A Talented Young Violinist’s Descent into Mental Illness and Crime

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Kim Knoble was mastering Mozart violin concertos by the time she hit middle school. As a high school senior, she played with the San Francisco Symphony Youth Orchestra — while doubling as concertmaster of its Marin counterpart.

Then, on a music scholarship at UC Irvine, her brain began to change.

She thought the FBI had tapped her phone, that Hollywood producers were sending her messages. She started using drugs. Years of difficulty followed: Hospitalization. Rehab. Relapse. Tough love. And homelessness.

What brought Knoble redemption was the crime she would commit. Agitated and off her medication two years ago, she pushed a 75-year-old man down the stairs of a city bus. He was injured. She was arrested.

But Knoble was fortunate. She was accepted into San Francisco’s Behavioral Health Court, which in lieu of incarceration offers comprehensive treatment, housing, vocational services and more under the supervision of a Superior Court judge.

by Lee Romney, Los Angeles Times

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National Survey of Schizophrenics Anonymous Members

Hello SA members!

clipboardSARDAA would appreciate your help in completing a national survey of SA members. Some of you may remember the 2000 survey designed by Michigan State University. Our goal is to replicate that survey and compare the results from 2000 and 2013. We had extremely strong participation (approximately 60% response rate!) in 2000 and would appreciate your participation this time around.

Students from Lone Star College in Houston, TX are helping with the survey. They are contacting all of the group leaders to ask how many copies of the survey your group needs. Please let them know how many copies you want, and we will mail them to you along with a pre-paid envelope for you to mail the completed surveys back to SARDAA. This broad survey of members will help SA and SARDAA see how the groups have evolved, specifically regarding issues such as group and member demographics as well as outcomes and/or benefits experienced by SA members.

Thank you for your help! If you have questions, please contact SARDAA volunteer Amy Larsen at 318-773-5404 or SARDAA’s toll free number 866-800-5199.

The New Science of Mind

THESE days it is easy to get irritated with the exaggerated interpretations of brain imaging — for example, that a single fMRI scan can reveal our innermost feelings — and with inflated claims about our understanding of the biological basis of our higher mental processes.

Such irritation has led a number of thoughtful people to declare that we can never achieve a truly sophisticated understanding of the biological foundation of complex mental activity.

In fact, recent newspaper articles have argued that psychiatry is a “semi-science” whose practitioners cannot base their treatment of mental disorders on the same empirical evidence as physicians who treat disorders of the body can. The problem for many people is that we cannot point to the underlying biological bases of most psychiatric disorders. In fact, we are nowhere near understanding them as well as we understand disorders of the liver or the heart.

But this is starting to change.

by Eric Kandel, The New York Times

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When Someone You Know Struggles With Fear, Anxiety and Stress

What do you do when someone you know has to deal with persistent fears, anxieties, or even depression? Well, the first thing you need to do is to get the person to seek the services of a professional who can lead them in the right direction and give them the help they need. In addition, here are some other techniques you can use to help the person cope.

Learn as much as you can about managing anxiety and depression. There are many books and information that will educate you on how to deal with fear and anxiety. Share this information with the person who is struggling. Education is the key to finding the answers you’re looking for in managing your fears. 

Be understanding and patient with the person struggling with their fears. Dealing with depression and anxiety can be difficult for the person, so do not add more problems than what is already there.

In every anxiety-related situation you experience, begin to learn what works, what doesn’t work, and what you need to improve on in managing your fears and anxieties. For instance, you have a lot of anxiety and you decide to take a walk to help you feel better. The next time you feel anxious you can remind yourself that you got through it the last time by taking a walk. This will give you the confidence to manage your anxiety the next time around.

Another thing to remember is that things change and events do not stay the same. For instance, you may feel overwhelmed today with your anxiety and feel that this is how you will feel the rest of the week or month. This isn’t correct. No one can predict the future with one hundred percent accuracy. Even if the thing that you feared does happen, there are circumstances and factors that you can’t predict which can be used to your advantage. You never know when the help and answers you are looking for will come to you. 

