| The Arlington Voice | |
| The Alliance for the Mentally Ill of Arlington | |
| Affiliated with -- and Supported by -- NAMI of Northern Virginia Families and Consumers Advocating Together that Mental Illnesses are Brain Disorders | |
| Vol. 11, No. 9/10 | May/June 2003 |
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UPCOMING AMI ADVOCACY MEETINGS • Tuesday, May 8 – Diana Manganelli, supervisor, Arlington County Child and Family Mental Health and Substance Abuse Services, will discuss Arlington’s services for children and adolescents who have psychiatric diagnoses. 7:30 p.m., Mt. Olivet United Methodist Church. • Thursday, October 9 – Annual Mental Illness Awareness Week Symposium sponsored by the Arlington Community Services Board. Tentatively set for 6 p.m. at the Arlington Central Library auditorium, 1015 North Quincy Street. |
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• Monday, May 19 – Joe O’Connor, ABC Nightline producer, will talk about “Media and Mental Illness.” This is a reschedule of the February meeting. Please note that this Speaker’s Meeting is the third Monday of the month to accommodate the Memorial Day weekend. • Monday, June 23 – Mark Bodner, special justice and practicing attorney, Fairfax County, will discuss his responsibilities as a Special Justice and other mental health-related legal issues. NAMI-Northern Virginia Speaker’s Meetings begin at 8 p.m. at the First Christian Church, 6165 Leesburg Pike (Route 7) Falls Church. The Church is located just east of Patrick Henry Drive at Seven Corners. Parking is available on church grounds. There are no NAMI-Northern Virginia Speaker’s Meetings in July and August. Speaker’s Meetings, which normally are the fourth Monday monthly, resume September 22. |
NAMI-Arlington Advocacy takes it annual summertime holiday, and will not meet in July, August, September or October. We celebrate our year of advocacy with our annual End-of-the-Year Potluck Supper, Wednesday, June 18, 6 p.m. at Clarendon House, and we mark the Annual Mental Illness Awareness Week Symposium as our October meeting. We resume our schedule of meetings Tuesday, November 11, 7:30 p.m., at the Mt. Olivet United Methodist Church. Our September/October newsletter will have more details.
NAMI-Arlington support group will meet the fourth Tuesdays – May 27 and June 24 – as scheduled, and will decide then whether to meet during July and August. To be absolutely sure, call 703/525-8616 to verify time. The place is also the Mt. Olivet United Methodist Church, 1500 North Glebe Road, Arlington.
• Members of Clarendon House mark Arlington County’s Neighborhood Day, Saturday, May 10, with their annual car wash. Proceeds go to the Consumers’ Fund, which supports special activities of the clubhouse members. The Car Wash is from 9 a.m. to 1 p.m. Cost is $7 for cars; $10 for SUVs.
• The 16th Annual Taste of Arlington, sponsored by Community Residences Inc. rain or shine Sunday, May 18, Wilson Boulevard by Ballston Commons Mall. This fundraiser supports the Arlington-based nonprofit that provides housing for those with mental disabilities, including mental illness. Admission to Taste of Arlington is free. Ticket books good for 8 tastes are available for $20 if purchased before May 8 and $25 thereafter. For more information, contact 703/841-7768, ext. 333.
• NAMI-Virginia Annual Convention, Thursday May 29, and Friday, May 30, Richmond. For more on the program, see related story on page 4.
• Annual End-of-the-Year Potluck Supper, Wednesday, June 18, 6 p.m., co-sponsored by the members of Clarendon House, the Friends of Clarendon House and NAMI-Arlington. Plan to attend the end-of-the-year activity that also honors the individual or individuals who have contributed to strengthening Arlington’s mental health services. The potluck is held at Clarendon House, 3141 North 10th Street, Arlington. NAMI-Arlington volunteers are needed to help with set-up, serving and clean up. Call Betsy Greer at 703/525-8616 to enlist.
• “Confronting the Mental Health Crisis in our Communities” is the theme of NAMI’s 2003 Annual Convention in Minneapolis, June 28 to July 1st. The focus is on eight program tracks on recovery, children’s care, affordable housing, the criminal justice system, geriatric issues, transitioning children to adult services, the Veterans Administration system and involving our faith communities. Research updates and “Ask-the-Doctor” sessions are also scheduled. For details, check NAMI’s website at www.nami.org.
ARLINGTON APPOINTS
MENTAL HEALTH MANAGER
Alan Orenstein, a retired director of two mental health districts in Washington, D.C., has been named manager of Arlington’s Community-Based Mental Health Services.
Orenstein succeeds Mary Kudless, who left the position of Arlington Mental Health Chief in August 2000. Under the reorganized Behavioral Healthcare Division, which merged mental health and substance abuse services into one unit, Orenstein’s position is different from what Kudless left. Orenstein will be responsible for the two outpatient treatment teams, the PACT team, Clarendon House, residential support services and The Job Avenue.
Under the reorganization, several areas of Kudless’ responsibility have been placed with other managers. Management of emergency services, intake for both mental health and substance abuse programs, discharge planning and homeless outreach services are under a new position for Client Service Entry. Medical Director Mildred Osborne is responsible for psychiatric and medical care and the medications unit. Substance Abuse Services Director Joe Bullock is responsible for mental health jail services.
Orenstein has been involved in mental health services for more than 30 years. He served as director of two mental health districts during his tenure in southeast Washington, D.C., where he initiated and supervised a psychosocial clubhouse program, a PACT team, and outpatient treatment and case-management teams. He also was responsible for residential programs. His philosophy supports consumer-driven programs and subscribes to the recovery model of service delivery.
Orenstein retired from the District mental health programs when his position was eliminated under a reorganization. He assumes his Arlington duties May 12.
Bullock, who has been acting Substance Abuse Manager, was named manager to fill that post, which has been vacant since the retirement of Phyllis Kohlmann.
