APRIL 2019

From the desk of Jackie Lane, Executive Director NAMI CC&I
May is Mental Health Awareness Month! While, we at NAMI CC&I, spend a great deal of time, all twelve months of the year, attempting to make people aware of mental health and its profound effect on our lives and the social fabric of our community, we felt that it was appropriate to plan some special activities for the Month of May.

In addition to media messaging and public displays, we are pleased to be collaborating with the Massachusetts Department of Mental Health in the presentation of a four-hour seminar on the brain and its development. This educational program will be held at the Cape Codder in Hyannis on May 21 from 8:30 – 12:30. All are invited to attend. (Please see information and link below.) I will also be on Martha’s Vineyard tomorrow, the first day of May, to do a NAMI CC&I presentation at the Chilmark Library at 5 PM. I hope to see many of our Vineyard members.

Education is at the core of the mission of NAMI CC&I and we have developed a strong agenda of community programming reaching out to those who are “boots on the ground” when it comes to mental health incidents in our communities. Our CCIT police training program, not only teaches police officers de-escalation techniques and advises them of services available, but also teaches the basics about mental illness as an illness like any other illness requiring medical treatment. Our Think:Kids program educates our public school teachers about mental health issues in children and teens and gives them additional tools for coping in their classrooms. We are in the process of holding Mental Health First Aid instructor trainings resulting in having 30 Mental Health First Aid instructors on the Cape and Islands to educate groups on mental health basics.

Mental and behavioral health issues are very prevalent in our modern society and we at NAMI CC&I are working diligently 12 months of the year to raise the awareness of the general public. In this newsletter, you will see current statistics demonstrating the need to make mental health awareness a priority in our communities. Let’s work together to erase the stigma concerning mental health!
K ey mental health statistics include:
·        1 in 5 adults in the U.S. lives with a mental health condition.
·        1 in 25 (10 million) adults in the U.S. lives with a serious mental illness.
·        43.8 million adults in the U.S. face the day-to-day reality of living with a mental illness.
·        Half of all lifetime mental health conditions begin by age 14 and 75% by age 24, but early intervention programs can help.
·        Additional facts and citations are available at Mental Health by the Numbers.
NAMI CCI Annual Meeting
and Election of 2019-20 Board of Directors
The NAMI Cape Cod & the Islands annual Meeting was held on Thursday, April 25th at 4 PM at the Cape Codder Resort.
Craig Rockwood, President of the Board of Directors chaired the Annual Meeting for members of NAMI CCI. Executive Director Jackie Lane shared the highlights of 2018. They fielded questions from members and then held the annual election.    

New Board Members Elected:

David McGraw
David McGraw, well-known philanthropist and resident of Osterville, has been President of Classic Coachworks, Cape Cod's premier auto restoration shop for almost 40 years, and has served as a steward of the auto collection at Heritage Museums and Gardens for three decades.

He has served as Chairman of the Board at Cape Cod Academy and has served on the Boards of Cape Cod Symphony and Heritage Museums and Gardens.

David and his wife Melissa received the Outstanding Philanthropist Award in 2013. They have continued their family's commitment to supporting Cape Cod's cultural, educational and health service nonprofits through their volunteer efforts, financial support and advocacy. Over the years, their support has benefited thousands of Cape Cod residents.
Kevin Lynch
After serving in the United States Navy, Kevin Lynch redirected his commitment to caring for, and fighting for, people in their times of need by entering the world of healthcare. He invested over 16 years in the private sector, working as a member of senior management teams at three different hospital systems (Miami Heart Institute, University Hospital, and JFK Medical Center) before spending five years at HCA's East Florida Division Office.

Kevin's effervescent energy to ignite change sparked him to found The Quell Foundation on a mission to change the care and treatment of people who suffer from mental illness. In June 2016, Kevin was invited to speak at The White House during the "Making Health Care Better" series on mental health. His participation as a member of Panel II: Deepening the Conversation on Mental Health catapulted The Quell Foundation into the national spotlight. 
Karen Gardner
Karen Gardner has served as CEO of Community Health Center of Cape Cod since 2003. Ms. Gardner has responsibility for all CHC operations and strategic initiatives. Under her guidance, the Health Center built a 33,000 square foot facility in Mashpee, implemented the electronic medical record system, expanded the continuum of care to include oral health, women's health, pharmacy, vision services and a full range of support/enabling services.

