Healthy body & mind 2014 e sub

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Healthy Hudson Valley OCTOBER 23, 2014

ULSTER PUBLISHING

HEALTHYHV.COM

Healthy Body & Mind

Getting better? How we gauge our communities' mental-health needs, what's up with local hospitals, vaccination schedules, what's enough now, and the secrets to survival and home medicine cabinets.

Health news for the Hudson Valley...


23, 2014 2 | October Healthy Body & Mind

Keeping an eye on the season’s real health issues A wellness focus on Columbia, Dutchess, Greene & Ulster counties

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ho’s not thinking about health these days? Is it possible to put out a special supplement like this edition of Healthy Body & Mind without mentioning once that big national scare for which we might eventually remember this period in history? We have taken a different route for the com-

munities we cover, and the readers we aim to service. Our primary focus this issue has been on the state of mental-health where we live, not in terms of what our problems might be but in terms of how we deal with them when situations arise. We have done so by focusing in on the main areas our weekly newspapers report on in Ulster County as a microcosm for the entire region where we are distributed. We also look into several items that are key to our healthcare needs this time of year. We look into what’s considered too much in various areas these days ... perfect considering that we are entering our annual season of abundance. We also take a warm glimpse into what local moms keep

on hand for the cold and flu season ahead. We find that, by and large, the local universe hasn’t changed as much as we may have thought. Finally, we offer up some basic health tips and health news, from the changes under way in our region’s hospitals and leading medical groups, a growing majority of them on the east side of the Hudson River. We focus also on Kingston-based Health Alliance’s continuing push to find partners with whom it can focus its service to its community. How are we doing in the Hudson Valley healthwise these days? According to the fifth edition of the county health rankings released last spring by the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute, it depends. Dutchess County, for example, is ranked eleventh in the state in terms of its health outcomes, judged by how long people there live and how healthy they are while alive, and ninth in overall health rankings, which combines data involving clinical care options, social and economic factors, and the natural environment. Ulster County came out 29th in the state in health outcomes, and the same in overall ranking; Columbia County came out 47th overall and 13th in terms of rankings; Greene was 57th out of 62 counties in outcomes and 51st in overall rankings. Looking better in the overall region was Putnam County, at fourth in both rankings; while nearby Sullivan County came out 61st and 60th in each. Looked at in terms of some of the issues discussed in these pages, it turns out that Ulster County has one of the highest numbers of mentalhealth professionals in the area, with a ratio of one professional per 388 residents, while Dutchess County has one per 487 residents, Columbia County has one per 812, and Greene County comes in very low at one professional per 1432 residents. In terms of bad habits, Ulster County leads the percentage of excessive drinking, at 25 percent, while Dutchess and Greene clock in at 19 percent. In terms of access to exercise, Dutchess County is strongest, with 85 percent of the county having such access, and Columbia County is weakest, at 47 percent access (Ulster County is at 75 percent access to exercise facilities).

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inally, in terms of clinical-care options, including access to hospitals, doctors, mental-health professionals, and percentage of uninsured residents, Dutchess County ranks 14th in the state, Columbia County 32nd, Ulster County 36th and Greene County 49th. As for overall quality of life in terms of health, Dutchess County ranked 14th, Ulster County 23rd, Columbia County 36th, and Greene County 52nd in the state. Lending a sense of comparison, Putnam County ranked fourth in the state and Sullivan County 59th.

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Your Health Aware Calendar…

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ational Health Observance (NHO) days started out in the same way that the United Nations began sponsoring World Observation days in the latter half of the twentieth century – as a means of raising awareness of specific issues for fundraising and self-observational purposes. The only way to break the spread of many diseases, runs the underlying idea, is to be vigilant of one’s own behavior and aware as well of the incidence of disease in one’s own community. As this publication comes out towards the end of October, it does so in the midst of National Bullying Prevention Month, National Down Syndrome Awareness Month, National Physical Therapy Month, Sudden Infant Death Syndrome (SIDS) Awareness Month, and after Mental Illness Awareness Week, Drive Safely Work Week, International Walk to School Day, National Depression Screening Day, Bone and Joint Health National Awareness Week, National Health Education Week, World Food Day, International Infection Prevention Week, Respiratory Care Week, International Stuttering Awareness Day and World Psoriasis Day. Coming up in November are COPD Awareness Month, Lung Cancer Awareness Month, National Alzheimer’s Disease Awareness Month, National Family Caregivers Month, National Healthy Skin Month, National Stomach Cancer Awareness Month, Drowsy Driving Prevention Week, Great American Smokeout, International Survivors of Suicide Day, Gastroesophageal Reflux Disease Awareness Week, and National Family Health History Day on Thanksgiving followed by World AIDS Day on December 1 (followed later that month by National Influenza Vaccination Week). Apart from the big national and world awareness days, there’s also lots of local health happenings, including the tail end of the flu vaccine season, which has been hosting community days throughout the season, and various lectures, workshops and support group meetings sponsored by and often at our region’s hospitals and key medical practices, as well as through our counties’ Offices of the Aging and most school districts.

Some key dates: Now through December 15. The annual open enrollment period to change Medicare health or prescription drug coverage for 2015 is from mid-October to December 7, during which time current Medicare beneficiaries can change from Original Medicare to a Medicare Advantage Plan, switch or drop a Medicare Advantage Plan, and join, switch or drop a Medicare Prescription Drug Plan. Local folks are urged to call their local offices for the aging for help navigating the system. For info in Ulster County call 340-3456 or toll free 1-877-914-3456. Now through New Year’s… The Dutchess County Department of Health clinic will be offering flu vaccine by appointment on Mondays at its new location at 29 North Hamilton Street in Poughkeepsie. To schedule an appointment, call 486-3535 or email clinics@DutchessNY.gov. In Ulster County, flu and pneumonia vaccination clinics are still scheduled from 10 to 11:30 a.m. on Friday, October 24 at Woodland Pond in New Paltz; from 10 to 11 a.m. on Friday, October 31 at the Woodstock Rescue Squad building; from 10:30 to 11:30 a.m. on Monday, November 10 at the Wallkill Fire Department; from 10 to 11:30 a.m. on Wednesday, November 12 at the Lake Katrine Senior Center; and from 10 to 11 a.m. on Monday, November 24 at Shandaken’s town hall. In addition, a flu hotline is available at 340-3093. The Columbia County Health Department is currently offering flu vaccines for children aged 6 months to 18 years of age by appointment at a regularly scheduled immunization clinic every Tuesday from 1 to 3:30 p.m. PM at 325 Columbia Street, Hudson, on the first floor. An evening immunization clinic is also available on the 3rd Wednesday of each month from 4 to 6 p.m., and also by appointment. Pneumonia vaccines will also be available at the community clinics to individuals 65 or older. Contact the Health Department at 518-828-3358.

Although many of our county health departments have already run through most of their traveling vaccination appointments, flu and pneumonia shots -- just in time for the season -- are still available through local doctors' offices, medical groups, and hospitals. It's better to be saafe than sick! Greene County had its vaccination clinics in September. The Centers for Disease Control (CDC) recommends annual vaccinations for everyone six months of age and older. All the counties charge for shots. Most take most insurance and Medicare, but do not accept credit cards. The seasonal flu vaccine is designed to protect against the main flu viruses that research suggests will cause the most illness during the upcoming flu season and those immunized last year are not protected against this year’s virus. Children between 6 months and 8 years of age may need two doses of flu vaccine to be fully protected from the flu. A doctor or other healthcare professional can advise you if that is the case. The top ways our local health departments suggest to avoid flu this season, in addition to shots, is to regularly wash your hands with soap and warm water. Use alcohol-based hand sanitizers or wipes if soap and water are not available. Try to stay in good general health by getting plenty of sleep, being physically active, and managing your stress, and eating nutritious food. Drink plenty of fluids. Avoid close contact with people who are sick and try to not touch surfaces that may be contaminated with the flu virus. And get your annual flu shot.

For November… Keep in mind that it is American Diabetes Month, which has become one of the leading causes of disability and death in our nation. If it’s not controlled, diabetes can cause blindness, nerve damage, kidney disease, and other health problems; and one in twelve Americans with another 79 million adults, or almost three out of that dozen, at high risk of developing type 2 diabetes. Why is awareness so key? Those at high risk for type 2 diabetes, or in its earliest stages, can lower their risk by more than half if they make healthy changes including eating healthy, increasing physical activity, and losing weight.How can American Diabetes Month make a difference? It backs up those struggling with those life change choices... Thursday, November 20... Navigating the state health marketplace at Northern Dutchess Hospital in Rhinebeck, taking place from 6 and 7 p.m., is a reminder and tool for those seeking to enter or reenter the state healthcare exchange for the coming year. At this free event, experts will be available to help individuals with the enrollment website and to discuss how to select a plan. Open enrollment takes place from November 15 through February 15.

