Recently, the Chicago CBS affiliate interviewed her briefly for a story about the signs of suicide, after the suicide of Chicago school board president, Michael Scott. Scott was among officials subpoenaed this summer in a federal investigation of admissions practices at Chicago’s selective enrollment high schools. He also was the subject of a Chicago Tribune investigation into a land deal and his key role on Chicago’s Olympics committee. He was found dead on Monday by a self-inflicted gunshot wound.

This time of year, many of us will be gathering to give thanks for what we do have in our lives — family, friends, and the ability to try and provide a better world for our children, and our children’s children. Efforts like Kathryn’s give us all renewed hope, and I give thanks that folks like her are in the world, spreading the word about the significant impact depression and suicide have on so many.

Watch the video Suicides Can Come Without Warning (preceded by a 30 sec. commercial)

Learn more about the International Foundation for Research and Education on Depression (iFred)

(Full disclosure: I sit on iFred’s advisory board, and I lost my best friend to suicide in my first year of graduate school.)

The solutions should be familiar to our regular readers — self-help techniques (most of which you can find online; but you can also find them in self-help books, freely available at your local library); self-help support groups (such as the ones we host here at Psych Central); an employee assistance program, or EAP (if you still have some connection with a job); and a host of ways of seeing professionals at reduced costs out-of-pocket.

For instance, in some communities, there are community mental health centers that will see you for a mental health concern on a sliding scale fee — the fee is based upon how much money you make. If you’re making $0, they will still ask for a small amount (usually $10 to $20 per session). If your mental health concerns are affecting your ability to work or live your life, this is money well spent. Some private therapists also will see clients on a sliding scale, but their fees usually won’t go as low as a community mental health center’s.

There are also other great tips in the article, and yours truly is quoted in it, so it can’t hurt to check it out! We also covered this topic two years ago, Finding Low-Cost Psychotherapy, so you may also want to read our take on it.

Read the full article: Patient Money - How to Find Mental Health Care When Money Is Tight.

Currently health care in this country is focused on illness rather than health, on procedures and face-to-face interventions rather than on coordination and prevention, and on fragmented, specialty-driven care rather than on a primary care-driven delivery system. There is a solid evidence base that shows that a health system centered on primary care costs less and has better outcomes on a population basis than one dominated by specialty-driven care.

For behavioral healthcare, this kind of system reform poses significant opportunities and challenges, specifically in the scaling up of the evidence-based integration of mental health and substance use treatment and prevention into primary care. Thus, it is through system reform—replacing a fragmented, specialty-dominated system with a more effective and efficient primary care-driven one—that national health care reform may have its greatest impact upon the behavioral healthcare field.

In other words, in order for mental health to be more accepted, primary care physicians — those docs who already see most people with mental health concerns initially anyway — really should be at the forefront of coordinating all of a patient’s care, including their mental health care. I’m not sure I entirely agree with this approach, but it makes a certain sense and is certainly a more elegant option than what currently exists today.

There were six working groups this year, and you can view both the video of the entire symposium and the powerpoint presentations of the working groups’ recommendations online. Since the recommendations are fairly lengthy, I’ll try my best to summarize the salient points from their slides below as succinctly as possible.

1. Reimbursement/Financing

• Define and promote a clearly articulated clinical integration model
• This makes it possible to have clearly defined outcomes tied to core payments, with performance incentives
• Financing that supports designs and outcomes (e.g. bundled payments)

2. Children and Adolescents

• Develop a National Children’s Agenda that drives a public health approach that addresses developmentally appropriate needs across the population (including prevention and health promotion).
• Promote the availability of holistic assessments that link the youth and family to services and supports that match developmental needs and promote resiliency and protective factors.

3. Workforce Development

• Expand the concept of who the workforce is and how we train that workforce to work together as equal partners in care in systems that fit the outcomes people desire while being served in their communities.
• The future healthcare workforce will be integrated, networked, collaborative, and community needs-driven, organized around the tenets of population health and the principles of recovery, including primary, secondary, and tertiary prevention, while sharing collective accountability.

4. Cultural and Ethnic Minorities

• Develop an integrated, community-owned health care delivery system that: aligns incentives for financing; supports community-defined evidence; fosters health IT, promotion, and prevention; addresses stigma; has culturally relevant, team-based care; and is accountable and outcomes-driven.
• Expand and improve the capacity of the primary and behavioral care workforce to meet the needs of racially, culturally, and ethnically diverse communities in an integrated setting

5. Research

• Build a registry for gathering promising practices to guide policy and reforms
• Conduct research on effectiveness of promising practices in the registry
• Use existing data sets to track the impact of health reform (e.g. how does reform impact spending on behavioral health?). Need to give more open and real-time access to data for researchers.
• Develop implementation strategies to ensure widespread dissemination of effective practices

6. Population Health and Prevention

• Advocate that existing task forces work on mental health issues and integration into primary care, as well as revise the evidence standards.
• Health reform money should be used on coordinated mental health promotion efforts.
• Identify groups, including public health advocates, to develop shared language, goals, and resources
• Obtain and fund community-level research on population-based interventions that have evidence, including comparative effectiveness work globally.

