IN-DEPTH COVERAGE: MENTAL HEALTH
Today’s article is the first in a three-part series that brings in-depth coverage about mental illness and its impact on Butler County. In the next two Sundays, the Journal-News will introduce readers to several people who are dealing with mental illness and also talk to community leaders to find out how they are coping with the growing number of people who are diagnosed with mental health issues.
COMING OCT. 12: Butler County residents share their experiences living with mental illness.
COMING OCT. 19: Mental health providers, government officials and others talk about the services available and those still needed to help a burgeoning number of people seeking mental health assistance.
Debbie Stanton has lost more than a dozen jobs since she started working at the age of 14. But, she says, she didn’t lose those jobs because she is a bad worker. Stanton, of Fairfield, has been battling mental illness for almost 40 years, and she isn’t alone. The number of people suffering some sort of mental illness in Butler County is growing, and so is the need to fund programs to help those people, officials said.
Rhonda Benson, the executive director of the local National Alliance on Mental Illness chapter, said the stigma surrounding mental illness is lessening but it is still difficult for most people to understand those who suffer.
“This is what I tell people, if God came down and said to you ‘do you want to be normal or do you want to live like this?’ Who would choose to live like this — no one,” she said.
The Butler County Mental Health Board has seen a 124 percent jump in people seeking their services over the past decade, from 4,471 clients served in 2004 to 9,997 in fiscal year 2014. More than 2,500 people have sought services already for fiscal year 2015, which began July 1. Federal and state funding has sagged while the need has spiked, hence the Nov. 4 levy request to renew local funding. The 0.5 mill levy renewal, which will not raise taxes, means the owner of a $100,000 home will continue to pay $7.30 annually.
The Mental Health Board, which oversees the county health system, providing funding, strategic planning, quality assurance and needs assessments for 10 providers, has seen a dramatic drop in state and federal funding. State funding dropped from $4.3 million annually from 2007 to 2011 to a projected $860,043 in funding next year.
Eric Wanndersleben, the director of media relations with the Ohio Department of Mental Health & Addiction Services, said the governor has taken many steps to ensure that mental health and addiction problems are being addressed. He noted the expansion of Medicaid is a major step that opens services up to a broader population.
“The biggest gain occurred when Gov. (John) Kasich extended Medicaid coverage, infusing $557 million in fiscal year 2015 into physical and behavioral health services for Ohioans living with mental illness or addiction, in addition to freeing up $70 million annually in county-funded clinical services,” he said.
Mental illness is prevalent locally
The recent tragic death of beloved comedian and actor Robin Williams brings home the fact that mental illness, in its many forms, lurks across socio-economic lines. A new study by The Greater Cincinnati Community Health Status Survey by Cincinnati-based Interact for Health, showed that 30 percent of the 324 people surveyed at random have been diagnosed with depression and two in 10 adults in Butler County or 18 percent said their mental health was not good for 14 or more out of the last 30 days. The numbers from a 2010 study were 26 percent and 16 percent, respectively.
The survey, which has a 5.4 percent margin for error, also found 39 percent of women reported they have been diagnosed with depression compared to 21 percent of men. All the Butler County numbers were higher than the greater Cincinnati area surveyed with only 23 percent reporting depression.
Jennifer Chubinski, director for community research at Interact for Health, said depression has continued to rise in the region going from 15 percent in 1999 to 23 percent now.
“There was a dramatic increase right in the middle of when we were collecting the data,” she said. “We saw a big jump in the early 2000s which has continued to increase slightly every year.”
Mental Health Board Executive Director Scott Rasmus said while 30 percent of the people surveyed openly admitted they have been depressed, there are likely many more who are unaware or afraid to admit they have a problem. He said statistics show about 20 percent of a given population suffer some form of mental illness. With 370,000 Butler County residents that would be about 75,000 people and about 25,000 are seeking help at any given time.
“That still leaves you 50,000 who are either undiagnosed, unaware, fearful of the stigma that comes from mental illness or are just not educated about mental illness and its treatment…,” he said. “It is prevalent out in our society, I think some say it’s more prevalent than breast cancer and a lot of physical ailments and it’s talked about the least.”
Fighting the stigma
Years ago mental illness was a hidden affliction that families did not discuss. It is a genetic illness and Benson said their older client families still take the blame for having a child with a condition like schizophrenia or bipolar — formerly manic depression — and younger parents are now feeling guilty they brought those children into the world.