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Health briefs Listen for Enterovirus D68 All the news is about other viruses, but the big one to keep an eye out for over the coming indoor months – besides the flu – is Enterovirus D68, which is sweeping through populations of school age kids this autumn. The illness is seen through such mild symptoms as fever, runny nose, sneezing, cough, and body and muscle aches; although in more severe cases symptoms may include wheezing and difficulty with breathing. It should start to wane in winter. To keep your kids and teenagers from catching EV-D68, have them avoid close contact with sick people as much as possible; ensure regular washing of hands often with soap and water; the covering of all coughs and sneezes; avoiding touching one’s face with unwashed hands; the cleaning and disinfecting of surfaces; and being sure to stay home when sick. There is no specific treatment for people with respiratory illness caused by EV-D68 and some people with severe respiratory illness such as asthma who contract EV-D68 may need to be hospitalized.There are no antiviral medications currently available for people who become infected with EV-D68. For more information, see www.cdc.gov/nonpolio-enterovirus/EV68/.

MHMG physicians migrate to MKMG The Fishkill-based Mid Hudson Medical Group (MHMG) is combining as of January 1 with the Mount Kisco Medical Group (MKMG), a multispecialty healthcare provider serving Westchester, Putnam and Dutchess counties. Founded in 1946 and consists of over 300 physicians, MKMG is a clinical affiliate of the Massachusetts General Hospital and the Mount Sinai Health System. MHMG currently works with approximately 120 specialist physicians working out of 20 sites in various fields in Dutchess and Ulster counties. MHMG recently announced the stationing of nine rotating practicing physicians from Albany Medical Center at its facility opposite Adams-Fairacre Farms in Ulster. “We are excited about the physicians of the Mid Hudson Medical Group becoming a part of MKMG”, stated Scott D. Hayworth, president and CEO of the Mount Kisco Medical Group. “Both groups have a shared passion and commitment for clinical excellence and improving our patients’ health and quality of life.” The absorption of the HMG physicians into MKMG seeks to distance the combined entity

Health Quest pushing regional wellness

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ealth Quest, which is branding itself as “the Hudson Valley’s largest integrated family of hospitals and healthcare providers,” is pushing regional wellness and overall preventive care through several new campaigns this fall. The six-week Walkway Fitness Challenge calls for enrollees to exercise on the Walkway for at least 30 minutes a week through November 15. Participants can enter a drawing for prizes each time they completes a workout. More than a million steps were taken and an estimated 47,744 calories were burned during the first effort last spring. Prizes include a Mike Arteaga’s Health and Fitness Centers membership or one-hour massage at Northern Dutchess Hospital. Winners will be drawn November 17 and announced on Health Quest’s social-media sites. “A little physical activity each week can prevent or minimize health issues. Yet, the majority of adult Americans spend their day sitting at a desk,” said Roufia Payman, supervisor of outpatient nutrition education at Northern Dutchess Hospital, a Health Quest affiliate. “Pick up your feet on the Walkway during this challenge and decrease your chance for long-term health problems.” There are four ways to enter, including a downloadable “Health Quest U” app available for smartphones, the taking of “selfies” from the midway point of the Walkway marked with a teal For more info visit www. hqwalkwayfitnesschallenge.com. Health Quest is also running a fall Wellness Lecture Series through November at its facilities throughout the Hudson Valley. Health Quest physicians and professionals from the greater medical community will speak on such subjects as The Healing Power of the Personal Narrative, Getting Rid of Winter Blues, Innovative Techniques in Spinal Disc Replacement, Egg Freezing for Fertility Preservation, and gynecology and colon cancer. All talks are free. Multiple locations throughout Dutchess and Putnam counties will be used, including Northern Dutchess Hospital in Rhinebeck and Vassar Brothers Medical Center in Poughkeepsie. Registration is required by calling 877-729-2444.

from the multiple malpractice suits that Dr. Spyros Panos, a founder of MHMG, faces. This is not an asset purchase. The MSMG staff will join the new organization as individuals. Dr. Hayworth told the Poughkeepsie Journal that “We’re not related at all to the suits.” MHMG’s medical equipment is included in the transaction. Mount Kisco will continue to lease

the buildings that MHMG occupies. And Heyworth added that “the vast majority” of MHMG support staff are being offered jobs by MKMG. Government regulators have sometimes contested deal arrangements made to avoid the assumption of the liabilities of a predecessor organization

HealthAlliance conducts regional survey Residents of the mid-Hudson Valley, including Westchester, Rockland, Putnam, Orange, Sullivan, Ulster and Dutchess counties, have been invited to take a short survey about their health and the services they use. The goal of the survey is “to learn more about the healthcare needs of the community to identify and plan localized healthcare delivery in the future,” according to news of the survey released by HealthAlliance of the Hudson Valley.. The survey is anonymous, will take less than ten minutes to complete, and is available online. Participants are encouraged to share the survey link and information about the survey with friends, family and other residents of the Hudson Valley. It is being launched as part of a comprehensive community needs assessment focused on local healthcare, an element of the state Delivery System Reform Incentive Payment program (DSRIP), which is designed to “transform” the state’s healthcare delivery system, reduce avoidable hospital use, and improve access to other healthcare services as a means of reducing Medicaid spending. The survey is being administered through a collaborative effort between HealthAlliance of Hudson Valley, the Center for Regional Healthcare Innovation at Westchester Medical Center, Montefiore Medical Center, and Refuah Health


October 23, 2014 Healthy Body & Mind

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Columbia Memorial Hospital grows its affiliations

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ack in the late 1980s, Columbia Memorial Hospital tried to ride to the rescue of Greene County Community Hospital in Catskill, which eventually closed and merged many of its functions into the Hudsonbased regional entity. Ever since, CMH has worked to bolster its own strengths, and provide for its sister county across the river. First it provided services, and then two years ago bought the again struggling Greene Medical Arts entity. This autumn, a newly renovated and expanded Columbia Memorial Pediatrics center opened at what is now known as the Greene Medical Arts building in Catskill, bringing to $8.5 million the investment that Columbia Memorial has invested into what’s becoming its second campus. CMH is now characterizing itself as “an advanced multi-specialty health care system” serving more than 100,000 residents in Columbia, Greene and Dutchess counties at 40 care centers, including 17 primary care and 23 specialty care centers, located throughout the region, including a 120-bed long-term care facility, Kaaterskill Care in Catskill. Announced this past summer is Columbia Memorial’s new “strategic alliance” with Albany Medical Center, a process “designed to lead to better coordination of care for residents of Columbia and Greene counties and greater operational efficiency for both organizations.” Planned are number of stages designed to better coordinate CMH and AMC clinical services, develop care integration practices, and find operational efficiencies between the two entities while their governing boards, medical staffs, employees and fundraising arms remain separate. “This move allows us to explore how we can work together with Albany Med to deliver better-coordinated patient care and improved access to specialty services,” said Columbia Memorial president and CEO Jay P. Cahalan. “As the healthcare landscape changes, virtually all providers will need to build stronger alliances Center Performing Provider Systems (PPS). It will be made available through several Hudson Valley healthcare provider websites and offices, including HealthAlliance, the Institute for Family Health and the Ulster County Department of Health and Mental Health. Results of the community survey will be available by November.

