My Support - August 7, 2009

My dreams for Courtland have not disappeared, they have just changed.

By Muffy Walker, MSN, MBA
Putting baby locks on the kitchen cabinets to protect her toddler was one thing, but locking away the steak knives from her seven year old was not what Muffy Walker ever imagined would be necessary. Walker also never imagined she would need to use her skills as a psychiatric nurse on her own child.

When Walker's youngest son Courtland turned four, she and her husband began noticing behaviors that were foreign to them. Court had become unusually aggressive; having uncontrollable temper tantrums in the grocery store aisle, throwing toys across the room at his brothers, and kicking his mom at the slightest parental control. Once a gregarious, outgoing child, he had become fearful, frightened to go to school, afraid to be in his room alone, or go outside to play. Court now shunned the beach; the sand bothered his toes, and in summer he wore winter clothes, complaining he was cold. The inside labels on his shirt and seams on his socks sent him into fits of rage.

Walker worried that like her other two children, Courtland might also have Attention-deficit Hyperactivity Disorder (ADHD), but perhaps a really, really bad form of it. Over the next 3 1/2 years, Court saw five psychiatrists, each offering a different diagnosis including Obsessive-Compulsive Disorder, ADHD, Oppositional-Defiant Disorder, and Post-traumatic Stress Disorder. Finally, after being incorrectly treated with an anti-depressant, Court experienced a full blown manic episode and was ultimately diagnosed with Early-onset Bipolar Disorder.

Bipolar Disorder, once known as manic depressive illness, affects 2.7 million adult Americans. It causes dramatic mood swings-from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression. It is the sixth leading cause of disability in the world. It results in 9.2 years reduction in expected life span, and as many as one in five patients with bipolar disorder complete suicide.

Even with medical training, the Walkers were ill prepared for the frustration they'd experience trying to steer their way through the mental health system, the fear they'd encounter not knowing what the future held for their youngest son, and the lack of understanding and support they'd meet on a daily basis. Within the first year following Courtland's diagnosis of Bipolar Disorder, Walker found very little support, both for herself and her family. She began talking with other moms at the playground, explaining why her son was different, what his aberrant behaviors meant. Slowly but surely, others began to confide, sharing their stories of sadness, grief over a future now robbed of its potential, loneliness for their excluded child, fear for their child's safety and unanswered questions about medications, hospitalizations, conservatorship, doctors, the lists were endless. From those connections and conversations, Walker, along with three other moms with bipolar children, started the California Bipolar Foundation (CBF). In less than a year's time, CBF has reached out to help 100s of families cope, find support and resources, and begin to understand how to navigate the complex mental health system.

What parents need to be aware of, warns Walker, is that just as with so many other illnesses, the symptoms of Bipolar Disorder range broadly along a spectrum. Although one child may be psychotic (loss of touch with reality) or a danger to himself (one in five children with Bipolar will kill themselves before the age of 18), another may be relatively high functioning, attend regular school, and hold a meaningful job. Think Rachmaninoff, Hemingway, Vincent Van Gogh, and Carrie Fisher. All are highly successful, extremely creative people, all who have/had Bipolar Disorder. "The network of parents supporting each other has been very uplifting,"says Walker. "We won't give up hope. My dreams for Courtland have not disappeared, they have just changed."

Muffy Walker is a freelance writer and mom of three boys. Muffy and her family live in Rancho Santa Fe, CA. She is the founder and President of California Bipolar Foundation and is a leading advocate for mental health issues

Local doctor advocates for people with bipolar disorder - Jensen specializes in work with children

By Arthur Lightbourn, Rancho Santa Fe Review
Saturday, July 25, 2009
His Scandinavian family tree is "genetically loaded" with relatives who suffered from the disorder that affects an estimated 5.7 million Americans and 222 million worldwide, causing extreme shifts in mood, energy and functioning, with a high incidence of suicide.

Jensen, 49, was recently appointed medical director of the California Bipolar Foundation, a not-for-profit organization founded two years ago by Rancho Santa Fe resident Muffy Walker after her young son was diagnosed as bipolar.

After several doctors had misdiagnosed her son, Walker recently said, it was Jensen who first considered and ultimately diagnosed her son with early-onset bipolar disorder.
In 2007, Walker and her husband, Dr. John Reed, president and CEO of The Burnham Institute, along with other parents of bipolar children, founded the California Bipolar Foundation (CBF).

CBF is dedicated to the eventual elimination of bipolar disorder through research, support services and public education to erase the stigma associated with the disorder, also known as manic-depressive illness.

Jensen served on CBF's scientific advisory board for the past year. The advisory board reviews grant applications from researchers. Last year, CBF funded two $50,000 grants for bipolar research.

As medical director, Jensen will be the "medical voice" of the foundation reviewing and ensuring that all information issued by CBF, including educational brochures, videos, webinars, blogs and live Webcasts, will be medically factual and user-friendly.
Many of Jensen's patients are children. One room in his office is devoted to an array of toys on the floor. "What I tell the children is: I have the best job in the world because I get paid to sit on the floor and play with toys and then tell their parents what to do."

Jensen's office is decorated with black-leather chairs and matching ottomans and a low side table, also occupied by toys and a laptop computer. No desk. "I don't like to set up barriers between myself and my patients," he said.

Jensen is board certified in child psychiatry, adult psychiatry, behavioral neurology and neuropsychiatry. He devotes about half his time to treating patients with mood disorders, both depression and bipolar disorder. In addition, he treats a variety of biologically-based mental illnesses in children and adults, such as Tourette Syndrome, OCD (obsessive compulsive disorder) and panic disorders.

