Monthly Updates
Porterville and Visalia Wellness Centers have reopened!  My Voice Media Center is holding one-on-one Zoom classes by appointment only. These organizations provide a supportive, stigma-free environment for individuals living with mental illness. They provide peer-led services for those individuals who are well on their way to wellness and recovery.  

Visit our Calendars Page for more information about the activities these organizations are offering for September 2020.
Your shopping can help our cause. Amazon has just about everything under the sun that you can imagine. When you shop with AmazonSmile, Amazon will donate 0.5% of their earnings to NAMI Tulare County.

AmazonSmile is also available in the Amazon Shopping app. Learn how to generate donations for NAMI Tulare County here.
Thank you for your support!
Election Day InformationBe an Active Citizen
SACRAMENTO, CA – With less than 100 days until Election Day, California voters are being encouraged to Vote Safe by voting-by-mail or voting early this fall. All registered California voters should begin to prepare by verifying their voter registration and signing up for ballot tracking now. The Secretary of State’s office is launching Vote Safe California to educate the public on the safety, security, and ease of voting in the November General Election amid the COVID-19 pandemic.

All citizens in California will be able to Vote Safe this fall,” Secretary of State Alex Padilla said. “Elections officials are expanding voting-by-mail and ballot tracking tools statewide, while also offering safe in-person early voting and Election Day options.”

“My message to voters is simple—don’t wait, prepare now. With less than 100 days until the General Election, you can take simple steps now to be ready to vote. It only takes a few minutes to confirm your voter registration information, make any necessary updates, and sign-up for ballot tracking. Taking these steps now will make the election smoother both for voters and elections officials,” Padilla added.

Californians can:

California is well positioned to expand vote-by-mail. More than 75 percent of California voters received a vote-by-mail ballot for the March 3, 2020 Presidential Primary.

No stamps, no problem. In California, every vote-by-mail ballot comes with a prepaid postage return envelope.

Verify Voter Status and Update Voter Registration

Californians should begin to prepare for the General Election by confirming that their voter registration record is up to date. It is especially crucial that elections officials have a current registration, mailing address, and e-mail address on file. Voters can verify their registration at 
and make any updates at

Expansion of Ballot Tracking Tool

The Secretary of State’s “Where’s My Ballot?” tracking tool is expanding statewide. Voters can sign up at for automatic updates on the status of their vote-by-mail ballot by text (SMS), email, or voice call.

Key Dates and Deadlines for the November 3, 2020, General Election:


State Assemblyman for District 26 (Tulare County):
Devon J. Mathis 
Phone: 559-636-3440  
Address: 100 West Willow Plaza, Ste. 405, Visalia, CA 93291
State Senator:
Shannon Grove
Phone: 661-323-0443
Address: 5701 Truxton Ave.,
Bakersfield, CA 93309
Fast-Fail Trial Shows New Approach to Identifying Brain Targets for Clinical Treatments
NIH-funded study identifies receptor as possible target for treating anhedonia

March 30, 2020 • Press Release

A first-of-its-kind trial has demonstrated that a receptor involved in the brain’s reward system may be a viable target for treating anhedonia (or lack of pleasure), a key symptom of several mood and anxiety disorders. This innovative fast-fail trial was funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health, and the results of the trial are published in Nature Medicine.

Mood and anxiety disorders are some of the most commonly diagnosed mental disorders, affecting millions of people each year. Despite this, available medications are not always effective in treating these disorders. The need for new treatments is clear, but developing psychiatric medications is often a resource-intensive process with a low success rate. To address this, NIMH established the Fast-Fail Trials program with the goal of enhancing the early phases of drug development.

“The fast-fail approach aims to help researchers determine—quickly and efficiently—whether targeting a specific neurobiological mechanism has the hypothesized effect and is a potential candidate for further clinical trials,” explained Joshua A. Gordon, M.D., Ph.D., director of NIMH. “Positive results suggest that targeting a neurobiological mechanism affects brain function as expected, while negative results allow researchers to eliminate that target from further consideration. We hope this approach will pave the way towards the development of new and better treatments for individuals with mental illnesses.”

In this study, researcher Andrew D. Krystal, M.D., who began the research while at the Duke University School of Medicine, Durham, North Carolina, and is now at the University of California, San Francisco, and colleagues report the first comprehensive application of this fast-fail approach. The researchers examined the kappa opioid receptor (KOR) as a possible neurobiological target for the treatment of anhedonia. Previous findings suggest that drugs that block the KOR, known as KOR antagonists, can affect reward-related brain circuits in ways that could improve reward processing and reverse anhedonia and associated symptoms.

