Thursday, June 18, 2009

Practicing From the Shadows

Lawyers and Judges are not immune from mental illness. The Texas Lawyers' Association Program has the following video available on their website "Practicing from the Shadows: Depression and the Legal Profession" DVDs now available. Click here to watch the video. Call TLAP at 1-800-343-8527 for a free copy. This is an excerpt from the Texas Lawyers' Assistance Program:
The nationally acclaimed Texas Lawyers' Assistance Program (TLAP) has evolved from helping lawyers with substance abuse disorders and alcoholism to assisting lawyers, judges and law students with mental health issues. The March 2007 issue of the Texas Bar Journal features articles and information about TLAP and the services offered.

TLAP was created to provide for the identification, peer intervention and rehabilitation of any Texas attorney or law student whose professional performance is impaired because of substance abuse, dependency or mental health disorders. Current estimates indicate that anywhere from 10,000 to 15,000 lawyers in Texas suffer from substance use disorders or mental health issues affecting their law practices. TLAP can help save the lives of these attorneys. Our work also contributes to the protection of the public, the improvement of the integrity and reputation of the legal profession, and, because assistance to an affected lawyer often prevents future ethical violations, the reduction of disciplinary actions.

Wednesday, June 17, 2009

What Lawyers Need to Know About Suicide During a Recession: Prevention, Identity and Law Firm Responsibility

This is a free download from the American Bar Association.
Suicide is our most preventable form of death. Many attorneys are in frequent contact with populations at elevated risk for suicide. In their professional roles, attorneys occupy a strategic position to intercept suicidal communications and identify and refer potentially suicidal clients, as well as employees and colleagues, for professional assessment and possible life-saving treatment. In addition Model Rule 1.14 gives the attorney broad power and responsibility when representing clients with diminished capacity.

Attorneys also have the highest rates of depression and suicide of any profession. Statistics suggest that the rate of suicide attempts among attorneys and their clients is increasing as the effects of the recession widen.

This program addresses the ethical responsibility employers have to assist attorneys in their employ that may be suicidal.

Tuesday, June 16, 2009

Officer Caught Beating Schizophrenic Says He Did Nothing Wrong

Contempt, by some, for the mentally ill is as old as the hills and much work in our enlightened society still needs to be done. Perhaps this officer falls within that category, or, perhaps not - as preliminary information is sketchy. At first glance: this is another disheartening story and sign of our times.
Officer Caught Beating Schizophrenic Says He Did Nothing Wrong

Monday, June 15, 2009

Bills Waiting to Be Signed By Governor Perry That Impact MHMR Centers

The general sense among Community MHMR Centers is that the 81st Legislative Session provided substantial and significantly new resources for improved community-based services across Texas. Some examples include: increases in medicaid waiver services for developmental disabilities; enhanced crisis services; stimulus and infrastructure funds; and a new benefit package in medicaid for substance use treatment. For a final listing of Senate and House bills relating to behavioral health or developmental disabilities that are awaiting the Governor's signature, click here .

from:
David Evans
Executive Director
Austin Travis County Mental Health Mental Retardation Center

Monday, June 8, 2009

The Advocacy Handbook: A Guide for Implementing Recommendations of the Criminal Justice / Mental Health Consensus Project

Download Handbook pdf.

The Advocacy Handbook reflects a shared effort among NAMI (the National Alliance for the Mentally Ill), the National Mental Health Association (NMHA), the National Association of State Mental Health Program Directors (NASMHPD), the Bazelon Center for Mental Health Law, and the Criminal Justice / Mental Health Consensus Project.

Transforming the Mental Health of Veterans

By Sam Shore, MSSW
Director, Texas Mental Health Transformation Project
Department of State Health Services

As a recipient of a Mental Health Transformation federal grant from the Substance Abuse and Mental Health Services Administration, Texas is charged with building a solid foundation for delivering evidence-based mental health and related services, fostering recovery, improving quality of life, and meeting the multiple needs of mental health consumers across the life span. As directed by the Governor of Texas, DSHS serves as the administrative home of the grant in Texas. The Governor directed 14 state agencies and consumers/family members to form the Mental Health Transformation Working Group. At its August 2008 meeting, the Transformation Working Group recommended that DSHS coordinate a subgroup to identify the behavioral health needs of veterans returning to Texas from Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom, and to describe gaps and provide recommendations.

