Work stress can play havoc with men’s heart health especially when the stressful working conditions are not matched with suitable compensation, says a new study published in the journal Circulation: Cardiovascular Quality and Outcomes. The study noted that the impact of work stress on women is inconclusive. The study was done on 6,500 white-collar workers in Canada, with an average age of 45. (Also read: World Heart Day 2023: Early warning signs of heart attack women may experience weeks before)

Work stress can also lead to plaque build-up and increase in blood pressure which in turn can affect heart. Mindfulness, exercise, meditation, stress relieving activities can help keep heart issues due to stress at bay.(Freepik)

The authors noted that “the impact of job strain and effort-reward imbalance combined was similar to the magnitude of the impact of obesity on the risk of coronary heart disease.”

Work stress can also lead to plaque build-up and increase in blood pressure which in turn can affect heart. Mindfulness, exercise, meditation, stress relieving activities can help keep heart issues due to stress at bay.

Why men are more vulnerable to work stress

“Men might be more vulnerable to some kinds of work-related stress, which may in some situations increase the risk of heart issues. It’s important to remember that everyone reacts to stress differently, and that other elements like genetics, lifestyle, and general health have a big impact on heart health,” says Dr. Subhendu Mohanty, Head Cardiologists from Sharda Hospital.

“Men and women commonly operate in environments and professions that are distinct from one another. In some select industries with high levels of stress, such as those in finance, police enforcement, etc, men may be more at risk for chronic stress in these industries due to the demands of the job or the culture of the company,” adds Dr Mohanty.

“Chronic work-related stress can significantly elevate the risk of heart disease, with men being particularly vulnerable. This phenomenon is deeply concerning from a medical standpoint. Prolonged exposure to stress triggers a cascade of physiological responses that lead to hypertension, inflammation, and an increased propensity for cardiovascular issues. It’s crucial for individuals, especially men, to recognize the importance of managing stress through lifestyle changes, exercise, and seeking support, “ says Dr. Puneet Varma, Consultant – Cardiology – Adult, Narayana Health City Bangalore.

“The link between work-related stress and its adverse impact on health has become increasingly evident, and a recent study highlighting the potential doubling of heart disease risk in men underscores the urgency of addressing this issue. This research sheds light on a concerning correlation that warrants serious attention from both individuals and organizations,” says Dr Amar Singhal, Senior Consultant, Interventional Cardiologist, Sri Balaji Action Medical Institute.

“Stress, especially chronic stress, can lead to a range of detrimental physiological responses in the body, including elevated blood pressure, inflammation, and unhealthy lifestyle choices like poor diet and lack of exercise. In the context of men’s heart health, these factors can collectively contribute to a higher risk of heart disease,” adds Dr Singhal.

How men can deal with work stress

“Stress at work must be managed. You may be aware of the mental and physical symptoms of stress, which can include tiredness, irritability, headaches, tension in the muscles, and trouble concentrating. Early detection of these symptoms can facilitate intervention. Make sure you get adequate sleep, consume a healthy diet, and exercise frequently. Mental well-being is significantly influenced by physical health. Analyse your stress levels and the success of your coping mechanisms on a regular basis. Adapt your strategy as necessary,” says Dr Mohanty.

“Employers play a pivotal role in mitigating this risk by promoting a healthier work environment. Encouraging breaks, implementing stress-reduction programs, and fostering a culture of work-life balance can significantly benefit employees. Furthermore, individuals must prioritize self-care and recognize the importance of seeking help when feeling overwhelmed,” says Dr Singhal.

Heart healthy measures for men

“Men need to take care of their hearts since they are more likely than women to get heart disease. Still, you should exercise according to a regular schedule. Exercise helps maintain a healthy weight, control blood pressure, and improve cardiovascular health. Consume plenty of fruits, vegetables, whole grains, and lean proteins as part of a heart-healthy diet. The risk of heart disease is decreased by reaching and maintaining a healthy weight. Determine your Body Mass Index (BMI) and strive to maintain it within the advised range. Heart disease risk can be increased by having high cholesterol levels. Get regular cholesterol checks, and, in conjunction with your doctor, maintain your cholesterol levels with diet, exercise, and, if necessary, medication. Attempt to get 7-9 hours of restful sleep each night,” says Dr Mohanty.

“In conclusion, the study’s findings are a stark reminder that work stress is not merely a mental health concern but a substantial threat to physical well-being, particularly in men. Addressing this issue comprehensively requires a joint effort from individuals, employers, and healthcare providers to reduce the burden of heart disease and improve overall health,” says Dr Singhal.

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Arizona’s mental health system continues to have problems, but it’s come a long way since the days when people with debilitating mental illnesses were left to fend for themselves in filthy boarding houses with no counseling, socialization or job training.

The impetus for change came from a landmark lawsuit known as Arnold vs. Sarn.

In 1981, Chick Arnold risked his job as the Maricopa County public fiduciary by suing his employer and the state of Arizona because people with mental illness were living deplorable lives. Not only was it wrong, Arnold knew it was against the law.

As public fiduciary, Arnold’s office acted as guardians or conservators for about 600 vulnerable adults, including a man named John Goss, a former New York City stockbroker who had developed schizophrenia in his 20s and was living in a single room in a dirty boarding house that he found so scary that he spent his days walking the streets of downtown Phoenix.

“He lived in a place called S&W Boarding home, which was notorious. It burned down three times. He was afraid to stay there,” Arnold said. “He didn’t have family, and so the court appointed the public fiduciary as his guardian.”

Arnold felt the state and county, per state law, were obligated to provide Goss with more support than he was getting, including a structured living situation, job training and counseling. Goss was the first plaintiff named in the lawsuit, which eventually turned into a class action.

“I balanced what I saw as my fiduciary responsibility with my employment responsibility, and that’s no contest — the fiduciary responsibility prevails,” Arnold said in a recent interview.

Arizona continually failed to care for people with mental illness

The supervisors fired Arnold over the now-historic Arnold vs. Sarn case (Sarn refers to Dr. James Sarn, who in was director of the Arizona Department of Health Services).

A judge ultimately ruled Arnold could have his job back, but Arnold soon quit anyway to work as a mental health lawyer, which was a job title unheard of at the time, he recalled. Arnold retired in 2020 after a career of helping patients and families of loved ones who were incapacitated by mental illness.

Arnold describes Arnold v. Sarn as having a “simple” premise of forcing the state to provide a comprehensive community mental health system to people with mental illness, which is required in state statute due to a law passed in 1979. Once the lawsuit got the public’s attention, the state didn’t have the “collective chutzpah” to take away rights, though officials did try to get the case dismissed, Arnold said.

“This guy (Goss) was walking the streets every day because there was nothing to do. What about the socialization program? What about the recreational program? What about the housing? All of that was set out in the statute, and it wasn’t being done,” Arnold said. “So that was the lawsuit, a very simple case.”

In 1986, a trial court ruled that the state and Maricopa County violated their statutory duty, and the Supreme Court affirmed the decision in 1989. The case ultimately stretched on for 33 years through seven different Arizona governors because of findings that the state continued to fall down on its job caring for people with serious mental illnesses.

