EXECUTIVE DIRECTOR'S LETTER
My name is Charlie McCarthy, and I was born and raised in
Anaconda, Montana. I have been married to my wife, Betty, for 31 years,
and we have one daughter and a five-year old grand daughter.
I am grateful that my daughter and granddaughter also live
in Helena.
My commitment to mental health services began in 1966. It
was that year that I was assigned to Montana State Hospital
and to the Alcoholism Treatment and Recovery Program as a
vocational rehabilitation counselor with additional responsibility
for services to Montana State Prison.
The experience in institutions gave me four years in which
to meet many wonderful people - staff, patients, and inmates.
It also gave me first-hand knowledge of man's inhumanity
to man and how it can be perpetuated by the system and the
will of the public - not by the individuals who work or live
in the system.
What do I mean by that? When I began employment at Warm
Springs, the campus facilities offered care and custody but
few services. There were too many patients, not enough attendants,
nurses or other professionals, and very few resources. Many
of the 1100-1300 patients in the State Hospital had not been "seen" by
their doctor in years. The hospital staff struggled daily
with what to do about the adolescents who were being committed
for behavior problems or drug offenses. There was no schooling
offered for either children or adolescents. Depending on
the local community, there were few or no resources available
in the community for discharged patients.
From 1966 to 1970, the public's willingness to do what was
necessary began to change. Fueled, I believe, by Federal
legislation, increased funding, and the advocacy efforts
of the Montana Mental Health Association and the Montana
Association for Retarded Children, the movement started to
discharge patients from institutions and provide services
in communities. Initially, this was made possible by the
establishment of a system of Community Mental Health Centers,
which began in Eastern Montana in the late 60's. Most communities
now provide an array of both children and adult mental health
services, but much remains to be done.
Since that time, I have spent my professional career dedicated
to bringing about positive changes in services and in the
attitudes of the general public toward persons receiving
those services. I am fortunate that the MMHA Board of Directors
has given me this new opportunity to use my talents and abilities
to once again serve persons who have a mental illness.
I started as Executive Director on February 1st. It is such
a pleasure to follow in the footsteps of the prior directors.
What Andrea said in her article of resignation in the last
newsletter bridges well to what I would ask of members. She
encouraged readers to contact the MMHA office with suggestions.
Please do so. The generosity of both the Piper Family and
Eli Lilly and Company will enable us to expand the Newsletter
beginning with the June issue. Consideration is being given
to improving two-way communication through Letters to the
Editor, Guest Editorials, and an Affiliates Corner. Again,
your suggestions are welcomed.
SCHIZOPHRENIA AND MEDICATION
Schizophrenia attacks 1% of the population worldwide
making it one of the worst diseases afflicting mankind. Over
two and a half million people in the United States have
schizophrenia. It strikes most often between the ages of
15 and 25 and equally in both genders. Although it comes
on suddenly for some, for most it develops gradually and
with increasing severity. It usually starts with subtle
symptoms like the inability to concentrate or sleep, or
to respond to feelings, accompanied by the inability to
take pleasure in activities once enjoyed. It progresses
to disordered thinking, delusions, hallucinations and motor
disturbances.
Public misunderstanding of this devastating disease has
increased the pain and misery of those who suffer from the
disease and their families. Schizophrenia is not a split
personality. Poor parenting does not cause schizophrenia,
and the majority of people who suffer from the disease are
neither dangerous nor violent. Research has learned that
people with schizophrenia have brains that are sensitive
to the neurotransmitter Dopamine as well as differences in
the shape and size of certain brain structures. Although
schizophrenia is currently not curable, it is treatable with
a combination of medication, supportive services and education
for victims and their families.
Antipsychotic medications are prescribed to control symptoms.
Each person with schizophrenia has a unique combination of
symptoms and no single medicine works well for all people.
Traditional antipsychotics (Haldol, Thorazine) often control
delusions, hallucinations, disordered thinking and muscle
spasms but frequently have little effect on depression, isolation,
or lack of energy. The newer antipsychotic medications (Clozapine,
Risperdal, and Zyprexa) offer beneficial relief over a broader
range of symptoms with fewer side effects. Many people with
schizophrenia stop taking the traditional medications because
they often produce unpleasant serious side effects that can
be irreversible, such as uncontrolled tics and facial expressions,
muscle spasms and motor restlessness.
Unfortunately, many people who could benefit from the
newer antipsychotic medications cannot get those benefits
because their insurance or managed care company is not
willing to pay the greater cost associated with newly produced
drugs on the market. Because there are physical and
mental health benefits from the newer drugs, even from
a cost benefit point of view, the policy of limiting access
to these new medications is shortsighted. The practice
of limiting access to more expensive medications is called "restrictive
formularies", and the MMHA Board is currently reviewing
proposed policies for the Association to address this issue.
