MENTAL HEALTH NEWS TM YOUR TRUSTED SOURCE OF INFORMATION, EDUCATION, ADVOCACY AND RESOURCES FALL 2008 FROM THE LOCAL, STATE, AND NATIONAL NEWS SCENE VOL. 10 NO. 4 The Interrelationship Between Physical and Mental Health
The Diabetes Co-Morbidity Initiative The Institute for Community Living Responds to Health Crisis
By Rosemarie Sultana-Cordero, LMHC Each module uses motivational tech- Jeanie Tse, MD niques to help consumers think about their and Andrew Cleek, PsyD experiences and values and how improv- ing health behaviors might be relevant to achieving life goals. An awareness of the o you know someone who is consumer’s readiness or “stage of change” living with diabetes? Most helps service providers to maintain a per- likely you do: About 1 in 3 son-centered approach throughout the people will develop diabetes process. The modules also allow consum- duringD their lifetime. Moreover, it is ers to discuss barriers to changing health more than twice as common in people behaviors, and guide problem-solving with serious mental illness when com- around those barriers. pared to the general population. The Diabetes Self-Management Work- These are some pretty staggering book is just one part of the DCI Toolkit. numbers, but here’s another wake-up The tools help both the consumer and the call: people with serious mental illness consumer’s treatment team to work to- die 25 years younger than the general gether in coordinating diabetes care. population. That puts the life expectancy These tools include the Diabetes Info of people with serious mental illness in Card, available as a pocket-sized or letter- the same ballpark as that of people in sized card. This card allows consumers to undeveloped countries like Sudan and record and track the six things they need Haiti. And one of the major causes of to know about their diabetes, made easy death is diabetes. to remember as the ABCDEF’s: A1c, a Clearly, this is a crisis! But crisis, as measure of blood glucose control, Blood we all know, is an opportunity for Why is diabetes more common in people mental illness to self-manage their diabe- pressure, Cholesterol, kiDney function, change. The Institute for Community who have mental illnesses? tes. On an organizational level, it seeks to Eye exams, and Foot exams. Living (ICL), working with the Urban develop the skills of staff working with The DCI Toolkit also includes form Institute for Behavioral Health, is proud Lifestyle factors like exercise and diet, consumers with diabetes and to improve letters that consumers can bring to their to be leading a New York State Health in addition to diabetes-related genes collaboration among health and mental primary care providers (PCP’s) and psy- Foundation-funded project, the Diabetes passed down through families, put people health providers. On a community level, chiatrists, that introduce the consumer as a Co-morbidity Initiative (DCI), to ur- at risk for developing Type 2 Diabetes. it seeks to develop awareness of the crisis DCI participant, request relevant health gently improve diabetes care for consum- The risk of developing Type 2 Diabetes is and support for people with diabetes, and information, and invite collaboration be- ers at 7 NYC agencies, including The higher for people with mental illness for a to provide easy-to-use educational materi- tween providers. Tools developed spe- Bridge, Comunilife, F.E.G.S., Jewish number of reasons. Low energy levels als to as many people as possible. cifically for mental health providers in- Board of Family and Children’s Ser- may make it difficult to be physically The DCI involves using a Diabetes clude the DCI Quik Guide, a laminated vices, William F. Ryan Community active. Changes in appetite and medica- Self-Management Workbook to help con- card with reminders on principles of per- Health Center, Services for the Under- tion side effects can make it difficult to sumers improve their diabetes self-care son-centered care provision, including tips served and Comunilife. eat a healthy diet. Some of the medica- and access quality medical care. This on ways to collaborate with consumers’ This project addresses type 2 diabetes tions used to treat mental illness have Workbook seeks to introduce a new ap- providers, family, friends and other sup- mellitus, which usually begins in adult- been shown to increase the risk for Type 2 proach in making lifestyle changes to self- ports. These and other tools are available hood and is preventable. Type 2 diabetes Diabetes. Other factors including poverty manage diabetes. Visually appealing and in English and Spanish. results from the body’s inability to keep have also been linked to increased risk. easy to read (grade 5 level), it consists of The DCI Toolkit will be introduced at a blood glucose (sugar) under control. A Furthermore, people with mental illness 9 modules designed to guide consumers in total of roughly 30 mental health programs glucose level that is too high damages rarely receive the full range of interven- setting achievable goals in the areas of: over the next two years, with an anticipated blood vessels and nerves, leading to dia- tions or coordination of care recom- 30 participants at each program. A team of • Understanding diabetes betes complications like: heart attacks, mended to prevent and treat diabetes. It’s researchers will be studying whether or not strokes, kidney failure, blindness and a complicated problem. The solution will • Caring for diabetes and mental health using the DCI Toolkit results in better foot infections (worst case: amputation). need to involve change at multiple levels: health for consumers with diabetes. Im- • Choosing healthy foods But keeping glucose in check can individuals, organizations and the com- provement in consumers’ A1c levels, a prevent complications and lead to a munity at large. • Being physically active measure of diabetes control, will be one of
longer life! The trouble is: keeping glu- • Taking medication the main indicators of whether the Toolkit cose in check is not always easy. Al- The Diabetes Co-morbidity Initiative (DCI) is effective. Changes in food choices, • Taking care of feet though medication is available to main- physical activity, foot care and smoking are tain healthy glucose levels, behavioral The DCI approaches the diabetes crisis • Checking glucose just some of the other outcomes that will changes involving diet and physical ac- on multiple levels. On the individual be studied. • Having a sick day plan tivity are also needed to manage this level, it seeks to enhance the motivation disease. and knowledge of people with serious • Quitting smoking see The Diabetes Initiative on page 37
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Mental Health News Education, Inc. To Become an Honored Sponsor Please Contact Mental Health News Education, Inc. David H. Minot, BA, Associate Director 16 Cascade Drive, Effort, Pennsylvania 18330 Mental Health News Education, Inc. E-mail: [email protected] Phone: (570) 629-5960 MENTAL HEALTH NEWS ~ FALL 2008 PAGE 3 Table of Contents
From the Publisher Our Cover Story Continued
4 Mental Health and the Economy and Our Cover Story 33 Heart Attacks: Signs, Symptoms, and Risk Factors
35 Linking Emotional and Physical Wellness to Recovery The Mental Health NewsDesk
6 Leaders Support Bilingual Mental Health Education Columns
6 Mental Health Screening for National Guard Soldiers 9 Point of View: Priorities for Physical and Mental Health
7 Center Established to Promote Best Practices 10 The NYSPA Report: Healthy Minds Series on Public TV
7 Preserving Sight for Some Patients with Diabetes 11 The Mental Health Lawyer: Guardianships and their Power
Our Cover Story: The Interrelationship Other Articles of Interest
Between Physical and Mental Health
17 Activities in Group Work with Children and Adolescents
1 The Diabetes Co-Morbidity Initiative 19 Four Winds Hospital Fall Education Supplement
13 The Effects of Depression on Physical and Mental Health 29 New Horizons for NYC Homeless Veterans
15 The Mental and Physical Health Connection 29 Tse Named to AAPA and Art Changes Perception of MR/DD 23 Improving Cultural and Linguistic Competence Mental Health News 23 Health Integration Activities in the NYC DOH & MH Upcoming Theme and Deadline Calendar Winter 2009 Issue: 24 Fountain House Members Improve Mind and Body “Understanding & Treating Posttraumatic Stress Disorder” Deadline: November 1, 2008 25 Improving Access to Health Care for Consumers Spring 2009 Issue: 25 Wellness Initiatives for People Living with Mental Illness “Follow-up Care After Psychiatric Hospitalization” Deadline: February 1, 2009
27 The Interplay Between Medical and Psychiatric Disorders Summer 2009 Issue: “Recovery and The Consumer Movement” 30 Creative Approaches Improve Health and Wellness Deadline: May 1, 2009
31 Healing From Within Fall 2009 Issue: “Understanding and Treating Families in Crisis” 33 Metabolic Syndrome and What Can You Do About It? Deadline: August 1, 2009
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Copyright © 2008 Mental Health News Education, Inc. All rights reserved. PAGE 4 MENTAL HEALTH NEWS ~ FALL 2008 From The Publisher
The Mental Health Repercussions of the Current Economy And The Interrelationship Between Physical and Mental Health
By Ira Minot, LMSW or may not react to the fear and stress As a consumer, I participated in years Founder and Executive Director brought on by traumatic external events of day-treatment programs and inpatient Mental Health News Education, Inc. can be difficult. stays in the hospital. I didn’t pay much If you think of it as a delicate tower of attention to it at the time, but looking blocks that little children have so much back, I can recall that my fellow consum- his issue of Mental Health News fun building, our mind and bodies make ers and I were all smoking way too much, explores the interrelationship up our own delicate and critical infra- were not eating healthy foods, and we between physical and mental structure. When one part of this structure were certainly not involved in any regular health. For treatment profes- begins to weaken, it can affect the other exercise programs. Overweight and chain Tsionals and service providers, this theme parts as well. As resilience to crisis varies smoking patients were the norm and what brings forth the knowledge that people tremendously from one person to another, you would see when you were in these with mental illness suffer from the ills of the stress that triggers one person’s head- programs. Our psychiatric illnesses pre- poor physical health to a much greater ache or stomach upset may cause some- vented most of us from working and earn- degree than the general population. Many one else to spiral into a deep depression. ing a decent living. Because of this, most of the articles in this issue address this Many scientists believe it all comes down consumers only had a few dollars a week troubling health crisis. As a consumer to genetics and body chemistry. We now from entitlement programs such as SSI, myself, I share this concern and have been understand that imbalances of serotonin in SSDI, Medicaid, and Medicare. What affected by it since I became ill with de- our brains are responsible for the onset of resources we did have that wasn’t going pression in 1989. Before I comment on many forms of mental illness. These re- to rent (even if you were in supportive that aspect of our theme, I can’t help but cent advances in our understanding of housing), utilities and transportation, was touch upon the mental health repercus- mental illness are leading to more effica- spent on buying inexpensive and easy to sions of the current economic crisis. cious and targeted medications used to prepare meals and cigarettes. In addition, Ira Minot, LMSW treat mental illness. This is a plus for few of us had good medical insurance The Current Economic Crisis those who suffer and continues to lead us plans and were continually short changed and The Nation’s Mental Health to understand that mental illness is a when it came to sufficient or preventive A clear example of the cost of fear and medical disease that can be treated. care. For example, few could afford or As people in communities throughout stress can be seen in soldiers returning Certainly, the tragic news reports I had insurance that covered dental health our nation are feeling the extreme pinch from Iraq and Afghanistan suffering from mentioned previously are troubling and care. When a tooth became problematic, of the economy, I find myself pausing to Posttraumatic Stress Disorders (PTSD). should cause us to be more sensitive and your only option was to have it pulled reflect upon the troubling mental health Unfortunately, we are likely to see a simi- vigilant to people going through tough rather than having a more expensive re- repercussions this is having on them. Here lar increase in cases of depression and economic times. As more and more peo- constructive or cosmetic procedure. Los- are just a few examples from recent eve- suicide in people across the nation during ple lose their homes, jobs, and fall closer ing your teeth this way is very humiliating ning news reports. these difficult economic times. to economic poverty, the mental health to consumers and certainly adds to your In one piece on the crisis in housing repercussions will surely continue to rise. already low self-esteem. These are all foreclosures, a well dressed, educated, Cause and Effect Will we be able to meet their needs and things that were brought out in the middle aged woman in Florida was sitting provide the mental health services needed NASMHPD report. in her kitchen with fear written across her Economists analyze how the stock to help them survive? One of the most important results of face. “I might be homeless in a few market responds to global fluctuations in the NASMHPD report is that it has weeks,” she replied, “Nobody seems to be the price of oil and how they are causing The Decline in Physical Health sounded a call to action in the mental able to help me, and I don’t really think the price of bread and milk at the grocery for People with Serious Mental Illness health community. In this issue, we read that anyone cares.” store to rise. Similarly, treatment profes- about several promising programs that Another piece reported on a woman sionals and mental health service provid- On the other side of this issues’ theme, hope to assist consumers in controlling from New York who managed the fam- ers understand how people’s emotional the recent “Morbidity and Mortality in diabetes, or preventing it in the first place, ily’s finances and had not told her hus- state respond to traumatic events in their People with Serious Mental Illness” report by exercising, choosing a more healthy band how badly they had fallen behind in lives. When someone loses their home or published in 2006 by the National Asso- diet and quitting smoking. These pro- their mortgage payments. Without warn- their job this cause and effect situation ciation of State Mental Health Program grams are beginning to sprout up in day- ing and with the knowledge that their triggers ripple effects in people’s physical Directors (NASMHPD), revealed a seri- treatment programs and are also following home was about to go into foreclosure, and mental health. Some people will re- ous decline in the physical health of peo- consumers in residential settings. I think she called their mortgage company to tell act with stomach upset and headaches ple with serious mental illness (SMI) this a good start, but needs to become a them that she had no other choice but to while others will fall into depression. across the United States. This report universal mind-set in mental health com- kill herself so that her family could collect As these ripple effects continue, we are found that people with SMI are dying 25 munities across the country. on the insurance and keep their home. now seeing other vital components of years earlier than the general population. Improving the assessment and treat- Soon after her call, the mortgage company state budgets in crisis due to serious de- This alarming report determined that peo- ment of SMI at the primary care level is called police to report her disturbing call. clines in revenues. Governors in many ple with SMI are falling victim to modifi- becoming increasingly important. In addi- By the time police arrived, she had al- states are now calling for departments in able risk factors such as smoking, obesity, tion, our inability to successfully house ready taken her own life. all sectors to cut budgets. These dire substance abuse, and inadequate access to people with co-occurring serious mental How sad and so real this story seemed situations are continuing to appear and are medical care. and physical disorders has caused many to to me. I know from my own experience not likely to go away quietly. Talk and As someone who survived a serious end up in nursing homes. More needs to with mental illness that there is nothing worry abounds within the mental health mental illness, I learned many things be done to enable people to live in the worse than feeling you will be unable to treatment and services community that along the way. It is alarming to me when community, and to improve access to financially support yourself and your fam- already thin operational budgets will be I think back on those years to the things I medical and dental care. By increasing the ily, or that you will lose your home and cut even more and that many programs experienced personally and what I was levels of healthcare coverage now being have no place to live. The cost of feeding throughout the nation will suffer or have able to witness firsthand within the ranks provided to people with SMI, consumers oneself (not to mention a family of three to be closed altogether. This does not of my fellow consumers in treatment. who rely on government entitlement for or four kids) has reached record highs, bode well for individuals and families Before I fell ill to depression in my late their healthcare will have a better chance and thousands of people every day are struggling with existing mental health 30’s, I was in relatively good health. I at fending off diabetes and cardiovascular being laid off from their jobs or losing problems, and for the ever increasing was a smoker, but not to the compulsive disease and live healthier and longer lives. their businesses across all levels of em- ranks of people that will be in need of degree that did develop during the darkest We are eager to hear from you, so ployment. This has surely lead to in- mental health care who are victims of the days of my 10-year ordeal. I was much please write to us at [email protected] creased feelings of fear, stress, and loss current economic crisis. thinner, did not have cardio-pulmonary and let us know what you think. for many. These negative emotions act as Because each of us has different levels disease, and did not suffer from rapidly triggers, and can cause decay in both of physical and psychological strengths, declining dental health that caused me to Good Luck in Your Recovery realms of our physical and mental health. understanding how and why people may lose many of my teeth. Have a Wonderful Fall Season !! MENTAL HEALTH NEWS ~ FALL 2008 PAGE 5 PAGE 6 MENTAL HEALTH NEWS ~ FALL 2008
MENTAL HEALTH NEWSDESK
Mental Health Leaders Meet to Support Bilingual Mental Health Education
Staff Writer Collado and Leiderman also serve on the Mental Health News MHNE Board. Keynote speakers at the event in- cluded: Arlene González-Sánchez, Com- eaders from the Latino mental missioner of the Nassau County Depart- health community met on June ment of Mental Health, Chemical Depend- 26th for the 3rd Annual Salud ency and Developmental Disabilities, Dr. Mental Latino Mental Health David Rosin, Deputy Commissioner of LLeadership Summit. The event, hosted by Mental Hygiene Services of the NYC De- the Jewish Board of Family and Chil- partment of Health and Mental Hygiene, dren’s Services (JBFCS) was designed to and Dr. Rosa Gil, President of Comunilife. demonstrate the community’s and mental A discussion session followed in health provider’s support for Salud Men- which all participants at the Summit made tal, a mental health education quarterly suggestions on how to best format the publication. Salud Mental is the metro- publication’s future goals and how to ex- NY region’s only bilingual (Spanish) pand its geographic reach. According to journal that is dedicated to providing in- Co-chair Carmen Collado, “We are ex- formation, education, advocacy and re- tremely pleased that the community has sources about mental health and substance come out to participate in this important abuse issues for individuals and families event, and many excellent ideas and sug- within the Latino community. The publi- gestions were shared in this process.” cation also targets its educational mission After a brief hiatus from its annual to treatment professionals and service ecutive Vice President and CEO of Summit were Carmen Collado, LCSW, calendar, Salud Mental plans to renew its providers to inform them about cultural JBFCS, and Dr. Peter Campanelli, Presi- Director of Immigrant and Latino Ser- publishing schedule this winter following competency and understanding the La- dent and CEO of the Institute for Commu- vices and Director of Public Policy and the successful completion of a feasibility tino/Hispanic culture and its impact on nity Living, and Chairman of the Board of Government Relations at JBFCS, and Dr. study which is expected to commence mental health services. Mental Health News Education, Inc. Leo Leiderman, Director of Latino Treat- after Labor Day. The study will engage Welcoming remarks at the Summit (MHNE), the organization which pub- ment Services at Saint Vincent Catholic were given by Paul Levine, LCSW, Ex- lishes Salud Mental. Co-chairs for the Medical Center in Westchester. Both see Bilingual Education on page 34
New York State Agencies and Vet Centers Team Up To Provide Mental Health Screening To New York’s National Guard Soldiers
By The New York State Rochester. The Soldiers returned home This latest expansion of the Yellow Michael F. Hogan, PhD, Commis- Division of Veterans Affairs this spring from a one-year mobilization Ribbon Reintegration Program involved sioner of the New York State Office of and combat tour in Afghanistan. coordination with the NYS Division of Mental Health, said: “The Office of Men- The Vet Centers started this program Veterans' Affairs and the NYS Office of tal Health is pleased to partner with the he New York State Division of with returning National Guard Soldiers in Mental Health, and the Vet Centers. Division of Veterans Affairs to offer men- Veterans Affairs and New York New Hampshire in 2004 and have since “The New York Army National Guard tal health screenings as part of the New State Office of Mental Health are extended it to Massachusetts, Connecti- launched our reintegration program to York Army National Guard Reintegration teaming up with the New York cut, Rhode Island, and Maine, said Dr. help Soldiers make the transition from full Program.” TState Division of Military and Naval Af- James Garrett, deputy regional Manager -time Soldiers back to full-time Civilian “As with all health problems, mental fairs to provide mental health screening to for the United States Department of Veter- less stressful,” said Major General Joseph health issues are best dealt with early and Citizen Soldiers returning from war zones. ans Affairs Vet Center Northeast Region. Taluto, the Adjutant General and com- close to home. Offering mental health The state agencies coordinated with “This program has been very success- mander of the New York National Guard. screenings as part of the reintegration the federal Department of Veterans Af- ful in several New England states in iden- “We welcome the efforts of the Division process will lead to early identification and fairs to plug the screening process into the tifying Soldiers with readjustment prob- of Veterans Affairs and the Office of support for those returning soldiers who existing New York Army National Guard lems and we are happy to expand it to Mental Health to make this already suc- are struggling to deal with the stresses of Yellow Ribbon Reintegration Program. New York,” Garrett said. “We consider it cessful program more effective for our deployment and war,” Hogan said. The new initiative begins this week- a real privilege to be able to speak with returning veterans.” The New York National Guard Yellow end, (August 1 and 2) with the Soldiers of these soldiers,” he added. “Adding our Vet Centers and their Ribbon Reintegration Program requires Company B, 3rd Battalion, 126th Avia- PTSD is anxiety disorder that can de- clinical screening capability into the mix Soldiers to be present for paid assemblies tion Regiment based in Rochester, N.Y. velop after exposure to a terrifying event of the National Guard's reintegration ef- at 30 and 60 days after their return from a The troops will meet with clinical rep- or ordeal such as combat operations. TBI forts takes New York's programs to assist combat zone, and invites families to at- resentatives from the U.S. Department of is related to the effects of combat action its returning Guardsmen and their Fami- tend as well. The sessions are held in a Veterans' Affairs Vet Centers to receive or wounds impacting a Soldiers' head, lies to unprecedented levels of support non-threatening, non-military environ- Post Traumatic Stress Disorder (PTSD) especially in the vicinity of improvised and care for their well-being,” said Jim ment, to provide Soldiers and families a and Traumatic Brain Injury (TBI) Medical explosive devices, artillery or rocket fire. McDonough, Director of the New York chance to share experiences and talk screening during their welcome home The Reintegration Program assures State Division of Veterans' Affairs. frankly with each other and counselors reintegration. The VA's Vet Centers that Soldiers are provided opportunities “This is exactly the type of coopera- about their experiences. across the state will support the effort for information about veterans' benefits, tion between state and federal govern- National Guard Soldiers are put back with trained and licensed staff to help education and job opportunities, available ment that our Veterans expect of us. I am in touch with people who shared and un- returning Guardsmen make the transition support networks and the military transi- pleased that the Division of Veterans' derstand their experience, at about the from Soldier to Citizen Soldier. tion from a full-time Soldier on active Affairs can be an enabler of such well- time the "honeymoon phase" of their The Soldiers will hold their Reintegra- duty back to a traditional Citizen Soldier rounded care for our returning Veterans,” tion session this Saturday, August 2, in serving in a local community. McDonough said. see Screening for Soldiers on page 34 MENTAL HEALTH NEWS ~ FALL 2008 PAGE 7
MENTAL HEALTH NEWSDESK
NYS Office of Mental Health and NYS Psychiatric Institute Establish Center to Promote Best Practices in Mental Health Services
Staff Writer Practice Technical Assistance Center will Already, EBP-TAC has begun assist- Mental health News help lead to better service outcomes for ing OMH in implementation of Well- New Yorkers with a mental illness. We ness Self Management, designed to pro- know that with appropriate treatment and mote and sustain wellness self manage- he New York State Office of supports, recovery from mental illness is ment services for adults with serious Mental Health (OMH) and the possible. We also know that there are treat- mental health problems. Wellness self New York State Psychiatric ments and interventions that have been management is a curriculum- based Institute (NYSPI) at Columbia documented by scientific research to be practice that expands upon the Illness TUniversity Medical Center, today an- effective, but oftentimes they are not being Management and Recovery practice, nounced the development of an Evidence- provided to individuals with mental illness. one of the nationally recognized evi- Based Practice Technical Assistance Cen- The Evidence-Based Practice Technical dence-based practices developed in re- ter (EBP-TAC) to build upon OMH’s plan Assistance Center will work to bridge that cent years. The program assists con- to promote the widespread availability of gap by helping to bring treatments that sumers in their recovery and results in a evidence-based practices to improve men- work to the people that need them.” fundamental change in agencies’ under- tal health services, insure accountability, Susan Essock, PhD, Director of the standing and support of recovery- and promote recovery-oriented outcomes Division of Mental Services and Policy oriented services. for consumers and families. Research, and Sharon Aungst, MS, the “The New York State Psychiatric The Center, which will be housed Center’s Associate Director, have been Institute is proud to provide leadership within NYSPI’s Division of Mental charged with seeing through its primary support to the Office of Mental Health Health Services and Policy Research, will functions, namely: building awareness, and the evidence-based practice techni- serve as a key resource to OMH and New partnership, and consensus; assisting pro- cal assistance center,” said Dr. Jeffrey York State’s public mental health system vider agencies in making organizational Lieberman, Director of the New York by spreading those practices identified as changes; supporting leadership to imple- State Psychiatric Institute. “This won- being most critical to accomplishing sys- Michael F. Hogan, PhD ment and sustain change; developing derful initiative will improve the quality tem-transformation initiatives. The part- clinical staff and supervisory competency; and effectiveness of mental health ser- nership with NYSPI provides unequalled families services that have strong evidence promoting culturally relevant adaptations; vices for thousands of citizens across access to expertise that will assist providers of success in achieving recovery. and evaluating consumer and organiza- the state. The new EBP-TAC will bring in developing the infrastructure and exper- OMH Commissioner Michael F. Ho- tional outcomes, and intervention and the latest knowledge from our science to tise needed to offer consumers and their gan, PhD, said, “The Evidence-Based implementation fidelity. help patients achieve recovery.”
