NAMI-NORTHERN VIRGINIA WEBSITE

     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.naminova.org>.  It’s as simple as that! 

     Mental health consumers also have a website.  Check out <http://members.aol.com/nvmhca>.

MENTAL ILLNESS AWARENESS WEEK FEATURES SYMPOSIUM

     Mary Ann Beall of Falls Church, an individual with psychiatric disabilities, keynotes Arlington’s Annual Mental Illness Awareness Week Symposium, which will be held, Thursday, October 9, at the auditorium of the Arlington County Central Library, 1015 North Quincy Street.

     Special this year is the “Nothing to Hide:  Mental Illness in the Family” photography exhibit, sponsored by the Friends of Clarendon House Inc., which highlights the family experience with mental illness.  The exhibit seeks to change negative stereotypes and misconceptions the public often holds about mental illnesses.  The exhibit is planned at the library to coincide with the Mental Illness Awareness Week celebration.

     Beall has long advocated and worked for the recovery model in the treatment of mental illness, serving as a voice for all who suffer from mental illness on national, state and local boards or commissions to promote better treatments and services.  She is a member of the NAMI-Virginia Board of Directors, of the Northern Virginia Mental Health Consumers Association and of the review committee for the federal Center for Mental Health Services grant program.  Current efforts also include working with the University of Illinois at Chicago’s Center for Psychiatric Services and with the National Institute for Disability and Rehabilitation Research to develop cutting-edge “best practices” for serving those with mental illness.

     As in the past, an Informational Fair at 6 p.m. in the auditorium lobby precedes the Symposium, which begins at 7 p.m.  A panel of individuals with serious mental illness also presents at the Symposium.

     Mental Illness Awareness Week is an opportunity to educate our neighbors and the public about serious mental illnesses.   Make a point to attend the Symposium and encourage family and friends to join you.

     Fairfax County holds its Fourth Annual Mental Illness Awareness Conference, Friday, October 3, at the Fair Oaks Holiday Inn from 9 a.m. to 2 p.m.  Following a theme of “Increasing the Hope of Recovery,” the Conference includes a morning workshop panel on “Community Integration and Recovery.”  The luncheon keynote speaker is Amy K. Long, a psychiatric nurse who works as a full-time educator and trainer for the National Empowerment Center, Boston.  Pathway Homes, Inc. has more information at 703/876-0390.

COUNTY BOARD USES LPACAP FUNDS FOR FACILITY PURCHASE

     The Arlington County Board in June unanimously allocated $2.7 million for the purchase of a 39-bed assisted living facility in South Arlington.

     The allocation was the first from the $7.5 million of federal Local Public Assistance Cost Allocation Program (LPACAP) dollars that the Board last year set aside for affordable supportive housing for individuals with disabilities, including those with mental disabilities.  The facility, Oak Springs, was a privately operated assisted living facility.  Once renovations are completed, the County will operate Oak Springs as an assisted living facility for older Arlingtonians who need more support services than provided in group homes.

     Overseeing the project is Cynthia Stevens, hired as acting Housing coordinator.

     The Arlington Community Services Board has established an ad hoc committee to ensure citizen involvement and to develop recommendations for the project.  Members of NAMI-Arlington’s Housing Committee are participating in the process.  The Human Services Department has identified 106 individuals who could qualify for Oak Springs.  These include 79 individuals who are seriously mentally ill or who are mentally retarded.

     In addition, the County Board allocated $150,000 for a consultant’s study of ways to provide effective residential services and supportive housing.  Also allocated as part of the Fiscal Year 2004 budget were $700,000 LPACAP dollars – including $200,000 one-time funds – for supportive housing services.

APPOINTMENTS FILL BEHAVIORAL HEALTHCARE POSTS

     Appointments of five managers complete the reorganization of Arlington’s mental health and substance abuse services into the Behavioral Healthcare Division.

     Ruby Brown, Sam Gaines, Marilyn Schmal and Leslie Weisman are all long-time Mental Health employees, while Leigh Sue comes with budgeting experience from within Arlington County.  Along with the earlier designations of Alan Orenstein as manager of Mental Health Services, Joe Bullock as manager of Substance Abuse Services and Keisha Barros as Compliance Officer, these appointments round out the top slots of the Behavioral Healthcare Division, which was established in the fall of 2002.