Innovation challenge picks three winners The New York State Department of Health recently announced winners of its inaugural New York State Health Innovation Challenge – a fourmonth contest among tech companies vying to create the most useful technological tool to help consumers make sense of health data. “Governor [Andrew] Cuomo’s OPEN NY initiative has made more of New York’s data available than ever before,”said acting state health commissioner Dr. Howard Zucker. “The Health Innovation Chal-

with industry partners to meet community healthcare needs and to achieve operational efficiencies. These formal discussions demonstrate our proactive approach to addressing the changes ahead.” “We’re proud to be working with the leadership of Columbia Memorial to develop a health system that will build on our respective strengths and enhance the access to high-quality care for patients throughout the region,” added Dr. Steven Frisch, MD, Albany Medical Center hospital systems general director. “In building its local healthcare system, Columbia Memorial, like Albany Med, has taken important steps to succeed in a world where reimbursement models are beginning to reward and emphasize clinical effectiveness and positive outcomes. Working together will help enable both institutions to move further in this direction under regionally based governance.”

lenge seeks to capitalize on this wealth of information to help consumers make better informed health care choices.” The initiative, pushed by the governor last spring, “aims to make state government more open, innovative, and cost-effective.” Under the innovation contest’s guidelines, multidisciplinary teams of coders and developers were invited to create tech-based solutions to help consumers access useful information about the quality, cost, and efficiency of healthcare services. Six judges then selected from “more than 18 submissions” and evaluated them based upon decision making, creativity, feasibility of implementation, target audience, and how data were utilized. Three winners were announced. DocSpot, a website which seeks to simplify consumers’ decision making by weaving numerous

publicly available data sets into one unified interface, won $30,000 for first place after judges lauded it for being clear and simple in its utilization of data from Health Data NY, Data.Medicare. gov, state medical boards, hospital and clinic physician directories, and reviews from the web, giving users the ability to compare providers using a variety of metrics. Taking home the $10,000 second-place prize was HealthRank, an application that enables patients to manage their own care by providing them with the ability to prioritize among cost, quality, and access on a five-point scale. Graphical displays of the data are also available to better depict how each of the top-ranked hospitals compare with regard to the four criteria. The $3000 third-place prize was awarded to NaviNext, which utilizes Google Maps to pinpoint

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23, 2014 6 | October Healthy Body & Mind hospitals that treat a particular condition or provide a specific service, all sorted among ‘highest rated’, ‘lowest cost’ and ‘closest to me.â€?. The winning presentations will are posted at www.health2con.com.

Getting your elders the care they need County and state health departments are currently assisting ease of contact online for senior care, pushing two sites in particular that can serve as introductions to the many programs available for all. At www.Govbenefits.gov, one should be able to enter as much material as one can, from parent’s health, disability, income, wealth (as in property owned), military veteran status, education level and more – and then push a button and get, within minutes, a list, details and access information for many, even scores, of beneficial government programs, supplements and/or services. At www.Benefitscheckup.org, a non-profit site, use of the same material may report added programs, details and contacts. The top ten programs everyone who is caring for an aging parent should know about, according to those at county and state departments of health, include: Medicare, which encompasses more than just the Part A hospital and Part B medical insurance coverage. If your aging parent is 65 or older and collecting Social Security, the insurance premiums are deducted from monthly benefits. Part D prescription drug coverage is subsidized by Medicare through payments to private company insurers who then fund an average of 90 percent of the cost of prescription drugs. If your parent is considered low income, receiving only Social Security, Medicare may subsidize all but about $10 of the monthly premiums. Social Security, which may include a larger monthly benefit than indicated by one’s lowerpaying jobs via the Supplemental Security Income (SSI) program and Medicaid program, which is also administered through the Social Security Administration. Administration on Aging (AoA) administers many national programs and services for elders, including health insurance counseling, legal assistance, protection from elder abuse and long-term care. The banner on the website has a link to Elders and Families, a good starting point, as well as a specific link and service For Caregivers. The Department of Veterans Affairs is particularly strong with those whose parents have a worsening disability. Prescription drug needs may

Poughkeepsie’s Vassar Brothers expands its emergency room

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assar Brothers Medical Center opened a new 7,000-square-foot addition to its state-ofthe-art Emergency Department this Fall, along with renovations to the 127-year-old hospital’s firstfloor corridors and lobby. “Our staff is proud of our long history of providing exceptional care to the community,� said Robert Friedberg, president of Vassar Brothers Medical Center. “This addition will enhance what is already the largest, most capable Emergency Department between New York City and Albany.� The $2 million expansion increases the treatment space by 15 bays for a total of 57. All bays have mounted computers, TVs and new equipment. The original ER was designed for approximately 55,000 visits annually. This year, it will treat well over 68,000 patients, according to projections. Vassar Brothers Medical Center, with 365 beds, is part of Health Quest, a nonprofit integrated family of hospitals and healthcare providers that includes Northern Dutchess Hospital in Rhinebeck, Putnam Hospital Center in Carmel, plus multiple Health Quest Medical Practice primary care and specialty locations, two Health Quest Urgent Care locations for walk-in urgent care, skilled nursing facility the Thompson House and affiliates that include Hudson Valley Home Care and The Heart Center.

be submitted. There are several types and levels of VA compensation and pension programs. The Health Insurance Portability and Accountability Act of 1966 provides your elderly parent privacy of his or her medical records. It is a regulation-and-restriction program for healthcare providers. The protection should be of concern to you and other family members because, unless your parent signs a form designating each of you as approved to discuss your medical concerns

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with the physician, he or she cannot do such, even if you prove your family connection. Better sooner than later, access the HIPAA website for the information and forms, or secure the forms from a physician, and file copies with every healthcare professional involved in your parent’s care. The United States Department of Justice is important to contact if one’s parent has a disability, particularly with physical movement The Food and Drug Administration is a key site to look into if one’s aging parent is taking five to ten different prescription drugs, perhaps prescribed by different doctors. Caregivers should be aware of every one of the drugs, know their mission in the body and, particularly the side effects and conflicts with other medications. You want to watch for a danger known aspolypharmacy. The federal Food and Drug Administration offers a giant database on every drug approved by the agency, listing active ingredients, purpose or mission of the medication, dosing recommendations and the side effects and conflicts. It is also recommended that caregivers be in

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October 23, 2014 Healthy Body & Mind touch with federal officeholders, whose staffs include specialists who can advocate. Finally, be in regular touch with one’s county office of the aging, which is staffed by professionals who know every elder program and service, including available funding sources, in your area. Staff is often aided by volunteers who serve as drivers for transport and Meals-on-Wheels, for respite services and other duties. Gather up the same information you collected for the two sites detailing the national, and even state, programs for which your parent may qualify and make an appointment to meet with a counselor at the Area Agency on Aging. The staff person can advise regarding programs and qualifications and even help prepare applications and documentation. Often, the counselor will even call a recommended agency, program or service to advise that your application is headed their way. Access your Area Agency on Aging through your telephone book and call the office for an appointment, at which time you should also ask if they have a website that you can access in advance of an in-person visit.

Medical marijuana is coming to New York! In July the state enacted the Compassionate Care Act, committing the Department of Health to implementing a comprehensive, safe and effective medical marijuana program that meets the needs of New Yorkers but is handled “with safety and care.” Under the New York program, which is currently in the review and policy-setting stage, medical marijuana will be accessible to patients with conditions including cancer, HIV/AIDS, Lou Gehrig’s disease (ALS), Parkinson’s disease, multiple sclerosis, damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity, epilepsy, inflammatory bowel disease, neuropathies and Huntington’s disease. The law includes these conditions when there is a clinical association with or complication of the condition resulting in cachexia or wasting syn-

drome, severe or chronic pain, severe nausea, seizures; or severe or persistent muscle spasms. The state is also exploring mechanisms that may accelerate access to medical marijuana for children suffering from epilepsy, and may expand the list of eligible conditions for which medical marijuana certifications may be issued by practitioners based on current research and lobbying. Under the program, practitioners will be required to complete a training course and register with DOH to issue certifications to their patients for medical marijuana. Practitioners must certify that their patients have a serious condition and the patients are likely to receive therapeutic or palliative benefits from the use of medical marijuana for the serious condition in order to issue the certification. This process will ensure that medical marijuana is available only to patients with serious conditions who will benefit from the treatment. Certified patients must also apply to DOH for a registry identification card. Certified patients may designate a caregiver, who must also apply to DOH for a registry identification card. The card will contain the practitioner’s dosing recommendations for the patient. DOH will be able to suspend or revoke the card of a patient who willfully violates any provision of the law. Organizations that wish to manufacture and dispense medical marijuana must apply for state registration. If approved, they must conform to specific requirements. Registration will be valid

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for two years at a time, will be renewable, and will be subject to revocation. Registered organizations will be required to comply with strict security and record-keeping requirements. The law allows for up to five registered organizations, located in New York State, to grow, manufacture, distribute and dispense marijuana for medical use. Each registered organization may operate up to four dispensing facilities statewide, for up to an initial total of 20 geographically-dispersed dispensing facilities. Registered organizations must contract with an independent laboratory located in New York State to test medical marijuana products. Registered organizations will be able to dispense up to a 30-day supply of medical marijuana to certified patients with a valid registry identification card. Patients may only possess up to a 30-day supply of medical marijuana, in pill, liquid or vaporizingfriendly formats. The medical marijuana will be dispensed in a sealed and properly labeled package, with a safety insert included. Patients must keep the medical marijuana in the original packaging in which it was dispensed. Comments are currently being taken by the state regarding its proposals. To date, several potential growers of medicinal marijuana have expressed interest in establishing their businesses in Orange County and have spoken to county executive Steve Neuhaus about setting up grow houses in the Newburgh and Goshen areas.