While bipolar typically develops in late adolescence or early adulthood, and usually lasts a lifetime, first symptoms can emerge during early childhood with symptomatic rapid mood swings between depression and destructive tantrums sometimes many times within a day.
Although there is no known cure as of yet, bipolar disorder can be managed with various medications (mood stabilizers, anti-seizure meds, antidepressants and others), psychotherapy, and, in severe cases, when all else fails, with electro-shock (ECT) therapy and hospitalization. "One big misconception that many have is that folks with bipolar disorder are somehow dangerous," Jensen said. "And they base this [misconception] on a very limited number of cases in which people with bipolar disorder, often under the influence of wrong medications, became violent."

"I'd like to erase any theories that still remain that this is somehow a psychologically-based disorder. It isn't, although psychotherapy is an important part of the treatment. We have identified now five of the genes responsible for bipolar disorder and decoded what those genes code for, which is a huge breakthrough. The search for additional genes continues. We're pretty sure we don't even have half of them yet."

"Additionally there may be what we call gene environment interactions that can trigger a mania. We know in animal models of bipolar disorder exposure to certain agents can trigger a mania, amphetamines or cocaine being the two most common. We think there may be in some people a role that severe stress may play in turning on some of these genes."

"Also," Jensen continued, "I'd like to erase the stigma that exists in the workplace towards people with bipolar disorder. The reality is that, well-treated, the vast majority with the disorder function extremely well. Many are CEOs, general counsels, and senior scientists."

Jensen was born in Peoria, Illinois. His father was an IBM salesman and executive. Growing up, Jensen lived with his family in Europe and various U.S. cities. In Baltimore, he recalled, he was the poster child for "the intelligent, extremely hyperactive ADHT child" and was given the then-relatively new drug Ritalin "without which I wouldn't be where I'm at today."
The family eventually moved to San Diego where Jensen earned his B.A. in chemistry at the University of San Diego in 1982 and went on to earn his medical degree from UCLA School of Medicine in 1986.

After earning his medical degree, he launched his specialization training at UCSD with a pediatric internship, an adult psychiatry residency, and a child psychiatry fellowship; followed by a child psychiatry fellowship at Stanford University, 1990-91.
He and his attorney wife, Karen Boudreau, moved to Lewiston, Maine, in 1991, where he opened a private practice and his wife commuted to Boston to practice law.

"I was drawn there because I was a young guy with educational debts and Maine was a cheap place to live and I could make a good living there ... and it was my best financial deal for a medical directorship at a nonprofit hospital (St. Mary's Regional Medical Center).

"And," he added, "in those days, the for-profit hospitals were in the news every week for unethical behavior, so I wouldn't go to work for one."

Between his medical directorship and a running a thriving practice, he paid off his student loans and built up his finances, but he was also working 80 hours a week and, after eight years in Maine, he and his wife decided it was time for a change. They returned to San Diego in 1999.

Jensen joined the Kaiser Permanente medical group as an outpatient psychiatrist, with a subspecialty in difficult-to-treat mood disorders, including bipolar disorder and depression.
He soon ran into conflict with the HMO over Kaiser's policy for psychiatrists in its San Diego area facilities that stipulated when they receive a request for a prescription for a patient from nonphysician staff psychologists, social workers or family therapists, they, in keeping with Kaiser's "multidisciplinary team-based approach", should write the prescription without the necessity of scheduling a visit with the patient.

"At the time, psychiatrists were prescribing psychiatric medications based solely on the evaluations of social workers and social work interns," he said.

Jensen objected, arguing that the policy was illegal and placed patients at risk. "I was fired," he said, "and then I sued them, not for money, but for an injunction to force them essentially so that the doctors would actually see patients before they prescribed psychiatric meds.
"The story hit the front page of the LA Times and became national news," Jensen said. "Ed Bradley [broadcast journalist] flew me to New York to do a 60 Minutes special which never aired because there was a settlement and essentially the result of it was that psychiatric patients at Kaiser are now seen by the psychiatrist personally prior to being prescribed medications."

"I actually feel in terms of my career accomplishments that did more for people than anything else I've done."

"And that's why I did it. My wife asked me why I wanted to do this. What I said to her was, 'I'm afraid I'm going to open up the newspaper one day and read a story that some high school or college kid shot up a school after a missed bipolar diagnosis and having been given a prescription for Prozac."

"It was one of the worst times of my life, but it was good decision that I made, although to this day among some people in town, I'm quite controversial. There's essentially a rule in medicine. Ed Bradley called it, 'The White Wall of Silence.' It's that doctors don't tell on doctors. And so, there will always be people in San Diego in the psychiatry community who will never forgive me for what I did."

More information on bipolar disorder is available at the CBF Website: www.californiabipolarfoundation.org

Read more: http://www.sdnn.com/sandiego/2009-07-25/lifestyle/local-doctor-advocates...

FDA Advisory Committee Votes In Favor Of SAPHRIS(R) (asenapine) For Acute Bipolar I Disorder And Acute Schizophrenia

Schering-Plough Corporation (NYSE: SGP) announced that the U.S. Food and Drug Administration (FDA) Psychopharmacologic Drugs Advisory Committee voted unanimously in favor of SAPHRIS(R) (asenapine) sublingual tablets as effective and safe for the acute treatment of manic or mixed episodes associated with bipolar I disorder in adults and in favor of use in acute treatment of schizophrenia in adults.
http://www.medicalnewstoday.com/articles/159397.php

If Bipolar Disorder Is Over-Diagnosed, What Are The Actual Diagnoses?

