The Chicago News Cooperative takes up the problem of Mayor Rahm Emanuel’s decision to cut six of Chicago’s 12 mental health centers. In Philly, that would be devastating, so I can’t imagine it’s any different there. Of course the government is saying that people will be taken care of somehow, but that’s the kind of thing they always say, right? They say they patients from the other centers can just go to the ones that will stay open. But, um, that would mean a 71 percent increase in patients for the remaining clinics and a 0 percent increase in resources. Sounds like a plan.
Go here to read the stories of the people whose lives will be impacted by the cuts. Interestingly, though you’d imagine they’re depressing, they’re actually stories of hope. People with these illnesses are so strong, they are such survivors. They’re remarkable, and they deserve better.
UPDATE: I go into this a bit further over at the Philly Post. Check it out, and thanks for your comments.
In today’s Daily Beast, Gail Sheehy writes about the exhaustive interviews she did with Newt Gingrich and his family members some years ago in preparation for a Vanity Fair article. Newt’s mother was living in Dauphin, Pa., at the time, and confessed to Sheehy that her son had a rough childhood—one she called “a heck of a mess.”
Newt’s was a rootless boyhood as his stepfather’s military career moved the family around the U.S. and abroad. His mother became more and more emotionally fragile. How did she survive? I asked Kit Gingrich.
“I almost didn’t,” she blurted out. “I had manic-depressive illness.”
“Oh, sure. My life was moving from one post to another and another doctor and more medicine,” she told me. “You name it,” she said, referring to all the medications she was given for bipolar disorder, “and I was on it.” When a new doctor took her off all medication, she said, “I almost fell apart.” Bob Gingrich was furious and demanded that she be medicated again. But in that brief window of clarity, she told me, she saw him with new eyes. “Bob is a tyrant,” she declared. “No question about it.”
Oddly, though Sheehy questions the impact that Bob (and Newt’s biological father) had on the politician, she goes on to say:
His mother’s legacy of manic-depression may be even more relevant. The condition is inherited in about 80 percent of cases. I asked Gingrich if he thought he had a genetic predisposition to bipolar disorder. He didn’t blink. He said he didn’t know, then applauded the special powers of leaders who are thought to have been bipolar.
“Churchill had what he called his ‘black dog,’” he said. “Lincoln had long periods of depression. You go down the list …” He speculated that leaders who are able to think on several levels at once may have a different biochemical makeup. “You have to have a genetic toughness just to take the beating,” he concluded.
Bizarrely, Sheehy spends the rest of the article essentially arguing that Newt may, in fact, have bipolar disorder. It’s pretty ridiculous and borderline offensive. She even quotes Frederick Goodwin, who should be ashamed of himself for stooping this low, as saying, “Gingrich’s quickness, his ability to pick things up quickly, is consistent with studies of first-degree relatives of manic-depressives.”
It’s veiled character assassination. I dislike Newt Gingrich very much, but political careers have been torpedoed by accusations of mental illness. Is that Sheehy’s agenda? I wonder if she’d treat a liberal politician the same way.
A combination of service cuts and recession job losses is flooding hospital ERs with people suffering from psychological crises. This is in addition to the people who already rely on ERs for psych services and who are already taxing the system because there is a lack of alternatives. People who use crisis centers are not being given the appropriate tools to manage crisis on their own or to minimize crisis in their lives. People who use the ER because they’re uninsured are victims of a negligent healthcare system that forces people to wait until things turn dire. Then there are people who are homeless who are seeking food and shelter and have nowhere else to go. If you want to see how massively this country fails its citizens, a few nights at your local ER will do it. The new population is an added problem.
“These are people without a previous psychiatric history who are coming in and telling us they’ve lost their jobs, they’ve lost sometimes their homes, they can’t provide for their families, and they are becoming severely depressed,” said Dr. Felicia Smith, director of the acute psychiatric service at Massachusetts General Hospital in Boston.
Visits to the hospital’s psychiatric emergency department have climbed 20 percent in the past three years.
“We’ve seen actually more very serious suicide attempts in that population than we had in the past as well,” she said.
Perhaps most disturbing is that people who come for care often don’t get it:
And many hospitals are not prepared for the increased caseload of psychiatric patients, says Randall Hagar, director of government affairs for the California Psychiatric Association.
