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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>\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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"slug": "she-strived-to-be-the-perfect-mom-and-landed-in-the-psych-ward",
"title": "She Strived to Be the Perfect Mom and Landed in the Psych Ward",
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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>\u003ca href=\"https://www.kqed.org/mindshift/48724/moms-of-teens-can-benefit-from-social-support-just-like-new-moms\">Moms Of Teens Can Benefit From Social Support, Just Like New Moms\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/mindshift/48724/moms-of-teens-can-benefit-from-social-support-just-like-new-moms\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/wp-content/uploads/sites/23/2017/07/mom-support-26cd7c594bc4ec2fbaa25185945a90a42f76f89e-1180x884.jpg\" alt=\"\" />\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>But then, about a month after the birth, her clarity came back. 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>\u003ca href=\"https://www.kqed.org/mindshift/48724/moms-of-teens-can-benefit-from-social-support-just-like-new-moms\">Moms Of Teens Can Benefit From Social Support, Just Like New Moms\u003c/a>\u003c/h3>\n\u003cfigure>\u003ca href=\"https://www.kqed.org/mindshift/48724/moms-of-teens-can-benefit-from-social-support-just-like-new-moms\">\u003cimg decoding=\"async\" src=\"https://ww2.kqed.org/wp-content/uploads/sites/23/2017/07/mom-support-26cd7c594bc4ec2fbaa25185945a90a42f76f89e-1180x884.jpg\" alt=\"\" />\u003c/a>\u003c/figure>\n\u003c/aside>\n\u003cp>But then, about a month after the birth, her clarity came back. 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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"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",
"title": "As Fire Trauma Lingers, Santa Rosa Health Care Center Takes the Long Road",
"headTitle": "The California Report | KQED News",
"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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"excerpt": "The Santa Rosa city school district started a wellness center last year in the aftermath of the Tubbs Fire. Students can get tutoring while parents access mental health counseling.\r\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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"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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"slug": "a-little-broken-first-responders-grapple-with-unseen-scars-of-the-2017-fire-siege",
"title": "'A Little Broken' - First Responders Grapple With Unseen Scars of the 2017 Fire Siege",
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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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"title": "'A Little Broken' - First Responders Grapple With Unseen Scars of the 2017 Fire Siege | KQED",
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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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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>KQED reporter Marisa Lagos contributed to this report. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The trauma of sexual assault or harassment is not only hard to forget; it may also leave lasting effects on a woman's health. This finding of a study \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.4886\" target=\"_blank\" rel=\"noopener\">published Wednesday\u003c/a> adds support to a growing body of evidence suggesting the link.[contextly_sidebar id=\"HEpAUbCt2g19YW7Y7Rht6rrTaYElddh0\"]\u003c/p>\n\u003cp>In the study of roughly 300 middle-aged women, an experience of sexual assault was associated with anxiety, depression and poor sleep. A history of workplace sexual harassment was also associated with poor sleep and with an increased risk of developing high blood pressure.\u003c/p>\n\u003cp>\"These are experiences that [a woman] could have had long ago ... and it can have this long arm of influence throughout a woman's life,\" says \u003ca href=\"https://www.publichealth.pitt.edu/home/directory/rebecca-thurston\">Rebecca Thurston\u003c/a>, lead author of the study, and a research psychologist and director of the Women's Behavioral Health Laboratory at the University of Pittsburgh.\u003c/p>\n\u003cp>The study data come from a survey of healthy women between ages 40 and 60 who had been recruited for a study on menopause and cardiovascular disease — not sexual harassment or assault. They all had their blood pressure checked at study visits, as well as height and weight.\u003c/p>\n\u003cp>Among other questions, the survey asked the women if they had ever experienced sexual harassment at work. Participants were also asked if they had ever \"been made or pressured into having some type of unwanted sexual contact.\" The women were not asked when those events occurred.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Twenty-two percent reported a history of sexual assault, and 19 percent said they'd experienced workplace sexual harassment.\u003c/p>\n\u003cp>Though the sample size was small, the results are statistically significant. Women who had experienced sexual assault had on average an almost threefold increased risk of developing depressive symptoms, compared to women who hadn't. They also had a greater incidence of clinically significant anxiety.[contextly_sidebar id=\"IsNCC9ByhjKnhi0QhEGUW78GbGlaWQIA\"]\u003c/p>\n\u003cp>About 1 in 4 women who had been sexually assaulted met criteria for depression, while approximately 1 in 10 who had not were depressed.\u003c/p>\n\u003cp>Those who experienced sexual harassment at work had a twofold increased risk compared to women who hadn't of developing high blood pressure. Poor sleep was more common, too.\u003c/p>\n\u003cp>\"These [traumatic experiences] are clearly critical things that happen to people early on, that have these really long-lasting effects,\" says \u003ca href=\"https://directory.sph.umn.edu/bio/sph-a-z/susan-mason\" target=\"_blank\" rel=\"noopener\">Susan Mason\u003c/a>, an assistant professor of epidemiology at the University of Minnesota who studies the effects of trauma. \"These really shape people's life trajectories.\"\u003c/p>\n\u003cp>Mason was not involved in this study, but says the findings dovetail with other research on the relationship between trauma and physical or mental health later in life. Intimate partner violence, for example, has been associated with the development of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23248189\" target=\"_blank\" rel=\"noopener\">diabetes\u003c/a> and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/22717307\" target=\"_blank\" rel=\"noopener\">high blood pressure\u003c/a>.\u003c/p>\n\u003cp>Wednesday's study is particularly noteworthy, Mason says, because it includes clinical data — in-office blood pressure checks, for example, and validated diagnostic tools for depression and anxiety — rather than depending exclusively on self-reported diagnoses.\u003c/p>\n\u003cp>Clinicians don't have the ability to corroborate women's memories of sexual assault or harassment, however. Thurston points to literature on the way traumatic memories are processed that demonstrates that discrete events like a sexual assault often remain vivid in a way other memories don't. This is why, she says, she trusts the study participants who say they've been through these experiences.[contextly_sidebar id=\"aop33xdUj0MLT7LwmTHbeoNCW1mJ7lyp\"]\u003c/p>\n\u003cp>\"If the patient thinks it's important, it's important,\" says Dr. Valerie Gilchrist, chair of the department of family medicine at the University of Wisconsin who has written about screening for sexual violence in primary care.\u003c/p>\n\u003cp>She recommends that clinicians ask patients if they've experienced sexual assault, particularly patients who are experiencing significant stress or have difficulty with pelvic exams. Authors note that sexual assault and harassment seemed to be less common in this group of women than in national estimates.\u003c/p>\n\u003cp>The prevalence in their cohort was significantly lower than a \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/ss6308a1.htm\" target=\"_blank\" rel=\"noopener\">2014 estimate from the Centers for Disease Control and Prevention\u003c/a>, which found that 19 percent of American women had been raped, and almost 44 percent had experienced another form of sexual violence.\u003c/p>\n\u003cp>Thurston thinks this is because the study excluded a fair number of women for reasons related to its original intent of researching menopause and cardiovascular disease. Women taking medications for depression were not included, for example, as well as those with serious medical problems.\u003c/p>\n\u003cp>\"Sexual assault and sexual abuse are much more common than people think,\" Thurston says. These are \"key toxic stressors for women.\"\u003c/p>\n\u003cp>While researchers weren't surprised that sexual assault and harassment seemed to be related to the development of mood disorders and poor sleep, they were impressed by the strength of the association.\u003c/p>\n\u003cp>\"These should be urgent public health priorities,\" Mason says. \"How do we address the fundamental ways that our social structure affects health?\"\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Mara Gordon is a family physician in Washington, D.C., and a health and media fellow at NPR and Georgetown University School of Medicine.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Sexual+Assault+And+Harassment+May+Have+Lasting+Health+Repercussions+For+Women&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The trauma of sexual assault or harassment is not only hard to forget; it may also leave lasting effects on a woman's health. This finding of a study \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.4886\" target=\"_blank\" rel=\"noopener\">published Wednesday\u003c/a> adds support to a growing body of evidence suggesting the link.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In the study of roughly 300 middle-aged women, an experience of sexual assault was associated with anxiety, depression and poor sleep. A history of workplace sexual harassment was also associated with poor sleep and with an increased risk of developing high blood pressure.\u003c/p>\n\u003cp>\"These are experiences that [a woman] could have had long ago ... and it can have this long arm of influence throughout a woman's life,\" says \u003ca href=\"https://www.publichealth.pitt.edu/home/directory/rebecca-thurston\">Rebecca Thurston\u003c/a>, lead author of the study, and a research psychologist and director of the Women's Behavioral Health Laboratory at the University of Pittsburgh.\u003c/p>\n\u003cp>The study data come from a survey of healthy women between ages 40 and 60 who had been recruited for a study on menopause and cardiovascular disease — not sexual harassment or assault. They all had their blood pressure checked at study visits, as well as height and weight.\u003c/p>\n\u003cp>Among other questions, the survey asked the women if they had ever experienced sexual harassment at work. Participants were also asked if they had ever \"been made or pressured into having some type of unwanted sexual contact.\" The women were not asked when those events occurred.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Twenty-two percent reported a history of sexual assault, and 19 percent said they'd experienced workplace sexual harassment.\u003c/p>\n\u003cp>Though the sample size was small, the results are statistically significant. Women who had experienced sexual assault had on average an almost threefold increased risk of developing depressive symptoms, compared to women who hadn't. They also had a greater incidence of clinically significant anxiety.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>About 1 in 4 women who had been sexually assaulted met criteria for depression, while approximately 1 in 10 who had not were depressed.\u003c/p>\n\u003cp>Those who experienced sexual harassment at work had a twofold increased risk compared to women who hadn't of developing high blood pressure. Poor sleep was more common, too.\u003c/p>\n\u003cp>\"These [traumatic experiences] are clearly critical things that happen to people early on, that have these really long-lasting effects,\" says \u003ca href=\"https://directory.sph.umn.edu/bio/sph-a-z/susan-mason\" target=\"_blank\" rel=\"noopener\">Susan Mason\u003c/a>, an assistant professor of epidemiology at the University of Minnesota who studies the effects of trauma. \"These really shape people's life trajectories.