NAMI’s Position (Summarized from the NAMI Policy Platform)
Treatment, not punishment:
NAMI believes that persons who have committed offenses due to states of mind or behavior caused by a brain disorder require treatment, not punishment. NAMI believes that a prison or jail is never an optimal therapeutic setting. NAMI believes that mental health systems have an obligation to develop and implement systems of appropriate care for individuals whose untreated brain disorders may cause them to engage in inappropriate or criminal behaviors.
Treatment while in correctional settings:
NAMI believes that states and communities have legal and ethical obligations to provide people with brain disorders humane and effective treatment while in correctional settings.
Training and education:
NAMI believes that education about brain disorders at all levels of judicial and legal systems is crucial to the appropriate disposition of cases involving offenders with brain disorders. Judges, lawyers, police officers, correctional officers, parole and probation officers, law enforcement personnel, court officers, and emergency medical transport and service personnel should be required to complete at least 20 hours of training about these disorders. Consumers and family members should be a part of this educational process.
NAMI believes that, in the overwhelming majority of cases, dangerous or violent acts committed by persons with brain disorders are the result of neglect or inappropriate or inadequate treatment of their illness.
NAMI supports the retention of the "insanity defense" and favors the two-prong test that includes the volitional as well as the cognitive standard. NAMI opposes the adoption of "guilty but mentally ill" statutes. NAMI supports systems that provide comprehensive, long-term care and supervision in hospitals and in the community to individuals found "not guilty by reason of insanity," "guilty except for insanity, or any other similar terminology used in state statutes pertaining to the insanity defense.
Parole and probation, transitional services:
NAMI believes that states must adopt systems for assisting individuals with serious brain disorders who have served sentences and are eligible for release on parole with appropriate treatment and services to aid their transition back into the community.
NAMI opposes the death penalty for persons with brain disorders.
The "Criminalization" Trend Is Today Worse Than Ever
In 1992, NAMI and Public Citizen’s Health Research Group released a report, entitled Criminalizing the Seriously Mentally Ill: The Abuse of Jails as Mental Hospitals, which revealed alarmingly high numbers of people with schizophrenia, bipolar disorder, and other severe mental illnesses incarcerated in jails across the country. Most of these people had not committed major crimes, but either had been charged with misdemeanors or minor felonies directly related to the symptoms of their untreated mental illnesses, or had been charged with no crimes at all. Unfortunately, the problems described in that report have worsened in the ensuing years.
A report issued by the United States Department of Justice in 1999 revealed that 16 percent of all inmates in state and federal jails and prisons have schizophrenia, manic depressive illness (bipolar disorder), major depression, or another severe mental illness. This means that on any given day, there are roughly 283,000 persons with severe mental illnesses incarcerated in federal and state jails and prisons. In contrast, there are approximately 70,000 persons with severe mental illnesses in public psychiatric hospitals, and 30 percent of them are forensic patients. Additionally, police are increasingly becoming front-line respondents to people with severe mental illnesses experiencing crises in the community.
Conditions in jails and prisons are often terrifying for people with severe mental illnesses. These settings are not conducive to effectively treating people with these brain disorders. Many correctional facilities do not have qualified mental health professionals on staff to recognize and respond to the needs of inmates experiencing severe psychiatric symptoms. Correctional facilities frequently respond to psychotic inmates by punishing them or placing them in physical restraints or administrative segregation (isolation), responses that may exacerbate rather than alleviate their symptoms. Inmates with severe mental illnesses usually do not have access to newer, state-of-the-art, atypical antipsychotic drugs because of the costs of these medications. Federal and state prisons generally do not have adequate rehabilitative services available for inmates with severe mental illnesses to aid them in their transition back into communities.
These alarming trends are directly related to the inadequacies of community mental health systems and services. The widespread adoption of systems with proven effectiveness in addressing the needs of people with the most severe mental illnesses, such as assertive community treatment programs, would sharply decrease the numbers of people with severe mental illnesses involved in criminal justice systems.
However, since these programs are available only sporadically throughout the country, NAMI’s strategies for reducing criminalization focuses both on improving community mental health services and on addressing the treatment and support needs of people with severe mental illnesses in criminal justice systems.
Strategies for Reducing the Criminalization of People with Severe Mental Illnesses:
NAMI is pursuing the following strategies for reducing the criminalization of people with severe mental illnesses:
Adopting programs such as the Memphis Police Crisis Intervention Team (CIT) program to train police officers who come into contact with people with severe mental illnesses in the community to recognize the signs and symptoms of these illnesses and to respond effectively and appropriately to people who are experiencing psychiatric crises.
Supporting mechanisms to divert people with severe mental illnesses from arrest and incarceration into treatment before they are arrested and come into contact with correctional and court systems. In FY 2002, Congress appropriated $4 million for the federal Jail Diversion program at the Center for Mental Health Services (CMHS) authorized under P.L. 106-310 (Section 520g). NAMI urges full funding of $10 million for this program in FY 2003.
Creating authority in state criminal codes for judges to divert non-violent offenders with severe mental illnesses away from incarceration into appropriate treatment. This includes authority for judges to defer entries of judgment pending completion of treatment programs and to dismiss charges and expunge the records of individuals who successfully complete treatment programs.
Establishing specialty "mental health courts" to hear all cases involving individuals with severe mental illnesses charged with misdemeanors or non-violent felonies, with the purpose of diverting as many of these cases as possible away from criminal incarceration into appropriate mental health treatment and services. In 2000, Congress enacted and former President Clinton signed into law a bill (P.L.106-515) authorizing grants to communities to establish demonstration mental health courts. In fiscal year (FY) 2002, Congress appropriated $4 million for these Courts. One of NAMI’s priorities is to ensure that Congress appropriates full funding of $10 million for these Courts as part of the FY 2003 Commerce-Justice-State Appropriations bill.
Training probate, civil, and criminal court judges and other Court personnel about severe mental illnesses and legal issues affecting people with these illnesses.
Creating specialized divisions or units within departments of parole and probation with specific responsibility for coordinating and administering services for people with severe mental illnesses who are on probation.
Providing specialized training to parole officers about severe mental illnesses, the needs of people with these illnesses on probation, and treatment resources and benefits available to these individuals.
MEDICARE COVERAGE OF MENTAL ILLNESS TREATMENT
NAMI strongly supports congressional efforts to modernize coverage of mental illness treatment under the Medicare program – specifically to address the discriminatory aspects of programs such as the 50 percent co-payment requirement for outpatient mental illness treatment and a 190 day lifetime limit on inpatient hospitalization. NAMI supports the following bills in Congress to address these other inequities in Medicare: HR 599, S 841, S 690 and HR 1522,
NAMI strongly supports bipartisan efforts in Congress to add a prescription drug benefit to the Medicare program that provides adequate protections against the high cost of medications, ensures eligibility for both senior citizens and non-elderly people with disabilities on SSDI and does not administer benefits through use of restrictive formularies.
Parity Under Medicare
Medicare coverage of mental illness treatment has remained virtually unchanged since the program’s inception in 1965. This coverage continues to impose stigma-based distinctions in coverage between mental illness and other medical treatment. Medicare beneficiaries must pay 50 percent of the cost of outpatient mental illness treatment, as opposed to 20 percent for all other outpatient services. Similarly, Medicare imposes a 190-day lifetime limit on inpatient psychiatric hospitalization that is not imposed on all other inpatient treatment.
NAMI strongly supports various bills now before Congress to address these historic inequities in the Medicare program. Among these are HR 599 (Roukema), S 841 (Snowe/Kerry), S 690 (Wellstone) and HR 1522 (Stark) and urges the Bush Administration and Congress to incorporate them into efforts to enact comprehensive restructuring of the program.
Outpatient Prescription Drug Coverage Needed
Both President Bush and congressional leaders have pledged to make coverage of outpatient prescription drugs part of the Medicare program. This issue has been commonly framed as "coverage of prescription-drug benefits for seniors." Much to NAMI’s regret, few elected officials have discussed this popular issue in terms of providing such coverage for the 1.3 million non-elderly people with disabilities who are eligible for Medicare by virtue of having been on Social Security Disability Insurance (SSDI) for a minimum of two years.
Later this year, Congress is expected to take up several competing measures to add a prescription drug benefit to Medicare. All of these competing plans agree on the need for any Medicare drug benefit to be universal (all Medicare beneficiaries would be eligible for the benefit) and an entitlement. Further, all of the competing plans include some type of "stop loss" coverage – establishing a threshold above which all costs are covered (ranging from as low as $3,500, up to $7,000 in competing bills).
The separate House and Senate bills vary widely on several critical issues: a) costs and b) whether the program should be administered within the existing structure of the Medicare program (generally favored by Democrats) or through private sector plans (generally favored by President Bush and Republicans). On the issue of costs, proposals vary from as low as $200 billion over 10 years, up to more than $750 billion over 10 years. Because of the looming retirement of the large baby-boom generation, putting off enactment of a drug benefit raises the eventual costs by as much as 18% a year.
On the issue of program structure and delivery, a leading proposal authored by Senate Democratic leaders would add a new Part D to Medicare would administer a new prescription drug benefit through the existing Medicare structure. By contrast, a proposal being pushed by House Republican leaders would direct insurance companies and HMOs to offer prescription-drug coverage. This new benefit would be enacted in conjunction with larger, systemic reform of the entire Medicare program. Under this legislation, the government would not directly provide drug coverage, purchase drugs, or regulate prices. Instead, private health plans would be expected to offer a variety of options that would include drug coverage integrated into Medicare as well as "drug only" coverage added to the traditional Medicare program. These private plans would be expected to pass discounts to beneficiaries based on a federal subsidy for the premium costs for drug coverage. Other proposals would rely on Pharmacy Benefit Management (PBM) providers to administer a new drug benefit and penalize manufacturers that refuse to discount drug prices.
On the issue of restrictive prescription-drug formularies, most of the competing congressional proposals attempt to respond to Medicare-enrollee frustrations about access to the newest and most effective medications. Most proposals would bar the establishment of a uniform national formulary for any class of FDA-approved drugs. At the same time, each proposal either explicitly or implicitly assumes that insurers will be able establish their own formularies and each will have a process to allow beneficiaries to appeal decisions to deny non-formulary drugs.
As part of the debate over Medicare prescription drug coverage, NAMI supports the following principles:
prescription drug coverage must address the underlying discrimination in Medicare’s existing, overall mental illness benefit,
the 1.3 million non-elderly persons receiving SSDI benefits (25 percent of whom are eligible for SSDI because of a mental illness) must be eligible on the same terms and conditions as elderly beneficiaries),
coverage should be a standardized with entitlement for all eligible Medicare recipients,
coverage must be sufficient enough to pay for the most expensive drugs for the treatment of severe and persistent mental illnesses and include "stop loss" coverage, and
prescription drug formulary policies must adhere to a principle of open access to the newest and most effective medications for serious brain disorders such as schizophrenia, bipolar disorder and major depression.
