Major Bipartisan Effort At Montana Legislature to Improve Montana's Mental Illness Treatment System

The Interim Children, Families, Health and Human Services Committee of the Montana Legislature finished up its work yesterday.  One of their main efforts was a study of Montana’s public institutions and how they care for people with serious mental illnesses.  Representative Jenny Eck developed the study proposal based on a NAMI Montana request. 

The Interim Legislative Committee and staff tackled this massive, complex and unavoidable problem.  It was really contentious; but they were able to come up with strong bipartisan solutions to challenges which include a State Hospital that is well over capacity. limited options for transitioning forensic patients back the community, and a dramatic rise in children placed in residential treatment facilities.

Some of the highlights of the bills they developed are:

• Significant investment in community mental health crisis services to help people get treatment in their community and avoid stays at Montana State Hospital and correctional facilities.
• Significant investment in transitioning forensic patients out of Montana State Hospital/Montana State Prison and back in the community.
• Significant investment in developing community crisis services for youth to reduce suicide and reduce the number of children placed in residential treatment facilities.
• The expansion of mobile crisis teams to care for people with co-occurring mental illness and developmental disabilities before they require hospitalization.

These bills offer tangible methods to help Montana families access effective care in their communities to minimize expensive stays at state institutions and residential treatment facilities. They were developed with input from a large number of organizations including: mental health providers, the Resident Council at MSH, Disability Rights Montana, the ACLU, law enforcement, Montana’s County Attorney Association, the Montana Association of Counties, developmental disability advocates, and others.   The specifics of the Committee’s efforts are available at the Committee website.

The members of this committee are: Senator Dave Wanzenried (D) (Chairman), Rep. Ron Ehli (R) (Vice-Chairman), Rep. Carolyn Pease-Lopez (D), Rep. Scott Reichner (R), Rep. Casey Schreiner (D), Senator Terry Murphy (R),  Senator Roger Web  (R), and Senator Jonathan Windy Boy (D).  They each played a critical role in finding ways to improve Montana’s mental illness treatment system. If you’d like to thank them, their contact information is available at this link.

If you’d like to support the Committee’s work, please take few minutes and ask Governor Steve Bullock to support the Interim Children and Family Committee’s efforts to improve Montana’s mental illness treatment system.  You can call the Governor’s office at (406) 444-3111 or send him a message through this link.

Thank you,

Matt

Matt Kuntz

Executive Director

NAMI Montana

www.namimt.org

(406) 443-7871

Please support the fight against mental illness by donating to Montana’s NAMIWalk. You can make a donation at my Walk page. Thanks for supporting this critical cause!

Angry and Tired

I am angry and I am tired. In a four day span this week in Helena this week, two of our young citizens (Ages 50 & 52) lost their lives due to the consequences of serious mental illnesses. One was a Son and a Father whose family will wonder every day for the rest of their lives what they could have done to prevent to prevent this tragedy. The other was a former neighbor, who in his teenage years, was a babysitter for my two sons. Many people do not realize that people living with serious mental illnesses have a life span 25 years shorter than those of us who are diagnosed as “normal.” Premature death can be due to accidents and suicides, but the adverse effects of psychiatric medications, while lifesaving, can result in obesity, diabetes and heart disease. It is a little known fact that people living with serious mental illnesses use tobacco to alleviate the symptoms of their illnesses. In fact, 44% of the people who use tobacco are the 6% of the population who suffer from serious mental illnesses.

Mental illnesses cannot be cured at this time. They are however very treatable if people can access appropriate treatment. Many people do not know that appropriate therapy and medication can alleviate the symptoms, but no treatment eliminates the symptoms. Mary Giliberti, J.D., Executive Director for the National Alliance on Mental Illness has said, “The reality is that the current treatments available for serious mental illnesses such as schizophrenia and bipolar disorder are palliative interventions, not curative. At their most optimal and effective use, they are able to improve functioning and allow some to experience recovery and community integration. For major mental illnesses, we are still waiting for discreet novel interventions that genuinely change the course on the illness and avoid lifelong disability and impairment. This includes the development of a new third generation of antipsychotic medications to treat psychotic disorders.”

I am angry that I live in a world that does not recognize serious illness as a legitimate disease. I am angry that people in a psychiatric crisis cannot access respectful, thoughtful, compassionate and caring treatment. I am angry that our jails and prisons are overwhelmed with people suffering from serious mental illnesses. I am angry that there are more offenders in the Montana State Prison receiving psychiatric medications than there are patients in the Montana State Hospital. I am angry at our elected officials, public health servants and mental health professionals who tell me that they understand, but very little changes or improves. I am angry at families who, because of stigma, shame and discrimination do not recognize mental illness or advocate for their family members. I am angry at people who live with serious mental illnesses who, because of stigma, shame and discrimination do not access available treatment.

Finally, I am tired of attending funerals for the children of families who have been lost due to serious mental illnesses. Remember, the enemy is the illness.

Dr. Gary Mihelish

President

NAMI Helena
618 Edgerton Road
Helena, MT 59602

Don't Give Up

By Debra Hoppe

Part Six

Giving up is a normal instinct that a person has so it is a struggle to do. I know that I am a strong person and have a will that is solid. I try to think of the positive aspect of life and carry on. I have lived through two comas and have been able to tell people about them so I can say I haven’t given up.

A person has to set goals in their life and stick to them. Goals are hard to accomplish but that is one of the reasons you don’t want to give up. Another reason is that it only hurts you and the people around you. I know it is hard but when the chips are down I just pick myself up and dust myself off and get with the program. It will be beneficial for all concerned if a person sticks it out and completes the goal at hand.

Another reason to not give up is your self esteem. Your self esteem is one of the main things a person has that carries them through in life. If a person is having a bad day with their self esteem try looking at yourself through the eyes of another person and see what you come up with. You might be surprised with what you see.

Self esteem is important to all concerned because it affects not only you but the people around you. I have a high opinion of myself. I guess that is why I haven’t given up. I have a family that is proud of me and a boss that is happy with what I am doing. That is all that matters right now so I manage to make the best out of every situation that comes my way.

I want to thank you for taking the time to read what I have to say and I hope that I have been an inspiration to you. Take care of yourself and please don’t give up. It is important to stick with it and you will be a better person for it. Next time I will be talking about sticking to treatment.