Ms. Gardner serves as Treasurer on the Board of Directors of the Massachusetts League of Community Health Centers and serves on a number of community-based steering committees. In addition, she is a Colonel in the U.S. Air Force Reserves and recently moved from her assignment at the Pentagon to become Commander at the Westover Air Force Base in Chicopee, MA.
Manny Marrero
Manny is a board certified and licensed occupational therapist at Cape Cod Healthcare where he provides evaluations, interventions, clinical education, crisis intervention, trauma informed care and client-centered discharge planning. He is a Clinical Instructor and mentor providing supervision, guidance and education to Occupational Therapist interns, nursing students and medical students. He is bilingual, fluent in Spanish and English.

Manny served as a Supervisor and Section Manager in the U.S. Marine Corps where he trained subordinates in their occupational specialties and leadership traits.

Manny was chosen as one of the "40 Under 40" by the Cape and Plymouth Business Magazine which spotlights the region's top young business leaders who excel in their industry and show dynamic leadership.

Board Members re-elected:
    Donna Aucoin, Beverly Arnett, Cecilia Brennan, Robert Kinlin, Bruce Williams     

    Our thanks to the Nominating Committee:Tim Telman, Chair, Craig Rockwood and Manny Marrero, from the Board and Carolann Gillard and Cliff Calderwood, from the membership of NAMI CC&I

Following the business meeting, a program, "Securing the Future for Loved Ones with a Disability" by Robert P. Mascali Esq. and "Guardianship: Is It the Solution" by Joan M. LeGraw, Esq. Both attorneys are from the Bourget Law Group of Falmouth and Hyannis, Attorney Mascali, one of our NAM CC&I pro bono attorneys, has specialized in this field and has practiced in New York as well as Massachusetts.

If you were not able to attend the meeting and would like a copy of either of these power point presentations, please call the NAMI office at 508-778-4277.
Patrick is the new Program Director at Bay Cove Human Services. He has worked in Human Services for 26 years, most recently as the Director of Cataumet, Gosnold’s Rehabilitation program. Prior to Gosnold he held administrative positions with JRI in Brockton and Stevens Treatment Programs in Swansea. He began his career at the Italian Home for Children in Boston.

"I am looking forward to working with all of the organizations to improve emergency services for people throughout Cape Cod"

Article Review

Brain region-specific alterations of RNA editing in PDE8A mRNA in suicide decedents”
Chimienti et al. Translational Psychiatry (2019)9:91

        My review this month is of a recently published research article. I hope to give you an understanding of some current research and its implications. The researchers are from France and New York. The study looked at a specific epigenetic change in brain tissue from eight patients with major depressive disorder who died from suicide. It compared these changes with a control group of eight people who died from sudden causes other than suicide and who did not have a defined mental health disorder.
 I have written in the past about two books that deal with epigenetics. Epigenetics is the study of cell processes that affect the transfer of information from our inherited DNA to the production of proteins involved in cell biochemistry. In this study the authors examine a specific type of epigenetics called RNA editing. DNA contains the genetic code for all our body’s proteins. Messenger RNA reads that code and transfers the information to the cell apparatus that then makes the protein. Epigenetic proteins can change the Messenger RNA which, in turn, effects the production of the subsequent protein. Such changes can significantly alter the amount and the effectiveness of these proteins. Such RNA editing has been found to occur primarily in cell tissues that are changing. Thus, these changes occur the most in the nervous system and the immune system. In this study they compared the patterns of RNA editing for the protein phosphodiesterase8A. It is a protein involved in inflammatory cell activation, memory and cognition.
 Their findings showed a significant difference in the pattern of editing between controls and the suicide decedents. They also showed a significant difference between the two brain areas examined. These areas were the anterior cingulate cortex and the dorsolateral prefrontal cortex. Both areas are “known to be critically involved in mood regulation and cognitive control processes.”
What are the implications of this research and what are the questions that it raises? First it lends evidence to the fact that from a biochemical standpoint there is a significant difference in the brain cells of suicide decedents with major depressive disorder and the population at large. By showing significant differences resulting from epigenetics it implicates a mechanism whereby a person’s experience/environment can affect one’s genetic makeup and
 subsequent behavior.
Secondly, the authors raise the possibility that their findings may lead to a biomarker for the risk of suicide from major depressive disorder. The authors hope to look at other body tissues that may lead to a possible blood test indicating suicidal risk. It would be important if further study can show a difference between those with major depressive disorder who turn to suicide and those who do not.
Thirdly, if epigenetic changes are key to subsequent suicidal behavior, how can those changes be reversed? What types of care can actually impact epigenetic changes? There is research being done to develop chemical substances that might target and reverse specific epigenetic changes.
Finally, if some day we can better predict suicidal behavior, how do we design and implement a mental health system that can best respond to that information?

