Category Archives: Mental Health News

After College?

Although the health care bill has recently passed, many of the new provisions will not take effect for some time.  For recent college graduates, staying on their parents’ coverage may be a good option since many insurance companies have already expanded their coverage to the children of dependents until they are 26.  As of last fall, health plans must offer this.  However, this might not be an option for everyone.

One important thing during this time of transition is to be consistent with a medication plan. In order to do so, it is a good idea to talk to your doctors before your coverage changes in order to develop strategies so that you guarantee continued coverage of your medication.  This will insure that you stay healthy both physically and mentally.  Getting a prescription for a 90 day supply is one potential option.

If you plan to buy your own health insurance, learning about the different options and plans is crucial.  First, it is a good idea to figure out how long you may be under or uninsured.  This would help you to decide if you should look at short-term health insurance plans or more long term plans.  Healthcare.gov has information on eligibility for public and private health insurance plans.  EHealthInsurance.com is a for-profit website, but can offer a useful comparison of different private plans.

Many insurance companies that provide short term insurance, offer plans where you can buy insurance a month at a time, usually for up to 6-12 months.  However, it is important to understand that short-term plans only provide coverage in the event of an emergency or a catastrophic event.  Many short-term plans don’t cover regular check-ups, pre-existing conditions, prescription medications, or other preventative care needs.

When considering a health insurance plan, learning about the limits and constraints of high deductibles vs. low deductibles, as well as the premiums is vital.  When considering an insurance plan, the annual deductible is the amount of money you have to pay out of pocket before your health insurance kicks in.  Normally, the higher the deductive, the lower the premium, or monthly payment.

Along with the security of health insurance, there are also several clinics that offer sliding fees. Depending on your income and other expenses, certain clinics can adjust the price of their services and other health care needs.  You can find more resources on our website or by calling one of our individual advocates.

Though graduation is accompanied by celebration and excitement, there are also lots of things to start thinking about.  It is especially important for people with mental illnesses to plan ahead when thinking about health insurance.  This summer in particular may leave many people not only jobless but also without the medical coverage they need.

Speaking with health care professionals and advocates can help.  They possess the tools and resources that can help in alleviating possible long-term stress or more serious illnesses.  Taking the time to learn about your options and coming up with a strategy now will certainly help you avoid the pain and anxiety of being in need of medical care later, and not having the coverage to afford it.

This post comes from volunteer blogger Margo Tell.

FDA Safety Alert – Risperidone (Risperdal) and Ropinirole (Requip): Medication Errors – Name Confusion

The Food and Drug Administration (FDA) notified health care professionals and the public of medication error reports in which patients were given risperidone (Risperdal) instead of ropinirole (Requip) and vice versa. In some cases, individuals who took the wrong medication needed to be hospitalized. The FDA determined that the factors contributing to the confusion between the two products include: 1) similarities of both the brand (proprietary) and generic (established) names; 2) similarities of the container labels and carton packaging; 3) illegible handwriting on prescriptions; and 4) overlapping product characteristics, such as the drug strengths, dosage forms, and dosing intervals.

Individuals who take Requip, Risperdal, or their generic equivalents are reminded to take note of the name and appearance of their medication, know why they are taking it, and to ask questions when the medication appears different than what they expect. Healthcare professionals are reminded to clearly print or spell out the medication name on prescriptions and make certain their patients know the name of their prescribed medication and their reason for taking it.

For additional information on this FDA drug safety alert, please link to: http://www.fda.gov/Drugs/DrugSafety/ucm258805.htm

Heat Alert

We’ve had a few hot days in Minnesota, and hope you all are beating the heat.

Individuals on certain medications may be more vulnerable to heat stress. Persons taking regular medication should consult with their physician.  Some medications cause an adverse reaction in hot weather, such as reducing a person’s ability to sweat. If you are on such a medication, or if you know someone who is, please take a look at these strategies for managing heat stress.

