Thanks to BP magazine for shining a bright light on a dark topic. I am glad to be a part of a support group that helps prevent suicide. For over 13 years our group has served the Jackson, Tn. community faithfully. "Thank you" to , A Better Tomorrow inspirational support group.

TAKING SUICIDE PREVENTION UPSTREAM

Across the country, school districts are providing mental health awareness and suicide prevention training for teachers and school personnel. Some are mandated or encouraged to do so by state law, others are motivated by recent incidents, and some introduce this kind of education because suicide is now the second-leading cause of death among youth aged 15-24.

Teacher and parent training are key components in any plan to address teen suicide. Increasingly, however, communities are recognizing that kids need to learn about mental health, too. Social and emotional learning across the lifespan reduces risk factors and promotes protection factors for violence, substance abuse, negative health outcomes, and suicide. One way to provide universal student training is by including a mental health component in the standard wellness or health curriculum. School districts and individual schools can implement individual, more targeted programs as well.

Knowing how to cope and developing resilience are at the core of mental health awareness and suicide prevention efforts being implemented in Massachusetts with children as young as elementary school. The Commonwealth of Massachusetts places a high value on suicide prevention, with dedicated line-item funding in the state budget for the Department of Public Health Suicide Prevention Program. With support from state officials, the DPH has launched suicide prevention programs across the state and for people across the lifespan.

Some of the skill-building and suicide prevention programs in Massachusetts schools are

• The PAX Good Behavior Game, which has been introduced by schools in collaboration with the DPH, teaches students self-regulation, self-control, and self-management in order to create an environment that is conducive to learning. (Ages 6-12)
• The Open Circle program, which strengthens students’ social and emotional learning skills to increase pro-social behaviors and reduce problem behaviors, is utilized by many school districts. (Grades K-5)
• Whyville utilizes problem-solving and other skills to help kids learn about their emotions in an online computer game. (Teens and pre-teens)
• SOS Signs of Suicide® focuses on prevention through education by teaching students to identify symptoms of depression, suicidality, and self-injury in themselves and their peers. (Grades 8-12)
• Break Free from Depression, developed by the Boston Children’s Hospital, focuses on increasing awareness about adolescent depression, how to recognize it, and how to get help. (High school)

There are dozens of programs that schools can use to promote skills development while fostering students’ mental health and their willingness to seek and accept help for mental health concerns. SAMHSA’s National Registry of Evidence-based Programs and Practices and the Suicide Prevention Resource Center Best Practices Registry include searchable descriptions for a wide variety of educational programs. For high school students, the SAMHSA Preventing Suicide: A Toolkit for High Schools has a comprehensive list of programs, but a search of the NREPP and BPR may yield programs added since the Toolkit was published.

What can you do? Find out how your school district handles mental health training and emotional skill building for students. If there is not currently a program and there is no interest from school officials, you might work with the parent-teacher organization, local mental health groups, and the local board of public health to raise awareness of the issue, then advocate for implementation of one or more programs. There may be grants available to cover the cost of training or there may be organizations in your community that would help subsidize the program.

The bottom line is that suicide prevention requires a comprehensive approach. It’s never too early to start and everyone – families, schools, communities, and peers that create supportive environments; individuals who learn and leverage positive coping skills; and mental and public health systems that treat and prevent risk factors – plays a part.

Your Turn

• What do you think about the mental health awareness and/or suicide prevention programs that are provided to kids in your community?
• What role should a school have in developing kids’ emotional and social skills?
• What steps will you take to improve mental health awareness and suicide prevention in your local schools?

Editor’s Note: The Families for Depression Awareness Teen Depression Webinaris an accessible, free resource for training parents, teachers, and others who work with youth to recognize depression, talk about depression with parents and youth, and know what to do to help a young person struggling with depression. Register for the Teen Depression Webinar live with Dr. Michael Tsappis on September 30. 

Thanks to the MA Department of Public Health Suicide Prevention Program and the Suicide Prevention Resource Center for their support in developing this post.

Mother Teresa practiced what she preached, serving her neighbors in great need. In contrast, every year Americans feel they must leave their suffering children "next door" to fly off to an exotic land to do God's work. Personally, I try to follow these words of the person who epitomized service and devotion to God.

I say, thank you, Mother Teresa, for leaving these words of wisdom and guidance.

More than once in life I've closed one chapter and opened another. I like to think I learned valuable lessons each time. I bet you feel much the same about your life too.

