The interim sheriff of Macon County, Illinois, posed the question in 2018 as he and Andricks discussed the community’s needs. When she responded that she’d have to do some research, she was told not to take too long because the offer wouldn’t be there forever.

“I thought: ‘Oh, my God, he’s serious,’” Andricks said.

That sheriff was Howard Buffett, the philanthropist son of billionaire investor Warren Buffett. The younger Buffett ended up giving Crossing about $30 million from his charitable foundation to build an addiction treatment center in Decatur, a city with a population of just over 69,000 in the heart of Macon County.

There was a caveat, though. The donation to Crossing was a one-time gift to pay only for the buildings. It was up to Andricks and her team to find money to run the programs. And that has proven difficult.

The covid-19 pandemic upended everything mere months after the facilities opened in October 2019. An audited financial statement said the inpatient recovery center had lost $2.5 million by June 2021, and management worried about its ability to continue operating. Even so, the center remained open while other addiction treatment facilities around the country shuttered.

Now communities nationwide are preparing for an unprecedented windfall of their own for addiction treatment from a nearly $26 billion national opioid settlement and a more than $300 million expansion of a federal pilot program for mental health. The experience at Crossing offers them a model but also a warning: It will take more than a single shot of money to build a treatment program that can last.

https://www.marketplace.org/2023/01/19/a-30-million-gift-to-build-an-addiction-treatment-center-then-staffers-had-to-run-it//popout

Drug addiction wasn’t on Howard Buffett’s radar, he told KHN, until he joined the Macon County sheriff’s office as an auxiliary deputy in 2012. While the county has had some treatment resources, like a behavioral health center, it has one of the state’s higher death rates from opioid overdoses.

Buffett moved to the area in 1992 to work for food-processing giant Archer Daniels Midland. He runs a farm nearby and his Decatur-based foundation donates hundreds of millions of dollars for initiatives ranging from helping people kidnapped by Joseph Kony’s Lord’s Resistance Army in central Africa to revitalizing the cacao industry in El Salvador.

Soon after Buffett was appointed interim sheriff in 2017, he toured Crossing to learn more about local social services. The health center offers primary care, including mental health, for all ages and sees roughly 17,500 patients a year. Most Crossing patients are on Medicaid, the public health insurance for people with low incomes.

“He was impressed with what we were able to provide patients,” Andricks recalled. “I don’t think he expected the scope and size of what we do.”

Addiction treatment, though, is notoriously difficult. Evidence supports treating addiction like a chronic illness, meaning even after difficult short-term behavior changes, it requires a lifetime of management. Research suggests relapse rates can be more than 85% in the first year of recovery. So any new treatment program is likely to face headwinds.

Buffett didn’t set Crossing up for failure. In fact, he has helped fund other aspects of the organization’s work. Part of the idea behind paying for the addiction treatment buildings but not the operations, Buffett said, is to keep his foundation “creative.” If it spends all its money on the same programming every year, that means less is available to fund other work around the globe. Buffett said it’s also about sustainability.

“If Tanya can show ‘with this investment I made this work,’” Buffett said, “then other people should be making that investment.”

Crossing’s inpatient recovery center holds eight beds for medication-assisted detox, 48 beds for rehabilitation, and a cafeteria where meals are cooked with input from dietitians working with patients. An outpatient treatment center also has classrooms for continuing education, a gym with a small bowling alley, and a movie theater. Buffett insisted on the last two amenities. (“People have to feel good about getting better,” he said.)

A separate building holds 64 beds of transitional housing, and just across the street are 20 rent-controlled apartments. Buffett spent an additional $25 million on buildings at that campus for other organizations focused on housing, workforce development, and education, among other things.

“There’s a lot to like in this program,” said Dr. Bradley Stein, director of Rand Corp.’s Opioid Policy and Tools Information Center.

As positives, Stein pointed specifically to the spectrum of care offered to patients as they progress in their recovery, the use of medication-assisted treatment to help stave off physical cravings for opioids, the connection to the health center, and even the involvement of law enforcement.

