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"content": "\u003cfigure id=\"attachment_9250\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr-e1370983947930.jpg\">\u003cimg class=\"size-large wp-image-9250\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr-620x413.jpg\" alt=\"(seliaymiwell/flickr)\" width=\"620\" height=\"413\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(seliaymiwell/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>California lawmakers announced a series of budget proposals Wednesday calling for more training of law enforcement officers on how to handle people with mental illness. While lawmakers have been working on the proposals for weeks, there is renewed emphasis on them in the aftermath of a gun rampage that left seven people dead near UC Santa Barbara last weekend.\u003c/p>\n\u003cp>“How do we stop this before it happens?” said Sen. Hannah-Beth Jackson (D-Santa Barbara).\u003c/p>\n\u003cp>Jackson said police officers who visited the shooter before the violence erupted failed to investigate him thoroughly and failed to recognize warning signs of mental health problems. “This is a young man whose mental illness was right out there on YouTube, right out there on Facebook, and in screeds that he posted on blogs,” Jackson said. “And yet no one did or was able to recognize the potential for violence that resulted in this mass set of murders.”\u003c/p>\n\u003cp>Sen. Loni Hancock (D-Berkeley) says the problem continues inside the state’s jails and prisons, where nearly half the inmates suffer from mental illness. She cited incidents where mentally ill inmates were improperly pepper sprayed.\u003c!--more-->\u003c/p>\n\u003cp>“You can be a correctional officer right out of high school,” Hancock said. “Nobody tells you about the demographics of the prison population, how to treat mentally ill people, how to de-escalate situations.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Senate Democrats want to see more money invested in training law enforcement and prison personnel in how to deal with mentally ill offenders. It’s just one of a series of policy and budget proposals the caucus has been working on.\u003c/p>\n\u003cp>But now they say their efforts have taken on even greater importance after \u003ca href=\"http://ww2.kqed.org/news/2014/05/26/amid-multiple-warning-signs-alleged-isla-vista-killer-slipped-through-system/\" target=\"_blank\">what happened in Isla Vista.\u003c/a>\u003c/p>\n\u003cp>“These proposals, finalized earlier this month, are now cast under a different light than any of us had every planned,” said Darrell Steinberg, Senate president pro tem. “It’s a cruel and sad coincidence.” Steinberg also stressed that most people with mental illness are not violent.\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/151876934&color=ff5500&auto_play=false&hide_related=false&show_artwork=true\">\u003c/iframe>\u003c/p>\n\u003cp>He and his allies want to spend $132 million on efforts aimed at reducing the number of people with mental illness who are incarcerated, and lowering recidivism rates of people who are released from prison, then re-offend because they could not get proper mental health treatment.\u003c/p>\n\u003cp>They draw their suggestions from \u003ca href=\"http://www.law.stanford.edu/sites/default/files/organization/149642/doc/slspublic/Report_v10.pdf\" target=\"_blank\">a report\u003c/a> released Wednesday by the Stanford Law School Three Strikes Project. It highlights how the population of mentally ill people in prison has ballooned in recent decades and outlines three key areas for change:\u003c/p>\n\u003col>\n\u003cli>Reform the way people with mental illness are sentenced, in part, by establishing more mental health courts that take a person’s mental health into account when judging a crime, and consider alternatives to incarceration for non-violent offenders.\u003c/li>\n\u003cli>Provide more meaningful treatment for the mentally ill, both while they are incarcerated and particularly, when they are released.\u003c/li>\n\u003cli>Establish a process and criteria for humane releases. People with mental illness are denied parole more often than other offenders, according to the Stanford report. Lawmakers suggest providing more case managers and services for parolees with mental illness.\u003c/li>\n\u003c/ol>\n\u003cp>A final budget is due next month. The Senate must first get the state Assembly and the governor to agree to these proposals before they become an official line item.\u003c/p>\n\u003cp>They’re unlikely to face opposition from law enforcement advocates who agree with the goals of the proposals.\u003c/p>\n\u003cp>“We need more training and better resources,” said Craig Brown, a lobbyist with the California Correctional Peace Officers Association. “We know we’ve been accumulating more and more inmates with mental illness. The Los Angeles County Jail has been saying for years that they’re the biggest mental health institution in the state.”\u003c/p>\n\u003cp>He says law enforcement is equally interested in reducing recidivism as lawmakers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We haven’t seen the details, and that’s where the devil is,” Brown said. “But nobody’s fighting over the goal.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_9250\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr-e1370983947930.jpg\">\u003cimg class=\"size-large wp-image-9250\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr-620x413.jpg\" alt=\"(seliaymiwell/flickr)\" width=\"620\" height=\"413\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(seliaymiwell/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>California lawmakers announced a series of budget proposals Wednesday calling for more training of law enforcement officers on how to handle people with mental illness. While lawmakers have been working on the proposals for weeks, there is renewed emphasis on them in the aftermath of a gun rampage that left seven people dead near UC Santa Barbara last weekend.\u003c/p>\n\u003cp>“How do we stop this before it happens?” said Sen. Hannah-Beth Jackson (D-Santa Barbara).\u003c/p>\n\u003cp>Jackson said police officers who visited the shooter before the violence erupted failed to investigate him thoroughly and failed to recognize warning signs of mental health problems. “This is a young man whose mental illness was right out there on YouTube, right out there on Facebook, and in screeds that he posted on blogs,” Jackson said. “And yet no one did or was able to recognize the potential for violence that resulted in this mass set of murders.”\u003c/p>\n\u003cp>Sen. Loni Hancock (D-Berkeley) says the problem continues inside the state’s jails and prisons, where nearly half the inmates suffer from mental illness. She cited incidents where mentally ill inmates were improperly pepper sprayed.\u003c!--more-->\u003c/p>\n\u003cp>“You can be a correctional officer right out of high school,” Hancock said. “Nobody tells you about the demographics of the prison population, how to treat mentally ill people, how to de-escalate situations.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Senate Democrats want to see more money invested in training law enforcement and prison personnel in how to deal with mentally ill offenders. It’s just one of a series of policy and budget proposals the caucus has been working on.\u003c/p>\n\u003cp>But now they say their efforts have taken on even greater importance after \u003ca href=\"http://ww2.kqed.org/news/2014/05/26/amid-multiple-warning-signs-alleged-isla-vista-killer-slipped-through-system/\" target=\"_blank\">what happened in Isla Vista.\u003c/a>\u003c/p>\n\u003cp>“These proposals, finalized earlier this month, are now cast under a different light than any of us had every planned,” said Darrell Steinberg, Senate president pro tem. “It’s a cruel and sad coincidence.” Steinberg also stressed that most people with mental illness are not violent.\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/151876934&color=ff5500&auto_play=false&hide_related=false&show_artwork=true\">\u003c/iframe>\u003c/p>\n\u003cp>He and his allies want to spend $132 million on efforts aimed at reducing the number of people with mental illness who are incarcerated, and lowering recidivism rates of people who are released from prison, then re-offend because they could not get proper mental health treatment.\u003c/p>\n\u003cp>They draw their suggestions from \u003ca href=\"http://www.law.stanford.edu/sites/default/files/organization/149642/doc/slspublic/Report_v10.pdf\" target=\"_blank\">a report\u003c/a> released Wednesday by the Stanford Law School Three Strikes Project. It highlights how the population of mentally ill people in prison has ballooned in recent decades and outlines three key areas for change:\u003c/p>\n\u003col>\n\u003cli>Reform the way people with mental illness are sentenced, in part, by establishing more mental health courts that take a person’s mental health into account when judging a crime, and consider alternatives to incarceration for non-violent offenders.\u003c/li>\n\u003cli>Provide more meaningful treatment for the mentally ill, both while they are incarcerated and particularly, when they are released.\u003c/li>\n\u003cli>Establish a process and criteria for humane releases. People with mental illness are denied parole more often than other offenders, according to the Stanford report. Lawmakers suggest providing more case managers and services for parolees with mental illness.\u003c/li>\n\u003c/ol>\n\u003cp>A final budget is due next month. The Senate must first get the state Assembly and the governor to agree to these proposals before they become an official line item.\u003c/p>\n\u003cp>They’re unlikely to face opposition from law enforcement advocates who agree with the goals of the proposals.\u003c/p>\n\u003cp>“We need more training and better resources,” said Craig Brown, a lobbyist with the California Correctional Peace Officers Association. “We know we’ve been accumulating more and more inmates with mental illness. The Los Angeles County Jail has been saying for years that they’re the biggest mental health institution in the state.”\u003c/p>\n\u003cp>He says law enforcement is equally interested in reducing recidivism as lawmakers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We haven’t seen the details, and that’s where the devil is,” Brown said. “But nobody’s fighting over the goal.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Hoarding Can Start Early, But Harder to Spot Signs in Teens",
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"content": "\u003cfigure id=\"attachment_19074\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/ifmomsaysok/8996434883/in/photolist-eGZ5Eg-39ZBrq-auLPiL-auHT2P-auLPjQ-auLxLh-8w5cVC-7oS9SZ-7UDctu-ehE328-8zBCrD-7P6yk3-64UPY7-8zBCyi-7DhR1b-dCciCy-c9GGad-9PXdNc-8rwLo5-9WjjM3-9Wgvg8-f6ou4V-aAJSwk-7De4n8-dtNsBS-duB32u-dsHCWZ-bt6RpC-bkr1DF-b3W2i8-eWYDYZ-6cA8K-dvS94Q-ic2Q5D-ic3u5K-7Y6r4-d7k4Pd-aWkhB4-zrdqw-7KV7j-cehk2C-g4XfU-oA5uq-b3WF6T-b3Why4-amJiv7-b3WnJt-kwMthD-baVMD8-ic3g7G\">\u003cimg class=\"size-large wp-image-19074\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/8996434883_7dc8eebe19_b-640x428.jpg\" alt=\"Teens may not have had enough time to accumulate a lot of stuff, but they may still have symptoms. (Tara R./Flickr)\" width=\"640\" height=\"428\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Teens may not have had enough time to accumulate a lot of stuff, but they may still have symptoms. (Tara R./Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Maanvi Singh, \u003ca href=\"http://www.npr.org/blogs/health/2014/05/09/310722812/hoarding-can-start-early-but-signs-are-hard-to-see-for-teens\" target=\"_blank\">NPR\u003c/a>\u003c/strong>\u003c/p>\n\u003cp style=\"color: #111111\">Hoarding disorder is generally diagnosed in older adults, after their inability to discard things and their anxiety over possessions leave them unable to function. But it may take root much earlier in life, though psychiatrists say they're just starting to figure that out.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Study shows 2 percent of teens may have the disorder. \u003c/aside>\n\u003cp style=\"color: #111111\">Hoarding symptoms may look different in teenagers than they do in adults, researchers reported at the American Psychiatric Association's annual meeting this week in New York.\u003c/p>\n\u003cp style=\"color: #111111\">A seriously cluttered living space is one of the main signs of hoarding disorder in adults. But teens who show some of the symptoms of hoarding usually haven't collected nearly as many things as adults, says Volen Ivanov, a psychologist at the Karolinska Institutet in Sweden.\u003c!--more-->\u003c/p>\n\u003cp style=\"color: #111111\">\"This could be due to a limit in freedom,\" \u003ca style=\"font-style: inherit;color: #4774cc\" href=\"http://ki.se/en/people/voliva\">Ivanov\u003c/a> tells NPR. Kids who still live under their parents' roofs aren't as free to buy or collect things in the same way as adults who live on their own. But it could also be that hoarding gets worse over time.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp style=\"color: #111111\">Losses in life like the death of a loved one can exacerbate hoarding, Ivanov says. \"So maybe it takes a little bit of time before life takes its toll on these youngsters.\"\u003c/p>\n\u003cp style=\"color: #111111\">Compulsive hoarding is debilitating psychiatric condition. While many people collect things, those with \u003ca style=\"font-style: inherit;color: #4774cc\" href=\"http://www.nhs.uk/Conditions/hoarding/Pages/Introduction.aspx#profile\" target=\"_blank\">hoarding disorder\u003c/a> usually accumulate huge quantities of things such as newspapers, household items and clothing. In extreme cases, the piles can result in dangerous or unhygienic living conditions. The disorder is difficult to treat, but working with a therapist helps many patients.\u003c/p>\n\u003cp style=\"color: #111111\">Ivanov and his colleagues looked at 8,500 Swedish adolescents born between 1994 and 1995. In \u003ca style=\"font-style: inherit;color: #4774cc\" href=\"http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0069140#s1\" target=\"_blank\">a study\u003c/a> published last year, he found that 2 percent of this adolescent population showed symptoms of hoarding. Other research has found that 2 to 5.5 percent of adults show the same symptoms.\u003c/p>\n\u003cp style=\"color: #111111\">To further understand teen hoarding, the researchers observed 21 young people who had trouble parting with possessions, regardless of their value — that's another key symptom of hoarding. But when the researchers looked at these teens' rooms, none of them showed the extreme levels of clutter that characterized adult hoarders' living spaces.\u003c/p>\n\u003cp style=\"color: #111111\">Either hoarding is a disorder that doesn't fully show up in people until adulthood, or we need to change the criteria we use to diagnose the disorder, Ivanov says.\u003c/p>\n\u003cp style=\"color: #111111\">Continuing to observe this group over time may clear things up, he says. \"We know that at least in adults there is a clear genetic component, and there is also an environmental component,\" he says. But beyond that, \"we don't know that much about this condition.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"7B6e81MKOlyrilLRbFJ6L1SGRkcoWxeQ\"]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19074\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/ifmomsaysok/8996434883/in/photolist-eGZ5Eg-39ZBrq-auLPiL-auHT2P-auLPjQ-auLxLh-8w5cVC-7oS9SZ-7UDctu-ehE328-8zBCrD-7P6yk3-64UPY7-8zBCyi-7DhR1b-dCciCy-c9GGad-9PXdNc-8rwLo5-9WjjM3-9Wgvg8-f6ou4V-aAJSwk-7De4n8-dtNsBS-duB32u-dsHCWZ-bt6RpC-bkr1DF-b3W2i8-eWYDYZ-6cA8K-dvS94Q-ic2Q5D-ic3u5K-7Y6r4-d7k4Pd-aWkhB4-zrdqw-7KV7j-cehk2C-g4XfU-oA5uq-b3WF6T-b3Why4-amJiv7-b3WnJt-kwMthD-baVMD8-ic3g7G\">\u003cimg class=\"size-large wp-image-19074\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/8996434883_7dc8eebe19_b-640x428.jpg\" alt=\"Teens may not have had enough time to accumulate a lot of stuff, but they may still have symptoms. (Tara R./Flickr)\" width=\"640\" height=\"428\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Teens may not have had enough time to accumulate a lot of stuff, but they may still have symptoms. (Tara R./Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Maanvi Singh, \u003ca href=\"http://www.npr.org/blogs/health/2014/05/09/310722812/hoarding-can-start-early-but-signs-are-hard-to-see-for-teens\" target=\"_blank\">NPR\u003c/a>\u003c/strong>\u003c/p>\n\u003cp style=\"color: #111111\">Hoarding disorder is generally diagnosed in older adults, after their inability to discard things and their anxiety over possessions leave them unable to function. But it may take root much earlier in life, though psychiatrists say they're just starting to figure that out.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Study shows 2 percent of teens may have the disorder. \u003c/aside>\n\u003cp style=\"color: #111111\">Hoarding symptoms may look different in teenagers than they do in adults, researchers reported at the American Psychiatric Association's annual meeting this week in New York.\u003c/p>\n\u003cp style=\"color: #111111\">A seriously cluttered living space is one of the main signs of hoarding disorder in adults. But teens who show some of the symptoms of hoarding usually haven't collected nearly as many things as adults, says Volen Ivanov, a psychologist at the Karolinska Institutet in Sweden.\u003c!--more-->\u003c/p>\n\u003cp style=\"color: #111111\">\"This could be due to a limit in freedom,\" \u003ca style=\"font-style: inherit;color: #4774cc\" href=\"http://ki.se/en/people/voliva\">Ivanov\u003c/a> tells NPR. Kids who still live under their parents' roofs aren't as free to buy or collect things in the same way as adults who live on their own. But it could also be that hoarding gets worse over time.