am-5pm the state experienced a reduction enacted at the national level, it is in the per member/per month imperative that the New York Affordable Caring cost of mental health services Senate hear from mental health over a five year period by more consumers, their supporters and PFCS does not deny treatment to Our services treat than 32%. Similarly, Texas ex- anyone because of inability to pay each person as a whole families, providers of such ser- perienced a more than 50% drop vices and the rest of us who, in

in per person/per month costs all likelihood will, in our life- when they enacted parity for Comprehensive times, directly or indirectly, be state employees. affected by mental illness and Prevention, treatment, rehabilitation and self help including: A New York-specific study Mental health and chemical dependency counseling for all ages was commissioned and Price Wa- substance abuse. terhouseCoopers has issued a 2002 must be the year that Psychiatric evaluations and medication management New York State enacts meaning- Crisis Intervention preliminary report on the esti- mated cost of enacting this law. ful parity legislation, and it must Recovery and rehabilitation through Continuing Day Treatment It reveals an estimate of $1.26 be the year that we, as a nation, Advocacy and linkage through Case Management per insured person per month – hold politically responsible those highly affordable and far from who so shamefully traded the the doomsday projections of the welfare of 20% of the American 1808 Route Six Carmel, New York insurance industry. population for the desires of the One dollar and twenty-six insurance industry giants. cents in additional premium per Luster chairs the Assembly month is a very modest cost Committee on Mental Health, (845) 225-2700 when contrasted with the costs Mental Retardation and Develop- associated with undiagnosed and mental Disabilities. A SPRING 2002 SUPPLEMENT TO MENTAL HEALTH NEWS SPONSORED BY FOUR WINDS HOSPITAL PAGE 15 FOUR WINDS HOSPITAL

Where You’ll Find Respectful and Caring Professionals

800 Cross River Road • Katonah, New York 10536 • 914-763-8151 • www.fourwindshospital.com

Let’s All Stop Bullying: The ABC Way

By Joel Haber, Ph.D. what they want increases their “silent majority” of children that status and self-esteem. They are can actually be very helpful in Every one of us with school- generally more aggressive and stopping the bully problem. aged children has heard the intimidating, and have little re- How do we know when our term, or even experienced the morse for others. They lack skills child is bullied or involved in a emotional pain that comes with in caring, empathy and coopera- bully incident? The most impor- incidents of bullying and teasing. tion. Bullies are not the kids tant thing we can do is ask the Unfortunately, bullying / teasing with less than average intelli- questions to address these is- are facts of life that occur daily gence. They can be very smart sues. For example, we want to for some children with serious and socially skilled. They have ask our children if they are bul- deleterious effects. Any teacher learned to be intimidating and lied or teased in school, or if they can tell you that these kinds of use that power to further them- have been involved in any bully- problems lead to disruptions in selves. Bullies do not hurt others ing towards others. It is impor- learning and social/emotional in front of adults like teachers or tant to ask your child if they al- consequences that are difficult to the principal. They know who ways have someone to eat with manage. Estimates of bullying has the power. They do their during lunch, or a friend to play are scary. Almost all children damage in unstructured and un- with during free periods. Ask know that bullying occurs in Joel Haber, Ph.D. supervised situations like the your child if they ever feel left out their schools. Fifty percent of playground, or school bus, when or feel picked on for any reason. children and more believe that Bullying, therefore, can en- they are less likely to be caught. Sometimes, a change in behavior bullying occurs a lot. In the compass a range of hurtful be- Most importantly, parents of bul- or disinterest in school, or a re- USA, between 20% and 50% of havior. Direct bullying is easy to lies usually support their child’s port of lunch money being miss- students report frequent and identify. A child who is hit, aggressiveness toward others. ing in school can be an alert to a regular bullying. It is believed kicked, pushed, shoved or has Victims on the other hand, potential problem. If you notice that in every classroom approxi- lunch money taken away are all can be vulnerable in some way. a problem, or suspect a problem, mately 10% of children live with examples of direct bullying. Indi- They may be nice, passive, anx- it is important to ask your child terrible fear of bullying. Develop- rect bullying is harder to see ini- ious, or lack self-confidence. The how they want you to intervene mentally, bullying escalates from tially, but in no way any less bully senses that these kids are or provide help. However, it is elementary school through 9th painful. These examples include: not able to easily defend them- important to stay cool and not grade and then gradually de- ignoring or excluding a child, tell- selves, and target them. These overreact when your child shares creases. ing lies or spreading rumors, try- children may not have the social this information with you. An When we talk about bullying ing to get other kids to dislike a skills needed to defend them- overreaction removes the safety we need to understand the term. child, and malicious teasing selves from an aggressor. Vic- in reporting that our children A child is seen as bullied when when a child cannot defend tims are not necessarily different need to feel when he/she shares he/she is exposed repeatedly and him/herself. Girls bully almost in appearance. They are different this information with you. You over time to negative actions on as much as boys do, but it is in their psychosocial abilities to want to ensure that your child’s the part of one or more kids. The usually indirect. defend themselves. report of a problem is not seen as “bully” behavior is seen as ag- Did we ever wonder who these In addition to the bullies and causing them more stress than it gressive, goes on over time, and bullies are and why they do what victims, there are also the major- already has. occurs in a relationship that is they do? Our old understanding ity of children who are not vic- The response to a bully prob- imbalanced in strength or power. of a bully was that they were the timized. These children fre- lem needs to be multifaceted. In Bullies, therefore, use their awkward, uncomfortable, big, quently have good interpersonal fact, bully problems that con- power to hurt or gain attention insecure kid who defended their relationship skills. They typically tinue and are not dealt with com- over someone who is weaker. insecurity by aggression. What do not insist on their own way prehensively can grow into Therein, lies the problem. Bullies we know now is that they are ag- and justify disagreements. They far greater problems. My clinical need a target that is weaker, so gressive and intimidating be- know how to compromise, apolo- they can test out their power. cause getting other people to do gize and negotiate well. It is this see Stop Bullying on page 18

Four Winds Hospital is the leading provider of Child and Adolescent Mental Health services in the Northeast. In addition to Child and Adolescent Services, Four Winds also provides comprehensive Inpatient and Outpatient mental health services for Adults, including psychiatric and dual diagnosis treatment. In the Spring and Fall of each year, Four Winds presents it's Community and Professional Education Program Lecture Series. Enlisting speakers who have an expertise on a myriad of mental health topics, these Grand Rounds, Community Lectures, and Special Events are provided as a resource for continuing education. Reprinted here are excerpts from presentations given by three of the speakers in the Fall of 2001. PAGE 16 A SPRING 2002 SUPPLEMENT TO MENTAL HEALTH NEWS SPONSORED BY FOUR WINDS HOSPITAL Four Winds Hospital - Spring 2002 Community and Professional Education Programs

APRIL MAY

Grand Rounds May is Mental Health Month

Friday, April 5th • 9:30 - 11:00 am Wednesday, May 1st • 1:00 - 4:00 pm Temperament – Linked Anger Management: Theoretical and Treatment Perspectives National Anxiety Disorders Screening Day Norman Brier, Ph.D., Director, Adolescent Division, Children’s Evaluation and A program for consumers designed to provide an anonymous screening and educa- Treatment Center and Clinical Professor of Pediatrics and Psychiatry, Albert Ein- tional information about anxiety and depressive illnesses. For information, or to stein College of Medicine, Bronx, NY; Private Practice, Bedford, NY schedule an appointment, please call 1-800-546-1754, ext. 2413. Free of charge. Drawing on the current literature, Dr. Brier will discuss the key factors that contrib- ute to emotional regulation problems in older youngsters and adolescents with a his- A Special Program for Children’s Mental Health Week tory of “difficult child” behaviors and will review the treatment strategies that have Thursday, May 2nd • 2:00 - 4:30 pm proven to be most efficacious with this population. Child Abuse Identification and Reporting

Fee: $10.00 payable to Four Winds Hospital Joanna Landau, Ph.D., Psychiatric Nurse Practitioner, Adult Service, Four Winds Hospital Save the Date! Wednesday, April 17th • 4:00 - 7:00 pm This course is required by all licensed professionals involved in reporting child abuse Nursing Career Day and neglect. A State Education Department certificate of completion will be given at Experience Four Winds firsthand during this informal event. the end of the class. Fee: $40.00 payable to the Four Winds Foundation, a non-profit organization Refreshments, Tours, an Opportunity to Meet with Nursing Leadership Competitive Salaries/Benefits

RSVP by Friday, April 12th • 914-763-8151, Ext. 2413 Grand Rounds Friday, May 3rd • 9:30 - 11:00 am A Special Community Program Dialectical Behavioral Therapy: Achieving a Balance Between Acceptance and Friday, April 19th • 9:30 - 11:00 am Change in the Treatment of Borderline Personality Disorder Assessment and Intervention in Children’s Grief Patricia Trainor, Ph.D., Private Practice, Mt. Kisco, NY Grace Christ, D.S.W., Associate Professor at Columbia University School of Social Work, New York City, NY Drawing on a blend of traditional cognitive behavioral therapies and elements of Zen philosophy, DBT offers a fresh, compassionate approach in the treatment of Borderline Dr. Christ will discuss how development impacts a child’s response to grief and loss. Personality Disorder. Dr. Trainor will present a theoretical overview and offer prag- Grieving is often affected by the context of the loss: whether it was anticipated, sud- matic strategies for effectively managing difficult behaviors. den, or traumatic. The death of a loved one, separation from friends and family, in- cluding foster care arrangements, and traumatic events such as the crisis of Septem- Fee: $10.00 payable to Four Winds Hospital

ber 11th, and it’s impact on children, will be discussed.

