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"content": "\u003cp>In Palo Alto, where Asian Americans make up nearly 40 percent of the \u003ca href=\"https://www.pausd.org/sites/default/files/pdn-news/attachments/Elementary%20Enrollment%20Demographics.pdf\" target=\"_blank\" rel=\"noopener\">student population\u003c/a>, they also make up roughly 40 percent of youth suicides over the last decade. And in just the last two years, four out of five teen suicides in Palo Alto have been East Asian kids.\u003c/p>\n\u003cp>But many parents are first-generation immigrants, leery of acknowledging and addressing mental health problems. So psychiatrists at \u003ca href=\"http://www.stanfordchipao.com/\" target=\"_blank\" rel=\"noopener\">Stanford University\u003c/a> are turning to an unlikely art form to start the conversation: theater.\u003c/p>\n\u003cp>“A lot of parents are reluctant to talk about their own feelings,” says \u003ca href=\"https://med.stanford.edu/profiles/rona-hu\" target=\"_blank\" rel=\"noopener\">Dr. Rona Hu\u003c/a>, a second-generation Chinese American Stanford psychiatrist and the main force behind a volunteer theater troupe whose job it is to model good parenting techniques informed by American psychiatry. “Immigrant parents often aren’t aware of or prepared for the way that their teenagers behave in this culture, because it’s so different from the way that they were raised.”\u003c/p>\n\u003cfigure id=\"attachment_13113614\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-13113614 size-medium\" src=\"https://ww2.kqed.org/arts/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-800x451.jpg\" alt=\"Each vignette is based on real life, and the psychiatrists channel their younger selves, as well as older relatives when performing on stage. Dr. Rona Hu says she draws on a combination of her mother and her aunt.\" width=\"800\" height=\"451\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-800x451.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-768x433.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-1020x575.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-1180x665.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-960x541.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-520x293.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Each vignette is based on real life, and the psychiatrists channel their younger selves, as well as older relatives when performing on stage. Dr. Rona Hu says she draws on a combination of her mother and her aunt. \u003ccite>(Photo: Jeff Enlow/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hu, who has no performing arts training beyond one drama class in 9th grade, came up with the idea of theatrical, therapeutic vignettes in 2015 while making the rounds as a speaker on mental health at local schools. Parents would come up to her after lectures and panel discussions and ask for more practical help. “You can \u003cem>tell\u003c/em> us to communicate better with our teenagers,” Hu says of her interactions with parents. “But \u003cem>show\u003c/em> us. How do we do it?”\u003c/p>\n\u003cp>She was also inspired by her days as a resident at the University of California, San Francisco (UCSF), where faculty members used theatrical vignettes to help young doctors learn how to interact with difficult patients. During these sessions, teachers would act out a negative exchange, talk in character about what went wrong, and then reenact the scene to demonstrate a better outcome.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Hu’s theater troupe is comprised mostly of medical professionals who write and perform skits inspired by their first and second-generation immigrant experience. They’ve been performing since March of 2016.\u003c/p>\n\u003cfigure id=\"attachment_13113615\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-13113615\" src=\"https://ww2.kqed.org/arts/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-800x451.jpg\" alt='In \"Awkward Hug,\" a son, played by Stanford student Jason Li, has to beg for a physical expression of affection from his father, played by Dr. Steven Sust. ' width=\"800\" height=\"451\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-800x451.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-768x433.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-1020x575.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-1180x665.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-960x541.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-520x293.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">In “Awkward Hug,” a son, played by Stanford student Jason Li, has to beg for a physical expression of affection from his father, played by Dr. Steven Sust. \u003ccite>(Photo: Jeff Enlow/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On a recent evening, the troupe performed at Jordan Middle School in Palo Alto for an audience of roughly 100 parents.\u003c/p>\n\u003cp>With the barest of sets and costumes, the cast – most of them medical professionals – played out six uncomfortable conversations, covering topics like bad language, poor test scores, and depression.\u003c/p>\n\u003cp>In the staged scenes, the parents all love their children, but their tendency to respond with shock, anger or denial drives an emotional wedge between the generations.\u003c/p>\n\u003cp>Though the scenes are often played broadly for laughs, they also reflect real-life experience. Hu says, “I’ve had any number of parents coming up to me with tears rolling down their cheeks, saying, ‘That vignette was my life.’”\u003c/p>\n\u003cp>\u003ciframe loading=\"lazy\" title=\"Vignettes for Asian Parents of Teens - "What's Wrong With You!"\" width=\"640\" height=\"360\" src=\"https://www.youtube.com/embed/3FFMhUEzB9A?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>As with the skits at UCSF, a moderator “interviews” the actors after their scene, so they can explain the psychological underpinnings of the argument. The audience also has an opportunity to weigh in with questions.\u003c/p>\n\u003cp>Then, the actor-psychiatrists model on stage what good parenting looks like. The father who first berated his son for failing another math test offers sympathy and practical solutions instead. The mother who first laughed off her daughter’s depression now agrees to help her consult a medical professional.\u003c/p>\n\u003cp>The overall idea of the theater project is to get parents talking about applying emotional intelligence to their daily interactions with their children. “’What’s wrong, sweetie?’ versus ‘What’s wrong with you?’ which sounds accusatory,” Hu says. “Especially if they’ve been raised in a culture where it was taboo to talk about feelings, these are skills that will take some work to acquire.”\u003c/p>\n\u003cfigure id=\"attachment_13113823\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-13113823 size-medium\" src=\"https://ww2.kqed.org/arts/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-800x450.jpg\" alt='In \"Just Be Happy,\" Dr. Bibi Das plays a mother struggling to talk to her daughter, played by Preeti Talwai, about depression.' width=\"800\" height=\"450\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-768x432.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-1180x664.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-960x541.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-520x293.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">In “Just Be Happy,” Dr. Bibi Das plays a mother struggling to talk to her daughter, played by Preeti Talwai, about depression. \u003ccite>(Photo: Jeff Enlow/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Federal researchers who \u003ca href=\"https://www.sccgov.org/sites/sccphd/en-us/Partners/collabproj/epi-aid/Pages/epi-aid.aspx\" target=\"_blank\" rel=\"noopener\">delved into the data\u003c/a> found many teen suicides in Palo Alto in recent years had underlying mental health issues. Each case is unique, but Hu says a child that feels his or her parent is an ally is less likely to hide problems that could develop into something serious, or even life-threatening.\u003c/p>\n\u003cp>“If the parent knows about the issue, then they can do something about it,” Hu says. “But if they don’t know, then there’s really nothing they can do.”\u003c/p>\n\u003cp>Gloria Zhang, a Palo Alto parent present at the Jordan Middle School event, says she doesn’t want to wait till there’s a crisis to develop a better relationship with her middle schooler. She says she feels like she could use more training to talk to her son without losing her temper. “I want to improve; communicate with him better, to let him to understand I love him,” Zhang says. “I want him healthy.”\u003c/p>\n\u003cfigure id=\"attachment_13113824\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-13113824 size-medium\" src=\"https://ww2.kqed.org/arts/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-800x451.jpg\" alt='In \"Party Dress,\" Jaime Jimenez, assistant nurse manager for inpatient psychiatry at Stanford, plays a dad shocked at what his teenage daughter, played by Dr. Renee Garcia, is wearing.' width=\"800\" height=\"451\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-800x451.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-768x433.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-1020x575.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-1180x665.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-960x541.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-520x293.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">In “Party Dress,” Jaime Jimenez, assistant nurse manager for inpatient psychiatry at Stanford, plays a dad shocked at what his teenage daughter, played by Dr. Renee Garcia, is wearing. \u003ccite>(Photo: Jeff Enlow/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That feeling isn’t limited to East Asian parents. By popular demand, the troupe has expanded its audience base to include Latino and South Asian families.\u003c/p>\n\u003cp>The Stanford psychiatrists are currently applying for grants to study whether the skits work in a scientific sense — as well as a theatrical one.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-medium wp-image-12127869\" src=\"https://ww2.kqed.org/arts/wp-content/uploads/sites/2/2016/09/Q.Logo_.Break_-800x78.jpg\" alt=\"Q.Logo.Break\" width=\"800\" height=\"78\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/2/2016/09/Q.Logo_.Break_.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/2/2016/09/Q.Logo_.Break_-400x39.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/2/2016/09/Q.Logo_.Break_-768x75.jpg 768w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The Stanford psychiatrists perform next for the American Psychiatric Association Saturday, May 20, in San Diego. More info \u003ca href=\"https://www.psychiatry.org/psychiatrists/meetings/annual-meeting\" target=\"_blank\" rel=\"noopener\">\u003cstrong>here\u003c/strong>\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "In Palo Alto, where Asian Americans make up roughly 40 percent of youth suicides, Stanford psychiatrists are writing and performing skits aimed at educating parents to have more productive conversations with their children.",
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"title": "Stanford Psychiatrists Take to the Stage | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In Palo Alto, where Asian Americans make up nearly 40 percent of the \u003ca href=\"https://www.pausd.org/sites/default/files/pdn-news/attachments/Elementary%20Enrollment%20Demographics.pdf\" target=\"_blank\" rel=\"noopener\">student population\u003c/a>, they also make up roughly 40 percent of youth suicides over the last decade. And in just the last two years, four out of five teen suicides in Palo Alto have been East Asian kids.\u003c/p>\n\u003cp>But many parents are first-generation immigrants, leery of acknowledging and addressing mental health problems. So psychiatrists at \u003ca href=\"http://www.stanfordchipao.com/\" target=\"_blank\" rel=\"noopener\">Stanford University\u003c/a> are turning to an unlikely art form to start the conversation: theater.\u003c/p>\n\u003cp>“A lot of parents are reluctant to talk about their own feelings,” says \u003ca href=\"https://med.stanford.edu/profiles/rona-hu\" target=\"_blank\" rel=\"noopener\">Dr. Rona Hu\u003c/a>, a second-generation Chinese American Stanford psychiatrist and the main force behind a volunteer theater troupe whose job it is to model good parenting techniques informed by American psychiatry. “Immigrant parents often aren’t aware of or prepared for the way that their teenagers behave in this culture, because it’s so different from the way that they were raised.”\u003c/p>\n\u003cfigure id=\"attachment_13113614\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-13113614 size-medium\" src=\"https://ww2.kqed.org/arts/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-800x451.jpg\" alt=\"Each vignette is based on real life, and the psychiatrists channel their younger selves, as well as older relatives when performing on stage. Dr. Rona Hu says she draws on a combination of her mother and her aunt.\" width=\"800\" height=\"451\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-800x451.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-768x433.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-1020x575.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-1180x665.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-960x541.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25054_Enlow_Parent_Skit-005-qut-520x293.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Each vignette is based on real life, and the psychiatrists channel their younger selves, as well as older relatives when performing on stage. Dr. Rona Hu says she draws on a combination of her mother and her aunt. \u003ccite>(Photo: Jeff Enlow/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hu, who has no performing arts training beyond one drama class in 9th grade, came up with the idea of theatrical, therapeutic vignettes in 2015 while making the rounds as a speaker on mental health at local schools. Parents would come up to her after lectures and panel discussions and ask for more practical help. “You can \u003cem>tell\u003c/em> us to communicate better with our teenagers,” Hu says of her interactions with parents. “But \u003cem>show\u003c/em> us. How do we do it?”\u003c/p>\n\u003cp>She was also inspired by her days as a resident at the University of California, San Francisco (UCSF), where faculty members used theatrical vignettes to help young doctors learn how to interact with difficult patients. During these sessions, teachers would act out a negative exchange, talk in character about what went wrong, and then reenact the scene to demonstrate a better outcome.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Hu’s theater troupe is comprised mostly of medical professionals who write and perform skits inspired by their first and second-generation immigrant experience. They’ve been performing since March of 2016.\u003c/p>\n\u003cfigure id=\"attachment_13113615\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-13113615\" src=\"https://ww2.kqed.org/arts/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-800x451.jpg\" alt='In \"Awkward Hug,\" a son, played by Stanford student Jason Li, has to beg for a physical expression of affection from his father, played by Dr. Steven Sust. ' width=\"800\" height=\"451\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-800x451.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-768x433.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-1020x575.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-1180x665.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-960x541.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25055_Enlow_Parent_Skit-007-qut-520x293.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">In “Awkward Hug,” a son, played by Stanford student Jason Li, has to beg for a physical expression of affection from his father, played by Dr. Steven Sust. \u003ccite>(Photo: Jeff Enlow/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On a recent evening, the troupe performed at Jordan Middle School in Palo Alto for an audience of roughly 100 parents.\u003c/p>\n\u003cp>With the barest of sets and costumes, the cast – most of them medical professionals – played out six uncomfortable conversations, covering topics like bad language, poor test scores, and depression.\u003c/p>\n\u003cp>In the staged scenes, the parents all love their children, but their tendency to respond with shock, anger or denial drives an emotional wedge between the generations.\u003c/p>\n\u003cp>Though the scenes are often played broadly for laughs, they also reflect real-life experience. Hu says, “I’ve had any number of parents coming up to me with tears rolling down their cheeks, saying, ‘That vignette was my life.’”\u003c/p>\n\u003cp>\u003ciframe loading=\"lazy\" title=\"Vignettes for Asian Parents of Teens - "What's Wrong With You!"\" width=\"640\" height=\"360\" src=\"https://www.youtube.com/embed/3FFMhUEzB9A?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>As with the skits at UCSF, a moderator “interviews” the actors after their scene, so they can explain the psychological underpinnings of the argument. The audience also has an opportunity to weigh in with questions.\u003c/p>\n\u003cp>Then, the actor-psychiatrists model on stage what good parenting looks like. The father who first berated his son for failing another math test offers sympathy and practical solutions instead. The mother who first laughed off her daughter’s depression now agrees to help her consult a medical professional.\u003c/p>\n\u003cp>The overall idea of the theater project is to get parents talking about applying emotional intelligence to their daily interactions with their children. “’What’s wrong, sweetie?’ versus ‘What’s wrong with you?’ which sounds accusatory,” Hu says. “Especially if they’ve been raised in a culture where it was taboo to talk about feelings, these are skills that will take some work to acquire.”\u003c/p>\n\u003cfigure id=\"attachment_13113823\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-13113823 size-medium\" src=\"https://ww2.kqed.org/arts/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-800x450.jpg\" alt='In \"Just Be Happy,\" Dr. Bibi Das plays a mother struggling to talk to her daughter, played by Preeti Talwai, about depression.' width=\"800\" height=\"450\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-768x432.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-1180x664.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-960x541.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25037_Enlow_Parent_Skit-034-qut-520x293.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">In “Just Be Happy,” Dr. Bibi Das plays a mother struggling to talk to her daughter, played by Preeti Talwai, about depression. \u003ccite>(Photo: Jeff Enlow/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Federal researchers who \u003ca href=\"https://www.sccgov.org/sites/sccphd/en-us/Partners/collabproj/epi-aid/Pages/epi-aid.aspx\" target=\"_blank\" rel=\"noopener\">delved into the data\u003c/a> found many teen suicides in Palo Alto in recent years had underlying mental health issues. Each case is unique, but Hu says a child that feels his or her parent is an ally is less likely to hide problems that could develop into something serious, or even life-threatening.