1

CUMBERLAND and

PERRY COUNTIES, PA NEWS

P. 1 - Family to Family promo P. 2 - Program schedules, Board

Roster, Membership solicita-tion

P. 3 - Good News, Bad News, and Sad News

P. 4 - directions to STAR; Notice of OCD support meeting; Dr. Torrey’s reaction to appoint-ment of SAMSHA Director

P. 5 - Understanding Borderline Personality Disorder

P. 6 - When to seek help; An-nouncement by President

P.7- Treatment of BPD P.8—9 Bonus pages for email recipients

August 17th-Support mtg in Carlisle

August 21st-Support mtg in Hsbg

August 22nd– NAMI C/P PA Bd Mtg

Sept. 7th-West Shore Support mtg

with speaker

Sept. 7th-Family to Family classes

begin

Sept. 21st-Support mtg in Carlisle AUGUST MEETING

NAMI PA of CUMBERLAND and PERRY COUNTIES

THURSDAY, AUGUST 17, 2017 at S.T.A.R.

253 Penrose Place, Carlisle, Pa. [See page 4 for directions]

7:00 —8:30 Support Meeting

P.O. Box 527 Carlisle, PA 17013

https://namicppa.org/

namipacp.info@gmail.com

Message line number:

620-9580

DON’T MISS NAMI Family-to-Family Education Program

This free course is taught by trained NAMI members who have lived with this experience and

offers education and support for families and friends of people with mental illness.

The course teaches the knowledge and skills that family members need to cope more effective-

ly.

Attend with other family members just like you in a confidential setting.

Gain insight into how mental illness affects your relative.

Take an eye-opening look inside some of today’s current brain research related to

mental illness.

Learn how families can become advocates for better treatments for their relatives.

Learn about the mental illness medication issues available and the latest treatment

options.

Learn to cope with the worry and stress; learn to focus on care for you as well as your

loved ones.

Many describe the impact of this program as life-changing. Join the more than 200,000 individ-

uals just like you who have gained information, insight, understanding and empowerment.

When: On 12 Thursdays from September 7th to November 30th from 7:00 pm to 9:30 pm.

(Skipping Thanksgiving week)

Where: First United Church of Christ, 30 N Pitt St, Carlisle, PA 17013. (Entrance into parking lot

in rear of church off Pitt St)

To Register for this free class: Call Sarah at (717) 249-7653.

Duplication and distribution of this Newsletter is made possible by the MH/IDD Board of Cumberland/Perry Counties

Inside this issue:

NAMI is the largest nationwide, grassroots membership organization devoted to improving the lives of those affected, directly and indirectly, by serious mental illness. NAMI is comprised of family members, friends and consumers.

Volume XX, Issue 8 August 2017

Calendar:

Contact Us:

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NAMI Pa. Cumberland/

Perry Counties

P.O. Box 527

Carlisle, PA 17013

http://www.namipacp.org

Message line number:

620-9580

Officers:

President:

Kathleen Zwierzyna 717-877-7214

namipacp.info@gmail.com

Vice President:

Thom Fager

Treasurer: Stephen

Zwierzyna

Secretary: Maureen

Baumgartner

Board of Directors:

Laryssa Gaughen

Sarah Roley

Dolores Stevens

Tonia Milliken

Publisher:

NAMI Pa. Cumberland/ Perry

Counties

Editor: Taylor P. Andrews

243-0123 or 243-1645

Aug. 2017 Vol. XX No. 8

What: Support Group Meeting When: Meets 3rd Thursday of each month Location: STAR (253 Penrose Place Carlisle, PA 17013) Time: 7:00 pm up to 8:30 pm there will occasionally be an edu-

cational program. When there is an education program it shall run from 7:00 PM until 7:50 PM, and the support meeting shall follow at 8:00 until 9:00 PM

August 17,

2017

7:00 up to 8:30 PM—Support Meeting

WEST SHORE SUPPORT GROUP

Meets at 6:30 PM on the 1st Thursday of each month at St. Timothy’s Lutheran

Church, 4200 Carlisle Pike, Camp Hill, PA. There may be an education program 1x

per quarter. Call Hazel at 737-8864 for information.

