Support for mood disorders: Allen Doederlien shares information Thursday
By Linda Braden Albert | email@example.com | July 20, 2014
A series of presentations focusing on mental health issues that began in March at the Blount County Public Library will continue Thursday as Allen Doederlein, president of the Depression and Bipolar Support Alliance (DBSA), speaks on bipolar disorder and depression. The presentations, sponsored by NAMI (National Alliance on Mental Illness) Maryville, are free and open to the public.
Doederlein said, “Our headquarters are in Chicago, Ill., and yet, we are really all over the country and have some incredible and important affiliates in Tennessee. The work they do is entirely volunteer. It’s done as a labor of love and it’s done from a very personal place.”
The organization is by and for people who live with depression or bipolar disorder. “That lived experience informs everything we do,” Doederlein said. “We provide information that’s easy and understandable, not written in ‘medicalese,’ not confusing but gets directly to what these conditions are and what you can do to live and get well. We provide empowerment. These are conditions that can make people feel disenfranchised, that can carry great stigma. We want to make sure that people are strong advocates for themselves.”
Doederlein said another goal is to raise concerns and needs to elected officials but also on a more personal level. “Also in their work places and their families — anyplace people with mood disorders may find themselves, to say, let’s work collaboratively and constructively to make sure everyone does well,” he said.
DBSA support groups provide valuable assistance and education for those with mood disorders. Doederlein said, “Our chapters operate free, in-person peer support groups. That’s a group that meets without a doctor or clinical professional present, just the people with a lived experience. There’s a great deal of scientific literature that shows that peer-to-peer experience is greatly beneficial and helps people get well and stay well.”
About 53,000 people are reached nationally in a year by these peer support groups, he added.
Doederlein said Larry Drain, president of the NAMI (National Alliance on Mental Illness) Maryville and initiator of the mental health informational series, is a wonderful example of someone with a great deal of power and intellect who has been challenged by mood disorders.
“He had taken that lived experience and made something in terms of giving back to others,” Doederlein said. “When you think that there are people doing that all over the country, it’s really, really something. Larry’s not only done that in terms of support but also as an advocate.”
At the national level, 50 percent of the paid professional staff and volunteers must, by charter, have personal experience in dealing with mood disorders.
“That perspective informs everything that we do,” Doederlein said. “That’s really important. Very often in health-related education or advocacy, it will be doctors talking to doctors, not really related to a person getting herself or himself well. We make sure that’s at the center of what we do.”
Mood disorders include a spectrum of conditions, including depression and bipolar disorder. Doederlein said, “About 21 million American adults are estimated to be affected by depression and bipolar disorder. That breaks down to about 14 million affected by depression, and between 6 and 7 million affected by bipolar disorder.”
Mood disorders are challenging, but they can be managed and those with the disorders can thrive and contribute to society, Doederlein said. A prime example — Abraham Lincoln.
To learn more, visit the DBSA at www.DBSAlliance.org or attend Thursday’s presentation. It begins at 6:30 p.m. at the Blount County Public Library.
Daisy Jabas, Assistant Director, submitted this abbreviated itinerary:
I wanted to give each of you Allen Doerderlein's Tennessee visit intenery as it is known now.
Exciting news is always welcome. One of our own steps out to bring national attention to those suffering due to lack of medical healthcare coverage. Links to articles in The Tennessean and USA Today are below.
The NBC Today show asked to interview Larry and Linda. The interview is expected to happen today. Airing of their interview is expected some time this week. Let's all send our best wishes and thoughts to this couple as they do all that they can to see that no one else needlessly suffers in like fashion.
Links to Larry and Linda's story:
Decision on Medicaid Expansion holds coverage for many Tennesseans in balance
By Kristi Nelson
Posted June 2, 2013, updated June 4 2013
It was supposed to be one of the strongest tenets of the 2010 Patient Protection and Affordable Care Act. Instead, it became a political football, a metaphor for states’ rights. After the Supreme Court ruled that the ACA could not force states to expand Medicaid, Gov. Bill Haslam was among those who rejected the Medicaid expansion, instead offering his alternative “Tennessee Plan” for federal government approval.
But whether the federal government and the General Assembly will accept Haslam’s plan remains to be seen, along with how well it will work to cover those who currently don’t have health insurance.
“He’s either politically brilliant, or he’s making one of the worst mistakes he could make,” Rep. Joe Armstrong, D-Knoxville, told the News Sentinel in March.
What the ACA intended
Originally, the Medicaid expansion provision was to give state health insurance coverage to a group of people who made too much to qualify for Medicaid but too little to afford insurance on the health insurance exchanges, even with the planned government subsidies.
It expanded Medicaid to qualify people younger than 65 whose income is below 138 percent of the federal poverty guideline (a little more than $15,860 annually for an individual, a little less than $32,500 annually for a family of four).
It meant that, for the first time, low-income adults who don’t have children could get state Medicaid coverage, and it standardized other qualifications.
Many states, including Tennessee, limit Medicaid enrollment to certain categories of people. To qualify for TennCare, for example, you have to be low-income and pregnant, a child, blind, disabled, aged, or fall under multiple, specific categories.
Tennessee has nearly 1 million uninsured residents, of whom at least 140,000 and maybe more than twice that number, by some estimates, likely would enroll in Medicaid if it were expanded under the ACA guidelines. About three-quarters would have been previously uninsured. Under the ACA expansion, the federal government would pick up the entire cost of new, previously ineligible enrollees for the first three years, phasing to 90 percent by 2020. In Tennessee, federal funds would have amounted to about $1.4 billion in the first year alone.
States could receive federal matching funds for covering additional low-income residents under Medicaid as early as April 2010, with wide-scale enrollment beginning this October and coverage starting Jan. 1, 2014. However, in June 2012, the U.S. Supreme Court ruled that the federal government could not make states expand Medicaid — making a linchpin of the ACA optional.
So far, 20 states have moved forward with Medicaid expansion. Ten have rejected it outright, while 10 others are not doing it now but are looking at alternatives and have not ruled it out for the future (the government gives no deadline, though states waiting much longer to decide stand to lose federal funds for the first year). Three states are still undecided, while seven — including Tennessee — are crafting their own, alternate plans.
On March 27, Gov. Bill Haslam announced that Tennessee would not expand TennCare rolls under the ACA, instead offering up an alternative he called the Tennessee Plan.
“I don’t think just pure expanding of a system that we all agree is too costly for us, is too costly for the federal government to afford long-term, is the right way,” he said then.