\u003c/p>\n\u003cp>“If the parent knows about the issue, then they can do something about it,” Hu says. “But if they don’t know, then there’s really nothing they can do.”\u003c/p>\n\u003cp>Gloria Zhang, a Palo Alto parent present at the Jordan Middle School event, says she doesn’t want to wait till there’s a crisis to develop a better relationship with her middle schooler. She says she feels like she could use more training to talk to her son without losing her temper. “I want to improve; communicate with him better, to let him to understand I love him,” Zhang says. “I want him healthy.”\u003c/p>\n\u003cfigure id=\"attachment_13113824\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-13113824 size-medium\" src=\"https://ww2.kqed.org/arts/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-800x451.jpg\" alt='In \"Party Dress,\" Jaime Jimenez, assistant nurse manager for inpatient psychiatry at Stanford, plays a dad shocked at what his teenage daughter, played by Dr. Renee Garcia, is wearing.' width=\"800\" height=\"451\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-800x451.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-768x433.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-1020x575.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-1180x665.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-960x541.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-240x135.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-375x211.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/2/2017/04/RS25035_Enlow_Parent_Skit-020-qut-520x293.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">In “Party Dress,” Jaime Jimenez, assistant nurse manager for inpatient psychiatry at Stanford, plays a dad shocked at what his teenage daughter, played by Dr. Renee Garcia, is wearing. \u003ccite>(Photo: Jeff Enlow/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That feeling isn’t limited to East Asian parents. By popular demand, the troupe has expanded its audience base to include Latino and South Asian families.\u003c/p>\n\u003cp>The Stanford psychiatrists are currently applying for grants to study whether the skits work in a scientific sense — as well as a theatrical one.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-medium wp-image-12127869\" src=\"https://ww2.kqed.org/arts/wp-content/uploads/sites/2/2016/09/Q.Logo_.Break_-800x78.jpg\" alt=\"Q.Logo.Break\" width=\"800\" height=\"78\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/2/2016/09/Q.Logo_.Break_.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/2/2016/09/Q.Logo_.Break_-400x39.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/2/2016/09/Q.Logo_.Break_-768x75.jpg 768w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The Stanford psychiatrists perform next for the American Psychiatric Association Saturday, May 20, in San Diego. More info \u003ca href=\"https://www.psychiatry.org/psychiatrists/meetings/annual-meeting\" target=\"_blank\" rel=\"noopener\">\u003cstrong>here\u003c/strong>\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>California prison officials could face hundreds of thousands of dollars in fines a day if they can't comply with a federal court order to eliminate delays in treatment for the most severely mentally ill inmates.\u003c/p>\n\u003cp>U.S. District Judge Kimberly Mueller this week threatened to fine prison officials to get them to meet the terms of a 1995 settlement of a decades-old class-action lawsuit. In 2009, state officials agreed that any prisoner with a life-threatening psychiatric crisis would get help within 24 hours. And inmates with severe mental illnesses would receive care within 30 days.\u003c/p>\n\u003cp>[contextly_sidebar id=\"kGXCSBdofUjwOtsxuO73a5jIRF8WO6jS\"]But in February, nearly a quarter of the 671 men and women eligible for acute care waited longer than 24 hours, according to a KQED analysis.\u003c/p>\n\u003cp>Mueller determined that there are enough \"mental health crisis\" beds in California. She’s giving prison officials until May 15 to comply with her order to eliminate the waitlist. Starting May 16, California prisons could be required to pay a fine of $1,000 a day for each inmate waiting for treatment.\u003c/p>\n\u003cp>Attorney Michael Bien, who sued to ensure mentally ill prisoners get the help they need, says that hundreds of people are waiting to get into inpatient programs at state hospitals and special psychiatric units within the prisons.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Some people died while on the waitlist,\" he said. \"We’re talking about a group of people where the doctors in the prison system agree that they need to get inpatient care, and the people running the inpatient program also agree the person qualifies. But instead of going, they’re on a waitlist.\"\u003c/p>\n\u003cp>At times prison officials have eliminated the backlog, but waits are growing again.\u003c/p>\n\u003cp>Prison officials are still evaluating the judge’s order. Vicky Waters, a spokeswoman with the California Department of Corrections and Rehabilitation, wrote in a statement that “mental health care delivery to inmates is very important to the department.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[documentcloud url=\"https://www.documentcloud.org/documents/3674715-April-Order-for-California-to-Comply-With-Timely\" notes=\"true\" text=\"true\" search=\"true\" sidebar=\"true\" pdf=\"true\" responsive=\"true\" page=\"1\"]\u003c/p>\n\n",
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"content": "\u003cp>Google the words “Donald Trump” and “nightmare,” and you get \u003ca href=\"https://www.google.com/#q=Donald+Trump+nightmare\">over 29 million results\u003c/a>.\u003c/p>\n\u003cp>While there are obviously those who believe that President Trump is the answer to America’s problems, there are others who feel quite the opposite -- and they’re carrying those negative thoughts and fears with them deep into slumberland.\u003c/p>\n\u003cp>A Los Angeles therapist is now treating patients dealing with what she calls \"Trumpmares.\"\u003c/p>\n\u003cp>“I am known as Dr. Dream. I’m not a doctor, I’m a hypnotherapist, but it’s just kind of a fun name to be called,” says \u003ca href=\"http://www.kellysullivanwalden.com/\">Kelly Sullivan Walden\u003c/a>. She’s written nine books on dreams, including \"Dreams and Premonitions,\" \"The Love, Sex and Relationship Dream Dictionary\" and \"It’s All In Your Dreams.\"\u003c/p>\n\u003cp>Walden has done a lot of talk shows, such as \"Dr. Oz\" and \"Ricki Lake,\" and her 17-year practice -- seeing clients privately and conducting dream workshops -- has covered pretty much whatever goes on in a person’s sleeping mind, including the intimidating presence of the newest resident of the White House.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I'm hearing a lot of Trump-related dreams,” explains Walden, who says she’s heard “over 100” Trumpmares from clients. “Once I started looking I started finding so many of them, not just in the people in my world, but beyond that.”\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcrmag/2017/04/2017-04-14c-tcrmag.mp3\" Image=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/04/RS24897_Mariah-and-Kelly-qut-800x600.jpg\" Title=\"Suffering From 'Trumpmares'? This L.A. Therapist Can Help\" program=\"The California Report\"]\u003c/p>\n\u003cp>\u003ca href=\"https://twitter.com/hashtag/trumpmare\">Social media\u003c/a> and the internet provide plenty of information to back that up. Trump has appeared in dreams as a tooth-yanking dentist, a horrible math teacher, the leader of a zombie apocalypse, a ranting Uber driver and a man chasing you in Wal-Mart.\u003c/p>\n\u003cp>But the president has sparked far worse visions in the night.\u003c/p>\n\u003cp>“Sexual violation. Deportation. Dreams about Hitler, Stalin, Mussolini or other no-faced dictators treating people like they don't matter,” Walden reveals. “They kind of run the gamut. The dream that Mariah had was a violent dream and very scary, like a nightmare. Classic.\"\u003c/p>\n\u003cp>Mariah Alexis Reyes is 19, and grew up in the Highland Park section of Los Angeles. Reyes met Walden when the therapist gave a lecture at Reyes’ school in 2011. Over the years they’ve discussed many dreams, but today they’re focusing on Reyes' recent Trumpmare.\u003c/p>\n\u003cp>\"I had a dream that I was visiting the White House, and as I was walking I saw Trump and he sees me, and he stabs me in the stomach,” says Reyes softly. “And as I fall down on the ground he tells his Secret Service to get rid of me. And no one knew I died and that he was responsible. I felt so devastated because I didn't even get to say goodbye to the people that I love.”\u003c/p>\n\u003cp>Walden and Reyes analyze the dream. They dissect the dream. They assess what Trump represents to Reyes and what she can learn from it.\u003c/p>\n\u003cp>“It makes me feel like I don’t matter,” Reyes says, “like I don’t have a voice.”\u003c/p>\n\u003cp>“This dream covers so many things,” says Walden. “There's so many layers. You're dealing with your own heartbreak around the election and also, a lot of people feeling stabbed in the gut.\u003c/p>\n\u003cp>“But then I love that you’re taking it to a higher place, and what does this say about me, and how can I become a better person as a result of this dream?”\u003c/p>\n\u003cp>So apparently there’s really nothing to fear from a Trumpmare after all. But what about the vice president? Are people experiencing the frightening specter of Number Two in their nocturnal world?\u003c/p>\n\u003cp>“I haven't heard a single Pence nightmare,” Walden admits. “I imagine if Trump, if he is invited not to come back to the White House, then I think the Pence nightmares will begin.”\u003c/p>\n\u003cp>To be fair, Walden points out that not all Trump dreams are a horror show.\u003c/p>\n\u003cp>“There's a lot of Trump healing dreams,” she says. “A lot of people are trying to heal him in their dreams. Loving him, throwing flowers on him, even having sex with him to heal him. Somebody was breastfeeding him, and she said in the dream she was very maternal with him.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It seems that some Americans are reaching out in their nightmares, hoping, at least behind the wall of sleep, that the president can be saved. After all, we are a nation of dreamers.\u003c/p>\n\n",
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"description": "Dream therapist Kelly Sullivan Walden says she’s heard 'over 100' nightmares involving Donald Trump from clients. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Google the words “Donald Trump” and “nightmare,” and you get \u003ca href=\"https://www.google.com/#q=Donald+Trump+nightmare\">over 29 million results\u003c/a>.\u003c/p>\n\u003cp>While there are obviously those who believe that President Trump is the answer to America’s problems, there are others who feel quite the opposite -- and they’re carrying those negative thoughts and fears with them deep into slumberland.\u003c/p>\n\u003cp>A Los Angeles therapist is now treating patients dealing with what she calls \"Trumpmares.\"\u003c/p>\n\u003cp>“I am known as Dr. Dream. I’m not a doctor, I’m a hypnotherapist, but it’s just kind of a fun name to be called,” says \u003ca href=\"http://www.kellysullivanwalden.com/\">Kelly Sullivan Walden\u003c/a>. She’s written nine books on dreams, including \"Dreams and Premonitions,\" \"The Love, Sex and Relationship Dream Dictionary\" and \"It’s All In Your Dreams.\"\u003c/p>\n\u003cp>Walden has done a lot of talk shows, such as \"Dr. Oz\" and \"Ricki Lake,\" and her 17-year practice -- seeing clients privately and conducting dream workshops -- has covered pretty much whatever goes on in a person’s sleeping mind, including the intimidating presence of the newest resident of the White House.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I'm hearing a lot of Trump-related dreams,” explains Walden, who says she’s heard “over 100” Trumpmares from clients. “Once I started looking I started finding so many of them, not just in the people in my world, but beyond that.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://twitter.com/hashtag/trumpmare\">Social media\u003c/a> and the internet provide plenty of information to back that up. Trump has appeared in dreams as a tooth-yanking dentist, a horrible math teacher, the leader of a zombie apocalypse, a ranting Uber driver and a man chasing you in Wal-Mart.\u003c/p>\n\u003cp>But the president has sparked far worse visions in the night.\u003c/p>\n\u003cp>“Sexual violation. Deportation. Dreams about Hitler, Stalin, Mussolini or other no-faced dictators treating people like they don't matter,” Walden reveals. “They kind of run the gamut. The dream that Mariah had was a violent dream and very scary, like a nightmare. Classic.\"\u003c/p>\n\u003cp>Mariah Alexis Reyes is 19, and grew up in the Highland Park section of Los Angeles. Reyes met Walden when the therapist gave a lecture at Reyes’ school in 2011. Over the years they’ve discussed many dreams, but today they’re focusing on Reyes' recent Trumpmare.\u003c/p>\n\u003cp>\"I had a dream that I was visiting the White House, and as I was walking I saw Trump and he sees me, and he stabs me in the stomach,” says Reyes softly. “And as I fall down on the ground he tells his Secret Service to get rid of me. And no one knew I died and that he was responsible. I felt so devastated because I didn't even get to say goodbye to the people that I love.”\u003c/p>\n\u003cp>Walden and Reyes analyze the dream. They dissect the dream. They assess what Trump represents to Reyes and what she can learn from it.\u003c/p>\n\u003cp>“It makes me feel like I don’t matter,” Reyes says, “like I don’t have a voice.”\u003c/p>\n\u003cp>“This dream covers so many things,” says Walden. “There's so many layers. You're dealing with your own heartbreak around the election and also, a lot of people feeling stabbed in the gut.\u003c/p>\n\u003cp>“But then I love that you’re taking it to a higher place, and what does this say about me, and how can I become a better person as a result of this dream?”\u003c/p>\n\u003cp>So apparently there’s really nothing to fear from a Trumpmare after all. But what about the vice president? Are people experiencing the frightening specter of Number Two in their nocturnal world?\u003c/p>\n\u003cp>“I haven't heard a single Pence nightmare,” Walden admits. “I imagine if Trump, if he is invited not to come back to the White House, then I think the Pence nightmares will begin.”\u003c/p>\n\u003cp>To be fair, Walden points out that not all Trump dreams are a horror show.\u003c/p>\n\u003cp>“There's a lot of Trump healing dreams,” she says. “A lot of people are trying to heal him in their dreams. Loving him, throwing flowers on him, even having sex with him to heal him. Somebody was breastfeeding him, and she said in the dream she was very maternal with him.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It seems that some Americans are reaching out in their nightmares, hoping, at least behind the wall of sleep, that the president can be saved. After all, we are a nation of dreamers.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Dia Yang is a cultural broker at the \u003ca href=\"http://www.fresnocenter.com/\">Fresno Center for New Americans\u003c/a>. She helps Southeast Asian refugees acclimate to the United States.\u003c/p>\n\u003cp>On this rainy day, she’s working with a dozen older Hmong men and women who find life in America really hard.\u003c/p>\n\u003cp>Yang instructs them in a crafts activity: decorating little paper gift boxes to fill with chocolate and give to a friend or relative. “It’s something to uplift them and keep them in the present moment,” she says. “And it gives them a chance to just be with each other.”\u003c/p>\n\u003cp>Yong Yang Xiong, 66, works on a red paper box at a long table littered with art supplies. Like the others here, he also goes to a weekly therapy group to talk about his problems.\u003c/p>\n\u003cp>“When I come here they [counselors] help me out. I’m not just by myself but in a group and everybody shares, and that helps ease up the depression,” says Yong Yang through an interpreter.\u003c/p>\n\u003cfigure id=\"attachment_11353290\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11353290 size-large\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/03/photo-6-1020x765.jpg\" alt=\"Counselors at the Center for New Americans lead group activities with clients suffering from depression. The clients chose not to be in the picture. \" width=\"640\" height=\"480\">\u003cfigcaption class=\"wp-caption-text\">Counselors at the Center for New Americans lead group activities with clients suffering from depression. The clients chose not to be in the picture. \u003ccite>(Alice Daniel/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Ghia Xiong is a psychologist with the center. He says activities and group therapy sessions provide peer support and help with depression, which is rampant in this population. Life is so different here, he says, and all the worries about money, jobs and transportation often lead to feelings of hopelessness and helplessness.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Xiong says life back home was much simpler. “… Just as long as you have a field to farm, and a jungle where you can go hunt and get food, and a river where you can get fish for your family,” Xiong says.\u003c/p>\n\u003cp>Back home is Laos. The Hmong knew the land well and were instrumental in helping the CIA fight its secret war against the Communists. When the long war ended, tens of thousands of Hmong were deserted. They fled on foot to refugee camps in Thailand and eventually resettled in the U.S. The second wave of refugees arrived only 13 years ago — among them was Yong Yang Xiong.\u003c/p>\n\u003cp>Ghia Xiong says there are many refugees like Yong Yang. “So now they’re carrying all this and they’re coming to therapy and we say, ‘Let’s talk about things that are really troubling to you,’ and they’re saying, ‘Do I trust you, are you sure you’re going to keep it confidential?’ I don’t know what confidentiality means. I mean that doesn’t exist in our culture.”\u003c/p>\n\u003cp>Xiong says it takes a very long time for most clients to open up even a little bit, to just scratch the surface of their sorrow. It’s almost anathema to their culture to talk about their deepest feelings.\u003c/p>\n\u003cp>It’s why group therapy is the best option at first, he says, because it gives them some basic tools to talk about themselves with the support of their peers. “Many do not understand yet or are not ready for individual therapy. They may not have the necessary resources or skills to really begin exploring depression,” he says.\u003c/p>\n\u003cp>Almost every older client, most of them in their mid-50s and 60s, comes into the center with symptoms of depression.\u003c/p>\n\u003cp>Part of Yong Yang Xiong’s depression comes from so much physical pain. He fought for six years in Laos.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘Many do not understand yet or are not ready for individual therapy. They may not have the necessary resources or skills to really begin exploring depression.’ \u003ccite>Ghia Xiong\u003c/cite>\u003c/aside>\n\u003cp>“As a petite man, I was given very heavy loads to carry for days and nights,” he says. “This is a reason why physically I’m not well now. I have a really bad back. It’s been bothering me a lot.”\u003c/p>\n\u003cp>Yong Yang lived in refugee camps for 26 years before coming to Fresno. He wanted to get a job but employers said he was too old, and he couldn’t speak English.\u003c/p>\n\u003cp>All of this stresses him out. Sometimes he’ll take an anxiety medication. “When I feel like I’m very depressed, I take the medication so it kind of like eases my mind, kind of like I’m slowly not thinking about all the stress and pain that I have, so it helps from time to time.”\u003c/p>\n\u003cp>The language barrier also makes him and other Hmong elders feel isolated. During group activities at the center, they have a chance to talk with each other about that isolation. Joua Thao, a college student who is interning here, points to a woman putting a sticker on the paper gift box she’s just made.\u003c/p>\n\u003cp>“She chose an owl because she only knows Hmong, and then her grandson only knows English, and then the only thing they both know is ‘owl,’ ” Thao says. It’s the grandmother’s way of reaching out to her grandson.\u003c/p>\n\u003cp>For the past nine years, the center has offered culturally sensitive mental health services for hundreds of refugees with depression under the \u003ca href=\"http://www.dhcs.ca.gov/services/mh/Pages/MH_Prop63.aspx\">Mental Health Services Act, \u003c/a>or Proposition 63. The program is called Living Well or Kaj Siab in Hmong. Counselors say Kaj Siab means to feel better, to see a better light at the end of the tunnel, to have better self-esteem. It’s a term that makes more sense to the Hmong than mental health. Aside from therapy groups, the program also offers community gardening and wellness walks.\u003c/p>\n\u003cfigure id=\"attachment_11353229\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11353229\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/03/photo-4-1020x1360.jpg\" alt=\"Vong Vang Xiong fought in Laos for six years in the CIA's Secret War. He does group crafts to help deal with depression.\" width=\"400\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Vong Vang Xiong fought in Laos for six years in the CIA’s Secret War. He does group crafts to help deal with depression. \u003ccite>(Alice Daniel/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Living Well Program not only works with Hmong but with other Southeast Asian communities, including Lao, Cambodian and Vietnamese. Ghia Xiong says depression is also rampant in these groups.\u003c/p>\n\u003cp>And while the center has helped a lot of people, Xiong worries that there are many who are not seeking help or don’t even know that help exists. So now the center is starting to go to where people live. It just got a grant through the \u003ca href=\"http://www.cdph.ca.gov/programs/Pages/Old%20-%20CaliforniaReducingDisparitiesProject.aspx\">California Reducing Disparities Project\u003c/a> to hire a program director, Melanie Vang.\u003c/p>\n\u003cp>“Part of my role is to do recruitment, through Hmong radio, Hmong TV, or through house visits or connecting through friends and families,” Vang says.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">On this day, she’s\u003c/span> \u003cspan style=\"font-weight: 400\">asking to visit the home of a widow she’s heard is depressed. There’s a branch of greenery hanging from her door.\u003c/span>\u003c/p>\n\u003cp>“Culturally if they have some kind of a green thing on the door, we normally have to ask them if we can go inside the house because spiritually the door is locked,” she tells me.\u003c/p>\n\u003cp>It means the family is protecting the house from bad spirits and may not let us in. But the door opens and we are allowed inside.\u003c/p>\n\u003cp>Pa Vang lives in this home. Pa means flower and there are artificial flowers and photos everywhere. But she can hardly see them because she’s going blind. She’s got diabetes; it’s so bad she needs dialysis. Her husband died a few years ago.\u003c/p>\n\u003cp>She used to be a home health aide and an activist in the Hmong community, but now the days are long for her. Listening to Hmong folk music helps. Melanie interprets for her.\u003c/p>\n\u003cp>“By listening to the music, I was able to at least kind of like ease myself out of pain and stress and depression,” Pa says.\u003c/p>\n\u003cp>Melanie suggests Pa come to the Fresno Center for New Americans to try out some of their services, and maybe even group therapy. Pa is receptive to the idea.\u003c/p>\n\u003cp>“I would like to attend some of these program to help me. However, I have dialysis three times a week. And now that I have a visual problem, I cannot drive,” she says.\u003c/p>\n\u003cp>Melanie Vang tells her the center plans to provide some transportation for clients in the near future. And hopefully, that will mean one less door for her to knock on.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">Alice Daniel \u003c/span>\u003c/i>\u003ci>\u003cspan style=\"font-weight: 400\">reported this story as part of a recent Journalists in Aging Fellowship supported by New America Media, the Gerontological Society of America and the Silver Century Foundation.\u003c/span>\u003c/i>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dia Yang is a cultural broker at the \u003ca href=\"http://www.fresnocenter.com/\">Fresno Center for New Americans\u003c/a>. She helps Southeast Asian refugees acclimate to the United States.\u003c/p>\n\u003cp>On this rainy day, she’s working with a dozen older Hmong men and women who find life in America really hard.\u003c/p>\n\u003cp>Yang instructs them in a crafts activity: decorating little paper gift boxes to fill with chocolate and give to a friend or relative. “It’s something to uplift them and keep them in the present moment,” she says. “And it gives them a chance to just be with each other.”\u003c/p>\n\u003cp>Yong Yang Xiong, 66, works on a red paper box at a long table littered with art supplies. Like the others here, he also goes to a weekly therapy group to talk about his problems.\u003c/p>\n\u003cp>“When I come here they [counselors] help me out. I’m not just by myself but in a group and everybody shares, and that helps ease up the depression,” says Yong Yang through an interpreter.\u003c/p>\n\u003cfigure id=\"attachment_11353290\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11353290 size-large\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/03/photo-6-1020x765.jpg\" alt=\"Counselors at the Center for New Americans lead group activities with clients suffering from depression. The clients chose not to be in the picture. \" width=\"640\" height=\"480\">\u003cfigcaption class=\"wp-caption-text\">Counselors at the Center for New Americans lead group activities with clients suffering from depression. The clients chose not to be in the picture. \u003ccite>(Alice Daniel/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Ghia Xiong is a psychologist with the center. He says activities and group therapy sessions provide peer support and help with depression, which is rampant in this population. Life is so different here, he says, and all the worries about money, jobs and transportation often lead to feelings of hopelessness and helplessness.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Xiong says life back home was much simpler. “… Just as long as you have a field to farm, and a jungle where you can go hunt and get food, and a river where you can get fish for your family,” Xiong says.\u003c/p>\n\u003cp>Back home is Laos. The Hmong knew the land well and were instrumental in helping the CIA fight its secret war against the Communists. When the long war ended, tens of thousands of Hmong were deserted. They fled on foot to refugee camps in Thailand and eventually resettled in the U.S. The second wave of refugees arrived only 13 years ago — among them was Yong Yang Xiong.\u003c/p>\n\u003cp>Ghia Xiong says there are many refugees like Yong Yang. “So now they’re carrying all this and they’re coming to therapy and we say, ‘Let’s talk about things that are really troubling to you,’ and they’re saying, ‘Do I trust you, are you sure you’re going to keep it confidential?’ I don’t know what confidentiality means. I mean that doesn’t exist in our culture.”\u003c/p>\n\u003cp>Xiong says it takes a very long time for most clients to open up even a little bit, to just scratch the surface of their sorrow. It’s almost anathema to their culture to talk about their deepest feelings.\u003c/p>\n\u003cp>It’s why group therapy is the best option at first, he says, because it gives them some basic tools to talk about themselves with the support of their peers. “Many do not understand yet or are not ready for individual therapy. They may not have the necessary resources or skills to really begin exploring depression,” he says.\u003c/p>\n\u003cp>Almost every older client, most of them in their mid-50s and 60s, comes into the center with symptoms of depression.\u003c/p>\n\u003cp>Part of Yong Yang Xiong’s depression comes from so much physical pain. He fought for six years in Laos.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘Many do not understand yet or are not ready for individual therapy. They may not have the necessary resources or skills to really begin exploring depression.’ \u003ccite>Ghia Xiong\u003c/cite>\u003c/aside>\n\u003cp>“As a petite man, I was given very heavy loads to carry for days and nights,” he says. “This is a reason why physically I’m not well now. I have a really bad back. It’s been bothering me a lot.”\u003c/p>\n\u003cp>Yong Yang lived in refugee camps for 26 years before coming to Fresno. He wanted to get a job but employers said he was too old, and he couldn’t speak English.\u003c/p>\n\u003cp>All of this stresses him out. Sometimes he’ll take an anxiety medication. “When I feel like I’m very depressed, I take the medication so it kind of like eases my mind, kind of like I’m slowly not thinking about all the stress and pain that I have, so it helps from time to time.”\u003c/p>\n\u003cp>The language barrier also makes him and other Hmong elders feel isolated. During group activities at the center, they have a chance to talk with each other about that isolation. Joua Thao, a college student who is interning here, points to a woman putting a sticker on the paper gift box she’s just made.\u003c/p>\n\u003cp>“She chose an owl because she only knows Hmong, and then her grandson only knows English, and then the only thing they both know is ‘owl,’ ” Thao says. It’s the grandmother’s way of reaching out to her grandson.\u003c/p>\n\u003cp>For the past nine years, the center has offered culturally sensitive mental health services for hundreds of refugees with depression under the \u003ca href=\"http://www.dhcs.ca.gov/services/mh/Pages/MH_Prop63.aspx\">Mental Health Services Act, \u003c/a>or Proposition 63. The program is called Living Well or Kaj Siab in Hmong. Counselors say Kaj Siab means to feel better, to see a better light at the end of the tunnel, to have better self-esteem. It’s a term that makes more sense to the Hmong than mental health. Aside from therapy groups, the program also offers community gardening and wellness walks.\u003c/p>\n\u003cfigure id=\"attachment_11353229\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11353229\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/03/photo-4-1020x1360.jpg\" alt=\"Vong Vang Xiong fought in Laos for six years in the CIA's Secret War. He does group crafts to help deal with depression.\" width=\"400\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Vong Vang Xiong fought in Laos for six years in the CIA’s Secret War. He does group crafts to help deal with depression. \u003ccite>(Alice Daniel/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Living Well Program not only works with Hmong but with other Southeast Asian communities, including Lao, Cambodian and Vietnamese. Ghia Xiong says depression is also rampant in these groups.\u003c/p>\n\u003cp>And while the center has helped a lot of people, Xiong worries that there are many who are not seeking help or don’t even know that help exists. So now the center is starting to go to where people live. It just got a grant through the \u003ca href=\"http://www.cdph.ca.gov/programs/Pages/Old%20-%20CaliforniaReducingDisparitiesProject.aspx\">California Reducing Disparities Project\u003c/a> to hire a program director, Melanie Vang.\u003c/p>\n\u003cp>“Part of my role is to do recruitment, through Hmong radio, Hmong TV, or through house visits or connecting through friends and families,” Vang says.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">On this day, she’s\u003c/span> \u003cspan style=\"font-weight: 400\">asking to visit the home of a widow she’s heard is depressed. There’s a branch of greenery hanging from her door.\u003c/span>\u003c/p>\n\u003cp>“Culturally if they have some kind of a green thing on the door, we normally have to ask them if we can go inside the house because spiritually the door is locked,” she tells me.\u003c/p>\n\u003cp>It means the family is protecting the house from bad spirits and may not let us in. But the door opens and we are allowed inside.\u003c/p>\n\u003cp>Pa Vang lives in this home. Pa means flower and there are artificial flowers and photos everywhere. But she can hardly see them because she’s going blind. She’s got diabetes; it’s so bad she needs dialysis. Her husband died a few years ago.\u003c/p>\n\u003cp>She used to be a home health aide and an activist in the Hmong community, but now the days are long for her. Listening to Hmong folk music helps. Melanie interprets for her.\u003c/p>\n\u003cp>“By listening to the music, I was able to at least kind of like ease myself out of pain and stress and depression,” Pa says.\u003c/p>\n\u003cp>Melanie suggests Pa come to the Fresno Center for New Americans to try out some of their services, and maybe even group therapy. Pa is receptive to the idea.\u003c/p>\n\u003cp>“I would like to attend some of these program to help me. However, I have dialysis three times a week. And now that I have a visual problem, I cannot drive,” she says.\u003c/p>\n\u003cp>Melanie Vang tells her the center plans to provide some transportation for clients in the near future. And hopefully, that will mean one less door for her to knock on.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "VA Hospitals Still Struggling With Adding Staff Despite Billions From Choice Act",
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"content": "\u003cp>Before they get to work on reforming the U.S. Department of Veterans Affairs, Congress and the White House might want to take a closer look at the last time they tried it — a $16 billion fix called the \u003ca href=\"https://www.govtrack.us/congress/bills/113/hr3230/text\">Veterans Choice and Accountability Act\u003c/a> of 2014, designed to get veterans medical care more quickly.\u003c/p>\n\u003cp>NPR and local member stations have been following that money, including the $10 billion for vets to get care \u003ca href=\"http://www.npr.org/series/479609181/from-back-at-base-coverage-of-the-veterans-choice-program\">outside the VA system\u003c/a>. The Choice Act also channeled about $2.5 billion for hiring more doctors, nurses and other medical staff at VA medical centers.\u003c/p>\n\u003cp>The goal of the hiring money was to address a simple math problem. The number of veterans coming to the VA has shot up in recent years, and the number of medical staff has not kept pace. The idea was that more caregivers would cut wait times.\u003c/p>\n\u003cp>But an investigation by NPR and local member stations found that: the VA has about the same number of new hires as the VA would have been projected to hire without the additional $2.5 billion; the new hires weren't sent to VA hospitals with the longest wait times; and the VA medical centers that got new hires were not more likely to see improved wait times.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/512052311/512592790\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>San Diego's wait-time dilemma\u003c/strong>\u003c/p>\n\u003cp>San Diego's experience is typical. The Southern California city is home to one of the largest concentrations of post-9/11 veterans, and when the Veterans Choice Act passed, the San Diego VA had some of the country's worst wait times for mental health care in particular. The act was meant to help former soldiers like Charlie Grijalva, who was diagnosed with PTSD when he was still in the Army.\u003c/p>\n\u003cp>Back in 2014, Grijalva lived with his wife, Gloria, in Imperial Valley — about two hours from the VA hospital in San Diego. After spending 18 months deployed in Afghanistan, and a year in Iraq, he started having suicidal thoughts.\u003c/p>\n\u003cp>The VA tried to help him. Early in 2014, the doctors there seemed to get his prescription right. By summer, his psychiatrist had left the VA, but Grijalva was transferred to a nurse practitioner. He missed an appointment in September 2014, according to records provided by the VA, but the new provider agreed to refill his prescription over the phone.\u003c/p>\n\u003cp>Because San Diego's wait times were so long, under the new Choice program, Grijalva qualified to see a private doctor outside the VA system. He had an initial consultation with the private psychiatrist near his home, but he didn't live to begin treatment. In December 2014, his medication ran out.\u003c/p>\n\u003cp>Grijalva had a young family and a new baby on the way. His wife said he insisted on giving his kids a magical Christmas.\u003c/p>\n\u003cp>\"He said, you know, 'I want to do what I did as a kid,' \" Gloria Grijalva said. \"Play some Christmas music. Have the kids decorate the tree, drink hot chocolate. ... Even though he was feeling the way he was, he wanted to have that kind of Christmas for his kids.\"\u003c/p>\n\u003cp>It wasn't to be. A few days before Christmas, his wife found him. He had hanged himself a few hours after he texted her, \"I love you.\"\u003c/p>\n\u003cp>\"He has told me when he was at his lowest that [he] 'didn't want my kids to see me like this; I don't want to put my kids through this,' \" she said.\u003c/p>\n\u003cp>His VA records show Grijalva went to one last appointment at the VA in San Diego, scheduled in December. His medication arrived just before his death. Around the time of his death, the VA was just beginning to implement the Veterans Choice Act.\u003c/p>\n\u003cp>San Diego seemed like a prime candidate to get extra staff. But the NPR and local member station analysis of the VA's own data show that San Diego got far fewer new staff members than it requested, and also fewer than many other VA centers that didn't have such bad wait times.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-medium wp-image-11298363\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/02/AddlStaffVA-800x730.jpg\" alt=\"AddlStaffVA\" width=\"800\" height=\"730\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlStaffVA.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlStaffVA-160x146.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlStaffVA-240x219.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlStaffVA-375x342.