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"bio": "Julie Small reports on criminal justice and immigration.\r\n\r\nShe was part of a team at KQED awarded a regional 2019 Edward R. Murrow award for continuing coverage of the Trump Administration's family separation policy.\r\n\r\nThe Society for Professional Journalists recognized Julie's 2018 \u003ca href=\"https://www.kqed.org/news/11636262/the-officer-tased-him-31-times-the-sheriff-called-his-death-an-accident\">reporting\u003c/a> on the San Joaquin County Sheriff's \u003ca href=\"https://www.kqed.org/news/11634689/autopsy-doctors-sheriff-overrode-death-findings-to-protect-law-enforcement\">interference\u003c/a> in death investigations with an Excellence in Journalism Award for Ongoing Coverage.\r\n\r\nJulie's\u003ca href=\"https://www.kqed.org/news/11039666/two-mentally-ill-inmates-died-one-month-in-santa-clara\"> reporting\u003c/a> with Lisa Pickoff-White on the treatment of mentally ill offenders in California jails earned a 2017 regional Edward R. Murrow Award for news reporting and an investigative reporting award from the SPJ of Northern California.\r\n\r\nBefore joining KQED, Julie covered government and politics in Sacramento for Southern California Public Radio (SCPR). Her 2010 \u003ca href=\"https://www.scpr.org/specials/prisonmedical/\">series\u003c/a> on lapses in California’s prison medical care also won a regional Edward R. Murrow Award for investigative reporting and a Golden Mic Award from the RTNDA of Southern California.\r\n\r\nJulie began her career in journalism in 2000 as the deputy foreign editor for public radio's \u003cem>Marketplace, \u003c/em>while earning her master's degree in journalism from USC’s Annenberg School of Communication.",
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"title": "Mental Health 'Catastrophe': Few Options for Residents as Care Homes Close",
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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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"excerpt": "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.",
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"title": "Mental Health 'Catastrophe': Few Options for Residents as Care Homes Close | KQED",
"description": "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.",
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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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"excerpt": "What can you do when you fear someone you know may be considering suicide? It can feel daunting, but suicide prevention experts say we all can help someone at risk by reaching out and showing we care.",
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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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"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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"slug": "uc-berkeleys-insurance-plan-change-will-limit-mental-health-care-for-students-therapists-say",
"title": "UC Berkeley's Insurance Plan Change Will Limit Mental Health Care for Students, Therapists Say",
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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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"title": "UC Berkeley's Insurance Plan Change Will Limit Mental Health Care for Students, Therapists Say | KQED",
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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": "\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": "\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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"headline": "All Too Often, California’s Default Mental Institutions Are Now Jails and Prisons",
"datePublished": "2019-02-07T07:00:10-08:00",
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"slug": "all-too-often-californias-default-mental-institutions-are-now-jails-and-prisons",
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"sourceUrl": "https://calmatters.org/articles/california-mental-health-treatment-in-prisons/",
"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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"content": "\u003cdiv class=\"post-body\">\u003cp>\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\u003c/div>\u003c/p>",
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"content": "\u003cp>Gov. Gavin Newsom has proposed bold steps to ensure more Californians have health coverage, but a new report underscores that his success may depend in part on large‐scale investments to expand the state’s health care workforce.\u003c/p>\n\u003cp>A coalition of health, labor and education leaders, in a \u003ca href=\"https://futurehealthworkforce.org/wp-content/uploads/2019/02/MeetingDemandForHealthFinalReportCFHWC.pdf\" rel=\"noopener\" target=\"_blank\">report\u003c/a> released Monday, cited a dearth of health care workers in many regions of the state and recommended spending up to $3 billion over 10 years to address the shortfall. It’s not clear where that money would come from, though the report cited several possible sources.\u003c/p>\n\u003cp>The proposals of the group, the \u003ca href=\"https://futurehealthworkforce.org/\" rel=\"noopener\" target=\"_blank\">California Future Health Workforce Commission\u003c/a>, include: creating more primary care and psychiatric residency slots; increasing the use of nurse practitioners; boosting scholarships for low‐income students who agree to work in underserved areas; and expanding the supply — and training — of home care workers.\u003c/p>\n\u003cp>The \u003ca href=\"https://futurehealthworkforce.org/about/commissioner-page-1/\" rel=\"noopener\" target=\"_blank\">commission\u003c/a> also recommended building a more culturally and linguistically diverse pool of health care professionals to better match California’s demographics.\u003c/p>\n\u003cp>To meet the needs of an aging population, the commission recommended training home care workers and putting them on a more defined career path. In addition, the report focuses on shortages in mental health care, with proposals to create a new training program for psychiatric nurse practitioners and expand the use of mental health peer counselors.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“As we strive to get everyone covered … we need to have the providers there to actually provide the care,” said California Assemblyman Jim Wood, a commission member and chairman of the state Assembly Health Committee. “We need to realize that this is a growing state and our workforce is not growing proportionally.”\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/news/11721672/newsoms-tactic-not-yet-health-care-for-all-but-health-care-for-more\" rel=\"noopener\" target=\"_blank\">Newsom’s Tactic: Not Yet Health Care for All, But Health Care for More\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/news/11721672/newsoms-tactic-not-yet-health-care-for-all-but-health-care-for-more\" rel=\"noopener\" target=\"_blank\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/wp-content/uploads/sites/10/2019/01/Newsom-1020x640.jpg\" alt=\"\">\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>Health care providers simply aren’t working in the areas of greatest need, resulting in a two‐tier system for the haves and have‐nots, he said.\u003c/p>\n\u003cp>An estimated 7 million Californians live in shortage areas, and the problem is expected to worsen as older physicians retire, baby boomers age and more people live with chronic diseases. About 45 percent of psychiatrists and 37 percent of psychologists in the state are over 60 years old, according to research from UCSF.\u003c/p>\n\u003cp>Among the areas experiencing shortages are the San Joaquin Valley and the Inland Empire, as well as the state’s rural northern and Sierra regions, according to the commission.\u003c/p>\n\u003cp>The \u003ca href=\"https://futurehealthworkforce.org/wp-content/uploads/2019/02/ExecutiveSummaryFinalReportCFHWC.pdf\" rel=\"noopener\" target=\"_blank\">report\u003c/a> comes less than a month after Newsom unveiled his ambitious health care agenda.\u003c/p>\n\u003cp>On his first day in office, the Democratic governor proposed extending Medicaid coverage to undocumented young adult immigrants, requiring all Californians to have health insurance, and supplementing federal health insurance subsidies with state money to help them pay for it. He also asked President Donald Trump and congressional leaders to amend federal law to allow California to move toward a single‐payer health care system.\u003c/p>\n\u003cp>Wood said such policies would not be effective without enough providers in the places where they are needed. “Coverage isn’t care, and we can’t just say ‘Everybody’s got coverage’ and walk away,” he said. “If you don’t have access to physicians or dentists or mental health providers in your area, that is an empty promise.”\u003c/p>\n\u003cp>The commission was established in August 2017 by several health philanthropies hoping to forge a strategy to build the workforce needed by 2030. It consisted of two dozen representatives from hospitals, schools, businesses and labor, and was chaired by University of California President Janet Napolitano and Dignity Health president and CEO Lloyd Dean.\u003c/p>\n\u003cp>Some of the commission’s proposals would face challenges — especially financial ones. Creating more residencies for primary care physicians and psychiatrists, for example, would cost an estimated $1.56 billion over a decade. And the state’s physicians are likely to oppose giving nurse practitioners more authority.\u003c/p>\n\u003cp>C. Dean Germano, CEO of Shasta Community Health Center in Redding, Calif., said his community has significant mental health needs and that health centers are often the first place many people go for treatment of depression or anxiety.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/news/11710961/she-strived-to-be-the-perfect-mom-and-landed-in-the-psych-ward\" rel=\"noopener\" target=\"_blank\">She Strived to Be the Perfect Mom and Landed in the Psych Ward\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/news/11710961/she-strived-to-be-the-perfect-mom-and-landed-in-the-psych-ward\" rel=\"noopener\" target=\"_blank\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/Lucy-0008-e1544224630222.jpg\" alt=\"\">\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>“We are sort of handicapped by not having the workforce on the primary care side or on the mental health side,” he said, adding that training students to work in underserved communities is the “golden ticket.”\u003c/p>\n\u003cp>In Los Angeles County, L.A. Care Health Plan is already working to expand the primary care workforce by offering full scholarships to certain medical school students and loan repayment for physicians recruited to practice in underserved areas.\u003c/p>\n\u003cp>Investing in more health care professionals — especially primary care providers — can help reduce the overall cost of health care, said Dr. David Carlisle, president and CEO of Charles R. Drew University of Medicine and Science in Los Angeles who served on the commission. The state is expected to need an estimated 4,100 more primary care clinicians in 2030.\u003c/p>\n\u003cp>“We shouldn’t be intimidated by the $3 billion price tag because, in many ways, we are paying for this already,” Carlisle said. “This is part of the reason why our health care system is so expensive — because patients have to delay care until they are really sick.”\u003c/p>\n\u003cp>Wood said the estimated cost of the commission’s proposals is a small fraction of the state’s $201 billion annual budget. The report cited other possible funding sources, including philanthropic grants, education dollars, health plan contributions and federal dollars.\u003c/p>\n\u003cp>Newsom has “established a vision for how to pursue a pro‐health agenda” in California, Carlisle said. “This report provides him with a road map.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>(Four organizations funded the project of the California Future Health Workforce Commission: the California Endowment, California Health Care Foundation, the California Wellness Foundation and Blue Shield of California Foundation. Kaiser Health News, which produces California Healthline, has received support from each of these organizations.)\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Gov. Gavin Newsom has proposed bold steps to ensure more Californians have health coverage, but a new report underscores that his success may depend in part on large‐scale investments to expand the state’s health care workforce.\u003c/p>\n\u003cp>A coalition of health, labor and education leaders, in a \u003ca href=\"https://futurehealthworkforce.org/wp-content/uploads/2019/02/MeetingDemandForHealthFinalReportCFHWC.pdf\" rel=\"noopener\" target=\"_blank\">report\u003c/a> released Monday, cited a dearth of health care workers in many regions of the state and recommended spending up to $3 billion over 10 years to address the shortfall. It’s not clear where that money would come from, though the report cited several possible sources.\u003c/p>\n\u003cp>The proposals of the group, the \u003ca href=\"https://futurehealthworkforce.org/\" rel=\"noopener\" target=\"_blank\">California Future Health Workforce Commission\u003c/a>, include: creating more primary care and psychiatric residency slots; increasing the use of nurse practitioners; boosting scholarships for low‐income students who agree to work in underserved areas; and expanding the supply — and training — of home care workers.\u003c/p>\n\u003cp>The \u003ca href=\"https://futurehealthworkforce.org/about/commissioner-page-1/\" rel=\"noopener\" target=\"_blank\">commission\u003c/a> also recommended building a more culturally and linguistically diverse pool of health care professionals to better match California’s demographics.\u003c/p>\n\u003cp>To meet the needs of an aging population, the commission recommended training home care workers and putting them on a more defined career path. In addition, the report focuses on shortages in mental health care, with proposals to create a new training program for psychiatric nurse practitioners and expand the use of mental health peer counselors.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“As we strive to get everyone covered … we need to have the providers there to actually provide the care,” said California Assemblyman Jim Wood, a commission member and chairman of the state Assembly Health Committee. “We need to realize that this is a growing state and our workforce is not growing proportionally.”\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/news/11721672/newsoms-tactic-not-yet-health-care-for-all-but-health-care-for-more\" rel=\"noopener\" target=\"_blank\">Newsom’s Tactic: Not Yet Health Care for All, But Health Care for More\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/news/11721672/newsoms-tactic-not-yet-health-care-for-all-but-health-care-for-more\" rel=\"noopener\" target=\"_blank\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/wp-content/uploads/sites/10/2019/01/Newsom-1020x640.jpg\" alt=\"\">\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>Health care providers simply aren’t working in the areas of greatest need, resulting in a two‐tier system for the haves and have‐nots, he said.\u003c/p>\n\u003cp>An estimated 7 million Californians live in shortage areas, and the problem is expected to worsen as older physicians retire, baby boomers age and more people live with chronic diseases. About 45 percent of psychiatrists and 37 percent of psychologists in the state are over 60 years old, according to research from UCSF.\u003c/p>\n\u003cp>Among the areas experiencing shortages are the San Joaquin Valley and the Inland Empire, as well as the state’s rural northern and Sierra regions, according to the commission.\u003c/p>\n\u003cp>The \u003ca href=\"https://futurehealthworkforce.org/wp-content/uploads/2019/02/ExecutiveSummaryFinalReportCFHWC.pdf\" rel=\"noopener\" target=\"_blank\">report\u003c/a> comes less than a month after Newsom unveiled his ambitious health care agenda.\u003c/p>\n\u003cp>On his first day in office, the Democratic governor proposed extending Medicaid coverage to undocumented young adult immigrants, requiring all Californians to have health insurance, and supplementing federal health insurance subsidies with state money to help them pay for it. He also asked President Donald Trump and congressional leaders to amend federal law to allow California to move toward a single‐payer health care system.\u003c/p>\n\u003cp>Wood said such policies would not be effective without enough providers in the places where they are needed. “Coverage isn’t care, and we can’t just say ‘Everybody’s got coverage’ and walk away,” he said. “If you don’t have access to physicians or dentists or mental health providers in your area, that is an empty promise.”\u003c/p>\n\u003cp>The commission was established in August 2017 by several health philanthropies hoping to forge a strategy to build the workforce needed by 2030. It consisted of two dozen representatives from hospitals, schools, businesses and labor, and was chaired by University of California President Janet Napolitano and Dignity Health president and CEO Lloyd Dean.\u003c/p>\n\u003cp>Some of the commission’s proposals would face challenges — especially financial ones. Creating more residencies for primary care physicians and psychiatrists, for example, would cost an estimated $1.56 billion over a decade. And the state’s physicians are likely to oppose giving nurse practitioners more authority.\u003c/p>\n\u003cp>C. Dean Germano, CEO of Shasta Community Health Center in Redding, Calif., said his community has significant mental health needs and that health centers are often the first place many people go for treatment of depression or anxiety.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/news/11710961/she-strived-to-be-the-perfect-mom-and-landed-in-the-psych-ward\" rel=\"noopener\" target=\"_blank\">She Strived to Be the Perfect Mom and Landed in the Psych Ward\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/news/11710961/she-strived-to-be-the-perfect-mom-and-landed-in-the-psych-ward\" rel=\"noopener\" target=\"_blank\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/Lucy-0008-e1544224630222.jpg\" alt=\"\">\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>“We are sort of handicapped by not having the workforce on the primary care side or on the mental health side,” he said, adding that training students to work in underserved communities is the “golden ticket.”\u003c/p>\n\u003cp>In Los Angeles County, L.A. Care Health Plan is already working to expand the primary care workforce by offering full scholarships to certain medical school students and loan repayment for physicians recruited to practice in underserved areas.\u003c/p>\n\u003cp>Investing in more health care professionals — especially primary care providers — can help reduce the overall cost of health care, said Dr. David Carlisle, president and CEO of Charles R. Drew University of Medicine and Science in Los Angeles who served on the commission. The state is expected to need an estimated 4,100 more primary care clinicians in 2030.\u003c/p>\n\u003cp>“We shouldn’t be intimidated by the $3 billion price tag because, in many ways, we are paying for this already,” Carlisle said. “This is part of the reason why our health care system is so expensive — because patients have to delay care until they are really sick.”