New at Watch… Mental Illness and the Criminal Justice System

Families in the maelstrom contend with a public mental health system that fails their loved ones in so many ways. One stark manifestation of this in the insufficiency of treatment beds for those most in need. Thanks to “deinstitutionalization” efforts in the past several years, many loved ones with severe mental illness are released from care far too early, if indeed they receive sufficient care at all.

The onus of this insufficiency often falls on law enforcement, which as a public institution now has far more contact with loved ones with psychiatric disabilities than does the mental health system. It is often noted that the largest mental health care facility in the United States today is… the Los Angeles County Jail!

To bring more light to this awful situation, the Treatment Advocacy Center has produced a powerful video entitled “Mental Illness and the Criminal Justice System”. Below is the video, in two parts. Families in the maelstrom–and all who care for them–should take note of the video’s important message.

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PsychOdyssey Presents “Vanquishing the Vexation” Housing Talk For NAMI Mercer

NAMI Mercer

PsychOdyssey’s director Tom Pyle recently presented a talk for NAMI Mercer on housing options for families in the maelstrom seeking housing solutions for their loved ones.

Entitled Vanquishing cover“Vanquishing the Vexation”, Tom’s talk offered an overview of the housing landscape by phase, from Emergency Housing to Transitional Housing, then to Supportive Housing, Subsidized Housing, to Affordable Housing, ultimately to Market Housing. 

Hosted by NAMI Mercer in conjunction with Princeton House Behavioral Health at its  Hamilton, NJ, facility, the talk about touched on the possibilities and challenges of sourcing rental subsidies, such as “Section 8” vouchers at the Federal level and “SRAPS” (State Rental Assistance Program vouchers) at the New Jersey level. The talk , part of a series of materials to be part of a forthcoming community access television series of the same title, featured over 100 slides of graphs, data, charts, and resource links.

To view Tom’s housing talk slides, click below:

Vanquishing the Vexation”: Tom Pyle’s Housing Presentation

PowerPoint format

pdf format

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Princeton University alumna April McQueen ’93 describes her reframed life with mental illness

Princeton University Alumna April McQueen '93

Princeton University Alumna April McQueen ’93

No one is immune from its devastations. Mental illness is an equal opportunity afflictor. The challenge for its victims is how to reframe life thereafter in face of a new reality. Recovery is a long and hard road. But success awaits the principled and persistent, especially those who also have good family support.

So is the story of Princeton University alumni April McQueen of Atlanta. A graduate of the Princeton Class of 1993, April’s high hopes were laid low by the onset of a severe and persistent mental illness. It struck two weeks before she was to sit for her bar examination to enter her intended legal career. Her career plans blew up. Thereafter she struggled to readjust and reposition. She tried many different jobs. Now she is a library paraprofessional, where the suitable pace and process of her work enables her to live and work through her illness’ symptoms. Family support along the way, she says, was invaluable.

April has redefined her hopes and now embraces her challenges with dignity, persistence, and grace. She is showing the rest of us what recovery truly is: an embodiment of hope, a model of courage and character.

To read and hear how April reframed her life, click here.

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New Service For Loved Ones In Crisis: Wellness Respite

Here’s news about an important emergency service for loved ones in distress. It is an alternative to an emergency room. It is a..

Wellness Respite Service

…offered in New Brunswick by our good friends Collaborative Support Services of New Jersey (CSPNJ). More info: t. 732-354-4403. Also,  www.newbrunswickrespite.org. 

16-11-21-cspnj-wellness-respite-flyer

Details:

  • 5 beds. All singles.
  • Can stay up to 10 days
  • Typical day:
    • 1 hour on wellness plan
    • Proceed to work, school, etc.

Routine: Work on wellness plans within 24 hours of admission. Meet staff daily to work on the plan.

Criteria for admission:

  • 18 years +
  • NJ resident. No country restrictions.
    • If within Middlesex county, can be picked up.
    • Near New Brunswick train station
    • Near the Moving Forward Wellness Center
  • Must be committed to working on wellness in a community setting
  • Must have a goal
  • Must have stable housing (i.e., no homelessness)
  • Cannot be a sex offender
  • Can self-refer. Referrals by family, friends also OK.

