bipolar disorder

A blonde woman participant in the NAMI group at a conference table

Family members of people with mental illness find support, skills

August 12, 2019 by Yen Duong

Family members of people with mental illness find support, skills - North Carolina Health News

NAMI’s Family-to-Family class, offered regularly by volunteers across the U.S., teaches families how to deal with a family member with mental illness.

By Yen Duong

Getting screamed at for something you didn’t do might ruin your day. But for people who have family members with mental illness, unanticipated outbursts can be just another part of everyday life that they have to cope with.

“I realized that taking [the screaming] personally wasn’t ever going to make anything any better,” said Don Tyson, president of the Charlotte chapter of the National Alliance on Mental Illness. “I started to depersonalize it and realize it was the illness that was raging at me and not my son.

“And I’d wait for those moments in time when my son would actually show up and the illness would fade into the background.”

Those types of personal revelations are par for the course in NAMI Family-to-Family classes, such as the one Tyson recently taught in a basement conference room of Mercy Hospital in Charlotte. For 12 weeks, 20 people met every Wednesday night to learn about mental illnesses and share their experiences as family members of people with diseases of the brain.

People with mental illnesses and their family members can visit NAMI NC for information on Family to Family and other classes and support groups.

“It’s like a cross between an educational course and a support group,” said Kara Guerriero, who coordinates the courses for NAMI Charlotte. “You’re learning a lot in a really supportive environment and you’re developing relationships that can help carry you well past the course.”

‘I learned more here than I did going to social work school’

The curriculum, developed by NAMI psychologist Dr. Joyce Burland in 1991, includes content on topics such as the latest research about mental illnesses, self-care, coping skills for crises or relapses, and information about medications.

“I felt that I learned more here than I did going to social work school,” said retired social worker Cecilia Illing in a New Jersey accent as she sat next to her husband, Fred, on the last day of the course. The Illing’s 53-year-old daughter, who has bipolar disorder, recently stayed with Cecilia and Fred for six months so they could help watch their 15-year-old grandson while she figured out how to manage her disease.

“In social work school, you really don’t learn much about the family and what they have to do to survive the mental illness and to be able to help their loved ones,” she said.

A participant in NAMI family to family course — Nirmala David, who has lived in Charlotte for 13 years, took the course to learn how to cope with her sister’s illness, which was diagnosed 16 years ago. Photo credit: Yen Duong

The free course, which has been taken by over 300,000 people nationwide in almost three decades, improves family members’ ability to cope with and accept mental illness, according to a 2011 study. Role-playing exercises teach strategies such as reflective listening, in which family members emphasize their empathy and understanding by reflecting what their loved ones say back to them.

“Honestly, I was like, ‘This is dumb. I’m just repeating what they’re saying,’” said 36-year-old Nirmala David, whose sister was diagnosed with bipolar disorder 16 years ago. “And then when I started practicing it, you could see the body language changing in my sister. She was willing to be more open with me.”

David, who regularly flies to New York to visit her parents and sister, said that the class has helped both her relationship with her sister and her internal mindset about her sister’s illness.

“Society has deemed us to be problem solvers and fix situations. This is not something you can fix,” David said. “That exercise really helped pull you out of that ‘solution’ orientation. They’re hearing words of empathy [and] affirmation as opposed to solutioning and protesting and fixing.”

Support group and self-care

The course emphasizes self-care for caregivers. Vivian Wilson juggled coming to the class with raising her son, working as a nanny and parent coach and checking on her 79-year-old mother, who has anxiety and depression and lived with Wilson from 2008 to 2018.

“You can’t give of yourself over and over and over again and expect that you won’t need to be replenished after that giving,” said Wilson, who adopted her ten-year-old son from her brother, who has paranoid schizophrenia and cancer. “No one is going to do it for you, especially not a family member who is suffering from mental illness. We have to learn how to do it for ourselves so that we can better be able to continue to help them.”

Part of the challenge for family members comes from stigma despite the fact that mental illnesses are widespread. According to NAMI, one in five Americans are affected by mental illness.

“In my culture, there’s a big stigma with talking about mental illness,” said David, who is from India. “I’d love to see more people being more open to talk about it.”

The course offers a place for family members to talk about mental illness with each other and break that stigma outside the group, an “unexpected benefit” of the class, said 32-year-old Christina Carpenter, whose mother was diagnosed with bipolar disorder when she was a toddler.

“I think there’s some shame in saying, ‘Hey, my mom has bipolar disorder,’ whereas saying, ‘Hey, I’m taking this cool class on mental illness and trying to understand my mom better’ is easier to tell people,” Carpenter said. “Almost everybody knows somebody who is touched by mental illness, so they feel like then they can open up to me or ask me questions.”

Anyone can sign up for a free eight-hour course on Mental Health First Aid, offered throughout North Carolina.

Taught by those who know

The classes are taught by volunteers who themselves have taken the class and then completed a three-day training. Teachers foster a supportive environment by sharing their personal experiences and reflections. For instance, Tyler said that a sometimes-depressing challenge is that mental illness can take away the idea of a “plannable future.”

Participants and instructors (Don Tyson and Connie Smith, center back) on the last day of their NAMI Family to Family class, which met at Mercy Hospital in Charlotte. Photo credit: Yen Duong

“Having a family member with a mental illness is a day-to-day thing,” said Tyson, who first took the course after his son was diagnosed with bipolar disorder. “You got to get through this day, and then wake up and get through the next day. And any ideas about what you’re going to get done two years from now or two months from now go right out the window.”