California cut $587 million in state-funded mental health services in the past two years, the most of any state, according to the National Alliance on Mental Illness, a patient advocacy group.
“They don’t have secure holding rooms. They don’t have quiet spaces. They don’t have a lot of things you need to help calm down a person in an acute psychiatric crisis,” Hagar said.
“Often you have a patient strapped to a gurney in a hallway outside of the emergency department where social workers are desperately trying to find an inpatient bed,” he said.
My emphasis. Can you imagine anything more troubling than going for help and then getting restrained instead?
The reader who brought this article to my attention said:
I fear for too long the mental health system has been considered infinitely elastic. Sadly, my peers and I are not. I wish the general population was more familiar with the nature, timing, and extent of the services our nation’s mental health system provides and the outcomes it fosters. I fear a great many have come to believe with the advent of “safer and effective medications” consumers need little more then a pill. If this was true the system could be viewed as infinitely elastic. As you know, things are not so simple.
Though he was able to get media coverage for this issue in 2009, admissions in the county hospital in his area continue to increase, from 4,639 in 2009 to 5,693 in 2011. And from what we’re reading, the trend seems likely to continue.
Health.com has come up with a list of celebrities who confessed in 2011 to having serious health issues, which is great because poring over back issues of People magazine would be enough to make me increase my meds. What strikes me is that those celebs with behavioral health issues are treated the same as those with issues like autoimmune illnesses. That’s progress. Instead of being deemed “crazy,” they’re being characterized as dealing with a health problem. So Catherine Zeta-Jones’ bipolar disorder is on the same list of health issues as Kim Kardashian’s psoriasis. The only problem with this is that Kim Kardashian exists at all. Also mentioned: Daniel Radcliffe (Harry Potter), who struggled with alcohol dependence but now seems to be doing well. He told People in July:
“I’m actually enjoying the fact that I can have a relationship with my girlfriend [Olive Uniacke] where I’m really pleasant and not fucked up totally all the time … As much as I would love to be the person that goes to parties and has a couple of drinks and has a nice time, that doesn’t work for me. I’d rather just sit at home and read, or go out to dinner with someone, or talk to someone I love, or talk to somebody that makes me laugh.”
As for Zeta-Jones, she wasn’t planning to discuss her bipolar disorder openly, but was forced to when the tabloids would did the job for her. Pretty despicable. When Michael Douglas appeared on Oprah, he blasted to tabs for “outing” her. Not all celebs want to serve as poster children for their conditions—nor should they have to. It was probably the last thing she needed after a psychiatric hospitalization.
I’m always proud to tell people I’m a Certified Peer Specialist (CPS), but it isn’t something that’s well understood by people outside of the mental health community (and even by some inside). Explaining it is a little awkward: Phrases like “lived experience” aren’t familiar to most laypeople, so you actually do have to say, “I have been trained to help people who, like I do, have behavioral health challenges.” Then you get into the problem of the language: Is it appropriate to say challenges? It’s more politically correct to say “people who have been diagnosed with…” but many disavow those diagnoses and feel they’re inaccurate. Additionally, the phrase “behavioral health” doesn’t mean much to laypeople either. I either end up doing a weird self-deprecating thing (which jibes with my overall shtick) about being “crazy” or getting far too detailed about the history and successes of peer support in the United States, which frankly bores the crap out of people.
This is why it’s good that the media continues to cover peer support—so that it becomes more widely understood and accepted. The New York Times‘ Benedict Carey, who’s the best journalist covering the mental health beat, bar none, wrote about peer support in the last installment of his series “Lives Restored,” about people with severe mental illnesses living full lives in the open. In this final episode, Carey profiles Antonio Lambert, who deals with the challenge of dual diagnosis, which, as Carey points out, is a bitch (well, he puts it differently, but you know).
About peer support, Carey is a bit abbreviated:
The mental health care system has long made use of former patients as counselors and the practice has been controversial, in part because doctors and caseworkers have questioned their effectiveness. But recent research suggests that peer support can reduce costs, and in 2007, federal health officials ruled that states could bill for the services under Medicaid — if the state had a system in place to train and certify peer providers.
