Online training could help rural doctors offer better mental health care

More than half of all U.S. mental health care takes place at the primary-care level, and that percentage is even higher in rural areas, where mental-health doctors are often hundreds of miles away, reports Newswise, a research-reporting service. A new online training program could help rural primary-care doctors better treat patients with mental health issues, and that could be important in Kentucky.

The Behavioral Health Education Center of Nebraska, a part of the University of Nebraska Medical Center, designed the program. Educational Director Howard Liu said primary care doctors are overwhelmed by the amount of mental health care they must provide. Newswise reports "the goal is to help primary care providers get more comfortable as they prescribe medications and refer patients to psychiatrists and therapists." The adolescent version of the program was released last fall and is being used by doctors worldwide. The adult and geriatric version will be released this spring.

Primary care doctor Angie Brennan estimates 35 percent of all visits to her practice have been mental health related. She said there are specific rural challenges to treatment, including "reluctance to see a counselor and a lack of mental health insurance coverage – combined with an intensified fear that someone in the community will find out a patient has mental health issues." (Read more)

Amid legislative action on 'Larry's Law,' report says mentally ill and intellectually disabled don't belong in personal-care homes

By Tara Kaprowy
Kentucky Health News

As state legislators move to change the procedure for admitting mentally ill patients to personal-care homes, a new report argues those patients shouldn't be in the institutions at all — and neither should people who have intellectual disabilities.

Kentucky Protection & Advocacy, an independent state agency, argues personal-care homes promote "congregate" and "segregated" living arrangements and, as such, run counter to the Americans with Disabilities Act and a court decision saying disabled patients  should live in the "most integrated setting," meaning one "that enables individuals with disabilities to interact with non-disabled persons to the fullest extent possible."

The report is based on data collected from 218 people in 20 of Kentucky's more than 80 free-standing personal-care homes. Of the facilities visited, 85 percent of the residents living there either had a mental-health diagnosis or an intellectual disability. The visits were unannounced, and individuals were asked at random if they wanted to participate in the survey.

The report found residents in personal-care homes are often restricted from their community either because of lack of transportation — nearly 43 percent said they had to walk in order to go anywhere — or because the home is geographically isolated from most of the community. Staff also rarely plan outings, with one in three respondents saying it never occurs. Another 14 percent said it happens "a couple times a year" and 14 percent said it happens weekly.

Though community mental health centers have programs for counseling and rehabilitation, only 13 percent of personal-care home residents said they go. "Many residents expressed interest in attending the therapeutic rehabilitative programs and the community mental health center for counseling or case management services; however, the staff at PCH would not arrange it," the report reads.

Adding to the argument that residents live in a congregate arrangement, the report points out residents are "subjected to regimented meal times, often with assigned seating, medication, smoke breaks, curfews and bedtimes;" have roommates but are not able to choose them; are not always allowed to refuse to take their medication; and have limited visiting hours.

Still, when asked if they have any complaints about living in a personal-care home, 51.2 percent said they didn't. Nearly 46 percent said they did, and 3.2 said they were unsure. Being lonely or having nothing to do was the single biggest complaint. To download the report in PDF form, click here.

Two bills have been filed to change the way people with mental illness or intellectual disability would be admitted to personal-care homes. Senate Bill 115, which the Senate Health and Welfare Committee approved today, would require that a potential resident receive a medical exam that includes a medical history, physical exam and diagnosis before being admitted. The same would be required by House Bill 307, which would also require more assessment for a person with an acquired brain injury. It hasn't seen action since it was posted in committee Feb. 6. 

The bills are dubbed "Larry's Law," after Larry Lee, who disappeared in August from Falmouth Nursing Home. Lee, who had a brain injury from childhood, had been diagnosed with schizophrenia, bipolar disorder and diabetes. He was found dead four weeks after his disappearance on the banks of the Licking River, which flows through Falmouth. (Read more)

"Larry Lee is not the first person to walk away from a personal care home and die," Beth Musgrave and Valarie Honeycutt Spears write for the Lexington Herald-Leader, citing cases from Grant and Letcher counties. (Read more)

Extensive series focuses on the many faces of mental illness

Mental illness in Rowan County is the subject of an eight-part series of stories written by Noelle Hunter for The Morehead News.