At their last session on May 29, before digging into a large potluck dinner which included pasta, salad, deviled eggs, pimiento cheese and a slew of desserts, the group read aloud their final handout, 10 mantras on how “to let go.”

“What I learned here was that it’s not my fault,” said Illing, the New Jersey grandmother. “That was a good feeling. It was a weight off my shoulders. I don’t worry like I used to; I don’t feel the guilt. I do what I can do.”

This course was the seventh one that Tyson had co-taught. Tyson and the rest of the NAMI Charlotte board, including Guerriero, volunteer their time to run the courses and several monthly support groups.

“The first day, the majority of people that came into that class [had] heads down, shoulders slumped forward, frowns on their faces, wondering ‘How the hell are we going to get through this?’” Tyson said. “When they left [on the final day], they were happy in that moment. And when you string those moments of happiness together, [you] discover that happiness is possible. And that’s something they didn’t have before.”

we see the back of the head of a white man, a younger African American woman is facing the camera, speaking to him. She looks like she's explaining something.

New Push to Help Mental Health Patients Determine Their Treatment in Emergencies

November 14, 2018 by Rose Hoban

New Push to Help Mental Health Patients Determine Their Treatment in Emergencies - North Carolina Health News

With passage of a bill last summer, more mental health treatment providers are helping their clients fill out psychiatric advance directives.

By Rose Hoban

Bill W was looking to change careers. After decades as an executive in the tire industry, he was most of the way through a program to become a chiropractor in South Carolina. But in early 2017, he rolled his truck, leaving him with broken ribs and several fractured vertebrae.

Recovering slowly, in pain while going to school and working, and a long-term heart problem had started getting worse.

To cope with all the stress, he started drinking for the first time in 14 years.

While visiting a friend in Charlotte over the holidays last year, Bill had chest pains that brought him to Novant Health Presbyterian Medical Center. There, doctors did a procedure to help Bill’s atrial fibrillation, but the doctors noticed he was agitated, depressed and suicidal.

Promise Resource Network has its next psychiatric advance directive workshop on Dec. 4,
from 2-4 pm

“I knew I was sick, but I didn’t give a shit,” Bill remembered. “You have no hope whatsoever, and if I hadn’t had three children, I would’ve done it.”

He ended up on the hospital’s psychiatric floor for several months.

Bill, who has a history of bipolar disorder, was eventually discharged to a men’s shelter in Charlotte, pretty different from his prior life as a corporate executive.

But these days, for a man who’s lost almost everything – house, money – Bill is remarkably cheerful. He’s sober and in recovery from his mental health and physical issues, largely due to his time at Promise Resource Network, a mental health and substance use recovery program run out of a little building in Charlotte’s rapidly gentrifying NoDa district, within sight of downtown skyscrapers.

On a recent Tuesday, Bill sat down with Princess Harris to fill out a psychiatric advanced directive.

“I’ve had like six psychiatric crises since I’ve been grown,” he told Harris. “I wound up in the hospital six or eight times over the course of 20 years.”

Filling out a psychiatric advance directive would make it simpler to get the right treatment, the treatment that works for him, should he ever end up in psychiatric crisis again.

That’s the hope.

Not widely used

Psychiatric advance directives have been around for some time in North Carolina, but they’re still not widely used. A psychiatric advance directive (which many people refer to as a PAD) goes into effect if a person is temporarily incapable of making sound decisions for himself, like Bill was over the holidays when he contemplated suicide.

During the past legislative session, North Carolina lawmakers reaffirmed and encouraged the use of PADs as part of a bill meant to reform the process of involuntary commitment for mental health treatment.

we see a man in a suit and tie facing the camera. He's ilstening to a man who we see only the back of his head. — Mecklenburg County Assistant Public Defender Bob Ward talks with a client at Promise Resource Network who has come to attend a workshop on creating a psychiatric advance directive. In the wake of new legislation encouraging the use of the documents, advocates are teaching mental health patients how to prepare them. Photo credit: Rose Hoban

Bill described how he gets when he’s depressed: “If I have bad posture, if I’m not talkative, if I’m not joking, if I’m real serious.”

“Usually, I’m charismatic. If I’m not engaging people, you know something is up and I need help.”

Bill can also be manic, not sleeping for days at a time.

“I paint my house and my neighbor’s house, in a day,” he said. “And I’m mad, extremely mad. I sit with my back against the wall because if I hear a sudden noise, and I’m hyperreactive, that shows my PTSD is kicking in.”

When things get bad, Bill has flashbacks to when he was 12 years old and driving with his parents. They all were in a car accident, he witnessed both his mother and father die violently.

So for Bill, when he’s agitated, he needs a quiet place, the right medications and someone to talk to. For example, he has a bad reaction to Prozac-like drugs.

But if he shows up at a psychiatric emergency room, there’s no way for physicians in the facility to know this about Bill, especially if his mental state leaves him unable to adequately express himself.

A physician is required to follow a person’s psychiatric advance directive, with these exceptions:

asking for something that’s not “standard care”
if what is asked for is not available/ feasible
if it’s an emergency
if there are safety issues present and the person is under involuntary commitment.

Having a PAD in place recognizes that mental health treatment is so personalized for each person that what works for one person might not work for another.

“It lets treatment providers… know what works for you but also what doesn’t,” Cherene Allen-Caraco, the head of Promise Resource Network, told a room full of people attending a workshop where they got help filling out their psychiatric advance directives.

