Over-Protective Disorder?

Image Border Editor: https://www.tuxpi.com/photo-effects/bordersThe recent arrest of parents and coaches for gaming their kids’ path into some of America’s most elite colleges casts an interesting angle into the contemporary mental health of our teens and young adults and, perhaps, some emergent challenges to the norms of contemporary parenting.

I had the opportunity last week to present Mental Health 101 to the Long Island chapter of the New York State Association for College Admission Counseling (NYSACAC). “MH101” is a one-hour construct of the Mental Health Association of New York State and serves to whet the appetite of attendees so that they will connect to the work of the Mental Health for Schools Resource Center as well as MHAs in general. The focus of the session was how colleges can engage prospective and incoming students with mental health resources.

NYSACAC members shared anecdotes about highly protective parents of applicants who all-too-frequently take the preponderance of responsibility for their child’s application, including serving as the point person for phone calls and emails regarding the status of their child’s applications. Several noted questions about the authenticity of the authorship of the student’s essays and also shared their classroom colleagues’ complaints about the invasiveness of parents within academic processes.

A recent TIME article about the state of mental health on college campuses reported a 30 percent increase between 2009 and 2015 in students seeking counseling services at colleges and universities. TIME further reported that, in 2017, “nearly 40 percent of college students said that they had felt so depressed in the past 12 months that it was difficult for them to function.” Furthermore, 61 percent reported that they had “felt overwhelming anxiety” in the past year. Suicide and self-harm also are reported to be on the rise. The Mental Health First Aid initiative advanced by the National Council for Behavioral Health, which MHAW offers with the help of a SAMHSA grant, now offers an enhanced module specifically for people, including students, who engage with students in higher education venues.

On the positive side, students’ use of services and willingness to be open about their experiences with stress are signs of progress against mental health stigma.  And it is positive that, according to TIME, colleges are stepping up staffing and other mental health responses to the needs of students. However, we also must consider the connection between the rise of these problems and the preparedness of students who take on the challenges and opportunities of college study, once considered a privilege and now considered generally as a necessity for future vocational success. And, here, parental roles – and their own fears about their kids’ plight – have to be examined.

How much parental protectiveness is okay, particularly as children become teens then young adults? Is there, perhaps, criteria to be discussed for “overprotective disorder”— such as when a parent feels so much concern about their child’s plight that they the need to assume functional responsibilities for them, up to and including providing protected paths (including bribery and legal threats) to desired goals? And, in some cases, those goals aren’t always those expressed by the child but more reflect the goals of the parent.

The “nature vs. nurture” debate often arises in conversations, whether clinical or casual, concerning kids. With the opioid crisis and debates about legalizing marijuana, our attention is often on brain development and chemistry, particularly for teens and young adults. Perhaps the travails of those parents whose sense of entitlement has become criminal can serve to swing needed attention to the experiences, pressures, and dynamics of our families.

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Posted in Anxiety, College, Depression, Higher Education, University

The Elusive Homeless Population

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Joanne Massimo, Program Director, Suffolk County United Veterans

Please welcome Ruth McDade, Director of Development at the Association for Mental Health and Wellness, as a returning guest blogger. Her story below motivates us to continue the important work we do every day. ~ Michael Stoltz

To help identify and address the issue of homelessness on Long Island, Joanne Massimo, Program Director for Suffolk County United Veterans, and I participate each year in the “Point in Time Count.” This annual event is overseen by the Long Island Coalition for the Homeless, which is designated by the Department of Housing and Urban Development to oversee the regional strategy for ending homelessness. To put the issue of homelessness into perspective, on this day in 2016 the number of homeless people in Suffolk and Nassau counties was 3,937.

This year it was an unusually warm January evening in eastern Suffolk County. Our first stop was a wooded area with a tent barely visible in the distance. Armed with MREs (Meals Ready to Eat) and a sleeping bag along with supplies of additional food, personal care items, and a list of housing resources courtesy of the Long Island Coalition for the Homeless, we called out to announce our presence. Despite our efforts, nobody responded to our offer of assistance. We could only leave a card nearby with a list of housing resources.

Our next stop was a local laundromat. I spoke with the woman behind the counter who informed me there are many homeless people who enter seeking refuge. She said she felt bad for them but after a period of time she has to tell them to leave. When I handed her a card with a list of housing resources, she smiled and thanked me for helping her.

Driving along a main road, Joanne and I spotted a man bundled up in layers of clothes with a shopping cart depositing collected bottles and cans inside a market. When he exited, we asked to speak with him, explaining we were here to help people who were homeless. Even though he was visibly unclean and in need of a shower, the man refused assistance and walked away from us while pushing his shopping cart.

