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"content": "\u003cfigure id=\"attachment_20865\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\">\u003cimg class=\"size-full wp-image-20865\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\" alt=\"A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Small\u003c/strong>\u003c/p>\n\u003cp>In response to a court order, California prison officials proposed a new approach Friday to how they treat mentally ill inmates who break rules or commit new crimes. The judge who ordered the change immediately approved the plan.\u003c/p>\n\u003cp>Right now, if a mentally ill inmate refuses to follow orders or attacks another inmate or guards, the prison sends him to a segregation unit. In segregation, prisoners spend more time confined to their cells and must submit to routine strip searches for weapons and drugs. Advocates for inmates have long insisted the conditions only worsen mental illness. Earlier this year, U.S. District Judge Lawrence Karlton unequivocally backed them up.\u003c/p>\n\u003cp>In an April ruling, \u003ca href=\"http://ww2.kqed.org/news/2014/04/11/california-mistreating-mentally-ill-inmates/\" target=\"_blank\">the judge wrote\u003c/a>, “placement of seriously mentally ill inmates in California’s segregation housing unit can and does cause serious psychological harm” by worsening symptoms, inducing psychosis and increasing suicidal urges.\u003c!--more-->\u003c/p>\n\u003cp>In a statement, Dana Simas, spokesperson with the California Department of Corrections and Rehabilitation said that \u003cspan style=\"color: #000000\">CDCR was continuing to make \"lasting cultural changes to how the Department responds to and treats mentally ill inmates.\" Simas also said that CDCR would \"continue to work with all parties to improve mental health care for inmates and to ensure that there is strong collaboration between custody and mental health staff.\" \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">In\u003c/span> the response sent to Judge Karlton, CDCR said it would no longer send mentally ill inmates to segregation units.\u003c/p>\n\u003cp>Instead, they’ll create new housing designed for them that offers twice as much out-of-cell time and more psychiatric care. Corrections staff on those units will take “a collaborative approach” with mental health staff “to ensure the well-being of the inmates housed in these new units,” they wrote.\u003c/p>\n\u003cp>“This is a big, big change,” said Michael Bien, an attorney for inmates who asked the judge to intervene. Bien said the state’s plan steers these prisoners away from the harshest conditions of punishment and into treatment that could help.\u003c/p>\n\u003cp>“They’ll be in one of the new units,” Bien said, “where they’ll get much more treatment, much more out-of-cell time, and hopefully experience less stress.”\u003c/p>\n\u003cp>More than 3,000 inmates in segregation have been diagnosed with serious mental disorders.\u003c/p>\n\u003cp>Corrections will conduct a case-by-case review of those prisoners -- starting with those who have the longest segregation terms -- to decide whether to keep them in the new units or release them back into the general prison population, if they are stable.\u003c/p>\n\u003cp>Friday’s plan is the final piece of a massive overhaul of California’s treatment of mentally ill prisoners. Corrections official have also agreed to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/california-prisons-to-restrict-pepper-spray-segregation-of-mentally-ill-inmates/\" target=\"_blank\">new restrictions on pepper-spraying \u003c/a>and strip-searching the inmates, and to more training and oversight of prison staff who interact with them.\u003c/p>\n\u003cp style=\"margin: 12px auto 6px auto;font-family: Helvetica,Arial,Sans-serif;font-style: normal;font-variant: normal;font-weight: normal;font-size: 14px;line-height: normal\">\u003ca style=\"text-decoration: underline\" title=\"View California Prisons Adopts Plan to Restrict Segregation for Mentally-Ill Inmates on Scribd\" href=\"http://www.scribd.com/doc/238135295/California-Prisons-Adopts-Plan-to-Restrict-Segregation-for-Mentally-Ill-Inmates\">California Prisons Adopts Plan to Restrict Segregation for Mentally-Ill Inmates\u003c/a> by \u003ca style=\"text-decoration: underline\" title=\"View KQED News's profile on Scribd\" href=\"http://www.scribd.com/KQED_News\">KQED News\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ciframe id=\"doc_27145\" class=\"scribd_iframe_embed\" src=\"//www.scribd.com/embeds/238135295/content?start_page=1&view_mode=scroll&access_key=key-SukfPfzdeMdOF3YkzxWp&show_recommendations=false\" width=\"640\" height=\"853\" frameborder=\"0\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20865\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\">\u003cimg class=\"size-full wp-image-20865\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\" alt=\"A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Small\u003c/strong>\u003c/p>\n\u003cp>In response to a court order, California prison officials proposed a new approach Friday to how they treat mentally ill inmates who break rules or commit new crimes. The judge who ordered the change immediately approved the plan.\u003c/p>\n\u003cp>Right now, if a mentally ill inmate refuses to follow orders or attacks another inmate or guards, the prison sends him to a segregation unit. In segregation, prisoners spend more time confined to their cells and must submit to routine strip searches for weapons and drugs. Advocates for inmates have long insisted the conditions only worsen mental illness. Earlier this year, U.S. District Judge Lawrence Karlton unequivocally backed them up.\u003c/p>\n\u003cp>In an April ruling, \u003ca href=\"http://ww2.kqed.org/news/2014/04/11/california-mistreating-mentally-ill-inmates/\" target=\"_blank\">the judge wrote\u003c/a>, “placement of seriously mentally ill inmates in California’s segregation housing unit can and does cause serious psychological harm” by worsening symptoms, inducing psychosis and increasing suicidal urges.\u003c!--more-->\u003c/p>\n\u003cp>In a statement, Dana Simas, spokesperson with the California Department of Corrections and Rehabilitation said that \u003cspan style=\"color: #000000\">CDCR was continuing to make \"lasting cultural changes to how the Department responds to and treats mentally ill inmates.\" Simas also said that CDCR would \"continue to work with all parties to improve mental health care for inmates and to ensure that there is strong collaboration between custody and mental health staff.\" \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">In\u003c/span> the response sent to Judge Karlton, CDCR said it would no longer send mentally ill inmates to segregation units.\u003c/p>\n\u003cp>Instead, they’ll create new housing designed for them that offers twice as much out-of-cell time and more psychiatric care. Corrections staff on those units will take “a collaborative approach” with mental health staff “to ensure the well-being of the inmates housed in these new units,” they wrote.\u003c/p>\n\u003cp>“This is a big, big change,” said Michael Bien, an attorney for inmates who asked the judge to intervene. Bien said the state’s plan steers these prisoners away from the harshest conditions of punishment and into treatment that could help.\u003c/p>\n\u003cp>“They’ll be in one of the new units,” Bien said, “where they’ll get much more treatment, much more out-of-cell time, and hopefully experience less stress.”\u003c/p>\n\u003cp>More than 3,000 inmates in segregation have been diagnosed with serious mental disorders.\u003c/p>\n\u003cp>Corrections will conduct a case-by-case review of those prisoners -- starting with those who have the longest segregation terms -- to decide whether to keep them in the new units or release them back into the general prison population, if they are stable.\u003c/p>\n\u003cp>Friday’s plan is the final piece of a massive overhaul of California’s treatment of mentally ill prisoners. Corrections official have also agreed to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/california-prisons-to-restrict-pepper-spray-segregation-of-mentally-ill-inmates/\" target=\"_blank\">new restrictions on pepper-spraying \u003c/a>and strip-searching the inmates, and to more training and oversight of prison staff who interact with them.\u003c/p>\n\u003cp style=\"margin: 12px auto 6px auto;font-family: Helvetica,Arial,Sans-serif;font-style: normal;font-variant: normal;font-weight: normal;font-size: 14px;line-height: normal\">\u003ca style=\"text-decoration: underline\" title=\"View California Prisons Adopts Plan to Restrict Segregation for Mentally-Ill Inmates on Scribd\" href=\"http://www.scribd.com/doc/238135295/California-Prisons-Adopts-Plan-to-Restrict-Segregation-for-Mentally-Ill-Inmates\">California Prisons Adopts Plan to Restrict Segregation for Mentally-Ill Inmates\u003c/a> by \u003ca style=\"text-decoration: underline\" title=\"View KQED News's profile on Scribd\" href=\"http://www.scribd.com/KQED_News\">KQED News\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ciframe id=\"doc_27145\" class=\"scribd_iframe_embed\" src=\"//www.scribd.com/embeds/238135295/content?start_page=1&view_mode=scroll&access_key=key-SukfPfzdeMdOF3YkzxWp&show_recommendations=false\" width=\"640\" height=\"853\" frameborder=\"0\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Diverting Mentally Ill to Treatment, Not Jail",
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"content": "\u003cfigure id=\"attachment_20935\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/mental-health-squad-2-3d58ec409058c60abfcad7c02e22d95277273dc1-s40-c85-e1408568139344.jpg\">\u003cimg class=\"size-large wp-image-20935\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/mental-health-squad-2-3d58ec409058c60abfcad7c02e22d95277273dc1-s40-c85-640x479.jpg\" alt=\"Officers Ned Bandoske (left) and Ernest Stevens are part of San Antonio's mental health squad — a six-person unit that answers the frequent emergency calls where mental illness may play a role. (Jenny Gold/KHN)\" width=\"640\" height=\"479\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Officers Ned Bandoske (left) and Ernest Stevens are part of San Antonio's mental health squad — a six-person unit that answers the frequent emergency calls where mental illness may play a role. (Jenny Gold/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>This week, Julie Small has reported on this blog about court-ordered overhauls in caring for mentally ill inmates in California prisons. About one-fourth of California's inmates -- 37,000 people -- have mild to severe mental illness.\u003c/p>\n\u003cp>As Small reported, U.S. District Judge Lawrence Karlton ordered the California Department of Corrections and Rehabilitation (CDCR) in April to draft new policies for \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/18/california-prisons-begin-use-of-force-reforms-for-mentally-ill-inmates/\" target=\"_blank\">use of force\u003c/a> and has signed off on CDCR's plans. Now the department is working on plans to comply with Karlton's orders to change how it \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/19/judge-orders-overhaul-in-segregation-for-californias-mentally-ill-inmates/\" target=\"_blank\">handles segregation\u003c/a> for inmates with mental illness.\u003c/p>\n\u003cp>So, I was riveted by a report this morning from \u003ca href=\"http://www.npr.org/blogs/health/2014/08/19/338895262/mental-health-cops-help-reweave-social-safety-net-in-san-antonio\" target=\"_blank\">NPR\u003c/a> and Kaiser Health News about a different approach -- a coordinated, comprehensive approach -- to a county-run mental health system. The story was set in Texas' Bexar County, (pronouced \"bear\") home to San Antonio and the Alamo, and the program is now a model for the nation.\u003c!--more-->\u003c/p>\n\u003cp>It used to be -- as recently as 15 years ago -- that Bexar County's jail was so overcrowded with people suffering from serious mental illness that the state was getting ready to impose fines, NPR reported.\u003c/p>\n\u003cp>Then Leon Evans, took over as head of San Antonio and Bexar County's mental health systems and had a vision: For people with mental illness, treatment works. Jail does not.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Evans wanted to stop the expensive revolving door from jail back to the streets. From the \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/August/20/San-Antonio-model-mental-health-system.aspx\" target=\"_blank\">NPR/KHN \u003c/a>report:\u003c/p>\n\u003cblockquote>\u003cp>\u003cspan style=\"color: #000000\">When people with a serious mental illness are released from jail, many end up living on the street, sick and often addicted. And then almost invariably, they end up back in jail for a minor nuisance crime, like panhandling (which is illegal in San Antonio), urinating in public, digging in dumpsters or sleeping on someone’s porch.\u003c/span>\u003c/p>\u003c/blockquote>\n\u003cp>Evans saw the most pressing problem in treatment: scattered services. The county and city agencies, the nonprofits, the jails, the hospitals -- none of them were talking to each other. \"People who fund these services only look at their little small piece of the pie and whether there is a return on investment,\" Evans told NPR.\u003c/p>\n\u003cp>It wasn't easy or fast, but Evans brought people together and, among many other things, looked at how how much money all the players were spending on mental health. They discovered enormous sums being spent to care for people -- and doing it poorly. Pooling money could offer significant savings. More from \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/August/20/San-Antonio-model-mental-health-system.aspx\" target=\"_blank\">NPR/KHN\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>\u003cspan style=\"color: #000000\">The courts, the jails, the hospitals, the county government and the police department agreed to work together on the issue. Everyone provided funding– the police even contributed their drug seizure money – to build a system where people with mental illnesses could get better. \u003c/span>\u003c/p>\u003c/blockquote>\n\u003cp>Today, there is one centralized complex offering services, and it's located across the street from San Antonio's \"state-of-the-art homeless shelter.\" Police officers all take a 40-hour course in handling mental health crises. The police department now has a six-person mental health squad -- officers specialize in responding to calls where mental illness may be a factor.\u003c/p>\n\u003cp>Advocates call the new approach a big success, plus it's saving money, about $10 million annually.\u003c/p>\n\u003cblockquote>\n\u003cp style=\"color: #000000\">“One thing that’s really important about the San Antonio approach is that they’ve integrated services together for mental health and substance abuse and homeless services, because most people have overlapping needs,” says Laura Usher, a program manager at the National Alliance on Mental Illness who helps set up collaborations between law enforcement agencies and mental health departments.\u003c/p>\n\u003cp style=\"color: #000000\">The center has a 48-hour inpatient psychiatric unit, sobering and detox centers, outpatient primary care and psychiatric services, a 90-day recovery program, housing for people with mental illnesses, and even job training and a program to help people transition to supported housing.\u003c/p>\n\u003cp style=\"color: #000000\">\"San Antonio realized that it’s more cost effective to provide mental health services and supports to people on the front end, rather than pay for jail beds and prison time,” says Usher.\u003c/p>\n\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>As the piece wrapped up, I tried to imagine how great the savings could be in California, the most populous state in the country, if mental health care could be so coordinated and comprehensive here.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20935\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/mental-health-squad-2-3d58ec409058c60abfcad7c02e22d95277273dc1-s40-c85-e1408568139344.jpg\">\u003cimg class=\"size-large wp-image-20935\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/mental-health-squad-2-3d58ec409058c60abfcad7c02e22d95277273dc1-s40-c85-640x479.jpg\" alt=\"Officers Ned Bandoske (left) and Ernest Stevens are part of San Antonio's mental health squad — a six-person unit that answers the frequent emergency calls where mental illness may play a role. (Jenny Gold/KHN)\" width=\"640\" height=\"479\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Officers Ned Bandoske (left) and Ernest Stevens are part of San Antonio's mental health squad — a six-person unit that answers the frequent emergency calls where mental illness may play a role. (Jenny Gold/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>This week, Julie Small has reported on this blog about court-ordered overhauls in caring for mentally ill inmates in California prisons. About one-fourth of California's inmates -- 37,000 people -- have mild to severe mental illness.\u003c/p>\n\u003cp>As Small reported, U.S. District Judge Lawrence Karlton ordered the California Department of Corrections and Rehabilitation (CDCR) in April to draft new policies for \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/18/california-prisons-begin-use-of-force-reforms-for-mentally-ill-inmates/\" target=\"_blank\">use of force\u003c/a> and has signed off on CDCR's plans. Now the department is working on plans to comply with Karlton's orders to change how it \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/19/judge-orders-overhaul-in-segregation-for-californias-mentally-ill-inmates/\" target=\"_blank\">handles segregation\u003c/a> for inmates with mental illness.\u003c/p>\n\u003cp>So, I was riveted by a report this morning from \u003ca href=\"http://www.npr.org/blogs/health/2014/08/19/338895262/mental-health-cops-help-reweave-social-safety-net-in-san-antonio\" target=\"_blank\">NPR\u003c/a> and Kaiser Health News about a different approach -- a coordinated, comprehensive approach -- to a county-run mental health system. The story was set in Texas' Bexar County, (pronouced \"bear\") home to San Antonio and the Alamo, and the program is now a model for the nation.\u003c!--more-->\u003c/p>\n\u003cp>It used to be -- as recently as 15 years ago -- that Bexar County's jail was so overcrowded with people suffering from serious mental illness that the state was getting ready to impose fines, NPR reported.\u003c/p>\n\u003cp>Then Leon Evans, took over as head of San Antonio and Bexar County's mental health systems and had a vision: For people with mental illness, treatment works. Jail does not.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Evans wanted to stop the expensive revolving door from jail back to the streets. From the \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/August/20/San-Antonio-model-mental-health-system.aspx\" target=\"_blank\">NPR/KHN \u003c/a>report:\u003c/p>\n\u003cblockquote>\u003cp>\u003cspan style=\"color: #000000\">When people with a serious mental illness are released from jail, many end up living on the street, sick and often addicted. And then almost invariably, they end up back in jail for a minor nuisance crime, like panhandling (which is illegal in San Antonio), urinating in public, digging in dumpsters or sleeping on someone’s porch.\u003c/span>\u003c/p>\u003c/blockquote>\n\u003cp>Evans saw the most pressing problem in treatment: scattered services. The county and city agencies, the nonprofits, the jails, the hospitals -- none of them were talking to each other. \"People who fund these services only look at their little small piece of the pie and whether there is a return on investment,\" Evans told NPR.\u003c/p>\n\u003cp>It wasn't easy or fast, but Evans brought people together and, among many other things, looked at how how much money all the players were spending on mental health. They discovered enormous sums being spent to care for people -- and doing it poorly. Pooling money could offer significant savings. More from \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/August/20/San-Antonio-model-mental-health-system.aspx\" target=\"_blank\">NPR/KHN\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>\u003cspan style=\"color: #000000\">The courts, the jails, the hospitals, the county government and the police department agreed to work together on the issue. Everyone provided funding– the police even contributed their drug seizure money – to build a system where people with mental illnesses could get better. \u003c/span>\u003c/p>\u003c/blockquote>\n\u003cp>Today, there is one centralized complex offering services, and it's located across the street from San Antonio's \"state-of-the-art homeless shelter.\" Police officers all take a 40-hour course in handling mental health crises. The police department now has a six-person mental health squad -- officers specialize in responding to calls where mental illness may be a factor.\u003c/p>\n\u003cp>Advocates call the new approach a big success, plus it's saving money, about $10 million annually.\u003c/p>\n\u003cblockquote>\n\u003cp style=\"color: #000000\">“One thing that’s really important about the San Antonio approach is that they’ve integrated services together for mental health and substance abuse and homeless services, because most people have overlapping needs,” says Laura Usher, a program manager at the National Alliance on Mental Illness who helps set up collaborations between law enforcement agencies and mental health departments.\u003c/p>\n\u003cp style=\"color: #000000\">The center has a 48-hour inpatient psychiatric unit, sobering and detox centers, outpatient primary care and psychiatric services, a 90-day recovery program, housing for people with mental illnesses, and even job training and a program to help people transition to supported housing.\u003c/p>\n\u003cp style=\"color: #000000\">\"San Antonio realized that it’s more cost effective to provide mental health services and supports to people on the front end, rather than pay for jail beds and prison time,” says Usher.\u003c/p>\n\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>As the piece wrapped up, I tried to imagine how great the savings could be in California, the most populous state in the country, if mental health care could be so coordinated and comprehensive here.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Prisons Begin 'Use-of-Force' Reforms for Mentally Ill Inmates",
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"content": "\u003cfigure id=\"attachment_20865\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\">\u003cimg class=\"size-full wp-image-20865\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\" alt=\"A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Small\u003c/strong>\u003c/p>\n\u003cp>The number of inmates with mild to severe mental illness has grown to 37,000 in California, about a quarter of the prison population.\u003c/p>\n\u003cp>A series of lawsuits brought by inmates against the state over the last two decades has exposed a correctional system poorly equipped to handle their extraordinary needs.\u003c/p>\n\u003cp>Now California is trying to comply with a federal court order to change when and how correctional officers use pepper spray to force uncooperative inmates to leave their cells or follow orders.\u003c/p>\n\u003cp>Pepper spray may have contributed to three inmate deaths and an unknown number of injuries -- unknown because the California Department of Corrections and Rehabilitations doesn’t consider the effects of pepper spray an injury.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The issue was brought to light last year through graphic videos shown in court in a lawsuit that was begun in 1990, a lawsuit brought by inmates to improve psychiatric care.\u003c/p>\n\u003cp>Prisons record some use of force incidents, according to department policy.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/18/a-day-in-californias-psychiatric-prison-units/\" target=\"_blank\">A Day in California's Psychiatric Prison Units\u003c/a>]\u003c/p>\n\u003cp>One video showed custody staff at Corcoran State Prison struggling to remove an inmate who was hallucinating and refusing to leave his cell in order to receive medication.\u003c/p>\n\u003cp>The inmate had taken off his clothes and smeared feces on himself. When he refused to submit to handcuffs, guards in gas masks sprayed a potent pepper spray into the cell, causing the inmate to gasp for air.\u003c/p>\n\u003cp>The video showed that as the inmate screamed for help, an officer ordered him to “turn around and cuff up.”\u003c/p>\n\u003cp>The inmate screamed back, “Open the door!”\u003c/p>\n\u003cp>When the inmate still wouldn't “cuff up” the officers sprayed him again, repeatedly.\u003c/p>\n\u003cp>Later, the video showed guards rushing in and wrestling the inmate to the floor and into restraints.\u003c/p>\n\u003cp>“He has described this as making him feel like less than an animal,” said Lori Rifkin, an attorney for inmate Jermaine Padilla, who is suing the Department of Corrections.\u003c/p>\n\u003cp>Rifkin says two years on, her client still has flashbacks and nightmares from the process prison officials refer to as a “cell extraction.”\u003c/p>\n\u003cp>Padilla believes the experience at Corcoran worsened his schizophrenia and bi-polar disorder and has permanently damaged him.\u003c/p>\n\u003cp>“It changed something in him,” Rifkin says. “He’d never been treated that badly, and it broke something in him.”\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/163303802&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>The Padilla video, and five others shown last fall, were the latest revelation in a long history of problems with mental health care in California prisons that have prompted federal court intervention.\u003c/p>\n\u003cp>U.S. District Judge Lawrence Karlton called the video evidence “horrific.” In April, he ordered new restrictions on the use of force. He banned the use of pepper spray on mentally ill inmates in cells and psychiatric holding facilities with few exceptions. He instructed prison officials whenever possible to defer to clinicians about whether to use force.\u003c/p>\n\u003cp>On August 1st, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/california-prisons-to-restrict-pepper-spray-segregation-of-mentally-ill-inmates/\" target=\"_blank\">the judge signed of\u003c/a>f on the Department of Corrections’ reform plan.