April 12, 2007

Topics Covered in this Edition:

• Boot the SHU Advocacy Day—April 17th
• MHANYS Spring Reception—May 3rd
• Bob Corliss Joins MHANYS Staff
• Civil Commitment Implementation
• Commissioner Hogan and Education Commissioner Mills to Present at Children’s Mental Health Awareness Day—May 8th
• Update on Parents with Psychiatric Disabilities

Boot The SHU Advocacy Day, April 17th

Boot the SHU
Legislative Advocacy Day 2007

STOP THE SUFFERING!

End the Abusive Practice of Placing People with Psychiatric Disabilities
in Solitary Confinement in NYS Prisons

Come to Albany in Support of the SHU Bill (S.333/A.4870)

TUESDAY, April 17th

*Please wear black to mourn those we have lost in solitary confinement.

Contact Tina at (212) 780-1400 x7772 or ckapeleris@cairn.org

MHANYS Reception on May 3rd Featuring Best Selling
Author Pete Earley

Celebrate Mental Health Awareness Month with the MHANYS Reception and Silent Auction on May 3rd at the State Room in Albany. The event features Pete Earley, former Washington Post Reporter, and best selling author of Crazy: A Father’s Search Through America’s Mental Health System. For more information and registration, log onto www.mhanys.org.

Bob Corliss to Join MHANYS Staff to Work on Mental Health/Forensics Issues

We are very pleased that Bob Corliss will be joining the staff of MHANYS at the end of April. Many people who work on mental health issue are very familiar with Bob’s work on forensics and mental health issues. He is regarded as one of the leading experts in the state in this area.

Prior to joining us, Bob has been the Associate Director for Criminal Justice for NAMI-NYS since 2000. While there, he helped countless family members in helping to provide advice and services to their loved one who were in the criminal justice system.

In addition, Bob has been a strong advocate for the banning of the use of solitary confinement for persons with psychiatric disabilities confined to the state prison system (SHU Bill). He has also been involved with the expansion of mental health courts and Crisis Intervention Teams (CIT) in local police departments as well as many other initiatives.

Before joining NAMI, Bob spent 19 years at the State Commission of Corrections where he served as assistant director of state operations.

MHANYS has had a long tradition of involvement on issues in the criminal justice arena. With Bob joining the staff, it is a real opportunity to continue to move that agenda forward. We will continue our advocacy around prison reform and maintain our strong opposition to the SHU’s, we will advocate to increase the number of mental health courts (as well as other jail diversion programs) across New York and we will use the example of the evidenced base best practice of the Memphis Model for Crisis Intervention Teams with local police department to expand this model across the state. We also look forward to working with the Executive and the Legislature to help create a more seamless system of re-entry for those individuals with mental illness released from jails and prisons. The Medication Grant Program at the Office of Mental Health has been a successful re-entry model for the medication needs of individuals. Programs like this should be expanded to help insure the successful integration of these individuals into the community.

On a personal note, Bob through his hard work and knowledge, has gained great credibility in the advocacy community. We are very pleased that he is working with us and we are also pleased that he will continue to play a major role in assisting individuals with psychiatric disabilities who have been involved in the criminal justice system.

April 13th, First Day of Civil Commitment Implementation

In another criminal justice related issue, tomorrow is the first day of official implementation of civil commitment. As we have said in the past, we will work with OMH and the other state agencies involved to insure that the safety needs of individuals currently in the psychiatric facilities are met. We will also continue to make the argument to policy makers that funding for civil commitment should not be in the mental health budget. There must be a separate funding stream in place and that will continue to be our mantra throughout next year’s budget process.

Mental Health Commissioner Hogan and Education Commissioner Mills to present at Children’s Mental Health Awareness Day Celebration on May 8th at the Cultural Education Center in Albany

For more information, click here.

We hope that this celebration is a positive sign of things to come in building a strong collaboration between OMH and the State Education Department and will start a powerful dialogue about the needs of youth with psychiatric disabilities as they transition out of adolescent settings.

