How funding to house #MentallyIll, #Homeless is a financial gain, not drain

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A director of a supportive housing center in Bronx, New York, talks with a resident and case worker in December 2015.
Bebeto Matthews/AP

Carol Caton, Columbia University Medical Center

As Congress considers the federal budget proposal for fiscal year 2018 to reduce funding for services to poor and homeless Americans, programs with proven cost-effectiveness should not be on the chopping block. One such program is supportive housing for homeless people with severe mental illness. The Conversation

Supportive housing, funded and coordinated by several different federal agencies and nonprofits, provides homeless people who have severe mental illness with housing coupled with treatment and support services. There is no increase in net public cost compared to street and shelter living.

While it may appear that paying for supportive housing is a drain on the federal budget, research has shown that ending homelessness for the severely mentally ill saves taxpayers money.

Because funding comes from several different agencies, it is hard to know specifically from the president’s budget plan how deep the cuts to supportive housing could be. Yet we do know that the president has proposed cuts in funding to Housing and Urban Development by 13 percent and to Health and Human Services by 19 percent. Both these agencies provide significant funding for supportive housing.

I research mental illness and homelessness. Cutting funds to house the homeless would cost us more money than it would save.

Supportive housing and the homeless mentally ill

Since the 1980s, homelessness has plagued cities and towns across the country. Today, more than a half-million people in the U.S. are homeless. One in every three homeless people suffers from a mental illness, which is often compounded by multiple health problems and substance abuse.

The homeless mentally ill are likely to remain undomiciled and without treatment for long periods of time. This brings a high social and economic cost to society. Disabled by mental illness and unable to work, these individuals have little hope of exiting homelessness without public assistance.

From www.shutterstock.com

Beset with extreme poverty and disability, their inability to work renders them heavily dependent on the largesse of government agencies for disability income, housing support and health care.

The challenges facing homeless people in general are daunting. Security, privacy and creature comforts are in short supply. The daily burden of being homeless involves finding ways to assuage exhaustion and hunger, and to sidestep the violence and victimization that regularly occurs in life on the streets. An estimated 14 to 21 percent of homeless people are victims of crimes, compared to about 2 percent of the general population.

Supportive housing, started in the early 1980s, has shown to make a big difference. Unlike the temporary respite provided by crisis shelters, it provides access to permanent housing, mental health treatment and support from mental health professionals to guide the adjustment from homelessness to stable residence in the community.

Supportive housing tenants must have a behavioral health condition that qualifies them for a federal disability income. Residents pay one-third of the cost of rent and utilities with their disability income (about US$733 per month). The balance is covered by a housing subsidy provided through private or governmental sources. In some cases, eligibility for a housing subsidy is based on duration of street and shelter living.

The numbers tell the story

In concert with the federal plan to “End Chronic Homelessness in Ten Years,” supportive housing has helped to reduce chronic homelessness by 35 percent between 2007 and 2016.

At an annual cost ranging from $12,000 to nearly $20,000 per unit, permanent supportive housing is expensive, but it is substantially less than the annual cost of a stay in a homeless shelter, jail or prison, or psychiatric hospital.

Some of the funding comes from the federal government, including from the Department of Housing and Urban Development’s Continuum of Care and from Section 8 housing subsidies. The Department of Health and Human Services and the Department of Veterans Affairs also provide funding.

States including New York, California, Washington and Connecticut have helped to fund housing for people with mental illness, as have some city and county governments.

Other sources of funding include low-income housing tax credits, private foundations and charitable donations to nonprofit housing providers. The Affordable Care Act Medicaid expansion program provides Medicaid reimbursement for services provided to individuals in supportive housing.

And the winner is…everyone

Controlled trials conducted in the United States and Canada have found the majority of people who have had access to supportive housing remain housed for a year or more, showing greater housing stability than that among comparison subjects. In addition, individuals in supportive housing not only stayed longer but also had a reduction in subsequent homelessness and decreased use of emergency departments and hospitals.

Cost offset studies show that supportive housing leads to less use of costly public services.