With Part 1 largely an introduction to the project, Part 2 gets into the facts and figures of the disorders that fall under the mental-illness umbrella. According to the Substance Abuse & Mental Health Services Administration, 45.9 million American adults — one in five — experienced some mental illness in the past year. In Kentucky, 180,000 people live with a serious mental illness, which includes schizophrenia, bipolar disorder, major depression, obsessive compulsive disorder, panic disorder and post-traumatic stress disorder.

Dr. Thomas Insell, director of the National Institute of Mental Health, described mental illnesses as "real brain disorders that result from complex genetic risks plus environmental factors." Neither prevalence nor mortality rates associated with mental illness have decreased over time. And though there have been advancements in treatments these disorders, most in the way of medication and therapy, there is still much that is unknown, Hunter reports.

That comes with larger cultural ramifications. In 2008, about 5,100 adults who have a mental illness were incarcerated in Kentucky prisons and almost 700 adults committed suicide, "almost always a result of untreated mental illness," Hunter reports.

The series is running on Tuesdays in the twice-a-week paper. Part 3 profiles a woman living with bipolar disorder; Part 4 will report on the views of clinicians and therapists; Part 5 will profile a man living with bipolar disorder; Part 6 will profile a person living with schizophrenia; Part 7 will focus on the effects on families; and Part 8 will look at treatment options and recovery. The website of the newspaper, part of Community Newspaper Holdings Inc., is here.

2009 U.S. suicide rate highest in 15 years; 600 Ky. teens in 2010

The year 2009 had the highest number of suicides in 15 years, data collected by the Centers for Disease Control and Prevention indicate.

Between 2008 and 2009, the suicide rate increased 2.4 percent, with 36,909 suicide deaths nationwide. In 2008, 13.4 percent of people who committed suicide had either job or money issues, reports research-reporting service Newswise. Numbers are expected to rise, with the National Suicide Prevention Lifeline reporting a 14 percent increase in call volume between 2010 and 2011.

Between 2008 and 2009 about 8.3 million adults (nearly 4 percent of the U.S. adult population) said they had serious thoughts about suicide in the past year, CDC data show. More than 2.2 million adults reported making plans for suicide in the past year and more than 1 million adults said they attempted suicide in the past year. (Read more)

About 600 Kentucky teens died by suicide last year, reports Jennifer Hewlett for the Lexington Herald-Leader.

Bills would require more assessment before a patient can be admitted to a personal-care home

Legislation dubbed "Larry's Law" is aimed at preventing what happened to Larry Lee from happening again.

House Bill 307, filed by Democratic Rep. Terry Mills, right, "would require an individual to be examined and assessed by a medical professional before admission to a personal care home, and it would require further assessment of the degree of disability for an individual with an acquired brain injury who was being considered for placement," report Valarie Honeycutt Spears and Beth Musgrave of the Lexington Herald-Leader.

Senate Bill 115, filed by Republican Sen. Jimmy Higdon, left, would require that a potential resident be evaluated by a mental health professional before someone is admitted to a personal care home, a cost that would be picked up by the state. Higdon and Mills are both from Lebanon, where Larry Lee lived until he went to Falmouth Nursing Home in Pendleton County.

In August, Lee, right, disappeared from the home, one of 82 free-standing personal care homes in Kentucky. Lee, who had a brain injury from childhood, had been diagnosed with schizophrenia, bipolar disorder and diabetes. He was found dead four week after his disappearance on the banks of the Licking River, which flows through Falmouth.

A pre-admission assessment "is the only thing that we found that could have saved Larry Lee," Higdon said. "His condition was too severe. He should have never been in a personal care home." (Read more)

Rosalynn Carter Fellowships help journalists report about mental health; applications due April 16

The Carter Center Mental Health Program is providing six Rosalynn Carter Fellowships for journalists to report on a selected mental-health or mental-illness topic for one year. The center overseen by former president Jimmy Carter says its intention is to increase accuracy in reporting about these issues and decrease the prevalence of incorrect and stereotypical information.