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23, 2014 8 | October Healthy Body & Mind

What’s too much … now Connecting with our inner vice squad by Jennifer Brizzi

A

s our connection to our vices evolves, that classic nightly pitcher of martinis from the 1960s is replaced by a mug of Sleepytime herbal tea or a bottle of kombucha (which does contain traces of alcohol and caffeine). Historic times when man, woman and child would drink alcohol all day (often because the water was toxic) have evolved into a good percentage of us being confirmed teetotalers. That pack of cigarettes that was once ubiquitous on every restaurant table and bar has been replaced by the smart phone, perhaps just as addicting. Starbucks’ coffees have double the caffeine of regular coffee, and we supplement them with caffeine shots or caffeine inhalers to amp it up. “Screen time,” which our ancestors never had to worry about, is something that experts now mandate limits on. Sugar, which we’ve loved in many forms over the years, reaches crazy levels these days in sodas and many processed and fast foods. Times have changed in how we perceive just how much of something is good or bad for us. How much is too much of a good thing? Sugar, salt, carbs, caffeine, alcohol, tobacco and being nose up to our electronic devices … who’s to say the correct amounts for any of us? It may depend on the person. While most would claim these days that any tobacco is too much, should 300 mg or 500 mg of caffeine be the daily limit? Should you have a drink a day, or more, or none? Is an hour a day of screen time — or seven — too much? Let’s start with dietary limits. With current trends from cutting out carbs to anything our Paleolithic ancestors didn’t eat, to banning sugar or soy or fat from our table, it’s challenging to wade through all the recommendations and know what

to cut out and what to keep.

Sugar, salt and fats The simplest carb, sugar, has no vitamins or

minerals (although some alternative sweeteners do) and doesn’t stick to our ribs, so to speak. The spike in blood sugar it gives us leaves in its wake a low that leaves us craving something more


October 23, 2014 Healthy Body & Mind Boozing it down When it comes to alcohol, consumption by Americans ranges from the total teetotalers to those who down more than ten drinks a day, and many levels in between. The early colonists drank

| 9

a lot, all day long, according to historian Ed Crews, at weddings, funerals and at work or college. They believed booze to be good for their health. Not only did it keep you warm and make you strong, they thought, but it helped digestion and eased

2014 Eating Disorder Conference substantial. The American Heart Association last year issued a recommendation of no more than 100 calories per day (about 6 teaspoons/24 grams) of sugar, for women, and no more than 150 calories per day (about 9 teaspoons/36 grams) a day for men. Sugar can be as addictive as anything else but we can wean ourselves off it and be happy with the natural sweetness of whole foods, from cauliflower to peas to pears. As with salt: getting used to less is a gradual process and well worth striving for. Sodium itself isn’t evil and occurs naturally in many foods, but we can taper it down and need less, especially if we have medical reasons to avoid it. Soy is controversial; although it has many health benefits, it, too, should be consumed in moderation, especially by some segments of the population. And carbs of any kind have a bad rap, from the Atkins craze to current trendy grain-avoiding. “Instead of reading labels to see how many carbohydrates are in our food,” says Dr. Eric Ashburn, “we should really look at the quality of the carbohydrates and make sure they’re whole food, high quality carbs.” Dr. Ashburn is an expert and speaker on health and wellness and proprietor of Ashburn Family Chiropractic Center in Fishkill. “And that goes for fats as well,” he adds. “The higher the quality of the fat, the better it is for you. Also whether it’s in whole foods versus trans fats or hydrogenated fats, those would be the things to look for.”

Hyped up When it comes to caffeine, on the other hand, it seems these days that the sky’s the limit. My mother-in-law never smoked and was very moderate in her wine consumption — one glass with dinner — but she would drink cup after cup of coffee all day long during her working days running her busy costume shop in the big city. My own doc suggested cutting down due to anxiety, so I halved my morning intake and only fill her back up if I have an especially sleep-deprived day. Coffee keeps us lively, but the Mayo Clinic says we should keep our caffeine intake under 400 mg per day, the amount in ten cans of cola or four average cups of coffee. Other experts say up to 500 mg is okay. But Mayo claims that some of us are more sensitive than others and may tolerate less. Or may not realize how much caffeine is in that 20-ounce Venti from Starbucks (415 mg). In 1830 we consumed three pounds of coffee a year, then by 1859 it was eight pounds. The current average intake is 300 mg of caffeine per day, well below that 400 mg maximum recommended by Mayo. Those of us who are 50 to 64 years old get the most caffeine, more than any other age group, according to the Department of Nutritional Sciences at Penn State. Although some are immune to its effects, falling asleep readily after an espresso, for example, some of us, if we overdo — per the Mayo Clinic — may get the jitters, or, worse, experience irritability, restlessness, nervousness, insomnia, muscle tremors, rapid heartbeat or an upset stomach. It can get in the way of the seven to eight hours of sleep we need, which can in turn affect our alertness during the day and contribute to a vicious cycle of needing more coffee which in turns affects sleep which affects concentration. Also, some medications interact adversely with caffeine, like some antibiotics, the bronchodilator theophylline and even the herb echinacea. But if we cut down or quit, we can get heachachey and irritability from withdrawal. Cutting back gradually can help, as can realizing where it lurks besides the obvious coffee and soda, like in some pain relievers, in lip balm and various energy drinks like Red Bull and such. If we keep to the right amount for our individual needs, it can not only help amp up physical energy and provide antioxidants but also boost mental tasks as well.

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23, 2014 10 | October Healthy Body & Mind colds, cholera, colic, laryngitis and labor pains. “In 1790,” says Crews, “United States govern-

ment figures showed that annual per-capita alcohol consumption for everybody over fifteen

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amounted to 34 gallons of beer and cider, five gallons of distilled spirits and one gallon of wine.” George Washington himself opened a distillery in 1798. “Mount Vernon’s whiskey production went from 600 gallons in 1797 to 4500 gallons in 1798 to 11,000 gallons in 1799,” says Crews. Although the Puritans and Ben Franklin called for moderation or abstinence, that alcohol could be addicting didn’t cross most people’s minds. Since then, as a nation, we’ve cut down considerably, especially in the past few decades. At least, most of us have. Gallup, who has tracked alcohol use for 71 years, recorded in 1939 that 58 percent of adults confessed to being drinkers. That number hit a low, in 1958, of 55 percent, and then the high point was 71 percent from 1976 to 1978. Dr. David J. Hanson, a sociology professor at SUNY Potsdam, reports via the National Institute on Alcohol Abuse and Alcoholism, “The per capita consumption of alcohol by Americans age 14 and older has dropped from 2.75 gallons in 1980 to 2.31 in 2007 (the latest date for which statistics are available).” Throughout the world, Dr. Hanson adds, men drink more than women and childless couples and those with adult children spend 30 percent more on hooch than the household average. Abstention is inversely proportional to social class and level of education, with the wealthier and more educated drinking more. Catholics and non-Christians drink more than Protestants and church attendees less than those who go rarely or never. And younger people are drinking less, with numbers still dropping, from 50 percent in 1979 to 14.7 percent in 2009 for ages 12 through 17, and 62 percent down to 38 percent of college freshmen, with per capita consumption in general dropping 23 percent since 1990. Of those who drink, the median consumption is three drinks a week, according to data from the National Epidemiologic Survey on Alcohol and Related Conditions, as reported in Philip J. Cook’s “Paying the Tab.” In a September 25 Washington Post piece by Christopher Ingraham, while 30 percent of Americans don’t drink at all and another 30 percent have less than one drink per week,

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October 23, 2014 Healthy Body & Mind the top 10 percent consumes 74 drinks a week, or a little more than ten drinks per day. However, according to an April 19 article in the British paper The Independent by Tomas Jivanda, former World Health Organization alcohol expert Dr Kari Poikolainen told the Daily Mail that up to 13 units of alcohol a day isn’t harmful, equivalent to over a 750 ml bottle of wine or five or six beers. But “too much,� whatever your standards of how much that is, can lead to relationship issues, health problems from cancer to liver disease, and worse. Sixty percent of homicides, drowning and fatal burns are attributed to alcohol use, half of severe trauma injuries and 40 percent of suicides and fatal car crashes. Sarah Allen Benton reports in Psychology Today’s column “The High-Functioning Alcoholic� that 8.5 percent of Americans have alcohol-use disorders and only 25 percent of alcoholics ever receive treatment.

from sensory overload,� she says, “lack of restorative sleep, and a hyper aroused nervous system, regardless of diagnosis — what I call electronic screen syndrome. These children are impulsive,

| 11

moody and can’t pay attention.� Time will tell what effects this newest health hazard, most recent in a long line of them, will have on future generations.

