7th Anniversary Issue
MENTAL HEALTH NEWSTM YOUR TRUSTED SOURCE OF INFORMATION, EDUCATION, ADVOCACY AND RESOURCES FALL 2006 FROM THE LOCAL, STATE, AND NATIONAL NEWS SCENE VOL. 8 NO. 4 The Psychological Dimensions of Physical Illness
By the National Institute cancer and other physical illnesses. How- of Mental Health (NIMH) ever, skilled health professionals will rec- ognize the symptoms of depression and Depression and Cancer inquire about their duration and severity, diagnose the disorder, and suggest appro- priate treatment. esearch has enabled many men, women, and young people with Depression Facts cancer to survive and to lead fuller, more productive lives, Depression is a serious medical condi- Rboth while they are undergoing treatment, tion that affects thoughts, feelings, and the and afterwards. As with other serious ill- ability to function in everyday life. De- nesses, such as HIV, heart disease, or pression can occur at any age. NIMH- stroke, cancer can be accompanied by sponsored studies estimate that 6 percent depression, which can affect mind, mood, of 9- to 17-year-olds in the U.S. and al- body and behavior. Treatment for depres- most 10 percent of American adults, or sion helps people manage both diseases, about 19 million people age 18 and older, thus enhancing survival and quality of life. experience some form of depression every About 9 million Americans of all ages year. Although available therapies allevi- are living with a current or past diagnosis ate symptoms in over 80 percent of those of cancer. People who face a cancer diag- treated, less than half of people with de- nosis will experience many stresses and pression get the help they need. emotional upheavals. Fear of death, inter- Depression results from abnormal ruption of life plans, changes in body im- cancer, depression may impact the course cancer patients in one study were receiv- functioning of the brain. The causes of age and self-esteem, changes in social of the disease and a person's ability to ing antidepressant medication. Persons depression are currently a matter of in- role, lifestyle, and medical bills are im- participate in treatment. with cancer, their families and friends, tense research. An interaction between portant issues to be faced. Still, not every- Despite the enormous advances in and even their physicians and oncologists genetic predisposition and life history one with cancer becomes depressed. De- brain research in the past 20 years, de- (physicians specializing in cancer treat- appear to determine a person's level of pression can exist before the diagnosis of pression often goes undiagnosed and un- ment) may misinterpret depression's risk. Episodes of depression may then be cancer or may develop after the cancer is treated. While studies generally indicate warning signs, mistaking them for inevita- triggered by stress, difficult life events, identified. While there is no evidence to that about 25 percent of people with can- ble accompaniments to cancer. Symptoms support a causal role for depression in cer have depression, only 2 percent of of depression may overlap with those of see Cancer on page 34 Heart Disease and Depression
Staff Writer the leading cause of death in the U.S. and untreated. Persons with heart disease, rowed or clogged and cannot supply Mental Health News While about 1 in 20 American adults ex- their families and friends, and even their enough blood to the heart, the result is periences major depression in a given physicians and cardiologists (physicians coronary heart disease. If not enough oxy- year, the number goes to about one in specializing in heart disease treatment) gen-carrying blood reaches the heart, the epression can strike anyone. three for people who have survived a may misinterpret depression's warning heart may respond with pain called an- However, research over the heart attack. signs, mistaking them for inevitable ac- gina. The pain is usually felt in the chest past two decades has shown Depression and anxiety disorders may companiments to heart disease. Symptoms or sometimes in the left arm and shoulder. that people with heart disease affect heart rhythms, increase blood pres- of depression may overlap with those of (However, the same inadequate blood Dare more likely to suffer from depression sure, and alter blood clotting. They can heart disease and other physical illnesses. supply may cause no symptoms, a condi- than otherwise healthy people, and con- also lead to elevated insulin and choles- However, skilled health professionals tion called silent angina.) When the blood versely, that people with depression are at terol levels. These risk factors, with obe- will recognize the symptoms of depres- supply is cut off completely, the result is a greater risk for developing heart disease. sity, form a group of signs and symptoms sion and inquire about their duration heart attack. The part of the heart that Furthermore, people with heart disease that often serve as both a predictor of and and severity, diagnose the disorder, and does not receive oxygen begins to die, and who are depressed have an increased risk a response to heart disease. Furthermore, suggest appropriate treatment. some of the heart muscle may be perma- of death after a heart attack compared to depression or anxiety may result in nently damaged. those who are not depressed. Depression chronically elevated levels of stress hor- Heart Disease Facts Chest pain (angina) or shortness of may make it harder to take the medica- mones, such as cortisol and adrenaline. As breath may be the earliest signs of heart tions needed and to carry out the treat- high levels of stress hormones are signaling Heart disease includes two conditions disease. A person may feel heaviness, ment for heart disease. Treatment for a "fight or flight" reaction, the body's me- called angina pectoris and acute myocar- tightness, pain, burning, pressure, or depression helps people manage both tabolism is diverted away from the type of dial infarction ("heart attack"). Like any squeezing, usually behind the breastbone diseases, thus enhancing survival and tissue repair needed in heart disease. muscle, the heart needs a constant supply but sometimes also in the arms, neck, or quality of life. Although we know more about the of oxygen and nutrients that are carried to jaws. These signs usually bring the person Heart disease affects an estimated 12.2 cause and treatment of mental illness to- it by the blood in the coronary arteries. million American women and men and is day, depression often goes undiagnosed When the coronary arteries become nar- see Heart Disease on page 30
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Sigurd H. Ackerman, MD, President & Medical Director Pam Forde, President Dominick Lepore, MS, CTRS, Vice President Edythe S. Schwartz, ACSW, Executive Director Silver Hill Hospital Putnam Family Support and Advocacy Westchester Medical Center - Behavioral Health Center Putnam Family & Community Services
Nadia Allen, Executive Director Michael B. Friedman, LMSW Andrew P. Levin, MD, Medical Director J. David Seay JD, Executive Director Mental Health Association in Orange County Public Policy Consultant Westchester Jewish Community Services NAMI - New York State
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Peter C. Ashenden, Executive Director Kenneth M. Glatt, PhD, ABPP, Commissioner Glenn Liebman, President & CEO Michael Silverberg, President Mental Health Empowerment Project Dutchess County Department of Mental Hygiene Mental Health Association In New York State NAMI - New York State
Chris Ashman, MS, Commissioner Arnold Gould, Co-President Robert Litwak, CSW, Assistant Executive Director Alan B. Siskind, PhD, Executive Vice President & CEO Orange County Department of Community Mental Health NAMI Queens/Nassau Mental Health Association of Westchester Jewish Board of Family and Children’s Services
Jeannine Baart, MS Flemming Graae, MD, Chief, Child & Adolescent Hon. Nita M. Lowey Jeffery Smith, MD Mental Health Education Consultant Psychiatry, Westchester Medical Center U.S. Congress - 18th District Private Practitioner
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Sharon E. Carpinello, RN, PhD, Commissioner Marsha Hurst, PhD, Director, Health Advocacy Program Evelyn J. Nieves, PhD, Executive Director Alan Trager, Executive Director & CEO New York State Office of Mental Health Sarah Lawrence College Fordham-Tremont Community Mental Health Center Westchester Jewish Community Services
Alison Carroll, CSW, Director of Day Treatment Beth Jenkins, Executive Director Karen A. Oates, DSW, President & CEO Jonas Waizer, PhD, Chief Operating Officer Putnam Family & Community Services Mental Health Association in Tompkins County Mental Health Association of Rockland County F.E.G.S. Health and Human Services System
Megan Castellano, Director Tom Jewell, PhD Senator Suzi Oppenheimer Joyce Wale, Senior Vice President - Behavioral Health Mental Health Association of Putnam County Family Institute for Education Practice and Research New York State Senate - 36th District New York City Health & Hospitals Corporation
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Steven K. Coe, Executive Director Rami P. Kaminski, MD, Medical Director of Operations Ellen L. Pendegar, MS, RN, CS, CEO Peter Yee, Assistant Executive Director Community Access New York State Office of Mental Health Mental Health Association In Ulster County Hamilton-Madison House
George M. Colabella, President John M. Kane, MD, Chief of Psychiatry Barry B. Perlman, MD, Chief of Psychiatry Neil Zolkind, MD, Clinical Director Colabella & Associates Hillside Hospital St. Joseph’s Hospital - Yonkers Westchester Medical Center - Behavioral Health Center
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Hugh Cummings, MD, President Ron Kavanaugh, Executive Director Cynthia R. Pfeffer, MD, Professor of Psychiatry Mental Health News wishes to expresses its deep Psychiatric Society of Westchester Search For Change Weill Cornell Medical College of Cornell University appreciation to the members of our Advisory Council for their inspiration, guidance and support. Joseph Deltito, MD, Clinical Professor of Psychiatry and James J. Killoran, Executive Director Michael J. Piazza, Jr., Commissioner Behavioral Science, New York Medical College Habitat For Humanity - Westchester Putnam County Department of Mental Health Many thanks to our readers, contributing writers and to our many advertisers for their support Anthony B. DeLuca, ACSW, Commissioner Thomas A. Kirk, Jr., PhD, Commissioner Carolyn Reinach Wolf, Esq. without which this publication would not be possible. Tompkins County Mental Health Services Connecticut Dept. of Mental Health & Addiction Services Reinach Wolf, Rothman, and Stern
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Kenneth J. Dudek, Executive Director Joshua Koerner, Executive Director Thomas E. Sanders, CSW, President & CEO Fountain House Choice Family Service of Westchester
Stephen P. Fahey, President & CEO Lois Kroplick, MD, Founder & Chairwoman Phillip Saperia, Executive Director Hall-Brooke Behavioral Health Services Mental Health Coalition of Rockland County Coalition of Voluntary Mental Health Agencies
Rena Finkelstein, President Rabbi Simon Lauber, Founder & CEO Jennifer Schaffer, PhD, Commissioner NAMI-FAMILYA of Rockland County Bikur Cholim Partners in Health Westchester County Department of Community Mental Health
Donald M. Fitch, MS., Executive Director Leo Leiderman, PsyD, ABPP, Director Judy L. Scheel, PhD, Director The Center For Career Freedom Saint Vincent Hospital - Latino Treatment Services Center for Eating Disorder Recovery
MENTAL HEALTH NEWS ~ FALL 2006 PAGE 3 Table of Contents
The Publisher’s Desk Columns
4 From the Publisher: Helping Children Cope with Stress 11 Point of View: Advice For the Next Governor of NY State 5 Letter to the Publisher: The Andrea Yates Case 12 The NYSPA Report: Understanding CATIE 6 Autism Issue Follow-up: New Brain Research Report 13 The Mental Health Lawyer: Credit Card Liability 14 The Economics of Recovery: Government Entitlements Mental Health NewsDesk 15 NAMI-NYS Corner: Inspired by Journeys of Recovery 7 New Binghamton Children’s Unit Ready for Occupancy 29 MHA of NYC: The Anniversary of 9/11 and Katrina
7 Duke Researchers to Evaluate New York’s AOT Program Additional Articles of Interest 8 Walgreens Recruits Employees with Disabilities 8 Kudos to Perlman and Coalition Honorees 23 WLIW Public Television Launches Healthy Mind Series
9 Campanelli New Chairman of Mental Health News Board Mental Health News 9 Stolper and Beitchman Join Mental Health News Board Upcoming Themes and Deadline Dates
The Psychological Dimensions of Physical Illness Winter 2007 Issue: Theme: “Managing Life Transitions” 1 Depression and Cancer Deadline: November 1, 2006 1 Depression and Heart Disease Spring 2007 Issue: 23 The Healing Power of Spiritual Support Groups Theme: “The Challenge of The Mental Health Workforce” 26 The Psychology of Physical Illness Deadline: February 1, 2007
Summer 2007 Issue: Four Winds Hospital: Fall Supplement Theme: “Child and Adolescent Mental Health” Deadline: May 1, 2007 17 The Use of The Self in Psychotherapy Fall 2007 Issue: 18 & 19 Four Winds Fall 2006 Calendar of Programs Theme: “Understanding and Treating Bipolar Disorder” 20 10 Child Mental Health Myths Deadline: August 1, 2007
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Donald M. Fitch, MS., Executive Director Barry B. Perlman, MD, Director of Psychiatry Phone us at (570) 629-5960 or (914) 948-6699 in the NYC Metro Area The Center For Career Freedom St. Joseph’s Hospital – Yonkers
Our e-mail address is [email protected]. Please visit our website Michael B. Friedman, LMSW Alan B. Siskind, PhD, Executive Vice President & CEO Public Policy Consultant Jewish Board of Family and Children’s Services
Mary Hanrahan, LCSW, Government Relations Specialist Giselle Stolper, EdM, Executive Director New York Presbyterian Hospital Mental Health Association of New York City www.mhnews.org Carolyn S. Hedlund, PhD, Executive Director & CEO Alan Trager, Executive Director & CEO Mental Health Association of Westchester Westchester Jewish Community Services Mental Health News does not endorse the views, products, or services contained herein. No part of this publication Leo Leiderman, PsyD, Director, Latino Treatment Services Jonas Waizer, PhD, Chief Operating Officer may be reproduced in any form without written permission. Saint Vincent Catholic Medical Center F.E.G.S. Health and Human Services System Mental Health News is not responsible for omissions or errors. Ira H. Minot, LMSW, Executive Director Mental Health News Education, Inc.
