Urgent Alert for Mental Health in Los Angeles County

Please raise your voice to oppose the consolidation of the Los Angeles County Departments of Mental Health, Health Services and Public Health.

Supervisor Antonovich is proposing to consolidate the three health agencies (Dept. of Mental Health, Dept. of Public Health, and Dept. of Health Services) in LA County into one agency. This will be heard at the Supervisor’s meeting on next Tuesday, 1/13/15). NAMI Los Angeles County Council is opposed to the consolidation of the health agencies for the following reasons:

  1. It is critical that the Department of Mental Health maintain direct accountability and communication with the Board of Supervisors and not through another entity.
  2. Consolidating these various health-related departments will make it more difficult to bring attention and funding to mental health concerns. Mental health may not be priority #1 in a new health agency, whereas it is of upmost concern to the current Department of Mental Health. Mental health is the leading form of disability and that element is always lost in the shuffle due to stigma and lack of attention in society.
  3. At the state level, California has attempted to consolidate the Department of Mental Health with Health Services — and years later — they continue to work out the operations and policies. This consolidation of health agencies in Los Angeles will create unnecessary confusion and obfuscation of mental health concerns and issues. This will create operational issues that will invariably decease resources aimed at recovery and wellness for individuals living with mental illness.
  4. The new agency may hire or maintain employees who do not necessarily have expertise about mental health and illness. Or, the new agency may opt to maintain employees with less experience and background in mental health than others. These measures may decrease the ability to make informed decisions about mental health issues at the proposed agency.
  5. We are making some progress on mental health issues via the current Department of Mental Health, which may be halted by consolidation efforts.
  6. The Board of Supervisors should consider stakeholder input in this tremendous decision.

In essence: Our county needs a greater focus on mental health, not less. This is what the state has done and it has not been a smooth transition. Delivery of services requires focus and attention to detail. Burying mental health in an even larger bureaucracy  will reduce focus, not improve it.

We encourage you to contact your Supervisors’ offices to make your voice heard on this matter. Please see the Letter to board of Supervisors 1-9-2015 from Brittney Weissman the Executive Director of the NAMI Los Angeles County Council.   For more information please see the article in the Los Angeles Time. The proposed motion can be accessed on the BOS Agenda.

Please call your district supervisor and let them know how you feel before 1/13/15.  For most of NAMI South Bay Supervisor Don Knabe or Supervisor Mark Ridley-Thomas is your supervisor.  Please connect to their links below to verify and raise your voice.

First District

Hilda L. Solis (213) 974-4111

Second District
Mark Ridley-Thomas (213) 974-2222
http://www.markridley-thomas.com/
Third District (westside)

Sheila Kuehl (213) 974-3333

Fourth District
Don Knabe (213) 974-4444
http://knabe.com/staff/
Fifth District
Michael D. Antonovich (213)974-5555

Study Finds Treatment-Resistant BPD Responds Better to ECT Than Medication

Bipolar Disorder. Image Credit: xpixel | shutterstock

Bipolar Disorder. Image Credit: xpixel | shutterstock

From Psychiatric News Alert: Electroconvulsive therapy (ECT) for treatment-resistant bipolar disorder appears to be more effective than an algorithm-based pharmacologic treatment in terms of symptom improvement, says the report “Treatment-Resistant Bipolar Depression: A Randomized Controlled Trial of Electroconvulsive Therapy Versus Algorithm-Based Pharmacological Treatment” in the January American Journal of Psychiatry. But remission rates did not differ between the two groups and remained modest regardless of treatment choice for this challenging clinical condition.

According to the research, ECT treatment was significantly more effective than the pharmacological treatment. For more details of the research, see the Psychiatric News article. There were possible limitations noted by Mauricio Tohen, M.D., Dr.P.H., and Christopher Abbott, M.D., M.S., additionally stating:

“In spite of the above limitations, this report adds major value to the evidence-based data on the use of ECT as a treatment option for bipolar depression.”

For more research on the use of ECT in depressive disorders, see the Psychiatric News article, “Ketamine Outperforms ECT in Depression Study.”