“It’s really sad, we all have genetic defects because we’re human,” she said. “If all of us quit having children because of genetic defects the human race would come to a standstill, we would cease to exist.”
The stigma surrounding mental illness has lessened, largely through the efforts of NAMI and other organizations dedicated to raising awareness and educating the public. Even the courts have become enlightened. Judge Michael Sage runs the first-ever felony mental health court in the country. He said awareness that mental illness is often the root of criminal behavior has resulted in a sea change in the way criminal defendants are treated. Five years ago few psychological screenings were ordered. That’s all changed.
“I think the stigma is going away, I think we have a very viable mental health system which is now identifying people much more effectively and we are finally now as a justice system beginning to look for those kind of factors as to why people are committing crimes…,” he said. “One of things we do now is a mental health screening… That was never done five years ago, now we do it.”
The stigma however has still not really permeated the business world, according to one Butler County mom who has been caring for her son — she did not want to reveal his name — for 38 years, 31 of those years have been spent dealing with bipolar disorder. Susan Dodgson’s son went to Cornell University and has a double major in chemistry and computer science and a master’s degree from the University of Cincinnati, but he can’t hold a job because his illness has rendered him totally disabled.
But even if his illness weren’t so debilitating Dodgson said she doubts he could get job.
“Employers don’t understand what mental illness is, they have preconceived ideas I guess,” she said. “I’ve had friends who have been working who have cancer or diabetes and those employers don’t turn them away, but as soon as somebody with a mental illness shows up a lot of employers will release them.”
Stanton, a 61-year-old Fairfield woman who suffers from bipolar disorder with depression, has a degree in accounting but has had at least a dozen jobs because of her illness.
“It disrupted my life, that’s what I didn’t like about it,” she said. “No matter how many times I would get a job, and I didn’t have any problems getting work, but I would lose my jobs because I’d have onsets of the illness.”
Treatment can be tricky
Rasmus said there are people suffering with mental illness who are able to get and keep jobs because many afflictions can be managed with medication and therapy. He said mental illness “runs a very large realm” with adjustment disorders on the low end, where say someone loses a job, becomes depressed but eventually they come out of it and “move on.” The severe end of the spectrum involves a biological component such as bipolar, schizophrenia and some severe depressions.
Dr. Ken Tepe, a psychiatrist from Community Behavioral Health (CBH), said one of the toughest things about treating people with severe mental illness is the fact they usually refuse to admit they are ill at all.
“They’ll be able to say I’m glad the voices went away but they’ll never be able to say I have a mental illness and need treatment,” he said. “They’ll say I’ll take the medicine because it makes me feel more calm, but that’s about the best endorsement you get. There is something about these mental illnesses that lets you ignore what’s right in front of you.”
Another big issue with the ability to keep a job is once people begin taking their medication, they start to feel better and then go off the pills and rebound. CBH is one of the Mental Health Board’s larger service providers and one of their services is finding jobs for the hard-to-hire. Jason Maurath, vice president of operations, said getting people stabilized on their medication is the first hurdle.
“Depending on the diagnosis and the severity of the mental health a lot of times just getting them stabilized with medication is very beneficial and powerful,” he said. “Getting them to maintain on the medication is also important. Many times people who suffer from mental illness, they may start taking the medication, they start feeling better then they quit taking it and then they start decomping back to their original state.”
Maurath said usually the clients they see aren’t just mentally ill, they are often also substance abusers and felons. Christy Morris, director of Case Management and Employment Services at CBH, said they have employers who are willing to take a chance on people with challenges like mental illness and they have a 55 percent placement rate, “which is pretty impressive for the clientele we work with.”
Benson said the services the Mental Health Board provides are critical. Often family is not available or in some cases unwilling to continue dealing with their severely mentally ill relative. She said when she was a case manager some years ago funds were available so she could keep close tabs on her charges even at their doctor’s appointments.
Severely ill patients would often tell their doctor everything is going well, but she could interject that the person thought the FBI was tapping their phone, letting the doctor know things aren’t what they seem. She said the state says that type of hands on involvement is no longer a covered expense. Many mentally ill people are also forced to live in unsafe neighborhoods, so the challenges these days are many.
“It’s the funding,” she said. “It’s always the funding.”
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