April 30, 2012 by David Stone, PhD

David Stone, Ph.D., CEO of Sound Mental Health

There is no dearth of conferences on health care reform these days.  Representatives from the insurance, employee benefits and medical provider sectors are quick to describe how the new federal health care reform law (or ACA) will soon impact our lives.  Considering the broad scope and reach of the ACA, their point seems well-taken.However, these mainstream health care conferences often offer little commentary on the role that behavioral health services and expertise could have in a health-care-reformed world.  There is occasional mention of the prevalence of depression among employees and chronically ill patients.  There also may be some acknowledgment of the increasing influence of mental illness and chemical dependency on the rising cost of health care.  However, there frequently is a general lack of recognition of the important part that behavioral health providers can play in addressing the many challenges posed by a transformed health care system in the U.S.The reasons for this lack of recognition are not because the facts aren’t compelling enough.  One of four Americans suffers from some form of mental illness every year. Depressive disorder is the leading cause of disability among Americans aged 14 to 44. Many conditions widely considered to be purely physical in nature (e.g. heart disease, diabetes, digestive disorders, some cancers, etc.) actually have a large psychological component. Finally, approximately 70 percent of all conditions having a significant behavioral health component are treated by primary care practitioners, rather than by behavioral health specialists.Government officials in Washington state have become attuned to these issues.  The state has submitted a proposal to the Centers for Medicare and Medicaid Services (CMS) as part of a planning grant it received to design an innovative care model for individuals eligible for both Medicare and Medicaid.  Of course, the state’s interest is partly due to the recent realization that the cost of care for this dual eligible population accounts for 50 percent of health care expenditures, while they only constitute 5 percent of the population.Washington state’s proposal follows ACA’s philosophy, which espouses the health home as the basis upon which the client’s total health care plan is constructed.  Perhaps the most essential elements of that model are care management and care coordination.  These two services hold great promise in promoting positive health outcomes for enrollees, and in assuring that funding is spent cost effectively.

Care management and care coordination are very similar to one of the most basic services offered by community behavioral health centers (CBHCs) nation-wide over the past twenty-five years: casemanagement.  With the Reagan administration’s shift in funding for these organizations from the federal government to states in the early 1980s, CBHCs were required to focus more attention upon persons with severe and chronic mental illness.  Since such individuals need a variety of health and human services, the case management model was created as a mechanism to coordinate those services in a cost-effective manner.

With this in mind, let’s connect the dots. We know that psychological factors play a major role in the health—and illness—of a great many Americans. We also know that most individuals who seek help for behavioral health-related conditions receive it (only) in the form of medication from general medical practitioners. Those who struggle with the more debilitating forms of such conditions (e.g. mental illness, addiction, etc.) require a variety of health and social services to survive outside of institutions. Countless studies, including a 2007 report by the American Journal of Managed Care, found that care management/care coordination improves health outcomes and lowers costs for clients and payers. Community behavioral health organizations, as mentioned earlier, have developed decades of experience in providing such services in a cost- effective manner, when compared with unmanaged services or those occurring in institutional settings.

In view of these facts, it appears that a valuable community resource is being overlooked by many members of the insurance, employee benefits and general health care fields.  That resource is the community behavioral health center.  Not only do such organizations have more clinical expertise to serve those with mental illness and addiction issues, but they also are likely to provide the case management functions that can assure the client successfully receives other valuable services s/he may need for a healthy physical and psychological recovery.

 

David Stone, Ph.D.  is CEO at Sound Mental Health, one of Washington state’s  most comprehensive behavioral health service and substance abuse providers. The nonprofit (found at www.smh.org) serves more than 18,000 people annually through 80 diverse programs.

You are invited to join NAMI EASTSIDE and participate in The Seattle Foundation’s GiveBIG.

• A one-day, online charitable giving event where your money is stretched further.
• Every online donation you make to NAMI EASTSIDE between midnight and midnight (Pacific Time) on May 2, 2012, will receive a proportional match from the GiveBIG stretch pool.
• The more you give, the higher the percentage of the stretch pool NAMI EASTSIDE will get.