     The appointments are:

·         Community Outreach and Education Manager – Ruby Brown, currently director of Project Resilience and a long-time member of Arlington’s Emergency Services.  Brown will be responsible for the County’s mental health response as part of its emergency preparedness for any disaster, for connecting families and consumers to services who are having difficulty accessing them, and to work with the community, especially the multicultural communities, to provide education, linkages and identify gaps.

·         Mental Health Jail Manager – Sam Gaines, currently a Mental Health therapist at the jail.  Gaines, a long-time Arlington employee, came to the county from Correctional Medical Services, a national medical provider to correctional institutions.  He has worked as a therapist in the jail and in Arlington’s outpatient programs.  He will supervise 5.5 full-time employees at the jail, including therapists on the mental health unit who, for the first time, will be providing programming for the unit.  Gaines’ experience includes a working relationship with Sheriff's Office staff.

·         Dual Diagnosis Manager – Marilyn Schmal, Arlington’s Dual Diagnosis specialist since the 1980s.  Schmal, whose work in this area is nationally recognized, will be responsible for developing and putting in place a new and strengthened dual diagnosis program.  Among her achievements are completing a book (with two co-authors) on dual diagnosis to be published next year and producing an 18-year outcome study on dual diagnosis.

·         Client Services Entry Manager – Leslie Weisman, a long-time mental health employee with a variety of experience in Emergency Services, Discharge Planning, and Homeless Case Management.  Weisman will oversee these services as well as Discharge Assistance and Diversion Services and a newly created Transition Team responsible for outreach to individuals resistant to treatment.  Assuming the role of “trouble-shooter,” Weisman developed the Arlington Diversion and Discharge program and supervised the Fellowship Health Resources program that carried it out.  She also pinch-hit as team leader of the Arlington Program for Assertive Community Treatment (PACT) and as supervisor of mental health jail programs. 

     Administrative Officer – Leigh Sue, currently in Environmental Services Department tracking the operating budget for the Utilities Office and Fund.  She will be the new budget and fiscal officer for the division and Arlington CSB.

     With the exception of Schmal, who starts her new post this month, the new appointees began work August 25.

JOB AVENUE HONORS PROGRAM’S EMPLOYERS

     The Job Avenue, Arlington County’s supported employment program, in July honored 22 area employers who hire Arlingtonians who suffer from serious mental illness.

     “We are celebrating a partnership between Arlington employers and those with a mental disability,” said Paul Ferguson, chair of the Arlington County Board, who keynoted the annual breakfast July 24 that has become the “thank you” to the program’s participating employers.

     The program “would not be possible without you,” Ferguson said, acknowledging employers’ role in providing individuals with disabilities the opportunity to work.  Employers know, he said, that they are gaining hard workers who give 100 percent day in and day out.

     For consumers who participate, the employment means getting out, making money, spending it and “participating in life,” said Ferguson.  He echoed the comments of Cindy Kemp, acting Behavioral Healthcare Division chief, who commended employers for the “unbelievable service” that they provide and lauded consumers who worked for their courage.  “Many people become independent and self-sufficient,” she said.

     Greg Cahill, owner of Whitlow’s on Wilson, spoke for employers.  His Job Avenue employees, Cahill said, were dependable and hard working.  “They do a great job and take pride in the business.  I am not talking about charity here.  The restaurant business is hard work, and they work hard.

     “All they need is a chance.  Once trained, they feel appreciated, and they work for you for a long time.  I am blessed to have them,” he said.

     William Spruiell and Stuart Cluff spoke on behalf of those who work.  Spruiell, a part-time evening receptionist at the Washington School of Psychiatry, described his work as “challenging.”  “I feel productive at my job,” he said, adding that the job allows him to live independently in his own apartment.  It permitted him recently to buy a “boombox” for himself and pay for a trip to New York to visit his family.  Cluff, who has worked for Whitlow’s on Wilson since July 2002, was brief and to the point.  “It makes me feel good that I work.”

     The Spring 2003 issue of The Job Avenue Employment News reported that during one of the snow storms last February, Cluff walked all the way from Columbia Pike to Clarendon to help open Whitlow’s on time for customers to enjoy Sunday Brunch.  Whitlow’s designated Cluff its “Employee of the Month.”