Tragic California Case Exposes Failings in Our Mental Health Care System

CareforYouMind Feb 10,'15

Rusty Selix
Executive Director, Legislative Advocate
California Council of Community Mental Health

In April 2012, Fred Paroutaud, a California man with no history of mental illness, experienced a psychotic episode. Mr. Paroutaud was hospitalized and diagnosed with bipolar disorder. Just 72 hours after he was admitted, and despite the fact that he was still experiencing hallucinations, he was discharged and referred to outpatient group therapy. Because his condition remained unstable he requested alternate therapy and one-on-one sessions with a psychiatrist. He was denied both by his health plan and his condition deteriorated.

Concerned by his worsening depression, his wife appealed to the health plan again and again. She pleaded that her husband required more supervised and personalized treatment. While waiting for an appointment with his psychiatrist, and just two months after his first psychosis, he died by suicide.

Mr. Paroutaud’s widow is convinced that if more intensive and timely care had been available, her husband would still be alive. In October 2013, she and two other plaintiffs filed a class-action lawsuit against the health plan claiming they were harmed by its systemic denial of timely access to mental health services.

Why this story sounds familiar
While Mr. Paroutaud’s story is unique, his circumstances were not. Upon his release from the hospital, he needed intensive, monitored care. That’s not what he got. Generally speaking, commercial health plans limit coverage to two levels of care: level one is a once a week therapy visit for mild to moderate problems and medication management; and level two is hospitalization.

Those two narrow levels of care are appropriate for many people, but not all, and certainly not for all stages of mental illness. The absence of those critical, in-between levels of care is one of the ways that our mental health system falls short and where it fails people like Fred Paroutaud and his family.

When someone is in the midst of a manic episode or considering suicide, hospitalization can provide the opportunity to stabilize the condition. Upon discharge, many patients require medically monitored care in a residential facility or highly personalized care in a medically-monitored outpatient setting. Unfortunately, that level and type of care is almost impossible to find in commercial health plans.

There is another way
My hope for a health system that offers comprehensive mental health services to better address the needs of individuals with a mental health condition is not pie-in-the-sky wishful thinking. In fact, this model of care, with multiple levels and degrees of intensity, already exists within the California Medicaid system. In our public programs, care ranges from community-based health management through low-intensity community-based services, high-intensity community-based services, medically-monitored non-residential services, medically-monitored residential services, and medically-managed residential services (i.e., inpatient treatment).

This structure, with six levels of care, is the backbone of the mental health system under California’s Medicaid system, and it provides a complete, stepped approach to rehabilitation.

This type of care should not be exclusive to the Medicaid population. One of the 10 essential health benefits under the Affordable Care Act is rehabilitation; another is mental health care. This means that rehabilitation for mental health care isan essential benefit, and all Americans in commercial health plans are entitled to more rehabilitation-focused mental health services.

What you can do now
Fred Paroutaud was denied access to stepped treatment and his story is tragic. It is thanks to his widow and her persistence that we know about it at all. Unfortunately, many people suffer similar situations and denials of care, but we do not hear about them.

With increased national attention on access to mental health care, now is the time to tell us about the problems you are having in accessing the care you need. We want to know what services you were denied and the barriers you faced, such as unaffordable out-of-pocket costs, transportation issues, or lack of trained providers in your plan’s network, etc.  We also need to know what you did or didn’t do in response and how this impacted your or your family member’s recovery. As advocates and advocacy organizations, we are positioned and prepared to knock on the door of government regulators and health plans and point out the disparity in care and demand access to appropriate rehabilitative services.

Many commercial insurers don’t cover rehabilitation services because they don’t believe they have to. And if no one demands otherwise, they are unlikely to ever change. Share your story. Don’t take ‘no’ as the only answer. Let’s realize the parity we deserve.

Questions

• How have you been denied equal insurance coverage for a mental health condition? Tell us your story.
• What levels of treatment are available to you under your health plan? Are they sufficient?

Bio

Rusty has been Executive Director and Legislative Advocate for CCCMHA since 1987. He is co-author of California’s Mental Health Services Act, a tax on personal incomes over $1 million to expand community mental health care. At CCMHA, he has been instrumental in moving forward a variety of critical mental health-related initiatives, including ensuring the implementation of the federal Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program to serve children with severe emotional disturbances. He also serves as Executive Director of the Mental Health Association in California.

