Mental Illness Awareness Week

The Policy Pub wishes to share with our patrons Mental Illness Awareness Week sponsored by the Substance Abuse & Mental Health Services Administration. Mental and behavioral health concerns are growing in awareness across the country. MIAW’s aim is to “help educate all Americans on the needs of individuals with mental illness—including serious mental illness—and their families.”

According to SAMHSA, of the approximately 10 million adults with a serious mental illness, less than one-half of those individuals will receive the services and care they need. Social stigmas continue to be a significant barrier in this regard. As part of its week long effort to continue bringing awareness and education combating stigmatization SAMHSA recommends:

  • supporting individuals with mental illness by helping them understand they are not alone;
  • becoming educated on ways to prevent mental illness, particularly by proactively screening and addressing potential issues during childhood;
  • building greater awareness that effective treatments of mental and behavioral health disorders are available; and
  • celebrating that very often those treatments make a tremendous difference in the quality of life of the individual: People do recover.
  • The SAMHSA website is a fantastic resource on a wide variety of knowledge and information on mental and behavioral health issues and concerns – from advocacy to education to emergency assistance. I encourage you to take a moment to become familiar with what is available there and share with others who might benefit from knowing where to turn – whether because they are seeking to help a loved one, someone they’ve never met, or themselves.

    Cheers,
      ~ Sparky

Depression, Addiction & Mental Health Policy

Pic For BlogThe last time I remember feeling as badly about a celebrity passing has to be December 8, 1980. I remember exactly where I was and what I was doing when a radio disk jockey (people that used to play and broadcast what were known as records on electronic turntables) broke the news over a song that John Lennon had been shot. About two minutes later, the music was stopped – and the sad news announced that he had been shot – and killed.

Queue up round the clock Beatles music and millions of tears across the world.  The next day in the Rock n Roll capital was damp and dreary. A cold mist just seemed to hang in the air. One of those days where ironically it would feel warmer if it would have just snowed. There are a lot of days like that in early December in Cleveland, Ohio. But this one so fit the mood.

Nobody saw that one coming. Whereas we all know now what only a few knew all to well before Monday: that Robin Willams’ mental demons were probably always only a few steps behind. Shadowing him like the inescapable darkness of a night in the forest, depression is a disease that lurks, pounces, retreats and then stalks – taking in turn at random how it chooses to haunt its victims.

Addiction, on the other hand, despite the cultural shift in attitudes over the past few decades, is not a disease. Writing in the Psychology Today blog a couple of years back, Dr. Lance Dodes explains how addiction has little in common with other diseases and cannot be explained by any disease process. But as he also astutely points out, neither is it the purview of individuals lacking in discipline and morality,  just being selfish and self-centered.

But to understand addiction is to understand the mental state of an individual leading up to and perpetuating its hold on that person.  Dr. Lance writes, “addictive behavior is a readily understandable symptom, not a disease.” In Williams’ case the connection between depression and resulting behavior leading to addiction is something that should continue to build awareness and understanding.

I realize it’s a sensitive line here because the last thing we want to do is roll back the progress made fighting stigmatization and the barrier and obstacles that has created in affecting treatment access. On the other hand, from a public policy perspective it is crucial that we continue to dig deeper: to understand mental health – and mental illness – as a critically holistic element impacting all varieties of personal well being, not just as a precept to alcoholism and addiction.

Robin Williams’ wife has asked that we remember her husband by not focusing on his death, “but on the countless moments of joy and laughter he gave to millions.” As the emotional pain subsides I am certain we will be able to do that. Before we get to that place, however, it is natural to question and seek answers on how this tragedy might have been avoided.

For millions of Americans suffering from, or affected by a loved one suffering from, a mental illness, alcoholism or addiction, Robin Williams’ death is a painful reminder of the fear and vulnerability they live with every day. And they are right to be questioning what might be done to help address that suffering. Yesterday, Rep. Tim Murphy (R-Pa) noted that, “Williams’ greatest gift to us, if we choose to accept it, is a focused determination to help those with brain illness and finally take real action to stop the loss of one more precious life.”

In December of last year, in response to the 2012 elementary school shooting in Connecticut, Murphy – a clinical psychologist – introduced H.R. 3717, The Helping Families in Mental Health Crisis Act. One of the most important initiatives in the bill is to address the Institutions for Mental Disease (IMD) Exclusion, which limits Medicaid coverage for inpatient mental health and addiction treatment.

The bill is complex, comprehensive and has faced a significant amount of criticism. Good coverage of this can be found in a blog post from Gary Earles, LICSW, writing last year for the Morning Zen on the Children’s Mental Health Network. Very doubtful that even with this latest tragedy the bill will move anywhere before the next Congress is installed. But what might now happen is the debate will move from the purview of policy wonks, trade groups and special interests into the real world where those aforementioned suffering can have a voice. We can only hope.