Joanne and I decided to drive to a shack situated at a church set back in the woods. Before we approached the shack, we spoke with a man who shared with us his own story of homelessness, and even though he had since secured housing, he asked us what would happen if his food stamp benefits were to run out in March with the current government shutdown. Our agency operates three food pantries, but it served as a reminder that homelessness can happen to anyone, even to those who do currently receive food stamp benefits. Joanne and I said goodbye to the man and walked on to the shack and announced our presence and offer of assistance. But again, there was no response. So, we once again left a list of housing resources along with supplies of MREs, food, and personal care items.

Our final stop was a Burger King. Joanne and I entered and explained to the woman working behind the counter why we were there. The woman replied there were many homeless people who congregated in the back area of the fast food restaurant. She also told us a story of a woman who once lived in a nearby apartment that had lost her housing and now can be seen walking along the road pushing a shopping cart. We decided to order some food and wait, but again, a homeless person was not to be found.

As a provider of emergency housing – our agency operates The Vets Place shelter in Yaphank – we know firsthand that homelessness does indeed exist here on Long Island.  If more of those on the front lines who routinely encountered people experiencing homelessness had housing resources to distribute, we just might see people exchanging the woods, shacks, and shopping carts, for a safe, permanent place to live.

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Posted in Homeless, Veterans

Visionary Law Mandates Mental Health Education in NY Schools

image-20160315-9262-d4fgb3There’s been an important and encouraging new development on the mental health front in New York State.

A new law holds forth the promise that significantly greater numbers of New Yorkers will be seeking out the care they need – and getting this care – in the years to come.

Effective July 1, an amendment to the State’s education law requires that mental health education must be provided in classrooms statewide. All elementary, middle, and high schools in New York State must modify their curriculum to include mental health as part of existing physical health instruction.

The welcome change is largely the outcome of five years of advocacy led by the Mental Health Association of New York State (MHANYS). New York State should be proud to now stand as a national leader in this vanguard modernization of our health education requirements. Virginia is the only other state with a similar law, and, coincidentally, its law went into effect on the exact same day.

However, this attention to actually getting people into care would be insufficient were it not for legislation passed by both houses – and awaiting the Governor’s signature – to strengthen the State’s Mental Health Parity laws. The “Mental Health and Substance Use Disorder Parity Report Act” went beyond the previous law which solely required plans to respond to consumer complaints. The new law requires plans to submit data on key parity measures – such as network adequacy and claims performance – to ensure that people are getting care when they seek it.

Mental heath providers have been painfully aware of the numerous obstacles to care – and we expect these reforms to help overcome some of them. The National Institute of Mental Health says that about 44.7 million Americans aged 18 or older had some form of mental illness in 2016. This represents nearly a fifth of all U.S. adults. Young adults aged 18-25 years had the highest prevalence of mental illness (22 percent) compared to adults aged 26-49 years (21 percent) and aged 50 and older (15 percent). About half of all chronic mental health conditions begin by age 14. About 22 percent of youth aged 13-18 experience serious mental disorders in a given year.

Yet only 43 percent of these adults received mental health treatment that year, with far more women (49 percent) than men (34 percent) getting help. And the percentage of young adults aged 18-25 years with who received treatment (35 percent) was lower than the proportion of adults with mental illness aged 26-49 years (43 percent) and aged 50 and older (47 percent) who got assistance.

Stigma and misinformation about mental illnesses are the most prevalent barriers to people obtaining care but the parity discrepancies have also contributed. To better understand this troublesome gap, Project Access – a study group convened by Roslyn Heights-based North Shore Child and Family Guidance – asked people who had successfully entered mental health care about their experience of obtaining that care. Fifty percent found it significantly more challenging than seeking physical health care. Three out of five said it took between two and 16 contacts to make a connection for mental health care.

Almost 24 percent couldn’t find providers that accepted their insurance. Nearly 39 percent had problems with affordability, 21 percent cited personal indecision as a factor, and 24 percent said their attempts at accessing help were futile.  Regrettably, these obstacles contribute to increasing rates of suicide, substance abuse, addiction morbidities, legal problems, social isolation, and other social and economic struggles.

These new laws represent a good start to helping address many of these barriers.

To help with implementation of the education law, MHANYS will soon launch an online School Mental Health Resource and Training Center that will be available to public and private schools statewide. The Center, supported with funding from the New York State Legislature and Governor Andrew M. Cuomo, will provide assistance and guidance, a hotline for school districts, and a team of experts in education and mental health.

