NYAPRS Member Only benefit: First 2014 MRLC Webinar, OUTCOMES, Jan 22, 2014

NYAPRS Note:  Join NYAPRS now and be a part of the first MRLC Webinar of 2014, Identifying, Collecting and Using Data for Improved Service Delivery, January 22, 2014. As New York’s Behavioral Health System transitions to managed care we are being confronted with multiple challenges including the ability to demonstrate the effectiveness of the services that we provide. We will all have to learn to use data in our EHR’s, and use clinical, administrative, and financial data to make decisions. This presentation will address the types of data that will need to be collected in our transformed system, and how that data can be used to improve practice, demonstrate effectiveness to payers, and make sound business decisions. January 1 marks one year and counting till we transition to fully capitated managed care for all our adult services. In this new environment, data is key!


Join Dr. Andy Cleek, Executive Officer, Senior Research Scientist, McSilver- Urban Institute for Behavioral Health as he presents and leads a discussion about this important topic. The MRLC is a special NYAPRS MEMBERS ONLY benefit. .  If you are not a NYAPRS Organizational member join now at http://www.nyaprs.org/join-us/ and don’t miss out on any of the exciting and informative upcoming MRLC webinars. After joining NYAPRS, contact mary@nyaprs.org to join the MRLC and access up to date information on health care reform, Health Home implementation, Medicaid Redesign and Managed Care.









Wednesday, January 22, 2014


“Identifying, Collecting and Using Data for Improved Service Delivery”


Your “go to webinar” registration invitation is sent to all MRLC members before the webinar. Join NYAPRS and join the MRLC to obtain the link.


The Agenda for the January 22nd , 2014 webinar is as follows:

  • Welcome, Review of Day’s Agenda: Edye Schwartz
  • State Health Home Advocacy/Informational Update: Harvey Rosenthal, NYAPRS Executive Director
  • Presentation: Identifying, Collecting and Using Data for Improved Service Delivery

Dr. Andy Cleek, Executive Officer, Senior Research Scientist,

McSilver- Urban Institute for Behavioral Health

  • Questions & Answers



If you are not a NYAPRS Organizational member join now at http://www.nyaprs.org/join-us/

and don’t miss out on any of the exciting and informative upcoming MRLC webinars.



CONTACT mary@nyaprs.org


Essential New Roles for Peers and Service Recipients in the Whole-Health Era

NYAPRS Note: See below an excerpt from the linked article exploring new roles and responsibilities in the ACA. Ron Manderscheid, Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors, explores the expanding opportunities for peers to make targeted whole health interventions for recipients with and without behavioral health needs, and the new role of recipients in directing their own treatment priorities.


Essential New Roles for Peers and Service Recipients in the Whole-Health Era

Behavioral Healthcare; Ron Manderscheid, PhD; 12/29/13

The whole-health era being ushered in by the ACA will bring dramatic changes to the roles of peers and service recipients. We need to implement these new roles in the incubator of emerging medical and health homes.

Much attention currently is devoted to the dramatic changes that the Affordable Care Act (ACA) will bring to behavioral healthcare providers. The major ACA change agents are insurance expansion with parity and service reconfiguration due to integrated care. By contrast, virtually no attention is devoted to the equally dramatic changes that the ACA will bring to the roles of peers and service recipients. I would like to explore these latter changes here.

Read more at: http://www.behavioral.net/blogs/ron-manderscheid/essential-new-roles-peers-and-service-recipients-whole-health-era


OM: BH Costs Account for 38% of Medicaid Costs for Kids

Behavioral Health Costs Account For 38% Of Medicaid Expenditures For Children

Open Minds  December 30, 2013


Developed by Open Minds, www.openminds.com.  All rights reserved.  You may not alter, transform, or build upon this work. You may not use this work for commercial purposes without written permission from Open Minds


Behavioral health costs accounted for 38% of Medicaid expenditures for children in 2005, but less than 10% of children in Medicaid used behavioral health services that year. That year 2.8 million children enrolled in Medicaid used some type of behavioral health services; total Medicaid expenditures for these services are estimated at $19.3 billion. Among 2.8 million children in Medicaid using behavioral health care, two-thirds were in the Temporary Aid to Needy Families (TANF) program, and one-third were children in foster care or receiving Supplemental Security Income (SSI) or disability payments. The subgroup of children in foster care and those on SSI/disability accounted for 56% of total behavioral health expenses for children in Medicaid. Behavioral health service use and expenses of children in foster care exceeded that of children on SSI/disability.


