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Posts Tagged ‘
mental health ’
Recovery means something different for every individual with a mental health condition, but every person can achieve some level of recovery in their lives. For some people recovery means they will be able to work; for others that they will be able to live independently; for others that they will be able to have a relationship; and for some it will involve any combination of those or other changes in their lives.
Each person with a mental health condition must define what recovery means for his or her life. A common misperception of what recovery means, however, is that a person no longer has any signs or symptoms of a mental illness. Whereas many individuals in recovery will have no signs or symptoms, this will not be the case for everyone, and regardless of a person's level of functioning, relapses can still happen. Like everyone in the world, most people in recovery from a mental health problem will always have certain challenges that they have to face in life, and some of them may require learning to handle symptoms without allowing the symptoms to control their lives.
The Substance Abuse and Mental Health Services Administration's Center for Mental Health Services assembled an expert panel to develop a consensus definition of recovery. Over 110 panelists, including consumers, family members, providers, researchers, and other stakeholders were involved. The definition was not designed to capture what recovery means for each individual person, but designed to give a broad definition to help people understand what recovery is about.
Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential. (Available at: http://mentalhealth.samhsa.gov/publications/allpubs/sma05-4129/)
The time that it takes to recover is different for each person and an important concept here is that each person must take responsibility for his or her own recovery. Family members, peers, providers, and others can help or motivate an individual, but recovery cannot be done to or for a person, it must be achieved by a person. Even developing the motivation to strive towards recovery is often challenging for individuals with mental health conditions, who often must cope with sedating medications, societal stigma, people telling them that they cannot recover, and other barriers. Motivation and hope are some of the best help that family members and other consumers can provide to individuals working on recovery.
There are ways to better orient mental health systems to help consumers in their journeys through the recovery process. A number of recovery-oriented best practices have been identified by experts (including consumers, family members, providers, clinicians, researchers and others) as particularly helpful in improving a mental health system's recovery orientation and operations. Some include:
Consumers can benefit if the mental health staff understand the vision, philosophy, values, and procedures necessary to ensure the full inclusion of consumers in developing their own individual plans of care. This approach looks at a number of aspects of a mental health system that may need to be addressed so that consumers can become full partners in developing their own plans of care.
A state's mental health emergency and acute care service system may not be operating as efficiently and effectively as it could to meet the needs of people in crisis. An evaluation of the system can help suggest ways to improve its accessibility and ability to meet the needs of diverse consumer populations.
People with Co-Occurring Mental Health and Substance Use Disorders have unique needs that cannot effectively be met in a system that is designed to serve people with only one of the two disorders. Use of integrated treatment methods that treat both concerns at the same time can help a service delivery system design an approach that more effectively meets the unique needs of dually diagnosed individuals.
Without having consumers involved in decisions about the service delivery process, it will be difficult for any one else to truly know what is best for them. This approach, which is highly adaptable to a system's individual needs, is designed to help more fully involve consumers in a variety of roles and functions throughout the process of service delivery.
This practice is in the form of a training to help providers, the general public, family members, and others understand the prevalence of past traumatic life experiences in the lives of consumers. The training then helps attendees to understand how trauma can affect peoples' lives well past the event, and how and why service delivery systems must be designed so as to be sensitive to these experiences, if the goal of recovery is to be realized.
There are many different practices that work for different consumers, but there are also many practices that have been identified as consistently beneficial, and they are known as Evidence Based Practices. Mental health systems can be helped to identify and implement one or more of these practices by looking at the state's resources and infrastructure, and assessing what needs to change to make a particular practice widespread.
Consumers must be able to make decisions for themselves about their own care. But providers, based on their clinical experience, have a responsibility to provide education about the possible outcomes that may result from various decisions. The reality is in most systems that consumers, particularly those with more chronic and disabling mental health conditions, are commonly instructed as to what treatments they need, with minimal if any effort to involve them in decisions. A recovery-oriented mental health system acknowledges and encourages consumer involvement and decision-making. Furthermore, a recovery-oriented mental health system is structured in ways that support consumers in their journeys of recovery.
Most individuals will need assistance to figure out what they need to do in order to move forward in the recovery process. The recovery process can take years; it is a journey, with both ups and downs, but it is a journey that is both possible and worthwhile for all consumers.
For more information on recovery or on how your state can obtain assistance with one of these or other recovery models, contact the author at timothy.tunner@nasmhpd.org.
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Tags: Acute Care, Co-Occuring Disorders, Consumer, Evidence-Based Practices, Involvement, mental health, programs, recovery, services, trauma
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Sally had been a soldier's wife for all twelve years of their marriage. She endured separations while her husband, Tom, was called to duty, and she toughed out raising twin boys alone. Sally said Tom loved her because, in his words, she was a "team player." But ever since Sally learned that Tom was killed in a roadside bomb in Iraq, Sally doubts whether she can be a team of one. "I'm really not that strong," Sally said. "It's just a good act."
When Rolanda was shot out of her helicopter, her husband Ray said he had no choice but to "pull himself together." He had to focus on his job and raising his stepdaughter. "I only cry at night, and then only for a second or two. We were practically newlyweds. I don't even know what I'll be missing."
"At least the kids are grown." It was the first thing that came to Linda's mind when she heard that her husband was killed in an ambush. But the relief was short—depression set in, and Linda felt "ashamed" for falling apart.
These stories provide a glimpse into the plight of many of the American families of downed warriors in Iraq. Each family's grief is unique, but most share issues that are familiar to mental health professionals–adjustment, loss, grief, and anger.
