I really enjoy reading the blog Kellevision.com. She says it like it is and seldom misses the point of what she's writing about. She identifies a problem in programming for homelessness and proposes a set of concepts to help clarify the situation.

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Many of the "barriers" faced by the chronically homeless are not external. They are self-inflicted. Repeatedly failing to pay one's utility bills is not a barrier. It is a behavior. Repeatedly getting into relationships with drug addicts and being evicted because you have allowed your new girlfriend to turn your affordable housing into a crack house is not a barrier. It is a behavior. Choosing to pay your boyfriend's bail instead of the rent is not a barrier, it is a behavior. Consistently refusing to hold down steady employment and being evicted for not being able to pay the rent is not a barrier, it is a behavior.

[..]Lastly, how we label the problem determines how we approach solving it. True social barriers need to be addressed by social services. Better programs need to be designed to specifically address the needs of the mentally ill population. Programs designed to assist the medically disabled need to be accessed. But behaviors require a clinical intervention - therapy. Clients who demonstrate patterns of behavior which result in repeated instances of homelessness need counseling, not social services. The problem is not a social problem. It is an individual problem which requires an individual intervention.

I think it's much more complicated than that. Our world has always had an underclass, a group of individuals who have been largely invisible in the US except during the Depression. These people largely function outside the visible society and economy. They share housing with family and friends, squat in abandoned buildings, and sometimes live under bridges. They live off their housemates or family, work for temp job agencies, borrow, steal, deal drugs, and even engage in formal criminal enterprise. Given our recent policies that have reversed the tax-based redistribution of wealth since FDR, the stagnant wages, disappearing jobs, and ever increasing cost of living, that underclass has become so large it is again visible.

They are chronically under or unemployment and are not collecting Social Security, either because they don't qualify, try though they may to apply, or they haven't the where-with-all to get themselves qualified. This chronic underclass is best described as a sub-culture. They are structurally built into the economy. "Full employment" doesn't include them. Because they have given up on finding work, they no longer register with unemployment offices and so are not counted among the unemployed. Those who are chronically homeless are a sub-group of this sub-culture, and probably represents some of its most dysfunctional members.

By describing the chronically homeless, Kellevision describes most of the common attributes of this subculture.

For the majority of the [chronically] homeless population, homelessness is a lifestyle, not an event.

[..]My purpose here is not to blame the victim, but to talk openly about the severe dysfunction I see in chronically homeless families. Unless we identify the true problem, we will not be able to form a lucid solution. Homeless families typically do not function well on any level. Children are frequently truant from school and display numerous behavior and developmental problems. Dorm rules are constantly broken and there is constant turmoil between the families on the dorm. Relationships are fleeting, intense and severely dysfunctional including domestic violence, substance abuse and exploitative. Interactions with other people are inappropriate or dysfunctional. Most homeless families have burnt all their bridges with every social service agency and with their own families because of their severe dysfunction. Shelter staff often feel like we are running a middle school rather than a homeless shelter. This behavior is what needs to be addressed rather than giving them more money or building more homes.

[..]What are the elements of the homeless mindset? I'm still trying to work this out in my mind, but here are some of them which I see frequently:

• An external locus of control
• the belief that they have no control or responsibility for their choices, actions or behaviors but they are the victim of circumstances
• the belief that the causes for good or bad events in your life are totally outside your control or responsibility
• Sense of entitlement
• the belief that the worlds owes them something and they should be able to collect immediately
• the belief that they should be taken care of by others, by the government or by social service agencies
• the belief that they should be given things they have not earned (i.e. free housing, clothing, food, etc.)
• the belief that others should "help" them (i.e. by paying their unpaid bills or appealing their housing denial)
• Impulsivity
• Poor boundaries
• Emotional immaturity
• Need for instant gratification
• Dependency issues
• Predatory/antisocial behaviors
• Pathological relationships

Certainly, not every member of what I'll call the "underclass sub-culture" share all of these attributes. Each and every person has a story behind their situation. A careful account of their histories, something they usually reluctantly give, chronicles the development of these problems. It's important to discourage a prejudice developing against a whole group of people who are already stigmatized along with the "welfare mother" of the AFDC era. But we are not going to get to a more complete solution without understanding the problem. I suspect that why there is little commentary on this topic.

Kellevision hits on what I believe to be one of the most common roots of dysfunction, repeated traumas throughout their life.

A vast majority of our clients seem to have endured some sort of trauma(s) during their childhood which has(have) halted their emotional development. The result is immaturity, impulsivity, dependency, a sense of entitlement (that someone should take care of them rather than being responsible for themselves), an external locus of control (seeing problems as existing outside of themselves and therefore being outside of their control and/or responsibility), immature relationships and emotional lability. These factors result in behavior which appears erratic and irresponsible.

