July News & Updates

July 15, 2017
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JulyIsNationalMinorityMentalHealthMonth July is National Minority Mental Health Awareness Month
Behavioral health conditions don't discriminate based on race, ethnicity, sexual orientation, religion, language, or gender. Unfortunately, minority populations are less likely to receive the quality care they need. This is just one of many reasons that, in 2008, the U.S. House of Representatives designated July as Bebe Moore Campbell National Minority Mental Health Month.
 
Mental Health America believes that all people should be able to speak freely about their mental health. That's why this July, Mental Health America will be raising awareness of the unique challenges faced by minority populations using the hashtag #NotACharacterFlaw. In doing so, MHA hopes to explore the cultural and institutional factors that impact how people seek care - and what we can do to mental health more accessible to everyone.
 
Share your story and learn from the experiences of others on Twitter, Facebook, or Instagram using #NotACharacterFlaw. 

What other ways will you work to address mental health disparities in your community - this month and year round? 

Melissa's Story
Melissa
Melissa Leistikow used to have to work three jobs to pay for her medications. She didn't have health insurance, so she had to pay out of pocket.

A recovering opioid addict, she paid about $100 a week for her methadone medication, which reduced her cravings and withdrawal symptoms caused by opiate use.

Today, Melissa is still recovering from her opioid addition but now has health insurance through AHCCCS. She has had the insurance for about two years. It covers all her medications and treatment for her opioid addiction, which she said is a big relief.

"I used to be very stressed out about finding money to pay for my medications," she said. "Now it gives me a piece of mind to know I don't have to worry about that anymore."

She said having health insurance through AHCCCS also means she no longer has to work up to three jobs and now has more time to spend with her family. She owns a small cleaning company in Tucson.

It also means she doesn't have to worry about going to the hospital and not having the money to pay for the visit. She said she has a $70,000 bill from an emergency room visit she did prior to having health insurance that she's still paying off.

Melissa said her opioid addiction stems from medication she was given to treat carpal tunnel several years ago. A doctor prescribed her medication but never warned her about the risks of opioid addition.

"If I were to lose this health insurance, the impact that would have on my life would be horrible," she said. "I wouldn't be able to cover my medications. I would have to go back to working two or three jobs, and I wouldn't have time to spend with my family."

Thank you to Melissa and to Protect Arizona's Healthcare for sharing this story. For more information about the impact of Affordable Care Act / Obamacare Repeal, visit www.protectazhealthcare.com. 

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SSISSDISurveySSI/SSDI Community Survey

MHA of Arizona is looking to develop a training for individuals in need of assistance in appealing their SSI and/or SSDI denials. But we need your help.  We would greatly appreciate your time in completing a brief survey. You may fill out the survey on behalf of yourself or your family member.
 

Please Note: We want to assure you that your responses are completely anonymous. Responses to anonymous surveys cannot be traced back to the respondent. No personally identifiable information is captured unless you voluntarily offer personal or contact information in any of the comment fields. Additionally, your responses are combined with those of many others and summarized in a report to further protect your anonymity and confidentiality.  

Thank you for your participation!
 

 
A new law in Texas will require all jails to assess the mental status of inmates. Individuals who exhibit symptoms or have a history of mental illness must be rehoused in a specialized facility.
 
The 2015 death of Sandra Bland sparked national outrage. Bland, who was pulled over in a routine traffic stop, died in jail by suicide. She had a history of depression. The police officer who arrested her was later fired for failure to follow protocol.
 