She advised the group to add details.

“If you’re saying, you don’t want Haldol, write a justification: ‘If I take Haldol, this is the effect it has on me,’” she said. “You can’t write too much. You can write too little but if you write a justification, and are very clear, and give your reasons why your preferences are what they are, it will be helpful.”

“You have a legal right to make sure that if you can’t speak for yourself your preferences around your mental health treatment, your hospitalization, medications, which hospital you want to go to, you have a right for all of that to be documented and reviewed in case you end up being hospitalized,” Caraco explained to the group.

Peer to peer

Promise Resource Network holds these informational workshops every six weeks to explain what the documents are and to give people assistance with creating them. They get help going through the process of filling out the multi-page form with someone who’s also had the experience of having coped with a mental illness.

A woman stands at the front of a classroom gesturing, a seated man, also at the front, smiles at her. We see the backs of the heads of students in the classroom. — Promise Resource Network head Cherene Caraco makes a point during the workshop on writing psychiatric advance directives with Mecklenburg County Assistant Public Defender Bob Ward. Photo credit: Rose Hoban

The agency emphasizes the role of peers in treatment, so much so that it’s completely staffed and run by people who have had their own experiences with mental illness and substance use, and who are in recovery.

Which is why the Promise Resource Network workshop was about evenly divided between people who were there to learn about creating a psychiatric advance directive and people who were there to help.

“This is a perfect opportunity for folks who may go into crisis at a certain time just to have a voice in a treatment,” said Marcus Boyd, a court liaison for the Mecklenburg County court system who was also at the meeting.

He said there’s an “understanding that ‘Hey if it becomes a situation where we can’t take all of those plans into consideration we’ll definitely do our best to abide by it as much as possible.’”

Boyd said a psychologist will still review the document.

“There may be something that they have to institute that may not be in the client’s wishes,” for example, an involuntary commitment to a psychiatric facility, he said. “But we want to make sure that [the patient’s] wishes are always considered.”

The only problem with PADs is that most people with mental health issues have not filled one out, Caraco said. That’s why she organizes these workshop every six weeks to explain PADs to their clients and facilitate people getting them done.

Once the PAD is complete, people can carry it with them, or for $10, they can file it on a password protected part of the North Carolina Secretary of State’s website. That way, the person only needs to carry a wallet card with a username and password that says they have a PAD on the website and directs a health care professional how to find it.

Step by step

After a 30-minute group introduction to the psychiatric advance directive, Bill and Harris retreated to a small office she shares with another peer support specialist.

Over the next hour, Harris walked Bill through the questions on the document. They listed his medications in detail, including even non-psychiatric medications such as Synthroid, a common thyroid hormone replacement drug which can produce psychiatric effects if the dose isn’t correct. Bill described how the wrong dose of Synthroid can actually nudge him into either a manic or depressive phase of his mental illness.

Bill and Harris discovered they had a common experience of having been admitted to the sixth floor of Novant Hospital, and receiving treatment there. They found other points of commonality, medications, ways of coping. As the hour passed, Bill’s posture in his chair became more relaxed. By the end, his legs were stretched out, ankles crossed, as the two shared confidences and swapped stories.

When they were done, it was hugs and gratitude.

“I knew Princess would take care of me,” Bill said, throwing his arm around her shoulders and giving her a side squeeze.

To complete a psychiatric advance directive:

an adult has to be of sound mind
signed in presence of two witnesses who are:
- not a relative
- not on the person’s treatment team
- not staff of a health care facility where the person is a patient
has to be notarized
has to be presented to a doctor or other mental health treatment representative at the time of treatment.

A woman interviews a man in a suit sitting at a black wood table with coffee and water in front of a window with greenery.

Patrick Kennedy – Fighting for Mental Health Parity

October 3, 2018 by Yen Duong

Patrick Kennedy – Fighting for Mental Health Parity - North Carolina Health News

Former congressman Patrick Kennedy, has a lot to say about the opioid crisis, medical marijuana and where the U.S. should go in addressing addiction.

By Yen Duong

One of the younger members of the storied Kennedy family, former congressman Patrick Kennedy, has become an advocate for mental health and addiction treatment after going public in the late 2000’s with his own struggles with substance use and bipolar disorder.

In 2017, Kennedy served on the President’s Commission on Combating Drug Addiction and the Opioid Crisis with Gov. Roy Cooper. Some of those recommendations are reflected in the Opioid Crisis Response Act of 2018 recently agreed upon by the House and the Senate. He also wrote a memoir about addiction and mental health, A Common Struggle.

North Carolina Health News sat down with Kennedy before he spoke at an Atrium Health event in Charlotte on Sept. 12.

This interview has been edited for length and clarity.

NCHN: What motivated you to sponsor the Mental Health Parity and Addiction Equity Act, which requires health care providers to cover mental health and addiction treatment the same way they cover physical ailments?

KENNEDY: Mental health and addiction are often left in the shadows of our health care system and treated in a separate and unequal way. They never get reimbursed the same; there’s never the same professional esteem for those who are delivering the care for mental health and addiction. And there’s never the respect for patients who are suffering from chronic illness and who need the same care as if they were suffering from diabetes, but are denied that care out of stigma and bigotry.

NCHN: Why does this parity act from 2008 add addiction and substance abuse to a similar 1998 bill?

KENNEDY: Addiction is a mental illness. I think the opioid crisis is fueled by people trying to treat their psychic pain, and a lot of overdoses are really suicides. We have a suicide crisis that’s off the charts. But has been dwarfed by an overwhelming opioid crisis, which has stolen all the headlines.