"Arrested development" is what Kellevision calls it. Indeed, this problem is pervasive and most often multi-generational. There are most often one or more of the following in the family history:

• lifelong repeated exposure to trauma:
  
  
  
  • child abuse and neglect
  
  
  • incest
  
  
  • domestic assault
  
  
  • gang or drug related violence
  
  
  • repeated exposure as a crime victim including assault, rape, and drive by shootings
  
  
  • inconsistent parenting ranging from abusive to no supervision
  
  
  • one or more family member who was murdered
  
  
  
  
• poor performance/attendance at school


• high school drop-out


• parenthood started by mid-teens


• by their twenties, they have several kids with mostly different partners


• sporadic work history and chronic unemployment


• efforts to qualify for Social Security


• family members relying on other families income, so no family member is able to break the pattern of poverty


• chemical abuse


• drug dealing to support a habit


• mental illness


• parents, spouses, brothers, sisters in prison


• criminal activity as income


• crime as a family enterprise

Persons who are members of the underclass see dysfunction as normal. They've never known any different. Many think this is how everyone lives. While they may dream of a good job, they appear to not have the self-discipline to keep a good job. Many of this group might be diagnosed with an anti-social personality DO. Personally, I think this diagnosis is misleading at best. A person earns this diagnosis if their history includes sufficient "anti-social" behavior. This doesn't account for family cultures that teach a confusing mix of conventional and anti-social values. Thus we have neighborhoods that have no constructive relationships with police, believe that justice is against them and label anyone reporting a crime as an informant and not to be trusted. This of course contributes to the chaos in the neighborhood.

In my experience people who get diagnosed anti-social are the ones the clinician don't trust or believe. The whole underclass culture tries to keep their business to themselves. Lying to protect one's family's reputation is encouraged. I suspect while there may be a few classic psychopaths out there, most of those folks who populate our jails are drug abusing, impulsive, underclass members with shut down emotional systems due to repeated chaos and trauma. These folks won't tell you the truth unless they are desperate and already feel they are the lowest of the low. Their judgment is so impaired that they see fear as a weakness they must squelch out. Danger in their world is everywhere and it must be faced, not avoided.

I have worked with some persons of the underclass who have a clinical presentation of PTSD after many years of participation in gang violence. They know what conventional values are, but they also know what is the law of streets. They are scared and tired of living a nightmare, and want a stable peaceful life but are tortured about what they've seen and what they've done to others over the years. Just seeing a gun sets off flashbacks. They describe their younger years as being "shut off" emotionally, and "not caring" about anyone or anything but money. But now in my office, they are presenting a mostly full range of emotion and a guilty conscience that suggests conventional values. Has their impulsive, "immature brain", associated with anti-social acts, matured into a more conventional pattern? Or is it more accurate to describe them as a product of an anti-social sub-culture? I suspect the latter is more accurate.

Returning to the homeless and Kellevision, she notes the major problem with relationships is homeless people's "picker is broken".

For every person in a homeless shelter with dependency issues we seem to have an predator waiting for them. Half the population seems to be working or receiving some form of assistance and the other half seem to be trying to hook up with them to take advantage of that income....

It is important to realize that single parents contribute to the problem of picking the wrong partner with their own pathology. The single mothers in the family dorm are not simply victims of the men they pick out. There seems to be a predominant attitude of these women that the man should "take care of them". They believe it is just a matter of picking out the right one. The first problem is that their "picker" is broken. They do not pick out a good one. They usually pick out one of the predators roaming the alley behind the shelter. The second problem is that you cannot sit at home expecting to be taken care of in our modern economy. That might have worked in the 1950's, even in the 1970's, but June Cleaver is no more. The modern American household takes two paychecks. Two full-time paychecks. The third problem presents it self when the man expects to be supported by the woman. Even if the woman is working full-time and picks out a man who wants to live off of her, women traditionally earn much lower wages than men. So the family's financial stability is even more shaky.

This predatory - dependent dyad seems to play out in most of their relationships and I wonder if it is not the source of their alienation from their families of origin. A person who constantly expects to be taken care of can be quite tiring. By contrast, a person who is constantly preying on others also becomes quite tiring.

Having grown up in a chaotic home and living a chaotic lifestyle, repeated trauma has numbed their emotions to the point that they are unable to make proper judgments about who is worthy of trust. The predator-prey dyad began in their family of origin where parents exploited the children when they were young, and when the children grow up, they exploit their vulnerable elderly parents. Recently, in my therapy group, one male member admonished a older woman for setting limits with her adult children because they were tacitly supporting her grandchildren for default on a loan she'd co-signed. He felt family was entitled to lean on, effectively use, each other.

Mental illness is often cited as a factor in homelessness. A significant number of homeless clients suffer from debilitating mental illnesses and many researchers sight the high numbers of mental illness in the population. However, each researcher seems to define it in their own way. Some include only the big three Axis I diagnoses (Schizophrenia, Bipolar I and Major Depression). Others include substance abuse (since it is an Axis I diagnosis in the DSM IV) which dramatically inflates the numbers of the "mentally ill". Others include Axis II personality disorders, but only some of them, usually Antisocial Personality Disorder. Still others include Post Traumatic Stress Disorder. In my experience, mental illness is a factor in about 10-20% of our homelessness clients and it is a serious problem. However, it does not explain the other 80%. These 80% use an unusually high percentage of services and monies devoted to the homeless and they are repeat customers.