\u003c/p>\n\u003cp>Wood said the estimated cost of the commission’s proposals is a small fraction of the state’s $201 billion annual budget. The report cited other possible funding sources, including philanthropic grants, education dollars, health plan contributions and federal dollars.\u003c/p>\n\u003cp>Newsom has “established a vision for how to pursue a pro‐health agenda” in California, Carlisle said. “This report provides him with a road map.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>(Four organizations funded the project of the California Future Health Workforce Commission: the California Endowment, California Health Care Foundation, the California Wellness Foundation and Blue Shield of California Foundation. Kaiser Health News, which produces California Healthline, has received support from each of these organizations.)\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>Originally Published Dec 7, 2018\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://itunes.apple.com/us/podcast/the-california-report-magazine/id1314750545?mt=2\" target=\"_blank\" rel=\"noopener\">Listen to this and more in-depth storytelling by subscribing to The California Report Magazine podcast.\u003c/a>\u003c/em>\u003c/p>\n\u003cp>[dropcap]L[/dropcap]isa Abramson says that even after all she’s been through – the helicopters circling her house, the snipers on the roof, and the car ride to jail – she still wants to have a second child.\u003c/p>\n\u003cp>Because, in the beginning, when her daughter was born, Lisa was smitten, just like the mom she’d imagined she would be. She’d look into her baby’s round, alert eyes and feel the adrenaline rush through her. She had so much energy. She was so excited.\u003c/p>\n\u003cp>“I actually was thinking like, ‘I don’t get why other moms say they’re so tired or this is so hard. I got this,’” she says.\u003c/p>\n\u003cp>Lisa wanted to be the perfect mom. She was ready to be the perfect mom. She’d been a successful marketing executive for a Silicon Valley tech company and a successful entrepreneur. And that first week after her baby was born, everything was going according to plan. The world was nothing but love.\u003c/p>\n\u003cp>But even when Lisa did get tired, and she got time to sleep, she couldn’t.\u003c/p>\n\u003cp>Then, the baby started losing weight, and the pediatrician told Lisa to feed her every two hours.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘It weighed on me as ‘I failed as a mom. I can’t feed my child.’ I needed to feed her, that was the most important thing, and my well-being didn’t matter.’\u003ccite>Lisa Abramson, new mother\u003c/cite>\u003c/aside>\n\u003cp>“That meant breastfeed and then pump, and then feed her the pumped milk and then clean the pumping parts, which is always something no one thinks about but takes about 20 minutes,” she says. “Basically, through that every two-hour feeding cycle, I had 10 minutes of downtime.”\u003c/p>\n\u003cp>Lisa started to feel like she couldn’t keep up. She felt overwhelmed and guilty. Really guilty.\u003c/p>\n\u003cp>“It weighed on me as ‘I failed as a mom. I can’t feed my child,’” she says. “I needed to feed her, that was the most important thing, and my well-being didn’t matter.”\u003c/p>\n\u003cp>She was barely sleeping. Even when she could get a release from breastfeeding purgatory, she couldn’t relax. As she got more and more exhausted, she started to get…confused.\u003c/p>\n\u003cp>“I was having a conversation with someone, their voices were just distorted and it was really hard for me to understand what they were saying.”\u003c/p>\n\u003cp>She tried going to a spin class, something she loved and had done up until the baby was born.\u003c/p>\n\u003cp>But 10 minutes in, she was out of there.\u003c/p>\n\u003cp>“That was not a good idea, because the noises and intense volume of the spin class was really alarming to me. It felt like the walls were talking to me,” she says. “I just said to my husband probably a hundred, 200 times that day, ‘Am I crazy? Am I crazy? Am I crazy?’”\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003c/h3>\n\u003c/aside>\n\u003cp>But then, about a month after the birth, her clarity came back.\u003c/p>\n\u003cp>It was like she woke up from a dream. It rained every day for the next week. The day the sun came out, she noticed police helicopters circling over their apartment. She heard them land on top of the building.\u003c/p>\n\u003cp>“There were snipers on the roof and there were spy cams in our bedroom and everyone was watching me and my cellphone was giving me weird messages,” she says.\u003c/p>\n\u003cp>Lisa waited for the police to come in and take her. But the next morning, she woke up in her own bed. The cops had arrested the nanny instead.\u003c/p>\n\u003cp>This was wrong, she thought, the nanny shouldn’t be punished for her crime. Lisa told her husband it wasn’t fair. She was going to put an end to all this. She was going to jump off the Golden Gate Bridge. And that’s when her husband told her he was going to drive her to the police station himself.\u003c/p>\n\u003cp>“It was like, ‘Oh, okay, he’s taking me in and I guess I’m getting arrested,’” Lisa says. “I remember my mom cooked me eggs and it was like, ‘You should eat these before you go.’ And I was like, ‘Oh, she’s giving me my final meal before I go to jail.’”\u003c/p>\n\u003cp>From her husband’s perspective, this was one of the worst days of his life.\u003c/p>\n\u003cp>“I’m bringing my wife to the hospital and then checking her into an inpatient unit. It was really, really challenging,” says David Abramson, relaying what really happened that day.\u003c/p>\n\u003ch2>Not Jail, the Psych Ward\u003c/h2>\n\u003cp>There was no crime, the nanny wasn’t arrested, and Lisa’s destination that day was not jail, but rather the general psychiatric ward of Sutter Health’s California Pacific Medical Center in San Francisco – though the hospital didn’t feel far off from where Lisa believed she was going.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘You have to wait for the door to be unlocked, the buzzer, and there’s security and it felt almost like bringing Lisa to jail, even though she didn’t do anything.’\u003ccite>David Abramson, Lisa’s husband\u003c/cite>\u003c/aside>\n\u003cp>“You have to wait for the door to be unlocked, the buzzer, and there’s security and it felt almost like bringing Lisa to jail, even though she didn’t do anything,” David recalls. “That was probably the most heart-wrenching thing, was having to leave her that night with the hospital staff. You could see in her eyes and her body language that she was panicked all of a sudden that we were leaving.”\u003c/p>\n\u003cp>The other patients were there for drug overdoses or alcohol withdrawal. People were screaming. One patient thought he was a dog, crawling around on all fours, barking. It didn’t seem like the right place for a new mom.\u003c/p>\n\u003cp>“Probably for the first five days I just didn’t speak to anyone,” Lisa says. “I don’t know if I couldn’t speak or I wasn’t speaking, but I was terrified enough of the environment that I decided I wasn’t going to answer anyone’s questions. I wasn’t going to talk to anyone.”\u003c/p>\n\u003cp>Lisa still thought this was all part of some conspiracy.\u003c/p>\n\u003cp>“I just thought I was there because I did something wrong,” she says. “Because I tried to get out to leave and I was locked in so you can’t leave. I was like, ‘Maybe I am in a jail, but it looks like a hospital? They’re saying it’s a hospital, but it’s really a jail?’”\u003c/p>\n\u003cp>Lisa doesn’t remember any doctors or nurses telling her why she was there or what was going on.\u003c/p>\n\u003cp>“They’re just like, ‘Take these medications,’ and they’re pissed at me because I wasn’t cooperating and going to any of the groups or talking to anyone,” she says. “No one told me what my diagnosis was, why I was there.”\u003c/p>\n\u003caside class=\"pullquote alignright\">‘I really was just like, “No. I’ve heard of postpartum depression. No, I have never heard that there’s postpartum crazy.” ‘ \u003ccite>Lisa Abramson\u003c/cite>\u003c/aside>\n\u003cp>It wasn’t until Lisa had been in the hospital more than a week that she remembers her husband telling her why she was there. He brought her a print out from the internet on postpartum psychosis.\u003c/p>\n\u003cp>“That was the first time where I was like, ‘He’s on my side. He made up this disease just to make me feel better. That was so sweet,’” she says.\u003c/p>\n\u003cp>The papers said it was elevated hormones from childbirth plus sleep deprivation that can trigger confusion and paranoia. Lisa figured it took her husband hours to photoshop all this.\u003c/p>\n\u003cp>“I really was just like, ‘No. I’ve heard of postpartum depression. No, I have never heard that there’s postpartum crazy.”\u003c/p>\n\u003ch2>New Data on Moms Who Die By Suicide\u003c/h2>\n\u003cp>Postpartum psychosis is real. It’s rare – it affects one or two women out of every thousand that give birth. But experts believe more women are affected than previously thought. And more of them are ending up dead, by suicide.\u003c/p>\n\u003cp>There are a handful of doctors and researchers trying to figure out why. States have never kept good data on this, so each suicide is like a mystery, and it takes a team of medical detectives to piece it together.\u003c/p>\n\u003cp>They start with death certificates and coroner reports, then work backward. They track down hospital records to figure out when the woman gave birth. Then they study medical charts for clues, signs of mental illness that the original doctors didn’t catch.\u003c/p>\n\u003cp>California researchers just finished their first big study like this. The state’s public health department hasn’t published it yet, but The California Report got a preview of some of the data: 99 new moms in the state died by suicide over a ten-year period.\u003c/p>\n\u003cp>The investigators determined that of those 99 suicides, 98 were preventable.\u003c/p>\n\u003cp>Nearly every single woman might not have died if the health care system in California had done a better job taking care of them: if women had been screened better, diagnosed better, treated better.\u003c/p>\n\u003cp>“The work that we do here is less than 10 percent of what needs to be done,” says Nirmaljit Dhami, a psychiatrist at El Camino Hospital in Mountain View. She’s one of the doctor-detectives who reviewed the suicides, but she did not talk about the report or share data from it.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/stateofhealth/185843/just-like-patients-therapists-also-battle-insurance-red-tape\">Frustrated You Can’t Find a Therapist? They’re Frustrated, Too\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/stateofhealth/185843/just-like-patients-therapists-also-battle-insurance-red-tape\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/Final.Insurance-e1464020830149-800x449.jpg\" alt=\"\" />\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>She is an expert in postpartum mental illness and often treats women in crisis, cleaning up what OB/GYNs miss. Based on her clinical experience and observations, she says a lot of doctors don’t know the early signs of postpartum psychosis; they don’t know that the symptoms wax and wane.\u003c/p>\n\u003cp>“A lot of times the patient will present very clearly, then at other times, will present with acute confusion and disorganization,” she says.\u003c/p>\n\u003cp>Like Lisa Abramson, of sound mind in one moment, then believing the walls are talking to her in the next.\u003c/p>\n\u003cp>“This is a symptom that clinicians who are not trained in this field can easily miss,” Dhami says, “because when they see the patient in their office with the family, they can think that the patient is normal and is probably suffering from sleep deprivation and discharge them home,” she says.\u003c/p>\n\u003cp>This is how women die. In the U.S., mental health problems are one of the leading causes of death among new moms, according to a 2018 report from the Building U.S. Capacity to Review and Prevent Maternal Deaths initiative at the CDC. Mental health problems are number seven on the list, nearly tied with high blood pressure complications. For white women, mental health problems are the fourth leading cause of death.\u003c/p>\n\u003cp>Even when women do get into care, Dhami says, it’s often inadequate or inappropriate. Doctors prescribe the wrong medications. Insurance companies push patients out of psych units before they’re ready. And the staff at psych units are generally not trained in these illnesses, Dhami says, and they may not be equipped for even the physical needs of new moms.\u003c/p>\n\u003cfigure id=\"attachment_11711000\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11711000\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/Lucy-0038-800x532.jpg\" alt=\"\" width=\"800\" height=\"532\" />\u003cfigcaption class=\"wp-caption-text\">David Abramson researched postpartum psychosis on the internet when he suspected his wife Lisa was showing signs of it after having their first daughter, Lucy. \u003ccite>(Claire Mulkey)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Take Lisa Abramson’s inpatient experience. When Lisa first arrived at the psych ward, her husband told the resident who admitted her that he thought Lisa had postpartum psychosis. The resident said to him, “Postpartum, what?” He promised David he’d study up on it.\u003c/p>\n\u003cp>Then, several days into Lisa’s stay, she complained of pain in her breasts. She’d stopped breastfeeding the instant she left home, and it didn’t seem to occur to anyone that her breast would become engorged.\u003c/p>\n\u003cp>Her husband had to negotiate to bring in Lisa’s breast pump from home. She remembers being put in a room with padded walls that looked like a solitary confinement chamber from a horror movie.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘A lot of times, symptoms of postpartum depression and psychosis involve the mother feeling that she’s like a bad mom.’\u003ccite>Dr. Nirmaljit Dhami, a psychiatrist at El Camino Hospital in Mountain View\u003c/cite>\u003c/aside>\n\u003cp>“That was where they sent me to go pump, and under supervision from doctors because they were worried,” she says. “God knows what I would do with the breast pump. A breast pump is a torture device already.”\u003c/p>\n\u003cp>But the worst thing of all, was not being allowed to see her baby. The inpatient unit has a strict policy: no infants or children on the ward. The hospital says this is intended as a safety measure, for everybody. Her family argued with the staff.\u003c/p>\n\u003cp>“They said, ‘She’s a new mom and she needs to see her baby. That’s keeping this bond going, it’s really, it’s important,” Lisa recalls, tearing up. “That was the hard part, was not getting to see her.”\u003c/p>\n\u003cp>About five days into her time there, Lisa’s family was able to negotiate short one-hour visits with her daughter, supervised by a person who kept looking at his watch.\u003c/p>\n\u003cp>Lisa’s family was so unhappy with her care at the hospital that her husband practically broke her out of there. They found Dr. Dhami and asked her to take over Lisa’s treatment. She enrolled in a comprehensive outpatient program Dhami runs at El Camino Hospital, called the Maternal Outreach Mood Services (MOMS) program, where Lisa could bring her baby along.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/stateofhealth/362850/to-screen-or-not-to-screen-doctors-debate-post-partum-depression-testing\">To Screen or Not to Screen? Doctors Debate Post Partum Depression Testing\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/stateofhealth/362850/to-screen-or-not-to-screen-doctors-debate-post-partum-depression-testing\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/wp-content/uploads/sites/27/2018/03/Wendy-Root-Askew-1180x885.jpg\" alt=\"\" />\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>Dr. Dhami says separating a mother from her newborn actually makes it harder for the mom to recover.\u003c/p>\n\u003cp>“A lot of times, symptoms of postpartum depression and psychosis involve the mother feeling that she’s like a bad mom,” she says. “It is a difficult situation for the mother to be in when she has so many negative thoughts and ruminations about herself and her ability to be a good mom.”\u003c/p>\n\u003cp>Under Dr. Dhami’s care, Lisa started to reclaim her grip on reality, but she didn’t know how long it would be before she’d start to feel better. She wondered if she’d ever feel like herself again.\u003c/p>\n\u003cp>California Pacific Medical Center declined to comment on Lisa’s case specifically, even though Lisa authorized the hospital to discuss her medical records. The inpatient psychiatric medical director, Dr. Stephanie Wilson, says breast pumps are now available to women who need them, and providers review new moms’ wishes to see their babies on a case-by-case basis.\u003c/p>\n\u003cp>“We take into full consideration all of the circumstances and the details of that patient, of the infant, and really seeing what, if any, benefit, or even potential harm, it could have to the mother,” Wilson says. “Once the symptoms of depression and psychosis start to get better, that’s when I would start to allow more visitations.”\u003c/p>\n\u003ch2>A Different Kind of Care for Moms\u003c/h2>\n\u003cp>There’s plenty of research dating back to the 1940’s on the ideal protocols for inpatient treatment of postpartum mental illnesses. The gold standard is to admit the mother and the baby into the hospital together, on a specialized mother-baby unit.\u003c/p>\n\u003cp>They’re treated as a pair. Part of the mom’s therapy is getting guidance on how to read the baby’s cues, and how to meet the baby’s needs as well as her own. At night, the baby sleeps in a supervised nursery, so mom can get uninterrupted sleep. In the United Kingdom, there are 21 of these mother-baby units. In France, there are 15. They’re in Belgium, New Zealand. There’s one in India.\u003c/p>\n\u003cp>In the U.S., there are zero.\u003c/p>\n\u003cp>The closest thing there is to a mother-baby unit in the U.S. is 3,000 miles from where Lisa lives – the hospital at the University of North Carolina in Chapel Hill.\u003c/p>\n\u003cp>The perinatal psychiatric unit here is reserved exclusively for pregnant women and new moms. They accept all kinds of commercial insurance and Medicaid, so any woman, wealthy or low-income can get treated here.\u003c/p>\n\u003cfigure id=\"attachment_11710976\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11710976\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/IMG_3438-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\" />\u003cfigcaption class=\"wp-caption-text\">Nurse Anna Soloway reads from the “Dear Mom” book at the perinatal psychiatry unit at UNC-Chapel Hill. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When women first arrive, nurses show them the “Dear Mom” book, where women who are close to being discharged write notes to the women just being admitted:\u003c/p>\n\u003cp>“Dear moms or mom to be: This place has saved my life and it will save yours…\u003c/p>\n\u003cp>Dear mom: You may think you’re the only “crazy” girl in the world like this, but I promise you, you’re not alone…\u003c/p>\n\u003cp>Dear mammas, you are strong, you are beyond brave and strong for coming here, and your family deserves you…\u003c/p>\n\u003cp>Dear mom: You are a wonderful mother…”\u003c/p>\n\u003cp>“There is a need for them to see other moms going through what they’re going through,” says psychiatrist Mary Kimmel, who runs the unit. She wears a denim jacket and black suede ankle boots, and whenever a patient asks if she’s a mom, too, she says yes, she had two kids.\u003c/p>\n\u003cp>She says everything here is tailored to the specific needs of new moms. Every room has a hospital-grade breast pump, there’s a lactation consultant who helps women with breastfeeding, and there’s a designated refrigerator for moms to store pumped milk.