\u003c/p>\n\u003cp>Among the changes: prison staff will be trained to collaborate and to exhaust every reasonable alternative to force.\u003c/p>\n\u003cp>Craig Brown, a lobbyist for the California Correctional Peace Officers Association agrees with this approach. “The critical element is to appropriately train our members to recognize what they’re dealing with,” Brown said.\u003c/p>\n\u003cp>Brown says the union has been pushing for better training for years. He says additional training will help them interact with the growing percentage of mentally ill inmates.\u003c/p>\n\u003cp>“They’ll recognize what’s going on,\" Brown said. \"They’ll know when they need to talk to a mental health professional. They know when they don’t.\"\u003c/p>\n\u003cp>The state department of corrections declined to be interviewed for this story. They referred KQED to their plan filed with the court.\u003c/p>\n\u003cp>Under that plan a mental health clinician must be called in to evaluate an inmate’s mental status to determine whether they’re able to understand directions. This evaluation now must happen before officers can proceed with use of force. If a clinician decides force shouldn’t be used, correctional officers can no longer override that decision. Instead, the conflict will be referred to senior management to resolve.\u003c/p>\n\u003cp>Dr. Alan Abrams says the state’s plan reinforces the values and strategies he used when he was the chief psychiatrist at the California Medical Facility in Vacaville. Abrams, who left the post a couple years ago, says staff at most prisons already collaborate well.\u003c/p>\n\u003cp>Abrams believes the problem is that there have been a limited number of ways to handle violent inmates.\u003c/p>\n\u003cp>“One (inmate) is brutalizing another,\" he explained. \"Yes, they’re labeled mentally ill, but you need to stop the violence very quickly. It’s not a discussion.”\u003c/p>\n\u003cp>In his 12 years working in prisons Abrams says he ordered force numerous times to keep inmates from killing each other or themselves.\u003c/p>\n\u003cp>“What do you do about the inmate who’s in their cell with a t-shirt, in a noose, saying they’re going to kill themselves unless you release them from prison?” says Abrams, “You’re not going to watch him hang himself. You’re not going to release him from prison, and so you say to your custody co-workers ‘You better get them down!’”\u003c/p>\n\u003cp>But Terry Kupers, a national expert on correctional mental health believes the pepper-spraying incidents indicate inadequate mental health care in the prisons. He says prisons can and should mitigate conditions that exacerbate mental illness.\u003c/p>\n\u003cp>“The pepper spray, the cell extractions, the beatings, the violence among prisoners--all those constitute reenactments of trauma in people who were previously traumatized and make them more emotionally disabled,” Kupers said.\u003c/p>\n\u003cp>California prison officials believe they will have fully implemented the reforms by the end of this year. But they’re still negotiating another critical change to how mentally ill inmates are managed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Judge Karlton wants a proposal by next week that will restrict how often and for how long prisons can house inmates with mental disorders in segregation units -- where their illnesses can and do worsen.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20865\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\">\u003cimg class=\"size-full wp-image-20865\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\" alt=\"A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Small\u003c/strong>\u003c/p>\n\u003cp>The number of inmates with mild to severe mental illness has grown to 37,000 in California, about a quarter of the prison population.\u003c/p>\n\u003cp>A series of lawsuits brought by inmates against the state over the last two decades has exposed a correctional system poorly equipped to handle their extraordinary needs.\u003c/p>\n\u003cp>Now California is trying to comply with a federal court order to change when and how correctional officers use pepper spray to force uncooperative inmates to leave their cells or follow orders.\u003c/p>\n\u003cp>Pepper spray may have contributed to three inmate deaths and an unknown number of injuries -- unknown because the California Department of Corrections and Rehabilitations doesn’t consider the effects of pepper spray an injury.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The issue was brought to light last year through graphic videos shown in court in a lawsuit that was begun in 1990, a lawsuit brought by inmates to improve psychiatric care.\u003c/p>\n\u003cp>Prisons record some use of force incidents, according to department policy.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/18/a-day-in-californias-psychiatric-prison-units/\" target=\"_blank\">A Day in California's Psychiatric Prison Units\u003c/a>]\u003c/p>\n\u003cp>One video showed custody staff at Corcoran State Prison struggling to remove an inmate who was hallucinating and refusing to leave his cell in order to receive medication.\u003c/p>\n\u003cp>The inmate had taken off his clothes and smeared feces on himself. When he refused to submit to handcuffs, guards in gas masks sprayed a potent pepper spray into the cell, causing the inmate to gasp for air.\u003c/p>\n\u003cp>The video showed that as the inmate screamed for help, an officer ordered him to “turn around and cuff up.”\u003c/p>\n\u003cp>The inmate screamed back, “Open the door!”\u003c/p>\n\u003cp>When the inmate still wouldn't “cuff up” the officers sprayed him again, repeatedly.\u003c/p>\n\u003cp>Later, the video showed guards rushing in and wrestling the inmate to the floor and into restraints.\u003c/p>\n\u003cp>“He has described this as making him feel like less than an animal,” said Lori Rifkin, an attorney for inmate Jermaine Padilla, who is suing the Department of Corrections.\u003c/p>\n\u003cp>Rifkin says two years on, her client still has flashbacks and nightmares from the process prison officials refer to as a “cell extraction.”\u003c/p>\n\u003cp>Padilla believes the experience at Corcoran worsened his schizophrenia and bi-polar disorder and has permanently damaged him.\u003c/p>\n\u003cp>“It changed something in him,” Rifkin says. “He’d never been treated that badly, and it broke something in him.”\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/163303802&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>The Padilla video, and five others shown last fall, were the latest revelation in a long history of problems with mental health care in California prisons that have prompted federal court intervention.\u003c/p>\n\u003cp>U.S. District Judge Lawrence Karlton called the video evidence “horrific.” In April, he ordered new restrictions on the use of force. He banned the use of pepper spray on mentally ill inmates in cells and psychiatric holding facilities with few exceptions. He instructed prison officials whenever possible to defer to clinicians about whether to use force.\u003c/p>\n\u003cp>On August 1st, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/california-prisons-to-restrict-pepper-spray-segregation-of-mentally-ill-inmates/\" target=\"_blank\">the judge signed of\u003c/a>f on the Department of Corrections’ reform plan.\u003c/p>\n\u003cp>Among the changes: prison staff will be trained to collaborate and to exhaust every reasonable alternative to force.\u003c/p>\n\u003cp>Craig Brown, a lobbyist for the California Correctional Peace Officers Association agrees with this approach. “The critical element is to appropriately train our members to recognize what they’re dealing with,” Brown said.\u003c/p>\n\u003cp>Brown says the union has been pushing for better training for years. He says additional training will help them interact with the growing percentage of mentally ill inmates.\u003c/p>\n\u003cp>“They’ll recognize what’s going on,\" Brown said. \"They’ll know when they need to talk to a mental health professional. They know when they don’t.\"\u003c/p>\n\u003cp>The state department of corrections declined to be interviewed for this story. They referred KQED to their plan filed with the court.\u003c/p>\n\u003cp>Under that plan a mental health clinician must be called in to evaluate an inmate’s mental status to determine whether they’re able to understand directions. This evaluation now must happen before officers can proceed with use of force. If a clinician decides force shouldn’t be used, correctional officers can no longer override that decision. Instead, the conflict will be referred to senior management to resolve.\u003c/p>\n\u003cp>Dr. Alan Abrams says the state’s plan reinforces the values and strategies he used when he was the chief psychiatrist at the California Medical Facility in Vacaville. Abrams, who left the post a couple years ago, says staff at most prisons already collaborate well.\u003c/p>\n\u003cp>Abrams believes the problem is that there have been a limited number of ways to handle violent inmates.\u003c/p>\n\u003cp>“One (inmate) is brutalizing another,\" he explained. \"Yes, they’re labeled mentally ill, but you need to stop the violence very quickly. It’s not a discussion.”\u003c/p>\n\u003cp>In his 12 years working in prisons Abrams says he ordered force numerous times to keep inmates from killing each other or themselves.\u003c/p>\n\u003cp>“What do you do about the inmate who’s in their cell with a t-shirt, in a noose, saying they’re going to kill themselves unless you release them from prison?” says Abrams, “You’re not going to watch him hang himself. You’re not going to release him from prison, and so you say to your custody co-workers ‘You better get them down!’”\u003c/p>\n\u003cp>But Terry Kupers, a national expert on correctional mental health believes the pepper-spraying incidents indicate inadequate mental health care in the prisons. He says prisons can and should mitigate conditions that exacerbate mental illness.\u003c/p>\n\u003cp>“The pepper spray, the cell extractions, the beatings, the violence among prisoners--all those constitute reenactments of trauma in people who were previously traumatized and make them more emotionally disabled,” Kupers said.\u003c/p>\n\u003cp>California prison officials believe they will have fully implemented the reforms by the end of this year. But they’re still negotiating another critical change to how mentally ill inmates are managed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Judge Karlton wants a proposal by next week that will restrict how often and for how long prisons can house inmates with mental disorders in segregation units -- where their illnesses can and do worsen.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_20737\" class=\"wp-caption aligncenter\" style=\"max-width: 561px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/robinwilliams.png\">\u003cimg class=\"size-full wp-image-20737\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/robinwilliams.png\" alt=\"An Instagram photo that comedian and actor Robin Williams posted on his last birthday, July 21. The caption: ‘Happy Birthday to me! A visit from one of my favorite leading ladies, Crystal.’\" width=\"561\" height=\"564\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams.png 561w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams-400x402.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams-320x322.png 320w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams-32x32.png 32w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams-64x64.png 64w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams-96x96.png 96w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams-128x128.png 128w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams-75x75.png 75w\" sizes=\"(max-width: 561px) 100vw, 561px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">An Instagram photo that comedian and actor Robin Williams posted on his last birthday, July 21. The caption: ‘Happy Birthday to me! A visit from one of my favorite leading ladies, Crystal.’\u003c/figcaption>\u003c/figure>\n\u003cp>You don't really expect a professional baseball player to be the one person to articulate the effect Robin Williams had on much of the general public, but that was my feeling when I read this quote in today's\u003ca href=\"http://www.sfgate.com/giants/article/Giants-probable-pitchers-5684932.php\" target=\"_blank\"> San Francisco Chronicle\u003c/a> from Giants pitcher Tim Lincecum, who had once been thrilled to receive a congatulatory handshake from Williams. Said Lincecum:\u003c/p>\n\u003cp>\"\u003cspan style=\"color: #000000\">He made things feel like they weren't so bad.\"\u003c/span>\u003c/p>\n\u003cp>Remembering some of Williams' early manic groundbreaking appearances on television and movies, the statement rang true, as did the chilling irony in its description of a man who seemingly had everything but clearly thought that things \u003cem>were\u003c/em> that bad, after all.\u003c/p>\n\u003caside class=\"pullquote alignleft\">The suicide rate for white men increased almost 40 percent between 1999 and 2011.\u003c/aside>\n\u003cp>Considering his suicide, it's not surprising that Williams' publicist said Monday that the comedian suffered from severe depression. Williams also struggled with substance abuse issues for decades. Since his death, a national conversation has ensued on the insidious effects of depression, and how it can prove fatal even in those who, to the outside world, seemingly have everything to live for.\u003c/p>\n\u003cp>Around the country, media organizations have been interviewing mental health experts on the subject. The \u003ca href=\"http://www.sfgate.com/health/article/Robin-Williams-death-shines-light-on-5684974.php\" target=\"_blank\"> Chronicle\u003c/a> talked to some who worried about the impact of Williams' suicide on those struggling with depression. \"I get concerned about people wondering if people as promising as him with all these resources available can't make it, what are the chances for them?\" Patricia Arean, a UCSF clinical psychologist and psychiatry professor, told the paper.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She said many people who are depressed often can't find their way to the appropriate treatment if what they're currently doing to address their condition isn't working.\u003c!--more-->\u003c/p>\n\u003cp>\"Unfortunately, what happens is that people don't know enough about their own illness to know if they're not getting better,\" Arean said.\u003c/p>\n\u003cp>Dr. Winston Chung, medical director of inpatient psychiatry at California Pacific Medical Center, said there is still a stigma on those with mental health conditions. Discovering physical traces of mental illness, such as genetic traits and biological markers, could help reduce that stigma, he said.\u003c/p>\n\u003cp>\"With cancer, you can see the cells under the microscope. In depression, you can't see it,\" Chung told the Chronicle. \"There's no broken bone, no radiological finding. We need to have concrete evidence, not unlike the cancer cell. Something we can see and reliably associate with mental health issues.\"\u003c/p>\n\u003cp>\u003cstrong>A Risk: Aging White Men\u003c/strong>\u003c/p>\n\u003cp>The \u003ca href=\"http://www.washingtonpost.com/national/health-science/robin-williams-in-a-group-facing-higher-risk-of-suicide-older-white-men-with-depression/2014/08/12/8e1164d6-225e-11e4-86ca-6f03cbd15c1a_story.html\" target=\"_blank\">Washington Post writes\u003c/a> that Williams belonged to a demographic with an especially high risk of suicide: older white men. ...\u003c/p>\n\u003cblockquote>\u003cp>If you tried to create a profile of someone at high risk of committing suicide, one likely example would look like this: A middle-aged or older white male toward the end of a successful career, who suffers from a serious medical problem as well as chronic depression and substance abuse, who recently completed treatment for either or both of those psychological conditions and who is going through a difficult period, personally or professionally.\u003c/p>\u003c/blockquote>\n\u003cp>Last year,the federal government reported the suicide rate for white men increased almost 40 percent between 1999 and 2011. And. because white men use more lethal methods, such as shooting themselves, they account for 80 percent of fatalities despite making up just 20 percent of attempts.\u003c/p>\n\u003cp>Another factor in the high suicide rate among older men: They are less likely to seek help, Older men may also be prone to reflecting negatively on what they have done with their lives, with an accompanying loss of self-esteem.\u003c/p>\n\u003cp>\"Has the career been worth it, or did I sacrifice my family . . . I think that is part of what happens for people,” Nadine Kaslow, a psychology professor at the Emory University School of Medicine, told the Post.\u003c/p>\n\u003cp>Christopher Kilmartin, a psychology professor at the University of Mary Washington, said he often refers to aging males as \"developmentally unsuccessful, because they’re not equipped to handle the challenges of getting older if they are so tied into their masculinity . . . and making a lot of money.\"\u003c/p>\n\u003cp>Said Dost Ongur, associate professor of psychiatry at Harvard Medical School: “Things aren’t the way they used to be. The power you knew, the control you knew, aren’t the same.”\u003c/p>\n\u003cp>In 2010, Williams told fellow comedian Marc Maron, on Maron's \u003ca href=\"http://www.wtfpod.com/podcast/episodes/remembering_robin_williams\" target=\"_blank\">WTF podcast\u003c/a>, that he had contemplated suicide in the past. When discussing what caused him to start drinking again in 2005, Williams told Maron, according to the \u003ca href=\"http://www.latimes.com/entertainment/movies/la-et-mn-robin-williams-last-days-20140813-story.html#page=1\" target=\"_blank\">L.A. Times\u003c/a>, \"It's trying to fill the hole, and it's fear. You're going, 'What am I doing in my career?' You bottom out. ... People say, 'You have an Academy Award.' The Academy Award lasted about a week, and then one week later people are going, 'Hey, Mork!'\"\u003c/p>\n\u003cp>\u003cstrong>Comics Prone to Depression\u003c/strong>\u003c/p>\n\u003cp>Comics are so prone to depression that the Laugh Factory, a comedy club in Los Angeles, started in-house therapy sessions in 2011. Owner Jamie Masada told the \u003ca href=\"http://articles.latimes.com/2011/feb/09/entertainment/la-et-comedy-therapy-20110209\" target=\"_blank\">L.A .Times\u003c/a> at the time, \"This is serious. This is something we have to do. From Richard Jeni putting a gun in his mouth and blowing himself up [in 2007] to Greg Giraldo taking drugs and overdosing [in 2010], I just can't stand to watch all of my family, one by one [self-destruct].\u003c/p>\n\u003cp>\"From Sam Kinison to Rodney Dangerfield to Paul Rodriguez, Dom Irrera — every comic, they have a little demon in them.\"\u003c/p>\n\u003cp>Clinical psychologist Ildiko L. Tabori told the Times that research indicated a \"higher degree of depression and bipolar disorder in comedians.\"\u003c/p>\n\u003cp>\"Laughter is a defensive mechanism,\" she said.\" It's one of the more mature defense mechanisms, but it still masks whatever it is that's going on inside.\"\u003c/p>\n\u003cp>The Washington Post took a look at \u003ca href=\"http://www.washingtonpost.com/news/morning-mix/wp/2014/08/12/robin-williams-was-one-of-many-comics-battling-depression/\" target=\"_blank\">other comedians who have suffered from depression\u003c/a>. Cited is a 2013 TEDxYouth Talk by comedian Kevin Breel called \"Confessions of a Depressed Comic.\"\u003c/p>\n\u003cblockquote>\u003cp>Breel is just 20, but he’s already had to battle suicidal urges. Outwardly, he said, he hardly seemed like the type you would suspect would be depressed — he was a model student and athlete. “Depression isn’t chicken pox,” Breel said. “You don’t beat it once and then it’s gone forever. It’s something you live with. It’s something you live in. It’s the roommate you can’t kick out. It’s the voice you can’t ignore and the feelings you can’t seem to escape, and the scariest part is, the scariest part is that after awhile, you become numb to it.”\u003c/p>\u003c/blockquote>\n\u003cp>\u003ciframe src=\"https://embed-ssl.ted.com/talks/kevin_breel_confessions_of_a_depressed_comic.html\" width=\"560\" height=\"315\" frameborder=\"0\" scrolling=\"no\" allowfullscreen=\"allowfullscreen\">\u003c/iframe>\u003c/p>\n\u003cp>\u003cstrong>The \u003ca href=\"http://www.sfgate.com/health/article/Robin-Williams-death-shines-light-on-5684974.php\" target=\"_blank\">Chronicle\u003c/a> compiled this list of resources in the Bay Area for those who are undergoing a mental health crisis\u003c/strong>:\u003c/p>\n\u003cp>-- Suicide prevention/crisis line: (800) 273-TALK (8255)\u003c/p>\n\u003cp>-- San Francisco General Hospital Psychiatric Emergency Services: (415) 206-8125\u003c/p>\n\u003cp>-- For any mental health emergency, call the San Francisco Suicide Prevention's 24-hour hotline at (415) 781-0500 or go to www.sfsuicide.org.\u003c/p>\n\u003cp>-- To find mental health help or other social services in Bay Area counties, dial 211 or go to http://211bayarea.org.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>-- San Francisco's Institute on Aging runs The Friendship Line, a hotline specifically for older adults, \u003cspan style=\"color: #3f4549\">1-800-971-0016\u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20737\" class=\"wp-caption aligncenter\" style=\"max-width: 561px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/robinwilliams.png\">\u003cimg class=\"size-full wp-image-20737\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/robinwilliams.png\" alt=\"An Instagram photo that comedian and actor Robin Williams posted on his last birthday, July 21. The caption: ‘Happy Birthday to me! A visit from one of my favorite leading ladies, Crystal.’\" width=\"561\" height=\"564\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams.png 561w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams-400x402.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams-320x322.png 320w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams-32x32.png 32w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams-64x64.png 64w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams-96x96.png 96w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams-128x128.png 128w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/robinwilliams-75x75.png 75w\" sizes=\"(max-width: 561px) 100vw, 561px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">An Instagram photo that comedian and actor Robin Williams posted on his last birthday, July 21. The caption: ‘Happy Birthday to me! A visit from one of my favorite leading ladies, Crystal.’\u003c/figcaption>\u003c/figure>\n\u003cp>You don't really expect a professional baseball player to be the one person to articulate the effect Robin Williams had on much of the general public, but that was my feeling when I read this quote in today's\u003ca href=\"http://www.sfgate.com/giants/article/Giants-probable-pitchers-5684932.php\" target=\"_blank\"> San Francisco Chronicle\u003c/a> from Giants pitcher Tim Lincecum, who had once been thrilled to receive a congatulatory handshake from Williams. Said Lincecum:\u003c/p>\n\u003cp>\"\u003cspan style=\"color: #000000\">He made things feel like they weren't so bad.\"\u003c/span>\u003c/p>\n\u003cp>Remembering some of Williams' early manic groundbreaking appearances on television and movies, the statement rang true, as did the chilling irony in its description of a man who seemingly had everything but clearly thought that things \u003cem>were\u003c/em> that bad, after all.\u003c/p>\n\u003caside class=\"pullquote alignleft\">The suicide rate for white men increased almost 40 percent between 1999 and 2011.\u003c/aside>\n\u003cp>Considering his suicide, it's not surprising that Williams' publicist said Monday that the comedian suffered from severe depression. Williams also struggled with substance abuse issues for decades. Since his death, a national conversation has ensued on the insidious effects of depression, and how it can prove fatal even in those who, to the outside world, seemingly have everything to live for.\u003c/p>\n\u003cp>Around the country, media organizations have been interviewing mental health experts on the subject. The \u003ca href=\"http://www.sfgate.com/health/article/Robin-Williams-death-shines-light-on-5684974.php\" target=\"_blank\"> Chronicle\u003c/a> talked to some who worried about the impact of Williams' suicide on those struggling with depression. \"I get concerned about people wondering if people as promising as him with all these resources available can't make it, what are the chances for them?\" Patricia Arean, a UCSF clinical psychologist and psychiatry professor, told the paper.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She said many people who are depressed often can't find their way to the appropriate treatment if what they're currently doing to address their condition isn't working.\u003c!--more-->\u003c/p>\n\u003cp>\"Unfortunately, what happens is that people don't know enough about their own illness to know if they're not getting better,\" Arean said.\u003c/p>\n\u003cp>Dr. Winston Chung, medical director of inpatient psychiatry at California Pacific Medical Center, said there is still a stigma on those with mental health conditions. Discovering physical traces of mental illness, such as genetic traits and biological markers, could help reduce that stigma, he said.\u003c/p>\n\u003cp>\"With cancer, you can see the cells under the microscope. In depression, you can't see it,\" Chung told the Chronicle. \"There's no broken bone, no radiological finding. We need to have concrete evidence, not unlike the cancer cell. Something we can see and reliably associate with mental health issues.\"\u003c/p>\n\u003cp>\u003cstrong>A Risk: Aging White Men\u003c/strong>\u003c/p>\n\u003cp>The \u003ca href=\"http://www.washingtonpost.com/national/health-science/robin-williams-in-a-group-facing-higher-risk-of-suicide-older-white-men-with-depression/2014/08/12/8e1164d6-225e-11e4-86ca-6f03cbd15c1a_story.html\" target=\"_blank\">Washington Post writes\u003c/a> that Williams belonged to a demographic with an especially high risk of suicide: older white men. ...