COUNTY BOARD TO APPROVE
ANNUAL BUDGET
The County Board is due to vote Saturday, April 26, on its Fiscal 2004 budget just after The Arlington Voice goes to press. It is expected that the Board will endorse the recommendations of County Manager Ron Carlee to maintain current mental health services, and the more than $1.6 million in new mental health program initiatives.
The proposed budget includes $29,300 of County dollars for merit increases for residential contractors. It uses federal Local Public Assistance Cost Allocation Program (LPACAP) funds to restore nearly $500,000 of fiscal 2002 and 2003 cuts in state funding that will ensure continued levels of mental health services. This was the recommended priority of the Arlington Community Services Board’s Mental Health Committee.
Specifically, the LPACAP funds pay for $103,400 of fiscal 2002 state cuts that covered a part-time clubhouse employee and a contract psychiatrist. LPACAP funds pay for last October’s mandated 11 percent cut of $396,000 in state funds that covered mental health’s consumer-directed programming, homeless case management and both County and CR [Community Residences] residential support services. The restored funds include the services of 6.5 full-time employees.
Also restored in this manner was $39,230 for child and family nonmandated services.
New strategic initiatives cover $1.2 million for supportive housing or housing-related services. This includes funding for short-term crisis or emergency stabilization beds ($154,500), for support services for individuals who are dually diagnosed ($290,000) and for support services ($300,000) for homeless persons at the Residential Program Center.
There is also $354,000 for residential support services for the newly invested $7.5 million for the supportive affordable housing initiative that the Board endorsed last November. Advocates have urged more funding for this purpose, and the Board’s final action may include additional dollars in this area.
New strategic initiatives include $352,000 for specific Behavioral Healthcare programs for enhanced medical and psychiatric care ($100,000) and for mental health services at the Arlington jail and juvenile center ($252,000). The funding for the jail allows the Arlington Community Services Board (ACSB) to take over mental health services in the jail.
Child and Family Mental Health Services gained $245,000 for four full-time employees for secondary prevention efforts at schools, a priority of the County’s Partnership for Youth program. Senior Adult Mental Health Services gained funds for eight hours of contract mental health services at the new Walter Reed Community Center Adult Day Health Program.
GENERAL ASSEMBLY
COMPLETES WORK ON STATE BUDGET
The 2003 Virginia General Assembly adjourned last month endorsing a budget that rejected $2.25 million in new cuts to community services boards across the state.
These cuts would have been in addition to the 11 percent cuts sustained in community-based services required last October by Gov. Mark Warner. The restored dollars also fund community-based programs in substance abuse and mental retardation services.
The final budget document contains protections under Warner’s plan for restructuring mental health services for patients in state psychiatric facilities. Warner is proposing to take $22 million of general fund support for state hospitals for community-based services. The General Assembly added $2 million to ensure that transition funding to community services is adequate. NAMI-Virginia advocated strongly in this area, saying “bridge funding” was needed in any restructuring.
The General Assembly approved the establishment of a Preferred Drug List (PDL) for Medicaid recipients. Although atypical antipsychotics are exempt, lawmakers did not “protect” other psychiatric medications other than to require the Department of Medical Assistance Services (DMAS) to consider all the benefits of medications before placing restrictions on them. NAMI-Virginia had urged that all psychiatric medications be exempt.
Advocates should remember that the HJR 240 Study Committee discussed the need for $400 million in new funding to meet the service needs of Virginia citizens with serious mental illness. In the years following that recommendation less than 10 percent of that amount has been funded and last year’s state budget cuts effectively took back the dollars voted by the 2001 General Assembly for community-based mental health services.
It’s that time when we in NAMI-Arlington pause to honor those among us and in our community who have worked to ensure that Arlington has a strong mental health program.
We are calling on you to help us identify the individual or individuals. We are talking about NAMI members, members of Clarendon House, members of other nonprofit organizations, a member of the Arlington Mental Health Bureau – anyone and everyone who has contributed to the objective of making sure Arlington has the needed services for people who have mental illness.
Mary Montgomery is pulling together a committee to select an honoree or honorees. We are looking for your nominations to guide them. Submit a name or names and your reasons why you believe a specific individual or individuals should be recognized, and send your nominations to Mary Montgomery, 2205 South Buchanan Street, Arlington, Virginia 22206. Then come to our annual June potluck supper at Clarendon House to join in honoring him, her or them.
The deadline is May 15. So, put your thinking caps on now!
NAMI-ARLINGTON RECOGNITION AWARD(S)
Name of Nominee____________________________________________
What is/was the activity (or activities) that merits recognition?
Send to Mary Montgomery, 2205 South Buchanan Street, Arlington Virginia 22206, by May 15.
Carolyn Sanger of NAMI-Montgomery County is a mother who raised a son with serious mental illness, a son who is a college graduate and now fully employed.
“A success story of sorts,” said Sanger, who said she knew “something was wrong” by the time her son was two. Sanger, a long-time member of NAMI’s former Children’s and Adolescents’ Network (NAMI-CAN) and former president and executive director of NAMI-Montgomery County, Maryland, addressed NAMI-Arlington’s April Advocacy meeting on “Issues Faced in Caring for a Child with a Psychiatric Diagnosis.” Her presentation offered advice to families caring for a child with a psychiatric diagnosis, tips that ranged from ensuring one obtains an accurate diagnosis to how to make sure an Independent Education Plan (IEP) is designed specifically for that child.
Lesson No. 1, said Sanger is the importance of an accurate diagnosis. “I wasted 12 years listening to my pediatrician. If the first doctor doesn’t get it right, go to a second or a third doctor. Trust your reaction.” Sanger said she also consulted a neurologist to focus on structural [brain] issues. A good diagnosis, Sanger said, means obtaining the right medications.
