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"content": "\u003cp>Amanda Bacon’s eating disorder was growing worse. She had lost 60% of her body weight and was consuming only about 100 calories a day.\u003c/p>\n\u003cp>But that wasn’t sick enough for her Medicaid managed-care company to cover an inpatient treatment program. She was told in 2017 that unless she weighed 10 pounds less — which would have put her at 5-foot-7 and 90 pounds — or was admitted to a psychiatric unit, she wasn’t eligible for coverage.\u003c/p>\n\u003cp>“I remember thinking, ‘I’m going to die,’ ” the Las Cruces, N.M., resident recalls.\u003c/p>\n\u003cp>Eventually, Bacon, now 35, switched to a plan that paid for treatment, although she says it was still an arduous process getting the services approved.\u003c/p>\n\u003cp>Many patients, like Bacon, struggle to get insurance coverage for their mental health treatment, even though two federal laws were designed to bring parity between mental and physical health care coverage. Recent studies and a legal case suggest serious disparities remain.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[aside tag='stress' label='Related Coverage']\u003c/span>\u003c/p>\n\u003cp>The 2008 \u003ca href=\"https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet.html\">Mental Health Parity and Addiction Equity Act\u003c/a> required large group health plans that provide benefits for mental health problems to put that coverage on an equal footing with physical illness. Two years later, the Affordable Care Act required small-group and individual health plans sold on the insurance marketplaces \u003ca href=\"https://aspe.hhs.gov/report/affordable-care-act-expands-mental-health-and-substance-use-disorder-benefits-and-federal-parity-protections-62-million-americans\">to cover mental health services\u003c/a>, and do so at levels comparable with medical services. (In 2016, parity rules \u003ca href=\"https://www.medicaid.gov/medicaid/benefits/downloads/fact-sheet-cms-2333-f.pdf\">were also applied to Medicaid\u003c/a> managed-care plans, which cover the majority of people in that federal-state health program for low-income residents.)\u003c/p>\n\u003cp>The laws have been partially successful. Insurers are no longer permitted to write policies that charge higher copays or deductibles for mental health care, nor can they set annual or lifetime upper-limits on how much they will pay for such care. But advocates for patients say insurance companies still interpret mental health claims more stringently than those for physical illness.\u003c/p>\n\u003cp>“Insurance companies can easily circumvent mental health parity mandates by imposing restrictive standards of medical necessity,” says \u003ca href=\"https://www.psych-appeal.com/meiram-bendat/\">Meiram Bendat\u003c/a>, a lawyer leading a class-action lawsuit against a mental health subsidiary of UnitedHealthcare.\u003c/p>\n\u003cp>In a closely watched ruling, a \u003ca href=\"https://www.nytimes.com/2019/03/05/health/unitedhealth-mental-health-parity.html\">federal court in March sided with Bendat\u003c/a> and patients who alleged the insurer was deliberately shortchanging mental health claims. Chief Magistrate Judge \u003ca href=\"https://drive.google.com/file/d/1XuzFQV4Z6vClFnpYpTaoS4vBT_RPhQsN/view\">Joseph Spero of the U.S. District Court for the Northern District of California ruled\u003c/a> that United Behavioral Health wrote its \u003ca href=\"https://www.manatt.com/Insights/Newsletters/Health-Update/Level-of-Care-Criteria-Ruled-Inconsistent\">guidelines for treatment\u003c/a> much more narrowly than common medical standards, covering only enough care to stabilize patients “while ignoring the effective treatment of members’ underlying conditions.”\u003c/p>\n\u003cp>UnitedHealthcare works to “ensure our products meet the needs of our members and comply with state and federal law,” says spokeswoman Tracey Lempner.\u003c/p>\n\u003cp>Several studies, though, have found evidence of disparities in insurers’ decisions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Growing gap in coverage in hospitals\u003c/strong>\u003c/p>\n\u003cp>In February, researchers at the \u003ca href=\"https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05226\">Congressional Budget Office\u003c/a> reported that private insurance companies are paying 13% to 14% less for mental health care than Medicare does.\u003c/p>\n\u003cp>The insurance industry’s own data shows a \u003ca href=\"https://www.healthcostinstitute.org/images/easyblog_articles/276/HCCI-2017-Health-Care-Cost-and-Utilization-Report-02.12.19.pdf\">growing gap\u003c/a> between coverage of mental and physical care in hospitals and skilled nursing facilities. For the five years ending in 2017, out-of-pocket spending on inpatient mental health care grew nearly 13 times faster than all inpatient care, according to inpatient data reported in February by the \u003ca href=\"https://www.healthcostinstitute.org/about-hcci\">Health Care Cost Institute\u003c/a>, a research group funded by the insurance companies Aetna, Humana, UnitedHealthcare and Kaiser Permanente. (Kaiser Health News is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>And a \u003ca href=\"http://www.milliman.com/uploadedFiles/insight/2017/NQTLDisparityAnalysis.pdf\">2017 report\u003c/a> by the actuarial firm Milliman found that an office visit with a therapist is five times as likely to be out-of-network, and thus more expensive, than a primary care appointment.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[aside tag='health' label='Related Coverage']\u003c/span>\u003c/p>\n\u003cp>In this environment, \u003ca href=\"https://journalistsresource.org/studies/government/health-care/mental-health-untreated-children-research/\">only half of the nearly 8 million children\u003c/a> who have been diagnosed with depression, anxiety or attention deficit hyperactivity disorder receive treatment, \u003ca href=\"https://jamanetwork.com/journals/jamapediatrics/fullarticle/2724377\">according to a February research letter\u003c/a> in the medical journal \u003cem>JAMA Pediatrics\u003c/em>. \u003ca href=\"https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm#tx\">Fewer than 1 in 5 people\u003c/a> with substance use disorder are treated, a national survey suggests, and, overall, \u003ca href=\"https://www.nimh.nih.gov/health/statistics/mental-illness.shtml\">nearly 6 in 10\u003c/a> people with mental illness get no treatment or medication, according to the National Institute Of Mental Health.\u003c/p>\n\u003cp>Amanda Bacon, who is still receiving care for her eating disorder, remembers fearing that she wouldn’t get treatment. She was at one point rushed to an emergency room for care, but after several days in the hospital she was sent home, no closer to getting well.\u003c/p>\n\u003cp>Today, because of her disability, Bacon’s primary medical insurance is through Medicare, which has paid for treatment that her earlier Medicaid provider, Molina Healthcare, refused. She has been treated in four inpatient programs in the past two years — twice through Presbyterian Centennial Care, a Medicaid plan she switched to after Molina, and twice though her current Medicare plan. Bacon is also enrolled in a state-run Medicaid plan.\u003c/p>\n\u003cp>Molina says it can’t comment on Bacon’s case. “Molina complies with mental health parity laws,” say spokeswoman Danielle Smith, and it “applies industry-recognized medical necessity criteria in any medical determinations affecting mental health.”\u003c/p>\n\u003cp>\u003cstrong>The ‘wrong criteria’\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.austenriggs.org/staff/eric-m-plakun\">Dr. Eric Plakun\u003c/a>, CEO of the Austen Riggs Center, a psychiatric hospital and residential program in Massachusetts, says that often insurers are “using the wrong criteria” for what makes something medically necessary. They pay enough only to stabilize a patient’s condition, Plakun says, but not enough to improve their underlying illness. He was one of the experts who testified in the case before Judge Spero in California.\u003c/p>\n\u003cp>Insurers say they recognize the importance of mental health care coverage and that they are \u003ca href=\"https://www.ahip.org/mental-health-parity-issue-brief/\">complying with the law\u003c/a>.\u003c/p>\n\u003cp>Cathryn Donaldson, a spokeswoman for the trade group America’s Health Insurance Plans, says the industry supports parity, but that it is also harder to prove when a mental health treatment is needed.\u003c/p>\n\u003cp>Compared with the data on medical and surgical care, she says, the data and standards to measure mental health care “trail far behind.” She cited \u003ca href=\"https://www.mnhospitals.org/Portals/0/Documents/policy-advocacy/mental-health/MHA%20Mental%20Health%20Avoidable%20Days%20Study%20Report%20July%202016.pdf\">a 2016 study\u003c/a> of Minnesota hospitals, where nearly one-fifth of the time patients spent in psychiatric units occurred after they were stabilized and ready to be discharged.\u003c/p>\n\u003cp>“Just like doctors use scientific evidence to determine the safest, most effective treatments,” insurers do the same to cover treatment “consistent with guidelines showing when and where it’s effective for patients,” Donaldson says.\u003c/p>\n\u003cp>Health plans commonly apply several controls that limit their coverage of mental health care. And these strategies by insurers are legal — unless they are applied more strictly for mental health care than medical care.\u003c/p>\n\u003cp>For example, they often require patients to try cheaper options first, a strategy called “fail first.” Patients referred by their doctors to a residential program for opioid addiction, for example, might be denied coverage by their insurers until they try — and fail — to improve at a less expensive part-time out-patient program.\u003c/p>\n\u003cp>Hiring doctors, nurses and pharmacists to review claims is another technique.\u003c/p>\n\u003cp>Dr. Frederick Villars, who reviews mental health claims for Aetna, remembers arguing with insurers to approve treatment when he was a practicing psychiatrist. His team decides what Aetna will cover based on clinical standards, he says. And providers upset about a coverage decision “are well aware of what these guidelines are.”\u003c/p>\n\u003cp>“It’s not a pleasant process,” Villars says, “but it’s the only tool that exists in this setting to try to keep costs under control.”\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> is a nonprofit, editorially independent program of the Kaiser Family Foundation. It is not affiliated with Kaiser Permanente. \u003c/em>\u003cem>Graison Dangor is a journalist living in Brooklyn.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2019 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=%27Mental+Health+Parity%27+Is+Still+An+Elusive+Goal+In+U.S.+Insurance+Coverage&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Amanda Bacon’s eating disorder was growing worse. She had lost 60% of her body weight and was consuming only about 100 calories a day.\u003c/p>\n\u003cp>But that wasn’t sick enough for her Medicaid managed-care company to cover an inpatient treatment program. She was told in 2017 that unless she weighed 10 pounds less — which would have put her at 5-foot-7 and 90 pounds — or was admitted to a psychiatric unit, she wasn’t eligible for coverage.\u003c/p>\n\u003cp>“I remember thinking, ‘I’m going to die,’ ” the Las Cruces, N.M., resident recalls.\u003c/p>\n\u003cp>Eventually, Bacon, now 35, switched to a plan that paid for treatment, although she says it was still an arduous process getting the services approved.\u003c/p>\n\u003cp>Many patients, like Bacon, struggle to get insurance coverage for their mental health treatment, even though two federal laws were designed to bring parity between mental and physical health care coverage. Recent studies and a legal case suggest serious disparities remain.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/span>\u003c/p>\n\u003cp>The 2008 \u003ca href=\"https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet.html\">Mental Health Parity and Addiction Equity Act\u003c/a> required large group health plans that provide benefits for mental health problems to put that coverage on an equal footing with physical illness. Two years later, the Affordable Care Act required small-group and individual health plans sold on the insurance marketplaces \u003ca href=\"https://aspe.hhs.gov/report/affordable-care-act-expands-mental-health-and-substance-use-disorder-benefits-and-federal-parity-protections-62-million-americans\">to cover mental health services\u003c/a>, and do so at levels comparable with medical services. (In 2016, parity rules \u003ca href=\"https://www.medicaid.gov/medicaid/benefits/downloads/fact-sheet-cms-2333-f.pdf\">were also applied to Medicaid\u003c/a> managed-care plans, which cover the majority of people in that federal-state health program for low-income residents.)\u003c/p>\n\u003cp>The laws have been partially successful. Insurers are no longer permitted to write policies that charge higher copays or deductibles for mental health care, nor can they set annual or lifetime upper-limits on how much they will pay for such care. But advocates for patients say insurance companies still interpret mental health claims more stringently than those for physical illness.\u003c/p>\n\u003cp>“Insurance companies can easily circumvent mental health parity mandates by imposing restrictive standards of medical necessity,” says \u003ca href=\"https://www.psych-appeal.com/meiram-bendat/\">Meiram Bendat\u003c/a>, a lawyer leading a class-action lawsuit against a mental health subsidiary of UnitedHealthcare.\u003c/p>\n\u003cp>In a closely watched ruling, a \u003ca href=\"https://www.nytimes.com/2019/03/05/health/unitedhealth-mental-health-parity.html\">federal court in March sided with Bendat\u003c/a> and patients who alleged the insurer was deliberately shortchanging mental health claims. Chief Magistrate Judge \u003ca href=\"https://drive.google.com/file/d/1XuzFQV4Z6vClFnpYpTaoS4vBT_RPhQsN/view\">Joseph Spero of the U.S. District Court for the Northern District of California ruled\u003c/a> that United Behavioral Health wrote its \u003ca href=\"https://www.manatt.com/Insights/Newsletters/Health-Update/Level-of-Care-Criteria-Ruled-Inconsistent\">guidelines for treatment\u003c/a> much more narrowly than common medical standards, covering only enough care to stabilize patients “while ignoring the effective treatment of members’ underlying conditions.”\u003c/p>\n\u003cp>UnitedHealthcare works to “ensure our products meet the needs of our members and comply with state and federal law,” says spokeswoman Tracey Lempner.\u003c/p>\n\u003cp>Several studies, though, have found evidence of disparities in insurers’ decisions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Growing gap in coverage in hospitals\u003c/strong>\u003c/p>\n\u003cp>In February, researchers at the \u003ca href=\"https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05226\">Congressional Budget Office\u003c/a> reported that private insurance companies are paying 13% to 14% less for mental health care than Medicare does.\u003c/p>\n\u003cp>The insurance industry’s own data shows a \u003ca href=\"https://www.healthcostinstitute.org/images/easyblog_articles/276/HCCI-2017-Health-Care-Cost-and-Utilization-Report-02.12.19.pdf\">growing gap\u003c/a> between coverage of mental and physical care in hospitals and skilled nursing facilities. For the five years ending in 2017, out-of-pocket spending on inpatient mental health care grew nearly 13 times faster than all inpatient care, according to inpatient data reported in February by the \u003ca href=\"https://www.healthcostinstitute.org/about-hcci\">Health Care Cost Institute\u003c/a>, a research group funded by the insurance companies Aetna, Humana, UnitedHealthcare and Kaiser Permanente. (Kaiser Health News is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>And a \u003ca href=\"http://www.milliman.com/uploadedFiles/insight/2017/NQTLDisparityAnalysis.pdf\">2017 report\u003c/a> by the actuarial firm Milliman found that an office visit with a therapist is five times as likely to be out-of-network, and thus more expensive, than a primary care appointment.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/span>\u003c/p>\n\u003cp>In this environment, \u003ca href=\"https://journalistsresource.org/studies/government/health-care/mental-health-untreated-children-research/\">only half of the nearly 8 million children\u003c/a> who have been diagnosed with depression, anxiety or attention deficit hyperactivity disorder receive treatment, \u003ca href=\"https://jamanetwork.com/journals/jamapediatrics/fullarticle/2724377\">according to a February research letter\u003c/a> in the medical journal \u003cem>JAMA Pediatrics\u003c/em>. \u003ca href=\"https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm#tx\">Fewer than 1 in 5 people\u003c/a> with substance use disorder are treated, a national survey suggests, and, overall, \u003ca href=\"https://www.nimh.nih.gov/health/statistics/mental-illness.shtml\">nearly 6 in 10\u003c/a> people with mental illness get no treatment or medication, according to the National Institute Of Mental Health.\u003c/p>\n\u003cp>Amanda Bacon, who is still receiving care for her eating disorder, remembers fearing that she wouldn’t get treatment. She was at one point rushed to an emergency room for care, but after several days in the hospital she was sent home, no closer to getting well.\u003c/p>\n\u003cp>Today, because of her disability, Bacon’s primary medical insurance is through Medicare, which has paid for treatment that her earlier Medicaid provider, Molina Healthcare, refused. She has been treated in four inpatient programs in the past two years — twice through Presbyterian Centennial Care, a Medicaid plan she switched to after Molina, and twice though her current Medicare plan. Bacon is also enrolled in a state-run Medicaid plan.\u003c/p>\n\u003cp>Molina says it can’t comment on Bacon’s case. “Molina complies with mental health parity laws,” say spokeswoman Danielle Smith, and it “applies industry-recognized medical necessity criteria in any medical determinations affecting mental health.”\u003c/p>\n\u003cp>\u003cstrong>The ‘wrong criteria’\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.austenriggs.org/staff/eric-m-plakun\">Dr. Eric Plakun\u003c/a>, CEO of the Austen Riggs Center, a psychiatric hospital and residential program in Massachusetts, says that often insurers are “using the wrong criteria” for what makes something medically necessary. They pay enough only to stabilize a patient’s condition, Plakun says, but not enough to improve their underlying illness. He was one of the experts who testified in the case before Judge Spero in California.\u003c/p>\n\u003cp>Insurers say they recognize the importance of mental health care coverage and that they are \u003ca href=\"https://www.ahip.org/mental-health-parity-issue-brief/\">complying with the law\u003c/a>.\u003c/p>\n\u003cp>Cathryn Donaldson, a spokeswoman for the trade group America’s Health Insurance Plans, says the industry supports parity, but that it is also harder to prove when a mental health treatment is needed.\u003c/p>\n\u003cp>Compared with the data on medical and surgical care, she says, the data and standards to measure mental health care “trail far behind.” She cited \u003ca href=\"https://www.mnhospitals.org/Portals/0/Documents/policy-advocacy/mental-health/MHA%20Mental%20Health%20Avoidable%20Days%20Study%20Report%20July%202016.pdf\">a 2016 study\u003c/a> of Minnesota hospitals, where nearly one-fifth of the time patients spent in psychiatric units occurred after they were stabilized and ready to be discharged.\u003c/p>\n\u003cp>“Just like doctors use scientific evidence to determine the safest, most effective treatments,” insurers do the same to cover treatment “consistent with guidelines showing when and where it’s effective for patients,” Donaldson says.\u003c/p>\n\u003cp>Health plans commonly apply several controls that limit their coverage of mental health care. And these strategies by insurers are legal — unless they are applied more strictly for mental health care than medical care.\u003c/p>\n\u003cp>For example, they often require patients to try cheaper options first, a strategy called “fail first.” Patients referred by their doctors to a residential program for opioid addiction, for example, might be denied coverage by their insurers until they try — and fail — to improve at a less expensive part-time out-patient program.\u003c/p>\n\u003cp>Hiring doctors, nurses and pharmacists to review claims is another technique.\u003c/p>\n\u003cp>Dr. Frederick Villars, who reviews mental health claims for Aetna, remembers arguing with insurers to approve treatment when he was a practicing psychiatrist. His team decides what Aetna will cover based on clinical standards, he says. And providers upset about a coverage decision “are well aware of what these guidelines are.”\u003c/p>\n\u003cp>“It’s not a pleasant process,” Villars says, “but it’s the only tool that exists in this setting to try to keep costs under control.”\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> is a nonprofit, editorially independent program of the Kaiser Family Foundation. It is not affiliated with Kaiser Permanente. \u003c/em>\u003cem>Graison Dangor is a journalist living in Brooklyn.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2019 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=%27Mental+Health+Parity%27+Is+Still+An+Elusive+Goal+In+U.S.+Insurance+Coverage&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>David Singer clicks through iTunes looking for “Ferris Bueller’s Day Off,” a film he watched at least 12 times when it first came out in 1986. He was in his early 20s then.\u003c/p>\n\u003cp>“You’re old,” his younger daughter mutters, as she nudges her dad to choose the HD version.\u003c/p>\n\u003cp>Singer has high hopes as he settles in to watch the film with his wife and their two daughters, Emma, 13, and Elliot, 16, at their home in San Francisco.\u003c/p>\n\u003cp>“I want them to fall in love with it, just the way I did,” he says, as the opening scenes begin to roll. “Getting them to watch a movie from my younger days is always a challenge. They look slower and not as much in focus.”\u003c/p>\n\u003cp>Singer is like so many other people who came of age in the 1980s and idolized Ferris Bueller. For them, it will always be a fun movie about a kid faking being sick and skipping school.\u003c/p>\n\u003cp>“He was just having a load of fun,” Singer says, remembering Ferris at the Cubs game and singing on the float in downtown Chicago. “Everyone has a friend like his buddy, who’s kind of a sad sack.”\u003c/p>\n\u003cp>[pullquote size='small' align='right' citation='Danny Wedding, author of Movies and Mental Illness']‘In the 1980s, there might have been a tendency to see these as just rebellious teenagers misbehaving and causing trouble. Now, we’re more likely to be sensitive to the mental illness themes and to see Cameron as somebody coping with depression.’[/pullquote]But more than 30 years later, Cameron Frye, and his friendship with Ferris, look different through the eyes of today’s teens. They notice different themes and different dynamics. Watching the film from today’s perspective and applying today’s vocabulary, it’s clear that Cameron wasn’t just a sad sack — he was depressed and anxious.\u003c/p>\n\u003cp>“I’m dying,” he groans in his first scene, cocooned in bed, staring at the ceiling. To which Ferris responds, “You’re not dying. You just can’t think of anything good to do.”\u003c/p>\n\u003cp>Throughout the film, Cameron’s fear is the foil to Ferris’ free spirit.\u003c/p>\n\u003cp>When they borrow Cameron’s dad’s precious Ferrari and things go wrong, Cameron “goes berserk,” in Ferris’ words, then spends the next several scenes in a catatonic state.\u003c/p>\n\u003cp>“Maybe he’s really sick,” Ferris says, nibbling an Oreo in a hot tub while Cameron stares straight ahead over the swimming pool. “Maybe he isn’t just torturing himself.”\u003c/p>\n\u003cp>Then Cameron tumbles into the pool, fully clothed, and sinks to the bottom. Ferris dives in to save him. It’s an ambiguous move — in the end, a prank, but with hints of suicide.\u003c/p>\n\u003cp>“Ferris Bueller, you’re my hero,” Cameron says sarcastically.\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=D6gABQFR94U\u003c/p>\n\u003cp>\u003cstrong>From Hero to Jerk\u003c/strong>\u003c/p>\n\u003cp>When David Singer watched this film in the ’80s, he did think of Ferris as a hero. But that wasn’t his daughter Elliot’s first reaction.\u003c/p>\n\u003cp>“I kinda hated him,” she says to her dad. “Ferris kinda sucks.”\u003c/p>\n\u003cp>He orders Cameron to get out of bed and pick him up, forces him to take his dad’s car, then dismisses Cameron’s concerns and blows him off as a worrier.\u003c/p>\n\u003cp>“He’s a very fun character,” Elliot says of Ferris. “But he’s also kind of an asshole.”\u003c/p>\n\u003cp>Plus, this whole taking-a-day-off-from-school business, pretending to be sick — that’s not how it goes down in her world. Elliot is a junior at Lick-Wilmerding, a private high school in San Francisco with a reputation for being high pressure.\u003c/p>\n\u003cp>“People come to school sick because, honestly, at the type of school I’m at, it’s more stressful not to be at school,” she says. “Going and having a fun day is really fun. But it’s also not fun – the amount of stuff you miss in a day.”\u003c/p>\n\u003cp>Elliot has had her own struggles with anxiety. It makes sense that she would pick up on different themes in the film than her dad and his generation.\u003c/p>\n\u003cp>[pullquote size='small' align='right' citation='David Singer, who recently watched the film with his two teenage daughters']‘Anxiety for teenagers, anxiety about the future, where do you go to college. It’s age-old.’[/pullquote]Since “Ferris Bueller” was made, teenage suicide rates have spiked, especially among young girls, according to \u003ca href=\"https://www.cdc.gov/nchs/data/databriefs/db241.pdf\" target=\"_blank\" rel=\"noopener\">CDC data\u003c/a>. And 70% of today’s teens view anxiety and depression as a major problem, according to a recent \u003ca href=\"https://www.pewsocialtrends.org/2019/02/20/most-u-s-teens-see-anxiety-and-depression-as-a-major-problem-among-their-peers/\" target=\"_blank\" rel=\"noopener\">study from the Pew Research Center\u003c/a>.\u003c/p>\n\u003cp>“The viewing public is much more attuned to mental illness and the problems confronting people who are coping with mental illness,” says Danny Wedding, a psychologist from Berkeley, who wrote the \u003ca href=\"https://books.google.com/books/about/Movies_and_Mental_Illness.html?id=20RfAgAAQBAJ\" target=\"_blank\" rel=\"noopener\">textbook “Movies and Mental Illness.”\u003c/a> He is working on the fifth edition now.\u003c/p>\n\u003cp>“In the 1980s, there might have been a tendency to see these as just rebellious teenagers misbehaving and causing trouble,” he says. “Now, we’re more likely to be sensitive to the mental illness themes and to see Cameron as somebody coping with depression.”\u003c/p>\n\u003cp>And the Ferrari? Wedding sees it as a metaphor for all the times his father failed to respond to Cameron’s needs.\u003c/p>\n\u003cp>Film representations began to change in the late 1980s and ’90s with films like “Rain Man,” which started explicitly addressing mental health, Wedding says. As public awareness grew, films got better. As films got better, public awareness grew more.\u003c/p>\n\u003cp>“One of the things that happened is that directors increasingly turned to mental health consultants to advise on films, and that happened in the ’90s,” he says.\u003c/p>\n\u003cp>\u003cstrong>Movie Myths Then and Now\u003c/strong>\u003c/p>\n\u003cp>But before that, movies were rife with subtle, subliminal messages about mental illness, often through sidekick characters like Cameron. All sorts of negative stereotypes were promulgated, Wedding says. He boils them down to three common myths.\u003c/p>\n\u003cp>Myth No. 1: People become mentally ill because their parents treated them badly.\u003c/p>\n\u003cp>[pullquote size='small' align='right' citation='Elliot Singer, 16']‘He’s a very fun character. But he’s also kind of an asshole.’[/pullquote]“Sybil” and “Carrie” are examples of this, as are all the horror films of the ’80s, like “Halloween” and “A Nightmare on Elm Street.” In that film, Freddy Krueger was the villain that slashed people in their dreams. Legend has it he was conceived when a nun at a mental hospital was locked in a room full of criminally insane men.\u003c/p>\n\u003cp>“They said that Freddy is the offspring of a thousand maniacs,” Wedding says.\u003c/p>\n\u003cp>Myth No. 2: People become mentally ill because of some traumatic event that happened.\u003c/p>\n\u003cp>Think of Robin Williams, who plays a character with schizophrenia in “The Fisher King,” Wedding says: “His symptoms develop after a traumatic event in which his girlfriend is killed in a restaurant.”\u003c/p>\n\u003cp>Some myths have persisted, like No. 3: Love will conquer mental illness.\u003c/p>\n\u003cp>You see this everywhere, Wedding says: “A Beautiful Mind,” “Mozart and the Whale,” “Benny & Joon.”\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=LlmtpC2sRC8\u003c/p>\n\u003cp>“You leave the theater thinking that Joon is gonna be OK because she’s found her true love,” he says. “But the fact is that schizophrenia is an illness that is chronic and cyclical, and oftentimes people who are loved very much by their families still have to grapple with the challenges of mental illness. They still get sick. Love is important. It’s not sufficient.”\u003c/p>\n\u003cp>It’s like that in “Ferris Bueller,” too. Cameron has a breakthrough at the end of the film. He decides he is not going to live in fear anymore. He is going to stand up to his dad. And all it took was a day off from school with his best friend.\u003c/p>\n\u003cp>[aside tag='mental-health' label='More Coverage']Today’s teenagers, Emma and Elliot Singer, say, “Yeah right.”\u003c/p>\n\u003cp>“It’s not realistic,” Emma says.\u003c/p>\n\u003cp>“I kind of agree,” Elliot replies. “I think it was like an abrupt romanticized transition for him.”\u003c/p>\n\u003cp>Their dad makes his case, tries to bring them around. He says the themes from the movie back then are the same as they are now.\u003c/p>\n\u003cp>“We have different words and maybe we talk about it more with more specificity or more transparency, but they were all still there, right?” he says. “Anxiety for teenagers, anxiety about the future, where do you go to college. It’s age-old.”\u003c/p>\n\u003cp>Elliot says, I dunno. It was funny. Maybe if she watches it another 11 times, she’ll see what her dad sees.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>David Singer clicks through iTunes looking for “Ferris Bueller’s Day Off,” a film he watched at least 12 times when it first came out in 1986. He was in his early 20s then.\u003c/p>\n\u003cp>“You’re old,” his younger daughter mutters, as she nudges her dad to choose the HD version.\u003c/p>\n\u003cp>Singer has high hopes as he settles in to watch the film with his wife and their two daughters, Emma, 13, and Elliot, 16, at their home in San Francisco.\u003c/p>\n\u003cp>“I want them to fall in love with it, just the way I did,” he says, as the opening scenes begin to roll. “Getting them to watch a movie from my younger days is always a challenge. They look slower and not as much in focus.”\u003c/p>\n\u003cp>Singer is like so many other people who came of age in the 1980s and idolized Ferris Bueller. For them, it will always be a fun movie about a kid faking being sick and skipping school.\u003c/p>\n\u003cp>“He was just having a load of fun,” Singer says, remembering Ferris at the Cubs game and singing on the float in downtown Chicago. “Everyone has a friend like his buddy, who’s kind of a sad sack.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>But more than 30 years later, Cameron Frye, and his friendship with Ferris, look different through the eyes of today’s teens. They notice different themes and different dynamics. Watching the film from today’s perspective and applying today’s vocabulary, it’s clear that Cameron wasn’t just a sad sack — he was depressed and anxious.\u003c/p>\n\u003cp>“I’m dying,” he groans in his first scene, cocooned in bed, staring at the ceiling. To which Ferris responds, “You’re not dying. You just can’t think of anything good to do.”\u003c/p>\n\u003cp>Throughout the film, Cameron’s fear is the foil to Ferris’ free spirit.