From the desk of Jackie Lane, Executive Director NAMI CC&I
In the introduction of the NAMI CC&I Strategic Plan draft, we are advocating for two over-reaching, long term concepts to be addressed as we work toward better mental health care for Cape Cod and the Islands of Nantucket and Martha’s Vineyard.
First and foremost, mental health care needs to be addressed as an important and integral part of primary care from birth until death. Mental health has been in a separate “silo” for far too long and the neglect of this crucial piece of child development is being manifested in the increasing incidents of childhood mental health issues. The latest statistics tell us that 17.2% of high school students have serious thoughts of suicide and among LGBT students the rate is 47.7%. Mental health monitoring is important throughout life and is especially important in the elderly as depression and dementia are often associated with other medical problems as well as medications.
And secondly, we need to be able to provide an easily accessible continuum of mental health care for all age groups. Step-down and continuing care facilities are few and far between and there are none on the Cape for children. Yes, it is ideal to have everyone mainstreamed into the community; however, in order to do this, we must have readily available support services as well as step-down facilities to bridge the gap between acute hospital care and mainstream community life. Also, we need to face the fact that not everyone will ever be able to live independently and therefore there is a dire need for supervised and safe housing.
This year we are placing a priority on the mental health needs of the very young as we are finding that ACES (Adverse Childhood Experiences) have a huge effect on the growth and development of a person throughout his life. I, personally, have been very interested in the work of Dr. Bruce Perry at his Texas trauma institute. Hopefully we will be able to get Dr. Perry and several other specialists together on the Cape for a symposium on childhood brain development. We are able to tap into the resources of Dr. Stuart Ablon (Think:Kids, Mass General Hospital and Harvard) for help with this project. We will keep you posted.
In this issue, you will find several presentations on the subject of early childhood brain development. These selections have been vetted and are offered by our Board of Directors’ member, Dr. James McGuire, who is passionate as well as very well informed on this subject. Dr. McGuire is fond of saying, “If you take care of mothers and their young children, you will be making a great impact on the mental well-being of society.” Our plan is to support, educate, and advocate for this cause.
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Spotlight On the Brain
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And how early experiences affect its development
James P.D.
. McGuire, MD
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One of Capecod NAMIs visions for 2020 is to share information with the community about how the human brain is built and and the risk and protective factors involved in development.
How we attend to our relationships with children early in their life has a profound developmental effect on the health of their brains and our shared future. Life experiences and developmental trajectories of children are shaped very early in life. Brain health and development is shaped by many factors but none more important than the relationships with the significant adults in their lives.
So, our initial focus in how brains are built will be on the importance of relationships in brain development. Genes determine when brain structures are built. Relationships determine how they are built,
An article
“The Science of Early Childhood Development“
from the Center for the Developing Child outlines how important healthy relational beginnings are to brain development. Some of the main points of the article are:
1.
Brains are built over time and from the bottom up. The basic architecture of the brain is constructed as an ongoing process that begins before birth and continues into adulthood.
2.
Early relational experiences with caregivers affects the quality and integrity of the architecture of the brain and the way we experience the world.
3.
In the first few years of life a MILLION new neural connections are being made EVERY SECOND. As adults, new connections are at rates in the hundreds. Thus, these connections in early childhood form the neural networks that are the foundation of the way we will experience the world we live in.
4.
Babies’ brains require stable caring interactions with adults -any way or any place they can be provided will benefit healthy brain development.
5.
Prolonged activation of the stress response systems in the absence of a stable, protective relationship shuts down the ability to adapt and learn. The priority then is to survive rather than thrive, and the brain is stunted from developing to its potential.
Bruce Perry, MD, PhD has spent the last 20 years researching to the impact of Toxic Stress in children’s lives. He is the director of the Child Trauma Institute in Houston, Texas. Dr. Perry has multiple public lectures and educational presentations from the Child Trauma Academy on YouTube that describe Brain Architecture and its Hierarchical Organization, as well as ways to begin to think about how to meet the needs of children and caregivers where their brains are.
