Patrick Kennedy on mental health

Former Congressman Patrick Kennedy discusses the stigma surrounding mental health and mental illness

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Aging Boomers' Mental Health Woes Will Swamp Health System: Report

TUESDAY, July 10 (HealthDay News) -- The United States faces an unprecedented number of aging baby boomers with mental health or substance use issues, a number so great it could overwhelm the existing health care system, a new report warned Tuesday.

"The report is sufficiently alarmist," said Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City. "I think [the report authors] are right."

Kennedy was not involved with the report, The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? It was mandated by Congress and issued by The Institute of Medicine in light of a "silver tsunami" of health care needs expected to accompany a senior population that will reach 72.1 million by 2030.

The "silver tsunami" is the result of simple supply-and-demand forces gone awry, the report authors explained.

Up to 8 million older Americans, or 20 percent of the current senior population, suffer from some form of mental health condition, often depression, at-risk drinking or dementia-related behavioral and psychiatric symptoms, according to the IOM report. (A basic diagnosis of Alzheimer's disease was excluded from the study.)

And 2 million seniors have severe mental illnesses, a number that is "greatly under-appreciated," said Dr. Peter Rabins, one of the authors of the report.

Also, as baby boomers age, studies indicate that their use of illicit drugs will continue.

"The reality is the Woodstock Generation has come of age," said Kennedy. "Their background is with psychedelic drugs, marijuana, recreational drugs, non-narcotics . . . It's a real problem."

Against these growing problems, meanwhile, the number of health providers and other service providers is shrinking in proportion. And that means, according to the report, that "a health care workforce that is not prepared to address either [mental health/substance use] problems or the special needs of an aging population is a compelling public health burden."

"The number of individuals with specialty training in both aging and either mental health or substance use issues is extremely small," said Rabins, who is a psychiatry professor at Johns Hopkins School of Medicine in Baltimore.

Nor are candidates rushing to fill the pipeline, Kennedy added, probably because of lower pay in geriatric specialties.

Each of these populations -- the elderly, and those with mental health and/or substance use issues -- require special care. But the two in combination represent a special challenge.

Older people metabolize both alcohol and drugs differently from younger people, putting them at risk for overdoses. According to one estimate, almost two-thirds of emergency room visits for adverse drug reactions in 2008 were by elderly people.

Also, elderly people -- particularly those with depression -- may be less able to adhere to complicated medication regimens for mental and physical ailments.

And medications to treat mental health issues may not react well with other medications needed to treat high blood pressure, diabetes and the host of other physical problems that become common as people age.

"The biggest challenge appears to be the fact that these problems rarely occur in isolation. Most [elderly] people who have mental health or substance use problems also have a physical health problem," said Rabin. "That's not true in younger age groups."

The report provides a number of recommendations for solutions, in what basically amounts to an overhaul of the health care system.

Key to handling the future explosion of seniors with mental health issues and/or substance use issues will be organizing a better health care workforce.

"We really need to be training the existing workforce, which interacts with both older people and mentally ill people, to have the skill set of the other group," said Rabins. "People with general mental health training, such as social workers, psychologists and psychiatrists, have very little training in treating the elderly. Those in the aging network have very little experience treating mental illness."

Better provisions, including funding, need to be made for training professionals to care for this population. This includes primary care providers, nurses and nursing-home assistants.

And Medicare/Medicaid reimbursement schedules need to be overhauled to make sure the services this population requires are covered.

The report also said the federal government should coordinate all the efforts that involve these two vulnerable populations.

In addition, Kennedy suggested that partial forgiveness of medical-school loans would "turn around the onward direction of trainees coming into the geriatric field."

More information

Visit the Institute of Medicine for more on the report.

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Health Care Law Offers Wider Benefits for Treating Mental Illness

Until now, people with mental illness and substance disorders have faced stingy annual and lifetime caps on coverage, higher deductibles or simply no coverage at all.

This was supposed to be fixed in part by the Mental Health Parity and Addiction Equity Act of 2008, which mandated that psychiatric illness be covered just the same as other medical illnesses. But the law applied only to larger employers (50 or more workers) that offered a health plan with benefits for mental health and substance abuse. Since it did not mandate universal psychiatric benefits, it had a limited effect on the disparity between the treatment of psychiatric and nonpsychiatric medical diseases.

Now comes the Affordable Care Act combining parity with the individual mandate for health insurance. As Dr. Dilip V. Jeste, president of the American Psychiatric Association, told me, “This law has the potential to change the course of life for psychiatric patients for the better, and in that sense it is both humane and right.”