You can access this paper by googling “translational psychiatry” and going to “browse articles” and scrolling down to 15 February 2019.

  Written by Dr. George Vitek, retired pediatrician who practiced for 28 years in Wilbraham, MA. Married father of four and grandfather of ten   
Mental health programs for Cape and Islands Brazilian community progressing
By Cynthia McCormick, Cape Cod Times, Posted Apr 21, 2019 at 5:42 PM

HYANNIS — One of the Cape’s few Portuguese-speaking licensed clinical social workers, Raffaella Almeida is on a mission to serve the mental health needs of the area’s Brazilian community. It’s been a challenging undertaking. In addition to barriers to care — including the issues of language and access to mental health care for all populations — there are also cultural concerns and stigma about seeking help, Almeida said. In the Brazilian community, people tend to get to work, not to therapy. “We don’t have time for depression, right?” Almeida, a licensed certified social worker, said. The need for help has been underscored in recent years by the deaths of several people by suicide in the Brazilian community, she said. “To me, it’s almost like a social crisis,” Almeida said.

Her mission is making headway thanks to funding and a partnership with the National Alliance on Mental Illness, or NAMI, Cape Cod and the Islands, which is based in Hyannis. Starting about three years ago with NAMI’s help, Almeida started developing educational programs, parent groups and support groups for people in the Brazilian community. The programs explained the different types of mental illness and how to get help, and brought together families whose loved ones are struggling with depression, anxiety and other illnesses. The groups, which meet during the school year, are hosted “by churches that have a large Brazilian contingent,” said NAMI Cape Cod and the Islands Executive Director Jacqueline Lane. “It was a big success,” Lane said. “The people were just so appreciative.” Having religious leaders host the groups at their churches went a long way toward removing some of the stigma attached to mental health issues,

Almeida said. Mental health programs for Cape and Islands Brazilian community are progressing. People think “if my pastor says it’s OK, it’s OK,” Almeida said. And in support groups, “they see they’re not the only ones facing the issues,” she said. “There’s hope,” Almeida said. “People are getting better.” But there’s still a long way to go. People in the Brazilian community can get psychiatric medications at community health centers, but it’s harder for Portuguese-speaking immigrants to get access to a bilingual counselor who can help them understand their illness and how to manage it, Almeida said. There is a “huge need” for counselors, said Almeida, who also works as a counselor at Barnstable High School under the auspices of Gosnold, a nonprofit organization that provides services for mental health and substance abuse disorders.

Money is tight as well. The local NAMI agency has struggled to find money to support the Brazilian programs, which run from September to May, Lane said. Cape Cod Healthcare and a private foundation have helped to underwrite the mental health program, but other attempts to secure grants have not done as well, Lane said. Despite that, the local agency is committed to sticking with the program, which board members consider important given the large number of Brazilians living on the Cape, Lane said. She said the Cape has one of the three highest concentrations of Brazilians in the state. “We couldn’t run the community without the hard-working Brazilians,” Lane said. “We are continuing growing the program. It’s been a very, very rewarding experience for us.” 
End of year event for one of the therapeutic support groups that meets weekly to support the Brazilian community facing barriers related to mental health and cultural differences. The group is led by a clinical social worker, Raffaella Almeida, LCSW, and is presented to be the community with the support of local churches, free of charge in their Portuguese native language.
Another successful Community Crisis Intervention Team (CCIT) Training
In April NAMI CCI sponsored another CCIT training for police officers, first responders and social service agencies throughout Cape Cod.
Taunton CCIT Team
Keith Bourden, Jackie Lane, Chief Mark Pawlina from Chatham, Kevin Rosario, Leonard Cardoza
Chief Frank Frederickson, Yarmouth
“April showers bring May flowers” certainly has been true this April, though I wish Mother Nature would turn off the waterworks for a bit and let the sun poke her head out every now and then! I love spring; with everything beginning to bloom, this time of year for me promises new beginnings.

NAMI CC&I on Nantucket has begun a new partnership with the former Nantucket Behavioral Health Task Force. The former Task Force recently reorganized as the Nantucket Behavioral Health Advisory Group under the umbrella of NAMI. This provides a partnership that gives NAMI the ability to fundraise and provide support in areas that benefit all the members of the advisory group. A prime example of this is the ongoing ambulance transportation funding to safely transport persons to a mental health care facility in a safe and expedient manner. Already I see a renewed spirit of collaboration between organizations as we work together in planning a joint series of events for May- Mental Health month. The first proposed event is a community “Let’s Talk” consisting of a panel of people with lived experience and community organizations that can offer resources and answer questions. We have also begun discussions for a mental health symposium with workshops and a keynote speaker as well as bringing in other educational speakers throughout the year.