When your fears and anxieties have the best of you, seek help from a professional. The key is to be patient, take it slow, and not to give up. In time, you will be able to find those resources that will help you with your problems.

BIOGRAPHY:

Stan Popovich is the author of “A Layman’s Guide to Managing Fear Using Psychology, Christianity and Non Resistant Methods” For additional information go to: http://www.managingfear.com/

SAMHSA Releases Report on Integrating Behavioral Health and Primary Care for Children and Youth

Behavioral health conditions among children and youth today occur at a disturbing rate, impacting their overall growth and develop- ment and leading to higher mortality rates as they reach adulthood. In fact, studies have shown that adults with mental illness who are served in the public mental health system have a shortened life expectancy of 11 to 25 years on average when compared to the general population. Key to disrupting this phenomenon is the development of preventive and early identification strategies, including integrating care systems for children with behavioral health conditionsb that address the primary care, behavioral health, specialty care, and social support needs of children and youth with behavioral health issues in a manner that is continuous and family-centered. This paper outlines different models for organizing the delivery of services, describes five core competencies of the integrated care systems for children with behavioral health issues, and describes financing mechanisms that can be used to support the approach of integrated care systems for children with behavioral health conditions.

Today’s behavioral health landscape for children and youth is grim, with rising rates of youth and adolescent depression and illicit drug use. The rates of mental illness and substance use rise as youth move into young adulthood, while studies show that people with serious mental illnesses and substance use disorders die earlier than the general population, in large part due to unmanaged physical health conditions.

To close the early mortality gap, there must be a shift in focus from treatment of chronic disorders to prevention, and greater emphasis on identifying early onset of behavioral health concerns among children and youth. Many factors point to the need for prevention and early identification strategies by primary care clinicians (PCC) in integrated care systems.

–SAMHSA

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APA Files Amended Complaint Against Anthem Health Plans: Unresolved Potentially Discriminatory Practices Risk Patient Harm

The American Psychiatric Association (APA), the Connecticut Psychiatric Society, and the Connecticut Council for Child and Adolescent Psychiatry filed an amended complaint Friday [September 20, 2013] in a lawsuit originally filed against Anthem Health Plans, Inc. and its parent company, Wellpoint, Inc. in April 2013. The amended complaint asks the Court to enforce federal and state laws designed to protect mental health patients against direct and indirect discrimination in the provision of health care benefits.

According to APA President Jeffrey Lieberman, MD, APA’s action comes after months of waiting to see whether the Connecticut Insurance Division alone or in combination with Anthem would end the discriminatory practices outlined in APA’s original complaint and ensure equal access to quality care for those seeking treatment for mental health or substance use disorders.  “Sadly, neither Anthem nor the Connecticut Insurance Division have made any effort to solve the problem,” said Lieberman.

APA alleges that Anthem Health Plans’ January 2013 and subsequent changes in its rate schedules for services provided by psychiatrists violate the Mental Health Parity and Addiction Equity Act (MHPAEA) and Connecticut parity law and restrict access to mental health care for patients in Connecticut. The actions by Anthem manipulate the rate reimbursed for psychiatrist-provided psychotherapy, imposing a greater burden upon mental health patients than for patients seeking other kinds of medical or surgical services.

“The actions taken by Anthem in Connecticut in manipulating the reimbursement rates for psychiatric services is an example of the kinds of barriers to care insurance providers unfairly impose on people with mental illness,” said Lieberman. “Insurance exchanges will soon be open under the Affordable Care Act and insurance plans should not be permitted to discriminate against mental illness. MHPAEA is a good law that needs to be enforced so that people in need of mental health care do not slip through the cracks. We can no longer tolerate discriminatory practices that impede access to care.”