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/futureofyou/2703/womens-health-is-too-often-overlooked-will-digital-health-be-the-exception\">Women’s Health is Too Often Overlooked; Will Digital Health be the Exception?\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/futureofyou/2703/womens-health-is-too-often-overlooked-will-digital-health-be-the-exception\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/wp-content/uploads/sites/27/2016/11/sad-child-770.jpg\" alt=\"\" />\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>The most distinctive feature about the program is the visitor policy. Most afternoons, the unit is bustling with husbands and kids.\u003c/p>\n\u003cp>“Babies can come to the unit and we really encourage that,” Kimmel says. “We encourage older kids to also come to the unit.”\u003c/p>\n\u003cp>Toddlers scurry around the day room during visiting hours, coloring, playing with toys, playing with each other. Women cradle their newborns, rocking them, feeding them.\u003c/p>\n\u003cp>The babies are not allowed to stay overnight though. There’s no nursery here like the units in Europe.\u003c/p>\n\u003cp>The main reason for that is the insurance companies.\u003c/p>\n\u003cp>Kimmel says no insurer in the U.S. would ever pay for a healthy baby to be admitted to the hospital.\u003c/p>\n\u003cp>“That baby doesn’t have a distinct need to be admitted and so it’s not possible to bill for that baby being at the hospital,” she says. And without that, the hospital can’t afford to run a nursery.\u003c/p>\n\u003cfigure id=\"attachment_11710977\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11710977\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/IMG_3469-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\" />\u003cfigcaption class=\"wp-caption-text\">Psychiatrist Mary Kimmel runs the mom’s psychiatry unit at UNC-Chapel Hill. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The unit is small — it has five beds — and women spend most of their time in the day room, a hospital lounge with a table and couch and a TV that’s usually tuned in to a home makeover show. The staff do what they can to make it feel homey here, less like a hospital, but there’s still a wall of glass around the nurses’ station, and patients have to knock on the window when they come to ask for something.\u003c/p>\n\u003cp>The days are very structured, with a range of treatments, all tailored specifically to pregnant women and new moms. There’s one-on-one therapy and lots of group classes: parenting and time management lessons, where women practice asking their partner for help. And a favorite among the moms: relaxation class.\u003c/p>\n\u003cp>“Get yourself as comfortable as you can, let your body relax,” murmurs recreational therapist Amber Koo over slow meditation music.\u003c/p>\n\u003cp>She puts on a special light machine that projects little stars onto the ceiling. That gives women a place to focus their mind, away from the negative thoughts coursing through their heads.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/mindshift/32835/got-a-minute-try-meditating\">Got a Minute? Try Meditating!\u003c/a>\u003c/h3>\n\u003c/aside>\n\u003cp>“Allow your breath to start going in your nose slowly,” Koo says.\u003c/p>\n\u003cp>For Alice Sarti, the moms unit at UNC was the first place that gave her hope as a new mom. After she had her son, she became engulfed by mania. She had dealt with depression many times before, but never this.\u003c/p>\n\u003cp>“Every minute I had to fill with a task: researching daycares, doing and re-doing my budget,” she says. “I’m not going to line up three bottles, I’m going to line up 17 bottles.”\u003c/p>\n\u003cp>She became an exaggerated version of herself. Super mom. She’s a business analyst and loves getting things done. She loved how productive she was. But then things started to spiral.\u003c/p>\n\u003cp>“There was a definite snap,” she says. “I started yelling about things that didn’t make sense. They made sense to me.”\u003c/p>\n\u003cp>It’s like the television show Homeland, when bipolar CIA agent Carrie Mathison sets up a situation room. She covers the walls with news articles and photos of the terrorists she’s chasing. She criss-crosses yellow string in all directions to illustrate the connections she sees.\u003c/p>\n\u003cp>It was like that in Alice’s mind.\u003c/p>\n\u003cp>“There was a logical chain there in my head, but externally those links were so far apart,” she says.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘I did have a social worker tell me I was going to lose my child if I didn’t ‘pull it together,’\u003ccite>Alice Sarti, new mother\u003c/cite>\u003c/aside>\n\u003cp>To her family, it was just an incoherent rage. They called the police and they took Alice to the nearest hospital that had an available bed, in this case, not the mom’s unit at UNC, but rather a general psych ward.\u003c/p>\n\u003cp>“You saw people that couldn’t speak, that could barely walk. People that were discharged in that condition,” she says.\u003c/p>\n\u003cp>Alice didn’t want to be drugged like that. She refused to take any meds, and that made her unpopular with the staff.\u003c/p>\n\u003cp>“I did have a social worker tell me I was going to lose my child if I didn’t ‘pull it together,’” she says.\u003c/p>\n\u003cp>During her three-week stay, she saw her son once, for 20 minutes.\u003c/p>\n\u003cp>“I was not able to touch him on any level. He was in his car seat and I reached for him and I was yelled at,” she says.\u003c/p>\n\u003cp>It’s hard for her to admit what it was like coming back to him, after she was discharged.\u003c/p>\n\u003cp>“It felt like a burden,” she says. “It felt like, ‘How am I ever going to do this?’ I held him, I bathed him, and I did all the things, but the connection was not there. I lost time with my son and I’m never going to get it back.”\u003c/p>\n\u003cp>Alice was not feeling better when she was sent home from that hospital. She ended up in another hospital, and discharged again, her mania still boiling. She eventually ended up at the mom’s psych unit at UNC Chapel Hill.\u003c/p>\n\u003cp>Finally, everyone seemed to understand what she was going through, the pressure she was feeling, the guilt. She saw her son regularly, and staff helped her start to re-establish her bond with him.\u003c/p>\n\u003cp>“It was this incredibly nurturing environment,” she says. “It changed the trajectory of my life and my son’s life.”\u003c/p>\n\u003cfigure id=\"attachment_11710979\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11710979\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/us_0918-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\" />\u003cfigcaption class=\"wp-caption-text\">Alice Sarti got help at the mom’s unit reconnecting with her son, and recovering from postpartum mental illness. \u003ccite>(Courtesy of Alice Sarti)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But even at this seemingly perfect place, things go wrong. When Alice was discharged, her mania cleared. But then she slipped into the deepest, darkest depression she had ever known. She checked herself into UNC again, afraid she was going to kill herself.\u003c/p>\n\u003cp>With Alice, and other patients, doctors are under so much pressure to get moms home quickly, sometimes they overshoot on the medications, says Dr. Mary Kimmel, who runs the unit. Some of that pressure comes from the moms themselves, who want to be with their kids, but it also comes from the insurance companies.\u003c/p>\n\u003cp>UNC’s mom’s unit pays the bills like other hospitals – they take insurance to cover the costs of care.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/futureofyou/442703/u-s-suicide-rates-are-rising-faster-among-women-than-men\">U.S. Suicide Rates Are Rising Faster Among Women Than Men\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/futureofyou/442703/u-s-suicide-rates-are-rising-faster-among-women-than-men\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/06/gender-depression-1-c396c6b070b1002bd68febe0f9805c93a75ea72a-1-1180x885.jpg\" alt=\"\" />\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>But the longer a patient stays, the more an insurer has to pay, and that’s not good for their bottom line. Kimmel and other doctors say as soon as a patient comes off suicide watch, insurers start calling, asking when she can go home.\u003c/p>\n\u003cp>“Our average length of stay runs from about one week to two weeks,” Kimmel says.\u003c/p>\n\u003cp>In Europe?\u003c/p>\n\u003cp>“About 40 to 50 days is the average length of stay there,” she says.\u003c/p>\n\u003cp>That means doctors in the U.S. start patients on new drugs, but don’t have time to see if they work. Or, they have to start women on the most intense medications that force her to stop breastfeeding, instead of slower therapies that could extend the mother’s time to feed her infant breast milk.\u003c/p>\n\u003cp>It also means that patients like Alice can end up hospitalized four times before they get better.\u003c/p>\n\u003cp>Insurers insist the decision to discharge is not just about cost, but about what’s best for patients.\u003c/p>\n\u003cp>“We want to make sure that they’re getting the care that they need in the most appropriate setting,” says Kate Berry, senior vice president of Clinical Innovation for America’s Health Insurance Plans, a trade group for insurers.\u003c/p>\n\u003cp>Hospitals are not necessarily the ideal environment, she says, especially for making sure medications are stabilized.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/news/11632413/the-plan-to-get-women-vets-to-use-more-health-services\">The Plan to Get Women Vets to Use More Health Services\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/news/11632413/the-plan-to-get-women-vets-to-use-more-health-services\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/wp-content/uploads/sites/10/2017/11/178431-full-1020x680.jpg\" alt=\"\" />\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>“There are other settings where the care can continue,” she says, “such as a partial hospital or an intensive outpatient care setting that may be more supportive of having the mom and the baby together.”\u003c/p>\n\u003cp>Alice says mental hospitals in the US are just warehousing people. Only the mom’s unit felt like a place of healing, and despite the limitations of the system, it was the only thing that worked for her.\u003c/p>\n\u003cp>“It’s a different kind of place,” she says. “It’s the type of mental health care that everyone should have access to, not just mothers. That’s what mental health care in this country should look like, and it doesn’t come close.”\u003c/p>\n\u003cp>Right now, UNC is the only hospital in the country that has a designated psych unit just for pregnant women and new moms. A hospital in New York has a women’s only unit. And El Camino Hospital in Mountain View, where Dr. Dhami practices, will soon start construction on a women’s-only psych unit with a special focus on new moms. It’s slated to open in 2019.\u003c/p>\n\u003ch2>Back in Silicon Valley\u003c/h2>\n\u003cp>Two years after giving birth, Lisa Abramson plays catch with her daughter Lucy.\u003c/p>\n\u003cp>“Ready? Set? Go!” Lucy shouts, and Lisa rolls her a mini rubber soccer ball.\u003c/p>\n\u003cfigure id=\"attachment_11710982\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11710982\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/IMG_2269-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\" />\u003cfigcaption class=\"wp-caption-text\">Lisa plays ball with her daughter, Lucy, age two pictured here. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lisa feels like she’s back to her normal self. But she’s been thinking a lot about her experience with postpartum psychosis.\u003c/p>\n\u003cp>Lisa is pregnant again.\u003c/p>\n\u003cp>“That was the most courageous moment of my life,” she says. “Without knowing anything of how this is really going to work out, ‘let’s try it again.’\u003c/p>\n\u003cp>She’s terrified, though, the psychosis will come back.\u003c/p>\n\u003cp>“It might still happen again. They say there’s about a 50 percent chance,” she says. “I can try to set up a more optimal situation, but you also just don’t know and it’s out of your control, which is hard.”\u003c/p>\n\u003cp>The number one thing she wants to avoid – is going back to the hospital.\u003c/p>\n\u003cp>“The hospitalization was probably the most traumatic of the whole experience,” Lisa says.\u003c/p>\n\u003cp>Her plan this time around is to make sure she’s getting enough sleep. She’s going to have a therapist and psychiatrist lined up if she needs medication. And if she can’t stand the tyranny of the breastfeeding schedule, she’s going to let it go. More than anything else, she’s giving herself permission to put herself first.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘I’m trying to put myself first, guilt-free, and know that that makes me a better mom.’\u003ccite>Lisa Abramson\u003c/cite>\u003c/aside>\n\u003cp>Part of the inspiration for this is…Oprah. Lisa’s been listening to the podcast Making Oprah, chronicling the history of the daytime talk show.\u003c/p>\n\u003cp>In it, Oprah talks about a show they were producing about where women put themselves on their “list.” She interviewed a life coach who had women draw up a list of all the people and things they needed to take care of. Then Oprah asked, where are you on that list?\u003c/p>\n\u003cp>Most of the women said, “I wasn’t on the list at all.” And if they were, they were last.\u003c/p>\n\u003cp>Lisa was shocked by what happened next.\u003c/p>\n\u003cp>“Then the coach said, ‘Okay, I want you to put you at the top of that list,’” Lisa says. “And the crowd booed. They booed her off the stage.”\u003c/p>\n\u003cp>That was 1992.\u003c/p>\n\u003cp>Lisa says, today in Silicon Valley, it doesn’t feel like much has changed. This is Ground Zero for women striving to have it all: high-stress career running a tech company, and two perfect kids. Women here think the over-achiever culture is one reason postpartum depression and anxiety rates are higher in California compared to the rest of the country.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/news/11486296/california-senate-votes-to-expand-parental-leave-law\">California Senate Votes to Expand Parental Leave Law\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/news/11486296/california-senate-votes-to-expand-parental-leave-law\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/wp-content/uploads/sites/10/2017/05/RS25455_20170515_StateCapitol_Sen_Hannah-BethJackson_credit_BertJohnson-2-qut-1180x787.jpg\" alt=\"\" />\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>Lisa says she still feels intense pressure to be the perfect mom.\u003c/p>\n\u003cp>“We’ve got so many messages of just self-sacrifice: Do anything for your kids, drop everything. That’s what it means to be a good mom and for me, that’s not what made me a good mom. That’s what made me fall apart,” she says. “I’m trying to put myself first, guilt-free, and know that that makes me a better mom.”\u003c/p>\n\u003cp>Lisa feels so strongly about this, she’s writing a book about it. It’s called the “Wise Mama Guide to Maternity Leave,” and it’s all about convincing Silicon Valley go-getters how to go easy on themselves when they have a baby.\u003c/p>\n\u003cp>She says throw out those ideas of fitting into your skinny jeans in a few weeks, pushing a cute stroller all put together. Shift your goals from giving a presentation to 100 people, to changing 15 diapers in a day.\u003c/p>\n\u003cp>“At Trader Joe’s, they say ‘Do you want help out to your car?’ Just say yes and practice feeling uncomfortable getting other people to really help you,” Lisa says.\u003c/p>\n\u003cp>Some Silicon Valley companies have asked Lisa to come talk to their female employees about how to not be so Type A about their maternity leave. She gives online courses, too.\u003c/p>\n\u003cp>“They’re like, ‘Oh I thought I could still get some stuff done, or I could tackle a project that I’ve been forgetting about during maternity leave.’ I’m like, ‘No, no,” she says.\u003c/p>\n\u003cp>It’s an interesting message from a woman who is herself cranking out a book while she’s pregnant. But then again, that’s the point. Finish everything well before the baby comes.\u003c/p>\n\u003cfigure id=\"attachment_11710983\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11710983\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/Lisa-and-Baby-Vivian_Aug-2017-800x532.jpg\" alt=\"\" width=\"800\" height=\"532\" />\u003cfigcaption class=\"wp-caption-text\">Lisa Abramson snuggles with her youngest daughter, Vivian. \u003ccite>(Claire Mulkey)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lucy, is almost five now. Her second daughter, Vivian, is a year and a half.\u003c/p>\n\u003cp>The postpartum psychosis did not come again. With all the precautions Lisa took to protect her sleep, to ask for help, to put herself first, she warded off the helicopters and the snipers.\u003c/p>\n\u003cp>Lisa says she loves being a mom.\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Originally Published Dec 7, 2018\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://itunes.apple.com/us/podcast/the-california-report-magazine/id1314750545?mt=2\" target=\"_blank\" rel=\"noopener\">Listen to this and more in-depth storytelling by subscribing to The California Report Magazine podcast.\u003c/a>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">L\u003c/span>\u003c/p>\u003cp>isa Abramson says that even after all she’s been through – the helicopters circling her house, the snipers on the roof, and the car ride to jail – she still wants to have a second child.\u003c/p>\n\u003cp>Because, in the beginning, when her daughter was born, Lisa was smitten, just like the mom she’d imagined she would be. She’d look into her baby’s round, alert eyes and feel the adrenaline rush through her. She had so much energy. She was so excited.\u003c/p>\n\u003cp>“I actually was thinking like, ‘I don’t get why other moms say they’re so tired or this is so hard. I got this,’” she says.\u003c/p>\n\u003cp>Lisa wanted to be the perfect mom. She was ready to be the perfect mom. She’d been a successful marketing executive for a Silicon Valley tech company and a successful entrepreneur. And that first week after her baby was born, everything was going according to plan. The world was nothing but love.\u003c/p>\n\u003cp>But even when Lisa did get tired, and she got time to sleep, she couldn’t.\u003c/p>\n\u003cp>Then, the baby started losing weight, and the pediatrician told Lisa to feed her every two hours.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘It weighed on me as ‘I failed as a mom. I can’t feed my child.’ I needed to feed her, that was the most important thing, and my well-being didn’t matter.’\u003ccite>Lisa Abramson, new mother\u003c/cite>\u003c/aside>\n\u003cp>“That meant breastfeed and then pump, and then feed her the pumped milk and then clean the pumping parts, which is always something no one thinks about but takes about 20 minutes,” she says. “Basically, through that every two-hour feeding cycle, I had 10 minutes of downtime.”\u003c/p>\n\u003cp>Lisa started to feel like she couldn’t keep up. She felt overwhelmed and guilty. Really guilty.\u003c/p>\n\u003cp>“It weighed on me as ‘I failed as a mom. I can’t feed my child,’” she says. “I needed to feed her, that was the most important thing, and my well-being didn’t matter.”\u003c/p>\n\u003cp>She was barely sleeping. Even when she could get a release from breastfeeding purgatory, she couldn’t relax. As she got more and more exhausted, she started to get…confused.