Mental illness as a political football - an online presentation

The "politics of mental illness" is now an Internet feature.

The American Prospect’s has done a special edition called “The Politics of Mental Illness,” which can be found here.

The topics include:

"Media and Madness," by Richard A. Friedman, which delves into how the news media and entertainment industry shape public opinion about mental illness.

"A Professor's Story," by Elyn Saks, which discusses going public about mental illness is not like revealing any other kind of disease.

"Combat Fatigue," by Tara McKelvey, which looks at how returning veterans suffer post-traumatic stress disorder in record numbers, and how a controversial new drug is being tested that would dampen their memories.

"A Worthy Diversion," by Sasha Abramsky, which looks at how Pennsylvania has developed a model program to keep offenders with mental illness out of the criminal-justice system.

"Finding Funding," by Pete Earley, which seeks to show how states should link mental-health funding to dedicated revenue sources independent of the political whims of legislators.

"Programs That Work," by Kate Sheppard, which discusses how clubhouses and ACT are proven successes. She asks: So why aren't they better known or funded?

Memo to states: Mental health services need money, so pull out your checkbook

Waiting lists for mental health services are growing, just as money is disappearing.

No shock there.

But, in the midst of budget season for most states, why is mental health constantly left off the table - particularly when the state reaches a budget deal and realizes it has enough money?

Not only is left off the table, but it's also the first thing that's cut when public officials are scrounging for more cash.

Maybe each state government needs to realize that mental health services can be part of the solution - helping people get back on their feet, turning people into functional members of society, keeping them out of jail - rather than part of the problem.

In New Jersey, for instance, Governor Corzine and the state Legislature have a budget deal. But the New Jersey Association of Mental Health Agencies Inc. called on the Legislature to provide an adequate contract increase to cover the expense of skyrocketing costs and to pay a livable wage to struggling employees.

“Because of inadequate resources, adults and children in need of mental health services often must wait weeks or months for services when they turn to non-profit mental health care providers for help. Our organizations have experienced double digit increases in insurance, fuel and energy,” said Megann Anderson, associate executive director of NJAMHA.

Anderson noted that the average starting salary of a community mental health care worker is only $30,000 and that state workers with comparable positions earn as much as 40 percent more.

As a result, vacancy and turnover rates are increasing in the community and individuals in need of mental health treatment and services often face long waits for services.

“Adults and children who cannot access service on a timely basis can deteriorate and end up in crisis, needing much more expensive treatment and services,” said Anderson. “We would not think of making a heart patient wait until he experiences a massive heart attack before providing treatment. We must end this discrimination against those with a mental illness.”

Two decades later, stability is within reach

I've often thought that if my stomach were my brain, I'd be the smartest person alive.

That perpetually grumbling thing beneath my ribs has always been a master manipulator that, unlike any other part of my body, has the ability to control. It's like some mad scientist kidnapped my body, carved out the nerve center of my brain and inserted into my digestive tract.

How my stomach reacts to stressful events, high levels of anxiety, hectic work schedules and my occasionally erratic diet will usually dictate how things go over a period of days – or, in some cases, even weeks.

Indeed, for much of the past two decades, I've suffered from anxiety that's turned some days – and many meals – into spin-the-wheel carnival games. Many times, I've woken up, my head spinning, wondering what stomach ailment would dictate my mood for the day: Acid reflux? Diarrhea? Gastroenteritis?

The residual effect has been on-an-off bouts with eating disorders that – while now manageable – have been debilitating and self-destructive. Feeling anxious and obsessing about what I'm about to eat – as well as the potential bloated side effects of eating and digesting a hot, fat-laden meal – has only added to stress that has caused me to, at times, withdraw from reality.

Not until I was about 30 years old – married, ready to have kids and accept responsibility – did I determine that the connection between my brain and stomach was too much to overcome. The realization forced me to seek help from a psychologists and psychiatrists who, through a combination of therapy and medication, have helped me feel as close to comfort as I've ever felt.

I also looked at my family history – three cases of alcoholism, combined with obsessive compulsive disorder that affected my great-grandfather, grandfather and mother – and saw a genetic line of mental illness that, very likely, did not skip my generation.

The best thing I can say about it is, thanks to therapy and willpower, I'm alive.

Indeed, it's been 20 years since I first experienced symptoms of eating disorders. The signs first appeared in the summer of 1988, after a break-up.

I'm of British descent, so I tried to keep a stiff upper lip. That’s how I was taught to handle a personal crisis. But being a rock is not in my DNA. Instead, I crumbled to the point that I couldn't eat or sleep for days at a time.

I ran five miles each morning, skipped my Rutgers classes so I could wallow in my bed during the afternoon, stare at the ceiling and cry. At night, I shoved my fingers down my throat, losing whatever bird-food-size portions of bread and crackers I ate for dinner.

Eating anything, in fact, gave me stomach gas and acid reflux so bad that I spent hours combing local drug stores in search of the right cure. I popped anywhere from 8 to 15 Tums and Gas-X tablets each day, hoping that some sizeable combination of antacids would calm my gut down.