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlStaffVA-520x475.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>\u003cstrong>No logical staffing pattern\u003c/strong>\u003c/p>\n\u003cp>The VA data show no logical pattern for distributing the 12,000 doctors, nurses and other medical staff hired under the Choice Act.\u003c/p>\n\u003cp>David Shulkin became head of the Veterans Health Administration after that law passed, but has been overseeing the reform since 2015. Last fall, he told NPR that the Choice hires were based on a survey of VA medical centers.\u003c/p>\n\u003cp>\"Our goal is to get [the medical centers] the health professionals that they need. So that's the Choice money. We wanted everybody to go out and execute on it, and to use that money as quickly as possible because we have a sense of crisis,\" said Shulkin, who has been nominated to become secretary of the Department of Veterans Affairs. His confirmation hearing is expected this week.\u003c/p>\n\u003cp>He also said the VA focused on places where the staff was most needed. Thirty-three medical centers were \"prioritized\" among the VA's 168 hospitals.\u003c/p>\n\u003cp>But the VA data show that prioritized medical centers didn't always get more resources than others. Los Angeles was prioritized and got only about 108 new hires from the Choice money. Dallas, a similarly large center, got almost three times as many (298), even though Dallas was not \"prioritized\" and didn't have particularly bad wait times.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-medium wp-image-11298376\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/02/AddlVAstaff-800x790.jpg\" alt=\"AddlVAstaff\" width=\"800\" height=\"790\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-160x158.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-240x237.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-375x370.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-520x514.jpg 520w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-96x96.jpg 96w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Albuquerque, New Mexico, and Cincinnati have about the same volume of appointments. But Albuquerque had among the worst wait times in the country for mental health, while Cincinnati was among the best. The VA's data show both received the same number of psychiatrists from the Choice money.\u003c/p>\n\u003cp>Wait times across the board have not come down, though the VA says that's because of a continuing surge in demand from patients. And Shulkin stressed that wait times are not the most important measure of health care. He says efficiency is up and the number of veterans waiting for urgent care has shrunk from tens of thousands to a mere dozen or two. Still, it was the long wait times — and the harm they did to veterans — that drove Congress to pass the Choice Act.\u003c/p>\n\u003cp>\u003cstrong>Slow hiring in a tough market\u003c/strong>\u003c/p>\n\u003cp>Doctors and nurses are scarce nationwide. In the economic centers where many vets live, medical professionals often find better offers at private hospitals. And in rural or remote areas, there often are very few doctors or nurses available to work at either VA or private hospitals.\u003c/p>\n\u003cp>Shulkin knows that his hiring process is cumbersome.\u003c/p>\n\u003cp>\"The complexity of hiring puts us at a disadvantage with the private sector. We are very fortunate that people wait and turn down private sector jobs because this is where they want to work and this is the mission ... but frankly we have to be competitive,\" he told NPR last fall.\u003c/p>\n\u003cp>Shulkin came to the VA from the private sector, he said, to get the department in step with best practices. He has succeeded in getting some salaries up to private-sector levels. But the roughly $2.5 billion from the Choice Act resulted in a net gain of only a few thousand doctors and nurses, across a system that serves about 9 million veterans.\u003c/p>\n\u003cfigure id=\"attachment_11298308\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11298308\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/02/Shulkin-800x503.jpg\" alt=\"Secretary of Veterans' Affairs-designate David Shulkin testifies during a Senate confirmation hearing on February 1, 2017.\" width=\"800\" height=\"503\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-800x503.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-160x101.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-1020x642.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-1180x742.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-960x604.jpg 960w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-240x151.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-375x236.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-520x327.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Secretary of Veterans Affairs-designate David Shulkin testifies during a Senate confirmation hearing on Feb. 1, 2017. \u003ccite>(ZACH GIBSON/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That's partly because the VA's process is so slow that about 13 percent of candidates drop out during the months-long lag time after they are hired. NPR and local member stations spoke with more than half a dozen current VA employees about this problem, but none agreed to be quoted. Almetta Pitts is a former VA employee who used to work at the VA in Seattle. Waiting to start that job nearly left her broke.\u003c/p>\n\u003cp>\"It took about six months. And so I had to think about ways to just put my money together to be able to really be able to pursue this job,\" she said.\u003c/p>\n\u003cp>Pitts liked the VA. She interned at the VA in Seattle while pursuing her master's in social work. Her mother, an Army vet, was already working there as a federal police officer. After a series of interviews, Pitts was notified she had been hired.\u003c/p>\n\u003cp>\"I received my acceptance letter and it did inform me that I started that September and I was like 'Oh my gosh, I'm so excited,' but ... 'Wow, it's like May.' \"\u003c/p>\n\u003cp>During the four months of waiting, Pitts moved back in with her mom to save money until the job started. She ended up working for the VA for 13 months and was laid off. At the time, Human Resources offered to help find another job at a VA out of state. She loved her work helping traumatized veterans, but Pitts decided she had to move on.\u003c/p>\n\u003cp>\u003cstrong>Budget shuffling\u003c/strong>\u003c/p>\n\u003cp>Another reason the $2.5 billion bump didn't seem to raise the VA's staffing levels may have more to do with Washington bureaucracy than health care.\u003c/p>\n\u003cp>NPR found that the rate of increase in VA staff after the Choice money was not noticeably different than past years without it.\u003c/p>\n\u003cp>The Choice hiring money from Congress mostly replaced, instead of augmented, the VA's normal hiring budget, which freed up less restricted money to take care of other needs. Shulkin defends how the money was spent.\u003c/p>\n\u003cp>\"When you're given a budget you face a number of new stresses on those resources. You have increases in pharmaceuticals, you have your wage increase, you have your leasing cost increases, you have IT increases. So without the Choice money, we would not have been able to have maintained the type of hiring that we were doing and expanded the type of hiring we were doing,\" Shulkin told NPR in December.\u003c/p>\n\u003cp>This sort of budgeting strategy is common in Washington, according to Phil Carter, of the Center for New American Security.\u003c/p>\n\u003cp>\"It makes complete sense for a self-interested bureaucracy to hire with that money first. I think VA hired staff with this money will all intention of improving access and quality. I think the VA leadership found it harder to do that,\" he said.\u003c/p>\n\u003cp>Carter says that the VA has a difficult time projecting what needs it will have across a system of 168 hospitals nationwide, and that the VA may just have been hiring at its maximum capacity in a tough market.\u003c/p>\n\u003cp>\"But I don't see malice here, just the basic inefficacy of American bureaucracy,\" Carter said.\u003c/p>\n\u003cp>But some Republicans in Congress do see something more malicious — a shell game to free up money from congressional restrictions.\u003c/p>\n\u003cp>A spokesman for the House Committee on Veterans Affairs said: \"It was a money grab, with no plan on where to put people, and VA used the funds to fill existing vacancies for the most part.\"\u003c/p>\n\u003cp>\u003cem>NPR's Juan Elosua contributed to this story.\u003c/em>\u003c/p>\n\u003cp>\u003cem>This story is part of a project we're calling \"\u003ca href=\"http://www.npr.org/series/363340041/back-at-base\">Back at Base,\u003c/a>\"\u003cem> in which NPR — along with public radio stations around the country — is chronicling the lives of America's troops where they live.\u003c/em>\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\">NPR.org\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Before they get to work on reforming the U.S. Department of Veterans Affairs, Congress and the White House might want to take a closer look at the last time they tried it — a $16 billion fix called the \u003ca href=\"https://www.govtrack.us/congress/bills/113/hr3230/text\">Veterans Choice and Accountability Act\u003c/a> of 2014, designed to get veterans medical care more quickly.\u003c/p>\n\u003cp>NPR and local member stations have been following that money, including the $10 billion for vets to get care \u003ca href=\"http://www.npr.org/series/479609181/from-back-at-base-coverage-of-the-veterans-choice-program\">outside the VA system\u003c/a>. The Choice Act also channeled about $2.5 billion for hiring more doctors, nurses and other medical staff at VA medical centers.\u003c/p>\n\u003cp>The goal of the hiring money was to address a simple math problem. The number of veterans coming to the VA has shot up in recent years, and the number of medical staff has not kept pace. The idea was that more caregivers would cut wait times.\u003c/p>\n\u003cp>But an investigation by NPR and local member stations found that: the VA has about the same number of new hires as the VA would have been projected to hire without the additional $2.5 billion; the new hires weren't sent to VA hospitals with the longest wait times; and the VA medical centers that got new hires were not more likely to see improved wait times.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/512052311/512592790\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>San Diego's wait-time dilemma\u003c/strong>\u003c/p>\n\u003cp>San Diego's experience is typical. The Southern California city is home to one of the largest concentrations of post-9/11 veterans, and when the Veterans Choice Act passed, the San Diego VA had some of the country's worst wait times for mental health care in particular. The act was meant to help former soldiers like Charlie Grijalva, who was diagnosed with PTSD when he was still in the Army.\u003c/p>\n\u003cp>Back in 2014, Grijalva lived with his wife, Gloria, in Imperial Valley — about two hours from the VA hospital in San Diego. After spending 18 months deployed in Afghanistan, and a year in Iraq, he started having suicidal thoughts.\u003c/p>\n\u003cp>The VA tried to help him. Early in 2014, the doctors there seemed to get his prescription right. By summer, his psychiatrist had left the VA, but Grijalva was transferred to a nurse practitioner. He missed an appointment in September 2014, according to records provided by the VA, but the new provider agreed to refill his prescription over the phone.\u003c/p>\n\u003cp>Because San Diego's wait times were so long, under the new Choice program, Grijalva qualified to see a private doctor outside the VA system. He had an initial consultation with the private psychiatrist near his home, but he didn't live to begin treatment. In December 2014, his medication ran out.\u003c/p>\n\u003cp>Grijalva had a young family and a new baby on the way. His wife said he insisted on giving his kids a magical Christmas.\u003c/p>\n\u003cp>\"He said, you know, 'I want to do what I did as a kid,' \" Gloria Grijalva said. \"Play some Christmas music. Have the kids decorate the tree, drink hot chocolate. ... Even though he was feeling the way he was, he wanted to have that kind of Christmas for his kids.\"\u003c/p>\n\u003cp>It wasn't to be. A few days before Christmas, his wife found him. He had hanged himself a few hours after he texted her, \"I love you.\"\u003c/p>\n\u003cp>\"He has told me when he was at his lowest that [he] 'didn't want my kids to see me like this; I don't want to put my kids through this,' \" she said.\u003c/p>\n\u003cp>His VA records show Grijalva went to one last appointment at the VA in San Diego, scheduled in December. His medication arrived just before his death. Around the time of his death, the VA was just beginning to implement the Veterans Choice Act.\u003c/p>\n\u003cp>San Diego seemed like a prime candidate to get extra staff. But the NPR and local member station analysis of the VA's own data show that San Diego got far fewer new staff members than it requested, and also fewer than many other VA centers that didn't have such bad wait times.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-medium wp-image-11298363\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/02/AddlStaffVA-800x730.jpg\" alt=\"AddlStaffVA\" width=\"800\" height=\"730\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlStaffVA.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlStaffVA-160x146.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlStaffVA-240x219.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlStaffVA-375x342.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlStaffVA-520x475.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>\u003cstrong>No logical staffing pattern\u003c/strong>\u003c/p>\n\u003cp>The VA data show no logical pattern for distributing the 12,000 doctors, nurses and other medical staff hired under the Choice Act.\u003c/p>\n\u003cp>David Shulkin became head of the Veterans Health Administration after that law passed, but has been overseeing the reform since 2015. Last fall, he told NPR that the Choice hires were based on a survey of VA medical centers.\u003c/p>\n\u003cp>\"Our goal is to get [the medical centers] the health professionals that they need. So that's the Choice money. We wanted everybody to go out and execute on it, and to use that money as quickly as possible because we have a sense of crisis,\" said Shulkin, who has been nominated to become secretary of the Department of Veterans Affairs. His confirmation hearing is expected this week.\u003c/p>\n\u003cp>He also said the VA focused on places where the staff was most needed. Thirty-three medical centers were \"prioritized\" among the VA's 168 hospitals.\u003c/p>\n\u003cp>But the VA data show that prioritized medical centers didn't always get more resources than others. Los Angeles was prioritized and got only about 108 new hires from the Choice money. Dallas, a similarly large center, got almost three times as many (298), even though Dallas was not \"prioritized\" and didn't have particularly bad wait times.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-medium wp-image-11298376\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/02/AddlVAstaff-800x790.jpg\" alt=\"AddlVAstaff\" width=\"800\" height=\"790\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-160x158.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-240x237.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-375x370.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-520x514.jpg 520w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/AddlVAstaff-96x96.jpg 96w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Albuquerque, New Mexico, and Cincinnati have about the same volume of appointments. But Albuquerque had among the worst wait times in the country for mental health, while Cincinnati was among the best. The VA's data show both received the same number of psychiatrists from the Choice money.\u003c/p>\n\u003cp>Wait times across the board have not come down, though the VA says that's because of a continuing surge in demand from patients. And Shulkin stressed that wait times are not the most important measure of health care. He says efficiency is up and the number of veterans waiting for urgent care has shrunk from tens of thousands to a mere dozen or two. Still, it was the long wait times — and the harm they did to veterans — that drove Congress to pass the Choice Act.\u003c/p>\n\u003cp>\u003cstrong>Slow hiring in a tough market\u003c/strong>\u003c/p>\n\u003cp>Doctors and nurses are scarce nationwide. In the economic centers where many vets live, medical professionals often find better offers at private hospitals. And in rural or remote areas, there often are very few doctors or nurses available to work at either VA or private hospitals.\u003c/p>\n\u003cp>Shulkin knows that his hiring process is cumbersome.\u003c/p>\n\u003cp>\"The complexity of hiring puts us at a disadvantage with the private sector. We are very fortunate that people wait and turn down private sector jobs because this is where they want to work and this is the mission ... but frankly we have to be competitive,\" he told NPR last fall.\u003c/p>\n\u003cp>Shulkin came to the VA from the private sector, he said, to get the department in step with best practices. He has succeeded in getting some salaries up to private-sector levels. But the roughly $2.5 billion from the Choice Act resulted in a net gain of only a few thousand doctors and nurses, across a system that serves about 9 million veterans.\u003c/p>\n\u003cfigure id=\"attachment_11298308\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11298308\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/02/Shulkin-800x503.jpg\" alt=\"Secretary of Veterans' Affairs-designate David Shulkin testifies during a Senate confirmation hearing on February 1, 2017.\" width=\"800\" height=\"503\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-800x503.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-160x101.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-1020x642.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-1180x742.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-960x604.jpg 960w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-240x151.jpg 240w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-375x236.jpg 375w, https://ww2.kqed.org/app/uploads/sites/10/2017/02/Shulkin-520x327.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Secretary of Veterans Affairs-designate David Shulkin testifies during a Senate confirmation hearing on Feb. 1, 2017. \u003ccite>(ZACH GIBSON/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That's partly because the VA's process is so slow that about 13 percent of candidates drop out during the months-long lag time after they are hired. NPR and local member stations spoke with more than half a dozen current VA employees about this problem, but none agreed to be quoted. Almetta Pitts is a former VA employee who used to work at the VA in Seattle. Waiting to start that job nearly left her broke.\u003c/p>\n\u003cp>\"It took about six months. And so I had to think about ways to just put my money together to be able to really be able to pursue this job,\" she said.