Rough Sleepers September book club selection

Our book club assignment for September is Rough Sleepers by Tracy Kidder.  Here is a summary of a model program from 1985 to the present at its website with a description of the book. Our History | Boston Health Care for the Homeless Program (bhchp.org)

"2023:  Rough Sleepers: Dr. Jim O’Connell’s Urgent Mission to Bring Healing to Homeless People by Tracy Kidder is published. Kidder tells the story of Dr. Jim O’Connell, (Boston Health Care for the Homeless Program) BHCHP’s founding physician and the BHCHP Street Team as they offer medical care and friendship to “rough sleepers”, our patients living on the streets. Tracy Kidder, a Pulitzer prize-winning author followed the Street Team for 5 years resulting in this New York Times bestseller.

Rough Sleepers appears on the cover of the New York Times magazine with a 10,000-word author essay by Tracy Kidder and a photo montage of patients cared for by the BHCHP Street Team.

Barbara McInnis House respite program [in 2023] opens the Complex Addiction Treatment (CAT) team specializing in the respite care of people with active SUD using best practices from addiction medicine, harm reduction, and trauma informed models of care. This is a unique model of care: The team’s goals are 

(1) to provide effective care to respite patients at BMH who are at high risk for adverse outcomes related to drug use 

(2) to retain these patients in care at BMH to address the medical need(s) for which they were admitted and 

(3) to decrease triggers and trauma for patients in respite who are not using drugs by cohorting and better supporting patients for whom cessation of use is not an option."

Additional information

Find Immediate Homelessness Assistance | SAMHSA

Need Housing Assistance? - HUD Exchange

"SAMHSA’s SOAR program increases access to Social Security disability benefits for eligible children and adults who are experiencing or at risk of homelessness and have a serious mental illness, medical impairment, and/or co-occurring substance use disorder." However I found it so complex, I couldn't figure it out. Find Treatment Locators and Helplines | SAMHSA  Definitely would require a whole department of specialists. But I also looked at the number of applicants in 17 years this department has helped, and I was not impressed.

"Under federal disability rights laws, alcohol addiction, whether current or past, is typically considered a disability due to the effects it has on a person’s brain and neurological functions and is protected by the ADA. 7 On the other hand, though drug addiction is generally considered a disability, the ADA only allows protections for those in recovery and not currently engaging in illegal drug use. 7

Is Addiction a Disability? ADA Protections & Disability Benefits (americanaddictioncenters.org)

Dr. Jim O'Connell wrote a memoir in 2015. House Calls To The Homeless: A Doctor Treats Boston's Most Isolated Patients : Shots - Health News : NPR

Medicaids-Role-in-Housing-1.pdf (macpac.gov)

Thousands in Columbus are waiting for affordable, Section 8 housing (dispatch.com)

The Right to Fail—PBS

Pro-Publica and Frontline reporting on moving high functioning mentally ill people out of managed homes to supportive “independent” living. The reporter Joaquin Sapien  focuses on Nestor Bunch who at 52 was living on his own for the first time. He was in and out of supported housing, hospital, had roommates, and a 4 hour a day aide.

The complexity of care—and caring—really surprised me.  The reporter had access to boxes of medical records.  Everything was recorded—successes, failures, medications, roommates.

I’ve seen a lot of criticism from Democrats of Ronald Reagan when he was governor of California for signing the law that closed the institutions for the mentally ill, and they say, no accuse, that he is the reason for California’s terrible homeless problem.  However, it was an idea about “rights” for the mentally ill that came from academics.  So I was shocked to see the same reasoning still applies today, as NYC tries to reduce its population of seriously mentally ill from protective, and even locked, housing for many adults, and turn them lose in the name of “right to fail.”

None of the people in this film appear to be “high functioning” to me, however, I don’t know to whom they are compared. They are desperate, lonely,  afraid, wandering the streets, getting into fights, eating poorly, with no socialization. Nestor Bunch was one of the fortunates in that a friend of his deceased mother still cared and looked out for him through the machinations of the huge bureaucracy.

“People with severe mental illness can be difficult to track: some wind up on the street or in psychiatric hospitals; phone numbers often change. After a series of dead ends, I was elated when I found Bunch — until I realized he could not reliably narrate his own life. As he jumbled the timeline of his addresses and experiences, it became clear he had a traumatic story to tell. It involved finding his first roommate naked and dead, landing in the hospital with a serious injury and being sent to the trash-strewed apartment of another roommate who died.”

https://www.pbs.org/video/right-to-fail-fz7iaq/

https://www.pbs.org/wgbh/frontline/article/behind-right-to-fail-a-propublica-frontline-collaboration-to-overcome-roadblocks-and-privacy-restrictions/?