The researchers conducted an eight-week double-blind, randomized placebo-controlled trial with 86 participants across six clinical sites in the United States. Participants were eligible if they were 21 to 65 years old, met the criteria for clinically significant anhedonia and the diagnostic criteria for a mood or anxiety disorder, and did not have other medical or psychiatric conditions. Participants were randomly assigned to receive either a 10 mg dose of the KOR antagonist JNJ-67953964 (previously CERC-501 and LY2456302) or an identical-looking placebo tablet. They received one dose daily over the eight-week trial.

To measure the effects of the KOR antagonist, the researchers examined
the activation of the ventral striatum, a structure located in the middle of the brain that is involved in decision making, motivation, reinforcement, and reward. Participants completed a reward anticipation task while their brain activity was measured in a functional MRI scanner. During the task, participants saw a cue that signaled whether the upcoming trial might lead to monetary gain, monetary loss, or neither. In some trials, participants had an incentive to press a specific button, as they could gain money or avoid losing money by doing so. They completed the task once at the beginning and again at the end of the trial.

Relative to those who received the placebo, participants who received the KOR antagonist showed increased activation in the ventral striatum when anticipating monetary gain (versus no-incentive trials). Additional analyses indicated that participants who received the KOR antagonist also showed greater activation of the ventral striatum during anticipation of loss.

Exploratory analyses indicated that lower ventral striatum activation in anticipation of monetary gain at baseline was associated with greater change in activation over the course of the trial, and this correlation was strongest for those who received the KOR antagonist. According to the researchers, this finding suggests that baseline ventral striatal activation may have promise as a neurobiological marker that identifies participants who are most likely to respond to the KOR antagonist. Further analyses suggest that the KOR antagonist also had observable effects on secondary behavioral and self-report measures, including decreased anhedonia scores.

“Together, these findings demonstrate that the KOR antagonist had the hypothesized effect on brain circuits involved in reward and pleasure, establishing proof of mechanism,” explained Dr. Krystal. “The results provide support for the usefulness and feasibility of fast-fail trials and—more specifically—for KOR antagonism as a potential target for drug development.”

Further testing in larger trials will allow researchers to examine whether using KOR antagonism to engage the ventral striatum yields observable therapeutic effects on anhedonia and related clinical outcomes.

“This study was the first successful implementation of the fast-fail approach and it serves as a proof of principle of the viability of this methodology,” says Mi Hillefors, M.D., Ph.D., acting deputy director of NIMH’s Division of Translational Research. “We hope that the knowledge gained from the study will lead to more informative treatment trials in the future, contribute to the field of psychopharmacology, and reduce the risks typically associated with developing new psychiatric medications.”


Krystal, A. D., Pizzagalli, D. A., Smoski, M., Mathew, S. J., Nurnberger, J., Lisanby, S. H., Iosifescu, D., Murrough, J. W., Yang, H., Weinger, R. D., Calabrese, J. R., Sanacora, G., Hermes, G., Keefe, R. S. E., Song, A., Goodman, W., Szabo, S. T., Whitton, A. E., Gao, K., & Potter, W. Z. (2020). A randomized proof-of-mechanism trial applying the ‘fast-fail’ approach to evaluating kappa-opioid antagonism as a treatment for anhedonia. Nature Medicine. doi:10.1038/s41591-020-0806-7
RESEARCH WEEKLY: People with Serious Mental Illness May Not Receive Adequate Care in California Under Current Laws 