Some of these are listed below:
Brain Development Zero to Three:
Most Learning Happens in the First Three Years:
Window of Tolerance Animation
Bruce Perry Early Childhood Brain Development
We hope you view some of these and let us know what you think!
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Teen vaping of marijuana is on the rise, survey finds
(
CNN)
Vaping remained popular among teens across the United States in 2019, according to a new report, and there were significant increases in vaping of marijuana by eighth, 10th and 12th graders.
The annual report,
Monitoring the Future
, from the University of Michigan's
Institute for Social Research
, found that while prescription opioid misuse, tobacco cigarettes smoking and alcohol use have declined among teens, the use of e-cigarettes continues to climb.
"The most salient finding, in my brain at least, is the very marked increases in vaping that we're seeing in teenagers, and it's vaping both for nicotine and vaping for THC, which is the active ingredient in marijuana," said Dr. Nora Volkow, director of the
National Institute on Drug Abuse
, which funded the report.
"The rates of increase in vaping that we have observed in teenagers actually surpasses anything that we have seen in the past, which is basically highlighting that vaping has basically been embraced very, very promptly by teenagers."
The report is based on an annual survey of drug, alcohol and cigarette use and related attitudes among eighth-, 10th- and 12th-graders in the United States. This year's survey included 42,531 students from 396 public and private schools nationwide.
The survey results showed that 20.8% of 12th graders reported vaping marijuana in the past year, as well as 19.4% of 10th graders and 7% of eighth graders.
Dr. Sanjay Gupta talks to teens about vaping dangers
For the first time, the survey measured the daily vaping of marijuana and found that 3.5% of 12th graders, 3% of 10th graders and 0.8% of eighth graders reported vaping marijuana daily.
The findings come at the same time as an outbreak of vaping-related lung injuries in the United States, with most of the cases associated with THC-containing vape products. There were 2,409 hospitalized cases of lung injury linked to vaping as of December 10, according to the
US Centers for Disease Control and Prevention
. Vaping injuries have been reported in all 50 states, the District of Columbia, Puerto Rico and the US Virgin Islands.
Among the illnesses, 78% were in people younger than 35, the CDC has reported, with a median age of 24. Patients have been as young as 13.
"We predict that next year that awareness that vaping of THC is associated with these acute lung injuries may lead to actually a reduction of vaping among teenagers," Volkow said. "We will find out."
Illicit drug use, other than marijuana, stays relatively low. Marijuana was the most commonly used illicit drug by adolescents while rates of other illicit drug use remained relatively low, according to the new report. After remaining mostly steady for many years, the reported daily use of marijuana has climbed significantly since 2018 among eighth and 10th graders, reaching 1.3% and 4.8% respectively, according to the report. Yet the overall past year marijuana use rates remained steady at 35.7% among 12th graders, 28.8% among 10th graders and 11.8% among eighth graders, the report said.
Among 12th graders, the report found relatively low past year rates of using LSD at 3.6%; synthetic cannabinoids at 3.3%; cocaine and ecstasy at 2.2%; and heroin, at 0.4%.
The percentage of students reporting alcohol use in the past year saw a significant decline among 10th and 12th graders from 2014 to 2019, now at 37.7% and 52.1% respectively.
The report also found that this year 2.4% of 12th graders said they smoked cigarettes daily, marking a significant decline from 3.6% last year -- but when it comes to e-cigarettes, 11.7% of 12th graders said they vaped nicotine daily in 2019, the first year daily vaping use has been measured in the report.
What are people vaping?
"Now we're seeing it on a daily basis," said Stanton Glantz, a professor of medicine and director of the University of California, San Francisco's
Center for Tobacco Control Research and Education
, who was not involved in the new report. He called the report "important" and the findings "very concerning."
"It usually takes years for kids to get from smoking cigarettes every once in a while up to daily use and the new generation of e-cigarettes is really accelerating that process," he said. The report has some limitations, including that the survey data included only teenagers who are in school and therefore do not include youth who might have dropped out of school. Additionally, the survey results are based on information that teenagers self-reported in surveys, and therefore are subject to bias associated with self-reporting.