\u003c/p>\n\u003cp>When they borrow Cameron’s dad’s precious Ferrari and things go wrong, Cameron “goes berserk,” in Ferris’ words, then spends the next several scenes in a catatonic state.\u003c/p>\n\u003cp>“Maybe he’s really sick,” Ferris says, nibbling an Oreo in a hot tub while Cameron stares straight ahead over the swimming pool. “Maybe he isn’t just torturing himself.”\u003c/p>\n\u003cp>Then Cameron tumbles into the pool, fully clothed, and sinks to the bottom. Ferris dives in to save him. It’s an ambiguous move — in the end, a prank, but with hints of suicide.\u003c/p>\n\u003cp>“Ferris Bueller, you’re my hero,” Cameron says sarcastically.\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/D6gABQFR94U'\n title='//www.youtube.com/embed/D6gABQFR94U'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cstrong>From Hero to Jerk\u003c/strong>\u003c/p>\n\u003cp>When David Singer watched this film in the ’80s, he did think of Ferris as a hero. But that wasn’t his daughter Elliot’s first reaction.\u003c/p>\n\u003cp>“I kinda hated him,” she says to her dad. “Ferris kinda sucks.”\u003c/p>\n\u003cp>He orders Cameron to get out of bed and pick him up, forces him to take his dad’s car, then dismisses Cameron’s concerns and blows him off as a worrier.\u003c/p>\n\u003cp>“He’s a very fun character,” Elliot says of Ferris. “But he’s also kind of an asshole.”\u003c/p>\n\u003cp>Plus, this whole taking-a-day-off-from-school business, pretending to be sick — that’s not how it goes down in her world. Elliot is a junior at Lick-Wilmerding, a private high school in San Francisco with a reputation for being high pressure.\u003c/p>\n\u003cp>“People come to school sick because, honestly, at the type of school I’m at, it’s more stressful not to be at school,” she says. “Going and having a fun day is really fun. But it’s also not fun – the amount of stuff you miss in a day.”\u003c/p>\n\u003cp>Elliot has had her own struggles with anxiety. It makes sense that she would pick up on different themes in the film than her dad and his generation.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Since “Ferris Bueller” was made, teenage suicide rates have spiked, especially among young girls, according to \u003ca href=\"https://www.cdc.gov/nchs/data/databriefs/db241.pdf\" target=\"_blank\" rel=\"noopener\">CDC data\u003c/a>. And 70% of today’s teens view anxiety and depression as a major problem, according to a recent \u003ca href=\"https://www.pewsocialtrends.org/2019/02/20/most-u-s-teens-see-anxiety-and-depression-as-a-major-problem-among-their-peers/\" target=\"_blank\" rel=\"noopener\">study from the Pew Research Center\u003c/a>.\u003c/p>\n\u003cp>“The viewing public is much more attuned to mental illness and the problems confronting people who are coping with mental illness,” says Danny Wedding, a psychologist from Berkeley, who wrote the \u003ca href=\"https://books.google.com/books/about/Movies_and_Mental_Illness.html?id=20RfAgAAQBAJ\" target=\"_blank\" rel=\"noopener\">textbook “Movies and Mental Illness.”\u003c/a> He is working on the fifth edition now.\u003c/p>\n\u003cp>“In the 1980s, there might have been a tendency to see these as just rebellious teenagers misbehaving and causing trouble,” he says. “Now, we’re more likely to be sensitive to the mental illness themes and to see Cameron as somebody coping with depression.”\u003c/p>\n\u003cp>And the Ferrari? Wedding sees it as a metaphor for all the times his father failed to respond to Cameron’s needs.\u003c/p>\n\u003cp>Film representations began to change in the late 1980s and ’90s with films like “Rain Man,” which started explicitly addressing mental health, Wedding says. As public awareness grew, films got better. As films got better, public awareness grew more.\u003c/p>\n\u003cp>“One of the things that happened is that directors increasingly turned to mental health consultants to advise on films, and that happened in the ’90s,” he says.\u003c/p>\n\u003cp>\u003cstrong>Movie Myths Then and Now\u003c/strong>\u003c/p>\n\u003cp>But before that, movies were rife with subtle, subliminal messages about mental illness, often through sidekick characters like Cameron. All sorts of negative stereotypes were promulgated, Wedding says. He boils them down to three common myths.\u003c/p>\n\u003cp>Myth No. 1: People become mentally ill because their parents treated them badly.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“Sybil” and “Carrie” are examples of this, as are all the horror films of the ’80s, like “Halloween” and “A Nightmare on Elm Street.” In that film, Freddy Krueger was the villain that slashed people in their dreams. Legend has it he was conceived when a nun at a mental hospital was locked in a room full of criminally insane men.\u003c/p>\n\u003cp>“They said that Freddy is the offspring of a thousand maniacs,” Wedding says.\u003c/p>\n\u003cp>Myth No. 2: People become mentally ill because of some traumatic event that happened.\u003c/p>\n\u003cp>Think of Robin Williams, who plays a character with schizophrenia in “The Fisher King,” Wedding says: “His symptoms develop after a traumatic event in which his girlfriend is killed in a restaurant.”\u003c/p>\n\u003cp>Some myths have persisted, like No. 3: Love will conquer mental illness.\u003c/p>\n\u003cp>You see this everywhere, Wedding says: “A Beautiful Mind,” “Mozart and the Whale,” “Benny & Joon.”\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/LlmtpC2sRC8'\n title='//www.youtube.com/embed/LlmtpC2sRC8'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>“You leave the theater thinking that Joon is gonna be OK because she’s found her true love,” he says. “But the fact is that schizophrenia is an illness that is chronic and cyclical, and oftentimes people who are loved very much by their families still have to grapple with the challenges of mental illness. They still get sick. Love is important. It’s not sufficient.”\u003c/p>\n\u003cp>It’s like that in “Ferris Bueller,” too. Cameron has a breakthrough at the end of the film. He decides he is not going to live in fear anymore. He is going to stand up to his dad. And all it took was a day off from school with his best friend.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Today’s teenagers, Emma and Elliot Singer, say, “Yeah right.”\u003c/p>\n\u003cp>“It’s not realistic,” Emma says.\u003c/p>\n\u003cp>“I kind of agree,” Elliot replies. “I think it was like an abrupt romanticized transition for him.”\u003c/p>\n\u003cp>Their dad makes his case, tries to bring them around. He says the themes from the movie back then are the same as they are now.\u003c/p>\n\u003cp>“We have different words and maybe we talk about it more with more specificity or more transparency, but they were all still there, right?” he says. “Anxiety for teenagers, anxiety about the future, where do you go to college. It’s age-old.”\u003c/p>\n\u003cp>Elliot says, I dunno. It was funny. Maybe if she watches it another 11 times, she’ll see what her dad sees.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>San Francisco Supervisors Hillary Ronen and Matt Haney want the city to offer free mental health care and substance abuse treatment to any city resident in need.\u003c/p>\n\u003cp>The supervisors, along with state Assemblyman Phil Ting (D-San Francisco), on Tuesday are announcing a push for a November ballot measure to create what they say would be the first universal mental health care system in the nation.\u003c/p>\n\u003cp>[pullquote size=“small” align=”right” citation=\"San Francisco Supervisor Hillary Ronen\"]‘Mental health and substance use programs in San Francisco right now are completely uncoordinated and a mess. We all see it … when we walk on the street and see people in misery.’[/pullquote]\u003c/p>\n\u003cp>“We have a crisis of people who are severely addicted to drugs and that have severe mental health illnesses that are wandering the street and that desperately need help,” Ronen said in an interview Tuesday morning.\u003c/p>\n\u003cp>“San Franciscans are ready for a bold and big change. They’re sick of little measures around the edges. They want a fix to this crisis. The status quo is dangerous,” she said. “We can’t keep failing.”\u003c/p>\n\u003cp>The plan, which would be called Mental Health SF, would be similar to the city’s \u003ca href=\"https://healthysanfrancisco.org/\" target=\"_blank\" rel=\"noopener\">Healthy San Francisco\u003c/a> program that offers health care services to uninsured city residents. It would provide treatment to anyone who has a mental health illness or substance addiction and asks for help — even if they have health insurance.\u003c/p>\n\u003cp>The proposal, first reported on by the \u003ca href=\"https://www.sfchronicle.com/bayarea/heatherknight/article/Bold-plan-to-tackle-SF-s-crisis-on-the-streets-13899585.php?psid=34ve\" target=\"_blank\" rel=\"noopener\">San Francisco Chronicle\u003c/a>, would be paid for by state funding and a proposed tax increase on companies that pay their chief executive officers 100 times more than the median compensation paid to their employees.\u003c/p>\n\u003cp>“We have become one of the most unequal cities in the country, with CEOs making hundreds and hundreds times more than their average worker,” Haney said.\u003c/p>\n\u003cp>[aside postID=news_11742865,news_11741821 label='Homelessness and Mental Health']\u003c/p>\n\u003cp>The plan calls for a 24-hour, seven-days-a-week service center that accepts anyone no matter how severe their needs and an office that would coordinate care.\u003c/p>\n\u003cp>“Mental health and substance use programs in San Francisco right now are completely uncoordinated and a mess. We all see it … when we walk on the street and see people in misery,” Ronen said. “Every single day we see people being released onto the street with their hospital bands on who are still clearly in crisis and don’t know what to do and where to go,” she said.\u003c/p>\n\u003cp>The program would also expand residential treatment and housing services already operating in San Francisco for people with severe mental illness and substance abuse.\u003c/p>\n\u003cp>Ronen and Haney plan to put a separate measure on the fall ballot, dubbed the Excessive CEO Salary Tax, that would place an extra surcharge on businesses that have chief executives who make at least 100 times more than the firms’ typical workers. They believe the tax would generate about $80 million a year, adding to the city’s $370 million annual budget for mental health and substance abuse treatment.\u003c/p>\n\u003cp>Mental Health SF would rely on some state money as well. The state Medi-Cal program covers half the cost of services to low-income Californians enrolled in the program. Ronen said San Francisco should draw down more funding from Proposition 63, a tax approved by voters in 2004 to fund services for Californians with serious mental illnesses.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The program would also use some funding from an IPO tax recently proposed by Supervisor Gordon Mar to raise the employer payroll tax on stock-based compensation.\u003c/p>\n\u003cp>A representative for a leading business lobbying group raised concerns about the idea.\u003c/p>\n\u003cp>“There’s little question that we need to do a far better job of providing mental health care services. It’s not just a San Francisco issue, it’s an issue across the entire Bay Area and California,” said Rufus Jeffris, a spokesman for the Bay Area Council.\u003c/p>\n\u003cp>“A big danger in this proposal is relying on highly volatile jobs and wealth taxes to fund an ongoing expansion of services. And given criticism about a lack of coordination and coherence in a system that some have described as ‘devastatingly broken,’ voters will need to decide whether spending more money is the right approach,” Jeffris said in an email.\u003c/p>\n\u003cp>Notably absent from the press conference announcing the plan were San Francisco’s mayor, London Breed, and anyone from the city’s department of public health.\u003c/p>\n\u003cp>Both offices said they couldn’t comment on the proposal yet because they both hadn’t seen it until Tuesday, when it was announced to the public.\u003c/p>\n\u003cp>Those offices have been trying to address shortfalls in mental health care. The mayor recently hired the city’s first ever director of mental health reform, Dr. Anton Nigusse Bland, who previously directed psychiatric emergency services at San Francisco General Hospital.\u003c/p>\n\u003cp>He is now tasked with evaluating the city’s mental health and substance abuse treatment services, particularly for homeless people, and making recommendations for changes.\u003c/p>\n\u003cp>The city is also participating in a pilot project overhauling the delivery of drug treatment services through Medi-Cal – a project that includes some features proposed in the Mental Health SF program.\u003c/p>\n\u003cp>But Ronen says it’s not nearly enough.\u003c/p>\n\u003cp>“We haven’t seen a single plan that comes out of the mayor’s office to deal with this crisis at the scale that we’re dealing with,” Ronen said. “We need a massive overhaul.”\u003c/p>\n\u003cp>To staff the program, Ronen believes the city can accomplish what the private health care industry can’t. Kaiser Permanente has been the target of numerous complaints about long wait times for mental health appointments, which clinicians there say is due to under staffing. Their union recently authorized a strike over the issue, following a five-day strike in December. Patients with Blue Shield coverage say when they call therapists listed on the insurer’s network, most are not taking new patients.\u003c/p>\n\u003cp>Both companies routinely explain this by saying there is a shortage of clinicians. But Ronen says this is an excuse.\u003c/p>\n\u003cp>“Part of Mental Health SF is we’re going to pay people what we need to pay them to attract them, and we’re going to have the revenue to do so,” she said.\u003c/p>\n\u003cp>The program will also rely heavily on peer counselors, who don’t carry the same high-level degree that demands such high salaries.\u003c/p>\n\u003cp>“Sometimes the best care, and the best coaching, it comes from people who’ve experienced the illness themselves,” she said.\u003c/p>\n\u003cp>The two supervisors plan to officially introduce the measure at next Tuesday’s board meeting. They need six supervisors to support the proposal, and currently five are backing it. Along with Ronen and Haney, Supervisors Mar, Shamann Walton and Norman Yee are on board. Ronen expects Supervisor Aaron Peskin to back it as well.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We have a crisis of people who are severely addicted to drugs and that have severe mental health illnesses that are wandering the street and that desperately need help,” Ronen said in an interview Tuesday morning.\u003c/p>\n\u003cp>“San Franciscans are ready for a bold and big change. They’re sick of little measures around the edges. They want a fix to this crisis. The status quo is dangerous,” she said. “We can’t keep failing.”\u003c/p>\n\u003cp>The plan, which would be called Mental Health SF, would be similar to the city’s \u003ca href=\"https://healthysanfrancisco.org/\" target=\"_blank\" rel=\"noopener\">Healthy San Francisco\u003c/a> program that offers health care services to uninsured city residents. It would provide treatment to anyone who has a mental health illness or substance addiction and asks for help — even if they have health insurance.\u003c/p>\n\u003cp>The proposal, first reported on by the \u003ca href=\"https://www.sfchronicle.com/bayarea/heatherknight/article/Bold-plan-to-tackle-SF-s-crisis-on-the-streets-13899585.php?psid=34ve\" target=\"_blank\" rel=\"noopener\">San Francisco Chronicle\u003c/a>, would be paid for by state funding and a proposed tax increase on companies that pay their chief executive officers 100 times more than the median compensation paid to their employees.\u003c/p>\n\u003cp>“We have become one of the most unequal cities in the country, with CEOs making hundreds and hundreds times more than their average worker,” Haney said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The plan calls for a 24-hour, seven-days-a-week service center that accepts anyone no matter how severe their needs and an office that would coordinate care.\u003c/p>\n\u003cp>“Mental health and substance use programs in San Francisco right now are completely uncoordinated and a mess. We all see it … when we walk on the street and see people in misery,” Ronen said. “Every single day we see people being released onto the street with their hospital bands on who are still clearly in crisis and don’t know what to do and where to go,” she said.\u003c/p>\n\u003cp>The program would also expand residential treatment and housing services already operating in San Francisco for people with severe mental illness and substance abuse.\u003c/p>\n\u003cp>Ronen and Haney plan to put a separate measure on the fall ballot, dubbed the Excessive CEO Salary Tax, that would place an extra surcharge on businesses that have chief executives who make at least 100 times more than the firms’ typical workers. They believe the tax would generate about $80 million a year, adding to the city’s $370 million annual budget for mental health and substance abuse treatment.\u003c/p>\n\u003cp>Mental Health SF would rely on some state money as well. The state Medi-Cal program covers half the cost of services to low-income Californians enrolled in the program. Ronen said San Francisco should draw down more funding from Proposition 63, a tax approved by voters in 2004 to fund services for Californians with serious mental illnesses.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The program would also use some funding from an IPO tax recently proposed by Supervisor Gordon Mar to raise the employer payroll tax on stock-based compensation.\u003c/p>\n\u003cp>A representative for a leading business lobbying group raised concerns about the idea.\u003c/p>\n\u003cp>“There’s little question that we need to do a far better job of providing mental health care services. It’s not just a San Francisco issue, it’s an issue across the entire Bay Area and California,” said Rufus Jeffris, a spokesman for the Bay Area Council.\u003c/p>\n\u003cp>“A big danger in this proposal is relying on highly volatile jobs and wealth taxes to fund an ongoing expansion of services. And given criticism about a lack of coordination and coherence in a system that some have described as ‘devastatingly broken,’ voters will need to decide whether spending more money is the right approach,” Jeffris said in an email.\u003c/p>\n\u003cp>Notably absent from the press conference announcing the plan were San Francisco’s mayor, London Breed, and anyone from the city’s department of public health.\u003c/p>\n\u003cp>Both offices said they couldn’t comment on the proposal yet because they both hadn’t seen it until Tuesday, when it was announced to the public.\u003c/p>\n\u003cp>Those offices have been trying to address shortfalls in mental health care. The mayor recently hired the city’s first ever director of mental health reform, Dr. Anton Nigusse Bland, who previously directed psychiatric emergency services at San Francisco General Hospital.\u003c/p>\n\u003cp>He is now tasked with evaluating the city’s mental health and substance abuse treatment services, particularly for homeless people, and making recommendations for changes.\u003c/p>\n\u003cp>The city is also participating in a pilot project overhauling the delivery of drug treatment services through Medi-Cal – a project that includes some features proposed in the Mental Health SF program.\u003c/p>\n\u003cp>But Ronen says it’s not nearly enough.\u003c/p>\n\u003cp>“We haven’t seen a single plan that comes out of the mayor’s office to deal with this crisis at the scale that we’re dealing with,” Ronen said. “We need a massive overhaul.”\u003c/p>\n\u003cp>To staff the program, Ronen believes the city can accomplish what the private health care industry can’t. Kaiser Permanente has been the target of numerous complaints about long wait times for mental health appointments, which clinicians there say is due to under staffing. Their union recently authorized a strike over the issue, following a five-day strike in December. Patients with Blue Shield coverage say when they call therapists listed on the insurer’s network, most are not taking new patients.\u003c/p>\n\u003cp>Both companies routinely explain this by saying there is a shortage of clinicians. But Ronen says this is an excuse.\u003c/p>\n\u003cp>“Part of Mental Health SF is we’re going to pay people what we need to pay them to attract them, and we’re going to have the revenue to do so,” she said.\u003c/p>\n\u003cp>The program will also rely heavily on peer counselors, who don’t carry the same high-level degree that demands such high salaries.\u003c/p>\n\u003cp>“Sometimes the best care, and the best coaching, it comes from people who’ve experienced the illness themselves,” she said.\u003c/p>\n\u003cp>The two supervisors plan to officially introduce the measure at next Tuesday’s board meeting. They need six supervisors to support the proposal, and currently five are backing it. Along with Ronen and Haney, Supervisors Mar, Shamann Walton and Norman Yee are on board. Ronen expects Supervisor Aaron Peskin to back it as well.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Frequent Assaults on Workers at San Leandro Psychiatric Hospital, Records Show",
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"content": "\u003cp>Staff at a psychiatric hospital in San Leandro were punched, slapped, spit on and kicked — mostly by patients — in at least 80 separate instances over the last year, according to records kept by the agency that operates the facility.\u003c/p>\n\u003cp>[aside label=\"related stories\" tag=\"john-george-psychiatric-hospital\"]\u003c/p>\n\u003cp>In some cases they were also bitten, scratched and had their hair pulled.\u003c/p>\n\u003cp>The union representing workers at John George Psychiatric Hospital has for years called for safer workplace conditions and more staffing, and is now pointing to the new data to cast light on the dangers of the job.\u003c/p>\n\u003cp>Overseen by the Alameda Health System, a public hospital authority that manages John George, the log details a litany of assaults on staff between May 2018 and the beginning of this month. The incidents occurred in several hospital units, including its emergency room, facility hallways and inpatient rooms, according to the log.\u003c/p>\n\u003cp>“It’s an incredible feeling of vulnerability and anxiety and distraction when this kind of thing can happen.” said Rachel Odes, a staff nurse at John George, who has studied workplace violence in healthcare settings.”We are short of staff, perpetually. We don’t have a deep enough bench to bring in replacement staff when someone gets hurt.”\u003c/p>\n\u003cp>The records include the time each assault happened, where in the hospital it occurred, the type of physical force used and whether the “aggressor” was a patient or a coworker. But no names or detailed descriptions are included.\u003c/p>\n\u003cp>“We are committed to providing a safe working environment that supports our staff’s ability to care for our patients, including staffing to state mandated staffing ratios at all facilities,” AHS said in a statement on Thursday.\u003c/p>\n\u003cp>AHS also said it would adhere to new workplace safety law requirements by reporting on a broader set of incidents to state regulators “including inappropriate touching or contact, and patients who resist hands-on staff assistance such as medication administration, restraint, seclusion or redirection.”\u003c/p>\n\u003cp>“In addition to this, we continue to implement various safety measures to ensure we are able to meet our patient needs and support our employees in delivering high quality care,” the statement said.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.kqed.org/news/11692990/state-fines-psychiatric-hospital-in-attack-on-nurse-amid-renewed-staffing-concerns\" target=\"_blank\" rel=\"noopener\">an incident\u003c/a> on Sept. 13, 2017, a patient at the hospital punched a nurse in the face and continued hitting him after he fell down, slamming his head into the ground, fracturing his facial bones and inducing a seizure. David McElveen, the victim of the attack, later suffered from a stroke and short-term memory problems.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘It’s an incredible feeling of vulnerability and anxiety and distraction when this kind of thing can happen.’ \u003ccite>Rachel Odes, staff nurse at John George Psychiatric Hospital\u003c/cite>\u003c/aside>\n\u003cp>California’s Division of Occupational Safety and Health (Cal/OSHA) subsequently fined AHS more than $11,000 in connection with the incident after identifying major shortcomings in the hospital’s mandated injury and illness prevention program.\u003c/p>\n\u003cp>The findings sparked calls by John George workers, represented by Service Employees International Union Local 1021, for additional staffing and more effective safety measures. AHS officials said then that creating and maintaining a safe environment for their workers, patients and visitors was a top priority.\u003c/p>\n\u003cp>But staff and union officials say the dangers are still present.\u003c/p>\n\u003cp>Odes said she witnessed an attack as recently as last weekend, when a nurse was discharging a patient who did not want to leave.\u003c/p>\n\u003cp>“He punched this nurse in the face,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In some cases they were also bitten, scratched and had their hair pulled.\u003c/p>\n\u003cp>The union representing workers at John George Psychiatric Hospital has for years called for safer workplace conditions and more staffing, and is now pointing to the new data to cast light on the dangers of the job.\u003c/p>\n\u003cp>Overseen by the Alameda Health System, a public hospital authority that manages John George, the log details a litany of assaults on staff between May 2018 and the beginning of this month. The incidents occurred in several hospital units, including its emergency room, facility hallways and inpatient rooms, according to the log.\u003c/p>\n\u003cp>“It’s an incredible feeling of vulnerability and anxiety and distraction when this kind of thing can happen.” said Rachel Odes, a staff nurse at John George, who has studied workplace violence in healthcare settings.”We are short of staff, perpetually. We don’t have a deep enough bench to bring in replacement staff when someone gets hurt.”\u003c/p>\n\u003cp>The records include the time each assault happened, where in the hospital it occurred, the type of physical force used and whether the “aggressor” was a patient or a coworker. But no names or detailed descriptions are included.\u003c/p>\n\u003cp>“We are committed to providing a safe working environment that supports our staff’s ability to care for our patients, including staffing to state mandated staffing ratios at all facilities,” AHS said in a statement on Thursday.\u003c/p>\n\u003cp>AHS also said it would adhere to new workplace safety law requirements by reporting on a broader set of incidents to state regulators “including inappropriate touching or contact, and patients who resist hands-on staff assistance such as medication administration, restraint, seclusion or redirection.”\u003c/p>\n\u003cp>“In addition to this, we continue to implement various safety measures to ensure we are able to meet our patient needs and support our employees in delivering high quality care,” the statement said.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.kqed.org/news/11692990/state-fines-psychiatric-hospital-in-attack-on-nurse-amid-renewed-staffing-concerns\" target=\"_blank\" rel=\"noopener\">an incident\u003c/a> on Sept. 13, 2017, a patient at the hospital punched a nurse in the face and continued hitting him after he fell down, slamming his head into the ground, fracturing his facial bones and inducing a seizure. David McElveen, the victim of the attack, later suffered from a stroke and short-term memory problems.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘It’s an incredible feeling of vulnerability and anxiety and distraction when this kind of thing can happen.’ \u003ccite>Rachel Odes, staff nurse at John George Psychiatric Hospital\u003c/cite>\u003c/aside>\n\u003cp>California’s Division of Occupational Safety and Health (Cal/OSHA) subsequently fined AHS more than $11,000 in connection with the incident after identifying major shortcomings in the hospital’s mandated injury and illness prevention program.\u003c/p>\n\u003cp>The findings sparked calls by John George workers, represented by Service Employees International Union Local 1021, for additional staffing and more effective safety measures. AHS officials said then that creating and maintaining a safe environment for their workers, patients and visitors was a top priority.\u003c/p>\n\u003cp>But staff and union officials say the dangers are still present.\u003c/p>\n\u003cp>Odes said she witnessed an attack as recently as last weekend, when a nurse was discharging a patient who did not want to leave.\u003c/p>\n\u003cp>“He punched this nurse in the face,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "This Beauty Queen Uses Her Platform to Ease Mental Health Stigma in Asian American Community",
"title": "This Beauty Queen Uses Her Platform to Ease Mental Health Stigma in Asian American Community",
"headTitle": "The California Report | KQED News",