Here I have to disagree with Kellevision. Everyone I've counseled with substance abuse were running from their feelings about themselves and/or their past. I have found Bipolar DO in significant numbers behind petty criminal activity, gambling addiction, alcoholism, sexual addiction, exotic dancing and prostitution. I participated in a local county survey that identified their most expensive clients. The general profile was bipolar chemically abusive who revolved in and out of the hospital, placements and jail. Personality disorders are mental illness. While many may think the rest of the world is the problem and are not willing to take responsibility, many others are desperate for relief from a horribly chaotic and often traumatic life.

There is a very high incidence of traumatic histories in the homeless community, even before they became homeless, usually during childhood. I believe that a majority of the substance abuse problem in this population is an effort to treat trauma symptoms. However, this can be said of other populations as well, including the substance abuse community. Most trauma survivors manage to maintain housing despite their trauma symptoms. Though trauma symptoms may play a factor in homelessness, I do not believe they are the sole cause.

Sole cause, no, it's the multi-generational underclass sub-culture with it's accompanied fractured families, drug abuse, trauma, predator/prey cycle, and chaotic lifestyles. Trauma comes in forms that are not readily identified. Chaotic events in close proximity in time give the victim the impression they have no control of their fate and so they scramble for every edge in the moment, and anxiously await for the next disaster to strike. Those in the underclass go way out of their way to withhold their histories of trauma and chaos, insisting that they can handle their own problems, and it's none of anyone's business. Or is this simply the accepted cultural method to deal with the shame of their past?

Most homeless clients do not have family support systems. If they did, the family would take them in and they would not be homeless. Many homeless clients come from families who are themselves very nomadic and teetering on homelessness. Some come from families rife with substance abuse, sexual abuse or domestic violence. Others have been rejected by their families for various reasons. These reasons often involve their dependent and/or dysfunctional behaviors.

Underclass families exploit each other until the resources are gone, or the member with resources cut off the leech. Once the underclass has used up their family resources, they become at risk for homelessness. Many have family who died young living violent or drug infested lifestyles, or who are in prison. By this time, they've burned out most of their friends as well. All they can do and meet new vulnerable people and continue a new predictor/prey dynamic.

So what solutions are there for healing the cultural divide? The problem is mostly economic. The underclass lacks a realistic chance for escaping their plight. Oh, sure a few make it, usually through advanced education. But many will hit a ceiling in achievement when they rely too heavily on "temporary feel good" behavior that provides relief from stress, but self-destructively complicates their lives and increases the chances they will fall out of their newly found middle-class status.

The middle-class in America is shrinking, many of the hard working blue collar workers are falling into the underclass from where with a floundering economy, escape will be difficult. Jobs programs, affordable housing, and counseling are sorely needed but remains largely unfunded. What infrastructure is present is actually shrinking with government tax dollars.

Too often the only role models for success are the gang members, drug dealers or pimps who drive fancy cars and flash wads of money. Too many get lost in this dream turn nightmare. But my experiences working with recovering gang members is that many are retrievable when they get desperate enough to escape with the right kind of treatment and patience with their guarded presentations. I work in a Partial Hospital Program (PHP) at an inner city public hospital that is designed to intervene with persons with personality disorders. It's largely based on the Crisis Intervention model that relies on the desperation of the client to inspire commitment, insight and behavior change in therapy. The PHP format is ideal for persons who are suffering from acute exacerbation of substance abuse, PTSD or personality disorder. I call it "mental health boot camp". We have a satisfaction rate of over 90%.

Kellevision lists a number of problems within the system.

In my humble opinion, our current social services system and is a major factor contributing to the homeless mindset. This is a complicated element to explain. But I think it is important to make an attempt.

I see two major problems with the social services system: 1) the system itself - how benefits are applied and eligibility determined and 2) the people working within the system - the mindset of caseworkers and social workers working with the homeless population.

• The social services system seems to be designed to punish attempts by the poor to achieve independence. Assistance programs penalize people for working "too much" by cutting off benefits when assets accrue. These systems often reinforce irresponsibility and impulsivity while punishing people who try to work and plan ahead.
• Many social services programs seem to "teach" clients to wait until the last minute then create a dramatic "emergency" in order to get help. This fosters the emotionally immature and histrionic displays in emergency rooms.
• Our current welfare system does not allow exchanging work for benefits. Benefits are given away free.
• Caseworkers and social workers have a bad habit of doing things for clients, rather than expecting the client to do it or teaching them how.
• So what have clients learned so far?
  • Don't work too much.
  • Don't plan ahead.
  • Expect someone else to provide you with what you need.
  • Don't take responsibility. Someone else will fix it for you.