Laura Cogan, a 36-year-old mother who has struggled with addiction since she was 14, is one of the patients working their way through the system.

Cogan said she was the first patient in the doors when the recovery center opened. Less than 24 hours later, she was also the first patient to walk out.

The biggest challenge with Cogan’s previous attempts at recovery, she said, was never being sure about her next steps: What was she supposed to do after getting out of detox and residential treatment?

Crossing’s approach was designed to address that by providing transitional housing, easy access to outpatient services, and educational programming.

On her third attempt, Cogan got a round of applause after completing the first three days in detox. After six days, she joined residential treatment. After a month, she moved over to transitional housing, began outpatient treatment, and started offering peer support at Crossing. She tutored other patients, taught a writing class, and helped them get on computers and fill out job applications.

Then the pandemic hit.

Like other health centers around the nation, Crossing turned its attention to providing covid testing and vaccines. Meanwhile, just about every aspect of addiction treatment became more expensive. Crossing halved the number of residential treatment beds so each room would have only one patient and converted the rooms into negative pressure chambers to reduce the risk of covid transmission.

Staffing grew harder amid a nationwide nursing shortage. The number of patients in residential treatment dropped, Andricks said, because few people wanted to live inside a facility and wear masks. It was common to have as few as 10 beds occupied on a given day. The women’s unit was temporarily closed due to lack of demand and staffing constraints.

Cogan said several other transitional housing residents left once the $1,200 pandemic stimulus checks arrived, with some resuming treatment when that money dried up. But Cogan continued. Eventually she moved into Crossing’s rent-controlled apartments, where she has been one of just a few tenants.

Without the federal Paycheck Protection Program’s $1,375,200 forgivable loan in 2020, Andricks said, the outpatient treatment program might have had to close altogether.

But momentum at the recovery center started to change last spring as covid cases tapered off, Andricks said. Hiring became easier. More patients arrived. In October, the center received a grant to use the apartments for women with a history of substance misuse who are pregnant or who have given birth within the prior year. They’ve placed six women, in addition to Cogan, there already. The inpatient recovery center now averages about 27 occupied beds a day, within striking distance of the 30 that Andricks said the inpatient center needs to survive.

Rand’s Stein suggested another measurement of a treatment program’s success: whether people in the community get into treatment when they need it. National “secret shopper” reports have found significant barriers to service, such as long wait times.

Crossing’s program quadrupled the number of residential treatment beds in Macon County, according to Andricks. In the three years since the inpatient recovery center opened, it has had over 1,300 admissions. While most patients haven’t stayed in recovery, staffers have seen a pattern of success with those like Cogan who stay on campus and become involved with recovery offerings — although Andricks estimated that’s fewer than 10% of the patients.

Cogan said she hopes Crossing doesn’t get discouraged. People are going to mess up, she said, but she’s living proof of the impact the recovery center can have.

“I’m one of the lucky ones and I don’t know why,” Cogan said, sitting on a couch in the apartment on Crossing’s campus that she shares with her 12-year-old son since regaining custody of him. “I just know that today I am. And I hope that more people get the opportunity.”

The post A $30 Million Gift to Build an Addiction Treatment Center. Then Staffers Had to Run It. appeared first on Medika Life.

Want an example of past excess in psychiatry? Read how Freud and Wilhelm Fliess, his associate, almost killed a patient by operating repeated on her nose because they believe she masturbated excessively. And it’s not that long ago that tragedies in these hospitals were tossed off as “treatments” that didn’t work. I’ve heard tales from elderly workers who were there during those unbelievably cruel times.

I’ve seen the paint-chipped walls that were sealed off to hide the ugly truth of the chains on the walls, the tubs, and the fire hoses. And I’ve seen the result of four-year-old children being shuttled away forever to live their lives in these institutions.

One woman had never had a birthday card, a gift, or a visitor and didn’t know how to open a car door or that everything in a supermarket wasn’t free for the taking. Her diagnosis? Of course, it was schizophrenia at age 4, when she had a seizure disorder and diabetes and learned to talk like a patient.