To get a sense of the magnitude of the potential benefit, consider that about half of Americans will experience a major psychiatric or substance disorder at some point, according to an authoritative 2005 survey. Yet because of the stigma surrounding mental illness, poor access to care and inadequate insurance coverage, only a fraction of those with mental illness receive treatment.

For example, surveys show that only about 50 percent of Americans with a mood disorder had psychiatric treatment in the past year — leaving the rest at high risk of suicide, to say nothing of the high cost to society in absenteeism and lost productivity. The World Health Organization ranks major depression as the world’s leading cause of disability.

One of the health care act’s pillars is to forbid the exclusion of people with pre-existing illness from medical coverage. By definition, a vast majority of adult Americans with a mental illness have a pre-existing disorder. Half of all serious psychiatric illnesses — including major depression, anxiety disorders and substance abuse — start by 14 years of age, and three-fourths are present by 25, according to the National Comorbidity Survey. These people have specifically been denied medical coverage by most commercial insurance companies — until now.

From an epidemiologic and public health perspective, the provision that young people can remain on their parents’ insurance until they turn 26 is a no-brainer: By this age, the bulk of psychiatric illness has already developed, and there is solid evidence that we can positively change the course of psychiatric illness by early treatment.

Mental disorders are chronic lifelong diseases, characterized by remission and relapse for those who respond to treatment, or persistent symptoms for those who do not. In schizophrenia, for example, relapse is common, even with the best treatment. It makes no sense to tell someone with this condition that his lifetime mental health benefit is just 60 days of inpatient hospitalization.

Psychiatric illness is treatable, but it is rarely curable; it may remit for a while, but it doesn’t go away. That is why the current limits on treatment are as irrational as they are cruel — the discriminatory hallmark of commercial medical insurance.

No more. The Affordable Care Act treats psychiatric illness like any other and removes obstacles to fair and rational treatment.

Older people with mental illness will also benefit, because the law will eventually fill in the notorious gap in Medicare drug coverage known as the “doughnut hole.” The law will immediately require drug companies to give a 50 percent discount on brand-name drugs and then gradually provide subsidies until the gap closes in 2020.

On the other hand, poor people with mental illness still have cause for concern. The new law would have expanded Medicaid to insure 17 million more Americans, but the Supreme Court ruled that states could decline to accept this expansion without losing their existing Medicaid funds. In states that opt out of the Medicaid expansion, poor people with mental illness may find themselves in a terrible predicament: They earn too much to qualify for Medicaid, yet not enough to get the federal subsidy to pay for insurance.

But on the whole, the Affordable Care Act is reason to cheer. Americans with mental illness finally have the prize that has eluded patients and clinicians for decades: the recognition that psychiatric illness should be on a par with all other medical disorders, and the near-universal mandate to make that happen.

Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College.

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International Panel of Experts Issue the Toronto Charter for Mental Health and Obesity

TORONTO, ONTARIO--(Marketwire -07/05/12)- Policy makers and health professionals have their work cut out for them when it comes to treating co-existing obesity and mental illness, if an international group of opinion leaders has their way.

In response to a worldwide epidemic of obesity and mental health disorders, the Canadian Obesity Network (CON-RCO) and the International Association for the Study of Obesity (IASO) in partnership with the Centre for Addiction and Mental Health (CAMH) organized a Hot Topic Conference on Obesity and Mental Health, in Toronto, Canada June 26th-28th.

Although obesity and mental illness are major health issues that affect millions of Canadians, the links between them are not well understood. Excess weight, beyond its adverse physiological consequences, also affects self-esteem, body image and eating behaviours while promoting depression and anxiety. The opposite is also true - a disproportionate number of patients living with mental health challenges struggle with obesity, diabetes, heart disease and premature mortality, all of which are interrelated. Both illnesses are associated with significant bias and discrimination.

As part of the event, hundreds of participants ratified the Toronto Charter for Mental Health and Obesity, a detailed call to action for health system funders, researchers and health practitioners to deal with this emerging issue. The Charter lists specific calls to action for governments and health providers to reduce the global burden of obesity and mental illness, chief among them:

 -- Mandatory education for health professionals on how to treat obesity and co-morbid mental illness.-- Immediate affirmative action by policy makers and funders to prioritize research and mandatory evaluation of interventions.-- Conducting a cost-analysis of mental illness co-morbid with obesity-- Compiling standards for responsible media coverage of obesity management and healthy body image.

The full Toronto Charter for Mental Health and Obesity can be viewed and downloaded here (http://www.obesitynetwork.ca/page.aspx?page=2899&app=182&cat1=457&tp=12&lk=no&menu=37).

"Separately, mental illness and obesity are understood to be huge health challenges, and it's an uphill battle for health systems to keep up with patients' needs," says Dr. Arya M. Sharma, scientific director for CON-RCO. "But taken together, the issue is greater than even the sum of its parts. The Charter was conceived as a discussion starter among stakeholders, and the first step towards real action."

