March 3, 2004 - The Georgetown Times (SC)

Mental Health Problems, Substance Abuse Often Linked

By Tommy Howard

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Years ago, people with mental health problems were often sent to the state mental hospital in Columbia. "Bull Street" carried a connotation of being crazy and unable to function in society. Most of the Bull Street complex has been closed because of age, said Anna Dozier-Kelly of Georgetown, chairman of the S.C. Mental Health Commission. "Stigma is a big problem," she said. "People call them crazy.

Even though they may have a behavior problem, they're still people who need help," she said. "We try to ease the stigma" of mental illness.

"We have a tendency to categorize people.

We try to avoid them, leave them alone. "What needs to be done is help them through programs and counseling. They're not all life issues.

Some can be cured or taken care of and live normal, healthy lives.

Everyone doesn't have to be institutionalized. They can be helped and live a good life in their home town or county," she said. Mental health and substance abuse professionals from around South Carolina gathered at the Myrtle Beach convention center last week to talk about how they can help more people by coordinating their efforts. In a three-day meeting at the Radisson Plaza Hotel and Conference Center, Feb. 22-24, several hundred people from hospitals, state and local mental health agencies, drug abuse prevention programs and the state's legal system discussed ways they can improve treatment for their clients. "In order for us to help individuals, we have to have a diagnosis to channel in the right direction.

If the person is diagnosed with mental illness and substance abuse, we have to treat differently than a strictly individual problem,", Dozier-Kelly told the Times. Most of the participants at the conference are in some form of treatment agency, whether it be alcohol, drugs or mental health, Dozier-Kelly said. "Today is coming together or melding, so we can treat people with co-occurring disorders." Before her appointment to the state Mental Health Commission, Dozier-Kelly served as chairman for the Waccamaw Center for Mental Health. John Magill of the Department of Psychiatry at the Medical University of South Carolina brought greetings from Gov. Mark Sanford, who was traveling in Washington, D.C. Sanford said he greatly appreciates the commitment and promotion of best practices for behavioral health. "The patient populations we are addressing deserve our attention," Magill said. "Even in these uncertain times we must continue our efforts to create a client-focused system for treatment." Magill is chairman of the S.C. Hospital Association Behavioral Health Council. George Gintoli, director of the S.C. Department of Mental Health, said "Together we're going to make dreams come true for the people we serve.

A year and a half ago, we saw tension between the two agencies ( S.C. Department of Mental Health and S.C. Department of Alcohol and Other Drug Abuse Services )." More than a quarter of the people coming to emergency rooms have a "co-occurring need" for mental health and substance abuse treatment, Gintoli said. Teams of care are being organized around the state. "The better we can have stronger community needs, the better care people will have," he continued. There's been a dramatic increase in employment among people who have mental illness, Gintoli said. "We need to invest more into prevention. The journey is just beginning." "What's so refreshing is recovery and resilience," Gintoli said. "We are building life in the community for everyone. ( Curie ) is bringing a message of what's working in our communities." Charles Curie of SAMHSA ( Substance Abuse Mental Health Services Administration ) was to meet with his boss, George W. Bush, in the afternoon after his talk in the morning session at the Radisson. Health care providers and the various agencies need to make sure the system is relevant to people, Curie said. "I learned a lot in moving from Pennsylvania to Washington, D.C.," he said. "'Imminent' in state government means six months to a year. In the federal government, it means two years and cost overruns." "SAMHSA has a blueprint for change, and you in South Carolina are on the cutting edge of that," he said. "Improving services for people with co-occurring disorders is the goal for everyone." After completing college, Curie's first job was in Ohio. He worked with people who had been in institutions for a decade or more. That was about the time that large mental institutions were being reduced in size and clients were either being returned to facilities closer to home or released from mental institutions. "What they said they needed was a job, a home and a date on weekends.

They defined what they needed in terms of getting a life and living a life," Curie said. "We have traditionally focused on clinical outcomes - which we should - and not necessarily on people having a life. "We are not finished until people gain and sustain recovery.

We are working and reaching out through many pathways," he said. "The criminal justice system is critical in this," Curie continued.

In Pennsylvania, 80 percent of the people in prison had a drug or alcohol problem.

