Bean’s Café is a non-profit soup kitchen and day shelter for homeless individuals and others in need in Anchorage. Bean’s Cafe has been serving hot meals to our neighbors living wth hunger since 1979. They provide a hot breakfast and a hot lunch seven days a week, as well as day shelter (a warm, safe place to go during the day). 

Bean’s Cafe is powered by volunteers.  It takes 92 volunteers to open for breakfast. Volunteers come from the client population as well as the community. Volunteers clean, prepare the meals, set up the dining area, and take care of other chores. Client volunteers have the opportunity to grow into Bean’s Cafe employees. I recently met someone who has worked at Bean’s for 15 years after coming there as a client, and it’s wonderful to see him giving through the organization that gave to him when he was in need.

In FY2011, Bean’s Cafe provided almost 420,000 meals. That’s about 575 people served per day. They also have a lunchbox program providing food for needy children on weekends and during the summer (almost 100,000 meals provided in a year).

Demand for meals and food stuffs has increased significantly over the last year, especially during the winter – and giving has decreased. Food banks are seeing more individuals and families requesting food boxes, which leaves less for the soup kitchens. It’s hard for organizations like Bean’s Cafe to continue to meet the need.

People receive more than just hot meals at Bean’s Cafe. They also have access to help with much needed social services. Coordination and referral services are provided in partnership with community agencies like Anchorage Community Mental Health Services,  Brother Francis Shelter, and others to help clients access all the services that might help them.

If you’re wondering “Why is this blog post about the soup kitchen?” — here’s why. Bean’s Cafe administrators report that individuals with mental health disorders make up 40-60% of their clients. The National Coalition for the Homeless reports that the symptoms and stresses of living with mental illness create a greater risk of becoming homeless, especially among people who experience a serious mental illnees like schizophrenia. Homelessness and food insecurity (or hunger) are inextricably linked.

So, while Bean’s Cafe and programs like it aren’t typically associated with the mental health system, they are an essential provider of services — and compassion — for individuals in poverty who also experience mental illness.

Photo by Bean’s Cafe

First, what is a “developmental disability?” According to the Centers for Disease Prevention and Control National Center on Birth Defects and Developmental Disabilities, a developmental disability is a severe and chronic condition due to mental and/or physical impairments. People who experience developmental disabilities may have problems talking, walking, learning, taking care of themselves, and living independently. Developmental disabilities present during childhood (up to age 22) and usually last a lifetime. Autism, FASD, blindness, intellectual impairments, and physical impairments are all examples of developmental disabilities.

When someone has a developmental disability and then develops a serious emotional disturbance or serious mental illness, it can be very hard for them to find and access the right services. Children with a dual diagnosis (developmental disability and mental health disorder) are often not identified early, which can lead to them to ending up in the child welfare or juvenile justice systems because their needs aren’t understood.

Mental health services are usually not offered by the same agenices — or even the same systems — as disability services. This fragmented way of caring for people can mean that people go without the services they need. Luckily, there is interest at the federal and state level to coordinate services better. 

In Alaska, the divisions of behavioral health and disability services work much more closely than they used to. And the Governor’s Council on Disabilities and Special Education is a frequent partner with the Alaska Mental Health Board and Advisory Board on Alcoholism and Drug Abuse in areas that help all of our constituents.

Even with that policymaking partnership, we hear that people with a dual diagnosis aren’t always able to find the right services. Not all mental health and substance abuse treatment providers have experience or expertise in treating people with developmental disabilities. And not all disability providers recognize when behaviors are due to mental or emotional disorders instead of cognitive impairments.

Have any of you had experiences trying to find services for a dual diagnosis? Were you able to find help in your community? Do you or someone you know need coordinated services for a developmental disability and mental health disorder?  We’d like to hear more from Alaskans on this issue as we explore how to better serve this specific population.

In the meantime, here are some resources that might be of interest:

• The National Association for Dual Diagnosis is a non-profit membership association established for professionals and families to increase understanding of and services for individuals who have developmental disabilities and mental health needs.
• The Co-Occurring Disorders Institute (CoDI) was founded to provide the best professional practices to providers working with mental health, substance abuse, developmental disabilities and complex behavioral health issues in the Mat-Su Borough. CoDI works with families who have youth in residential treatment. The care management services CoDI provides can help address the fragmented services systems that families and people experiencing dual diagnoses must navigate.
• Alaska’s Aging and Disability Resource Centers (ADRC) connect seniors, people with disabilities, and caregivers with long-term services and supports of their choice. The ADRC network serves Alaskans statewide, regardless of age or income level. For more information, call
  1-877-6AK-ADRC (1-877-625-2372).
• The Complex Behaviors Collaborative was developed by the Divisions of Behavioral Health and Senior and Disability Services (and many others) to provide expert technical assistance and consultation to providers, caregivers, and families to help individuals whose challenging behaviors (due to disability) place them at risk of institutionalization.  The Collaborative serves adults and youth who experience mental illness and developmental disabilities (among other disabilities).