"The fields of obesity and mental health are intimately linked, of enormous public and personal health importance but both remain under-recognized, under-resourced and under-researched," Professor Nick Finer, chair of the IASO's Education and Management Task Force, said. "It is our hope that the Charter begins to change all of that."

About the Canadian Obesity Network - Reseau canadien en obesite (CON-RCO)

CON-RCO was founded in 2006 to link the research, policy and practice communities to advance the development and delivery of effective obesity prevention and treatment solutions. The network's core strategies focus on addressing the stigma associated with excess weight, changing the way policy makers and health professionals approach obesity, and improving access to prevention and treatment resources. Currently, more than 7,000 professionals in Canada are members of the network. CON-RCO is hosted by the University of Alberta, and is based at the Royal Alexandra Hospital in Edmonton, AB. www.obesitynetwork.ca.

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Nutrition and Your Mental Health

Be My Friend - http://www.myspace.com/psychtruth

Nutrition by Natalie

Nutrition and Your Mental Health

What does nutrition have to do with mental health? You might be surprised to find out the truth behind what happens when a person has a nutritional deficiency.

Nutritional deficiencies can cause all sorts of psychiatric symptoms including apathy, low energy, irritability, insomnia, low energy, agitation, fatigue, concentration problems, aches and pains, weight changes, including weight loss or weight gain. Sound a lot like the symptoms of depression? The truth is the average American diet of fast food is low in vital nutrition that you need for your body to function correctly.

This isn't to say that all depression is caused by bad nutrition but it's certainly a contributing factor in many cases and poor nutrition will always make depression worse. Antidepressant drugs also do not correct nutritional problems. So if your depressed because of nutritional problems an antidepressant will only partially cover up the problem and you body still won't function correctly.

Please visit Natalie's website at

http://www.nutritionbynatalie.com

To find out more about orthomolecular psychiatry visit,

http://orthomolecular.org/index.shtml

This video was produced by Psychetruth

http://www.myspace.com/psychtruth
http://www.youtube.com/psychetruth
http://www.livevideo.com/psychetruth

© Copyright 2007 Zoe Sofia. All Rights Reserved.

This video maybe displayed in public, copied and redistributed for any strictly non-commercial use in its entire unedited form. Alteration or commercial use is strictly prohibited.

View the original article here

Nutrition and Your Mental Health

Be My Friend - http://www.myspace.com/psychtruth

Nutrition by Natalie

Nutrition and Your Mental Health

What does nutrition have to do with mental health? You might be surprised to find out the truth behind what happens when a person has a nutritional deficiency.

Nutritional deficiencies can cause all sorts of psychiatric symptoms including apathy, low energy, irritability, insomnia, low energy, agitation, fatigue, concentration problems, aches and pains, weight changes, including weight loss or weight gain. Sound a lot like the symptoms of depression? The truth is the average American diet of fast food is low in vital nutrition that you need for your body to function correctly.

This isn't to say that all depression is caused by bad nutrition but it's certainly a contributing factor in many cases and poor nutrition will always make depression worse. Antidepressant drugs also do not correct nutritional problems. So if your depressed because of nutritional problems an antidepressant will only partially cover up the problem and you body still won't function correctly.

Please visit Natalie's website at

http://www.nutritionbynatalie.com

To find out more about orthomolecular psychiatry visit,

http://orthomolecular.org/index.shtml

This video was produced by Psychetruth

http://www.myspace.com/psychtruth
http://www.youtube.com/psychetruth
http://www.livevideo.com/psychetruth

© Copyright 2007 Zoe Sofia. All Rights Reserved.

This video maybe displayed in public, copied and redistributed for any strictly non-commercial use in its entire unedited form. Alteration or commercial use is strictly prohibited.

View the original article here

Kids with Mental Health Disorders at Risk for Long-Term Opioid Use

Laura Richardson, MD, discusses a study that examined the association between mental health disorders and subsequent risk for long-term opioid use among adolescents and young adults ages 13 to 24. She and research teams at Seattle Children's Research Institute and the University of Washington found that those with mental health disorders were not only more likely to be prescribed opioids for chronic pain but 2.4 times more likely to become long-term opioid users than those who didn't have a mental health disorder. The study was published in the June 2012 Journal of Adolescent Health.

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Mental Health and Bullying: Magellan Health Services Launches Second Annual “Take Mental Health to Heart” Campaign

Tue, May 1, 2012, 11:04 AM EDT - U.S. Markets close in 4 hrs 56 mins

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Mental Health Problems - God Damn Your Beautiful

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Nutrition and Your Mental Health

Be My Friend - http://www.myspace.com/psychtruth

Nutrition by Natalie

Nutrition and Your Mental Health

What does nutrition have to do with mental health? You might be surprised to find out the truth behind what happens when a person has a nutritional deficiency.

