Vol 34 No 1 January 2016
Editor, Ann Akland
www.nami-wake.org (919) 848 4490
The Iris
From the President’s Desk
NAMI Wake County
by Andrea Chase
One Word
Taking action can be the ultimate antidote to the
feelings of despair many of us feel when trying
to interact with an overwhelmed system of care.
My intention is to be part of the solution.
Stigma prevents many from seeking treatment
for a brain illness. I knew I had to stand up,
share my story and skills so others could receive
the same support and education that I received
through NAMI Wake County. Read my story at
http://nami-wake.org/files/IrisFebruary2015.
pdf.
Monthly Education Meeting
January 25, 2016, 7:00 - 8:30 pm
Advocacy
NAMI NC’s Public Policy Platform
Nicholle Karim, LCSW, Public Policy
Coordinator & Registered Lobbyist,
NAMI North Carolina
Breaking the silence can transform what may be
a devastating life experience into newfound pride
and courage. Self-stigma can be self-defeating.
To advocate provides a path forward.
If those aren’t compelling enough reasons to
advocate, NAMI national has released the third
annual report of trends, themes and effective
practices with a focus on legislative activity per
state. North Carolina is mentioned in this report
as one of three states that have “been in steady
decline” with respect to mental health care funding over the past three years.
“Particularly troubling, states like Wyoming, North
Carolina and Alaska have decreased state mental
health budgets for the last three years running. In
Continued on Page 2
The Iris
Why advocate?
1
During the month of January, many of us reflect
on our goals for the coming year. Selecting a
word to guide our actions can help us focus on
what is most important. As I step into a new role
on the NAMI Wake County Board of Directors,
the word that stands out to me for our affiliate is
“advocate”.
NAMI Wake County
NAMI Wake County is a grassroots, volunteer
organization. We know what it is like to live
with a mental illness either as the individual
affected or as a family member or significant
other. Join us! Join our Celebration of Courage
fund raising team.
2
The Iris
continued from page 1
North Carolina, after two years of cuts, the governor had
proposed a modest 4% increase to the state mental health
budget. After a difficult political fight, the end result was
that the budget took a startling $84 million (14%) cut.
However, the state did fund a psychiatric bed registry and
150 additional psychiatric beds in rural areas.” Read the
report here: https://www.nami.org/About-NAMI/
Publications-Reports/Public-Policy-Reports/StateMental-Health-Legislation-2015
In 2015, the UNC Health Care Crisis and Assessment
Center at Wakebrook received a federal grant which will
be used to expand its primary care treatment including
dental care. The Wakebrook inpatient unit has 16 beds for
adults with plans to add 12 more in 2016.
Here are three steps you can take to move towards
advocacy.
3.
Volunteer with NAMI Wake County. Contact
the NAMI Wake County Program Coordinator, Heather
Pomeroy ([email protected]) to find out about
volunteer opportunities with NAMI programs such as
Sharing Hope, In Our Own Voice, NAMI Basics or
Peer-to-Peer. Serve on a NAMI Wake County board
committee. Committees include Advocacy, Sharing
Hope, Marketing, Membership, Fund raising and
Programs.
As we continue our advocacy work together in 2016,
please let me know how we can help you stand up and
join NAMI Wake County to ensure everyone affected by
mental illness receives the education and support they
deserve. ([email protected] / 919-848-8913)
10th Annual Celebration of Courage
Save the Dates - May 1 -7 2016
1.
Seek support. Participate in a NAMI Wake
County support group. Locate a mental health
professional who practices cognitive or dialectical
behavioral therapy. If you are experiencing anger, grief
or guilt, NAMI Wake County is here to offer support.
Moving towards advocacy is a process that evolves over
time. To advocate means we have an opportunity to focus
our anger, grief and guilt and can uniquely affect positive
change.
May
May
May
May
May
1
2
5
6
7
Irises at Rex
Irises at Sponsor sites
Recovery Luncheon
Gala
NAMI Walks
2.
Learn about local mental health resources.
Register for a NAMI Wake County education class.