Some families rely on friends, the Armed Forces community, and supportive family for help. But one of the issues that many (certainly not all) of these families also share is their reluctance to use the mental health services available to them.
Why? What makes providing counseling to these families so different from non-military families in mourning? And how can mental health professionals serve these families' needs?
Let's start with learning a little more about some of these families. Bear in mind, that there are many reactions to the loss of a family member and that not all families of downed warriors react the same. Yet, a constellation of beliefs, fears and adjustment issues does exist amongst many of these families, and it is important to become familiar with them.
At first, it seems that the most common issues of military families do not differ from the problems of families not in the military. People are people, as some say. After all, humans share common problems. Yet, military families often add elements to these issues that are unique to them.
Many families worry about being seen in counselors' halls and waiting rooms and about being judged and "found out." They also worry about confidentiality. They believe that no matter what the organization, if it's affiliated with the armed forces, it will keep records that could easily be shared with other branches and departments.
Non-military families may have similar feelings, but military families carry with them an extra dose of shame of being "found flawed." They also say they "have had it" with the power of military and government rules. They long for privacy, and they have far higher doubts that their insurance can protect them.
When the emotional and behavioral problems become too great, families might reach out to the mental health services of their insurance plans. Many families experience uneven quality of services, problems of continuity of care, restrictions on the number of mental health sessions or lack of freedom to choose they want.
Yet, non-military families experience these same issues. The difference is what one of my clients called "reaching the end of her rope" with her insurance. These families have higher expectations of the quality of their care. They believe that serving and sacrificing for their country permits them better treatment.
These families feel hurt and disrespected. When these feelings become too painful, the families often avoid seeking help.
The latest information about the unacceptable quality at Walter Reed Veterans Hospital reinforces their lack of trust in all services. However, there are many excellent Veterans Administration hospitals. When frustration peaks, it is easy to toss all hospitals and services into the "not good" pile.
Unfortunately, traveling to a quality Veterans Administration hospital is not easy. Military families may not have the financial ability or the family resources of a grandmother or aunt to assist with child-care. As one of my clients said, the families get "jaded and just give up."
Since these families have now experienced both the anguish of not being able to control their grief reactions and also the shock of seeing what they perceive as a weak and shameful self, their trust in most military mental health services finally erodes. They believe that if they can't trust themselves any longer, then they certainly aren't going to trust the institution that let them down.
Like many American soldiers who fought in Viet Nam, the American soldiers of Iraq and their families risk experiencing negative judgments from the public because of the civil and military difficulties, length of time of the war and loss of lives.
Families often worry about being accepted as well as valued for their patriotic contribution and sacrifice. One wife and mother said, "In the beginning, everyone clamored to wear a 9/11 pin. Now, no one wears one anymore."
Military spouses are usually viewed as hardy, "salt-of-the-earth" type of people who raise resilient children to withstand relocations, absent parents and emotional pain. When the death of a spouse and parent occurs, these families often experience shame in feeling weak, out of control, and emotional.
The comments of one daughter speak for many: "I feel like I'm a disappointment to my father's legacy. He would be furious if he saw me crying and just being a basket case right now."
Military personnel often choose spouses whom they think can manage the anxiety of military life. The spouses often fit along a range from "independent and capable" to "can carry out orders." Imagine, then, the shock when some spouses find that after the death of their husband or wife, their life, household and financial management abilities crumble.
"I thought I had everything under control. I guess I've just been a soldier, not an officer," one wife said. She was fine as long as her husband provided a script, but she faltered at making new decisions.
Like trauma survivors of the Holocaust and childhood sexual abuse, many surviving military spouses and family members describe themselves as "living on two tracks." One track takes them through daily life and the image they present to the world.
But the other track leads to their darker world inside, filled with anxiety, anger and depression. Even worse, some feel like imposters. "If you can fake it, you can make it," becomes their rally call.
Unresolved grief is one the biggest issues that military families report. As a result of their difficulties in handling grief, the families experience several "disconnections" between:
a) what was—and still is—expected of their coping skills,
b) their previous view of themselves as hardy, tough and sturdy,
c) normal grief and adjustment reactions, and
d) their struggle to view these reactions as normal and not weak or shameful. Families often
say things such as "I always saw myself as strong." Shame and confusion replace confidence.
To deal with their grief, families frequently rely on the same ineffective and often damaging coping mechanisms of non-military families. For example, depression, substance abuse or difficulty in working and parenting might occur.
What makes these grief responses of military families so different is that their unique burden of shame of not coping better, disappointment and anger in the quality of their mental health services and lack of perceived national support heightens the emotional intensity, duration, frequency and resistance to changing their ineffective coping tools.
Grief is already a lonely experience. This extra burden makes it even heavier. Soon, the families are caught in a shame-grief-shame cycle that eats away at their ability to change their behavior and negative self-view.
Finally, like many widows and widowers, the spouses often reassess their marriages. For example, wives might discover that they are "relieved" to be out of a bad marriage. Children also may see the deceased parent differently.
The difference in military families is the perceived pressure from the military community to maintain positive views of the deceased partner or parent. For example, serious flaws, such as domestic violence or child abuse might get overlooked. Children may have to work extra hard to conceal their anger at the living parent for having chosen a bad partner.
Military families often flip-flop internally between seeing the truth and glorifying the deceased. The family members sense a heightened taboo against saying anything negative about the deceased and keep secrets about their real feelings.