What happens next? It’s expected that because the policy summit is attended by the leaders from a wide range of organizations, businesses, and government representatives, they take these policy recommendations back to their respective groups to help guide their organization’s future work. It’s an imperfect system, but you can’t mandate change — you need to persuade it. It usually occurs gradually, in small steps over time.

Note your top picks in the comments and we’ll review those and the ones on our own list to come up with our big list for the year. If you had a favorite blog entry from the past year, we’d love to hear about that too in the comments!

The Year in Review will be published in December.

The first is from Leigh Pretnar Cousins, MS called Always Learning. Leigh is a private tutor and is studying in educational psychology. Although her blog will focus on the topic of educational psychology and learning, she believes these lessons are of value to all of us throughout life:

Every day my work teaches me some lesson that holds, not only for kids, but for all of us. I can hardly wait to share these things with you.

I’m excited to have this place to talk about learning and all its facets… Learning and school, learning and work, learning and emotions, learning and relationships, Learning and Life.

I agree. Learning doesn’t stop just because we don’t go to school any longer, and I look forward to reading her blog in the days and weeks to come.

Our second blog is called The Y Factor, which will talk about men, dating and the single life (from a woman’s perspective). Kate Nickerson (and others) will share her insights with us as she learns from her life experiences and psychotherapy:

I had no conscious realization how my life had been seriously screwed up by the way I related to men. So now I’m going to face the truth — deal with men in my life. Take the lessons and leave the negative memories in the past.

These lessons are what the “The Y Factor” will explore. From my father and grandfathers, to ex-boyfriends and bosses — all of the relationships with the men in my life will be dissected herein and my pithy insights revealed.

I’d also like to take this opportunity to remind our regular readers that we’re always looking for new bloggers and contributors here!

If you’re a mental health professional — especially a practicing clinician or researcher — and a writer (or someone who very much enjoys writing!), we’d love to talk to you. Drop us a line at:

blogs [at] psychcentral.com

We hope you enjoy these two new blogs!

Check out our new blogs now:

• Always Learning
• The Y Factor

So what does the Army do? Does it recognize the significance of this number with a solemn, sincere statement? No, instead it turns on the full denial PR machine:

“We are almost certainly going to end the year higher than last year,” General Peter Chiarelli, the Army’s vice chief of staff, told a Pentagon briefing.

“This is horrible, and I do not want to downplay the significance of these numbers in any way.” [...]

Chiarelli cautioned against generalizing about the causes of the suicides, or assuming links to combat stress on forces stretched thin by the wars in Iraq and Afghanistan.

So in one breath, General Chiarelli says he doesn’t want to downplay the significance of these numbers. In the next, he says we can’t generalize these numbers to any actual military combat missions that soldiers may be actively involved in. Huh?

With all due respect, perhaps General Chiarelli needs to take a course in logic or read more of the prior reports released about this increasing problem within the U.S. military. To not connect the dots between the never-ending wars in Iraq and Afghanistan (did no one study military history and the Russian invasion of Afghanistan?) is to be in a state of irrational and delusional denial. Sorry, General, but such statements make you sorely out of touch with your people and reality.

When you’re threatening court martial to moms who can’t find child care for their 10-month old before deployment and have psychiatrists shooting up your training bases because you don’t acknowledge the inherent conflicts in service amongst your ranks (or your officers don’t have the stomach to discharge someone they clearly saw as problematic), then yes, you have some serious problems. And yes, they are related to the two wars you are currently fighting.

As the article notes, the military’s suicide rate among active-duty soldiers was about 20 per 100,000, nearly double the national U.S. rate of 11.1 suicides per 100,000 people.

There is something significantly wrong there if twice as many people in your service are taking their own lives. This hasn’t always been the case. And rather than trying to whitewash the issue, you should be pulling out all the stops — and all significantly increasing the funding — to figure out how to stop the blood letting.

Read the full article: Army suicides set to hit new high in 2009

One researcher, John Horgan PhD at Pennsylvania State University, found that people who are more open to terrorist recruitment and radicalization tend to:

• Feel angry, alienated or disenfranchised.
• Believe that their current political involvement does not give them the power to effect real change.
• Identify with perceived victims of the social injustice they are fighting.
• Feel the need to take action rather than just talking about the problem.
• Believe that engaging in violence against the state is not immoral.
• Have friends or family sympathetic to the cause.
• Believe that joining a movement offers social and psychological rewards such as adventure, camaraderie and a heightened sense of identity.