She was fortunate to be able to send her son to a therapeutic school in Connecticut where he received care by “well-trained, objective professionals, who made a difference in stabilizing her son.” It was this experience that led Sanger to work with Way Station in Frederick, Maryland, a subsidiary of Sheppard & Enoch Pratt Foundation, to establish a respite program for parents of adolescents 11 to 17 years of age.
Her experience taught her that if one cannot keep balance at home, one cannot help a child. “Don’t let the level of tension at home reach a level that paralyzes you,” she counseled. She hired babysitters who worked in therapeutic settings as one way of support.
Sanger said that families have to learn to deal with the “terminology of emotionally disturbed.” “Don’t let that get in the way.” Sanger always used the term “mentally ill” and talked about “mentally ill (slash) emotionally disturbed.”
Still another lesson she learned was to be a better advocate. “Don’t regret that you don’t have a normal child, but find the best things in the child’s life and work for that.”
Parents, though, can get caught in a Catch-22 situation. Mental health professionals don’t understand the school system, and teachers don’t see mental illnesses. “You’ve got to deal with what you’ve got,” she said. “You’ve got to talk to schools in their language.” Sanger consulted lawyers (“But don’t bring a lawyer with you – schools hate lawyers”) and educational consultants. “I became a well-educated and informed parent, but I learned how to talk to school officials.”
Lastly, Sanger said, parents cannot begin the process of getting the best services in school until the child is tested. “If the child’s brain is miswired, the child has other cognitive deficits – such as, a deficit in processing language. One should obtain good psychoeducational testing to know what’s going on in the child’s brain along with the bipolar and depressive disorders.” She encouraged parents to urge the school to provide an independent evaluation or, if the family can afford it, get an independent evaluation by a neuropsychologist. “Get a clear picture of what your child’s strengths and deficits are,” she said.
Schools will put the emphasis on what is best about the child so that he or she won’t need to be coded for special services. If one disagrees with the evaluation done by the school, “get an independent evaluation,” she advised.
Sanger counseled to “do everything” in writing – and to keep envelopes to document actual time a response was sent. “If I had a conversation with a school official, I wrote a letter immediately saying ‘this is what I heard you say.’” The National Information Center for Children and Youth with Disabilities (www.nichcy.org) has draft letters for families with a child with mental illness that can be copied.
Next, Sanger said, comes the IEP. “You have to craft an IEP individualized to your child. It should not be ‘canned.’” The IEP contains the academic and social goals to enable your child to become better functioning with the family, peers and the school. Parents should show the school that they are cooperative, willing participants in the education of their child. One should obtain a draft copy of the IEP before the meetings, looking especially at the goals and objectives. Goals are general, while objectives define the specific skills the child is to learn.
“Talk to your doctor, therapist and your child’s teacher” to be sure you have their thoughts. Sanger urged. Make sure the IEP is specific. If the proposed IEP is not to your liking, ask that the meeting be postponed.
The IEP meeting will include a number of individuals, including a teacher, special education teacher and representatives of related social service agencies. Sanger recommends that parents bring someone to take notes – the educational consultant or a good friend – and tape-recorder. Let school officials know in advance that you are bringing individuals with you and that you plan to tape-record the session. Make sure, too, she said, that you understand what is said, repeating a statement with “Did I hear you correctly?”
If a regulation is cited, ask to see the regulations for yourself.
Lastly Sanger said, don’t be afraid not to sign an IEP. “Don’t sign it if you have any reservations. Once you sign an IEP, the school can implement it in any other year. By not signing an IEP, you are noting that the child’s needs are not met.”
Sanger said she did not expect her son to graduate high school. “I would do things differently,” she said. “I would have gotten a diagnosis earlier and got him on medications sooner.”
One lesson learned is the recognition that teachers lack training in teaching a child with mental illness. A student herself in early child development, Sanger said she never had any coursework in abnormal development and, she added sadly, that remains the situation today.
With this issue, The Arlington Voice offers a new, more readable format, thanks to Christina Kozyn, who volunteered her newsletter skills to NAMI-Arlington. Wayne Bert and Tom Quinn assist with proofreading, and Barbara Keish helps with the newsletter’s mailing. Richard and Betsy Greer began publication of The Arlington Voice in May 1992 to cover mental illness issues in Arlington County. NAMI-Arlington thanks all for their assistance and invites other volunteers to join in the newsletter production.
NAMI-Arlington has several committees that support its advocacy work, and invites interested individuals to become actively involved in one of these committees. These are a Criminal Justice Committee under Wayne Bert (wbert@cs.net), which is working to improve the way that Arlington handles those with mental illness who become involved in the criminal justice system; a Housing Committee under Kathy Donovan (kdonovan7@comcast.net), which is ensuring NAMI-Arlington’s voice is heard in the continuing work to obtain housing for those who suffer mental illness; and a Budget Committee (vacant chair) to formulate NAMI-Arlington positions – and make sure these positions are voiced – on state and local expenditures for programs that serve those with mental illness.
NAMI–ARLINGTON COMMITTEE
CRIMINAL JUSTICE FOLLOWS AGENDA
For some months the Criminal Justice Committee has been looking into the question of how better services can be provided in Arlington for the mentally ill. One issue we have been investigating is the process by which mentally ill people are committed for treatment. Members of the committee have attended commitment hearings, and we have consulted with numerous people about how these hearings might be improved.
We are convinced that one important issue is the presence of legal representation for the petitioner, the person who is requesting that a consumer be committed. In Arlington, these petitioners almost never have legal representation. A lawyer representing the petitioner would be able to better present a case for commitment, to surmount legal problems that may arise (such as someone changing their testimony), and would also be able to formulate alternate plans for dealing with the person being committed. The committee is therefore investigating the possibilities for getting such legal representation for petitioners.