I recently attended the NAMI CC&I annual meeting at the Cape Codder in Hyannis. It was empowering to hear of the inroads NAMI continues to make. One of the highlights was meeting Cecelia Brennan, a NAMI Board member from Martha’s Vineyard. I am looking forward to some inter-island sharing of ideas with Cecelia and Lisa! 

April began with the Health Fair at Martha’s Vineyard Hospital. Over a hundred vendors lined the halls of the hospital presenting Islanders with information on topics such as mental illness, nutrition, exercise, dental hygiene, hospice, homeopathic treatments, cancer care, massage therapy and so much more. Our NAMI MV table was busy throughout. Cecilia Brennan and I answered questions, passed out dozens of pamphlets and support group flyers, and encouraged those who needed a friendly shoulder to lean on.
Our Family-to-Family class continues and has been an incredible help to those enrolled. We have parents, children, siblings, friends, and spouses of someone living with mental illness participating. It’s a varied group, but a deep bond has already formed.
We are gearing up for Mental Health Awareness Month. Jackie Lane will be visiting MV on May 1 to speak about NAMI at the Chilmark Library. On May 7, I will be hosting an afternoon showing of Disney’s Inside Out at the Oak Bluffs Library for children after school. We’ll talk about feelings, watch the movie, have a few themed snacks, and play a couple of games.
We have planned two Dinner and a Movie events: On Monday, May 13 we will be showing As Good As It Gets and hosting a guest speaker for a Q & A after the film. Chef Gavin Smith (A Food Minded Fellow) has created a fantastic menu to correspond with the movie. On Monday, May 20 we will be showing The Soloist . Dr. Charlie Silberstein is our guest speaker. Chef Tanya Chipperfield will be cooking up a gourmet meal with a California feel, including orange-chocolate mousse cups in orange halves for dessert.
On Saturday, May 18, attorney Debra Rahmin Silberstein of Burns & Levinson LLP in Boston, will present a three-hour session on Estates, Trusts, Wills, and Long-term planning for loved ones with mental illness.
I’m going to host a second Inside Out afternoon at the Edgartown Library on May 22. With seven elementary schools on Island, I’m hoping to reach as many children as possible.
We will finish out Mental Health Awareness Month with two special events with author and suicide survivor Craig Miller. On May 30, Craig will speak to the students at the Martha’s Vineyard Regional High School in the morning in a closed session. On Thursday night, Craig will be speaking to the general public at the Katharine Cornell Theatre.
It is our hope that events and activities will raise awareness and help cure the stigma of mental illness, and also increase the presence of NAMI here on Martha’s Vineyard.

RESEARCH WEEKLY: Sunlight and Bipolar Disorder
For individuals with bipolar I disorder, the more severe form of the illness , a drastic change in sunlight between winter and summer may be associated with increased suicide attempts, according to new international research.
Research has long suggested a link between the natural environment and symptoms of mental illness. Seasonal affective disorder, which affects an estimated 10 million Americans  , is characterized as depression related to seasonal changes, and most often occurs in fall and winter when sunlight is scarce. A similar pattern has been shown for some individuals with bipolar disorder -when mania, or a period of excessive euphoria or excitement, tends to occur during spring or summer months, and depression tends to come about in the fall and winter. And while studies on the topic draw varying conclusions, a majority of research on seasonal changes in suicide rates finds a somewhat paradoxical relationship, indicating increased rates in the spring and summer.
Recently, an international team of researchers conducted an exploratory study to further investigate the link between seasonal changes in sunlight and suicide attempts of individuals with bipolar I disorder. The researchers studied available data for 3,365 individuals diagnosed with bipolar I disorder between 2010 and 2016. Data included limited demographic information, history of suicide attempts, birth location, onset location of bipolar disorder, and current location. The study population included people with 310 onset locations in 51 countries. A majority of individuals were living in the same country and city in which onset occurred.
The researchers then calculated the average solar insolation-the amount of the sun's electromagnetic energy hitting Earth's surface-for each onset location during winter and summer months. For locations in the southern hemisphere, data were shifted by 6 months to approximate similar seasons in the northern hemisphere. The difference between the amount of sunlight observed during the winter and the amount observed during the summer was greatest near the Earth's poles, according to the results. For locations closer to the equator, levels of sunlight remain much more constant in the transition from winter to summer.
When applying these findings to the study population's suicide data, the researchers found that the risk of attempting suicide increased significantly when the location where a person's bipolar disorder first manifested saw more extreme changes in sunlight throughout the year. While 31.1% of all studied individuals had a history of attempted suicide, the odds of an attempt increased by 49% for individuals with onset locations closest to the North Pole, compared to locations closest to the equator.
The study authors highlight previous research that offers context for the findings. As humans have adapted to 24-hour light-dark cycles, regulation of physiological processes depends on maintaining alignment with one's environment using external cues such as available sunlight. Certain neurotransmitters, such as serotonin, and Vitamin D have also been shown to be lowest during the winter. Both of these biological molecules affect mood regulation, and deficiencies have been linked with depression and suicidal behavior. 
The authors note that the study comes with many limitations. In particular, data were not available for individual characteristics likely associated with risk of suicide, such as socioeconomic indicators, other psychiatric or medical conditions, or psychiatric treatment history. However, the findings provide further evidence of the impact of sunlight on the expression of mental illness, meriting additional exploration of the topic.
Jessica Walthall
Research and Advocacy Associate
Treatment Advocacy Center