Nutritional deficiencies can cause all sorts of psychiatric symptoms including apathy, low energy, irritability, insomnia, low energy, agitation, fatigue, concentration problems, aches and pains, weight changes, including weight loss or weight gain. Sound a lot like the symptoms of depression? The truth is the average American diet of fast food is low in vital nutrition that you need for your body to function correctly.

This isn't to say that all depression is caused by bad nutrition but it's certainly a contributing factor in many cases and poor nutrition will always make depression worse. Antidepressant drugs also do not correct nutritional problems. So if your depressed because of nutritional problems an antidepressant will only partially cover up the problem and you body still won't function correctly.

Please visit Natalie's website at

http://www.nutritionbynatalie.com

To find out more about orthomolecular psychiatry visit,

http://orthomolecular.org/index.shtml

This video was produced by Psychetruth

http://www.myspace.com/psychtruth
http://www.youtube.com/psychetruth
http://www.livevideo.com/psychetruth

© Copyright 2007 Zoe Sofia. All Rights Reserved.

This video maybe displayed in public, copied and redistributed for any strictly non-commercial use in its entire unedited form. Alteration or commercial use is strictly prohibited.

View the original article here

Nutrition and Your Mental Health

Be My Friend - http://www.myspace.com/psychtruth

Nutrition by Natalie

Nutrition and Your Mental Health

What does nutrition have to do with mental health? You might be surprised to find out the truth behind what happens when a person has a nutritional deficiency.

Nutritional deficiencies can cause all sorts of psychiatric symptoms including apathy, low energy, irritability, insomnia, low energy, agitation, fatigue, concentration problems, aches and pains, weight changes, including weight loss or weight gain. Sound a lot like the symptoms of depression? The truth is the average American diet of fast food is low in vital nutrition that you need for your body to function correctly.

This isn't to say that all depression is caused by bad nutrition but it's certainly a contributing factor in many cases and poor nutrition will always make depression worse. Antidepressant drugs also do not correct nutritional problems. So if your depressed because of nutritional problems an antidepressant will only partially cover up the problem and you body still won't function correctly.

Please visit Natalie's website at

http://www.nutritionbynatalie.com

To find out more about orthomolecular psychiatry visit,

http://orthomolecular.org/index.shtml

This video was produced by Psychetruth

http://www.myspace.com/psychtruth
http://www.youtube.com/psychetruth
http://www.livevideo.com/psychetruth

© Copyright 2007 Zoe Sofia. All Rights Reserved.

This video maybe displayed in public, copied and redistributed for any strictly non-commercial use in its entire unedited form. Alteration or commercial use is strictly prohibited.

View the original article here

Nutrition and Your Mental Health

Be My Friend - http://www.myspace.com/psychtruth

Nutrition by Natalie

Nutrition and Your Mental Health

What does nutrition have to do with mental health? You might be surprised to find out the truth behind what happens when a person has a nutritional deficiency.

Nutritional deficiencies can cause all sorts of psychiatric symptoms including apathy, low energy, irritability, insomnia, low energy, agitation, fatigue, concentration problems, aches and pains, weight changes, including weight loss or weight gain. Sound a lot like the symptoms of depression? The truth is the average American diet of fast food is low in vital nutrition that you need for your body to function correctly.

This isn't to say that all depression is caused by bad nutrition but it's certainly a contributing factor in many cases and poor nutrition will always make depression worse. Antidepressant drugs also do not correct nutritional problems. So if your depressed because of nutritional problems an antidepressant will only partially cover up the problem and you body still won't function correctly.

Please visit Natalie's website at

http://www.nutritionbynatalie.com

To find out more about orthomolecular psychiatry visit,

http://orthomolecular.org/index.shtml

This video was produced by Psychetruth

http://www.myspace.com/psychtruth
http://www.youtube.com/psychetruth
http://www.livevideo.com/psychetruth

© Copyright 2007 Zoe Sofia. All Rights Reserved.

This video maybe displayed in public, copied and redistributed for any strictly non-commercial use in its entire unedited form. Alteration or commercial use is strictly prohibited.