The Committee has also been looking at Mental Health Courts. To date, no such courts exist in Virginia. But federal grants have been available for establishing pilot court projects and the committee believes this is something worth examining. Mental Health Courts basically provide for diversion from the regular court system to a path of treatment of people who are mentally ill and who are accused of nonviolent misdemeanors.
We have been investigating having a symposium on Mental Health Courts or submitting an application for federal money for a pilot project in Arlington. Right now, the Committee is talking with the Arlington Community Services Board about getting its assistance in promoting both Mental Health Courts and the issue of legal counsel in commitment hearings, discussed above.
The Committee is also attempting to find the resources to provide training for the police department to allow them to improve their ability to deal with those who are mentally ill.
NAMI-ARLINGTON INVOLVED
WITH LPACAP HOUSING PLANS
Two members of the NAMI-Arlington Housing Committee were among the 23 individuals who attended a March 29 Human Services Department workshop discussing types of housing and services needs under the just-approved Supportive Affordable Housing initiative for individuals with disabilities, including those with mental illness.
Human Services Department staff had invited advocates and housing providers to review what kind of housing would be needed and what kind of supportive services would be required to maintain individuals in such housing permanently.
The workshop is to lay the groundwork for developing plans under the $7.5 million program established last year by the County Board. A summary of the workshop’s discussion is expected to be issued shortly.
Representing the NAMI-Arlington Housing Committee were co-chairs Kathy Donovan and Sue Lowry.
Seeking information about NAMI activities in Northern Virginia – including speakers at the NAMI-Northern Virginia monthly Speaker’s Meeting? Check the NAMI-Northern Virginia website at www.aminv.org. It’s as simple as that!
Mental health consumers also have a website. Check out http://members.aol.com/nvmhca.
The Warner Administration’s restructuring plan, Ticket to Work Initiative, and how to deal with people with mental illness involved with the criminal justice system are among the discussion topics at NAMI-Virginia’s 2003 Annual Convention, Thursday, May 29 and Friday, May 30, Richmond.
Virginia Commissioner James Reinhard of the Mental Health, Mental Retardation and Substance Abuse Services Department, Consumer Activist Moe Armstrong and author Virginia Holman (Rescuing Patty Hearst) are among the headliners addressing the two-day event.
Breakout sessions will discuss mental health insurance and upcoming 2004 legislation, spotlighting mental illness in the forthcoming state General Assembly elections and a progress report on Virginia’s Assertive Community Treatment (PACT) teams. The ever-popular “Ask the Attorney” and “Ask the Doctor” sessions are also scheduled.
For more information and to register, contact NAMI-Virginia’s toll-free telephone line at 1/888/486-8264.
The Northern Virginia Regional Partnership, established to put the Warner Administration’s plan for reinvestment into effect, plans to issue an interim report this summer and seeks feedback before sending it to Richmond.
The Partnership is studying how to downsize the number of beds at the Northern Virginia Mental Health Institute and use the “saved” money for community-based programs. The Partnership includes representatives from the community services boards of Arlington, Falls Church-Fairfax, Prince William and Loudoun counties and the city of Alexandria, advocacy organizations (including NAMI-Northern Virginia) and the Institute.
Plans are to have the interim report on the web that individuals can download. The website is that of the Falls Church-Fairfax County CSB: www.fairfaxcounty.gov/service/csb/homepage/htm. To access the report, click on Health and Human Service, Human Service, F-FCCSB.
The report is expected to be filed in July.
Special Report
of the
Friends of Clarendon House, Inc.
OPEN HOUSE
HIGHLIGHTS ‘STARS’
More than 70 individuals heard the music of and saw the painting, photography and pottery produced by Clarendon House members during an Open House that featured the artistic talents of clubhouse members.
In his remarks opening the festive “Evening with Our Stars,” County Board Member Jay Fisette congratulated Clarendon House members and staff for making the Arlington program “a special place.”
“Clarendon House just got accreditation [from the Commission on the Accreditation of Rehabilitation Facilities (CARF)],” Fisette said. “Not everyone gets accredited – only the good programs.”
Under decorations of hanging golden stars, Clarendon House members performed original songs and played musical instruments. Also displayed were paintings, photographs, pottery, sculpture and a crafted wooden box and jewelry. The talents of 20 individuals were featured.
Besides Fisette, special guests included Arlington Community Services Board Chair Dean Bonney, Board members Kathy Donovan, Betsy Greer and Patrick Hope, Friends of Clarendon House President and Vice President Jan Macdonald and Richard Wakefield, respectively, and Susanne Eisner, deputy DHS director.
Support Clarendon House’s
Annual Car Wash
Saturday, May 10
from 9 a.m. to 1 p.m.
3141 N. 10th St., Arlington
CHANNEL 31 TO AIR
CLARENDON HOUSE
OPEN HOUSE
Individuals who subscribe to Arlington Cable TV have the opportunity to see the April 9 “Evening with Our Stars” Clarendon House Open House that featured the artistic talents of clubhouse members on Arlington’s government access cable channel – Channel 31 – later this month. To find out the dates and time, check the Channel’s schedule guide on the internet:
www.co.arlington.va.us/chan31.
Members of the Friends of Clarendon House, Inc. Wednesday, April 16, unanimously approved five bylaws changes. The vote came after a majority of members indicated support for the revisions that, for one, expand Friends’ activities beyond support for Clarendon House members to “all adults who are served the mental health programs of the Arlington Behavioral Healthcare Division.” Other revisions:
• Remove a prohibition that restricted officers from serving more than two consecu- tive full terms in the same office.
• Allow the president to establish working committees as needed rather than specify standing committees.
• Set a meeting quorum of six members.
• Allow the President to authorize another member to sign Friends’ checks along with the Friends’ treasurer.
• Establish a new family membership category.
The changes take effect immediately.