Fee: $20.00 payable to the Four Winds Foundation, a non-profit organization Save the Date! Location: Northern Westchester Center for the Arts, 272 North Bedford Road, Mt. Thursday, May 16th • 8:15 am - 3:30 pm Kisco, NY 10549 The 23rd Annual Child and Adolescent Workgroup Conference

Registration required: Please call 1-800-546-1754, ext. 2413 Co-sponsored by Rockland Unified Services, Child and Adolescent Workgroup, Four Conference Space Generously Donated by Winds Hospital, BOCES, SETRIC and the Mental Health Association of Rockland the Northern Westchester Center for the Arts County. Location: Stony Point Conference Center, Stony Point, NY

For information and to register, please call Eileen Finn at (845) 364-3705. Conference Tuesday, April 30th • 10:00 am - 1:00 pm Treating Troubled Children and Their Families: A Brief Integrative Approach Grand Rounds Friday, May 17th • 10:00 - 11:30 am Ellen F. Wachtel, J.D., Ph.D., noted Author and Lecturer The Use of Art in Healing the Silent Screams Dr. Wachtel will present a method of working with young children and their families Bobbie Kaufman, MPS, ATR-BC., Director, South Fork Mental Health Programs for to bridge the gap between child and family approaches. This workshop is designed the Family Service League of Long Island to teach individual and family therapists, as well as school counselors and psycholo- gists, how to provide help to young children by working with both the family and This presentation will offer the audience the opportunity to learn to ‘read’ the messages child in short-term, active therapy. presented in the drawings of survivors of childhood sexual abuse. Ms. Kaufman will review a series of survivor’s drawings and will point out how the impact of sexual Fee: $25.00 payable to Four Winds Hospital abuse is reflected in each. The collaborative use of verbal and art therapy will be ex- Books will be available for sale. Location: Hillside Manor, 240 Blvd., Route 32, plored. Attendees are invited to bring in client’s artwork so that possible interventions Kingston, NY. Registration Required: Please call 1-800-546-1754, ext. 2413 Co- which might be helpful in the survivor’s healing journey can be discussed. sponsored by Ulster County Mental Health, Astor Home for Children, Inc. and Four Fee: $25.00 payable to the Four Winds Foundation, a non-profit organization Winds Hospitals in Westchester and Saratoga

All of the Grand Rounds, Special Trainings and Events, and Community Lectures will be held at the Four Winds Conference Center unless otherwise noted.

Due to limited seating, registration is limited to the first 120 paid registrants. For those requiring special services, please call no later than two weeks prior to the conference date so that the appropriate arrangements can be made. For Registration and Information Please Call us at 1-800-546-1754 • 914-763-8151 ext. 2413 www.fourwindshospital.com A SPRING 2002 SUPPLEMENT TO MENTAL HEALTH NEWS SPONSORED BY FOUR WINDS HOSPITAL PAGE 17 ADHD: Attention Deficit Hyperactivity Disorder

By Eugene M. Kornhaber, M.D., Board Certi- ADHD individuals, even with signifi- The primary medication used with vention (kindergarten through second fied Adult, Adolescent and Child Psychiatrist cant learning disabilities, tend to have ADHD are stimulants. Their history is grade). However, it is never too late to higher IQ’s than the average population. long, safe and effective (Dexedrine, 1937 treat ADHD. My oldest ADHD patient is ADHD is a neurobiological disorder. In fact, although ADHD is present before and Ritalin, 1957.) Both have no long- 78 years old. Simply put, it is physically, not emotion- age seven, it may not become sympto- term side effects. They are the most ADHD is an eminently treatable disor- ally based. ADHD has nothing to do with matic until high school, or even college. studied medications in pediatric litera- der. I have been honored, and gratified, motivation, parenting, etc. It is a clearly This is because ADHD children tend to ture. The main side effect from the medi- to work with this population for twenty- diagnosable, and treatable, medical condi- possess wonderful auditory memories. cations is not to use them when they are six years. They are truly special people. tion. They can remember things in class, and indicated. Many untreated ADHD indi- It is important to help them find their get good grades, in spite of very little ef- viduals resort to marijuana and alcohol to own unique areas of giftedness. fort and doing minimal homework. Even- self medicate and, thereby, embark on a Dr. Kornhaber is a Board Certified tually, however, their auditory memories path of self-destruction. Adult, Adolescent and Child Psychiatrist cannot cope with material that is becom- One of the key elements of treatment in Private Practice in Mount Kisco, New ing more and more complex and, as a is preventing damage to self-esteem. York. He can be reached by calling 914- consequence, a formally good student This can be achieved through early inter- 241-0682 starts to falter.

Types of ADHD: Outpatient Treatment Services There are four types of ADHD: 1-800-528-6624 Predominantly hyperactive/impulsive: fidgety, overactive, on the go, talks exces- Child Partial Hospitalization Program

sively, Curious George, into everything, ● Ages 5-12 etc. Gender Ratio: 9 boys to 1 girl. ● Treatment alternative to inpatient care Predominantly inattentive: spacey, day- ● 24 hour crisis intervention Eugene M. Kornhaber, M.D. dreamy, confused, in a fog, low activity ● Flexible full or half-day scheduling Discussion: level, loving child, not a behavior prob- ● Weekly multi-family group lem, disorganized, forgetful, etc. Gender ● On-site school There is no test for ADHD. It remains Ratio: 1 boy to 1 girl ● 5 days a week (9:00 am - 3:00 pm) a clinical diagnosis, as is true with depres- sion, Alzheimer’s, etc. While rating Combined type: (combination of hyperac- tive/impulsive and inattentive types) scales and other tests are helpful, they Adolescent Partial Hospitalization Program only confirm the presence, or absence of Adult ADHD: 25% of those having ● Ages 13-17 symptoms. For example, there are at least ADHD as children carry it into adulthood. ● Treatment alternative to inpatient care eight causes of short attention span, only Crucial to diagnosis is the presence of ● 24 hour crisis intervention one of which is ADHD. ADHD as a child, along with current ● Flexible full or half-day scheduling Additionally, there is no such thing as symptoms such as impulsivity, disorgani- ● Weekly multi-family group borderline ADHD. That would be like zation, high activity level, inability to sit ● On-site school being borderline pregnant. You either are still for long periods of time, short fuse, ● 5 days a week (9:00 am - 3:00 pm) ADHD or you’re not. ADHD symptoms etc. can, however, be present on a spectrum of Diagnosis: Adult Partial Hospitalization Program mild to severe. In fact, ADHD symptoms ● Ages 18 years of age and older are not abnormal, but an extreme of nor- As the diagnosis is medically based, it is mal. For example, all of us, at some point best made by a medical doctor. This re- ● Treatment alternative to inpatient care in time, have a short attention span. quires about two to three hours and must ● 24 hour crisis intervention It is crucial to understand that ADHD include a careful detailed history as well ● Flexible full or half-day scheduling is a disorder of inhibition. “He can’t start as both neurological and psychiatric ex- ● Specialized treatment tracks doing what he’s supposed to do because ams. As symptoms may mimic those of ● Individual case management he can’t stop doing what he’s not sup- other disorders, it is crucial to differenti- ● 5 days a week (9:00 am - 3:00 pm) posed to do.” ate between them and ADHD. Likewise, Children with ADHD also have selec- there is a high frequency of ADHD coex- tive attention spans. This means they can isting with other disorders such as depres- CHOICES 1-800-528-6624 (OASAS licensed) pay attention for hours to things that inter- sion, anxiety, and learning disabilities. It A full service Alcohol/Chemical Dependency Outpatient Center providing est them, (e.g. Nintendo), but have more is important that these disorders be ac- day and evening services for Adults including: difficulty than average maintaining con- knowledged and properly treated. centration on things of less interest. At- Clinic Services Treatment: ● Assessments ● Interventions tention is selective as the ADHD brain is ● Early Recovery Group ● Dual Diagnosis Track a sleepy brain. Hence, these children Treatment should be multimodal, en- ● Individual and Family Counseling ● Acupuncture for Detoxification need to be constantly stimulated. They compassing all aspects of the child, and love excitement, danger, and activity, as ● New York State Department of Motor Vehicles clearly focus on the child’s strengths. Mandatory Drinking Driving Program (DDP) Assessments the sleepy brain needs a constant wakeup Medication should not be considered a call. A child with a sleepy brain, in a “last resort.” It is, frequently, the corner- classroom with ‘boring’ schoolwork, may become fidgety, talkative, and a general stone of treatment. Just as diabetes is a Adult Ambulatory Detoxification Program nuisance. Likewise, the daydreaming chemically based disorder, so is ADHD. A medically supervised 24 hour, 7 day a week program To not give medication, when warranted, ADHD student may ‘zone out’ at various in which all substances can be detoxed. 23-hour crisis bed available. times and, thereby, be subject to gaps in is, in some ways, like withholding insulin Visit our website at www.fourwindshospital.com for a photo tour learning. from a diabetic. and further information about inpatient and outpatient services.

