May 2021 Newsletter

MAY 2021

Editor: Denise Nelson

(559) 627-1306

MAY IS MENTAL HEALTH MONTH

Spread the Word, Raise Awareness!

Help raise mental health awareness by sharing our website with a family member, friend, or colleague. Visit our website to learn about different mental health conditions, how to manage living with them, common warning signs and symptoms, different treatment options, and so much more. Empower yourself! Empower others!

VISIT OUR WEBSITE and SHARE WITH A FRIEND

MONTHLY UPDATES

NAMI Tulare County Help Lines

If you are concerned for a family member or friend, please call our help lines:

Office Cell Phone: (559) 967-6168
Visalia Contact: Ralph, (559) 627-1306
Porterville Contact: Donna, (559) 280-5258

NAMI Tulare County Support Group

We are pleased to announce we will be resuming our in-person, monthly Family Support Group in Porterville once again. Walk-ins are welcome. Come join us!

Porterville Location

Time: 6:00 pm

When: First Thursday of the month; next meeting is May 6

Location: Porterville Wellness Center, 333 W. Henderson Ave.

Porterville and Visalia Wellness Centers

Wellness Center activity calendars are on the NAMI TC website: www.namitularecounty.org

My Voice Media Center

The Speakers Bureau group is now meeting twice a month. Do you want to share your personal story? Contact Olivia at 559-802-3266.

Your shopping can help generate donations for NAMI Tulare County. Go to AmazonSmile, and Amazon will donate 0.5% of the price of your eligible purchase.

When you log in, please choose NAMI Tulare County as your charitable organization, and your donation will be linked directly to us.

LEARN MORE

Pre-register for your plate at Beingwellca.org!

Mental Health Awareness License Plate Program

SB 21 is a bill, introduced by State Senator Steve Glazer, that would generate funds for mental health services in public schools by establishing a mental health awareness license plate program. The license plates would feature a mental health awareness message. The extra fees paid by drivers will help fund the California Department of Education’s critical work to provide mental health services in California’s public schools.

Tulare County Mental Health Board Meetings

The Tulare County Mental Health Board meets on the first Tuesday of the month, at 3:00 pm, via ZOOM.

https://tchhsa.org/eng/index.cfm/community/tulare-county-mental-health-board/mental-health-board/

Public Comment is at the beginning of their meeting.

FEATURED ARTICLES

RESEARCH WEEKLY: Suicide Risk and Prevention in Women with Serious Mental Illness

By Elizabeth Sinclair Hancq

The U.S. Centers for Disease Control and Prevention (CDC) made headlines last week with newly released data showing that suicide deaths decreased overall in 2020, despite dire predictions of the impact on COVID-19 on suicide due to the increased stress, grief, loneliness and economic difficulties associated with the pandemic.

There were 44,834 individuals who died by suicide in 2020, according to data from the CDC, a 6% decrease from 2019. By contrast, 345,323 individuals died from complications of COVID-19 in 2020, according to the same data.

While the news that suicide deaths in the United States are trending downward is a step in the right direction, suicide rates are still at a 30-year high. As we wrote in this blog this past February, people with serious mental illness, including schizophrenia and bipolar disorder, are at a significantly increased risk of death by suicide than the general population. Experts agree that suicide prevention strategies must be tailored to address the unique needs of people with serious mental illness.

Suicide risk prediction in women with serious mental illness

Researchers from the Semel Institute for Neuroscience & Human Behavior at the David Geffen School of Medicine at UCLA developed a machine learning algorithm that identified risk factors for self-harm or suicide attempts in women with serious mental illness after having been hospitalized for a physical medical illness. Because women with serious mental illness are at significantly increased risk of suicidal behavior and most women who die by suicide have had a recent contact with a healthcare provider, exploring factors that may predict self-harm among women after a medical hospitalization could help identify who may need further psychiatric care.