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp style=\"color: #111111\">Losses in life like the death of a loved one can exacerbate hoarding, Ivanov says. \"So maybe it takes a little bit of time before life takes its toll on these youngsters.\"\u003c/p>\n\u003cp style=\"color: #111111\">Compulsive hoarding is debilitating psychiatric condition. While many people collect things, those with \u003ca style=\"font-style: inherit;color: #4774cc\" href=\"http://www.nhs.uk/Conditions/hoarding/Pages/Introduction.aspx#profile\" target=\"_blank\">hoarding disorder\u003c/a> usually accumulate huge quantities of things such as newspapers, household items and clothing. In extreme cases, the piles can result in dangerous or unhygienic living conditions. The disorder is difficult to treat, but working with a therapist helps many patients.\u003c/p>\n\u003cp style=\"color: #111111\">Ivanov and his colleagues looked at 8,500 Swedish adolescents born between 1994 and 1995. In \u003ca style=\"font-style: inherit;color: #4774cc\" href=\"http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0069140#s1\" target=\"_blank\">a study\u003c/a> published last year, he found that 2 percent of this adolescent population showed symptoms of hoarding. Other research has found that 2 to 5.5 percent of adults show the same symptoms.\u003c/p>\n\u003cp style=\"color: #111111\">To further understand teen hoarding, the researchers observed 21 young people who had trouble parting with possessions, regardless of their value — that's another key symptom of hoarding. But when the researchers looked at these teens' rooms, none of them showed the extreme levels of clutter that characterized adult hoarders' living spaces.\u003c/p>\n\u003cp style=\"color: #111111\">Either hoarding is a disorder that doesn't fully show up in people until adulthood, or we need to change the criteria we use to diagnose the disorder, Ivanov says.\u003c/p>\n\u003cp style=\"color: #111111\">Continuing to observe this group over time may clear things up, he says. \"We know that at least in adults there is a clear genetic component, and there is also an environmental component,\" he says. But beyond that, \"we don't know that much about this condition.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"7B6e81MKOlyrilLRbFJ6L1SGRkcoWxeQ\"]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_18708\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/RS7994_sign02_GDC-hpf.jpg\">\u003cimg class=\"size-full wp-image-18708\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/RS7994_sign02_GDC-hpf.jpg\" alt=\"(Photo/Gregory D. Cook)\" width=\"640\" height=\"455\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/04/RS7994_sign02_GDC-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/04/RS7994_sign02_GDC-hpf-400x284.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/04/RS7994_sign02_GDC-hpf-320x228.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo/Gregory D. Cook)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Hannah Guzik,\u003c/strong> \u003ca href=\"http://www.healthycal.org/archives/15351\" target=\"_blank\">HealthyCal\u003c/a>\u003c/p>\n\u003cp>California's jails and prisons hold far more people with severe psychiatric illnesses than state hospitals, according to a recent \u003ca href=\"http://www.tacreports.org/storage/documents/treatment-behind-bars/treatment-behind-bars.pdf\" target=\"_blank\">report\u003c/a> from the Treatment Advocacy Center and the National Sheriffs’ Association.\u003c/p>\n\u003cp>“For a state with 38 million people -- 1 in every 8 Americans lives in California -- there are almost no public psychiatric beds available for individuals with serious mental illness,” the report says.\u003c/p>\n\u003cp>Four state hospitals -- Metropolitan, Patton, Napa, and Atascadero -- have just over 4,500 beds, but 88 percent of them are reserved for mentally ill individuals who have been charged with crimes, according to the report. Another state hospital at Coalinga is used almost exclusively for sexually violent predators.\u003c!--more-->\u003c/p>\n\u003cp>California's major prisons house more than 33,000 mentally ill inmates. That’s 28 percent of the 120,000 inmates in those prisons.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In addition, 26 of California’s 58 counties have no psychiatric inpatient beds.\u003c/p>\n\u003cp>“For mentally ill individuals who need to be hospitalized briefly to become stabilized on medication, this leaves few options,” the authors of the report write.\u003c/p>\n\u003cp>The Affordable Care Act has expanded treatment coverage for those with certain mental illnesses, but some advocates say it doesn’t go far enough. It doesn’t require states to have a certain number of inpatient psychiatric beds, for example.\u003c/p>\n\u003cp>California jails and prisons are also ill equipped to effectively treat patients with mental illness, the report says.\u003c/p>\n\u003cp>Last Thursday, a federal judge ruled that the state’s treatment of mentally ill inmates is unconstitutional because it involves cruel and unusual punishment through excessive use of pepper spray and isolation.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.utsandiego.com/news/2014/apr/10/judge-california-mistreating-mentally-ill-inmates/\" target=\"_blank\">Associated Press\u003c/a> reported that the ruling came after the public release of videotapes made by prison guards. The footage shows the guards throwing chemical grenades and pumping large amounts of pepper spray into the cells of mentally ill inmates, some of whom are heard screaming.\u003c/p>\n\u003cp>“Most of the videos were horrific,” U.S. District Court Judge Lawrence Karlton wrote in his 74-page ruling.\u003c/p>\n\u003cp>Karlton ordered the state to update its polices on the use of pepper spray and isolation units, but did not ban the methods.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"eh6W1IrHJWuw9tf2dKncOFFFNYKD8JHc\"]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In addition, 26 of California’s 58 counties have no psychiatric inpatient beds.\u003c/p>\n\u003cp>“For mentally ill individuals who need to be hospitalized briefly to become stabilized on medication, this leaves few options,” the authors of the report write.\u003c/p>\n\u003cp>The Affordable Care Act has expanded treatment coverage for those with certain mental illnesses, but some advocates say it doesn’t go far enough. It doesn’t require states to have a certain number of inpatient psychiatric beds, for example.\u003c/p>\n\u003cp>California jails and prisons are also ill equipped to effectively treat patients with mental illness, the report says.\u003c/p>\n\u003cp>Last Thursday, a federal judge ruled that the state’s treatment of mentally ill inmates is unconstitutional because it involves cruel and unusual punishment through excessive use of pepper spray and isolation.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.utsandiego.com/news/2014/apr/10/judge-california-mistreating-mentally-ill-inmates/\" target=\"_blank\">Associated Press\u003c/a> reported that the ruling came after the public release of videotapes made by prison guards. The footage shows the guards throwing chemical grenades and pumping large amounts of pepper spray into the cells of mentally ill inmates, some of whom are heard screaming.\u003c/p>\n\u003cp>“Most of the videos were horrific,” U.S. District Court Judge Lawrence Karlton wrote in his 74-page ruling.\u003c/p>\n\u003cp>Karlton ordered the state to update its polices on the use of pepper spray and isolation units, but did not ban the methods.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"eh6W1IrHJWuw9tf2dKncOFFFNYKD8JHc\"]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_18538\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/482664019-e1396633537590.jpg\">\u003cimg class=\"size-large wp-image-18538\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/482664019-640x426.jpg\" alt=\"Television news live trucks at the front gate of Fort Hood, Texas. (Joe Raedle/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Television news live trucks at the front gate of Fort Hood, Texas. (Joe Raedle/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>To state the obvious, the shooting at Fort Hood is a tragedy. But in press reports the alleged shooter, Ivan Lopez, cannot be mentioned without \u003ca href=\"http://time.com/49093/fort-hood-shooter-mental-health-ptsd/\" target=\"_blank\" rel=\"noopener noreferrer\">reference\u003c/a> to his recent evaluation and treatment for mental health issues.\u003c/p>\n\u003cp>As NPR correctly points out, the fact of the shooter's treatment could not have predicted that the violent event would have occurred. Worse, the press reports wrongly scare people into thinking that mental illness is easily linked to violent behavior.\u003c/p>\n\u003cp>It's not. From\u003ca href=\"http://www.npr.org/blogs/thetwo-way/2014/04/03/298752099/shooting-unfairly-links-violence-with-mental-illness-again\" target=\"_blank\" rel=\"noopener noreferrer\"> NPR\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>One national survey in 2006 found that most Americans — 60 percent — believed people with schizophrenia were likely to be violent. But the vast majority of people with psychiatric disorders are \u003ca href=\"http://www.nimh.nih.gov/health/publications/schizophrenia/index.shtml\" target=\"_blank\" rel=\"noopener noreferrer\">not violent\u003c/a>. In fact, another study found they are far more likely to be the \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961851-5/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">victims of violence\u003c/a>, and that 1 in 4 experience violence every year.\u003c!--more-->\u003c/p>\n\u003cp>Dr. Carl Bell, a psychiatrist at the University of Illinois at Chicago, says being able to predict who will be violent in advance \"is impossible.\"\u003c/p>\n\u003cp>\"The reality,\" Bell says, \"is that prediction of violence is only useful in an immediate clinical situation: Someone comes in and says, 'I'm going to kill myself.' Then you take their word for it, and can predict violence in the short term. But you cannot use that to predict violence in the long term.\"\u003c/p>\n\u003cp>Army officials said Thursday that Lopez had seen a psychiatrist in the past month, but there were no indications that he was suicidal.\u003c/p>\u003c/blockquote>\n\u003cp>Yes, Ivan Lopez was being treated for depression and anxiety. \u003ca href=\"http://www.cdc.gov/mentalhealth/basics/burden.htm\" target=\"_blank\" rel=\"noopener noreferrer\">According to the CDC\u003c/a>, close to 7 percent of Americans suffer a major depressive episode every year, and about 10 percent suffer from an anxiety disorder.\u003c/p>\n\u003cp>In other words, Lopez was diagnosed with very common conditions. Reporters may as well discuss the color of Lopez' hair or his height.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"ROkzHelapGxpsGmh87Q4nmiqt6V130Ff\"]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_18538\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/482664019-e1396633537590.jpg\">\u003cimg class=\"size-large wp-image-18538\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/482664019-640x426.jpg\" alt=\"Television news live trucks at the front gate of Fort Hood, Texas. (Joe Raedle/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Television news live trucks at the front gate of Fort Hood, Texas. (Joe Raedle/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>To state the obvious, the shooting at Fort Hood is a tragedy. But in press reports the alleged shooter, Ivan Lopez, cannot be mentioned without \u003ca href=\"http://time.com/49093/fort-hood-shooter-mental-health-ptsd/\" target=\"_blank\" rel=\"noopener noreferrer\">reference\u003c/a> to his recent evaluation and treatment for mental health issues.\u003c/p>\n\u003cp>As NPR correctly points out, the fact of the shooter's treatment could not have predicted that the violent event would have occurred. Worse, the press reports wrongly scare people into thinking that mental illness is easily linked to violent behavior.\u003c/p>\n\u003cp>It's not. From\u003ca href=\"http://www.npr.org/blogs/thetwo-way/2014/04/03/298752099/shooting-unfairly-links-violence-with-mental-illness-again\" target=\"_blank\" rel=\"noopener noreferrer\"> NPR\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>One national survey in 2006 found that most Americans — 60 percent — believed people with schizophrenia were likely to be violent. But the vast majority of people with psychiatric disorders are \u003ca href=\"http://www.nimh.nih.gov/health/publications/schizophrenia/index.shtml\" target=\"_blank\" rel=\"noopener noreferrer\">not violent\u003c/a>. In fact, another study found they are far more likely to be the \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961851-5/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">victims of violence\u003c/a>, and that 1 in 4 experience violence every year.\u003c!--more-->\u003c/p>\n\u003cp>Dr. Carl Bell, a psychiatrist at the University of Illinois at Chicago, says being able to predict who will be violent in advance \"is impossible.\"\u003c/p>\n\u003cp>\"The reality,\" Bell says, \"is that prediction of violence is only useful in an immediate clinical situation: Someone comes in and says, 'I'm going to kill myself.' Then you take their word for it, and can predict violence in the short term. But you cannot use that to predict violence in the long term.\"\u003c/p>\n\u003cp>Army officials said Thursday that Lopez had seen a psychiatrist in the past month, but there were no indications that he was suicidal.\u003c/p>\u003c/blockquote>\n\u003cp>Yes, Ivan Lopez was being treated for depression and anxiety. \u003ca href=\"http://www.cdc.gov/mentalhealth/basics/burden.htm\" target=\"_blank\" rel=\"noopener noreferrer\">According to the CDC\u003c/a>, close to 7 percent of Americans suffer a major depressive episode every year, and about 10 percent suffer from an anxiety disorder.\u003c/p>\n\u003cp>In other words, Lopez was diagnosed with very common conditions. Reporters may as well discuss the color of Lopez' hair or his height.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cfigure id=\"attachment_16785\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/153486560-e1387328697174.jpg\">\u003cimg class=\"size-large wp-image-16785\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/153486560-640x421.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"421\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>Don Fox prepared for his late-night rounds. He collected a few warm blankets and protein bars, then hit the streets, seeking out people in crisis who needed food and warmth. “Our principle is, we hang out where people are,” said Fox. “We walk the streets in those areas, make eye contact, and ask if they need help.”\u003c/p>\n\u003cp>Fox is an Episcopal priest with San Francisco Night Ministry, a program founded by volunteer clergy in 1964 to serve a then-emerging population of mentally ill homeless people. A half-century later, the problem hasn't gone away.\u003c/p>\n\u003cp>On a recent night Fox walked San Francisco's Civic Center, where he met a 53-year-old Navy veteran slumped on the sidewalk. The man, a slight figure in a torn sweatshirt and Oakland A’s cap, said he had been homeless and in and out of jail for about six years.\u003c/p>\n\u003cp>He said that a few months ago, he had run out of his anti-psychotic medication, Risperdal. Late one night he started to feel suicidal and went to San Francisco General Hospital for help. “I wasn't well, put it that way,” he told me. He spent the early morning hours in the emergency department, but then said he was told to leave. “I was telling them that I needed to stay a little longer. They wouldn't let me stay longer, so they made me leave.”\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>San Francisco General’s psychiatry department is down to 20 acute beds, and all of them were full. The Navy vet said he became even more depressed because he wasn’t getting the help he needed. “So I felt like ending it. And that’s what happened.”\u003c/p>\n\u003cp>A few hours after he left the hospital, he said he tried to jump in front of a bus, but a friend pulled him away at the last moment, and he wasn't hurt.\u003c/p>\n\u003cp>At one time this man might have been admitted for treatment. In 2000, for example, San Francisco General had ten times more inpatient psychiatric beds than it has now. But since then there has been a big shift in how psychiatric care is delivered, away from locked hospitals.\u003c/p>\n\u003cp>\u003cstrong>Residential vs. Hospital-Based Treatment\u003c/strong>\u003c/p>\n\u003cp>Dr. Mark Leary, deputy director of U.C. San Francisco’s psychiatry department at S.F. General, said high staffing requirements make inpatient care the most expensive way to treat severely ill patients. Hospital care is also restrictive and, as some mental health advocates believe, inhumane. Leary said San Francisco closed 180 emergency inpatient psychiatry beds and shifted the funding into residential care.\u003c/p>\n\u003cp>“We have community services where patients can get intensive treatment in a residential setting,” said Leary. “They're there in a house with mental health staff. They can receive medications, psychotherapy, social support, and safety in that setting, and it doesn't require a hospital to deliver it,” he said.\u003c/p>\n\u003cp>That sounds like just the type of treatment people such as the Navy veteran need. Yet he and other homeless people with a mental illness remain on the streets. Fr. Fox said San Francisco may have good community services, but it still lacks the one thing many mentally ill homeless people need. “If they need a bed, it's a disaster. There's hardly any places,” said Fox.