Sept. 7, 2017

6:30 to 8:00 PM—Speaker will be Becky from the Cumberland County

Office of Aging and Community Service. She will provide information

about transition services for individuals when they reach age 65

support

DAUPHIN COUNTY SUPPORT GROUP [Assoc with NAMI PA Dauphin County]

Meets at 7:00 on the 3rd Monday of each month at the Epiphany Lutheran Church

at 1100 Colonial Rd., Harrisburg, PA. Contact Marge Chapman at 574-0055 for more

information.

Aug. 21, 2017

6:30 to 8:00 PM—Support Meeting

$40.00 For an individual

Membership includes membership in NAMI [national] and NAMI PA, and Subscriptions to The Advocate,

and NAMI Cumberland and Perry, PA Newsletter.

$50.00 For a Household

Same price as an individual. A family consists of two people living at the same address. A family has one

vote, and will receive one copy of subscriptions.

$5 - $40.00 For “Open Door” membership

Anybody can opt to join as an open door member. Dues are any amount that can be afforded. This

option is available so that membership is not denied due to financial hardship. Open door members are

regular members with all the privileges and powers of membership including all subscriptions.

$50.00 For Professional Membership

A Professional member shows support for the mission and goals of the organization. Upon request, NAMI

PA C/P will provide multiple copies of our newsletter for the waiting room of Professional Members.

Make Payment to: NAMI PA C/P

Send Payment to: NAMI PA C/P , Box 527, Carlisle, Pa 17013

JOIN NOW TO BECOME PART OF THE NAMI FAMILY

Memberships submitted now will extend for a year

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GOOD NEWS, BAD NEWS, AND SAD NEWS By Taylor P. Andrews, Editor

GOOD NEWS:

We should all note and applaud the many positive strides made by our NAMI Cumberland and Perry Counties, PA Board of Directors. I note the following in the last year:

NAMI C/P PA has established an informative Facebook page

NAMI C/P PA has improved its website to show a calendar of activities and that streams information from NAMI

Education programs have continued including the Family to Family course that will start this September

Obvious communication and cooperation with the new State organization, NAMI Keystone

Increased recruitment of speakers for support meetings

The Pennsylvania Association of County Administrators of Mental Health and Developmental Services (PACA MH/DS) has issued a White Paper after a significant evaluation of MH trends and recent research. In this White Paper the Associa-tion supports an amendment of the PA Mental Health Proce-dures Act to create an expanded criteria for involuntary outpa-tient commitment consistent with Assisted Outpatient Treat-ment (AOT) that has been demonstrated to be a positive evi-dence-based program.

I have been involved in activity for MHPA reform for more than 20 years. This awakening by County Administrators is most welcome.

The commitment criteria in our current law was established in the mid 1970s, and we have learned a lot about mental illness and treatment and the implications of non-treatment since then. Changes to our law should enable earlier effective inter-vention and less criminalization of individuals with serious mental illness.

HB 1233 of 2017 has been introduced in Harrisburg and may now have more support than has been the case for AOT in past years.

AOT is now favored by Federal legislation that was passed last year with bipartisan support.

Note the article on page 4 regarding the appointment of the new Director of SAMSHA in Washington, DC. This is also good news for those seeking public policies and programs that will foster enhanced treatments for individuals with serious mental illness.

BAD NEWS:

Silvia Herman, Cumberland County’s MH-IDD Administrator has announced that Geisinger Holy Spirit is terminating its con-tract to provide Extended Acute Care (EAC) at its Behavioral Health Center in Camp Hill. The 12 bed unit was started as a

part of the closure of Harrisburg State Hospital 11 years ago. The EAC has been an important part of our service system and a service that is strongly aligned with our values regarding recov-ery. This was a 12 bed unit with Franklin Fulton MH having 3 beds and the other beds being managed by our MH Office. This service has also served individuals from our HealthChoices col-laborative.

