Every day in California, nine people die by suicide. Both in California and nationwide, suicide is the 10th leading cause of death. According to a recent study, in 2009, more than a half-million adults in California seriously thought about killing themselves. Last fall, the California Mental Health Services Authority launched a statewide campaign called Know the Signs as part of a larger suicide prevention initiative.
One of the highest risk groups for suicide is people who have previously attempted suicide. In Sacramento, an innovative program seeks to reach that group directly and easily: through the simple phone call.
One of the program’s clients is John, a 29-year-old student at Sacramento’s American River College. Today, he describes himself as happy-go-lucky. But a year ago, he had lost two jobs, was facing bankruptcy and had to move in with friends.
Already feeling “emotionally and mentally stripped,” he was then was diagnosed with HIV. “That took away pretty much the last thing that I had, which I thought was my health,” he recalls.
One day last August, he reached an end. Feeling he was “tired of doing this,” he decided to take his own life.
“In my room, I wrote out my note,” he remembered. “I got all my medication out on my bed and I just started taking it. And … All of a sudden, what I just realized is here I am laying here on my floor. … I think, ‘Oh My God, what am I doing? What am I doing?’”
He called out for help, and his roommates called 9-1-1.
He woke up in downtown Sacramento at Sutter General Hospital’s emergency department with nurses pumping his stomach. He recovered. But before he was discharged, he was visited by a social worker, who told him about a unique program that would match him with a suicide prevention specialist. John signed up. That person would give him a call every few days for a month just to check in.
“Ultimately, I knew that I had a cushion for support,” John said about receiving those calls. “I knew that if I was having a hard time, I absolutely had somebody available there.” Continue reading →
Chef Lars Kronmark teaches veterans how to remove the skin of a fish; part of a four-day “boot camp” at Napa’s Culinary Institute of America where injured veterans and their spouses learn healthy cooking tips. (Mina Kim/KQED)
In a stainless-steel teaching kitchen deep within the old stone walls of the elite Culinary Institute of America in Napa Valley, acclaimed chef Lars Kronmark pulls a piece of fat from the cavity of a raw, whole chicken.
“A big chunk of fat like that, it doesn’t really hurt to leave it in there,” Kronmark said. “But in the end of the day, that’s still going to be too much fat.”
It looks like a standard cooking class. But this is an unusual class for an unusual group of students. It’s a healthy cooking “boot camp” designed for wounded veterans of the Iraq and Afghanistan wars with a goal of helping veterans connect with each other and learn to eat healthier.
Six military veterans and their spouses dressed in white chef’s coats and hats watch Kronmark closely. His healthy cooking techniques are welcome tips to the group of 12, including veteran James McQuoid, who lives with post-traumatic stress disorder.
“I’m of the larger variety,” McQuoid said. “A couple years ago, I didn’t care about my health. I was very reclusive and what not, but through therapy and stuff I’ve come to realize — I’ve got a younger child — I want to be around a bit longer, and I’m really not helping myself at all.”
A healthy dinner is served at Napa’s Culinary Institute of America healthy-cooking boot camp for injured veterans. (Mina Kim/KQED)
Federal officials estimate more than 70 percent of the veterans receiving care in the VA are overweight or obese. McQuoid’s doctor recommended he get more omega-3 fatty acids by eating fish instead of fatty meats.
“But I didn’t know how to cook fish,” McQuoid said. “After being here though, I can cook fish!”
The four-day boot camp is a program of the Wounded Warrior Project, a nonprofit that serves injured veterans transitioning to civilian life. The camp’s days begin with lectures on subjects like the physiology of taste and end with vets and their partners preparing dishes for dinner. Today’s menu includes roast chicken with lemon and rosemary, Baja fish tacos, and pork loin cooked in a pomegranate glaze. Continue reading →
President Obama speaks at an interfaith vigil for the shooting victims at Sandy Hook Elementary School (Olivier Douliery-Pool/Getty Images).
On Monday White House spokesman Jay Carney pointed to the federal health law as evidence that the administration has already started to tackle the issue. Mental health issues are “clearly a factor that needs to be addressed in some of these cases of horrific violence,” Carney said. ”Obamacare, if you will, has ensured that mental health services are a part of the services” provided under the health law.
While the Affordable Care Act, along with the Mental Health Parity Act of 2008, go a long way toward assuring coverage for most Americans, some gaps remain.
Here are some answers to frequently asked questions about mental health coverage:
Didn’t the Mental Health Parity Act already guarantee coverage for Americans with insurance?
