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"content": "\u003cfigure id=\"attachment_24660\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/iStock_000051802834_Large-e1427130549474.jpg\">\u003cimg class=\"size-large wp-image-24660\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/iStock_000051802834_Large-640x427.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Lisa Gillespie,\u003c/strong> \u003ca title=\"http://kaiserhealthnews.org/news/depression-related-ailments-take-their-toll-on-the-workplace-study-finds/\" href=\"http://kaiserhealthnews.org/news/depression-related-ailments-take-their-toll-on-the-workplace-study-finds/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>For every dollar spent on treating depression, nearly five dollars more is spent on related medical conditions like back and chest pain, sleep disorders and migraines. Depression can also lead to lost productivity, placing a greater financial burden on businesses and the health care system, \u003ca title=\"http://www.psychiatrist.com/jcp/article/Pages/2015/v76n02/v76n0204.aspx\" href=\"http://www.psychiatrist.com/jcp/article/Pages/2015/v76n02/v76n0204.aspx\" target=\"_blank\">according to new research\u003c/a> measuring the economic impact of depression.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Average worker with major depression loses the productivity of 32 days a year.\u003c/aside>\n\u003cp>“The fact that they’re finding such greater costs with all these different [related conditions] underscores how the fragmented system is not helpful for our economy because people with mental illness are not getting the rounded health care they need,” said Lynn Bufka, with the American Psychological Association, who was not affiliated with the study.\u003c/p>\n\u003cp>The total cost to the U.S. economy of major depressive disorder rose to $210 billion in 2010, up more than 20 percent from $173 billion in 2008.\u003c!--more-->\u003c/p>\n\u003cp>About half of that is for direct treatment and suicide-related services, but the rest is workplace costs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The rise is partially accounted for by the increase in population, but also because depression is being diagnosed and treated more often. The incidence of major depressive disorder rose during this time period from 6.4 percent of the population to 6.8 percent.\u003c/p>\n\u003cp>In addition, some of this growth might have been caused by the nation’s 2008 economic downturn and tight job market, factors that combined to make it harder for those suffering from depression to retain their jobs and even more difficult for those with this condition who are job seekers to find work, according to Paul Greenberg, a study author and director of health economics at the Analysis Group, a consulting firm in Boston.\u003c/p>\n\u003cp>Meanwhile, the study also examined how depression plays out in the workplace.\u003c/p>\n\u003cp>Mental health experts and economists have long known that someone’s depression can have a significant cost on the workplace, Greenberg said.\u003c/p>\n\u003cp>For example, the study found that the average worker who had major depression disorder lost the productivity of about 32 workdays a year due to what’s known as “\u003ca title=\"https://hbr.org/2004/10/presenteeism-at-work-but-out-of-it\" href=\"https://hbr.org/2004/10/presenteeism-at-work-but-out-of-it\" target=\"_blank\">presenteeism\u003c/a>.” That is a term for when an employee is at work but not complet\u003cstrong>i\u003c/strong>ng daily tasks and responsibilities.\u003c/p>\n\u003cp>Experts say that, though this loss in productivity highlights the economic toll mental health issues have on the work place, small and medium-sized employers may not have the knowledge or tools to improve the situation.\u003c/p>\n\u003cp>“While employers suspect depression will lead to greater absenteeism, I’m not sure they know how to judge what effect it’s having on their business,” said Paul Gionfriddo, president of Mental Health America, an advocacy group. “It’s really hard for businesses that are small to medium that account for so much employment to say, ‘this is why this guy is less productive and here’s what I can do about it.’”\u003c/p>\n\u003cp>\u003cstrong>Expansion of Health Coverage May Help\u003c/strong>\u003c/p>\n\u003cp>Greenberg said, though, that changes in health coverage may alter this landscape. For example, more people gaining health care coverage through the health law and other efforts to integrate mental and medical care could provide more care for people with depression and lessen the workplace burden.\u003c/p>\n\u003cp>Robert Roca, chairman of the American Psychiatric Association’s council on geriatric psychiatry, says the gradual integration of mental health care into primary care means more people may be diagnosed early and treated. “The ACA sets the stage for this kind of integration effort, and I’m optimistic that we’ll see benefit down the road,” said Roca, who was not affiliated with this study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The \u003ca title=\"http://www.psychiatrist.com/jcp/article/Pages/2015/v76n02/v76n0204.aspx\" href=\"http://www.psychiatrist.com/jcp/article/Pages/2015/v76n02/v76n0204.aspx\" target=\"_blank\">research was published \u003c/a>in the February edition of the Journal of Clinical Psychiatry and used data from adults 18 to 64 diagnosed with major depressive disorder in 2005 or 2010 from an OptumHealth claims database and from the National Survey on Drug Use and Health.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The rise is partially accounted for by the increase in population, but also because depression is being diagnosed and treated more often. The incidence of major depressive disorder rose during this time period from 6.4 percent of the population to 6.8 percent.\u003c/p>\n\u003cp>In addition, some of this growth might have been caused by the nation’s 2008 economic downturn and tight job market, factors that combined to make it harder for those suffering from depression to retain their jobs and even more difficult for those with this condition who are job seekers to find work, according to Paul Greenberg, a study author and director of health economics at the Analysis Group, a consulting firm in Boston.\u003c/p>\n\u003cp>Meanwhile, the study also examined how depression plays out in the workplace.\u003c/p>\n\u003cp>Mental health experts and economists have long known that someone’s depression can have a significant cost on the workplace, Greenberg said.\u003c/p>\n\u003cp>For example, the study found that the average worker who had major depression disorder lost the productivity of about 32 workdays a year due to what’s known as “\u003ca title=\"https://hbr.org/2004/10/presenteeism-at-work-but-out-of-it\" href=\"https://hbr.org/2004/10/presenteeism-at-work-but-out-of-it\" target=\"_blank\">presenteeism\u003c/a>.” That is a term for when an employee is at work but not complet\u003cstrong>i\u003c/strong>ng daily tasks and responsibilities.\u003c/p>\n\u003cp>Experts say that, though this loss in productivity highlights the economic toll mental health issues have on the work place, small and medium-sized employers may not have the knowledge or tools to improve the situation.\u003c/p>\n\u003cp>“While employers suspect depression will lead to greater absenteeism, I’m not sure they know how to judge what effect it’s having on their business,” said Paul Gionfriddo, president of Mental Health America, an advocacy group. “It’s really hard for businesses that are small to medium that account for so much employment to say, ‘this is why this guy is less productive and here’s what I can do about it.’”\u003c/p>\n\u003cp>\u003cstrong>Expansion of Health Coverage May Help\u003c/strong>\u003c/p>\n\u003cp>Greenberg said, though, that changes in health coverage may alter this landscape. For example, more people gaining health care coverage through the health law and other efforts to integrate mental and medical care could provide more care for people with depression and lessen the workplace burden.\u003c/p>\n\u003cp>Robert Roca, chairman of the American Psychiatric Association’s council on geriatric psychiatry, says the gradual integration of mental health care into primary care means more people may be diagnosed early and treated. “The ACA sets the stage for this kind of integration effort, and I’m optimistic that we’ll see benefit down the road,” said Roca, who was not affiliated with this study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The \u003ca title=\"http://www.psychiatrist.com/jcp/article/Pages/2015/v76n02/v76n0204.aspx\" href=\"http://www.psychiatrist.com/jcp/article/Pages/2015/v76n02/v76n0204.aspx\" target=\"_blank\">research was published \u003c/a>in the February edition of the Journal of Clinical Psychiatry and used data from adults 18 to 64 diagnosed with major depressive disorder in 2005 or 2010 from an OptumHealth claims database and from the National Survey on Drug Use and Health.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_22472\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000016939839_Large-e1415663541743.jpg\">\u003cimg class=\"size-large wp-image-22472\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000016939839_Large-640x420.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"420\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/194211358\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Going out to dinner is really stressful for Carolyn Desimone. She has a lot of friends who work in the tech sector, and they always want to go to trendy places.\u003c/p>\n\u003cp>“I went out for ramen with some startup kids and it was 30 bucks a person. It was stupid,” she says. “Everyone at the table is making twice as much as I do.”\u003c/p>\n\u003cp>And they’re willing to spend twice as much on food. It’s an economic dynamic she notices in the cost of therapy, too. Desimone pays $65 an hour at a community clinic to get help with her anxiety.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'Geek whisperers' needed now more than ever as the price of mental health services rises.\u003c/aside>\n\u003cp>“The pool of my friends, they’re all $100, $120 per appointment,” she says. “I’d never be able to do that. I couldn’t do that and pay my rent.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The influx of tech workers to the Bay Area has had a profound effect on the local economy: Affordable housing is nearly impossible to find. Dining out has become a competitive sport. And now, it seems the tech sector is applying upward pressure on the cost of some mental health services, too.\u003c/p>\n\u003cp>“One big variable is money,” says Michael Klein, a clinical psychologist in San Francisco. “The other is stress.”\u003c!--more-->\u003c/p>\n\u003cp>IPOs and venture capital rounds have armed tech workers with a lot of disposable income. With that money comes intense competition, long hours and the ever-looming threat of failure. That means there are more people willing to pay higher prices for someone to talk to.\u003c/p>\n\u003cp>“There are more and more people that have the affluence that they can afford therapy, and they have enough stress where therapy becomes more of a need,” Klein says.\u003c/p>\n\u003cp>Some large tech companies will even foot the bill. Managers see really talented engineers mess up projects because they don’t know how to work well with others.\u003c/p>\n\u003cp>“Their emotional maturity is on the lower side,” says Klein.\u003c/p>\n\u003cp>Klein is something of a geek whisperer. He’s been practicing in San Francisco for 20 years, and he often treats socially awkward tech workers.\u003c/p>\n\u003cp>When he asks new clients how they feel, they can’t answer the question.\u003c/p>\n\u003cp>“They don’t know what I’m talking about,” he says.\u003c/p>\n\u003cp>But after six months or a year of therapy, that changes.\u003c/p>\n\u003cp>“They blossom,” Klein says. “They can really track different emotions in themselves. And then they can start to notice them in their co-workers.”\u003c/p>\n\u003cp>\u003cstrong>Therapy Prices Rise\u003c/strong>\u003c/p>\n\u003cp>The increased demand for therapy from tech workers is compounded by another trend. About half the therapists in private practice in the state don't accept insurance, according to a recent survey by the California Association of Marriage and Family Therapists. That means their clients have to pay out-of-network fees, or completely out of pocket.\u003c/p>\n\u003cp>“Most people in the tech world can afford to do that,” Klein says.\u003c/p>\n\u003cp>Therapists can set prices accordingly -- leaving receptionists, waiters and teachers competing with wealthy tech workers for appointments. Established therapists in the Bay Area routinely charge $150 to $200 an hour.\u003c/p>\n\u003cp>“Many experienced therapists charge a lot and they’re out of reach to lower-middle-class or some middle-class people,” says Klein.\u003c/p>\n\u003cp>There are other options, he says. Less experienced therapists charge less, and there are several training institutes in San Francisco where people can see unlicensed therapists for as low as $30 a session.\u003c/p>\n\u003cp>Yet, even some of those clinics have had to raise their prices recently.\u003c/p>\n\u003cp>Take the Access Institute, where Carolyn Desimone goes for care. It is now facing its own set of financial pressures because of the tech boom -- evidenced by the new neighbors who have moved in since the clinic opened its doors 10 years ago in Hayes Valley.\u003c/p>\n\u003cp>A few blocks down the street in one direction is the Twitter office. In the other, near the corner of Hayes and Gough, there’s now an artisanal chocolate shop, an Oysteria and a Warby Parker glasses shop.\u003c/p>\n\u003cp>When the lease at Access Institute was up for renewal last year, the landlord wanted to increase the rent by almost 90 percent.\u003c/p>\n\u003cp>“We had been paying $5,900 a month,” said executive director Bart Magee, speaking over the construction noise outside his office. “It’s going to go to $11,000 a month.”\u003c/p>\n\u003cp>Magee managed to negotiate -- a bit. He still has to pay the full increase, but not for another five years. In the meantime, he got a 40 percent rent hike.\u003c/p>\n\u003cp>“That’s $50,000 a year that we could have provided more services; with that we’re not going to be able to,” he says, adding that the clinic has had to raise salaries as well, so the therapists who work there can afford the increases they’re facing in cost-of-living expenses.\u003c/p>\n\u003cp>Magee says the clinic had no choice but to raise its prices.\u003c/p>\n\u003cp>He’s also looking for new philanthropic donors, but he says the clinic needs a long-term plan for when the full rent increase takes effect or they won't be able to stay.\u003c/p>\n\u003cp>“There’s really no place to go,” he says. “Our commercial real estate has gotten to be one of the most expensive in the country.”\u003c/p>\n\u003cp>Carolyn Desimone says she doesn’t know what she’d do if Access Institute were ever forced to move or shut down.\u003c/p>\n\u003cp>“That would be really hard,” she says. “I’m worried that if I lost them, that the barrier to entry would seem too hard to find somebody else, and then I would get really bad again. I’m afraid I would be too overwhelmed by having to find somebody, that I would just not.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Curious about the boom/bust cycle that is reshaping the Bay Area? Check out our \u003ca href=\"http://kqed.org/boomtown\" target=\"_blank\">Boomtown series.\u003c/a>\u003c/em>\u003c/p>\n\n",
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"excerpt": "The tech boom is not just increasing the cost of housing and dining. Even mental health services have become pricy.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22472\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000016939839_Large-e1415663541743.jpg\">\u003cimg class=\"size-large wp-image-22472\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000016939839_Large-640x420.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"420\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/194211358&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/194211358'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Going out to dinner is really stressful for Carolyn Desimone. She has a lot of friends who work in the tech sector, and they always want to go to trendy places.\u003c/p>\n\u003cp>“I went out for ramen with some startup kids and it was 30 bucks a person. It was stupid,” she says. “Everyone at the table is making twice as much as I do.”\u003c/p>\n\u003cp>And they’re willing to spend twice as much on food. It’s an economic dynamic she notices in the cost of therapy, too. Desimone pays $65 an hour at a community clinic to get help with her anxiety.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'Geek whisperers' needed now more than ever as the price of mental health services rises.\u003c/aside>\n\u003cp>“The pool of my friends, they’re all $100, $120 per appointment,” she says. “I’d never be able to do that. I couldn’t do that and pay my rent.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The influx of tech workers to the Bay Area has had a profound effect on the local economy: Affordable housing is nearly impossible to find. Dining out has become a competitive sport. And now, it seems the tech sector is applying upward pressure on the cost of some mental health services, too.\u003c/p>\n\u003cp>“One big variable is money,” says Michael Klein, a clinical psychologist in San Francisco. “The other is stress.”\u003c!--more-->\u003c/p>\n\u003cp>IPOs and venture capital rounds have armed tech workers with a lot of disposable income. With that money comes intense competition, long hours and the ever-looming threat of failure. That means there are more people willing to pay higher prices for someone to talk to.\u003c/p>\n\u003cp>“There are more and more people that have the affluence that they can afford therapy, and they have enough stress where therapy becomes more of a need,” Klein says.\u003c/p>\n\u003cp>Some large tech companies will even foot the bill. Managers see really talented engineers mess up projects because they don’t know how to work well with others.\u003c/p>\n\u003cp>“Their emotional maturity is on the lower side,” says Klein.\u003c/p>\n\u003cp>Klein is something of a geek whisperer. He’s been practicing in San Francisco for 20 years, and he often treats socially awkward tech workers.\u003c/p>\n\u003cp>When he asks new clients how they feel, they can’t answer the question.\u003c/p>\n\u003cp>“They don’t know what I’m talking about,” he says.\u003c/p>\n\u003cp>But after six months or a year of therapy, that changes.\u003c/p>\n\u003cp>“They blossom,” Klein says. “They can really track different emotions in themselves. And then they can start to notice them in their co-workers.”\u003c/p>\n\u003cp>\u003cstrong>Therapy Prices Rise\u003c/strong>\u003c/p>\n\u003cp>The increased demand for therapy from tech workers is compounded by another trend. About half the therapists in private practice in the state don't accept insurance, according to a recent survey by the California Association of Marriage and Family Therapists. That means their clients have to pay out-of-network fees, or completely out of pocket.\u003c/p>\n\u003cp>“Most people in the tech world can afford to do that,” Klein says.