A year ago, a study by Rhode Island Hospital and Brown University researchers reported that fewer than half the patients previously diagnosed with bipolar disorder received an actual diagnosis of bipolar disorder after using a comprehensive, psychiatric diagnostic interview tool -- the Structured Clinical Interview for DSM-IV (SCID).
http://www.medicalnewstoday.com/articles/159344.php

Patients With Bipolar Disorder At Increased Risk For Wide Range Of Health Problems,Thomson Reuters Study Finds

A new study from Thomson Reuters found that patients with bipolar disorder were at greater risk for a wide range of medical conditions than a control group of patients with no mental health diagnoses. http://www.medicalnewstoday.com/articles/159104.php

Side Effects of Bipolar Disorder Medications - Index

Bipolar Medications Library
All the medications listed here may at some time be prescribed as part of drug therapy for bipolar disorder (manic depression). Pages list common, less common, and rare side effects, and where appropriate include overdose and withdrawal symptoms.
http://bipolar.about.com/cs/sfx/l/bl_side_indx.htm?nl=1
About.com

Depression Screening In 2nd Grade

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on July 22, 2009
A new study suggests screening children for symptoms of depression, the most common mental health disorder in the United States, can begin a lot earlier than previously thought, as early as the second grade.

University of Washington researchers followed nearly 1,000 children from the second to the eighth grades. During the investigation they discovered five distinct patterns for the way symptoms of depression develop among adolescents.

"Some children are reporting that they don't have as many friends, feel lonelier and are more anxious than their peers," said James Mazza, a UW professor of educational psychology and lead author of the study.

"They are telling us that they feel different from the typical happy- go-lucky second grader.

"We can start to build a profile of children's mental health in the second grade. This is important because children who are experiencing depression symptoms early on may be at great risk for mental health concerns during adolescence, based on other research studies.

"We want to reassure parents that everyone, including children, may feel sad or depressed once in a while, but that doesn't mean they will go on to develop depression. We are trying to understand how depression starts and evolves in childhood so that we can develop interventions to help children," Mazza said.

The new study relied on annual self reports from the children as well as parental and teacher evaluations collected as part of the Raising Healthy Children study, a larger, long-term investigation looking at the development of healthy and problem behaviors among children at 10 suburban schools in the Pacific Northwest.

The depression study used data from 511 boys and 440 girls, and 81 percent of the participants were white.

The study identified five patterns of depression symptoms, but 56 percent of the children showed no or very few symptoms of depression in the second grade.

The five patterns of depression symptoms the researchers found and the percentage of students in each group are:

• Low stables - 26 percent. These children showed none or very few signs of depression in the second grade and their rates didn't change over time through the eighth grade.
• Low risers - 30 percent. Children in this group also had no or few symptoms in the second grade, but the number went up by a small amount in subsequent years.
• Mild stables - 24 percent. This group had few symptoms and then went up by a small amount in subsequent years.
• Moderate changers - 11 percent. These children started out with a few more symptoms than the previous group and their number of symptoms rose through elementary school and then dropped in middle school.
• Moderate risers - 9 percent. This group started off with a similar number of symptoms as the moderate changers, however their symptoms did not decrease in middle school.

The study identified different early depression risk factors for boys and girls. For boys, behavior and attention problems predicted membership in the different depression groups. For girls anxiety was an early risk factor.

The research also reaffirmed previous findings showing gender differences in underlying depressive symptoms, with girls experiencing more symptoms than boys in the eighth grade.
 

"Our children are our best resource in knowing what they are feeling inside. But it is also important to have multiple perspectives. Collecting assessments from parents, teachers and the child to identify children at early risk for depression is a good method for spotting those who may go on to have later mental health risks," Mazza said.
Source: University of Washington

The Next Blockbuster Drugs - From cholesterol fighters to asthma relief, these treatments could earn Big Pharma $170 billion

By Mike Tarsala | 24/7 Wall St.
Jul 22, 2009
Safety and efficacy data are critical to drug candidates. But what really makes a potential drug attractive is strong top-line data, a new biotech-based treatment, and a massive potential market. With help from Thomson Reuters' SD Pharma database and our own backlog of coverage, BioHealthInvestor.com, a 247wallst.com website, sought to find the most promising biopharmaceutical candidate from both biotech and pharmaceutical companies in each of the top 10 most prevalent medical conditions in the U.S.

To do so, we reviewed data and Thomson Reuters revenue projections for 745 prescription drugs. We started by identifying the top sellers in each of the top 10 conditions, then looked at promising candidates that threaten to one day supplant the market leaders. All of these challenger treatments can lead easily to a blockbuster drug status, meaning annual sales of $1 billion or more.
Here are the top 10 medical conditions, sales estimates for the leading drugs, and the up-and-coming biotech-based candidates:

1. CHOLESTEROL FIGHTERS:
2. INSULIN AND DIABETES TREATMENTS:
3. BLOOD PRESSURE
4. IMMUNE SYSTEM BOOSTERS/SUPRESSANTS
5. ASTHMA
6. ANTIPSYCHOTICS

Mental illnesses might not be top of mind when it comes to a list of top medical conditions. Yet one in four adults in the U.S. has a diagnosable mental disorder in a given year. About 6 percent have a serious mental illness, according to the National Institute of Mental Health.
One of the top mental illnesses being treated with prescription drugs is bipolar disorder, a disease that can cause extreme mood swings, from infrequent manic highs to more common depressive lows. It is the leading mental health diagnosis that contributes to lost work productivity. The median age for the disease's onset is 25 years, which is why many with bipolar disorder are on antipsychotic medications for most of their adult lives.

