A Message from NAMI About Stigma

Here is a good message from NAMI.  It comes with a quiz.   Stigma harms one in five Americans who has mental illness.  

Santa Clara County Mental Health Urgent Care

This is a place to go with urgent mental health issues in Santa Clara County:

Trastorno Obsesivo Compulsive OCD (Spanish)

This is a pamphlet produced by National Institute of Mental Health.  It is in Spanish and covers OCD, and anxiety disorder.  Provided are symptoms, and possible next moves.  The most poignant thing of this pamphlet is the subtitle: When undesirable thoughts take control.  That is a good description in a nut shell. 


Hay ayudas por esta enfermedad.  Lo mejor seria hacer contacto con el departamento de salud mental en el condado donde ud vive.

Seven Statements that Hurt People with Anxiety; My Reaction

Seven Statements that Hurt People with Anxiety if an article Curejoy.com.  This article gives seven hurtful statements, and in each case gives an idea of what to say instead which will lead to a helpful rather than hurtful relationship.
1. You have a lot to be grateful for.
2. You Should_____.
3. Everything will be OK.
4. Just be happy.
5. It's all in your head!
6. What do you have to be anxious about?
7. There are people with much bigger problems.

There is a great lesson here.  As I read the statements, I am convinced I can do better around others.  This article is a keeper and I suggest you clic on the link to read it.

May Is Mental Health Month: Each Mind Matters

A ribbon to wear and information about the Each Mind Matters Campaign.

May is Mental Health Month from Rene Santiago

 Message from René G. Santiago 

May is Mental Health Matters Month. Our Behavioral Health Services Department has been leading efforts to help reduce the stigma around mental health. Stigma is when someone views a person in a negative way just because they have a mental health condition. Some people describe stigma as a feeling of shame or being judged by someone else. Fighting stigma is key to getting people the care they need and preventing suicides. 

Last year the department conducted a successful campaign geared towards middle aged men, the group with the highest suicide rate in Santa Clara County. The Suicide Prevention communication work group used research to learn what messages and images would work best. This was important to reducing the stigma around seeking help for mental health issues. During the campaign the percentage of calls from these men to the Suicide and Crisis Hotline doubled. Because it was so successful, the campaign is set to run again. 

The department is also working on a number of initiatives to encourage youth in our community to seek help. Since young people text more than make phone calls, a text crisis line will be added to Crisis and Suicide Hotline services. A social media campaign to young people will also be launched this summer. It’s a bit of a myth that more people attempt suicide in the winter and over the holidays. Unfortunately, suicides are attempted by all groups all year long. 

Each year millions of Americans face the reality of living with a mental health condition. 1 in 5 Americans will be affected by a mental health condition in their lifetime and every American is affected or impacted through their friends and family. To help anyone in our community access services for themselves, family or friends, the department will be implementing a one phone number point of entry. This will go a long way in helping people get to the services they need. 

Suicide is the second leading cause of death of youth ages 15-24 and the 10th leading cause of death for all Americans. These numbers demonstrate why these activities and so many other initiatives taken on by our Behavioral Health Services Department and their partners are so important to the health and well-being of our community. 

You can help to reduce stigma and raise awareness about the importance of mental health. When you are posting or tweeting, spread the word by showing #MillionsLikeMe. You can also learn more about collaborative efforts at http://www.eachmindmatters.org/ 

Pamphlet Notes: Obsessive Compulsive Disorder

This is a pamphlet from National Institute of Mental Health.
Obsessive Compulsive Disorder is when someone has to recheck and recheck things.  Not the once or twice which is normal, but over and over.  It can include ritualistic behavior as well.  Thoughts and actions associated with OCD get in the way of daily life and cause distress.
Signs and symptoms to look for:
Repeated thoughts about things, such as fear of germs, intruders etc.
Do the same rituals over and over.
Can't control unwanted thoughts.
Don't get pleasure form the rituals, but momentary relief.
Spend at leas one hour per day on the thoughts and rituals.
The cause of OCD is still not known however there is a genetic component.
OCD responds to both psychotherapy and medication.  A preferred psychotherapy is cognitive behavioral therapy.  CBT teaches someone how to control their thoughts.  Antidepressants also are helpful when taking under a doctor's direction,
Lastly combined psychotherapy and medication are also useful.