\u003c/p>\n\u003cp>Pitts liked the VA. She interned at the VA in Seattle while pursuing her master's in social work. Her mother, an Army vet, was already working there as a federal police officer. After a series of interviews, Pitts was notified she had been hired.\u003c/p>\n\u003cp>\"I received my acceptance letter and it did inform me that I started that September and I was like 'Oh my gosh, I'm so excited,' but ... 'Wow, it's like May.' \"\u003c/p>\n\u003cp>During the four months of waiting, Pitts moved back in with her mom to save money until the job started. She ended up working for the VA for 13 months and was laid off. At the time, Human Resources offered to help find another job at a VA out of state. She loved her work helping traumatized veterans, but Pitts decided she had to move on.\u003c/p>\n\u003cp>\u003cstrong>Budget shuffling\u003c/strong>\u003c/p>\n\u003cp>Another reason the $2.5 billion bump didn't seem to raise the VA's staffing levels may have more to do with Washington bureaucracy than health care.\u003c/p>\n\u003cp>NPR found that the rate of increase in VA staff after the Choice money was not noticeably different than past years without it.\u003c/p>\n\u003cp>The Choice hiring money from Congress mostly replaced, instead of augmented, the VA's normal hiring budget, which freed up less restricted money to take care of other needs. Shulkin defends how the money was spent.\u003c/p>\n\u003cp>\"When you're given a budget you face a number of new stresses on those resources. You have increases in pharmaceuticals, you have your wage increase, you have your leasing cost increases, you have IT increases. So without the Choice money, we would not have been able to have maintained the type of hiring that we were doing and expanded the type of hiring we were doing,\" Shulkin told NPR in December.\u003c/p>\n\u003cp>This sort of budgeting strategy is common in Washington, according to Phil Carter, of the Center for New American Security.\u003c/p>\n\u003cp>\"It makes complete sense for a self-interested bureaucracy to hire with that money first. I think VA hired staff with this money will all intention of improving access and quality. I think the VA leadership found it harder to do that,\" he said.\u003c/p>\n\u003cp>Carter says that the VA has a difficult time projecting what needs it will have across a system of 168 hospitals nationwide, and that the VA may just have been hiring at its maximum capacity in a tough market.\u003c/p>\n\u003cp>\"But I don't see malice here, just the basic inefficacy of American bureaucracy,\" Carter said.\u003c/p>\n\u003cp>But some Republicans in Congress do see something more malicious — a shell game to free up money from congressional restrictions.\u003c/p>\n\u003cp>A spokesman for the House Committee on Veterans Affairs said: \"It was a money grab, with no plan on where to put people, and VA used the funds to fill existing vacancies for the most part.\"\u003c/p>\n\u003cp>\u003cem>NPR's Juan Elosua contributed to this story.\u003c/em>\u003c/p>\n\u003cp>\u003cem>This story is part of a project we're calling \"\u003ca href=\"http://www.npr.org/series/363340041/back-at-base\">Back at Base,\u003c/a>\"\u003cem> in which NPR — along with public radio stations around the country — is chronicling the lives of America's troops where they live.\u003c/em>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\">NPR.org\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "On a 'Eugenics Registry,' a Record Of California's Thousands Of Sterilizations",
"title": "On a 'Eugenics Registry,' a Record Of California's Thousands Of Sterilizations",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>There's a grim chapter in American history that involves forced sterilization. And for much of this past century, California had one of the most active sterilization programs in the country.\u003c/p>\n\u003cp>A state law from 1909 authorized the surgery for people judged to have \"mental disease, which may have been inherited.\" That law remained on the books until 1979.\u003c/p>\n\u003cp>University of Michigan professor Alexandra Minna Stern has been working to identify people who were forcibly sterilized under California's program. NPR's Ailsa Chang spoke with Stern, who said this idea of eugenics was intended to \"eradicate certain genes from the population.\"\u003c/p>\n\u003cp>The professor describes the program as a historic injustice and called for the state of California to compensate surviving victims of sterilization of relatives of those who are now deceased.\u003c/p>\n\u003cp>\u003cem>The interview highlights contain some extra content that did not air in the broadcast version.\u003c/em>\u003c/p>\n\u003chr>\n\u003ch3>Interview highlights\u003c/h3>\n\u003cp>\u003cstrong>On how she found the names of all the victims \u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The names are located in 19 microfilm reels that I happened upon while doing research in Sacramento about seven years ago.\u003c/p>\n\u003cp>\u003cstrong>On what made her look at the microfilms\u003c/strong>\u003c/p>\n\u003cp>I've written a book on the history of eugenics in California. But at that point, I still knew very little about the sterilizations themselves; who was sterilized, where did all of the sterilizations take place, how is the policy enacted?\u003c/p>\n\u003cp>So I did a bit of sleuthing and went to the actual departments themselves — the department of mental health in this case, in Sacramento — and was fortunate that someone there directed me to some file cabinets that contained microfilm reels with materials that had been microfilmed over the course of the '60s and '70s.\u003c/p>\n\u003cp>And lo and behold, there they were! I was able to begin using them as historical documents and that's how the project started.\u003c/p>\n\u003cp>\u003cstrong>On whether she found any patterns among the 20,000 names she discovered\u003c/strong>\u003c/p>\n\u003cp>Our team (and I should say this is the effort of a research team that includes epidemiologists, historians, digital humanists), we have a found a variety of patterns and we keep discovering more.\u003c/p>\n\u003cp>For example, we have determined that patients with Spanish surnames were much more likely to be sterilized than other patients, demonstrating that there was a racial bias in the sterilization program. We were also able to show the kinds of diagnoses that were given to patients, how that affected times of sterilization. We're able to look at age of sterilization and also patterns related to gender.\u003c/p>\n\u003cp>So there's a whole range of patterns that will help us to understand this pattern of history in California and also how it relates to national dynamics more broadly.\u003c/p>\n\u003cfigure id=\"attachment_273662\" class=\"wp-caption alignnone\" style=\"max-width: 427px\">\u003cimg src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich.jpg\" alt=\"University of Michigan professor Alex Stern has completed a database of thousands recommended for sterilization when California had eugenics laws on the book and she says those alive should be compensated.\" width=\"427\" height=\"320\" class=\"size-full wp-image-273662\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich.jpg 427w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich-375x281.jpg 375w\" sizes=\"(max-width: 427px) 100vw, 427px\">\u003cfigcaption class=\"wp-caption-text\">University of Michigan professor Alex Stern has completed a database of thousands recommended for sterilization when California had eugenics laws on the book and she says those alive should be compensated. \u003ccite>(Michigan Photography)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>On what Stern and her team found with regard to age and gender patterns\u003c/strong>\u003c/p>\n\u003cp>Well, we found that people were sterilized at very young ages, that really often the focus was on minors, people as young as 7. The average age of sterilization was the low 20s, so many of these people were 15, 16, 17 and 18. We also found that, as I mentioned before, that the Spanish surname individuals were more likely to be sterilized at younger ages, indicating that there was interest on behalf of the state at targeting them at lower reproductive ages. In terms of gender, that pattern that I just mentioned, pertains to women as well.\u003c/p>\n\u003cp>One of the interesting things that we discovered is that initially, more men were sterilized. It started off as sterilization in general and across the country and in California, focused more on men in the teens and 20s and into the 30s. But by the 1930s, that pattern started to change. So by the '40s and '50s, more women were being sterilized.\u003c/p>\n\u003cp>\u003cstrong>On what kinds of \"mental diseases\" were focused on \u003c/strong>\u003c/p>\n\u003cp>It's very important to take that terminology with many historic grains of salt. If we go back in time and look at what the terms meant, it often meant people who were not conforming to societal norms, people who were poor, people who lacked education, perhaps didn't speak sufficient English to make it through school, and so on.\u003c/p>\n\u003cp>But what it meant for those who were enacting the law were people who were determined to have poor IQs, people with certain psychiatric disorders. But generally, often the way it was used was much more as a catch-all category — so people who just didn't fit, kind of like the misfits of society, so to speak. That's the way they looked at them.\u003c/p>\n\u003cp>Looking back on it, I would say that those who were institutionalized — because many more people where institutionalized than actually sterilized — was because maybe they had a psychiatric condition and they were sent to an institution as was the policy at the time in the mid-20th century. ...\u003c/p>\n\u003cp>But for the most part, this program of eugenics ... the idea of sterilization was to eradicate certain genes from the population.\u003c/p>\n\u003cp>\u003cstrong>On whether anyone among those who were sterilized are still alive\u003c/strong>\u003c/p>\n\u003cp>I haven't found anyone who's still alive. I have been contacted by relatives ... people who contacted me whose aunts or uncles were sterilized at some of these institutions. In the recent paper that my team published, we determined through statistical analysis that it is likely that slightly over 800 people, about 500 women and 300 men, are alive today.\u003c/p>\n\u003cp>Those numbers don't map on to exact people, they don't correspond to a precise person. But what we've done, we've generated the most reliable estimates, and based on that estimate and also looking at the timing, we estimate that the majority of these people were sterilized between 1945 and 1949 and their average age is about 88, so fairly old.\u003c/p>\n\u003cp>So what we could do is we could go and look at the records. And that's where I'd like to work with the state of California, because we've essentially created a eugenics registry. We can look at the records and identify likely individuals and then reach out and contact them.\u003c/p>\n\u003cp>I, however, would like to mention that two states that have enacted policies for monetary reparations for sterilization victims — North Carolina and Virginia — the states have to lead in kind of creating a committee and a registry. And because it was the state seeking to provide some type of redress and acknowledge this history, the state was able to actively set up a program and seek out and try to identify individuals. So they would come to the state and they would confirm through documentation that they had been sterilized and then receive recognition and monetary compensation.\u003c/p>\n\u003cp>\u003cstrong>On if there are indications that California is interested in compensating victims of sterilization\u003c/strong>\u003c/p>\n\u003cp>There's indication that the state is interested in this history and is aware of possibility of sterilization abuse. Just three years ago, news broke that about 150 women in two California women's prisons \u003ca href=\"http://www.npr.org/2013/09/20/219366146/calif-seeks-answers-on-questionable-prison-sterilizations\">had been sterilized\u003c/a> without proper consent and proper procedure. That resulted in a state audit in the interest of the state legislators and eventually, a law that was unanimously passed, banning sterilizations except under extreme medical circumstances in California state prisons. So this issue is on the radar screen.\u003c/p>\n\u003cp>It's easy to forget about these patients who were in these remote institutions in the 1940s and '50s in California. However, I think it behooves the state to not forget this history, and all of us to not forget this history. So hopefully, having this fairly solid number that we've generated of an estimate of likely living survivors could help facilitate that process. ...\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>It would also be a good idea to think about other forms of recognition of this historical injustice. For example, putting up a historical plaque in Sacramento somewhere to recognize those who were sterilized, or at one of the institutions such as the Sonoma State Home or the Patton State Home, making sure this history is included in K-12 curriculum. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. \u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=On+A+%27Eugenics+Registry%2C%27+A+Record+Of+California%27s+Thousands+Of+Sterilizations&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There's a grim chapter in American history that involves forced sterilization. And for much of this past century, California had one of the most active sterilization programs in the country.\u003c/p>\n\u003cp>A state law from 1909 authorized the surgery for people judged to have \"mental disease, which may have been inherited.\" That law remained on the books until 1979.\u003c/p>\n\u003cp>University of Michigan professor Alexandra Minna Stern has been working to identify people who were forcibly sterilized under California's program. NPR's Ailsa Chang spoke with Stern, who said this idea of eugenics was intended to \"eradicate certain genes from the population.\"\u003c/p>\n\u003cp>The professor describes the program as a historic injustice and called for the state of California to compensate surviving victims of sterilization of relatives of those who are now deceased.\u003c/p>\n\u003cp>\u003cem>The interview highlights contain some extra content that did not air in the broadcast version.\u003c/em>\u003c/p>\n\u003chr>\n\u003ch3>Interview highlights\u003c/h3>\n\u003cp>\u003cstrong>On how she found the names of all the victims \u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The names are located in 19 microfilm reels that I happened upon while doing research in Sacramento about seven years ago.\u003c/p>\n\u003cp>\u003cstrong>On what made her look at the microfilms\u003c/strong>\u003c/p>\n\u003cp>I've written a book on the history of eugenics in California. But at that point, I still knew very little about the sterilizations themselves; who was sterilized, where did all of the sterilizations take place, how is the policy enacted?\u003c/p>\n\u003cp>So I did a bit of sleuthing and went to the actual departments themselves — the department of mental health in this case, in Sacramento — and was fortunate that someone there directed me to some file cabinets that contained microfilm reels with materials that had been microfilmed over the course of the '60s and '70s.\u003c/p>\n\u003cp>And lo and behold, there they were! I was able to begin using them as historical documents and that's how the project started.\u003c/p>\n\u003cp>\u003cstrong>On whether she found any patterns among the 20,000 names she discovered\u003c/strong>\u003c/p>\n\u003cp>Our team (and I should say this is the effort of a research team that includes epidemiologists, historians, digital humanists), we have a found a variety of patterns and we keep discovering more.\u003c/p>\n\u003cp>For example, we have determined that patients with Spanish surnames were much more likely to be sterilized than other patients, demonstrating that there was a racial bias in the sterilization program. We were also able to show the kinds of diagnoses that were given to patients, how that affected times of sterilization. We're able to look at age of sterilization and also patterns related to gender.\u003c/p>\n\u003cp>So there's a whole range of patterns that will help us to understand this pattern of history in California and also how it relates to national dynamics more broadly.\u003c/p>\n\u003cfigure id=\"attachment_273662\" class=\"wp-caption alignnone\" style=\"max-width: 427px\">\u003cimg src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich.jpg\" alt=\"University of Michigan professor Alex Stern has completed a database of thousands recommended for sterilization when California had eugenics laws on the book and she says those alive should be compensated.\" width=\"427\" height=\"320\" class=\"size-full wp-image-273662\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich.jpg 427w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich-375x281.jpg 375w\" sizes=\"(max-width: 427px) 100vw, 427px\">\u003cfigcaption class=\"wp-caption-text\">University of Michigan professor Alex Stern has completed a database of thousands recommended for sterilization when California had eugenics laws on the book and she says those alive should be compensated. \u003ccite>(Michigan Photography)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>On what Stern and her team found with regard to age and gender patterns\u003c/strong>\u003c/p>\n\u003cp>Well, we found that people were sterilized at very young ages, that really often the focus was on minors, people as young as 7. The average age of sterilization was the low 20s, so many of these people were 15, 16, 17 and 18. We also found that, as I mentioned before, that the Spanish surname individuals were more likely to be sterilized at younger ages, indicating that there was interest on behalf of the state at targeting them at lower reproductive ages. In terms of gender, that pattern that I just mentioned, pertains to women as well.\u003c/p>\n\u003cp>One of the interesting things that we discovered is that initially, more men were sterilized. It started off as sterilization in general and across the country and in California, focused more on men in the teens and 20s and into the 30s. But by the 1930s, that pattern started to change. So by the '40s and '50s, more women were being sterilized.\u003c/p>\n\u003cp>\u003cstrong>On what kinds of \"mental diseases\" were focused on \u003c/strong>\u003c/p>\n\u003cp>It's very important to take that terminology with many historic grains of salt. If we go back in time and look at what the terms meant, it often meant people who were not conforming to societal norms, people who were poor, people who lacked education, perhaps didn't speak sufficient English to make it through school, and so on.\u003c/p>\n\u003cp>But what it meant for those who were enacting the law were people who were determined to have poor IQs, people with certain psychiatric disorders. But generally, often the way it was used was much more as a catch-all category — so people who just didn't fit, kind of like the misfits of society, so to speak. That's the way they looked at them.