\u003c/p>\n\u003cp>A hard-to-reach contingent of people cycle in and out of the ER, sometimes taking their medication, sometimes not, but never really recovering. This population of patients needs more structured intervention, says Michael Fitzgerald, executive director of Behavioral Health Services at El Camino Hospital in Mountain View. “We have streets full of people with significant mental illness who are not receiving the care that they need,” said Fitzgerald. “And when they're in an acute crisis, often they're not going to go to drop-in clinics. It's not meeting the patient where they're at or what they need,” he said.\u003c/p>\n\u003cp>\u003cstrong>Crisis Stabilization\u003c/strong>\u003c/p>\n\u003cp>The problem, according to Fitzgerald, is that people in a crisis often need to be stabilized first, before they can transition to community services. Yet there hasn't been an adequate support system to help them take that crucial first step.\u003c/p>\n\u003cp>Next year, funding from a \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB82\" target=\"_blank\">new law\u003c/a> will begin to provide that missing link.\u003c/p>\n\u003cp>“What's lacking in the system is the crisis beds that allow somebody to get stable,” said Sen. Darrel Steinberg (D-Sacramento) who sponsored the law. In addition, \"the people who can help somebody get from those settings to a place where they can begin to get help.\u003c/p>\n\u003cp>Steinberg's law, the Investment in Mental Health Wellness Act, targets those gaps by providing $206 million in funding for 2000 new crisis stabilization beds, for mobile response teams and for 600 new triage workers. Steinberg says the new providers are key. The plan is to station these mental health professionals at jails and county emergency rooms to identify people in crisis and connect them with the new services.\u003c/p>\n\u003cp>Counties will be vying for the new funds, and some already have begun submitting grant proposals. A few mental health providers are even starting to feel hopeful. “We'll see how it rolls out. We'll see if the funding continues,” said Fitzgerald. “Certainly at least it's funding, and the focus on crisis stabilization is a good plan,” he said.\u003c/p>\n\u003cp>For now, after years of facing budget cutbacks, Fitzgerald is actually optimistic. He said there may finally be a chance of getting effective mental health treatment to the people who have been the hardest to reach.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/125459282&color=ff6600&auto_play=false&show_artwork=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"166\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor’s note: This is the third of three stories about psychiatric inpatient services airing this week on \u003ca href=\"http://www.californiareport.org/\" target=\"_blank\">The California Report.\u003c/a> In part one, reporter Elaine Korry looked at the lack of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/16/sharp-drop-in-psychiatric-beds-leaves-severely-mentally-ill-with-few-places-to-go/\" target=\"_blank\">psychiatric inpatient services for adults\u003c/a>. In part two, she examined \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/17/how-californias-mentally-ill-children-suffer-few-hospital-beds-statewide/\" target=\"_blank\">the lack of services for children\u003c/a>. \u003c/em>\u003c/p>\n\n",
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"excerpt": "Don Fox prepared for his late-night rounds. He collected a few warm blankets and protein bars, then hit the streets, seeking out people in crisis who needed food and warmth. “Our principle is, we hang out where people are,” said Fox. “We walk the streets in those areas, make eye contact, and ask if they need help.”\r\n\r\nFox is an Episcopal priest with San Francisco Night Ministry, a program founded by volunteer clergy in 1964 to serve a then-emerging population of mentally ill homeless people. A half-century later, the problem hasn't gone away.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16785\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/153486560-e1387328697174.jpg\">\u003cimg class=\"size-large wp-image-16785\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/153486560-640x421.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"421\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>Don Fox prepared for his late-night rounds. He collected a few warm blankets and protein bars, then hit the streets, seeking out people in crisis who needed food and warmth. “Our principle is, we hang out where people are,” said Fox. “We walk the streets in those areas, make eye contact, and ask if they need help.”\u003c/p>\n\u003cp>Fox is an Episcopal priest with San Francisco Night Ministry, a program founded by volunteer clergy in 1964 to serve a then-emerging population of mentally ill homeless people. A half-century later, the problem hasn't gone away.\u003c/p>\n\u003cp>On a recent night Fox walked San Francisco's Civic Center, where he met a 53-year-old Navy veteran slumped on the sidewalk. The man, a slight figure in a torn sweatshirt and Oakland A’s cap, said he had been homeless and in and out of jail for about six years.\u003c/p>\n\u003cp>He said that a few months ago, he had run out of his anti-psychotic medication, Risperdal. Late one night he started to feel suicidal and went to San Francisco General Hospital for help. “I wasn't well, put it that way,” he told me. He spent the early morning hours in the emergency department, but then said he was told to leave. “I was telling them that I needed to stay a little longer. They wouldn't let me stay longer, so they made me leave.”\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>San Francisco General’s psychiatry department is down to 20 acute beds, and all of them were full. The Navy vet said he became even more depressed because he wasn’t getting the help he needed. “So I felt like ending it. And that’s what happened.”\u003c/p>\n\u003cp>A few hours after he left the hospital, he said he tried to jump in front of a bus, but a friend pulled him away at the last moment, and he wasn't hurt.\u003c/p>\n\u003cp>At one time this man might have been admitted for treatment. In 2000, for example, San Francisco General had ten times more inpatient psychiatric beds than it has now. But since then there has been a big shift in how psychiatric care is delivered, away from locked hospitals.\u003c/p>\n\u003cp>\u003cstrong>Residential vs. Hospital-Based Treatment\u003c/strong>\u003c/p>\n\u003cp>Dr. Mark Leary, deputy director of U.C. San Francisco’s psychiatry department at S.F. General, said high staffing requirements make inpatient care the most expensive way to treat severely ill patients. Hospital care is also restrictive and, as some mental health advocates believe, inhumane. Leary said San Francisco closed 180 emergency inpatient psychiatry beds and shifted the funding into residential care.\u003c/p>\n\u003cp>“We have community services where patients can get intensive treatment in a residential setting,” said Leary. “They're there in a house with mental health staff. They can receive medications, psychotherapy, social support, and safety in that setting, and it doesn't require a hospital to deliver it,” he said.\u003c/p>\n\u003cp>That sounds like just the type of treatment people such as the Navy veteran need. Yet he and other homeless people with a mental illness remain on the streets. Fr. Fox said San Francisco may have good community services, but it still lacks the one thing many mentally ill homeless people need. “If they need a bed, it's a disaster. There's hardly any places,” said Fox.\u003c/p>\n\u003cp>A hard-to-reach contingent of people cycle in and out of the ER, sometimes taking their medication, sometimes not, but never really recovering. This population of patients needs more structured intervention, says Michael Fitzgerald, executive director of Behavioral Health Services at El Camino Hospital in Mountain View. “We have streets full of people with significant mental illness who are not receiving the care that they need,” said Fitzgerald. “And when they're in an acute crisis, often they're not going to go to drop-in clinics. It's not meeting the patient where they're at or what they need,” he said.\u003c/p>\n\u003cp>\u003cstrong>Crisis Stabilization\u003c/strong>\u003c/p>\n\u003cp>The problem, according to Fitzgerald, is that people in a crisis often need to be stabilized first, before they can transition to community services. Yet there hasn't been an adequate support system to help them take that crucial first step.\u003c/p>\n\u003cp>Next year, funding from a \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB82\" target=\"_blank\">new law\u003c/a> will begin to provide that missing link.\u003c/p>\n\u003cp>“What's lacking in the system is the crisis beds that allow somebody to get stable,” said Sen. Darrel Steinberg (D-Sacramento) who sponsored the law. In addition, \"the people who can help somebody get from those settings to a place where they can begin to get help.\u003c/p>\n\u003cp>Steinberg's law, the Investment in Mental Health Wellness Act, targets those gaps by providing $206 million in funding for 2000 new crisis stabilization beds, for mobile response teams and for 600 new triage workers. Steinberg says the new providers are key. The plan is to station these mental health professionals at jails and county emergency rooms to identify people in crisis and connect them with the new services.\u003c/p>\n\u003cp>Counties will be vying for the new funds, and some already have begun submitting grant proposals. A few mental health providers are even starting to feel hopeful. “We'll see how it rolls out. We'll see if the funding continues,” said Fitzgerald. “Certainly at least it's funding, and the focus on crisis stabilization is a good plan,” he said.\u003c/p>\n\u003cp>For now, after years of facing budget cutbacks, Fitzgerald is actually optimistic. He said there may finally be a chance of getting effective mental health treatment to the people who have been the hardest to reach.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/125459282&color=ff6600&auto_play=false&show_artwork=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"166\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor’s note: This is the third of three stories about psychiatric inpatient services airing this week on \u003ca href=\"http://www.californiareport.org/\" target=\"_blank\">The California Report.\u003c/a> In part one, reporter Elaine Korry looked at the lack of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/16/sharp-drop-in-psychiatric-beds-leaves-severely-mentally-ill-with-few-places-to-go/\" target=\"_blank\">psychiatric inpatient services for adults\u003c/a>. In part two, she examined \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/17/how-californias-mentally-ill-children-suffer-few-hospital-beds-statewide/\" target=\"_blank\">the lack of services for children\u003c/a>. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How California's Mentally Ill Children Suffer – Few Hospital Beds Statewide",
"title": "How California's Mentally Ill Children Suffer – Few Hospital Beds Statewide",
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"content": "\u003cp>\u003cstrong>\u003cem>\u003c/em>\u003c/strong>\u003cem>CORRECTION: Due to a reporting error, the original version of this story incorrectly identified John Muir Medical Center, Concord as the facility where Maria Ramirez's granddaughter was taken. We regret that error. The post has been edited so that it no longer contains the incorrect information.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>Maria Ramirez began caring for her granddaughter when the girl was just a toddler. Her granddaughter began hurting herself -- cutting her arms and swallowing things -- before she was 10. Soon, says Ramirez, she couldn't let the girl out of her sight. “She was running in front of cars, just really impulsive,” says Ramirez. “It was out of control, and I was really scared.”\u003c/p>\n\u003cp>Ramirez has a job and health insurance, so she did what any parent or guardian would do: she took her granddaughter to her local hospital for treatment. But instead of finding help, she always got the same reply, “No beds, no beds.”\u003c/p>\n\u003cp>Ramirez, a Bay Area artist who loves gardening, says she knew early on that her granddaughter was going to need help. “She was a hard child to make smile. She was very serious,” says Ramirez.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She was also very anxious. The girl couldn't leave the bathroom if there was water in the tub. A wrinkled bedspread could ruin her day. By the time she was 12 she was taking medication and seeing a therapist. But she was not getting better.\u003c/p>\n\u003cp>Then one day she stabbed herself. Ramirez rushed her to a psychiatric emergency service, where she remained for days.\u003c/p>\n\u003cp>“It had been five days, and she was not getting helped,” says Ramirez. “She was confined. There was no intervention, there was no therapy, there were no services. There was nothing.“\u003c/p>\n\u003cp>Finally the girl was admitted to a child psychiatric facility.\u003c/p>\n\u003cp>\u003cstrong>No Regional Planning\u003c/strong>\u003c/p>\n\u003cp>Liz Stallings is the chief operations officer at John Muir Behavioral Health Center in Contra Costa County and expert on child mental health care. She, says the scarcity of hospital beds is a problem throughout California. “We have 12 child beds here at John Muir Behavioral Health, and they are occupied all the time from all over the state,” says Stallings.\u003c/p>\n\u003cp>Stallings, a psychiatric nurse, also chairs the California Hospital Association Center for Behavioral Health. The CHA has been sounding an alarm over the steady loss of hospital beds for adult and child psychiatric emergencies. In the entire state there are now fewer than 100 beds reserved for children 12 and under. Most of those beds are in the Bay Area or the Los Angeles basin; the overwhelming majority of California's 58 counties have no beds at all for your children experiencing a psychiatric emergency.\u003c/p>\n\u003cfigure id=\"attachment_16767\" class=\"wp-caption alignleft\" style=\"max-width: 269px\">\u003ca href=\"http://www.calhospital.org/sites/main/files/file-attachments/psych_bed_data_14.pdf\">\u003cimg class=\"size-medium wp-image-16767 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Screen-Shot-2013-12-16-at-9.25.34-PM-300x334.png\" alt=\"In California, 47 of 58 counties have no child or adolescent inpatient psychiatric hospital beds. This map was created by the California Hospital Association using 2011 state data.\" width=\"269\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">In California, 47 of 58 counties have no child or adolescent inpatient psychiatric hospital beds. This map was created by the California Hospital Association using 2011 state data.\u003c/figcaption>\u003c/figure>\n\u003cp>This didn't happen overnight, according to Stallings. Lawmakers decentralized mental health care in the 1990s, which gave counties more local control -- at the expense of regional planning. Both private and county hospitals started closing psychiatric wards to save money. “There is no planning process,” says Stallings. “They just expect me to absorb these patients.”\u003c/p>\n\u003cp>Since John Muir's beds are always occupied, local children can wind up stalled in the ER, like Ramirez' granddaughter. Or they are sent far away, where their parents can't visit or attend family therapy.\u003c/p>\n\u003cp>It's a problem officials in some counties are working to address.\u003c/p>\n\u003cp>Gail Price was appointed to the Santa Clara County Mental Health Board after her own son's psychiatric emergency. Now she co-chairs of the Family, Adolescents & Children’s Committee At 17 he had an episode of bipolar mania, which took the entire family by surprise. “It is very anxiety-producing, and most people are not prepared for this,” says Price.\u003c/p>\n\u003cp>Price was shocked to find that wealthy Santa Clara County doesn't have a single hospital psychiatric bed for adolescents. So she rallied all her connections and finally got her son admitted to a hospital about an hour away. He’s doing better now, but Price never forgot the experience. “We're comfortable. We speak English; we have transportation and resources. We were very fortunate, but I often think of individuals who did not have the advantages we had,” says Price.\u003c/p>\n\u003cp>Some of the hospital closures were done with the best intentions: public health officials and some mental health advocates insist psychiatric patients respond better to treatment in community settings, instead of being locked in a hospital. Price says that may be true for stable patients, but in a real emergency such as her son’s, Price says people need more structured intervention. Not only that, she adds, budget cuts have left most county services, including mental health, in tatters. “Frankly, I think it's a lack of political will,” says Price. “The data's there, and it's clear we have a moral responsibility to do something.”\u003c/p>\n\u003cp>When mental illness is treated, people can recover. But left untreated, their jobs and relationships can suffer. Many people with a serious mental illness wind up homeless or in jail. Earlier this year, state lawmakers recognized that after years of deep budget cuts, they needed to shore up the mental health system. Under the leadership of Sen. Darrel Steinberg, (D-Sacramento), the legislature approved $206 million in new mental health funding.\u003c/p>\n\u003cp>“What's lacking in the system is the crisis beds that allow somebody to get stable and the people who can help somebody get from those settings to a place where they can begin to get help,” says Steinberg.\u003c/p>\n\u003cp>Ramirez's granddaughter now lives in a psychiatric residential program for teenagers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor’s note: This is the second of three stories about psychiatric inpatient services airing this week on \u003ca href=\"http://www.californiareport.org/\" target=\"_blank\" rel=\"noopener noreferrer\">The California Report.\u003c/a> In part one, reporter Elaine Korry looked at the lack of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/16/sharp-drop-in-psychiatric-beds-leaves-severely-mentally-ill-with-few-places-to-go/\" target=\"_blank\" rel=\"noopener noreferrer\">psychiatric inpatient services for adults\u003c/a>. In part three, Korry looks at how \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/18/after-years-of-decline-more-psychiatric-resources-coming/\" target=\"_blank\" rel=\"noopener noreferrer\">new mental health fundin\u003c/a>g will be implemented.\u003cbr>\n\u003c/em>\u003c/p>\n\n",