Join us at the NAMI EASTSIDE/HERO House Open House on May 2nd from 3:00pm to 8:00pm at the Clubhouse:

14230 NE 21st St.
Bellevue, WA  98007.

• Stop by to meet staff and Volunteers to find out what is coming up in 2012 and beyond for NAMI EASTSIDE.
• Enjoy refreshments from HERO House’s Hospitality Unit while viewing the “Artist on the Edge” display.
• Volunteers will be available to help you make an online donation during the Open House

Click Here to Donate
If you need assistance in making online donations, please call the NAMI EASTSIDE office (425) 885-6264 on May 2nd; we will gladly process your donation. You can also email us at info@nami-eastside.org.

The NAMI Washington Education Committee has announced the following NAMI Teacher Training schedule. More trainings will be held over the next 12 months, including In Our Own Voice and additional trainings for courses where the demand is greatest.

If you are intereseted in becoming a NAMI Eastside teacher/facilitator please contact Barbara Thompson at 425-885-6264 or email barbthompson@nami-eastside.org for any of the courses offered.

For Family to Family training please contact Nina Weaver at 425-417-9011 or email ninaweaver@yahoo.com

2012 Training Dates and Locations

May 18 – 20    Family to Family Teacher Training, Stanwood, WA

June 22 – 24   Family Support Group Facilitator Training, Stanwood, WA

June 22 – 24   Basics Teacher Training, Stanwood, WA

July 27 – 29   Connections Support Group Facilitator Training, Federal Way, WA

August 24 – 26    Peer to Peer Teacher Training, Federal Way, WA

Teachers and Facilitators Needed Now!

Teachers are needed to teach Family to Family Class, a 12 week course for caregivers of adult individuals with a mental illness.

Facilitators are needed to lead our Family Support Groups that are designed to assist family members, employers and friends of people impacted by mental illness.

Teachers are needed to teach Basics Class, a 6 week course for parents, educators and caregivers of children with a mental illness.

Facilitators Connections Support Groups a peer recovery support program for people living with a mental illness.

Teachers are needed to teach Peer to Peer Class, a 10 week recovery education course for adults living with a mental illness.    

All classes are offered free of charge to the public.

A version of this editorial appeared in print on March 24, 2012, on page A18 of the New York edition with the headline: A Bizarre Outcome on Generic Drugs.

Dozens of suits against drug companies have been dismissed in federal and state courts because of a decision by the Supreme Court last year that makes it virtually impossible to sue generic manufacturers for failing to provide adequate warning of a prescription drug’s dangers. This outrageous denial of a patient’s right to recover fair damages makes it imperative that Congress or the Food and Drug Administration fashion a remedy.

Generic Drugs Proving Resistant to Damage Suits (March 21, 2012)

This situation is particularly bizarre because patients using the brand-name drug can sue when those using the generic form of the drug cannot, as on Wednesday. In 2008, the Supreme Court ruled that a Vermont woman who had her hand and forearm amputated because of gangrene after being injected with a brand name antinausea drug could sue the manufacturer for inadequate warning of the risks; she won $6.8 million from Wyeth.

In 2011, the court ruled that similar failure-to-warn suits could not be brought against makers of generic drugs. As a result, an Indiana woman who was also forced to have her hand amputated because of gangrene after being injected with a generic version of the same antinausea drug had her case dismissed.

Same drug. Same devastating health consequences. Opposite results. This injustice will affect more people as generics, which already dominate the market, expand even more under the pressure to control health care costs.

The Supreme Court’s disparate rulings hinge on the ability of the drug makers to change a warning label if they detect new evidence of dangers. In 2008, the court found that brand-name manufacturers had the unilateral power to change warnings through various mechanisms even before asking the Food and Drug Administration for a formal change.