Nearly $16.7 billion will be spent in the U.S. this year on medications to treat mental illnesses including bipolar disorder, according to Thomson Reuters SD Pharma. The top drug in the category is the bipolar disorder drug Seroquel, made by AstraZeneca plc, with expected sales of $5.4 billion, accounting for about a third of all antipsychotic drug sales. The No. 2 drug in the category is Eli Lilly & Co.'s Zyprexa, for treating bipolar disorder and schizophrenia. Expected sales this year are $4.6 billion.

There are other potential markets for drug manufacturers, and for some drugs already in the category. Mental illnesses that may require antipsychotics include major depressive disorder, anxiety disorder, panic disorder, and obsessive-compulsive disorder. Many affected by mental illness have multiple disorders and phobias.

The Potential Blockbusters:
There are a number of seemingly promising antipsychotic drug candidates, but one at the top of the list is paliperidone palmitate for treating schizophrenia. The drug is being developed by Johnson & Johnson, with NanoCrystal technology from Elan Corp.
The FDA in August 2008 asked for more data on the drug before allowing it on to the U.S. market. But it has not asked for additional trials. The drug was effective in studies, with only 10 to 15 percent of patients relapsing, vs. 40 percent in the placebo group.
The main advantage of paliperidone palmitate could be in its delivery. It's an injection taken once monthly, which in theory could make it much easier for schizophrenics to stay on their medications. more http://www.newsweek.com/id/207928

NAMI Annual Conference; California

NAMI California will hold their annual conference 2009 on August 21 & 22 in Torrance. The theme is Destination: Recovery!

Tom Wootton, author of The Bipolar Advantage will be the keynote speaker. His speech is entitled "Bipolar in Order - Looking at Depression, Mania, and Schizophrenia From the Other Side."

Wootton's book, The Bipolar Advantage has remained on Amazon's top 10 books on bipolar disorder since its publication in 2005. Tom developed and has presented workshops on Bipolar in Order since 2002. He is considered to be a leading speaker and consumer advocate on bipolar disorder.

Also presenting at the conference on Friday will be Dr. Akikur Reza Mohammad, MD on the topic of "Dual Diagnosis and Importance of Treatment of Both Psychiatric Illness and Addiction." Dr. Clayton Chau, MD, PhD will discuss "Overcoming PTSD."
On Saturday, Aug. 22, Dr. Alejandro Kopelowicz, MD will speak on the subject of "Moving Towards a Recovery Model in Biobehavioral Treatment." Gene Johnson, LCSW will speak on the topic of " Recovery: Raising our Own Expectations," and Dr. Curley L Bonds, MD will speak on "Community Reintegration & Recovery: Peers Helping Peers."
In addition to the speakers there will be a variety of workshops on both Friday and Saturday. For more information about the conference and to pre-register contact NAMI California through the website, or call (916) 567-0163.

The conference will be held at the Torrance Marriott South Bay, 3635 Fashion Way, Torrance, CA 90503. The hotel phone number is (310) 316-3636. Hotel reservations for the event can be made by calling (888) 228-9290 and ask for the specifically negotiated rate for the NAMI conference. Reservations must be made by August 12, 2009 to ensure the conference rate.

GOVERNOR SIGNS BUDGET PLAN - MAKES ADDITIONAL BIG CUTS IMPACTING SENIOR PROGRAMS, PUBLIC HEALTH AIDS PROGRAMS, IHSS

Makes Additional $50 Million Cut to Regional Centers That Governor Says Can Be Made Up By Prop 10 Commission Funding

SACRAMENTO, CALIF (CDCAN) [Updated 07/28/09 12:55 PM (Pacific Time) - Calling the budget solution to close a $26 billion deficit "the good, the bad and the ugly," Governor Arnold Schwarzenegger signed this morning (July 28) the revised budget bill approved by the Legislature last week that includes over $15 billion in new spending cuts on top of what was in the 2009- 2010 State Budget passed in February. The spending plan makes deep cuts to education, health and human services, local government, state employees, the state's prison system and also includes no new tax increases beyond the temporary tax increases that were included last February.

The Governor, using his line item veto power, made additional major cuts in spending including reductions that eliminate all State general funding for several programs, including those under the Office of AIDs, under the Department of Public Health and major cuts in spending to two senior programs under the Department of Aging (Linkages and Senior Community Based Programs) and also to In-Home Supportive Services and Child Welfare Services. The additional cut to IHSS essentially eliminated the exemption of persons under protective supervision, persons under paramedical care and persons who receive over 120 hours of IHSS per month from having their domestic and related services eliminated if their functional index ranking (different from "functional index score") is lower than "4" in that specific service.

The Governor also made additional cuts to developmental services (regional centers), though in the case of regional centers, requested that the additional $50 million cut be replaced by funding from the California Children's and Families First Commission. The reduction would remain however even if the commission declined to makeup the cut.

The Assembly and State Senate passed the main revised budget bill (AB 1x4) [the "x4" means 4th special or extraordinary session) and a package of additional budget "trailer bills" [called that because it follows or trails the main budget bill, making necessary changes to state law to implement the cuts or other policy changes] after a grueling all night session that began July 23 and ended Friday on July 24th. Both houses adjourned for their summer recess and will return back to the State Capitol on August 17 at 12 noon.

SSI/SSP Grants Not Hit By Additional Governor Line Item Veto
No additional cuts were made to SSI/SSP
(Supplemental Security Income/State Supplemental Payment) grants to persons with disabilities, the blind and low income seniors beyond what was already in the 2009-2010 State Budget.