View the original article here

Afghan Shooter's US Base, Mental Health Treatment

March 14 (Bloomberg) -- Michael Courts, a retired U.S. army colonel who served at Joint Base Lewis-McChord in Washington state, talks about the base's Madigan Army Medical Center and mental health-care treatment for service members and veterans. Lewis-McChord was the home base of a U.S. Army staff sergeant who is accused of killing at least 16 civilians in Afghanistan villages. Courts, who is now a city council member in nearby DuPont, Washington, spoke with Bloomberg's Alison Vekshin and Britton Staniar yesterday. (Source: Bloomberg)

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Vermont charting future of mental health care

Xenia Williams calls herself a survivor of the Vermont State Hospital, the now-closed psychiatric crisis treatment center in Waterbury. "It was very retraumatizing," she said.

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Vet groups, VA split over mental health expansion

WASHINGTON (AP) — Two years after Congress passed a high-profile law to improve health care for military veterans, lawmakers and advocates are again raising alarms that the sprawling Department of Veterans Affairs is not expanding help for the nation's former fighters and their families as quickly or widely as intended.

This time the dispute is over two mental health measures: one to establish a network of peer counselors so that Iraq and Afghanistan veterans have someone to consult with who shares their war experience, the other to give the families of National Guard and reserve members temporary access to mental health services at VA facilities.

Veterans Affairs, the second largest federal agency after the Defense Department, says it was already providing the help that Congress wrote into law in May 2010. Advocates for veterans, though, say the VA is effectively ignoring the law's demand for those two steps.

"The VA does some wonderful stuff, don't get me wrong, but they seem to be ignoring their obligations under this law, almost to the point of being a scofflaw," said Peter Duffy, deputy director for legislative programs at the National Guard Association of the United States.

The VA says it already offers peer support and family counseling at about 300 vet centers around the country. The vet centers are located in strip malls, downtown stores and in office buildings around the country. About two-thirds of the workers are veterans. So, rather than create an entirely new program, the department has told lawmakers that it's meeting the bill's requirements through existing services.

"I think we need to use the legislation in a positive sense to reinforce what we're already doing," said Dr. Jan Kemp, director of the VA's suicide prevention program. "As the need increases, which it inevitably will, we've got the legislation now to help us move resources in that direction. It's an evolving sort of process."

The VA's response has upset those who fought to get the legislation passed. They expected the VA to establish a peer support network consisting of Iraq and Afghanistan vets at each of its 152 hospitals. They also expected family members of guardsmen and reservists to temporarily have access to the full range of mental health services available at the VA's hospitals and its nearly 800 outpatient clinics.

"The language in the bill was not written with the precision that you would like to see, but you can't read a provision of law and say it has no meaning, which is essentially what the VA is doing," said Ralph Ibson, national policy director for the Wounded Warrior Project, a nonprofit group that assists injured service members and veterans. "To say we're already doing this is to say Congress is an ass."

Ibson said the conflict reminds him of an earlier disagreement over the bill's provision of financial aid to caregivers of wounded vets. When the department announced in early 2011 how the program would work, lawmakers and advocacy groups complained that it would help fewer families than expected. The department subsequently expanded the program's reach to about 3,500 families.

Proponents of the legislation said that establishing a strong peer network throughout the VA system would supplement the care veterans get from doctors. Many veterans report feeling more comfortable talking with somebody who has shared similar experiences. The rapport that a veteran counselor develops with clients could encourage more vets to access and stick with their care.

A Rand Corp. study has indicated that accessing care is a significant problem. Researchers found in a 2008 study that barely more than half of those veterans exhibiting symptoms of major depression or PTSD had sought help from a physician or mental health provider in the previous year.

Ryan Alaniz, 32, who suffered from post-traumatic stress disorder after serving in Iraq, said he can attest to the benefits of having fellow veterans to turn to when coming back from war. Alaniz, a specialist in the Army, said he essentially became a shut-in after returning. He drank a lot, felt stressed and had frequent flashbacks to his time in Baghdad, where he helped stabilize and load seriously wounded soldiers for evacuation. One day, while on guard duty, he watched as a chain of bombs killed or maimed dozens of Iraqi civilians.

Alaniz received treatment for post-traumatic stress disorder at the VA's medical hospital in Houston and has praise for the psychologist who worked with him. But he said he made important strides after linking up with fellow veterans at a program in San Antonio administered by the Wounded Warrior Project. One aspect of the program involved spending a week with about 10 of his peers in the Utah countryside. Another helped improve his focus and reduce anxiety during stressful situations. He said there is a comfort that comes from talking to people who have been through a similar experience.

"People don't understand that vets don't actively like to share our stories with someone who hasn't been there," Alaniz said.

Veterans groups and lawmakers are big backers of the peer support work done at vet centers.

"Congress has spoken on this issue and it's time for the VA to move forward and implement these provisions," said Sen. Jon Tester (D-Montana), who led the effort to get the two programs into law after the original authors of the provisions — Republican Pete Domenici and Democrat Barack Obama — had left the Senate.