 Differences among the three populations were reported as follows:

  • Children in TANF represented 92.3% of children in Medicaid, but 67.2% of the 2.8 million using some type of behavioral health care. These children accounted for 44% of spending. The mean annual behavioral expenditure for these children was $3,028.
  • Children in foster care represented 3.2% of children in Medicaid, but 15% of the 2.8 million using some type of behavioral health care. These children accounted for 28.6% of spending. The mean annual behavioral expenditure for these children was $8,094.
  • Children receiving SSI/disability payments represented 4.5% of children in Medicaid, but 17.8% of the 2.8 million using some type of behavioral health care. These children accounted for 27% of spending. The mean annual behavioral expenditure for these children was $7,264.


The findings were reported in “Faces of Medicaid: Examining Children's Behavioral Health Service Utilization and Expenditures” by Sheila Pires, MPA; Katherine Grimes, M.D., MPH; Todd Gilmer, Ph.D.; Kamala Allen, MHS; Roopa Mahadevan, MA; and Taylor Hendricks, all of the Center for Health Care Strategies (CHCS). The authors sought to identify behavioral health use and expenditures for children in Medicaid. This report is part of the CHCS series, “Faces of Medicaid.” The current study was funded by the Annie E. Casey Foundation, with support from the Substance Abuse And Mental Health Services Administration, and the Commonwealth Fund. The analysis is based on utilization and expenditure data from the Medicaid Analytic Extract system that includes 29 million children and youth who received Medicaid-financed services in 2005. CHCS is currently pursuing a second phase of this study using 2008 claims data.


The 29 million children enrolled in Medicaid represented 38% of the 74.7 million children in the total United States population in 2005. The findings are reported for various age groups, gender, race/ethnicity. The use and costs of psychotropic medication are reported by age, gender, race/ethnicity, and psychiatric diagnosis. Key findings about the 29 million children enrolled in Medicaid in 2005, included the following:

  • About 92.3% of children qualified for Medicaid through the Temporary Aid to Needy Families program; 3.2% were in foster care, and 4.5% were receiving SSI/disability payments.
  • 2.8 million (9.6%) used some type of behavioral health care—Within this group, 39.1% had no behavioral health diagnosis
  • 1.9 million (6.7%) used behavioral health services, with or without psychotropic medications
  • 1.7 million (5.8%) used psychotropic medications with or without behavioral health services
  • 1.1 million (3.8%) used only behavioral health services
  • 0.5 million (1.7%) used only psychotropic medications


The 9.6% of children using behavioral health care had estimated costs of $19.3 billion. Their overall mean Medicaid expenditure for physical and behavioral health care was $8,520 annually (or $23.8 million). The annual mean behavioral health expenditure was $4,868; the annual mean physical health expenditure was $3,652.


The Center for Health Care Strategies released “Faces of Medicaid: Examining Children's Behavioral Health Service Utilization and Expenditures” in December 2013. A copy can be downloaded atwww.chcs.org/publications3960/publications_show.htm?doc_id=1261588#.Uq2f242A14- (accessed December 26, 2013).


For more information, contact: Nancy Archibald, M.B.A., M.H.A., Communications Officer, Center for Health Care Strategies, Inc., 200 American Metro Boulevard, Suite 119, Hamilton, New Jersey 08619; 609-528-8400; Fax: 609-586-3679; E-mail: narchibald@chcs.org; Website: www.chcs.org


SAMHSA: Resources for Peers and Providers to Build Employment Opportunities




Employment and the Path of Recovery

Are you a person in recovery who has considered pursuing a career or wants to get back into the job market? Have you experienced barriers in your job searches or felt desirable jobs are beyond your reach? Are you concerned that returning to work could impact public benefits you receive? Would you like to find a meaningful and fulfilling occupation, one that matches your skills and interests?