We agree with the Commissioner of the New York State Office of Mental Health, Dr. Ann Sullivan, who said that “by introducing mental health education at age-appropriate levels from elementary through high school, mental health will be normalized just as physical health is, stigma will be reduced, and children and parents will learn about prevention, and when and how they should ask for help.”

Coupled with insurance parity strengthening, this visionary law will encourage early intervention for mental health conditions – breaking from a pattern where too many commence their care after a hospital or ER visit. It can also serve as a catapult to efforts to ensure the repair of access issues. Let’s encourage and support our school districts to all do what they can to make the law a success.

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Posted in Depression, Education, mental health, Parity, Schools, Stigma

The Opioid Dens of Medicaid

Today’s post is by guest blogger, Robert Detor, LCSW, a member of the board of the Association for Mental Health and Wellness.  The following column was submitted to the Wall Street Journal.

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Robert Detor, LCSW

Everyone needs to be constantly discriminating when reading published information and this editorial is a perfect example of why “Fake News” needs to be taken seriously. That doesn’t mean everything is fake, but everyone must exercise a hyper alertness and understand the source. Often the sources will telegraph the intent and trigger alarms to dive deeper. This editorial is one of those pieces that demands further review. It unabashedly purports to implicate ObamaCare and Medicaid in the Opioid crisis and the resulting deaths. So many deaths that in fact the expected lifespan for Americans has decreased in the past few years!

The basis for your editorial is a report issued by Sen. Ron Johnson from the Senate Homeland Security and Governmental Affairs Committee. What you do not explain is this so-called report, from the Wisconsin Senator, who last week accused the FBI of having a “Secret Society” (like the Illuminati), was authored by the Senate Republican Majority staff. It is not a report from an independent bonafide research entity. Without such a disclaimer it is easy for readers to assume this is fact. Rather, it is interpretation and I would suggest biased.

You write that Medicaid offers cheap access to drugs (as if commercial plans don’t), for a low co-pay, then jump to some anecdotes to morally indict Medicaid beneficiaries complicit in a fraud to dupe unsuspecting pharmacists. Next is an admission “fraud is a feature of any government program” as you jump to a Bronx bodega and a cabal of health-care providers in Miami. (I don’t think you’re referencing the multi-million dollar fraud case of the healthcare company the Governor of Florida ran by Medicare?)

Next, the unbelievable distortion: Obamacare is to blame! Yes, you cite the report where there was a 55 percent increase in criminal cases filed between 2014 and 2017, compared to the four years before the expansion of health care. to the poor and middle class. So it appears there is a causal effect between the expansion of access for the middle class and poor to healthcare and crime?

There is no doubt the opioid crisis has severely impacted our country. The deaths during the past four years have soared; 64,000 deaths in 2016 according to the National Institute on Drug Abuse. NIDA reported synthetic opioids were the leading cause of death, with heroin, natural and semi-synthetic opiates, cocaine and methamphetamines also on the rise. It is a true epidemic of historic proportions. But the link Johnson’s report makes to the increased access to prescriptions doesn’t hold water. According to the National Institute of Health, overdose deaths by prescription drugs peaked in 2011, three years before Obamacare.

I suggest you take a look at the testimony provided at the June 8, 2017 Congressional Joint Economic Committee on the “Economic Aspects of the Opioid Crisis.” In this hearing, factual data is presented that states clearly those most impacted by the crisis are between 26 and 34 years old and historically had the least access to healthcare coverage. 51.4 percent of the people with an OUD (opioid disorder) have incomes below 200 percent of the Federal poverty level ($23,764 for an individual) and have not had access to coverage.  Also…Fact: the drugs fentanyl and heroin, the most frequent causes in overdoses, are obtained illegally, not by prescription or resale of drugs obtained by prescription. And to restate, NIDA clearly shows overdose by prescription drugs peaked in 2011, three years before Obamacare!

It seems to me that any publication with an ounce of integrity should restate its position based upon all the facts. This report by the Senate Majority was released not to further the cause of solving the horrendous problem of the lives being lost to overdose. If it was, it entirely misdirects our efforts.

So, should we wonder why this was released? Or even better, why were our taxpayer dollars used to produce such rubbish? And what was your real point?

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Posted in Addiction, Affordable Care Act, Opioid

Seven ‘Dirty Words’ Words You Can’t Say About Healthcare

Seven WordsSo…how are we now to tell people what’s good or bad mental health care?

