New Video: A Day In The Life Of A PACT Team

act_logoIn the field of psychiatric rehabilitation, one of the best established evidence-based practices is “ACT”, or Assertive Community Treatment. ACT is a comprehensive community outreach care modality for persons with psychiatric disabilities that do not or cannot participate in group programs at a central site. PACT teams consist of a full transdisciplinary group of mental health professionals reaching out together: psychiatrists, therapists, case workers, specialists in co-occurring disorders, supported employment, supported education, and peer counselors (Schmidt, Pinninti, Garfinkle, & Solomon, 2013). ACT is like a hospital without walls.

The concept originated in Wisconsin in the 1960s (Stein & Test, 1980).  It is based on several service principles, e.g.:

  • Comprehensive, intensive, individualized care
  • Assertive, flexible, open-ended, consumer-based care
  • Community-based
  • 24/7 availability

In New Jersey, the practice is called PACT, for Program of Assertive Community Treatment. The New Jersey Division of Mental Health and Addictions Services contracts with various community agencies around the state to provide PACT services. (For a list of all New Jersey mental health service providers, including PACT, click here.)

Assertive Community Treatment is effective both in its clinical outcomes and its economic value (SAMHSA, 2008). It is also very hard work. ACT work is indeed almost a calling, and  loved ones and their families can greatly benefit from the special care it delivers.

Catholic CharitiesCatholic Charities Trenton, which fields 4 PACT Teams, has produced an insightful 18 minute video that soberly portrays the intense work performed every day by its PACT teams. The video can help families in the maelstrom understand the dimensions and difficulties of this important care modality.

References

Schmidt, L. T., Pinninti, N. R., Garfinkle, B., & Solomon, P. (2013). Assertive community treatment teams. In K. Yeager, D. Cutler, D. Svendsen, & G. M. Sills (Eds.), Modern community mental health: An interdisciplinary approach (pp. 293-301). New York: Oxford University Press. Retreived on January 7, 2016 from https://books.google.com/books?hl=en&lr=&id=mRtpAgAAQBAJ&oi=fnd&pg=PA293&dq=garfinkle+assertive+community+treatment&ots=EgyyZMQkGO&sig=2MINsbnyiwfBUjywGANEFlGieo0#v=onepage&q=garfinkle%20assertive%20community%20treatment&f=false.

Stein, L. I., & Test, M. A. (1980). Alternative to mental hospital treatment. Archives of General Psychiatry, 37, 392-397.

Substance Abuse and Mental Health Services Administration. (2008). Assertive community treatment: Evidence-based practices (EBP) kit. (DHHS Pub. No. SMA-08-4344). Rockville, MD: Center for Mental Health Services Retrieved from http://store.samhsa.gov/product/Assertive-Community-Treatment-ACT-Evidence-Based-Practices-EBP-KIT/SMA08-4345.

Posted in Uncategorized | Leave a comment

Telepsychiatry: The New Wave for the Underserved

1docywayTwo weeks ago PsychOdyssey attended a talk at NAMI New York Metro about telepsychiatry, a new and fast developing field in psychiatry. The presenter was Mr. Samir Malik, Co-Founder and CEO of 1DocWay, a fascinating start-up telepsychiatry technology company.

Samir Malik, Co-Founder of 1DocWay, a telepsychiatry technology company

Samir Malik, Co-Founder of 1DocWay, a telepsychiatry technology company

Lack of access to psychiatry is an enormous problem, especially in remote areas. Existing telemedicine solutions are not adequate. They are neither scalable nor sufficiently service oriented. Malik’s company, 1DocWay, “brings the doctor’s office online”. It does so with these product features:

  • Secure video chat
  • Appointment scheduling
  • Patient notes recording and filing
  • Turnkey implementation
  • HIPAA compliance
  • Emphasis on ease of use

In the US today, over 80 million people live more than 60 miles from a psychiatric specialist. Malik believes this inaccessibility will drive enormous demand for telepsychiatric services. In just 5 years, Malik predicts the potential market for telepsychiatric services will reach $30 billion. As to connection security,1DocWay uses 256 bit encryption, which is the same as online banking facilities.