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"description": "CORRECTION: Due to a reporting error, the original version of this story incorrectly identified John Muir Medical Center, Concord as the facility where Maria Ramirez’s granddaughter was taken. We regret that error. The post has been edited so that it no longer contains the incorrect information. By Elaine Korry Maria Ramirez began caring for her",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>\u003cem>\u003c/em>\u003c/strong>\u003cem>CORRECTION: Due to a reporting error, the original version of this story incorrectly identified John Muir Medical Center, Concord as the facility where Maria Ramirez's granddaughter was taken. We regret that error. The post has been edited so that it no longer contains the incorrect information.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>Maria Ramirez began caring for her granddaughter when the girl was just a toddler. Her granddaughter began hurting herself -- cutting her arms and swallowing things -- before she was 10. Soon, says Ramirez, she couldn't let the girl out of her sight. “She was running in front of cars, just really impulsive,” says Ramirez. “It was out of control, and I was really scared.”\u003c/p>\n\u003cp>Ramirez has a job and health insurance, so she did what any parent or guardian would do: she took her granddaughter to her local hospital for treatment. But instead of finding help, she always got the same reply, “No beds, no beds.”\u003c/p>\n\u003cp>Ramirez, a Bay Area artist who loves gardening, says she knew early on that her granddaughter was going to need help. “She was a hard child to make smile. She was very serious,” says Ramirez.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She was also very anxious. The girl couldn't leave the bathroom if there was water in the tub. A wrinkled bedspread could ruin her day. By the time she was 12 she was taking medication and seeing a therapist. But she was not getting better.\u003c/p>\n\u003cp>Then one day she stabbed herself. Ramirez rushed her to a psychiatric emergency service, where she remained for days.\u003c/p>\n\u003cp>“It had been five days, and she was not getting helped,” says Ramirez. “She was confined. There was no intervention, there was no therapy, there were no services. There was nothing.“\u003c/p>\n\u003cp>Finally the girl was admitted to a child psychiatric facility.\u003c/p>\n\u003cp>\u003cstrong>No Regional Planning\u003c/strong>\u003c/p>\n\u003cp>Liz Stallings is the chief operations officer at John Muir Behavioral Health Center in Contra Costa County and expert on child mental health care. She, says the scarcity of hospital beds is a problem throughout California. “We have 12 child beds here at John Muir Behavioral Health, and they are occupied all the time from all over the state,” says Stallings.\u003c/p>\n\u003cp>Stallings, a psychiatric nurse, also chairs the California Hospital Association Center for Behavioral Health. The CHA has been sounding an alarm over the steady loss of hospital beds for adult and child psychiatric emergencies. In the entire state there are now fewer than 100 beds reserved for children 12 and under. Most of those beds are in the Bay Area or the Los Angeles basin; the overwhelming majority of California's 58 counties have no beds at all for your children experiencing a psychiatric emergency.\u003c/p>\n\u003cfigure id=\"attachment_16767\" class=\"wp-caption alignleft\" style=\"max-width: 269px\">\u003ca href=\"http://www.calhospital.org/sites/main/files/file-attachments/psych_bed_data_14.pdf\">\u003cimg class=\"size-medium wp-image-16767 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Screen-Shot-2013-12-16-at-9.25.34-PM-300x334.png\" alt=\"In California, 47 of 58 counties have no child or adolescent inpatient psychiatric hospital beds. This map was created by the California Hospital Association using 2011 state data.\" width=\"269\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">In California, 47 of 58 counties have no child or adolescent inpatient psychiatric hospital beds. This map was created by the California Hospital Association using 2011 state data.\u003c/figcaption>\u003c/figure>\n\u003cp>This didn't happen overnight, according to Stallings. Lawmakers decentralized mental health care in the 1990s, which gave counties more local control -- at the expense of regional planning. Both private and county hospitals started closing psychiatric wards to save money. “There is no planning process,” says Stallings. “They just expect me to absorb these patients.”\u003c/p>\n\u003cp>Since John Muir's beds are always occupied, local children can wind up stalled in the ER, like Ramirez' granddaughter. Or they are sent far away, where their parents can't visit or attend family therapy.\u003c/p>\n\u003cp>It's a problem officials in some counties are working to address.\u003c/p>\n\u003cp>Gail Price was appointed to the Santa Clara County Mental Health Board after her own son's psychiatric emergency. Now she co-chairs of the Family, Adolescents & Children’s Committee At 17 he had an episode of bipolar mania, which took the entire family by surprise. “It is very anxiety-producing, and most people are not prepared for this,” says Price.\u003c/p>\n\u003cp>Price was shocked to find that wealthy Santa Clara County doesn't have a single hospital psychiatric bed for adolescents. So she rallied all her connections and finally got her son admitted to a hospital about an hour away. He’s doing better now, but Price never forgot the experience. “We're comfortable. We speak English; we have transportation and resources. We were very fortunate, but I often think of individuals who did not have the advantages we had,” says Price.\u003c/p>\n\u003cp>Some of the hospital closures were done with the best intentions: public health officials and some mental health advocates insist psychiatric patients respond better to treatment in community settings, instead of being locked in a hospital. Price says that may be true for stable patients, but in a real emergency such as her son’s, Price says people need more structured intervention. Not only that, she adds, budget cuts have left most county services, including mental health, in tatters. “Frankly, I think it's a lack of political will,” says Price. “The data's there, and it's clear we have a moral responsibility to do something.”\u003c/p>\n\u003cp>When mental illness is treated, people can recover. But left untreated, their jobs and relationships can suffer. Many people with a serious mental illness wind up homeless or in jail. Earlier this year, state lawmakers recognized that after years of deep budget cuts, they needed to shore up the mental health system. Under the leadership of Sen. Darrel Steinberg, (D-Sacramento), the legislature approved $206 million in new mental health funding.\u003c/p>\n\u003cp>“What's lacking in the system is the crisis beds that allow somebody to get stable and the people who can help somebody get from those settings to a place where they can begin to get help,” says Steinberg.\u003c/p>\n\u003cp>Ramirez's granddaughter now lives in a psychiatric residential program for teenagers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor’s note: This is the second of three stories about psychiatric inpatient services airing this week on \u003ca href=\"http://www.californiareport.org/\" target=\"_blank\" rel=\"noopener noreferrer\">The California Report.\u003c/a> In part one, reporter Elaine Korry looked at the lack of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/16/sharp-drop-in-psychiatric-beds-leaves-severely-mentally-ill-with-few-places-to-go/\" target=\"_blank\" rel=\"noopener noreferrer\">psychiatric inpatient services for adults\u003c/a>. In part three, Korry looks at how \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/18/after-years-of-decline-more-psychiatric-resources-coming/\" target=\"_blank\" rel=\"noopener noreferrer\">new mental health fundin\u003c/a>g will be implemented.\u003cbr>\n\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Sharp Drop in Psychiatric Beds Leaves Severely Mentally Ill With Few Places to Go",
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"content": "\u003cfigure id=\"attachment_16713\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Carole-Ford_Korry-e1386982312190.jpg\">\u003cimg class=\"size-large wp-image-16713 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Carole-Ford_Korry-640x480.jpg\" alt=\"Carole Ford (Elaine Korry/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Carole Ford of Lakeport, seen here in front of the community health center she runs, was often taken to hospitals far from her Lakeport home to treat her mental illness. (Elaine Korry/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>In the small town of Clearlake, about a hundred miles north of San Francisco, Carole Ford, a great-grandmother with a mane of silver-gray hair, runs a community mental health center called The Bridge. She leads support groups and prepares meals for her mostly homeless clients. It's hardly glamorous work, but Ford says this is her dream job. “I know that I’m where I’m supposed to be -- and doing what I’m supposed to be doing,” she says.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Employees had to scour the state, looking for a vacant psychiatric bed. “Then it's another 2 to 3 hour drive.”\u003c/aside>\n\u003cp>But Ford, 71, hasn't always been so content. She had a traumatic childhood and many bouts of depression. As a younger adult adult she often felt suicidal. She recalls being dragged away to the hospital in Lake County, where she says she felt like she was dumped. There was no psychiatrist or therapist; no peer support or services of any kind.\u003c!--more-->\u003c/p>\n\u003cp>Ford was often forced to wait in the emergency room for hours for an evaluation, suffering all the while. “First of all, you hate feeling the way you're feeling -- horrible, and you can't face life.” She adds, “You're there, waiting, sort of alone in your emotions. It definitely added to my anxiety.”\u003c/p>\n\u003cp>By the time county behavioral health workers arrived for evaluations, Ford was often so upset that she was perceived to be in danger of hurting herself. So crisis workers ordered her to be hospitalized -- more than once -- without her consent for a three-day hold. Ford says it was the last thing she wanted. But it wasn't a matter of admitting her to the hospital affiliated with the emergency room. That hospital had no beds for psychiatric patients. Employees had to scour the state, looking for a vacant psychiatric bed. “Then it's usually like another 2 to 3 hour drive,” says Ford. “Waiting, you're in limbo.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Finally, Ford says, she would be dropped off, frightened and alone, at some unfamiliar place several counties away. “The door is locked behind you and here you are, surrounded by a bunch of strangers,” says Ford. “It was horrifying.”\u003c/p>\n\u003cp>\u003cstrong>Shortage of Acute Psych Beds\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_16710\" class=\"wp-caption alignleft\" style=\"max-width: 286px\">\u003ca href=\"http://www.calhospital.org/sites/main/files/file-attachments/psych_bed_data_14.pdf\">\u003cimg class=\"size-medium wp-image-16710 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Screen-Shot-2013-12-13-at-4.42.45-PM-300x314.png\" alt=\"Screen Shot 2013-12-13 at 4.42.45 PM\" width=\"286\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The counties colored white have no inpatient psychiatric services of any kind, according to the California Hospital Association which created this map from state data.\u003c/figcaption>\u003c/figure>\n\u003cp>The guiding principle of medicine is to do no harm. Yet, advocates for people with mental illness say they go through this sort of ordeal all the time. Some lawmakers concede there's a problem. “There are still significant holes in the system and at or near the top of the list is the shortage of acute psychiatric beds,” says Darrel Steinberg, the President Pro Tem of the California Senate.\u003c/p>\n\u003cp>Steinberg, the author of the\u003ca href=\"http://www.dmh.ca.gov/prop_63/mhsa/\" target=\"_blank\"> Mental Health Services Act\u003c/a>, and other key legislative reforms, says it wasn't supposed to be this way.\u003c/p>\n\u003cp>Advocates for reform wanted to move mental health treatment from locked hospitals to less restrictive, and less costly, community settings. The reform movement goes back to the 60s. People with schizophrenia or bipolar disorder who were once locked away in state asylums now often live with their illnesses in the community. But that reform movement may have gone too far too fast, some advocates say. Over the last 15 years, psychiatric facilities have closed in record numbers. California lost one in three hospital beds once reserved for behavioral health emergencies. At the same time funding shifted from inpatient to outpatient treatment, the system of community care never got fully built.\u003c/p>\n\u003cp>A wave of corporate hospital closures and county budget cuts resulted in California losing about 4,000 hospital beds once reserved for psychiatric emergencies. Some areas were hit harder than others. Most of the rural northern and Sierra counties have no inpatient mental health services at all.\u003c/p>\n\u003cp>\u003cstrong>\"We Do Medical Care Here\"\u003c/strong>\u003c/p>\n\u003cp>At Sutter Lakeside Hospital, in the county seat of Lakeport, you can have back surgery, or give birth, but chief administrator Siri Nelson says if you're hallucinating or suicidal, then you're out of luck. “We're not a psychiatric facility,” says Nelson. “We do medical care here.”\u003cstrong>\u003cem> \u003c/em>\u003c/strong>\u003c/p>\n\u003cp>Serious mental illness is a brain disorder which also requires proper medical care. But Nelson says there simply isn't enough demand in this small county of 65,000 people to make a psychiatric unit profitable. And that calculation affects a wide array of other county services.\u003c/p>\n\u003cp>Because there are no local beds, last year Fire Chief Willie Sapeta had to transport 200 patients out of Lake County for psychiatric treatment. “Those transports can be a four-hour turnaround time to as much as a 10- or 12-hour turnaround,” he says, “when we've had to go to Salinas or up into Humboldt or Del Norte County.”\u003c/p>\n\u003cp>And it's not just paramedics who are affected. If the patient is considered potentially dangerous, then law enforcement has to step in. Sheriff's deputies have had to monitor patients in the emergency department for 10 to 12 hours at a time before a county behavioral health worker arrives.\u003c/p>\n\u003cp>Lt. Chris Chwialkowski, with the Lake County Sheriff’s Department, says the wait is a hardship for the patient, but also for his department. “If that deputy is on overtime, you're talking about time-and-a-half,” says Chwialkowski. \"If that deputy's not on overtime, then you're taking a deputy off the street.”\u003c/p>\n\u003cp>It's a bad situation all around, says Kristy Kelly, behavioral health director for Lake County. “It's difficult for law enforcement because they may have to stand by to make sure that it's safe,” she says. “It's difficult for the ER because that's their patient and they want to move their patients on. It's difficult for the Mental Health Department because we're trying to find a placement and we're calling and calling and calling and calling, and we're getting a lot of nos.\u003c/p>\n\u003cp>With the scarcity of beds, the moment one patient is discharged from a psychiatric bed, another is moved in. So the timing has to be just right for Kelly’s people to find a vacant bed. “We just keep calling until we get a yes,” says Kelly.\u003c/p>\n\u003cp>Back at The Bridge, Ford described how she found peace. About 15 years ago, she reached out to self-help groups and embarked on what she calls a spiritual path. She is much more settled now and says it's been years since she was hospitalized.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/125135790&color=ff6600&auto_play=false&show_artwork=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"166\">\u003c/iframe>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Editor's note: This is the first of three stories about psychiatric inpatient services airing this week on \u003ca href=\"http://www.californiareport.org\" target=\"_blank\">The California Report.\u003c/a> \u003c/em>\u003c/p>\n\n",