This past week, President Trump directed officials at the Centers for Disease Control and Prevention (CDC) to cease using seven terms, including “diversity,” “vulnerable,” “science-based,” and “evidence-based.” While as amusing as comedian George Carlin’s routine, this move leaves many social services, health, and behavioral health leaders befuddled as to what the administration believes should guide professionals and advocates in our responses to people who are seeking help for adversities that have impacted their lives.

Mental health and addiction care have forever been magnets for well-marketed remedies without regard to any documentation that they will help or even harm people. Over centuries, these have ranged from sadistic physical measures to some psychotropic medicines that did more damage than good to a bevy of “snake oil” and body-assaulting remedies, some that continue to abound in the marketplace today.

I will never forget conversations I had with a tearful psychiatrist, Dr. William Turner, an early board member at Clubhouse of Suffolk, who painfully lamented his participation in the 1930s in lobotomies at Long Island State hospitals and the VA.  I also recall a tour of our nation’s first public hospital in Williamsburg, opened in 1773 by Virginia’s Governor as the “Public Hospital for Persons of Insane and Disordered Minds” where tools of torture were used – purported science that could cure “persons who are so unhappy as to be deprived of their reason.”  Treatments “consisted of restraint, strong drugs, plunge baths and other ‘shock’ water treatments, bleeding, blistering salves…(and later included) an electro-static machine.” Virginia’s Governor hailed these treatments as “science” for “diseases of the brain and nervous system, and the mentally ill (who) chose to be irrational.”

So, pursuant to this CDC directive, what shall become the most-trusted source for care recommendations to people who ask for help for themselves or loved ones? Some considerations, I guess, might include:

  • Social media optimization: “What treatments are approved as: ‘Facebook-Friendly Care,’ ‘Highly-Twittered Help,’ or ‘Most-Instagrammed Treatment’? Of course, the repeal of net neutrality may mean “pay-to-play” competition among healthcare providers to promote their products and services.
  • Spiritual guidance: “What treatment does God want me to pursue?” (Note: Many wonderful clergy leaders have been working with behavioral health leaders to help ensure that their congregants can access the most responsible information.)
  • Bartender or illegal drug dealer: “Sir, I want to stop using your products and services. Who can best help me?” Or, more progressive:
  • Apple-directed care options: “Siri, who should I go see to help me with my mental health problem?”

To be fair, behavioral health care has not always been adequately directed by “best science.” But, we remain at a time when there are mounting major challenges to helping people access mental health and substance abuse care. These include combating stigma, a workforce that is not sufficiently competent culturally or linguistically, forthcoming Medicaid cuts, and inadequate networks and payment confusion in insurance and managed care companies. (A “shout-out” to the just-released “Project Access” report by North Shore Child Guidance’s CEO Andy Malekoff and his colleagues!).

Amid our nation’s opioid and suicide crises, which includes our military Veterans, this censorship of health care communication imposed on our leading health safety organization just doesn’t seem helpful.

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Posted in CDC, Centers for Disease Control, health, mental health, Politics, Veterans, wellness

An Inspiring Day in Friendly Manitoba Province

My wife, Robin, and I spent Wednesday at a wonderful museum in Winnipeg: the Canadian Human Rights Museum.

It was remarkable by its thorough and historical discussion of human rights abuses around the world, but also by its humble inclusion of Canada’s incursions perpetrated within its own borders. For example, the Museum includes a deep and stirring examination of a “child welfare” system campaign in the 1960’s to “improve” the lives of Aboriginal (“First Nation”) children by removing them from their impoverished family homes and tribal communities and placing them far away in foster care — often with unmonitored and abusive families. Called the “60’s Scoop,” testimonies by these children and their parents, like all the exhibits, are a painful reminder of the consequences of ethnocentric thought.

In fact, the Museum has been a watershed for criticisms in Canada. Groups that feel left out or minimized — i.e. their suffering did not receive fair attention in comparison with that given other incursions against ethnicities, races, religions, gender, LGBTQ communities, people with disabilities, and (an important debate in Canada) linguistic differences (i.e. French vs. English speakers).

The Museum ends with a floor dedicated to  a hopeful consideration of dozens of emergent leaders and voices in human rights causes, many of whom are remarkable for being “everyday people” who just want to make a difference.

Despite its controversies, Canada should feel proud of its effort to document the path to human rights especially as nations like ours choose leaders with more isolationist views. The slope to indifference, bias, and hate can deepen rapidly should we fail to protect and defend our core freedoms.