ASHTON HEIGHTS’ AUCTION
SUPPORTS CLARENDON HOUSE FRIENDS
The Friends of Clarendon House, Inc. will be a beneficiary of the Ashton Heights Civic Association auction, an annual community event that supports nonprofit organizations. The auction is set for Wednesday evening, May 21, at 7:30 p.m. at the Lyon Park Community House at North Pershing Drive and North Fillmore Street. Members of the Friends and NAMI-Arlington are encouraged to attend and help support this neighborhood event.
HELP SPREAD THE WORD
Remember – The Friends of Clarendon House next monthly meetings are
Wednesday, May 21 and June 18, at 7:45 a.m.,
at Clarendon House, 3141 North 10th Street, Arlington
Members of Clarendon House participated in a number of social events during 2002, many of them sponsored or backed by the Friends of Clarendon House, Inc., according to the Annual Report of the nonprofit organization that supports the clubhouse and Arlingtonians served by the County’s Behavioral Healthcare Division.
“There were the traditional Halloween and annual Holiday parties, [with] the latter continuing to be an open house for the community-at-large,” the report said. The Potluck Supper, jointly sponsored with the members of Clarendon House and NAMI-Arlington, has become an annual end-of-the-year event in June, bringing together members, family, neighbors and volunteers.
The report cited the Friends’ support of the annual Arlington Neighborhood Day car wash and the Clarendon House Fall Review, which publishes the literary and artistic talents of clubhouse members. The Friends also co-sponsored the Annual Mental Illness Awareness Week Symposium with Arlington County, and paid the way for eight Clarendon House members to the Virginia IASPRS Conference in Virginia Beach.
The Friends continued its tradition of supporting the Employer Recognition Breakfast, which honors the Arlington-area businesses and agencies that support The Job Avenue and the Clarendon House Transitional Employment Program. More than 60 persons attended the June 2002 event that said “Thank You” to employers for providing competitive employment opportunities to individuals with mental illness.
Also discussed was the Friends’ Emergency Fund, established in 1998, that provides funds for any Arlingtonian served by the County’s Behavioral Healthcare Division who faces unexpected expenses. Last year’s loans were for rental apartment deposits, dental care, repairs for a car used to get to a job and medications – “those day-to-day items which are vital to all of us,” the report said. Under the Friends’ Emergency Fund program, individuals who receive these loans are expected to repay at least a portion of them.
The report recognized the professional staff at Clarendon House “who support each individuals quest toward recovery from his or her mental illness.” The clubhouse and The Job Avenue “are two important elements of the needed strong community-based services to provide the required support for individuals with mental illness to allow them to achieve their highest level of independence within the community.”
The report concluded with an invitation to join with the Friends in its “work in supporting those we love to live in our community in a productive and satisfying way.”
THOSE WHO HAVE A DUAL DIAGNOSIS —
A SPECIAL CHALLENGE
Editor’s note: There is growing awareness that many who have mental illness also abuse substances, and that more is needed than traditional mental health and substance abuse programs. The following articles from the newsletters of NAMI Dane County (Madison, Wisconsin) and NAMI Southwestern Pennsylvania illustrate this.
From the NAMI-Dane
County newsletter:
Those who struggle both with serious mental illness and substance abuse face problems of enormous proportions. Mental health services are often not well prepared to deal with patients having both afflictions. If both are recognized, the individual may bounce back and forth between services for mental illness and those for substance abuse, or they may be refused treatment by each of them.
The problem of dual diagnosis is being recognized and there is an increasing number of programs trying to address it. It is now generally agreed that as much as 50 percent of the mentally ill population also has a substance abuse problem. The drug most commonly used is alcohol, followed by marijuana and cocaine. Prescription drugs such as tranquilizers and sleeping medicines may be abused. Both families of mentally ill relatives and mental health professionals underestimate the amount of drug dependency among people
continued on page 7, Dual Diagnosis
Dual Diagnosis, cont’d from page 6
in their care.
Substance abuse complicates almost every aspect of care. However, better understanding of the problem and potential treatments are on the way. Just as consumers and families have faced other very troublesome problems in the past and developed adequate responses to them, they can also learn to deal with this one in a way that their lives become less troubled and better treatment is received.
Most service systems have not been well designed with this population in mind. Typically a community has treatment services for people with mental illness in one agency and treatment for substance abuse in another. Clients are referred back and forth between them in what some have called “ping pong” therapy. What are needed are “hybrid” programs that address both illnesses together. Development of those programs locally requires considerable advocacy efforts.
Treatment programs designed for people whose problems are primarily substance abuse are generally not recommended for people who also have a mental illness. These programs tend to be confrontive and coercive and most people with severe mental illnesses are too fragile to benefit from them. Heavy confrontation, intense emotional jolting, and discouragement of the use of medications tend to be detrimental.
These treatments may produce levels of stress that exacerbate symptoms or cause relapse.
Desirable programs for this population should take a more gradual approach. Staff should recognize that denial is an inherent part of the problem. Patients often do not have insight as to the seriousness and scope of the problem. Abstinence may be a goal of the program but should not be a precondition for entering treatment. If dually diagnosed clients do not fit into local Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) groups, special peer groups based on AA principles might be developed.
From the
NAMI-Southwestern Pennsylvania newsletter:
Clients with a dual diagnosis have to proceed at their own pace in treatment. An illness model of the problem should be used rather than a moralistic one. Staff needs to convey understanding of how hard it is to end an addiction problem and give credit for any accomplishments. Attention should be given to social networks that can serve as important reinforcers. Clients should be given opportunities to socialize, have access to recreational activities, and develop peer relationships. Their families should be offered support and education.