Large Employers (more than 50 workers): If large companies include mental health services in their insurance plans, they must cover those services at same or higher level as other medical conditions. That means that the plans could not provide fewer inpatient hospital days or require higher out-of-pocket costs, more cost sharing or separate deductibles for mental health conditions. But Paul N. Samuels, director and president of the Legal Action Center, says that some people still aren’t receiving equal coverage, and the law is not always enforced. “That’s a problem we’re really concerned about,” he says. Note that large employers are not required to offer mental health insurance, but most do.
Small Business/Individual Plans: Not included in the Parity Act.
In short, whether you have mental health coverage in an employer-sponsored insurance plan depends on where you work.
What if I don’t have mental health coverage in my employer’s insurance plan? Will the ACA change that?
Small group and individual plans will be required to offer the coverage in 2014 through health exchanges created under the law. But employers with 50 or more workers can continue to not offer the benefits.
I’m planning to buy an insurance plan through one of the new exchanges. What kind of mental health coverage will I have?
Again, as noted above, all plans sold in the exchanges will be required to provide coverage for mental health and substance abuse. The exchanges will be open to individuals and small businesses.
The same rules will apply to small group and individual plans purchased outside of the exchange.
In other words, beginning in 2014, if you (or your small employer) are purchasing any new insurance plan, coverage will include mental health benefits on par with any other medical condition.
I’ll be covered under the Medicaid expansion authorized by the law. What kind of mental health coverage will I get?
If you earn less than 138 percent of the federal poverty level (about $32,809 for a family of four), you may be newly eligible for Medicaid coverage in 2014. Like people who purchase coverage through the exchange, new Medicaid beneficiaries will receive mental health benefits on par with other medical or surgical needs.
What problems might arise?
While the ACA “provides enormous potential and opportunity to make sure than many millions more Americans obtain the services they need,” says Samuels, “that will only happen if the implementation of those reforms is effective.” Samuels worries that the rules from HHS will not be clear or strong enough to make the parity laws meaningful. He also worries about getting everyone who is eligible for coverage enrolled, particularly those with severe mental health disorders who be may homeless or living on the fringes of society.
Access to treatment will likely also remain a serious stumbling block. As many as 30 million people are expected to gain insurance coverage beginning in 2014. Of those, the U.S. Substance Abuse and Mental Health Services Administration estimates that 6 to 10 million will have untreated mental illnesses or addiction, adding additional demands to a system that is already overwhelmed. Patients may experience long wait times to see a psychiatrist, for example, and may require additional investments to expand the mental health workforce.
But unlike other clinics in Alameda County, TRUST will be one of just two which will offer integrated health services, including primary care, behavioral health, case management with housing assistance, and medical-legal partnerships.
“This clinic is a very innovative idea. It’s not something that’s being done in very many places,” said Dr. Michael Boroff, a clinical psychologist who will be working at the clinic. “It embraces the integrated health care … with medical and mental health and all of these different aspects of services combining and working together as a team.”
Alameda County Mobile Health Services Unit van, set up to treat patients in downtown Berkeley. (Photo: Alvin Tran)
The walking wounded wander the streets of Alameda County.
They are people who are homeless and live day to day in public parks and shelters. They are people in need of support for mental health issues and drug and alcohol addiction. And says Addie Brown, they are also one of the most difficult groups of patients to treat.
Brown would know. She oversees the operation of the Mobile Health Services Van headed by the Alameda County Health Care for the Homeless Program (ACHCHP). The van travels throughout Alameda County serving approximately 160 homeless individuals each month. A team of healthcare providers, including nurse practitioners and social workers, provide no-cost primary care and support services, such as counseling and testing for sexually transmitted diseases.
“Over the years, we’ve saved a lot of lives. A lot of clients come with conditions that would have gone untreated had we not gone out there. We’ve been able to help them with their medical issues and getting them hooked up to the appropriate clinic, or doctor, or specialty care,” Brown explained. Continue reading →
(Courtesy: African American Health Institute San Bernardino County)
African-Americans in California are less likely than white people to get the mental health care they need. State public health officials have lacked a good road map on how to change those disparities, until now. A statewide study released today looks at ways to reduce disparities in mental health care for black Californians.
The report, commissioned by the California Department of Mental Health, sifted through more than a decade of literature on why African-Americans in California aren’t getting adequate mental health care. A major reason is poverty and all of the barriers to getting health care that come with it.
“It is unpleasant to admit, but some people do not receive appropriate services,” Woods said.
The Northern California city of Richmond is nearly 27 percent African American, and has many pockets of low-income neighborhoods. Anne Cevallos is a therapist at Rubicon, a nonprofit in Richmond that offers treatment and housing for people mental illnesses. She says her clients face multiple barriers to treatment.