Suicide Motivation and Neural Circuits: Connecting the Studies

by Matt Kuntz

Executive Director
NAMI Montana

Note: I've underlined certain sections of this article to clearly link similar analyses in various research. All of this underlining is my own and a should not be ascribed to the quoted individual.


A University of British Columbia research team just completed a systematic analysis to help understand the motivations to commit suicide. The study, led by UBC PhD candidate Alexis May, was published by Suicide and Life-Threatening Behavior – the official journal of the American Association of Suicidology. (Read the study's official press release here.) The study was based on 120 participants who recently attempted suicide. The results suggest many motivations believed to play important roles in suicide are relatively uncommon. For example, the researchers found that suicide attempts were rarely the result of impulsivity, a cry for help, or an effort to solve a financial or practical problem. Of all motivations for suicide, the two found to be universal in all participants were hopelessness and overwhelming emotional pain.

This study's participants were Canadian outpatients and undergraduate students, but it is important to note that the motivations behind the participants' suicide attempts mirror the findings in a similar study of United States’ soldiers. In that analysis, researchers from the the University of Utah questioned soldiers who had attempted suicide. Out of the 33 reasons the soldiers could use to describe their motivation to committed suicide; all of the soldiers included one in particular — a desire to end intense emotional distress. (Read more about that study here.)

According Dr. Craig Bryan, the coauthor of that study, the soldiers tried "to kill themselves is because they have this intense psychological suffering and pain."

Beyond college students and soldiers, the New York Task Force on Life and the Law (New York Task Force) issued a report in May of 1994 stated that "the common stimulus to suicide is intolerable psychological pain." That report cited Dr. Edwin Shneidman's book, Some Essentials for Suicide and Some Implications for Response, which was published in 1986.

The accumulation of multiple decades of research into populations as varied as college students, soldiers, and people with terminal illnesses seem to generally agree that suicidal thinking and actions are a response to intense psychological pain. As someone with a brain wired to occasionally do battle with that demon, I agree with that analysis.

The unavoidable follow-on question is "What causes psychological pain so intense that suicide appears to be the only option." The New York Task Force provides that, "Contrary to popular opinion, suicide is not usually a reaction to an acute problem or crisis in one's life or even to a terminal illness. Single events do not cause someone to commit suicide."

The Task Force further specified that "Studies that examine the psychological background of individuals who kill themselves show that 95 percent have a diagnosable mental disorder at the time of death" Since serious mental disorders can generally be defined as disruptions in neural circuits, the logical conclusion is that there is something within the neural circuitry of a suicidal person's brain that causes them to experience extremely high levels of emotional pain - beyond the scope of any environmental stressors occurring in their life.

Neuroscientists are working to develop a better understanding of the process behind these deadly neural circuitry disruptions. After examining eighteen different studies, researchers from the University of California San Francisco proposed a tentative neural network for psychological pain that involves the following sections of the brain: the thalamus, anterior and posterior cingulate cortex, the prefrontal cortex, cerebellum, and parahippocampal gyrus. (See the abstract of their article in Brain Imaging and Behavior from March 2013 here). The proposed network has significant overlap with the neural network utilized when we experience traditional physical pain.

Take a minute to process that information. The neural circuits that transmit the feeling of physical pain such as a person's hand being on fire are similar to the circuits that transmit feeling of emotional pain. It's not surprising that a disruption in that powerful of a system in the brain would lead to the number one cause of disability in the world, depression, and potentially suicide.

It is hard to pinpoint what causes these neural disruptions and those causes may be different for different people. Genetic susceptibility, emotional trauma, brain injuries, and substance abuse are all potential contributing factors; especially when combined together.

There is no miracle cure for these devastating neural conditions, but recovery is possible through effective treatment and lifestyle changes. Life doesn't have to be a fight for survival.

***   ***

If you're experiencing suicidal thoughts and deep psychological pain, please call 1-800-273-8255. If you're worried about a loved one, call that number to learn about what you can do to get them help.

A Written Letter: An Undervalued But Essential Advocacy Tool

Navigating through the mental illness treatment system can be difficult. It can be especially troubling when trying to find care for a loved one who so deeply enmeshed in symptoms that they cannot care for themselves.

With privacy laws and everything else, it’s hard to know who you can even talk to.

Outside of a crisis situation where someone’s life is immediately at risk, the most effective tool to express your about your or your loved ones treatment is also the simplest. Write a letter.

Write the treating clinician a letter describing what you’re worried about, why you’re worried and what you think should be done. If you don’t feel comfortable making specific recommendations, just tell them that you’re worried and ask if the treatment team can review the situation to make sure it’s being handled properly. It’s that simple.

If you don’t receive a response, wait a week or two and then send them another one. And then another one. Make sure to always keep a copy for your records.

Be polite, yet be specific about what you’re worried about and why. Don’t forget to put your name and contact information on the letter.

The same technique also works with city and county attorneys if the situation has become so dire that a 

commitment might be necessary. Or, with institution administrators if your or your loved one is not receiving effective treatment in their facility.

A written letter serves two purposes. The first is to let the person know about the issue. The second to build up a record in case something bad happens. Both of these purposes are important tools to utilize to help you or your loved one get effective care.

To find out more about mental illness, advocacy, and recovery go to www.namimt.org.

p.s. Please share this video with your friends and family to help them understand the power of writing letters in mental illness advocacy.

"Of Two Minds" will be Making Its Montana Premiere on April 24th

On April 24th, the movie "Of Two Minds" will be making its Montana premiere at 7:00 pm in the Carroll College Cube at 7:00 pm. The movie examines the experiences of bipolar disorder through firsthand testimony from people living and coping with it.

Lisa Klien, the co-director, writer, and producer will present the film and be available for questions after the showing. Don't miss it

Watch the movie's trailer now!

 



OF TWO MINDS Official Trailer from Douglas Blush on Vimeo.

A Peek at the Future: Mental Illness Early Detection and Prevention

by Matt Kuntz

Note: This story is a fun look at what mental illness detection and prevention might be like in the future. None of the screening methods described in the story are up and running yet, but they are all based on actual research in the field. Check the links at the end to find out more.

Timmy dribbled the basketball down the court, ten steps behind another dribbling student. The student did a right handed layup into the basketball hoop. A few seconds later, Timmy’s ball bounced off the rim and fell through the net.