Leadership and Excellence In Mental Health Care for Children, Adolescents and Adults 24 Hours A Day ● 7 Days A Week visit our website at www.fourwindshospital.com PAGE 18 A SPRING 2002 SUPPLEMENT TO MENTAL HEALTH NEWS SPONSORED BY FOUR WINDS HOSPITAL Child Psychopharmacology In The Emergency Room

By Robert Catenaccio, M.D. for short, was sent via ambulance by the what few questions would be most help- Bipolar disorder in children is a hot Assistant Clinical Professor school for an aggressive tantrum, begin- ful to ask? Well, treatment must await topic, but definitive studies are hard to of Psychiatry, Albert Einstein College ning over a trifling argument with a peer, some diagnosis, however imperfect, and come by. Family history, aggressive- of Medicine escalating as the teacher scolded both the process of diagnosis here comes ness, grandiosity, paranoia, wide swings boys, and ending up with the school se- down to focusing on the differences be- in mood and energy level, and marked Since every kind of problem finds its curity staff and the assistant principal tween A.D.H.D., mood disorders, anxi- instability of sleep-wake cycles are way into the emergency room, let us, in restraining J, as he bit, punched, kicked ety disorders, and subtle presentations of prime symptoms to look for. Lithium is order to provide some focus for our dis- and was apparently heading for the win- psychosis. While a thorough discussion not a medicine we can use in our setting, cussion, limit our enquiry to the most dow. of the differential diagnosis would be but valproate (Depakote) is – we then common problems which might plausi- The background is as follows: J is ten beyond the scope of this talk, a brief expect liver function tests as part of the bly be responsive to medication. Of years old, in a special education place- review may be helpful. routine follow-up. But increasingly we course, the usual caveats apply: medica- ment for the past three years, for lan- A.D.H.D. is extremely common, of- are trying Gabapentin (Neurontin), tion works best in the context of ongoing guage delays and explosiveness. He has ten missed, and frequently can be which is generally very well tolerated, treatment relationship including other had four similar incidents this school masked by oppositionalism. It can be unlike valproate, which almost always modalities; medication compliance and year, and one or two in previous years. part of a more diffuse picture of brain makes people tired and hungry. Both the adjustment of dosage require a treat- He has many milder tantrums at home – damage in severe learning disabilities or medications are reasonably effective for ment alliance with both parent and child; according to his mother, who has just retardation. In intelligent children, the aggressive outbursts, even when a firm and the doctor must be an educator arrived from home shepherding three impulsivity is often, in the history, more diagnosis of bipolar disorder is not pos- rather than simply a technician, working smaller ones. He generally resists limits, prominent that the distractibility, since sible. to sharpen the awareness and articulation is moody and easily frustrated, and has they can fade in and out and still get the Finally, a word about psychosis, of symptoms, to flesh out a diagnosis been too rough with his little brother; job done. In the emergency room itself, which of course is not a disease entity, which is meaningful in ordinary lan- two weeks ago, in fact, he had grabbed a unlike oppositional children, who re- but a general term related both to spe- guage, and to create a modest and realis- kitchen knife in a fit of rage. The bio- spond to the long waits, the boredom and cific symptoms, like hallucinations and tic set of expectations, of risks and bene- logical father has never been involved, the inertness of the environment by first delusions, and to a global assessment of fits. and is currently incarcerated; a stepfather rebelling and then complying, children functioning. In a population of impul- What distinguishes emergency room has been out of the home for over a year. with A.D.H.D. progressively disorgan- sive, over stimulated, often cognitively psychiatry from routine practice is, J. had been in foster care for six ize, exposing the organic roots of the impaired children, some types of halluci- sometimes, severity, sometimes the sud- months when he was five, because of condition. nations or near hallucinations are very denness with which difficulties have some combination of domestic violence The good news here is that psy- common: visions of movie monsters at developed, and, most of the time, the and maternal substance use; and, when chostimulants are clearly effective, eas- bedtime, a voice urging destructive ac- appalling incompleteness of the informa- he was eight, he had stayed with a great- ily explained, and safe enough to begin tion when frustration mounts. In tion available to the clinician. Certainly, aunt for a few months because his in the emergency room, although dos- younger children, we rarely medicate then, it is best to do as little as possible, mother couldn’t handle him. Two brief ages will have to be adjusted later. If a such symptoms. If disturbed modes of so as to do no harm; much of the time it episodes of treatment had petered out, child is old or large enough, it makes thinking or perceiving lead to action, is simply the holding function of the once because of a move, once because sense to start with a long-acting prepara- however, or to chronic anxiety and de- emergency room which provides the his mother felt that he was better: he has tion, and simply skip the visits to the pression, then a very low dose of one of treatment. If a child already has a psy- never been on medication, and his school nurse altogether, thereby gaining the newer atypical antipsychotics can be chiatrist, and if time and conversation mother doesn’t know what condition J in privacy as well as convenience. helpful. The parent deserves a good talk have, by defusing the crisis, made it safe has. Maybe if he could talk his feelings Making a convincing diagnosis of a about risks and benefits, including for the patient to wait until the next out- out, she suggests, he could get to the mood disorder is a bit harder, certainly if drowsiness, weight gain and, rarely patient appointment, it is most responsi- bottom of things – is it sadness over the presenting problem is as we have tardive dyskinesia. In addition, caretak- ble to defer to the more knowledgeable missing his father? sketched out above. There is a ubiquity ers and clinicians alike should be aware clinician. But many cases fall into the J. himself, however, is quite clear of tragic loss in the lives of our children; of an unfortunate tendency in our field to zone where it is not possible to discharge about what the problem is: the teacher is often it is hard to distinguish treatable continue such medications indefinitely, the child without having first made a mean and unfair, the other kids start depression from the lingering character perhaps out of fear of unmasking the medication decision, and yet where actu- trouble with him, his mother favors his effects of emotional deprivation. Still, if psychosis. Yet here, unlike the case in ally admitting the child to a hospital brother, and if he doesn’t get GameBoy all criteria are met, we make the diagno- adult schizophrenia, we are often dealing would be undesirable or impractical. Advance he will kill himself! sis and try an SSRI; often especially in with errors in processing which brain For the sake of vividness we will Since essentially all cases that come young teens, there is chronic ruminative development alone will ultimately cor- imagine such a case, the most typical of into the E.R. sound like this, how can we worry underlying the defensiveness, and rect. all those boys, mostly, who are escorted possibly come up with a set of rational this can get remarkably better in a week Dr. Catenaccio has a private practice into our emergency room. This boy, medication choices? With time and or two. The only danger is in worsening in Larchmont, New York. He can be whom I shall call John/Juan/Jovann, or J many shrill demands pressing upon us, an unrecognized bipolar disorder. reached at 914-834-2214.

Stop Bullying from page 15 includes parents, teachers, teacher-aides when they learn skills to help each other Health: Tools for the 21st Century. and students, is the effective way to in the classroom, feel safe in using these Dr. Haber has served as a Consultant work in this area led to the creation of a manage and reduce bullying. skills, and know that their actions to help to the New York State Office of Domestic comprehensive program, “A Better A community approach means that each other will work. We all can make a Violence as a trainer of health profes- Community: The ABC Program; Skills school administration, teachers, teacher- difference by becoming a “majority sionals in the detection and treatment of for Caring, Cooperation and Conflict aides, school personnel, children and voice” in our schools and having a clear, Domestic Violence. Dr. Haber’s work Resolution”. The ABC Program was parents all understand the dynamics of consistent approach to reduce bullying. has also focused on ways to enlighten designed for school systems interested in bullying and what constitutes an effec- A comprehensive approach lets the real people on the effects of violence in fami- reducing the bully problem. No one per- tive response. The ABC Program pro- ABC’s take place. lies, and the management of "bullying son can solve bullying alone! In fact, a vides the training and language that is Dr. Joel D. Haber has been a Clini- problems in school systems". Within this parent or a teacher working alone is no developmentally appropriate. This pro- cal Psychologist since 1983. He is a co- domain he has developed "The ABC Pro- match for children who don’t have the vides all of us with ways to talk about owner and Clinical Director of Prime skills to manage their behavior. The and deal with bullying/teasing. Parental Care Psychiatric & Behavioral Health gram: A Better Community; Skills for only way to effectively deal with these involvement in training provides ways to Services, a multidisciplinary group men- Caring, Cooperation and Conflict Reso- problems is to enlist all school personnel identify and deal with their children if a tal health practice in White Plains, New lution". The ABC Program is a school- in training, education, skill development problem is identified and helps parents York. In addition, in private practice, he based/community anti-bullying program and effective management techniques to feel empowered in their report- specializes in treatment of adults and that teaches children how to help each deal with bullies and their victims. All ing/management of bully incidents to the families. Dr. Haber is extensively pub- other reduce bullying and teasing. of us want safe schools and healthy school in ways that will provide resolu- lished and has recently completed a Dr. Haber can be reached at (914) learning environments. A community tion. book tour promoting his newest publica- 686-6891, ext. 23. He can be faxed at approach to the bully problem, which Children deal with bullies/teasing tion, Primary Care Meets Mental (914) 682-7518. MENTAL HEALTH NEWS ~ SPRING 2002 PAGE 19 Ticket to Work & The Economics of Recovery