“My feet,” she said to a mental health worker, “are talking to me.” How would you hear that? Actually, she had painfully distorted feet and large bunions, but she said the pain was “talk’” and they labeled her psychotic. How many children were raised in these institutions? Yes, raised. Once they reached 18, they were transferred to an adult facility. Do you know how sad it is to see seesaws at a psychiatric hospital?

I was taken to one in an East Coast state, and it was a forlorn horror worthy of something out of a Wes Craven film. The lights in the halls were from 25-watt bulbs, and the road leading to it was a mire of mud next to a filthy pond.

Today, I read that an impressive advocate for the mentally ill had died in October 2021 with little notice. How cavalierly we toss our heroes aside when it doesn’t suit us. Her name was Darby Penney. In addition to patient advocacy, she wrote The Lives They Left Behind, an examination of the wrenching contents of suitcases in a psychiatric hospital attic and the people who never left.

Those who died in these institutions were often buried in graves marked, if at all, with numbers. There, their remains lay in overgrown fields, forgotten by many, unbelievably, that these cemeteries existed at all. I knew a group that had set out to give all of them back their names in a tireless effort reading crumbled hospital notes left behind in abandoned buildings. They are heroes. The dead do speak to us if we listen.

Mental Health Progress

How far have we come from those dark days of whippings, rapes (a form of therapy by one of the medical directors), and starvation? The perspective and the research would seem to point to incredible advances supported by millions in grants. Much of the result has been to provide newer medications. But some researchers continue on a path that harks back to the age of mechanical interventions.

Do we truly understand the neurobiology of mental illness and, if not, what is to be done? Should we be seeking to bombard the scalp with light or yet more versions of electrical stimulation? When we still don’t know the precise mechanism, how can we know what to do to help bring the patients’ minds into some manner of normalcy? How much can artificial intelligence help in this effort? Are we using it sufficiently?

We seem to be taking a singular approach to a more complex problem similar to dear old Dr. Walter Freeman and his golden icepick. Even a Kennedy sister was one of his patients.

Perhaps the question should be directed first at diagnosis rather than treatment. Has the American Psychiatric Association’s DSM gone too far? It gives behavioral indicators only for diagnosing a mental disorder. How can that be adequate when we know there’s much more here than behavior?

Freud believed masturbation in women was a problem. How many know what was fact and what was fiction in his writings? Was Jeffrey Masson too close to the truth, and that’s why Anna Freud didn’t give him the care of Freud’s archive?

I suspect Freud was too full of himself not to see his own limitations and biases. When did he come up with the construct of Thanatos? When he was dying of mouth cancer from smoking too many cigars. Did he smoke cigars because of “oral fixation?”

The questions beg answers, and we are often footslogging without intense, lengthy questioning. Of course, you can see me as jaded, misguided, or too full of myself. That is your prerogative. I ask only that you ask. And that we never forget the forgotten lost in the mire of mental illness.

Thank you, Darby Penney, for reminding me that we need reminding.

The post The Forgotten in Mental Health Facilities Do Have a Few Advocates appeared first on Medika Life.

First, realize that mental health professionals aren’t feeling somewhat concerned that they don’t have an instant answer, a pill, a technique, something to lift this gray veil from our mind’s eyes miraculously.

One physician at a major hospital poured out his feelings in an article. An elderly patient had asked him if he could help her with feelings of loneliness. “I wish I could say yes. I wish I could prescribe her some antidepressants and be satisfied that I had done my best, but the truth is she’s not clinically depressed. It’s just that she has been left behind by a world that no longer revolves around her, not even the littlest bit of it.”

The physician said he saw the hospital as a “last resort” for people who found their beloved elderly relatives interfering with the holiday celebrations, requiring too much attention, being too needy. Did those people stop and think about how they would feel if they were no longer relevant to what the physician termed a culture addicted to youth?