An Office of the Court Monitor assigned to ensure the state reached compliance in its duties to people with mental illness did yearly audits of the Maricopa County mental health system that Arnold describes as “dreadful, year after year.”

After one scathing audit report, Maricopa County Superior Court Judge Bernard Dougherty in a 2004 minute entry called the mental health system “shocking” and “dysfunctional,” and said the audit showed “deplorable failure by the state and its agent/providers in meeting their commitments.”

Among the problems were poor patient care and problems with case management.

Another blistering audit in 2009 led Maricopa County Superior Court Judge Karen O’Connor to say Maricopa County’s mental health system was in crisis, Arizona Republic archives say.

A lack of housing is ‘shortsighted,’ Arnold says

The case was dismissed under Republican Gov. Jan Brewer, who has a family member with serious mental illness. The 2014 agreement to end the case included an agreement from the state to increase the number of Assertive Community Treatment, or ACT, teams, which are mobile teams of specialists who bring services like life skills, job help and medication to individuals with serious mental illness directly to wherever they are living.

The case technically was about Maricopa County because it grew out of the dysfunction in 1981 when it was filed. But as the case matured, its effects were statewide, Arnold said.

The settlement also included an agreement that the state would provide supported employment, permanent supportive housing and peer and family support services for people with serious mental illness. Arnold said he unsuccessfully fought to include more specifics on housing in the settlement agreement.

“What was lacking, and is still lacking through the mental health system, is effective housing. You can’t recover in the absence of having a safe and secure place to live,” Arnold said.

“That has never been addressed. … It’s impossible to get the benefits of a system in the absence of adequate housing. Shortsighted is the kindest way of describing it.”

The housing issue is extremely frustrating for Laurie Goldstein, who is vice president of the Phoenix-based Association for the Chronically Mentally Ill. Goldstein misses the days when the Arnold vs. Sarn case included a court monitor who could force the state to meet its obligations to people with mental illness.

“The court monitor was kind of the final judge. Now, there’s no one to go to,” Goldstein said.

As of June 30, 5,003 Arizonans were on a waiting list for permanent supportive housing through a program funded by the state general fund, and 4,674 of them were designated as having serious mental illness. The data comes from officials with the Arizona Health Care Cost Containment System, which administers the housing program but does not fund it.

Another problem with mental health in Arizona right now, Arnold said, is the way the state, via AHCCCS, contracts out all its mental health care to regional behavioral health authorities. The state ought to be directly providing that care itself, much the way Arizona’s Department of Developmental Disabilities does, he said.

“I believe the government has some inherent responsibilities, one of which is to provide health care, and we don’t do that,” Arnold said. “We contract out for it and that has been an issue that has stuck in my throat for 40 years … The case managers in the (Arizona) mental health system are employed by a private company that contracts with another company that contracts with the state.”

Emptying of psychiatric hospitals preceded Arnold vs. Sarn

Arnold vs. Sarn was in part a response to a nationwide problem.

People across the country who had been locked up in psychiatric facilities were released into communities with an aim of restoring their civil rights. But often they ended up like John Goss, who was a former resident of the state hospital and ended up living in the community, feeling lonely and without the support he needed.

“Part of the lawsuit’s energy was driven by the notion of stopping institutional care,” Arnold said. “His (Goss’) story was a typical story at the time. People were given acute care when needed, but then released into nothing. There was no system.”

In 1952, when Arizona’s population was about 842,000, there were nearly 2,800 patients in the Arizona State Hospital, which first opened in 1887 as the Insane Asylum of Arizona, then State Asylum for the Insane. It is the most restrictive facility in the state for people with serious mental illness.

While the state’s population has increased more than eightfold since 1952, the patient census at the Arizona State Hospital these days hovers around 316.

The drastic drop in psychiatric patients at the hospital that happened during the 1960s and 1970s was because of what’s known as “deinstitutionalization,” which took hold across the U.S. after the Community Mental Health Act of 1963. The act was signed by President John F. Kennedy one year after Ken Kesey published his novel “One Flew Over the Cuckoo’s Nest” and at a time when medication to treat mental illness was showing more effectiveness than in the past.

The deinstitutionalization left many patients such as Goss struggling and suffering. Goss did not live long enough to see the changes that came about as a result of Arnold vs. Sarn. According to Arizona Republic archives, he died in 1983 at age 41.

“I think he just gave up,” Arnold told the Republic in 1985. “He wasn’t a dumb man, but he had become a frustrated one. He knew he could do more.”

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes.

This article originally appeared on Arizona Republic: How Arnold v. Sam changed Arizona’s mental health system

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One day, you are 17 years and 364 days old, seeing your life-long pediatrician who has guided you through every step of your medical journey from childhood to your adolescent years. The next day, it’s your 18th birthday, an exciting milestone for many, but the option to see your pediatric primary care provider may need to change. This abrupt transition can be overwhelming for patients with lengthy, complex medical histories, especially if there is little in the way of a clear path forward, explained Sarah Mennito, M.D.

This, she explained, is where the necessity for prearranged transitional care plans come into play, particularly for these complex patient populations. Mennito, a Med-Peds-trained pediatric hospitalist, is an expert in this field, having published eight papers on the subject of adult to pediatric health care transition. Med-Peds refers to a specialty that combines the fields of Internal Medicine and Pediatrics.

So what does a successful transitional care plan entail? What are the tools needed to help patients to flourish during the process of changing over care?

The transition from pediatric to adult care services can be quite a mental challenge for patients with chronic illnesses. Certain diagnoses require a multisystemic approach, meaning that in order to treat such complex conditions, considering what care is necessary from various specialties is essential. A major consideration when transitioning from pediatric to adult care involves parting ways with deep-rooted relationships – the very physicians who have supported these patients throughout their lifetimes.

Crafting a comprehensive transitional program for the pediatric population can ensure smooth transfers to the adult health care environment as well as increase self-sufficiency and independence and develop a strong foundation for practicing self-advocacy. While there is no one-size-fits-all instruction manual to navigate through the health care system, there are resources – and more are on the way.

 Dr. Mark Scheurer

“There are lots of transition models out there. In general, there is still so much opportunity nationally to help. And I would say there’s a lot of these different models because there is great need, and frequently, transitions are not consistently done across all specialties in the country. I would say that we are neither behind nor yet at the forefront. But I think we have an opportunity to do more work in that space. And frankly, with the way we’re organized, I think it allows us to do that easier than some,” said Mark Scheurer M.D., chief for Children’s and Women’s Health.

In the short term, the goal, according to Scheurer, is to reinforce the overall structure by developing programs, processes and templates that each specialty can use for their specific needs. Transitioning care from gastroenterology in a pediatric setting to an adult setting, for instance, is going to differ from how it would look for endocrinology or transplant care.

To meet that goal, the MUSC Shawn Jenkins Children’s Hospital recently introduced two new resources to support providers, patients and their families through the transition process. The hospital’s first effort came in August with the development and release of electronic handouts modeled after resources crafted by the national nonprofit organization Got Transition. These handouts will be uploaded to patients’ MyChart After Visit Summary pages. They include a health care transition timeline for youth form, transition readiness assessments and questions for doctors to consider during the transition process. 