     Employers honored were the American Psychological Association, Arlington County, Arlington County Public Schools, Clarendon Grille, CVS Pharmacy, Giant Food Inc., Just Grooming, Kinder Haus Toys, Mister Days, PRS, SOC, Strategic Property Management, the Arc of Northern Virginia, The Carlin, U.S. Department of State, U.S. Patent and Trademark Office, Washington School of Psychiatry and Whitlow’s on Wilson.  Individuals hired by these employers were also honored.

     The American Psychological Association in July hired also 45 members of Clarendon House and The Job Avenue to stuff packets for its annual convention.

BERT JOINS ARLINGTON CSB

     Wayne Bert, chair of NAMI-Arlington’s Criminal Justice Committee, was appointed in July as a member of the Arlington Community Services Board.  He will join the CSB’s Administration Committee.  NAMI-Arlington congratulates Bert on his appointment.

     The CSB, which is the citizen advisory board to the County Board on mental health, mental retardation and substance abuse programs, always seeks citizen involvement and support.  NAMI-Arlington encourages all its members to think seriously about joining one of the CSB working committees – on Administration, Substance Abuse, Children and Youth, Mental Retardation and Mental Health.  Each of these committees meets one evening a month for two to three hours, and any Arlington resident may participate.  It is a good way to learn about and understand Arlington’s programs in these areas.  Those of us with family experience in a disability area have good information to share to improve these services.

     For more information, contact Betsy Greer at 703/525-8616.

DELACY NAMED INSTITUTE DIRECTOR

     Lynn C. DeLacy has been named director of the Northern Virginia Mental Health Institute (NVMHI).

     DeLacy, who has worked at the Institute for 25 years, has been acting director since November 2002 when Mohamed El-Sabaawi resigned.  The Institute is a 132-bed psychiatric facility in Falls Church.

     “Lynn DeLacy has directed nursing services at the Institute for 20 years, shouldering full administrative and clinical responsibilities for critical patient care,” said Commissioner James Reinhard of the Virginia Mental Health, Mental Retardation and Substance Abuse Services Department, who announced the appointment.   “She is recognized nationally for her leadership in methods to reduce seclusion and restraint.  She is respected by the community and by the staff at the facility.”

     DeLacy was director of Nursing at the Institute from 1983 to November 2002.   She previously served as acting director from November 1997 until April 1998.  She is a doctoral candidate at George Mason University’s College of Nursing and Health Science, having received a Master’s degree from VCU’s Medical College of Virginia.  Her undergraduate degree is from American University.

     Among the awards that DeLacy has received is the 2001 Mental Health Consumer Award for Service Provider Excellence from the Northern Virginia Mental Health Consumers’ Association.

     Meanwhile, the U.S. Justice Department closed its case on Western State Hospital, the fifth Virginia institution investigated under the federal statute protecting the civil rights of institutionalized individuals.  The department, however, warned the Commonwealth to continue to maintain appropriate standards of care.  The lack of such standards caused the department initially to investigate conditions at the Northern Virginia Training Center, a facility for individuals with mental retardation, and four psychiatric facilities – Eastern State, Central State and Western State hospitals and the Northern Virginia Mental Health Institute.  All investigations have been ended following state agreement to improve facility programs.

IN MEMORIAM

     We of NAMI-Arlington have lost a friend and fierce advocate for those with mental illness with the passing of Caitlin Wright-Binning.  Among her many achievements, Caitlin, deputy director of NAMI-Virginia from 1995 to 2001, worked diligently to transform Virginia’s Protection and Advocacy program, to revise Virginia’s Not-Guilty-By-Reason-of-Insanity laws and to liberalize Virginia’s Medicaid eligibility standards.  She is the primary reason that the death of Gloria Huntley in the mid-1990s at Central State Hospital was brought to public attention and became a national scandal, focusing on the need for strengthened human rights safeguards and especially the elimination of seclusion and restraint practices within Virginia’s treatment system.  The individual with mental illness was her specific concern.  All in the mental health community have lost a passionate friend and supporter.  NAMI-Arlington offers its sympathy to Caitlin’s many friends and family.  We share their loss.

NEW PROVIDERS BRING SERVICES TO ARLINGTON

     Pathway Homes, Inc. and Fellowship Health Resources, Inc., two area mental health providers, have been awarded contracts to serve Arlingtonians with serious mental illness.

     Pathway Homes, a Fairfax County-based nonprofit started 20 years ago by NAMI families, will provide residential case management services to individuals living independently within the community, allowing Arlingtonians with mental illness a choice in selecting a support services provider.  Community Residences Inc. (CR) has been responsible for this service under its Community Living program.  It will continue to serve clients as well.