1DocWay believes that 85% of all psychiatric sessions can be done online. Major insurers, including Medicare, United HealthCare, Blue Cross, and Aetna, are now willing to reimburse doctors for telepsychiatry. Even Medicaid in all but one state now reimburses telepsychiatry services. And today 9 states—and very soon, 26 states—require commercial insurers to do so.

A telepsychiatrist consults remotely with her patient.

A telepsychiatrist consults remotely with her patient.

Working in over a dozen states with 70 registered clinicians, currently 1DocWay’s technology enables telepsychiatry for over 30,000 patients, of which 97% are Medicaid beneficiaries. Telepsychiatry is opening up new therapeutic horizons. Nearly 85% of 1DocWay’s patients were not seeing a psychiatrist previously. Pathologies that seem particularly suited to telemedical care include dual disorders and mood disorders, while phobias and thought disorders so far seem less well suited to it.

Psychiatrists are finding telepsychiatry a suitable compensation modality. Clinical outcomes of telepsychiatry appear from research to be as good as face-to-face consulations. Ancillary benefits include reduced institutional resource utilization, wider patient access, and reduced transportation and logistic constraints.

Legal issues are not insignificant, but they are addressable.  Clinicians need to be licensed in those states where they provide care. In some cases under Federal domain, clinicians licensed in one state can practice in another state. With some exceptions, they also need to be credentialed by organizations for which they are providing care. Malpractice coverage remains needed for telemental health.

Indeed, 1DocWay’s biggest challenge is not technology or even regulation, but credentialing, e.g., the credentialing requirements of third party payers for providers and facilities that seek to participate with 1DocWay. Efforts to standardize credentialing, such as the Federal non-profit Council for Affordable Quality Health Care (CAQH) are somewhat helpful, but many hospitals think CAQH’s required credentialing data is not sufficient, which complicates 1DocWay’s enrollment efforts.

According the Malik, the states right now most favorable to telepsychiatry are California, Michigan, and Minnesota. Thanks to robust efforts of the University of Texas Medical Branch’s telehealth initiative, Texas has become the most developed telepsychiatry state. Unfortunately, the worst state for telemedicine is New Jersey, due to the Garden State’s lowest-in-the-country Medicaid rates and its hostile regulatory climate.

For families navigating the maelstrom, telepsychiatry represents an interesting modality that can increase a loved one’s services, especially in rural and other hard to serve areas. In time, telemedicine will also be useful for family members for modalities like family psychoeducation and social networking for solutions to common but difficult coping problems.

For further information about the emerging telepsychiatry market, University of Colorado Denver maintains a very helpful website on all things telepsychiatric at http://www.tmhguide.org/.

 

Posted in Educational, Medical, Psychiatric, Uncategorized | Leave a comment

Best of PsychOdyssey: 10 Key Points About Violence and Mental Illness

Gun in headThe public is quite understandably distraught about last week’s evil ISIS-inspired terrorist slaughter of innocents in San Bernardino. Meanwhile, controversial mental health legislation is also moving through Congress that some partisans are wrongly claiming to be akin to evil. In both cases, there are too many false associations of violence and mental illness being publicly proclaimed by too many politicians and pundits who should know better and behave better.

Over two years ago, PsychOdyssey editorialized on this problem with copious academic references. It seems a good time to re-read it, so we offer it again to help leaven the public discourse on the highly overwrought association of violence and mental illness.

——————

10 Key Points About Violence and Mental Illness

PsychOdyssey Op-Ed, June 4, 2013

John Monahan, a great New Jersey community mental health leader and retired CEO of Greater Trenton Behavioral Health (now part of Oaks Integrated Care)

John Monahan, a great New Jersey community mental health leader and retired CEO of Greater Trenton Behavioral Health (now part of Oaks Integrated Care)

John Monahan, CEO of Greater Trenton Behavioral Healthcare in Trenton, NJ, is a leader in New Jersey’s mental health field. He has written a fine editorial in his local Trenton Times, entitled “Mental Illness Should Not Be The Scapegoat For Violence”. For his editorial and his leadership we commend Mr. Monahan. He is right: the issue of violence is not about mental illness per se. Those with mental illness who commit violence are a small minority—and who usually have one tragic fact in common: lack of sufficient (or any) treatment.