The VA operates a vast health care system. It started opening vet centers after the Vietnam War as a one-stop clearinghouse that vets could turn to when they needed help and lived far away from a VA hospital. About two-thirds of the workers are veterans. They screen visitors for drug and alcohol abuse. They help the homeless find a shelter or apartment, and the unemployed find a job.

"Our approach is a personal approach. It's another veteran looking you in the eye, establishing a contact and then getting you to the support services that you need," said Dr. Alfonso Batres, who oversees the vet centers as director of the VA's Readjustment Counseling Service. "Our job is to get them to the right individuals, but we do have the capacity to provide a fair amount of counseling at the vet centers."

The proponents also view mental health care for family members as a temporary service that would help more veterans take advantage of treatment: If a spouse or child can get help for depression that stems from the soldier's war experiences, then the veteran may also seek care.

Yet, the clock is already ticking for many families eligible for that benefit because it only applies to a three-year period that begins once a veteran returns from deployment.

On the House side, lawmakers serving on the House Committee on Veterans Affairs have been pressing the VA for details about the legislation's implementation. Rep. Jerry McNerney, D-Calif., and Rep. Ann Marie Buerkle, R-N.Y., both said they believe the VA has fallen short of requirements.

"I don't think they're stalling. I think they're failing to communicate, failing to coordinate and failing to understand that there was a significant attempt to give our veterans and their families what they needed, and I don't think they're getting it done," said Buerkle, the Republican chairwoman of the Committee on Veterans Affairs' health subcommittee.

Kemp insisted that there is no resistance to the legislation. She said the VA also has some veterans who work as peer counselors at the medical centers and that it's conducting site visits that could lead to more hiring. The department is also entering into a contract later this year with an organization that would train the department's peer counselors. She wants the first training program to be completed by the end of September. VA officials said that the timeframe is appropriate because it wanted to give multiple bidders the chance to compete.

"It's a big responsibility to bring peers in and get them trained and up and going," Kemp said. "Getting there is harder than it sounds."

This story is the latest installment in a joint initiative by The Associated Press and Associated Press Media Editors taking a closer look at this latest generation of war veterans as they return to civilian life, and the effect this is having on them, their families and American society.

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State Sued Over Mental Health Services

A lawsuit has been filed against the state by people with severe mental illness who said New Hampshire is falling short in providing services and assistance.

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Mental health stigma in Africa?

Top psychiatrist Frank Njenga has changed how many Kenyans think about mental health issuesNjenga helped build the first private in-patient psychiatric hospital in KenyaHe's also created a television talk show in an effort to build better understandingEditor's note: Every week CNN International's African Voices highlights Africa's most engaging personalities, exploring the lives and passions of people who rarely open themselves up to the camera.

(CNN) -- As Kenya's leading psychiatrist, Frank Njenga has been championing the cause of better mental health care on the east African country and the continent for more than three decades.

He's been working tirelessly to bring quality mental health care in a country where mentally disabled people receive little help from the state and face massive stigma from society.

"It's a horrible indictment on what we've done but the truth and reality is that very little has been done systematically and deliberately by government or by ourselves to bring up the level of mental health in this part of the world," says Njenga.

In Kenya, an estimated three million, mostly poor, people live with intellectual and mental disabilities, according to NGO and United Nations figures. At the same time, the ratio of psychiatrists to the population is dismal -- just one psychiatrist to half a million people.

See also: Kenya's mentally ill locked up and forgotten

But Njenga, who is president of the African Association of Psychiatrists, says the problem is even worse in other countries on the continent.

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"It is a major challenge but it is a challenge that is very sadly is spread across the whole of the Africa continent," he says Njenga.

"In fact, Kenya is ironically behind South Africa and perhaps Egypt in the ratios of psychiatrists that are available per population. There are countries in Africa where there is no single psychiatrist to five-six million people."

This has motivated Njenga to dedicate his life helping mental health patients and raising awareness in a continent where mental disorders are often neglected and described as "un-African" and belonging to "people in the West."

Njenga, however, discards such claims as "clear nonsense."

"For as long as you are a self-confessed human being you will continue to suffer human conditions of which mental disorders are an integral part," he says.

Read also: Namibia's 'miracle doctor' brings gift of sight

Njenga describes Africa as "truly the traumatized continent" that's been plagued by wars, human suffering and lethal dictatorships.

"Whether you are looking at Rwanda or southern Sudan or Sierra Leone or DRC, the number of women and children and adults who have suffered severe trauma is greater than any other continent that I can think of."

We are losing far too many men and women to mental illness and therefore to un-productivity by not treating them for mental illness.
Frank Njenga

He underlines the link between good mental health and productivity and calls policy makers to make mental health services a priority in order to help their countries escape poverty.

