Sangamon County Sheriff Wes Barr joins Gov. Bruce Rauner, and other officials in promoting Illinois' attempt to expand services available to Medicaid recipients.
Amanda Vinicky / WUIS
October 17, 2016

Minding The Mental Health Gap

Mental health centers were decimated during Illinois’ extended budget stalemate. Illinois is moving forward with plan to extend and expand behavioral health services to people who couldn't otherwise afford it, in a way that officials say will be cost-neutral to taxpayers. 

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Bruce Rauner signs budget approced by the Illinois Senate
(Photo: Illinois Governor’s Office)
March 26, 2015

Rauner Signs Off On Plan To Fix Budget Hole

Governor Bruce Rauner took to the Illinois Senate floor to shake hands Thursday after senators passed a plan to plug a $1.6 billion hole in the state budget.  He signed the measure late in the day.

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June 19, 2014

Illinois May Let Psychologists Prescribe

Illinois could become the third state in the U.S. to allow psychologists to prescribe medications that are used to treat mental illness.

Under legislation approved by the state’s assembly and now awaiting Gov. Pat Quinn’s signature, psychologists would need to undergo training and would have to work under the supervision of a medical doctor.

Bonnie Miller Rubin has been covering this story for the Chicago Tribune and joins Here & Now’s Jeremy Hobson with details.

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A police officer stands outside the entrance to Sandy Hook Elementary School in Newtown, Conn., on Dec. 15, 2012.
(Spencer Platt/Getty Images)
May 08, 2014

Mental Health 101: Program Helps Police Intervene In Crises

How do you tell the difference between someone who needs to be taken to jail and someone who needs to be taken to the hospital? It can be a delicate situation to decipher, and it's been a big concern in Connecticut since the Newtown shootings of 2012.

Lance Newkirchen, a regular patrol officer in the town of Fairfield, is also specifically trained to respond to mental health calls. On a recent weekday, he headed out in his patrol car for a follow-up call.

"We're going to go meet with a father whose 21-year-old son — two days [ago], at 3 o'clock in the morning — through his depressive disorder, was having suicidal thoughts," Newkirchen explains.

Fairfield has 107 officers, and 18 are trained like Newkirchen. They're part of what's called a Crisis Intervention Team, a program that Fairfield implemented about three years ago. The department's target is to train 20 percent of its force. The Fairfield team is one of about 2,700 nationwide — a fraction of the 18,000 state and local law enforcement jurisdictions in the country.

In Fairfield, police say they want to make sure families have as much support as possible. They also want to make sure police have as much information as they can, in case they ever have to go back.

"They know they're dealing with someone who is depressed," Newkirchen says. For instance, he continues, officers might know "that they're dealing with someone who may have a samurai sword collection in their basement. They know that they're dealing with someone whose parents are divorced and the father is very anti-police and the mother is pro-police."

It's the kind of information that makes it easier for cops like Newkirchen to do their jobs. There are many such details, Newkirchen says, that if gathered in a first visit, can later give an officer responding to an emergency call, "as he's walking up the front walk, 90 percent of the information he needs to be effective."

Inside, Newkirchen talked through a brochure of services — people and agencies that can help the family out if needed. And he went through a two-page list of questions about the son's diagnosis.

Newkirchen says doing this job means being a good listener. But it doesn't mean being soft or forgetting police tactics. It just means adding to them a few more skills.

It's easy to interview "the person who just stole four tires from BJ's" and get that person to admit what's going on, Newkirchen says. But "it's incredibly difficult to get someone who believes they have an assignment from the FBI to really admit that they don't, and [that] they do need help, and it's time to go and talk to somebody at the hospital. So that's the skill set."

A few weeks ago, Newkirchen and 50 or so officers from across the state gathered for the first day of a five-day Crisis Intervention Team seminar. Such workshops touch on everything from making suicide assessments to talking to people on the autism spectrum. They also discuss forging partnerships with community mental health providers and understanding de-escalation techniques.

"The characteristic of your work that sets you apart from every other professional is that you never know what you're walking into," says Madelon Baranoski, of Yale School of Medicine's Law and Psychiatry division. Baranoski's first goal is to give the officers she trains an understanding of various types of behavioral health issues. Psychotic illnesses, for instance, are the ones that make a person unable to tell the difference between thought and reality.