It was basketball week at sixth grade gym class. The P.E. teacher drilled them on the fundamentals for the first three days before the next two days of games.

“Timmy Johnson!” a female voice hollered from a door on the other side of the gym.

A female student ran away from the school nurse and Jimmy ran towards her.

“Hi Mrs. Woolridge,” Timmy said.

“Hi Timmy,” she replied. “I’ve just got a few quick tests for you. All of our students have to take them during their sixth grade year.”

“Mr. Cory told us all about it.”

“Great, it’ll just take a few minutes. Start by sitting down and putting on a headset and glasses.”

Timmy took a seat then slipped on the Electroencephalography (EEG) headset and the dark glasses.

Mrs. Woolridge looked at the screen in front of her to make sure the EEG sensors on the headset had a clear read of Timmy’s brain waves.  She turned the system on. “Do you see the blue dot?”

“Yes.”

“Good. All you have to do follow that dot with your eyes.  When it moves left, you look left. Got it.”

“Yes.”

After completing the eye movement test, Timmy stood in front of a screen and copied the movements of a little cartoon boy. The cartoon boy raised his left foot. Timmy raised his left foot.  The cartoon boy rotated his arms in circles. Timmy rotated his arms in circles. A motion sensor instantly recorded and analyzed Timmy’s gross motor skills.

Then Timmy moved over to the table in front of a small black computer that measured fine motor skills.  The computer timed Timmy while he rotated a round sensor between each of his fingers. After finishing that test, Timmy had to trace a line through a circular maze on the computer as fast as possible without touching the borders of the maze. Finally, he tapped the screen each time a purple frog appeared. The purple frogs started appearing slow, then they sped up. Timmy’s hand moved across the screen tapping frogs wherever they appeared.

After running through the frog test three times, Mrs. Woolridge let Timmy go back to class.

One week later, Timmy and his parents sat in chairs in Mrs. Woolridge’s office.

“First of all, I want to let you know that this isn’t something that should scare you. Timmy did come up on one of our health screening tests as vulnerable to serious mental illness, but there’s no reason to be frightened.

Timmy’s mother put her hand on Timmy’s father’s knee. “Stan’s mother had schizophrenia. He died from suicide when Stan was just a boy.”

Mrs. Woolridge nodded, “We have a lot of families with mental illness susceptibility. With a little prevention, there’s no reason to worry.”

Mrs. Woolridge handed each of them a piece of paper. “I screened Timmy’s eye movements, skin conductance, gross motor skills, and fine motor skills last week.  His eye movement and gross motor skills were fine, but Timmy’s skin conductance was a little low and had some difficulty with his fine motor skills.”

“Stupid frogs,” Timmy grumbled.

“Stupid frogs,” Mrs. Woolridge agree with a wink.

Mrs. Woolridge continued, “Mental illnesses are basically disruptions in neural circuits in the brain. If you think of the brain as a big set of wires with information passing through them, sometimes things go wrong with the wires. Those disruptions affect how people, think, feel and act. They also affect overall nervous system through the basal ganglia and other areas.”

“The basal what?” Timmy’s father asked.

“The basal ganglia. It’s a group of nerves in the center of the brain. You’ll see that it’s highlighted in red on your picture. When something affects the basal ganglia, it can impact a person’s ability to control their muscles. So basically we test the students eye movements, galvanic skin response, major body movements and delicate finger movements as a way of checking the function of the basal ganglia.

“So problems with fine motor skills mean somethings wrong with the basal ganglia?” Timmy’s mother asked.

“Not for sure,” Mrs. Woolridge responded, “But it is an indicator that something may be going on. Same thing with the galvanic skin conductance. After Timmy’s failed the fine motor portion of that exam, we ran some of his blood that you deposited with the school health center at the beginning of the year through a genetic scan for mental illness susceptibility.

“Not surprising that it turned something up,” Timmy’s mother said.  “I’ve also got depression and anxiety issues on my side.”

“So I have mental illness?” Timmy asked.

“Not full blown mental illness, but maybe the beginning stages. We can’t say that for sure Timmy without a full brain scan. You could run one of those, but it’s not necessary. The medical field is pretty hesitant in scanning young brains.  There’s a lot of radiation in a scan so we try to avoid them if possible.”

“So what can we do?” Timmy’s father asked.

Mrs. Woolridge pointed to the sheet. “We’re basically trying to prevent any potential neural disruptions into expanding into a major brain disruption event - psychosis. Some of the ways to avoid that are pretty simple. You can start off by eating well, taking Omega 3 vitamins, exercising and keeping regular sleep patterns. Oh, and don’t do any recreational drugs. Seriously, anything that messes around with the brain to make a person feel high could be really, really dangerous for you. That includes marijuana.”

“We’ll pick up some Omega 3 vitamins on the way home,” Timmy’s mother said.  “The rest of it shouldn’t be a problem.  Timmy’s a good kid, but we’ll keep an eye on him.”

“I will too,” Mrs. Wooldridge said with a smile. “Timmy, I’ve got a present for you.”

“A present?”

Mrs. Woolridge pulled a box out from under her chair. The box had a picture of a boy wearing a headset while looking at a small handheld video game tablet. “It’s a fun way to make sure that you’re brain is doing okay. It’s got one of the EEG headsets that you used when you put on the goggles and followed the dot. Basically, you just put on the headset, breath in the holes on the side of the machine, play the video game, then breath in the holes in the side of the machine again.”

“What kind of games do you have,” Timmy asked.

“They’re fun,” Mrs. Woolridge promised. “Way more fun than the dot and frog tests. It’s basic cognitive training along with some relaxation through mindfulness and neurofeedback.”

“How often does he have to use it?” Mrs. Johnson asked.

“We’ll start out with just twice a week, maybe Monday and Thursday. If he’s doing well, then we’ll drop it down to once. If things aren’t going well, then we’ll boost it up to three times. The exercises are great for the brain even if you don’t have a susceptibility to mental illness.”

“What do you mean if I’m doing well?” Timmy asked.

“The machine will automatically report back to me on your galvanic skin response, brain waves, stress hormone levels and cognitive skills. It’ll wave the flag if there’s excess anxiety, depression, or other dramatic changes in thought processes. We’ll increase the frequency of the exercises if either of those variable suggests we need to.  If things really get out of line, I’ll recommend a therapist for relaxation and communication skills training. If the neurons are still struggling to talk with each other, then you’ll have to go to a psychiatrist to take a closer look at what’s going on and maybe even prescribe something.”