Ordinary heroes: Drains honored for speaking out for health care equality

B

y Linda    Braden

Larry and Linda Drain are quiet, unassuming people. But when circumstances arose that threatened Linda’s life, they both began speaking out, their voices ringing loudly to bring awareness to — and a solution for — themselves and others who have fallen through the cracks of the health care system in Tennessee. Their income is too high to qualify for TennCare, Tennessee’s public insurance program, and too low to qualify for federal subsidies under the Affordable Care Act, also called Obamacare.

In acknowledgement of their efforts, the Tennessee Health Care Campaign presented the Drains with the 2014 Heroes for Health Award in August at the John Seigenthaler First Amendment Center, Nashville. The award was given “for your dedicated support to affordable access to high-quality health care for all Tennesseans.”

The event honoring the Heroes was part of the Tennessee Health Care Campaign’s 25th Anniversary celebration. In addition to the Drains, Laura Sell was honored for the major work she did as a volunteer to promote and support enrollment in the Patient Protection and Affordable Care Act, collaborating with the Blount County Public Library.

Larry said, “It was a very eventful night. We got to speak to a lot of people, meet a lot of people that were heavy-hitters that we knew about or read about. That was neat. And to get people to treat us like we were important. As we were walking out the door, I said, ‘Linda, do you ever get over being surprised when people treat us nice?’ I’m surprised every single, solitary time. It’s just been a strange happening. When it first started out, we didn’t have a clue ... The way we look at it is that we are extraordinarily ordinary people, and the idea that people would know who we are or that people would listen to what we have to say — I wouldn’t have predicted that in a thousand, million years. Then when it took off, it went insane.”

Story begins

The story began with Linda, who has been drawing Supplemental Security Income (SSI) for some time because of epilepsy, brain surgery and additional health conditions. Larry said, “She has TennCare. She has to have the TennCare in order to live. If she does not have the medication, if she doesn’t have the medical care, she will die.

“Ten years ago, a good day for her was having 10 to 15 grand mal seizures. She went through brain surgery, and the last 10 to 14 years have been extraordinarily eventful, but the medication is her pathway to life.”

After Larry turned 62 last September, he decided to take early retirement and begin drawing Social Security.

“If I had to take all the dumb, stupid, worst things in my entire life that I have ever done, that one is so far to the top that there is not a second place,” he said. “The way we had it figured out, we could live if we took what she made in SSI and what I made in retirement. We weren’t going to be rich — in fact, we were going to be poor — but we would be able to pay our bills, do what we needed to do. We were going to be OK.

“After a couple of months, Social Security called us in and said, ‘You guys make way too much money.’ They were very nice, not cruel or mean or anything like that. ... But they said, ‘We have a limit on unearned income, and you guys are way over it.’”

Larry questioned how that could be, and was told that his Social Security retirement is considered unearned income. He said, “I asked them, how could that be unearned income? I worked 47 years for that. It’s my money. They said, legally it’s unearned income. They told Linda that her check for $720 was going to become $20. We were going to lose $700. I said, ‘I’ll just give the retirement back. I’ll just get another job and we’ll be OK.’ And they said, ‘Well, you can do that, but the only way you can do that is to give us back every single penny we have given you today.’ Well, if I could give it all back today, I would never have needed it to begin with.”

No recourse

Larry thought he could continue drawing his retirement and also have a job to make ends meet. He said, “What they said after that has basically driven the whole situation. They said, ‘You have to understand, that because your wife is on TennCare, if you make over $85 in a month, she will lose her TennCare.’ So we went home, and we did all the figuring we could.”

Their projected budget for January would leave them with $30 for essentials such as food and gasoline, and the following months would be worse. “We looked at everything we could, trying to find a way. ... But there wasn’t a way,” Larry said. “We were in a position where, if I got a job to give us enough money to live on, it would kill my wife. It would take her insurance away, and it would kill her. If I didn’t get a job, we couldn’t live. We couldn’t live on a dollar a day. It just wasn’t doable. So on Dec. 26, after 33 years of marriage, we separated.”

The original plan was for Linda to stay with a relative until they could find her a permanent place so she could retain her SSI and TennCare. Larry would then find a place as close by as he could. Larry said, “At that time, our understanding was that, according to the way the laws were in the state of Tennessee, we would never again live together as man and wife.”