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"excerpt": "In the small town of Clearlake, about a hundred miles north of San Francisco, Carole Ford, a great-grandmother with a mane of silver-gray hair, runs a community mental health center called The Bridge. She leads support groups and prepares meals for her mostly homeless clients. It's hardly glamorous work, but Ford says this is her dream job. “I know that I’m where I’m supposed to be -- and doing what I’m supposed to be doing,” she says.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16713\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Carole-Ford_Korry-e1386982312190.jpg\">\u003cimg class=\"size-large wp-image-16713 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Carole-Ford_Korry-640x480.jpg\" alt=\"Carole Ford (Elaine Korry/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Carole Ford of Lakeport, seen here in front of the community health center she runs, was often taken to hospitals far from her Lakeport home to treat her mental illness. (Elaine Korry/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>In the small town of Clearlake, about a hundred miles north of San Francisco, Carole Ford, a great-grandmother with a mane of silver-gray hair, runs a community mental health center called The Bridge. She leads support groups and prepares meals for her mostly homeless clients. It's hardly glamorous work, but Ford says this is her dream job. “I know that I’m where I’m supposed to be -- and doing what I’m supposed to be doing,” she says.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Employees had to scour the state, looking for a vacant psychiatric bed. “Then it's another 2 to 3 hour drive.”\u003c/aside>\n\u003cp>But Ford, 71, hasn't always been so content. She had a traumatic childhood and many bouts of depression. As a younger adult adult she often felt suicidal. She recalls being dragged away to the hospital in Lake County, where she says she felt like she was dumped. There was no psychiatrist or therapist; no peer support or services of any kind.\u003c!--more-->\u003c/p>\n\u003cp>Ford was often forced to wait in the emergency room for hours for an evaluation, suffering all the while. “First of all, you hate feeling the way you're feeling -- horrible, and you can't face life.” She adds, “You're there, waiting, sort of alone in your emotions. It definitely added to my anxiety.”\u003c/p>\n\u003cp>By the time county behavioral health workers arrived for evaluations, Ford was often so upset that she was perceived to be in danger of hurting herself. So crisis workers ordered her to be hospitalized -- more than once -- without her consent for a three-day hold. Ford says it was the last thing she wanted. But it wasn't a matter of admitting her to the hospital affiliated with the emergency room. That hospital had no beds for psychiatric patients. Employees had to scour the state, looking for a vacant psychiatric bed. “Then it's usually like another 2 to 3 hour drive,” says Ford. “Waiting, you're in limbo.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Finally, Ford says, she would be dropped off, frightened and alone, at some unfamiliar place several counties away. “The door is locked behind you and here you are, surrounded by a bunch of strangers,” says Ford. “It was horrifying.”\u003c/p>\n\u003cp>\u003cstrong>Shortage of Acute Psych Beds\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_16710\" class=\"wp-caption alignleft\" style=\"max-width: 286px\">\u003ca href=\"http://www.calhospital.org/sites/main/files/file-attachments/psych_bed_data_14.pdf\">\u003cimg class=\"size-medium wp-image-16710 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Screen-Shot-2013-12-13-at-4.42.45-PM-300x314.png\" alt=\"Screen Shot 2013-12-13 at 4.42.45 PM\" width=\"286\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The counties colored white have no inpatient psychiatric services of any kind, according to the California Hospital Association which created this map from state data.\u003c/figcaption>\u003c/figure>\n\u003cp>The guiding principle of medicine is to do no harm. Yet, advocates for people with mental illness say they go through this sort of ordeal all the time. Some lawmakers concede there's a problem. “There are still significant holes in the system and at or near the top of the list is the shortage of acute psychiatric beds,” says Darrel Steinberg, the President Pro Tem of the California Senate.\u003c/p>\n\u003cp>Steinberg, the author of the\u003ca href=\"http://www.dmh.ca.gov/prop_63/mhsa/\" target=\"_blank\"> Mental Health Services Act\u003c/a>, and other key legislative reforms, says it wasn't supposed to be this way.\u003c/p>\n\u003cp>Advocates for reform wanted to move mental health treatment from locked hospitals to less restrictive, and less costly, community settings. The reform movement goes back to the 60s. People with schizophrenia or bipolar disorder who were once locked away in state asylums now often live with their illnesses in the community. But that reform movement may have gone too far too fast, some advocates say. Over the last 15 years, psychiatric facilities have closed in record numbers. California lost one in three hospital beds once reserved for behavioral health emergencies. At the same time funding shifted from inpatient to outpatient treatment, the system of community care never got fully built.\u003c/p>\n\u003cp>A wave of corporate hospital closures and county budget cuts resulted in California losing about 4,000 hospital beds once reserved for psychiatric emergencies. Some areas were hit harder than others. Most of the rural northern and Sierra counties have no inpatient mental health services at all.\u003c/p>\n\u003cp>\u003cstrong>\"We Do Medical Care Here\"\u003c/strong>\u003c/p>\n\u003cp>At Sutter Lakeside Hospital, in the county seat of Lakeport, you can have back surgery, or give birth, but chief administrator Siri Nelson says if you're hallucinating or suicidal, then you're out of luck. “We're not a psychiatric facility,” says Nelson. “We do medical care here.”\u003cstrong>\u003cem> \u003c/em>\u003c/strong>\u003c/p>\n\u003cp>Serious mental illness is a brain disorder which also requires proper medical care. But Nelson says there simply isn't enough demand in this small county of 65,000 people to make a psychiatric unit profitable. And that calculation affects a wide array of other county services.\u003c/p>\n\u003cp>Because there are no local beds, last year Fire Chief Willie Sapeta had to transport 200 patients out of Lake County for psychiatric treatment. “Those transports can be a four-hour turnaround time to as much as a 10- or 12-hour turnaround,” he says, “when we've had to go to Salinas or up into Humboldt or Del Norte County.”\u003c/p>\n\u003cp>And it's not just paramedics who are affected. If the patient is considered potentially dangerous, then law enforcement has to step in. Sheriff's deputies have had to monitor patients in the emergency department for 10 to 12 hours at a time before a county behavioral health worker arrives.\u003c/p>\n\u003cp>Lt. Chris Chwialkowski, with the Lake County Sheriff’s Department, says the wait is a hardship for the patient, but also for his department. “If that deputy is on overtime, you're talking about time-and-a-half,” says Chwialkowski. \"If that deputy's not on overtime, then you're taking a deputy off the street.”\u003c/p>\n\u003cp>It's a bad situation all around, says Kristy Kelly, behavioral health director for Lake County. “It's difficult for law enforcement because they may have to stand by to make sure that it's safe,” she says. “It's difficult for the ER because that's their patient and they want to move their patients on. It's difficult for the Mental Health Department because we're trying to find a placement and we're calling and calling and calling and calling, and we're getting a lot of nos.\u003c/p>\n\u003cp>With the scarcity of beds, the moment one patient is discharged from a psychiatric bed, another is moved in. So the timing has to be just right for Kelly’s people to find a vacant bed. “We just keep calling until we get a yes,” says Kelly.\u003c/p>\n\u003cp>Back at The Bridge, Ford described how she found peace. About 15 years ago, she reached out to self-help groups and embarked on what she calls a spiritual path. She is much more settled now and says it's been years since she was hospitalized.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/125135790&color=ff6600&auto_play=false&show_artwork=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"166\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's note: This is the first of three stories about psychiatric inpatient services airing this week on \u003ca href=\"http://www.californiareport.org\" target=\"_blank\">The California Report.\u003c/a> \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Health Law Nudges Therapists Toward Group Practice",
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"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_15838\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/148129971.jpg\">\u003cimg class=\"size-large wp-image-15838 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/148129971-640x494.jpg\" alt=\"\" width=\"640\" height=\"494\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Because mental health is one of the ACA's required benefits, many therapists are now having to deal with insurance contracts for the first time. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Sarah Varney\u003c/strong>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/October/24/Health-Law-Changes-Therapy-Business.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>In the corporate world of American health care, with its consolidating hospital chains and doctors’ groups, psychologists and other mental health therapists are still mostly Mom-and-Pop shops; they’ve built solo practices, hanging their own shingles, not unlike Lucy in the Peanuts gang: “Psychiatric Help 5¢, The Doctor Is In.”\u003c/p>\n\u003cp>But that business model is shifting from solo practices toward large medical groups, say mental health experts. The shift is propelled by the Affordable Care Act, which mandates mental health benefits in insurance coverage, and the 2008 mental health parity law, which requires private and public insurers to cover mental health needs just as they do medical conditions by charging similar co-pays, for example.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“It’s a big change for us. There is a loss of autonomy that a lot of therapists are frightened about.” \u003c/aside>\n\u003cp>“It’s a big change for us,” said Barbara Griswold, a marriage and family therapist in San Jose. “I spent all of my life setting up this practice where I choose my clients, I choose my hours.”\u003c/p>\n\u003cp>In just the last few months, Griswold has weighed a new contract with a giant health insurer, warned other therapists to watch what they’re signing in payment negotiations and considered the extinction of her own solo practice. “The idea of me moving into an interdisciplinary practice where somebody else is taking care of my billing, and someone is choosing my clients for me —there is a loss of autonomy that a lot of therapists are frightened about,” Griswold said.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Organizations that advocate for mental and behavioral health, groups that long complained they were treated as second-class providers, have applauded the federal laws. “Some people have paid for mental health out of pocket because they didn’t have mental health insurance,” said Dr. Katherine Nordal, executive director for professional practice at the American Psychological Association. “I think now they’ll expect their providers to accept insurance.”\u003c/p>\n\u003cp>But inclusion into the mainstream has come with some unhappy caveats: Cash was simple. Patients used to paying $150 in cash for a therapy session will, with some limitations, be covered by their health plan.\u003c/p>\n\u003cp>That means many therapists will have to figure out innumerable insurance plans and byzantine billing codes for the first time. “A lot of people come to me and they’re almost falling apart,” said Griswold who wrote a book called, “Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance – and Whether You Should.” “It’s almost like a therapy session with these therapists. Seriously! I had a woman cry on my couch. She was like, ‘I don’t know how to do this!’”\u003c/p>\n\u003cp>Therapists who already accept insurance typically take a big pay cut since insurers negotiate fees that are about half of what they charge for cash visits. Blue Shield of California, for example, recently asked Griswold to accept a 10- to 30-percent discount off of her already discounted rate for patients who will buy health plans through the new online insurance marketplace. She refused and then wrote about the negotiations in her popular newsletter. “I put out in my newsletter, ‘Do you even know what you signed?’ And people wrote back, ‘Oh my God, I had no idea!’”\u003c/p>\n\u003cp>In many ways, therapists are encountering what medical doctors have complained about for years: the confusing and confounding – some say hostile – insurance bureaucracy that providers must tangle with in order to get paid. Therapists are expected to invest in expensive electronic billing software and electronic health records and comply with a tome of regulations.\u003c/p>\n\u003cp>“Just keeping up with all of that quite frankly is exhausting,” said Erica Savino Moffatt, a psychiatric nurse practitioner in Boston. “If you’re Jane Therapist hanging her shingle down the office from her home, it used to be the benefit was a better work-life balance and control over your immediate work environment. But a lot of that is lost in trying to track all of these logistics.”\u003c/p>\n\u003cp>The dizzying complexity of running a practice has meant more therapists are taking down their shingles, and consolidating with each other to share the burden, executives at national mental groups say. Or they are joining large medical groups in which mental health services are part of a continuum of care.\u003c/p>\n\u003cp>The changes are part of a remaking of a system that has long treated the mind as separate from the body. “If you look how many airlines there are today versus 10 years ago; if you look at hardware stores versus Home Depot and Lowe’s; it’s really a monopoly economy,” said Linda Rosenberg, president of the National Council for Behavioral Health. “And I think solo practitioners are going to be employees of big systems.”\u003c/p>\n\u003cp>In Tacoma, Wash., Dr. Barry Anton works as a clinical psychologist at Rainier Associates, an outpatient mental health clinic staffed by 17 therapists. Solo practitioners “might find it difficult to succeed in the new environment because the health care delivery system is evolving,” Anton said.\u003c/p>\n\u003cp>As insurance companies look to provide mental health care on a large scale, clinics like Rainier Associates are attractive partners. “It’s been very convenient and efficient for the insurance company to work with a bigger group,” said Anton. “We only have one tax ID number; we take care of all the credentialing; we take care of all the billing. They cut one check. It’s just more efficient for them.”\u003c/p>\n\u003cp>Psychologists, psychiatrists and other therapists in larger groups gain bargaining power as well and can demand higher reimbursement rates from insurance companies. “For those mental health practitioners who can develop group practices where they can provide a full range of services – from psychotherapy to family therapy to marriage therapy to medication management – they are going to be in a much better position to negotiate not only with commercial carriers but also with the federal government,” said Nordal of the American Psychological Association.\u003c/p>\n\u003cp>In addition to super-sizing mental health practices, mental health providers are beginning to play a bigger role at primary care clinics.\u003c/p>\n\u003cp>Savino Moffatt is a newly minted graduate who, instead of starting her own practice, saw where the future was headed: She works as a psychiatric nurse practitioner at a large clinic in Boston that is well positioned for the era of integrated medicine. She sits alongside internists and pediatricians who previously didn’t know where to turn \u003cspan style=\"text-decoration: line-through\">to \u003c/span>for psychological help with their patients. Now, Savino Moffit is just down the hall. “Once you say, ‘Hey, I’m here! I do psychiatry.’ And they kind of look at you like, ‘Oh thank goodness! I have a patient and I’m so worried!’”\u003c/p>\n\u003cp>Savino Moffit says she can identify mental health conditions like depression that might be masquerading as physical symptoms and which allows physicians to better serve their patients. It also can save the clinic from ordering costly and unnecessary tests, an important consideration for large medical groups that receive a set amount of money each month to cover all the needs of their patients.\u003c/p>\n\u003cp>Mental health experts say setting up these new business models will take time; that it’s a marathon, not a sprint. Barbara Griswold, sitting in her therapist’s chair at her office in San Jose, says that’s about the right speed. “I tend to think therapists overreact about change. We’re not really good with change, which is funny because we help people with change.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv>\u003c/div>\n\n",