By Kelli South
According to a report released last week by the California State Auditor’s office, California should increase its hospital bed capacity and access to assisted outpatient treatment (AOT) for those suffering from severe mental illness, while also overhauling its data collection practices. 
The audit reviewed practices from the Lanterman-Petris Short Act (LPS) for three counties: Los Angeles County, San Francisco County and Shasta County. The LPS Act, originally passed in California in 1967, “permits involuntary mental health treatment when, because of mental illness, individuals pose a risk of harm to themselves or others or cannot provide for their basic needs.” 
Individuals Lack Appropriate Care 
One major finding of the audit is that the state and local governments in California do not currently have enough psychiatric hospital bed
capacity to treat all those who are in need. State hospitals are required to treat individuals involved in the criminal justice system, which leaves less beds available for other individuals in need of treatment. At the time of the audit, California’s number of state hospital beds was just under 6,300 and only 11% of these beds were occupied by individuals receiving treatment under the LPS Act, while 84% of the beds were occupied by criminal justice-involved individuals. 
Additionally, wait times for the existing beds has increased by nearly 500% since 2014, the audit shows. In 2014, there was an
average of 31 individuals waiting for a bed in a state hospital, but by 2019, there was an average of 197. State Hospital officials estimated that they would need an additional 330 beds in order to adequately meet the treatment needs of all individuals at any given time. 
County Ability to Provide Assisted Outpatient Treatment is Limited 
The audit reinforced the importance of assisted outpatient treatment (AOT) as a treatment option for people with severe mental illness in the community. The auditors found that many counties in the state were restricted from forming AOT programs due to the current state law. 
A number of individuals in the three counties studied were found to have been placed under multiple short-term holds or conservatorships. Between 2014-2019, over 500 individuals in Los Angeles were placed on 72-hour holds each of whom had already been placed on at least 50 prior holds in their lifetime. The costs associated with just one 72-hour hold were estimated to be between $2,800 and $8,400, according to the report.  
In total, between 2014-2019, Los Angeles placed 166,447 people on short-term holds under the LPS Act. Using the midpoint estimated cost associated with a 72-hour hold, the cost of this was over $932 million. 

The report finds that AOT would be an efficient, cost-effective alternative to the repeated short-term holds and conservatorships that are currently happening. However, only 19 of 58 counties currently have an AOT program in place, and, even in
counties that currently have AOT programs, many individuals who could benefit from AOT were not enrolled.
From 2015 to 2018, “Los Angeles had nearly 7,400 individuals with five or more short‑term holds… and only nine percent of those individuals were enrolled in full‑service partnerships or assisted outpatient treatment,” and in San Francisco, only about one in 20 individuals were enrolled in these programs. 
The audit recommends that AOT become a transitional program for individuals between a conservatorship and less intensive community treatment. This would reduce the number of individuals who, while stable at the end of their conservatorship, experience a regression in their illness due to lack of treatment, often leading the individual to be placed on more short-term holds. 
State Needs Data Management Overhaul 
The last major finding of the audit focuses on the need for improved data management across California in order to better understand where money for mental health services is being spent and how effective it has been. 
The auditors recommend “a statewide framework for determining spending and outcome information across all funding sources” and say that until this system is in place, California “will remain unable to fully and efficiently understand the effects of its investments in mental health services and, if necessary, make changes to better serve those who need critical services.” 
Last year, counties received $3 billion in funding for mental health but are unable to measure how successful their goals were after the funding was used. As stated in a previous Research Weekly regarding the importance of good data, implementing a new state-wide data collection and reporting framework will hold counties accountable for funding received while increasing cost-effectiveness and program effectiveness. 
Broader Implications
Building on the research presented in the report, the audit also provides a number of policy recommendations to fix the issues discovered. A few of the major policy recommendations for the California State Legislature include: 
  • Requiring all counties to implement assisted outpatient treatment and changing certain regulations associated with AOT programs, like allowing courts to require medications as part of treatment and changing eligibility requirements to allow individuals leaving conservatorships to be enrolled. 
  • Developing a framework for mental health services reporting procedures, which would include data from all funding sources and outcomes data for county and state mental health programs. 
  • Allowing counties to spend Mental Health Services Act funds to connect individuals to “community-based services” like AOT after they leave an involuntary hold or conservatorship. 
If these recommendations are followed, California could see major improvements to its mental health care system. Furthermore, other states could use this report to examine their own mental health practices and highlight areas for improvement. 
Kelli South is the research assistant at the Treatment Advocacy Center.

Reopen schools and let parents decide how to educate their children in the COVID pandemic.

"Children can be harmed by lack of education, nutrition, and mental health care. We cannot ignore the casualties of all other conditions to contain COVID."

Dr. Elinore McCance-Katz,
Opinion Contributor

Each of us today experience an unprecedented time in our nation’s history — a time that demands reflection, introspection and great caution about our next steps as a people. And, while today is just a moment in time, our actions will have consequences for future generations. In no place is that more true than in decisions around whether or not to reopen our schools. 

I am a psychiatrist and I know the grave consequences of not sending our children to school. I know that pre-pandemic, about 10% of our nation's 74 million children lived with serious emotional disturbances and more than half of these children get their mental health services in school; this proportion only increases for minority children with mental health needs. I know that, unlike what we have seen so far in the vast majority of children who have contracted COVID-19, the impact of untreated mental illness can be lifelong.