Texas has the third largest population of veterans in the United States and contributes a significant number of the military service members deployed as part of Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom. According to the RAND Corporation’s Invisible Wounds of War report, up to 15% and 14% of service members returning from Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom are affected by post-traumatic stress disorder or major depressive disorder, respectively. These conditions require ongoing behavioral health services and supports for veterans as well as their families.

Many federal, state, and private organizations provide behavioral health services for veterans. At the federal level, the U.S. Department of Veterans Affairs has primary responsibility for combat veterans who have been discharged from active duty. Veterans Affairs offers comprehensive health care coverage for veterans, including inpatient and outpatient mental health and substance abuse diagnosis and treatment. Veterans Affairs also offers counseling and reintegration services at hundreds of Veteran Centers across the country, including 15 in Texas. All combat veterans and their families are eligible for Veteran Center services at no charge for military-related issues, including confidential screening, counseling, and linkage to other services.

At the state level, multiple state, federal, and private partners have joined together in a memorandum of understanding under the name “Partners Across Texas.” This partnership is an interagency and multi-organizational collaboration to enhance support for Texas veterans and their families. A variety of services are available from agencies, such as the Texas Veterans Commission, Texas Military Forces, Health and Human Services Commission, Department of Assistive and Rehabilitative Services, and Texas Workforce Commission, along with DSHS. State services ensure that veterans are linked to federal benefits and are supported, as they attempt to return to work and deal with the physical, psychological, and emotional impacts of combat experience. As part of Partners Across Texas, the Texas Information and Referral Network (2-1-1 Texas) and the TexVet: Partners Across Texas website (www.texvet.com) provide comprehensive information about services in Texas for veterans and their family members.

At the local level, there are 37 DSHS-funded community mental health centers that serve as a foundation for the locally managed public system of care for Texans with serious mental illness. The centers provide an array of behavioral health services that veterans or their family members may need, including crisis services and case management. Many other individuals and systems also interact with veterans at the community level, including the criminal justice system, courts, employers, hospitals, schools, and community groups.

Based on the identified gaps and the resources currently available, the Mental Health Transformation Working Group Returning Veterans Subgroup recommended the following:

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Data. Collaborate with federal and state partners to gather comprehensive data on the behavioral and physical health status of Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom veterans and their families.
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Service utilization. Develop outreach strategies utilizing the Texas Information and Referral Network (2-1-1 Texas), 12-Step Groups, peer support services, and the TexVet: Partners Across Texas website.
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Quality and effectiveness of services. Provide education and training to medical and behavioral health service providers, information and referral specialists, law enforcement officers, and others to increase understanding of veterans’ behavioral health issues.
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Health care coverage and access. Explore options to address gaps in health care coverage and access, especially for families of Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom veterans. Evaluate the costs to help pay health insurance premiums for families of these veterans, and encourage Veterans Affairs to refer veterans to qualified community providers when there are gaps between needed behavioral health services, and those available at the Veterans Affairs facility nearest to the home of the veteran.
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Coordination and communication. Cultivate partnerships among multiple federal, state, and local entities to foster improved coordination. Build upon partnerships established in the “Partners Across Texas” memorandum of understanding, and coordinate recommendations with other efforts at the state and national levels.

Given the great number of Texas veterans, these partnerships must be maintained and strengthened. The Mental Health Transformation Working Group will move forward with these recommendations, and address the behavioral health needs of veterans and their families.
For more information

* Behavioral Health Services for Returning Veterans and Their Families: Services, Gaps, and Recommendations. A 2008 Report of the Returning Veterans Subgroup of the Mental Health Transformation Working Group, www.mhtransformation.org.
* Invisible Wounds of War: Summary and Recommendations for Addressing Psychological and Cognitive Injuries. A 2008 Report by the RAND Corporation, http://www.rand.org/pubs/monographs/2008/RAND_MG720.1.pdf.
* TexVet: Partners Across Texas, (www.texvet.com)

Bringing Them Home: Addressing the Behavioral Health Needs of Veterans and Their Families

By Kay Hart, MPAff Candidate
Lyndon B. Johnson School of Public Affairs
The University of Texas at Austin

No one leaves war unchanged and those changes may include both physical and mental trauma that adversely affects the quality of life for those who serve in the military and the families that love and support them. Nationally, 1.5 million soldiers have served in Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) and 60% of these soldiers are married and/or have children. With the third largest population of resident veterans and 14 major military bases, Texas is deeply impacted by issues affecting military personnel and their families.

