Don't Link Violence with Mental Illness

 Opposing view: Don't Link Violence With Mental Illness

Rather than forcing more people into treatment, dedicate adequate resources toward prevention

By Wayne Lindstrom  USA Today OP ED  January 11, 2013

 

Calls to make it easier to commit people for involuntary mental health treatment will do little or nothing to prevent violent acts. It will only scare people from seeking help voluntarily and fail to increase the number who are committed.

The premise that we can predict or prevent violent acts is unsupported. Even in the case of severe mental illnesses, mental health professionals possess no special knowledge or ability to predict future behavior.

The fact is people with mental health conditions are no more likely to be violent than is the general population. Continuing to link violence and mental illness only stigmatizes people and deters them from seeking care.

Paradoxically, making it easier to commit people to treatment will not lead to more commitments or more people getting care. A chronically underfunded mental health system, which has experienced $4.6 billion in state budget cuts since 2009, does not have the capacity to meet those needs.

When Illinois lowered its standard to allow the commitment of virtually every person with schizophrenia and bipolar disorder, commitments decreased because of the continued reduction in public and private inpatient beds.

In Washington, a study of the state's lowered commitment standard revealed fewer voluntary admissions and a rapid increase in the revolving door of discharges and re-admissions. In fact, the number of people who meet existing commitment standards in every state already exceeds the beds available for them.

It is highly unlikely we will increase the number of psychiatric beds. Nor should we.

Rather than forcing more people into treatment, we should dedicate adequate resources toward prevention and early identification of emotional disturbances in children and fund cost-effective community-based interventions that work.

Just two-thirds of those with severe mental illness and one-third with moderate illness receive appropriate services. When care is provided, there is a gap of up to 10 years between their first symptoms and first treatment.

Expanding access to care under the Affordable Care Act and mental health parity law will serve people better than changing commitment laws that will change nothing.

 

Wayne Lindstrom is the CEO of Mental Health America.

 

Christmas Windows

CHRISTMAS WINDOWS

It has started to snow.

It isn't much and it still isn't the right time for it to stick around, but it's snow and a step in the right direction.

It's dark too. Not pitch black night time dark, but the fuzzy dark that happens as the sun makes its final exit and the day comes to an end.

And it's cold. Not really cold temperature-wise, but damp cold: the kind that gets into your joints that you don't really understand until you get older.

Ronin and I are out walking.

This is our time.

I try to mix up the routes we take just to keep it interesting. I think I am doing it for him, but the truth is he doesn't care. We could walk the same path every day and he would be fine with that. He makes new discoveries every day and everywhere. All that matters is that I honor the commitment and take him out.

As it gets darker outside, we become more aware of the lights on in each of the houses we pass. We are not voyeurs, but, on these dimly-lit streets, the lights from the houses just naturally draw your attention.

It's hard not to notice as the occupants move from room to room and turn on lights. It's hard not to notice who's having dinner and who's watching TV. And, at this time of year, it's hard not to notice who have already put up their holiday lights.

As the blue-gray of dusk becomes the charcoal gray of twilight becomes the black of night, we cross streets and round corners. At every pole, sign or hydrant, Ronin stops to read and/or sign the guest book while I search my pockets for anything I can find with which to wipe my running nose.

We pass more houses and more of them have a tree, or a wreath, or one of those inflatable lawn sculptures. Each reminds me that I need to find our decorations and get started on our house. Each is like the open door on an Advent calendar reminding us that Christmas is coming ever closer.

Each window is also a reminder of every Christmas past: the trips to the Atwater Market to pick out the tree, untangling the gordian knot of lights and promising myself that I would take more care putting this year's lights away so as not to have the same problem next year, sitting in the living room late at night bathed in the warmth of the decorated tree and Mahalia Jackson's version of “Silent Night” on the hi-fi. Each is a reminder of gifts given and received and the growing list of family and friends who have “gone on ahead.”

As Ronin and I walk on through the darkening evening, I become aware that I am looking at these decorated houses through the soft-focused lens of memory. It doesn't snow much around here, but at each house I see with a yard tree, I am imagining it poking up through a snowbank, its limbs staggering under a thick frosting of snow. As our six feet move silently along the pavement, I am hearing the sound of them crunch in snow—the same sound you hear when you chew a mouthful of cereal.

There is a real danger of being kidnapped by memories of Christmas Past: it robs you of your Christmas present and the ability to appreciate the here and the now. Just as Hollywood stars of a certain age look better in soft focus, too much time spent looking in the rear view mirror can give you a false sense of how things really were. I know that and yet the nostalgic warmth that emanates from these houses seems really tangible to me tonight.

We walk past a house with a screened in porch and right at the corner there are a pair of figures from a large molded Nativity scene, but instead of being arranged in the traditional semi-circle around the manger, the figures of Mary and Joseph are right up against the screen looking out toward the street. In this context, without the figures of the Wise Men and the Baby Jesus, the figures look like the expectant children who used to crowd around the Morgan's Department Store window watching the animated holiday window display. They literally have their noses pressed up against the screen in anticipation.

I am struck by this image because it seems to capture my own arrested perspective on Christmas.

Without a doubt, this was my most favorite time of the year and now....

I guess I tend to approach each Christmas with the same ambivalence that I have for my own birthday. There is a hope that is mixed with disappointment; there is fear and anger, there is depression. (I'm not sure that I am not confusing Christmas with New Year's.)

Christmas is a benchmark, a milestone and a goal. “I Saw Mommy Kissing Santa Claus,” “All I Want for Christmas is My Two Front Teeth,” “I'll Be Home for Christmas”: the notion of comparison and contrast is built right in. “Look what Santa brung me!” “You have to put up the lights, everyone else has theirs up already.”