To avoid heat-related illness:

  • Avoid, as much as possible, working or playing in the hot sun or other hot areas.  If you must be out in the sun, wear a head covering and sunscreen.  A wide brimmed hat or visor will not only protect your head from intense rays of the sun; it will also provide a shield for your eyes.
  • Shut blinds and open windows slightly during the day to release trapped hot air.  Use air conditioners if you have them.
  • Wear lightweight clothing.
  • Drink plenty of water and fruit juices; avoid alcohol, carbonated or caffeinated drinks.  Because the body loses fluids in the heat, drinking lots of liquids helps to avoid dehydration.
  • Eat frequent, small meals; avoid high-protein foods
  • Take cool baths or showers—cold water can lower body temperatures 25 times faster than sitting in an air-conditioned room
  • Spend time (even 2 hours will reduce the risk of heat-related illness) in an air-conditioned environment or basement; cover windows to block direct sunlight; turn lights on low or off; use fans to blow hot air outside.  Public libraries, community centers or other similar locations may be a good option for spending some time away from the heat.
  • Do NOT direct fans to blow in at you.  Fans can actually increase heat stress.
  • Do not leave older people, children, or pets, alone in cars.

Non-emergency questions about how to stay cool—call 2-1-1 or for emergency heat-related health problems—call 9-1-1

Anti-inflammatory drugs may decrease the effectiveness of SSRI antidepressants

A study published online in the Proceedings of the National Academy of Sciences, suggests that anti-inflammatory drugs may decrease the effectiveness of SSRI antidepressants. Researchers at the Fisher Center for Alzheimer’s Disease Research at The Rockefeller University found that mice that were treated concurrently with SSRI antidepressants and anti-inflammatory drugs had diminished behavioral responses compared to mice treated with SSRI antidepressants alone.  To see if this finding had the same effect on humans, the researchers examined data extracted from the completed National Institute of Mental Health funded STAR*D study. The findings from the STAR*D data showed that individuals that were depressed and taking an SSRI antidepressant and an anti-inflammatory drug were less likely to have their symptoms relieved (40%), compared with individuals that were depressed and taking an SSRI depressant, but not taking an anti-inflammatory (54%).

Experts caution that this is a preliminary study and further studies need to be done. Individuals should not change their medication regimen based upon these recent findings, but should follow the advice of their prescribing physician.

Is your medical care working for you?

Care Manager vs. Primary Care Provider…does it matter who you are seeing in regards to your health?  In some cases it may.  NIMH supported research has shown benefits for people with multiple medical conditions who use primary care plus case-managed care.

According to CMSA, the term “case management” is defined as “collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes.”

To evaluate the effectiveness of this combined approach, Wayne Katon, M.D., of the University of Washington, and other colleagues conducted a study that zeroed in on methods of care for patients with diabetes or heart disease and depression.  Patients such as these, on average, tend to practice poorer self-care methods and experience more complications due to treatment.

To aid in decreasing these detrimental issues researchers developed a model in which a nurse care manager and primary care provider coordinated care.  This approach was used to ease depression symptoms and improve medical conditions.  Of the 214 patients that participated in this study, half experienced a 12-month trial with the additional case management. In this trial the nurse care manager’s role was to act as an advocate for the patients by informing them about their medical condition and by motivating them to take a more proactive role in their treatment.  The remaining half of the patients were treated with usual care, solely by a primary care provider.

The two groups were compared and the result of this study showed that patients experiencing the case management found it to be a successful approach.  More  of these patients reported a decrease in depressive symptoms, improved blood glucose levels, and improved blood pressure when compared to patients that only received the primary care.   The recipients of the additional resources also reported better overall wellness and felt their care had improved.