Founder and Publisher Copyright © 2006 Mental Health News. All rights reserved. Mental Health News and Salud Mental PAGE 4 MENTAL HEALTH NEWS ~ FALL 2006 From The Publisher Helping Our Children Understand and Cope With Today’s Anxieties Will Prepare Them for the Eventual Stresses They Will Experience As Adults
By Ira H. Minot, LMSW, Founder As parents, we need to be more open By disclosing their own feelings, par- and Publisher, Mental Health News with our children when it comes to serious ents encourage children to acknowledge illness, death, divorce and other stresses. their fears and concerns. For example, Although it is a difficult area to explain to about a divorce, a parent might say, “I am n this issue of Mental Health News a child, they will benefit greatly and thank sad about the divorce, too. But, I also we examine “The Psychological you for being there for them in this way. know it is the right thing for mommy and Dimensions of Physical Illness.” I found some helpful advice on the daddy to do. Even though we cannot live Much of the literature explores the internet at a Merck pharmaceutical site: together anymore, we will both always Imany psychological issues that affect the www.merck.com/mmhe/sec23/ch287/ch2 love you and take care of you.” By doing primary patient. However, those close to 87a.html, which follows in the following this, parents are able to discuss their the physically ill person are also vulner- quoted text. own feelings, offer reassurance, and able to psychic distress. Those at risk in- “In order to thrive, a child must experi- explain that divorce is the right choice clude the children, spouse, relatives, ence the consistent and ongoing care of a for them. Sometimes children, particu- friends and co-workers who know and loving, nurturing caregiver, whether it be larly younger ones, need to hear the care about the person who is sick. a parent or someone else. The security same message repeatedly. When we are young and growing up, and support that such an adult can provide Sometimes a parent must raise a diffi- we are all exposed to events in our fami- give a child the self-confidence and resil- cult topic with a child, such as telling the lies and in the world around us that may iency to cope effectively with stress. child about a serious illness in a relative influence our mental health as we grow In order to mature emotionally and or friend. If tragedy affects someone else, into adulthood. We also know that genet- socially, children must interact with peo- children may feel more confident, and less ics play a major role in the development ple outside the home. These interactions helpless, if they can contribute—for ex- of our mental fortitude. Added to that typically occur with close relatives; ample, by picking flowers; writing or mix, is that even the best of parents can friends; neighbors; and people at childcare drawing a card; wrapping a present; or unwittingly create weaknesses in the Ira H. Minot, LMSW sites, schools, churches, and sports teams collecting food, clothing, money, or toys. building blocks of their children’s psychic or other activities. By coping with the When a child appears withdrawn or sad, development. One way they may do this minor stresses and conflicts of these inter- refuses to engage in usual activities, or is by not helping them experience and and handling illnesses and interpersonal actions, children gradually acquire the becomes aggressive, the parent should learn to cope with some of the harsher problems with those around them. We all skills to handle more significant ones. seek professional help. events around them. Such events include: have problems coping in these areas, but However, certain major events, such as A parent may also have to address a illnesses, deaths, accidents, interpersonal my hunch is that these sensitivities are a illness and divorce, may challenge a difficult aspect of the child's own behav- upheavals and other unfortunate events in remnant of an overly protected childhood. child's abilities to cope. These events may ior. For example, a parent who suspects the child’s immediate or extended fami- Many parent’s today still hold to the also interfere with the child's emotional the child or adolescent of using drugs or lies. I don’t mean to sound too Freudian old mental health philosophy of “push and social development. For example, a alcohol should address the issue directly about it, but many parents who overpro- back your problems, and move on.” Can chronic illness may prevent a child from with the child. A parent might say “I am tect their children, may limit their kids this prove to be been a recipe for later participating in activities and also impair worried that you are using drugs. I feel ability to learn how to cope with traumatic emotional problems in their children? performance in school. this way because . . .” The parent should events later in life. Another mistake is made when families Events affecting the child may also then calmly list the behaviors that concern Don’t get me wrong. Most parents are know there is history of mental illness in have adverse consequences for people him, limiting the list to three or four be- devoted and loving, in accomplishing the the family, and thru fear, shame, and lack close to the child. Everyone who cares for haviors. If the child denies there is a hardest job in the world. However, some of understanding, do not openly acknowl- a sick child is under stress. The conse- problem, the parent should restate the parents still adhere to the ‘old school of edge this situation. Knowing that there is quences of such stress vary with the na- concerns calmly and explain to the child child development.’ They believed they a family history of mental illness is actu- ture and severity of the illness and with that there is a plan of action in place should shield their kids from facing many ally a good thing to know about, because the family's emotional and other resources (such as an appointment with a pediatri- of life’s more difficult events. By overly it can provide early intervention strategies and supports. cian or counselor). shielding children from having to deal for families to spot and quickly deal with Many life events, including illness or Throughout any discussion, the parent with problems in a psychically normal emotional problems in other family mem- death of someone close, divorce, and bul- should reassure the child that he is loved sort of way, many building blocks of a bers before they reach a crisis point. lying, are scary or unpleasant for children. and will be supported.” strong and healthy mental health may be When I was in my early 30’s my Mom Even events that do not directly affect the I want you to know that there is a lot of lost. My experience as the youngest of became seriously ill with Lymphoma, a child, such as natural disasters, war, or good news relevant to this discussion. The five kids was that there were many in- deadly form of cancer. Over the course of terrorism, may cause anxiety. Fears about mental health community has many won- stances where I was shielded by my par- time, she went in and out of remission all of these, rational or irrational, can pre- derful resources to which people can turn ents from having to deal with some of the while the cancer and the chemotherapy occupy a child. for help with a multitude of individual and major calamities that were going on in the took its toll on her body. Throughout her Children often have difficulty talking family problems. Unfortunately, many world around me. Going to the hospital to illness, I felt terribly distressed—a normal about unpleasant topics. However, open individuals and families are not familiar visit ill family members, deaths and funer- reaction to such a situation. What I real- discussion can help the child deal with with this and many are ashamed or afraid als, divorces and other emotional upheav- ized later on, was that I should have had difficult or embarrassing topics and dispel to ask for help. als in our own and extended family were someone to talk with, to help me deal with irrational fears. A child needs to know Mental Health News is actively trying kept from me and existed in an invisible my feelings rather than trying to tough it that anxiety is normal and will get better. to change this. We strive to provide our world away from my own. At the time, it out as I had been brought up to do. Parents should discuss difficult topics readers with relevant and up to date infor- was certainly a pleasant world for a child In keeping with my parents rules on during a quiet time, in a private place, and mation about mental illness, while provid- to live in, and provided me with a basi- keeping problems in a lock-box, we were when the child is interested. Parents should ing a roadmap to the providers of mental cally happy life at home, school, and with on our own to deal with a hopeless situa- remain calm, present factual information, health services in your community. We my friends. But all that troublesome stuff tion. Although she put up a valiant fight and give the child undivided attention. Ac- think this is a good way to eradicate that was floating in that hidden world for some years, Mom did not make it. I knowledging what was said with phrases stigma and to provide hope to many. around me would visit me later on in my will never forget my last visit to see her in such as, “I understand,” or with a quiet nod With your support of our community life. Periods of unexplained blue moods Florida while she was in a cancer induced encourages the child to confide; so does education mission, we will continue to began to creep into my life as I grew from semi-conscious state in the hospital. reflecting back what was said. For example, bring new and vital issues that impact the secondary school into high school. I did When she opened her eyes and saw that I if a child mentions anger about a divorce, lives of people with mental illness to the not have a clue as to their origin, and was at her bedside, she struggled to feebly one could say, “So, the divorce makes you forefront. Please continue to send me Mom and Dad certainly were not able to write me a message on a piece of paper. angry,” or “Tell me more about that.” Ask- your comments and suggestions to my E- give me the insight I needed. She wrote, “What are you doing here? Go ing how the child feels can also encourage mailbox at [email protected]. □ As we grow into adulthood, many chil- home. I will be OK.” Several days later him to discuss sensitive emotions or fears— dren begin to experience certain (almost she died. What a sad, yet perfectly ra- for example, fear of abandonment by the Good luck in your own recovery
predictable) psychic weakness when it tional way (in her own mind) to say good- noncustodial parent during a divorce or guilt and NEVER give up trying . comes to loss, separation, death and dying bye to me. for causing the divorce. Have a Wonderful Fall !! MENTAL HEALTH NEWS ~ FALL 2006 PAGE 5 Letter To The Publisher Beware the Injustice of The Court System for People With Mental Illness: Death Qualified Juries and Other Forms of Bias
By Joseph A. Deltito, MD someone guilty even if previously found otherwise be inclined not to pursue the not guilty for that particular crime. Once Death Penalty in a given case but never- judged not guilty one should be freed theless will do so knowing they will have n June 20, 2001 a then 36 year from the fear of future prosecution. I be- an easier “Sell” of guilty to such a jury. old Andrea Yates systemati- lieve most Americans on some philoso- Simply put, such jurors are more likely to cally drowned her 5 children phical and visceral level agree with this convict anyone of any accused crime than O ages 6 months to 7 years old. principal. In the Yates case the State of would the normally constituted jury which (At the current time I am writing this edi- Texas decided to try her for the murders would include objectors to the Death pen- torial she is in the middle of her second of not all 5 of her children, but on only 3. alty. It is an unintended consequence of trial for the murder of these children. It is They apparently did so with the strategy constructing a Death Qualified Jury that you likely that her trial will not be concluded that if they lost the case and she was ac- add bias towards an ultimate conviction. by the deadline for submission of this quitted for reasons of insanity they could In all honesty I have no solution to this editorial but her fate will be known by the then try her again for the death of the issue; to allow those who are firmly time this issue of The Mental Health fourth child. Should there be a similarly against the death penalty on such juries News reaches its readership. For this pub- "unsatisfactory" outcome of this next trial would mean that there would in essence lication anomaly I apologize, nevertheless and she would be acquitted a second time be no trial at all as one could never reach I will continue with her story.) After she they could then try her a third time for the a unanimous vote of guilty. But now rec- completed the drowning of her children death of the fifth child. Therefore they ognizing that an individual is being judged she called her husband telling him that he would have 3 chances to find her guilty by a jury psychologically biased towards “Better come home...it’s the children…all on what any reasonable and fair-mined conviction makes me personally unable to of them” and also called 911 asking for individual would see as the same crime. accept such verdicts as fair and certainly I them to come to the house. Upon inter- Joseph A. Deltito, MD Hence they included “Double Jeopardy” do not find them to be acceptable. I would view with the police she said “I killed my within their overall strategy. The system rather have a person's punishment limited to children, I am a bad mother.” It appears in stacked the deck against her from the “Life” (in prison) at least knowing the proc- retrospect that she was not saying that she determine whether or not she could be beginning! ess in some basic way was fair (I do confess was a bad mother because she killed her tried at all. At this hearing for her “mental Most people in this country both un- to be basically against the Death Penalty children, but as she was a bad mother (she competency” she stated that she wanted to derstand and accept the procedure of be- except in only exceptionally limited circum- believed she was possessed by Satan) she be executed so that she and Satan, in pos- ing judged by “A jury of one's peers” who stances for reasons beyond those discussed needed to kill her children in order to insure session of her, would both be destroyed. are considered to be impartial, fair- in this essay). their eternal salvation in Heaven. She stated She also maintained that she did not want minded and who can not benefit in any- Back to Andrea Yates. She had a first that she believed that “God would take them to plea not guilty and did not need an at- way by the verdicts they reach. When the trial that ended in her being found guilty up,” if she did not kill them they would go torney. She cut her hair in a particular State of Texas decided to pursue the of murder of 3 of her children. It was hen to hell. She was arrested and charged with way because she believed the number, Death Penalty in the Yates case they then decided not to give her the death penalty the murder of her children. 666 (representing the Antichrist), was engaged in the practice of impaneling a and she was sentenced to life in prison. She was a woman with obvious and printed on her scalp. In short she should “Death Qualified Jury.” In Texas for After the trial it was discovered that a long standing psychiatric illness. While have appeared to anyone as markedly someone to be found guilty of murder the very prominent Psychiatrist employed by there is debate as to which may be the compromised by her mental illness. Nev- 12 members of the jury need to unani- the prosecution gave testimony about An- most appropriate diagnosis there is no ertheless she was determined to be com- mously agree that the defendant is guilty drea Yates which was proven to be false. doubt that she had a psychotic illness at petent to stand trial in the State of Texas. beyond a reasonable doubt. Even if just The prosecution mentioned this evidence play for at least two years continuously With some background presented on one juror declines to reach such certainty in its closing arguments and made it a and episodic features of psychosis, de- this particular case I now wish to focus on of guilt a "Hung-jury" is declared and a cornerstone of their case suggesting she pression and suicidality over a longer pe- two areas I see as Injustice on the part of whole new trial needs to be brought willfully and in sound mind voluntarily riod than that. She had made two suicide the Courts (although I think there are against the defendant. Similarly 100 % elected to murder her children. The judge attempts in the past with multiple and many other examples of Injustice sur- unanimity is also needed in reaching a declared a mistrial and she was trans- consistent psychiatric treatments for at rounding the whole case of Andrea verdict of not guilty. In the case of Andrea ferred from a Prison to a Psychiatric Hos- least 7 years previous to her killing her Yates). It is also my educated medical Yates it would be a verdict of not guilty pital. (The Psychiatrist in question ap- children. The working Diagnosis most opinion that no murder charges should for reasons of Insanity .Therefore the peared to confuse some facts in giving his speculated on in the Courts and in the have been pursued in the first place in an prosecutions seeks to and is allowed to false testimony, and did not appear to be Media has been Post-Partum Psychosis individual who was so obviously persis- reject all those potential jurors from actu- willfully or maliciously lying). She is which is seen in about one in every five tently and seriously mentally ill and in- ally getting on a jury if they flat out de- currently in the middle of her retrial, this hundred births in the USA. (I ,personally, sane at the time of the killings. The con- clare that they do not believe in the Death time the death penalty is not being sought. highly suspect she suffers from a severe cept of Insanity is a legal and not a strictly Penalty and would never vote guilty if it Yet in many ways she is still fighting for form of Bipolar disorder with delusional medical term. In general it means that due meant the defendant may possibly be exe- her life. If convicted she will most likely and hallucinatory features exacerbated by to a mental disorder or defect a person did cuted. People could object for any reason: spend the rest of her life in a prison, if the multiple births of her children and not comprehend right from wrong, or Religious, Philosophical or Practical. So found not guilty by reason of insanity she inappropriate psychopharmacological could not understand the consequences of eventually we arrive at a jury that is com- will not be released but remanded to a treatments.) She had been treated with their actions. (In this case the prosecution prised of those who are willing to vote for Psychiatric Hospital where she may also various forms of antidepressants and an- argued narrowly that she did comprehend Death. It appears both obvious and sup- spend the rest of her life. Injustices can tipsychotic medicines over the years and that others would judge what she did as ported by behavioral research that such a occur in all sorts of legal proceedings, but had been recently taken off antipsychotic wrong; yet obviously she was following a group of individuals not only are willing I firmly believe that those with severe medicines previous to the killing of her higher authority of God to save her chil- to impose Death if they feel the defendant Mental illness are particularly exposed to children. She was charged with murder dren through her killing them. It follows is guilty but compared to the general pool the possibilities of being grossly mis- and because there were the “aggravating that she, in her delusional state believed of potential jurors are more likely to con- treated by “The System.” At least that's circumstances,” that she killed someone what she did was not only considered by vict someone. Such people may be more the way I see it! under the age of 6 and killed multiple her as “not wrong” but as “right” as it moralistic, more vindictive, more fright- persons, she was deemed by the State of followed God's will.) Her ability to judge ened by a perceived criminal class of peo- Joseph A. Deltito, M.D. is a Clinical Texas to be eligible for the Death Penalty. right from wrong was obviously markedly ple, feel defense lawyers are more devious Professor of Psychiatry at New York Her lawyers felt she was clearly insane compromised. and dishonest, believe that if the State Medical College and has an office prac- at the time of the murders and planned on Many are familiar with the concept of bring charges against someone they are tice for psychopharmacological consul- using an Insanity Plea Defense. In fact “Double Jeopardy” and why it is impor- most likely guilty, are more willing to tations and forensic psychiatry in they felt she was so compromised by her tant to keep the state from engaging in potentially make the mistake of finding a Greenwich, Connecticut. He is a foren- mental illness that she was not competent this practice. Simply stated we maintain truly innocent person guilty and very con- sic Psychiatry consultant for Court TV to stand trial (basically so delusional that that an individual can not be tried over cerned over letting a potentially guilty and CNN. Dr. Deltito serves on the she could not cooperate in her own de- and over for a particular crime if the person go unpunished. In fact these biases Clinical Advisory Board of Mental fense).So initially there was a hearing to State's Prosecutor is determined to find are recognized by Prosecutors who may Health News. □ PAGE 6 MENTAL HEALTH NEWS ~ FALL 2006