  • Bauer, M., et al. (2019, June). Association between solar insolation and a history of suicide attempts in bipolar I disorder. Journal of Psychiatric Research. Advance online publication.

Like Heart Disease or Certain Cancers, Understanding How Bipolar Disorder Runs in Families Can Lead to More Accurate Diagnoses and Proper Treatment – and Better Lives

When Carrie* was a teenager, her father began to act strangely. He was irritable all of the time and started arguments with everyone; he never seemed to sleep; and he spent money recklessly, causing the family to go into debt. He withdrew from his friends and started having trouble at work. “He went from being social and fun to be around, to quiet and withdrawn,” Carrie recalls. “The change was dramatic.” Then, without any warning, Carrie’s father abandoned her family.

Years later, Carrie, now a devoted wife and mother of three, began to experience some of the same behaviors that she saw her father struggle with. She experienced rapid mood swings, overspent when she went shopping, had racing thoughts and found herself uninterested in things she used to enjoy. “I had a strong tendency to isolate myself,” Carrie explains. When she began having suicidal thoughts, her family convinced her to see a psychiatrist, who hospitalized her and diagnosed her with bipolar disorder. “When I saw the doctor, he asked if anyone in my family had a mental illness,” Carrie says. “I told him that my father had been diagnosed with depression before he died. But as we discussed my behaviors – and my father’s – it became clear that my dad probably had bipolar disorder. I wish that someone could have figured that out when I was young. Maybe our family wouldn’t have been torn apart.”

“Bipolar disorder, sometimes called manic depression, often runs in families, just like heart disease or certain types of cancers,” explains Julie Totten, president and founder of Families for Depression Awareness, a national non-profit organization that helps families recognize and cope with depressive disorders. “If people can provide their doctors with information about their family’s mental health history, physicians can more quickly and accurately diagnose the condition.” Research suggests that more than two-thirds of people with bipolar disorder have at least one close relative with the condition or with major depression. Additionally, studies suggest that children of parents with bipolar disorder are more likely to develop a mood disorder, including bipolar disorder, than children of parents who do not have psychiatric illness.

If diagnosed correctly, bipolar disorder can be treated, and people with the condition can live healthy and productive lives. But the consequences of not recognizing its symptoms, misdiagnosis, and improper treatment can be serious, even fatal. “So much suffering and tragedy could be prevented if people examined their family tree for crucial clues about bipolar disorder, or another mental illness, in the family,” Totten explains. “It’s critical that everyone learn to recognize behaviors associated with bipolar disorder in themselves and in close relatives. Families need to understand that bipolar disorder is a familial medical condition, and that discussing this family connection can reduce the feelings of shame and blame that sometimes surround this illness.”

What bipolar disorder is – and is not
People with bipolar disorder fluctuate between overly “high” or irritable moods and sad and hopeless feelings, often with periods of “normality” in between. The condition usually begins during the teen years or in young adulthood and can last throughout a person’s life. No one knows what causes bipolar disorder, but researchers think it may be the result of a chemical imbalance that affects certain parts of the brain. This imbalance is thought to be caused by the irregular production of certain hormones, or by a problem with certain chemicals in the brain, called neurotransmitters, that send messages to our nerve cells. Scientists don’t believe that there is a single “bipolar gene.” Several genes may play a role in how likely a person is to have bipolar disorder and pass it on to the next generation. By using advanced genetic testing and by studying families that are affected by the illness, scientists are working to pinpoint these genes and the brain proteins they influence, so that better treatments and preventive measures can be developed.