Then, in 2011, the court found that, under the F.D.A.’s interpretation of a 1984 law, known as the Hatch-Waxman amendments to the Food, Drug and Cosmetic Act, the generic versions must carry warning labels identical to those of the brand-name drug. The goal was to minimize confusion and dispel any doubt that a generic was therapeutically equivalent to the brand-name drug. Generic makers can’t change the warnings but can propose a change to the F.D.A., which can then bring about a revision of the brand-name label to trigger a corresponding change in the generic label. The court ruled that because the generic makers do not control the labeling, they cannot be sued under state law for inadequate warnings.

Justice Clarence Thomas, writing for the majority in 2011, acknowledged that the distinction “makes little sense” in the eyes of consumers, and Justice Sonia Sotomayor, writing the dissent, predicted “absurd consequences” depending on the “happenstance” of whether a prescription was filled with a brand-name or generic drug.

Congress should fix the disparity by amending the law to make it clear — as Representative Henry Waxman, a co-author of the statute contends — that the act did not intend to pre-empt all failure-to-warn claims. Alternatively, the F.D.A. should fix the liability problem by amending its regulations to allow generic manufacturers to change the warning labels.

Generic drugs have rapidly expanded their reach, and, by one estimate, from one-third to one-half of all generic drugs no longer have a brand-name competitor. The regulatory system needs to hold generic companies, many of them large multinationals, accountable for labels on the products they sell.

By KATIE THOMAS
New York Times

Published: March 20, 2012

A version of this article appeared in print on March 21, 2012, on page A1 of the New York edition of the New York Times with the headline: Generic Drugs Prove Resistant to Damage Suits.

Debbie Schork, a deli worker at a supermarket in Indiana, had to have her hand amputated after an emergency room nurse injected her with an anti-nausea drug, causing gangrene. She sued the manufacturer named in the hospital’s records for failing to warn about the risks of injecting it. Her case was quietly thrown out of court last fall.

That result stands in sharp contrast to the highly publicized case of Diana Levine, a professional musician from Vermont. Her hand and forearm were amputated because of gangrene after a physician assistant at a health clinic injected her with the same drug. She sued the drug maker, Wyeth, and won $6.8 million.

The financial outcomes were radically different for one reason: Ms. Schork had received the generic version of the drug, known as promethazine, while Ms. Levine had been given the brand name, Phenergan.

“Explain the difference between the generic and the real one — it’s just a different company making the same thing,” Ms. Schork said.

Across the country, dozens of lawsuits against generic pharmaceutical companies are being dismissed because of a Supreme Court decision last year that said the companies did not have control over what their labels said and therefore could not be sued for failing to alert patients about the risks of taking their drugs.

Now, what once seemed like a trivial detail — whether to take a generic or brand-name drug — has become the deciding factor in whether a patient can seek legal recourse from a drug company. The cases range from that of Ms. Schork, who wasn’t told which type of drug she had been given when she visited the hospital, to people like Camille Baruch, who developed a gastrointestinal disease after taking a generic form of the drug Accutane, as required by her health care plan.

“Your pharmacists aren’t telling you, hey, when we fill this with your generic, you are giving up all of your legal remedies,” said Michael Johnson, a lawyer who represented Gladys Mensing, one of the patients who sued generic drug companies in last year’s Supreme Court case, Pliva v. Mensing. “You have a disparate impact between one class of people and another.”

The Supreme Court ruling affects potentially millions of people: nearly 80 percent of prescriptions in the United States are filled by a generic, and most states permit pharmacists to dispense a generic in place of a brand name. More than 40 judges have dismissed cases against generic manufacturers since the Supreme Court ruled last June, including some who dismissed dozens of cases consolidated under one judge.

Public Citizen, a consumer advocacy group, has petitioned the Food and Drug Administration to give generic companies greater control over their labels, a rule change that could allow users of generic drugs to sue, but the agency said earlier this month that it needed more time to decide. “Congress can make this problem go away, and the F.D.A. could, too,” said Allison Zieve, the director of Public Citizen Litigation Group. “But we haven’t seen signs that either of them is paying much attention.” A spokeswoman for the F.D.A. declined to comment.

The Supreme Court’s ruling, which was split 5 to 4 on ideological lines, has its roots in the Hatch-Waxman Act, the 1984 law that opened the floodgates to generic drugs. That law allowed companies to skip the lengthy process required to approve new drugs if they could prove that the generic drug was equivalent to its brand-name counterpart.