A landmark analysis of administrative data from multiple public service systems examined the impact of supportive housing placement on 4,679 individuals and their use of the public shelter system, public and private hospitals, and correctional facilities. The study found that persons placed in supportive housing experienced significant reductions in use of homeless shelters, hospitals and time incarcerated. In fact, public service cost reductions following housing placement nearly offset the cost of the housing itself.

Significantly, supportive housing is nearly half the average cost per year of $35,578 for a chronically homeless person. Part of the reason is that stable housing resulted in a shift in service use from expensive crisis services to less costly community-based care.

Strong and compelling evidence indicates that supportive housing is a “win-win” for both the homeless mentally ill and the holders of the public purse. It offers people with mental illness safe and adequate housing and greater access to treatment, essential elements in their recovery. And it can lead to greater cost-efficient use of public services.

Currently there are not nearly enough supportive housing units to house the thousands of individuals with severe mental illness who are currently unstably housed or are at risk of falling into homelessness.

It would not make economic sense to cut funding for a cost-effective intervention that provides a solution to homelessness. Rather, what we need now is the public will to bring supportive housing to scale so that the most fragile among us might achieve stable residence in the community. They, too, deserve the opportunity for personal fulfillment and involvement in mainstream society.

Carol Caton, Professor of Sociomedical Sciences (Psychiatry and Public Health), Columbia University Medical Center

This article was originally published on The Conversation. Read the original article.

Four ways to stay mentally fit if you’re struggling with the political climate

A protest in New York’s Washington Square Park days after Donald Trump’s election. Muhammed Muheisen/AP
A protest in New York’s Washington Square Park days after Donald Trump’s election. Muhammed Muheisen/AP

Roxanne Donovan, Kennesaw State University

“This can’t be happening.”
“I feel like throwing up.”
“I don’t want to get out of bed in the morning.”
“Life is going to get a lot worse for people like me.”
“I’m so sad I can’t even think about it anymore.”
“Things are never going to be the same again.”

I’ve actually heard these statements from people pained by Donald Trump’s election. Such sentiments convey a mix of disbelief, despondency, powerlessness and fear.

That said, there are many people who are thrilled with the new administration. As a psychologist who researches the ways discrimination experiences impact well-being, however, I am particularly sensitive to those in distress.

My research, and that of other social scientists, helps explain why a Trump presidency is difficult for so many people – and particularly acute for those who have already experienced trauma based on some of the issues identified with Trump.

For example, many women who have been sexually abused were deeply affected because of recorded statements he had made about grabbing women in their crotches. Additionally, many African-Americans who felt empowered and validated by an Obama presidency felt deep sorrow and fear at Trump’s election, due in part to published accounts of his father’s company not renting to African-Americans. There is some good news among all this; there are strategies for coping.

Repeated stress wears the body down

It has proven hard for those opposed to Trump to adjust to his election. Many have felt like they are in the middle of an ongoing stress storm. Immigrants, for example, are stressed over concerns about being deported and separated from their families.

Making matters worse, some are more vulnerable to this storm’s impact than others. The more storms a person has endured, the greater the damage this new storm can inflict.

The reason why this happens is called allostatic load – the wear and tear on the body caused by ongoing stress. This deterioration is cumulative and can lead to physical, psychological and cognitive declines, including early death.

Along with genetics, environment and behavior, social demographics like race, gender and age also influence the weight of the load. University of Michigan public health professor Arline Geronimus and her colleagues captured this phenomenon when they examined allostatic load in black and white women and men.

They found that black participants, particularly black women, were more likely to have higher allostatic loads than white women and white men, above and beyond the effects of poverty. In other words, black people generally carried more stress in their daily lives.

Age matters too. Allostatic loads were similarly distributed across race and gender prior to age 30. From there, however, the loads disproportionately increased with age, revealing racial and gender gaps that widened over time (white men consistently had the lowest scores, followed closely by white women).

It’s not easy being different

Some psychologists believe the stress of otherness – being viewed and treated negatively due to group membership – is one reason for the unequal “weathering” effect. Mounting evidence gives credence to this belief.

