GLIMPSES: A compilation of uncensored real life experiences with Mental Illness

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Introduction

Since I was diagnosed as having Bipolar Affective Disorder in November 2001 I have had the good fortune to meet and work with a multitude of people who have a mental illness. These people are far from the stereotypical mentally ill portrayed by the media and sensationalised in film. These people work, own businesses, run companies, are highly trained and/or qualified, exceptional artists, volunteers; they raise families, socialise and all the other things so called ̳normal‘ people do. For that is what we are, ̳normal‘ people, with a treatable, but not curable illness; similar to other illnesses caused by a chemical imbalance such as Diabetes, Hypertension and Hyper/Hypo-Thyroidism.
It was through my desire to reduce the fear and sense of isolation associated with diagnosis for sufferers and their loved ones, as well as increasing awareness and reducing stigma surrounding mental illness, that the goal of producing an uncensored and accurate glimpse into the lives of those with a mental illness was put into action.

All who have contributed to this book did so in hope that their story will help others with a mental illness, their families and friends, by benefiting from the ̳real life experiences‘, encouraging better communication and acceptance of mental illness within their immediate circle; most of all recognising that they are not alone in this endless struggle.
Some contributions were written in the midst of an ̳episode‘ where the writers perception is askew and their ability to articulate their thoughts are diminished, disjointed and inconsistent; therefore their stories may seem hard to understand or follow due to the irregular thought patterns. Where this occurs, I ask that you do not try to understand at the time of reading but take on board that what is being shared, accurately reflects what the person is experiencing at that point in time.

There are far more people with a diagnosed mental illness than is acknowledged in society and I would not be exaggerating if I said every third person I speak with has a relative or friend with a mental illness. With many of us choosing to ̳come out‘, society will learn of the many positive contributions we make to society and this will inturn reduce the stigma surrounding mental illnesses.

There are some wonderful books available to increase understanding of the manifestations of these illnesses. These are of particular importance to families and friends of those with a mental illness. Knowing the danger signs as they begin to appear can be the difference between a full-blown episode and a little bump on the charts. But more importantly, they assist our ability to recognise the signs leading up to a suicide attempt.

If you know where to look, support networks are available to assist or refer you to other appropriate organisations/groups and many have recommended reading lists. For your benefit the larger organisations are listed at the back of the book, so that you do not encounter the circular attempts to find assistance as I, and many others have encountered when first diagnosed.

If you would like to tell your story to help increase awareness send it to c/o 43 Browallia Dr Rose Park 3214, fax 03 5222 6847 or forwalls@xi.com.au, the more people we can touch with our stories, the better.

I wish you well on your path to insight, education and recovery.

Nicci Wall

GLIMPSES© 2007 For permission to use the content of this manuscript please contact Nicci Wall at forwalls@xi.com.au or fax +61 3 5222 6847

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Few Americans Aware of Law Broadening Access to Mental Health Treatment

APA survey reveals nearly 90 percent of Americans have never heard of mental health parity or law

WASHINGTON — An overwhelming majority of Americans remain unaware of a law mandating equal coverage of mental health benefits by insurance companies, a cause for concern by psychologists at a time when one-quarter of Americans are reported to have a mental health disorder and only a minority are receiving treatment.

In a survey recently conducted by the American Psychological Association (APA), 89 percent of Americans said they had not heard about the Mental Health Parity and Addiction Equity Act of 2008, a federal law now in effect for people who have health insurance through a group or employer plan. And only a scant seven percent of respondents said they recognized the phrase “mental health parity.”

More than 26 percent of American adults have a diagnosable mental health disorder, but of those, only 33 percent are receiving care, according to data from the National Institute of Mental Health. And of that number, one-third is receiving treatment that is considered only minimally adequate.

In the APA survey, which was conducted online by Harris Interactive among 2,940 adults in December 2010, nearly one-third of adults (29 percent) said they don’t know if they have adequate mental health coverage and 45 percent said they are unsure if their insurances reimburses for mental health care.

The law, signed by President Bush in 2008 and put into effect for most plans on Jan. 1, 2011, extends equal coverage to all aspects of health insurance plans. It preserves existing state mental health and addiction parity laws while extending protection of behavioral health services to 82 million Americans not previously protected by state laws. The law also requires parity for mental health coverage when provided both in-network and out-of-network.

