A friend of mine who is a federal judge in the county told me once that his biggest lament in this job is the fact that about 60% of the people he convicts to the criminal justice system suffer from some degree of mental illness which is often undiagnosed.
This week the Cleveland Plain Dealer ran a sobering article in the Sunday Focus Section describing the fate of the nearly 300 mentally defendants who file into Cuyahoga County jail each day.The article explains that there are Mental Health services sections in the jail and even mental health courts.The challenges lie in the area of providing the psychiatric support and most importantly, the medications needed to stabilize patients.
The Nord Family Foundation has a legacy of providing support to the mentally and emotionally ill members of the community.Founder Walter Nord served on the Lorain County Mental Health board in the 1940’s and with personal investment leveraged with funding from the State Mental Health board established what is now The Nord Center.
“Nearly 1 million people a year suffer a heart attack – making teaching CPR an important element in public health education. But while 1 million is a big number, it represents less than 1 percent of the population.
Meanwhile, about one in four Americans experience depression, anxiety or other mental illness. That means you’re much more likely to encounter someone having a mental health crisis than someone having a heart attack.”
The MHFA program is offered in the form of a 12-hour course that presents an overview of mental illness and substance use disorders in the U.S. and introduces participants to risk factors and warning signs of mental health problems, builds understanding of their impact, and overviews common treatments. Those who complete the 12-hour course are then certified as Mental Health First Aiders and learn a 5-step action plan encompassing the skills, resources and knowledge to help an individual in crisis connect with appropriate professional, peer, social, and self-help care. The program is suitable for a variety of audiences including primary care professionals, employers and business leaders, faith communities, school personnel and educators, state police and corrections officers, nursing home staff, mental health authorities, state policymakers, and the general public.
Suggested by Trustee who had heard about the MHFA our staff has been laying the groundwork for a foundation initiative to bring MHFA to Lorain County. To institutionalize MHFA in Lorain County, we are initiating a Train-the-Trainer option. One local individual has completed national instructor training through Mental Health First Aid USA.This is a five-day training program that results in a three-year certification as a MHFA Instructor, qualified to offer the 12-hour community education course and certify Mental Health First Aiders.Instructors must commit to provide MHFA training at least three times annually in their community.
The Lorain County Board of Mental Health has committed financial and in-kind resources to assist with the launch of this effort.
Starting this summer, MHFA courses will be offered in Lorain County, at no cost to Lorain County residents.The 12-hour course is ideally offered over two consecutive days for a maximum of 25 people at a time.Each participant is provided with a workbook and a variety of handouts..
A number of suitable training facilities are available in Lorain County. The Lorain County Chapter of the American Red Cross has offered their facility as a community training location, underscoring the intent of MHFA to become as common as the Red Cross’ First Aid training program.
Foundation investment in the pilot is $20,000.This amount will cover the costs associated with training a local Instructor, then to subsequently offer a total of up to six community trainings over a two-year period for a total of 300 people.We see this as an important contribution to educating the public on the need to understand mental illness in our communities and respond appropriately.
Many thanks to Senior Program Officer Karen Cook who did most of the research behind this post.
In October 2011, I attended a session at the Annual Meeting of Philanthropy Roundtable with the title: Four Models for Addressing Chronic Unemployment and Homelessness. Four Models for Addressing Chronic Unemployment and Homelessness
Homelessness, hunger, and unemployment cry out for solutions. The most sustainable solutions, however, often depend on the homeless, hungry, and unemployed building self-reliance and in turn reclaiming their lives and restoring their positions in their families and their communities. Training programs can help people to accomplish this for themselves in a variety of ways. On this panel, representatives of four exemplary social service organizations will outline the best ways for private charity to help people to help themselves—from faith-based approaches and getting people off the streets to providing permanent housing and re-purposing unused food for job training.
Barbara Elliott, president and founder, Center for Renewal and board member, Work Faith Connection
Sister Mary Scullion, executive director and president, Project Home
Jennifer Vigran, chief executive officer, Second Helpings
Matt Minkevitch, executive director, The Road Home
Betsy Bikoff, vice president and chief grant making officer,Richard M. Fairbanks Foundation (Moderator)
Each of the panelists described programs they developed to assist the homeless as they identify a path to self-sufficiency. It was evident that the number of homeless people is increasing in each of the geographic areas represented by the panel. “Overwhelming” was a word used to describe the pressures the increased numbers place on their organizations. Every one of these programs is able to describe success for a large number of the clients they served; but at the same time, they admitted to seeing an increasing number of people for whom the simplest steps to recovery and “self-help” remains a challenge.