A lot of this is not particularly surprising, as we learn time and time again from the profiles constructed in the media of famous terrorists after-the-fact. But the insights gained from talking to ex-terrorists helps us better understand individual terrorists’ motivations:

For instance, based on what he’s gleaned about why people leave organizations, a particularly promising strategy may be highlighting how the promised glamorous lifestyle never comes to pass — an experience poignantly recounted by a former terrorist now in hiding. The man told Horgan he was lured into a movement as a teen when recruiters romanticized the cause. But he soon discovered his comrades held sectarian values, not the idealistic ones he had, and he was horrified when he killed his first victim at point-blank range.

“The reality of involvement is not what these kids are led to believe,” says Horgan. “Speaking with repentant former terrorists, many with blood on their hands, offers an extraordinary opportunity to use the terrorists’ own words and deeds against them.”

Arie Kruglanski PhD, co-director of the National Consortium for the Study of Terrorism and Responses to Terrorism (START), conducted a study that surveyed thousands of people in 15 countries. In the yet-unpublished research, he found that “Muslims who have a more collectivistic mentality are more likely to support terrorist attacks against Americans than those with more individualistic leanings. The research also found that the lower people’s reported personal success in life, the greater their tendency to endorse collectivistic ideas and to support attacks against Americans. The findings suggest that joining terrorist groups may confer a sense of security and meaning that people do not feel as individuals.”

Psychologist Clark McCauley PhD, a co-investigator at START and director of the Solomon Asch Center for Study of Ethnopolitical Conflict at Bryn Mawr College, believes that too much focus is on terrorist behaviors and their motivations, while ignoring the larger picture of how governments can unintentionally be reinforcing some of the terrorist’s actions:

[I]f terrorists commit an attack and a state uses extreme force to send a punishing message back, the terrorists may use that action to drum up greater anti-state sentiment among citizens, lending justification to their next actions. Yet research focuses almost solely on terrorist actions and neglects the important other side of the equation, he contends.

So how do you combat terrorism, if not by sheer force (which, as we’ve seen, is largely ineffective)? Kruglanski and other researchers have some ideas, by implementing anti-terrorism programs that are delivered to captured terrorist prisoners. The programs have three parts:

• An intellectual component involving moderate Muslim clerics who hold dialogues with imprisoned detainees about the Qu’ran’s true teachings on violence and jihad.
• An emotional component that defuses detainees’ anger and frustration by showing authentic concern for their families, through means such as funding their children’s education or offering professional training for their wives. This aspect also capitalizes on the fact that detainees are weary from their lifestyles and imprisonment.
• A social component that addresses the reality that detainees often re-enter societies that may rekindle their radical beliefs. A program in Indonesia, for instance, uses former militants who are now law-abiding citizens to convince former terrorists that violence against civilians compromises the image of Islam.

Similar programs like this can help entire radical Islamic groups renounce violence when well-implemented and embraced, as the original article notes with specific examples. The key is teach potential terrorists that much of their terrorist teachings were based upon lies, that you need to address their anger and frustration, and help them find a life within everyday society. This doesn’t seem like rocket science, and yet today, we still seem to ignore the potential of these interventions and strategies for helping to reduce terrorism in the world.

Although it’s lengthy, if you’re interested in this topic, the full article is well worth a read.

Read the full article: Understanding terrorism

Individuals reporting lower marital satisfaction experienced more non-specific physical illness symptoms over a 4-year period than individuals with higher marital satisfaction. Among healthy women, lower marital satisfaction was also associated with a more rapid progression of carotid atherosclerosis. Furthermore, women who were initially dissatisfied in their marital relationship were more likely to develop metabolic syndrome over an 11-year period.

Among women hospitalized for an acute coronary event, those who reported moderate to severe marital strain at baseline were 3 times more likely to experience a recurrent coronary event during a 5-year follow-up, compared to women reporting less marital stress. Poor marital quality was also associated with a lower 3-year survival rate among end-stage renal disease patients, and a lower 8-year survival rate among congestive heart failure patients.

Collectively, these results from prospective observational studies provide evidence of an association between marital stress and negative health outcomes.

The latest research from Graham et al. (2009) shows that couples who are more considerate and rational during a fight release lower amounts of stress-related proteins. This suggests that rational communication between partners can ease the impact of marital conflict on the immune system.