Currently in action, The Diamond Program and MN 10 by 10 have been implemented in Minnesota to promote  holistic approaches to mental illness.  The Diamond program includes primary care physicians, consulting psychiatrists, care managers, and other mental health specialists working together to provide the best care for patients.  The care manager plays an important role in this process in that they manage the components of the program for the patient.  The patient is responsible for taking an active part in their own care. MN 10 by 10 aims to reduce early mortality of the persons with mental illnesses by 10 years in 10 years. Similarly, this program focuses on improving primary care by educating health care professionals (social workers , case managers, primary care physicians, counselors etc…).  They also provide information such as health check lists are available to patients so they can learn how to get the most for their doctor visits.

At the end of the day it is important for these programs to continue educating health care professionals on how to built the best possible care for individuals faced with multiple medical conditions.  This will hopefully generate more satisfied patients who then become motivated to take better care of themselves.

At MHAM we offer Steps to Wellness that can be use as a helpful guide in learning how to motivate yourself in terms of improving your own wellness. To order the Steps to Wellness kits, please call us at 651-493-6634 or kits can also be ordered online. Individual items from these kits can be downloaded from our website as well. Providers that need multiple copies, please contact Brett Dumke, Education Coordinator, at [email protected].

This post was written by Jahna Sandkamp, who is interning with MHAM this Spring.

It’s not that simple…

By Ben Ashley-Wurtmann, MHAM Policy and Outreach Associate

In the wake of the tragic shooting in Arizona, many people have been asking questions about the mental health system and how it responds to individuals who may be capable of violence.  We believe that a strong health system is better able to handle individuals in crisis when it focuses on providing a strong continuum of care.  When every case is an emergency, few people will get the kind of care they require.  However, some of the discussion around the nation has been focused on the perceived danger presented by “the mentally ill.”

The truth is that people with mental illnesses vary greatly in terms of the symptoms they experience, the personalities they have, the experiences they have lived through, and the extent to which their illnesses affect their daily life.  Simply put, there is no one experience of mental illness, or even a particular condition, such as schizophrenia.

An interesting article was posted by the Wall Street Journal, questioning the validity of link of violence and mental illness caught our attention.

But another, more recent study showed that people with schizophrenia are no more likely to commit violence than those without mental illness. That research did find an increased risk of violence among those with schizophrenia who are also using drugs or alcohol.

Complicating things is that even if someone with schizophrenia commits a violent act, the illness isn’t necessary[sic] the reason for the behavior, say experts. With regard to Loughner, “my concern is that people immediately leap to the explanation that [the mental illness is] the master answer to why he committed this crime,” says Swanson. “It’s much more complicated than that.”

These are both important points to keep in mind.  Mental illnesses do not automatically make people violent, nor do they explain everything there is to know about a person.  More than ever, the public understands that mental illnesses are biological and treatable.  Unfortunately, this has not led to a reduction in stigma. This is an ongoing conversation at MHAM as we pursue our vision of improved lives for people with mental illnesses.  You can find more about how stigma works and how we are changing our struggle against it in our recent newsletter (page 4), on our blog, in the news, or by contacting us at [email protected].

Expanded Medical Assistance

As promised and expected, Gov. Dayton signed an executive order to expand Medical Assistance (MA) eligibility for single adults under %75 of the poverty line.  Federal law will expand eligibility even more in the future, but these changes are not scheduled to take place until 2014.  In the mean time, states are being given options to begin the transition early.  Under Gov. Pawlenty, Minnesota had declined these funds, but signed a compromise that would let the next Governor to take action.

Dayton’s signature on this is a major step forward.  MA, unlike the weakened GAMC plan that emerged last session, is a comprehensive plan.  It allows eligible individuals to seek treatment at any number of hospitals and clinics, not just a handful of locations in the Twin Cities.  Unlike Minnesota Care, it offers real coverage for expensive inpatient hospitalization for those least able to afford it.  While we are still waiting on information about how long the transition will take place and individuals are enrolled, we are very heartened to have good news to share.  Particularly for individuals who have lost work or housing and are living with mental illnesses, Medical Assistance represents a better hope for good quality medical care.

