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WINTER 2015 www.namimendocino.org

NAMI is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services, treatment, supports and research and is steadfast in its commitment to raising awareness and building a community of hope for all of those in need.

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In This Issue NAMI Mendocino County Interview – Donna Moschetti Chair’s Letter NAMI Mendocino Goals 2015 Fort Bragg Mental Health Court State News Comparisons of County MHSA Programs www.namicalifornia.org Laura’s Law/AOT Mendocino Co. Health Measures Hoover Commission Report -- MHSA Public MH Funding Sources in CA National News NAMI Policy Recommendations Largest LE Group Endorses AOT Addictions 2 Book Reviews 4 Family Lessons--Patrick Brown Board of Directors 2015 Donna Moschetti - President Sonya Nesch - Vice President/ Newsletter/Membership Jan McGourty - Secretary/Education Gladys Telschow - Treasurer Dorothy Dunlap-Community Outreach Mel Lockey - Family Support Groups Raven Price - Peer-to-Peer Recovery

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NAMI Mendocino County

DONNA MOSCHETTI INTERVIEW Donna was born in Ukiah and has resided here all of her life. She attended St. Mary’s Elementary School and graduated from Ukiah High School. She went to Mendocino College for one-year then transferred to Cypress College Mortuary Science Program in Southern California. Donna always wanted to be a Mortician, since she was a young girl. Upon graduation she was hired by Eversole Mortuary and has been employed there since September 1, 1985. Donna is very active in contributing to our community and she works extremely hard and always with a good sense of humor. Besides being NAMI President,

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past Secretary, and a Board member since 2010, she is part of Soroptimist International of Ukiah since 1998 and has served as their Secretary and Vice President. Donna has served on the Board of Redwood Children’s Services (now Redwood Community Services) since 2000 and is Vice-Chair and a past Chair. Since 2004, Donna has been a Member of Ukiah Sons of Italy #2104. She just completed a term as President and the wonderful Sons of Italy honored Donna with a generous $500 gift to NAMI Mendocino County. We are very grateful to them. Donna is also on the Board of Manzanita Services since 2011 and currently serves as Secretary. Donna says,

My first brush with mental illness happened in 1994 when a very close friend disclosed to me that her daughter was suffering from schizophrenia. I had known her daughter for years. Unfortunately in 1997, after numerous attempts to receive the right help, she committed suicide. I was on the outside looking in; but my eyes were opened to certain issues and I became much more empathetic. In December 2008, her son, and my godson with whom I am very close, had his first break at age 16. Help was not expeditiously forthcoming. Long story short, due to his violence towards his grandmother, he moved in with me and for the next 17 months I watched helplessly as his illness progressed to a drastic stage. A kind, considerate young man turned into a monster right before my eyes. It was ugly, scary, painful, and inhumane and I lived it with him. He was finally hospitalized in 2010. When he was released, he was stable and highly drugged but I could see that the boy I once knew was back. I finally had a chance to breathe. It was then that I decided to become active in the mental health arena to try to make things better in any way that I could for those who are ill and for those who love them.

Chair’s Letter

Dear NAMI Family and Friends, Back in 2008 when I was thrown headfirst into the world of mental illness I had never heard of NAMI, much less NAMI Mendocino. In 2010 someone finally mentioned NAMI to me; it had been 16 years since my first taste of the disease. Unfortunately, NAMI Mendocino is still not well known. We are on a mission to get our name out into the community. We want all people who are ill and their family members and friends, whether they have been dealing with these issues for years, are brand-new to the illness, or haven’t been blindsided yet, to know there is a resource available to them offering FREE Support, Education, and Advocacy. That resource is NAMI Mendocino. NAMI Mendocino is in an exciting growth process but we can’t do it on our own. As with all successful organizations, the involvement of NAMI members and friends are what makes NAMI a success. There are many opportunities to be active at whatever level you feel comfortable. Whether you prefer to be behind the scenes or out front, distribute flyers or be a teacher, or anything in between, all are needed, appreciated and important. We have formed committees that include: Community Outreach, Fundraising, and Program. There are various needs for each committee. I will be sending emails with more in-depth information and new opportunities as they arise along with updates in following newsletters. Please feel free to email me with your contact information, areas you are interested in, ideas, comments and/or concerns. livefromoz@yahoo.com We look forward to working, growing and learning together with you, to make NAMI Mendocino an easily recognizable and valuable resource to all.