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"excerpt": "In the corporate world of American health care, with its consolidating hospital chains and doctors’ groups, psychologists and other mental health therapists are still mostly Mom-and-Pop shops; they’ve built solo practices, hanging their own shingles, not unlike Lucy in the Peanuts gang: “Psychiatric Help 5¢, The Doctor Is In.”\r\n\r\nBut that business model is shifting from solo practices toward large medical groups, say mental health experts. The shift is propelled by the Affordable Care Act.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15838\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/148129971.jpg\">\u003cimg class=\"size-large wp-image-15838 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/148129971-640x494.jpg\" alt=\"\" width=\"640\" height=\"494\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Because mental health is one of the ACA's required benefits, many therapists are now having to deal with insurance contracts for the first time. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Sarah Varney\u003c/strong>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/October/24/Health-Law-Changes-Therapy-Business.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>In the corporate world of American health care, with its consolidating hospital chains and doctors’ groups, psychologists and other mental health therapists are still mostly Mom-and-Pop shops; they’ve built solo practices, hanging their own shingles, not unlike Lucy in the Peanuts gang: “Psychiatric Help 5¢, The Doctor Is In.”\u003c/p>\n\u003cp>But that business model is shifting from solo practices toward large medical groups, say mental health experts. The shift is propelled by the Affordable Care Act, which mandates mental health benefits in insurance coverage, and the 2008 mental health parity law, which requires private and public insurers to cover mental health needs just as they do medical conditions by charging similar co-pays, for example.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“It’s a big change for us. There is a loss of autonomy that a lot of therapists are frightened about.” \u003c/aside>\n\u003cp>“It’s a big change for us,” said Barbara Griswold, a marriage and family therapist in San Jose. “I spent all of my life setting up this practice where I choose my clients, I choose my hours.”\u003c/p>\n\u003cp>In just the last few months, Griswold has weighed a new contract with a giant health insurer, warned other therapists to watch what they’re signing in payment negotiations and considered the extinction of her own solo practice. “The idea of me moving into an interdisciplinary practice where somebody else is taking care of my billing, and someone is choosing my clients for me —there is a loss of autonomy that a lot of therapists are frightened about,” Griswold said.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Organizations that advocate for mental and behavioral health, groups that long complained they were treated as second-class providers, have applauded the federal laws. “Some people have paid for mental health out of pocket because they didn’t have mental health insurance,” said Dr. Katherine Nordal, executive director for professional practice at the American Psychological Association. “I think now they’ll expect their providers to accept insurance.”\u003c/p>\n\u003cp>But inclusion into the mainstream has come with some unhappy caveats: Cash was simple. Patients used to paying $150 in cash for a therapy session will, with some limitations, be covered by their health plan.\u003c/p>\n\u003cp>That means many therapists will have to figure out innumerable insurance plans and byzantine billing codes for the first time. “A lot of people come to me and they’re almost falling apart,” said Griswold who wrote a book called, “Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance – and Whether You Should.” “It’s almost like a therapy session with these therapists. Seriously! I had a woman cry on my couch. She was like, ‘I don’t know how to do this!’”\u003c/p>\n\u003cp>Therapists who already accept insurance typically take a big pay cut since insurers negotiate fees that are about half of what they charge for cash visits. Blue Shield of California, for example, recently asked Griswold to accept a 10- to 30-percent discount off of her already discounted rate for patients who will buy health plans through the new online insurance marketplace. She refused and then wrote about the negotiations in her popular newsletter. “I put out in my newsletter, ‘Do you even know what you signed?’ And people wrote back, ‘Oh my God, I had no idea!’”\u003c/p>\n\u003cp>In many ways, therapists are encountering what medical doctors have complained about for years: the confusing and confounding – some say hostile – insurance bureaucracy that providers must tangle with in order to get paid. Therapists are expected to invest in expensive electronic billing software and electronic health records and comply with a tome of regulations.\u003c/p>\n\u003cp>“Just keeping up with all of that quite frankly is exhausting,” said Erica Savino Moffatt, a psychiatric nurse practitioner in Boston. “If you’re Jane Therapist hanging her shingle down the office from her home, it used to be the benefit was a better work-life balance and control over your immediate work environment. But a lot of that is lost in trying to track all of these logistics.”\u003c/p>\n\u003cp>The dizzying complexity of running a practice has meant more therapists are taking down their shingles, and consolidating with each other to share the burden, executives at national mental groups say. Or they are joining large medical groups in which mental health services are part of a continuum of care.\u003c/p>\n\u003cp>The changes are part of a remaking of a system that has long treated the mind as separate from the body. “If you look how many airlines there are today versus 10 years ago; if you look at hardware stores versus Home Depot and Lowe’s; it’s really a monopoly economy,” said Linda Rosenberg, president of the National Council for Behavioral Health. “And I think solo practitioners are going to be employees of big systems.”\u003c/p>\n\u003cp>In Tacoma, Wash., Dr. Barry Anton works as a clinical psychologist at Rainier Associates, an outpatient mental health clinic staffed by 17 therapists. Solo practitioners “might find it difficult to succeed in the new environment because the health care delivery system is evolving,” Anton said.\u003c/p>\n\u003cp>As insurance companies look to provide mental health care on a large scale, clinics like Rainier Associates are attractive partners. “It’s been very convenient and efficient for the insurance company to work with a bigger group,” said Anton. “We only have one tax ID number; we take care of all the credentialing; we take care of all the billing. They cut one check. It’s just more efficient for them.”\u003c/p>\n\u003cp>Psychologists, psychiatrists and other therapists in larger groups gain bargaining power as well and can demand higher reimbursement rates from insurance companies. “For those mental health practitioners who can develop group practices where they can provide a full range of services – from psychotherapy to family therapy to marriage therapy to medication management – they are going to be in a much better position to negotiate not only with commercial carriers but also with the federal government,” said Nordal of the American Psychological Association.\u003c/p>\n\u003cp>In addition to super-sizing mental health practices, mental health providers are beginning to play a bigger role at primary care clinics.\u003c/p>\n\u003cp>Savino Moffatt is a newly minted graduate who, instead of starting her own practice, saw where the future was headed: She works as a psychiatric nurse practitioner at a large clinic in Boston that is well positioned for the era of integrated medicine. She sits alongside internists and pediatricians who previously didn’t know where to turn \u003cspan style=\"text-decoration: line-through\">to \u003c/span>for psychological help with their patients. Now, Savino Moffit is just down the hall. “Once you say, ‘Hey, I’m here! I do psychiatry.’ And they kind of look at you like, ‘Oh thank goodness! I have a patient and I’m so worried!’”\u003c/p>\n\u003cp>Savino Moffit says she can identify mental health conditions like depression that might be masquerading as physical symptoms and which allows physicians to better serve their patients. It also can save the clinic from ordering costly and unnecessary tests, an important consideration for large medical groups that receive a set amount of money each month to cover all the needs of their patients.\u003c/p>\n\u003cp>Mental health experts say setting up these new business models will take time; that it’s a marathon, not a sprint. Barbara Griswold, sitting in her therapist’s chair at her office in San Jose, says that’s about the right speed. “I tend to think therapists overreact about change. We’re not really good with change, which is funny because we help people with change.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv>\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Mental Health Funds Well-Spent or Wasted? Prop. 63 Authors Divided",
"title": "Mental Health Funds Well-Spent or Wasted? Prop. 63 Authors Divided",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>By Elaine Korry, KQED\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_13769\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003cimg class=\"size-large wp-image-13769\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/07/RS5694_Korry-Prop-63-art-therapy-Daniels-Place-scr-620x465.jpg\" alt=\"Young people with mental health needs find help through art therapy at Daniel's Place, a drop-in center in Santa Monica. (Elaine Korry/KQED)\" width=\"620\" height=\"465\">\u003cfigcaption class=\"wp-caption-text\">Young people with mental health needs find help through art therapy at Daniel's Place, a drop-in center in Santa Monica. (Elaine Korry/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Remember Proposition 63? The voter initiative known as the Mental Health Services Act was approved in 2004. It imposed a 1 percent surtax on income over $1 million to fund services for Californians with a serious mental illness. Now, nine years later, the state auditor is about to release a long-awaited report, detailing how nearly $9 billion in taxpayer money raised by Prop. 63 has been spent. Whether that money has been spent wisely is being hotly debated, and even the bill's co-authors are divided.\u003c/p>\n\u003cp>“What did they do with the money? Where has all the money gone? We would like to know,” said Rose King, one of the initiative’s original co-authors. Lawmakers requested the audit after whistle-blowers including King complained that the funds were being misused.\u003c/p>\n\u003cp>As written, nearly three-quarters of the money raised by Prop 63 was slated to fund services for people already diagnosed with a severe mental illness. Twenty percent was reserved for prevention and early intervention strategies. The remaining funds would go to oversight, administration, and innovations.\u003c!--more-->\u003c/p>\n\u003cp>Instead, King, who has battled for years to get mental health services for members of her own family, charges that voters who approved Prop. 63 have been duped. “It is a model of discrimination and waste,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The other co-author of Prop. 63, Rusty Selix, also welcomes the audit, but for a different reason. “We think that the audit will affirm that 99 percent of the money has gone exactly where it should go,” said Selix, who heads the state Council of Community Mental Health Agencies. He says Prop. 63 is funding a continuum of care for the very people who need coordinated services most.\u003c/p>\n\u003cp>Not so, according to Peter Mantas, the former chairman of the Contra Costa County Mental Health Commission, whose own family was ravaged by mental illness. Mantas’ son, who was diagnosed with paranoid schizophrenia, took his own mother’s life during a schizophrenic break.\u003c/p>\n\u003cp>In the aftermath of that tragedy, Mantas says he witnessed first-hand a fragmented system that allows people with severe disorders to cycle through emergency rooms over and over until the unthinkable happens “They wind up getting jailed, not taking medication, continuing the downward spiral, and society pays a very hefty fine for that, beyond the emotional toll,” said Mantas.\u003c/p>\n\u003cp>According to Mantas, Proposition 63 should be revamping mental health care from the ground up to make the most vulnerable people with severe illness the priority. Instead, Mantas wound up quitting the county commission in frustration after two years, charging that too much money was being funneled into what he calls “little feel-good programs,” that don’t impact the entire system.\u003c/p>\n\u003cp>Yet supporters of these programs say they are the very kind of services that might have helped Mantas’ son before it was too late.\u003c/p>\n\u003cp>They cite examples such as Daniel’s Place, a comfortable drop-in center in Santa Monica, where young people who are troubled can come, whether diagnosed with a mental disorder or not. Some of the clients receive traditional case management; others come for support groups, or non-traditional services such as art therapy, drama therapy or even a popular drumming group.\u003c/p>\n\u003cp>Program manager Emily James says Daniel’s Place is a low-barrier environment by design. “It’s a lot easier to start talking to a young person about coming to an art group than saying, ‘Come in and see our psychiatrist and get on psychotropic medications.’ That’s just not something that a lot of people want to do,” said James.\u003c/p>\n\u003cp>Prop. 63 also pays for peer advocates at Daniel’s Place, such as Duane Lynch, who has received mental health services himself. “There’s someone around their age, someone who understands what they’re going through because they lived through the same thing,” said Lynch. He says some young clients can connect better with a peer advocate than a professional therapist because the two have had a shared experience.\u003c/p>\n\u003cp>Daniel’s Place is all about building relationships to catch mental illness early, when it’s more easily treated. Prop. 63 co-author Rusty Selix says early intervention has to be a big part of any mental health strategy. He understands the frustration of family members who have dealt with a loved one’s long-term illness, but he says to criticize Prop. 63 is misdirected. “They’re looking at the way Prop. 63 money is being spent, and that’s not where the problem is,” says Selix. “The problem is we don’t have the other money that we used to have. That’s why [Prop 63] hasn’t achieved its goals.”\u003c/p>\n\u003cp>According to Selix, Prop. 63 money, about $1 billion per year, was intended to supplement an existing $2 billion state mental health budget. Instead, he says, the recession prompted Sacramento to slash the existing budget almost in half. The new funds from Prop. 63 have barely filled the gap.\u003c/p>\n\u003cp>UCLA psychiatrist Joel Braslow says Prop. 63 averted what would have been an even worse collapse in public mental health. “Most people are not being adequately cared for that have severe mental illness,” said Braslow, a historian of public mental health systems. “What Prop. 63 has done is at least allowed for better care than would have been possible otherwise,” he said.\u003c/p>\n\u003cp>According to Braslow, the feud over Prop. 63 spending misses the point. He says, both sides are correct: better services are needed for severe mental illness -- and for prevention and early intervention strategies. “Actually I think it would be more useful to turn it around and say, ‘Why aren’t we providing more resources?’”\u003c/p>\n\u003cp>The state audit, scheduled to be released next month, may answer some questions about how Prop. 63 funds are being allocated. But Braslow says no matter what it shows, mental illness will remain a neglected social problem until Californians get real about what it costs to adequately care for people who can’t take care of themselves.\u003c/p>\n\u003cp>\u003cstrong>Listen to the story:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\">\u003cparam name=\"movie\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201307220850a.xml\">\u003cembed src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" type=\"application/x-shockwave-flash\" width=\"335\" height=\"85\" flashvars=\"file=http://www.kqed.org/radio/archives/R201307220850a.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"excerpt": "Remember Proposition 63? The voter initiative known as the Mental Health Services Act was approved in 2004. It imposed a 1% surtax on income over $1 million to fund services for Californians with a serious mental illness. Nine years later, the state auditor is about to release a long-awaited report, detailing how nearly $9 billion in taxpayer money raised by Prop 63 has been spent.\r\n\r\n“What did they do with the money? Where has all the money gone? We would like to know,” said Rose King, one of the initiative’s original co-authors. Lawmakers requested the audit after whistle-blowers including King complained that the funds were being misused.",
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"description": "Remember Proposition 63? The voter initiative known as the Mental Health Services Act was approved in 2004. It imposed a 1% surtax on income over $1 million to fund services for Californians with a serious mental illness. Nine years later, the state auditor is about to release a long-awaited report, detailing how nearly $9 billion in taxpayer money raised by Prop 63 has been spent.\r\n\r\n“What did they do with the money? Where has all the money gone? We would like to know,” said Rose King, one of the initiative’s original co-authors. Lawmakers requested the audit after whistle-blowers including King complained that the funds were being misused.",