My research group, for example, found black, Latino and Asian undergraduates report significantly more individual and ethnic-group discrimination than white undergraduates. Similarly, almost 100 percent of the black college women my collaborators and I sampled reported experiencing racial discrimination. In both studies, incidences of discrimination were associated with depressive symptoms and, in some cases, anxiety.

So the interplay between high allostatic load and low social position increases vulnerability. This is not good news for the many people of color, women, undocumented immigrants, sexual minorities and Muslims who are stressed out about a Trump presidency.

Strategies that can help

Before giving in to despair, there are reasons for cautious optimism. Psychological research points to promising coping techniques shown to lighten allostatic load and mitigate negative stress outcomes, even among those exposed to prolonged high-stress situations.

  1. Avoid avoidance. As tempting as it might be to address negative feelings through avoidance – think excessive shopping, working, drinking, eating, gaming, online surfing – doing so can be detrimental in the long run. Instead, choose behaviors shown to improve mood over time, like exercise and meditation. Mindfulness-Based Stress Reduction (MBSR), a standardized eight-week program that teaches mindful meditation, shows great promise at reducing stress and improving mood in a wide variety of populations.
  2. Problem-solve. Taking action to address a perceived stressor can be therapeutic. Called problem-focused coping in the psychological literature, this technique has been shown in my research and that of other social scientists to buffer the negative health effects of stress. Donating time or money to a preferred political candidate, party or cause or participating in a protest or letter-writing campaign are examples of problem-focused actions.
  3. Seek support. An aspect of problem-focused coping worthy of individual attention is social support. Connecting with empathetic others has the interrelated benefits of reduced stress, lower allostatic load and improved health and well-being. A solid support network doesn’t have to be large. It can contain just a few people you perceive as reliable. Need to build your network? Start by reaching out to those already in your life that you’d like to know better. Joining civic organizations or neighborhood groups are also good options. If you go this route, facilitate connections by volunteering to help the organizers.
  4. Get help. Sometimes our coping efforts don’t yield desired results, or we can’t bring ourselves to try anything. In these situations, professional help might be warranted. The American Psychological Association is a great resource for information about the benefits of psychotherapy and how to go about finding a therapist.

If you plan to endure the social changes under way with gritted teeth and clenched fists, I invite you to experiment with the above techniques to find what combination might work for you. Four years is a long time to be battered by a storm; preparation could mean a lot less damage, especially if previous storms have worn you down.

The Conversation

Roxanne Donovan, Professor of Psychology and Interdisciplinary Studies, Kennesaw State University

This article was originally published on The Conversation. Read the original article.

How To Know When Holiday Drinking Is Hurting Your Brain

Holiday drinking brings good cheer, but it also could be a sign of problem drinking.
Holiday drinking brings good cheer, but it also could be a sign of problem drinking.

Jamie Smolen, University of Florida

For many, the holidays are indeed the most wonderful time of the year. Families and friends come together and enjoy food, good cheer – and, often, alcohol.

Commercially speaking, alcohol and the holidays seem to be made for each other. Alcohol can be a quick and easy way to get into the spirit of celebration.

And, it feels good. After two glasses of wine, the brain is activated through complex neurobiochemical processes that naturally release dopamine, a neurotransmitter of great importance.

When the dopamine molecule locks on to its receptor located on the surface of a neuron, or basic brain cell, a “buzz” occurs. It is often desirably anticipated before the second glass is empty.

This image shows an illustration of a man drinking a pint of beer, indicating how the body metabolizes alcohol and the organs that this alcohol affects.
Wellcome Images via Flickr, CC BY-NC-ND

There are those, however, who drink right past the buzz into intoxication and, often, into trouble. For them, the brain starts releasing the same enjoyable dopamine, no different than what happens in the casual drinker’s, but it doesn’t stop there. A compulsion to binge drink can result.