"There is no health without mental health and there is no economy," says Njenga. "We are losing far too many men and women to mental illness and therefore to un-productivity by not treating them for mental illness."

Born in Kenya, Njenga was inspired as a teenager by the work of psychiatrist Frantz Fanon, writer of "Wretched of the Earth," a seminal book that explores identity and the post-colonial experience.

From then on, Njenga was convinced he wanted to be a psychiatrist. He went on to study psychology throughout medical school in Kenya before moving to the UK for his post-graduate studies at the Maudsley Hospital -- the world's oldest psychiatric hospital.

At the end of this studies, however, Njenga chose not to pursue a career in the UK but to return to his home country, committed to promoting the cause of better mental health in the continent.

"I went to the UK to come back and to come back as a psychiatrist and to make a difference in my homeland and in my continent. That is the reason I left Kenya and that is the reason I came back," he says.

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On his return to Kenya, Njenga embarked on a mission to reduce the social stigma that is attached to going to a psychiatrist or seeing a mental health professional.

In a ground-breaking weekly show called "Frankly Speaking," Njenga spoke with his patients on television, putting the spotlight on tough issues such as schizophrenia and substance abuse -- taboo topics that were usually kept out of public sight.

Today the discussion of mental health issues on this continent is focused and is positive -- about that I feel proud and privileged.
Frank Njenga

"I felt powerful and relaxed I felt at last here I was able to tell it exactly as it was," he says. "Of all the things I have done in this society and community it is the program on television -- Frankly Speaking -- because I spoke frankly as my name is and my patients spoke very frankly indeed."

In his commitment to providing top-notch mental health care, Njenga also helped build a private in-patient psychiatric hospital, the first of its kind in Kenya.

He's also authored several children's books in a bid to build better understanding of mental illness and advocated for an insurance cover for mental health patients as chairman of the largest insurance company in Kenya.

Through awareness and affordable treatment, Njenga has changed how many people in Kenya think about mental health.

"Today the discussion of mental health issues on this continent is focused and is positive -- about that I feel proud and privileged," he says.

CNN's Leposo Lillian, David McKenzie and Jessica Ellis contributed to this report.

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Mental health calls up sharply

As serious mental health calls to police and social service groups rise, law-enforcement agencies are investing in extra training to help officers untangle situations ranging from erratic behavior to drug overdoses to suicide attempts.

Anoka and Dakota counties have seen their mental health 911 calls, including suicides and attempts, increase by more than 25 percent in the past two years, to more than 2,000 in Anoka and about 1,730 in Dakota. Some police departments, including those in Eagan, Hastings, Burnsville and Buffalo, have increased officer training to better handle such calls or have plans to do so.

There's no clear explanation for the increase, but theories include unemployment and financial stress, the struggles of returning military veterans and lack of access to mental health services, said Daniel Reidenberg, a psychologist and executive director of Suicide Awareness Voices of Education, a nonprofit in Bloomington.

"There is still a lot of apprehension about the economy," said Eagan Police Chief Jim McDonald. "Almost everyone knows someone who lost a job or a house or was in the service overseas. ... We are taking steps to make sure our officers are prepared for those situations." Eagan's mental health calls have increased more than 30 percent since 2007.

Other factors also may be involved. Jon Roesler, a state Health Department epidemiology supervisor, said greater access to powerful anti-depressants and painkillers may contribute to higher suicide rates and more drug overdose calls.

Reidenberg also faults social changes. "Families are more isolated by technology -- not communicating face to face, but so much online," he said. "We are becoming a far more disconnected society."

The numbers are harder to pin down in the big cities. St. Paul police don't specifically track mental health calls. Minneapolis handles roughly 2,500 of the more serious calls per year, but information on whether that number has increased is not available. And it's hard to compare numbers across departments, some of which track or categorize calls differently.

In St. Paul, the police department has emphasized crisis-intervention training -- with classes held every six months -- for about five years, said training coordinator Sgt. Paul Paulos.

"It's an alternative to rushing in and solving the problem. You step in and take time to talk to the person to conquer the anxiety they are going through or problems and come to a rational solution," Paulos said. "Nine out of 10 times, no force is used. You gain ... their confidence."

Hennepin County has 24-hour crisis phone lines and two teams that handle mental health calls. Those calls have risen about 20 percent a year since 2006, said Kay Titkin, county mental health services director. She said suicidal thoughts or acts account for about a third of about 11,000 crisis calls handled last year.

Minneapolis holds about one crisis-intervention class a year for officers, said Sgt. Steve Wickelgren, a department counselor who is also clinical director of the state Crisis Intervention Training Officers Association. The training features actors who play mentally ill people whom police officers practice working with, he said.