Individuals in a stressful situation — as in a troubled relationship — typically have elevated levels of chemicals known as cytokines. These proteins are produced by cells in the immune system and help the body mount an immune response during infection. However, abnormally high levels of these proteins are linked to illnesses such as cardiovascular disease, type-2 diabetes, arthritis and some cancers.

When people used words in a conflict-resolution discussion with their spouse that were indicative of a rational, calm and thoughtful discussion — words like think, because, reason, why — the researchers found lower amounts of cytokines, the stress-related proteins. The researchers suggest it is because these kinds of words suggest that people are either making sense of the conflict, or at least thinking about it in a deeper, more meaningful manner.

Virtually the same research team led by Gouin et al. (2009) looked at the same set of couples’ attachment style in a separate study. Attachment style refers to Bowlby’s (1982) theory about how babies reacted to their parents in times of stress or danger: “Securely attached children exhibit distress upon separation from their mothers, but are quickly comforted when reunited. In contrast, anxious children exhibit intense distress upon separation, and are not easily soothed following their mother’s return. Avoidant children do not display signs of distress upon separation, and refrain from seeking contact upon reunion with their mothers.” The researchers note how this corresponds to adulthood relationships:

[Other researchers] argued that in adulthood, the attachment bond established between long-term romantic partners is similar to that of the parent–child relationship, albeit both partners serve reciprocally as attachment figures for one another.

Adulthood attachment style is defined along two dimensions. Attachment anxiety reflects fear of the partner’s rejection, separation or abandonment, while attachment avoidance represents difficulties in relying upon and opening up to others, and avoidance of intimacy with and dependency on one’s romantic partner. [...]

Anxious individuals worry about being rejected in their close relationships and are overly dependent on others for support and self-esteem. Avoidant individuals become uncomfortable and pull away when their partners get too close and prefer being self-reliant rather than asking others for help.

The researchers found that individuals with higher levels of attachment avoidance — those who pull away when their partners get too close — had larger stress-related proteins to a marital disagreement, compared to less avoidant individuals. These same folks also displayed more negative behaviors and less positive behaviors during the discussion of a marital disagreement. They found no significant relationship between people with attachment anxiety and the stress-related proteins.

The take-aways from these two studies?

Learning conflict-resolution skills will likely benefit your relationship. Being able to calmly and rationally discuss difficult issues in a relationship — money, family, child-rearing — will result in less stress. In addition, being “securely attached” in your relationship, or at least not using an avoidant attachment style, will benefit you as well. People who pull away in relationships are likely to have more of those stress-related proteins, behave more badly, and have less positive behaviors during a disagreement.

Read the full news article: Thoughtful Words Reduce Stress of Marital Conflict

References:

Gouin, J-P., Glaser, R., Loving, T.J., Malarkey, W.B., Stowell, J., Houts, C., & Kiecolt-Glaser, J.K. (2009). Attachment avoidance predicts inflammatory responses to marital conflict. Brain, Behavior, and Immunity, 23(7), 898-904.

Graham, J.E., Glaser, R., Loving, T.J., Malarkey, W.B., Stowell, J.R., & Kiecolt-Glaser, J.K. (2009). Cognitive word use during marital conflict and increases in proinflammatory cytokines. Health Psychology, 28(5), 621-630.

Pager et al. (2009) wanted to see if individuals of different races who had the same fictitious resumes would be treated equally when they applied for real, entry-level, low-wage positions throughout New York City. The researchers trained teams of participants — each of which included a white, black and Latino — to act and dress in a similar manner during the interview process. The participants were “chosen on the basis of their verbal skills, interactional styles (level of eye-contact, demeanor, and verbosity), and physical attractiveness.”

Across the board, the whites of the teams were offered jobs more often than either blacks or Latinos. Many times the white candidates were also channeled to better positions than the one that the employer advertised. Blacks and Latinos, on the other hand, were only half as likely to be offered a job compared to whites. And when they were offered a job, it was often a lower-paying, inferior position than the position advertised.

And here’s the real kicker — employers chose a white applicant who was just released from prison just as often as they chose a black or Latino applicant with a clean background. In many employers’ minds, a white criminal is on equal footing with non-criminal blacks and Latinos. Amazing.

It’s interesting that the researchers studied whether criminality had any effect on a person’s perceptions of suitability for a job, because when it comes to race and crime, it gets even worse.

In many crimes, the strongest and most convincing evidence is often that of an eyewitness to the crime. So it seems reasonable to ask — are eyewitness accounts reasonably accurate? I won’t delve into the research that examines this broader question, but instead I want to focus on just one component of this question — Can a white eye witness reliably and correctly identify faces of a different racial makeup than their own? Eyewitness accounts are the primary evidence used by prosecutors, jurors often regard eyewitness testimony as the most useful evidence in a trial, and eye-witness accounts are the most sought-after form of evidence during the criminal investigation.

