Mental health or more precisely, mental disease, is one of the most difficult issues to talk about, much less do anything about. Mental illness has such a strong social stigma that people who experience it are reluctant to seek help.
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The members of Women’s Fund El Dorado, all 300 and some, noted the seriousness of the problem in El Dorado County and voted to tackle the issue head-on.
Having identified the issue as the top priority for 2014, the Women’s Fund arranged a community needs forum to inform its members about the breadth and scope of mental health problems locally.
On Jan. 23, at a dinner program at the Cameron Park Community Services District Community Center, the theme was “Providing Solutions to Mental Health Challenges.”
This is step one. In step two, requests for proposals will be received by mid-March. The grant committee will score the applications by March 31 in step three. In step four, ballots will be sent to members. Step five is site visits to applicants. In step six the Women’s Fund will approve successful grant applications. Step seven is approval by the El Dorado Community Foundation. Finally step eight, the grants gala, where the recipients will receive their awards.
At the grants gala on June 5, a suite of larger awards and another suite of smaller awards will be given, as well as scholarships created by a legacy gift from Marian Wickline.
At the Community Needs Forum, former El Dorado County Superintendent of Schools Vicki Barber moderated the evening program. The three panelists were: Jon Lehrman, MD; Carolyn Sauer, PsyD; and David Toston.
Lehrman retired from his family medical practice in Placerville in 2012 after 40 years. He was chief-of-staff at Marshall Medical Center in 1985, and served on the board for 11 years. He was assistant clinical professor at the University of California, Davis Medical Center. He served as medical director for New Morning Youth and Family Services and has published a book on substance abuse.
He is currently board chairman and medical director for Access El Dorado (ACCEL), a countywide collaborative of Marshall and Barton Memorial, medical clinics, physicians groups and county departments that provide access to care and advocacy for the “safety net population.”
Sauer is a licensed clinical psychologist in private practice in El Dorado County. She is clinical supervisor for the county Senior Peer Counseling program, which offers no-cost, clinically-supervised individual counseling for residents 55 and older who suffer from grief, depression, loss, diminishing health and other problems.
Toston is executive director of both the El Dorado County Special Education Local Plan Area (SELPA) and the Charter SELPA. The El Dorado County SELPA is responsible for special education programs run by the County Office of Education as well as the 14 districts on the western slope. Lake Tahoe Unified School District is a separate SELPA. In addition, the SELPA provides parent education, interagency coordination, legal assistance, professional development and supports community advisory committees.
Discussion of mental health needs
The panel responded to prepared questions:
Question 1: Will the new affordable health care provide adequate mental health coverage?
Mental health coverage is one of the 11 mandatory elements required by the Affordable Care Act (ACA). Mental health costs are hard to estimate, depending on the type of illness and the treatment. The ACA will not cover all costs. The ACA has different plan levels, with higher or lower deductibles.
Question 2: How serious is a bipolar condition in the mental health spectrum?
Sauer said it is a long-term mood disorder that is characterized by revolving episodes of mania and depression. It can render people unable to work. “It is one of the most lethal. People can be self-destructive,” she said. An equal number of men and women develop bipolar illness and it is found in all ages, races, ethnic groups and social classes. The cause is not clear, but risk factors relating to family history and environment have been identified. Treatment involves medication and psychotherapy.
Question 3: What are the conditions for prescribing Ritalin? Is it over-prescribed to young people?
Ritalin is one of the brand names for methylphenidate, a central nervous system stimulant. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control. It is prescribed to treat attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD). It is more common in boys than girls. For young people diagnosed with these conditions, Ritalin can help them concentrate and be more successful in school.
Sauer said schools favor the female brain. “They are limiting physical education and music, activities that benefit males in their development.”
Lehrman said he is concerned about one of the side effects. Children with unknown heart conditions using Ritalin can suffer arrhythmia and heart attacks.
Some children with ADD or ADHD don’t need medication he said. For them, “a functional family is the best therapy.” And some children get better as they get older, he added.
Ritalin is considered habit-forming and should not be shared. But it is readily available and commonly bought and sold in school parking lots.
Sauer said Ritalin is often used by college students to help study for tests.
Toston said an “umbrella of support is needed,” with families, schools, medical providers and others participating.
Question 4: What are women’s most challenging mental health issues?
Sauer said young women have a lot of social anxiety. Will I fit in? Will I find a boyfriend?
Later, they are attempting to balance careers and families, trying to do everything for everybody, and putting everybody else’s needs before their own. Often, they are taking care of elderly parents. And as they age, they lose family members and friends. At any of these stages, depression and anxiety can develop.
Toston said programs that explore health and human development can help.
Lehrman added that poverty and violent relationships add to mental illness problems.
Question 5: What are the significant issues confronting the senior population when it comes to mental health challenges?
Seniors have lots of losses — friends, skills, said Sauer. They need to feel that it is OK to ask for help, that it doesn’t mean they are crazy. They need the courage to ask questions and sometimes challenge what they are told. In El Dorado County, particularly, many are isolated and have limited transportation.