To reduce violence, especially gun violence, society would be far better served by concentrating on urban gang warfare and continuing “stop and frisk” policies. To reduce the small percentage of violence by those with serious mental illness, we should get them not unconstitutionally listed in some national registry, but earlier and better assessed and into treatment at more good community mental health agencies like Greater Trenton Behavioral Health.

Above all, let’s also keep all the facts in view—and in perspective. From our own research, here are 10 important points that PsychOdyssey has learned about violence and mental illness:

1.  Statistically speaking, yes, there is a moderate association between schizophrenia and violence (Matthias & Angermeyer, 2000; Mulvey, 1994).

2.  But severe mental illness alone does not independently predict violent behavior. Those with mental illness exhibiting violence do so mostly because of other factors (Elbogen & Johnson, 2009).

3.  One such factor is substance abuse. The association of substance abuse and violence is far greater (Matthias & Angermeyer, 2000) than of schizophrenia and violence.

4.  So, those with schizophrenia who abuse substances are much more prone to violence than those who don’t (Elbogen & Johnson, 2009; Steadman Hj & et al., 1998).

5.  In any event, when someone with schizophrenia is violent, it is mostly towards other family members and rarely towards strangers (Ferriter & Huband, 2003).

6.  The different symptoms of schizophrenia (e.g,, “positive” like hallucinations and delusions; “negative” like alogia, anhedonia, and avolition) factor differently in any particular association with violence. There is no one consistent risk factor for violence among those with schizophrenia who exhibit violence (Swanson, Swartz, Van Dorn, & et al., 2006).

7.   4 million Americans have severe psychiatric disorders. 10% of these (400,000) would be problematic if not treated. 1% (only 40,000) are estimated to be “dangerous” if not treated (Torrey, 2008). By contrast, the FBI says there are 1.4 million active gang members (Federal Bureau of Investigation, 2013).

8.   While those with schizophrenia may be relatively more prone to violence than those without it, the relative incidence of violence caused by those with schizophrenia than by those without is small  (Walsh, Buchanan, & Fahy, 2002).

9.   Why is treatment critical? Because the association of violence and schizophrenia is 15 times higher for those not being treated than for those being treated (Nielssen & Large, 2010).

10.    In any event, current research about the association of violence and schizophrenia is limited and needs to increase and improve (Mulvey, 1994).

 

References

Elbogen, Eric B., & Johnson, Sally C. (2009). The intricate link between violence and mental disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry, 66(2), 152-161. doi: 10.1001/archgenpsychiatry.2008.537

Federal Bureau of Investigation. (2013). 2011 national gang threat assessment: Emerging trends. from http://www.fbi.gov/stats-services/publications/2011-national-gang-threat-assessment

Ferriter, M., & Huband, N. (2003). Experiences of parents with a son or daughter suffering from schizophrenia. Journal of Psychiatric & Mental Health Nursing, 10(5), 552. doi: 10.1046/j.1365-2850.2003.00624.x

Matthias, & Angermeyer, C. (2000). Schizophrenia and violence. Acta Psychiatrica Scandinavica, 102, 63-67. doi: 10.1034/j.1600-0447.2000.00012.x

Mulvey, Edward P. (1994). Assessing the evidence of a link between mental illness and violence. Hospital & Community Psychiatry, 45(7), 663-668.

Nielssen, Olav, & Large, Matthew. (2010). Rates of homicide during the first episode of psychosis and after treatment: A systematic review and meta-analysis. Schizophrenia Bulletin, 36(4), 702-712. doi: 10.1093/schbul/sbn144

Steadman H.J., Mulvey, E. P., Monahan J. [no relation], & et al. (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry, 55(5), 393-401. doi: 10.1001/archpsyc.55.5.393

Swanson, J.W., Swartz, M. S. , Van Dorn, R. A., & et al. (2006). A national study of violent behavior in persons with schizophrenia. Archives of General Psychiatry, 63(5), 490-499. doi: 10.1001/archpsyc.63.5.490

Torrey, E. Fuller. (2008). The insanity offense. New York: W.W. Norton & Co., Inc.