\u003c/p>\n\u003cp>Looking back on it, I would say that those who were institutionalized — because many more people where institutionalized than actually sterilized — was because maybe they had a psychiatric condition and they were sent to an institution as was the policy at the time in the mid-20th century. ...\u003c/p>\n\u003cp>But for the most part, this program of eugenics ... the idea of sterilization was to eradicate certain genes from the population.\u003c/p>\n\u003cp>\u003cstrong>On whether anyone among those who were sterilized are still alive\u003c/strong>\u003c/p>\n\u003cp>I haven't found anyone who's still alive. I have been contacted by relatives ... people who contacted me whose aunts or uncles were sterilized at some of these institutions. In the recent paper that my team published, we determined through statistical analysis that it is likely that slightly over 800 people, about 500 women and 300 men, are alive today.\u003c/p>\n\u003cp>Those numbers don't map on to exact people, they don't correspond to a precise person. But what we've done, we've generated the most reliable estimates, and based on that estimate and also looking at the timing, we estimate that the majority of these people were sterilized between 1945 and 1949 and their average age is about 88, so fairly old.\u003c/p>\n\u003cp>So what we could do is we could go and look at the records. And that's where I'd like to work with the state of California, because we've essentially created a eugenics registry. We can look at the records and identify likely individuals and then reach out and contact them.\u003c/p>\n\u003cp>I, however, would like to mention that two states that have enacted policies for monetary reparations for sterilization victims — North Carolina and Virginia — the states have to lead in kind of creating a committee and a registry. And because it was the state seeking to provide some type of redress and acknowledge this history, the state was able to actively set up a program and seek out and try to identify individuals. So they would come to the state and they would confirm through documentation that they had been sterilized and then receive recognition and monetary compensation.\u003c/p>\n\u003cp>\u003cstrong>On if there are indications that California is interested in compensating victims of sterilization\u003c/strong>\u003c/p>\n\u003cp>There's indication that the state is interested in this history and is aware of possibility of sterilization abuse. Just three years ago, news broke that about 150 women in two California women's prisons \u003ca href=\"http://www.npr.org/2013/09/20/219366146/calif-seeks-answers-on-questionable-prison-sterilizations\">had been sterilized\u003c/a> without proper consent and proper procedure. That resulted in a state audit in the interest of the state legislators and eventually, a law that was unanimously passed, banning sterilizations except under extreme medical circumstances in California state prisons. So this issue is on the radar screen.\u003c/p>\n\u003cp>It's easy to forget about these patients who were in these remote institutions in the 1940s and '50s in California. However, I think it behooves the state to not forget this history, and all of us to not forget this history. So hopefully, having this fairly solid number that we've generated of an estimate of likely living survivors could help facilitate that process. ...\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It would also be a good idea to think about other forms of recognition of this historical injustice. For example, putting up a historical plaque in Sacramento somewhere to recognize those who were sterilized, or at one of the institutions such as the Sonoma State Home or the Patton State Home, making sure this history is included in K-12 curriculum. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. \u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=On+A+%27Eugenics+Registry%2C%27+A+Record+Of+California%27s+Thousands+Of+Sterilizations&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Some Bay Area suicide prevention hotlines say they experienced an increase in calls following the election of Donald Trump as president last week.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.sfsuicide.org/\">San Francisco Suicide Prevention\u003c/a> hotline saw a 30 percent spike in calls in the five days after the vote.\u003c/p>\n\u003cp>Director Courtney Brown said she’s never seen anything like it.\u003c/p>\n\u003cp>“We don’t have the numbers, but the only comparable incidents have been 9/11 and the Loma Prieta earthquake,” she said.\u003c/p>\n\u003cp>Brown was taking calls at 7 a.m. on Nov. 9, the day after the election. She said many of the callers were wondering what their lives were going to look like for the next four years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Wondering if they’re going to have the same health care,” she said. “Some of them wondering if they’re going to still be in the country — still be allowed to be in the country.”\u003c/p>\n\u003cp>Brown started tracking these calls. In the five days after the election, around 20 percent of callers cited increased distress due to the election.\u003c/p>\n\u003cp>Brown’s data go back to 2007. After previous elections, the records generally show a small bump in calls. And after President Obama’s election in 2008, she says, there was even a slight decrease in the number of calls.\u003c/p>\n\u003cp>“It seems that there’s something about this election that is really affecting the most vulnerable people in our community,” Brown said.\u003c/p>\n\u003cp>Other suicide hotlines are reporting a similar pattern.\u003c/p>\n\u003cp>Joy Alexiou, public information officer for Santa Clara County’s \u003ca href=\"https://www.sccgov.org/sites/mhd/Services/CallCenter/Pages/default.aspx\">Behavioral Health Services\u003c/a>, said an informal survey of hotline staff found an increase in calls post-election.\u003c/p>\n\u003cp>“While most callers expressed disappointment and worry about what will happen now that Trump is elected president, none of the callers disclosed or shared that they wanted to engage in suicidal behaviors because of election results,” Alexiou wrote in an email.\u003c/p>\n\u003cp>Libby Craig, the Bay Area director of the national organization Crisis Text Line (80 percent of whose clientele are millennials), said the day after the election the service experienced four times the usual number of texters.\u003c/p>\n\u003cp>“The most common words we saw used by texters were ‘scared’ and ‘election.’ The word ‘scared’ was often associated with LGBTQ issues,” Craig wrote in an email.\u003c/p>\n\u003cp>While there have been upticks in mental health calls related to past events like the San Bernardino terrorist attack and Robin Williams’ suicide, according to Craig, this is the first time her organization has seen an increase related to politics.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you or someone that you know is experiencing post-election distress, here is some advice from the \u003ca href=\"http://suicidepreventionlifeline.org/\">National Suicide Prevention Lifeline\u003c/a>, which also received more calls than usual, both leading up to the election and in the aftermath.\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Stick to routines.\u003c/strong> Even if you don’t feel like going to work or working out like you usually do, stick to going as much as possible. Routines ground us in the here and now, and remind us of things within our control that do not have to change.\u003c/li>\n\u003cli>\u003cstrong>Seek social supports.\u003c/strong> Talk about your thoughts and feelings with others, enjoy time to share experiences that can help you cope with the feelings, or distract you from them temporarily so you can take an “emotional breather.”\u003c/li>\n\u003cli>\u003cstrong>Limit your interaction\u003c/strong> with things that might aggravate your stress right now.\u003c/li>\n\u003cli>\u003cstrong>Take compassionate, caring actions\u003c/strong> to support others, where you can. Be the one to help a friend in crisis, or a stranger in need, or volunteer to assist others in a cause that you care about.\u003c/li>\n\u003cli>\u003cstrong>Call the Lifeline\u003c/strong> if you are in distress or would like to speak to someone. It’s available 24/7, and is free and confidential. You can call us at 1-800-273-TALK (8255).\u003c/li>\n\u003c/ul>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Wondering if they’re going to have the same health care,” she said. “Some of them wondering if they’re going to still be in the country — still be allowed to be in the country.”\u003c/p>\n\u003cp>Brown started tracking these calls. In the five days after the election, around 20 percent of callers cited increased distress due to the election.\u003c/p>\n\u003cp>Brown’s data go back to 2007. After previous elections, the records generally show a small bump in calls. And after President Obama’s election in 2008, she says, there was even a slight decrease in the number of calls.\u003c/p>\n\u003cp>“It seems that there’s something about this election that is really affecting the most vulnerable people in our community,” Brown said.\u003c/p>\n\u003cp>Other suicide hotlines are reporting a similar pattern.\u003c/p>\n\u003cp>Joy Alexiou, public information officer for Santa Clara County’s \u003ca href=\"https://www.sccgov.org/sites/mhd/Services/CallCenter/Pages/default.aspx\">Behavioral Health Services\u003c/a>, said an informal survey of hotline staff found an increase in calls post-election.\u003c/p>\n\u003cp>“While most callers expressed disappointment and worry about what will happen now that Trump is elected president, none of the callers disclosed or shared that they wanted to engage in suicidal behaviors because of election results,” Alexiou wrote in an email.\u003c/p>\n\u003cp>Libby Craig, the Bay Area director of the national organization Crisis Text Line (80 percent of whose clientele are millennials), said the day after the election the service experienced four times the usual number of texters.\u003c/p>\n\u003cp>“The most common words we saw used by texters were ‘scared’ and ‘election.’ The word ‘scared’ was often associated with LGBTQ issues,” Craig wrote in an email.\u003c/p>\n\u003cp>While there have been upticks in mental health calls related to past events like the San Bernardino terrorist attack and Robin Williams’ suicide, according to Craig, this is the first time her organization has seen an increase related to politics.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you or someone that you know is experiencing post-election distress, here is some advice from the \u003ca href=\"http://suicidepreventionlifeline.org/\">National Suicide Prevention Lifeline\u003c/a>, which also received more calls than usual, both leading up to the election and in the aftermath.\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Stick to routines.\u003c/strong> Even if you don’t feel like going to work or working out like you usually do, stick to going as much as possible. Routines ground us in the here and now, and remind us of things within our control that do not have to change.\u003c/li>\n\u003cli>\u003cstrong>Seek social supports.\u003c/strong> Talk about your thoughts and feelings with others, enjoy time to share experiences that can help you cope with the feelings, or distract you from them temporarily so you can take an “emotional breather.”\u003c/li>\n\u003cli>\u003cstrong>Limit your interaction\u003c/strong> with things that might aggravate your stress right now.\u003c/li>\n\u003cli>\u003cstrong>Take compassionate, caring actions\u003c/strong> to support others, where you can. Be the one to help a friend in crisis, or a stranger in need, or volunteer to assist others in a cause that you care about.\u003c/li>\n\u003cli>\u003cstrong>Call the Lifeline\u003c/strong> if you are in distress or would like to speak to someone. It’s available 24/7, and is free and confidential. You can call us at 1-800-273-TALK (8255).\u003c/li>\n\u003c/ul>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The staff of Clinica Sierra Vista, which has health centers throughout the Central Valley, screened its mostly low-income patients last year for mental health needs and determined that nearly 30 percent suffered from depression, anxiety or alcoholism.\u003c/p>\n\u003cp>Christopher Reilly, Sierra Vista’s chief of behavioral health services, said he was concerned about the high percentage of patients afflicted, but even more so about the clinic’s ability to treat them.\u003c/p>\n\u003cp>That’s in part because at health centers like Clinica Sierra Vista, a large group of mental health providers are excluded from reimbursement by Medi-Cal, the government program for low-income Californians. But that will soon change. Gov. Jerry Brown last week signed a law allowing federally funded health centers and rural clinics to bill Medi-Cal for the services of licensed marriage and family therapists.\u003c/p>\n\u003cp>“I am ecstatic that this passed,” Reilly said. “It means a lot more people are going to get attention for their behavioral health needs a lot earlier.”\u003c/p>\n\u003cp>The new law, which takes effect Jan. 1, is designed to address gaps in mental health care, particularly in rural areas where recruiting and retaining behavioral health providers is a challenge. Under the current law, clinics hire licensed clinical social workers and psychologists for their Medi-Cal patients, but they often can’t find enough to meet their needs. Many clinics don’t provide behavioral health services at all.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>About 40,000 marriage and family therapists are licensed in the state, compared to about 22,000 social workers and 21,000 psychologists, according to a \u003ca href=\"http://www.legtrack.com/bill.html?bill=201520160AB1863\" target=\"_blank\">state analysis\u003c/a> of the legislation, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1863\" target=\"_blank\">Assembly Bill 1863\u003c/a>.\u003c/p>\n\u003cp>Sierra Vista’s Reilly, who himself is a marriage and family therapist, said he expects another benefit from the law: less reliance on medication. Instead of simply being referred to doctors for prescriptions, the patients will be able to have regular counseling. Often, Reilly noted, patients’ depression or anxiety stems from family problems, domestic violence or substance use. Marriage and family therapists can help with those situations, he said.\u003c/p>\n\u003cp>Access to mental health services has long been a challenge in California, especially for low-income residents. In 2014, millions more Californians became eligible for Medi-Cal and for mental health services under the Affordable Care Act. That put even more pressure on the system.\u003c/p>\n\u003cp>The new law signed by the governor affects nearly 1,000 federally-funded and rural health clinics, according to the state analysis. The clinics accept patients regardless of their ability to pay and rely heavily on Medi-Cal reimbursements.\u003c/p>\n\u003cp>One of them, OLE Health, treats about 25,000 patients each year in Napa. CEO Tanir Ami said it’s been a challenge to find enough social workers to treat patients, many of whom have depression and anxiety, often exacerbated by poverty and inadequate housing.\u003c/p>\n\u003cp>“Now we get to recruit from a whole other pool of qualified candidates,” Ami said. “I am hoping it will make it exponentially easier to find the workforce we need.”\u003c/p>\n\u003cp>Gov. Brown vetoed a similar bill last year. The bill’s author, Assemblyman Jim Wood, (D-Healdsburg), said the governor had been concerned about its cost. But this year, Wood said he and the bill’s supporters convinced Brown that providing more mental health services could actually reduce health care costs.\u003c/p>\n\u003cp>“If you get people the behavioral health they need, you potentially keep them out of emergency rooms, which is a huge savings,” Wood said.\u003c/p>\n\u003cp>The bill was sponsored by CaliforniaHealth+ Advocates, an arm of the California Primary Care Association, and the California Association of Marriage and Family Therapists. The California chapter of the National Association of Social Workers and the California Psychological Association opposed it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org\" target=\"_blank\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"_blank\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The staff of Clinica Sierra Vista, which has health centers throughout the Central Valley, screened its mostly low-income patients last year for mental health needs and determined that nearly 30 percent suffered from depression, anxiety or alcoholism.\u003c/p>\n\u003cp>Christopher Reilly, Sierra Vista’s chief of behavioral health services, said he was concerned about the high percentage of patients afflicted, but even more so about the clinic’s ability to treat them.\u003c/p>\n\u003cp>That’s in part because at health centers like Clinica Sierra Vista, a large group of mental health providers are excluded from reimbursement by Medi-Cal, the government program for low-income Californians. But that will soon change. Gov. Jerry Brown last week signed a law allowing federally funded health centers and rural clinics to bill Medi-Cal for the services of licensed marriage and family therapists.\u003c/p>\n\u003cp>“I am ecstatic that this passed,” Reilly said. “It means a lot more people are going to get attention for their behavioral health needs a lot earlier.”\u003c/p>\n\u003cp>The new law, which takes effect Jan. 1, is designed to address gaps in mental health care, particularly in rural areas where recruiting and retaining behavioral health providers is a challenge. Under the current law, clinics hire licensed clinical social workers and psychologists for their Medi-Cal patients, but they often can’t find enough to meet their needs. Many clinics don’t provide behavioral health services at all.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>About 40,000 marriage and family therapists are licensed in the state, compared to about 22,000 social workers and 21,000 psychologists, according to a \u003ca href=\"http://www.legtrack.com/bill.html?bill=201520160AB1863\" target=\"_blank\">state analysis\u003c/a> of the legislation, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1863\" target=\"_blank\">Assembly Bill 1863\u003c/a>.\u003c/p>\n\u003cp>Sierra Vista’s Reilly, who himself is a marriage and family therapist, said he expects another benefit from the law: less reliance on medication. Instead of simply being referred to doctors for prescriptions, the patients will be able to have regular counseling. Often, Reilly noted, patients’ depression or anxiety stems from family problems, domestic violence or substance use. Marriage and family therapists can help with those situations, he said.\u003c/p>\n\u003cp>Access to mental health services has long been a challenge in California, especially for low-income residents. In 2014, millions more Californians became eligible for Medi-Cal and for mental health services under the Affordable Care Act. That put even more pressure on the system.\u003c/p>\n\u003cp>The new law signed by the governor affects nearly 1,000 federally-funded and rural health clinics, according to the state analysis. The clinics accept patients regardless of their ability to pay and rely heavily on Medi-Cal reimbursements.\u003c/p>\n\u003cp>One of them, OLE Health, treats about 25,000 patients each year in Napa. CEO Tanir Ami said it’s been a challenge to find enough social workers to treat patients, many of whom have depression and anxiety, often exacerbated by poverty and inadequate housing.\u003c/p>\n\u003cp>“Now we get to recruit from a whole other pool of qualified candidates,” Ami said. “I am hoping it will make it exponentially easier to find the workforce we need.”\u003c/p>\n\u003cp>Gov. Brown vetoed a similar bill last year. The bill’s author, Assemblyman Jim Wood, (D-Healdsburg), said the governor had been concerned about its cost. But this year, Wood said he and the bill’s supporters convinced Brown that providing more mental health services could actually reduce health care costs.\u003c/p>\n\u003cp>“If you get people the behavioral health they need, you potentially keep them out of emergency rooms, which is a huge savings,” Wood said.\u003c/p>\n\u003cp>The bill was sponsored by CaliforniaHealth+ Advocates, an arm of the California Primary Care Association, and the California Association of Marriage and Family Therapists. The California chapter of the National Association of Social Workers and the California Psychological Association opposed it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org\" target=\"_blank\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"_blank\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Coping With Depression When Treatment Doesn't Work",