What if self-medicating?

  • Should go to rehab first. Respite is a non-restrictive, very flexible setting.
  • Can accept those wanting and waiting to go to rehab.

Staff:

  • 24/7 presence
  • 8 team members, of which:
    • 6 BA level
    • 2 MA level counselors

Reasons: Conditions that typically bring people to the respite center:

  • Anxiety, depression (e.g., breakup of a relationship, grief, overwhelmed)

Costs?

  • No costs to loved one.
  • State funded. Will bill Medicaid in the future. But insurance not required.

Occupancy:

Varies. Highest so far: 88%. Right now: no waiting list.

 

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PsychOdyssey Reviews Presidential Candidates’ Mental Health Plans

Election Day is here tomorrow… finally! As a service to families navigating the maelstrom of mental illness, PsychOdyssey below provides links to the mental health plans of the candidates.

Mrs. Clinton’s plan is by far the more comprehensive, although it doesn’t sufficiently address the economic context (e.g., national debt, deficit, constrained Medicaid funding) in which the Nation’s public mental health sector finds itself. Mr. Trump’s plan has no specific mental health policy details, although his healthcare plan relates heavily to the economics of healthcare insurance.

Hillary Clinton’s Mental Health Plan: https://www.hillaryclinton.com/briefing/factsheets/2016/08/29/hillary-clintons-comprehensive-agenda-on-mental-health/. Well written and comprehensive, evidently prepared by an analyst knowledgeable of the current issues in behavioral health. Highlights include support for integration of behavioral and physical healthcare, early intervention, suicide prevention. Supports more police training for handling mental illness. Suffers from possible contradictions between, e.g., calls for more employment supports for individuals with psychiatric disabilities and pledges to increase minimum wage to unrealistic levels for supported employment. Supports more Housing Choice (“Section 8”) vouchers for those with psychiatric disabilities. Doesn’t sufficiently address the flooding of the Medicaid system with 25% more enrollees without commensurate increase in providers especially in high-cost states like New Jersehy. Also doesn’t address need to increase Medicaid rates overall to cover certain important supports like supportive housing.

Hillary Clinton’s Caregivers Plan: https://www.hillaryclinton.com/briefing/factsheets/2015/11/22/caring-economy/. Interesting ideas, like enabling a stay-at-home caretaker to earn Social Security credits for retiring. Clinton’s Caregivers Plan, however, contains no provisions for caretakers of loved ones with psychiatric disabilities.

Donald Trump’s Health Plan: https://www.donaldjtrump.com/positions/healthcare-reform.  No specific mention of mental health issues, except for need for integrated care for veterans. Focuses on the troubled economics of Obamacare and ways to increase competition of insurance providers. Also advocates increasing Medicaid block grants to the states, which would presumably improve New Jersey’s highly constrained, lowest-in-the-nation Medicaid rate structure.

Business Insider’s Comparison of the Candidates’ Health Care Plans: http://www.businessinsider.com/clinton-and-trump-on-healthcare-2016-9

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Passage To Hope: A Personal Invitation

A personal invitation from PsychOdyssey’s Tom Pyle:

passage-to-hope-title-shotMany of my friends know of my family’s personal challenge navigating the maelstrom of mental illness. For the past ten years, this challenge has led me and my family to all corners—and alerted us to all the concerns—of New Jersey’s mental health system.

Now, for NAMI Mercer, I have produced a film about this experience. I invite you to a special event this coming Sunday afternoon, October 23: the debut screening of “Passage to Hope”, an 11 minute documentary about the tests, trials, and triumphs of family members and their loved ones navigating mental illness.

As a special feature of Princeton Theological Seminary’s 2016 film festival, this extraordinary short film describes the real life experiences of local family members coping with mental illness. It presents an authentic voice of people who faced crisis, endued despair, suffered stigma, made accommodations, learned acceptance, and now are filled with hope for ultimate recovery.