With few exceptions, it also required generic manufacturers to use the same labels — the lengthy list of a drug’s uses, dosages and risks — used by the brand names.

If a problem develops, the brand-name companies are responsible for changing the label, and the generic companies must follow their lead. As a result, the court’s majority ruled, generic companies cannot be held responsible for failing to alert patients to problems with their drug. The dissent, which was written by Justice Sonia Sotomayor, argued that generic companies nevertheless have a responsibility to report problems to the F.D.A. and should be held liable for failing to warn patients.

The ruling came just two years after the Supreme Court established —in Ms. Levine’s case — that, by contrast, brand-name companies can be sued for failing to adequately warn patients.

Ms. Levine was given an injection of Phenergan in 2000 during a visit to a clinic to treat a migraine headache. Her hand and forearm turned black and eventually had to be amputated. Reports had shown that the drug can cause gangrene if it enters an artery, especially if it is placed directly into the vein rather than injected into the muscle or through a diluted intravenous drip. Although the label warned that gangrene could occur if the drug came into contact with arterial blood, Levine argued that the warning did not go far enough.

She sued Wyeth and a Vermont jury awarded her $6.8 million. Wyeth appealed and the Supreme Court sided with Ms. Levine, agreeing that the company could be held liable for failing to adequately warn about the risks of a drug.

Ms. Schork, 52, was given the generic version of Phenergan when she visited the hospital in 2007 with a stomachache and nausea related to her diagnosis of Crohn’s disease.

When a nurse injected the drug into her arm, it entered her artery, and Ms. Schork’s right hand developed gangrene. In asking that the case be dismissed, lawyers for Baxter Healthcare Corporation, which then was one of several companies that made the drug but has since sold its injectable generics to another company, argued that Ms. Schork could not conclusively prove that Baxter had made the drug she took.

The judge agreed that the question could be debated at trial but said it was irrelevant because of the Supreme Court’s ruling.

Ms. Schork filed a malpractice claim against the hospital with the Indiana Department of Insurance, and received what her lawyer described as a limited award; the amount was confidential. She said she could not continue to work at her supermarket job and is now unemployed.

Soon after Ms. Levine won her case, Ms. Schork wrote to congratulate her and to share her own story. At the bottom of the letter, Ms. Levine recalled, Ms. Schork apologized for her handwriting because she was writing with her left hand. “The fact that it had happened to her and she had this same struggle — and then to hear now that it’s getting dismissed — is just beyond me,” said Ms. Levine.

Ms. Schork said she and Ms. Levine later spoke on the telephone. “I’m glad for her,” she said, “but it didn’t help me any.”

Lawyers for generic drug companies say their clients are able to provide low-cost drugs because their primary task is replicating drugs. If the companies were expected to take responsibility for updating their labels, “we would effectively start to turn generic companies into brand companies, and of course the tremendous cost savings that American consumers have benefitted from would start to wane,” said Jay Lefkowitz, who served as the lead attorney representing generic companies before the Supreme Court.

The Supreme Court recognized that its decision must make “little sense” to plaintiffs who sue generic drug companies. However, Justice Clarence Thomas wrote for the court, “Congress and the F.D.A. retain the authority to change the law and regulations if they so desire.”

Some attorneys who follow the issue have speculated that Congress and the F.D.A. are reluctant to deal a blow to generic companies, which are responsible for providing cheap drugs to millions of American consumers, especially in an election year when health care is a hot issue.

In a statement last week, Representative Henry A. Waxman, Democrat of California, who co-wrote the Hatch-Waxman Act, said he was exploring ways to address the issue, either through legislation or a rule change.

Mr. Waxman argued in a brief opposing the generic companies in the Supreme Court case last year that Congress had never intended for generic companies to be freed of all responsibility. “Congress did not intend for consumers’ rights to be categorically eliminated simply because they purchased a generic rather than a brand-name drug,” he wrote.