By Donald M. Fitch, M.S. In addition to encouraging choices for persons with psychi- stamps are minimal ($10/mo) for Executive Director, The Center recipients to leave SSI/SSDI for atric disabilities in Westchester; persons in supported housing. for Career Freedom competitive employment and self- VESID, The Center for Career For example, a person who wants sufficiency, other purposes of the Freedom, Human Development to go back to work and earn Ticket Program are to: Services of Westchester (HDSW), $400/mo. keeps only $6 out of and the Mental Health Associa- the $400. • Increase beneficiary choice in obtaining rehabilitation ser- tion of Riverdale. Hopefully, the next milestone will enable SSI recipients to tran- vices, and to The Ticket is a milestone on the road to recovery and we ap- sition to full time employment by • Remove barriers that require plaud the efforts of the advo- providing a higher earnings people with disabilities to cates, caregivers and legislators threshold, at least at the poverty choose between health care who brought it to fruition. How- level. coverage and work. ever, had it not been for the he- SSDI beneficiaries who want

Importantly, for the first time roic efforts of Harvey Rosenthal of to go back to work and earn ever, the recipient will have a NYAPRS who, along with others, $400/mo. maintain an almost choice in deciding who they want chained themselves to Governor 2:1 economic advantage over SSI to assist them in obtaining em- Pataki’s office to urge passage of beneficiaries. According to SSA’s ployment and other support ser- the Medicaid Buy-In initiative, “Red Book on Employment Sup- vices. They will no longer be the ticket could not fulfill its port”, SSDI beneficiaries can earn promise. up to $780./mo and still retain Don Fitch mandated to utilize VESID, New York State Education Depart- Currently, SSI/Medicaid their disability status and in- ment’s Vocational and Educa- beneficiaries who attempt to work come. For example, the average According to the Social Secu- tional Services for Individuals their way off of SSI to self- consumer at our Center receives rity Administration, 19,418 dis- with Disabilities. sustaining competitive employ- 800/mo in Social Security Dis- abled beneficiaries of SSI and Other benefits to the recipient ment are penalized because SSI ability. If they went back to work SSDI, 18-64 years old, residing in for leaving SSI/SSDI and return- takes one-half of all earnings over and earned $750, their total Westchester County will receive a ing to competitive employment $85./mo. This and the Medicaid monthly income would be $1550 “Ticket-to-Work and Self- include: spend-down requirement to- with a net gain of $280. This Sufficiency” Voucher in the next gether wipe out most of what does not include on going pre- several months. In NYS about • Extended Medicare coverage they earn. Dollar wise, these scription drug costs which can 614,000 persons with disabilities from the current 4 years to 8 have been the major barrier to re- run $150-$400+/mo. (These are ½ years will receive it. Distribution in entry into the workforce. deductible). Westchester began on February • No Medical Continuing Dis- On January 23rd, the NYS As- To address the con- 11th. ability Review for 5 years dur- sembly and Senate passed the sumer/survivor’s response to The “Ticket” is SSA’s latest ef- ing employment Medicaid Buy-In legislation, a these changes The Center re- fort to encourage persons with landmark opportunity which al- cently initiated a survey among • psychiatric or physical disabili- Access to benefits planning to lows disabled people to earn up SSI and SSDI beneficiaries to ties to return to work. ease the transition to self- to $45,500/year and still receive quantify the impact of future sufficiency. SSA estimates that fewer than Medicaid coverage (at a cost of earnings on benefits and the de- 1% of SSI or SSDI beneficiaries A booklet which accompanies $1,260/year in premiums). If it sire to return to work. Results leave the disability rolls and re- the Ticket to Work instructs re- is signed into law and funded, will be reported in a future issue turn to work. If only one-half of cipients to call MAXIMUS at 1- the program would begin in April of Mental Health News. one percent ceased receiving 866-968-7842 to learn where 2003 giving people a year to pre- It is the responsibility of every benefits as a result of returning they can obtain vocational ser- pare, train and test the waters caregiver to understand and to work, the savings to the Social vices. To learn even more about with part-time employment. communicate the realities of the Security Trust Fund would be ticket to work, you should visit While this is certainly good economics of recovery to all con- over three and a half billion dol- www.yourtickettowork.com or news, major hurdles still exist; sumers/survivors who want to lars over the work life of these www.ssa.gov/work. rent takes .30 of every $1.00, return to work and especially to individuals. Currently there are four (Sec. 8/Shelter Plus), and food the Ticket-holders.

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CallCall UsUs NowNow ForFor DetailsDetails (914)(914) 948948--66996699 MENTAL HEALTH NEWS ~ SPRING 2002 PAGE 21 The Sopranos: Violence, Psychiatry and the Mob

By Joseph Deltito M.D., Clinical attractive character many of us formed answer to this question is child, nor is it a sign of psycho- Professor of Psychiatry and Behavioral might want in our lives. that it may or may not! The prac- pathology that a Buddhist monk Science, New York Medical College, Con- Much of the storyline in the ticing therapist should be cau- might set himself on fire to pro- sultation Practice: Greenwich, CT “Sopranos” is revealed in the in- tioned not to automatically view test an unjust war. We generally teraction of Tony with Dr. Melfi, it as such. Who is pathologically applaud members of our Armed his psychoanalytically oriented violent and who is essentially de- Forces for using deadly force to psychotherapist. Tony suffers fending his country, tribe, family repel our enemies; we do not from Post Traumatic Stress Dis- or self oftentimes has more to do think of them individually as suf- order, panic attacks, ambivalent with the person making the judg- fering from blood thirst and anti- feelings about the violence he ments than the individual perpe- social behavior. dispatches to his enemies, and trating apparently violent acts. As a psychiatrist, often in- the multiple wounds inflicted One man’s terrorist is another volve the forensic cases and de- upon him by a mother with a man’s freedom fighter. Violence bate, I marvel at many of my col- primitive personality disorder in certain sub-cultures, as in or- leagues who continue to describe (who even conspired to have him ganized crime families or East violent gang members as antiso- assassinated). He is haunted by Los Angeles gangs, may say little cial sociopaths, without any re- the belief that he was destined to about the presence of neither gard for anyone in society when live this and only this life, and personality nor psychiatric dys- many of their crimes are moti- that perhaps even his son is function in their individual mem- vated by an intense loyalty to similarly genetically injured so bers. One could certainly argue their fellow gang members. I’m that he can only expect to have a that such violence may be “evil” not suggesting we legally give life and the future full violence. but it may not be “crazy” in any Mafiosi or members of gangs, like Tony strives to balance his own real sense of the word as it repre- the Crypts, a pass, just that their brand of power and force with his sents a shared worldview of a co- violence may very well in no way sense of duty to protect and to hesive subgroup. In such groups represent individual psychiatric provide for his family and friends; murder to protect the whole or to nor personality disease. a burden that weighs heavily enact revenge may be a socially Some would argue that man- Joseph Deltito M.D. upon him. Tony therefore is a expected duty on the part of its kind, itself, is inherently violent. complex man dealing with threat- members. The full anthropological record To some people “Anna Kare- ening and burdensome decisions. Back to Tony Soprano! He does not support this position as nia” will always remain no more He tries to cope with the aid of maintains to Dr Melfi that the there are distinct societies were than a novel about an unfortu- Psychotherapy and better himself violent acts he commits are mor- war and personal violence seems nate train accident and “Moby in the process. ally acceptable and not a sign of to not exist, as may be found in Dick” will endure solely as a story Dr. Melfi, his psychiatrist, being psychiatrically ill because some Inuit cultures. There is of an elaborate fishing expedition blends some practical counseling he is “like a soldier in a war”. great evidence that humankind is gone tragically wrong. Should served up with psychoanalytically This is logically congruent with a easily corruptible through mis- you fall into this category you will oriented interpretations about strong ethic within the mob not guided authority. The message of most likely regard the “Sopranos” Tony’s worldview and behaviors. to injure “civilians,” the word the horrors of the Holocaust in as nothing more than another She also dispenses a somewhat used to describe those not di- Nazi Germany is not that there mob story about the violent lives unsophisticated brand of phar- rectly involved in mob activities. was a violent bloodthirsty society of a group of Italian-American macotherapy. As such, I believe In addition there is a strong code who killed so many Jews, Gyp- gangsters. Should you possess she actually portrays a rather regarding who deserves extermi- sies and other perceived certain sensibilities, you may credible rendition of what a psy- nation and who does not. “Undesirables” but that otherwise even see this weekly TV drama as chiatrist may represent in a gen- Micheal Corleone in the psychologically normal people anti-Italian, perpetuating dis- eral office psychiatric practice. “Godfather” makes the argument were convinced to participate (or turbing ethnic stereotypes. For Dr. Melfi is humanized through to his then girlfriend that sena- look the other way) in its occur- those who look at their Drama the depiction of her own frailties tors and governors are involved rence because the dominant au- from a deeper level there is noth- and confusions. She deals with in crimes and murder and that thority deemed it proper to do so. ing neither stereotypical nor anti- personal fears generated by therefore what his father does is Tony Soprano is part classic Italian to be found here. This knowing the confidences of a just “business.” David Chase, the Greek tragic figure, part every- popular TV show parallels a clas- man, the knowledge of which creator of the “Sopranos,” illus- man, who lives in a world which sic Greek tragedy in its portrayal may prove personally dangerous trates many members of society trades in violence. He psychologi- of its main character and “Hero,” to her. Despite her fear, ambiva- as pervasively corrupt in their cally struggles with his participa- Tony Soprano. As the series’ lence and inconvenience (at one approach to their fellow man. tion in such a world. He is a main character, he is arguably point she needs to go into hiding) These include otherwise well re- man who tries to do the best he depicted as the most psychologi- she persists in her role as Tony’s garded politicians, college admin- can, while trying to comprehend cally complete and complex char- therapist. At some point during istrators, college students, Black a better life for himself and his acter ever portrayed on an Ameri- the therapy Dr. Melfi is violently activist-preachers and others. family. He lives a life according to can TV series. He is a most sym- raped by an unknown assailant, The resounding message is that a well-defined code of ethics and pathetic character to millions of whose identity is later discovered. many people are corrupt; Tony is behaviors. Americans due to his mixture of She nobly fails to disclose this to just another businessman play- Tony psychologically struggles fragility and power. While being Tony as she and everyone Ameri- ing a dangerous game by a fixed with the thought that he’s a slave the powerful “Capo di tutti Capi” can knows he would feel obli- set of rules. to destiny and fate and cannot of the North Jersey mob, he nev- gated to eliminate this man him- Psychiatric diagnoses and make any change in the future of ertheless suffers from any of the self. In not sharing this informa- evaluations are not meant to be his life. I would like to think that frailties most of us recognize in tion with Tony she subjugates made in a reductionistic fashion: with the help of Dr. Melfi Tony ourselves. Tony who loyally pro- her own thirst for violence and patient shows X, it must mean Y. can come to a better peace within tects those he loves may appeal revenge to the greater good of not In the age of Managed Care and his world and learn how to give to viewers as the prototypical shifting the nature of her psycho- HMO erosions of reasoned and personal direction to his future. best friend most of us crave. Re- therapeutic relationship with comprehensive psychiatric He’s not condemned by genetic member the utterances of that Tony, thus enabling him to con- evaluations such reductionism is constitution or personal develop- other most famous mob boss, tinue his psychotherapy with her. rampant. Any good psychothera- ment to suffer the inability to Don Vito Corleone, of the This brings me to the core is- pist knows that they must evalu- change the direction of his life. “Godfather” -- if Tony Soprano sue I wish to explore in this arti- ate a patient within their ethnic, Psychotherapy is not about was your friend “your enemies cle. Should a life full of violence, religious, cultural and sub- cul- “insight” but it is about “positive would certainly become his ene- in itself, be considered a feature tural context. It is not delusional adaptive change based on in- mies” and few people would of psychiatric disease or person- for a Christian to firmly believe sight;” this is the essence of “this bother you. He is therefore an ality pathology? I believe the in- that a virgin could give birth to a thing of ours,” we Psychiatrists. PAGE 22 MENTAL HEALTH NEWS ~ SPRING 2002