\"\u003c/p>\n\u003cp>Mason was not involved in this study, but says the findings dovetail with other research on the relationship between trauma and physical or mental health later in life. Intimate partner violence, for example, has been associated with the development of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23248189\" target=\"_blank\" rel=\"noopener\">diabetes\u003c/a> and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/22717307\" target=\"_blank\" rel=\"noopener\">high blood pressure\u003c/a>.\u003c/p>\n\u003cp>Wednesday's study is particularly noteworthy, Mason says, because it includes clinical data — in-office blood pressure checks, for example, and validated diagnostic tools for depression and anxiety — rather than depending exclusively on self-reported diagnoses.\u003c/p>\n\u003cp>Clinicians don't have the ability to corroborate women's memories of sexual assault or harassment, however. Thurston points to literature on the way traumatic memories are processed that demonstrates that discrete events like a sexual assault often remain vivid in a way other memories don't. This is why, she says, she trusts the study participants who say they've been through these experiences.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"If the patient thinks it's important, it's important,\" says Dr. Valerie Gilchrist, chair of the department of family medicine at the University of Wisconsin who has written about screening for sexual violence in primary care.\u003c/p>\n\u003cp>She recommends that clinicians ask patients if they've experienced sexual assault, particularly patients who are experiencing significant stress or have difficulty with pelvic exams. Authors note that sexual assault and harassment seemed to be less common in this group of women than in national estimates.\u003c/p>\n\u003cp>The prevalence in their cohort was significantly lower than a \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/ss6308a1.htm\" target=\"_blank\" rel=\"noopener\">2014 estimate from the Centers for Disease Control and Prevention\u003c/a>, which found that 19 percent of American women had been raped, and almost 44 percent had experienced another form of sexual violence.\u003c/p>\n\u003cp>Thurston thinks this is because the study excluded a fair number of women for reasons related to its original intent of researching menopause and cardiovascular disease. Women taking medications for depression were not included, for example, as well as those with serious medical problems.\u003c/p>\n\u003cp>\"Sexual assault and sexual abuse are much more common than people think,\" Thurston says. These are \"key toxic stressors for women.\"\u003c/p>\n\u003cp>While researchers weren't surprised that sexual assault and harassment seemed to be related to the development of mood disorders and poor sleep, they were impressed by the strength of the association.\u003c/p>\n\u003cp>\"These should be urgent public health priorities,\" Mason says. \"How do we address the fundamental ways that our social structure affects health?\"\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Mara Gordon is a family physician in Washington, D.C., and a health and media fellow at NPR and Georgetown University School of Medicine.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Sexual+Assault+And+Harassment+May+Have+Lasting+Health+Repercussions+For+Women&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New Smartphone App Aims to Monitor Your Mental Health",
"title": "New Smartphone App Aims to Monitor Your Mental Health",
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"content": "\u003cp class=\"danger-zone\">In the world of digital health, Silicon Valley-based \u003ca href=\"https://www.statnews.com/2017/08/07/mindstrong-insel-mental-illness/\" target=\"_blank\" rel=\"noopener\">Mindstrong\u003c/a> stands out. It has a star-studded team and tens of millions in venture capital funding, including from Jeff Bezos’ VC firm.[contextly_sidebar id=\"KMLJnak6yPOdRS3TfVoiDTc6a7Cm51Xf\"]\u003c/p>\n\u003cp class=\"danger-zone\">It also has a captivating idea: that its app, based on cognitive functioning research, can help detect troubling mental health patterns by collecting data on a person’s smartphone usage — how quickly they type or scroll, for instance.\u003c/p>\n\u003cp class=\"danger-zone\">The promise of that technology has helped Mindstrong build incredible momentum since it launched last year; already more than a dozen counties in California have agreed to deploy the company’s app to patients.\u003c/p>\n\u003cp class=\"\">Does the app live up to its promise? There’s no way to tell. Almost no one outside the company has any idea whether it works. Most of the company’s key promises or claims aren’t yet backed up by published, peer-reviewed data — leading some experts to wonder if the technology is ready for the real world.\u003c/p>\n\u003cp class=\"\">“I wouldn’t waste all that time and money in the wild until they get sure that some of those things are as specific as they hope they are,” said Rosalind Picard, a researcher at MIT Media Lab who is familiar with Mindstrong’s work and tries to use data from smartphones and wearables to detect a person’s mood.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Even as one of the company’s executives, Dr. Tom Insel, acknowledged to STAT that the app isn’t perfect, the company’s CEO emphasized that Mindstrong could provide unprecedented insight into conditions like depression.[contextly_sidebar id=\"Kw9tNYwAAP3TxDDlzs24FDdim0qufSVP\"]\u003c/p>\n\u003cp>Mindstrong is not alone in pushing the frontiers of smartphone-based digital health. Many companies use so-called digital phenotyping, collecting scientific data on a person’s digital life, to gain insights into his or her physical or mental health.\u003c/p>\n\u003cp>The company’s app collects information about how people are typing and runs it through a machine learning algorithm to determine which data can predict their emotional state. Mindstrong has already used it in controlled clinical settings and trials — including one run by a company developing new antidepressants and another done in a \u003ca href=\"https://www.statnews.com/2018/09/24/ketamine-clinics-severe-depression-treatment/\" target=\"_blank\" rel=\"noopener\">ketamine clinic\u003c/a>. The app is available in Apple’s app store, but requires a participant code to access it.\u003c/p>\n\u003cp>“We’ve done the validation work against the gold-standard clinical tests for depression, for anxiety, for cognitive decline, whether it’s memory or executive function,” said Dr. Paul Dagum, the company’s founder. “We’re confident, we’re already seeing some really exciting results.”\u003c/p>\n\u003cp>In the last year, Mindstrong’s footprint and reach have already grown exponentially. The Palo Alto-based company’s workforce has doubled to 42 employees and it made \u003ca href=\"https://www.hsph.harvard.edu/magazine/magazine_article/philanthropic-impact-digital-phenotyping/\" target=\"_blank\" rel=\"noopener\">a sizable gift\u003c/a> to Harvard’s school of public health. In February, it launched a partnership with Takeda to develop new biomarkers that will be able to aid the pharmaceutical giant’s clinical trials for depression treatments.\u003c/p>\n\u003cp>The idea is to use that data to establish a “normal” pattern — so it can be compared against someone’s typing habits on any given day. If the habits look off, slower or more agitated than normal, the app can alert a health care provider.\u003c/p>\n\u003cp>Abnormal patterns, Mindstrong says, might show up if a person is more depressed or anxious, or if just about anything else about their mental health changes. When asked which disorders Mindstrong might be able to detect, Dagum replied, “all of them.” (Dagum, a data scientist and physician, founded the company in 2017 with Rick Klausner, the founder and director of CAR-T pioneer Juno Therapeutics and \u003ca href=\"https://www.statnews.com/2018/06/02/grail-cancer-blood-test-asco/\" target=\"_blank\" rel=\"noopener\">Grail\u003c/a>, a liquid biopsy company.)[contextly_sidebar id=\"XHhLlvPBCoPTlN54jyme2G0wpse1GITN\"]\u003c/p>\n\u003cp>Mindstrong officials told STAT that among their most encouraging results is that its app can even predict how a person will feel next week, or at least how a person will perform on the Hamilton Rating Scale for depression — kind of like a weather app for your mood.\u003c/p>\n\u003cp>The data behind this claim is being published soon, said Insel, who is the former head of the National Institute of Mental Health and came to the company in 2017 after a short stint at \u003ca href=\"https://www.statnews.com/2016/03/28/google-life-sciences-exodus/\" target=\"_blank\" rel=\"noopener\">Verily\u003c/a>.\u003c/p>\n\u003cp>The app can detect a seven-point change on the Hamilton scale, Insel said. That kind of difference could indicate a patient who is not normally depressed now shows signs of mild or moderate depression, or that a person with moderate depression is now showing signs of a very severe condition.\u003c/p>\n\u003cp>“For a clinician and for someone taking care of a patient, knowing that, it could be very, very powerful,” Dagum said.\u003c/p>\n\u003cp>The company’s momentum has taken it to the cusp of a real-world deployment in California. About 15 counties — including the most populous county in the United States, Los Angeles County — will be spending about $60 million over the next four years to bring companies like Mindstrong and other apps into their health care system.\u003c/p>\n\u003cp>These counties hope apps will help them get better services to people with mental illnesses like depression, schizophrenia, bipolar disorder, and post-traumatic stress disorder.\u003c/p>\n\u003cp>The Mindstrong program itself is limited: Patients can choose voluntarily whether to use the app, which will be free to them, and that decision won’t affect the rest of the mental health services they can access.\u003c/p>\n\u003cp>\u003cstrong>Lack of Public Data\u003c/strong>\u003c/p>\n\u003cp>So far, the Mindstrong app has only been used in controlled clinical settings and trials — including one run by a company developing new antidepressants and another done in a ketamine clinic. The company has also claimed that a “\u003ca href=\"https://mindstronghealth.com/clinical-programs/\" target=\"_blank\" rel=\"noopener\">nationwide employer\u003c/a>” and private substance abuse clinics in D.C. are using the app.[contextly_sidebar id=\"KGoxoWR6m8MUKnLishPvyacpod0HWpt7\"]\u003c/p>\n\u003cp>But other than the change on the Hamilton scale — which hasn’t yet gone through peer review and was disclosed to STAT in an interview — almost no data about how well Mindstrong’s technology works is available to independent observers.\u003c/p>\n\u003cp>The company’s website describes five completed clinical trials, but it has not yet published the results of any. Only a handful of other published works — all from the last year — have hinted at how well it works or its scope with data to back up the claims.\u003c/p>\n\u003cp>The company \u003ca href=\"https://www.nature.com/articles/s41746-018-0018-4\" target=\"_blank\" rel=\"noopener\">published\u003c/a> a 27-person pilot study in the journal npj Digital Medicine earlier this year. Dagum is also an author on a poster \u003ca href=\"https://www.nature.com/articles/npp2017265#t122-assessing-anhedonia-with-quantitative-tasks-digital-and-patient-reported-measures-in-a-multicenter-doubleblind-trial-with-btrx246040-for-the-treatment-of-major-depressive-disorder\" target=\"_blank\" rel=\"noopener\">presentation\u003c/a> given at the American College of Neuropsychopharmacology’s 2017 conference, another \u003ca href=\"https://isctm.org/public_access/Feb2018/PDFs/Smith-poster.pdf\" target=\"_blank\" rel=\"noopener\">poster\u003c/a> that reported results from a very wide variety of digital phenotyping techniques — not just typing — and a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29074231\" target=\"_blank\" rel=\"noopener\">paper\u003c/a> describing a clinical trial protocol — not results.\u003c/p>\n\u003cp>As Mindstrong steps toward a wider rollout, the scientific studies behind its claims will matter. Federal regulators, for one, have \u003ca href=\"https://www.ftc.gov/news-events/blogs/business-blog/2016/01/mind-gap-what-lumosity-promised-vs-what-it-could-prove\" target=\"_blank\" rel=\"noopener\">cracked down\u003c/a> on \u003ca href=\"https://www.ftc.gov/news-events/press-releases/2016/12/marketers-blood-pressure-app-settle-ftc-charges-regarding\" target=\"_blank\" rel=\"noopener\">commercial apps\u003c/a>that misleadingly reference a study’s conclusions to market their app.