Are you an employer who wants to promote health and wellness within your company? Have you wondered how you can support and maintain positive attitudes within your work environment? Would you like to hire and retain people with lived experiences that you feel can add value to your workforce? Are you interested in learning about what other employers have done to achieve these goals?

The Substance Abuse and Mental Health Services Administration (SAMHSA) ADS Center works to increase dialogue and support implementation and replication of socially inclusive practices, programs, and policies throughout the country. In this e-resource update, we highlight a range of resources available at the SAMHSA ADS Center Web site designed to assist individuals seeking fulfilling and steady employment, help companies be supportive of their employees in recovery, and assist companies in reaching out to all their employees regarding mental health and wellness. The following resources and programs are a few of many found on the SAMHSA ADS Center Web site, http://promoteacceptance.samhsa.gov.

  • Know your rights and your responsibilities. Look up Accommodation Information by Disability to understand how the Americans with Disabilities Act (ADA) defines disability, how particular disabilities are covered, what accommodations are required of employers, and ideas for implementing accommodations. Find this index under the Brochures, Fact Sheets, Guides and Toolkits page of the Employment section of our Web site at http://promoteacceptance.samhsa.gov/topic/employment/brochures.aspx.
  • Watch the archived teleconference The Role of Employment in Recovery and Social Inclusion: An Integrated Approach to learn about the important role employment plays in recovery, solutions to common barriers to employment, and current initiatives taking place to help support employment among people with mental health and substance use issues. You may access this archived teleconference at http://promoteacceptance.samhsa.gov/teleconferences/archive/training/teleconference08142012.aspx.
  • Read the recent article How Mental Health May Be Impacting Your Career to learn about the various factors that affect people with mental health issues. The article discusses how the health care system, unemployment offices, and employers can improve their services and resources to better accommodate these capable individuals. Find this article and others on the Books, Articles, and Research page of the Employment section of our Web site at http://promoteacceptance.samhsa.gov/topic/employment/books.aspx.

Peers . . .

  • Gain insight and access valuable resources from the Peerlink National Technical Assistance Center. Learn about peer-run supports and services, including Project OPEN (Oregon Peer Employment Network), their peer employment specialist program; disclosing to your employer; and reasonable accommodations you may request. Find this resource organization and others at the Employment section of our Web site at http://promoteacceptance.samhsa.gov/topic/employment/organizations.aspx.
  • Check out Social Security’s Ticket to Work program, which supports career development for Social Security beneficiaries with disabilities to help them build a career, save money, and progress toward financial independence. You can visit the program Web site and others from our page at http://promoteacceptance.samhsa.gov/topic/employment/brochures.aspx.

Employers . . .

  • Visit the Employer Assistance and Resource Network for guidance on best practices for recruiting, hiring, supervising, retaining, and advancing individuals with disabilities within your company. Find this resource organization and others at the Employment section of our Web site at http://promoteacceptance.samhsa.gov/topic/employment/organizations.aspx.
  • Watch the archived teleconference Corporate Pioneers—Creating Cultures of Caring: Enhancing Health and Safety in the Workplace and the Larger Community to learn how three distinct, exemplary workplace initiatives in both private and public sector organizations have invested in emotional wellness and how this has led to benefits including enhanced corporate health, employee well-being, and employee retention. You may access this archived teleconference at http://promoteacceptance.samhsa.gov/teleconferences/archive/training/teleconference05092013.aspx.

Share with us how employment has helped shape your recovery and inspire others on their journey by sharing your experience! Learn more about submitting your story to the My Story section of the SAMHSA ADS Center Web site at http://promoteacceptance.samhsa.gov/publications/mystory/mystoryguidelines.aspx.

To learn more about recovery and socially inclusive programs and practices, visit our Web site at http://promoteacceptance.samhsa.gov.

We invite you to share this update with others who may be interested and to encourage them to join the SAMHSA ADS Center listserv by visiting http://promoteacceptance.samhsa.gov/main/listserve.aspx.

Subscribe to the SAMHSA ADS Center listserv by visiting the SAMHSA ADS Center Web site or by calling an ADS Center representative at 800–540–0320.