NAMI Housing Fact Sheet
NAMI supports efforts to increase funding in FY 2002 for the HUD Section 811 program (above its current $241million level) and to maintain the integrity of the capital-advance and project-based rental-assistance portion of the program (maintaining the existing 75 percent threshold). For the 25 percent of the Section 811 program that HUD directs to tenant-based rental assistance, NAMI supports separate funding – outside of the 811 program – for renewal of all expiring tenant-based subsidies (estimated to cost $32 million in FY 2003). Separate funding for these renewals is needed to avoid cuts to the Section 811 program and erosion of the program’s core mission of increasing the stock of decent, safe and affordable housing for people with more severe disabilities that need supports and services to live in the community.
NAMI supports continued funding for a separate allocation of tenant-based rental assistance for non-elderly people with disabilities adversely affected by the designation of public and assisted housing as "elderly only." (Congress has allocated over $250 million for this purpose since 1996).
NAMI supports increased funding for federal homeless-assistance programs and continued implementation of a minimum threshold for permanent housing programs for homeless adults with severe mental illness (e.g., Shelter Plus Care, SHP permanent housing). NAMI supports efforts in Congress to continue renewal of all expiring Shelter Plus Care and SHP permanent housing rent subsidies through the Housing Certificate Fund (HCF) as proposed in separate House and Senate bills (HR 3995 and S 2573).
NAMI supports legislation authorizing a new federal housing production program to serve households at 30 percent of median income and below (including HR 2349), with specific targeting of individuals for whom tenant-based rental vouchers have proven ineffective for securing stable housing.
NAMI opposes efforts to erode standards in the Fair Housing Act that protect group homes and other shared-living arrangements in the community from discriminatory zoning and land use policies.
Access to decent, safe, and affordable housing remains a tremendous challenge for adults with severe mental illnesses. Unfortunately, in virtually every part of the United States people with severe mental illnesses struggle to find good-quality housing they can afford. Many people with the most severe and disabling mental illnesses also need access to appropriate services and supports so that they can successfully live in community-based housing, which promotes their independence and dignity.
Unfortunately, the U.S. Department of Housing and Urban Development (HUD) and many state and local agencies responsible for administering our nation's affordable-housing system do little to alleviate this struggle to access community-based housing and supports. Historically HUD has made little effort to understand the real implications and bitter reality of recent federal housing policies, policies that have reduced the federally subsidized housing units available to people with severe mental illnesses and other disabilities.
Current housing policies were enacted by Congress in 1992 and 1996 to permit public and assisted-housing providers to designate housing as "elderly only." People with disabilities and their advocates understand that Congress must replace the hundreds of thousands of units of federally subsidized housing no longer available to people with disabilities, including people with severe mental illnesses. Unfortunately, HUD has also failed to preserve and adequately fund the Section 811 Supportive Housing for Persons with Disabilities program, which was designed to provide housing and supports to people with severe disabilities. But for the efforts of a few leaders in Congress, an increasing number of adults with severe mental illnesses would continue to live at home with aging parents or in substandard housing. Without additional resources, too many adults with severe mental illnesses will likely end up homeless or remain unnecessarily in inappropriate settings (e.g., homeless shelters and local jails and prisons).
The bitter irony of this loss of housing is that it comes when people with all types of disabilities (particularly severe mental illnesses) are increasingly able to live successfully in homes of their own—but only if independent housing is affordable and paired with appropriate supports and services. According to a 1999 HUD report, nearly 40 percent of the nation’s homeless are single adults with severe mental illnesses. In addition, an new report "Priced Out in 2000" reports that SSI income amounts to only 18.5 percent of median income nationally and that the average rent for a modest, one-bedroom apartment consumes, on average, 98 percent of a person's monthly SSI check.
These homeless and income numbers clearly demonstrate that people with disabilities (including severe mental illnesses) have the "worst" of the "worst case needs" and that their needs cannot be ignored by Congress, HUD, or state and local governments. While funding for tenant-based vouchers are helpful to many very low-income individuals with mental illnesses, new housing to serve people at the bottom of the economic ladder is also needed.
NAMI therefore supports efforts underway in Congress to establish a new, federal, flexible housing-production program for households at 30 percent of median income and below. In addition, proposals to restrict enforcement of the Fair Housing Act could make it more difficult to combat the "NIMBYism" that results from stigma and discrimination faced by group homes and other shared community-based housing.
Even though finding decent, safe, and affordable housing with adequate and appropriate support remains daunting for so many consumers and families, some progress has been made in recent years. Since 1997, NAMI worked closely with allies in Congress, including Rep. Rodney Frelinghuysen (R-NJ), to add more than $250 million to the HUD budget for tenant-based rental assistance for people with disabilities who have been (and will be) adversely affected by "elderly only" public and assisted housing designation. (Adults with severe mental illnesses are especially vulnerable in the "elderly only" housing designation process because of the stigma associated with their illnesses).
In 2001, Congress also maintained funding for homeless-assistance programs under the McKinney-Vento Act at $1.02 billion and continued separate funding for a $100 million account to ensure that all expiring rent subsidies under the Shelter Plus Care program are renewed in future years. Shelter Plus Care (part of the federal McKinney-Vento Homeless Assistance Act) is a critical resource for helping states and communities fund permanent housing and supportive services for homeless individuals with severe mental illnesses. This new account at HUD will ensure that formerly homeless tenants in Shelter Plus Care housing will not be at risk of losing their housing. In addition to the new account at HUD for Shelter Plus Care renewals, Congress continued for 2001 the requirement for a minimum 30 percent of funds to go toward developing permanent housing (and a 25 percent match requirement for communities using funds for services).
NAMI supports both a reliable, long-term source of funds for Shelter Plus Care and SHP permanent housing renewals and the 30-percent permanent housing set-aside, believing they are critical for ending homelessness instead of institutionalizing a homeless services system. NAMI supports HUD programs that finance permanent housing and public mental heath programs that fund supportive services to assist formerly homeless tenants in these settings. A 2001 University of Pennsylvania study demonstrates that permanent supportive housing for individuals with mental illness who are homeless are nearly as much as the costs of homelessness (emergency room treatment, psychiatric hospitalization, incarceration, etc.).
Finally, NAMI continues to work with allies in the disability community to oppose legislative proposals intended to scale back the existing protections in the Fair Housing Act that bar discriminatory zoning and the land-use policies that restrict placement of group homes and shared living arrangements in the community.
NAMI's Support for Federal Funding for Mental Illness
NAMI strongly supports efforts to substantially increase federal funding to ensure that there are adequate resources for promising biomedical research into brain disorders and genetics and supports initiatives focused on neural receptors, receptor subtypes, and modulators. NAMI applauds efforts in Congress and from the Bush Administration to increase funding for NIH, and urges that increases enacted in FY 2003 for the NIMH be directed to the most serious and disabling brain disorders. NAMI also supports changes in the NIMH mission that will place greater emphasis on the most serious brain disorders—including schizophrenia, major depression and bipolar disorder—in its research portfolio.
NAMI supports targeted increases in funding for programs at the Center for Mental Health Services (CMHS) at the Substance Abuse and Mental Health Services Administration (SAMHSA) that are focused on assisting states and communities in replicating evidence-based programs that serve children and adults living with severe mental illnesses.
National Institute of Mental Health (NIMH)
NAMI is extremely grateful to bipartisan leadership in Congress, and on the part of President Bush, to complete the goal of doubling the federal investment in biomedical research at the National Institutes of Health (NIH) by 2003. Completing this effort is a major achievement that you and your colleagues in Congress can truly can be proud of and that people with severe mental illness and their families are extremely grateful.
Thanks to important research funded by NIMH, through its current $1.118 billion budget, critical advances have been achieved in treatment for people living with serious brain disorders, such as schizophrenia and bipolar disorder, over the last decade. But we still have a long way to go. Medical science has yet to produce cures for severe mental illnesses. Furthermore, the most promising evidence-based treatments and services remain inaccessible for people who need and deserve them. From biomedical research to services research, NAMI believes that research on severe mental illnesses are under-funded. The proposed FY 2003 investment lacks equitable proportion to the scientific opportunities that exist and the tremendous burden of cost and pain that such disorders impose on NAMI families and the general public.
According to a recent study conducted by the World Health Organization, no less than four of the top ten causes of disability worldwide are severe mental illnesses. Major depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder account for an estimated 20 percent of total disability resulting from all diseases and injuries. Based on NIH’s own estimates, for every research dollar spent, 15 cents is allocated to AIDS, 10 cents on cancer, two cents on heart disease, and less than one cent on schizophrenia and other severe mental illnesses. In contrast, the total costof schizophrenia to society, per research dollar spent, is $161.26, compared to only $65.65 for heart disease, $9.96 for cancer, and $6.86 for AIDS.
Clearly, more equitable, increased investment is needed for NIMH. Therefore while NAMI strongly applauds the increases proposed by the Bush Administration for NIH, NAMI also recognizes that the recommended increase for NIMH lags far behind the nearly 14% increase proposed for the other NIH institutes. NAMI therefore urges Congress to enact an equitable increase for NIMH relative to increases for the entire NIH as part of the FY 2003 Labor-HHS-Education Appropriations bill.
Center for Mental Health Services (CMHS)
The budget of the Center for Mental Health Services at SAMHSA contains a number of important programs that assist states and localities in increasing access to treatment and supports and improving the overall quality of services. NAMI urges Congress to support the following priorities as part of the FY 2003 Labor-HHS-Education Appropriations bill:
PATH – NAMI strongly supports the $7 million increase proposed by the President for the Projects to Assist Transition from Homelessness (PATH) program to help homeless individuals with severe mental illnesses and co-occurring substance abuse disorders. The Administration’s proposed increase for PATH would result in an additional 31,000 homeless individuals with severe mental illnesses receiving services. Given the disproportionate representation of adults with severe mental illness among the chronically homeless population, NAMI strongly supports the Administration’s efforts to place the highest priority in meeting their needs for permanent supportive housing and community-based services.
Mental Health Block Grant – The President’s budget proposes freezing the Mental Health Block Grant program at its FY 2002 level of $433 million. As a result of budget cuts at the state level, we are witnessing a continued widening of gaps in the public mental illness treatment system. The consequences of these emerging cracks in the service system are readily apparent, not just to our consumer and family membership, but also to the public: the growing number of homeless adults on our nation’s streets who receive no treatment services, well publicized tragic incidents involving individuals with severe mental illness who are not accessing adequate treatment services and the growing trend of "criminalization" of mental illness and the stress it is placing on state and local jails and prisons. NAMI supports an increase for the Mental Health Block grant program for FY 2003 and to target any additional funds for the program to replication of evidence-based service delivery models for persons with severe mental illness in the community. In particular, NAMI urges Congress to direct CMHS to target Block Grant funding to assertive community treatment (including the Program of Assertive Community Treatment, PACT).