NCHN: In North Carolina, the opioid crisis is booming. Do we have a mental health crisis?

KENNEDY: We need a checkup from the neck up, from cradle to grave. We need to be watching out for people’s vulnerability for addiction and mental illness. We need to do a better job at intervening when this is still stage one or two of the disease. The way we still treat this illness is when it’s at stage four.

I guarantee you, if you did a forensic on the health history of people dying of overdose, you would find indicators that would put them in high-risk categories.

NCHN: What is fueling this ‘suicide crisis’?

KENNEDY: There’s great unease in this country about people’s economic status and their future despite the fact that Wall Street’s doing well. I think that we’re in a huge transformation in our economy and the old predictability of having a lifetime occupation and a pension and health benefits—that’s now more elusive. That was precipitated after the 2008 crash. There isn’t a job out there that isn’t being outsourced.

Then Big Pharma over-marketing drugs like Oxycontin, when all the evidence, even back then showed that that was dangerous. And yet, they found co-conspirators, if you will, with the medical establishment, which got swept up in the money. That all influences public policy, which in turn incentivized the treatment of pain over the recognition of the potential consequences of addiction.

NCHN: It sounds like you’re saying that pharmaceutical companies, doctors and politicians are all profiting to the detriment of patients.

KENNEDY: It’s an insidious thing where money influences so much. There’s a financial incentive for doctors to prescribe because [the federal Centers for Medicare and Medicaid Services] won’t reimburse hospitals if the [patient satisfaction] score is low. And if you have an addiction, you know that, because you’re very manipulative because of the nature of your illness, and you can hold your doctor hostage to [prescribe] you whatever you want. If they don’t, you can retaliate through a bad patient report.

NCHN: That gives a lot more power to patients than patients feel like they have.

KENNEDY: I’m speaking from experience. I’m in long-term recovery from opioid use disorder. I played every game in the book and I know how this game is run.

NCHN: Can you tell us about your journey from addiction to recovery?

KENNEDY: I, like many in 12 Step recovery, hit a point of pitiful and incomprehensible demoralization… bottom. I found myself in that awful place.

I feel blessed to have had enough willingness to go to 12 Step recovery and rebuild my life in another city, with not having my old job, my old friends, my old life. I literally changed everything. I went from being a Congressman to not knowing what I was going to do with myself.

I had been in and out of treatment, because we treat these illnesses in an episodic way when what we ought to be doing is treating them as chronic diseases. So, I lived the old model, which was I cycled in and out of hospitals.

I was prescribed Suboxone for two to three years, and it did help.

Suboxone was a real lifesaver for me. I was able to address other things in my life that were compounding and contributing to… my addiction. But that was not ultimately able to sustain me. I was missing the spiritual component, [recovery] really necessitates you being totally honest with another human being.

I was surrounded by people, but you can be alone in a crowded room.

I was [working] on the parity law, which put me in contact with the recovery community. So ironically, even though I was still suffering, I’m leading the charge to ensure that insurance companies don’t discriminate against people with these illnesses.

NCHN: You were struggling with addiction even while you were writing addiction into the act?

KENNEDY: They all knew, but I didn’t know.

When I wrote A Common Struggle, I went back and talked to the people that I used to work with. They said they knew I was a disaster. I wanted to say, ‘How come all of you didn’t do something?’ But that’s really the heart of the ‘common struggle’ that I talk about, and that’s the silence that pervades this issue and prevents us from making any real progress.

NCHN: How can we break the stigma and taboo around mental health issues?

KENNEDY: You need to do it from the bottom up and the top down.

Passing the Civil Rights Act did not cure this nation of racism. That law created a new normal so that my kids grow up and they see integration. The law helps create cultural change because people have to now work together. There’s a new normal.

To make that metaphor with the mental health and addiction movement– they’ve never been part of the health care system, they’ve been on the side, and never included in your medical chart.

So, when your other physicians try to do your checkup, they have no idea what’s really going on with you, because it’s not integrated. So I used to score most of my opioids from my other docs; none of them had a clue. And I had this serious back operation, and boom, they’d write whatever I want.

None of them got any training in addiction at medical school.

Atrium, they’re making sure there’s an [informed] handoff for those with addiction in the ER, which is where a lot of people with addiction present.

They believe in pushing to change the system so that all of their medical professionals get educated. That should be the norm, it will be in 10 years. The question is, how fast do we get there?

NCHN: Tell us about Smart Approaches to Marijuana, your anti-legalization organization.

Today we’re talking about opioids, now it’s fentanyl. There’ll be other substances that are going to come down the line and the bottom line is we have to be taking all of this very seriously. I co-founded SAM because I believe that in five to 10 years, we’re going to have a marijuana crisis in this country.

Youth use rates are skyrocketing, and we’re not talking [low percentages of tetrahydrocannabinol]. Today it’s like we have the fentanyl of marijuana in terms of its potency.

NCHN: Don’t you think legalization would help with research into the effects of marijuana?

We already have Epidiolex medication, which was just approved by the FDA to address people with seizure disorders. That was the Trojan horse for this whole medical marijuana movement and we have Marinol for people with cancer.

NCHN: So you want to keep marijuana illegal?

Marijuana is pretty ubiquitous and I am against people being arrested for using at low levels. It’s wrong. Commercializing marijuana is what I’m against. We don’t need a new Big Tobacco. We don’t need a new Corporate Marijuana that has addiction as its driving force.