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Posted in Canada, Canadian Human Rights Museum, Disabilities, Human Rights

When Your Problem is My Problem, Too: A Timely Flashback to the Road to Mental Health Parity

parity1“I shouldn’t be forced to pay for your health problems and your family’s health problems”

While many opponents perceive that the current health bills are popular among Conservative Republicans mainly because it paves the way for a huge tax benefits for wealthy people, and punishes poor people, there are two real Federalism debates that warrant serious attention here: 1) Should people be forced to buy insurance when they’re healthy and don’t feel the need for it? And 2) Whether health insurance and health care should be regulated closer to home, by States and not by the Federal government.

Aside from major cuts in Medicaid, which pays for nearly 40 percent of all behavioral health services in our country, the most critical issues for mental health stakeholders in the current debate is the preservation of the gains of the 20-plus year crusade to mental health parity and the inclusion of a basic mental health benefit, including addiction treatment, in any public or commercial insurance policy. BEWARE: There’s a “red herring” in the swamp of the House and Senate bills, assuaged by the President, which puts a few dollars into a separate pool for opioid addiction treatment. Such a fracture of the behavioral health benefit is a populist strategy but one that will effectively spell the end of the broader mental health and addiction benefit requirement.

To get a picture of the impact removal of this requirement would look like, all one has to do is remember the days before parity.

MHAW’s ancestral agency, Clubhouse of Suffolk, was founded by six people who had family members affected by psychiatric disabilities. In those days, many family members shared a saga of going to any extent possible to find treatment that held hope of reversing the course of their loved ones spiral. In those times, 38 percent of commercial insurances didn’t cover mental health conditions, 45 percent didn’t cover substance abuse, and many people needing care had both issues. For most of those with policies that did provide coverage for these conditions, there were annual and lifetime caps on treatment services. As a result, many bankrupted their family savings trying to obtain care for their loved one. Family fractures and divorce were common consequences as families wrestled with decisions like state hospital commitment and “tough love” strategies. Many families and people, at their most vulnerable points in their despair, were taken in by charlatans who offered hope through high-priced and unproven, even bizarre treatments.

Many families saw their loved ones end up in jail…prisons like Rikers Island became the newest and largest psychiatric institutions in the nation – a problem that has still not be adequately addressed.

There is much to learn from these times: As State institutions emptied and the paradigm for behavioral treatment in the community pushed forward, it took two leading U.S. politicians who were political polar-opposites to forge a movement that would change behavioral healthcare for the next generation. New Mexico Senator Pete Domenici, a conservative and one of the Republican Party’s elder statesman, and Paul Wellstone, a liberal Democrat from Minnesota, shared the experience that each had family members affected by psychiatric disabilities.

Their efforts led initially to the Mental Health Parity Act of 1996 which provided that large group health plans cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical/surgical benefits. Some States, like New York, began to build on this Act and pass their own parity bills. Tragically, Senator Wellstone perished in a plane crash in 2002 and did not live to see what became the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. This Act prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.

Following the passage of the 2008 law, Senator Domenici – retiring from his position due to a degenerative brain disease, reflected to TIME magazine on the bi-partisanship that led to the adoption of this commitment to mental health care in all health insurance:

“Now when I’m finished with a speech and I’m mingling around — even if the meeting were oil and gas operators in Dallas, Texas — almost always somebody will come up and say, “Hey, keep with it, Pete, I’ve got a nephew…” Or, “My uncle Billy had this…” In other words, it is more prevalent than you think. Out of almost any crowd somebody will tell you a story about their family. Those kinds of things are always coming up. Even President Bush spoke to me personally and very eloquently about it. He said, “You don’t have to convince me, I’m over that hurdle.” Every time we got close [to passing the bill], he’d ask about it.”

“Strangely enough, when I would speak to this among a group of Senators, it took more time than I thought to get some of them to come up and join me and say, ‘I want to work on this because I have a relative or a friend.’ But eventually, four or five Senators came up to me and said, ‘We got to work on this, Pete, because it’s real.’ It took many a month until that first bill got to the floor. Then we just rolled it through the Senate.”

Because of that bi-partisan policy conviction, we have seen significant progress in shortening and reducing hospitalizations and emergency room visits, the evolution of evidence-based practices for more complex conditions including co-morbid addiction and mental health conditions, trauma-informed care (which has been vital for serving our Veterans), and early intervention. And, thanks to increased mental health education and anti-stigma efforts, greater access to behavioral health services. We still have a long way to go – especially when it comes to serving people of color and minority cultures in our country.

But we should have long passed the residue of self-centered thought in health care and mental health care – thanks to courageous leaders like Senators Domenici and Wellstone. We are all inter-connected in health through our shared vulnerabilities, whether that be for mental illness, addiction, heart disease, aging, or cancers.

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Posted in Affordable Care Act, mental health, Parity
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