'A major concern'
While much progress has been made in reducing the use of alcohol, opioids and some other substances among youth, Dr. Georges Benjamin, executive director of the
American Public Health Association
, called the growth in vaping and marijuana use among young people "a major concern."
"Of more concern is that the youth often don't know what they are vaping and many believe it is safe. In some ways youth are simply switching from one set of addictive substance to another which is not safer," said Benjamin, who was not involved in the report.
He said that increased public education about what youth are vaping is needed. "We also should double down our efforts on the other adolescent addictions to ensure they continue to decrease," Benjamin said. "The recently agreed upon increase to age 21 for both combustible tobacco and e-cigarettes included in the appropriations bill being voted on this week is an additional needed step."
Lawmakers have agreed to ban the sale of tobacco products to
anyone under the age of 21
as part of the sweeping year-end spending agreement, according to multiple people involved in the talks. The increased age restriction for tobacco purchases is one of several provisions outside the spending measures themselves that will be attached to the broader $1.4 trillion spending agreement and likely become federal law.
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Mary Zdanowicz, Esq.
ADVOCACY
Note: This is the first in a series of articles that will explore a variety of guardianship topics.
Guardianship Overview
Guardianship
may
be appropriate when an individual lacks the capacity to care for his or her self. Under Massachusetts law, an “incapacitated person” for purposes of guardianship is an individual who has a clinically diagnosed condition that results in an inability to receive and evaluate information or make or communicate decisions to such an extent that the individual lacks the ability to meet essential requirements for physical health, safety, or self-care.
Determining whether an individual is an “incapacitated person” is the threshold question in guardianship. But there are many other issues that must be considered before determining whether guardianship is appropriate. Court guardianship proceedings are complicated, time consuming and can be costly. Alternatives to guardianship, such as durable power of attorney, health care proxy, or social security representative payee, should be considered before proceeding with guardianship.
A guardianship order may be permanent or temporary and may be limited to specific aspects of an incapacitated person’s activities. Conservatorship is a separate proceeding that may be appropriate when an incapacitated person is unable to manage his or her money, property, or business affairs due to a disability.
Medical decision-making is commonly addressed in guardianship cases. Intrusive medical treatments and procedures, including antipsychotic medication in Massachusetts, are considered “extraordinary treatment” and require special consideration by the courts. A court must approve a Rogers treatment plan before antipsychotic medication may be administered to an incapacitated person because such an individual lacks capacity to make an informed decision about treatment.
Massachusetts law requires judicial review before an incapacitated person may be admitted to a nursing home. End of life decisions may also require judicial review. Guardians do not have authority to involuntarily hospitalize an incapacitated person; involuntary commitment procedures must be followed.
A guardian must act and make decisions in the best interest of the incapacitated person. A guardian makes medical and personal decisions on behalf of the incapacitated person, although the court may limit a guardian’s authority to only the areas in which the person is impaired. For purposes of HIPAA, a guardian “stands in the shoes” of the incapacitated person and is entitled to make the same decisions and obtain the same information about the individual’s care and treatment.
Each year, a guardian must submit a care plan/report to the court. Rogers monitors, who may or may not be the same person appointed guardian, must file a separate report.
In future articles in this series, these topics will be covered in greater detail. If there is a specific topic of interest that is not listed above, please send an email to mary@mtzesq.com.
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Bedlam: An Intimate Journey Into America’s Mental Health Crisis
by Kenneth Paul Rosenberg, MD
When I first heard about this new book, I said to myself “Oh, it’s just another one of those books.” Wrong! I’m glad I got it and read it. It is an excellent book that I recommend to everyone. It is well written, clear, well referenced, up to date and full of useful information. The author is a psychiatrist working in New York who has spent several years training and working in Los Angeles. The book is based on extensive interviews with many people working around the country. It also describes the experiences of several patients, as well as, the experience of his sister who had schizophrenia.