Being tossed aside is terrible enough. Having it happen when everyone is in a celebratory mood and you’re excluded kills people earlier than they need to die. How disheartening for the physician, but most of all, for those abandoned to the care of strangers. BTW, that is the title of an excellent book on the history of the American hospital system.

Of course, we have studies of loneliness, especially during a time of a lockdown in a pandemic. Isn’t that what mental health professionals provide?

Who are those who suffer from loneliness most during this time? Younger adults, people with low income, the economically inactive, and people with mental health conditions were more likely to be in the highest loneliness class than the lowest. Everyone in these groups has a good reason to feel isolated and lonely. Wouldn’t you?

The thread that connects all of them and all of us is seen in the data; social connection. If we can maintain social relationships, we may keep ourselves afloat during particular times of emotional privation where the intensity ratches up—holiday times.

During the year, any year without a pandemic, we work toward solidifying our human and even animal connections. Some will join like-minded groups for activity; others will be sure to schedule regular social interactions either face-to-face or via technology. It will include quiet walks in parks or interactions with animals in the home or outside for some.

Pet ownership, in my opinion, can be quite a healthful activity. They may provide a sense of need and security and prevent rash actions. If it’s true that dogs have masters, cats have staff; then we know they have the power to help us. Fighting loneliness is one of their tasks. For dogs, they provide unconditional love as they perceive our need and they give it to us. Dogs can be saviors, but not everyone can have one.

Articles aplenty will appear now in all manner of publications. They will offer sure-cure ways to tackle loneliness and make it something positive. And some of the advice is good because everything can be seen in more than one light. My advice?

Seek to firm up your relationships now and remind yourself that you have power over your life, no matter where you are or what you no longer do. Unfortunately, we live in a world that defines us not simply by age (ageism) but by what we do for a living.

What is one of the first questions people ask you when you meet? Of course, it’s “And what do you do?” I am almost bursting at the seams because I want to respond, “Do about what?” I am not what I do or what I did. I am me, and that matters.

Want to fight loneliness? Begin today in whatever way you can (I leave the creativity up to you) and work at it as you would have worked (or work) at a career. This is the most important, satisfying work you will ever do.

The post Combating Loneliness Is Everyone’s Job appeared first on Medika Life.

It is increasingly difficult, if not bordering on impossible, in today’s America to find decent mental health care. Therapists are in short supply and spoilt for choice. They can cherry-pick patients from the long waiting lists of people requiring their help and insurers are reticent to pay for care.

In my colleague’s case, she had the added burden of wanting to find a Korean-speaking therapist who would not only be able to speak her native tongue but more importantly, would understand the dynamic of an Asian family.

She turned to the Employee Assistance Program (EAP) offered by her employer to try and secure the services of a therapist. Although she has now established contact with one, the process was onerous, time-consuming and a far cry from ideal.

The therapist she found isn’t Asian and doesnt speak Korean — according to the American Psychology Association, only 5% of psychologists in America are Asian. He also isn’t covered by her insurer but she is left with no other choice and has decided to commit.

Not everyone does. Providing family therapy is a complex process and it requires a clear understanding of the interpersonal dynamics at play. Asian families differ from Mexican families in the same way that White American families differ from African-American families or European families. It’s a cultural thing.

To provide effective treatment the therapist has to be intimately versed in the family’s culture and traditions. Jewish people look for Jewish therapists, Irish Americans look for therapists with Irish backgrounds, and so on. This raises the question, what happens when you are presented with a system like her EAP that doesn’t have the flexibility to address these elements? The answer is simple.

You are provided sub-standard levels of care or at worst, no care at all as the recommendations are not suited to the patient. This is a system that works partially, but that is built to enforce racial and cultural biases, not intentionally, but consequentially. Before you go off on the racial bandwagon, it is very doubtful that the creators of this system purposely designed it this way.

It merely suffers from a poor or inadequate design that is further restricted by an inability to evolve or adapt to the fluid landscape it inhabits.