Pamphlet Review: Depression

This is a pamphlet from the National Institute of Mental Health.  It is a pamphlet for lay people, how to determine if they have depression and whether to get help.  Signs of depression include feeling sad; feeling hopeless, anxious or guilt; loss of interest in favorite activities; feeling tired; not being able to concentrate; overeating or not wanting to eat; thoughts of suicide or attempts; aches, pains cramps, digestive issues.
Some of depression is genetically caused, but it also has an environmental component.  Sometimes genes play a role in resilience, and ability to recover from hardship.  Depression either causes, or is caused by subtle changes in the brain.
The first step for treatment of depression is to visit a doctor or mental health worker.  Depression can respond to medications, psychotherapy or both.
For those in Santa Clara County on MediCal, the number to call for assistance is 1-800-704-0900

Living with Depression

This is a story of depression presented on the Mormon Channel.  Depression has two components, physical and emotional.  Often times, without first treated the physical causes of depression, it is very difficult for someone to make the needed changes to tackle the other issues.  However, talk therapy is known to help with depression.

Intensive Case Management Services for the Severely Mentally Ill

This is the summary of a comparative research conducted in Santa Clara County. I don't see any dates on this but the results were released in 1993.

A Comparative Evaluation of Three Intensive Case Management Services for the Severely Mentally Ill:

Jeanette M. Jerrell, Ph.D., Director of Research

Rex S. Green, Ph.D. Evaluation Research Specialist

Santa Clara County Mental Health Services Research Center

Santa Clara County Mental Health Bureau

Bob Martinez, Director

Summary: It is certain that severely mentally ill adults with high levels of need for services can be managed and treated most effectively using intensive case management programs.  These programs clearly reduce the total direct care costs for clients over time and improve client functioning in the community as well.  These findings indicate that expansion of these case management services will result in substantial savings to the County mental health system while improving client outcome.

The Mental Health Bureau has been evaluating the relative cost-effectiveness of three of its intensive case management programs which specifically target their services to adults who are severely and persistently mentally ill and are high users of the acute and subacute treatment services.  These clients have two or more inpatient or skilled nursing facility episodes during the year prior to their entry into one of these three case management programs, as well as being noncompliant with previous outpatient services, being conserved and receiving SSI payments.  the three case management programs are: Virginia Street Project, Community Companions, and Downtown Mental Health Center.  Each program offers clients a different mix of outpatient, medication, case management, housing, and supportive day services, depending on their service philosophy and their caseload size.

Overall, the three intensive case management programs currently serving severely and persistently mentally ill adults are substantially reducing the direct service costs for these clients and improving their psychosocial functioning in the majority of clients served.  Our data also indicate that these reductions in direct mental health service costs do not increase the burden on families or other social/criminal justice services.  However, there are differences among the three programs in the degree to which they are lowering direct service costs and increasing client functioning.  The relative cost-effectiveness of the three programs depends on which outcome (treatment cost reductions versus client improvement) is considered.

The most cost-effective service from both of these perspectives is the Virginia Street Project which is reducing the total cost of mental health services to its clients by about $14,000 per year, compared to the level of care they required prior to receiving this service.  the greatest reduction is in the inpatient days and skilled nursing facility days of service used (see Figure 1).

They are also providing significantly more supportive outpatient and case management services to these clients (see Figure 2), but these services are offered at only a fraction of the cost of acute and subacute treatment facility costs.  Client functioning is improving to the greatest extent among VSP clients as well (see Figure 3).

