Dallas Morning News explores effects of war on military families
For the paper’s series on military families, Dallas Morning News reporter Dave Tarrant has spent four months investigating what he calls the “relentless cycle of crisis and stress” that affects soldiers’ loved ones. The broad series touches on everything from the Fort Hood suicides to the Army’s preventative measures to Tarrant’s latest, “Wife faces life-or-death decision for her war-injured husband.”
Most of the content is behind the Morning News paywall, but there’s enough on the landing pages to, at the very least, help you understand where Tarrant’s investigation has taken him and just how wide-ranging the health effects of prolonged war can become.
Hoban compares N.C. mental health system to other states
Filed under: Government, Health journalism, Health policy, Hot Health Headline, Member news
WUNC’s Rose Hoban took advantage of an AHCJ fellowship to create far-reaching series on what state and local governments are doing to accommodate and treat residents with mental health disorders, particularly in terms of housing.
Rose Hoban
I recommend you start with Hoban’s honest and personal explanation of how the series came about. It was facilitated by an AHCJ Media Fellowship on Health Performance, supported by the Commonwealth Fund, but the initial impetus came from Hoban’s 12 years of nursing experience and firsthand experiences with treatment models for the mentally ill.
Her original plan for the fellowship, which called for a broad, systemic analysis, was to compare North Carolina’s health system to that of a an equivalent state elsewhere in the country. As she soon found, it’s not that simple.
… as I started digging, I learned that’s just not possible. States have so many varied ways of organizing mental health care delivery – Local-control or state-control? Combine with substance abuse services and developmental disabilities or not? Pull in lots of federal dollars or depend on state dollars? Rely on institutions or more on community-based services?
On top of that, states have many ways of paying for mental health services – Medicaid? State dollars? County dollars? Private dollars? Public-private-partnerships? Tax dollars? Insurance dollars? Fees?
With the insight provided by that false start, Hoban recalibrated by choosing to compare specific components of the North Carolina system with those of other relevant states. The results, along with some relevant past work and original blog posts, are available on Hoban’s NC Voices: Mental Health Disorder blog.
The centerpiece, a five-part radio series focusing on housing issues for those with mental health problems, aired on North Carolina Public Radio. The links below will take you to stories, transcripts and blog posts.
- Part 1: What Kind of Housing for People with Mental Health Problems? (blog)
- Part 2: http://wunc.org/programs/news/archive/NRH041911.mp3/view (blog)
- Part 3: Tennessee Finds Ways To House People With Mental Health Disabilities (blog)
- Part 4: Roadblocks for Housing for People with Mental Health Disabilities (blog)
- Part 5: How to Create Better Housing for People with Mental Health Disabilities (blog)
Report on juvenile mental health courts earns award
AHCJ member Laurie Udesky’s writing was part of the winning entry in the weekly newspaper category of the Price Child Health and Welfare Journalism awards. Udesky’s award-winning piece in the East Bay Express, a weekly paper that covers Alameda and Contra Costa counties in northern California, profiles a local mental health court created to assist teenagers who have broken the law, but suffer from underlying psychiatric issues. It’s an innovative approach to reducing the load on the juvenile detention and judicial systems.
In Alameda County and about fourteen other US counties, attorneys have teamed up with judges, social workers, psychologists, psychiatrists, and families to offer treatment and services to minors with psychiatric problems who’ve broken the law. The idea is to get teenagers like Cindy out of the penal system and help them lead productive lives. Instead of watching kids get thrown out of school for behavior problems, advocates attempt to create environments that would enable them to stay in school. Rather than cycling through group homes, these kids get help so they can live with their families. Instead of simply handing out referrals for psychiatric help, mental-health court makes sure that teens actually attend their appointments. And rather than simply sentencing kids to jail for violating probation, mental-health court tries to address the problems that caused the violation.
Florida addicts priced out of private rehab
In the St. Petersburg Times, reporter Leonora LaPeter Anton attempts to reconcile a local paradox: The state has suffered from epidemic of prescription drug abuse, yet Florida’s numerous private drug rehab centers remain empty. Why aren’t supply and demand coming together? The short answer, she found, is price.
… few who succumb to prescription drugs get the treatment they need. A national drug study estimated that just 10 percent of those who need treatment ever get it.
The problem is cost. Those with insurance quickly exhaust meager benefits and most don’t have $5,000 to $20,000 a month for round-the-clock rehab.
And the long answer? It comes back to insurance, then takes a sharp turn toward federal legislation. Insurers are reluctant to cover even 30-day treatment stays these days, Anton writes. “The typical plan at Blue Cross and Blue Shield of Florida, for example, offered $2,500 a year in substance abuse benefits. Anything over that was not covered.”