Applicants must have at least three years of professional experience in print or electronic journalism. If selected, they will be required to attend orientation and presentation meetings at the beginning and end of the fellowship year. They will also be awarded a $10,000 stipend, but will not be required to leave their current job.

Those wishing to participate must submit a completed application by April 16, 2012. Awards will be announced July 13, 2012. For more information and the application packet, click here.

Monday, Oct. 10 is World Mental Health Day

Oct. 10 is World Mental Health Day, observed with the aim of raising public awareness about mental health issues. On average, Kentuckians report four mentally unhealthy days per month.

Adults in Pike County reported having the most days a month — seven — that they felt stressed, depressed or emotionally unstable. Those in Daviess, Fayette, Henderson, Mason, McCracken and Webster counties reported the lowest number of mentally unhealthy days. County-by-county data can be found by clicking here.

The theme of this year's day, as decided by the World Health Organization, is "Investing in Mental Health," with the purpose of highlighting the funding shortages that exist to treat people with mental health. In Kentucky, mental health has received the same amount of funding in the state budget each year for the past 15 years.

Second death in five years raises questions about placement of mentally ill Kentuckians in personal-care homes

The second death in five years of a mentally ill person who has walked out of a personal care home has "prompted advocates for the brain injured and the mentally ill to question whether personal care homes, which do not provide skilled nursing care, are the appropriate place to house people who have serious, chronic and complex problems," Beth Musgrave and Valarie Honeycutt Spears report for the Lexington Herald-Leader.

Larry Joe Lee, 32, who "had a brain injury, was schizophrenic, bipolar and diabetic," was found dead in after walking away from the Falmouth Nursing Home, the writers note. "In 2007, Larry Bruce Huff, 64, who had schizophrenia and a history of alcoholism, walked away from Golden Years Rest Home in Letcher County and later froze to death." The state closed Golden Years last week, and legislators say they will address the overall problem in the 2012 General Assembly.

"Personal care homes provide long-term care for people who do not need full-time nursing home care but need some assistance," the newspaper explains. "They receive a small state stipend and social security disability — $1,194 a month — to provide services to a complex population that includes the mentally ill, mentally disabled and even those who have recently been released from prison. There are 82 free-standing personal care homes in Kentucky serving more than 3,000 people." (Read more)

Caregivers of wounded soldiers find their lives are also changed; getting compensation

The wars in Iraq and Afghanistan disproportionately affect rural areas, which provide more than the average number of recruits. The soldiers who make it home alive come back changed, with traumatic brain damage, post-traumatic stress syndrome or other injuries that require full-time care. Mostly wives and older parents are left bearing the burden.

Catrin Einhorn of The New York Times reports that many caregivers have to quit their jobs and are forced to spend their savings and retirement funds to pay for treatment. A growing number of caregivers suffer from anxiety, depression and exhaustion as a result of their new routines. Rosie Babin, 51-year-old mother of a severely wounded 22-year-old son, was managing an accounting office before her son's injury. Though she's happy to have her son home alive, she now has to take blood-pressure medicine and sleeping pills. "I felt like I went from this high-energy, force-to-be-reckoned-with businesswoman to a casualty of war," Babin told Einhorn. "And I was working furiously at not feeling like a victim of war."

According to research by Joan Griffin, a research investigator with the Minneapolis Veterans Affairs Health Care System, most of the injured are in their 20s and 30s, making this the first time since Vietnam the V.A. has seen such an influx of youth, which extending the length of care to years and sometimes decades. On average, Griffin found that family members spend more than 40 hours a week providing care, making it nearly impossible for them to keep a job.

Organizations like the Wounded Warrior Project have tried to ease the financial burden on these families by lobbying Congress to provide direct compensation and other benefits to caregivers and their families. In 2010, the veteran's agency approved 1,222 applications and awarded monthly stipends of $1,600 to $1,800 to caregivers. Along with the money, they can receive health insurance and counseling, Einhorn reports. This law only applies to caregivers of service members injured after Sept. 11, 2001, and it's uncertain who will qualify and how compensation will be determined.
(Read more)