This week’s blog was written by Teri Lyon. Teri is a Senior Technical Support Specialist at PAR. She has been with PAR for more than 20 years. She enjoys punk music and painting.

I like to watch CBS Sunday Morning every weekend. Recently, I watched a segment on the prevalence of dyslexia in the prison population, which immediately caught my attention. Working at PAR and knowing Dr. Steven Feifer, I know how important it is to diagnose dyslexia and other learning disabilities early so a student can achieve his or her full potential. What I did not realize are the numbers behind this issue.

The segment told of a study that shows almost 50% of the prison population in Texas has dyslexia. In addition, approximately 80% of inmates are functionally illiterate. The segment went on to talk about how prisons are addressing this issue with more funding and prison reform. Although these things certainly help people in prison lead better lives, this does not prevent these individuals from ending up there in the first place.

Although this is not a case where you can throw money at a problem, we do know that schools in more affluent communities have higher test scores and graduation rates. While the parents and students may have more resources and may not have concerns like how to study while hungry, you can’t ignore how much better they do. Recently, the thinking on spending in education has changed. Studies show significant long-term gains for students when educational spending increased. The issue is that districts need to determine the best way to use their money.

Currently, the U.S. spends more on prisons than we do on education. California alone spends $53,147 more per year on a prisoner than it does a student. Overall, there are 15 states that spend more than $27,000 a year more per prisoner than they do per student.

Even with the Every Student Succeeds Act (ESSA), there are kids who fall between the cracks of education and into the justice system. It’s clear that this issue is multifaceted and complicated. From starting mandatory schooling at an earlier age, to better training for teachers, there are many ways this issue can be addressed. One thing is clear, though, we have to start somewhere.

I think it’s important to take a step back and realize how PAR instruments can help with greater societal issues. Because this is such an important topic, I immediately sent letters to both my congressman and senator letting them know my thoughts. Hopefully, this will get a very important subject the attention that it deserves.  

Approximately 14 million Americans have alcohol disorders. As prevalent as the disorder is, much can be done to assist those who are dependent on alcohol, and their loved ones.

In 1999, the National Institute on Alcohol Abuse and Alcoholism and the Substance Abuse and Mental Health Services Administration partnered to create a community-based intervention to target alcohol abuse: National Alcohol Screening Day (NASD). Screening is held annually on the first Thursday of the first full week of April. For 2016, screening will be held on April 7. NASD’s objectives include:

• Educating the public on the effect of alcohol on overall health


• Administering anonymous, free alcohol screenings to the public


• Providing referrals for those whose screening determined their drinking is at an unhealthy level

Thousands of organizations nationwide offer either on-site and online screenings to college students, military personnel, and the general public. Each organization receives the appropriate resources to help them conduct the program, such as videos, posters, educational handouts, and screening forms. On the day of screening, a 10-question screening scale is administered that was developed to identify those who consume alcohol at hazardous or harmful levels. Those who score above a specified cut-off score are referred for further evaluation or treatment.

Those interested can get started by visiting the website, How Do You Score? There they can take an anonymous self-assessment or search for on-site screening locations, which are located in screening centers across the United States. Those who are screened will be asked a series of questions to determine whether symptoms of alcohol abuse are present and whether medical help is required. At the end of the session, they receive immediate feedback and will be provided resources to assist them in getting the help they need.

At-risk drinking can be identified based on how much a person drinks on any given day, and how often a person has a heavy drinking day. In general, the following limits identify at-risk drinking:

• Men: More than 4 drinks in a day or 14 per week


• Women: More than 3 drinks in a day or 7 per week

As with any illness, early detection is the key to increasing chances of swift recovery. Alcohol abuse is misunderstood and is, therefore, often not considered a legitimate disorder that can be treated. National recognition goes a long way toward educating the public and reducing the negative effects of alcohol abuse for those affected and their families.

Share your thoughts on alcohol abuse risks and screening. PAR wants to hear from you, so leave a comment and join the conversation!

We are used to thinking of alcohol dependence as black or white: Either someone is or isn’t an alcoholic. Dr. John Mariani, who researches substance abuse at Columbia University, says that the field of psychiatry now recognizes shades of gray between someone who doesn’t drink at all and someone who suffers from an alcohol addiction.

At least 38 million adults drink too much. Binge drinking, high weekly use, and any alcohol use by pregnant women or people under the age of 21 are included in this category. In the United States each year, about 88,000 deaths are alcohol related, and alcohol abuse costs the U.S. economy about $224 billion each year.

A recent study by the Centers for Disease Control and Prevention (CDC) showed that 90% of excessive drinkers were unlikely to need addiction treatment, and another revealed that only 1 in 6 adults talk with their doctor, nurse, or other health professional about their drinking. Among adults who binge drink 10 times or more a month, only 1 in 3 have discussed drinking. And only 17% of pregnant women have talked about drinking.

