Archive Hosted by the AFL-CIO

Discussion: Minnesota Mental Health

August 19, 2014 By Deb Balzer, Communications Director

The recent death of beloved entertainer, Robin Williams, has opened conversation about depression, mental illness and suicide. Here in Minnesota, deaths by suicide have increased over the last decade—especially among the baby boomer generation.

While suicide is a complex issue, in many cases it can be prevented. Officials say there are many contributing factors that can lead to suicide or an attempt, including depression and mental illness which can be treated.

What needs to be done to address mental health issues in our state?

Joining us is Ed Eide, executive director of the Mental Health Association of Minnesota, an advocacy and education organization. His organization works to enhance mental health, promote individual empowerment, and increase access to treatment and services for persons with mental illnesses.

The conversation is open all day. We welcome your questions and invite you to join in the discussion!

 

 Post your comments or questions in the box below, scroll down to see the ongoing conversation, and use "refresh" to see new comments.

Thanks for participating! Commenting on this conversation is now closed.

27 Comments:

  • Judge Kevin Burke says:

    August 19, 2014 at 7:49 am

    A couple of years ago I wrote a commentary for MinnPost which more fully expresses my thoughts. It can be found at: http://www.minnpost.com/community-voices/2011/09/dealing-mentally-ill-we-need-do-better. Regrettably the legal system arguably has gotten worse over the last few decades despite the fact that medical science has gotten better. We have too many mentally ill people in prisons and jails. We have a health care delivery system that is difficult to access if you are suffering from mental illness.

    • Steve Fletcher says:

      August 19, 2014 at 8:15 am

      That’s a very helpful article.  Thanks for sharing!  It does seem like, when we try to think systemically about policy directions that could divert suicide attempts, criminal justice is one of the major areas where we can make progress.  I appreciate your call for community-based treatment plans, as opposed to incarceration, even while you acknowledge the practical barriers we face to implementation.

  • Ed Eide says:

    August 19, 2014 at 7:55 am

    Good morning, my name is Ed Eide and I am the Executive Director of the Mental Health Association of Minnesota (MHAM).  For over 75 years MHAM has advocated for individuals with mental illnesses in Minnesota.  Our goal is to allow people with mental illnesses live independently as they choose.

    Any time a celebrity makes the news people respond.  With the suicide of Robin Williams attention has been drawn to depression and the impact it has on people’s lives.  It is a tragedy to lose someone like Robin Williams, and many of us cannot understand what would bring him to this act.  Much has been written and speculated about his situation, but it is a tragedy every day that anyone dies from suicide.

    Economic issues, family problems, job loss, divorces, are issues that people state as perhaps why suicides occur. We can only surmise, we really don’t know what the triggering action is. The darkness we hear and read about are real, they don’t just go away. How can someone help a loved one when we don’t know the depth of the entire situation?

    Treatment works. There are millions of people living a life of recovery with a mental illness. They know what works well for them.  Whether it is medication, exercise and a good diet, the love of friends and family members pep0le are living a life filled with success. As with any chronic disease, mental illnesses are treatable, but they are also cyclical and there will be times when someone’s health is not as good as other times. That is when being surrounded by people who care for us is important.

    • Steve Fletcher says:

      August 19, 2014 at 8:22 am

      Thanks for leading the conversation, Ed.  I wonder if you can share more about the correlation between economic issues (foreclosure, job loss, etc.) and suicides.  Was there an uptick in the recession?  I know anecdotally that foreclosures in particular put an unbelievable amount of stress on families, but I’m curious about what we know about the causal relationship.  How much could changes in economic policy that stabilize jobs and housing positively impact mental health?

  • Judy W. says:

    August 19, 2014 at 8:05 am

    For one thing, Medicare could expand its coverage for therapy. Right now, a therapist must be a Ph.D. in order to be covered, which limits the number of psychologists available to people. This makes no sense because a Ph.D. does not make a person a better psychologist. It’s also difficult to find psychiatrists as there are not enough of them, especially ones who take Medicare. If you find one, you hold your breath and hope they’re good.  These limitations just add to the stigma of having any kind of mental illness, including depression. We really need to make these services more easily available to those who need them and to allow for whatever type of therapy works best for the person. Depression, in particular, has a variety of causes that may be complex and people respond differently to different types of therapy and medication. Many have treatment-resistant depression. It is very expensive to get the treatment you need if you don’t have adequate coverage. Some just give up. Untreated depression can also negatively affect physical health…which, of course, is something for which it is easier to find help.

