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October 4, 2016
SPECIAL GUEST COLUMN Supporting NAMI Mass’ Position Opposing Recreational Marijuana, Question 4 on Ballot
CONTRIBUTED BY Dost Ongur, M.D., Chief, Psychotic Disorders Division at McLean Hospital and Associate Professor of Psychiatry at Harvard Medical School
There is ongoing public debate about legalization of marijuana – first for medicinal and more recently for recreational uses. Societal attitudes towards this issue have changed dramatically in a relatively short period of time. One issue that is not sufficiently addressed in this debate is the relationship between marijuana use and psychotic disorders such as schizophrenia, schizoaffective disorder, and some forms of bipolar disorder. These are common and severe conditions that affect many lives and families in Massachusetts.
There has long been evidence that marijuana use is associated with relapse and worsening of symptoms for individuals with psychotic disorders. More recent and disturbing evidence indicates that marijuana use in teenage years is associated with subsequent emergence of psychotic disorders1. In fact, teenagers who use marijuana daily are at higher risk of later being diagnosed with a psychotic disorder than those who use weekly. Those who do not use are at lowest risk. In addition, this vulnerability appears to be specific to adolescence and early adulthood; individuals who use marijuana in their late 20s and 30s are not at higher risk of later being diagnosed with a psychotic disorder. This evidence indicates that marijuana use during brain development (at least from birth until age 21 but likely into one’s mid-20s) increases risk for major psychiatric conditions. Although legal recreational marijuana use is not intended for teenagers, this population is at high risk for problem marijuana use. Expanding access to recreational marijuana can be reasonably expected to lead to increased access to marijuana by teenagers.
There is debate among psychiatrists and neurologists about whether marijuana use can be said to directly “cause” psychotic disorders or is part of larger complex disease mechanisms. But the research is quite clear about one thing: people who avoid using marijuana are at lower risk for these conditions. Therefore, reduction of teenager and young adult marijuana use is a compelling public health intervention. It is possible that one of the chemicals within marijuana is specifically to blame. But until we know more about this issue and understand its implications, I remain concerned about the adverse outcomes from the increased availability of recreational marijuana for many young people and their families.
Murray RM, Di Forti M. Cannabis and Psychosis: What Degree of Proof Do We Require? Biol Psychiatry. 2016 Apr 1;79(7):514-5.
At the NAMI Mass Convention on October 29, 2016, Members will be voting for SIX NAMI MASS Board of Directors. When we sent out the absentee ballots we made an error in the instructions. Please note the correct ballot instructions below:
On the Absentee Ballot, that was mailed to you recently
WE SAID: If voting instructions are not followed, your ballot is invalid and will not be counted. Please vote for NO MORE THAN SIX of the following candidates. INCORRECT INSTRUCTIONS
WE SHOULD HAVE SAID: If voting instructions are not followed, your ballot is invalid and will not be counted… Please vote for SIX of the following candidates. CORRECT INSTRUCTIONS
Please contact the office with any questions you have, 800-370-9085 or 617-580-8541.
The NAMI Mass Criminal Justice Diversion Project works to help local police departments and other law enforcement personnel across the Commonwealth respond effectively and compassionately to citizens struggling with and displaying symptoms of mental illness and/or substance use conditions.
NAMI Peer-to-Peer is a free 11-week recovery-focused educational program for adults working to establish and maintain wellness in response to mental health challenges. Peer-to-peer provides a confidential place to learn from shared experiences in an environment of sincere, uncritical acceptance.
Allies for Student Mental Health is a two-hour professional development program designed to help K-12 teachers, parents and school staff work as allies to identify and understand mental health conditions that have a significant impact on students’ academic success and overall well-being.
If you are a family member eager to share your perspective in order to help others, there may be a role for you in one of these programs! Flexible schedule, low time commitment. Please fill out the application form and email it to Annabel Lane at email@example.com by December 1st. Once we receive the form we’ll be in touch to discuss more details.
Today the Legislative Committee on Mental Health and Substance Abuse is holding an informational hearing on Bridgewater State Hospital to begin the conversation with the Administration, Legislature, advocates and family members about the future of Bridgewater State Hospital.
