NAMI SOUTH KING COUNTY
South King County's Voice on Mental Illness
515 West Harrison St, Suite 215, Kent, WA 98032
(253) 854-NAMI (253) 854-6264
OFFICERS AND DIRECTORS 2010
| John Corr, President
| Sue Ray, Vice President
| Mary Grizzle, Secretary
| Ted Schwarz, Treasurer
| Sandy Klungness, Facilitator
| Loretta Alake
| Aileen Fink Ambrose
| DottiAnn Blakemore
| Dave Emery
| Mike Grizzle
| Lisa Moore
| Marsha Williams
ACCESS TO CARE
Near 10% of our population are believed to have mental disorders serious enough to interfere with normal activities according to the National Comorbidity Survey Replication (NCS-R) completed in 2005. This survey used interviews with 9282 randomly selected households. Because the survey excluded schizophrenia, autism, and some other less common disorders, actual illness prevalence is higher than the survey shows. Half of those with serious disorders are never treated. For those who are treated, it typically begins after 10 years or more of delay and the treatment is often inadequate. (Washington Post, June 7, 2005).
The survey did not explore reasons for lack of proper treatment. The factual part of this article stops here and I will, below, tell you my guesses about the reasons for delayed treatment or, worse, for no treatment.
Reason 1 - Denial (Anosognosia)
Our son denied existence of his illness for several years. (This delusion, very common, is called anosognosia.) I looked forward, with hope, to the day he acknowledged his illness. When it finally happened, I was struck with sadness, thinking of how awful this new awareness must have felt to him. Denial, for whatever time it lasts, must give comfort to the ill person.
Reason 2 - Stigma and Punishment
Many illness victims avoid treatment because of the associated stigma. Aware of their illness, they choose to avoid treatment.. Some victims, for valid reasons, fear persecution if supervisors or employers become aware of their illness.
Reason 3 - Non-Medical “Help”
Many victims confide in a pastor, priest, counselor, or friend, and, if the confidant(e) is smart enough to send the victim to medical help, it’s useful. Often, though, the confidant(e) thinks that discussion and empathy is enough so no useful medical help happens. Time passes, the victim has reached out, but to the wrong place, for help.
Reason 4 - Money
It could cost your life to delay treatment for appendicitis. But it’s easier to delay treatment for mental illness. Treatment is expensive and much of it is ineffective, or, to the unknowing victim, even harmful (per the Washington Post article cited above). In many cases, if you don’t have the money, you can’t get treatment. Many insurance companies deny parity coverage for mental illness. If you become mentally ill, your insurance company is not your friend. Half, or more, of our state legislators do not support insurance parity for mental illness so they are not our friends either.
Reason 5 - Limited Government Help Traditionally, burdens like treatment for illness would be a state responsibility. But we voters are the state and we don’t want to help destitute mentally-ill friends and neighbors. This resembles our reluctance to use taxes to feed and educate our children. LEADERS could make the difference but politicians, with a few exceptions, are followers, not leaders. Governor Gregoire is a notable exception to this pattern. She has assured temporary help to the mentally ill with some politically heroic actions. We can’t expect this to happen often.
Federal help is another matter. Medicare and Medicaid are wonderful benefits for the mentally ill who qualify. Federal help is not assuredly permanent and, in the future, villain members of Congress could cater to the voters greed and cut off much, or all, the federal money. Stay Aware!
Reason 6 - Rationing Obstacles
Theoretically, if you are a severely ill citizen, you qualify for Medicare or Medicaid so you would not be denied treatment. There are reasons, however, that severely ill victims do not qualify. You need motivation, persistence, and help to overcome the enrollment barriers and qualify. A psychotic, confused, homeless, person may not want to qualify (He’s not mentally ill!). If he wants to qualify he can’t remember and travel to the appointments and jump through all the hoops. Many clinically eligible victims are not on the Medicare/Medicaid rolls. It’s like giving free wheelchairs to those who can jump over the fence to get them. Usually, where federal help fails, it is through clumsiness rather than meanness. Not always.
Remember that Ronald Reagan, just after decreeing ketchup to be a vegetable for school lunches, set up a campaign to illegally remove ill children from Medicaid and it took lawsuits to restore eligible children to proper status. Villains come in all disguises.
Reason 7 - “Out of Bounds"
Lots of people worry about “non-Medicaids” but they don’t have the money needed to help. In years past, care providers could save a little Medicaid money and use it to help non-Medicaid patients. This practice was eventually prohibited by the feds. Our answer, nowadays, for mentally ill non-Medicaid victims is to just look the other way. Non-Medicaids are out of bounds.
Reason 8 - Alcohol/Street Drugs
Mentally ill victims often self-medicate with alcohol and/or street drugs. Treatment folks assume all users are addicted, but many are not. They use the drugs for situational, rather than addiction, reasons. It was traditional, for years, to toss patients back and forth between medical treatment for mental illness and non-medical addiction treatment. Today, we mostly accept that simultaneous treatment for “dual diagnosis” situations is possible but many therapists aren’t trained to do it and others haven’t yet bought off on up-to-date treatment knowledge and policy.
Reason 9 - Homelessness
Treatment doesn’t work if you’re homeless. It is important, though, that we keep up the pretense that it does because we don’t want to buy roofs and beds for the mentally ill homeless and we don’t want the guilt that comes from leaving them psychotic on the street. There is some belief that you solve “the homeless problem” by putting the victim under a roof. This action is necessary but not sufficient. Homelessness, for the mentally ill, is a symptom of a more difficult underlying problem. You can temporarily hide the symptom by putting the person under a roof but, unless appropriate treatment is included, the patient will revert to homelessness.
So here we are! We are getting better and better at counting and tabulating the needs of the mentally ill.
SAMHSA Offers First in New Series of Informational Kits to Help Promote Evidenced-Based Mental Health Practices
The Substance Abuse and Mental Health Services Administration (SAMHSA) is offering a new Assertive Community Treatment Knowledge Informing Transformation (ACT KIT) packet as the first in a new series of Evidence-Based Practice Knowledge Informing Transformation (EBP KIT) packets. EBP KIT materials help mental health caregivers provide a broad range of proven mental health services in a wide variety of community settings.
The EBP KITs provide information and guidance on tools and resources that States, communities, and organizations can use to find the evidence-based practices best suited to the unique mental health care needs of the populations they serve.
The ACT KIT offers information and guidance on providing comprehensive mental health treatment and support services to help individuals with serious mental illness stay out of the hospital and live successfully in the community. The information provided in the ACT KIT can help mental health providers develop community-based services that are better suited to the individual needs of clients.
Included in the ACT KIT and future EBP KITs:
materials to introduce the practice to a wide variety of stakeholders, including Spanish and English videos, brochures, and a PowerPoint presentation
information for state mental health authorities and program administrators to help them set up systems to support the practice
a manual and accompanying video to train front-line staff
evaluation/quality assurance materials to ensure the practice works as planned, and
a summary of the scientific evidence for the effectiveness of the practice
Free versions of the KIT are available online and in CD-ROM/DVD format. To access and download the online version of the KIT, go to
To order the CD-ROM/DVD version, call 1-877-SAMHSA-7 (1-877-726-4727).
SAMHSA is a public health agency within the U.S. Department of Health and Human Services. The agency is responsible for improving the accountability, capacity and effectiveness of the nation’s substance abuse prevention, addictions treatment and mental health services delivery systems.