MENTAL HEALTH PROBLEMS, SUBSTANCE ABUSE OFTEN LINKED

Years ago, people with mental health problems were often sent to the state
mental hospital in Columbia. "Bull Street" carried a connotation of being
crazy and unable to function in society. Most of the Bull Street complex
has been closed because of age, said Anna Dozier-Kelly of Georgetown,
chairman of the S.C. Mental Health Commission. "Stigma is a big problem,"
she said. "People call them crazy.

Even though they may have a behavior problem, they're still people who need
help," she said. "We try to ease the stigma" of mental illness.

"We have a tendency to categorize people.

We try to avoid them, leave them alone. "What needs to be done is help them
through programs and counseling. They're not all life issues.

Some can be cured or taken care of and live normal, healthy lives.

Everyone doesn't have to be institutionalized. They can be helped and live
a good life in their home town or county," she said. Mental health and
substance abuse professionals from around South Carolina gathered at the
Myrtle Beach convention center last week to talk about how they can help
more people by coordinating their efforts. In a three-day meeting at the
Radisson Plaza Hotel and Conference Center, Feb. 22-24, several hundred
people from hospitals, state and local mental health agencies, drug abuse
prevention programs and the state's legal system discussed ways they can
improve treatment for their clients. "In order for us to help individuals,
we have to have a diagnosis to channel in the right direction.

If the person is diagnosed with mental illness and substance abuse, we have
to treat differently than a strictly individual problem,", Dozier-Kelly
told the Times. Most of the participants at the conference are in some form
of treatment agency, whether it be alcohol, drugs or mental health,
Dozier-Kelly said. "Today is coming together or melding, so we can treat
people with co-occurring disorders." Before her appointment to the state
Mental Health Commission, Dozier-Kelly served as chairman for the Waccamaw
Center for Mental Health. John Magill of the Department of Psychiatry at
the Medical University of South Carolina brought greetings from Gov. Mark
Sanford, who was traveling in Washington, D.C. Sanford said he greatly
appreciates the commitment and promotion of best practices for behavioral
health. "The patient populations we are addressing deserve our attention,"
Magill said. "Even in these uncertain times we must continue our efforts to
create a client-focused system for treatment." Magill is chairman of the
S.C. Hospital Association Behavioral Health Council. George Gintoli,
director of the S.C. Department of Mental Health, said "Together we're
going to make dreams come true for the people we serve.

A year and a half ago, we saw tension between the two agencies (S.C.
Department of Mental Health and S.C. Department of Alcohol and Other Drug
Abuse Services)." More than a quarter of the people coming to emergency
rooms have a "co-occurring need" for mental health and substance abuse
treatment, Gintoli said. Teams of care are being organized around the
state. "The better we can have stronger community needs, the better care
people will have," he continued. There's been a dramatic increase in
employment among people who have mental illness, Gintoli said. "We need to
invest more into prevention. The journey is just beginning." "What's so
refreshing is recovery and resilience," Gintoli said. "We are building life
in the community for everyone. (Curie) is bringing a message of what's
working in our communities." Charles Curie of SAMHSA (Substance Abuse
Mental Health Services Administration) was to meet with his boss, George W.
Bush, in the afternoon after his talk in the morning session at the
Radisson. Health care providers and the various agencies need to make sure
the system is relevant to people, Curie said. "I learned a lot in moving
from Pennsylvania to Washington, D.C.," he said. "'Imminent' in state
government means six months to a year. In the federal government, it means
two years and cost overruns." "SAMHSA has a blueprint for change, and you
in South Carolina are on the cutting edge of that," he said. "Improving
services for people with co-occurring disorders is the goal for everyone."
After completing college, Curie's first job was in Ohio. He worked with
people who had been in institutions for a decade or more. That was about
the time that large mental institutions were being reduced in size and
clients were either being returned to facilities closer to home or released
from mental institutions. "What they said they needed was a job, a home and
a date on weekends.

They defined what they needed in terms of getting a life and living a
life," Curie said. "We have traditionally focused on clinical outcomes -
which we should - and not necessarily on people having a life. "We are not
finished until people gain and sustain recovery.

We are working and reaching out through many pathways," he said. "The
criminal justice system is critical in this," Curie continued.

In Pennsylvania, 80 percent of the people in prison had a drug or alcohol
problem.