 Signs of Bipolar DisorderDepressive Behaviors Manic Behaviors
• Sad, depressed, or empty mood • Excessive crying • Loss of interest or pleasure in people or activities that were once enjoyed • Sleeping too much or too little • Low energy • Restlessness • Difficulty concentrating • Irritability • Loss of appetite or overeating • Feelings of worthlessness and hopelessness • Ongoing physical problems not caused by physical illness or injury (headaches, digestive problems, pain) • Thoughts of death or suicide* • Increased energy with decreased need for sleep • More talkative or rapid speech • Inappropriate sense of euphoria (excitement), or irritability or anger • Reckless behavior • Excessive energy • Racing thoughts; talking too much • Out-of-control spending • Difficulty concentrating • Abnormally increased activity, including sexual activity, spending sprees, erratic driving • Poor judgment • Aggressiveness *If someone is suicidal, treat it as a medical emergency. Call the person’s clinician or call 911 or take him or her to your local hospital’s emergency room.

Understanding behaviors – past and present – is the key
Recognizing the signs of bipolar disorder is not always easy. In its early stages, the illness can masquerade as a different problem, such as depression, alcohol or drug abuse, poor performance at school or work, or relationship difficulties. Alice,* a single mom, became increasingly worried about the behavior of her 12-year-old daughter, June* . June would come home from school crying every day and beg not to go to school the next. She seemed to have more energy than usual, had terrible nightmares, and became preoccupied with knives. For a full year, officials at June’s school told Alice she was fine, and the girl never saw a doctor. And then June attempted suicide. Finally, June was diagnosed with bipolar disorder. She is now being treated successfully with medication and therapy. Unfortunately, many people with bipolar disorder can face up to ten years or more coping with symptoms before they get an accurate diagnosis. In fact, nearly two thirds of people with bipolar disorder are misdiagnosed, often with depression, just as Carrie’s father was. “People with bipolar disorder often don’t see a doctor until they are deep in a depressive episode,” explains Eric Youngstrom, Ph.D., associate professor, Department of Psychology, University of North Carolina at Chapel Hill. “Others may not realize that they’ve had manic episodes in the past, or they don’t see manic behaviors as problems they should mention to their doctor. This can lead a doctor to misdiagnose major depression instead of bipolar disorder.” Many doctors agree that if family members shared the manic behaviors they see in their loved ones, it could help them make quicker, more accurate diagnoses and decide on the best course of treatment. “A person’s family mental health history is an important piece of the diagnosis puzzle,” notes Dr. Youngstrom. “If a depressed patient tells me that his mother has racing thoughts and money troubles, and that his sister consistently engages in risky behaviors, it sheds more light on his condition and may help me figure out whether he’s suffering from depression or from bipolar disorder.”

The Mental Health Family Tree
To uncover family behavior patterns that could indicate bipolar disorder, Families for Depression Awareness has created a simple, interactive tool called the Mental Health Family Tree builder. The builder is a brief questionnaire that helps people identify personal and family behaviors associated with bipolar disorder. The completed builder results in a “family tree” that can be printed out and used to spark conversations with doctors or relatives. The builder can be found on # , along with other helpful resources, including tips for patients and families on dealing with bipolar disorder. The more you know about bipolar disorder, the easier it will be for you to discover if it appears in your family’s health history. By building a Mental Health Family Tree, you can pinpoint the behaviors of family members who may have – or are suspected to have– bipolar disorder. Just as Carrie came to realize that her father may have had untreated bipolar disorder, Alice now believes that her ex-husband’s aunt, who was an alcoholic, had untreated bipolar disorder. In both cases, knowing their family’s mental health history has made it easier for them to understand, accept and deal with the illness – and to realize what can happen if it goes untreated. Kate,* a woman in her 40s who has been hospitalized for her bipolar disorder, received many wrong diagnoses before getting the accurate one of bipolar disorder type II. Both her mother and her uncle had received diagnoses of bipolar disorder, and her mother committed suicide. After being led through the questionnaire about the specific behaviors of family members that she had witnessed or heard about, Kate now suspects that her grandfather probably suffered from untreated bipolar disorder. “If I had built a Mental Health Family Tree earlier, it would have given my doctor and me a clearer picture of what I was dealing with,” Kate says. “It might have pointed us in the right direction a little quicker.” Realizing now that there is an obvious “family line” of bipolar disorder, Kate has already used the Mental Health Family Tree builder to help her daughter understand the behaviors and warning signs associated with the illness. “You need to ask yourself, ‘What have I got to lose by looking into my family’s past or asking relatives about their mental health?’” Totten notes. “The first job is to get yourself or your loved one into treatment. You need to take action – for everyone’s sake.”