     Initially Pathway Homes projects it will have two full-time counselors serving 28 consumers in Arlington.  The counselors will work closely with Arlington case managers to support their efforts with consumers by providing authorized services such a transportation to doctors’ appointments and help with daily living activities.

     Introduced to the Mental Health Committee of the Arlington Community Services Board in April, Pathway Homes CEO Joel McNair said his organization is aware that any kind of change is stressful.  His message to consumers:  “We will be doing our best to accommodate you.  We want to assure you that we will be there for you.  Our services are flexible and individualized.  It’s not just about what you need, but what you want.  Our goal is to be there for you and to get to know each of you individually.”

     Pathway Homes, started in the mid-1980s by NAMI-Northern Virginia families, is a housing and residential-support service provider in Fairfax County.  It began serving Arlingtonians July 1.

     Under its newly completed contract, Fellowship Health Resources, a Rhode Island-based nonprofit, will provide community crisis and emergency stabilization services under its ACCESS program.  The program is similar to that previously provided by CR in its CARE facility, which CR will continue to operate.  The ACCESS program, like CARE, seeks to divert individuals in crisis from hospitalization by providing intensive community-based treatment.

     Fellowship currently operates Arlington’s Discharge and Diversion (DAD) program in South Arlington.

NAMI-ARLINGTON COMMITTEE NEWS

     NAMI-Arlington has three committees that support its advocacy work, and it invites interested individuals to become actively involved in one of these committees.  The Committees are:  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;  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 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 CRIMINAL JUSTICE COMMITTEE ACTIVITIES

     Members of the NAMI-Arlington Criminal Justice Committee met in July with Arlington Police Chief C. Douglas Scott to discuss the issue of increased training in preparing police for dealing with persons with mental illness.

     Along with Ron Honberg, NAMI-National Policy Director and Legal Counsel, the Committee members suggested that the best model for such training is the Memphis approach, where a crisis intervention team is given intensive training (44 hours) in dealing with those who suffer mental illness.

     Chief Scott expressed his view that the department is doing a good job, but he also offered a willingness to consider additional training for the department.

     One big concern for the police that surfaced in the discussion is the time a police officer may spend waiting for a temporary detention order for an individuals to be involuntarily held for an assessment.  The police are not allowed to leave a patient until the temporary order is obtained.  The Committee agreed to review the process to see if changes can be made to reduce the time of involvement by police in such cases.

     Chief Scott also made the point that when the police are called because someone with mental illness is threatening violence, it is important that the person calling describe the behavior.  Saying a person is “bipolar and acting crazy” doesn’t tell the police what they need to know.  But saying a person has locked himself in a room with a knife and is threatening to kill himself helps the police know what to expect and how to deal with the situation.

     The police chief also said for folks seeking an emergency mental health evaluation need to state clearly this request to avoid having police dispatchers send Emergency Medical Service (EMS) teams to the scene.  The mental health Emergency Services professionals are trained to do mental health assessments, which determine if a person is a danger to self or others, while EMS teams are trained in medical matters.

     The Criminal Justice Committee continues to work with the Community Services Board to try to get legal representation for petitioners in civil commitment hearings.  The Department of Human Services is currently collecting data on hearings and a meeting will then be held to determine whether legal representation can be provided.  It appears that all agree that legal representation for petitioners would improve the conduct of the hearing and help provide the best information for the judge’s decision, but DHS is not sure it can provide such representation.

     The Committee is also working with the Community Services Board to inform the community about Mental Health Courts.  It is hoped that an application for a pilot project grant will be submitted in FY 2004.  At present the CSB is studying the issue. 

     The Committee meets once a month and welcomes anyone interested in attending.  It also welcomes new issues that the Committee should pursue.  For information about the Committee and its next meeting, please contact Wayne Bert at 703/532-4479.

NAMI-ARLINGTON BUDGET COMMITTEE ACTIVITIES

     NAMI-Arlington desperately needs a willing person or persons to head up its Budget Committee activities.  Members of the Committee would monitor both the state and county budget process, keep the NAMI-Arlington membership informed and offer proposed positions for NAMI-Arlington to take in the budget process.