\u003c/p>\n\u003cblockquote>\u003cp>If you tried to create a profile of someone at high risk of committing suicide, one likely example would look like this: A middle-aged or older white male toward the end of a successful career, who suffers from a serious medical problem as well as chronic depression and substance abuse, who recently completed treatment for either or both of those psychological conditions and who is going through a difficult period, personally or professionally.\u003c/p>\u003c/blockquote>\n\u003cp>Last year,the federal government reported the suicide rate for white men increased almost 40 percent between 1999 and 2011. And. because white men use more lethal methods, such as shooting themselves, they account for 80 percent of fatalities despite making up just 20 percent of attempts.\u003c/p>\n\u003cp>Another factor in the high suicide rate among older men: They are less likely to seek help, Older men may also be prone to reflecting negatively on what they have done with their lives, with an accompanying loss of self-esteem.\u003c/p>\n\u003cp>\"Has the career been worth it, or did I sacrifice my family . . . I think that is part of what happens for people,” Nadine Kaslow, a psychology professor at the Emory University School of Medicine, told the Post.\u003c/p>\n\u003cp>Christopher Kilmartin, a psychology professor at the University of Mary Washington, said he often refers to aging males as \"developmentally unsuccessful, because they’re not equipped to handle the challenges of getting older if they are so tied into their masculinity . . . and making a lot of money.\"\u003c/p>\n\u003cp>Said Dost Ongur, associate professor of psychiatry at Harvard Medical School: “Things aren’t the way they used to be. The power you knew, the control you knew, aren’t the same.”\u003c/p>\n\u003cp>In 2010, Williams told fellow comedian Marc Maron, on Maron's \u003ca href=\"http://www.wtfpod.com/podcast/episodes/remembering_robin_williams\" target=\"_blank\">WTF podcast\u003c/a>, that he had contemplated suicide in the past. When discussing what caused him to start drinking again in 2005, Williams told Maron, according to the \u003ca href=\"http://www.latimes.com/entertainment/movies/la-et-mn-robin-williams-last-days-20140813-story.html#page=1\" target=\"_blank\">L.A. Times\u003c/a>, \"It's trying to fill the hole, and it's fear. You're going, 'What am I doing in my career?' You bottom out. ... People say, 'You have an Academy Award.' The Academy Award lasted about a week, and then one week later people are going, 'Hey, Mork!'\"\u003c/p>\n\u003cp>\u003cstrong>Comics Prone to Depression\u003c/strong>\u003c/p>\n\u003cp>Comics are so prone to depression that the Laugh Factory, a comedy club in Los Angeles, started in-house therapy sessions in 2011. Owner Jamie Masada told the \u003ca href=\"http://articles.latimes.com/2011/feb/09/entertainment/la-et-comedy-therapy-20110209\" target=\"_blank\">L.A .Times\u003c/a> at the time, \"This is serious. This is something we have to do. From Richard Jeni putting a gun in his mouth and blowing himself up [in 2007] to Greg Giraldo taking drugs and overdosing [in 2010], I just can't stand to watch all of my family, one by one [self-destruct].\u003c/p>\n\u003cp>\"From Sam Kinison to Rodney Dangerfield to Paul Rodriguez, Dom Irrera — every comic, they have a little demon in them.\"\u003c/p>\n\u003cp>Clinical psychologist Ildiko L. Tabori told the Times that research indicated a \"higher degree of depression and bipolar disorder in comedians.\"\u003c/p>\n\u003cp>\"Laughter is a defensive mechanism,\" she said.\" It's one of the more mature defense mechanisms, but it still masks whatever it is that's going on inside.\"\u003c/p>\n\u003cp>The Washington Post took a look at \u003ca href=\"http://www.washingtonpost.com/news/morning-mix/wp/2014/08/12/robin-williams-was-one-of-many-comics-battling-depression/\" target=\"_blank\">other comedians who have suffered from depression\u003c/a>. Cited is a 2013 TEDxYouth Talk by comedian Kevin Breel called \"Confessions of a Depressed Comic.\"\u003c/p>\n\u003cblockquote>\u003cp>Breel is just 20, but he’s already had to battle suicidal urges. Outwardly, he said, he hardly seemed like the type you would suspect would be depressed — he was a model student and athlete. “Depression isn’t chicken pox,” Breel said. “You don’t beat it once and then it’s gone forever. It’s something you live with. It’s something you live in. It’s the roommate you can’t kick out. It’s the voice you can’t ignore and the feelings you can’t seem to escape, and the scariest part is, the scariest part is that after awhile, you become numb to it.”\u003c/p>\u003c/blockquote>\n\u003cp>\u003ciframe src=\"https://embed-ssl.ted.com/talks/kevin_breel_confessions_of_a_depressed_comic.html\" width=\"560\" height=\"315\" frameborder=\"0\" scrolling=\"no\" allowfullscreen=\"allowfullscreen\">\u003c/iframe>\u003c/p>\n\u003cp>\u003cstrong>The \u003ca href=\"http://www.sfgate.com/health/article/Robin-Williams-death-shines-light-on-5684974.php\" target=\"_blank\">Chronicle\u003c/a> compiled this list of resources in the Bay Area for those who are undergoing a mental health crisis\u003c/strong>:\u003c/p>\n\u003cp>-- Suicide prevention/crisis line: (800) 273-TALK (8255)\u003c/p>\n\u003cp>-- San Francisco General Hospital Psychiatric Emergency Services: (415) 206-8125\u003c/p>\n\u003cp>-- For any mental health emergency, call the San Francisco Suicide Prevention's 24-hour hotline at (415) 781-0500 or go to www.sfsuicide.org.\u003c/p>\n\u003cp>-- To find mental health help or other social services in Bay Area counties, dial 211 or go to http://211bayarea.org.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "California Prisons to Restrict Pepper Spray, Segregation of Mentally Ill Inmates",
"title": "California Prisons to Restrict Pepper Spray, Segregation of Mentally Ill Inmates",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_20494\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/IMG_0203.jpg\">\u003cimg class=\"size-large wp-image-20494\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/IMG_0203-640x480.jpg\" alt=\" Bunk of an empty segregation cell at California State Prison-Sacramento. (Julie Small/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Bunk of an empty segregation cell at California State Prison-Sacramento. (Julie Small/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Small\u003c/strong>\u003c/p>\n\u003cp>California prison officials proposed major policy changes Friday to curtail when and how correctional staff use pepper spray on mentally ill inmates or segregate them from the general prison population.\u003c/p>\n\u003cp>The California Department of Corrections and Rehabilitation (CDCR) planned to vest mental health clinicians with greater say in whether correctional staff may use force or segregate inmate patients. The agency also set strict time limits on the segregation of mentally ill inmates who had committed no serious violations or crimes in prison.\u003c/p>\n\u003cp>CDCR proposed these changes to comply with a court order issued by U.S. District Judge Lawrence Karlton. Judge Karlton \u003ca href=\"http://ww2.kqed.org/news/2014/04/11/california-mistreating-mentally-ill-inmates/\" target=\"_blank\">ordered the changes \u003c/a>to California’s policies in April, after a lengthy evidentiary hearing.\u003c!--more-->\u003c/p>\n\u003cp>In court the judge viewed videotapes of custody staff repeatedly pepper spraying mentally ill inmates to force them from their cells. Judge Karlton \u003ca href=\"http://ww2.kqed.org/news/2014/04/11/california-mistreating-mentally-ill-inmates/\" target=\"_blank\">called such use of force on mentally ill inmates “horrific” \u003c/a>and said the state’s policies “demonstrate deliberate indifference to their mental illness and the harms caused by the weapons.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In papers filed Friday in the U.S. Eastern District Court, CDCR agreed to limit the amount of pepper spray that custody officers can use and to ban completely the practice in certain types of housing, unless the prison’s warden authorizes it.\u003c/p>\n\u003cp style=\"text-align: center\">\u003cstrong>[Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2011/11/22/health-effects-of-pepper-spray-and-tips-to-treat-it/\" target=\"_blank\">How Does Pepper Spray Cause Harm?\u003c/a>]\u003c/p>\n\u003cp>CDCR also proposed changes that would allow mental health clinicians to block the use of force if they believed it would harm their inmate patients. Correctional officers could no longer override such objections. Instead, senior managers would resolve any disputes.\u003c/p>\n\u003cp>Michael Bien, an attorney who represents mentally ill prisoners, called the proposed changes “meaningful reforms that go a long way to addressing some of the critical issues we raised during the trial last fall.”\u003c/p>\n\u003cp>Bien is the lead attorney in a 1990 case -- yet to be resolved -- to improve psychiatric care in prisons.\u003c/p>\n\u003cp>Gov. Jerry Brown \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/26/state-seeks-return-to-full-control-over-prison-system-mental-health-care/\" target=\"_blank\">tried to get the case dismissed last year\u003c/a>, saying that the state had met its constitutional obligation to provide prisoners with mental health care.\u003c/p>\n\u003cp>The move back-fired, however, when attorneys for inmates presented fresh evidence of problems, prompting the judge to order new improvements.\u003c/p>\n\u003cp>Bien said that one of the most significant changes CDCR agreed to would reduce the number of strip searches of mentally ill inmates in segregated housing units.\u003c/p>\n\u003cp>Corrections officials also agreed to transfer some inmates out within 72 hours, if they were placed in segregated housing only because there was no other housing available.\u003c/p>\n\u003cp>California prisons isolate prisoners who violate rules or commit new crimes in prison. But they’ve also placed mentally ill inmates in those same segregation units when they couldn’t find space for them in a psychiatric treatment unit.\u003c/p>\n\u003cp>Inmates in segregation spend more time each day inside their cells than inmates in the general population and must submit to strip searches each time they leave and return to those cells.\u003c/p>\n\u003cp>Prison officials testified last year that mentally ill inmates suffered no harm from those conditions because the department still met their needs for mental health care.\u003c/p>\n\u003cp>Judge Karlton rejected that claim. In his ruling he asserted segregated housing “can and does cause serious psychological harm, including decompensation, exacerbation of mental illness, inducement of psychosis, and increased risk of suicide.”\u003c/p>\n\u003cp>Karlton wants prisons to develop a more rigorous process for deciding whether inmates with mental illness who violate the rules, or commit new crimes should be segregated.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Prisons officials are still negotiating those changes with the federal court’s special master. The parties must reach agreement and file those plans by August 15.\u003c/p>\n\n",
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"excerpt": "The new policy is to comply with a federal court order to stop \"horrific\" use of force.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20494\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/IMG_0203.jpg\">\u003cimg class=\"size-large wp-image-20494\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/IMG_0203-640x480.jpg\" alt=\" Bunk of an empty segregation cell at California State Prison-Sacramento. (Julie Small/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Bunk of an empty segregation cell at California State Prison-Sacramento. (Julie Small/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Small\u003c/strong>\u003c/p>\n\u003cp>California prison officials proposed major policy changes Friday to curtail when and how correctional staff use pepper spray on mentally ill inmates or segregate them from the general prison population.\u003c/p>\n\u003cp>The California Department of Corrections and Rehabilitation (CDCR) planned to vest mental health clinicians with greater say in whether correctional staff may use force or segregate inmate patients. The agency also set strict time limits on the segregation of mentally ill inmates who had committed no serious violations or crimes in prison.\u003c/p>\n\u003cp>CDCR proposed these changes to comply with a court order issued by U.S. District Judge Lawrence Karlton. Judge Karlton \u003ca href=\"http://ww2.kqed.org/news/2014/04/11/california-mistreating-mentally-ill-inmates/\" target=\"_blank\">ordered the changes \u003c/a>to California’s policies in April, after a lengthy evidentiary hearing.\u003c!--more-->\u003c/p>\n\u003cp>In court the judge viewed videotapes of custody staff repeatedly pepper spraying mentally ill inmates to force them from their cells. Judge Karlton \u003ca href=\"http://ww2.kqed.org/news/2014/04/11/california-mistreating-mentally-ill-inmates/\" target=\"_blank\">called such use of force on mentally ill inmates “horrific” \u003c/a>and said the state’s policies “demonstrate deliberate indifference to their mental illness and the harms caused by the weapons.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In papers filed Friday in the U.S. Eastern District Court, CDCR agreed to limit the amount of pepper spray that custody officers can use and to ban completely the practice in certain types of housing, unless the prison’s warden authorizes it.\u003c/p>\n\u003cp style=\"text-align: center\">\u003cstrong>[Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2011/11/22/health-effects-of-pepper-spray-and-tips-to-treat-it/\" target=\"_blank\">How Does Pepper Spray Cause Harm?\u003c/a>]\u003c/p>\n\u003cp>CDCR also proposed changes that would allow mental health clinicians to block the use of force if they believed it would harm their inmate patients. Correctional officers could no longer override such objections. Instead, senior managers would resolve any disputes.\u003c/p>\n\u003cp>Michael Bien, an attorney who represents mentally ill prisoners, called the proposed changes “meaningful reforms that go a long way to addressing some of the critical issues we raised during the trial last fall.”\u003c/p>\n\u003cp>Bien is the lead attorney in a 1990 case -- yet to be resolved -- to improve psychiatric care in prisons.\u003c/p>\n\u003cp>Gov. Jerry Brown \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/26/state-seeks-return-to-full-control-over-prison-system-mental-health-care/\" target=\"_blank\">tried to get the case dismissed last year\u003c/a>, saying that the state had met its constitutional obligation to provide prisoners with mental health care.\u003c/p>\n\u003cp>The move back-fired, however, when attorneys for inmates presented fresh evidence of problems, prompting the judge to order new improvements.\u003c/p>\n\u003cp>Bien said that one of the most significant changes CDCR agreed to would reduce the number of strip searches of mentally ill inmates in segregated housing units.\u003c/p>\n\u003cp>Corrections officials also agreed to transfer some inmates out within 72 hours, if they were placed in segregated housing only because there was no other housing available.\u003c/p>\n\u003cp>California prisons isolate prisoners who violate rules or commit new crimes in prison. But they’ve also placed mentally ill inmates in those same segregation units when they couldn’t find space for them in a psychiatric treatment unit.\u003c/p>\n\u003cp>Inmates in segregation spend more time each day inside their cells than inmates in the general population and must submit to strip searches each time they leave and return to those cells.\u003c/p>\n\u003cp>Prison officials testified last year that mentally ill inmates suffered no harm from those conditions because the department still met their needs for mental health care.\u003c/p>\n\u003cp>Judge Karlton rejected that claim. In his ruling he asserted segregated housing “can and does cause serious psychological harm, including decompensation, exacerbation of mental illness, inducement of psychosis, and increased risk of suicide.”\u003c/p>\n\u003cp>Karlton wants prisons to develop a more rigorous process for deciding whether inmates with mental illness who violate the rules, or commit new crimes should be segregated.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Prisons officials are still negotiating those changes with the federal court’s special master. The parties must reach agreement and file those plans by August 15.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Mental Health Training for Police Officers Helps Defuse Crises",
"title": "Mental Health Training for Police Officers Helps Defuse Crises",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_20349\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/islavista-2-e1401137755639.jpg\">\u003cimg class=\"size-full wp-image-20349\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/islavista-2-e1401137755639.jpg\" alt=\"An impromptu memorial in Isla Vista, Calif. for a victim of the mass shooting May 23, 2014. (Diane Block/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/07/islavista-2-e1401137755639.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/07/islavista-2-e1401137755639-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/07/islavista-2-e1401137755639-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">An impromptu memorial in Isla Vista, Calif. for a victim of the mass shooting May 23, 2014. Incidents such as these have raised the issue of how well law enforcement officers are trained to deal with people with severe mental illness. (Diane Block/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Stephanie O’Neill\u003c/strong>\u003c/p>\n\u003cp>Debbie is a Ventura County mother of a 23-year-old son diagnosed with bipolar disorder. At times his condition becomes so severe that he gets delusional and requires hospitalization.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"They weren’t threatening; they didn't scare him. It stayed really, really calm.\"\u003c/aside>\n\u003cp>\"He doesn’t understand that he’s ill and that he needs help,\" Debbie says. \"He thinks he’s fine.\"\u003c/p>\n\u003cp>Debbie, who asked that her last name be withheld for privacy reasons, says when that happens, she calls the sheriff’s department for help -- as she did earlier this year. Their response, she says, was heartening.\u003c/p>\n\u003cp>\"The police officers ... were so great, because they kept telling him, ‘You’re not in trouble, we’re here to help you,' \" she says. \"So they weren’t threatening; they didn't scare him. It stayed really, really calm.\"\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And that allowed the deputies to take Debbie's son to the county psychiatric hospital for emergency observation without incident.\u003c/p>\n\u003cp>\"As far as a bad experience goes, it was as good a bad experience as was possible in this situation,\" she says.\u003c/p>\n\u003cp>Among the responding deputies were several who had received special training in what's known as a \"Crisis Intervention Team\" program or CIT. In the training, the deputies had learned how to better handle people suffering from mental illness. The training is based on \u003ca href=\"http://www.citinternational.org/training-overview/163-memphis-model.html\" target=\"_blank\">a renowned model started in Memphis, Tennessee\u003c/a> in 1988 that is now taught internationally.\u003c/p>\n\u003cp>In the CIT training, first responders learn skills that have been shown to help in increasing jail diversion in people with mental illness and improve the likelihood that people will continue treatment with mental health professionals in the community. The training also resulted in decreased rates of injury among police officers.\u003c/p>\n\u003cp>Tragedies such as \u003ca href=\"http://ww2.kqed.org/news/uc-santa-barbara-shootings\" target=\"_blank\">the Isla Vista mass-killings\u003c/a> in late May; the 2011 \u003ca href=\"http://www.scpr.org/news/2013/06/07/37624/trial-set-for-ex-fullerton-cops-in-homeless-beatin/\" target=\"_blank\">beating death of a homeless man\u003c/a> by police in Orange County and the\u003ca href=\"http://www.10news.com/news/u-s-world/video-shows-chp-officer-punching-woman-on-los-angeles-freeway\" target=\"_blank\"> recent video\u003c/a> of a CHP officer repeatedly punching a woman who had run onto a Los Angeles freeway have raised the issue of how well police officers are trained to deal with people who are mentally ill.\u003c/p>\n\u003cp>\u003ca href=\"http://www.post.ca.gov\" target=\"_blank\">California’s Commission on Peace Officer Standards and Training\u003c/a> (POST) requires that all peace officers undergo a minimum of six hours of mental health training while in the academy.\u003c/p>\n\u003cp>The amount and type of additional training required by any agency, however, varies widely:\u003c/p>\n\u003cul>\n\u003cli>Orange County offers a 16-hour modified CIT program offered to law enforcement\u003c/li>\n\u003cli>San Diego Police and Sheriff Departments adopted a 24-hour Psychiatric Emergency Response Team (PERT) training\u003c/li>\n\u003cli>San Francisco Police Department as well as law enforcement agencies in Monterey and Ventura adopted a 40-hour CIT program\u003c/li>\n\u003c/ul>\n\u003cp>\"The idea is to … deescalate and slow down the situation,\" says Kiran Sahota, who oversees CIT training in Ventura County where 72 percent of officers have completed the program. \"Sometimes by just knowing ahead of time that (law enforcement officers) are going to be listening and spending a little extra time, it really can defuse a situation.\"\u003c/p>\n\u003cp>\u003cstrong>\"Sometimes People Fall Through the Cracks\"\u003c/strong>\u003c/p>\n\u003cp>But even so, breakdowns still happen.\u003c/p>\n\u003cp>In Debbie’s case, she says the Ventura County psychiatric hospital released her son before the end of his 14-day hold. Then while he was still in a delusional state, she says, he broke into a neighbor’s vacant house that he thought was his own. He was later arrested and now faces criminal charges.\u003c/p>\n\u003cp>\"He’s never done anything illegal,\" Debbie says. \"If he was in his right mind, he would be mortified.\"\u003c/p>\n\u003cp>A county spokeswoman says patient privacy laws prevent the hospital from commenting on the case.\u003c/p>\n\u003cp>\"Sometimes people fall through the cracks,\" said Devon Corpus, crisis supervisor for Monterey County and an expert in the field of Crisis Intervention Team training. \"You might have officers that have received great training. They’re doing this good work and then they do a hand off to an agency, and there really isn’t a collaboration or team approach to that hand-off.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">\"He was out of his mind. He began to bang his head on the wall, saying, 'If you don’t get me out of here, I’m going to kill myself.'\"\u003c/aside>\n\u003cp>That may have been what happened late last year when Stephanie –- who also lives in Ventura County -- called authorities for help with her 26-year-old son who has bipolar disorder.\u003c/p>\n\u003cp>Stephanie, whose last name was omitted for privacy reasons, says for several days prior to the incident, she and other family members had tried to get her then-suicidal son into a psychiatric hospital.\u003c/p>\n\u003cp>\"But he hadn’t really acted up enough,\" she said. \"And you really have to essentially be out of your mind for them to take you without violating personal rights.\"\u003c/p>\n\u003cp>Ultimately, her son had a fight with his father that became the grounds the family needed to make the call for help.\u003c/p>\n\u003cp>Crisis Intervention Team officers from the Ventura Police Department responded. As happened with Debbie's son, Stephanie says, they were able to calm her son and the situation.\u003c/p>\n\u003cp>But the assault meant her son had to be booked into county jail before being transferred to the psychiatric hospital. Stephanie says the officers told her he would be in jail for just three or four hours before the transfer.\u003c/p>\n\u003cp>\"So I went to bed for the first time in about six weeks with a peaceful mind,\" says Stephanie. \"'Okay, this one’s done. He’s in the hospital. I know he doesn’t love it there, but he’s safe.'\"\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/160271846&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>But, as it turned out, Stephanie says her son wasn't in the hospital, or safe.\u003c/p>\n\u003cp>\"He wound up being in the Ventura County Jail for 28 to 29 hours -- no medication,\" she said. \"They stripped him naked because they thought he might kill himself, somehow, with his clothing. ... So not only was he completely ashamed and out of his mind, he began to bang his head on the wall, saying, 'If you don’t get me out of here, if you don’t get me out of here, I’m going to kill myself.'\"\u003c/p>\n\u003cp>Stephanie says her son’s self-inflicted injuries left him with a severe concussion, a swollen face and two black eyes. A spokesman for the Ventura County Sheriff’s Department, which runs the jail, says the agency could not comment on the case.\u003c/p>\n\u003cp>California Senator Darrell Steinberg (D-Sacramento) says stories like Stephanie’s and Debbie’s are a too-common byproduct of a fragmented and overcrowded mental health system.\u003c/p>\n\u003cp>“The issue of mental illness in the criminal justice system have gotten far too little attention and far too few resources,” Steinberg said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Steinberg and other lawmakers introduced a series of budget proposals to address the needs of those with mental illness. While none creates a uniform standard for additional statewide training of law enforcement officers, one of the measures adopted in the new state budget provides $12 million to train law enforcement and prison personnel in better handling those with mental illness.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20349\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/islavista-2-e1401137755639.jpg\">\u003cimg class=\"size-full wp-image-20349\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/islavista-2-e1401137755639.jpg\" alt=\"An impromptu memorial in Isla Vista, Calif. for a victim of the mass shooting May 23, 2014. (Diane Block/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/07/islavista-2-e1401137755639.