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Borderline Personality Disorder Conference

Close relatives of individuals with Borderline Per- sonality Disorder (BPD) often report feeling bewildered and inadequately prepared in relating to and helping their family members. Working with several patients and their families, Dr. Perry Hoffman of New York- Presbyterian Hospital, Westchester Division, has co- founded the National Education Alliance for Borderline Personality Disorder (NEA-BPD). The organization is hosting a conference, to be held at Columbia Univer- sity on October 19 and 20, 2002, which will provide an opportunity for families and BPD professionals to share information and learn from each other. Further information is available on the Web at www.borderlinepersonalitydisorder.com; by e-mail at [email protected]; or by phone at (914) 835-9011.

Let Us Bring Your Vital Program or Event To the Attention of Our 60,000 Readers Call Mental Health News Today !! (914) 948-6699 MENTAL HEALTH NEWS ~ SPRING 2002 PAGE 23 Specialized Treatments For Personality Disorders Offered at New York-Presbyterian Hospital, Westchester Staff Writer have undergone intensive train- Kulchycky, MD, Sheila Cherico, ment approaches (DBT, TFP, Mental Health News ing by certified DBT trainers, in- MSW, William Deal, PhD, and SPP), the Institute is offering a clude Dale Terelli, RT; Randee P. Joan Jablow, CNS, NP. one-year course of treatment free Beginning in the 1970s un- Levitt, MS, RN; Carol S. Sandak, Two related but distinct forms of charge to those who meet the der the leadership of Otto Kern- ACSW; and Jeremy Stone, PhD. of psychodynamic psychother- criteria for admission. Informa- berg, MD—internationally recog- Psychiatric coverage and phar- apy are offered at the clinic. tion about the Personality Disor- nized as an expert in the field of macology are provided by Ruth Transference Focused Psycho- ders Institute is available at personality disorders—New York- Lubleski, MD and Katherine therapy (TFP) was developed by [email protected]; or Presbyterian Hospital in White Grunes, MD. Dr. Otto Kernberg and his col- by phone at (914) 997-5906. For Plains has been in the vanguard Formulated in the 1970s by leagues at the Westchester Divi- information about the study, of researching and developing Dr. Marsha M. Linehan, a re- sion. The treatment consists of contact Nina Huza, (914) 997- specialized treatments for people searcher and clinical psycholo- twice-weekly individual psycho- suffering from the symptoms and gist, DBT is a manualized, semi- therapy, in which a specific treat- 5906. behaviors associated with these structured therapy where treat- ment contract between the thera- mental illnesses. ment goals are organized hierar- pist and the patient is drawn up Personality disorders are chically, with the top priority the at the beginning of therapy. The characterized by mood instability reduction of parasuicidal and contract is directed at the sup- and difficulties in interpersonal life-threatening behaviors. “If a pression of problematic behaviors relationships, self-image and be- patient has engaged in self- outside the session hours. This havior. This group of conditions injury, the session will focus on suppression, combined with the is more prevalent than either this behavior and will be spent interpretation of “equivalent” be- schizophrenia or bipolar disorder, doing a detailed behavioral analy- haviors within the session, serves afflicting approximately 15% of sis.” says Dr. Hoffman. Other to increase development of in- the general population of the goals include reducing or elimi- sight into the evolution of the cir- United States. The most com- nating behaviors that interfere cumstances which led to prob- mon is borderline personality dis- with therapy; decreasing behav- lematic behaviors, and thereby order (BPD), which affects mainly iors that hinder or destroy qual- offers the possibility of control young women and involves a ity of life while increasing those over them. The ultimate aim of high rate of self-injury, as well as that enhance life; learning emo- TFP is to bring about change in suicide attempts and completed tional, relationship and problem- the patient’s personality struc- suicide. Other symptoms include solving skills; and reducing suf- ture. impulsive behaviors such as un- fering by addressing the sources Supportive Psychodynamic safe sex, overspending, and un- of emotional pain. Psychotherapy (SPP), developed stable, unpredictable mood fluc- Participation in the DBT Day by Drs. Ann Appelbaum and tuations, including inappropriate, Treatment Program varies from Monica Carsky and their col- intense anger. This symptom pic- several weeks to several months, leagues, usually involves one in- orderline patients suf- ture is often complicated by sub- with patients attending the pro- dividual session per week. Using fer from a dominance stance abuse, eating disorders gram for three hours a day, five techniques such as reframing, of negative affects: and mood disorders. All of these days a week. The multidiscipli- education, modeling, emphasiz- B anxiety, rage, guilt, depres- behaviors increase the likelihood nary treatment team provides ing strengths and encouraging sion, irritability, fear. . . . of lost relationships and jobs. ongoing comprehensive evalua- health-promoting behaviors to These affects may reflect Despite the severity of BPD tions, skills training and psycho- increase adaptive functioning, neurobiological disparities and related personality disorders, therapy groups, individual psy- the therapist pays attention to and/or severely traumatic effective treatments have evolved chotherapy, multifamily therapy, maintaining an appropriately experiences in their early in recent years that are making it and psychiatric medications, positive relationship between pa- years. The effects of these possible for patients to recover when needed. Controlled clini- tient and therapist. Difficulty negative affects are chronic from the debilitating effects of cal research has documented the tolerating “negative” feelings such disturbances in these pa- these conditions. These treat- effectiveness of DBT in reducing as anger is often the precursor of tients’ relations with signifi- ments are grouped into two sepa- parasuicidal behaviors and impulsive acts, and the suppor- cant others, and with them- rate approaches: dialectical be- length of inpatient hospitalization tive therapist helps the patient selves—what is called iden- havior therapy, based on cogni- and in improving social adjust- increase his or her capacity to tity disturbance or identity tive behavioral strategies, and ment. For further information, tolerate feelings without having diffusion. Various psy- psychodynamic psychotherapy, please contact Dr. Hoffman at to act impulsively. As with DBT, chopharmacological treat- based on psychodynamic strate- (914) 997-8628. all psychodynamic psychothera- ments may reduce these gies. Both are available at the peutic approaches use psy- Psychodynamic Approaches negative affects and help the Westchester Division. chopharmacological interventions patients to achieve a more Another approach to person- where appropriate. Dialectical Behavior Therapy effective equilibrium. In the ality disorders, psychodynamic For further information about long run, however, special- Perry D. Hoffman, PhD, is psychotherapy, focuses on the these specialized psychodynamic ized psychotherapeutic treat- Coordinator of the Dialectical Be- importance of the therapeutic psychotherapies, contact Dr. ments such as DBT or TFP havior Therapy Day Treatment relationship in eliciting the moti- Catherine Haran, (914) 997- may be more effective in Program, which focuses on be- vations of patients who engage in 5840; or Sheila Cherico, MSW, achieving lasting improve- havioral change in creating and self-destructive behaviors, and (914) 997-5746. ments, particularly in some enhancing one’s quality of life. helping them to substitute Dialectical Behavior Therapy more successful behaviors. Personality Disorders Institute cases where TFP may bring (DBT), a form of cognitive ther- “Psychodynamic psychotherapy about fundamental personal- The Personality Disorders apy, emphasizes a balance of ac- is effective to the degree that it ity changes that resolve the Institute at the Westchester Divi- identity diffusion. cepting, in the moment, what helps patients understand their can’t be changed, and using own motivations in maintaining sion, under the direction of Drs. Otto Kernberg and John Clarkin, Otto F. Kernberg, M.D. problem-solving skills to make problematic behaviors and en- changes where possible. Patients courages changes in these behav- has conducted research into the Otto F. Kernberg, M.D., is Director are expected to make a commit- iors through the use of the rela- treatment of people with person- of the Personality Disorders Institute ment to life while acquiring adap- tionship with the therapist,” says ality disorders for many years. at New York-Presbyterian Hospital, Currently engaged in an ongoing Westchester Division and Professor of tive coping strategies to effec- Catherine Haran, PsyD. Person- Psychiatry, Weill Medical College tively manage emotions. The ality Disorders Clinic staff in ad- comparison study of the effective- of Cornell University. therapeutic staff, all of whom dition to Dr. Haran are Sonia ness of the most up-to-date treat- PAGE 24 MENTAL HEALTH NEWS ~ SPRING 2002 Parenting The Angry Child