Of that number, some 12 to 15 percent also suffered with mental illness.
SAMHSA also comes in touch with the welfare and education systems. For just
about everyone, including people at the conference, home and career are
among their top three or four needs or goals. Curie's agency uses a matrix
of programs and issues as they relate to "cross-cutting principles." If a
concern comes up, his leadership team is charged to determine whether it
fits in the matrix. "In these type government positions, we are stewards,"
Curie said. "What we do, is it sustainable. We examine funding requests in
terms of doing the right things and whether they work." In his proposed
budget for 2005, President Bush included a six percent increase in programs
dealing with substance abuse, Curie said. That's about $199 million in a
$3.6 billion budget for the agency.

Curie said people working in the field deserve much of the credit for the
increase. The many pathways to recovery that Curie speaks of include
effective treatment programs and counseling. "We also know that people are
transformed by the power of faith, and by 12-Step programs," he said.
"Vouchers allow consumer choice." Some of the elements of success in
recovery are no drug or alcohol use, and no involvement with the criminal
justice system. "We can better communicate our message through stories
about success," Curie said. "We are clearly focused on recovery as being
the outcome." Many successful people develop goal lists.

For his part, Curie's agency has a to-do list, an action agenda to
transform mental health.

Elements of the to-do list include criminal justice, housing, labor,
veterans, medication and substance abuse. Various agencies, such as
Medicaid and SAMHSA, need to give the same message of recovery, Curie said.
"Transformation is a bold effort to bring recovery to the mental health and
substance abuse fields." When the agencies provide care, it must focus on
the individual's ability to deal with life, Curie continued, not just on
managing symptoms. All of this will require a shift in thinking for most
Americans, he said. "Mental illness is a treatable illness," he said. But,
it has to be diagnosed for correct treatment. When President Bush announced
plans for increases in his agency's funding, he told a too-familiar story,
Curie said. A 14-year-old boy was depressed and administered self-treatment
through taking drugs.

He spent a lot of time over the next 16 years in various treatment programs
and in the criminal justice system.

When he turned 30, the President related, he began to get treatment for
bi-polar disorder. "Even though he was treated in adulthood, I can't help
but think about the 16 years that were lost because of not getting
treatment," Curie said. "Too many people lose that time because our system
doesn't deal with these problems.

Fortunately, we know more and more." In a national household survey, SAMHSA
found that about four million people have co-occurring disorders.

One out of every five people with a substance abuse problem also has a
serious mental disorder, he said. Barriers to proper treatment of these
people include separate organizations, under-funding and dealing with
separate systems. "Any door is the right door to come in for treatment,"
Curie said. Over the past several years, 40 states competed for grants for
dealing with co-occurring disorders.

The agency wants to broaden efforts to share information about successful
treatment programs. A lot of change has taken place over the last several
decades. "Everyone is for progress," Curie quipped, "it's the change they
don't like." "Change is never easy, but it's better when we share a common
goal - recovery for everyone." Curie quoted Army General Douglas MacArthur:
"In the central place of every heart, there is a recording chamber; so long
as it receives messages of beauty and hope, cheer and courage, you are
young. "When the wires are all down and your heart is covered with the
snows of pessimism and the ice of cynicism, then and only then have you
grown old." People working in mental health and substance abuse "must do
all we can to make sure the messages get through to the strings of our
heart," Curie said. "Many times we represent the last bastion of hope. We
must make sure we do it right and do it well," he said. "One reason people
relapse is because they didn't get that life in the community." As for the
criminal justice system, Curie said, "I think you could make an argument
that every court should be a drug court, when you consider that 80 percent
of the people in the criminal justice system have a substance abuse
problem." Curie believes the time is right to transform the delivery system
for co-occurring disorders. "Already, federal agencies that have never been
concerned about mental health are putting their resources on the table,"
Curie said. "Five years ago, this type of conference would have been hard
to imagine," he said.

Along with these sessions, others for the conference included looks at the
criminal justice system, data analysis, developing and implementing
community teams, judicial involvement, and pharmacology and treatment. For
information about drug abuse, contact the Georgetown County Alcohol and
Drug Abuse Commission at (843) 546-6081. Their office is located at 1423
Winyah St. in Georgetown. For mental health concerns or questions, contact
the Waccamaw Center for Mental Health at (843) 546-6107. Their office is at
525 Lafayette Circle.