\u003c/p>\n\u003cp>Therapists can set prices accordingly -- leaving receptionists, waiters and teachers competing with wealthy tech workers for appointments. Established therapists in the Bay Area routinely charge $150 to $200 an hour.\u003c/p>\n\u003cp>“Many experienced therapists charge a lot and they’re out of reach to lower-middle-class or some middle-class people,” says Klein.\u003c/p>\n\u003cp>There are other options, he says. Less experienced therapists charge less, and there are several training institutes in San Francisco where people can see unlicensed therapists for as low as $30 a session.\u003c/p>\n\u003cp>Yet, even some of those clinics have had to raise their prices recently.\u003c/p>\n\u003cp>Take the Access Institute, where Carolyn Desimone goes for care. It is now facing its own set of financial pressures because of the tech boom -- evidenced by the new neighbors who have moved in since the clinic opened its doors 10 years ago in Hayes Valley.\u003c/p>\n\u003cp>A few blocks down the street in one direction is the Twitter office. In the other, near the corner of Hayes and Gough, there’s now an artisanal chocolate shop, an Oysteria and a Warby Parker glasses shop.\u003c/p>\n\u003cp>When the lease at Access Institute was up for renewal last year, the landlord wanted to increase the rent by almost 90 percent.\u003c/p>\n\u003cp>“We had been paying $5,900 a month,” said executive director Bart Magee, speaking over the construction noise outside his office. “It’s going to go to $11,000 a month.”\u003c/p>\n\u003cp>Magee managed to negotiate -- a bit. He still has to pay the full increase, but not for another five years. In the meantime, he got a 40 percent rent hike.\u003c/p>\n\u003cp>“That’s $50,000 a year that we could have provided more services; with that we’re not going to be able to,” he says, adding that the clinic has had to raise salaries as well, so the therapists who work there can afford the increases they’re facing in cost-of-living expenses.\u003c/p>\n\u003cp>Magee says the clinic had no choice but to raise its prices.\u003c/p>\n\u003cp>He’s also looking for new philanthropic donors, but he says the clinic needs a long-term plan for when the full rent increase takes effect or they won't be able to stay.\u003c/p>\n\u003cp>“There’s really no place to go,” he says. “Our commercial real estate has gotten to be one of the most expensive in the country.”\u003c/p>\n\u003cp>Carolyn Desimone says she doesn’t know what she’d do if Access Institute were ever forced to move or shut down.\u003c/p>\n\u003cp>“That would be really hard,” she says. “I’m worried that if I lost them, that the barrier to entry would seem too hard to find somebody else, and then I would get really bad again. I’m afraid I would be too overwhelmed by having to find somebody, that I would just not.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Curious about the boom/bust cycle that is reshaping the Bay Area? Check out our \u003ca href=\"http://kqed.org/boomtown\" target=\"_blank\">Boomtown series.\u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "People with Low Incomes Say They Suffer Poorer Health",
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"content": "\u003cfigure id=\"attachment_24117\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/Screen-Shot-2015-03-02-at-11.16.25-AM.png\">\u003cimg class=\"size-large wp-image-24117\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/Screen-Shot-2015-03-02-at-11.16.25-AM-640x423.png\" alt=\"Uzuri Pease-Greene talks with two police officers in the public housing complex in San Francisco where she lives. (Talia Herman/NPR)\" width=\"640\" height=\"423\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Uzuri Pease-Greene talks with two police officers in the public housing complex in San Francisco where she lives. (Talia Herman/NPR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Patti Neighmond,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2015/03/02/389347123/people-with-low-incomes-say-they-pay-a-price-in-poor-health\" href=\"http://www.npr.org/blogs/health/2015/03/02/389347123/people-with-low-incomes-say-they-pay-a-price-in-poor-health\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>When you ask people what impacts health you'll get a lot of different answers: Access to good health care and preventative services, personal behavior, exposure to germs or pollution and stress.\u003c/p>\n\u003cp>But if you dig a little deeper you'll find a clear dividing line, and it boils down to one word: money.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"My health is deteriorating, and I know what the cause of it is, but I can't fix it.\" \u003c/aside>\n\u003cp>People whose household income is more than $75,000 a year have very different perceptions of what affects health than those whose household income is less than $25,000. This is one key finding in\u003ca href=\"http://media.npr.org/documents/2015/feb/What_Shapes_Health_Report.pdf\" target=\"_blank\"> a poll\u003c/a> conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health. \u003ca href=\"http://www.npr.org/blogs/health/2015/03/02/388994897/poll-finds-factors-large-and-small-shape-peoples-health\" target=\"_blank\">One third of respondents\u003c/a> who are low income say lack of money has a harmful effect on health.\u003c/p>\n\u003cp>This is the case for 29-year-old Anna Beer of Spokane, Wash. She lives with her husband in the basement of her father's house. Beer got laid off from her job as a nanny last summer. Now she is attending college in the hope that she will get a better than minimum-wage job when she graduates. Beer's husband earns $10 an hour working at a retail store. \"This is probably the most poor we've been,\" Beer says.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When she was working, Beer could afford to buy fresh fruits and vegetables and chicken from the local farmer's markets. She can't afford that any more.\u003c/p>\n\u003cp>Her migraines are worse, and her health has deteriorated. It's frustrating, she says. \"I know what the cause of it is, but I can't fix it. It's hard.\"\u003c/p>\n\u003cp>One in five people in our poll say they are in a similar position — low paying jobs or unemployment harms their health. And there's research to back this up. \u003ca href=\"http://www.albany.edu/sph/24581.php\" target=\"_blank\">Kate Strully\u003c/a>, a sociologist at the University at Albany, State University of New York,\u003ca href=\"http://link.springer.com/article/10.1353/dem.0.0050\" target=\"_blank\"> studied \u003c/a>what happened when healthy people were laid off following a plant closing. She found that losing a job increased the odds of developing stress-related health conditions by 83 percent — conditions like stroke, heart disease, diabetes and emotional or psychiatric conditions.\u003c/p>\n\u003cp>Another social fact that affects health is housing. Forty percent of the low-income people in our poll say bad housing causes bad health. Uzuri Pease-Greene says this is true for her family. She rents a small two-bedroom apartment with her husband, two daughters and a grandchild in a public housing complex in San Francisco. When something breaks, she says it takes years to get it fixed. Ovens don't work, there are holes in the walls, the water doesn't work or there's a sewage backup.\u003c/p>\n\u003cp>Then there is the constant stress of the neighborhood. \"You have shootings, stabbings and break-ins,\" Pease-Greene, 49, says. \"People with their music up at all times of the night, people arguing, fighting, fussing, people using dope, being drunk.\" She worries about her 4-year-old granddaughter growing up in this environment.\u003c/p>\n\u003cp>The impact of childhood experiences on adult health is another surprising finding in our poll. More than any other factor in childhood, people say abuse and neglect contribute to poor health in adults. This is what happened to Daniel, who is 65 years old and lives in San Diego. We agreed not to use his full name because he worries about losing his job.\u003c/p>\n\u003cp>When he was about 8 years old and his sister was 4, \"I walked in to the dining room and my mother was beating my sister with a big old wooden spoon,\" he says. \"My mother's just wailing on her, telling her she's a dirty little girl and a pig.\"\u003c/p>\n\u003cp>It turned out Daniel's sister had gone across the street to the grocery store. A man touched her inappropriately and she told her mother. When he saw his sister being beaten, Daniel started crying. His stepfather said, \"I'll give you something to cry about.\" And he started \"beating the hell out of me too, so there we were — that's our Sunday — not untypical at all.\"\u003c/p>\n\u003cp>By the time he was 12 years old, Daniel says, he was smoking cigarettes and drinking alcohol. He started doing drugs after getting out of the military, all to nearly unbelievable extremes. On any given day, seven days a week, Daniel says he drank 12 to 18 beers, a half bottle of whiskey and smoked two to four packs of cigarettes a day.\u003c/p>\n\u003cp>Daniel traces his addictions to the abuse he suffered as a child. And by the time he reached his 50s, Daniel's health problems were severe. He was 60 pounds overweight; he had high blood pressure, high cholesterol, liver damage, lung damage and diabetes. But nothing was as overwhelming as the emotional burden. \"Have you ever seen a dog that's been beaten and abused?\" he says. \"You raise your hand and the dog will cower.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Daniel was finally diagnosed with \u003ca href=\"http://www.ptsd.va.gov/public/types/violence/index.asp\">PTSD\u003c/a> when he was in his mid-50s. It was a relief, he says. With the help of talk therapy he learned to manage his symptoms. He quit smoking, rarely drinks and has lost weight, exercising four times a week. And life is finally tolerable.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_24117\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/Screen-Shot-2015-03-02-at-11.16.25-AM.png\">\u003cimg class=\"size-large wp-image-24117\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/03/Screen-Shot-2015-03-02-at-11.16.25-AM-640x423.png\" alt=\"Uzuri Pease-Greene talks with two police officers in the public housing complex in San Francisco where she lives. (Talia Herman/NPR)\" width=\"640\" height=\"423\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Uzuri Pease-Greene talks with two police officers in the public housing complex in San Francisco where she lives. (Talia Herman/NPR)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Patti Neighmond,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2015/03/02/389347123/people-with-low-incomes-say-they-pay-a-price-in-poor-health\" href=\"http://www.npr.org/blogs/health/2015/03/02/389347123/people-with-low-incomes-say-they-pay-a-price-in-poor-health\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>When you ask people what impacts health you'll get a lot of different answers: Access to good health care and preventative services, personal behavior, exposure to germs or pollution and stress.\u003c/p>\n\u003cp>But if you dig a little deeper you'll find a clear dividing line, and it boils down to one word: money.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"My health is deteriorating, and I know what the cause of it is, but I can't fix it.\" \u003c/aside>\n\u003cp>People whose household income is more than $75,000 a year have very different perceptions of what affects health than those whose household income is less than $25,000. This is one key finding in\u003ca href=\"http://media.npr.org/documents/2015/feb/What_Shapes_Health_Report.pdf\" target=\"_blank\"> a poll\u003c/a> conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health. \u003ca href=\"http://www.npr.org/blogs/health/2015/03/02/388994897/poll-finds-factors-large-and-small-shape-peoples-health\" target=\"_blank\">One third of respondents\u003c/a> who are low income say lack of money has a harmful effect on health.\u003c/p>\n\u003cp>This is the case for 29-year-old Anna Beer of Spokane, Wash. She lives with her husband in the basement of her father's house. Beer got laid off from her job as a nanny last summer. Now she is attending college in the hope that she will get a better than minimum-wage job when she graduates. Beer's husband earns $10 an hour working at a retail store. \"This is probably the most poor we've been,\" Beer says.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When she was working, Beer could afford to buy fresh fruits and vegetables and chicken from the local farmer's markets. She can't afford that any more.\u003c/p>\n\u003cp>Her migraines are worse, and her health has deteriorated. It's frustrating, she says. \"I know what the cause of it is, but I can't fix it. It's hard.\"\u003c/p>\n\u003cp>One in five people in our poll say they are in a similar position — low paying jobs or unemployment harms their health. And there's research to back this up. \u003ca href=\"http://www.albany.edu/sph/24581.php\" target=\"_blank\">Kate Strully\u003c/a>, a sociologist at the University at Albany, State University of New York,\u003ca href=\"http://link.springer.com/article/10.1353/dem.0.0050\" target=\"_blank\"> studied \u003c/a>what happened when healthy people were laid off following a plant closing. She found that losing a job increased the odds of developing stress-related health conditions by 83 percent — conditions like stroke, heart disease, diabetes and emotional or psychiatric conditions.\u003c/p>\n\u003cp>Another social fact that affects health is housing. Forty percent of the low-income people in our poll say bad housing causes bad health. Uzuri Pease-Greene says this is true for her family. She rents a small two-bedroom apartment with her husband, two daughters and a grandchild in a public housing complex in San Francisco. When something breaks, she says it takes years to get it fixed. Ovens don't work, there are holes in the walls, the water doesn't work or there's a sewage backup.\u003c/p>\n\u003cp>Then there is the constant stress of the neighborhood. \"You have shootings, stabbings and break-ins,\" Pease-Greene, 49, says. \"People with their music up at all times of the night, people arguing, fighting, fussing, people using dope, being drunk.\" She worries about her 4-year-old granddaughter growing up in this environment.\u003c/p>\n\u003cp>The impact of childhood experiences on adult health is another surprising finding in our poll. More than any other factor in childhood, people say abuse and neglect contribute to poor health in adults. This is what happened to Daniel, who is 65 years old and lives in San Diego. We agreed not to use his full name because he worries about losing his job.\u003c/p>\n\u003cp>When he was about 8 years old and his sister was 4, \"I walked in to the dining room and my mother was beating my sister with a big old wooden spoon,\" he says. \"My mother's just wailing on her, telling her she's a dirty little girl and a pig.\"\u003c/p>\n\u003cp>It turned out Daniel's sister had gone across the street to the grocery store. A man touched her inappropriately and she told her mother. When he saw his sister being beaten, Daniel started crying. His stepfather said, \"I'll give you something to cry about.\" And he started \"beating the hell out of me too, so there we were — that's our Sunday — not untypical at all.\"\u003c/p>\n\u003cp>By the time he was 12 years old, Daniel says, he was smoking cigarettes and drinking alcohol. He started doing drugs after getting out of the military, all to nearly unbelievable extremes. On any given day, seven days a week, Daniel says he drank 12 to 18 beers, a half bottle of whiskey and smoked two to four packs of cigarettes a day.\u003c/p>\n\u003cp>Daniel traces his addictions to the abuse he suffered as a child. And by the time he reached his 50s, Daniel's health problems were severe. He was 60 pounds overweight; he had high blood pressure, high cholesterol, liver damage, lung damage and diabetes. But nothing was as overwhelming as the emotional burden. \"Have you ever seen a dog that's been beaten and abused?\" he says. \"You raise your hand and the dog will cower.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Daniel was finally diagnosed with \u003ca href=\"http://www.ptsd.va.gov/public/types/violence/index.asp\">PTSD\u003c/a> when he was in his mid-50s. It was a relief, he says. With the help of talk therapy he learned to manage his symptoms. He quit smoking, rarely drinks and has lost weight, exercising four times a week. And life is finally tolerable.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_24091\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-13-e1425075174221.jpg\">\u003cimg class=\"size-large wp-image-24091\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-13-640x427.jpg\" alt=\"Richard Sandor, 65, of Hayfork, took the hour long bus ride to Mad River Clinic to pick up his medication for chronic pain. (Heidi de Marco/KHN).\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Richard Sandor, 65, of Hayfork, took the hour-long bus ride to illad River Clinic to pick up his medication for chronic pain. (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>\u003cstrong>The biggest barrier to treatment for residents of a tiny town in the mountains of Northern California isn’t insurance coverage -- it’s distance.\u003c/strong>\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Daniela Hernandez,\u003c/strong> \u003cem>Kaiser Health News\u003c/em>\u003c/p>\n\u003cp>HAYFORK, Calif. -- It’s Tuesday morning, half past eight and already hot, when the small bus pulls up to the community clinic. Most of the passengers are waiting in front -- an old man with a cane, two mothers with four kids between them, packed lunches in hand.\u003c/p>\n\u003cp>Two more arrive. A gray-bearded man with a pirate bandana steps from the shelter of his Subaru. A sunken-cheeked woman rushes up on her bike.\u003c/p>\n\u003cp>“Woohoo! We have a full car!” the driver says brightly after they’ve all climbed aboard. The riders smile back, some with a hint of resignation. It’s time for the weekly trip to the clinic in Mad River, about 30 miles down a winding mountain road. The tight twists and turns are hard on the stomach, but even harder on the joints -- especially if you have chronic Lyme disease, as more than a few of these riders do.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Jeff Clarke is one of them. He acquired Lyme long ago from deer ticks that dwell in the region’s sprawling forests. But today he’s going to ask about a lump that’s been growing in his left breast. It’s starting to hurt, and he’s worried. His fellow riders list their own ailments matter-of-factly: asthma, dental decay, diabetes, drug addiction, heart disease and much more.\u003c!--more-->\u003c/p>\n\u003cfigure id=\"attachment_24094\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-24_C-e1425076091597.jpg\">\u003cimg class=\"wp-image-24094 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-24_C-300x200.jpg\" alt=\"Hayfork-24_C\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jeff Clarke, 57, at his trailer in Hayfork, Calif. Clarke says the lack of health care in Hayfork makes it hard to treat his high blood pressure, hepatitis C and Lyme disease. (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>They wouldn’t be making this trip if they didn’t have to. In Hayfork, “we’re down to the remnants of the medical personnel,” says Clarke, 58, a well-spoken musician with a love for science and cats. “It just came to the point where if I needed to deal with anything important I just felt much more comfortable going over to Mad River.