Older Treatment May Be More Effective In Preserving Sight for Some Patients with Diabetes
By The National Institute is the first study to compare the long-term oid-treated group, 28 percent experienced compared to 13 percent of those in the of Health benefits of both treatments and evaluate substantial vision loss as compared to 19 laser-treated group. In addition, almost their potential side effects. While triamci- percent in the laser-treated group. In addi- half of the corticosteroid-treated group nolone was used in this study, there is no tion, about one-third of the eyes treated had increased eye pressure, which may promising new drug therapy scientific rationale at this time that one with laser therapy showed substantial lead to glaucoma. One-third of this group used to treat abnormal swelling corticosteroid preparation should be sub- improvement in vision. Laser treatment needed eye drop medications to lower in the eye—a condition called stantially different from another. had previously been perceived to prevent their eye pressure. The laser-treated group A diabetic macular edema— “Results of this study should confirm further vision loss, but not to improve had significantly less of a problem with proved less effective than traditional laser the use of laser treatment for diabetic vision. Improvements in vision were not eye pressure, as 8 percent of the group treatments in a study funded by the Na- macular edema and will have a significant found in the only prior study evaluating required eye drop medications. tional Eye Institute (NEI), part of the Na- impact on quality of life for tens of thou- laser treatment for diabetic macular edema Researchers found that, while not as tional Institutes of Health (NIH). The sands of people being treated for diabetic because most subjects enrolled in that effective as the laser treatment, corticoster- study, published online in July in the jour- macular edema in the United States each study already had good to excellent visual oid treatment did provide some benefit. nal Ophthalmology, demonstrates that year,” according to Paul A. Sieving, acuity and therefore, no room to improve. "Our findings raise the possibility that laser therapy is not only more effective M.D., Ph.D., director of the NEI. Only “Many of the investigators were sur- combining laser with corticosteroids might than corticosteroids in the long term treat- diabetic macular edema was examined as prised by the results,” said Dr. Michael Ip, produce greater benefit," said Dr. Neil ment of diabetic macular edema, but also part of this study. Macular edema from associate professor of ophthalmology at Bressler, chair of the Diabetic Retinopathy has far fewer side effects. conditions other than diabetes may re- the University of Wisconsin, and chair of Clinical Research Network and professor Between 40 and 45 percent of the 18 spond to corticosteroid treatment and laser this protocol for the Diabetic Retinopathy of ophthalmology at The Johns Hopkins million Americans diagnosed with diabe- treatment differently. Clinical Research Network (DRCR.net). University. The Diabetic Retinopathy tes have vision problems, such as diabetic A total of 693 patients with diabetic “These findings substantiate the impor- Clinical Research Network is conducting a macular edema. This condition occurs macular edema participated in the study at tance of laser treatment in the manage- study that is comparing a combination of when the center part of the eye's retina 88 sites across the United States. Each ment of diabetic macular edema.” The corticosteroids and laser with laser alone. called the macula swells — possibly lead- person was randomly assigned to corticos- DRCR.net is a collaborative network, For more information on the Diabetic ing to blindness. Ophthalmologists tradi- teroid or traditional laser treatment. Fol- supported by the NEI, dedicated to facili- Retinopathy Clinical Research Network tionally use lasers to reduce the swelling lowing the treatment, investigators tested tating multicenter clinical research of dia- visit www.drcr.net. The National Eye in areas of the macula. However, starting each patient to determine whether the betic retinopathy, diabetic macular edema Institute (NEI) is the lead agency for vi- around five years ago, early reports of procedure had prevented substantial vi- and associated conditions. sion research that leads to sight-saving success in treating diabetic macular sion loss. Investigators defined substantial The corticosteroid-treated group was treatments and plays a key role in reduc- edema with injections of a corticosteroid vision loss as reading at least two less also far more likely to experience side ing visual impairment and blindness. For called triamcinolone led to the rise in lines on a standard eye chart two years effects. In fact, 51 percent of the corticos- more information, visit the NEI Website popularity of this alternative therapy. This after entering the study. In the corticoster- teroid-treated group had cataract surgery at www.nei.nih.gov/. PAGE 8 MENTAL HEALTH NEWS ~ FALL 2008 MENTAL HEALTH NEWS ~ FALL 2008 PAGE 9 POINTPOINT OFOF VIEVIEWW
Physical Health Should Be a Priority of the Mental Health System and Mental Health Should Be a Priority of the Health System
By Michael B. Friedman, LMSW is spent are not just disabled, but people in which federal and state governments with co-occurring serious health, mental have approached reducing Medicaid costs health, and substance use disorders. This is by decreasing the number of people ver the past couple of years, it is true for all age groups—children, work- eligible for Medicaid. This includes mak- has become increasingly clear ing age adults, and older adults. ing it more difficult for people to transfer that physical health needs to be It appears that many of these people assets so as to become eligible for Medi- O a priority of the mental health get intensive health and mental health caid prior to becoming impoverished. system and that mental health needs to be services intermittently. A crisis brings The other major effort is to reduce a priority of the health system. Why it them to emergency rooms and to long utilization of nursing homes by enabling took so long to realize this is not entirely periods of hospitalization, after which people to remain in their own homes clear to me, because the basic facts have they often disappear for a while, only to re longer. Both home health care, case man- been known for quite some time. In part, -emerge in crisis later. Many have not agement in the home, and day care are it’s that we’ve all been busy with other gotten the services that might sustain intended to do that. This process is important matters like building an array of them in relative health in the interim. known sometimes as “long-term care re- mental health services and supports to Clearly, integrated physical health, form” and sometimes as “long-term care enable people with serious mental illness mental health, and substance abuse ser- restructuring.” (It is important to note that to live in the community. The develop- vices are needed at all points of contact this restructuring effort is done not only to ment of housing, rehabilitation, outpatient with this population—in emergency save Medicaid dollars, but also to make it treatment, inpatient services in general rooms, during inpatient care, and in com- possible for people to live where they want hospitals, improved quality of care in state munity-based services. Outreach is par- to live—generally in the community.) hospitals, case management, and assertive ticularly important to this population. The success of long-term care restruc- outreach into the community have all What’s tricky about this is that a num- turing depends, of course, on identifying been—and still are—vital areas of devel- Michael B. Friedman, LMSW ber of studies have indicated that provid- and addressing the reasons why people go opment for the mental health system. The ing integrated services to everyone with to nursing homes, and public policy seems other reason for the delay, of course, has serious co-occurring disorders does not to be built on the notion that people go to been the perception that the health system cation that life expectancy has gone result in cost savings—although it does nursing homes because of physical dis- is responsible for physical health and the down over the past quarter of a century, improve lives for no or very little addi- abilities, including Alzheimer’s disease. mental health system is responsible for a period during which there has been a tional cost. As a result, Professor Billings This, however, is a very partial truth. 50% mental health. Neither system thought of considerable reduction of inpatient ser- and others have been working on the de- or more of people in nursing homes have itself as responsible for the considerable vices and a growth of community-based velopment of a method to predict who mental illnesses, such as depression, anxi- overlap between the two. So money didn’t mental health services. will be the high cost cases in the near fu- ety, and psychoses in addition to physical get invested in integrated services. Although there have been different ture, which could be used to target ser- disabilities. And many are there only be- Why is it so important that policy shift emphases on the causes of low life expec- vices to those people. This, hopefully, cause of mental disabilities. Sadly these to emphasize integration of physical and tancy in different studies, it is reasonably would reduce costs and make it possible conditions are often ineffectively addressed mental health services? A number of rea- clear that they include poor health, poor to reinvest the savings over time in in- before placement in nursing homes as well sons have emerged including: (1) The low health care, exposure to the risks of street creasing services to more and more peo- as when people are in the homes. life expectancy of people with severe, life, suicide, and “accidents”, often over- ple. Of course, it’s also possible that the The most important reasons why long-term mental illnesses, (2) the cost of doses of medication. state would take the savings so as to re- many—perhaps most—people are in nurs- care for, and the suffering of, people with A comprehensive approach to increas- duce the state budget. ing homes are (1) that their behavior cre- co-occurring severe behavioral and physi- ing life expectancy needs to address all of ates a mix of risks and annoyances that cal disorders, (3) the impact of mental and these causes. But attention to health is Chronic Health Problems those providing support in the community substance abuse disorders on the out- particularly important. People with seri- can’t handle, (2) that they don’t have fami- comes for people with serious, chronic ous mental illness are at high risk of obe- More and more studies done over the lies that can provide the supportive care physical health disorders—such as diabe- sity (in part because of the medications past decade indicate that people who have they need in the community, and (3) that tes, (4) the large part that mental and be- they take), hypertension, diabetes, heart chronic physical illnesses such as diabe- there are not enough alternatives to hous- havioral disorders play in the placement disease, pulmonary problems, and com- tes, heart disease, and neuro-muscular ing people with disabilities in institutions. of people in nursing homes, which are municable diseases such as HIV/AIDS. disorders with co-occurring depression The placement of people with designed for people with physical disabili- Addressing these issues with preventive are (1) at much higher risk for disability “difficult” behaviors in institutions re- ties but occupied by a lot of people with interventions such as diet and exercise is and premature mortality and (2) have flects in large part the inadequate training mental and behavioral problems, and (5) at least as important as improving health much higher costs for their physical of staff who provide services in the home the fact that most people with mental dis- care for this population. health care than people with the same to deal with mental and behavioral prob- orders go first to their primary care physi- chronic conditions who are not depressed. lems. There is little doubt in my mind cians, who, unfortunately, often fail to High Cost Cases Unfortunately, neither primary care that the development of home care pro- identify mental illness or to treat it ade- physicians nor medical specialists gener- viders and day care workers with special- quately. The rising cost of health care has be- ally have expertise in identifying or treat- ized expertise would significantly reduce come a matter of major social concern— ing mental and/or substance use disorders referrals to institutions. Low Life Expectancy even for the Presidential candidates. At that can seriously complicate their pa- Similarly, I have no doubt that provid- the state level the primary concern is tients’ physical health. The solutions? ing support for family caregivers—who It has been known for a quarter century Medicaid costs. We have known for some Better prepared health care providers and provide 80% of the care for people with or more that people with serious, long- time that a small portion of the covered increased collaboration between health and disabilities—would result in sustaining term mental illnesses have a lower life population incurs the vast majority of the mental health professionals. More on this people in places they want to live in the expectancy than the general population. costs of Medicaid. (The 20-80 rule-of- in my comments on primary care below. community. Some disabled older adults Until recently the number most often thumb appears to be a modern metaphysi- don’t have family, of course. In other claimed was 10 years—a matter of great cal principle.) We have also known for Long-Term Care cases families who have tried their very concern. But a recent study has resulted years that people with disabilities and best to provide care ultimately burn out. in the truly alarming claim that life expec- older people receive the most costly care In the effort to contain the costs of They are at high risk for depression, anxi- tancy is 25 years lower for this popula- (not to be confused with the best care.) Medicaid, one of the major targets is long ety disorders, and physical illnesses that tion. I’m not sure why the number has Recently, John Billings did a study of -term care, which includes not only nurs- rob them of their ability to bear the stress. changed so dramatically. Let’s hope it’s Medicaid spending in NYC that revealed ing homes but also day care, case man- an artifact of research rather than an indi- that the people on whom the most money agement, and home health care. One way see A Priority on page 34 PAGE 10 MENTAL HEALTH NEWS ~ FALL 2008
The NYSPA Report: Healthy Minds Series on NY Public Television’s WLIW 21
By Jeffrey Borenstein, MD Manager Terrel Cass. “We hope this se- Malaspian of NYU, Dr. Alice Medalia of CEO and Medical Director ries will serve as a resource for families the Lieber Center at Columbia, and Dr. Holliswood Hospital and healthcare providers to open lines of Judy Rapaport of the National Institute communication.” Healthy Minds is made of Mental Health. We also will have in- possible in part by NARSAD, Value Op- terviews with Dominic Carter of the ca- am privileged to serve as the host of tions, New York Academy of Medicine, ble news channel, NY 1, who speaks Healthy Minds, a public television The van Ameringen Foundation and by about his mother who had schizophrenia series which premiered in the Fall of the New York State Office of Mental and William Cope Moyers, who is the 2006 on producing station WLIW, Health. The series is available for broad- Executive Director at Hazeldon, who ChannelI 21. As a psychiatrist and as an speaks about his recovery from chemical cast on other Public Televisions Stations. active member of the New York State Your local station can contact the Execu- dependency. The second season is sched- Psychiatric Association, I am very much tive Producer, Theresa Statz-Smith (516- uled to premier on Sunday, October 12 at aware of the importance of educational 367-2100, ext. 8481; [email protected]). 9:30 a.m. outreach to the public. I believe that in All thirteen episodes of season one can be the past, we as a field, have not been pro- viewed on line at www.wliw.org/ Dr. Jeffrey Borenstein, a board certi- active in reaching out to the public using healthyminds. fied psychiatrist, is the CEO/Medical Di- the powerful medium of television. For We are currently in production for a rector of Holliswood Hospital. He is a this reason, I worked to help create and second season. We are working on a two- graduate of Harvard University and New develop the Healthy Minds television part episode on the important topic of York University School of Medicine. Dr. series. The series aims to remove the autism and the autism spectrum disorders. Borenstein serves as the Chair of the stigma that can prevent patients and their This will include interviews with families, Mental Health Services Council of New families from seeking help for mental educators, and experts. The goal is to York State and on the Commissioner’s disorders. Everyone is touched by psychi- shed light on this condition, especially Medical Advisory Panel of the Office of atric conditions, either themselves or a what steps families can take to ensure that Alcoholism and Substance Abuse Ser- loved one. I want people to know that Jeffrey Borenstein, MD their child reaches their highest potential. vices. Dr. Borenstein serves as the Editor with help, there is hope. I have had the Guests for the second season include: of Psychiatric Quarterly and as the Editor opportunity to interview people who share Commissioner Michael F. Hogan of the of the New York State Psychiatric Asso- their personal experiences and have also get through the stress of a loved one’s NYS Office of Mental Health, Commis- ciation Bulletin. He also serves as the interviewed leading researchers and ex- illness. Mike spoke about how treatment sioner Karen M. Carpenter-Palumbo of President of the National Association of perts who provide the latest up-to-date -- medication and talk therapy -- helped the NYS Office of Alcoholism and Sub- Psychiatric Health Systems and is a Fel- information about diagnosis and treat- him recover from depression. He also stance Abuse, Dr. Lloyd Sederer, Medi- low of the New York Academy of Medicine ment. Episodes cover a wide range of spoke about the importance of exercise cal Director of NYS OMH, Dr. Jeffrey and serves as the Chair of the Section on topics, including schizophrenia, bipolar and how staying active also helped his Lieberman of Columbia, Dr. Dolores Psychiatry at the Academy. disorder, depression, post traumatic stress recovery. Most striking to me is that with
disorder, Alzheimer’s Disease, chemical treatment Mike has had many years of a dependency, attention deficit disorder, full, healthy and happy life.