* Names has been changed to protect privacy.


NAMI Support Group Notes:
Ø Due to Memorial Day, there will NOT be a Falmouth Support Group meeting on May 27, 2019.

Ø Please note the time change for the support group in Orleans that meets every Saturday for people managing their own mental health. The group is meeting from 2:00 - 3:30 on Saturday afternoons at the Federated Church, 162 Main Street, East Orleans. On May 11 th , the Support Group will return to the 10:00 – 11:30 meeting time.

Ø New Support Group: For family members, caregivers and friends of those with a dual diagnosis. Dual diagnosis refers to individuals who have a mental health issue and a substance use disorder. Substance abuse is a barrier for treating mental health. NAMI will have a support group facilitated by a retired alcohol/drug counselor-family therapist on the second and fourth Thursday of each month at the NAMI office located at 5 Mark Lane, Hyannis (Brick building located behind New England Pizza on W. Main St. 2nd floor) 1:00 – 2:30 p.m. The May meeting dates are May 9 th and 23 rd .

Ø Location Change: The YMCA daytime Support Group will now meet at
St. Mary’s Church, 3055 Main St. (6A) Barnstable in the St. James room. This meeting will be on the 2 nd Thursday of the month, 2:00 – 3:30 p.m. The May meeting is on May 9 th .

* All NAMI Support Groups are free, open for drop in, and confidential. Please call the NAMI office with questions or for more information at 508-778-4277.

NAMI Education:
New classes are in the planning stages and will begin soon. If you are interested in attending Family to Family, Homefront, or a 4 week education program specific to Dual Diagnosis, please call Kim Lemmon at 508-778-4277 or email klemmon@namicapecod.org

A New NAMI Course for Military Families Facilitated by Veterans
In Boston's Brigham and Women's Hospital:

 Urgent Care On Demand, Except This Time For Mental Health
·                                                     By Martha Bebinger  4.19.19

The sleepless nights and dull, meaningless days began last summer. In the late fall, Grace, who asks that we just use her middle name, stopped taking her medication for depression and anxiety. It wasn’t helping. By mid-winter, Grace says she often struggled to get through a day. “If I had to do it over again, I wouldn’t be here. If I weren’t born, I wouldn’t care, if you know what I mean,” says Grace, looking up at a physician she has just met.

Dr. David Kroll, a psychiatrist at Brigham and Women’s Hospital, nods. He continues an evaluation that includes deeply personal, sometimes painful questions. Has Grace thought about how she might kill herself? No, says Grace, just fleeting ideas. Has she thought about harming someone else? No.

Grace has a regular psychiatrist, but even during one of her lowest periods, she couldn’t get an appointment to see that doctor right away. “A couple months ago I tried to book an appointment, and I was given a date in June,” Grace says with exasperation. “I’ve had it.”

Kroll knows from experience why it's hard to squeeze patients in. Psychiatrists typically work alone rather than in teams that include a nurse practitioner and medical assistants. And the traditional approach is a thorough evaluation that builds toward a deep relationship. "But sometimes you just need a quick look to see if there's something that can be done in the moment that might get you back on track for your care," Kroll says.
Long wait times for an appointment are one of the main reasons Kroll opened the unusual clinic where he sees Grace today. It offers walk-in visits with a psychiatrist one afternoon a week. There’s a social worker on staff to help arrange follow-up care. So far, the clinic is only open to patients whose primary doctor or specialist is affiliated with the Brigham.

There are just a handful of clinics in Massachusetts where patients can get mental health care on demand and few  examples   around the country . Eight states are testing a free-standing community center  model . Some hospitals are developing  walk-in care for addiction  during the opioid epidemic, which may include treatment for anxiety and depression. CVS and Walgreen's, two of the largest retail clinic networks, do not offer mental health care.

A key obstacle is money. Danna Mauch, president and CEO of the Massachusetts Association for Mental Health, says having a psychiatrist available, waiting to see patients is expensive. "You can’t plan for the emergence of the urgent thing," says Mauch, "so people have to have staff there, whether somebody shows up at that day or that hour or not." Mauch is developing an urgent mental health care model for children.

A recent  report  from the Blue Cross Blue Shield Foundation of Massachusetts says the state and private insurers must find ways to fund walk-in mental health visits and a more robust network of urgent care centers because too many patients can't find adequate or timely care. Kroll says the early numbers show that psych urgent care will pay for itself at the Brigham because demand is so high. The hospital plans to expand the clinic from one to at least three afternoons a week by October.