In many ways, especially those related to mental health, the impact on military personnel serving in OEF/OIF and their dependents is unprecedented. For example, half of those serving have been Reservists or members of the National Guard. These service men and women do not deploy from or return to regular military bases. Thus, they and their families often do not have the support that comes from living in a community of people who share their experiences.

Another unprecedented aspect of OEF/OIF is the number of deployments faced by many in the military. Nearly 500,000 service men and women have been deployed for more than one tour with four and five tours being common. Being deployed more than once increases the exposure to trauma for military persons, and lengthy and frequent separations increases the stress experienced by their loved ones.

Also, unlike previous conflicts where the typical soldier was a young, single male, 20% of those serving in Iraq and Afghanistan are female and most soldiers have families. In fact, 23,000 of those serving in OEF/OIF are single parents with custody of their children. Dual military families, where both spouses serve, are also a significant factor in the military. As a result of these changing demographics, 2 million children have been directly affected by the deployment of a parent and 40% of these under 5 years old.

All of these factors combine to produce significant mental health risks for active duty military personnel, veterans, and their families. It is estimated that 30-40% of Iraq veterans will face depression, anxiety, or Post Traumatic Stress Disorder (PTSD). In addition, 320,000 OIF/OEF veterans have experience Traumatic Brain Injury (TBI), a physical injury to the brain that is associated with symptoms similar to PTSD.

The family also faces mental health risks associated with both the deployment and reunion phases of military service. With so many infants and young children experiencing separation from one or both parents, mental health workers are concerned about attachment issues and negative impacts on brain development. Furthermore, adolescents with a deployed parent are more likely to participate in risky behavior, such as teen pregnancy and substance abuse. These are compounded by troubling evidence that the stress of loneliness and worry experienced by the caregiving spouse results in an increased risk for child maltreatment during periods of deployment. Even after the return of the military family member, difficulties in adjustment and mental or physical health issues faced by the veteran can result in increased anxiety and depression in their children.

Promoting resilience in the families of veterans and service personnel offers hope that behavioral health issues can be avoided in the long-run. People with resilience are able to harness inner strength, access external help, and rebound more quickly from setbacks. Without resilience, people turn to unhealthy coping mechanisms such as substance abuse and may develop significant mental health problems. The task of helping military families develop greater resilience rests with the entire community.

An important first step in promoting resiliency is recognizing the warning signs of mental illness and knowing what treatment options are available. The National Center for Posttraumatic Stress Disorder provides excellent information about warning signs and treatment options for PTSD and other mental health conditions. They also provide information for the family about coping during deployment. This information is helpful not only for families affected by deployment, but for those who want to support them during this time.

Promoting resiliency and offering support to veterans and their families can happen in a variety of ways. For example, a group in California offers Surf Camp to the children of wounded or fallen service members. There are numerous organizations like this and it is important to connect them with members of the community that want to help and veterans and their families that need help. TexVet: Partners Across Texas (TexVet P.A.T.) is a collaborative effort of various local, state, and federal entities and programs to ensure the availability of a system of resources and referrals for members of our military service, veterans, and their families. The TexVet website provides valuable information that helps provide those connections.

While no one leaves war unchanged and the burdens of war are born by even the children of those that serve, those burdens do not have to be born alone. Bringing our service men and women home to stable families, strong communities, and a committed mental health care system can provide the best outcomes for everyone affected by the trauma of war.
For more information

* The National Center for Posttraumatic Stress Disorder
http://www.ncptsd.va.gov/ncmain/information/
* Coping When a Family Member Has Been Called to War
http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/familycoping.html?opm=1&rr=rr116&srt=d&echorr=true
* Surf Camp
http://www.ourmilitary.mil/Content.aspx?ID=45009891
* TexVet
http://www.texvet.com/