A Follow-up to Our Summer Autism Issue Researchers Gain Insight Into Why Brain Areas Fail To Work Together Basis For Why People With Autism Think In Pictures
By The National Institute of Child volved in language interact with brain re- Health and Human Development gions that process images. Dr. Just (NICHD) explained that earlier studies, as well as anecdotal accounts, suggest that people with autism rely more heavily on visual and spa- esearchers have found in two tial areas of the brain than do other people. studies that autism may involve In this study, the researchers used a lack of connections and coor- fMRI to examine brain functioning in dination in separate areas of the participants with autism and in normal Rbrain. In people with autism, the brain participants during a true-false test involv- areas that perform complex analysis ap- ing reading sentences with low imagery pear less likely to work together during content and high imagery content. A typi- problem solving tasks than in people who cal low imagery sentence consisted of do not have the disorder, report research- constructions like "Addition, subtraction, ers working in a network funded by the and multiplication are all math skills." A National Institutes of Health. The re- high imagery sentence, "The number eight searchers found that communications be- when rotated 90 degrees looks like a pair tween these higher-order centers in the of eyeglasses," would first activate left brains of people with autism appear to be prefrontal brain areas involved with lan- directly related to the thickness of the guage, and then would involve anatomical connections between them. parietal areas dealing with vision and im- In a separate report, the same research agery as the study participant mentally team found that, in people with autism, manipulated the number eight. brain areas normally associated with vis- As the researchers expected, the visual ual tasks also appear to be active during no significant differences between the chrony and the properties of some of the brain areas of the normal participants language-related tasks, providing evi- participants with and without autism in neurological "cables" or white matter fi- were active only when evaluating sen- dence to explain a bias towards visual age or I.Q. ber tracts that connect brain areas. tences with imagery content. In contrast, thinking common in autism. The first of the two new studies re- White matter consists of fibers that, the visual centers in the brains of partici- "These findings provide support to a cently was published online in the journal like cabling, connect brain areas. The pants with autism were active when new theory that views autism as a "Cerebral Cortex". In that study, the re- largest of the white matter tracts is known evaluating both high imagery and low failure of brain regions to communicate searchers used a brain imaging technique as the corpus callosum, which allows imagery sentences. with each other," said Duane Alexander, known as functional magnetic resonance communication between the two hemi- "The heavy reliance on visualization in M.D., Director of NIH's National Institute imaging, or fMRI, to view the brains of spheres (halves) of the brain. people with autism may be an adaptation of Child Health and Human Development. people with autism as well as a compari- "The size of the corpus callosum was to compensate for a diminished ability to "The findings may one day provide the son group of people who do not have au- smaller in the group with autism, call on prefrontal regions of the brain," basis for improved treatments for autism tism. All of the study participants were suggesting that inter-regional brain ca- Dr. Just said. that stimulate communication between asked to complete the "Tower of London" bling is disrupted in autism," Dr. Just said. The second study also confirmed the brain areas." test. The task involves moving three balls In essence, the extent to which the two observations in the first study -- that the The studies and the theory are the into a specified arrangement in an array of key brain areas (prefrontal and parietal) of prefrontal and parietal brain regions of the work of Marcel Just, Ph.D., D.O. Hebb three receptacles. The "Tower of London" the autistic participants worked in syn- cortex in people with autism were less likely Professor of Psychology at Carnegie Mel- is used to gauge the functioning of the chrony was correlated with the size of the to work in synchrony than were the brains lon University in Pittsburgh, Pennsyl- prefrontal cortex. corpus callosum. The smaller the corpus of normal volunteers. The second study also vania, and Nancy Minshew, M.D., Profes- This brain area, located in the front, callosum, the less likely the two areas confirmed that the extent to sor of Psychiatry and Neurology at the upper part of the brain, deals with strate- were to function in synchrony. In the nor- which the two parts of the cortex could University of Pittsburgh School of Medi- gic planning and problem-solving. The mal participants, however, the size of the work together was correlated with the size cine and their colleagues. prefrontal cortex is the executive area of corpus callosum did not appear to be cor- of the corpus callosum that connected them. The research was conducted by the Col- the brain, in which decision making, judg- related with the ability of the two areas to Dr. Just and his colleagues are con- laborative Program of Excellence in ment, and impulse control reside. work in synchrony. ducting additional studies to ascertain the Autism, a research network funded by the A little further back is the parietal cor- "This finding provides strong evidence nature of the abnormality of the connec- NICHD and the National Institute on Deaf- tex, which controls high-level visual that autism is a disorder involving the tions in the brains of people with autism. ness and Other Communication Disorders. thinking and visual imagery, supporting biological connections and the coordina- The NICHD sponsors research on de- People with autism often have diffi- the visual aspects of the problem-solving. tion of processing between brain areas," velopment, before and after birth; culty communicating and interacting so- Both the prefrontal and parietal cortex Dr. Just said. He added, however, that the maternal, child, and family health; repro- cially with other people. The saying play a critical part in performing the thickness, or extent, of connections be- ductive biology and population issues; "unable to see the forest for the trees" "Tower of London" test. tween brain areas may not be the basis for and medical rehabilitation. For more in- describes how people with autism fre- In the normal participants, the prefrontal the disorder. Although the neurological formation, visit the Institute's Web site at quently excel at details, yet struggle to cortex and the parietal cortex tended to connections between the prefrontal cortex http://www.nichd.nih.gov/. comprehend the larger picture. For exam- function in synchrony (increasing and de- appear to be reduced in autism, the brains The National Institutes of Health ple, some children with autism may be- creasing their activity at the same time) of people with autism have thicker con- (NIH) -- "The Nation's Medical Research come spelling bee champions, but have while solving the Tower of London task. nections between certain brain regions Agency" -- includes 27 Institutes and difficulty understanding the meaning of a This suggests that the two brain areas were within each hemisphere. Centers and is a component of the U.S. sentence or a story. working together to solve the problem. "At this point, we can say that autism Department of Health and Human Ser- An earlier finding by these researchers In the participants with autism, how- appears to be a disorder of abnormal neu- vices. It is the primary federal agency for described how a group of people ever, the two brain areas, prefrontal and rological and informational connections conducting and supporting basic, clinical with autism tended to use parts of the brain parietal, were less likely to function in of the brain, but we can't yet explain the and translational medical research, and it typically associated with processing shapes synchrony while working on the task. nature of that abnormality," Dr. Just said. investigates the causes, treatments, and to remember letters of the alphabet. The researchers made another discov- In the second study, published online in cures for both common and rare diseases. Participants with autism in both cur- ery, for the first time finding a relation- the journal "Brain", the researchers exam- For more information about NIH and rent studies had normal I.Q. There were ship between this lower level of syn- ined the extent to which brain areas in- its programs, visit www.nih.gov. □
See Page 31 For Our Upcoming Themes and Deadlines MENTAL HEALTH NEWS ~ FALL 2006 PAGE 7
MENTAL HEALTH NEWSDESK
New Children’s Inpatient Unit at Binghamton Ready for Occupancy
Staff Writer Decades of research support the find- gether, they discussed various design ele- Mental Health News ings that: mental health problems can be ments that would enhance the recovery recognized as early as preschool; risk fac- process, as well as those that may inhibit tors for the development of mental health it. As a result, the new unit is truly de- embers of the Greater Bing- problems can be identified in childhood, signed to support recovery: it balances hamton mental health pro- and many are modifiable; failure to iden- individual privacy and appropriate super- vider community recently tify and intervene can have life-long and vision, provides a safe and therapeutic had an opportunity to tour often devastating effects; scientifically- environment, and is family friendly - es- MGreater Binghamton Health Center’s validated tools for early recognition exist; pecially in the visiting areas. (GBHC) newly renovated, 14-bed inpa- and a range of effective intervention ser- A newly-renovated hospitality house tient unit for children and adolescents. vice programs exist, and they have a is also available for families of children “This new inpatient unit will comple- strong science base. who require inpatient care. The hospi- ment the quality care that has been avail- “I believe that the primary locus of tality house will enable parents who live able to children and adolescents through mental health care should be in the com- out of the immediate Binghamton area the Greater Binghamton Health Center’s munity, enabling children to remain at to become full partners in their child’s clinic, day treatment and crisis residence home, at work, in school, with friends and treatment, by providing temporary ac- programs,” said Sharon E. Carpinello, loved ones. But this does not mean that commodations for them here on the RN, PhD, Commissioner of the New York we can dismiss the need for quality inpa- campus of the Greater Binghamton State Office of Mental Health (OMH). “It tient care when it is needed,” said Com- Health Center. will enable the facility to treat those missioner Carpinello. “I would also like to acknowledge children who are most troubled on an “We believe it best when families are Senator Thomas Libous for his ongoing inpatient basis, and will complete the Dr. Sharon Carpinello full participants in all aspects of service advocacy and support for children and continuum of care available to children planning and delivery,” Commissioner families served by the Office of Mental and adolescents in New York State’s only 30 percent of children age14 and Carpinello said. She explained that a co- Health,” Commissioner Carpinello said. Southern Tier.” older with emotional disturbance graduate operative process helped to determine the The Greater Binghamton Health Cen- The knowledge base around psychiat- with a standard high school diploma; structural design of the new unit. OMH ter is completing finishing touches on the ric disabilities among children and adoles- among all disabilities, emotional distur- convened a focus group during which building, and working with other mental cents continues to grow, and continues to bance was associated with the highest rate administrators and the project’s architect health providers in the Greater Bingham- inform providers in the field. Research of school dropout; and suicide is the third met with children who have been hospi- ton area to finalize referral procedures. has shown that: one out of ten children leading cause of death among children talized and their families, facility staff and The new unit is expected to open in the have a serious emotional disturbance; and adolescents. other area mental health providers. To- coming months. □
Researchers From Duke University To Evaluate Assisted Outpatient Treatment in New York State
Staff Writer researchers will provide OMH and all New national experts convened to study the use health systems give these individuals pri- Mental Health News Yorkers with an objective assessment of of legal mandates in community treat- ority access to case management and issues that are central to understanding how ment. The team will begin its evaluation other services necessary to ensure safe well AOT has been implemented and is this summer and a final report of findings and successful community living. haron E. Carpinello, RN, PhD, working for recipients of mental health ser- will be completed by March of 2009. The original Kendra’s Law statute was Commissioner of the New York vices,” said Commissioner Carpinello. “The Office of Mental Health is enacted by the Legislature and signed into State Office of Mental Health “Their work will provide an important com- pleased to have the Duke University Re- law by Governor George E. Pataki in S (OMH) today announced that a plement to OMH’s work in this area, which search Team review the use of AOT in 1999, and the law was extended for an- team of mental health services researchers has found that individuals with mental ill- NewYork State,” said Chip Felton, OMH other five years in June 2005. This exter- from Duke University has been awarded a ness who participate in AOT are able to Senior Deputy Commissioner and Chief nal evaluation of AOT is a requirement of contract to evaluate the implementation make and maintain progress in their recov- Information Officer. “OMH is continu- the law’s 2005 extension, and the contract and effectiveness of New York State’s ery. We have seen improved access to mental ously looking to improve the quality of award announced today concludes a com- Assisted Outpatient Treatment (AOT) health services, improved coordination of ser- mental health services, and this team’s petitive Request for Proposals process. initiative. Established as a provision of vice planning, and significant reductions in insight and expertise in the field of man- Findings from OMH’s evaluation of Kendra’s Law, AOT is the procedure for harmful behaviors such as arrests, incarcera- dated community treatment will help to AOT’s first five years are now available obtaining court orders for certain indi- tions, homelessness and hospitalizations.” ensure that individuals with mental illness on the Office of Mental Health website at viduals to receive outpatient treatment for The Duke University research team is receive the high quality services and sup- http://www.omh.state.ny.us/omhweb/stati mental illness. The legislation is named led by Dr. Marvin Swartz, who has a na- ports they need to live successfully in stics/. Up-to-date statistical data on AOT in memory of Kendra Webdale, who died tional reputation for his involvement in their communities.” program operations, the demographic and after being pushed in front of a subway studies of mandated community treat- The AOT program is designed to en- diagnostic characteristics of AOT recipi- train by a man with a history of mental ment. Dr. Swartz’s team includes mem- sure that certain individuals with a mental ents, and outcomes for AOT recipients is illness and hospitalizations. bers of the Research Network on Man- illness are safely and effectively treated. also available, at the Statewide, regional “The expertise of the Duke University dated Community Treatment, a group of The law also ensures that local mental and county-level. □
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MENTAL HEALTH NEWSDESK
Walgreens Recruits Employees with Disabilities Through New and Highly Accessible Web Site