"title": "Coping With Depression When Treatment Doesn't Work",
"headTitle": "Future of You | KQED Future of You | KQED Science",
"content": "\u003cp>Rini Kramer-Carter has tried everything to pull herself out of her dark emotional hole: individual therapy, support groups, tai chi and numerous antidepressants.\u003c/p>\n\u003cp>The 73-year-old Los Angeles musician rattles off the list: Prozac, Cymbalta, Lexapro.\u003c/p>\n\u003cp>“I’ve been on a bunch,” she said. “I still cry all the time.”\u003c/p>\n\u003cp>She has what’s known as “treatment-resistant depression.” It’s commonly defined as depression that doesn’t respond to two different medications when taken one after the other, at the right dose and for the right amount of time.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-medium wp-image-224252\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/DepressedMan-800x453.jpg\" alt=\"DepressedMan\" width=\"800\" height=\"453\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-800x453.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-400x227.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-768x435.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-1180x669.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-960x544.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Nearly 16 million adults have major depression, and up to \u003ca href=\"http://www.ajgponline.org/article/S1064-7481%2816%2930126-9/fulltext?rss=yes\">a third\u003c/a> do not respond to treatment. The disease afflicts people of all ages, but experts say that as many as half of older adults don’t get better with standard treatment.\u003c/p>\n\u003cp>Mental health experts expect treatment-resistant depression to become more widespread as baby boomers age. Boomers already have been identified as having \u003ca href=\"http://www.gallup.com/poll/181364/reports-depression-treatment-highest-among-baby-boomers.aspx\">higher rates\u003c/a> of depression than previous generations, and over time their depression may no longer respond to medication.\u003c/p>\n\u003cp>“We are seeing treatment-resistant depression more, and we are recognizing it more,” said Helen Lavretsky, a geriatric psychiatrist at UCLA. “And in older adults, the answer to understanding what it is and what to do about it is more complicated than in younger adults.”\u003c/p>\n\u003cp>The consequences among older adults can be devastating. Persistent depression can raise the risk of early death and suicide, expedite memory decline and lead to a loss of independence.\u003c/p>\n\u003cp>\u003cstrong>Why Antidepressants Aren't Enough\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>The phenomenon isn’t well studied, but psychiatrists believe there are several reasons why depression in older adults may not respond to treatment. For one thing, if a person has been depressed and taken different medications for a long time, it can diminish their effectiveness. Patients also may neglect to take their medication as prescribed, because they have memory problems or they believe they no longer need it.\u003c/p>\n\u003cp>“Sometimes people say, ‘I’m better. I don’t need this,’ and stop the medicine,” said Anthony P. Weiner, who directs outpatient geriatric psychiatry at Massachusetts General Hospital. “Then the symptoms recur … and if the person goes back on the medicine, it may not be fully effective.”\u003c/p>\n\u003cp>Seniors are also more likely to have chronic medical illnesses, which raises the risk of depression. Their illnesses may make it more difficult for them to recover from depression. And it can mask whether antidepressants are working, because symptoms of chronic illness can be mistaken for depression — and vice versa.\u003c/p>\n\u003cp>Poverty, isolation, pain, grief over the loss of a spouse, or being a caregiver can also lead to or intensify a senior’s depression. And no matter what medication the patients take, Lavretsky noted, those external factors don’t go away.\u003c/p>\n\u003cp>“Either they change their perspective or they change their circumstances, or the depression just persists,” she said.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-medium wp-image-225685\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/depressedwomanrain-800x473.jpg\" alt=\"depressedwomanrain\" width=\"800\" height=\"473\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-800x473.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-400x236.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-768x454.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-1180x698.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-960x568.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Antidepressants can help seniors gain some perspective. But Lavretsky and others agree that even if the medications are effective, they shouldn’t be used in isolation. “It’s an emotional experience,” Weiner said. “The whole answer isn’t just, ‘Oh, here take a pill.’ There is such a central role for psychotherapy.”\u003c/p>\n\u003cp>Kramer-Carter, who speaks slowly and hugs everyone she meets, has felt depressed for as long as she can remember. As a young adult, she worked as a secretary and a proofreader but got fired more than once because she had trouble getting out of bed and making it to work on time. She went to the emergency room many times and in her 30s, she was diagnosed with depression.\u003c/p>\n\u003cp>Now, she spends a few days each week driving her husband, Eugene Carter, to medical appointments. When she feels up to it, she volunteers delivering food to poor families.\u003c/p>\n\u003cp>Kramer-Carter checks all the boxes for being at high-risk of treatment-resistant depression. She is a long-time caregiver, first for her parents and now for her husband, a stroke survivor with short-term memory problems. Her own list of health problems is long: diabetes, high blood pressure, arthritis, fibromyalgia and gout.\u003c/p>\n\u003cp>“Who wants to be aching all the time?” she said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If I can stay in bed all day, that’s what I do.'\u003ccite>Rini Kramer-Carter\u003c/cite>\u003c/aside>\n\u003cp>Money problems don’t help either. The couple depends financially on Social Security. If she had more money, she said she would go to the theater or see live concerts. She misses both.\u003c/p>\n\u003cp>“We wouldn’t be so stuck,” she said. As it is, they spend everything on food, rent and other bills.\u003c/p>\n\u003cp>“It’s a constant struggle,” she said. “You have to borrow from Peter to pay Paul.”\u003c/p>\n\u003cp>Despite the prevalence of treatment-resistant depression, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363299/\" target=\"_blank\">few resources\u003c/a> exist to help psychiatrists make treatment decisions. Clinical trials have been scant, and there are no universally accepted protocols for the condition. The risks and benefits of different medications for older adults are largely unknown.\u003c/p>\n\u003cp>Given a shortage of geriatric psychiatrists, decisions on treatment are often left to primary care providers, who may not have relevant training or might be reluctant to take on such complicated care.\u003c/p>\n\u003cp>Doctors with patients who don’t respond to traditional therapies frequently make ad hoc decisions about whether to change the dosage, add a medication or switch to a new one.\u003c/p>\n\u003cp>“The clinicians use their best experience and trial and error,” said Evelyn Whitlock, chief science officer at the Patient-Centered Outcomes Research Institute. “They try something, and if it doesn’t work, they try something else.”\u003c/p>\n\u003cp>Trial and error is not ideal, she said. Many of these people have been living with depression for so many years, and providers need to be able to provide them with effective treatment.\u003c/p>\n\u003cp>\u003cstrong>New Approaches\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>In an effort to produce better medical outcomes for people with treatment-resistant depression, the Patient-Centered Outcomes Research Institute announced in July that it was funding \u003ca href=\"http://www.pcori.org/news-release/pcori-board-approves-40-million-improving-treatment-options-depression\" target=\"_blank\">three major studies\u003c/a> that will test different approaches to the illness. The goal of the research is to produce tangible evidence that can be used immediately to help patients and their doctors make more informed treatment decisions. [contextly_sidebar id=\"QvUjqDKFRFEtGPmtPTeoqpzPvYGJtv45\"]\u003c/p>\n\u003cp>The Washington, D.C. nonprofit, which finances health research, earmarked $40 million for the five-year studies, which it expects to begin this fall. They will include more than 2,500 patients at sites in California, Ohio, New York, Texas, Pennsylvania and elsewhere.\u003c/p>\n\u003cp>One of the studies will examine electroconvulsive therapy — its impact on quality of life and its potential for relieving the symptoms. Another will compare the effectiveness and safety of three strategies — using magnetic fields to stimulate nerve cells in the brain, adding an antipsychotic medication or switching to a specific antidepressant. The research will assess how these approaches affect the patients’ ability to function at home and work.\u003c/p>\n\u003cp>The third and largest study, with about 1,500 patients, will focus specifically on older adults, testing different drugs and studying how aging affects the risk and benefits of antidepressants. UCLA, where Kramer-Carter is being treated, is part of the third study, which will weigh life circumstances and disabilities in addition to depression.\u003c/p>\n\u003cp>The grants represent an “unprecedented opportunity to look at this population,” Lavretsky said.\u003c/p>\n\u003cp>“It will be a comprehensive look at the condition, why it happens and what are the ways of alleviating suffering,” she said. “Are there some similarities among all people with treatment-resistant depression? I suspect we will find some.”\u003c/p>\n\u003cp>On a recent afternoon, Rini Kramer-Carter visited Lavretsky at UCLA. She said the only time she truly escapes her sadness is when she plays percussion along with other musicians. But she hasn’t been playing lately, and she has been sleeping up to 20 hours a day.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-257360\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/10/Prozac-428x600.jpg\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/10/Prozac-428x600.jpg 428w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Prozac-400x560.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Prozac.jpg 731w\" sizes=\"(max-width: 428px) 100vw, 428px\">\u003c/p>\n\u003cp>“If I can stay in bed all day, that’s what I do,” she said.\u003c/p>\n\u003cp>Sometimes she watches TV comedies to try to dissipate her black moods.\u003c/p>\n\u003cp>Kramer-Carter said she learned about Lavretsky after seeing a newspaper ad for another research study, of a drug typically used to treat early-stage dementia. During their appointment, Lavretsky went over a list of questions included in the study. “On a scale of zero to 10, where do you place yourself in terms of depression?” the doctor asked her. Nine, she responded.\u003c/p>\n\u003cp>She told Lavretsky she sometimes felt restless and anxious, but not suicidal.\u003c/p>\n\u003cp>“Do you feel full of energy?” Lavretsky asked.\u003c/p>\n\u003cp>“Do I look like I am full of energy?” she responded with a sigh.\u003c/p>\n\u003cp>Lavretsky told her that no pill will completely fix her problems, but medication might give her more energy and the ability to cope. Kramer-Carter said she knows a drug won’t produce any miracles. She just wants some relief.\u003c/p>\n\u003cp>“I just want to be able to live my life,” she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Rini Kramer-Carter has tried everything to pull herself out of her dark emotional hole: individual therapy, support groups, tai chi and numerous antidepressants.\u003c/p>\n\u003cp>The 73-year-old Los Angeles musician rattles off the list: Prozac, Cymbalta, Lexapro.\u003c/p>\n\u003cp>“I’ve been on a bunch,” she said. “I still cry all the time.”\u003c/p>\n\u003cp>She has what’s known as “treatment-resistant depression.” It’s commonly defined as depression that doesn’t respond to two different medications when taken one after the other, at the right dose and for the right amount of time.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-medium wp-image-224252\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/DepressedMan-800x453.jpg\" alt=\"DepressedMan\" width=\"800\" height=\"453\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-800x453.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-400x227.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-768x435.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-1180x669.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/DepressedMan-960x544.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nearly 16 million adults have major depression, and up to \u003ca href=\"http://www.ajgponline.org/article/S1064-7481%2816%2930126-9/fulltext?rss=yes\">a third\u003c/a> do not respond to treatment. The disease afflicts people of all ages, but experts say that as many as half of older adults don’t get better with standard treatment.\u003c/p>\n\u003cp>Mental health experts expect treatment-resistant depression to become more widespread as baby boomers age. Boomers already have been identified as having \u003ca href=\"http://www.gallup.com/poll/181364/reports-depression-treatment-highest-among-baby-boomers.aspx\">higher rates\u003c/a> of depression than previous generations, and over time their depression may no longer respond to medication.\u003c/p>\n\u003cp>“We are seeing treatment-resistant depression more, and we are recognizing it more,” said Helen Lavretsky, a geriatric psychiatrist at UCLA. “And in older adults, the answer to understanding what it is and what to do about it is more complicated than in younger adults.”\u003c/p>\n\u003cp>The consequences among older adults can be devastating. Persistent depression can raise the risk of early death and suicide, expedite memory decline and lead to a loss of independence.\u003c/p>\n\u003cp>\u003cstrong>Why Antidepressants Aren't Enough\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>The phenomenon isn’t well studied, but psychiatrists believe there are several reasons why depression in older adults may not respond to treatment. For one thing, if a person has been depressed and taken different medications for a long time, it can diminish their effectiveness. Patients also may neglect to take their medication as prescribed, because they have memory problems or they believe they no longer need it.\u003c/p>\n\u003cp>“Sometimes people say, ‘I’m better. I don’t need this,’ and stop the medicine,” said Anthony P. Weiner, who directs outpatient geriatric psychiatry at Massachusetts General Hospital. “Then the symptoms recur … and if the person goes back on the medicine, it may not be fully effective.”\u003c/p>\n\u003cp>Seniors are also more likely to have chronic medical illnesses, which raises the risk of depression. Their illnesses may make it more difficult for them to recover from depression. And it can mask whether antidepressants are working, because symptoms of chronic illness can be mistaken for depression — and vice versa.\u003c/p>\n\u003cp>Poverty, isolation, pain, grief over the loss of a spouse, or being a caregiver can also lead to or intensify a senior’s depression. And no matter what medication the patients take, Lavretsky noted, those external factors don’t go away.\u003c/p>\n\u003cp>“Either they change their perspective or they change their circumstances, or the depression just persists,” she said.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-medium wp-image-225685\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/depressedwomanrain-800x473.jpg\" alt=\"depressedwomanrain\" width=\"800\" height=\"473\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-800x473.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-400x236.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-768x454.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-1180x698.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/depressedwomanrain-960x568.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Antidepressants can help seniors gain some perspective. But Lavretsky and others agree that even if the medications are effective, they shouldn’t be used in isolation. “It’s an emotional experience,” Weiner said. “The whole answer isn’t just, ‘Oh, here take a pill.’ There is such a central role for psychotherapy.”\u003c/p>\n\u003cp>Kramer-Carter, who speaks slowly and hugs everyone she meets, has felt depressed for as long as she can remember. As a young adult, she worked as a secretary and a proofreader but got fired more than once because she had trouble getting out of bed and making it to work on time. She went to the emergency room many times and in her 30s, she was diagnosed with depression.\u003c/p>\n\u003cp>Now, she spends a few days each week driving her husband, Eugene Carter, to medical appointments. When she feels up to it, she volunteers delivering food to poor families.\u003c/p>\n\u003cp>Kramer-Carter checks all the boxes for being at high-risk of treatment-resistant depression. She is a long-time caregiver, first for her parents and now for her husband, a stroke survivor with short-term memory problems. Her own list of health problems is long: diabetes, high blood pressure, arthritis, fibromyalgia and gout.\u003c/p>\n\u003cp>“Who wants to be aching all the time?” she said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If I can stay in bed all day, that’s what I do.'