As the months went by, however, things just got worse. It wasn't until one of my roommates literally pulled my out of the bathroom, forced me to sit in a chair and talked me out of my misery that I finally summoned up my strength, and pulled myself out of the abyss. By that point, I was 6 foot 2 inches tall, 132 pounds.

I never forced myself to throw up again. In the years after that initial bout with bulimia, I only forced myself not to throw up. But each time I faced some kind of crisis, I also had to summon up that same personal strength that forced me to face the immediate, as well as the long-term, future.

Still, life was a struggle, and marriage in 1996 finally brought stability my very unstable state-of-being.

Until then – just like my stomach – my work as a journalist was very erratic. My social behavior was also unsettling, and downright scary. I spent many weekends in Belmar, N.J. drinking until I was totally numb. I slept with various women who were so tanked up with tequila shots and beer that they passed out before we even left the bar.

But it was my wife who introduced me to therapy, where I finally learned - in 2000 - that there was something about me that was different. From there, we were able to work with what we have.

The big battle of Iraq has yet to begin - at home, not abroad

The number of dead soldiers in Iraq continues to climb. Others lose their limbs when yet another IED blast blows up their transport vehicles as they move in and out of war-torn Baghdad.

The potential after-effects that soldiers may suffer from this war, however, has become one big ticking time-bomb that could explode the military's already fragile morale - if nothing is ever done about it.

And post-traumatic stress disorder has the potential to tear apart families already burdened by the roller-coaster ride of National Guard soldiers being called in-and-out of duty that they thought would simply help pay their college tuition.

Already, this PTSD enemy looks firmly entrenched: A recent report showed that 32 soldiers killed themselves in the war zone last year - a record high since the war began five years ago, according to The Hartford Courant.

The number of suicides in Iraq in 2007 climbed 18 percent from 2006, despite efforts by military officials to improve training and education in suicide prevention and mental health, The Courant reported.

The number of Army troops suffering from severe combat stress is "skyrocketing," rising from just over 1,000 new cases in 2003 to more than 28,000 soldiers today diagnosed with PTSD, according to The Baltimore Sun.

Yet, no one who has, or may have the power to do something - that being Congress, the Pentagon, Barack Obama, John McCain, President Bush and on and on - has come out with a clear-cut battle-plan for tackling post-traumatic stress disorder on a large scale.

On his website, Obama talks about recruiting more health professionals, improving screening, offering more support to families and making PTSD benefits claims fairer.

McCain, a former Vietnam POW, has advocated for disability benefits to veterans with cancer and other health problems caused by Agent Orange, and also treatment for tobacco-related illnesses and substance abuse problems. He's sponsored legislation to cover mental health care in military retiree health plans, according to his website.

But all those ideas lacks specifics. Finding out how they stand is also difficult; each candidate addresses PTSD only in hard-to-find places that are buried in their websites. PTSD is missing from their bombastic, speech-driven rhetoric.

On the Pentagon's website, there is little-to-no talk of casulties of the psychological kind - perhaps sending the message that the only way a soldier can be wounded is either by a bullet or a bomb.

Even the Army seems to recognize the obvious omission. Lt. Gen. Eric B. Schoomaker, the Army's top medical officer, has said he does not know how many additional soldiers suffer from symptoms of combat stress - such as hyper-vigilance, sleeplessness and irrational anger - and he does not know how many of these soldiers are receiving treatment, according to The Baltimore Sun.

"As a nation, our mental health capability is not adequate to the need," and the Army suffers from the same problem, Schoomaker recently told defense reporters.

He also said the Army needs 300 more top mental health professionals to care for the growing numbers of soldiers suffering from severe stress, according to the Sun. But the Army has filled only 180 of those positions.

Anyone who is familiar with the tragedy of the Vietnam era or, at the very least, how it was portrayed in history books, newspaper reports and movies, should know that PTSD has the next potential to be the wound that, for many soldiers, never goes away.

Indeed, symptoms of PTSD often don't show up right away, according to the National Institute of Mental Health. Many Vietnam veterans, in fact, didn't report signs of illness until 10, or even 20 years after they served.

What's amazing is that signs of Iraq-related PTSD were first reported by The Associated Press four years ago, when the Army's first study of the mental health of troops who fought in Iraq found that about one in eight reported symptoms of post-traumatic stress disorder.

This was long before troop divisions that were shuffled out after the fall of Baghdad were forced to return and then, quite possibly, return again. Families who waited months for their loved ones to return were forced to, yet again, wait.

This was before the public really began to lose faith in the war, and then started to lose faith in President Bush, whose popular rating has fallen to Richard Nixon levels.

Whether troops leave Iraq sooner or later, managing PTSD is the battle that, for many, needs to begin now.

This article appeared in The Huffington Post on June 10, 2008.

The sounds of speaking out

A New Jersey teenager with obsessive compulsive disorder has found a platform for speaking about her illness, and sharing stories with those who are like her: recovering.

At the same time, she understands business, and he's found a marketing approach to a usually unapproachable subject: Getting the website declared a nonprofit corporation.