NAMI Southwestern Pennsyl-vania asked that state’s deputy secretary about the vision and priorities of the Office of Mental Health and Substance Abuse Services. Part of the reply:
“Pennsylvania has begun to focus on the treatment needs of many special populations, including persons with serious mental illness who also abuse substances. The treatment for persons with these co-occurring diagnoses must be completely integrated and is different than the existing services provided within the two separate state agencies’ systems. We have not yet overcome some of the obstacles inherent in providing appropriate treatment to the same persons under two separate delivery systems. We will continue to work, through the funding of pilots and other endeavors, to facilitate integrated treatment. In a similar vein, we recognize the needs of, and will prioritize the treatment of, persons with serious mental illness who are in jail or prison. Pennsylvania must ensure that it is never easier to get arrested than it is to get treatment.”
NAMI-ARLINGTON
FAMILY TO FAMILY
COMPLETES 2003 COURSE
NAMI-Arlington completed a 12-week Family to Family course Saturday, April 5, awarding 21 certificates to class attendees. Betsy Greer and Anne Taylor co-facilitated the free course that teaches primary caregivers to individuals with serious mental illness, among other things, basic information about the brain disorders and the medications used to treat these disorders, how the brain works, coping strategies and communication skills. Course members included 12 parents, four with parents who suffer from mental illness, three siblings and two spouses. Eight class members came from Arlington, four from Fairfax County and three from Alexandria. Tentative plans call for giving the course again in January 2004.
The website of the National Information Center for Children and Youth with Disabilities is a good source for information for families caring for children with psychiatric diagnoses. Also check links with children’s websites at www.nami.org. Other sites are: www.aacap.org, www.ocfoundation.org, www.bpkids.org, http://aboutourkids.org, www.nimh.nih.gov, , www.ndmda.org, www.citizen.org/eletter, (up-to-date information on both older and newer medications). Listserves include: EDFAIRFAX@yahoo.com and mcneeds@yahoogroups.com.
• Mental illnesses are physical brain disorders that profoundly disrupt a person’s ability to think, feel, and relate to others and their environment.
• Mental illnesses are more common than cancer, diabetes, or heart disease.
• In any given year, more than five million Americans suffer from an acute episode of mental illness.
• One in every five families is affected in their lifetime by a severe mental illness, such as bipolar disorder, schizophrenia and major depression.
• One in 10 children and adolescents have mental illnesses severe enough to cause some level of impairment. Yet fewer than one in five of these young people receives needed treatment.
u The treatment success rate for schizophrenia is 60 percent, 65 percent for major depression, and 80 percent for bipolar disorder. Comparatively, the success rate for treatments of heart disease ranges from 41- 52 percent.
• The number one reason for hospital admissions nationwide is a biological psychiatric condition. At any moment, people with a mental illness fill almost 21 percent of all hospital beds.
• The total price tag of mental illnesses in this country is $148 billion, including direct costs (hospitalizations, medications) and indirect costs (lost wages, family caregiving, losses due to suicide).
• Despite media focus on the exceptions, individuals receiving treatment for schizophrenia are no more prone to violence than the general public. Unfortunately, almost one-third of all U.S. jails incarcerate people with severe mental illnesses who have no charges against them, but are merely waiting for psychiatric evaluation or the availability of a psychiatric hospital bed.
• Today, roughly 283,000 people with severe mental illnesses are incarcerated in jails and prisons, mostly for crimes they committed because they were not being treated for their illness.
• On any given day, approximately 150,000 people with severe mental illness are homeless, living on the streets or in public shelters.
• Roughly 80 to 90 percent of people with serious brain disorders are unemployed.
– A NAMI 2001
Mental Illness Awareness Week Fact Sheet
The Center for Mental Health Services has published six booklets that provide practical and positive self-help guidance for individuals with mental illness to help in their recovery.
“The self-care skills and strategies outlined in the guides can be used to complement other mental health care treatment. The guides offer practical steps that people need to keep in mind as they work on their own recovery,” said Charles Curie, administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), the parent agency of the Center for Mental Health Services.
The six booklets, which are free, are:
• Action Planning for Prevention and Recovery
• Dealing with the Effects of Trauma
• Speaking Out for Yourself
• Developing a Recovery and Wellness Lifestyle
• Building Self-Esteem
• Making and Keeping Friends
The free booklets may be ordered singly or as packets of all six along with a booklet Recovering your Mental Health: A Self-Help Guide. They can be ordered through SAMHSA’s National Mental Health Services Knowledge Exchange Network at P.O. Box 42490, Washington, D.C., 20015. Telephone is 1-800-789-2647.
A RESPITE PROGRAM
FOR PRE-TEENS
AND ADOLESCENTS
A Maryland-based subsidiary of the Sheppard and Enoch Pratt Foundation is offering short-term care for pre-teens and adolescents who suffer from serious mental illness.
Way Station Camp Journey Respite House in Frederick, Maryland, provides preventive therapeutic respite services for up to eight individuals, aged 11 to 17. The program offers a planned daylong schedule, recreational activities or schoolwork supervision. Medication therapy is also provided and monitored. The program permits pre-registration of a child in advance of actually using it.
Way Station Camp, which costs $155 daily (and may be covered by private insurance), can be used for respite or for therapeutic breaks for the child and the rest of the family.
For more information, contact 301/662-0099, extension 1702, or toll-free, 1/888/549-0629.
PULITZER GIVEN FOR SERIES
ON MENTAL ILLNESS ABUSES
The New York Times and its reporter, Clifford Levy, earned a 2003 Pulitzer Price in Investigative Reporting for their series on abuses in adult homes for people with mental illnesses. NAMI, in 2001, awarded the paper and reported its Outstanding Media Award in its initial stories on adult home scandals. NAMI also noted that last year, Pulitzer Prizes were awarded to editorial writers Alex Raksin and Bob Sipchen of the Los Angeles Times “for exemplary leadership in addressing issues facing homeless people with severe mental illness.” NAMI earlier had honored the paper and Raksin for editorial writing.