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/07/islavista-2-e1401137755639-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/07/islavista-2-e1401137755639-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">An impromptu memorial in Isla Vista, Calif. for a victim of the mass shooting May 23, 2014. Incidents such as these have raised the issue of how well law enforcement officers are trained to deal with people with severe mental illness. (Diane Block/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Stephanie O’Neill\u003c/strong>\u003c/p>\n\u003cp>Debbie is a Ventura County mother of a 23-year-old son diagnosed with bipolar disorder. At times his condition becomes so severe that he gets delusional and requires hospitalization.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"They weren’t threatening; they didn't scare him. It stayed really, really calm.\"\u003c/aside>\n\u003cp>\"He doesn’t understand that he’s ill and that he needs help,\" Debbie says. \"He thinks he’s fine.\"\u003c/p>\n\u003cp>Debbie, who asked that her last name be withheld for privacy reasons, says when that happens, she calls the sheriff’s department for help -- as she did earlier this year. Their response, she says, was heartening.\u003c/p>\n\u003cp>\"The police officers ... were so great, because they kept telling him, ‘You’re not in trouble, we’re here to help you,' \" she says. \"So they weren’t threatening; they didn't scare him. It stayed really, really calm.\"\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And that allowed the deputies to take Debbie's son to the county psychiatric hospital for emergency observation without incident.\u003c/p>\n\u003cp>\"As far as a bad experience goes, it was as good a bad experience as was possible in this situation,\" she says.\u003c/p>\n\u003cp>Among the responding deputies were several who had received special training in what's known as a \"Crisis Intervention Team\" program or CIT. In the training, the deputies had learned how to better handle people suffering from mental illness. The training is based on \u003ca href=\"http://www.citinternational.org/training-overview/163-memphis-model.html\" target=\"_blank\">a renowned model started in Memphis, Tennessee\u003c/a> in 1988 that is now taught internationally.\u003c/p>\n\u003cp>In the CIT training, first responders learn skills that have been shown to help in increasing jail diversion in people with mental illness and improve the likelihood that people will continue treatment with mental health professionals in the community. The training also resulted in decreased rates of injury among police officers.\u003c/p>\n\u003cp>Tragedies such as \u003ca href=\"http://ww2.kqed.org/news/uc-santa-barbara-shootings\" target=\"_blank\">the Isla Vista mass-killings\u003c/a> in late May; the 2011 \u003ca href=\"http://www.scpr.org/news/2013/06/07/37624/trial-set-for-ex-fullerton-cops-in-homeless-beatin/\" target=\"_blank\">beating death of a homeless man\u003c/a> by police in Orange County and the\u003ca href=\"http://www.10news.com/news/u-s-world/video-shows-chp-officer-punching-woman-on-los-angeles-freeway\" target=\"_blank\"> recent video\u003c/a> of a CHP officer repeatedly punching a woman who had run onto a Los Angeles freeway have raised the issue of how well police officers are trained to deal with people who are mentally ill.\u003c/p>\n\u003cp>\u003ca href=\"http://www.post.ca.gov\" target=\"_blank\">California’s Commission on Peace Officer Standards and Training\u003c/a> (POST) requires that all peace officers undergo a minimum of six hours of mental health training while in the academy.\u003c/p>\n\u003cp>The amount and type of additional training required by any agency, however, varies widely:\u003c/p>\n\u003cul>\n\u003cli>Orange County offers a 16-hour modified CIT program offered to law enforcement\u003c/li>\n\u003cli>San Diego Police and Sheriff Departments adopted a 24-hour Psychiatric Emergency Response Team (PERT) training\u003c/li>\n\u003cli>San Francisco Police Department as well as law enforcement agencies in Monterey and Ventura adopted a 40-hour CIT program\u003c/li>\n\u003c/ul>\n\u003cp>\"The idea is to … deescalate and slow down the situation,\" says Kiran Sahota, who oversees CIT training in Ventura County where 72 percent of officers have completed the program. \"Sometimes by just knowing ahead of time that (law enforcement officers) are going to be listening and spending a little extra time, it really can defuse a situation.\"\u003c/p>\n\u003cp>\u003cstrong>\"Sometimes People Fall Through the Cracks\"\u003c/strong>\u003c/p>\n\u003cp>But even so, breakdowns still happen.\u003c/p>\n\u003cp>In Debbie’s case, she says the Ventura County psychiatric hospital released her son before the end of his 14-day hold. Then while he was still in a delusional state, she says, he broke into a neighbor’s vacant house that he thought was his own. He was later arrested and now faces criminal charges.\u003c/p>\n\u003cp>\"He’s never done anything illegal,\" Debbie says. \"If he was in his right mind, he would be mortified.\"\u003c/p>\n\u003cp>A county spokeswoman says patient privacy laws prevent the hospital from commenting on the case.\u003c/p>\n\u003cp>\"Sometimes people fall through the cracks,\" said Devon Corpus, crisis supervisor for Monterey County and an expert in the field of Crisis Intervention Team training. \"You might have officers that have received great training. They’re doing this good work and then they do a hand off to an agency, and there really isn’t a collaboration or team approach to that hand-off.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">\"He was out of his mind. He began to bang his head on the wall, saying, 'If you don’t get me out of here, I’m going to kill myself.'\"\u003c/aside>\n\u003cp>That may have been what happened late last year when Stephanie –- who also lives in Ventura County -- called authorities for help with her 26-year-old son who has bipolar disorder.\u003c/p>\n\u003cp>Stephanie, whose last name was omitted for privacy reasons, says for several days prior to the incident, she and other family members had tried to get her then-suicidal son into a psychiatric hospital.\u003c/p>\n\u003cp>\"But he hadn’t really acted up enough,\" she said. \"And you really have to essentially be out of your mind for them to take you without violating personal rights.\"\u003c/p>\n\u003cp>Ultimately, her son had a fight with his father that became the grounds the family needed to make the call for help.\u003c/p>\n\u003cp>Crisis Intervention Team officers from the Ventura Police Department responded. As happened with Debbie's son, Stephanie says, they were able to calm her son and the situation.\u003c/p>\n\u003cp>But the assault meant her son had to be booked into county jail before being transferred to the psychiatric hospital. Stephanie says the officers told her he would be in jail for just three or four hours before the transfer.\u003c/p>\n\u003cp>\"So I went to bed for the first time in about six weeks with a peaceful mind,\" says Stephanie. \"'Okay, this one’s done. He’s in the hospital. I know he doesn’t love it there, but he’s safe.'\"\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/160271846&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>But, as it turned out, Stephanie says her son wasn't in the hospital, or safe.\u003c/p>\n\u003cp>\"He wound up being in the Ventura County Jail for 28 to 29 hours -- no medication,\" she said. \"They stripped him naked because they thought he might kill himself, somehow, with his clothing. ... So not only was he completely ashamed and out of his mind, he began to bang his head on the wall, saying, 'If you don’t get me out of here, if you don’t get me out of here, I’m going to kill myself.'\"\u003c/p>\n\u003cp>Stephanie says her son’s self-inflicted injuries left him with a severe concussion, a swollen face and two black eyes. A spokesman for the Ventura County Sheriff’s Department, which runs the jail, says the agency could not comment on the case.\u003c/p>\n\u003cp>California Senator Darrell Steinberg (D-Sacramento) says stories like Stephanie’s and Debbie’s are a too-common byproduct of a fragmented and overcrowded mental health system.\u003c/p>\n\u003cp>“The issue of mental illness in the criminal justice system have gotten far too little attention and far too few resources,” Steinberg said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Steinberg and other lawmakers introduced a series of budget proposals to address the needs of those with mental illness. While none creates a uniform standard for additional statewide training of law enforcement officers, one of the measures adopted in the new state budget provides $12 million to train law enforcement and prison personnel in better handling those with mental illness.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Kaiser Therapists, Patients Allege Long Waits for Mental Health Care",
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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\">\u003cimg class=\"size-large wp-image-20284\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/jpg-640x480.\" alt=\"Kaiser Permanente’s newly opened medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente’s newly opened medical center in Oakland. (Lisa Aliferis/KQED) \u003ccite>(Lisa Aliferis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One month, three months, even five months.\u003c/p>\n\u003cp>That's how long some Northern California Kaiser patients wait to see an individual therapist -- according to many Kaiser patients and therapists.\u003c/p>\n\u003cp>KQED's Jon Brooks has reported extensively on this issue over the last two months. He talked to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">close to two dozen therapists and patients \u003c/a>who said that they were experiencing long wait times. One therapist whose specialty is geriatric care told him that she had written to her superiors saying, \"I can't tell a patient that has six months to live that I'll see them in five months.\"\u003c!--more-->\u003c/p>\n\u003cp>Kaiser maintains that patients do have access to therapy, that it has 14 percent more therapists now than three years ago, and that therapists need to work with patients to ensure patients get the care they need.\u003c/p>\n\u003cp>KQED News anchor Mina Kim interviewed Brooks Monday evening about the questions surrounding Kaiser and its mental health services:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/159722017&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Earlier this month, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/01/sonoma-co-supervisor-presses-kaiser-on-mental-health-services/\" target=\"_blank\">Brooks reported\u003c/a> that a Sonoma County Supervisor whose husband had committed suicide while in Kaiser's care had taken a public stance on the issue of waiting times.\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\">\u003cimg class=\"size-large wp-image-20284\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/jpg-640x480.\" alt=\"Kaiser Permanente’s newly opened medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente’s newly opened medical center in Oakland. (Lisa Aliferis/KQED) \u003ccite>(Lisa Aliferis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One month, three months, even five months.\u003c/p>\n\u003cp>That's how long some Northern California Kaiser patients wait to see an individual therapist -- according to many Kaiser patients and therapists.\u003c/p>\n\u003cp>KQED's Jon Brooks has reported extensively on this issue over the last two months. He talked to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">close to two dozen therapists and patients \u003c/a>who said that they were experiencing long wait times. One therapist whose specialty is geriatric care told him that she had written to her superiors saying, \"I can't tell a patient that has six months to live that I'll see them in five months.\"\u003c!--more-->\u003c/p>\n\u003cp>Kaiser maintains that patients do have access to therapy, that it has 14 percent more therapists now than three years ago, and that therapists need to work with patients to ensure patients get the care they need.\u003c/p>\n\u003cp>KQED News anchor Mina Kim interviewed Brooks Monday evening about the questions surrounding Kaiser and its mental health services:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/159722017&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Earlier this month, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/01/sonoma-co-supervisor-presses-kaiser-on-mental-health-services/\" target=\"_blank\">Brooks reported\u003c/a> that a Sonoma County Supervisor whose husband had committed suicide while in Kaiser's care had taken a public stance on the issue of waiting times.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Therapists, Patients Criticize Kaiser Over Long Delays for Therapy",
"title": "Therapists, Patients Criticize Kaiser Over Long Delays for Therapy",
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"content": "\u003cfigure id=\"attachment_20235\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/photo-3.jpg\">\u003cimg class=\"size-large wp-image-20235\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/photo-3-640x480.jpg\" alt=\"Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED) \u003ccite>(Lisa Aliferis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>This is the second of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/01/sonoma-co-supervisor-presses-kaiser-on-mental-health-services/\" target=\"_blank\">two parts\u003c/a> about mental health services at Northern California Kaiser.\u003c/em>\u003c/p>\n\u003cp>In January 2013 a woman named “Nina” had a terrible falling out with her father. Soon after, she found out he had incurable cancer and was going to die. In the ensuing weeks, she tried to patch things up, but with the pressures inherent in the last months of a dying man, was unable to attain any form of closure. Some six months after their fight, he was gone.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"People are suffering, and I fear some of my patients will commit suicide for lack of ongoing treatment.\"\u003c/aside>\n\u003cp>\"Nina,\" who did not want us to use her real name for reasons of privacy, had been prone to depression. Zoloft had helped, but the now irreparable family rift left her severely depressed, with occasional thoughts of suicide. \"I was in a state of constant emotional pain and confusion,\" she says. “It was affecting all aspects of my life.\"\u003c/p>\n\u003cp>She went for an intake appointment at the psychiatric department at Kaiser Permanente’s Oakland Medical Center, with the expectation she'd be able to see a therapist for individual appointments during this severe emotional crisis. She requested those sessions, but the intake therapist told her Kaiser only offered group therapy.\u003c/p>\n\u003cp>“I said I'm not comfortable talking about my situation with a bunch of strangers,” Nina says. “She very kindly tried to make me aware of the value of group therapy. But I knew in my heart it wasn’t where I wanted to be.\"\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Nina left even more dispirited. Over the next year, she white-knuckled her depression on her own, before having the epiphany that maybe her medication needed adjustment. She went to see a Kaiser psychiatrist and mentioned she’d been told there was no individual therapy.\u003c/p>\n\u003cp>The psychiatrist seemed startled. She told Nina individual therapy was offered. “They probably just didn’t have the space,” the psychiatrist said.\u003c/p>\n\u003cp>Nina was shocked. “I could not believe that a professional therapist would lie to an obviously depressed patient who was sincerely seeking help.”\u003c/p>\n\u003cp>She finally did get to see a Kaiser therapist, whom she describes as “fantastic,” but who told her she could only book Nina maybe once every four weeks. At that point, Nina's expectations had been lowered to the point she was grateful to get any therapy at all. She also availed herself of a free Kaiser yoga class, which she considers to have been useful in her recovery.\u003c/p>\n\u003cp>Her therapist, she says, is really helping her with the depression.\u003c/p>\n\u003cp>Still, Nina's contact with Kaiser’s psychiatric department left her unnerved. “I started thinking maybe it’s my problem,” she says about her rejection of group therapy. \"It just added to my anxiety. But to share with other people what I was going through was just too much for me at that time. How depressed did this therapist need me to be in order to make room in the schedule for individual therapy?”\u003c/p>\n\u003cp>\u003cstrong>Kaiser Under Fire\u003c/strong>\u003c/p>\n\u003cp>Last year, Kaiser was\u003ca href=\"http://www.dmhc.ca.gov/Portals/0/AboutDMHC/PressReleases/2013/prkmhs.pdf\" target=\"_blank\"> fined $4 million\u003c/a> by the California Department of Managed Health Care for not accurately tracking patient waiting times for initial mental health appointments. And now the health plan is in the middle of another controversy over its mental health care: Some of its therapists and patients say there is a dangerous lack of access to individual therapy appointments and an over-reliance on group therapy.\u003c/p>\n\u003cp>Kaiser maintains that hiring in its psychiatric departments is up, and that patients do not have problems getting appropriate care. It points to its high rating in behavioral and mental health on the \u003ca href=\"http://reportcard.opa.ca.gov/rc2014/hmotopic.aspx?Category=HMOHEDIS&Topic=MentalHealthCare\" target=\"_blank\">2014 California Office of the Patient Advocate report card\u003c/a>. In addition, it has asserted that much of the controversy has been fueled by the union representing mental health clinicians, the National Union of Healthcare Workers (NUHW), which has been \u003ca href=\"http://www.californiahealthline.org/articles/2012/1/24/three-unions-announce-one-day-strike-at-kaiser-over-labor-negotiations\" target=\"_blank\">embroiled in contract negotiations\u003c/a> with Kaiser since 2010.\u003c/p>\n\u003cp>In reporting this story I talked to some two dozen current and former Kaiser clinicians and mental health patients as well as outside therapists. The vast majority express similar complaints: While health plans are required to provide medically necessary appointments within 10 business days, Kaiser patients have to wait long periods, sometimes months, between individual therapy appointments. These critics say Kaiser is referring patients to group therapy even in cases where ongoing individual sessions are clinically necessary. The reason, the union and clinicians say, is a serious staff shortage.\u003c/p>\n\u003cp>\u003cstrong>Therapists, Patients Speak Out\u003c/strong>\u003c/p>\n\u003cp>As \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/01/sonoma-co-supervisor-presses-kaiser-on-mental-health-services/\" target=\"_blank\">we've reported\u003c/a>, the issue came to a head this year when a \u003ca href=\"http://90daystochange.com/\" target=\"_blank\">behind-the-scenes blog \u003c/a>by Andy Weisskoff, a now-former therapist at the health plan’s Santa Rosa Medical Center, detailed long waiting times for therapy appointments and the deleterious effects on both patients and therapists.\u003c/p>\n\u003cp>“When I see someone today with suicidal thoughts ... I am often uncertain how well they’ll fare in the intervening weeks,” he \u003ca href=\"http://90daystochange.com/2014/03/04/even-if-youre-thinking-of-killing-yourself/\" target=\"_blank\">wrote\u003c/a>. “Did I miss something in our hour long interview?… Maybe I should have sent them to our intensive outpatient group instead of a skills group designed for people who are higher functioning. And then I wait, at least a month, to see if my intuition, one way or another, was correct.”\u003c/p>\n\u003cp>One Kaiser therapist from a Northern California facility described similar concerns. She wants to remain anonymous out of fear for her job. She is unnerved by the common practice of steering patients into groups instead of individual therapy sessions.\u003c/p>\n\u003cp>“I feel unethical when I go home at night, and feel really guilty,” she said. \"People are suffering, and I fear some of my patients will commit suicide for lack of ongoing treatment, but I’m powerless to treat them because I don’t have return visits available.”\u003c/p>\n\u003cp>Another therapist who worked at a South Bay Kaiser says she quit her position earlier this year because she considered the treatment of patients there \"unethical.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">\"We believe these descriptions are not reflective of the millions of mental health visits we provide each year in Northern California.\"\u003c/aside>\n\u003cp>\"Patients that need individual therapy are not getting it,” she said. “We had to tell patients we offer group therapy. ... The patients that are the most severely mentally ill are the ones that can’t speak up for themselves, and the ones who get lost in the system. With the Affordable Care Act, we’re seeing more and more of those patients.\"\u003c/p>\n\u003cp>A number of Kaiser patients also reported similar dissatisfaction with the unavailability of individual sessions. Loran Watkins’ story was typical of the complaints many patients described to me.\u003c/p>\n\u003cp>Watkins, 53, said that in 2010 her husband was battling cancer and \"desperately needed therapy to get through this. They said he could go to a group. There was no way in God's green earth he would have gone to a group. He was already a social introvert, was on six different kinds of pain medications so his ability to focus was very limited.\"\u003c/p>\n\u003cp>After \"pushing and pushing and pushing,\" Watkins says, her husband was finally given the okay to see a therapist, but only once a month.\u003c/p>\n\u003cp>\"Here you have a man actively battling cancer, was relapsing,\" she said. \"After the seventh or eighth appointment, the therapist said he was retiring, and that there were no more appointments available.\"\u003c/p>\n\u003cp>Watkins added that when her own longtime therapist at Kaiser's Walnut Creek medical center retired, she told Watkins there was no replacement available.\u003c/p>\n\u003cp>\"I asked her for a referral. She said there's no one to refer you to. The only thing I can do is they will place me in a group type setting; there's no individual therapy appointments anymore.\"\u003c/p>\n\u003cp>Kaiser responded to an email outlining these accounts and disputed the allegations that individual therapy is not available:\u003c/p>\n\u003cp>\u003cem>We apologize if there are members who may have received incorrect information about the availability of services. All of our medical centers provide individual therapy as part of the wide range of mental health treatments available to Kaiser Permanente patients.\u003c/em>\u003c/p>\n\u003cp>\u003cem>We encourage our members and staff to share their concerns, and we investigate thoroughly and work to resolve any issues. We take the examples in your email very seriously. Out of respect for patient privacy, we cannot respond in the media about individual cases. Each patient’s concern is important to us and we will investigate with the information we have. We believe these descriptions are not reflective of the millions of mental health visits we provide each year in Northern California, but we recognize that we have opportunities to make our program even better and are committed to doing so.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Group Therapy vs. Individual Therapy\u003c/strong>\u003c/p>\n\u003cp>Dr. Mason Turner is Kaiser’s director of patient operations for regional mental health services in Northern California. He takes umbrage at the notion that individual therapy is the “gold standard,” as he puts it, and that group therapy is somehow inferior. “This is a disservice to the hundreds of thousands of Kaiser Permanente members -- and millions throughout the country -- who have benefited from this type of proven, effective treatment and to the mental health professionals, including our Kaiser Permanente therapists, who provide it.\u003c/p>\n\u003cp>“There is no evidence that individual psychotherapy is superior to group therapy.\"\u003c/p>\n\u003cp>I asked Dr. John Norcross, a psychology professor at the University of Scranton, if that was true. Norcross’ research is on treatment adaptations -- \"how to tailor therapy for individual patients,” he says.\u003c/p>\n\u003cp>Norcross is a “big supporter” of group therapy, but only when indicated. And group treatment is contraindicated, he said, if the patient has a strong preference for individual therapy. That can make a difference in both retention of the patient and effectiveness of the treatment.\u003c/p>\n\u003cp>“There are dozens of studies that show we should always begin with patients’ preferences if ethically or clinically possible,” he said.\u003c/p>\n\u003cp>I recounted to him the experience of Nina, the woman who had expressed a preference for individual therapy at Kaiser Oakland and was erroneously told it wasn’t offered. Norcross said in her case a group would not be effective.\u003c/p>\n\u003cp>“If this woman wants 50 minutes to express and resolve longstanding conflicts, you’re not going to get that kind of opportunity in a therapy group of 6-12 people,” he said.\u003c/p>\n\u003cp>Andy Weisskoff, the former Kaiser therapist who blogged about his experience at Kaiser Santa Rosa, wrote that only a quarter of those who were referred to groups attended one.\u003c/p>\n\u003cp>“The assertion that groups are better than individual therapy is a little bit beside the point if they don’t go to the groups in the first place,” he says.\u003c/p>\n\u003cp>Some patients who I spoke with amplified his concern. For example, a 60-year-old woman who uses Kaiser’s Roseville facility and suffers from panic disorder said the last time she had an appointment, the therapist told her she could be seen maybe once every three months.\u003c/p>\n\u003cp>Instead she was sent to a group, where she says the discussions triggered her anxiety attacks. She estimated the number of patients in another group at about two dozen -- “like cattle in there, how can anyone’s needs be met?” she said. So she quit.\u003c/p>\n\u003cp>On disability because of her anxiety, unable to tolerate medication, and with the cost of an outside therapist out of reach, she sees no available options. “There’s nowhere for me to go,” she said.