Profiles of three who are leaving their individualized marks on behavioral healthcare by THE STAFF OF BEHAVIORAL HEALTH MANAGEMENT
| People who work in behavioral healthcare certainly do so because of a special calling to serve those who are in deep distress. But working with people with mental illnesses and substance abuse problems can be difficult, and it isn’t made any easier by limited funding, regulatory paperwork, and constant questions about treatment effectiveness from both outside and inside the field. Many in the field have risen to meet these challenges, to the benefit of millions of people with behavioral health disorders, and some have even excelled to the point of leaving a significant mark on the wider practice of behavioral healthcare. |
In this issue of Behavioral Health Management, we profile the accomplishments of three such “champions” of the field—a patient, a researcher, and a provider. We hope you find their stories interesting and inspiring as you go about your daily task of meeting your call to serve. We hope, too, that you will be inspired to share your own stories of champions in behavioral healthcare. E-mail us at firstname.lastname@example.org.
Relying on Cultural—and Personal—Experiences
“My first exposure to serious mental illness came personally, not through the medical world,” recalls Alex Kopelowicz, MD, who recently was honored by the American Psychiatric Foundation (APF) with an Award for Advancing Minority Mental Health.
A friend suffered with schizophrenia when the two were teenagers. His friend was able to stabilize his illness with the help of medication by his early 20s and is now married, has two kids, and works full time. “When I first went into medicine, my expectations for people with illnesses like schizophrenia were not pessimistic because my first experience was very optimistic,” he says.
It was from this experience that Dr. Kopelowicz became interested in the recovery model of treating mental illness. “The recovery model is really focused more on trying to improve people’s overall functional outcome. It’s not just focused on symptoms,” he explains.
Born in Buenos Aires, Argentina, Dr. Kopelowicz and his family moved to the United States when he was a young child. Growing up, Dr. Kopelowicz spoke English and Spanish, which helped him when he completed his residency in heavily Latino-populated Los Angeles, where he remains today. Dr. Kopelowicz is medical director at the San Fernando Mental Health Center, which treats 1,800 patients, half of whom are Hispanic. When he started at the center, he was the only clinician on the staff who spoke Spanish; of the clinic’s roughly 900 Hispanic patients, half speak only Spanish. “I basically became the doctor for the Spanish-speaking people. That’s where I started using my Spanish for day-to-day work,” he says. Now, four of the seven doctors at the clinic speak Spanish.
At the second annual APF Awards for Advancing Minority Mental Health (supported by Otsuka America Pharmaceutical, Inc.), formerly known as the Minority Mental Health Awards, Dr. Kopelowicz received an award based on his incorporation of cultural differences into his research at the center. “One of the things that struck me was how many of the patients, even the ones with serious illnesses, lived with their families,” he says. “The Hispanic family was particularly interested in maintaining their ill relative and not putting him or her in a facility.”
Dr. Kopelowicz initiated a program to teach family members how to help their relatives with social skills training, as well as to help adhere to medication regimens, report medication side effects, and monitor symptoms. “If we could teach them how to help the ill relative rather than do it for them, then we were much more likely to be successful,” he says.
Patients whose family members received training were less likely to present to a hospital, had fewer symptoms, and were more likely to take their medications, the study found (Kopelowicz A, Zarate R, Gonzalez Smith V, et al. Disease management in Latinos with schizophrenia: A family-assisted, skills training approach. Schizophr Bull 2003;29:211-27). However, while patients in the study got better, the families didn’t feel less burdened. “We were asking the families to sort of serve as case managers,” Dr. Kopelowicz notes. “We were asking them to do work!” A new study currently under way is aimed at enhancing the program by focusing on multiple-family groups incorporating several patients and their families. The groups attempt to identify and fix through problem solving the most difficult issues facing both the patients and the families. “We’re in the middle of it now—it’s going really well,” he says.
Along with his duties at the San Fernando Mental Health Center, Dr. Kopelowicz is an associate professor of psychiatry at UCLA, president-elect of the American Society of Hispanic Psychiatry, and vice-president in charge of programs for the Latino Behavioral Health Institute, whose annual conference will be held September 20-22 in Los Angeles.
And what about the friend who personally brought mental illness to Dr. Kopelowicz’s attention? “I’m in touch with him every week—he’s still my best friend,” he says.
—Michael Peltier, Assistant Editor
| For more information on the Awards for Advancing Minority Mental Health, see www.psychfoundation.org/awardsandfellowships/minority.cfm. |
The Value of “Sticking With It”
By her own admission, Helen Reinherz, MSW, ScD, likes to “stick with things.” She certainly has in her research, in which she has spent more than a quarter century as the principal investigator of the Simmons Longitudinal Study. This endeavor began in 1977, tracking 5-year-olds in one New England community as they progressed through various stages of development. The study examines behavioral, health, and family factors that lead to good or poor mental health. Today about 400 of the original participants, now around age 33, are still being interviewed, and Dr. Reinherz and her fellow researchers have published results on predictors of major depression in early adulthood, predictors of eating disorders in young adult women, childhood risk factors for drug disorders later in life, and more.
“There is enormous value in being able to follow lives over time,” says Dr. Reinherz, who has “stayed with” the Simmons College (Boston) School of Social Work for 40 years. Her research earned her the 2005 Distinguished Achievement Award from the national Society for Social Work and Research. “I chose longitudinal research in the field of mental health with a ‘typical’ community population since I believe that such studies can enrich our understanding of the development of mental health problems, leading to programs of early intervention. In other words, I believe ‘a stitch in time saves nine.’”