Passage To Hope film and sound crew: THP, Will Leavey, Brian Boni, Robert T. Hedden, Chris Nesi

Passage To Hope film and sound crew: THP, Will Leavey, Brian Boni, Robert T. Hedden, Chris Nesi

Even more extraordinary is how this film was made. Made possible with generous assistance of Princeton Community Television, the documentary not only features family members and loved ones telling their stories about mental illness. It was also entirely filmed, edited, and scored by family members and loved ones coping with mental illness.

Mental illness is a heavy cross to bear. Yet, hard to believe, many blessings can come from the experience. One is the heroic perseverance and progress of our loved ones in recovery. Another is the love and support of so many good people along the way. And, most certainly, one is this film. It so well captured the sense of our experience. And it so well mobilized the creativity and collaboration of so many outstanding participants living with and through their psychiatric situations. I’m very proud of this film and all associated with it. I’d like to share this film personally with you.

Event:

Premier of Passage to Hope, a video documentary from NAMI Mercer about the local family experience with mental illness.

Date:

Sunday, October 23, 2016 at 2 pm (until 3:30 pm, with reception to follow)

Place:

Old Borough Council Room, First Floor, Princeton Borough Hall, One Monument Drive, Princeton, New Jersey

(Below is a little foretaste: the trailer, created by Chris Nesi:)

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PsychOdyssey Comments on NJ’s Comprehensive Waiver Demonstration Application

PsychOdyssey's CommentsAs part of its ongoing advocacy work, PsychOdyssey on Friday submitted its comments regarding a State of New Jersey application to the Centers for Medicare and Medicaid. The application is for permission to extend by another 5 years its current so-called Medicaid “Waiver Demonstration” program. This demonstration program relates to ongoing changes and innovations for New Jersey’s Medicaid system, which funds much of the state’s public mental health services system.

Warning! This is wonkish stuff. Please bear with us as we try to explain. Not all families will be able to delve into all this. For those that can, however, we hope the explanation below will make the matter more intelligible. Regardless, all families in the maelstrom have a stake in the changes that this application proposes to New Jersey’s Medicaid program.

What is this Application About?

The application is formally titled “New Jersey Family Care 1115 Comprehensive Waiver Demonstration Application for Renewal: Strengthening Medicaid: Alignment & Redesign Through Care Integration, dd. June 10, 2016”. The applicant is the New Jersey Division of Medical Assistance and Health Services (i.e,. NJ Medicaid), which is part of the New Jersey Department of Human Services (where also is located the NJ Division of Mental Health and Addiction Services).

Why is this important?

The entire Medicaid Waiver undertaking is complex and hard for the average family member to follow. Still, it is very important since each time such a waiver is proposed and granted, there can be significant effects on what and how Medicaid funds in New Jersey. Many of our loved ones with psychiatric disabilities are covered by Medicaid. Many services within our public mental health system, such as outpatient programs, are funded by Medicaid. And mental health advocates believe that many other services, like services for supportive housing, should be funded by Medicaid.

Background

Medicaid is a Federal/State partnership. Each state has a State Medicaid Plan. Each plan details all the aspects of a state’s Medicaid program. Each state’s plan is written by the state government and approved by the Centers for Medicare and Medicaid (CMS) at the Federal level.

From time to time, states determine that their state plans need changing or modernization. To do this, states propose “waivers” to their approved plans. Waivers are generally sought for periods of five years and can be renewed or expanded. Waivers can cover a variety of changes. Such changes can include experimental innovations, or pilot projects, to try new ideas to improve the state’s Medicaid system. Such experiments are called “demonstration projects”, since they seek to demonstrate, or prove, a particular new approach before integrating it into the State Medicaid plan permanently.

In New Jersey, the government entity that manages the Garden State’s Medicaid system is the New Jersey Department of Medical Assistance and Health Services (NJDMAHS). NJDMAS is a part of the New Jersey Department of Human Services (NJDHS), under which also resides the division of particular interest to families of loved ones with psychiatric disabilities: the New Jersey Division of Mental Health and Addiction Services (NJDMHAS). [Note the subtle difference in the two acronyms, which look almost alike. NJDMAHS is NJ Medicaid’s administrative home. NJDMHAS is the administrative home of NJ’s public behavioral health systems and programs.]