The outcomes of this service have been very positive. The length of stay average for our residents is 77 days. This unit was designed as a diversion to State Hospitals where individuals often must wait for a bed to become available as they have not been able to be stabilized on Acute Inpatient Psychiatric Units. This service has also allowed individuals to remain close to home and maintain important connections to family, friends, providers, etc. and receive intensive treatment from their entry into the EAC. Active discharge planning from Day 1 of EAC stay provided for the development of strong and comprehensive discharge planning. Since this unit was a part of a hospital indi-viduals with physical health needs could be served there. There is currently one other EAC in our 5 county HealthChoices collab-orative, Wellspan Philhaven. Philhaven is a free standing Inpa-tient Hospital and individuals with significant physical health needs are not able to be served. Additionally, Philhaven is kept at or near census with individuals from Dauphin, Lancaster and Lebanon counties. In the fall, Wellspan Philhaven, is opening an EAC at Ephrata Hospital, a 12 bed unit. The reason the 5 county collaborative was working with providers to help this occur was the need for more hospital based EAC beds in our region.

SAD NEWS:

Dr. Hazel Brown has been a very active and effective member of our NAMI Family. She supported NAMI when she served for many years on the MH/MR Advisory Board. She served on the Board of Directors of our affiliate for multiple terms. She has facilitated the West Shore Support Group for many years as well.

Our NAMI family notes with sadness the death of Hazel Brown’s husband, Robert F. Brown, on July 22nd. Mr. Brown was a veteran of the U.S. Army. He spent 322 days in combat in WWII. He went on to help build the Rite Aid Corporation from which he retired as VP and Treasurer after 38 years of service.

We extend out deepest sympathies to Dr. Hazel Brown and her family.

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DR. E. FULLER TORREY APPLAUDS THE APPOINTMENT OF DR ELINOR McCANCE-KATZ TO SAMSHA

AND REFLECTS ON IMPACT OF TREATMENT ADVOCACY CENTER

The confirmation hearing for Dr. Elinore McCance-Katz as the first assistant secretary for mental health and sub-stance abuse represented a monumental moment for mental health reform and signals a new direction in how our government prioritizes mental illness care. Below you'll find an excerpt of a message by Treatment Advoca-cy Center founder, Dr. E. Fuller Torrey, sent to the TAC board of directors.

It was extremely satisfying to watch the confirmation hearings today and realize what the Treatment Advocacy Center has accomplished. This would not have occurred without us. Shortly after the Treatment Advocacy Center was founded we realized that the main obstacle to our goal of making treatment for individuals with serious mental illness more available was SAMHSA. The fact that out federal tax dollars were being used to block attempts to improve care seemed fundamentally wrong. We therefore undertook what became a 15 year campaign to change SAMHSA.

Our initial effort was "Hippie Healthcare Policy", pub-lished in the Washington Monthly in 2002. It detailed how SAMHSA-funded groups were blocking attempts to improve treatment laws in California and elsewhere; how SAMHSA was sponsoring conferences at which speakers called schizophrenia "a healthy, valid, desirable condi-tion ..not a disorder"; etc. We continued this campaign intermittently for 10 years with articles and, in 2011 re-leased a YouTube video in which we awarded SAMHSA the Worst Government Agency Award. We also made sure that all this information got to the desks of the key members of Congress.

Finally, in 2012 Rep. Tim Murphy joined the cause to re-form SAMHSA and the rest is history. In the byzantine political events of the past five years, our advocacy staff have been key players in the establishment of the new position of Assistant Secretary, in creating federal AOT grant legislation and much more.

DIRECTIONS TO S.T.A.R.

From I-81:

Take Hanover St. Exit and turn towards town, [Rt. 34 North]:

At the major intersection at Noble Blvd, turn left on Noble

Blvd.