I suffer by comparison.

I had goals and expectations and each year they seem to be further away, like Santa's sleigh at the end of his hard day's night.

I walk past these windows and see glimpses of the Christmas of my past and I can still feel the scratchiness of the new clothes, smell the aromas of the holiday baking and hear the frantic competition of oneupsmanship in the telling of the horribly corny riddles from the Christmas crackers. It calls to me like the memory of the ocean's roar trapped in a sea shell.

Ronin and I pass more windows with different degrees of lights and decoration. Many of the major movements in art history are represented in the houses we pass: realism, impressionism, expressionism each are expressed in light and texture, line and color. There are even some nihilists who don't bother decorating.

I write about Christmas because it has the same sort of all and nothing meaning represented by our neighborhood's decorators. It informs where I am by reminding me where I came from and also that another lap around life's racecourse is coming to an end. It's a time to be warmed by the familiarity of “A Charlie Brown Christmas,” mourn losses, and be reminded of victories.

That is Christmas's present to us all.

It's getting darker and I have forgotten to bring my gloves.

We turn the last corner and enter the final stretch of our walk.

Ronin stops, stiffens and, from somewhere deep in his massive chest, a growl begins to form.

He's staring at something but, try as I might, I can't make it out. There's only one street light on this part of the walk and everything beyond its beams is out of focus to my stigmatic eyes.

I hear them before I see them, a trio of deer wander lazily into the light from between a pair of houses.

Ronin barks.

They stop, turn in our direction and then, in a twinkling, they are gone in a flash. They clear the split rail fence that encloses the golf course on our left as it it didn't even occur to them.

The dog stares after them as they disappear into the darkness.

I tighten the lead and pick up the pace. Time to go home and get warm.

Posted by Graham Campbell at 11:31 AM No comments:

 

Originally published by http://notanotherslideshow.blogspot.com/

Tool No. 10: Get Professional Help If You Need It

We have come to the end of our inventory of the 10 tools in the Live Your Life Well Toolkit and, in many respects, this is perhaps the most difficult one of all.

It's a difficult tool to use because asking for help requires a measure of self-awareness.  You have to be able to identify that you are in a hole before you can ask for a way out.  Once the situational aspect is addressed, i.e., where you are, the next question is transformational, i.e., how does one change and who can help.

There are a whole series of jokes about people in crisis asking a variety of specialists how they can resolve their circumstances.  If they ask an economist, the solution invariably involves economic theory, a surgeon advocates for an intrusive operation, a politician promotes legislation as their answer.  Everyone has a unique opinion and it is frequently a challenge to figure out how to make the best choice--kind of like picking a calling plan for your cellphone.

For some, the journey to self-awareness comes easily and they can move seamlessly into action, but these are less likely to be the people for whom help is required.  I remember watching a performance of Penn & Teller where Penn--the talking giant--was juggling broken bottles.  He says as part of the bit that he gets asked about whether he is concerned that he might catch the flying bottles by the wrong ends.  He says something like that is unlikely, but if it were to happen, if he did catch one of the bottles by the jagged end, he would almost immediately let go of it.

For the rest of us, those less like Penn and more like lobsters in a pot, the recognition that our circumstances have become a problem comes on much more gradually.  Instead of responding instinctively, we take the time to map the pot and appreciate the blending as our shells move from green to red. We don't know we need help until we catch a whiff of melted butter and by then the response options are far fewer.

I am forced to admit that much of my early thinking about mental health comes from comedy psychiatrist like Bob Newhart and, later,  Dr. Katz.  One of the earliest jokes I can remember is about a guy who rushes into a psychiatrist's office and says, "Doc, I've been having suicidal thoughts all week, can you help me?"  And the doctor says, "Sure, but from now on, you pay in advance."

The only other thing I knew about psychiatry was that they had sample packs of medications that looked like packages of Dentyne gum.  I only knew this because my father had a sock drawer full of them.  One year he took me to England and talked about how hard it was for him to drive on the "wrong side of the road".  The pills helped him with that, he said.  I don't think he ever had a professional relationship with a psychiatrist, but it seemed like he always had samples.  Later, when my mother went back to school, got degrees in applied social science and became a trained counselor, my father would dismiss her chosen field as the "helping professions."

Once you get to the point where you begin to think about professional help then there comes with that the unasked question about what it says about you if you think you need professional help.

Although I didn't fully understand it at the time, I think this was how I learned about the stigma associated with mental illness.  I learned that it was something to be made fun of, mental health was the obsession of celebrities and none of it was to be taken seriously.  I don't think anyone ever said that if I was sad I should just get over it, but I also know that when I was sad, I was most often left alone to deal with it.  (At least that's what I recall.)

Identifying the need for help and getting past whatever internalized stigmas you might carry are important steps, but they only serve to bring you to the next question and that is identifying what kind of help you need to address your situation.

There are many paths toward recovery and the "right" path is going to be different for each person. A quick trip through your local bookstore's self-help section will demonstrate that there as many therapies as there is shelf space to hold them. Recovery could also lead you to connect with a community of faith. Your path to recovery may seem, at first, more like a maze with many false starts and dead ends, but the drive to get out of the hole, or out of the pot, should sustain you through this period.

Kind of like Dorothy in the "Wizard of Oz", you have the power to influence your recovery.  It's most likely going to be more complicated than clicking your heels and reciting "there's no place like home" and there is a very real chance that, at some point, you could have your own encounter with flying monkeys but the only way to get home is go through that.