Among other benefits, the law equalizes the out-of-pocket cost of mental health treatments to those of physical health coverage. No longer will insurance consumers pay deductibles and co-pays that are more costly for psychotherapy than a visit to their family physician. The parity act also removes the cap on the number of outpatient visits allotted per year, as long as no cap exists for physical health-related visits.

“The implementation of mental health parity is a great milestone in recognizing that mental health care is just as crucial to a healthy life as prevention and treatment of physical ailments,” said psychologist Katherine Nordal, PhD, APA executive director for professional practice. “But laws alone have clearly not been enough to put parity into full use. Our survey shows that too few Americans are aware of these new rights and too many people have avoided treatment because of costs. And without that knowledge, people may keep not getting the care needed for themselves or a family member.”

More than half of respondents (56 percent) selected cost of care as a reason why they or a family member might give for not seeking treatment. The other commonly selected reasons pointed to a need for improved communications about mental health treatment: not knowing how to find the right professional (42 percent) and not knowing if seeking help is appropriate (40 percent).

And while stigma is often considered a deterrent to seeking professional mental health care, only eight percent of adults cited stigma as a top reason for not seeking treatment. An equal number reported their top concern as privacy or confidentiality.

On a positive note, this lack of awareness did not translate to lack of support. The majority of adults surveyed said they agree with parity for various features of mental health benefits coverage, such as equality in co-pays, prescription costs, deductibles, out-of-pocket maximums and limits on hospital days or outpatient sessions.
Mental health disorders are the leading cause of disability in the United States, according to the National Institute of Mental Health, and suicide was the 10th leading cause of death in the country in 2007.

“Science continues to demonstrate how absolutely the mind and body are connected. Our government has mandated that insurance companies recognize that connection as well and provide for treatment of the whole person, covering physical and mental health care equally,” Nordal said. “But it’s also clear that we need to communicate more effectively with employers and potential consumers of mental health services so that parity can be fully implemented and people can more easily obtain the services they need.”

A summary of the survey findings is parity-law (PDF, 439KB).

Methodology

The survey was conducted online within the United States by Harris Interactive on behalf of the American Psychological Association, between December 14 and 27, 2010, among 2,940 adults aged 18+ who reside in the United States.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 150,000 researchers, educators, clinicians, consultants, and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession, and as a means of promoting health, education, and human welfare.

Harris Interactive is a global leader in custom market research. With a long and rich history in multimodal research that is powered by our science and technology, we assist clients in achieving business results. Harris Interactive serves clients globally through its North American, European, and Asian offices and a network of independent market research firms. For more information, please visit Harris Interactive.

Sophie Bethune & Angel Brownawell
American Psychological Association
http://www.apa.org/news/press/releases/2011/01/law-mental-health.aspx

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New Type of Mental Health Center Would Stress Coordinated Care

Federally qualified behavioral health centers would expand care beyond that provided by existing community mental health centers (CMHCs) through requirements that they use only evidence-based practices (not required for existing CMHCs) and provide wraparound services.

A proposed new national network of federally funded “behavioral health centers” was dropped from the final version of the health care reform law, but similar mental health treatment programs may be established anyway through future regulations, according to the congressional leader who proposed the original initiative.

After a proposal to establish a national network of federally qualified behavioral health centers (FQBHCs) was eliminated during legislative wrangling over terms of the Patient Protection and Affordable Care Act, Rep. Doris Matsui (D-Calif.) introduced legislation (HR 5636) that would authorize a total of $2.1 million in Fiscal 2012 and Fiscal 2013 to begin creating these new entities. These centers would help expand the nation’s public mental health system and provide additional services beyond those provided by existing federally funded community mental health centers, according to the legislation.

Matsui’s initiative was originally included in the version of the health care reform law (HR 3962) passed by the House of Representatives in November 2009. However, the measure was not included in a Senate version of the reform legislation, which was the version ultimately enacted into law (PL 111-148).

But the health center network proposed in Matsui’s bill may come into existence through regulatory actions by President Obama’s administration, Matsui said in a November 2010 interview with Psychiatric News.