"title": "Mental Health Funds Well-Spent or Wasted? Prop. 63 Authors Divided | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Elaine Korry, KQED\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_13769\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003cimg class=\"size-large wp-image-13769\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/07/RS5694_Korry-Prop-63-art-therapy-Daniels-Place-scr-620x465.jpg\" alt=\"Young people with mental health needs find help through art therapy at Daniel's Place, a drop-in center in Santa Monica. (Elaine Korry/KQED)\" width=\"620\" height=\"465\">\u003cfigcaption class=\"wp-caption-text\">Young people with mental health needs find help through art therapy at Daniel's Place, a drop-in center in Santa Monica. (Elaine Korry/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Remember Proposition 63? The voter initiative known as the Mental Health Services Act was approved in 2004. It imposed a 1 percent surtax on income over $1 million to fund services for Californians with a serious mental illness. Now, nine years later, the state auditor is about to release a long-awaited report, detailing how nearly $9 billion in taxpayer money raised by Prop. 63 has been spent. Whether that money has been spent wisely is being hotly debated, and even the bill's co-authors are divided.\u003c/p>\n\u003cp>“What did they do with the money? Where has all the money gone? We would like to know,” said Rose King, one of the initiative’s original co-authors. Lawmakers requested the audit after whistle-blowers including King complained that the funds were being misused.\u003c/p>\n\u003cp>As written, nearly three-quarters of the money raised by Prop 63 was slated to fund services for people already diagnosed with a severe mental illness. Twenty percent was reserved for prevention and early intervention strategies. The remaining funds would go to oversight, administration, and innovations.\u003c!--more-->\u003c/p>\n\u003cp>Instead, King, who has battled for years to get mental health services for members of her own family, charges that voters who approved Prop. 63 have been duped. “It is a model of discrimination and waste,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The other co-author of Prop. 63, Rusty Selix, also welcomes the audit, but for a different reason. “We think that the audit will affirm that 99 percent of the money has gone exactly where it should go,” said Selix, who heads the state Council of Community Mental Health Agencies. He says Prop. 63 is funding a continuum of care for the very people who need coordinated services most.\u003c/p>\n\u003cp>Not so, according to Peter Mantas, the former chairman of the Contra Costa County Mental Health Commission, whose own family was ravaged by mental illness. Mantas’ son, who was diagnosed with paranoid schizophrenia, took his own mother’s life during a schizophrenic break.\u003c/p>\n\u003cp>In the aftermath of that tragedy, Mantas says he witnessed first-hand a fragmented system that allows people with severe disorders to cycle through emergency rooms over and over until the unthinkable happens “They wind up getting jailed, not taking medication, continuing the downward spiral, and society pays a very hefty fine for that, beyond the emotional toll,” said Mantas.\u003c/p>\n\u003cp>According to Mantas, Proposition 63 should be revamping mental health care from the ground up to make the most vulnerable people with severe illness the priority. Instead, Mantas wound up quitting the county commission in frustration after two years, charging that too much money was being funneled into what he calls “little feel-good programs,” that don’t impact the entire system.\u003c/p>\n\u003cp>Yet supporters of these programs say they are the very kind of services that might have helped Mantas’ son before it was too late.\u003c/p>\n\u003cp>They cite examples such as Daniel’s Place, a comfortable drop-in center in Santa Monica, where young people who are troubled can come, whether diagnosed with a mental disorder or not. Some of the clients receive traditional case management; others come for support groups, or non-traditional services such as art therapy, drama therapy or even a popular drumming group.\u003c/p>\n\u003cp>Program manager Emily James says Daniel’s Place is a low-barrier environment by design. “It’s a lot easier to start talking to a young person about coming to an art group than saying, ‘Come in and see our psychiatrist and get on psychotropic medications.’ That’s just not something that a lot of people want to do,” said James.\u003c/p>\n\u003cp>Prop. 63 also pays for peer advocates at Daniel’s Place, such as Duane Lynch, who has received mental health services himself. “There’s someone around their age, someone who understands what they’re going through because they lived through the same thing,” said Lynch. He says some young clients can connect better with a peer advocate than a professional therapist because the two have had a shared experience.\u003c/p>\n\u003cp>Daniel’s Place is all about building relationships to catch mental illness early, when it’s more easily treated. Prop. 63 co-author Rusty Selix says early intervention has to be a big part of any mental health strategy. He understands the frustration of family members who have dealt with a loved one’s long-term illness, but he says to criticize Prop. 63 is misdirected. “They’re looking at the way Prop. 63 money is being spent, and that’s not where the problem is,” says Selix. “The problem is we don’t have the other money that we used to have. That’s why [Prop 63] hasn’t achieved its goals.”\u003c/p>\n\u003cp>According to Selix, Prop. 63 money, about $1 billion per year, was intended to supplement an existing $2 billion state mental health budget. Instead, he says, the recession prompted Sacramento to slash the existing budget almost in half. The new funds from Prop. 63 have barely filled the gap.\u003c/p>\n\u003cp>UCLA psychiatrist Joel Braslow says Prop. 63 averted what would have been an even worse collapse in public mental health. “Most people are not being adequately cared for that have severe mental illness,” said Braslow, a historian of public mental health systems. “What Prop. 63 has done is at least allowed for better care than would have been possible otherwise,” he said.\u003c/p>\n\u003cp>According to Braslow, the feud over Prop. 63 spending misses the point. He says, both sides are correct: better services are needed for severe mental illness -- and for prevention and early intervention strategies. “Actually I think it would be more useful to turn it around and say, ‘Why aren’t we providing more resources?’”\u003c/p>\n\u003cp>The state audit, scheduled to be released next month, may answer some questions about how Prop. 63 funds are being allocated. But Braslow says no matter what it shows, mental illness will remain a neglected social problem until Californians get real about what it costs to adequately care for people who can’t take care of themselves.\u003c/p>\n\u003cp>\u003cstrong>Listen to the story:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\">\u003cparam name=\"movie\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201307220850a.xml\">\u003cembed src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" type=\"application/x-shockwave-flash\" width=\"335\" height=\"85\" flashvars=\"file=http://www.kqed.org/radio/archives/R201307220850a.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Where California Stands in Mental Health Needs and Services",
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"content": "\u003cfigure id=\"attachment_13688\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://www.flickr.com/photos/93587218@N00/25840514/in/photolist-3hru7-3hru5-9aQE1-3hru6-3hrNZ-2Y453-3hrNX-3hs7T-3hs7P-3hs7R-3hrP1-3hrNY-3hs7Q-3hrP3-3hrP2-3hs7S-3hs7U-3hsmb-3hsm9-3hsma-8s3Xb5-66oLS7-7HCMm-mMfbc-5RunBD-bVCerP-2PW8Wr-2Q1AKw-2Q1Ayq-2PWb7v-2Q1zgQ-2PWa2x-2PW9CR-2Q1Aif-2Q1AQC-2Q1BjG-2Q1B2G-2Q1AuA-2Q1zLh-2PWb2M-2PW9yn-2PW9n6-2Q1AqN-2PWajV-2Q1A4d-2PW9gB-2Q1B7Y-2PW9QZ-2PW9bg-2PWaSi-2PW96V\">\u003cimg class=\"size-large wp-image-13688\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/07/Fresno-620x368.jpg\" alt=\"The San Joaquin Valley has rates of mental health professionals far below state average. (Melissa Wiese/Flickr)\" width=\"620\" height=\"368\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The San Joaquin Valley has rates of mental health professionals far below state average. (Melissa Wiese/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Two new assessments released Wednesday gave an overview of mental health in California – from suicide rates to access to care to the supply of mental health professionals.\u003c/p>\n\u003cp>While there are bright spots, they provide a pretty sobering view. The first, \u003ca href=\"http://www.chcf.org/publications/2013/07/mental-health-california\" target=\"_blank\">Mental Health Care in California: Painting A Picture\u003c/a>, details that nearly 1 in 6 adults in the state has \"a mental health need\" and 1 in 20 has a serious mental illness. The rate in children is even higher: 1 in 13.\u003c/p>\n\u003cp>And too many people are not getting treatment. According to the analysis, half of adults and two-thirds of adolescents with a mental heath illness do not receive treatment. A big contributing factor is likely the state of the mental health workforce in California which is quantified in both the first report and \u003ca href=\"http://www.chcf.org/publications/2013/07/complex-case-mental-health\" target=\"_blank\">the second\u003c/a>. Both analyses are from the California HealthCare Foundation. They describe a varied and fragmented delivery and financing system in the state.\u003c/p>\n\u003cp>Steve Schilling knows the issue all too well. He's CEO of Clinica Sierra Vista which has multiple health centers in southern San Joaquin Valley. He said \"scarcity\" would be a better word than \"variation\" when it came to describing mental health services. In the CHCF analysis, the San Joaquin Valley fell well below a state average for all mental health professions. The Inland Empire also fared poorly. \"I really think we have a non-system of behavioral health in California,\" he said.\u003c!--more-->\u003c/p>\n\u003cp>California has a layer-upon-layer system of mental health funding that can vary dramatically according to what county you live in, or where you seek care. This year's state budget brought \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/06/11/budget-deal-restores-some-health-programs-while-slashing-others/\" target=\"_blank\">a ray of good news\u003c/a> with a boost of $140 million in funds. But county funding has long been determined by an arcane formula. CHCF's researchers noted that \"(w)hile no current analysis comparing county's total per capital mental health program revenues and expenditures is publicly available, it is widely assumed that the amounts vary greatly between counties.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Then there's federal funds. Because Clinica Sierra Vista is a federally-qualified health center, or FQHC, it is constrained by federal rules as to who can provide services. This is an issue because California's mental health workforce has a different composition from that of the U.S. as a whole. In particular, California has more Marriage and Family Therapists, or MFTs, than the U.S. But, in general, MFTs are barred from billing Medi-Cal or Medicare, so, essentially, barred from serving those patients.\u003c/p>\n\u003cp>These reports come at a critical time -- as the state is preparing for the full implementation of the federal health law on Jan. 1 and the tens -- or hundreds -- of thousands of newly insured people seeking access to care.\u003c/p>\n\u003cp>\"The challenge is going to be ... do we have the manpower and the capacity within the system to meet everyone's needs,\" said Dr. Neal Adams with the California Institute for Mental Health, one of the co-authors of the Painting a Picture study.\u003c/p>\n\u003cp>A big uncertainty, Adams noted, is \u003ca href=\"http://www.samhsa.gov/healthreform/parity/\" target=\"_blank\">a 2008 law\u003c/a> requiring parity between mental health services and medical/surgical services. While the law specifically covered group health plans only, the Centers for Medicare and Medicaid Services (CMS) has yet to issue regulations to put the law into effect. The Affordable Care Act and the benefits package in Covered California, the health care marketplace being set up by the state to comply with the ACA, both mention parity. But, \"absent guidelines,\" Adams says, \"I'm worried there will be continued problems with access.\"\u003c/p>\n\u003cp>He pointed out that Proposition 63, passed by the voters in 2004, was intended to provide state funding to community-based mental health services. But while revenue from this so-called \"millionaires' tax\" -- since it created a 1 percent tax on personal income in excess of $1 million -- has flowed, alternative state funding to mental health services was cut in the wake of the economic downturn.\u003c/p>\n\u003cp>Still, the upcoming expansion of insurance under the ACA -- both through the new marketplace and the expansion of Medi-Cal will bring new dollars to health care overall. Adams is optimistic that \"we're going to see more people come into the system with benefits and better ability to pay for services.\"\u003c/p>\n\u003cp>While Rusty Selix, executive director of California Council of Community Mental Health Agencies, argued that better outpatient mental health programs are sorely needed, the ACA's new funding should make a difference.\u003c/p>\n\u003cp>\"Mental health has always been under-funded,\" he observed. Under Obamacare, \"there will be funding.\"\u003c/p>\n\u003cp>Learn More:\u003c/p>\n\u003cp>\u003ca href=\"http://www.kqed.org/a/forum/R201307170930\" target=\"_blank\">\u003cstrong>Higher Mental Illness Rates Among Low-Income Californians\u003c/strong>\u003c/a> (KQED Forum):\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "Two new assessments released Wednesday gave an overview of mental health in California – from suicide rates to access to care to the supply mental health professionals. \r\n\r\nWhile there are bright spots, they provide a pretty sobering view. The first, Mental Health Care in California: Painting A Picture, details that nearly 1 in 6 adults in the state has \"a mental health need\" and 1 in 20 has a serious mental illness. The rate in children is even higher: 1 in 13.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_13688\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://www.flickr.com/photos/93587218@N00/25840514/in/photolist-3hru7-3hru5-9aQE1-3hru6-3hrNZ-2Y453-3hrNX-3hs7T-3hs7P-3hs7R-3hrP1-3hrNY-3hs7Q-3hrP3-3hrP2-3hs7S-3hs7U-3hsmb-3hsm9-3hsma-8s3Xb5-66oLS7-7HCMm-mMfbc-5RunBD-bVCerP-2PW8Wr-2Q1AKw-2Q1Ayq-2PWb7v-2Q1zgQ-2PWa2x-2PW9CR-2Q1Aif-2Q1AQC-2Q1BjG-2Q1B2G-2Q1AuA-2Q1zLh-2PWb2M-2PW9yn-2PW9n6-2Q1AqN-2PWajV-2Q1A4d-2PW9gB-2Q1B7Y-2PW9QZ-2PW9bg-2PWaSi-2PW96V\">\u003cimg class=\"size-large wp-image-13688\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/07/Fresno-620x368.jpg\" alt=\"The San Joaquin Valley has rates of mental health professionals far below state average. (Melissa Wiese/Flickr)\" width=\"620\" height=\"368\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The San Joaquin Valley has rates of mental health professionals far below state average. (Melissa Wiese/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Two new assessments released Wednesday gave an overview of mental health in California – from suicide rates to access to care to the supply of mental health professionals.\u003c/p>\n\u003cp>While there are bright spots, they provide a pretty sobering view. The first, \u003ca href=\"http://www.chcf.org/publications/2013/07/mental-health-california\" target=\"_blank\">Mental Health Care in California: Painting A Picture\u003c/a>, details that nearly 1 in 6 adults in the state has \"a mental health need\" and 1 in 20 has a serious mental illness. The rate in children is even higher: 1 in 13.\u003c/p>\n\u003cp>And too many people are not getting treatment. According to the analysis, half of adults and two-thirds of adolescents with a mental heath illness do not receive treatment. A big contributing factor is likely the state of the mental health workforce in California which is quantified in both the first report and \u003ca href=\"http://www.chcf.org/publications/2013/07/complex-case-mental-health\" target=\"_blank\">the second\u003c/a>. Both analyses are from the California HealthCare Foundation. They describe a varied and fragmented delivery and financing system in the state.\u003c/p>\n\u003cp>Steve Schilling knows the issue all too well. He's CEO of Clinica Sierra Vista which has multiple health centers in southern San Joaquin Valley. He said \"scarcity\" would be a better word than \"variation\" when it came to describing mental health services. In the CHCF analysis, the San Joaquin Valley fell well below a state average for all mental health professions. The Inland Empire also fared poorly. \"I really think we have a non-system of behavioral health in California,\" he said.\u003c!--more-->\u003c/p>\n\u003cp>California has a layer-upon-layer system of mental health funding that can vary dramatically according to what county you live in, or where you seek care. This year's state budget brought \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/06/11/budget-deal-restores-some-health-programs-while-slashing-others/\" target=\"_blank\">a ray of good news\u003c/a> with a boost of $140 million in funds. But county funding has long been determined by an arcane formula. CHCF's researchers noted that \"(w)hile no current analysis comparing county's total per capital mental health program revenues and expenditures is publicly available, it is widely assumed that the amounts vary greatly between counties.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Then there's federal funds. Because Clinica Sierra Vista is a federally-qualified health center, or FQHC, it is constrained by federal rules as to who can provide services. This is an issue because California's mental health workforce has a different composition from that of the U.S. as a whole. In particular, California has more Marriage and Family Therapists, or MFTs, than the U.S. But, in general, MFTs are barred from billing Medi-Cal or Medicare, so, essentially, barred from serving those patients.\u003c/p>\n\u003cp>These reports come at a critical time -- as the state is preparing for the full implementation of the federal health law on Jan. 1 and the tens -- or hundreds -- of thousands of newly insured people seeking access to care.\u003c/p>\n\u003cp>\"The challenge is going to be ... do we have the manpower and the capacity within the system to meet everyone's needs,\" said Dr. Neal Adams with the California Institute for Mental Health, one of the co-authors of the Painting a Picture study.