Staff Writer information about Walgreens partnership people with various disabilities and to Mental Health News with 13 local disability agencies. Know- meet the international Web Content Ac- ing the difficult challenges faced by peo- cessibility Guidelines of the World Wide ple with disabilities who want to work, Web Consortium (W3C). algreens (NYSE, NASDAQ: Walgreens designed the Web site to ad- The Paciello Group was founded by WAG), the nation's largest dress concerns such as transportation, Mike Paciello with a mission to make drugstore chain, has housing and the impact of gainful employ- information technology resources avail- W launched an innovative ini- ment on Medicaid, SSI or SSDI benefits. able to the full spectrum of people with tiative to hire people with disabilities at its “We know this requires more than a disabilities. Paciello has pioneered the new distribution center in Anderson, S.C. 'build it and they will come' attitude to be field of accessible interface design as a and is recruiting through a new, specially- successful,” said Randy Lewis, Walgreens technologist, consultant, author and pro- designed Web site. senior vice president of distribution and fessional speaker. His internationally best- Walgreensoutreach.com describes jobs logistics. Lewis, who has a son with au- selling book, “Web Accessibility for Peo- available at the Walgreens distribution tism, knows first-hand the challenges of ple With Disabilities,” remains the defini- center and is designed to be accessible by everyday life for people with disabilities. tive reference for accessibility design, people with sensory, physical and cogni- “Our local partners and statewide officials implementation and usability. tive disabilities. have worked tirelessly in setting up a sup- “The impact of this new Walgreens The center has begun pre-hire training port network to make this outreach with Web site is immeasurable," said Paciello. and will open in 2007. Initially, Wal- the disability community a success,” said "It will be embraced by the disability greens will hire more than 200 employees Lewis. community as a critical tool in the em- with plans to ramp up to more than 600 Randy Lewis Larry Kraemer, human resources man- ployment process. TPG is proud to be a employees. Walgreens goal is to have at ager for the Anderson distribution center, part of this forward-thinking Walgreens least one-third of the workforce consist of signed to be accessible to blind and low said, “This is a workforce that is under- initiative.” employees with a variety of disabilities vision individuals who use screen reader employed and has not had the same op- Walgreen Co. is the nation's largest working in a fully-integrated team. This technology. Under the jobs section, videos portunities as others. This is a chance to drugstore chain with fiscal 2005 sales of "real work for real pay" environment will show employees performing various jobs, change that.” Walgreensoutreach.com $42.2 billion. The company operates be competitive employment in which per- and the text describes what the workers also features success stories. One is that 5,294 stores in 46 states and Puerto Rico. formance standards must be maintained. are doing. Prospective employees unsure of Chuck Studzienko, an employee with Walgreens also provides additional ser- Job openings at the Anderson distribution if they can perform the essential job func- Asperger's Syndrome (a form of autism) vices to pharmacy patients and prescrip- center include a number of management tions can take a self-quiz to get an idea of who has worked at Walgreens Lehigh tion drug and medical plans through Wal- positions. the tasks involved. Valley distribution center in Pennsylvania greens Health Services, its managed care Walgreensoutreach.com provides in- From the same page, a series of photos since 2004. Studzienko started as a division, which includes Walgreens formation to help potential employees shows an employee arriving at work and stocker and was promoted to split-case Health Initiatives Inc. (a pharmacy bene- understand what work will be like at the going through the daily routine – going to picker, where he has a 100 percent pro- fits manager), Walgreens Mail Service distribution center. The site incorporates a locker, storing lunch, walking to a work ductivity rate. Inc., Walgreens Home Care Inc. and Wal- audio messages, photos, video and a station, taking a break and ending the day. Walgreens worked with The Paciello greens Specialty Pharmacy. More infor- large-print text option to depict jobs and For potential employees considering Group (TPG) of Nashua, N.H., to make mation on Walgreens is available at Wal- worklife at Anderson. The site also is de- relocating to Anderson, the site also has Walgreensoutreach.com accessible for greens.com or Walgreensespanol.com. □
Kudos on Perlman Appointments and Coalition Award Honorees
Staff Writer Coalition Benefit Honors Mental Health News Siskind, Carpinello & Moore
Perlman Receives State and National Appointments he Coalition of Voluntary Mental Health Agencies held its 22nd Annual Awards r. Barry B. Perlman, the Director Benefit in June, honoring of Psychiatry at Saint Joseph’s TNYS Office of Mental Health Com- Medical Center in Yonkers, missioner Dr. Sharon Carpinello, NY N.Y. and a member of the Board Times bestselling author Bebe Moore Dof Mental Health News, was recently ap- Campbell and Dr. Alan Siskind, Ex- pointed to the Hudson Valley Regional Ad- ecutive Vice President & CEO of the visory Committee of the Commission on Jewish Board of Family and Chil- Health Care Facilities in the 21st Century by dren’s Services, and past Chairman of Senator Joseph Bruno, the NYS Senate Ma- the Board of Mental Health News. jority Leader. The Commission was created Wide representation from the com- to make recommendations to the Governor munity mental health sector. elected and legislature regarding the “rightsizing” of officials and representatives from city the hospitals and nursing homes in the state. and State government attended, in- Recently, Dr. Perlman also was ap- cluding Assembly Member James pointed as Chair, Committee on Govern- Brennan (D-Brooklyn), who chaired ment relations of the American Psychiatric the Assembly’s Mental Health Com- association. He recently completed his 2nd mittee for five years, and the current two year term as President of the New York Dr. Barry B. Perlman Chair, Assembly Member Peter Rivera Dr. Alan Siskind State Psychiatric Association. □ (D-Bronx). □ MENTAL HEALTH NEWS ~ FALL 2006 PAGE 9
MENTAL HEALTH NEWSDESK
Peter Campanelli Elected Chairman of the Mental Health News Board
Staff Writer growth of the agency to a nationally recog- He currently serves at the pleasure of Mental Health News nized agency serving over 5,000 people per the State Commissioner of Mental Health year with an annual budget of $60 million. on the Families and Children Committee Dr. Campanelli is a licensed Clinical of the Commissioner and is a member of s spring ushered in its’ new Psychologist in both New York and New the Executive Committee of the Human season of growth and vitality, Jersey and is the recipient of numerous Services Council of New York City. it also heralded a passing of local and national awards including the Dr. Campanelli received a Bachelor of A the torch for Chairman of the Peterson Prize awarded by the Graduate Arts degree in Psychology from St. Fran- Mental Health News Board of Directors. School of Applied and Professional Psy- cis College, Brooklyn, New York in 1972, Dr. Peter C. Campanelli was elected to the chology of Rutgers University, two Gold a Master of Science degree and a Profes- position at the organization’s June annual Awards from the American Psychiatric sional Diploma in Educational Psychol- meeting. He succeeds Dr. Alan B. Siskind Association, as well as various congres- ogy from St. John’s University in 1974 who lead the award-winning mental health sional and legislative awards. and 1975, respectively, and a Doctorate in newspaper since 2003. Prior to joining the staff at ICL, Dr. Clinical Psychology with specialty foci in The formal announcement was made Campanelli served as Chief of Service of Public Administration and Health Care by Janet Z. Segal, LCSW, BCD, Vice- the Community Residential Service for Delivery and Behavioral Medicine and Chairman of the Mental Health News South Beach Psychiatric Center, a New Health Psychology from the Graduate Board of Directors. According to Segal, York State psychiatric hospital. He has School of Applied and Professional Psy- “We are so honored to have someone of served on the faculty of Pace University, Dr. Campanelli’s stature, lead the Men- Rutgers University and Metropolitan Col- chology at Rutgers, the State University tal Health News Board of Directors. He lege of New York within their graduate of New Jersey. is such a dedicated and respected leader training programs. According to Dr. Campanelli, “I am of the Metro-New York mental health Dr. Peter C. Campanelli Dr. Campanelli is President of the delighted to have this opportunity to lead community.” Coalition of Voluntary Mental Health the Mental Health News Board of Direc- Dr. Campanelli is currently the Presi- Executive Director in 1986 and was Agencies, an agency comprised of the tors. Mental Health News’ mission of dent and Chief Executive Officer of the named President and Chief Executive majority of mental health care providers providing mental health education to the Institute for Community Living (ICL), an Officer in 1987. in New York City. He is also Chairman of community is a such a vital part of help- award-winning, multifaceted and full ser- As President and Chief Executive Offi- the Board of Directors of the Association of ing people with mental illness, and it also vice mental health agency based in New cer, Dr. Campanelli is responsible for the Community Living, Inc. a statewide group serves to strengthen everything we do as York City. He joined ICL as Associate overall operation of ICL, and has led the of over 120 providers of residential services. service providers.” □
Giselle Stolper and Peter Beitchman Join the Board of Mental Health News
Staff Writer Staff Writer Mental Health News Mental Health News
iselle Stolper, EdM, is the Ex- r. Peter Beitchman has worked ecutive Director of the Mental and advocated within New Health Association of New York's mental health system G York City (MHA of NYC), for almost 40 years. He is one of the metropolitan area’s leading DExecutive Director of The Bridge, Inc., a mental health advocacy and direct ser- comprehensive multi-service agency for vices organizations. men and women with serious mental ill- Since joining the Association in ness located in New York City. The 1990, Giselle’s leadership has brought Bridge operates more than 40 programs in the organization to the forefront of in- Manhattan, Queens and the Bronx provid- novative direct service and public edu- ing residential, rehabilitation, clinical and cation models in the commu- support services to more than 1100 indi- nity. Giselle pioneered the development viduals each year. In addition to serving and growth of 1-800-LIFENET, New men and women with serious mental ill- York City’s leading mental health hot- ness, The Bridge provides specialty ser- line, which has achieved national vices to the mentally ill homeless, to prominence through its award-winning those dually-diagnosed with mental ill- model of information and referral ser- ness and substance abuse, to persons with vices. In the wake of the 9/11 attacks, Giselle Stolper, EdM HIV/AIDS who are experiencing signifi- Dr. Peter Beitchman LifeNet became the official hotline for cant mental health problems and to per- residents in the tri-state area to call if Giselle’s commitment to improving men- sons with mental illness who have been in Mental Health, Mental Retardation and they were experiencing emotional dis- tal health services for all New Yorkers. the criminal justice system. Alcoholism Services. He was also the tress. The MHA of NYC’s success with Before joining the MHA of NYC, Giselle Prior to assuming the position of Ex- Executive Director of the New York LifeNet led to the award of a federal worked for the New York State Office of ecutive Director of The Bridge six years State Assembly Special Subcommittee grant to develop the National Suicide Mental Health for 15 years at Manhattan's ago, he served as the agency’s Deputy on Urban Mental Health, and was Ex- Prevention Lifeline, 1-800-273-TALK, Children's Psychiatric Center. Today she Executive Director for 16 years. Before ecutive Director of the Coalition of which now includes 115 crisis centers is a catalyst for transformation within the coming to The Bridge, Dr. Beitchman Voluntary Mental Health Agencies, the nationwide, helping callers find refer- city’s mental health system by acting as a held a number of key public mental advocacy and technical assistance or- rals to nearby mental health resources. tireless advocate for policy change, giving health policy positions. He was a mem- ganization that represents New York A personal experience with mental ber of the Commissioner’s senior staff illness in her family originally fueled see Giselle Stolper on page 34 in the New York City Department of see Peter Beitchman on page 34 PAGE 10 MENTAL HEALTH NEWS ~ FALL 2006 MENTAL HEALTH NEWS ~ FALL 2006 PAGE 11 POINTPOINT OFOF VIEVIEWW
Advice for the Next Governor of New York State
By Michael B. Friedman, LMSW The next Governor should commit child-serving systems, use of a home and the role of Medicaid in supporting the to continued progress towards the de- community-based waiver program to re- state’s public mental health system. velopment of a comprehensive commu- duce institutionalization, and—this year— Without doubt, Medicaid spending will nity-based mental health system for a vast increase in screening, assessment, be a major target for the next administra- adults with long-term psychiatric dis- and treatment through Clinics Plus. If tion. But Medicaid spending in NYS is abilities with particular attention to Timothy’s Law passes the Senate as extremely complex, reflecting decisions to problems of transinstitutionalization. promised and Governor Pataki signs it cover more people and services than other A half century ago NYS passed the into law (no word as I write this), services states as well as the high costs of health first community mental health act in the will also be increasingly available to those care in general. The next Governor United States setting the stage for the na- covered by employer-based health plans. probably knows this already, but it would tion’s shift from institution-based mental But all of these gains leave much be surprising if he knows much about the health policy to community-based policy. still to be accomplished. The next Gov- use of Medicaid as the major underpin- The first step in the transition was ernor should commit not only to contin- ning of New York’s mental health system “deinstitutionalization.” It helped many ued expansion and improvement of and of its use to generate federal funds to people avoid unneeded long-term institu- mental health services for kids in the supplant state and local funds. The new tionalization, but it also resulted in the public sector but should also press for Governor needs to understand that cuts to abandonment of tens of thousands of peo- increased access through workplace Medicaid for mental health are likely to ple in communities unprepared to serve benefits and programs. ultimately drive up the state’s costs. He them. (Fortunately, families filled the The march of demography calls for should support the remarkably clever state void for many of them.) A quarter cen- increased attention to the mental health bureaucrats who have figured out year after tury ago, NYS instituted the Community needs of minorities and older adults. year how to use Medicaid to preserve and Support Program, which—over time—has Our society is undergoing major demo- improve NYS’s mental health system. addressed shortcomings of deinstitution- graphic shifts. Over the next quarter cen- The new Governor should also under- alization with expanded outpatient treat- tury minority populations will grow from stand that efforts to reduce Medicaid costs Michael B. Friedman, LMSW ment, housing, rehabilitation, family and 30% of the population to 43%. The popu- by closing general hospitals can inadver- peer support, and more. lation of older adults will grow from 13% tently have a devastating effect on NY’s For those of us who have been around of the population to 20%. Neither NYS mental health system—which relies heav- since the late 1970’s, the progress is appar- nor the nation is prepared to meet the ily on general hospitals to provide essen- he next Governor of New York ent—but so is continuing need. The next mental health challenges of these demo- tial inpatient and outpatient services. In will have to confront a vast ar- Governor should continue the momentum graphic shifts. In NYS some progress has general, the next Governor needs to rec- ray of mental health issues. with expanded housing and more services been made. The Geriatric Mental Health ognize that, while mental health consti- Here are a few observations I and supports oriented to recovery, par- Act has led to the creation of a planning tutes an extremely small part of the over- Thope will be helpful. ticularly for those most likely to be under- council and a services demonstrations all Medicaid budget, Medicaid is abso- Mental health is important to all served, such as people with co-occurring grants program. There may soon be cen- lutely crucial to the of the public mental New Yorkers and should be one of the mental and addictive disorders. ters of excellence in minority mental health system. next Governor’s priorities. Continued progress will entail con- health. But so much more is needed: a Are new approaches to the way Medicaid 50% of us will have a mental disorder fronting the future of the state hospital workforce that speaks the language of its is used to fund mental health possible? in our lifetimes, and 20% will have a dis- system and the nature of “reinvestment” if clientele and is knowledgeable about geri- Probably, but both the Cuomo and the order in any given year. Most mental more hospitals are closed. This will be atrics, cultural differences, etc.; public Pataki administrations developed brilliant illnesses are not severe, but they result in among the thorniest of political issues the education to overcome stigma; develop- ideas about how to restructure Medicaid substantial pain for both people with men- next Governor will have to face. ment of more mobile services providing funding for mental health, and both failed. tal illness and for their families. They In addition, the new Governor should outreach to populations unable or reluc- The next Governor needs to understand why also take a toll on the economy. Mental anticipate that the large presence of peo- tant to seek out mental health services; before taking off in similar directions. illness is the leading cause of disability in ple with serious mental illnesses in adult integration of services, and more. Since becoming a mental health advo- the United States and the fastest growing homes, nursing homes, jails, and prisons The next Governor should lead NYS cate, I have lived through two gubernato- cause of disability in the workforce. Un- will re-emerge as a major crisis as they into the future by laying the groundwork rial changes—Cuomo and Pataki. Both treated mental illness reduces productivity did in the Carey, Cuomo, and Pataki ad- now for meeting the needs that will in- were rough for mental health because and costs American business over $100 ministrations. It would be wise for the new creasingly emerge as the march of demog- neither new Governor initially understood billion per year. Governor to confront transinstitutionali- raphy moves ineluctably forward. how delicately balanced the mental health Mental illness also drives up the cost zation before it confronts him. Among Quality of mental health services is system is. It relies on a mix of state, com- of health care. Psychogenetic symptoms other things, this will entail a commitment uneven in NYS. The Governor should munity, and general hospital providers. It result in unnecessary testing and treat- to increase and remodel housing for people commit to continued support of re- relies on leadership by state and local gov- ment. And, when combined with mental with serious mental illness. search and the use of best practices. ernments. And it relies on a very complex illness, physical illness becomes more The Governor should commit to con- Improving the quality of mental health mix of funding sources—federal, state, lo- complicated—and costly. For example, tinued progress towards the development services through the translation of re- cal, philanthropic, private insurance, and people with cardiac conditions and de- of a community-based mental health sys- search into practice has become one of the self-pay. The new Governor needs to keep pression cost almost twice as much to tem for children and adolescents. central tenets of mental health policy in all this in mind if the next transition is to be treat for their heart problems. Over the past quarter century, incre- NYS and in the nation. Doing so requires smoother than the previous two. A Governor committed to a high mental progress (with a big leap this year) a research agenda that has eventual appli- quality of life for New Yorkers and to a has been made in addressing the mental cation to the real world and a commitment Michael B. Friedman is the Director of thriving economy should make mental health needs of children and adolescents. to support the use of best practices. New the Center for Policy and Advocacy of health a priority. He should focus, of This has included the development of York State has been a leader in research and The Mental Health Associations of NYC course, on how the public sector can more specialized child mental health ser- in the effort to improve practice. The new and Westchester. The opinions expressed promote mental health, but also should vices, the development of non-traditional Governor should support these efforts. in this column are his own and do not focus on helping the private sector to services, new efforts to treat families Using Medicaid to fund mental necessarily reflect the positions of the understand that promoting mental health with respect and as partners in care, health care has reduced NYS’s costs. MHAs. Mr. Friedman can be reached at is good for business. strides towards integration with other The next Governor needs to understand [email protected]. □ PAGE 12 MENTAL HEALTH NEWS ~ FALL 2006