    • Ben Ashley-Wurtmann says:

      August 19, 2014 at 9:00 am

      Judy-

      I’m not sure that’s the whole picture.  Many different kinds of providers can give therapy under MA and bill for it.  Licensed Independent Clinical Social Workers, Psychiatric Nurse Practitioner, Licensed Marriage and Family Therapist, etc…can all do therapy.

      You can see more here: http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_136562

      For psychologists, yes, a PhD is required.  But there are other educational paths a person can take to practice therapy in Minnesota.  We always balance the quality of providers with access. 

      I definitely agree that we need more access to psychiatry in Minnesota.  Many providers can prescribe medications, but they often do so without enough consultation or support from knowledgeable specialists.  For example, a general practitioner doctor can give a person a script for an anti-depressant, but they might not see the signs that indicates that the patient has more acute needs.  More MA providers are needed, and we now have services available for doctors who treat children to get a consultation over the phone before they prescribe psychiatric medications to kids.  Models like that that support other providers to do what they can to ease the shortage in a safe way could be a possibility.

  • Deb Balzer says:

    August 19, 2014 at 8:09 am

    Good morning Ed and thanks for taking time to join us. What can you tell us about suicide prevention plans in the state and how committed we are as a community to offering emergency services?

  • Darlene says:

    August 19, 2014 at 8:27 am

    I am happy to see this kind of forum.  I suffer from severe depression and as a result have attempted suicide on a number of occassions.  So coming from those deepest times in my life I can totally understand why somebody would commit suicide.  The pain and the dispair are hard to handle and you get to a point that the only way that you can see the pain going away is to end your life.  No matter how hard I tried to fight those demons it never felt like there was any hope of getting better.  Your mind plays tricks on you and gets you to thinking that everybody would be better off if you were gone.  At times it felt like nobody would even miss me if I took my life.
    Thank God for medication and the help that I got I am in a much better place right now.  For years I have kept silent about what I have gone through but now with the recent death of Robin Williams I felt that I can no longer keep quiet.  I want to find a way to help others who feel like there is no hope.  I also want to help others that are left behind when a loved one ends their life and their only question is why or how could they do that? 
    I can honestly say that it isn’t a selfish act but it is an act of totaly desperation and hopelessness.

    • Deb Balzer says:

      August 19, 2014 at 8:38 am

      Thanks for joining the discussion today, Darlene.

    • Ben Ashley-Wurtmann says:

      August 19, 2014 at 8:42 am

      Darlene-

      I’m so glad that you were able to survive what sounds like an incredibly difficult experience. 

      There are so many things that people who have lived with mental illness can bring to the table in creating hope.  Minnesota has a program for creating Certified Peer Specialists, people who have lived with mental illness and found recovery, so that they can help out on Mobile Crisis Teams, at mental health clinics, or other settings.  They can help people who are new to getting help understand what’s going on, and assure them that things can get better.  Having people who have “been there, done that” helps patients and doctors understand each other better.

      There are plenty of programs in the community, such as becoming a moderator for a support group, or working to educate others about what resources are available.  You can connect with the Mental Health Association at www.mentalhealthmn.org, and we have listings for other mental health community programs and advocacy groups.  I’m sure you’ll find a great way to contribute.

  • Kyle says:

    August 19, 2014 at 8:28 am

    Are there any avenues of free help beyond hotlines? What happens when someone seeking clinical help is unable to obtain it, purely because of financial reasons? Medications are expensive, doctors are expensive, and and these issues are super complex. It seems there has been lots of out cry for getting people help in the past decades, but really - people getting help still need more.

    While the short term process of opening up access to those that are need is worked on - what is being done to ensure that long term care is available? I think that is where MN needs more planning with health care.

    • Ben Ashley-Wurtmann says:

      August 19, 2014 at 8:37 am

      Kyle-

      Absolutely.  A growing number of Minnesota counties have mobile crisis teams that can go out to a person’s home and do immediate crisis deescalation.  85-90% of the time, a person who might have needed to go to the hospital can use other resources after seeing a crisis team. 

      Medical Assistance is now available for adults without children up to 133% of the federal poverty line.  There is a good set of benefits available through MA, including some longer term options.  Between walk-in/sliding fee clinics, premium assistance, and expanded MA, insurance access to care is improving significantly.  That’s not the whole picture, but it’s an important cornerstone.