\u003c/p>\n\u003cp>“I was having a conversation with someone, their voices were just distorted and it was really hard for me to understand what they were saying.”\u003c/p>\n\u003cp>She tried going to a spin class, something she loved and had done up until the baby was born.\u003c/p>\n\u003cp>But 10 minutes in, she was out of there.\u003c/p>\n\u003cp>“That was not a good idea, because the noises and intense volume of the spin class was really alarming to me. It felt like the walls were talking to me,” she says. “I just said to my husband probably a hundred, 200 times that day, ‘Am I crazy? Am I crazy? Am I crazy?’”\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003c/h3>\n\u003c/aside>\n\u003cp>But then, about a month after the birth, her clarity came back.\u003c/p>\n\u003cp>It was like she woke up from a dream. It rained every day for the next week. The day the sun came out, she noticed police helicopters circling over their apartment. She heard them land on top of the building.\u003c/p>\n\u003cp>“There were snipers on the roof and there were spy cams in our bedroom and everyone was watching me and my cellphone was giving me weird messages,” she says.\u003c/p>\n\u003cp>Lisa waited for the police to come in and take her. But the next morning, she woke up in her own bed. The cops had arrested the nanny instead.\u003c/p>\n\u003cp>This was wrong, she thought, the nanny shouldn’t be punished for her crime. Lisa told her husband it wasn’t fair. She was going to put an end to all this. She was going to jump off the Golden Gate Bridge. And that’s when her husband told her he was going to drive her to the police station himself.\u003c/p>\n\u003cp>“It was like, ‘Oh, okay, he’s taking me in and I guess I’m getting arrested,’” Lisa says. “I remember my mom cooked me eggs and it was like, ‘You should eat these before you go.’ And I was like, ‘Oh, she’s giving me my final meal before I go to jail.’”\u003c/p>\n\u003cp>From her husband’s perspective, this was one of the worst days of his life.\u003c/p>\n\u003cp>“I’m bringing my wife to the hospital and then checking her into an inpatient unit. It was really, really challenging,” says David Abramson, relaying what really happened that day.\u003c/p>\n\u003ch2>Not Jail, the Psych Ward\u003c/h2>\n\u003cp>There was no crime, the nanny wasn’t arrested, and Lisa’s destination that day was not jail, but rather the general psychiatric ward of Sutter Health’s California Pacific Medical Center in San Francisco – though the hospital didn’t feel far off from where Lisa believed she was going.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘You have to wait for the door to be unlocked, the buzzer, and there’s security and it felt almost like bringing Lisa to jail, even though she didn’t do anything.’\u003ccite>David Abramson, Lisa’s husband\u003c/cite>\u003c/aside>\n\u003cp>“You have to wait for the door to be unlocked, the buzzer, and there’s security and it felt almost like bringing Lisa to jail, even though she didn’t do anything,” David recalls. “That was probably the most heart-wrenching thing, was having to leave her that night with the hospital staff. You could see in her eyes and her body language that she was panicked all of a sudden that we were leaving.”\u003c/p>\n\u003cp>The other patients were there for drug overdoses or alcohol withdrawal. People were screaming. One patient thought he was a dog, crawling around on all fours, barking. It didn’t seem like the right place for a new mom.\u003c/p>\n\u003cp>“Probably for the first five days I just didn’t speak to anyone,” Lisa says. “I don’t know if I couldn’t speak or I wasn’t speaking, but I was terrified enough of the environment that I decided I wasn’t going to answer anyone’s questions. I wasn’t going to talk to anyone.”\u003c/p>\n\u003cp>Lisa still thought this was all part of some conspiracy.\u003c/p>\n\u003cp>“I just thought I was there because I did something wrong,” she says. “Because I tried to get out to leave and I was locked in so you can’t leave. I was like, ‘Maybe I am in a jail, but it looks like a hospital? They’re saying it’s a hospital, but it’s really a jail?’”\u003c/p>\n\u003cp>Lisa doesn’t remember any doctors or nurses telling her why she was there or what was going on.\u003c/p>\n\u003cp>“They’re just like, ‘Take these medications,’ and they’re pissed at me because I wasn’t cooperating and going to any of the groups or talking to anyone,” she says. “No one told me what my diagnosis was, why I was there.”\u003c/p>\n\u003caside class=\"pullquote alignright\">‘I really was just like, “No. I’ve heard of postpartum depression. No, I have never heard that there’s postpartum crazy.” ‘ \u003ccite>Lisa Abramson\u003c/cite>\u003c/aside>\n\u003cp>It wasn’t until Lisa had been in the hospital more than a week that she remembers her husband telling her why she was there. He brought her a print out from the internet on postpartum psychosis.\u003c/p>\n\u003cp>“That was the first time where I was like, ‘He’s on my side. He made up this disease just to make me feel better. That was so sweet,’” she says.\u003c/p>\n\u003cp>The papers said it was elevated hormones from childbirth plus sleep deprivation that can trigger confusion and paranoia. Lisa figured it took her husband hours to photoshop all this.\u003c/p>\n\u003cp>“I really was just like, ‘No. I’ve heard of postpartum depression. No, I have never heard that there’s postpartum crazy.”\u003c/p>\n\u003ch2>New Data on Moms Who Die By Suicide\u003c/h2>\n\u003cp>Postpartum psychosis is real. It’s rare – it affects one or two women out of every thousand that give birth. But experts believe more women are affected than previously thought. And more of them are ending up dead, by suicide.\u003c/p>\n\u003cp>There are a handful of doctors and researchers trying to figure out why. States have never kept good data on this, so each suicide is like a mystery, and it takes a team of medical detectives to piece it together.\u003c/p>\n\u003cp>They start with death certificates and coroner reports, then work backward. They track down hospital records to figure out when the woman gave birth. Then they study medical charts for clues, signs of mental illness that the original doctors didn’t catch.\u003c/p>\n\u003cp>California researchers just finished their first big study like this. The state’s public health department hasn’t published it yet, but The California Report got a preview of some of the data: 99 new moms in the state died by suicide over a ten-year period.\u003c/p>\n\u003cp>The investigators determined that of those 99 suicides, 98 were preventable.\u003c/p>\n\u003cp>Nearly every single woman might not have died if the health care system in California had done a better job taking care of them: if women had been screened better, diagnosed better, treated better.\u003c/p>\n\u003cp>“The work that we do here is less than 10 percent of what needs to be done,” says Nirmaljit Dhami, a psychiatrist at El Camino Hospital in Mountain View. She’s one of the doctor-detectives who reviewed the suicides, but she did not talk about the report or share data from it.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/stateofhealth/185843/just-like-patients-therapists-also-battle-insurance-red-tape\">Frustrated You Can’t Find a Therapist? They’re Frustrated, Too\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/stateofhealth/185843/just-like-patients-therapists-also-battle-insurance-red-tape\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/Final.Insurance-e1464020830149-800x449.jpg\" alt=\"\" />\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>She is an expert in postpartum mental illness and often treats women in crisis, cleaning up what OB/GYNs miss. Based on her clinical experience and observations, she says a lot of doctors don’t know the early signs of postpartum psychosis; they don’t know that the symptoms wax and wane.\u003c/p>\n\u003cp>“A lot of times the patient will present very clearly, then at other times, will present with acute confusion and disorganization,” she says.\u003c/p>\n\u003cp>Like Lisa Abramson, of sound mind in one moment, then believing the walls are talking to her in the next.\u003c/p>\n\u003cp>“This is a symptom that clinicians who are not trained in this field can easily miss,” Dhami says, “because when they see the patient in their office with the family, they can think that the patient is normal and is probably suffering from sleep deprivation and discharge them home,” she says.\u003c/p>\n\u003cp>This is how women die. In the U.S., mental health problems are one of the leading causes of death among new moms, according to a 2018 report from the Building U.S. Capacity to Review and Prevent Maternal Deaths initiative at the CDC. Mental health problems are number seven on the list, nearly tied with high blood pressure complications. For white women, mental health problems are the fourth leading cause of death.\u003c/p>\n\u003cp>Even when women do get into care, Dhami says, it’s often inadequate or inappropriate. Doctors prescribe the wrong medications. Insurance companies push patients out of psych units before they’re ready. And the staff at psych units are generally not trained in these illnesses, Dhami says, and they may not be equipped for even the physical needs of new moms.\u003c/p>\n\u003cfigure id=\"attachment_11711000\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11711000\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/Lucy-0038-800x532.jpg\" alt=\"\" width=\"800\" height=\"532\" />\u003cfigcaption class=\"wp-caption-text\">David Abramson researched postpartum psychosis on the internet when he suspected his wife Lisa was showing signs of it after having their first daughter, Lucy. \u003ccite>(Claire Mulkey)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Take Lisa Abramson’s inpatient experience. When Lisa first arrived at the psych ward, her husband told the resident who admitted her that he thought Lisa had postpartum psychosis. The resident said to him, “Postpartum, what?” He promised David he’d study up on it.\u003c/p>\n\u003cp>Then, several days into Lisa’s stay, she complained of pain in her breasts. She’d stopped breastfeeding the instant she left home, and it didn’t seem to occur to anyone that her breast would become engorged.\u003c/p>\n\u003cp>Her husband had to negotiate to bring in Lisa’s breast pump from home. She remembers being put in a room with padded walls that looked like a solitary confinement chamber from a horror movie.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘A lot of times, symptoms of postpartum depression and psychosis involve the mother feeling that she’s like a bad mom.’\u003ccite>Dr. Nirmaljit Dhami, a psychiatrist at El Camino Hospital in Mountain View\u003c/cite>\u003c/aside>\n\u003cp>“That was where they sent me to go pump, and under supervision from doctors because they were worried,” she says. “God knows what I would do with the breast pump. A breast pump is a torture device already.”\u003c/p>\n\u003cp>But the worst thing of all, was not being allowed to see her baby. The inpatient unit has a strict policy: no infants or children on the ward. The hospital says this is intended as a safety measure, for everybody. Her family argued with the staff.\u003c/p>\n\u003cp>“They said, ‘She’s a new mom and she needs to see her baby. That’s keeping this bond going, it’s really, it’s important,” Lisa recalls, tearing up. “That was the hard part, was not getting to see her.”\u003c/p>\n\u003cp>About five days into her time there, Lisa’s family was able to negotiate short one-hour visits with her daughter, supervised by a person who kept looking at his watch.\u003c/p>\n\u003cp>Lisa’s family was so unhappy with her care at the hospital that her husband practically broke her out of there. They found Dr. Dhami and asked her to take over Lisa’s treatment. She enrolled in a comprehensive outpatient program Dhami runs at El Camino Hospital, called the Maternal Outreach Mood Services (MOMS) program, where Lisa could bring her baby along.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/stateofhealth/362850/to-screen-or-not-to-screen-doctors-debate-post-partum-depression-testing\">To Screen or Not to Screen? Doctors Debate Post Partum Depression Testing\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/stateofhealth/362850/to-screen-or-not-to-screen-doctors-debate-post-partum-depression-testing\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/wp-content/uploads/sites/27/2018/03/Wendy-Root-Askew-1180x885.jpg\" alt=\"\" />\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>Dr. Dhami says separating a mother from her newborn actually makes it harder for the mom to recover.\u003c/p>\n\u003cp>“A lot of times, symptoms of postpartum depression and psychosis involve the mother feeling that she’s like a bad mom,” she says. “It is a difficult situation for the mother to be in when she has so many negative thoughts and ruminations about herself and her ability to be a good mom.”\u003c/p>\n\u003cp>Under Dr. Dhami’s care, Lisa started to reclaim her grip on reality, but she didn’t know how long it would be before she’d start to feel better. She wondered if she’d ever feel like herself again.\u003c/p>\n\u003cp>California Pacific Medical Center declined to comment on Lisa’s case specifically, even though Lisa authorized the hospital to discuss her medical records. The inpatient psychiatric medical director, Dr. Stephanie Wilson, says breast pumps are now available to women who need them, and providers review new moms’ wishes to see their babies on a case-by-case basis.\u003c/p>\n\u003cp>“We take into full consideration all of the circumstances and the details of that patient, of the infant, and really seeing what, if any, benefit, or even potential harm, it could have to the mother,” Wilson says. “Once the symptoms of depression and psychosis start to get better, that’s when I would start to allow more visitations.”\u003c/p>\n\u003ch2>A Different Kind of Care for Moms\u003c/h2>\n\u003cp>There’s plenty of research dating back to the 1940’s on the ideal protocols for inpatient treatment of postpartum mental illnesses. The gold standard is to admit the mother and the baby into the hospital together, on a specialized mother-baby unit.\u003c/p>\n\u003cp>They’re treated as a pair. Part of the mom’s therapy is getting guidance on how to read the baby’s cues, and how to meet the baby’s needs as well as her own. At night, the baby sleeps in a supervised nursery, so mom can get uninterrupted sleep. In the United Kingdom, there are 21 of these mother-baby units. In France, there are 15. They’re in Belgium, New Zealand. There’s one in India.\u003c/p>\n\u003cp>In the U.S., there are zero.\u003c/p>\n\u003cp>The closest thing there is to a mother-baby unit in the U.S. is 3,000 miles from where Lisa lives – the hospital at the University of North Carolina in Chapel Hill.\u003c/p>\n\u003cp>The perinatal psychiatric unit here is reserved exclusively for pregnant women and new moms. They accept all kinds of commercial insurance and Medicaid, so any woman, wealthy or low-income can get treated here.\u003c/p>\n\u003cfigure id=\"attachment_11710976\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11710976\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/IMG_3438-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\" />\u003cfigcaption class=\"wp-caption-text\">Nurse Anna Soloway reads from the “Dear Mom” book at the perinatal psychiatry unit at UNC-Chapel Hill. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When women first arrive, nurses show them the “Dear Mom” book, where women who are close to being discharged write notes to the women just being admitted:\u003c/p>\n\u003cp>“Dear moms or mom to be: This place has saved my life and it will save yours…\u003c/p>\n\u003cp>Dear mom: You may think you’re the only “crazy” girl in the world like this, but I promise you, you’re not alone…\u003c/p>\n\u003cp>Dear mammas, you are strong, you are beyond brave and strong for coming here, and your family deserves you…\u003c/p>\n\u003cp>Dear mom: You are a wonderful mother…”\u003c/p>\n\u003cp>“There is a need for them to see other moms going through what they’re going through,” says psychiatrist Mary Kimmel, who runs the unit. She wears a denim jacket and black suede ankle boots, and whenever a patient asks if she’s a mom, too, she says yes, she had two kids.\u003c/p>\n\u003cp>She says everything here is tailored to the specific needs of new moms. Every room has a hospital-grade breast pump, there’s a lactation consultant who helps women with breastfeeding, and there’s a designated refrigerator for moms to store pumped milk.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/futureofyou/2703/womens-health-is-too-often-overlooked-will-digital-health-be-the-exception\">Women’s Health is Too Often Overlooked; Will Digital Health be the Exception?\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/futureofyou/2703/womens-health-is-too-often-overlooked-will-digital-health-be-the-exception\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/wp-content/uploads/sites/27/2016/11/sad-child-770.jpg\" alt=\"\" />\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>The most distinctive feature about the program is the visitor policy. Most afternoons, the unit is bustling with husbands and kids.\u003c/p>\n\u003cp>“Babies can come to the unit and we really encourage that,” Kimmel says. “We encourage older kids to also come to the unit.”\u003c/p>\n\u003cp>Toddlers scurry around the day room during visiting hours, coloring, playing with toys, playing with each other. Women cradle their newborns, rocking them, feeding them.\u003c/p>\n\u003cp>The babies are not allowed to stay overnight though. There’s no nursery here like the units in Europe.\u003c/p>\n\u003cp>The main reason for that is the insurance companies.\u003c/p>\n\u003cp>Kimmel says no insurer in the U.S. would ever pay for a healthy baby to be admitted to the hospital.\u003c/p>\n\u003cp>“That baby doesn’t have a distinct need to be admitted and so it’s not possible to bill for that baby being at the hospital,” she says. And without that, the hospital can’t afford to run a nursery.\u003c/p>\n\u003cfigure id=\"attachment_11710977\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11710977\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/IMG_3469-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\" />\u003cfigcaption class=\"wp-caption-text\">Psychiatrist Mary Kimmel runs the mom’s psychiatry unit at UNC-Chapel Hill. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The unit is small — it has five beds — and women spend most of their time in the day room, a hospital lounge with a table and couch and a TV that’s usually tuned in to a home makeover show. The staff do what they can to make it feel homey here, less like a hospital, but there’s still a wall of glass around the nurses’ station, and patients have to knock on the window when they come to ask for something.\u003c/p>\n\u003cp>The days are very structured, with a range of treatments, all tailored specifically to pregnant women and new moms. There’s one-on-one therapy and lots of group classes: parenting and time management lessons, where women practice asking their partner for help. And a favorite among the moms: relaxation class.\u003c/p>\n\u003cp>“Get yourself as comfortable as you can, let your body relax,” murmurs recreational therapist Amber Koo over slow meditation music.\u003c/p>\n\u003cp>She puts on a special light machine that projects little stars onto the ceiling. That gives women a place to focus their mind, away from the negative thoughts coursing through their heads.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/mindshift/32835/got-a-minute-try-meditating\">Got a Minute? Try Meditating!