\u003c/p>\n\u003cp>Like so many American small towns, Hayfork has lost its vitality and much of its youth to bigger places. Nestled midway between Redding and Eureka, it’s not near anything. Even Weaverville, the tiny county seat, is 45 minutes away. There are no retail stores, theaters, museums, fancy restaurants. What the town has is star-filled skies and tree-lined ridges.\u003c/p>\n\u003cp>“We were all just fine with that,” says Shannon Barnett, a 41-year-old a former school teacher who grew up here. “Now it’s different.”\u003c/p>\n\u003cp>She’s referring to the dearth of basic health services.\u003c/p>\n\u003cp>There’s a local clinic but it’s staffed by doctors who rotate in from Weaverville once or twice a week, and otherwise it’s run by physician’s assistants. There are no hospitals for miles.\u003c/p>\n\u003cp>The Mad River clinic is bigger than Hayfork’s and offers a wider array of services but Clarke says it’s so backed up with patients it can take weeks to get an appointment.\u003c/p>\n\u003cp>In 2012, according to state data, there were \u003ca href=\"http://www.oshpd.ca.gov/HWDD/HWC/FactSheets/PhysiciansSurgeonsMD.pdf\">11 medical doctors\u003c/a> practicing in all of Trinity County, roughly one per 1,200 residents. Statewide, the ratio is closer to one per 300. Specialists like dentists and psychiatrists are nearly non-existent in the county.\u003c/p>\n\u003cp>A county behavioral office offers counseling in Hayfork, but a counselor isn't there every day and sessions are by appointment only. Sometimes the most expedient treatment comes in jail -- Clarke calls it the “nudge from the judge.”\u003c/p>\n\u003cp>He mentions an acquaintance named Robbie, who suffers from paranoid schizophrenia. Since being released from jail, he’s been off his meds, Clarke says. He walks up and down Hayfork’s main strip, muttering to passers-by about the many people who are after him.\u003c/p>\n\u003cp>In these tiny towns of California’s far north, lacking insurance is not the biggest obstacle to care. Most people are insured, a good number are on Medi-Cal.\u003c/p>\n\u003cp>What’s ailing these people is geography – that, and poverty. The median household income in \u003ca href=\"http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_5YR_B19013&prodType=table\">Hayfork is about $34,000 a year\u003c/a>, well below the \u003ca href=\"http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_1YR_S1901&prodType=table\">statewide figure of about $60,000\u003c/a>,.. Unemployment is extraordinarily high – estimates range between \u003ca href=\"http://www.homefacts.com/unemployment/California/Trinity-County/Hayfork.html\">9\u003c/a> and \u003ca href=\"http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_5YR_S2301&prodType=table\">26 percent\u003c/a>. Many people lack a sturdy car to drive, or even money for gas.\u003c/p>\n\u003cp>In the federal government’s parlance, Hayfork is a “medically underserved” community – one of 170 in California and roughly 3,500 in the country.\u003c/p>\n\u003cp>By definition, these areas have too few primary care providers, high infant mortality, pervasive poverty or a significant elderly population. Some medically underserved areas are islands of deprivation within otherwise well-stocked urban areas. Others are dots on the map like Hayfork, far from where doctors and medical services are clustered. According to the National Rural Health Association, \u003ca href=\"http://www.ruralhealthweb.org/go/left/about-rural-health/what-s-different-about-rural-health-care\">only about ten percent of physicians practice in rural America, where nearly a quarter of the population lives.\u003c/a>\u003c/p>\n\u003cp>For Hayforkers, health care is available – just on the other side of the mountain. “The problem, says Greg Schneider, a 65-year-old writer and band mate of Clarke’s, “is getting there.”\u003c/p>\n\u003cp>\u003cstrong>Lumberjacks and Janes\u003c/strong>\u003c/p>\n\u003cp>For decades\u003cstrong>,\u003c/strong> Hayfork had been fortunate. Well after the rise of urban health systems and their intricate business arrangements, it had a tight-knit local “system” founded on the simple, generous commitment of two people: a general practitioner and a pharmacist.\u003c/p>\n\u003cp>“He was everybody’s doctor,” Barnettsays of Dr. Earl Mercill, a GP who moved up from the Central Valley almost 50 years ago. “You never thought about going to anyone else.”\u003c/p>\n\u003cp>Mercill moved his large family to Hayfork in 1967 on a friend’s recommendation. It was still a mill town then, filled with lumberjacks and Janes, as the women were known, though it also had restaurants, shops and even a thriving art and music scene.\u003c/p>\n\u003cp>They built a house and settled on 40 acres. Mercill opened a clinic downtown.\u003c/p>\n\u003cfigure id=\"attachment_24096\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-18-e1425076271333.jpg\">\u003cimg class=\"wp-image-24096 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-18-300x200.jpg\" alt=\"Hayfork-18\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Earl Mercill moved his family to Hayfork in 1967. He opened the town's first clinic and was the only doctor for decades until he retired in the late 1990s. (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>He was beloved almost from the beginning. He made house calls -- sometimes walking over precariously narrow log bridges or shuttling to his patients’ homes by snowmobile. He delivered babies by flashlight after storms knocked down power and waited by his patients’ bedsides for hours, sometimes charging little more than a slice of cake.\u003c/p>\n\u003cp>“If they didn’t have any money, I saw them,” recalls Mercill, who’s now 91 years old. “If they could pay later, fine.\" If they didn’t, they didn’t.”\u003c/p>\n\u003cp>In 1982, Gerry Reichelderfer, a genial pharmacist from Marin County, came up and fell in love with mountain life. He took over the drug store next to Mercill’s clinic.\u003c/p>\n\u003cp>Reichelderfer lived just seven minutes and a single stop sign away from his shop. He’d open up anytime people needed a prescription. If they couldn’t pay right then, he’d put it on an I.O.U.\u003c/p>\n\u003cp>The men joined forces, talking daily by intercom. The partnership would last nearly two decades.\u003c/p>\n\u003cp>Mercill officially retired in the late 1990s, though he kept seeing patients for some time afterward. The town dedicated a clock to him in the square.\u003c/p>\n\u003cp>Eventually he sold his clinic to a doctor based in Weaverville. That doctor recently sold it again, to a district hospital.\u003c/p>\n\u003cp>“It was like a limb being cut off,” Barnett says of Mercill’s retirement. “I know at first I didn’t have another doctor for a long time. Other people didn’t either.”\u003c/p>\n\u003cp>\u003cstrong>A Turn of Fortune\u003c/strong>\u003c/p>\n\u003cp>After Hayfork’s mill closed in the early-1990s, the town's population -- never higher than the low thousands -- dwindled. Homelessness, poverty and drug addiction took hold.\u003c/p>\n\u003cp>Clarke, a runaway and hitchhiker in his youth, was in some ways typical of Hayfork’s new generation. He arrived in the 1980s, in the clutches of methamphetamine addiction, a habit he picked up in the bars where he played guitar. For years, he landed jobs and lost them -- working as a wood chopper, sandwich maker and cabinet craftsman. He started seeing a woman he met in rehab, then split with her, but not before they had a daughter. They named her Stormy Brooke. He gained custody and lost it more than once.\u003c/p>\n\u003cp>The 12-step meetings at Hayfork’s Solid Rock Church saved his life, he says. He goes every Monday and has been sober 10 years.\u003c/p>\n\u003cp>His health is ok, considering. He lost his teeth. His bottom denture wore out long ago and his top one is breaking\u003cstrong>. \u003c/strong>He has high blood pressure and hepatitis C, plus the Lyme disease that became chronic because it wasn’t treated right away.\u003c/p>\n\u003cp>Clarke lives in a two-room trailer next to the town cemetery. Supported by $889 a month in disability insurance, he spends his time organizing 12-step meetings, reading and volunteering as a sound engineer at a local coffee shop. On good nights, he gets paid a little. He wants to stay as healthy as possible, hesays, so he can look after 23-year-old Stormy and her 2-year-old son, Tony, who lives with his dad.\u003c/p>\n\u003cp>Stormy Clarke, a tall beauty too insecure to know it, cuts herself and has made several attempts at suicide. Her porcelain arms bear the scars.\u003c/p>\n\u003cp>“She has no self-esteem,” Jeff Clarke says. “She has no faith in love, or trust for any other human beings. She has some real darkness inside her, you know? I’m sure I’m responsible for a majority of that.”\u003c/p>\n\u003cp>Stormy Clarke has tried to get help, she says, but it's only sporadically available and hasn't helped much.\u003c/p>\n\u003cp>In June, during a fight with her father, Stormy had what Jeff thought was a stroke. En route to Redding in an ambulance, she started seizing so they put her on a chopper. At the hospital, the doctors said she’d had a stress-induced seizure\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp>After three hours, the doctors released her with a prescription to control her seizures and panic attacks, and told her to follow-up with her primary care physician.\u003c/p>\n\u003cp>“I had to laugh,” Jeff Clarkesays. “We’re in Hayfork!”\u003c/p>\n\u003cp>\u003cobject id=\"flashObj\" width=\"486\" height=\"412\" classid=\"D27CDB6E-AE6D-11cf-96B8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=9,0,47,0\">\u003cparam name=\"movie\" value=\"http://c.brightcove.com/services/viewer/federated_f9?isVid=1\">\u003cparam name=\"bgcolor\" value=\"#FFFFFF\">\u003cparam name=\"flashVars\" value=\"videoId=4064883481001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\">\u003cparam name=\"base\" value=\"http://admin.brightcove.com\">\u003cparam name=\"seamlesstabbing\" value=\"false\">\u003cparam name=\"allowFullScreen\" value=\"true\">\u003cparam name=\"swLiveConnect\" value=\"true\">\u003cparam name=\"allowScriptAccess\" value=\"always\">\u003cembed src=\"http://c.brightcove.com/services/viewer/federated_f9?isVid=1\" bgcolor=\"#FFFFFF\" flashvars=\"videoId=4064883481001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\" base=\"http://admin.brightcove.com\" name=\"flashObj\" width=\"486\" height=\"412\" seamlesstabbing=\"false\" type=\"application/x-shockwave-flash\" pluginspage=\"http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash\">\u003c/embed>\u003c/object>\u003c/p>\n\u003cp>\u003cstrong>Back on the Bus\u003c/strong>\u003c/p>\n\u003cp>After the bus pulls into the Mad River clinic -- a remodeled blue cottage that used to serve as the local forest service office -- the riders start their wait. They are used to it by now: The kids pull out games and books; the adults chat in the waiting room or by a weathered picnic table on the back lawn.\u003c/p>\n\u003cp>Everybody has to be seen before the bus can head back.\u003c/p>\n\u003cp>On this day, Clarke is among the first in line. The physician’s assistant on duty examines his chest lump and advises against a biopsy, an invasive procedure, because he wants to run more tests. Clarke takes the news with some concern.\u003c/p>\n\u003cp>“I was pretty freaked out. I went in there with the agenda of the biopsy. They wanted to explore other options,” he says afterward.\u003c/p>\n\u003cp>By the time the bus gets back to Hayfork, it’s mid-afternoon. He drives back to his trailer, frustrated and spent.\u003c/p>\n\u003cp>A few Tuesdays later, he takes the bus back to Mad River and is referred to a specialist in Weaverville.\u003c/p>\n\u003cp>It is another two months before he learns the lump is a side effect of the medications he’s taking -- a hypothesis he’d mentioned earlier to physicians and their assistants in Hayfork and Mad River\u003c/p>\n\u003cp>Now he has to start thinking about replacing those dentures, which means another bus trip -- or several – around the mountain.\u003c/p>\n\u003cp>\u003cstrong>The Final Loss\u003c/strong>\u003c/p>\n\u003cp>Reichelderfer, 82 and in failing health, began looking for a buyer for his shop last year. Even the independents weren’t interested. Pharmacists’ family members didn’t want to move to Hayfork, and his business model wasn’t working.\u003c/p>\n\u003cp>Always generous about cutting patients like Clarke a break on payment, he wasn’t recouping enough from insurers. The clinic next door, Mercill’s former base, was referring patients to Weaverville.\u003c/p>\n\u003cp>With great sadness, he shut his doors on Sept. 18.\u003c/p>\n\u003cp>“I wish I could have been able to sell it to somebody,” he says, “for the convenience of the people.\"\u003c/p>\n\u003cp>From now on, Hayforkers will havto e to get a ride to Owens Pharmacy in Weaverville or Wal-Mart or CVS in Redding.\u003c/p>\n\u003cp>It took only a few days to board up a drug store open for 32 years.\u003c/p>\n\u003cp>It’s a relic now, standing just yards from the clock the town dedicated to Mercill, with his years of service gratefully memorialized on a plaque.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong>Heidi De Marco and Carol Eisenberg contributed reporting.\u003c/strong>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_24091\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-13-e1425075174221.jpg\">\u003cimg class=\"size-large wp-image-24091\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-13-640x427.jpg\" alt=\"Richard Sandor, 65, of Hayfork, took the hour long bus ride to Mad River Clinic to pick up his medication for chronic pain. (Heidi de Marco/KHN).\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Richard Sandor, 65, of Hayfork, took the hour-long bus ride to illad River Clinic to pick up his medication for chronic pain. (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>\u003cstrong>The biggest barrier to treatment for residents of a tiny town in the mountains of Northern California isn’t insurance coverage -- it’s distance.\u003c/strong>\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Daniela Hernandez,\u003c/strong> \u003cem>Kaiser Health News\u003c/em>\u003c/p>\n\u003cp>HAYFORK, Calif. -- It’s Tuesday morning, half past eight and already hot, when the small bus pulls up to the community clinic. Most of the passengers are waiting in front -- an old man with a cane, two mothers with four kids between them, packed lunches in hand.\u003c/p>\n\u003cp>Two more arrive. A gray-bearded man with a pirate bandana steps from the shelter of his Subaru. A sunken-cheeked woman rushes up on her bike.\u003c/p>\n\u003cp>“Woohoo! We have a full car!” the driver says brightly after they’ve all climbed aboard. The riders smile back, some with a hint of resignation. It’s time for the weekly trip to the clinic in Mad River, about 30 miles down a winding mountain road. The tight twists and turns are hard on the stomach, but even harder on the joints -- especially if you have chronic Lyme disease, as more than a few of these riders do.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Jeff Clarke is one of them. He acquired Lyme long ago from deer ticks that dwell in the region’s sprawling forests. But today he’s going to ask about a lump that’s been growing in his left breast. It’s starting to hurt, and he’s worried. His fellow riders list their own ailments matter-of-factly: asthma, dental decay, diabetes, drug addiction, heart disease and much more.\u003c!--more-->\u003c/p>\n\u003cfigure id=\"attachment_24094\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-24_C-e1425076091597.jpg\">\u003cimg class=\"wp-image-24094 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-24_C-300x200.jpg\" alt=\"Hayfork-24_C\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jeff Clarke, 57, at his trailer in Hayfork, Calif. Clarke says the lack of health care in Hayfork makes it hard to treat his high blood pressure, hepatitis C and Lyme disease. (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>They wouldn’t be making this trip if they didn’t have to. In Hayfork, “we’re down to the remnants of the medical personnel,” says Clarke, 58, a well-spoken musician with a love for science and cats. “It just came to the point where if I needed to deal with anything important I just felt much more comfortable going over to Mad River.\u003c/p>\n\u003cp>Like so many American small towns, Hayfork has lost its vitality and much of its youth to bigger places. Nestled midway between Redding and Eureka, it’s not near anything. Even Weaverville, the tiny county seat, is 45 minutes away. There are no retail stores, theaters, museums, fancy restaurants. What the town has is star-filled skies and tree-lined ridges.\u003c/p>\n\u003cp>“We were all just fine with that,” says Shannon Barnett, a 41-year-old a former school teacher who grew up here. “Now it’s different.”\u003c/p>\n\u003cp>She’s referring to the dearth of basic health services.\u003c/p>\n\u003cp>There’s a local clinic but it’s staffed by doctors who rotate in from Weaverville once or twice a week, and otherwise it’s run by physician’s assistants. There are no hospitals for miles.\u003c/p>\n\u003cp>The Mad River clinic is bigger than Hayfork’s and offers a wider array of services but Clarke says it’s so backed up with patients it can take weeks to get an appointment.\u003c/p>\n\u003cp>In 2012, according to state data, there were \u003ca href=\"http://www.oshpd.ca.gov/HWDD/HWC/FactSheets/PhysiciansSurgeonsMD.pdf\">11 medical doctors\u003c/a> practicing in all of Trinity County, roughly one per 1,200 residents. Statewide, the ratio is closer to one per 300. Specialists like dentists and psychiatrists are nearly non-existent in the county.\u003c/p>\n\u003cp>A county behavioral office offers counseling in Hayfork, but a counselor isn't there every day and sessions are by appointment only. Sometimes the most expedient treatment comes in jail -- Clarke calls it the “nudge from the judge.”\u003c/p>\n\u003cp>He mentions an acquaintance named Robbie, who suffers from paranoid schizophrenia. Since being released from jail, he’s been off his meds, Clarke says. He walks up and down Hayfork’s main strip, muttering to passers-by about the many people who are after him.\u003c/p>\n\u003cp>In these tiny towns of California’s far north, lacking insurance is not the biggest obstacle to care. Most people are insured, a good number are on Medi-Cal.\u003c/p>\n\u003cp>What’s ailing these people is geography – that, and poverty. The median household income in \u003ca href=\"http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_5YR_B19013&prodType=table\">Hayfork is about $34,000 a year\u003c/a>, well below the \u003ca href=\"http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_1YR_S1901&prodType=table\">statewide figure of about $60,000\u003c/a>,.. Unemployment is extraordinarily high – estimates range between \u003ca href=\"http://www.homefacts.com/unemployment/California/Trinity-County/Hayfork.html\">9\u003c/a> and \u003ca href=\"http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_5YR_S2301&prodType=table\">26 percent\u003c/a>. Many people lack a sturdy car to drive, or even money for gas.