For years, decades really, NAMI Mass has strongly opposed the fact that people with histories of mental illness and trauma are confined to Bridgewater State “hospital” which is really a medium-security prison run by the Department of Corrections. Massachusetts is the only state in the entire country that gives its state prison authority to assume responsibility for men who in any other state in the country would the responsibility of the state Department of Mental Health. All patients committed to Bridgewater State Hospital who have not committed a crime should be transferred immediately to the Department of Mental Health.
For more information, please read the testimony of NAMI Mass’ Executive Director, Laurie Martinelli.
And to learn more about Bridgewater State Hospital, please come to the NAMI Mass Convention on Saturday, October 29, 2016, when one of our workshops will focus on Bridgewater State and what advocates can do to start demanding real change.
Testimony of Laurie Martinelli, Executive Director
National Alliance on Mental Illness of Massachusetts (NAMI Mass)
Joint Committee on Mental Health and Substance Abuse
Tuesday, September 13, 2016
Chairwomen Flanagan and Malia, and members of the Committee:
My name is Laurie Martinelli, and I am the Executive Director of the National Alliance on Mental Illness of Massachusetts (NAMI Mass). I am appearing today on behalf of NAMI’s Board of Directors, members, affiliates and NAMI supporters across the Commonwealth.
NAMI is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services and is steadfast in its commitment to raising awareness about mental illness. Since our inception in 1979, NAMI has been dedicated to improving the quality of life of individuals and families affected by mental illness.
I want to thank you for this opportunity to offer input on the status of Bridgewater State Hospital, a medium-security prison run by the Department of Correction. This facility has been wrongly tasked with providing housing and treatment to a significant number of “civilly committed” men with mental illness. For decades, the Commonwealth has asked its Department of Correction to take responsibility for people who have mental health issues, trauma, and substance use disorders. In virtually every other state in the country, these same individuals would be cared for by the state mental health and public health systems.
Continuing to require our Department of Correction to care for them is costly, both in economic and human terms. The collateral consequences of incarceration are incredibly damaging, from the disruption in treatment to the loss of housing, employment, and family support. For people with histories of trauma and mental illness, being confined in a prison is uniquely harmful, inhumane and punishing. This experience greatly reduces their chances for restoration, recovery, and integration back into the community. Bridgewater State Hospital’s history has been marked by decades of being hidden and forgotten until tragedy strikes and the media publicizes the stories of individuals and families who have experienced the inadequacies of the care and treatment being provided to patients.
I present one such story to you today from one of our NAMI members but there are countless others. This person’s 31-year-old son, Bob, was sent to Bridgewater State Hospital for a forensic evaluation by the Salem District Court. Because of Bob’s psychosis, he had a disorderly conduct charge from a hospital stay. Bob’s parents tried in vain to explain to the Court that Bob was not a violent person and was in need of mental health treatment. The clinician at the Salem District Court decided to send Bob to Bridgewater State hospital rather than another venue such as Lemuel Shattuck.
While at Bridgewater State Hospital, he was initially placed in the Intensive Treatment Unit and remained there for about two weeks. At one point, he had four-point restraints and medication was forced upon him against his wishes. One evening during the 2011 Labor Day weekend he was attacked by another inmate with a footlocker as he lay on his bunk in his unit. The blow to his head fractured one of his orbital bones. Severely bruised, he was sent to Morton hospital in Taunton for an evaluation and was returned to Bridgewater. Bob’s parents visited him and were shocked to see his condition. Bob and his parents were greatly concerned for his safety. Eventually, 9 months later, Bob was transferred to Taunton State Hospital and began to receive meaningful and effective individual and group therapy. We are now happy to report that he has secured full-time employment in construction and has successfully reintegrated back into his community.
For a time, public scrutiny from stories like Bob’s leads to additional resources and improvements; however, once the spotlight is off of the facility, it reverts back to what it is– a correctional facility, staffed by correction officers who, even when clinical staff are available some of the time, are not and can never be mental health workers.