anxiety disorders, insomnia, and suicide I also interviewed Jane Pauley, who prevention. shared her experience with bipolar disor- The response to the series has been der. Jane has also spoken publicly about New York State beyond my wildest dreams. I have re- her illness and in the interview shared ceived many e-mails and phone calls from personal feelings about how her illness Psychiatric Association people who have seen the show and have affected her family. She spoke about be- been touched by our message. A common ing diagnosed with bipolar disorder and theme is that the show has helped to open what this meant to her and her family. up conversations among family mem- She shared what it was like for her to be Area II of the American Psychiatric Association bers—silence has been replaced by com- hospitalized and her ultimate recovery. munication among loved ones. The se- Jane shared her insights about ongoing Representing 4500 Psychiatrists in New York ries has struck a chord with the public. treatment for bipolar disorder and by ex- People are hungry for information – pre- tension other psychiatric conditions. She sented in a thoughtful, user-friendly way – is very much aware of potential early Advancing the Scientific about psychiatric conditions. I am pleased symptoms and will intervene at the earli- that my vision of reaching out to the pub- est signs of trouble. She spoke about the and Ethical Practice of Psychiatric Medicine lic through television has helped to reduce importance of sleep, making sure she had stigma and encourage people to seek help a good routine to insure a full night’s rather than suffer in silence. sleep and also the importance of dealing Advocating for Full Parity In the premier episode, I had the op- with stress. She has avoided a relapse by portunity to interview veteran news re- carefully monitoring her condition. in the Treatment of Mental Illness porter Mike Wallace and his wife Mary in In addition to well known people, I also the intimacy of their home. Mike has had the opportunity to interview other peo- written about and spoken about his ex- ple who have recovered from psychiatric Advancing the Principle that all Persons perience with depression, but during the conditions as well as family members. The interview both Mike and Mary spoke in experts who participated include two No- with Mental Illness Deserve an Evaluation very great detail about what it was like to ble Laurettes – Dr. Eric Kandel of Colum- live with depression. They spoke about bia University and Dr. Paul Greengard of with a Psychiatric Physician to Determine Mike’s suicide attempt which resulted in a Rockerfeller University. hospitalization. He spoke about the issue The first season of Healthy Minds was Appropriate Care and Treatment of stigma – his own physician said he honored with four prestigious Telly should not publicly acknowledge his treat- Awards. Tellys recognize the very best ment for depression – “it would be bad for local, regional, and cable television pro- your image.” Mary spoke about how dif- grams, as well as video and film produc- Please Visit Our Website At: ficult it is for the spouse of a person with tions. “Healthy Minds reflects a core mis- depression. How the spouse can feel iso- sion of public television, providing access lated from friends. She even recom- to information that directly impacts the www.nyspsych.org mended that family members consider lives of families in the communities we getting treatment for themselves to help serve,” said WLIW President and General MENTAL HEALTH NEWS ~ FALL 2008 PAGE 11
THE MENTAL HEALTH LAWYER
Guardianships for Incapacitated Persons and The Limitations On a Guardian’s Ability to Consent To or Refuse Psychiatric Treatment
By Douglas K. Stern, Esq. sell property, pay bills, and apply for actually allows for a guardian to be granted and Carolyn Reinach-Wolf, Esq. government benefits. This is certainly not the power to “consent to or refuse generally an exhaustive list of powers. As stated accepted routine or major medical treat- earlier, the court can grant as wide or nar- ment”, which includes “the administration any times people lose the row a set of powers to the guardian as the of psychotropic medication or ECT”. capacity to make personal court deems necessary in order to meet However, despite this clear language in and financial decisions on the particular functional capabilities and the statute, New York courts have con- their own behalf. Often limitations of the alleged Incapacitated cluded that this power cannot be granted timesM this occurs as a result of declining to a guardian. In other words, the courts Person. mental faculties, such as when the person have interpreted the statute so as to re- reaches an advanced age, suffers from Limitations on A Guardian’s Power move this authority and therefore, a court mental illness, or experiences traumatic or As it Relates to Psychiatric Care and cannot grant a guardian the authority to unexpected injury. Regardless of the rea- Treatment and End of Life Issues accept or reject psychiatric treatment on son, when an individual loses the ability behalf of an incapacitated person. While a to make decisions on their own someone Article 81, specifically excludes the guardian cannot be granted this power, if must step in to act as a surrogate and power to involuntarily commit an individ- the incapacitated person is involuntarily make these necessary decisions for the ual to a psychiatric institution. While a confined to a psychiatric hospital, the person who no lacks the mental or physi- guardian may have the general power to hospital can apply to the court for an or- cal capacity to do so on their own. These choose the place where the incapacitated der to treat the person with medication or decisions can include where to live, what person may live, this does not include ECT over the person’s objection. medical procedures are appropriate, can involuntary psychiatric hospitalization. If The Court’s reasoning for removing and how should the person travel, as well the guardian believes the Incapacitated this authority from the guardianship law as simple financial transactions such as Person for whom he or she is responsible was based upon prior case law regarding banking and the payment of bills. Under requires care and treatment in a psychiat- the involuntary treatment of psychiatric New York State Mental Hygiene Law, Douglas K. Stern, Esq. ric hospital the guardian must pursue op- patients. In a landmark case, Rivers v. Article 81, someone concerned with the tions available in Article 9 of the Mental Katz, the Court of Appeals, New York’s welfare of a person who is alleged to have such a way so as to eliminate a guardian’s Hygiene Law, which govern involuntary highest court, concluded that only if a lost the capacity to make decisions for ability to possess this authority. psychiatric treatment. court finds that a person (1) lacks the ca- him or herself (“alleged Incapacitated This article will discuss, in broad More controversial has been a guard- pacity to make a reasoned decision re- Person”) can petition the Court to have a terms, what is required for a court to ap- ian’s power to consent to or refuse treat- garding the risks and benefits of the pro- guardian appointed to make many if not point a guardian to make personal and/or ment of the Incapacitated Person with posed medication, (2) the benefits of the all of these decisions. financial decisions for an Incapacitated psychiatric medications and/or ECT treat- Article 81 of the Mental Hygiene Law Person. It will also discuss the limitations ment. The guardianship statute, as written, see Guardians on page 13 permits the appointment of a guardian for on a guardian’s authority as it relates to an Incapacitated Person to oversee finan- psychiatric treatment and end of life deci- cial and/or health care decision making. sions and the reasons for these limitations. The court has discretion to grant as broad Carolyn Reinach Wolf, Esq. or as limited an array of powers as When a Guardian May Be Appointed and Douglas K. Stern, Esq. of deemed necessary in order to protect the health and finances of the alleged inca- A court may appoint a guardian when pacitated person. Prior to the enactment it is presented with facts which convince ABRAMS, FENSTERMAN, FENSTERMAN, EISMAN, of Article 81 in 1993, the law only al- the court, by clear and convincing evi- GREENBERG, FORMATO & EINIGER, LLP lowed for a heavy handed and clumsy, all dence, that the subject of the guardianship or nothing, framework. The court could is likely to suffer harm because: (1) the Attorneys at Law only deem the alleged incapacitated per- person is unable to care for their personal son either capable to make decisions for or property needs; and (2) the person can- Devoted to the Practice of Mental Health Law him or herself or, totally incapacitated not adequately understand and appreciate without the ability to make any decisions the nature and consequences of their own The Firm represents more than twenty major medical centers, whatsoever. With the passage of Article inability. In addition, if the person recog- as well as community hospitals, nursing homes and outpatient clinics, 81, the law now permits the court to nar- nizes their own need for assistance with in the New York metropolitan area in the field of mental health litigation, rowly tailor the powers a guardian pos- personal and financial decisions and con- consultation, advocacy, and related disciplines. sesses to fit the capabilities and limita- sents to the appointment of a guardian the tions of the alleged incapacitated person. court can provide them with a guardian in In addition, our team of attorneys, with more than forty years combined The efficacy of Article 81 lies in its flexi- accordance with the person’s functional experience, offers legal representation to families and individuals affected bility, allowing judicial decision makers limitations and ability to manage his or to tailor a guardianship individually to the her property. by mental illness. We provide a broad range of legal services and counsel on case at hand. The court, in reaching a decision on such matters as: mental health case management and continuity of care; Despite the seemingly amenable nature incapacity, will take into account the per- discharge planning; Assisted Outpatient Treatment (Kendra’s Law); of Article 81, designed to fit any particu- son’s functional limitations and abilities, Mental Health Warrants; Hospital Treatment over Objection and lar situation, outside the laws purview is such as managing his or her activities of Retentions; Patients’ Rights and Guardianships. psychiatric care and treatment in an in- daily living (dressing, feeding, toileting, patient setting as well as providing psy- etc.). Moreover, the court will also take Our firm regularly contributes to a number of publications concerned with chiatric medication to an individual over into consideration the persons wishes, Mental Health and related Health Care issues and participates in seminars their objection. This is true both for psy- preferences, value choices. and presentations to professional organizations and community groups. chotropic medication and electro-convulsive Some powers the court may grant to a therapy (ECT). As the statute is written, guardian are the power to make gifts, de- Article 81 would appear to allow for a cide where the person can live, make de- 220 E. 42nd Street - Suite 505 1111 Marcus Avenue - Suite 107 guardian to make decisions regarding cisions regarding major medical treat- New York, New York 10017 Lake Success, New York 11042 psychiatric medications and ECT. How- ment, decide if the person can travel or (212) 279-9200 (516) 829-3838 ever, courts have interpreted the statute in have a driver’s license, initiate lawsuits, PAGE 12 MENTAL HEALTH NEWS ~ FALL 2008 MENTAL HEALTH NEWS ~ FALL 2008 PAGE 13 The Effects of Depression on Physical and Mental Health
By Lisette Rodriguez, MS, APRN ployment, disability and low work per- Patient Care Director, The Women's Program formance in individuals who are de- NewYork Presbyterian - Westchester Division pressed. People diagnosed with depres- sion have general medical costs twice those of healthy individuals and visit hos- epression is a significant and pital emergency rooms with significantly pervasive problem across edu- greater frequency (U.S. Department of cational, socioeconomic, racial Health & Human Services, 2001). Ac- and ethnic groups. The Diag- cording to the National Institute of Mental nosticD and Statistical Manual Fourth Edi- Health (2006), the cost of depression in tion (DSM IV) has helped to standardize the United States is estimated to be 83 the definition of depression across prac- billion dollars which has a tremendous tice disciplines such as medicine, psychia- economic impact to society. try, nursing and social work. Depression Well-known Psychiatrist and Theorist is defined as a mood disorder or a sad Aaron T. Beck explains depression within affective state with loss of pleasure or the context of an affective state that can interest in activities for a period of two be regarded as the consequence which the weeks or more. This disorder is unrelated individual views self, views the world and to the effects of a substance or bereave- views the future. A negative view of one- ment and can manifest itself as a single or self, the world and the future therefore, recurrent episode (American Psychiatric are the three components of the cognitive Association, 1994). To be diagnosed with triad that lead to depression. depression, according to the DSM IV, the The gold standard therapy for depres- following five or more symptoms need to Depression can lead to serious physical leading causes of death in ages 10-64 sion is Beck’s Cognitive Behavioral Ther- be present: persistent sadness, insomnia, consequences for individuals affected by years old in the United States (CDC, apy which is touted to be effective and irritability, low self esteem, appetite the disorder. The risk of death from heart 2005). Approximately 50% of depressed teachable with relative ease. The premise changes, worthlessness, loss of interest, or disease, stroke or respiratory disorder is persons report feelings of wanting to die, behind Cognitive Behavioral Therapy is thoughts of suicide. higher among people with depression as 33 % consider suicide and 8.8 % attempt to replace and/or reframe negatively bi- Women, in particular, have diverse depressed people are more likely to en- suicide (Hasin, Goodwin, Stinson, & ased or distorted views with more realis- needs in relation to their emotional and gage in behaviors such as smoking, drug Grant, 2005). Approximately 90% of tic, achievable, adaptive, and pleasure mental health. Quite often women occupy use, overuse of alcohol, limited or no ex- those who commit suicide are depressed giving views. The goal is to help de- various social roles such as wife, mother, ercise and poor nutrition (Sederer et al. (Gaynes et al. 2004). pressed individual feel less depressed as caretaker and professional to name just a 2007). In addition, depression can lead to According to World Health Organiza- negative thoughts are reframed into more few. These roles can be complex and lost worker productivity, disability, unem- tion (2000), depression is the fourth most positive ones. This therapy, combined stressful as women are juggling multiple ployment, poor physical health and sui- disabling illness worldwide. The cost of with antidepressant medications, has been responsibilities among their own needs. cide (Greenberg, Stiglin, Finkelstein & depression to society is also quite substan- proven to be effective in treating depres- This commonly results in women’s own Berndt, 1993). tial when factoring in increased use of sion and restoring mental and emotional needs being pushed aside to care for oth- Suicide is another serous consequence expensive emergency services, inpatient well-being, and as a result, physical health ers and depression sets in. of depression and it is one of the top ten care, high Medicaid utilization, unem- as well.
Guardians from page 11 pacity in order to be able to make a rea- guardianship law did not alter the legal treatment. It should be noted, that general soned decision about the risks and bene- landscape in this area. A guardian may be perceptions or intuitions regarding the proposed medication outweigh the risks, fits of the psychiatric medication and/or provided this daunting authority. How- person’s wishes on life sustaining treat- and (3) there is no less intrusive alterna- ECT. More importantly however, the ever, a guardian may only be granted this ment, or the wishes of family or the tive, can medication be given to an indi- guardianship statute provides no mecha- power where there is clear and convincing guardian as to what they would choose, vidual over their objection. nism to weigh the risks and benefits of evidence that these were the prior ex- will not suffice, no matter how close the Comparing the decision in Rivers v. the proposed medication or to reach deci- pressed wishes of the Incapacitated Per- third party decision maker is to the infirm Katz and the guardianship law, the Court sions about whether there are less restric- son. Such clear and convincing evidence individual. Moreover, where a guardian concluded that they are incompatible. tive alternatives than the treatment re- can be in the form of a prior written docu- wishes to withhold, or withdraw, such First, a guardian may be granted the quested. As mentioned earlier, both of ment when the person had capacity, such treatment, the guardian must return to power to make medical decisions for an these considerations are required under as a health care proxy, living will, or do court for this specific grant of authority. indefinite period of time. As a result, it is Rivers v. Katz. not resuscitate order. In addition, evi- This is true even if at the time of appoint- possible that at the time the proposed in- Another controversial topic revolves dence can also be presented to the court in ment the guardian was granted the widest voluntary psychiatric medication or treat- around a guardian’s authority to make the form of verbal expressions, such as swath of authority. ment is proposed the individual in ques- decisions regarding life sustaining treat- specific conversations had with the person tion may have regained at least some ca- ment. Simply put, the enactment of the who is to be deprived of life sustaining see Guardians on page 36 PAGE 14 MENTAL HEALTH NEWS ~ FALL 2008 MENTAL HEALTH NEWS ~ FALL 2008 PAGE 15 The Mental and Physical Health Connection: Visiting Nurses Services in Westchester Treats The “Whole Person”
Staff Writer sessive compulsion disorder are ranked Mental Health News among the ten leading causes of disability. These disorders cause such distress and a reduced ability to function in every-day lmost 60 years ago, the World life. People with mental illness suffer Health Organization (WHO) debilitating effects, affecting family, rela- defined health as “a state of tionships and employment. Mind and A complete physical, mental and body are inseparable, and we cannot treat social well being and not merely the ab- one effectively without treating the other. sence of disease or infirmity.” The choice between good or bad behav- This definition has opened the doors to iors and habits rests largely on a person’s an increased understanding of the inter- mental state of mind. “The WHO notes relationship between physical and mental that mental health is now recognized as an health. Mental health problems are real. essential and inseparable part of health” – They affect one’s thoughts, body, feelings Cayman News, October 2005, by Kiran and behavior. These feelings and behav- Kuman. Especially important is for iors are not just a passing phase, they can women to recognize that they are affected be severe enough to seriously interfere twice as often as males by depression, with a person’s life. anxiety and eating disorders. There is now sufficient evidence on the Scientists are working hard to unravel relationship between mind and body. The the mystery behind the mind/body connec- relationship between physical and mental tion. The split between mind and body in health is often not recognized. More re- healthcare has been a problem for years. cently, evidence has emerged about the More recently, evidence has emerged about adverse long-term effect of untreated be- Physical symptoms can mask an underly- gated the relationship between stress and the long-term medical effects of untreated havioral disorders. Different psychologi- ing depression and may present as hyper- physical health. Stress interferes with the mental health disorders. These two dynam- cal reasons can create risks both physical tension, ulcers, allergies, and asthma. body’s ability to adapt, thereby increasing ics now suggest that we combine mental and mental. “The evidence is growing Depression can also lead to substance the likelihood of illness. Stress may be and physical health coverage—essentially stronger that states of mind can affect abuse and alcoholism. They are a major responsible for raising cholesterol levels financing both on the same basis. This physical health. Psychological factors co-occurring problem for adults with and lead to heart disease. High blood would result in a small added healthcare affect the way people experience medical mental disorders. “Adolescents with a pressure during mental stress can lead to cost at worst, and quite possibly, a net re- symptoms, even when the mind does not diagnosis of depression or bi-polar disor- blood vessel blockage – Science News, duction in total costs. affect the underlying disease process” – der have an increased risk of substance January 11, 2006. People with increased The main basic point is that it is best to Psychology Today, Mind/Body Medicine abuse and cigarette smoking. With the stress are prone to developing asthma, treat the whole person. Treating emo- by Daniel Goleman and Joel Gurin. increase in cocaine abuse, there is also an arthritis, diabetes, kidney disease, lung tional distress should be an essential part Different psychological reasons can increased risk of stroke and heart attacks.” disease and ulcers, to name a few. of the health care system. Illness of the create risks that affect cardiac health. – Science Daily, April 3, 2007, Pg. 14-16. Mind/Body Medicine describes a vari- mind remains shrouded in fear and misun- They can be classified into three catego- One in five persons, after a heart attack, ety of treatments ranging from medica- derstanding. People can be active partici- ries: Chronic, Episodic and Acute. will experience depression. It can have tions, relaxation and stress reducing tech- pants in their own health care and may be Chronic factors can play a role in the significant physical symptoms, such as niques, bio-feedback and palliates. These able to prevent disease or shorten its build up of artery-blocking plaques. unexplained aches/pains, decreased en- techniques may actually alter the course course by managing their own psycho- “Increase of blood pressure during mental ergy, increased fatigue and insomnia. of the disease itself. They will assist the logical states. stress can lead to blood vessel blockage” Relatively new attention is being paid patient in learning to control muscle ten- Basically, we need to eliminate the – Science News, December 3, 2007. to Post Partum Depression. It can affect sion and decrease the heart rate. distinction between the quality and kinds Negative emotions can also be associated up to 80% of women. The emotional Anxiety is another mental health disor- of services available for physical and with cardiac arrhythmias. Chronic long surges are believed to be from a natural der associated with panic attacks, increase mental health. As long as mental illness term effects of stress can suppress the hormone shift that occurs during preg- in blood pressure and palpitations. Persons is seen as existing separately from physi- immune system. nancy and childbirth. It can happen any- with anxiety have a higher risk of peptic cal health, then mental health will not Depression and other major mental ill- time during the first year after childbirth. ulcer disease. Eating disorder patients receive the attention it deserves. nesses can have devastating effects on a Women experience feelings of loss, sad- have a fear of gaining weight, an increase With its dedicated Mental Health person’s body. Depression can lead to ness, tearful episodes. These usually sub- in stress and anxiety related to food intake. Home Care Program, Visiting Nurse Ser- poor health as it often leaves people unmo- side within a few weeks. A more severe They may have a reduction of weight to the vices in Westchester is working actively tivated and causes high risk patients to form of mental illness is Post Partum Psy- point of severe malnutrition, cardiac abnor- toward this objective, emphasizing treat- ignore any prevention and treatments. chosis. It is a rare occurrence – 1 or 2 in malities and electrolyte imbalance. ment of the whole person with the Depression is a risk factor for the develop- every 1,000 births. Symptoms can in- Mental disorders are an immense bur- agency’s core multidisciplinary approach. ment of cardiovascular diseases and stroke. clude delusions, hallucinations and/or den in the U. S. Major depression is now For details, visit www.vns.org, call (914) Mental Health problems can exacer- obsessive thoughts. the leading cause of disability in the U.S. 682-1480 Ext. 648 or e-mail Mental- bate or produce physical problems. A great deal of research has investi- Schizophrenia, bipolar disorder and ob- [email protected]. INFOPSYCHLINE A SERVICE OF THE PSYCHIATRIC SOCIETY OF WESTCHESTER 914-967-6810 This is an information and referral service sponsored by the Westchester District Branch of the American Psychiatric Association.