There were two possible solutions: Change Social Security laws or expand TennCare, the state’s managed Medicaid program which provides health care coverage primarily for low-income children, parents, pregnant women and elderly or disabled adults. Social Security laws were not going to be changed, but Tennessee Gov. Bill Haslam could spearhead expansion of Medicaid. Larry said, “If he expanded Medicaid, then Linda didn’t have to be a member of a category, she didn’t have to be ‘disabled,’ to get it. All she had to do was be poor. If he expanded Medicaid, then she would have her insurance, which meant we could live together, I could get a job, and although we’d struggle, we would live. Without him expanding Medicaid, we had no help at all.”

Letters to governor

Larry began drawing attention to the need for TennCare expansion by writing a series of letters to the governor. Some were very personal, some general and policy oriented, but in each letter, Larry pleaded with Haslam to submit a plan for TennCare expansion. The 100th letter was emailed on Sept. 2. As of that date, the governor had not responded to the Drains, but he did announce on Aug. 28 that he plans to submit a proposal to Washington to expand Tennessee’s Medicaid program. He did not release any details, however.

Larry said more than 1,200 individuals from across Tennessee have told him they also contacted Haslam. Larry’s 100th letter to the governor begins to list the names, and he plans to continue adding names in subsequent letters until every one is included.

Each letter is available atdeargovernorhaslam.wordpress.com and is viewed by 4,000 to 6,000 persons daily. In addition, a petition entitled “Gov. Haslam: Expand TennCare and Let Me Stay With My Wife!” at www.thepetitionsite.com has almost 46,000 signatures in support of the Drains.

The Drains’ story was told in the Nashville Tennessean and other major news outlets, drawing even more attention to those who, as Larry said, “didn’t fall through the cracks — we live in the cracks.”

Twenty-five miles separate this couple now. Linda is in Knox County, while Larry is in Blount County. They are waiting for the time when they can once again live together as man and wife without Linda losing her life.

Larry said, “I should not have to drive 25 miles to see my wife. It’s wrong in every sense of the word.”

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:

• Christopher George Handley was shot to death on May 20.
• James Madden was shot to death on May 17.
• Hassan Johnson, 20, was killed on May 19.
• 34-year-old Michael Thornton was killed May 18.

Arizona:

• Ramon Garcia was shot to death on May 17.
• Charla Faust was shot to death on May 20.
• Faustino Solis Garcia, 23, and Kassandra Medina, 20, were shot to death on May 21.

Arkansas:

• Douglas Cloyes, 72, was killed in a domestic disturbance on Sunday.
• James Green, 56, was chased out of his apartment and fatally shot on Sunday.

California:

• A shooting at a barbershop left one dead and three injured
• Sunday night.Derrick Whitfield, 23, was shot to death at the Potrero Hill housing complex on May 21.
• Gail Temple, 75, died from a gunshot wound on May 16.
• April Jace, 40, was shot to death on May 20, reportedly by her husband, actor Michael Jace.
• A 26-year old mom was killed by stray bullet in Compton on Tuesday.
• Anthony Johnson, 28, was shot to death on Monday.
• A man shot in Oakland on Monday became the city's 31st homicide of the year.
• Leonicio Banuelos was shot to deathon Saturday.
• Janet Jimenez, 17, "was riding in a carlate Friday with friends when someone fired into the vehicle, striking her in the upper torso and killing her."
• A Stockton, California, shooting and fire left one dead on Sunday.
• A 69-year-old was shot dead by an armed robber on May 16 while hiking with his 76-year-old companion.
• There was a triple shooting in San Bernardino on May 16 that resulted in the deaths of 21-year-old David Lawler, his 20-year-old half brother Terry Freeman and cousin Kavin Johnson.
• Alex Gines, 23 was shot to death on May 17.
• A woman shot to death in Hyde Park in Los Angeles on Monday.

Colorado:

• Marcus Anthony Armstrong, 44, was shot to death on May 19.

Florida:

• Clausell Stevens, 23, was shot to death on May 18.
• Alex Mazzan, 20, was shot to death on May 19.
• Frank Carl Jones III was shot to death on May 18.
• Victor Navarro, 24, was shot to deathat a barbershop after demanding Xanax and brandishing a weapon.
• Terrell Williams, 30, was reportedlyshot to death while in passenger seat of the truck that was not his.

Georgia:

• Marshal Tucker, 48, was found deadof a gunshot late Monday night.