The NYSPA Report
Clinical Antipsychotic Trials of Intervention Effectiveness: A Primer for Patients, their Families, and Friends
By Leslie Citrome, MD, MPH CATIE Had Three Parts tients stayed on olanzapine longer than on Director, Clinical Research and quetiapine or risperidone. Patients on Evaluation Facility, Nathan S Kline CATIE’s design included 3 main olanzapine had fewer hospitalizations and Institute for Psychiatric Research phases. The results of Phases 1 and 2 have greater decreases in their symptoms, espe- been published. Phase 1 included 1493 cially at the start of treatment. However, patients who received one of 5 antipsy- patients on olanzapine had a higher ten- esearch studies comparing an- chotics, chosen at random: perphenazine, dency to gain weight and have increases tipsychotics have usually been olanzapine, quetiapine, risperidone, or in blood cholesterol and triglycerides. conducted by the manufactur- ziprasidone. Patients with a history of Patients receiving perphenazine discontin- ers of the medications, and tardive dyskinesia (abnormal involuntary ued because of extra-pyramidal side ef- Rhave usually included only two medica- movements) could not receive per- fects more frequently than with the other tions, and the results are not always made phenazine, an older antipsychotic that can medications. Ziprasidone had little effect publicly available. Large scale, independ- cause tardive dyskinesia more often than on weight or associated problems, and ently-conducted, multiple-medication the newer medications. Patients who patients remained on it for as long as the studies are needed. The Clinical Antipsy- stopped their initial medication before the other medications except for olanzapine. chotic Trials of Intervention Effectiveness 18 months was up were offered a new We still have unanswered questions – (CATIE) have emerged as a rich source of medication in Phase 2, and 543 patients Were there differences in quality of life? information from which clinicians can accepted. Those that stopped their phase Memory? Did substance abusers do better gather information about the relative 2 medication were offered treatment in on some agents rather than others? Were strengths and weaknesses of the newer, Phase 3 with one or two antipsychotics. hospitalized patients different in terms of “second-generation” antipsychotics. It When enrolled in the study, patients were their response? Was weight gain associ- compared them amongst each other as made aware that these switches were possi- ated with improvement? well as to a “first generation” antipsy- ble. Nearly half of all patients who enrolled chotic. A list of publications and re- finished a full 18 months of follow-up. Phase 2 Results sources follows this article. Leslie Citrome, MD, MPH Phase 1 Results The more popular pathway was that What is CATIE? medication worked in reducing symptoms involving the possibility of receiving zip- (such as hallucinations, delusions, anxiety) Almost three-quarters of the patients rasidone. Fewer patients chose to partici- CATIE was a randomized controlled and was free of disabling side-effects for discontinued phase 1. The most common pate in the pathway where they could trial, not sponsored by the pharmaceutical that person. The longer the time someone reason for discontinuation was “patient have received clozapine. For those that industry, which evaluated the effective- takes the medication, the more “effective” it decision” at 30% - these patients for the did, patients stayed on clozapine longer ness of antipsychotics in approximately was thought to be. most part declined further participation in than they stayed on risperidone or 1,500 patients with schizophrenia over an CATIE, and did not go on to Phase 2. The quetiapine. For patients who participated 18-month period. It was paid for by an CATIE Was Both next most common reason for discon- in the other pathway where they would NIMH contract worth over $40 million Inclusive and Exclusive tinuation was lack of efficacy (the medi- possibly receive ziprasidone, patients who dollars awarded to the University of North cation did not relieve symptoms ade- received olanzapine or risperidone stayed Carolina for the period from 10/1/99 to Much has been said about CATIE being quately) at 24% - these patients were en- on those drugs longer than those who re- 12/31/05. Over 50 different clinical cen- more generalizable than the usual study be- couraged to participate in Phase 2 in a ters in diverse settings across the USA cause it included patients who may have pathway that involved receiving clozap- ceived either ziprasidone or quetiapine. participated in this project. needed other medications in addition to antip- ine, olanzapine, quetiapine, or risperi- Weight gain and associated problems sychotics, and also included patients who may done. Intolerability (side effects) was the were more frequently seen with olanzap- What is Treatment Effectiveness? have had problems with alcohol or drug abuse. reason given for discontinuation in only ine, and less frequently seen with ziprasi- On the other hand, CATIE did exclude several 15% of the patients – 4% because of done. Patients who had gained weight in Treatment effectiveness is a broad term important groups of patients: patients whose weight gain or associated problems, 4% Phase 1 were more likely to lose weight in that includes the concepts of efficacy symptoms first began less than 3 years ago, because of extra-pyramidal symptoms Phase 2 if they received ziprasidone. (ability of a medication to reduce symp- patients treated with medication for the first (tremor, stiffness, other abnormal move- toms), tolerability/safety (side effects), and time in the past year, patients who have a his- ments), and 2% because of sedation. Phase 3 Results treatment adherence (taking the medication). tory of non-response to olanzapine (Zyprexa), These patients were encouraged to partici- The CATIE trial measured effectiveness by quetiapine (Seroquel), risperidone (Risperdal), pate in Phase 2 in a pathway that involved Phase 3 results have not been pub- seeing how long a patient remained on a ziprasidone (Geodon), or perphenazine randomization to ziprasidone, olanzapine, lished. Relatively small numbers of pa- medication This amount of time taking the (Trilafon), patients who have been on clozap- quetiapine, or risperidone. tients entered into this open-label phase medication reflects both the patient and the ine (Clozaril), and patients who have a diagno- The antipsychotics differed in terms of clinician’s opinion as to whether or not the sis of schizoaffective disorder. how long patients remained on them. Pa- see CATIE on page 34
New York State Psychiatric Association - Area II of the American Psychiatric Association
Representing 4500 Psychiatrists in New York
Advancing the Scientific and Ethical Practice of Psychiatric Medicine
Advocating for Full Parity in the Treatment of Mental Illness
Advancing the Principle that all Persons with Mental Illness Deserve an Evaluation with a Psychiatric Physician to Determine Appropriate Care and Treatment
Please Visit Our Website At: www.nyspsych.org MENTAL HEALTH NEWS ~ FALL 2006 PAGE 13
THE MENTAL HEALTH LAWYER
Understanding Contractual Capacity Protecting People with Mental Illness from Credit Card Liability
By Carolyn Reinach Wolf, Esquire contractual capacity as a legal concept has There is hope. An argument can be then consider contacting the credit card and Douglas K. Stern, Esqire its roots in case law that is over one hun- made that it would be inequitable for a company and negotiate a reduction in the dred years old. In 1892, the New York court to enforce a credit card contract overall debt with an acceptable payment Court of Appeals (the state’s highest against a psychotic, manic or impulsive plan. If these options fail, a more asser- court), held that the legal standard for individual who did not know what he/she tive approach may be necessary. For ex- determining an individual’s contractual was doing at the time of signing the con- ample, you might apprise the credit card capacity is, “whether [the mind] was so tract and using the card or could not con- company of the fact that the credit card affected as to render him wholly and ab- trol an impulse to do same. The credit debtor lacked contractual capacity and solutely incompetent to comprehend and card holder would in this situation need to refuse to pay. Keep in mind, however, the understand the nature of the transaction” 1 establish that he/she lacked contractual following caveat: the credit card company That same year, the Court of Appeals capacity at the time he/she returned the may bring a lawsuit. If this occurs, the modified this standard to include a ques- application and charged purchases with credit card debtor would either have to tion as to the individuals ability to, “make the card. Furthermore, proof would likely claim that he/she lacked contractual ca- a rational judgment concerning [the] need to be shown that the purchases were pacity as a legal defense or file for bank- transaction.” 2 These two factors are typi- not “ratified,” or approved at a time when ruptcy protection. Either of these options cally referred to as the “cognitive rule.” the credit card holder was mentally well. will likely require legal representation and Subsequently, courts have concluded un- Because of its uncertainty, the judicial legal fees. Therefore, before exercising der this cognitive rule that there must be a route may not be the choice of first resort. either of the latter options one should seek direct link between the “insanity” and the A better option would be to ascertain professional advice. making of the contract.3 Please note that how much credit card debt there is and An ounce of prevention, if possible, the cognitive rule was created at a time from which institutions. If the debt is a may go a long way. A concerned relative when little was known about the science small sum of money that the credit card or friend may want to approach the potential behind psychiatric disabilities and the debtor is willing and able to repay, then credit card applicant (“the applicant”) and Carolyn Reinach Wolf, Esquire terms used to describe the mentally ill the credit card company should be con- make arrangements for intervening prior were considerably more stigmatizing. tacted to arrange for a repayment plan. If to the application process. The applicant Over the next several decades, the the debt is large and/or the credit card redit cards. We all need them. study of mental illness was embraced by debtor is unwilling and/or unable to repay, see Credit Cards on page 33 We all use them. Many people the scientific community as well as the use them wisely but some fall general public. In terms of contractual C prey to their convenience and capacity, judicial decisions soon reflected the allure of not having to pay out cash. this greater understanding. The Court of This is where the trouble begins and the Appeals supplemented their cognitive rule debts start to mount. Should one be held with a “motivational rule,” which encom- The Law Firm of accountable if the credit card is obtained passes the concept that while a person’s and used during a time when that individ- cognitive ability may not be impaired that ual did not have the capacity to under- person may be unable to control his con- Reinach Wolf, Rothman, and Stern, LLP stand what he or she was doing? duct due to impulsive behavior.4 How- A credit card application, like the ones ever, the Court of Appeals qualified this that invade your mailboxes daily, is actu- rule by stating that there must be “nothing Devoted to the Practice ally a contract for the provision of credit. less than serious…medically classified You sign the credit card application, the psychosis” and that the other party knew of Mental Health Law company sends you the card upon ap- or should have known of such illness at proval and you begin to charge your pur- the time of the transaction.5 If the other chases. By doing so, you agree to repay party did not know of the existence of the The Law Firm of Reinach, Wolf, Rothman, and Stern LLP, represents more the sums charged at a pre-arranged inter- psychosis, there was still a possibility for than twenty major medical centers, as well as community hospitals, nurs- est rate. The assumption by the credit the mentally ill party who was contracting ing homes and outpatient clinics, in the New York metropolitan area in card company is that the individual who for something to obtain some equitable the field of mental health litigation, consultation, advocacy, and related 6 executes such a credit card application is relief. In 1979, the Court of Appeals disciplines. 18 years of age or older and has the ca- opened the door to the possibility that a pacity to understand the contents of what disability defined as something less than a she/he is signing. The former is quite clinically classified psychosis may excuse In addition, our team of attorneys, with more than forty years combined ex- easy to verify while the latter, under these an individual from having to live up to a perience, offers legal representation to families and individuals affected by circumstances, is nearly impossible. But contract.7 It appears this is the last time mental illness. We provide a broad range of legal services and counsel on what happens when an individual who is our highest court has meaningfully such matters as: mental health case management and continuity of care; dis- mentally ill, symptomatic and unable to weighed in on the topic of contractual charge planning; Assisted Outpatient Treatment (Kendra’s Law); Mental understand the contents of such an appli- capacity or the ability to legally enter into Health Warrants; Hospital Treatment over Objection and Retentions; Pa- cation, obtains a credit card and rings up and be held to a contract. tients’ Rights and Guardianships. thousands of dollars in debt? The answer What does this all mean for our credit is not entirely clear. This article will card debtor? It appears that the current grapple with this question, one that has state of contractual capacity law offers Our firm regularly contributes to a number of publications concerned with come across my desk on numerous occa- little assistance in making a legal argu- Mental Health and related Health Care issues and participates in seminars sions over the past several years. This ment for the individual with a mental ill- and presentations to professional organizations and community groups. problem can result in lifelong credit disre- ness who obtains a credit card while in a pair, debt and mounting stress. decompensated state. Why? Because all Please keep in mind that mental illness of the reported cases on this topic deal 60 Cutter Mill Road - Suite 407 by itself does not render an individual with contracts that were executed at “arms incapable of being a party to a contract or length,” in person. Not by mail, where Great Neck, New York 11021 in legal language, lacking “contractual the parties will never have an opportunity capacity.” In fact, courts have noted that to see one another or meaningfully be able (516) 829-3838 mental illness alone would not be a reason to assess mental state. Does this mean the to declare a contract void. In New York, credit card company wins? No. PAGE 14 MENTAL HEALTH NEWS ~ FALL 2006 The Economics of Recovery: A Column From the Center for Career Freedom
How to Understand & Access (SSA) to designate two income benefit A. There are a few simple tricks I use that programs for persons with disabilities. may be helpful: Government Entitlements Generally, to be eligible for SSDI ($900/mo avg.), a person must have 1) Define the population carefully e.g. By Donald M. Fitch, MS worked ten or more years (40 qtrs). single adults (18-64) living alone (a major Executive Director SSI recipients don’t require the same cause of confusion over the recent Medi- Center for Career Freedom work history. While SSI recipients care Part D program rules was that gov- receive on average about $200 less than ernment, community agencies & the me- he purpose of this column is to SSDI recipients (up to $689/mo). dia kept using the terms “Seniors” and assist providers and consumers They are also entitled to food stamps (up “disabled” as if these two populations to be more effective when nego- to $152) and Medicaid which includes were interchangeable). tiating with local government prescription drugs and dental. Tagencies for income, health care, housing, 2) Use the 80/20 rule i.e. you probably food, transportation, job training, employ- Q. As a Social Worker with a caseload of only need to know 20% of the ment and other social services. thirty consumers, I regularly interact with sites’ content because it usually applies to The focus is on single adults (18-64 local government units (LGU’s). I often 80% of your population. Don’t waste 80% years) with a mental and/or physical dis- find the quality of regulatory information of your time chasing down issues that ability, substance abuse issues and the varies by their caseworker. Where can I apply to 20% of your population. homeless. The information is gleaned go to find the “truth”? from government websites and local, state Q. Many of my clients don’t get enough and federal government offices. A. Unfortunately, our “mystery shop- to eat, especially towards the end of the Tips for accessing benefits are based per” (consumers interviewing their month. Aside from food stamps, where on assisting over nine hundred persons at Donald M. Fitch, MS caseworkers) research at the Center con- can they go for food? the Center. Our experience is supple- firms your experience. Our questions A. Food pantries (see yellow pages) for mented by regular mystery shopper, pro- If the patient is not disabled but needy, about Medicare Part D, Ticket to Work 1-2 bags of groceries once-twice/month, vider and consumer surveys. refer them to the local Department of So- and Food Stamp awards average fifty per- hot/cold meals at shelters, community cial Services (DSS) office cent accurate (recent surveys of IRS and agencies, Drop-ins, Club Houses and a Q. I have about fifteen minutes to spend (www.otda.stste.ny.us). To prepare for the VA hotlines found similar percentages). few houses of Worship, Restaurants with a patient, what can I do to help stabi- interview, they should acquire form We rely on the appropriate federal/state/ and day old bakeries. (One enterprising lize them in the community? #LDSS-2921. Pay particular attention to county/government agency websites or young man buys rotisserie chickens for $1 the required documentation to avoid re- state/local Commissioner inquires. around closing time) A. If the patient has a disability that ad- peated visits. versely affects their ability to work for the Q. I spend too much time trying to deci- next twelve months, refer them to the So- Q. What is the difference between per- pher “government speak”. Their sites and Please send me questions for future cial Security Administration (SSA) at 1- sons who are eligible for SSI and SSDI? publications are vague, full of caveats and columns to [email protected]. If 800-772-1213. To prepare for the inter- refer you to equally obtuse resources. your questions are used in the column you view, they should download form A. SSI and SSDI are abbreviations used How can I cut through this verbiage and will receive a complimentary copy of our #SSA-3368-BK (www.ssa.gov). by the Social Security Administration get to the facts? Case Managers’ Toolkit. □
The Center for Career Freedom
On & Off Site Computer Training for Persons with Disabilities
Microsoft® Certified Office Specialist Training Center
Licensed by NYS Department of Education
DCMH Drop-in Center
Consumer Survey Research
New 2006 Case Managers Referral Card (914) 288-9763
One East Post Road White Plains, New York 10601 www.freecenter.org MENTAL HEALTH NEWS ~ FALL 2006 PAGE 15 The NAMI-NYS Corner Providing support to families and friends of individuals with mental illness and INFOPSYCHLINE working to improve the quality of life for individuals with mental illness. A SERVICE OF THE PSYCHIATRIC SOCIETY OF WESTCHESTER www.naminys.org, Families Helping Families, Helpline: 800-950-3228 (NY
914-967-6810 This is an information and referral service sponsored by the Westchester Inspiration: Many Journeys of Recovery District Branch of the American Psychiatric Association.