By Stephanie Speer, MA life situations. The Managing tention deficit, Tourette's, depres- struction, guidance and support. Coordinator of Community Education Defiant Behavior course, like sion, bipolar, obsessive compul- A parenting skill-building series Mental Health Association in most behavior management ap- sive, learning disabilities or As- serves to provide information, Dutchess County, Inc. proaches, did not sufficiently fo- perger's. Dr. Greene goes beyond education and instruction in the cus upon the emotional content the diagnosis and provides tools context of a safe, supportive and As the Coordinator of Com- of a child's experience but in- and skills designed to: structured environment. As a

munity Education at the Mental stead relied upon rewards and • member of the group, parents Health Association in Dutchess punishments as the primary ap- reduce hostility and antago- nism between the child and soon discover they are not alone. County, I have recently developed proach for managing behaviors. adults Participants receive ongoing sup- a six session skill-building series When I came upon the work of port, understanding and guid- for parents who have children Ross W. Greene, Ph.D., author of • anticipate situations in which ance not only from the instructor who are easily frustrated, chroni- The Explosive Child, child psy- the child is most likely to ex- but from the participants as well. cally inflexible and explosive. For chologist and researcher at Mas- plode The specific time set aside for the past six years, I have been sachusetts General Hospital and • create an environment in each class, away from the chil- facilitating a popular and effec- Harvard Medical School, I discov- dren and the demands of daily tive skill-building series ered an alternative approach that which explosions are less likely to occur living, helps to focus attention, "Managing Defiant Behavior" cre- specifically focused upon pre- concentrate efforts, reinforce ated by Russell A. Barkley, Ph.D. venting and managing explosions • focus less on reward and skills and gain the strength to Although this nine-session pro- in children who are easily frus- punishment and more on continue. This program is not a gram series has proven to be use- trated and chronically inflexible. communication and collabo- quick fix or a simple recipe but ful and beneficial for the majority Dr. Greene has created a rative problem-solving rather an in-depth exploration of participating families, I noticed practical and systematic ap- • and individualized approach to that for certain parents this pro- proach designed to help parents help the child develop self- regulation and thinking skills helping parents help their child gram did not appear to be helpful and providers manage, cope and to reduce and better handle frus- for their children who in some help the children who are easily to be more flexible and han- trations, prevent and diminish instances were extremely volatile, frustrated and inflexible. These dle frustration more adap- intense emotional outbursts and aggressive or destructive. children often make life extraor- tively aggressive behaviors. I began to investigate ways in dinarily challenging and frustrat- Although the work of Ross W. which I could help parents to bet- ing for themselves, parents, sib- Greene, Ph.D. is readily available The Mental Health Association ter understand and address the lings, teachers, other adults and in his book The Explosive Child, I in Dutchess County, Inc., is lo- emotional content that motivated peers. Many of these children have chosen to create and pro- cated in Poughkeepsie, NY at 510 and manifested within their are diagnosed with disorders vide a skill-building series for Haight Avenue. You may reach child's behaviors and reactions to such as oppositional defiant, at- parents that would provide in- them at (845) 473-2500. MENTAL HEALTH NEWS ~ SPRING 2002 PAGE 25 JBFCS Center for Trauma Program Innovation Expands Key Element in Trauma Treatment Response By Caroline Peacock, Hunter College variety of interrelated areas. interventions aimed at stabilizing affect great deal of these symptoms, which was School of Social Work Intern To address the unique impact of dysregulation and counteracting disso- to be expected just one month after the 9/11, the CTPI is developing a new trau- ciation. These included teaching relaxa- event. Now, at the five-month anniver- matic grief module within its pre- tion and grounding techniques and self- sary, another round of surveys will be existing Loss and Bereavement Program care activities. distributed to determine the amount of for Children and Adolescents. This pro- In response to the attacks, JBFCS new and established clients who are ex- gram’s highly experienced clinicians established seven drop-in centers at its periencing trauma-related symptoms as a provide group services to children and clinics to provide services free of charge result of 9/11, as the number has proba- adolescents who have lost a parent. The to those affected by the event. A crisis bly grown. As many JBFCS clients have groups for children run concurrently hotline was established to provide refer- been previously exposed to trauma in with groups for the surviving caregiver. rals to individuals in need. Various their lifetimes, this increases the prob- In response to 9/11, the Loss and Be- JBFCS mental health professionals also ability of re-traumatization. reavement Program will be offering a provided counseling for individuals and As previously mentioned, the CTPI traumatic bereavement group beginning groups at companies and community accomplished many of these goals with in March for children who lost a parent centers throughout the city. They re- the help of experts in trauma work who and their parents who lost a spouse in ceived rapid intensive training from Dr. have been appointed to the Saul Z. the attacks. Preschool and toddler pro- Claude Chemtob and various CTPI staff Cohen Chair in Child and Family Mental Robert Abramovitz, M.D. grams are a priority for the CTPI, as including Dr. Abramovitz, Dr. Paula Health. The Chair has focused on en- many families with small children lost a Panzer and Libbe Madsen. These efforts hancing JBFCS’ trauma competence. Its The World Trade Center disaster parent in the World Trade Center. This addressed more than 3,000 individuals recipients have included Dr. Bessel van required New York City Mental Health is just one of many ways that the CTPI and 200 companies. In addition to this der Kolk, Director of the Trauma Center, agencies to rapidly mobilize their ser- is responding to the needs of the com- work, clinicians continued to respond to Allston, MA; Dr. Sandra Bloom, Direc- vices and created an unprecedented de- munity since 9/11. the needs of their established clients, tor of Creative Alternatives, Philadel- mand for clinicians that possessed a Jewish community outreach and sup- many of whom were re-traumatized by phia, PA; and currently, Dr. Claude sophisticated understanding of the trau- port groups will be enhanced though the the events of 9/11. Chemtob, Director of Child Trauma matizing effects of disaster. The neces- Jewish Healing Center, one of the One month after 9/11, the CTPI con- Program, CATCH, at Mount Sinai sity to respond in this manner taxed agency’s programs which is already ducted a survey of all agency clients to School of Medicine in New York. every agency’s capacity. However, ac- providing ongoing bereavement groups determine the level of exposure to the Before the creation of the CTPI, Dr. cording to Dr. Abramovitz, chief psy- and trauma counseling. Trauma treat- attacks. As research indicates, people Bessel van der Kolk, a renowned expert chiatrist at the Jewish Board of Family ment specialty services will be devel- exposed to traumatic events often do not on post-traumatic stress disorder from and Children’s Services (JBFCS) and oped within the agency’s 14 mental acknowledge the trauma until months or Harvard University, was appointed the founder and director of its Center for health clinics to prepare for the onset of years after. The data indicated that Trauma Program Innovation, “JBFCS many people seeking trauma-related JBFCS clients were not experiencing a see JBFCS Expands on page 29 was able to mount a robust response services. Crisis and disaster interven- thanks to aggressive planning in trauma- tion programs will be developed to pre- focused programs at our agency over the pare the agency and the CTPI for any past six years.” future disasters, or small-scale crises in In 1998, JBFCS launched the Center the community. The area of secondary for Trauma Program Innovation (CPTI), trauma resources will be enhanced in the result of a unique gift that created anticipation of the needs of our clini- the Saul Z. Cohen Chair in Child and cians. The CTPI became part of the Family Mental Health. The mission of Partnership For Recovery in the New CTPI is to create appropriate services York City schools by building upon its for JBFCS programs interested in estab- Youth Counseling League’s pre-exiting Serving New Yorkers for More than a Century lishing a trauma treatment capability, as on-site school-based program at Stuyve- well as enhancing the trauma resources sant High School. This is a disaster re- in the community. The CPTI addresses covery program which began with the JBFCS Continues to Respond to the Aftermath of 9/11