One of the surviving spouses described the difficulty of "keeping up appearances" that her husband and the father of her children was a "good man." "I don't know who I am anymore," she said. Over time, family tensions increased. The children sensed the lie, and the truth came out only after one of the children arrived at school drunk.
1. Renew your trust in mental health professionals. Try them out—just as you might try out a family physician. Find a person who makes you feel comfortable. Many professionals are willing to speak to you on the phone or provide a free consultation. Some people "Interview" several therapists. Ask openly about their willingness to work with military families. Ask if they have expertise with your specific issue.
2. Rethink your views of seeking help. You deserve to be happy and in charge of your life. Seeking help does not mean you are weak or ineffective. There is no shame in using therapists, pastors and other mental health professionals. In fact, most professionals know that the strong are often the ones most likely to ask for help.
3. Before you go to your appointment, make a list of the topics you want to discuss. Include information such as: a) when the problem began, b) what measures you've taken to solve the problem, c) why you think your efforts didn't work and d) what do you think might work.
4. If you don't like your therapist, speak up about what's not working. Consider trying the therapist for another visit before you select another one. Keep up the momentum of seeking help. If you thought you needed help, follow through on that instinct. Problems sometimes have a way of losing their urgency, but don't let this lull fool you. They tend to crop up again if you don't make effective changes.
5. Contact the Counseling Network of the Special Operations Warrior Foundation Counseling Network., www.specialops.org, a select network of therapists who are providing mental health services for free to families of downed warriors of the Iraq war.
The Warrior Foundation's initial mission was to guarantee college educations to all the children of downed special operations warriors. Over time, however, these families expressed their strong desire to receive counseling from outside their insurance company and the military establishment. Right now, there are over 600 children whose college education will be paid for by the monies that the Foundation raised.
The main office of the Foundation is in Tampa, Florida. Carolyn Becker is the Counseling Director. My husband and I have worked with Carolyn in setting up a free counseling network of volunteer counselors. If you are a family in need of help, you can contact Carolyn Becker at
beckerc@specialops.org
Or you may call Dr. L.B. Wish at 941-363-0505 in Sarasota, Florida or reach her by e-mail at dr.l.b.wish@comcast.net.
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Tags: families, grief, grieving, Iraq, mental health, social worker, veterans, war, widow
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Introduction
Although we may think of the United States as cultural melting in which most of us share the same values and cultural beliefs, the reality is that America is made up of many diverse groups of people. When we talk about social workers providing culturally competent or culturally sensitive services we are talking about the relatively recent trend of providing services that are sensitive and responsive to these cultural differences.
The impact of a person's unique cultural differences – including race and ethnicity, national origin, religion, age, gender, sexual orientation, or physical ability – on their care is now being taken into account. Social workers are adapting their skills to fit a family's ethics, values and customs.
Social workers assisting diverse populations should be acutely aware of the dilemmas they may encounter when they recognize the needs of the diverse clients regarding behaviors, advocacy, controversial issues (such as abortion, gay rights, or women's rights), and dual relationships.
An examination of an outpatient mental health clinic in New York City which serves a diverse population provides a good illustration of the need for cultural sensitivity. Many of the clinic’s clients are immigrants and refugees from Central Asian countries that made up the portions of the former Soviet Union (i.e., Uzbekistan, Turkmenistan, etc.). Russian is the first language for many of them.
Most of the families served are considered to be part of the Bukharian culture, a very close-knit community. Arranged marriages still occur in the Bukharian culture. Any known incidences of mental illness, substance abuse or family conflicts can tarnish a family's standing in the community. Therefore, privacy and confidentiality is of the utmost importance.
A common practice at the clinic has been to use staff with similar backgrounds as the populations they serve. However, such practices are not always meeting the needs of the individuals. Because privacy and confidentiality are so important to Bukharian clients, they will often request a social worker who is in no way connected to the Bukharian community. Other Russian speaking staff is available and culturally competent, it should not be assumed that speaking a client's language ensures cultural competence. The Bukharian culture is closer to Central Asian cultures of Uzbekistan and Turkmenistan while, Russian culture is more European in nature.
Boris S. is a 35-year-old Bukharian man of the Jewish faith. He came to the clinic complaining of anxiety, irritability, anger, and serious marital problems. Mr. S. has been married for 15 years. His problems started six to seven years ago after he immigrated to the United States. His wife's adaptation to life in the new country was greater as she learned English faster and graduated from college, and began working sooner. As a result Mr. S. started feeling guilty and saw himself as a poor provider.
He began to listen to his wife's phone conversations, checking telephone bills, accusing his wife of being unfaithful, and other apparently jealous behaviors. He attempted to control his wife's behavior by criticizing her clothes, the amount of money she spent, and the number of times she could talk to her parents and friends.
Boris had poor anger management skills and would yell at his wife and children. His communication with his teenage children suffered because he was unable to accept the way they dressed or spoke to him.
In his case, education about cultural differences was key for Boris to better accept the issues causing him conflict in his new environment. Social workers were able to help him become more comfortable with these cultural differences.
Family support was key to identifying cultural expectations and norms of behavior and how immigration may have affected his conflict with family members. Often, children of families who have immigrated become "parentified". They are depended upon to translate the English language and negotiate various systems for their parents. This situation is usually temporary but for parents who have difficulty adapting to the new environment or otherwise impaired, the road can to cultural transition can be long and difficult.