PTSD is a mental health disorder that results from experiencing a traumatic event. A traumatic event can be something like a violent assault or rape, serving or living in a combat situation, surviving a natural disaster like an earthquake or flood, or being in a terrible car crash. 

Not everyone who experiences a violent or traumatic event develops PTSD.  Of people who experience a traumatic event, about 8% of men and 20% of women develop PTSD. For people who have been sexually assaulted or in combat, the estimates are higher.

And not everyone who develops PTSD directly experienced the trauma. Children who witness domestic violence and abuse, or other violent acts against a parent or sibling, can develop PTSD.  In Alaska, we also recognize that historical or intergenerational trauma can lead to people experiencing symptoms of PTSD (despite the remoteness of the traumatic event).

When we experience a traumatic event, it’s normal to feel afraid, angry, anxious, sad or depressed, or guilty. The symptoms of PTSD are different from these basic reactions to stress and trauma.

Someone who has PTSD might relive the event over and over, feeling all the terrible feelings from the original event. This can lead to the person to avoid anything or anyone that could remind them, or trigger flashbacks, about the event. Emotional numbness is a symptom of PTSD — an inability to feel anything good as a way to avoid feeling the fear and anxiety associated with the trauma. Some people have trouble remembering what happened (or try not to remember). Some people are agitated, hypervigilant and alert, jittery, and easily startled. People with PTSD often feel ashamed or isolated. Some people use alcohol or illegal drugs to deal with these symptoms (but this is not a helpful or healthy way to cope).

PTSD can be treated, and people can regain their lives. Cognitive behavioral therapy has been shown to work for some people who experience PTSD. Some medications, especially in conjunction with counseling, have helped people with PTSD.

The U.S. Veterans Administration has created a National Center for PTSD where you can find all sorts of information and interactive education about PTSD, its causes and symptoms, effective treatments, and where to find help.

And remember, if you are in crisis or need someone to talk to, call Alaska Careline or access live chat 24/7 from the Veterans Crisis Line.

The goal of these teleconferences is to hear from stakeholders about what budget and policy recommendations AMHB and ABADA should make for the 2014-2015 fiscal years. We need your help to make sure that the recommendations made are relevant and helpful to you and your communities. Everyone is welcome at all the teleconferences, though we have tried to focus on a particular group of stakeholders for each. Provider teleconferences are for all prevention, treatment, and recovery services providers.

Here’s the schedule — all the calls are at noon at 1-800-315-6338, code 8920#.

Consumers and Family Members (statewide) ~ June 12, 2012
Regional Providers in Anchorage, Mat-Su ~ June 13, 2012
Regional Providers in Fairbanks, Interior ~ June 18, 2012
Regional Providers in the Arctic, Northwest Alaska ~ June 19, 2012
Regional Providers in the Southwest, Far West Alaska ~ June 20, 2012
Behavioral Health Aides (statewide) ~ June 21, 2012
Regional Providers in the Copper River, Kenai Peninsula Region ~ June 22, 2012
Regional Providers in Southeast Alaska ~ June 29, 2012
Consumers and Family Members (statewide) ~ July 2, 2012
Last Chance Teleconference (all are welcome) ~ July 3, 2012 

If you have questions, call us at 465-8920 or 1-888-464-8920. Thank You!

The Mental Health Budget is developed by the Alaska Mental Health Trust Authority in conjunction with the Alaska Mental Health Board, the Advisory Board on Alcoholism and Drug Abuse, the Commission of Aging, and the Governor’s Council on Disabilities and Special Education.  These boards — and all of our constituents – play a key role in deciding what programs and projects are recommended for funding in the Mental Health Budget.

In order to make sure the Mental Health Budget reflects the needs of Alaskan communities, we need your help. We depend on stakeholder input to provide guidance about operating and capital budget recommendations. An important consideration in making budget recommendations is identifying the gaps in our continuum of care. We recognize that you, as the individuals and organizations providing and receiving services from the public behavioral health system, are most aware of those gaps and how best to fill them. We look to you for help to find the best ways to address system needs. The information you provide complements the information we gather year-round from meetings with stakeholders around the state.

We will be accepting stakeholder input for the FY2014-2015 Mental Health Budget until July 6, 2012. We know your time is valuable, so we want to keep this process informal. You can leave a comment here on Speak Your Mind, post to either of the Boards’ Facebook pages, or email our director at Kate.Burkhart@alaska.gov.