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NAMI Mendocino County Goals

1. Establish Family Support Groups and Family-to-Family Education classes in ALL our communities. 2. Increase our visibility in the County so family members can find us by: our Newsletter; Website; speaking to community groups; participating in Health Fairs; putting our brochures in medical clinics, hospitals, elsewhere; and putting articles about mental illness, our classes and support groups in the media. 3. Advocate for accessible, competent mental health treatment services. 4. Work with others (long term) to establish permanent supported housing for people with severe mental illness and their families.

Fort Bragg Mental Health Court

Mental Health Court began in Fort Bragg on January 7, 2015, thanks to Supervisor Dan Gjerde. Judge Brennan says, “We’re really excited to bring this expansion of court services to the Mendocino Coast. I see it as part of a larger community effort to improve our response to behavioral health issues.” Mental Health Court has been operating in Ukiah since March of 2013. They have a caseload of 20 people and more than 100 participants have been involved. Judge Moorman says, “We’ve been very pleased with the results so far. Many of the people in the program are far more stable than they were prior to entry, and many of the barriers to maintaining their ongoing health and stability have been removed. It's a very effective long-term solution to reducing the numbers of mentally ill defendants cycling through the jails and courts."

State News Comparisons of County MHSA Programs

The NAMI California website lists the various MHSA Programs by County. Check out Programs in: Placer County, Sonoma County, Stanislaus County, Sutter/Yuba County, Nevada County. Many of the counties have excellent programs like Mobile Units, Family and Friend Coordinator Programs to help during Crises, Functional Family Therapy, Community Culture Camp/Concert, Native Youth Development/Mentoring, Shared Permanent Supported Homes, Healing through Writing and Spoken Word, Programs for Veterans and their Families, Nature-Based Therapy Programs, Multiple types of Integrated Treatment Programs for people with Severe Mental Illness and Substance Use Disorder. http://www.namicalifornia.org/announcements/eng/mhsa%20full%20report%20final.pdf

Laura’s Law/AOT

February 3rd, the Contra Costa County Board of Supervisors voted 5-0 to implement Laura’s Law, making it the eighth county in California to embrace Assisted Outpatient Treatment as a tool for making treatment possible for individuals with severe mental illness. They join: Los Angeles, San Francisco, Orange, Nevada, Yolo, Placer, Mendocino, Contra Costa Counties. San Diego County will be the 9th to implement Laura’s Law within the next 3 months. Laura’s Law, provides for court-ordered Assisted Outpatient Treatment for people with severe mental illness who are frequently hospitalized and incarcerated, and do not know they have an illness that can be treated.

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Mendocino County Health Measures and Rankings Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute.

Sources (along with links) and definitions can be found at http://www.ehealthscores.com/county-health/sources.html This is an interesting website that compares California counties and the State averages on 34 different health-related metrics as well as a variety of socioeconomic and demographic information. You can add, say Humboldt County, for comparisons that are all on the same page with Mendocino and the State data. Mendocino County ranks 44th on “Health Outcomes” 50th on “Mortality” and we have 7,975 “Premature Deaths” compared to 5,570 for the State. On “Health Behaviors”, we rank 45th. For “Excessive Drinking” we’re at 24% with the State at 17%. For “Alcohol-Impaired Driving Deaths, we’re at 33% compared to 32% for the State. There’s much more so check it out. Little Hoover Commission Report to Governor Jerry Brown January 2015 http://www.lhc.ca.gov

Promises Still to Keep: A Decade of the Mental Health Services Act The Mental Health Services Act (MHSA) won a majority vote in November 2004 with promises of fewer mentally ill Californians on the streets and in jail, better community-based care and strict oversight of spending. The act has since raised more than $13 billion for mental health programs through an income tax surcharge on California’s wealthiest residents. After a decade there are some successes in improving lives but oversight has been lacking. The state now needs to begin to answer these questions.

