Plan to “Decimate” Mental Health Care

Leading mental health advocates are strongly condemning the Senate Republican health care bill proposed on June 22 for cutting Medicaid programs that provide vital lifelines to Americans struggling with mental illness.

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The criticism follows the harsh reaction voiced earlier this year to the American Health Care Act proposed by House Republicans to replace the Obama administration’s Patient Protection and Affordable Care Act, or Obamacare.

The National Alliance on Mental Illness, the nation’s largest grassroots mental health organization, said this week that the Senate Republicans’ Better Care Reconciliation Act “will slash Medicaid benefits for critical mental health services millions of Americans need to lead productive lives. NAMI opposes this effort to decimate our nation’s already struggling mental health system.”

NAMI explained the importance of Medicaid to mental health care:

“Medicaid is the largest source of funding for public mental health services in our nation. One-third of people covered by Medicaid expansion lives with a mental health or substance use condition and Medicaid serves as a lifeline for people with mental illness who typically fall through the cracks. It provides critical coverage so people have access and receive the mental health treatment they need to finish school, get back to work and contribute to their communities.”

NAMI said that the Senate and House proposals to convert Medicaid to a “per capita cap” for states will result in “devastating cuts to mental health services.”

“NAMI is deeply concerned that the Better Care Reconciliation Act will force people with mental illness out of the health care coverage they need and on to the streets and into costly emergency rooms, hospitals and jails. We encourage Senators to reject this harmful bill, and instead, ensure that Americans have receive the mental health care they need to lead healthy and productive lives.”

Paul Gionfriddo, president and CEO of Mental Health America, echoed NAMI’s concerns. He said the Senate Republican legislation would “do significant harm to people with all chronic conditions, including mental illnesses.” He said the proposal “replaces much of both the core and expanded Medicaid program—lifelines to people with serious and persistent mental illnesses.”

Gionfriddo called for changes to Obamacare to be made “in the context of rational health policy. We would all be well served if Congress were to go back to the drawing board and get this right. Too many lives depend on it.”

Similar to the House legislation, the Senate version would cut health care coverage to 22 million people, according to the Congressional Budget Office. “Repealing and replacing” Obamacare was a major campaign promise made by President Donald Trump. Trump’s Republican Party controls both houses of Congress.

NAMI is organizing a “Virtual Hill Day” on Thursday June 29 to lobby Congress against cuts in mental health coverage, demanding: “We need more mental health care, not less.”

The organization says that 1,000 mental health advocates will meet face-to-face with members of Congress; it encourages others to voice their opposition to cuts by phoning, emailing, or tweeting at their congressional representatives.

Bravo “Dear Evan Hansen”

“Dear Evan Hansen” is a musical about teenagers in the age of social media dealing with anxiety, confusion, loneliness, hurt, and suicide. A brilliant, cathartic narrative for our times, it cries out for us to recognize human fragility and empathize with it.

 

 

That message spread far beyond Broadway on Sunday night when “Dear Evan Hansen” won six Tony Awards, including for best musical, best actor, and best score. The musical’s cast album, with songs like “You Will Be Found,” “Requiem,” and “Waving Through a Window,” debuted in the Billboard Top 10 earlier this year.

Best-actor winner Ben Platt, who is 23, reached out to vulnerable teenagers in his acceptance remarks during the nationally televised ceremony at Radio City Music Hall:

“To all young people watching at home, don’t waste any time trying to be like anybody but yourself, because the things that make you strange are the things that make you powerful.”

In the plot, anxiety-ridden teen Evan Hansen writes pep-talk letters to himself on the advice of his therapist. One of the letters ends up in the pocket of a social outcast named Connor, who then dies by suicide. The Connor connection takes Evan into a swirl of lies as he fabricates stories about a friendship with Connor and pursues the crush he has on Connor’s sister. Evan achieves temporary social media-fueled fame as a campaigner to aid other youth experiencing Connor’s mental health struggles. Evan’s charade collapses, but the ordeal brings him to a reconciliation with his single-parent mom and to healthier self-awareness.

“Dear Evan Hansen” has been praised for its sensitive handling of mental disorders and suicide. The production has openly associated itself with mental health and suicide prevention organizations like the Child Mind Institute, the Crisis Text Line, The Jed Foundation, and The Trevor Project.

The show’s songwriters, Benj Pasek and Justin Paul, who won the Tony Award for best original score, spoke to Variety about the care they took in writing about teen suicide. As Paul put it:

“We wanted to make sure the subject was treated thoughtfully and sensitively. There was vetting of the script and of the story with mental health professionals, to make sure what we were telling felt truthful and honest, and like we weren’t trying to sugarcoat things, but that also wasn’t trying to provoke anything. There’s a small change in the show that we made between Second Stage and Broadway, the addition of two little lines toward the very, very end of the show, that we added after some feedback that we’d gotten from families of teenagers or people who had taken their own lives.”