Camille Baruch, 18, and her family say that is precisely what happened to her. When she was 12, Camille, of Rockville, Md., began taking the generic version of the antiacne drug Accutane and developed severe gastrointestinal pain several months later. Her diagnosis was ulcerative colitis, a type of inflammatory bowel disease, and she had to have her large intestine removed.

Six years and eight operations later, doctors have not been able to stabilize her condition. Her parents said the disease transformed their daughter from a talented basketball and softball athlete to someone who will struggle with debilitating physical challenges for the rest of her life.

Thousands of patients have sued Roche, the maker of Accutane, claiming that it caused their inflammatory bowel disease, and several have won multimillion-dollar verdicts against the company. In 2009, citing litigation costs and competition from generics, Roche removed Accutane from the market. In 2010, Camille sued the makers of the three generic versions of Accutane she took. Her lawyer, Tayjes Shah, said lawyers for the companies have told him they intend to ask for a dismissal. “I have very little optimism,” Mr. Shah said.

Camille, who was in the hospital this month recovering from another operation, said she had heard the arguments that the generic companies had made. “It makes me almost want to cry every time that I think that I took something that is nearly identical” to Accutane, yet she cannot sue, she said. “I lost everything. That is not a reason enough that these people aren’t to blame.”

NAMI Connections #1, Every Wednesday, 6:30pm-8pm
Together Center, 16315 NE 87^th St., Building B, Baker/Adams Conference Room, Redmond
Brian Youngberg (206) 760-9215, brianyoungberg@gmail.com

NAMI Connections #2, Every Friday, 6:30 pm-8pm
Snoqualmie Fire Dept. Training Room, 3700 SE Snoqualmie Parkway
Yolanda LePley (425) 829-2417

Young Adults 18-30, 2^nd Thursday, 7pm-8:30pm
Washington Cathedral Church, 12300 Woodinville-Redmond Rd. NE, Redmond, Bldg. 12280, Room 206
NAMI Eastside Office (425) 885-6264

Consumer and Family Support Groups

Mental Health & Spirituality, 2^nd and 4^th Wednesdays 7pm-8:30pm
(for consumers and family members)
St. Brendan’s Catholic Church, 10049 NE 195^th St., Bothell, 2^nd Floor Teachers’ Lounge
Joe (206) 375-2028, stevensfmly@msn.com

Grupos de Apoyo Para Familias
(Family and Consumer Spport Group for Spanish Speakers)
time and location vary.
Luis Viquez, lviquez63@hotmail.com  (206) 992-6844

Family Support Groups

Family Support Group #1, 2nd Wednesday, 7pm-8:30pm
at the Church, 12700 SE 32^nd St, Bellevue (near Factoria), building left of the Sanctuary, Room 207
Robb and Diane (425) 788-9988

* NEW! Family Support Group #2,    3rd Wednesday, 7pm-8:30pm
Fairfax Hospital, in the Boardroom, 10200 NE 132^ndSt, Kirkland
NAMI Eastside Office (425) 885 6264

Family Support Group #3,   1^st Tuesday, 7pm-8:30pm
Fairfax Hospital, in the Boardroom, 10200 NE 132^nd St, Kirkland
Karla (206) 227-7430

Family Support Group #4,   3^rd Wednesday, 7pm-8:30pm
Issaquah City Hall, Coho Room, 130 E. Sunset Way, Issaquah
Karin (425) 688-5637, miller.karin2@gmail.com

Family Support Group #5,   4^th Thursday, 7pm-8:30pm
Washington Cathedral Church, 12300 Woodinville-Redmond Rd. NE, Redmond
Karla (206) 227-7430

]]> http://www.nami-eastside.org/blog/2012/04/nami-eastside-monthly-support-groups/feed/ 0 http://www.nami-eastside.org/blog/2012/04/mental-illness-culture-and-violence/ http://www.nami-eastside.org/blog/2012/04/mental-illness-culture-and-violence/#comments Mon, 16 Apr 2012 04:50:49 +0000 Editor http://www.nami-eastside.org/blog/?p=104 NAMI Eastside Educational Forum – April 17, 2012

“Mental Illness, Culture and Violence”

Guest Speaker:
Kevin St. Jacques, Psy.D. LMHC

Dr. St. Jacques has been working with the forensic mental health population in Seattle since 1999. He began working with Sound Mental Health 9 years ago as a forensic mental health clinician in the Dangerous Mentally Ill Offender Program. Dr. St. Jacques is an international presenter on forensic behavioral health and has provided trainings for the Department of Corrections, Washington State Criminal Justice Training Commission and Seattle area housing agencies on the treatment of mentally ill offenders.