Svetlana K., a 72-year-old Bukharian widow of the Jewish faith, lives with a single son. She is anxious to see that he gets married. Mrs. K. began experiencing agitated depression and she had suicidal thoughts. She was accompanied by her oldest son to the appointments, especially when her symptoms began worsening. Following discussions between the social worker and her other children, hospitalization was recommended for Svetlana. Cultural sensitivity was required to help the family work around the stigmatizing issues of mental illness, respect to elders in the family, and concerns related to marriage prospects should a family member become psychiatrically hospitalized.
While hospitalized Mrs. K's younger daughter had a newborn son, and she did not want to miss the Jewish newborn ceremony of bris. Her son organized a twenty-four hour watch over his mother using the entire extended family and supervised her medication closely. Treatment dilemmas in considering cultural factors included a conflict between the decision to immediately transport her to the nearest emergency room which might alienate the family from future treatment and the consideration of their cultural beliefs and norms. In this case, they requested a well-known Jewish hospital and voluntary admission outside their immediate community. Out of respect for their need for privacy, religion, and treatment engagement, as well as the family history of protecting their mother from harm, this choice was made.
In closing, providing useful services to diverse populations requires much more than having caregivers with similar backgrounds and languages of client population. Cultural considerations are far reaching. Cross cultural knowledge, leadership, language, and skills are often not enough and, in some ways perhaps, inadequate and limiting. In being truly culturally competent, social workers look beyond the obvious and incorporate all their knowledge and competencies in the field to professionally and adequately address the needs of all people.
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Tags: Clinic, cultural sensitivity, diversity, mental health, outpatient, social workers
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Using the Web to Prevent Suicide
As questions of institutional liability after student suicide have received much more attention in recent years, many health officials have called for improved suicide prevention strategies. But carrying out such efforts is not the easiest of tasks when no one knows for sure what will push one student instead of another to want to take his or her own life.
Officials at the American Foundation for Suicide Prevention believe that colleges can do much more via the Web to help students contemplating suicide. For the past five years, the group has been fine-tuning a "College Screening Program" that uses the Internet to identify students at risk for suicide and to refer them for treatment. Through pilot tests that have reached thousands of students, officials believe they have the statistics to prove that the program works — and, in fact, more institutions have started using it this semester, based on that data. Still, some caution that questions of institutional liability and confidentiality concerns could prevent some campus officials from wanting to use it.
The program uses a screening instrument called the Student Health Questionnaire, which is sent to groups of instituion-selected students anonymously online through a secure Web site. "Unique to this screening tool is that the clinical evaluation is individually tailored to the student," said Ann Haas, a research director with AFSP. "A clinically trained counselor writes a personalized assessment and offers the student the opportunity for online dialogue or encourages a face-to-face meeting."
Pilot testing of the project began in the spring 2002 semester at Emory University, and, in spring 2004, a second pilot test site was created at the University of North Carolina at Chapel Hill. Both campuses are still using the program today. Officials chose to focus on different groups of students — at Emory, all freshmen have received the e-mail invitations; UNC Chapel Hill, meanwhile, focused on seniors.
In more than three years of the pilot testing, 14,500 students were invited to participate in the screening via campus e-mail. They all received an e-invitation to visit a secure Web site, register using a unique alias and password, and complete a Student Health Questionnaire, which asks them a variety of questions about their feelings and behaviors, including current psychiatric treatment or use of psychiatric medications, if any.
(AFSP officials provided this example of a hypothetical depressed student's responses to the questionnaire and the online input that he or she would receive.)
Haas said that for every 1,000 students invited to participate, about 80 completed the questionnaire, about 20 engaged in online dialogues, and about 10 entered treatment. Over 50 percent of those completing the questionnaire had significant mental health problems with some kind of elevated suicide risk, she said, and few reported being in therapy or taking psychiatric medications.
"If you can get 10 or 15 more students to come in who have serious problems, you've done something radical to address campus suicide," said Haas.
Health officials are quick to note that there is no typical suicide victim. It happens to both the rich and poor, to males and females, to gays and straights and among all the races. Several studies have shown that people who have sought treatment for mental disorders are more likely to kill themselves, but campus health officials rarely have access to a student's mental health background until after he or she has committed or tried to commit suicide.
Still, campuses like George Washington University, which currently faces a lawsuit from a student who claims he was forced to leave the institution and threatened with criminal prosecution after he sought help for depression at the university's counseling center, have tried to increase their prevention efforts. The Massachusetts Institute of Technology, for instance, started providing more campus-based therapy and depression screening programs after a student lit herself on fire in her dorm room and died in 2000. And many institutions nationwide have beefed up campus health center Web sites with information that point struggling students to places to seek help.
In those cases, however, its often up to a troubled student to initiate contact. With the AFSP model, the usual scenario is flipped.
"Over 90 percent of the students with whom I communicate face-to-face or via e-mail say they would not have sought help without having used this questionnaire," said Jill Rosenberg, a licensed social worker at Emory who runs the program, reviewing all questionnaires at the institutions and contacting students based on their responses. "Students were uniformly enthusiastic about the university offering such a service."
Rosenberg said that as a result of the pilot program, Emory was able to fine-tune the questionnaire and the timing of the e-mailings. "Currently, we mail the invitation to complete the online questionnaire to each class at staggered intervals during the academic year," she said. "Students are advised that they can complete the questionnaire and avail themselves of the services that are offered at any time during the year."
Gary Pavela, director of judicial programs at the University of Maryland at College Park who monitors student psychological legal issues, said that a potential benefit of such a program might be the added sense that some other person cares about them and is willing to offer support. "It's usually preferable that such contact be in person," he said, "but there is research showing that letters and – presumably – e-mail can also have good results."
