 This is Think Tech Hawaii, Community Matters here. Welcome to Shrink Rap, Hawaii. My name is Steven Phillip Katz. I'm a licensed marriage and family therapist right here in Honolulu. And I am stoked because my guest today is Tricia Chang, who is the program manager at Nami, Hawaii. And just to kick things off, would you tell everybody what Nami stands for? So Nami stands for the National Alliance on Mental Illness. And we are a national mental health nonprofit with state chapters and local affiliates. And so I'm the program manager for the Nami Hawaii State Chapter. Nami's mission statement nationally is to provide education, advocacy, and services for people affected by mental illness. So both those living with it and their loved ones. So what does that actually mean? Like what are some of the programs that you're the director of? Well, the bread and butter of Nami Hawaii is our family-to-family classes. And our family-to-family classes are a 12-week free course to teach the loved ones. Free, you said free. Free, absolutely free. And I think that's important to note about Nami is that everything we offer is free. There's never a charge. So the family-to-family course is a 12-week long course. And it's for people who have loved ones with mental illness. And these are spouses, parents, siblings, and sometimes even children. And the course talks about medication, therapy, access to services, self-care, problem-solving, communication. So everything that someone would need as a toolkit to better take care of their loved one with mental illness, that's our bread and butter. But we also, and you know this as well. Wait, before we skip ahead too much. So let's say I'm a parent and I'm suddenly faced with the reality that my child has a diagnosis of bipolar disorder or schizophrenia. How would I get in touch with Nami? So the Nami-Hawaii office, you can call us at our number. And our number, should I say it now? Say it now. Our number is 808-591-1297. And then we are also accessible by email, which is info at NamiHawaii.org. And so they would contact us. I would probably be the first door that they would get through. And any inquiry they have, they can ask us. We can't guarantee that we'd be able to answer every inquiry to the degree that they want that to be answered, but we do our best. So this family-to-family program, is it an ongoing thing? Does somebody just jump in any time? How does that work? So unfortunately, you would have to wait for every 12 week rotation. So we are currently ending a rotation now. But the next one will start up in mid-September. And so we are going to be advertising that on our website. And hopefully, we can get the word out in other ways. But that will last 12 weeks, as well. So no, you can't jump in at any time. I'm glad you mentioned that. But you would have to wait for the next 12 weeks. So if they go to the website, Nami-Hawaii.org, they could find out when the next one is starting. Yes, they would. Maybe they could send an email saying, hey, do you want to be part of the next session or call you up? Yes, and then we would put them on the wait list. And this is often the case. I will often get inquiries when the class is not available at that moment. So what we then follow them into are the family support groups. And I know you know a lot about that. The family support groups, right. I run the Winwood Oahu family support group, which meets the fourth Tuesday of each month at 5.30 at the Castle Medical Center's Weinberg Wellness Center. Like you said, since it's an Omi program, it's totally free. And like all of the support centers, it's for people who have a loved one in their life, mother, father, sister, brother, even friend, cousin, who has a serious mental illness. Because it's very stressful to those people. Of course, it's stressful to the person who has the illness. But it's incredibly stressful on relationships. Because it's often the case the person with the illness especially in the early stages is unaware that they're ill, but is behaving strangely, losing jobs, getting into fights, making family life very difficult, put stressing marriages. And the support group, I don't think I've ever seen it not happen the first time that somebody comes to a support group and tells their story about what's going on in their life at that time with their loved one to people who have been through or are going through the same kind of thing. I always try to remember to take a tissue box because there's something about sharing that information that makes it hard to talk, brings up the emotions. It's sadness, but also relief that you're talking to other people that get it. Because if it hasn't happened in your life directly, it's impossible to really deeply understand what that means. And I think it's hard to talk about things that no one wants to talk to you about. I think there's a lot of stigma regarding mental illness and mental health conditions. And so a lot of these family members come to us thinking, I can't talk about this with anyone. So just over the phone, I can hear this outpouring of relief. I have witnessed family to family courses where people just break down sobbing, where they begin to hug each