Psychiatrists of this organization are dedicated to providing treatment for mental disorders and advocating for equal health care for mental and physical conditions.
If you need information about psychiatry or assistance in finding a psychiatric physician - please call us. THE PSYCHIATRIC SOCIETY OF WESTCHESTER 333 WESTCHESTER AVENUE - SUITE LN-01 • WHITE PLAINS, NEW YORK 10604 PAGE 16 MENTAL HEALTH NEWS ~ FALL 2008
MENTAL HEALTH NEWS ~ FALL 2008 PAGE 17 Activities in Group Work with Children and Adolescents
By Andrew Malekoff, LCSW, CASAC agendas (i.e. don’t use activities to “get one of them touched a chord in the others Executive Director and CEO them to talk about their feelings,” unless as they spoke… “he’s like gold…she will North Shore Child and Family Guidance Center group members understand that it is an always be in my heart…he was my best activity might promote conversation and friend…he’s my hero…” The room was expression of emotion, for example). enveloped in a warm glow. he use of physical, and other, Be conscious that the outside world It was the end of the school year. Plan- activities in group work is more might devalue the use of activities with ning a memorial for Geoffrey coincided than a “tool,” more than pro- kids, especially when the groups are noisy with the end of the group. They organized grammed content, more than or messy (i.e. there is a tendency to trivi- a fund-raiser that revolved around selling T“canned” exercises, and more than a baked goods and homemade candy. They alize as frivolous, anything that is not mechanistic means to an end. Group work particularly psychological and anything advocated successfully with the school scholar Ruth Middleman aptly described that looks like good fun). administration for space in the courtyard the “toolness of program more as putty Following are illustrations of two mental for what they called a “reflecting garden,” than a hammer, i.e., as a tool that also health groups, in two different settings, both that would contain a bench and tree to changes as it is used.” In addition to a using activities to cope with loss and grief. remember their friend. wealth of structured resource material After a week or so when the stones (e.g., manuals, games, exercises), there Rock and Reflective Garden were dry, a memorial ceremony that the are the activities that grow spontaneously 9/11 bereavement group planned was out of the living together that the group A group of pre-adolescent boys and held. This was an important ritual for kids does. These are the creative applications, girls who lost parents in the attack on the whose moms and dads bodies were never the group member- and group worker- World Trade Center prepared for the end- recovered or were found only in parts. initiated innovations that can be cultivated ing of their group by decorating stones to During one group meeting Alison re- and brought to life in the group, contribut- be placed in a memorial rock garden. At vealed that her family couldn’t decide ing to a growing sense of groupness and the same time another group of high whether to bury her father in regular-sized rich history of experience together. Andrew Malekoff, LCSW, CASAC school students attending an alternative casket or a baby casket. She explained, school for students with serious emotional “All they found was his arm.” The cere- Extending the Bonds of Belonging out to large groups in statewide forums. disturbances approached their principal mony was held in the evening. The sur- Beyond the Group Itself On a one-to-one basis they sell buttons about planting a tree in the school court- viving parents and siblings, many of and wristbands that proclaim: Youth yard to memorialize their friend Geoffrey, whom also decorated stones in their A well-conceived activities program in Power. The latter process gives them a a group member who succumbed to a groups, participated in the candlelit cere- group work can add texture to the group more intimate opportunity to “sell” their chronic disease. mony. Each one had a chance to place their experience, fueling its capacity to trans- message. Their motto: Nothing about us, The kids in the bereavement group sat rock in a spot of their choosing in the rock form itself into a unique entity, something without us. Their work together is clearly together around a rectangular table cov- garden. If they chose to they could say a few new and special that has never existed aimed at extending the bonds of belong- ered with newspaper. In front of each of words or silently place their stone. before. This is the unbreakable, malleable ing to youth across New York State, add- them was a smooth oval shaped stone, The installation of the bench and tree stuff that real life groups are made of, ing strength and support to a “youth roughly double the size of a portable CD planting Geoffrey took place on the last creating “something-ness” from “nothing- voice” in matters that affect young people player. They decorated the stones with week of the school year, a bright and ness.” In group work with children and struggling with emotional disturbances. unique designs of paint and glitter, each sunny June day. The family of their de- youth, physical and other activities can help one a personal remembrance of their ceased friend attended. They would later to promote a sense of competence, belong- Cautionary Notes moms or dads. As they decorated, the say that they were overcome with the ing, self discovery, invention and creativity; group worker moved from one to another, thoughtful and sweet nature of the modest and can help to extend the bonds of belong- When using evidence-based activity admiring and asking them about each memorial. A touching and tastefully de- ing beyond the group itself. manuals or other protocols in group work, one’s design. “Mine is painted gold,” signed four-page booklet that the group In the development of a Children’s I suggest that you do not blindly follow beamed Mac. “I painted it gold because designed contained the details for the me- Mental Health Plan, for example, the New the manualized instructions. Please keep my dad is like gold to me.” Jenny’s design morial program. On the top of the front York State Office of Mental Health has the following cautionary notes in mind: was framed by a heart, “because my mom cover was printed in calligraphy, In Lov- formed a Youth Workgroup composed of Activities should not be used to keep kids will always be in my heart.” On Seth’s ing Memory of Geoffrey B. Underneath youth consumers, to contribute to the de- busy and practitioners anxiety-free. stone were two intertwined hands, a small was a color illustration of a flower. And velopment of the Plan, along with four When using curricula (i.e. anger man- one and a larger one that showed “me and beneath the flower and the words, We see complementary adult groups. At statewide agement, conflict resolution) activities my dad were best friends.” Victoria your love in every flower that blooms and forums, one aspect of the youth message should not be curriculum-driven, rather painted a fire hat and said, “my dad is my grows. Several of the group members has been projected through the use of a curriculum-guided so as not to minimize hero.” On some stones they painted, “I sang “The Storm is Over.” Others wept video created, in part, by the youth them- opportunities for interaction, mutual aid, will miss you,” on others, “I will always openly, even the some of the tougher selves that speaks to critical issues such as and spontaneity. love you,” and on some a combination of boys, and hugged one another. the impact of stigma. Many of these youth Have a clear and above board purpose both. Many included a patriotic theme. have become capable advocates, speaking for the use of activities and no hidden There were lots of stars and stripes. Each see Group Work on page 35 PAGE 18 MENTAL HEALTH NEWS ~ FALL 2008 A FALL 2008 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL PAGE 19
Post Traumatic Stress Disorder
By Lawrence J. Winters, BPS, LMHC needed, which is to embrace the experi- Senior Clinical Group Psychotherapist ence of inner death and seek a new iden- and Coordinator of Veterans Treatment tity and spiritual rebirth. The common Four Winds Hospital therapeutic model, that is, misses the point that PTSD is primarily a moral, spiritual and aesthetic disorder – in effect ntil recently in our society, a not a psychological but a soul disorder. warrior held on to his identity You may hear in this next poem some when he had returned from of the rage from PTSD that had disassem- U war. His role remained as one bled me after coming home from the war. who had and would continue to protect the society in which he lived. The warrior AMERICA was trained to put his personal fears and needs aside for the others. He was the “For all of you that live here during the one called when there was danger. He was Vietnam War” I killed for you. You may the one who would teach society what war not have asked me to, But I killed for you. was really about. This social role provided I didn’t ask to go to Vietnam. an identity for returning soldiers. I didn’t support the war. During the Vietnam War, however, many civilians did not see returning sol- Still I killed for you and for me. diers as warriors. Because of changing I killed for you, While you paid your political and social perceptions, returning taxes. You watched me kill on TV, warriors were all too often seen as CONFESSION Nowhere in all my searching did I find While you were eating cheeseburgers. trained killers or, at best, misguided any individual or group that understood I killed for you. While you were souls. As we all know now, this caused a I’m ashamed that I may not have what the war had done to me. I searched protesting that I was killing for you, I grievous wound to the psyches of our killed anyone in Vietnam; like a well-trained Marine looking for the killed for you. While you were avoiding soldiers. To have been asked by your I’m ashamed that I may have killed someone. enemy. No one seemed to want to know the draft, While running off to Canada, country to risk your life—and to take the what the war did to my insides. I killed for you. lives of others—and not be honored for I’m proud that I was a Marine; That is, until recently when I read Ed your sacrifice when you return, is a soul I’m embarrassed to tell anyone that Tick’s book War and the Soul. I lay in I killed for you wound. I was in the Marines. bed each evening for three weeks reading While you waited in line at the supermarket,
Today, this is recurring with reference While you were out getting drunk, I grew up believing in God and country. it. I wept so frequently that I stopped try- to soldiers returning from the Iraq and In Vietnam I lost my belief in God and ing to hide it. When you got your first good job Afghanistan Wars. distrust anything my country told me. Ed Tick’s thirty years of working with after college, As you enjoyed free love, I recently finished writing a book vets had opened his heart. His expansive I was killing for you. I have carried pain titled The Making and Unmaking of a Vietnam was the most beautiful country scholarship on the topic of the warrior for you. Guilt for you. Shame for you. Marine, which is about my journey from I ever saw; vibrant colors, skies tradition was helping me pull my frag- For all the killing I did for you. childhood through Vietnam to the pre- piled with cumulus clouds, beautiful mented soul together. Finding someone To get on with my life for you. sent. I’d spent fifteen years working on women with silk black hair; who understood the interior of me as a To be productive for you. that book and thirty years writing poems Vietnam was an ugly, blood-drenched, Marine was deeply affirming. All the To marry you. To raise children for you. about my war experiences. Since my sweating inferno where women and chil- academic treatises I’d read on PTSD left And most of all to forget for you. return from Vietnam, I had been in per- dren were, at times, weapons themselves. out the fact that human beings have souls. sonal therapy for many years. I attended In my life of study and learning, I have Often at these presentations, I am years of school to become a therapist. I Vietnam made heroes out of schoolboys; never thirsted to take in anything as much asked by clinicians questions like, “What enrolled in more workshops that I can Vietnam made traitors out of scared boys as the teachings of War and the Soul. My tools do you have that I can use when a list, from Robert Bly’s men’s groups to who hated what they were told to do eyes and heart opened when I read on vet comes into my office and won’t open professional conferences concerning but did it anyway. page 108, “We have seen that classifying up?” or “How do you deal with the anger PTSD. I even went back to Vietnam in and treating PTSD merely as a stress and that these men carry?” or “How do street 1994 with a group of health care profes- I wanted my father to be proud of me for anxiety disorder fails to address its deeper drugs play a role in PTSD when you sionals to deal with my ghosts and to ask standing up and fighting for my country; dimensions. Moreover, while medication know drugs were a part of the war?” Of for forgiveness from the Vietnamese My father never asked me anything about may rebalance biochemical functioning, it course, I put on my clinician’s hat and people. the War when I returned. cannot heat the inner self. In the standard field these questions as best I can, but This is a poem that I wrote shortly kind of treatment, the veteran feels when I leave, I don’t feel like I have got- after returning from Vietnam in 1970. I missed my girlfriend and married her pathologized and is expected to “get on ten my point across. Upon reflection, I Listen for the confusion in it and you as soon as I got home; with life”. He feels encouraged to meas- think looking for new and unique tools to will begin to understand how many of I divorced my wife and for years could ure his progress against normative civilian today’s returning soldiers feel. not father our child. functioning rather than to do what is truly see PTSD on page 22
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. PAGE 20 A FALL 2008 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL A FALL 2008 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL PAGE 21 PAGE 22 A FALL 2008 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL
PTSD from page 19 enough, open up wide enough, one may they had urgently needed since the ending of we use the word “hero” because we don’t hear the oblique tenor of war. Mother the Vietnam War five years earlier. Finally, have to see the depth of pain in the sol- heal PTSD is not what is really needed. Teresa understood when she said, “Kind the effects of war trauma on soldiers – diers we are pinning the medals on. They There are an abundance of toolboxes from words can be short and easy to speak, but which in previous wars had been called stand erect, proud to be acknowledged, many modalities that are used to treat their echoes are truly endless.” “Shell Shock” or “Soldiers Heart” – became and later implode at the bar or with family PTSD ranging from exposure therapy to Human souls have many forms of com- legitimized and the VA was held responsi- or when they are alone. standard cognitive behavioral therapy munication, and words can only hold so ble for its treatment. What can we do to help heal those who approaches. Attention to this topic is good much. Silence, if heard as simply empty When declaring PTSD an illness and have protected us from the furies of the out- because it has forced the medical and psy- moments needing to be filled, only closes listing it in the mental health manual for side world? I believe that first, we must chological communities to focus on PTSD the treatment door. Taking time, tolerating the treatment of individuals, we effec- understand that we can heal our soldiers and and its treatment. silence, waiting, witnessing the presence of tively isolated the problem into the cate- our society, that the damage we are con- In my opinion, we are missing the target another human being in pain, and staying gory of mental illness. This, in turn, fronted with is not insurmountable. Some- when we look for new tools. In my experi- in the room are the skills needed to com- placed the onus of healing on the patient where in our makeup are patterns or in- ence, there is no tool that can put the soul municate with a war veteran. It has so and the patient’s treatment team. stincts left that can guide us towards open- into a box so it can be examined. There is no much more to do with being present than All of this misses the point that war ing our arms to each other, towards opening blueprint for how to treat PTSD that works speaking. You should know that it is an wounds the soul, and soul wounds are not our ears to human pain and allowing com- any better than the caring, listening, and honor if a veteran speaks to you about war, listed in the DSM. passion to return to the social equation. compassionate truthfulness of a clinician. and if it happens, please share with them There is a reason that such a large num- When Abraham Lincoln said, “With By putting the trauma of war into a diagnos- that you’re honored. What I have just said ber of Vietnam vets are coming to the VA malice toward none, with charity for all, tic category, we remove responsibility from could be summed up by the famous anony- with PTSD symptoms some 37 years after with firmness in the right as God gives us to our society for having traumatized our sol- mous who said, “When you walk the walk, the war. They have hidden from the society see the right, let us strive on to finish the diers by sending them into war. In addition, people listen.” that shamed them for what they had done. work we are in, to bind up the nation’s PTSD therapeutic tools are nothing more When I returned to Vietnam in 1994, I With the change in attitude towards our wounds, to care for him who shall have than diagnostic armor working to protect us was visiting a Vietnamese Cemetery. Af- current soldiers or at least the use of politi- borne the battle and for his widow and his from the painful, dehumanizing, soul- terwards, I wrote this poem: cally correct language such as “I don’t sup- orphan, to do all which may achieve and wounding events our clients report to us. port the war but I support the troops,” these cherish a just and lasting peace among our- These tools come from the heads of schol- VIETNAM Vietnam vets now have come for help with selves and with all nations,” he was pointing ars and keep us one step removed from the Cemetery Worker at Viet Cong Memorial symptoms that have become a way of life the nation towards its obligation to help and souls that may be withering before us. Yes, for them and their families. heal its returning soldiers and their families. tools are important and are useful, but they I called to you. “Come here, I have Another thing we miss when we see He knew that this would, in turn, heal soci- insulate us from feelings, which should, in something for you”. You mumbled back. PTSD as an individual disorder is the fact ety. my opinion, be a central source of informa- I called again. You mumble again. that it is an infectious illness. We may treat Our obligation to veterans goes beyond tion on how we work as therapists and I wave for you to come. You looked away the individuals with PTSD but ignore that it parades, VA hospitals, and military medals. healers. and spoke clearly. “I no come here”. has spread into their families and their com- Only when we watch our willingness to help The best tool I know for speaking with I wanted to give you money. You who munities where it goes largely untreated. heal our soldiers in their commitment to go a war veteran is to know that one cannot takes care of my enemy’s graves. The VA is not responsible for the veterans’ to war will we begin to stop their suicides, speak to a vet about war if one hasn’t lis- But you turned away. Both of us families, so who is there to help them? their relief from pain with addiction, their tened first. I mean the kind of listening knowing it could never be enough. Unless we accept our responsibility as a spilling of rage in domestic violence, and in that uses more than the ears. I would call society in the healing of PTSD, our veterans short, their self destructiveness within our it deep listening; Ed Tick would call it Charles Swindoll, the evangelical will not find peace and nor shall we. midst. I would like to end with a poem that I soul listening. It’s easy to hear the facts, Christian pastor said, “Forgiveness is not Our social responsibility means seeing and wrote and read to the Vietnamese in 1994: assess the circumstances, analyze the dif- an elective in the curriculum of life. It is a listening to our vets when they come home ficulties and even devise a game plan to required course and the exams are always from war. But when we send our soldiers to WAR help. However, there are few who take the tough to pass.” isolated VA hospitals, we don’t have to sit time needed to hear a soldier. If a soldier In 1980 PTSD became a diagnosis in the next to them in our waiting rooms. When we If a man kills another man, is going to speak about war, it will be Diagnostic and Statistical Manual of Mental bring our war dead home under the cover of He must dig two graves – within his or her own time frame, not Disorders or DMS II at that time. This was darkness, we won’t have to watch. When we One in the earth for the dead man, yours or managed care. Most of what gets seen by many health care professionals as put Ipod plugs in, we don’t have to listen to And one in his heart said about war is in the punctuated si- making great strides for combat veterans; our veteran’s war stories. For his own spirit, lences. However, if one listens long they would now be eligible for the treatment We are also protecting ourselves when Or he will not return. Mental Health News - New York City Section: Fall 2008 Page 23 The Mental Health News New York City Section
Improving Cultural and Linguistic Competence: The Case of Integrated Physical And Mental Health Care
By Denise Reed, MBA, MPH Among the demographic factors that Elizabeth Siantz, MSW, Ron Turner influenced the passing of this bill was the and Roberto Lewis-Fernández, MD growing proportion of New York resi- Center of Excellence for Cultural Competence dents (and of the US population as a New York State Psychiatric Institute whole) who belong to a racial, ethnic, and linguistic group that is underserved by the health care system. While this population ealth is not possible without shift is most evident in the state’s urban mental health, and quality centers, rural communities are equally mental health care cannot be impacted. A longstanding injustice affect- achieved without culturally ing ethnic, racial, and linguistic underserved andH linguistically relevant services. These groups in New York State (regardless of are the two principles that guide the work urban or rural location) is the persisting of the Center of Excellence for Cultural level of disparity in the care of both physi- Competence at New York State Psychiat- cal and mental health. In fact, the gap ap- ric Institute (“the Center”). The impetus pears to be widening between non-Latino for the creation of the Center was the re- white Americans and other groups with view of the status of mental health in New respect to several indices of health care York State performed by the NYS Stand- access, quality, and outcome. ing Committee on Mental Health, Mental The increasing number of unmet Retardation, and Developmental Disabili- Top Row: Elizabeth Siantz, Luz Marte, Roberto Lewis Fernandez MD, Stephanie physical health needs of individuals re- ties. Under the leadership of its Chairman, Sosa, PHD, Denise Reed. Bottom Row: Hannah Carliner, Ron Turner, Andel Nicasio ceiving treatment for chronic mental dis- Hon. State Assemblyman Peter M. orders, also defined as serious mental Rivera, the committee undertook a com- conclusion: “The current system of ser- The follow-up work performed by the illnesses (SMI), is one byproduct of this prehensive review of the mental health vice delivery was not meeting the needs Subcommittee on Underserved Popula- demographic shift. As a result of the delivery system in New York State. Not of the citizens of the state. As a result, tions led to the passing of Assembly bill marked morbidity and mortality associ- surprisingly, the Committee’s report re- thousands of mentally ill persons have A01612 to create two centers, one at Na- ated with physical illness, ethnic/racial leased in 2002, titled Broken Promises, suffered indignities and abuse, and hun- than Kline Institute in Orangeburg, New and linguistic minority individuals coping Broken Lives: A Report On the Status of dreds of others have succumbed to un- York and the other at the New York State with SMI are one of the most vulnerable the Mental Health Delivery System in timely deaths due to a dysfunctional men- Psychiatric Institute in Manhattan. Both New York State, reached the following tal health system.” were funded in November, 2007. see Improving Competence on page 37
Health Integration Activities in the NYC Department of Health and Mental Hygiene