The researchers used electronic health records from 1,628 women with serious mental illness from UCLA Medical Center who had a general hospitalization between 2006 and 2017. Obstetric hospitalizations, those due to child birth, were excluded from the analysis to focus the study on risk profiles of women outside of the antenatal or postpartum periods. A machine learning classification model was implemented to determine

predictive features and identify risk groups, which the researchers also applied to a data set of patients from

New York City to ensure its replicability. The researchers published their findings in Medical Care earlier this year.

Risk Groups for Self-Harm in Women with Serious Mental Illness

The researchers found multiple predictors of suicide-related hospital readmissions in women with serious mental illness who had previously been medically hospitalized. The strongest predictor was previous medical illness, however this relationship differed depending on the severity of the medical comorbidity prior to hospitalization. For example, women with more severe comorbid medical illness were at higher risk for self-harm if they also had previous suicidal behavior. Conversely, women with less severe medical illness were at increased risk for self-harm if they were younger than 55 years old.

A history of pregnancy-related mental illness was associated with a significantly increased risk of self-harm after general hospitalization, according to the study results. This finding is important because although there has been a lot of work focused on suicide risk during pregnancy and postpartum, little has been examined following this period. The sample from this study was predominantly postmenopausal women with a mean age of 58 years old, which suggests there are additional risk mechanisms for self-harm in women with a history of pregnancy-related mental illness, according to the authors.

“Women who experienced psychological trauma associated with hospitalization for childbirth may retain vulnerability to trauma reminders during subsequent hospitalizations,” the study authors write. Prevention of self-harm and suicide attempt among women with serious mental illness following acute medical illness could be improved by screening for sex-specific predictors, such as pregnancy-related psychiatric illness. Considering more than 700,000 women attempt suicide each year, increased attention to the unique factors that contribute to self-harm in women with serious mental illness is warranted.

References:

Edgcom, J. B., et al. (2021, February). Machine learning to differentiate risk of suicide attempt and self-harm after general medical hospitalization of women with mental illness. Medical Care.

If you or someone you know may be struggling with suicidal thoughts, you can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) any time day or night, or chat online.

Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they dial 741-741.

Elizabeth Sinclair Hancq is the Director of Research at the Treatment Advocacy Center.

Medication Management

How come whenever I am hospitalized, a new medication is added?

During hospitalization, there is pressure to find solutions to immediate problems and adding a new medication that helps, if only in the short term, is common, yet existing medications are often continued. The result is a plethora of medications upon discharge. The out-patient team will often touch base to make sure renewal scripts re in place but may not have sufficient time for a comprehensive review of the overall treatment plan and strategy.

Do I really need all these medications?

The management of bipolar, as with any medical condition, involves a collaboration between the health-care team and the individual (and the family). A successful management strategy combines the expertise of the care team with the engagement of the individual to form a therapeutic alliance to treat the illness over time. At regular intervals it is wise to review the overall medication management plan “x” ? What are the risks and benefits?

Occasionally one medication may interfere with the metabolism of another, so be sure to ask about interactions. An additional consideration is age: older people are often more sensitive to medications, and too many medications can cause confusion and delirium.

What else should I ask my treatment team about?

As you review your treatment strategy with your care providers, you may want to know not only if all the medications you are taking are necessary, but also whether any could be causing problems. Antipsychotic medications

can be a lifesaver in the case of an acute manic or depressive episode, and continued use of this class of medications can be highly successful in ongoing care and maintenance; however, if the doses are kept too high or if the individual is taking more than one medication from this class, the result can be over-sedation. The use of antidepressants requires caution, as these may cause unstable moods or irritability, or precipitate an episode of mania. The use of stimulants, likewise, may cause mood instability. The mainstay of the maintenance of bipolar treatment is mood stabilization, and there are many medication options available that should be discussed with the treatment team.

How can I learn more about medication management?

These days, it is easier than ever to remain informed. Two authoritative and credible websites I can recommend are canmat.org (Canadian Network for Mood and Anxiety Treatments) and nimh.nih.gov/health/topics/bipolar-disorder or insert schizophrenia (National Institute of Mental Health).