Several parents who are part of the Pediatric Family Advisory Council (PFAC) can be credited for the creation of these tools. Got Transition provides a plethora of public tools and handouts necessary for providing support through health care transitions. With approval from the organization, the PFAC worked together to determine how best to modify the documents in order to meet the institution’s specific policies and needs. Secondly, at the end of September, SJCH will introduce a peer support community, which is open to SJCH patients seeking guidance.

“In terms of Got Transition, I see it as a great resource that has really been structured with the goal of making all of their tools accessible to everyone as well as creating tools that are reproducible and editable so that they can be made appropriate for whatever clinical area they’re being used in,” said Mennito. 

 Dr. Sarah Mennito

Mennito will lead future support groups, along with second-year medical student Brian Linder, who participated in pediatric peer support groups at Duke University for adolescents with chronic health conditions seeking support throughout the health care transition process.

“I think that the support groups, by encouraging positive youth development, provide a holistic approach to transitional care,” Linder said. “It doesn’t replace what is happening in the clinical space, but I do think it really helps create the support for those kids who are struggling a little bit more with transition, who might need a little more space to process their diagnosis.”

He expounded on the benefits and importance of focusing on a seamless and positive transition for these patients. “Whether it is living as a teenager with lifelong illness, just feeling different or other than your peers at school, having a space where everyone in the room has a chronic condition who can really empathize and relate to the experiences of each other can be encouraging. To find out what being healthy means to you and to others or to set goals, especially on how to advocate for yourself in the presence of a provider,” he said. 

All of the components that the support groups will bring, he added, will really strengthen how kids and their families function in the clinical space as well as in transition. 

“Obviously, going to the doctor is very important. You have to get those recommendations for your health and have that treatment plan in place in order to keep your wellness in check. What’s really important for folks is to have that support, to be encouraged to actually implement these changes so they can start to value their health more and realize that the self-management piece is the actual manifestation of implementation,” Linder said, adding, “Personally, I think that aspect has become more and more important to me as I’ve seen it through my own experiences as well as learning throughout medical school and with the interactions I’ve had in clinic.”

If you are interested in learning more about the peer-support community for teens with chronic disease, email Sarah Mennito, M.D.

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OTHELLO — The Columbia Basin Health Association is the recipient of a $500,000 grant designed to help children and teens who need behavioral health care to get it more quickly. The CBHA was one of five winners nationwide in the “Community Health Entrepreneur Challenge.”

Dalina Hoffman, CBHA director of programs, said the money will be used to build an AI platform that will help young people connect with mental health professionals.

“We use an interactive artificial intelligence to help guide the students or counselors through a process of scheduling an appointment with a behavioral health consultant, virtually,” Hoffman said. “By doing that we are using an innovative way to reach our students so they can get those mental health services using technology, which is what they use every day.”

The competition was sponsored by Advocates for Community Health and UnitedHealthcare.

The Othello School District has been using the platform for about two weeks, Hoffman said. The health association plans to expand it to the Connell and North Franklin school districts.

“So they can grab their phone (and) scan a QR code,” Hoffman said. “With that QR code, they’ll go to a chatbot and it will ask them a series of questions. (If) they need immediate assistance we can actually connect them to the crisis line, where they can speak to someone right there and then. Or if they want to schedule an appointment with a behavioral consultant, virtually, they’re able to do that.”

The online system means young people can have access to a mental health professional without leaving school, she said. They’re online visits, but all the behavioral health professionals are CBHA employees.

“We’re really excited with the initiative that was put forward here because it’s really bolstering existing providers that are serving the community,” said Kate Paris, vice president of policy and advocacy for UnitedHealthcare Community & State.

Because not all children have a phone, Hoffman said each participating school will have a tablet setup that allows a counselor to connect the youths to CBHA.

The goal, she said, is to ensure young people get the care they need as quickly as possible.

“To receive behavioral health services, it can take up to three months sometimes to schedule an appointment,” Hoffman said. “So having providers specifically for school-based behavioral health is a solution for that.”

School officials within CBHA’s service area had identified that as an area where they needed help getting the services, she said, and it’s been an area of focus for the health association too.

“And it’s specifically for the school, and students are able to scan it,” Hoffman said.

The QR code will be as visible as CBHA can make it, she said.

“We’re going to get stickers, bag tags, everything pretty much that kids are using,” she said. “Now they have stickers on their water bottles, so we’re going to give them water bottles. And I reached out to all the superintendents and counselors, so they also can provide ideas (about) what are the things that students at that school are using or would probably have accessible to them,” she said. “Basically we’re going to put it everywhere, so they know it’s accessible.”

The health association also is considering holding some events to provide children and teens with more information on mental health and encourage them to seek help if they need it.

“It’s something that CBHA wants to be a part of, to eliminate those barriers. Fifty percent of our patients are under the age of 18, so we know that the majority of them are students. This is a huge issue across the areas we serve, and we want to be able to help with that.”

Cheryl Schweizer may be reached via email at cschweizer@columbiabasinherald.com.

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CARE Court, a controversial and costly initiative set to launch in eight California counties by December before going statewide, gives hope to many.

Under the program, judges will be able to order people with untreated psychotic disorders, such as schizophrenia, to get help, with counties required to provide the aid. Anita Fisher sees it as a possible lifeline for people like her son, Pharoh Degree, who was diagnosed with schizophrenia while serving in the Army 22 years ago. He’s now 45 and said living with the illness can be difficult.

“Constant overthinking,” he said, describing how difficult experiencing schizophrenia can be when it’s untreated. “Your brain is always racing, your inner voice is always talking, racing, racing. No peace. Never any solace and peace.”

Why do supporters say CARE Court is needed?

Until now, Fisher says there has been little recourse to make sure her son gets help. Her son stopped taking his medication last year. For seven months, Fisher called for a psychiatric intervention, but without her son’s consent, she says her attempts were ignored.

Pharoh became homeless. Fisher spent days searching for him at local spots near their home. She said it was clear he was unwell when she found him.

Anita Fisher works as a mental health advocate. Her son was diagnosed with schizophrenia. 

60 Minutes

“He would be, ‘I’m fine.’ But no, he wouldn’t look fine at all,” Fisher said.

Last October, he was arrested for vandalism. In custody, he received medication and enrolled in a treatment program. 

Gov. Gavin Newsom, a fierce advocate for CARE Court, describes the current system as a “fail-first system” rather than a “care-first system.”

“Which means you have to end up in the criminal justice system before finally someone provides support, and a bed and a solution,” Newsom said. “We’ve got to change that. And that’s what we’re doing.”

California already has laws on the books to help many of those with a severe mental illness, but many believe the current laws fall short. Critics have said the Lanterman-Petris-Short Act, which sets rules for involuntary psychiatric treatment, kicks in too late, only helping when someone is already in crisis. Laura’s Law, which authorizes assisted outpatient treatment, or court-ordered mental health treatment plans, has also been largely seen as a failure because it is not statewide and was not implemented with significant funding attached. 