Proceed straight ahead at the first Stop sign at West St.;

Turn right after the gas station on Penrose Pl.;

The Penrose Plaza is immediately on your left;

STAR is the last store front on the right end of the

Plaza. From Downtown Carlisle:

Take Hanover St. out of town [Rt. 34 South].

At the major intersection at Noble Blvd, turn right on Noble

Blvd.

Proceed straight ahead at the first Stop sign at West St.

Turn right after the gas station on your right;

The Penrose Plaza is immediately on your left;

STAR is the last store front on the right end of the Plaza.

OCD SUPPORT GROUP

ENCOURAGING, INFORMATIVE, MEETINGS FOR PERSONS WITH OCD AND THEIR FAMILIES AND FRIENDS

Third Monday of each month - 6:30 p.m. ‘til 8:00 p.m.

Trinity Evangelical Lutheran Church, 2000 Chestnut St., Camp Hill, PA 17011

PROFESSIONALLY FACILITATED - FREE OF CHARGE

(this is not a NAMI group)

After 15 years, there will now be some oversight of SAM-HSA, the federal agency with a $3.5 billion budget that was supposed to provide leadership on mental illness is-sues. Obviously, the person who is appointed to the posi-tion will be key.

And on that issue there is also good news. Dr. McCance-Katz was our candidate for the job because she was the best qualified and most likely to make significant changes.

Her appointment represents a major win for the Treat-

ment Advocacy Center and for everyone in the US with a

serious mental illness. Our supporters should be justly

proud of what has been accomplished. And, of course,

the real work to improve the treatment system has just

begun!

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UNDERSTANDING BORDERLINE PERSONALITY DISORDER By Laura Greenstein | Jun. 05, 2017

Selfish. Manipulative. Untreatable. Clingy.

This is how people (even mental health professionals) describe those who live with Borderline Personality Disorder (BPD). But considering what a person experiencing BPD deals with daily, these labels aren’t fair.

“People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.” That’s how BPD specialist Marsha Linehan describes the deeply misunderstood mental health condition.

That badly burned “emotional skin” means peo-ple living with BPD lack the ability to regulate their emo-tions, behaviors and thoughts. In fact, “Dysregulation Disorder” would be a more exact, less stigmatizing name for the condition according to NAMI’s Medi-cal Director, Ken Duckworth.

What Does BPD Look Like? Like other personality disorders, BPD is a long-term pattern of behavior that begins during adolescence or early adulthood. But what makes BPD unique from other personality disorders is that emotional, interpersonal, self, behavioral and cognitive dysregulation. What does that mean?

Well, put simply: Relationships can deeply affect a person with BPD’s self-image, behavior and ability to function. The possibil-ity of facing separation or rejection can lead to self-destructive behaviors, self-harm or suicidal thinking. If they feel a lack of meaningful relationships and support, it damages their self-image. Sometimes, they may feel as though they do not exist at all.

When entering a new relationship, a person experiencing BPD may demand to spend a lot of time with their partner. They will share their most intimate details early on to quickly create a meaningful relationship. In the beginning, they will show im-mense love and admiration to their partner. But if they feel as though their lover doesn’t care enough, give enough or appre-ciate them enough in return, they will quickly switch to feelings of anger and hatred. In this space of devaluing their partner, a person living with BPD may show extreme or inappropriate anger, followed by intense feelings of shame and guilt. These feelings often contribute to a self-image of being bad or evil.

Possibly because of this, individuals who live with borderline personality disorder are among the highest risk population for suicide (along with anorexia nervosa, depression and bipolar disorder). Completed suicide occurs in 10% of people with BPD

and 75% of individuals with BPD have cut, burned, hit or injured themselves. These self-destructive behaviors are usually in re-sponse to threats of separation or rejection, but may also occur to reaffirm the ability to feel.