Jail Diversion – The President’s budget requests $5 million for the CMHS Jail Diversion program for FY 2003. People with serious mental illness are frequently arrested for minor offenses, many times as a result of homelessness, and then they are incarcerated in jails where their mental health needs are not met. There are also significant numbers of persons with serious mental illness who come in contact with the police, but are not arrested. The U.S. Department of Justice estimates that 16% of all inmates in state and federal jails have a severe mental illness, as many as 283,000 people with serious mental illnesses were in jail or prison - more than four times the number in state mental hospitals. The CMHS Jail Diversion program assists states and communities in developing treatment programs to get non-violent offenders with mental illness out of the criminal justice system and into treatment. NAMI urges support for the Bush Administration’s request for the CMHS Jail Diversion program for FY 2003.
CMHS Discretionary Programs – The President’s budget proposes a $7 million reduction for the CMHS Projects of Regional and National Significance (PRNS) for FY 2003. Included in this proposal is a reduction for the Community Action Grants program. The Community Action Grants at CMHS are a critical link in federal efforts to support knowledge dissemination and replication of evidence-based practices, including integrated treatment, jail diversion, police training and cultural competence. There is growing concern that without guidance from Congress, CMHS will discontinue Community Action Grants in FY 2003. Communities have used these grants constructively to stimulate the development of good programs and services for people with severe mental illnesses. NAMI supports continuation of the Community Action Grants program in FY 2003.
New Project to Collect Data for Advocacy Asks: What is Necessary for Recovery?
The U.S. Surgeon General and the President's New Freedom Commission on Mental Health agree that now, more than ever, there are historic possibilities for consumer recovery. Yet, consumers are not fully benefiting from the increased chances for recovery. Both major national studies agree that for consumers to completely enjoy the possibility for recovery, we must understand the large gap that exists between what is possible for recovery, and the reality of the care environment across the country.
To investigate this gap and harness the possibilities for recovery, NAMI is launching TRIAD - Treatment/Recovery Information and Advocacy Database. TRIAD is a process by which NAMI, in collaboration with other stake-holders, will collect a variety of data that characterizes the gap between the services, supports, and environment we all agree are necessary for recovery and what exists in each state. But TRIAD will not just collect data - it also seeks to inform advocacy efforts with better data to achieve better investment and better services to ultimately close that gap.
In this process of data collection, TRIAD is organized around 12 standards of care that reflect the core services, supports and environmental requirements for a system to promote recovery among adults with serious mental illness. These standards of care directly reflect the Institute of Medicine's landmark study on reforming American healthcare-Crossing the Quality Chasm-when it calls for standards of safe, effective, timely and patient centered care that is equitably and efficiently delivered.
TRIAD Standards of Care
Access to Appropriate Medication
General Medical Care
Integrated Services for Dual Diagnosis
Family Psychoeducation and Support
Peer Provided Services and Supports
Supported Employment Services
Affordable Housing and Supports
Jail Diversion Programs
Non-stigmatizing and Non-discriminating Environment
Current TRIAD efforts include:
reports on the implementation of evidence-based treatments and outcomes for severe mental illnesses in adults;
a systematic assessment of discrimination in legislation and newspaper coverage of mental illness across the 50 states;
a national survey of consumer and family member experiences of evidence-based care and outcomes;
a consumer and family member oriented website with an interactive guide to evidence-based schizophrenia treatment.
To learn more about TRIAD or how you can help, please contact Abigail Graf at firstname.lastname@example.org.
Find Out More:
Institute of Medicine, National Academy of Sciences. (2001). Crossing the Quality Chasm.
Washington, DC. National Academy Press.
Interim Report of the President's New Freedom Commission on Mental Health. (2002).
U.S. Department of Health and Human Services. (1999). Mental health: A report of the Surgeon
General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
The 1999 Surgeon General’s report (Mental Health: A Report of the Surgeon General) revealed that fewer than one-third of all people with a diagnosable mental disorder in the U.S. receive treatment in a given year. And, the 1998 report from the Schizophrenia Patient Outcomes Research Team (PORT) study revealed that fewer than 50% of all people with schizophrenia receive even minimally adequate treatment in a given year. These treatment access problems are even worse for children and adolescents with severe mental disorders.
There are many factors contributing to low rates of treatment and services for people with mental illnesses across the country. One contributing factor is the lack of qualified psychiatrists and other mental health providers in many regions of the country, particularly in rural areas.
One solution proposed to address access to care barriers is to expand prescribing privileges to psychologists. In 2002, New Mexico became the first State to enact legislation expanding prescription privileges to certain psychologists. Emboldened by success in New Mexico, it is anticipated that psychologists will push similar legislation in other states with renewed vigor in 2003 and beyond. In fact, Task Forces to explore the feasibility of expanding prescription privileges to psychologists have been formed in 31 states.
There are many difficult questions that must be addressed as the debate on prescription privileges for psychologists ensures. These include:
What impact would expanding prescription privileges to psychologists have on the quality of care, safety and well-being of individuals with mental illnesses?
What amount of academic training, hands-on experience, and clinical supervision and oversight is necessary to adequately prepare psychologists to prescribe psychiatric medications?
What impact, if any, will expanding prescription privileges have on access to care and quality of care for individuals with mental illnesses residing in rural or under-served regions?
Should different standards apply to psychologists prescribing medications for the treatment of acute, temporary mental health conditions (e.g. situational depression) versus prescribing medications for the treatment of chronic, severe mental illnesses (which are often compounded by other complex medical conditions)?
Should psychologists authorized to prescribe medications be limited to prescribing certain medications on formulary or afforded unlimited authority to prescribe all psychiatric medications?
Are the experiences of other allied mental health professionals with limited prescribing authority in many states (such as physicians assistants and nurse practitioners) instructive in informing the debate on whether psychologists should prescribe?
What outcomes have been derived in current or previous experiences with psychologists prescribing medications (e.g. the Department of Defense Psychopharmacology Demonstration Project, the year old New Mexico law) that can help inform this debate?
A goal of NAMI is to make high quality ACT teams available to all who need them and to educate others about the effectiveness of this model. On this page you will find many different documents about ACT -- an effective, evidence-based, outreach-oriented, service delivery model for people with severe and persistent mental illnesses. NAMI seeks to educate people about ACT, expand and strengthen current ACT programs, and to ensure that the practices and values of ACT support consumer choice and meaningful participation in treatment and services.
Please note that NAMI does not directly or indirectly operate any Assertive Community Treatment (ACT) teams or Programs of Assertive Community Treatment (PACT) teams. We use the terms Assertive Community Treatment (ACT) and Program of Assertive Community Treatment (PACT) interchangeably. ACT programs can be operated on a state, county, or local level by mental health centers, private non-profit or for-profit organizations, outpatient units of hospitals, managed care companies, and other providers.
NAMI Staff Biographies
Learn more about NAMI staff below. For more information or to get a high resolution photo please contact Alexis O'Brien, Media Relations Associate.
NAMI Legal Center
The NAMI Legal Center advocates on behalf of individuals with severe mental illnesses and their families. Our Legal Center works both independently and collaborates with private attorneys, legal service organizations, mental health and consumer advocacy organizations on projects of mutual interest.
Jail Diversion Strategies, including Police Crisis Intervention Training (CIT) teams & Mental Health Courts;
Access to treatment for inmates with serious mental illnesses;
Discharge planning & transitional services; and
Training of Law Enforcement & Court Personnel.
NAMI Law and Science Center - - The Center was created to provide technical assistance to lawyers suing third party public and private sector payers to promote unrestricted access to medications. The Center provides technical assistance on clinical, legal and health economics issues to lawyers representing people with mental illnesses or their families in pertinent cases, with a particular focus on linking lawyers with information, materials and experts needed to develop and advance their cases on access to medications and services.
Unfortunately the NAMI Legal Center is not able to provide individual representation in legal matters. However, we maintain two lawyer referral panels, a general referral panel and an elder and estate planning panel, and may be able to refer you to an attorney for representation. If you are interested in a lawyer referral, or in joining our panels, please click here.
What is Eating Disorder Not Otherwise Specified (EDNOS)?
The Diagnostic and Statistical Manual – 4th Edition (DSM-IV) recognizes two distinct eating disorder types, anorexia nervosa and bulimia nervosa. If a person is struggling with eating disorder thoughts, feelings or behaviors, but does not have all the symptoms of anorexia or bulimia, that person may be diagnosed with eating disorder not otherwise specified (EDNOS). The following section lists examples of how an individual may have a profound eating problem and not have anorexia nervosa or bulimia nervosa.
A female patient could meet all of the diagnostic criteria for anorexia nervosa except she is still having her periods
A person could meet all of the diagnostic criteria for anorexia nervosa are met except that, despite significant weight loss the individual's current weight is in the normal range.
A person could meet all of the diagnostic criteria for bulimia nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for duration of less than 3 months.
The person could use inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies). This variant is often called purging disorder.
The person could repeatedly chewing and spitting out, but not swallowing, large amounts of food.
Binge-eating disorder is also officially an EDNOS category (see separate fact sheet for BED): recurrent episodes of binge eating in the absence if the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa.
The examples provided above illustrate the variety of ways in which disordered eating can look when a person has EDNOS, but this list of examples does not provide a complete picture of the many different ways that eating disorder symptoms can occur.
The “not otherwise specified” label often suggests to people that these disorders are not as important, as serious, or as common as anorexia or bulimia nervosa. This is not true. Far more individuals suffer from EDNOS than from bulimia and anorexia combined, and the risks associated with having EDNOS are often just as profound as with anorexia or bulimia because many people with EDNOS engage in the same risky, damaging behaviors seen in other eating disorders.
Individuals with EDNOS who are losing weight and restricting their caloric intake often report the same fears and obsessions as patients with anorexia. They may be overly driven to be thin, have very disturbed body image, restrict their caloric intake to unnatural and unhealthy limits, and may eventually suffer the same psychological, physiological and social consequences of anorexic people. Those who binge, purge, or binge and purge typically report the same concerns as people with bulimia, namely, that they feel they need to purge to control their weight, that they are afraid of getting out of control with their eating, and that binging and/or purging often turn into a very addictive, yet ineffective coping strategy that they feel they can not do without. In all meaningful ways, people with EDNOS are very similar to those with anorexia or bulimia, and are just as likely to require extensive, specialized, multidisciplinary treatment.
Who develops EDNOS?
Eating Disorder NOS typically begin in adolescence or early adulthood although they can occur at any time throughout the lifespan. Like anorexia nervosa and bulimia, EDNOS is far more common in females; however, among those individuals whose primary symptom is binge eating, the number of males and females is more even. Because EDNOS has not been studied as extensively as anorexia and bulimia, it is harder to gauge an exact prevalence, but estimates suggest that EDNOS accounts for almost three quarters of all community treated eating disorder cases.