Those studying the homeless populations now make distinctions among the people they serve: (1) those who are homeless due to sudden changes in economic situation or temporary set-back and (2) the “chronically homeless” who appear to be mentally and/or emotionally ill and/or with substance dependency. Typically this group faces a longer time horizon to stabilization and the rates of recidivism are very high. Some never reach stabilization. During the question and answer period, I referenced an article from the December 24, 2010 New York Times called, “The Street Level Solution.” The article cites studies that find a significant number of chronically homelessness people having a history of Traumatic Brain Injury (TMI). The author David Bornstein writes that it is important for providers to distinguish the chronically homeless in order to better understand the true problem. His research brought him to Dr. James O’Connell,“…a doctor who has been treating the most vulnerable homeless people on the streets of Boston for 25 years, (he) estimates that 40 percent of the long-term homeless people he’s met had such a brain injury. ‘For many it was a head injury prior to the time they became homeless,’ he said. ‘They became erratic. They’d have mood swings, bouts of explosive behavior. They couldn’t hold onto their jobs. Drinking made them feel better. They’d end up on the streets.’ ” I asked the panelists if they were aware of this and related research and; if so, were they seeing it? Every one of the panelists shook their heads in agreement and suggested that there was little understanding among those in the public sector about the gravity of this problem. Matt Minkevitch said he is certain that many clients at The Road Home have had a history of past brain injury.
In his opinion, the crisis is rooted in the fact that clients often present symptoms that look more like those that need to treated by an assortment prescribed psychotropic drugs usually through mental health departments. He described one client in particular who had been in and out of the mental health system treated as a schizophrenic and sedated. He never responded to the pharmacopeia of psychotropic medications which puzzled the many physicians and mental health providers. The client who was well-known to all at the Road Home discussed his suffering on many occasions. He killed himself after a particularly violent episode. His case was of enough interest that an autopsy was performed. The autopsy report showed that the man was not schizophrenic at all, but had been experiencing brain seizures related directly to a traumatic brain injury.
Clearly the chronically homeless will remain a challenge for many in the years to come. Most disturbing to us and the providers is the increasing number of veterans who are appearing at homeless shelters across the country. This phenomenon parallels the stories of men and women returning from Iraq and Afghanistan suffering from Post Traumatic Stress Disorder – a subset of whom have experienced brain trauma.
As a foundation that hopes to address the root causes of poverty, I think this apparent link between homelessness and TBI is worth exploring. I would suggest that other foundations that support programs dealing with homeless populations do the same. Since January 1, 2002, The Nord Family Foundation trustees approved 70 grants totaling $1,460,300 that provided support in some form or another to homeless populations. This number includes grants across both the Health and Human Services &Civic Affairs program areas, and includes supportive programs such as Children’s Garden that provides child care for homeless families and the Lorain County Furniture Bank that provided furniture to families transitioning out of homelessness. Other foundation grants by geographic areas (excluding matching grants) include:
Damen Project
The Delores Project The Gathering Place
St. Francis Center
Urban Peak
Warren Village Step 13
Columbia:
Family Shelter
Salvation Army Midlands
Women’s Shelter
The Nord Family Foundation’s concern for the homeless can be traced to the early 1940’s when Walter Nord became invested in creating the Nord Center due to the large number of returning war veterans who suffered from “shell shock” and who had little support. How many of those men had experienced some form of TBI in their service? Then, as now, the more severe manifestations of TBI were referred to the mental health system. Advances in biotechnology have improved the understanding of the brain and its functions. Doctors are now discovering what many front-line providers have sensed for a long time; that is. the cognitive and physical manifestations in the homeless that people attribute to mental illness, mental retardation and or drug use have deeper idiopathic explanations. Consequently the way to really help these people is advocating for expanded primary health care access to those suffering from homelessness. Forging partnerships between mental health providers and primary health care workers who can better diagnose TBI will help to relieve the crush on the overtaxed mental health systems and at the same time better address the root causes of homelessness.
In September 2011, I was introduced to the Craig Hospital in Denver Colorado. Craig is dedicated exclusively to Spinal Cord Injury (SCI) and Traumatic Brain Injury (TBI). In follow-up to my visit, I asked several staff members if they too were looking at this topic. I made connection with Kristi Staniszewski, RPT Clinical Specialist from the Research Department. Kristi let me know the link between TBI and homeless populations is recognized as underreported and an important policy item for the Brain Injury Alliance of Colorado. Kristi asked she thought there might be value in the Nord Family Foundation helping the alliance convene a meeting of clinicians, and providers who are seeking support to advance the recommendations of the Executive Order on Traumatic Brain Injury – Final Report which was presented to Governor Bill Ritter, Jr. in December 2009. With minimal investment of funding, the foundation is in a position to convene a discussion on the subject to include providers and appropriate medical practitioners to gather more information on TBI and its impact on the social service sector. My research revealed that in one conference on the topic took place in 2010 in Maine. I included an opening talk by one of the presenters. Please notice that she starts her talk saying that few conference on the topic of homlessness every address the link with TBI. We can serve as a catalyst and hopefully bring this topic to NE Ohio, Columbia, SC; and perhaps Boston.
I welcome any comments from foundation representatives or service providers.