Pack to screen Which leaves us to that ever-present smart phone and its predecessor the pack of cigarettes, or screen time eclipsing tobacco. I don’t think any studies show that any amount of tobacco is good for us, since the Surgeon General’s 1964 report that cigarette smoking causes chronic bronchitis and cancer, with bans on advertising in broadcast media and required warnings on cigarette packages following shortly thereafter. And now the Centers for Disease Control reports that although 438,000 of us die every year because of tobacco and 45 million still smoke, many are quitting, and almost half of the people who have ever smoked have since quit. But don’t be too hasty to replace that pack with a phone. Between handheld devices, computers and TV, we spend much of our days glued to the screen. The average child spends more than seven hours a day that way, according to Victoria L. Dunckley, M.D., in a Psychology Today article from February 27, and “too much� causes brain damage, affecting emotional processing, executive attention, decision making, cognitive control, planning, prioritizing, organizing, impulse control and empathy and compassion for others. “I observe that many of the children I see suffer

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23, 2014 12 | October Healthy Body & Mind

Healthcare partnering

Health Alliance, formed from the forced merger of Kingston's two hospitals, keeps searching — as with all regional hospitals -- for the right partners, and feels it's again close to ever-better working alliances. to combine with Poughkeepie-based HealthQuest. Some HAHV board members are believed to favor this choice, though the board does not normally make its deliberations public. Neither HAHV or HealthQuest is defined as a tertiary or full-service hospital system, although HealthQuest has some of the characteristics of one. Scarpino only noted at the YMCA that with this option “we still won’t have everything.” However the process ends up, it’s clear that the century-old model of the standalone hospital in smaller New York State communities is coming to a swift close. That era is over. Chief strategy officer Josh Ratner cautioned that the options, which the HAHV board has not made official policy, could change. No rigorous due-diligence audit of the preferred options has yet been conducted. Various state permissions and funding approvals are necessary for any course of action. A federal anti-monopoly waiver may be required. And beyond that, Scapino said, “we need a bank to lend us money.” The funding award from HAHV’s application for its share of the eight billion dollars statewide in DSRIP (Delivery System Reform Incentive Payment) funding in early December will contain the

David Scarpino discloses present options for Kingston system By Geddy Sveikauskas

K

ingston-based Health Alliance of the Hudson Valley has narrowed its choices in its search for organizational partners. President and CEO David Scarpino last Wednesday told an audience of 20 persons at the Kingston YMCA that HAHV’s first affiliation option was coming together with two tertiary hospital systems, St. Peter’s Health Partners in Albany to the north and Westchester Medical Center in Valhalla to the south. Earlier planning documents indicate that the kinds of partnerships, if consummated as described, will differ from each other to some degree, with the former focusing on a system of primary care and the latter laying greater emphasis on community health services. A second option for HAHV, Scarpino said, was

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David Scarpino, Health Alliance President and CEO. next signal of the Kingston hospital system’s intentions, including with whom and how it intends to partner. In the past, such affiliations have often not been irreversible. Given the serious amount of dowry money involved and the importance of the state health department (DOH) in the process, however, the new partnerships, once established, may not be easily reversed. Here’s how HAHV’s application. for which it received $340,000 in a state project design grant on September 3, put it: “Our ability to drastically reform the delivery of healthcare in Ulster County rests with our ability to consolidate to a single campus from two hospitals less than a quartermile apart, and to repurpose hospital infrastructure to be used as a medical village,” it said. “How and when we consolidate hospital operations is dependent upon coming to an agreement with an affiliate partner.”

“No longer alone” Scarpino and his colleagues envisage the HAHV hospital system shrinking from being the largest purveyor of healthcare in its service area to being something less, mostly a coordinator of local healthcare. On the bricks-and-mortar side, Scarpino said that would probably mean 200 beds in one Kingston hospital facility rather than 150 beds each in two. “How small will we get from where we are now to zero?” asked Scarpino rhetorically at the YMCA meeting. It was a question that HAHV has until now been loathe publicly to entertain. There it

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October 23, 2014 Healthy Body & Mind suddenly was, out in the open. Scarpino explained that healthcare in the future will involve an increase in non-physician medical care (“medical extenders”), in treatment of chronic diseases, and in outpatient visits. Decreases are expected in in-patient stays and in patients with acute diseases. HAHV says it has enlisted 35 community partners in its reorganizational efforts. The December application to the state, he said, “will tell the state how we’ll coordinate them.” “It isn’t just us any more,” Scarpino said. “We’ll no longer be alone.”

Design planning The prospective active partners currently under consideration are significantly larger than the Kingston health system, even with HAHV’s Woodland Pond retirement community and its Margaretville facilities included). At about 600 beds, three hospitals and a considerable outreach network, HealthQuest is the smallest. Westchester Medical, which has 895 beds, recently bought St. Francis Hospital in Poughkeepsie. And St. Peter’s, itself a merger of four Albany-area hospitals three years ago, is about seven times as large as HAHV. With state encouragement St, Peter’s is also working closely with Schenectady-based Ellis Medicine, a 430-bed hospital with other facilties and a similar primary-care model to HAHV’s. This summer Ellis received a $500,000 DSRIP

planning grant to “actively explore partnering with HealthAlliance.” Westchester, which got a million dollars of state money to design its planning model to integrate health care in the lower Hudson Valley region. It too promises to help build “a network of medical neighborhoods (or hubs) comprised of local professionals supported by shared infrastructure and resources.” The local delivery hubs, Westchester’s application said, “will develop collaborative working relationships, integrate community and public-health resources, work with providers to implement workflow changes to implement evidence-based practice guidelines, engage patients and families, and support workforce transformation.” Westchester earnestly promised “to recognize the particularity of each locality.” The state’s December 2013 health innovation plan had described its goal as “at its heart an advanced primary-care model that integrates care with all parts of the healthcare system, including behavioral health and community-based providers, and aligns payment with this care model.” The premise of the plan was a belief that such a model, defined as “an augmented patient-centered medi-

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23, 2014 14 | October Healthy Body & Mind

Mental health services Where does one turn in a crisis these days?

T

he delivery of mental health care in our society is challenging. Though people with enough money can seek private psychotherapy, many individuals facing mental health issues cannot afford treatment and may fear the stigma of a diagnosis. Because state budget cuts have reduced funding for governmental mental health services — by a full $8 million over the last five years in Ulster County alone — the situation has become even more difficult. Below, our reporters look at the current state of local mental health care in the communities of Woodstock and Shandaken, New Paltz, Saugerties and the Kingston school district.