clinical needs, trauma training, commu- specific intention of serving the five nity collaboration, program develop- high schools in lower Manhattan that ●

ment and research within and outside were evacuated on 9/11; it has now ex- Expanded Loss and Bereavement Program the agency. panded to provide services for the entire ● Jewish Bereavement Support Groups This allowed JBFCS to begin the school system. Finally, the agency will necessary trauma-related work described provide public education on trauma- ● Counseling Services for Individuals, Couples herein immediately on 9/11. Fortu- related subjects with the intention of Children and Families nately, the CTPI will be able to continue informing the community on what to to provide services made necessary by expect in the aftermath of a large-scale ● Training and Consultation Available through the the aftermath of 9/11 and the continuing disaster. state of danger that has ensued and be All of these new programs represent JBFCS Center for Trauma Program Innovation able to sustain this effort for years to an expansion of work begun directly come. As a result of generous philan- following the attack on the World Trade Save the Date - October 7, 2002 thropic gifts and the award of an NIMH Center. The CTPI immediately began grant, JBFCS is expanding the Center. distributing information on trauma and A Professional Conference on Violence and Trauma The NIMH grant was obtained through a disaster, and its effects on children and close collaboration between the CTPI adults, to clinicians and staff. Accord- Sponsored by JBFCS and the Mount Sinai School of Medi- ing to Dr. Abramovitz “we did that be- cine’s Child Trauma Program and aims cause we knew that psycho-education to build a true academic-community and resources that supported active cop- For more information, call us or visit our website partnership to foster clinical and evalua- ing were critical to counteracting the tion projects. acute effects of exposure to such an With the help of the current Cohen overwhelming event.” Understanding (888) JBFCS-NY www.jbfcs.org

Chair, the CTPI will provide trauma- that in the immediacy of disasters of this th related resources to the agency and com- magnitude a person can experience ei- 120 West 57 Street, New York, NY munity as it expects an increase in the ther a great deal of distress and arousal, number of people suffering from PTSD. or extensive denial and numbing, the The agency plans to create a continuum CTPI stressed interventions that re- United Way of New York City of services through development in a establish safety and emphasized PAGE 26 MENTAL HEALTH NEWS ~ SPRING 2002

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Staff Writer an option the family flatly rejected. tic symptoms. Selective Serotonin Reup- gies, gastrointestinal problems, or sleep Mental Health News The Johnsons instead talked to take Inhibitors (SSRI) are commonly disorder. The information in this article Jimmy’s doctor about various medica- used to treat joint attention and help con- is meant to be general and not to be con- Catherine Johnson remembers think- tions. While there are no direct medical trol mood swings and temper in some sidered medical advice. Please consult ing about the future of her first child -- interventions to treat autism, some pa- individuals with autism and those diag- your family physician, neurologist or one filled with great promise. tients have benefited from select medi- nosed with clinical depression. psychiatrist before deciding on any treat-

But a few years after her oldest son, cines. ments for autism spectrum disorders. Autism: Symptoms Jimmy, was born, he was diagnosed with Jimmy’s psychiatrist suggested that Autism Resource List autism and it seemed that the world -- and Jimmy take a tranquilizer and as a result Symptoms of autism spectrum disor- her family’s future -- had ended. John- the boy was transformed. About a year ders include delays or abnormal develop- Autism Resources - www.autism- son, of Irvington, N.Y., compares the later, Jimmy started acting out again, but ment in social interaction and language. info.org ; Autism Society of America - pain of that realization to the pain of began taking another prescription to help Although normal in appearance, children www.autism-society.org ; Families for childbirth -- only mental. him sleep. The family doctor suspected with autism are often withdrawn within Early Autism Treatment - “I thought my life, and his life, was Jimmy was misbehaving because he was their own world and are unable to com- www.feat.org ; National Institute of over,” she recalled. “It was devastating, exhausted. As he started sleeping regu- municate normally, relate to others or Child Health & Human Development - and also very confusing because my child larly, his behavior improved again. It was learn to understand the infinite nuances of www.nichd.nih.gov/autism ; National was not dead, but my dream of what his the right combination for Jimmy, who is human interaction. Children with autism Institute of Mental Health - life would be was never the same.” now approaching 15. Today, he attends are typically unable to participate in www.nimh.nih.gov ; National Center on Autism is a complex brain disorder high school and is on-track to have a full, imaginative play and may engage in odd Birth Defects & Developmental Dis- that often inhibits a person’s ability to rewarding life. behaviors and rituals and are commonly abilities - www.cdc.gov/ncbddd/dd ; Na- communicate, respond to their surround- Like his older brother, Andrew also resistant to change. tional Alliance for Autism Research - ings, or form relationships with others. has made progress through a strong edu- A baby might show early warning www.naar.org ; New York Families for Few disorders are as devastating to a cational program and prescribed medica- signs of autism if he or she: Does not Autistic Children - www.nyfac.org ; child and his or her family. An estimated tions. He came out of his shell and babble or coo by 12 months; Does not Westchester (N.Y.) Parent Link - 500,000 people in the country are living started to interact with others after his gesture, wave or grasp by 12 months; www.westchesterparentlink.org ; West- with some form of autism. third birthday, when he started taking an Does not speak single words by 16 chester Institute for Human Develop- Autism is considered a spectrum dis- antidepressant, commonly used to treat months; Does not speak two-word ment - www.nymc.edu/wihd phrases on their own by two years; Has order because symptoms and severity some symptoms of autism. Making a Difference vary widely from individual to individual. Today, Andrew engages in pretend any loss of any language or social skills Autism spectrum disorders occur in as play, makes good eye contact and is a at any age. Interested in making a difference? It is as easy as taking a walk. WALK many as one in every 500 births, making very outgoing and warm boy. Although Autism: Treatment & Interventions it the third most common developmental he still does not speak, he is teaching F.A.R. for NAAR, the National Alliance disability, after cerebral palsy and mental himself how to read, and has a wonderful Early interventions, especially those for Autism Research’s signature fundrais- retardation. Currently, there are no bio- personality. beginning before the age of three, have ing and autism awareness event, is com- logical markers, specific medical treat- Johnson said it is vital for parents of provided the most promising improve- ing to the Westchester/Fairfield commu- ment or cure for autism. It is a disability children with autism and other disorders ments. However, any delay in diagnosis nity for the first time on Sunday, June 2 that often requires lifelong supervision to remember to focus on the positive can reduce the effectiveness of early at Manhattanville College in Purchase, and care. things about their children’s life that treatments. NY. Proceeds from this event benefit Johnson and her husband, Edward, make them special. According to the National Institute of will help NAAR further advance autism accepted that their son had autism, but “People with autism often times have Child Health & Human Development, research. For more information, please also adopted a fierce commitment to pro- many special, hyper-specific skills, which some treatments providing hope to many call (203) 862-9447 or visit vide him with a happy, healthy life -- no may be useful in the workplace,” said families of children with autism include: www.autismwalk.org. matter what. Johnson. “We have to recognize these Individualized Education Programs, Walk F.A.R. for NAAR is held annu- Maintaining that commitment would special talents and see how they can help which involve a wide variety of interven- ally in numerous communities across the not be easy. people with autism have a brighter fu- tions and are designed to help individuals United States. Despite Jimmy’s occasionally difficult ture.” with autism overcome specific problems. Established in 1994, the National Alli- behavior, they took him out to restau- In addition to immersing herself in Comprehensive Treatment Programs ance for Autism Research (NAAR) is the rants, on airplanes and to visit with learning about autism, Johnson became range from specific learning methods to first national non-profit organization in friends. They did not allow Jimmy to run an active volunteer for the National Alli- reaching specific developmental goals. the country dedicated to funding and ac- wild, which meant constant physical ance for Autism Research (NAAR), the Typically, children need to be in this type celerating biomedical research for autism struggles that became more intense as he first non-profit organization in the US of program between 15 – 40 hours each spectrum disorders. The organization grew older. dedicated to advancing biomedical re- week for two or more years to benefit was established by parents of children “A child should not be a tragedy,” she search that seeks to find the causes, pre- from the therapy. with autism who were concerned about said. “Children with autism, or any disor- vention, treatment and cure for autism Applied Behavior Analysis focuses on the limited amount of funding for autism der, deserve parents that are very proud spectrum disorders. reducing specific behaviors and teaching research. Last year alone, NAAR com- of them and what they can accomplish.” She served several years on NAAR’s new skills. Recently, these programs mitted more than $3 million in grants for Having a child with autism presents Board of Trustees and as editor of the have included interventions used prior to biomedical research projects worldwide many challenges. Having more than one organization’s autism research newsletter, or following problematic behavior as well that seek to find the causes, prevention, is even more challenging. NAARRATIVE. Johnson is currently as treatments useful during problematic effective treatments and, ultimately, cure The family welcomed twins when helping to organize the first WALK behavior. These interventions seek to for autism spectrum disorders. Addition- Jimmy was seven. Experts told the John- F.A.R. for NAAR autism walkathon in reduce the chances that certain situations ally, NAAR was instrumental in estab- son’s that they had never seen a family the Westchester/Fairfield community. will trigger problematic behavior. lishing the Autism Tissue Program, the with more than one case of autism -- until The event takes place Sunday, June 2 at Positive Behavioral Interventions & first parent-led brain tissue donation pro- Andrew and Christopher were born. Manhattanville College in Purchase, NY. Support attempts to increase positive be- gram for autism research. havior and decrease problematic behavior NAAR has achieved many milestones Like his older brother, Andrew was Autism Symptoms & Treatment diagnosed with autism by the age of two. by focusing on the interactions that indi- in its brief history, but much more must But unlike Jimmy, he had different be- Autism was first identified by Dr. Leo viduals with autism have with their envi- be done. Despite a national interest in havior challenges. Andrew did not act Kanner more than 50 years ago, and is ronment and their learning processes. autism and high prevalence, autism re- wildly, but was totally non-verbal and typically diagnosed by the age of three. Pharmacological treatments can help search remains one of the lowest funded detached. Andrew’s twin brother, Chris- Some symptoms of autism spectrum improve behavior or relieve some symp- areas of research by both private and pub- topher, does not have autism. disorders mirror those associated with toms of autism. Medications are used to lic sources. Support for NAAR enables it Johnson estimates that it took her and other mental conditions, such as clinical target a specific behavior such as self- to continue funding autism research that her husband about two years to “mourn” depression and obsessive-compulsive injurious, aggressive or compulsive be- will one day find the causes, preventions each diagnosis of autism and reemerge, disorder. Common symptoms include haviors that may allow the individual to and treatments, and a cure for autism and stronger than before. mood swings and intense, repetitive be- focus on other things such as learning. related disorders. That strength was tested when behav- havior. When considering treatment options, it For information on supporting autism ior experts told the Johnsons that their In addition, some pharmacological is important that patients with autism be research and becoming a NAAR donor, oldest son would likely have to be placed treatments commonly used to treat clini- evaluated for co-morbid, potentially treat- please call 1-888-777-NAAR or visit in a home -- away from his family. It was cal depression are also used to treat autis- able conditions, such as seizures, aller- their website at www.NAAR.org. PAGE 28 MENTAL HEALTH NEWS ~ SPRING 2002