The welfare system is complex, cumbersome, and difficult to change into a working entity. The major problem is that it is designed not to serve the poor, but to mollify the political needs of the tax payer. That makes it inherently punitive. As we know from behavioral science, punishment doesn't change behavior. I believe it in fact feeds the cycle similar to the one Kellevision describes above. As long as we put political considerations ahead of evidence-based methods, we'll have a broken system.

Kellevision proposes ideas that I think have significant merit.

I think counseling should be provided liberally. Teach people how to fish. Teach them how their maladaptive behaviors impair their ability to function. Stop rewarding bad behavior. Stop giving away money. Stop cleaning up their messes for them. Stop giving away free stuff.

Once homeless clients are assigned jobs, they would be provided with counseling to address the behavior problems that interfered with their ability to maintain employment. If they failed to come to work due to a poor work ethic, substance abuse problems, domestic violence or other relationship issues, etc. instead of getting fired - again - and having another black mark on their work history, they would be required to participate in counseling or group work to address it.

Many of the boomer adults were raised with a lot of TV. It would appear things have gotten worse. We know a lot more about what TV does to children, but it doesn't appear to have had much effect. Simple logic will tell us that the experience of TV will decrease a child's ability to tolerate a delay in gratification of desires. Certainly, the TV ads are designed to create the desire for things we didn't know we needed, a certain frustration that we can't have it all, now. But it's much worse than that.

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John M Grohol PsyD owner of PsychCentral.com is usually a man who politely understates things. But, he pulls no punches in a recent article.

Most child psychologists and child development experts recommend no TV whatsoever for a child before the age of 2 or 3. None. Yet a whopping 43 percent of parents plop their toddler down in front of the television set, apparently blind to the consequence of their actions.

[..]There are also the studies that show that teens who watch more sexual content on TV are twice as likely to be involved in a pregnancy over the next three years than their peers.

[From the Boston Globe]

Countless studies have documented the inverse link between devotion to the boob tube and achievement in school. Researchers at Columbia's College of Physicians and Surgeons concluded in 2007, for example, that 14-year-olds who watched one or more hours of television daily "were at elevated risk for poor homework completion, negative attitudes toward school, poor grades, and long-term academic failure.'' Those who watched three or more hours a day were at even greater risk for "subsequent attention and learning difficulties,'' and were the least likely to go to college.

In 2005, a study published in the American Archives of Pediatrics and Adolescent Medicine found that the harm caused by TV watching shows up even after correcting the data to account for students' intelligence, family conditions, and prior behavioral problems. The bottom line: "Increased time spent watching television during childhood and adolescence was associated with a lower level of educational attainment by early adulthood.''

The baleful effects of TV aren't limited to education. The University of Michigan Health System notes on its extensive website that kids who watch TV are more likely to smoke, to be overweight, to suffer from sleep difficulties, and to have high cholesterol.

From Research Digest Blog, here is an excerpt from an article commenting on the effects of TV on in the background while a young child plays.

Schmidt's team described the disruptive effects of the background TV as "real but small". While the current study doesn't say anything about the possible developmental consequences of TV-disrupted play, previous research has shown that shorter play episodes and less focused attention tend to be associated with poorer developmental outcomes. Moreover, a previous unpublished study by the present team of researchers showed that background TV reduces how often parents interact with their children. "Taken together," the researchers said, the new and previous findings lead us to "hypothesise that background television, as a chronic influence, is by itself an environmental risk factor in children's development."

According to these articles, Visual voodoo: the biological impact of watching TVandThe Psychologist, TV is a cause for attention deficits in children.

Sigman's review in fact only cites two published studies that show direct associations between TV viewing in this age group and negative consequences. The first, a 2004 longitudinal study by Dimitri Christakis and colleagues of 1200 children, found that for every extra hour of average daily TV viewing between birth and three years, the children were 10 per cent more likely to have attentional problems at age seven. The second, a cross-sectional study by Dimitri Christakis and Darcy Thomson, found that among 2068 infants aged between four months and three years, those who watched more television also tended to have less regular afternoon and nighttime sleeping schedules. The research base becomes more substantial when the focus is broadened to include TV viewing in older childhood and adolescence. For example, two studies by Robert Hancox and colleagues reported detrimental associations between TV viewing between the ages of five and 15, and educational attainment and several health measures at 26 years. Sigman's review, which also discusses harmful associations between adult TV viewing and mental and physical health, concludes these 'findings are set to re-cast the role of the television screen as the greatest unacknowledged public health issue of our time'. However, not all experts are sympathetic to Sigman's view. Dr Brian Young at the University of Exeter told us children are active in the way they use TV - they don't just sit on the receiving end of a stream of audiovisual input. 'There certainly are benefits for children interacting with TV,' he said. 'They learn stuff - it's as simple as that. But the best learning environment is where the mother or the family collectively consume television and discuss what's being seen. In that sense it's a 'window on the world'. However, he added: 'Any medium has a downside and unsupervised viewing by very young children - the "TV as a babysitter" - is not helpful.'