Another thing that Dorothy had going for her was the support of trusted friends--see Connect with Others.  At every step of her journey they helped her to make the best possible decisions.

For some, medications can play a role in their recovery. There are many success stories about the use of neuropharmacology, but there are also questions as to the risk vs. benefit of this approach. It is a subject to discuss carefully with your psychiatrist. As with most medications there is the risk of adverse side-effects and you should learn as much about those as possible.

Whether you are dealing with a social worker, a psychologist, a psychiatrist, or other mental health professional, it is important to have trust in that relationship. If you don't have confidence in the help you are getting then it is often possible to change providers.

Mental Health America of Licking County dies not provide direct treatment services, but we can make referrals to area providers.

I need to go home and walk my dog, so I am going to leave you with this short clip from "The West Wing" in which the late, great John Spencer tells a story about a man who found himself in a hole and needed help.



-- Graham Campbell
Associate Director

Mental Health America of Licking County: The Case for Funding

Recently, Mental Health America’s QA (Quality Assurance) Committee reviewed an incident involving a local 14-year old school girl who contacted our office because she had received some inappropriate attention from an adult male in an online forum.  She called our offices about the incident because she remembered a classroom presentation from our PAVE program from a year before.

She didn’t engage her parents, or the school, or the police, she called Mental Health America and we made sure that the proper authorities were notified.

By being in the schools and teaching age-appropriate lessons on issues relating to cyber bullying and relationship violence and media literacy, Mental Health America provided that student with the tools to recognize that she had gotten herself into a dangerous situation and we were a resource to decrease the impact on her and her family, not to mention the potential risk to her personal safety.

The authors of a 2004 World Health Organization (WHO) summary report entitled Prevention of Mental Disorders:  Effective Interventions and Policy Options include a definition of mental disorder prevention from Mrazek & Haggerty:

Mental disorder prevention aims at “reducing incidence, prevalence, recurrence of mental disorders, the time spent with symptoms, or the risk condition for a mental illness, preventing or delaying recurrences and also decreasing the impact of illness in the affected person, their families and the society.  (WHO, 17)[1]

It might be argued that receiving a photograph of male genitalia is not a public health risk, but mental illness is and trauma and trauma-related stress can be contributing factors to mental health conditions.  In the same WHO report, the authors write:  “Adverse conditions such as child abuse, violence, war, discrimination, poverty and lack of access to education have a significant impact on the development of mental ill-health and the onset of mental disorders”  (WHO, 14).

We have reached a point where the deterioration in available resources has intersected with the process of responding to a growing public health concern, i.e. mental illness.  No longer, it seems, can we consider a broad portfolio that would permit tailored responses based on the condition of an individual, but we must adopt a one-size approach based on a medical model where patients are assessed, prescribed and allotted targeted engagements with a counselor.

It seems less a medical model than a factory model.

Responding to mental illness is a huge problem and getting bigger, no question about it.  It is forecast that by 2020, behavioral health disorders will surpass all physical diseases as a major cause of disability world-wide (Harding, p. 21)[2].   One forecast quoted in a paper called “Mental health promotion and mental illness prevention:  the economic case,”[3] prepared by the London School of Economics and Political Science looked at the expected costs of mental illness by condition in a 20 year period from 2007 to 2026.  Their findings indicate that costs of depression, anxiety, schizophrenia, bipolar, eating disorders, personality disorders, child and adolescent mental health and dementia will increase by an average of 79% (Knapp, McDaid & Parsonage, eds. 2011).

Higher prevalence and more costs with no clear sense of when there will be more resources in the public system with which to respond.

A reasonable person might conclude that the medical model is the wisest choice in that it stands the greatest chance of impacting the largest number of people.  But, just as there is no single mental illness and not everyone with the same diagnosis will respond to the same treatment, there has to be room in our response to the challenge of these disorders to offer a variety of responses.

Cost containment is a laudable goal, but it is not a patient goal and it should not be our only goal in designing the next generation of public health care.

A generation ago, we convinced ourselves that the state hospitals were a draconian response to those who experience mental health conditions.  Our leaders felt that it was better for the patient that they be returned to their communities where they could be closer to family.  Prior to that time, conventional wisdom held that persons with these conditions should be locked away where they could not harm themselves, or others and where the general public would not have to encounter them. 

Time and circumstance have combined to bring about significant changes in community attitudes toward those who experience mental health conditions.  We have come to understand that, instead of being the “other” and different from us, persons with mental health conditions are our friends, neighbors and even our family members.

And, just as we have become more comfortable with the prevalence of mental health conditions, we are also learning that there is much we can do to mitigate their impact.

Health promotion/education and disease prevention are tools that also come from the medical model and have enabled us to respond to and prevent all manner of medical events.

Prenatal and perinatal care are clear determinants in childhood development.  We know expectant mothers should be monitored during pregnancy and we know that their children should get vaccinated because there is risk to both mother and child, but that risk is manageable.

By the same token, we know that while “there are genetic and biological components to mental illness…emerging evidence suggests that certain behavioral health problems can be prevented, while in others onset may be delayed and severity of symptoms decreased” (San Mateo, p.1)[4]. 

Mental health promotion/education and mental illness prevention can play an important role in supporting the psychiatrist-counselor-case manager relationship.  Educating the public about the signs and symptoms of mental illnesses and their contributory factors supports help-seeking behavior, as in the case of the student who contacted our office following the inappropriate contact.  Education also empowers those who engage with medical personnel to make better informed decisions about their care.  Anti-psychotics are powerful tools in response to mental illnesses but they can come with significant side effects and an informed consumer is a more equal partner in their own recovery.