\u003c/p>\n\u003cp>Corlene Van Sluizer described the same lack of options for her sister, 71. Her sister was ordered into an inpatient facility this year after telling her Kaiser Santa Rosa psychiatrist of plans to commit suicide, Van Sluizer says. Even with a diagnosis of major depression, after being released she was told she’d have to pay for any individual therapy on her own. Instead, she was sent to a group.\u003c/p>\n\u003cp>“It lasted 6 sessions. She got no benefit from it,” Van Sluizer says.\u003c/p>\n\u003cp>Many non-Kaiser therapists sent me emails asserting some of their patients have been forced to pay out-of-pocket because they cannot get individual therapy at Kaiser.\u003c/p>\n\u003cp>A typical response came from Karen Taylor, a therapist in Campbell: “(I) see a number of Kaiser clients. (Kaiser) tells them to go to a group or will only see them every six weeks for private therapy. Neither of these options have been appropriate or effective for my clients.”\u003c/p>\n\u003cp>A therapist who wanted to remain anonymous said that a patient was referred to her by Kaiser staff following his suicide attempt and hospitalization. “I considered him high risk for a second suicide. He attempted again soon after our intake. None of these incidents convinced Kaiser to provide individual therapy to him. … Kaiser continued to refer him to groups.”\u003c/p>\n\u003cp>In a statement, Kaiser said therapists have a responsibility to inform more senior staff of need for specific services:\u003c/p>\n\u003cp>\u003cem>The well-being of our patients is our primary concern. We would expect any therapist with concerns about a patient's urgent needs to immediately respond and escalate appropriately, and we support them in doing so.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Kaiser Disputes Shortage of Staff\u003c/strong>\u003c/p>\n\u003cp>Kaiser's Dr. Turner says any notion that a staff shortage is driving the choice of treatment options is untrue.\u003c/p>\n\u003cp>“We have nearly 14 percent more therapists in Northern California than three years ago, and we are continuing to recruit and hire,” he told me.\u003c/p>\n\u003cp>Some Kaiser mental health staff say any new hiring hasn’t kept up with the influx of patients due to Obamacare. But Turner disputes that. “Staffing increases (have) increased significantly ahead of membership growth,” he said. “Seventy percent of our therapy is individual psychotherapy.\" While that figure includes the intake sessions for new patients, Turner said the “bulk” of the 70 percent figure is for return visits.\u003c/p>\n\u003cp>“To say that 4-6 weeks is the time between visits is not accurate,” Turner said. “We encourage therapists to look at all the different contact modalities: telephone appointments, email visits, and individual visits, to understand how best to reach out.”\u003c/p>\n\u003cp>He called Kaiser’s system of care “multi-modal, highly integrated,” and listed medication management, crisis intervention, “evidence-based group programs,” and intensive outpatient and inpatient services among its services for mental health.\u003c/p>\n\u003cp>Turner says patients can get individual therapy at more frequent intervals if they, in consultation with their therapist, consider that is the best course of treatment. He also put the responsibility for arranging appropriate care on therapists.\u003c/p>\n\u003cp>“We would expect our therapists, if they thought (a patient) needed to be seen sooner, would elect to discuss it with their manager and look for alternative times. Or have a discussion with their colleagues how they’ve managed patients like that before. It’s really up to the patient and therapist to make sure that occurs. ...\u003c/p>\n\u003cp>“(But) we have ways of accommodating this when it comes up.“\u003c/p>\n\u003cp>\u003cstrong>Bringing Concerns to Management\u003c/strong>\u003c/p>\n\u003cp>Kaiser Oakland psychologist Melinda Ginne says she tried that, to no avail. She and other Kaiser clinicians eventually went to California's Department of Managed Health Care with their complaints.\u003c/p>\n\u003cp>“For the past two-and-a-half years I have (been) writing my management about … the dangerously long wait times for a return appointment,” she told me. “The response was literally nothing.”\u003c/p>\n\u003cp>Ginne works with seniors and patients who have serious physical ailments like cancer. She sent me the email she wrote to Kaiser managers last September.\u003c/p>\n\u003cp>“My patients have been waiting 3 months for a routine follow-up appointment,” she wrote. “This has been a dire situation with often adverse consequences for the patients. But now they must wait 5 months.”\u003c/p>\n\u003cp>“Believe me,” she continued. “I can’t tell a patient with 3-6 months to live that I’ll see them in 5 months.”\u003c/p>\n\u003cp>One former Kaiser therapist said she brought her concerns about patients not getting enough individual therapy to management “multiple times throughout the five years I was there, and they just don’t want to hear it.”\u003c/p>\n\u003cp>She said it was possible for a therapist to get approval to see a client individually, but only by “really insist(ing). And even if they feel the patient needs it, they don’t have room on their schedule because of the way Kaiser books them back to back.”\u003c/p>\n\u003cp>\u003cstrong>Kaiser’s Regulator Weighs In\u003c/strong>\u003c/p>\n\u003cp>Marta Green, the California Department of Managed Health Care’s (DMHC) deputy director of communications and planning, said whether Kaiser is in violation of regulations would depend on whether it displayed a pattern of steering patients to groups instead of medically necessary individual sessions.\u003c/p>\n\u003cp>\"If the medically necessary care to treat an enrollee's condition is an individual therapy session, then the plan must make that session available within a clinically appropriate timeframe and comply with the regulatory timeframes\" of 10 business days,” she wrote in an email.\u003c/p>\n\u003cp>However, if a physician or triage professional, using professionally recognized standards of practice, determines that a longer waiting time will not have a detrimental impact on a patient, that period between appointments may legally be extended.\u003c/p>\n\u003cp>Green said if Kaiser can't provide individual therapy to a patient that needs it, then Kaiser would be obligated to partially pay for outside therapy. Any Kaiser enrollees who think this situation may apply to them should file a claim with Kaiser at the same time they \u003ca href=\"http://www.dmhc.ca.gov/FileaComplaint/ConsumerIndependentMedicalReviewComplaint.aspx#.U8gtb41dWSM\" target=\"_blank\">ask the DHMC for a free independent medical review\u003c/a>.\u003c/p>\n\u003cp>Against this backdrop of reports of patient and therapist dissatisfaction, Kaiser maintains that staffing complaints are driven by its four-year-plus contract negotiation with the National Union of Healthcare Workers, which represents many of the therapists. In its statement to KQED, Kaiser said the union \"has not been cooperative in finding solutions that will enable us to meet our members' needs.\"\u003c/p>\n\u003cp>In particular, Kaiser has \"entered into an agreement with Value Options,\" a network of mental health providers, to \"make sure that our members have timely access to therapists when we need flexibility in staffing.\" But NUHW \"has so far not agreed to this solution -- despite the union making it clear that its members would not be able to take on the extra demand.\"\u003c/p>\n\u003cp>Fred Seavey of the NUHW responds that clinicians have requested to bargain with Kaiser “about the impact of these changes -- for example, how these changes in the acuity levels of their patients will affect clinicians' schedules, caseloads, etc and whether Kaiser should alter the productivity quotas under which clinicians currently operate.”\u003c/p>\n\u003cp>Seavey says Kaiser's clinicians have tried to get Kaiser to address staffing shortages for years. “Kaiser has simply turned a blind eye to them,” he says.\u003c/p>\n\u003cp>A follow-up DMHC report to the one that resulted in last year’s $4 million fine is due in the fall. The DMHC’s Marta Green said it will take into account any complaints about long waits for follow-up appointments to individual therapy.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20235\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/photo-3.jpg\">\u003cimg class=\"size-large wp-image-20235\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/photo-3-640x480.jpg\" alt=\"Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED) \u003ccite>(Lisa Aliferis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>This is the second of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/01/sonoma-co-supervisor-presses-kaiser-on-mental-health-services/\" target=\"_blank\">two parts\u003c/a> about mental health services at Northern California Kaiser.\u003c/em>\u003c/p>\n\u003cp>In January 2013 a woman named “Nina” had a terrible falling out with her father. Soon after, she found out he had incurable cancer and was going to die. In the ensuing weeks, she tried to patch things up, but with the pressures inherent in the last months of a dying man, was unable to attain any form of closure. Some six months after their fight, he was gone.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"People are suffering, and I fear some of my patients will commit suicide for lack of ongoing treatment.\"\u003c/aside>\n\u003cp>\"Nina,\" who did not want us to use her real name for reasons of privacy, had been prone to depression. Zoloft had helped, but the now irreparable family rift left her severely depressed, with occasional thoughts of suicide. \"I was in a state of constant emotional pain and confusion,\" she says. “It was affecting all aspects of my life.\"\u003c/p>\n\u003cp>She went for an intake appointment at the psychiatric department at Kaiser Permanente’s Oakland Medical Center, with the expectation she'd be able to see a therapist for individual appointments during this severe emotional crisis. She requested those sessions, but the intake therapist told her Kaiser only offered group therapy.\u003c/p>\n\u003cp>“I said I'm not comfortable talking about my situation with a bunch of strangers,” Nina says. “She very kindly tried to make me aware of the value of group therapy. But I knew in my heart it wasn’t where I wanted to be.\"\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nina left even more dispirited. Over the next year, she white-knuckled her depression on her own, before having the epiphany that maybe her medication needed adjustment. She went to see a Kaiser psychiatrist and mentioned she’d been told there was no individual therapy.\u003c/p>\n\u003cp>The psychiatrist seemed startled. She told Nina individual therapy was offered. “They probably just didn’t have the space,” the psychiatrist said.\u003c/p>\n\u003cp>Nina was shocked. “I could not believe that a professional therapist would lie to an obviously depressed patient who was sincerely seeking help.”\u003c/p>\n\u003cp>She finally did get to see a Kaiser therapist, whom she describes as “fantastic,” but who told her she could only book Nina maybe once every four weeks. At that point, Nina's expectations had been lowered to the point she was grateful to get any therapy at all. She also availed herself of a free Kaiser yoga class, which she considers to have been useful in her recovery.\u003c/p>\n\u003cp>Her therapist, she says, is really helping her with the depression.\u003c/p>\n\u003cp>Still, Nina's contact with Kaiser’s psychiatric department left her unnerved. “I started thinking maybe it’s my problem,” she says about her rejection of group therapy. \"It just added to my anxiety. But to share with other people what I was going through was just too much for me at that time. How depressed did this therapist need me to be in order to make room in the schedule for individual therapy?”\u003c/p>\n\u003cp>\u003cstrong>Kaiser Under Fire\u003c/strong>\u003c/p>\n\u003cp>Last year, Kaiser was\u003ca href=\"http://www.dmhc.ca.gov/Portals/0/AboutDMHC/PressReleases/2013/prkmhs.pdf\" target=\"_blank\"> fined $4 million\u003c/a> by the California Department of Managed Health Care for not accurately tracking patient waiting times for initial mental health appointments. And now the health plan is in the middle of another controversy over its mental health care: Some of its therapists and patients say there is a dangerous lack of access to individual therapy appointments and an over-reliance on group therapy.\u003c/p>\n\u003cp>Kaiser maintains that hiring in its psychiatric departments is up, and that patients do not have problems getting appropriate care. It points to its high rating in behavioral and mental health on the \u003ca href=\"http://reportcard.opa.ca.gov/rc2014/hmotopic.aspx?Category=HMOHEDIS&Topic=MentalHealthCare\" target=\"_blank\">2014 California Office of the Patient Advocate report card\u003c/a>. In addition, it has asserted that much of the controversy has been fueled by the union representing mental health clinicians, the National Union of Healthcare Workers (NUHW), which has been \u003ca href=\"http://www.californiahealthline.org/articles/2012/1/24/three-unions-announce-one-day-strike-at-kaiser-over-labor-negotiations\" target=\"_blank\">embroiled in contract negotiations\u003c/a> with Kaiser since 2010.\u003c/p>\n\u003cp>In reporting this story I talked to some two dozen current and former Kaiser clinicians and mental health patients as well as outside therapists. The vast majority express similar complaints: While health plans are required to provide medically necessary appointments within 10 business days, Kaiser patients have to wait long periods, sometimes months, between individual therapy appointments. These critics say Kaiser is referring patients to group therapy even in cases where ongoing individual sessions are clinically necessary. The reason, the union and clinicians say, is a serious staff shortage.\u003c/p>\n\u003cp>\u003cstrong>Therapists, Patients Speak Out\u003c/strong>\u003c/p>\n\u003cp>As \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/01/sonoma-co-supervisor-presses-kaiser-on-mental-health-services/\" target=\"_blank\">we've reported\u003c/a>, the issue came to a head this year when a \u003ca href=\"http://90daystochange.com/\" target=\"_blank\">behind-the-scenes blog \u003c/a>by Andy Weisskoff, a now-former therapist at the health plan’s Santa Rosa Medical Center, detailed long waiting times for therapy appointments and the deleterious effects on both patients and therapists.\u003c/p>\n\u003cp>“When I see someone today with suicidal thoughts ... I am often uncertain how well they’ll fare in the intervening weeks,” he \u003ca href=\"http://90daystochange.com/2014/03/04/even-if-youre-thinking-of-killing-yourself/\" target=\"_blank\">wrote\u003c/a>. “Did I miss something in our hour long interview?… Maybe I should have sent them to our intensive outpatient group instead of a skills group designed for people who are higher functioning. And then I wait, at least a month, to see if my intuition, one way or another, was correct.”\u003c/p>\n\u003cp>One Kaiser therapist from a Northern California facility described similar concerns. She wants to remain anonymous out of fear for her job. She is unnerved by the common practice of steering patients into groups instead of individual therapy sessions.\u003c/p>\n\u003cp>“I feel unethical when I go home at night, and feel really guilty,” she said. \"People are suffering, and I fear some of my patients will commit suicide for lack of ongoing treatment, but I’m powerless to treat them because I don’t have return visits available.”\u003c/p>\n\u003cp>Another therapist who worked at a South Bay Kaiser says she quit her position earlier this year because she considered the treatment of patients there \"unethical.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">\"We believe these descriptions are not reflective of the millions of mental health visits we provide each year in Northern California.\"\u003c/aside>\n\u003cp>\"Patients that need individual therapy are not getting it,” she said. “We had to tell patients we offer group therapy. ... The patients that are the most severely mentally ill are the ones that can’t speak up for themselves, and the ones who get lost in the system. With the Affordable Care Act, we’re seeing more and more of those patients.\"\u003c/p>\n\u003cp>A number of Kaiser patients also reported similar dissatisfaction with the unavailability of individual sessions. Loran Watkins’ story was typical of the complaints many patients described to me.\u003c/p>\n\u003cp>Watkins, 53, said that in 2010 her husband was battling cancer and \"desperately needed therapy to get through this. They said he could go to a group. There was no way in God's green earth he would have gone to a group. He was already a social introvert, was on six different kinds of pain medications so his ability to focus was very limited.\"\u003c/p>\n\u003cp>After \"pushing and pushing and pushing,\" Watkins says, her husband was finally given the okay to see a therapist, but only once a month.\u003c/p>\n\u003cp>\"Here you have a man actively battling cancer, was relapsing,\" she said. \"After the seventh or eighth appointment, the therapist said he was retiring, and that there were no more appointments available.\"\u003c/p>\n\u003cp>Watkins added that when her own longtime therapist at Kaiser's Walnut Creek medical center retired, she told Watkins there was no replacement available.\u003c/p>\n\u003cp>\"I asked her for a referral. She said there's no one to refer you to. The only thing I can do is they will place me in a group type setting; there's no individual therapy appointments anymore.\"\u003c/p>\n\u003cp>Kaiser responded to an email outlining these accounts and disputed the allegations that individual therapy is not available:\u003c/p>\n\u003cp>\u003cem>We apologize if there are members who may have received incorrect information about the availability of services. All of our medical centers provide individual therapy as part of the wide range of mental health treatments available to Kaiser Permanente patients.\u003c/em>\u003c/p>\n\u003cp>\u003cem>We encourage our members and staff to share their concerns, and we investigate thoroughly and work to resolve any issues. We take the examples in your email very seriously. Out of respect for patient privacy, we cannot respond in the media about individual cases. Each patient’s concern is important to us and we will investigate with the information we have. We believe these descriptions are not reflective of the millions of mental health visits we provide each year in Northern California, but we recognize that we have opportunities to make our program even better and are committed to doing so.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Group Therapy vs. Individual Therapy\u003c/strong>\u003c/p>\n\u003cp>Dr. Mason Turner is Kaiser’s director of patient operations for regional mental health services in Northern California. He takes umbrage at the notion that individual therapy is the “gold standard,” as he puts it, and that group therapy is somehow inferior. “This is a disservice to the hundreds of thousands of Kaiser Permanente members -- and millions throughout the country -- who have benefited from this type of proven, effective treatment and to the mental health professionals, including our Kaiser Permanente therapists, who provide it.\u003c/p>\n\u003cp>“There is no evidence that individual psychotherapy is superior to group therapy.\"\u003c/p>\n\u003cp>I asked Dr. John Norcross, a psychology professor at the University of Scranton, if that was true. Norcross’ research is on treatment adaptations -- \"how to tailor therapy for individual patients,” he says.\u003c/p>\n\u003cp>Norcross is a “big supporter” of group therapy, but only when indicated. And group treatment is contraindicated, he said, if the patient has a strong preference for individual therapy. That can make a difference in both retention of the patient and effectiveness of the treatment.\u003c/p>\n\u003cp>“There are dozens of studies that show we should always begin with patients’ preferences if ethically or clinically possible,” he said.\u003c/p>\n\u003cp>I recounted to him the experience of Nina, the woman who had expressed a preference for individual therapy at Kaiser Oakland and was erroneously told it wasn’t offered. Norcross said in her case a group would not be effective.\u003c/p>\n\u003cp>“If this woman wants 50 minutes to express and resolve longstanding conflicts, you’re not going to get that kind of opportunity in a therapy group of 6-12 people,” he said.\u003c/p>\n\u003cp>Andy Weisskoff, the former Kaiser therapist who blogged about his experience at Kaiser Santa Rosa, wrote that only a quarter of those who were referred to groups attended one.\u003c/p>\n\u003cp>“The assertion that groups are better than individual therapy is a little bit beside the point if they don’t go to the groups in the first place,” he says.\u003c/p>\n\u003cp>Some patients who I spoke with amplified his concern. For example, a 60-year-old woman who uses Kaiser’s Roseville facility and suffers from panic disorder said the last time she had an appointment, the therapist told her she could be seen maybe once every three months.\u003c/p>\n\u003cp>Instead she was sent to a group, where she says the discussions triggered her anxiety attacks. She estimated the number of patients in another group at about two dozen -- “like cattle in there, how can anyone’s needs be met?” she said. So she quit.\u003c/p>\n\u003cp>On disability because of her anxiety, unable to tolerate medication, and with the cost of an outside therapist out of reach, she sees no available options. “There’s nowhere for me to go,” she said.\u003c/p>\n\u003cp>Corlene Van Sluizer described the same lack of options for her sister, 71. Her sister was ordered into an inpatient facility this year after telling her Kaiser Santa Rosa psychiatrist of plans to commit suicide, Van Sluizer says. Even with a diagnosis of major depression, after being released she was told she’d have to pay for any individual therapy on her own. Instead, she was sent to a group.\u003c/p>\n\u003cp>“It lasted 6 sessions. She got no benefit from it,” Van Sluizer says.\u003c/p>\n\u003cp>Many non-Kaiser therapists sent me emails asserting some of their patients have been forced to pay out-of-pocket because they cannot get individual therapy at Kaiser.\u003c/p>\n\u003cp>A typical response came from Karen Taylor, a therapist in Campbell: “(I) see a number of Kaiser clients. (Kaiser) tells them to go to a group or will only see them every six weeks for private therapy. Neither of these options have been appropriate or effective for my clients.”\u003c/p>\n\u003cp>A therapist who wanted to remain anonymous said that a patient was referred to her by Kaiser staff following his suicide attempt and hospitalization. “I considered him high risk for a second suicide. He attempted again soon after our intake. None of these incidents convinced Kaiser to provide individual therapy to him. … Kaiser continued to refer him to groups.”\u003c/p>\n\u003cp>In a statement, Kaiser said therapists have a responsibility to inform more senior staff of need for specific services:\u003c/p>\n\u003cp>\u003cem>The well-being of our patients is our primary concern. We would expect any therapist with concerns about a patient's urgent needs to immediately respond and escalate appropriately, and we support them in doing so.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Kaiser Disputes Shortage of Staff\u003c/strong>\u003c/p>\n\u003cp>Kaiser's Dr. Turner says any notion that a staff shortage is driving the choice of treatment options is untrue.\u003c/p>\n\u003cp>“We have nearly 14 percent more therapists in Northern California than three years ago, and we are continuing to recruit and hire,” he told me.\u003c/p>\n\u003cp>Some Kaiser mental health staff say any new hiring hasn’t kept up with the influx of patients due to Obamacare. But Turner disputes that. “Staffing increases (have) increased significantly ahead of membership growth,” he said. “Seventy percent of our therapy is individual psychotherapy.\" While that figure includes the intake sessions for new patients, Turner said the “bulk” of the 70 percent figure is for return visits.\u003c/p>\n\u003cp>“To say that 4-6 weeks is the time between visits is not accurate,” Turner said. “We encourage therapists to look at all the different contact modalities: telephone appointments, email visits, and individual visits, to understand how best to reach out.”\u003c/p>\n\u003cp>He called Kaiser’s system of care “multi-modal, highly integrated,” and listed medication management, crisis intervention, “evidence-based group programs,” and intensive outpatient and inpatient services among its services for mental health.\u003c/p>\n\u003cp>Turner says patients can get individual therapy at more frequent intervals if they, in consultation with their therapist, consider that is the best course of treatment. He also put the responsibility for arranging appropriate care on therapists.\u003c/p>\n\u003cp>“We would expect our therapists, if they thought (a patient) needed to be seen sooner, would elect to discuss it with their manager and look for alternative times. Or have a discussion with their colleagues how they’ve managed patients like that before. It’s really up to the patient and therapist to make sure that occurs. ...\u003c/p>\n\u003cp>“(But) we have ways of accommodating this when it comes up.“\u003c/p>\n\u003cp>\u003cstrong>Bringing Concerns to Management\u003c/strong>\u003c/p>\n\u003cp>Kaiser Oakland psychologist Melinda Ginne says she tried that, to no avail. She and other Kaiser clinicians eventually went to California's Department of Managed Health Care with their complaints.\u003c/p>\n\u003cp>“For the past two-and-a-half years I have (been) writing my management about … the dangerously long wait times for a return appointment,” she told me. “The response was literally nothing.”\u003c/p>\n\u003cp>Ginne works with seniors and patients who have serious physical ailments like cancer. She sent me the email she wrote to Kaiser managers last September.\u003c/p>\n\u003cp>“My patients have been waiting 3 months for a routine follow-up appointment,” she wrote. “This has been a dire situation with often adverse consequences for the patients. But now they must wait 5 months.”\u003c/p>\n\u003cp>“Believe me,” she continued. “I can’t tell a patient with 3-6 months to live that I’ll see them in 5 months.”\u003c/p>\n\u003cp>One former Kaiser therapist said she brought her concerns about patients not getting enough individual therapy to management “multiple times throughout the five years I was there, and they just don’t want to hear it.”\u003c/p>\n\u003cp>She said it was possible for a therapist to get approval to see a client individually, but only by “really insist(ing). And even if they feel the patient needs it, they don’t have room on their schedule because of the way Kaiser books them back to back.”\u003c/p>\n\u003cp>\u003cstrong>Kaiser’s Regulator Weighs In\u003c/strong>\u003c/p>\n\u003cp>Marta Green, the California Department of Managed Health Care’s (DMHC) deputy director of communications and planning, said whether Kaiser is in violation of regulations would depend on whether it displayed a pattern of steering patients to groups instead of medically necessary individual sessions.\u003c/p>\n\u003cp>\"If the medically necessary care to treat an enrollee's condition is an individual therapy session, then the plan must make that session available within a clinically appropriate timeframe and comply with the regulatory timeframes\" of 10 business days,” she wrote in an email.\u003c/p>\n\u003cp>However, if a physician or triage professional, using professionally recognized standards of practice, determines that a longer waiting time will not have a detrimental impact on a patient, that period between appointments may legally be extended.\u003c/p>\n\u003cp>Green said if Kaiser can't provide individual therapy to a patient that needs it, then Kaiser would be obligated to partially pay for outside therapy. Any Kaiser enrollees who think this situation may apply to them should file a claim with Kaiser at the same time they \u003ca href=\"http://www.dmhc.ca.gov/FileaComplaint/ConsumerIndependentMedicalReviewComplaint.aspx#.U8gtb41dWSM\" target=\"_blank\">ask the DHMC for a free independent medical review\u003c/a>.\u003c/p>\n\u003cp>Against this backdrop of reports of patient and therapist dissatisfaction, Kaiser maintains that staffing complaints are driven by its four-year-plus contract negotiation with the National Union of Healthcare Workers, which represents many of the therapists. In its statement to KQED, Kaiser said the union \"has not been cooperative in finding solutions that will enable us to meet our members' needs.\"\u003c/p>\n\u003cp>In particular, Kaiser has \"entered into an agreement with Value Options,\" a network of mental health providers, to \"make sure that our members have timely access to therapists when we need flexibility in staffing.\" But NUHW \"has so far not agreed to this solution -- despite the union making it clear that its members would not be able to take on the extra demand.\"\u003c/p>\n\u003cp>Fred Seavey of the NUHW responds that clinicians have requested to bargain with Kaiser “about the impact of these changes -- for example, how these changes in the acuity levels of their patients will affect clinicians' schedules, caseloads, etc and whether Kaiser should alter the productivity quotas under which clinicians currently operate.”\u003c/p>\n\u003cp>Seavey says Kaiser's clinicians have tried to get Kaiser to address staffing shortages for years. “Kaiser has simply turned a blind eye to them,” he says.\u003c/p>\n\u003cp>A follow-up DMHC report to the one that resulted in last year’s $4 million fine is due in the fall. The DMHC’s Marta Green said it will take into account any complaints about long waits for follow-up appointments to individual therapy.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "San Francisco Supes Approve Laura's Law, Can Compel Mentally Ill Into Treatment",