What came before: The 2013 Comprehensive Waiver

In 2013, NJDHS, acting through NJDMAHS, organized a massive consolidation of NJ Medicaid programs. The consolidation ombined eight different Medicaid programs that had accumulated separately over the years into one bigger program. This consolidation was achieved under something called the “Comprehensive Waiver”. At that time, the state also received approval for several “demonstration programs” as part of that Comprehensive Waiver. The consolidation and demonstration projects all related to particular sections of the Social Security Act of 1935 under which such things were legislation. These sections include “Section 1115”, “Section 1915(a)”, “Section 1915(b)”, and so on. We’ll leave to the policy wonks the exact terms of these sections.

Several years have now passed since the approval and implementation of the Comprehensive Waiver. Now NJDHS, again acting through NJMAHS, is again approaching CMS to approve more demonstration programs for the next 5 years. Some of these projects would continue work being done under the previously approved demonstration projects. Some of these projects are new demonstration projects in their own right.

The Proposed Demonstration Projects

What are the demonstration projects in this new application? Simply noted, they are:

  1. More managed care and “Medicaid Long Term Supports and Services” (MLTSS)
  2. Behavioral health systems improvement, including substance abuse treatment
  3. More supports for loved ones with developmental disabilities
  4. Modernization of eligibility and enrollment processes
  5. Help for ex-prisoners returning to the community
  6. More housing supports for the homeless and those nearly so
  7. More “alternative providers”
  8. Better purchasing systems and methods
  9. More “health partnerships”

Each of these has impacts on important services that many of our loved ones receive, either now or potentially.

The “Public Comment” period

A typical aspect of such applications is a “public comment” period. Such periods enable the public to comment on elements in such requests. They also enable advocates to state important principles that they believe must be included to guide all such changes.  One such principle stated by many in this application’s public comment period is “Housing First”, the idea that all loved ones with various disabilities should first receive safe and secure housing to stabilize their lives and provide an adequate foundation for recovery. This is different from the traditional view that, say, a loved one with an addiction should get clean first before receiving housing.

PsychOdyssey also participated in this public comment period. In our own name, but on behalf of families in the maelstrom all over New Jersey, PsychOdysset submitted 6 pages of comments covering each proposed demonstration project and offered general comments about overall changes.

The Relevant Documents

To help families in the maelstrom know more about this entire undertaking, PsychOdyssey is pleased to post the following documents:

  1. PsychOdyssey’s summary of the Waiver Demonstration Application context (prepared for NAMI Mercer), a simple primer on the Comprehensive Waiver’s recent history and process.
  2. New Jersey Medicaid’s Application (“NJ Family Care 1115 Comprehensive Waiver Demonstration Application for Renewal”, dd. June 10, 2016), the State’s somewhat turgid and hard-to-understand application.
  3. PsychOdyssey’s Comments about NJ Medicaid’s Application, dd. August 12, 2016, focusing on each of the State’s proposed projects.
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What’s The Biggest Threat to Psychiatric Rehabilitation and Recovery?

The most serious threat to psychiatric rehabilitation and recovery for loved ones with psychiatric disabilities is…

  • Not the insufficiency of new antipsychotic medications…
  • Not the shortage of adequate supportive housing…
  • Not the shortage of residential treatment beds in state hospitals…
  • Not the stigma against those with psychiatric disabilities…

It is the grave underfunding of public sector pensions. These are the promised retirement payments to state workers, e.g., policemen, firemen, county workers, civil service employees, and public school teachers.

PsychOdyssey’s home state of New Jersey is in the worst condition. New Jersey’s public pensions are underfunded to the tune of $44 billion! The problem first arose when politicians, principally Democratic politicians corruptly catering to their public employee union partisans, enacted such public pensions on terms usually more generous than private sector ones. Then, the problem worsened under a succession of governors from both parties who diverted state budget funds away from the heavy pension funding obligations to other short-term needs.