Woodstock and Shandaken struggle to provide services By Violet Snow

A

s the county seat, Kingston is a hub for delivery of services. Woodstock is twelve miles from Kingston, and parts of Shandaken are 30 miles away. Family of Woodstock, the local social-services organization, has a county reach and fills in a good deal of the gap to serve local needs. “Because we have a hotline and a walk-in center, there’s a variety of ways we might be an entry point into systematic treatments,” said Tamara Cooper, Family’s program coordinator. She sees people obtaining help from three categories of resources: formal, informal, and internal. “As monies dry up, with fewer affordable mental health options for people, those informal and internal resources take on more importance,” Cooper said. “It’s important to really understand how to use those resources.” The hotline, staffed 24/7, is an informal resource. With phone plans now including free long-distance, the line receives calls from all over the country. The majority of callers, however, are from all parts of Ulster County. Individuals seek immediate support for emotional distress, including suicidal feelings. Or people call for advice on how to get help for a family member, friend, neighbor, or someone they see on the street. Family’s walk-in center on Rock City Road serves a similar function and is open 9:30 a.m. to 9:30 p.m., seven days a week. “We have a lot of

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Woodstock is where the region's mental health giant, Family, started as a means of taking care of the many young people flocking to the area in the early 1970s and still maintains a major presence for those in need of help. Now the not-for-profit is headquartered in Kingston with active offices in New Paltz and Ellenville as well. people in Woodstock who can no longer afford to live in town but consider themselves part of the community,” said Cooper. “They come to shop at our free store or hang out in the front room, which is a cooling or warming center, depending on the weather.” Both on the hotline and at the walk-in center, explained Cooper, “we talk with people about their concerns and help them think about what steps to take. We have information about where resources might be, and we encourage them to come in and call us. Sometimes we are the resource, since we have some people in our county and our town who are system-resistant, fearful of going for more formal resources.” Family has a limited capacity to offer formal counseling. “If someone wants to sit down and talk with one person once a week,” said Cooper, “we can hook them up with someone who works on our staff.” For more extensive psychotherapy, clients must go through private practitioners or through the county. Over the past three years, the budget cuts have prompted Ulster County to reorganize its mental health service delivery system. A public-private partnership was established with Hudson Valley Mental Health (HVMH) to operate the county’s clinics in Kingston, Ellenville, and New Paltz. Assistance for children and adolescents is provided through Astor Family Services. Other formal resources are available through the Institute for Family Health, which has clinics in Highland, New Paltz and Kingston, and the Mental Health Association of Ulster County. The support group system is widespread in Ulster County, providing meetings of Alcoholics Anonymous and other twelve-step programs from Al-Anon to Narcotics Anonymous. The National Alliance for Mental Illness offers assistance for families and friends of people with mental health Hours: Mon.-Fri. 9-6 • Sat. 9-4

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challenges. PEOPLe, Inc. (Projects to Empower and Organize the Psychiatrically Labeled) was started a decade ago as a peer-based informal resource and runs programs such as the Rose Houses. This hospital diversion program houses people with mental health diagnoses for a few days as a shortterm alternative to hospitalization. The group also supplies advocates to accompany and support individuals when they go to an emergency room for psychiatric evaluation. Mental health issues may come to light when the police are called to deal with volatile situations. If an individual is showing signs of mental imbalance, a police officer may refer him or her to county mental health services. If the problem is acute, ambulance staff may be called for evaluation or for assistance in avoiding potential violence, according to Shandaken supervisor Rob Stanley, who added that sometimes the person might be transported to a hospital in Kingston for assessment. “It’s a hard call for first responders,” said Cooper. “In our society, personal rights outweigh public concerns except under specific criteria. The person has to be a clear danger to self or others to be taken against their will for formal assessment. They can be held up to 72 hours while the assessment is happening.” At the hospital, the person or team performing the assessment converses with the individual and speaks to other people in their life to determine whether the person is a danger. “The evaluators might say, ‘Yes, this person needs mental health treatment whether they want it or not, in order to stay safe or safeguard the community,’” elaborated Cooper. “Or they could say, ‘This person doesn’t meet the criteria, they seem to know who they are, where they are, and they’re not expressing suicidal ideation or threats of violence.’ Then the person


October 23, 2014 Healthy Body & Mind

| 15

help is easier to find for some By Terence P. Ward

R

SUNY New Paltz provides key services for its large student body, although it still comes down to dispatchers in most towns, as seen at right, to guide people in crisis to the aid they need. would be released.” While evaluation at a hospital or clinic is the first step in entering the county system, it’s a step that most people find intimidating and is seldom taken voluntarily. To address this problem, the state recently approved over $400,000 in funding for a new mobile mental health crisis response team for Ulster County. Designed to provide emergency intervention, connect patients with services, and lessen the burden on emergency rooms, mobile units have been shown to reduce the number of unnecessary psychiatric hospitalizations, according to county executive Michael Hein’s office. Similar teams already exist in Orange County and in Dutchess County, where the service may be accessed through a helpline. The details of access are still to be worked out in Ulster County. It’s expected that the mobile unit will be called upon by police and ambulance crews, and it will also be available to families, who can request intervention in moments of crisis, possibly through 911. The team will have a medical director on call and will provide face-to-face clinical assessment, facilitating referrals to community services. Internal supports may be the most important resources for all individuals. “I always remember that people facing mental health challenges still have inner strengths they can rely on,” emphasized Cooper, “including their hope for recovery and their belief in God or some other spiritual belief. For some, it’s optimism, or their love of nature, pets, or family. People have the ability to seek help and build relationships.” To augment the potential of those relationships, Family is turning to a new first-aid model

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that calls for community members to be trained in mental health support. “We teach you how to approach and engage people who are having mental health challenges,” said Cooper. “It could be a neighbor, someone on the street, a family member. The training specifically looks at depression, anxiety, substance abuse, suicide, and psychosis. It goes through an action plan for each of these issues, including immediate response in a crisis.” Trainees learn how to listen and give reassurance and information, encouraging appropriate professional help while engaging in self-help and other support strategies. The eight-hour training, often spread out over two days of a weekend, has received more attention since the tragedy at Sandy Hook Elmentary School in Connecticut, where a young man with mental health problems killed over a score of children and teachers. “As other resources become less obtainable, we need to learn how to recognize problems and how to be of assistance,” said Cooper. “How do we, as a community, identify and help people in need?” Anyone interested in the training should call the Family hotline. A session is currently being considered for the first weekend in November.

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esources are available for those experiencing a mental health crisis in New Paltz, and for those close to someone who is. Exactly what resources are immediately available depends largely upon who you are, though. The New Paltz community is experiencing a crisis. Some segments of the population – in particular, college students and senior citizens -- have a more robust safety net around them, meaning that problems may be caught before they spiral out of control. Other residents have options only if they know who to call. Exactly who should be called is a question that employees of various different government agencies answer differently. Three responses are the most common: call the police, the Ulster County Department of Mental Health, and Family of New Paltz. Family of New Paltz is the local office of Family of Woodstock. Among the many programs it offers, the New Paltz office has trained volunteers staffing a crisis hotline and according to director Kathy Cartagena anyone answering the phone is able to do triage to determine what kind of help the caller needs, and how urgent it is. “They’re able to quickly determine what the problem is, and decide if they need a referral to a local professional, or to talk to one of the counselors we have on staff,” Cartagena explained. “Some of our volunteers have a background in mental health, and they’re often willing to take a lot of time talking to someone if necessary.” Cartagena said that some clients, such as the honeless, are more at risk than others, and not everyone can be given the help they need easily. “Some people are so ill, they try to avoid treatment,” she said. “They’re afraid of being locked up, or their medications are so strong they have powerful side effects.” If there is a concern that someone is likely to become violent, calling the police is the option. Cartagena has a lot of confidence in the New Paltz Police. “They are the most gentle, caring individuals,” Cartagena said. “If we have to call

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Saugerties is a town, like many throughout the region, where local police are the front line for mental health crises and take their added responsibility seriously, through training and gentle interactions with those on the edge. them, they spend so much time talking the person down, so that they leave willingly instead of strapped to a gurney. I sometimes get teary-eyed, they’re so kind and well-trained.” According to lieutenant Rob Lucchesi of the New Paltz Police, the officers are given some training in evaluating the mental state of people they encounter, and react appropriately. “As first responders, we try to assess the person’s needs and determine the most appropriate course of action.” If there is a real concern about violence to self or another person, that’s probably going to mean a trip to the hospital. Talking the individual down has the goal of getting them to agree to being transported there, though state mental health law authorizes officers to compel the person if necessary. If officers have concerns which don’t rise to that level, the county mental health office is called instead. The chief of that department regularly meets with the police, and officers receive in-service training around working with those in crisis and with longer-term mental health issues. The town and village governments have no formal role to play in mental health issues in the community, but the concern is still there. Despite cutbacks, the county is still the appropriate level of government to address these concerns because of its size, said village mayor Jason West. Town supervisor Susan Zimet agreed that her government, while not technically responsible, provides funding to Family for its work, as well as the town youth program (which has a staff trained to counsel teens) and activities for senior citizens (which can reduce the isolation that contributes to depression and other problems). Still, local officials do sometimes need to make a determination. West pointed to the building department as one with employees that may be the first to contact someone in need. The village’s director of planning, building and code enforcement, Bren White, acknowledged that this is the case. “Our code enforcement officers deal with it on a case-by-case basis,” she said. They will try to contact “someone who can help,” be it a family member, the offices of mental health or the aging at the county level, or some other resource. “Each case is going to be different,” she said. Stacy Delarede, a building inspector for the town, said, “We’re not certified to determine someone’s mental condition,” but will contact the office of the aging for an elderly person in need, or the police if their own safety is in jeopardy. On the SUNY New Paltz campus, the counseling center has set an ambitious goal, according to director Gwen Lloyd: get every employee trained to assess students for a possible crisis. The number of stressors on college students can be large. Often their level of independence is greater than they have ever experienced. In addition, a psychotic break is more likely to happen to a person between 18 and 30 years of age. By next year, Lloyd wants everyone from custodians to professors to be able to ask simple, direct questions and to make an assessment. “People are uncomfortable asking someone directly if they are planning to hurt themselves of