The CDC recommends that physicians and other health providers include basic alcohol screening and brief counseling as part of routine medical practice by:

• talking directly with patients about how much and how often they drink;


• providing information about the health dangers of drinking too much;


• offering options for patients who may want to stop drinking, cut down, maintain their current level of drinking, or seek further help; and


• referring patients who need specialized treatment for alcohol dependence.

Screening and brief counseling have been proven to work by reducing how much alcohol a person drinks on an occasion by 25% and by improving health and saving money in the same way that blood pressure screening, flu vaccines, and cholesterol or breast cancer screening do.

Drinker’s Checkup, an online confidential screening tool, is a good resource to share with clients; it provides detailed, objective feedback for people who aren’t sure whether their drinking is excessive and provides help with making a decision about whether to change drinking habits. An app called Moderate Drinking can be downloaded to help monitor drinking habits; its effectiveness has been demonstrated in a study published in the Journal of Consulting and Clinical Psychology.

In the context of mental illness, the word “asylum” conjures, for many of us, some very negative images. We picture a scene with characters like the abusive Nurse Ratched from the movie “One Flew over the Cuckoo’s Nest,” or even worse, tragic true stories of the overcrowded, understaffed psychiatric hospitals of the last century where healthy, sick, disabled, and poor patients alike were locked away for years with no effective treatment or hope of release.

These images may be the reason that a JAMA viewpoint published last month has garnered so much attention: Bioethicists from the Perelman School of Medicine at the University of Pennsylvania are calling for a return to asylums for long-term psychiatric care.

At Penn, Dominic Sisti, PhD, Andrea Segal, MS, and Ezekiel Emanuel, MD, PhD, have been studying the current system for treating the chronically mentally ill and the evolution over the past half-century away from inpatient psychiatric hospitals. They observe that although the United States population has doubled since 1955, the number of inpatient psychiatric beds has been cut by nearly 95 percent to just 45,000—a very small number when compared to the 10 million U.S. residents who are currently coping with serious mental illness.

According to Sisti and his colleagues, the result of this trend has not be “de-institutionalization” but rather “trans-institutionalization.” That is, people with chronic mental illness are being treated in hospital emergency rooms and nursing homes at best, and more often receiving no treatment and living on the street. “Most disturbingly, U.S. jails and prisons have become the nation’s largest mental health care facilities,” say the authors, in a January 20 Penn Medicine press release. “Half of all inmates have a mental illness or substance abuse disorder; 15 percent of state inmates are diagnosed with a psychotic disorder…. This results in a vicious cycle whereby mentally ill patients move between crisis hospitalization, homelessness, and incarceration.”

As a solution, the authors propose a modern and humane asylum—but they use the word in its original sense, that is, a place of safety, sanctuary, and healing. In addition, they advocate reforms in the psychiatric services offered in such institutions, including both inpatient services, for those who are a danger to themselves and others, as well as outpatient care for those with milder forms of mental illness.

The proposal has been controversial, to say the least.  Some in the mental health community find the idea of a return to asylums misguided and even frightening. In her article called “Asylum or Warehouse?” author Linda Rosenberg, President and CEO of the National Council for Behavioral Health, asserts that although Sisti and his colleagues accurately describe the problems of the current mental health system, their solution is to “just simply lock some people up” and that “the simple solution offered, recreating asylums, is not helpful—it’s dangerous.”

Others have viewed the proposal in a more positive light. Christine Montross, a staff psychiatrist at Butler Hospital in Providence, Rhode Island and author of “Falling into the Fire: A Psychiatrist’s Encounters with the Mind in Crisis” wrote an op-ed piece in the February 18 New York Times in support of a move toward modern asylums.

“The goals of maximizing personal autonomy and civil liberties for the mentally ill are admirable,” says Montross. “But as a result, my patients with chronic psychotic illnesses cycle between emergency hospitalizations and inadequate outpatient care. They are treated by community mental health centers whose overburdened psychiatrists may see even the sickest patients for only 20 minutes every three months. Many patients struggle with homelessness. Many are incarcerated. A new model of long-term psychiatric institutionalization, as the Penn group suggests, would help them.”

What do you think? Are modern, reimagined asylums a potential solution for the chronically mentally ill, or has history proven that institutions cannot work? PAR wants to hear from you, so leave a comment and join the conversation!

 

In 1987, Ronald Reagan declared the month of March as National Disabilities Awareness Month. It serves as a formal time to recognize the efforts, struggles, and initiatives surrounding people with disabilities. In 1990, the Americans with Disabilities Act was passed, thus officially giving legal rights to those with disabilities regarding workplace discrimination.