The returns on investments in health promotion/education and prevention are more difficult to evaluate than other mental health expenditures because their impact is in that which is not seen.  Ideally, the outcome of an effective program would be an increase in patients not seen, prescriptions not written, persons not arrested and children without behavior problems.

What is easy to see is their cost.  Prevention and health promotion/education can be delivered in a variety of formats, but there is evidence suggesting that they are most effective when they include a personal contact between the program recipient and an advocate.  Anecdotally, we know that the 14-year old student remembered MHA’s classroom presentation.

Our funders recognize the value of health promotion/education and prevention and have made considerable investments in the programs of our agency and others throughout Licking County.  The challenge faced presently is in prioritizing the limited funds available.  Can they afford to mount a robust medical response and still offer mental health and prevention programs?

Of course, it is our position that they cannot afford not to.

There is compelling research indicating the returns on investments in a long term education and prevention strategy.  From our work on workplace mental health we know that integrating mental health into the benefits package can return $4 - $5 dollars for every dollar in expense.  In the LSE paper, they calculate Year One returns on suicide prevention training for family practice doctors at more than 19:1 (Knapp, McDaid & Parsonage, eds. 2011, p. 40).

The costs associated with responding to chronic diseases such as mental health conditions are staggering.  The financial costs in terms of treatment services and lost productivity are estimated at $247 billion annually (Institute of Medicine [IOM] Policy Brief, p. 1)[5].  There is a broad consensus that something must be done to “bend the curve” in health care expenditure in order to prevent a crippling burden on our economy.

Where the consensus begins to fall apart is in how to go about lightening that load.

An often-heard answer is that we should get more patient buy-in, that they should have some “skin in the game” and once they know what the real cost of healthcare is then they will be more invested in what services they purchase, not elect so many expensive tests and unnecessary procedures.  Sticker shock will control costs.

This makes sense when you are evaluating accessories for your new car, or premium services for your cable TV, but not when discussing people’s health.  Illness is not a choice.  The uninsured cancer patient is just as sick as the insured. 

It is unrealistic to expect that those two patients will receive the same level of care, but if life choices and bad luck have left a patient without insurance coverage, do we not have some responsibility to do what we can to help them be as healthy as possible for as long as possible?

This is the promise of health promotion/education, prevention and early intervention programs.

In a recent compelling article in the New Yorker[6], it was noted that a statistical analysis of hospital visits in Camden, New Jersey revealed that between January of 2002 and June of 2008, two buildings and a combined total of 900 residents were responsible for 4,000 hospital visits and some $200,000,000 in medical bills, or roughly $222,000 per person (Gawande, p. 4).  The story goes on to document efforts to provide coordinated care for these and other high-cost patients, the net effect of which is to reduce their impact on health care resources.  Granted, part of the response to these high-cost patients involved connecting them with more targeted health interventions, but a significant part involved lifestyle interventions designed to mitigate symptoms and delay hospitalizations.

What is clear from the New Yorker piece is that while both interventions would be impactful on the patient’s quality of life, it is in their combination that there lies the greatest opportunity to both control costs and improve health outcomes:  the health promotion/education, prevention and medical models working together with everyone educated to the fullest extent possible.

We are all interested in achieving the best possible outcome for the consumer while being responsible stewards of available resources.  Times being what they are, we know that we cannot do as much as we perhaps might like.  What is troubling is how, during the current contraction of services, does that 14 year-old girl, or her peers, get the information they need to respond to a stressor, mitigate a potential traumatic situation and support her mental health?  There isn’t a pill for that.

Mental disorders are inextricably linked to human rights issues.  The stigma, discrimination and human rights violations that individuals and families affected by mental disorders suffer are intense and pervasive.  At least in part, these phenomena are consequences of a general perception that no effective preventive or treatment modalities exist against these disorders.  Effective prevention can do a lot to alter these perceptions and hence change the way mental disorders are looked upon by society.  Human rights issues go beyond the specific violations that people with mental disorders are exposed to, however.  In fact, limitations on the basic human rights of vulnerable individuals and communities may act as powerful determinants of mental disorders.  Hence it is not surprising that many of the effective preventive measures are harmonious with principles of social equality, equal opportunity and care of the most vulnerable groups in society.  Examples of these interventions include improving nutrition, ensuring primary education and access to the labour (sic) market, removing discrimination based on race and gender and ensuring basic economic security.  Many of these interventions are worth implementing on their own merit, even if the evidence for their effectiveness for preventing specific mental disorders is sometimes weak.  The search for further scientific evidence on effectiveness and cost-effectiveness, however, should not be allowed to become an excuse for non-implementation of urgently needed social and health policies.  (WHO, foreward).

---

[1] World Health Organization.  “Prevention of Mental Disorders, Effective Interventions and Policy Options:  Summary Report.”  United Nations, 2004.  Web.  11 April 2011 <http://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_sr.pdf>.

[2] Harding, Fran.  “Strategic Initiative #1:  Prevention of Substance Abuse and Mental Illness.”  Center for Mental Health Services, Draft 10/01/10.  Web.  11 April 2011 < http://www.samhsa.gov/about/siDocs/prevention.pdf>.

[3] Knapp, Martin, David McDaid and Michael Parsonage, eds.  “Mental Health Promotion and Mental Illness Prevention:  The Economic Case.”  London School of Economics and Political Science, 2011.  Web.  11 April 2011 <www2.lse.ac.uk/LSEHealthAndSocialCare/.../MHPP%20The%20Economic%20Case.pdf>.

[4] San Mateo County Health System:  Behavioral Health & Recovery Services.  “A Primary Prevention Framework for Substance Abuse and Mental Health.”  San Mateo County, CA, 2009.  Web.  11 April 2011 <http://www.sanmateo.networkofcare.org/contentFiles/PreventionFrameworkFinal_050909.pdf>.