On any given night, more than 170,000 people are living on California’s streets or in its shelters. About 1 in 4 has a serious mental illness. The Newsom administration believes CARE Court, which is not restricted to those experiencing homelessness, will help an estimated 12,000 people.

While Fisher, who also works as a mental health advocate, hopes her son never needs CARE Court, she said she wouldn’t hesitate to initiate proceedings for it. 

“I hope that if it does, that he even sees it as a positive experience where his voice is heard,” she said. 

Who is eligible for CARE Court and how does it work?

Only those 18 and older with a diagnosis of schizophrenia or other psychotic disorders are eligible for CARE Court. Other eligibility requirements include the individual’s likelihood of surviving safely in the community without supervision or without harming themself or others. Individuals are also only eligible if it is deemed  likely that the person will benefit from being a CARE Court  participant.

A person referred to CARE Court for a severe mental illness is evaluated and a CARE Court judge reviews the petition, which can be filed by a close family member, roommate, hospital director, first responder, police officer or licensed behavioral health professional. 

If the individual is considered likely to meet the required criteria, the judge can order a clinical evaluation. Based on those results, a judge can order a mental health treatment plan including medication, therapy and a place to live. The plan will run for one year, with a one-time option to extend the plan for a second year. 

Those in CARE Court will have access to a public defender and can refuse treatment without being sent to jail, but there’s a catch. If someone in CARE Court does refuse treatment, a judge could refer them for conservatorship — an extreme outcome that strips them of rights and forces them to comply with treatment. 

The controversy over CARE Court

Critics say the program, set to launch statewide by the end of next year, is coercive, removing choices and forcing treatment. Eve Garrow, a homelessness policy analyst for the ACLU of Southern California, sees the state plan as a pipeline to conservatorship and the deprivation of civil liberties. Among other things, she worries people would lose the right to determine what medications go into their bodies.

“There’s no forced medication, but when there’s pressure and coercion, you’re more likely to potentially comply with treatment that actually isn’t meeting your needs,” Garrow said. 

Garrow believes the state should provide comprehensive care for all Californians with mental health disabilities, she said. She sees it as a plan that could be a reality if California invests in those services instead of diverting funds to the new court system. 

The Newsom administration invested about $17 billion to fight homelessness and treat mental illness this year. But leaders in many counties say money earmarked for CARE Court is nowhere near enough for the thousands of people expected to land in the system.

Some of that money will go toward Los Angeles, a county where 1 in 8 of the nation’s homeless people live. Marquesha Babers, 28, was homeless for years, on and off, in the area’s notorious Skid Row. When 60 Minutes met Babers, she was living in a shelter and told us she had several serious mental health conditions, including bipolar disorder.

Marquesha Babers has dealt with homelessness. She told 60 Minutes she has several serious mental health conditions, including bipolar disorder.

60 Minutes

“I go almost every day to ask if I could speak to a therapist or if I can, you know, get some mental health services or help,” Babers said. “And there are really none. Or if you do find one it’s like, ‘Oh, well, the waiting list is six months before you can actually talk to a therapist.'”

She does not support CARE Court and said she views it as “medical incarceration” because of the threat of conservatorship, where people can be locked up in psychiatric facilities and treated without their consent.

“I think there just needs to be way more attention to services and prevention rather than the consequences of not having those services,” she said.

Last month, Babers was reported missing by her family. 

Many of Babers’ concerns about CARE Court have also been voiced by advocacy groups. In all, more than 50 advocacy groups have condemned CARE Court as a “costly mistake” that’s “likely to do real harm.” 

Newsom counters that conservatorship as a possibility is nothing new. He understands that people don’t want to see it happen, but it’s a reality already and he believes CARE Court could be key to ensuring that some people experiencing psychotic disorders get the help they need.

“And here’s all I ask: prove us wrong,” Newsom said. “Don’t assume us wrong. Your compassion is not superior to our compassion.”

This story was reported by: Cecilia Vega, Natalie Jimenez Peel, Jaime Woods

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Aliza Chasan

Aliza Chasan is a digital producer at 60 Minutes and CBS News.

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In Sept. 2019, Adejoke Adedeji created Nexus of Hope, a psychiatric clinic in Lakeville, Minn., offering a wide range of services from talk therapy to transcranial magnetic stimulation (TMS), medication-assisted treatment and telehealth. 

When the COVID pandemic struck in 2020, she thought business might slow down.

She was wrong.

“Things got even busier, as we know, you know, a lot of people experience a lot of anxiety and stress during COVID,” she said.

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The psychiatric nurse practitioner said during the height of COVID-19 and the justice movement following the murder of George Floyd by a Minneapolis police officer, she saw more people of color who felt agitated, had questions and were searching for someone who could understand them and share their cultural experiences.

Nexus of Hope founder Adejoke Adedeji works at her desk in the company’s Lakeville, Minn., offices on Sept. 5.

Ben Hovland | MPR News

Adedeji, who was born in the U.S. but grew up in Nigeria, says while there’s been progress, there are still too many people in African immigrant communities who feel too stigmatized by their mental health concerns to seek help. And she says even health privacy laws don’t ease their concerns.

“They are still concerned that things are too close to home,” she said. “So sometimes that is not what they seek out. If they do seek out help, they aren’t seeking out somebody within their culture.”

Adedeji says her own experiences have helped her connect with the people she helps.

She originally went to school with plans on becoming a creative writer — but plans changed once she experienced first-hand the impact of mental illness. In 2010 she lost a cousin to suicide and later that year her youngest brother died very suddenly.

“And so that was very, very hard for the entire community, especially since we really hadn’t been hit with death with young people before,” she said. 

Uplifting messages line the walls inside Nexus of Hope’s Lakeville, Minn., clinic on Sept. 5, a little over a year after moving to its new, larger building.

Ben Hovland | MPR News

Adedeji says that experience taught her quickly about the lack of support in her community when it comes to suicide and illness. 

She made it a goal to remove the stigma by validating people’s experiences. 

“And really exploring all those feelings and knowing that your feelings are valid, and you don’t have to repress them, or hide them,” she said.

Adedeji went on to get her master’s degree in public health from Florida International University, before earning a Master of Science in Nursing at the University of Tennessee. 

Now, she’s helping patients across the country find their voice and a treatment plan. 

Colin Skerrett, 28 from Eden Prairie, Minn., says one of his parents is Black and the other is white. He says seeking treatment for his addiction and anxiety was not an easy journey — until now. 

“Honestly, the way [Adedeji] was able to understand me and both coming from a background that was not your traditional kind of American upbringing really helped,” he said. “There were a lot of similarities that just in my day to day life that were actually kind of big points of contention at that point in time, she was able to understand and appreciate.” 

Olushola Olukoga, 28, has also struggled with anxiety and depression for years. Born in Nigeria, Olukoga said the COVID-19 pandemic was her breaking point. After years of feeling shame for her battle with mental health, she says treatment has been liberating — thanks in big part — to finding a Nigerian therapist. 

Transcranial magnetic stimulation machines, pictured at Nexus of Hope’s Lakeville, Minn., clinic Sept. 5, use a magnetic field to stimulates nerve cells.