“We didn’t get [the behavioral health center network] into the final bill, but we believe that the administration will undertake this on its own anyway,” said Matsui in an interview following a Capitol Hill forum on federal support for mental illness screening programs.

Such a regulatory initiative would likely come from the Department of Health and Human Services, but its media office did not respond to a request to comment for this article.

Matsui said she was disappointed that the health care law did not contain her initiative, because the proposed network of behavioral health centers would expand the types of mental health care beyond those now provided by federally funded community mental health centers. Those care expansions include integrated treatment for substance use disorders that are comorbid with other psychiatric illnesses.

Matsui also explained that FQBHCs would expand access to care by creating more public mental health treatment locations in addition to those of existing federally funded centers, which already provide care to 6.4 million low-income people with psychiatric illness, according to the bill’s supporting documentation. An additional 1.5 million people are expected to seek mental health care at existing community mental health centers due to other provisions of the health care law (including the expansion of Medicaid eligibility and the creation of subsidized state insurance marketplaces), according to estimates by the National Council for Community Behavioral Healthcare (NCCBH). The expected increase in demand for care from community health centers was among the reasons that her legislation was added to the House version of health care reform, Matsui noted.

The proposed centers also would expand the use of integrated care, which combines mental health and other types of medical care as well as screening (though not treatment) for chronic non-psychiatric conditions such as diabetes and hypertension.

Such coordinated care is needed to address the high rates of early mortality among people with co-occurring serious mental illness and other health conditions, according to many mental health advocates. While the average U.S. life expectancy in 2006 was nearly 78 years, the average age of death for people with either schizophrenia, bipolar disorder, or major depression was 53, according to a survey that year by the National Association of State Mental Health Program Directors.

“These horrific mortality rates are primarily caused by co-occurring chronic illnesses [such as] asthma, diabetes, cancer, heart disease, and cardiopulmonary conditions,” said Linda Rosenberg, president and CEO of the NCCBH, during a September 2010 congressional briefing. “Lack of access to primary care and specialty medicine is a critical factor in these tragic outcomes, and health care reform provides unique opportunities to address this public health emergency.”

Rosenberg said the FQBHC measure introduced by Matsui also is needed to at least partially replace an estimated $2 billion in state and local mental health program funding that has been cut during the recession of the last few years.

Some of those eliminated local programs nationwide provided vital wraparound services—such as assistance in obtaining housing and transportation help—to people with “serious mental illnesses.” Matsui’s bill directs the new FQBHCs to provide those ancillary services, which mental health advocates describe as critical in helping people with psychiatric conditions adhere to their treatment plans.

Additionally, the bill would help raise the clinical standards of mental health care, according to Matsui, by requiring FQBHCs to provide only evidence-based treatments (such as cognitive-behavioral therapy, according to the bill’s supporting documentation). Clinicians in existing federally funded community mental health centers may use any type of mental health care they choose.

The Mental Health and Addictions Safety Net Equity Act can be accessed at <http://thomas.loc.gov> by searching on the bill number, HR 5636. Graphic

Reported by Rich Daly
Psychiatric News January 21, 2011
Volume 46 Number 2 Page 10

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LOOKING FORWARD TO 2011

The NIMH Director reflects on opportunities for innovative science in the year ahead.

Tom Insel, M.D.
NIMH Director
Director’s Blog
http://www.nimh.nih.gov/about/director/2011/looking-forward-to-2011.shtml

Disclaimer: Neither SARDAA nor SA, assume any legal liability, responsibility nor does inclusion of articles or comments constitute or imply its endorsement, recommendation, or favoring for the accuracy, completeness, or usefulness of any information, product or process disclosed in the blog.

The Truth Wears Off, Is there something wrong with the scientific method?

On September 18, 2007, a few dozen neuroscientists, psychiatrists, and drug-company executives gathered in a hotel conference room in Brussels to hear some startling news. It had to do with a class of drugs known as atypical or second-generation antipsychotics, which came on the market in the early nineties. The drugs, sold under brand names such as Abilify, Seroquel, and Zyprexa, had been tested on schizophrenics in several large clinical trials, all of which had demonstrated a dramatic decrease in the subjects’ psychiatric symptoms. As a result, second-generation antipsychotics had become one of the fastest-growing and most profitable pharmaceutical classes. By 2001, Eli Lilly’s Zyprexa was generating more revenue than Prozac. It remains the company’s top-selling drug.