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JBFCS Expands from page 25 The most recently appointed Cohen Chair, Dr. Claude Chem- first Cohen Chair to address the tob, is an expert in disaster men- treatment needs of traumatized tal health. He has been interna- populations. Through his work tionally recognized for his work in enhancing the trauma re- with children in post-disaster sources at JBFCS, the CTPI was situations, and has served as a created in 1998. This group consultant to a Presidential brings together JBFCS’ core Commission established by the group of trauma experts who French Republic to develop a na- have continued to elaborate on tional response system to disas- the work of the Cohen Chair in ters. His appointment (made the agency and community. The prior to 9/11) has been excep- second appointed chair, Dr. San- tionally helpful in assisting the dra Bloom, introduced the Sanc- CTPI to create a response to the tuary Model to the agency. This attacks on the World Trade Cen- was implemented in residential ter. programs to create a safe com- The newly expanded CTPI in- munity for potentially violent tends to respond to the current adolescents who had been ex- needs of those affected by the posed to traumatic events. Addi- World Trade Center attack and tionally, the Sanctuary Model build a long term capacity to of- was implemented at one of our fer sophisticated trauma services shelters for battered women. The model also addresses the through the development of “secondary” trauma experienced unique programs and initiatives. by staff working with these popu- Thus, JBFCS will also be able to lations. The Sanctuary Model will address the many other forms of expand at domestic violence interpersonal and community shelters and youth residential violence that have traumatized programs. large numbers of JBFCS clients.

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Rabbi Simon Lauber, Executive Director Victor Pagano, Executive Director Kren K. Shriver, M.P.H., M.D., Clinical Director Bikur Cholim of Rockland County Resource Center Hudson River Psychiatric Center

Andrew P. Levin, M.D., Medical Director Ellen L. Pendegar, M.S., R.N., C.S., CEO Michael Silverberg, President Westchester Jewish Community Services Mental Health Association In Ulster County NAMI - New York State

Lawrence Levy, M.D., Clinical Director-Behavioral Health Center Barry B. Perlman, M.D., Chief of Psychiatry Elliott R. Singer, M.D., President Westchester Medical Center St. Joseph’s Hospital - Yonkers Psychiatric Society of Westchester

Constance Lieber, President, Board of Directors Susan Perr, M.A., Mental Health Advocacy Coordinator Alan B. Siskind, Ph.D., Executive Vice President NARSAD WILC - Mental Health Advocacy Project Jewish Board of Family and Children’s Services

Robert Litwak, C.S.W., Assistant Executive Director Cynthia R. Pfeffer, M.D., Professor of Psychiatry Steven H. Smith, Psy.D., Consulting Psychologist Mental Health Association of Westchester Weill Cornell Medical College of Cornell University Grace Church Community Center

Hon. Nita M. Lowey Hon. Michael J. Piazza, Jr., Commissioner Jeffery Smith, M.D. U.S. Congress - 18th District Putnam County Department of Mental Health Private Practice - Scarsdale, NY

Frank A. Marquit, CEO - President Diane Polhemus, Peer Specialist Andrew Solomon, Contributing Writer, Magazine National Artists for Mental Health, Inc. Consumers In Action of Rockland, Inc. The New York Times

Hon. Naomi C. Matusow Premkumar Peter, M.D., Medical Director Hon. Nicholas A. Spano New York State Assembly - 89th District Putnam Hospital Center - Mental Health Services New York State Senate - 35th District

Richard H. McCarthy, Ph.D., M.D., C.M. Perry M. Rattiner, Regional Marketing Representative Hon. Andrew J. Spano Hillside Hospital New York State Education Department Westchester County Executive

Steven Miccio, Executive Director James R. Regan, Ph.D., Chief Executive Officer Harris B. Stratyner, Ph.D., C.A.S.A.C., Director PEOPLe Hudson River Psychiatric Center NYPH & UHC Chemical Dependency Program

David H. Minot, Ithaca College, Chairman John Rock, Consumer Liaison Timothy B. Sullivan, M.D., Clinical Director Mental Health News - University Advocacy Division Hudson River Psychiatric Center Saint Vincent’s Behavioral Health Center - Westchester

Grant E. Mitchell, M.D., Director, Mental Health Services Evelyn Roberts, Executive Director Richard P. Swierat, Executive Director The Mount Vernon Hospital NAMI - New York City Metro Westchester ARC

Margaret E. Moran, CSW, VP, Administrative Services Harvey Rosenthal, Executive Director Kenneth G. Terkelsen, M.D. Saint Vincent’s Behavioral Health Center - Westchester NYAPRS Cape Cod & Islands Community Mental Health Center

Meryl Nadel, D.S.W., Chairwoman L. Mark Russakoff, M.D., Director of Psychiatry Hon. Ronald C. Tocci Iona College - School of Social Work Phelps Memorial Hospital Center New York State Assemblyman - 85th District

Samad Namin, M.D. Joseph F. Ryan, Ph.D., Dean Alan Trager, Executive Director & CEO New York Presbyterian Hospital PACE University School of Public Administration Westchester Jewish Community Services

Sarah Newitter, Executive Director Thomas E. Sanders, C.S.W., President & CEO Anthony F. Villamena, M.D., Chief of Psychiatry NAMI of Westchester, Inc. Family Service of Westchester Lawrence Hospital Center

Harvey I. Newman, Executive Director Jack C. Schoenholtz, M.D., L.F.A.P.A., Medical Director Jonas Waizer, Ph.D., Chief Operating Officer The Center for Preventive Psychiatry Rye Hospital Center FEGS - Behavioral & Health Related Services

Terri M. Nieves, MS.Ed, M.S., Director of Counseling Services Judy L. Scheel, Ph.D., Director Maralee Walsh, Ph.D., Program Director-Behavioral Health Center Mercy College Center for Eating Disorder Recovery Westchester Medical Center

Megan Nowell, Director Edythe S. Schwartz, A.C.S.W., Executive Director Hon. Mary Ann Walsh-Tozer, Commissioner Mental Health Association of Putnam County Putnam Family & Community Services Rockland County Department of Mental Health

Karen A. Oates, President & CEO J. David Seay J. D., Executive Director Michael Wein, CSW-R, CASAC, Administrator Mental Health Association of Rockland County NAMI - New York State NY United Hospital - Behavioral Health Services

Hon. Suzi Oppenheimer Janet Z. Segal, C.S.W., Chief Operating Officer Douglas L. York, Executive Director-Behavioral Health Center New York State Senate - 36th District Four Winds Hospital Westchester Medical Center

Matthew O’Shaughnessy, Senior Vice President Melanie Shaw, J.D., Director, Advance Directive Training Project Committee In Formation WVOX & WRTN Radio Resource Center

Mental Health News Wishes To Express Its Sincere Gratitude And Appreciation To The Members Of Its Advisory Council And To The Organizations And Supporters Who Make This Publication Possible PAGE 32 MENTAL HEALTH NEWS ~ SPRING 2002

CALL US TO PUT IT ALL TOGETHER.

Anxiety · Stress · Mood Swings Changes in Relationships · Lack of Energy Eating Disorders · Hopelessness · Irritability Substance Abuse · Sleeplessness · Problems at Work

If you’re suffering from emotional stress or have any of the above symptoms prompted by a medical problem, we can help. From toddlers to seniors, the Behavioral Health Center at Westchester is uniquely qualified with a comprehensive range of behavioral health services. If you need

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To put it all together, simply call 914-493-7088

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