\u003c/p>\n\u003cp>In the federal government’s parlance, Hayfork is a “medically underserved” community – one of 170 in California and roughly 3,500 in the country.\u003c/p>\n\u003cp>By definition, these areas have too few primary care providers, high infant mortality, pervasive poverty or a significant elderly population. Some medically underserved areas are islands of deprivation within otherwise well-stocked urban areas. Others are dots on the map like Hayfork, far from where doctors and medical services are clustered. According to the National Rural Health Association, \u003ca href=\"http://www.ruralhealthweb.org/go/left/about-rural-health/what-s-different-about-rural-health-care\">only about ten percent of physicians practice in rural America, where nearly a quarter of the population lives.\u003c/a>\u003c/p>\n\u003cp>For Hayforkers, health care is available – just on the other side of the mountain. “The problem, says Greg Schneider, a 65-year-old writer and band mate of Clarke’s, “is getting there.”\u003c/p>\n\u003cp>\u003cstrong>Lumberjacks and Janes\u003c/strong>\u003c/p>\n\u003cp>For decades\u003cstrong>,\u003c/strong> Hayfork had been fortunate. Well after the rise of urban health systems and their intricate business arrangements, it had a tight-knit local “system” founded on the simple, generous commitment of two people: a general practitioner and a pharmacist.\u003c/p>\n\u003cp>“He was everybody’s doctor,” Barnettsays of Dr. Earl Mercill, a GP who moved up from the Central Valley almost 50 years ago. “You never thought about going to anyone else.”\u003c/p>\n\u003cp>Mercill moved his large family to Hayfork in 1967 on a friend’s recommendation. It was still a mill town then, filled with lumberjacks and Janes, as the women were known, though it also had restaurants, shops and even a thriving art and music scene.\u003c/p>\n\u003cp>They built a house and settled on 40 acres. Mercill opened a clinic downtown.\u003c/p>\n\u003cfigure id=\"attachment_24096\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-18-e1425076271333.jpg\">\u003cimg class=\"wp-image-24096 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/02/Hayfork-18-300x200.jpg\" alt=\"Hayfork-18\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Earl Mercill moved his family to Hayfork in 1967. He opened the town's first clinic and was the only doctor for decades until he retired in the late 1990s. (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp>He was beloved almost from the beginning. He made house calls -- sometimes walking over precariously narrow log bridges or shuttling to his patients’ homes by snowmobile. He delivered babies by flashlight after storms knocked down power and waited by his patients’ bedsides for hours, sometimes charging little more than a slice of cake.\u003c/p>\n\u003cp>“If they didn’t have any money, I saw them,” recalls Mercill, who’s now 91 years old. “If they could pay later, fine.\" If they didn’t, they didn’t.”\u003c/p>\n\u003cp>In 1982, Gerry Reichelderfer, a genial pharmacist from Marin County, came up and fell in love with mountain life. He took over the drug store next to Mercill’s clinic.\u003c/p>\n\u003cp>Reichelderfer lived just seven minutes and a single stop sign away from his shop. He’d open up anytime people needed a prescription. If they couldn’t pay right then, he’d put it on an I.O.U.\u003c/p>\n\u003cp>The men joined forces, talking daily by intercom. The partnership would last nearly two decades.\u003c/p>\n\u003cp>Mercill officially retired in the late 1990s, though he kept seeing patients for some time afterward. The town dedicated a clock to him in the square.\u003c/p>\n\u003cp>Eventually he sold his clinic to a doctor based in Weaverville. That doctor recently sold it again, to a district hospital.\u003c/p>\n\u003cp>“It was like a limb being cut off,” Barnett says of Mercill’s retirement. “I know at first I didn’t have another doctor for a long time. Other people didn’t either.”\u003c/p>\n\u003cp>\u003cstrong>A Turn of Fortune\u003c/strong>\u003c/p>\n\u003cp>After Hayfork’s mill closed in the early-1990s, the town's population -- never higher than the low thousands -- dwindled. Homelessness, poverty and drug addiction took hold.\u003c/p>\n\u003cp>Clarke, a runaway and hitchhiker in his youth, was in some ways typical of Hayfork’s new generation. He arrived in the 1980s, in the clutches of methamphetamine addiction, a habit he picked up in the bars where he played guitar. For years, he landed jobs and lost them -- working as a wood chopper, sandwich maker and cabinet craftsman. He started seeing a woman he met in rehab, then split with her, but not before they had a daughter. They named her Stormy Brooke. He gained custody and lost it more than once.\u003c/p>\n\u003cp>The 12-step meetings at Hayfork’s Solid Rock Church saved his life, he says. He goes every Monday and has been sober 10 years.\u003c/p>\n\u003cp>His health is ok, considering. He lost his teeth. His bottom denture wore out long ago and his top one is breaking\u003cstrong>. \u003c/strong>He has high blood pressure and hepatitis C, plus the Lyme disease that became chronic because it wasn’t treated right away.\u003c/p>\n\u003cp>Clarke lives in a two-room trailer next to the town cemetery. Supported by $889 a month in disability insurance, he spends his time organizing 12-step meetings, reading and volunteering as a sound engineer at a local coffee shop. On good nights, he gets paid a little. He wants to stay as healthy as possible, hesays, so he can look after 23-year-old Stormy and her 2-year-old son, Tony, who lives with his dad.\u003c/p>\n\u003cp>Stormy Clarke, a tall beauty too insecure to know it, cuts herself and has made several attempts at suicide. Her porcelain arms bear the scars.\u003c/p>\n\u003cp>“She has no self-esteem,” Jeff Clarke says. “She has no faith in love, or trust for any other human beings. She has some real darkness inside her, you know? I’m sure I’m responsible for a majority of that.”\u003c/p>\n\u003cp>Stormy Clarke has tried to get help, she says, but it's only sporadically available and hasn't helped much.\u003c/p>\n\u003cp>In June, during a fight with her father, Stormy had what Jeff thought was a stroke. En route to Redding in an ambulance, she started seizing so they put her on a chopper. At the hospital, the doctors said she’d had a stress-induced seizure\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp>After three hours, the doctors released her with a prescription to control her seizures and panic attacks, and told her to follow-up with her primary care physician.\u003c/p>\n\u003cp>“I had to laugh,” Jeff Clarkesays. “We’re in Hayfork!”\u003c/p>\n\u003cp>\u003cobject id=\"flashObj\" width=\"486\" height=\"412\" classid=\"D27CDB6E-AE6D-11cf-96B8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=9,0,47,0\">\u003cparam name=\"movie\" value=\"http://c.brightcove.com/services/viewer/federated_f9?isVid=1\">\u003cparam name=\"bgcolor\" value=\"#FFFFFF\">\u003cparam name=\"flashVars\" value=\"videoId=4064883481001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\">\u003cparam name=\"base\" value=\"http://admin.brightcove.com\">\u003cparam name=\"seamlesstabbing\" value=\"false\">\u003cparam name=\"allowFullScreen\" value=\"true\">\u003cparam name=\"swLiveConnect\" value=\"true\">\u003cparam name=\"allowScriptAccess\" value=\"always\">\u003cembed src=\"http://c.brightcove.com/services/viewer/federated_f9?isVid=1\" bgcolor=\"#FFFFFF\" flashvars=\"videoId=4064883481001&playerID=1875349721&playerKey=AQ~~,AAAAAG_HivY~,sgDjaI7wvsueyxYvBTnH9ElGyGMdLEbW&domain=embed&dynamicStreaming=true\" base=\"http://admin.brightcove.com\" name=\"flashObj\" width=\"486\" height=\"412\" seamlesstabbing=\"false\" type=\"application/x-shockwave-flash\" pluginspage=\"http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash\">\u003c/embed>\u003c/object>\u003c/p>\n\u003cp>\u003cstrong>Back on the Bus\u003c/strong>\u003c/p>\n\u003cp>After the bus pulls into the Mad River clinic -- a remodeled blue cottage that used to serve as the local forest service office -- the riders start their wait. They are used to it by now: The kids pull out games and books; the adults chat in the waiting room or by a weathered picnic table on the back lawn.\u003c/p>\n\u003cp>Everybody has to be seen before the bus can head back.\u003c/p>\n\u003cp>On this day, Clarke is among the first in line. The physician’s assistant on duty examines his chest lump and advises against a biopsy, an invasive procedure, because he wants to run more tests. Clarke takes the news with some concern.\u003c/p>\n\u003cp>“I was pretty freaked out. I went in there with the agenda of the biopsy. They wanted to explore other options,” he says afterward.\u003c/p>\n\u003cp>By the time the bus gets back to Hayfork, it’s mid-afternoon. He drives back to his trailer, frustrated and spent.\u003c/p>\n\u003cp>A few Tuesdays later, he takes the bus back to Mad River and is referred to a specialist in Weaverville.\u003c/p>\n\u003cp>It is another two months before he learns the lump is a side effect of the medications he’s taking -- a hypothesis he’d mentioned earlier to physicians and their assistants in Hayfork and Mad River\u003c/p>\n\u003cp>Now he has to start thinking about replacing those dentures, which means another bus trip -- or several – around the mountain.\u003c/p>\n\u003cp>\u003cstrong>The Final Loss\u003c/strong>\u003c/p>\n\u003cp>Reichelderfer, 82 and in failing health, began looking for a buyer for his shop last year. Even the independents weren’t interested. Pharmacists’ family members didn’t want to move to Hayfork, and his business model wasn’t working.\u003c/p>\n\u003cp>Always generous about cutting patients like Clarke a break on payment, he wasn’t recouping enough from insurers. The clinic next door, Mercill’s former base, was referring patients to Weaverville.\u003c/p>\n\u003cp>With great sadness, he shut his doors on Sept. 18.\u003c/p>\n\u003cp>“I wish I could have been able to sell it to somebody,” he says, “for the convenience of the people.\"\u003c/p>\n\u003cp>From now on, Hayforkers will havto e to get a ride to Owens Pharmacy in Weaverville or Wal-Mart or CVS in Redding.\u003c/p>\n\u003cp>It took only a few days to board up a drug store open for 32 years.\u003c/p>\n\u003cp>It’s a relic now, standing just yards from the clock the town dedicated to Mercill, with his years of service gratefully memorialized on a plaque.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Heidi De Marco and Carol Eisenberg contributed reporting.\u003c/strong>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "4-Year Contract Dispute Between Kaiser, NUHW Thaws; Union 'Hopeful'",
"title": "4-Year Contract Dispute Between Kaiser, NUHW Thaws; Union 'Hopeful'",
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"content": "\u003cfigure id=\"attachment_19926\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/07/6980198171_a6cbed3bdf_k-e1424973125499.jpg\">\u003cimg class=\"size-large wp-image-19926\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/07/6980198171_a6cbed3bdf_k-640x358.jpg\" alt=\"(Ted Eytan/Flickr)\" width=\"640\" height=\"358\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Ted Eytan/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>For more than four years, the National Union of Healthcare Workers, representing 2,600 Kaiser mental health clinicians in California, has been in a small war with the health care giant.\u003c/p>\n\u003cp>NUHW members have gone on strikes of varying lengths three times over what it says are lengthy delays in providing care to mental health patients.\u003c/p>\n\u003cp>In 2011, the union filed a \u003ca href=\"//nuhw.org/wp-content/uploads/2014/01/CareDelayedCareDenied.pdf%E2%80%9D\" target=\"_blank\">34-page complaint\u003c/a> with the California Department of Managed Health Care alleging Kaiser's mental health services were \"sorely understaffed and frequently fail to provide timely and appropriate care.”\u003c!--more-->\u003c/p>\n\u003cp>Individually, union members have been \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">scathing in their assessments\u003c/a> of Kaiser's mental health services, at times implying or outright stating that the company was unethical in the way it rationed patient appointments.\u003c/p>\n\u003cp>Kaiser, for its part, has frequently brushed aside such complaints as a negotiating tactic designed to win a new contract. As recently as January, just before a weeklong strike by mental health workers, the HMO took direct aim at the union. John Nelson, vice president of government relations for Kaiser Permanente, released \u003ca href=\"http://share.kaiserpermanente.org/article/statement-on-nuhw-strike-from-john-nelson-vice-president-of-government-relations-kaiser-permanente/\" target=\"_blank\">a statement\u003c/a> that read in part:\u003c/p>\n\u003cblockquote>\u003cp>“NUHW is a small California union representing fewer than 5,000 of Kaiser Permanente¹s 175,000 employees. Since its creation in 2009, it has never negotiated a contract with Kaiser Permanente. In fact, NUHW stands alone as the only union that has been unwilling or unable to reach a fair agreement concerning a contract covering our employees during that time.”\u003c/p>\u003c/blockquote>\n\u003cp>For weeks since, the two had not been at the bargaining table.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But now, in the midst of a second DMHC report finding \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/02/25/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist/\" target=\"_blank\">significant deficiencies in Kaiser’s mental health care\u003c/a>, the relationship appears to be thawing.\u003c/p>\n\u003cp>[contextly_sidebar id=\"hRElI21H21RuhFYYJOkkigsM02jlA9UM\"]\u003c/p>\n\u003cp>“There are multiple meetings scheduled through next week where Kaiser management is seriously listening to their clinicians, getting their ideas how to fix the DMHC's findings,” said NUHW President Sal Roselli. \"I'm hopeful -- I'm not saying this is going to happen -- but I'm hopeful\" that a contract that \"formalizes change in how Kaiser provides care and engages with clinicians\" could be forthcoming.\u003c/p>\n\u003cp>Kaiser confirmed that \u003ca href=\"http://fortherecord.kp.org/kaiser-permanente-and-nuhw-ibhs-bargaining-february-19-and-20-2015/\" target=\"_blank\">bargaining resumed last week\u003c/a> in Northern California. It said that bargaining in Southern California is scheduled for the second week in March.\u003c/p>\n\u003cp>“As we have said all along, we need the union representing mental health care providers to work with us cooperatively,\" said John Nelson in a statement sent to KQED. \"Delays, roadblocks, and other challenges to continued improvement do nothing to help our members and patients. We all deliver our best when we work constructively together to remove obstacles and solve problems more quickly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He said that Kaiser \"remain(s) committed to resolving our differences.\"\u003c/p>\n\n",
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"excerpt": "The contract negotiations take place as state regulators cited Kaiser for deficiencies in mental health services.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19926\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/07/6980198171_a6cbed3bdf_k-e1424973125499.jpg\">\u003cimg class=\"size-large wp-image-19926\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/07/6980198171_a6cbed3bdf_k-640x358.jpg\" alt=\"(Ted Eytan/Flickr)\" width=\"640\" height=\"358\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Ted Eytan/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>For more than four years, the National Union of Healthcare Workers, representing 2,600 Kaiser mental health clinicians in California, has been in a small war with the health care giant.\u003c/p>\n\u003cp>NUHW members have gone on strikes of varying lengths three times over what it says are lengthy delays in providing care to mental health patients.\u003c/p>\n\u003cp>In 2011, the union filed a \u003ca href=\"//nuhw.org/wp-content/uploads/2014/01/CareDelayedCareDenied.pdf%E2%80%9D\" target=\"_blank\">34-page complaint\u003c/a> with the California Department of Managed Health Care alleging Kaiser's mental health services were \"sorely understaffed and frequently fail to provide timely and appropriate care.”\u003c!--more-->\u003c/p>\n\u003cp>Individually, union members have been \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">scathing in their assessments\u003c/a> of Kaiser's mental health services, at times implying or outright stating that the company was unethical in the way it rationed patient appointments.\u003c/p>\n\u003cp>Kaiser, for its part, has frequently brushed aside such complaints as a negotiating tactic designed to win a new contract. As recently as January, just before a weeklong strike by mental health workers, the HMO took direct aim at the union. John Nelson, vice president of government relations for Kaiser Permanente, released \u003ca href=\"http://share.kaiserpermanente.org/article/statement-on-nuhw-strike-from-john-nelson-vice-president-of-government-relations-kaiser-permanente/\" target=\"_blank\">a statement\u003c/a> that read in part:\u003c/p>\n\u003cblockquote>\u003cp>“NUHW is a small California union representing fewer than 5,000 of Kaiser Permanente¹s 175,000 employees. Since its creation in 2009, it has never negotiated a contract with Kaiser Permanente. In fact, NUHW stands alone as the only union that has been unwilling or unable to reach a fair agreement concerning a contract covering our employees during that time.”\u003c/p>\u003c/blockquote>\n\u003cp>For weeks since, the two had not been at the bargaining table.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But now, in the midst of a second DMHC report finding \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/02/25/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist/\" target=\"_blank\">significant deficiencies in Kaiser’s mental health care\u003c/a>, the relationship appears to be thawing.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“There are multiple meetings scheduled through next week where Kaiser management is seriously listening to their clinicians, getting their ideas how to fix the DMHC's findings,” said NUHW President Sal Roselli. \"I'm hopeful -- I'm not saying this is going to happen -- but I'm hopeful\" that a contract that \"formalizes change in how Kaiser provides care and engages with clinicians\" could be forthcoming.\u003c/p>\n\u003cp>Kaiser confirmed that \u003ca href=\"http://fortherecord.kp.org/kaiser-permanente-and-nuhw-ibhs-bargaining-february-19-and-20-2015/\" target=\"_blank\">bargaining resumed last week\u003c/a> in Northern California. It said that bargaining in Southern California is scheduled for the second week in March.\u003c/p>\n\u003cp>“As we have said all along, we need the union representing mental health care providers to work with us cooperatively,\" said John Nelson in a statement sent to KQED. \"Delays, roadblocks, and other challenges to continued improvement do nothing to help our members and patients. We all deliver our best when we work constructively together to remove obstacles and solve problems more quickly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He said that Kaiser \"remain(s) committed to resolving our differences.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Calif. Calls Kaiser Mental Health Services 'Inadequate' as Treatment Delays Persist",