Attend a NAMI monthly education meeting. Meetings
are open to everyone.
with WRAL news Anchor
Gala Featuring
actress, singer, producer &
Broadway Star
Lauren Kennedy
David Crabtree
sponsorships available:
http://www.namiwakecounty.org/coc-sponsors.html
NAMI Wake County
EARLY TREATMENT
IS KEY TO RECOVERY
by Gerry Akland
3
The Iris
The NIMH has recently released results from a
seven year program, Recovery After Initial Schizophrenia
Episode, or commonly referred to as the RAISE. Canada,
Australia, Great Britain, and Norway have been using
early intervention treatment models for decades. In fact,
Dr. E. Fuller Torrey advocated for early intervention more
than 30 years ago in his ground breaking book, Surviving
Schizophrenia. Thus, shortening the duration of untreated
symptoms has become seen as a key to improving longterm outcomes, but not generally applied here in the U.S.
The study primarily targeted individuals from
15-35 years of age, when psychotic spectrum disorders
such as schizophrenia and schizoaffective disorder are
most likely to develop and before treatment has begun.
One part of the study was a team-based, multicomponent
treatment program designed to be implemented in
routine mental health treatment settings and aimed at
guiding people with a first episode of psychosis (and their
families) toward psychological and functional health. The core services provided in the treatment
program included a family education program, individual
resiliency training, supported employment and education,
and individualized medication treatment. It embraced
shared decision-making that focused on strengths and
resiliency and on collaboration with clients and family
members in treatment planning and reviews.
Results indicated that comprehensive and
aggressive early treatment can change the overall course
of the illness, confirming results in other countries. Also,
the study indicated that the duration of symptoms
and whether symptoms were active or stable were not
determining factors, but being untreated was.
So what is new, one might ask? The overall
project was successful in that the treatment program was
delivered here in the U.S. with our fragmented health
care system. It demonstrated feasibility of delivering
the coordinated specialty care model with high rates of
engagement among individuals who are typically difficult
to engage in treatment. One aspect of the study for a
select group of the participants showed that with a social
support technique that involved schools, families, and talk
therapists, lower use of antipsychotics was possible.
And how does this study relate to the OASIS
(Outreach And Support Intervention Service) treatment
program that we have here in Wake County and Chapel
Hill, where it started? OASIS was started by UNC
researchers after they found that the greater the interval
between the onset of psychosis and its treatment, the
greater the severity of negative symptoms. The primary
author, Dr. Diana Perkins, said in her 2005 paper, “the
sooner treatment is started, the better the clinical and
functional outcome. Early treatment can reduce the
symptoms of the initial psychosis, which will reduce the
immediate suffering and burden of disease experienced
by patients and their families and improves long-term
prognosis by limiting progression of the illness and
preserving a person’s ability to respond to antipsychotic
medication.” OASIS works to help young adults who are
newly diagnosed with schizophrenia or schizoaffective
disorder recover and return to school, work and their
social lives with minimal disruption. The program
provides therapy for individuals and family members,
education about the illness, and outreach in homes
alongside medical treatment.
Clearly, the research behind the UNC OASIS
program at Chapel Hill and Raleigh and the recent RAISE
study indicate that early treatment is key to recovery.
Furthermore both draw on the importance of family and
other support, including talk therapy, as key components
for recovery. It is important for us to advocate for the
expansion of the early psychosis model at the state level.
Included in this effort is the need to include those who
have private insurance, Medicare and Medicaid as most
of the young people with emerging psychosis will not be
eligible for this comprehensive array of speciality services.
December 16, 2015
trained to ask screening questions to determine if one of
those professionals should go along on the ambulance
run.
A pilot program to bring people in mental health crisis
straight to psychiatric services gets some traction.
“Sometimes between a third and a quarter of those can
be brought straight to a psychiatric facility,” Currie said.
An example of someone who wouldn’t be diverted to a
psychiatric facility is a person who drank too much and
simply needs to sober up.
By Rose Hoban
For the past few years, several counties have
experimented with allowing emergency medical
technicians and paramedics to transport people having
mental health crises directly to psychiatric facilities –
such as crisis urgent care centers – bypassing hospital
emergency rooms where those patients might end up
sitting for days.
Starting on Tuesday, EMS agencies in 12 counties now
have the ability to bill directly to the state and state-run
mental health management entities to get reimbursed for
the service.
“Paramedics are pretty well trained,” said Crystal
Farrow, manager for the Department of Health and
Human Services’ Crisis Solutions Initiative. She said the
only reason they hadn’t been taking people directly to
psychiatric facilities was because they weren’t reimbursed
for doing it.