[5] Institute of Medicine.”  “Preventing Mental, Emotional and Behavioral Disorders Among Young People:  Progress and Possibilities, Report Brief for Policymakers.” Institute of Medicine, 2009.  Web.  11 April, 2011 < http://www.iom.edu/~/media/Files/Report%20Files/2009/Preventing-Mental-Emotional-and-Behavioral-Disorders-Among-Young-People/Preventing%20Mental%20Emotional%20and%20Behavioral%20Disorders%202009%20%20Report%20Brief%20for%20Policymakers.pdf>.

[6] Gawande, Atul.  “The Hot Spotters,” The New Yorker January 24, 2011.  Web.  11 April, 2011  < http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande>

Everybody Needs Somebody

GUEST BLOG: Getting Ahead Grad Joins the Y

My family and I took part in the tour of  the YMCA facilities to find out more information about it and the scholarships that the YMCA offers lower income people.  

I had already been quite aware of the YMCA scholarship and how to apply, however, I was not aware of  ALL the great benefits of a YMCA membership--until I attended the tour that was organized by Mental Health America for graduates of the Getting Ahead class for low income parents.  My family and I were VERY impressed with the YMCA facilities and extras--such as free child care while you are working out and the fact that a membership covers all parts of the facility, including the outdoor and indoor pools! I was very excited to learn about the Zumba fitness class and my daughters were about indoor soccer and gymnastics and my husband thought the weight room looked GREAT!  

Attending this tour was JUST the thing I needed to  motivate me to apply for a YMCA scholarship and I was approved!  Now thanks to the YMCA and Mental Health America---my family will be happier and healthier! Thank you!

Peggy Wachenschwanz

“June is…”

Adopt a Shelter Cat Month…I encourage you to go to the Licking County Animal Shelter, and if you have room in your home and your heart for a homeless cat, adopt one today!

Effective Communication Month…Give someone a compliment and mean it! Start an interesting discussion with someone. Tell someone how you feel.

Great Outdoors Month…You don’t have to spend money to have a great time this summer. Stop by a local park and play on the swing set; go camping; take a hike; have a picnic in your backyard; get creative!

Turkey Lovers Month…Try a new recipe that contains turkey. Or hug a turkey, if you know where to find one.

Perennial Gardening Month…Be kind to the environment and plant a perennial. Perennials are plants that grow back every year. You can look online for information on plants that would be suitable for your garden.

National Bathroom Reading Month…Enough said!

National Smile Month…So smile! Sometimes we go through our day thinking about all the tasks we must get done and how stressed we are. The simple act of smiling helps relieve our stress, and the stress of those people around us. Make sure you brush your teeth to keep those pearly whites sparkling!

Rebuild Your Life Month…Contact us here at Mental Health America if you are struggling. We have a variety of programs and resources available to you. Also, dialing 2-1-1 in Licking or Knox County will link you with caring, trained professionals who can help point you in the right direction for whatever resource you need.

Sports America Kids Month…Attend a Little League Baseball game and watch those kids run after pop flies in left field and scurry around the bases! Get your child involved in sports or play outdoor games with them to keep them (and you) healthy and physically fit!

By participating in different monthly celebrations, we can be mindful of things we wouldn’t normally think about. All of the celebrations listed above can improve your mental and physical health in some way!

We hope you have a very happy JUNE!

--Brittany Schumann
Suicide Prevention Coordinator

Leave the Decisions to the Rodents...?

Surprise, surprise, we have six more weeks of winter. Who had the idea of leaving the determination of the coldest season of the year up to a rodent? Especially one named Phil! This winter, we have had to dig ourselves out of the mounds of snow the clouds have dropped on us, much like a groundhog digs out of his burrow, and the abundance of post-holiday snow has not improved my mood.

My saving grace has been my camera and my new puppy. Rufus is an energetic mixed dog we got from a rescue group. Helping an animal in need did help brighten my mood. It made me feel so much better as I looked out at the dreary grey days outside to have a squirming puppy licking me and cuddling me as close as he could get. Helping those around you who are in need can help lighten your mood when you are feeling down, whether they are of the two-legged or four-legged variety.

In the winter, my house can get pretty dark. Our house is nestled at the bottom of a valley, which shortens the length of daylight I get even more than winter does. So I have to take my dogs outside to take pictures of them since the indoor lighting is poor. Getting outside requires layers upon layers of clothing, but as soon as I am outside taking photographs of my dogs running and jumping and playing in the snow, I find myself laughing. And by the time our play session is over and we come inside, I am ready for a nap.

Seasonal Affective Disorder (SAD) is a form of depression; it is also called the winter blues or winter depression. SAD occurs when a person suffers from depressive symptoms during the months of winter. Seasonal Affective Disorder is thought to be caused by a person’s reduced exposure to sunlight due to the shortened (and cold) days of winter. Cloud cover can increase the symptoms by reducing exposure to sunlight even more. Symptoms of SAD include eating too much or too little, sleeping too much or too little, feeling hopeless or helpless, and a decrease in energy level. There are treatment options available for SAD, which includes light therapy, cognitive-behavioral therapy, and medications. For light therapy, a person is exposed to a bright light, usually coming from a device called a light box. If you would like more information on Seasonal Affective Disorder, please do not hesitate to call (740-522-1341) or email (prevention@mhalc.org) us here at MHALC. We would be happy to hear from you and help you!

The good news is that the bulk of winter is behind us and spring is on its way. At least I hope so. It’s Ohio, so it very well may snow in June. Who knows?