There is good reason for society to support the extra
expense of these drugs. Schizophrenia costs as much
as $48 billion each year in the United States in medical
treatment, Social Security Disability benefits, and loss
of productivity. When the human suffering for the persons
with the disease and their families are considered, the
additional cost for the newer drugs is worth the investment.
Medication alone may be beneficial for the person with schizophrenia
but is most effective when used in combination with supportive
services in housing and jobs and opportunities for social
and personal relationships. Also, helping families and communities
understand the illness and related services has proved essential
in aiding in the recovery process. Understanding of the disease
and the reduction of stigma also promote early detection
and prompt treatment.
Recently national attention focused on Ted Kaczynski and
Russell Weston, Jr. - both persons afflicted with schizophrenia
that was untreated at the time of their actions and they
gained notoriety through criminal behaviors that are not
typical of persons with this disease. Hopefully, the media
and the general public will be less governed by the few sensational
stories and more resources will be devoted to research, treatment
and services that will improve the lives of persons who experience
this potentially devastating disease when it is either not
treated or is inadequately treated.
Readers are encouraged to learn more about schizophrenia
by calling the MMHA office or going to the website www.schizophrenia.com.
LEGISLATIVE INTERIM ACTION
Legislators are not inactive during this off year, especially
those involved with the Mental Health Oversight Advisory
Council and the HJR 35 Interim Committee on Mental Health.
The Mental Health Oversight Advisory Council is chaired
by Senator Bob Keenan and is meeting the second Monday of
every month. There are three committees: adults, children
and criminal justice. The recommendations of the committees
will be very important to the establishment of a Draft Montana
Mental Health Plan 2000-2005 that will be released for public
review and comment by the Department of Public Health and
Human Services by November of this year. MMHA Board Members
Brian Garrity and Joan-Nell Macfadden are active MHOAC members.
The agendas for meetings are posted at www.dphhs.state.mt.us/hot/mhap.htm.
Persons who want to get more information on the work of the
committee may contact either Matt McKinney at the Montana
Consensus Council 406-444-2075 or Marcia Armstrong of the
Addictive and Mental Disorders Division 406-444-2878.
The Legislative Finance Committee is chaired by Senator
Chuck Swysgood and has been meeting monthly to study further
development and monitoring of the public mental health care
system. The broad mandate of HJR 35 has required the committee
to take a close look at state financing and contracting for
services. The committee has conducted a detailed review of
state funding, eligibility and access to services.
Among other topics of interest, the committee has heard
reports and discussed lessons learned from mental health
managed care, a survey of mental health services in jails,
progress on completion of the new Montana State Hospital
Facility and positive results of pilot projects in Billings
and Helena serving persons with a serious mental illness
(PACT). Persons desiring more information on the HJR 35 Study
of Mental Health Services may contact Lois Steinbeck at the
Legislative Fiscal Division 406-444-5391.
SOME RESOURCES ON LINE
National Mental Health Association: www.nmha.org
National Alliance for Mentally Ill: www.nami.org
MH Consumers Clearinghouse: www.mhselfhelp.org
Members Notice - MMHA By-Laws to be Amended: The
Board of Directors takes this opportunity to notify members
that the by-laws are being revised at the Annual Meeting
on May 5, 2000. Please review the notice included with this
newsletter. If you would like to have a copy of the proposed
amendments and by-laws in their entirety, or, if you would
like to provide comments on the proposed amendments, please
call or mail the office and a copy will be sent to you.
MENTAL HEALTH SYSTEM UPDATE
SURGEON GENERAL'S REPORT: In a fitting tribute to
our entry to the new millennium, Surgeon General David Satcher,
M.D., Ph.D. released the first ever Mental Health Report
of the Surgeon General. This historical document will guide
public mental health services and citizen advocacy for many
years to come. The report stresses the importance of information,
policies and action that will reduce and eventually eliminate
the cruel and unfair stigma attached to mental illness. The
reviews of research shows a wide range of effective treatments
exist for most mental disorders; however, half of all Americans
who have a mental illness do not seek treatment. For a copy
of the Executive Summary contact the MMHA office.
INITIATIVE TARGETS PRESCHOOL PRESCRIPTION DRUG USE: The
Clinton Administration has picked up on the growing concern
in the United States that young children with emotional and
behavioral problems may be overmedicated. Led by First Lady
and U.S. Senate candidate Hillary Rodham Clinton, who has
made children's and family issues central to her campaign
platform. The White House announced last week a plan to study
the use of psychotropic medication, such as Novartis Corp.'s
Ritalin, for young children. In addition, the Clinton Administration
will start a campaign to educate families on treatment choices
for children with emotional and behavioral problems and push
the Food and Drug Administration to clarify prescription
guidelines for children's medications.
