Montana Mental Health Bulletin

Cutting Edge Answers: Multisystemic Therapy

Submitted by David Groot, MSW, Vice-President of Community Programs Yellowstone Boys & Girls Ranch

It’s a question that signifies our times: what do we do with a 12–17 year-old youth who has had multiple arrests, is deeply involved with delinquent peers, has problems at school, abuses drugs and lives in a single-parent household that has multiple needs and problems?

Multisystemic Therapy (MST) may be a real answer to this problem, in Montana and elsewhere. This family-oriented, home-based program targets seriously emotionally disturbed youth and their families. The outcomes are astonishing. Youth who have participated in MST Therapy demonstrate reductions in criminal activity, substance abuse and other antisocial behaviors. They spend less time in expensive out-of-home placements, which translates into tremendous savings. One recent study by the Washington State Institute for Public Policy estimated savings of $31,000 – $131,000 for each youth served*.

What’s the secret? Part of it is in the “multisystemic” approach. In 1999, the Surgeon General’s Report on Children’s Mental Health emphasized that childhood psychopathology rose from the complex interactions of an interrelated network of systems, including individual, family, peers, neighborhood, school and the larger social and cultural context. In other words, problems are multi-determined. MST is a multi-dimensional intervention that addresses issues on many fronts. Interventions are individualized, comprehensive and highly integrated.

MST uses a home-based service delivery model that reduces the barriers families often face in accessing services. Therapists work with clinical “teams” and have small caseloads. Support is available to families 24 hours a day, 7 days a week, with treatment durations of 3–5 months. In the early phases of treatment, therapists may spend multiple hours every day with the youth and the family. MST therapists focus on empowering parents and improving their parenting skills, helping to identify strengths and develop natural support systems. This family-therapist collaboration encourages the family to set and achieve treatment goals.

MST, a SAMHSA Model Program, has been successfully employed by the Yellowstone Boys and Girls Ranch (YBGR). This approach is part of their priority to establish research-validated interventions and initiate models of care that can be adapted as best practices for Montana, despite the large geographic area, low population and highly rural environment. At this point, this is part of the YBGR request for congressional appropriation that will support model programs in Montana.

* Multisystemic Therapy: a SAMHSA Model Program. http://modelprograms.samhsa.gov.

From the Desk of the President: New Directions

The need for mental health services and education has never been greater, yet public resources are at an all-time low. While mental illness is as serious an issue as cancer or heart disease, services and coverage lag far behind those available for “physical” illnesses, even in the best of economic times. MMHA is an organization involved in a dynamic process of change.

MMHA’s mission is to advocate and educate for mental health. Currently, we are creating a five-year strategic plan to help us achieve our goals. MMHA is a strong, persuasive voice in the fight to provide access to good mental health care for all Montanans, and to ensure that mental health services have full parity.

The new logo and new moniker represent this new direction. Watch this newsletter. We’ll be offering cutting-edge information, highlighting what’s working in Montana and in the nation. MMHA conferences will make sure you have the most up-to-date information and most qualified speakers available. We’re headed in the right direction and hope you’ll come along with us on this challenging journey. It will take all of us, working together, to reach our goals.

Cindy Dolan , President
Montana Mental Health Association

Voice of the Consumer

Moving Toward Recovery

by Yvon Remark

The familiar, though painful,
routines of mental illness
that I leave behind will have
my claw marks all over them.

I learn:

• Recovery is a day by day process, not an end point.
• I’m not alone - that it is possible to accept help from others.
• To think through the illness and live a productive life anyway.
• To forgive and value myself.
• To realistically order my priorities, choosing self-affirming thoughts and lifestyle.

Because mental illnesses are disorders of brain chemistry and/or function, I may need the help of medication to normalize neurological balance.

I recognize recovery as I:

• Deal with reality and adapt to change;
• Order my daily life without being disabled by tension and anxiety;
• Establish and maintain mutually satisfying connections to other persons;
• Direct my energies into creative and constructive outlets and
• Find more satisfaction in giving than receiving.

Affiliate Highlights - Great Falls

Psychiatrist Mary Anne Evans was the guest speaker at the January 14, 2003 Annual Meeting. of the Great Falls Mental Health Association. Welcome to new board members, Kathy VanTighem, Ronda Remsin, Heidi Gibson, Jo Shaurer, Amia Watson, Pat Kraus, Colette Gray and Chris Reilly.

Executive Board Elect:
-President - Deborah Oleynik
-1st Vice- Priscilla Kuka
-2nd Vice- Debbie Hood
-Secretary- Nancy Hampton
-Treasurer- Darlene Meddock

Anxiety Disorders - Overview

Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders fill people’s lives with overwhelming anxiety and fear. This chronic and relentless disorder can grow progressively worse if not treated. Each anxiety disorder has its own distinct features, but all share a common theme of excessive, irrational fear and dread. Pharmacotherapy and psychotherapy are both used in treating anxiety disorders. Alone or together, both methods have proved effective.