other, because this is a place where they don't feel alone. And in fact, Nami's model is you are not alone. And I think that I love that you mentioned the burden that the caretakers take on, because a lot of mental health nonprofits will help those who have the mental illness. And that, of course, is a vulnerable population. We need to address that. But not many mental health nonprofits. I could be wrong in saying this, but I think Nami is at the forefront of this, taking care of the caregiver. And that's so important, because without that caregiver, the loved one will fall into homelessness, incarceration, and hospitalization could possibly even die. So what we tell the caregivers is you have to take care of yourself, because you are the only thing standing between your loved one and a lifetime of hardship. And so I'm really glad that you mentioned that. And I think that that's why I'm very proud to work with Nami is because they do acknowledge that. Yeah, yeah. I mean, you often read about the metaphor with the airplane. You have to put your own mask on first before you help somebody else or else. You're both not going to make it. And the responsibility, since in many ways was still in a very primitive state of research when it comes to the brain, there is no magic bullet. It's very often, not always, but very often a lifetime struggle. And we have members of Nami in their 90s who are dealing with children in their 60s. And sometimes it gets better, sometimes it gets worse. And you need a network of support. And Nami provides some of that. But that also makes me think of what's been going on in Washington about financial support, insurance. The Republican agenda in wanting to undo Obamacare just to put it bluntly, what would that mean for people dealing with a severe mental illness? That is a question that Nami has been looking at. And now I'm talking about Nami National. Nami, because it is a nonprofit, is nonpartisan. But this is a partisan issue, health care reform debate. And nonprofits like ourselves, Planned Parenthood, are now faced with a difficult situation of, we are nonpartisan, but this is an obviously partisan debate. How do we go about this? And I think Nami has been very good at, instead of going against the Republicans, going against the ideas the Republicans have put forth. Because we are calling for, and I personally would love to see a bipartisan effort. But when it comes to how this health care reform debate is going to affect people living with mental illness, it's going to affect them tremendously. And I think that the vulnerable are always the first ones to be affected. Primarily, it's going to hit Medicaid. And Medicaid is the primary provider for mental health care services for a lot of those who live with mental illness. And it's going to hit Medicaid in many, many, many different ways. And I think the primary way that many people have been hearing about on the news and just in late night talk shows is the fact that it's going to make it optional for states to cover essential health care benefits, one of them being mental health care. So that would mean that depending on what state you're in, you may have mental health care services covered or not. And we in Hawaii are lucky. And you and I were fortunate enough to talk to the staff of the Congress people that we in Hawaii have when we're at the National Convention in DC. But Hawaii's on board. So people in Hawaii won't really have to worry about Hawaii opting into that waiver. The states that are in trouble are those who have, at this point, Republican senators. And Kentucky is a great example of that. Kentucky has benefited from Obamacare. And you'll see sort of a mixed reaction about what I just said on the internet. But Kentucky has benefited from Obamacare in the sense that the rate of their uninsured has dramatically decreased. I think it was from a quarter of uninsured to now 6% uninsured. So 25% uninsured before Obamacare, 6% uninsured now. And if, say, the Senate version of the House bill, the Trump care bill passed, that would probably go back? Yes. What it would do is it would severely limit the amount that Medicaid expansion would provide. And what that means is it would be harder for people to qualify for Medicaid. And even if they did qualify for Medicaid, the states now have the option of saying, well, these essential health care benefits are no longer covered. And at this point, Nami can't stand by and say nothing, because we're not talking about reduced health care coverage. We're talking about no health care coverage for mental health. And that's just unacceptable. Well, because if you're dealing with a severe mental illness, it's likely that you're not going to have a job that gives you health benefits. So you have to pay out of pocket. And they would either make it totally unaffordable or just unavailable. Well, that's also something. One of the things that the news hasn't been talking about a lot are all the little sort of, I hate using this word, but insidious kind of things that are put into the Better Care Reconciliation Act, which was the Senate's version of the bill. And even in the skinny repeal, this was mentioned. But an insidious requirement