But the data presented at the Brussels meeting made it clear that something strange was happening: the therapeutic power of the drugs appeared to be steadily waning. A recent study showed an effect that was less than half of that documented in the first trials, in the early nineteen-nineties. Many researchers began to argue that the expensive pharmaceuticals weren’t any better than first-generation antipsychotics, which have been in use since the fifties. “In fact, sometimes they now look even worse,” John Davis, a professor of psychiatry at the University of Illinois at Chicago, told me.

Before the effectiveness of a drug can be confirmed, it must be tested and tested again. Different scientists in different labs need to repeat the protocols and publish their results. The test of replicability, as it’s known, is the foundation of modern research. Replicability is how the community enforces itself. It’s a safeguard for the creep of subjectivity. Most of the time, scientists know what results they want, and that can influence the results they get. The premise of replicability is that the scientific community can correct for these flaws.

But now all sorts of well-established, multiply confirmed findings have started to look increasingly uncertain. It’s as if our facts were losing their truth: claims that have been enshrined in textbooks are suddenly unprovable. This phenomenon doesn’t yet have an official name, but it’s occurring across a wide range of fields, from psychology to ecology. In the field of medicine, the phenomenon seems extremely widespread, affecting not only antipsychotics but also therapies ranging from cardiac stents to Vitamin E and antidepressants: Davis has a forthcoming analysis demonstrating that the efficacy of antidepressants has gone down as much as threefold in recent decades…………..

Reported by Jonah Lehrer
The New Yorker
http://www.newyorker.com/reporting/2010/12/13/101213fa_fact_lehrer#ixzz1BsfsvR7M

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NIH-LED STUDY IDENTIFIES GENETIC VARIANT THAT CAN LEAD TO SEVERE IMPULSIVITY

A multinational research team led by scientists at the National Institutes of Health (NIH) has found that a genetic variant of a brain receptor molecule may contribute to violently impulsive behavior when people who carry it are under the influence of alcohol. A report of the findings, which include human genetic analyses and gene knockout studies in animals, appears in the December 23, 2010 issue of Nature.

http://www.niaaa.nih.gov/NewsEvents/NewsReleases/Pages/NIH-ledstudyidentifiesgeneticvariantthatcanleadtosevereimpulsivity.aspx

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SO FAR AWAY: TWENTY QUESTIONS AND ANSWERS ABOUT LONG-DISTANCE CAREGIVING

This new resource tackles difficult issues faced by many of today’s caregivers. This completely redesigned and updated 44-page booklet provides advice and resources to help caregivers assess what kind of help is needed, coordinate with family members, keep up with medical care, decide when a move is needed, and more.

http://www.nia.nih.gov/HealthInformation/Publications/LongDistanceCaregiving

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TEEN MARIJUANA USE INCREASES, ESPECIALLY AMONG EIGHTH-GRADERS—NIDA’S MONITORING THE FUTURE SURVEY SHOWS INCREASES IN ECSTASY USE AND CONTINUED HIGH LEVELS OF PRESCRIPTION DRUG ABUSE

Fueled by increases in marijuana use, the rate of eighth-graders saying they have used an illicit drug in the past year jumped to 16 percent, up from last year’s 14.5 percent, with daily marijuana use up in all grades surveyed, according to the 2010 Monitoring the Future Survey. For 12th-graders, declines in cigarette use accompanied by recent increases in marijuana use have put marijuana ahead of cigarette smoking by some measures

Press Release: http://www.nida.nih.gov/newsroom/10/NR12-14.html

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Understanding Severe Mental Illness

When a tragedy occurs like the shooting in Tucson this past weekend, all of us seek an explanation. While there remain many questions, a leading hypothesis is that the suspect has a serious mental illness (SMI), such as schizophrenia. The topic of violence and mental illness is never an easy discussion: with issues such as stigma, incarceration, public safety, and involuntary treatment in the mix. There is a legitimate concern that talking about violence and mental illness in the same sentence increases the likelihood that people with serious illness will be further marginalized and less likely to receive appropriate care. But tragic events, whether at a Safeway in Tucson or a classroom at Virginia Tech, require us to address this uncomfortable subject with the science available.