     The state budget process begins in mid-December when the Governor offers his budget recommendations.  Members of the state money committees – the House Appropriations and Senate Finance committees – hold a hearing in Northern Virginia on the governor’s recommendations either just before or after the New Year’s holiday.  In addition, members of Arlington’s delegation to the General Assembly hold their pre-session hearing on or about the first week of January.  NAMI-Virginia keeps all NAMI members up-to-date on what is happening in Richmond, and often calls on advocates from around the state to contact local lawmakers.  NAMI-Arlington’s Budget Committee would monitor these activities.

     At the County level, the Committee would review in February the County Manager’s proposed budget and organize NAMI-Arlington’s position(s) on the proposed budget for presentation to the County Board either at the March Board Budget hearings, by letter or by individual visits to the Board members.  For further information, contact Betsy Greer at 703/525-8616.

NAMI-ARLINGTON STARTS NEW SUPPORT GROUP

NAMI-Arlington has started a new support group for individuals who have a parent with serious mental illness.  The support group, patterned after NAMI-Arlington’s long-time support group for family members, meets the third Thursday monthly at 7 p.m. at the Mt. Olivet United Methodist Church, 1500 North Glebe Road.  Help NAMI-Arlington spread the word about this new group, which is special because of its specific focus.

Friends of Clarendon House, Inc.

HELP SPREAD THE WORD

     Just ask ONE neighbor, friend or relative who is a federal employee to designate No. 6003 in the 2003 Combined Federal Campaign.  No. 6003 is the number of the Friends of Clarendon House.  This designation will help the Friends in its mission to support the emergency needs of mental health consumers served by Arlington County.  The Friends will be glad to provide a brochure on its mission and its work upon request.  Call 703/525-8616 for more information.

SPECIAL ST. CHARLES TITHE SUPPORTS THE FRIENDS

Members of St. Charles Borromeo Church again supported the Friends of Clarendon House, collecting in a special May tithe more than $1,600 for the nonprofit group.  Last year, St. Charles forwarded a check for more than $1,400 to the Friends, which supports Arlingtonians with mental illness who are served by the Behavioral Healthcare Division in a variety of ways.  A major program is the Friends’ emergency fund, which gives financial assistance for those who may need a deposit for an apartment, for emergency dental work or to buy an emergency prescription of psychiatric medications.

Remember – The Friends of Clarendon House next monthly meetings are

Wednesday, September 17 and October 15, at 7:45 a.m., at Clarendon House

3141 North 10^th Street, Arlington.

Be sure to come.

PRESIDENTIAL COMMISSION ISSUES REPORT

     The New Freedom Commission on Mental Health, established by President Bush, issued its final report, “Achieving the Promise:  Transforming Mental Health Care in America,” last July.

     The report highlighted the serious fragmentation of the nation’s mental health system, and emphasized the need to transform this system.  The report can be obtained from the Internet at www.mentalhealthcommission.gov or by calling 800/662-4357.

     NAMI National Executive Director Richard Birkel said what happens in the coming months will determine the value of the report.  “If it works as well as we hope to stimulate action, then it will be a great report.  If it’s a snapshot of a system in shambles in 2003 and nothing happens, it will be a terrible report,” Birkel said.

     “The goals and standards [the Commission] has set are good ones.  Get people into treatment early, have high expectations of recovery.  This is the opposite of what we have now.”

     Birkel said a shortcoming of the report were the actual next steps to take to improve the system.

     The Treatment Advocacy Center said the report “squandered an opportunity to be a unique champion for those most severely impacted” by mental illnesses.  It said the Commission “left out the people who needed them most” – individuals who are the most ill.  The Center faulted the Commission report for failing to recommend programs, such as assisted outpatient treatment, which targets those who are severely ill and who resist treatment.

EFFECTIVE COMMUNICATION REQUIRES ACTIVE LISTENING

Families are often baffled by their inability to discuss symptoms and treatment with their relative who is mentally ill.  A NAMI-Washtenaw County (Ann Arbor, Michigan) meeting talked about how to discuss these issues productively.

     While brain disorders are like other (somatic) illnesses in that a specific part of the body is affected, there is an important difference.

     People with heart or lung disease often deny the problem, ignoring advice to exercise or stop smoking.  But with mental illness, the problem is primarily a lack of insight rather than denial.  Individuals with mental illness remain unaware of their illness and its symptoms.  In the experience of Dr. Gregory Dalack, chief of Psychiatry at the Ann Arbor VA Hospital, only about 10 to 15 percent of his patients have insight into their illness.