The issue here, in terms of the systems we deploy in healthcare, is primarily a discriminatory one, based on cultural ignorance or a conscious decision to focus on the predominantly white American patient model for developing solutions.

This raises another question. Which other systems do we currently use that have been developed using white middle-class American patients as a baseline? Which products are currently being developed that will further enforce this systemic bias? New technology-based solutions that promote cultural disparities in healthcare and reduce access to care?

I can assure you these are in development as we speak, with most developers blithely unaware of the consequences of their chosen data set or model.

The Rainbow Society of Modern Day America

America is a melting pot of cultures, colors, and religions. A human stew, each ingredient having contributed to the growth of the country and each one as deserving of proper medical care as the other. To ignore this is to ignore the very fabric of what once made America great. Diversity is a strength, shared under one flag. That’s the theory.

In practice, things look bleak. Racism and cultural discrimination permeate American healthcare, in much the same way they permeate American society. Healthcare is, arguably, simply an extension of the society it serves, so this shouldn’t come as a surprise to anyone.

Don’t take my word for it, speak to someone of color if you’re white, or read one of the many excellent articles on the topic from people that experience health disparities first hand. This week, Asian-Americans experienced the brunt of this evil, next week the Hispanic community may be up.

This ugly undercurrent flows continuously through modern-day America, thinly disguised beneath an increasingly tenuous veneer of civility. I dislike the term “racism”, but for the purposes of this article, it will suffice and I raise this point for one simple reason.

If we have inherent racism and bias being exhibited by providers, unintentional or otherwise,, and we then add the burden of racially or culturally biased systems to the equation, what chance do these groups stand of accessing fair and equitable care?

Systems and people are not the same things. Systems are easily fixed if the desire and motivation exist. We can easily begin assessing software and digital health solutions for inbuilt biases that may inadvertently discriminate against certain communities. We can examine entrenched systems and develop guidelines for new systems.

Well-built, robust systems are designed to evolve and expand beyond their original parameters. Staid, old, and inflexible solutions will simply fall by the wayside. For instance, simply broadening the societal scope under which products are developed to account for cultural differences would directly and immediately benefit patient outcomes.

It’s a complicated world, where solutions cannot be everything to everyone. Issues around race and culture have to be considered alongside age, sex, and other complex criteria that affect our ability to deliver care. Where patient-facing technology is deployed, inclusivity must be maximized and where certain demographics are left incapable of accessing these solutions, alternatives must be provided.

We no longer have the excuse of ignorance on our side. Healthcare is aware of its failings and it is aware of the steps needed to address these issues. The problem, as I see it, is that this is not the only ill that hangs over American Healthcare. Other issues, equally pressing and equally as important to the delivery of effective care, also need to be addressed.

It is a question of priorities, of repairing other systems that are not fit for purpose. Where the issues of addressing cultural and racial disparities fit into the jigsaw puzzle of an industry barely holding together under the stresses of a pandemic and logistical demands, remains to be seen.

But address them we must. The mechanisms I refer to can and do result in death. Take the simple, but terrible example of mortality rates among black American women in childbirth. Racism and discrimination have no place in our house, and it’s time to draw a line and rid the industry of biases.

Perhaps the most important thing we can do for future generations of patients is to screen healthcare students for racial bias. A purge, forced on us by our current inability to respond to the underrepresented voices clamoring for care and basic dignity.

The post We Have Inadvertently Built Cultural Discrimination Into Our Healthcare Systems appeared first on Medika Life.

As an Asian American healthcare worker and a caregiver, it is tough to balance work and personal life and the pandemic has made it worse.

We have experienced a different level of racism in the US after Covid-19, which has been stressful for my family and me. What was just a distressing event before Covid-19 is now something that drains everyone’s energy. I have found myself exhausted from the challenges at work and now face the challenges of finding mental health help for my family and myself.

Many healthcare organizations like mine offer an Employee Assistance Program (EAP). Essentially, an employee assistance program is an employee benefit program that assists employees with personal problems and/or work-related problems that may impact their job performance, health, mental and emotional well-being. In theory, they’re a great idea.