People with Mental Illness in the Criminal Justice System: A Cry for Help

FROM NAMI BLOG
By Jackie Feldman, M.D.

Several years ago, in partnership with Dear Abby, a request was sent out in her newspaper column asking those with mental illness or family members with mental illness who had “interfaced” with the criminal justice system.  I was part of a committee called Psychiatry and the Community, with the Group for the Advancement of Psychiatry, and received almost 3,000 letters.

Each one was read and we decided a practical response was to develop a monograph entitled: “People with Mental Illness in the Criminal Justice System: A Cry for Help,” hopefully to be published soon with the help of the American Psychiatric Foundation (and available to the public, providers, and purveyors of care in the criminal justice system).

The demographics of the criminal justice system are devastating. In a year’s time:

  • 2 million arrests in the U.S. involve persons with serious mental illness
  • 550,000 people with serious mental illness are in jails and prisons
  • 900,000 are in some kind of community control

The system is woefully understaffed and often poorly educated about the needs of those with mental illness.

However, a few things about the criminal justice system became apparent as I read the letters.

  1. It can be ignorant and insensitive, usually not because providers are evil, but because they are tired and lack resources like time, money, training, space and manpower.
  2. It often lacks innovation in response to crises and focuses on safety and boundary setting via restraint and seclusion.
  3. It uses short-term fixes and “efficiencies” to save money, but lacks a commitment to assessing long-term consequences of these fixes.
  4. And importantly, it can and will respond to advice and training.

The document that was developed after reading this letters will hopefully offer guidance to mental health care providers on how to interact with the criminal justice system to advocate for skills development, provide training opportunities, develop partnerships and enhance care.

In addition, the final product will provide practical advice for individuals with serious mental illness and their families on how to be prepared for an interaction with the criminal justice system.

  • Carry the name and contact information of your psychiatrist/mental health care provider (they can be contacted to advocate and educate law enforcement, jail and court personnel). Sign and carry a pre-emptive release form allowing communication with your mental health provider and law enforcement.
  • Carry a sheet with your diagnosis and list of medicines (some of my patients have taken to wearing medical alert bracelets).
  • Keep the lines of communication open.  Family members should ask to speak with local leadership such as a police chief, sheriff or patient advocate if care isn’t being provided in a timely fashion. Insist on treatment, but also understand that jails and prisons have very limited formularies that often contain the cheapest medications. You will need to lobby hard to get formularies to expand, or more practically, negotiate with the jail to use your family member’s own medication supply (there may be barriers to this tactic). Require adequate transition/discharge planning (a call at 11 p.m. telling you that your son is being discharged at midnight with no medication and no follow-up is basically a guarantee for failure).
  • If law enforcement has been trained, develop and share your WRAP (Wellness Recovery Action Plan) in advance.
  • Advocate for crisis intervention training of local law enforcement. Make sure to participate and offer your viewpoint as an individual with mental illness or as a family member.  Personal stories carry incredible weight, especially if delivered face-to-face.
  • Support/advocate/demand the development of mental health courts and drug courts.

I’d be interested in hearing how y’all deal with these challenges and if these suggestions have been helpful.

This is Jackie Feldman’s inaugural blog since starting her volunteer position as Associate Medical Director. She is a family member of near and dear relatives who have experienced depression and psychosis, and the consequences of the stigma of hospitalization, side effects to medicine, and memory loss from ECT. 

She is also a psychiatrist. When she retired in mid-2014, she had spent the last 24 years in community psychiatry, running a public mental health center at the University of Alabama at Birmingham. In this position, she was privileged to work with thousands of individuals with serious mental illness and their family members.  She was a member of the NAMI state board, a federal court monitor for the Alabama women’s prison system, and helped the Department of Justice investigate state hospitals in Georgia.

Mental Health Investment By States Slowed in 2014

By Jessica Hart, NAMI State Advocacy Manager

NAMI just released a report highlighting what went on in state legislatures in 2014 across the country when it comes to mental health issues. The report, State Mental Health Legislation 2014 shows that investment in mental health services slowed from last year and that when progress was made around specific policy issues much of the legislation felt like it only skimmed the surface.