State lawmakers were impressed with what they saw with
a pilot program in Wake County and in this year’s budget
allocated $225,000 for a yearlong pilot to gather data on
the effectiveness and cost-efficiency of direct transport.
DHHS officials found an additional $264,000 from
federal mental health and substance abuse block grants to
match those funds.
Farrow has been working with community partners in 13
counties, 12 of which were ready this week to go live with
the statewide pilot. Other partners in the initiative are
the state-funded mental health management entities and
local crisis centers.
Many communities don’t have crisis centers, but
Currie said there are times when Assertive Community
Treatment teams can provide services in the home.
Starting Dec. 15, EMS agencies can bill back to the beginning of this fiscal year and bill DHHS until the money
runs out.
Farrow said she expects that by the middle of next year
there will be about a year’s worth of data.
“We’ll know about clients, about what percentage of the
behavioral health population can go to non-emergency
department crisis centers, what their insurance is and
where to advocate for other payers,” she said.
Next fall, Farrow and other DHHS officials will return to
the legislature to report on how the pilot ran.
“I look forward to presenting the results,” she said. “And
I’m looking forward to getting some sustainability behind
that program.”
“Any events that meet criteria for diversion from hospital
can be billed starting [Tuesday],” Farrow said.
“We evaluate about 240 people a month,” said Benjamin
Currie, district chief of the Advanced Practice Paramedic
program in Wake County, who has been involved with a
seven-year-long pilot program there.
Currie said there are 16 full-time paramedics in
Wake County who have attended additional training
and education and are among the most experienced
employees. When a call comes into 911, dispatchers are
Counties involved in the pilot: Brunswick, Onslow,
Wake, Durham, Lincoln, Forsyth, Stokes, Rockingham,
McDowell, Halifax, Orange and Guilford
The Iris
On Tuesday, mental health services in North Carolina hit
a quiet milestone.
4
This article is reprinted from http://www.
northcarolinahealthnews.org/2015/12/16/paramedicsto-be-paid-for-mental-health-transportation/
NAMI Wake County
Paramedics To Be Paid for
Mental Health Transportation
Community housing for
the mentally ill still scarce
by Gerry Akland
This article was published in the 12/07/2015 edition of
the News and Observer. http://www.newsobserver.com/
opinion/op-ed/article48503225.html
The reviewer pointed out that there was not an
appropriate level of community services to support
these people. In fact, most received only one visit per
month. Furthermore, the settlement only provided
one housing option for people wanting to move from
adult care homes into permanent supportive housing
in the community, in spite of the lack of state funding to
provide the appropriate level of help. For example, some
people might have preferred to move to a smaller, familytype setting where they would receive similar help as in
the large adult care homes. However, the DOJ agreement
rules out both group homes and family care homes as an
option.
Without safe, affordable, supported housing, the mental
health system cannot and should not expect to see
improvements for those living with mental illness. The
DOJ settlement is hailed as a major victory by many
advocates. It calls for assertive “in reach” or visits with
seriously mentally ill people to convince them that they
can live in the community.
Most are people with major deficits in their cognitive
ability who have little insight about the services being
offered or their own ability to fend for themselves.
Many are convinced to leave an assisted living center,
maybe not a perfect place, to fend for themselves with
Unlike the mental health system that has eliminated at
least 50 percent of the state psychiatric hospital beds,
the correctional system has legal mandates that require
jails and prisons to provide adequate beds for prisoners.
This will be the fate for many people who have a brain
disease unless we, as advocates along with state and
federal systems of protection, stop the magical thinking
that all you have to do to help a person “recover” from
mental illness is to get them out of psychiatric hospitals
and adult care homes and into community housing with
a token level of service. It is time for North Carolina to
commit to a Medicaid waiver for people with mental
illness that provides an adequate level of support to help
people live in the community.
There are far too many things wrong with the current
mental health system for most of us to understand, let
alone navigate in times of need. Furthermore, the system
lacks stability due to continual changes to procedures,
service definitions, Managed Care Organizations and
funding for services for complex needs.
However, housing with the appropriate level of
community mental health services must be the highest
priority if we hope to improve the mental health system.
Gerry Akland is past -president of NAMI Wake County.