Bland's tragic death is representative of a widespread problem: nearly half of unarmed civilians killed by police have a behavioral health condition. This law is a step in the right direction, and we hope to see this type of compassionate mental health policy in other states.
APSStepping Up Update:

Dawn Noggle, PhD, CCHP
Mental Health Director
Maricopa County Correctional Health Services

Arizona achieved a landmark in May becoming the first state in which every county signed a Stepping Up Proclamation with La Paz signing in May! Tireless advocacy to reduce the incarceration of the seriously mentally ill by volunteer led David's Hope made this possible. Natassia Walsh, the Stepping Up National Coordinator, and featured guest speaker for the August Statewide Stepping Up Summit, is calling Maricopa County next week to hear more about our efforts which are attracting national attention. Join leaders across the state to hear more and contribute by attending the  Summit . Across Arizona, Counties, in tandem with the Regional Behavioral Health Authorities (Health Choice, Integrated Care, Mercy Maricopa Integrated Care and Cenpatico Integrated Care) continue to bolster training and resources for officers to avoid unnecessary jail bookings, to increase diversion opportunities once mentally ill individuals are brought to jail and to strengthen connections to care upon release to interrupt this revolving door that so negatively impacts the lives of individuals who need treatment and social supports rather than incarceration.

Stepping Up acknowledges that we must address individuals with substance use disorders (SUD). As with the seriously mentally ill, these are predominately low risk individuals who wind up in jail accused of nonviolent offenses, rather than directed to "solutions", effective treatment and support for problematic substance use. Less guidance has been offered in the Stepping Up Toolkit  https://stepuptogether.org/toolkit specific to addressing this population.  

At Maricopa County, as part of Stepping Up, Correctional Health Services decided to actively address substance use in the jail population. We implemented the SAMHSA best practice SBIRT (Screening, Brief Intervention and Referral to Treatment) in March 2016. This has been an ongoing effort over the past 15 months involving changes to our electronic health record (to incorporate evidence based screening questions) and training of all mental health and nursing staff to screen all individuals (remaining past the 24 hour Initial Appearance Court). We have also, with the help of Public Health, are training mental health staff and medical/psychiatric providers in "brief interventions", and are increasing referrals to substance misuse treatment while incarcerated (CHS Intensive SUD program, Mosaic (see video link) and referrals to community agencies upon release, including "warm hand offs" to increase service engagement. A shift to Motivational Interviewing is foundational to SBIRT and all strategies addressing substance use/misuse. Providing educational materials and encouraging abstinence alone, we know, are failed interventions. As our electronic health record reports are completed, CHS will be able to routinely report and trend substance use and misuse, brief interventions and treatment referrals and ultimately the impact on overall jail recidivism. Fundamental to all Stepping Up efforts is the 2 pronged approach to develop baseline data (e.g. number of SMI designated; number of individuals at risk for and having SUD) and to measure impact of interventions on decreasing the use of jail for a low risk population better served in the community. Maricopa County was awarded a National Association of County Organizations (NACO) Achievement Award in June 2017 for this implementation.

Stepping Beyond: Meeting the Opioid Crisis Head On

Across the nation we know from CDC data that in 2016 there were at least 60,000 deaths related to opioid use. The CDC has called this the worst drug overdose epidemic in our history. In Arizona 790 died from opioid overdoses, an increase of 74% over the past 4 years. In recognition of Arizona's becoming one of the most impacted states, on June 5, 2017 Governor Doug Ducey declared a Public Health State of Emergency.
  
The Governor's Initative calls for the following steps:

* prevent prescription opioid drug abuse through appropriate prescribing practices,
* develop guidelines to educate healthcare providers on responsible prescribing practices,
* expand access to treatment, especially Medication Assisted Treatment (MAT), and
* reverse overdoses through the distribution of naloxone.

The governor is also requesting up to date reporting by Counties and agencies across the state for more "real time" information regarding overdoses, deaths related to overdose and attempts to reverse overdose (e.g. via naloxone and narcan). In response, Maricopa County Public Health is coordinating our County's reporting to the Governor's Office suspected opioid overdoses and administration of naloxone.

Recommendations for a "full spectrum" public health response to the opioid crisis are being established (such as the Drug Policy Alliance June 2017 document http://www.azdhs.gov/prevention/womens-childrens-health/injury-prevention/opioid-prevention/index.php). Echoing Stepping Up, there is a call to increase access to community based effective treatment, especially for individuals with greatest social determinant risk; to increase education to reduce stigma and to raise prescribe awareness; to increase harm reduction strategies focusing on safety and keeping people alive (over the outdated concerns that anything other than promoting abstinence is "risky"); and to decrease "criminalization" when community based treatment is the most appropriate response. Notably these recommendations are strongly urging harm reduction strategies such as increased availability for overdose reversal medications, including for law enforcement (e.g. naloxone) and family members along with those at risk. We must also increase the safety for IV drug users including safe injection sites and needle exchanges. 

