Excessive Heat Exposure Can Pose Higher Risks for those on Psychotropic Medication or Other Substances

During this period when parts of the nation are experiencing record high temperatures, SAMHSA is reminding everyone that these conditions can pose certain health risk to everyone – including people with mental and substance use disorders.

Exposure to excessive heat is dangerous and can lead to heatstroke which is considered a medical emergency.  Heatstroke occurs when an abnormally elevated body temperature is unable to cool itself.  Internal body temperatures can rise to levels that may cause irreversible brain damage and death.

Individuals with behavioral health conditions who are taking psychotropic medications or using certain substances such as illicit drugs and alcohol may be at a higher risk for heatstroke and heat-related illnesses.  These medications and substances can interfere with the body’s ability to regulate heat and an individual’s awareness that their body temperature is rising.

According to the Centers for Disease Control and Prevention (CDC), effective methods to prevent heat exhaustion includes drinking plenty of fluids, replacing salt and minerals that may be removed from heavy sweating, wear loose light-colored clothing, wear sunscreen, stay cool indoors with air conditioning, and monitor those at high risk.

For individuals who may be living in facilities, it is important that caretakers ensure that those individuals are well hydrated, have access to cooler areas, and have their temperature levels monitored — especially for those individuals who may be taking antipsychotic and anticholinergic medications.

For more information on how to prevent, recognize, and treat heat-related illnesses, please see the CDC’s publication, Extreme Heat: A Prevention Guide to Promote Your Personal Health and Safety.   SAMHSA is partnering with the CDC to promote physical and emotional health and prevent co-morbid medical conditions for individuals with mental and substance use disorders.  Please visit SAMHSA’s Wellness Initiative Web site.


This Column Will Change Your Life: The Mind-Body Connection

Their hunch was that dualists, deep down, think of their bodies as husks – containers for their “real” selves – and thus treat them with less respect than physicalists, who think of their bodies as themselves. Sure enough, people primed to think in a dualist way (by reading a short text making the case for dualism) proved significantly less keen to endorse statements such as “I limit the amount of fat I eat” and “I regularly go to the gym” than those primed for physicalism. Asked to pick a cookbook as a reward for participating, dualists were more likely to choose one on desserts or barbecue than vegetarian or organic food. It worked in reverse, too: making people think about health foods made them less dualist.

…Much of our thinking on happiness, actually, relies on a hidden dualism. Faced with some problem of the mind – depression, anxiety – the “natural-born dualists” assume the solution must lie on the level of the mind, too. Exercise might give them a boost, but they tend to assume it can’t be a real solution to such woes; that has to come from therapy, meditation, or other “psychological” work. Yet who says so? Talk of the “mind-body connection” is often dismissed as new-age quackery, but if physicalism’s right, mind and body are more than just connected: they’re essentially the same thing. If I were a dictator, page one of every self-help book would read, in bold, inch-high capitals: “FIRST, GO FOR A SWIM.”

by Oliver Burkeman at The Guardian


VA Supports Family and Friends Seeking to Encourage Vets to Get Mental Health Services

The VA recently completed a media campaign for its call center Coaching Into Care, a telephone service which provides assistance to family members and friends trying to encourage their Veteran to seek health care for possible readjustment and mental health issues. The Coaching Into Care service offers free coaching to callers, with no limit to the number of calls they can make. The goal of these sessions is to connect a Veteran with VA care in his or her community with the help and encouragement of family members or friends. Callers will be coached on solving specific logistical problems and ways to encourage the Veteran to seek care while respecting his or her right to make personal decisions.


Survey Finds More Evidence That Mental Disorders Often Begin in Youth

About 8 percent of U.S. teens meet current criteria for having a serious emotional disturbance, according to two NIMH-funded studies published in the April 2012 issue of the Archives of General Psychiatry.


A September 2010 study using data from the NIMH-funded National Comorbidity Survey-Adolescent Supplement (NCS-A) found that about 20 percent of youth are affected by a mental disorder sometime in their lifetime. The NCS-A is a nationally representative, face-to-face survey of more than 10,000 teens ages 13 to 18. Parents or caregivers were also asked to complete a corroborating questionnaire after teens were interviewed. The NCS-A used criteria established by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV) to assess for a wide range of mental disorders including mood and anxiety disorders, behavior disorders like attention deficit hyperactivity disorder (ADHD), eating disorders, and substance use disorders.