Richard Kadison, director of mental health services at Harvard University who has reviewed the program, believes its online application allows institutions to reach more at risk students who are reluctant to walk in the door of a counseling center. "I think anything that raises awareness and reduces stigma is a good thing," he said. "I don't think you can do effective psychotherapy on the Internet — maybe we will be able to someday, but not today – because the interpersonal relationship, nuances of body language, and sense of connection don't really allow for that."
Haas agrees that long-term treatment over the Internet is probably not in a patient's best interest, but argues that such a program can help remove barriers from getting at risk people in to visit counselors. "We've got to find ways of doing more treatment online," she said. "This is a mode that today's students communicate through."
Kadison said that many institutions already use an existing online screening program at mentalhealthscreening.org, which allows students to screen for problems and self refer. He believes that the AFSP model positively expands on that site's abilities by providing personalized feedback from a counselor.
Haas said that despite the results thus far, some institutions might be wary about instituting the program due to liability and confidentiality issues.
"Tort lawyers do not lack creativity in filing new kinds of lawsuits," Pavela said regarding the liability issue. "But strong public policy reasons support this initiative and I don't think judges will be quick to expand the scope of potential liability. The key to minimizing liability risks will be explaining pertinent limits in advance, delivering on what is promised, and doing everything possible to obtain prompt local help from a qualified professional for a student determined to be at risk of suicide."
"There are certainly concerns about liability for the college, but I think it is far better to try to help students who may be struggling than to not offer help because of fears of liability," said Rosenberg.
Liability issues aside, Rosenberg said that one of the greatest challenges in students who have used the program involves confidentiality. "I have the opportunity to address this concern via the anonymous, online dialogue," she explained. "I try to reassure students that the information they provide to me will be kept confidential except as required by law (i.e. if they are homicidal, suicidal or abusing a child or an elder person) and that my goal is to help, not to be punitive."
The project is currently being expanded to be used by MIT, Morehouse College, the University of Pittsburgh and Vanderbilt University, and AFSP has had initial discussions with institutions that wish to focus specifically on graduate students or medical students.
— Rob Capriccioso
Reprinted with permission of Inside Higher Ed.
Tags: institutional liability, mental health, prevent, prevention, strategies, student, suicide, using the web
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Ads Coincide with One-Year Anniversary of Hurricane Katrina
The Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services and the Ad Council today launched a series of new national public service print and billboard ads to encourage individuals who may be experiencing psychological distress from last year’s hurricanes to seek mental health services. The Public Service Announcements (PSAs), the latest ads created for the Hurricane Mental Health Awareness Campaign, are being distributed to media outlets nationwide this week to coincide with the one-year anniversary of Hurricane Katrina.
The Hurricane Mental Health Awareness Campaign launched last fall is designed to help adults, children and first responders who have been affected by the hurricanes and who may be in need of mental health services. The public service ads reach out to adult hurricane survivors and first responders and to parents and caregivers who can assess their children’s emotional well-being. These public service ads are part of a larger effort by SAMHSA and the Federal Emergency Management Agency to speed mental health recovery to persons affected by the hurricanes, to date, totaling nearly $110 million in mental health service grants.
Helping Survivors
“Most survivors of Katrina, Rita and Wilma are demonstrating remarkable resiliency and are rebuilding their lives,” said Assistant Surgeon General Eric Broderick, DDS, MPH, Acting Deputy Administrator of SAMHSA. “The new public service ads offer a doorway to help for survivors who are still struggling with the emotional toll of last year’s hurricanes.”
Research on the mental health consequences of disasters tells us that the psychological effects of last year’s hurricanes can be extensive and long-lasting. Individuals displaced by the storms lost their homes, schools, communities, places of worship, daily routines, social support, personal possessions and much more. In some cases, these losses were amplified by the loss of loved ones and the experience of destruction, pain and violence.
Catastrophic Events
Soon after a catastrophic event, some survivors may experience symptoms of post-traumatic stress disorder (PTSD), including depression, grief and anger, or they may experience other behavioral or physical health problems. For other disaster survivors, some of these problems may not surface for years. As many as half of last year’s hurricane survivors have experienced symptoms of depression, and one in 10 have had symptoms of PTSD.
One year later, survivors continue to mourn their losses; some remain separated by the miles between them and families and friends. The one-year anniversary may trigger the reappearance of the same emotions survivors experienced immediately following the hurricanes.
The new print and outdoor advertising features close-up photographs of hurricane survivors’ faces, and say, “a year later, the hurricane isn’t over in the minds of many survivors.” The photos were taken by Clayton James Cubbitt, a native of New Orleans and the Gulf Coast.
The campaign also includes television and radio spots, available in English and Spanish, which are being redistributed at this one-year anniversary.
Public Service Announcements (PSAs)
All of the PSAs encourage audiences to take time to check in on how they and their families are doing and to call a confidential, toll-free number (1-800-789-2647) to speak with a trained professional who can help with information and referral to local services.
“Mental health experts and recent studies have revealed that hurricane victims continue to suffer from the devastating losses they experienced last year,” said Peggy Conlon, President and CEO of The Advertising Council. “As we approach the first anniversary of the hurricanes, it is important to remind survivors that help is available. The new print and outdoor ads, created pro bono by Grey Worldwide, powerfully and beautifully convey this critical message.”
The PSAs are being distributed to media outlets nationwide via the FastChannel Network and will air in advertising time and space that will be donated by the media.