What are the common signs of EDNOS?
Signs of EDNOS are the same signs you would look for in anorexia and bulimia nervosa. Constant concern about food and weight is a primary sign, as are behaviors designed to restrict eating or compensate for eating (such as exercise or purging). For individuals who binge, most notable is the disappearance of large amounts of food, long periods of eating, or noticeable blocks of time when the individual is alone. Individuals who restrict often find the need to eat by the end of the day and the urge is so strong that it results in a binge. This binge can lead to guilt and shame the leads to purging, which may prompt the individual to promise to “do better tomorrow” by restricting. Cycles like this are consistent with EDNOS and bulimia, and can become very intractable if not addressed. Characteristically, these individuals have many rules about food -- e.g. good foods, bad foods -- and can be entrenched in these rules and particular thinking patterns. This preoccupation and these behaviors allow the person to shift their focus from painful feelings and reduce tension and anxiety perpetuating the need for these behaviors appropriately.
Are there any serious medical complications?
Individuals with EDNOS are at risk for many of the medical complications of anorexia or bulimia, depending on the symptoms they have. Those who binge and purge run risks similar to bulimia in that they can severely damage their bodies. Electrolyte imbalance and dehydration can occur and may cause cardiac complications and, occasionally, sudden death. In rare instances, binge eating can cause the stomach to rupture, and purging can result in heart failure due to the loss of vital minerals like potassium. Persons with EDNOS who are restricting may have low blood pressure, slower heart rate, disruption of hormones, bone growth, and significant mental, and emotional disturbance.
Do we know what causes EDNOS?
As with other eating disorders that have been more widely studied, the cause of EDNOS is most likely a combination of environmental and biological factors that contribute to the development and expression of these disorders. While each individual may feel that they developed these behaviors “on their own” they are often amazed to find that other people have the same obsessions, irrational fears, and self-loathing. They are not alone, and they are not to blame for having this problem.
Is treatment available for persons with EDNOS?
Unfortunately, treatment studies specifically for EDNOS are rare. Cognitive-behavioral therapy, either in a group setting or individual therapy session, has been shown to benefit many people with bulimia and would logically be applicable to those with EDNOS who binge or purge. It focuses on self-monitoring of eating and purging behaviors as well as changing the distorted thinking patterns associated with the disorder. Cognitive-behavioral therapy is often combined with nutritional counseling and/or antidepressant medications such as fluoxetine (Prozac).
Treatment plans should be adjusted to meet the needs of the individual concerned, but usually a comprehensive treatment plan involving a variety of experts and approaches is best. It is important to take an approach that involves developing support for the person with an eating disorder from the family environment or within the patient’s community environment (support groups or other socially supportive environments).
What about prevention?
Prevention research is increasing as scientists study the known "risk factors" for these disorders. Given that EDNOS and other eating disorders are multi-determined and often affect young people, there is preliminary information on the role and extent such factors as self esteem, resilience, family interactions, peer pressure, the media and dieting might play in its development. Eating disorders and body image is commonly seen as a problem affecting women, but men are also touched by media influence. Steroid abuse and body image to create the strong, cut male physic results in many short and long term effects, but falls off under the radar in terms of indicating distorted body image and eating disorders. Advocacy groups are also engaged in prevention through efforts such as removing damaging articles from teen magazines on "dieting" and the importance of "being thin.
The Eating Attitudes Test (EAT) is a commonly used method used to standardized the measure of symptoms and behaviors that are characteristic of eating disorders. The original EAT had 40 items, but this is the latest updated and shortened version designed to be self-administered or administered by health-professionals, school counselors, coaches and others.
This test alone does not diagnose an eating disorder and should not be thought of as the sole means of identification. Only a qualified health care professional can provide a diagnosis. The EAT-26 is used to assess “eating disorder risk.” All self-report measures require open and honest responses in order to provide accurate information. The test usually provides useful information about the eating symptoms and concerns that are common in eating disorders.
Close to a third of the population are overweight, and in addition eating disorders are on the rise especially among young women. The preoccupation of body image and the pursuit to be thin has professionals looking at weight as they affect the physical and mental health of those involved. The concept of a healthy weight emerged from the recognition that we needed to shift our attention away from only body weight and focus on healthy living in general. Healthy living involves eating well, being active, and feeling good about oneself.
A healthy body weight is a weight range appropriate for a particular height and body build. It should not be confused with a thin weight. A healthy weight is the point at which you feel: fit and flexible, healthy and energetic, and are at a lower risk for weight-related health problems. The healthiness of your weight can be measured using the Body Mass Index (BMI) calculator Calculate your BMI. The calculator uses a person’s body weight and in relation of their height to define normal, overweight, and obesity.
To achieve a healthy body weight regular physical activity in combination with healthy eating promises the best hope. The type of physical activity one chooses can range from walking, riding a bike, dancing, gardening, running with your dog…but joining an expensive gym or sport club is not the only option or an excuse.
Healthy Eating Guidelines
Many people eat for emotional reasons. It is typically triggered by stress and anxiety too often leads to overeating and/or making poor food choices. In a study done by the International Journal of Eating Disorders compares the daily journals kept by a group of normal-weight women, half of whom were binge-eaters. The key influence on emotional eating, however, is not just negative or stressful events, but rather its people’s response to them. People who are less thrown off by stress tend to focus on how they want to constructively deal with a negative situation or they simply put it aside and move on. These who tend to experience more disruption due to negative situations are more inclined to stay focused on the problem, mentally replaying a distressing situation over and over again.
Those whose healthy-eating goals, are often disrupted by emotions can benefit from finding new strategies to help them respond more effectively to stressful situations. A study found that people gave in to eating temptations every time they didn’t have a strategy to deal with stressful situations. Individuals who respond to a negative situation with both positive and negative thoughts and constructive action are able to avoid emotion-based eating. Action responses might include attempts to fix a problem by asking a friend, family member, or associate for their advice, or through claming and soothing yourself by taking a walk, listening to music or deep breathing. Examples of positive thinking include reminding yourself that the problem is not really as big as it seems, or that brainstorming different approaches to the problem to find the most effective solution.
It has been observed that many people use food as a means to distract themselves from emotions ranging from simple boredom to frustration to elevated anxiety. Differentiating between biological hunger and other urges to eat, and trying to identify the feelings and needs behind non-hunger urges is the baseline for understanding what is behind the hunger. When a rest or distraction or refreshing relief from routine is needed simply learning to acknowledge it is appropriate to take a break can be freeing. If you’re not hungry, use breaks to read, nap or take a walk.
It is shown that emotional eating can be a significant source of excess of calories. This can result in overweight or obesity, which can increase problems. The American Institute for Cancer Research emphasizes the need to choose portions appropriate to our individual needs and to avoid popular super-sized foods. Emotional eating is controlled with healthier foods or smaller portions, and by getting whatever help and support you need to learn how to handle non-hunger urges without actually turning to food for temporary solace.
Men are from Mars and Women are from Venus, but other than origin the genders also see differences in their nutritional requirements. What does everyone need to be concerned about and what health concerns do men and women specifically need to be aware about?
Women: Calcium is important in lowering a woman’s risk of osteoporosis. A diet high in calcium and Vitamin D has been proven to lower the risk of bone fractures and regulate blood pressure. Women under 50 years of age the recommended amount of daily calcium is 1,000 milligrams and 1,200 mg for women over 50 years.
Men: Calcium is important in lowering the risk of osteoporosis in men, but can be harmful in large doses. Studies have shown that men who consumed high levels of calcium saw an increased risk in prostate cancer. For all ages the recommended amount is 800mg or 3 servings of dairy per day.
Women: Women require more iron then men because of their monthly menstrual cycles. Signs of iron-deficiency anemia include fatigue, inability to concentrate and difficulty breathing. If these symptoms appear, speak to a doctor. The recommended amounts of daily iron are 18mg and eight milligrams for postmenopausal women. The difference is one of the reasons why it’s important to choose an age-appropriate formula if you are taking multi-vitamin supplements.
Men: The recommended amount is 8mg for men of all ages. Studies have shown that men with high iron stores were associated with increased risk of heart attacks. It is important to choose an age-appropriate as well as gender-appropriate formula if taking a multi-vitamin supplement.
3. Omega 3 fatty acids
Women: Omega 3 fatty acids are a type of polyunsaturated fatty acids, which have been shown to help lower triglycerides and increase the good HDL cholesterol. They may also act as an anticoagulant to prevent blood from clotting. Omega 3 fatty acids can be found in almost all fish, but they are particularly high in fatty fish such as mackerel, salmon, sardines and herring. They can also be found in nuts and seeds as well as vegetable cooking oils. There is no official recommendation on how much omega 3 fatty acids women should eat, but the American Heart Association recommends eating fish at least two times a week.
Men: Omega 3 fatty acids benefit men, but only the marine kind from fish oil. Vegetable omega 3, also known as alpha-linolenic acid (ALA) may not be good for men. Still controversial a high intake of ALA has been linked to higher risk of prostate cancer. Until more is known, men should avoid taking concentrated ALA supplements such as flaxseed oil pills.
Women: Protein provides energy and it is also important in growth and repair. As a result of the high-protein diet hype, many people eat more protein than required. Excess protein accelerates calcium loss in urine, therefore, women with a high risk of osteoporosis should be careful not to eat too much protein. The average requirement is based on 0.8 grams of protein per kilogram of body weight. For example, a 130 pound woman would need 47 grams of protein daily.
Men: Men weigh more and therefore need more protein. Excess protein accelerates calcium loss in urine, even in men. Thus, men with a high risk of kidney stones should watch their intake. The same calculation is applied to men when determining an individual’s average requirement of daily protein. Based on 0.8 grams of protein per kg of body weight a 165 pound man would need 60 grams of protein daily.
In general healthy men and women will do fine with a daily 60 grams (8oz) of protein. If you are an athlete, however, your needs and requirements will increase.
Women: Fiber prevents constipation, hemorrhoids, diverticulosis and can help reduce the risk for some chronic diseases such as colon and breast cancer. In addition, it may help lower bad LDL cholesterol and total cholesterol reducing the risk of heart disease. Fiber can also help lower the blood sugar to help manage diabetes. Women under 50 require 25 grams of fiber, while those over 50 require 21 grams. This is equivalent to at least two cups of vegetables and 1.5 cups of fruit.
Men: In a brief statement, men require more fiber than women. Men in general need more calories and in turn they need more fiber. Fiber requirements are calculated to provide the greatest protection against heart disease and are based on energy intake. Men under 5 require 38 grams of fiber, while those over 50 require 30 grams of fiber. This is equivalent to at least three cups of vegetables and two cups of fruit.