In this presentation he will discuss the relationship between mental illness and violence and will share strategies for interacting with mentally ill individuals acting out violently.

The presentation will also explore the concept of violence from a cultural perspective.

Join us! This event is FREE and open to EVERYONE!

Date:
Tuesday, April 17, 2012, 7 PM – 9 PM

Location:
Evergreen Hospital, Suite Tan 100,
12303 NE 130th Lane,
Kirkland, WA 98034

PHONE: 425-885-NAMI (6264)
WEB: WWW.NAMI-EASTSIDE.ORG
E-MAIL: INFO@NAMI-EASTSIDE.ORG

Urge White House to Issue Final Ruling

on Mental Health Parity Act

Every day across the United States, families struggle with mental illness or substance abuse. Often, the difference between being overwhelmed as a family or meeting the challenges head-on and making progress against the illness can be just one factor: access to meaningful health insurance. Even those who think they have quality health coverage can be overwhelmed when a loved one receives a diagnosis of mental illness or is a substance abuser. They discover that their health insurance does not cover needed services or that the out-of-pocket expenses are prohibitive and significantly more than what is charged for physical ailments.

Starting Wednesday, March 21, 2012

There are now two NAMI Eastside Family to Family Support Groups meeting at Fairfax Hospital in Kirkland, WA.

This new Family to Family support group will meet the third Wednesday of each month
in the board room at Fairfax Hospital.  The group will meet from 7:00PM – 8:30PM.

This Support Group is in addition to the other NAMI Eastside Family to Family Support Group
that meets the first Tuesday of each month at Fairfax Hospital from 7:00PM – 8:30PM.

NAMI Eastside support groups provide support, knowledge and understanding along
with an opportunity for group members to share experiences in a confidential setting.
Meetings are led by NAMI members who have personal experience with the topic.

For more information, please contact NAMI Eastside at:

Phone:
425-885-NAMI (6264)

Web:
WWW.NAMI-EASTSIDE.ORG

E-mail:
info@NAMI-EASTSIDE.ORG

]]> http://www.nami-eastside.org/blog/2012/03/new-support-group-at-fairfax-hospital/feed/ 0 http://www.nami-eastside.org/blog/2012/03/suicide-prevention/ http://www.nami-eastside.org/blog/2012/03/suicide-prevention/#comments Thu, 15 Mar 2012 23:52:46 +0000 Editor http://www.nami-eastside.org/blog/?p=83  

NAMI Eastside Educational Forum - March 20, 2012 

“SUICIDE PREVENTION”

Guest Speaker: Kelly McDonald, MPH

Kelly McDonald, MPH has worked in suicide prevention for more than 10 years, including with the US Army at Fort Lewis and Kitsap County Health District. She currently facilitates suicide awareness education and training for Washington State’s Youth Suicide Prevention Program and is providing support to community groups in King County and to schools in the implementation of peer-to-peer suicide prevention education.

In this presentation she will talk about suicide (facts, warning signs), the higher risk of gay, lesbian and bisexual youth, the relationship between suicide, bullying and depression. She will also offer information on how to help someone with suicidal thoughts and the resources available in the community.
Join us! This event is FREE and open to EVERYONE!

Date:
Tuesday, March 20, 2012, 7 PM – 9 PM

Location:
Evergreen Hospital, Suite Tan 100,
12303 NE 130th Lane,
Kirkland, WA 98034

Phone:
425-885-NAMI (6264)

Web:
WWW.NAMI-EASTSIDE.ORG

E-mail:
info@NAMI-EASTSIDE.ORG