To view the ads, please visit www.samhsa.gov or www.adcouncil.org and click on the link on the homepages.
The Substance Abuse and Mental Health Services Administration, a public health agency within the U.S. Department of Health and Human Services, is the lead Federal agency for improving the quality and availability of substance abuse prevention, addiction treatment and mental health services in the United States. For more information about SAMHSA and its hurricane mental health response, go to www.samhsa.gov
The Ad Council is a private, non-profit organization with a rich history of marshalling volunteer talent from the advertising and media industries to deliver critical messages to the American public To learn more about the Ad Council and its campaigns, visit www.adcouncil.org.
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Tags: Ad Council, help, hurricane Katrina, mental health, Public Service Announcements, SAMHSA, social work, survivors
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Introduction
Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator Charles Curie today announced almost $9.6 million over three years for eight new grants to support national suicide prevention efforts. He made the announcement at a hearing on suicide prevention in American Indian/Alaska Native communities at the Senate Committee on Indian Affairs. The first year grant total is almost $3.2 million. This grant program is authorized under the Garrett Lee Smith Memorial Act, which provides funding for programs to combat suicide.
“For far too long suicide prevention is an issue that was ignored. Now we are taking action and I have made suicide prevention a priority at SAMHSA,” Curie said “As a result of the Garrett Lee Smith Memorial Act, SAMHSA is now working with state and local governments and community providers to stem the number of youth suicides in our country. Each of these new grantees will help fill a significant need in their community.”
Nationally, an estimated 900,000 youth had made a plan to commit suicide during their worst or most recent episode of major depression, and 712,000 attempted suicide during such an episode. The data are from SAMHSA’s National Survey on Drug Use and Health, which asked youth ages 12-17 about symptoms of depression, including thoughts about death or suicide.
Further grants will be awarded this year under announcements of available funding for campus suicide prevention grants, state-sponsored suicide prevention and post-hurricane Katrina suicide prevention.
The eight grants announced today will be administered by SAMHSA’s Center for Mental Health Services to the following:
Maniilaq Association — $400,000 in the first year and similar amounts in subsequent years to provide a variety of prevention approaches to a region that has one of highest youth suicide rates in the world. The project will include both a cultural and educational component. A media campaign will help to underscore the fact that suicide is preventable and unacceptable within an Inupiat (an Alaska Native culture) context. A cultural renewal film project will enhance cultural continuity and increase youth resilience– two factors linked to lower suicide rates. The educational component will focus on school and community prevention training and will increase community level protective factors and decrease risk factor.
United American Indian Involvement, Inc., — $400,000 in the first year and similar amounts in subsequent years to implement a Youth Suicide Prevention and Early Intervention Project targeting American Indian and Alaska Native children and youth ages 10-24 in Los Angeles County. The program will collaborate with other agencies, providers and organization to share information and resources by promoting awareness that suicide is preventable. The program will develop a culturally appropriate youth suicide prevention and intervention effort to include screening, gatekeeper training, and enhanced, accessible crisis services and referrals sources.
Connecticut Department of Mental Health and Addictions Services — $400,000 in the first year and similar amounts in subsequent years to collaborate with several providers and agencies to support the existing youth suicide infrastructure. This support will include the implementation of the Signs of Suicide (SOS) program; an expansion of a training program targeting foster and adoptive parents, school nurses, parent/teacher organizations, youth service bureaus, and juvenile justice personnel. This collaboration will increase the availability, accessibility, and linkages to mental health treatment services in school- based and community- based hospital clinics.
Idaho State University — $400,000 in the first year and similar amounts in subsequent years to reduce suicide attempts and completions among Idaho youth ages 10-24, regardless of ethnic or racial heritage by implementing a public/private partnership. The partnership will utilize cultural best practices; provide statewide suicide prevention referral sources; develop low-cost campaign materials to increase awareness; and create a system for providing information and statistics on youth suicide in Idaho.
Montana Wyoming Tribal Leaders Council — $390,751 in the first year and similar amounts in subsequent years to increase tribal awareness of suicide-related issues, reduce suicidal behavior among tribal youth, and improve access to suicide prevention services for American Indian people. This project will bring prevention efforts to six Montana and Wyoming American Indian Reservations, serving the Blackfeet, Crow, Northern Cheyenne, Fort Peck, Fort Belknap and Wind River populations.
Oregon Department of Human Services — $400,000 in the first year and similar amounts in subsequent years to reduce suicide among youth ages 10-24. The program will be implemented in Lane County, Josephine County, Jackson County; Baker County, Umatilla County, Union County, and Wallowa County, and at the Confederated Tribes of Warm Springs Reservation. Expected short-term outcomes include: increased referrals to care; increased linkage to care; decreased barriers to care; increased knowledge among clinicians, crisis response workers, school staff, youth, and lay persons; and increased social support for survivors.
University of Utah– $400,000 in the first year and similar amounts in subsequent years to expand family-centered suicide prevention services and evaluate service outcomes in the juvenile court system for all youth assigned to probation. The project will improve mental health status of juvenile offenders and decrease suicide risk factors; improve recidivism and suppression rates through family-centered prevention services; and improve source allocations for mental health services. The objective is to increase employment, school enrollment, family stability, access to services, and social support, and decrease involvement with the criminal justice system and utilization of psychiatric inpatient beds.