Ben Hovland | MPR News

“There were so many times I almost lost my life because of shame, instead of choosing to get proper help,” said Olukoga.“So seeing someone who grew up within those cultural restraints, those conflicts, and not only grew up in it, but like a professional, it did a lot for me, more than [Adedeji] would ever know.”

Olukoga says it was a specific moment during her first time meeting with Adedeji that assured her she found the right therapist. She says it was when Adedeji was open and honest about her own mental health journey, including taking medication and going to therapy. 

Olukoga said that helped calm some of her fears about getting psychiatric treatment.

“Like, are they using me for some kind of experiment? Are you doing stuff for fun? But the fact that she helps people and is not afraid to get help herself if and when she needs it,” Olukoga said. 

According to the National Alliance on Mental Illness, people of color are less likely to receive mental health services compared to those who are white. In 2021, only 39.4 percent  of Black or African Americans with mental illness accessed treatment, compared to 47.2 percent of all U.S. adults.

Adejoke Adedeji demonstrates the TMS machine at the clinic on Sept. 5. It is used to treat symptoms of depression, OCD and smoking cessation.

Ben Hovland | MPR News

State lawmakers passed legislation in 2022 to build and reform mental health care systems — including an act that creates a grant program for mental health providers who have at least 25 percent of their clients on public insurance or a sliding fee and who primarily serve underrepresented communities. 

Lawmakers also enacted a policy that establishes a juvenile court guardianship program for at-risk youth.

Adedeji knows people are more likely to seek help if they think their provider can  empathize with their background and cultural differences. 

“I’m not saying the problem is going to be fixed right away, or that I have any magic bullet,” she said. “But what can I do today to help ease that suffering? For some people, it is medication; for some people, it’s direction. For some people, it is just normalizing their experiences and letting them know that I’m here.”

The most recent National Alliance on Mental Illness report shows three in 10 adults reported symptoms of anxiety or depression in Feb. 2022, compared to a rate of one in 10 in Jan. 2019.

The report also marks 2022 as a mental health milestone — with the launch of the 988 Suicide and Crisis Lifeline.

If you or someone you know is in crisis or thinking about suicide, call or text 988 to reach the Suicide and Crisis Lifeline.

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Warning: This article contains mentions of suicide and suicidal ideation. Take care when reading.

Canadians are increasingly struggling with their mental health, a new report suggests, a concerning trend that appears in part to be driven by the economy and personal finances.

In the last year, about one in seven Canadians have thought about suicide, a poll from Mental Health Research Canada (MHRC) shows.

Among the concerns noted by the research group, suicide ideation is more predominant in younger people, and is particularly high among 16- and 17-year-olds, including other age groups like 18-to 34-year-olds.

Some of the main contributors to declining mental health are difficult financial situations, inflation, and housing and food security, the survey showed.

“Financial instability is impacting suicide ideation, with those experiencing money problems being more likely to have considered it,” the study published Wednesday reads. “Specifically, those who are unemployed (24 per cent), have an income below $30,000 (21 per cent), have financial troubles (41 per cent) or have gone into debt due to inflation (30 per cent) indicated having had suicidal thoughts in the past year.”

The survey polled 3,819 Canadians across the country from July 27 to Aug. 13, 2023. It is the 17th report of its kind from MHRC, which has tracked the mental health of Canadians since April 2020.

Previous editions noted a small improvement in the mental health of respondents when COVID-19 restrictions were lifted. Researchers anticipated the indicators would increase further, but instead, the most recent data suggests mental health is “flatlining.”

(MHRC)

FINANCIAL CONCERNS A ‘MAJOR’ FACTOR

Poll 15 of this project uncovered the trend that a poor economy and inflation were negatively impacting Canadians.

Months later, in Poll 17, the data shows a similar trend line.

Almost 40 per cent of respondents said they feel the state of the economy is negatively impacting their mental health. Those with lower incomes were more likely to say they have high anxiety and depression, the study says.

In the past year, the Bank of Canada has been increasing interest rates in an effort to bring down inflation. This has negatively impacted many Canadians in both the rental and housing markets, who are now, or were already, struggling to afford the higher cost of living.

About 23 per cent of Canadians said they were concerned about paying for housing, Poll 17 shows, which is an increase of 3 per cent since the spring and 8 per cent more year-over-year.

Along with housing pressures, the rising rate of inflation means Canadians are paying much more for groceries, causing stress for many who worry whether their paycheque will cover the essentials.

“There has been no relief for those with food insecurities,” the study says.

Prior to the uncertain economic times, there were many people in Canada living in food insecurity, but since the pandemic and with recent rising costs, this number has increased exponentially in the past several years, based on the polling by MHRC.

About one-third of Canadians worry they cannot afford healthy food, the latest poll shows, and 3 per cent of respondents said they are dependent on food programs, such as food banks.

“Those experiencing high levels of anxiety or depression are significantly more likely to experience food insecurities,” the study reads.

Younger Canadians (aged 18 to 34), women, those who have children under nine, unemployed people, minorities and those with chronic pain are the most food insecure in Canada, according to the survey.

WHAT CANADIANS HAVE DONE TO COMBAT INFLATION

To combat higher costs of living, 25 per cent of respondents said they have gone into debt.

“Those who rate their anxiety and depression as very high are more likely to have gone into debt, as are those likely to have symptoms of a severe mental disorder and who have possible alcohol or cannabis dependency,” the study shows.

Inflation has impacted three-quarters of Canadians in the past year, a four per cent increase since the last poll a few months earlier.

To manage high costs, many people (46 per cent) are reducing discretionary spending or reducing essential spending (34 per cent).

About 23 per cent are using their savings to pay for essential costs and 17 per cent rely on a credit card or loans to pay for items. About 11 per cent say they borrowed money from friends or family to keep afloat.

As inflation continues to pinch the pockets of Canadians, the correlation between mental health is apparent, those behind the surveys say.

The polling suggests that 39 per cent of people have been negatively impacted by the economic downturn, and 37 per cent said they may not be able to pay all of their household bills in 2023.

(MHRC)

CANADIANS KNOW WHERE TO GET SUPPORT BUT CAN’T AFFORD IT

Knowing the impacts of mental health, about 72 per cent of people said they are somewhat or very confident they know how to access support for themselves or loves ones.

This is an increase of 5 per cent from Poll 16 and a huge leap (17 per cent) from Poll 15.

“Those who have accessed mental health supports in the past year are more likely to feel very confident, (which is) consistent with Poll 16 findings,” the study says.

People with high anxiety are less confident in getting support but those with a diagnosis are more confident, the latest poll suggests.

Despite many Canadians knowing how to access support, about one in 10 people reported using mental health services in the last year.

One of the reasons for not accessing support is the financial burden, the study says.

“Of those who felt they needed mental health support but didn’t access it, almost one-in-three said they couldn’t afford to pay for it,” Poll 17 data shows. “This is an increase of 11 per cent from Poll 16 and 14 per cent from Poll 15.”

Other barriers include wait times, accessibility, a lack of confidence in the health care system and no coverage through benefits.