Walsh, Elizabeth , Buchanan, Alec, & Fahy, Thomas. (2002). Violence and schizophrenia: examining the evidence. The British Journal of Psychiatry, 180(6), 490-495. doi: 10.1192/bjp.180.6.490

Posted in Uncategorized | Leave a comment

PsychOdyssey Editorial: Paranoia About Pot Is Rational

Marijuana smokerAmericans today see a vast public movement favoring decriminalization of marijuana, whether for medicinal purposes (as in many states, including PsychOdyssey’s home state of New Jersey) or even for recreational purposes (as in Colorado). Many Americans seem to favor such action. But for most families navigating schizophrenia, such action is antithetical to good mental health. Indeed, such action hinders family efforts to curb their loved ones from its deleterious use.

Marijuana seems to induce psychosis in some. While marijuana is not believed to cause schizophrenia, many believe marijuana can trigger schizophrenia if latent and certainly exacerbates the illness when manifest. For many families, to facilitate greater public access and use of today’s highly potent marijuana is  foolish, misguided, dangerous to public health, and even an irresponsible and harmful act against those with schizophrenia.

Daily MailPsychOdyssey opposes policies that would loosen strictures on the public’s use of marijuana, especially for recreational use. Marijuana has undeniable–and for many, damaging–effects on the brain, shown by increasing research evidence and deduced from simple logic and experience. Like alcohol, the substance for many is dangerous, especially to youth during prime periods of cognitive and neuronal development. Why would society wish to encourage increased use of it?

yale_university_school_of_medicine_logo_colorPsychOdyssey’s anxiety about marijuana’s dangerous association with schizophrenia is rekindled by a recent news article. The UK’s Daily Mail reported that a new Yale Medical Study study on marijuana underscores the psychotic dangers of marijuana. As published in the academic journal Biological Psychiatry, the Yale study, led by Dr. Deepak D’Souza, seems to show that marijuana induces schizophrenia-like psychosis, and thus implies that marijuana can be a particularly bad substance for use by those with schizophrenia, either manifest or latent.

The research article concludes (in technical language) the following:

At doses that produced psychosis-like effects, Δ9-THC increased neural noise in humans in a dose-dependent manner. Furthermore, increases in neural noise were related with increases in Δ9-THC-induced psychosis-like symptoms but not negative-like symptoms. These findings suggest that increases in neural noise may contribute to the psychotomimetic effects of Δ9-THC [emphasis added].

For the link to UK Daily Mail’s news article about the Yale research study, click here.

For the link to the Biological Psychiatry abstract about the research study, click here.

For the link to Dr. Deepak D’Souza’s website and a list of his research articles about cannabis and schizophrenia, click here.

Below is a video on marijuana’s schizophrenic effects from Britain’s National Health Services:

.

Even pro marijuana advocates urge caution. Below is a video on physical side effects of medical cannabis… with a warning about use by those with schizophrenia (from Americans for Safe Access, a pro-medical marijuana organization) (pardon the ad…):

.

To view all of PsychOdyssey’s editorials, click here.

Posted in Uncategorized | Leave a comment

New at “Read…”: Meds Made Elizabeth “Sick”: A Theatrical Review

NJPRAAt last month’s New Jersey Psychiatric Rehabilitation Association annual conference, PsychOdyssey’s Tom Pyle witnessed an incredible performance. The keynote speaker was actress/activist Elizabeth Kenny. Instead of a speech, she presented a one-woman play. Titled Sick, the drama was about her own turbulent psychodyssey. As her website describes, “Sick is a true story of misdiagnosis and medication is a fearless, unsentimental and hilarious testament to our ability to find ourselves, even in the darkest conditions. “As a parent struggling alongside a loved one struggling with schizophrenia,” Tom reported, “it moved me to tears.”