NCHN: How can we avoid this corporatization, given that support for legalization is already rising in the U.S.?

You can decriminalize and not legalize, there’s a huge difference there. So you cannot allow pot tarts, gummy bears filled with THC, elixirs which are like Red Bull of THC, brownies, chocolate, all kinds of candies with THC, vaping which is like smoking 98 percent THC. The bottom line is it’s a whole industry, it would not flourish if we did not legalize it.

NC Prison Breaks Its Own Rules for Suicide Prevention

May 22, 2018 by Taylor Knopf

NC Prison Breaks Its Own Rules for Suicide Prevention - North Carolina Health News

Prison staff recently held an inmate with mental illnesses in solitary confinement for more than 150 days despite the Department of Public Safety’s policy to limit restrictive housing of prisoners with such diagnoses to one month. And advocates say this issue may be widespread.

By Taylor Knopf

Last spring, Devon Davis said he was riding in the passenger seat of his early 2000s model Lexus when he and his buddy were stopped by Raleigh police.

There was a gun in the vehicle. Davis said it belonged to the driver. The driver said it belonged to Davis: A classic case of “he said,he said.”

shows a young man staring at the camera, expressionless — Mugshot of Devon Davis following his arrest on April 14, 2017. Courtesy of the Raleigh/Wake City-County Bureau of Identification.

Davis, 26, has a felony record; under state law, he’s forbidden to own or possess a firearm. Insisting the weapon wasn’t his, Davis said he told the officer to check for his fingerprints on it.

Then, Davis recounted that he was frazzled. He resisted arrest. His car was impounded, and he was escorted to Wake County jail.

After several months in jail awaiting sentencing, Davis was convicted of the firearms charge and sent to Central Prison in Raleigh, where from 2012 to 2015 he spent 1,001 days alone in a cell.

Devon Davis was first featured in a two-part News & Observer story in 2016 called “Solitary to the Streets.”

During this incarceration, his mental health problems got worse. And prison officials violated their own policies.

Davis, who’s been diagnosed with a number of mental health issues, was immediately placed back into solitary confinement. Prison officials call it “restrictive” or “segregated” housing, but it equates to an inmate spending 22 to 24 hours a day alone in a cell roughly the size of a parking space.

Those familiar with prison procedures said returning inmates are often placed in the same custody level they left. For Davis, this meant back to solitary where he remained for 154 days before being moved to the regular prison population.

This is a long time particularly for an inmate with no infractions — such as fighting, spitting, cursing or disobeying orders.

Additionally, keeping Davis in solitary for an extended time violated a 2016 prison policy that prohibits housing inmates with mental illness in restrictive housing for more than 30 days.

But here’s where it gets tricky. Davis was not put on the prison’s mental health caseload, even though he received psychiatric care during most of his previous three-year incarceration.

Davis said he asked for his mental health medication — twice — but he had to wait and wait to get it. From the time Davis entered Central Prison on Oct. 13, 2017 until February 2 — 113 days — he went without medication, according to his medical records received by Disability Rights NC attorney Susan Pollitt.

Denying an inmate appropriate medical care is a violation of the Eighth Amendment of the U.S. Constitution, according to Chris Brook, legal director of the American Civil Liberties Union of North Carolina.

Davis didn’t leave solitary confinement until March 15. And that’s after a lawyer and a NC Health News reporter began inquiring about him.

According to other attorneys who work with inmates, Davis isn’t the only prisoner with a mental illness being held in solitary for more than a month.

‘Walls close in’

Davis has a long history of mental illness coupled with a difficult upbringing.

He was born with cocaine in his system, which can cause long-term developmental problems. After developing auditory hallucinations at age 6, he was admitted to a psychiatric hospital.

Davis’ mother and father each did time in prison, and the court ultimately terminated their parental rights. Davis bounced between group homes and foster care.

A young African American man stands with a thick sheaf of papers in hte crook of his arm. He's smiling at the camera. — Devon Davis walks down Fayetteville Street in downtown Raleigh holding his prison psychiatric records in April 2016. Photo credit: Taylor Knopf.

His court records detail 11 psychological evaluations throughout his childhood, after which doctors made several diagnoses, including ADHD, bipolar disorder and a psychotic disorder.

Davis entered a state prison before he was 21, where he endured three years of solitary confinement, which experts say can exacerbate the symptoms of a mental illness.

During Davis’ first incarceration, prison records say he acted out, yelled and cursed at staff. He exhibited signs of depression and paranoia, including a time when he smeared feces in his cell, telling staff that voices told him to do it.

“It just did something to me,” Davis said in 2015 after he was released from his first incarceration.

“You stay back there for so long, you start to get comfortable. As you start to get comfortable, it does something to you physically. It does something to you mentally. Now you don’t know if you’re coming or going. Walls close in on you. You so anxious to get out your room, but they [the guards] don’t want you to come out. They take your [recreation time], saying that you’re asleep.”

During his first incarceration, Davis tried to hurt himself multiple times and was placed on suicide watch, records show.

Changes ordered

Shortly after Davis’ story ran in The News & Observer in 2016, the state Department of Public Safety announced a new suicide prevention program with updated health policies. A number of the changes involved better monitoring and evaluation of inmates with a mental health diagnosis.

One of the program goals: keep inmates with mental illnesses out of solitary confinement.

A young African American man sits at a table, writing in a workbook. — Devon Davis works on his GED writing test in the spring of 2016. Photo credit: Taylor Knopf

“As placement of a mentally ill inmate in restrictive housing is discouraged and shall take place only as a last resort, such placement should be limited to 30 days in one calendar year,” the policy states.