The ‘Tennessee Plan’
Haslam’s proposal is that the state use federal funds not to expand TennCare but to purchase private insurance through the insurance exchange for people who would have qualified for coverage under Medicaid expansion.
He outlined the proposal in the broadest terms, including five “key points”:
Individuals identified as being eligible for the Medicaid expansion group would instead be directed to the exchange, where they would be allowed to choose any qualified health plan that offers a certain level of benefits (the Silver Plan).
The state would pay the monthly premiums, matchable with 100 percent federal dollars, for those people to enroll in the Silver Plan.
People in the Medicaid expansion group would be treated like all other people enrolled in the Silver Plan, with access to the same benefits and appeals process as other people in the plans.
People in the Medicaid expansion group would have the same cost-sharing as other Silver Plan enrollees with incomes below 250 percent of the federal poverty guidelines. (On average, Silver Plan policies would pay for 70 percent of health care costs, with the remaining 30 percent paid by the planholder.)
The arrangement would have a “circuit-breaker,” or “sunset,” ending after the three-year period of 100 percent federal matching dollars, and could be renewed only with approval of the General Assembly. (This is true for states accepting the Medicaid expansion as well; they can stop using federal funds and drop the expanded coverage at any time.)
In addition, Haslam would seek to reform the way providers are paid for services, with payment based on outcomes rather than a set fee for services. The money saved, he said, would be enough to cover the state’s 10 percent share of costs after the government’s share goes to 90 percent.
“One option for covering the Medicaid expansion group is simply to add them to the Medicaid rolls, or the TennCare rolls, in our case,” Haslam said of the plan. “We don’t want to do that. There are a lot of federal requirements that come with Medicaid that make it difficult to provide quality care in the most cost-effective way possible.”
But the federal government may not allow Haslam to forgo some of those requirements. While national Centers for Medicare and Medicaid Services guidelines indicate that the main tenets of the plan — using federal dollars to pay premiums for low-income people to have commercial insurance, and reforming payment — meet federal requirements, some of the details don’t align with federal requirements intended to protect Medicaid enrollees.
For example, Tennessee would need to give those with serious health conditions a choice of enrolling in TennCare or private insurance, unless CMS were to grant Tennessee a waiver to that requirement.
The federal government would require supplementation of benefits (sometimes called “wraparound”) to make sure the commercial insurance plans include all services that would be available through Medicaid. Hypothetically, this could be done through a supplemental premium to the Silver Plan insurance provider.
The government also limits co-payments for Medicaid-eligible enrollees.
There is also an appeals process in place, required by past Supreme Court rulings, so that Medicaid patients and their doctors can challenge insurance companies’ refusals to cover “necessary treatments.” Under federal law, Tennessee would have to allow Medicaid-eligible patients this due process.
A federal entitlement program, Medicaid was designed for a population upon whom “poverty imposes special needs and the need for special protections,” said Carole Myers, a nurse practitioner and associate professor in the University of Tennessee’s College of Nursing. “They don’t have the same voice in government as those with different economic statuses and organizational affiliations.”
Haslam acknowledged in April that Tennessee probably would have to limit co-payments and provide the wraparound services for Medicaid-eligible enrollees for the federal government to approve his alternative, but he said he still thinks his overall plan is “workable.”
Haslam’s plan is modeled on a plan by Arkansas, which also wants to use federal matching dollars to pay commercial insurance premiums for those eligible for the Medicaid expansion. But while Arkansas got legislators’ approval before approaching the federal government, Haslam has taken the opposite approach, presenting his plan to CMS first.
Haslam did not ask state legislators to vote on whether to take the federal Medicaid expansion funds this session, though he said he has not ruled out calling a special legislative session later this year to meet federal deadlines for the health exchange enrollment starting in October.
The Medicaid expansion is the only provision in the ACA that provides insurance coverage specifically to those between 101 percent and 138 percent of the federal poverty guideline. If Haslam fails to reach an agreement with the federal government, or does not opt to accept the federal Medicaid expansion plan (which he could still do), that population likely would remain uninsured.
However, the latest word among hospital executives and advocates is that an agreement could be near.
“I think (Health and Human Services) Secretary (Kathleen) Sebelius is really eager to find some alternative plans that meet the goals of the ACA but do so in creative ways and allow states to create plans beneficial to those individual states,” said Jerry Askew, senior vice president for governmental relations for Tennova Healthcare.
Through Tennova’s parent company, Health Management Associates, Askew works with hospitals in seven states. All of them, except those in Kentucky and West Virginia, have said no to the expansion.
“They’re all trying to figure out what to do. It’s really interesting to watch how the state is to meet their individual objectives,” Askew said. As for Tennessee, he added, “It is fair to say that the governor’s plan is being built on principles that the majority in the Legislature would agree with. But it’s not a given. It’s a lot of hard work.”
Consumer-advocate groups and hospitals were in favor of the expansion, especially since hospitals stand to lose money on uncompensated “charity” care that would have been partially covered, at least, if more people were insured through Medicaid. The Tennessee Hospital Association has said the state stands to lose 90,000 jobs and nearly $13 billion.
Having that population continue to go uninsured also means higher costs in the long run, Myers said, as studies have shown that those without insurance are less likely to get preventive or early care.
“When you are resorting to getting care only when it becomes so bad you can’t stand it, and you’re in the emergency room, it’s causing a major human toll,” she said. “We know that intervention on the earliest point of the illness trajectory is the most cost-efficient. The true measure of whether we’re successful in what we’re doing in health care is in whether people have long, happy, productive lives.”
Business writer Carly Harrington contributed to this report.
© 2013, Knoxville News Sentinel Co.
The death of the Murphy Bill: On being the national spokesman
The Murphy Bill as we know is dead. The Republican leadership in the House announced a change in strategy. They basically decided to toss in the towel on the more controversial parts of the plan and try to see if they can move forward on elements that seem to have a greater consensus behind them. There may be CPR efforts yet but it appears done.
It was a bill in trouble from the start despite the massive pr campaign that tried so hard to say it wasnt so. It managed to unify groups that might not agree on what kind of reforms they wanted, but were absolutely sure what they didnt want and that was the Murphy Bill.
Part of the problem was Murphy himself. He assumed that as "the only psychologist in Congress" he was the obvious and deserved national spokesman for mental health reform. He wasnt. Being a psychologist certainly didnt qualify for the role. Neither did being a member of the House of Representatives. It seemed that Dr. Torrey annointed him and for some reason they both thought that mattered. In the end it was hard to know where he started and Dr. Torrey ended and that was perhaps a fatal flaw.