"title": "Calif. Calls Kaiser Mental Health Services 'Inadequate' as Treatment Delays Persist",
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"content": "\u003cfigure id=\"attachment_23433\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\">\u003cimg class=\"size-full wp-image-23433\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\" alt=\"Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>A teenager with major depression and thoughts of suicide is forced to wait 24 days for an initial appointment.\u003c/p>\n\u003cp>A sexual assault victim, diagnosed with PTSD and major depression, sends numerous emails requesting individual psychotherapy, only to have her psychiatrist suggest she should get outside help at her own expense because no weekly appointments are available. Total time between appointments: Five months.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Following up on a survey that resulted in a $4 million fine against the HMO in 2013. \u003c/aside>\n\u003cp>A patient deemed high-risk for domestic abuse doesn't show up for appointments, but mental health staff do not attempt contact. The couples therapy called for in his treatment plan does not occur. Domestic violence resulting in severe injury ensues. The man then tries to make an appointment but can't get one.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>These are just a few of the cases documented in the California Department of Managed Health Care’s\u003ca title=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" target=\"_blank\"> latest report of Kaiser’s mental health services,\u003c/a> released to the public Tuesday. The report, a follow-up to the survey that \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">resulted in a $4 million fine against Kaiser in 2013,\u003c/a> says that while the health care giant has made progress in providing mental health services to its enrollees, it still has a long way to go in adequately serving patients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Despite the very significant strides made by the Plan in monitoring and assessing corrective action related to timely access to behavioral health services,\" the report reads, \"the Plan’s monthly access reports suggest that the Plan’s current behavioral health provider network remains inadequate to serve the needs of its enrollee population.\u003c/p>\n\u003cp>\"(T)he Plan’s own monthly access reports continue to show a lack of stability or a lack of available providers within the Plan’s behavioral health provider network,\" the DMHC writes in its conclusion to the 32-page report.\u003c/p>\n\u003cp>\"Even with all the changes Kaiser has made, there are still serious concerns about patients' ability to get timely access to mental health services,\" Shelley Rouillard, director of the Department of Managed Health Care, \u003ca title=\"http://www.latimes.com/business/la-fi-kaiser-mental-health-20150225-story.html\" href=\"http://www.latimes.com/business/la-fi-kaiser-mental-health-20150225-story.html\" target=\"_blank\">told the Los Angeles Times\u003c/a>. \"I want Kaiser to fix the problem and do what they need to do to make sure their members get the mental health services they need.\"\u003c/p>\n\u003cp>Kaiser, which serves nearly 7.7 million members statewide, agreed to pay the $4 million fine last September after an initial appeal. That penalty resulted from a routine DMHC \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bh031813.pdf\" target=\"_blank\">survey\u003c/a> finding four basic deficiencies related to plan members experiencing excessive wait times for initial appointments.\u003c/p>\n\u003col>\n\u003cli>Kaiser measured wait times for initial appointments in ways that minimized their length. For instance, it used paper waiting lists, not counting the days patients languished there. Or it logged the interval between a canceled appointment and a new appointment instead of from the original appointment, thus decreasing its wait times statistically.\u003c/li>\n\u003cli>Kaiser's methodology for measuring timely access -- averaging all reported enrollee wait times for a given month -- obscured the lengthy wait times of some individuals. \"Such an approach could prevent effective treatment of an enrollee’s condition or fail to prevent further deterioration of an enrollee’s health,\" the DMHC said in its follow-up report.\u003c/li>\n\u003cli>Long wait times for an initial appointment and the failure of the plan's quality assurance program to address these delays violated department regulations.\u003c/li>\n\u003cli>By focusing on limitations and exclusions of mental health benefits, some Kaiser mental health personnel, as well as printed and online materials, disseminated \"inaccurate and misleading health education information to enrollees regarding the scope of their coverage for behavioral health services.\" Some materials, for instance, failed to inform enrollees that coverage for severe mental illness or serious emotional disturbances of a child is required.\u003c/li>\n\u003c/ol>\n\u003cp>The current report designates deficiencies 1 and 2 as \"corrected\" and numbers 3 and 4 as \"not corrected.\" The new report has been referred to the DMHC's Office of Enforcement \"for further investigation and possible disciplinary action, based on the Plan’s failure to correct Deficiencies #3 and #4.\"\u003c/p>\n\u003cp>\"Financial penalties are an option available to the DMHC,\" said DMHC information officer Rodger Butler, \"but it's too early to say if that will be the course of action.\"\u003c/p>\n\u003cp>\u003cstrong>Focusing on the Positive\u003c/strong>\u003c/p>\n\u003cp>In a lengthy \u003ca href=\"http://share.kaiserpermanente.org/article/kaiser-permanente-comments-on-the-department-of-managed-health-care-follow-up-mental-health-survey/\" target=\"_blank\">statement\u003c/a>, Kaiser focused on the progress the DMHC said Kaiser had made in correcting problems:\u003c/p>\n\u003cblockquote>\u003cp>\"We are proud of the progress we have made to improve access to mental health care. The DMHC’s initial survey was conducted in 2012. This follow-up survey was conducted in 2013-14, including the case review portion. Since the follow-up review was conducted, we have made even more progress. We have hired new mental health therapists in Northern and Southern California, and we currently are recruiting to hire more. We have engaged with high quality community-based mental health care providers, including ValueOptions, a network of community providers with which we began successfully partnering in 2014, to ensure our patients receive timely access to mental health care, especially in locations where there are increases in appointment requests.\"\u003c/p>\u003c/blockquote>\n\u003cp>In its statement, Kaiser acknowledged that DMHC had found some Kaiser health centers experienced significant fluctuations in providing timely access. The report cited four unnamed medical centers in Northern California at which access rates plummeted over several months or more.\u003c/p>\n\u003cp>Last year, the National Union of Healthcare Workers, which has been in a years-long, bitter contract fight with Kaiser, provided statistics to KQED that showed timely access rates at both the Oakland and Richmond medical centers suddenly dropped 28 percent and 32 percent, respectively, over the course of one month.\u003c/p>\n\u003cp>[contextly_sidebar id=\"DtHW2FaezVom7dvstOt3kRTcbQqNDv75\"]\u003c/p>\n\u003cp>\"While the report acknowledges that Kaiser Permanente ‘took significant steps’ to track and address timely access challenges,\" Kaiser said in its statement issued Tuesday, \"there remain locations where access to appointments is not consistently where it should be. We are continuing to address these challenges, through making caregivers available where they are needed, continuing to recruit more staff, partnering more with community providers and being more flexible and innovative in finding solutions.\"\u003c/p>\n\u003cp>The report did point to some success stories stemming from Kaiser's efforts at truncating wait times. In early 2013, for example, the psychiatry department at the Napa-Solano Medical Center was experiencing a months-long decline in on-time appointments.\u003c/p>\n\u003cp>\"The Plan began video and telephone appointments, utilized a psychiatrist from another medical center, increased clinic hours, recruited new staff, and utilized use of other staff temporarily to fulfill the duties,\" DMHC said. \"For the remainder of the year, the rate was above 90% with 100% compliance in December.\"\u003c/p>\n\u003cp>NUHW President Sal Roselli said, \"For four years-plus, our clinicians have been bringing these major issues to Kaiser and for four years-plus, Kaiser has dismissed their concerns, refused to talk about them.\" Roselli said Kaiser and the union returned to the bargaining table in Northern California last week, and that the DMHC report was \"certainly helping.\"\u003c/p>\n\u003cp>\u003cstrong>Delays and Misinformed Patients\u003c/strong>\u003c/p>\n\u003cp>The current report took into account delays in follow-up care in addition to initial appointments. Delays in follow-up appointments at Kaiser were the subject of an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">investigation by KQED's State of Health\u003c/a> last year, which found Kaiser patients and therapists complaining about delays similar to those found by the DMHC.\u003c/p>\n\u003cp>Department regulations state that non-urgent initial appointments with a therapist must be available within 10 business days of request; non-urgent appointments with a psychiatrist must be available within 15 business days, and urgent appointments that do not require prior authorization must be available within 48 hours.\u003c/p>\n\u003cp>The DMHC follow-up survey included a look at the medical records of 297 patients -- 149 in Kaiser's Southern Region and 148 in the Northern Region. It found that in the north, 33 out of 148 patients, or 22 percent, did not receive timely initial or follow-up appointments within those timeframes. Just 9 percent experienced the same delays in the south.\u003c/p>\n\u003cp>Regarding uncorrected deficiency No. 4, \"inaccurate and misleading information provided to enrollees about the limits of their coverage,\" the DMHC found that Kaiser mental health personnel did not inform patients they could be seen as often as medically necessary. From the report:\u003c/p>\n\u003cblockquote>\u003cp>\"To the contrary, messages conveyed to enrollees in certain cases indicated that access to behavioral health services is quite limited in scope. (Such) information ... can actively discourage patients from obtaining care. In addition, in situations where providers misunderstand the scope of benefits available to enrollees, they may fail to schedule patients for additional, medically necessary covered services.\"\u003c/p>\u003c/blockquote>\n\u003cp>The report pointed to examples of clinicians misinforming patients about their rights to coverage.\u003c/p>\n\u003cp>\"No one ever sees a therapist once a week in the Kaiser Health Plan,\" one psychiatrist wrote in an email to a patient. \"Not a covered benefit for the past 20 something years and will not be a benefit in the future.”\u003c/p>\n\u003cp>Andy Weisskoff, a former Kaiser therapist who published a scathing \u003ca href=\"http://90daystochange.com/\" target=\"_blank\">series of blog posts\u003c/a> last year about his experiences with treatment delays at Kaiser Santa Rosa, thought the report was a step in the right direction but that it probably undercounted the number of delays. He pointed to a footnote in which the DMHC said it was \"difficult to differentiate between appointment availability and lack of clinical follow-up.\"\u003c/p>\n\u003cp>\"The reviewers were uncertain if the delays between initial appointment and follow-up were because a follow-up was unavailable or if the therapist didn't set one up properly,\" he said.\u003c/p>\n\u003cp>\"These reviewers were clearly uninformed about the great lengths therapists at Kaiser have gone to to try to make more appointments available.\"\u003c/p>\n\u003cp>Still, he was pleased.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"I feel relieved that the facts are coming out, and they're coming out in such a dramatic and public way.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23433\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\">\u003cimg class=\"size-full wp-image-23433\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\" alt=\"Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>A teenager with major depression and thoughts of suicide is forced to wait 24 days for an initial appointment.\u003c/p>\n\u003cp>A sexual assault victim, diagnosed with PTSD and major depression, sends numerous emails requesting individual psychotherapy, only to have her psychiatrist suggest she should get outside help at her own expense because no weekly appointments are available. Total time between appointments: Five months.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Following up on a survey that resulted in a $4 million fine against the HMO in 2013. \u003c/aside>\n\u003cp>A patient deemed high-risk for domestic abuse doesn't show up for appointments, but mental health staff do not attempt contact. The couples therapy called for in his treatment plan does not occur. Domestic violence resulting in severe injury ensues. The man then tries to make an appointment but can't get one.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>These are just a few of the cases documented in the California Department of Managed Health Care’s\u003ca title=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" target=\"_blank\"> latest report of Kaiser’s mental health services,\u003c/a> released to the public Tuesday. The report, a follow-up to the survey that \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">resulted in a $4 million fine against Kaiser in 2013,\u003c/a> says that while the health care giant has made progress in providing mental health services to its enrollees, it still has a long way to go in adequately serving patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Despite the very significant strides made by the Plan in monitoring and assessing corrective action related to timely access to behavioral health services,\" the report reads, \"the Plan’s monthly access reports suggest that the Plan’s current behavioral health provider network remains inadequate to serve the needs of its enrollee population.\u003c/p>\n\u003cp>\"(T)he Plan’s own monthly access reports continue to show a lack of stability or a lack of available providers within the Plan’s behavioral health provider network,\" the DMHC writes in its conclusion to the 32-page report.\u003c/p>\n\u003cp>\"Even with all the changes Kaiser has made, there are still serious concerns about patients' ability to get timely access to mental health services,\" Shelley Rouillard, director of the Department of Managed Health Care, \u003ca title=\"http://www.latimes.com/business/la-fi-kaiser-mental-health-20150225-story.html\" href=\"http://www.latimes.com/business/la-fi-kaiser-mental-health-20150225-story.html\" target=\"_blank\">told the Los Angeles Times\u003c/a>. \"I want Kaiser to fix the problem and do what they need to do to make sure their members get the mental health services they need.\"\u003c/p>\n\u003cp>Kaiser, which serves nearly 7.7 million members statewide, agreed to pay the $4 million fine last September after an initial appeal. That penalty resulted from a routine DMHC \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bh031813.pdf\" target=\"_blank\">survey\u003c/a> finding four basic deficiencies related to plan members experiencing excessive wait times for initial appointments.\u003c/p>\n\u003col>\n\u003cli>Kaiser measured wait times for initial appointments in ways that minimized their length. For instance, it used paper waiting lists, not counting the days patients languished there. Or it logged the interval between a canceled appointment and a new appointment instead of from the original appointment, thus decreasing its wait times statistically.\u003c/li>\n\u003cli>Kaiser's methodology for measuring timely access -- averaging all reported enrollee wait times for a given month -- obscured the lengthy wait times of some individuals. \"Such an approach could prevent effective treatment of an enrollee’s condition or fail to prevent further deterioration of an enrollee’s health,\" the DMHC said in its follow-up report.\u003c/li>\n\u003cli>Long wait times for an initial appointment and the failure of the plan's quality assurance program to address these delays violated department regulations.\u003c/li>\n\u003cli>By focusing on limitations and exclusions of mental health benefits, some Kaiser mental health personnel, as well as printed and online materials, disseminated \"inaccurate and misleading health education information to enrollees regarding the scope of their coverage for behavioral health services.\" Some materials, for instance, failed to inform enrollees that coverage for severe mental illness or serious emotional disturbances of a child is required.\u003c/li>\n\u003c/ol>\n\u003cp>The current report designates deficiencies 1 and 2 as \"corrected\" and numbers 3 and 4 as \"not corrected.\" The new report has been referred to the DMHC's Office of Enforcement \"for further investigation and possible disciplinary action, based on the Plan’s failure to correct Deficiencies #3 and #4.\"\u003c/p>\n\u003cp>\"Financial penalties are an option available to the DMHC,\" said DMHC information officer Rodger Butler, \"but it's too early to say if that will be the course of action.\"\u003c/p>\n\u003cp>\u003cstrong>Focusing on the Positive\u003c/strong>\u003c/p>\n\u003cp>In a lengthy \u003ca href=\"http://share.kaiserpermanente.org/article/kaiser-permanente-comments-on-the-department-of-managed-health-care-follow-up-mental-health-survey/\" target=\"_blank\">statement\u003c/a>, Kaiser focused on the progress the DMHC said Kaiser had made in correcting problems:\u003c/p>\n\u003cblockquote>\u003cp>\"We are proud of the progress we have made to improve access to mental health care. The DMHC’s initial survey was conducted in 2012. This follow-up survey was conducted in 2013-14, including the case review portion. Since the follow-up review was conducted, we have made even more progress. We have hired new mental health therapists in Northern and Southern California, and we currently are recruiting to hire more. We have engaged with high quality community-based mental health care providers, including ValueOptions, a network of community providers with which we began successfully partnering in 2014, to ensure our patients receive timely access to mental health care, especially in locations where there are increases in appointment requests.\"\u003c/p>\u003c/blockquote>\n\u003cp>In its statement, Kaiser acknowledged that DMHC had found some Kaiser health centers experienced significant fluctuations in providing timely access. The report cited four unnamed medical centers in Northern California at which access rates plummeted over several months or more.