\u003c/a>\u003c/h3>\n\u003c/aside>\n\u003cp>“Allow your breath to start going in your nose slowly,” Koo says.\u003c/p>\n\u003cp>For Alice Sarti, the moms unit at UNC was the first place that gave her hope as a new mom. After she had her son, she became engulfed by mania. She had dealt with depression many times before, but never this.\u003c/p>\n\u003cp>“Every minute I had to fill with a task: researching daycares, doing and re-doing my budget,” she says. “I’m not going to line up three bottles, I’m going to line up 17 bottles.”\u003c/p>\n\u003cp>She became an exaggerated version of herself. Super mom. She’s a business analyst and loves getting things done. She loved how productive she was. But then things started to spiral.\u003c/p>\n\u003cp>“There was a definite snap,” she says. “I started yelling about things that didn’t make sense. They made sense to me.”\u003c/p>\n\u003cp>It’s like the television show Homeland, when bipolar CIA agent Carrie Mathison sets up a situation room. She covers the walls with news articles and photos of the terrorists she’s chasing. She criss-crosses yellow string in all directions to illustrate the connections she sees.\u003c/p>\n\u003cp>It was like that in Alice’s mind.\u003c/p>\n\u003cp>“There was a logical chain there in my head, but externally those links were so far apart,” she says.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘I did have a social worker tell me I was going to lose my child if I didn’t ‘pull it together,’\u003ccite>Alice Sarti, new mother\u003c/cite>\u003c/aside>\n\u003cp>To her family, it was just an incoherent rage. They called the police and they took Alice to the nearest hospital that had an available bed, in this case, not the mom’s unit at UNC, but rather a general psych ward.\u003c/p>\n\u003cp>“You saw people that couldn’t speak, that could barely walk. People that were discharged in that condition,” she says.\u003c/p>\n\u003cp>Alice didn’t want to be drugged like that. She refused to take any meds, and that made her unpopular with the staff.\u003c/p>\n\u003cp>“I did have a social worker tell me I was going to lose my child if I didn’t ‘pull it together,’” she says.\u003c/p>\n\u003cp>During her three-week stay, she saw her son once, for 20 minutes.\u003c/p>\n\u003cp>“I was not able to touch him on any level. He was in his car seat and I reached for him and I was yelled at,” she says.\u003c/p>\n\u003cp>It’s hard for her to admit what it was like coming back to him, after she was discharged.\u003c/p>\n\u003cp>“It felt like a burden,” she says. “It felt like, ‘How am I ever going to do this?’ I held him, I bathed him, and I did all the things, but the connection was not there. I lost time with my son and I’m never going to get it back.”\u003c/p>\n\u003cp>Alice was not feeling better when she was sent home from that hospital. She ended up in another hospital, and discharged again, her mania still boiling. She eventually ended up at the mom’s psych unit at UNC Chapel Hill.\u003c/p>\n\u003cp>Finally, everyone seemed to understand what she was going through, the pressure she was feeling, the guilt. She saw her son regularly, and staff helped her start to re-establish her bond with him.\u003c/p>\n\u003cp>“It was this incredibly nurturing environment,” she says. “It changed the trajectory of my life and my son’s life.”\u003c/p>\n\u003cfigure id=\"attachment_11710979\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11710979\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/us_0918-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\" />\u003cfigcaption class=\"wp-caption-text\">Alice Sarti got help at the mom’s unit reconnecting with her son, and recovering from postpartum mental illness. \u003ccite>(Courtesy of Alice Sarti)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But even at this seemingly perfect place, things go wrong. When Alice was discharged, her mania cleared. But then she slipped into the deepest, darkest depression she had ever known. She checked herself into UNC again, afraid she was going to kill herself.\u003c/p>\n\u003cp>With Alice, and other patients, doctors are under so much pressure to get moms home quickly, sometimes they overshoot on the medications, says Dr. Mary Kimmel, who runs the unit. Some of that pressure comes from the moms themselves, who want to be with their kids, but it also comes from the insurance companies.\u003c/p>\n\u003cp>UNC’s mom’s unit pays the bills like other hospitals – they take insurance to cover the costs of care.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/futureofyou/442703/u-s-suicide-rates-are-rising-faster-among-women-than-men\">U.S. Suicide Rates Are Rising Faster Among Women Than Men\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/futureofyou/442703/u-s-suicide-rates-are-rising-faster-among-women-than-men\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/06/gender-depression-1-c396c6b070b1002bd68febe0f9805c93a75ea72a-1-1180x885.jpg\" alt=\"\" />\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>But the longer a patient stays, the more an insurer has to pay, and that’s not good for their bottom line. Kimmel and other doctors say as soon as a patient comes off suicide watch, insurers start calling, asking when she can go home.\u003c/p>\n\u003cp>“Our average length of stay runs from about one week to two weeks,” Kimmel says.\u003c/p>\n\u003cp>In Europe?\u003c/p>\n\u003cp>“About 40 to 50 days is the average length of stay there,” she says.\u003c/p>\n\u003cp>That means doctors in the U.S. start patients on new drugs, but don’t have time to see if they work. Or, they have to start women on the most intense medications that force her to stop breastfeeding, instead of slower therapies that could extend the mother’s time to feed her infant breast milk.\u003c/p>\n\u003cp>It also means that patients like Alice can end up hospitalized four times before they get better.\u003c/p>\n\u003cp>Insurers insist the decision to discharge is not just about cost, but about what’s best for patients.\u003c/p>\n\u003cp>“We want to make sure that they’re getting the care that they need in the most appropriate setting,” says Kate Berry, senior vice president of Clinical Innovation for America’s Health Insurance Plans, a trade group for insurers.\u003c/p>\n\u003cp>Hospitals are not necessarily the ideal environment, she says, especially for making sure medications are stabilized.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/news/11632413/the-plan-to-get-women-vets-to-use-more-health-services\">The Plan to Get Women Vets to Use More Health Services\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/news/11632413/the-plan-to-get-women-vets-to-use-more-health-services\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/wp-content/uploads/sites/10/2017/11/178431-full-1020x680.jpg\" alt=\"\" />\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>“There are other settings where the care can continue,” she says, “such as a partial hospital or an intensive outpatient care setting that may be more supportive of having the mom and the baby together.”\u003c/p>\n\u003cp>Alice says mental hospitals in the US are just warehousing people. Only the mom’s unit felt like a place of healing, and despite the limitations of the system, it was the only thing that worked for her.\u003c/p>\n\u003cp>“It’s a different kind of place,” she says. “It’s the type of mental health care that everyone should have access to, not just mothers. That’s what mental health care in this country should look like, and it doesn’t come close.”\u003c/p>\n\u003cp>Right now, UNC is the only hospital in the country that has a designated psych unit just for pregnant women and new moms. A hospital in New York has a women’s only unit. And El Camino Hospital in Mountain View, where Dr. Dhami practices, will soon start construction on a women’s-only psych unit with a special focus on new moms. It’s slated to open in 2019.\u003c/p>\n\u003ch2>Back in Silicon Valley\u003c/h2>\n\u003cp>Two years after giving birth, Lisa Abramson plays catch with her daughter Lucy.\u003c/p>\n\u003cp>“Ready? Set? Go!” Lucy shouts, and Lisa rolls her a mini rubber soccer ball.\u003c/p>\n\u003cfigure id=\"attachment_11710982\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11710982\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/IMG_2269-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\" />\u003cfigcaption class=\"wp-caption-text\">Lisa plays ball with her daughter, Lucy, age two pictured here. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lisa feels like she’s back to her normal self. But she’s been thinking a lot about her experience with postpartum psychosis.\u003c/p>\n\u003cp>Lisa is pregnant again.\u003c/p>\n\u003cp>“That was the most courageous moment of my life,” she says. “Without knowing anything of how this is really going to work out, ‘let’s try it again.’\u003c/p>\n\u003cp>She’s terrified, though, the psychosis will come back.\u003c/p>\n\u003cp>“It might still happen again. They say there’s about a 50 percent chance,” she says. “I can try to set up a more optimal situation, but you also just don’t know and it’s out of your control, which is hard.”\u003c/p>\n\u003cp>The number one thing she wants to avoid – is going back to the hospital.\u003c/p>\n\u003cp>“The hospitalization was probably the most traumatic of the whole experience,” Lisa says.\u003c/p>\n\u003cp>Her plan this time around is to make sure she’s getting enough sleep. She’s going to have a therapist and psychiatrist lined up if she needs medication. And if she can’t stand the tyranny of the breastfeeding schedule, she’s going to let it go. More than anything else, she’s giving herself permission to put herself first.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘I’m trying to put myself first, guilt-free, and know that that makes me a better mom.’\u003ccite>Lisa Abramson\u003c/cite>\u003c/aside>\n\u003cp>Part of the inspiration for this is…Oprah. Lisa’s been listening to the podcast Making Oprah, chronicling the history of the daytime talk show.\u003c/p>\n\u003cp>In it, Oprah talks about a show they were producing about where women put themselves on their “list.” She interviewed a life coach who had women draw up a list of all the people and things they needed to take care of. Then Oprah asked, where are you on that list?\u003c/p>\n\u003cp>Most of the women said, “I wasn’t on the list at all.” And if they were, they were last.\u003c/p>\n\u003cp>Lisa was shocked by what happened next.\u003c/p>\n\u003cp>“Then the coach said, ‘Okay, I want you to put you at the top of that list,’” Lisa says. “And the crowd booed. They booed her off the stage.”\u003c/p>\n\u003cp>That was 1992.\u003c/p>\n\u003cp>Lisa says, today in Silicon Valley, it doesn’t feel like much has changed. This is Ground Zero for women striving to have it all: high-stress career running a tech company, and two perfect kids. Women here think the over-achiever culture is one reason postpartum depression and anxiety rates are higher in California compared to the rest of the country.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/news/11486296/california-senate-votes-to-expand-parental-leave-law\">California Senate Votes to Expand Parental Leave Law\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/news/11486296/california-senate-votes-to-expand-parental-leave-law\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/wp-content/uploads/sites/10/2017/05/RS25455_20170515_StateCapitol_Sen_Hannah-BethJackson_credit_BertJohnson-2-qut-1180x787.jpg\" alt=\"\" />\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>Lisa says she still feels intense pressure to be the perfect mom.\u003c/p>\n\u003cp>“We’ve got so many messages of just self-sacrifice: Do anything for your kids, drop everything. That’s what it means to be a good mom and for me, that’s not what made me a good mom. That’s what made me fall apart,” she says. “I’m trying to put myself first, guilt-free, and know that that makes me a better mom.”\u003c/p>\n\u003cp>Lisa feels so strongly about this, she’s writing a book about it. It’s called the “Wise Mama Guide to Maternity Leave,” and it’s all about convincing Silicon Valley go-getters how to go easy on themselves when they have a baby.\u003c/p>\n\u003cp>She says throw out those ideas of fitting into your skinny jeans in a few weeks, pushing a cute stroller all put together. Shift your goals from giving a presentation to 100 people, to changing 15 diapers in a day.\u003c/p>\n\u003cp>“At Trader Joe’s, they say ‘Do you want help out to your car?’ Just say yes and practice feeling uncomfortable getting other people to really help you,” Lisa says.\u003c/p>\n\u003cp>Some Silicon Valley companies have asked Lisa to come talk to their female employees about how to not be so Type A about their maternity leave. She gives online courses, too.\u003c/p>\n\u003cp>“They’re like, ‘Oh I thought I could still get some stuff done, or I could tackle a project that I’ve been forgetting about during maternity leave.’ I’m like, ‘No, no,” she says.\u003c/p>\n\u003cp>It’s an interesting message from a woman who is herself cranking out a book while she’s pregnant. But then again, that’s the point. Finish everything well before the baby comes.\u003c/p>\n\u003cfigure id=\"attachment_11710983\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11710983\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/Lisa-and-Baby-Vivian_Aug-2017-800x532.jpg\" alt=\"\" width=\"800\" height=\"532\" />\u003cfigcaption class=\"wp-caption-text\">Lisa Abramson snuggles with her youngest daughter, Vivian. \u003ccite>(Claire Mulkey)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Lucy, is almost five now. Her second daughter, Vivian, is a year and a half.\u003c/p>\n\u003cp>The postpartum psychosis did not come again. With all the precautions Lisa took to protect her sleep, to ask for help, to put herself first, she warded off the helicopters and the snipers.\u003c/p>\n\u003cp>Lisa says she loves being a mom.\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_11715427\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/RS34586_IMG_3726-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11715427\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/RS34586_IMG_3726-qut.jpg\" alt=\"\" width=\"1920\" height=\"1415\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/12/RS34586_IMG_3726-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/12/RS34586_IMG_3726-qut-160x118.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/12/RS34586_IMG_3726-qut-800x590.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/12/RS34586_IMG_3726-qut-1020x752.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/12/RS34586_IMG_3726-qut-1200x884.jpg 1200w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">S.F. therapist Alicia Cruz’s sons, Ozzie (7) and Rio (11), collect toys to give to children released from immigrant detention in Texas. \u003ccite>(Courtesy of the Cruz-Hunt family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On a recent Friday, on the playground of the Creative Arts Charter School in San Francisco, Alicia Cruz watched as her son, Rio, stepped to the microphone during morning announcements.\u003c/p>\n\u003cp>“My mom is going to work in Texas to help the families in detention and families seeking asylum,” the fifth-grader told the crowd of students and teachers. “Please donate toys, like yo-yo’s, Legos, Slinkies or any small toys for kids.”\u003c/p>\n\u003cp>It wasn’t the first time Rio had collected toys for children coming out of Immigration and Customs Enforcement detention centers. Rio’s mom, a marriage and family therapist for Kaiser San Francisco, was moved to volunteer last year, when she learned that federal officials were taking infants and children away from their parents at the border.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/news/11714145/migrant-children-across-the-u-s\">Migrant Children Across the U.S.\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/news/11714145/migrant-children-across-the-u-s\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/trauma_122018_final-1180x764.jpg\" alt=\"\">\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>At Kaiser, Cruz specializes in adolescent trauma. She knew those family separations would create crises, especially for families who had fled violence in their home countries in Central America.\u003c/p>\n\u003cp>“The idea of being separated, to a parent, it’s just unimaginable,” Cruz said.\u003c/p>\n\u003cp>Rio cannot imagine it either.\u003c/p>\n\u003cp>“It would just be super hard if I got separated from my mom,” said the 11-year-old. “That’s why we’re trying to make a difference in this community.”\u003c/p>\n\u003cp>Cruz made the trip to Texas twice last year, using vacation time, as well as money and frequent flyer miles donated by other parents at the school. She brought the migrant children toys that Rio had collected, and gave small cash donations to their parents. Cruz heads to Texas again on Wednesday, Jan. 2.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/news/11710491/migrant-family-separations-didnt-end-despite-executive-order\">Migrant Family Separations Didn’t End Despite Executive Order\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/news/11710491/migrant-family-separations-didnt-end-despite-executive-order\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/GettyImages-973124260-e1544131091680.jpg\" alt=\"\">\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>“I’m going to go as often as I can because it’s amazing work and it’s much needed,” Cruz said. “I wish there were more therapists who could come.”\u003c/p>\n\u003cp>In June, \u003ca href=\"https://www.kqed.org/news/11677646/judge-bars-migrant-family-separations-orders-return-of-children-within-30-days\">a court forced the government to end the policy\u003c/a> that led to almost 2,700 family separations. And more than 90 percent of those kids have since been reunited. But immigration authorities continue to detain thousands of migrant families — most of them at two ICE facilities in Texas.\u003c/p>\n\u003cp>After parents pass an initial asylum screening, called a credible fear interview, most families are released from custody, typically after several weeks in detention. Each day, ICE agents \u003ca href=\"https://www.kqed.org/news/11701728/advocates-question-timing-of-change-in-migrant-families-releases\" target=\"_blank\" rel=\"noopener\">drop off\u003c/a> dozens of families at the Greyhound station in San Antonio, where they wait for buses that will take them to sponsors or family members across the country.\u003c/p>\n\u003cp>When Cruz gets to Texas, she will join other volunteers who hand out food, water, blankets and backpacks at the bus station and help guide migrants on the next leg of their journey.\u003c/p>\n\u003cp>The Refugee and Immigrant Center for Education and Legal Services, a local nonprofit group, has devised a bare-bones, 10-minute legal orientation.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘It is really a front-line, grassroots effort at the bus station. You have the families come in and you are squatting, you’re sitting on the floor with them, you are interacting with their children.’\u003ccite>Juan Rocha, The Refugee and Immigrant Center for Education and Legal Services\u003c/cite>\u003c/aside>\n\u003cp>“It is really a front-line, grassroots effort at the bus station,” said Juan Rocha, who runs the program for the group, known as \u003ca href=\"https://www.raicestexas.org/about/\" target=\"_blank\" rel=\"noopener\">RAICES\u003c/a>. “You have the families come in and you are squatting, you’re sitting on the floor with them, you are interacting with their children.”\u003c/p>\n\u003cp>Last year, RAICES provided its “know your rights” legal orientation to 1,972 parents who passed through the San Antonio Greyhound station.