Now consider the effects of violence in TV and video games. Are we training our children to tolerate routine violence? I think so. It fact, it would appear that TV is an experiment on our children increasing obesity, tobacco and alcohol use, risky sexual behaviors, violence and social isolation.

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A Bill that I hope will become law in Minnesota and an example for the nation is moving through the Legislature.

StarTribune.com

The bill would prohibit "harassment, bullying, intimidation and violence" based on a student's personal characteristics such as race, sexual orientation or religion.

It would, in effect, "simply expand the categories of people that schools already cover with their anti-bullying policies," according to OutFront Minnesota, one of the organizations pushing for its adoption.

Education Minnesota, the state's teachers union, is the most prominent of several other groups backing the bill.

Bullying has been the scourge of childhood relationships inside and outside of schools. It has done tremendous damage to developing children at a highly sensitive time. We all know examples of the results of bullying that hit the headlines. But for every headline, there are millions of children who grow up with invisible wounds to their perception of self, their sense of safety, and their belief that they can make a place for themselves in this world.

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Coordination of care is one of the hidden dysfunctional aspects of medical care. The problem is that coordination of care is not reimbursed by insurance companies. Providers are expected to do the right thing and contact other providers between clients.

From the outside looking in, that would appear to make sense. Good medical care requires consulting with other providers to ensure everyone is working on the same plan and not against each other.

However, the economic crunch on medicine has been on for the past decade. Physicians and other providers are making less income than at anytime in the past generation. Providers are pushed to be more efficient. The result is that coordination of care gets less attention. This problem promises only to get worse with further cuts in Medicare and insurance reimbursement inevitable. If coordination of care remains non-reimbursed, quality will continue to suffer.

McClatchy Washington Bureau

Elijah Mense, a talkative 5-year old with dark curly hair, is very sick and his family doesn't know exactly why.

They know some of what's wrong. But not everything. So they've been tossed from one specialist to the next. "I learned up here the doctors don't work together," says his mother, Serene Mense.

She has butted up against a serious weakness in the U.S. medical system: Lack of coordination among doctors.

Insurance won't pay a doctor to coordinate care in a complex case, and it's difficult to do. The doctor has to contact all the other doctors involved, see that test recommendations are carried out, and battle with insurance companies over coverage for specific treatments.

Yet a complicated case like Elijah's clearly demands such coordination.

One of every three people you know will be treated for a mental illness sometime in their lifetime. If you know someone in your family who suffers from a mental illness, chances are there are others struggling as well. As many as 60% of those who suffer from mental illness self-medicate with alcohol or drugs.

Chances are if you know someone with a drug or alcohol problem, they are self-medicating their mental illness.

Educated yourself about mental illness. The problem WILL affect you, if it hasn't already. It's just a matter of time.

Join thousands of other Americans in observing Mental Health Month under this year's theme, "MIND Your Health," which calls attention to the important message that mental health is fundamental to overall health.

• Download free Mental Health Month tip sheets for posting in your workplace, doctor’s office, or place of worship. Visit our online store for additional “MIND Your Health” merchandise including pens, post-its, and buttons to support your efforts.
• Visit the Mental Health Event Calendar to check out Mental Health Month activities occurring across the country and encourage your family and friends to join the celebration.
• Ask your co-workers and local community leaders to sign Mental Health America’s Vision for Change Petition and join the growing movement of Americans who call on Congress to make mental health a national priority.

Mental Health Month Observances
National Parity Day (May 2) - Call your representative!
National Anxiety Disorders Screening Day (May 2)
Children’s Mental Health Week (May 6-12)
Childhood Depression Awareness Day (May 8)
National Anxiety and Depression Awareness Week (May 6-12)
National Mental Health Counseling Week (May 6-12)
Older Americans’ Mental Health Week (May 20-26)
Schizophrenia Awareness Week (May 20-26)

In some ways, the medical insurance business is in the Dark Ages. Mental and chemical health treatment are often not even included in insurance coverage. Even if it is, it is seldom afforded coverage equivalent for what you might get for a heart attack or other major surgery. Senator Paul Wellstone led a 5 year fight for mental health insurance parity, until he tragically died campaigning for a second term. His and other's attempts to changing the law has been beaten back by business lobbies concerned about increased costs and special interest lobbies with considerable clout, like Scientology. The fact is, mental health coverage does not increase insurance costs. Finally, with changes in the legislature, there is a growing consensus to change this blatant discrimination. But this is not a sure thing and it needs your support. Send an email with just a click to your legislators at the link below to urge his support.

