Background

Mary Jane Rotheram-Borus, Ph.D., of the University of California, Los Angeles, and colleagues examined the effectiveness of the NIMH-funded Healthy Living Program among a subgroup of HIV-positive adults. The program was designed for HIV-infected adults in general who continued to engage in risky behavior after learning of their infection. It consists of three intervention modules of five sessions each, designed to help participants reduce risky sexual behavior and drug use, improve their quality of life and stick to healthy behaviors.

A previous trial with 737 HIV-infected adults found the program to be effective in reducing risky behaviors. For this study, the authors analyzed data from 270 participants who were homeless or had been homeless in the three years prior to and during the study.

Results of the Study

Compared with a control group who did not receive the Healthy Living intervention, the authors found a significant reduction of risky sexual behavior among the subgroup. Up to 34 percent fewer risky sexual acts took place, and 72 percent fewer sexual encounters occurred with partners who were HIV negative or of unknown HIV status. In addition, individuals in the subgroup experienced up to 26 percent fewer days of alcohol, marijuana and hard drug use.

Significance

In the United States, HIV infection is more commonly found among populations with significant life stressors, such as homelessness and drug use. The results of this study highlight the importance of programs designed to prevent or reduce the spread of HIV among these specific populations. It also supports the notion that intervention programs that focus on skills development and target both the physical and mental health needs of participants are more likely to succeed than programs designed only to reduce HIV transmission rates.

What’s Next?

Future research into intervention programs such as Healthy Living are needed to identify the most effective components and determine if the programs can be applied on a wider scale. Future research also can examine how, in what format, and by whom the next generation of programs can be implemented.

Reference

Rotheram-Borus MJ, Desmond K, Comulada WS, Arnold EM, Johnson M, Healthy Living Trial Group.Reducing risky sexual behavior and substance use among currently and formerly homeless adults living with HIV. American Journal of Public Health. Nov 08. 98(11).

NBC’s show is designed to be a social experiment placing teenage couples in many different family situations, which includes “borrowing infants and toddlers for a few days to get a taste of parenthood.

The APA issued this statement:

“The American Psychiatric Association deplores the use of babies and toddlers as props or experimental subjects for a television program. It is inappropriate and sometimes harmful to remove very young children from their families and familiar environments, and the level of harm may not be apparent on simple observation. Since the program is meant to reveal whether or not the ‘borrowers’ are competent to care for these children, at least some of the children will have been exposed to incompetent and confused caregivers, and to whatever problematic situations arose as the caregivers struggled with each other. We urge NBC never to repeat this misuse of children; not to allow reruns to air; and to use every means to discourage the use of episodes in parenting classes or other venues where they might well be shown.”

The American Psychiatric Association is the nation’s leading medical specialty society whose more than 38,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at www.psych.org and www.HealthyMinds.org.

ALEXANDRIA, VA. (July 1, 2008)-The reports today of the death of a mental health patient in the Kings County Hospital psychiatric emergency room are deeply troubling and demand further investigation to determine the root cause of this incident.  Given the problems that were first raised in a federal lawsuit filed a year ago, it should also spur greater scrutiny of the hospital’s administration and practices.

Mental Health America’s fear is that this incident reflects a broader public attitude that devalues individuals with severe mental health conditions who are served in public systems.   We call on people who share our abhorrence at these acts to continue to combat the ignorance and discrimination that still exists toward people with mental illnesses.  If appropriately treated people, even with the most severe illnesses, can and will recover.  Hope and respect are central components of this treatment.  Devaluing people further prolongs their disability and likely contributes to the 25 years of lost life for persons with severe mental illnesses that are served in public systems. 

This incident is also a tragic illustration of systemic problems in public mental health, where needed mental health care is too often provided as a last resort instead of a first response, and where medical problems too often go unrecognized and untreated.   