Have statewide rates of incarceration and homelessness declined?

Are Californians getting the help they need to stay in school or continue working?

How have statewide rates of suicide changed since the MHSA was enacted?

Are more programs available to meet California’s diverse cultural and linguistic needs?

Which Californians are being served and who is falling through the cracks?

To monitor the success of programs and services, the Oversight Commission identified the following 12 priority indicators:

Consumer Outcomes: School Attendance; Employment; Homelessness and Housing; Arrests

System Performance: Demographic Profile of Consumers Served; Demographic Profile of New Consumers; Penetration of Mental Health Services; Access to a Primary Care Physician; Perceptions of Access to Services; Involuntary Status; Consumer Wellbeing; Satisfaction with Services.

It is hard for small counties to maintain an adequate corps of well-trained mental health professionals. Some counties have dealt with these challenges by pooling their funds regionally. Facing local shortages of psychiatrists, for example, some counties have collectively used funds from the act to pay off school loans for psychiatrists attracted to their remote locations.” Small counties need specialty skills in assembling tax credits and other layered funding sources to build supportive housing. Now they can apply directly to the DHCS through a partnership with the CA Housing Finance Authority.

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Public Mental Health Funding Sources in California

Federal:

Federal Medicaid Match: The majority of federal funding for mental health services in California comes through federal matching funds to counties for providing specialty mental health treatment to Medi-Cal beneficiaries. Beginning in 2014, a significant new federal match flowed to the state as a result of California’s adoption of a new Medi-Cal benefit for non-specialty mental health services to all beneficiaries. Federal reimbursement is based on California’s Federal Medical Assistance Percentage (FMAP), which is 50 percent for all Medi-Cal beneficiaries that qualify for Medi-Cal under pre-Affordable Care Act (ACA) eligibility criteria, such as a disability. However, for those Medi-Cal beneficiaries enrolled under the expanded eligibility criteria established under the ACA, California will receive an enhanced FMAP of 100 percent for 2014 – 2016, which then phases down to a permanent 90 percent match beginning 2020.

Substance Abuse and Mental Health Services Administration: The mental health block grants are noncompetitive grants that provide funding to counties for substance abuse and mental health services.

State:

Realignment: A portion of the state’s revenues from sales tax and vehicle license fees is directed to the counties to pay for increased responsibilities for a number of mental health and other programs. Funding supports services provided to individuals who are dangers to themselves or others or who are unable to provide for their immediate needs, community-based mental health services, state hospital services for civil commitments and institutions for mental disease which provide long-term care services.

Mental Health Services Act: A surtax on personal income over $1 million which flows to counties for community- based mental health services, prevention and early intervention services, innovative programs, mental health workforce development and others.

General Fund: Support for the state hospitals and Medi-Cal program constitute the majority of state General Fund spending. Over $1.5 billion in state General Fund dollars supports inpatient psychiatric and mental health services to inmates and patients at California’s five state hospitals. Additionally, more than $800 million is spent annually on psychiatric prescription drugs and non-specialty mental health benefits for Medi-Cal beneficiaries, behavioral health therapy for Medi-Cal enrollees with autism up to age 21 and educationally related mental health services for disabled students.

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Local:

Various sources: Counties collect local property taxes, patient fees, payments from private insurance companies to fund mental health services and other funding sources which they primarily use for their maintenance of effort – the level of spending required to receive their portion of state realignment revenue for mental health services. Funds may also go toward Medi-Cal services allowing the county to draw down additional federal dollars, or on services not reimbursable through Medi-Cal.