Understanding Food Labels and Nutrition Facts
Food labels have become synonymous with cryptic ingredients, hidden macronutrients and undecipherable content amounts. Grocery shopping for some can be a real headache and stressful experience, but it doesn’t have to be. Determining whether or not a product fits into your healthy lifestyle has become easier with the addition to listing the amounts of macronutrients and vitamin and mineral contents. The food label provides good information to help a consumer determine if a particular food product meets his or her nutritional needs.
In 1990, the Nutrition Labeling and Education Act went into effect with the intention that food labels are designed to help consumers make healthy food choices. The USDA and the FDA developed these guidelines so that consumers would have access to useful nutritional information. According to this act all packaged food MUST contain the following information:
Common name of the product
Name and address of the product’s manufacturer
Net contents in terms of weight, measure or count, and;
Ingredient list and Nutrition Facts
The most frustrating and yet most sought after component is the Nutrition Facts panel. Required fields include components of common nutrients, such as total fat, cholesterol, and sodium. Each package must identify the quantities of specified nutrients and food constituents per serving. Note the following measurements:
1 gram of fat = 9kcal
1g of protein = 4kcal
1g of carbohydrate = 4kcal
1g of alcohol = 7kcal
Nutrients Listed, Serving Size, Calories (kcal)
Total fat, saturated fats, cholesterol, total carbohydrate, protein, vitamins A and C, calcium and iron, are required on the label. Other nutrients are optional and may be listed at the discretion of the manufacturer. The percent daily values provide an estimate of the percentage of a nutrient from one serving in a typical 2000kcal diet. Also included is the daily reference values footnote. This reminds consumers of the daily intake of different foods depending on their own nutritional needs. In addition, a few other nutrients relevant to heart health are important to pay attention to when reading a label. At the beginning of January 2006 all labels will also include trans fatty acids.
Serving sizes are standardized to make for easier comparison among similar products. They are expresses in common household and metric measures. It is always important to pay attention to a serving size. For example, if you eat four pieces and the serving size is two then you need to double the amount of nutrition content listed on the label.
It is important to find out the total amount of calories. Calories provide a measure of how much energy you obtain after eating a portion of food. Many consumers are surprised to find out that fat-free is not synonymous with low calorie. Just as sugar-free is not always low in Calories or fat. See a comparison of low-fat or fat-free with regular food products.
The Bottom Line: regarding food labels
Food labels and Nutrition Facts enable consumers to compare products based on key ingredients. When comparing foods, focus on the ingredients that are most important to you. Tips to consider when comparing food labels.
If you are concerned about you weight, compare products based on BOTH their calories and fat.
If you have heart disease or high blood pressure, focus on the amount of total fat, saturated fat, trans fat, cholesterol and sodium. Then choose products that contain less than 20 percent Daily Values for fat, cholesterol and sodium.
If you have diabetes, focus on the amount of carbohydrate, sugar added as well as fiber.
Good fats, bad fats, low-fat, fat-free, low-calorie. These are just some of the many terms that get thrown at us as consumers daily by food manufacturers. They are enticing and intriguing especially with Americans’ preoccupation with body image. The fact is that we need fats, and reduced fat items have more sugar added to them to enhance the flavor. What you may think is a conscious effort to be healthy may result in the unintended outcomes and sabotage. Fats get a bad reputation and are one of the first nutrients monitored when people begin their quest for health. It is true that all fats are not equal and some promote health while others increase the risk of heart disease, it is also true that fats help nutrient absorption, nerve transmission, and maintaining cell membrane integrity. The key is to replace the bad fats with good fats in our diet.
Good fats include monounsaturated fats (MUFAs) and polyunsaturated fats. They lower total cholesterol and LDL cholesterol (bad cholesterol). MUFAs aid in increasing HDL cholesterol and have been found to help weight loss, especially in body fat. Food stuffs that supply MUFAs include nuts such as peanuts, walnuts, almonds, and pistachios, avocado, canola and olive oil. Polyunsaturated fats include the well-known group omega 3 fatty acids. Seafood such as salmon and fish oil, corn, soy, safflower and sunflower oils are high of this type of fat.
Bad fats include saturated fats and the highly talked about trans fats. Saturated fats raise total blood cholesterol and LDL cholesterol. They are mainly found in animal products such as meat, dairy, eggs and seafood. Some plant foods such as coconut oil, palm oil and palm kernel oil are also high in saturated fats. Trans fats are not found in nature, but were invented as scientists began to "hydrogenate" liquid oils so that they can withstand better in food production process and provide a better shelf life. Trans fatty acids are found in many commercially packaged foods, commercially fried food, other packaged snacks as well as in vegetable shortening and hard stick margarine.
To reduce your intake of bad fats consider these simple changes. Avoid using cooking oils that are high in saturated fats and/or trans fats such as coconut oil, palm oil or vegetable shortening. Instead, use oils that are low in saturated fats and high in monounsaturated and polyunsaturated fats such as canola oil, olive oil and flax seed oil. Minimize using commercially packaged foods which are high in trans fats, and read labels to look for trans-fat free alternatives. Use lower-fat dairy products such as 1% or skim milk instead of whole milk and trim visible fats and skins from meat products to reduce saturated fats.
The truth about fats and calories is not the only myth surrounding nutrition. Other common myths seen in the dieting and the nutrition world are brown eggs are more nutritious than white, avoid carbohydrates to lose weight, avoid nuts because they are fattening, eating for two is necessary during pregnancy, and red meat is bad for health. All of these “truths” can easily be debunked with the knowledge of dietitians and their work.
1. Brown Eggs are more nutritious than White Eggs
This widely believed myth that the color of the eggshell has an affect on the eggs overall nutritional value has no scientific support. The color has nothing to do with the nutritional value, quality, flavor, cooking characteristics, or shell thickness. It only tells you what breed of hen produced the egg. The white shelled eggs are produced by hens with white feathers and white earlobes whereas the brown shelled eggs are produced by hens with red feathers and red earlobes.
2. Avoid carbohydrates to lose weight
Many low-carb diets convey the message that carbohydrates promote insulin production, which in turn results in weight gain. The problem is many low-carb diets do not provide sufficient carbohydrates to your body for daily maintenance. This means the body will begin to burn stored carbohydrates (glycogen) for energy, and when your body starts burning glycogen, water is released. This water release is the reason for the initial weight loss of a low-carb diet. These diets are often calorie-restricted allowing an average of1000 - 1400 calories, compared to 1800 - 2200 calories needed for most people. Carbohydrates are not the pinnacle of successful weight loss. You can lose weight by healthfully reducing your caloric intake by 500 calories per day in respect to your normal diet.
3. Avoid Nuts because they are fattening
Nuts are caloric and it is easy to overeat them, but when properly portioned nuts can be part of a healthy diet. Nuts are high in good fats, monounsaturated and polyunsaturated fats, as well as plant sterols, which have all been shown to lower bad LDL cholesterol. Instead of simply adding nuts to your diet, the best approach is to eat them in replacement of foods high in saturated fats.
4. Eating for two is necessary during pregnancy
The idea that pregnancy allows for women to eat double and ice cream is a free-for-all is a nutrition myth. Generally it is recommended that pregnant women increase their daily intake by 100 kcal in the first trimester and 300 kcal in the second and third trimesters. A daily prenatal multivitamin supplement is recommended and an extra snack before bedtime such as a piece of fruit, a serving of milk or yogurt, and a few biscuits is enough.
5. Red Meat is bad for health
Some studies have linked red meat with increased risk of heart disease due to the saturated fat content, but even chicken can contain as much saturated fat as a cut of lean pork or beef. Poultry is naturally lower in saturated fats but only if you do not eat the skin. Red meat altogether is not bad for your health. Instead of excluding red meat altogether, choose leaner cuts. For beef, choose eye of round, top round roast, top sirloin and flank; for pork, choose tenderloin and loin chops.
Recovery is a process, beginning with diagnosis and eventually moving into successful management of your illness. Successful recovery involves learning about your illness and the treatments available, empowering yourself through the support of peers and family members, and finally moving to a point where you take action to manage your own illness by helping others.
Untreated Mental Illness: A Needless Human Tragedy
Severe mental illnesses are treatable disorders of the brain. Left untreated, however, they are among the most disabling and destructive illnesses known to humankind.
Millions of Americans struggling with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, know only too well the personal costs of these debilitating illnesses. Stigma, shame, discrimination, unemployment, homelessness, criminalization, social isolation, poverty, and premature death mark the lives of most individuals with the most severe and persistent mental illnesses.
Mental Illness Recovery: A Reality Within Our Grasp
The real tragedy of mental illness in this country is that we know how to put things right. We know how to give people back their lives, to give them back their self-respect, to help them become contributing members of our society. NAMI's In Our Own Voice, a live presentation by consumers, offers living proof that recovery from mental illness is an ongoing reality.
Science has greatly expanded our understanding and treatment of severe mental illnesses. Once forgotten in the back wards of mental institutions, individuals with brain disorders have a real chance at reclaiming full, productive lives, but only if they have access to the treatments, services, and programs so vital to recovery.
Newer classes of medications can better treat individuals with severe mental illnesses and with far fewer side effects. Eighty percent of those suffering from bipolar disorder and 65 percent of those with major depression respond quickly to treatment; additionally, 60 percent of those with schizophrenia can be relieved of acute symptoms with proper medication.
Assertive community treatment, a proven model treatment program that provides round-the-clock support to individuals with the most severe and persistent mental illnesses, significantly reduces hospitalizations, incarceration, homelessness, and increases employment, decent housing and quality of life.
The involvement of consumers and family members in all aspects of planning, organizing, financing, and implementing service-delivery systems results in more responsiveness and accountability, and far fewer grievances.
Speak out on the policy issues that affect people with mental illnesses.
NAMI Provider Education
Teaching Those Who Serve Us
The NAMI Provider Education Program presents a penetrating, subjective view of family and consumer experiences with serious mental illness to line staff at public agencies who work directly with people with severe and persistent brain disorders. The course helps providers realize the hardships that families and consumers endure and appreciate the courage and persistence it takes to find ways to reconstruct lives which must be lived, through no fault of the consumer or family, "on the verge."
The Provider Course emphasizes the involvement of consumers in the challenging work of provider-staff training. The teaching team consists of five people:
two family members trained as NAMI Family-to-Family Education Program teachers;
two consumers who are knowledgeable about their own mental illness, have a supportive relationship with their families, and are dedicated to the process of recovery; and
a mental health professional who is also a family member or consumer.
Few teaching programs employ consumers in this kind of sustained training effort in which they are paid to participate on a teaching team as they present a 10-week course.
The course reflects a new knowledge base, the "lived experiences" of coping with a brain disorder or caring for someone who struggles with this life-long challenge. Including this deeply personal perspective creates an appreciable difference in the program's content. It adds a means of teaching the emotional aspects and practical consequences of these illnesses to the academic medical information in the course.
In written evaluations and in focus-group surveys of their reactions to these classes, staff members reported that the course was fresh, relevant, helpful, enlightening, and emotionally overwhelming.