Correctional Health Services has certainly been seeing the rising tide of opioid use. We have been actively tracking individuals reporting opioid use/dependence booking into our jails for the past 18 months. Our records show well over 900 individuals per month reporting ongoing opioid use (with our average daily census floating around 8,000). We have implemented a "full spectrum" approach involving continuation of Medical Assisted Treatment (MAT) for individuals on methadone treatment in the community which includes coordination of care and warm transfers upon release. Despite lingering negative responses by some quarters, methadone, as an agonist treatment, has been established through research to prevent relapse back to illicit substances and to decrease further criminal justice involvement. Despite this, only 12% of opioid dependent individuals are engaged in such treatment. CHS also provides in custody intensive substance use disorder treatment (Mosaic Program-see video). 
  
Stepping Beyond:

Most recently, CHS has begun a multi-agency Vivitrol Pilot (including Darwyn Chern, MD, Chief Medical Director of Partners in Recovery and AZ Society of Addiction Medicine Board Vice President, Saul Perea, MD, Terros, Charles Booker, MD, CleanSlate, and representatives from Community Bridges, Cross Roads, Maricopa County Adult Probation, the Maricopa County Sheriff's Office (MCSO), and Community Medical Services. Candidates who have completed intensive treatment and who agree to continue treatment with one of the above community partner agencies will receive a Vivitrol injection prior to release. Vivitrol, an antagonist treatment, is known to reduce cravings and can be administered monthly. Arizona Department of Corrections has also begun administration of Vivitrol for consenting individuals with Opioid Use Disorder, prior to prison release. This treatment provides a safe bridge to the most important next step, ongoing psychosocial and pharmacological treatment. Yavapai County Jail has already successfully implemented such use of Vivitrol and Mohave County is in planning stages. 
  
Beginning July 1, CHS is taking another critical step in the battle to reduce overdose deaths. Leaving jail and prison is a known high risk time for overdose. Individuals who have been abstinent for a period of time can easily overdose. Returning to a dose previously tolerated can be fatal. Perhaps the "supply chain" poses the greater risk as it contains opioids and synthetic derivatives, such as fentanyl, 50 to 1,000 times stronger than typical heroin, easily available through the "dark web". CHS will begin distribution of naloxone "kits" for opioid dependent individuals, not on MAT, releasing from custody. We are budgeting to provide 400 kits a month, which indicates how serious this problem is in our community. Our initial July supply is being provided by Sonoran Prevention, the agency that has been out there providing education and reversal kits to law enforcement across the Valley. Haley Coles, Sonoran Prevention Director, reports that between September 2016 and end of May 2017, her staff have distributed 9,131 naloxone kits and received reports of them being used to reverse an overdose 822 times. 538 kits have been provided to law enforcement between January 2017 and end of May 2017. In addition, Sonoran Prevention, in tandem with Maryvale Police Department, began a needle exchange program providing clean syringes, a program known to reduce risk of infectious disease. Such harm reduction efforts are essential to reversing the disturbing trends we are witnessing in Arizona and across the country. Sonoran Prevention is essentially a behavioral "start up" agency designed to address this crushing and previously unmet community need. With a bare bones staff and without a "bricks and mortar" office, Arizona may yet see a slowing if not reversal of overdose deaths in 2017 with their efforts and law enforcement's decision to serve as first responders. Time will tell as data is collected. 

Stay tuned for more on other steps we will all be taking to address the opioid epidemic. New efforts will be seeded by the federal Health and Human services STR (State Targeted Response to the Opioid Crisis) grants, one of two rounds of funding to be provided to states under the SAMHSA administered 21st Century Cures Act. According to Shana Malone, AHCCCS's leader and architect for this campaign: 

"AHCCCS and partnering state agencies, health plans, universities and community providers will soon be launching statewide prevention and treatment activities through the Opioid STR grant to address the continuum of opioid misuse, abuse and dependency."