“Prescribe something? I remember my mother’s medication had some pretty horrible side effects,” Mr. Johnson said.

“There probably won’t be any need for medication.” Mrs. Woolridge said. “But in the worse case, the medication that they give before psychosis now doesn’t have anywhere near the same side effects as the old ones. The ingredients in one of them, that focuses on the neurotransmitter glutamate were even sold over the counter to treat people that had taken too much aspirin.”

“Thank God,” Mr. Johnson said.

Timmy wasn’t listening anymore. He already had the box half open. “This looks awesome,” he mumbled.

End Notes

Eye Movement - http://www.iovs.org/content/28/2/366.full.pdf

Motor Proficiency in Children with Psychosis - http://ptjournal.apta.org/content/63/2/194.full.pdf

EEG Symmetry Patterns Predicting Anxiety and Depression - http://www.ncbi.nlm.nih.gov/pubmed/16223557

Basal Ganglia - http://en.wikipedia.org/wiki/Basal_ganglia

Prospective Biomarker for Schizophrenia - http://psychcentral.com/news/2012/03/29/prospective-biomarker-for-schizophrenia/36687.html

Using Biomakers to Identify and Treat Schizophrenia - http://www.sciencedaily.com/releases/2012/07/120711134557.htm

Cortisol levels Increased in Youth with Psychosis - http://www.medwire-news.md/47/101079/Psychiatry/Cortisol_levels_increased_in_youth_at_high_risk_for_psychosis_.html

Attention, Memory and Motor Skills as Childhood Indicators of Risk of Schizophrenia - http://ajp.psychiatryonline.org/article.aspx?articleID=174316


Palau Early Psychosis Study: Neurocognitive Functioning in High Risk Adolescents - http://www.ncbi.nlm.nih.gov/pubmed/17005375

Neurocognition in Early On-Set Schizophrenia and Schizoaffective Disorders - http://www.ncbi.nlm.nih.gov/pubmed/20215926

Electrodermal Predictors of Functional Outcome and Negative Symptoms in Schizophrenia - http://www.ncbi.nlm.nih.gov/pubmed/16008777

Distinguishing Youths At Risk for Anxiety Disorders From Self-Reported BIS Sensitivity and its Psychopsysiological Concomitants - http://www.ncbi.nlm.nih.gov/pubmed/23016527

Effects of Stress, Depression, and Their Interaction on Heart Rate, Skin Conductance, Finger Temperature, and Respiratory Rate: Sympathetic-Parasympathetic Hypothesis of Stress and Depression - http://www.ncbi.nlm.nih.gov/pubmed/21905026

Glutamate, Shizophrenia and other CNS Disorders - http://www.promentispharma.com/technology/Glutamate/index.html

The Wrong Diagnosis

I applaud the New York Review of Books for publishing Dr. Marcia Angell’s articles on “The Illusions of Psychiatry.” Three years ago, I responded to my step-brother’s suicide by giving up my practice as a corporate attorney to become the Executive Director of the National Alliance on Mental Illness for Montana (NAMI Montana). Shortly after that, another one of my loved ones was struck by serious mental illness. I have been personally and professionally immersed in the stark realities of serious mental illnesses and the haphazard treatment system that has evolved to treat those conditions.

While I disagree with many of Dr. Angell’s conclusions, I could not agree more that the method of diagnosing mental illnesses needs serious improvement. This ineffective diagnostic methodology has led to too many people taking medications that they do not need and too many people that do need medications taking the wrong types or dosages. As Dr. Angell described, some of the most heart-breaking examples of this systemic failure involve the improper medication of children. The financial impacts of these misdiagnoses on the public and private healthcare system are staggering. The pharmaceutical industry’s marketing efforts deserve some of the blame for this state of affairs, but it is not the main culprit.

The real problem is that medical providers are trying to diagnose biologically-based conditions without biologically-based screening tests. Doctors do not have effective brain scans, blood tests, or other tangible biological screening tool to identify which patients are affected by biologically-based mental illnesses. Instead, they try to use patients’ perceptions and behaviors to discern the presence or absence of a biological condition. It is the equivalent of trying to determine whether a patient has a broken leg by asking them if they can walk or if they are in pain. If we were forced to apply that method of diagnosing broken legs, one would expect to find a number of books decrying the number of casts on people that did not need them and the number of people in need of casts that are forced to go without.

We must find a way to foster the development of biologically-based mental illness diagnostic tools. There are many ways of going about this task and many of them would likely succeed. Personally, I recommend establishing a Mental Illness Screening X Prize, similar to the multi-million dollar prizes that have been used to stimulate innovation in commercial space flight and fuel efficient vehicles. The winner of the Mental Illness Screening X Prize would be able to use a biological test to determine whether a person has either schizophrenia or bipolar disorder.

That biological test would be a major step toward revamping our broken mental illness treatment system to address many of the legitimate issues that Dr. Angell described in her article. With the billions of dollars that our nation spends on treating these conditions each year, it is time to make the development of that screening tool a priority.

Matt Kuntz, JD
Executive Director
NAMI Montana

Thoughts for a Rainy Day

It's flooding two blocks from my front door and the rain is coming down. I can't think of a better thing to do than share my thoughts on serious mental illness and advocacy.

COMMENT: Treating serious, disabling mental illness is difficult. Having a family member living with serious, disabling mental illness is more difficult. Living with a serious, disabling mental illness is most difficult.

QUOTE FROM THE NAMI FAMILY-TO-FAMILY EDUCATION CLASS: Perhaps the best definition of advocacy was voiced by Eleanor Roosevelt (quote): "You must do things you think you cannot do." In facing the stigma and shame that still surrounds mental illness, we are tested by many challenges Each of us has to break through boundaries of fear and convention to help our family members; each of us has felt the discrimination that exists against people who have brain disorders. In our struggle to "stand with" and "stand up for" our loved ones, we are all advocates.