Horry & Wright (2008) studied this question and came to the conclusion that, consistent with previous research, participants were almost twice as likely to misidentify a black face in the study compared to a white face:

Participants could remember the context for White targets better than they could for Black targets. This is an important finding. It is the first demonstration that White people are better at remembering the context in which they saw White faces. This suggests that people are less likely to remember the circumstances in which they encountered an individual of a different race. Research into bystander misidentification and mugshot exposure has shown that people can and do make mistakes concerning the context in which a face has been encountered. This study shows that these transference errors may be more likely in cross-race identifications.

Ouch. That means that when it comes to eye-witness identification, whites are twice as likely to mis-identify a black person than a white person. Obviously, this sort of high error rate has significant ramifications for trials and the use of eye-witness accounts. With lower accuracy comes a higher likelihood of error and identifying someone as the perpetrator of a crime when, in fact, they were not.

As the researchers noted, context is especially important. “When making an identification, witnesses must not only remember whether they have ever seen a specific individual, but also in what circumstance they encountered that individual.” Just because you recognize a face doesn’t mean you saw that face committing a crime (you could’ve seen them earlier in the day on the bus, or bumped into them on the way out of a bank).

Psychology researchers have been studying this phenomenon for years. They call it “cross face recognition” and term the bias we have toward correctly recognizing and identifying faces of our own race as “own-race bias (ORB).” This finding is fairly robust and has been replicated time and time again, across several races and in a wide variety of experimental settings.

As we can see from these two studies, we have a long way to go when it comes to racial equality in America. And not just in America, but also in the virtual worlds we create. We treat different races differently, and discrimination still exists. It affects our children in significant ways. Even when it comes to identifying a face in a crime — something that seems so straightforward and simple — it appears our ability to do so reliably is significantly compromised if that face a different race than our own.

References:

Horry, R. & Wright, D.B. (2008). I know your face but not where I saw you: Context memory is impaired for other race faces. Psychonomic Bulletin & Review, 15(3), 610-614.

Pager, D., Western, B., & Bonikowski, B. (2009). Discrimination in a low-wage labor marketing: A field experiment. American Sociological Review, 74(5).

But did you know that even a photo of you can create a first impression? New research discussed over at one of Newsweek’s blogs demonstrates how easily — and accurately — photos can convey information about our personalities. Simply by just looking at natural photos of other people, you can usually do a pretty good job of accurately gauging 9 out of 10 personality characteristics:

In the study, observers looked at full-body photos of 123 people they had never met. The observers viewed the people either in a controlled pose with a neutral facial expression or in a natural pose and then rated them on 10 personality characteristics. The authors of the study combined self-reported ratings from the people photographed with evaluations from close acquaintances to determine how well the observers were able to guess the traits.

Even when people stood in the controlled pose, the observers accurately judged some major personality traits, including extroversion, self-esteem, and even religiosity.

When people stood in a natural position, the judgments were accurate for nine of the 10 personality traits: extroversion, agreeableness, conscientiousness, emotional stability, openness, likability, self-esteem, loneliness, religiosity, and political orientation.

How does this relate to online? Well, guess what people tend to share with others on social networking websites like Facebook and Flickr? You got it — natural photos of themselves with others.

Such photos, according to a new study specifically examining Facebook, can tell a lot about you (even if you don’t think so):

A forthcoming study on Facebook, which will be published in Psychological Science next year, found that online social networking sites are not effective for promoting “idealized” identity. Instead, such sites often portray personality quite accurately, a finding that might help explain their popularity. As with the study on personality based on physical appearance, the Facebook study found that accuracy was strongest for judging extroversion and openness.

While it’s difficult to influence the way strangers judge you from a photograph, it’s even harder to control your overall online persona when other features like friend lists and Facebook message walls come into play.

“If I want to appear extroverted, I can’t just suddenly create 450 friends and have them post on my wall and have photos of me yelling drunkenly at the camera at yet another party,” says Samuel Gosling, an associate professor of psychology at the University of Texas and an author of both personality studies. “You can’t just fabricate those.”

These kinds of studies illustrate how difficult it is to remain “private” while on such networks. Even when you think you are minimally sharing, you are likely sharing more information about yourself than you realize. A photo here, a status update there… and before you know it, your entire personality (and good chunks of your personal life) and there for all to see. Fantastic, if that’s what you intended. A little scary if you thought you were sculpturing a specific persona for others to see.