\u003c/p>\n\u003cp>Based on her own research, at least one expert in digital health and mood said she’s skeptical that Mindstrong can, in a general population, work as well as the company claims. MIT’s Picard said that while there are ways to predict or detect mood changes, you usually need more than just a single type of data to do so.\u003c/p>\n\u003cp>“I’m suspicious that a single modality like typing is going to be sufficient. It would be like saying there’s a single question [on a screening questionnaire] that a doctor could be using,” said Picard, who is also CEO of a company that works on digital phenotyping, like Mindstrong does.\u003c/p>\n\u003cp>“My guess is that their specificity to depression is going to be relatively low,” Picard said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Her \u003ca href=\"https://www.jmir.org/2018/6/e210/\" target=\"_blank\" rel=\"noopener\">own\u003c/a> \u003ca href=\"https://ieeexplore.ieee.org/abstract/document/954607\" target=\"_blank\" rel=\"noopener\">research\u003c/a>, for example, relies on temperature and skin conductivity as well as calls and the amount of time spent on a phone to predict mood changes. It is about 80 percent accurate.\u003c/p>\n\u003cdiv class=\"quote-inner\">\n\u003cp>Especially in the field of digital mental health, “we need more peer review,” said Dr. Steven Steinhubl, the director of digital medicine at Scripps Research Translational Institute. (Steinhubl is also the co-editor-in-chief of npj Digital Medicine.) Though he said he strongly believes in the potential of apps like Mindstrong, Steinhubl cautioned that peer review has a purpose.[contextly_sidebar id=\"8bFNH4xsL9O8lTSDRHnxnqtYwxOF2Z5k\"]\u003c/p>\n\u003cp>“[Peer review] is a very imperfect system, but there’s really nothing in the peer-reviewed literature. That means that other experts aren’t able to weigh in,” he said. “If you have committees and other people reviewing something who maybe don’t have the same level of expertise, you’ll have people saying, ‘Yeah, that sounds good.’”\u003c/p>\n\u003cp>Other researchers have also found that neuropsychological tests, more broadly, have relatively low accuracy rates.\u003c/p>\n\u003cp>In a study that examined people who were already being treated for depression, one computerized test could only accurately predict their condition in about 40 percent of cases. Another showed a 44 percent accuracy rate for a similar computerized test used to examine people with major depression.\u003c/p>\n\u003cp>A neuropsychological test — if it’s used as a screening test — is “going to miss a lot of people who are depressed,” said Richard Porter, a psychology researcher based at the University of Otago in New Zealand who conducted one of the studies.\u003c/p>\n\u003cp>And even if depressed people do show some kind of cognitive impairment, it’s impossible to tell what caused it.\u003c/p>\n\u003cp>Many things other than mental illness might cause a person to perform poorly on cognitive tests — like living with another disorder, having a lower baseline performance on cognitive tests, having a drink or taking prescription, over-the-counter, or illegal drugs.\u003c/p>\n\u003cp>Mindstrong’s leaders aren’t worried about that kind of noise in their data. Some of those factors are important to note, both for patients and the health care professionals working with them.\u003c/p>\n\u003cp>“You’re hungover, you didn’t sleep well, you didn’t take your medication, you have a medication side effects, you’re having stress and challenges at work and at home. Those are things that we want to measure,” Dagum said.\u003c/p>\n\u003cp>But even Insel admitted that there are plenty of issues that could affect typing speed — and which Mindstrong hasn’t figured out how to sort out yet. Sticky fingers after lunch, full hands at an airport, wearing gloves during winter, or a broken hand might also plausible affect a person’s typing speed — and, therefore, the app’s performance.\u003c/p>\n\u003cp>“One thing we’ve thought about is how we factor in those unusual environmental issues,” Insel said. “We’re working on that. But I can’t say that we’ve solved all of those possible issues.”\u003c/p>\n\u003cp>\u003cstrong>A Looming Launch in the Golden State\u003c/strong>\u003c/p>\n\u003cp>Insel and others linked with the company are fond of comparing their app to a smoke detector — something that’s intended to enhance humans’ senses to detect danger.\u003c/p>\n\u003cp>But part of the value of a smoke detector is that if it’s functioning properly, we know it isn’t going off at random. It only goes off in certain conditions and carries a specific message: Your house is on fire or about to be. Do something.\u003c/p>\n\u003cp>At least for now, that’s where Mindstrong differs from a smoke detector. There’s no way to tell, yet, how specific it is or how sensitive its algorithm is.\u003c/p>\n\u003cp>Insel said that information is coming. He said the company has the data about the app’s accuracy — but he declined to provide those figures, citing papers pending publication. “[They] square very well with clinically used biomarkers,” he said.\u003c/p>\n\u003cp>California authorities suggest they have been shown some of that data. But they’re nevertheless cautious about how the app will work in their new, different setting.\u003c/p>\n\u003cp>One official said there will be “clear writing” included with the state’s version of the app about what it can do, what it cannot do, and what goals the counties hope it will help them achieve.\u003c/p>\n\u003cp>Those goals are pretty lofty. At least some counties eventually plan to use it not only to supplement the existing system, but potentially to bring more people into its fold.\u003c/p>\n\u003cp>“We might be able to go to colleges, emergency departments, other places,” said Debbie Innes-Gomberg, a deputy director at the Los Angeles County Department of Mental Health. “There’s a process of identifying that they’re symptomatic, but [our target population is] people that are in our system and people who maybe need to be.”\u003c/p>\n\u003cp>And even before the app launched in the original five counties that had signed on, the pilot has expanded. Another 11 counties have recently decided to join.\u003c/p>\n\u003cp>Still, Innes-Gomberg said, it’s going to be rolled out with caution. “We’re not going to oversell this.”\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/10/04/mindstrong-questions-over-evidence/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003c/p>\n\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">In the world of digital health, Silicon Valley-based \u003ca href=\"https://www.statnews.com/2017/08/07/mindstrong-insel-mental-illness/\" target=\"_blank\" rel=\"noopener\">Mindstrong\u003c/a> stands out. It has a star-studded team and tens of millions in venture capital funding, including from Jeff Bezos’ VC firm.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">It also has a captivating idea: that its app, based on cognitive functioning research, can help detect troubling mental health patterns by collecting data on a person’s smartphone usage — how quickly they type or scroll, for instance.\u003c/p>\n\u003cp class=\"danger-zone\">The promise of that technology has helped Mindstrong build incredible momentum since it launched last year; already more than a dozen counties in California have agreed to deploy the company’s app to patients.\u003c/p>\n\u003cp class=\"\">Does the app live up to its promise? There’s no way to tell. Almost no one outside the company has any idea whether it works. Most of the company’s key promises or claims aren’t yet backed up by published, peer-reviewed data — leading some experts to wonder if the technology is ready for the real world.\u003c/p>\n\u003cp class=\"\">“I wouldn’t waste all that time and money in the wild until they get sure that some of those things are as specific as they hope they are,” said Rosalind Picard, a researcher at MIT Media Lab who is familiar with Mindstrong’s work and tries to use data from smartphones and wearables to detect a person’s mood.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Even as one of the company’s executives, Dr. Tom Insel, acknowledged to STAT that the app isn’t perfect, the company’s CEO emphasized that Mindstrong could provide unprecedented insight into conditions like depression.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Mindstrong is not alone in pushing the frontiers of smartphone-based digital health. Many companies use so-called digital phenotyping, collecting scientific data on a person’s digital life, to gain insights into his or her physical or mental health.\u003c/p>\n\u003cp>The company’s app collects information about how people are typing and runs it through a machine learning algorithm to determine which data can predict their emotional state. Mindstrong has already used it in controlled clinical settings and trials — including one run by a company developing new antidepressants and another done in a \u003ca href=\"https://www.statnews.com/2018/09/24/ketamine-clinics-severe-depression-treatment/\" target=\"_blank\" rel=\"noopener\">ketamine clinic\u003c/a>. The app is available in Apple’s app store, but requires a participant code to access it.\u003c/p>\n\u003cp>“We’ve done the validation work against the gold-standard clinical tests for depression, for anxiety, for cognitive decline, whether it’s memory or executive function,” said Dr. Paul Dagum, the company’s founder. “We’re confident, we’re already seeing some really exciting results.”\u003c/p>\n\u003cp>In the last year, Mindstrong’s footprint and reach have already grown exponentially. The Palo Alto-based company’s workforce has doubled to 42 employees and it made \u003ca href=\"https://www.hsph.harvard.edu/magazine/magazine_article/philanthropic-impact-digital-phenotyping/\" target=\"_blank\" rel=\"noopener\">a sizable gift\u003c/a> to Harvard’s school of public health. In February, it launched a partnership with Takeda to develop new biomarkers that will be able to aid the pharmaceutical giant’s clinical trials for depression treatments.\u003c/p>\n\u003cp>The idea is to use that data to establish a “normal” pattern — so it can be compared against someone’s typing habits on any given day. If the habits look off, slower or more agitated than normal, the app can alert a health care provider.\u003c/p>\n\u003cp>Abnormal patterns, Mindstrong says, might show up if a person is more depressed or anxious, or if just about anything else about their mental health changes. When asked which disorders Mindstrong might be able to detect, Dagum replied, “all of them.” (Dagum, a data scientist and physician, founded the company in 2017 with Rick Klausner, the founder and director of CAR-T pioneer Juno Therapeutics and \u003ca href=\"https://www.statnews.com/2018/06/02/grail-cancer-blood-test-asco/\" target=\"_blank\" rel=\"noopener\">Grail\u003c/a>, a liquid biopsy company.)\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Mindstrong officials told STAT that among their most encouraging results is that its app can even predict how a person will feel next week, or at least how a person will perform on the Hamilton Rating Scale for depression — kind of like a weather app for your mood.\u003c/p>\n\u003cp>The data behind this claim is being published soon, said Insel, who is the former head of the National Institute of Mental Health and came to the company in 2017 after a short stint at \u003ca href=\"https://www.statnews.com/2016/03/28/google-life-sciences-exodus/\" target=\"_blank\" rel=\"noopener\">Verily\u003c/a>.\u003c/p>\n\u003cp>The app can detect a seven-point change on the Hamilton scale, Insel said. That kind of difference could indicate a patient who is not normally depressed now shows signs of mild or moderate depression, or that a person with moderate depression is now showing signs of a very severe condition.\u003c/p>\n\u003cp>“For a clinician and for someone taking care of a patient, knowing that, it could be very, very powerful,” Dagum said.\u003c/p>\n\u003cp>The company’s momentum has taken it to the cusp of a real-world deployment in California. About 15 counties — including the most populous county in the United States, Los Angeles County — will be spending about $60 million over the next four years to bring companies like Mindstrong and other apps into their health care system.\u003c/p>\n\u003cp>These counties hope apps will help them get better services to people with mental illnesses like depression, schizophrenia, bipolar disorder, and post-traumatic stress disorder.