By David A. Rosin, MD Health and Mental Hygiene’s (DOHMH) ceive follow-up phone calls between their Executive Deputy Commissioner Division of Mental Hygiene (DMH) regular office visits. During these calls for Mental Hygiene Services through its Bureau of Mental Health and care managers may periodically administer Offices of Health Integration and Mental the PHQ-9 depression screen to assess Hygiene Quality Improvement is engaged changes or improvement in symptoms, n recent years, health has come to be in a two-part approach to integrating help people adhere to their treatment plan, recognized more as a state of physi- physical and mental health services. The and encourage self-management goals such cal, mental, behavioral and social first focuses on detection and manage- as exercise. This information is shared with well-being, and not merely the ab- ment of depression in primary care set- the treating primary care provider, who senceI of disease or infirmity. The link tings. The second focuses on addressing may also consult with a psychiatrist as between physical and behavioral health the physical health needs of individuals needed. DMH began working to place care has been measured in New York’s own receiving mental hygiene services. managers in selected Federally Qualified population. According to the 2004 New While depression is commonly seen in Health Centers (FQHCs) in 2007 and is York City Health and Nutrition Examina- primary care settings, it is frequently un- currently evaluating the model. tion and Survey (NYC-HANES), on aver- recognized by primary care physicians The DOHMH strategy for integrating age, New Yorkers who had significant and, even when diagnosed, often results in physical health care into behavioral health emotional distress were 12% more likely less than adequate treatment. DOHMH’s settings includes working with mental to engage in behaviors (including physical Depression Initiative aims to better pre- hygiene providers through the DMH inactivity, binge drinking, smoking, and pare primary care physicians to screen Quality IMPACT Initiative to conduct poor diet) that put them at increased risk and manage depression through training, continuous quality improvement projects for co-morbid medical conditions. technical assistance, and care manage- aimed at improving the assessment, moni- Adults with serious mental illnesses, David A. Rosin, MD ment support. toring, and care coordination of consum- such as schizophrenia, bipolar disorder To improve the quality of depression ers’ physical health issues in mental hy- and depression, as well as co-occurring a much higher rate than individuals who and management in primary care, DMH giene treatment programs. In fiscal year serious mental illness and substance use, do not have a serious mental illness. Peo- works with local health care providers to (FY) 09 50 participating providers will lose significant years of their life to dis- ple living with serious mental illnesses promote integrated care.. In one model, complete health screening instruments, ability, morbidity, and mortality resulting encounter additional barriers to adequate depression care managers provide follow- assess for unmet physical health needs, from a combination of physical and be- health care such as system fragmentation up, outreach and support to individuals and establish goals in partnership with havioral health factors. Many die prema- and stigma and as a result receive fewer who have screened positive for depressive individuals to address identified health turely from conditions such as cardiovas- routine preventative services. symptoms and are receiving care from cular, pulmonary and infectious disease at The New York City Department of their primary care doctor. Individuals re- see Health Integration on page 36 Page 24 Mental Health News - New York City Section: Fall 2008
Fountain House Members Improve Mind and Body
By Ruth Parson, MA, Unit Director ness unit’s work over the last year. Here and Wellness Unit Participants are some comments: Fountain House “The Wellness unit helps me keep my mind directed toward being healthy.” “I feel better than when I was working in the everal years ago Fountain House, Snack Bar. We talk about diabetes a lot in the originator of the Clubhouse the Wellness Unit and I am now more model of psychiatric rehabilita- aware of how much sugar I eat.” S tion, witnessed the statistical rise “In my old unit, the Snack Bar, we in morbidity that affects those living with learned about cooking, bussing and work- mental illness within our own consumer ing as a cashier. But in the Wellness ranks. We suffered loses to a degree that Unit, we learn how to stay focused about we could not overlook. After two years what we eat, how to lose weight and how working as a wellness committee, we to make healthy foods and drinks. Since realized that taking such a small step working in the Wellness Unit, I have cut would not sufficiently address all the is- down drastically on the amount of sugar I sues of concern. To remedy this, we have eat, and I have noticed that I have lost developed a Wellness Work Unit that will some weight! Sometimes I use the tread- include: a health food bar and healthy mill in the gym, and I do exercises at cooking program, a gym, and a personal home, also.” training program. In addition we are “The Wellness Unit has changed my working on building relationships with mind about eating healthier. This unit community clinics, agencies, businesses, educates me about eating well, which has and providers to develop articles, infor- had a strong impact on me. The Snack mation, and workshops on such topics as Bar was good in a way, but they served diabetes, smoking cessation, yoga, and junk food. In the Wellness Unit we try to other integrative health modalities. convince people that health food is better The oldest and fastest growing part of for you and that exercise is good for you, our program is personal training at our in- too. When the Snack Bar ended, many house gym. We offer fifteen classes dur- people in the House were upset and said ing the week and make our gym available that they could never eat health food. But before and after our work day. Our Berry now the same people who said they would- Xcellent Café offers a morning and after- n't try our smoothies, juices, soups, salads noon Health Bar with homemade bever- and granola bars are regulars at the juice ages, soups, and salads. Research and bar, and love all of our healthy food!” information collection occurs throughout “The Wellness Unit is about eating the day providing us with answers to our healthy. I eat healthier now that the own questions and those coming from our Wellness Unit is here. Our unit is a health community members. To help the pro- and nutrition unit so we want people to be gram inspire a cultural change toward in shape. I've been leading the chair exer- physical and mental health, we offer cises for almost a year. It is important for healthy alternatives at every chance we people to do them. The chair exercises get. The Wellness unit’s also contributes make working out accessible to everyone; to our social program in a healthy way by chair exercises are easier to do than other offering dancing, biking, spa-ing— exercises, and they are less intimidating. I always with a healthy slant on the foods think people should exercise, eat right we offer. and watch their bodies.” The question remains, is there a corre- “It's the best unit in the house. I don't lation between physical and mental health eat cooked or fresh veggies, but I'll drink and how do we know if we are seeing the the juices! The veggie drinks brought me effects of the interrelationship here at in. I first thought there wasn't going to be Fountain House? We hear it from each much of anything but it's excellent. The other in the elevator and on the staircase. prices are very affordable. I checked out We observe it when a member decides to the gym and I started today. The unit is come in more regularly to exercise on the the best thing that's happened in the house treadmill and meet for relaxation exer- since I came in 1974.” cises in order to stay calm enough to pass “I joined the Wellness Unit because I her driving test. We see it in the transfor- thought that I might have the chance to mation of the person who heads for the use some of my learning and skills from gym looking quiet, pale and sluggish who my job as a physician. I found that work- after their workout steps into the rest of ing on the unit taught me many things their day with animated posture and ex- about nutrition, exercise and especially pression, thanking us for the time and food preparation. I've started on a cardio asking for help to learn more about a nu- routine for the first time in over a tritional issue. It’s still a little early for us year. I've enjoyed watching how the rest to call our observations scientific evi- of the House has come around to making dence, but the anecdotes abound and in- use of what we have to offer. This is so terest is increasing beyond our hope in thrilling because I believe that this could our first year. When we began our work contribute to improving life expectancy three years ago, very few discussions among my fellow members.” took place about staying healthy physi- “It provides a morning an opportunity cally and even fewer about the effect it to drink a vegetable juice that provides my could have on mental health. These days greens, which I need because I am defi- this is a fairly common topic, not only at cient in iron. I also find the exercise gym lunch time but where ever we meet each vital to my good health. I find especially other. We asked a few people to share their thoughts on the effect of the Well- see Fountain House on page 36 Mental Health News - New York City Section: Fall 2008 Page 25
Improving Access to Health Care for Mental Health Consumers
By Jack Carney, DSW, Senior Director training program and case management each of the case managers who partici- F·E·G·S Citywide & Brooklyn protocol whose primary objective is to pre- pated selected a second consumer who, Blended Case Management Programs pare consumers and case managers to work like those in the first group, was being closely together to improve our consumers’ prescribed one of the atypical anti- access to necessary medical treatment. psychotic medications or had a chronic ecently published studies have We called our initiative the Integrated physical ailment. The case managers then startled mental health profes- Collaborative Case Management Demon- proceeded to share with this second group sionals with the assertion that stration Project (ICCM) to reflect our the information that they had acquired in persons with serious mental newly balanced emphasis on behavioral the formal training. Rillnesses in the United States can now ex- and physical health care and the collabo- The case managers and both sets of pect to live, on average, 25 years less than ration between consumer, case manager consumers then set out to operationalize everybody else. The CATIE and the State and health care providers that it requires. our ICCM Protocol, which, in summary, Mental Health Program Directors studies We anticipate that improved treatment involves the following: detail a hierarchy of causative factors. access and coordination will bring with First, they point to the “second generation” them reduced use by our consumers of • initiation by each consumer’s primary or “atypical” neuroleptic medications, emergency room medical care and in- care physician (PCP) or psychiatrist which are linked to excessive weight gain patient hospitalization, and, ultimately, of the Metabolic Syndrome Monitor- and insulin resistance in many of the per- longer and healthier lives. ing Protocol; sons prescribed them. The weight gain and We launched the Project in September insulin resistance appear to account for the 2007, when a small group of self-selected • review by the PCP or psychiatrist of emergence in many persons with serious case managers, consumers and team su- the Protocol’s test results with con- mental illnesses of a medical condition Jack Carney, DSW pervisors of the FEGS City-wide and sumer and case manager, as well as termed “Metabolic Syndrome” which if Brooklyn Blended Case Management communication of the results to the left untreated, can lead to the development I direct the New York City-based case Programs began a fourteen hour-long consumer’s other physician; of Diabetes II and cardio-vascular and management programs for FEGS, a large training course designed to prepare them other systemic medical conditions. mental health and social welfare agency to improve these consumers’ access to • referral (s) for recommended treatment. Finally, other presumably remediable active throughout the City and in Nassau necessary health care. It was decided to causes include consumers’ life style and Suffolk counties. At present, 50 case train consumers and case managers to- Our ICCM Demonstration Project con- choices, i.e., smoking, lack of exercise, managers serve 720 clients with serious gether because we assumed that a true cluded in April 2008, when the last of our poor nutrition, abuse of intoxicants; their mental illnesses located in all five bor- collaborative effort between the two will outcome data from the Project’s partici- exposure, in shelters and mental health oughs. After discussions with program be required to overcome the barriers to pants was fully collected. At its conclusion, residences, to communicable diseases; staff, consumers and the senior vice presi- health care personified by overtaxed and the final participant cohort was comprised and, ultimately, their lack of access to dent of the agency’s Behavioral Health often intolerant health care providers. appropriate and effective medical care. division, we decided to develop a pilot As soon as the training was completed, see Improving Access on page 36
Wellness Initiatives for People Living with Mental Illness
By Salene Browne, Glenn Stelzer mental task that was too intensive and a and Allison Wendell, F·E·G·S Health potential trigger for angry and impulsive and Human Services System actions. Gabrielle reports that since join- ing the Wellness group she is happier at home and on her job, she feels better and ccording to New York State’s has not gotten in trouble for aggressive Commissioner of Mental behavior. Her appetite is better and she Health, Michael Hogan PhD, understands the need for good nutrition A “There really is no recovery and healthy foods. Even her sleep has without some overall experience of well- improved. At 25 she is developing healthy ness. There is no wellness without posi- habits that can help her stay well both tive mental health. We need integration of mentally and physically. care in every place. We have to approach In order to achieve this goal, F·E·G·S it from a lot of different angles in behav- conducts groups like Gabrielle’s at all of ioral health care settings to address its residential programs. F·E·G·S’s Burn- emerging health problems.” Dr. Hogan side Community Residence, for instance, served on the committee which published offers a full compliment of Wellness Self- the 2006 “Morbidity and Mortality in Management groups to aid residents in People with Serious Mental Illness” report improving their overall well-being and by the National Association of State Men- move toward healthier, more independent tal Health Program Directors and happier lives. The weekly groups (NASMPHD). The report found that peo- offered are: New Consumer Orientation; ple with mental illness die 25 years earlier Fitness Lab; Stress Reduction; “Eating for than the general population, largely due to Life”; Symptom Management; Peer Sup- treatable medical conditions caused by port, which includes sessions on smoking smoking, obesity and inadequate access to cessation; Paths to Recovery; and Medica- medical care. Salene Browne, Glenn Stelzer, and Allison Wendell tion Management. The groups are having F·E·G·S Residential Services highly success with the Eli Lilly’s Solutions for values the wellness of its tenants and maintaining a balanced and healthful diet, trition groups provided at the residence by Wellness and Team Solutions workbook places a strong emphasis on the influence and exercising daily. trained staff to address her health, as well materials which allow group participants that physical health has over an individ- Gabrielle, 25, is a resident of Tanya as, emotional issues. to identify the issues they struggle with in ual’s emotional well-being. As part of the Towers Apartment Program, one of the Before she joined the group, Gabrielle their lives and in doing so make the first Urban Institute of Behavioral Health numerous housing programs offered by was agitated and impulsive; she didn’t step toward resolving them. One partici- (UIBH)/OMH Wellness Self-Management F·E·G·S for people who are living with a have much appetite and had trouble sleep- pant said, “The book taught me how to get Initiative, F·E·G·S has trained it residen- mental illness. Tanya Towers is a special- ing. The group offered her the education around obstacles and gave me a better tial staff to help all tenants maintain the ized building that houses persons who are and support necessary to better manage understanding on how to deal with every lifestyle habits that are an integral part of deaf while they may have other disabili- her life. The group helped her commit to day life.” maintaining good mental health, such as ties. In March 2008, Gabrielle began at- avoiding unhealthy foods and beverages, abstaining from alcohol and street drugs, tending newly formed Wellness and Nu- and learn how to identify any physical and see Wellness Initiatives on page 34 Page 26 Mental Health News - New York City Section: Fall 2008 Mental Health News - New York City Section: Fall 2008 Page 27 Addressing a Risky Business: The Interplay Between Medical and Psychiatric Disorders
By Richard J. Gersh, MD conditions, such as cardiovascular dis- Director of Psychiatric Services ease, diabetes, pulmonary conditions, and and I. Bruce Gordon, MD, MBA cancer. We do not yet understand if this Medical Director, Jewish Board is a consequence of poor self-care, ne- of Family and Children’s Services glect, exposure to other risk factors, or some physiologic or genetic connection between physical and mental illness. rior to the last decade, the inter- Additionally, the above factors, involv- face between medical and psy- ing the interface of medical and psychiat- chiatric disorders was largely ric disorders, occur in children as well as discussed as medical conditions adults. This raises questions about poten- thatP are risk factors for behavioral prob- tial effects on development and long term lems. More recently, however, we are consequences. focusing on the ways in which psychiatric conditions are risk factors for medical A Response to Health Risks (physical) disorders. It still bears reminding ourselves of At the Jewish Board of Family and Chil- common medical conditions – and com- dren’s Services, a high priority project is mon medical treatments – that can pro- developing programs to assist clients in duce a clinical picture that mimics a psy- managing both medical and psychiatric chiatric disorder. For example, hyperthy- issues. Solutions will address a broad roidism – an overactive thyroid gland – range of services for clients of all ages will often cause an individual to complain with diverse needs and support systems. of feeling anxious, jittery, having trouble New programs will reach our residential sleeping, and losing weight, which may and community-based services as well as look like an anxiety disorder, if the under- our day treatment programs and clinics. lying medical condition is not recognized. Richard J. Gersh, MD I. Bruce Gordon, MD, MBA Two new initiatives have already An underactive thyroid gland – hypo- started in our residential programs. In thyroidism – will present a clinical picture would be considered. It is not unusual for taking psychiatric medication, to gain a cooperation with the Institute for Commu- of feeling tired, sluggish, confused, and a thorough psychiatric evaluation to re- significant amount of weight. In the past, nity Living (ICL), JBFCS is participating gaining weight, which might be mistaken veal a medical problem that has been un- we attributed this to an improvement in in a grant funded by the New York State for depression. In each instance, it would recognized by primary care practitioners. appetite as psychiatric symptoms re- Health Foundation to advance best prac- be a mistake to treat the behavioral phe- In practice, however, it is often difficult to solved. Now we can more closely associ- tices in diabetes management. nomena, when the underlying thyroid dis- maintain this standard, and psychiatrists ate weight gain with particular medica- A new curriculum was developed to order should more properly be addressed. generally limit a medical work-up to the tions, notably antipsychotic medications, assist adults with chronic mental illness in Similarly, fluctuating blood sugar most likely problems that must be assessed. although others can produce some in- identifying and dealing with issues of levels – seen in diabetes mellitus and hy- crease, as well. obesity, elevated blood sugar, and both poglycemia – can produce periods of con- The Medical Side of Psychiatric Illness More thorough investigation has re- type I and type II diabetes. fusion, anxiety, personality changes, and vealed that these medications can also In our children’s residential programs, mood swings. Older treatments for hyper- Of growing importance, in more recent cause elevations of blood sugar – which an intensive education initiative focuses tension, such as alpha-methyldopa, were years, are the medical aspects of psychiat- can progress to diabetes mellitus – ele- on obese clients with pre-diabetes, type I notorious for causing depressive symp- ric illness. Since the introduction of mod- vated blood pressure, and elevated triglyc- and type II diabetes. Exercise and weight toms. Steroids, used to treat a variety of ern psychiatric medications in the 1950’s, erides and cholesterol. These issues con- loss programs and reward systems are in disorders, are associated with mood we have recognized various medical com- tribute to an overall increase in risk fac- progress and they are proving effective. swings and psychosis. plications that could result from their use. tors for cardiovascular disease, which can In a short period of time, children have More recently, Retin-A, a powerful We referred to these consequences as result in heart attacks, strokes, and death. achieved significant weight loss, and we acne medicine, has been associated with “side effects” or “adverse events,” such as This constellation of risk factors has be- are planning new modules to help our cases of clinical depression. Pancreatic sedation, muscle stiffness, tremors, dry come known as the “metabolic syn- clients continue their progress. cancer, which is often undetected until it mouth, dizziness, constipation, and others. drome,” and is of concern throughout the Our adult continuing day treatment is advanced, is associated with symptoms These side effects can generally be general population, for all ages, beyond programs are incorporating components of depression, which may be the first well managed by adjusting the dose of the psychiatric community. of established “wellness” programs to signs of the cancer. Disorders that in- medications, changing medications, or While it now seems clear that some promote healthy living, in general, and volve brain structures, such as HIV infec- adding another medication that reduces psychiatric medications increase the risk of minimize the risky medical effects of ill- tions, strokes, brain tumors, head injuries, the side effect. Some psychiatric medica- certain medical problems, we have also ness and medication, specifically. We are and seizure disorders, commonly produce tions require periodic blood tests to monitor recognized that individuals with a chronic considering ways to make the monitoring changes in mood, personality, cognitive possible toxic effects on liver functioning, psychiatric condition are at risk for medical of weight, blood pressure, blood sugar functioning, perceptions and behavior. kidneys, thyroid, blood cell production, and complications, independent of treatment. control, and cholesterol status part of our From these examples, we see how im- other normal physiology, that might go un- On average, individuals with chronic routine care, even in clinic patients. portant it is to consider the patient’s medi- noticed without these special tests. schizophrenia have a twenty percent Increasingly, the care of individuals cal status when assessing a suspected psy- Presently, and for the foreseeable fu- shorter lifespan than people without psy- with mental health problems also requires chiatric condition. Ideally, all possible ture, we are turning our attention to a set chiatric illness. Individuals with chronic a consideration of physical health issues, medical conditions – such as those men- of medical problems that we underappre- psychiatric illness – including schizophre- and demands new efforts to intervene in tioned above – would be tested for or ciated for many years. It is common for nia and bipolar disorder – are at greater effective ways. JBFCS will continue to ruled out before any psychiatric treatment individuals with a psychiatric condition, risk of developing many serious medical respond to this interplay of needs.