References: Mental Health Services Oversight and Accountability Commission, Financial Oversight Committee. January 22, 2015. Financial Oversight Report. Also, Legislative Analyst’s Office. November 4, 2013. “The 2013-14 Budget: California Spending Plan.” Also, California HealthCare Foundation. July 2013. “A Complex Case: Public Mental Health Delivery and Financing in California.” Also, Department of Finance, Governor’s Proposed Budget, FY 2015-16, Department of Health Care Services. Also, SB 852 (Leno), Chapter 25, Statutes of 2014.

National News NAMIs policy recommendations for states in 2015 are: 1. Strengthen public mental health funding. 2. Hold public and private insurers and providers accountable for appropriate, high-quality services with measurement of outcomes. 3. Expand Medicaid with adequate coverage for mental health. 4. Implement effective practices such as first episode psychosis (FEP), assertive community treatment (ACT) and crisis intervention team (CIT) programs.

World’s Largest Law Enforcement Group Endorses Court-Ordered Outpatient Treatment for At-Risk People with Severe Mental illness http://www.treatmentadvocacycenter.org

The International Association of Chiefs of Police (IACP), voting at their annual convention in Florida, endorsed unanimously, the “authorization, implementation, appropriate funding, and consistent use of assisted outpatient treatment (AOT) laws to ensure treatment in the least restrictive setting possible for individuals whose illness prevents them from otherwise accessing such care voluntarily.” The IACP represents more than 20,000 members in more than 100 countries. "AOT will help those who need help the most get the treatment they need, which will improve outcomes for this population and reduce the burden on law enforcement," said Chief of Police Richard Beary, IACP's president. The IACP joins the National Sheriffs’ Association on record in support of AOT, which the U.S. Department of Justice has deemed an evidence-based practice for reducing crime and violence. “Untreated severe mental illness is highly associated with arrest and incarceration,” said New Windsor, N.Y. Chief of Police Michael Biasotti, a member of the Treatment Advocacy Center Board of Directors who championed the resolution. “A disproportionate number of these individuals are ending up in the criminal justice system when they should be receiving treatment. “We expect AOT to reduce the burden of untreated severe mental illness on law enforcement and also produce taxpayer savings,” he said. “This tool will help increase law enforcement capacity and return the care of the most severely ill to the mental illness treatment system.”

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Addictions -- Two Book Reviews by Sonya Nesch

In the Realm of Hungry Ghosts: Close Encounters with Addiction by Gabor Mate, MD. Dr. Mate addresses the spectrum of addictions including: shopping, work, food, nicotine, the Internet, cosmetic surgery, exercise, wealth, power, sex, and more. Dr. Mate is a psychiatrist working with drug addicts in Vancouver’s Downtown Eastside, a drug ghetto. He writes about the addicts overwhelming: fear, rage, despair, emptiness, and painful longing in their hearts. He writes about the failure of the War on Drugs, the importance of human connection, and what might be a humane, evidence-based approach to the treatment of severe drug addiction. He explores the scientific and psychological causes of addiction, and some paths for healing. He also goes into the research literature and the development of the human brain and personality. He covers the addiction process, the social roots of addiction, an enlightened social policy on drugs, the ecology of healing, our relation to one another and to our physical surroundings. Dr. Mate says, “ . . . the discoveries of science, the teachings of the heart, and the revelations of the soul all assure us that no human being is ever beyond redemption. The possibility of renewal exists so long as life exists. How to support that possibility in others and in ourselves is the ultimate question.” Families and Addiction: How to Stop the Chaos and Restore Family Balance by Robert H. Brown, LCSW, MPH, Margaret E. Brown, MA, Patrick L. Brown, PhD This book is so much like our NAMI Family-to-Family classes, where we provide practical education and support to family members and stress self-care as they do. Seven skills are woven throughout the book -- “How to Create and Maintain Boundaries” “How to Work Effectively as a Team” “How to Find and Use Appropriate Support” “How to Manage Loss of Trust” “How to Give Up Control of Outcomes for the Addict” “How to Improve Communication with the Addict and with other Family Members” and “How to Take Care of Yourself”. You will learn to focus on what you can control (your environment and how to manage it in the face of addiction) and away from what you can’t directly control (the actions and outcomes for the addict). The book helps families “regardless of whether the addicted person ever gets help, gets help and relapses, gets help and relapses many times, or gets help and stays clean and sober.” “Being untrustworthy is an inevitable and predictable result of addiction. Learning to understand this and to work with it rather than feeling angry and hurt when it happens, is an important milestone. It is good when you are not surprised to find that the addict has lied to you. It means that you are starting to see the addict more realistically. Of course they are lying. That’s what addicts do. This acceptance doesn’t mean your values need to change, or that you now think lying is OK. It means you are facing the facts and creating a basis for dealing appropriately with the untrustworthiness.” You learn to step back and say nothing, instead of reacting. You just watch their behavior and remember, “Actions speak louder than words”. Instead of saying, “You’re a liar” or “I don’t believe you” you can say, “Let’s see how it works out”. This book is full of practical information and advice, and it is transformative. “Many books focus on how to ‘fix’ the addict and assume that getting the addict into a treatment program will be the final solution to the problem. The authors know from experience that there is no quick fix for addiction. This book focuses on how the family can reclaim its integrity in the face of addiction whether or not the addict embraces a program of recovery. As it turns out, the family skills taught here are precisely the skills necessary to provide the optimal environment to support an addict