He begins by laying out some of the elements of our mental health care crisis. He writes about the continuing stigma of mental illness. This stigma not only prevents people from getting services and early treatment, but also allows our nation to ignore the serious problems faced by so many people. Another aspect of the crisis is the lack of new medications for treatment and the serious side effects of current medicines. He also writes about the crisis in availability of hospital beds, the problem of homelessness among those with serious mental illness, and the criminalization of mental illness.
In a chapter titled “Dungeons and Dragons: Criminalizing Mental Illness” he writes that “approximately 383,000 individuals with severe psychiatric disease are living behind bars.” “If you are an American with mental illness, you are up to ten times more likely to be incarcerated than hospitalized.” He notes that, “Mental illness crises are the only health emergency in which law enforcement are the first responders.” He goes on to talk about crisis intervention team (CIT) training. This, of course, is an important program that NAMI has spearheaded here on the Cape. CITs are an important way to identify people who are falling between the cracks and are not getting the care that they need.
Rosenberg includes a brief discussion about the etiology of severe mental illness. While there is still so much we do not know about the specific causes of mental illness, Rosenberg points out the important role of not only genetics but also social factors, stress, inflammation, life traumas and socioeconomic stress.
In a chapter titled “My Son Died with His Civil Liberties Intact” the author discusses the role of Assisted Outpatient Treatment programs. Massachusetts remains one of the very few states that still do not have laws that allow courts to enforce treatment programs in lieu of hospitalization. These programs have certainly helped many patients and it seems that we in Massachusetts could come up with a program that not only benefits patients but respects their civil liberties.
Rosenberg also writes about the development of assertive community treatment (ACT) programs that bring care right to the patient. These programs use a multidisciplinary team approach and provide a range of care and support services in the home. Rosenberg also writes, “Another solution would be treatment facilities that people actually want to be in….Making treatment more inviting will require a cultural shift toward more respectful and welcoming care. It will mean providing decent housing and wraparound health care and avoiding chemical and physical restraints whenever possible…It will also require money. Not necessarily more money- as emergency rooms and jails are very costly- but money that’s better spent on addressing the underlying illnesses and the associated social ills such as homelessness and poverty.”
There is an excellent chapter titled “Practical Advice For Persons With Serious Mental Illness and Their Families.” The first piece of advice is “Connect with NAMI”! Others pieces of advice include develop a crisis plan, create a support team, prioritize empathy and collaboration, and get psychiatric help. Near the end of the book Rosenberg writes, “We are not alone. But we desperately need one another. We need to share our stories. We need comradery and a unified movement. As many of us have found out the hard way, none of us can fix these diseases alone. None of us, rich or poor, can insulate and protect our family members from psychiatric disorders….We can only solve this together, as an outspoken, unified, undeterred, and unashamed community.”
Read this book. It has a lot in it
Written by Dr. George Vitek, retired pediatrician who practiced for 28 years in Wilbraham, MA. Married father of four and grandfather of nine.
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NEW NAMI ON NANTUCKET PHONE #:
508-280-8777
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SAVE THE DATE
DRAGONFLY 2020 will be held on Thursday,
July 23, 2020
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T
he New Year is off to a great start for NAMI MV!
We hosted our first event, Dine-to-Donate, at Offshore Ale on Thursday, January 9. The fundraiser ran from 11:30 am to 8:30 pm. A portion of the proceeds from patrons’ lunches and dinners was donated to NAMI MV. I don’t have the final total yet, but we raised over $500.
The Peer Outreach Group at the High School is fabulous. The week before mid-terms we brought therapy dogs to the school from 9 am to 2 pm on Thursday and Friday. The students LOVED it. I can’t tell you how many students asked if the dogs could come to school every week.
One young lady said, “I’ll take mid-terms every week if you bring the dogs.”
I want to thank: Matt Malowski and Tully, Betsy McPherson and Roadie, Cynthia Segal and Shelby, Karen Ogden and Hannah, and Jeremy Jones and Annabelle, and the awesome MVRHS staff, especially the folks in the library where we were set up.