In Wright County, Buffalo police have seen a near doubling of mental health incidents over the past five years, to 94 calls in 2011, said Chief Mitch Weinzetl. "The across-the-board increase in acute mental health issues is troubling," said Weinzetl, who is planning mental health-assessment training for his officers. He noted an increase in cases involving acts or talk about suicide.

In 2010, the most recent data available, both the state and the seven-county metro area had the highest age-adjusted suicide rates seen since the mid-1990s, according to the state Health Department. The 2010 metro rate was 10.3 suicides per 100,000 residents, below the state rate of 11.1

The 599 suicides in Minnesota in 2010 was the highest figure recorded, Roesler said. The state's preliminary count in the first half of 2011 was 316, nearly half in the seven-county metro area.

Anoka County saw its age-adjusted suicide rate go from 8.1 in 2004 to 14.9 in 2010, the highest rate among metro area counties. The state record was about 17 per 100,000 people during the Great Depression in the 1930s, Roeseler noted.

Anoka's high rate was partly due to a handful of student suicides that prompted the Anoka Hennepin School District to offer a 24-hour student mental health help line last summer, said Cindy Cesare, interim director of the county mental health department. She said the county has held forums in area high schools to talk about depression, suicide and bullying.

Burnsville police have seen their mental health calls double since 2008, to more than 300 last year, said Chief Bob Hawkins. His department also has undergone extra crisis training over the past five years.

"Our focus," he said, "is to make sure we keep people healthy and safe."

Jim Adams • 952-746-3283

25 percent

increase in mental health 911 calls in Anoka and Dakota counties in the past two years

30 percent

increase in mental health 911 calls in Eagan since 2007

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Houston mental health expert does his part to help veterans

Dr. John Oldham is president of the American Psychiatric Association and chief of staff at the Menninger Clinic in Houston.

Last week, Oldham participated in a roundtable discussion at the White House on raising awareness among civilian health care providers of combat-related mental health conditions, and to better coordinate care among civilian, military and veterans health care systems.

Chronicle reporter Lindsay Wise interviewed Oldham about the national effort to reduce the stigma surrounding post-traumatic stress disorder and traumatic brain injury, and to help military personnel and their families transition smoothly to civilian life.

Q: What did you discuss Tuesday at the White House?

A: This is in connection with this initiative that was launched by Michelle Obama and Dr. Jill Biden called Joining Forces, and what that entails is really to try to address some of the needs of the returning military from overseas and combat, and help them even beyond the regular channels that they would normally be using to get help. … They want not only to provide educational information for the families and the public, they also want to facilitate access to appropriate mental health care, and the third thing they want to do is help returning veterans with obtaining meaningful employment. And so what the Joining Forces initiative has done is, it's pulled together key officials from the Department of Defense and from Veterans Affairs and is trying to link and bridge all of their efforts with leaders from all of the civilian organizations that would be pertinent in a comprehensive program of care. What they want to do is build a strong bridge between the military help that they receive immediately on returning from deployment and continuing care as they re-enter society.

Q: Why is it important to raise awareness among civilian health care providers about neurological and psychological issues affecting military service members and their families?

A: It's estimated that about 50 percent of military personnel who need mental health care do not get it, and one of the big reasons is the tremendous stigma that's associated with seeking help for mental problems. Part of the goal here is to heighten awareness among the public to what they call the military culture, so part of the educational materials that this effort is putting together include trying to help people understand the military culture, which really doesn't make it comfortable for these people to seek help for psychiatric problems. Sometimes there are soldiers who are coming back and want to go back for another tour of duty, so there has to be a careful evaluation as to whether that's safe for the soldiers and whether they're fully recovered or can become fully recovered to do that. An analogy is the stories you see in the news about professional football players who have concussions and don't want people to know it because they want to be able to go back in the game.

Q: I've spoken to troops and their families who said they don't want to see a military doctor or therapist for mental health issues because they're worried it will affect their security clearances or damage their careers.

A: That's not uncommon because there's a real perception that you're going to jeopardize your military career if you're known to be seeing mental health care providers, and that's part of what this whole effort wants to work against, and help people get over and get past.

Q: What can civilians do that the military isn't already doing?

A: We hope that we can also encourage civilian employers to become a little more proactive in reaching out to returning soldiers to make employment opportunities available to them. Employers would benefit from availing themselves of a lot of this educational material to understand what the re-entry process is like and the experience is like for soldiers returning from combat. … Over the next four years there will be about a million military personnel coming off of active duty as the military downsizes. So that's a lot of people who are going to be looking for alternative occupational situations and having to make pretty remarkable changes because a lot of these are career military who haven't known a whole lot else.

lindsay.wise@chron.com

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Mental Health Video

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