Read the full article: Making a Digital First Impression: Why You Can’t Fake Your Facebook Profile

If you didn’t know, The Carter Center has been a leading force in helping to coordinate national mental health policy over the past two and a half decades. It does most of its work behind the scenes and is rarely noted for what it does best — bringing all stakeholders to the same table to talk and work on how they can advance policy and mental health agendas in the country. They do this through year-round work and collaborations with legislatures, advocates, organizations, non-profits, and others. And they hold an annual symposium that they describe like this:

In 1985, former First Lady Rosalynn Carter initiated the annual Rosalynn Carter Symposium on Mental Health Policy to bring together national leaders in mental health to focus and coordinate their efforts on an issue of common concern.

The symposia have represented a unique opportunity each year for this leadership to hear remarks from a variety of individuals with expertise on a selected topic; discuss diverse viewpoints in an open forum; identify areas of consensus and potential collaborations as well as points of divergence; and to recommend action steps for symposium participants to move an agenda forward.

Held each November, the symposia have examined such issues as mental illness and the elderly, child and adolescent illness, family coping, financing mental health services and research, treating mental illness in the primary care setting, and stigma and mental illness.

Of course, in the past decade, mental health (professionally, often referred to as “behavioral health”) and substance abuse in this country have undergone some significant changes. One of the more significant is the increasing communication among health professions — primary care physicians talking to mental health professionals, mental health professionals talking to substance abuse professionals, and so on.

“One of the most striking things I’ve seen happen has been the reduction in the silos between a lot of the disciplines we have to work with,” said Dr. Thomas Bornemann. “I have never seen the mental health and substance abuse worlds cooperating on the same agenda as they are doing now.”

Dr. Bornemann echoed that cooperation with primary care doctors has also improved substantially.

“We all go through primary care to get our health care,” Dr. Bornemann continued. “It doesn’t matter what diagnosis you receive, you will have to go through primary care to get there. Primary care is that doorway in, but it’s now a far more receptive doorway [for mental health concerns].”

He was also quick to note that he wasn’t just talking about primary care physicians, though, since a lot of specialties have increased their behavioral health focus and outreach as well.

“Primary care is broader than a single physician… Pediatrics, for instance, is a key component of reaching out to children early in their lives. Pediatricians have the ability to start catching issues much earlier, perhaps even preventing them from turning into adult concerns. OBGYN doctors for women can help reach out to women, for things like postpartum depression.” I asked Dr. Bornemann about some of the achievements the program is most proud of in the past few years, and naturally the conversation turned to the national parity law passed last year which takes effect on January 1, 2010. This law makes it illegal for insurance companies to discriminate against mental health concerns, such as the common practices of limiting their treatment or denying coverage for pre-existing conditions.

(left) Carter Center Mental Health Program Director Thomas Bornemann Ed.D. and (right) former First Lady Rosalynn Carter share notes from the 25th anniversary Rosalynn Carter Symposium on Mental Health Policy. The 2009 symposium theme was “Health Care Reform: Challenges and Opportunities for Behavioral Health Care Reform.”

“I’m proud of the work we did behind the scenes on parity. But remember, we were just one small player among many. Mrs. Carter played a particularly strong role, particularly near the end, when she made endless phone calls and visits with legislatures to help ensure its passage.”

“Working with our colleagues in many different organizations, we all banded together and got it done. That was very rewarding to finally see happen after all these years.”

In addition to its behind-the-scenes work on national mental health parity, The Carter Center was also instrumental in helping to craft how to get the message out for the groundbreaking Surgeon General’s report on mental health, the first of its kind. What makes The Carter Center’s role in mental health policy unique?

“Our voice and our organizational abilities can help bring disparate groups to work together,” Dr. Bornemann noted.

“We work with universities, academics, advocates, government entities, pharmaceutical companies, health plans, but we’re not owned by any of them. We bring those groups together and serve in a catalytic function.”

“We don’t have a dog in the race. We’re uniquely positioned to help these groups come together, communicate, learn to work together.”

In two upcoming blog entries, I’ll be discussing Georgia’s struggle with its state mental health programs and facilities (which will be familiar to regular readers of World of Psychology), as well as the specific recommendations that came out of the 25th symposium.

Learn more about The Carter Center’s Mental Health Program.

The mistake we’re repeating today is not doing enough to recognize and take care of veterans’ mental health needs. This isn’t some feel good mantra. This is a very real need that the military continues to have problems meeting. A professional, nonprofit that represents 1,600 behavioral healthcare organizations released a press release yesterday detailing some of the continuing issues.

“For instance, while the Veterans Mental Health Act was signed into law more than a year ago, a new survey released today by the National Council for Community Behavioral Healthcare (National Council) finds that veterans still face significant barriers to accessing mental health and substance use treatment. The Act requires the US Department of Veterans Affairs (VA) to partner with community behavioral health centers to increase capacity and expand mental health services to include marriage and family counseling.