\u003c/p>\n\u003cp>Last year, the National Union of Healthcare Workers, which has been in a years-long, bitter contract fight with Kaiser, provided statistics to KQED that showed timely access rates at both the Oakland and Richmond medical centers suddenly dropped 28 percent and 32 percent, respectively, over the course of one month.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"While the report acknowledges that Kaiser Permanente ‘took significant steps’ to track and address timely access challenges,\" Kaiser said in its statement issued Tuesday, \"there remain locations where access to appointments is not consistently where it should be. We are continuing to address these challenges, through making caregivers available where they are needed, continuing to recruit more staff, partnering more with community providers and being more flexible and innovative in finding solutions.\"\u003c/p>\n\u003cp>The report did point to some success stories stemming from Kaiser's efforts at truncating wait times. In early 2013, for example, the psychiatry department at the Napa-Solano Medical Center was experiencing a months-long decline in on-time appointments.\u003c/p>\n\u003cp>\"The Plan began video and telephone appointments, utilized a psychiatrist from another medical center, increased clinic hours, recruited new staff, and utilized use of other staff temporarily to fulfill the duties,\" DMHC said. \"For the remainder of the year, the rate was above 90% with 100% compliance in December.\"\u003c/p>\n\u003cp>NUHW President Sal Roselli said, \"For four years-plus, our clinicians have been bringing these major issues to Kaiser and for four years-plus, Kaiser has dismissed their concerns, refused to talk about them.\" Roselli said Kaiser and the union returned to the bargaining table in Northern California last week, and that the DMHC report was \"certainly helping.\"\u003c/p>\n\u003cp>\u003cstrong>Delays and Misinformed Patients\u003c/strong>\u003c/p>\n\u003cp>The current report took into account delays in follow-up care in addition to initial appointments. Delays in follow-up appointments at Kaiser were the subject of an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">investigation by KQED's State of Health\u003c/a> last year, which found Kaiser patients and therapists complaining about delays similar to those found by the DMHC.\u003c/p>\n\u003cp>Department regulations state that non-urgent initial appointments with a therapist must be available within 10 business days of request; non-urgent appointments with a psychiatrist must be available within 15 business days, and urgent appointments that do not require prior authorization must be available within 48 hours.\u003c/p>\n\u003cp>The DMHC follow-up survey included a look at the medical records of 297 patients -- 149 in Kaiser's Southern Region and 148 in the Northern Region. It found that in the north, 33 out of 148 patients, or 22 percent, did not receive timely initial or follow-up appointments within those timeframes. Just 9 percent experienced the same delays in the south.\u003c/p>\n\u003cp>Regarding uncorrected deficiency No. 4, \"inaccurate and misleading information provided to enrollees about the limits of their coverage,\" the DMHC found that Kaiser mental health personnel did not inform patients they could be seen as often as medically necessary. From the report:\u003c/p>\n\u003cblockquote>\u003cp>\"To the contrary, messages conveyed to enrollees in certain cases indicated that access to behavioral health services is quite limited in scope. (Such) information ... can actively discourage patients from obtaining care. In addition, in situations where providers misunderstand the scope of benefits available to enrollees, they may fail to schedule patients for additional, medically necessary covered services.\"\u003c/p>\u003c/blockquote>\n\u003cp>The report pointed to examples of clinicians misinforming patients about their rights to coverage.\u003c/p>\n\u003cp>\"No one ever sees a therapist once a week in the Kaiser Health Plan,\" one psychiatrist wrote in an email to a patient. \"Not a covered benefit for the past 20 something years and will not be a benefit in the future.”\u003c/p>\n\u003cp>Andy Weisskoff, a former Kaiser therapist who published a scathing \u003ca href=\"http://90daystochange.com/\" target=\"_blank\">series of blog posts\u003c/a> last year about his experiences with treatment delays at Kaiser Santa Rosa, thought the report was a step in the right direction but that it probably undercounted the number of delays. He pointed to a footnote in which the DMHC said it was \"difficult to differentiate between appointment availability and lack of clinical follow-up.\"\u003c/p>\n\u003cp>\"The reviewers were uncertain if the delays between initial appointment and follow-up were because a follow-up was unavailable or if the therapist didn't set one up properly,\" he said.\u003c/p>\n\u003cp>\"These reviewers were clearly uninformed about the great lengths therapists at Kaiser have gone to to try to make more appointments available.\"\u003c/p>\n\u003cp>Still, he was pleased.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cfigure id=\"attachment_23631\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Daisy-Matthias-Photo.jpg\">\u003cimg class=\"size-large wp-image-23631\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Daisy-Matthias-Photo-640x478.jpg\" alt=\"Daisy Matthias is a counselor at the San Francisco-based Mental Health Triage Warm Line. Most callers are struggling with anxiety, depression, loneliness, and stress. (Jeremy Raff /KQED)\" width=\"640\" height=\"478\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Daisy Matthias is a counselor at the San Francisco-based Mental Health Triage Warm Line. Most callers are struggling with anxiety, depression, loneliness, and stress. (Jeremy Raff /KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's note: a warm line is a place where people struggling with mental illness, but not in an acute state of crisis, can call and talk to a trained counselor as long as they need to. As part our community health series \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\" target=\"_blank\">Vital Signs\u003c/a>, we caught up with Daisy Matthias, a counselor at San Francisco’s new warm line, in between phone calls.\u003cbr>\n\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Daisy Matthias\u003cbr>\n\u003c/strong>\u003cbr>\nThe majority of the people call about anxiety, depression, loneliness, or even stress.\u003c/p>\n\u003cp>We’ll be there for as long as you need us. We don’t have a time limit. And other warm lines sometimes will have a time limit of 20 minutes, 30 minutes.\u003c/p>\n\u003cp>Every counselor has a history of dealing with mental health.\u003c!--more-->\u003c/p>\n\u003cp>In my case, there was a moment I was very stressed out at my last job. I really just couldn't take it anymore. I was depressed, and since I worked overnight I had no one to call. I called a crisis line and I said, “I just want someone to talk to.” But they couldn't help me cause I wasn't going to commit suicide.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So when I heard about the warm line and applied for it, I was like, “Oh thank god -- there’s something like that here.”\u003c/p>\n\u003cp>Every since I was a little girl, I've been living with depression and anxiety. I did do my best to find ways to cope with it, but I always felt like I was different.\u003c/p>\n\u003cp>I grew up in the United States -- with American values in a very traditional Mexican home. So there was a lot of conflict especially when it came to gender roles.\u003c/p>\n\u003cp>Even though I was a student at UC Berkeley, none of my accomplishments mattered because I was bisexual. That little fact seemed to block everything else I've done -- and that led to my anxiety and depression.\u003c/p>\n\u003cp>The reasons why we have callers is that people just want to vent, and they just want to talk.\u003c/p>\n\u003cp>In the medical community, sometimes ... they don’t listen to us, they don’t want to talk to us. They just want to solve the problem.\u003c/p>\n\u003cp>Here in the warm line, I love it because we can talk to people. They don’t have to be in an extreme crisis.\u003c/p>\n\u003cp>Sometimes people are stressed out; they need someone to talk to. They just want to hear a voice, just to hear, \"It's going to be ok.\"[soundcloud url=\"https://api.soundcloud.com/tracks/189660688\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://ww2.kqed.org/news/author/jeremyraff\" target=\"_blank\">Jeremy Raff\u003c/a> reported this story. Email him: jraff@kqed.org\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Reach a Mental Health Triage Warm Line counselor at (855) 845-7415; or\u003c/em> \u003ca href=\"http://mentalhealthsf.org/\" target=\"_blank\">chat with counselor\u003c/a>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23631\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Daisy-Matthias-Photo.jpg\">\u003cimg class=\"size-large wp-image-23631\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Daisy-Matthias-Photo-640x478.jpg\" alt=\"Daisy Matthias is a counselor at the San Francisco-based Mental Health Triage Warm Line. Most callers are struggling with anxiety, depression, loneliness, and stress. (Jeremy Raff /KQED)\" width=\"640\" height=\"478\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Daisy Matthias is a counselor at the San Francisco-based Mental Health Triage Warm Line. Most callers are struggling with anxiety, depression, loneliness, and stress. (Jeremy Raff /KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's note: a warm line is a place where people struggling with mental illness, but not in an acute state of crisis, can call and talk to a trained counselor as long as they need to. As part our community health series \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\" target=\"_blank\">Vital Signs\u003c/a>, we caught up with Daisy Matthias, a counselor at San Francisco’s new warm line, in between phone calls.\u003cbr>\n\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Daisy Matthias\u003cbr>\n\u003c/strong>\u003cbr>\nThe majority of the people call about anxiety, depression, loneliness, or even stress.\u003c/p>\n\u003cp>We’ll be there for as long as you need us. We don’t have a time limit. And other warm lines sometimes will have a time limit of 20 minutes, 30 minutes.\u003c/p>\n\u003cp>Every counselor has a history of dealing with mental health.\u003c!--more-->\u003c/p>\n\u003cp>In my case, there was a moment I was very stressed out at my last job. I really just couldn't take it anymore. I was depressed, and since I worked overnight I had no one to call. I called a crisis line and I said, “I just want someone to talk to.” But they couldn't help me cause I wasn't going to commit suicide.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So when I heard about the warm line and applied for it, I was like, “Oh thank god -- there’s something like that here.”\u003c/p>\n\u003cp>Every since I was a little girl, I've been living with depression and anxiety. I did do my best to find ways to cope with it, but I always felt like I was different.\u003c/p>\n\u003cp>I grew up in the United States -- with American values in a very traditional Mexican home. So there was a lot of conflict especially when it came to gender roles.\u003c/p>\n\u003cp>Even though I was a student at UC Berkeley, none of my accomplishments mattered because I was bisexual. That little fact seemed to block everything else I've done -- and that led to my anxiety and depression.\u003c/p>\n\u003cp>The reasons why we have callers is that people just want to vent, and they just want to talk.\u003c/p>\n\u003cp>In the medical community, sometimes ... they don’t listen to us, they don’t want to talk to us. They just want to solve the problem.\u003c/p>\n\u003cp>Here in the warm line, I love it because we can talk to people. They don’t have to be in an extreme crisis.\u003c/p>\n\u003cp>Sometimes people are stressed out; they need someone to talk to. They just want to hear a voice, just to hear, \"It's going to be ok.\"\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/189660688&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/189660688'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://ww2.kqed.org/news/author/jeremyraff\" target=\"_blank\">Jeremy Raff\u003c/a> reported this story. Email him: jraff@kqed.org\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Reach a Mental Health Triage Warm Line counselor at (855) 845-7415; or\u003c/em> \u003ca href=\"http://mentalhealthsf.org/\" target=\"_blank\">chat with counselor\u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Kaiser Mental Health Workers Launch 7-Day Strike",
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"content": "\u003cfigure id=\"attachment_20284\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/jpg-e1420908404158.jpg\">\u003cimg class=\"size-large wp-image-20284\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\" alt=\"Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED) \u003ccite>(Lisa Aliferis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By April Dembosky\u003c/strong>\u003c/p>\n\u003cp>Mental health clinicians at Kaiser are walking off the job Monday, commencing a week-long, statewide strike. Their main complaint: Kaiser isn't hiring enough therapists and psychologists to see patients in a timely manner.\u003c/p>\n\u003cp>But the strike also comes after four years of contract negotiations between Kaiser and the National Union of Healthcare Workers have yielded few agreements.\u003c/p>\n\u003cp>\"We’ve tried one and two day actions in the past. Kaiser is not paying attention to that,\" says Clement Papazian, a social worker at Kaiser and a local union representative. \"We feel like it’s the appropriate time to escalate these actions.\"\u003c/p>\n\u003cp>Kaiser called the strike \"unnecessary and counterproductive.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>John Nelson, Kaiser's vice president of government relations, says the the hospital system is meeting its patients' mental health needs, even after Kaiser has taken on thousands of new patients under the Affordable Care Act.\u003c/p>\n\u003cp>\"Since 2011, we’ve grown membership by eight percent in California. We’ve increased the number of therapists in California who work at Kaiser Permanente by 25 percent,\" Nelson said. \"That's quite an accomplishment.\"\u003c!--more-->\u003c/p>\n\u003cp>Nelson said that health care systems across the country have been having difficulty hiring enough therapists and psychologists, because of a shortage of professionals. He said there isn't enough incentive to get people to enter the field.\u003c/p>\n\u003cp>\"There are challenges in encouraging folks to pursue that training and to go to school and complete the long licensing process,\" he said.\u003c/p>\n\u003cp>Kaiser has faced the ire of state regulators \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">over wait times \u003c/a>for mental health care. In 2013, the Department of Managed Health Care fined Kaiser $4 million over long wait times for mental health care. Kaiser initially contested the fine, but agreed to pay it last September -- while still \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">insisting it had not violated regulations\u003c/a>.\u003c/p>\n\u003cp>Nelson insisted the strike was really a bargaining strategy by the union. The latest issue to be debated in contract negotiations is retiree health benefits.\u003c/p>\n\u003cp>\"They want to carve out retiree health care,\" said Clement Papazian. He says Kaiser's latest proposal is to put current employees, once they retire, on a \"substandard\" Medicare plan. \"It’s a much less desirable health care benefit, and it's a bitter pill for those of us who work in health care and expend a career providing these services.\"\u003c/p>\n\u003cp>The union plans to hold rallies outside Kaiser facilities in Northern and Southern California throughout the week.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Nelson says Kaiser has enough non-union staff to handle any urgent psychiatric needs during the strike, but some routine therapy appointments will be canceled.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20284\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/jpg-e1420908404158.jpg\">\u003cimg class=\"size-large wp-image-20284\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\" alt=\"Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED) \u003ccite>(Lisa Aliferis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By April Dembosky\u003c/strong>\u003c/p>\n\u003cp>Mental health clinicians at Kaiser are walking off the job Monday, commencing a week-long, statewide strike. Their main complaint: Kaiser isn't hiring enough therapists and psychologists to see patients in a timely manner.\u003c/p>\n\u003cp>But the strike also comes after four years of contract negotiations between Kaiser and the National Union of Healthcare Workers have yielded few agreements.\u003c/p>\n\u003cp>\"We’ve tried one and two day actions in the past. Kaiser is not paying attention to that,\" says Clement Papazian, a social worker at Kaiser and a local union representative. \"We feel like it’s the appropriate time to escalate these actions.\"\u003c/p>\n\u003cp>Kaiser called the strike \"unnecessary and counterproductive.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>John Nelson, Kaiser's vice president of government relations, says the the hospital system is meeting its patients' mental health needs, even after Kaiser has taken on thousands of new patients under the Affordable Care Act.\u003c/p>\n\u003cp>\"Since 2011, we’ve grown membership by eight percent in California. We’ve increased the number of therapists in California who work at Kaiser Permanente by 25 percent,\" Nelson said. \"That's quite an accomplishment.\"\u003c!--more-->\u003c/p>\n\u003cp>Nelson said that health care systems across the country have been having difficulty hiring enough therapists and psychologists, because of a shortage of professionals. He said there isn't enough incentive to get people to enter the field.\u003c/p>\n\u003cp>\"There are challenges in encouraging folks to pursue that training and to go to school and complete the long licensing process,\" he said.\u003c/p>\n\u003cp>Kaiser has faced the ire of state regulators \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">over wait times \u003c/a>for mental health care. In 2013, the Department of Managed Health Care fined Kaiser $4 million over long wait times for mental health care. Kaiser initially contested the fine, but agreed to pay it last September -- while still \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">insisting it had not violated regulations\u003c/a>.\u003c/p>\n\u003cp>Nelson insisted the strike was really a bargaining strategy by the union. The latest issue to be debated in contract negotiations is retiree health benefits.\u003c/p>\n\u003cp>\"They want to carve out retiree health care,\" said Clement Papazian. He says Kaiser's latest proposal is to put current employees, once they retire, on a \"substandard\" Medicare plan. \"It’s a much less desirable health care benefit, and it's a bitter pill for those of us who work in health care and expend a career providing these services.\"\u003c/p>\n\u003cp>The union plans to hold rallies outside Kaiser facilities in Northern and Southern California throughout the week.