\u003c/p>\n\u003cp>Most of the people arriving at the station are Central Americans who have been released from ICE’s largest family detention facilities, each about an hour outside San Antonio. Fathers with sons come from the Karnes County Residential Center, and mothers with children arrive from the South Texas Family Residential Center in Dilley.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Rocha said the families have been through a lot.\u003c/p>\n\u003cp>“There is so much trauma experienced by the time that they get to the bus stations that all we can do is be cognizant of it, provide some simple comfort, and then get them on their way with as much knowledge as possible,” he said.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/news/11711704/after-eight-month-separation-an-salvadoran-asylum-seeker-reconnects-with-4-year-old-son\">After 8-Month Separation, Salvadoran Asylum-Seeker Reconnects With 4-Year-Old Son\u003c/a>\u003c/h3>\n\u003cfigure>\u003c/figure>\n\u003c/aside>\n\u003cp>On her last trip to San Antonio, Cruz said, she counseled parents on how to respond when their children act out their anger or anxiety from what they’ve been through — experiences that can include witnessing acts of violence, a harrowing trip through unfamiliar countries and weeks in jail-like conditions. Cruz said she hands out pamphlets in Spanish on post-traumatic stress disorder and looks up contact information for psychological services in the cities where the migrants are heading.\u003c/p>\n\u003cp>With some families, Cruz only has a few minutes before their bus arrives. With other families she may spend hours.\u003c/p>\n\u003cp>When there was time, Cruz said, she took families to San Antonio’s River Walk, just a few blocks from the station, where they could stroll under the trees or let the kids romp in the grass.\u003c/p>\n\u003cp>She said this was often the family’s first experience in the United States, free from detention.\u003c/p>\n\u003cp>“They are in awe,” she said. “I get to see some hope and life in them.”\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_11715427\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/RS34586_IMG_3726-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11715427\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/RS34586_IMG_3726-qut.jpg\" alt=\"\" width=\"1920\" height=\"1415\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/12/RS34586_IMG_3726-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/12/RS34586_IMG_3726-qut-160x118.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/12/RS34586_IMG_3726-qut-800x590.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/12/RS34586_IMG_3726-qut-1020x752.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/12/RS34586_IMG_3726-qut-1200x884.jpg 1200w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">S.F. therapist Alicia Cruz’s sons, Ozzie (7) and Rio (11), collect toys to give to children released from immigrant detention in Texas. \u003ccite>(Courtesy of the Cruz-Hunt family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On a recent Friday, on the playground of the Creative Arts Charter School in San Francisco, Alicia Cruz watched as her son, Rio, stepped to the microphone during morning announcements.\u003c/p>\n\u003cp>“My mom is going to work in Texas to help the families in detention and families seeking asylum,” the fifth-grader told the crowd of students and teachers. “Please donate toys, like yo-yo’s, Legos, Slinkies or any small toys for kids.”\u003c/p>\n\u003cp>It wasn’t the first time Rio had collected toys for children coming out of Immigration and Customs Enforcement detention centers. Rio’s mom, a marriage and family therapist for Kaiser San Francisco, was moved to volunteer last year, when she learned that federal officials were taking infants and children away from their parents at the border.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/news/11714145/migrant-children-across-the-u-s\">Migrant Children Across the U.S.\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/news/11714145/migrant-children-across-the-u-s\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/trauma_122018_final-1180x764.jpg\" alt=\"\">\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>At Kaiser, Cruz specializes in adolescent trauma. She knew those family separations would create crises, especially for families who had fled violence in their home countries in Central America.\u003c/p>\n\u003cp>“The idea of being separated, to a parent, it’s just unimaginable,” Cruz said.\u003c/p>\n\u003cp>Rio cannot imagine it either.\u003c/p>\n\u003cp>“It would just be super hard if I got separated from my mom,” said the 11-year-old. “That’s why we’re trying to make a difference in this community.”\u003c/p>\n\u003cp>Cruz made the trip to Texas twice last year, using vacation time, as well as money and frequent flyer miles donated by other parents at the school. She brought the migrant children toys that Rio had collected, and gave small cash donations to their parents. Cruz heads to Texas again on Wednesday, Jan. 2.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/news/11710491/migrant-family-separations-didnt-end-despite-executive-order\">Migrant Family Separations Didn’t End Despite Executive Order\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/news/11710491/migrant-family-separations-didnt-end-despite-executive-order\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/12/GettyImages-973124260-e1544131091680.jpg\" alt=\"\">\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>“I’m going to go as often as I can because it’s amazing work and it’s much needed,” Cruz said. “I wish there were more therapists who could come.”\u003c/p>\n\u003cp>In June, \u003ca href=\"https://www.kqed.org/news/11677646/judge-bars-migrant-family-separations-orders-return-of-children-within-30-days\">a court forced the government to end the policy\u003c/a> that led to almost 2,700 family separations. And more than 90 percent of those kids have since been reunited. But immigration authorities continue to detain thousands of migrant families — most of them at two ICE facilities in Texas.\u003c/p>\n\u003cp>After parents pass an initial asylum screening, called a credible fear interview, most families are released from custody, typically after several weeks in detention. Each day, ICE agents \u003ca href=\"https://www.kqed.org/news/11701728/advocates-question-timing-of-change-in-migrant-families-releases\" target=\"_blank\" rel=\"noopener\">drop off\u003c/a> dozens of families at the Greyhound station in San Antonio, where they wait for buses that will take them to sponsors or family members across the country.\u003c/p>\n\u003cp>When Cruz gets to Texas, she will join other volunteers who hand out food, water, blankets and backpacks at the bus station and help guide migrants on the next leg of their journey.\u003c/p>\n\u003cp>The Refugee and Immigrant Center for Education and Legal Services, a local nonprofit group, has devised a bare-bones, 10-minute legal orientation.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘It is really a front-line, grassroots effort at the bus station. You have the families come in and you are squatting, you’re sitting on the floor with them, you are interacting with their children.’\u003ccite>Juan Rocha, The Refugee and Immigrant Center for Education and Legal Services\u003c/cite>\u003c/aside>\n\u003cp>“It is really a front-line, grassroots effort at the bus station,” said Juan Rocha, who runs the program for the group, known as \u003ca href=\"https://www.raicestexas.org/about/\" target=\"_blank\" rel=\"noopener\">RAICES\u003c/a>. “You have the families come in and you are squatting, you’re sitting on the floor with them, you are interacting with their children.”\u003c/p>\n\u003cp>Last year, RAICES provided its “know your rights” legal orientation to 1,972 parents who passed through the San Antonio Greyhound station.\u003c/p>\n\u003cp>Most of the people arriving at the station are Central Americans who have been released from ICE’s largest family detention facilities, each about an hour outside San Antonio. Fathers with sons come from the Karnes County Residential Center, and mothers with children arrive from the South Texas Family Residential Center in Dilley.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Rocha said the families have been through a lot.\u003c/p>\n\u003cp>“There is so much trauma experienced by the time that they get to the bus stations that all we can do is be cognizant of it, provide some simple comfort, and then get them on their way with as much knowledge as possible,” he said.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>\u003ca href=\"https://www.kqed.org/news/11711704/after-eight-month-separation-an-salvadoran-asylum-seeker-reconnects-with-4-year-old-son\">After 8-Month Separation, Salvadoran Asylum-Seeker Reconnects With 4-Year-Old Son\u003c/a>\u003c/h3>\n\u003cfigure>\u003c/figure>\n\u003c/aside>\n\u003cp>On her last trip to San Antonio, Cruz said, she counseled parents on how to respond when their children act out their anger or anxiety from what they’ve been through — experiences that can include witnessing acts of violence, a harrowing trip through unfamiliar countries and weeks in jail-like conditions. Cruz said she hands out pamphlets in Spanish on post-traumatic stress disorder and looks up contact information for psychological services in the cities where the migrants are heading.\u003c/p>\n\u003cp>With some families, Cruz only has a few minutes before their bus arrives. With other families she may spend hours.\u003c/p>\n\u003cp>When there was time, Cruz said, she took families to San Antonio’s River Walk, just a few blocks from the station, where they could stroll under the trees or let the kids romp in the grass.\u003c/p>\n\u003cp>She said this was often the family’s first experience in the United States, free from detention.\u003c/p>\n\u003cp>“They are in awe,” she said. “I get to see some hope and life in them.”\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"disqusTitle": "Mental Health Workers Start Weeklong Strike in California",
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"content": "\u003cp>Thousands of Kaiser Permanente mental health professionals throughout California started a weeklong strike Monday to protest what they say is a lack of staffing that affects care.\u003c/p>\n\u003cp>Outside Kaiser Permanente hospitals and clinics in the San Francisco Bay Area, dozens of workers marched Monday holding signs that said: \"Kaiser, Don't Deny My Patients Mental Health Care,\" and \"Care Delayed is Care Denied.\"\u003c/p>\n\u003cp>About 4,000 psychologists, therapists, social workers, psychiatric nurses and other medical professionals represented by the National Union of Healthcare Workers say they will picket through Friday.\u003c/p>\n\u003cp>Some non-urgent mental health and other appointments may need to be rescheduled but anyone in need of urgent mental health or other health care will receive the services they need, said Elita Fielder, a spokeswoman for Kaiser Permanente.\u003c/p>\n\u003cp>\"They've canceled appointments for these five days, but there's a critical situation every day of the year,\" Sal Rosselli, National Union of Healthcare Workers president, \u003ca href=\"https://www.eastbaytimes.com/2018/12/09/kaiser-strike-mental-health-workers-to-picket-over-staffing-benefits/\" target=\"_blank\" rel=\"noopener\">told\u003c/a> the East Bay Times.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Rosselli said patients have to wait a month or more for follow-up appointments because of inadequate staffing.\u003c/p>\n\u003cp>Fielder said Kaiser Permanente has added more than 500 mental health care therapists and invested $175 million to expand mental health care offices since 2015, when the threat of an open-ended strike was averted after the union and Kaiser agreed to a contract.\u003c/p>\n\u003cp>The union's main concern is increasing its workers' wages, which she said are already the highest in the state.\u003c/p>\n\u003cp>Rosselli said negotiators are seeking pay increases as well as benefits packages equal to those given to other medical professionals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Although Kaiser has hired hundreds more mental health professionals, patient care and access have stayed the same or worsened as the health care provider has expanded its client base significantly and some caregivers have left, Rosselli said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Thousands of Kaiser Permanente mental health professionals throughout California started a weeklong strike Monday to protest what they say is a lack of staffing that affects care.\u003c/p>\n\u003cp>Outside Kaiser Permanente hospitals and clinics in the San Francisco Bay Area, dozens of workers marched Monday holding signs that said: \"Kaiser, Don't Deny My Patients Mental Health Care,\" and \"Care Delayed is Care Denied.\"\u003c/p>\n\u003cp>About 4,000 psychologists, therapists, social workers, psychiatric nurses and other medical professionals represented by the National Union of Healthcare Workers say they will picket through Friday.\u003c/p>\n\u003cp>Some non-urgent mental health and other appointments may need to be rescheduled but anyone in need of urgent mental health or other health care will receive the services they need, said Elita Fielder, a spokeswoman for Kaiser Permanente.\u003c/p>\n\u003cp>\"They've canceled appointments for these five days, but there's a critical situation every day of the year,\" Sal Rosselli, National Union of Healthcare Workers president, \u003ca href=\"https://www.eastbaytimes.com/2018/12/09/kaiser-strike-mental-health-workers-to-picket-over-staffing-benefits/\" target=\"_blank\" rel=\"noopener\">told\u003c/a> the East Bay Times.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Rosselli said patients have to wait a month or more for follow-up appointments because of inadequate staffing.\u003c/p>\n\u003cp>Fielder said Kaiser Permanente has added more than 500 mental health care therapists and invested $175 million to expand mental health care offices since 2015, when the threat of an open-ended strike was averted after the union and Kaiser agreed to a contract.\u003c/p>\n\u003cp>The union's main concern is increasing its workers' wages, which she said are already the highest in the state.\u003c/p>\n\u003cp>Rosselli said negotiators are seeking pay increases as well as benefits packages equal to those given to other medical professionals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Although Kaiser has hired hundreds more mental health professionals, patient care and access have stayed the same or worsened as the health care provider has expanded its client base significantly and some caregivers have left, Rosselli said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "As Fire Trauma Lingers, Santa Rosa Health Care Center Takes the Long Road",
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"content": "\u003cp>Naxheli Zuniga Contreras first came to the Integrated Wellness Center in Santa Rosa to get her kids some tutoring help. She liked that it was a place open after school and work, that she didn't need any documentation and the services were free. There was even a nurse and mental health counseling. But it wasn't until the smoke from the Butte County Camp Fire some 150 miles away drifted over Santa Rosa that she found herself there asking for the first time for mental health care.\u003c/p>\n\u003cp>\"I'm worried for myself, the safety for my family. We haven't been able to sleep,\" Zuniga said, through a translator.\u003c/p>\n\u003cp>The smoke took them back to that horrifying night of the Tubbs Fire a year ago when they smelled smoke and heard the flames coming and had to race from their home. When the family returned a week later their home was a smoke-damaged disaster.\u003c/p>\n\u003cp>\"We are so worried it's going to come back and it's going to be another fire,\" said Zuniga. \"And we're going to have to go back to that situation and start all over again.\"\u003c/p>\n\u003cp>Zuniga began feeling so anxious she said she couldn't find the words to calm her children, so she took them to the Integrated Wellness Center.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"I think when the parent has anxiety, the kids pick up on this,\" she said. Zuniga's daughter had come home from school and told her mom that girls she knew were crying at school after they saw the smoke.\u003c/p>\n\u003cp>\"I want her to talk to a counselor. I hope they can help.\" she said.\u003c/p>\n\u003cfigure id=\"attachment_11707501\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-11707501 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/11/IMG_4287-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4287-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4287-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4287-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4287-1200x900.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4287-1920x1440.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Students can get tutoring while parents access mental health counseling. \u003ccite>(Julia McEvoy/KQED News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Santa Rosa City Schools District started the center temporarily in an empty school building during the holidays last year after the Tubbs fire when it was clear families were going to continue to need help during the school break. It's since become a permanent community clinic of sorts, open three days a week after school.\u003c/p>\n\u003cp>Clients now include a secondary wave of families who are renters who have been displaced, sometimes by home owners who needed to move back in. Sometimes these renters could only find housing miles away from their kids' schools, says Steve Mizera, head of the district's student and family services.\u003c/p>\n\u003cp>\"The long term-ness of these problems for these families that have been displaced is really hitting hard right now,\" said Mizeri.\u003c/p>\n\u003cp>The Integrated Wellness Center is open again this holiday season, staffed by county office emergency fire recovery therapists, or school counselors, Mizera said.\u003c/p>\n\u003cfigure id=\"attachment_11707503\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-11707503 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/11/IMG_4294-e1542734651444-800x1067.jpg\" alt=\"\" width=\"800\" height=\"1067\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4294-e1542734651444-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4294-e1542734651444-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4294-e1542734651444-1020x1360.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4294-e1542734651444-900x1200.jpg 900w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4294-e1542734651444-1920x2560.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Some of the books available to kids in the Wellness Center.\u003c/figcaption>\u003c/figure>\n\u003cp>Santa Rosa city schools are feeling the long-term effects of the Tubbs fire, which leveled much of Coffey Park and destroyed thousands of homes. Sonoma County Office of Education calculates the county has lost some 1,600 students. But for those who lost homes and have been able to resettle, the stressors continue and Mizera says that anxiety is showing up in classrooms.\u003c/p>\n\u003cp>\"There was an initial first wave of impact and now this second wave,\" said Mizera. \"We call it 'fire-affected'. He said its hard to know how many families are dealing with this because many try to hide their troubles.