FRIDAY, JUNE 10, 2011: I received a call from a women in Colorado whose brother-in-law is receiving mental health services at the Center for Mental Health in Helena. He has been diagnosed as suffering from schizophrenia and/or bipolar disorder. He has received services at the Montana State Hospital and the Montana State Prison. He was a part of the ACT Team in Helena, but was released from the ACT Team because he was probably non-compliant and the ACT has recently undergone structural changes. Several days after being released from the ACT Team he attempted suicide and was committed to the Montana State Hospital. After six days in the MSH he was scheduled for release. With the help of NAMI National she was able to compose a letter and he was kept in the hospital for sixty days. He has been released, but not returned to the ACT Team. He tried independent living, but was unsuccessful. "He was living in deplorable conditions." He has since been living in a foster care facility and doing relatively well. She would like to find a private therapist because she does not think one hour a month is adequate for therapy and has asked me to help her find a private therapist.

SATURDAY, JUNE 11, 2011: I received a call from a mother in California whose son has been receiving services at the Western Montana Mental Health Center in Bozeman. he has been diagnosed with schizophrenia and substance abuse disorders. He has been non-compliant and was sentenced to the WATCH Program at Warm Springs after his 4th DUI. He also was in the prerelease program, but was non-compliant because he was not responsible and accountable. He has been transferred to the Montana State Prison because he has failed to comply with the goals of the program. He has not contacted his mother and his mother has been told she may not visit him for 45 to 120 days until he is processed. If the underlying mental illness is not treated appropriately, prerelease and substance abuse treatment will never be successful.

DISCLAIMER: I have been in the Montana mental Illness treatment system for almost 27 years and realize emotional family members do not always relate events as they actually occur. However, this is their perception of events as they unfolded.

The treatment of serious, disabling mental illnesses is very difficult. But, a definition of insanity is: "Doing the same things over and over again and expecting different results." Last Thursday the census at the Montana State Hospital was 156. This is the lowest census in years. Those with an optimistic view would say this is due to improved community services and transition services out of the hospital. Some of us with a skeptical point of view would point to the fact that it has been more and more difficult to commit individuals with mental illnesses, who are in psychiatric crisis, to the Montana State Hospital. Commitment laws make it more and more difficult to accomplish early intervention and treatment. It may also be that more people at the Montana State Hospital are being transferred to the Montana State Prison and thereby lowering the census. The questions is? Does the Montana State Prison have the resources to adequately treat and care for those mentally ill individuals who are being transferred to their care. The Department of Corrections has the obligation to protect our society from those who might harm us. But, do they have the resources and training to treat the increased numbers of mentally ill they are receiving?

We are approaching a time of limited resources and funding to treat those who live with serious mental illnesses. We are rationing treatment and medication although it is not called that. Maybe we should spend our resources on those who suffer from mental illnesses in their teens and twenties when recovery is more possible. Then we would spend our funds to just maintain individuals in their 30's, 40's 50's and 60's who are so much a part of the "revolving door" that is characteristic nature of these illnesses. Just a provocative thought!

NAMI family members need to advocate for their mentally ill family members who live with serious, disabling mental illnesses because there are very few out there who are capable of understanding our lived experiences.
Dr. Gary Mihelish, President
NAMI-Helena

Thoughts on Mothers Day

Since 1997 Sandra and I have taught the NAMI Family-to-Family Education Program to over 500 Montanans. During those classes I have come to the conclusion that having a serious mental illness in the family is an extreme burden to families, especially mother's. "In mental illness, our grown children regress to an earlier, desperately frightening stage of need. Mothers hastily adopt the old mode of mothering; all the care taking alarms go off when their child fails to thrive. This is why mothers have a hard time pulling out of the care-taking role. Because they have to keep themselves together and protect, they cannot risk letting down into grief: and to mothers, letting go of grief often fells like they are abandoning their own flesh and blood."

Several days ago I received a message from a Montana NAMI Mommy. We all may realize how difficult and traumatic it must be to live with a serious mental illness. The effects of serious mental illness are devastating and traumatic to the individual living with a mental illness. The stigma, discrimination and the isolation of being treated as a second class citizen is life altering. Many "normals" do not understand this same stigma and discrimination extends to the families of the mentally ill.

I've attached this NAMI Mommy's message to heighten that understanding:

Sandy, I have been thinking of you & Gary earlier tonight...our daughter stopped over and though she is feeling somewhat better on her new meds , after being recently hospitalized for about a week. and is now SLEEPING at night.

She struggles with portioning her day, & sometimes is looking groggy. I'm glad she doesn't drink, because it looks like it! Earlier this evening, she went for a coke with a girl friend, & sometimes it's REALLY hard not to compare her life, with her friend's, who is successful, makes $80K or more a year at her regular job. Lost 80# so far, is training for a marathon, & says life is so good.

I know my daughter and her husband have a very thin financial thread. To try to make ends meet until the end of the month, especially since both of them are on SSI. She's having a heck of a time losing any weight at all, & it's all she can do to stay ALIVE. And stay WELL, & be somewhat optimistic...I guess regular people have no idea what persons with "mental problems" endure, unless they have had it in their own family. WE family members also suffer right along with our "person."

I'm reading "Stop Walking On Eggshells" now, book and workbook which has been recommended to me. What a MAJOR task for me to try to Mind my Own business, and not obsess over her. Or even buy them all their groceries, and CLOTHES. It's hard to find clothes to FIT her now as she's 5X...

Anyway, thanks again to you & Gary for ALL YOUR NAMI WORK, and that I was blessed to be in your classes. Little did I know that I'd have to learn and RE-learn those lessons, that would be coming up, & re-occurring again and again...

So, on Mother's Day, to all of you NAMI Mommies: Never give up and NEVER, NEVER, EVER give up HOPE!

HAPPY MOTHER'S DAY!!!! YOU ARE ALL THE BEST!!!!!!!!!!!

Gary Mihelish

Frustration, Anger, and Hopelessness

Many people cannot understand why NAMI people are frustrated and angry so much of the time. Almost every day, or at least several times a week, we receive phone calls and e-mails from NAMI members totally frustrated by the "mental illness treatment system." With permission I would like to share an e-mail we received last Friday.

Hello Gary & Sandy,

My daughter who is 30 years old was committed to the state hospital in nearby state. While waiting for a bed she broke out of the private hospital they were holding her in until a bed was ready. She was caught and booked into jail and the next morning she was released on her own; homeless with no meds. Two days after getting out of jail she was again arrested with 4 felonies that carry life sentences. i was down there in January with my wife and helped her get into a hospital for treatment. She had an assessment done by the county mental health folks there back then and I talked to them and told them she was a danger to herself and others, but they let her go and that's when she went on a crime spree. She has lost her home and her three children now and the mental health professionals agree they made a mistake in not committing her back in January.