Those systemic problems go far deeper than breakdowns in psychiatric emergency services.  By their very nature, emergency services are not adequate alternatives for the many people whose illness could be managed before it becomes a crisis

Rather, this tragic incident underscores a real crisis in mental health service-delivery – the failure to invest adequately in early-intervention and other community-based services and supports, even as hospitals have reduced psychiatric bed capacity.  The facts are that over two-thirds of adults and over half of children with a diagnosable mental health condition do not receive the mental health treatment and services they need.  At the same time, people with serious mental illnesses served in the public system die, on average, 25 years early from preventable health problems such as heart disease and diabetes. 

As we discuss and debate “health care reform,” these shocking data highlight the importance of making mental health reform a key component of needed health reform. 

Mental Health America is the country’s leading nonprofit dedicated to helping all people live mentally healthier lives.  With our more than 320 affiliates nationwide, we represent a growing movement of Americans who promote mental wellness for the health and well-being of the nation – everyday and in times of crisis.

Contact: Steve Vetzner (703) 797-2588 or svetzner@mentalhealthamerica.net

According to news reports, a woman who was suffering from agitation and psychosis, was kept waiting in the emergency room for almost 24 hours because the hospital reportedly did not have a bed available for psychiatric patients. She collapsed onto the floor and then lay there for approximately one hour before emergency room personnel tried to revive her. Tragically, the woman died of causes that have yet to be determined.

“The question is how and why hospital personnel could ignore a person who fell to the floor in an emergency room and stood by or walked around her while she died,” said APA president Nada Stotland, M.D. “Still, the lack of emergency services for psychiatric patients is only one part of an overall health care crisis, which extends to and includes mental health services.”

Stotland pointed to a lack of state and community-centered mental health services that can intervene earlier, circumventing a crisis that would lead to the person seeking help at an emergency room that is ill-equipped to handle such crises. The fact is that most hospitals lose money on psychiatric services, and that may play a subtle role in how high a priority the hospital places on mental health cases.

“Incidents like this reflect a complete breakdown of the mental health system,” Stotland said. “There is little continuity of care, and there are few, inadequately funded outpatient services, resulting in repeated mental breakdowns, emergency room visits, and the need for hospitalization in the sickest individuals. Emergency rooms designed and staffed to treat patients with heart attacks and broken bones are faced with hundreds, sometimes thousands, of patients with critical psychiatric problems, often complicated by general medical disorders, homelessness, abuse and a lack of insurance coverage.”

A lack of funding has led to an ongoing shrinkage of the number of hospital beds for these individuals. At the same time, many times hospitals have no emergency room physician on duty that is qualified to handle mental health problems. The difficulty of accessing needed services may only intensify the sense of stigma many patients feel in seeking help for a psychiatric problem in the first place.

“The time to intervene is long before a person finds herself in the position of needing emergency help from a hospital that is ill-equipped to care for her,” Stotland said. “The tragedy is that we know how to help these individuals recover and remain productive members of society; this suffering is needless and ends up costing society as much or more than adequate care would cost. Our society is failing to provide the most basic safety net for our most vulnerable citizens.”

About the American Psychiatric Association: The American Psychiatric Association is the nation’s leading medical specialty society whose more than 38,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at www.psych.org and www.HealthyMinds.org

The National Association of Social Workers (NASW) and its Louisiana Chapter filed an amicus curiae brief in Kennedy v. Louisiana (https://www.socialworkers.org/assets/secured/
documents/ldf/briefDocuments/Kennedy%20v.%20Louisiana.pdf)  arguing that the death penalty for child rape harms the victims it is intended to help.  The Court adopted the reasoning in NASW’s brief as support for its conclusion that the death penalty is a disproportionate consequence for a crime that does not result in the death of the victim.  NASW was joined on the brief by several coalitions of sexual assault treatment providers from across the nation. 