In the years since, “peer support has just exploded; I have been in this field for 25 years, and I have never seen anything happen so quickly,” said Larry Davidson, a mental health researcher at Yale. “Peers are living, breathing proof that recovery is possible, that it is real.”
One thing that struck me about the article is something I don’t hear people say enough: that peer specialists are willing to do things other traditional helpers are not. Lambert, now a successful recovery motivational speaker and counselor, started small but had a tremendous impact on the first place he worked as a peer specialist.
“He had the worst cases; he had to go into these high gang areas, places no one else would go,” said Sue Bethune, his boss at the time, who is now a mental health consultant in Greensboro. “He really opened the door for the program to be able to send people in there.”
When I managed peer specialists with dual diagnosis, in particular, that was something I saw again and again: fearlessness. There is nothing they haven’t been through and nothing they won’t do now to help someone else. That’s why it’s risky work for them, and why some, even Lambert, do relapse. But their ability to show up in dark places tells the person they’re working with: you’re important and I’m here and I’ll be here no matter where you go.
Lambert still struggles to believe he’s gotten to where he is. I’ve heard that a lot too. People who say, “I used to live on that grate and I’d score crack around that corner, and now I’m walking by in a suit and tie on my way to a meeting with city officials to talk about how to deal with people living on grates and scoring crack.” That disjunction can be a little overwhelming, and it’s a lot of pressure to be seen as a model for a community. What if you don’t measure up?
Read the rest of Lambert’s story and see a video of him here to see how he handles it all.
I cited Natasha Tracy’s post on AOT a few days ago, and got some intense feedback. I’d like to clarify my position. I fully understand people’s mistrust of system interventions and compelled treatments and the proverbial slippery slope they believe such treatments represent. But after working on the front lines of direct services to people with chronic mental illness, I believe you might feel differently—at least in some cases.
No one is advocating AOT for every person who has been diagnosed with a mental illness. That’s not how things work. People who are monitored under AOT have met certain criteria, like committing a criminal act. It is unfortunate that people’s illnesses do infrequently cause them to commit illegal acts, but when they do, they must—like every other person in our society—be held to account for those actions. Because we don’t want them to just be thrown in jail without considering their health problems, we find alternative ways to address issues of safety and accountability.
AOT for someone who has committed a crime is not, in my opinion, a slippery slope to someone like me—diagnosed with bipolar disorder—being forced to submit to similar conditions in my everyday life. I think the invocation of the slippery slope is a lazy rhetorical device employed by people who are afraid and angry, sometimes justifiably so. But is it borne out by facts? I don’t believe so.
A couple years ago I was the manager of a peer support program for a mental health organization. The goal of the peer support program was to reduce repeat hospital visits for “frequent flyers,” as the hospitals so sweetly called them. This reduction in hospital visits had an obvious benefit for the people we worked with. And I don’t think anyone objecting to AOT, which has the same goal in many cases, would object to peer support. There are many different tools we use to make lives better for people who have been diagnosed. Those who live in extremis due to their illness—those who are homeless, or who spend every weekend in the ER—need bold intervention.
I have a friend who runs an Assertive Community Treatment (ACT) program. Some people object to ACT for the same reasons they object to AOT. But my friend has seen people’s lives change radically—especially people living in poverty who were unable to manage their own resources. Sometimes in our zeal to protect rights in general, across the board, we forget about the individuals who are suffering on a daily basis. Should someone who lives in poverty and can’t get food because of his delusions prevent him from processing the complexity of government paperwork for food stamps be denied help so the rest of us can preserve our rights—which we only theorize are being threatened?
I am no fan of E. Fuller Torrey or TAC. I think he’s terribly destructive. He does not allow for subtlety. He has a twisted agenda. He’s a dangerous guy. I am not endorsing his positions, and I didn’t mention him—though someone affiliated my remarks with him. I do endorse careful, responsible consideration of practices that may help individuals in a system that continues to underserve them.
Hey, everyone. So I’m out on vacation today and tomorrow, celebrating the holidays in Los Angeles, of all places. I wish I could be here with you, but I’m giving you the next best thing—or maybe something much better: puppies. I know this is Christmas, and some of you may not be Christian (as I’m not). But I think we can all agree that puppies are religion-neutral, unless it’s the religion of CUTE.