\u003c/p>\n\u003cp>The Mindstrong program itself is limited: Patients can choose voluntarily whether to use the app, which will be free to them, and that decision won’t affect the rest of the mental health services they can access.\u003c/p>\n\u003cp>\u003cstrong>Lack of Public Data\u003c/strong>\u003c/p>\n\u003cp>So far, the Mindstrong app has only been used in controlled clinical settings and trials — including one run by a company developing new antidepressants and another done in a ketamine clinic. The company has also claimed that a “\u003ca href=\"https://mindstronghealth.com/clinical-programs/\" target=\"_blank\" rel=\"noopener\">nationwide employer\u003c/a>” and private substance abuse clinics in D.C. are using the app.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But other than the change on the Hamilton scale — which hasn’t yet gone through peer review and was disclosed to STAT in an interview — almost no data about how well Mindstrong’s technology works is available to independent observers.\u003c/p>\n\u003cp>The company’s website describes five completed clinical trials, but it has not yet published the results of any. Only a handful of other published works — all from the last year — have hinted at how well it works or its scope with data to back up the claims.\u003c/p>\n\u003cp>The company \u003ca href=\"https://www.nature.com/articles/s41746-018-0018-4\" target=\"_blank\" rel=\"noopener\">published\u003c/a> a 27-person pilot study in the journal npj Digital Medicine earlier this year. Dagum is also an author on a poster \u003ca href=\"https://www.nature.com/articles/npp2017265#t122-assessing-anhedonia-with-quantitative-tasks-digital-and-patient-reported-measures-in-a-multicenter-doubleblind-trial-with-btrx246040-for-the-treatment-of-major-depressive-disorder\" target=\"_blank\" rel=\"noopener\">presentation\u003c/a> given at the American College of Neuropsychopharmacology’s 2017 conference, another \u003ca href=\"https://isctm.org/public_access/Feb2018/PDFs/Smith-poster.pdf\" target=\"_blank\" rel=\"noopener\">poster\u003c/a> that reported results from a very wide variety of digital phenotyping techniques — not just typing — and a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29074231\" target=\"_blank\" rel=\"noopener\">paper\u003c/a> describing a clinical trial protocol — not results.\u003c/p>\n\u003cp>As Mindstrong steps toward a wider rollout, the scientific studies behind its claims will matter. Federal regulators, for one, have \u003ca href=\"https://www.ftc.gov/news-events/blogs/business-blog/2016/01/mind-gap-what-lumosity-promised-vs-what-it-could-prove\" target=\"_blank\" rel=\"noopener\">cracked down\u003c/a> on \u003ca href=\"https://www.ftc.gov/news-events/press-releases/2016/12/marketers-blood-pressure-app-settle-ftc-charges-regarding\" target=\"_blank\" rel=\"noopener\">commercial apps\u003c/a>that misleadingly reference a study’s conclusions to market their app.\u003c/p>\n\u003cp>Based on her own research, at least one expert in digital health and mood said she’s skeptical that Mindstrong can, in a general population, work as well as the company claims. MIT’s Picard said that while there are ways to predict or detect mood changes, you usually need more than just a single type of data to do so.\u003c/p>\n\u003cp>“I’m suspicious that a single modality like typing is going to be sufficient. It would be like saying there’s a single question [on a screening questionnaire] that a doctor could be using,” said Picard, who is also CEO of a company that works on digital phenotyping, like Mindstrong does.\u003c/p>\n\u003cp>“My guess is that their specificity to depression is going to be relatively low,” Picard said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Her \u003ca href=\"https://www.jmir.org/2018/6/e210/\" target=\"_blank\" rel=\"noopener\">own\u003c/a> \u003ca href=\"https://ieeexplore.ieee.org/abstract/document/954607\" target=\"_blank\" rel=\"noopener\">research\u003c/a>, for example, relies on temperature and skin conductivity as well as calls and the amount of time spent on a phone to predict mood changes. It is about 80 percent accurate.\u003c/p>\n\u003cdiv class=\"quote-inner\">\n\u003cp>Especially in the field of digital mental health, “we need more peer review,” said Dr. Steven Steinhubl, the director of digital medicine at Scripps Research Translational Institute. (Steinhubl is also the co-editor-in-chief of npj Digital Medicine.) Though he said he strongly believes in the potential of apps like Mindstrong, Steinhubl cautioned that peer review has a purpose.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“[Peer review] is a very imperfect system, but there’s really nothing in the peer-reviewed literature. That means that other experts aren’t able to weigh in,” he said. “If you have committees and other people reviewing something who maybe don’t have the same level of expertise, you’ll have people saying, ‘Yeah, that sounds good.’”\u003c/p>\n\u003cp>Other researchers have also found that neuropsychological tests, more broadly, have relatively low accuracy rates.\u003c/p>\n\u003cp>In a study that examined people who were already being treated for depression, one computerized test could only accurately predict their condition in about 40 percent of cases. Another showed a 44 percent accuracy rate for a similar computerized test used to examine people with major depression.\u003c/p>\n\u003cp>A neuropsychological test — if it’s used as a screening test — is “going to miss a lot of people who are depressed,” said Richard Porter, a psychology researcher based at the University of Otago in New Zealand who conducted one of the studies.\u003c/p>\n\u003cp>And even if depressed people do show some kind of cognitive impairment, it’s impossible to tell what caused it.\u003c/p>\n\u003cp>Many things other than mental illness might cause a person to perform poorly on cognitive tests — like living with another disorder, having a lower baseline performance on cognitive tests, having a drink or taking prescription, over-the-counter, or illegal drugs.\u003c/p>\n\u003cp>Mindstrong’s leaders aren’t worried about that kind of noise in their data. Some of those factors are important to note, both for patients and the health care professionals working with them.\u003c/p>\n\u003cp>“You’re hungover, you didn’t sleep well, you didn’t take your medication, you have a medication side effects, you’re having stress and challenges at work and at home. Those are things that we want to measure,” Dagum said.\u003c/p>\n\u003cp>But even Insel admitted that there are plenty of issues that could affect typing speed — and which Mindstrong hasn’t figured out how to sort out yet. Sticky fingers after lunch, full hands at an airport, wearing gloves during winter, or a broken hand might also plausible affect a person’s typing speed — and, therefore, the app’s performance.\u003c/p>\n\u003cp>“One thing we’ve thought about is how we factor in those unusual environmental issues,” Insel said. “We’re working on that. But I can’t say that we’ve solved all of those possible issues.”\u003c/p>\n\u003cp>\u003cstrong>A Looming Launch in the Golden State\u003c/strong>\u003c/p>\n\u003cp>Insel and others linked with the company are fond of comparing their app to a smoke detector — something that’s intended to enhance humans’ senses to detect danger.\u003c/p>\n\u003cp>But part of the value of a smoke detector is that if it’s functioning properly, we know it isn’t going off at random. It only goes off in certain conditions and carries a specific message: Your house is on fire or about to be. Do something.\u003c/p>\n\u003cp>At least for now, that’s where Mindstrong differs from a smoke detector. There’s no way to tell, yet, how specific it is or how sensitive its algorithm is.\u003c/p>\n\u003cp>Insel said that information is coming. He said the company has the data about the app’s accuracy — but he declined to provide those figures, citing papers pending publication. “[They] square very well with clinically used biomarkers,” he said.\u003c/p>\n\u003cp>California authorities suggest they have been shown some of that data. But they’re nevertheless cautious about how the app will work in their new, different setting.\u003c/p>\n\u003cp>One official said there will be “clear writing” included with the state’s version of the app about what it can do, what it cannot do, and what goals the counties hope it will help them achieve.\u003c/p>\n\u003cp>Those goals are pretty lofty. At least some counties eventually plan to use it not only to supplement the existing system, but potentially to bring more people into its fold.\u003c/p>\n\u003cp>“We might be able to go to colleges, emergency departments, other places,” said Debbie Innes-Gomberg, a deputy director at the Los Angeles County Department of Mental Health. “There’s a process of identifying that they’re symptomatic, but [our target population is] people that are in our system and people who maybe need to be.”\u003c/p>\n\u003cp>And even before the app launched in the original five counties that had signed on, the pilot has expanded. Another 11 counties have recently decided to join.\u003c/p>\n\u003cp>Still, Innes-Gomberg said, it’s going to be rolled out with caution. “We’re not going to oversell this.”\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/10/04/mindstrong-questions-over-evidence/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003c/p>\n\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>David McElveen recently had a stroke. The 59-year-old Vallejo resident and John George Psychiatric Hospital nurse has short-term memory problems and has been out of work for more than a year. The stroke may be linked to an attack he suffered last summer.\u003c/p>\n\u003cp>He was working the morning shift on Sept. 13, 2017 at the Alameda County mental health care facility in San Leandro when a patient punched him the face.\u003c/p>\n\u003cp>“I heard somebody running and that’s the last thing I remembered,” McElveen said in an interview on Monday.\u003c/p>\n\u003cp>He fell to the floor. The patient kept hitting him, slamming his head against the ground.\u003c/p>\n\u003cp>“The injured was unconscious and had a seizure while bleeding from his face and head area,” an investigator with California’s Division of Occupational Safety and Health (Cal/OSHA) wrote in the agency’s investigation into the attack, obtained through a California Public Records Act Request.\u003c/p>\n\u003cp>McElveen’s facial bones were fractured.\u003c/p>\n\u003cp>“The left side of my skull was busted open. My right eye was closed for more than 10 days. My jaw was broken in two different places. And, I lost a tooth,” he said.\u003c/p>\n\u003cfigure id=\"attachment_11694380\" class=\"wp-caption alignright\" style=\"max-width: 480px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11694380\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/09/mcelveen-e1537822957258.jpg\" alt=\"\" width=\"480\" height=\"640\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/09/mcelveen-e1537822957258.jpg 480w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/09/mcelveen-e1537822957258-160x213.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/09/mcelveen-e1537822957258-240x320.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/09/mcelveen-e1537822957258-375x500.jpg 375w\" sizes=\"(max-width: 480px) 100vw, 480px\">\u003cfigcaption class=\"wp-caption-text\">David McElveen, a John George Psychiatric Hospital nurse, was attacked by a patient in September 2017. \u003ccite>(Courtesy David McElveen)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>McElveen was hospitalized and underwent surgery. Doctors wired his jaw shut. He also says the morning he was attacked, the hospital was short-staffed.\u003c/p>\n\u003cp>“We didn’t have enough mental health workers. We didn’t have enough nurses,” he said. “Everyone was just overwhelmed.”\u003c/p>\n\u003cp>Union officials who represent McElveen and other John George workers say the attack is the result of low staffing at the facility’s emergency room (known as “emergency services”) and poor security protocols at a hospital that has repeatedly come under scrutiny for dangers posed to employees and patients.\u003c/p>\n\u003cp>Now, dozens of Service Employees International Union Local 1021 members plan to hold an informational picket in Oakland on Tuesday afternoon to draw attention to staffing issues there and two other Alameda County medical facilities.\u003c/p>\n\u003cp>Two months after McElveen was attacked, \u003ca href=\"https://www.sfgate.com/crime/article/Runaway-psych-patient-hit-by-car-in-San-Leandro-12417473.php\" target=\"_blank\" rel=\"noopener\">another patient\u003c/a> fled from the hospital, tried to carjack two vehicles, assaulted a teenage boy and bit an elderly man.