The Iris
Martha Knisley, an independent mental health expert
charged with reviewing North Carolina’s program for
compliance, found that after three years the state has
successfully relocated only 400 people (about 50 percent
of the target), although another 100 people (25 percent)
tried living independently and failed. Of those who failed,
approximately 20 percent died, others were evicted
(without follow-up), some moved back to adult care
homes, while others ended up in jail and state psychiatric
beds.
The DOJ independent reviewer’s report cites lack of
cooperation of family members and guardians as a major
challenge to getting more people to move out of the
homes. With all the system failures, there is good reason
for them to be concerned. Convincing more people to
move into an abyss where there is no one to stop their
fall will only create more hardship as another failure of
the mental health system unfolds.
5
The U.S. Department of Justice 2012 settlement with
North Carolina might appear to be a good thing, but
it has only complicated the housing landscape for the
mentally ill by requiring those living in adult care homes
be moved to independent “supported” housing in the
community.
only minimal help from the state mental health system.
They are leaving a place where they have medication
management, prepared meals, transportation to
appointments, no financial worries and other people to
talk with.
NAMI Wake County
Computer model analyzes state
hospital beds for central NC
Researchers look for ways to cut time mental health patients
wait in ERs
Researchers at the University of North Carolina at Chapel
Hill and Duke University used a computer model and
information about hospital admissions to determine how
many state hospital beds would be needed to cut wait
times for entry.
In addition to Central Regional, the state operates
Cherry Hospital in Goldsboro and Broughton Hospital
in Morganton. The research results apply only to Central
Regional and its 25-county region.
With interest in hospital wait time growing, researchers
wanted to develop a computer model to evaluate “supplyside” solutions, said lead author Elizabeth La, now at RTI
Health Solutions.
Researchers used information from 2011 and 2012 in the
study.
Data from the state Department of Health and Human
Services covering July 2014 to March 2015 indicate that
average wait times for Central Regional were longer than
three days.
“It’s clear there is a shortage of psychiatric hospital beds
in North Carolina,” said Joseph Morrissey of UNC-Chapel
Hill, one of the authors. But adequate community support
is necessary for people discharged from hospitals, he said.
“Hospital beds alone are not the answer,” he said.
Short-term care
The state has reduced space in state hospitals significantly
since 2000. A legislative report from 2013 marked the
decline in state hospital beds: The state had 1,755 in 2001
and 850 in 2012. Though there was talk among legislators
in 2013 about building a fourth hospital in the southwest
region of the state, nothing came of that idea.
The state has been trying to address the need for shortterm in-patient mental health care by paying for space at
local hospitals.
But local hospitals are not a substitute for state hospitals,
and most do not have the staff to treat severely ill patients
who may become violent, the study says.
Rep. Gary Pendleton, a Raleigh Republican, hopes money
from the sale of the Dorothea Dix hospital property in
Raleigh will be used to convert spaces in rural hospitals,
to make them suitable for mentally ill patients. Moving
patients there would ease the pressure on bigger
hospitals’ emergency rooms, he said.
Legislators want to use about half the money from the
sale of Dorothea Dix property, $25 million, to develop
beds for mentally ill patients in hospitals around the state.
Pendleton said hospitals that have high vacancy rates
or those that have closed, such as hospitals in Louisburg
or Belhaven, could reopen beds to accept mentally ill
patients who are waiting for admission to state hospitals.
The state would lease space and pay the smaller hospitals
to operate the special wards, Pendleton said.
“It would be helping the little hospitals survive and the
bigger ones unclutter their emergency departments,” he
said.
Rep. Verla Insko, a Chapel Hill Democrat, said the state
has never spent enough on community mental health
services that would keep people from crises that send
them to emergency rooms.
“We’ve never fulfilled the goal to provide enough
community-based services to keep people stable,” she
said.
As the state closed state hospital beds, the plan was to
shift money to community services, said Insko. But that
didn’t happen.
Insko said she’d like to see the legislature’s program
evaluation office compare the cost of opening more
hospital beds with providing adequate community
mental health services.
Dr. Marvin Swartz, a Duke researcher and one of the study
co-authors, agreed that the state has not compensated
for the shrinking state hospital space with enough
community services and support.
“The bottom line is we haven’t created enough
alternatives to the beds that we closed,” he said.