\u003ccite>Rini Kramer-Carter\u003c/cite>\u003c/aside>\n\u003cp>Money problems don’t help either. The couple depends financially on Social Security. If she had more money, she said she would go to the theater or see live concerts. She misses both.\u003c/p>\n\u003cp>“We wouldn’t be so stuck,” she said. As it is, they spend everything on food, rent and other bills.\u003c/p>\n\u003cp>“It’s a constant struggle,” she said. “You have to borrow from Peter to pay Paul.”\u003c/p>\n\u003cp>Despite the prevalence of treatment-resistant depression, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363299/\" target=\"_blank\">few resources\u003c/a> exist to help psychiatrists make treatment decisions. Clinical trials have been scant, and there are no universally accepted protocols for the condition. The risks and benefits of different medications for older adults are largely unknown.\u003c/p>\n\u003cp>Given a shortage of geriatric psychiatrists, decisions on treatment are often left to primary care providers, who may not have relevant training or might be reluctant to take on such complicated care.\u003c/p>\n\u003cp>Doctors with patients who don’t respond to traditional therapies frequently make ad hoc decisions about whether to change the dosage, add a medication or switch to a new one.\u003c/p>\n\u003cp>“The clinicians use their best experience and trial and error,” said Evelyn Whitlock, chief science officer at the Patient-Centered Outcomes Research Institute. “They try something, and if it doesn’t work, they try something else.”\u003c/p>\n\u003cp>Trial and error is not ideal, she said. Many of these people have been living with depression for so many years, and providers need to be able to provide them with effective treatment.\u003c/p>\n\u003cp>\u003cstrong>New Approaches\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>In an effort to produce better medical outcomes for people with treatment-resistant depression, the Patient-Centered Outcomes Research Institute announced in July that it was funding \u003ca href=\"http://www.pcori.org/news-release/pcori-board-approves-40-million-improving-treatment-options-depression\" target=\"_blank\">three major studies\u003c/a> that will test different approaches to the illness. The goal of the research is to produce tangible evidence that can be used immediately to help patients and their doctors make more informed treatment decisions. \u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The Washington, D.C. nonprofit, which finances health research, earmarked $40 million for the five-year studies, which it expects to begin this fall. They will include more than 2,500 patients at sites in California, Ohio, New York, Texas, Pennsylvania and elsewhere.\u003c/p>\n\u003cp>One of the studies will examine electroconvulsive therapy — its impact on quality of life and its potential for relieving the symptoms. Another will compare the effectiveness and safety of three strategies — using magnetic fields to stimulate nerve cells in the brain, adding an antipsychotic medication or switching to a specific antidepressant. The research will assess how these approaches affect the patients’ ability to function at home and work.\u003c/p>\n\u003cp>The third and largest study, with about 1,500 patients, will focus specifically on older adults, testing different drugs and studying how aging affects the risk and benefits of antidepressants. UCLA, where Kramer-Carter is being treated, is part of the third study, which will weigh life circumstances and disabilities in addition to depression.\u003c/p>\n\u003cp>The grants represent an “unprecedented opportunity to look at this population,” Lavretsky said.\u003c/p>\n\u003cp>“It will be a comprehensive look at the condition, why it happens and what are the ways of alleviating suffering,” she said. “Are there some similarities among all people with treatment-resistant depression? I suspect we will find some.”\u003c/p>\n\u003cp>On a recent afternoon, Rini Kramer-Carter visited Lavretsky at UCLA. She said the only time she truly escapes her sadness is when she plays percussion along with other musicians. But she hasn’t been playing lately, and she has been sleeping up to 20 hours a day.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-257360\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/10/Prozac-428x600.jpg\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/10/Prozac-428x600.jpg 428w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Prozac-400x560.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Prozac.jpg 731w\" sizes=\"(max-width: 428px) 100vw, 428px\">\u003c/p>\n\u003cp>“If I can stay in bed all day, that’s what I do,” she said.\u003c/p>\n\u003cp>Sometimes she watches TV comedies to try to dissipate her black moods.\u003c/p>\n\u003cp>Kramer-Carter said she learned about Lavretsky after seeing a newspaper ad for another research study, of a drug typically used to treat early-stage dementia. During their appointment, Lavretsky went over a list of questions included in the study. “On a scale of zero to 10, where do you place yourself in terms of depression?” the doctor asked her. Nine, she responded.\u003c/p>\n\u003cp>She told Lavretsky she sometimes felt restless and anxious, but not suicidal.\u003c/p>\n\u003cp>“Do you feel full of energy?” Lavretsky asked.\u003c/p>\n\u003cp>“Do I look like I am full of energy?” she responded with a sigh.\u003c/p>\n\u003cp>Lavretsky told her that no pill will completely fix her problems, but medication might give her more energy and the ability to cope. Kramer-Carter said she knows a drug won’t produce any miracles. She just wants some relief.\u003c/p>\n\u003cp>“I just want to be able to live my life,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>If you are not redirected to the story, please \u003ca href=\"https://ww2.kqed.org/stateofhealth/series/state-of-mind/\">click here\u003c/a> to explore a special series on access to mental health care by KQED's The California Report and State of Health.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cp>\u003ca href=\"http://www.nami.org/Learn-More/Mental-Health-By-the-Numbers\" target=\"_blank\">One in five\u003c/a> Americans is estimated to have a mental health condition at any given time. But getting treatment remains difficult — and it’s worse for children, especially those who identify as black or Hispanic.\u003c/p>\n\u003cp>That’s the major finding in \u003ca href=\"http://joh.sagepub.com/content/early/2016/08/11/0020731416662736.abstract\" target=\"_blank\">research published Friday\u003c/a> in the International Journal of Health Services. The study examines how often young adults and children were able to get needed mental health services, based on whether they were black, Hispanic or white. Using a nationally representative sample of federally collected \u003ca href=\"https://meps.ahrq.gov/mepsweb/\" target=\"_blank\">survey data\u003c/a> compiled between 2006 and 2012, researchers sought to determine how often people reported poor mental health and either saw a specialist or had a general practitioner bill for mental health services.\u003c/p>\n\u003cp>“No one is necessarily bigoted — and yet we have a system that creates the kind of discrimination we see in the paper,” said Steffie Woolhandler, a professor at City University of New York School of Public Health, and one of the study’s authors. “Kids are getting half as much mental health treatment — and they have the same level of mental health problems.”\u003c/p>\n\u003cp>Young people in general aren’t likely to see mental health specialists. But the numbers fell further when racial and ethnic backgrounds were factored in. About 5.7 percent of white children and young adults were likely to see a mental health specialist in a given year, compared with about 2.3 percent for black or Hispanic young people.\u003c/p>\n\u003cp>Put another way: Even when controlling for someone’s mental health status, insurance and income, black and Hispanic children saw someone for treatment far less often than did their white counterparts — about 130 fewer visits per thousand subjects. Black young adults visited a mental health specialist about 280 fewer visits per thousand; Hispanics had 244 fewer visits per thousand.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the data indicate that mental illness incidence rates are generally consistent across racial groups, according to the study. Of adults between the ages of 18 and 34, between 4 and 5 percent indicated having fair or poor mental health, regardless of racial background. For children, white and black subjects were reported to need care at about the same rate — between 11 percent and 12 percent — compared with about 7 percent of Hispanic children.\u003c/p>\n\u003cp>The paper outlines a few possible reasons for this disconnect. Different communities may attach greater stigma about mental health care, or they may place less trust in the doctors available. Plus, there is a shortage of child psychiatrists across the country, and black and Hispanic families often live in the most underserved areas.\u003c/p>\n\u003cp>“There are problems of access all around,” said Harold Pincus, vice chair of psychiatry at Columbia University’s College of Physicians and Surgeons. “We have to change the way we do things.”\u003c/p>\n\u003cp>The findings suggest that lawmakers have focused on trying to improve access to mental health care, but “we can’t rest on our laurels,” said Pincus, who wasn’t affiliated with the study. He also noted that treating white children’s level of access as the golden standard is probably unwise, since research suggests they also receive inadequate care.\u003c/p>\n\u003cp>One of the study’s clear messages, argued Woolhandler, is that racial minorities received markedly less care — regardless of socioeconomic or health status. The gap suggests a targeted intervention is needed.\u003c/p>\n\u003cp>The study highlights a need to ensure doctors know how to counsel patients of different racial backgrounds and will do so, said Benjamin Le Cook, an assistant professor of psychiatry at Harvard Medical School, who was also not affiliated with the study. Ending racial and cultural disparities in access to care is a more pressing concern than erasing the stigmas about mental illness in minority communities, he said.\u003c/p>\n\u003cp>That’s especially relevant given minorities are \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24178249\" target=\"_blank\">less likely to be treated\u003c/a> by doctors of their ethnicity. In addition, research suggests that mental health specialists sometimes discriminate based on race when seeing patients.\u003c/p>\n\u003cp>“It has to do with experiences people in the community have had that haven’t matched their expectations or aligned with problems they’re having,” LeCook said. “Cultural stigma is a factor, but not the main one.”\u003c/p>\n\u003cp>Beyond better training, more funds are needed for resources like community health centers, which often serve black and Hispanic patients, Woolhandler said.\u003c/p>\n\u003cp>“I see these great people trying to work in community mental health, but they need more resources to do their job,” she said.\u003c/p>\n\u003cp>But, the research doesn’t account for other areas where minorities may access mental health services, Pincus noted. Churches and social service agencies, for instance, may be filling some of the void and wouldn’t be accounted for by the survey data.\u003c/p>\n\u003cp>Researchers and policymakers should explore those sectors, he said, to see if they could be better leveraged to help people get connected to care they’ll actually trust. As experts try to bolster the mental health system — both to improve access across the board and also to close race-based gaps — they need to use a multipronged approach, pulling in different kinds of caregivers than those who might normally treat mental illness.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“There’s all kinds of ways by which the mental health system doesn’t play a role in helping people,” he said. “Family and community supports, social services — they’re all part of the picture.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"http://www.nami.org/Learn-More/Mental-Health-By-the-Numbers\" target=\"_blank\">One in five\u003c/a> Americans is estimated to have a mental health condition at any given time. But getting treatment remains difficult — and it’s worse for children, especially those who identify as black or Hispanic.\u003c/p>\n\u003cp>That’s the major finding in \u003ca href=\"http://joh.sagepub.com/content/early/2016/08/11/0020731416662736.abstract\" target=\"_blank\">research published Friday\u003c/a> in the International Journal of Health Services. The study examines how often young adults and children were able to get needed mental health services, based on whether they were black, Hispanic or white. Using a nationally representative sample of federally collected \u003ca href=\"https://meps.ahrq.gov/mepsweb/\" target=\"_blank\">survey data\u003c/a> compiled between 2006 and 2012, researchers sought to determine how often people reported poor mental health and either saw a specialist or had a general practitioner bill for mental health services.\u003c/p>\n\u003cp>“No one is necessarily bigoted — and yet we have a system that creates the kind of discrimination we see in the paper,” said Steffie Woolhandler, a professor at City University of New York School of Public Health, and one of the study’s authors. “Kids are getting half as much mental health treatment — and they have the same level of mental health problems.”\u003c/p>\n\u003cp>Young people in general aren’t likely to see mental health specialists. But the numbers fell further when racial and ethnic backgrounds were factored in. About 5.7 percent of white children and young adults were likely to see a mental health specialist in a given year, compared with about 2.3 percent for black or Hispanic young people.\u003c/p>\n\u003cp>Put another way: Even when controlling for someone’s mental health status, insurance and income, black and Hispanic children saw someone for treatment far less often than did their white counterparts — about 130 fewer visits per thousand subjects. Black young adults visited a mental health specialist about 280 fewer visits per thousand; Hispanics had 244 fewer visits per thousand.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the data indicate that mental illness incidence rates are generally consistent across racial groups, according to the study. Of adults between the ages of 18 and 34, between 4 and 5 percent indicated having fair or poor mental health, regardless of racial background. For children, white and black subjects were reported to need care at about the same rate — between 11 percent and 12 percent — compared with about 7 percent of Hispanic children.\u003c/p>\n\u003cp>The paper outlines a few possible reasons for this disconnect. Different communities may attach greater stigma about mental health care, or they may place less trust in the doctors available. Plus, there is a shortage of child psychiatrists across the country, and black and Hispanic families often live in the most underserved areas.\u003c/p>\n\u003cp>“There are problems of access all around,” said Harold Pincus, vice chair of psychiatry at Columbia University’s College of Physicians and Surgeons. “We have to change the way we do things.”\u003c/p>\n\u003cp>The findings suggest that lawmakers have focused on trying to improve access to mental health care, but “we can’t rest on our laurels,” said Pincus, who wasn’t affiliated with the study. He also noted that treating white children’s level of access as the golden standard is probably unwise, since research suggests they also receive inadequate care.\u003c/p>\n\u003cp>One of the study’s clear messages, argued Woolhandler, is that racial minorities received markedly less care — regardless of socioeconomic or health status. The gap suggests a targeted intervention is needed.\u003c/p>\n\u003cp>The study highlights a need to ensure doctors know how to counsel patients of different racial backgrounds and will do so, said Benjamin Le Cook, an assistant professor of psychiatry at Harvard Medical School, who was also not affiliated with the study. Ending racial and cultural disparities in access to care is a more pressing concern than erasing the stigmas about mental illness in minority communities, he said.\u003c/p>\n\u003cp>That’s especially relevant given minorities are \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/24178249\" target=\"_blank\">less likely to be treated\u003c/a> by doctors of their ethnicity. In addition, research suggests that mental health specialists sometimes discriminate based on race when seeing patients.\u003c/p>\n\u003cp>“It has to do with experiences people in the community have had that haven’t matched their expectations or aligned with problems they’re having,” LeCook said. “Cultural stigma is a factor, but not the main one.”\u003c/p>\n\u003cp>Beyond better training, more funds are needed for resources like community health centers, which often serve black and Hispanic patients, Woolhandler said.\u003c/p>\n\u003cp>“I see these great people trying to work in community mental health, but they need more resources to do their job,” she said.\u003c/p>\n\u003cp>But, the research doesn’t account for other areas where minorities may access mental health services, Pincus noted. Churches and social service agencies, for instance, may be filling some of the void and wouldn’t be accounted for by the survey data.\u003c/p>\n\u003cp>Researchers and policymakers should explore those sectors, he said, to see if they could be better leveraged to help people get connected to care they’ll actually trust. As experts try to bolster the mental health system — both to improve access across the board and also to close race-based gaps — they need to use a multipronged approach, pulling in different kinds of caregivers than those who might normally treat mental illness.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“There’s all kinds of ways by which the mental health system doesn’t play a role in helping people,” he said. “Family and community supports, social services — they’re all part of the picture.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"marketplace": {
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"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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"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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},
"perspectives": {
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"order": 14
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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.",
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"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",
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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/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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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",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
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