\u003c/p>\n\u003cp>In 2016, the \u003ca href=\"https://www.eastbayexpress.com/oakland/overwhelmed/Content?oid=4705660\" target=\"_blank\" rel=\"noopener\">East Bay Express\u003c/a> and \u003ca href=\"http://www.ktvu.com/news/2-investigates/2-investigates-patients-say-conditions-at-john-george-mental-hospital-were-hell\" target=\"_blank\" rel=\"noopener\">KTVU\u003c/a> reported on severe overcrowding at the hospital where workers described the facility’s emergency room as dangerous and inhumane, with patients sleeping and eating on the floor — some moaning and crying for help.\u003c/p>\n\u003cp>Despite that media scrutiny and probes by government agencies, not much has changed, according to the SEIU Local 1021 field supervisor Ann Schuyler.\u003c/p>\n\u003cp>“The number of injuries is not abating and the severity of these injuries, caused while at work, is heartbreaking,” Schuyler said in an interview.\u003c/p>\n\u003cp>\u003cstrong>Investigation Into the Attack\u003c/strong>\u003c/p>\n\u003cp>The Alameda County Sheriff’s Office has identified 51-year-old Michael Lindsay of Fairfield as the patient who allegedly assaulted McElveen.\u003c/p>\n\u003cp>Lindsay was on the third day of his stay at John George and “was extremely agitated” during the two-and-a-half hours before the attack, state workplace regulators said.\u003c/p>\n\u003cp>The patient “expressed that he wanted to leave the facility” and was “verbally abusive to staff,” Cal/OSHA’s report states.\u003c/p>\n\u003cp>McElveen and another hospital worker tried to redirect Lindsay’s attention and de-escalate his behavior. Hospital staff gave him medication but said it was unclear if he faked digesting the pill.\u003c/p>\n\u003cp>Minutes later Lindsay went behind McElveen and punched him in the face and continued attacking him, according to the report.\u003c/p>\n\u003cp>Other staff members subdued the patient, called 911 and administered CPR to McElveen.\u003c/p>\n\u003cp>When an Alameda County Sheriff’s deputy arrived, Lindsay was being held down by staff and was yelling. The deputy placed handcuffs on Lindsay and put his knee on his back while other law enforcement officers arrived.\u003c/p>\n\u003cp>“McElveen was bleeding from a large wound on his head and was complaining of pain to his jaw,” wrote deputy Jeriah Gurley in a report on the incident, noting that the victim had blood on his clothes and there was blood on the floor next to him. Witnesses told the deputy McElveen was gasping for air.\u003c/p>\n\u003cp>McElveen was taken to Eden Medical Center in Castro Valley where he was treated for the next three days.\u003c/p>\n\u003cp>Lindsay was taken to San Leandro Hospital and eventually arrested.\u003c/p>\n\u003cp>Prosecutors later filed felony battery charges against Lindsay.\u003c/p>\n\u003cp>He has pleaded not guilty and his case is expected to go to trial in November, according to Alameda County District Attorney spokeswoman Teresa Drenick.\u003c/p>\n\u003cp>The deputy’s report also found that there were no surveillance cameras in the area where the attack took place.\u003c/p>\n\u003cp>Cal/OSHA concluded that Lindsay arrived at the hospital using a different name and that John George did not have policies in place to handle patients who use aliases. Without those procedures, the hospital failed to identify Lindsay as a patient who had a violent history at the facility.\u003c/p>\n\u003cp>\u003cstrong>Safety and Staffing Issues at the Hospital\u003c/strong>\u003c/p>\n\u003cp>In March, Cal/OSHA cited the Alameda Health System (AHS), which runs the hospital. It issued a $11,250 fine against AHS for a “serious” violation for having an injury and illness prevention program that was ineffective.\u003c/p>\n\u003cp>AHS officials did not appeal the penalty, and in June they paid the fine.\u003c/p>\n\u003cp>But hospital leaders emphasize that the facility correctly followed protocol before, during and after the incident.\u003c/p>\n\u003cp>Luis Fonseca, AHS’s chief operating officer, told Cal/OSHA that Linsday did not show signs of violence beforehand.\u003c/p>\n\u003cp>“We initiated safe practices and processes,” Fonseca said. The hospital immediately contacted law enforcement, helped McElveen press charges and provided him with emotional support, he said.\u003c/p>\n\u003cp>Sandra Williams, director of the hospital system’s environmental health and safety department, told a Cal/OSHA inspector “our actions were reasonable and responsible” on the day of the attack.\u003c/p>\n\u003cp>Lorna Fernandes, an AHS spokeswoman, emphasized that creating and maintaining a safe environment for its workers, patients and visitors is a top priority.\u003c/p>\n\u003cp>“AHS self-reported this incident to Cal/OSHA and then took immediate action and actively engaged all appropriate protocols to address the situation. Further, AHS cooperated with Cal/OSHA over the course of a thorough investigation,” Fernandes said in an statement emailed to KQED.\u003c/p>\n\u003cp>“Alameda Health System realizes that keeping our employees safe from harm so they can provide quality patient care is of the utmost importance. We continue to proactively address and adjust protocols to ensure we are adhering to best practices for maximum protection for AHS employees, patients, visitors and the community we serve,” Fernandes said.\u003c/p>\n\u003cp>Currently, the nurses’ contract with AHS at John George calls for one nurse for for every six patients at the emergency room, according to SEIU.\u003c/p>\n\u003cp>But the union’s Schuyler says with 40 to 60 patients in the ER, the hospital often goes over that ratio.\u003c/p>\n\u003cp>She says SEIU has pushed for years for more staffing.\u003c/p>\n\u003cp>“Patients keep arriving,” Schuyler said. “There is still an enormous need. It’s a constant struggle.”\u003c/p>\n\u003cp>AHS officials have yet to respond to questions about staffing at John George.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Dozens of SEIU 1021 members plan to hold an informational picket in Oakland on Tuesday afternoon to draw attention to staffing issues at John George Psychiatric Hospital and two other Alameda County medical facilities.",
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"title": "State Fines Psychiatric Hospital in Attack on Nurse Amid Renewed Staffing Concerns | KQED",
"description": "Dozens of SEIU 1021 members plan to hold an informational picket in Oakland on Tuesday afternoon to draw attention to staffing issues at John George Psychiatric Hospital and two other Alameda County medical facilities.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>David McElveen recently had a stroke. The 59-year-old Vallejo resident and John George Psychiatric Hospital nurse has short-term memory problems and has been out of work for more than a year. The stroke may be linked to an attack he suffered last summer.\u003c/p>\n\u003cp>He was working the morning shift on Sept. 13, 2017 at the Alameda County mental health care facility in San Leandro when a patient punched him the face.\u003c/p>\n\u003cp>“I heard somebody running and that’s the last thing I remembered,” McElveen said in an interview on Monday.\u003c/p>\n\u003cp>He fell to the floor. The patient kept hitting him, slamming his head against the ground.\u003c/p>\n\u003cp>“The injured was unconscious and had a seizure while bleeding from his face and head area,” an investigator with California’s Division of Occupational Safety and Health (Cal/OSHA) wrote in the agency’s investigation into the attack, obtained through a California Public Records Act Request.\u003c/p>\n\u003cp>McElveen’s facial bones were fractured.\u003c/p>\n\u003cp>“The left side of my skull was busted open. My right eye was closed for more than 10 days. My jaw was broken in two different places. And, I lost a tooth,” he said.\u003c/p>\n\u003cfigure id=\"attachment_11694380\" class=\"wp-caption alignright\" style=\"max-width: 480px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11694380\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/09/mcelveen-e1537822957258.jpg\" alt=\"\" width=\"480\" height=\"640\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/09/mcelveen-e1537822957258.jpg 480w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/09/mcelveen-e1537822957258-160x213.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/09/mcelveen-e1537822957258-240x320.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/09/mcelveen-e1537822957258-375x500.jpg 375w\" sizes=\"(max-width: 480px) 100vw, 480px\">\u003cfigcaption class=\"wp-caption-text\">David McElveen, a John George Psychiatric Hospital nurse, was attacked by a patient in September 2017. \u003ccite>(Courtesy David McElveen)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>McElveen was hospitalized and underwent surgery. Doctors wired his jaw shut. He also says the morning he was attacked, the hospital was short-staffed.\u003c/p>\n\u003cp>“We didn’t have enough mental health workers. We didn’t have enough nurses,” he said. “Everyone was just overwhelmed.”\u003c/p>\n\u003cp>Union officials who represent McElveen and other John George workers say the attack is the result of low staffing at the facility’s emergency room (known as “emergency services”) and poor security protocols at a hospital that has repeatedly come under scrutiny for dangers posed to employees and patients.\u003c/p>\n\u003cp>Now, dozens of Service Employees International Union Local 1021 members plan to hold an informational picket in Oakland on Tuesday afternoon to draw attention to staffing issues there and two other Alameda County medical facilities.\u003c/p>\n\u003cp>Two months after McElveen was attacked, \u003ca href=\"https://www.sfgate.com/crime/article/Runaway-psych-patient-hit-by-car-in-San-Leandro-12417473.php\" target=\"_blank\" rel=\"noopener\">another patient\u003c/a> fled from the hospital, tried to carjack two vehicles, assaulted a teenage boy and bit an elderly man.\u003c/p>\n\u003cp>In 2016, the \u003ca href=\"https://www.eastbayexpress.com/oakland/overwhelmed/Content?oid=4705660\" target=\"_blank\" rel=\"noopener\">East Bay Express\u003c/a> and \u003ca href=\"http://www.ktvu.com/news/2-investigates/2-investigates-patients-say-conditions-at-john-george-mental-hospital-were-hell\" target=\"_blank\" rel=\"noopener\">KTVU\u003c/a> reported on severe overcrowding at the hospital where workers described the facility’s emergency room as dangerous and inhumane, with patients sleeping and eating on the floor — some moaning and crying for help.\u003c/p>\n\u003cp>Despite that media scrutiny and probes by government agencies, not much has changed, according to the SEIU Local 1021 field supervisor Ann Schuyler.\u003c/p>\n\u003cp>“The number of injuries is not abating and the severity of these injuries, caused while at work, is heartbreaking,” Schuyler said in an interview.\u003c/p>\n\u003cp>\u003cstrong>Investigation Into the Attack\u003c/strong>\u003c/p>\n\u003cp>The Alameda County Sheriff’s Office has identified 51-year-old Michael Lindsay of Fairfield as the patient who allegedly assaulted McElveen.\u003c/p>\n\u003cp>Lindsay was on the third day of his stay at John George and “was extremely agitated” during the two-and-a-half hours before the attack, state workplace regulators said.\u003c/p>\n\u003cp>The patient “expressed that he wanted to leave the facility” and was “verbally abusive to staff,” Cal/OSHA’s report states.\u003c/p>\n\u003cp>McElveen and another hospital worker tried to redirect Lindsay’s attention and de-escalate his behavior. Hospital staff gave him medication but said it was unclear if he faked digesting the pill.\u003c/p>\n\u003cp>Minutes later Lindsay went behind McElveen and punched him in the face and continued attacking him, according to the report.\u003c/p>\n\u003cp>Other staff members subdued the patient, called 911 and administered CPR to McElveen.\u003c/p>\n\u003cp>When an Alameda County Sheriff’s deputy arrived, Lindsay was being held down by staff and was yelling. The deputy placed handcuffs on Lindsay and put his knee on his back while other law enforcement officers arrived.\u003c/p>\n\u003cp>“McElveen was bleeding from a large wound on his head and was complaining of pain to his jaw,” wrote deputy Jeriah Gurley in a report on the incident, noting that the victim had blood on his clothes and there was blood on the floor next to him. Witnesses told the deputy McElveen was gasping for air.\u003c/p>\n\u003cp>McElveen was taken to Eden Medical Center in Castro Valley where he was treated for the next three days.\u003c/p>\n\u003cp>Lindsay was taken to San Leandro Hospital and eventually arrested.\u003c/p>\n\u003cp>Prosecutors later filed felony battery charges against Lindsay.