Practically though, for me, the EAP has proved far from a solution right now. I contacted the program, and I received an email with a list of providers’ phone numbers. I called all ten practices listed during breaks, through the drives, and between taking care of kids. None, except one, would take EAP patients because of high demand.

It’s a pandemic and we’ve ramped up all the other medical services, but one of the most critical, mental health, has been left behind.

Some asked if I wanted to be waitlisted. I also inquired about bilingual practitioners who could speak Korean as an option while searching because of my family’s ethnicity and cultural sensitivity. The EAP representative contacted me back with bad news after five days. She could not find anyone that matched my preferences, but she said she would keep looking since telehealth would also be an option to consider.

I appreciated her gesture. It is hard to find someone who will spend that much time in healthcare nowadays. I asked her why they did not provide emails to me? I could send one email to all providers to inquire about the service rather than calling each practice, leaving a voicemail, waiting for them to call back during my work hours, and calling them back again to leave a message and repeat.

She agreed how frustrating the process was for someone in my position to find suitable help with my needs. This process alone took me at least a week to figure out I could only see one specific therapist. I needed someone my insurer would cover as I suspected our family would need more than the six sessions provided under EAP coverage to see any progress. I have been there and done that. 

The therapist told me I would need to drive to a more distant location among his insured offices to cover me after the EAP sessions or when my insurance elected to stop paying for virtual visits. Since I am determined to make progress in healing, I have moved forward with him and will be seeing him next week through a virtual visit.

From the point of inception, this entire process till we eventually see a family therapist will take us three weeks. I don’t even know if he will be a good fit. I am hopeful he is, as he sounded very caring. He is not bilingual or from my ethnic background, but I have no choice. I can pay out of pocket towards my deductible and get mental care that way, but I don’t want to waste resources provided to me when I don’t know whether he/she will be a good fit for our family.

I have already spent more than $12,000+ on mental health and am exhausted from trying to find a solution that works for my family. This is my last hope.

I wonder what families of other healthcare workers that need mental health care are going through, especially those like me who may have specific needs. What about people who don’t even have resources like me? What do they do? Healthcare workers get to work in the emotional turmoil of patients and caregivers. They are expected to provide the best care possible while dealing with their own well-being.

Referring health care workers to an EAP is not enough. Employers need to assume more responsibility for the wellbeing of frontline healthcare. Healthcare leadership needs to be aware of healthcare workers’ mental health needs, a priority that affects their ability to provide the best care for patients. This has less to do with race/cultural differences and more to do with basic care for employees.

We ALL suffer to varying degrees from mental health challenges, and the pandemic has amplified our need for qualified and effective care.

The aspects of race and culture add dimension to the challenge of securing proper care and cannot be ignored. Cases like my own should be seen as opportunities to assess and improve care access, not as problems that exist outside of the system.

The dangerous and rampant racism experienced by Asian Americans deserves attention as well.

There are solutions

There are many simple and effective solutions that we can apply to improve the current workflow of EAP’s.

• Organizations can assist in the process by providing an onsite therapist healthcare workers can see and who can, in turn, refer for longer care.
• Maybe reach out to volunteer organizations or mental health organizations to see if retired therapists can help. They are often eager to assist voluntarily.
• EAP’s need to be more flexible and upgrade old analog systems to fit patients’ needs.
• Phone numbers are not enough in this digital era of the internet, where texts and emails are now how we communicate.
• Correctly qualifying the patient’s needs before providing a list of names can significantly improve matching patients with providers.
• An awareness of the culture and language of the employees and patients before providing a list of providers is not only important but essential. If not available, having the flexibility and options to expand the network of providers should be considered.

For everyone to move forward with this pandemic, we need to work together to make changes now. And it has to start with caring for healthcare workers so that we can care properly for our patients. Healing in this era of Covid-19 is possible only when we are open to changes in healthcare.

The post Being an Asian Healthcare Worker Complicated My Access to Mental Health Care appeared first on Medika Life.