The problem is critical because such underfunded pensions will at some point surely erupt as a huge political issue. When this volcano explodes, the political lava spewing from it will force diversion of state funds away from critical social service entities like the NJ Division of Mental Health Services.  This will bring excruciating pain to the State of New Jersey’s fiscal condition, the public credit rating of which is already rated 49th out of 50th in the country–and to the citizens of New Jersey, already the highest taxed in the country.

With no borrowing capacity and no political ability to raise taxes, how will the New Jersey state government solve this crisis? Perhaps it will cynically allow the problem to get even worse, so that its pension system becomes “too big to fail”. Then it might turn to the Federal government for a bail out. Bankrupt Puerto Rico is pursuing this path right now.

If New Jersey pursues that corrupt calculus, it may have to stand in line behind many other unfunded public pensions of other bankrupt cities, counties, and states pursuing the same corrupt strategy. (Besides Puerto Rico, consider Stockton, CA, Detroit, MI, and the State of Illinois…) And how will–or can–the United States government respond? The United States currently owes $19 trillion of debt, which has doubled in the last 8 years. Who will lend us such enormous money to fund all our unfunded pension liabilities at a time when our country is already so massively in debt? China?

Families of loved ones with psychiatric disabilities must remain clear-eyed, vigilant, and vocal about forthcoming state legislatrive initiatives. Programs upon which they depend, such as supporting housing, PACT services, outpatient programs, and, most of all, Medicaid, will be affected.

Below is a 2 minute video from nj.com explaining New Jersey’s pension crisis:

 

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New Video… Using Technology to Train the Brain to Overcome Schizophrenia

“Do you suffer from schizophrenia? Do you hear distressing voices? There’s an app for that.”

Using computer technology to address schizophrenia is a new project of Dr. Sophia Vinogradov, Professor and Vice Chair, Department of Psychiatry, University of California, San Francisco and Associate Chief of Staff Mental Health Services, San Francisco VA Medical Center. Based on the concept of “brain plasticity”, or the ability of the brain to change with exercise, Dr. Vinogradov contends that the use of computer programs can help reshape brains of those with schizophrenia to reduce symptoms and improve recovery prospects.

While the causes of schizophrenia are thought, in part, to lie in a still obscure combination of genetic, environmental and developmental factors, a big step towards curing its symptoms has recently been accomplished by a research team at the University of California, San Francisco, led by Dr. Vinogradov. The symptoms of schizophrenia, beyond delusions and hallucinations, include a range of cognitive and social deficits which affect memory, decision-making, attention, and social cognition.

According to Dr. Vinogradov, these problems are not helped by current antipsychotic drugs, and psychotherapeutic measures are only of limited benefit. For the past 10 years, Dr. Vinogradov has focused on the design, implementation, and evaluation of neuroscience-informed computerized exercises to improve these undervalued symptoms–with life-changing implications for patients. A 2012 study demonstrated that “a serious behavioral deficit in schizophrenia, and its underlying neural dysfunction, can be improved by well-designed computer cognitive training, resulting in a better quality of life.”

Below, Dr. Vinogradov presents a 15 minute talk on this compelling subject. All families with loved ones with schizophrenia should take note.

Dr. Vinagradov’s pioneering work is supported by the One Mind Institute (IMHRO).

See all of PsychOdyssey’s recommended videos here.

 

 

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On Capital Hill, VA State Sen. Craig Deeds Vocalizes Family Frustrations Felt Everywhere

In a powerful testimony before Congress, Virginia State Representative Craig Deeds laments the desperate state of the public mental health system and its deleterious effects on families of loved ones in the maelstrom. Senator Deeds is the father of Gus Deeds, a promising son befelled by mental illness. Desperate to get Gus the help he needed, Senator Deeds tried in vain to find an appropriate bed or program to address Gus’ needed. In the end, with nowhere to turn, Gus committed a violent suicide, but not before he slashed his father several times, including across his face. Senator Deeds’ moving words echo the plaintiff pleas of family members everywhere in the maelstrom.

See Senator Deeds brief remarks starting at 3:06:00.

[Thanks to advocate Peter Earley, also a family member, for bringing this to our attention.]

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