Is violence more common in people with SMI? Yes, during an episode of psychosis, especially psychosis associated with paranoia and so-called “command hallucinations”, the risk of violence is increased. People with SMI are up to three times more likely to be violent and when associated with substance abuse disorders, the risk may increase much further.i But, mental illness contributes very little to the overall rate of violence in the community. Most people with SMI are not violent, and most violent acts are not committed by people with SMI. In fact, people with SMI are actually at higher risk of being victims of violence than perpetrators. Teplin et al found that those with SMI are 11 times more likely to be victims of violent crime than the general population.ii

The most common form of violence associated with mental illness is not against others, but rather, against oneself. In 2007, the most recent year for which we have statistics, there were almost 35,000 suicides, nearly twice the rate of homicides. Suicide is the 10th leading cause of death in the United States.iii Although it is not possible to know what prompted every suicide, it is safe to say that unrecognized, untreated mental illness is a leading culprit.

Treatment may be the key to reducing the risk of violence, whether that violence is self-directed or directed at others. Research has suggested that those with schizophrenia whose psychotic symptoms are controlled are no more violent than those without SMI.iv It’s likely that treatment not only helps ease the symptoms of mental illness, but also curbs the potential for violence as well.

As we learn more about the circumstances surrounding the tragedy in Tucson, we should be working harder to ensure people with SMI receive the care they need. Early intervention offers the best hope to prevent more tragedies in the future.

For more information on SMI and other mental health statistics, please visit NIMH’s Statistics page.

Information on coping with trauma.

iSwanson JW. Mental disorder, substance abuse, and community violence: an epidemiological approach. In: Monahan J, Steadman HJ, eds. Violence and mental disorder: developments in risk assessment. Chicago: University of Chicago Press, 1994:101-36.

iiTeplin et al. Crime victimization in adults with severe mental illness. Archives of General Psychiatry.2005 Aug. 62. 911-921.

iiiCenters for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). www.cdc.gov/ncipc/wisqars.

ivSteadman HJ, Mulvey EP, Monahan J, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Arch Gen Psychiatry 1998;55:393-401.

Thomas Insel, M.D.
NIMH Director
Director’s Blog

Disclaimer: Neither SARDAA nor SA, assume any legal liability, responsibility nor does inclusion of articles or comments constitute or imply its endorsement, recommendation, or favoring for the accuracy, completeness, or usefulness of any information, product or process disclosed in the blog.

Mental Health and Mental Disorders

Goal
Improve mental health through prevention and by ensuring access to appropriate, quality mental health services.

Overview
Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with challenges. Mental health is essential to personal well-being, family and interpersonal relationships, and the ability to contribute to community or society.

Mental disorders are health conditions that are characterized by alterations in thinking, mood, and/or behavior that are associated with distress and/or impaired functioning. Mental disorders contribute to a host of problems that may include disability, pain, or death.

Mental illness is the term that refers collectively to all diagnosable mental disorders.
Why Is Mental Health Important?

Mental disorders are among the most common causes of disability. The resulting disease burden of mental illness is among the highest of all diseases. According to the National Institute of Mental Health (NIMH), in any given year, an estimated 13 million American adults (approximately 1 in 17) have a seriously debilitating mental illness.1, 2 Mental health disorders are the leading cause of disability in the United States and Canada, accounting for 25 percent of all years of life lost to disability and premature mortality.3 Moreover, suicide is the 11th leading cause of death in the United States, accounting for the deaths of approximately 30,000 Americans each year.4, 5

Mental health and physical health are closely connected. Mental health plays a major role in people’s ability to maintain good physical health. Mental illnesses, such as depression and anxiety, affect people’s ability to participate in health-promoting behaviors. In turn, problems with physical health, such as chronic diseases, can have a serious impact on mental health and decrease a person’s ability to participate in treatment and recovery.6

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=28

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