Mental health parity took its critical first steps toward enactment with Senate committee adoption on February 14th of a parity bill introduced two days earlier by Senators Pete Domenici, Ted Kennedy, Mike Enzi and 18 other senators. The Senate Health Education, Labor and Pensions (HELP) Committee approved the Mental Health Parity Act of 2007 (S 558), which aims to end discriminatory treatment towards persons with mental illness. This legislation would expand an existing federal law and require employers and health plans to end insurance coverage limitations for mental health conditions that do not apply to other medical conditions.

Action Required

It is vitally important that strong and immediate bipartisan support be demonstrated for this legislation. Mental Health America supports the Mental Health Parity Act of 2007 and urges you to contact your senators today and ask for their support and co-sponsorship.

Why is this bill important?

Enacting this legislation is a crucial step toward improved access to care, but it is also a step toward realizing the broader goal of addressing mental illness with the same urgency and priority as we attach to other chronic illnesses.

• Mental health is fundamental to overall health, and mental disorders are readily diagnosable and treatable.
• There is no justification for a health plan to impose limits or conditions on coverage that do not apply to all other illnesses.
• Discriminatory insurance practices can be devastating to individuals and families as well as to businesses and communities, ranging from increased disability to job loss and reduced productivity, and tragically even to loss of life.

For more information on mental health parity please click at the link.

Those senators cosponsoring S. 558 at the time of bill introduction are:
Sen. Akaka, Daniel K. [HI]
Sen. Biden, Joseph R., Jr. [DE]
Sen. Boxer, Barbara [CA]
Sen. Brown, Sherrod [OH]
Sen. Cantwell, Maria [WA]
Sen. Cardin, Benjamin L. [MD]
Sen. Coleman, Norm [MN]
Sen. Collins, Susan M. [ME]
Sen. Enzi, Michael B. [WY]
Sen. Feingold, Russell D. [WI]
Sen. Graham, Lindsey [SC]
Sen. Hatch, Orrin G. [UT]
Sen. Kennedy, Edward M. [MA]
Sen. Lautenberg, Frank R. [NJ]
Sen. Murkowski, Lisa [AK]
Sen. Nelson, E. Benjamin [NE]
Sen. Roberts, Pat [KS]
Sen. Smith, Gordon H. [OR]
Sen. Snowe, Olympia J. [ME]
Sen. Stabenow, Debbie [MI]
Sen. Warner, John [VA]

If your senator is not already a co-sponsor of S. 558, please ask for their support and co-sponsorship of mental health parity.

A group of physician, patient and constituency groups concerned about confusing messages in popular culture suggesting that depression is "just the blues" or worse, a "made-up disease."

Although they don't say so, I suspect this movement intends at least in part, to counter the very well organized and highly funded lobbying effort by Tom Cruise and his Scientology friends to debunk psychiatry and depression. Instead they want us all to believe that depression is best alleviated by removing the sufferer's covering of tiny disembodied souls of aliens dispersed by the Galactic Federation leader Xenu. And to learn that technique, you must send thousands of dollars to the "Church" of Scientology. In the process you will learn all about the delusional beliefs of founder L. Ron Hubbard.

For whatever reason, they have put together a nice website and are pursuing a worthwhile educational program.

Psychiatric News

The initiative will spread science-based information to counteract "made-up" facts and misconceptions. A coalition of physician, patient, and community groups is tackling widespread misinformation about depression with a public information campaign emphasizing that the ailment, affecting nearly 19 million Americans, is serious, debilitating, and potentially fatal.

The Depression Is Real campaign, which was launched at a press conference last month in Washington, D.C., will use public service announcements, advertising, and a Web site, to increase awareness of depression and its causes and treatments.

Among the coalition members is the American Psychiatric Foundation, whose participation supports APA's "Healthy Minds, Healthy Lives" campaign. "A third of all Americans believe that mental illnesses like depression are caused by emotional or personal weaknesses, and almost that number think they are caused by old age alone," said Altha Stewart, M.D., president of the American Psychiatric Foundation. "We believe we have a responsibility to tell the public the truth about depression—based on scientific evidence and clinical research, not made-up `facts' or wishful thinking."

Coalition members said the lack of health care reimbursement parity for mental health treatments also trivializes depression and other mental illnesses.

It's Mental Illness Awareness Week! There is all kinds of information and materials to lead your own media campaign at NAMI.org

Since 1990, mental health advocates across the country have joined together during the first week of October to celebrate Mental Illness Awareness Week (MIAW).

What is Mental Illness Awareness Week?

Established in 1990 by Congress, the first week of October is designated as "Mental Illness Awareness Week" (MIAW) in recognition of NAMI’s efforts to raise mental illness awareness. "Bipolar Disorder Awareness Day" (BDAD) is held each year on the Thursday of MIAW to encourage further understanding and promote early intervention and treatment for this mental illness.

MIAW and BDAD are NAMI’s premiere public awareness and public education campaigns that link the organization nationally to the organization’s over 1100 local affiliates across the country.

Over the past 16 years, MIAW has become a tradition in NAMI. It presents an opportunity for all three levels of NAMI –national, state and local – to work together in communities across the country in meeting the NAMI mission through a variety of outreach, educational, and advocacy efforts.