\u003c/p>\n\u003cp>He has pleaded not guilty and his case is expected to go to trial in November, according to Alameda County District Attorney spokeswoman Teresa Drenick.\u003c/p>\n\u003cp>The deputy’s report also found that there were no surveillance cameras in the area where the attack took place.\u003c/p>\n\u003cp>Cal/OSHA concluded that Lindsay arrived at the hospital using a different name and that John George did not have policies in place to handle patients who use aliases. Without those procedures, the hospital failed to identify Lindsay as a patient who had a violent history at the facility.\u003c/p>\n\u003cp>\u003cstrong>Safety and Staffing Issues at the Hospital\u003c/strong>\u003c/p>\n\u003cp>In March, Cal/OSHA cited the Alameda Health System (AHS), which runs the hospital. It issued a $11,250 fine against AHS for a “serious” violation for having an injury and illness prevention program that was ineffective.\u003c/p>\n\u003cp>AHS officials did not appeal the penalty, and in June they paid the fine.\u003c/p>\n\u003cp>But hospital leaders emphasize that the facility correctly followed protocol before, during and after the incident.\u003c/p>\n\u003cp>Luis Fonseca, AHS’s chief operating officer, told Cal/OSHA that Linsday did not show signs of violence beforehand.\u003c/p>\n\u003cp>“We initiated safe practices and processes,” Fonseca said. The hospital immediately contacted law enforcement, helped McElveen press charges and provided him with emotional support, he said.\u003c/p>\n\u003cp>Sandra Williams, director of the hospital system’s environmental health and safety department, told a Cal/OSHA inspector “our actions were reasonable and responsible” on the day of the attack.\u003c/p>\n\u003cp>Lorna Fernandes, an AHS spokeswoman, emphasized that creating and maintaining a safe environment for its workers, patients and visitors is a top priority.\u003c/p>\n\u003cp>“AHS self-reported this incident to Cal/OSHA and then took immediate action and actively engaged all appropriate protocols to address the situation. Further, AHS cooperated with Cal/OSHA over the course of a thorough investigation,” Fernandes said in an statement emailed to KQED.\u003c/p>\n\u003cp>“Alameda Health System realizes that keeping our employees safe from harm so they can provide quality patient care is of the utmost importance. We continue to proactively address and adjust protocols to ensure we are adhering to best practices for maximum protection for AHS employees, patients, visitors and the community we serve,” Fernandes said.\u003c/p>\n\u003cp>Currently, the nurses’ contract with AHS at John George calls for one nurse for for every six patients at the emergency room, according to SEIU.\u003c/p>\n\u003cp>But the union’s Schuyler says with 40 to 60 patients in the ER, the hospital often goes over that ratio.\u003c/p>\n\u003cp>She says SEIU has pushed for years for more staffing.\u003c/p>\n\u003cp>“Patients keep arriving,” Schuyler said. “There is still an enormous need. It’s a constant struggle.”\u003c/p>\n\u003cp>AHS officials have yet to respond to questions about staffing at John George.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Firefighters across California have been put through a lot this summer: days-long shifts, weeks away from home and six firefighter deaths.\u003c/p>\n\u003cp>People tend to think of firefighters as calm under pressure, stoic about the risks they take and private about the devastation they witness. Many firefighters prefer to maintain that image.\u003c/p>\n\u003cp>But as fire seasons intensify, more firefighters are realizing it’s better to open up — at least to each other.\u003c/p>\n\u003cp>At the Mendocino Complex Fire base camp, dozens of massive engines are lined up ready to go. Leaning against one is Cal Fire Battalion Chief Rich Dennett.\u003c/p>\n\u003cp>At first he’s really hesitant to talk to me, tries to give me a fake name.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I’m Norm Brown,” he says.\u003c/p>\n\u003cp>“That’s different than what’s on your name tag,” I quip back.\u003c/p>\n\u003cp>Dennett and some of his co-workers standing nearby chuckle.\u003c/p>\n\u003cp>“All right, I’m Rich Dennett,” he finally says as the laughter dies down.\u003c/p>\n\u003cfigure id=\"attachment_11689400\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11689400\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/08/dennett-crew-800x575.jpg\" alt=\"\" width=\"800\" height=\"575\">\u003cfigcaption class=\"wp-caption-text\">Cal Fire Battalion Chief Rich Dennett (third from left) is the leader of this strike team based out of Mendocino. Dennett stands in front of one of the team’s engines with some of his co-workers. \u003ccite>(Sonja Hutson/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dennett looks in many ways exactly like you’d expect a veteran firefighter to look. He’s tall, in good shape and has a thick mustache with flecks of gray in it. He’s wearing a blue uniform topped with a dusty Cal Fire baseball hat.\u003c/p>\n\u003cp>Dennett fits the bill of that guy you wouldn’t expect to open up about his feelings.\u003c/p>\n\u003cp>But, “over the past 20, 30 years, we don’t bottle things up inside like we used to,” Dennett says. “We’re more apt now to talk about those things, and I think it really helps.”\u003c/p>\n\u003cp>Dennett says there’s still some truth to the perception that firefighters are stoic and don’t share their emotions.\u003c/p>\n\u003cp>“To the public, it’s probably pretty accurate,” he says. “But with each other, if there’s trying times or things that are difficult to handle sometimes with medical-type calls or other things, we’re really good about talking to each other and getting each other to open up. Sometimes it could be in the fire engine, sometimes it could be under the shade of a tree and just sit and talk.”\u003c/p>\n\u003cp>I ask him if there was a traumatic incident that he’d experienced on the job that he would be willing to talk about.\u003c/p>\n\u003cp>“Nothing that I’m willing to share publicly,” he says.\u003c/p>\n\u003cfigure id=\"attachment_11689401\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11689401\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/08/cal-fire-engines-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-1180x885.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-960x720.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-240x180.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-375x281.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">These engines make up the Cal Fire strike team that Rich Dennett leads. They are parked in a lot at the Mendocino Complex Fire base camp after 24 hours on the front lines. \u003ccite>(Sonja Hutson/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>There are still firefighters who aren’t comfortable showing emotional weakness to each other. Some see it as a stigma. Cal Fire has been trying to chip away at that.\u003c/p>\n\u003cp>At a morning briefing last month at the Carr Fire base camp in Anderson, officials reminded the hundreds of firefighters gathered around the stage to take care of themselves emotionally.\u003c/p>\n\u003cp>“Please take a moment today and tomorrow and every day just to check in with yourself and check in with your crews making sure you’re emotionally and psychologically available and ready to go rock and roll in what we’re doing out here. I just wanna let you know that we have a peer support trailer set up over here by check-in,” the head of Employee Support Services said.\u003c/p>\n\u003cp>Down at the Mendocino Complex base camp in Ukiah, their air-conditioned peer counseling trailer sits slightly off the beaten path to protect firefighters’ privacy. It’s where peer counselor Nikole Schutz is stationed. She used to be a firefighter, too.\u003c/p>\n\u003cfigure id=\"attachment_11689405\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11689405\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/08/schutz-800x1067.jpg\" alt=\"\" width=\"800\" height=\"1067\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-800x1067.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-160x213.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-1020x1360.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-900x1200.jpg 900w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-1920x2560.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-1180x1573.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-960x1280.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-240x320.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-375x500.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-520x693.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Nikole Schutz provides peer counseling to firefighters and was a firefighter, too. \u003ccite>(Sonja Hutson/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“When folks call and they do need help, there’s somebody on the line that understands what it’s like to be in the station, who understands what it’s like to be on the fire line,” Schutz says. “It’s that credibility.\u003c/p>\n\u003cp>On a big wildfire like the Mendocino Complex Fire, about 30 people drop by the trailer every day, Schutz says. About half of them will seek help from an outside therapist.\u003c/p>\n\u003cp>“We tell them if your body says you need to cry a little bit, that’s fine, too,” Schutz says. “So we just tell folks, you know, be human.”\u003c/p>\n\u003cp>Schutz says besides missing home and feeling fatigued, firefighters can witness some pretty traumatic things, especially on medical calls.\u003c/p>\n\u003cp>“On our front there is a lot of post-traumatic stress out there. What we try to do as peer support is really educate people, so then they can catch it early,” she says.\u003c/p>\n\u003cp>This is helpful not just for an individual firefighter. It’s a larger safety issue. Because on the front lines of a fire, everyone needs to be laser-focused and looking out for each other.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Cal Fire officials say they’re considering increasing their staffing to prevent some of the 48-hour shifts that become necessary at the outbreak of a large fire, as well as grant more vacation days for firefighters to recharge.\u003c/p>\n\n",
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"excerpt": "People think of firefighters as calm under pressure, stoic about the risks they take and private about the devastation they witness. But as fire seasons intensify, more firefighters are realizing it’s better not to bury their feelings.",
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"title": "Amid Traumatizing Work, Firefighters Open Up — to Each Other | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Firefighters across California have been put through a lot this summer: days-long shifts, weeks away from home and six firefighter deaths.\u003c/p>\n\u003cp>People tend to think of firefighters as calm under pressure, stoic about the risks they take and private about the devastation they witness. Many firefighters prefer to maintain that image.\u003c/p>\n\u003cp>But as fire seasons intensify, more firefighters are realizing it’s better to open up — at least to each other.\u003c/p>\n\u003cp>At the Mendocino Complex Fire base camp, dozens of massive engines are lined up ready to go. Leaning against one is Cal Fire Battalion Chief Rich Dennett.\u003c/p>\n\u003cp>At first he’s really hesitant to talk to me, tries to give me a fake name.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I’m Norm Brown,” he says.\u003c/p>\n\u003cp>“That’s different than what’s on your name tag,” I quip back.\u003c/p>\n\u003cp>Dennett and some of his co-workers standing nearby chuckle.\u003c/p>\n\u003cp>“All right, I’m Rich Dennett,” he finally says as the laughter dies down.\u003c/p>\n\u003cfigure id=\"attachment_11689400\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11689400\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/08/dennett-crew-800x575.jpg\" alt=\"\" width=\"800\" height=\"575\">\u003cfigcaption class=\"wp-caption-text\">Cal Fire Battalion Chief Rich Dennett (third from left) is the leader of this strike team based out of Mendocino. Dennett stands in front of one of the team’s engines with some of his co-workers. \u003ccite>(Sonja Hutson/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dennett looks in many ways exactly like you’d expect a veteran firefighter to look. He’s tall, in good shape and has a thick mustache with flecks of gray in it. He’s wearing a blue uniform topped with a dusty Cal Fire baseball hat.\u003c/p>\n\u003cp>Dennett fits the bill of that guy you wouldn’t expect to open up about his feelings.