He didnt understand that leadership was built or that it was a two way street. He alienated people who had lived mental health reform their entire adult lives. He thought it was about them joining him and never seemed to know it was the other way around. And he never realized that trust was everything and that when he snuck AOT into the medicare bill he destroyed his chances of trust with people whose support he needed.
He was naive. The only people who believe federal laws change everything are federal lawmakers and most of them know better. To say that his law was going to prevent the next shooting was simply ego. He believed his own press clippings and his posturing before the dead were even buried just seemed like rank opportunism.
Mental health reform is an ongoing effort by many, many people with different values and priorities. Sometimes it is its own worst enemy. People who cant stand each other have a hard time standing together for anything. Murphy I hope has to some degree taught people they can find unity despite their differences. And maybe the fragile unity borne of him will be the biggest take-away from the entire thing.
He may indeed try again. He probably will. Dr. Torrey most surely will. He has won many, many short term victories and will doubtless win more, but the big prize has eluded him again. He is not the national spokesman he has annointed himself to be either.
Thanks for the support
by Larry Drain, hopeworkscommunity
The following organizations have offered support of "Dear Governor Haslam". They have put links to this site or printed the letters on their websites. I really appreciate it. I invite you or your organization to do the same.
Tennessee Health Care Campaign.
Tennessee Citizen Action.
Tennessee Disability Coalition.
Tennessee Chapter Depression and Bipolar Support Alliance.
WRITE GOVERNOR HASLAM TODAY
hopeworkscommunity | June 1, 2014
byLarry Drain, hopeworkscommunity
Rep. Murphy has not went gently into the good night. Dr. Torrey will never go gently into the good night. They are trying it sounds like to provide cpr to their bill. Rather the things that didnt work the first time will work on second effort is anyone's guess. I think sometimes it is really hard for annointed national spokesmen to realize they are not and never were.
But this post is not about that. It is about a fundamental misunderstanding of the American mental health system that was part of the reason that may have doomed the Murphy Bill from the start.
Murphy seemed to believe we were doing far too much for too many. He thought people who were doing better in the system were robbing those who were doing poorly of help and resources. And he thought if resources were properly allocated things would be okay. Using terms like "worried well" he seemed to want to pit one group against another or at least give worried family members someone to blame. Somehow, I never really understood how, he seemed to think that this misallocation of resources was the fault of Samsha. It was us against them, with guys in black hats, just lacking an afternoon channel from being great soap opera. People were getting rich, famous and powerful off the worried well and just abandoned those in serious need. It had drama, moral outrage, and more than a little passion. It just lacked truth.
Anyone who had watched or been part of the last few years would tell you that state after state year after year had cut their mental health budgets to the bone. In some places there was only skin. The bone had long since disappeared. It was not that too much was done for too many. Too little was done for everyone. Many people lacked insurance and couldnt even access the services that were there. It wasnt misallocation of funds. It was abandonment. Never, not once, have I ever heard anyone touting the Murphy bill ever acknowledge this.
The baggage from Dr. Torrey obscured their vision. No state bought his love affair with psychiatric hospitals. It was too little bang for way too much bucks. No one believed. It was a cash cow around their necks that threatened to bankrupt their community systems. There was little or no proof it worked. When insurance companies basically stop paying for a service that service is on borrowed time. No one drank the kool aid any more.
There will probably always be psychiatric hospitals. But they will never be the centerpiece of the mental health system again. Putting your money into backline services, what you do when things go wrong, destroys your ability to keep things from going wrong. There was never any conspiracy. People just decided what they thought mattered and all of Dr. Torrey's pr and marketing campaigns just didnt change that. In the end I dont think federal law can bring back psychiatric hospitalization as the gold standard of mental health care. The truth is that even people with "severe mental illness" can and do make it in their communities with effective support and services.
The notion that one group of people needing help was more worthy than another and that they were in competition just seemed like such a mean and stupid notion. It completely just ignored the reality of the bloody battle for funding that is the reality for so many states. It was a pseudo explanation for the fact that state after state just said "Dr. Torrey we dont buy what you say and your way will not increase the amount of services for people with severe needs but radically decrease it."
Count me cynical. Count me way cynical. Murphy lost because it was never about a battle for the "severely mentally ill." It was a battle for Dr. Torrey and a vision found lacking a long time ago.
hopeworkscommunity | June 11, 2014
Gun Violence Killed At Least 80 People The Week Prior To Elliot Rodger's Rampage
Sam Stein, Jason Cherkis05/28/14 12:00 AM ET
WASHINGTON --The Memorial Day weekend saw a community eviscerated by gun violence that left several dead and many more injured. But it wasn't UC Santa Barbara that witnessed this particular round of bloodshed. It was New Orleans. By weekend's end, the city had seen 19 people shot, four fatally. On Friday, a fight broke out at a high school graduation party that resulted in one person being killed and seven wounded. On Sunday, three men were shot with an assault rifle. That night, a murder took place at a Cajun seafood joint. On Monday morning, a triple shooting happened right outside a hospital, where people sitting in a car were hit with bullets in their backs, arms and legs. All survived. That same day, a 17-year-old died after being shot multiple times. Even earlier, a man riding his bike was shot under an overpass. The day ended with ahomicide in the Lower Ninth Ward. Outside of New Orleans, the U.S. was pocked with bad news. In the week prior to Elliot Rodger's shooting spree in Isla Vista, there were at least 80 gun-related deaths across the country, according to a Huffington Post analysis of local news reports. That these shootings failed to garner the national attention that the one in Isla Vista did shouldn't shock anyone who has followed the gun control debate. High-profile instances of gun violence are more likely to grab the spotlight than the everyday scourge of gun-related killings. And certainly, the shooting of three (and stabbing of three others) by the 22-year-old son of a Hollywood director who happened to leave a dark, depressing trail of self-made YouTube videos qualifies as high-profile. But instances such as the one at UC Santa Barbara are rare in respect to gun-related homicides. In fact, FBI data shows that there were 900 people who died in mass shootings from 2006 through 2012. By contrast, firearms were used in 11,078 homicides in 2010 alone,according to the U.S. Centers for Disease Control and Prevention. And for those on the frontline of the gun control debate, it's a bit of a head-scratcher as to how the press tends to cover instances of violence. "There's a grim calculus in the heads of journalists about what makes a shooting newsworthy," said Mark Glaze, executive director of the Bloomberg-backed Everytown for Gun Safety. "The total number killed and injured tends to be variable one. The role of young people as perpetrators or victims is a close number two." Glaze argued that press coverage was actually becoming more comprehensive, with reporters "actually paying more attention to the 33 daily gun murders in America than they did five or 10 years ago." That may be true. But, unlike with Rodger's killing spree, there was no national news coverage for the killings in New Orleans. Indeed, unless the shooting involved an athlete or a TV star, the only media that covered gun-related killings the week before Rodger took up arms was in the communities affected. Below are the local stories that The Huffington Post found from the week prior to Rodger's rampage. Alabama:
Helping me through my depression
Blogger, Kelley Baker, shares hints her family uses to help her through depression.