The Supreme Court stated, “It is not at all evident that the child rape victim’s hurt is lessened when the law permits the death of the perpetrator.” (http://www.supremecourtus.gov/opinions/
07pdf/07-343.pdf) It indicated that the repeated testimony required of the child victim in a capital case “forces a moral choice on the child, who is not of mature age to make that choice.”  It also pointed out the concerns cited in NASW’s brief that the death penalty provides an incentive for the perpetrator to kill his victim who is often the only witness, is likely to increase the emotional trauma to the victim due to repeated court testimony about acts of brutality, and may increase the underreporting of child sexual abuse, as perpetrators are often family members.

These factors, taken together, along with the Court’s substantial discussion of the lack of clear consensus among the states on the death penalty for child rape and the evolving standards of decency, formed the basis for the Court’s definitive ruling.

“We are heartened that the Court found the real-life experiences of victims and their families, as well as research on the reporting of child sexual abuse, persuasive.  This ruling supports the investigation and prosecution of child sexual abuse while providing an opportunity for victims to heal,” said NASW Executive Director Elizabeth J. Clark, PhD, ACSW, MPH. 

NASW is the largest association of social workers in the world, with 145,000 members and 56 chapters throughout the United States and abroad.  Professional social workers provide treatment and advocacy for victims of sexual assault and other crimes.  NASW also advocates the adoption of policies that promote assistance for victims of crime and supports research on the effects of crime on victims.  NASW’s brief was prepared by the pro bono legal team of David M. Gossett and Kevin Ranlett from Mayer Brown LLP in Washington, DC and Joseph Thai of the University of Oklahoma College of Law.

About the National Association of Social Workers
NASW is the largest association of social workers in the world, with nearly 150,000 members in 56 chapters throughout the United States and abroad. It promotes, develops, and protects the practice of social work and social workers.  NASW also seeks to enhance the well-being of individuals, families, and communities through its advocacy.

Details…

Philip Wang, M.D., Dr.P.H., formerly of Harvard University, and now director of the NIMH Division of Services and Intervention Research, and colleagues conducted telephone surveys in early 2006 with 1,043 adults who had been affected by the hurricane in Alabama, Mississippi and the New Orleans metropolitan area. Respondents were asked if they had a diagnosed mental disorder, such as depression or anxiety, prior to the hurricane for which they received professional treatment. Those who did not have a pre-existing disorder were asked if they had developed and been treated for a mental disorder since the hurricane struck. Treatment included medication and/or psychotherapy from mental health professionals, general medical providers, religious or spiritual advisors, or complementary and alternative medicine professionals.

Nineteen percent of people surveyed said they had developed a mental disorder after the hurricane. Among them, only 18.5 percent were receiving any treatment. Among the 21 percent of respondents who said they had been in treatment for a mental disorder prior to the hurricane, 23 percent were having difficulty maintaining treatment after the storm, and were receiving reduced treatment or no treatment at all.

Respondents with pre-hurricane mental disorders cited loss of financial resources, such as unemployment and loss of insurance, as a significant barrier to maintaining treatment. In addition, they noted that many mental health care facilities and personnel were lost after the hurricane, especially in the New Orleans area. Those who were identified as having a post-hurricane mental disorder commonly indicated they felt no need to seek treatment. The majority of the respondents who did get treatment after the hurricane received it from general medical providers. Many of these respondents received medication, but few had access to psychotherapy.

The researchers note that their study sample likely underrepresented those who were most disadvantaged or ill because people unreachable by phone were excluded. Wang and colleagues conclude that future disaster management plans should anticipate the mental health care needs of people with pre-existing disorders who need to maintain treatment, as well as survivors who may be vulnerable to emotional difficulties and mental disorders triggered by the disaster itself.

Reference

Wang PH, Gruber MJ, Powers RE, Schoenbaum M, Speier AH, Wells KB, Kessler RC. Disruption of existing mental health treatments and failure to initiate new treatments after hurricane Katrina. American Journal of Psychiatry. Published online ahead of print Dec 17, 2007.

According to a 2006 report by the United States Department of Justice (DOJ), entitled “Mental Health Problems of Prison and Jail Inmates,” more than half of the population incarcerated in U.S. prisons and jails – including 56 percent of state prisoners, 45 percent of federal prisoners and 64 percent of local jail inmates – were found to have a mental illness. Many of these inmates suffer from treatable disorders such as major depression, bipolar disorder and substance use disorder.