such as work credits for Medicaid. So someone would have to prove that they were working or prove that they were in some sort of job training or some schooling or some sort of job coaching in order to qualify for Medicaid. Now, on the outside, this sounds like a great idea. We're incentivizing people to work, et cetera, et cetera. Let's make them work for their insurance. But the thing is, most people who qualify for Medicaid income-wise are already working. They are employed. There are people who are not working because they have a disability or they're in school. So for those who live with mental illness, it's because they cannot work because of their disability. So having them be required to have a work credit is, in a sense, punishing them for their health. And that's not what health insurance is supposed to do. So having that work credit requirement is backward in many ways, one of which being it would exempt you if you had a disability. But you and I know how hard it is to be labeled disabled in terms of getting Social Security disability. Oh, yeah, it often takes years to get Social Security benefits because it seems like the first time you apply, you automatically get denied. Right. So in the meantime, is that person supposed to remain uninsured? And that would unfortunately be the case. And unless they can prove disability, they would remain uninsured. And the reality is, if somebody is having severe symptoms and they're on the street and they end up at the emergency room, the emergency room by law in many places is not allowed to turn them away. They have to give them services. So who pays for the service? So that's another really big thing. And I think there's this misconceived notion. And it's one that I've always sort of wrestled with because I can never understand why people think this way. But there's this misconceived notion that if fewer people are on insurance and we can kick more people off, then it will be cheaper for the rest of us. You know, those of us who are privately insured or just insured in general. And I think besides that being a bit of a morally bankrupt argument, it just doesn't work. It's not true. It's not true because someone is going to have to front the cost of the uninsured. Unless you're totally, you know, say, OK, well, I'll just let them die on the street. They can't go to the emergency room. Right. And even then, we would front the cost of the uninsured. Because they wouldn't just drop that on the street. They would probably go to a hospital first. And the hospital would have to front the care. If it's a non-profit hospital, they would absorb the cost to the point where you have to take a break and be to cut you off. We'll be right back with shrink wrap Hawaii. Don't touch your mouse. This is Think Tech Hawaii, raising public awareness. Welcome to Sister Power. I'm your host Sharon Thomas Yarbrough, where we motivate, educate, empower, and inspire all women. We are live here every other Thursday at 4 PM. And we welcome you to join us here at Sister Power. Aloha and thank you. Living in this crazy world, so far up in the confusion. Nothing is making sense for me. Welcome back to Shrink Wrap Hawaii. I'm Stephen Phillip Katz. And I'm still with Trisha Chang, the program manager for NAMI Hawaii. And we were talking about the insurance implications here. Yes. So to sort of go back to where we were, there's a lot of misconceptions regarding insuring people in general. And so no matter what, and I think it just comes down to this, no matter what, people are going to see treatment, whether they are insured or not. And you can put many barriers up to them being insured. But we're going to have to front that cost eventually when they end up hospitalized. And if we don't do that another way, especially with the mental health care system, if we don't get medication to people who need it, we are going to contribute to the homelessness issue. Right. And they're going to show up at the emergency rooms more often. Yes. Or the substance abuse epidemic, because they're going to start self-medicating. That's another group that will lose coverage under this, what is it called, the BRCA? The Better Care Reconciliation Act. Oh, BC, OK. BR. Right. So basically they're telling addicts that they can't get treatment, because nobody's going to pay for it, and it's expensive. And that doesn't mean that they're going to suddenly stop being addicts, because it's no longer insured. Right. So as a society, as a whole, it ends up being more expensive. Yes. And I think it comes down to the fact that people who live with mental health conditions are going to be chronic users of the health care system. And that is not a fault on them, and that's not something they should be penalized for. Looks like being a diabetic, you need medication. Exactly. And it's about preventative care. And to me, one of the most unfortunate things is a loss in human capital. When we lose someone in the mental health care system, when we let them go psychotic, when we let them go manic, when we let them be homeless, when we let them get addicted to substances, what we're basically saying is we don't care whether you're a productive member of society