someone else,” she said, “because they don’t want to put the idea in their head. But the research shows that that isn’t going to happen.” The university police work closely with the counseling center and the office of residence life to keep tabs on students on campus, and if they are asked to connect someone to the emergency counselor on duty “they just ask for the person’s name and number.” If transport to a hospital is warranted, the college has a close relationship with Kingston Hospital, and is able to follow closely the case of any student brought there. In short, if someone is in crisis in New Paltz, call Family if possible, or the police if violence is a concern. On campus or for a student, a call to the university police will get a quick connection to the counseling center. And don’t be afraid to ask someone directly if they think they may cause themselves harm.

How the Saugerties Police deal with the mentally ill By Dawn Green

M

ental illness can consist of many behaviors. It might be a person threatening to harm himself or others. It might be a disheveled person pacing up and down a busy street in the village, muttering obscenities. It might even be a man chasing a taxi with a hammer in hand,

a scenario that Saugerties police chief Joseph Sinagra says once played out on his community’s streets not so long ago. In such events, concerned family members or bystanders would most likely call the Saugerties police. Although there is no town policy in place on how to handle situations such as these, town supervisor Greg Helsmoortel says his suggestion would be for residents to do just that: call the police. Chief Sinagra confirms that residents often alert the department that someone has suffered a mental break or a lapse. What happens from there, Sinagra says, depends on a number of factors. A person who has harmed himself or others is placed under arrest. During intake, the officers determine whether this behavior is out of character for the perpetrator. If the police think that he or she has lapsed on taking medications or perhaps needs an adjustment to medications, the police will transport the person to the hospital. There, they will receive a mental health evaluation and devise a safety plan for adjusting or ensuring remaining on the correct dosage of medication. Last year, Sinagra said, Saugerties had 96 mental health transports. Saugerties may be unique in the area in that the police department transports these citizens in a police vehicle. In most localities, an ambulance is dispatched to transport. However, after paramedics employed by Diaz Ambulance Services were injured by a mentally unstable person a year and a half ago, the new policy was put into place. Only police personnel and vehicles can be used for mental health transfers now. The year before this policy was initiated, the department assisted in only a dozen such transfers. Sinagra sees additional benefits to this town policy. For one thing, it eliminates the possibility that an ambulance a resident with a serious medical emergency would otherwise have used has been taken out of service for a mental health transport. A mentally ill person taken to the hospital might stay there a few days, and then be turned away, most of the time for financial reasons. Often, these folks end up back onto the streets again, where there is no one there to ensure that they are taking their medication or acting rationally. As Sinagra puts it with a sigh, “The cycle begins again.” He says he receives calls for the same people repeatedly. His officers watch behaviors deteriorate until once again a physical crime is committed. The Saugerties chief concedes that it’s frustrating to watch the same scenario play out time and time again. But “my hands are tied,” he explains. He puts the department at potential risk of liability for intervening too early. Sinagra knows there is a better way. When he worked as a paramedic in the 1980s, he said, he and his team would transport people directly to the county’s office of mental health services for help. Now, he says, it is his department who most often must deal with this population. Although police officers have some training with

As the county seat, Kingston has long been a magnet for those drawn by social services. From its schools to such private entities as Mental Health Associates, the city works to meet and surpass its challenges.


October 23, 2014 Healthy Body & Mind mental health issues, such as how to talk someone down from a harmful act or how to physically restrain someone, Sinagra stresses that they are not mental health experts. The mentally ill are not criminals, he says, and they shouldn’t be in the criminal justice system. According to him, funding needs to be restored to mental health services, something which could, he says, prevent some problems before they arise. Sinagra tells of an incident in which his department had to issue an order of protection against a mentally ill man who had defecated on the floor of a church. The man’s parents told him they had tried for years to get him help, but had been met with obstacles at every turn. Sinagra says it is as though we have “washed our hands as a society” of the mentally ill.

or many teenagers, opening up about their feelings can sometimes be weighed down with shame or embarrassment. One Kingston High School junior is hoping that by opening up a dialogue on the topic, other students will feel more comfortable discussing and addressing mental illness. “I’ve suffered from anxiety my entire life,” said Natalie Browning, a member of the girls’ varsity swim team, student government, the Spanish Honor Society, Math Team and Pillow Fight for Cancer. Diagnosed with an anxiety disorder at the age of nine, Browning had a difficult time feeling like she belonged in middle school until she began opening up about her struggles to friends. After hearing about Bring Change 2 Mind, a non-profit initiative for mental health advocacy involving actress Glenn Close, Browning decided to bring that spirit into Kingston High. With assistance from school social worker Amy Kapes and English teacher Christina Krzywonos, she began creating PSA’s to be shown on KHS-TV to bring awareness to the student body. “Mental illness is so common, and I think a lot of people don’t realize it because it’s not spoken about and it wasn’t until I came to high school that I realized that there were other people my age who struggled with it, and a lot of people who were ashamed of it,” said Browning in a PSA. “And I’ve decided not to be ashamed of my disorder. So I really wanted to bring awareness to that and who even people who don’t struggle through mental illness that it is the kid sitting next to you in class, your best friend or the kid you play soccer with, and that you should be supportive of everybody and be aware of the words you use and the things you say.” Kingston schools superintendent Paul Padalino said that hearing about mental health issues from a classmate may get the point across better even with all the resources the high school can offer students.

“Students will sometimes listen to another student more than they’ll listen to an adult,” said Padalino. “Knowing that they’re not alone, it’s good for other people her age to know. They’re not the only people struggling, and there are people they can go and speak to. Some kids haven’t even identified things that are issues for them, but when they hear from one of their peers who says, ‘This is what I’m going through,’ they might say, ‘That’s me.’” Paladino added that he’s thankful for Browning’s work, and also for the many other partnerships that helps his large district stay ahead of the sorts of mental health issues the nation seems to return to on a national basis via reoccurring tragedies. He noted, as an example, how Mental Health Association of Ulster County provides services and educational opportunities for elementary school children throughout the Kingston school district. Their work is augmented by that of so many others. “We have a lot of community resources in our buildings, and all that helps us in our overall goal, to meet the needs of our students,” said Padalino, also pointing to partnerships with Children’s Home of Kingston, the Family Health Institute, and Family of Woodstock, the last being integral to the Student Success Center at the high school. “We can’t do that alone.” The school district also employs School Resource Officers in the middle schools and high school through partnerships with the police departments of Ulster and Kingston. “Their value cannot be understated,” said Padalino. “Their being here is helpful in so many ways. People think they’re policemen walking around dealing with safety issues, and they do that. But they also deal with other issues. They work on many different things with our students and families.” For the school district, Padalino said, it’s about more than simply ensuring a student gets good grades, something with which not everyone in the community agrees. “A lot of people don’t think it’s the school’s responsibility to deal with some of these issues, that our job is A-B-Cs and 1-2-3s,” he said. “But my philosophy is that it is our job to deal with every aspect of a student, and if we can provide services here or help a student here, whether it’s mental health or physical well-being, we should do it. We have the students here, they’re our responsibility and we care about them, and not only to have them be academically successful, but also to make sure that they are well-rounded and getting everything that they need.” The district works hard to achieve that balance, said Padalino. “We take a multiple-path approach,” he explained. “We have school psychologists and have social workers in every building. Sometimes its roots are in the family, and being able to engage the entire family in conversations is sometimes the way to do it.” He reiterated how important an added effort such as Browning’s mental health awareness activities can be, in the greater picture. “It’s great,” he said. “She was really adamant about getting that word out. It changed her life, and she wanted