--Brittany Schumann
Suicide Prevention Coordinator

January is National Stalking Awareness Month

By Ashley Shaw, PAVE Coordinator, Mental Health America of Licking County

As a violence prevention educator, people often tell me stories about their experiences with violence and many of the stories involve the serious crime of stalking.

According to the Stalking Resource Center, stalking is defined as a course of action directed at a specific individual that would cause a reasonable person to feel fear.

Television and movies promote commonly held beliefs about stalking which are inaccurate. For instance, many think that only strangers, often with a mental illness, are the ones who commit this serious crime, when almost the exact opposite is true. According to statistics from the Stalking Resource Center:

• 77% of female victims and 64% of male victims know their stalker.
• 59% of female victims and 30% of male victims are stalked by an intimate partner.
• Intimate partner stalkers frequently approach their targets, and their behaviors escalate quickly.

Through the impact stalking can have on a victim’s daily life, it is very clear to see why more people need to be made aware of them.

A victim of stalking is very likely to experience serious changes to his or her daily life.

• 26% of stalking victims lost time from work as a result of their victimization, and 7% never returned to work.
• 30% of female victims and 20% of male victims sought psychological counseling.
• The prevalence of anxiety, insomnia, social dysfunction, and severe depression is much higher among stalking victims than the general population.

Because of the prevalence, stalking is something that each of us needs to take seriously. The number of stalking victims in the United States is astounding: 1,006,970 women and 370,990 men are stalked annually. The good news is that there is help available to victims of such a serious crime.

A first line of defense when dealing with stalking is educating yourself about the topic and the legal aspects that can be involved. I urge all readers to familiarize themselves with the topic of stalking so that it can be recognized and prevented as much as possible. The state of Ohio has laws in place to protect victims and prosecute stalkers. Depending on the seriousness of the crime, charges can range from a first degree misdemeanor to a fourth degree felony. Jail or prison time varies as well depending on the specifics of any given case. If you or someone you know is being stalked, call 9-1-1 immediately to get law enforcement involved.

Through education and awareness, communities can support victims and combat the crime. There are plenty of resources available at Mental Health America of Licking County or on websites such as the Stalking Resource Network Website (www.ncvc.org/src).

The P.A.V.E program (Prevent Assault and Violence Education) is participating in a community awareness campaign by hanging up informational posters in area Licking County schools. We hope that through the poster campaign we can build a knowledgeable community that offers support to stalking victims and increases the prevention of potential victims.

For more information please contact Ashley Shaw at (740) 522-2277 or ashaw@mhalc.org.

Grieving

The death of someone close to us is one of life’s most stressful events. It takes time to heal and each of us responds differently. Grieving is not orderly and you may need help to cope, but in the end, coping effectively is vital to your mental health.

Mourning and the complex stages of the grieving process are necessary and it takes time. The period of grieving varies greatly from person to person. Grieving is not a weakness; it is a necessity. Refusing to grieve is not courageous and may cause you a great deal of harm later on both emotionally and physically.

The grief process has many stages, but most people do not usually flow from the first stage to the last in a logical order. Some people will jump back and forth between stages and the length of time it takes to go through the stages will vary.

• shock and denial – feeling emotionally numb


• anger – it’s unfair, you may be mad at yourself (for not being kinder) or mad at the deceased (for leaving you etc.)


• guilt – blaming yourself or feeling like you are losing emotional control


• feeling dragged down – the blues or the blahs or even experiencing the signs and symptoms of depression


• loneliness – really missing the person (it’s time to reach out to others)


• hope – you will reach a stage where you can focus on your future

First a person is in numbness or shock. It can feel like you are “sleepwalking” through life and it may last several weeks or longer; then there is a time of disorganization when feelings begin to come alive again, but it may be hard to focus and make sense of life; and eventually, the re-organization happens. A great hurt is never completely forgotten; rather it takes its place among life’s other, more immediate demands.

Living with loss means that you are taking care of your emotional needs. Some suggestions on coping: Be with caring people; express your feelings; take enough time; accept a changed life; take care of your physical health; support others in their grief; come to terms with your loss; make a new beginning; Postpone major life changes (if you just can’t think clearly); Reach out for help – call Mental Health America of Licking County at 740-522-1341 or email me: paddykutz@alink.com for referrals.

Helping Children Grieve: Children who experience a major loss may grieve differently than adults. A child’s sense of security or survival may be affected. Often, they are confused about the changes they see taking place around them, particularly if well-meaning adults try to protect them from the truth.

Limited understanding and an inability to express feelings put very young children at a special disadvantage. Young children may revert to earlier behaviors (such as bed-wetting), ask questions about the deceased that seem insensitive, invent games about dying or pretend that the death never happened.

Coping with a child’s grief puts added strain on a bereaved parent. However, angry outbursts or criticism only deepen a child’s anxiety and delays recovery. Instead, talk honestly with children in terms they can understand. Take extra time to talk with them about death and the person who has died. Explain to them what happens next such as burial and memorial services, and take time to answer questions. Help them work through their feelings and remember that they are looking to adults for suitable behavior.

Helping others Grieve: To help someone who has lost a loved one, you can help them through the grieving process.

• Share the sorrow – allow them, even encourage them – to talk about their feelings of loss and share memories of the deceased.


• Don’t offer false comfort – it doesn’t help the grieving person when you say “it was for the best” or “you’ll get over it in time” or “they are in a better place now.” Instead, offer a simple expression of sorrow and take time to listen.


• Offer practical help – baby-sitting, cooking and running errands are ways to help someone who is in the midst of grieving.