By Kelley Baker
Most of the time, I’m the one you call when you want someone to cheer you up. I like to dance. I love rock concerts, farmers markets, dogs and children. But there’s another side to me: I have been living with clinical depression since I was a child.
Thanks to treatment, coping tools and lifestyle changes—working from home, eating a natural diet—I am better now than I have ever been. Still, every so often I feel the depression returning. I have described it to my husband as a demon eating my brain.
I know it’s confusing for him as one day I seem fine and the next I am sad, distant, or even angry and pushing him away. And I know he wants to help me, but sometimes it’s hard for family members and friends to know what to do.
I had to learn how to be more open with my husband about how I’m feeling and what I need from him. These are some of the things I’ve shared with him:
Help keep clutter at bay. A person spiraling into depression may feel like they are slowing down while the world around them speeds up. The daily routine feels overwhelming: The mail stacks up, dishes pile up in the sink, laundry goes undone. It feels more and more impossible to keep up. Getting extra help with kitchen chores and other mundane tasks keeps things under control so everyone in the house is happier.
Pitch in on meal plans. People who are depressed tend to either eat too little or overeat—usually going for something less than nutritious. Plus, driving through the pick-up lane at a fast food restaurant or ordering a pizza feels so much more manageable than fixing a meal. Having someone make a healthy meal not only contributes to my physical and mental well-being, but also eases my “mom guilt” over what my kids are eating.
A simple ‘Do you want to tell me what you’re feeling?’ makes me feel less alone.
Ask how I’m feeling. If I am able to articulate what I am going through, it helps my husband understand what I am dealing with—and sometimes it helps me understand better, too. Unfortunately, I won’t talk about what I’m going through unless someone asks me. I don’t want to impose, or I don’t think they care. A simple “Do you want to tell me what you’re feeling?” makes me feel less alone.
Encourage self-care. A lot of things fall by the wayside during a depression, including personal appearance. Brushing your teeth and taking a shower just don’t seem to matter—much less getting a haircut or going to the dentist. It all just seems too hard. That attitude can snowball quickly into greater feelings of worthlessness: “Now I’m such a mess, no one could ever love me.” Hearing something like, “I’m going to do the dishes, why don’t you go enjoy a bubble bath?” is often what I need to make me feel okay about doing something self-loving.
Offer a hug. Studies show that a sincere hug lasting longer than 20 seconds can release feel-good chemicals in the brain and elevate the mood of giver and receiver. The fact that people who are depressed often don’t want to be touched can make this tricky, but a hug from the heart, with no expectation of anything further, just may help.
Offer reassurance. Along with the feelings of worthlessness, anger and even guilt that are part and parcel of depression, there’s often fear of ending up alone because really, who would want to put up with these episodes forever? Being reassured I won’t scare away my family because I have an illness takes a huge weight off my mind.
Give a reality check. A never-ending loop of painful, destructive thoughts—“I’m unlovable, I’m a failure, I’m ugly, I’m stupid”—loop through the mind of someone with depression. When my husband reminds me how hard I worked to get a teaching credential, or tells me I’m a great mom or that he loves me, it helps me keep those kind of thoughts in check.
Remember the good. When I’m depressed, I sometimes forget that I was ever happy. Looking at pictures of vacations with my family, watching home movies, hearing things from my husband and kids that they like about me, reminds me that while I may feel sad or numb right now, I’ll get through it.
Why Can’t Doctors Identify Killers?
Will you speak???
The divine is the sea. All religions are rivers leading to the sea. Some rivers wind a great deal. Why not go to the sea directly?
~ Mother Meera
When you strip away all the fancy words and the tons and tons of rhettoric about what the Murphy Bill says and simply ask yourself "What is the plan?" you get a few core ideas. What does Rep. Murphy think we actually need to do to serve the severely mentally ill? There are many other provisions of the bill that has nothing to do with what I am about to talk about. Many of them are the most positive features of the bill. But this is what I think the essence of the Murphy plan is. These are his bottom lines. These are his "new ideas."
He believes, in effect, that many of the severely mentally ill suffer from a defiency of psychiatric hospitalization. He seems to see that as the answer to so many people with "mental illness" being in jails and prisons. He thinks that way too many hospital beds are gone and it is time to increase hospitalization radically.
Perhaps I am wrong but I believe that ship has sailed. A mental health system with psychiatric hospitalization as its corner stone is not financially sustainable in this country. Insurance companies pay less and less for it. They do not see it as medically necessary but in the most extreme circumstances and then for brief periods of time. In Tennessee I believe most psychiatric hospitals are struggling to break even and most of them are losing that struggle. States are getting out of the business. They realize that a large hospital system leaves them unable to finance a community system and if you dont have a community system to serve the people coming out of the hospital what is the point of the hospital. If you look at how often and how quickly people leaving the hospital system end up back there you begin to realize the impact of disemboweling the community system. I cant even imagine the circumstances under which Tennessee would act to increase the beds in any kind of dramatic way, indeed in any way at all. It is far too little bang for way too many bucks.
His method for making psychiatric hospitalization possible is to remove the IMD exclusion on medicaid funding. Basically it makes it possible for medicaid to then pay for state psychiatric hospitals. One question comes to me immediately. If Congressman Murphy thinks that medicaid funding is such an important part of mental health reform why did he vote to repeal the ACA over 50 times? That bill through its provisions for medicaid expansion would have given millions of people with "mental illness" access to programs and services that if he has his way they will never access.
A couple of other questions come to mind. What about the people who dont have medicaid access? Many people with "mental illness" and particularly many people who are having serious problems in life simply dont have insurance. Another question is the response of states to finding out now that medicaid funds can pay for psychiatric hospitals. In most states that I am aware the medicaid program eats up a considerable portion of their state budget and I really question, particularly in the states that choose not to expand medicaid, how receptive they will be to finding out that medicaid expenses are about to soar through the roof. In Tennessee the most likely two responses are to adopt the private insurance definitions of medical necessity and decide not that many people need hospitalizations and/or cut benefits and provider payments to pay for any any expenses the increase in hospitalization is likely to cause. The provider rates for psychiatric care, at least in Tennessee, are so low that very few people will even provide services anyway and there is a serious real question about where the professionals to do all this treatment are to come from.