An increasing number of Canadians (39 per cent) reported they are paying out of pocket due to a lack of coverage. This has increased 9 per cent since Poll 16.

——

If you or someone you know is in crisis, here are some resources that are available.

Canada Suicide Prevention Helpline (1-833-456-4566)

Centre for Addiction and Mental Health (1 800 463-2338)

Crisis Services Canada (1-833-456-4566 or text 45645)

Kids Help Phone (1-800-668-6868)

If you need immediate assistance call 911 or go to the nearest hospital.

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A team from the Yale School of Public Health will use the grant to offer their evidence-based therapeutic tools to community centers across the country.

Richard George

3:07 am, Sep 08, 2023

Yale Athletics

With a $4 million grant from the National Institute of Mental Health, Yale researchers are seeking to offer new therapeutic interventions to LGBTQ+ community centers across the country. 

The five-year grant, which was announced in a press release last week, will support research by John Pachankis, who is a professor of public health, and his team at Yale’s LGBTQ Mental Health Initiative. The team will administer novel LGBTQ+ affirmative cognitive behavioral therapy to over 90 community centers and 540 mental health providers across the United States.

“LGBTQ+-affirmative CBT recognizes LGBTQ+ people’s exposure to identity-related stressors,” Pachankis said, speaking about a form of psychological treatment called cognitive behavioral therapy. “It teaches LGBTQ+ people to undo harmful legacies that led them to be more ashamed, and replace them with new, empowered ways of thinking and being.” 

Pachankis and his team hope to use the NIMH grant to compare different methods of educating providers on LGBTQ+-affirmative CBT. They will evaluate the therapy’s effectiveness alongside other factors including cost and competence. 

Pachankis’s research on LGBTQ+-affirmative CBT finds that a client’s reactions to “minority stressors” — negative emotional experiences like hypervigilance, concealment and fear — are caused by stigma against queer people. This stigma can stem from harmful personal interactions or larger structural changes targeting the queer community, such as the rise of legislation blocking access to health care for transgender individuals. Mental health providers trained in LGBTQ+-affirmative CBT ask questions about clients’ past to help them reflect on why they experience negative emotions to improve their self-esteem.

“The identities we have and the prejudices people have about them have real and tangible consequences for people’s health,” Skyler Jackson, an assistant professor of public health and a clinical psychologist with the Initiative, said. “One of the distinguishing factors of our approach is the use of best practices in psychotherapy honed in on the areas, issues and challenges we know queer people face due to previous anti-LGBTQ+ stigma.” 

The team’s LGBTQ+-affirmative CBT is the only evidence-based approach in addressing the mental health challenges of the queer community. From their initial research to putting that research into practice, Pachankis and his team have acknowledged the wide diversity of the queer community. LGBTQ+-affirming CBT encourages providers to approach clients’ multiple identities with cultural competence, curiosity and tailored questioning.

“LGBTQ+-affirmative CBT has an explicit focus on intersectionality,” Pachankis said. “It recognizes that people and identities are complex and shaped by intersecting structural and social conditions.”

Through the therapy, providers and clients recognize the clients’ diverse identities beyond their sexual orientation or gender identity to pinpoint the causes of their struggles. According to Jackson, identifying these sources of shame encourages clients to be proud of themselves. 

Danielle Chiaramonte, an associate research scientist and community psychologist with the initiative, told the News that LGBTQ+-affirmative CBT is a popular mental health approach.  “Therapists can feel confident in the treatment they provide, and there are people all over who are interested in it.” 

LGBTQ+ community centers, many of which were created to help respond to the HIV/AIDS crisis, have transformed into primary healthcare centers that provide comprehensive services. By implementing evidence-based practice, Pachankis said that his team believes community centers can improve their mental health divisions through federal funding and external support. The team insists that working with local community centers will spark sustainable change that impacts providers, clients and the wider queer community. 

“Community centers are doing the work that the rest of society isn’t,” Pachankis said. “They provide care to those who are uninsured, people of color, transgender. They are on the frontlines of addressing mental health needs of the LGBTQ+ community members at the greatest risk.”

With the grant’s help, Pachankis said his team hopes to accelerate bringing LGBTQ+-affirmative CBT to the real world. By supplying workers in community centers with evidence-based therapeutic tools, the Initiative aims to build a more informed group of mental health providers. 

“Initiatives like this are crucial to ensure that LGBTQ individuals receive the support they need and help increase access to lifesaving, medically necessary care,” said Samuel Byrd, director of Yale’s Office of LGBTQ Resources. “This five-year grant will undoubtedly make a significant impact in addressing mental health disparities within our community and providing evidence-based care to those who may not have had access before.”

Ultimately, Pachankis said his team understands that their research will not completely solve discrimination against the LBGTQ+ community. 

Still, he said, they hope to empower queer people to cope and confront their current realities.

“We are committed to building a world that works for all of us,” Jackson affirmed. “We need to arm queer people with armor to navigate a world that is still unfair and unjust. We need to give LGBTQ+ people all that they can to survive and thrive.”

The Yale LGBTQ Mental Health Initiative was founded in 2013. 

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Photo by Gabriel C. Pérez/KUT

Tuesday, September 5, 2023 by Olivia Aldridge, KUT

Integral Care, the mental health authority for Austin-Travis County, voted Thursday to approve a budget that eliminates nearly 10 percent of its positions. Along with the 48 individuals who were identified for layoffs, 67 vacant positions were also cut.

Employees in the union United Workers of Integral Care said layoffs would further strain staff already struggling to meet the needs of its large client base. As of 2022, Integral Care reported serving 27,550 people, making it the largest local provider of mental health services.

Megan Moriarty, who does intake and counseling at Integral’s Care’s Second Street clinic, said some patients without health insurance already don’t get the services they need due to a lack of organizational resources.

“We don’t have the staff to do it – before any cuts, before layoffs, before programs disappearing, we already don’t have enough people,” Moriarty said Thursday at Integral Care’s budget meeting.

The agency’s $131.5 million budget for the 2024 fiscal year is more than $22 million less than last year’s budget. Officials have largely attributed this dip to unexpected changes in the funding Integral Care receives from federal and state sources.

As the local mental health authority, Integral Care gets funding from the county and the city of Austin, as well as Travis County’s public hospital district, Central Health. However, state funding sources make up the largest share of its budget.

Previously, state funding primarily came by way of a federal 1115 Medicaid Waiver. In states that have chosen not to expand Medicaid under the Affordable Care Act, these waivers finance programs that provide care to uninsured and low-income patients. Texas’ 1115 Medicaid Waiver was temporarily in jeopardy, however, when the Biden administration challenged its renewal in 2021. Although the challenge was ultimately dropped, Texas still made adjustments to how it supports entities like Integral Care, funneling money through the state’s Charity Care Program and Directed Payment Program (DPP).

According to the agency’s Chief Operations Officer Dawn Handley, these programs allow less flexibility in how funds are used. Whereas the Medicaid 1115 functioned like a grant that supported entire programs, the state’s new model ties funding to the number of units of service the organization delivers. During FY 2022, Integral Care did not deliver as many services as the state expected and must return $1.6 million to the state as a result, Handley said.