"title": "San Francisco Supes Approve Laura's Law, Can Compel Mentally Ill Into Treatment",
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"content": "\u003cfigure id=\"attachment_20083\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/RS1833_SanFranciscoCityHall-scr.jpg\">\u003cimg class=\"size-large wp-image-20083\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/RS1833_SanFranciscoCityHall-scr-640x428.jpg\" alt=\"(jivedanson/Flickr)\" width=\"640\" height=\"428\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(jivedanson/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Update 10pm by Isabel Angell\u003c/strong>\u003c/p>\n\u003cp>San Francisco Supervisors passed a version of Laura's Law today that compels treatment for certain mental health patients. Supervisor Mark Farrell, who sponsored the legislation, said Laura's Law will be an \"important tool\" for the city.\u003c/p>\n\u003cp>\"I do believe we need to do more as a city and we need to do more to help those who are clearly suffering and cannot help themselves. In order to make a difference here at the local level, we have to continue to challenge ourselves and the status quo,\" Farrell said before the vote.\u003c/p>\n\u003cp>A last-minute amendment from Supervisor Jane Kim that added an external evaluation after three years helped the ordinance pass 9-2. Supervisor Eric Mar, who cast one of the \"no\" votes, called mental health treatment a civil rights issue.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"I really feel that if we move forward without full and adequate funding of our mental health system this may be leading to a false hope of safety in our neighborhoods...and I worry that there's a danger of further stigmatizing people with mental illness.\"\u003c/p>\n\u003cp>\u003cstrong>Original post\u003c/strong>:\u003c/p>\n\u003cp>\u003cstrong>By Lynne Shallcross\u003c/strong>\u003c/p>\n\u003cp>The San Francisco Board of Supervisors voted 9-2 Tuesday afternoon to enact Laura's Law, \u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\">with Supervisors John Avalos and Eric Mar voting no.\u003c/span>\u003c/span>\u003c/p>\n\u003cp>It’s been more than a decade since California enacted Laura’s Law, allowing courts to compel mentally ill people into treatment. But that doesn't mean it's in force statewide. It's up to counties to implement the law, and they've been slow. Since the law was passed, just two of California's 58 counties have adopted it -- Orange and Nevada counties -- while Yolo and Los Angeles counties are experimenting with versions of the law.\u003c/p>\n\u003cp>Supporters of Laura’s Law say it helps assist those who are too ill to realize or accept that they need treatment, while the law’s critics say it risks stripping away a person's civil rights and won’t adequately address the issue of mental health treatment. They say a better approach would be to simply expand the availability of community mental health services.\u003c/p>\n\u003cp>Laura’s Law was named for Laura Wilcox, who was killed in 2001 by a behavioral health client in Nevada City, a small community northeast of Sacramento. The law allows a family member, roommate, mental health provider, police officer or probation officer to ask the court to order a mentally ill individual into outpatient treatment. The law has clear stipulations: it can apply only to people who have been hospitalized or jailed twice in the previous three years due to mental illness -- or those who have been violent to themselves or others in the previous four years. Additionally, anyone subject to this law must be given the chance to voluntarily enter treatment and then refuse.\u003c/p>\n\u003cp>Two mental health experts and the politician behind bringing Laura’s Law to San Francisco discussed their differing perspectives on the law on \u003ca href=\"http://www.kqed.org/a/forum/R201407080900\" target=\"_blank\">KQED’s Forum\u003c/a> Tuesday morning.\u003c/p>\n\u003cp>Mark Farrell is the San Francisco supervisor, representing District 2, who introduced the proposal to implement Laura's Law. He said that of the more than 40 million Americans who suffer from mental illness, close to 10 million suffer from severe mental illnesses, such as schizophrenia and bipolar disorder — and half of those go untreated.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/157864583&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false&visual=true\" width=\"100%\" height=\"450\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>In San Francisco, Farrell said, about 40 percent of people who are homeless suffer from mental illness. “This is not a panacea to cure homelessness, but it is a tool in a toolbox that we need as a city and county.” Most importantly, he said, the law will help those who are severely mentally ill receive the treatment they deserve.\u003c/p>\n\u003cp>Farrell points to data from counties in the state that have implemented the law, as well as other states that have similar laws on the books. He said the results show that not only do the laws help mentally ill individuals and their families, but they also alleviate the burden on public safety departments.\u003c/p>\n\u003cp>John Rouse, a psychiatry professor at UC San Francisco, said the power of the court under Laura’s Law lies in forcing a person back to the hospital for treatment or evaluation.\u003c/p>\n\u003cp>“The people who have put this into practice have told me that with each patient, they pretty much have to do that once, and at that point, the patient will realize how it works,” Rouse said. “And the next time you say, ‘Look, we really don’t want you to have to go back to the hospital, let’s get you back to the clinic.’ And it usually works from then on.”\u003c/p>\n\u003cp>But Eduardo Vega, executive director of the Mental Health Association of San Francisco, believes this law misses the mark. Vega said that while his group doesn’t ordinarily oppose a call for expanded mental health services, he said in this case the city needs to do better.\u003c/p>\n\u003cp>“What we’ve seen, unfortunately, with this particular legislation -- and the reason we’ve opposed it the last two times it came to the Board of Supervisors -- is that there’s a court order attached to what is otherwise a nice frame for intensive services,” Vega said. The court order, he said, works against people’s rights and doesn’t help the therapeutic relationship.\u003c/p>\n\u003cp>“The one thing I’ve come away with after 25 years of working with people with the most serious psychiatric issues is that when you approach people in the spirit of human kindness, with genuine outreach and positive engagement, you can make progress with them,” Vega said. “When you approach people with a stick behind your back, or a threat to their dignity and to their self-determination, that relationship is not the same and it never will be.”\u003c/p>\n\u003cp>The \u003cem>Forum\u003c/em> guests could not even agree on the data surrounding the impact of legislation like Laura’s Law. Vega said that no study has been able to show that a court order alone makes a difference in whether mentally ill people engage successfully with treatment.\u003c/p>\n\u003cp>Rouse, on the other hand, pointed to data from New York, which has a similar law called Kendra’s Law. The data there, Rouse said, indicates that people who were ordered into treatment had no greater sense of coercion and in fact felt more “connected” to their treatment, including greater attachment to case managers and sense of participation in their own treatment.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Though Vega’s organization didn’t support the law’s adoption, he said it will work proactively with others, such as public defenders and patients’ rights groups, as the law is implemented. “We want to create value, we want to help people who are very severely disabled. We might disagree on what the right mechanisms for that are, but we don’t disagree that we need to be doing more, and we need to restore funding in general.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20083\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/RS1833_SanFranciscoCityHall-scr.jpg\">\u003cimg class=\"size-large wp-image-20083\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/RS1833_SanFranciscoCityHall-scr-640x428.jpg\" alt=\"(jivedanson/Flickr)\" width=\"640\" height=\"428\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(jivedanson/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Update 10pm by Isabel Angell\u003c/strong>\u003c/p>\n\u003cp>San Francisco Supervisors passed a version of Laura's Law today that compels treatment for certain mental health patients. Supervisor Mark Farrell, who sponsored the legislation, said Laura's Law will be an \"important tool\" for the city.\u003c/p>\n\u003cp>\"I do believe we need to do more as a city and we need to do more to help those who are clearly suffering and cannot help themselves. In order to make a difference here at the local level, we have to continue to challenge ourselves and the status quo,\" Farrell said before the vote.\u003c/p>\n\u003cp>A last-minute amendment from Supervisor Jane Kim that added an external evaluation after three years helped the ordinance pass 9-2. Supervisor Eric Mar, who cast one of the \"no\" votes, called mental health treatment a civil rights issue.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I really feel that if we move forward without full and adequate funding of our mental health system this may be leading to a false hope of safety in our neighborhoods...and I worry that there's a danger of further stigmatizing people with mental illness.\"\u003c/p>\n\u003cp>\u003cstrong>Original post\u003c/strong>:\u003c/p>\n\u003cp>\u003cstrong>By Lynne Shallcross\u003c/strong>\u003c/p>\n\u003cp>The San Francisco Board of Supervisors voted 9-2 Tuesday afternoon to enact Laura's Law, \u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\">with Supervisors John Avalos and Eric Mar voting no.\u003c/span>\u003c/span>\u003c/p>\n\u003cp>It’s been more than a decade since California enacted Laura’s Law, allowing courts to compel mentally ill people into treatment. But that doesn't mean it's in force statewide. It's up to counties to implement the law, and they've been slow. Since the law was passed, just two of California's 58 counties have adopted it -- Orange and Nevada counties -- while Yolo and Los Angeles counties are experimenting with versions of the law.\u003c/p>\n\u003cp>Supporters of Laura’s Law say it helps assist those who are too ill to realize or accept that they need treatment, while the law’s critics say it risks stripping away a person's civil rights and won’t adequately address the issue of mental health treatment. They say a better approach would be to simply expand the availability of community mental health services.\u003c/p>\n\u003cp>Laura’s Law was named for Laura Wilcox, who was killed in 2001 by a behavioral health client in Nevada City, a small community northeast of Sacramento. The law allows a family member, roommate, mental health provider, police officer or probation officer to ask the court to order a mentally ill individual into outpatient treatment. The law has clear stipulations: it can apply only to people who have been hospitalized or jailed twice in the previous three years due to mental illness -- or those who have been violent to themselves or others in the previous four years. Additionally, anyone subject to this law must be given the chance to voluntarily enter treatment and then refuse.\u003c/p>\n\u003cp>Two mental health experts and the politician behind bringing Laura’s Law to San Francisco discussed their differing perspectives on the law on \u003ca href=\"http://www.kqed.org/a/forum/R201407080900\" target=\"_blank\">KQED’s Forum\u003c/a> Tuesday morning.\u003c/p>\n\u003cp>Mark Farrell is the San Francisco supervisor, representing District 2, who introduced the proposal to implement Laura's Law. He said that of the more than 40 million Americans who suffer from mental illness, close to 10 million suffer from severe mental illnesses, such as schizophrenia and bipolar disorder — and half of those go untreated.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/157864583&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false&visual=true\" width=\"100%\" height=\"450\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>In San Francisco, Farrell said, about 40 percent of people who are homeless suffer from mental illness. “This is not a panacea to cure homelessness, but it is a tool in a toolbox that we need as a city and county.” Most importantly, he said, the law will help those who are severely mentally ill receive the treatment they deserve.\u003c/p>\n\u003cp>Farrell points to data from counties in the state that have implemented the law, as well as other states that have similar laws on the books. He said the results show that not only do the laws help mentally ill individuals and their families, but they also alleviate the burden on public safety departments.\u003c/p>\n\u003cp>John Rouse, a psychiatry professor at UC San Francisco, said the power of the court under Laura’s Law lies in forcing a person back to the hospital for treatment or evaluation.\u003c/p>\n\u003cp>“The people who have put this into practice have told me that with each patient, they pretty much have to do that once, and at that point, the patient will realize how it works,” Rouse said. “And the next time you say, ‘Look, we really don’t want you to have to go back to the hospital, let’s get you back to the clinic.’ And it usually works from then on.”\u003c/p>\n\u003cp>But Eduardo Vega, executive director of the Mental Health Association of San Francisco, believes this law misses the mark. Vega said that while his group doesn’t ordinarily oppose a call for expanded mental health services, he said in this case the city needs to do better.\u003c/p>\n\u003cp>“What we’ve seen, unfortunately, with this particular legislation -- and the reason we’ve opposed it the last two times it came to the Board of Supervisors -- is that there’s a court order attached to what is otherwise a nice frame for intensive services,” Vega said. The court order, he said, works against people’s rights and doesn’t help the therapeutic relationship.\u003c/p>\n\u003cp>“The one thing I’ve come away with after 25 years of working with people with the most serious psychiatric issues is that when you approach people in the spirit of human kindness, with genuine outreach and positive engagement, you can make progress with them,” Vega said. “When you approach people with a stick behind your back, or a threat to their dignity and to their self-determination, that relationship is not the same and it never will be.”\u003c/p>\n\u003cp>The \u003cem>Forum\u003c/em> guests could not even agree on the data surrounding the impact of legislation like Laura’s Law. Vega said that no study has been able to show that a court order alone makes a difference in whether mentally ill people engage successfully with treatment.\u003c/p>\n\u003cp>Rouse, on the other hand, pointed to data from New York, which has a similar law called Kendra’s Law. The data there, Rouse said, indicates that people who were ordered into treatment had no greater sense of coercion and in fact felt more “connected” to their treatment, including greater attachment to case managers and sense of participation in their own treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Though Vega’s organization didn’t support the law’s adoption, he said it will work proactively with others, such as public defenders and patients’ rights groups, as the law is implemented. “We want to create value, we want to help people who are very severely disabled. We might disagree on what the right mechanisms for that are, but we don’t disagree that we need to be doing more, and we need to restore funding in general.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_19874\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/smile-in-crops-e1404169943328.jpg\">\u003cimg class=\"wp-image-19874 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/smile-in-crops-640x480.jpg\" alt=\"smile in crops\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Cha Deng Vang, 68, tends to the community garden at Fresno Interdenominational Refugee Ministries. Working in the garden helps Vang, a refugee from Laos, relieve anxiety and get exercise. (Annabelle Beecher/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's Note: Refugees face unique challenges building lives in the United States. Cha Deng Vang fled Laos in 1987 after fighting as soldier in the US-backed forces. As part of our ongoing health series, \u003ca href=\"blogs.kqed.org/stateofhealth/series/vital-signs/\">\u003cstrong>Vital Signs\u003c/strong>\u003c/a>, we hear from 68-year-old Vang who has found that a community garden for Hmong refugees at\u003ca href=\"http://www.firminc.org/\"> Fresno Interdenominational Refugee Ministries\u003c/a> has helped him build community and relieve stress. Chong Vang and Sam Chang helped to translate his story.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Cha Deng Vang\u003c/strong>\u003c/p>\n\u003cp>On this side we are growing Hmong pumpkin. They're very round and very big compared to the American version.\u003c/p>\n\u003cp>Growing up my parents taught me how to garden and farm. As soon as I turned 18, I became a soldier, and that was basically my entire life.\u003c/p>\n\u003cp>When I first came to America, I had no education. I couldn't find a job which equals no money to help my family. So with no financial support, it was a lot of stress on the entire family. And on top of that we also had a lot of illness in the family, which also caused a lot of stress on me as well.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When I come to the community garden and I start doing hard labor, like digging and fixing things, it makes me sweat and it releases my stress because it cools my body down at the same time.\u003c/p>\n\u003cp>When I have anxiety, I come here and it relaxes me. It also helps with my health. Due to a lot of the injuries I've had as a soldier, this helps me with exercise. So, it's basically what helps me get through the day.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Since 1975, roughly 200,000 Hmong refugees have left Laos -- 90 percent of them have resettled in the US.\u003c/aside>\n\u003cp>The majority of the people that utilize this community garden are older like me and are using Social Security Income. So, the garden also provides fresh produce for my family.\u003c/p>\n\u003cp>In Laos, everything was very green and lush. And coming here during the summer, everything turns yellow.\u003c/p>\n\u003cp>When I come here to the community garden and I see all the corn and all the beans and everything's so green, it just helps relieve all of that stress and it helps clear my mind. So, I absolutely love it here.\u003c/p>\n\u003cp>\u003cem>This story was reported by Sasha Khokha.\u003c/em>\u003c/p>\n\u003cp>\u003ca style=\"font-weight: bold;color: #114999\" href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\" target=\"_blank\">Share your own story about health in your community on the radio.\u003c/a>\u003c/p>\n\u003cp>\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/157314143&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19874\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/smile-in-crops-e1404169943328.jpg\">\u003cimg class=\"wp-image-19874 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/smile-in-crops-640x480.jpg\" alt=\"smile in crops\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Cha Deng Vang, 68, tends to the community garden at Fresno Interdenominational Refugee Ministries. Working in the garden helps Vang, a refugee from Laos, relieve anxiety and get exercise. (Annabelle Beecher/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's Note: Refugees face unique challenges building lives in the United States. Cha Deng Vang fled Laos in 1987 after fighting as soldier in the US-backed forces. As part of our ongoing health series, \u003ca href=\"blogs.kqed.org/stateofhealth/series/vital-signs/\">\u003cstrong>Vital Signs\u003c/strong>\u003c/a>, we hear from 68-year-old Vang who has found that a community garden for Hmong refugees at\u003ca href=\"http://www.firminc.org/\"> Fresno Interdenominational Refugee Ministries\u003c/a> has helped him build community and relieve stress. Chong Vang and Sam Chang helped to translate his story.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Cha Deng Vang\u003c/strong>\u003c/p>\n\u003cp>On this side we are growing Hmong pumpkin. They're very round and very big compared to the American version.\u003c/p>\n\u003cp>Growing up my parents taught me how to garden and farm. As soon as I turned 18, I became a soldier, and that was basically my entire life.\u003c/p>\n\u003cp>When I first came to America, I had no education. I couldn't find a job which equals no money to help my family. So with no financial support, it was a lot of stress on the entire family. And on top of that we also had a lot of illness in the family, which also caused a lot of stress on me as well.\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 I come to the community garden and I start doing hard labor, like digging and fixing things, it makes me sweat and it releases my stress because it cools my body down at the same time.\u003c/p>\n\u003cp>When I have anxiety, I come here and it relaxes me. It also helps with my health. Due to a lot of the injuries I've had as a soldier, this helps me with exercise. So, it's basically what helps me get through the day.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Since 1975, roughly 200,000 Hmong refugees have left Laos -- 90 percent of them have resettled in the US.\u003c/aside>\n\u003cp>The majority of the people that utilize this community garden are older like me and are using Social Security Income. So, the garden also provides fresh produce for my family.\u003c/p>\n\u003cp>In Laos, everything was very green and lush. And coming here during the summer, everything turns yellow.\u003c/p>\n\u003cp>When I come here to the community garden and I see all the corn and all the beans and everything's so green, it just helps relieve all of that stress and it helps clear my mind. So, I absolutely love it here.\u003c/p>\n\u003cp>\u003cem>This story was reported by Sasha Khokha.\u003c/em>\u003c/p>\n\u003cp>\u003ca style=\"font-weight: bold;color: #114999\" href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\" target=\"_blank\">Share your own story about health in your community on the radio.\u003c/a>\u003c/p>\n\u003cp>\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/157314143&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Sonoma Co. Supervisor Takes Issue with Kaiser over Mental Health Services",
"title": "Sonoma Co. Supervisor Takes Issue with Kaiser over Mental Health Services",