      There needs to be a balance between short-term and long-term, intensive and ongoing kinds of resources.  The good news is that most people who experience mental illness also experience recovery.  Previous models of care relied on keeping people away from the community for a long time.  New models are developing that intend to support people in the community.

  • Chloette Haley says:

    August 19, 2014 at 8:36 am

    I have been very pleased with the “Make It Okay” campaign through Regions Hospital and the excellent pieces they have been running on TPT, providing a platform for individuals living with mental illness, their families, friends and the community to talk about their experiences.  Open and honest conversation can go a long way toward changing attitudes, which I believe will help more people seek out the treatment they need.  I totally agree that our insurance coverage/access system for mental health recovery services needs improvement.  Health care access in all areas of health needs for people with disabilities is a major civil rights issue in this country.  The resources are there.  Do we have the compassion and will to make it different?

    • Ben Ashley-Wurtmann says:

      August 19, 2014 at 8:50 am

      Chloette-

      You are very right to note that this is an issue of empathy and understanding.  More and more, Americans understand that mental illnesses are caused by biological issues in the brain.  But at the same time, they believe in recovery less and less even when we know that it is very possible for most people who experience mental illness.  They might blame a person less along moral lines, but be less willing to see that person as a coworker, neighbor or friend.  (http://theconversation.com/brains-genes-and-chemical-imbalances-how-explanations-of-mental-illness-affect-stigma-28324)

      What does seem to move the needle on stigma is having known and respected figures self-disclose their struggles and recovery from mental health issues.  While it is absolutely tragic, particularly for his family and friends, that Robin Williams died from suicide, that does not erase all the years in which he was successful and brought entertainment and joy to others. The recovery perspective does not see a finish line, it sees the whole race.  Hopefully, more people can see that breakthroughs and setbacks can all be part of a person’s experience.

  • Ed Eide says:

    August 19, 2014 at 8:39 am

    Often it takes a crises for people to be seen by a mental health professional.  It is difficult to screen for suicide, we are unable to predict the future.  With the advent of the Affordable Care Act more people have insurance, but are unfamiliar of how to access care.  They are used to using the emergency department and must change how they access treatment through clinics.  Perhaps we will see a change in treatment as we move forward.

    Primary care providers are often unaware of appropriate mental health services when they see a patient for the first time and begin the diagnosis of a mental illness.  We are seeing more young people using our online screening when they feel they may have depression or anxiety.

    Online Mental Health Screening

    This free online mental health self-assessment is made available to everyone visiting the MHAM website and is taken anonymously. This screening is not a substitute for a diagnosis, but it will help determine whether or not a consultation from a health professional would be helpful. The self-assessment screens for depression, bipolar disorder, post-traumatic stress disorder, and generalized anxiety disorder.

    http://www.mentalhealthmn.org/be-informed/education-programs/online-screening-for-mood-and-anxiety-disorders

    There are some reduced fee clinics out there, but they are usually pretty booked. Currently 95% of Minnesotan’s have health insurance. That is usually the best start for care.

  • Ed Eide says:

    August 19, 2014 at 8:46 am

    Here is information on the economy and suicides

    http://www.minnpost.com/second-opinion/2011/04/suicide-rates-rise-and-fall-economy-say-cdc-researchers

  • Teresa says:

    August 19, 2014 at 8:59 am

    One member of our extended family took his own life as a youth and another from the succeeding generation
    suffered from mental health problems and was feared to be suicidal.  Both these youths lived in northern
    Minnesota where county administration was averse to committing funds for mental health support.
    Perhaps the state should provide support for a basic level of therapy to reduce the disparity resulting
    from the range in attitudes toward mental health treatment from county to county.

    • Ben Ashley-Wurtmann says:

      August 19, 2014 at 9:45 am

      Teresa-

      I’m so sorry for your loss.  Suicide is an incredibly traumatic way to lose a loved one.

      There are all kinds of reactions from counties to mental health.  One of the things that Ed does is travel to Local Advisory Councils (groups that bring together the people who use the services, the providers, and the county staff) all around the state.  I know in one small town Ed went to, the local mental health group marched in the summer parade!  They were well received, and proud of their recovery in the community. 

      Other places…not so much.  Some folks still insist that mental illness doesn’t happen in their community. 

      There are statewide initiatives and funding to provide some services, but we have a long way to go in ensuring more even access to prompt care in the community.  For some places, needed services might be hours away.