 

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TIME’s Susanna Schrobsdorff captures the incredible impact “Dear Evan Hansen” is having on teenagers—and their parents:

Ask one of the many teenagers in the audience if the play seems authentic and they can barely get the words out. They say things like, “I’m in shock, it’s so good.” And often, right behind them, is a parent who’s also feeling undone. I lost it in the first act when the two stellar actors who play mothers of teens sing about feeling totally unqualified for the job of being a parent. “Does anybody have a map?” they cry. “Anybody maybe happen to know how the hell to do this?”

Mayor Svante Myrick: Support Suicide Prevention

Ithaca Mayor Svante Myrick issued a proclamation Wednesday in support of The Watershed Declaration, a commitment by local mental health stakeholders to intensify efforts to prevent suicide in the community.

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“I call upon our citizens, government agencies, non-governmental organizations, health care providers, and educational institutions to raise awareness of Ithaca’s mental health support services, encourage those in need to seek treatment, honor those in our community we have lost too soon, and commit to an all-out effort to prevent suicide,” Svante said in issuing the proclamation at the start of the Ithaca Common Council meeting Wednesday evening.

The Watershed Declaration was adopted by acclamation at the close of a meeting held on April 17 of leaders from Tompkins County, the City of Ithaca, non-profit organizations, and the campuses of Cornell University, Ithaca College, and Tompkins Cortland Community College. The declaration termed suicide a “serious public health concern” and pledged to intensify suicide prevention efforts in Ithaca and Tompkins County.

Myrick said there is strong evidence that a comprehensive public health approach is effective in preventing suicide, and called on the community’s health and behavioral health systems to prevent suicide deaths using the best available information and practices.

Moreover, Myrick said, “every member of our community can play a role in protecting their friends, family members, and colleagues from suicide. Our community needs to advance suicide prevention by fighting the stigma around mental health and seeking treatment for mental disorders.”

Lee-Ellen Marvin, executive director of the Suicide Prevention and Crisis Service in Ithaca, expressed her gratitude for “the mayor’s support for reinvigorating our community’s commitment to suicide prevention. The need has never been greater. Unfortunately, suicide rates have been increasing in the last 15 to 20 years.”

“This proclamation is highlighting the need to address suicide prevention,” said Sharon MacDougall, deputy commissioner of Mental Health Services in Tompkins County. MacDougall added that her agency is working with the New York State Office of Mental Health to create a Tompkins County Suicide Prevention Coalition. “Selected key stakeholders will be invited to a planning meeting to start the Tompkins Suicide Prevention Coalition this summer,” she said. “This coalition will help coordinate the efforts of multiple agencies, providers and others to improve suicide prevention across Tompkins.”

Proclamation

The Watershed Declaration was adopted by acclamation at a meeting of 18 organizations hosted by The Sophie Fund, which was established in memory of Cornell University art student Sophie Hack MacLeod to promote improved mental health for young people in the greater Ithaca area.

The Watershed Declaration stated:

“We the assembled mental health stakeholders of the greater Ithaca community and Tompkins County recognize suicide as a serious public health concern. Today we renew our commitment to suicide prevention and pledge to intensify efforts toward saving lives and bringing hope to those struggling with suicide thoughts or affected by suicide loss.”

Photo caption: Ithaca Mayor Svante Myrick, The Sophie Fund Co-Donor Advisor Scott MacLeod, and Suicide Prevention & Crisis Service Executive Director Lee-Ellen Marvin

Military Suicides: Understanding “Moral Injury”

As America commemorates Memorial Day honoring those who gave their lives for their country, let us recognize the tragedy of military suicides among active duty soldiers and veterans.

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In 2014, 273 U.S. servicemen died by suicide compared to 58 killed in action in Afghanistan (55) and Iraq (3). And 7,403 vets took their own lives in 2014—18 percent of all adult suicides in the United States—according to the Veteran’s Administration. A factor receiving increasing attention in military suicides is known as moral injury.

Military service by definition is fraught with moral quandaries, from whether a particular war is “just” or an individual action within a “just” war is morally right. Psychiatrist Jonathan Shay, a specialist in combat trauma who has studied Vietnam veterans, says moral injury “is present when there has been a betrayal of “what’s right,” either by a person in legitimate authority or by one’s self, in a high stakes situation.” Both forms of moral injury impair the capacity for trust and elevate despair, suicidality, and interpersonal violence, Shay says.

Laura Greenstein of the National Alliance on Mental Illness (NAMI) illustrates the dilemma:

Imagine you are a young soldier leading your unit on a foot patrol in an Afghan village. One moment your environment is peaceful, the next your unit hears a loud explosion and you realize you are taking fire from the enemy. You find a secure position to radio your overhead observer, to determine where the threat is originating. It’s your job to take out the enemy before any soldiers or innocent civilians are harmed. Your overhead observer gives you the location and describes the enemy for you: an 11-year-old Afghan boy who is firing at your unit with a machine gun. At this point, you are ordered to take out the enemy. You follow the orders to save your soldiers and the innocent civilians in the village.

Six months later, you finished your deployment and are welcomed home by your friends and family. You begin to remember many of the experiences from your deployment, several you wish you could forget—including the day with the 11-year-old boy. This experience has made you question who you are, the morality you believe you had and causes you to worry that people may view you differently.