Psychiatrists of this organization are dedicated to providing treatment for By J. David Seay, Esquire Mental Illness: A White Paper of the mental disorders and advocating for equal health care for mental Executive Director National Alliance on Mental Illness of and physical conditions. NAMI-New York State New York State, described in my last NAMI Corner column, is a road map for If you need information about psychiatry or assistance in finding these journeys and is must-reading for a psychiatric physician - please call us. anyone even remotely connected to some- one with a serious mental illness, includ- THE PSYCHIATRIC SOCIETY OF WESTCHESTER ing providers at every level, family mem- 555 THEODORE FREMD AVENUE • SUITE B-100 • RYE • NEW YORK bers, consumers and policy makers. The document is available at our web site www.naminys.org or copies can be ob- tained by calling our Help Line (800) 950-FACT (3228) or (518) 462-2000. Yet another inspiration-giving experi- ence comes from the In Our Own Voice program. Developed by NAMI as one its signature programs, NAMI-NYS brought IOOV to New York beginning in 2004. We work with our local affiliates to iden- tify consumers who are willing and able to go out into the community and tell their stories of their own personal jour- neys towards recovery. They speak to community groups such as churches, J. David Seay, Esquire schools, civic associations and others. They are carefully trained before launch- ing upon this particular journey and are itting at the keyboard waiting for accompanied by a NAMI video that sets inspiration to strike, it struck me the context for the In Our Own Voice that inspiration is key to what presentation. This marvelous program is S NAMI is all about. As I attended both a therapeutic and enabling program the 2006 NAMI convention in Washing- for the consumer and a public awareness ton this summer I heard many voices of raising and anti-stigma campaign at the recovery from some strikingly wonderful same time. Consumers are paid a small people – Suzanne Vogel-Scabilia, Fred stipend for each presentation and meticu- Frese, Mary Raaymakers, Phil Kirschner lous records are kept on how many pres- and many more – it dawned on me that entations were given and how many audi- for many persons with serious mental ences were reached. In New York in just illness, recovery is far more than a proc- the first six months of this year, 84 pres- ess or even an achieved state of accom- entations were given to a cumulative au- plishment or achievement of potential; it dience of nearly 2,000 people. is a journey. For them it is a many- NAMI-NYS is especially proud to faceted trip with many stops, detours and make this valuable and successful pro- u-turns along the way. While it is no va- gram available to our affiliates and their cation, neither is it necessarily a visit to various communities as we strive to “feed hell, although that is often one of many the grass roots” of our movement. If any- waypoints in the journey. I was inspired one is interested in having an In Our by the stories I heard and I know that this Own Voice presentation made or in be- inspiration is what fuels the leadership of coming an IOOV presenter, the person to our NAMI movement at every level -- contact at NAMI-NYS is Rachel Greco, local, state and national. Program and Outreach Manager, at either What family members can learn from of the phone numbers listed above. these many journeys is hope. Hope and Excitement is already building for resilience. And dogged persistence. And NAMI New York State’s 24th Annual although we cannot literally walk a mile in Meeting and Educational Conference their shoes, we can go along with them for From Research to Recovery: Improving the ride, at times helping them when they the Lives of New Yorkers with Mental get lost and at others running to keep up. Illness. It will be held at the Crowne We can share with them their travel memo- Plaza Hotel in White Plains, New York ries, both good and painful, and we can November 3-5, 2006. Please mark your marvel as they play the tour guide for us as calendars to attend. Thanks to Conference we better understand their illness, what they Chair Sherry Janowitz Grenz and the en- are going through and how we can help. tire planning scommittee, this event is These journeys encompass many land- shaping up to be the best ever, so plan to scapes. Medication compliance is one; so be there. Speakers will include Suzanne are side effects, relapse and re- Vogel-Scabilia, MD, Xavier Amador, hospitalization. Family members and Commissioner Sharon Carpinello, mental friends can help guide them along their health legislative committee chairmen way, and in fact, family members provide Senator Thomas Morahan and Assembly- the lion’s share of care management for man Peter Rivera, plus leading mental persons with serious mental illness. The illness researches and clinicians from the new publication Helping Families to Help Their Loved Ones with Serious see Inspiration on page 30 PAGE 16 MENTAL HEALTH NEWS ~ FALL 2006 A FALL 2006 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL PAGE 17
The Use of The Self in Psychotherapy
By Samuel C. Klagsbrun, MD own unique, different and separate stories. Medical Director, Four Winds Hospital Encouraging them to experience and try out behaviors as a result of our stories – hopefully leaves them with their own sychotherapy is the most belea- identities, their own experiences, as op- guered treatment option available posed to simply mimicking us. to us in the current climate. Cer- My own view of profound and com- tainly psychotherapy which takes prehensive therapy is that to the degree Ptime and which requires a one on one ap- that we can help people dream proach is expensive, long lasting and un- again…reach for visions of their popular in the managed care age we’re own…take chances…initiate ac- living through. In addition, the quick tions…then the symptoms that they strug- fixes approaches, which are favored today gle with become less of an impediment to and aimed at symptom control, have the extent that they are successful in gained enormous popularity both with reaching out more. Certainly any tech- patients as well as with professionals. nique that lessens symptoms allows fur- There is no question about the fact that ther dreams to be sought, but talking the focused techniques - the short-term about dreams is as much a part of therapy approaches, are enormously useful, practi- as is biofeedback for symptoms of phobic cal and often achieve their goals. In addi- behavior. Dreaming is part of therapy. tion, the tremendous advances of pharmaco- What works in psychotherapy? Is it therapy have successfully eased the pain of really the school of thought or the tech- many, many patients whose suffering has nique the therapist uses? Or, could it be impeded their lives as well as the lives of the relationship and the caring experi- their families for long periods of time. Pro- enced by the patient in relationship to the gress has certainly been made. therapist? For example, if you ask a pa- Why then do I bemoan the loss of the tient to describe what it is that they dislike person in this process? I find myself ex- about a therapist, you frequently hear, tremely concerned about the image we “He doesn’t seem interested. He takes have created in the field of mental health, Samuel C. Klagsbrun, MD notes and never looks at me.” On the other suggesting that our focus is on managing hand, if you ask a patient what they like about symptoms as opposed to helping a person In my own case I have over the dec- myself is based on a false image, but I a specific therapist, you would hear…“She grow and become the best he or she can ades moved away from being a relatively would argue that the positive image is understands me so well. She goes out of her be. Alleviating suffering is certainly a nota- anonymous person to using parts of my what helps you reach for new opportuni- way to make me feel comfortable.” ble goal to reach for, but is that all that we own life – where appropriate- to help im- ties and persevere in reaching for goals. A So really, it is all about the relation- started out to do in the beginning days of prove the connection between myself and positive self-image is crucial to moving on. ship, not about the school of thought that psychotherapy and psychoanalysis? my patients. In most cases for example, We have all throughout our lives iden- the therapist adheres to. If that’s true, I certainly remember in my early days patients who come into therapy often feel tified with particular people or have been how come volumes have been written and of training being profoundly inspired by like failures, as if they have dropped the inspired by certain stories. I find that research has been focused on schools of stories of clinicians who got down in the ball along the way, some place. They “telling stories” is enormously effective in thought to such a tremendous extent, as dirt with their severely ill patients wres- often feel ashamed and embarrassed and helping people move on. Again the theme opposed to an analysis of the nature of the tling with them to bring them back into have difficulty articulating those feelings. here is not symptom control but reaching relationship between patient and therapist. reality, not settling for just symptom con- This is especially true if they see their for a fuller life which is what’s been left The language used in examining the rela- trol, but reaching for a meaningful and therapist as a successful person who’s aside in current therapeutic techniques. tionship uses the words, transference or productive life for their patients. Since doing well, in charge of their life, making The use of self in therapy is obviously counter-transference, which have the im- there was nothing essentially available in decisions and being independent. The an approach fraught with problems and plication of taking the relationship and those days on a sophisticated pharmacol- contrast between their self-image and the difficulties. While we want to encourage placing it on the shoulders of past rela- ogical level, what those clinicians had was image they have of their therapist is a open communications and create an at- tionships…parental ones espe- just themselves. And so today, is there a black and white one. I frequently use my mosphere of profound understanding, we cially…almost as a way of avoiding a real role for the use of the self in doing psy- less than successful beginnings to create a certainly don’t want to have people mimic look at what goes on in the actual rela- chotherapy? We were all taught in early better connection between myself and my us, become identified with us or feel that tionship between patient and therapist. days to present a blank screen to our pa- patients, as well as a realistic and truthful they have to become our clones. In telling I emphasize that the use of the self in tients. The theory at the time had to do invitation to demonstrate people’s abili- our stories therefore, we need to find a psychotherapy applies to our self as well as with allowing our patients to delve into ties to overcome failure. tone…an avenue, which imparts images to our patients. In reviewing our own experi- themselves and reveal their inner feel- A basic sense of trust and acceptance without inviting identification. The art of ence with our patients, in listening to our own ings and thoughts…their fantasies and of who I am has been helpful in managing offering that kind of therapy is based on stories, both uplifting ones as well as depress- dreams, without being influenced by us some of the downsides of life. One might the idea of encouraging our patients to ing ones, we continue to learn, to grow, to or directed by us. argue that the positive image I have of take the message, but imbue it with their clarify and to become better therapists. □
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. P AGE 18 A FALL 2006 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL FOUR WINDS HOSPITAL ● FALL 2006 A FALL 2006 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL PAGE 19 PAGE 20 A FALL 2006 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL 10 Child Mental Health Myths
By Kevin T. Kalikow, MD rarely are these side effects of clinical least equally effective as medicine and importance. And, even then, they are of perhaps more effective in the long run. concern in the long run, not short run. For OCD, a combination of these treat- our child is hurting. You need The allegations that stimulants caused ments seems best of all. Many parents to do something, but you’re sudden death are unproven and, if proven also benefit from counseling that teaches not sure what. Your first goal to be true, would still appear to be very, them how to deal with their child’s diffi- is getting accurate information very rare. On the other hand, we must culties, regardless of whether their child Yabout the psychiatric disorders of child- never be cavalier. While much is known takes medicine. hood and their treatment. The following about the stimulants, we can always learn are 10 common myths and what you need more, for example, about their use in chil- to know. dren with underlying heart deformities. (9) My child’s medicine is so easy to use that I hardly (1) Children are too young need to see the doctor. to have psychiatric disorders. (6) Never take a medicine that has the FDA’s Black Box warning! No. Modern psychiatric medicines are often relatively safe and easy to use. No. Many years ago it was thought No. A Black Box warning is the However, all medicines carry risk. Also, that children were too young to have dis- FDA’s strongest way of pointing out that there is often little medical information orders, such as Depression. Although we a medicine has a certain risk. The FDA about the combinations of medicines that have much to learn about the psychiatric still approves of the use of the medicine many children take. In addition, many disorders of children, researchers have for treating a specific age group with a children with psychiatric disorders are at shown that children can suffer with disor- particular disorder. Some of the side ef- risk for other difficulties that require an ders such as Depression and Obsessive fects that are given black box warnings ongoing working relationship with a men- Compulsive Disorder (OCD). Illnesses, are rare. The specifics must be discussed tal health professional. such as Bipolar Disorder, also occur in Kevin T. Kalikow, MD with one’s physician. children, but their exact presentation is the (10) Too many children are taking subject of debate among physicians. (4) Anti-depressants, like Prozac, medicines, like Ritalin. make children suicidal. (7) Anti-depressants only treat Depression Yes and No. Some children are given (2) Anyone can have a little bit of Yes and No. When researchers exam- and stimulants only stimulate. psychiatric medicine too quickly when Attention Deficit or ined whether this was true, they discov- another treatment might be more effective Obsessive Compulsive Disorder. ered that none of the more than 4,400 No and No. There are a host of rea- or when, perhaps, no treatment is needed. children and adolescents studied commit- sons that medicines are classified under a Other children would benefit greatly from No. We all have characteristics that ted suicide. However, they also discov- given name, like anti-depressants, but a psychiatric medicine, but never receive make us who we are. Some of us are a bit ered that while 1-2% of those taking pla- their name does not limit what they do. one. Every parent, however, must be con- more fidgety and others more slow mov- cebo (fake medicine) developed new sui- Anti-depressants, such as Prozac, also cerned that their child is properly treated. ing. Some are fastidious and others are a cidal thoughts or made a suicidal act, 3- treat illnesses such as Panic Disorder, That means having a proper evaluation mess. But, for those with a disorder, the 4% of those taking anti-depressants did Social Anxiety Disorder and OCD. from a trusted professional with whom characteristic has become a symptom, so. They concluded that an extra 1-2% of Stimulants do not stimulate children with you can discuss the risks and benefits of something that significantly interferes children and adolescent will have in- ADHD, unless you want to look at them medicine to decide if it is the correct treat- with the person’s life. creased thoughts or acts of suicide from as stimulating the child’s brakes. Rather, ment for your child. taking these medicines. Again, there were stimulants help children focus and lower no actual suicides. So, while this is an their impulsivity. Interestingly, stimu- In short, parents should be neither (3) Children get addicted obvious concern that mandates close fol- lants also improve the focus of children overly fearful, nor cavalier about psychi- to psychiatric medicine. low-up of young people starting these and adults who do not have ADHD. atric medicine. Rather, with their physi- medicines, this risk must be weighed cian, parents must weigh the risks and No. While some of the medicines used against the risk of Depression or the other benefits of medicine against those of other in psychiatry, such as the stimulants, like disorder that is being treated. These dis- (8) If medicine helps, it’s treatments and, with their child in the bal- Ritalin, or the anti-anxiety medicines, like orders, in particular Depression, carry the only treatment my child needs. ance, decide the best treatment. Xanax, are addictive when used at doses their own risks, especially of suicide. that are higher than normally used by phy- No. Research has shown that while Kevin T. Kalikow, MD, is a Child and sicians, the responsible, physician man- (5) Stimulants, like Ritalin medicine is effective for the treatment of Adolescent Psychiatrist with a Private aged use of these medicines does not lead and Adderall, cause ADHD and Depression, treatment with Practice, in Mt. Kisco, New York. He is to addiction in children. In fact, research the sudden death of children. medicine combined with a behavioral an Assistant Clinical Professor in Child suggests that taking stimulants lowers the treatment, such as Cognitive Behavioral Psychiatry at New York Medical College, risk of drug and alcohol abuse among No. Although stimulants are well Therapy (CBT), is more effective. For and is the author of “Your Child in the adolescents and young adults with known to cause insignificant increases in disorders such as Obsessive Compulsive Balance: An Insider's Guide to the Psy- ADHD. the child’s pulse and blood pressure, Disorder, CBT has been shown to be at chiatric Medication Dilemma” □ MENTAL HEALTH NEWS ~ FALL 2006 PAGE 21 PAGE 22 MENTAL HEALTH NEWS ~ FALL 2006
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 counseling, therapy or medication, help is just a phone call away.
To put it all together, simply call 914-493-7088
B cH Behavioral Health Center Mental Health News - New York City Section: Fall 2006 Page 23 The Mental Health News New York City Section
The Healing Power of Spiritual Support Groups
By Rabbi Simkha Y. Weintraub, LCSW There is a Hebrew folk saying that a relaxation response for people who need Rabbinic Director, New York Jewish “The trouble of many is half a comfort.” healing. Herbert Benson, MD, President, Healing Center and National Center for In other words, other people who are go- Mind Body Medical Institute and Associ- Jewish Healing ot the Jewish Board of ing through similar experiences can offer ate Professor of Medicine at Harvard Family and Children’s Services (JBFCS) understanding, support and knowledge of Medical School, is a researcher who coping strategies. We can learn from each coined the term “relaxation response,” a other’s difficulties. The Talmud, a collec- physical state that alters the physical and n 1982, right after my ordination tion of ancient rabbinic writings, says that emotional response to stress. The term from the Jewish Theological Semi- “The prisoner cannot free himself from grew out of Dr. Benson’s research with nary, doctors decided to remove a jail.” In any society, at any point, a person Buddhist monks who meditated and growth on my thyroid that they had living with a serious illness feels like they achieved a lower heart rate following their Ibeen watching throughout the year. The are in a prison, isolated, punished. We meditation. A roomful of people draws doctors needed to determine if the growth need other people to help us. In the Jewish out the power of niggunim. was benign or malignant. As it turned out, tradition as in other religious traditions, Spiritual support groups offer insights the growth was malignant. I had cancer of there is a belief that there is no healing into coping with illness, and they provide the thyroid. without other people. a spiritual safety net for social, psycho- The next day a senior colleague called Sharing strategies, insights and experi- logical and emotional nurturing. It’s a to say I should tell no one of the diagnosis ences is the core of the Sustaining Our place where people can let their hair because I would not get a job as a rabbi if Spirits group, a program of the JBFCS down, fall apart and have everybody sup- it were known I had cancer. I thanked New York Jewish Healing Center in Man- port them. The groups also help people re- him, hung up the phone, and plunged into hattan for members of the Jewish commu- build their life narrative which brings us the deep doubt of now what? nity who are living with serious illness. back to where I began. I was twenty-six-years old. The group meets twice a month for an People who have a chronic, serious Rabbi Simkha Y. Weintraub, LCSW Twenty minutes later the phone rang, hour and a half. We are not organized illness need a way to integrate their physi- and it was a member of the congregation around a specific illness and our group cal challenges into their life narrative so where I was working. He said, “Simkha, us our lives should be filled with working includes people with multiple sclerosis, they can understand their experiences at a welcome to the club!” out in the gym and eating healthy diets heart disease, cancer, chronic pain and profound level. A serious illness trans- “What?” I asked. that allow us to live to be one-hundred- more. We’ve found that offering different forms one’s life story into a deeper ques- “Well, I’ve had stomach cancer, and twenty-years-old, at which point we’ll die perspectives from people coping with tion, what I speak of as, “Who lives in my another woman in the congregation had a quick death without pain. It’s a society different illnesses brings more resources name?” Spiritual support groups provide a breast cancer, another member Hodgkin’s that’s death-denying, grief-avoidant and for people to draw on. crucial role in that transformation by al- lymphoma. We needed a thyroid!” illness-adverse. The group helps people with family lowing people to hear each other’s stories, That was the best of all the calls I re- But if we talked about death, if we and personal issues and uses spiritual re- try out new ideas and learn new paths for ceived following my diagnosis. Through- were with the dying, if they weren’t sources which can be everything from their deep-rooted exploration. out the previous year of symptoms and stowed away in a hospital room, we’d get poetry to stories, psalms or rituals, wise If there’s one word that summarizes heal- medical tests, I had no one talk to. My to know death. And if we had a better sayings or ethical writings. These tools ing, it’s connection, connection to nature, to best friends tried, but they didn’t know understanding of death, we might have a help explore meaning, faith, or hope and other people, to oneself, to God, to the cos- how to handle it. I was lonely, isolated, in better acceptance of illness. That’s not to spark discussion and reflection. One com- mos. At Sustaining Our Spirits, we try to despair. Now someone had reached out say we’d rejoice in the diagnosis, but it mon purpose of prayer is to give voice to help people make the connections they who understood. would fit into a narrative, a way of under- expression beyond language. When there need. If you or someone you know is facing I tell this story because it creates a new standing life. Right now illness inter- are no words to describe feelings, the a serious illness and may be right for a Jew- narrative in a society which denies that for rupts our narrative of how life unfolds. group may turn to prayer. ish spiritual support group, please call us. every human being, since creation, there’s People who receive a diagnosis of a Niggunim, wordless chanting, is an- For more information, contact the JBFCS deterioration, physical pain and unpredict- serious illness are thrown into a tailspin; other tool we use to help group members New York Jewish Healing Center at (212) able physical challenges. Our culture tells it’s a shock. express themselves. Niggunim also create 399-2320, ext. 201. □ WLIW New York Public Television Launches Healthy Minds Series