Participants felt that not only had their approach towards families changed, but that their understanding of consumers' dealing-with-life dilemmas had expanded as well. Almost every participant described how his or her own clinical practice had changed because of what was learned in class.
The NAMI Provider Education Program is currently being taught in twenty-two states: Arizona, California, Colorado, Connecticut, Florida, Hawaii, Iowa, Indiana, Kentucky, Minnesota, Missouri, Mississippi, Montana, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah, Vermont, and Wisconsin. The Provider program is also available in the Canadian province of Ontario. For more information, contact Joyce Burland or Joe Harris at the National NAMI office at (703) 524-7600, or e-mail email@example.com or firstname.lastname@example.org to find out if the Provider Program is available in your area.
What You Need to Know About Insurance Parity
Share Your Story
Share your personal experiences with parity implementation. What positive experiences have you had? Are you having a negative experience with the new law? NAMI needs to hear from you.
This information is critical to informing policymakers in the U.S. Congress and the Obama Administration on additional steps that may need to be taken to strengthen the law and ensure adequate enforcement. In addition, it is critical for NAMI to demonstrate to the larger public that parity is making a real difference in improving coverage of mental illness treatment and expanding access to critical medical services for children and adults living with mental illness.
Visit this site for email and phone contact information and resources that answer the following questions:
what the federal law covers;
how a state's law works with the federal parity act
where to file a complaint;
what's involved in filing an insurance claim with your health plan when benefits have been denied;
when an external review is warranted and
what it means to file an ERISA claim.
Fight Stigma: Become A StigmaBuster!
What is NAMI StigmaBusters?
NAMI StigmaBusters is a network of dedicated advocates across the country and around the world who seek to fight inaccurate and hurtful representations of mental illness.
Whether these images are found in TV, film, print, or other media, StigmaBusters speak out and challenge stereotypes. They seek to educate society about the reality of mental illness and the courageous struggles faced by consumers and families every day. StigmaBusters' goal is to break down the barriers of ignorance, prejudice, or unfair discrimination by promoting education, understanding, and respect.
Each month, close to 20,000 advocates receive a NAMI StigmaBusters Alert, and it is read by countless others around the world online. Send it to your own personal and professional networks.
Recent legislation has helped more veterans and their families access the mental health care and other services they need. More action will be needed on behalf of the nation's veterans of today and tomorrow.
Posttraumatic Stress Disorder (PTSD) is an anxiety disorder than can develop after a person witnesses a traumatic event. A traumatic event can take many forms--a natural disaster, sexual abuse or a terrorist attack such as 9/11--but for veterans, PTSD is most often related to combat or military exposure.
In wars prior to Vietnam, the disorder was referred to as “shell shock” or “battle fatigue” and was not very well understood beyond the fact that it limited the soldier’s performance on the battlefield. Today, the disorder is more widely studied. We know that PTSD can lead to other mental health problems such as depression, social withdrawal and substance abuse.
Our PTSD section for veterans includes resources where you can find out more about PTSD, learn about treatments and read about how PTSD affects families and children of veterans.
More than 100,000 combat veterans sought help for mental illness since the start of the war in Afghanistan in 2001, and about one in seven of those have left active duty since then, according to VA records collected through 2007. Almost one-half of those were PTSD cases.
Mental health cases among war veterans, including PTSD, drug and alcohol dependency and depression, grew by 58 percent from 63,767 in 2006 to 100,580 in 2007, VA records show.
A study released in 2007 stated that of 103,788 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans seen at VA health care facilities, 25,658 (25 percent) received mental health diagnoses; 56 percent of whom had two or more distinct mental health diagnoses.
Overall, 32,010 (31 percent) of veterans in the same study received mental health and/or psychosocial diagnoses. The youngest group of OEF/OIF veterans (aged 18-24 years) were at greatest risk for receiving mental health or posttraumatic stress disorder diagnoses compared with veterans 40 years or older.
In 2003, an estimated 56.6 percent of veterans used alcohol in the past month compared with 50.8 percent of comparable nonveterans. An estimated 13.2 percent of veterans reported driving while under the influence of alcohol or illicit drugs in the past year compared with 12.2 percent of comparable nonveterans. Daily cigarette use was more common among veterans, with an estimated 18.8 percent smoking cigarettes daily in the past month compared with 14.3 percent of comparable nonveterans.
In 2002/2003, an estimated 1.2 million male veterans were identified as living with serious mental illness. Approximately 340,000 of these individuals had co-occurring substance abuse disorders. Approximately 209,000 female veterans (13.1 percent) reported serious mental illness, and 25,000 (1.6 percent) reported co-occurring substance use disorder with mental illness.
Army Veteran Jennifer Crane discusses her recovery from
For example, the Department of Veterans Affairs offers a Center for Women Veterans on its website and the VA Palo Alto Health Care System introduced the Women’s Health Care Center in 2002. Designed to be sensitive to women’s concerns, it offers individual and group therapy, with psychoeducational classes and seminars tailored to the unique needs of women veterans. The Women Veterans Health program was elevated to a Strategic Health Care Group within the Office of Public Health and Environmental Hazards in 2007.
As part of the National Center for PTSD in Menlo Park, Calif., the Department of Veterans Affairs also introduced the National Women’s Trauma Recovery Program to treat women veterans living with PTSD or Military Sexual Trauma (MST). According to the National Center for PTSD, women in the military run a double risk of developing PTSD—10 percent of women versus 4 percent of male service members—for reasons ranging from battle stress and sexual harassment to assault. The VA also says that women may take longer to recover from PTSD and are four times more likely than men to experience long-lasting PTSD.
For women veterans we have included information on gender-specific PTSD treatment as well as VA services and links to organizations serving women veterans.
Sesame Street Family Connections offers videos and
resources to help kids understand a variety of life-changing
events like a family member's deployment and return.
Some families don’t reunite. The Army’s Medical Health Advisory Team surveyed married junior enlisted officers in 2008 and found that after 15 months of deployment, almost 30 percent were planning divorce or separation. According to data compiled by the Associated Press, divorce rates in the Marine Corps and Army have increased. There are fewer recent statistics about divorce rates after leaving active duty, but the National Center for PTSD cites studies of Vietnam Veterans which found that rates of divorce were much higher than among the general population. This may be related to PTSD and associated problems with intimacy or caregiver stresses.
If a veteran has returned with a disability, the family’s finances may be affected while caregivers’ responsibilities are further stretched by the complicated claim system. Yet with help, many veterans can access VA-backed loans, educational benefits, employment assistance and even educational benefits for dependents that can help get their families back on track.
Army Long-term Family Case Management
This call center and website offer long-term assistance to those who have lost a loved one who was a service member. They provide information about Social Security, VA and death benefits as well as lists of local programs for children and other kinds of support.
Coming Home Project
This nonprofit organization is dedicated
to providing compassionate expert care, support, education and stress management tools for Iraq and Afghanistan veterans, service members and their families.
Gold Star Wives
Gold Star Wives is a nonprofit membership organization for people who have lost spouses in the military. They offer local chapters, memorial programs, support and benefit information.
Society of Military Widows
The Society of Military Widows is a nonprofit membership advocacy and support organization. They provide information about benefits, supports and networking via local chapters.
Comfort Zone Camp Comfort Zone Camp provides grief support weekend camps for children ages 7 to17 and offers special programs for children in military families.
TAPS (Tragedy Assistance Program for Survivors)
TAPS offers support for survivors: peer support as well as 24-hour crisis intervention. They also provide information about benefits and other services, survivor seminars, camps for children and online chat.
General Sources for Support
The American Legion
The American Legion is a national community service organization with leadership and community programs across all 50 states, the District of Columbia, Puerto Rico, Mexico, France and the Philippines.
AMVETS provides information, counseling and claims service to all honorably discharged veterans and their families concerning benefits. They are also involved in community service and advocacy.
Disabled American Veterans (DAV)
This organization is led by disabled veterans who are focused on building better lives for disabled veterans and their families.
Research is vital to advancing our understanding of mental illness and, eventually, finding a cure. Research is the ultimate source of hope for people living with mental illness and their families. And research is imperative if we are to understand early intervention strategies as well as all we can about the mental illness continuum including medication side-effects, nutrition, recovery and more.
In addition to the information resources below, NAMI frequently features research content in the Advocate, NAMI’s membership magazine. Join today to start receiving the Advocate. If you're already a member, visit the Advocate online.
Welcome to the NAMICITCenter. Our mission is to provide NAMI members, local law enforcement and mental health providers with assistance and up-to-date information about Crisis Intervention Team (CIT) programs. The NAMICITCenterserves as a clearinghouse of information about CIT programs nationwide. The Center facilitates ongoing communications between CIT programs and engages in national networking to establish standards and promote the expansion of CIT.
For more information, or to sign up for our mailing list, email Laura Usher at email@example.com.To subscribe on our e-newsletter, CIT in Action, go to www.nami.org/subscribe and follow the instructions to subscribe to a newsletter. Click on the links below to read past issues of CIT in Action.
Individuals with binge eating disorder (BED) experience episodes of rapid food consumption: periods in which they “lose control” of the ability to stop eating. They may eat until after they are already full or at times when they were not hungry to begin with. People with BED will often eat alone or in secret because they are embarrassed by their behaviors. For some people, binging can cause a sense of relief or fulfillment initially. This feeling fades as the episode progresses and leads to feelings of disgust, guilt, worthlessness or depression after the episode is over.
Binge eating disorder is not a mental illness that is formally characterized in the DSM-IV-TR (the system used by many mental health professionals in America). However, it is a recognized clinical syndrome that has been diagnosed and treated for over 50 years. During this time, BED has been called by other names—compulsive overeating, emotional eating or food addiction—but the core symptom of dysfunctional binge eating episodes remains the same.
There is no specific test (e.g., blood test or x-ray) that can diagnose a person with binge eating disorder. Instead, a diagnosis of BED is made by a mental health professional based on a clinical assessment that includes a formal history and collateral information. Any person newly diagnosed with BED should have a physical exam and performed by their primary care physician (or pediatrician) in order to screen for complications of this illness that can include obesity, high cholesterol and heart disease.
Who develops binge eating disorder?
Binge eating disorder is the most prevalent eating disorder in America. Approximately 3.5 percent of females and 2 percent of males will experience this illness at some point in their life. In obese individuals, the prevalence of BED is even higher and may be up to 20 percent. The average age of onset for BED is in young adulthood, although binge eating in children is likely increasing. People with BED are more likely to be diagnosed with anxiety disorders (e.g., phobias, posttraumatic stress disorder), mood disorders (e.g., depression), and substance abuse disorders.
BED has been shown to run in families and it is believed to be influenced by both genetic and environmental factors. Although no specific genes have been identified, scientists are actively researching a number of genes that affect both the brain and the digestive system. People who have developed unhealthy patterns of eating may be at increased risk of developing BED. Individuals who have experienced stressful life events (e.g., bullying or trauma) may also be at increased risk of developing this condition.