Diagnosing BPD The estimated prevalence of BPD diagnosis is 1.6%, but may be as high as 5.9%. The number is unclear because BPD is often misdiagnosed and underdiagnosed. In fact, one research study showed that 40% of participants with BPD were previously mis-diagnosed. We need to do better.

There are nine criteria listed in the Diagnostic Statistic Manual (DSM-5) to determine whether someone has this condition. A person must present with five or more of the following:

Desperate efforts to avoid real or imagined abandonment.

A pattern of unstable relationships switching between ex-tremes of admiration and hatred.

Unstable self-image.

Impulsivity in at least two areas that are potentially self-damaging (such as spending, sex, substance abuse, reckless driving or binge-eating).

Repeated suicidal behavior and threats or self-harm.

Erratic mood swings.

Chronic feelings of emptiness.

Intense anger or difficulty controlling anger.

Temporary, stress-related paranoid ideation or dissociative symptoms.

BPD typically needs more observation than other mental health conditions to diagnose because the symptoms are often comor-bid (paired) with illnesses such as depression, anxiety, eating disorders, post-traumatic stress disorder, substance abuse dis-orders and bipolar disorder. The book Borderline Personality Disorder: The NICE Guideline on Treatment and Management explains that the rate of comorbidity is so high that it’s rare to see an individual with solely borderline personality disorder.

While research hasn’t yet uncovered the exact cause of the con-dition, BPD is about five times more common among first-degree biological relatives of those with the disorder. Research also suggests that one of the major causes of the condition is trauma. In a study trying to treat 214 women with BPD, 75% of the participants had a documented history of childhood sexual abuse.

What Should I Do Now? If you or someone you know was recently diagnosed with bor-derline personality disorder, here are a few first steps to take in managing this difficult condition:

Seek Treatment. Individuals who engage in treatment often show improvement within the first year. People with BPD are

(Continued on page 6)

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Four Signs It’s Time to Seek Mental Health Help

It can be difficult to know when it’s time to seek mental health help. It also can be hard take the leap and actually seek help. Here are four signs that it’s time and four reasons why it might be a good idea. Four Signs That Now is The Time for Mental Health Help:

Your life (home, work, relationships, and more) is becoming more disrupted because of your mental health symptoms.

Your coping skills aren’t as effective as they used to be. Sleeping has become problematic; you’re sleeping too much or not enough. You want to get better and could use extra support. Four Reasons Why Getting Mental Health Help Could Be a Good Idea:

1. You’ll work on decreasing each of your symptoms as well as increasing the quality of your life.

2. You will develop new, effective coping skills and a toolbox of helpful strategies. 3. Your mental and physical health can begin to work together again, so that things like sleeping and eating become regular. 4. You’ll have a partner on your journey to wellness who will listen and support you as you heal. Listen to yourself and honor your desire—and ability—to thrive.

often treated with a combination of psychotherapy, peer and family support and medications.

Connect with Others. It can be incredibly helpful to have an emotional support system of people who know what you’re going through. It’s a reminder that you are not alone and you can recover. You can find others living with BPD through peer-support groups or online message boards or groups. For exam-ple, Healing From BPD includes a peer-hosted chat room.

Practice Self-Care. Part of healing is ensuring that no lifestyle choices are worsening symptoms and preventing recovery. Prac-ticing healthy habits such as exercise, eating well and finding healthy ways to cope with stress and symptoms can be a key part of recovery. Also, it’s essential to avoid drugs and alcohol because these substances can worsen symptoms and disturb your emotional balance.

BPD should not come with a label of “manipulative” or “clingy.” It’s not a personality defect. It’s a serious personality condition that needs attention and care. If you experience this condition, keep in mind that these symptoms are not your fault. You are not behaving or thinking in a certain way because you are a bad or evil person: You are just a person who has a mental illness and you need support and treatment.