Cheers,
  Sparky

Don’t Make Mental Health Policy About the Stigma

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Cost of not caring: Stigma set in stone by Liz Szabo, USA TODAY.

This second article of a USA Today series, Mentally Ill Suffer in Sick System, this morning began exploring, "the human and financial costs that the country pays for not caring more about the nearly 10 million Americans with serious mental illness." But the article didn’t address any of the aggregate human costs nor any of the financial costs the country pays due to serious mental illness. Maybe future articles will, and that’s what I would like to encourage with this post.

Now, admittedly, USA Today isn’t in the top 10% of resources I normally rely upon for keen insights and emerging trends and drivers in healthcare, but nonetheless I think they deserve enormous credit for using their national reach to bring greater awareness to a critically important issue.

From a public policy perspective, however, this first contribution is wide of the mark in advancing the type of dialogue that could actually lead to meaningful public policy initiatives impacting mental and behavioral health services. So though I very much doubt their editors will ever see this post, I would like to provide some input that might be useful in developing content for future articles in the series.

Today’s article focused on two themes: the latent impact that stereotypes associated with mental illness still have, often creating self-absorbed obstacles to seeking and receiving much-needed diagnosis, treatment, support services and ongoing care; and the dramatic lack of sufficient resources committed to helping those who are brave enough to seek assistance and support.

Of course, stigmatism is still very real, yet very difficult to understand: it isn’t just a case of stereotyping and ignorance. Mental illness is difficult for many of us to comprehend because the mechanism responsible for its existence is the same mechanism we use to understand it. Most of us can use our brains to understand heart disease, diabetes and lung cancer. But somehow using our brains to explore and reason through a disease process that in others (or, to be sure, often ourselves) impacts our thinking can be uncomfortably counterintuitive.

The inherent stigmatization isn’t just in the fact that someone with mental illness is, "different." It’s the added frustration of having difficulty understanding why they are different. An individual receiving chemotherapy for cancer may look different than their appearance prior to disease. Someone who has had an amputation resulting from diabetes has a noticeable difference in appearance. But mental illness very often doesn’t carry with it the externalities of these changes in appearance (the manifestation of behavioral health consequences resulting from mental illness may lead to dramatic changes in appearance, but those are usually self-chosen much the same way one would choose a different hair color or style).

So while it may be said that ignorance is a lack of understanding acted upon, I agree we should continue to concentrate efforts on building understanding and awareness through continued education, rather than trying to coach away ignorance through reprimand and humiliation that too often characterize so many public awareness campaigns.

Such efforts have had beneficial impact: as a society we are generally much more accepting today than 20 years ago that mental illness is not a self-chosen condition bearing the shame of poor choices and moral subservience. And they have concurrently raised awareness about the urgent need to develop more effective public policy to address accelerating mental and behavioral health needs.

And so, as related in the USA Today article, the most emotionally convenient and expedient approach to lobbying for additional funding in support of MH/BHS is to continue making the case that mental illness should be viewed just as any other disease of a human organ – since the brain is, after all, a human organ. This reflects the inherent strategy that fighting the stigmatization of mental illness will hold sway over those able to increase funding of MH/BHS policy initiatives. But I don’t think it will because every dollar allocated to healthcare is becoming increasingly precious.

From a policy perspective, I believe it is both folly and a wasted effort to spend valuable resources on lobbying for more funding without being able to provide realistic and achievable budgetary offsets. To do this, advocates of MH/BHS programs need to focus their time and energy on generating evidentiary support for where and how funding of existing programs that address the consequences of mental illness can be more effectively invested in programs that diagnose and treat mental illness – i.e., before that illness results in consequences which place resource strain on other areas of social health and welfare (e.g., utilization of hospital emergency departments and the criminal justice system, the economic impact on families and the cascading effect that has on the rest of society). This is, I assume, what USA Today claims the series intends to do via relaying the “human and financial costs” of mental illness. We will see.

In healthcare, we are now living in an era where the expectation that research and evidence support clinical decision-making has steadfastly made its way into organizational administrative and financial decision-making. Quite obviously, we cannot hope that will ever be the same in Congress, but through the Affordable Care Act and various programmatic changes impacting state Medicaid budgets legislators are by default forcing healthcare providers to much more carefully analyze alternative investments – and to use return on investment as a tool for that analysis. Mental health advocates need to recognize this reality if they want their efforts to ultimately result in constructive public policy consistent with their overarching goals and objectives.

I really hope this understanding is reflected in future articles in the USA Today series. I understand anecdotal human-interest stories that tug at the heartstrings help sell newspapers, but they contribute very little to the knowledgebase of understanding needed to assess where and how limited resources can best be reallocated to address this tremendously difficult challenge that we all face as a society.

Cheers,
  Sparky

Picture Credit ~ Jim C. Jeong for USA Today

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