More to come in the next Stepping Up update!
 
The Arizona Psychiatric Society thanks Dr. Noggle for her comprehensive updates that keep our community informed about the progress made by Maricopa County, counties across Arizona, and community organizations, including David's Hope, NAMI Arizona, Mental Health America Arizona, and many others, to advance Stepping Up initiatives to reduce people with mental illness in our jails.  We greatly value and hope you enjoy Dr. Noggle's updates and the additional linked resources provided for your benefit.  We look forward to continued updates on progress made in Arizona and hope you will be a part of this important initiative.

EricGilbertsonAdvocacyApply Today for the 2017 Eric Gilbertson Advocacy Institute for Behavioral Health!

Are you interested in learning more about our state's public behavioral health system? The Eric Gilbertson Advocacy Institute for Behavioral Health is a great place to start.

This Institute, hosted by Arizona Behavioral Health Corporation, provides an overview of the behavioral health services available in Arizona. Participants will learn about individual, provider, and state-level issues, meet leaders in the field, and prepare to advocate for great care.
 
The 6-session program will take place on six Saturdays from September through December:
  • September 9th and 23rd
  • October 7th and 21st
  • November 4th December 2nd
Interested parties should submit the attached application, two letters of reference, and a $10 application fee to Arizona Behavioral Health Corporation no later than Friday, August 25th . If you are accepted, you will be notified by Friday, September 1st



UpcomingEvents
Stepping Up the Right Way Webinar: Best practices in the treatment of persons with Serious Mental Illness who have contact with the criminal justice system
July 19th
2 pm - 3:30 pm

Eric Gilbertson Advocacy Institute for Behavioral Health Training 
Six Saturdays beginning September 9th and ending December 2nd  (dates above)
9:30 am - 4 pm
Recovery Empowerment Network (REN), 212 E. Osborn Rd., Phoenix, AZ 85012

MIKID Fundraiser and
Beautifully Bipolar Event
September 16th
1pm - 4 pm
Flagstaff Medical Center, 1200 N. Humphreys, Flagstaff, AZ 86001

CommunityCalendar
Check out more events in the Phoenix Area!

Arizona Trauma Institute  
ASU Center for Applied Behavioral Health Policy  
Health Choice Interated Care Community  
Mercy Maricopa Integrated Care
 
NAMI Arizona  Calendar


In November 2017, AHCCCS will issue a Request for Proposal (RFP) to integrate physical and behavioral healthcare services and streamline services for members. Beginning October 2018, members will choose one healthcare  plan for  medical care (physical) as well as any needed behavioral health services (with exceptions for SMI and CMPD populations and crisis services). Before the RFP opens, we would like to hear from current AHCCCS members so we can best address questions during the process.
If you are a provider or advocacy group, please share this webpage with AHCCCS members and encourage them to take our member survey.
AHCCCSSurvey
SupportGroups
Please see the attachment for the current information for FREE mental health Peer Support Groups.  The groups are located throughout Maricopa County and in Yarnell.  They are open to people 18+ diagnosed with a mental illness.



The free support groups are sponsored by the 
Mental Health Guild.

MHA OF AZ 2017 BOARD OF DIRECTORS
MHABoard
Michael Shafer, Ph.D. Chair  
Joshua Mozell, J.D., Vice Chair  
Jason Bernstein, C.P.A., Treasurer
Karen Pitico, M.P.H., Secretary

Kathy Bashor, M.C.
Sheri George
Charles Goldstein, M.D
Laurie Goldstein
Emily Jenkins, J.D. 
Marcus Johnson, M.P.H.
Charles Montgomery
Mohamed Ramadan, M.D. 
Clarke Romans, Ph.D.
Charlene Smith
Myra Richman
Mental Health America of Arizona 
Email: mhaofarizona@gmail.com
Website: www.mhaarizona. org
Contact
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