SAMHSA Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health



OM: 18% Of Unemployed Adults Have Addiction Disorder

18% Of Unemployed Adults Have Addiction Disorder

Open Minds December 30, 2013


Developed by Open Minds, www.openminds.com.  All rights reserved.  You may not alter, transform, or build upon this work. You may not use this work for commercial purposes without written permission from Open Minds


During 2012, about 18.1% of unemployed adults aged 18 or older reported using illegal drugs in the past month, representing 2.5 million of the approximately 13.5 million unemployed adults seeking work. Among employed adults about 9% used illegal drugs, representing 14.5 million of the 144 million adults age 16 and older with full-time or part-time jobs. The estimates include people with co-occurring mental illness and addiction disorder. Illegal drug use rates were lowest among full-time workers (8.9%) than among part-time (12.5%) or unemployed (18.1%) workers.


The findings were reported in “National Survey on Drug Use and Health (NSDUH): Summary of National Findings 2012” by the Substance Abuse and Mental Health Services Administration (SAMHSA). The NSDUH is an annual nationally representative survey of about 67,500 people age 12 and older. The national summary report was released in September 2013. The NSDUH obtains information on nine categories of illicit drug use and alcohol. Illicit drug use includes illegal substances (marijuana, cocaine, heroin, hallucinogens), inhalants, and non-medical use of prescription pain relievers, tranquilizers, stimulants, and sedatives. Use of over-the-counter drugs and legitimate use of prescription drugs are not included in the estimates.


The survey asks about past-month use of illegal drugs and/or alcohol, lifetime use, past year and lifetime treatment episodes, and collects demographic information, including employment status. A related NSDUH report, “Results From The 2012 National Survey On Drug Use and Health: Mental Health Findings” released in December 2013 provides additional information about addiction disorder co-occurring with mental health disorders.


An estimated 21.5 million adults age 18 and older used illegal drugs in the past month, and 14.6 million (67.9%) were employed in a full- or part-time job; 2.5 million were unemployed; and 4.4 million were not in the workforce or looking for work for various reasons (including disability, retirement, being a full-time student, or being a caregiver to a child or a disabled family member).


A table in the national findings report, “Past Month Illicit Drug Use Among Persons Aged 18 Or Older, By Employment Status,” provided the following additional findings on the general topic of illegal drug use in the past month among unemployed adults stratified by employment status:


  • The percentage of adults employed full time who were current illicit drug users increased between 2011 (8.0%, representing 9.3 million workers) and 2012 (8.9%, representing 10.5 million workers).
  • The prevalence of past month illicit drug use among those employed part time was 11.6% (3.8 million) in 2011 and 12.5% (4.1 million) in 2012. The difference was not identified as statistically significant.
  • The prevalence of past month illicit drug use among the unemployed was 17.2% (2.3 million) in 2011 and 18.1% (2.5 million) in 2012. The difference was not identified as statistically significant.
  • The prevalence of past month illicit drug use among those with other employment status was 6.4% (4.5 million) in 2011 and 6.3% (4.4 million) in 2012. The difference was not identified as statistically significant.


According to the related NSDUH report, “Results From The 2012 National Survey On Drug Use and Health: Mental Health Findings” about 8.0% of unemployed adults age 18 and older had co-occurring mental illness and addiction disorder. Among employed adults, 3.4% of full-time workers and 4.1% of part-time workers had co-occurring disorders.


A link to the full text of “National Survey on Drug Use and Health (NSDUH): Summary of National Findings 2012” may be found in The OPEN MINDS Circle Library atwww.openminds.com/library/091513nsduh2012.htm

A link to the full text of “Results From The 2012 National Survey On Drug Use and Health: Mental Health Findings” may be found in The OPEN MINDS Circle Library atwww.openminds.com/library/120113results.htm

OPEN MINDS also reported on this topic in “20% Of Young Adults Used Illegal Drugs In 2012.” The article is available at www.openminds.com/market-intelligence/premium/omol/2013/110413mhcd1.htm