As someone who has studied alcohol use disorder for over 15 years and who has treated thousands of patients who have it, I think it’s a major, yet often poorly understood, public health problem. Our culture seems to be moving beyond the point of labeling those with opioid addictions as “weak,” and I hope we can do the same for those with alcohol use disorder, too, which is more widespread than people may appreciate. Excessive drinking accounted for one in 10 deaths among working-age adults in the United States.

Moving beyond judgment

Although alcohol can feel as though it is relieving stress, it contributes to 88,000 deaths in the United States each year. That is more than double the number of people killed by heroin and opioid prescription drug overdose, another major public health crisis, in 2014.

In addition, more than 66.7 million Americans reported binge drinking in the past month in 2015, according to the recent report on addiction by the surgeon general.

The consequences to the individual and the family are staggering, affecting physical and mental health, an increased spread of infectious disease, reduced quality of life, increased motor vehicle crashes and abuse and neglect of children, to mention a few.

Scientific study of the brain has helped explain binge drinking even if it may be hard for family and friends to understand. It’s defined as drinking five or more drinks for men and four for women on the same occasion on at least one day in the past 30 days.

Binge drinking is a medical condition. It happens through no fault of the individual, who is victimized by the comparative malfunction of the pleasure circuits in the brain. This causes the drinker to want more and more alcohol. Brains of binge drinkers have a disease, acknowledged by the American Medical Association since the 1950s, yet binge drinkers are often vilified.

Americans typically want to know and are willing to make some lifestyle changes out of fear and common sense when it comes to diseases such as heart disease, obesity and cancer. We as a society are not quite at the same point with substance abuse disorders, but researchers are desperately trying to bring that same willingness for prevention and treatment to substance use disorders.

Science understands the cause well enough to explain it and treat it so that lives can be saved and spared the devastating consequences for the millions who suffer with these conditions, their families and communities. This has become an urgent matter of national importance for scientists and medical practitioners.

The three stages of addiction

The alcohol addiction process involves a three-stage cycle: Binge-Intoxication, Withdrawal-Negative Affect, and Preoccupation-Anticipation.

It begins in the neurons, the basic type of brain cell. The brain has an estimated 86 billion of these cells, which communicate through chemical messengers called neurotransmitters.

Neurons can organize in clusters and form networks or circuits in order to perform specific functions such as thinking, learning, emotions and memory. The addiction cycle disrupts the normal function of some of these networks in three areas of the brain – the basal ganglia, the extended amygdala and the prefrontal cortex.

The disruptions do several things that contribute to continued drinking. They enable alcohol or drinking-associated triggers (cues) which lead to seeking alcohol. They also reduce the sensitivity of the brain systems, causing a diminished experience of pleasure or reward, and heighten activation of brain stress systems. Last, they reduce function of brain executive control systems, the part of the brain that typically helps make decisions and regulate one’s actions, emotions and impulses.

These networks are critical for human survival. Unfortunately for the binge drinker, they become “hijacked,” and the bingeing continues even after the harmful effects have begun.

Because binge drinkers’ brains feel intense pleasure from alcohol, there is a powerful motivation to binge drink again and again. What may begin as social binge drinking at parties for recreation can cause progressive neuro-adaptive changes in brain structure and function. The brain is no longer well enough to function normally. It’s getting sick. Continued partying can transition into a chronic and uncontrollable daily pattern of alcohol use. These maladaptive neurological changes can persist long after the alcohol use stops.

Your brain on alcohol

During the Binge-Intoxication Stage, a part of the brain called the basal ganglia rewards the drinker with pleasurable effects, releasing dopamine, the neurotransmitter responsible for the rewarding effects of alcohol and creating the desire for more.

With continued bingeing, the “habit circuity” is repeatedly activated in another part of the basal ganglia called the dorsal striatum. It contributes to the compulsive seeking of more alcohol. This explains the intense desire (craving) which is triggered while a binge drinker is driving by a favorite bar and can’t resist pulling in, even after a promise to go directly home after work.

During the Withdrawal-Negative Affect Stage, there is a break from drinking. Because the reward circuit has a diminished ability to deliver a dopamine reward, there is far less pleasure with natural (safe) experiences – such as food and sex – compared to alcohol.