Mental Health Association of Milwaukee City — $399,745 in the first year and similar amounts in subsequent years to develop culturally sensitive, cross systems and consumer- inclusive projects in 10 communities with elevated risk of youth suicide. The project will build an infrastructure and increase capacity to support the development of further projects. This process will educate and identify at-risk groups in their communities, focusing particular attention on three targeted populations with elevated risk for suicide, including: Native American youth; youth who are deaf; and youth in rural areas. The project includes 55 local entities and four tribes.
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Introduction
 |
Dawn Simpson recently became
a licensed clinical social worker. |
Catalina Island Medical Center is now offering mental health services. Dawn Sampson, who received her masters in social work in 2001, recently became a licensed clinical social worker – a designation that required that Sampson provide 3,200 hours of supervised therapy as well as pass two comprehensive examinations. That designation also allows her to provide therapy to the island community.
For the past four years, Sampson has been providing counseling to local residents while being supervised both through the Guidance Center and by local resident Dan Hirst, who is also a licensed clinical social worker. “Dan volunteered his time to help me complete my hours,” Sampson said. “I couldn’t have done it without him.”
Now that she’s completed her hours and passed her exams, Sampson will be able to counsel patients with insurance through MediCal and Medicare. “Those patients haven’t been able to get services locally,” Sampson said. “That’s the gap that I’ll be able to fill.” Through the Catalina Island Medical Center, Sampson will also accept some other insurance programs.
She expects that most of her patients will be contending with depression, anxiety or adjusting to trauma. Many may also have relationship issues or substance abuse problems. “Most typically, people will be referred to me by their medical providers,” Sampson said. “But people can also self refer.” Appointments will be available immediately on Tuesdays, Fridays and Wednesday mornings. Call Sampson at 310-510-0520.
Her new professional title also comes with a new title at Catalina Island Medical Center. She is now the social services director and clinical therapist. Linda Altherr has been hired to round out the social services department. Altherr will now be responsible for discharge planning for patients who are going home from the hospital and for providing information and referrals about medical services to local residents. Altherr will be responsible for grant management.
For more information about the social services department at Catalina Island Medical Center, call Dawn Sampson at 310-510-0520.
Reprinted with permission of The Catalina Island Journal
Tags: Catalina Island Journal, counseling, Dawn Simpson, licensed clinical social worker, mental health, real life story, services, social worker
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Local Mental Health Authority Says Local Trend Is Counterintuitive
One said she was going to kill herself with the gun she had in her hand. Another said she was going to cut her wrists with a knife. One teen boy made suicidal statements to his mother and then took off in an automobile.
In all, the Price County Sheriff’s Department recorded five suicide threats over the two weeks beginning April 10. That’s significantly higher than average. None followed through, but the spike in threats underscores the need to remain vigilant against depression and suicide, according to local authorities.
Gregg Engfer, a clinical social worker and the director of the Counseling and Development Center in Phillips, said in his experience an upsurge in depression and reports of suicidal threats are typical for spring – which bucks conventional wisdom.
“You would think that in the dead of winter people would get depressed, but in the spring it is worse for some strange reason,” he said.
Engfer could not correlate the surge to any particular factors, but he speculated that people are on the move in the spring, which tends to reveal problems that were under cover during the winter months. Alcohol and illicit drug use almost always aggravate circumstances, he added.
Engfer also said current events aren’t helping people’s mental health in general.
“There doesn’t seem to be anything good on the horizon,” he said, citing the war in Iraq, terrorism, gas prices and confrontational politics. “Everyplace you look there seems to be a crisis or a looming crisis.”
Gas prices seem to be a particular source of anxiety for people, he said, because the prospect of $4 per gallon of fuel forces people to evaluate their lives in ways they aren’t accustomed to. Even financially stable people might have to rethink long-anticipated getaways or change other priorities when it costs $50 or $60 to fill a tank.
“If I was to make a prediction, I’d say we’re going to have a long, hot summer,” Engfer said.
There are avenues for people who are struggling with depression or suicidal thoughts.
Suicidal thoughts should be addressed immediately. Suicidal individuals or others who suspect a person might be suicidal should call 9-1-1.
For people who feel they are suffering from depression, Engfer recommends an appointment with a physician so that possible physical factors can be evaluated. Mental health staff at the counseling center can be reached at 715339-3048.
Reprinted with permission of THE BEE.
Tags: clinical social worker, mental health, real life story, Ryan Stutzman, springtime, suicidal, THE BEE, trend
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Introduction
Schizophrenia is one of the most debilitating of all mental illnesses. It affects approximately 1% of the population from all realms of society throughout the world. The onset for most people is in their late teens to early 20s, though it can start earlier or later as well. The average age of onset is 18 in men and 25 in women, though the disease affects men and women equally.
Recent years have added many advances to our understandings about the causes of schizophrenia. Scientists today widely accept that it is a biopsychosocial illness. This means that it is caused by a combination of biological, psychological and social factors.
Each person has a different biological predisposition for developing the illness, meaning that based on the genetic makeup of their brain, they have a certain likelihood of having it develop. Psychological and social stressors (sometimes the two are referred to in combination as ‘environmental stressors') then have an impact on the brain and its development.
If the person's likelihood of developing the illness is high enough, and the psychological and social stressors are strong enough, then they will develop schizophrenia. A person who has a very high predisposition for developing the illness may not need a lot of psychological and/or social stressors, whereas a person with a very low predisposition of developing the illness would be able to handle a lot of such stressors, and still not develop the illness.