“The survey of National Council members nationwide shows some of the most
serious roadblocks that prevent veterans from getting treatment include:

• Access to Care: Almost two-thirds of respondents said veterans and their families experience long delays to get initial appointments for people in crisis and excessive waits in between appointments.
• Long Distances: Veterans often must travel long distances to the VA or a military base. Travel times can be as long as five hours in rural areas. Others do not have access to a vehicle or public transportation, or may be unable to drive or take public transportation because of physical and
  mental limitations.
• Stigma: Many veterans are concerned that seeking treatment from the VA or military will be noted in their personnel records, negatively impact their careers, and label them as “weak” or “crazy.”
• Lack of Family Involvement: Though the Act specifically includes marriage and family counseling, few family members are involved in treatment. Respondents suggested these services are either not being provided or have not been widely promoted.”

“[Survey] respondents cited the consequences of not meeting the needs of veterans, service members and their families. For example, Indiana received 69 calls from returning de-activated soldiers that involved suicide attempts during the first six months of 2009. Six of those returning service members ultimately died. Respondents in other states reported problems of domestic violence, divorce, homelessness, unemployment, and criminal justice system involvement.”

While we remember veterans today, we must not forget the very real mental health concerns they face when they return home. Vets, both young and old, should not be forgotten.

Major Nidal Malik Hasan is now apparently conscious and talking in his hospital bed, after being shot multiple times by Sgt. Kim Munley, a civilian police officer, who selflessly and heroically put herself in harm’s way in order to save countless of others’ lives. Munley is in stable but good condition and is very upbeat, according to news reports. Virginia Tech helped guide Munley’s aggressive response to Hasan’s shootings. “The lesson from Virginia Tech was, don’t wait for backup but move to the target and eliminate the shooter,” says Chuck Medley, chief of Fort Hood’s emergency services, telling the Christian Science Monitor. “It requires courage and it requires skill.”

It’ll be interesting to hear what Hasan has to say, but don’t be surprised if he sheds little new light on his actions. Criminals often justify their acts with rationalizations that make rational sense only to them.

What is clear is that Major Hasan was a troubled, conflicted individual. Some are calling him a terrorist, which means, literally, the systematic use of terror (a state of intense, extreme fear or anxiety), especially as a means of coercion. I’m not certain what Hasan was hoping to coerce by his actions — perhaps an end to the wars in Afghanistan and Iraq? — and I’m not sure he was very systematic about it, since he chose a place where most of have never been, seen or knew much about (an Army training camp). But indeed, if his aim was to induce terror, I’m certain he was successful that day.

Hasan’s Increasing Opposition to the Wars

Hasan increased his opposition to the wars as his military career — and the wars — progressed (he entered the military before the wars). According to the most recent New York Times article, during the past five years, Hasan also began openly opposing the wars on religious grounds. But amongst the rank of doctors, opposition to war is not uncommon. After all, doctors see the bloody reality of war in their work every day. And Hasan — in his work as a psychiatrist as someone who sometimes saw and talked to veterans who returned from combat — likely understood the psychological and emotional toll such combat can have on a human being.

The New York Times also reports that over the past decade, Hasan had increasingly turned to his own religion, Islam, for answers. This is not uncommon for a person to do, especially after he lost both his parents within 3 years of one another in 2001. Combined with the terrorist attacks on the U.S. in 2001, instead of making Hasan more pro-American, it apparently turned him more pro-Islam. Ordinarily that wouldn’t be much an issue for most people. But it certainly could become an issue when you’re fighting two wars against people who are primarily Muslim.

The heart of the matter is this, however — Muslims serve with honor throughout the military, in society and in our government every day. While many of them object to the wars — just as many, many Americans in general do — most of them don’t take forceful, violent action with their objections.

Hasan Lacked Support, Conflicted About His Religion

Hasan was different. He psychologically had difficulty with accepting his conflicting roles as a Muslim and as someone who would be called upon to heal those who are actively fighting Muslims. (As a psychiatrist, while he may have indeed been in a combat zone, it’s unlikely he would’ve seen any direct action himself.) When most of us are seriously conflicted about major decisions in our lives, most of us take actions to find a solution to the conflict — we work it out with others, we talk to a professional, we seek guidance in our faith, friends and family.

Hasan apparently didn’t have a lot of friends and also doesn’t seem to have had much contact with his family. Social support — so important in keeping us connected with society and those around us — seemed to be seriously lacking in this man’s life. He sought others’ counsel and friendship, but apparently did little with the advice he was given and had only a few acquaintances.

Except that theory isn’t exactly based in logic or what we know about parenting from research. What new parents of their first child most often rely on for their parenting expertise and skills are their own upbringing and advice from their own parents or siblings who have children already. Not exactly rocket science, right? I mean, how hard is it parent a child??