It is time to end the use of Bridgewater State Hospital for the evaluation or civil commitment of people not convicted of a crime. Efforts to provide clinical staff at the Bridgewater facility have come up short time and time again. The Department of Mental Health must assume responsibility for those individuals with histories of trauma, mental health, and substance use.
Massachusetts stands alone in the country by requiring its state prison authority to assume responsibility for men who in any other state would be the responsibility of the state Department of Mental Health. We must finally catch up to the rest of the country and transfer Bridgewater State Hospital to the Department of Mental Health in order to care for the Commonwealth’s sickest patients in a way that is humane, will promote recovery, and will avoid senseless tragedies like that experienced by Joshua Messier, Leo Marino and countless others.
It is our hope that more of the men currently residing at Bridgewater State Hospital can acquire the treatment necessary to experience a full recovery, like Bob. While we laud the Administration for the proposed changes laid out in the Boston Globe today, how they set forth standards for staffing levels, the range of clinical services provided, staff training and new policies and procedures remains to be seen. While any long-needed improvements are welcome, NAMI Mass believes that they will always be limited by the Department of Correction’s continued responsibility for the evaluation and treatment of men with mental illness.
Thank you for the opportunity to testify.
August 30, 2016
To the Editor:
Thank you to the Globe Spotlight Team for your article (“The Desperate and the Dead: Community Care”) that shines a light on the complex and sensitive topic of mental health care.
While we are offended by the Spotlight series’ focus on linking violence to those suffering from mental illness, we agree with much that was written about the chronic underfunding of a mental health care system that leaves so many people without the care that they desperately need. NAMI Mass members experience daily the negative consequences of low insurance reimbursement rates and lack of systemic coordination that result in outpatient mental health care facilities closing and the number of available hospital beds being reduced.
As the Globe acknowledged, the Baker Administration has made initial, though modest, steps to address these problems but more aggressive steps are needed. It is important to remember that we do not need to start from scratch. There are successful programs–(the Children’s Behavioral Health Initiative (CBHI) and the Program of Assertive Community Treatment (PACT) are examples—already in place, but they are all too often inadequately funded and narrowly disseminated.
We must provide high quality, affordable and effective mental health care to those who need it most, but it will take much more funding than is currently in the system.
* The listening sessions were set up by NAMI to try to understand why many people who seek mental health care drop out. NAMI reports that 70% that drop out do so after their first or second visit.
* This report about Engagement represents a major paradigm shift. “If we want to improve the lives of individuals with mental health conditions and their families, we must shift to a culture that embraces engagement as a new standard of care.”
* And engagement is not a “covert adherence strategy,” but a genuine compassionate, capable concern and care for the whole person. If we want to see true
change, the mental health system
needs to promote more effective engagement.
* Engagement is a broader concept than compliance. It involves the participation of people who both deliver and seek services. With effective engagement, NAMI reports that the likelihood of ongoing participation in services and supports increases. When care is respectful, compassionate and centered on an individual’s life goals, the likelihood of recovery is sharply increased.”
Jacqueline Martinez, Nominated by NAMI Massachusetts
Member of NAMI Latino Metro Boston
I am the parent of a child with mental illness struggling with my own lived experience. I have dedicated my life to bringing awareness, education, advocacy, resiliency and hope to those without a voice. I am committed to fighting stigma and unifying all communities to overcome the barriers we face.
Mental Health Coordinator I/Certified Peer Specialist, Massachusetts Department of Mental Health
Director of Advocacy, NAM Latino Metro Boston
NAMI Connections State Trainer, NAMI Massachusetts
President, Board of Directors, Transformation Center, 2016-2017
Chair, Protection and Advocacy for Individuals with Mental Illness Advisory Council (PAIMI AC), Disability Law Center, 2015-2016
In 2006, my local NAMI Latino affiliate invited me to a meeting. I was Director of Casa Primavera, the only US Latino Clubhouse. Never Having heard of NAMI, I was greeted with acceptance by Spanish-speaking members who gave me a sense of purpose – and my journey began. I served 6 years as V.P. of my affiliate, participated in 9 NAMIWalks, provided Spanish interpretation at our convention, and currently serve as Director of Advocacy for Massachusetts NAMI Latino Metro Boston affiliate. Early on I served as a NAMI Connections Champion supporting 7 clubhouse members, then became a NAMI Connections Facilitator, a state NAMI Connections trainer, and now train nationally in Spanish (NAMI Conexiones). I took IOOV training and participated in Family-to-Family workshops, then co-facilitated family support groups in Spanish and English. I participated in the Sharing Hope Latino Leaders focus group, then secured a Compartiendo Esperanza grant to make it accessible to Latinos locally.