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Nelson says Kaiser has enough non-union staff to handle any urgent psychiatric needs during the strike, but some routine therapy appointments will be canceled.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_22567\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/impact1.png\">\u003cimg class=\"size-large wp-image-22567\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/impact1-640x353.png\" alt=\"Ellen Frudakis (left) and Johanna Baker co-founded Impact Young Adults ten years ago. (Kenny Goldberg/KPBS)\" width=\"640\" height=\"353\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Ellen Frudakis (left) and Johanna Baker co-founded Impact Young Adults 10 years ago. (Kenny Goldberg/KPBS)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Kenny Goldberg,\u003ca title=\"http://www.kpbs.org/news/2014/nov/12/having-fun-mental-illness/\" href=\"http://www.kpbs.org/news/2014/nov/12/having-fun-mental-illness/\" target=\"_blank\"> KPBS\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>The National Institute of Mental Health says about\u003ca title=\"http://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-adults.shtml\" href=\"http://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-adults.shtml\" target=\"_blank\"> one in five young adults\u003c/a> has a diagnosable mental illness.\u003c/p>\n\u003cp>It’s not uncommon for young people with mental health issues to withdraw from others and to isolate themselves. That can make their situation worse.\u003c/p>\n\u003cp>A group in San Diego has made it their mission to encourage young adults with mental illness to get out of their shell, make friends and have a good time.\u003c/p>\n\u003cp>The group is operated by young people.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>On a recent Sunday afternoon at the downtown branch of the San Diego library, the group called \u003ca title=\"http://impactyoungadults.org\" href=\"http://impactyoungadults.org\" target=\"_blank\">Impact Young Adults\u003c/a> celebrated its 10th anniversary.\u003c/p>\n\u003cp>“'Impact Young Adults,' 10 years in the making,\" Ellen Frudakis told the audience. \"Today, San Diego. Tomorrow, world domination!”\u003c/p>\n\u003cp>The crowd laughed and applauded.\u003c/p>\n\u003cp>\u003cstrong>The Genesis\u003c/strong>\u003c/p>\n\u003cp>Ten years ago, Frudakis and Johanna Baker were both struggling with mental illnesses. Frudakis was diagnosed with bipolar disorder when she was 20.\u003c/p>\n\u003cp>She spent a lot of time grappling with it behind closed doors.\u003c/p>\n\u003cp>“But I really needed to be able to connect with other people like myself, to remind me that I was bigger and more than the diagnosis,” Frudakis recalled.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/177532038&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>Baker was knocked down by major depression. She lost her career as a music teacher and her social circle.\u003c/p>\n\u003cp>“So I needed people in my life, where I would feel accepted and feel like I belonged,\" Baker said.\u003c/p>\n\u003cp>Baker and Frudakis felt that life had to be more than visits to the psychiatrist and sitting at home alone. They wanted to have fun with people their own age.\u003c/p>\n\u003cp>Beginning in 2005, they formed their own social group and organized weekly social events such as rock climbing, ice skating and going out to the movies.\u003c/p>\n\u003cp>In its 10 years of operation, Impact Young Adults has hosted more than 500 get-togethers and community events.\u003c/p>\n\u003cp>There are other social programs run by mental health agencies, but Impact is the only one in California run by young adults.\u003c/p>\n\u003cp>Impact currently has 60 members in San Diego. Members must be between 18 and 35, have a mental illness and be involved in some form of treatment or other effort to improve their health.\u003c/p>\n\u003cp>\u003cstrong>'Impact' Has Big Impact\u003c/strong>\u003c/p>\n\u003cp>When he was in college on the East Coast in 2009, Mike Robertson’s life was derailed by schizophrenia. He started treatment in San Diego and heard about Impact.\u003c/p>\n\u003cp>“It’s really difficult to find people like me, when not in the hospital, you know,\" Robertson said. \"And then finding Impact was just great, I really fit in with everybody.”\u003c/p>\n\u003cp>Robertson has to take some pretty heavy medication to control his condition. It helps him lead a normal life. He considers Impact to be just as important.\u003c/p>\n\u003cp>“I love sharing my passions with other people,\" Robertson said. \"I love getting to share fishing, surfing with people, and it just makes me feel good.”\u003c/p>\n\u003cp>\u003cstrong>Feeling Good\u003c/strong>\u003c/p>\n\u003cp>Baker says helping members feel good is one of Impact's goals.\u003c/p>\n\u003cp>She doesn’t deny that mental illness can be debilitating and tough to manage, but Baker contends it doesn’t have to be someone’s defining characteristic.\u003c/p>\n\u003cp>“It’s just a piece of who you are,\" she explained. \"It’s not meant to be this limitation that prevents you from doing all the things you might ever have wanted to do.”\u003c/p>\n\u003cp>Frudakis is proud of what Impact has done in its first 10 years. She’d like to see groups like it spring up in other parts of the country.\u003c/p>\n\u003cp>Frudakis said that when you have a mental illness, one thing’s for sure: being isolated is the worst thing of all.\u003c/p>\n\u003cp>“When you stay isolated, you don’t find resources, you don’t find a way out,\" Frudakis said. \"And so, I would love for more young people across the country to be able to find what we’ve found, and have the joy and the experience with their peers that we’ve been able to have.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>According to the U.S. Census, there are more than 63 million Americans ages 18 to 34. Based on National Institute of Mental Health estimates, that means more than 12 million young adults in the U.S. have a diagnosable mental illness. The numbers alone show there is definitely a need for more programs like Impact.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22567\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/impact1.png\">\u003cimg class=\"size-large wp-image-22567\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/impact1-640x353.png\" alt=\"Ellen Frudakis (left) and Johanna Baker co-founded Impact Young Adults ten years ago. (Kenny Goldberg/KPBS)\" width=\"640\" height=\"353\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Ellen Frudakis (left) and Johanna Baker co-founded Impact Young Adults 10 years ago. (Kenny Goldberg/KPBS)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Kenny Goldberg,\u003ca title=\"http://www.kpbs.org/news/2014/nov/12/having-fun-mental-illness/\" href=\"http://www.kpbs.org/news/2014/nov/12/having-fun-mental-illness/\" target=\"_blank\"> KPBS\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>The National Institute of Mental Health says about\u003ca title=\"http://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-adults.shtml\" href=\"http://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-adults.shtml\" target=\"_blank\"> one in five young adults\u003c/a> has a diagnosable mental illness.\u003c/p>\n\u003cp>It’s not uncommon for young people with mental health issues to withdraw from others and to isolate themselves. That can make their situation worse.\u003c/p>\n\u003cp>A group in San Diego has made it their mission to encourage young adults with mental illness to get out of their shell, make friends and have a good time.\u003c/p>\n\u003cp>The group is operated by young people.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>On a recent Sunday afternoon at the downtown branch of the San Diego library, the group called \u003ca title=\"http://impactyoungadults.org\" href=\"http://impactyoungadults.org\" target=\"_blank\">Impact Young Adults\u003c/a> celebrated its 10th anniversary.\u003c/p>\n\u003cp>“'Impact Young Adults,' 10 years in the making,\" Ellen Frudakis told the audience. \"Today, San Diego. Tomorrow, world domination!”\u003c/p>\n\u003cp>The crowd laughed and applauded.\u003c/p>\n\u003cp>\u003cstrong>The Genesis\u003c/strong>\u003c/p>\n\u003cp>Ten years ago, Frudakis and Johanna Baker were both struggling with mental illnesses. Frudakis was diagnosed with bipolar disorder when she was 20.\u003c/p>\n\u003cp>She spent a lot of time grappling with it behind closed doors.\u003c/p>\n\u003cp>“But I really needed to be able to connect with other people like myself, to remind me that I was bigger and more than the diagnosis,” Frudakis recalled.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/177532038&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>Baker was knocked down by major depression. She lost her career as a music teacher and her social circle.\u003c/p>\n\u003cp>“So I needed people in my life, where I would feel accepted and feel like I belonged,\" Baker said.\u003c/p>\n\u003cp>Baker and Frudakis felt that life had to be more than visits to the psychiatrist and sitting at home alone. They wanted to have fun with people their own age.\u003c/p>\n\u003cp>Beginning in 2005, they formed their own social group and organized weekly social events such as rock climbing, ice skating and going out to the movies.\u003c/p>\n\u003cp>In its 10 years of operation, Impact Young Adults has hosted more than 500 get-togethers and community events.\u003c/p>\n\u003cp>There are other social programs run by mental health agencies, but Impact is the only one in California run by young adults.\u003c/p>\n\u003cp>Impact currently has 60 members in San Diego. Members must be between 18 and 35, have a mental illness and be involved in some form of treatment or other effort to improve their health.\u003c/p>\n\u003cp>\u003cstrong>'Impact' Has Big Impact\u003c/strong>\u003c/p>\n\u003cp>When he was in college on the East Coast in 2009, Mike Robertson’s life was derailed by schizophrenia. He started treatment in San Diego and heard about Impact.\u003c/p>\n\u003cp>“It’s really difficult to find people like me, when not in the hospital, you know,\" Robertson said. \"And then finding Impact was just great, I really fit in with everybody.”\u003c/p>\n\u003cp>Robertson has to take some pretty heavy medication to control his condition. It helps him lead a normal life. He considers Impact to be just as important.\u003c/p>\n\u003cp>“I love sharing my passions with other people,\" Robertson said. \"I love getting to share fishing, surfing with people, and it just makes me feel good.”\u003c/p>\n\u003cp>\u003cstrong>Feeling Good\u003c/strong>\u003c/p>\n\u003cp>Baker says helping members feel good is one of Impact's goals.\u003c/p>\n\u003cp>She doesn’t deny that mental illness can be debilitating and tough to manage, but Baker contends it doesn’t have to be someone’s defining characteristic.\u003c/p>\n\u003cp>“It’s just a piece of who you are,\" she explained. \"It’s not meant to be this limitation that prevents you from doing all the things you might ever have wanted to do.”\u003c/p>\n\u003cp>Frudakis is proud of what Impact has done in its first 10 years. She’d like to see groups like it spring up in other parts of the country.\u003c/p>\n\u003cp>Frudakis said that when you have a mental illness, one thing’s for sure: being isolated is the worst thing of all.\u003c/p>\n\u003cp>“When you stay isolated, you don’t find resources, you don’t find a way out,\" Frudakis said. \"And so, I would love for more young people across the country to be able to find what we’ve found, and have the joy and the experience with their peers that we’ve been able to have.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>According to the U.S. Census, there are more than 63 million Americans ages 18 to 34. Based on National Institute of Mental Health estimates, that means more than 12 million young adults in the U.S. have a diagnosable mental illness. The numbers alone show there is definitely a need for more programs like Impact.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Counties Expand Mental Health Services with State Funds",
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"content": "\u003cfigure id=\"attachment_22517\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/IMG_27381.jpg\">\u003cimg class=\"size-full wp-image-22517\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/IMG_27381.jpg\" alt=\"Hope House, a residential treatment program in Martinez, helps people in a mental health crisis make the transition back to the community. (Elaine Korry/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/11/IMG_27381.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/11/IMG_27381-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/11/IMG_27381-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Hope House, a residential treatment program in Martinez, helps people in a mental health crisis make the transition back to the community. (Elaine Korry/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>It's lunchtime at Hope House, a new 16-bed residential facility in Martinez, east of San Francisco. People who live here are busy preparing lunch in what looks like a big country kitchen.\u003c/p>\n\u003cp>\"We’ve designed it as much as possible to have a homelike atmosphere,\" says program director Christopher Roach. \"We want people to be thinking, this is a transition to the community.\"\u003c/p>\n\u003cp>Many of the residents here have arrived directly from a hospital. Among them are young adults facing a psychotic break, chronically-ill homeless men or mothers battling mental illness and addiction. After an average two-weeks of intense counseling, Roach says they’ll leave with hope for recovery.\u003c/p>\n\u003cp>\"What you’re able to accomplish in 14 days is huge if you know what you’re looking for,\" he says.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>19-year-old Chris Nguyen says his very life was on the line before he made it to this safe haven.\u003c/p>\n\u003cp>\"I have bipolar disorder,\" he explains, \"so I was having manic depressive symptoms and eventually it led to self-harm thoughts, suicidal thoughts, and I almost acted on it, but my family members were there to intervene and get me the help I needed.\"\u003c/p>\n\u003cp>Clinicians here helped Nguyen give up the marijuana and alcohol he had been using to treat his extreme anxiety. After getting proper medication, he started therapy -- individual, family and group -- where he began to talk about his fears of failure.\u003c/p>\n\u003cp>\"It let me calm down, slow things down finally, there’s all that pressure that you feel at a young age - so going here allowed me to take a step back and look at it. Wait, I need to build some support systems, take care of myself before I try to look at the path to success.\"\u003c/p>\n\u003cp>Now back home, Nguyen continues his treatment in an outpatient program.\u003c/p>\n\u003cp>Experts say residential treatment centers are a critical link in a system of care designed to keep people in a mental health crisis from spiraling downward.\u003c/p>\n\u003cp>\"What you have is a place where you can intervene to stop and redirect what would be an inpatient, involuntary, psychiatric admit to a hospital.\"\u003c/p>\n\u003cp>Randall Hagar is with the California Psychiatric Association, which has lobbied for years for more residential treatment options. Psychiatric services have been severely underfunded in California for decades. Cutbacks closed hospital wards and left big gaps in the system of care. But that process has been reversed over the last two years. Last year lawmakers passed the Investment in Mental Health Wellness Act.\u003c/p>\n\u003cp>Contra Costa County used grant money from the 2012 so-called \"Millionaires Tax\" proposition to fund Hope House. Hagar says without these sources of money, places like Hope House couldn’t exist. Cash-strapped counties simply can’t afford to build them on their own.\u003c/p>\n\u003cp>\"The money is very welcome, and it’s going toward very desperately needed services,\" Hagar says.\u003c/p>\n\u003cp>Besides residential treatment, counties around the state are using mental health grants to fund new urgent care units and \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/11/07/new-state-funding-improves-county-mental-health-services/\" href=\"http://ww2.kqed.org/stateofhealth/2014/11/07/new-state-funding-improves-county-mental-health-services/\" target=\"_blank\">mobile crisis teams\u003c/a> that pair clinicians with police officers to keep psychiatric patients out of jail.\u003c/p>\n\u003cp>\"The grants are going to do a great job of getting these things set up,\" Hagar said. \"Counties are going to have to find a way to keep them going, and that’s the rub.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Hagar says for counties that have few resources, finding long-term funding will be the toughest challenge.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22517\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/IMG_27381.jpg\">\u003cimg class=\"size-full wp-image-22517\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/IMG_27381.jpg\" alt=\"Hope House, a residential treatment program in Martinez, helps people in a mental health crisis make the transition back to the community. (Elaine Korry/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/11/IMG_27381.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/11/IMG_27381-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/11/IMG_27381-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Hope House, a residential treatment program in Martinez, helps people in a mental health crisis make the transition back to the community. (Elaine Korry/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>It's lunchtime at Hope House, a new 16-bed residential facility in Martinez, east of San Francisco. People who live here are busy preparing lunch in what looks like a big country kitchen.\u003c/p>\n\u003cp>\"We’ve designed it as much as possible to have a homelike atmosphere,\" says program director Christopher Roach. \"We want people to be thinking, this is a transition to the community.\"\u003c/p>\n\u003cp>Many of the residents here have arrived directly from a hospital. Among them are young adults facing a psychotic break, chronically-ill homeless men or mothers battling mental illness and addiction. After an average two-weeks of intense counseling, Roach says they’ll leave with hope for recovery.\u003c/p>\n\u003cp>\"What you’re able to accomplish in 14 days is huge if you know what you’re looking for,\" he says.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>19-year-old Chris Nguyen says his very life was on the line before he made it to this safe haven.\u003c/p>\n\u003cp>\"I have bipolar disorder,\" he explains, \"so I was having manic depressive symptoms and eventually it led to self-harm thoughts, suicidal thoughts, and I almost acted on it, but my family members were there to intervene and get me the help I needed.\"\u003c/p>\n\u003cp>Clinicians here helped Nguyen give up the marijuana and alcohol he had been using to treat his extreme anxiety. After getting proper medication, he started therapy -- individual, family and group -- where he began to talk about his fears of failure.\u003c/p>\n\u003cp>\"It let me calm down, slow things down finally, there’s all that pressure that you feel at a young age - so going here allowed me to take a step back and look at it. Wait, I need to build some support systems, take care of myself before I try to look at the path to success.