BY LYNN BONNER
[email protected]
http://www.newsobserver.com/news/politicsgovernment/state-politics/article49465690.
html#storylink=cpy
The Iris
People often wait for days in local hospital emergency
rooms for admission to state hospitals, which are almost
always at or near capacity. The university researchers
found the state would need 356 more state psychiatric
beds to reduce average wait times in emergency rooms
from about three days to less than a day.
Approaches to public mental health have vexed policymakers for years. Sheriffs complain about mentally ill
people filling jails, while hospitals struggle to move
patients from emergency rooms.
6
The research, published online by the Psychiatric Services
journal, does not name the hospital, but it is 398-bed
Central Regional, one of the state’s three large psychiatric
facilities.
“To make those functionally equivalent to state
psychiatric beds, training would have to be bolstered
somehow,” La said.
NAMI Wake County
Space in state hospitals has been reduced but mental health
services have not kept up
The state would need another psychiatric hospital nearly
the size of Central Regional in Butner to reduce average
wait times for beds to about one day for patients in the
middle of the state, according to a study released this
month.
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NAMI Wake Board of Directors 2016
Andrea Chase
President & Programs Com. Chair
[email protected]
Gerry Akland
Past President
[email protected]
Paul Robitaille
Treasurer, Advocacy
[email protected]
Ellen Betts Clemmer
Secretary
[email protected]
Amanda Johanson
Marketing, Membership & Funds Com. Chair
[email protected]
Ann Akland
Advocacy Com. Chair, Contract Project Officer,
[email protected]
Sarah Weathersby
Sharing Hope Chair
[email protected]
Tom Hadley
At Large, Donor & Membership Data Base, CIT
[email protected]
Heather Scott
Consumer Rep., Support Group, IOOV
[email protected]
Louise Jordan
At Large, COC, Advocacy
[email protected]
Mary O’Neal
At Large, CIT
Anju Verma
At Large
[email protected]
William Stanley
At Large, Advocacy
[email protected]
Christine Taylor
At Large
[email protected]
Dorothy Clift
At Large, IOOV
[email protected]
Judith DeHavilland
At Large, Cary Suppport Group, Events
[email protected]
Contractor
Support
Virginia Rodillas
Outreach Specialist
[email protected]
Jessica Borie
Administrative Specialist [email protected]
Heather Pomeroy
Program Coordinator
[email protected]
The Iris
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Raleigh, NC
NAMI Wake County
PO Box 12562
Raleigh, NC 27605-2562
January 2016
For Information about NAMI Wake County
support groups and classes, and other
programs, visit our website or call us:
www. nami-wake.org
919 848 4490
The mental health organization you can count on if you live in Apex, Cary, Fuquay Varina, Garner, Holly Springs, Knightdale, Morrisville,
Raleigh, Rolesville, Wake Forest, Wendell, Zebulon. We also appreciate our members & donors outside Wake County.
A free, 12 session education program for family,
friends and significant others of adults living
with mental illness.
The course includes information on illnesses
such as schizophrenia, borderline personality
disorder, bipolar disorder, major depression,
schizoaffective disorder and other mental health
conditions.
The course is designed to facilitate a better
understanding of mental illness, increase coping skills and empower participants to become
advocates for their families.
Now accepting registrations for winter classes.
12 week course: Saturdays, 9:30 am – noon,
downtown Raleigh – begins Jan 9th
6 week course: Saturdays, 9:00 am – 3:00 pm,
Cary – begins Feb 6th
To register, contact Andrea Chase at
[email protected], 919-848-8913 or visit
http://www.namiwakecounty.org/support-groups.html
YOU can make a difference!
Recruiting Volunteer NAMI Basics Teachers
NAMI Basics is a 6 session education program designed
to provide critical strategies for parents and other family
caregivers of children and adolescents who have either
been diagnosed with a mental health condition or who are
experiencing symptoms but have not yet been diagnosed.
Participants learn the facts about mental health conditions
and how best to support their child at home, at school and
when they’re getting medical care.
Prospective teachers must be parents or other primary
caregivers of an individual who exhibited mental illness
symptoms prior to age 13 (the formal diagnosis may have
been made years later, but symptoms appeared prior
to age 13). Ideally prospective teachers will have taken
the NAMI Basics course, but this is not required. Time
Commitment: 6 consecutive weeks, approximately four
hours per week (OR over a period of 3 consecutive weeks, 2
classes per week.) Training is provided.
For more information, contact Heather Pomeroy. Email:
[email protected]