"content": "\u003cp>At first glance, Sophia Ng has all the hallmarks of a typical pageant queen: She has beauty, brains and charisma.\u003c/p>\n\u003cp>But last August, when Ng, 27, competed in San Francisco’s\u003ca href=\"https://www.missasianglobal.com/\"> Miss Asian Global & Miss Asian America\u003c/a> pageant, the longest-running Asian beauty pageant in the nation, she surprised her audience with what she revealed on stage.\u003c/p>\n\u003cp>“I was once in a suicide depression, and in my hour of darkness, I believed I was worthless and that life was not worth living,” she told the crowd at Herbst Theatre in San Francisco. The audience that night was mostly Asian.\u003c/p>\n\u003cp>Later that evening, Ng was crowned Miss Asian America. It was the first pageant she had ever competed in.\u003c/p>\n\u003cp>At 5 foot 9 inches tall, Ng never used to wear high heels. But now, she is a pro. Since she has entered the pageant world, she regularly dons a gown, sash and crown to attend charity and community events, like this year’s Lunar New Year Parade in San Francisco.\u003c/p>\n\u003cfigure id=\"attachment_11746925\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-11746925 size-full\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/05/RS37059_IMG_3611-qut.jpg\" alt=\"\" width=\"1920\" height=\"1440\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-1200x900.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-1832x1374.jpg 1832w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-1376x1032.jpg 1376w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-1044x783.jpg 1044w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-632x474.jpg 632w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-536x402.jpg 536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Sophia Ng, second from right, strikes a pose on a Lunar New Year Parade float with some court members of the Miss Asian Global & Miss Asian America pageant, 2019. \u003ccite>(Sonia Paul/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But along with the networking and modeling opportunities, Ng spends her time doing what inspired her to compete in pageants in the first place: raising awareness about mental health, particularly among the Asian American and Pacific Islander communities.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Ng is a mental health therapist, a profession she says offers an impact that’s deep but often struggles with reach. Until recently, she counselled students at elementary and high schools in San Francisco.\u003c/p>\n\u003cp>Earlier this spring, she embarked on a typical work day at Lowell High School — one of the most competitive high schools in the state.\u003c/p>\n\u003cp>As students attended classes and roamed the hallways during breaks, Ng met with her clients at Lowell’s Wellness Center, a place where students can come in for counseling and access community resources, or relax and sip a cup of tea.\u003c/p>\n\u003cfigure id=\"attachment_11747793\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11747793\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/05/Sophia-Ng-Reading-800x603.jpg\" alt=\"Sophia Ng reviews some paperwork in an office at Lowell High School's Wellness Center. As a mental health therapist, Ng visited schools in San Francisco and counseled students.\" width=\"800\" height=\"603\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/05/Sophia-Ng-Reading-800x603.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/Sophia-Ng-Reading-160x121.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/Sophia-Ng-Reading-1020x769.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/Sophia-Ng-Reading-1200x904.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/Sophia-Ng-Reading.jpg 1736w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Sophia Ng reviews some paperwork in an office at Lowell High School's Wellness Center. As a mental health therapist, Ng visited schools in San Francisco and counseled students. \u003ccite>(Sonia Paul/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In a small office in the Wellness Center, as a white noise machine hummed nearby to help protect privacy during conversations, one student told Ng about the painful relationship he has with his mom.\u003c/p>\n\u003cp>“She went on a rant,” he told Ng, referring to a recent incident involving him, his brother and his mother, in which their mother told them they were \"useless.\"\u003c/p>\n\u003cp>“She also mention[ed] something like, 'you guys were a waste of giving birth' in Chinese.\"\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation='Sophia Ng']'I was once in a suicide depression, and in my hour of darkness, I believed I was worthless and that life was not worth living.'[/pullquote]Like this student, and many of the students she works with, Ng is also Chinese, growing up in Hong Kong. She says many students and their parents hesitate to seek out therapy, and that this may trace back to a culture in which shame and honor play an important role.\u003c/p>\n\u003cp>It's also seen in the parenting style, where they use shame and guilt to parent their kid, said Ng, who stressed that not all Asian American moms and dads do this.\u003c/p>\n\u003cp>Parents also worry that if their kids need help, maybe they’ve done something wrong as parents. But, she noted, people in the community are under pressure to present a good face to the world despite whatever their going through.\u003c/p>\n\u003cp>[aside tag='mental-health' label='More Coverage of Mental Health Issues']In fact, Asian Americans are \u003ca href=\"https://www.apa.org/pi/oema/resources/ethnicity-health/asian-american/article-mental-health\">three times less likely\u003c/a> to seek out mental health services than white people. And they make up only \u003ca href=\"https://www.apa.org/workforce/publications/16-demographics/report.pdf\">4%\u003c/a> of the U.S. psychology workforce, which is mostly white. That all influences the reaction Ng gets when students come to her for the first time, she said.\u003c/p>\n\u003cp>\"They're like, ‘Oh, I expected you to be, like, a white person,’” she said.\u003c/p>\n\u003cp>A therapist she had as a teenager inspired Ng to do this work. Ng had been on her way to becoming a competitive athlete, when an accident during a basketball tournament crushed her leg. She was 16, and her whole identity at that time revolved around being an athlete.\u003c/p>\n\u003cp>“While I was still like, recovering physically, my mind definitely began to sort of spiral downwards,” Ng said.\u003c/p>\n\u003cp>Ng had a hard time getting out of bed and didn’t want to hang out with friends.\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation='Sophia Ng']'My passion is removing the stigma that exists around mental health.'[/pullquote]At her lowest point, Ng said she attempted suicide by taking a bunch of sleeping pills. That’s when she found herself in a therapist’s office, talking with someone who could offer the perspective her family and friends couldn’t.\u003c/p>\n\u003cp>“I think at that time, people in your personal life, they kind of have this ... need or urge to just sort of, like, get you out of that mentality ASAP,” Ng said. “So they tell you to be positive, they tell you to, you know, not think like that, and just, you know, things will get better. And I think those were not the things I needed to hear at the time. Because it didn't make me feel listened to.”\u003c/p>\n\u003cp>The night Ng won the Miss Asian America title and talked openly about her suicide attempt, a common refrain echoed among the audience.\u003c/p>\n\u003cp>“'Whoa, like, you were extremely vulnerable up there,'” Ng said, recalling the conversations she had after the pageant ended. The people she met knew what it meant for her to challenge the cultural pressures to keep those struggles quiet.\u003c/p>\n\u003cfigure id=\"attachment_11746928\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-11746928 size-full\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/05/RS37057_IMG_3777-qut.jpg\" alt=\"\" width=\"1920\" height=\"1440\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-1200x900.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-1832x1374.jpg 1832w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-1376x1032.jpg 1376w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-1044x783.jpg 1044w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-632x474.jpg 632w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-536x402.jpg 536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Sophia Ng started competing in pageants to raise awareness around mental health, especially among the Asian American and Pacific Islander community. Now that she is a pageant titleholder, she often goes to community events, like this Bay Area Chinese Association banquet, that offer her a platform to spread her message. \u003ccite>(Sonia Paul/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On a Saturday night, Ng was once again out as a beauty queen, this time at a dinner banquet in Pinole that was sponsored by the Chinese Association of Hercules. She was joined by two other winners of the Miss Asian Global & Miss Asian America pageant. The three of them were dolled up for the occasion in long gowns and flawless hair and makeup.\u003c/p>\n\u003cp>When it was time to introduce the women to the banquet attendees, Ng took the mic and spoke in both Cantonese and in English.\u003c/p>\n\u003cp>“My passion is removing the stigma that exists around mental health. And I’m currently doing that by doing a lot of speaking engagements, especially with college students, educating them about this,” she told the dinner guests, knowing the banquet was another platform for her, too. They burst into applause.\u003c/p>\n\u003cp>In the last few weeks, a lot has changed for Ng. She left her job as a school counselor because she is moving back to Hong Kong to be closer to her parents and her fiancé, who got a job in China. She hopes to someday start her own therapy practice, and launch a mental health consulting agency for companies and schools.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Ng's international move fits her new beauty queen title. She recently stepped down as Miss Asian America because she was crowned “\u003ca href=\"https://missglobal.com/\">Miss Global\u003c/a>” in a worldwide competition — the second pageant in which she has ever competed. She says in this new role, she’ll continue to spread her message that it’s \"OK not to be OK.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>At first glance, Sophia Ng has all the hallmarks of a typical pageant queen: She has beauty, brains and charisma.\u003c/p>\n\u003cp>But last August, when Ng, 27, competed in San Francisco’s\u003ca href=\"https://www.missasianglobal.com/\"> Miss Asian Global & Miss Asian America\u003c/a> pageant, the longest-running Asian beauty pageant in the nation, she surprised her audience with what she revealed on stage.\u003c/p>\n\u003cp>“I was once in a suicide depression, and in my hour of darkness, I believed I was worthless and that life was not worth living,” she told the crowd at Herbst Theatre in San Francisco. The audience that night was mostly Asian.\u003c/p>\n\u003cp>Later that evening, Ng was crowned Miss Asian America. It was the first pageant she had ever competed in.\u003c/p>\n\u003cp>At 5 foot 9 inches tall, Ng never used to wear high heels. But now, she is a pro. Since she has entered the pageant world, she regularly dons a gown, sash and crown to attend charity and community events, like this year’s Lunar New Year Parade in San Francisco.\u003c/p>\n\u003cfigure id=\"attachment_11746925\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-11746925 size-full\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/05/RS37059_IMG_3611-qut.jpg\" alt=\"\" width=\"1920\" height=\"1440\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-1200x900.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-1832x1374.jpg 1832w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-1376x1032.jpg 1376w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-1044x783.jpg 1044w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-632x474.jpg 632w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37059_IMG_3611-qut-536x402.jpg 536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Sophia Ng, second from right, strikes a pose on a Lunar New Year Parade float with some court members of the Miss Asian Global & Miss Asian America pageant, 2019. \u003ccite>(Sonia Paul/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But along with the networking and modeling opportunities, Ng spends her time doing what inspired her to compete in pageants in the first place: raising awareness about mental health, particularly among the Asian American and Pacific Islander communities.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Ng is a mental health therapist, a profession she says offers an impact that’s deep but often struggles with reach. Until recently, she counselled students at elementary and high schools in San Francisco.\u003c/p>\n\u003cp>Earlier this spring, she embarked on a typical work day at Lowell High School — one of the most competitive high schools in the state.\u003c/p>\n\u003cp>As students attended classes and roamed the hallways during breaks, Ng met with her clients at Lowell’s Wellness Center, a place where students can come in for counseling and access community resources, or relax and sip a cup of tea.\u003c/p>\n\u003cfigure id=\"attachment_11747793\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11747793\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/05/Sophia-Ng-Reading-800x603.jpg\" alt=\"Sophia Ng reviews some paperwork in an office at Lowell High School's Wellness Center. As a mental health therapist, Ng visited schools in San Francisco and counseled students.\" width=\"800\" height=\"603\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/05/Sophia-Ng-Reading-800x603.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/Sophia-Ng-Reading-160x121.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/Sophia-Ng-Reading-1020x769.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/Sophia-Ng-Reading-1200x904.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/Sophia-Ng-Reading.jpg 1736w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Sophia Ng reviews some paperwork in an office at Lowell High School's Wellness Center. As a mental health therapist, Ng visited schools in San Francisco and counseled students. \u003ccite>(Sonia Paul/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In a small office in the Wellness Center, as a white noise machine hummed nearby to help protect privacy during conversations, one student told Ng about the painful relationship he has with his mom.\u003c/p>\n\u003cp>“She went on a rant,” he told Ng, referring to a recent incident involving him, his brother and his mother, in which their mother told them they were \"useless.\"\u003c/p>\n\u003cp>“She also mention[ed] something like, 'you guys were a waste of giving birth' in Chinese.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Like this student, and many of the students she works with, Ng is also Chinese, growing up in Hong Kong. She says many students and their parents hesitate to seek out therapy, and that this may trace back to a culture in which shame and honor play an important role.\u003c/p>\n\u003cp>It's also seen in the parenting style, where they use shame and guilt to parent their kid, said Ng, who stressed that not all Asian American moms and dads do this.\u003c/p>\n\u003cp>Parents also worry that if their kids need help, maybe they’ve done something wrong as parents. But, she noted, people in the community are under pressure to present a good face to the world despite whatever their going through.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>In fact, Asian Americans are \u003ca href=\"https://www.apa.org/pi/oema/resources/ethnicity-health/asian-american/article-mental-health\">three times less likely\u003c/a> to seek out mental health services than white people. And they make up only \u003ca href=\"https://www.apa.org/workforce/publications/16-demographics/report.pdf\">4%\u003c/a> of the U.S. psychology workforce, which is mostly white. That all influences the reaction Ng gets when students come to her for the first time, she said.\u003c/p>\n\u003cp>\"They're like, ‘Oh, I expected you to be, like, a white person,’” she said.\u003c/p>\n\u003cp>A therapist she had as a teenager inspired Ng to do this work. Ng had been on her way to becoming a competitive athlete, when an accident during a basketball tournament crushed her leg. She was 16, and her whole identity at that time revolved around being an athlete.\u003c/p>\n\u003cp>“While I was still like, recovering physically, my mind definitely began to sort of spiral downwards,” Ng said.\u003c/p>\n\u003cp>Ng had a hard time getting out of bed and didn’t want to hang out with friends.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>At her lowest point, Ng said she attempted suicide by taking a bunch of sleeping pills. That’s when she found herself in a therapist’s office, talking with someone who could offer the perspective her family and friends couldn’t.\u003c/p>\n\u003cp>“I think at that time, people in your personal life, they kind of have this ... need or urge to just sort of, like, get you out of that mentality ASAP,” Ng said. “So they tell you to be positive, they tell you to, you know, not think like that, and just, you know, things will get better. And I think those were not the things I needed to hear at the time. Because it didn't make me feel listened to.”\u003c/p>\n\u003cp>The night Ng won the Miss Asian America title and talked openly about her suicide attempt, a common refrain echoed among the audience.\u003c/p>\n\u003cp>“'Whoa, like, you were extremely vulnerable up there,'” Ng said, recalling the conversations she had after the pageant ended. The people she met knew what it meant for her to challenge the cultural pressures to keep those struggles quiet.\u003c/p>\n\u003cfigure id=\"attachment_11746928\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-11746928 size-full\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/05/RS37057_IMG_3777-qut.jpg\" alt=\"\" width=\"1920\" height=\"1440\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-1200x900.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-1832x1374.jpg 1832w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-1376x1032.jpg 1376w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-1044x783.jpg 1044w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-632x474.jpg 632w, https://ww2.kqed.org/app/uploads/sites/10/2019/05/RS37057_IMG_3777-qut-536x402.jpg 536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Sophia Ng started competing in pageants to raise awareness around mental health, especially among the Asian American and Pacific Islander community. Now that she is a pageant titleholder, she often goes to community events, like this Bay Area Chinese Association banquet, that offer her a platform to spread her message. \u003ccite>(Sonia Paul/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On a Saturday night, Ng was once again out as a beauty queen, this time at a dinner banquet in Pinole that was sponsored by the Chinese Association of Hercules. She was joined by two other winners of the Miss Asian Global & Miss Asian America pageant. The three of them were dolled up for the occasion in long gowns and flawless hair and makeup.\u003c/p>\n\u003cp>When it was time to introduce the women to the banquet attendees, Ng took the mic and spoke in both Cantonese and in English.\u003c/p>\n\u003cp>“My passion is removing the stigma that exists around mental health. And I’m currently doing that by doing a lot of speaking engagements, especially with college students, educating them about this,” she told the dinner guests, knowing the banquet was another platform for her, too. They burst into applause.\u003c/p>\n\u003cp>In the last few weeks, a lot has changed for Ng. She left her job as a school counselor because she is moving back to Hong Kong to be closer to her parents and her fiancé, who got a job in China. She hopes to someday start her own therapy practice, and launch a mental health consulting agency for companies and schools.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Ng's international move fits her new beauty queen title. She recently stepped down as Miss Asian America because she was crowned “\u003ca href=\"https://missglobal.com/\">Miss Global\u003c/a>” in a worldwide competition — the second pageant in which she has ever competed. She says in this new role, she’ll continue to spread her message that it’s \"OK not to be OK.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The trauma specialists working in Butte County schools knew they'd start seeing kids act out around six months after the deadly Camp Fire, since anniversaries are known to \u003ca href=\"https://www.apa.org/helpcenter/anniversary\" target=\"_blank\" rel=\"noopener\">trigger survivors\u003c/a> into reliving moments of the traumatic event.\u003c/p>\n\u003cp>But there aren't enough counselors to help all of the students, teachers and staff dealing with this second wave of trauma.\u003c/p>\n\u003cp>“We have six schools that have requested help, and we can't bring help to them,” said Roy Applegate, who helps coordinate Recovery Trauma Services for the Butte County Office of Education. “It’s a little bit like rain in the desert in the summer: As soon as it hits the ground, it disappears. We can give our counselors as many hours as they need, and they're full up all the time. They're working to the max.”[pullquote align='right' citation='Roy Applegate, Recovery Trauma Services Co-Coordinator']'We can give our counselors as many hours as they need, and they're full up all the time. They're working to the max.’[/pullquote]Just like during the fire itself, different people are dealing with different levels of trauma.\u003c/p>\n\u003cp>\"It depends on whether or not they've secured some basic levels of need: housing, food, routine access to resources,\" said Dena Kapsalis, director of student services for the Paradise Unified School District.\u003c/p>\n\u003cp>But regardless of their situation, all families may notice their kids exhibiting unusual behavior.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We're seeing lots and lots of manifestations of trauma,\" Kapsalis said. \"A lot of acting out, tiredness, inability to focus, shutting down, being unable to maintain relationships with adults or peers.”\u003c/p>\n\u003cp>While it may be distressing for parents to see their kids struggling, Kapsalis says counselors try to instead view this acting out as a form of communication.\u003c/p>\n\u003cp>“The gift of being with kids is that they don't second-guess themselves typically. So we're afforded the ability to have more transparent responses and communication from them,” Kapsalis said. “So they're communicating loss, they're communicating a need for help, a need for support.”\u003c/p>\n\u003cfigure id=\"attachment_11745116\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11745116\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/05/IMG_0356-800x533.jpg\" alt=\"Workers with a backhoe remove debris from the burned down Paradise Elementary.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Workers use a backhoe to remove debris from the burned-down Paradise Elementary. \u003ccite>(Michelle Wiley/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But for their teachers — many of whom were also impacted by the fire that erupted on Nov. 8 — it’s much more difficult for support staff to determine how they’re doing.\u003c/p>\n\u003cp>“With adults it's much harder because they have all kinds of systems of coping that often disguise what's really going on with them,” Kapsalis said.\u003c/p>\n\u003cp>To better support their teachers, counselors have started setting up shop in common areas — including staff rooms, hallways and even near copiers — to encourage conversation and help connect them with services.\u003c/p>\n\u003cp>To fill the need for more counselors, the Butte County Office of Education has called several of their workers out of retirement to help out.[pullquote align='right' citation='Dena Kapsalis, Director of Student Services for Paradise Unified']'We're seeing lots and lots of manifestations of trauma. A lot of acting out, tiredness, inability to focus, shutting down, being unable to maintain relationships with adults or peers.'[/pullquote]\"When I got the phone call, I said, 'Oh no, I really don't want to go back to work,' and they said, 'No, we really need you,' \" said Pamela Beeman, who'd been retired for nearly five years when she got the call. \"You can't just say no to that.\"\u003c/p>\n\u003cp>Beeman is currently working as a fire recovery counselor at \u003ca href=\"https://www.chicoer.com/2018/11/28/former-spring-valley-school-site-will-reopen-for-concow-students/\" target=\"_blank\" rel=\"noopener\">Spring Valley School\u003c/a>, but she doesn't know how long she can continue.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We're just getting started,\" Beeman said. \"This is a long road, and some of the worst symptoms for survivors are starting to emerge. It's really easy to lose heart.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We're seeing lots and lots of manifestations of trauma,\" Kapsalis said. \"A lot of acting out, tiredness, inability to focus, shutting down, being unable to maintain relationships with adults or peers.”\u003c/p>\n\u003cp>While it may be distressing for parents to see their kids struggling, Kapsalis says counselors try to instead view this acting out as a form of communication.\u003c/p>\n\u003cp>“The gift of being with kids is that they don't second-guess themselves typically. So we're afforded the ability to have more transparent responses and communication from them,” Kapsalis said. “So they're communicating loss, they're communicating a need for help, a need for support.”\u003c/p>\n\u003cfigure id=\"attachment_11745116\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11745116\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/05/IMG_0356-800x533.jpg\" alt=\"Workers with a backhoe remove debris from the burned down Paradise Elementary.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Workers use a backhoe to remove debris from the burned-down Paradise Elementary. \u003ccite>(Michelle Wiley/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But for their teachers — many of whom were also impacted by the fire that erupted on Nov. 8 — it’s much more difficult for support staff to determine how they’re doing.\u003c/p>\n\u003cp>“With adults it's much harder because they have all kinds of systems of coping that often disguise what's really going on with them,” Kapsalis said.\u003c/p>\n\u003cp>To better support their teachers, counselors have started setting up shop in common areas — including staff rooms, hallways and even near copiers — to encourage conversation and help connect them with services.\u003c/p>\n\u003cp>To fill the need for more counselors, the Butte County Office of Education has called several of their workers out of retirement to help out.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\"When I got the phone call, I said, 'Oh no, I really don't want to go back to work,' and they said, 'No, we really need you,' \" said Pamela Beeman, who'd been retired for nearly five years when she got the call. \"You can't just say no to that.\"\u003c/p>\n\u003cp>Beeman is currently working as a fire recovery counselor at \u003ca href=\"https://www.chicoer.com/2018/11/28/former-spring-valley-school-site-will-reopen-for-concow-students/\" target=\"_blank\" rel=\"noopener\">Spring Valley School\u003c/a>, but she doesn't know how long she can continue.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We're just getting started,\" Beeman said. \"This is a long road, and some of the worst symptoms for survivors are starting to emerge. It's really easy to lose heart.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When it comes to getting homeless people off the streets and into stable housing, San Francisco politicians face hard choices. Some want to expand a controversial legal process called conservatorship that they say would help homeless people with severe substance abuse problems and mental illness. But so far, implementation has been slow and bumpy.\u003c/p>\n\u003cp>When San Francisco Mayor London Breed went to Sacramento earlier this month to \u003ca href=\"https://www.senate.ca.gov/media/senate-judiciary-committee-20190409/video\" target=\"_blank\" rel=\"noopener\">tell state legislators\u003c/a> about the plight of the city’s most desperate people, she had someone in mind from her former district when she was a supervisor — an older homeless man with a serious substance abuse problem.\u003c/p>\n\u003cp>“When he gets his check at the beginning of the month, his money gets taken by some other individuals in the neighborhood,” she said. “He was well-known to all the neighbors, all the merchants, all of us. We all did our very best to try and assist him but, sadly, he’s still out in the community.”\u003c/p>\n\u003cp>Breed and other San Francisco politicians had hoped that changes to conservatorship rules would allow city health workers to help homeless people with substance abuse and mental health problems by legally and temporarily stepping in to force a mentally ill person into treatment.\u003c/p>\n\u003cp>“We believe that there are 50 to 100 people on our streets who are so severely mentally ill and drug addicted — can’t make decisions for themselves and who are dying — and who could benefit from a conservatorship,” said state Sen. Scott Wiener, who sponsored \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB1045\" target=\"_blank\" rel=\"noopener\">Senate Bill 1045\u003c/a>, which became law last year.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation='S.F. Supervisor Rafael Mandelman']‘We don’t want to recreate the hospitals of the past but we have a kind of institutionalization today, which is jail.’[/pullquote]\u003c/p>\n\u003cp>The new law established a pilot program in San Francisco, Los Angeles and San Diego to allow conservatorships for severely drug-addicted people. To qualify, a homeless person has to be held involuntarily in a hospital for psychiatric reasons eight times in the past year.\u003c/p>\n\u003cp>But when they began to implement the law, San Francisco officials found that last-minute amendments made it too narrow to apply to many people.\u003c/p>\n\u003cp>“As drafted, SB 1045 would allow us to help fewer than five individuals,” Breed told the state Senate Judiciary Committee on April 9. She said lawmakers needed to make changes to broaden the law.\u003c/p>\n\u003cp>So Wiener wrote new legislation, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB40\" target=\"_blank\" rel=\"noopener\">Senate Bill 40\u003c/a>, which would tweak the conservatorship law in a few ways. Most importantly, it would remove the requirement that someone with a drug problem or severe mental illness try advanced outpatient treatment first. This qualification means someone has to fail out of such treatment, when specialists agree that the drug users who conservatorship is intended to reach aren’t good candidates for that kind of program. Doctors also say such a requirement gets in the way of providing help.\u003c/p>\n\u003cp>The bill does little to address the concerns of advocates for the homeless and mentally ill, who say it could violate the civil rights of the homeless. They protested outside a town hall on April 6 at UC Hastings School of Law, then followed Wiener inside and briefly shut down the meeting with booing and singing.\u003c/p>\n\u003cp>“It’s not progressive to let people die on our streets,” Wiener said.\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation='Raia Small, community organizer with Senior and Disability Action']‘This expansion of conservatorship doesn’t actually create any new services. There’s no new housing units provided.’[/pullquote]\u003c/p>\n\u003cp>Raia Small, a community organizer with Senior and Disability Action, said conservatorship could violate civil rights without helping people with what they really need.\u003c/p>\n\u003cp>“Our greatest fear is that this law is going to be used to take away the civil liberties of people with mental illnesses and drug users, and that it’s going to do that without providing the care and treatment that people need to be able to access voluntarily,” Small said.\u003c/p>\n\u003cp>Small’s group is part of a coalition, \u003ca href=\"https://sdaction.files.wordpress.com/2019/02/voluntary-services-first-coalition-comments-on-draft-report.pdf\" target=\"_blank\" rel=\"noopener\">Voluntary Services First\u003c/a>, that is organizing against conservatorship. Other members include the Mental Health Association of San Francisco and the Coalition on Homelessness.\u003c/p>\n\u003cp>[aside tag='homelessness' label='More coverage of homelessness in the Bay Area']\u003c/p>\n\u003cp>They say the city should be investing in permanent supportive housing, intensive case management, programs for people with both substance use disorder and serious mental illness, and case managers who can find people when they don’t show up for appointments.\u003c/p>\n\u003cp>“This expansion of conservatorship doesn’t actually create any new services,” Small said. “There’s no funding for it. There’s no new housing units provided.”\u003c/p>\n\u003cp>City Supervisor Rafael Mandelman said critics are overstating their case.\u003c/p>\n\u003cp>“We don’t want to recreate the hospitals of the past but we have a kind of institutionalization today, which is jail, and a lot of these folks are finding themselves in jail, in prison or on the streets,” he said.\u003c/p>\n\u003cp>In the face of contemporary addiction, conservatorship needs to adapt.\u003c/p>\n\u003cp>“It is half a century old. It was not written to address things like meth-induced psychosis or people who suffer from serious meth addiction. We see that as a huge problem in San Francisco every day,” Mandelman added.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Because of critics’ concerns, San Francisco has been slow to implement conservatorship — and it could stop altogether. Before anyone in the city can be forced into conservatorship, the Board of Supervisors has to pass an ordinance that spells out how. The supervisors’ Rules Committee could review the proposed ordinance on May 13.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The new law established a pilot program in San Francisco, Los Angeles and San Diego to allow conservatorships for severely drug-addicted people. To qualify, a homeless person has to be held involuntarily in a hospital for psychiatric reasons eight times in the past year.\u003c/p>\n\u003cp>But when they began to implement the law, San Francisco officials found that last-minute amendments made it too narrow to apply to many people.\u003c/p>\n\u003cp>“As drafted, SB 1045 would allow us to help fewer than five individuals,” Breed told the state Senate Judiciary Committee on April 9. She said lawmakers needed to make changes to broaden the law.\u003c/p>\n\u003cp>So Wiener wrote new legislation, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB40\" target=\"_blank\" rel=\"noopener\">Senate Bill 40\u003c/a>, which would tweak the conservatorship law in a few ways. Most importantly, it would remove the requirement that someone with a drug problem or severe mental illness try advanced outpatient treatment first. This qualification means someone has to fail out of such treatment, when specialists agree that the drug users who conservatorship is intended to reach aren’t good candidates for that kind of program. Doctors also say such a requirement gets in the way of providing help.\u003c/p>\n\u003cp>The bill does little to address the concerns of advocates for the homeless and mentally ill, who say it could violate the civil rights of the homeless. They protested outside a town hall on April 6 at UC Hastings School of Law, then followed Wiener inside and briefly shut down the meeting with booing and singing.