• Be patient – remember that it can take a long time to recover from a loss. Make yourself available to talk.


• Encourage professional help when necessary. Don’t hesitate to recommend professional help when you feel someone is experiencing too much pain to cope alone.

Profound emotional reactions may occur. These reactions may include anxiety attacks, chronic fatigue, and/or depression. The death of a loved one is always difficult. Mourning is the natural process you go through to accept a major loss. Remember, it takes time to fully absorb the impact of a loss. You never stop missing your loved one, but the pain eases after time and allows you to go on with your life.

--Paddy Kutz
Executive Director
Mental Health America of Licking County

Families Are Like Opinions

With wars, recession and a sleigh-full of uncertainty, holiday spirit has been in short supply this year. Each night, the inflatable Homer Simpson as Santa comes to life in my neighborhood, but the grim sense that a larger and more menacing inflatable Mr. Burns is just around the corner is never too far away.

For just about as long as I can remember, the holidays have made me a nervous wreck.

We had the tree and the stockings, the presents and the toys, but the centerpiece of every Christmas was the dinner. Because we lived in a small house, our family always went either to the home of my aunt’s family or to that of my uncle. So instead of the anticipatory preparation of turkey and fixings, there was the dread associated with getting into scratchy clothes and snow boots for the drive to dinner.

My parents were of the cocktail generation and so once the coats were hung up and the “what did you get for Christmas-es” were dispensed with, the kids were dispatched to the television room not to return until dinner was served. My father was fond of saying that “children should be seen and not heard” and so we quickly learned our roles at these gatherings.

All of the cousins were just enough older than either my brother or me that we never had all that much in common to talk about. At these gatherings we would still be sitting at the kids table while they were able to sit with the adults.

Among my clearest memories about these gatherings was the laughter. The meal would begin with an old English tradition of opening Christmas crackers. These are tube-shaped paper novelties that contain a paper cap, a small toy such as used to be included in Cracker Jack boxes, a paper hat, and a piece of paper with a merry joke or riddle. (“Q: How do you stop a charging rhino? A: Take away his credit card.”)

Once the multi-colored paper hats were in place, the adults table would take turns reading their joke over the sharp-tongued critiques of the others. A small laugh initiated by the old joke would become a belly laugh when “topped” with some sarcastic remark about the joke teller, or some reference to an incident from the past that cast them in a bad or embarrassing light.

The challenge for anyone wishing to join in the conversation was that they had to be loud enough to seize any gap in the conversation and they had to be funny. And once you had everyone’s attention, there was no room for any kind of uncertainty. You either had something to say, or you didn’t and if you fumbled then that only provided more grist for the comedy mill.

It was kind of like the celebrity roasts that show up on television from time to time. There was not as much bleeping, but the tone was the same. It was not an environment for the faint of heart. Bringing an outsider to the table was a real test of the strength of your relationship. If they came back, it was a sign of the promise of the relationship and if they participated in the comedic free-fire zone and were funny then that was a whole different ballgame.

From my vantage point at the kids table, my cousins all seemed really smart. They could give just as well, or better, than they got, they were laser-accurate in their observations and they all seemed to enjoy the game. They made it seem effortless and like something you would want to be a part of.

By the time I was old enough to sit at the adults table, many of my cousins were no longer coming home for the holidays and I discovered that I had neither the confidence nor the ability to participate in the conversation.

There’s another old riddle that goes, “What’s the secret of comed--? Timing!”

If I have any skill telling a joke—a question frequently debated—it was hard-earned. Even reading the lame Christmas cracker riddles, it was far too easy to misplace the emphasis and lose the joke. And when I did, my loving family was right there to point it out. (Perhaps I should have read more into the fact that those paper hats never fit me....)

As children, we only ever know what we know and so we don’t often have the luxury of seeing our situation for what it is. Often it takes an outsider to tell you that you are having a hard time, or that your environment is toxic. The work I do now is based on this idea.

Still, family is complicated. It’s not destiny—we’re not all doomed to be just like our parents, cousins, etc.—but it is complicated. It’s years later and I don’t go home as much as I used to. I’m not as close to my family as I would like to think but if I don’t go home, I don’t have any relationship with them at all.

Families are like opinions: everybody’s got one and everyone thinks their’s is the most screwed up. There’s no question that some are better than others, but there’s help available to work on those relationships, or how you respond to them. Mental Health America exists to connect people with resources to improve their mental health, including their family ties. If we can help you, please give us a call.

Please accept my best wishes for a safe and healthy holiday season.

--Graham Campbell
Associate Director

My Odyssey in Mental Illness

I spent the first five years recognizing the symptoms, then the next twenty years fighting the disease and getting on with my working life, my social life and, most of all, my faith.

I wanted to work because I didn’t want to be on social security for the rest of my life and not have anything to show for it, like a home, a car and other pleasures. To strengthen my self mentally, morally and mostly spiritually, I wanted to build my faith on the wisdom of the Bible and other literature.

Then I joined Schizophrenia Anonymous and realized that I had accomplished those goals. About five years ago I received the Mental Health America Consumers of the Year award from my mentors in the Agency; and now I’m setting new goals in work, school, and faith-based endeavors to help others overcome their afflictions.

--Sam Irvin

Cobbler's Children

My grandfather, an electrician for Pennsylvania Railroads, never seemed to get around to completing the wiring in his own home, where he and my grandmother raised five children. The wires were looped onto nails and the switches didn't get boxes until he died, at which point my grandmother hired someone to do it. It was a case of "the cobbler's children get no shoes," according to my grandmother.

In the same way, I sometimes catch myself doing a poor job of caring for my own mental health, even though I've learned a lot about mental health by working at MHA for 11 years.