\"\u003c/p>\n\u003cp>Now back home, Nguyen continues his treatment in an outpatient program.\u003c/p>\n\u003cp>Experts say residential treatment centers are a critical link in a system of care designed to keep people in a mental health crisis from spiraling downward.\u003c/p>\n\u003cp>\"What you have is a place where you can intervene to stop and redirect what would be an inpatient, involuntary, psychiatric admit to a hospital.\"\u003c/p>\n\u003cp>Randall Hagar is with the California Psychiatric Association, which has lobbied for years for more residential treatment options. Psychiatric services have been severely underfunded in California for decades. Cutbacks closed hospital wards and left big gaps in the system of care. But that process has been reversed over the last two years. Last year lawmakers passed the Investment in Mental Health Wellness Act.\u003c/p>\n\u003cp>Contra Costa County used grant money from the 2012 so-called \"Millionaires Tax\" proposition to fund Hope House. Hagar says without these sources of money, places like Hope House couldn’t exist. Cash-strapped counties simply can’t afford to build them on their own.\u003c/p>\n\u003cp>\"The money is very welcome, and it’s going toward very desperately needed services,\" Hagar says.\u003c/p>\n\u003cp>Besides residential treatment, counties around the state are using mental health grants to fund new urgent care units and \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/11/07/new-state-funding-improves-county-mental-health-services/\" href=\"http://ww2.kqed.org/stateofhealth/2014/11/07/new-state-funding-improves-county-mental-health-services/\" target=\"_blank\">mobile crisis teams\u003c/a> that pair clinicians with police officers to keep psychiatric patients out of jail.\u003c/p>\n\u003cp>\"The grants are going to do a great job of getting these things set up,\" Hagar said. \"Counties are going to have to find a way to keep them going, and that’s the rub.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Hagar says for counties that have few resources, finding long-term funding will be the toughest challenge.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_22472\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000016939839_Large-e1415663541743.jpg\">\u003cimg class=\"size-large wp-image-22472\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000016939839_Large-640x420.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"420\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>The Joslyn Center in Burbank is a place where older adults come for low-cost healthy meals and activities ranging from fitness and computer classes to music lessons.\u003c/p>\n\u003cp>But several times lately, the normally placid environment of the center has been disrupted. One client who uses the services was showing signs of mental illness. Renee Crawford coordinates social services at the Center.\u003c/p>\n\u003cp>“She gets very loud, very aggressive and very anxious,\" Crawford said, in reference to the troubled client. \"And then we have to go in and tell her, 'Calm down, relax, you can’t be this loud,' Then she gets very upset and very irate.”\u003c/p>\n\u003cp>The woman seemed to be suffering from paranoid delusions, and Crawford says the workers here aren’t trained to help her.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Staff gets very uncomfortable with it. We have called the police. We have asked her to leave the building.”\u003c/p>\n\u003cp>Until recently, there were few places for Crawford to go for help. But \u003ca title=\"http://www.treasurer.ca.gov/chffa/imhwa/\" href=\"http://www.treasurer.ca.gov/chffa/imhwa/\" target=\"_blank\">legislation passed last year\u003c/a> in Sacramento provides more than $140 million in grant funds for, among other things, mobile crisis support teams.\u003c/p>\n\u003cp>Because Crawford was worried her client might become violent, she turned to a service of the Burbank Police Department, called a Mental Health Evaluation Team. The team pairs a clinical psychologist and a patrol officer, who respond together to mental health crises. Psychologist Jennifer Hunt says the goal is to assess people and, if appropriate, connect them with mental health services. The team seeks to head off a confrontation that could land a person, like Crawford's client, either in the hospital or jail.\u003c/p>\n\u003cp>“We would want to make sure not only that we are addressing the needs that she continues to present,\" says Hunt, \"but also to make sure that everybody’s safe.”\u003c/p>\n\u003cp>Back in the patrol car, Kristiana Sanchez, the police officer who works with Hunt, says units like this one free up other patrols to focus on their primary mission -- fighting crime. Before crisis teams were in use, she says police officers wasted valuable time in waiting rooms.\u003c/p>\n\u003cp>“It took many officers out of the field to deal with transporting someone who was in a mental health crisis to the hospital and then sitting there for multiple hours,\" Sanchez says. \"And that took two officers for just one person.”\u003c/p>\n\u003cp>Now, says Sanchez, specially-trained officers like her are able to recognize the symptoms of mental disorders.\u003c/p>\n\u003cp>Linda Boyd, who started the emergency outreach bureau for Los Angeles County, says responding to mental illness requires very different skills from disarming criminals.\u003c/p>\n\u003cp>“We treat people with respect,\" Boyd says. \"We don’t rush in. … We give the person time to calm down. With folks who have a mental illness, you really have to slow down.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Mobile crisis teams are expensive, and were only available in parts of the Los Angeles County until last year when lawmakers approved the Investment in Mental Health Wellness Act. It restored badly needed funding for psychiatric services. Now, with the new grant money, Los Angeles has more than a dozen new mobile crisis teams, and is doubling the number of its urgent care units -- places where people in a psychiatric emergency can go for help, instead of the hospital or jail.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22472\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000016939839_Large-e1415663541743.jpg\">\u003cimg class=\"size-large wp-image-22472\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/iStock_000016939839_Large-640x420.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"420\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>The Joslyn Center in Burbank is a place where older adults come for low-cost healthy meals and activities ranging from fitness and computer classes to music lessons.\u003c/p>\n\u003cp>But several times lately, the normally placid environment of the center has been disrupted. One client who uses the services was showing signs of mental illness. Renee Crawford coordinates social services at the Center.\u003c/p>\n\u003cp>“She gets very loud, very aggressive and very anxious,\" Crawford said, in reference to the troubled client. \"And then we have to go in and tell her, 'Calm down, relax, you can’t be this loud,' Then she gets very upset and very irate.”\u003c/p>\n\u003cp>The woman seemed to be suffering from paranoid delusions, and Crawford says the workers here aren’t trained to help her.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Staff gets very uncomfortable with it. We have called the police. We have asked her to leave the building.”\u003c/p>\n\u003cp>Until recently, there were few places for Crawford to go for help. But \u003ca title=\"http://www.treasurer.ca.gov/chffa/imhwa/\" href=\"http://www.treasurer.ca.gov/chffa/imhwa/\" target=\"_blank\">legislation passed last year\u003c/a> in Sacramento provides more than $140 million in grant funds for, among other things, mobile crisis support teams.\u003c/p>\n\u003cp>Because Crawford was worried her client might become violent, she turned to a service of the Burbank Police Department, called a Mental Health Evaluation Team. The team pairs a clinical psychologist and a patrol officer, who respond together to mental health crises. Psychologist Jennifer Hunt says the goal is to assess people and, if appropriate, connect them with mental health services. The team seeks to head off a confrontation that could land a person, like Crawford's client, either in the hospital or jail.\u003c/p>\n\u003cp>“We would want to make sure not only that we are addressing the needs that she continues to present,\" says Hunt, \"but also to make sure that everybody’s safe.”\u003c/p>\n\u003cp>Back in the patrol car, Kristiana Sanchez, the police officer who works with Hunt, says units like this one free up other patrols to focus on their primary mission -- fighting crime. Before crisis teams were in use, she says police officers wasted valuable time in waiting rooms.\u003c/p>\n\u003cp>“It took many officers out of the field to deal with transporting someone who was in a mental health crisis to the hospital and then sitting there for multiple hours,\" Sanchez says. \"And that took two officers for just one person.”\u003c/p>\n\u003cp>Now, says Sanchez, specially-trained officers like her are able to recognize the symptoms of mental disorders.\u003c/p>\n\u003cp>Linda Boyd, who started the emergency outreach bureau for Los Angeles County, says responding to mental illness requires very different skills from disarming criminals.\u003c/p>\n\u003cp>“We treat people with respect,\" Boyd says. \"We don’t rush in. … We give the person time to calm down. With folks who have a mental illness, you really have to slow down.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Mobile crisis teams are expensive, and were only available in parts of the Los Angeles County until last year when lawmakers approved the Investment in Mental Health Wellness Act. It restored badly needed funding for psychiatric services. Now, with the new grant money, Los Angeles has more than a dozen new mobile crisis teams, and is doubling the number of its urgent care units -- places where people in a psychiatric emergency can go for help, instead of the hospital or jail.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Students Struggle to Access Mental Health Services on UC Campuses",
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"content": "\u003cfigure id=\"attachment_21642\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/hankzby/2346334452/in/photolist-63LgLe-9x2t1S-63QvZU-hupmxC-4yah92-bCkeua-aF4nGK-5WNAjf-7a4T2e-4zkzuh-xFWZ6-bCkgmF-drmDCx-9wYsLx-9x2sTA-9x2teE-9wYhit-e4cWxN-e47fJi-CPD4-9wYsDB-5bE76S-e4d17U-e47mve-e4cVnQ-e4cYtd-e47iNg-e47hxM-e47jyR-e4cVKy-e47mT6-e47jWB-e47kKP-e47kjn-e4cZHW-moUE-n79pfx-7a5FcV-79Nvk2-79Nva8-79NtVz-79Skgw-79SmcL-79Nvtk-79Nu7x-79Ntxa-7a9r1J-bpqkoj-bCkg1R-drn6pU\">\u003cimg class=\"size-large wp-image-21642\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/2346334452_f5e85a3e82_o-copy-640x361.jpg\" alt=\"Students at Sproul Plaza, UC Berkeley. (Henry Zbyszynski/Flickr)\" width=\"640\" height=\"361\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Students at Sproul Plaza, UC Berkeley. In the last six years, the number of students seeking health at counseling centers has increased 37 percent across the UC system. (Henry Zbyszynski/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ciframe width=\"100%\" height=\"20\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/168470037&color=ff5500&inverse=false&auto_play=false&show_user=true\">\u003c/iframe>\u003c/p>\n\u003cp>Students throughout the University of California system are having trouble accessing mental health care, and health services directors are raising alarms that increased staffing and funding could be warranted to meet demand.\u003c/p>\n\u003cp>“The increased need for mental health services on our campuses is outstripping our ability to provide those services,” said Dr. John Stobo, senior vice president for health sciences and services for the University of California. “It is a major problem. It’s not only a problem for UC, this is a national issue.”\u003c/p>\n\u003cp>In the last six years, the number of students seeking help at university counseling centers has increased 37 percent, according to data presented at UC Regents board meeting on Thursday.\u003c/p>\n\u003cp>“This is real. Students are having difficulty accessing mental health services on campus,” said Dr. Gina Fleming, medical director for the UC Self-Insured Health Plans. “They’re waiting longer to get an appointment. They’re having fewer appointments within the course of therapy, and more are needing to be referred off campus.”\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Wait times for regular appointments have been four weeks, or more in some cases. A typical student who calls in complaining of mild anxiety and procrastination in the first few weeks of the semester could be waiting until finals for therapy to begin in earnest.\u003c/p>\n\u003cp>“What might have started as a routine procrastination intervention may now be a crisis in full bloom,” said Elizabeth Gong-Guy, executive director of Counseling and Psychological Services at UCLA.\u003c/p>\n\u003cp>“Increasingly, we find that many of the students who make their way to our counseling centers are seasoned perfectionists who’ve driven themselves to unsustainable positions in which their lives lack any semblance of balance or self-compassion. These are students with eating disorders, crippling obsessive-compulsive disorders, cutting histories, addictions, and illicit stimulant abuse.”\u003c/p>\n\u003cp>She says more students are seeking help now because of awareness campaigns that helped reduced stigma around mental health issues. Those campaigns were funded through a $6.8 million grant the university received under Proposition 63, a voter-approved ballot measure that raised taxes on the wealthiest Californians to provide funds for the state’s public mental health system.\u003c/p>\n\u003cp>But that funding to the university ends this year, and health services directors worry they do not have enough money to hire the staff needed to keep up with unabated demand.\u003c/p>\n\u003cp>Gong-Guy said the UCLA counseling center treated 8,500 students last year – that amounts to 21 percent of the student population and a 23 percent increase over the year before.\u003c/p>\n\u003cp>System-wide, 25 percent of students who receive services at campus counseling centers are on psychotropic medications.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“This increased utilization is now seriously limiting access to timely treatment that’s needed to support student success,” she said.\u003cbr>\nThe UC Regents asked the health services committee to bring a list of potential solutions to the next board meeting in November.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_21642\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/hankzby/2346334452/in/photolist-63LgLe-9x2t1S-63QvZU-hupmxC-4yah92-bCkeua-aF4nGK-5WNAjf-7a4T2e-4zkzuh-xFWZ6-bCkgmF-drmDCx-9wYsLx-9x2sTA-9x2teE-9wYhit-e4cWxN-e47fJi-CPD4-9wYsDB-5bE76S-e4d17U-e47mve-e4cVnQ-e4cYtd-e47iNg-e47hxM-e47jyR-e4cVKy-e47mT6-e47jWB-e47kKP-e47kjn-e4cZHW-moUE-n79pfx-7a5FcV-79Nvk2-79Nva8-79NtVz-79Skgw-79SmcL-79Nvtk-79Nu7x-79Ntxa-7a9r1J-bpqkoj-bCkg1R-drn6pU\">\u003cimg class=\"size-large wp-image-21642\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/2346334452_f5e85a3e82_o-copy-640x361.jpg\" alt=\"Students at Sproul Plaza, UC Berkeley. (Henry Zbyszynski/Flickr)\" width=\"640\" height=\"361\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Students at Sproul Plaza, UC Berkeley. In the last six years, the number of students seeking health at counseling centers has increased 37 percent across the UC system. (Henry Zbyszynski/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ciframe width=\"100%\" height=\"20\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/168470037&color=ff5500&inverse=false&auto_play=false&show_user=true\">\u003c/iframe>\u003c/p>\n\u003cp>Students throughout the University of California system are having trouble accessing mental health care, and health services directors are raising alarms that increased staffing and funding could be warranted to meet demand.\u003c/p>\n\u003cp>“The increased need for mental health services on our campuses is outstripping our ability to provide those services,” said Dr. John Stobo, senior vice president for health sciences and services for the University of California. “It is a major problem. It’s not only a problem for UC, this is a national issue.”\u003c/p>\n\u003cp>In the last six years, the number of students seeking help at university counseling centers has increased 37 percent, according to data presented at UC Regents board meeting on Thursday.\u003c/p>\n\u003cp>“This is real. Students are having difficulty accessing mental health services on campus,” said Dr. Gina Fleming, medical director for the UC Self-Insured Health Plans. “They’re waiting longer to get an appointment. They’re having fewer appointments within the course of therapy, and more are needing to be referred off campus.”\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Wait times for regular appointments have been four weeks, or more in some cases. A typical student who calls in complaining of mild anxiety and procrastination in the first few weeks of the semester could be waiting until finals for therapy to begin in earnest.\u003c/p>\n\u003cp>“What might have started as a routine procrastination intervention may now be a crisis in full bloom,” said Elizabeth Gong-Guy, executive director of Counseling and Psychological Services at UCLA.\u003c/p>\n\u003cp>“Increasingly, we find that many of the students who make their way to our counseling centers are seasoned perfectionists who’ve driven themselves to unsustainable positions in which their lives lack any semblance of balance or self-compassion. These are students with eating disorders, crippling obsessive-compulsive disorders, cutting histories, addictions, and illicit stimulant abuse.”\u003c/p>\n\u003cp>She says more students are seeking help now because of awareness campaigns that helped reduced stigma around mental health issues. Those campaigns were funded through a $6.8 million grant the university received under Proposition 63, a voter-approved ballot measure that raised taxes on the wealthiest Californians to provide funds for the state’s public mental health system.\u003c/p>\n\u003cp>But that funding to the university ends this year, and health services directors worry they do not have enough money to hire the staff needed to keep up with unabated demand.\u003c/p>\n\u003cp>Gong-Guy said the UCLA counseling center treated 8,500 students last year – that amounts to 21 percent of the student population and a 23 percent increase over the year before.\u003c/p>\n\u003cp>System-wide, 25 percent of students who receive services at campus counseling centers are on psychotropic medications.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“This increased utilization is now seriously limiting access to timely treatment that’s needed to support student success,” she said.\u003cbr>\nThe UC Regents asked the health services committee to bring a list of potential solutions to the next board meeting in November.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
"info": "Sold Out: Rethinking Housing in America",
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