\u003c/p>\n\u003cp>“It’s not progressive to let people die on our streets,” Wiener said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘This expansion of conservatorship doesn’t actually create any new services. There’s no new housing units provided.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Raia Small, a community organizer with Senior and Disability Action, said conservatorship could violate civil rights without helping people with what they really need.\u003c/p>\n\u003cp>“Our greatest fear is that this law is going to be used to take away the civil liberties of people with mental illnesses and drug users, and that it’s going to do that without providing the care and treatment that people need to be able to access voluntarily,” Small said.\u003c/p>\n\u003cp>Small’s group is part of a coalition, \u003ca href=\"https://sdaction.files.wordpress.com/2019/02/voluntary-services-first-coalition-comments-on-draft-report.pdf\" target=\"_blank\" rel=\"noopener\">Voluntary Services First\u003c/a>, that is organizing against conservatorship. Other members include the Mental Health Association of San Francisco and the Coalition on Homelessness.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>They say the city should be investing in permanent supportive housing, intensive case management, programs for people with both substance use disorder and serious mental illness, and case managers who can find people when they don’t show up for appointments.\u003c/p>\n\u003cp>“This expansion of conservatorship doesn’t actually create any new services,” Small said. “There’s no funding for it. There’s no new housing units provided.”\u003c/p>\n\u003cp>City Supervisor Rafael Mandelman said critics are overstating their case.\u003c/p>\n\u003cp>“We don’t want to recreate the hospitals of the past but we have a kind of institutionalization today, which is jail, and a lot of these folks are finding themselves in jail, in prison or on the streets,” he said.\u003c/p>\n\u003cp>In the face of contemporary addiction, conservatorship needs to adapt.\u003c/p>\n\u003cp>“It is half a century old. It was not written to address things like meth-induced psychosis or people who suffer from serious meth addiction. We see that as a huge problem in San Francisco every day,” Mandelman added.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Because of critics’ concerns, San Francisco has been slow to implement conservatorship — and it could stop altogether. Before anyone in the city can be forced into conservatorship, the Board of Supervisors has to pass an ordinance that spells out how. The supervisors’ Rules Committee could review the proposed ordinance on May 13.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>This summer, Tom Gray will lose his home.\u003c/p>\n\u003cp>A slim man with hunched shoulders and a halting voice, Gray, 72, has schizophrenia. Before he landed in Carmen Palarca’s board-and-care home 11 years ago, he spent 20 years living on the streets, many of them huddled in a doorway across from a San Francisco Whole Foods.\u003c/p>\n\u003cp>“I feel kind of sad and worried a little bit,” Gray said quietly, sitting in the home’s small kitchen one recent afternoon.\u003c/p>\n\u003cp>He hadn’t yet received official notice from Palarca of her plans to close, but knew it was likely. She had, in fact, sent a letter to the city a few days earlier outlining her intent to shutter the home.\u003c/p>\n\u003cp>The planned closure of yet another board-and-care home—this one nestled near Golden Gate Park—reflects a broader trend affecting thousands of low-income Californians with serious mental illness. While housing values soar and minimum-wage increases drive up staffing costs, state reimbursement rates to board-and-cares have remained stagnant. The result: more facilities are shutting their doors.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>There are no reliable statewide data on the decrease of homes serving this specific population. But since 2012, San Francisco has lost more than a third of licensed residential facilities that serve people under 60, and more than a quarter of those serving older clients. Much of the decline has been in small, homelike facilities like Palarca’s, which provide food, laundry and medication help—and are more likely to accept low-income people with mental illnesses.\u003c/p>\n\u003cp>Los Angeles, which has a large portion of the state’s board-and-cares, has lost more than 200 beds for low-income people with serious mental illness in the past year.\u003c/p>\n\u003cp>Advocates say the state needs to collect better data—and significantly increase reimbursement rates—if it hopes to save the remaining facilities.\u003c/p>\n\u003cp>“If legislators don’t get onto this, we’re in big trouble,” said Lisa Kodmur, who is contracting with Los Angeles County on the issue. “We will see more homelessness, more incarceration, more institutionalization, more people living on the streets.”\u003c/p>\n\u003cp>[pullquote size='medium' align='left' citation='Sacramento Mayor Darrell Steinberg']The losses here are only making an already horrendous problem worse.’[/pullquote]\u003c/p>\n\u003cp>The housing crisis has placed those concerned about board-and-care residents with mental illness in a strange predicament: Many now find themselves advocating for facilities they consider to be of poor quality and outmoded. That’s because the alternatives they see—homelessness, incarceration, long-term placement in nursing homes or locked facilities—are worse.\u003c/p>\n\u003cp>“Our inventory is so dire that we are now trying to save an industry that is not a darling,” said Adriana Ruelas, legislative affairs director of \u003ca href=\"https://steinberginstitute.org/\" target=\"_blank\" rel=\"noopener\">The Steinberg Institute\u003c/a>, which advocates for better mental health policies.\u003c/p>\n\u003cp>Sacramento Mayor Darrell Steinberg is a former state senate leader who founded the institute and was recently appointed by Gov. Gavin Newsom to lead a new commission on homelessness and supportive housing. He calls the closures “catastrophic.”\u003c/p>\n\u003cp>“They are not the perfect solution for everybody,” he said. “But, perspective here: it’s real shelter with care. The losses here are only making an already horrendous problem worse.”\u003c/p>\n\u003cp>At the root of the problem is money. Many facilities are closing because owners are selling the properties, or because operators are aging and their children don’t want to inherit a business that is not financially sound.\u003c/p>\n\u003cp>Licensed board-and-cares, also known as adult residential facilities, receive a government-set monthly rent of $1058—just under $35 a day—from tenants to pay for housing, 24-hour-care and three daily meals. The tenants cover that cost with their monthly \u003ca href=\"https://www.ssa.gov/ssi/\" target=\"_blank\" rel=\"noopener\">Supplemental Security Income\u003c/a> (SSI) checks, a combination of federal and state funds for people with serious mental illness, among others.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.ltcccsf.org/wp-content/uploads/2019/02/LTCCC-Assisted-Living-Workgroup-Final-Report-January-2019.pdf\" target=\"_blank\" rel=\"noopener\">report\u003c/a> published in January by San Francisco’s Long-Term Care Coordinating Council noted the minimum wage there has increased by 46% since 2012, while the SSI rate for assisted living residents has increased by just 8%. The report estimated the monthly break-even rate for board-and-cares at more than $2,000 per bed, more than double what low-income residents currently pay.\u003c/p>\n\u003cp>Some counties, including San Francisco and Los Angeles, pay a “patch” using local and state funds to boost this rate to about $1,700 a month. Operators say that’s still not enough.\u003c/p>\n\u003cfigure id=\"attachment_11741845\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11741845\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/closures.05-e1555102729831-800x545.jpg\" alt=\"\" width=\"800\" height=\"545\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.05-e1555102729831-800x545.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.05-e1555102729831-160x109.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.05-e1555102729831-1020x695.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.05-e1555102729831-1200x817.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.05-e1555102729831-1920x1308.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.05-e1555102729831.jpg 2000w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Resident Concepcion Wedell makes her way to the kitchen while walking past Setsuko Letchford in the living room at Palarca’s Rest Home in San Francisco. \u003ccite>(Jessica Christian, San Francisco Chronicle)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dr. Jonathan Sherin, director of the Los Angeles Department of Mental Health, says he’s been “ranting and raving” for years about the “alarming rate” of disappearance of board-and-cares in his city.\u003c/p>\n\u003cp>“It’s a broken business model,” he said. When homes close, his county scrambles to place the residents elsewhere. But that worsens the backlog for people in jails, hospitals or locked psychiatric facilities waiting for housing in the community.\u003c/p>\n\u003cp>And once homes are sold, NIMBYism—the “Not in My Backyard” attitude—can make it difficult to open new facilities in the same locations.\u003c/p>\n\u003cp>Ideally, Palarca said she would like to sell the home where Tom Gray lives to someone willing to maintain it as a board-and-care. But so far, she says, no potential buyer has seen a way to make the numbers work.\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation='Larry Mateo']‘We had to call the sheriff to move them out because they just didn’t want to move….They said, ‘This is my home. Why are you moving me out?’”‘[/pullquote]\u003c/p>\n\u003cp>Larry Mateo, 59, once operated five board-and-care homes in San Francisco. By the end of last year, he’d closed them all. Now one is for sale and two others are being rented to young people—“they call them millennials”—who can pay the high rates commanded in the city.\u003c/p>\n\u003cp>“That’s an easy no-brainer decision,” Mateo said. “I don’t have payroll, I don’t have to go buy groceries, I don’t have to deal with clientele.”\u003c/p>\n\u003cp>There were residents, however, who initially refused to leave.\u003c/p>\n\u003cp>“Some said, ‘I have no place to go. I love this place,’” Mateo said. “We had to call the sheriff to move them out because they just didn’t want to move. I’m not sure if it was part of their mental illness, but they didn’t want to adapt to change. They said, ‘This is my home. Why are you moving me out?’ ”\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11741850 alignleft\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/copy-break-down-californias-mental-health-system-in-crisis-big-breakdown-2-300x225.jpg\" alt=\"\" width=\"300\" height=\"225\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/copy-break-down-californias-mental-health-system-in-crisis-big-breakdown-2-300x225.jpg 300w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/copy-break-down-californias-mental-health-system-in-crisis-big-breakdown-2-300x225-160x120.jpg 160w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\">\u003c/p>\n\u003cp>About a third of homeless individuals have serious mental illness, according to the \u003ca href=\"https://www.treatmentadvocacycenter.org/\" target=\"_blank\" rel=\"noopener\">Treatment Advocacy Center\u003c/a>, a nonprofit that advocates for expanded psychiatric services. With California’s homeless population nearing \u003ca href=\"https://www.usich.gov/homelessness-statistics/ca/\" target=\"_blank\" rel=\"noopener\">130,000\u003c/a>, an estimated 43,000 of them may be suffering from serious mental illness. As tent encampments proliferate, efforts to house these people have gained traction. Last fall, voters passed the \u003ca href=\"https://elections.calmatters.org/2018/california-ballot-measures/proposition-2-mental-health-money-for-housing/\" target=\"_blank\" rel=\"noopener\">No Place Like Home Act\u003c/a>, allowing the state to borrow $2 billion to increase the supply of permanent supportive housing, which pairs affordable housing with mental health services.\u003c/p>\n\u003cp>But not everyone with a serious mental illness is independent enough to thrive in permanent supportive housing. Some still need help with meals and laundry and medications. The disappearance of board-and-cares leaves these vulnerable people without an option, said Ruelas of The Steinberg Institute.\u003c/p>\n\u003cp>“The folks we’re talking about, they’re not ready to be successful in supportive housing,” she said. “And they need to start somewhere.”\u003c/p>\n\u003cp>After landing in hospitals due to psychosis, paranoia, and hallucinations in his early 20s, Tristan Scremin was discharged to board-and-care homes. Without this option, Scremin, now 45, speculates he might have ended up on the streets. Instead, he was able to stabilize and now works as a community liaison for \u003ca href=\"https://paintedbrain.org/\" target=\"_blank\" rel=\"noopener\">Painted Brain\u003c/a>, an arts-based mental health agency in Los Angeles.\u003c/p>\n\u003cp>“I see a lot of seriously mentally ill people on the street who are obviously having difficulty figuring out basic things,” he said. “If I had lost my chance to be in a board-and-care home, if I’d become homeless, I think it would have been very difficult.”\u003c/p>\n\u003cp>“We’re just really failing this population,” says Molly Davies, Los Angeles County’s long-term care ombudsman. She worries that funding gaps are not only forcing closures, but worsening conditions at board-and-cares that can be “inhumane.”\u003c/p>\n\u003cp>She’s seen bedbug and rat infestations, and a typhus outbreak.\u003c/p>\n\u003cp>Regulators are sometimes lenient, she said, because they don’t want to lose more beds. They know that as licensed homes close, unlicensed ones proliferate—with no oversight whatsoever.\u003c/p>\n\u003cp>At Carmen Palarca’s board-and-care, residents now face the possibility of being relocated to Central Valley communities they’ve never visited.\u003c/p>\n\u003cp>“I’m settled here. I’m used to it here,” said Setsuko Letchford, 70, who has frizzy gray hair and is missing teeth, and who says she hears voices that constantly badger her. “I don’t have any place to go,” she said. “They should find me some place to go.”\u003c/p>\n\u003cp>Palarca, 77, and her husband, Domingo, 87, bought the seven-bedroom home for $96,000 in 1976, after they moved to San Francisco from the Philippines. Carmen was working as a benefits eligibility worker for the city of San Francisco; Domingo was a mechanic for United Airlines. They wanted additional income to pay for their kids’ college educations.\u003c/p>\n\u003cp>Now, they want to relax and travel. Still, Palarca worries for Letchford and Gray and the home’s seven other residents. Clients in the home she closed in 2016 were farmed out to other facilities, some outside of the city.\u003c/p>\n\u003cp>“They didn’t have a choice,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11741847\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11741847\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/closures.02-1-e1555103400555-800x546.jpg\" alt=\"\" width=\"800\" height=\"546\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.02-1-e1555103400555-800x546.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.02-1-e1555103400555-160x109.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.02-1-e1555103400555-1020x696.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.02-1-e1555103400555-1200x818.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.02-1-e1555103400555-1920x1309.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.02-1-e1555103400555.jpg 2000w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Carmen Palarca checks in on resident Sandy Pemberton as she eats lunch at Palarca’s Rest Home in San Francisco. \u003ccite>( Jessica Christian, San Francisco Chronicle)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Kelly Hiramoto, director of transitions for the San Francisco Health Network, says the city is aware closures can be stressful for residents, although she wouldn’t label it a crisis because she said the city is generally able to find alternative placements.\u003c/p>\n\u003cp>The city subsidizes board-and-care beds for about 500 individuals, she said, starting at an additional $22 a day on top of the SSI rate, with half of those located outside of the county.\u003c/p>\n\u003cp>Benson Nadell, San Francisco’s long-term care ombudsman, says he expects the city’s remaining board-and-care homes to disappear in the next 15 years, if not sooner, given the current funding model. But he says he’d like to see new models, ones that prioritize programming and independence for the residents, while also addressing the squalor and neglect endemic in many facilities.\u003c/p>\n\u003cp>Ruelas of the Steinberg Institute also would like to see a dynamic system that provides life skills and activities, not just medication, laundry and food. She thinks \u003ca href=\"http://www.progressfoundation.org/\" target=\"_blank\" rel=\"noopener\">Progress Foundation\u003c/a>, which offers residential treatment options in San Francisco, Napa and Sonoma, is one model to consider.\u003c/p>\n\u003cp>Steve Fields, the nonprofit’s executive director, says board-and-care homes should be saved—and transformed into something better. Otherwise, he said, “counties without any imagination go back and reinvent the thing we don’t need anymore.”\u003c/p>\n\u003cp>Across the city from Palarca’s closing home, Aurora Concepción is trying to keep hers open.\u003c/p>\n\u003cp>She’s closed two homes in recent years because of staffing costs, but still has three others.\u003c/p>\n\u003cp>Brightly lit, with immaculate blonde wood floors and big windows that look out on the Financial District, the homes, perched on a hill in the Portola neighborhood, are much nicer than most board-and-cares, says city ombudsman Nadell.\u003c/p>\n\u003cfigure id=\"attachment_11741848\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11741848\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/closures.12-e1555103177887-800x551.jpg\" alt=\"\" width=\"800\" height=\"551\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.12-e1555103177887-800x551.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.12-e1555103177887-160x110.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.12-e1555103177887-1020x703.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.12-e1555103177887-1200x827.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.12-e1555103177887-1920x1323.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.12-e1555103177887.jpg 2048w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Resident Maureen Pinell relaxes in a chair in the living room at Aurora Concepcion’s Residential Care Home in San Francisco. \u003ccite>(Jessica Christian, San Francisco Chronicle)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Concepción, 70, lives among her clients and says she feels driven by a mission.\u003c/p>\n\u003cp>“What I have is what they have; what I eat is what they eat,” she said. “I always tell them, we are a family here.”\u003c/p>\n\u003cp>Arriving from the Philippines in 1972, she took a bank job doing data entry. After her daughter was born with multiple sclerosis, she decided to stay home to care for her. She opened her first board-and-care in 1978, then another, then another. At her peak, she cared for 30 people. With the closures, she’s down to 16.\u003c/p>\n\u003cp>[pullquote size='large' align='right' citation='Aurora Concepción']‘“I make a joke all the time: We’re the cheapest hotel in town.’[/pullquote]\u003c/p>\n\u003cp>To stay open, she has reduced paid staff from four to one. She and her ex-husband and kids handle shopping, cooking and medications. She washes the laundry at night when utility rates are cheaper, buys food in bulk on sale, and said she hasn’t taken a real vacation in 40 years.\u003c/p>\n\u003cp>“We’re pinching pennies,” she said. “I make a joke all the time: We’re the cheapest hotel in town.”\u003c/p>\n\u003cp>On a recent morning, residents gathered to eat the lunch Concepción had prepared: salami-and-cheese sandwiches, chicken tomato soup and chocolate sandwich cookies. Silvia Velarde, 59, who has paranoid schizophrenia, said she loves the home, which feels clean and safe and orderly to her. The previous board-and-care she lived in—now closed—was “terrible, really nasty,” she said, and infested with bedbugs.\u003c/p>\n\u003cp>After lunch, Lori Loo, 56, who has schizophrenia and bipolar disorder and has been living here nine years, waited patiently for Velarde and the others to finish eating. She wanted to set the table for dinner. She said she feels comfortable here, and always volunteers to help clean up because there’s not much else to do.\u003c/p>\n\u003cp>After lunch, Concepción offered a tour of one of the homes she’s closed. The brightly lit upstairs looks out onto a city panorama. It will doubtless command a fortune in rent on the private market. But Concepción laments that she couldn’t keep it open for residents with mental illness.\u003c/p>\n\u003cp>“They deserve a second chance,” she said. “They deserve a home.”\u003c/p>\n\u003cp>\u003cem>Jocelyn Wiener is a contributing writer to CALmatters. Photos by Jessica Christian, San Francisco Chronicle. This story, the third in our series “Breakdown: Mental Health in California,” was supported by a grant from the California Health Care Foundation.\u003c/em>\u003c/p>\n\u003cp>Part 1: \u003cem>\u003ca href=\"https://calmatters.org/articles/california-mental-health-treatment-in-prisons/\" target=\"_blank\" rel=\"noopener\">All too often, California’s default mental institutions are now jails and prisons\u003c/a>\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Part 2: \u003ca href=\"https://calmatters.org/articles/californians-struggle-to-get-mental-health-care/\" target=\"_blank\" rel=\"noopener\">\u003cem>For families across California, a desperate struggle to get mental health care\u003c/em>\u003c/a>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>This summer, Tom Gray will lose his home.\u003c/p>\n\u003cp>A slim man with hunched shoulders and a halting voice, Gray, 72, has schizophrenia. Before he landed in Carmen Palarca’s board-and-care home 11 years ago, he spent 20 years living on the streets, many of them huddled in a doorway across from a San Francisco Whole Foods.\u003c/p>\n\u003cp>“I feel kind of sad and worried a little bit,” Gray said quietly, sitting in the home’s small kitchen one recent afternoon.\u003c/p>\n\u003cp>He hadn’t yet received official notice from Palarca of her plans to close, but knew it was likely. She had, in fact, sent a letter to the city a few days earlier outlining her intent to shutter the home.\u003c/p>\n\u003cp>The planned closure of yet another board-and-care home—this one nestled near Golden Gate Park—reflects a broader trend affecting thousands of low-income Californians with serious mental illness. While housing values soar and minimum-wage increases drive up staffing costs, state reimbursement rates to board-and-cares have remained stagnant. The result: more facilities are shutting their doors.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>There are no reliable statewide data on the decrease of homes serving this specific population. But since 2012, San Francisco has lost more than a third of licensed residential facilities that serve people under 60, and more than a quarter of those serving older clients. Much of the decline has been in small, homelike facilities like Palarca’s, which provide food, laundry and medication help—and are more likely to accept low-income people with mental illnesses.\u003c/p>\n\u003cp>Los Angeles, which has a large portion of the state’s board-and-cares, has lost more than 200 beds for low-income people with serious mental illness in the past year.\u003c/p>\n\u003cp>Advocates say the state needs to collect better data—and significantly increase reimbursement rates—if it hopes to save the remaining facilities.\u003c/p>\n\u003cp>“If legislators don’t get onto this, we’re in big trouble,” said Lisa Kodmur, who is contracting with Los Angeles County on the issue. “We will see more homelessness, more incarceration, more institutionalization, more people living on the streets.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "The losses here are only making an already horrendous problem worse.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The housing crisis has placed those concerned about board-and-care residents with mental illness in a strange predicament: Many now find themselves advocating for facilities they consider to be of poor quality and outmoded. That’s because the alternatives they see—homelessness, incarceration, long-term placement in nursing homes or locked facilities—are worse.\u003c/p>\n\u003cp>“Our inventory is so dire that we are now trying to save an industry that is not a darling,” said Adriana Ruelas, legislative affairs director of \u003ca href=\"https://steinberginstitute.org/\" target=\"_blank\" rel=\"noopener\">The Steinberg Institute\u003c/a>, which advocates for better mental health policies.\u003c/p>\n\u003cp>Sacramento Mayor Darrell Steinberg is a former state senate leader who founded the institute and was recently appointed by Gov. Gavin Newsom to lead a new commission on homelessness and supportive housing. He calls the closures “catastrophic.”\u003c/p>\n\u003cp>“They are not the perfect solution for everybody,” he said. “But, perspective here: it’s real shelter with care. The losses here are only making an already horrendous problem worse.”\u003c/p>\n\u003cp>At the root of the problem is money. Many facilities are closing because owners are selling the properties, or because operators are aging and their children don’t want to inherit a business that is not financially sound.\u003c/p>\n\u003cp>Licensed board-and-cares, also known as adult residential facilities, receive a government-set monthly rent of $1058—just under $35 a day—from tenants to pay for housing, 24-hour-care and three daily meals. The tenants cover that cost with their monthly \u003ca href=\"https://www.ssa.gov/ssi/\" target=\"_blank\" rel=\"noopener\">Supplemental Security Income\u003c/a> (SSI) checks, a combination of federal and state funds for people with serious mental illness, among others.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.ltcccsf.org/wp-content/uploads/2019/02/LTCCC-Assisted-Living-Workgroup-Final-Report-January-2019.pdf\" target=\"_blank\" rel=\"noopener\">report\u003c/a> published in January by San Francisco’s Long-Term Care Coordinating Council noted the minimum wage there has increased by 46% since 2012, while the SSI rate for assisted living residents has increased by just 8%. The report estimated the monthly break-even rate for board-and-cares at more than $2,000 per bed, more than double what low-income residents currently pay.\u003c/p>\n\u003cp>Some counties, including San Francisco and Los Angeles, pay a “patch” using local and state funds to boost this rate to about $1,700 a month. Operators say that’s still not enough.\u003c/p>\n\u003cfigure id=\"attachment_11741845\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11741845\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/closures.05-e1555102729831-800x545.jpg\" alt=\"\" width=\"800\" height=\"545\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.05-e1555102729831-800x545.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.05-e1555102729831-160x109.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.05-e1555102729831-1020x695.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.05-e1555102729831-1200x817.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.05-e1555102729831-1920x1308.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.05-e1555102729831.jpg 2000w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Resident Concepcion Wedell makes her way to the kitchen while walking past Setsuko Letchford in the living room at Palarca’s Rest Home in San Francisco. \u003ccite>(Jessica Christian, San Francisco Chronicle)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dr. Jonathan Sherin, director of the Los Angeles Department of Mental Health, says he’s been “ranting and raving” for years about the “alarming rate” of disappearance of board-and-cares in his city.\u003c/p>\n\u003cp>“It’s a broken business model,” he said. When homes close, his county scrambles to place the residents elsewhere. But that worsens the backlog for people in jails, hospitals or locked psychiatric facilities waiting for housing in the community.\u003c/p>\n\u003cp>And once homes are sold, NIMBYism—the “Not in My Backyard” attitude—can make it difficult to open new facilities in the same locations.\u003c/p>\n\u003cp>Ideally, Palarca said she would like to sell the home where Tom Gray lives to someone willing to maintain it as a board-and-care. But so far, she says, no potential buyer has seen a way to make the numbers work.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘We had to call the sheriff to move them out because they just didn’t want to move….They said, ‘This is my home. Why are you moving me out?’”‘",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Larry Mateo, 59, once operated five board-and-care homes in San Francisco. By the end of last year, he’d closed them all. Now one is for sale and two others are being rented to young people—“they call them millennials”—who can pay the high rates commanded in the city.\u003c/p>\n\u003cp>“That’s an easy no-brainer decision,” Mateo said. “I don’t have payroll, I don’t have to go buy groceries, I don’t have to deal with clientele.”\u003c/p>\n\u003cp>There were residents, however, who initially refused to leave.\u003c/p>\n\u003cp>“Some said, ‘I have no place to go. I love this place,’” Mateo said. “We had to call the sheriff to move them out because they just didn’t want to move. I’m not sure if it was part of their mental illness, but they didn’t want to adapt to change. They said, ‘This is my home. Why are you moving me out?’ ”\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11741850 alignleft\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/copy-break-down-californias-mental-health-system-in-crisis-big-breakdown-2-300x225.jpg\" alt=\"\" width=\"300\" height=\"225\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/copy-break-down-californias-mental-health-system-in-crisis-big-breakdown-2-300x225.jpg 300w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/copy-break-down-californias-mental-health-system-in-crisis-big-breakdown-2-300x225-160x120.jpg 160w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\">\u003c/p>\n\u003cp>About a third of homeless individuals have serious mental illness, according to the \u003ca href=\"https://www.treatmentadvocacycenter.org/\" target=\"_blank\" rel=\"noopener\">Treatment Advocacy Center\u003c/a>, a nonprofit that advocates for expanded psychiatric services. With California’s homeless population nearing \u003ca href=\"https://www.usich.gov/homelessness-statistics/ca/\" target=\"_blank\" rel=\"noopener\">130,000\u003c/a>, an estimated 43,000 of them may be suffering from serious mental illness. As tent encampments proliferate, efforts to house these people have gained traction. Last fall, voters passed the \u003ca href=\"https://elections.calmatters.org/2018/california-ballot-measures/proposition-2-mental-health-money-for-housing/\" target=\"_blank\" rel=\"noopener\">No Place Like Home Act\u003c/a>, allowing the state to borrow $2 billion to increase the supply of permanent supportive housing, which pairs affordable housing with mental health services.\u003c/p>\n\u003cp>But not everyone with a serious mental illness is independent enough to thrive in permanent supportive housing. Some still need help with meals and laundry and medications. The disappearance of board-and-cares leaves these vulnerable people without an option, said Ruelas of The Steinberg Institute.\u003c/p>\n\u003cp>“The folks we’re talking about, they’re not ready to be successful in supportive housing,” she said. “And they need to start somewhere.”\u003c/p>\n\u003cp>After landing in hospitals due to psychosis, paranoia, and hallucinations in his early 20s, Tristan Scremin was discharged to board-and-care homes. Without this option, Scremin, now 45, speculates he might have ended up on the streets. Instead, he was able to stabilize and now works as a community liaison for \u003ca href=\"https://paintedbrain.org/\" target=\"_blank\" rel=\"noopener\">Painted Brain\u003c/a>, an arts-based mental health agency in Los Angeles.