(Continued from page 5) ANNOUNCEMENT BY

KATHY ZWIERZYNA, PRESIDENT

We are pleased to have been accepted into the Boscov's Friends Helping Friends event this year! The event benefits non-profit organizations, including our NAMI affiliate; it is scheduled for Tuesday, October 17, 2017.

We will be offering 25% off Boscov's Shopping Passes for $5.00. The passes can be only used during the event. Boscov's will be providing special sales, free re-freshments and chances to win prizes on that day.

Our affiliate will benefit from your purchase of the Shop-ping Pass ($5.00). We will bring passes to our support meetings, educational programs, Board meetings, and other events. We will also accept mail orders and we'll gladly deliver passes if requested. Thank you for helping us with this fundraiser!

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TREATING BORDERLINE PERSONALITY DISORDER By Laura Greenstein | Jun. 07, 2017

Imagine having difficulty controlling your thoughts and actions. Imagine that your sense-of-self is almost entirely dependent on your relationships with others. Imagine struggling to manage stress, rejection or conflict. This is what it’s like to live with Borderline Personality Disorder (BPD): a mental health condition characterized by a pattern of ongoing instability in moods, behavior, self-image and functioning.

BPD is a highly-misunderstood condition—even within the mental health field. So, to better understand this complex condition, I talked with a NAMI HelpLine volun-teer who bravely told me his story.

Randy* was diagnosed with BPD at 17 after a suicide attempt landed him in the hospital. “The concept of be-ing able to like yourself and want to live just went over my head,” he explained. “I also couldn’t handle being rejected. If I sent a text message and they didn’t get back to me for five minutes, I’d already be thinking about kill-ing myself.”

After several years of talk therapy and one month of cog-nitive behavioral therapy, Randy's therapist suggested dialectical behavior therapy last January. Dialectical be-havior therapy (DBT) is a cognitive behavioral treatment developed to help people manage symptoms that are considered “difficult to treat,” such as: impulsivity, inter-personal problems, emotional dysregulation, self-harm and suicidal behaviors. DBT works for a range of condi-tions (substance abuse, depression, PTSD, among others), but it was originally developed to treat chronically suicid-al individuals with BPD.

Skill-Building Through DBT DBT is a combination of group therapy and individual treatment designed to help therapists offer the best treatment possible. What makes DBT unique and effec-tive is its focus on teaching participants a set of behavior-al skills that help them cope with their difficult symp-toms. “The skills are what people talk about when they talk about DBT; they are the active ingredient in DBT,” explains the creator of DBT, Dr. Marsha Linehan. These skills include:

Mindfulness: Being fully aware and present Distress Tolerance: Tolerating difficult or uncomfort-

able situations Interpersonal Effectiveness: Asking for what you

want and saying no when you need to (while still

maintaining self-respect and healthy relationships)

Emotion Regula-tion: Changing emotions that you want to change

Each skill is a separate module of DBT and it takes a full year to go through all four modules in group therapy. Some may choose to repeat a module to help make those specific skills stick—like Randy, who repeated all the mod-ules twice and the distress tolerance module three times because that’s the skill he struggles with the most. It takes a lot of time and energy to learn these coping mechanisms and implement them when symptoms flare.

Everything in DBT is connected and works together to help people manage their symptoms. Skills are introduced in group therapy lessons and are learned through practice and homework. “We have a handbook,” Randy says. “It ranges from things like how to talk to someone you don’t agree with without getting emotional to ‘I’m freaking out, what do I do?’” This is followed with individual therapy that includes lessons tailored to each person so they can apply what they’ve learned to everyday life.

The Gold Standard While it takes time and effort, the components of DBT work together effectively. Even though DBT has only been around for a couple decades, it has already improved and saved the lives of many. Research shows it’s incredibly effective—one study from 2014 showed that 77% of par-ticipants no longer met criteria for BPD diagnosis after un-dergoing treatment.

DBT is recognized as the “gold standard” for people with BPD. “It’s weird how much better I’ve gotten from it. Look-ing back, I was so different; I didn’t know how to handle life. Sometimes I still don’t, but I’m getting there. I’m getting better.”