It’s a gap that the newly implemented Mental Health Parity and Addiction Treatment Act was designed to overcome. The new laws require that issues like substance abuse be covered at the same level that classic “medical” problems are.
Still, the new regulations apply only to companies with 51 or more employees. Though the law will likely improve care and make it more affordable, it won’t change the way insurers decide what is medically necessary. So with the push away from inpatient treatment, many addicts will try outpatient programs, which cost less, experts say.
Perhaps that is why 120 outpatient programs opened across Florida in the past two years. Florida licensed almost 400 new substance abuse treatment programs across the state, including 62 in the Tampa Bay area. Many focus on intervention, detox and the use of weaning medications such as Suboxone and methadone.
DoD: No condolence letter if soldier committed suicide
Writing on the NPR health blog, Whitney Blair Wyckoff writes that while American soldiers who commit suicide receive full military honors, their families don’t receive a letter of condolence from the White House. It’s a substantial omission because, as Wyckoff notes, “the number of soldiers who committed suicide in the U.S. military rivaled those who were killed on the battlefield in Afghanistan this year.”
Suicide prevention and mental health advocates are circulating petitions to reverse the policy, which is gaining media attention at a time when the military’s attempting to destigmatize mental illness. The administration’s only reply was an e-mail from the Department of Defense stating that “Under the current program, the Secretary of Defense does not send condolence letters to next-of-kin of members who commit suicide.”
Stories focus on suicides of doctors, soldiers
New York Times columnist Pauline Chen, M.D., serves up a reminder that suicide prevention isn’t just a matter of access to counseling and resources, in the form of a story about high physician suicide rates. If there’s any sector of the population that should be able to recognize that they are suffering from mental illness, and that the condition is treatable, it should be doctors, Chen writes. Yet still they kill themselves at a rate above the American average.
For several decades now, studies have consistently shown that physicians have higher rates of suicide than the general population — 40 percent higher for male doctors and a staggering 130 percent higher for female doctors. While research has traced the beginning of this tragic difference to the years spent in medical school, the contributing factors remain murky. Students enter medical school with mental health profiles similar to those of their peers but end up experiencing depression, burnout and other mental illnesses at higher rates. Despite better access to health care, they are more likely to cope by resorting to dysfunctional behaviors like excessive drinking and are less likely to receive the right care or even recognize that they need some kind of intervention.
Chen mentions two recent studies published in the Journal of the American Medical Association that shed more light on the issue, one showing that in medical school depression and burnout are separate entities, and the other showing that depressed students believe others view them as incompetent. In the end, she calls for further long-term research, but does not take the next logical step and investigate comparative research and statistics. Is it just American medical students who are depressed? Do countries with low-cost, low-pressure med schools produce doctors with better mental health? There’s a lot of room for investigation.
Suicides in another high-access group
Chen’s New York Times colleague, James McKinley, writes that as many as 20 soldiers connected with the Army base at Ft. Hood have killed themselves this year, despite the Army’s suicide prevention efforts.
The spate of suicides in Texas reflects a chilling reality: nearly 20 months after the Army began strengthening its suicide prevention program and working to remove the stigma attached to seeking psychological counseling, the suicide rate among active service members remains high and shows little sign of improvement. Through August, at least 125 active members of the Army had ended their own lives, exceeding the morbid pace of last year, when there were a record 162 suicides.
As of July, the Army requires all returning soldiers to be evaluated by a mental health specialist, though veteran advocates still point to a shortage of psychiatrists and an emphasis on treatment through medication rather than through therapy. The system is taxed by record numbers of soldiers seeking help for psychological problems, and mental health was the leading reason for hospitalization in the Army last year, McKinley writes.
Each suicide is unique, McKinley writes, and it’s hard to find patterns.
Why Texas is failing to privatize mental health care
Filed under: Health care reform, Health policy, Hot Health Headline
In 2003, Texas passed a law that sought to turn mental health care in the state into a competitive marketplace. It’s 2010, and that marketplace still hasn’t materialized. The Texas Tribune’s Brian Thevenot tried to find out why. Thevenot describes it as “a textbook case of legislative intent crashing on the rocks of bureaucratic maneuvering and logistical realities.”
The state’s local Mental Health and Mental Retardation authorities are supposed to become “providers of last resort,” who turned most direct medical services over to networks of private providers. Instead, the state has remained among the nation’s worst in terms of mental health funding and, as Thevenot reports, the prison system and not the mental health infrastructure, has served as the real provider of last resort for Texas’ mentally ill.