This is going to be a difficult legislative session, as the Governor and Legislature wrestle with a 6.2 Billion deficit.  Further cuts are all but inevitable.  With expanded MA, more low income individuals will be able to access resources they need to keep themselves healthy and safe.  For Minnesotans with mental illnesses, this is a victory.

Please stay tuned for further updates and stay in contact with your state legislators.  You can find out who represents you here.  They need to hear from you early and often as they consider the steps necessary to balance the State’s budget.  Let them know why your services are important to you and your community.

Proposed Rule Changes by Social Security Could Markedly Reduce the Eligibility of Persons with Mental Illness

The Social Security Administration (SSA) is looking at making some very important changes to the mechanisms by which disability is determined for people with mental illness. The proposed changes would probably be expected to make it much more difficult to be found disabled by the SSA if the primary basis of disability is a mental illness.

The Bazelon Center for Mental Health Law has studied and provided a recap of the proposed rule changes Major concerns revolve about the proposed implementation of standardized tests and eligibility determinations hinging on the number of standard deviations from the mean on the new standardized tests. Bazelon projects that only one to two percent of the nation’s population will qualify as disabled as a result of a mental illness under the rule change if adopted. This is far below the most conservative of the estimates of the people with mental illness that are thought to be unable to work.

There are no standardized tests that have a body of evidence that suggest the tests will be able to predict an individuals ability to work Adoption of the proposed rules can be expected to result in many people being turned down by Social Security, but who will not, due to their mental illness, be able to work.

You may express your concerns and/or objections to the proposed rule changes to the Social Security Administration, but you must do so by November 17, 2010. Address your comments to the SSA by one of the following methods:

Go to the http://www.regulations.gov/search/Regs/home.html#home website and search for docket number SSA-2007-0101 and follow directions.

or Fax the SSA at 410-966-2830

or mail the Office of Regulations, Social Security Administration, 137 Altmeyer Bldg., 6401 Security Boulevard, Baltimore, MD 21235-6401

The Future for Anti-Depressants

In the United States alone, nearly 15 million adults suffer from a major depressive disorder. Though there are several treatment options, many of the medications that are prescribed to patients with depression have a delay in their onset of action. During this time, the patients’ condition may even deteriorate to dangerous levels.  Despite this, there are signs that research by pharmaceutical companies on depression medications has slowed.

This creates a strong need to find a drug that will begin to work soon after beginning therapy.  One possibility has come through drug studies on Ketamine by the National Institute of Mental Health.  This research has shown a possible route to more quickly treat patients who suffer from depression and bipolar disorder.  Previous NIMH studies have learned more about the receptors that are acted on by this drug.  Now, they have focused on predicting which patients will see the benefit of this kind of treatment.

In this recent study, researchers found that activity in the pregenual anterior cingulate cortex (pgACC), the area of the brain that has connections to both emotional and cognitive brain centers, provided indicators that patients would respond to therapy using Ketamine.  For patients with certain activity patterns, the drug worked quickly and effectively to relieve symptoms of depression.  The authors noted that areas of the brain normally associated with emotional control were at work for these patients, even when given a task with no emotional content.

Unfortunately, Ketamine has far too many side effects to be used widely.  In fact, it can be abused as a recreational drug.   Side effects can include hallucinations and euphoria when the drug is given in high doses.  Ketamine is a most often used as an anesthetic during minor surgery and is approved by the Food and Drug Administration at much higher doses. Nonetheless, its use is limited because there have been cases where patients have hallucinated while recovering from anesthesia.

While this particular drug may never be used to specifically treat depression, this research has revealed a great deal about how this drug works, and the function of brain receptors in the treatment of depression.  Hopefully, this will lead the way to developing a new generation of faster-acting medications. However, until more research has been done, it is important to be patient with trying new medications.  Working with your doctor by discussing improvements or side effects of certain medications is a good start to creating a treatment plan that works for you.

This post comes from our guest blogger, Margo Tell.