During abstinence from alcohol, stress neurotransmitters such as corticotropin-releasing factor (FRC) and dynorphin are released. These powerful neurochemicals cause negative emotional states associated with alcohol withdrawal. This drives the drinker back to alcohol in order to gain relief and attempt to reestablish the rewards of intoxication.

Regions of the brain are affected differently by alcohol.
Surgeon General’s Report on Addiction

After a period of abstinence from alcohol, which may last only hours, the drinker enters the Preoccupation-Anticipation Stage. This involves the prefrontal cortex, where executive decisions are made about whether or not to override the strong urges to drink. This part of the brain functions with a “Go system” and “Stop system.”

When the Go circuits stimulate the habit-response system of the dorsal striatum, the drinker becomes impulsive with a craving and seeks a drink, perhaps even subconsciously. The Stop system can inhibit the activity of the Go system and is important especially preventing relapse after being triggered by stressful life events.

Brain imaging studies show that binge drinking can disrupt the function in both the Go and Stop circuits. This interferes with proper decision making and behavioral inhibition. The drinker is both impulsive and compulsive.

An illness that can be treated

There is good news, as scientific evidence shows that this disorder can be treated.

The FDA has approved three medications for treatment that should be offered whenever appropriate. There is well-supported scientific evidence that behavioral therapies can be effective treatment. This includes recovery support services, such as Alcoholic Anonymous.

Most importantly, it is important to know that alcohol use disorder is a brain disorder causing a chronic illness. It is no different from diabetes, asthma or hypertension. When comprehensive continuing care is provided, the recovery results improve, and the binge drinker has the hope of remaining sober as long as lifelong treatment and maintenance of sobriety become a dedicated lifestyle choice.

The Conversation

Jamie Smolen, Associate Professor of Medicine, University of Florida

This article was originally published on The Conversation. Read the original article.

How Family, Neighborhood Affect A Person’s Mental Health #MentalHealth #UniteBlue #LibCrib

How Family, Neighborhood Affect A Person’s Mental Health

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Children’s mental health is strongly affected by their family and neighborhood, according to a new study published in the Journal of Psychiatric Research. Researchers from the Lund University in Sweden, Stanford University School of Medicine in California, and Virginia Commonwealth University followed 542,195 children for 11 years in an effort to learn more about the “potential

associations between individual-, family-, and neighborhood-level factors and psychiatric disorders in children and adolescents.” Children were specifically measured for internalizing psychiatric disorders, which refer to anxiety and mood, and externalizing disorders, which refer to ADHD and other conduct disorders. And as researchers predicated, family and neighborhood did impact mental health.

More than 26,000 children developed a psychiatric disorder; 29 percent of these cases were attributed to the child’s family and 5 percent were attributed to their neighborhood deprivation. Neighborhood deprivation refers to the relation between certain neighborhoods and health-related resources, like fresh fruits and vegetables at a supermarket — and it in particular was associated with a 2-fold risk of externalizing disorders, though not specifically ADHD. Prior research from the Robert Wood Johnson Foundation based in Princeton, N.J., found this type of deprivation can increase incident cases of type 2 diabetes and major depression.

“However, we also found that familial random effects, including both genetic and family environmental factors, accounted for six to eight times as much of the total variation in psychiatric disorders, compared with neighborhood random effects,” Jan Sundquist, lead researcher, said in a press release. “The estimated risks and random effects indicate that children are strongly affected by both their family and neighborhood environments and that the former seems to be more important at a population level.”

Sundquist added the study’s “rich amount of data” results in a comprehensive look at children and adolescent mental heath, answering the many questions people have when it comes to young people. However, more research needs to be done in order to identify means of intervention, as well as the mental health policies needed in order to properly address and manage these risk factors.

As is, researchers concluded, “these findings call for policies to promote mental health that consider potential influences from children’s family and neighborhood environments.”

Source: Sundquist J, et al. Familial and neighborhood effects on psychiatric disorders in childhood and adolescence. Journal of Psychiatric Research, 2015.

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