\u003c/p>\n\u003cp>“I see a lot of seriously mentally ill people on the street who are obviously having difficulty figuring out basic things,” he said. “If I had lost my chance to be in a board-and-care home, if I’d become homeless, I think it would have been very difficult.”\u003c/p>\n\u003cp>“We’re just really failing this population,” says Molly Davies, Los Angeles County’s long-term care ombudsman. She worries that funding gaps are not only forcing closures, but worsening conditions at board-and-cares that can be “inhumane.”\u003c/p>\n\u003cp>She’s seen bedbug and rat infestations, and a typhus outbreak.\u003c/p>\n\u003cp>Regulators are sometimes lenient, she said, because they don’t want to lose more beds. They know that as licensed homes close, unlicensed ones proliferate—with no oversight whatsoever.\u003c/p>\n\u003cp>At Carmen Palarca’s board-and-care, residents now face the possibility of being relocated to Central Valley communities they’ve never visited.\u003c/p>\n\u003cp>“I’m settled here. I’m used to it here,” said Setsuko Letchford, 70, who has frizzy gray hair and is missing teeth, and who says she hears voices that constantly badger her. “I don’t have any place to go,” she said. “They should find me some place to go.”\u003c/p>\n\u003cp>Palarca, 77, and her husband, Domingo, 87, bought the seven-bedroom home for $96,000 in 1976, after they moved to San Francisco from the Philippines. Carmen was working as a benefits eligibility worker for the city of San Francisco; Domingo was a mechanic for United Airlines. They wanted additional income to pay for their kids’ college educations.\u003c/p>\n\u003cp>Now, they want to relax and travel. Still, Palarca worries for Letchford and Gray and the home’s seven other residents. Clients in the home she closed in 2016 were farmed out to other facilities, some outside of the city.\u003c/p>\n\u003cp>“They didn’t have a choice,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11741847\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11741847\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/closures.02-1-e1555103400555-800x546.jpg\" alt=\"\" width=\"800\" height=\"546\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.02-1-e1555103400555-800x546.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.02-1-e1555103400555-160x109.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.02-1-e1555103400555-1020x696.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.02-1-e1555103400555-1200x818.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.02-1-e1555103400555-1920x1309.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.02-1-e1555103400555.jpg 2000w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Carmen Palarca checks in on resident Sandy Pemberton as she eats lunch at Palarca’s Rest Home in San Francisco. \u003ccite>( Jessica Christian, San Francisco Chronicle)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Kelly Hiramoto, director of transitions for the San Francisco Health Network, says the city is aware closures can be stressful for residents, although she wouldn’t label it a crisis because she said the city is generally able to find alternative placements.\u003c/p>\n\u003cp>The city subsidizes board-and-care beds for about 500 individuals, she said, starting at an additional $22 a day on top of the SSI rate, with half of those located outside of the county.\u003c/p>\n\u003cp>Benson Nadell, San Francisco’s long-term care ombudsman, says he expects the city’s remaining board-and-care homes to disappear in the next 15 years, if not sooner, given the current funding model. But he says he’d like to see new models, ones that prioritize programming and independence for the residents, while also addressing the squalor and neglect endemic in many facilities.\u003c/p>\n\u003cp>Ruelas of the Steinberg Institute also would like to see a dynamic system that provides life skills and activities, not just medication, laundry and food. She thinks \u003ca href=\"http://www.progressfoundation.org/\" target=\"_blank\" rel=\"noopener\">Progress Foundation\u003c/a>, which offers residential treatment options in San Francisco, Napa and Sonoma, is one model to consider.\u003c/p>\n\u003cp>Steve Fields, the nonprofit’s executive director, says board-and-care homes should be saved—and transformed into something better. Otherwise, he said, “counties without any imagination go back and reinvent the thing we don’t need anymore.”\u003c/p>\n\u003cp>Across the city from Palarca’s closing home, Aurora Concepción is trying to keep hers open.\u003c/p>\n\u003cp>She’s closed two homes in recent years because of staffing costs, but still has three others.\u003c/p>\n\u003cp>Brightly lit, with immaculate blonde wood floors and big windows that look out on the Financial District, the homes, perched on a hill in the Portola neighborhood, are much nicer than most board-and-cares, says city ombudsman Nadell.\u003c/p>\n\u003cfigure id=\"attachment_11741848\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11741848\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/closures.12-e1555103177887-800x551.jpg\" alt=\"\" width=\"800\" height=\"551\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.12-e1555103177887-800x551.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.12-e1555103177887-160x110.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.12-e1555103177887-1020x703.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.12-e1555103177887-1200x827.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.12-e1555103177887-1920x1323.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/closures.12-e1555103177887.jpg 2048w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Resident Maureen Pinell relaxes in a chair in the living room at Aurora Concepcion’s Residential Care Home in San Francisco. \u003ccite>(Jessica Christian, San Francisco Chronicle)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Concepción, 70, lives among her clients and says she feels driven by a mission.\u003c/p>\n\u003cp>“What I have is what they have; what I eat is what they eat,” she said. “I always tell them, we are a family here.”\u003c/p>\n\u003cp>Arriving from the Philippines in 1972, she took a bank job doing data entry. After her daughter was born with multiple sclerosis, she decided to stay home to care for her. She opened her first board-and-care in 1978, then another, then another. At her peak, she cared for 30 people. With the closures, she’s down to 16.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>To stay open, she has reduced paid staff from four to one. She and her ex-husband and kids handle shopping, cooking and medications. She washes the laundry at night when utility rates are cheaper, buys food in bulk on sale, and said she hasn’t taken a real vacation in 40 years.\u003c/p>\n\u003cp>“We’re pinching pennies,” she said. “I make a joke all the time: We’re the cheapest hotel in town.”\u003c/p>\n\u003cp>On a recent morning, residents gathered to eat the lunch Concepción had prepared: salami-and-cheese sandwiches, chicken tomato soup and chocolate sandwich cookies. Silvia Velarde, 59, who has paranoid schizophrenia, said she loves the home, which feels clean and safe and orderly to her. The previous board-and-care she lived in—now closed—was “terrible, really nasty,” she said, and infested with bedbugs.\u003c/p>\n\u003cp>After lunch, Lori Loo, 56, who has schizophrenia and bipolar disorder and has been living here nine years, waited patiently for Velarde and the others to finish eating. She wanted to set the table for dinner. She said she feels comfortable here, and always volunteers to help clean up because there’s not much else to do.\u003c/p>\n\u003cp>After lunch, Concepción offered a tour of one of the homes she’s closed. The brightly lit upstairs looks out onto a city panorama. It will doubtless command a fortune in rent on the private market. But Concepción laments that she couldn’t keep it open for residents with mental illness.\u003c/p>\n\u003cp>“They deserve a second chance,” she said. “They deserve a home.”\u003c/p>\n\u003cp>\u003cem>Jocelyn Wiener is a contributing writer to CALmatters. Photos by Jessica Christian, San Francisco Chronicle. This story, the third in our series “Breakdown: Mental Health in California,” was supported by a grant from the California Health Care Foundation.\u003c/em>\u003c/p>\n\u003cp>Part 1: \u003cem>\u003ca href=\"https://calmatters.org/articles/california-mental-health-treatment-in-prisons/\" target=\"_blank\" rel=\"noopener\">All too often, California’s default mental institutions are now jails and prisons\u003c/a>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Part 2: \u003ca href=\"https://calmatters.org/articles/californians-struggle-to-get-mental-health-care/\" target=\"_blank\" rel=\"noopener\">\u003cem>For families across California, a desperate struggle to get mental health care\u003c/em>\u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Reach Out: Ways to Help a Loved One at Risk of Suicide",
"title": "Reach Out: Ways to Help a Loved One at Risk of Suicide",
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"content": "\u003cp>\u003cem>If you or someone you know may be considering suicide, contact the \u003c/em>\u003ca href=\"http://suicidepreventionlifeline.org/\">National Suicide Prevention Lifeline\u003c/a>\u003cem> at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the \u003c/em>\u003ca href=\"http://www.crisistextline.org/\">Crisis Text Line\u003c/a>\u003cem> by texting HOME to 741741.\u003c/em>\u003c/p>\n\u003chr>\n\u003cp>If you know someone struggling with despair, depression or thoughts of suicide, you may be wondering how to help.\u003c/p>\n\u003cp>Most Americans say that they understand that suicide is preventable and that they would act to help someone they know who is at risk, according to a\u003ca href=\"https://afsp.org/harrispoll/\" target=\"_blank\" rel=\"noopener\"> national survey\u003c/a> conducted by the \u003ca href=\"https://afsp.org/our-work/education/talk-saves-lives-introduction-suicide-prevention/?gclid=Cj0KCQjwhuvlBRCeARIsAM720Hqxm9eZDpNjndysuxGpkBIjgkhtH4_bIuVW60dbiQYBf6p9_iL4r3AaAvKaEALw_wcB\">American Foundation for Suicide Prevention\u003c/a> and the\u003ca href=\"https://theactionalliance.org/\" target=\"_blank\" rel=\"noopener\"> National Action Alliance for Suicide Prevention \u003c/a>in 2018.\u003c/p>\n\u003cp>Yet many of us are afraid to do the wrong thing. In fact, you don't have to be a trained professional to help, says \u003ca href=\"https://afsp.org/about-afsp/doreen-marshall-ph-d/\" target=\"_blank\" rel=\"noopener\">Doreen Marshall\u003c/a>, a psychologist and vice president of programs at the AFSP.\u003c/p>\n\u003cp>\"Everyone has a role to play in suicide prevention,\" she says. But \"most people hold back. We often say, 'Trust your gut. If you're worried about someone, take that step.' \"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And that first step starts with simply reaching out, says Marshall. It may seem like a small thing, but survivors of suicide attempts and suicide experts say, it can go long way.\u003c/p>\n\u003cp>Simple acts of connection are powerful, says\u003ca href=\"https://www.ursulawhiteside.org/about-1\" target=\"_blank\" rel=\"noopener\"> Ursula Whiteside\u003c/a>, a psychologist and a faculty member at the University of Washington.\u003c/p>\n\u003cp>\"Looking out for each other in general reduces [suicide] risk,\" says Whiteside. \"Because people who feel connected are less likely to kill themselves.\"\u003c/p>\n\u003cp>And \"the earlier you catch someone,\" she adds, \"the less they have to suffer.\"\u003c/p>\n\u003cp>Here are nine things you can do that can make a difference.\u003c/p>\n\u003ch3>1. Recognize the warning signs\u003c/h3>\n\u003cp>\u003ca href=\"https://afsp.org/about-suicide/risk-factors-and-warning-signs/\" target=\"_blank\" rel=\"noopener\">Signs of suicide risk to watch for\u003c/a> include changes in mood and behavior, Marshall says.\u003c/p>\n\u003cp>\"For example, someone who is usually part of a group or activity and you notice that they stop showing up,\" explains Marshall. \"Someone who is usually pretty even-tempered, and you see they are easily frustrated or angry.\"\u003c/p>\n\u003cp>Other signs include feeling depressed, anxious, irritable or losing interest in things.\u003c/p>\n\u003cp>Pay attention to a person's words, too.\u003c/p>\n\u003cp>\"They may talk about wanting to end their lives or seeing no purpose or wanting to go to sleep and never wake up,\" says Marshall. \"Those are signs that they may be thinking about [suicide]. It may be couched as a need to get away from, or escape the pain.\"\u003c/p>\n\u003cp>According to the AFSP, people who take their own lives often show a combination of these warning signs.\u003c/p>\n\u003cp>And the signs can be different for different individuals, says \u003ca href=\"https://www.mailman.columbia.edu/people/our-faculty/msg5\" target=\"_blank\" rel=\"noopener\">Madelyn Gould\u003c/a>, a professor of epidemiology in psychiatry at Columbia University who studies suicide and suicide prevention.\u003c/p>\n\u003cp>\"For some people, it might be starting to have difficulty sleeping,\" she says. Someone else might easily feel humiliated or rejected.\u003c/p>\n\u003cp>\"Each one of these things can put [someone] more at risk,\" explains Gould, \"Until at some point, [they're] not in control anymore.\"\u003c/p>\n\u003ch3>2. Reach out and ask, \"Are you OK?\"\u003c/h3>\n\u003cp>So, what do you do when you notice someone is struggling and you fear they may be considering suicide?\u003c/p>\n\u003cp>Reach out, check in and show you care, say suicide prevention experts.\u003c/p>\n\u003cp>\"The very nature of someone struggling with suicide and depression, [is that] they're not likely to reach out,\" says Marshall. \"They feel like a burden to others.\"\u003c/p>\n\u003cp>People who are having thoughts of suicide often feel trapped and alone, explains\u003ca href=\"https://www.suicidology.org/about-aas/board\" target=\"_blank\" rel=\"noopener\"> DeQuincy Lezine\u003c/a>, a psychologist and a member of the board of directors of the \u003ca href=\"https://www.suicidology.org/\" target=\"_blank\" rel=\"noopener\">American Association of Suicidology\u003c/a>. He is also a survivor of suicide attempts.\u003c/p>\n\u003cp>When someone reaches out and offers support, it reduces a person's sense of isolation, he explains.\u003c/p>\n\u003cp>\"Even if you can't find the exact words [to say], the aspect that somebody cares makes a big difference,\"says Lezine.\u003c/p>\n\u003cp>Questions like \"Are you doing OK?\" and statements like \"If you need anything, let me know\" are simple supportive gestures that can have a big impact on someone who's in emotional pain, explains Julie DeGolier, a medical assistant in Seattle and a survivor of suicide attempts. It can interrupt the negative spiral that can lead to crisis.\u003c/p>\n\u003cp>The website for the National Suicide Prevention Lifeline has a list \u003ca href=\"https://suicidepreventionlifeline.org/help-someone-else/\" target=\"_blank\" rel=\"noopener\">of do's and don'ts \u003c/a>when trying to help someone at risk.\u003c/p>\n\u003ch3>3. Be direct: Ask about suicide\u003c/h3>\n\u003cp>\"Most people are afraid to ask about suicide, because they [think they] don't want to put the thought in their head,\" says Marshall. \"But there's no research to support that.\"\u003c/p>\n\u003cp>Instead, she and other suicide prevention experts say discussing suicide directly and compassionately with a person at risk is key to preventing it.\u003c/p>\n\u003cp>One can ask a direct question like, \"Have you ever had thoughts of suicide?\" says Marshall.\u003c/p>\n\u003cp>More general questions like, \"What do you think of people who kill themselves?\" can also open up a conversation about suicide, says Gould. \"Now they are talking about it, when you might not have had the conversation before.\"\u003c/p>\n\u003ch3>4. Assess risk and don't panic: Suicidal feelings aren't always an emergency\u003c/h3>\n\u003cp>Say a loved one confides in you that they have been thinking about suicide. What do you do then?\u003c/p>\n\u003cp>\"Don't let yourself panic,\" says Whiteside.\u003c/p>\n\u003cp>People often believe that a person considering suicide needs to be rushed to the hospital. But \"not everyone who expressed these thoughts needs to be hospitalized immediately,\" says Marshall.\u003c/p>\n\u003cp>Research shows that most people who've had suicidal thoughts haven't had the kind of overpowering thoughts that might push them to make an attempt, explains Whiteside. In other words, \u003ca href=\"https://www.sprc.org/scope/attempts\" target=\"_blank\" rel=\"noopener\">many more people experience suicidal thoughts\u003c/a> than take action on them.\u003c/p>\n\u003cp>But how do you know whether your loved one's situation is an immediate crisis?\u003c/p>\n\u003cp>Whiteside suggests asking direct questions like: \"Are you thinking of killing yourself in the next day or so?\" and \"How strong are those urges?\"\u003c/p>\n\u003cp>For help with this conversation, psychiatrists at Columbia University have developed \u003ca href=\"http://cssrs.columbia.edu/the-columbia-scale-c-ssrs/about-the-scale/\" target=\"_blank\" rel=\"noopener\">the Columbia Protocol,\u003c/a> which is a risk-assessment tool drawn from their research-based suicide severity rating scale. It \u003ca href=\"http://cssrs.columbia.edu/wp-content/uploads/Community-Card-2women-2018c.pdf\" target=\"_blank\" rel=\"noopener\">walks you through six questions\u003c/a> to ask your loved one about whether they've had thoughts about suicide and about the means of suicide and whether they have worked out the details of how they would carry out their plan.\u003c/p>\n\u003cp>Someone who has a plan at hand is at a high risk of acting on it — according to the \u003ca href=\"https://www.sprc.org/scope/attempts\" target=\"_blank\" rel=\"noopener\">Suicide Prevention Resource Center\u003c/a>, about 38 percent of people who have made a plan go on to make an attempt.\u003c/p>\n\u003ch3>5. If it's a crisis, stick around\u003c/h3>\n\u003cp>So what if you've assessed risk and you fear your loved one is in immediate crisis? First, request them to hold off for a day or so, says Whiteside, at the same time being \"validating and gentle.\"\u003c/p>\n\u003cp>The kind of intense emotions that might make someone act on an impulse, \"usually resolve or become manageable in less than 24 or 48 hours,\" she says. If you can, offer to stay with them during that time period, she adds. Otherwise, help them find other immediate social support or medical help. They shouldn't be alone at these times of crisis.\u003c/p>\n\u003cp>Ask whether they have any means of harming themselves at hand and work with them to remove those things from their environment. \u003ca href=\"https://www.hsph.harvard.edu/means-matter/means-matter/saves-lives/\">Research shows\u003c/a> that removing or limiting access to means reduces suicide deaths.\u003c/p>\n\u003cp>The National Suicide Prevention Lifeline offers this guide to the \u003ca href=\"http://www.bethe1to.com/bethe1to-steps-evidence/\" target=\"_blank\" rel=\"noopener\">five action steps to take\u003c/a> if someone you know is imminent danger.\u003c/p>\n\u003cp>If you don't feel confident about helping someone through a crisis period, call the \u003ca href=\"https://suicidepreventionlifeline.org/\" target=\"_blank\" rel=\"noopener\">National Suicide Prevention Lifeline\u003c/a>, says Gould.\u003c/p>\n\u003ch3>6. Listen and offer hope\u003c/h3>\n\u003cp>If the person is not in immediate risk, it is still important to listen to them, say survivors of suicide attempts like Lezine and DeGolier.\u003c/p>\n\u003cp>\"The biggest thing is listening in an open-minded way, to not be judgmental,\" says DeGolier.\u003c/p>\n\u003cp>\"Don't tell a person what to do. They're looking to be heard, to have their feelings acknowledged.\"\u003c/p>\n\u003cp>The next step is to offer hope, says Whiteside. It helps to say things like, \"I know how strong you are. I've seen you get through hard things. I think we can get through this together,\" she explains.\u003c/p>\n\u003cp>One of Lezine's closest friends in college did just that during his suicidal phases, he says.\u003c/p>\n\u003cp>\"For one thing, she never lost faith in me,\" says Lezine. \"She always believed I have a positive life possible and I would achieve good things.\"\u003c/p>\n\u003cp>He says her faith in him kept him from giving in to his despair completely.\u003c/p>\n\u003cp>\"Having somebody, a confidante who absolutely believed as a person in [my] ability to do something meaningful in life\" was instrumental in his recovery, he says.\u003c/p>\n\u003ch3>7. Help your loved one make a safety plan\u003c/h3>\n\u003cp>When a person is not in immediate risk of attempting suicide, it's a good time to think about preventing a future crisis.\u003c/p>\n\u003cp>\"That's where we want to make help-seeking and adaptive coping strategies a practice,\" says Gould.\u003c/p>\n\u003cp>Suicide prevention experts advise people develop what's known as a safety plan, which research has shown \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/11/628029412/a-simple-emergency-room-intervention-can-help-cut-future-suicide-risk\" target=\"_blank\" rel=\"noopener\">can help reduce suicide risk.\u003c/a> It's a simple plan for how to cope and get help when a crisis hits, and typically, an at-risk person and their mental health provider create it together, but a family member or friend can also help.\u003c/p>\n\u003cp>The American Foundation for Suicide Prevention has a \u003ca href=\"https://suicidepreventionlifeline.org/wp-content/uploads/2016/08/Brown_StanleySafetyPlanTemplate.pdf\" target=\"_blank\" rel=\"noopener\">template for creating a safety plan\u003c/a>. It includes making a list of the person's triggers and warning signs of a coming crisis, people they feel comfortable reaching out to for help and activities they can do to distract themselves during those times — it can be something simple as watching a funny movie.\u003c/p>\n\u003cp>Safety planning includes helping your loved one make their environment safer. This is one of the most \u003ca href=\"https://www.hsph.harvard.edu/means-matter/means-matter/saves-lives/\" target=\"_blank\" rel=\"noopener\">important steps to preventing suicide\u003c/a>, says Marshall. That involves a conversation about lethal means.\u003c/p>\n\u003cp>\"If you ask what kinds of thoughts you're having, they may tell you the means,\" she says.\u003c/p>\n\u003cp>If they don't volunteer that information, it's worth asking them directly, she adds. Once they say what means they have thought of using, one can discuss with them how to limit their access to it.\u003c/p>\n\u003cp>\"The more time and space you can put between the person and harming themselves, the better,\" says Marshall. \"If this is someone who is a firearm owner, you may talk with them to make sure they don't have ready access to firearm in moments of crisis.\"\u003c/p>\n\u003ch3>8. Help them tackle the mental health care system\u003c/h3>\n\u003cp>When someone is in urgent crisis mode, it's often not the best time to try to navigate the mental health care system, says DeGolier. But to prevent a future crisis, offer to help your loved one connect with a mental health professional to find out whether medications can help them and to learn ways to manage their mood and suicidal thinking.\u003c/p>\n\u003cp>A kind of talk therapy called\u003ca href=\"https://www.sprc.org/resources-programs/dialectical-behavior-therapy\" target=\"_blank\" rel=\"noopener\"> dialectical behavior therapy\u003c/a>, or DBT, has been\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25806661\" target=\"_blank\" rel=\"noopener\"> shown to be effective\u003c/a> in reducing risk of suicide. It teaches people strategies to calm their minds and distract themselves when the suicidal thoughts surface.\u003c/p>\n\u003cp>It can be hard for someone who's struggling with negative emotions to get and keep a mental health appointment. Family members and friends can help, notes Whiteside.\u003c/p>\n\u003cp>\"Know that it takes persistence,\" she says. \"You don't stop until you have an appointment for them. That may mean you call 30 people until you find someone who has an availability. You take the day off from work, go with them.\"\u003c/p>\n\u003cp>Lezine says he was fortunate to have had that kind of help and support from his college friend when he was struggling.\u003c/p>\n\u003cp>\"One of the things that was helpful ... was she went with me [to my appointment],\" he says. \"When you're feeling really down and feeling like you don't matter as much, you might not want to take time, or think that it's worth the time, or feel like I don't want to go through this.\"\u003c/p>\n\u003cp>Many people don't make it to their first appointment, or don't follow up, he says. Having a person hold your hand through the process, accompany you to your appointments can prevent that.\u003c/p>\n\u003cp>\"If somebody is sitting there with you, you can have eye contact, touch contact,\" says Lezine. \"It does make a difference, making you feel like you have another person who cares.\"\u003c/p>\n\u003ch3>9. Explore tools and support online\u003c/h3>\n\u003cp>For those struggling to access mental health care there are some evidence-based digital tools that can also help.\u003c/p>\n\u003cp>For example, there's a smartphone app called \u003ca href=\"https://itunes.apple.com/us/app/virtual-hope-box/id825099621?mt=8\" target=\"_blank\" rel=\"noopener\">Virtual Hope Box\u003c/a>, which is modeled on cognitive behavioral therapy techniques. Research shows that veterans who were feeling suicidal and used the app were able to \u003ca href=\"https://www.research.va.gov/research_in_action/Virtual-Hope-Box-smartphone-app-to-prevent-suicide.cfm\" target=\"_blank\" rel=\"noopener\">cope better with negative emotions. \u003c/a>\u003c/p>\n\u003cp>Whiteside and her colleagues started a website called\u003ca href=\"https://www.nowmattersnow.org/\" target=\"_blank\" rel=\"noopener\"> Now Matters Now\u003c/a>, which offers videos with personal stories of suicide survivors talking about their own struggles and how they have overcome their suicidal thoughts. Stories of survival and coping with suicidal thoughts have been shown to \u003ca href=\"https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/role-of-media-reports-in-completed-and-prevented-suicide-werther-v-papageno-effects/DFF62CAE7A44147EE9CAB4DFB50B49F0\" target=\"_blank\" rel=\"noopener\">have a positive effect\u003c/a> on people at risk of suicide.\u003c/p>\n\u003cp>The website also has videos that teach some simple skills that are otherwise taught by a therapist trained to offer DBT.\u003c/p>\n\u003cp>Those skills include mindfulness and paced breathing, which involves breathing with exhales that last longer than the inhales. Whiteside explains that this can calm the nervous system. Similarly, a cold shower or splashing ice water on one's face or making eye contact with someone can distract and/or calm the person who is at immediate risk of taking their own life.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Surveys show that people who visit the website and watch the videos have a short-term reduction in their suicidal thoughts, she says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2019 NPR. To see more, visit https://www.npr.org.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Reach+Out%3A+Ways+To+Help+A+Loved+One+At+Risk+Of+Suicide&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>If you or someone you know may be considering suicide, contact the \u003c/em>\u003ca href=\"http://suicidepreventionlifeline.org/\">National Suicide Prevention Lifeline\u003c/a>\u003cem> at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the \u003c/em>\u003ca href=\"http://www.crisistextline.org/\">Crisis Text Line\u003c/a>\u003cem> by texting HOME to 741741.\u003c/em>\u003c/p>\n\u003chr>\n\u003cp>If you know someone struggling with despair, depression or thoughts of suicide, you may be wondering how to help.\u003c/p>\n\u003cp>Most Americans say that they understand that suicide is preventable and that they would act to help someone they know who is at risk, according to a\u003ca href=\"https://afsp.org/harrispoll/\" target=\"_blank\" rel=\"noopener\"> national survey\u003c/a> conducted by the \u003ca href=\"https://afsp.org/our-work/education/talk-saves-lives-introduction-suicide-prevention/?gclid=Cj0KCQjwhuvlBRCeARIsAM720Hqxm9eZDpNjndysuxGpkBIjgkhtH4_bIuVW60dbiQYBf6p9_iL4r3AaAvKaEALw_wcB\">American Foundation for Suicide Prevention\u003c/a> and the\u003ca href=\"https://theactionalliance.org/\" target=\"_blank\" rel=\"noopener\"> National Action Alliance for Suicide Prevention \u003c/a>in 2018.\u003c/p>\n\u003cp>Yet many of us are afraid to do the wrong thing. In fact, you don't have to be a trained professional to help, says \u003ca href=\"https://afsp.org/about-afsp/doreen-marshall-ph-d/\" target=\"_blank\" rel=\"noopener\">Doreen Marshall\u003c/a>, a psychologist and vice president of programs at the AFSP.\u003c/p>\n\u003cp>\"Everyone has a role to play in suicide prevention,\" she says. But \"most people hold back. We often say, 'Trust your gut. If you're worried about someone, take that step.' \"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And that first step starts with simply reaching out, says Marshall. It may seem like a small thing, but survivors of suicide attempts and suicide experts say, it can go long way.\u003c/p>\n\u003cp>Simple acts of connection are powerful, says\u003ca href=\"https://www.ursulawhiteside.org/about-1\" target=\"_blank\" rel=\"noopener\"> Ursula Whiteside\u003c/a>, a psychologist and a faculty member at the University of Washington.\u003c/p>\n\u003cp>\"Looking out for each other in general reduces [suicide] risk,\" says Whiteside. \"Because people who feel connected are less likely to kill themselves.\"\u003c/p>\n\u003cp>And \"the earlier you catch someone,\" she adds, \"the less they have to suffer.\"\u003c/p>\n\u003cp>Here are nine things you can do that can make a difference.\u003c/p>\n\u003ch3>1. Recognize the warning signs\u003c/h3>\n\u003cp>\u003ca href=\"https://afsp.org/about-suicide/risk-factors-and-warning-signs/\" target=\"_blank\" rel=\"noopener\">Signs of suicide risk to watch for\u003c/a> include changes in mood and behavior, Marshall says.\u003c/p>\n\u003cp>\"For example, someone who is usually part of a group or activity and you notice that they stop showing up,\" explains Marshall. \"Someone who is usually pretty even-tempered, and you see they are easily frustrated or angry.\"\u003c/p>\n\u003cp>Other signs include feeling depressed, anxious, irritable or losing interest in things.\u003c/p>\n\u003cp>Pay attention to a person's words, too.\u003c/p>\n\u003cp>\"They may talk about wanting to end their lives or seeing no purpose or wanting to go to sleep and never wake up,\" says Marshall. \"Those are signs that they may be thinking about [suicide]. It may be couched as a need to get away from, or escape the pain.\"\u003c/p>\n\u003cp>According to the AFSP, people who take their own lives often show a combination of these warning signs.\u003c/p>\n\u003cp>And the signs can be different for different individuals, says \u003ca href=\"https://www.mailman.columbia.edu/people/our-faculty/msg5\" target=\"_blank\" rel=\"noopener\">Madelyn Gould\u003c/a>, a professor of epidemiology in psychiatry at Columbia University who studies suicide and suicide prevention.\u003c/p>\n\u003cp>\"For some people, it might be starting to have difficulty sleeping,\" she says. Someone else might easily feel humiliated or rejected.\u003c/p>\n\u003cp>\"Each one of these things can put [someone] more at risk,\" explains Gould, \"Until at some point, [they're] not in control anymore.\"\u003c/p>\n\u003ch3>2. Reach out and ask, \"Are you OK?\"\u003c/h3>\n\u003cp>So, what do you do when you notice someone is struggling and you fear they may be considering suicide?\u003c/p>\n\u003cp>Reach out, check in and show you care, say suicide prevention experts.\u003c/p>\n\u003cp>\"The very nature of someone struggling with suicide and depression, [is that] they're not likely to reach out,\" says Marshall. \"They feel like a burden to others.\"\u003c/p>\n\u003cp>People who are having thoughts of suicide often feel trapped and alone, explains\u003ca href=\"https://www.suicidology.org/about-aas/board\" target=\"_blank\" rel=\"noopener\"> DeQuincy Lezine\u003c/a>, a psychologist and a member of the board of directors of the \u003ca href=\"https://www.suicidology.org/\" target=\"_blank\" rel=\"noopener\">American Association of Suicidology\u003c/a>. He is also a survivor of suicide attempts.