For more information, contact: Nora Younes, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Room 8-1029, Rockville, Maryland 20857; 240-276-2130; Fax: 240-276-2135; E-mail: nora.younes@samhsa.hhs.gov; Website: www.samhsa.gov; or Brad W. Stone, Director, Office of Communications, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Room 8-1029, Rockville, Maryland 20857; 240-276-2130; Fax: 240-276-2135; E-mail: Bradford.Stone@SAMHSA.hhs.gov; Website: www.samhsa.gov



NYT: Medicare to Cover More Mental Health Costs

Medicare to Cover More Mental Health Costs

New York Times; Judith Graham, 12/27/2013

For decades, older adults with depression, anxiety and other psychological conditions have received unequal treatment under Medicare. The program paid a smaller share of the bill for therapy from psychiatrists, psychologists or clinical social workers than it did for medical services. And Medicare imposed strict lifetime limits on stays in psychiatric hospitals, although no such limits applied to medical care received in inpatient facilities.

There was never a good rationale for this disparity, and in 2008 Congress passed the Medicare Improvements for Patients and Providers Act. The law required Medicare to begin covering a larger share of the cost of outpatient mental health services in 2010 and to phase in additional increases over time.

On Jan. 1, that process will be complete, and for the first time since Medicare’s creation seniors who seek psychological therapy will be responsible for 20 percent of the bill while Medicare will pay 80 percent, the same percentage it covers for most medical services. (Payment kicks in once someone exhausts an annual deductible - $147 next year.)

In 2008, Medicare covered 50 percent of the cost of psychological treatment. Last year, it covered 65 percent.

The Medicare change follows new regulations issued last month by the administration for the Mental Health Parity and Addiction Equity Act, which expanded the principle of equal treatment for psychological illnesses to all forms health insurance. But that law does not apply to Medicare.

“Hopefully, older adults who previously were unable to afford to see a therapist will now be more likely to do so,” said Andrea Callow, a policy lawyer with the Center for Medicare Advocacy.

But parity under Medicare remains incomplete, and hurdles still stand in the way of older adults receiving services. A 190-day lifetime limit on inpatient services at psychiatric hospitals is the most notable example. There is no similar cap on any other inpatient medical services provided through Medicare.

“It’s just an arbitrary cap that targets people with serious mental illnesses who need care,” Ms. Callow said.

Are mental health services covered under Medicare otherwise on equal footing with medical and surgical services? And do Medicare Advantage plans - private, managed-care-style arrangements that serve more than 14 million elderly people - apply the same sort of controls to mental health that they do to medical and surgical services?

Sadly, no one knows. “There are no analyses of this issue that I’m aware of,” said Ron Manderscheid, a leading expert on mental health care and the executive director of the National Association of County Behavioral Health and Developmental Disability Directors.

By far the largest group of Medicare beneficiaries needing mental care have psychological conditions such as minor depression that, while painful, can be treated successfully and are not permanently disabling. But the move toward parity may not help many of them, because the law does little to remedy a lack of access to appropriately trained professionals.

“There are a lot of mental health providers out there, but very few have training to work with older adults,” said Dr. Gary Kennedy, director of the division of geriatric psychiatry at Montefiore Medical Center in New York City. And there is little incentive for that to change, because Medicare reimbursement rates are relatively low, given the amount of time providers spend with patients.

A study published this month in JAMA Psychiatry reported an alarming trend: a nearly 20 percent decline in the number of psychiatrists willing to accept new patients covered by Medicare between 2005 and 2010. Just over half of psychiatrists (54.8 percent) reported being willing to take payments from Medicare in 2010, potentially compromising care for the elderly.

What is needed to bring adequate mental health care to more older adults? Kimberly Williams, director of the Geriatric Mental Health Alliance in New York City, suggests that Medicare should pay more to providers who care for psychologically troubled homebound seniors. A wider range of therapists with varying levels of training should be approved to deliver services, she said.

And Medicare should pay for much-needed coordination between primary care doctors and psychiatrists, psychologists or social workers – something that rarely happens at present.

What problems have you observed with Medicare’s coverage of mental health? And what kinds of changes do you think are necessary?