Over the last several years, there has been an effort across the nation — and in North Carolina — to decrease or eliminate the use of solitary confinement in jails and prisons.

World leaders have compared the use of solitary confinement to torture. And for decades, researchers have documented the detrimental psychological effects prolonged isolation has on a person’s mental health.

N.C. prison leaders even sought outside help from the Vera Institute of Justice to reduce their use of solitary confinement for disciplinary purposes. When the suicide prevention policies went into effect in 2016, advocates said, “it was a step in the right direction.”

But today, people like Davis are still being sent to solitary.

And in the last five months, prison officials reported five North Carolina inmates died by suicide. At least two were in restrictive housing at the time of death.

Many factors determine length of solitary

NC Prisoner Legal Services, lawyers who work doing indigent services for the N.C. court system, continues to receive letters from inmates with diagnosed mental illnesses who have been kept in segregation longer than a month, said Michele Luecking-Sunman, PLS civil litigation managing attorney.

Shows a list of rights and contact information for the agency — A description of Prison Legal Services posted near a pay phone at Central Prison, fall 2016. Photo credit: Rose Hoban.

However, she has not personally come across a case like Davis’ where prison staff withheld psychiatric medication and kept an inmate in segregation.

“What we do see all the time are people who have very clear mental health issues who are being put in segregation,” Luecking-Sunman said.

And during an interview, Davis said there were other men with him — in what he calls “lock-down” — who also had mental health issues.

Gary Junker, the director of behavioral health for the N.C. DPS, Division of Prisons, said that inmates with a diagnosed mental illness are assessed when entering a restrictive housing unit and at 30-day intervals after that.

“A decision to maintain an offender in restrictive housing is based on many factors including current mental status, adjustment to restrictive housing, as well as consideration for institutional safety and security,” Junker said in a written statement to NC Health News.

“In some instances, an offender with a mental illness refuses to leave restrictive housing,” he continued. “If the multidisciplinary team determines that removing an offender from restrictive housing may place others at risk for assault or injury, or would potentially disrupt the orderly running of the institution, a decision can be made to continue the offender’s housing status.”

Prison officials would not say how many inmates are on a mental health caseload and also held in restrictive housing.

Lack of resources in and out of prison

One problem the prison faces is a lack of resources to properly treat all inmates with mental illness in the system, said PLS Director Mary Pollard.

ACLU attorney Chris Brook seconded that, saying DPS needs “improved and more robust mental health screening when someone comes into prison, so that prisoners with mental illness do not fall through the cracks.”

Brook said there also needs to be “ironclad rules” to make sure inmates aren’t sent to segregation due to behavior caused by their mental illness.

The ACLU of NC also receives complaints from inmates who say they’re not receiving proper medical care, both for physical and mental health issues.

“Prisoners have a constitutional right to receive appropriate medical care when they are incarcerated,” Brook said. “The Eighth Amendment prohibits cruel and unusual punishment. Depriving a prisoner of necessary medical treatment is a violation of the Eighth Amendment.”

However, Brook claimed mental illness is often seen as “less serious” than physical ailments.

“We would all agree that it’s their responsibility to treat a prisoner who is suffering from a heart attack,” he continued. “The same logic says that we need to be treating folks who are incarcerated who suffer from mental illness.”

Brook emphasized that an inmate’s medical issues don’t just exist inside the prison walls. When they are released, they will become issues that society then must address.

“I think Mr. Davis’ case makes this plain as well, this is not just an ‘inside the walls’ issue,” Brook said. “We need better mental health treatment options in our communities, especially for those who have just been released from prison.”

They are your neighbors

North Carolina prisons currently house about 36,500 people. And almost all of these inmates – 95 percent – will eventually return to society. Every year, about 24,000 prisoners are released at the ends of their sentences.

Over the past decade, there has been a 60 percent increase of inmates diagnosed with chronic illnesses and a 65 percent increase of those diagnosed with a mental illness, according to Joe Prater, DPS secretary of administration for adult corrections and juvenile justice.

About 17 percent of the total prison population have a mental health diagnosis, Prater said. And the majority of inmates with these illnesses have more than one diagnosis.

Gov. Roy Cooper recently declared the last week in April as “Reentry Week.”

“North Carolina is a better and safer place when those who take responsibility for and learn from their mistakes can get another chance to live productive, purposeful lives,” Cooper said in a press release.

The State Reentry Council Collaborative, established by lawmakers last year, is made up of work groups looking at issues that affect people exiting prison such as unemployment, transportation, mental health issues and substance abuse.

These are some of the things Davis dealt with when he left prison the first time. He struggled to find housing and a job. He was homeless for a time. He went on and off his mental health medication, frequently missing appointments.

Davis said he was working as a barber and living out of his car when he was arrested again last spring.

Right now, Davis is happy to be in the prison’s regular population. His mood is better, and he’s smiling again. Back on his medications, Davis described himself as “a walking pharmacy.”

Now that he’s out of solitary, Davis is part of a prison work program, which gives him credits toward his overall sentence time. From 8 a.m. to 1 p.m., he serves on the prison’s hospital janitorial staff, sweeping floors, wiping windows, and emptying trash cans.

Davis said he’s just keeping his head down and riding out his sentence. He vows to stay away from the bad crowd that landed him in prison the second time around.