Educating People about Parents with Psychiatric Disabilities

For many years, MHANYS has had a contract with the New York State Office of Mental Health for Parents with Psychiatric Disabilities. There are a staggering number of parents with mental illness who end up losing custody of their child solely because of their diagnosis. This is another prime example of the discrimination that continues to exist for individuals with mental illness.

Over the years, MHANYS and our affiliates have worked hard to dispel these myths by creating capacity through PWPD networks, by creation and distribution of the Parent Support Tool Kit, by providing trainings on best practices and holding yearly conferences on this issue.

In recent years, a growing recognition of this issue has emerged. This year the legislature has significantly increased funding for this program for the future. Under the leadership of Helena Davis, MHANYS Deputy Director and Lorraine McMullin, the MHANYS Project Coordinator for Parents with Psychiatric Disabilities, along with our colleagues at NYAPRS, we look forward to working with OMH and CQCAPD to prioritize funding so that it addresses capacity issues, recipient empowerment issues plus legal and lay advocacy.

For more information about the MHANYS program, please contact Lorraine McMullin at www.lmcmullin@mhanys.org.

IN THE NEWS

Long-Term Therapy Effective in Bipolar Depression
New York Times, April 10, 2007
By Nicholas Bakalar

Psychotherapy for as long as nine months is significantly more effective than short-term treatment for alleviating depression associated with bipolar disease, new research suggests.

The drugs used to treat depression are of limited use in treating the repeating depressive episodes of bipolar illness, according to background information in the article, published last week in The Archives of General Psychiatry.

The researchers studied 293 patients with bipolar disease at 15 medical centers nationwide. They randomly assigned one group of 163 people to one of three kinds of psychotherapy (cognitive behavioral therapy, interpersonal and social rhythm therapy, or family therapy) consisting of up to 30 50-minute sessions over nine months.

A second group of 130 patients was assigned to “collaborative care,” three sessions over six weeks designed to offer a brief version of the most common psychological and behavioral strategies shown to be beneficial in bipolar illness. The participants, whose average age was 40, were followed for one year, and all were also being treated with mood-stabilizing medicines.

Cognitive behavioral therapy focuses on challenging and controlling negative thoughts. In interpersonal and social rhythm therapy, patients concentrate on stabilizing daily routines and resolving interpersonal problems. Family therapy engages family members to help solve problems related to the illness, like failing to take medication properly, and to reduce the number of negative family interactions.

Therapists at each of the 15 medical centers received brief training in the therapies they administered.

“The study included real-world patients experiencing the early phases of a depressive episode,” said David J. Miklowitz, the study’s lead author and a professor of psychology and psychiatry at the University of Colorado. “And the therapists who delivered the treatment were trained by experts in the field with low-intensity training, which is typical of what’s available in real-life practice.”

Recovery rates after one year were a combined average of 64 percent for the intensive therapy groups, but only 52 percent for those who had brief therapy. In any given month, the researchers calculated, a patient undergoing longer-term therapy was more than one and a half times as likely to be well as one who had short-term treatment. Family therapy was slightly more effective than interpersonal or cognitive behavioral therapy, but the differences among the types of intensive treatment were not statistically significant.

“This is a monumental study,” said Myrna M. Weissman, a professor of psychiatry at Columbia who was not involved in the work. “There are no pharmaceutical companies willing to pay for research in psychotherapy, so we don’t have many clinical trials.” But, she added: “Psychosocial treatment for bipolar illness is not an alternative to medication. It’s a supplement.”

The authors, one of whom has received grant support and consulting fees from several pharmaceutical companies, found that the median time to recovery for the patients in long-term therapy was 169 days, compared with 279 days for those who received the brief treatment.

The cost of long-term therapy is high, and insurance companies are reluctant to cover it. But according to Dr. Weissman, the cost of not covering it could be higher. “It isn’t just the cost of the therapy. It’s the long-term cost. Bipolar illness has devastating effects on families as well as on the patients themselves.”

Criteria for Depression Are Too Broad, Researchers Say - Guidelines may encompass many who are just sad
Washington Post, April 3, 2007
By Shankar Vedantam

Up to 25 percent of people in whom psychiatrists would currently diagnose depression may only be reacting normally to stressful events such as a divorce or losing a job, according to a new analysis that reexamined how the standard diagnostic criteria are used.