     Cognitive impairment also affects the ability to evaluate risks and benefits, and to make appropriate decisions.  Lack of insight becomes a major barrier to treatment, and results in a poorer course of illness, aggressive behavior, and involuntary treatment.

     The situation is complex.  Family members recognize the suffering caused by untreated mental illness, and mourn how different theirs and others' lives are from what was expected.  Families also have concerns about not being able to treat the disorder early.  According to Dalack, the importance of early, consistent treatment can not be overestimated.  As with other chronic diseases, the best outcome is achieved if multiple episodes can be avoided.  Repeated episodes damage the brain and make it harder to control symptoms.

     While families recognize the importance of adherence to treatment, the tendency is to ignore non-adherence until it almost too late – why ruffle feathers?  But waiting until later can make a difference.  Over time, the situation becomes even more difficult.

     The audience was asked about goals for treatment.  Families identified their goals as stability, illness recognition, medications, medications with tolerable side effects, and trust with parents and physician.  One consumer added, “I want to behave so people can't tell I'm mentally ill.”

     Dalack said that it is not necessary to discuss a specific mental illness.  If there is not agreement on the subject, one may just hit a brick wall.  A more effective approach is to talk about things your ill relative brings up, seeking areas that both sides can agree on.  An example might be concern about not doing well in school or at work.

     Look for shared goals and ideas.  Listening is the key.  Separate yourself from the emotional upheaval and hear what your ill relative is saying.  Do this over and over, grabbing opportunities as they arise.  Emotional responses are expected and understandable, but they need to be processed to get beyond them.  NAMI groups help by providing encouragement and helping people stay with the process, which may take a long time.

     Empathize with the loved one who is suffering. You might say that you realize how difficult it must be to feel that someone is always watching, so that one is unable to go anywhere without being under observation.

     You can agree with feelings without agreeing with something that is not true.  Agree that the ill individual feels scrutinized, or that it is bad when sleep is disrupted, or that the medication has side effects.  It is important to put aside your own disappointment and instead show that you recognize how miserable your ill relative's experience is.  The goal may be to decrease the discomfort about being watched so that he or she can better deal with the situation.  List as many areas of agreement as possible, acknowledging what is going on with the individual.  Discuss the good and bad of what is on the list.  You may be able to agree that disturbed sleep or inability to work is a problem, while the advantages of treatment are not recognized.  This can take time and discussion on more than one occasion.

     Dalack referred to Xavier Amador's book, I'm Not Sick, I Don't Need Help, which summarizes this process using the letters LEAP. 

     Listen to the person and ask about frustrations and desires.  You convey respect just by listening.

     Empathize by showing that you understand how the person feels.  “If this were happening to me, I would feel the same way.”

     Agree with the person.  Try to talk about just those things you can agree on, such as how he or she perceives the advantages or disadvantages of treatment.

     Partner.  Partnering happens when both understand the others needs and can move forward with what both agree on. – From the January 2003 issue of Connections, the newsletter of NAMI of Washtenaw County.

WORK BEGINS ON FISCAL 2005 BUDGET

     Arlington County is only eight weeks into its Fiscal Year 2004 budget, and work is already under way for Fiscal Year 2005 spending.

     As the September/October issue of The Arlington Voice goes to press, the Arlington Community Services Board committees have started their review of mental health, mental retardation and substance abuse programs to make recommendations for funding levels and program initiatives for the next budget year.  In addition, the Board and the director of the Human Services Department are scheduled to hold a combined hearing when the public can testify on program supports and needs.  The date, time and place for that annual hearing, still to be set, can be obtained by calling Lessie Dew, administrative assistant to the CSB, at 703/228-5001 or emailing Dew at ldew@co.arlington.va.us.

     This is a the time to let our Arlington policymakers know what programs and services are working to help our ill family members to achieve recovery, and where the gaps are that prevent such recovery.

     As in the past, the budget process begins with staff recommendations that are reviewed by the CSB that, in turn, makes its recommendations to the director of Human Services Department.  The director incorporates these budget recommendations within the department’s submission to the County Manager in November.  The County Manager presents his recommended budget to the County Board in early February.  County Board hearings on the budget occur in early March, with the Board making final budgetary decisions by mid- to end-April.