\u003c/p>\n\u003cp>When someone reaches out and offers support, it reduces a person's sense of isolation, he explains.\u003c/p>\n\u003cp>\"Even if you can't find the exact words [to say], the aspect that somebody cares makes a big difference,\"says Lezine.\u003c/p>\n\u003cp>Questions like \"Are you doing OK?\" and statements like \"If you need anything, let me know\" are simple supportive gestures that can have a big impact on someone who's in emotional pain, explains Julie DeGolier, a medical assistant in Seattle and a survivor of suicide attempts. It can interrupt the negative spiral that can lead to crisis.\u003c/p>\n\u003cp>The website for the National Suicide Prevention Lifeline has a list \u003ca href=\"https://suicidepreventionlifeline.org/help-someone-else/\" target=\"_blank\" rel=\"noopener\">of do's and don'ts \u003c/a>when trying to help someone at risk.\u003c/p>\n\u003ch3>3. Be direct: Ask about suicide\u003c/h3>\n\u003cp>\"Most people are afraid to ask about suicide, because they [think they] don't want to put the thought in their head,\" says Marshall. \"But there's no research to support that.\"\u003c/p>\n\u003cp>Instead, she and other suicide prevention experts say discussing suicide directly and compassionately with a person at risk is key to preventing it.\u003c/p>\n\u003cp>One can ask a direct question like, \"Have you ever had thoughts of suicide?\" says Marshall.\u003c/p>\n\u003cp>More general questions like, \"What do you think of people who kill themselves?\" can also open up a conversation about suicide, says Gould. \"Now they are talking about it, when you might not have had the conversation before.\"\u003c/p>\n\u003ch3>4. Assess risk and don't panic: Suicidal feelings aren't always an emergency\u003c/h3>\n\u003cp>Say a loved one confides in you that they have been thinking about suicide. What do you do then?\u003c/p>\n\u003cp>\"Don't let yourself panic,\" says Whiteside.\u003c/p>\n\u003cp>People often believe that a person considering suicide needs to be rushed to the hospital. But \"not everyone who expressed these thoughts needs to be hospitalized immediately,\" says Marshall.\u003c/p>\n\u003cp>Research shows that most people who've had suicidal thoughts haven't had the kind of overpowering thoughts that might push them to make an attempt, explains Whiteside. In other words, \u003ca href=\"https://www.sprc.org/scope/attempts\" target=\"_blank\" rel=\"noopener\">many more people experience suicidal thoughts\u003c/a> than take action on them.\u003c/p>\n\u003cp>But how do you know whether your loved one's situation is an immediate crisis?\u003c/p>\n\u003cp>Whiteside suggests asking direct questions like: \"Are you thinking of killing yourself in the next day or so?\" and \"How strong are those urges?\"\u003c/p>\n\u003cp>For help with this conversation, psychiatrists at Columbia University have developed \u003ca href=\"http://cssrs.columbia.edu/the-columbia-scale-c-ssrs/about-the-scale/\" target=\"_blank\" rel=\"noopener\">the Columbia Protocol,\u003c/a> which is a risk-assessment tool drawn from their research-based suicide severity rating scale. It \u003ca href=\"http://cssrs.columbia.edu/wp-content/uploads/Community-Card-2women-2018c.pdf\" target=\"_blank\" rel=\"noopener\">walks you through six questions\u003c/a> to ask your loved one about whether they've had thoughts about suicide and about the means of suicide and whether they have worked out the details of how they would carry out their plan.\u003c/p>\n\u003cp>Someone who has a plan at hand is at a high risk of acting on it — according to the \u003ca href=\"https://www.sprc.org/scope/attempts\" target=\"_blank\" rel=\"noopener\">Suicide Prevention Resource Center\u003c/a>, about 38 percent of people who have made a plan go on to make an attempt.\u003c/p>\n\u003ch3>5. If it's a crisis, stick around\u003c/h3>\n\u003cp>So what if you've assessed risk and you fear your loved one is in immediate crisis? First, request them to hold off for a day or so, says Whiteside, at the same time being \"validating and gentle.\"\u003c/p>\n\u003cp>The kind of intense emotions that might make someone act on an impulse, \"usually resolve or become manageable in less than 24 or 48 hours,\" she says. If you can, offer to stay with them during that time period, she adds. Otherwise, help them find other immediate social support or medical help. They shouldn't be alone at these times of crisis.\u003c/p>\n\u003cp>Ask whether they have any means of harming themselves at hand and work with them to remove those things from their environment. \u003ca href=\"https://www.hsph.harvard.edu/means-matter/means-matter/saves-lives/\">Research shows\u003c/a> that removing or limiting access to means reduces suicide deaths.\u003c/p>\n\u003cp>The National Suicide Prevention Lifeline offers this guide to the \u003ca href=\"http://www.bethe1to.com/bethe1to-steps-evidence/\" target=\"_blank\" rel=\"noopener\">five action steps to take\u003c/a> if someone you know is imminent danger.\u003c/p>\n\u003cp>If you don't feel confident about helping someone through a crisis period, call the \u003ca href=\"https://suicidepreventionlifeline.org/\" target=\"_blank\" rel=\"noopener\">National Suicide Prevention Lifeline\u003c/a>, says Gould.\u003c/p>\n\u003ch3>6. Listen and offer hope\u003c/h3>\n\u003cp>If the person is not in immediate risk, it is still important to listen to them, say survivors of suicide attempts like Lezine and DeGolier.\u003c/p>\n\u003cp>\"The biggest thing is listening in an open-minded way, to not be judgmental,\" says DeGolier.\u003c/p>\n\u003cp>\"Don't tell a person what to do. They're looking to be heard, to have their feelings acknowledged.\"\u003c/p>\n\u003cp>The next step is to offer hope, says Whiteside. It helps to say things like, \"I know how strong you are. I've seen you get through hard things. I think we can get through this together,\" she explains.\u003c/p>\n\u003cp>One of Lezine's closest friends in college did just that during his suicidal phases, he says.\u003c/p>\n\u003cp>\"For one thing, she never lost faith in me,\" says Lezine. \"She always believed I have a positive life possible and I would achieve good things.\"\u003c/p>\n\u003cp>He says her faith in him kept him from giving in to his despair completely.\u003c/p>\n\u003cp>\"Having somebody, a confidante who absolutely believed as a person in [my] ability to do something meaningful in life\" was instrumental in his recovery, he says.\u003c/p>\n\u003ch3>7. Help your loved one make a safety plan\u003c/h3>\n\u003cp>When a person is not in immediate risk of attempting suicide, it's a good time to think about preventing a future crisis.\u003c/p>\n\u003cp>\"That's where we want to make help-seeking and adaptive coping strategies a practice,\" says Gould.\u003c/p>\n\u003cp>Suicide prevention experts advise people develop what's known as a safety plan, which research has shown \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/11/628029412/a-simple-emergency-room-intervention-can-help-cut-future-suicide-risk\" target=\"_blank\" rel=\"noopener\">can help reduce suicide risk.\u003c/a> It's a simple plan for how to cope and get help when a crisis hits, and typically, an at-risk person and their mental health provider create it together, but a family member or friend can also help.\u003c/p>\n\u003cp>The American Foundation for Suicide Prevention has a \u003ca href=\"https://suicidepreventionlifeline.org/wp-content/uploads/2016/08/Brown_StanleySafetyPlanTemplate.pdf\" target=\"_blank\" rel=\"noopener\">template for creating a safety plan\u003c/a>. It includes making a list of the person's triggers and warning signs of a coming crisis, people they feel comfortable reaching out to for help and activities they can do to distract themselves during those times — it can be something simple as watching a funny movie.\u003c/p>\n\u003cp>Safety planning includes helping your loved one make their environment safer. This is one of the most \u003ca href=\"https://www.hsph.harvard.edu/means-matter/means-matter/saves-lives/\" target=\"_blank\" rel=\"noopener\">important steps to preventing suicide\u003c/a>, says Marshall. That involves a conversation about lethal means.\u003c/p>\n\u003cp>\"If you ask what kinds of thoughts you're having, they may tell you the means,\" she says.\u003c/p>\n\u003cp>If they don't volunteer that information, it's worth asking them directly, she adds. Once they say what means they have thought of using, one can discuss with them how to limit their access to it.\u003c/p>\n\u003cp>\"The more time and space you can put between the person and harming themselves, the better,\" says Marshall. \"If this is someone who is a firearm owner, you may talk with them to make sure they don't have ready access to firearm in moments of crisis.\"\u003c/p>\n\u003ch3>8. Help them tackle the mental health care system\u003c/h3>\n\u003cp>When someone is in urgent crisis mode, it's often not the best time to try to navigate the mental health care system, says DeGolier. But to prevent a future crisis, offer to help your loved one connect with a mental health professional to find out whether medications can help them and to learn ways to manage their mood and suicidal thinking.\u003c/p>\n\u003cp>A kind of talk therapy called\u003ca href=\"https://www.sprc.org/resources-programs/dialectical-behavior-therapy\" target=\"_blank\" rel=\"noopener\"> dialectical behavior therapy\u003c/a>, or DBT, has been\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25806661\" target=\"_blank\" rel=\"noopener\"> shown to be effective\u003c/a> in reducing risk of suicide. It teaches people strategies to calm their minds and distract themselves when the suicidal thoughts surface.\u003c/p>\n\u003cp>It can be hard for someone who's struggling with negative emotions to get and keep a mental health appointment. Family members and friends can help, notes Whiteside.\u003c/p>\n\u003cp>\"Know that it takes persistence,\" she says. \"You don't stop until you have an appointment for them. That may mean you call 30 people until you find someone who has an availability. You take the day off from work, go with them.\"\u003c/p>\n\u003cp>Lezine says he was fortunate to have had that kind of help and support from his college friend when he was struggling.\u003c/p>\n\u003cp>\"One of the things that was helpful ... was she went with me [to my appointment],\" he says. \"When you're feeling really down and feeling like you don't matter as much, you might not want to take time, or think that it's worth the time, or feel like I don't want to go through this.\"\u003c/p>\n\u003cp>Many people don't make it to their first appointment, or don't follow up, he says. Having a person hold your hand through the process, accompany you to your appointments can prevent that.\u003c/p>\n\u003cp>\"If somebody is sitting there with you, you can have eye contact, touch contact,\" says Lezine. \"It does make a difference, making you feel like you have another person who cares.\"\u003c/p>\n\u003ch3>9. Explore tools and support online\u003c/h3>\n\u003cp>For those struggling to access mental health care there are some evidence-based digital tools that can also help.\u003c/p>\n\u003cp>For example, there's a smartphone app called \u003ca href=\"https://itunes.apple.com/us/app/virtual-hope-box/id825099621?mt=8\" target=\"_blank\" rel=\"noopener\">Virtual Hope Box\u003c/a>, which is modeled on cognitive behavioral therapy techniques. Research shows that veterans who were feeling suicidal and used the app were able to \u003ca href=\"https://www.research.va.gov/research_in_action/Virtual-Hope-Box-smartphone-app-to-prevent-suicide.cfm\" target=\"_blank\" rel=\"noopener\">cope better with negative emotions. \u003c/a>\u003c/p>\n\u003cp>Whiteside and her colleagues started a website called\u003ca href=\"https://www.nowmattersnow.org/\" target=\"_blank\" rel=\"noopener\"> Now Matters Now\u003c/a>, which offers videos with personal stories of suicide survivors talking about their own struggles and how they have overcome their suicidal thoughts. Stories of survival and coping with suicidal thoughts have been shown to \u003ca href=\"https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/role-of-media-reports-in-completed-and-prevented-suicide-werther-v-papageno-effects/DFF62CAE7A44147EE9CAB4DFB50B49F0\" target=\"_blank\" rel=\"noopener\">have a positive effect\u003c/a> on people at risk of suicide.\u003c/p>\n\u003cp>The website also has videos that teach some simple skills that are otherwise taught by a therapist trained to offer DBT.\u003c/p>\n\u003cp>Those skills include mindfulness and paced breathing, which involves breathing with exhales that last longer than the inhales. Whiteside explains that this can calm the nervous system. Similarly, a cold shower or splashing ice water on one's face or making eye contact with someone can distract and/or calm the person who is at immediate risk of taking their own life.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Surveys show that people who visit the website and watch the videos have a short-term reduction in their suicidal thoughts, she says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2019 NPR. To see more, visit https://www.npr.org.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Reach+Out%3A+Ways+To+Help+A+Loved+One+At+Risk+Of+Suicide&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Young Women in the Eastern Coachella Valley Address Mental Health Through Storytelling",
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"headTitle": "The California Report | KQED News",
"content": "\u003cp>Mental health is a largely stigmatized conversation among young Latina women and other women of color in the Eastern Coachella Valley, a rural, unincorporated area of Riverside County. In 2018, a small group of young women, ranging from ages 15-25, and their adult allies launched a new storytelling collective called ¡Que Madre! Media with the goal of challenging those stigmas through storytelling.\u003c/p>\n\u003cp>Together, they use storytelling on \u003ca href=\"https://www.instagram.com/quemadremedia/\" target=\"_blank\" rel=\"noopener\">Instagram\u003c/a> and elsewhere to elevate their own personal experiences struggling with mental health challenges -- and to connect community members with local mental health service providers.\u003c/p>\n\u003cp>Filmmaker Olivia Rodriguez, 25, sat down with a fellow founding member of ¡Que Madre! Media, Juliana Taboada, 17, to talk about the mental and emotional distress young women in the Eastern Coachella Valley face, and how storytelling can help end mental health stigmas.\u003c/p>\n\u003cp>\u003cstrong>Can you talk about the mental health challenges facing young women in the Eastern Coachella Valley? I know that you have been a big advocate through your writing.\u003c/strong>\u003c/p>\n\u003cp>\u003cb>Taboada:\u003c/b> Being in a predominantly Latino community, women are always assumed to be irrational or overly emotional. And when we deal with those feelings, we are seen as crazy or mentally unstable. I think we forget that you need to deal with your emotions; you can't just put them aside, because that makes them worse over time.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When we have spaces like \u003ca href=\"https://deskgram.net/quemadremedia\" target=\"_blank\" rel=\"noopener\">¡Que Madre! Media\u003c/a>, where we are allowed to talk about these things, it shows us that what we feel is valid, especially with an outlet to write about those feelings.\u003c/p>\n\u003cp>I think being a part of this group for young women of color helps me feel like I’m not the only person who deals with these issues. I won’t refer to it as group therapy, but when we talk about these [mental health] issues it feels like raw coping together, raw healing. I think that's really powerful.\u003c/p>\n\u003cp>\u003cstrong>In your poems you write about your anxiety. Is that something you discovered about yourself in high school, or had you been dealing with anxiety for a while?\u003c/strong>\u003c/p>\n\u003cp>\u003cb>Taboada:\u003c/b> My whole life. I had anxiety since I was about eight years old; I think that's when it became super, super big to me. I remember I had a teacher who used to give me panic attacks in class because she was so rude to me, and I was also dealing with a lot of stuff at home. I remember one day I locked myself in the restroom because I didn’t want to go to school. I think that's when I knew that what I felt wasn’t what I should have been feeling at eight years old. When I got older, I put the word ‘anxiety’ to that feeling.\u003c/p>\n\u003cp>\u003cstrong>How did you find that term, 'anxiety,' or discover those resources at such a young age?\u003c/strong>\u003c/p>\n\u003cp>\u003cb>Taboada:\u003c/b> I have a family member with very high-functioning anxiety, like me. She was the one who told me about it, and I'm grateful for that.\u003c/p>\n\u003cp>I think mental health is a big thing that we need to talk about. We need to have access to that kind of health care. We need to have access to therapists. Therapy can't be seen as a necessity when it's priced as a luxury. I think therapy is great; I have a therapist, but it's tough to find the right person.\u003c/p>\n\u003cp>[aside postID='news_11737874,news_11737834,news_11738458' label='The Coachella You Might Not Have Heard About']\u003c/p>\n\u003cp>\u003cstrong>How did you find your therapist?\u003c/strong>\u003c/p>\n\u003cp>\u003cb>Taboada:\u003c/b> I found my therapist through one of my mentors. She and I were at a retreat called \u003ca href=\"https://www.calendow.org/sisterhood-rising/\" target=\"_blank\" rel=\"noopener\">Sisterhood Rising\u003c/a>, and I had a panic attack during a conversation about depression. That moment triggered me in a way that I hadn't dealt with before, so I had to step out of the room because I was freaking out.\u003c/p>\n\u003cp>My mentor came to talk to me later on that night, and I explained to her that I don't always know how to deal with my emotions by myself. Sometimes it's so overwhelming. During that retreat she introduced me to someone who started a nonprofit organization that provides free therapy for young folks.\u003c/p>\n\u003cp>\u003cstrong>What are the hopes and dreams you have for yourself and your community?\u003c/strong>\u003c/p>\n\u003cp>\u003cb>Taboada:\u003c/b> For myself, I want to create a show. I don't know if any of you are familiar with \u003ca href=\"https://www.misterrogers.org/\" target=\"_blank\" rel=\"noopener\">Mister Rogers’ Neighborhood\u003c/a>, but I want to make a show similar to that, but for kids of color. I also want to make films and write plays, and to be someone who young women of color can look up to.\u003c/p>\n\u003cp>For my family, I want them to be as happy as possible. For my community, I hope that we all know we're resilient people and that we are all aware of the power that we have. But I want us to become even more powerful. I want us to become more vocal and more prominent. And I want us to one day say, ‘We are the Eastern Coachella Valley and we are never going to leave. We're here to stay.'\u003c/p>\n\u003cp>\u003cstrong>Thank you so much for sharing your personal story and for the impact you've had on our community.\u003c/strong>\u003c/p>\n\u003cp>\u003cb>Taboada:\u003c/b> Thank you for letting me share my story.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ci>Olivia Rodriguez, 25, is a writer and filmmaker behind \u003ca href=\"https://www.desertsun.com/story/news/politics/2018/11/02/salton-sea-film-estamos-aqui-focuses-community-not-politicians/1827987002/\" target=\"_blank\" rel=\"noopener\">Estamos Aqui\u003c/a>. ¡Que Madre! Media Collective is supported by the Regional Access Project Foundation and The California Endowment.\u003c/i>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Mental health is a largely stigmatized conversation among young Latina women and other women of color in the Eastern Coachella Valley, a rural, unincorporated area of Riverside County. In 2018, a small group of young women, ranging from ages 15-25, and their adult allies launched a new storytelling collective called ¡Que Madre! Media with the goal of challenging those stigmas through storytelling.\u003c/p>\n\u003cp>Together, they use storytelling on \u003ca href=\"https://www.instagram.com/quemadremedia/\" target=\"_blank\" rel=\"noopener\">Instagram\u003c/a> and elsewhere to elevate their own personal experiences struggling with mental health challenges -- and to connect community members with local mental health service providers.\u003c/p>\n\u003cp>Filmmaker Olivia Rodriguez, 25, sat down with a fellow founding member of ¡Que Madre! Media, Juliana Taboada, 17, to talk about the mental and emotional distress young women in the Eastern Coachella Valley face, and how storytelling can help end mental health stigmas.\u003c/p>\n\u003cp>\u003cstrong>Can you talk about the mental health challenges facing young women in the Eastern Coachella Valley? I know that you have been a big advocate through your writing.\u003c/strong>\u003c/p>\n\u003cp>\u003cb>Taboada:\u003c/b> Being in a predominantly Latino community, women are always assumed to be irrational or overly emotional. And when we deal with those feelings, we are seen as crazy or mentally unstable. I think we forget that you need to deal with your emotions; you can't just put them aside, because that makes them worse over time.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When we have spaces like \u003ca href=\"https://deskgram.net/quemadremedia\" target=\"_blank\" rel=\"noopener\">¡Que Madre! Media\u003c/a>, where we are allowed to talk about these things, it shows us that what we feel is valid, especially with an outlet to write about those feelings.\u003c/p>\n\u003cp>I think being a part of this group for young women of color helps me feel like I’m not the only person who deals with these issues. I won’t refer to it as group therapy, but when we talk about these [mental health] issues it feels like raw coping together, raw healing. I think that's really powerful.\u003c/p>\n\u003cp>\u003cstrong>In your poems you write about your anxiety. Is that something you discovered about yourself in high school, or had you been dealing with anxiety for a while?\u003c/strong>\u003c/p>\n\u003cp>\u003cb>Taboada:\u003c/b> My whole life. I had anxiety since I was about eight years old; I think that's when it became super, super big to me. I remember I had a teacher who used to give me panic attacks in class because she was so rude to me, and I was also dealing with a lot of stuff at home. I remember one day I locked myself in the restroom because I didn’t want to go to school. I think that's when I knew that what I felt wasn’t what I should have been feeling at eight years old. When I got older, I put the word ‘anxiety’ to that feeling.\u003c/p>\n\u003cp>\u003cstrong>How did you find that term, 'anxiety,' or discover those resources at such a young age?\u003c/strong>\u003c/p>\n\u003cp>\u003cb>Taboada:\u003c/b> I have a family member with very high-functioning anxiety, like me. She was the one who told me about it, and I'm grateful for that.\u003c/p>\n\u003cp>I think mental health is a big thing that we need to talk about. We need to have access to that kind of health care. We need to have access to therapists. Therapy can't be seen as a necessity when it's priced as a luxury. I think therapy is great; I have a therapist, but it's tough to find the right person.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>How did you find your therapist?\u003c/strong>\u003c/p>\n\u003cp>\u003cb>Taboada:\u003c/b> I found my therapist through one of my mentors. She and I were at a retreat called \u003ca href=\"https://www.calendow.org/sisterhood-rising/\" target=\"_blank\" rel=\"noopener\">Sisterhood Rising\u003c/a>, and I had a panic attack during a conversation about depression. That moment triggered me in a way that I hadn't dealt with before, so I had to step out of the room because I was freaking out.\u003c/p>\n\u003cp>My mentor came to talk to me later on that night, and I explained to her that I don't always know how to deal with my emotions by myself. Sometimes it's so overwhelming. During that retreat she introduced me to someone who started a nonprofit organization that provides free therapy for young folks.\u003c/p>\n\u003cp>\u003cstrong>What are the hopes and dreams you have for yourself and your community?\u003c/strong>\u003c/p>\n\u003cp>\u003cb>Taboada:\u003c/b> For myself, I want to create a show. I don't know if any of you are familiar with \u003ca href=\"https://www.misterrogers.org/\" target=\"_blank\" rel=\"noopener\">Mister Rogers’ Neighborhood\u003c/a>, but I want to make a show similar to that, but for kids of color. I also want to make films and write plays, and to be someone who young women of color can look up to.\u003c/p>\n\u003cp>For my family, I want them to be as happy as possible. For my community, I hope that we all know we're resilient people and that we are all aware of the power that we have. But I want us to become even more powerful. I want us to become more vocal and more prominent. And I want us to one day say, ‘We are the Eastern Coachella Valley and we are never going to leave. We're here to stay.'\u003c/p>\n\u003cp>\u003cstrong>Thank you so much for sharing your personal story and for the impact you've had on our community.\u003c/strong>\u003c/p>\n\u003cp>\u003cb>Taboada:\u003c/b> Thank you for letting me share my story.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ci>Olivia Rodriguez, 25, is a writer and filmmaker behind \u003ca href=\"https://www.desertsun.com/story/news/politics/2018/11/02/salton-sea-film-estamos-aqui-focuses-community-not-politicians/1827987002/\" target=\"_blank\" rel=\"noopener\">Estamos Aqui\u003c/a>. ¡Que Madre! Media Collective is supported by the Regional Access Project Foundation and The California Endowment.\u003c/i>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Psychotherapist Orit Weksler operates out of a bright office in Berkeley outfitted with a big, yellow couch, a box filled with sand and shelves stocked with small plastic figurines for patients to play with.\u003c/p>\n\u003cp>“Take whatever speaks to you, put it in the sand, and it creates a kind of picture, kind of like a dream scene,” Weksler said. “It’s just a way to start a conversation.”\u003c/p>\n\u003cp>\u003ca href=\"https://www.berkeley.edu/\" target=\"_blank\" rel=\"noopener\">UC Berkeley\u003c/a> students make up about a third of Weksler’s practice. Navigating things like the red-tape imposed by insurance companies and erratic student schedules makes the job tough. “It’s a very big commitment on our part,” Weksler said. “We do this because we love working with students.”\u003c/p>\n\u003cfigure id=\"attachment_11737674\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11737674\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/Orit-Weksler-800x600.jpg\" alt=\"Psychotherapist Orit Weksler poses in her Berkeley office with her sand tray and shelves of figurines.\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-1200x900.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-1920x1440.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-1832x1374.jpg 1832w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-1376x1032.jpg 1376w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-1044x783.jpg 1044w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-632x474.jpg 632w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-536x402.jpg 536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler.jpg 2048w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Psychotherapist Orit Weksler in her Berkeley office with her sand tray and shelves of figurines. \u003ccite>(Chloe Veltman/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Now, Berkeley’s decision to change up its health insurance provider — for the third time in six years — is putting that love to the test.\u003c/p>\n\u003cp>The main issue is the choice of insurance provider: \u003ca href=\"https://www.blueshieldca.com/\" target=\"_blank\" rel=\"noopener\">Blue Shield\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Weksler is one of five mental health professionals interviewed for this story in person, on the phone or via email. All of them complained about the company’s low reimbursement rates and slow, bureaucratic processes.\u003c/p>\n\u003cp>“\u003ca href=\"https://www.anthem.com/\" target=\"_blank\" rel=\"noopener\">Anthem\u003c/a> and \u003ca href=\"https://www.aetna.com/\" target=\"_blank\" rel=\"noopener\">Aetna\u003c/a> before them only pay us about 50 percent of our regular full fee,” Weksler said of UC Berkeley’s current and previous two student medical insurance partners. “Blue Shield will offer even less, which will make it impossible for most of us to offer more than one or two slots per week for students, due to the cost of living.”\u003c/p>\n\u003cp>[pullquote size='small' align='right' citation='Shana Charles, an assistant professor at Cal State Fullerton in the public health department']‘The UC system is a public system, and it does have a charge to take care of its students. This calls for possible government intervention or regulation of some kind.’[/pullquote]\u003c/p>\n\u003cp>Weksler said many of her colleagues have voiced their concerns on a community listserv about what the switch to Blue Shield might mean for students’ access to services going forward, in a climate where there are more students seeking therapy than there are therapists to provide it.\u003c/p>\n\u003cp>“People are going to get on the Blue Shield list to be able to continue to provide care for students who are currently on their caseload,” Weksler says. “But they’re not going to open any slots for new students.”\u003c/p>\n\u003cp>The new plan will serve around 20,000 students and is scheduled to begin Aug. 1.\u003c/p>\n\u003cp>Blue Shield spokeswoman Amanda Wardell said her company plans to make the transition as easy as possible and provide a high level of care.\u003c/p>\n\u003cp>“As a nonprofit health plan, Blue Shield of California is dedicated to meeting the healthcare needs of UC Berkeley students with our extensive network of providers,” Wardell said in a statement. “We are committed to working with UC Berkeley Student Health Insurance Plan (SHIP) to make this transition easy and ensuring access to high-quality care that is worthy of our family and friends.”\u003c/p>\n\u003cfigure id=\"attachment_11737676\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11737676\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/Bahar-Navab-800x600.jpg\" alt=\"Bahar Navab, associate director of insurance and business development for UC Berkeley's University Health Services.\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-1200x900.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-1920x1440.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-1832x1374.jpg 1832w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-1376x1032.jpg 1376w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-1044x783.jpg 1044w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-632x474.jpg 632w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-536x402.jpg 536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab.jpg 2048w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Bahar Navab, associate director of insurance and business development for UC Berkeley’s University Health Services. \u003ccite>(Chloe Veltman/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>UC Berkeley \u003ca href=\"https://uhs.berkeley.edu/home\" target=\"_blank\" rel=\"noopener\">University Health Services\u003c/a>’ (UHS) associate director of insurance and business development, Bahar Navab, defended the switch as being necessary in the face of ever-escalating healthcare costs.\u003c/p>\n\u003cp>“We have to find the right balance of let’s reimburse our providers a livable wage, while also not having the cost of the plan be unsustainable,” Navab said.\u003c/p>\n\u003cp>Navab said UHS considered bids from 10 insurance providers, and engaged students, the Berkeley administration and other campus stakeholders during the five-month-long bidding and evaluation process, before settling on Blue Shield. (The California-based provider is offering its services in collaboration with \u003ca href=\"https://wellfleetinsurance.com\" target=\"_blank\" rel=\"noopener\">Wellfleet\u003c/a>, a Massachusetts-based insurance firm that specializes in student insurance plans.)