I am so tired of the broken mental HELL system. She has catastrophic PTSD, severe depression, poly substance abuse issues and Bi-Polar,..right now she is in the county jail with no meds. Oh, she tried to kill herself in jail a few weeks ago and was flat lined and taken to the hospital, then put back into treatment and then committed to the State Hospital when she broke out.

There is no cure for mental illness at this time. Successful treatment is extremely difficult, but it is possible. I have been in Montana's mental illness treatment system for over 26 years. After our family's 7 years of Hell we were able to get a diagnosis and develop a relationship with caring, compassionate, competent mental health professionals. Things have only gotten better, but we are not the average family who gets involved in this system. We were fortunate to have mental health professionals who believed in the collaborative treatment model which involved the individual with the illness and the family in developing a plan to manage serious mental illness.

When will ALL mental health professionals embrace the collaborative model? When will individuals with mental illness and their families be recognized as part of the solution and not the problem? Montana's Olmstead Report (Which is gathering dust on a shelf somewhere) concluded what is really needed to improve and change Montana's mental illness treatment system is a change in attitude.

And, until we see that change in attitude, Montana's individuals living with serious mental illness and their families will continue to be frustrated, angry and feel hopeless.

Dr. Gary Mihelish
NAMI Montana's Director of Government Affairs

Tips for Coping with the Holidays

TIPS FOR COPING WITH THE HOLIDAYS

from NAMI Connections

• Stay close to family and friends who understand your illness.
• Take your medications as prescribed. Be sure to get the sleep you need.
• Celebrate the holidays in ways that are comfortable for you.
• The holiday season does not stop feelings of sadness and loneliness. Give yourself permission to work through these feelings.
• Don’t compare this season with previous ones. Enjoy all the little things you have now.
• Talk about the stress you feel with family and friends.
• Keep expectations manageable. Plan your work and work your plan.
• Set a budget and stick with it. Many items that you can give do not cost money – a phone call to a friend may mean more.
• Do something nice for someone else. Do something nice for yourself.
• Stay out of department stores.
• Play your favorite non-holiday music.

Happy holidays from NAMI Montana

Thoughts from NAMI 2010 Convention

Six members of NAMI-Montana were among the 1300 NAMI members who participated in the annual NAMI Convention in Washington, D.C., June 30th thru July 3rd. Of course the highlight of the convention was NAMI-Montana's own Quentin Schroeter was presented the Lionel Aldridge Award, which recognizes and individual with mental illness who has exhibited courage, leadership and service on behalf of all people living with mental illness. CONGRATULATIONS QUENTIN

We also participated in an awards ceremony in the Russell Senate Building where NAMI presented Senator Max Baucus and award for his role in healthcare reform and his continued advocacy on behalf of individuals and families who live with serious mental illness. Thursday was Advocacy when we met with our Congressional Representative on Capitol Hill. We were able to meet personally with Senator Baucus and his staff, Representative Denny Rehburg and his staff and the staff of Senator John Tester.

There are always so many presentations and workshops that educate and inspire. I would like to mention three.

The research plenary discussed the NIMH RAISE Study: Altering the Course of Schizophrenia. The presenters were Tom Insel, M.D.. Director of the National Institute of Mental Health and the lead researchers, Dr. Jeff Lieberman Chairman, Department of Psychiatry, Columbia University and Dr. John Kane, Chair Schizophrenia Research, Zucker Hillside Hospital, Glen Oaks, N.Y. RAISE is a large scale research project to explore the effectiveness on early and aggressive treatment in reducing the symptoms of schizophrenia and preventing the gradual deterioration of functioning that is characteristic of chronic schizophrenia. In other words, early intervention and treatment can prevent cognitive deficits and promote a higher level of recovery. We hope to have a leading researcher at the Montana State Conference on Mental Illness in October in Billings.

The panel of Dr. Xavier Amador, Jonathan Stanley, J.D. and Delaney Ruston. M.D., presented a overcrowded presentation on "Confronting Anosognosia: How to Get Help to Those Who Don't Know They're Sick." It was interesting and provocative. Remember: TREATMENT WORKS IF YOU CAN GET IT!" Hopefully. Dr. Ruston will be a presenter at the Montana State Conference in October. She will screen her documentary film, "UNLISTED" which will premiere on PBS in October. It is a film about her relationship with her father who lived with schizophrenia. She will also present a workshop" Psychiatric Advanced Directives: Giving a Voice to Consumers."

But the "Ask the Doctor" session are always great. My favorite was "Recovery and Neuroscience by Jill Bolte-Taylor Ph.D., author of My Stroke of Insight (For $15.00 a must read), and spokesperson, Harvard Brain Tissue Resource Center. Dr. Jill is a Harvard trained brain scientist, a NAMI members and former National Board member whose brother lives with schizophrenia. Her book was on the New York Times best seller list, she has appeared on the Oprah Winfrey Show and at a reception last Saturday we learned they will be making a movie of her life. The movie will star Jodie Foster and the only problem is that Jodi Foster is not as good looking and Dr. Jill. Dr. Jill currently teaches at the University of Indiana Medical School. She has been a featured presenter at two Montana State Conference on Mental Illness and she is a friend. On December 10, 1996, she suffered a massive stroke in the left hemisphere of her brain. Complete recovery took eight years. Her presentation stressed the similarities of recovery from a brain injury (stroke) and mental illness. The most memorable quote from the convention for me was:

'SLEEPING TIME IS HEALING TIME!"

TEN PRINCIPLES FOR RECOVERY; For Individuals who live with mental illness and their families. Maybe even for mental health professionals.

1. Honor the healing power of sleep.
2. Treat me like I will recover completely.
3. Challenge my brain systems immediately.
4 Love me for who I am now.
5. Help me define my priorities for energy use.
6. Focus on my abilities.
7. Give my brain years to recover.
8. Divide every task into small action steps.
9. I am not stupid, I am wounded. Repeat for me!
10. Come close. Do not be afraid of me.

Lastly, I am not deaf. I am wounded. Raising your voice will wound me.