Even if you start to use medicaid funding it does not begin to pay for all the new costs. The state institutions in Tennessee for example are aging. There is a need for new buildings and new spaces if beds are added. Who pays for new hospitals?? What about the cost of new staff?? Who pays? I can only speak to Tennessee but there is no commitment to psychiatric hospitalization, especially on a massive scale, as the answer to anything by state officials, by mental health professionals. by anyone that I know and removing the IMD exclusion is unlikely to change that. The strong perception is that the community system is the most cost effective and effective means to help people meet their needs and that it is defiencies in that system that lead most to people falling through the cracks.
And even if it was possible would it work?? I know of no evidence, that other than providing a place for stabilization, that psychiatric hospitals work in any enduring fashion. They dont, if you look at return rates, even work well enough to keep people out of psychiatric hospitals.
I dont know but would be willing to hazard a guess that many of the "mentally ill" in the prisons and jails have had considerable psychiatric experience with little or no solid gains. Criminal behavior is not a symptom of mental illness and the "put them in the hospital" solution ignores things like poverty, drug addiction, racism, lack of work, homelessness and history of trauma and other adverse events that lead to someone actually committing criminal acts. The other thing to consider is not the degree to which "mental illness" causes criminal behavior but the extent to which incarceration causes "mental illness." Is treatment needed?? Are mental health resources needed and might for some people those resources be inpatient resources??? Of course. I wonder what percent of those people in jail would even meet the criteria for hospitalization?? I dont know the answers but tend to believe it is the lack of effective and accessible community resources that engender emotional involvement with the people they serve that is the root of the great numbers of "mentally ill" in jails and prisons.
Another core point of Murphy is that he believes that too many people get mental health services and that it is the "worried well " that are basically stealing resources that are better used by the severely mentally ill. Given the fact that most mental health systems have been starved and cut back over the last few years it seems a little like telling one person eating bread and water that the the person next to him is eating too much bread and water and not considering that the problem is the diet of bread and water. It is an argument of little integrity that resorts to an us vs. them argument as a pseudo explanation. It ignores totally the fact that state legislature after state legislature has sacrificed their mental health system on the fires of "financial responsibility" over the last few years.
There are without question people who are victims of a psychiatric system eager to diagnose every event in life as an enotional illness. There is a reason that pharmaceutical companies make money. But there are also people who struggle every day with serious mental health issues, trauma, and distress and to dismiss those people as dupes or malingers is stupid, dishonest and evil. If you think the biggest problem in the mental health system is that too many people need or are seeking help then you are a simple minded person not worthy of being taken seriously.
If you take the notion of "worried well" seriously it takes you to some strange places. How do you decide who is "worried well"? Who decides? Based on what criteria? What do you do to the "worried well"? Do you limit their access to services? How? How much and why? If you dont limit their access to services arent you being complicit in the people who need help being hurt?? And how much is all this going to cost?? Do we need programs to make sure that people who need services get them and another program to make sure those that dont are kept out. This is a treacherous notion that if you take serious leads to nightmares.
Another core notion is making assisted outpatient treatment a law in every state. They tell you that aot is a major problem solver but dont really explain why most of the 45 states that have it dont really use it. And they dont really explain why you need to make something a federal law that is already a state law. And they dont really explain why if 45 states can choose to have it 5 states cant.
I think the truth is that most states who are not willing to throw $32 million a year at it like New York find it more irrelevant than anything. It costs too much and does too little and in an environment of increasingly limited resources is not something that a lot of people are going to turn to to solve many things. And none of this even begins to touch on the questions of choice and coercion that so many people find so fundamentally troubling.
Another core notion of the Murphy Bill is that too many people complain about the human rights of people in the system being important and those people need to be quiet. It would basically eviscerate the protection and advocacy programs like Paimi and legislate away their voice. The idea that people in the system dont need protection is naive and self serving and something you might figure a psychologist or psychiatrist might come up with. Ask anybody in the system. See how safe they feel in the system.
The final key element is to do away with the notion of recovery and the best way to do that is to cut the legs out from under Samsha. Samsha is as close to a boogeyman as there is in this play. They are blamed for everything bad that has happened or will happened. The fact that thousands of people have found recovery to be a real thing is explained away by saying they probably didnt need help anyway or that they are in a remission that would have happened anyway regardless of what they did. If you dont like what you see it works really well to convince yourself that it was really something else.
Samsha is blamed for many things it doesnt decide about. The state of Tennessee decides what kind of services it will offer the people it serves....not Samsha.
Like I said at the start there is more to the Murphy Bill than what I have described here. He took a lot of peoples good ideas and made them part of his bill. None of them seem though to be core elements that define the bill and that is a shame. He has told people he will work with them on a better bill but no one knows what that means because he has compromised on nothing. I have been told by a lot of people I know that is bill is in trouble and very unlikely to be passed as written. I dont know how true that is, but know it is in everybodies best interest to know the bottom lines of what he proposes and decide what that means for them and the way they would like to see the mental health system change.
hopeworkscommunity | May 16, 2014
What is borderline personality disorder?Borderline personality disorder is a serious mental illness marked by unstable moods, behavior, and relationships. In 1980, the Diagnostic and Statistical Manual for Mental Disorders, Third Edition (DSM-III) listed borderline personality disorder as a diagnosable illness for the first time. Most psychiatrists and other mental health professionals use the DSM to diagnose mental illnesses.
Because some people with severe borderline personality disorder have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders.1 While mental health experts now generally agree that the name "borderline personality disorder" is misleading, a more accurate term does not exist yet.
Most people who have borderline personality disorder suffer from:
According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have borderline personality disorder in a given year.2
Borderline personality disorder is often viewed as difficult to treat. However, recent research shows that borderline personality disorder can be treated effectively, and that many people with this illness improve over time.1,3,4
What are the symptoms of borderline personality disorder?According to the DSM, Fourth Edition, Text Revision (DSM-IV-TR), to be diagnosed with borderline personality disorder, a person must show an enduring pattern of behavior that includes at least five of the following symptoms:
Suicide and Self-harmSelf-injurious behavior includes suicide and suicide attempts, as well as self-harming behaviors, described below. As many as 80 percent of people with borderline personality disorder have suicidal behaviors,7 and about 4 to 9 percent commit suicide.4,7
Suicide is one of the most tragic outcomes of any mental illness. Some treatments can help reduce suicidal behaviors in people with borderline personality disorder. For example, one study showed that dialectical behavior therapy (DBT) reduced suicide attempts in women by half compared with other types of psychotherapy, or talk therapy. DBT also reduced use of emergency room and inpatient services and retained more participants in therapy, compared to other approaches to treatment.7 For more information about DBT, see the section, "How is borderline personality disorder treated?"