I will devote particular effort to remove barriers within diverse communities to accessing NAMI signature programs as an essential key that increases public awareness. I will advocate leveraging technology to expand capacity at the grassroots level as a game-changing way to connect with many communities and age groups. As an advocate for access in integrated health care reform and parity, these changes need to lead to improved outcomes in particular for people who are difficult to engage: homeless, involved with the criminal justice system, veterans, young people, and families. My particular strength lies in helping others overcome the overwhelming fear to voice our opinions, speak up for our rights and create change. Building the NAMI community through national bilingual education efforts, I am dedicated to role modeling how sharing our message also serves to recruit influential allies that will unite and support our work.
Letter to the Editor of the Boston Globe, July 13, 2016
Sunday’s Boston Globe Spotlight article, “When despair meets deadly force” highlighted the challenging work police officers do in responding safely to people with mental health and substance use conditions.
Yet high quality mental health training and the requisite follow up community-building work between police and community providers remain inaccessible to the vast majority of police departments in the Commonwealth.
The consequences are devastating – from injuries and deaths for both individuals and officers, to unnecessary arrest and incarceration for actions that stem from illness rather than criminal intent.
NAMI Mass partnered with Senator Jason Lewis to file Senate Bill #2320 – An Act to Establish the Center of Excellence in Community Policing and Behavioral Health. This legislation scales up best practices with proven results. It makes crucial mental health de-escalation training available to police officers statewide, and provides technical assistance to improve policies and procedures and develop partnerships with local service providers that maximize referrals to treatment. The benefits include greater safety and significant cost savings associated with unnecessary criminal justice involvement.
The current lack of a statewide strategy puts both officers and citizens at risk. The legislature must take immediate action. Massachusetts is better than this.
June S. Binney
Director, Criminal Justice Diversion
Joint Statement in Response to Initial Story in Globe Spotlight Series on Mental
Health in Massachusetts
July 1, 2016
We are deeply concerned that the initial Spotlight series story on Massachusetts’ mental health care system has done long‐term damage by perpetuating the false impression that individuals with mental health conditions are inherently violent.
The facts show that they are not any more prone to violence than any other group, and while we acknowledge the tragic incidents reported by the Globe, we strongly believe that the Globe series, by linking mental illness and violence in such a sensationalistic way, will increase the stigma that has long plagued individuals with mental health conditions and their families.
As individuals in recovery, family members, service providers and legal advocates, we know that recovery is possible and access to a broad range of services is essential to meeting the needs of individuals living with a mental illness. We also know that tens of thousands of people living with a mental illness in Massachusetts lead full and productive lives every day. It’s unfortunate that the initial Spotlight report did nothing to highlight these individuals.
As advocates for restoring and revitalizing the Commonwealth’s mental health system, we call for greater investment of resources targeted to significant gaps in early intervention, treatment services and recovery supports for individuals, families and their communities. Massachusetts has time-tested talent and service and program successes that can serve as essential building blocks in this critically needed reform. Signed by:
Association for Behavioral Healthcare
Center for Public Representation
Children’s Mental Health Campaign
Disability Law Center
Health Law Advocates
Massachusetts Association of Behavioral Health Systems, Inc.
Massachusetts Association for Mental Health
Massachusetts Psychiatric Society
Massachusetts Society for the Prevention of Cruelty to Children
Mental Health Legal Advisors Committee
National Alliance on Mental Illness of Massachusetts
The Transformation Center