Eva Perón may have had a lobotomy. It’s a shocking revelation because we think of Evita as strong, competent, lucid and driven. How could this have happened to her? The answer is that Perón had cervical cancer, and was lobotomized to ameliorate her pain—one of the reasons were performed in 1952. From the New York Times:
Dr. [Daniel E.] Nijensohn’s research, to be published soon in the journal World Neurosurgery and recently posted online, turned up several pieces of suggestive evidence. He confirmed details of Dr. Udvarhelyi’s story and found other contemporaries of Perón who had said she had had surgery for her pain.
Dr. Nijensohn also unearthed information indicating that Dr. James L. Poppen, a neurosurgeon at the Lahey Clinic in Boston and an international expert on the use of lobotomy for intractable pain, had been summoned to operate on Perón in the summer of 1952. X-rays of Perón’s skull, Dr. Nijensohn found, showed indentations in the areas where lobotomies were usually performed.
Dr. Nijensohn believes that a lobotomy was performed in May or June of 1952, meaning that Perón may have already had the procedure at the time of her last public appearance, riding in a limousine at her husband’s second inaugural.
The idea of utilizing lobotomy to treat pain is interesting to me. I can almost go for it. What would I prefer: excrutiating chronic pain or being a bit of an idiot? The latter sounds a lot more appealing. But as author Barron H. Lerner points out, there was already pain treatment available: opiates. And those make you idiotic too, so it’s like two for the price of one but without any surgery.
Hat tip to Susan and Holly for this article.
If you recall, we recently posted about Facebook’s new effort to combat suicide in conjunction with Lifeline. Today comes news of a beautiful, reportedly bubbly young woman (pictured) who posted to her account shortly before throwing herself under a train. From The Independent:
Gabrielle Joseph, 16, posted a message to friends on the social networking site hours before taking her own life. The teenager, from Briton Ferry in South Wales, went on to post a message to a friend saying: “I am going to kill myself tonight.”
The words were written after a boy she had planned to go with to the cinema called off their date.
The news of her Facebook message came out at an inquest about her death, which occurred in April.
I’m not sure if things have changed or if my perspective on them has changed, but it seems as though the world is a more dangerous place if teenage suicides are triggered by a canceled date. Even when we felt “suicidal” about a boy’s rejection when I was in high school, there was always enough perspective to understand that it wasn’t the end of the world. I was lucky to have a parent there for me, reminding me that things would be different. Perhaps Josephs didn’t.
All that being said, surely this wasn’t the only thing that was troubling the young model. While the headlines are focusing on the fact of the date being the precipitating factor, there’s something missing, right? Even her father said she seemed “groggy and pale” the day of the event, which was out of character for her. I wonder if we’ll find out there were drugs involved—and when I say drugs, I actually mean either illicit drugs or newly prescribed antidepressants.
So it’s December 21st, which means it’s only 10 days away from the due date, as it were, for NAMI’s Countdown to Recovery. It’s a fundraising concept meant to highlight NAMI’s work, and given that they do, in fact, play a very important role in the lives of people with whatever-you-call-it (mental illnesses, Freudian slippages, brain disorders, yadda blah blah), I’d encourage you do donate if you can.
I have heard plenty of people complain about NAMI—about its being compromised by Big Pharma involvement or about its teaming up with TAC in some instances. But I’ll tell you, in my experience working in the mental health field, I have been blown away by how incredibly helpful and supportive NAMI groups are for people whose loved ones have been diagnosed with mental illness. I’ve been at these groups and watched parents cry and share and be there for each other in a way no one else in their life can. I’ve seen NAMI sponsor educational events that cleared the way for people to get better. And I’ve seen NAMI stand at the forefront of peer support advocacy and every other struggle people with mental illnesses fight for. No organization is perfect. I can’t speak for every single state and city affiliated group. But overall, the balance of the work that NAMI does is frankly indispensable.
Perhaps the PR gambit is an unfortunate choice of word, though, when we know that 10 days from now everything in the system will be exactly the same. As one reader wrote of the Countdown, “Of course, my peers and I will find the same system we’ve always had come January 1, 2012.” No question, wise reader.