Our next Peer Outreach meeting will be a planning session for Mental Health Awareness month. The students are considering a NAMI walk, tabling events in school, and a movie night.
NAMI MV, the Island Wide Youth Collaborative, Island Intervention Center, Darkness into Vineyard Light, and the MVRHS guidance office joined together to view
The “S” Word.
We are planning an all-school event in May and sorting through options for the best idea.
We held our first planning meeting for the next Family-to-Family class, which begins on March 5. We are waiting to find out whether we’ll be teaching the new 8-week course or the traditional 12-week course.
Warm wishes to all,
Lisa
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Education and Support News
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NAMI Homefront is a 6 session, peer-delivered course designed for families or support persons of Veterans and service members with mental health conditions. You will learn how to:
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Manage crises, solve problems, communicate effectively
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Care for yourself; manage stress
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Develop confidence to support your loved one with compassion
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Identify and access federal, state and local services
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Be informed on the latest research on mental health
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Understand current treatments, therapies and medications
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Navigate the challenges and impact of mental health on the family
Most importantly, be with others who face similar challenges. You are not alone!
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FAMILY-TO-FAMILY
A free, comprehensive 12-week course designed
specifically for families and friends of persons managing a mental health issue. Family to Family offers education, support, and resources.
Classes start Tuesday, March 3, 2020 from 6:00 – 8:30 pm
IN HARWICH
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Family Connections NEA-BPD
This 12-week, research-based program for family members of individuals who have difficulty managing their emotions, provides current information, teaches communication skills, and creates the opportunity to develop a support network.
Is This Program For You?
•
I am a family member, partner/spouse, caregiver or close friend of someone struggling with symptoms or a diagnosis of Borderline Personality Disorder. (A mental health disorder characterized by unstable moods, behavior, and relationships.)
• I want to improve my relationships.
• I am willing to consider how my own behavior impacts the relationship.
• I am willing to try out new skills even though they may be uncomfortable at first.
• I am willing to attend all classes.
• I am willing to participate and practice new skills.
• I want to have the knowledge and tools to create better relationships.
Family Connections is being planned for the Spring 2020 in Barnstable.
To register for the upcoming classes in Harwich and Barnstable, or to be notified about another offering in the future, call or email Kim Lemmon, Director of Family Programs. 508-778-4277 or
klemmon@namicapecod.org
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A
Alzheimer's Family Support Center
of Cape Cod, Brewster
Main St
On Friday, January 24, 2020, St. Peter the Apostle Church in Provincetown hosted a training for Community Responders – “Fighting Alzheimer’s/Dementia Together”. There were Police Officers, EMT’s, Community Health Workers, COA employees and some primary caregivers in attendance.
The training was facilitated by the Alzheimer’s Family Support Center in an effort to develop awareness in the community about how to recognize an individual who may be exhibiting the signs of dementia and create a safe and friendly environment to assist that individual.
Dementia is a medical term that refers to the loss of intellectual functioning. Changes in cognitive function, personality, mood, and behaviors can be signs of one of the diagnosis that are under the umbrella of dementia. Alzheimer’s Disease is the most common, but there are other dementia diagnosis, so a proper evaluation is important. Education and support for primary caregivers is very important. The challenges for people caring for an individual with dementia can be overwhelming and create negative health consequences for the caregiver.
For more information, educational opportunities, and support schedules, go to
info@capecodalz.org
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RESEARCH WEEKLY: January Roundup
R
esearch Roundup is a monthly public service of the Office of Research and Public Affairs. Each edition describes a striking new data point about severe mental illness and summarizes recently published research reports or developments.
DATAPOINT of the month
35% decline in inpatient beds and 24% increase in suicide rates.
Between 1998 and 2013, there has been an estimated 35% decline in the number and availability of inpatient psychiatric beds in the United States. In that same time period, there has been a 24% increase in the age-adjusted suicide rate in the population.