*Name has been changed to protect our volun-teer's privacy

Laura Greenstein is communications coordinator at NAMI.

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"That Which Is Good Is That Which Works"

The United States incarcerates more individuals with mental illness than any other nation on earth, a result of both our in-carceration rate and the disproportionate prevalence of mental illness in our inmate population. Based on the most recent prevalence estimates, an estimated 213,780 state and federal prisoners and 163,800 jail inmates had psychiatric symptoms or had previously been diagnosed with a serious mental health condition in 2011-12 - 377,580 men and women altogether.* Most of these individuals do not receive treatment behind bars, and many are released from incarceration under condi-tions that all but guarantee they will not succeed in the com-munity. As just one example, the US Inspector General recently reported that 13% of prisoners in a sample of individuals with mental illness in solitary confinement were released directly from an isolation cell to the community with no transition through the general prison population and with no outside support put in place. In a new paper now online in Behav-ioral Sciences and the Law, Drs. H. Richard Lamb, a research pioneer on the criminalization of mental illness, and Linda E. Weinberger examine the issues surrounding the release of indi-viduals with serious mental illness and practices that would reduce their risk of re-incarceration and over adverse consequences. "Throughout, a pragmatic ethics is advocated," they write, "that which is good is that which works." "Formidable" Problems The authors identify several challenges to implementing "that which works" for this population.

The successful use of mental health courts to divert people from incarceration after arrest is contingent on the availability and quality of local services (e.g., therapy, housing, rehabilita-tion), which may be lacking.

Clinicians in correctional settings find that post-release supports their clients need for success in the community may not be available.

Mental health professionals trained to treat non-forensic patients can feel overwhelmed, fearful and unprepared to work with clients who have been incarcerated and may be at risk for violence.

Coordination between the criminal justice system (e.g., parole and probation officers, court personnel) and mental health system is essential but not guaranteed.

Structured living can be critical to success for individuals leaving the institutional setting of jails or prisons but may not be not available.

Community housing and treatment options are often not equipped to manage and treat patients who are resistant to treatment, with symptoms that are difficult to control, or who are at risk for violence.

Involuntary options such as assisted outpatient treatment (AOT) reduces the risk of re-arrest and re-incarceration for indi-viduals with a history of negative consequences from not ad-hering to treatment but are not universally available. "The list of problems is formidable," the authors write, "but they can be resolved." What Works Noting that individuals with mental illness are a heterogeneous group, Lamb and Weinberger call for better recognition that diverse needs require more diverse resources and interven-tions. "Outpatient treatment and services for persons placed in the community should be for those who are the most likely to succeed and the least likely to fail and as a result need costly, lengthy hospitalizations and/or be at risk of re-arrest for serious offences," they say. At the same time, there is a substantial minority, "who need the structure and support found in acute, intermediate or long-term care in a hospital setting or a highly structured, locked 24-hour care community facility." To reduce criminalization and promote the success of individu-als with mental illness re-entering the community from jail or prison they propose:

A very large increase in the number of community mental health services, including forensic assertive community treat-ment teams and intensive case management

Treatments for the co-occurring substance disorders that are common in the population

Practices that assure administration of prescribed medica-tions after release

Crisis response teams

Appropriate structured, monitored and supportive housing

Vocational and rehabilitation therapies

Provision for acute care in the community and for acute, intermediate and long-term inpatient care when needed

Less restrictive civil commitment laws to facilitate emer-gency intervention sooner

The use of AOT and conservatorships/guardianships when indicated.

