A SHORTLIST OF SOLUTIONS FOR THE 4% WITH SERIOUS MENTAL ILLNESS (SMI) by Dede Ranahan

From my presentation to Covered California today, August 23, 2017.

SAMHSA: One in five in the US suffers from mental illness. One in 25 suffers from serious mental illness (SMI) such as schizophrenia (1.15%) and severe bipolar disorder (2.2%).  Of the 4% with SMI (11 million), 40-50% have anosognosia or lack of insight into their illness.

In no particular order:

  • Reclassify SMI as brain diseases or neurological illnesses so the affected can receive integrated psychiatric/primary care and coverage in the physical health system. Just like Parkinson's, Alzheimer's, and dementia.
     
  • Use Assisted Out Patient (AOT) treatment programs delivered with care and compassion. 
     
  • Cut county mental health programs that don’t directly serve the needs of the SMI. I.e. wasteful and ineffective stigma campaigns. Make bussing out of county illegal.
     
  • Rename the system “Mental Illness System.” Mental health and SMI are not the same thing.
     
  • Reconcile the Medical Model (meds and beds) and the Recovery Model (peer support and social services). Make evidence-based programs compulsory for each model.
     
  • End the Institutes of Mental Disease (IMD) Exclusion which limits beds.
     
  • Change Medicare’s 190 day lifetime cap on psychiatric hospitalization.
     
  • Amend outdated and confusing HIPAA laws that prevent families and caregivers from helping their loved ones. Allow caregiver evidence of “best interest.” Pass a Caregiver Rights Bill.
     
  • Require law enforcement to receive and investigate reports from family and community members. Require Crisis Intervention Training (CIT) as routine training.
     
  • Increase FACT (Forensic Assertive Community Treatment) teams to help ill persons remain in treatment during parole and probation.
     
  • Provide beds in facilities that offer long-term psychiatric care. California Hospital Association: 50 mental health beds are needed per 100,000 people.
     
  • Enforce the Mental Health Parity and Addiction Equity Act of 2008, including parity for the 4% on Medicaid. (The 4% don’t receive “essential benefits” under the CA WI Codes.)
     
  • Stop dumping the SMI into jails and ERs. Treatment and Advocacy Center 2014 study: Mentally ill inmates are ten times the number of patients in psychiatric hospitals. 
     
  • Eliminate the inhumane standard — “Must be a danger to self or others” before intervening.
     
  • Encourage family advocacy groups and consumer advocacy groups to work together.
     
  • Create supported housing, employment, and education.

 

Photo credit: Michael Toy

Photo credit: Michael Toy

ZAC, MY DARLING SON by Laura Pogliano

He was the little boy who wouldn't eat until you had lunch also.
He kissed every animal and crustacean and reptile he ever saw.
He bounced on my bed and sang in his baby lisp, "When I Gwow up, I'm having Wots of Babies, Cuz I Wike Them!"
He swung on our swing butt naked, singing, "It's Good To Be King,"
He loved God and at 5 announced, happily, that one day he'd see his real Father, and he couldn't wait! He'd be "where everything was beautiful and there was never any pain."
He got his own feelings hurt when his puppy got scolded and when a classmate with disabilities was chosen last.
He cried so hard the first day of kindergarten, because there was too much to remember and he "forgot to make a friend."
He purposely partnered on school projects with the kid with no partner.
He refused to do homework for a teacher who made racial remarks toward the Mexicans in their class.
He told me in second grade he'd thought of a way to never have to go to college and leave me.
At 9, his goal was to marry a best friend, a girl who wasn't concerned with fashion. He thought, practically, that picking one out sooner rather than later was a good idea.
At 10, he went to the store and bought shoes for his friend for Easter who he thought was wearing "girl shoes."
He defended his rescue dog Butters' destruction of most of our shoes and half the house with, "You people don't understand. He's just upset cuz he got left."
At 11, he told me he might have bad news for me. Boys couldn't date their mothers, he'd discovered, so our Friday night movies had to stop. 

I will never get over what happened to this child, the torment he endured and the beautiful life he was cheated out of. He reminds me of the Cummings poem, "i sing of Olaf, glad and big," especially the last line — "he was more brave than me: more blond than you."
 

Laura and Zac

Laura and Zac

Zac

Zac

Zaccaria Pogliano was born August 1, 1991. He died January 18, 2015.  Zac suffered from serious mental illness. 

From the oldest

MISSING - LAST SEEN IN MESA AZ

UPDATE: Ryan called his mom at 3 a.m. this morning and let her take him to the hospital.

Another mother's beloved son's gone missing.
Imagine if this young man were your son.

WHAT HAVING SCHIZOPHRENIA IS LIKE by Joe IV

One of the many things misunderstood about schizophrenia is that people think it's a disease or that it automatically makes the person dangerous. The negative stigma it's gotten makes it harder for the ones who have to live with it. They are people's sons, daughters, mothers, brothers, sisters, fathers and friends.