     An initial review of Arlington’s mental health services in June, showed program needs for the equivalent of five new full-time employees at a cost of more than $300,000, and $1.1 million in new net program costs.

     Meanwhile, the County Board last April approved its Fiscal 2004 budget, which included more than $1.6 million in new mental health initiatives.  County supervision of mental health programs in the Arlington jail and strengthened mental health services in Arlington’s Residential Program Center, a homeless shelter, are among the new initiatives.

WORKING TO OBTAIN “BEST PRACTICES”

The following article is from a booklet by the Ohio Department of Mental Health Program Evaluation and Research Office and is based on a 1999 Longitudinal Consumer Outcomes Study.

     The Longitudinal Consumer Outcomes Study (LCO) is part of a longitudinal study of the mental health services, needs, and outcomes of adult consumers with severe mental disabilities (SMD) in Ohio.  This research includes five waves of measurement, spanning a period of eight years (1991-1998).  At each wave, consumers have participated in in-depth interviews regarding their services, needs, and outcomes.  Their case managers have provided additional information about needs, clinical diagnoses, medications, symptomatology and functioning.  The study was conducted in two urban and two rural board areas in Ohio.

     Originally designed to test a model that included client and service system characteristics, service mix received, and consumer outcomes achieved, the study has been adapted to incorporate new issues relevant to mental health consumers.  For example, examining such issues as service empowerment, recovery, effects of using new antipsychotic medications, and crime victimization and perpetration.

Top Ten Findings

     1. Consumers’ perceptions that their needs are met are the best predictors of positive mental health outcomes.  In the most recent measurement period of the study, structural equation modeling was used to identify those things most highly linked to consumer outcomes.  The consumer's perception of the degree to which his/her needs were being met was the strongest predictor and accounted for 20 percent of the variance in symptomatology outcomes and 35 percent of the variance in quality of life outcomes.  Mental health outcomes were not related to the amounts or types of services consumers received.  Practice implication:  To improve consumers' outcomes, service providers must attend to individual consumer’s perceptions of what services are needed and the extent to which the consumer thinks his/her needs are being met.  The lack of a link between service use and outcomes suggests that services are not as focused as needed.  Given the strong evidence that certain well-structured services are effective (e.g., PACT, family/consumer education and support groups), there is a need to incorporate proven practices into Ohio programs.

     2. The top two unmet needs identified by consumers are (1) vocational assistance, and (2) finding out about services.  By comparing the amount of help consumers need in a number of areas with the amount of help they receive, the LCO study was able to determine unmet need.  According to consumers, 12 needs were unmet

1.        Vocational assistance.

2.        Finding out about available services.

3.        Making friends.

4.        Medical and dental care.

5.        Educating others about their problems.

6.        Talking about problems.

7.        Legal issues.

8.        Benefits and income supports.

9.        Complaining about services.

10.     Interpersonal issues.

11.     Housing.

12.     Transportation.

     The top two unmet needs identified by consumers have remained the same in every year of the LCO study.  Practice implication:  Local systems need to concentrate more energy on meeting consumers' needs, especially in the areas of vocational assistance and information about available services.

     3. Consumers and case managers have different perceptions of met needs.  Consumers' perceptions of needs are better predictors of mental health outcomes than are case managers' perceptions of needs.  Case managers thought that consumers had only eight unmet:

1.        Making friends.

2.        Vocational assistance.

3.        Interpersonal issues.

4.        Managing money.

5.        Legal issues.

6.        Managing medications.

7.        Help with day-to-day things.

8.        Medical and dental care.

     Three of these needs were seen as met or overly met by consumers:  Interpersonal issues, managing money and managing medications.  In contrast to Finding No. 1, case managers' perceptions of met needs predicted less than 1 percent of the variance in symptomatology and quality of life outcomes and 14 percent of the variance in functioning outcomes.  Practice implications:  Service providers' views often do not reflect consumers' perceptions of their needs.  Providers should reexamine how or the extent to which they engage in active listening to consumers around their needs and work toward incorporating more consumer perspective in treatment planning.

     4. Consumers' perceptions of their level of service empowerment (e.g., their involvement in treatment planning and decisions about services) was the variable most highly correlated with the degree to which they felt their needs were being met.  Empowerment accounted for approximately 21 percent of the variance in met needs.  Consumers who feel more empowered seem to be more able to get their needs met.  As indicated in Finding No. 1, getting needs met has the greatest impact on positive outcomes.