On November 13, the U.S. House of Representatives passed, by a vote of 347 to 62, the Second Chance Act, legislation sponsored by Congressman Danny Davis (D-Ill.). The legislation would provide transitional assistance to ex-offenders in an effort to reduce recidivism. Additionally, the legislation would extend and provide a full continuum of care for treatment of substance use disorders. The legislation also seeks to improve mental health screening and treatment and provides grants for family treatment programs. In August, the U.S. Senate Judiciary Committee approved similar legislation, sponsored by Senator Joseph Biden, Jr. (D-Del.).

The Mentally Ill Offender Treatment and Crime Reduction Reauthorization and Improvement Act (H.R. 3992 and S. 2304) aims to improve services for mentally ill prisoners by reauthorizing and boosting funding for a grant program that provides treatment for inmates and training for law enforcement officers who treat them. The House bill is sponsored by Representative Robert Scott (D-Va.) and the Senate bill is sponsored by Senators Edward Kennedy (D-Mass.) and Pete Domenici (R-N.M.). On November 7, the House Judiciary Committee passed H.R. 3992, which will now head to the full House for a vote. On November 5, the Senate introduced S. 2304.

In response to the legislative actions, the APA issued the following statement:

“It is a national tragedy that jails and prisons have become the primary mental health care facilities in the United States today.

“People with mental illness, left untreated, can develop symptoms and behaviors that lead to their arrest and incarceration. Mental health and substance use disorder treatment in appropriate settings is often the answer, and adequate funding for such treatment is urgently needed.

“Ending the ‘criminalization of the mentally ill’ and the inappropriate incarceration of persons with mental illness could prevent unnecessary building of correctional facilities and make room for violent and repeat offenders.

“Providing more adequate funding and cooperative programs between mental health care professionals and correctional agencies is a step in the right direction. Providing these cooperative resources could, in the end, help improve overall public safety.”

“We applaud the bi-partisan action taken by both the House and Senate. If enacted, the legislation would represent significant steps forward in improving access to mental health

services and substance abuse treatment programs in the United States for those incarcerated within the prison system.”

About the American Psychiatric Association:

The American Psychiatric Association is a national medical specialty society whose more than 38,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at www.psych.org and www.HealthyMinds.org.
###

Washington – Upholding the profession of social work’s commitment to human rights and social justice, the National Association of Social Workers (NASW) supports the ability of Guantanamo detainees to challenge their detention through our Constitutional system of  government checks and balances.

The cases, Boumediene v. Bush and Al Odah v. U.S., represent a clear violation of the rights of these detainees to gain access to the courts and to question the legality of their detention.  The cases do not directly address the innocence or guilt of the detainees, but rather the circumstances in which they are being held and their access to independent judicial review.

”Social workers uphold the key tenents of the profession – social justice and human rights — by taking a stand  against the unchecked use of power by the executive branch,” said Dr. Elvira Craig de Silva, NASW president.  “We serve as advocates so that everyone may have access to justice and basic legal rights under our Constitutional system of government.”

The NASW Code of Ethics notes that one of the core values of the profession is social justice.  To achieve social justice, governments must be able to guarantee  access to due process of law.

Habeas corpus is one of the fundamental elements of the U.S. legal system.  To strip courts of jurisdiction to review the legality of the detention overrides the detainees’ human rights.  Social workers’ abiding concern for social justice and human rights underlies our vision of equal access to justice for all people, regardless of where they are detained and for what reason.

The Amicus Brief was filed by The Constitution Project, Human Rights First, Human Rights Watch and The Rutherford Institute through the efforts of a pro bono legal team from Fulbright & Jaworski in Washington, DC.  NASW, along with a coalition of other non-governmental organizations, signed on to the brief, which was filed August 24, 2007.

For more information about this and other briefs that NASW files on behalf of the social work profession, please visit the NASW Legal Defense Fund.