What are the medical complications of binge eating disorder?
People with BED are at increased risk of experiencing weight gain and obesity which place them at risk for a wide variety of medical complications. These can include high cholesterol, Type II Diabetes (e.g., non-insulin-dependent diabetes mellitus), high blood pressure and heart disease. In some cases of severe weight gain, people may be at risk of developing arthritis, obstructive sleep apnea or other weight-related illnesses.
What is the treatment of binge eating disorder?
Treatment of binge eating disorder targets both the elimination of binge eating and the development and maintenance of a healthy weight. Most people with BED will benefit from psychotherapy and some may benefit from medications. Usually an inpatient psychiatric hospitalization is not required; however an inpatient eating disorders treatment program may be helpful in stopping severe binge eating behaviors.
Cognitive behavioral therapy (CBT), either in a group setting or individual therapy session, is one of the most studied forms of treatment for BED. CBT is often referred to as the first-line treatment for this condition. This treatment focuses on self-monitoring of eating behaviors, identifying binge eating triggers, and changing distorted thinking patterns about food and self-image. CBT can help reduce binge frequency and promote binge abstinence. Most people who try CBT can expect a 50 percent or greater decrease in their symptoms.
In some cases, certain people may find that medications are useful in helping to control their symptoms. Some antidepressants from the selective-serotonin reuptake inhibitor class (SSRIs)—including citalopram (Celexa), fluoxetine (Prozac), and sertraline (Zoloft)—have been shown to be helpful in decreasing the symptoms of BED. The use of other medications—including topiramate (Topamax)—is beyond the scope of this review. It is important to note that no medications are currently indicated by the FDA for the treatment of binge eating disorder. Furthermore, all treatment decisions should be discussed with one’s physicians as the risks and benefits for each individual may vary.
Comprehensive treatments usually involve a variety of treatment providers that can include mental health professionals, primary care physicians and nutritionists or dieticians. As the importance of family support cannot be understated, many individuals and their loved ones will find family therapy to be quite helpful in the treatment process.
With thorough treatment and the support of their loved ones, most people with binge eating disorder can expect to see a significant decrease in their symptoms and to live healthy lives in absence of serious medical complications. Family members and friends can be most helpful in providing nonjudgmental support of their loved one and by encouraging their loved one to seek treatment for this serious condition.
Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., January 2013
NAMI is pleased to be working with the College of Psychiatric and Neurological Pharmacists to offer a new section where Psychiatric Pharmacists write and answer questions that they experience in the course of their work with individuals with mental illness. We will periodically be posting new questions and answers so be sure to check back frequently.
Up-to-date information about a range of mental illnesses, including co-occurring mental illnesses and substance use disorders.
Impact of mental illness on the brain.
Current research on treatments including medication, side effects and evidence-based therapies.
Training in preparedness and emotional resiliency
Skills related to managing crises, solving problems and communicating effectively.
Strategies for self-care including management of stress and emotional overload.
Guidance on locating appropriate local supports and services.
Perhaps most importantly, as a participant you can gain comfort in knowing you are not alone. Recovery is a journey and there is hope for all families and individuals dealing with a mental illness. The in-person group experience of NAMI Family-to-Family provides the opportunity for mutual support and positive impact. You can experience compassion and reinforcement from people who relate to your experiences. Through your participation, you have the opportunity to help others grow.
What Others Have To Say About NAMI Family-to-Family
"Before I took the course, I felt alone and overwhelmed dealing with my daughter’s mental illness. By taking this course, I have met others who are going through the same things I am and have learned about many resources that I never knew existed."
"I thought my wife and I knew just about everything there is to know about the system and the illness. Boy, were we wrong. Without a doubt, this is the best support course I have had the privilege of taking part in, bar none."
De Familia a Familia de NAMI
De Familia a Familia de NAMI is available in a limited number of states. Please contact your NAMI State Organization to learn if De Familia a Familia de NAMI is available near you.
have to say about
“Family members who take the NAMI Family-to-Family course are better equipped to work with mental health clinicians in a collaborative manner. My bottom-line recommendation? Take this course. It will help you learn to cope successfully with a major challenge in your life, and that, in turn, will help your loved one as he or she works toward recovery.”
-- Peter Weiden, M.D., author of Breakthroughs in Antipsychotic Medications
Bulimia nervosa is a serious eating disorder. People with bulimia nervosa are overly concerned with their body’s shape and weight and engage in detrimental behaviors in an attempt to control their body image. Bulimia nervosa is often characterized by a destructive pattern of binging (eating too much unhealthy food) and inappropriate, reactionary behaviors to control one’s weight following these episodes.
Binge eating is the rapid consumption of an unusually-large amount of food in a short period of time. Unlike simple overeating, people who binge feel “out of control” during these episodes. This means that one “cannot stop the urge to eat” once it has begun, even after their stomach is full. Binging may “feel good” initially, but it quickly becomes distressing for the person who is absorbed in this behavior. Food is often eaten secretly and quickly. A binge is usually ended only with abdominal discomfort, social interruption or running out of food. When the binge is over, the person with bulimia often feels guilty and will engage in inappropriate behaviors to rid their body of the excess calories that were eaten.
Inappropriate behaviors to control one’s weight can include purging. Purging behaviors are potentially dangerous and can consist of a wide variety of actions “to get rid of everything I ate.” This can include self-induced vomiting, the abuse of laxatives, enemas or diuretics (e.g., caffeine). Other behaviors such as “fasting” or restrictive dieting following binge-eating episodes are also common, as well as excessive exercising.
Who develops bulimia nervosa?
Bulimia nervosa is often under-diagnosed because many people who experience this illness may be of normal weight (or even overweight), as opposed to individuals with anorexia nervosa. The typical age of onset for bulimia nervosa is late adolescence or early adulthood, but onset can and does occur at any time throughout the lifespan. Like other eating disorders, bulimia nervosa mainly affects females, although at least one in 10 individuals with this condition is male. Bulimia nervosa is more common than anorexia nervosa and likely occurs in up to three percent of the population. Like all mental illnesses, Bulimia nervosa is found in all racial, religious, ethnic and socioeconomic groups.
Bulimia nervosa often occurs with other psychiatric disorders such as mood disorders (e.g., depression), anxiety disorders (e.g., obsessive-compulsive disorder), substance abuse disorders, and disorders of self-injurious behavior (e.g., borderline personality disorder). Many people with bulimia nervosa will also be diagnosed with anorexia nervosa or another eating disorder at some point in their lives. As with any other condition, adequate treatment of coexisting mental illnesses is necessary goal of treatment in bulimia nervosa.
What are the common signs of bulimia nervosa?
Constant obsession with food and weight is a primary sign of bulimia nervosa. Other important indicators are signs of binging (e.g., hidden candy wrappers under a bed or multiple empty cereal boxes stuffed in a closet) and purging (e.g., boxes of laxatives or enemas stored in one’s desk without a clear medical indication for these products).
People with bulimia may also experience irregular menstrual periods or depressed mood. These symptoms may cause a person to go to their doctor. Similarly, doctors may also find they are examining their patients for unexplained stomach pain or sore throat before a diagnosis of bulimia nervosa is made.
Doctors may see common signs of self-induced vomiting including unexplained damage to the teeth (due to the acidity of vomit) and scarring on the backs of the hands and fingers (due to repeatedly pushing fingers down the throat to induce vomiting). A number of people with bulimia will have swollen cheeks (due to damage of their parotid glands).
Are there any serious medical complications of bulimia nervosa?
People with bulimia nervosa—even if their weight remains “normal”—can severely damage their bodies by binging and purging. Self-induced vomiting can injure the various parting of the body involved in eating and digesting food: tooth decay, esophageal and stomach injury, and acid reflux are all common in people with bulimia nervosa. Excessive purging behaviors can cause dehydration and changes in the body’s electrolytes (e.g., low potassium). This can lead to multiple problems including cardiac arrhythmias, heart failure and even death.
Do we know what causes bulimia nervosa?
Although the precise causes of bulimia nervosa are unknown, scientists agree that it is caused by a combination of genetic and environmental factors. People with a family history of eating disorders or a personal history of mental illness, including depression, anxiety, substance abuse and other illnesses, are more likely to develop bulimia nervosa. Traumatic events (e.g., physical or sexual abuse) as well as life-stressors (including being bullied at school) can also increase the risk of developing bulimia nervosa. While no specific region of the brain has been directly connected with bulimia nervosa, certain chemicals in the brain (e.g., the neurotransmitter serotonin) have been shown to have a relationship with binging and purging behaviors.
What is the treatment for bulimia nervosa?
The most important thing to do in the treatment of bulimia nervosa is to ensure good medical treatment. As mentioned above, bulimia can cause serious medical complications and before anything else can be done, a thorough medical evaluation—either by a primary care provider or in the hospital setting—should be performed in order to ensure the individual’s safety.
Similar to other eating disorders, therapy is a cornerstone of treatment in bulimia nervosa. Individual therapy can include a wide-variety of techniques: cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) have been shown in scientific studies to decrease the symptoms of bulimia nervosa. Group psychotherapy can be useful in helping individuals with a supportive, therapeutic environment to discuss the challenges they face throughout treatment. Family psychotherapy can be useful in helping to support both the individual with bulimia nervosa and their family members. Nutritional counseling is useful in guiding individuals towards a healthy diet and regular eating habits.
Many medications have been used to treat symptoms of bulimia nervosa, the specifics of which are beyond the scope of this review. The only FDA approved medication for bulimia nervosa is fluoxetine (Prozac). This medication helps by decreasing the symptoms of bulimia nervosa, but it does not cure the illness. As with any other mental illness, it is important to discuss any medication decisions with one’s psychiatrist and other members of the treatment team.
With thorough treatment and the support of their loved ones, most people with bulimia nervosa can expect to see a significant decrease in their symptoms and to live healthy lives in absence of serious medical complications. Family members and friends can be most helpful in providing nonjudgmental support of their loved one and by encouraging their loved one to seek treatment for this serious mental illness.
Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., January 2013
Anorexia nervosa is a serious and potentially life-threatening mental illness. Anorexia nervosa is an eating disorder defined by an inability to maintain one’s body weight within 15 percent of their Ideal Body Weight (IBW). Other essential features of this disorder include an intense fear of gaining weight, a distorted image of one’s body, denial of the seriousness of the illness, and—in females—amenorrhea, an absence of at least three consecutive menstrual cycles when they are otherwise expected to occur.
There is no specific test than can diagnose this complex illness. Rather, a diagnosis of anorexia nervosa is made when a physician or a mental health professional recognizes the signs, symptoms and patterns of thinking and behavior that characterize this illness. It should be further noted that a number of common medical illnesses can cause symptoms that are similar to those seen in anorexia nervosa. Therefore it should be stressed that prior to a diagnosis of anorexia nervosa being made, a person should have a complete medical evaluation to rule out common illnesses with similar symptoms (thyroid disease, inflammatory bowel disease, etc.).