Additional cuts that the Governor would want to make to SSI/SSP beyond what was already in the revised budget bill before him would have required changes to State law that must be approved by the Legislature first.

The revised budget bill that the Governor signed however did include an additional reduction to SSI/SSP grants that the Legislature did approve, that would lower grants to couples to the lowest level allowed by the federal government, and also reduce grants for individuals by another $5 per month.

This reduction follows a 2.3% cut to SSI/SSP grants that went into effect July 1, 2009 (as part of the 2009- 2010 State Budget that was passed in February), and the suspension of the State cost of living that was due June 1, 2009 (suspended as part of the 2007-2008 State Budget and the cut in the federal cost of living that was made effective May 1, 2009 (as part of the 2009-2010 State Budget passed in February). That means SSI/SSP grants were, after today's budget signing, cut four times in one calendar year (though in different budget acts).

One Budget Crisis Nears End - While Another Continues
While the Governor approved the revised budget and budget trailer bills that were, as a package meant to close most of the $26 billion budget shortfall, the plan could fall apart within weeks if revenues continue to drop below what the budget projects, if spending grows at a faster rate and if lawsuits block certain cuts - like lawsuit threatened by cities and counties are successful in blocking the borrowing by the State of local government funds that is a key part of the budget plan. That doesn't include the impact of other lawsuits - including those that have blocked, at least temporarily, IHSS worker wages, and a lawsuit (to be heard on August 19th in federal court in San Francisco) that seeks to reverse the elimination of 9 Medi-Cal optional benefits.

With revenues continuing to drop and one-time budget fixes not possible again, the State still will face a likely budget shortfall of over $15 billion in the next budget year (2010-2011), and even larger deficits beyond that with the temporary tax increases ending.

CDCAN SUMMARY OF GOVERNOR'S LINE ITEM VETOES
The Governor made several additional reductions using his line item veto power - and also added some additional provisions to the 2009-2010 State Budget - that impact people with disabilities, mental health needs, the blind, seniors, low income families, community organizations and workers who provide services and supports.

Some of those additional provisions have potential major impact - including one that calls for major review of the California Children's Services (CCS) Program (see below). Not included in this summary are additional cuts made to other programs, such as Department of Corrections and Rehabilitation, Parks and Recreation and other Education programs not specific to persons with special needs. Watch later today for full CDCAN Report on details of all the budget cuts and changes - including the Governor's line item vetoes impacting people with disabilities, mental health needs, seniors, low income families and others.

It is important to note that the Governor's additional cuts - and additional provisions are in addition to what is in the 2009-2010 Revised Budget (as contained in AB 1s4) and implemented through changes in state law in the package of trailer bills (see below). CDCAN will issue a full report later today covering all the reductions and changes:

Public Health Cuts that Eliminate All Funding for Several Programs
Governor used his line item veto power to make the following additional cuts to various public health programs that eliminate funding for several key programs:

• $52,133,000 reduction that eliminates all State general funding for various programs administered by the Office of AIDS: Education and Prevention, Therapeutic Monitoring, Counseling and Testing, Early Intervention, Home and Community Based Care, and Housing
• $16,337,000 reduction that eliminates all State general funding for the Domestic Violence Program
• $9,000,000 reduction that eliminate all State general funding for the Adolescent Family Life Program
• $3,003,000 reduction that eliminate all State general funding for the Black Infant Health Program
• Governor wrote in his line item vetoes of the funding for these programs that "the effect of my action reflects the deletion of various legislation restorations for public health local assistance programs to increase the reserve and to reduce the state's structural deficit, consistent with my May Revision proposals. When making these difficult reductions to important program services, I have sought to protect the continued delivery of drug therapies to low-income individuals living with HIV and thus retained funding for the AIDS Drug Assistance Program."

Senior Programs
Governor used his line item veto power to make following additional cuts to senior programs under the Department of Aging (total additional reduction of $6,160,000) :

• $3,879,000 additional reduction from the Linkages Program
• $2,281,000 additional reduction from the Senior Community-based programs
• Also, related to the above two reductions, reduced a total of $106,000 and 0.5 personnel years for the two programs under the Department of Aging ($79,000 for the Linkages Program and $27,000 for Community Based Programs)

Governor also used his line item veto power to make additional reductions under the Department of Public Health, adding a new provision to the budget act to Budget Line Item 4265-111-0001 of Section 2.0 that says "the appropriation in this item for the Alzheimer's Research Centers shall be used for direct services, including, but not limited to, diagnostic screening, case management, disease management, support for caregivers, and related services necessary for positive client outcomes."

Developmental Services (including Regional Centers)
Governor used his line item veto power to make the following additional cut to developmental services, specifically regional center funded services (beyond the over $334 million in cuts in state general fund spending in the 2009-2010 State Budget, and not including on-going 3% cut in payments to most regional center providers and on-going 3% cut in regional center operations that went into effect retroactively to February 1, 2009):

• $50,000,000 additional reduction for services to children up to age 5 though the Governor wrote in his veto message that he wants the cut made up with other funding because "as these services are due to program growth and thus eligible for funding from the California Children and Families First Commission. I am directing the Secretary for the Health and Human Services Agency, the Department of Developmental Services, and the Department of Finance to immediately request funds from the Commission for this purpose."
• Governor indicated in his veto message that "I do not intend to pursue separate legislation changing eligibility or services for these children for purposes of achieving these [the additional $50 million reduction] savings. I urge the Commission to provide supplemental funding for the growth in these services"

In-Home Supportive Services
Governor used his line item veto power to make the following additional cut of $37,550,000 (beyond cuts and major policy changes already in the revised budget bill passed last week by the Legislature) impacting In-Home Supportive Services under the Department of Social Services:

• $28,900,000 additional cut that eliminates the exceptions made by the Legislature exempting persons under protective supervision, persons with paramedical services and persons with more than 120 hours of service per month from losing their domestic and related services (if their functional index ranking - different from function index score - is lower than "4" in any of those services) . The Governor wrote in his line item veto of this because of a "determination that it is necessary to waive exemptions [included in AB 4x4, specifically paragraph 2 of subdivision (e) of Section 29] to maintain federal financial participation. Due to this determination, more IHSS recipients will be impacted by the reduction in services authorized" in AB 4x4.
• $8,655,000 reduction in funding for IHSS Public Authority Administration. Governor's veto message says that "This leaves $10,000,000 General Fund available for the Public Authorities to provide assistance to recipients in finding IHSS providers, investigate qualifications of potential IHSS providers and offer training to IHSS providers."

Mental Health
Governor used his line item veto power to make the following additional cut of $4,082,000 directed at the Caregiver Resource Centers.

• $4,082,000 reduction, due to, the Governor wrote in his line item veto message "I am reducing the item of General Fund appropriation in subdivision (e) of this section [Section 18.40] by $4,082,000 as opposed to approving the item as presented without reduction." The reduction was made specifically to budget item 4440-111-0001 of Section 2.00, reduced by $7,629,000 instead of $3,547,000 which was in the revised budget passed by the Legislature last week.

Medi-Cal and Health
Governor used his line item veto power to make the following additional cuts to programs under the Department of Health Care Services:

• $25,000,000 reduction to Primary and Rural Health programs saying in his line item veto message that "This reduction is consistent with my May Revision proposal to eliminate General Fund grants for Community Clinic Programs. Many, if not all of these clinics, will continue to receive funding through remaining state programs, federal programs, local programs, and private funds. Increased federal stimulus funs are available to many of these clinics and will help to minimize the overall impact of this reduction."
• $60,569,000 reduction to county administration
• Medicaid Funding: Adds to the 2009-2010 Budget Act new Provision 13 to Budget Item 4260-101- 0001 of Section 2: "It is the intent of the Legislature to actively pursue the receipt of federal funds within the Medicaid (Medi-Cal) Program which are past due from the federal government, including, but not limited to: (a) disability insurance benefits that resulted in state expenditures instead of federal Medicare expenditures, (b) the retroactive payment of Part B premiums due to systemic errors by the federal Social Security Administration, (c) needed adjustments to formulas that penalize California, such as the Medicare Part D "clawback", and (d) receipt of federal funds due to California under various existing Medi- Cal waiver programs."
• California Children's Services (CCS) Program Review: Adds to the 2009-2010 Budget Act new Provision 3 to Budget item 4260-101-0001 of Section 2: "The State Department of Health Care Services shall convene a diverse workgroup as applicable that, at a minimum, represents families enrolled in the California Children's Services (CCS) Program, counties, specialty care providers, children's hospitals, and medical suppliers to discuss the administrative structure of the CCS Program, including eligibility determination processes, the use and content of needs assessment tools in case management, and the processes used for treatment authorizations. The purpose of this workgroup will be to identify methods for streamlining, administrative cost-efficiencies, and better utilization of both state and county staff, as applicable, in meeting the needs of children and families accessing the CCS Program. The department [Health Care Services] may provide policy and fiscal committees of each house of the Legislature with periodic updates of outcomes as appropriate."

Child Welfare Services
Governor used his line item veto power to make the following additional unallocated (meaning not specified how it will be achieved) reduction to Child Welfare Services.

• Reduction of $19,075,000 to Title IV-E Waiver (Program 26) unallocated reduction in the Child Welfare Services Program
• Reduction of another $60,881,000 from Budget Item 5180-151-0001 (also impacting Child Welfare Services)

Education
Governor used his line item veto power to make additional reductions to Education, including one that impacts specifically children with special needs:

• $3,894,000 reduction for State Special Schools for student transportation allowances.
• Governor wrote in his line item veto message that "This item would provide $3,894,000 Proposition 98 General Fund for student transportation at the State Special Schools. However, the Legislature subsequently provided special education federal funds (Provision 11 of Item 6110-161-0890) for the same purpose with the understanding that this Proposition 98 appropriation is no longer necessary. Therefore, on a technical basis, I delete this item to remove duplicative funding for student transportation at the State Special Schools."

Healthy Families
Governor used his line item veto power to make following additional reduction to the Healthy Families program (the program that provides - with federal matching funds - health care coverage for low income children not eligible for Medi-Cal):

• $50,000,000 additional reduction [on top of what was already approved in the revised budget bill] to the Healthy Families program, writing in his line item veto message that "While this is a very difficult reduction, the Healthy Families program is not an entitlement and is a program that can be reduced during this difficult economic period. I hereby direct the Health and Human Services Agency to continue to work with the California Children and Families Commission, with local commissions, foundations, and other interested parties to provide additional resources to supplement General Fund appropriations and provide health care coverage for as many children as possible."
• The Governor added to the 2009-2010 Budget Act an additional provision related to Healthy Families (Provision 2, to Budget Item 4280-101-0001 of Section 2): "It is the intent of the Legislature, during these unprecedented fiscal times, to maintain the integrity of the Healthy Families Program to continue to provide health, dental, vision coverage to low-income children. However, assistance from philanthropic organizations and other sources will be necessary in order for California to obtain its full allotment of federal funds to support this program. In the event funds are not available, it is the intent of the Legislature for the Managed Risk Medical Insurance Board [the agency that oversees the Healthy Families program] to utilize its existing authority to establish a waiting list of children for enrollment in the program".