Caitlin Carey's website, www.stepoutofthesilence.org, is a series of narrative stories and breaking news that spotlight people's battles with OCD, bulimia and other illnesses.

Peruse the site and you'll come across Alyssa's battles and friendships with people suffering from eating disorders, as well as her own personal struggles:

"So what's wrong with me?...That's the question that I really secretly know the answer to. My problem is love. My problem is hearbreak-- not always the romantic kind, but the frienship kind as well. My problem is defined by no other words but love, and disappointment. In others, but also in myself. In this very life I live."

But the news is not always about mental health, but what's happening in mental health. Indeed, it's also about the success of the site, and how it's success will aid the cause in the long run.

The latest news?

"Out of the Silence, Inc. is now OFFICIALLY a registered U.S. non-profit organization! We fall under the category of 501(c)(3), an IRS code that designates the non-profit, tax-exempt status."

"Prior to this, Out of the Silence was recognized as a state (New Jersey) non-profit, but now the national government also acknowledges us as a public charity. This may not seem like a big deal, but this really opens up so many more opportunities for our organization. "

War is hell, but suicide is worse

The Army is losing its battle to stem suicides among troops serving in Iraq, with a new report showing that 32 soldiers killed themselves in the war zone last year — a record high since the war began five years ago, according to The Hartford Courant.

The number of suicides in Iraq in 2007 climbed 18 percent from 2006, despite multiple new efforts by military officials to improve training and education in suicide prevention and mental health, The Courant reported. Suicide was a leading cause of non-combat deaths in Iraq last year, accounting for nearly one in three non-hostile Army fatalities.

Army officials who released the report were reluctant to draw a link between combat exposure and suicide, repeating assertions made in past years that failed personal relationships, along with legal and financial problems, were the main factors driving suicides, according to The Courant. But they did acknowledge that long and repeated tours of duty were wearing down soldiers' mental resilience.

"Is it the war? It's unquestionable that the high op-tempo, the multiple deployments and long deployments put a real strain on relationships," said Col. Elspeth Ritchie, the Army's top psychiatrist, in a conference call with reporters. "There's also normal, girlfriend-boyfriend breaking up, irrespective of the war, marital difficulties that arise in both civilians and soldiers. ... We're not seeing a clear relationship between conflict increase and suicide."

Elspeth Ritchie Photo Ritchie and Brig. Gen. Rhonda L. Cornum, assistant surgeon general for force protection, said The Courant that Army leaders would continue to emphasize training programs that alert commanders and soldiers to signs of stress and that encourage troubled troops to seek professional help.

"One of the things that I believe is happening, looking at these reports, is that the Army is very, very busy, and perhaps we haven't taken care of each other as much as we'd like to," Ritchie said.

The increase in suicides in the war zone was one factor driving an overall increase in suicides among active-duty soldiers last year, The Courant reported. The Army released figures showing 115 confirmed suicides in 2007, both stateside and abroad — the highest number recorded since the Army began keeping such records in 1980. In 2006, 102 suicides were reported. The numbers do not include suicides among veterans who left the service.

The active Army suicide rate reached 18.8 suicides per 100,000 soldiers last year — also the highest rate on record and an increase over the 2006 suicide rate of 17.5 per 100,000.

Army leaders said they had scrambled in recent months to hire 180 new mental-health workers to treat troops at home bases, but they did not announce plans to beef up the contingent of counselors treating troops deployed in Iraq, The Courant reported. Despite the rising suicide numbers in Iraq, the ratio of mental-health counselors to soldiers in the war zone has dropped — from one provider for every 387 troops in 2004, to one for every 734 last year.

The Army has made a number of changes to its suicide-prevention and mental-health programs in the past several years, some prompted by a Courant series in 2006 that found the military was failing to adequately screen and treat troops with psychological problems. New policies adopted since then call for closer monitoring of troops on psychiatric medications and limits on keeping troops with mental-health problems in combat zones, according to The Courant.

The Army finally admits it: Soldiers suffer stress while in combat

Hard to believe that the Army once considered post-traumatic stress disorder to be a made-up malady. Now the armed services uses terms such as "skyrocketing" to describe PTSD.

The number of Army troops suffering from severe combat stress is skyrocketing, rising from just over 1,000 new cases in 2003 to more than 28,000 soldiers today diagnosed with post-traumatic stress disorder, the Army surgeon general said in the Associated Press.

Lt. Gen. Eric B. Schoomaker, the Army's top medical officer, said that he does not know how many additional soldiers suffer from lesser symptoms of combat stress, such as hyper-vigilance, sleeplessness and irrational anger, and does not know how many of these soldiers are receiving treatment, according to the AP.

Schoomaker also said that the Army has inadequate facilities and too few mental health care providers.

"As a nation, our mental health capability is not adequate to the need," and the Army suffers from the same problem, Schoomaker told defense reporters. He said the Army recognizes it needs 300 more top mental health professionals to care for the growing numbers of soldiers suffering from severe stress. It has filled only 180 of those positions, according to the AP.