In this most recent analysis, Kathleen Merikangas, Ph.D., of NIMH, Ron Kessler, Ph.D., of Harvard University, and colleagues examined the prevalence of mental disorders, as well as the severity of the disorders, within a 12-month period to estimate the rate of serious emotional disturbances (SED) in youth. SED was defined by the Substance Abuse and Mental Health Administration (SAMHSA) as a “mental, behavioral, or emotional disorder … that resulted in functional impairment which substantially interferes with or limits the child’s role or functioning in family, school, or community activities.”

Results of the Study

The researchers found that about 8 percent of all respondents had SED. Those with behavior disorders were most likely to be considered to have a severe disorder. Those with three or more coexisting disorders were also more likely to be severely affected. Similar to adults, anxiety disorders were the most common conditions in adolescents. Echoing many other studies, girls were more likely to have a mood or anxiety disorder or eating disorder, while boys were more likely to have a behavior disorder like ADHD or substance use disorder. Contrary to regional studies, this report showed a lower rate of depression among Hispanics compared to whites.


The findings in this study reflect the widely held belief that most psychiatric disorders first manifest in childhood or adolescence and tend to persist or recur throughout a person’s life. The researchers conclude that the high prevalence rate of mental disorders in U.S. adolescents underscores the need for more research focused on changing the trajectory of mental disorders in youth.

What’s Next

More research is needed to better understand the differences in prevalence rates among cultural and ethnic groups in different regions of the country.

–National Institute of Mental Health (NIMH)


Rate of Bipolar Symptoms Among Teens Approaches That of Adults

The rate of bipolar symptoms among U.S. teens is nearly as high as the rate found among adults, according to NIMH-funded research published online ahead of print on May 7, 2012, in the Archives of General Psychiatry.


Nationally representative data indicate that about 3.9 percent of adults meet criteria for bipolar disorder in their lifetime, and 2.6 percent meet criteria in a given year.1 However, limited data exist on the rates of bipolar disorder among adolescents, despite strong evidence indicating that bipolar disorder tends to emerge in adolescence or early adulthood.

Kathleen Merikangas, Ph.D., of NIMH, and colleagues analyzed data from the NIMH-funded National Comorbidity Survey-Adolescent Supplement (NCS-A), a nationally representative, face-to-face survey of more than 10,000 teens ages 13 to 18. Using criteria established by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV), the researchers assessed teens for the hallmark symptoms of bipolar disorder—mania and depression. They also examined the rates of teens who showed evidence of mania alone.

Results of the Study

The researchers found that 2.5 percent of youth met criteria for bipolar disorder in their lifetime, and 2.2 percent met criteria within a given year. About 1.7 percent reported having mania alone within their lifetime, and 1.3 percent reporting having mania alone within a given year. Rates increased with age—about 2 percent of younger teens reported bipolar disorder symptoms, whereas 3.1 percent of older teens did.


The findings reveal that the prevalence of bipolar disorder in adolescents approaches that of adults, underscoring the widely held belief that the disorder first appears in youth. In addition, the presence of mania alone suggests that mania without depression should receive greater attention when evaluating mood disorders in teens, especially since it may precede or be associated with behavioral problems such as substance use disorders and attention deficit hyperactivity disorder, according to the researchers.

What’s Next

The researchers highlighted the need to follow up with these youth, to see if they continue to manifest bipolar symptoms as they age. More research is needed on the overlap of mania with other emotional and behavioral disorders, as well as the core features and risk factors for the development of mania in adolescents.

–National Institute of Mental Health (NIMH)


How We Can Stop Older Americans From Being “Bullied”

Picture of the stopbullying.gov URLWritten By: Ingrid Donato, Mental Health Promotion Branch Chief, Center for Mental Health Services

Bullying-like aggression can happen to people of all ages – including older Americans. One has to look no further than the situation of Karen Klein, the 68-year-old monitor of Bus 784 in Greece, NY who was tormented by adolescents in a school bus.

Although bullying is typically defined as occurring among youth, what happened on this bus shows that this type of aggression can happen to anyone.  For older adults these problems can occur in many settings, including their homes and long-term care facilities, such as nursing homes or assisted living residencesllying can come at the hands of many people in direct contact with elders, including caregivers, family, or even facility residents.

One of the most painful forms of bullying is isolation.

As hard as it is to spot, and sometimes accept, offenders may include family members and old friends, newly developed “friends” who intentionally prey on older adults, and service providers in positions of trust.