It’s not hard to be a parent to a child. But it is incredibly hard to be a consistent, good parent to a child (as first-time parents quickly learn). Children are a constant, never-ending responsibility from age 0 to somewhere in their teens (and of course, even then, it doesn’t really stop).

So in our focus on raising good children, we should respect research that demonstrates that it’s not one’s sexual orientation that determines good parenting or not. (In fact, that’s a ridiculous assumption to begin with; why not suggest that people who have a certain religious perspective make the best parents, or only those who were raised in a house with more than 2 children themselves?) Yet, in an effort to put restrictions on gay fathers and mothers who want to have children, you see some people arguing against them for the sake of the children. Thankfully, the research doesn’t back up their argument, as Lisa Belkin in The New York Times Magazine so thoughtfully noted in a recent article on the topic:

But even if parents who seek parity do so for their own sanity and in pursuit of their own ideals, might it not also be better for their children?

Yes, if less conventional, more tolerant children are your goal. Because if the children of gays and lesbians are different, it is presumably related to the way they were raised — by parents with a view of domestic roles that differs from most of their heterosexual peers.

Same-sex couples, it seems, are less likely to impose certain gender-based expectations on their children.

The article is based upon a new book from Abbie E. Goldberg, an assistant professor in the department of psychology at Clark University, that reviews more than 100 research studies about this very topic — how do children of lesbian mothers (mostly, as gay dads haven’t been studied as much) fare? Dr. Goldberg summarizes her findings — “These children do just fine.” She didn’t find any negative impact to children being raised in a gay household.

If we want what’s best for the children, then, we have to acknowledge that gay parents don’t pose any particular problem. In fact, such parents may actually help raise more gender-neutral children who are open to more possibilities for their careers and lives. Food for thought as the gay marriage debate continues on throughout the country.

Read the full article: The Way We Live Now - What Gay Parenting Teaches Us All

In the meantime, I present to you some of the best postings from our blogs in the past week:

The Fort Hood Massacre: A disturbed psychiatrist, a gun and the reality of war

(Depression On My Mind) - I will go to my therapist’s office this afternoon. I will sit in the waiting room and read an old magazine. Another client will walk from a hallway that leads to my therapist’s office, pass through the waiting room and leave. My therapist will poke her head out, smile and …

Reclaiming Sexual Intimacy in Your Relationship

(Healing Together for Couples) - It takes more than just showing up to reclaim or renew a good sexual relationship. Would you just show up on the dance floor to dance the tango together? Apart from the fact that you may have no interest in the tango – probably not. To really dance, you …

Exploring the Upside of Depression

(Mindfulness and Psychotherapy) - Sharon Begley, science editor for Newsweek and author of The Plastic Mind: New science reveals our extraordinary potential to transform ourselves, just wrote an interesting article titled The Upside of Depression. In this article she reviews some recent research that basically flies in the face of the “Happiness” surge and says …

Are We Exploiting Daniel Johnston?

(Celebrity Psychings) - Out of those of you who weren’t familiar with Daniel Johnston when I told you about his performance at the Austin City Limits Music Festival last month, I’m willing to bet more than a few of you found him interesting (even if you read only my brief introduction to him). …

More Thoughts on Hurtful Family Relationships

(Family Mental Health) - Hello dear Family Mental Health readers. Due to an inclusion in an Everyday Health newsletter, my blog post Can You Step Away From a Hurtful Family Relationship? post got a tremendous response. If you are now a new reader because you saw that post and have come back for more…

Beyond Mindfulness

(Anxiety and OCD Exposed) - My wife, Dr. Smith, and I are big fans of mindfulness approaches to therapy and we’ve included discussions of mindfulness in most of our self help books within the For Dummies series (including Borderline Personality Disorder For Dummies). In brief, Mindfulness is typically described as involving focused attention on experiences …

Bipolar Disorder Q & A: How Do I Tell My Doc, “This Isn’t Working?!”

(Bipolar Beat) - Garett Asks: “Five months ago, I was diagnosed as having bipolar disorder. First I was on Depakote and then I told my doctor I was still having major problems with my sleep. I was always up and about knowing it was 3 o’clock in the morning. I told her about the …”

7 Signs Your Body Image Is Bruised (and 5 Solutions)

(Weightless) - In this day and age, it seems like a positive body image is a rarity. Whether you fit today’s skinny standards or wish you did, most women have issues with their bodies. Some may argue that bickering with one’s body is as old as time. We frequently hear friends and family lament about their thick thighs or pudgy middle. Personally, whether I’m with family or friends, an hour doesn’t go by without someone saying that they shouldn’t be eating that much, must skip dessert…