Illinois:

• Juwan Williams, 18, was shot on May 18 and died two days later.
• Kayshaun Hall, 17, was shot to death May 19.
• Leonard Goldman, 29, was shot to death on May 19.
• Lewis Jenkins, 38, was shot to death on May 21.
• Brian McKinney, 20, was shot to death on May 22.
• Robert Waldon, 18, was shot to death on May 22.
• Kevin Diaz, 14, was shot to death on May 22.

Indiana:

• Two men were shot to death at the front door of a home in Indianapolis late Monday night.

Kentucky:

• Crystal Parker, 25, died from an apparent gunshot wound on May 19. Police arrested and charged her estranged boyfriend.

Louisiana:

• Early Tuesday morning or late Monday night, a 16-year-old male was shot dead in Tangipahoa Parish.

Maryland:

• James Lee Butler, 28, was shot (multiple times) and killed on Saturday.
• Davon McLaurin Sr., 37, was shot dead on Wednesday morning.
• John Jackson III, a 40-year-old father of two, was shot to death late last week.
• Rodolfo Miguel Cervantes, 31, wasfound dead on Friday afternoon.

Massachusetts:

• Shannon Richardson, 25, was shot several times while walking a streeton Wednesday. Taken to a hospital, he was later pronounced dead.

Michigan:

• Johnny Clyburn, an active duty Air Force sergeant, was shot to death on Tuesday morning. The suspect was a 19-year-old man who was the son of the women he was scheduled to marry.

Mississippi:

• A man was shot inside a Ford F-250 pickup truck late last week and died of a gunshot wound to the neck.

Missouri:

• Darrah Lane, 17, and Leon Davis, 27,were found shot to death in a car on May 21.

Nevada:

• An adult male died from apparent multiple gunshot wounds near the Desert Inn Road on May 22.
• An aspiring rapper named "Hollywood Will" died from a shot in the chest during a fight at a party in the Palms Hotel Casino on Thursday.

New Mexico:

• Jose Mesa, 27, was shot to death on Sunday. Police arrested 61-year-old Enrique Carmona.

New York:

• Lamont Smith, 45, was fatally shotnear a school on May 21.

North Carolina:

• Markee Watson, 26, was shot just after 4 a.m. on May 17. Medicspronounced him dead on the scene.
• Gary Lane Jr., 36, was shot and killedearly Saturday morning.

Ohio:

• 50-year-old Tyrone Hilton was fatally shot in the head and his 28-year-old son Lamont Quarterman, was shot in the arm. A young girl witnessed the shooting, which happened on Sunday.
• A 28-year-old man was found with gunshot wounds to the chest by police on Monday. He died from his injuries in the hospital.
• 21-year-old Raheem Stenson wasshot just before midnight on March 17.

Oklahoma:

• Jesse Lee Taylor, 24, was shot to death on May 18.

Pennsylvania:

• Tezjuan Taylor, 20, was fatally shot outside a Sunoco gas station early Saturday morning.

South Carolina:

• Mitzi Larson was shot to death the day after her 42nd birthday on May 17. Her husband has been charged with the murder.
• Tyrone Moore Jr., 21, brother of an NFL star, shot to death May 17outside a nightclub.
• Shamoray Antonio Robinson, 18, was shot to death on May 18 following an argument at a party.

Tennessee:

• 26-year-old William Brock was fatally shot by his 67-year-old father, Ralph, on Sunday in what was described as a domestic dispute.
• Michael Richard, 47, was killed by the man with whom he was walking on May 23, law enforcement officials allege.

Texas:

• Two people were shot to death on May 19. The victims were identified as Dylan Headrick, and Rudy Hernandez III
• William Hill, 29, was shot to death at a shopping center on Wednesday.
• A man was shot to death at a northwest Houston hotel on Thursday morning.
• Jennilynn Montana, 6-year-old girl,was fatally shot Sunday.

Virginia:

• 18-year-old Elijah-Juan Zaire Vanness of Hampton, Virginia, was shot to death on May 16.

Washington:

• Monique V. Williams, 29, was found dead on Monday in what police suspect is a murder-suicide involving her boyfriend.

Washington, D.C.:

• Simwone Keith Milstead, 36, was shot to death on May 17.
• Antwone Dwayne Tolson, 19, was shot and killed on May 19.
• Ronnell Daniels, 40, was shot and killed on May 19.

Wisconsin:

• A 34-year-old man from Milwaukeewas shot dead on May 17 after what police suspect was a fight.
• One person was shot to death on Saturday in Plover, Wisconsin.