(Continued on page 9)

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Medicine and technology continue to improve treatment and outcomes for many medical conditions, but mental health and substance abuse disorders continue to be left behind. The lat-est evidence of the disparity can be found in the federal gov-ernment's June 2017 statistical brief on trends in hospital inpa-tient stays. From 2005 to 2014, the total number of hospital stays for men-tal health/substance use conditions rose 12.2% in the United States. This was the only category of hospitalization that in-creased in the time period. For all conditions, the number of inpatient stays dropped by 6.6% from 2005-2014. The largest reported decrease (12.0%) was for surgical stays, the smallest (4.3%), for injury stays. Hospitalization is the most intensive and expensive interven-tion for any medical condition. Because prevention and com-munity treatment often can avert the need for inpatient treat-ment, hospitalization is considered a poor outcome for many medical issues, including mental illness. Overall, hospitalization associated with mental health or sub-stance use accounted for nearly 6% of all hospital stays in 2014, a 20.1% increase in the share of such stays from 2005. At the same time, less money was spent per hospital stay for mental health/substance use in 2014 than in 2005, after adjusting for inflation. In every other category of hospitalization, spending increased. The data were reported by the Agency for Healthcare Research and Quality's (AHRQ) Healthcare Cost and Utilization Project, known as H-CUP. Hospitalization by Age and Diagnosis The bulk of the increase in mental health hospitalizations was associated with mood disorders, which include bipolar disorder and major depression. The number of stays for this category rose by 23.2% in the 10-year period, from 690,900 stays in 2005 to 851,100 in 2014. Driving the increase were hospitalizations for patients from 0-17 years and 45-64 years. In 2005, mood disorders were not found among the top five reasons patients these ages became inpatients. By 2014, they had become the top non-maternal/non-neonatal reason chil-dren and adolescents were hospitalized (overtaking pneumo-

"Many of these interventions are evidence-based practices," the authors conclude. "With a sufficient amount of all of these ser-vices being made available, the number of persons with (serious mental illness) being criminalized should fall significantly, and many more should be able to make progress toward wellness and live more enriched lives in the community." In its entirety, the paper covers the issues of asylum and sanctu-ary; the need for structure; various forms of involuntary treat-ment; an assessment of the capabilities and limitations of out-patient treatment; appropriate treatment goals; liaison be-tween treatment and criminal justice staff; and management of violence.

* Based on survey data released by the US Department of Jus-

tice, Bureau of Justice Statistics, June 2017.

Doris A. Fuller

Chief of Research and Public Affairs

References:

McDermott, K.W. et al. (June 2017). "Trends in hospital inpatient stays in the United States, 2005-2014." Agency for Healthcare Research and Quality

(Continued from page 8)

Hospitalization Trends in Mental Illness

nia, acute bronchitis, electrolyte disorders and appendicitis). They were the number three non-maternal/non-neonatal reason individuals aged 45-64 were hospitalized. In both 2005 and 2014, mood disorders were the leading reason for hospitalization among patients from 18-44 years old, the age at which serious mental illness most com-monly is diagnosed. Schizophrenia and other psychotic disorders remained the num-ber two reason for hospitalization in the 18-44 age range from 2005 to 2014. Psychotic conditions were not a leading reason for hospitalization in any other age group. While substance use was combined with mental health into a single category for gen-eral reporting purposes, the condition was not one of the top reasons for hospitalization in any age group.

(Continued on page 10)

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Questions Requiring Answers AHRQ's statistical brief provides no explanation for the dichot-omy between the growing number of hospitalization stays for mental health/substance use and the shrinking number of stays for every other category. The numbers suggest questions that urgently need answers, among them:

Why are so many more Americans being hospitalized for psychiatric conditions today than 10 years ago?

What must change for people with psychiatric and sub-stance use disorders to receive timely and effective inter-ventions needed to avoid hospitalization?

How is the increase in psychiatric hospital stays at a time

(Continued from page 9) when psychiatric beds is in decline affecting bed waits in

emergency rooms and corrections facilities and having oth-

er impacts on mental health?

Doris A. Fuller

Chief of Research and Public Affairs

References:

Lamb, H.R. & L. Weinberger. (July 2017). Understanding and

treating offenders with serious mental illness in public sector

mental health. Behavioral Sciences and the Law.

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