Unlike suicide attempts, self-harming behaviors do not stem from a desire to die. However, some self-harming behaviors may be life threatening. Self-harming behaviors linked with borderline personality disorder include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. People with borderline personality disorder may self-harm to help regulate their emotions, to punish themselves, or to express their pain.8 They do not always see these behaviors as harmful.
When does borderline personality disorder start?Borderline personality disorder usually begins during adolescence or early adulthood.1,9 Some studies suggest that early symptoms of the illness may occur during childhood.10,11
Some people with borderline personality disorder experience severe symptoms and require intensive, often inpatient, care. Others may use some outpatient treatments but never need hospitalization or emergency care. Some people who develop this disorder may improve without any treatment.12
Studies suggest early symptoms may occur in childhood
What illnesses often co-exist with borderline personality disorder?Borderline personality disorder often occurs with other illnesses. These co-occurring disorders can make it harder to diagnose and treat borderline personality disorder, especially if symptoms of other illnesses overlap with the symptoms of borderline personality disorder.
Women with borderline personality disorder are more likely to have co-occurring disorders such as major depression, anxiety disorders, or eating disorders. In men, borderline personality disorder is more likely to co-occur with disorders such as substance abuse or antisocial personality disorder.13
According to the NIMH-funded National Comorbidity Survey Replication—the largest national study to date of mental disorders in U.S. adults—about 85 percent of people with borderline personality disorder also meet the diagnostic criteria for another mental illness.2
Other illnesses that often occur with BPD include diabetes, high blood pressure, chronic back pain, arthritis, and fibromyalgia.14,15 These conditions are associated with obesity, which is a common side effect of the medications prescribed to treat borderline personality disorder and other mental disorders. For more information, see the section, "How is borderline personality disorder treated?"
What are the risk factors for borderline personality disorder?Research on the possible causes and risk factors for borderline personality disorder is still at a very early stage. However, scientists generally agree that genetic and environmental factors are likely to be involved.
Studies on twins with borderline personality disorder suggest that the illness is strongly inherited.16,17 Another study shows that a person can inherit his or her temperament and specific personality traits, particularly impulsiveness and aggression.18 Scientists are studying genes that help regulate emotions and impulse control for possible links to the disorder.19
Social or cultural factors may increase the risk for borderline personality disorder. For example, being part of a community or culture in which unstable family relationships are common may increase a person's risk for the disorder.1 Impulsiveness, poor judgment in lifestyle choices, and other consequences of BPD may lead individuals to risky situations. Adults with borderline personality disorder are considerably more likely to be the victim of violence, including rape and other crimes.
How is borderline personality disorder diagnosed?Unfortunately, borderline personality disorder is often underdiagnosed or misdiagnosed.20,21
A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect borderline personality disorder based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can help rule out other possible causes of symptoms.
The mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illnesses. This information can help the mental health professional decide on the best treatment. In some cases, co-occurring mental illnesses may have symptoms that overlap with borderline personality disorder, making it difficult to distinguish borderline personality disorder from other mental illnesses. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional's attention.
No single test can diagnose borderline personality disorder. Scientists funded by NIMH are looking for ways to improve diagnosis of this disorder. One study found that adults with borderline personality disorder showed excessive emotional reactions when looking at words with unpleasant meanings, compared with healthy people. People with more severe borderline personality disorder showed a more intense emotional response than people who had less severe borderline personality disorder.6
What studies are being done to improve the diagnosis of borderline personality disorder?Recent neuroimaging studies show differences in brain structure and function between people with borderline personality disorder and people who do not have this illness.22,23 Some research suggests that brain areas involved in emotional responses become overactive in people with borderline personality disorder when they perform tasks that they perceive as negative.24 People with the disorder also show less activity in areas of the brain that help control emotions and aggressive impulses and allow people to understand the context of a situation. These findings may help explain the unstable and sometimes explosive moods characteristic of borderline personality disorder.19,25
Another study showed that, when looking at emotionally negative pictures, people with borderline personality disorder used different areas of the brain than people without the disorder. Those with the illness tended to use brain areas related to reflexive actions and alertness, which may explain the tendency to act impulsively on emotional cues.26
These findings could inform efforts to develop more specific tests to diagnose borderline personality disorder.6
How is borderline personality disorder treated?Borderline personality disorder can be treated with psychotherapy, or "talk" therapy. In some cases, a mental health professional may also recommend medications to treat specific symptoms. When a person is under more than one professional's care, it is essential for the professionals to coordinate with one another on the treatment plan.
The treatments described below are just some of the options that may be available to a person with borderline personality disorder. However, the research on treatments is still in very early stages. More studies are needed to determine the effectiveness of these treatments, who may benefit the most, and how best to deliver treatments.
PsychotherapyPsychotherapy is usually the first treatment for people with borderline personality disorder. Current research suggests psychotherapy can relieve some symptoms, but further studies are needed to better understand how well psychotherapy works.27
It is important that people in therapy get along with and trust their therapist. The very nature of borderline personality disorder can make it difficult for people with this disorder to maintain this type of bond with their therapist.
Types of psychotherapy used to treat borderline personality disorder include the following:28
One type of group therapy, Systems Training for Emotional Predictability and Problem Solving (STEPPS), is designed as a relatively brief treatment consisting of 20 two-hour sessions led by an experienced social worker. Scientists funded by NIMH reported that STEPPS, when used with other types of treatment (medications or individual psychotherapy), can help reduce symptoms and problem behaviors of borderline personality disorder, relieve symptoms of depression, and improve quality of life.32 The effectiveness of this type of therapy has not been extensively studied.
Families of people with borderline personality disorder may also benefit from therapy. The challenges of dealing with an ill relative on a daily basis can be very stressful, and family members may unknowingly act in ways that worsen their relative's symptoms.
Some therapies, such as DBT-family skills training (DBT-FST), include family members in treatment sessions. These types of programs help families develop skills to better understand and support a relative with borderline personality disorder. Other therapies, such as Family Connections, focus on the needs of family members. More research is needed to determine the effectiveness of family therapy in borderline personality disorder. Studies with other mental disorders suggest that including family members can help in a person's treatment.33
Other types of therapy not listed in this booklet may be helpful for some people with borderline personality disorder. Therapists often adapt psychotherapy to better meet a person's needs. Therapists may switch from one type of therapy to another, mix techniques from different therapies, or use a combination therapy. For more information see the NIMH website section on psychotherapy.