About Elizabeth Kenny:

Elizabeth KennyElizabeth is an actor, playwright, teacher, and lecturer. She has been working in the professional theater since 1993 and became an Artistic Associate at New City Theater in 1998, working as a generative collaborative artist under the direction of John Kazanjian. Elizabeth has honed her writing and contemporary performance skills as a key collaborator, developer, and performer of new work by playwrights Kristen Kosmas and Ki Gottberg, and is an accomplished solo performer, receiving critical acclaim for performances including Neil Labute’s Bash and Ki Gottberg’s The Compendium of Nastiness. Elizabeth and Kristen Kosmas founded Shady Lane Productions in 2007. Shady Lane is a theater company focused on the development of new work that is intimate, immediate, and provocative.

Prescribed medication for an ovarian cyst, Elizabeth began having inexplicable reactions. She was plunged into the maelstrom. One thing led to another, all to nowhere good, even to psych hospitals and varied psychosis diagnoses. Thank God for her parents, who didn’t believe all their desperate daughter had been told, including  Elizabeth’s many supposed psychotic disabilities. Finally, a random doctor determined the original medication’s toxicity–and began reversing all the erroneous diagnoses, prescriptions, psychic trauma–and, hopefully, stigma.

About her play, Sick :

SICK-Elizabeth3Sick, a solo performance written and performed by Elizabeth and collaboratively created with New City Theater Artistic Director John Kazanjian, premiered at New City Theater in 2011. Sick explores a patient’s two-year odyssey inside the most advanced healthcare system in the world—an odyssey that almost killed her. It investigates how treatment by well-meaning, sophisticated practitioners for a common gynecological issue plunged her into a downward spiral through the complex medical and mental health establishments. It examines the ways that the intricate threads woven between healthcare providers, pharmaceutical makers, insurance companies, and medical educators unknowingly conspire to undermine patient care. Sick is the story of everyone trying hard to get it right…but getting it wrong anyway.

“It didn’t have to happen this way!” By God’s grace, Elizabeth survived the resurrection from “schizophrenia” to normal health intact. Her one-woman play, excerpted here as a 15 minute Ted-Med Talk, offers an inspiring–but also frightening, exasperating, and infuriating–account of how badly wrong things in psychiatry can sometimes go. Elizabeth’s deeply moving story is a cautionary tale for all families navigating the maelstrom of mental illness–and all in the field of psychiatry–and everyone else.

Visit Elizabeth Kenny’s website here.

See all of PsychOdyssey’s film and theatre reviews here.

See all of PsychOdyssey’s book reviews here.

Posted in Educational, Emotional | Tagged , , | Leave a comment

New at “Link…”: Family Caregiver Alliance and Caregiver Action Network

Every family navigating the maelstrom of mental illness becomes all too familiar with the challenges and burdens of family caregiving for a loved one.  On this last day of National Family Caregivers Month, I was pleased to come upon some important resource links for families navigating the maelstrom of mental illness.

First is the Family Caregiver National Family Caregiver AllianceAlliance. Founded in the late 1970s, the Alliance supports and sustains the important work of families nationwide caring for loved ones with chronic, disabling health conditions. It is one of the first community-based nonprofit organization in the country to address the needs of families and friends providing long-term care for loved ones at home. The Alliance addresses the caregivers’ daily challenges to better the lives of caregivers nationally, provide them assistance, and champion the family caregiver cause through education, services, research and advocacy. Have a look at this short intro video from FCA’s Executive Director, Kathy Kelly:

Caregiver Action NetworkSecond is the Caregiving Action Network (CAN). Founded in 1993 as the former National Family Caregivers Association (different from the Family Caregiver Alliance above), CAN is another leading family caregiver organization working to improve the quality of life for the millions of Americans who care for loved ones with chronic conditions, disabilities, disease, or the frailties of old age. CAN serves a broad spectrum of family caregivers ranging from the parents of children with special needs, to the families and friends of wounded soldiers; from a young couple dealing with a diagnosis of MS, to adult children caring for parents with Alzheimer’s disease. CAN (formerly the National Family Caregivers Association) is a non-profit organization providing education, peer support, and resources to family caregivers across the country free of charge.

Also, here is a helpful list of articles about National Family Caregiver Month from the Huffington Post.