While there is no typical profile of an abuser, the following are some behavioral signs that may indicate problems:

  • Abusing alcohol or other drugs
  • Controlling elder’s actions: whom they see and talk to, where they go
  • Isolating elders from family and friends, which can increase dependence
  • Emotional/ financial dependency on elder; inability to be self‐sufficient
  • Threatening to leave or send elder to a nursing home
  • Appearing to be indifferent to the child or elder; seeming apathetic or hostile
  • Minimizing an elder’s injuries, blaming victim or others for the abuse, neglect, or exploitation
  • Threatening to harm a victim’s pet
  • Calling the elder and or young person names
  • Previous criminal history
  • Longstanding personality traits (bad temper, hypercritical, tendency to blame others for problems)

Taking time to listen and to really “hear” people–of any age—are the first lines of defense against bullying.  Looking for these signs and carefully talking with the older people in your life can be an important first step in determining whether or not there is a problem.  If you know someone who is being bullied or is a victim of aggressive behavior, there are steps you can take to get the bullying to stop – and the information is available at: http://www.stopbullying.gov/what-is-bullying/related-topics/young-adults/index.html.

If you suspect elder abuse, neglect, or exploitation, visit the National Center on Elder Abuse to find phone numbers for your state, or call the Eldercare Locator at 1-800-677-1116.  If someone is in immediate danger,call 911 or the local police.

Through communication and action, older Americans and people of all ages can free themselves of the risks, torment and trauma of events like what happened on Bus 784.



Behavioral Health Hampered: Ineligible for Federal Incentive Payments

Behavioral Health Hampered in Adopting HIT, Survey Finds

Washington, DC, July 11, 2012—Behavioral health organizations in the U.S. are committed to improving patient care through the “meaningful use” of health information technology (HIT), but face considerable barriers in adopting electronic health records (EHRs) and other technological advances, according to a new report releasedby the National Council for Community Behavioral Healthcare (National Council).The report, HIT Adoption and Meaningful Use Readiness in Community Behavioral Health, reveals that only 2 percent of community mental health and addictions treatment organizations feel ready to meet meaningful use requirements, compared to 27 percent of Federally Qualified Health Centers and 20 percent of hospitals.

The report attributes the disparity in large part to the American Recovery and Reinvestment Act of 2009, which provided more than $19 billion for incentive payments to support the “meaningful use” of HIT, but did not qualify behavioral health organizations to receive facility incentive payments.

“The real victims are some of our nation’s most vulnerable populations — the more than eight million adults, children, and families with mental illnesses and addiction disorders that behavioral health organizations serve,” said Linda Rosenberg, National Council’s President and CEO. “People with mental and substance use disorders have historically been excluded from the mainstream, and now they are excluded from the supports for HIT adoption offered to the rest of the safety net.”

Despite the inequity, the report finds that behavioral health organizations are eager to move forward on implementing EHRs to:

  • Facilitate communication with other healthcare organizations to improve care coordination (36 percent)
  • Improve quality care and streamline operations (33 percent)
  • Position organization for growth and expansion in emerging healthcare delivery systems (32 percent)

“It took us years to save money to be able to afford an EHR but I can’t emphasize enough how much these systems improve care for mental health patients, help avoid unnecessary tests, and enhance patient safety,” said Dr. Robert Meisner, psychiatrist at the McClendon Center in Washington, D.C.

When asked about barriers to implementing HIT, 30 percent of survey respondents identified “upfront financial costs” as the leading roadblock, followed by 12 percent who listed “ongoing maintenance costs.” Other significant impediments include workforce issues such as:

  • Lack of dedicated staff to implement technology (9 percent)
  • Lack of project management staff (8 percent)
  • Lack of skills to properly select technology (8 percent)
  • Lack of dedicated staff to maintain the systems (7 percent)

“It’s hard to take the money you need to fix leaking roofs and ensure safe buildings and divert it to electronic health records. We really need the support of Congress to make this happen. Without HIT funding, we are going to fall further and further behind in meeting patient needs,” said Jeff Richardson, CEO of Mosaic Community Services, the largest community-based behavioral health organization in Maryland employing more than 700 staff and serving thousands of children, adolescents, and adults annually.

Even patients feel that care is fragmented when provided in a paper-based system. Rebekah diFrancesca Parshall, a client at Mosaic Community Services, lamented that the big picture is missing in the absence of a well-orchestrated environment, causing different providers to each “do their own thing.”

“Behavioral health is simply not on a level playing field with the rest of healthcare,” said Mike Lardiere, the National Council’s Vice President of HIT and Strategic Development. “Without these federal incentive payments, behavioral health organizations are unfairly restricted from achieving the Triple Aim of improving the patient experience of care, improving the health of the populations, and reducing the per capita cost of healthcare.”