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New Horizons for NYC Homeless Veterans: Institute for Community Living Assumes Operation of Borden Avenue Veterans Residence in Long Island City
Staff Writer Borden Avenue Veterans’ Residence • Vocational training and employment Mental Health News services will include: services, including training to be- come a Peer Counselor at BAVR, at • Individualized treatment plans for one of ICL’s 84 other programs and/ he Institute for Community Liv- rehabilitation and recovery, includ- or non-profits around the city, job ing (ICL) recently assumed op- ing onsite mental health services training for people with disabilities eration of Borden Avenue Vet- from ICL’s Guidance Center of erans’ Residence (BAVR), the Brooklyn; onsite medical care by and employment with ICL’s subsidi- Tonly shelter exclusively for homeless vet- ICL’s clinic HealthCare Choices; ary Phoenix Maintenance erans in New York City. and self-care skills focusing on “Our veterans deserve the best New wellness management and commu- • Access to support and resources in York City has to offer,” said Robert V. nity re-entry the community, facilitated by ICL, Hess, Commissioner of the New York Community Advisory Boards and the City Department of Homeless Services. • Peer support and counseling, an es- Borden Avenue Good Neighbor Plan “Based on its expertise and management sential component of ICL’s program, strategy, the Institute for Community Liv- helps veterans feel empowered and The Institute for Community Living ing team will continue the level of care know that they are not alone. Veter- serves over 8,000 disabled adults, children Homeless veterans have come to expect at ans will be connected with colleagues and families each year. This New York- Borden.” who share common interests or life July 1 marks the beginning of the tran- experiences and have successfully based 21-year-old nonprofit offers an ar- sition phase for BAVR. A team of 85 full- met similar challenges; they will re- ray of services including residential op- time employees, including two social ceive information about community tions for adults and children providing worker/recovery specialists, two recrea- Dr. Peter Campanelli resources, develop problem-solving housing stability with a unique family tion specialists and an entitlements coun- strategies and build social skills reunification program as an alternative to selor, will utilize individualized planning, “Working with veterans is an honor for foster care; mental health and healthcare vocational training, substance abuse coun- us, and we thank the Department of • Support and opportunities for sociali- clinics offering evidence-based treatment seling and employment opportunities to Homeless Services for this opportunity,” zation and recreation and best practice approaches; assertive assist a projected 600 to 700 veterans each says Dr. Peter Campanelli, CEO and community outreach; and case manage- • year to return to independent housing. President, ICL. “Through our experience Service coordination and advocacy to ment services to individuals with mental Additionally, residents of BAVR will be gained in other shelters, we will imple- find permanent housing placement in illness, mental retardation and/or develop- linked to the continuum of ICL’s services, ment evidence-based practices -- ap- VA housing, affordable or supportive as well as to those of the federal Depart- proaches that achieve results-- and will housing, publicly-funded supportive mental disabilities. ICL’s programs are ment of Veterans Affairs, DHS and Pro- incorporate the new shelter wellness mod- housing, Section 8 housing or even a located in Brooklyn, Manhattan, the ject TORCH (The Outreach and Rehabili- ule, developed by the Urban Institute for shared living arrangement with an- Bronx, Queens and Montgomery County, tation Center for Homeless Veterans). Behavioral Health of NYC.” other client Pennsylvania.
Dr. Jeanie Tse Named President-Elect of the AAPA - NY Chapter and Brooklyn Museum and ICL Team Up to Change Public Perception of MR/DD
Staff Writer Dr. Tse certainly fits into that cate- The product of her experience, which for their works in clay, paint and photogra- Mental Health News gory. As Director of Integrated Health at includes working at many sites and with phy. New York State of Mind ran from ICL, Dr. Tse serves as medical coordina- different populations, is the potential for August 14 through August 31 and was an tor of the Diabetes Co-morbidity Initia- her to bridge the gap between academic offshoot of a four-year collaboration be- Dr. Jeanie Tse Named President Elect tive, a groundbreaking coalition of NYC psychiatry and the clinical reality of dis- tween Brooklyn Museum and Institute for of the AAPA - NY Chapter behavioral health agencies improving the advantaged communities. Through the Community Living (ICL), a not-for-profit way the system works with people with network of the AAPA, Dr. Tse’s leader- agency specializing in services to people serious mental illness and co-existing ship will mutually benefit her vision, her with mental illness, mental retardation and/ r. Jeanie Tse has recently been Type 2 Diabetes. As part of this Initia- colleagues in the field and those who or developmental disabilities (MR/DD). named president-elect of the tive, she co-authored the Diabetes Self- receive services for mental illness, sub- The exhibition will featured art in three NY Chapter of the American Management and Healthy Living Work- stance abuse disorders and developmen- mediums. Visual impairment heightens the Association of Psychiatric books, the central tools of the program. tal disabilities. importance of touch. Works in Clay re- AdministratorsD (AAPA), an educational, This project introduces a new way of sulted from touching select bronze pieces
networking and support resource for psy- approaching and making lifestyle from the Museum’s collection. The artists chiatrists working in administration and changes to address diabetes and other co- used wire armature to capture self- management. The honor reflects her inno- occurring medical disorders. expression. Clay was applied to complete vative work as Director of Integrated The AAPA promotes the professional the sculptures. Works in Photography and Health at the Institute for Community development of psychiatrists at all levels Works in Paint reflect the artists search for Living (ICL), a non-profit mental health of expertise, who practice in sites of vary- “elements that inspire,” including light, agency that serves over 8,000 individuals ing complexity and represent various sec- New York State of Mind: seasonal changes and life in the city. with psychiatric disabilities, mental retar- tors – public, private and academic. Dr. Collaborative Works by Artists with In an ongoing effort to better integrate dation and/or developmental disabilities. Tse’s work reflects the breadth of its Mental Retardation and/or Developmental individuals with MR/DD into their com- On her new role, Dr. Tse says, “Our reach. She provides psychiatric care in Disabilities Help to Change munities, as well as bring a unique experi- goal is to build community and capacity ICL’s MICA (Mental Illness/Chemical The Public’s Perception of MR/DD ence of the arts back into their lives, ICL among psychiatrists who have chosen to Abuse) day treatment program, child and residents attended monthly trips to Brook- work in the public sector by providing family clinics and school-based mental lyn Museum for guided tours focused on education and networking opportunities. health programs. She also maintains an he impact of New York City is specific themes inspired by the museum’s I hope to expand the visibility of the academic appointment as Public Psychia- striking on its inhabitants – artists special exhibits and permanent collection. AAPA and to better address the needs of try Fellow at Columbia University and has and non-artists alike. In a recent The resulting exhibition, New York State child and adolescent psychiatrists among published research on the effectiveness of Brooklyn Museum exhibition, of Mind, will help to change the general our membership. It’s a real privilege to be cognitive behavioral therapy and social skills TNew York State of Mind, artists with men- public’s perception of individuals with working with some of New York’s foremost training in disruptive behavior and autism tal retardation and severe visual impair- MR/DD from that of those who need care public psychiatry leaders in the AAPA.” spectrum disorders at McGill University. ment have used inspiration from the city to those who are strong and capable.. Page 30 Mental Health News - New York City Section: Fall 2008 Exploring Creative Approaches to Improve Health and Wellness
By Marie Sabatino, Training Specialist unique abilities, talents, passions and their stories at cultural venues in the city Center for Rehabilitation and Recovery dreams, and to move beyond the exclu- which contributed towards their integration Coalition of Behavioral Health Agencies sive role of patient. This study demon- as active members in the community. strated that engaging the whole of the I also understand the first-hand bene- person in the creative arts yielded oppor- fits of using creative self-expression to t is widely recognized that a strong tunities for change, personal growth and promote healing. During a particularly connection between physical health a greater sense of meaning in life. difficult period while recovering from a and mental health exists. But where Responsive to these themes, the Coali- health condition, writing about my physi- do we go from here? What creative tion of Behavioral Health Agencies’ Cen- cal pain and emotional distress served as approachesI can health care providers ex- ter for Rehabilitation and Recovery, New a catalyst for transformation. The crea- plore for improving general health and York City’s primary education and train- tive process functioned as a distraction mental wellness to enhance recovery? ing entity for mental health providers, is from physical symptoms, provided an With a growing shift toward recovery- introducing a training module on leader- outlet for deep, reflective thinking, al- oriented person-centered care, and a lack ship development to include information lowed me to redirect intense emotions of integrated services to help people re- on the use of narrative as an essential tool toward healing, and helped to shift my cover from physical and mental health for communication directed toward perspective from loss of meaning to pur- needs, it is reasonable to consider the role change. The art of forming narratives or pose and value in life. of the creative arts in facilitating healing storytelling will be used as one approach Engaging in the creative process can for people with co-occurring physical and to help providers improve interpersonal help people develop insights, organize mental health conditions. While formal art skills, identify common values, challenge their thinking, and find relief from events therapy programs incorporate models of perspectives and stimulate meaningful which cause distress or pain, all of which counseling and psychotherapy, engaging changes that promote hope, empowerment have critical implications for physical in the creative arts with less clinical em- Marie Sabatino and a greater sense of purpose among health and mental wellness. Because phasis offers promise as a more self- both givers and receivers of care. individuals have different interests, directed intervention to healing. and the arts had a profound effect on Professionally, I have used the creative strengths, desires and dreams, a variety Often underutilized as an approach to well-being by increasing an individual’s arts, though storytelling, as an interven- of creative options are needed. Creative fostering health and wellness, the free- capacity to make healthy changes in life- tion when working with individuals with and artistic activities ranging from sing- dom and self-determination associated style. The Manchester study measured co-occurring disorders of mental health ing and dancing, painting and drawing, with expressing oneself through the arts general health, anxiety and depression, disabilities and HIV. In collaboration with to storytelling and drama, may be of in- has been found to engender feelings of well-being, and work and life attitudes The Moth Outreach Program, an organi- terest. These activities can inspire self- empowerment and autonomy, improve across six different art projects involving zation which conducts storytelling work- directed action toward healthy living and sense of well-being and quality of life, 104 participants. Outcomes in all do- shops with underserved groups in New recovery. and increase motivation toward adopting mains of health, including somatic symp- York City, participants who actively en- For resources about arts and healing pro- healthy behaviors (Kilroy et al., 2007). toms, improved significantly following gaged in personal storytelling were able to grams, please go to: www.nea.gov/resources/ Research conducted by the Arts for engagement with creative arts. Provid- “find” their voice, develop empathy, iden- accessibility/rlists/artsnhealthresources.html Health team of Manchester Metropolitan ing outlets for creative self-expression tify with one another’s pain, deepen rela- or www.manhattanarts.com/resources. University in England by Kilroy and enabled individuals to share their tionships and build social supports among To learn more about the Center’s trainings colleagues found that engaging individu- thoughts, feelings and ideas in non- group members. Upon completion of the please visit our website: www.coalitionny.org/ als in creative expression through culture conventional ways, to discover their workshop, members were invited to perform the_center/ for future updates. MENTAL HEALTH NEWS ~ FALL 2008 PAGE 31 Healing From Within
By Dr. Brenda Shoshanna full healing to take place it may be essen- and correct our lack of balance and what tial to make changes in one's total life. our illness is saying to us. When illness comes, it is useful to ease Most of the time we are reluctant to he connection between our up and begin to look within. This does not notice the quality of our lives, moment by mind, body and spirit has been preclude also having fine medical care. It moment. We are all experts at brushing documented widely. When we simply includes taking a broader attitude things under the carpet. Then the carpet feel balanced, loved and con- not only towards our illness. One step in begins to roll up at the corners, and we Tnected, the immune system is stronger and healing from within includes a meditative feel we are coming unglued. During ill- the body finds its own health. Heartbreak, state of mind, or mindfulness practice, ness the body is rebelling. It is demanding loss, anger and other forms of stress inevi- where we are taught to stop, pay attention that we pay attention to all that has been tably take a toll, not only on our personal and respect all that comes to us. It is as if unattended. We may have been pushing lives, but on our physical health. we were re-focusing a camera, receiving ourselves for too long. Now our body is As we tense up to fight our personal our experience through a different lens. For fed up. Stop and listen to me, it pleads. problems, our body tenses as well and example, usually there is a deep sense that We could have been looking and listen- begins to block the natural healing ener- pain is bad, and must be removed at any ing all along, but we are not taught to stop, gies that would otherwise flow. Beyond cost. As we begin healing from within we pay attention to and respect what we are that, the way we handle our illness can see that pain is not bad. Pain arises from feeling. In the time of pain and sadness it is compound this situation. Modern medi- lack of balance and contains much infor- of the utmost urgency to learn how to re- cine is based upon the notion of battle. mation. It brings many messages along connect with our own inner understanding We battle germs and fight for life. As with it. When we see our pain as a mes- and source of strength. When we learn how soon as we feel pain or discomfort, we senger and learn how to respect and listen to listen and how to reply, an entirely new immediately try to stop it from happening to it, healing begins in all kinds of ways. life begins. Then pain and illness become and look for some way to soothe what we The first step is to learn how to see an opportunity for vital change. are going through. We feel we must Dr. Brenda Shoshanna pain as an ally and to "dialogue" with it. change our illness or problems, over- This requires a complete turn around. Learning To Listen power them with our expertise. This ori- Instead of tensing up and gearing for bat- entation leads to increasing stress and a or overly exhausted. The illness may be the tle, we learn how to pause and look for We usually listen only to part of our- never ending battle with all that impinges only way they can give themselves permis- the lesson we have to learn. When we do selves. The rest is rejected. But no matter upon us. However, often, after one illness sion to stop, rest, and make much needed this we find the pain often comes holding what we are rejecting, soon or later we or problem is conquered, another arises. changes in our lives. Each illness has it's a gift in its hands. Usually we feel like must come up against it and face it There is little room for ease of mind. own story. When someone is in physical victims and expect the doctor or psy- straight on. Rejecting something never When we include a psychological and pain and suddenly understands what is chologist to take control of our illness and makes it go away. In fact, it will come spiritual component to healing many troubling them personally, what needs to make us well. This attitude itself is part of back time and again, just for you to accept changes can take place. be done in their life, or how they may have the disease. When we take this attitude we it. Everything needs to be loved and To begin, let us look at illness itself. to grow, they often let go, and it is not un- are relinquishing our part in the illness, Illness often comes when we feel defeated usual for physical problems to subside. For denying our inherent ability to understand see Healing on page 34
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(845) 278-7600 MENTAL HEALTH NEWS ~ FALL 2008 PAGE 33 What is the Metabolic Syndrome and What Can You Do About It?