For those who have family with mental health issues

This young lady is the daughter of a friend.  Not sure of her age, but she’s about 19-20. I spent some time with her about 7 years ago when she was in middle school—such a sweet, beautiful child.  We have been praying for her and her mother. Recently she had some serious problems, and today posted this:

“Hi all, I just thought I would share with you what 2019 has held for me so far. I’ve been through some stuff I wouldn’t wish upon my worst enemy. I’ll start with my most recent “adventure”. I’ve struggled with mental health issues for just about as long as I can remember, whether it be anxiety, depression or Bipolar 1. These past 9 days I was hospitalized due to these issues and I would like to share my experience in hopes to help anyone going through something similar.

I was at the lowest of the low. I was unstable, depressed, hopeless, dissociated, anxious you name it. I wasn’t sleeping. I wasn’t eating. I lost 20 pounds in the past month or so. Even though I have a strong support system, I had never felt so alone. I couldn’t describe in words how awful that feeling was.

The first night I was there, I wished that I wasn’t alive. I wished that I had never been born. I wished I could fall asleep and never wake up. Looking back now, I want to tell myself that everything was going to get better with each passing day.

I met some incredible people during my stay in which I hope to keep in touch with for the rest of my days. Hearing people talk about their experiences and being able to relate with you and talk through your problems, is the most amazing way to start your healing process. I cried with them, I laughed with them, but most importantly they taught me that having mental health issues is okay. They taught me so many valuable skills and lessons that I will cherish for the rest of my life. During any future struggles I may have, everything I’ve learned from them will help me come out stronger than before.

Through this experience, I’ve learned not to be ashamed or embarrassed. I’ve talked about my problems, which is totally not my style, but it’s helped immensely. I’m happier, I’m healthier and I have a whole new, positive, outlook on life. I will continue to better myself day by day.

I thought I had no way out. It felt like there was no light at the end of the tunnel. Some of you may be able to relate in your own ways, some of you may not and that’s perfectly okay.  . .

Thank you to my Family, Friends and everyone else who has supported me through my struggles. I appreciate it so very much and I don’t know what I would do without you!”

Guns purchased by Social Security recipients?

There is no national data base of the mentally ill that I'm aware of. Yet I know people concerned that the latest restriction on the 2nd amendment defeated on Wednesday was to protect us from them. Obama wanted to identify people based on their Social Security status as needing 3rd party assistance to receive benefits so they would be flagged in the National Instant Criminal Background Check System. Is that legal for denying other rights, like speech or religion or assembly? I can't imagine that advocacy groups for the disabled didn't take this on as a very slippery slope. 

The man who robbed, raped and murdered a 21 year old OSU student last week as she left work probably wouldn't have been on that sweep of people who receive benefits, but he had recently been released from prison with a rap sheet, including sexual assault, going back to his pre-teen years. Is that a mental illness or just a very sloppy judicial system?

Obama's Executive Order squeaked through in late December probably just to irritate the gun lobby, but was first proposed in 2012 after the Sandy Hook killer was determined to be mentally ill. The problem is this rule wouldn't have caught him. He stole his mother's guns and first killed her before going to the school.
 http://www.breitbart.com/2nd-amendment/2016/12/23/obama-administration-finalizes-social-security-gun-ban/

https://obamawhitehouse.archives.gov/the-press-office/2016/01/04/fact-sheet-new-executive-actions-reduce-gun-violence-and-make-our

Were serious signs overlooked?

I was watching news coverage of the mental state of the former TV news colleague in Virginia who killed two reporters of WDBJ-TV live on camera yesterday then uploaded his murders to Facebook like an ISIS terrorist. Other colleagues said he interpreted everything as racial. It's unfortunate that someone didn't spot his problem--or maybe they did and were afraid to say it out loud for fear of being called racist.

About 45 years ago, and I still haven't forgotten her, a pleasant, plump, middle aged woman joined our adult education committee at First Community Church. She mentioned she was a faculty wife and her husband taught at Ohio State. There was the usual chit chat and joking as we all introduced ourselves, and suddenly her face clouded, and she said (paraphrase), "I know you are all in on it; you know about my husband's affair; you're covering for him; I won't stand for it."