Previously I’ve posted on the power of language in our work, and how important it is to use empowering and inclusive language. So I love (LOVE!) the idea of considering people who have survived an attempt to commit suicide as “overcomers.” Overcoming despair, overcoming hopelessness, overcoming depression, overcoming suicide – whether it’s for a day, a month, or a year –   is an achievement we should support and celebrate.

The data shows that someone who attempts suicide is more likely to attempt suicide again within the next 6-12 months. In Alaska, 819 people attempted suicide in 2007 and 149 people died by suicide. We focus on the lives we’ve lost, and the grief we feel over those losses – but shouldn’t we also celebrate and support the 670 people that lived?

What prevents us from supporting and caring for someone who has attempted suicide?

Are we afraid that if we talk about it, they will try again? (That’s just not true – research shows that talking with someone about their feelings of suicide and how to find help actually can prevent suicide.)

Are we afraid it might be our fault? (We can’t assume responsibility for the feelings of suicide experienced by someone else. We can take responsibility for helping, or choosing not to help, someone in crisis.)

Are we afraid we don’t know what to say? (You can find something to say. You can seek out training, like Mental Health First Aid or ASIST, to learn how to listen and what to say. Or, you can simply say “Your life matters to me.”)

If we acknowledge our own fears, and recognize that those fears are unfounded, we can then be brave and open our hearts to someone who needs support and love in their journey of overcoming.

A Quilt Made in Honor of Loved Ones Lost to Suicide

Listen

Too often we are busy thinking about what we want to say, rather than listening. But listening is one of the best things you can do for someone who has attempted suicide. In your listening, be honest and open with them and with yourself. Part of that is, if you say “you can call me anytime,” make sure your phone is on and you’re able to be there any time.

Learn

Learn what helps the person by listening and asking them “how can I help?” Then, support them in the way(s) that best help them. Learn what services and supports are available in your community so you can encourage the person to seek help and support (and you can seek help and support for yourself if you need it).

Love

The panelists who had attempted suicide shared the value of love in supporting someone who is at risk. Their advice: express care and concern for the person who has attempted suicide. Be brave and confront stigma and your own misunderstandings about suicide (part of that learning aspect). Take care of yourself, too. Know your own limitations and honor them – don’t take on more than you can handle emotionally or mentally.

Live

This was a surprising point made by the panelists, who warned against making supporting someone who has attempted suicide the central part of your life. It’s understandable that we would want to make the safety and health of someone we love the most important thing in our lives – but that turns out not to be helpful to the person who has attempted suicide. Living and sharing our own lives is an important way of supporting someone who has attempted suicide.

We can support a friend or loved one after an attempt. We can help them on their journey of recovery, if we are brave and honest in our efforts.

And if you are someone who has attempted suicide, know that you are courageous and strong. And on days when you feel hopeless and alone, know that there are people – many of whom have walked the same road you are on — who want to support and care for you.

Your life matters.

If you are interested in finding or providing support for yourself or someone who has attempted suicide, there are some resources available. While there are not formal support groups for attempt survivors in Alaska, the Peer Support Consortium can help you find a peer support organization in your community. NAMI has chapters in communities in Alaska. If you know about other resources, or are interested in developing supports in your community, email kate.burkhart@alaska.gov.

Interestingly enough, the same topic came up in several of this week’s discussions related to updating Alaska’s state suicide prevention plan. There was concern that the language we use in our planning and prevention work might be confusing or even off-putting to the very people we want to engage.

In suicide prevention, a “survivor” is someone who has lost a loved one to suicide. A person who survives an attempt to commit suicide is referred to as an “attempter.” So, in order for there to be a survivor, someone has to die. That just doesn’t make sense.

Suicide prevention is broken into three categories: prevention – intervention – postvention. When I started this work, I wondered “what the heck is postvention?” I learned it’s a label created for how we respond after a suicide to prevent the domino effect often seen after someone dies by suicide.  If the point is to prevent additional suicides, why isn’t it just “prevention?”

This laguage issue is a possible barrier to bringing primary care providers into the suicide prevention effort. Suicide prevention focuses on preventing death in a time of crisis – kind of like the way emergency rooms treat people.  This focus on the end, and the emergency nature of the end, of the spectrum has made it hard to get primary care providers involved in this work. Their job is to diagnose and manage diseases, not do triage and emergency medicine. So why would they focus on what are thought to be exclsuively mental health emergencies?

Maybe if we explained that suicide responds to the same protocols and interventions as other chronic diseases, that would make more sense. You wouldn’t treat hypertension without checking (and rechecking) a patient’s blood pressure. You wouldn’t treat hypertension without explaining to the patient what he can do to help lower his blood pressure. And you wouldn’t treat hypertension without connecting the patient to the services and supports he needs to improve his condition. All those things – screening, patient education, referrals  — work to help someone early on to prevent the crisis that can lead to suicide.