For psyches, Gulf is Valdez on ‘fast forward’
CNN’s Jessica Ravitz reports that the damage to Gulf communities in the wake of the spill has played out like a faster version of the disintegration of Cordova, Alaska, in the wake of Exxon Valdez. Unfortunately, she writes, that doesn’t mean a quicker route to recovery. It just means a deeper dive into discombobulation and destruction. Ravitz profiles the local victims and those reaching out to help them. In the process, she paints a bleak long-term picture.
Concern about communities sends [environmental sociologist Steven] Picou on an 80-mile drive west to Bayou La Batre, a small fishing town on the opposite side of Mobile Bay. He’s traveling around the Gulf Coast to where people are hurting – to start conversations, impart what he’s learned and teach people how to listen to each other. It’s a response modeled after programs devised in Alaska.
“Unlike a natural disaster where you have a therapeutic community emerging to help you rebuild, we know that in Alaska a corrosive community emerged,” he says. “All of a sudden you have this incredible collapse of community capital.”
He describes how people may self-isolate to cope and how their distrust of others will grow and likely spread. Cynicism about BP, he says, will move on to the federal government, the Coast Guard, the Environmental Protection Agency, local governments, neighbors. Even family.
Ravitz looks at the strong sense of community now present in these places and whether the changes wrought by an influx of new people and money from BP will be permanent. She also reports that domestic violence shelters and hotlines are busier than ever as stress builds and and oil workers, who used to be away from home for weeks at a time, are now stuck on land.
For its part, BP has so far declined a request from Louisiana for $10 million for mental health aid for its residents. Catholic Charities is waiting to hear from BP about another grant that includes about $1.2 million for counseling. Peer-to-peer counseling programs, in which local residents are trained to reach out to other community members, have been launched. One mental health worker says people who were affected by Katrina have been “re-traumatized” by the oil spill.
In major leagues, mental illness losing its stigma
Calling Major League Baseball a “longtime fortress against psychiatry” Sports Illustrated’s Pablo S. Torre profiles the organization’s recent efforts to go from an organization notorious for its lack of crying to one which takes the mental health of its players very seriously.
Photo by Sister72 via Flickr
… baseball has led the way in supporting a growing number of players who have been brave enough to seek assistance for such problems and speak out about them. “Baseball’s older generations like to say, ‘Guys these days just aren’t as tough,’” says Ray Karesky, a licensed psychologist who has directed the Oakland A’s Employee Assistance Program (EAP) since 1984. “But what’s different is just that guys have come out and actually admitted their problems.”
Baseball, with its high failure rates (a great hitter still fails two out of every three at-bats), spotlight on individual performance, substantial downtime and long nights on the road, is loaded with mental health stressors. But it’s only now, thanks to the “cover” provided by those few major leaguers bold enough to come forward with their problems, that players at all levels are comfortable enough to address mental health. The revolution began last year, when an unprecedented five big leaguers went on the disabled list for mental health problems — so-called “mental DLs.”
This number isn’t anywhere close to those reported for the general population—the National Institute of Mental Health estimates that 26.2% of Americans ages 18 and older suffer from a diagnosable mental disorder in any given year—but for baseball it represents a sea change: Between 1972 and ‘91 the grand total of mental DLs in the major leagues was zero.
N.C. county’s mental health services overwhelmed
The one million people who live in North Carolina’s Mecklenburg County are served by a single 66-bed county mental health facility. Charlotte Observer reporter Ames Alexander found that, given those numbers, the math just doesn’t add up. Demand for mental health services has increased in recent years, while the supply of care has actually contracted. Problematic or dangerous patients are “given medicine and sent home,” and the percentage of critically ill patients actually admitted to the hospital is below past numbers as well as those of comparable facilities around the country.
In a 2003 study, the 66-bed hospital concluded that it would need up to 67 more beds in the coming decade - an expansion that was expected to cost as much as $49 million.
“The current facility can not meet the needs of existing volume, much less future needs,” the report said.
Since 2003, the needs have only intensified. Visits to the hospital’s emergency department have grown 25 percent.
In March, when Chapman sought help, emergency department visits jumped to the highest number in 10 months and the hospital’s adult units were running at 105 percent capacity. That same month, the number of calls to the hospital topped 24,000 - a record.
As you may have guessed, the needed expansion never materialized and, with budgets being cut in the county, it doesn’t seem likely any time soon. In addition to a number of well-chosen anecdotes and an exploration of the consequences of untreated mental illness, Alexander helps illuminate the problem by framing it as part of a larger discussion of who is responsible for public mental health treatment: The state or the county?
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