Staff Writer tions such as Columbia University, Rocke- is to share cutting edge information from reveal for the first time intimate details about Mental Health News feller University and the Cold Spring Har- experts along with personal experiences his suicide attempt and ultimate recovery. bor Laboratory providing the latest informa- from people who have overcome psychi- Series guests also include Nobel Prize winning tion about diagnosis and treatment. Epi- atric conditions. I want people to know author and lecturer Eric Kandel and broadcast ne in ten Americans experience sodes will cover a wide range of topics, that with help, there is hope.” journalist Jane Pauley, who shares her personal some disability from a diagnos- including anxiety, stress, insomnia, chemi- “Healthy Minds reflects a core mission of struggle with bipolar disorder. able mental illness in the course cal dependency, post-traumatic stress syn- public television, providing access to informa- Healthy Minds is made possible in part O of any given year, but for many drome (PTSD), attention deficit disorder, tion that directly impacts the lives of families by NARSAD, Value Options, New York families, the fear and shame associated with Alzheimer’s Disease and schizophrenia, to in the communities we serve,” said WLIW Academy of Medicine, The van Amerin- a diagnosis often leads to suffering without bring the general public a better understand- President and General Manager Terrel Cass. gen Foundation and by the New York hope. Healthy Minds is a new weekly edu- ing of disorders that can affect anyone, at “We hope this series will serve as a resource State Office of Mental Health. cational public television series premiering any age. The series is hosted by Dr. Jeffrey for families and healthcare providers to open WLIW New York is an innovator in this fall on producing station WLIW that Borenstein, CEO and Medical Director of lines of communication.” broadcasting, production and distribution for aims to remove the stigma that can prevent Holliswood Hospital and Chair for the Sec- Healthy Minds will premiere in the New public television. WLIW has produced a patients and their families from seeking help tion on Psychiatry at the New York Acad- York metropolitan area on WLIW21 Sundays variety of programming exploring health- for mental disorders. Each half-hour episode emy of Medicine. at 11:30 am beginning September 10, 2006 care issues including The Other Drug Prob- humanizes a particular mental health condi- As Dr. Borenstein explains, “Everyone and air for 13 weeks. In the premiere episode, lem, Pharmacists: Unsung Heroes and tion through inspiring personal stories, with is touched by psychiatric conditions, ei- news veteran Mike Wallace and his wife Mary Healthcare: Healing the System. For more leading researchers and experts from institu- ther themselves or a loved one. Our goal discuss how they dealt with his depression and information, visit wliw.org. □ Page 24 Mental Health News - New York City Section: Fall 2006
Representing Mental Health Providers Who Deliver Support and Services in the Diverse Neighborhoods of New York City
Phillip Saperia Patricia Gallo Goldstein Executive Director Deputy Executive Director
Peter Campanelli, PsyD President
90 Broad Street, 8th floor, New York, NY 10004
(212) 742-1600 www.cvmha.org
Mental Health News Metro-New York Leadership Committee
Peter D. Beitchman, DSW, Executive Director The Bridge
Wendy Brennan, Executive Director NAMI - New York City Metro
Peter C. Campanelli, PsyD, President & CEO Institute for Community Living
Amy Chalfy, Mental Health Director - Bronx District JASA
Marianne Coughlin, Vice President Program Development The Mount Sinai Medical Center
Kenneth J. Dudek, Executive Director Fountain House
Mary Guardino, Founder & Executive Director Freedom From Fear
Mark D. Gustin, MBA, Senior Associate Director Kings County Hospital Center
Mary Hanrahan, LCSW, Government Relations Specialist New York Presbyterian Hospital - Payne Whitney Division
Peg Moran, LMSW, Senior Vice President F.E.G.S. Health and Human Services System
Evelyn J. Nieves, PhD, Executive Director Fordham-Tremont Community Mental Health Center
Phillip Saperia, Executive Director Coalition of Voluntary Mental Health Agencies
Alan B. Siskind, PhD, Executive Vice President & CEO Jewish Board of Family & Children’s Services
Giselle Stolper, EdM, Executive Director Mental Health Association of New York City
Jonas Waizer, PhD, Chief Operating Officer F.E.G.S. Health and Human Services System
Joyce Wale, Senior Vice President - Behavioral Health New York City Health & Hospitals Corporation
Chantal Weinhold, Executive Director North Shore LIJ Health System - Zucker Hillside Hospital Mental Health News - New York City Section: Fall 2006 Page 25 Page 26 Mental Health News - New York City Section: Fall 2006 The Psychology of Physical Illness
By Jeff Shames manage their self-care and overall health MSW Intern, New York University while reducing their healthcare costs. Institute for Community Living Such self-care factors as diet and a seden- tary lifestyle are thought to be a major factor in the increase in this disease. he National Institute of Health Being a person with diabetes can feel (NIH) notes that since 1980 the isolating. The daily challenges include percentage of obese individuals the need to carry out a treatment regimen in the United States has dou- that it is demanding and unpleasant. Tbled, from 15 percent to 30 percent of the One’s blood sugar must be monitored, and adult population. Also, in the last 20 diet adjusted accordingly. This, in a soci- years the percentage of children and ado- ety that is so oriented around the pleasure lescents who are obese has doubled. This of food consumption. Another example can also be seen with diabetes; in recent of self-care is that the diabetic must exam- years the percentage of people with diabe- ine his/her feet frequently, since even tes has increased dramatically. What was minor cuts can be dangerous to the per- once known as adult onset diabetes is now son’s health. The feet must be kept clean labeled type 2 diabetes, because it now and in comfortable shoes. diagnosed so often in children. This is There are varying views about the chal- even a more serious issue for individuals lenges of living with diabetes. One view is with mental illness. that optimistic beliefs play a significant role There is increased consciousness in adaptation (control) to chronic disease. today about the correlation between a (Fournier, de Ridder, Bensing, 2003) The person’s thoughts and attitudes and her/ authors examine optimistic beliefs that dif- his physical health. In the 1960s, after a (including eating fresh foods, and whole came a holding environment that served fer in degree of controllability, which is long career as the editor of the Saturday grains, and reducing intake of white sugar) to heal. These artists continued in their attributed to a person’s actual or perceived Review magazine, Norman Cousins can help lead to better physical condition. work in spite of the constant physical ability to control events. The authors con- became a pioneer in promoting unortho- Social supports can also improve a person’s challenges in doing so. trast the issues people face in dealing with dox ways in his day, for people to deal physical and mental health. Similarly, Tobi Zausner (1998) noted different chronic illnesses, and compare with illness. Cousins wrote a number of Similarly, positive psychology is meant that physical illness had an impact on dealing with Type I Diabetes (when a per- books, and made use of his personal to build on a person’s strengths. By exam- creativity, when examining the careers of son is born with the disease) and multiple methods of dealing with physical illness ining where a person falls on the scale of six such artists as Toulouse-Lautrec, Degas, sclerosis. Type I diabetes is perceived to be as an example for others. In fighting virtues (wisdom and knowledge, courage, and Henri Matisse. In these individuals a more controllable, since patients can im- heart disease, Cousins took massive humanity, justice, temperance and transcen- period of illness served as a time of transi- prove self-care, diet, exercise, and insulin, to doses of Vitamin C, and used laughter dence) and 24 corresponding character tion into a new period of creativity and prevent worsening symptoms of disease. as a means of dealing with pain. styles, a person’s strengths can be recog- production of new art. This is compared to Multiple Sclerosis, At UCLA, he founded the group that nized and these assets can be used in dealing Another example is present day artist which is perceived as having a lower level became The Cousins Center for Psycho- with life situations. (Peterson and Seligman, Lauren D (not her real name). From of controllability. It is a progressive disease, neuroimmunology (PNI), whose website 2004) The goal is to better understand the childhood Lauren had found a creative with fewer options for improved self-care. is at www.cousins.pni.org. There it is range of emotions that may exist. There is a outlet in painting. In adulthood she had In contrast, Snoek (et al 1999), wrote stated that Cousins believed that “a pa- correlation that people are healthier, more stopped painting. Lauren is a person with of the difficulty of dealing with diabetes tient’s psychological approach to illness successful and more socially engaged, when diabetes, and is also a consumer at a resi- on a day-to-day basis, while living a could have an effect on biological states happiness is defined as positive emotion and dence that is run by the Institute for Com- “normal” life. “Diabetes care is consid- and health. He was particularly interested pleasure, being engaged in life, and finding munity Living (ICL). ered one of the most psychologically and in the impact (on health) of positive emo- meaning in life. (Seligman, 2002) In recent years Lauren began painting behaviorally demanding of the medical tions and attitudes, such as purpose, deter- I have a close friend who self- again, at the Living Museum on the chronic illnesses.” They felt that up to mination, love, hope, faith, will to live medicated with alcohol. After getting grounds of Creedmoor Psychiatric Center 30% of patients have difficulty keeping and festivity” PNI bridges the fields of sober seven years ago, Margaret (not her in Queens. Her passion for art has been proper glycemic levels due to poor adher- behavioral science, neuroscience, immu- real name) was diagnosed with bipolar essential for helping her deal with the ence to a treatment program. Challenges nology and health. Cousins’ work may be disorder and PTSD. A number of psycho- physical and mental health challenges she include the daily need to carry out a treat- seen as a forerunner for the fields of posi- tropic medications were prescribed. Her has faced. Lauren finds that painting pro- ment regimen that it is demanding and tive psychology and health psychology. mental health is affected by her physical vides her with a reason to get out of bed unpleasant, as well as the isolation of be- In the traditional medical model, when issues, including neurological damage that in the morning, as well as an outlet for her ing a person with diabetes. a person is ill he/she seeks medical treat- affects her balance. Margaret has had a creative energy. In the spring of 2006 she Practices exist that can help diabetics ment, in order to get cured, or fixed. The difficult time accepting her physical limi- had an art exhibit at the Living Museum. face these daily challenges more easily. burden is on the medical practitioner to tations. She rails against her mental and Diabetes is a serious health issue that affects Motivational interviewing is a nonjudg- find a way to make the illness go away. physical health problems, and realizes that approximately 8% of the general population, a mental client-centered style of counseling, The idea of utilizing the patient’s inner this may make it more difficult to accept rate that has been growing rapidly in recent founded on the basic principles of ex- strengths is not a part of the process. her health concerns and take care of her- years. The rate among individuals with seri- pressing empathy, developing discrep- Health Psychology is a relatively new self. On several occasions she has ig- ous mental illness is estimated to be two or ancy, rolling with resistance, and support- branch of the field that examines how nored or pushed past her physical limits, three times this number. ing efficacy.” (La Brie, Pederson, Earley- psychological, biological and social fac- which then can have severe consequences. A thorough needs assessment was wine and Olsen, 2005) These techniques tors can influence illness and health. Her ataxia worsens during hot weather. done by ICL, in which it was learned that were developed from the transtheoretical Health psychologists seek to promote While walking her dog this summer, a large percentage of consumers at ICL model of behavior change (Prochaska & healthy lifestyle habits while reducing or Margaret had so much difficulty walk- residences with serious mental illness had DiClemente, 1994), with stages including preventing unhealthy behaviors. They ing that she had to be helped back to the one or more chronic diseases. Type II pre-contemplation, contemplation, action assist patients in coping with physical building by a neighbor. She is an exam- diabetes ranks among the most prevalent and maintenance. It is being observed if illness, and their quality of life during ple of someone who might be helped by of these chronic medical conditions, and motivational interviewing techniques are recovery. One area of the field is con- positive psychology. as many as one in four consumers are effective in helping ICL diabetic consum- cerned with how people react psychologi- What inner strengths can a person thought to be diabetic. ers with serious mental illness more easily cally to being diagnosed with a physical make use of, in dealing with physical ill- Thanks to a grant from the United face these challenges. illness. It is recognized that a person’s ness? In her dissertation Evelyn Torton Hospital Fund, ICL is conducting a Even with the strides that society has coping skills, attitude and viewpoint can Beck (2005) examines the work of Franz twelve-month pilot study to develop a made in recent decades in medical care, affect their health. Such factors as anxi- Kafka and Frida Kahlo in terms of “beta” version of a toolkit to assist these the increases in obesity and a sedentary ety and depression can affect the person’s the correlation of physical illness and diabetic consumers in taking better care of lifestyle have led to a rapid increase in immune system, thus making her/him less "psychological woundedness." Both art- themselves. Through its medical arm, diseases like diabetes. Changes in the likely to ignore self-care issues, and to ists portrayed wounds that can not be ver- Health Care Choices, ICL is utilizing edu- fields of psychology, and motivational seek medical assistance. An increase in balized but could be expressed through cation, support, and case management, in interviewing, may help in addressing physical activity and change of diet the medium of art. To Beck, their art be- the hope that these individuals will better these trends. □ Mental Health News - New York City Section: Fall 2006 Page 27 Page 28 Mental Health News - New York City Section: Fall 2006 Mental Health News - New York City Section: Fall 2006 Page 29
The Anniversary of 9/11 and Hurricane Katrina: Shows Us That Mental Health Response is Key Part of Disaster Relief
By Giselle Stolper, Executive Director hile there are moments stood by either the disaster-response that people who need help are able to The Mental Health Association when it seems as if an eon community or the affected individuals access it. [See the sidebar to learn Of New York City has passed since the attacks themselves. more about the program.] W of September 11, 2001, for The impact is evident: the World But that is only the beginning. While many New Yorkers, the memory of 9/11 Health Organization estimates a 7 to10 we hope there will never be another 9/11 remains part of our current consciousness. percent rate of moderate-to-severe long- or a natural disaster as devastating as Hur- Our reminders are constant and visceral: term psychological distress for those ex- ricane Katrina, we must still be prepared, our forever altered skyline; the tributes on posed to a disaster. For many, early inter- and mental health must be part of relief New York City’s fire trucks memorializ- vention improves the outcome, yet again and recovery planning both nationally and ing the heroes who fought to keep others and again we see that a sense of shame – locally. For starters, we need to make sure alive; the news stories about the rebuild- “Why can’t I move ahead with my life?” that mental health trauma specialists are ing efforts at ground zero or the work on – and denial – “There’s nothing wrong available and ready and that long-term the 9/11 memorial.; the anguish captured with me” – prevent people from seeking services are in place, because we know in the voices of responders and 911 dis- the help they need. that disaster-related problems do not al- patchers, frozen in time on tape. Nearly five years after 9/11, the ways emerge immediately. We must The fifth anniversary of the 9/11 at- MHA of NYC’s mental health crisis, spread information about the psychologi- tacks brings sadness, but also presents an information and referrals services hot- cal effects of trauma to de-stigmatize the opportunity to examine the mental health line, 1-800-LIFENET, still receives an need for help and ease the way for people impact of disasters. Experience shows that average of 9,000 calls a month, sev- to come forward. a disaster is not something that happens at eral times the monthly volume it re- As painful as the memory of 9/11 is, we a single point in time and then dissipates. ceived before the attacks. To date, can – and should – use it as a reminder of The psychological effects of events like more than 10,000 participants have what a caring society can do to help those 9/11 and Hurricane Katrina can be felt for enrolled in the 9/11 Mental Health and whose lives are destroyed by disaster. months, and even years. afterwards. Substance Abuse Program, which is Mental health recovery is as critically Despite the fact that trauma can cre- funded by the American Red Cross. important as regaining physical health ate psychological problems as real and As the January 2, 2007 enrollment in the aftermath. It is essential that the Giselle Stolper debilitating as a heart attack or stroke, deadline approaches, increased out- services are in place to make sure that the consequences are not always under- reach efforts are underway to ensure happens. □
A Mental Health Association of New York City Reminder: Deadline Approaching to Enroll in the 9/11 Mental Health and Substance Abuse Program