Another consequence is that Integral Care will officially end several of its programs, including its 15th Street respite center and mood disorder clinic. Officials said services offered through those programs would be folded into other Integral Care offerings.

Additionally, organization leaders said, $4 million in expected funding from the Legislature did not materialize this session. Instead, lawmakers approved only $400,000 in annual payments over the next two years.

While Integral Care leadership searched for grants and other sources to make up for the unexpected losses, Handley said, they were not successful in time for this year’s budget process.

“(We) worked diligently to reduce the shortfall as much as possible,” she said at a budget forum earlier in August. “In addition to looking at new and existing funding streams, we also looked at ways to reduce administrative costs and more. We’ll continue these efforts into the next year as well.”

A number of Integral Care employees and clients expressed concern over the layoffs at Thursday’s meeting, so the board of trustees voted to approve the layoffs and reduced budget with a caveat – that affected employees get 12 weeks of notice before their positions are eliminated instead of six. Integral Care will also keep those employees informed of positions that become available due to potential new revenue sources.

In a statement, the union’s leadership said the change was an improvement, although “not an all-out win.” Over the next three months, UWIC said, it will turn its attention to local funders who could offer support.

“The union is now calling on the City of Austin and Travis County elected leaders to use this 12 week period to urgently work with (the Integral Care board) to secure additional funding to prevent any employee layoffs and cuts to services,” union leaders said in a statement.

This story was produced as part of the Austin Monitor’s reporting partnership with KUT.

The Austin Monitor’s work is made possible by donations from the community. Though our reporting covers donors from time to time, we are careful to keep business and editorial efforts separate while maintaining transparency. A complete list of donors is available here, and our code of ethics is explained here.

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A man sleeps next to trash cans in downtown San Diego. Photo by Chris Stone

Under the low hum of cold fluorescent lights in a nondescript office park in Orange County, dozens of Californians gathered to find out if they could get help for their loved ones under the state’s new CARE Court system.

Unless that loved one has a medical diagnosis specific to schizophrenia or some other psychotic disorders, the answer was probably not.

The mid-August meeting was one of a series held by a mental health advocacy group in Orange County with the officials in charge of implementing CARE Court starting in October, about what the new system can and cannot do.

“What we’re here to do is share the facts to help manage expectations,” said Veronica Kelley, Orange County’s chief of Mental Health and Recovery Services.

Community Assistance, Recovery, and Empowerment (CARE) Court was Gov. Gavin Newsom’s biggest legislative priority last year — what state lawmakers and local politicians hoped would be one answer to California’s dual, overlapping homelessness and mental health crises. 

The new program allows family members and others to petition someone with untreated mental illness into civil courts, where a judge would order a treatment plan and require county mental health departments to provide it. 

Backed by millions in new state funds, it’s a mandate for those departments at a time Californians have become increasingly frustrated with one of the most visible consequences of the state’s trenchant homelessness crisis — people with the most severe mental illnesses languishing on the streets. 

Counties will be judged on how well they’re able to get people who may be resistant to help inside and into treatment, even though CARE Court is not exclusively a program targeting homelessness. Local mental health officials are warning it won’t be a panacea.

“There’s been a presumption — and this is, to be clear, driven by how the administration talked about CARE Court at the outset — a broad presumption that CARE Court is going to fix homelessness or have a broad impact on the nexus of homelessness and behavioral health,” said Luke Bergmann, director of the San Diego County Behavioral Health Services department. 

In reality, he said, it’s “actually going to be a pretty small program. It’s not going to be this thing that dramatically changes homelessness.”

The program aims to walk the line between forced treatment and completely voluntary treatment for those with the gravest needs. Disability rights groups decry it as a violation of a person’s civil liberties, and a potential path toward conservatorship and the loss of legal rights for those who repeatedly decline care. 

Annette Mugrditchian, deputy director, speaks to community members about CARE Court at the Behavioral Health Training Center in Orange County on Aug. 17. Photo by Lauren Justice for CalMatters

CARE Court survived a legal challenge from Disability Rights California and other civil rights groups earlier this year. The group sat on a state working group for the program’s implementation and will monitor its rollout. 

The program was welcomed by some family members of those with severe mental illness, who have complained the state’s privacy and patients’ rights laws only allow their loved ones to be compelled into treatment when in crisis, trapping them in a revolving door of short-term hospital stays and homelessness.

The first courts will open across the state in about a month. Seven counties, urban and rural, have been deep in preparation to be the first to roll out the program in October. 

Los Angeles County, whose roughly 75,000-person unhoused population is the state’s largest, will start the program in December; the rest of the state will follow next year.

Those in the first group — San Francisco, Orange, San Diego, Riverside, Stanislaus, Glenn and Tuolumne counties — have had numerous questions to address, such as: 

• Who will find and serve respondents with their CARE Court petition if the respondent is unhoused?
• How can county courts make the paperwork-heavy petition process easy for family members?
• How many mental health treatment beds will counties need to add?
• Where will people live after completing the court-ordered plans?

The state estimates between 7,000 and 12,000 people will qualify. They needn’t be homeless to receive the services, though many who qualify are likely to be unhoused. The state’s homeless population on any given night last year topped 171,000. 

A UC San Francisco study of homelessness statewide this year found that more than a quarter of unhoused people had been hospitalized at any point in their lives for a mental health problem; the homeless services authority in Los Angeles has estimated a quarter of the city’s homeless adults has a severe mental illness. But CARE Court is targeted at an even narrower set of diagnoses and circumstances. 

So counties are also playing a careful game of “level-setting,” Bergman said, “about what this thing will actually be.”

Still, local officials see the program as an opportunity to get more people into mental health care who haven’t been treated, before their condition deteriorates to the point of being put in conservatorships. 

And the state’s Department of Health Care Services says it will be looking out for whether the program reduces emergency room visits, police encounters, short-term hospital stays and involuntary psychiatric holds — and whether it helps people find stable housing.

Managing Expectations

One major uncertainty counties face, officials say, is even knowing how many cases they’ll get. 

That’s in part because the law allows a wide range of people to petition for someone to be in CARE Court, including family members, roommates, health care providers, paramedics, hospital officials or homeless outreach workers.

But the list of actual conditions the program targets is narrow, limited to schizophrenia and related illnesses. 

That could disappoint those whose loved ones have other diagnoses — and create an unknown amount of work for counties if a flood of those family members file petitions. Behavioral health departments must evaluate each person if it’s not clear whether they qualify for the program.

San Diego County estimates it will get 1,000 petitions in the first year and establish court-ordered treatment plans for 250 people; the remainder likely will either not qualify or agree to services voluntarily, Bergmann said. Orange County expects about 1,400 petitions and anywhere from 400 to 600 treatment plans. 

Officials in Riverside County don’t even have an estimate, citing varying data there on the prevalence of schizophrenia in the unhoused population. 

“We really think it’s unknowable,” said Marcus Cannon, the county’s deputy behavioral health director.