And at the end of this month, he’ll be out.

shows a paper reading, "Insurance policy" with glasses and a pen in the foreground

ACA Made it Possible for More with Mental Health Problems to Get Care

November 27, 2017 by Rose Hoban

ACA Made it Possible for More with Mental Health Problems to Get Care - North Carolina Health News

New research shows that people with a range of mental health problems were able to get insurance, and so were able to access care.

By Rose Hoban

People who cope with mental health issues ranging from mild to severe were more likely to get treatment in the wake of the Affordable Care Act, according to a study led by a health economist from UNC Chapel Hill.

The report, published this month in the journal Psychiatric Services, found that in the years since implementation of the ACA (often called Obamacare), people with mental health issues, including anxiety, depression, bipolar disorder or schizophrenia, were more likely to have a regular doctor and were less likely to skip health care and mental health care because of the expense.

shows a woman smiling — Kathleen C. Thomas, Photo courtesy: Sheps Center for Health Services Research

According to UNC health economist, Kathleen C. Thomas, who led the analysis, the findings applied to people in states that expanded Medicaid and states such as North Carolina that chose not to extend the program to lower-income residents.

Thomas, who works at the Sheps Center for Health Services Research, said that the improvement was, in part, because of the improved insurance quality standards created under the ACA. The law defined a package of “essential health benefits” all new insurance policies were required to meet, which included access to mental health services.

“Our findings have to do more with improved quality of the insurance that people did have,” she said in an interview. “These findings underscore some of the importance of the standards laid out in the policy.”

More access

From a panel of more than 47,000 people interviewed before implementation of the law and then at several points afterward the researchers examined questions about people’s access to care and whether they had regular health care providers. Compared to before implementation of the law, people with mental health problems were more likely to have “a usual source of care” and were less likely to have “unmet need for mental health care (unaffordable).”

“Less than half the population of people with diagnosed problems have access to any mental health care,” said Thomas, who noted in the paper that prior research has found only 41 percent of people with mental health disorders use any services.

People with mental health issues “carry a significant burden of chronic illness and early mortality,” Thomas said. Research has shown that people with mental health issues are twice as likely to have a chronic disease and to die young.

“Increasing insurance and access to care for these people are significant policy achievements,” she said.

Thomas and her co-authors also found that people with mental health issues were slightly more likely to be employed after implementation of the ACA than before.

“There is evidence that people receiving comprehensive care can improve mental health functioning and, subsequently, their rates of employment,” the authors said.

She noted that in the run-up to the ACA going into effect, critics said people would be more likely to quit their jobs in order to get onto Medicaid, or that workers would end up with reduced hours at their jobs because employers did not want to cover their full-time workers.

But that wasn’t what the data showed.

“The health improvements that people with mental health conditions may enjoy as a result of improved access to care may result in improved employment outcomes over time,” they wrote.

This story has been updated with a clarification about how researchers examined the data.

Clubhouses For People with Persistent Mental Illness Fear State Cuts

June 13, 2017 by Taylor Knopf

Clubhouses For People with Persistent Mental Illness Fear State Cuts - North Carolina Health News

Clubhouses such as Durham's Threshold help a population that's hard to serve and they depend on state funds - and they face another round of cuts.

By Taylor Knopf

Jasmine Thomas boards a van at her group home a couple days a week to visit a special kind of clubhouse tucked away in an East Durham neighborhood.

woman stands in front of a white board with schedules on it. — Threshold member Jasmine Thomas checks out the task board showing who is helping with what at the Threshold clubhouse. Photo credit: Taylor Knopf

Threshold is an accredited clubhouse for adults with severe mental illnesses. It’s a place for its members to socialize, eat lunch, build life skills, and find job opportunities.

Research on clubhouses around the country shows that, for a relatively small investment, members are better able to stay out of the hospital, reducing the cost burden to municipalities and states.

But this year, clubhouse directors in North Carolina worry that they could lose some of their state funding if General Assembly lawmakers get their way.

Self-sufficient

Established in 1985, Threshold, located at 609 Gary St. in East Durham, serves about 40 people daily, and some say it’s one of the area’s best-kept secrets. The clubhouse is a resource for people with psychotic disorders such as schizophrenia and bipolar.

blurred woman in the backgrond, in the foreground, a polaroid of the same woman dressed up. — A polaroid of Threshold member Jasmine Thomas at the clubhouse prom last month. Photo credit: Taylor KnopfMembers of the clubhouse help run it. Thomas, 30, gives tours to visitors and said she likes to work the sign-in desk. Others make calls to check on members they haven’t seen for a while. A few help make lunch using produce grown in the clubhouse garden.

“We work together to accomplish a common goal,” said Threshold Associate Director Ali Swiller, who has worked at the facility for two decades. “It’s a prepositional difference. We do things with people, not to and for them.”

She said that many so-called “psycho-social rehabilitation” programs merely keep people busy with tasks that, in the end, are meaningless.

“Arts and crafts are great, but they aren’t a reason to get up every day,” she said. “People can go home at the end of the day and know that if they were not here, lunch wouldn’t have been made, tours wouldn’t have been given, and phones wouldn’t have been answered.”

Photo of a fenced in garden with beds full of green leafy vegetables. — Threshold’s garden was created by a local Eagle Scout in 2011. Since then, volunteers, staff and members work side by side to grow healthy food for the members. Photo credit: Taylor Knopf

Threshold’s 11-person staff works alongside members to operate the clubhouse. Community volunteers also help with tasks such as maintaining the garden.