\u003c/p>\n\u003cp>But, “over the past 20, 30 years, we don’t bottle things up inside like we used to,” Dennett says. “We’re more apt now to talk about those things, and I think it really helps.”\u003c/p>\n\u003cp>Dennett says there’s still some truth to the perception that firefighters are stoic and don’t share their emotions.\u003c/p>\n\u003cp>“To the public, it’s probably pretty accurate,” he says. “But with each other, if there’s trying times or things that are difficult to handle sometimes with medical-type calls or other things, we’re really good about talking to each other and getting each other to open up. Sometimes it could be in the fire engine, sometimes it could be under the shade of a tree and just sit and talk.”\u003c/p>\n\u003cp>I ask him if there was a traumatic incident that he’d experienced on the job that he would be willing to talk about.\u003c/p>\n\u003cp>“Nothing that I’m willing to share publicly,” he says.\u003c/p>\n\u003cfigure id=\"attachment_11689401\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11689401\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/08/cal-fire-engines-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-1180x885.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-960x720.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-240x180.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-375x281.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/cal-fire-engines-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">These engines make up the Cal Fire strike team that Rich Dennett leads. They are parked in a lot at the Mendocino Complex Fire base camp after 24 hours on the front lines. \u003ccite>(Sonja Hutson/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>There are still firefighters who aren’t comfortable showing emotional weakness to each other. Some see it as a stigma. Cal Fire has been trying to chip away at that.\u003c/p>\n\u003cp>At a morning briefing last month at the Carr Fire base camp in Anderson, officials reminded the hundreds of firefighters gathered around the stage to take care of themselves emotionally.\u003c/p>\n\u003cp>“Please take a moment today and tomorrow and every day just to check in with yourself and check in with your crews making sure you’re emotionally and psychologically available and ready to go rock and roll in what we’re doing out here. I just wanna let you know that we have a peer support trailer set up over here by check-in,” the head of Employee Support Services said.\u003c/p>\n\u003cp>Down at the Mendocino Complex base camp in Ukiah, their air-conditioned peer counseling trailer sits slightly off the beaten path to protect firefighters’ privacy. It’s where peer counselor Nikole Schutz is stationed. She used to be a firefighter, too.\u003c/p>\n\u003cfigure id=\"attachment_11689405\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11689405\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/08/schutz-800x1067.jpg\" alt=\"\" width=\"800\" height=\"1067\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-800x1067.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-160x213.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-1020x1360.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-900x1200.jpg 900w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-1920x2560.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-1180x1573.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-960x1280.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-240x320.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-375x500.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2018/08/schutz-520x693.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Nikole Schutz provides peer counseling to firefighters and was a firefighter, too. \u003ccite>(Sonja Hutson/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“When folks call and they do need help, there’s somebody on the line that understands what it’s like to be in the station, who understands what it’s like to be on the fire line,” Schutz says. “It’s that credibility.\u003c/p>\n\u003cp>On a big wildfire like the Mendocino Complex Fire, about 30 people drop by the trailer every day, Schutz says. About half of them will seek help from an outside therapist.\u003c/p>\n\u003cp>“We tell them if your body says you need to cry a little bit, that’s fine, too,” Schutz says. “So we just tell folks, you know, be human.”\u003c/p>\n\u003cp>Schutz says besides missing home and feeling fatigued, firefighters can witness some pretty traumatic things, especially on medical calls.\u003c/p>\n\u003cp>“On our front there is a lot of post-traumatic stress out there. What we try to do as peer support is really educate people, so then they can catch it early,” she says.\u003c/p>\n\u003cp>This is helpful not just for an individual firefighter. It’s a larger safety issue. Because on the front lines of a fire, everyone needs to be laser-focused and looking out for each other.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Cal Fire officials say they’re considering increasing their staffing to prevent some of the 48-hour shifts that become necessary at the outbreak of a large fire, as well as grant more vacation days for firefighters to recharge.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "african-american-seniors-struggle-to-find-therapists-who-understand",
"title": "African-American Seniors Struggle to Find Therapists Who Understand",
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"content": "\u003cp>Choosing the right mental health therapist means finding connection and trust. For some African-American seniors living in the Bay Area, finding that therapist takes extra work. Finding someone they trust and who understands the challenges older people face is important, but African-American seniors say another major factor is that the provider understands race and culture.\u003c/p>\n\u003cp>Paula Marie Parker, 64, is a retired newspaper journalist. She stays active in the Oakland community as a health advocate for people of color and as a \u003ca href=\"https://www.youtube.com/watch?v=bv468eIM0dU\" target=\"_blank\" rel=\"noopener\">storyteller\u003c/a>. Parker’s family has a history of mental health challenges, and she is particular about what she seeks in a therapist.\u003c/p>\n\u003cp>“I’m looking for somebody who is a really good listener,” Parker says. “I’m looking for somebody who is empathetic.”\u003c/p>\n\u003cp>Parker, who identifies as African-American with some Native American ancestry, says a therapist with an understanding of her race and culture is another requirement.\u003c/p>\n\u003cp>“I am really focused on finding someone who’s a fit for me as a woman of color,” Parker says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Finding a black therapist can be tough, even in a city as diverse as Oakland. According to the American Psychological Association, a little over 5 percent of working psychologists in the country are black.\u003c/p>\n\u003cp>African-Americans, including those who are seniors, go to therapy in lower numbers compared to white people. Lack of financial resources to pay for treatment is one reason. But there’s also concern the provider won’t understand, nor empathize, with their racial and cultural experiences. Black seniors face problems in their personal lives, but social issues affect them, too.\u003c/p>\n\u003cp>“White therapists may be really great, “ Parker says. “But when you talk about the [mental] impact of worrying about black men in your family being pulled over by the police, beaten or killed — they just can’t feel it the way that somebody of an African-American background can.”\u003c/p>\n\u003cp>Parker bonded with her former black therapist, who was closer to middle age.\u003c/p>\n\u003cp>“We would hug at the end of the session,” she recalls. “Even though she wasn’t my age, she was a woman of enough age that she understood a lot of things.”\u003c/p>\n\u003cp>Parker is currently with a therapist who is white, whom she likes. They discussed early on Parker’s need for a therapist to understand her race and culture.\u003c/p>\n\u003cp>“Day one I was worried that I would scare her off,” Parker says. “But I just laid my cards out on the table. I still think that’s just the best way because she will understand why I seem skittish. I’m sizing her up.”\u003c/p>\n\u003cp>Senior black clients come in the door dealing with the high cost of living, homelessness, raising their grandchildren, health issues and more, according to Dr. Patricia Maul-Jones, an African-American psychotherapist who practices in the Pill Hill neighborhood, home to many Oakland hospitals and medical clinics.\u003c/p>\n\u003cp>Maul-Jones came to this practice when there were no black therapists. She says older black clients had a hard time opening up with her white colleague. But Maul-Jones made a connection.\u003c/p>\n\u003cp>“They say, ‘You know exactly where I’m coming from,’” Maul-Jones says. “Yeah I know, because that’s my uncle, that’s me.”\u003c/p>\n\u003cp>\u003cstrong>The Ripple Effect of Medical Racism\u003c/strong>\u003c/p>\n\u003cp>Maul-Jones says African-American seniors have some distrust of the mental health field and remember historical incidents of medical racism like the \u003ca href=\"https://www.washingtonpost.com/news/retropolis/wp/2017/05/16/youve-got-bad-blood-the-horror-of-the-tuskegee-syphilis-experiment/?noredirect=on&utm_term=.970421a8e3dd\">Tuskegee experiment.\u003c/a>\u003c/p>\n\u003cp>Racial inequality in health services still exists. A 2011 \u003ca href=\"http://www.acbhcs.org/providers/QI/docs/Alameda_African_American_Utilization_Report.pdf\" target=\"_blank\" rel=\"noopener\">Alameda County Behavioral Health Care Services report\u003c/a> said African-Americans are disproportionately misdiagnosed and labeled with mental health issues that are much more serious than their actual problems.\u003c/p>\n\u003cp>Maul-Jones says it’s important for providers to know and understand the history of black clients. Generations of trauma continue to affect African-Americans’ mental health, such as poverty, abuse and daily encounters with racism.\u003c/p>\n\u003cp>“Even if you were not personally traumatized, your mother probably was, your grandmother probably was, your neighbor, so you are surrounded by trauma in some form,” Maul-Jones says.\u003c/p>\n\u003cp>Chances are there was little to no mental health support to help them recover from the trauma years ago. But some effort is being made in the field today, such as cultural trainings and classes for aspiring therapists.\u003c/p>\n\u003cp>Still, there are those who can’t or choose not to see a therapist. They may turn instead to community structures for mental health support.\u003c/p>\n\u003cp>Joe Anderson is one example. He’s chairman of \u003ca href=\"https://blackmenspeak.org/\" target=\"_blank\" rel=\"noopener\">Black Men Speak\u003c/a>, a group in East Oakland that spreads the word about mental health to the community. Many of the men who participate are over 50 and live with mental health challenges common in elderly populations.\u003c/p>\n\u003cp>“I’m 69 years old and I cannot work full time,” Anderson says. “I do not have the income to rent a home or even an apartment right now. I’m basically homeless, living in a room.”\u003c/p>\n\u003cp>Anderson has been a Black Men Speak member for nearly 10 years.\u003c/p>\n\u003cp>“Black Men Speak became my lifesaver, my support group,” he says. “I have people with similar backgrounds, who share the same hopes, who have been through some of the traumatic situations. But they found a way to create something. That’s how Black Men Speak was created.”\u003c/p>\n\u003cp>And Anderson is around people who share his culture. Years ago, he had a white therapist who he says didn’t listen to him during their sessions. The therapist made an angry phone call to Anderson when he stopped using his services. It brought back memories from Anderson’s early days in Texas.\u003c/p>\n\u003cp>“It made me feel like I was down South again,” Anderson recalls. “Like the boss man was telling me what I should do and then reprimands me because I didn’t.“\u003c/p>\n\u003cp>He stopped seeing therapists after that incident.\u003c/p>\n\u003cp>“It goes back to basically respect,” adds 63-year-old James Glenn, a member of Black Men Speak who is also a retired assistant mental health clinician. “One of the worst sins that anyone can do working with a black person is not listen to them. And I mean really empathetically listen to them. Listening not only with the words, but with the body language.”