The amended complaint alleges that Anthem’s discriminatory practices unfairly burden people with mental illness by discouraging receiving medical and psychotherapy services in one visit and instead setting up a system that would require patients to make two appointments, miss more time from work and make additional out of pocket payments. These barriers to care do not exist for other illnesses like cancer or diabetes. Anthem’s failure to pay psychiatric physicians in a manner comparable to other physicians performing similar services results in fewer psychiatrists willing to participate in a network and restricts patient access and choice.

“The APA continues to fight for equal rights for people with mental illness,” said Lieberman. “Our efforts in Connecticut are indicative of our vigilance for ensuring patients have access to a full continuum of psychiatric services.”

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.

Nobel Laureate Comments on Biology of Psychiatric Disorders

In an op-ed essay that appeared in the May 28 New York Times, David Brooks claimed that psychiatry is not really a science, but a semi-science. This claim prompted Eric Kandel, M.D., to respond in his own op-ed essay, which appeared in the September 6 New York Times. In addition to being a professor at Columbia University, Kandel was a recipient of the 2000 Nobel Prize in Physiology or Medicine.

–Psychiatric News Alert

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NYT Article by David Brooks: Heroes of Uncertainty

NYT Article by Eric Kandel: The New Science of Mind

APA Holds Press Conference on Key Mental Health Issues

Last year’s SARDAA “Shattering Stigma – Realizing Recovery” Award recipient, the Honorable Patrick Kennedy, has tremendous commitment to mental health issues. This Psychiatric News article describes a White House conference on mental health (with President Obama and Vice-President Biden) to which he was invited.

Patrick Kennedy, a former member of Congress, cosponsored the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act in the House of Representatives and worked hard to ensure its passage. Today he serves as a senior strategic advisor for APA.

Two continuing struggles—to combat stigma and get federal officials to issue a rule implementing the parity law—dominated the agenda.

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Trajectory of Adolescent Cannabis Use on Addiction Vulnerability

The adolescent brain is a period of dynamic development making it vulnerable to environmental factors such as drug exposure. Of the illicit drugs, cannabis is most used by teenagers since it is perceived by many to be of little harm. This perception has led to a growing number of states approving its legalization and increased accessibility. Most of the debates and ensuing policies regarding cannabis were done without consideration of its impact on one of the most vulnerable population, namely teens, or without consideration of scientific data. We provide an overview of the endocannabinoid system in relation to adolescent cannabis exposure and provide insights regarding factors such as genetics and behavioral traits that confer risk for subsequent addiction. While it is clear that more systematic scientific studies are needed to understand the long-term impact of adolescent cannabis exposure on brain and behavior, the current evidence suggests that it has a far-reaching influence on adult addictive behaviors particularly for certain subsets of vulnerable individuals.

by Yasmin L. Hurd, Michael Michaelides, Michael L. Miller, and Didier Jutras-Aswad

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Navy Medicine Chaplain Offers Compassion for Suicide Prevention

I remember my first experience interacting with someone who was suicidal. Even though I was with my pastor, it was a scary occurrence.

I was 23 years old and learning to be a chaplain. He had been called by this young man who said that he had taken some pills. We immediately left his office and went to his house. On the way, he explained the situation to me. I was wondering how we are going to handle this situation and what I should say. My heart was racing as I prepared for this moment.

We rang the doorbell and his parents answered. As my pastor told them why we were there, they said that he was upstairs and they don’t think he’s suicidal.

“I want to talk with him,” said my concerned pastor.

“No problem,” said the parents.

They called him downstairs and my pastor asked him if he had taken some pills and attempted to kill himself. He said yes.

“We don’t believe him,” said the parents.

Since my pastor had known about the struggles of this 17-year-old teenager, he said, “I believe him and I would like to take him to the ER.”

I stood amazed and astonished by the parents’ response.

They said, “Go ahead and take him to the ER. He’s just looking for attention.”

by Capt. Roosevelt Brown, a chaplain with the U.S. Navy

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