Carter symposium on mental health policy

Status report: meeting the mental health needs of the country in the wake of September 11

Funding from: Annenberg, Bristol-Meyers Squibb, Freddie Mac, Gannett, MacArthur, Michaels video, NIMH, Pfizer, SAMHSA, CDC

Charge: strategies for preparedness w/o mental health of citizens in future traumatic events

Around 100 present, some other People Who here: from New York, John Allen, Jennifer, Mat. From SOCSI, Cynthia Wainscott. No People Who I recognize on the program or planning committee. Joel Slack is a Rapporteur

Notes are partly from speakers, partly from printed background material

Carter: pass parity in Wellstone's memory

Beardslee: evidence-base

Pynoos: Early childhood history of physical or sexual abuse has a direct bearing on the course and complications of bipolar disorder. Trauma history and PTSD symptoms are associated with more severe and treatment-resistant depression. Reactivity to trauma reminders underlies mis-diagnosis of unexplained aggressive or even seemingly psychotic behavior.

Interested discussions of objective danger - actual, real, false alarms - and subjective reactions - fear of recurrence, living with uncertainty, worries about others, information exposure, behaviors that are protective, restrictive, aggressive, anxious, changes in spiritual schema, ...

National Child Traumatic Stress Network: Survey of 12 - 17 year old youth reported lifetime prevalence of sexual assault (8%), physical assault (17%), and witnessing violence (39)%. 25% of kids in N Carolina experienced at least one potentially traumatic event by age 16. 30% of inner cit kids have witnessed a stabbing; 26% have witnessed a shooting.

Raphael: debriefing after trauma: talking in homogeneous groups may be more helpful than in heterogeneous groups; debriefing groups with individuals having different levels and types of exposures may spread exposure from those with high trauma to those with low trauma resulting in more symptoms in low exposure individuals; different people have different stories and concerns, groups often tend to want to on agree on a single perspective, in a heterogenous group this may lead to isolation and stigmatization of some participants

Courtwright on drug regulation: "Policy is way out of alignment with the potential danger of a drug. ... I think the drug to attack is the cigarette."

Hunter: "Making health and health care a centerpiece of U S foreign policy would call on the best that America has to offer. Treating health as foreign policy is the positive vision of a better world that should complement the defensive actions that we must now take against terrorism. Compared to health, no other area today offers the United States a greater chance to purse a purposeful vision of the future, to exercise leadership, and to promote our core values and interests. If we are wise ... promoting health and health care will play a steadily increasing role in our foreign policy. (Robert Hunter et al, Rand Review, Summer 2002, p 22 and )

Knisley: there are no psychotropic medications in the nation's stockpile for disaster planning.

We were bussed back to our hotels (many of us were at a Holiday Inn near Georgia Tech) where we had a few minutes to freshen before the bus ride back to the Carter Center for a reception with drinks, a vegetarian pot sticker, and a light supper. (salad, roll, salmon filet, julienned veggies, a sweet potato puff, berries; vegetarian - same plate without the protein)

after dinner - Mayberg: "It's not symptom reduction; it's recovery." person-first language for mental health professionals

Guiliani: World is actually safer, because we are now confronting reality. (He seems to me similar in person as he was on TV, real, present, sincere, relevant, unrehearsed, no notes. His $26 book on sale here, pre-autographed.) Administration messages: "Be afraid." and we have to learn how to deal with it. Daily life has much greater risk than terrorism, and we deal comfortably and without much concern with the risks of drunk driving, .. Daily, we manage fear. We feel the fear, put it in proper perspective, and go on with our lives. Preparing for terrorist attacks can bring an enormous amount of side-benefits, increasing competent emergency response to more ordinary things, influenza, ...

Pincus: barriers between primary care and behavioral health - shame, duality, lack of parity, ...

Do away with separating mental and physical.

Don: "The public health system is unprepared for its role as first responder in the event of biological, chemical, or radiological attack."

McCombs: transform the capacities of local communities, use community-based language and ideas, use faith community, connect the faith and mental health communities, use the fait community to deal with undiagnosed distress, free-floating trauma: treating grief/depression = healing the broken-hearted; action is the antidote to despair. Attend to the medicalization of suffering.

Ursano: health, in particular mental health, must be a part of our national security plan, because mental health is the target of terrorist events;

Schuster: re 9/11, those who watched the most televison reported the most stress.

Of note, I saw no data people at this symposium.

Fink: collaboration and integration of services is a major theme of this symposium. Primary care providers loathe to refer to mental health specialty services, hence collaboration not happening.

NDMDA has changed its name to Depression and BiPolar Support Alliance. I don't know the initials or URL - DBSA, DBPSA?

Ask to see your state's disaster response plan; review the mental health and disability pieces.

Work group responses to charge (see beginning of notes):

citizen, neighborhood, community are the starting place; state must develop and communicate response plan; feds should collaborate

empower neighborhoods, use technology, create better relationships, strengthen resilient communities, use youth and community service programs to grow communities; information is powerful because you possess it, reduce professionalization of helping, integration and coordination of all resources, bureaucratic and personal barriers, foster natural supports in the community