Clients served by Community Companions demonstrate the next greatest improvement (see Figure 3) in functioning, and their total treatment costs are reduced $5,000 per client per year, the first year they are provided intensive case management services.  This outcome seems consonant with Companion's program philosophy which emphasizes client empowerment and rehabilitation as well as compliance with taking medications and explicit avoidance of hospitalization.

Downtown Mental Health Center clients showed reduced annual direct treatment costs of about $7,800, per client per year.  Client functioning improved less in the first year than for the other two programs, although Downtown MHC clients demonstrated the same pattern of overall change as the clients in VSP or Companions (Figure 3).  These outcomes seem consistent with the program's emphasis on maintaining clients in the community by providing supportive outpatient counseling and medications and with staff caseloads being twice the size of those at VSP or Community Companions during this study.

NAMI: Peer to Peer

NAMI is a national organization to support those with mental illness and their families.  Peer-to-Peer is a program of mental health consumers helping other mental health consumers.

Mental Health Advocacy Project: Santa Clara County

The mission of the Mental Health Advocacy Project (MHAP) is to empower people identified as having mental or developmental disabilities to live more independent, secure and satisfying lives through the enforcement of their legal rights and the advancement of their social and economic well-being.  They now service of 5,000 client annually.  The provide legal services for economic rights, housing rights and patients' rights.  They also provide outreach and education as well as technical assistance to mental health, social service and housing programs.  They can be accessed at 1-800-248-MHAP or 408-280-2420.

Primary Care Behavioral Health Services

A new trend in mental health treatment, is to offer services in house at the medical clinic.  More than five years ago Santa Clara County initiated primary care behavioral health services where the psychiatrist and therapist are colocated with the medical clinics.  This services are for individuals with mild to moderate problems, and not those needing intensive case management services.  Santa Clara County Mental health boasts five such clinics.  There are more clinics in the works.  Additionally there are contracted providers which also have behavioral health mild to moderate components, and offer services conjointly with primary care.

Article Review: Raising Cain: The Problem of Family Homicides

This is not a pleasant topic for Christmas time, but this is a report on an article in Psychiatric Times, by E. Fuller Torrey, MD, August 2016.  This is the first study of the prevalence of family homicides in the families of the mentally ill.  Of the more than 16,000 homicides in the U.S. in 2013, 4000 were within the same family.  Of those within the same family, most were spouse on spouse, which are not attributed to the mentally ill.  However, the majority of child on parent and parent on child homicides are.  In calculating the total, this study estimates that the mentally ill are responsible for about 29 percent of the family homicides, or 1150.  The weapon used was guns and sharp objects and beatings (each however in less than a third of the cases.)  It appears the elderly are vulnerable to family homicide by mentally ill, in light of the mentally ill more often living at home rather than in the hospital.  Two issues play a major roll,  Not taking medications is associated with increased homicides, as is co-occurring substance abuse, particularly alcohol.  Persons with mental illness account for over seven percent of the total homicides in the U.S., over 1000 annually.  Suggestions to reduce this number are:
Adequate psychiatric care.  Clozapine is shown to reduce aggression, but under utilized in the U.S.
Assuring medications are being taken.  A switch to injectables is likely to help in this area.
Assisted Outpatient Treatment (AOT in which the recipient in which an individual is required to follow his prescribed plan to live in the community has shown a reduction in violent, threatening and aggressive behavior.
Reform of HIPAA requirements which keep vital information from family members.
Focus on individuals with the most need.  Prior warnings are usually given before homicides which include threats of harm and assaultiveness.  Interpretation of laws regarding involuntary psychiatric hospitalization and treatment for these threats should not be interpreted narrowly.
Improved data collection to further study this problem would give a better idea of the prevalence.  This would lead to better tools for assessing possible problems.
The author lastly claims that mental health stigma is incumbent on violent acts.  This is because of media perception in the newspapers.  Only by reducing these violent acts will stigma decrease.