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"content": "\u003cfigure id=\"attachment_19926\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/taedc/6980198171/in/photolist-kVUsJn-eGWJpD-eH3UvL-eH48ed-eHtuta-hgqafv-eH4bjh-hgqbix-kEW2uE-kETNJV-hgparf-kEWbXs-kEUgBk-kEWbaL-kEW5B1-kEWano-kETRrP-kEW9Ch-dV2CTf-kEUupp-kEUotr-kETSBV-kETPxD-kETYEM-bCPkiT-bCPkce-bpUopJ-bpUoPJ-bpUpgm-bpUoZA-bCPkJk-nPgeUA-hgpzoJ-nMnX5A-eH3RGE-hgoS7g-eDjdgJ-eDd2LX-eDje1o-eDd4Gk-eDcYsR-eDjb8S-eDjbyj-eDj7FN-eDjewu-eDcXRD-eDjvNy-eDjtxE-eDd5Lr-eDjfiQ\">\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>\u003cem>This is Part 1 of a series on issues surrounding Kaiser Permanente's mental health services. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">Part 2\u003c/a> looks at allegations of long wait times for mental health treatment at Kaiser. \u003c/em>\u003c/p>\n\u003cp class=\"p1\">Sonoma County Supervisor Shirlee Zane is frustrated with Kaiser Permanente.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"Kaiser better change the way they do business when it comes to mental health services.\" -- Shirlee Zane, Sonoma Co. Supervisor\u003c/aside>\n\u003cp class=\"p1\">\"I can tell you I have heard a lot of stories within the last few days about these types of incidents over and over again,\" she says, \"of people who were so wronged by their treatment, by either being referred out of the system or by saying, 'We don’t have the appointments.'\"\u003c/p>\n\u003cp class=\"p1\">She's referring to allegations of long delays for mental health services at Kaiser Permanente, accusations the health plan has been dealing with for several years. Now, Zane is trying to leverage a very personal tragedy -- the suicide of her husband -- into pressing Kaiser on reforming its mental health practices.\u003c!--more-->\u003c/p>\n\u003cp class=\"p1\">Last year, the California Department of Managed Health Care (DMHC) levied a \u003ca href=\"http://www.sacbee.com/2013/06/26/5524446/kaiser-mental-health-care-lacking.html\" target=\"_blank\">$4 million fine\u003c/a> against Kaiser, the second-largest penalty since the agency was created in 2000. DMHC said Kaiser was not accurately tracking how long it took patients to gain access to a therapist when they first tried to make an appointment, and that “significant numbers of enrollees with untreated or prolonged health conditions may suffer harm.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp class=\"p1\">Kaiser, which is appealing the fine, argues that DMHC did not find problems with the quality of mental health care provided or with the ability of enrollees to obtain urgent or emergency care.\u003c/p>\n\u003cp class=\"p1\">The controversy picked up steam recently when Zane said she will use the 2011 suicide of her husband while under the care of Kaiser's Santa Rosa psychiatric department, plus her role in approving Kaiser's contract with the county, to push for changes.\u003c/p>\n\u003cp class=\"p1\">Zane informed me that she told Kaiser, “I have personal tragedy, political power and a national debate on the failure to provide mental health services all on my side -- and I’m going to use all three of them.“\u003c/p>\n\u003cp class=\"p1\">Zane's ire was triggered recently by a scathing series of ongoing blog posts written by former Kaiser Santa Rosa therapist Andy Weisskoff. Called \"\u003cstrong>\u003ca href=\"http://90daystochange.com/\" target=\"_blank\">90 Days to Change\u003c/a>\u003c/strong>,\" it chronicled Weisskoff's campaign, after he gave three months notice, to improve what he says are abysmal waiting times for Kaiser mental health patients who want individual therapy appointments.\u003c/p>\n\u003cp class=\"p1\">Weisskoff, as well as some other Kaiser therapists and patients, say that enrollees experience long delays between individual appointments, with group therapy sessions offered instead to fill the gap. These groups may or may not be adequate, Weisskoff and other Kaiser critics say.\u003c/p>\n\u003cp class=\"p1\">Moreover, critics say, the intervals between individual appointments have been increasing because of the influx of patients from Covered California and the expansion of Medi-Cal. “For years, the time between visits for my clients had held at 3-4 weeks,” Weisskoff wrote in his blog in March. “Now it was drifting to 4-5 weeks.”\u003c/p>\n\u003cp class=\"p1\">Kaiser has denied there are any problems with waiting times, and says it employs almost 14 percent more therapists in Northern California than it did three years ago.\u003c/p>\n\u003cp>\u003cstrong>A Suicide in Sonoma County\u003c/strong>\u003c/p>\n\u003cp>Supervisor Zane took a public stance on the issue after she recognized a description of her husband in one of Weisskoff's posts (since removed).\u003c/p>\n\u003cp>The post was a reprinting of a letter Weisskoff had sent to Kaiser administrators in May. In the letter, Weisskoff used the suicide of a former patient to illustrate his concerns about patients who do not show up for group sessions they're sent to.\u003c/p>\n\u003cp class=\"p3\">While Weisskoff did not identify the patient, Zane later read the blog and recognized Weisskoff was talking about her husband, a patient who had been anxious over problems at work. Weisskoff wrote:\u003c/p>\n\u003cblockquote>\u003cp>The first time I met him was for a very brief screening interview – twenty minutes. At that time our structure was to meet people briefly face to face to determine if they were appropriate to continue in our department, and if they were, to meet again in a week for a full intake interview....After twenty minutes, I gave him a preliminary diagnosis of Adjustment Disorder and made an appointment a week later to see him for an hour-long interview.\u003c/p>\n\u003cp>A week later he remained distraught. During our interview I learned more about his history, and updated his diagnosis to Panic Disorder and Major Depression, Recurrent. He claimed he didn’t have suicidal thoughts, that he was having the most difficulty managing his panic, so I booked him for our Introduction to Anxiety Disorders group, within a week, and also set him up for my next available individual appointment with me. Forty-two days later.\u003c/p>\n\u003cp>He made it to the Intro to Anxiety Group, and was referred on to the Anxiety Basics Group starting the following month. He did not make it to the first session of the Basics group, however. He killed himself two weeks after the introductory class, and two weeks before I was scheduled to see him next.\u003c/p>\u003c/blockquote>\n\u003cp>Weisskoff went on to write that he met with the patient's widow (unnamed, but it was Zane), wishing he'd told her: “I have no idea what would have happened if I was able to meet with your husband weekly during his crisis. I wish I could have seen him more frequently, but had no time in my schedule to do so. We’ll never know, now, if more frequent individual sessions could have saved him.”\u003c/p>\n\u003cp>When the \u003ca href=\"http://www.pressdemocrat.com/article/20140614/articles/140619728\" target=\"_blank\">Santa Rosa Press Democrat\u003c/a> wrote about the controversy, Zane told the paper that Weisskoff's criticisms were \"spot on about Kaiser's failure to meet the mental health needs of their patients.\" Later, in a conversation with me, she said Kaiser had provided \"insufficient care\" for her husband. She told me Kaiser apologized to her in a meeting on June 25.\u003c/p>\n\u003cp>Zane, who has been active in mental health policy issues and is a former practicing licensed therapist, was critical that her husband's primary care physician, as is often the case, was managing his medication instead of a psychiatrist. She also believes Kaiser should have known her husband had tried to commit suicide before and that it did not meet his need for individual therapy as opposed to a group.\u003c/p>\n\u003cp>\"Waiting 40 days to see a therapist certainly wasn't going to be helping him,\" she says.\u003c/p>\n\u003cp>\u003cstrong>Angry Letter to Kaiser\u003c/strong>\u003c/p>\n\u003cp>In the meantime, the National Union of Healthcare Workers (NUHW) \u003ca href=\"http://nuhw.org/sonoma-county-supervisor-shirlee-zanes-letter-kaiser-officials/\" target=\"_blank\">has requested\u003c/a> that U.S. Attorney General Eric Holder launch a criminal investigation into Kaiser over appointment delays and alleged falsification of appointment records. The union has likened Kaiser's mental health practices to those implicated in the current VA scandal. Kaiser has dismissed the allegations as a stunt by NUHW to gain leverage in protracted contract negotiations.\u003c/p>\n\u003cp>That prompted Zane to send an angry letter to Kaiser officials, saying that its belittling of the union's claims was \"upsetting and offensive.\" She went on:\u003c/p>\n\u003cblockquote>\u003cp>To blame a labor dispute for the deficiency in Kaiser’s delivery of mental health services is the lowest form of scapegoating I have ever seen. As the widow of a Kaiser patient who was so grossly undertreated for severe depression that he hung himself, I am literally sickened that you have concocted such a callous and unfounded defense for the broken healthcare system you represent. As an educated woman, your comments strike me as extremely insulting and even dangerous.\u003c/p>\u003c/blockquote>\n\u003cp>Also in the letter was a veiled threat:\u003c/p>\n\u003cblockquote>\u003cp>I am a Sonoma County Supervisor who each year approves one of Kaiser’s largest contracts. It troubles me that I am hearing my story echoed by so many other northern California subscribers and I am beginning to wonder how I can, in good faith, approve for County employees healthcare services that I know to be dangerously inadequate.\u003c/p>\u003c/blockquote>\n\u003cp>Last Wednesday, on June 25, Zane met with Kaiser officials. She says that she told them that Kaiser was relying too much on group treatment at the expense of individual therapy appointments. \"You guys need to offer group therapy as (only) an alternative. This doesn’t look voluntary,\" she described saying. \"You can't put people who are acutely depressed in a group. Groups are helpful for grief and substance abuse, but there’s a whole host of mental health problems. ... I said individual therapy always needs to be offered.\"\u003c/p>\n\u003cp>Zane told me that Kaiser agreed with her and would make changes.\u003c/p>\n\u003cp>\"They agreed to no longer offer group therapy as being the only option for their members, but only offer that as an alternative.\"\u003c/p>\n\u003cp>But when I asked Kaiser to verify that, they had a different take on the meeting. In a statement, Kaiser said any characterization of an agreement with Zane was incorrect:\u003c/p>\n\u003cblockquote>\u003cp>In our meeting with Ms. Zane we discussed KP's commitment to the combinations of mental health treatment that are optimal for a patient's condition. Every patient’s situation is evaluated and treated individually. If a patient's treatment plan involves follow up individual appointments with a therapist, the patient will receive those appointments. When we offer group therapy, an individual therapist appointment is always also available to the patient. Often group therapy or health education classes are important parts of a patient's treatment, and if patients are not taking advantage of those, we will partner with the patient to determine other courses of treatment.\"\u003c/p>\u003c/blockquote>\n\u003cp>Kaiser also told the \u003ca href=\"http://www.pressdemocrat.com/article/20140628/articles/140629575#page=0\" target=\"_blank\">Santa Rosa Press Democrat\u003c/a> that it had already been taking steps to improve its service before the meeting with Zane.\u003c/p>\n\u003cp>Which brings us back to the top of the article and Zane's frustration with Kaiser. She is not happy that its description of what happened in the meeting appears less than resolute in acknowledging what some say are problems with individual appointment delays and an over-reliance on group therapy. She says she will circle back with Kaiser on the matter when she meets with plan representatives on July 30. And she says she's heard from plenty of unhappy Kaiser patients since the dispute went public.\u003c/p>\n\u003cp>\"Stories that would make the hair on the back of your head stand up,\" she says. \"Kaiser better start paying attention.They better change the way they do business when it comes to mental health services.\"\u003c/p>\n\u003cp>Kaiser, for its part,says that any focus on a lack of individual therapy is a mistake, as there is no evidence that it is more effective than group therapy.\u003c/p>\n\u003cp>Meanwhile, as to the question of Kaiser's alleged negligence in not providing Zane's husband with a timely individual therapy appointment, Kaiser will not speak publicly about it, citing privacy laws. But speaking generally about the issue, Dr. Mason Turner, Kaiser's director of patient operations for regional mental health for Northern California, told me last week that if therapists feel their patients need more individual therapy, it is the therapists' responsibility to make sure it happens:\u003c/p>\n\u003cp>“We would expect our therapists, if they thought (a patient) needed to be seen sooner, would elect to discuss it with their manager and look for alternative times,\" he said. \"Or have a discussion with their colleagues how they’ve managed patients like that before. It’s really up to the patient and therapist to make sure that occurs... (But) we have ways of accommodating this when it comes up.“\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>But the Kaiser clinicians I have spoken to say it's not possible for them to offer more individual therapy to all of the people who need it, because there are simply not enough appointments available. We'll look at that issue and more about Kaiser's mental health services in upcoming posts.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19926\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/taedc/6980198171/in/photolist-kVUsJn-eGWJpD-eH3UvL-eH48ed-eHtuta-hgqafv-eH4bjh-hgqbix-kEW2uE-kETNJV-hgparf-kEWbXs-kEUgBk-kEWbaL-kEW5B1-kEWano-kETRrP-kEW9Ch-dV2CTf-kEUupp-kEUotr-kETSBV-kETPxD-kETYEM-bCPkiT-bCPkce-bpUopJ-bpUoPJ-bpUpgm-bpUoZA-bCPkJk-nPgeUA-hgpzoJ-nMnX5A-eH3RGE-hgoS7g-eDjdgJ-eDd2LX-eDje1o-eDd4Gk-eDcYsR-eDjb8S-eDjbyj-eDj7FN-eDjewu-eDcXRD-eDjvNy-eDjtxE-eDd5Lr-eDjfiQ\">\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>\u003cem>This is Part 1 of a series on issues surrounding Kaiser Permanente's mental health services. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">Part 2\u003c/a> looks at allegations of long wait times for mental health treatment at Kaiser. \u003c/em>\u003c/p>\n\u003cp class=\"p1\">Sonoma County Supervisor Shirlee Zane is frustrated with Kaiser Permanente.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"Kaiser better change the way they do business when it comes to mental health services.\" -- Shirlee Zane, Sonoma Co. Supervisor\u003c/aside>\n\u003cp class=\"p1\">\"I can tell you I have heard a lot of stories within the last few days about these types of incidents over and over again,\" she says, \"of people who were so wronged by their treatment, by either being referred out of the system or by saying, 'We don’t have the appointments.'\"\u003c/p>\n\u003cp class=\"p1\">She's referring to allegations of long delays for mental health services at Kaiser Permanente, accusations the health plan has been dealing with for several years. Now, Zane is trying to leverage a very personal tragedy -- the suicide of her husband -- into pressing Kaiser on reforming its mental health practices.\u003c!--more-->\u003c/p>\n\u003cp class=\"p1\">Last year, the California Department of Managed Health Care (DMHC) levied a \u003ca href=\"http://www.sacbee.com/2013/06/26/5524446/kaiser-mental-health-care-lacking.html\" target=\"_blank\">$4 million fine\u003c/a> against Kaiser, the second-largest penalty since the agency was created in 2000. DMHC said Kaiser was not accurately tracking how long it took patients to gain access to a therapist when they first tried to make an appointment, and that “significant numbers of enrollees with untreated or prolonged health conditions may suffer harm.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"p1\">Kaiser, which is appealing the fine, argues that DMHC did not find problems with the quality of mental health care provided or with the ability of enrollees to obtain urgent or emergency care.\u003c/p>\n\u003cp class=\"p1\">The controversy picked up steam recently when Zane said she will use the 2011 suicide of her husband while under the care of Kaiser's Santa Rosa psychiatric department, plus her role in approving Kaiser's contract with the county, to push for changes.\u003c/p>\n\u003cp class=\"p1\">Zane informed me that she told Kaiser, “I have personal tragedy, political power and a national debate on the failure to provide mental health services all on my side -- and I’m going to use all three of them.“\u003c/p>\n\u003cp class=\"p1\">Zane's ire was triggered recently by a scathing series of ongoing blog posts written by former Kaiser Santa Rosa therapist Andy Weisskoff. Called \"\u003cstrong>\u003ca href=\"http://90daystochange.com/\" target=\"_blank\">90 Days to Change\u003c/a>\u003c/strong>,\" it chronicled Weisskoff's campaign, after he gave three months notice, to improve what he says are abysmal waiting times for Kaiser mental health patients who want individual therapy appointments.\u003c/p>\n\u003cp class=\"p1\">Weisskoff, as well as some other Kaiser therapists and patients, say that enrollees experience long delays between individual appointments, with group therapy sessions offered instead to fill the gap. These groups may or may not be adequate, Weisskoff and other Kaiser critics say.\u003c/p>\n\u003cp class=\"p1\">Moreover, critics say, the intervals between individual appointments have been increasing because of the influx of patients from Covered California and the expansion of Medi-Cal. “For years, the time between visits for my clients had held at 3-4 weeks,” Weisskoff wrote in his blog in March. “Now it was drifting to 4-5 weeks.”\u003c/p>\n\u003cp class=\"p1\">Kaiser has denied there are any problems with waiting times, and says it employs almost 14 percent more therapists in Northern California than it did three years ago.\u003c/p>\n\u003cp>\u003cstrong>A Suicide in Sonoma County\u003c/strong>\u003c/p>\n\u003cp>Supervisor Zane took a public stance on the issue after she recognized a description of her husband in one of Weisskoff's posts (since removed).\u003c/p>\n\u003cp>The post was a reprinting of a letter Weisskoff had sent to Kaiser administrators in May. In the letter, Weisskoff used the suicide of a former patient to illustrate his concerns about patients who do not show up for group sessions they're sent to.\u003c/p>\n\u003cp class=\"p3\">While Weisskoff did not identify the patient, Zane later read the blog and recognized Weisskoff was talking about her husband, a patient who had been anxious over problems at work. Weisskoff wrote:\u003c/p>\n\u003cblockquote>\u003cp>The first time I met him was for a very brief screening interview – twenty minutes. At that time our structure was to meet people briefly face to face to determine if they were appropriate to continue in our department, and if they were, to meet again in a week for a full intake interview....After twenty minutes, I gave him a preliminary diagnosis of Adjustment Disorder and made an appointment a week later to see him for an hour-long interview.\u003c/p>\n\u003cp>A week later he remained distraught. During our interview I learned more about his history, and updated his diagnosis to Panic Disorder and Major Depression, Recurrent. He claimed he didn’t have suicidal thoughts, that he was having the most difficulty managing his panic, so I booked him for our Introduction to Anxiety Disorders group, within a week, and also set him up for my next available individual appointment with me. Forty-two days later.\u003c/p>\n\u003cp>He made it to the Intro to Anxiety Group, and was referred on to the Anxiety Basics Group starting the following month. He did not make it to the first session of the Basics group, however. He killed himself two weeks after the introductory class, and two weeks before I was scheduled to see him next.\u003c/p>\u003c/blockquote>\n\u003cp>Weisskoff went on to write that he met with the patient's widow (unnamed, but it was Zane), wishing he'd told her: “I have no idea what would have happened if I was able to meet with your husband weekly during his crisis. I wish I could have seen him more frequently, but had no time in my schedule to do so. We’ll never know, now, if more frequent individual sessions could have saved him.”\u003c/p>\n\u003cp>When the \u003ca href=\"http://www.pressdemocrat.com/article/20140614/articles/140619728\" target=\"_blank\">Santa Rosa Press Democrat\u003c/a> wrote about the controversy, Zane told the paper that Weisskoff's criticisms were \"spot on about Kaiser's failure to meet the mental health needs of their patients.\" Later, in a conversation with me, she said Kaiser had provided \"insufficient care\" for her husband. She told me Kaiser apologized to her in a meeting on June 25.\u003c/p>\n\u003cp>Zane, who has been active in mental health policy issues and is a former practicing licensed therapist, was critical that her husband's primary care physician, as is often the case, was managing his medication instead of a psychiatrist. She also believes Kaiser should have known her husband had tried to commit suicide before and that it did not meet his need for individual therapy as opposed to a group.\u003c/p>\n\u003cp>\"Waiting 40 days to see a therapist certainly wasn't going to be helping him,\" she says.\u003c/p>\n\u003cp>\u003cstrong>Angry Letter to Kaiser\u003c/strong>\u003c/p>\n\u003cp>In the meantime, the National Union of Healthcare Workers (NUHW) \u003ca href=\"http://nuhw.org/sonoma-county-supervisor-shirlee-zanes-letter-kaiser-officials/\" target=\"_blank\">has requested\u003c/a> that U.S. Attorney General Eric Holder launch a criminal investigation into Kaiser over appointment delays and alleged falsification of appointment records. The union has likened Kaiser's mental health practices to those implicated in the current VA scandal. Kaiser has dismissed the allegations as a stunt by NUHW to gain leverage in protracted contract negotiations.\u003c/p>\n\u003cp>That prompted Zane to send an angry letter to Kaiser officials, saying that its belittling of the union's claims was \"upsetting and offensive.\" She went on:\u003c/p>\n\u003cblockquote>\u003cp>To blame a labor dispute for the deficiency in Kaiser’s delivery of mental health services is the lowest form of scapegoating I have ever seen. As the widow of a Kaiser patient who was so grossly undertreated for severe depression that he hung himself, I am literally sickened that you have concocted such a callous and unfounded defense for the broken healthcare system you represent. As an educated woman, your comments strike me as extremely insulting and even dangerous.\u003c/p>\u003c/blockquote>\n\u003cp>Also in the letter was a veiled threat:\u003c/p>\n\u003cblockquote>\u003cp>I am a Sonoma County Supervisor who each year approves one of Kaiser’s largest contracts. It troubles me that I am hearing my story echoed by so many other northern California subscribers and I am beginning to wonder how I can, in good faith, approve for County employees healthcare services that I know to be dangerously inadequate.\u003c/p>\u003c/blockquote>\n\u003cp>Last Wednesday, on June 25, Zane met with Kaiser officials. She says that she told them that Kaiser was relying too much on group treatment at the expense of individual therapy appointments. \"You guys need to offer group therapy as (only) an alternative. This doesn’t look voluntary,\" she described saying. \"You can't put people who are acutely depressed in a group. Groups are helpful for grief and substance abuse, but there’s a whole host of mental health problems. ... I said individual therapy always needs to be offered.\"\u003c/p>\n\u003cp>Zane told me that Kaiser agreed with her and would make changes.\u003c/p>\n\u003cp>\"They agreed to no longer offer group therapy as being the only option for their members, but only offer that as an alternative.\"\u003c/p>\n\u003cp>But when I asked Kaiser to verify that, they had a different take on the meeting. In a statement, Kaiser said any characterization of an agreement with Zane was incorrect:\u003c/p>\n\u003cblockquote>\u003cp>In our meeting with Ms. Zane we discussed KP's commitment to the combinations of mental health treatment that are optimal for a patient's condition. Every patient’s situation is evaluated and treated individually. If a patient's treatment plan involves follow up individual appointments with a therapist, the patient will receive those appointments. When we offer group therapy, an individual therapist appointment is always also available to the patient. Often group therapy or health education classes are important parts of a patient's treatment, and if patients are not taking advantage of those, we will partner with the patient to determine other courses of treatment.\"\u003c/p>\u003c/blockquote>\n\u003cp>Kaiser also told the \u003ca href=\"http://www.pressdemocrat.com/article/20140628/articles/140629575#page=0\" target=\"_blank\">Santa Rosa Press Democrat\u003c/a> that it had already been taking steps to improve its service before the meeting with Zane.\u003c/p>\n\u003cp>Which brings us back to the top of the article and Zane's frustration with Kaiser. She is not happy that its description of what happened in the meeting appears less than resolute in acknowledging what some say are problems with individual appointment delays and an over-reliance on group therapy. She says she will circle back with Kaiser on the matter when she meets with plan representatives on July 30. And she says she's heard from plenty of unhappy Kaiser patients since the dispute went public.\u003c/p>\n\u003cp>\"Stories that would make the hair on the back of your head stand up,\" she says. \"Kaiser better start paying attention.They better change the way they do business when it comes to mental health services.\"\u003c/p>\n\u003cp>Kaiser, for its part,says that any focus on a lack of individual therapy is a mistake, as there is no evidence that it is more effective than group therapy.\u003c/p>\n\u003cp>Meanwhile, as to the question of Kaiser's alleged negligence in not providing Zane's husband with a timely individual therapy appointment, Kaiser will not speak publicly about it, citing privacy laws. But speaking generally about the issue, Dr. Mason Turner, Kaiser's director of patient operations for regional mental health for Northern California, told me last week that if therapists feel their patients need more individual therapy, it is the therapists' responsibility to make sure it happens:\u003c/p>\n\u003cp>“We would expect our therapists, if they thought (a patient) needed to be seen sooner, would elect to discuss it with their manager and look for alternative times,\" he said. \"Or have a discussion with their colleagues how they’ve managed patients like that before. It’s really up to the patient and therapist to make sure that occurs... (But) we have ways of accommodating this when it comes up.“\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the Kaiser clinicians I have spoken to say it's not possible for them to offer more individual therapy to all of the people who need it, because there are simply not enough appointments available. We'll look at that issue and more about Kaiser's mental health services in upcoming posts.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Living -- Successfully -- with Mental Illness",