“From a mental health perspective there could be triggers,” Cevallos said. “Not having enough to eat, domestic violence, neighborhood violence, never learning to cope.”
Lali Moheno & her family worked the fields in Modesto. Three of her family members had untreated mental health problems. (Sandy Huffaker/Getty Images)
Lali Moheno went to school in Texas as a kid. But she, her parents, and her six siblings would bus to Modesto, California every summers to work the fields. Then in late August or September, her parents would put her and her siblings back in a bus to Texas. Mohseno worked the fields all the way through graduating from the University of Texas.
“Life was hard,” said Moheno said during a press conference at UC Davis. “We had three family members who had mental health issues. But of course, in our family, we didn’t recognize it. They’d say, ‘Ese? Esta un poquito loco [Him? He's a little crazy]. Don’t pay attention to him. We don’t know what to do with him. He just follows us into the migrant camps.”
Moheno said her family didn’t know that visiting a psychologist or psychiatrist was even an option. That’s why she became a health activist working with farmworkers in Visalia. And that’s why she participated in a series of community forums looking at Latino mental health care disparities.
“Often when someone suffers from depression, unfortunately some family members — and I have seen it in churches also — they say it’s because of the weak character that they have, or they haven’t prayed hard enough.”
Latinos make up over one-third of the nation’s population, and they’re the largest racial or ethnic group in California. But they’re also one of the most under-served communities in the state when it comes to getting mental health care.
Access to health insurance, transportation and language services all play into it. As does stigma associated with getting mental health care. Access to care also fluctuates based on ethnicity: Latinos of Mexican descent are less likely to get mental health care than other Latino groups, like Puerto Ricans. The report says about eighty-five percent of Mexican immigrants who need mental health services remain untreated.
Iranians protest in San Francisco. (Steve Rhodes: Flickr)
California has resettled more Middle Eastern refugees over the past decade than any other state in the U.S. In Northern California, Santa Clara County is a resettlement hub for Middle Eastern refugees — more than 1,300 have moved there since 2006. The majority of these refugees are from Iran and Iraq, and many carry memories of past trauma with them.
Twenty-four year old Iraqi refugee Jasmine said she definitely brought her past memories with her to California. Jasmine (not her real name) and her family fled Iraq in 2006 after insurgents killed her father in a drive-by shooting. She said they escaped to Syria, then resettled in San Jose three years later.
“You left your home. You left the place that you belong to. Your people who loved there,” Jasmine said. “Sometimes I feel like everything for me after Iraq is different: the roads, the air, the dust. I know back home. The dust of back home. I know the air of back home.”
“What happened will remain like a scar inside yourself. Especially like we saw a lot of stuff not normal … Like people killed in front of your eye. I don’t believe I’m going to forget them.”
Jasmine said she was in survival mode in Iraq and experienced a delayed reaction to the stress of war. But when she did land in America, depression hit Jasmine hard.
In a final decision five years in the making, a federal appeals court in San Francisco ruled Monday that the courts lack jurisdiction to order changes in the way the Veterans Administration handles mental health claims.
Two veterans groups said in a 2007 lawsuit that the VA had made mental health care virtually unavailable to thousands of discharged soldiers through perfunctory exams, long waits for referrals and treatment, and a prolonged medical benefits process in which vets can’t hire lawyers.
At a trial in 2008, Department of Veterans Affairs documents showed that the system took an average of 4.4 years to review veterans’ health care claims, that more than 1,400 veterans who had been denied coverage died in one six-month period while their appeals were pending, and that 18 veterans per day were committing suicide, much higher than the rate among the general population. Continue reading →
The need for mental health services among veterans has increased 35% since 2007. (Getty Images)
The Department of Veterans Affairs has announced that it will add 1,600 mental health clinicians and 300 support staff to veterans hospitals across the country to help contend with the rising demand for mental health care among returning veterans. That’s an almost 10% increase in mental health staff and is sorely needed at hospitals that can’t keep up with the requests for appointments. In some places, wait time for care is much longer than the VA’s 14 day policy, the subject of a report by the department’s inspector general to be released next week.
Northern California may be faring slightly better than the rest of the country on mental health issues. “In Northern California we have many veterans coming back. We also have a lot of staff,” said Robin Jackson, a spokeswoman for the Department of Veterans Affairs Northern California Health Care System. “We’ve tripled our mental health staff in the last 4 years. So we many be ahead of the curve,” she added. Jackson said that staff in Northern California realized that traumatic brain injury and other mental trauma would be the most common illnesses in returning Iraq and Afghanistan veterans, so they ramped up their staffing to meet the need. Continue reading →