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to be able to help others.” The county Mental Health Association is integral to mental health care in the school district. “Being in Kingston and the Town of Ulster is very important to us,” said Ellen Pendegar, CEO of Mental Health Association in Ulster County, primarily based on Aaron Court in Kingston. “We find that location is extremely valuable in that people who have had mental health issues over a period of time in their life often do not have a lot of financial resources, so they don’t always have reliable transportation. A great number of people can get to that site, and from there we can provide services to people with limited income. At the same time, we also provide community support groups for anybody in the community, and it’s a well-known spot in the City of Kingston that anybody can get to.” The MHA began as a not-for-profit organization in 1959 with the goal of promoting mental health issues and working to ensure improved resources were available for people with mental illness. Focusing on adults, children and families, MHA offers residential services, mental health education, rehabilitation, therapeutic foster care, support groups, and community initiatives like the Youth Booth in the Hudson Valley Mall. As is true of many community-based services, MHA doesn’t go it alone. “We work very much with law enforcement in both the city and the town, and we have very good relationships with them,” said Pendegar. “In fact, we gave the Town of Ulster an award for their professionalism and the dignity they’ve always treated us and our residents.” Some off-duty officers from the Town of Ulster work with MHA in a security capacity at residences operated by the organization, primarily to ensure the safety of the residents. This closeness allows police officers the chance to get to know some of the people in the community with mental health issues in an environment less potentially chaotic than they might otherwise experience. When the police have seen people who’ve dealt with mental health issues over the course of their lives, when they are called at times it’s usually when people are in crisis and don’t have the opportunity to see the person as a whole person, said Pendegar. “Being around in our facility, it’s a win-win on both sides, and we feel it’s for the best for the community.” Family of Woodstock walk-in centers are at 16 Rock City Road in Woodstock, 51 North Chestnut Street in New Paltz, and 221 Canal Street in Ellenville. The hotline can be reached at 679-2485 or 338-2370. For information on other local resources, see http://familyofwoodstockinc.org. For Mental Health Association of Ulster County call 3399090. For Ulster County Mental Health call 3404100 from 9 to 5 on weekdays.


23, 2014 18 | October Healthy Body & Mind

PHOTOS BY LISA CARROLL

Medicine cabinet A mother’s guide to surviving colds, coughs and drips By Lisa Carroll

T

here is a lot I can handle on the sickbed front. I can hold my children’s hair back as they vomit. Sometimes they make it to the provided receptacle and sometimes they miss. I can manage poop with the best of them — explaining why it comes in so many shapes, forms and colors as though I were discussing fine art. I can fend off high fevers with a mixture of Tylenol and TV time. On a whole, my two kids and their vast sniffles, coughs and bugs have fazed me little. I can attribute that to my parents, both nurses. As children, my brother and I saw very little of the doctor’s office. Beyond my parents’ mantra of “whatever doesn’t kill you only makes you stronger,” they were well-versed on the ways of curing

common colds, stomach bugs and everything in between. I remember time on the sick couch — we weren’t allowed to stay in bed — with a glass of ginger ale at my side. Cartoon characters danced in my head as I would slip into and out of sleep. Within a day or two, my parents’ regimen would work wonders, and I would be trotting off to school again. So, it’s no wonder that four-year-old Shelby and two-year old Sammie have seen little of their pediatrician aside from necessary vaccines and wellness visits. We’ve been blessed with very few illnesses, aside from Sammie’s odd bug-bite reactions that leave her body in a rash. But as healthy as my kids tend to be, they are not immune to the many sniffles and bugs that surround them — especially going into the fall season, and Shelby’s first year in school. There have already been the telltale signs of a good cold season brewing ahead of us. I can see it in the faces of my children. Sammie often employs the snot-salute, wiping her nose directly across her check. When caked with sandbox sand, she looks like she’s prepared for a game of mighty-

mite football. And Shelby — since she knows how to use a tissue — employs the high-pitched nasal whine to signal a need for Tylenol, and a nap, STAT. Within the first few weeks of Pre-k, she has already needed one sick day, which prompted me to stockpile the necessities for this cold season. My husband and I are not big believers in medicine. We store very little in the house — mostly out of fear that one of our children would think it was candy despite the fact that any medicine we do keep, we keep well out of reach. Plus, we usually consult grandma, our go-toperson for any medical problems for her sage wisdom, which nine times out of ten stems from common sense and experience rather than medical textbooks. To many, my medicine cabinet must look pretty sparse. I have a thermometer. Two, in fact, a digital thermometer that serves the family (armpits for kids, mouths for adults) —and yes, it’s washed often — and a temple-reading thermometer that I don’t quite trust. When the kids are a little older and can abide by temperature-taking rules like


October 23, 2014 Healthy Body & Mind not talking with it in their mouths or chewing on it, I’ll upgrade. And, I’ve got acetaminophen — Tylenol, in name brand lingo. Shelby will take the grapeflavored medicine like a champ. Sammie on the other hand requires restraint or bribery. That sums up my kid-medicine cabinet, aside from various-shaped bandages strewn around which seem to do well band-aiding both real and imaginary wounds. But don’t let the lack of cabinet fillers fool you. I take a full-on approach to kicking bugs’ butts. When either kid, or both as it seems to happen mostly, are too sick for bed they are directed to the couch. They are lavished with attention — one reason why I think they don’t mind being sick — and given plenty of fluids. We start with ginger ale, the ginger calming an upset tummy. I dole out ginger ale regardless of the symptoms, whether I’m dealing with a head cold or a stomach bug. For sniffles, running noises and all things snotrelated, we use lots of pillows to keep their heads up and have a stock pile of tissues at the ready. When the kids were younger, we used that rubber bulb-syringe hospitals give out as baby-delivering gift favors. They’re gross but effective. We also would fold a beach towel and stick it under the head of the crib mattress to get their little heads higher. If it’s stomach related — and frequent bathroom visits or diaper changes ensue — we enforce the BRAT diet: bananas, rice, applesauce and toast. Once the ginger ale goes down and stays in, we move on to one of the BRAT items, subsequently adding from the list until the kids get better or something comes back out. When fevers get high or they’re just too uncomfortable, I dole out meds. I put a movie on and let them snuggle under their favorite blankets with a

| 19

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The treatment of chemical dependency requires physical, mental and spiritual rehabilitation, with the goal of restoring addicted persons to a meaningful, productive life.

The treatment program is multidisciplinary in scope and individualized in approach. Our inpatient programs consist of detoxification, assessment, rehabilitation, and family support.

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Serving Ulster and Surrounding Counties With:

In a world of uncertainty, sometimes all we need is a gentle hand to guide us...

gentle yoga, cory, 10-11:30 yoga level I-II, kate hagerman, 6-7:30

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23, 2014 20 | October Healthy Body & Mind

Better emergency preparedness Red Cross community event demonstrates new resilience aims

I

t’s not every political season that governmental health preparedness becomes a key campaign issue. In Kingston on October 18, the American Red Cross hosted a Community Emergency Preparedness Event at Alcoa Fastening Systems in tandem with the county Office of Emergency Management and the U.S. Department of Homeland Security. The idea was to not only train involved emergency response workers in the Red Cross’ new “Building Resilience” push, inaugurated in the postKatrina years, but also to celebrate the various ways that preparedness and coordination efforts work. “Ulster County is a great example of the ‘whole

community approach’ to disaster preparedness and response,” said Michael Raphael, disaster program manager for the American Red Cross in the region. “Over the past year, many community partners have come together to address local emergency issues, and we are pleased to be working in partnership with Alcoa to continue this important work in the county.” The day-long forum and open house recognized established programs with a focus on available community services and county-wide volunteering opportunities. Speakers included Richard French of the Office of Emergency Management and the Department of Homeland Security; Ulster County emergency man-

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ager Steve Peterson, and Raphael. Information booths focused on local aid organizations, citizen CPR, fire safety awareness, “Masters of Disaster” children’s activities, and a blood drive, with free food and music. Raphael has also been named lead for health services and mental health services throughout all 17 counties in the northeastern New York region two years ago after coming to the region from the Project Hope disaster mental-health program funded by FEMA following Hurricane Irene and a career of community outreach, project management and conflict resolution work with governmental and non-governmental agencies in Eastern Europe, Central Asia and the Middle East. “My goal is to be as efficient and responsive as I possibly can,” said Raphael, “to meet the needs of the community during times of disasters.”

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