Diversion Saves Resources, Provides Better Option in NC

NYAPRS Note: The North Carolina crisis diversion program highlighted in the below article is similar to the models provided by Rose House in Orange County, NY and the three Parachute programs in NYC. With the expansion of Medicaid Managed Care to cover mainstream BH as well as specialty BH needs through a HARP, NY will expand the crisis diversion model throughout the state. Vital to this process is integrating an issue highlighted in this article: while crisis diversion indeed saves money and resources, the primary goal is appropriate treatment for and recovery of the individual needing assistance through a crisis. Person-centeredness must remain the central focus of the various models of crisis diversion that will surely arise in the coming years.


Wake Diverts Mentally Ill from ER to Treatment

WRAL: Cullen Browden, 12/27/13

A Wake County program designed to get faster treatment for people with mental illness and cut medical costs is garnering national attention.

Of the nearly 90,000 Wake County EMS runs this year, about 5 percent were for people with mental health or substance abuse problems. In the past, paramedics took them straight to a hospital emergency room, but the county has changed that practice.

"That is a broken model," said Dr. Brent Myers, Wake County EMS director. "Patients are not calling us because they need to go to the (emergency room). They're calling us because they need help, and we're trying to modify to meet the patients' needs."

Paramedics went through training to better identify non-medical issues, and in the past year, EMS diverted 350 people to the WakeBrook Campus, a crisis care and recovery center in Raleigh operated by UNC Health Care, and other places that specialize in mental health care.

"It's been nice to give them an opportunity and give them another resource other than just simply taking them to the emergency room and continuing that cycle," EMS supervisor Michael Lyons said.

The state Department of Health and Human Services last month called the program a model for a statewide crisis intervention program to keep people with mental health and substance abuse problems out of hospitals. This week, the Wake County program was profiled on the front page of The New York Times.

"It's catching on across the country because it's the right thing to do," Myers said.

Studies show that mental health patients typically take up 14 straight hours of emergency room bed time, so diverting them saves money and time and frees up resources.

Hospitalization costs related to the mentally ill are expected to jump from $20.3 billion in 2003 to $38.5 billion next year, according to federal estimates.

"The nice thing about that is, oh, by the way, it's better for the health care community, it's better for health care economics," Myers said. "But that's not where you start. You start with what's right for the patient."

Mental health advocate Ann Akland said the Wake County program only works if North Carolina has enough beds and care outside of hospitals for the mentally ill.

"It's a great thing to divert them from the ER as long as there is capacity," said Akland, who heads the local chapter of the National Alliance for the Mentally Ill. "What's going to happen is they're going to show up someplace else. If there aren't hospital beds, they're going to be on the streets. They're going to be picked up."

WakeBrook Campus medical director Dr. Brian Sheitman blamed the dearth of community treatment options, in part, for estimates that show the number of people with mental illness entering hospital emergency rooms in North Carolina is double the national average.

"When the state hospital closed that level of service (on the Dorothea Dix campus), it's been hard to replicate that in the community," Sheitman said.



Save the Date for the April 24-5 NYAPRS Executive Seminar!

NYAPRS NOTE: For the past 9 years, the NYAPRS Annual Executive Seminar has presented the latest information about where our system, field and movement is headed from key change agents and policymakers to an audience that uniquely brings together provider, peer, plan and policy leaders in New York and the nation.

Next April 24-5 in Albany, our 10th Annual Seminar occurs is especially timely, occurring a few weeks after a state budget agreement and several months before the advent of integrated managed behavioral and physical healthcare in New York.

Entitled “Managing Care, Managing Change,” April’s program will feature plenary presentations on emerging policy trends and practice innovations along with a number of interactive sessions that will offer a bridge between beneficiaries, providers and health plans. It will also look deeply into how the state’s 1915.i services will play far greater, more robust roles in the new environment, most notably peer, crisis, employment, housing and family supports and self-directed care.

There will also be a focus on the interplay between the Health and Recovery Plans, the FIDA plans for those with both Medicaid and Medicare coverage and the Managed Long Term care plans, as well as health homes and care coordination.

We’ll have a lot more details in the coming weeks. In the meantime, please keep checking your NYAPRs ENews postings and our website, where you can now see a flyer version of the information below at http://bit.ly/1h1U2cq. See you in April!