Several parts of the brain play key roles in the dynamic interplay that gives rise to fear and anxiety. Different parts of the brain control responses that trigger fear, anxiety, obsessive compulsive or posttraumatic stress reactions. Twin and family studies suggest that genes play a role in the origin of anxiety, but heredity alone can’t explain what goes awry. Researchers are attempting to learn how genetics and experience interact in each of the anxiety disorders as they search for clues to prevention and treatment. (www.clinicaltrials.gov)

If you have symptoms of anxiety, a visit to a physician can help determine whether the symptoms are due to an anxiety disorder or to some other medical condition. The next step is a referral to a mental health professional. It is best to look for a professional who has specialized training in behavioral therapy and is open to the use of medications, should they be needed. Many people with anxiety disorders benefit from joining a self-help group, talking with trusted friends, and family support. Stress management techniques and meditation may help enhance the effects of therapy, although there is as yet no scientific evidence to support these “wellness” approaches to recovery. There is preliminary evidence that aerobic exercise may also be of value, and it is known that caffeine, illicit drugs and some over the counter cold medications can aggravate the symptoms of anxiety.

Anxiety disorders include:

• Panic Disorder: The heart may pound, and sensations may include feeling sweaty, weak, faint, dizzy or flushed and chilled. Hands may tingle or feel numb. Nausea, chest pain or smothering sensations can create sensations mimicking a heart attack. Many people feel as if they are on the verge of death.
• Obsessive-Compulsive Disorder: This disorder includes anxious thought. Sufferers may feel that they are out of control, may be plagued by persistent, unwelcome thought or images, or by the urgent need to engage in certain rituals.
• Post-Traumatic Stress Disorder: A debilitating condition that can develop following a terrifying event. You may have persistent frightening thoughts and memories of their ordeal and feel emotionally numb.
• Social Anxiety Disorder: This disorder involves overwhelming anxiety and excessive self-consciousness in everyday social situations. A persistent, intense and chronic fear of being watched and judged by others and feelings of embarrassment or humiliation are common.
• Specific Phobias: An intense or irrational fear of something that poses little or no actual danger. Some of the common specific phobias are centered around closed-in places, heights, escalators, tunnels, highway driving, water, flying, dogs and injuries involving blood.
• Generalized Anxiety Disorder: Much more than the normal anxiety people experience day to day, this chronic anxiety involves exaggerated worry and tension, even though there is little or nothing to provoke it.

- Gratefully excerpted from Anxiety Disorders, Department of Health and Human Services, Public Health Service and NIMA, 2000

Upcoming Calendar of Events

March 13-14, 2003
Addiction: Hijacking the Brain, Holiday Inn, Great Falls, MT
Sponsored by MHA-Great Falls
Contact Richard Terra at (406) 771-1138

March 20-22, 2003
Advancing Help and Hope, Holiday Inn, Bozeman, MT Johnson
Institute Workshop on Delivering Addiction Recovery Services.
Contact Kathy Taylor at 202-662-7107

March 27-28, 2003
Co-occurring Disorders: Research on Effective Treatments,
Mary Alice Fortin Health Conference Center. Sponsored by
MHA-Billings, Deaconess Mental Health Center & NAMI Billings.
Contact Jennifer Donovan at 800-266-7198

April 6-7, 2003
Synchronized Systems - 3rd National Conference on Disability,
Workforce Development and Self Employment, Holiday Inn
Parkside, Missoula, MT. For more information, call (406) 721-8550

April 29- May 1, 2003
Prevent Child Abuse and Neglect Conference, Holiday Inn
Grand, Billings, MT. Contact DPHHS, Child and Family
Services Division, Helena, MT

May 30-31, 2003
Self-Mastery Workshop-Domestic Violence, Double Tree
Creekside Inn, Missoula, MT, Montana Silent Witness Initiative.
For more information, call (406) 222-8901

2003 Legislative Banquet & Awards

Joan-Nell Macfadden

The Legislative Banquet held January 10 was a success, with over 125 consumers, advocates and legislators in attendance. Featured speakers included Ombudsman Bonnie Adee and advocate Joan-Nell Macfadden.

The 2003 MMHA Awards for outstanding accomplishments went to:

• Service Provider: Patty Lavin, APRN
• Administrative Award: Kathy Beason
• Board Member: Milt Markuson
• Long-Term Service to Mental Health: Kay Door, PhD
• Program: NAMI Provider Training, accepted by Gary and Sandy Mihelish.