Proposed Mental Health Reforms for the Commonwealth of PA

Here's our support group, New Directions of Abington, PA.

PA Congressman Tom Murt of Hatboro, PA, R-152, asked my help in reforming our broken-down mental health system. The incentive was the shootings in Newtown, CT.
 
Tom Murt.

I sent an email to our group members asking for suggestions. A dozen people responded. Their ideas are incorporated in the below proposal.

My colleague, Ada Moss Fleisher, came over and helped to write and structure the essay.

MENTAL HEALTH REFORMS FOR THE COMMONWEALTH OF PA

Recommendations

1-Mental Health Clients

Education classes by peers and therapists such as social workers, nurses, psychologists. Classes should be held after initial diagnosis of bipolar, depression, schizoaffective, anxiety, schizophrenia, OCD, etc., directly after client has been discharged from the hospital, or given a psychiatric diagnosis by a psychiatrist.

Two 90-minute classes should suffice. If clients have questions, they may follow-up with class instructors.

Explanation of illness, its course, what to expect, and medications used.

List of resources such as treatment centers, including private ones – for people with insurance – and the public sector, for low-income people. New Directions has an excellent list.

These treatment centers provide psychiatrists and therapists.

Provide “peer specialist” to visit and check up on client. This is currently provided only for people on Medicaid. It should be available to everyone.

Helpful online resources will be given out such as PsychCentral.com

Refer clients to support groups for peer support.

Classes will be paid for by insurance companies which will repay themselves by decreasing expensive hospital stays. They might also be paid for by the Montgomery County Office of Behavioral Health or the Bucks County Office of Mental Health. 

Vocational Training.  Places in Philadelphia include Jewish Vocational Services, state and federal-funded Office of Vocational Rehab, and AHEDD for the disabled.

There are also “job coaches” to help “disabled” individuals find and acclimate to a job. 

2- Families and Loved Ones

Two 90-minute classes should be provided for families. Focus on understanding what client is feeling – their fears, altered thoughts, mistrust, paranoia, spending sprees, etc. - and how to be of help to them. Importance of talking tactfully to them. See video at Mental Health First Aid where client’s beliefs, even if false, are reinforced by caregiver in order to help the client get appropriate treatment.

NAMI (National Alliance on Mental Illness) holds classes for families in their 12-week free Family-to-Family classes, funded by individual NAMI chapters. Classes include those in Philadelphia, Bucks and Montgomery County and others across the nation.

3 - Hospitalization  

Many patients leave a psychiatric hospital without knowing what happened to them. They need a diagnosis by a psychiatrist. Hospitals should explain to patients - and also to family members - about the diagnosis and medications given to treat the condition.

Hospitals are often perceived as boring places and a waste of time. Hospitals should offer meaningful therapy, as well as classes such as yoga, mindfulness meditation, art therapy, horticulture therapy, to make the patient’s stay worthwhile. 



Hospitals are often seen as inhospitable, unfriendly places that patients avoid at all costs, many times to their great detriment. If the experience is a pleasurable one, hospitals will get a deserved good name and patients won’t have to be coerced into checking in.

Crisis Centers -  A crisis occurs when (1) someone has suicidal thoughts or is so depressed they are unable to care for themselves or (2) when they are manic and a danger to themselves and others. 

Crisis centers are located at general hospitals, though not all of them contain one. They are also a part of psychiatric hospitals.

The admission process may take many long hours, while the patient is acutely ill and suffering terribly, many times with thoughts of suicide. This appallingly inhumane treatment should be corrected. 

Compare this to checking into a regular hospital, such as Abington, if you are having a stroke or heart attack. To delay may be fatal.

Respite Facilities. Strive for small inpatient facilities where client can be removed from daily stresses and catch his or her breath. A doctor would supervise medication, if necessary, while staff takes care of patient and offers relaxing activities such as listed above under hospitals. In the past, one such excellent place was The Ranch House in Norristown, PA, closed due to lack of funding.

4-Community Education

Education for police officers is provided by Montgomery County Emergency Service for all Montco police districts. NAMI Bucks County does police officer training in Bucks County.  

However, since MH clients are often too ill or psychotic – out of reality - to obey simple orders and may even appear violent, officers may get unnecessarily rough. Refresher courses should be offered with the enthusiastic backing of the police chief.  This will help the officers do their jobs in the best way possible and they will be grateful.   

School personnel such as teachers, counselors, nurses from K-12 often encounter mentally ill children and teens. They should have yearly in-services by:  “a certified peer specialist,” (this is a person with a mental illness who has been trained to talk about mental illness), knowledgeable mental health clients, nurses or therapists on how mental illness manifests in youngsters - which is often different than adults - and what to do about it, including where to refer them.

One such program already in place in PA is the PA Student Assistance or CSAP which deals with both mental illness and substance abuse. See website. 

Talks to the entire student body from middle school on up to encourage tolerance and support of classmates with MH issues and also of parents who may have MH issues. Currently, Bucks County NAMI is holding 50-minute “Health Classes” to help students understand their mentally ill peers.

Talks to corporations, businesses, fraternal organizations, churches and synagogues, nursing schools, medical schools, family doctors’ offices to foster understanding and tolerance. 

College campuses. A distinguished organization called “Active Minds on Campus” educates students about mental illness at colleges across the country. They offer education and support. See website.  

Public Awareness of Mental Illness and Media Coverage. Publicity about mental illness is critical. 

          We, in New Directions, have written guest columns and letters to the editor, have appeared on Comcast Newsmakers and public radio.

Every May the National Alliance on Mental Illness (NAMI.org) has an awareness walk in every state of the union. In Montgomery County, the Walk is held at Montgomery County Community College on a Saturday morning. 

This year’s date is May 4.  Last year, the walk was briefly covered by Action News.

          One excellent anti-stigma campaign was developed in Australia and imported to the U.S. “Mental Health First Aid” is being used in many states and we suggest its implementation in PA. 

This interactive 12-hour course grants a certificate to teach the program in the community. 

Charlie Rose on PBS has a wonderful series on the Brain, in which mood disorders and schizophrenia have been thoroughly discussed and real people with the illness have appeared. What an excellent way to educate the public.

More positive TV appearances are suggested.

How about a “ribbon” on the back of a car for “Mental Health Awareness.”

Mental illness needs to be brought out in the open. By hiding it, we perpetuate the prejudice against people with mental illness. The community needs to know that “We have more in common with you than we have differences.”