We were all just stunned. Apologies were made for anything offensive we'd said, the meeting proceeded, but after the meeting we all got away from her as quickly as possible. Of course, we were not at fault—she was obsessed with her marital problems and decided we all knew.

The crisis in mental health beds

Perhaps you watched 60 minutes Sunday night about Austin Deeds, son of Virginia state Sen. Creigh Deeds, who left a Virginia hospital emergency room, went home, stabbed his father, and then killed himself. He was mentally ill, and there were no hospital beds. The implication of the story was that America has failed, won't financially support treatment for the mentally ill. But I was around in the 1970s when there was another "civil rights" movement for the mentally ill, led by former patients of institutions, social workers, academics and church do-gooders. With new drugs, small group homes, counseling, etc., large institutions weren't needed, we were told.

In the late 70s we took a friend having a break down to Riverside hospital, he wasn't even a citizen, and he was treated for a week or so, got counseling, drugs, and his life was saved and today is a functioning, healthy person. That couldn't happen today. There are no beds. Take someone to ER today having a breakdown and you might get a few hours of help. And it was liberals, not conservatives, who did this. If the mall shooter of last week in MD had shown signs of his mental illness, his mother would have been helpless, as was the mother of the Sandy Hook shooter. We called it civil rights then; today we call it helpless to save them.

Some bi-polar and schizophrenic people do very well on medication—so well that they decide not to take them any more. But parents can’t always intervene if they are adults, and their hands are tied to get help.  Such a story was told in the December issue of (614) of Adam Helbling who felt a huge let down on medication and he was no long Jesus Christ. We did them no favors when we closed the care facilities in favor of medication.  Both are needed.

 

 http://nation.time.com/2014/01/27/lawmaker-whose-son-attacked-him-faults-mental-health-system/

The Columbia Mall Shooting

They always look for motives. He wasn't poor—a preppy; he graduated from a great pubic high school; he had a job; was environmentally conscientious; liked by others; loved by his family.  But he was suicidal and apparently did want to be known before he left this life. There are common denominators in these tragedies--young and male and mentally troubled. Three dead (including the shooter) and five injured.

http://www.washingtonpost.com/local/crime/2014/01/27/

Darion Marcus Aguilar

Two law enforcement officials, speaking on the condition of ­anonymity because the investigation is ongoing, said Aguilar kept a journal in which he described suicidal thoughts. When the young man’s mother reported him missing Saturday, they said, a police detective was sent to the home. He began reading the journal, but Aguilar’s mother demanded he stop.

Later, after authorities identified Aguilar as the shooter, police seized the journal. In addition to the references to suicide, it contains notes expressing hatred of certain groups, according to the officials, who did not elaborate in detail.

Update: "Howard County police said they have reviewed Aguilar's journal and are examining his cellphone and a home computer, but have found nothing that connects him with the victims. Of the journal, authorities said only that Aguilar "knew he was having mental health issues. . . For more than a year, Aguilar had lived with his mother in the 4700 block of Hollywood Road in College Park — about a half-hour drive from the mall. Before that, Aguilar and his family lived in Silver Spring, about 20 minutes from the mall.

Aguilar did not have a driver's license, according to a Rockville gun shop owner who sold him the shotgun used in the attack. Aguilar used a state learner's permit for identification when he bought the gun Dec. 10." Baltimore Sun

Bi-polar disorder in children

For the general population, a conservative estimate of an individual’s risk of having full-blown bipolar disorder is one percent. Disorders in the bipolar spectrum may affect 4 to 6 percent. When one parent has bipolar disorder, the risk to each child is 15 to 30 percent. When both parents have bipolar disorder, the risk increases to 50 to 75 percent. The risk in siblings and fraternal twins is 15 to 25 percent. The risk in identical twins is approximately 70 percent.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695748/

A peek at government health care in today's Dispatch

There's a brief article in the Dispatch today that is a peek at what we all can expect when the government controls our health care: lawsuits, people not signed up, information arrives too late to be useful, appointments are not set up, qualified recipients don't receive their medicine or services, or they are lost in the system.