Leading patient advocacy groups say they are excited about this emerging option for mental health treatment. Teri Brister, the director of information and support at the National Alliance on Mental Illness, says mental health services should be available in urgent care clinics just like blood pressure or stress tests. Delays, says Brister, trigger emergency room visits, hospital stays that could have been avoided and sometimes time in jail. "The stress on the person and the stress on the family and the potential for symptoms worsening when treatment isn't received immediately only make things more difficult," Brister says. Lisa Lambert, director of the Parent Professional Advocacy League, says providing mental health care in a retail or urgent care clinic will remove some of the stigma patients feel in seeking treatment for depression or anxiety. "When mental health care looks more like primary care or regular medical care and less like behavioral health care, for some people that's going to make a difference," Lambert says.

But there are potential pitfalls.
During Grace's appointment, Kroll scans dozens of drugs Grace has tried over the years. Grace sees a counselor, attends some groups and exercises, but can’t seem to find a medication that helps. "I don’t necessarily remember what I felt like on them," Grace tells Kroll. "I guess I switched off them because they weren’t working, but I don’t remember why."
Kroll can review Grace’s medical record because she’s a Brigham patient. But what if he didn’t know what medicine Grace had tried, or what pills she still had in the medicine cabinet? "I think it’s a setup for long term confusion and bad care with errors in it," says Dr. Joseph Parks, medical director at the National Council for Behavioral Health, representing 3,000 mental health and addiction treatment programs. Parks says coordinating care will have to be a priority as interest in urgent care psych clinics grows.
At the Brigham, Kroll says urgent care won't work if patients need a medication that requires careful monitoring. He mentions lithium, which is commonly prescribed for biopolar disorder.

Kroll prescribes two new medications for Grace, describes potential side effects, and tells her to follow up with her regular psychiatrist. Grace says she's relieved. "You’ve been so helpful I really, and very thorough, my goodness, for just seeing me on the quick," Grace tells Kroll as she leaves.

The Brigham clinic is designed as a bridge between routine psychiatric visits, but Kroll acknowledges that on-demand care will appeal to many mental health patients. "That's been one of the big worries," Kroll says. "That's why we built this up gradually. We were worried that once you opened the flood gates, then it could become overwhelming very quickly. Most of the time that doesn't happen." Kroll says the clinic is busy some Wednesdays, but less so on others. The typical visit with a patient lasts from 20 to 60 minutes, which is longer than the average urgent care visit. The Brigham clinic sees a disproportionately large number of Medicaid patients. And it welcomes patients who've been kicked out of established psychiatry practices for repeatedly missing appointments. So called "no-shows" are common in mental health practices, says Karen Wrenn, a licensed social worker who manages the Brigham's urgent care psych clinic. It could be something as simple as navigating public transportation or finding parking. Some mental health conditions get in the way of seeking care. "With depression," says Wrenn, "folks will not be able to get out of bed. If you have more acute issues like psychosis, that's going to be a barrier." But less of a barrier, Wrenn says, if patients know they can walk-in and be seen, when they're ready.


The Cape and Islands Suicide Awareness Walk is a three mile loop walk in Orleans, Cape Cod, MA on Saturday, May 18, 2019 beginning at 10 am. 
Registration is  online  and also available on-site the morning of the walk beginning at 8.30 am. Water and refreshments will be available for walkers. Education materials will be available before and after the walk. All walkers who raise $50 qualify for an END THE SILENCE T-shirt. 
All proceeds go to three local non-profits; the Samaritans on Cape Cod and the Islands, the Cape and Islands Suicide Prevention Coalition and Sharing Kindness, Inc. to provide education and advocacy for suicide prevention. 
Copyright © *2019* *Sharing Kindness*, All rights reserved.
Our website is: www.sharingkindness.org 


10:00 – 11:30 AM
Becoming a mother presents with a lot of challenges and for many woman this time can be very overwhelming and intense. We can feel sad, worried, irritable, restless, isolated, experience sleep disturbances beyond the expected sleep deprivation motherhood brings. We can feel angry and lose interest in the things we normally enjoy. We can be filled with doubt and be afraid. Experiencing these feelings is normal and you are not alone. It doesn’t define who you are as a person or reflect on your ability to be a good mother. Whether you are a new mom or a mom well on her journey we welcome you to join us in a cozy, calming, open, honest and loving environment. Childcare will be offered upon request.
Support Group Facilitated by: Erin Soderstrom & Aimee Facchini
Erin Soderstrom is a trained GPS (Group Peer Support) Facilitator, Erin directly experienced and healed from Postpartum mood complications
Aimee Facchini is a LICSW, MSW Child & Family Therapist in Barnstable Village. GPS, CBT and DBT
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