SHARED VISION PROJECT: CIRCLES OF CARE: This project
is providing a unique contribution to the delivery of culturally
appropriate mental health services to American Indian children
and their families. The project is funded by the Federal
Substance Abuse Mental Health Services Administration and
is in its second year of operation. Qualitative and quantitative
data has been collected and analyzed from each of the seven
reservations in Montana and is in the process of being reviewed
by tribal officials, tribal health CEOs and the State. Circles
of Care is operated by In-Care Network, Inc. of
Billings, which is the only therapeutic foster care program
in the U.S. designed specifically to serve American Indian
children. The Project is guided by an advisory committee
of representatives from all seven reservations, the urban
Indian community and service providers. For more information
contact Debra Wetsit, Shared Vision Project, In-Care Network,
Inc., 2906 2nd Ave N, Suite 316, Billings, MT 59101. Ph.
406-256-8388.
TWO WORLDS IMMERSION SEMINAR: The Shared Vision
Institute is offering a one-week, "Two Worlds Cultural
Immersion Seminar" during the week of August 12-18, 2000.
The Seminar is partially supported by a grant from the
Administration for Native Americans. "It is the goal of
the Seminar to carefully examine the American Indian way
of life, values, health, and well-being in a manner that
will allow more effective mental health and social services
delivery," according to Bill Snell, Jr., Executive Director
of In-Care Network. This unique opportunity is designed
specifically to assist mental health providers, social
workers, educators and others to "see" from a Native worldview
through a full, rich immersion in the Northern Plains Indian
cultures. The Seminar is an encampment setting, and participants
are encouraged to reside in camp during the week. Alternative
arrangements will be made for those unable to do so. Native
cultural experts will provide instruction in activities
based on Native cultures including singing and flute demonstrations,
Native food gathering and preparation. Registration deadline
is June 15th, and early registration is encouraged, as
enrollment is limited. The fee is $985 and covers all of
the week's activities.
LAURIE REPORT ON-LINE: The DPHHS Mental Health Services
Bureau website now has the final report, Positive Lessons
Learned through the Mental Health Access Plan for Child and
Adolescent Mental Health Services by Ira Laurie, M.D.
To access the report go to www.dphhs.state.mt.us and
follow the link to the Addictive and Mental Disorders Division.
AMDD BULLETIN - PHARMACY REBATE: The Addictive and
Mental Disorders Division last November mailed letters to
dozens of pharmaceutical companies that manufacture drugs
covered by the state Mental Health Services Plan (MHSP).
The letters encouraged companies to participate in a rebate
program at the same rate as the Medicaid program uses. The
Division recently announced that Glaxo Wellcome has agreed
to the program. The company sells Wellbutrin and Lamictal,
both prescribed medications on the MHSP formulary and important
to treatment of many Montanans with depression (Wellbutrin)
or epilepsy (Lamictal). According to Randy Paulson, Mental
Health Services Bureau Chief, "The rebate program helps all
parties involved. Pharmaceutical companies have their products
covered by the program, patients have access to products
at less cost, and the state receives a return on its costs."
OMBUDSMAN REPORT: The Mental Health Ombudsman Office
has been operating since August, 1999. The following are
some of the issues and priorities identified during the past
six months. To contact the Ombudsman Office, call toll-free
at 1-888-444-9669 or email: mentalhealthhelp@state.mt.us Access
to services is one of the most difficult issues the Ombudsman
Office deals with. A single adult with a gross monthly income
over $1,044 is not financially eligible for the Mental Health
Services Plan (MHSP). Typically an adult with serious mental
illness who is not financially eligible either receives SSDI-
federal disability insurance based on the amount the person
contributed to Social Security while working- or works at
a low-paying or part-time job that does not offer health
insurance. In either case, individuals must purchase their
own psychiatric medications, often at a cost of several hundred
dollars a month. A family of four must make less than $2131
a month to qualify for the MHSP. A seriously emotional disturbed
child may need testing, medication, therapy, and sometimes
out-of-home care in a hospital or residential treatment facility.
The cost of care for a child who is financially ineligible
for MHSP (or CHIP) and not covered by Medicaid can deplete
a family's financial resources. Parents struggle with how
to get help for their child. The Ombudsman Office will advocate
that the Mental Health Services Plan expand financial eligibility
to 200% of the federal poverty level to include more of the
vulnerable population in need of mental health services.
|