“The fact that the winners of NAMI media awards in 2001 have gone on to receive Pulitzer Prizes in two success years is testament to the seriousness and urgency of the ongoing crisis in the nation’s mental healthcare system,” NAMI said.
PARENTS AND TEACHERS
AS ALLIES
NAMI has a special pamphlet designed to help parents and teachers work together in educating a child with a psychiatric diagnosis. The 26-page monograph helps parents and teachers identify key warning signs of early onset mental illness, and discusses the issues these mental illnesses raise. The monograph is intended to provide an educational tool to advance mutual understanding and communication. Single copies may be obtained from NAMI (1/800/950-6264). Multiple copies may be ordered at $1 each through Lynn Saunders at 703/524-7600.
The National Institute of Mental Health’s Clinical Brain Disorders Branch is holding a special lecture and tour of its in-patient facility Thursday afternoon, May 29, in Bethesda. Research scientist Dr. Llewellyn Bigelow will speak on “The Art of Diagnosing Schizophrenia.” The place is Room 2C116 in Building 10 at the NIH Campus in Bethesda. The time is 1 p.m. to 4 p.m. Those interested should contact Anne Riley at 301/435-8970.
ARLINGTON APPOINTS
MENTAL HEALTH MANAGER
Alan Orenstein, a retired director of two mental health districts in Washington, D.C., has been named manager of Arlington’s Community-Based Mental Health Services.
Orenstein succeeds Mary Kudless, who left the position of Arlington Mental Health Chief in August 2000. Under the reorganized Behavioral Healthcare Division, which merged mental health and substance abuse services into one unit, Orenstein’s position is different from what Kudless left. Orenstein will be responsible for the two outpatient treatment teams, the PACT team, Clarendon House, residential support services and The Job Avenue.
Under the reorganization, several areas of Kudless’ responsibility have been placed with other managers. Management of emergency services, intake for both mental health and substance abuse programs, discharge planning and homeless outreach services are under a new position for Client Service Entry. Medical Director Mildred Osborne is responsible for psychiatric and medical care and the medications unit. Substance Abuse Services Director Joe Bullock is responsible for mental health jail services.
Orenstein has been involved in mental health services for more than 30 years. He served as director of two mental health districts during his tenure in southeast Washington, D.C., where he initiated and supervised a psychosocial clubhouse program, a PACT team, and outpatient treatment and case-management teams. He also was responsible for residential programs. His philosophy supports consumer-driven programs and subscribes to the recovery model of service delivery.
Orenstein retired from the District mental health programs when his position was eliminated under a reorganization. He assumes his Arlington duties May 12.
Bullock, who has been acting Substance Abuse Manager, was named manager to fill that post, which has been vacant since the retirement of Phyllis Kohlmann.
COUNTY BOARD TO APPROVE
ANNUAL BUDGET
The County Board is due to vote Saturday, April 26, on its Fiscal 2004 budget just after The Arlington Voice goes to press. It is expected that the Board will endorse the recommendations of County Manager Ron Carlee to maintain current mental health services, and the more than $1.6 million in new mental health program initiatives.
The proposed budget includes $29,300 of County dollars for merit increases for residential contractors. It uses federal Local Public Assistance Cost Allocation Program (LPACAP) funds to restore nearly $500,000 of fiscal 2002 and 2003 cuts in state funding that will ensure continued levels of mental health services. This was the recommended priority of the Arlington Community Services Board’s Mental Health Committee.
Specifically, the LPACAP funds pay for $103,400 of fiscal 2002 state cuts that covered a part-time clubhouse employee and a contract psychiatrist. LPACAP funds pay for last October’s mandated 11 percent cut of $396,000 in state funds that covered mental health’s consumer-directed programming, homeless case management and both County and CR [Community Residences] residential support services. The restored funds include the services of 6.5 full-time employees.
Also restored in this manner was $39,230 for child and family nonmandated services.
New strategic initiatives cover $1.2 million for supportive housing or housing-related services. This includes funding for short-term crisis or emergency stabilization beds ($154,500), for support services for individuals who are dually diagnosed ($290,000) and for support services ($300,000) for homeless persons at the Residential Program Center.
There is also $354,000 for residential support services for the newly invested $7.5 million for the supportive affordable housing initiative that the Board endorsed last November. Advocates have urged more funding for this purpose, and the Board’s final action may include additional dollars in this area.
New strategic initiatives include $352,000 for specific Behavioral Healthcare programs for enhanced medical and psychiatric care ($100,000) and for mental health services at the Arlington jail and juvenile center ($252,000). The funding for the jail allows the Arlington Community Services Board (ACSB) to take over mental health services in the jail.
Child and Family Mental Health Services gained $245,000 for four full-time employees for secondary prevention efforts at schools, a priority of the County’s Partnership for Youth program. Senior Adult Mental Health Services gained funds for eight hours of contract mental health services at the new Walter Reed Community Center Adult Day Health Program.
GENERAL ASSEMBLY
COMPLETES WORK ON STATE BUDGET
The 2003 Virginia General Assembly adjourned last month endorsing a budget that rejected $2.25 million in new cuts to community services boards across the state.
These cuts would have been in addition to the 11 percent cuts sustained in community-based services required last October by Gov. Mark Warner. The restored dollars also fund community-based programs in substance abuse and mental retardation services.
The final budget document contains protections under Warner’s plan for restructuring mental health services for patients in state psychiatric facilities. Warner is proposing to take $22 million of general fund support for state hospitals for community-based services. The General Assembly added $2 million to ensure that transition funding to community services is adequate. NAMI-Virginia advocated strongly in this area, saying “bridge funding” was needed in any restructuring.
The General Assembly approved the establishment of a Preferred Drug List (PDL) for Medicaid recipients. Although atypical antipsychotics are exempt, lawmakers did not “protect” other psychiatric medications other than to require the Department of Medical Assistance Services (DMAS) to consider all the benefits of medications before placing restrictions on them. NAMI-Virginia had urged that all psychiatric medications be exempt.