About the National Association of Social Workers
The National Association of Social Workers (NASW), in Washington, D.C., is the largest membership organization of professional social workers with 150,000 members.  It promotes, develops, and protects the practice of social work and social workers.  NASW also seeks to enhance the well-being of individuals, families, and communities through its advocacy.

Over the past two years, the concept of social work advocacy for social justice has been under attack. In 2005, the Chronicle of Higher Education published an article regarding a request from the National Association of Scholars asking the U.S. Department of Education to investigate the Council on Social Work Education for “politicized standards” — encouraging universities to evaluate students based on “their commitment to social justice.” Several social work groups responded to this challenge.

NASW responded by emphasizing that “professional education is the vehicle through which members of a discipline become acquainted with the theoretical foundation and the knowledge base of a profession. It is also the method for socializing new entrants about a profession’s values and ethical standards. Consequently, the social work profession has not only the right, but the responsibility of assuring that new professionals understand the profession’s ethical and philosophical underpinnings.”

Our response concluded by stating, “NASW proudly embraces and supports the guiding value of social work justice in social work education and practice.”

Also in 2005, social work advocacy came under public scrutiny. Emily Brooker, a social work student at Missouri State University, with the help of the conservative Alliance Defense Fund, sued the university in federal court for religious persecution. The suit was based on an assignment related to advocacy that Ms. Brooker claimed violated her Christian beliefs. She alleged that she was given a poor grade because of her refusal to sign a letter supporting adoptions by gay couples.

Ms. Brooker was enrolled in a course being taught by social work professor Frank Kauffman. The syllabus for the course indicated that the course included the advocacy element of social work.

The university settled the lawsuit out of court, so Ms. Brooker’s allegations were never proven or discounted. According to a recent article (March 2007) by Alan Cooperman in The Washington Post, both Kauffman and Brooker “insist they were misunderstood.” Kauffman, a former assistant pastor in the Assemblies of God church, maintains that in the classroom, he has always given equal time to everyone’s views.

Why is this issue still getting media attention in 2007? Partly this is due to the fact that in April 2007, the Missouri House of Representatives passed the Emily Brooker Intellectual Diversity Act with the goal of protecting students from “viewpoint discrimination.”

Also related to this issue, in March, Stanley Fish wrote an editorial titled “Advocacy and Teaching” for The New York Times in which he stated that “advocacy is just not what should be going on in a university.” NASW President Elvira Craig de Silva sent a letter to the editor of the Times in which she clarified that “social work requires its members to advocate for individual clients and for systemic reform that improves communities.”

As social workers, we all must stand to differ with individuals and groups such as Stanley Fish, the Alliance Defense Fund, the National Association of Scholars and the Missouri House of Representatives. We cannot allow other groups or individuals to define or limit our profession.

Advocacy is the cornerstone on which social work is built. It is so important that it is framed in three sections of our Code of Ethics. Advocacy for individuals, communities and systems is not just a suggested activity for social workers. It’s not a “do it if you have some extra time” or a “do it if the inequity and disparity are very great” activity. It is a requisite.

Most of us came to the profession of social work to make a difference, to bring about positive social change, to better society. We could have chosen other professions that focus mainly on the individual, on intrapsychic issues rather than on the person-in-the-environment. We could have chosen psychiatry, psychology, mental health counseling or psychiatric nursing. We didn’t.

We became social workers and committed our careers to working not just with, but on behalf of, others. We work towards ensuring healthy individuals, functioning communities and a better society. That’s where advocacy comes into the picture. The Social Work Dictionary defines “advocacy” as “the act of directly representing or defending others — of championing the rights of individuals or communities through direct interventions or through empowerment.”

If being a social worker means standing up for others — all others — and trying to better society, then our critics are correct. We are guilty as charged — and we are unapologetic. Without advocacy, there would be no social work profession. And without social workers, this country would be a much less hospitable and caring place.

To comment to Elizabeth J. Clark: newscolumn@naswdc.org