To illustrate, she confesses something many people feel when giving a public talk — she's nervous, and worried about how people will react. But she knows those are her thoughts, and no one else's.

"As long as I know I'm thinking it, I have a choice on how to change my behavior," Baranoski says. "But if I were mentally ill — particularly if I had a mental illness that interfered with what we call reality testing — I think, 'Because you're staring at me, you're thinking I'm stupid.' "

This training is an eye-opener for third-year officer John McGrath.

"You know, protocol for a police officer is always, 'Protect yourself,' " McGrath says. "To be able to learn what they're thinking and what's going on in their mind, kind of gives you a better perspective of what's going on and what you're able to do to further protect yourself and to protect them."

Newkirchen says that the training these officers are getting is extremely practical. He probably gets two or three calls related to mental health in an eight-hour shift. He says not all calls go as well as the visit with the family of the man who was suicidal, but a lot of them do.

"I would say 50 percent of the time, [the calls we get] are calls like this — where we are making, I think, a huge difference. We won't be back, and that family has a very different sense of what we do as police officers."

Late Wednesday night, Connecticut lawmakers passed a bill ensuring that all police in the state can get some kind of training like Newkirchen's.

This story is part of a reporting partnership with NPR, WNPR and Kaiser Health News.

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It's not clear why children, teenagers and young adults would be at greater risk of suicide when they start taking antidepressants.
(iStockphoto)
April 28, 2014

Higher Doses Of Antidepressants May Raise Teen Suicide Risk

Antidepressants are thought to increase the risk of suicide in young people, but that may be caused by starting them on larger doses of the drugs, a study finds.

Children and young adults who started taking selective serotonin reuptake inhibitor antidepressants in higher than average doses were twice as likely to attempt suicide as people taking average doses, according to a study published Monday in JAMA Internal Medicine.

Earlier randomized controlled trials found that taking SSRI antidepressants increased suicidal thinking and behavior in children and teenagers. That prompted the Food and Drug Administration to issue a warning on the risk in 2004. The agency later expanded that warning to include young adults up to age 25.

But the warning remains controversial, and more recent analyses have suggested that the benefits of treating anxiety and depression with SSRIs outweigh increased risks of suicidal behavior.

This latest study doesn't look at whether taking SSRIs increases the risk of suicide. Instead, it looks at whether different doses of the medications affect the risk of suicidal behavior.

"The design of the study was meant to really address the question, does dose matter?" Dr. Matthew Miller, an associate professor at the Harvard School of Public Health and lead author of the study, told Shots.

 

To find out, Miller and his colleagues looked at pharmacy benefits records for 162,625 people who had been diagnosed with depression and prescribed antidepressants for the first time from 1998 to 2010. They then sifted through those records and matched up people based on their risk factors for various health problems, so they were as similar as possible.

They found that people under age 25 who got a higher initial dose of antidepressants were twice as likely to try to harm themselves, while that wasn't true for people 25 and older.

That meant an additional one suicide attempt for every 150 people started with higher-dose therapy, the study found. The risk was especially high in the first three months of treatment.

"It certainly is one more piece of information that should make doctors reluctant to start younger patients on high doses," Miller says, "even if those doses are within the therapeutic range."

Thatt's not saying that taking the average dose is safe, Miller notes, because the people taking an average dose had a higher suicide risk than the older people, too. "It doesn't give SSRIs a pass at all."

Although the researchers were careful to try to remove any influence from various risk factors, since this was an observational study, it leaves key questions unanswered.

That includes why higher doses would increase suicide risk; whether increasing dosage after a few months would also increase risk; or if switching drugs would be more effective and less risky than increasing the amount.

It also leaves open the question of the safest way to stop taking antidepressants. Other research has found that discontinuing antidepressants or changing the dosage can boost suicide risk.

And then there's the question of why doctors prescribe what they do. Almost 20 percent of people in the study were given an initial prescription for higher dose antidepressants, even though prescribing guidelines don't recommend that.


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