New mental health programs, medications unveiled at NAMI meeting

Wednesday, October 29, 2008

As the National Alliance on Mental Illness of Northwest Iowa (NAMI) hosted its annual meeting in Spencer, participants not only learned about new types of therapy, programs and services being offered locally, they were also informed of several new medications available to treat various medical illnesses.

As state Rep. Mike May, (R-Spirit Lake), assured those in attendance that he looks forward to hearing from them about issues affecting them, he also painted a gloomy budget picture.

"I'd like to tell you that the funding issues we're concerned about today are going to be rectified and we're going to take care of them. But you know that's not the truth," he said. "If I had my way, we'd pay for mental health care in the state of Iowa at the state level. Now having said that, you know the problem just as well as I do: The state makes promises and then it doesn't keep the promises that it makes. ... But you have to hold us to the fire on that.

"Again, the budget does not look good. We underfund Medicaid every year and we underfunded it by at least $50 million this year. It looks to me like when the Revenue Estimating Conference comes around, they're going to say that we're going to have an additional $8 or $10 million in the budget and we're going to have a deficit close to $50 million in Medicaid. ... We're going to try to find a way to keep our commitment to you because we're not giving you enough to begin with, and we darn well better try to protect at least what we're giving to you."

While it's true that mental health funding for counties has been compromised due to 2002 budget cuts, which have not yet been recouped, meeting attendees learned that several creative ways are being offered locally -- including dialectic behavioral therapy (DBT), the local peer support program (PSP) and the Integrated Service Pathways (ISP) project -- to help persons in need.

Dialectic Behavioral Therapy

Seasons Center for Community Mental Health employees Julianne Klesel and Alison Brennan offered an overview on this type of therapy, which was originally designed for people with borderline personality disorder. The local DBT group class offered is based on Marsha Linehan's approach to assist with solving difficult emotional and interpersonal problems to improve everyday functioning.

Participants accepted in this group are required to attend individual counseling sessions and may have additional diagnoses such as major depression, bipolar disorder, post-traumatic stress disorder, anxiety disorders, eating disorders and/or substance abuse disorders. Group objectives include improving participants' disorganized or confused thinking, eliminating life-threatening and impulsive behaviors, reducing emotional sensitivity and reactivity and improving abilities to act effectively in relationships.

"It's very helpful for decreasing hospitalizations, increasing skills, decreasing self-harm or increasing any behavior that is challenging to their life or causing them distress," explained Brennan, a DBT coordinator. "...Clients are to be in individual therapy as they're going through the group because it's more of a class than it is a therapy."

DBT group sessions, for individuals aged 18 and above, are held weekly for six months. New participants are accepted every six weeks.

Klesel and Brennan reported there are currently eight clients who take part in the Spirit Lake Oak Haven group, which occurs Tuesdays from 9:30 - 11:30 a.m.; approximately seven people who participate in the Spencer group at Seasons Center, which occurs Tuesdays from 1:30 - 3:30 p.m.; and about five participants in the Emmetsburg group, which takes place on Thursdays from 2:30 - 4:30 p.m.

Integrated Service Pathways

This collaborative project began locally to prevent the revolving door in the area county jails. ISP offers a supportive network to those who are mentally ill or dually-diagnosed with mental illness and substance abuse disorder and involved in the legal system.

Referrals come from the court system, attorneys and jails.

"The goal of ISP is to stabilize an individual. How we do that is we work through their mental health issues, their substance abuse issues and the court system," explained Karee Kuilenburg, the ISP case coordinator. "...When I think about the services we provide, some of the basic services are food and shelter."

Other services offered through the ISP network include referrals to therapy and assistance in finding work. In addition, Kuilenburg makes weekly visits to participants in the area's county jails. Of her current 28-inmate caseload, Kuilenburg is working with 10 in Clay County.

The local ISP case coordinator acknowledged it takes about one month's worth of weekly meetings in order for clients to trust her. Kuilenburg also said her personal goal is to put each person she works with in contact with a support network.