Counties want the state to help them manage public expectations. Both Kelley and Cannon said they’ve heard from local leaders who have floated having city workers file petitions for a wide swath of unhoused residents, to get them indoors.

“What the public thinks CARE Court is and what it is are definitely two very different things,” said Michelle Doty Cabrera, director of the County Behavioral Health Directors Association. 

In an emailed statement, state Department of Health Care Services spokesperson Sami Gallegos said that counties “are managing public relations among local elected officials and others” to spread the message about who the program is and isn’t for. 

After learning of the narrow eligibility criteria at a community meeting in August, Nancy Beltran considered her options.

Beltran, of Anaheim, said she lives with a family member whose psychotic condition caused him to hit another relative in 2020, landing him in the hospital against his will. She said he’s refused treatment and doesn’t believe he’s sick. Another psychotic episode earlier this year didn’t qualify him for hospitalization, she said, because the symptoms weren’t as severe. 

“I didn’t want it to get to that point,” she said. “I don’t want him to be incarcerated. I want it to be the least restrictive, least traumatic experience.”

She’s still not sure whether the program is for her family member, because they haven’t gotten a clear diagnosis, she said. 

Beltran said she also wishes the program could help a friend, who is already enrolled in therapy sessions for diagnosed schizophrenia, find a place to live. Her friend’s condition, she said, deteriorates because he is unhoused, but he remains on waiting lists for housing. But CARE Court, she was disappointed to learn at the meetings, is only for those with untreated schizophrenia. 

Threading a Needle

Everyone involved in CARE Court in Orange County — from the judge who would ultimately order treatment to the public defender who will represent respondents to the behavioral health officials responsible for finding, diagnosing and treating them — had the same message for the public: The program will be voluntary. 

Critics, however, contend that there’s no way a court process can be voluntary since at some point there is a judge’s order. By law, counties must try at least twice to persuade a respondent to accept treatment before a judge orders it. Even then, the treatment plan, which can include therapy, medication and housing, doesn’t come with much enforcement. Medication can be ordered, but not forcibly administered. 

Judge Ebrahim Baytieh speaks to community members about CARE Court at the Behavioral Health Training Center in Orange County on Aug. 17. Photo by Lauren Justice for CalMatters

Over the course of a year, respondents will attend court hearings to see whether they’re adhering to the treatment, and whether the county is providing it. Counties can be fined as much as $1,000 a day for not providing the care; if the person fails to complete treatment they could be considered for conservatorship. 

But county officials stressed that’s not the goal. 

“We have tried for 40 years in this wonderful country of ours to force people with mental illness” to be treated, Orange County Superior Court Judge Ebrahim Baytieh told family members at another community meeting, in a church in Cypress. “Study after study has found it doesn’t work. We all know there’s no magical answer. But we will be patient, and we will be persistent.”

Kelley’s department is training its workers and peer supporters — people who also have mental illness or have recovered who can help guide a respondent through CARE Court — in a well-regarded communication method called LEAP to persuade respondents to accept care. It will offer services to those in CARE Court under a “whatever it takes” approach, whether it’s a ride to the doctor’s office, help enrolling in food stamps, addiction treatment or temporary housing.

The task will take time.

At the community meetings, Kelley and her colleagues repeatedly described a pilot program she ran as behavioral health director in San Bernardino County. The program took referrals from family, police or other community members who wanted to prod those who were resistant into mental health treatment. 

The time it took for county workers using the LEAP method to persuade respondents to enter treatment varied, Kelley said. But on average, she said it took 20 visits if a respondent was housed — and 40 visits if they were unhoused. Visit times varied, from a few minutes to a whole day, so the whole process could take weeks or months, Kelley said.

The timetables set by law for CARE Court are much tighter. 

If counties initially determine a client won’t agree to treatment, they get 14 days to try again before the next court hearing. Kelley said the judges in her county are sympathetic toward those concerns, but not all counties will get such flexibility.

“I can’t do 40 face-to-face visits in 14 days,” she said. 

Civil rights advocates balked at the counties’ suggestion that any program involving the pressure of the judicial system, even a non-criminal court, could be voluntary. 

“If you’re trying to engage somebody, and there’s a petition that involves a court,” there’s less hope of building genuine trust, said Keris Myrick, a mental health advocate who lives with schizophrenia and a board member of Disability Rights California. 

The group is particularly concerned the court process could be ineffective or harmful among Black residents, who are overrepresented both in California’s homeless population and among people diagnosed with schizophrenia.

Myrick, who is Black, said she has been subject to involuntary treatment, and described harrowing experiences during which she was handcuffed in the back of a police car or strapped down to a gurney for hours before a doctor visited. She said one thing that actually helped her recover was having a peer supporter who was also African American and related to her experiences, eventually persuading her to get treatment on her own terms. 

She later ran a peer support program in Los Angeles County and trained workers in the county mental health department. Myrick says the state needs to expand those services, as well as housing and social supports to help people live stable lives, without the threat of a judicial order.

Alex Barnard, a sociologist at New York University who has studied involuntary mental health treatment in California, is skeptical about whether the state can appease both civil libertarians and those who want more aggressive treatment. But he said the program’s mandate of a year of persistent engagement is promising. 

“If CARE Courts works, it will probably be because of that,” he said. “It creates some accountability on the provider to keep trying to work with somebody who might be very challenging, and elsewhere in the system would just have their file closed out.”

Long-Term Resources

Those implementation questions are among a list of other practical hurdles counties face for the program to be successful. 

There’s long-term funding. The first seven counties were given $26 million in one-time state grants to start the programs; some have estimated annual costs of the services themselves will far exceed those allotments. 

The state says most services will be covered by Medi-Cal or private insurance, and expects counties to submit reimbursement requests, including the costs of going to court or finding respondents. 

But the nationwide shortage of behavioral health workers has made it a challenge for some departments to hire. In San Diego County, Bergmann’s department plans to add 55 new staff, including 10 clinicians, for CARE Court. Only 35% have been hired so far, a spokesperson said.

And there’s housing and beds, which all agree is crucial to making treatment a success. 

Health officials believe most people who qualify for CARE Court will need a more intensive treatment placement in the beginning, while some may be able to be placed in residential facilities or their own apartments after being stabilized. 

But there are shortages across that spectrum. A 2021 Rand analysis found the state is short more than 4,700 psychiatric inpatient treatment beds and nearly 3,000 residential facility beds such as board-and-cares —long-term housing for people with severe mental illness and one option for respondents to live after they complete CARE Court. 

Included in last year’s state budget was nearly $1 billion in new funding for counties to expand temporary housing placements for those with mental illness, with priority given to people in CARE Court. 

Orange County and some others are using the grants to open new treatment beds. In San Diego, Bergmann’s department will use the money to pay for board-and-care placements. But significant new infrastructure will take years to complete. Over the past five years, Bergmann said, the county has lost a fifth of those residential facilities. 

“In the near term, those funds will help us help people with the fewest resources to compete more” for placements, he said. “It’s not going to all of a sudden create a net increase in infrastructure.”

Marisa Kendall contributed to this reporting.

CalMatters is a public interest journalism venture committed to explaining how California’s state Capitol works and why it matters.

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