REVISED BUDGET BIILL AND TRAILER BILLS
See separate CDCAN Report later today (July 28) for more details of what is in the budget trailer bills that have significant impact to children and adults with disabilities, mental health needs, people with traumatic brain and other injuries, people with MS, Alzheimer's and other disorders, seniors, community organizations and workers who provide services and others. Copies of all the trailer bills below are on the CDCAN website at www.cdcan.us

CDCAN Note: "x4" stands for the 4th extraordinary or special session. The main revised budget bill (AB 1x4) and most of the budget trailer bills take effect immediately after the Governor signs it and it is officially filed ("chaptered") by the Secretary of State. However many of the provisions in the budget trailer bills have different dates when certain cuts or policy changes take effect. Majority vote bills take effect 90 days after the end of the special session (which is different from regular session majority vote bills approved by the Governor take effect the following January 1).

MEDI-CAL (HEALTH) TRAILER BILLS

• Health Trailer Bill (AB 5x4) that includes Medi- Cal, adult day health centers, long term care facilities
• Medi-Cal Managed Care Trailer Bill (AB 6x4) contains authorization for Department of Health Care Services to take steps to expand Medi-Cal managed care plans.

IHSS - ALSO CALWORKS, SSI/SSP TRAILER BILLS

• Human Services Trailer Bill (AB 4x4) includes In- Home Supportive Services reductions as agreed to by Democrats in late June; grant reduction to SSI/SSP, reductions to CalWORKS, Child Welfare including Adoption Assistance and Foster Care Programs, Community Care Licensing.
• In-Home Supportive Services Reforms Trailer Bill (AB 19x4) - contains the reforms including mandatory fingerprinting and background checks for IHSS workers - and also mandatory fingerprinting of persons receiving IHSS, changes regarding time sheets.
• CalWORKS Reform (AB 8x4) includes reforms and reductions to the CalWORKS program - most of which was proposed by the Governor.

REGIONAL CENTERS & DEVELOPMENTAL CENTERS TRAILER BILL

• Developmental Services Trailer Bill (AB 9x4) - includes reductions to regional centers and developmental centers. This bill is nearly identical to AB 45x3 that Democrats passed (but never went to the Governor) in late June.

TRANSPORTATION TRAILER BILL
This trailer bills changes existing State law to allow for fund shifts and reductions dealing with transportation - including transportation programs that directly impact people with disabilities, mental health needs, seniors.

• Transportation Trailer Bill (AB 10x4) contains changes in State law to implement reductions to transportation.

EDUCATION TRAILER BILL

• Education Trailer Bill (AB 2x4) contains education cuts including those impacting students in special education (suspension of the California High School Exit Examination for students with special needs); cuts to community colleges that impact students with special needs in Disabled Students Services Program.

Mental Illness Was The Costliest Condition Between 1996 To 2006

The number of Americans under care for depression and other mental illnesses nearly doubled between 1996 and 2006, and the overall cost of treating them jumped by nearly two-thirds, according to the latest News and Numbers from HHS' Agency for Healthcare Research and Quality. http://www.medicalnewstoday.com/articles/159924.php

Explaining Bipolar Disorder to Others

About.com
How do you explain your, or a loved one's, condition to others? Here are a few sentences to help you organize your thoughts. Choose the most appropriate explanations and modify as needed.

Here's How:
Stripped down to basics, people with bipolar disorder have mood swings, from elation to depression, that don't necessarily have anything to do with what's going on in their lives.
Bipolar disorder is also called manic depression, and it appears to be caused by electrochemical abnormalities in the brain.

TV shows like to show people with bipolar disorder as criminals, but don't worry -- only a small percentage are ever violent, and I'm not one of them!

"Mania" and "manic" don't mean "crazy" -- they refer to extra high emotions, full of energy, fast talking, not needing much sleep, [add appropriate symptoms for yourself].

I am a rapid cycler -- that means I can be ultra-excited one day and deeply depressed the next, for no obvious reason. [Modify this to fit the person's cycle pattern.]

I get into what are called "mixed states" when I seem to have a lot of energy but at the same time am really down, angry or panicky.

There are a lot of possible medications for bipolar disorder. My doctor has started me out on _____, but if that doesn't work, we'll just try something else.

When I'm manic, I have particular problems with [choose symptoms like: spending too much money, talking too much, not making a lot of sense].

Inappropriate anger can be a symptom of bipolar disorder. I might say or have said hurtful things that I really don't mean -- I'm sorry! Finding the right medication should help control that behavior.

When I get depressed or into a mixed state, I sometimes feel suicidal. That's my illness talking -- but it's serious. You might have to get me to a hospital if I seem really bad.

Bipolar disorder seems to be inherited but the exact cause is not known yet.

Don't worry if I _________ [behavior you and your doctor agree is symptomatic but not dangerous by itself].

If I start ________ [behavior you and your doctor agree is dangerous], tell me to call my doctor, or take me to the hospital.

Tips:

• All of the above can be modified to be about someone else, not yourself -- e.g., "He is a rapid cycler" or "she gets into mixed states."
• Educate yourself as much as possible about your condition by reading up on it, and urge close family members to do the same.
• Give careful consideration to whom and to what extent you share these very personal details about yourself. There are those who will simply never understand. If you lose a friend, it is their loss!

New Book Helps Those with Bipolar Disorder Manage Diets - and Lives

Author Sarah Freeman recently published a new book entitled, "The Bipolar Diet: Managing Mood, Food and Weight." The book is designed to provide a roadmap for those with bipolar disorder on improving diet and making lifestyle changes that can improve both mental and physical health.