This year, only 29 states and the District of Columbia increased funding for mental health services. Overall, the mental health care system still simply needs to recover lost ground from the state budget cuts of 2009-2012. But reinvestment is unsteady. See where your state fell in investment this year below.

There were some victories this year. Minnesota, Virginia and Wisconsin were leaders in the country by passing measures that can serve as models for other states in areas such as workforce shortage, children and youth, school-based mental health, employment and criminal justice.

Our policy recommendations for states in 2015 are:

  • Strengthen public mental health funding.
  • Hold public and private insurers and providers accountable for appropriate, high-quality services with measurement of outcomes.
  • Expand Medicaid with adequate coverage for mental health.
  • Implement effective practices such as first episode psychosis (FEP), assertive community treatment (ACT) and crisis intervention team (CIT) programs.

What can you do?

Write to your Governor and State Legislators to let them know that they need to make mental health care a priority.

Connect with your local NAMI to see how you can help advocate for mental health services and supports in your community.

Frontiers in Addiction Treatment Series: How 12 Steps Heal PTSD

Presented by
Thelma McMillen Center and Betty Ford Center

Presenter

  • Ronald E. Smith, M.D., Ph.D.
    Captain, Medical Corps US Navy (Ret)

Attendees Will:

  • Identify three symptoms of PTSD
  • Confirm and understand the 12 Steps of recovery
  • Describe how the 12 Steps relate to two or more psychological healing processes for PTSD

FREE CMEs and CEUs
FREE Continental Breakfast Provided

Thelma McMillan Center

Thelma McMillan Center

Location

  • Hoffman Health Conference Center
    3315 Medical Center Drive

Date & Time

  • Tuesday, January 20, 2015
    9:00 a.m. – 11:30 a.m. (registration/breakfast at 8:30 a.m.)

RSVP not required

Parking

FREE Parking in the MAIN HOSPITAL STRUCTURE (off Lomita on Hospital & Technology Dr.), near the Emergency area. SHUTTLE AVAILABLE.

Torrance Memorial Medical Center is accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA) to provide continuing medical education for physicians. Torrance Memorial Medical Center designates this live activity for a maximum of 2.5 AMA PRA Category I creditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This credit may also be applied to the CMA Certification in Continuing Medical Education.

Call (310)-257-5758 for further information.

Study Finds Patients With First-Episode Schizophrenia Disorders Show Greater Body Fat, Cardiovascular Risk

Research Folders Laptop Mean Investigation Gathering Data And An

Christoph Correll, M.D., a professor of psychiatry and molecular medicine at the Zucker Hillside Hospital in New York, and colleagues studied approximately 400 patients with FES. Photo Credit: Stuart Miles | DPC

From Psychiatric News Alert: The duration of psychiatric illness and treatment for patients after first-episode schizophrenia spectrum disorders (FES) appears to be associated with weight gain and having other cardiometabolic abnormalities, according to a study published in JAMA Psychiatry.

Data showed that when evaluated after experiencing FES, nearly 50% were obese or overweight, 40% had prehypertension, 10% had hypertension, and 13.2% had some form of metabolic syndrome. Longer psychiatric illness duration correlated significantly with higher body mass index, fat percentage, and waist circumference. Treatment with antipsychotic medications, such as olanzapine and quetiapine, was associated with higher triglyceride levels in the blood.

“In patients with FES, cardiometabolic risk factors and abnormalities are present early in the illness and likely related to the underlying illness, unhealthy lifestyle, and [use of] antipsychotic medications, which interact with each other. Prevention of and early interventions for psychiatric illness and treatment with lower-risk agents, routine antipsychotic adverse effect monitoring, and smoking-cessation interventions are needed from the earliest illness phases.”

To read more about research into cardiovascular risk associated with psychiatric illness and use of psychotropic medications, see the Psychiatric News articles

For more on this topic, see the study