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in recovery.” “The authors share their experiences and teach the skills they have found to be most effective.” We are fortunate to have an article written specifically for our NAMI Newsletter by one of the authors, Patrick Brown.

Four Important Lessons about Addiction that Changed our Family Life By Patrick Brown

About twenty years ago, our son lost his wife, his job, and his home as he gradually descended into alcoholism and mental illness (bipolar disorder; anxiety; depression). For the next fifteen years, he mainly lived on the streets of Seattle, New Orleans, and Honolulu; as well as in the jails, psychiatric wards and emergency rooms of those and other cities in spite of the best efforts of his family and friends. Change a few details, and this story has been and is being repeated hundreds of thousands of times throughout the United States and the rest of the world. For fifteen years, my wife and I did everything in our power to rescue our son. We read everything we could get our hands on to help us understand what was happening, went to AA and Alanon meetings, talked to experts, etc. Then we found a “family class” associated with an addiction treatment facility in Hawaii, led by Bob Brown, a retired addiction counselor who is the co-author of this book, and slowly things began to change. After a while the downward trajectory of our lives began to level out and then improve as we experimented with the lessons learned in that class. As we began to make changes in our lives and how we interacted with our son, his hopeless existence also began to show signs of change. He is now in his fourth year of sobriety, is compliant with medications, and meets weekly with a psychologist. He is taking college classes and has interests and activities that are allowing him to develop positive peer relationships. He still has problems dealing with changes in his therapists, with medication adjustments and relationship challenges. However, his sobriety makes it possible for him to manage his mental illness symptoms more successfully. At about the same time as our son’s sobriety began to take hold, my wife and I began a three-year project: writing a book with the teacher of the “family class” about the ideas and skills that had allowed us to make progress after fifteen years of struggle and hopelessness. Here are some of the most important and practical things we learned in the course of our struggle with addiction and mental illness in our family. The first thing we learned is that THERE IS HOPE. For fifteen years we did everything we thought we should do to help our son. We rescued him, had him live with us, tried to control his activities, and spent incredible amounts of energy, time, and money. We were basically ineffective. However, once we were exposed to practical knowledge about what we were facing, and once we began to practice the skills we were being taught in the “family class”, we started seeing progress. What we took from this became the basis of our belief that there is hope even when things seem hopeless. We learned that how we think about addiction and what we learned to do about it made a huge difference, both for ourselves and for our addicted son. We wish every family who faces similar issues had access to a resource like the “family class” that provided us with valuable information, support, and practical guidance. The problem we found with other groups that we tried, was that the other participants were just as frustrated and worn out as we were! We could compare stories and make suggestions, but none of us had a thirty-year professional