(PRWEB) August 5, 2009 -- Author Sarah Freeman has overcome many challenges when it comes to dealing with her bipolar disorder. Now, she hopes to share some of the insight she has gained through a recently published book entitled, "The Bipolar Diet: Managing Mood, Food and Weight."

The book provides a roadmap for those with bipolar disorder on improving diet and making lifestyle changes that can improve both mental and physical health.
Freeman, who was diagnosed with bipolar/manic depression in 2005, said that nutrition and diet should be of paramount concern for those being treated for the condition.

"When I first started taking medication for my bipolar disorder I gained over 40 pounds," Freeman said. It was because of this rapid weight gain and deterioration of her own health that she wrote this new book. Along the way, she learned a lot about the causes of her dietary troubles and her mood swings, as well as the seriousness of the risks associated with having bipolar disorder -- including a greatly increased risk of early death from diabetes, heart disease and stroke.

"I read a medical textbook that explained how many people with bipolar disorder also have reactive hypoglycemia -- that is low blood sugar that occurs one to three hours after a meal," she said. "The symptoms include fatigue, depression, irritability, foggy thinking, panic attacks, and even outbursts of rage. Thankfully there is a practical solution. By learning to eat in a way that stabilizes insulin and blood sugar, my moods improved dramatically, and I was able to easily shed all that unwanted fat."

In February 2009, the medical journal Psychiatric Services published findings showing that bipolar disorder can double the risk of early death from a range of medical conditions -- including some that can be controlled through diet and exercise.

"'The Bipolar Diet' explains how to protect yourself from illnesses like diabetes and heart disease that often co-occur with bipolar disorder," Freeman said. "It also discusses weight control as so many people experience significant weight gain as a side effect of their bipolar medication. 'The Bipolar Diet' also explains the food/mood connection, and how smart food choices can protect from mood swings into both mania and depression."

About Bipolar-Lives.com
Bipolar-Lives is one of the Internet's leading sites on bipolar disorder, offering a unique mix of the latest research, practical tools and personal stories. For more information, contact Freeman at 850-294-6806, or visit http://www.bipolar-lives.com.

America the Beautiful - National Parks and Federal Recreational Lands Pass - Access Pass - Free.

America the Beautiful - National Parks and Federal Recreational Lands Pass - Access Pass
This is a lifetime pass for U.S. citizens or permanent residents with permanent disabilities. Documentation is required to obtain the pass. Acceptable documentation includes: statement by a licensed physician; document issued by a Federal agency such as the Veteran's Administration, Social Security Disability Income or Supplemental Security Income; or document issued by a State agency such as a vocational rehabilitation agency. The pass provides access to, and use of, Federal recreation sites that charge an Entrance or Standard Amenity. The pass admits the pass holder and passengers in a non-commercial vehicle at per vehicle fee areas and pass holder + 3 adults, not to exceed 4 adults, at per person fee areas (children under 16 are admitted free). The pass can only be obtained in person at the park. The Access Pass provides a 50 percent discount on some Expanded Amenity Fees charged for facilities and services such as camping, swimming, boat launching, and specialized interpretive services. In some cases where Expanded Amenity Fees are charged, only the pass holder will be given the 50 percent price reduction. The pass is non-transferable and generally does NOT cover or reduce special recreation permit fees or fees charged by concessionaires.

Chairman Miller on CNN discussing seclusion and restraint techniques

Chairman George Miller was on The Situation Room with Wolf Blitzer last week discussing the use and abuse of seclusion and restraint techniques in schools. On May 19, 2009, the Committee held a hearing examining the abusive and deadly use of seclusion and restraint in schools. In response to the GAO report delivered at that hearing, Chairman Miller said, "The GAO's report shows that in too many cases, a child's life wound up being threatened even though that child was not a threat to others. This behavior, in some instances, looks like torture. The current situation is unacceptable and cannot continue."
more... http://edlabor.house.gov/blog/2009/07/chairman-miller-on-cnn-discuss.shtml

Do You Have a Favorite Book about Bipolar Disorder?

Thursday July 23, 2009
Earlier this week I noted in a blog one of my favorite books. I've now heard from a few of you sharing yours. Manda, a long time member of our Chat Community, shared an extensive list of books for the chat book club. They are currently reading I Never Promised You a Rose Garden by Joanne Greenberg. In our Forums, Averill shared, An Unquiet Mind by Dr. Kay Redfield Jamison has always been my absolute favorite book about bipolar. I can relate to it so much and I give it to people to read to show what goes through our minds as bipolar people in an episode, and that with treatment we can be very successful people." "Bipolar Disorder for Dummies is my favorite book ... I recommend it all the time. The thing I like about it most is that it is easy to read. I think it should be given out each time someone is diagnosed," contributed Oakgiraffes. Erica, our Community Coordinator, has posted a poll in the Forums listing what she thinks are the top few books:

• Bipolar Disorder for Dummies
• Bipolar Disorder: A Guide for Patients and Families
• Madness: A Bipolar Life
• An Unquiet Mind: A Memoir of Moods & Madness

Want to MEET Dr. Jamison in person? Dr. Jamison and artist Miguel Cordera will be speaking at a special dinner September 4 in San Diego. For tickets: Contact@CaliforniaBipolarFopundation.org

CBF's Annual Family Pool Party

Saturday, August 29th
1:00 - 4:00pm
Carmel Valley
Look for your e-vite or RSVP to us at: Contact@CaliforniaBipolarFoundation.org