The report calls on Congress to stop the widening digital divide between behavioral health and the rest of healthcare by passing the Behavioral Health Information Technology Act (S. 539/H.R. 6043), which will add community mental health centers, psychiatric hospitals, mental health treatment facilities, and substance abuse treatment facilities to the list of organizations eligible for federal incentive payments.

The HIT survey report is available on the National Council website.

The National Council is a not-for-profit, 501(c)(3) association of 1,950 community healthcare organizations that provide treatment and rehabilitation for mental illnesses and addiction disorders to more than 8 million adults, children and families in communities across the country. Learn more at www.TheNationalCouncil.org.

The 1999 Olmstead Decision by the U.S. Supreme Court

(July 5, 2012) Among the dozens of workshops offered at NAMI’s 2012 convention in Seattle last week was one of particular interest to us: “The Supreme Court’s Olmstead Decision: Implications for Mental Health Systems Reform.”

namiThe 1999 Olmstead decision by the U.S. Supreme Court determined that states, must make community mental health treatment available as an alternative to institutional treatment for certain patients who could be safely integrated into the community. Although the decision was explicit that it should not be read “to impel States to phase out institutions, placing patients in need of close care at risk,” the case has widely been used as a justification to do just that.

In the workshop, a Department of Justice (DOJ) official detailed the benefits of the 40 “enforcements” of the Olmstead decision now underway in 25 states, including Delaware, whose mental health director was also on the panel. While there has unquestionably been a need to remedy deplorable conditions in Delaware and elswhere, what went unmentioned in the DOJ presentation were the inevitable negative consequences of incomplete remedies.

The combination of DOJ enforcement and dire state fiscal issues has led to a radical reduction in the number of public psychiatric beds as hospital patients with severe mental illness are “transitioned” into communities that far too often are unprepared to serve their special needs. DOJ special counsel Allison Barkoff  acknowledged that “mistakes” were made in “opening the doors of institutions without looking at alternatives in the community” but failed to describe the practical, unintended outcomes of a process that has left hundreds of thousands of people “reinstitutionalized” in jails, prisons and hospital emergency rooms.

These and other consequences are “implications” of mental health system “reform,” too, and they need attention if deplorable conditions are truly to be remedied and not merely shifted elsewhere.

The DOJ maintains a website to provide its take on Olmstead.  To see what the Department of Justice found in Delaware, click here.

–The Treatment Advocacy Center


The Treatment Advocacy Center: When People Don’t Like Us

The very last person who visited the Treatment Advocacy Center’s booth on the very last day of the NAMI 2012 convention in Seattle was a warm and friendly woman who, upon spotting my name tag, reached across the high table that held our materials to shake my hand and say, “Congratulations!”

doris-fullerI was impressed that she followed our news and developments closely enough to know I was our still relatively new executive director and was happy to meet still another supporter. One of the delights of attending NAMI is putting faces to names and voices and hearing so many people say, “I love what you guys do! Thank you!”

But this visitor didn’t love what we do. She remained friendly as she told us that she doesn’t like founder E. Fuller Torrey, and she doesn’t like us. She said she follows us because she likes to know what we’re doing to promote involuntary treatment, which she doesn’t like at all.

She was the only opponent I’d met at this booth this year so I asked her one of the questions I always have when I meet people who oppose court-ordered treatment: “Then what do you do, for example, to help the homeless person who is delusional, hungry, filthy and so ill he wouldn’t seek care even if the best treatment in the world was just behind the door on whose step he was sleeping?”

There was a pause. “I don’t know,” she said. And then, after a bit of deliberation, she mentioned respecting and identifying each individual’s needs by talking to the person about what he or she wants.

There are an estimated 3.3 million people living with untreated schizophrenia or severe bipolar living in this country today. The most conservative estimate of inmates with severe mental illness in jails and prisons is running at about 350,000, many of them in solitary confinement. Nearly 200,000 of the men and women who will sleep on the streets tonight are estimated to be suffering severe, untreated mental illness. An untold number of people who are acutely ill also are sitting in hospital ERs right now, handcuffed to gurneys or otherwise restrained because they are unsafe to themselves or others but can’t be hospitalized because there are no psychiatric beds for them.

We respect their needs. That’s why we advocate for improved civil commitment laws and their widespread implementation. We want these people, too, to enjoy the stability that makes it possible for people who themselves once were acutely ill to recover so much they are able to become our opponents.

–The Treatment Advocacy Center