Now this story involves a very small group, incarcerated mentally ill. How hard can they be to keep track of and serve with medication? It seems one in four declines post release services, but that hasn't kept advocates for nine former inmates from suing Ohio for more services. More of the mentally ill refuse post-prison help | The Columbus Dispatch

When you hear the sob stories in the MSM about Americans who die without health care (which is untrue because we have laws that require their treatment, even for the illegals and no amount of "preventive" medicine helps alcoholics, overeaters and smokers if they refuse to change), keep in mind that many people eligible for services either don't apply, or find the process so complicated and daunting they give up. There is so much red tape strangling the poor, the homeless, the mentally ill, the confused and the elderly, it's not surprising that millions don't use the health programs to which they are entitled. Without a family member advocate, many of the programs are useless. That won't change regardless of the trillions Obama throws at the problem. His intentions are evil; the results won't be any better because this take-over has nothing to do with health.

Death at the Camp Liberty Counseling Center

“Monday's shooting also raises new questions about how the U.S. military screens and treats soldiers suffering from post-traumatic stress disorder and other combat-related psychological maladies.” Wall St. Journal story . WSJ, the most liberal newspaper in the country, provides a nice side bar chart of all the military deaths for the last 7 years--less than the number of teens we lose in a year of auto accidents or soldiers in one battle in WWI.

Yes, and the anti-war, anti-military talking heads will come out of the wood work on this one. Actually, have you ever worked or associated with a mentally ill, depressed or “stressed” person and tried to get help? There is no easy way to do this--I’ve experienced it and you might be safer to transfer or quit rather than try to battle the system that protects everyone except the friend, co-worker or boss who knows there’s a problem. Just yesterday I stopped to visit an OSU friend--we worked together 30+ years ago, and Oh the stories we could tell about our former boss whose mental stability was fragile (she was brilliant, but thought everyone else was dumb and against her). At one incident (physical danger) we just stood in terrified disbelief and one of the calm Christian student employees, who probably didn’t know enough to be scared or felt closer to God than I did, softly and quietly talked her down. She wasn’t fired or transferred--but her contract wasn’t renewed the next year and she went on to become someone else’s problem at another university.

The Virginia Tech Korean immigrant student Cho had a long history of problems and “help” dating back to middle school before he went on a killing rampage, as did the immigrant center killer Wong in Binghamton. And for all the talk about “bullying” in schools after Columbine launched a thousand workshops, that turns out not to be the case in so many situations. We have a local case in Ohio where a teen has committed suicide after sexting her own nude photos, but the parents want to blame the school for not confiscating cell phones and checking them (this is illegal). And like the unfortunates at those other “gun free” zones, “Troops at Camp Liberty are supposed to keep their weapons unloaded, which may have made it harder for soldiers at the clinic to defend themselves when the assailant started shooting.” Obviously, the shooters don’t follow all the rules, do they?

I’m thinking a lot of people who worked with Army Sgt. John M. Russell knew he was in trouble--the trouble he hid from his family and close friends, because if you are stressed or depressed or even paranoid--you aren't that way 24/7. He loved the military and obviously wanted this career--he wanted to stay in, and he hadn’t risen in rank. The investigation hasn't happened yet but we know the military and the war will be blamed--at least in the media. We don’t even know how much combat he’d seen; but someone knew there was a problem and referred him for help. And 5 people died. At least six families are suffering, and our prayers are for them.

Men: are you depressed?

And I don't mean about a serious international incident as Joe Biden promised us if we elected Obama. No, this is the depression we were told about in the Surgeon General's report in 1999: About 20 percent of adults will experience depression during their lifetime. Within this 20 percent, an estimated 6.4 million American men will suffer from depression each year. So you see, you are already a minority in this problem, just by being a male, because women have cornered this health problem.

But there's no money in studying depressed white men even though they would be the majority of this minority--German Americans, Irish Americans or descendants of Swiss Mennonites. So "disparity" is the necessary key word to get funding just as it is in many lucrative health grants. If you can't find it in the lab with real research and cure it, or develop a drug to treat it, then find it in the data, graphs, charts or neighborhood anecdotes and put people into race based studies. On November 6, 2008 there was a conference, Symposium on Health Disparities in Male Depression, supported by a $25,000 grant from the Robert Wood Johnson Foundation to alert the various professional organizations, non-profits, insurance companies and government officials of the cultural barriers, stigma and treatment minority men suffer with depression. When wealthy foundations provide this kind of money to launch something, it is the signal that prevention and policy money from the government will be forthcoming for this problem. Oink, oink. Come to the trough, for all is ready.