If you have a question a question for your treatment team, write it down and ask it early in the appointment to allow time for discussion. Don’t be shy about asking for clarification or advice.

What if I don’t agree with my doctor?

If you have a disagreement with your providers, ask them to explain their recommendations. It is a good idea to ask for a second opinion. It is not a good idea to do something (e.g., stop medication) on your own, -- but if you do, always inform your treatment team.

Mevin G. McInnis, MD., FRCPsych. He is a professor of Bipolar Disorder and Depression in the Department of Psychiatry at the University of Michigan School of Medicine. He is also the director of the Heinz C. Prechter Bipolar Research Program and associate director of the University of Michigan Depression Center.

Bp Magazine, Fall, 2020

Email questions to mailbag@bphope.com

We Need a National Vaccination Strategy for People with Severe Mental Illness

By Lisa Dailey, Acting Executive Director of the Treatment Advocacy Center, and Paul Gionfriddo, President and CEO of Mental Health America Opinion Page of The Hill; 21 April 2021

COVID-19 and our nation’s response to it, magnifies a sad truth: We have ignored our fellow citizens with severe mental illness.

When we ignore those citizens, we’re leaving behind people with many more barriers to vaccination than the average person. Studies show those living with serious mental illness experience a lack of knowledge and awareness about immunization, a lack of accessibility, a cost barrier, fears about immunization and often no recommendation to receive an immunization from a primary care provider.

Only 25 percent of adults with severe mental illness receive the annual flu vaccine, compared to almost 50 percent of adults in the general population. Without a strategically designed vaccination program able to bring the vaccine to people with serious mental illness, potentially preventable deaths will occur from COVID-19.

According to a bombshell report published in JAMA Psychiatry this January, a schizophrenia diagnosis is the second largest predictor of mortality from COVID-19, after age. Based on this alarming finding, leading scientific experts agree we must minimize the barriers to vaccination and maximize access to vaccines for people with severe mental illness.

As everyone becomes eligible to receive a vaccine, we must develop strategies that go beyond eligibility alone. We created a national strategy to bring the vaccine directly to senior citizens in acknowledgement of the challenges they faced and we must do the same for individuals with severe mental illnesses. We cannot sacrifice individuals with severe mental illness to this pandemic or accept their higher mortality rate as inevitable. People with

schizophrenia and bipolar disorder deserve better.

As leaders of mental health organizations who have seen the devastating effects of COVID-19 on people with severe mental illness, we’re calling on our state and national leaders to provide guidance and funding to state and local health departments to establish COVID-19 vaccination programs specifically designed to increase vaccination rates for people with mental illness. These must include mobile vaccine clinics for aggregate housing facilities, robust outreach to at-risk populations at homeless shelters and encampments, engagement by peer support specialists, training of community health workers, nurses and other public health workers and efforts to address sources of vaccine hesitancy in this population.

Here’s how to put this strategy into action:

First, we must allocate vaccines to inpatient psychiatric hospitals, community mental health centers, community behavioral health organizations and other mental health and substance use service providers who are best positioned to reach those with serious mental illness.

Second, we must create multimedia materials for states and local communities to provide education about the importance of vaccination and dispelling myths about vaccine safety tailored to those with serious mental illness.

Third, we must include peer support specialists in the process — they can connect with those with serious mental illness on a personal level. These peer support specialists should be deployed to community health centers and public health agencies to address emotional or mental health stressors related to vaccination for individuals with severe mental illness.

Fourth, we must gather and publish data on the vaccination rates of people with severe mental illness and determine whether subgroups of people who experience multiple disparities are getting access to vaccines.

As President Biden said in his address to the nation on March 11, the one-year anniversary of the national shutdown due to COVID-19, the most important function of the government is to protect the American people. We must start with those most in need of government action and protection from this deadly virus.