or not. And we lose that human capital. So we've just lost an individual. Well, not only an individual, you can also lose other family members, because it just takes so much emotional and physical energy to deal with that by yourself. And I think that that's where people like Nami come in, is that we try really hard to plug up that hole that is unfortunately in the mental health care system, where there's people drop out. And I get a lot of increase, a lot of solving increase, about people saying, how do I get my son, my daughter, my sister, brother, husband, wife, how do I get them to accept care? How do I get them to get care? And unfortunately, a lot is bizarrely wrong with the system. But organizations like Nami try to provide a blanket in the blizzard. It's not nearly enough. Talk about things wrong with the system. I don't think most people are aware that there are far more people in our jails and prison than there are in mental hospitals and mental wards in regular hospitals in the United States, in every single state of the country, Hawaii being no exception. And our jails and prisons aren't set up for that kind of treatment. So basically people go untreated, then they get released, and then they bounce right back because there's no treatment. So this is exactly why going back to health care reform, that's exactly why you can't look at one issue in isolation, that if we don't treat people who struggle with mental health conditions, we are adding to the homelessness issue, the incarceration issue. Because people who are suffering from severe mental illnesses are not always, they don't always possess agency. And so a lot of them get slammed and sent to jail for misuse. Agency meaning they can't take care of themselves. They can't take care of themselves, and they also don't currently have control of their faculty. For example, delusional thinking or hallucinations, especially command hallucinations that can lead them to do petty crimes, such as burglary or loitering or public nudity or things like that. And they get penalized for it. And it's not something within their control. And so it's a very backward system where we would rather lock you up in a jail than pull you off the streets to hospitalize you and treat you, because we don't want to infringe upon your liberty. Yeah, that's a big deal. I mean, right now the way the system is, unless you say you're going to kill somebody or yourself, if you don't want to go, you won't get treatment at all. And that's unfortunately something we hear a lot from the parents and the loved ones. That's probably the number one inquiry I get at NAMI as a program manager is, how do I get my loved one help? And unfortunately, the answer, depending on the situation, is you have to wait. And there are a few things that break my heart more than telling a parent, you have to wait until your son or daughter commits a crime or raises a weapon against you or raises a weapon against yourself before anyone wants to look at them. So if somebody does come to the family to family educational group class, what does that look like? What happens at these classes? So the first class will be sort of bonding moment, getting to know each other. The class fills up at 15 participants. So it's relatively small. It's relatively close knit. And it's really just a beginning to healing because these are people that have come across, as I said before, a broken mental health care system. And they are frustrated. And I'm sure you see this at the family support group. They are confused. They are beleaguered. And sometimes they just want to be told that they're on the right track, that they're doing the right thing by getting power of attorney, et cetera, et cetera. But it starts off with sort of bonding. And then it moves from topical class to topical class. So we'll talk about different diagnosis. We'll talk about different medications. We don't prescribe any particular medication. But we talk about the mechanisms of medication. We talk about access to health care services. There is a class where someone who lives with a mental illness will come and speak to the loved one so that they can kind of get an empathy. And there is exercises and empathy in a class where they put themselves in the mindset of someone who does hear a command hallucination. So the class is very multifaceted. And our hope is that when they leave this class, they will feel that they have more strategies for self care, that they feel a little more informed about the health care system, and they feel less alone. It's when I went through that class, one of the things that I had to deal with was a sense of guilt, like, what did I do wrong as a parent, which it's not like you take care of it and then you don't have it anymore. It seems to recur, right? I mean, in a way, it's my own issue that I have to deal with. And it was very helpful in the class because actually, it wasn't centuries ago where parents were blamed, especially mothers, right? They had this thing called the schizo-phrygenic mother, like blaming mothers and their personalities and the way that they looked after their babies for the schizophrenia of their child. And that was a real thing that we've