Some symptoms of borderline personality disorder may come and go, but the core symptoms of highly changeable moods, intense anger, and impulsiveness tend to be more persistent.34 People whose symptoms improve may continue to face issues related to co-occurring disorders, such as depression or post-traumatic stress disorder.4 However, encouraging research suggests that relapse, or the recurrence of full-blown symptoms after remission, is rare. In one study, 6 percent of people with borderline personality disorder had a relapse after remission.4
MedicationsNo medications have been approved by the U.S. Food and Drug Administration to treat borderline personality disorder. Only a few studies show that medications are necessary or effective for people with this illness.35 However, many people with borderline personality disorder are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression. Often, people are treated with several medications at the same time,12 but there is little evidence that this practice is necessary or effective.
Medications can cause different side effects in different people. People who have borderline personality disorder should talk with their prescribing doctor about what to expect from a particular medication.
Other TreatmentsOmega-3 fatty acids. One study done on 30 women with borderline personality disorder showed that omega-3 fatty acids may help reduce symptoms of aggression and depression.36 The treatment seemed to be as well tolerated as commonly prescribed mood stabilizers and had few side effects. Fewer women who took omega-3 fatty acids dropped out of the study, compared to women who took a placebo (sugar pill).
With proper treatment, many people experience fewer or less severe symptoms. However, many factors affect the amount of time it takes for symptoms to improve, so it is important for people with borderline personality disorder to be patient and to receive appropriate support during treatment.
How can I help a friend or relative who has borderline personality disorder?If you know someone who has borderline personality disorder, it affects you too. The first and most important thing you can do is help your friend or relative get the right diagnosis and treatment. You may need to make an appointment and go with your friend or relative to see the doctor. Encourage him or her to stay in treatment or to seek different treatment if symptoms do not appear to improve with the current treatment.
To help a friend or relative you can:
How can I help myself if I have borderline personality disorder?Taking that first step to help yourself may be hard. It is important to realize that, although it may take some time, you can get better with treatment.
To help yourself:
What if I or someone I know is in crisis?If you are thinking about harming yourself, or know someone who is:
For more information on borderline personality disorderVisit the National Library of Medicine's:
For information on clinical trials
National Library of Medicine clinical trials database
Information from NIMH is available in multiple formats. You can browse online, download documents in PDF, and order materials through the mail. Check the NIHM website for the latest information on this topic and to order publications. If you do not have Internet access, please contact the NIMH Information Resource Center at the numbers listed below.
National Institute of Mental Health
Science Writing, Press & Dissemination Branch
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or 1-866-615-NIMH (6464) toll-free
TTY: 301-443-8431 or 1-866-415-8051 toll-free
Differentiating Borderline Personality Disorder from Bipolar Disorder
By BERNADETTE GROSJEAN, MD
Borderline personality disorder (BPD) and bipolar disorder frequently co-occur (numbers range from 8% to 18%), although they are distinct clinical entities (Paris J et al, Compr Psychiatry2007;48(2):145–154). A proper diagnosis guides the most effective treatment, but you’ve probably faced the difficult challenge of diagnosing these conditions, which share several clinical features.
BPD can be described by four types of psychopathology: affective disturbance, impulsivity, cognitive problems, and intense, unstable relationships. What’s most important—in addition to seeing that your patient meets DSM-IV criteria for BPD—is to establish that patterns of affective instability, impulsivity, and unstable relationships have been consistent over time. Thus, obtaining a detailed history is crucial. Also, the key features we see in BPD, such as dissociation, paranoia, and cognitive problems, are often affected by the patient’s environment and, particularly, his or her relationships. A patient might have a history of rapid and sudden deterioration when relationships change—such as threatening suicide after a breakup or severe mood swings when separated from her family. Generally, the more intense or significant the relationship is, the greater the risk of chronic stress and mood dysregulation.
Many of the same features are seen in patients with bipolar disorder, such as dysphoria, hyperactivity, impulsivity, suicidality, and psychotic symptoms. As a result, borderline patients with this cluster of symptoms are often misdiagnosed with bipolar disorder, possibly because of the effectiveness of psychopharmacological treatments for such symptoms. In fact, a more thorough assessment might show that these patients actually suffer from a personality disorder. In one study, more than one third of those misdiagnosed with bipolar disorder met DSM-IV criteria for BPD (Zimmerman M et al, Compr Psychiatry2010;51(2):99–105).
In BPD, mood changes are generally short-lived, lasting only for a few hours at a time. In contrast, mood changes in bipolar disorder tend to last for days or even weeks or months. Mood shifts in BPD are usually in reaction to an environmental stressor (such as an argument with a loved one or a frustration in the waiting room), whereas mood shifts in bipolar disorder may occur out of the blue. Some clinicians consider BPD an “ultrarapid-cycling” form of bipolar disorder, but there’s little evidence to support this link (Gunderson JG et al, Am J Psychiatry 2006;163(7):1173–1178). Patients with BPD might rapidly cycle through depression, anxiety, and anger, but these mood shifts rarely involve elation; more often, the mood shifts are from feeling upset to feeling just “OK.” Likewise, the anxiety or irritability of BPD should not be mistaken for the mania or hypomania of bipolar disorder, which usually involve expansive or elevated mood.
At a more existential level, patients with BPD—particularly younger patients— often struggle with feelings of emptiness and worthlessness, difficulties with self-image, and fears of abandonment. These are less common in bipolar disorder, where grandiosity and inflated self-esteem are common, especially during mood episodes. And while both conditions may include a history of chaotic relationships, a patient with BPD may describe relationship difficulties as the primary—or sole—source of her/his suffering, while the bipolar patient may see them as an unfortunate consequence of his behavior.
A pattern of self-harm and suicidality often serves as a cue for diagnosing BPD (but are not necessarily required). But both can be seen in bipolar disorder, too. In BPD, suicide threats and attempts may occur along with anger at perceived abandonment and disappointment. Patients often explain these impulses as a way to be relieved of pain, or to “stop their thinking,” more so than to end their lives, per se. Patients with BPD may experience “micropsychotic” phenomena of short duration (lasting hours or at most a few days), including auditory hallucinations, paranoia, and episodes of depersonalization. However, patients generally retain insight, and can acknowledge that “something strange is happening” without strong delusional thought. When psychotic symptoms occur in bipolar disorder, they happen in the context of a mood episode, they tend to last longer, and patients may be unable to reflect on their behavior.