The NYAPRS Collective presents the

10th Annual Executive Seminar on Systems Transformation


Managing Care: Managing Change


April 24 – 25, 2014
Hilton Albany

State & Lodge Streets, Albany, NY


Check our website for updates, including information

on workshops and speakers at www.nyaprs.org!


Cultural Competence in Japan Aids Recovery After Tsunami

NYAPRS Note: Below is an excerpt from an article relaying the challenges of overcoming widespread trauma in Northeast Japan after a tsunami claimed thousands of lives there in 2011. The article highlights how culturally competent treatments-including comfortable settings where peers could communicate in groups—have been the most effective for protecting the mental health of individuals and communities. The response has not ended, however; the article notes that a 25-year study of Chernobyl, where a radioactive blast devastated the Ukraine city in 1986, implicated protracted mental health challenges as more significant than the physical health calamities associated with nuclear radiation. Mental health professionals in Japan continue to seek culturally appropriate innovations to alleviate  the suffering of survivors.


Getting on With Life in Japan After Tsunami’s Mental Challenges

The Vancouver Sun; Erin Ellis, 12/21/2013


The nascent field of disaster psychology is looking at the aftermath of such catastrophes and debating the best action for preventing mental illness among victims. The message from Japan is that culture matters in recovery, and Western notions about what victims need - beyond immediate shelter, clean water and food - may be far off the mark.

Dr. Tsuyoshi Akiyama is the head of neuropsychiatry at NTT Medical Centre Tokyo and has served on professional committees focused on disaster response, both immediately after the earthquake and in the event of future emergencies. He’s also passionate about the uneasy situation of residents living in the Fukushima area, his hometown.

He says Japan turned down offers of psychological assistance teams after the 2011 earthquake and tsunami because it learned from the 1995 Kobe earthquake that it wasn’t a useful addition.

“When there is a disaster, what people need first are basic comforts. Ordinary counselling - let’s talk about the experience - is not helpful... When you ask people to try to remember the trauma, it may consolidate the symptoms rather than relieve them.”

Instead, psychological relief teams that have visited the tsunami zone found the best approach was to hold coffee houses where evacuees could talk to each other, and professionals if they wished. One-on-one counselling was a non-starter. Why? Because Japanese people don’t want to tell strangers they are suffering.

“In general, the Japanese people hate, hate, to be seen as complainers,” says Akiyama. “In Western culture, if you can’t explain your thoughts, that is not good. You are not contributing to society. But traditionally in Japan, people have to be careful about expressing an opinion.”

While Japan felt confident in mobilizing only its own mental health professionals, he says Indonesia let in foreign teams after the 2004 tsunami smashed into the Banda Aceh region, bringing with them culturally inappropriate techniques - like hugging. His colleagues there have told him there was no huge surge in the number of cases of post-traumatic stress disorder because most victims are Muslims who believe they must accept the will of God.

In Japan, Akiyama says there is also a tradition of accepting one’s destiny, perhaps because of the strong Buddhist influence. And there is a high social value placed on quietly and privately coping with stressful situations.

“I cannot imagine that the impact of a life-threatening experience is so different between Japanese and non-Japanese. However, PTSD arises from a psychological interpretation of the situation. My hypothesis is that through trust in other people, the stress after a disaster may be lessened in the Japanese. Or, when Japanese don’t feel much anger about the disaster, it may help them to avoid additional stress.”

While hard numbers on mental illness following the earthquake-tsunami aren’t available due to chaotic record keeping in the immediate aftermath, experts say it’s generally accepted that 20 per cent of survivors and about 15 per cent of caregivers developed post-traumatic stress disorder.

Dr. Norio Narita is a neurosurgeon in Kesennuma who oversaw the city hospital’s emergency services after the tsunami. He says PTSD and other mental conditions have been a real problem in the community and among his staff, but treating them is like aiming at a moving target.

Disaster psychology research suggests that PTSD peaks about six to eight weeks after the event and waves of Japanese teams were fanning out to evacuation centres to treat victims by then, Narita said. But living in overcrowded emergency centres in schools and community halls had already taken its toll, particularly on the elderly, who often withdrew and become immobilized.

Today, unemployment and displacement continue to plague the area.

Most of the workers who are clearing the land and hauling away debris have come from outside.