\u003c/p>\n\u003cp>[pullquote size='small' align='right' citation='Bahar Navab, University Health Services at UC Berkeley']‘We have to find the right balance of let’s reimburse our providers a livable wage, while also not having the cost of the plan be unsustainable.’[/pullquote]\u003c/p>\n\u003cp>Navab said her department has been working closely with Blue Shield to advocate for reimbursement rates on par with what the current insurer, Anthem, paid healthcare providers. She also said the new plan will not require doctors and other specialists to join the standard Blue Shield network. Instead, UHS has negotiated a special “carve out” for healthcare providers to work with UC Berkeley students.\u003c/p>\n\u003cp>“The carve out will offer providers more consistent rates,” Navab said. “Additionally, we have been working with Blue Shield to reduce administrative barriers, figure out how to streamline the transition and make it as seamless and painless as possible.”\u003c/p>\n\u003cp>Weksler is skeptical of phrases like “carve out”: “It’s just words,” she said.\u003c/p>\n\u003cp>She wants UHS leaders to engage health practitioners in more conversations about policy and best practices in order to serve students’ healthcare needs in a way that makes financial sense for the university, students and providers.\u003c/p>\n\u003cp>\u003cb>\u003c/b>“I want to see that they understand what the actual problems are and that they’re committed to helping us,” Weksler said.\u003c/p>\n\u003cfigure id=\"attachment_11737675\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11737675\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/Nuha-Khalfay-800x533.jpeg\" alt=\"UC Berkeley senior, Nuha Khalfay.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Nuha-Khalfay-800x533.jpeg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Nuha-Khalfay-160x107.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Nuha-Khalfay-1020x680.jpeg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Nuha-Khalfay-1200x800.jpeg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Nuha-Khalfay.jpeg 1600w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">UC Berkeley senior, Nuha Khalfay. \u003ccite>(Chloe Veltman/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>UC Berkeley student Nuha Khalfay, who studies public health, said she’s confident the university has students’ best interests at heart and is happy about some aspects of the new plan — such as the coverage of facial feminization surgery for transgender students for the first time.\u003c/p>\n\u003cp>[aside tag='mental-health' label='Mental Health Care in California']\u003c/p>\n\u003cp>But Khalfay said some of her friends on campus have had to travel far to find in-network providers willing to see them in recent months, and worries about the situation getting worse.\u003c/p>\n\u003cp>“If providers can’t be reimbursed at the rates that they need to take students who go to UC Berkeley, then UC Berkeley students will lose out on the diversity of providers that they could have access to,” Khalfay said.\u003c/p>\n\u003cp>According to Didi Wu, president of \u003ca href=\"https://sspc.berkeley.edu/\" target=\"_blank\" rel=\"noopener\">Student-to-Student Peer Counseling\u003c/a>, a network of Berkeley students offering counseling services to their fellow students, the need for mental health care on campus has never been greater. “There has definitely been increasing demand for counseling among students,” Wu said.\u003c/p>\n\u003cp>A UC system spokeswoman said Berkeley was the only campus in the system to offer Blue Shield as a primary provider.\u003c/p>\n\u003cp>“To switch providers multiple times within a few years is kind of unusual,” said Shana Charles, an assistant professor at \u003ca href=\"http://www.fullerton.edu/\" target=\"_blank\" rel=\"noopener\">Cal State Fullerton\u003c/a> in the public health department and a faculty associate with the \u003ca href=\"https://healthpolicy.ucla.edu\" target=\"_blank\" rel=\"noopener\">UCLA Center for Health Policy Research\u003c/a>.\u003c/p>\n\u003cp>Charles said the fact that mental health specialists are speaking out against the new plan before it’s even been put into motion suggests “a broken system.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cb>\u003c/b>“The UC system is a public system, and it does have a charge to take care of its students,” Charles said. “This calls for possible government intervention or regulation of some kind.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Psychotherapist Orit Weksler operates out of a bright office in Berkeley outfitted with a big, yellow couch, a box filled with sand and shelves stocked with small plastic figurines for patients to play with.\u003c/p>\n\u003cp>“Take whatever speaks to you, put it in the sand, and it creates a kind of picture, kind of like a dream scene,” Weksler said. “It’s just a way to start a conversation.”\u003c/p>\n\u003cp>\u003ca href=\"https://www.berkeley.edu/\" target=\"_blank\" rel=\"noopener\">UC Berkeley\u003c/a> students make up about a third of Weksler’s practice. Navigating things like the red-tape imposed by insurance companies and erratic student schedules makes the job tough. “It’s a very big commitment on our part,” Weksler said. “We do this because we love working with students.”\u003c/p>\n\u003cfigure id=\"attachment_11737674\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11737674\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/Orit-Weksler-800x600.jpg\" alt=\"Psychotherapist Orit Weksler poses in her Berkeley office with her sand tray and shelves of figurines.\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-1200x900.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-1920x1440.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-1832x1374.jpg 1832w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-1376x1032.jpg 1376w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-1044x783.jpg 1044w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-632x474.jpg 632w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler-536x402.jpg 536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Orit-Weksler.jpg 2048w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Psychotherapist Orit Weksler in her Berkeley office with her sand tray and shelves of figurines. \u003ccite>(Chloe Veltman/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Now, Berkeley’s decision to change up its health insurance provider — for the third time in six years — is putting that love to the test.\u003c/p>\n\u003cp>The main issue is the choice of insurance provider: \u003ca href=\"https://www.blueshieldca.com/\" target=\"_blank\" rel=\"noopener\">Blue Shield\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Weksler is one of five mental health professionals interviewed for this story in person, on the phone or via email. All of them complained about the company’s low reimbursement rates and slow, bureaucratic processes.\u003c/p>\n\u003cp>“\u003ca href=\"https://www.anthem.com/\" target=\"_blank\" rel=\"noopener\">Anthem\u003c/a> and \u003ca href=\"https://www.aetna.com/\" target=\"_blank\" rel=\"noopener\">Aetna\u003c/a> before them only pay us about 50 percent of our regular full fee,” Weksler said of UC Berkeley’s current and previous two student medical insurance partners. “Blue Shield will offer even less, which will make it impossible for most of us to offer more than one or two slots per week for students, due to the cost of living.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘The UC system is a public system, and it does have a charge to take care of its students. This calls for possible government intervention or regulation of some kind.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Weksler said many of her colleagues have voiced their concerns on a community listserv about what the switch to Blue Shield might mean for students’ access to services going forward, in a climate where there are more students seeking therapy than there are therapists to provide it.\u003c/p>\n\u003cp>“People are going to get on the Blue Shield list to be able to continue to provide care for students who are currently on their caseload,” Weksler says. “But they’re not going to open any slots for new students.”\u003c/p>\n\u003cp>The new plan will serve around 20,000 students and is scheduled to begin Aug. 1.\u003c/p>\n\u003cp>Blue Shield spokeswoman Amanda Wardell said her company plans to make the transition as easy as possible and provide a high level of care.\u003c/p>\n\u003cp>“As a nonprofit health plan, Blue Shield of California is dedicated to meeting the healthcare needs of UC Berkeley students with our extensive network of providers,” Wardell said in a statement. “We are committed to working with UC Berkeley Student Health Insurance Plan (SHIP) to make this transition easy and ensuring access to high-quality care that is worthy of our family and friends.”\u003c/p>\n\u003cfigure id=\"attachment_11737676\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11737676\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/Bahar-Navab-800x600.jpg\" alt=\"Bahar Navab, associate director of insurance and business development for UC Berkeley's University Health Services.\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-1200x900.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-1920x1440.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-1832x1374.jpg 1832w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-1376x1032.jpg 1376w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-1044x783.jpg 1044w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-632x474.jpg 632w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab-536x402.jpg 536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Bahar-Navab.jpg 2048w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Bahar Navab, associate director of insurance and business development for UC Berkeley’s University Health Services. \u003ccite>(Chloe Veltman/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>UC Berkeley \u003ca href=\"https://uhs.berkeley.edu/home\" target=\"_blank\" rel=\"noopener\">University Health Services\u003c/a>’ (UHS) associate director of insurance and business development, Bahar Navab, defended the switch as being necessary in the face of ever-escalating healthcare costs.\u003c/p>\n\u003cp>“We have to find the right balance of let’s reimburse our providers a livable wage, while also not having the cost of the plan be unsustainable,” Navab said.\u003c/p>\n\u003cp>Navab said UHS considered bids from 10 insurance providers, and engaged students, the Berkeley administration and other campus stakeholders during the five-month-long bidding and evaluation process, before settling on Blue Shield. (The California-based provider is offering its services in collaboration with \u003ca href=\"https://wellfleetinsurance.com\" target=\"_blank\" rel=\"noopener\">Wellfleet\u003c/a>, a Massachusetts-based insurance firm that specializes in student insurance plans.)\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘We have to find the right balance of let’s reimburse our providers a livable wage, while also not having the cost of the plan be unsustainable.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Navab said her department has been working closely with Blue Shield to advocate for reimbursement rates on par with what the current insurer, Anthem, paid healthcare providers. She also said the new plan will not require doctors and other specialists to join the standard Blue Shield network. Instead, UHS has negotiated a special “carve out” for healthcare providers to work with UC Berkeley students.\u003c/p>\n\u003cp>“The carve out will offer providers more consistent rates,” Navab said. “Additionally, we have been working with Blue Shield to reduce administrative barriers, figure out how to streamline the transition and make it as seamless and painless as possible.”\u003c/p>\n\u003cp>Weksler is skeptical of phrases like “carve out”: “It’s just words,” she said.\u003c/p>\n\u003cp>She wants UHS leaders to engage health practitioners in more conversations about policy and best practices in order to serve students’ healthcare needs in a way that makes financial sense for the university, students and providers.\u003c/p>\n\u003cp>\u003cb>\u003c/b>“I want to see that they understand what the actual problems are and that they’re committed to helping us,” Weksler said.\u003c/p>\n\u003cfigure id=\"attachment_11737675\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11737675\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/04/Nuha-Khalfay-800x533.jpeg\" alt=\"UC Berkeley senior, Nuha Khalfay.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Nuha-Khalfay-800x533.jpeg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Nuha-Khalfay-160x107.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Nuha-Khalfay-1020x680.jpeg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Nuha-Khalfay-1200x800.jpeg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/04/Nuha-Khalfay.jpeg 1600w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">UC Berkeley senior, Nuha Khalfay. \u003ccite>(Chloe Veltman/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>UC Berkeley student Nuha Khalfay, who studies public health, said she’s confident the university has students’ best interests at heart and is happy about some aspects of the new plan — such as the coverage of facial feminization surgery for transgender students for the first time.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But Khalfay said some of her friends on campus have had to travel far to find in-network providers willing to see them in recent months, and worries about the situation getting worse.\u003c/p>\n\u003cp>“If providers can’t be reimbursed at the rates that they need to take students who go to UC Berkeley, then UC Berkeley students will lose out on the diversity of providers that they could have access to,” Khalfay said.\u003c/p>\n\u003cp>According to Didi Wu, president of \u003ca href=\"https://sspc.berkeley.edu/\" target=\"_blank\" rel=\"noopener\">Student-to-Student Peer Counseling\u003c/a>, a network of Berkeley students offering counseling services to their fellow students, the need for mental health care on campus has never been greater. “There has definitely been increasing demand for counseling among students,” Wu said.\u003c/p>\n\u003cp>A UC system spokeswoman said Berkeley was the only campus in the system to offer Blue Shield as a primary provider.\u003c/p>\n\u003cp>“To switch providers multiple times within a few years is kind of unusual,” said Shana Charles, an assistant professor at \u003ca href=\"http://www.fullerton.edu/\" target=\"_blank\" rel=\"noopener\">Cal State Fullerton\u003c/a> in the public health department and a faculty associate with the \u003ca href=\"https://healthpolicy.ucla.edu\" target=\"_blank\" rel=\"noopener\">UCLA Center for Health Policy Research\u003c/a>.\u003c/p>\n\u003cp>Charles said the fact that mental health specialists are speaking out against the new plan before it’s even been put into motion suggests “a broken system.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "All Too Often, California’s Default Mental Institutions Are Now Jails and Prisons",
"title": "All Too Often, California’s Default Mental Institutions Are Now Jails and Prisons",
"headTitle": "The California Report | KQED News",
"content": "\u003cp>[dropcap]J[/dropcap]effrey Jurgens stood in a cage in an orange jumpsuit, screaming that he was Jesus Christ. From her seat in the Sacramento courtroom, his mother watched through tears. Joanna Jurgens knew how important it was for the district attorney prosecuting Jeffrey for stealing a car—and the judge deciding his fate—to see the extent of her son’s illness. But it was torture to watch.\u003c/p>\n\u003cp>For years, she had begged judges to steer Jeffrey, who has schizoaffective disorder, into long-term treatment. She worried he would get hurt. She feared he could hurt someone else.\u003c/p>\n\u003cp>Joanna, 56, knew Jeffrey, who was 22 at the time of that 2014 hearing, did not belong behind bars. But after struggling to stabilize him through treatment in the community, she’d become convinced the criminal justice system was her last hope.\u003c/p>\n\u003cp>These days, the main path to treatment at a state psychiatric hospital is through jail. However controversial those state hospitals may be, many families conclude they are the best option for their loved ones.\u003c/p>\n\u003cp>“That is a sad state of affairs in our society, that only when you get locked up does it become a priority to get you treatment,” said Los Angeles District Attorney Jackie Lacey, who said she’s heard many parents describe similar feelings of desperation.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Perhaps nowhere is California’s mental health crisis more evident than in its criminal justice system. After decades of failure to create and fund policies that effectively help people with serious mental illnesses, many now say the jails and prisons have become the state’s default mental institutions.\u003c/p>\n\u003cp>\u003ca href=\"https://law.stanford.edu/wp-content/uploads/2017/05/Stanford-Report-FINAL.pdf\" target=\"_blank\" rel=\"noopener\">Close to a third of California’s inmates\u003c/a> have a documented serious mental illness, according to the California Department of Corrections and Rehabilitation.\u003c/p>\n\u003cp>“We’re going to end up with an incarceration system that’s mainly dealing with people that have serious mental health problems,” said Democratic Sen. Jim Beall of San Jose. “It’s our own fault, in a way, for not having a good mental health system.”\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Graphic-1-.jpg\">\u003cimg class=\"aligncenter size-medium wp-image-11723765\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Graphic-1--800x750.jpg\" alt=\"\" width=\"800\" height=\"750\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Graphic-1--800x750.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Graphic-1--160x150.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Graphic-1--1020x956.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Graphic-1--1200x1124.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Graphic-1--1920x1799.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003c/p>\n\u003cp>In the past five years, the number of people in California who were deemed incompetent to stand trial after arrest—and ordered sent to state hospitals for treatment—increased by 60 percent, state figures show. Judges make such referrals when doctors determine that defendants are unable to understand legal proceedings or cooperate with their attorneys—the goal generally being that they get stabilized and then return to stand trial.\u003c/p>\n\u003cp>Often this leaves people who need mental health treatment stuck in county jails. Inmates in Jeffrey’s condition can wait in limbo for months, or even years, before being sent to a state hospital.\u003c/p>\n\u003cp>Five years ago, an average of 343 inmates with mental illness were awaiting placement. Last year, that number shot up to 819.\u003c/p>\n\u003cp>The increasing number of people deemed incompetent to stand trial may also reflect changing attitudes among public defenders, who now see questioning someone’s competency as an avenue to a more therapeutic environment, said David Meyer, professor with the USC Institute of Psychiatry, Law, and Behavioral Science. Forty years ago, “we would never, ever refer somebody for incompetency proceedings if we could in any way get away with it,” he said. “People would be incarcerated for mental health treatment at a state hospital for a longer time than they would serve if they simply pled guilty.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://e.infogram.com/629df325-41a8-4d8c-8ec9-02ce2bc573d9?src=embed\" title=\"Criminal referrals swamp state mental hospitals grouped graphics\" width=\"800\" height=\"900\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>One major reason for the growing waitlist is that, while the number of state hospital beds has increased, it has not kept pace with the need. State hospitals now have more than 6,200 beds—a significant portion of which are reserved for other needs. In recent years, the state has added about 700 hospital and “jail-based competency restoration” beds.\u003c/p>\n\u003cp>A few decades ago, fewer than half of state hospital patients came from the criminal justice system. Today \u003ca href=\"http://www.dsh.ca.gov/Publications/docs/ADA2017AnnualRept.pdf\" target=\"_blank\" rel=\"noopener\">more than 90 percent\u003c/a> of them do—with more than a fifth of those individuals found incompetent to stand trial. The next largest group were tried and found not guilty by reason of insanity.\u003c/p>\n\u003cp>“We have hundreds of people sitting in our (community) hospitals right now who could benefit from a long-term stay at a state hospital, but we can’t get them in there,” said Sheree Lowe, vice president of behavioral health for the California Hospital Association.\u003c/p>\n\u003cp>That said, many experts believe state hospital stays are so restrictive and expensive that solutions to the crisis must be found elsewhere. The broader issue is that society is “letting people get so sick” they end up in jails and emergency rooms, Lowe said.\u003c/p>\n\u003cp>Jennifer Mathis, director of policy and legal advocacy at the Bazelon Center for Mental Health Law, describes state hospitals as “kind of like living in prison.”\u003c/p>\n\u003cp>“It’s not really a life on a long-term basis,” she said, but added that many families have gone so long without good community mental health services for their loved ones they see no other real option.\u003c/p>\n\u003cp>State data show that 47 percent of the inmates who were found incompetent to stand trial last year had no Medi-Cal mental health services during the six months before they landed in jail. Almost half were unsheltered; in many cases, the charges they faced were directly related to their homelessness and untreated psychosis, according to the Department of State Hospitals.\u003c/p>\n\u003cp>It was not that the system didn’t know them, though. In Napa State Hospital, state data show, nearly half of the people who were incompetent to stand trial had been arrested 15 or more times before they were deemed incompetent.\u003c/p>\n\u003cp>____\u003c/p>\n\u003cp>[dropcap]J[/dropcap]oanna Jurgens’ memories of Jeffrey’s childhood—soccer games and fishing trips and visits to the snow—have been obscured by the shadow of his illness. As a little boy, he acted out so much it was hard to keep him in preschool. By middle school, she was receiving daily calls from the principal’s office. Freshman year in high school, he started getting into fights and brought a knife to school.\u003c/p>\n\u003cfigure id=\"attachment_11723762\" class=\"wp-caption alignleft\" style=\"max-width: 360px\">\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-1.png\">\u003cimg class=\"size-full wp-image-11723762\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-1.png\" alt=\"\" width=\"360\" height=\"640\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-1.png 360w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-1-160x284.png 160w\" sizes=\"(max-width: 360px) 100vw, 360px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jeffrey Jurgens at age 5.\u003c/figcaption>\u003c/figure>\n\u003cp>Unable to control his behavior, Joanna—who operates a clinic for UC Davis Medical Center—and her ex-husband prevailed upon the school district to send their son to a locked residential program in Utah. The structure appeared to help. But after nine months, she said, he returned home, and the same behaviors resurfaced.\u003c/p>\n\u003cp>That Thanksgiving, when Jeffrey was 17, his mother drove him to his grandmother’s house in Tahoe. He couldn’t stop obsessing about a white car he thought was trailing them, which he insisted carried either government agents or the CIA.\u003c/p>\n\u003cp>Joanna took him to psychiatrist after psychiatrist. They put him on mood stabilizers and, eventually, anti-psychotics. He continued to spiral. Marijuana made the symptoms worse. He stole Joanna’s car again and again. Then, at 19, Jeffrey stole a friend’s parents’ car. They pressed charges.\u003c/p>\n\u003cp>“He needs help and I don’t know what to do,” Joanna remembers telling an El Dorado County judge around 2010. “We’re waiting for a disaster to happen.”\u003c/p>\n\u003cp>The judge was sympathetic, but told Joanna his hands were tied. He sent Jeffrey to jail for 90 days. After he got out, Jeffrey was on and off the streets, lost in a haze of street drugs and psychosis.\u003c/p>\n\u003cp>Over and over, he’d land in psychiatric hospitals. But each time he’d stabilize after a few weeks and his insurance provider would insist he be discharged, Joanna said. Joanna was certain her son needed longer-term inpatient treatment. She begged doctors to put him under a conservatorship, allowing a legal guardian to make decisions on his behalf.\u003c/p>\n\u003cp>A doctor who saw him at Sierra Vista Hospital in Sacramento agreed with her, Joanna said. Jeffrey spent six weeks there while the doctor pushed for him to be conserved. The county refused—Joanna remembers being told that Jeffrey needed to fail out of community treatment once more to be eligible.\u003c/p>\n\u003cp>Michelle Lazark, who at the time worked on the Sacramento Police Department’s mobile crisis unit, remembered the first time she came upon the disheveled-looking young man wearing tattered clothes and no shoes.\u003c/p>\n\u003cp>“Are you a new guy?” she asked. Jeffrey told her his name. Lazark asked if she could call his mom.\u003c/p>\n\u003cfigure id=\"attachment_11723761\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2-.jpg\">\u003cimg class=\"wp-image-11723761\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2-.jpg\" alt=\"\" width=\"1920\" height=\"1303\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2-.jpg 4820w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2--160x109.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2--800x543.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2--1020x692.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2--1200x814.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2--1920x1303.jpg 1920w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Michelle Lazark, a Sacramento police officer who works in the Mental Health Unit, put Jeffrey Jurgens back in touch with his mother. \u003ccite>(Randy Pench/CALmatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Oh my God,” Joanna said after she picked up the phone. “Where did you find him?”\u003c/p>\n\u003cp>Over the years, Lazark would often help Joanna search for Jeffrey. Sometimes he was relatively lucid, and she’d share her sandwich with him and chat. Other times she took him to the hospital. If he was self-medicating with meth, she’d take him to jail for a few hours to sober up.\u003c/p>\n\u003cp>“You want to protect them and you want to take them to a safe place where they can detox,” Lazark said. “If that was jail, then that’s what I would do every time. It’s not criminalizing it, it’s keeping them safe.”\u003c/p>\n\u003cp>But not all interactions with law enforcement went well.\u003c/p>\n\u003cp>In 2012, two CHP officers saw him driving a stolen car the wrong way down a one-way street in Sacramento. After a high-speed chase, he came to a stop. A lawsuit filed by the family in federal court said that although he was unarmed and had raised his hands, officers began kicking and beating him with their batons, leaving him with a broken hand and a traumatic brain injury—and then high-fived each other.\u003c/p>\n\u003cp>After an in-car camera video of the incident came out, the district attorney dropped charges against Jeffrey. Last spring, Jeffrey received \u003ca href=\"https://www.courthousenews.com/wp-content/uploads/2018/05/Jurgens-CHP-SETTLEMENT.pdf\" target=\"_blank\" rel=\"noopener\">a $1 million settlement\u003c/a>. (The officers involved all remain employed by the CHP).\u003c/p>\n\u003cp>The day he was discharged from jail, Jeffrey disappeared back into homelessness, said his attorney, Beau Weiner. Months later, on Dec. 5, 2013, he stole a car from valet parking in downtown Sacramento and was peacefully apprehended.\u003c/p>\n\u003cp>Twice a week, his mother visited him in jail.\u003c/p>\n\u003cp>“I see you in here a lot,” she remembers a security officer telling her one day.\u003c/p>\n\u003cp>“I visit my son,” she said.\u003c/p>\n\u003cp>“He probably doesn’t deserve it,” the officer said.\u003c/p>\n\u003cp>Joanna Jurgens looked at him sadly. Why bother trying to explain?\u003c/p>\n\u003cp>“You don’t know the whole situation,” she said.\u003c/p>\n\u003cp>___\u003c/p>\n\u003cp>[dropcap]B[/dropcap]ecause their mental illness leaves them so vulnerable, inmates in that condition are often kept in solitary confinement for their own protection. But extended stays in solitary exacerbate their mental illnesses, too.\u003c/p>\n\u003cp>“You put a bird in a cage, you got to let him out sometime, or he’ll die,” says Samuel Mays, whose adult son, Lorenzo, has been in Sacramento County Jail for eight years waiting to be declared competent. Lorenzo Mays, who has cognitive delays as well as mental illness, is the lead plaintiff in a class action complaint being brought by Disability Rights California against Sacramento County. The complaint cites overcrowding, understaffing and “dangerous, inhumane and degrading conditions,” including use of extended solitary confinement on inmates with serious mental illness.\u003c/p>\n\u003cp>“He’s suffering,” Samuel Mays said of his son. “You can only take so much of that.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://e.infogram.com/dc3a4f7c-1557-4c9e-a357-cd680f620e49?src=embed\" title=\"mental illness\" width=\"800\" height=\"800\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Douglas Clark, who landed in jail on an attempted burglary charge in 2009, picked up a new charge in prison after throwing feces at a correctional officer. Clark, who has schizophrenia and hears spirits talking to him, was found incompetent to stand trial, said his mother Tammy Clark. He was sent to regain competency at the state hospital. He returned to jail to be tried, she said, but went off his medication, or had it changed, and then became mentally unstable again. That cycle keeps repeating, she said.\u003c/p>\n\u003cp>She tries not to seem upset when she talks to him—she wants to be “a light” in his dark world.\u003c/p>\n\u003cp>But sometimes he can tell she’s been crying. “It’s so disheartening,” she said.\u003c/p>\n\u003cp>___\u003c/p>\n\u003cp>[dropcap]E[/dropcap]ven as the population of inmates with mental illness burgeons, some advocates see the beginning signs of hope.\u003c/p>\n\u003cp>Sen. Beall, who himself has a family member with schizoaffective disorder, said the administrations of former governors Arnold Schwarzenegger and Jerry Brown rebuffed policy proposals meant to make comprehensive mental health services available in the community.\u003c/p>\n\u003cp>But last year, Brown signed a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1810\" target=\"_blank\" rel=\"noopener\">provision\u003c/a> to allow courts to divert certain offenders with mental illness into community-based inpatient or outpatient treatment programs, and \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB1187\" target=\"_blank\" rel=\"noopener\">another\u003c/a> to reduce the maximum wait time for an inmate to become competent to stand trial—from three years to two.\u003c/p>\n\u003cfigure id=\"attachment_11723760\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3.jpg\">\u003cimg class=\"wp-image-11723760\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3.jpg\" alt=\"\" width=\"1920\" height=\"1302\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3.jpg 4786w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3-160x109.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3-800x543.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3-1020x692.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3-1200x814.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3-1920x1302.jpg 1920w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Joanna Jurgens reflects on her son Jeffrey, who has struggled with mental illness and is now living at Atascadero State Hospital after stealing a car. \u003ccite>(Randy Pench/CALmatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Last month, Gov. Gavin Newsom proposed a state budget that includes tens of millions of dollars for mental health programs, including training law enforcement officers on crisis de-escalation. The budget would also provide one-time grants to treat young people experiencing early psychosis and $100 million for “whole person care” programs that seek to address the housing, health, mental health and substance abuse needs of people experiencing homelessness.