By Richard H. McCarthy, MD, CM, PhD ment about many of the components of When you see your physician you want Research Psychiatrist the problem. These include issues related to make sure that, in addition to finding to weight, blood sugar and diabetes, how out your blood pressure, you also want at the body handles fats, including choles- least 2 blood tests to determining how number of psychiatric medica- terol and triglycerides, and blood pres- your body manages sugars and fats. You tions are associated with the sure. You no doubt recognize these as want your blood pressure to be less than metabolic syndrome. The medi- many of the factors that are important in 130/85, your blood sugar (glucose ) to be A cations most typically related to maintaining good physical health in gen- less than 100, your triglycerides to be less this syndrome are the so called Atypical eral and good heart health in particular, than 150, and your so-called good choles- Antipsychotics, the newest class of and they are just that. Obesity is now terol (HDL) to be more than 40 for men medication available to psychiatry. calculated in a different way than was and more than 50 for women. The Ameri- While called antipsychotic, these medi- once the case. A general index called the can Heart Association and the National cations are also used to treat an ever Body Mass Index is used. It is based on Heart, Lung, and Blood Institute say that increasing range of difficulties includ- weight and height and is the same for men you have the metabolic syndrome if you ing the symptoms of mania and depres- and women. It is a bit complicated but can have a large waist and any 2 of these other sion of Bipolar Disorder. be done on line at www.nhlbisupport.com/ problems. Triglycerides are made by the In medicine, the term syndromes im- bmi/. The surprise about BMI is how thin body when we eat fats, alcohol and carbo- plies a collection of signs (things that the hydrates. We can lower them by eating you have to be to be normal. The average physician finds on exam or through tests) less of these substances. We can also male American is 5”10 inches tall, and is and symptoms (things that are observable lower our triglyceride levels by increasing said to be overweight at more than 173 or that the patient reports) that often occur our aerobic exercise. Over the counter together, such that the presence of one pounds and obese if he is more than 209 products such as fish oil, large doses of element of the syndrome will lead the pounds. The average female is 5” 5’ tall the vitamin niacin, and statins, medica- and is said to be overweight at more than physician to look for other elements of the Richard H. McCarthy, MD, CM, PhD tions prescribed by doctors, can reduce syndrome. It is very important to note 149 pounds and obese if she is more than triglyceride levels. Before you add in the that a syndrome is not the same as a spe- other potential causes before we look for 180 pounds. For those individuals that do over the counter products, talk with your cific disease. A disease is a specific prob- treatments. Another problem with not have access to the internet, an easy physician. Cholesterol is more compli- lem and different diseases or underlying “Syndromes” is that they are often de- way to determine if you are obese is to cated. It is also made by the body and problems can give rise to similar syn- fined differently by different people; as a look at your belt size. For men obesity comes from the diet. Avoiding many of dromes. Most psychiatric illnesses are result there are many Metabolic Syn- starts at 40 inches and at 35 inches for the same foods that will elevate triglyc- really syndromes, where many different dromes depending on which definition is women. Unfortunately, weight and waist erides will also help keep cholesterol un- pathological processes can lead to the being used. In spite of the variation in size are the only real symptom of meta- der control. Interestingly, exercise for 30 problems being observed. For example, definitions, individuals with a metabolic bolic syndrome. All of the rest of the minutes a day will also help to increase depression can be caused by a wide vari- syndrome have more than twice to three components that go into metabolic syn- the good cholesterol. Blood sugar is also ety of medical illnesses and an even larger times the risk of a significant cardiovascu- drome are signs, which mean that they related to the diet, but the best thing to number of drugs, both medications pre- lar problem and have twice the risk of all must be discovered by the doctor. So, if lower this is to lose weight. Obesity in and scribed by physicians and drugs of abuse . causes of mortality. you are obese or have a larger waist than of itself will raise blood sugar. The presence of the syndrome of depres- While there are many metabolic syn- you should, you need to see a physician sion will lead us to look for these and dromes, there tends to be general agree- for a couple of blood tests. see Metabolic Syndrome on page 36
Heart Attacks: Signs, Symptoms, and Risk Factors
By Colm James McCarthy both arms, back, neck, jaw, or stomach is not so well understood and can happen Emergency Medical Technician regions. This is called referred pain. at rest as well as during exercise. Most These symptoms are usually followed other heart attacks are due to blockages closely by cold sweating, nausea, and that occur in arteries in the heart that are eart Attacks, called myocardial vomiting. Typically, men have the more too narrow. Arteries become narrow over infarctions by physicians, are classical symptoms of chest-centered pain age with the build up of a fatty substance one of the leading causes of and women have the pain in the arms and called plaque. This process is called death and disability in our jaw. A characteristic feature of most forms atherosclerosis and it not only narrows the country.H They occur more frequent in of angina is that it increases with exercise blood vessels, it weakens them as well. If males but lead to death more often when (when the heart needs to work hard and these plaques break up or if a small blood they happen in females. Heart attacks needs oxygen) and decreases with rest clot occurs, the blood vessel can become occur when the blood supply to the heart (when less heart work is necessary). Do blocked and a heart attack ensues. is interrupted. While it may seem odd to not be fooled by the fact that the pain Those factors that worsen atherosclero- think that an organ that is filled with comes and goes with exercise and rest. A sis will make heart attacks more likely. blood may need more, that is exactly what serious problem is taking place within the Some of these factors are outside of our happens. The heart is a unique muscle heart. This is a true medical emergency control, such as age (usually over 65), within the body. It is constantly working and attempts to “walk the pain off” or being a male, or having a family history and it needs both oxygen and energy to do “push through the pain” are more likely to of early death due to heart attacks. How- this work. These nutrients are delivered lead to death than they will lead to recov- ever, the most important factors that lead to the heart by an intricate series of blood ery. The patient should sit and rest and to heart disease are within our control, at vessels that extensively penetrate the heart 911 should be called immediately. Be pre- least partially. These include smoking, muscle. When these blood vessels are pared to do CPR. If you do not know CPR high cholesterol, high blood pressure, blocked or closed off, the heart muscle is attempt to find someone who does. If you physical inactivity, obesity, and high deprived of nutrients and oxygen and or someone you know has a preexisting blood sugar or diabetes. Alert readers heart cells die. If large areas of the heart Colm James McCarthy heart condition, be aware of what medica- will see that the metabolic syndrome in- die, then the heart will not be able to work tions are being taken, specific information cludes many of these factors. The single and the patient will not survive. Occa- ally shortness of breath. The shortness of about that condition, and have the medica- most important thing to do to reduce the sionally heart attacks are silent, that is breath is either closely related to a squeez- tion with you at all times. risk of heart attacks is to quit smoking. they occur with no pain. More often there ing pressure that develops into pain in the All forms of heart attack are due to a The second is the control and prevention of is a very distinctive pain that occurs, center of the chest. This can last for sev- restriction of the blood flow in the heart. diabetes. After that exercise, a healthy diet, called angina. This is the most prominent eral minutes and is often confused with There is a special kind of heart attack losing weight and control of blood pressure symptom of a heart attack. indigestion. As the pain increases, it will where the blood vessels go into spasm and will all reduce your risk for a heart attack The initial sign of a heart attack is usu- often move, typically migrating to one or close off. Called Prinzmetal’s Angina, it as well as other diseases. PAGE 34 MENTAL HEALTH NEWS ~ FALL 2008
A Priority from page 9 people do not follow through on referrals. Bilingual Education from page 6 Comunilife; Michael B. Friedman, And if they did, we would rapidly run out LMSW, Chairman of the Geriatric Men- Even though there are well-tested forms of mental health professionals to refer additional key members of the Latino tal Health Alliance of New York; Arlene of family support that address the mental them to. There is simply no alternative to mental health community in personal González-Sánchez, Commissioner of the health needs of family members and re- continued widespread reliance on primary meetings to discuss the future of the pub- Nassau County Department of Mental sult in substantial delays in nursing home care physicians to provide treatment for lication. The proposed theme for the next Health, Chemical Dependency and De- placements, little has been invested in mental illness. How to prepare them to issue of Salud Mental will be: “Bilingual velopmental Disabilities; (Rear: L to putting these supports in place. do this continues to be a serious problem. Service Providers and Consumers of R) Ira H. Minot, LMSW, Executive Di- Housing for people with co-occurring “Training” sounds like the right solution, Mental Health Services: Facing the Chal- rector, Mental Health News Education, serious mental and physical disorders is but often doesn’t work, except under par- lenges”. For more information contact Inc.; Peter C. Campanelli, PsyD, Presi- also a critical need. Many people end up ticular conditions. However, screening Salud Mental at [email protected]. dent and CEO of the Institute for Com- in nursing homes just because mental tools are available to help physicians Photo (Front: L to R): Michael Stol- munity Living; Leo Leiderman, PsyD, health housing programs and other sup- identify potential problems, and several ler, Executive Director, Human Services Director of Latino Treatment Services at portive housing programs just don’t have collaborative treatment models in which Council of New York City; Suzanne M.L. Saint Vincent Catholic Medical Center the capacity to deal with serious physical physical and mental health providers Colin, Ph.D., President, Association in Westchester; Carmen Collado, LCSW, health concerns. It is easy enough to con- work together at the same site have been Hispanic Mental Health Professionals; Director of Immigrant and Latino Ser- ceptualize appropriate housing, but close well-tested. There also needs to be in- David A. Rosin, MD, Deputy Commis- vices and Director of Public Policy and to impossible for the mental health and creased use of tele-psychiatry both for sioner of Mental Hygiene Services of the Government Relations at JBFCS; and health systems to work together to do it. consultation and for treatment. NYC Department of Health and Mental Paul Levine, LCSW, Executive Vice Hygiene; Dr. Rosa Gil, President of President and CEO of JBFC. Mental Health In Primary Care Conclusion
Most people with mental and/or sub- All of the above are compelling rea- stance use disorders go to primary care sons for focusing mental health and Healing from page 31 Some live with deep fear. They be- physicians for health care or even for health policy on the inter-relationship of lieve life is full of defeat. Other do not mental health care. Unfortunately most health and mental health. But we will accepted, including our illness and pain. allow themselves too much beauty or of these physicians are not trained to need to work hard to make the case com- The best way is to make friends with the pleasure. They drive themselves relent- identify or to treat mental illness. As a pelling not just to those of us in the health pain. Fighting intensifies it. If we can lessly. Is it any wonder they become ill? result, according to the National Co- and mental health professions, but to pub- relax into it for a little while and explore In order to heal from within, it is es- Morbidity Replication survey, primary lic officials, who need to adopt new poli- it, many possibilities arise. When we let sential to handle these long standing pat- care physicians provide “minimally ade- cies stressing integration of care. go, and allow ourselves to speak to the terns, to change them to attitudes and quate mental health care” only 13.8% of pain, and to listen to what it has to say, patterns that are productive of well-being. the time. And their ability to identify Michael Friedman is the Director of incredible changes can happen. Health comes with learning to say "yes" mental illness is so poor in general that the Center for Policy and Advocacy of the To do this, we simply close our eyes, to all of our experience, in being willing upwards of 70% of older adults who com- Mental Health Associations of NYC and stop fighting, and ask our pain what it is to experience it just as it is. Wellness mit suicide have seen their primary care Westchester. The opinions expressed in saying to us, what does it need from us right emerges out of the balance and harmony physicians within 30 days, some even on this essay are his own and do not neces- now? Then we become very quiet and listen of all parts of ourselves. the same day. sarily reflect the views of the Mental deeply. An answer may not come right When we are well, we feel whole, ac- The answer is not referral to mental Health Associations. He can be reached away. Patience is needed. This attitude is cepting and in harmony with ourselves health professionals because so many at [email protected]. called making friends with the pain. An- and the entire world we live in. Like a swers come in different ways. Some hear fresh water stream flowing, this state of answers within. Others see images, some being brings continual refreshment and have dreams. We learn to be open to all that healing day by day. Wellness Initiatives from page 25 Kingsbridge CR/SRO is a creative exam- comes and in this openness, we learn. As Dr. Brenda Shoshanna, psycholo- ple of engaging residents who were not we do this process over and over, fear di- gist and workshop leader, is the au- going out during the day and giving them minishes and we begin to hear. thor of Jewish Dharma (A Guide to The health and wellness groups pro- something to take care of. The residents For example, if we are sad for too long the Practice of Judaism and Zen), vided by F·E·G·S have had a tremendous get a hands-on connection with nature and have not done enough crying, our Perseus Books, and the ways in which impact on its clients. A wellness manage- and they realize they have an effect on bodies may begin to cry for us through it can heal your life. In practice in ment group at the Simon Community something else that is living. David has the illness we are going through. If we Manhattan, she has offered over 500 Residence started in September 2007 with been participating in The Horticultural feel that life is meaningless, our bodies workshops on all aspects of personal ten consumers of whom five moved to Therapy Group since its inception, and can start to express this by shriveling up and spiritual growth and developing independent living, three moved to an states that he has been feeling more re- and dying. If we have held onto difficult authentic peace of mind. An award apartment treatment program, one moved laxed and it also gives him a “sense of attitudes, our bodies will bear the burden winning author, some of her other to an SRO, and one moved independently purpose”. David has also been able to of them. Persistent negative attitudes be- books include The Anger Diet, (30 to her own apartment. A resident at Burn- reconnect with his family members and come wounds upon our entire selves. Days to Stress Free Living), Zen and side stated that the groups have helped his estranged grandson who has since We must look at the basic attitudes we the Art of Falling in Love and many her “learn to be responsible and patient.” become a part of his life. David was also live with and ask ourselves if they are others. www.jewishdharma.com. Con- Another resident, who had experienced accepted into the Supported Apartment conducive to our health, or do they con- tact her at: [email protected], multiple long-term psychiatric hospitali- Program. tain the very seeds of pain? (212) 288-0028. zations, poor attendance at her day treat- In recognizing the impact maintaining ment program, and difficulties at the resi- and improving consumer’s physical health has on their overall well-being, dence, has been attending many of the Screening for Soldiers from page 6 ment and other topics. Army studies groups offered. She is very active in her F·E·G·S is better positioned to help cli- have found that these issues occur at ents achieve self-sufficiency and feel ful- participation in the fitness and “eating for homecoming starts fading. And with their about those times. Again, spouses and filled in their lives. One group participant life” group and her disposition at the day families by their side, they hear about families are invited along and the Na- treatment program has improved dramati- said that the wellness group “was very benefits and programs outlined (and po- tional Guard pays for the hotel for this educational. It helped me with my mental cally. She is focused on improving skills tentially ignored) at briefings during de- session. illness. I learned skills which will help me in self-medication and maintaining her mobilization. At the 90-day interval the Soldiers psychiatric stability. She says that she to move to my own apartment…It is good At two months, there are briefings on return to regular drilling status and report to know that even though you have a feels that she looks better and feels better anger management, substance abuse, to their Armory for medical checks and mental illness, you can still do stuff.” By because of her participation in the groups. compulsive behaviors, financial manage- additional briefings. Having a focus on health combined encouraging clients to make healthy life with using a structured Wellness Self choices and to control what they can in Management curriculum (we use both the their lives, F·E·G·S each day is helping OMH curriculum and Eli Lilly’s) has individuals realize their true potential benefited so many clients. There are and, with the support of staff and peers, Visit us Online many examples of residents who are now develop viable ways to achieve it. more careful about abstaining from alco- Salene Browne is Director of the Simon Mental Health News: www.mhnews.org hol and drugs, have become motivated by Community Residence, Glenn Stelzer is the material, staff and the success of Director of the Tanya Towers Apartment Salud Mental: www.mhnews-latino.org peers, and are moving on to more inde- Program, and Allison Wendell is Director pendent living and moving on in their of the Burnside Community Residence of Autism Spectrum News: www.mhnews-autism.org recovery. A horticulture group at the F·E·G·S Health and Human Services System. MENTAL HEALTH NEWS ~ FALL 2008 PAGE 35
Integrative Healing: Linking Emotional and Physical Wellness to Recovery
By Joseph Galasso, PsyD rence). This is true for several reasons, Physical activity & exercise. Exercise Meadowview Psychiatric Hospital including: (a) we become aware of our is essential to recovery. By caring for bodies and are better able to notice subtle your physical self you can increase the differences in mood or physical states effectiveness of medical intervention. ecovery from mental illness is before having a full-blown episode of This is particularly true of depressive ill- a complex process marked by depression or anxiety, (b) physical well- nesses and anxiety. While not recognized ebbs and flows of wellness and ness can promote improved cognitive as a cure for depression and anxiety, a relapse. Furthermore, it in- functioning, helping us to make better/less growing body of research has indicated Rvolves the interaction of many internal that when used in conjunction with therapy self-destructive decisions, (c) we may (i.e., physical and psychological) and ex- notice increased self-esteem (i.e., how we and medication, exercise has had great ternal (i.e., housing and family) systems. feel about ourselves) and self-efficacy (i.e., success in reducing symptomatology (see Our past two articles have focused pri- our perception of how much control we Babyak et al., 2000 & Johnsgard, 2004). marily on how external factors (i.e., hous- can exert over our situation), (d) we can Stress reduction. The ability to reduce ing and employment) can impact one’s strengthen our immune system, (e) we can stress can be the key to keeping yourself ability to recover from a psychiatric ill- moderate the negative side effects of medi- emotionally balanced. For some, however, ness. This article’s primary objective is cation, and (f) we can all benefit from the the ability to reduce stress can be a very somewhat different, as it focuses chiefly natural anti-depressant effects of exercise. challenging process. One such way, is to on the interconnectedness of one’s own Steps to living well. While the concept become comfortable expressing your feel- physical and emotional life and how these of Mind and Body may seem straightfor- ings. Learning how to express your feel- two internal factors impact recovery. In ward, the real challenge appears when it is ings in appropriate ways eases stress, re- this article, I will focus on three factors time to implement this in our own lives. duces anxiety, and combats depression. It related to the interrelationship of physical To make it easier, we can recognize that can also help us to gain assertiveness and emotional wellness in the process of our success lies in balance. If we are truly skills, which in turn, help us to advocate recovery from mental illness. These three balanced, we should notice that we have a in our treatment and gain a sense of em- factors include: (a) Mind-Body Connec- Joseph Galasso, PsyD calm mind and a strong body. powerment with whom we are and where tivity; (b) Psychological Symptomatology Treatment compliance. Remaining we are in our recovery. and Physical Health; and (c) Connecting developing significant physical health disciplined within the confines of your The positive and successful incorpora- Your Mind to Your Body. problems. As such, physical health and treatment is extremely important. This can tion of mental and physical wellness into Mind-Body Connectivity: How Your interventions which promote positive include keeping regular doctor’s appoint- your daily life, and into your recovery can Feelings Affect Your Health. The connec- physical wellness should be considered as ments, taking medication, and attending a help you to feel better and do better. Re- tion between Mind and Body has been an integral aspect of one’s personal recov- treatment program. Also, by meeting with covery requires growth on many levels. In established through empirical examination ery plan, treatment plan, and daily life. your doctor regularly and receiving edu- this case, being able to recognize how (see Ray, 2003; Pally, 1998) by many Psychological Symptomatology and cation about your condition, you are more your physical state effects your emotional different scientific communities (i.e., psy- Physical Health. Research has found the likely to recognize when symptoms are state (and vice versa) will facilitate the chological, biological, and medical). As link between depressive disorders, anxiety increasing or subsiding. process by increasing your ability to re- such, the medical and social service commu- disorders, and physical health to be the Furthermore, meeting with your treat- main resilient and to empower you to be- nities have begun to reinforce the need to most prevalent. In fact, the World Federa- ment providers allows you the opportunity come a more active participant in your strike a firm partnership when treating people tion of Mental Health conducted the Mind- to discuss other factors that influence re- own treatment and recovery. with mental illness. Body Connection Survey in 2007 and their covery, including sleep and nutrition man- According to Ray (2003), both what findings emphasized how being aware of agement. Having a healthy diet can influ- This article was written using the in- we think and believe can have a signifi- physical and emotional well-being, or lack ence how well your immune system func- formation disseminated through the Fam- cant impact on our overall health. The thereof, can influence the rate at which one tions, how you are able to manage co- ily Education Group. The FEG is de- reverse is true as well, because our physi- can recover from a depressive episode. occurring medical issues (i.e., diabetes), signed for individuals who have a family cal functioning and health will also im- For people who have suffered from and how you feel about yourself. The member or loved one struggling with a pact our emotional functioning. When depression or anxiety in the past, or are same is true for sleep. Not maintaining an mental illness. We meet the second considering people with mental illness, predisposed to feeling sad or nervous, a adequate sleep schedule (i.e., approxi- Wednesday of every month. For more in- the benefits of integrating mind-body positive focus on our physical health can mately 8 hours per night) can influence formation about the Family Education treatments are integral, given that people help to provide the barrier necessary for how clearly you can think, mood states, Group or Meadowview Hospital, please with mental illness are at a higher risk for preventing an occurrence (or reoccur- and physical wellness. contact Meghan Farrell at (201) 319-3660.