 

 

Posted in Uncategorized | Leave a comment

New at “Research…”: The State of Mental Health in America 2015

MHA State of MH in America 2015For many years, Mental Health America has wanted to identify a common set of data indicators for mental health that would give a more complete picture of mental health status in America. As both the Mental Health Parity and Addiction Equity Act and the Patient Protection and Affordable Care Act were implemented, it also saw a need to establish a baseline from which we could document the successes and failures of both federal and state initiatives aimed at improving mental health status. This report is the result.

For the first time, Mental Health America has pulled together a number of indicators available across all fifty states and the District of Columbia. It has organized them into general categories relating to mental health status and access to mental health services. Some indicators are specific to children; others to adults. Together,they paint a picture across the entire nation of both the nation’s mental health and how well the nation is caring for it.

Click here to see MHA’s America’s Parity or Disparity: The State of Mental Health in America 2015.

Click here to be directed to all of PsychOdyssey’s research items.

Posted in Educational, Financial | Leave a comment

“Public Finance 101”: PsychOdyssey Explains PsyR Funding in New Jersey

NJPRALast Thursday, PsychOdyssey’s Tom Pyle led a workshop at the 2015 annual conference of the New Jersey Psychiatric Rehabilitation Association, of which Tom is also a board member. Entitled “Show Me The Money: PsyR Public Finance 101”, Tom explained the specific funding sources for mental health in New Jersey’s proposed FY 2016 budget. Tom’s presentation slides are accessible below.

Public Finance 101 for NJPRA

PsyR Public Finance 101

 

Posted in Educational, Financial, Uncategorized | Leave a comment

From Pete Earley: Democrats Attack, Republicans Defend Murphy’s Mental Health Bill During Markup

Pete Earley's website 2Mental Health Advocate and fellow family champion Pete Earley (pictured here with his son; journalist and acclaimed author of Crazy: A Father’s Search Through America’s Mental Health Madness) today blogged important news that final “mark-up” work is now underway in Washington on the most important mental health legislation currently before Congress, HR 2646, The Helping Families in Mental Health Crisis Act. This legislation is attempting to bring much needed reforms to a broken mental health system as many families in the maelstrom want and need.

The bill is offered by Rep. Tim Murphy of Pennsylvania, a practicing psychologist who has emerged as Congress’ leading mental health services reformer. Rep. Murphy’s website contains several interesting short videos about the mental health debate in Washington over the last few months. These provide a worthy update for families in the maelstrom who want to understand better and participate in this critical national dialogue.

HR 2646 is supported by family groups, but is drawing fire from civil liberties advocates, mental health services consumer groups, practitioner professional associations, and community health service providers.

Opening remarks of the session in the video below reveal the differences between the Democrats and Republicans on this important legislation. This 45 minute video is recommended viewing for all family members. The essential differences are summarized in the first 5 minutes of remarks, first by Rep.  Gene Green (D-TX), followed by Rep. Murphy (R-PA).

Also see Pete Earley’s blog here: Democrats Attack, Republicans Defend Murphy’s Mental Health Bill During Markup.

.

Posted in Uncategorized | Leave a comment

New at Link… Monarch Housing Associates in New Jersey

Monarch Housing AssociatesLoved ones need proper independent housing and supportive housing to facilitate their recoveries. But such housing for those in the maelstrom is often extremely difficult to procure, especially in states like New Jersey with very high property costs.

Monarch Housing Associates is a mission driven, results oriented New Jersey non-profit dedicated to providing housing solutions for those in need. Its vision is that every person will have quality affordable, permanent housing that fosters freedom, independence and community integration. Its mission is to expand the supply, accessibility and variety of affordable, permanent supportive housing through development, planning, advocacy and partnerships. Monarch Housing assists consumers, providers and family organizations to develop, manage and operate permanent, affordable and supportive housing for persons with disabilities. This is accomplished by developing partnerships with public-private entities and the non-profit community.

An introductory video by Monarch appears below. To see Monarch’s website, click here. To see all of PsychOdyssey’s links, click here.

Posted in Uncategorized | Leave a comment