\u003c/p>\n\u003cp>Judge Stephen Manley started one of the nation’s first mental health courts in Santa Clara County more than 20 years ago. In these courts, public defenders, prosecutors, judges and social service providers work together to connect people with mental illness who have been arrested for certain crimes with services and treatment, with a goal of keeping them out of jail.\u003c/p>\n\u003cp>“Everyone wants to tell me, ‘It’s so complex, we can’t solve it.’” Manley said. “And I say, ‘No, you can. Get together and figure out what you can do.’”\u003c/p>\n\u003cp>Over the years, the model has expanded to counties around California.\u003c/p>\n\u003cp>On a recent afternoon in Department 8 in the downtown Sacramento courthouse, Judge Lawrence Brown called up the mental health court participants one by one. He complimented a woman’s red hat, another man’s poncho. He ribbed those who had a lot of hair, contrasting it with his own balding pate.\u003c/p>\n\u003cp>Standing alongside their public defenders, some participants beamed as he lauded their progress staying on medications and off drugs, getting jobs and doing their dishes. Others squirmed uncomfortably in the spotlight. One woman’s voice cracked as she described her troubled relationship with her mother.\u003c/p>\n\u003cp>“The fact that you’re taking all of these steps to take care of yourself, we’re behind you 1,000 percent,” the judge told her.\u003c/p>\n\u003cp>Brown, who has run the county’s mental health court since 2013 and has helped it to expand, says he’s been drawn to the work because of the “humanity of it all.”\u003c/p>\n\u003cp>“Keeping them in jail once they’re back on their medication is not a very compassionate approach,” he said. “They’re living a nightmare being behind bars. That setting of being in a cell, with loud noises, is not an opportune manner in which to address serious mental illness.”\u003c/p>\n\u003cp>For now, though, such courts still only serve a fraction of the ballooning need. Sex offenders, arson registrants, active gang members, those who have caused great bodily injury or death, and those arrested for driving under the influence are among those who are typically excluded. And many such courts aren’t designed to serve those who are incompetent to stand trial.\u003c/p>\n\u003cp>___\u003c/p>\n\u003cp>[dropcap]J[/dropcap]effrey Jurgens doesn’t remember much about the months he waited in jail to get a bed at Atascadero State Hospital—one of the five state hospitals that house people with serious mental illness. Reached over the phone there, Jurgens, now 27, said at first only that being in jail “doesn’t feel too good.”\u003c/p>\n\u003cfigure id=\"attachment_11723763\" class=\"wp-caption alignright\" style=\"max-width: 1242px\">\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-4.png\">\u003cimg class=\"size-full wp-image-11723763\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-4.png\" alt=\"\" width=\"1242\" height=\"2208\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-4.png 1242w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-4-160x284.png 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-4-800x1422.png 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-4-1020x1813.png 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-4-675x1200.png 675w\" sizes=\"(max-width: 1242px) 100vw, 1242px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jeffrey Jurgens at Atascadero State Hospital couple of years ago, surrounded by his parents.\u003c/figcaption>\u003c/figure>\n\u003cp>After his mother prompted him, he recalled being periodically locked in solitary confinement at the Sacramento County Jail after he was arrested in December 2013, alone with the voices, emerging—in her memory—for just an hour every couple of days.\u003c/p>\n\u003cp>“It was a bummer,” he said quietly. “I was going a little stir crazy. I didn’t know what to do, what to think. Nobody would help me while I was there. They just pushed me off because I wasn’t like everyone else.”\u003c/p>\n\u003cp>His mother figures it’s good he doesn’t remember more. Because she does.\u003c/p>\n\u003cp>She remembers the day he called her, panicked, after his heavyset new cellmate kept trying to give him bear hugs. She remembers him whispering into the phone: “I’m really scared.” With Lazark’s help, she got him moved.\u003c/p>\n\u003cp>Joanna also remembers the night Jeffrey called her, agitated and delusional. She was so terrified of what he might do to himself or someone else that she raced to the jail and refused to leave until she spoke to a sergeant.\u003c/p>\n\u003cp>After Jeffrey was arrested for stealing the car from the valet, weeks passed before he appeared before the judge, screaming that he was Jesus. In February 2014, he was admitted to a state hospital.\u003c/p>\n\u003cp>At the end of August, after six months of receiving treatment and preparing for a court appearance, he was found competent enough to have a trial. Months later, in May 2015, he was found not guilty by reason of insanity. He returned to Atascadero State Hospital that June. Someday he hopes he’ll be well enough to get out, so he can spend time with his family and get a job at a grocery store.\u003c/p>\n\u003cp>Joanna wishes her son had received intensive treatment earlier.\u003cbr>\nIt troubles her to think about all the other inmates like him, stuck behind bars with no one to speak up for them.\u003c/p>\n\u003cp>“You’ve got to fight,” she said. “If somebody doesn’t have someone to advocate for them, they don’t stand a chance. They don’t stand a chance.”\u003c/p>\n\u003cp>\u003cem>This is the first of a series exploring the challenges Californians face in the pursuit of mental health care.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Jocelyn Wiener is a contributing writer to CALmatters. This story was supported by a grant from the California Health Care Foundation.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://calmatters.org\" target=\"_blank\" rel=\"noopener\">CALmatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/em>\u003c/p>\n\n",
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"excerpt": "In the past five years, the number of people in California who were deemed incompetent to stand trial—and ordered sent to state hospitals—increased by 60 percent.",
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"nprByline": "\u003cstrong>\u003ca href=\"https://calmatters.org/articles/author/jocelyn-wiener/\">Jocelyn Wiener\u003c/a>\u003c/strong>\u003cbr>\u003cstrong>\u003ca href=\"https://calmatters.org/articles/author/jocelyn-wiener/\">CALmatters\u003c/a>\u003c/strong>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">J\u003c/span>\u003c/p>\u003cp>effrey Jurgens stood in a cage in an orange jumpsuit, screaming that he was Jesus Christ. From her seat in the Sacramento courtroom, his mother watched through tears. Joanna Jurgens knew how important it was for the district attorney prosecuting Jeffrey for stealing a car—and the judge deciding his fate—to see the extent of her son’s illness. But it was torture to watch.\u003c/p>\n\u003cp>For years, she had begged judges to steer Jeffrey, who has schizoaffective disorder, into long-term treatment. She worried he would get hurt. She feared he could hurt someone else.\u003c/p>\n\u003cp>Joanna, 56, knew Jeffrey, who was 22 at the time of that 2014 hearing, did not belong behind bars. But after struggling to stabilize him through treatment in the community, she’d become convinced the criminal justice system was her last hope.\u003c/p>\n\u003cp>These days, the main path to treatment at a state psychiatric hospital is through jail. However controversial those state hospitals may be, many families conclude they are the best option for their loved ones.\u003c/p>\n\u003cp>“That is a sad state of affairs in our society, that only when you get locked up does it become a priority to get you treatment,” said Los Angeles District Attorney Jackie Lacey, who said she’s heard many parents describe similar feelings of desperation.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Perhaps nowhere is California’s mental health crisis more evident than in its criminal justice system. After decades of failure to create and fund policies that effectively help people with serious mental illnesses, many now say the jails and prisons have become the state’s default mental institutions.\u003c/p>\n\u003cp>\u003ca href=\"https://law.stanford.edu/wp-content/uploads/2017/05/Stanford-Report-FINAL.pdf\" target=\"_blank\" rel=\"noopener\">Close to a third of California’s inmates\u003c/a> have a documented serious mental illness, according to the California Department of Corrections and Rehabilitation.\u003c/p>\n\u003cp>“We’re going to end up with an incarceration system that’s mainly dealing with people that have serious mental health problems,” said Democratic Sen. Jim Beall of San Jose. “It’s our own fault, in a way, for not having a good mental health system.”\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Graphic-1-.jpg\">\u003cimg class=\"aligncenter size-medium wp-image-11723765\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Graphic-1--800x750.jpg\" alt=\"\" width=\"800\" height=\"750\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Graphic-1--800x750.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Graphic-1--160x150.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Graphic-1--1020x956.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Graphic-1--1200x1124.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Graphic-1--1920x1799.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003c/p>\n\u003cp>In the past five years, the number of people in California who were deemed incompetent to stand trial after arrest—and ordered sent to state hospitals for treatment—increased by 60 percent, state figures show. Judges make such referrals when doctors determine that defendants are unable to understand legal proceedings or cooperate with their attorneys—the goal generally being that they get stabilized and then return to stand trial.\u003c/p>\n\u003cp>Often this leaves people who need mental health treatment stuck in county jails. Inmates in Jeffrey’s condition can wait in limbo for months, or even years, before being sent to a state hospital.\u003c/p>\n\u003cp>Five years ago, an average of 343 inmates with mental illness were awaiting placement. Last year, that number shot up to 819.\u003c/p>\n\u003cp>The increasing number of people deemed incompetent to stand trial may also reflect changing attitudes among public defenders, who now see questioning someone’s competency as an avenue to a more therapeutic environment, said David Meyer, professor with the USC Institute of Psychiatry, Law, and Behavioral Science. Forty years ago, “we would never, ever refer somebody for incompetency proceedings if we could in any way get away with it,” he said. “People would be incarcerated for mental health treatment at a state hospital for a longer time than they would serve if they simply pled guilty.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://e.infogram.com/629df325-41a8-4d8c-8ec9-02ce2bc573d9?src=embed\" title=\"Criminal referrals swamp state mental hospitals grouped graphics\" width=\"800\" height=\"900\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>One major reason for the growing waitlist is that, while the number of state hospital beds has increased, it has not kept pace with the need. State hospitals now have more than 6,200 beds—a significant portion of which are reserved for other needs. In recent years, the state has added about 700 hospital and “jail-based competency restoration” beds.\u003c/p>\n\u003cp>A few decades ago, fewer than half of state hospital patients came from the criminal justice system. Today \u003ca href=\"http://www.dsh.ca.gov/Publications/docs/ADA2017AnnualRept.pdf\" target=\"_blank\" rel=\"noopener\">more than 90 percent\u003c/a> of them do—with more than a fifth of those individuals found incompetent to stand trial. The next largest group were tried and found not guilty by reason of insanity.\u003c/p>\n\u003cp>“We have hundreds of people sitting in our (community) hospitals right now who could benefit from a long-term stay at a state hospital, but we can’t get them in there,” said Sheree Lowe, vice president of behavioral health for the California Hospital Association.\u003c/p>\n\u003cp>That said, many experts believe state hospital stays are so restrictive and expensive that solutions to the crisis must be found elsewhere. The broader issue is that society is “letting people get so sick” they end up in jails and emergency rooms, Lowe said.\u003c/p>\n\u003cp>Jennifer Mathis, director of policy and legal advocacy at the Bazelon Center for Mental Health Law, describes state hospitals as “kind of like living in prison.”\u003c/p>\n\u003cp>“It’s not really a life on a long-term basis,” she said, but added that many families have gone so long without good community mental health services for their loved ones they see no other real option.\u003c/p>\n\u003cp>State data show that 47 percent of the inmates who were found incompetent to stand trial last year had no Medi-Cal mental health services during the six months before they landed in jail. Almost half were unsheltered; in many cases, the charges they faced were directly related to their homelessness and untreated psychosis, according to the Department of State Hospitals.\u003c/p>\n\u003cp>It was not that the system didn’t know them, though. In Napa State Hospital, state data show, nearly half of the people who were incompetent to stand trial had been arrested 15 or more times before they were deemed incompetent.\u003c/p>\n\u003cp>____\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">J\u003c/span>\u003c/p>\u003cp>oanna Jurgens’ memories of Jeffrey’s childhood—soccer games and fishing trips and visits to the snow—have been obscured by the shadow of his illness. As a little boy, he acted out so much it was hard to keep him in preschool. By middle school, she was receiving daily calls from the principal’s office. Freshman year in high school, he started getting into fights and brought a knife to school.\u003c/p>\n\u003cfigure id=\"attachment_11723762\" class=\"wp-caption alignleft\" style=\"max-width: 360px\">\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-1.png\">\u003cimg class=\"size-full wp-image-11723762\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-1.png\" alt=\"\" width=\"360\" height=\"640\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-1.png 360w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-1-160x284.png 160w\" sizes=\"(max-width: 360px) 100vw, 360px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jeffrey Jurgens at age 5.\u003c/figcaption>\u003c/figure>\n\u003cp>Unable to control his behavior, Joanna—who operates a clinic for UC Davis Medical Center—and her ex-husband prevailed upon the school district to send their son to a locked residential program in Utah. The structure appeared to help. But after nine months, she said, he returned home, and the same behaviors resurfaced.\u003c/p>\n\u003cp>That Thanksgiving, when Jeffrey was 17, his mother drove him to his grandmother’s house in Tahoe. He couldn’t stop obsessing about a white car he thought was trailing them, which he insisted carried either government agents or the CIA.\u003c/p>\n\u003cp>Joanna took him to psychiatrist after psychiatrist. They put him on mood stabilizers and, eventually, anti-psychotics. He continued to spiral. Marijuana made the symptoms worse. He stole Joanna’s car again and again. Then, at 19, Jeffrey stole a friend’s parents’ car. They pressed charges.\u003c/p>\n\u003cp>“He needs help and I don’t know what to do,” Joanna remembers telling an El Dorado County judge around 2010. “We’re waiting for a disaster to happen.”\u003c/p>\n\u003cp>The judge was sympathetic, but told Joanna his hands were tied. He sent Jeffrey to jail for 90 days. After he got out, Jeffrey was on and off the streets, lost in a haze of street drugs and psychosis.\u003c/p>\n\u003cp>Over and over, he’d land in psychiatric hospitals. But each time he’d stabilize after a few weeks and his insurance provider would insist he be discharged, Joanna said. Joanna was certain her son needed longer-term inpatient treatment. She begged doctors to put him under a conservatorship, allowing a legal guardian to make decisions on his behalf.\u003c/p>\n\u003cp>A doctor who saw him at Sierra Vista Hospital in Sacramento agreed with her, Joanna said. Jeffrey spent six weeks there while the doctor pushed for him to be conserved. The county refused—Joanna remembers being told that Jeffrey needed to fail out of community treatment once more to be eligible.\u003c/p>\n\u003cp>Michelle Lazark, who at the time worked on the Sacramento Police Department’s mobile crisis unit, remembered the first time she came upon the disheveled-looking young man wearing tattered clothes and no shoes.\u003c/p>\n\u003cp>“Are you a new guy?” she asked. Jeffrey told her his name. Lazark asked if she could call his mom.\u003c/p>\n\u003cfigure id=\"attachment_11723761\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2-.jpg\">\u003cimg class=\"wp-image-11723761\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2-.jpg\" alt=\"\" width=\"1920\" height=\"1303\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2-.jpg 4820w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2--160x109.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2--800x543.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2--1020x692.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2--1200x814.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-2--1920x1303.jpg 1920w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Michelle Lazark, a Sacramento police officer who works in the Mental Health Unit, put Jeffrey Jurgens back in touch with his mother. \u003ccite>(Randy Pench/CALmatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Oh my God,” Joanna said after she picked up the phone. “Where did you find him?”\u003c/p>\n\u003cp>Over the years, Lazark would often help Joanna search for Jeffrey. Sometimes he was relatively lucid, and she’d share her sandwich with him and chat. Other times she took him to the hospital. If he was self-medicating with meth, she’d take him to jail for a few hours to sober up.\u003c/p>\n\u003cp>“You want to protect them and you want to take them to a safe place where they can detox,” Lazark said. “If that was jail, then that’s what I would do every time. It’s not criminalizing it, it’s keeping them safe.”\u003c/p>\n\u003cp>But not all interactions with law enforcement went well.\u003c/p>\n\u003cp>In 2012, two CHP officers saw him driving a stolen car the wrong way down a one-way street in Sacramento. After a high-speed chase, he came to a stop. A lawsuit filed by the family in federal court said that although he was unarmed and had raised his hands, officers began kicking and beating him with their batons, leaving him with a broken hand and a traumatic brain injury—and then high-fived each other.\u003c/p>\n\u003cp>After an in-car camera video of the incident came out, the district attorney dropped charges against Jeffrey. Last spring, Jeffrey received \u003ca href=\"https://www.courthousenews.com/wp-content/uploads/2018/05/Jurgens-CHP-SETTLEMENT.pdf\" target=\"_blank\" rel=\"noopener\">a $1 million settlement\u003c/a>. (The officers involved all remain employed by the CHP).\u003c/p>\n\u003cp>The day he was discharged from jail, Jeffrey disappeared back into homelessness, said his attorney, Beau Weiner. Months later, on Dec. 5, 2013, he stole a car from valet parking in downtown Sacramento and was peacefully apprehended.\u003c/p>\n\u003cp>Twice a week, his mother visited him in jail.\u003c/p>\n\u003cp>“I see you in here a lot,” she remembers a security officer telling her one day.\u003c/p>\n\u003cp>“I visit my son,” she said.\u003c/p>\n\u003cp>“He probably doesn’t deserve it,” the officer said.\u003c/p>\n\u003cp>Joanna Jurgens looked at him sadly. Why bother trying to explain?\u003c/p>\n\u003cp>“You don’t know the whole situation,” she said.\u003c/p>\n\u003cp>___\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">B\u003c/span>\u003c/p>\u003cp>ecause their mental illness leaves them so vulnerable, inmates in that condition are often kept in solitary confinement for their own protection. But extended stays in solitary exacerbate their mental illnesses, too.\u003c/p>\n\u003cp>“You put a bird in a cage, you got to let him out sometime, or he’ll die,” says Samuel Mays, whose adult son, Lorenzo, has been in Sacramento County Jail for eight years waiting to be declared competent. Lorenzo Mays, who has cognitive delays as well as mental illness, is the lead plaintiff in a class action complaint being brought by Disability Rights California against Sacramento County. The complaint cites overcrowding, understaffing and “dangerous, inhumane and degrading conditions,” including use of extended solitary confinement on inmates with serious mental illness.\u003c/p>\n\u003cp>“He’s suffering,” Samuel Mays said of his son. “You can only take so much of that.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://e.infogram.com/dc3a4f7c-1557-4c9e-a357-cd680f620e49?src=embed\" title=\"mental illness\" width=\"800\" height=\"800\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Douglas Clark, who landed in jail on an attempted burglary charge in 2009, picked up a new charge in prison after throwing feces at a correctional officer. Clark, who has schizophrenia and hears spirits talking to him, was found incompetent to stand trial, said his mother Tammy Clark. He was sent to regain competency at the state hospital. He returned to jail to be tried, she said, but went off his medication, or had it changed, and then became mentally unstable again. That cycle keeps repeating, she said.\u003c/p>\n\u003cp>She tries not to seem upset when she talks to him—she wants to be “a light” in his dark world.\u003c/p>\n\u003cp>But sometimes he can tell she’s been crying. “It’s so disheartening,” she said.\u003c/p>\n\u003cp>___\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">E\u003c/span>\u003c/p>\u003cp>ven as the population of inmates with mental illness burgeons, some advocates see the beginning signs of hope.\u003c/p>\n\u003cp>Sen. Beall, who himself has a family member with schizoaffective disorder, said the administrations of former governors Arnold Schwarzenegger and Jerry Brown rebuffed policy proposals meant to make comprehensive mental health services available in the community.\u003c/p>\n\u003cp>But last year, Brown signed a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1810\" target=\"_blank\" rel=\"noopener\">provision\u003c/a> to allow courts to divert certain offenders with mental illness into community-based inpatient or outpatient treatment programs, and \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB1187\" target=\"_blank\" rel=\"noopener\">another\u003c/a> to reduce the maximum wait time for an inmate to become competent to stand trial—from three years to two.\u003c/p>\n\u003cfigure id=\"attachment_11723760\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3.jpg\">\u003cimg class=\"wp-image-11723760\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3.jpg\" alt=\"\" width=\"1920\" height=\"1302\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3.jpg 4786w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3-160x109.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3-800x543.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3-1020x692.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3-1200x814.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-3-1920x1302.jpg 1920w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Joanna Jurgens reflects on her son Jeffrey, who has struggled with mental illness and is now living at Atascadero State Hospital after stealing a car. \u003ccite>(Randy Pench/CALmatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Last month, Gov. Gavin Newsom proposed a state budget that includes tens of millions of dollars for mental health programs, including training law enforcement officers on crisis de-escalation. The budget would also provide one-time grants to treat young people experiencing early psychosis and $100 million for “whole person care” programs that seek to address the housing, health, mental health and substance abuse needs of people experiencing homelessness.\u003c/p>\n\u003cp>Judge Stephen Manley started one of the nation’s first mental health courts in Santa Clara County more than 20 years ago. In these courts, public defenders, prosecutors, judges and social service providers work together to connect people with mental illness who have been arrested for certain crimes with services and treatment, with a goal of keeping them out of jail.\u003c/p>\n\u003cp>“Everyone wants to tell me, ‘It’s so complex, we can’t solve it.’” Manley said. “And I say, ‘No, you can. Get together and figure out what you can do.’”\u003c/p>\n\u003cp>Over the years, the model has expanded to counties around California.\u003c/p>\n\u003cp>On a recent afternoon in Department 8 in the downtown Sacramento courthouse, Judge Lawrence Brown called up the mental health court participants one by one. He complimented a woman’s red hat, another man’s poncho. He ribbed those who had a lot of hair, contrasting it with his own balding pate.\u003c/p>\n\u003cp>Standing alongside their public defenders, some participants beamed as he lauded their progress staying on medications and off drugs, getting jobs and doing their dishes. Others squirmed uncomfortably in the spotlight. One woman’s voice cracked as she described her troubled relationship with her mother.\u003c/p>\n\u003cp>“The fact that you’re taking all of these steps to take care of yourself, we’re behind you 1,000 percent,” the judge told her.\u003c/p>\n\u003cp>Brown, who has run the county’s mental health court since 2013 and has helped it to expand, says he’s been drawn to the work because of the “humanity of it all.”\u003c/p>\n\u003cp>“Keeping them in jail once they’re back on their medication is not a very compassionate approach,” he said. “They’re living a nightmare being behind bars. That setting of being in a cell, with loud noises, is not an opportune manner in which to address serious mental illness.”\u003c/p>\n\u003cp>For now, though, such courts still only serve a fraction of the ballooning need. Sex offenders, arson registrants, active gang members, those who have caused great bodily injury or death, and those arrested for driving under the influence are among those who are typically excluded. And many such courts aren’t designed to serve those who are incompetent to stand trial.\u003c/p>\n\u003cp>___\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">J\u003c/span>\u003c/p>\u003cp>effrey Jurgens doesn’t remember much about the months he waited in jail to get a bed at Atascadero State Hospital—one of the five state hospitals that house people with serious mental illness. Reached over the phone there, Jurgens, now 27, said at first only that being in jail “doesn’t feel too good.”\u003c/p>\n\u003cfigure id=\"attachment_11723763\" class=\"wp-caption alignright\" style=\"max-width: 1242px\">\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-4.png\">\u003cimg class=\"size-full wp-image-11723763\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/02/Mental-health-part-1-Photo-4.png\" alt=\"\" width=\"1242\" height=\"2208\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-4.png 1242w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-4-160x284.png 160w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-4-800x1422.png 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-4-1020x1813.png 1020w, https://ww2.kqed.org/app/uploads/sites/10/2019/02/Mental-health-part-1-Photo-4-675x1200.png 675w\" sizes=\"(max-width: 1242px) 100vw, 1242px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jeffrey Jurgens at Atascadero State Hospital couple of years ago, surrounded by his parents.\u003c/figcaption>\u003c/figure>\n\u003cp>After his mother prompted him, he recalled being periodically locked in solitary confinement at the Sacramento County Jail after he was arrested in December 2013, alone with the voices, emerging—in her memory—for just an hour every couple of days.\u003c/p>\n\u003cp>“It was a bummer,” he said quietly. “I was going a little stir crazy. I didn’t know what to do, what to think. Nobody would help me while I was there. They just pushed me off because I wasn’t like everyone else.”\u003c/p>\n\u003cp>His mother figures it’s good he doesn’t remember more. Because she does.\u003c/p>\n\u003cp>She remembers the day he called her, panicked, after his heavyset new cellmate kept trying to give him bear hugs. She remembers him whispering into the phone: “I’m really scared.” With Lazark’s help, she got him moved.\u003c/p>\n\u003cp>Joanna also remembers the night Jeffrey called her, agitated and delusional. She was so terrified of what he might do to himself or someone else that she raced to the jail and refused to leave until she spoke to a sergeant.\u003c/p>\n\u003cp>After Jeffrey was arrested for stealing the car from the valet, weeks passed before he appeared before the judge, screaming that he was Jesus. In February 2014, he was admitted to a state hospital.\u003c/p>\n\u003cp>At the end of August, after six months of receiving treatment and preparing for a court appearance, he was found competent enough to have a trial. Months later, in May 2015, he was found not guilty by reason of insanity. He returned to Atascadero State Hospital that June. Someday he hopes he’ll be well enough to get out, so he can spend time with his family and get a job at a grocery store.\u003c/p>\n\u003cp>Joanna wishes her son had received intensive treatment earlier.\u003cbr>\nIt troubles her to think about all the other inmates like him, stuck behind bars with no one to speak up for them.\u003c/p>\n\u003cp>“You’ve got to fight,” she said. “If somebody doesn’t have someone to advocate for them, they don’t stand a chance. They don’t stand a chance.”\u003c/p>\n\u003cp>\u003cem>This is the first of a series exploring the challenges Californians face in the pursuit of mental health care.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Jocelyn Wiener is a contributing writer to CALmatters. This story was supported by a grant from the California Health Care Foundation.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
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},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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"amazon": "https://music.amazon.com/podcasts/26099305-72af-4542-9dde-ac1807fe36d5/kqed-s-the-california-report",
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}
},
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"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
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"id": "city-arts",
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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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"order": 1
},
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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},
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"id": "freakonomics-radio",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
"fresh-air": {
"id": "fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"here-and-now": {
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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},
"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
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"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/onourwatch",
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"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"rss": "https://feeds.npr.org/510360/podcast.xml"
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},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"info": "One of public radio's most dynamic voices, Sam Sanders helped launch The NPR Politics Podcast and hosted NPR's hit show It's Been A Minute. Now, the award-winning host returns with something brand new, The Sam Sanders Show. Every week, Sam Sanders and friends dig into the culture that shapes our lives: what's driving the biggest trends, how artists really think, and even the memes you can't stop scrolling past. Sam is beloved for his way of unpacking the world and bringing you up close to fresh currents and engaging conversations. The Sam Sanders Show is smart, funny and always a good time.",
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