For example, she cites the need to study the “long shadows” childhood depression casts into adulthood. She and her colleagues have found that kids who had suicidal thoughts and suicide attempts at age 15 had poorer mental health at ages 18 and 30 than their peers. Dr. Reinherz believes such research reinforces the value of screening for mental health problems at a young age and preventive efforts: “I believe you can offer help early to avoid a lifelong disabling condition.”
Another example of Dr. Reinherz and her team’s research is their examination of women in the study who developed eating disorders as adults. They found that these women had more serious health problems before age 5, and their mothers reported anxiety-depression at age 9. Families of these women had more histories of depression, eating problems, and changes in family financial circumstances before age 15. Their mothers described them at age 15 as having more behavioral problems.
In another examination of the study participants at age 21, the researchers found that siblings’ substance use disorders predicted depression and drug disorders for both men and women in the study. Specific risk factors for drug abuse/dependence were larger family size, lower socioeconomic status, hyperactivity, attention problems, and aggression.
Dr. Reinherz acknowledges the bond she has developed with her research subjects over the years as she has stuck by them. “I feel very tied to them,” she says, remembering the joy she felt when they married and had children of their own, or sadness when participants or parents have died (Dr. Reinherz usually writes personal notes in response to family losses).
Dr. Reinherz and her team have stayed in touch with participants through frequent interviews (every three or four years) and semiannual newsletters reporting findings and age-appropriate advice (e.g., educational opportunities and tips for recreation, home buying [a major goal of many of the study participants], and parenting). They offer prompt responses to participants’ requests for counseling referrals. “Thus far, we have kept in touch with the majority, but it does take constant and hard, although rewarding, work,” reflects Dr. Reinherz.
Dr. Reinherz acknowledges that her research has its strengths and weaknesses: “The strengths of the study include the capacity to trace lives over important periods of development in a primarily working-class/middle-class community. We can also track individual pathways for each respondent so that unusual strengths or difficulties can be uncovered. The weaknesses include the fact that a single community in a New England town cannot encompass the diversity representative of the entire country. But we can generalize to primarily working/middle-class groups.”
Dr. Reinherz encourages professionals in mental health service delivery to stick with their work through these tough times for behavioral healthcare. “I hope people in the field don’t get discouraged because it’s very hard these days. I hope that they keep helping and caring about children and their families.” With the research Dr. Reinherz and her colleagues continue to develop, perhaps mental health practitioners’ efforts will be even more successful.
—Douglas J. Edwards, Managing Editor
| For more information on the Simmons Longitudinal Study, visit www.simmons.edu/ssw/sls. |
From Schizophrenia to System Reform
“My first experience with mental health was as a person who was diagnosed with paranoid schizophrenia at age 19,” explains Joseph Rogers, now president and CEO of the Mental Health Association of Southeastern Pennsylvania (MHASP). “I had a psychotic break and ended up in a hospital and from there really struggled with mental illness.”
Rogers spent those years in and out of psychiatric hospitals, and on his release he found himself directionless and wandering. “This was in the early 1970s, so there really wasn’t the level of community health services that we have today,” Rogers says. “Part of my problem in getting treatment was that I was somewhat in denial, and also somewhat transient in my approach to life, so I never really connected well with community mental health services. At the time, community mental health services were relatively small and underfunded—as they are today—and didn’t have the resources to take a sophisticated look at people with very serious problems. It was hard for me to connect and for services to connect with me.”
All that changed, however, with a chance encounter. “I lucked out and got involved in a community mental health program and got some medications and other treatment that really helped out,” recalls Rogers. “Part of my illness is that I’ll be destabilized by it, and then it might take two or three years for things to settle down. Some things can happen that will destabilize me, but I was on a good cycle, and I was able to get back into school and involved with this community mental health program. Not to say that I didn’t end up struggling a bit—I ended up in the hospital a few years later—but I was able to get some work. I found this concept of self-help and mutual support to be very good for me personally, as well as being something that I could help organize.”
Rogers got active and found his niche in organizing, something he had done in the past with the United Farm Workers and some antiwar groups. “At the time, there was a real push to reform mental health services, to develop community mental health services as opposed to relying on institutional care or just dumping people into the community,” he says. “The federal government had established the Community Support Program through the National Institute of Mental Health, which was essentially grants to states to help them develop their community mental health systems.” Through working on that project, Rogers got involved in efforts to organize several consumer-run self-help and mutual support programs, an approach he has championed over the years. Although it seemed radical to the mental health community at the time, Rogers shared the idea that individuals with mental illnesses are best qualified to run their own organizations, and thus the concept of peer-run “consumer” mental healthcare was born.
In 1984, he ended up in Philadelphia at MHASP and began to build a structure of many different types of community mental health programs. With Rogers onboard, MHASP expanded its scope, and in 1997 he became president and CEO.
Now MHASP is one of the largest mental health associations in the world, with more than 300 staff members, the majority of whom have mental illness. For his work, Rogers was recently honored with the $250,000 Heinz Award for the Human Condition. From a life of despair and homelessness, Rogers has climbed the ladder of success and used his mental illness as a positive tool to help others, changing the mental health services landscape along the way. BHM
—Todd Hutlock, Assistant Editor
|For more information on consumer-run self-help and mutual support programs, visit the National Mental Health Consumers’ Self-Help Clearinghouse Web site at www.mhselfhelp.org.|