The finding could have far-reaching consequences for the diagnosis of depression, the growing use of symptom checklists to identify those who may be depressed, and the $12 billion-a-year U.S. market for antidepressant drugs.

Diagnoses are currently made on the basis of a constellation of symptoms that include sadness, fatigue, insomnia and suicidal thoughts. The diagnostic manual used by doctors says that anyone who has at least five such symptoms for as little as two weeks may be clinically depressed. Only in the case of someone grieving over the death of a loved one is it normal for symptoms to last as long as two months, the manual says.

The new study, however, found that extended periods of depression-like symptoms are common in people who have been through other life stresses such as a divorce or a natural disaster and that they do not necessarily constitute illness.

The study also suggested that drug treatment may often be inappropriate for people who are experiencing painful -- but normal -- responses to life's stresses. Supportive therapy, on the other hand, may be useful -- and may keep someone who has been through a divorce or has lost a job from going on to develop full-blown depression.

The researchers -- including Michael B. First of Columbia University, the editor of the authoritative diagnostic manual -- based their findings on a national survey of 8,098 people. They found that those who had experienced a variety of stressful events frequently had prolonged periods in which they reported many symptoms of depression. Only a fraction, however, had severe symptoms that could be classified as clinical depression, the researchers said.

An estimated one in six Americans suffer depression at some point in their lives. Under the more limited criteria the researchers urged, that number would be 25 percent lower.

"The cost of not looking at context is you think anyone who comes under this diagnosis has a biological disorder, so should more or less automatically get antidepressant medication, and everything else is superfluous," said lead author Jerome Wakefield, a New York University researcher who studies the conceptual foundations of psychiatry. "There is a trend to treat people in this somewhat mechanized way."

Said First: "One issue this would play out at is at the level of medication. If someone has a normal grief reaction, you wouldn't give that person an antidepressant, you would favor counseling. If someone has major depression you would be more likely to medicate. So this could influence how clinicians think about medications or psychotherapy."

Drawing the line between normal and abnormal suffering has long been controversial in psychiatry, because people who have no disorders often experience the same symptoms as those who do, but their reactions typically are less prolonged and intense. Where to draw the line involves a degree of subjective judgment: If the criteria are too strict, some people who are depressed may not receive help.

After First oversaw the writing of the current edition of the manual, for example, a number of doctors contacted him about difficulties they had in applying the diagnosis, First said. One described a patient who was feeling acute grief after the death of her dog. The manual says doctors need not diagnose depression if symptoms follow the death of a loved one, and the doctor wanted to know whether the death of a pet met the criterion.

That question, First said, illustrated how difficult it was to establish a set of criteria that could encompass the complexity of human sorrow: The death of a spouse or a family member, he said, was only one of many things that could cause an acute grief reaction.

But he warned that people who are in pain after a divorce or other stressful event should not conclude that they simply ought to "buck up." They should seek the counsel of clinicians who would take the time to explore what caused the symptoms and whether they need treatment.

Still, Wakefield and Allan Horwitz, a researcher at Rutgers University who studies the sociology of mental disorders, said their study, which was published in this month's issue of the Archives of General Psychiatry, pointed out that sadness has increasingly come to be seen as pathological in the United States. They have written a book called "The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder."

Pharmaceutical companies, the psychiatric profession and patient advocacy groups have all contributed to the phenomenon, Horwitz added. Companies stand to make more money from the one-size-fits-all approach, researchers find the cookie-cutter model of disease makes it easier to do studies, and psychiatry has come to think of itself as "the arbiter of normality," he said.

Patient groups, Horwitz added, think that the stigma attached to mental illnesses would be reduced if they were shown to be more common.

"The way in which people interpret their emotions is changing," Horwitz said. "People are starting to think that any sort of negative emotion is unnatural, that they can take medication and feel better. What that can also do is . . . make it less likely for people to make real changes in their lives that might be better than medications.