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career dealing with the theory and practice of addiction. We were the blind leading the blind. Expertise makes a difference. Deep and persistent love is not enough. Nor for that matter, is expertise alone enough. Love with expertise is the key. The second thing we learned is the importance of finding support for what can otherwise be a very lonely journey. In our book we describe two kinds of teams: a “core team” of family members and close friends; and a “support team” that includes others who are dealing with similar issues. Our “core team” was particularly important because alcoholics and other addicts tend to become highly skilled at manipulating the people around them in their single-minded desire to use their drug of choice. We came to appreciate how important it was for us to be unified in our understanding of our goals and strategies. Divisions or major disagreements among family members made for “easy pickings” for our son, who was an expert in finding and using enablers. However, when we were unified and consistent in our responses, this tended to force our son to make changes himself when his habitual targets (us) were no longer available for manipulation. The third and perhaps most important thing we learned is that it was necessary for us to put away the idea that we could control outcomes for our son. We had to learn this the hard way, by wearing ourselves out over a period of years trying to control our son’s behavior in every way we could imagine. We tried to talk common sense, to make him see how destructive his behavior was, to appeal to his better nature, and to manipulate him with rewards and punishments. But this was not a winning strategy as it did not work and we were exhausted, angry, resentful, overwhelmed and felt hopeless. This is not a place from which it is possible to be helpful to the afflicted family member or to other members of your family. The first step toward being able to help our son find his own healing process was to begin the process of healing ourselves. We took small, concrete steps to create self-protective boundaries within which we recovered our own lives, step by step. Finding the ability to focus on our own needs and our own life was the first step toward creating an environment where our son could also find his healing. This is really just common sense, though it’s hard to see it when you’re in the middle of chaos. We learned to work deliberately on what was within our own control: ourselves, and how we reacted to what was going on in our own environment. The fourth critical thing we had to learn was that managing life with an addict, especially an addict with additional mental illness challenges, is a matter of learning and practicing specific skills on a day-to-day basis. In our class discussions, we identified seven skills that are essential to counter the ongoing stress caused by substance abuse. Learning those skills was a process that involved practice, repetition, and trial and error. We, like every family, had to implement them in a way that fit our unique situation. For my wife and myself, the sole purpose for working with Bob to write Families and Addiction was to share a learning process that helped us emerge from the darkest experience of our forty years together. If you find it useful, we have our reward. If any of you, the readers of this NAMI issue, use our book and have comments or questions for us, we’d love to hear from you at plr7brown@gmail.com. Also, my wife and I visit the Ft. Bragg/Mendocino area almost every fall. If anybody starts a group using our book and would like to discuss it with us, you can contact us directly or through Sonya snesch@mcn.org . NAMI Mendocino hopes to present Coast and Inland presentations by Pat and Mardi on Families and Addiction. These will be well publicized, free, and open to the public.

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NAMI Mendocino County National Alliance on Mental Illness P.O. Box 1945 Ukiah, CA 95482 www.namimendocino.org NAMI Family Support Groups: Fort Bragg – First Thursday of each month 5:30 pm to 7 pm 201 E. Fir St. 707-937-3339 Ukiah – Every other Tuesday 707-485-0239 270 Pine St. Mental Health Board 3rd Wednesday March 18th 778 S. Franklin Fort Bragg 10 am to 1 pm www.co.mendocino.ca.us/hhsa/mh_board.htm

NAMI Membership/Renewal Application Name ______________________________________________________________ Address ______________________________________________________________ Phone email ______________________________________________________________ 3-Way NAMI Membership (Local, State & National) $35 Local Quarterly NAMI Newsletter only $10 Open Door/Low Income Membership ($3 or sliding scale) $__________ Benefactor/Patron Membership and Donation $__________ Mail to NAMI Mendocino County P.O. Box 1945, Ukiah, CA 95482