\u003c/p>\n\u003cp>A big uncertainty, Adams noted, is \u003ca href=\"http://www.samhsa.gov/healthreform/parity/\" target=\"_blank\">a 2008 law\u003c/a> requiring parity between mental health services and medical/surgical services. While the law specifically covered group health plans only, the Centers for Medicare and Medicaid Services (CMS) has yet to issue regulations to put the law into effect. The Affordable Care Act and the benefits package in Covered California, the health care marketplace being set up by the state to comply with the ACA, both mention parity. But, \"absent guidelines,\" Adams says, \"I'm worried there will be continued problems with access.\"\u003c/p>\n\u003cp>He pointed out that Proposition 63, passed by the voters in 2004, was intended to provide state funding to community-based mental health services. But while revenue from this so-called \"millionaires' tax\" -- since it created a 1 percent tax on personal income in excess of $1 million -- has flowed, alternative state funding to mental health services was cut in the wake of the economic downturn.\u003c/p>\n\u003cp>Still, the upcoming expansion of insurance under the ACA -- both through the new marketplace and the expansion of Medi-Cal will bring new dollars to health care overall. Adams is optimistic that \"we're going to see more people come into the system with benefits and better ability to pay for services.\"\u003c/p>\n\u003cp>While Rusty Selix, executive director of California Council of Community Mental Health Agencies, argued that better outpatient mental health programs are sorely needed, the ACA's new funding should make a difference.\u003c/p>\n\u003cp>\"Mental health has always been under-funded,\" he observed. Under Obamacare, \"there will be funding.\"\u003c/p>\n\u003cp>Learn More:\u003c/p>\n\u003cp>\u003ca href=\"http://www.kqed.org/a/forum/R201307170930\" target=\"_blank\">\u003cstrong>Higher Mental Illness Rates Among Low-Income Californians\u003c/strong>\u003c/a> (KQED Forum):\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>Editor's Note: Many Americans seek prescription medication to manage stress, anxiety and depression. But for some, the pills become a problem in their own right. As part of our first-person series \u003ca href=\"http://www.californiareport.org/specialcoverage/whatsyourstory/index.jsp\" target=\"_blank\">\"What's Your Story?\"\u003c/a> Sabirah Mustafa of \u003ca href=\"http://oaklandvoices.us/\" target=\"_blank\">Oakland Voices\u003c/a> tells how she and her doctor came up with another approach. \u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Sabirah Mustafa\u003c/strong>\u003c/p>\n\u003cfigure class=\"wp-caption alignleft\" style=\"max-width: 360px\">\u003cimg class=\" \" src=\"http://u.s.kqed.net/2013/04/03/sabirahmustafa.jpg\" alt=\"\" width=\"360\" height=\"203\">\u003cfigcaption class=\"wp-caption-text\">When Sabirah Mustafa was suffering from depression, she found that medication wasn't the best prescription for her. (Shuka Kalantari/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>I used to wish for a magic pill that would enable me to swallow away my problems, so I could successfully navigate my unfulfilled life. But when I found it, it wasn’t in any pharmacy. For many years I suffered from trauma and abuse, but I saw them as symptoms of a soul struggling to find answers in a question complicated life.\u003c/p>\n\u003cp>I wasn’t necessarily searching for easy solutions, just a way to cope with it all. When my doctor became aware of the overwhelming helplessness and sadness I felt, he prescribed medication he thought would help. But the debilitating side-effects were terrible. My environment appeared apart and distant from me. My mind and body felt out of sync with how I moved and spoke, which made me feel awkward and self-conscious. Joy, anger, sympathy and other emotions non-medicated people experience routinely were lost to me. I began to doubt not just the meds' function, but also their purpose. When I complained about their side effects, my medications were adjusted, but the adjustments would transform one problem into another.\u003c/p>\n\u003cp>Roller coaster treatment finally reached a conclusion one day, when I saw my primary physician for chest pain and difficulty breathing. “Let’s talk,\" he said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->He performed his routine check of my blood pressure and temperature, but he also listened as I described my personal and workplace challenges. My physical symptoms, he determined, were due to not managing my stress well. I was feeling overwhelmed at work and wasn't communicating well with my boss.\u003c/p>\n\u003cp>My doctor suggested some ideas around communicating better, streamlining my workload, even considering a new job. Most of his suggestions I had already tried unsuccessfully. But he didn’t give up. We dug deeper. We spent about an hour going over each obstacle, including my complicated personal life. His prescription and referral tablet never left his pocket. Instead he spoke to me as a person who understood human challenges, without judging me.\u003c/p>\n\u003cp>It was difficult working through my issues without medication as a crutch. I wanted to just let myself off the hook and let my doctor solve all my problems for me, but it didn’t work that way this time, I had to come up with my own plan, tackling each problem until I could choose a solution I felt comfortable committing to.\u003c/p>\n\u003cp>I had to become the boss of my own life, a responsibility I had given to medication.\u003c/p>\n\u003cp>Confronting problems is not without uncomfortable side effects, too, I learned, like fear and worry, and like my medication, I had to adjust to the uncomfortable side effects of confronting my problems. But the benefit of being my own boss had surely outweighed the negative.\u003c/p>\n\u003cp>I now have a personal prescription for my magic pill that I wrote for myself: “Life is a drama. You write the script.\"\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201304030850c.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201304030850c.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Sabirah Mustafa is a community liaison for \u003ca href=\"http://oaklandvoices.us/author/sabirah-mustafa/\" target=\"_blank\">Oakland Voices,\u003c/a> a project of The Oakland Tribune.\u003c/strong>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Editor's Note: Many Americans seek prescription medication to manage stress, anxiety and depression. But for some, the pills become a problem in their own right. As part of our first-person series \u003ca href=\"http://www.californiareport.org/specialcoverage/whatsyourstory/index.jsp\" target=\"_blank\">\"What's Your Story?\"\u003c/a> Sabirah Mustafa of \u003ca href=\"http://oaklandvoices.us/\" target=\"_blank\">Oakland Voices\u003c/a> tells how she and her doctor came up with another approach. \u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Sabirah Mustafa\u003c/strong>\u003c/p>\n\u003cfigure class=\"wp-caption alignleft\" style=\"max-width: 360px\">\u003cimg class=\" \" src=\"http://u.s.kqed.net/2013/04/03/sabirahmustafa.jpg\" alt=\"\" width=\"360\" height=\"203\">\u003cfigcaption class=\"wp-caption-text\">When Sabirah Mustafa was suffering from depression, she found that medication wasn't the best prescription for her. (Shuka Kalantari/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>I used to wish for a magic pill that would enable me to swallow away my problems, so I could successfully navigate my unfulfilled life. But when I found it, it wasn’t in any pharmacy. For many years I suffered from trauma and abuse, but I saw them as symptoms of a soul struggling to find answers in a question complicated life.\u003c/p>\n\u003cp>I wasn’t necessarily searching for easy solutions, just a way to cope with it all. When my doctor became aware of the overwhelming helplessness and sadness I felt, he prescribed medication he thought would help. But the debilitating side-effects were terrible. My environment appeared apart and distant from me. My mind and body felt out of sync with how I moved and spoke, which made me feel awkward and self-conscious. Joy, anger, sympathy and other emotions non-medicated people experience routinely were lost to me. I began to doubt not just the meds' function, but also their purpose. When I complained about their side effects, my medications were adjusted, but the adjustments would transform one problem into another.\u003c/p>\n\u003cp>Roller coaster treatment finally reached a conclusion one day, when I saw my primary physician for chest pain and difficulty breathing. “Let’s talk,\" he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->He performed his routine check of my blood pressure and temperature, but he also listened as I described my personal and workplace challenges. My physical symptoms, he determined, were due to not managing my stress well. I was feeling overwhelmed at work and wasn't communicating well with my boss.\u003c/p>\n\u003cp>My doctor suggested some ideas around communicating better, streamlining my workload, even considering a new job. Most of his suggestions I had already tried unsuccessfully. But he didn’t give up. We dug deeper. We spent about an hour going over each obstacle, including my complicated personal life. His prescription and referral tablet never left his pocket. Instead he spoke to me as a person who understood human challenges, without judging me.\u003c/p>\n\u003cp>It was difficult working through my issues without medication as a crutch. I wanted to just let myself off the hook and let my doctor solve all my problems for me, but it didn’t work that way this time, I had to come up with my own plan, tackling each problem until I could choose a solution I felt comfortable committing to.\u003c/p>\n\u003cp>I had to become the boss of my own life, a responsibility I had given to medication.\u003c/p>\n\u003cp>Confronting problems is not without uncomfortable side effects, too, I learned, like fear and worry, and like my medication, I had to adjust to the uncomfortable side effects of confronting my problems. But the benefit of being my own boss had surely outweighed the negative.\u003c/p>\n\u003cp>I now have a personal prescription for my magic pill that I wrote for myself: “Life is a drama. You write the script.\"\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201304030850c.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201304030850c.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Sabirah Mustafa is a community liaison for \u003ca href=\"http://oaklandvoices.us/author/sabirah-mustafa/\" target=\"_blank\">Oakland Voices,\u003c/a> a project of The Oakland Tribune.\u003c/strong>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "State Investigation Reprimands Kaiser Over Mental Health Services",
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"content": "\u003cp>By \u003ca href=\"http://www.kqed.org/radio/about/staff/mina-kim.jsp\" target=\"_blank\">Mina Kim\u003c/a>, KQED\u003c/p>\n\u003cfigure id=\"attachment_21359\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/480294317-e1410283672646.jpg\">\u003cimg class=\"size-medium wp-image-21359\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/480294317-300x183.jpg\" alt=\"(Getty Images)\" width=\"300\" height=\"183\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Kaiser Permanente is failing to provide timely access to mental health treatment for some of its members according to a \u003ca href=\"http://nuhw.squarespace.com/storage/docs/kaiser-docs/DMHC-FinalReportKaiserMentalHlthSvces3-18-13.pdf\" target=\"_blank\">recent report\u003c/a> by the Department of Managed Health Care.\u003c/p>\n\u003cp>The report says Kaiser's mental health services are deficient in key areas.\u003c/p>\n\u003cp>State regulators found insufficient staffing at some clinics across the state -- with patients waiting longer than the legal limit of 10 days for appointments. The report also says some patients were being misled due to inaccurate information about Kaiser's mental health services. Regulators also found that at Northern California facilities staff members were not accurately tracking and reporting how long patients had to wait to get initial appointments or follow ups.\u003c!--more-->\u003c/p>\n\u003cp>Shelly Rouillard, chief deputy director at the department, says the agency will be taking the unusual step of conducting a follow-up survey in six months rather than the normal 18 months.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"These are significant deficiencies, and we're concerned that consumers aren't getting the care that they need when they need it,\" she said \"and particularly when they are in distress.\"\u003c/p>\n\u003cp>Kaiser employees affiliated with the National Union of Healthcare Workers are calling the report a vindication of concerns they laid out in 2011. Clement Papazian is a social worker with Kaiser Oakland and a chapter officer for the union that represents more than 2000 clinicians and psychologists. Papazian says delays have been hard on patients.\u003c/p>\n\u003cp>\"Some of them will drop out of care,\" he described. \"Some of them will seek medication only -- or the services that are available to them: group services.\"\u003c/p>\n\u003cp>But Kaiser Permanente officials say the problems occurred at a limited number of sites and did not effect the quality of mental health care. Mason Turner is assistant director of regional mental health for Kaiser Permanente Northern California. He says the agency has been working hard to correct problems since it received a draft of the report last August.\u003c/p>\n\u003cp>\"We have hired more staff,\" he said. \"We have provided more appointments for our patients, and we're very committed to correcting these issues and providing the highest quality of care that we possibly can.\"\u003c/p>\n\u003cp>Kaiser also issued a \u003ca href=\"http://www.dmhc.ca.gov/library/reports/med_survey/surveys/055bhplanresponse031813.pdf\" target=\"_blank\">complete response\u003c/a> to all its members.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Department of Managed Health Care's enforcement office is now evaluating options for penalties, including fines.\u003c/p>\n\n",
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"excerpt": "Kaiser Permanente is failing to provide timely access to mental health treatment for some of its members according to a recent report by the Department of Managed Health Care.\r\n\r\nThe report says Kaiser's mental health services are deficient in key areas.\r\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By \u003ca href=\"http://www.kqed.org/radio/about/staff/mina-kim.jsp\" target=\"_blank\">Mina Kim\u003c/a>, KQED\u003c/p>\n\u003cfigure id=\"attachment_21359\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/480294317-e1410283672646.jpg\">\u003cimg class=\"size-medium wp-image-21359\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/480294317-300x183.jpg\" alt=\"(Getty Images)\" width=\"300\" height=\"183\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Kaiser Permanente is failing to provide timely access to mental health treatment for some of its members according to a \u003ca href=\"http://nuhw.squarespace.com/storage/docs/kaiser-docs/DMHC-FinalReportKaiserMentalHlthSvces3-18-13.pdf\" target=\"_blank\">recent report\u003c/a> by the Department of Managed Health Care.\u003c/p>\n\u003cp>The report says Kaiser's mental health services are deficient in key areas.\u003c/p>\n\u003cp>State regulators found insufficient staffing at some clinics across the state -- with patients waiting longer than the legal limit of 10 days for appointments. The report also says some patients were being misled due to inaccurate information about Kaiser's mental health services. Regulators also found that at Northern California facilities staff members were not accurately tracking and reporting how long patients had to wait to get initial appointments or follow ups.\u003c!--more-->\u003c/p>\n\u003cp>Shelly Rouillard, chief deputy director at the department, says the agency will be taking the unusual step of conducting a follow-up survey in six months rather than the normal 18 months.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"These are significant deficiencies, and we're concerned that consumers aren't getting the care that they need when they need it,\" she said \"and particularly when they are in distress.\"\u003c/p>\n\u003cp>Kaiser employees affiliated with the National Union of Healthcare Workers are calling the report a vindication of concerns they laid out in 2011. Clement Papazian is a social worker with Kaiser Oakland and a chapter officer for the union that represents more than 2000 clinicians and psychologists. Papazian says delays have been hard on patients.\u003c/p>\n\u003cp>\"Some of them will drop out of care,\" he described. \"Some of them will seek medication only -- or the services that are available to them: group services.\"\u003c/p>\n\u003cp>But Kaiser Permanente officials say the problems occurred at a limited number of sites and did not effect the quality of mental health care. Mason Turner is assistant director of regional mental health for Kaiser Permanente Northern California. He says the agency has been working hard to correct problems since it received a draft of the report last August.\u003c/p>\n\u003cp>\"We have hired more staff,\" he said. \"We have provided more appointments for our patients, and we're very committed to correcting these issues and providing the highest quality of care that we possibly can.\"\u003c/p>\n\u003cp>Kaiser also issued a \u003ca href=\"http://www.dmhc.ca.gov/library/reports/med_survey/surveys/055bhplanresponse031813.pdf\" target=\"_blank\">complete response\u003c/a> to all its members.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Department of Managed Health Care's enforcement office is now evaluating options for penalties, including fines.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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"tagline": "True-life supernatural stories",
"info": "",
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