I think about these children and their families every day and wonder what has happened to their treatment, how they are progressing, how they will survive with such a gap in care and services. I also think about the children who do not have these severe conditions, but who rely on social interaction with their peers, who need the aid of a teacher to learn — what will their future be? As a physician, I agree with the American Academy of Pediatrics. I have not even a small doubt that children should be in school. But I’m not writing this from that perspective only. 

A Parents' Job is to Weigh Risks, Benefits 

Rather, I write as a mom and because of what I know medically. As a mother, if I had a school-aged child, I would be demanding answers. I hope every American parent reading this knows you can and should be demanding answers from your local officials. Parenting is about weighing risks and benefits as we make decisions for our children. Every decision — from the type of car seat you brought your newborn baby home in to whether or not your teenage son was allowed to go to that unsupervised party — is about you as a parent weighing those risks and benefits and deciding what is best for your child. 

This one, arguably one of the most important ones, not just where your child will be educated but whether they will be, has been taken from you. Yet it has not been taken from all. My three children, now adults, attended public schools which provided them a great foundation for their future. But, today, I can tell you with certainty that if my children were in a public school system which elected not to open, as a doctor, as a psychiatrist, as an infectious disease epidemiologist and as a mother, I would want them in school despite the risk of COVID-19.

As so many parents are doing today, I would remove them from the public school system and pay for them to be educated elsewhere. I would have that choice to weigh the risk of my children getting COVID-19 against my children not getting the education so critical for their growth and development, and I would choose to educate them. 
Whose making the decisions about schools: School reopening debate shows power of local school boards

The current reality is that for millions of Americans this choice does not exist. State and local officials have taken away your ability to parent your children. Why, as a mother, shouldn’t you be able to do the risk analysis you do with everything else simply because your income may be a certain level? When a school is closed, the message is that your child’s education is less important than the risk of COVID-19, mental health services are less important than the risk of COVID-19. It tells you that the risk of your child getting poor nutrition is less important than the risk of COVID-19. It tells you that your child’s special needs provided for in school are less important than the risk of COVID-19. It tells you that your ability to go to work and feed your family is less important than the risk of COVID-19.

These officials decide all of that. I ask — who are they to make that decision for you? 

And again, we must remember the “you” here are only those that may not be able to afford to make a different decision if they wish to. Private schools in my county were ordered closed, but after 10,000 signatures of paying parents and only 48 hours, that decision was overturned. Minority children are disproportionately underrepresented in American private schools. As we struggle with race relations in our country, why is it that local politicians who claim so vigorously to support movements like Black Lives Matter, make decisions that will have a disproportionate impact on the ability of young Black and brown students to get the education they deserve?

Open Schools to Protect US Future 

When schools are closed, we simply accept that there will be millions of children who do not get educated, but more importantly we also accept that there will be certain children who continue their education without interruption. A 2018 study found that 17 million students lacked internet at home and a third of them were children of color. The divide and disparity that exists today may have begun years before us, but its perpetuation and expansion will be a direct result of the actions knowingly taken today. I can only imagine the protests 20 years from now. 

In no way do I believe that COVID-19 is a small matter. Thankfully, its effect on children to date has been very low. The Trump administration and I simply believe that all children have a right to an education, which means the right to attend public schools and all parents have the right to weigh the very real risk of harm from being out of school against the risk of potential harm from COVID-19.

The Trump administration whole-heartedly understands and appreciates the difficult choice ahead of us. All parents may not elect to make the decision I would make, but all parents should be afforded the opportunity to decide. Schools should not open without safety plans and precautions; we have tools and safety measures that can and should be put in place to protect your child from contracting the virus in school.

However, care should also be exercised to protect your child from harm due to lack of education, lack of nutrition, lack of mental health care. We cannot simply continue to ignore the casualties of all other conditions in favor of containing the virus. Our nation’s future depends on the action we take today. Parents, demand that we take the right actions and demand that your voice as the people truly responsible for the health, safety and future of your own children not be silenced. 
Dr. Elinore McCance-Katz is Assistant Health and Human Services Secretary for Mental Health and Substance Abuse. Follow her on twitter: @DrMcCance_Katz
Ralph Nelson, President
Sandra Juarez, Vice President
Mary Mederos, Treasurer
Kathy Farrell, Secretary
Donna Grigsby
Karen Mabry
Bruce Nicotero
Elizabeth Vander Meer
Ivy Jones
Ray Lara