New Orleans was a social service nightmare before Katrina. It's mental health infrastructure was likely underfunded like many other inner city services. But the results of the devastating trauma of Katrina spawned flood, people are stressed beyond their ability to cope. Psychiatric beds have shrunk by 80% while many professionals have abandoned the city along with half it it's residents. It's often those without alternatives who are left to return, to conditions worse than they ever were.

New Orleans needs licensed mental health professionals. Looking for meaningful work? Here is your opportunity.

Newsweek

[...]the state-funded Central City Mental Health Center has chosen a more practical way to mark the anniversary of the nation's biggest natural disaster--one that may well be the most fitting. Free testing for depression and post-traumatic stress disorder (PTSD) will be conducted all day on Aug. 29, punctuated by a lunch at which overburdened staff members will reminisce about the tumultuous year that was.

[...]the most serious health problems directly attributable to the storm have been mental, not physical. In the four months between Aug. 29 and the end of 2005, the Orleans Parish coroner's office "conservatively" estimates that the suicide rate tripled.

[...]In April, a survey conducted by the local Council on Alcohol and Drug Abuse found that one in seven people were drinking more to deal with stress; another study, by researchers at the University of New Orleans, found that "symptoms of depression have at a minimum doubled"--and its responders were all homeowners and apartment dwellers, not residents of FEMA trailers whose unhappiness levels must surely be higher. Those not medicating themselves with alcohol are turning in greater numbers to antidepressants: sales of psychiatric drugs have held steady at their pre-Katrina level, despite the fact that less than half the population has returned.

As the stress has mounted, the infrastructure to deal with it has all but collapsed. "We are facing crisis," says Dr. Andrew Calhoun, the medical director of the Central City Mental Health Center. "We need more doctors, more social workers, more hospital beds." Pre-Katrina, the parishes of Orleans, Jefferson and St. Bernard boasted 480 psychiatric beds. Downtown New Orleans's Charity Hospital boasted 100 alone; now there are 80 total and only 27 psychiatrists. When patients are suicidal (and the number of them at Calhoun's clinic has risen to as many as five per month, up from some pre-Katrina months when there were none at all) Calhoun must refer them to a hospital emergency room where they may wait up to three days before a nurse can find them a bed somewhere in the state.

Dr. Jeffrey Rouse, deputy psychiatric coroner for Orleans parish, agrees with Calhoun's assessment. When people are suicidal, homicidal or too mentally ill to take care of themselves, authorities bring them to Rouse with orders for protective custody. "When a family member comes to us, they are desperate, and I have to look them in the eye and tell them that my best option--my only option--is to have them brought to an emergency room where there may or may not be a psychiatrist on duty," he says. "The travesty of the whole damn thing is that the federal government sent all these SAMSA [the federal government's Substance Abuse and Mental Health Services Administration] counselors down here at tremendous cost, and meanwhile Tulane University Hospital has had to cut its psychiatry department in half. [Louisiana State University] cut its psychiatry department in half. It's happening all over town. We got all these volunteer grief counselors, and meanwhile the mental-health structure and personnel have withered on the vine."

Dr. Calhoun, whose office window is still covered with plywood from where it was broken by looters after the storm, says that in a perfect world he would like a new building (the roof leaked for years before Katrina), but that even incremental improvements would help the system enormously--new clinical social workers to replace the four he lost, for example. His facility has a case load of 3,000 patients, and 40 to 70 people--from walk-ins and those needing medication refills to patients scheduled for individual or group counseling--are seen per day. The majority of pre-Katrina patients were people with serious illnesses like schizophrenia and bi-polar disorder. Now, "in addition to the chronically ill," says clinic manager Sybil Wilson, "we have lots more cases of anxiety, grief, depression. Substance abuse has soared." Says Dr. Calhoun: "We used to be more selective about who we took and reserved our facility for those who had the most critical needs. But since there are now so few alternatives, we pretty much take all comers."

By some estimates, a third of the city's inhabitants are suffering from post-traumatic stress disorder, but Dr. Calhoun thinks those numbers do a disservice to those still struggling through. "The fanning of the flames of PTSD are not necessarily beneficial to the community," he says. "It is better if we look at the people here as survivors, who have persevered and who are still plugging away." Besides, it's hard to have PTSD when neither the trauma nor the stress have abated. "I liken it to a marathon," Calhoun says. "Right at the beginning you're moving along--and in the beginning people were gutting houses, getting on with things. But at one point you hit the wall, and we are definitely in the wall. You guess you're getting somewhere but it doesn't feel like it; the end is miles and miles away and you're really tired. You'll probably get there but it's so far away you can't see it."

What does he tell people to counter such a bleak outlook? He tells them to "expand their focus. It sounds corny but everybody needs to come together and pitch in and work. People who feel stressed in this environment are not sick. It's normal to look at what needs to be done to put this city back together and be unhappy. But we don't all need to be patients. We need to support each other."