2011 NAMI Convention, Chicago, Illinois
2012 NAMI Convention, Seattle, Washington CLOSER!!!!!!!


Dr. Gary Mihelish
NAMI Montana

Goodbye to a Friend and Advocate

NAMI Montana friends and family. I am sorry to announce the death of our dear friend and fellow advocate Carol Waller. Carol lived with Bipolar Disorder and was a strong advocate for effective treatment for mental illness. It's an honor to have worked with her as NAMI Montana's volunteer Senior Specialist.

I'd like to share with you an article that Carol wrote about this time last year so her wisdom will continue to live on.

Thank you for all of your work Carol. Rest in peace, but please keep praying for us. It's a tough fight and we can still use your help.

matt

Dear Readers:

My name is Carol Waller. I fall into the Senior Citizen category according to the census figures. I live independently and drive my own car. I live a fairly active life and get along pretty well. But the most important thing I can tell you about myself is that I have a mental illness; depression and anxiety, and I am concerned over other people who might be in the same age range. And possibly they have mental illness, such as depression, and may not even be aware of it!



First let me give you some statistics. Montana has the highest rate of suicide in our nation! From the Census 2000, senior citizens, 65 years of age and older account for over 10% of the total population, with the numbers rising each year as the “Baby Boomers” come into their golden years. Now consider the fact that about one out of ten people in this age group suffers from some sort of mental illness, most of which is some type of depression. Of this number, two will make a suicide attempt, half of which succeed. When you consider all of this data, it seems that depression and the elderly are not taken as seriously as it might need to be.



Why do so many seniors with depression go untreated? I have often wondered that as I have been treating my own depression since my early 20’s. One reason is very obvious to me and that is the stigma that still hangs over mental illness. I grew up in a time when a person with a mental illness was classified as “crazy” and often shunned and rarely understood. Today it is not quite as bad, but still the stigma exists and can be the cause of denial in order to appear to be “normal”. Today it is also viewed as a disease by most educated people and it can be treated and you can live a fairly normal life. But still there is a stigma attached that can keep people from getting the help that they need.



So how can you tell if a person is suffering from depression? Most people have periods of sadness in their lives which is normal and different from depression. I have listed some of the signs which seem to indicate some degree of depression is present.



Of course the obvious sign is sadness: like after a death or loss of a loved one, but one that does not go away in a reasonable length of time. Usually a person suffers mild forms of depression at times like this about two times in their lifetime. A more serious depression can develop from this with other signs present.



One of the obvious signs of depression is disruption of sleep patterns. Either there is excessive sleep, not wanting to get up and start their days. The other is insomnia, where the person has trouble falling asleep and staying asleep. Personally, I had trouble with both, wanting to sleep during the daytime and then not being able to fall asleep or stay asleep. Either way usually there is no feeling of being rested.



Appetite is another thing that is affected. Either there is over eating or no appetite. I fall into the no appetite group. But in either case there is very little enjoyment of the food.



Decision making becomes very hard and at time impossible. This causes frustration and the feeling of not being up to “snuff”.



There is a loss of energy and movements may become slower and harder to make. Another loss is that of interest. Things that have excited or pleased the person in the past loose their attraction.



Low self esteem is a common problem with depression. There are memories of losses or failures and the depressed person takes the blame and feels as though they are not “good enough” or guilty of something.



As the depression episode continues there is a feeling of hopelessness; that no matter how temporary a situation may be in reality, the feeling that it will never get better hangs on. This leaves the person with no incentive for living or motivation for changing the things that depress the person.



People who observed the depressed individual apply labels which are untrue but appear to be valid, like being lazy or stupid or changed to the point that they are so ill they are useless.
This is usually followed by the thoughts of suicide. If you are thinking in these terms or have friends or family talking or thinking in terms of this being the end, do not take it lightly! This is a serious situation and needs medical attention as soon as possible. This is a case for medical attention such as a personal physician, psychiatrist or even the emergency room.



I can tell you that the road back from the brink is a hard one! Many times it is one step forward and two steps back. But this road of ups and downs is well worth the trouble. Remember, suicide is a permanent solution to a temporary situation. Recovery is an arduous journey but it is possible.



This journey usually involves medication which may alleviate some of the symptoms, psychotherapy of some sort, group activities, the love of family and friends and understanding. For more information on this topic, I suggest you contact the NAMI, MT at 443-7871, and Center for Mental Health at 443-7151, the Crisis Line at 443-5353, Warm Line at 1-877-688-3377, or your personal physicians. If it is a case of emergency, you will probably get the quickest results with 911.



It is my hope that I have provided my senior friends with some understanding of this disease, this mental illness, called depression and that the statistics do not continue to grow at such an alarming rate. This does not have to be the end, but rather a beginning of recovery.



Thank you for your interest and time.

Sincerely,
Carol Waller

Mental Illness and Justice: The Need for a New Paradigm

Last fall, I received a call from a distressed father asking me to review his son’s case. His son had been diagnosed with bipolar disorder (manic depression). The son was on parole for a crime that he had committed when he was in a manic stage. He quit taking his medication again, went manic, and committed another series of crimes. The son was eventually sentenced to seventy years in prison with twenty suspended.

I talked with the son’s attorney before sentencing and expressed my sorrow that the parole officer, family, or someone else hadn’t been able to force the son into treatment when it became clear that he was off his medication and headed for serious trouble. In many cases, a couple of days or a few weeks with the proper medical care would be all that it takes to stabilize a patient’s brain chemistry so they can return to their normal life.

The attorney looked at me in disgust and responded “but that would have violated his civil rights.”

I can’t think of a clearer depiction of our profession’s inability to grasp the realities of mental illness. The system that we’ve established and operate helped this young man avoid a short involuntary stay in favor of a lifetime in prison. It’s not surprising that under this system our State Prison houses several times more people with serious mental illness than the State Hospital.

Last month, our office worked with the family of a Helena man who suffered from a mental illness-induced psychosis that involved a major battle between angels and demons. According to his delusions, the battle would end on a specific day in early March when the man must kill the Antichrist. The family was terrified that the delusion of the Antichrist would be projected on an innocent victim on the street. The legal and medical communities felt legally blocked from averting potential tragedy.