\u003c/p>\n\u003cp>Many African-American seniors in California, like Joe Anderson, are from the South and still practice Southern manners. They expect a higher level of respect when speaking with them, such as the provider asking if they prefer to be called mister or miss.\u003c/p>\n\u003cp>Dr. Maul-Jones explains: “You go to therapy, walk in and a young white woman says, ‘OK John, I’ll see you.’ She says a black senior may think, ‘This white woman called me John?’ It’s uncomfortable. Now as a senior, I’m wondering if you’re disrespectful because I’m black and you’re white.”\u003c/p>\n\u003cp>This question of disrespect may resurrect memories from a time when black people had to address white people by their last names, but white people addressed black people by their first names.\u003c/p>\n\u003cp>Yet, with so few black providers available, Paula Marie Parker urges seniors to remain open.\u003c/p>\n\u003cp>“There are really good people out there, in all colors,” she says. “It might be somebody who is in a whole other packaging and yet is an old soul who can really hear you and help you.”\u003c/p>\n\u003cp>Parker says the lack of black therapists won’t stop her from working on healing.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced with the support of a journalism fellowship from New America Media, the Gerontological Society of America and the Commonwealth Fund.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Choosing the right mental health therapist means finding connection and trust. For some African-American seniors living in the Bay Area, finding that therapist takes extra work. Finding someone they trust and who understands the challenges older people face is important, but African-American seniors say another major factor is that the provider understands race and culture.\u003c/p>\n\u003cp>Paula Marie Parker, 64, is a retired newspaper journalist. She stays active in the Oakland community as a health advocate for people of color and as a \u003ca href=\"https://www.youtube.com/watch?v=bv468eIM0dU\" target=\"_blank\" rel=\"noopener\">storyteller\u003c/a>. Parker’s family has a history of mental health challenges, and she is particular about what she seeks in a therapist.\u003c/p>\n\u003cp>“I’m looking for somebody who is a really good listener,” Parker says. “I’m looking for somebody who is empathetic.”\u003c/p>\n\u003cp>Parker, who identifies as African-American with some Native American ancestry, says a therapist with an understanding of her race and culture is another requirement.\u003c/p>\n\u003cp>“I am really focused on finding someone who’s a fit for me as a woman of color,” Parker says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Finding a black therapist can be tough, even in a city as diverse as Oakland. According to the American Psychological Association, a little over 5 percent of working psychologists in the country are black.\u003c/p>\n\u003cp>African-Americans, including those who are seniors, go to therapy in lower numbers compared to white people. Lack of financial resources to pay for treatment is one reason. But there’s also concern the provider won’t understand, nor empathize, with their racial and cultural experiences. Black seniors face problems in their personal lives, but social issues affect them, too.\u003c/p>\n\u003cp>“White therapists may be really great, “ Parker says. “But when you talk about the [mental] impact of worrying about black men in your family being pulled over by the police, beaten or killed — they just can’t feel it the way that somebody of an African-American background can.”\u003c/p>\n\u003cp>Parker bonded with her former black therapist, who was closer to middle age.\u003c/p>\n\u003cp>“We would hug at the end of the session,” she recalls. “Even though she wasn’t my age, she was a woman of enough age that she understood a lot of things.”\u003c/p>\n\u003cp>Parker is currently with a therapist who is white, whom she likes. They discussed early on Parker’s need for a therapist to understand her race and culture.\u003c/p>\n\u003cp>“Day one I was worried that I would scare her off,” Parker says. “But I just laid my cards out on the table. I still think that’s just the best way because she will understand why I seem skittish. I’m sizing her up.”\u003c/p>\n\u003cp>Senior black clients come in the door dealing with the high cost of living, homelessness, raising their grandchildren, health issues and more, according to Dr. Patricia Maul-Jones, an African-American psychotherapist who practices in the Pill Hill neighborhood, home to many Oakland hospitals and medical clinics.\u003c/p>\n\u003cp>Maul-Jones came to this practice when there were no black therapists. She says older black clients had a hard time opening up with her white colleague. But Maul-Jones made a connection.\u003c/p>\n\u003cp>“They say, ‘You know exactly where I’m coming from,’” Maul-Jones says. “Yeah I know, because that’s my uncle, that’s me.”\u003c/p>\n\u003cp>\u003cstrong>The Ripple Effect of Medical Racism\u003c/strong>\u003c/p>\n\u003cp>Maul-Jones says African-American seniors have some distrust of the mental health field and remember historical incidents of medical racism like the \u003ca href=\"https://www.washingtonpost.com/news/retropolis/wp/2017/05/16/youve-got-bad-blood-the-horror-of-the-tuskegee-syphilis-experiment/?noredirect=on&utm_term=.970421a8e3dd\">Tuskegee experiment.\u003c/a>\u003c/p>\n\u003cp>Racial inequality in health services still exists. A 2011 \u003ca href=\"http://www.acbhcs.org/providers/QI/docs/Alameda_African_American_Utilization_Report.pdf\" target=\"_blank\" rel=\"noopener\">Alameda County Behavioral Health Care Services report\u003c/a> said African-Americans are disproportionately misdiagnosed and labeled with mental health issues that are much more serious than their actual problems.\u003c/p>\n\u003cp>Maul-Jones says it’s important for providers to know and understand the history of black clients. Generations of trauma continue to affect African-Americans’ mental health, such as poverty, abuse and daily encounters with racism.\u003c/p>\n\u003cp>“Even if you were not personally traumatized, your mother probably was, your grandmother probably was, your neighbor, so you are surrounded by trauma in some form,” Maul-Jones says.\u003c/p>\n\u003cp>Chances are there was little to no mental health support to help them recover from the trauma years ago. But some effort is being made in the field today, such as cultural trainings and classes for aspiring therapists.\u003c/p>\n\u003cp>Still, there are those who can’t or choose not to see a therapist. They may turn instead to community structures for mental health support.\u003c/p>\n\u003cp>Joe Anderson is one example. He’s chairman of \u003ca href=\"https://blackmenspeak.org/\" target=\"_blank\" rel=\"noopener\">Black Men Speak\u003c/a>, a group in East Oakland that spreads the word about mental health to the community. Many of the men who participate are over 50 and live with mental health challenges common in elderly populations.\u003c/p>\n\u003cp>“I’m 69 years old and I cannot work full time,” Anderson says. “I do not have the income to rent a home or even an apartment right now. I’m basically homeless, living in a room.”\u003c/p>\n\u003cp>Anderson has been a Black Men Speak member for nearly 10 years.\u003c/p>\n\u003cp>“Black Men Speak became my lifesaver, my support group,” he says. “I have people with similar backgrounds, who share the same hopes, who have been through some of the traumatic situations. But they found a way to create something. That’s how Black Men Speak was created.”\u003c/p>\n\u003cp>And Anderson is around people who share his culture. Years ago, he had a white therapist who he says didn’t listen to him during their sessions. The therapist made an angry phone call to Anderson when he stopped using his services. It brought back memories from Anderson’s early days in Texas.\u003c/p>\n\u003cp>“It made me feel like I was down South again,” Anderson recalls. “Like the boss man was telling me what I should do and then reprimands me because I didn’t.“\u003c/p>\n\u003cp>He stopped seeing therapists after that incident.\u003c/p>\n\u003cp>“It goes back to basically respect,” adds 63-year-old James Glenn, a member of Black Men Speak who is also a retired assistant mental health clinician. “One of the worst sins that anyone can do working with a black person is not listen to them. And I mean really empathetically listen to them. Listening not only with the words, but with the body language.”\u003c/p>\n\u003cp>Many African-American seniors in California, like Joe Anderson, are from the South and still practice Southern manners. They expect a higher level of respect when speaking with them, such as the provider asking if they prefer to be called mister or miss.\u003c/p>\n\u003cp>Dr. Maul-Jones explains: “You go to therapy, walk in and a young white woman says, ‘OK John, I’ll see you.’ She says a black senior may think, ‘This white woman called me John?’ It’s uncomfortable. Now as a senior, I’m wondering if you’re disrespectful because I’m black and you’re white.”\u003c/p>\n\u003cp>This question of disrespect may resurrect memories from a time when black people had to address white people by their last names, but white people addressed black people by their first names.\u003c/p>\n\u003cp>Yet, with so few black providers available, Paula Marie Parker urges seniors to remain open.\u003c/p>\n\u003cp>“There are really good people out there, in all colors,” she says. “It might be somebody who is in a whole other packaging and yet is an old soul who can really hear you and help you.”\u003c/p>\n\u003cp>Parker says the lack of black therapists won’t stop her from working on healing.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"order": 9
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"order": 18
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"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
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"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
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"source": "American Public Media"
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"masters-of-scale": {
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"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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},
"mindshift": {
"id": "mindshift",
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"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
"id": "morning-edition",
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"order": 11
},
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"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"link": "/radio/program/on-the-media",
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},
"pbs-newshour": {
"id": "pbs-newshour",
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"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
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},
"link": "/radio/program/pbs-newshour",
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"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
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},
"perspectives": {
"id": "perspectives",
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"order": 14
},
"link": "/perspectives",
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"planet-money": {
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
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},
"link": "/radio/program/planet-money",
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"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
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"rss": "https://feeds.npr.org/510289/podcast.xml"
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},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"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.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"order": 5
},
"link": "/podcasts/politicalbreakdown",
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"amazon": "https://music.amazon.com/podcasts/e0c2d153-ad36-4c8d-901d-f1da6a724824/political-breakdown",
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"rss": "https://ww2.kqed.org/news/tag/political-breakdown/feed/podcast"
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"possible": {
"id": "possible",
"title": "Possible",
"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.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
"meta": {
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"source": "Possible"
},
"link": "/radio/program/possible",
"subscribe": {
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
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