  • W. D. (Bill) Hamm says:

    August 19, 2014 at 9:00 am

    It is too bad Ed that your so called study looking at economic factors didn’t even look at suicide by income as well. That is particularly tragic since the study cites the use of prescription drugs as an underlying cause yet does nothing to look at which socio/economic groups are being overprescribed the most of these drugs. That is a pitiful study compared to what we need for information to help these people.

    • Nick Stumo-Langer says:

      August 19, 2014 at 9:15 am

      Bill,

      It seems like, at this point, we are hoping for any critical discourse about mental health in our state and in our country. While I do agree that the study could be improved in a few different ways, it doesn’t debase the value of the study. The greatest recommendation of a study is to do more research with the conclusions gained in mind. I would be very pleased if you or anyone on this forum were so motivated to carry out your own study to help move this dialogue forward. Mental health is a serious issue and should be combated seriously and not dismissed as a half-measure.

      • W. D. (Bill) Hamm says:

        August 19, 2014 at 10:14 am

        Well Nick, I would be happy to utilize any resources you are willing to funnel my way to do that, but barring that I would be happy to serve with others on a State Committee, using State monies to do what they should have already done. My children and I have had to deal with a lifetime of suicidal issues surrounding their mother so we are no strangers to this issue or the fact that many of these mentally ill people spend years being passed from one under educated Psychologist to another until they finally make adequate connection. Psychology is now still in it’s Symptemology stage, (meaning more interested in treating symptoms for money than working to cure any underlying problems), and because of this coupled with pushing Drugs for big Pharma, and insuring that we keep our prisons full to benefit Union Public employee’s, we are far from having anything near an adequate mental health system of help those in need.

  • Judy W. says:

    August 19, 2014 at 9:27 am

    Ben, I am talking about psychologists in private practice. If you don’t have a doctorate degree, you have to work in a clinic that is supervised by someone who does. When I went on Medicare I already had a psychologist in private practice but cannot bill Medicare. At this stage in my life, I do not want to switch providers so I have to cover it myself which is harder now since I’m retired. To me, it’s worth it because shopping around and hoping for the best is not what I want to do any more.

    • Ben AW says:

      August 19, 2014 at 9:39 am

      I see.  That is a very tricky situation.  Provider relationships take a long time to build and change can create disruptions.  If you haven’t already, you may want to see what other services you can get through MA to augment the therapy you’re getting from the private provider.  You’d be welcome to contact MHAM’s client advocates: 651-493-6634 or 800-862-1799.

      • Judy W. says:

        August 19, 2014 at 2:03 pm

        I am on Medicare, NOT MA. I have an Advantage plan.

  • Retha Dooley says:

    August 19, 2014 at 11:44 am

    Access to treatment and services in the rural areas of Minnesota is abysmally lacking. In many instances the “wait” to see a therapist is beyond what one can endure, especially when one is in crisis. Crisis Centers and/or local hospital ERs’ try to take up the slack, but there are a limited number of beds in local hospitals to assess and treat the increasing numbers of people experiencing mental illness challenges.

    I don’t have any answers, but I am concerned.

  • howard j miller says:

    August 19, 2014 at 2:06 pm

    Is there a chance that we can finally discuss the validity (or lack thereof) of treatment models we lean on so heavily to promote mental health in this country? When one considers decades of data generated via meta-analyses by the Cochrane Collaboration specifically on psychotropic medications, the combined works of Robert Whitaker, Dr. Peter Breggin and others, the coincident escalation of SSRI use, obesity and diabetes, and so on, it would seem that there is some justification for doing so. So often after a tragedy involving someone with an apparent mental illness the press sighs, ‘if only they had received treatment.’ In too many cases they have been or were actively receiving treatment. CBT, DBT have incredible track records without the risk of akathisia, dyskinisia, weight gain, tooth decay (see dry mouth) and, yes, even suicide. Good diet, employment, social networks and exercise are also cheap and well established alternative treatment models. They lack corporate sponsorship however.

  • howard j miller says:

    August 19, 2014 at 2:54 pm

    Kings College London psychiatrist and World Psychiatric Association President Dinesh Bhugra has announced in The Lancet Psychiatry that the journal is launching a commission of inquiry into the future of psychiatry… In his commentary, Bhugra concedes that, “First among the internal threats to psychiatry is the often scandalous history of the profession, including appalling human rights abuses in asylums and the profession’s inability at times to challenge these.” He also describes the profession today as “embattled and divided,” and notes that, “Psychiatry’s history of diagnostic confusion, including the medicalisation and inappropriate treatment of individuals with normal human emotions and experiences, remains a topic of debate and a matter of concern.”