While I understand that there is a real need to revise some of Montana’s laws pertaining to mental illnesses, I can’t help but think that part of the problem is our profession’s failure to understand the role of brain chemistry in mental illnesses and crises. Would we be this paralyzed if the dangerous delusions had been caused by someone slipping him LSD? I have to believe that we would have done more to keep this poor man’s path from intersecting with the SWAT Team or the coroner.

The man was arrested before the delusional apocalypse and sent into treatment. While we can all be happy that broad tragedy has been averted, it is shameful that he had to become a criminal in order to be freed from his debilitating hallucinations.

We can and must do better than that.

The legal system flounders when faced with someone whose biological brain disorder affects how they think, feel, and act. People who live with serious mental illnesses and their families expect us to do better than seizing someone who acts irrationally because of a medical condition and punishing them for acting irrationally. Our profession must update our conception of mental illness to reflect society’s new understanding of the effects of mental illnesses on the functioning of the brain.

The realities of the challenges presented by mental illness mirror the plight of a person who is “involuntarily intoxicated.” For instance, bipolar disorder drastically alters the release of the brain chemicals dopamine, serotonin and norepinephrine. The different levels and timing of these chemicals affect mood regulation, stress responses, pleasure, reward, and cognitive functions to cause mania, depression, or even a mix of both. A man or woman in the grips of a manic or depressive episode has effectively been drugged by their illness.

While not a silver bullet, the involuntary intoxication paradigm can be can be a valuable tool to help attorneys navigate through the complex civil rights, neglect, and public safety issues presented by someone in a mental illness crisis. It offers a major step forward in adapting our legal system to reflect the medical realities presented by these devastating illnesses.

Mental Illness, Football, and Dangerousness

"BOTTOM LINE: MENTAL ILLNESS IS A TRAGIC THING THAT CHANGES LIVES AND FAMILIES FOREVER." Family Quote.

Please be patient for me. but it has been a bad week for individuals who live with serious mental illnesses and their families. On this beautiful Montana Winter day I would like to be a little philosophical.

Long before I was a passionate advocate for those individuals who live with serious mental illness and their families, I was just as passionate about the game of football. That is why I have attached the following story which was printed in the "Helena Independent Record" this past Wednesday. Because of my passion for mental illness and football, I have followed this story closely. Until I was old enough to play high school football, my father took me to every Grizzly home game. I enjoyed a 25 year career as a high school and college football official until mental illness entered my family. My youngest son played college football and has been a successful college and high school coach since 1996. Sandra and I have had season tickets for Bobcat football since we returned to the state in 1971. Every Friday night and Saturday afternoon in the Fall we can usually be found at a high school or college football game.

This last week has again shown how the mental illness treatment has failed those individuals who live with serious mental illnesses and their families again. The Pentagon shooting involved a young man suffering from mental illness, The suicide in Helena probably involved mental illness and the attempted suicide in Butte involved mental illness. And it is all topped of by the attached story.

I do not know how much longer we can rely on the current commitment laws to meet the needs of the mentally ill. For almost 40 years we have used the criteria of "imminent danger to self or others" to commit individuals for treatment. One definition of insanity is to keep doing the same thing over and over again and expect different results. People! The system is not working. The present laws allow people to become so sick some of them lose their lives and sometime harm others. We need to change the commitment laws so to allow the mentally ill to access early intervention and experience the hope of recovery. We can no longer afford business as usual!

Helena Independent Record, Sports, Wednesday, March 3, 2010

"Iowa jury convicts man in football coach killing." by Nigel Duara, Associated Press.

Allison, Iowa -- Mark Becker stood passively Tuesday as a jury found him guilty in the shooting of a nationally known high school football coach. He seemed far removed from the man whose mind was filled with images of angels and horned demons who lurked in the shadows of every room, telling him that the community was plotting against him and that Aplington-Parkersburg coach Ed Thomas-known for his winning record and town leadership-was Satan.

Becker, 24, had explained to psychiatrists that after months of torment, he short Thomas at least six times in the high school weight room, then kicked his body before walking away.

Jurors deliberated 24 hours over four days before convicting Becker of first-degree murder, rejecting his plea of not guilty by reason of insanity. The guilty verdict carries a mandatory life-in-prison sentence. Minutes after the verdict was read, Becker's mother, Joan comforted a crying relative sitting behind her. "It's OK," Joan Becker said. "Just pray he gets the right medication." Details of Becker's mental state emerged during the 14-day trial healed in tiny Allison, about 150 miles northeast of Des Moines. Jurors heard from defense attorneys that Becker's delusions were so severe that he didn't know right from wrong.when he shot Thomas. Psychiatrists testified Becker believed invisible forces were pushing down on his eyes. Police interrogation videos showed him sitting alone, speaking to no one, swatting the air.

Prosecutors acknowledged that Becker suffered from a mental illness, but said that he also coldly calculated the killing, taking practice shots with his .22 caliber pistol he used to kill Thomas and lying to people in search for the coach.

After the verdict, the Thomas and Becker families-who attend the same Parkersburg church-said they would pray for each other. But they took away different lessons from a system that couldn't help Becker but ultimately succeeded in convicting Thomas's killer.

Joan Becker said the mental health support system in Parkersburg and Butler County failed her son. A psychiatrist in a Waterloo hospital agreed to his release just days after he was hospitalized following a violent incident and arrest. Police weren't notified when he was let out of the psychiatric unit. "Ed Thomas was a victim of a victim," she said. "Although Mark and we as his parents attempted to go through proper channels to get Mark the proper mental health treatment he desperately needed, the system failed miserably."

Thomas's son, Aaron, said both families have only begun to grieve, and the conviction wouldn't change that. But he said the justice system did what was necessary. "We do want to recognize that there truly are no winners in this case, but the system worked," he said.

The question of why Becker's delusions focused on Thomas remains unanswered. Thomas last coached Becker six years before the shooting and Becker had spent significant time away from Parkersburg.

Thomas amassed a 292-84 record and two state titles in 37 season as a head coach-34 of them at Aplington-Parkersburg High School- and coached four players in the NFL. He also was a leader in rebuilding Parkersburg after nearly one-third of the 1800-person town was wiped out in May, 2008, by a tornado that killed six people.

TRAGICALLY ONE MAN HAS BEEN KILLED, ONE YOUNG MAN IMPRISONED FOR LIFE AND TWO FAMILIES DEVASTATED FOREVER. THINGS MUST CHANGE!

Dr. Gary Mihelish
Former President of NAMI Montana