Advocates should remember that the HJR 240 Study Committee discussed the need for $400 million in new funding to meet the service needs of Virginia citizens with serious mental illness. In the years following that recommendation less than 10 percent of that amount has been funded and last year’s state budget cuts effectively took back the dollars voted by the 2001 General Assembly for community-based mental health services.
Members of the Friends of Clarendon House, Inc. Wednesday, April 16, unanimously approved five bylaws changes. The vote came after a majority of members indicated support for the revisions that, for one, expand Friends’ activities beyond support for Clarendon House members to “all adults who are served the mental health programs of the Arlington Behavioral Healthcare Division.” Other revisions:
• Remove a prohibition that restricted officers from serving more than two consecu- tive full terms in the same office.
• Allow the president to establish working committees as needed rather than specify standing committees.
• Set a meeting quorum of six members.
• Allow the President to authorize another member to sign Friends’ checks along with the Friends’ treasurer.
• Establish a new family membership category.
The changes take effect immediately.
Serious and persistent mental illnesses are biologically based brain disorders. For adults, these illnesses include schizophrenia, major depression, bipolar disorder, panic disorder and obsessive compulsive disorder. For children, the above illnesses are included and can also include autism, pervasive developmental disorder, attention deficit hyperactivity disorder and Tourette's syndrome.
Mental illness is not the same as mental retardation. In mental retardation, there is a loss of cognitive functioning, usually from birth. With mental illness, intellectual functioning can remain intact even though the brain chemistry and/or structure are affected. Additionally, many mental illnesses do not become evident until late adolescence or early adult-hood. It is possible for a person to be diagnosed with both a mental illness and mental retardation.
• NAMI-Arlington Advocacy. Meets 2nd Tuesday each month, 7:30 p.m. Mount Olivet United Methodist Church, 1500 North Glebe Road, Arlington. Contact is Betsy Greer at 703/525-8616.
• NAMI-Arlington Support Group. Meets 4th Tuesday each month, 7:30 p.m. Mount Olivet United Methodist Church, 1500 North Glebe Road, Arlington. Contact is Betsy Greer at 703/525-8616.
• Depression and Related Disorders (Family members only). Annandale. Contact is Barbara at 703/691-5538.
• Children and Adolescents Network Support Group. For further information, contact Ellen Storck at 703/534-3440.
• All diagnoses. Meets every Wednesday, 7:30 p.m. Prince William Hospital, Manassas. Contacts are Ann G. at 703/365-2019 or Shawn P. at 703/730-2665.
• Depressive and Manic Depressive Group. Meets 2nd and 4th Mondays each month, 7 p.m. Sunrise of Falls Church, 200 North Washington Street, Falls Church. Contacts are Barbara Solow at 703/620-5538 or Marshall Epstein at 703/641-5460.
• Depression and Related Disorders. School-age children and their parents only. Arlington. Contact is Madelyn 703/575-9054.
• Mood Disorder Group. Meets every Thursday, 7 p.m. 6245 Leesburg Pike – Suite 420, Falls Church. Contact is Anne Cowley at 703/354-5104.
• Depression and Related Disorders. Oakton. Contact is Brenda at 703/431-7592.
• Depression and Related Disorders. Meets 1st and 3rd Tuesday monthly at 7 p.m. Good Shepherd Lutheran Church, 1516 Moorings Drive, Reston. Contact is Tracy at 703/433-1448.
• Depression and Related Disorders. Meets 2nd and 4th Wednesday monthly at 7:30 p.m. Prince of Peace Lutheran Church, 8304 Keene Mill Road, Springfield. Contact is Alan Berkowitz at 703/256-5338 or 202/366-4795.
• Recovery Inc. offers free support group meetings in the Washington area for individuals struggling with anxiety, fear, depression, panic anger and other mental, nervous and emotional problems. For more information call 301/431-1818.
• Schizophrenia. Meets every third Wednesday, 7 p.m. to 8:30 p.m. Northern Virginia Mental Health Institute, 3302 Gallows Road, Falls Church. Contact is NAMI-Northern Virginia at 703/525-0686.
• Schizophrenics Anonymous. Meets every 2nd and 4th Monday and Wednesday from 2 p.m. to 2:45 p.m. Open to all consumers and held at PRS, 510 W. Annandale Road, Falls Church. For more information, contact Jim Gladden at 703/823-1419.
• Northern Virginia Mental Health Consumers' Association. Meets the 1st Sunday of each month, 4 p.m. Endependence Center of Northern Virginia (ECNV), 3100 Clarendon Boulevard, Arlington. Call 703/566-1699, Ext. 30# to verify time and location – in case of changes. Check the Association’s website at http://members.aol.com/nvmhca.
The final congressional FY 2004 budget resolution continues full federal funding for Medicaid, rejecting a proposal to cut $92 billion from the medical insurance program that supports low-income individuals, especially many with serious mental illness. The plan drew enormous criticism, not just from NAMI and other national advocacy organizations, but also from the nation’s governors and a bipartisan coalition of 79 senators.
Medicaid is the most important source of funding for public sector mental illness treatment and support services.
The House initially supported the $92 billion cut but, in face of Senate opposition, voted 399-22 to repudiate this action. The final result on the budget resolution, which sets the parameters for all spending legislation, excludes future cuts to Medicaid.
THE ARLINGTON VOICE is published bi-monthly for NAMI-Arlington, an affiliate of NAMI-Northern Virginia, by Betsy Greer, 4141 North Henderson Road -- 624, Arlington, Virginia 22203. The telephone number is 703/525-8616. The FAX number is 703/525-4080. E-mail address is rtgreer@erols.com. Comments and articles are happily solicited.
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