Accurate diagnosis of BPD and bipolar disorder can be difficult, but it’s essential for proper treatment and optimal outcome. Remission rates in BPD can be as high as 85% in 10 years (Gunderson et al, Arch Gen Psychiatry 2011;68(8):827–837), particularly with effective psychotherapeutic treatments (Zanarini MC, Acta Psychiatr Scand 2009;120(5):373– 377). Unfortunately, such treatment is not always available. Some medications can be used in BPD, such as an SSRI for impulsivity, severe and persistent depression and/or suicidality, or an atypical antipsychotic for recurrent dissociative symptoms or disinhibition. However the only consensus seems to be that medications should be used as adjuncts to psychotherapy (Silk KR, J Psychiatric Practice 2011;17(5):311–319). The long-term use of a mood stabilizer or atypical should be reserved for known cases of bipolar disorder.
TCPR’s VERDICT: Clinicians sometimes think of a BPD diagnosis as pejorative (chronic and untreatable) and may be reluctant to disclose it, but patients and their families often find it helpful to be informed of the diagnosis. Similarly with bipolar disorder, accurate diagnosis often determines prognosis and effective treatment. For the clinician, however, it’s imperative that you make the proper diagnosis in these two often overlapping, but fundamentally quite distinct, conditions in order to optimize your patients’ outcomes.
TMHCA is, once again, excited to announce an upcoming FREE WRAP® “refresher” course in Nashville, Tn. This training is funded by TDMHSAS.
Location: TAADAS Conference Room
1321 Murfreesboro Pike
Nashville, Tn.; Office 155 37217
COURSE DESCRIPTION: The WRAP Refresher Course is a three day, interactive course co-facilitated by TMHCA Advanced Level WRAP® Facilitators. The primary purpose of this Course is to sharpen & expand facilitation skills to further engage students in Wellness Recovery Action Planning.
Through attendance in this course, WRAP® Facilitators will:
1. Recognize expanded options on how to give group introductions.
2. Identify additional knowledge areas, Values & Ethics of WRAP®
3. Apply new skills to sharpen & expand group facilitation skills.
4. Develop new, creative approaches to Facilitation to accommodate participant challenges & different group needs.
The Copeland Center strongly recommends that WRAP® Facilitators attend a Refresher Course @ least every two years to stay up on new developments and best practices.
If the mental health system was sane…
There would be a range of services availible reflecting the human needs of those it serves.
Those services would be availible to those that need them.
Those services would be based on what works, not what makes money, reflects any particular philosphy or interest, and not because it is what we are used to doing.
Asking for help would not label someone, brand them, be a cause of shame, a source of discrimination. Asking for help should not be a problem.
It would realize that lack of a place to live, lack of food, lack of adequate clothing, lack of a job are frequently barriers and problems for the people they serve and address them in a direct and effective manner.
It would know that inadequate health and inadequate health care are common problems for the people they serve and be part of an effort to serve the entire person in an integrated fashion.
The goal would be to empower, educate, and support people towards gaining control over their lives so as to maximize their chances of leading happy, meaningful and successful lives.
This would not be empty words, but a passionate conviction that fuels and structures everything done in the system.
It would not mistake the people it serves for the labels it places upon them.
It would know that the most important thing about help is that it is what you do with people and not what you do to them. It would see itself as partnering with the people it serves.
It would know that people can say no and that not be a symptom of illness or distress.
It would view peoples values, hopes, thoughts, and aspirations as a source of strength and not a symptom of illness.
It would take substance abuse ultimately seriously. Drinking and drugging are the two primary ways people with mental health issues try to treat themselves.
It would make sure that one of the core experiences that someone seeking help has is contact and interactions with others who have dealt with similiar issues. It would treat seriously the idea that you can learn from the experience of others and them from you.
It would not tell people who have hard times or more problems they have failed or are failures.
It would take the issue of trauma seriously. Knowing how people have been hurt and not being part of hurting them further should be cornerstones of the system.
It would treat the issue of what happens in jails and prisons to people with mental health issues as a moral outrage and the impulse to do something about it as a moral necessity.
It would be honest about the risks and benefits of psychotropic medication. Help people to make real and informed choices.
It would treat families as important and not as irrelevant or a threat to what it is doing.
It would treat justice as a driving force and value in everything it does.
It would be honest with the people it serves about what it doesnt know if it wants them to have trust in what it does know.
It would attack the issue of suicide with passion. No one should ever feel like death is the best solution to life.
It would tell people that no problems make you less human,
It would view hope as realistic and know that when they dont they do more harm than good.
May 2014: Kathy Flaherty
Kathy Flaherty works as a senior staff attorney at Statewide Legal Services of CT, Inc. She has dedicated her professional life to advocating for the rights of the underserved. A graduate of Kingswood-Oxford School, Wellesley College and Harvard Law School, Kathy has 17 years of experience in poverty law, specifically focusing on housing, benefits, and consumer law.
Kathy lives with bipolar disorder. She makes full use of her work place’s very generous sick leave benefits and a flexible schedule. Kathy was diagnosed her first year of law school after being civilly committed. She was not permitted to return to Harvard until the next fall, at which point the school put conditions on her return.
During her third year of law school, she used the Harvard Law School newspaper as the forum to come out about her illness. Against the advice of the Office of Public Interest Advising, when applying for jobs after law school, she included her position on the council of former patients of McLean Hospital, making her disability fairly obvious. “If someone didn’t want to hire me because of my disability, I didn’t want that job.” Kathy says that she has gotten jobs because she has disclosed.
Kathy shares that her biggest barrier to the legal profession was getting admitted to the Connecticut Bar. Despite the fact that she had already been admitted to the Massachusetts and New York Bars, she had to wait for a year and a half and then was conditionally admitted. For the next nine years, she had to report that she was taking her medication, as well as provide a doctor’s note twice a year confirming that she was in fact taking her medication.
Since 1999, Kathy has served as a volunteer trainer, presenter, and facilitator for Connecticut’s chapter of the National Alliance on Mental Illness (NAMI-CT). Combining her personal experience as a recipient of mental health services and her legal background, she is able to speak to issues affecting those living with mental illness from a multi-faceted perspective. Her advocacy work has earned her numerous honors including the Dr. Karen Kangas Advocacy Award from Advocacy Unlimited in 2010. “Winning an award named for someone who is a role model for advocacy and a very dear friend is humbling.”
Kathy currently serves as a member of the Board of Directors of Advocacy Unlimited, Lawyers Concerned for Lawyers-CT, and the Connecticut Alliance to Benefit Law Enforcement (CABLE). She also serves on Governor Malloy’s Sandy Hook Advisory Commission. Her goal for the future? “To continue to do work I enjoy.”