According to The Arc, whose mission is to protect the rights of human beings with intellectual and developmental disabilities, at least 4.6 million Americans have a disability. The Arc advocates in many ways for those with disabilities, including shaping public policy, providing services like employment programs and residential support, and preserving and protecting rights through education and activism.


Triangle is a nonprofit organization in Malden, Massachusetts, that “empowers people with disabilities to enjoy rich, fulfilling lives.” Together with the Accessible Icon Project, they are working to transform the original International Symbol of Access into something more visually representative of today’s individuals with disabilities. The new image conjures up words like “active, abled, engaged, ready for action, determined, and motivated…which helps provoke discussion on how we view disabilities and people with disabilities in our culture.” (Read more on the About section of the Accessible Icon Project Web site.)

Follow these suggestions or add your own to raise awareness for those with disabilities:

• Make the Accessible Icon your profile picture on Facebook, and post a status on social media (i.e., Facebook, Twitter) like, “I support and celebrate people with disabilities, and you should too!”


• Volunteer or donate to the cause in your area. Use the Network for Good as a starting place.


• Contact your legislator to advocate for public policy to assist people with disabilities.


• Support businesses that employ people with disabilities.


• Take time to educate yourself and others about the needs of people with disabilities in your area.


• Make sure that your own words and actions are respectful of those with disabilities.


• Get involved in community-based activities that raise awareness in your school or business.

 

They say a picture is worth a thousand words. But an image is not always a true representation of reality. From Instagram, Facebook, and Tumblr to fashion magazines and reality shows, we are bombarded with images that have been created, filtered, manipulated, and staged. And it’s often very difficult to sift through what’s real and what’s not.

This is precisely why Dove began its Campaign for Real Beauty—to start a global discussion surrounding the definition of real beauty. It first conducted a study titled “The Real Truth About Beauty: A Global Report,” which revealed that less than 2% of women worldwide considered themselves beautiful. In a Dove Real Sketches video, participants were asked to describe themselves to an artist, who drew them behind a curtain, using only their descriptions of themselves as a guide. Then the same women returned to describe fellow participants. The difference between the two drawings was astonishing, and it revealed how hard we are on ourselves versus how others see us.

According to the National Eating Disorder Association (NEDA), 30 million people will be affected by an eating disorder during their lifetime. A full 69% of American school-age girls who read magazines say that the pictures they see influence how their concept of an ideal body shape. Boys are also affected, and largely because of cultural bias and stereotypes, they are much less likely to seek treatment. In addition, teen athletes are more at risk of developing an eating disorder or having a negative body image.

It is daunting to compete with society and media, so the NEDA has developed an Educator’s Toolkit to help those in schools reach out to students suffering from an eating disorder. It covers everything from myths surrounding these disorders (e.g., that eating disorders are a choice; p. 6) to school strategies for assisting these students (p. 11). NEDA also has a Feeding Hope Fund, which grants funding to researchers who are seeking out new ways to combat this illness.

Some of the most groundbreaking work has been done related to connecting genetics to eating disorders, according to Amy Novotny in an article published in the American Psychological Association publication the Monitor. One study by Kelly Klump in Psychological Medicine demonstrates that heritability influences disordered eating most when estrogen levels are highest, and another suggests that in some females, bulimia may be hard-wired.

Organizations like Project Heal are contributing to the healing process in a different way: the organization, started by two women who suffered from eating disorders, provides scholarship funding for those who can’t afford treatment. And still others are trying innovative interventions, including art therapy and yoga, which could encourage participants to view their bodies in a more compassionate way.

The NEDA Web site offers a plethora of resources, including a resource page with contact information and a helpline (1-800-931-2237) for those who may know someone who suffers from an eating disorder. Visit NEDA’s Get Involved page to learn more about how to raise awareness.

For many of us, the holidays are a joyful time to celebrate together with family and friends. Yet for those who have recently suffered the loss of a loved one, the holidays can be an especially difficult time. What are the best ways to support someone who is grieving during the holidays?

The National Hospice and Palliative Care Organization (NHPCO), a nonprofit organization that advocates for improved end-of-life care, offers some guidance to help those who don’t know what to say or do for a grieving friend or family member. The NHPCO’s hospice professionals offer these suggestions:

1. Be supportive of the way the person chooses to handle the holidays. Some may wish to follow traditions; others may choose to avoid customs of the past and do something new. It’s okay to do things differently.


2. Offer to help the person with decorating or holiday baking. Both tasks can be overwhelming for someone who is grieving.


3. Offer to help with holiday shopping. Share catalogs or online shopping sites that may be helpful.


4. Invite the person to join you or your family during the holidays. You might invite them to join you for a religious service or at a holiday meal where they are a guest.


5. Ask the person if he or she is interested in volunteering with you during the holidays. Doing something for someone else, such as helping at a soup kitchen or working with children, may help your loved one feel better about the holidays.