“It makes me feel good and I can encourage others,” Thomas said about working at the clubhouse.

Though she says that was nervous her first few visits, she has been participating for 11 years and has made lots of friends. Thomas said Threshold members attended a prom with Club Nova in Carrboro last month. In her pocket, she carries a Polaroid photo of herself wearing a white feather boa in front of a Hollywood sign from the event.

The members always have a few activities going on. Last month they went on a fishing trip organized by two Durham crisis intervention officers.

two men stand on a dock, holding a fishing pole, they look at the camera and smile. — A member of the Durham Police Department’s Crisis Intervention Team casts a line with one of Threshold’s members during a recent fishing trip. The officers come and interact with members while wearing their uniforms so that if an incident happens, the members will be familiar and comfortable with a person in uniform. Photo courtesy: Threshold’s Facebook page

Many Durham CIT officers visit Threshold during their initial training. Officers frequently visit the clubhouse in plain clothes just to check in. Swiller said this makes everyone more comfortable with the officers for the times when they have to return in uniform to respond to a mental health crisis.

On the chopping block

As state lawmakers negotiate the budget, both the Senate and House budget aim to decrease annual funding that pays for non-Medicaid services to the seven LME-MCOs (behavioral health management organizations) that manage care in North Carolina.

Legislators also proposed a cut of more than $30 million in one-time funding for the upcoming fiscal year. However, they have ordered the LME-MCOs to maintain the same level of service, by using money the LME-MCOs already have in reserve.

Threshold receives about $60,000 in state money allocated through Alliance, the LME-MCO that serves the Durham area.

“It can’t keep being depleted at the state level,” Swiller said. “The reality is, by setting a budget that doesn’t focus on prevention and community-based services, you are going to pay tenfold in emergency costs on the crisis end with psych hospitalizations, jails and homelessness.”

frienly looking woman looks at the camera, sits in front of a desk with papers on it. — Threshold Associate Director Ali Swiller has been working at the clubhouse for 21 years. Photo credit: Taylor Knopf

Swiller said 90 percent of Threshold members reported no rehospitalizations last year, which saves the state’s mental health system money.

Threshold staff also coordinate members’ care with their doctors, social workers and group homes. Because the staff sees members on a regular basis, they can detect emerging issues before they become crises. Or staff can report to the prescribing doctor how a member is doing with a medication change.

“Eliminating a line item from a budget doesn’t dissipate the need,” Swiller said. “I get that if you thought about every dollar you were cutting as a human being, it would be pretty hard to do your job. But it is a face. It is not a dollar.”

The clubhouse’s operating budget is around $800,000. Funds come from the state, individual donations and billing Medicaid for some members. The organization gets some grants, but Swiller noted foundations don’t often want to fund operating expenses.

an older man and a younger woman fill plates with fried rice in a commercial kitchen. — Threshold member TJ and staff member Cassidy prepare egg rolls and fried rice for lunch. Photo credit: Taylor Knopf

Due to some Medicaid service exclusions, Swiller said Threshold is unable to bill for about 20 percent of its members.

“We maintained those members,” she said. “The only thing that changed was our ability to be reimbursed for it. Their treatment needs had not changed.”

Getting back to work

A major focus at Threshold is helping members find a job if they would like to work. The clubhouse has relationships with local employers such as Timmons Fabrication, Zaxby’s Chicken Fingers & Buffalo Wings, Durham County Library and Old Navy.

“We don’t say, ‘Can you give this poor mentally ill person a job?’” Swiller said. “We say, ‘Give us an entry-level job that you are having trouble keeping filled and we will provide a service.’ We will fill that position and support the person as long as they need, for six to nine months, at which point they transition off.”

Man sits at a table, elbow on the table, looking at the camera. — Threshold member James Edgerton, 59, got an entry level custodial job at Angus Barn and clubhouse staff transport him to and from his job. Photo credit: Taylor Knopf

Limiting the term length of the job helps ease members who haven’t had a job or who have trouble keeping a job back into the workforce.

“So this gives light at the end of the tunnel,” Swiller said. “They start at their job and they know it’s six months. We ride it out with them the entire way, and it’s not as overwhelming.”

If a member can’t go to work one day, a Threshold staff member takes the shift for them.

Threshold member James Edgerton, 59, got an entry level custodial job at Angus Barn on Glenwood Avenue. He works three days a week, and the clubhouse organizes his transportation to and from work. Edgerton said he enjoys the extra money and likes to spend it on new clothes.

“James is awesome. He has the best attitude and is one of our favorites,” said Marcia Felton, Angus Barn HR director. “We are happy to have a position to help people who haven’t had a job in a while. We feel this is a way to help people transition into the working world. It’s our way of giving back.”

Additional Thanks

Categories

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Family members of people with mental illness find support, skills - North Carolina Health News

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NC Prison Breaks Its Own Rules for Suicide Prevention

NC Prison Breaks Its Own Rules for Suicide Prevention - North Carolina Health News

By Taylor Knopf

‘Walls close in’

Changes ordered

Many factors determine length of solitary

Lack of resources in and out of prison

They are your neighbors

ACA Made it Possible for More with Mental Health Problems to Get Care

ACA Made it Possible for More with Mental Health Problems to Get Care - North Carolina Health News

By Rose Hoban

More access

Clubhouses For People with Persistent Mental Illness Fear State Cuts

Clubhouses For People with Persistent Mental Illness Fear State Cuts - North Carolina Health News

By Taylor Knopf

Self-sufficient

On the chopping block