Group Work from page 17 chance to address issues along the coop- eration-competition continuum); bringing Now some time has passed. Surround- “stuff” in (e.g. more than just show-and- Mental Health News ing the rock garden are benches. In the tell, what kids bring in to the group, for highschool reflecting garden sits a bench example, as a remembrance of a de- Upcoming Theme and Deadline Calendar bearing Geoffrey’s name and small tree ceased parent has deep meaning and can with its first leaves. Sacred places created aid in the grief process); role playing by caring group members. Places that (e.g. creating scenarios and “directing” Winter 2009 Issue: they will return to for just a look or to sit the action is empowering, providing “Understanding & Treating Posttraumatic Stress Disorder” for awhile and remember. Two special group members with greater control than places for young people to remember they may be accustomed to); poetry, art, Deadline: November 1, 2008 someone dear and to recall their time to- music, and dance (e.g. to provide alter- gether as a group. native means of expression); and pho- Spring 2009 Issue: tography (e.g. in one group teenage Conclusion moms, with the aid of a professional “Follow-up Care After Psychiatric Hospitalization” photographer they photographed their Deadline: February 1, 2009 Activity manuals and curriculum babies, developed the film, and created guides, when used thoughtfully have albums to reinforce their attachment, great value in addressing mental health their bonds with their babies). These are Summer 2009 Issue: issues through group work. Of equal or but a few ideas that I offer to encourage “Recovery and The Consumer Movement” greater value are the activities that come you to be creative and never discount the out of the life of the group itself. These interests, inventiveness, and creativity of Deadline: May 1, 2009 include holiday celebrations (e.g. when your group members. there has a been a loss in the family a Next time a colleague asks you, “Do Fall 2009 Issue: carefully planned celebration in the group you have any activities books?” Give can include a time to reminisce); games them what you have. But first, have a “Understanding and Treating Families in Crisis” (e.g. making up their own games can tap conversation and encourage them to look Deadline: August 1, 2009 into kids’ creativity and give them a to their groups for activities too. PAGE 36 MENTAL HEALTH NEWS ~ FALL 2008
Improving Access from page 25 • nineteen of the twenty-two consumers We are convinced of these individuals’ close to 2000 clients residing in all five who completed the Project had primary need to be connected to primary care phy- boroughs of New York City and Nassau of nine case managers, nine consumers care physicians at the Project’s conclu- sicians and were quite successful in and Suffolk counties.) who had completed the formal training and sion, and all twenty-two consumers achieving this with our Demonstration Training will commence in September, thirteen who had been recruited at the for- were seeing psychiatrists regularly; Project consumer cohort. Yet, we are 2008, and will continue in three two-month
mal training’s conclusion. • Metabolic Syndrome risk factors had troubled that the principal treatment venue training cycles, each consisting of eight two- Training evaluation data was collected been identified in sixteen consumer for our consumers is hospital clinics with hour training sessions, until all thirty-five from case manager and consumer partici- participants, and remedies to address their rotating medical residents and the case managers and their accompanying con- pants at the outset of the training program, the risk factors had been ordered by potential for disruption of care continuity sumers are trained. We estimate that this at its conclusion and after each training their physicians; which that represents. process will take seven months and should session; from the second group of con- (2) While our decision to pursue initia- be completed by no later than March, 2009. sumer participants when they joined the • fifteen reported being diagnosed tion of the Metabolic Syndrome Monitor- As each training cycle is completed, an ad- Project; and from all participants at the with chronic physical ailments, with ing Protocol for our consumers was on ditional consumer cohort will be recruited three- and six-months marks of the Dem- all fifteen also reporting ongoing target, we did not conceptualize it as a cru- for in vivo training by their case managers. onstration Project. The intent was to de- treatment coordinated by a primary cial preventative measure, which it should In sum, we will replicate, with only minor termine the effectiveness of each of the care physician; prove to be, and more apt in application for adjustments, what we believe to be a proven
seven training sessions – which the data • eighteen consumer participants ex- those of our clients who have yet to be and effective training model. did substantiate – and, more importantly, pressed satisfaction with the quality diagnosed with chronic medical illnesses. Since our ultimate objective is to develop the impact of the training on the learning of their medical care, and nineteen re- Accordingly, when we expand ICCM and a “best practices” paradigm that can eventu- of the participants over the course of the ported improved access to medical care. proceed to train our thirty-five remaining ally be adopted agency-wide and possibly next six months. Indeed, the case manag- case managers and combined cohorts of state-wide by other case management pro- ers who completed the training pro- However, several key treatment and seventy consumers, half of the consumers grams and adapted to meet the needs of their nounced themselves “empowered” and systems issues surfaced as our Demon- selected will have diagnosed chronic consumers, we will continue collecting out- “well-informed;” and one of our consum- stration phase came to a close that we had physical ailments and half will not. Efforts come data to determine the effectiveness of ers characterized the training’s objective not anticipated. will be made to connect all seventy to our training approach in preparing case as teaching consumers and case managers (1) We find ourselves more aware of the PCPs, and to monitor their medical pro- managers and consumers to work collabora- to “ask questions and get answers.” acute vulnerability of those of our clients gress over the course of twelve months. tively to improve consumers’ access to Our conclusions: that our training who have been diagnosed with chronic However, the initiation of the Metabolic health care and prolong their lives. Outcome model proved effective; more specifically, medical ailments. Further, we believe we Syndrome Monitoring Protocol will be data from both the New York City and Nas- that our consumers could learn both in the have identified key variables which pursued primarily for those consumers sau-Suffolk study participants will be col- classroom and as they put what they had heighten their risk of premature death, viz., without diagnosed chronic ailments. Our lected over a twelve month long period to learned into practice; and that our case a diagnosed chronic medical illness, a clear objectives will be two-fold: to forestall in determine how effective we have been in managers could teach the consumers in indication of biological vulnerability; age – the members of this consumer cohort the achieving these goals and, whether, in the traditional case management fashion, viz., particularly as they approach or enter their development of chronic ailments and to process, we have achieved any cost savings “side by side” as they carried out the tra- 50’s; active or history of substance abuse, mitigate their risk of premature death. by reducing consumers’ medical emergency ditional case management functions of particularly alcohol and crack cocaine. We (3) We plan to expand our ICCM room visits and hospitalizations. linking to and monitoring of requisite suspect that gender might represent another model program-wide and, while doing so, services. risk factor, particularly for males, although to conduct a comparison study with case Please note that much of the foregoing Access to Medical Care: Project out- the 2006 study conducted by the National managers and consumers from the article was first published on MI- come data at the Project’s conclusion in- Association of State Mental Health Pro- agency’s Nassau-Suffolk case manage- Watch.org. For further information or dicated improved consumer access to gram Directors found no correlation be- ment programs. (FEGS employs approxi- continued discussion, feel free to contact health care. Specifically: tween increased risk and gender. mately 150 case managers who work with the author at [email protected].
Health Integration from page 23 cialist in each clubhouse will provide and Guardians from page 13 illness presents. Symptoms vary wildly supervise cessation services, supported by from person to person, even within the care needs. Participating mental hygiene technical assistance from Department Conclusion same diagnosis. The effects that any par- providers will also focus on a particular staff. An important component of the ticular symptom of mental illness may area of need for their program (metabolic program is outreach to consumers’ treat- Article 81 has provided great relief to have on one’s capacity to make decisions disorders, smoking, obesity, infectious ing primary care providers and psychia- those who are incapacitated, those who regarding medication also varies from per- disease, or inadequate dental care). trists, both to offer education about best care for and love them, as well as the son to person. Additionally, the side effect In addition, DMH’s FY 2008 geriatric treatment practices and to ensure proper courts in that its flexible nature allows the profile that psychiatric medications present mental health initiative funded by the care coordination. incapacitated individual to retain as much is equally diverse. Hence, nothing less than New York City Council supported nine The burden of behavioral health prob- freedom as possible while still allowing an individual approach will suffice. programs that worked to integrate health lems has historically been underestimated for assistance in the areas that are needed. Likewise, because of the seriousness and mental health services for the people because it has failed to adequately reflect However, when it comes to psychiatric and the permanency of a decision to with- they serve. Efforts in these programs have concomitant physical health problems. treatment and care, an individual ap- hold, or withdraw, life sustaining treat- incorporated medical screenings that focus Mental illness increases risk for commu- proach is required. ment that power can only be granted on various potential problem areas: breast nicable and non-communicable diseases This approach must take into account where there is specific proof that this is cancer, colon cancer, cardiovascular health, and contributes to unintentional and in- the specific facts at the time in question. what the Incapacitated Person would have etc. as well as providing mental health out- tentional injury. Conversely, many physi- This individual process is required because wanted were they capable of making the reach in primary care offices for seniors. cal health conditions increase the risk for of the unique situation that psychiatric decision for themselves. DMH is partnering with the Depart- mental illness. These often-overlooked co ment’s Bureau of Tobacco Control to -morbidities impede help-seeking, diag- pilot smoking cessation projects at two nosis, and treatment. DMH, through its community-based clubhouse programs. In ongoing efforts, is working to improve Metabolic Syndrome from page 33 ing how to lose weight and doing it are response to high smoking prevalence how physical health needs are addressed two very different things. In a future col- among individuals with psychiatric diag- in mental hygiene service settings, and The metabolic syndrome is a real umn we will discuss this more. In the noses – 75% percent compared to 22% in how mental health needs are addressed in problem. While psychiatric medications mean time, you can help yourself by the general population – participating primary care settings. Early identification may make it worse, it can be improved by watching your diet, increasing exercise, programs will deliver smoking cessation and treatment of all health problems, in- simple things like a good diet, weight and avoiding the one thing that will make awareness training and treatment to club- cluding addressing unmet physical and loss, and exercise. While these are sim- the metabolic syndrome worse than any- house members and staff and will imple- behavioral health needs, can have a dras- ple they are not necessarily easy. Know- thing else, smoking. ment a smoke-free facility policy. A full- tic effect on the quality and length of a time certified Tobacco Treatment Spe- person’s life.
Fountain House from page 24 the morning juice, and a healthier body. This has definitely helped my mind. I find Send Us Your Ideas and Suggestions the cardio-vascular machines to be the keeping up physically helps me be more most potent and most helpful of my exer- productive and enjoy life to a greater ex- For Upcoming Themes and To Provide us With Feedback cise regimen. I get anxiety attacks very tent. In short, healthy diet, vigorous exer- often; since I've been exercising I go cise, meaningful work, and prayer have Email: [email protected] home free of anxiety attacks. There is created, for me, the environment of a definitely a correlation between exercise, healthy person.” MENTAL HEALTH NEWS ~ FALL 2008 PAGE 37 Improving Competence from page 23 first-generation migrants, frequently with and public health promotion so that con- will then conduct the third phase, which limited English fluency. In Harlem, 67% sumers, families, and providers can work consists of a more thorough baseline underserved populations in New York of community members are African together to transcend cultural and linguis- evaluation of each clinic. We will assess State. Even without taking into account American –including a substantial com- tic barriers and empower diverse consum- information on cultural competence of the effect of SMI, African American and munity of African and Haitian immigrants ers to make healthy choices. In order to existing services, detection/ management Latino communities are at higher risk of -- 20% are Latino, and 3% Asian. These develop such a model, the Center is en- of physical health problems, patient en- obesity, diabetes, hypertension, and other demographics have created challenges for gaging in a five-phase community out- gagement, self-management of lifestyle adverse physical conditions than non- delivering culturally and linguistically reach project centered in Northern Man- choices that affect health --such as diet, Latino white communities. Across all competent care in Northern Manhattan. hattan that will develop culturally compe- exercise, and smoking-- and patient out- ethnic/racial and linguistic groups, the This region also has one of the highest tent, person-centered best practices for comes. During the fourth phase the re- presence of SMI worsens the risk of in- concentrations of poverty in the City, delivering physical health care to SMI search team will assist each mental health adequate detection of physical health which contributes to the disparity between patients. This project is being conducted clinic to implement the intervention they problems in mental health settings, fre- need and service capacity. in collaboration with diverse community have chosen. Finally, the fifth phase con- quently the predominant source of general As a result of the high number of im- stakeholders, including consumers, family sists of a post-intervention assessment, health care for the SMI community. migrants residing in Northern Manhattan, members, care providers, faith-based which will be used to assess the interven- However, when their illness is detected, inattention to language and cultural fac- leaders, and community residents. We tion’s impact and sustainability. During ethnically and linguistically underserved tors constitutes a serious barrier to the have started this work with the commu- all five phases the Center research team groups with SMI experience a lower like- delivery of adequate mental and physical nity surrounding our base at the New will employ a mix of qualitative and lihood of receiving guideline-concordant health care to persons who are monolin- York State Psychiatric Institute in North- quantitative research methods, which have care. This increases the already-elevated gual in Spanish, French, or Haitian Cre- ern Manhattan, and will then expand from become the standard methodology for risk of adverse outcomes, resulting in ole. Health care providers and mental there into a statewide initiative. studies of this sort. A mix of surveys, higher rates of disability and premature health advocates who are committed to a The five-phase project will start to participant observation, individual inter- death among African Americans and Lati- paradigm of cultural and linguistic com- address the gaps in the physical health views, and focus groups will be used. nos in New York State relative to white petence try to convey to patients and fam- care of underserved patients with SMI by Throughout the whole research process New Yorkers. Since people with SMI die ily members that they are not alone. This outreaching to several mental health clin- the Center will engage consumers and on average 25 years earlier than the gen- cultural engagement is an opportunity to ics in our surrounding neighborhood, in- their families, providers, and other key eral population, it is clear that chronic build solidarity and a sense of community cluding consumers, staff members, and helpers (such as their faith-based commu- mental illness compounds already existing with stigmatized individuals and families other stakeholders. The first phase of the nity) through person-centered approaches racial/ethnic disparities, resulting in a true experiencing mental illness. The challenge project is a program needs assessment, that employ self-management models. health crisis among ethnically, racially, is to ensure that this message of hope tran- involving an initial evaluation of 6 mental We also recognize the importance of and linguistically underserved persons scends cultural and linguistic barriers and health clinics across Northern Manhat- strengthening support networks in order to with SMI. creates an environment that is truly condu- tan. The goals of this phase are to engage help the person through his/her recovery Although shifting demographics have cive to recovery and that addresses both community stakeholders, explore existing process. Ultimately, the Center’s goal is contributed to increasing health disparities physical and mental wellbeing. programs related to physical health care, to work together with the person and his/ throughout all of New York, census esti- The Center is committed to the integra- and start to develop alternative models for her recovery team to develop a sustain- mates indicate that Northern Manhattan tion of mental health and physical health integrated physical and mental health ser- able programmatic infrastructure that em- has one of the highest concentrations of care for illnesses such as heart disease, vices. During the second phase we will beds culturally competent best practices ethnically/racially and linguistically un- hypertension, diabetes, and other obesity- work with the programs, clinics, and com- for physical health care into his/her exist- derserved individuals in the state. Ap- related conditions that frequently co-occur munity members to collaboratively ing network of mental health services. proximately 72% of residents in Washing- with mental illness. In order to address choose interventions to enhance culturally The staff of the Center of Excellence ton Heights and Inwood are of Latino this integration in a culturally competent competent management of physical health for Cultural Competence at New York origin and 20% are African American; way, it is critical to explore culturally problems in a way that addresses patients’ State Psychiatric Institute also contrib- over 90% of the Latino community are adaptable models of service integration needs. Jointly with all stakeholders, we uted to the publishing of this article.
The Diabetes Initiative from page 1 weekly diabetes group. One week, a knowledge. When this F.E.G.S. Case ing that they take their medications as group was held for participating consum- Manager learned of her client’s diagnosis, prescribed. There was also an increase in Early experience with the Diabetes ers who were working on monitoring their she immediately linked him to a nurse the number of people reporting that they Self-Management Workbook blood glucose levels through finger sticks. who contacted his primary care provider had useful ways of managing stress in Chinese food from the “diet” menu was and coordinated care. He asked ques- their lives. The Workbook was recently piloted ordered and served as a reward. Intrigued tions about diabetes, and they used the The initial experience with the Diabe- across several programs at ICL, The that a favorite food could be served in the Workbook together to look for answers. tes Self-Management Workbook is en- Bridge, F.E.G.S. and William F. Ryan context of a diabetes group, the individual He began to take small steps toward im- couraging, and ICL and the DCI partner Community Health Center. About 200 attended. Gradually, this person not only proving his eating and physical activity. agencies hope to make an even bigger consumers with mental illness and diabe- became “a regular” at the weekly diabetes He tried limiting sweets and “portion impact with the enhanced DCI Toolkit. tes volunteered to participate in trying out group, but noticeable changes in attitude sizes,” and was surprised that he could Consumers can beat the diabetes crisis, the Workbook, some in a diabetes group and behavior became apparent. Moreover, feel full with less food. He also began working with the people that support them and some during individual sessions, ac- the positive changes he made produced doing push-ups. He started using his glu- towards self-management and full recov- cording to their preference. Staff used immediate results: his A1c level (i.e. his cometer, which had never before been taken ery—physical, mental and spiritual. motivational enhancement techniques to blood glucose) was slowly but consis- out of its box, to measure his blood glucose. More information about diabetes is develop interest in participation. tently dropping to a normal range. He reports that his mood has improved since available at: The American Diabetes As- Le’Nise Watson-Hudson, Director of A Case Manager for F.E.G.S. in Nas- he began making these changes, and shares sociation: www.diabetes.org and The Nursing at ICL, recalls one individual at sau County says that a consumer shared diabetes-related news with his Case Man- Joslin Diabetes Center: www.joslin.org. ICL’s Milestone Residence on the campus with her for the first time that he had dia- ager each time they meet. Rosemarie Sultana-Cordero, LMHC, of Creedmoor Psychiatric Center in betes when the Workbook was introduced Preliminary results of data analysis Diabetes Co-morbidity Initiative Clinical Queens, who was challenged with high at their program. Case managers are the show positive trends in the proportion of Coordinator, at the Institute for Commu- A1c levels, blood pressure and choles- “glue” in the mental health services sys- consumers reporting that they talk to their nity Living. Jeanie Tse, MD, is a Psychia- terol. Previously, this person avoided all tem and are responsible for referring and primary care providers about diabetes, ask trist and Director of Integrated Health at groups and did not want to talk about his motivating consumers to access health about their A1c level and regularly check the Institute for Community Living. Andrew diabetes. Staff respected his decision care services. They also help consumers blood glucose. A significant change was Cleek, PsyD, is Director of the Urban In- while still extending invitations to the to develop self-management skills and found in the proportion of people indicat- stitute for Behavioral Health.
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