The illness itself can actually be a gift. There are metaphysics behind the illness. There are cases of schizophrenia corresponding with chakras. Once someone with schizophrenia reaches spiritual maturity, they can be the most compassionate people because they explore many different perspectives. They're usually open minded people. A schizophrenic mind can be intelligent, empathetic and creative despite it's drawbacks. It's a matter of perspective within the person who has it. People with schizophrenia have a hard time focusing on a mind set and staying consistent. Their dial always turns. They can be all over the place. That can be improved with spiritual maturity and dedication. That involves a high level of self awareness.

It's hard for people like me to maintain a sense of self. Our minds are a broad spectrum. People who don't have schizophrenia usually just stay on one channel their whole lives, maybe wandering a little bit. People who have schizophrenia usually do a complete 360 degree spin on the dial. It can be extremely frustrating when they have a realization of self or knowledge just to have it all of a sudden slip away. Imagine spending hours building a complicated puzzle just to see all the pieces fall away and disappear. They're easily distracted in their own minds. Isolation can be a best friend and worst enemy at the same time. In isolation, they don't have to deal with the outside world but they have to deal with being alone with their thoughts.

Schizophrenia can be induced by trauma. At some point in their lives they may have had their personal boundaries violated. Many with schizophrenia die from suicide or poor health before they grow old due to not knowing how to cope. It's a search for sense of self. It can be very frustrating being an enigma or outcast of society. There's usually a lot of shame and guilt involved. No two people with schizophrenia are the same and they shouldn't be treated as such. It is one of the most misunderstood and mysterious mental illnesses on the planet. A lot of people don't even research it before projecting judgments on the ones who have to live with it.

Joe IV

Joe IV

Joe IV's Music Page

"Samudaya Sufferer" on youtube.com

 

POWER IN NUMBERS by Heidi Franke

Day 5 of 90, maybe 56, for good time. My son's jail time that's left after being kicked out of mental health court. No more probation after his days served. No felony conviction, thank God. Misdemeanors only. That frees him. He is 22, soon 23. He started mental health court at age 19. It kept him alive.

Heidi and Mitch

Heidi and Mitch

I'll never forget the night when Mitch called from his apartment in a panic. He was sure there were men in his house with guns. I told him to call the police immediately. He first took a baseball bat and broke open his bedroom window to escape and went to the neighbors' house in the middle of the night and called the police. He let them in his house. There was drug paraphernalia. We were trying to see if he could live on his own with his disability. He did well for almost a year, but the neighborhoods that those on disability can afford are drug infested. There were two heroin deaths in the apartment below my son's. But that was then.

Today, to get by in jail, Mitch imagines that jail is the only world that exists. If he thinks of his freedom, he says he will fall into depression. So, to him, there is no outside world. He says that helps him cope. I fear he will likely learn to be a better criminal. I want him to be a better person. They do give him his antipsychotic meds, but jail is no place for the mentally ill. They need to be in treatment. I worry jail will become familiar to him. Imagine a mentally ill person having to create an alternate universe for themselves because the one they are in feels so dangerous. How pathetic is that?

We send him money on his commissary account so he can buy food so he doesn't go to bed hungry. Ramen noodles are gold.

His last cell mate was a skin head. Swastikas were tattooed on his skin. Mitch said his cell mate's skin was peeling and landed like dust. The skin head's skin would fall into a pile on the floor. Mitch found the dead skin and this cell mate disgusting. He's so glad that one is gone.

His current cell mate talks to himself. The cell mate sits on the metal stool in the cell facing Mitch's bottom bunk just looking at him. That's now frightening Mitch and he wants to do something about it. I encouraged him to be curious and not confrontational. Mitch finds it creepy. Me too. 

I need to remember to send him isometric exercises for his shoulder which was recently surgically repaired.

Tonight, there's to be a movie for the pod. He says it's currently a good pod. But it's always changing.

That was Day 5.

Once done with his time in jail, Mitch's through with mental health court. He didn't graduate from it. They basically kicked him off because nothing seemed to help him. He was on and off his meds, on and off the streets, in and out of hospitals, and in and out of jail. People with serious mental illness live in their own world. The best we can do sometimes is to meet them where they are with delusions, paranoia, and attempts at self harm. They need love and support. Please help break the stigma of mental illness. Tell your stories. We do not gain in shame. 

One day at a time. Thank you to all the family, friends, and mothers I've met along the way in this journey. I'm forever in your debt for being a light in this complicated dark journey. I especially want to thank Sim Gill and the judges in the Salt Lake City Mental Health Court for their compassion. We must fund more programs for our seriously mentally ill and those with co-occurring substance use disorder. Keep peeling back the layers.

With all my gratitude, now on Day 6.

Thank you Adam OzunaTommy KrausRobert BoguesWendy Nielson ConwayAlec BangTommy J. Oberst, Laura Webb, Pamela MullinsSue Swaner, Carol and Richard EvansNicholas ShortCarol Anne Schuster EvansCaroline GilsonCarole StrongPaul GentnerCindy PhelpsDebbie Pierce St. ClairCarmen Kolyer WeaverMelody FlorezDebbie Moorehead ThorpeDede Moon Ranahan, Dr. Douglas Gray, soon to be again, Dr. Kevin McCauley, my mother, The Treatment Advocacy Center, and most recently, a few members of the LDS church and so many more for listening and not judging. For sharing your stories. Power in numbers. @abedinstead