Who develops anorexia nervosa?
Like all eating disorders, anorexia nervosa tends to occur in adolescence, but can develop at any time throughout one’s lifetime. It predominately affects adolescent girls and young adult women, although it also occurs in boys, men, older women and younger girls. Others especially at risk for eating disorders include athletes, dancers and models for which thinness has become a “professional requirement.”
Many people with anorexia nervosa are also diagnosed with other psychiatric illnesses including depression, anxiety and substance abuse disorders. It has also been suggested that the presence of depression and anxiety disorders may increase the risk of developing anorexia nervosa later in life.
Slightly less than one percent of females will be diagnosed with the illness throughout the course of their lives. Historically, anorexia nervosa was thought to be most common in upper-middle class Caucasian females. Over the past few decades, it is clear that women of all ethnicities and socioeconomic backgrounds are confronted with the challenges of anorexia nervosa. Males are significantly less likely to have anorexia nervosa, but it has been suggested that as awareness grows, more males are being treated for this severe mental illness.
What are the common signs of anorexia nervosa?
The main symptoms of Anorexia Nervosa are a preoccupation with food and an inability to maintain normal body weight. One of the most frightening aspects of the disorder is that people with anorexia nervosa continue to think they “look fat” even when have become dangerously thin. Individuals with anorexia nervosa may develop odd and ritualistic eating habits such as cutting their food into tiny pieces, refusing to eat in front of others or fixing elaborate meals for others that they themselves don't eat. Food and weight become obsessions as people with this disorder constantly think about their next encounter with food.
In addition to decreasing their food and liquid intake, people with anorexia nervosa will often exercise excessively as another means of weight loss. They might also try increasing caffeine intake (to increase urination and water loss) or abusing laxatives as other means of weight loss.
As people become thinner, their body starts to experience physical changes associated with malnutrition and starvation. Their nails and hair become brittle, their skin may become dry and yellow and they may grow fine hair (called lanugo) on parts of their body previously without hair. People with anorexia nervosa often complain of feeling cold as their body loses the ability to maintain its temperature. They may also report feeling tired, without energy, or unable to focus both due to their malnutrition and to the hormonal (e.g., thyroid) changes that may occur.
The starvation experienced by persons with anorexia nervosa can cause damage to vital organs such as the heart, kidneys and brain. Pulse rate and blood pressure drop, and people suffering from this illness may experience irregular heart rhythms or heart failure which can lead to death in certain situations. Nutritional deprivation along with purging behaviors causes electrolyte abnormalities such as low potassium and low sodium. Nutritional deprivation also leads to calcium loss from bones, which can become brittle and prone to breakage (e.g., osteoporosis). Nutritional deprivation also leads to decreased brain volume which can cause changes in a person’s thinking. In the worst-case scenario, people with anorexia can actually starve themselves to death. Anorexia nervosa has the highest mortality rate of any psychiatric illness, both due to the complications of malnutrition and the high rate of suicide in this population.
What are the causes of anorexia nervosa?
Scientists have studied the role of genetics, environment and biochemistry of people with anorexia nervosa. Although its precise cause remains unknown, scientists agree that it is caused by a combination of genetic and environmental factors. Eating disorders tend to run in families, with female relatives most commonly affected. Close relatives of a person with anorexia nervosa are more than 10 times more likely to have an eating disorder themselves than someone without this illness in their family. Scientific studies have shown that certain chemicals in the brain, specifically the neurotransmitters norepinephrine and serotonin, are not functioning optimally in patients with anorexia nervosa, something which can worsen in times of malnutrition and starvation.
Behavioral and environmental influences also play a role in vulnerability to the illness and stressful life events have been found to increase the risk of developing anorexia nervosa. This has been shown from a scientific standpoint: the hormones controlling the body’s response to stressful events, specifically cortisol and vasopressin, have been shown to be dysfunctional in people with anorexia nervosa.
What treatments are available for anorexia nervosa?
Recovery from anorexia nervosa is possible. In long term studies of people with this illness, about one-half fully recover, many have intermittent periods of recovery and relapse, and a small percentage continue to experience a more chronic form of anorexia nervosa with ongoing symptoms of this and other eating disorders. It is still unknown exactly how to predict who will have a short-lived course of this illness and for whom it will be a more chronic and debilitating illness.
Fortunately, most of the complications experienced by persons with anorexia nervosa are reversible when they restore their weight through engagement in treatment. People with this disorder should be diagnosed and treated as soon as possible because eating disorders are most successfully treated when diagnosed early. Some patients can be treated as outpatients, but others may need medical hospitalization to stabilize their dangerously low weight through “re-feeding” treatment. This may include the use of feeding tubes, intravenous fluids, and structured diets with supervised meals. Weight gain is usually gradual: one to three pounds per week is considered safe and desirable. Given the large overlap between medical and psychiatric symptoms of anorexia nervosa, coordination of care between different medical and mental health professionals is of upmost importance.
A variety of psychotherapeutic approaches are used to help people with anorexia nervosa. Individual therapy is a standard treatment for this illness. Dialectical behavioral therapy (DBT) can help to teach coping skills and cognitive behavioral therapy (CBT) can be used to change unhealthy thoughts and behaviors. Group therapy is often advised to create a safe environment where people can share their experiences with others. Family therapy is important—particularly if the individual is living at home and is a child or young adolescent—and is specifically useful in mobilizing family support for this complex illness.
Unfortunately there is no medication that can cure anorexia nervosa. In fact, many psychiatric medications have been studied and have been found to be unhelpful in the treatment of this complex illness. In general, certain psychiatric medications may be useful in treating isolated symptoms of anorexia nervosa, but this is beyond the scope of this review and should be discussed at length with one’s treating physicians. While not indicated for anorexia nervosa itself, medication treatment of coexisting anxiety, depression, and other mental illnesses can very helpful for people with anorexia nervosa.
Families and friends can be most helpful in encouraging their loved ones to seek treatment for this complex mental illness. With coordinated treatment and the support of family and friends, most people with Anorexia Nervosa can expect to see a decrease in their symptoms as they go on to live meaningful lives.
Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., January 2013
The Information HelpLine is an information and referral service which can be reached by calling 1 (800) 950-NAMI (6264), Monday through Friday, 10 a.m.- 6 p.m., EST. Business callers, including those seeking particular NAMI staff members, should call 1 (703) 524-7600.
Trained volunteers provide information, referrals and support to all who have questions about or are affected by serious mental illness.
The Information HelpLine offers:
Information. We provide general (non-professional) information on illnesses such as schizophrenia, bipolar disorder, depression; issues affecting children, adolescents & young families; general questions about medication; NAMI programs (such as Family-to-Family and In Our Own Voice); NAMI policy positions (such as mental health parity); and more.
Referrals. Callers are referred to NAMI State Organizations, NAMI Affiliates and support groups throughout the country and to other organizations serving the needs of those affected by serious mental illness.
NAMI Legal Resource Service. While NAMI does not have resources to provide individual representation, our Legal Resource Volunteers can connect individuals with attorneys in their local area, please call 1 (800) 950-NAMI (6264).
Support. Trained volunteers,consumers and family members are in a unique position to offer support and empathy from people who know what it's like and who have "been there."
Help yourself online! Before you call, please visit the sections below to find answers to questions related to:
The NAMI Helpline is sponsored by
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and a grant from Allsup.
This video about veterans living with a traumatic brain disorder is part one of three in the In Their Boots documentary series.
A brain injury is a long-term or temporary disruption in brain function resulting from injury to the brain. Traumatic Brain Injury (TBI) occurs when there is a strong enough impact to the head to cause damage to the brain. Common causes of TBI include motorcycle accidents, sports injuries, falls or acts of violence.
TBI has been called the “signature injury” of the current conflicts in Iraq and Afghanistan. Increasingly, soldiers are surviving nearby bomb blasts, which produce brain injury through pressure waves that “shake” the brain, which can cause symptoms ranging from dizziness and drowsiness to vomiting, severe headache and shock. If the injury is severe enough the damage can be irreversible, leaving lasting mental effects including depression, anxiety, personality changes, aggression, acting out and social inappropriateness. TBI can cause changes in personality, thinking and sensation and increase the risk of conditions such as Parkinson’s disease, Alzheimer’s disease and other brain disorders.
In soldiers, the symptoms may also overlap with Posttraumatic Stress Disorder (PTSD), making it more difficult for doctors to treat.
Veterans affected by TBI and their families often need help navigating the system and support that takes into account the special needs of veterans. The good news is that there are many others who have been touched by a TBI and are trying to help others. See this Washington Post Q & A with Cheryl Lynch, mother of someone living with a traumatic brain injury and founder of American Veterans with Brain Injuries.
NAMI created the Multicultural Action Center in 2002 to focus attention on system reform to eliminate disparities in mental health care for diverse communities, ensure access to culturally competent services and treatment for all Americans and particularly to help and support people of diverse backgrounds who are affected by serious mental illness.
High expectations, loneliness and stress can lead to the Holiday Blues during the season from Thanksgiving to New Year’s. In most cases, symptoms are temporary, but they can be serious if they last for more than 2 weeks, leading to clinical anxiety and/or depression. People already living with mental illness often find that their conditions worsen during the holidays.
NAMI's Medical Director, Ken Duckworth, M.D., is available to talk about the holiday blues on your radio or TV show.
NAMI offers information to health and lifestyle editors, producers and reporters and others working on stories about the holiday blues. They include tips on avoiding or minimizing the blues, as well as related topics.
Welcome to the NAMI Newsroom, the place for reporters, advocates and other media professionals. NAMI's communications services team is available around-the-clock to news media for:
Expert analysis on a wide range of issues related to severe mental illnesses or brain disorders such as schizophrenia, bipolar disorder/manic-depression, major depression, and anxiety disorders.
Current data on research, treatments, rates of prevalence
Interviews with national spokespersons and technical experts
Access to persons with serious mental illness and their families who are willing to share personal stories with the media
Comment on breaking news
Bob Carolla, Director of Media Relations
3803 North Fairfax Drive
Arlington, VA 22203
Telephone: (703) 524-7600
Fax: (703) 516-7238
Examining our Mental Health System
Recent news and other national tragedies have resulted in important examinations of our nation’s mental health system. Along with working with our nation's leaders and holding discussions about how to improve mental health care it is important to look at all of the underlying causes that lead to these events and look at how we can prevent them in the future as well as providing resources and care for all of those affected.
This guide includes resources for policymakers, news media and the general public with information about NAMI policy, mental illness, outreach initiatives and resources for families. ... Read More.
For NAMI Press Releases, you may read the most recent release below, or visit the Press Release Archive to browse releases from 1997 - present.