Lehrman said there are an increasing number of seniors with Alzheimer’s, Parkinson’s and alcoholism. They also suffer from depression, physical limitations and loss of self-image. Their bodies dwindle because their appetites are poor. One of Lehrman’s concerns is the large number of medications that are prescribed for elderly patients.
Question 6: How are mental health problems addressed in the school age population (for example, autism)?
Autism spectrum disorder describes a group of complex disorders of brain development. The symptoms generally appear at the age of 2 or 3. The effects can range from intellectual disability to preeminence in visual skills, music, math and art. Other areas affected are social interactions and physical health.
Toston said the schools individualize support. Schools have on-site agency help. A systemic approach is used: developing behavior skills, regulating diet and sleep and reducing negative behaviors. Residential placement is provided if necessary.
Question 7: How are families affected when a member has a mental illness?
Mental illnesses are not readily apparent to the public, as are physical illnesses. There is a lot of guilt, blame and shame, said Sauer. Parents are told they can’t control their children, that it’s their fault.
Lehrman compared it to a chronic disease. “There is tremendous caregiving for a lifetime, with extraordinary expenses.
Question 8: When looking at intervention models for teen bullying, what sort of programs or models seem to be the most effective and efficient, if any?
School-wide programs that support positive behavior are seen to be most effective, said Toston. Adult reinforcement of peer support works best. They are both important.
Question 9: What is the extent of the drug problem in our county? Are local mental health services able to keep up with the needs for service?
Lehrman reported that Marshall Medical Center recently did a three-year needs assessment tallying visits by four zip codes to the emergency department for mental health problems related to substance abuse. Of the four communities, Diamond Springs had the most visits, followed by Placerville, second; Pollock Pines, third; and Georgetown, fourth.
Lehrman said that Marshall has no experts to treat mental health problems. Those patients may also have physical problems, which can be treated. But they have to be sent out of county or out of state for mental health treatment.
“Meth has a huge grasp,” he said. “It goes with our rural iconoclastic life.”
In El Dorado County, alcoholism is the leading cause of substance abuse. The county does have AA, NARCANON and ALANON services but it lacks a large detoxification center.
Lehrman noted that New Morning Executive Director David Ashby has said that 100 percent of the kids who come there with drug abuse problems also come from abusing households.
“It’s difficult to counsel students when drug abuse and violence are glorified in the home,” said Lehrman.
Use of prescription medications such as Ritalin, Vicodin and Oxycontin and non-prescription drugs such as pot, meth, LSD and heroin, are rising fast, said Lehrman. The likelihood of unintentional overdoses is rising also.
The scene is ever-changing. It’s a huge challenge, he said.
Question 10: What role does the nonprofit community play with drug dependency in the county?
Several of the nonprofits in El Dorado County were created to provide treatment for drug dependency. New Morning Youth and Family Services was established in 1970 to address the growing drug epidemic affecting the community and its youth in El Dorado County.
The El Dorado Council on Alcoholism provides drug rehab and alcohol addiction treatment.
Other nonprofits have specific supporting roles.
Question 11: On the plight of homeless children, what mental health needs are not being met?
Homeless children have a higher incidence of poor physical health, as well as mental health problems. Chronic diseases generally go untreated. In addition, they are often subject to abuse or neglect. Chronic stress and anxiety result in depression and/or aggressive behavior at an early age. Toston said the children are sometimes hard to identify because they are couch surfing and not part of any community.
Question 12: What types of early intervention programs assist with addressing mental health programs for women?
Wellness programs provide early identification of mental health problems without the social stigma. Programs that give professional and/or peer support for issues that women experience throughout their lives help prevent mental health problems from escalating and provide a path to treatment if necessary.
Health care providers, education programs and community organizations are sources for services that address teen social relations, parenting, co-parenting, dealing with serious illness or accident, or bereavement, substance abuse, physical or emotional abuse and other issues.
Question 13: Isolation is a common occurrence in older adults. What program models have shown positive effects on decreasing that isolation?
Social support, whether in groups at a center or by home visits, is critical. Often it is necessary to have a friend or caretaker provide transportation and companionship. Churches and senior centers help in most communities.
Sauer commented that one of the programs she believes benefits everyone is the Men’s Alternative to Abusive Patterns offered by The Center of Violence-free Relationships in Placerville.
Lehrman brought up a relatively new issue. Post Traumatic Stress Syndrome is a real problem in El Dorado County, he said. “It has huge proportions.”
Message from the chairwoman
Women’s Fund El Dorado Chairwoman Maureen Carter informed the audience that through member donations, the Women’s Fund has donated $255,000 in grants in El Dorado County. In addition, the membership has created a $275,000 endowment fund.
Putting “Mental Health Challenges” into the present context, she said El Dorado County ranks 14th in child abuse in California, 19th in youth abuse and 22nd in domestic violence.
“We want to lower those rankings,” she said.