Of that number, some 12 to 15 percent also suffered with mental illness. SAMHSA also comes in touch with the welfare and education systems. For just about everyone, including people at the conference, home and career are among their top three or four needs or goals. Curie's agency uses a matrix of programs and issues as they relate to "cross-cutting principles." If a concern comes up, his leadership team is charged to determine whether it fits in the matrix. "In these type government positions, we are stewards," Curie said. "What we do, is it sustainable. We examine funding requests in terms of doing the right things and whether they work." In his proposed budget for 2005, President Bush included a six percent increase in programs dealing with substance abuse, Curie said. That's about $199 million in a $3.6 billion budget for the agency.

Curie said people working in the field deserve much of the credit for the increase. The many pathways to recovery that Curie speaks of include effective treatment programs and counseling. "We also know that people are transformed by the power of faith, and by 12-Step programs," he said. "Vouchers allow consumer choice." Some of the elements of success in recovery are no drug or alcohol use, and no involvement with the criminal justice system. "We can better communicate our message through stories about success," Curie said. "We are clearly focused on recovery as being the outcome." Many successful people develop goal lists.

For his part, Curie's agency has a to-do list, an action agenda to transform mental health.

Elements of the to-do list include criminal justice, housing, labor, veterans, medication and substance abuse. Various agencies, such as Medicaid and SAMHSA, need to give the same message of recovery, Curie said. "Transformation is a bold effort to bring recovery to the mental health and substance abuse fields." When the agencies provide care, it must focus on the individual's ability to deal with life, Curie continued, not just on managing symptoms. All of this will require a shift in thinking for most Americans, he said. "Mental illness is a treatable illness," he said. But, it has to be diagnosed for correct treatment. When President Bush announced plans for increases in his agency's funding, he told a too-familiar story, Curie said. A 14-year-old boy was depressed and administered self-treatment through taking drugs.

He spent a lot of time over the next 16 years in various treatment programs and in the criminal justice system.

When he turned 30, the President related, he began to get treatment for bi-polar disorder. "Even though he was treated in adulthood, I can't help but think about the 16 years that were lost because of not getting treatment," Curie said. "Too many people lose that time because our system doesn't deal with these problems.

Fortunately, we know more and more." In a national household survey, SAMHSA found that about four million people have co-occurring disorders.

One out of every five people with a substance abuse problem also has a serious mental disorder, he said. Barriers to proper treatment of these people include separate organizations, under-funding and dealing with separate systems. "Any door is the right door to come in for treatment," Curie said. Over the past several years, 40 states competed for grants for dealing with co-occurring disorders.

The agency wants to broaden efforts to share information about successful treatment programs. A lot of change has taken place over the last several decades. "Everyone is for progress," Curie quipped, "it's the change they don't like." "Change is never easy, but it's better when we share a common goal - recovery for everyone." Curie quoted Army General Douglas MacArthur: "In the central place of every heart, there is a recording chamber; so long as it receives messages of beauty and hope, cheer and courage, you are young. "When the wires are all down and your heart is covered with the snows of pessimism and the ice of cynicism, then and only then have you grown old." People working in mental health and substance abuse "must do all we can to make sure the messages get through to the strings of our heart," Curie said. "Many times we represent the last bastion of hope. We must make sure we do it right and do it well," he said. "One reason people relapse is because they didn't get that life in the community." As for the criminal justice system, Curie said, "I think you could make an argument that every court should be a drug court, when you consider that 80 percent of the people in the criminal justice system have a substance abuse problem." Curie believes the time is right to transform the delivery system for co-occurring disorders. "Already, federal agencies that have never been concerned about mental health are putting their resources on the table," Curie said. "Five years ago, this type of conference would have been hard to imagine," he said.

Along with these sessions, others for the conference included looks at the criminal justice system, data analysis, developing and implementing community teams, judicial involvement, and pharmacology and treatment. For information about drug abuse, contact the Georgetown County Alcohol and Drug Abuse Commission at ( 843 ) 546-6081. Their office is located at 1423 Winyah St. in Georgetown. For mental health concerns or questions, contact the Waccamaw Center for Mental Health at ( 843 ) 546-6107. Their office is at 525 Lafayette Circle.

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