Locals formerly employed in fish-processing plants — the main industry on this stretch of coastline — have no place to work.

Alcoholism is reported to be on the rise among those with no jobs or homes and who are living on government assistance.

“We still need mental health treatment,” says Narita. “But the needs are different than earlier on.”

That includes ongoing uncertainty for about three million people living in the area of Fukushima.

Akiyama is collaborating with other psychiatrists - including several from the U.S. - and local health workers to encourage residents to stop hiding in their homes and start living again.

Little is known about the long-term effects of low-level radiation exposure, he says, except that anxiety about it has strong psychological effects.

“The tsunami was one day... We cannot bring back the lives lost, we can only rebuild,” he says. “Radiation is a much different case.”

Long-term research on the effects of a nuclear accident and widespread release of radioactive material in Chernobyl, Ukraine, in 1986 has shown an increase in thyroid cancers and also a significant increase in suicide, depression and alcoholism among cleanup workers and residents.

A 25-year study published last year concluded that mental rather than physical ill effects have been the main health problem.

“That is the case in Fukushima, too,” said Akiyama. “Naturally the anxiety level is higher and you cannot fight against it.”



NYT: Response to Article Linking Violence and Psychiatric Disability

NYAPRS Note: In a NYT article from 12/22 entitled “When the Right to Bear Arms Includes the Mentally Ill”, the author states once that “A vast majority of people with mental illnesses are not violent”. Otherwise, the content of the article is based on a presumption that persons with psychiatric disabilities or emotional disturbances are volatile, and that lawmakers around the country have been unable to find a proper balance in containing the threat such individuals pose to public health. The stated implication is that the balance is between safety and maintaining second amendment rights; there is no mention of balance between public safety and effective treatment, recovery, and personal choice. There is also no broader discussion about the traumatic or emotional incidents that lead persons to gun violence in general, nor any conclusive data regarding gun deaths or possession of firearms, nor the inclusion of a recovery voice.

Below are two excellent “Letters to the Editor”-one from Susan Rogers, the Director of the National Mental Health Consumers’ Self-Help Clearinghouse-that were published online yesterday. Advocates must continue to offer a strong voice in presenting the rights and realities of persons with lived experience. It must also be our responsibility to identify and promote solutions for all individuals and families that cope with violent inclinations or behavior as a result of trauma or a lack of engagement. The letters below provide a template for how to approach media with these significant concerns and alternative perspectives.

To the Editor:

As someone who has a mental illness, I was dismayed to read your article about guns and violence. It misses the point, which is that the United States needs much stronger gun control laws for everyone.

Although the prevalence of mental health conditions is about the same around the world, the “U.S. firearm homicide rate is 20 times higher than the combined rates of 22 countries that are our peers in wealth and population,” according to the Brady Campaign to Prevent Gun Violence. That is because of the ease of acquiring firearms here.

Although your article does correctly state that the “vast majority of people with mental illnesses are not violent,” this kind of coverage can only add to the discrimination and prejudice associated with mental health conditions and drive people away from seeking treatment.

Philadelphia, Dec. 23, 2013

To the Editor:

Your article refers to a “widely cited study” by Dr. Jeffrey W. Swanson finding that 33 percent of people with a serious mental illness reported past violent behavior, compared with 15 percent of people without such a disorder.

Yet Dr. Swanson, in an article entitled “Gun Laws and Mental Illness: How Sensible Are the Current Restrictions?,” also concluded that the contribution to public safety of laws that restrict firearm access to people with mental illness “is likely to be small because only 3 to 5 percent of violent acts are attributable to serious mental illness, and most do not involve guns.”

Identifying factors associated with violence is complex. Research suggests that demographics - being young, male and of lower socioeconomic status - are the major determinants of violence. A national coalition of mayors, Mayors Against Illegal Guns, conducted an analysis of every mass shooting in America that occurred between 2009 and 2013. It found a strong connection (57 percent of cases) between mass shootings and domestic or family violence, compared with 11 percent of these events involving a mental health issue.

Focusing on mental illness and gun control as a means of promoting public safety reinforces the mental health stigma and misses the boat.


Brooklyn, Dec. 23, 2013