Family and Children Services: Deaf and Hard of Hearing Program

In Santa Clara County, the primary provider of mental health services to the deaf and hard of hearing community is family and Children Services of Silicon valley.  Their primary location is on Julian Street, just off of the Alameda.  The communicate with the deaf community through video phone and email.  They have counseling, case management and mental health services for deaf individuals, support for their families, offer ASL classes, provide education to the community and are knowledgeable about resources for the deaf community.

Medications for Mental Health

Medications are such an integral part of treatment for mental illness.  This brochure gives a brief overview.  Of course information is given about specific medication when is is prescribed.

Each category includes specific medications.  Of course each medication comes with benefits.  Medications are taken to reduce symptoms, prevent relapse and improve quality of life.  Successful medication treatment requires taking them as prescribed, take them at the same time each day, do not change you dose, follow instructions with regards to take with food or not, do not stop taking or reduce the dose without talking to your doctor.  Report to your doctor and allergies you may have, if you are taking other drugs , including street drugs, are pregnant or breast-feeding, have diabetes, kidney liver or heart disease, are on a special diet, drink alcohol or smoke, experience side effects.

Booklet Review: Information Booklet for Families in Crisis

This is a good little booklet for families who might have a family member in need of psychiatric hospitalization.  It explains the process of being put on a hold including 5150 (72-hour hold).  This means a psychiatric placement for up to 72 hours, but not often that long, 5250 or 14-day certification for Intensive Treatment.  EPS is the program in Santa Clara County where most individuals on a hold go, until they are either able to go home, or certified for longer placement.  CIT (Crisis Intervention Team) is the program with police officers in Santa Clara who are trained to deal with mental health emergencies.  Family members are allowed to provide information to psychiatric providers, or CIT officers.  This information should be accurate.  Common terms are Danger to Others (threatening to hurt others), Danger to Self (threatening to hurt oneself), Gravely Disabled (so ill the individual cannot take care of his/herself).

This booklet is put out by Santa Clara County Behavioral Health

Pamphlet Review: Suicide: How faith Communities Can Provide Hope and Promote Healing

This is an interesting pamphlet form Mental Health Ministries and distributed by National Alliance for the Mentally Ill.  We here so much about suicide, 1,000,000 people attempt suicide.  In the United States this accounts for 36,000 deaths annually.  Risk factors include previous attempt, depression, alcohol or drug abuse, family history of suicide, physical illness or chronic pain.  Most people who complete a suicide give some warning, either giving away possessions, impulsive purchase of a firearm, or obtaining other means of killing oneself.  As an individual you can acknowledge the pain of those who are in need, talk to them and listen, don't be afraid to ask if someone is contemplating suicide, ask if they are seeing a therapist or taking medication, help them get help or to a safe environment.  Do not try to argue someone out of suicide.  Let them know you care and they are not alone.  As for the faith community there is a need to talk openly about suicide, and provide information.  Mental illness is a treatable illness, no a moral or spiritual issue.  Be aware of local resources and hotlines.  In Santa Clara County the line is 1-855-278-4202

**Like a Broken Vessel

This is a presentation based on the talk given by Elder Jeffrey R. Holland a few years back dealing with hope and depression.  It presents about ten individuals telling their stories of depression.  However it is also a message of hope.  There is hope in jesus Christ for a better life, things will get better.  One warning, in watching the video several people present their stories.  The first part can be depressive.  Watch to the end where the message of hope dominates.

Co-Occurring Populations (Substance Use Disorder and Mental Health)

I attended a recent training on the clinical supervision of clinicians working with Co-Occurring Populations.  The training was well done, but wanted to share a few things about the effects of drugs on people.
Mouse Party is a program developed by the University of Utah to look at the physical effects of drugs on the brain.  Drugs can be so addictive because the effect the inner workings of the brain.  It is interesting to see the explanations of how the drug effects the brain which is where the pleasure is sensed and the addiction happens.