\u003c/p>\n\u003cp>But this fall when school started Mizera said staff picked up on the tension right away, \"It was like it was spring,\" he said, referring to the end of school energy teachers often brace for during a normal school year, \"Everyone noticed it.\"\u003c/p>\n\u003cp>Mizera said the fallout from the fires here is still rippling out for staff and students well past the one year anniversary last October, \"It's just a lot of anxiety of living conditions. So all those little stressors have kind of magnified themselves in many many ways.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"There's a lot of angst,\" he said.\"We are realizing fire trauma may be something we will be dealing with for a long time.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Naxheli Zuniga Contreras first came to the Integrated Wellness Center in Santa Rosa to get her kids some tutoring help. She liked that it was a place open after school and work, that she didn't need any documentation and the services were free. There was even a nurse and mental health counseling. But it wasn't until the smoke from the Butte County Camp Fire some 150 miles away drifted over Santa Rosa that she found herself there asking for the first time for mental health care.\u003c/p>\n\u003cp>\"I'm worried for myself, the safety for my family. We haven't been able to sleep,\" Zuniga said, through a translator.\u003c/p>\n\u003cp>The smoke took them back to that horrifying night of the Tubbs Fire a year ago when they smelled smoke and heard the flames coming and had to race from their home. When the family returned a week later their home was a smoke-damaged disaster.\u003c/p>\n\u003cp>\"We are so worried it's going to come back and it's going to be another fire,\" said Zuniga. \"And we're going to have to go back to that situation and start all over again.\"\u003c/p>\n\u003cp>Zuniga began feeling so anxious she said she couldn't find the words to calm her children, so she took them to the Integrated Wellness Center.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I think when the parent has anxiety, the kids pick up on this,\" she said. Zuniga's daughter had come home from school and told her mom that girls she knew were crying at school after they saw the smoke.\u003c/p>\n\u003cp>\"I want her to talk to a counselor. I hope they can help.\" she said.\u003c/p>\n\u003cfigure id=\"attachment_11707501\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-11707501 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/11/IMG_4287-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4287-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4287-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4287-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4287-1200x900.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4287-1920x1440.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Students can get tutoring while parents access mental health counseling. \u003ccite>(Julia McEvoy/KQED News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Santa Rosa City Schools District started the center temporarily in an empty school building during the holidays last year after the Tubbs fire when it was clear families were going to continue to need help during the school break. It's since become a permanent community clinic of sorts, open three days a week after school.\u003c/p>\n\u003cp>Clients now include a secondary wave of families who are renters who have been displaced, sometimes by home owners who needed to move back in. Sometimes these renters could only find housing miles away from their kids' schools, says Steve Mizera, head of the district's student and family services.\u003c/p>\n\u003cp>\"The long term-ness of these problems for these families that have been displaced is really hitting hard right now,\" said Mizeri.\u003c/p>\n\u003cp>The Integrated Wellness Center is open again this holiday season, staffed by county office emergency fire recovery therapists, or school counselors, Mizera said.\u003c/p>\n\u003cfigure id=\"attachment_11707503\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-11707503 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/11/IMG_4294-e1542734651444-800x1067.jpg\" alt=\"\" width=\"800\" height=\"1067\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4294-e1542734651444-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4294-e1542734651444-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4294-e1542734651444-1020x1360.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4294-e1542734651444-900x1200.jpg 900w, https://ww2.kqed.org/app/uploads/sites/10/2018/11/IMG_4294-e1542734651444-1920x2560.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Some of the books available to kids in the Wellness Center.\u003c/figcaption>\u003c/figure>\n\u003cp>Santa Rosa city schools are feeling the long-term effects of the Tubbs fire, which leveled much of Coffey Park and destroyed thousands of homes. Sonoma County Office of Education calculates the county has lost some 1,600 students. But for those who lost homes and have been able to resettle, the stressors continue and Mizera says that anxiety is showing up in classrooms.\u003c/p>\n\u003cp>\"There was an initial first wave of impact and now this second wave,\" said Mizera. \"We call it 'fire-affected'. He said its hard to know how many families are dealing with this because many try to hide their troubles.\u003c/p>\n\u003cp>But this fall when school started Mizera said staff picked up on the tension right away, \"It was like it was spring,\" he said, referring to the end of school energy teachers often brace for during a normal school year, \"Everyone noticed it.\"\u003c/p>\n\u003cp>Mizera said the fallout from the fires here is still rippling out for staff and students well past the one year anniversary last October, \"It's just a lot of anxiety of living conditions. So all those little stressors have kind of magnified themselves in many many ways.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"There's a lot of angst,\" he said.\"We are realizing fire trauma may be something we will be dealing with for a long time.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Judge Orders Investigation of Possible Fraud in Prisoner Psychiatric Care Case",
"title": "Judge Orders Investigation of Possible Fraud in Prisoner Psychiatric Care Case",
"headTitle": "The California Report | KQED News",
"content": "\u003cp>A federal judge overseeing improvements to psychiatric care in California’s prisons plans to appoint an experienced fraud investigator to look into allegations that state officials gave her inaccurate or misleading data in a long-running civil lawsuit.\u003c/p>\n\u003cp>In an eight-page order issued late Tuesday, U.S. District Judge Kimberly Mueller said the investigation would focus first on whether prison leaders committed fraud upon the court.\u003c/p>\n\u003cp>The decision follows revelations in a report last month by the chief psychiatrist for the prisons, Dr. Michael Golding, who \u003ca href=\"https://www.kqed.org/news/11700464/did-california-prison-officials-distort-record-on-psychiatric-care\" target=\"_blank\" rel=\"noopener\">accused \u003c/a>state officials of distorting data to mask the state’s \u003ca href=\"https://www.kqed.org/news/11702604/california-prisons-chief-psychiatrist-says-hidden-data-exposes-broken-system-of-care\" target=\"_blank\" rel=\"noopener\">failure\u003c/a> to meet court-mandated deadlines for providing treatment for prisoners who suffer from mental illness.\u003c/p>\n\u003cp>Initially resistant to the idea of appointing an independent investigator to look into the allegations, Mueller wrote she was convinced to move forward after learning of a second \u003ca href=\"https://www.kqed.org/news/11704769/second-state-psychiatrist-files-complaint-on-prisoner-care-in-california\" target=\"_blank\" rel=\"noopener\">whistleblower\u003c/a> just last week.\u003c/p>\n\u003cp>“The court is persuaded that appointment of an experienced, highly competent, independent investigator is necessary to an efficient resolution of the issues presented by the Golding Report,” Mueller wrote.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The judge also rebuked attorneys for the state for backtracking on their support for an independent investigation at a Nov. 5 status conference.\u003c/p>\n\u003cp>\"Their change in position appears motivated by the desire to prevent any independent investigation at the court’s behest,\" Mueller stated. \"But the court cannot shrink from the need to resolve the questions of fraud raised by Dr. Golding’s report.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The judge said she will also ask the investigator to consider whether the state needs to change how it reports to the court on prison psychiatric care, to make sure she gets an accurate picture of whether mental health care for inmates is improving.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A federal judge overseeing improvements to psychiatric care in California’s prisons plans to appoint an experienced fraud investigator to look into allegations that state officials gave her inaccurate or misleading data in a long-running civil lawsuit.\u003c/p>\n\u003cp>In an eight-page order issued late Tuesday, U.S. District Judge Kimberly Mueller said the investigation would focus first on whether prison leaders committed fraud upon the court.\u003c/p>\n\u003cp>The decision follows revelations in a report last month by the chief psychiatrist for the prisons, Dr. Michael Golding, who \u003ca href=\"https://www.kqed.org/news/11700464/did-california-prison-officials-distort-record-on-psychiatric-care\" target=\"_blank\" rel=\"noopener\">accused \u003c/a>state officials of distorting data to mask the state’s \u003ca href=\"https://www.kqed.org/news/11702604/california-prisons-chief-psychiatrist-says-hidden-data-exposes-broken-system-of-care\" target=\"_blank\" rel=\"noopener\">failure\u003c/a> to meet court-mandated deadlines for providing treatment for prisoners who suffer from mental illness.\u003c/p>\n\u003cp>Initially resistant to the idea of appointing an independent investigator to look into the allegations, Mueller wrote she was convinced to move forward after learning of a second \u003ca href=\"https://www.kqed.org/news/11704769/second-state-psychiatrist-files-complaint-on-prisoner-care-in-california\" target=\"_blank\" rel=\"noopener\">whistleblower\u003c/a> just last week.\u003c/p>\n\u003cp>“The court is persuaded that appointment of an experienced, highly competent, independent investigator is necessary to an efficient resolution of the issues presented by the Golding Report,” Mueller wrote.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The judge also rebuked attorneys for the state for backtracking on their support for an independent investigation at a Nov. 5 status conference.\u003c/p>\n\u003cp>\"Their change in position appears motivated by the desire to prevent any independent investigation at the court’s behest,\" Mueller stated. \"But the court cannot shrink from the need to resolve the questions of fraud raised by Dr. Golding’s report.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The judge said she will also ask the investigator to consider whether the state needs to change how it reports to the court on prison psychiatric care, to make sure she gets an accurate picture of whether mental health care for inmates is improving.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>[dropcap]S[/dropcap]hortly after Lucas Boek joined his local fire department, he saw a veteran firefighter walk into firehouse and drop all his gear. “’That’s it, I’m done,’” Boek remembers the man saying. “’I can’t do this anymore.’ And he left.”\u003c/p>\n\u003cp>Over the years, the incident stuck with him.\u003c/p>\n\u003cp>Now, Boek is sitting and talking with two other men in a Ukiah high school classroom. Between the three — medic Corey Bender, 44, and firefighters Lucas Boek, 40, and Brendan Turner, 46 — they have nearly 60 years of experience in emergency response. Sixty years of running toward car accidents, gunshots and flames.\u003c/p>\n\u003cp>But it’s not the physical danger of the work that these guys are talking about today. \u003c/p>\n\u003cp>It’s something else, something that until recently has been pretty difficult to discuss openly: their mental health. A \u003ca href=\"http://rudermanfoundation.org/white_papers/police-officers-and-firefighters-are-more-likely-to-die-by-suicide-than-in-line-of-duty/\" target=\"_blank\" rel=\"noopener\">2017 study\u003c/a> found that police officers and firefighters are more likely to die by suicide than in the line of duty. Another \u003ca href=\"https://www.phoenix.edu/about_us/media-center/news/uopx-releases-first-responder-mental-health-survey-results.html\" target=\"_blank\" rel=\"noopener\">survey\u003c/a> done last year by the University of Phoenix found that 85 percent of first responders have symptoms related to mental health issues.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“To a certain extent I agree with what my therapist said, which is that she’s never met a first responder that’s been working in the field full-time for more than 20 years that isn’t a little bit messed up,” Turner says.\u003c/p>\n\u003cfigure id=\"attachment_11698397\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/10/IMG_2982-800x533.jpg\" alt=\"Brendan Turner stands by his fire truck behind the Redwood Valley Fire Department in Mendocino.\" width=\"800\" height=\"533\" class=\"size-medium wp-image-11698397\">\u003cfigcaption class=\"wp-caption-text\">Brendan Turner stands by his fire truck behind the Redwood Valley Fire Department in Mendocino. \u003ccite>(Marisa Lagos/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>As they talk, these guys keep going back to the metaphor of “the bucket” to explain the effect of cumulative stress on their psyches. \u003c/p>\n\u003cp>Each call they respond to adds another rock to that bucket, and when that bucket overflows, the effects can be disastrous.\u003c/p>\n\u003cp>Bender says he’s personally known veteran paramedics and firefighters who have quit on a dime, have been alienated from their families or have committed suicide after years of service.\u003c/p>\n\u003cp>“And the number one killer in the fire and EMS services is heart attack,” Bender says.\u003c/p>\n\u003cp>The conversation these three guys are having was pretty unthinkable even just a few years ago. But for many of those who responded to the October fire siege, this conversation is not only urgent now — but finally possible.\u003c/p>\n\u003cp>“You know every single call was a drop in that bucket, and that bucket for some of us was pretty darn close to full before that happened,” Turner says. “It got kicked over in October for many of us.”\u003c/p>\n\u003ch2>Last October\u003c/h2>\n\u003cp>On Oct. 8, 2017, Turner was acting fire chief in Redwood Valley, when he got a call around 11:30 p.m. about a fire in the neighboring town of Potter Valley. An hour later, an ember pushed by incredibly high winds ignited another fire that was sweeping down into Redwood Valley.\u003c/p>\n\u003cp>Firefighters consider a fire moving at 3 mph to be extremely dangerous, Turner says. This fire was moving 18-20 mph.\u003c/p>\n\u003cfigure id=\"attachment_11698403\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/10/IMG_3013-e1539362096335-800x1200.jpg\" alt=\"Redwood Valley relies on a largely volunteer firefighting department like many rural towns.\" width=\"800\" height=\"1200\" class=\"size-medium wp-image-11698403\">\u003cfigcaption class=\"wp-caption-text\">Redwood Valley relies on a largely volunteer firefighting department like many rural towns. \u003ccite>(Marisa Lagos/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“You can’t outrun that on foot,” Turner says.\u003c/p>\n\u003cp>Turner remembers that night like a series of movie trailers in his head — disjointed and in no particular order. It is a blur of trying to rescue people trapped by flames and making split-second life-or-death decisions.\u003c/p>\n\u003cp>“I don’t know that I’m ever going to have that full movie in my head,” he says.\u003c/p>\n\u003cp>It was like nothing Turner had seen before, and it devastated their tiny community of fewer than 2,000 people, burning down more than 500 homes. \u003c/p>\n\u003cp>Turner’s in-laws lost their home. Another volunteer firefighter drove past his own home on fire, to evacuate people from harm’s way. He wasn’t able to confirm until the following morning that his wife made it out alive. Nine people, including two teenagers, died.\u003c/p>\n\u003cp>For Turner and Boek, this fire was incredibly personal. They had spent time inside the homes that were burning and knew the burn patients they were bandaging and sending to the hospital.\u003c/p>\n\u003cp>“For me it just really wrecked me, like it really hurt a lot,” Boek said.\u003c/p>\n\u003ch2>An Injury, Not a Disorder\u003c/h2>\n\u003cp>Turner says in the months after the fire he became a hermit. He stopped going out in public or shopping at the local supermarket.\u003c/p>\n\u003cp>“My perception was that, you know, people were looking at me different,” he said.\u003c/p>\n\u003cp>But isolation also didn’t help. He would wake up in the night in full fight-or-flight mode, replaying the worst calls of his career. When the wind picked up, his whole body would go taut and his chest would tighten.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch2>Mental Health Resources for First Responders\u003c/h2>\n\u003cul>\n\u003cli>\u003ca href=\"http://www.managingtheghosts.org/resources/\">‘Managing the Ghosts,’ a Meeting Directory for First Responders\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.facebook.com/managingtheghosts/?ref=br_rs\">A First Responders Facebook Group\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.helpguide.org/articles/ptsd-trauma/helping-someone-with-ptsd.htm\">Resources for the Loved Ones of First Responders\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"http://ptsdusa.org/get-help/first-responders/ptsd-assessment-form/\">A PTSD Assessment Form for First Responders\u003c/a>\u003c/li>\n\u003c/ul>\u003c/aside>\n\u003cp>Then on Christmas Eve, a friend who’d also been an emergency responder came up to him at a party.\u003c/p>\n\u003cp>“That person approached me and said, ‘I think you need to talk to somebody,'” Turner remembers. “Without blinking. I said, ‘Yes I think that’s a good idea.'”\u003c/p>\n\u003cp>In therapy Turner was finally able to talk about not just the October firestorm, but his 23 years of being a witness to some of the most extreme and traumatic events human beings experience. It all came tumbling out of him.\u003c/p>\n\u003cp>Not surprisingly, Turner was diagnosed with PTSD. But he doesn’t think of it as a disorder, which implies a pre-existing condition. He calls it an injury.\u003c/p>\n\u003cp>“I look at it the same way as if I were to break my ankle on a call,” he says. “I would go to an orthopedic surgeon, right, and get that fixed? I view this the same way.”\u003c/p>\n\u003cp>Turner says now he is learning how to treat this injury, through breathing techniques, meditation and by reaching out to other first responders.\u003c/p>\n\u003ch2>Not the Only One\u003c/h2>\n\u003cp>Earlier this year, Turner reached out to Corey Bender, his old friend from paramedic school, with the idea of putting together a peer group.\u003c/p>\n\u003cp>“I’m like, ‘I think that’s an amazing idea,'” Bender says.\u003c/p>\n\u003cfigure id=\"attachment_11698401\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/10/IMG_3363-800x600.jpg\" alt=\"Corey Bender has been a medic for 18 years. He now lives in Redwood Valley.