Important to note is that a person is believed to develop the disease over a period of time, and it would be difficult to say that one event was solely responsible. Scientists believe though, that very early stressors on the brain as it develops and grows—in some cases even before birth—may be particularly potent, and can alter a person's biological predispositions. The illness will actually begin to develop later, when an adequate amount of environmental stressors impact a person with a high-enough predisposition, at which time a person will start to have symptoms.
Research suggests that there is also a period between the actual onset of the illness and a person's first psychotic episode. This period can range from a few weeks to years. There may also be warning signs in a person's youth—such as a child being unusually shy and withdrawn from others. This does not mean that children with such characteristics will develop schizophrenia, but researchers have found that many (but not all) individuals who later developed schizophrenia displayed such characteristics during their childhoods.
Family studies provide evidence that both biological and environmental impacts together cause the illness. A person with a direct biological family member who has the illness has a ten-times greater chance of developing the illness than someone without an affected direct family member. On the other hand, around 50% of identical twins of individuals with the illness never develop schizophrenia. Evidence thus seems clear that there is a biological component, but that there must also be environmental causes for schizophrenia to develop.
Symptoms of schizophrenia are mostly divided into categories of positive, negative, and disorganized symptoms.
- "Positive" symptoms generally refer to when a person sees or experiences things that are not real. Hallucinations, for example, refer to when a person senses something that is not there. The most common hallucinations are visual and auditory, but a person may have hallucinations from any of their five senses. The other most common positive symptoms are delusions. These are false beliefs a person is convinced are true. For example a person may believe that they are a famous person, such as Napolean. Persecutory delusions are another common type. A person with such a delusion may believe that the CIA or others are after them or watching them.
- "Negative" symptoms generally refer to a lack of things that should be there. An individual who has flat or expressionless emotions, or who shows a lack of interest in life or pleasure would have negative symptoms. Sometimes a psychiatrist will want to prescribe different medications if a person has more negative than positive symptoms, so it is important for the doctor to know all symptoms that a person is having.
- "Disorganized" symptoms refer to those where a person has difficulty keeping their thinking, speech, or other activities organized or coherent. An individual, for example, might ramble in an incoherent jumble of words that have no apparent connection to each other, which is called a "word salad." Another person may walk around doing and saying things that make no apparent sense to other people.
The last few years have seen dramatic steps forward in the treatment of schizophrenia. Between new medications, enhanced prescribing knowledge, and new knowledge demonstrating effective psychosocial treatments, we now have a greatly improved understanding of how to treat the biological, psychological and social aspects of a person's illness. These available options are making recovery a very real possibility for all individuals who have schizophrenia. Having a broad training in looking at all the different aspects of a person's illness, a social worker can be a great asset for a person who has schizophrenia to move forward and make of their life what they want.
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Introduction
Depressive disorders affect approximately 19 million American adults, according to the National Institute for Mental Health. If you or someone you care for is suffering from depression, there are numerous options for professional treatment and help available, and much reason for hope.
Recent headlines focusing on the incidence of postpartum depression in celebrities has helped illustrate just how difficult yet common and treatable this disease can be. Given the stigma surrounding mental illness, recognition that depression is a disease is long overdue.
Many people have internalized some amount of bias regarding depression and mental illness. Many of us consciously or subconsciously harbor the belief that the problem stems, at least partially, from some failure on the part of the individual, as if suffering from depression were a choice. This stigma often interferes with reaching out for help and prolongs suffering.
Depression is often the result of a complex interplay between brain chemistry, environmental stressors and psychological factors. Symptoms of depression may include a persistent sad mood, loss of interest in previously pleasurable activities, a change in sleeping and/or eating patterns, irritability, loss of energy, feelings of worthlessness, excessive guilt, a sense of hopelessness, difficulty concentrating and recurrent thoughts of death or suicide.
Research indicates that individuals suffering from depression show the most improvement when they receive a combination of antidepressant medication plus psychotherapy (also called "Talk Therapy").
The effectiveness of the numerous anti-depressant medications available today is well documented. Having said this, unless a persistent or dire condition exists, medication need not be the first line of treatment.
A thorough psychological assessment by a qualified mental health professional to help determine the underpinnings of an individual's depression is an appropriate place to begin. Once this has been conducted, medication should be considered as only one possible component of a comprehensive treatment plan.
There are numerous talk therapy approaches available. These treatment techniques are documented to be effective in eighty percent of cases (NIMH).
- Insight-oriented treatments, designed to explore past psychological hurt often prove eye opening, liberating, and important to the resolution of depressive feelings.
- Behavioral techniques, designed not to revisit the past but to remain focused in the present, can help identify and modify current negative thought patterns that give generate depressive feelings prevent them from ending.
- Personal therapy can help relieve depression by helping clients work through relationship issues that often contribute to depression.
- Identification and expression of anger is often a key component of treating depression. Unexpressed anger may linger and haunt people in the form of low self-esteem, feelings of helplessness and irritability.
Many therapists use a multidimensional approach to combat depression, drawing from these and other methods.
Depression is a highly treatable disease that warrants professional intervention.
Don't isolate yourself, disregard how you're feeling or blame yourself. Reach out to whomever you feel most comfortable with, whether it is a friend, family member or professional. If you are feeling suicidal, go to or call your nearest emergency room immediately. There is nothing to be ashamed of – and everything to gain!
Books:
When Words Are Not Enough, by Valerie Davis Raskin, MD New York: Broadway Books, 1997.
Mind Over Mood, by Dennis Greenberger, PhD and Christine A. Padesky, PhD, New York: The Guilford Press, 1995.
Websites:
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