There is a movement to help people stay healthier so they avoid the health conditions that can end up in the emergency room (heart attacks, strokes, etc.), Shouldn’t suicide prevention include a similar focus, helping people stay mentally and emotionally healthy so they don’t end up in that place where they are considering suicide and need emergency services?  And shouldn’t we use common language?

Maybe we need to think about how we talk about suicide, and find ways to use empowering and common sense language in this work? If so, how would we do that?

So, what is “suicidology?” It’s a term for the research and study of suicide and suicide prevention. Many people see it as an area of study that crosses many disciplines, rather than being narrowly focused on psychology or psychiatry. The  American Association of Suicidology is a national organization of researchers, suicide prevention professionals, survivors of suicide and others committed to furthering research and evidence based prevention strategies.

I am honored to have been invited by the American Association of Suicidology to not only present at their annual conference in Portland, but to work with a rock star group of experts tomorrow to problem solve the integration of suicide prevention in primary care. This is especially exciting for me, given the work the Suicide Prevention Resource Center, Alaska Native Tribal Health Consortium, and the Boards have put in to developing a pilot project in Alaska.

The Suicide Prevention Resource Center has developed a primary care suicide prevention toolkit to help physicians and community health providers screen and respond to patients at-risk for suicide. (This is the tool I’m hoping we can pilot in Alaska.) The National Association of Pediatric Nurse Practitioners will soon have a new online resource for pediatric nurse practitioners (I got to meet the creator, Dr. Ginger Biddle tonight at dinner). These are just two examples of efforts to help family practitioners, nurses, optometrists, dentists, and other primary care providers serve as a resource for early identification of suicide risk and better intervention to save lives.

I’ll be blogging about AAS and everything I learn this week, so please check back and share your thoughts and ideas. Together, we can all act to prevent suicide in Alaska.

“The sun feels warm on my face.”
“The yummy smell of that soup on the stove reminds me of my grandma’s kitchen. I used to love to sit there and watch her cook.”
“My legs are sore after that workout, but I feel so much less stressed now.”

That sounds simple (and maybe silly), but think about all the times you looked down and your plate was clean but you had no idea how your dinner tasted.  Or looked up at 5:00 p.m. and wondered where the day went.  Or realized that you just hung up the phone and couldn’t remember what you and your friend had talked about.

A wandering mind will not lead you to happiness and well-being. According to recent research, people spend almost half their time (47%) thinking about something other than what they are doing. 

(Yes, I’m multi-tasking as I write this.  I’ll stop and come back later when I can pay better attention to it.)

. . .

All that day-dreaming and distraction, according to recent research reported in the Harvard Gazette and Science, can lead to unhappiness. Psychologists Matthew Killingsworth and Daniel Gilbert (both of Harvard University) reported that the “human mind is a wandering mind, and a wandering mind is an unhappy mind.” 

 That’s kind of depressing – we’re naturally disposed to woolgather, but that means we’re naturally disposed to being unhappy?

Their study involved 2,250 people aged 18-88.  According to the study, participants reported their minds wandered away from whatever they were doing nearly half the time.  What they were doing didn’t really matter – their minds drifted to other things 30% (or more) of the time.  The researchers found that people were happiest exercising, having a conversation with someone, and  . . . (yes, it’s what you think).  They were least happy when resting, working or using their home computer. 

So, the fact that you are vegging out on the couch reading this blog means you are probably less happy than you would be if you were at the gym or gabbing with a friend.

According to Matthew Killingsworth, “mind-wandering is an excellent predictor of people’s happiness.” How often our minds leave the present — and where they end up – is a better predictor of happiness than the activity we’re doing.  Which led him and his research partner to conclude that the idea that happiness is “in the moment” – and that being aware and present in the here and now is healthier than always thinking about what’s next or what was – is probably right.

Knowing that, how can we learn to be mindful? For some people, it can be as easy as slowing down, taking a breath, pausing. For others, it’s yoga or meditation. Mary, a participant in the Sound Minds in Sound Bodies campaign, shared that she is using basic yoga to help her boost her awareness of her mind and body, and she’s feeling happier: “I feel totally grounded and have way more energy.”  Just by making time to pay attention each morning (before the day’s distractions kick in.)

The common theme to these mindfulness-building exercises is single-mindedness. Not texting and talking. Not thinking about what’s for dinner while you wolf down your lunch. Not making your list of household repairs while your dad is trying to tell you about his colonoscopy.  (Okay, maybe you get a pass on that last one. . .)

The essential idea is that, by paying attention and noticing what’s happening around you and how you feel inside, you can actually increase your happiness, which boosts your mood and leads to better health.