A British mental health advocacy organization came up with a provocative way to challenge the stigma of mental illness. They commissioned a sculpture of Winston Churchill in a straitjacket. The British Prime Minister, who led the British people through WWII, is widely considered a heroic figure inspiring honor, persistence against overwhelming odds, and unbending will. Many have taken exception to what they consider to be a undignified association. Churchill suffered from depression, an experience he called his "black dog."

Rethink .org

Rethink severe mental illness today (September 14) defied an official ban to protest at the “last taboo” of mental health stigma and start a debate on how to overcome it. The charity had planned to unveil a “black dog” statue of former Prime Minister Winston Churchill in a straitjacket in London's Trafalgar Square to draw dramatic attention to the stigma surrounding mental ill-health.

But the statue, emblazoned with a “prejudice, ignorance and fear” sash, was banned. Instead, the statue is taking to the road and touring central London in defiance of the ban, imposed by the Greater London Authority, which controls access to Trafalgar Square.

Rethink chief executive Cliff Prior said: “Mental illness is the last taboo. People deny it, try to hide it and hide from it. We are determined to break out of the straitjacket and challenge prejudice, ignorance and fear wherever they appear.

I admire their creativity and courage to face the consequences of controversy for a good cause. Let's hope it helps!

Cutting taxes can only mean one thing for people suffering from mental illness, there will be fewer and less quality in the services available. This is true for the public system certainly, but it is also likely to spread extensively into the private system. Public dollars tend to account for a significant part of the business for even the private mental health provider. Fewer dollars will mean a continued exodus of providers from direct service. Salaries have fallen hehind the market for master and doctoral level practitioners. That can only mean fewer new providers coming into the field, and more exiting the field for more lucrative opportinuties.

The mentally ill account already for at least 25% and more likely 50% or more of the homeless in this country. That number can only go up as the services decline. Many working people end up disabled because they can't find sufficient services to help them put their lives together. Many of the homeless are disabled with too much pride to ask for help.

We as a country can do better than that. The complete report is available at the link. A report card chart with all the states is at this link.

NAMI.org

We live in a time where people with serious mental illness are at increased risk. State systems are under tremendous financial strain. As this report goes to press, actions that are being considered in Congress are likely to do more harm than good. Sadly, the promise of community mental health remains unfulfilled.

In 1990, NAMI released its last state ratings report. It described a system of services that, despite enormous expenditure of resources, was not “even minimally acceptable.” It detailed great regional and state variations in the existing system of care. Sixteen years later, mental illnesses cause more disability than any other class of medical illness in America. Recent reports from the U.S. Surgeon General, President Bush’s New Freedom Commission, and the Institute of Medicine describe well a “system in shambles” and the “chasm” between promise and performance.

Simply put, treatment works, if you can get it. But in America today, it is clear that many people living with the most serious and persistent mental illnesses are not provided with the essential treatment they need. As a result, they are allowed to falter to the point of crisis The outcome of this neglect and lack of will by policymakers remains often horrendous. The number of people with serious mental illness incarcerated in jails and prisons is on the rise. Emergency room use is increasing. The availability of housing is being threatened. Increasingly, access to effective treatments is being limited by many state governments.

NAMI | Support the Goals of Mental Illness Awareness Week

In 1989, Congress designated the 90's as the "Decade of the Brain" and proclaimed the first week of October as Mental Illness Awareness Week (MIAW) as a means to increase research and public awareness on issues related to mental illness. On this, the 15th anniversary year of Mental Illness Awareness Week, I am writing as your constituent to ask you to work for policies that achieve equitable services and treatment for the more than 15 million Americans living with severe mental illnesses and their families.

Mental illnesses can affect persons of any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing.

Mental illnesses are treatable. Most people with serious mental illness need medication to help control symptoms, but also rely on supportive counseling, self-help groups, assistance with housing, vocational rehabilitation, income assistance and other community services in order to achieve their highest level of recovery.

Mental illnesses are the leading cause of disability (lost years of productive life) in this country. Yet, according to the President's New Freedom Commission Report, America's mental health system is "in shambles." Much progress has been made during the last 15 years in the scientific research on the genetic and biochemical causes of mental illness. But I am very alarmed that, despite this new research and evidence, most adults and children are still denied access to the help that they need.

I am an active supporter of the National Alliance on Mental Illness. NAMI is one of the most effective voices for the rights and needs of people affected by mental illness.

Action Expected on FY 2005 Funding Bills
for Mental IllnessWith the 2004 elections now behind them, Congress will return to Washington the
week of November 15 for a "lame duck" session to complete action on spending legislation for the current
fiscal year. Among the bills that Congress will be taking up are spending measures regarding mental
illness research and services, housing and veterans programs. Congress hopes to complete these
measures quickly given that FY 2005 began back on October 1 and agencies are still operating under an
extension of last year's budget.