is now back in the dustbin of psychology, together with phrenology, where they would diagnose you by the shape of your head. Getting used to the idea that mental illness, especially severe mental illness is like schizophrenia and bipolar, chronic depression, are an illness that are chemically based. Yes, there is interaction with your whole body or whole self and their environmental triggers, but it's an illness the same way heart disease or high blood pressure or cancer is an illness. Speaking of cancer, the new head of the National Institute of Mental Health at that convention, I think he was the one that said something. If we spent the kind of money doing research on the brain that we've spent on cancer, we would be far more ahead than we are right now. Not to say that the money spent on cancer was ill spent. It's wonderful that so many cancers now are curable, treatable, but it would be nice if we did the same for mental illness, because it still feels so much like we're shooting in the dark. And I think that's another thing that Burden's parents and other loved ones is that every attempt of treatment is a shot in the dark. And especially I am tuning into what you said previously in that there is no magic bullet. And I think we all wish that there was. There was a pill that would automatically take everything away. And ironically, there is no pill that will automatically take it away. But a lot of critics of psychiatry will say you are relying on the one pill to take it all away. And so I think that there's this misunderstanding on both sides, people who embrace psychiatry and people who are suspicious of psychiatry, and that they don't technically agree with what treatments are available. And I think it's also just public attitude in regards to mental illness. We are finding funding things like cancer and juvenile diabetes and AIDS and other things like that, because we don't see it as anyone's fault. Before, AIDS was seen as someone's fault. And hence not a lot of funding went into it. I think in the realm of mental illness, we are still looking at it as it's your fault. And if you rely on medications, it's a crutch. And therefore, we're not going to pay for your crutch. We're not going to. Well, and people who are mentally ill themselves buy into that, like, I don't need this medicine. Yes, yes. And that also, I mean, there's so many reasons why people with mental illness reject medication. But that is primarily one of them, is it's anosognosia, which is a lack of insight, that they don't realize that they need this medication and that they're behaving normally, but also because of public attitude towards medication. Yeah. Yeah, I mean, if the medication works, you feel fine. And once you feel fine, you say, I'm fine. I don't need the medication. Right, right. Which is also a problem in other chronic illnesses. Medication on confines is an issue across chronic diseases. I think I've read an article about 30% of patients will eventually be medication on compliant in terms of diabetes medication, heart disease medication. Across the board. And it's for many reasons. They forget it. They don't want to take it, right? I want to jump in here because we won't be doing our job if we don't tell people. So all these programs are free, but they need to be paid for. So how, let me just say it, there is a big fundraiser every year. It's called the NAMI Walk. When is it happening this year? So NAMI Walk is happening October 14th and it will be at where it always is at Honolulu Holly Ground. And it's the largest charity slash advocacy walk for mental health in the nation. And the way I usually spin it, because I tend to be a bit of a skeptic and people are like, oh, I walk, but I'm not actually doing anything. And I only raise a dollar, whatever. Surely every dollar counts. Every dollar is more paper clips for me. So, and I do appreciate that. I do, I appreciate more paper clips. So how could people sign up to do the walk? Yes, so you can register on namihawai.org. Namihawai.org. Yes, and we will have a link that takes you to our walk page. And you can register online. Is it free to register? It is free to register. Anybody can walk. You don't even have to give money to walk. No. Okay. You know, as long as you don't take money, you know, you can't give negative money. So as long as you have a open attitude towards mental illness, we invite you. Right, because I'm part of it is breaking down the stigma, right? So the fact that we have 500 or 1,000 or more people show up there and say with their bodies, I support, you know, getting help for people with mental illness and their families, that's a good thing. And then if they want to give money, that certainly would be a good thing. Exactly. And so the skeptic in me breaks down when I realize, you know, walking is not the achievement. Walking moves me to feel and feeling will lead me to achievement. I love that. Right. Walking itself is very therapeutic. Yes. Well, thank you, Trish, for coming to Shrink Rap Hawaii and getting the word out about Nami Hawaii. Keep up the good work. Thank you for all the work you do for us as well. Thanks again. Thank you. Tune in next time for Shrink Rap Hawaii. Aloha.