Writing in The Conversation, Holly Arrow and William M. Schumacher explain how mental health treatment and positive social interactions can help the healing:

Preliminary evidence suggests that cognitive-behavioral therapy (CBT) modified to treat issues related to moral injury can reduce depression as well as guilt- and shame-related thoughts. Treatment can come in other forms, as well. Psychotherapist Edward Tick, for example, organizes trips to Vietnam for U.S. veterans to meet their Vietnamese counterparts, for the healing of decades-long wounds.

However, we don’t need to be trained therapists to make a difference. Everyday social connections can also help the morally injured heal. In his dissertation, the second author of this article conducted a series of interviews with veterans exposed to potentially morally injurious events and found consistent differences between those with higher levels of depression and suicidal thoughts and those with fewer symptoms. Veterans who weren’t doing so well felt isolated and lacked support by friends, by family and by peers. Veterans with few symptoms felt supported by family, friends, peers and by their community. That’s the rest of us.

When we discover that someone has a military background, replacing the perfunctory “Thank you for your service” (which rarely leads to a meaningful exchange) with questions that start a conversation can create a new connection. The hopes, dreams, insecurities and mistakes of those who have served may be somewhat different based on their military background; many won’t be different at all.

Photo: Airmen of the 374th Security Forces Squadron, Yokota Air Base, Japan, May 15, 2017. Airman 1st Class Donald Hudson/U.S. Air Force

 
[If you or someone you know feels the need to speak with a mental health professional, you can contact the National Suicide Prevention Lifeline at 1-800-273-8255 or contact the Crisis Text Line by texting HOME to 741-741.]

[Veterans Crisis Line connects Veterans in crisis and their families and friends with Department of Veterans Affairs responders through a confidential toll-free hotline, online chat, or text. Veterans and their loved ones can call 1-800-273-8255 and Press 1, chat online, or send a text message to 838255 to receive confidential support 24 hours a day, 7 days a week, 365 days a year.]

[Visit the NAMI Veterans and Active Duty page for treatment resources, disclosure, and staying healthy during the transition to civilian life.]

 

Thank You for Your Service

By David Shapiro

Thank You For Your Service, the 2016 documentary by Tom Donahue, opened my eyes to the mental trauma that our military veterans can fall victim to. Among the shocking realities highlighted by the film is that 20 veterans take their own lives every day in the United States. Thank You for Your Service goes beyond the statistics to reveal the failed mental health policies within the U.S. military.

It is a privilege for Family & Children’s Service in Ithaca to share this important movie with our community and participate in advocacy for improved mental health care for our veterans and active service men and women. The screening of Thank You For Your Service at Cinemapolis on May 17-18 is sponsored through Family & Children’s Pamela and Robert Swieringa Education Center, carrying on a tradition we began last year in using cinema as a powerful public educational platform during Mental Health Awareness Month.

Thank You for Your Service features all manner of players and experts discussing the mental health crisis in the U.S. military, including former Defense Secretary Robert Gates, ex-CIA chief David Petraeus, and war correspondents like Sebastian Junger and Dexter Filkins. But most importantly, the film gives voice to the voiceless veterans themselves. The Hollywood Reporter aptly summarized the story in its review of Thank You for Your Service:

The interview subjects all agree that the Defense Department and the Veterans Administration have not sufficiently attended to veterans’ mental health needs, and the problems they cite are numerous. Among them are bureaucratic inefficiencies, lack of funding, the overprescribing of psychotropic medications, a lack of qualified therapists, and extended tours of duty that result in soldiers serving far longer than they bargained for.

But it’s not the expert commentary, as illuminating as it is, that gives the film its power. Rather, it’s the handful of veterans who discuss their emotional struggles, both while serving in Iraq and Afghanistan and after their discharge. One describes watching his best friend being burned alive, while another relates how he felt so guilty over civilians killed as a result of his actions that he attempted to find their family members to apologize. They talk about suffering from nightmares and PTSD; resorting to drugs and alcohol to numb the pain; and, in one case, playing Russian roulette.

Thank You for Your Service has won awards, but its producers are determined to achieve something else: change. They are urging movie-goers to take action in support of a proposed Behavioral Health Corps in the armed services that would focus on addressing critical mental health needs.

“If the public takes one message away from this film: reach out to your member of congress and request that they support a behavior health corps in the military,” says Daniel Rice, president of the Thayer Leader Development Group. “That will be the best action that they can take to help address the plague of suicides that our veterans are suffering.”

David Shapiro is chief executive officer of Family & Children’s Service in Ithaca

Cinemapolis Program Details:

May 17: Film at 6:30 p.m., Panel Discussion at 8:30 p.m.

May 18: Film at 7 p.m.

Also in Mental Health Awareness Month:

Family & Children’s Service Annual Celebration

Honoring:

Adga Osborn Award recipient Joan Jacobs Brumberg

Family Partner of the Year Serendipity Catering

Volunteer of the Year Bert Odom-Reed

Guest Speaker:

Karl Pillemer

Director of Bronfenbrenner Center for Translational Research.

Tuesday May 16

8-9:30 a.m.

Ithaca Country Club

189 Pleasant Grove Road

Click here to purchase tickets