Dr. Steve Sharfstein argues
the loss of psychiatric beds and shortening of inpatient hospital stays has affected clinician’s ability to interrupt a suicidal impulse and the lack of capacity to take care of psychiatric emergencies has become a public health crisis.
RESEARCH of the month
Disparities in mental health care among Asian Americans.
Asian Americans have the lowest rate of mental health care access compared to other racial-ethnic groups. One hypothesis to explain this disparity is that Asian Americans do not access mental health care because they have a lower perceived unmet need of mental health services compared to other racial-ethnic groups. New research published this month in
Psychiatric Services
dispels this argument, however. The authors found that even among Asian Americans who said they were in need of mental health care, access and receipt of services was lower than for Caucasian Americans.
“Health care systems should strive to improve the cultural sensitivity of their mental health care to better serve Asian-American patients,” the authors write. The authors also suggest that future research should examine mental health awareness and treatment access among different subgroups of Asian Americans to develop more tailored approaches.
Lumateperone for short-term treatment of schizophrenia.
Lumateperone is an atypical anti-psychotic medication that was approved by the Federal Drug Adminstration (FDA) in late 2019 for the treatment of schizophrenia. Backed by more than 20 clinical trials that included almost 2,000 patients, Lumateperone has a new way of treating schizophrenia that differs from other antipsychotic medications. The drug works by modulating three neurotransmitters known to be involved in the symptoms associated with schizophrenia, serotonin, dopamine, and glutamate, while having limited effect on off-target receptors.
Results from a clinical trial of Lumateperone were published this month in
JAMA Psychiatry,
which suggests that the drug is effective in treating acute schizophrenia in adults while minimizing adverse effects. In a phase 3 randomized control trial of 450 patients with schizophrenia who were experiencing an acute exacerbation of psychotic symptoms, Lumateperone was found to be effective in reducing symptoms among patients after 28 days of once-daily administration. In addition, compared to control patients given a placebo, Lumateperone did not have any short-term adverse effects on motor, cardiometabolic or endocrine systems that other antipsychotic medications are known to have.
Note: The Treatment Advocacy Center does not accept funding from companies or entities involved in the sale, marketing or distribution of pharmaceutical products.
Elizabeth Sinclair Hancq
Director of Research, Treatment Advocacy Center
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Time to Start KNITTING FOR NAMI
We are again partnering with A Great Yarn in Chatham to knit panels for blankets to be donated to the Housing Assistance Corp (HAC) for the homeless and the newly homed. Knit-A-Thon continues through April.
All you need to do is knit 50 stitches across and 72 inches long, any washable worsted weight yarn, any colors, on size 8 needles.
From A Great Yarn: "This is our fifth annual Knit-a-Thon, and last year you guys produced 215 blankets for the Cape’s homeless. Amazing! This year our goal is to make 250 blankets. We know that’s an ambitious target, but we also know that the demand for the blankets keeps growing. Last year the HAC ran out of our blankets even before the really cold weather set in."
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Feb 15, Mar 21, Apr 18
Healing Arts Collective
47 Main St, Orleans
Register at
www.sueandersenyoga.com
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TIDBITS
The next Community Crisis Intervention Team Training will take place
April 7,8,9, 14, 15, 2020.
There is limited space available for non police or first responders. If you are interested in taking this 5-day course, please call the office at 508-778-4277.
Important Dates
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When shopping on Amazon, think NAMI CC&I and Amazon Smile.
Every dollar you give to NAMI CC&I goes to help support, educate and advocate for the residents of Cape Cod, Nantucket and Martha's Vineyard.
Amazon donates 0.5% of your eligible purchases.
It's so easy, you can still use your Amazon Prime and you still collect points. All you need to do is:
When you are going to make a purchase on Amazon, first enter
http://smile.amazon.com
i
n your internet browser. On your first visit to AmazonSmile, you will be prompted to select a charitable organization . Select NAMI Cape Cod Inc. It costs you nothing, but provides funds for NAMI CC&I.
Thank You!
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