he 9/11 Mental Health and Sub- Eligible participants include those who: stance Abuse Program will • lost a family member close enrollment on January 2, 9/11 Mental Health 2007. This benefit provides • were physically injured Tfinancial assistance for people who were • lived below Canal Street directly affected by 9/11 and need help to And Substance Abuse Program • worked in the World Trade Center pay for treatment. It covers services from area – whether or not they were at the day of the attacks through December work that day 31, 2007. Please tell your friends, family Please tell your friends, family and • were evacuated from the World clients: now is the time to take advantage Trade Center area and clients: Now is the time to take of this important program. • attended a school near the World Trade Center or are the parent of a advantage of this important program Available treatment includes: child who attended a school nearby • Counseling: Support, advice and edu- • were a rescue, recovery, or recon- cation about problems you are ex- struction worker assigned to a For more information or to enroll… periencing to help change thinking or “restricted site” behavior. • were an emergency dispatcher on 9/11 or worked in the morgues serv- • Medication: Can be used to treat ing the attack sites Call 1-800-LIFENET some types of emotional problems, like depression or anxiety. • worked south of Canal Street or at Ronald Reagan Airport, and before 1-877-AYUDESE for Spanish • Substance Abuse Programs: Reha- January 11, 2002 lost a job or earned bilitation and detox services for alco- less than 70% of their pre-9/11 in- hol and drug abuse. come, or… or 1-877-990-8585 for Chinese if you are a family member or shared a • In-Patient Care: Hospitalization home with any of the people whose situa- and/or substance abuse treatment. tions are listed here. Or visit our Web site Financial assistance for treatment is ret- • Auricular Acupuncture: A therapy roactive to September 11, 2001. That means that applies acupuncture to the outer if you are eligible and you received treat- ear. It can be used for alcohol or drug ment after the initial attacks, your out-of- www.9-11MentalHealth.org abuse, or for anxiety. pocket costs may still be covered. □
PAGE 30 MENTAL HEALTH NEWS ~ FALL 2006 Inspiration from page 15 with a full description of the confer- ence, topics and speakers will be going New York State Psychiatric Institute, out right after Labor Day. the Nathan Kline Institute for Psychiat- And for your 2007 calendar, you may ric Research and others. And there will mark down Tuesday, February 20th, 2007 be a grand total of twelve separate as the NAMI-NYS 2007 Legislative workshops on topics ranging from luncheon and conference. It will be held schizophrenia and bi-polar disorder to in “the well” of the Legislative Office When you need help, Westchester Jewish Community Services is here for you managing the co-occurring disorders of building in Albany and will feature many mental illness and diabetes, a consumer prominent speakers from the New York WJCS offers comprehensive mental health services session on side effects and medication State Legislature, Office of Mental compliance, a workshop on implement- Health, NAMI-NYS leaders and others. ing cultural competence plans, as well Be there and be a part of positive change as the ever-popular “ask the doctor” and to improve the lives of New Yorkers with Out-patient Treatment for People of All Ages “ask the lawyers” sessions. Brochures serious mental illness. □ Specialized services for individuals with developmental disabilities See Page 31 - For the Mental Health News Intensive Community–based Services Upcoming Themes and Deadlines Calendar for Children and Their Families Learning Center for children and adults Want to Submit an Article or Reserve Ad Space ? Geriatric Care Call (570) 629-5960 or E-mail:[email protected] Continuing Day Treatment Mobile clinical services Heart Disease from page 1 promote adherence and behavior change that may increase the impact of available Case management to a doctor for the first time. Neverthe- pharmacological and behavioral ap- less, some people have heart attacks with- proaches to both diseases. Social Clubs out ever having any of these symptoms. Exercise is another potential pathway COMPEER Risk factors for heart disease other to reducing both depression and risk of than depression include high levels of heart disease. A recent study found that All services are offered on a non-sectarian basis cholesterol (a fat-like substance) in the participation in an exercise training pro- blood, high blood pressure, and smoking. gram was comparable to treatment with On the average, each of these doubles the an antidepressant medication (a selective chance of developing heart disease. Obe- serotonin reuptake inhibitor) for improv- Call WJCS at (914) 761-0600 sity and physical inactivity are other fac- ing depressive symptoms in older adults tors that can lead to heart disease. Regular diagnosed with major depression. Exer- exercise, good nutrition, and smoking cise, of course, is a major protective fac- cessation are key to controlling the risk tor against heart disease as well. factors for heart disease. Treatment for depression in the con- Heart disease is treated in a number of text of heart disease should be managed ways, depending on how serious it is. For by a mental health professional—for ex- You Recognize This Warning Sign, many people, heart disease is managed ample, a psychiatrist, psychologist, or with lifestyle changes and medications, clinical social worker—who is in close And You Take Action. including beta-blockers, calcium-channel communication with the physician pro- blockers, nitrates, and other classes of viding the heart disease treatment. This is drugs. Others with severe heart disease especially important when antidepressant Can You Recognize may need surgery. In any case, once heart medication is needed or prescribed, so disease develops, it requires lifelong man- that potentially harmful drug interactions A Problem With Your agement. can be avoided. In some cases, a mental health professional that specializes in Get Treatment for Depression treating individuals with depression and Child’s Mental Health co-occurring physical illnesses such as Effective treatment for depression is heart disease may be available. As Well? extremely important, as the combination While there are many different treat- of depression and heart disease is associ- ments for depression, they must be care- ated with increased sickness and death. fully chosen by a trained professional Prescription antidepressant medications, based on the circumstances of the person To Help A particularly the selective serotonin reup- and family. Recovery from depression take inhibitors, are generally well- takes time. Medications for depression Child You Know, tolerated and safe for people with heart can take several weeks to work and may disease. There are, however, possible need to be combined with ongoing psy- Call interactions among certain medications chotherapy. Not everyone responds to and side effects that require careful moni- treatment in the same way. Prescriptions (914) 636-4440 toring. Therefore, people being treated for and dosing may need to be adjusted. No heart disease who develop depression, as matter how advanced the heart disease, ext. 200 well as people in treatment for depression however, the person does not have to suf- who subsequently develop heart disease, fer from depression. Treatment can be should make sure to tell any physician effective. they visit about the full range of medica- Other mental disorders, such as bipo- tions they are taking. lar disorder (manic-depressive illness) Specific types of psychotherapy, or and anxiety disorders may occur in peo- "talk" therapy, also can relieve depres- ple with heart disease, and they too can sion. Ongoing research is investigating be effectively treated. whether these treatments also reduce the Remember, depression is a treatable associated risk of a second heart attack. disorder of the brain. Depression can be Preventive interventions based on cogni- treated in addition to whatever other ill- tive-behavior theories of depression also nesses a person might have, including merit attention as approaches for avoiding heart disease. If you think you may be adverse outcomes associated with both depressed or know someone who is, don't disorders. These interventions may help lose hope. Seek help for depression. □ MENTAL HEALTH NEWS ~ FALL 2006 PAGE 31
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HDSW HOPE HOUSE 930 Mamaroneck Avenue 100 Abendroth Avenue Mamaroneck, NY 10543 Port Chester, NY 10573 (914) 835 - 8906 (914) 939 - 2878 MENTAL HEALTH NEWS ~ FALL 2006 PAGE 33
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Credit Cards from page 13 impact upon an individual and their loved ones in dealing with inappropriate credit should give clear instructions to a trusted transactions. KASSOFF, ROBERT & LERNER, LLP person as to his/her wishes for financial Bibliography decisions if incapacity arises. A Power of Attorney will enable a concerned individual 1. Aldrich v. Bailey, 132 N.Y. 85; (Court Joan Lensky Robert, Esq. of Appeals - 1892). to deal with credit card companies or other credit providers at the onset of a period of 2. Paine v. Aldrich, 133 N.Y. 544; (Court Past Chair, New York State Bar Association incapacity. The recipient of the Power of of Appeals – 1892). Attorney, will have the legal authority to 3. Moritz v. Moritz, 153 A.D. 147; (App. Elder Law Section cancel credit cards at the time they are inap- Div., 1st Dept. – 1912). propriately issued or to engage in damage 4.Ortelere v. Teacher’s Retirement Board, control at an early stage of indebtedness. If 25 N.Y.2d 196; (Court of Appeals – it appears that the applicant is incapacitated 1969) and there are no advanced planning tools, (516) 766-7700 such as the Power of Attorney or guardian- 5. id. 6. Id. ship, credit card companies, as appropriate, 7. Padula v. State of New York, 48 should be notified that they just issued a N.Y.2d 366; (Court of Appeals – 1979); 100 Merrick Road, Suite 508 West credit card to an applicant who did not have Blatt v. Manhattan Medical Group, P.C., “contractual capacity.” The ultimate goal is 131 A.D.2d 48; ( App. Div., 1st Dept – Rockville Centre, New York 11570 to minimize the financial and emotional 1987). □ PAGE 34 MENTAL HEALTH NEWS ~ FALL 2006 Giselle Stolper from page 9 Giselle received her undergraduate de- Peter Beitchman from page 9 for Behavioral Health of New York City. gree from New York University. She at- The Institute seeks to improve quality in testimony and serving on boards and task tended graduate school at Columbia Univer- City’s non-profit mental health sector. the City’s mental health system through forces for prestigious organizations in sity, Teachers College, where she received Dr. Beitchman received a Doctorate in the dissemination of evidence-based and Albany, Washington, and New York City. her MA and Ed.M. degrees in Special Edu- Social Welfare from the City University promising practices. Dr. Beitchman just She serves on the National Institute of cation and Program Administration. of New York. He also earned a Masters completed a 6-year term as board member Mental Health Research Review Board According to Dr. Peter Campanelli, degree in Social Work from Hunter Col- and Treasurer of the National Alliance for and is a member of the New York City Chairman of the Mental Health News lege School of Social Work. For many the Mentally Ill-New York City Metro Community Services Board for many Board, “We are simply delighted to have years he was Adjunct Assistant Professor Affiliate. He was a Vice President of the years. She has written numerous reports Giselle join our board. She is key leader at Hunter College School of Social Work American Association for Psychosocial and policy briefs, and delivered lectures of the mental health community and has where he taught masters and post-masters Rehabilitation. Dr. Beitchman has been and presentations both nationally and been an ardent supporter of Mental courses in social welfare administration active with the New York City Chapter of internationally. Health News.” □ and public policy. the National Association of Social Work- In addition to his work at The Bridge, ers for many years. He currently chairs Dr. Beitchman is a Board Member of the its Fundraising Committee and serves on Coalition of Voluntary Mental Health its Finance Committee. Visit Mental Health News Online Agencies and chairs its Committee on Janet Segal, Vice Chair of the Mental Co-Occurring Psychiatric and Substance Health News Board said, “Peter will be a www.mhnews.org Abuse Disorders. He also serves on the huge asset to our organization and we are Steering Committee of the Urban Institute so excited to have him on board.” □
Cancer from page 1 • Changes in bowel or bladder habits undergoing complicated regimens for can- is in close communication with the physician • Indigestion or difficulty swallowing cer or other illnesses. providing the cancer treatment. This is espe- side effects of medications, or other envi- • Unexplained changes in weight Prescription antidepressant medica- cially important when antidepressant medica- ronmental factors. Whatever its origins, • Unusual bleeding or discharge tions are generally well-tolerated and safe tion is needed or prescribed, so that potentially depression can limit the energy needed to for people being treated for cancer. There harmful drug interactions can be avoided. In keep focused on treatment for other disor- When these or other symptoms occur, they are, however, possible interactions among some cases, a mental health professional that ders, such as cancer. are not always caused by cancer. They may some medications and side effects that specializes in treating individuals with depres- require careful monitoring. Therefore, Cancer Facts also be caused by infections, benign tumors, or sion and co-occurring physical illnesses such other problems. It is important to see a doctor people undergoing cancer treatment who as cancer may be available. Cancer can develop in any organ or tis- about any of these symptoms or about other develop depression, as well as people in While there are many different treatments sue of the body. Normally, cells grow and physical changes. Only a doctor can make a treatment for depression who subse- for depression, they must be carefully chosen quently develop cancer, should make sure divide to produce more cells only when the diagnosis. One should not wait to feel pain; by a trained professional based on the circum- to tell any physician they visit about the body needs them. But sometimes cells keep early cancer usually does not cause pain. stances of the person and family. Recovery full range of medications they are taking. dividing when new cells are not needed. Treatment for cancer depends on the type from depression takes time. Medications for These extra cells may form a mass of tissue, of cancer; the size, location, and stage of the Specific types of psychotherapy, or "talk" therapy, also can relieve depression. depression can take several weeks to work and called a tumor. Tumors can be either benign disease; the person's general health; and may need to be combined with ongoing psy- (not cancerous) or malignant (cancerous). other factors. People with cancer are often Use of herbal supplements of any kind should be discussed with a physician be- chotherapy. Not everyone responds to treat- Cells in malignant tumors are abnormal and treated by a team of specialists, which may ment in the same way. Prescriptions and dos- divide without control or order, resulting in fore they are tried. Recently, scientists include a surgeon, radiation oncologist, ing may need to be adjusted. No matter how damage to the organs or tissues they invade. have discovered that St. John's wort, an medical oncologist, and others. Most can- advanced the cancer, however, the person does Cancer cells can break away from a ma- cers are treated with surgery, radiation ther- herbal remedy sold over-the-counter and not have to suffer from depression. Treatment lignant tumor and enter the bloodstream or apy, chemotherapy, hormone therapy, or promoted as a treatment for mild depres- can be effective. the lymphatic system. This is how cancer biological therapy. One treatment method or sion, can have harmful interactions with spreads, or "metastasizes," from the original a combination of methods may be used, some other medications. Other mental disorders, such as bipolar cancer site to form new tumors in other or- depending on each person's situation. Treatment for depression can help people disorder (manic-depressive illness) and anxiety gans. The original tumor, called the primary feel better and cope better with the cancer disorders, may occur in people with cancer, cancer or primary tumor, is usually named Get Treatment for Depression treatment process. There is evidence that the and they too can be effectively treated. For more information about these and other mental for the part of the body in which it begins. lifting of a depressed mood can help en- Cancer symptoms include: At times it is taken for granted that can- hance survival. Support groups, as well as illnesses, contact NIMH. cer will induce depression, that depression is Remember, depression is a treatable disor- • Thickening or lump in the breast or any medication and/or psychotherapy for de- a normal part of dealing with cancer, or that pression, can contribute to this effect. der of the brain. Depression can be treated in other part of the body depression cannot be alleviated for a person Treatment for depression in the context of addition to whatever other illnesses a person • Obvious change in a wart or mole suffering from cancer. But these assump- cancer should be managed by a mental health might have, including cancer. If you think you • A sore that does not heal tions are false. Depression can be treated professional—for example, a psychiatrist, may be depressed or know someone who is, • Nagging cough or hoarseness and should be treated even when a person is psychologist, or clinical social worker—who don't lose hope. Seek help for depression. □
CATIE from page 12 negative (lack of involvement in activi- tients with chronic schizophrenia follow- The NIMH Clinical Antipsychotic Trials ties), depressive (sadness), and cognitive ing discontinuation of a previous atypical Of Intervention Effectiveness Study The many choices, including combina- (memory, thinking, concentration), as antipsychotic. Am J Psychiatry (CATIE) — Phase 1 Results. Available at tions, and other medications such as well as the reduction of relapse or exacer- 2006;163(4):611-622. www.nimh.nih.gov/healthinformation/cati aripiprazole (Abilify) and fluphenazine bation, and the avoidance of rehospitaliza- e_qa.cfm decanoate (Prolixin Depot), will make it tion. Optimizing functioning can only McEvoy JP, Lieberman JA, Stroup TS, et difficult to compare the different choices. come from efficacious and well-tolerated al. Effectiveness of clozapine versus olan- NIMH. Press release related to Phase 2 re- medications prescribed based on an indi- zapine, quetiapine, and risperidone in sults dated April 1, 2006 available at Decisions, Decisions, Decisions vidual’s clinical history and profile. The patients with chronic schizophrenia who www.nimh.nih.gov/press/catie_phase2.cfm variety of advantages and disadvantages did not respond to prior atypical antipsy- It is clear to everyone that a person of the various antipsychotics points to the chotic treatment. Am J Psychiatry NIMH. Questions And Answers About may respond to one medication and not need for the clinician to have access to all 2006;163(4):600-610. The NIMH Clinical Antipsychotic Trials another. From CATIE we can see differ- of them so as to make the best fit for the Of Intervention Effectiveness Study ences in large groups of patients who re- individual patient being treated. Citrome L, Stroup TS. Schizophrenia, (CATIE) — Phase 2 Results. Available at ceived these different medications. Olan- Clinical Antipsychotic Trials of Interven- www.nimh.nih.gov/healthinformation/cati zapine and clozapine appeared to do bet- Resources tion Effectiveness (CATIE) and number e_qa2.cfm ter in terms of decreasing symptoms. Zip- needed to treat: how can CATIE inform rasidone appeared to do better in terms of Lieberman JA, Stroup TS, McEvoy JP, et clinicians? International Journal of Clini- avoiding or reducing weight gain and as- al. Effectiveness of antipsychotic drugs in cal Practice 2006;60(8):933-940. Dr. Citrome is Director of the Clinical sociated problems. When clinicians tailor patients with chronic schizophrenia. N Research and Evaluation Facility at the a treatment strategy, information such as Engl J Med 2005;353(12):1209-1223. NIMH. Press release related to Phase 1 re- Nathan S Kline Institute for Psychiatric past history of response and ease of use of sults dated September 19, 2005 available at Research in Orangeburg, New York. He is medications are important too. Ultimately Stroup TS, Lieberman JA, McEvoy JP, et www.nimh.nih.gov/press/catie_release.cfm also a Professor of Psychiatry at the New the goal is reduction of symptoms, includ- al. Effectiveness of olanzapine, quetiap- York University School of Medicine in ing positive (hallucinations, delusions), ine, risperidone, and ziprasidone in pa- NIMH. Questions And Answers About New York City. □ MENTAL HEALTH NEWS ~ FALL 2006 PAGE 35 Subscribe to MHNews Advertise in MHNews
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Deadline Release Date Ad Sizes - In Inches
November 1, 2006 January 2007 (winter issue) Width Height February 1, 2007 April 2007 (spring issue) Full Page (1) 10.375 12.9 May 1, 2007 July 2007 (summer issue) August 1, 2007 October 2007 (fall issue) Half Vertical (2) 5.088 12.9
Half Horizontal (3) 10.375 6.3
6 3 4 Quarter Vertical (4) 5.088 6.3 1 2 Quarter Horizontal (5) 10.375 3.05
5 7 Eighth Vertical (6) 5.088 3.05 Full Page Half Vertical Half Horizontal Quarter V & H Eighth V & H $1,000 $750 $750 $500 $300 Eighth Horizontal (7) 10.375 1.425 PAGE 36 MENTAL HEALTH NEWS ~ FALL 2006
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