As it was mentioned that ISP started being funded by the county in May, Clay County Supervisor Sylvia Schoer reported, "The dollars we spend on her program are saving the county dollars down the road."

Peer Support Program

Laura Konkle-King, a former intern who recently became a licensed clinical therapist for Seasons Center, is overseeing this new Clay County program that links people who have experienced mental health issues themselves with individuals who are seeking assistance in the same area. The two are encouraged to meet a few times each month for community- and support-based activities such as having coffee, going window shopping or meeting in one of the individual's homes. The PSP mentor also works with the other person seeking assistance on goals he or she hopes to accomplish.

Individuals who may participate in the PSP are Seasons Center clients between the ages of 18 and 65 who: Have a psychiatric diagnosis; are relatively stable in their mental illness; are a low risk to themselves and others; live in or are in transition to community-based housing; and have Medicaid or other funding.

"We're not there to check on them to make sure they're taking their medicine or to make sure that they've met their goals on all their other programs," Konkle-King explained. "So, there's a trust level there from peer to peer in the Peer Support Program that doesn't exist in many other relationships."

The local program coordinator reported there is one person currently using the program, as well as four referrals in process now. As Konkle-King told those gathered at the NAMI meeting that other referrals are also being sought, she noted the program is expected to soon be able to serve people in Oak Haven, as well as those transitioning into the community.

New mental health medications available

Lisa Anderson and Mary Marske, nurses who work on Spencer Hospital's mental health unit, told NAMI annual meeting attendees that there are several new medications available for mental health clients. The two women explained these tend to target nerve cells to release more chemicals to neurotransmitters in the brain. While some may only be taken orally, others are delivered intravenously or through intramuscular injections, into the nasal or rectal cavities, sublingually or via a patch or lotion.

Fazaclo, used to treat severe schizophrenia symptoms, Risperdal, used to treat schizophrenia and symptoms of bipolar disorder, and Zyprexa, used to treat bipolar disorder and schizophrenia, are among the newer orally-dissolving tablets which take effect faster.

Medication delivered through depot injections, which usually occur subcutaneously or intramuscularly, tend to be released over a long time. Newer examples on the market include Risperdal Consta, which helps reduce symptoms associated with schizophrenia, and the antipsychotics Haloperidol Decanoate and Prolixin Decanoate, used in the management of chronic schizophrenic patients.

Medications delivered via a transdermal patch, which Marske and Anderson said can be good for cancer patients, include Nitroglycerine, Fentanyl, which is used for chronic pain, Emsam, used to treat depression, and Exelon, used in the treatment of mild to moderate Alzheimer's dementia. The two nurses also reported new medicated patches are available with Abilify, used to manage major depression, schizophrenia and bipolar disorder; Invega, a medication used for the treatment of schizophrenia and psychosis; and Pristiq, an antidepressant used for major depressive disorder.

"The problem with new drugs is they may be an improvement, but they are so expensive that people can't afford them," Marske said.

"There's a lot of really new, good drugs on the market right now," Anderson added. "But the main thing we're seeing is that clients can't afford to take them. And it's not really the clients who have Medicare and Medicaid that we're talking to much, because they do get services. It's what we call 'the new working poor' -- people that are trying to make a living, trying to carry on with their lives who have a mental illness and can't afford the medications. Unfortunately, we see more and more people coming through with that kind of a situation."

While it was suggested that pharmaceutical companies do have cost-assistance programs available to qualifying individuals, Marske said, "It's very important to turn to those sources for help, rather than go without."

In regard to the large number of medications many mental health clients are prescribed before the find the right fit, Marske assured, "It's not like diabetes: You can't take a blood test and say, 'You need this drug at this concentration.' We can't do that, which is why they have to try so many different things before the client finds the one that's going to work for them. In the future, down the road, they're going to be able to do more of that because of gene therapy. They're going to be able to look at your genes and say, 'This is the drug that will work for you.' But it's not here yet."

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