6. Never tell someone that he or she should be “over it.” Instead, give the person hope that, eventually, he or she will enjoy the holidays again.


7. Be willing to listen. Active listening from friends and family is an important step to helping some cope with grief and heal.


8. Remind the person you are thinking of him or her and the loved one who died. Cards, phone calls, and visits are great ways to stay in touch.

For more information about NHPCO and their resources on grief, loss, and hospice care, visit www.nhpco.org.

In a technical report issued by the American Academy of Pediatrics (AAP) last month, chronic sleep loss among middle and high school students was cited as a “serious threat to academic success.” There are many contributing factors to a generation of sleepyheads—among them increased caffeine consumption and the use of electronic devices, whose low-intensity light can disrupt circadian rhythms and suppress melatonin production. The AAP study outlines that one key contributor could be best manipulated to help alleviate this problem: later school start times.

Beside extending sleep duration, this delay would have significant positive effects on self-reported sleepiness and academic achievement, says the Academy. But according to a U.S. Department of Education 2011-12 survey, of the 18,000 high schools in America, less than 15% start at 8:30 a.m. or later, and more than 40% start before 8 a.m.

Dr. Bob Weintraub, headmaster of Brookline High School in Massachusetts from 1992 to 2011 and now professor of educational leadership at Boston University, says that during his tenure the high school moved start times for most students to 8:30 a.m. But he also points out that these shifts raise concerns like how to have maximum participation in after-school activities like athletics, drama, and music when later start times means later end times (which means in the dark during winter months in the Northeast).

Despite these challenges, the AAP argues that communities nationwide have been creative in coming up with solutions to this challenge, including providing free periods and study halls at the end of the day, exempting student athletes from PE, and installing lights for athletic fields.

In sum, the Academy “strongly supports the efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times that allow students the opportunity to achieve optimal levels of sleep and to improve physical and mental health, safety, academic performance, and quality of life.”

Every day, police officers across the U.S. respond to calls involving people with mental illnesses. These individuals are often incarcerated, and nationwide jails hold 10 times as many people with serious mental illnesses as state hospitals, according to a report from Kaiser Health News.

“There are, shamefully, lots of people with public mental illness who are known to public systems, out there on the streets, very much at the risk of being victimized or engaging in conduct that could get them in trouble with the police,” says Robert Bernstein, president and executive director of the Bazelon Center for Mental Health Law, in an article in the online newsletter The Science of Us. When mentally ill persons are approached as possible perpetrators, the mental health system is failing, Bernstein says.

Michael Woody knows this scenario firsthand: on a call for the Akron, Ohio, police department several years ago, he encountered a 27-year-old mentally ill individual who threatened his life and ultimately committed suicide. This prompted him to question the small amount—just five hours—of mandatory mental health training officers were then required to take, and he pushed for more. Since then, he has become an advocate for training to help police officers de-escalate crisis situations involving the mentally ill. Today he serves as president of CIT International, a nonprofit whose primary purpose is to support mental health training for police forces across the country.

According to a recent FBI report, the expense to implement and maintain crisis intervention training (CIT) outweighs the cost of not establishing a program. Injuries to law enforcement personnel and individuals with mental illness as well as repeat calls for these issues are considerably reduced when CIT programs are in place which encourage officers to direct persons with mental illness to mental health-care facilities for treatment prior to issuing any criminal charges. This process reduces lawsuits, medical bills, and jail costs and improves the quality of life for the community, according to the FBI report.

Through the work of people like Woody and CIT International, police departments are beginning to take note and to require CIT. In San Antonio, Texas, police officers now take 40 hours of crisis intervention training, and the city has a six-person unit specially equipped to respond to 9-1-1 calls involving mental health disturbances.

The officers’ training helps them better determine whether people need to go to jail or a hospital or would be best served by being taken to the city’s Restoration Center. The centralized complex, across from the city’s homeless shelter, was built using cross-departmental resources to divert people with serious mental health illness from jail and into treatment instead. Among other things, it provides a space for police to bring arrestees to sober up, which saves them a costly trip to the emergency room. Together the CIT training and Restoration Center have saved the City of San Antonio and its police force an estimated $50 million over the past five years and at least $600,000 a year in overtime pay, according to the Kaiser Health News report.

As those who work in the mental health arena know all too well, the stigma associated with mental illness often prevents people from seeking the help they need. Students at the University of Leeds in the U.K. chose to confront that stigma by sharing their personal struggles with mental illness in a powerful video. Directed by the university union’s welfare officer Harriet Rankin and featuring members of the Leeds “Mind Matters” mental health support group, the video has gone viral and is now being shared by major internet news outlets in the U.K. and the U.S.

The students’ message is very simple: You are not alone, and help is available. Please take a moment to view the video now!

https://www.youtube.com/watch?feature=player_detailpage&v=kYwyzkb67pA