For example, I tend to scarf down my lunch at the computer instead of taking a lunch break. It seems that I will get more done that way, but research says I would probably get more done (and have to re-do fewer things) if I would take regular breaks from my desk.

I need to exercise, eat right, drink enough water, get enough sleep, and find healthy ways to deal with stress to stay healthy, and that includes being mentally healthy.

I need to keep my work area and home a pleasurable place to be in; mess is depressing. I need to make time to spend with my family and friends. Come to think of it, those are the same things I suggest to parents and others that I work with at MHA.

So, I'm going to publicly state my goals for the next few months:

• Start a success team for 4-6 people to meet with me weekly. We will brainstorm with each other about problems and solutions and share goals and successes


• Start an acoustic jam session once a month to get more music back in my life

I invite you to ask me about those goals if we talk. I don't know if it's mentally healthy or not, but for me, fear of mortification is a powerful incentive for following through and a disincentive against procrastination.

Happy trails,

Judith Allee

Parent Support Coordinator

Three Noses

When I first applied for the position as Suicide Prevention Coordinator, I told several of my close acquaintances. When I got the interview, I told more people about the job. Since my first day on the job, I have told even more people about my job.

Nearly every time I tell someone that I am the Suicide Prevention Coordinator at Mental Health America of Licking County, I am given either strange or sympathetic looks. (Thankfully, I do get the occasional look of admiration, along with the comment that I am doing very tough work.) At first, I understood why people I knew gave me the looks of sympathy or fear. Suicide is one of the last taboos in America. We can freely talk about sex, pedophilia, homosexuality, HIV/AIDS, and abortion. But mention suicide, and people take several steps back, like you’ve just grown a second nose.

This is why I have a job. Since people don’t talk to their friends, parents, children, and so on about suicide, not many people know the truth about it. Unfortunately, this also means that the rate of suicide in America is still alarmingly high. Most of the completed suicides stem from mental illness, most often depression. Depression is a treatable brain disorder (another word for mental illness). Logically, this means that suicide is preventable if depression is caught early enough. Having just attended Gatekeeper training with the Ohio Suicide Prevention Foundation, I would like to impart some of my knowledge about how to prevent suicide to you.

When we encounter stressful or threatening situations in our lives, our brain (three pounds of protoplasm housed in our skulls) helps protect us. With the way the economy and politics are going, more Americans will be facing stressful and threatening situations in their lives. Our brain, or more specifically, our amygdala, releases three different hormones that are related to fight-or-flight. We become equipped to either stand up for ourselves (fight) or escape the danger (flight).

• Testosterone is what gives us strength in our muscles to either fight or run away.



• Epinephrine (also known as adrenaline) moves blood flow from body functions that are not necessary for the fight-or-flight response, like digestion, to our muscles and brain.



• Cortisol soothes the body after fight or flight has taken place. (Ever used hydroCORTISONE cream to make swelling go away?)

There is only one problem. These days, none of us are chased by saber-toothed tigers or giant wooly mammoths; instead, we sit at our desks or on our couches, and when stressful or threatening situations occur, we don’t use up the testosterone, epinephrine or cortisol that are released into our system. As beneficial as these hormones are to our body, too much of them in our system destroy little things in our brains called neurons. Most often, the neurons in the part of our brain that stores short-term memory, mood and emotions, the hippocampus, are affected. The breaking down of the neurons that determine our emotions and moods causes people to become depressed.

Like I mentioned earlier, 90% of people who die by suicide suffer from some form of brain disorder (mental illness), mostly depression. Depression, like other mental illnesses (thanks, Kristen!), is highly treatable with medications and therapy. If we begin to screen everyone for depression, we can catch it, treat it, and prevent suicides.

I do hope that one day, I work myself out of a job, but there is much work to be done until then.

Oh yeah, and exercise as much as you can, and you can help save your neurons from destruction!

--Brittany Schumann

Suicide Prevention Coordinator

I Am Very Excited

My name is Ashley Shaw, and I am the new PAVE coordinator for Mental Health America of Licking County. I am very excited to be working in this agency and to have to have the position as coordinator.

Speaking of PAVE, it is up and running for the 2008-2009 school year and I am learning a lot. We (Jan and I) have already been in two schools and we have another one this week. I am still new at the curriculum, so I am doing a lot of learning myself. PAVE orientation was a couple weeks ago, and I think it went very well. There were a handful of new teens from area high schools whom I am excited to get to know. In addition to working with teens, we were excited to work with kids at Kid’s 1st Fest in Heath selling pop and lollipops during the treacherous wind storm that came through Ohio.

I am also excited to announce that we have a guest speaker coming in on 9/29, Teresa Flores, to speak about her personal experience being trafficked as a teen. I cannot wait to hear her speak, I think that she has a wonderful story to share, and that anyone willing to listen will benefit from it. Speaking of Teresa Flores, I recently finished the book she wrote about her experiences being trafficked as a human sex slave for two years, and I could not believe what I read. To think that trafficking is such a problem in the United States upsets me. Trafficking is a topic that is never talked about as being a problem in the United States, although it is a major one. I think it is a topic that more people need to be aware of, instead of thinking it is nonexistent. Because it seems to me that once a people become aware of a problem more can be done about it, instead of people simply not knowing.

Anyways, back to work related things. I have a lot of good volunteers coming from the area colleges (OSU-N and Denison) to train to become Respect Educators. I am really excited about the enthusiasm and determination that they are going to bring to the program. This year is going to be a great year for PAVE, and will keep you all updated!

Ashley Shaw

PAVE Coordinator