"title": "Living -- Successfully -- with Mental Illness",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_19311\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10453_IMG_0346-hpf.jpg\">\u003cimg class=\"size-full wp-image-19311\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10453_IMG_0346-hpf.jpg\" alt=\"Esme Wang, an award-winning writer, lives with bipolar disorder. (Nora Elmeligy/KQED)\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/05/RS10453_IMG_0346-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/05/RS10453_IMG_0346-hpf-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/05/RS10453_IMG_0346-hpf-320x214.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Esme Wang, an award-winning writer, lives with bipolar disorder. (Nora Elmeligy/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Nora Elmeligy\u003c/strong>\u003c/p>\n\u003cp>It's been a week since the \u003ca href=\"http://ww2.kqed.org/news/uc-santa-barbara-shootings\" target=\"_blank\">deadly shooting rampage\u003c/a> near Santa Barbara. Much attention has been paid to the apparent perpetrator's \u003ca href=\"http://ww2.kqed.org/news/2014/05/26/amid-multiple-warning-signs-alleged-isla-vista-killer-slipped-through-system/\" target=\"_blank\">mental health status\u003c/a>.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"It is still possible to live a really exciting, thriving, magnificent life, even with those limitations.\" \u003c/aside>\n\u003cp>Horrific events -- and the intense media attention paid to them -- feed a false perception that people with mental illness are violent. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/04/04/why-is-fort-hood-shooters-mental-health-constantly-reported/\" target=\"_blank\">They are not.\u003c/a> They may be more likely to be \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961851-5/fulltext\" target=\"_blank\">victims of violence\u003c/a> than to cause it.\u003c/p>\n\u003cp>For people who live with mental illness, the timeliness of the Isla Vista rampage is especially wrenching -- May is Mental Health Month, a time when community groups are trying to stress the importance of protecting and promoting mental health.\u003c/p>\n\u003cp>The Mental Health Association of San Francisco (MHASF) works together with its umbrella organization Mental Health America in working to change attitudes towards mental health and mental health care. They group says believing people who are mentally ill are likely to be violent is just one of three major stigmas they encounter. The others are the perception that people with mental illness are childlike or incompetent.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>MHASF is trying to break these stigmas down and create a new dialogue through an innovative peer program. People who have \"lived experience with a mental health challenge\" are resources to others who need help, rather than solely relying on traditionally-trained clinicians. Perhaps the most poignant example of MHASF’s peer-based approach is \u003ca href=\"http://www.mentalhealthsf.org/programs/solve/\">SOLVE\u003c/a> - \u003cem>Sharing Our Lives, Voices, and Experiences \u003c/em>- a speakers’ bureau where people who have lived through mental health conditions share their experiences, train others to tell their stories, and in doing so continue their own healing.\u003c/p>\n\u003cp>These four SOLVE speakers paint a different portrait of the face of mental illness -- and mental health.\u003c/p>\n\u003cfigure id=\"attachment_19313\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10533_IMG_0328-hpf.jpg\">\u003cimg class=\"size-medium wp-image-19313\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10533_IMG_0328-hpf-300x200.jpg\" alt=\"David Lewis. (Nora Elmeligy/KQED)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">David Lewis. (Nora Elmeligy/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>David Elliot Lewis\u003c/strong>\u003c/p>\n\u003cp>Lewis has suffered what he describes as “debilitating depression,” following the loss of his job and broken relationships. Despite having two graduate degrees, including a doctorate, he found himself homeless for a period. When he felt he had hit rock bottom, he sought help. David says he considers himself lucky for having found conscientious doctors that understood him and treated him well.\u003c/p>\n\u003cp>He has put his life back together and now lives well with his depression diagnosis. in addition to becoming an advocate for mental health, Lewis took up photography. Among several other hats he wears, Lewis is co-chair of the Mental Health Board of San Francisco, and is helping design crisis intervention training programs for police officers. The goal is to focus on verbal de-escalation and other techniques to handle those going through a mental health episode.\u003c/p>\n\u003cp>“Obviously there’s a percentage of all people that can be harmful to others,\" Lewis told me, \"that’s why we have police forces. But people suffering mental health crises aren’t at a higher rate of being harmful to others. They \u003cem>are\u003c/em> at a higher rate, though, of being harmful to themselves: not taking care of themselves, suicides, self-destructive behavior, things like that. The true tragedy of mental illness is what it does to the person experiencing it.”\u003c/p>\n\u003cp>\u003cstrong>Gaynorann Siataga\u003c/strong>\u003c/p>\n\u003cp>\u003cem>“For so long I felt like I was an issue and a burden and, just not meant to be here.. And coming to find out that I am a good person but just have issues to overcome has been amazing.”\u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_19315\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10532_IMG_0322-hpf.jpg\">\u003cimg class=\"size-medium wp-image-19315\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10532_IMG_0322-hpf-300x200.jpg\" alt=\"Gaynorann Siataga (Nora Elmeligy)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gaynorann Siataga (Nora Elmeligy)\u003c/figcaption>\u003c/figure>\n\u003cp>By the time Siataga was 11-years-old, she already felt like she wasn't accepted anywhere. She had suffered physical and sexual abuse, but says her Asian-Pacific Islander family did not permit discussion of any mental health challenges. She turned to a gang for refuge and simply tried to suppress all she had been through in an attempt to deny that she was struggling.\u003c/p>\n\u003cp>Siataga says the biggest thing SOLVE has done for her was to help her break her own stigma about herself. Only after she could admit she was struggling did her own recovery begin, she says. She received several diagnoses, including bipolar disorder, depression and post traumatic stress disorder. She is now off medications and says she uses her activism as a form of therapy. Siataga helps run workshops to prevent gang violence, including the \"\u003ca href=\"http://www.pivp.org/#!workshops/ctlp\" target=\"_blank\">Gang /Turf Violence\u003c/a>\" workshop at the first-of-its-kind \u003ca href=\"http://www.pivp.org/\" target=\"_blank\">Pacific Islander Violence Prevention Conference\u003c/a>. The workshop will look at increasing gang violence among Pacific Islanders and strategies to combat the lure of young Pacific Islanders joining gangs.\u003c/p>\n\u003cp>\u003cstrong>Leonila Adams\u003c/strong>\u003c/p>\n\u003cp>\u003cem>“The SOLVE program helped me to come out from wherever I’m hiding. Maybe through my stories I will help to open their hearts. Maybe not their minds, but at least their hearts.”\u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_19314\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10534_IMG_0340-hpf.jpg\">\u003cimg class=\"size-medium wp-image-19314\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10534_IMG_0340-hpf-300x200.jpg\" alt=\"Leonila Adams (Nora Elmeligy)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Leonila Adams (Nora Elmeligy)\u003c/figcaption>\u003c/figure>\n\u003cp>When Leonila graduated high school in the Philippines, her mother cried. But they were not tears of joy. Adams' mother was crying because she thought her daughter would never go to college. Adams has severe bipolar disorder, and her mother cried to her, \"I know this is the last time I will see you graduate.\"\u003c/p>\n\u003cp>Adams says employers, counselors, and even doctors have echoed that sentiment over the years. But Adams persevered. She went on to college, first earning an Associate's, then a Bachelor's degree. Today she is a full-time case manager with Family Services Agency in San Francisco. Every day, she works with people who have severe mental challenges or substance abuse problems. Finally, she was just accepted to California Institute of Integral Studies to become a counselor. Oddly, Adams credits her mother with motivating her. “What my mother said, that I will never graduate past high school, … it kept me going,” she says. As a testament to how different people recover differently, Leonila says that her faith in God, and her faith in what she can do, have pushed her to succeed.\u003c/p>\n\u003cp>\u003cstrong>Esme Wang\u003c/strong>\u003c/p>\n\u003cp>Today, Wang is \u003ca href=\"http://www.esmewang.com\" target=\"_blank\">a successful writer\u003c/a>. She's won numerous awards and fellowships.\u003c/p>\n\u003cp>But when she was 19, she was asked to leave Yale University.\u003ca href=\"http://www.esmewang.com/201102why-i-left-yale-mental-illness-higher-education/\" target=\"_blank\"> In an essay\u003c/a>, she describes that she had been diagnosed with bipolar disorder in the summer before her freshman year. By the beginning of her sophomore year, she had become desperately ill.\u003c/p>\n\u003cp>While the struggles of her bipolar disorder have changed and interrupted her life, Esme says the challenges she most commonly faces are the ones that come with how \u003cem>other\u003c/em> people respond to her mental health conditions and assume things about her.\u003c/p>\n\u003cp>The most immediate of these challenges was with her family, who took years to accept\u003cem> \u003c/em>that she had a condition, let alone overcome the stigma that was so built into their culture. When she first told her family that she needed a psychiatrist, “My mother started yelling me and saying, ‘How could you do this to us? We’ve given you everything you always wanted.’”\u003c/p>\n\u003cp>“I was born to immigrant parents who had pretty standard ideas of what their Chinese children should grow up to look like,\" Wang says. \"I was very much marked as an overachiever early on in life. Later, as I was getting older ... I started exhibiting symptoms of what was then called depression and anxiety, and over the years it became clearer and clearer that there was something that was increasingly wrong.”\u003c/p>\n\u003cp>After Wang was asked to leave Yale, her family became much more supportive. Ultimately, Wang transferred to Stanford where she graduated with stellar GPA and a degree in psychology and creative writing. She later earned a Masters degree in creative writing.\u003c/p>\n\u003cp>In addition to her writing, and the work she does with SOLVE, Wang is working with a think tank to come up with a set of best practices regarding colleges and universities -- and how they manage (or \u003ca href=\"http://www.newsweek.com/2014/02/14/how-colleges-flunk-mental-health-245492.html\" target=\"_blank\">don't manage\u003c/a>) students with mental health challenges.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I think one aspect of my success story,\" Wang says, \"is realizing that I do have limitations, and that those limitations are not to be taken lightly, and they’re not to be plowed through as though they don’t exist, because that has caused problems for me in the past as well. But that it is still possible to live a really exciting, thriving, magnificent life, even with those limitations.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19311\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10453_IMG_0346-hpf.jpg\">\u003cimg class=\"size-full wp-image-19311\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10453_IMG_0346-hpf.jpg\" alt=\"Esme Wang, an award-winning writer, lives with bipolar disorder. (Nora Elmeligy/KQED)\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/05/RS10453_IMG_0346-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/05/RS10453_IMG_0346-hpf-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/05/RS10453_IMG_0346-hpf-320x214.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Esme Wang, an award-winning writer, lives with bipolar disorder. (Nora Elmeligy/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Nora Elmeligy\u003c/strong>\u003c/p>\n\u003cp>It's been a week since the \u003ca href=\"http://ww2.kqed.org/news/uc-santa-barbara-shootings\" target=\"_blank\">deadly shooting rampage\u003c/a> near Santa Barbara. Much attention has been paid to the apparent perpetrator's \u003ca href=\"http://ww2.kqed.org/news/2014/05/26/amid-multiple-warning-signs-alleged-isla-vista-killer-slipped-through-system/\" target=\"_blank\">mental health status\u003c/a>.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"It is still possible to live a really exciting, thriving, magnificent life, even with those limitations.\" \u003c/aside>\n\u003cp>Horrific events -- and the intense media attention paid to them -- feed a false perception that people with mental illness are violent. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/04/04/why-is-fort-hood-shooters-mental-health-constantly-reported/\" target=\"_blank\">They are not.\u003c/a> They may be more likely to be \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961851-5/fulltext\" target=\"_blank\">victims of violence\u003c/a> than to cause it.\u003c/p>\n\u003cp>For people who live with mental illness, the timeliness of the Isla Vista rampage is especially wrenching -- May is Mental Health Month, a time when community groups are trying to stress the importance of protecting and promoting mental health.\u003c/p>\n\u003cp>The Mental Health Association of San Francisco (MHASF) works together with its umbrella organization Mental Health America in working to change attitudes towards mental health and mental health care. They group says believing people who are mentally ill are likely to be violent is just one of three major stigmas they encounter. The others are the perception that people with mental illness are childlike or incompetent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>MHASF is trying to break these stigmas down and create a new dialogue through an innovative peer program. People who have \"lived experience with a mental health challenge\" are resources to others who need help, rather than solely relying on traditionally-trained clinicians. Perhaps the most poignant example of MHASF’s peer-based approach is \u003ca href=\"http://www.mentalhealthsf.org/programs/solve/\">SOLVE\u003c/a> - \u003cem>Sharing Our Lives, Voices, and Experiences \u003c/em>- a speakers’ bureau where people who have lived through mental health conditions share their experiences, train others to tell their stories, and in doing so continue their own healing.\u003c/p>\n\u003cp>These four SOLVE speakers paint a different portrait of the face of mental illness -- and mental health.\u003c/p>\n\u003cfigure id=\"attachment_19313\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10533_IMG_0328-hpf.jpg\">\u003cimg class=\"size-medium wp-image-19313\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10533_IMG_0328-hpf-300x200.jpg\" alt=\"David Lewis. (Nora Elmeligy/KQED)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">David Lewis. (Nora Elmeligy/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>David Elliot Lewis\u003c/strong>\u003c/p>\n\u003cp>Lewis has suffered what he describes as “debilitating depression,” following the loss of his job and broken relationships. Despite having two graduate degrees, including a doctorate, he found himself homeless for a period. When he felt he had hit rock bottom, he sought help. David says he considers himself lucky for having found conscientious doctors that understood him and treated him well.\u003c/p>\n\u003cp>He has put his life back together and now lives well with his depression diagnosis. in addition to becoming an advocate for mental health, Lewis took up photography. Among several other hats he wears, Lewis is co-chair of the Mental Health Board of San Francisco, and is helping design crisis intervention training programs for police officers. The goal is to focus on verbal de-escalation and other techniques to handle those going through a mental health episode.\u003c/p>\n\u003cp>“Obviously there’s a percentage of all people that can be harmful to others,\" Lewis told me, \"that’s why we have police forces. But people suffering mental health crises aren’t at a higher rate of being harmful to others. They \u003cem>are\u003c/em> at a higher rate, though, of being harmful to themselves: not taking care of themselves, suicides, self-destructive behavior, things like that. The true tragedy of mental illness is what it does to the person experiencing it.”\u003c/p>\n\u003cp>\u003cstrong>Gaynorann Siataga\u003c/strong>\u003c/p>\n\u003cp>\u003cem>“For so long I felt like I was an issue and a burden and, just not meant to be here.. And coming to find out that I am a good person but just have issues to overcome has been amazing.”\u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_19315\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10532_IMG_0322-hpf.jpg\">\u003cimg class=\"size-medium wp-image-19315\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10532_IMG_0322-hpf-300x200.jpg\" alt=\"Gaynorann Siataga (Nora Elmeligy)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gaynorann Siataga (Nora Elmeligy)\u003c/figcaption>\u003c/figure>\n\u003cp>By the time Siataga was 11-years-old, she already felt like she wasn't accepted anywhere. She had suffered physical and sexual abuse, but says her Asian-Pacific Islander family did not permit discussion of any mental health challenges. She turned to a gang for refuge and simply tried to suppress all she had been through in an attempt to deny that she was struggling.\u003c/p>\n\u003cp>Siataga says the biggest thing SOLVE has done for her was to help her break her own stigma about herself. Only after she could admit she was struggling did her own recovery begin, she says. She received several diagnoses, including bipolar disorder, depression and post traumatic stress disorder. She is now off medications and says she uses her activism as a form of therapy. Siataga helps run workshops to prevent gang violence, including the \"\u003ca href=\"http://www.pivp.org/#!workshops/ctlp\" target=\"_blank\">Gang /Turf Violence\u003c/a>\" workshop at the first-of-its-kind \u003ca href=\"http://www.pivp.org/\" target=\"_blank\">Pacific Islander Violence Prevention Conference\u003c/a>. The workshop will look at increasing gang violence among Pacific Islanders and strategies to combat the lure of young Pacific Islanders joining gangs.\u003c/p>\n\u003cp>\u003cstrong>Leonila Adams\u003c/strong>\u003c/p>\n\u003cp>\u003cem>“The SOLVE program helped me to come out from wherever I’m hiding. Maybe through my stories I will help to open their hearts. Maybe not their minds, but at least their hearts.”\u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_19314\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10534_IMG_0340-hpf.jpg\">\u003cimg class=\"size-medium wp-image-19314\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/RS10534_IMG_0340-hpf-300x200.jpg\" alt=\"Leonila Adams (Nora Elmeligy)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Leonila Adams (Nora Elmeligy)\u003c/figcaption>\u003c/figure>\n\u003cp>When Leonila graduated high school in the Philippines, her mother cried. But they were not tears of joy. Adams' mother was crying because she thought her daughter would never go to college. Adams has severe bipolar disorder, and her mother cried to her, \"I know this is the last time I will see you graduate.\"\u003c/p>\n\u003cp>Adams says employers, counselors, and even doctors have echoed that sentiment over the years. But Adams persevered. She went on to college, first earning an Associate's, then a Bachelor's degree. Today she is a full-time case manager with Family Services Agency in San Francisco. Every day, she works with people who have severe mental challenges or substance abuse problems. Finally, she was just accepted to California Institute of Integral Studies to become a counselor. Oddly, Adams credits her mother with motivating her. “What my mother said, that I will never graduate past high school, … it kept me going,” she says. As a testament to how different people recover differently, Leonila says that her faith in God, and her faith in what she can do, have pushed her to succeed.\u003c/p>\n\u003cp>\u003cstrong>Esme Wang\u003c/strong>\u003c/p>\n\u003cp>Today, Wang is \u003ca href=\"http://www.esmewang.com\" target=\"_blank\">a successful writer\u003c/a>. She's won numerous awards and fellowships.\u003c/p>\n\u003cp>But when she was 19, she was asked to leave Yale University.\u003ca href=\"http://www.esmewang.com/201102why-i-left-yale-mental-illness-higher-education/\" target=\"_blank\"> In an essay\u003c/a>, she describes that she had been diagnosed with bipolar disorder in the summer before her freshman year. By the beginning of her sophomore year, she had become desperately ill.\u003c/p>\n\u003cp>While the struggles of her bipolar disorder have changed and interrupted her life, Esme says the challenges she most commonly faces are the ones that come with how \u003cem>other\u003c/em> people respond to her mental health conditions and assume things about her.\u003c/p>\n\u003cp>The most immediate of these challenges was with her family, who took years to accept\u003cem> \u003c/em>that she had a condition, let alone overcome the stigma that was so built into their culture. When she first told her family that she needed a psychiatrist, “My mother started yelling me and saying, ‘How could you do this to us? We’ve given you everything you always wanted.’”\u003c/p>\n\u003cp>“I was born to immigrant parents who had pretty standard ideas of what their Chinese children should grow up to look like,\" Wang says. \"I was very much marked as an overachiever early on in life. Later, as I was getting older ... I started exhibiting symptoms of what was then called depression and anxiety, and over the years it became clearer and clearer that there was something that was increasingly wrong.”\u003c/p>\n\u003cp>After Wang was asked to leave Yale, her family became much more supportive. Ultimately, Wang transferred to Stanford where she graduated with stellar GPA and a degree in psychology and creative writing. She later earned a Masters degree in creative writing.\u003c/p>\n\u003cp>In addition to her writing, and the work she does with SOLVE, Wang is working with a think tank to come up with a set of best practices regarding colleges and universities -- and how they manage (or \u003ca href=\"http://www.newsweek.com/2014/02/14/how-colleges-flunk-mental-health-245492.html\" target=\"_blank\">don't manage\u003c/a>) students with mental health challenges.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I think one aspect of my success story,\" Wang says, \"is realizing that I do have limitations, and that those limitations are not to be taken lightly, and they’re not to be plowed through as though they don’t exist, because that has caused problems for me in the past as well. But that it is still possible to live a really exciting, thriving, magnificent life, even with those limitations.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
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},
"californiareport": {
"id": "californiareport",
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"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
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"officialWebsiteLink": "/californiareport",
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"order": 8
},
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},
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"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"order": 1
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"source": "Commonwealth Club of California"
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"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
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"order": 9
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"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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"id": "fresh-air",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"meta": {
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"source": "NPR"
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"how-i-built-this": {
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"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"order": 18
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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},
"masters-of-scale": {
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"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
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