\" width=\"800\" height=\"600\" class=\"size-medium wp-image-11698401\">\u003cfigcaption class=\"wp-caption-text\">Corey Bender has been a medic for 18 years. He now lives in Redwood Valley. \u003ccite>(Sukey Lewis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Completely independently, Bender found he was being approached by more and more people — military veterans, police officers, medics and sheriff’s deputies — all of them speaking about the same thing: PTSD and cumulative stress.\u003c/p>\n\u003cp>The peer group now gets together every few weeks or so, and they just talk.\u003c/p>\n\u003cp>Turner remembers a meeting in which he was describing the symptoms he has of chest discomfort — a kind of numbing sensation that travels down his arm.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘I don’t want my kids to think that I’m hurt or broken, even though maybe I am a little hurt and broken.’\u003ccite>Firefighter Lucas Boek\u003c/cite>\u003c/aside>\n\u003cp>“One of the members of that group said, ‘Oh no it starts right here.’” Turner says the man pointed to an area on his chest.\u003c/p>\n\u003cp>“‘And it feels like crawling under your skin,’” Tuner says. “And I apologized. I said, ‘I’m sorry did I already tell you this?’ He goes, ‘No, I’m telling you what I experience.’ It was almost identical.”\u003c/p>\n\u003cp>The group is made up primarily of people who have been doing this work for decades. They share bad calls, but also talk about their fears, their feelings and their families.\u003c/p>\n\u003cp>Firefighter Boek says he called up Turner one day because he felt like he was letting down his kids. He was used to being able to handle anything — he kind of felt like Superman. Now he found himself crying in the kitchen for no apparent reason.\u003c/p>\n\u003cp>“I don’t want my kids to think that I’m hurt or broken, even though maybe I am a little hurt and broken,” Boek says.\u003c/p>\n\u003cfigure id=\"attachment_11698400\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/10/IMG_3366-800x600.jpg\" alt=\"Firefighter Lucas Boek says the Redwood Valley Fire hit himself and his community really hard.\" width=\"800\" height=\"600\" class=\"size-medium wp-image-11698400\">\u003cfigcaption class=\"wp-caption-text\">Firefighter Lucas Boek says the Redwood Valley Fire hit himself and his community really hard. \u003ccite>(Sukey Lewis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But Turner says he has come to see that they’ve been actually letting down their families for years — by pretending that they’re not affected by this work. They can actually help their own kids, he says, and other young people who are just starting out as emergency responders by modeling emotional openness.\u003c/p>\n\u003cp>“If there’s one positive that I can see from that horrible incident, it’s that the shell that was starting to crack — the attitude and really the lack of honesty about emotions in emergency services — it went from having some cracks in it to shattering for a lot of us,” Turner says.\u003c/p>\n\u003ch2>A New Kind of Emergency Responder\u003c/h2>\n\u003cp>A few months ago, Turned stepped down as assistant fire chief in Redwood Valley. He still volunteers, but he has a new job now teaching health occupations to high school kids.\u003c/p>\n\u003cp>Along with homework assignments and reading, the words “evacuations” and “disaster response” are written on whiteboard in his classroom.\u003c/p>\n\u003cp>Many of his students are considering a career in emergency response. He wants them to go into this work with their eyes wide open.\u003c/p>\n\u003cp>Recently, Turner’s class did a review of Hurricane Katrina. They spent three days watching footage of the disaster and discussing the health care crisis that occurred in the hurricane’s aftermath.\u003c/p>\n\u003cp>“That’s pretty heavy for some high school kids to watch that,” Turner says.\u003c/p>\n\u003cp>So, a counselor for the school came into the classroom and did a presentation on techniques to deal with stress and emotions. Turner said when things would get intense, they would take a break and all practice breathing exercises.\u003c/p>\n\u003cfigure id=\"attachment_11698407\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/10/RanchFire_AW_105-800x533.jpg\" alt=\"A firefighter holds a hand tool ready to build containment around the Ranch Fire. \" width=\"800\" height=\"533\" class=\"size-medium wp-image-11698407\">\u003cfigcaption class=\"wp-caption-text\">A firefighter holds a hand tool ready to build containment around the Ranch Fire. \u003ccite>(Anne Wernikoff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Turner hopes by sharing his own experiences and teaching these young people the tools to cope with those experiences, he can better equip them to manage their own buckets of rocks, now and in the future.\u003c/p>\n\u003cp>“It doesn’t have to end with the firefighter walking in and dropping their gear on the floor and saying you know, ‘Bleep this, I’m done,'” he says. “And I think that’s really what we want to prevent.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>KQED reporter Marisa Lagos contributed to this report. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">S\u003c/span>\u003c/p>\u003cp>hortly after Lucas Boek joined his local fire department, he saw a veteran firefighter walk into firehouse and drop all his gear. “’That’s it, I’m done,’” Boek remembers the man saying. “’I can’t do this anymore.’ And he left.”\u003c/p>\n\u003cp>Over the years, the incident stuck with him.\u003c/p>\n\u003cp>Now, Boek is sitting and talking with two other men in a Ukiah high school classroom. Between the three — medic Corey Bender, 44, and firefighters Lucas Boek, 40, and Brendan Turner, 46 — they have nearly 60 years of experience in emergency response. Sixty years of running toward car accidents, gunshots and flames.\u003c/p>\n\u003cp>But it’s not the physical danger of the work that these guys are talking about today. \u003c/p>\n\u003cp>It’s something else, something that until recently has been pretty difficult to discuss openly: their mental health. A \u003ca href=\"http://rudermanfoundation.org/white_papers/police-officers-and-firefighters-are-more-likely-to-die-by-suicide-than-in-line-of-duty/\" target=\"_blank\" rel=\"noopener\">2017 study\u003c/a> found that police officers and firefighters are more likely to die by suicide than in the line of duty. Another \u003ca href=\"https://www.phoenix.edu/about_us/media-center/news/uopx-releases-first-responder-mental-health-survey-results.html\" target=\"_blank\" rel=\"noopener\">survey\u003c/a> done last year by the University of Phoenix found that 85 percent of first responders have symptoms related to mental health issues.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“To a certain extent I agree with what my therapist said, which is that she’s never met a first responder that’s been working in the field full-time for more than 20 years that isn’t a little bit messed up,” Turner says.\u003c/p>\n\u003cfigure id=\"attachment_11698397\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/10/IMG_2982-800x533.jpg\" alt=\"Brendan Turner stands by his fire truck behind the Redwood Valley Fire Department in Mendocino.\" width=\"800\" height=\"533\" class=\"size-medium wp-image-11698397\">\u003cfigcaption class=\"wp-caption-text\">Brendan Turner stands by his fire truck behind the Redwood Valley Fire Department in Mendocino. \u003ccite>(Marisa Lagos/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>As they talk, these guys keep going back to the metaphor of “the bucket” to explain the effect of cumulative stress on their psyches. \u003c/p>\n\u003cp>Each call they respond to adds another rock to that bucket, and when that bucket overflows, the effects can be disastrous.\u003c/p>\n\u003cp>Bender says he’s personally known veteran paramedics and firefighters who have quit on a dime, have been alienated from their families or have committed suicide after years of service.\u003c/p>\n\u003cp>“And the number one killer in the fire and EMS services is heart attack,” Bender says.\u003c/p>\n\u003cp>The conversation these three guys are having was pretty unthinkable even just a few years ago. But for many of those who responded to the October fire siege, this conversation is not only urgent now — but finally possible.\u003c/p>\n\u003cp>“You know every single call was a drop in that bucket, and that bucket for some of us was pretty darn close to full before that happened,” Turner says. “It got kicked over in October for many of us.”\u003c/p>\n\u003ch2>Last October\u003c/h2>\n\u003cp>On Oct. 8, 2017, Turner was acting fire chief in Redwood Valley, when he got a call around 11:30 p.m. about a fire in the neighboring town of Potter Valley. An hour later, an ember pushed by incredibly high winds ignited another fire that was sweeping down into Redwood Valley.\u003c/p>\n\u003cp>Firefighters consider a fire moving at 3 mph to be extremely dangerous, Turner says. This fire was moving 18-20 mph.\u003c/p>\n\u003cfigure id=\"attachment_11698403\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/10/IMG_3013-e1539362096335-800x1200.jpg\" alt=\"Redwood Valley relies on a largely volunteer firefighting department like many rural towns.\" width=\"800\" height=\"1200\" class=\"size-medium wp-image-11698403\">\u003cfigcaption class=\"wp-caption-text\">Redwood Valley relies on a largely volunteer firefighting department like many rural towns. \u003ccite>(Marisa Lagos/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“You can’t outrun that on foot,” Turner says.\u003c/p>\n\u003cp>Turner remembers that night like a series of movie trailers in his head — disjointed and in no particular order. It is a blur of trying to rescue people trapped by flames and making split-second life-or-death decisions.\u003c/p>\n\u003cp>“I don’t know that I’m ever going to have that full movie in my head,” he says.\u003c/p>\n\u003cp>It was like nothing Turner had seen before, and it devastated their tiny community of fewer than 2,000 people, burning down more than 500 homes. \u003c/p>\n\u003cp>Turner’s in-laws lost their home. Another volunteer firefighter drove past his own home on fire, to evacuate people from harm’s way. He wasn’t able to confirm until the following morning that his wife made it out alive. Nine people, including two teenagers, died.\u003c/p>\n\u003cp>For Turner and Boek, this fire was incredibly personal. They had spent time inside the homes that were burning and knew the burn patients they were bandaging and sending to the hospital.\u003c/p>\n\u003cp>“For me it just really wrecked me, like it really hurt a lot,” Boek said.\u003c/p>\n\u003ch2>An Injury, Not a Disorder\u003c/h2>\n\u003cp>Turner says in the months after the fire he became a hermit. He stopped going out in public or shopping at the local supermarket.\u003c/p>\n\u003cp>“My perception was that, you know, people were looking at me different,” he said.\u003c/p>\n\u003cp>But isolation also didn’t help. He would wake up in the night in full fight-or-flight mode, replaying the worst calls of his career. When the wind picked up, his whole body would go taut and his chest would tighten.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch2>Mental Health Resources for First Responders\u003c/h2>\n\u003cul>\n\u003cli>\u003ca href=\"http://www.managingtheghosts.org/resources/\">‘Managing the Ghosts,’ a Meeting Directory for First Responders\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.facebook.com/managingtheghosts/?ref=br_rs\">A First Responders Facebook Group\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.helpguide.org/articles/ptsd-trauma/helping-someone-with-ptsd.htm\">Resources for the Loved Ones of First Responders\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"http://ptsdusa.org/get-help/first-responders/ptsd-assessment-form/\">A PTSD Assessment Form for First Responders\u003c/a>\u003c/li>\n\u003c/ul>\u003c/aside>\n\u003cp>Then on Christmas Eve, a friend who’d also been an emergency responder came up to him at a party.\u003c/p>\n\u003cp>“That person approached me and said, ‘I think you need to talk to somebody,'” Turner remembers. “Without blinking. I said, ‘Yes I think that’s a good idea.'”\u003c/p>\n\u003cp>In therapy Turner was finally able to talk about not just the October firestorm, but his 23 years of being a witness to some of the most extreme and traumatic events human beings experience. It all came tumbling out of him.\u003c/p>\n\u003cp>Not surprisingly, Turner was diagnosed with PTSD. But he doesn’t think of it as a disorder, which implies a pre-existing condition. He calls it an injury.\u003c/p>\n\u003cp>“I look at it the same way as if I were to break my ankle on a call,” he says. “I would go to an orthopedic surgeon, right, and get that fixed? I view this the same way.”\u003c/p>\n\u003cp>Turner says now he is learning how to treat this injury, through breathing techniques, meditation and by reaching out to other first responders.\u003c/p>\n\u003ch2>Not the Only One\u003c/h2>\n\u003cp>Earlier this year, Turner reached out to Corey Bender, his old friend from paramedic school, with the idea of putting together a peer group.\u003c/p>\n\u003cp>“I’m like, ‘I think that’s an amazing idea,'” Bender says.\u003c/p>\n\u003cfigure id=\"attachment_11698401\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/10/IMG_3363-800x600.jpg\" alt=\"Corey Bender has been a medic for 18 years. He now lives in Redwood Valley.\" width=\"800\" height=\"600\" class=\"size-medium wp-image-11698401\">\u003cfigcaption class=\"wp-caption-text\">Corey Bender has been a medic for 18 years. He now lives in Redwood Valley. \u003ccite>(Sukey Lewis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Completely independently, Bender found he was being approached by more and more people — military veterans, police officers, medics and sheriff’s deputies — all of them speaking about the same thing: PTSD and cumulative stress.\u003c/p>\n\u003cp>The peer group now gets together every few weeks or so, and they just talk.\u003c/p>\n\u003cp>Turner remembers a meeting in which he was describing the symptoms he has of chest discomfort — a kind of numbing sensation that travels down his arm.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘I don’t want my kids to think that I’m hurt or broken, even though maybe I am a little hurt and broken.’\u003ccite>Firefighter Lucas Boek\u003c/cite>\u003c/aside>\n\u003cp>“One of the members of that group said, ‘Oh no it starts right here.’” Turner says the man pointed to an area on his chest.\u003c/p>\n\u003cp>“‘And it feels like crawling under your skin,’” Tuner says. “And I apologized. I said, ‘I’m sorry did I already tell you this?’ He goes, ‘No, I’m telling you what I experience.’ It was almost identical.”\u003c/p>\n\u003cp>The group is made up primarily of people who have been doing this work for decades. They share bad calls, but also talk about their fears, their feelings and their families.\u003c/p>\n\u003cp>Firefighter Boek says he called up Turner one day because he felt like he was letting down his kids. He was used to being able to handle anything — he kind of felt like Superman. Now he found himself crying in the kitchen for no apparent reason.\u003c/p>\n\u003cp>“I don’t want my kids to think that I’m hurt or broken, even though maybe I am a little hurt and broken,” Boek says.\u003c/p>\n\u003cfigure id=\"attachment_11698400\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/10/IMG_3366-800x600.jpg\" alt=\"Firefighter Lucas Boek says the Redwood Valley Fire hit himself and his community really hard.\" width=\"800\" height=\"600\" class=\"size-medium wp-image-11698400\">\u003cfigcaption class=\"wp-caption-text\">Firefighter Lucas Boek says the Redwood Valley Fire hit himself and his community really hard. \u003ccite>(Sukey Lewis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But Turner says he has come to see that they’ve been actually letting down their families for years — by pretending that they’re not affected by this work. They can actually help their own kids, he says, and other young people who are just starting out as emergency responders by modeling emotional openness.\u003c/p>\n\u003cp>“If there’s one positive that I can see from that horrible incident, it’s that the shell that was starting to crack — the attitude and really the lack of honesty about emotions in emergency services — it went from having some cracks in it to shattering for a lot of us,” Turner says.\u003c/p>\n\u003ch2>A New Kind of Emergency Responder\u003c/h2>\n\u003cp>A few months ago, Turned stepped down as assistant fire chief in Redwood Valley. He still volunteers, but he has a new job now teaching health occupations to high school kids.\u003c/p>\n\u003cp>Along with homework assignments and reading, the words “evacuations” and “disaster response” are written on whiteboard in his classroom.\u003c/p>\n\u003cp>Many of his students are considering a career in emergency response. He wants them to go into this work with their eyes wide open.\u003c/p>\n\u003cp>Recently, Turner’s class did a review of Hurricane Katrina. They spent three days watching footage of the disaster and discussing the health care crisis that occurred in the hurricane’s aftermath.\u003c/p>\n\u003cp>“That’s pretty heavy for some high school kids to watch that,” Turner says.\u003c/p>\n\u003cp>So, a counselor for the school came into the classroom and did a presentation on techniques to deal with stress and emotions. Turner said when things would get intense, they would take a break and all practice breathing exercises.\u003c/p>\n\u003cfigure id=\"attachment_11698407\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/10/RanchFire_AW_105-800x533.jpg\" alt=\"A firefighter holds a hand tool ready to build containment around the Ranch Fire. \" width=\"800\" height=\"533\" class=\"size-medium wp-image-11698407\">\u003cfigcaption class=\"wp-caption-text\">A firefighter holds a hand tool ready to build containment around the Ranch Fire. \u003ccite>(Anne Wernikoff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Turner hopes by sharing his own experiences and teaching these young people the tools to cope with those experiences, he can better equip them to manage their own buckets of rocks, now and in the future.\u003c/p>\n\u003cp>“It doesn’t have to end with the firefighter walking in and dropping their gear on the floor and saying you know, ‘Bleep this, I’m done,'” he says. “And I think that’s really what we want to prevent.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"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. ",
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"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.",
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"mindshift": {
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"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>",
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"order": 12
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"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?",
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"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"pri-the-world": {
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"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
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"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
"airtime": "SAT 4pm-5pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/reveal300px.png",
"officialWebsiteLink": "https://www.revealnews.org/episodes/",
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"link": "/radio/program/reveal",
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"rss": "http://feeds.revealradio.org/revealpodcast"
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},
"rightnowish": {
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