Moderator: Jane Tobler
December 7, 2010
2:00 pm CT

Coordinator: Welcome and thank you for standing by.

At this time all participants are in a listen only mode until the question and answer session.

Today’s conference is being recorded. If you have any objection you may disconnect at this time.

The PowerPoint presentation, PDF version, the audio recording of the teleconference and a written transcript will be posted to the SAMHSA 10x10 Campaign web site at http://www.10x10.samhsa.gov.

Our presentation today will take place during the first hour and will be followed by a 30 minute question-and-answer session at which time you may press star 1 to ask a question.

I would now like to turn the call over to Jane Tobler. Thank you. You may begin.

Jane Tobler: Hello and welcome to Prevention and Holistic Approaches to Wellness, a Fresh Perspective on Mental Health Recovery.

Today’s teleconference is sponsored by the Substance Abuse and Mental Health Services Administration 10x10 Wellness campaign.

SAMHSA is the leading federal agency on mental health and substance abuse and is located in the U.S. Department of Health and Human Services.

Through an interagency agreement, SAMHSA is privileged to partner in this effort with the U.S. Food and Drug Administration Office of Women’s Health.

The views expressed in this teleconference do not necessarily represent the views, policies and positions of the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration, the U.S. Food and Drug Administration or the U.S. Department of Health and Human Services.

As the Operator has said today’s conference is being recorded and archived. And at the end of the presentation there’ll be a question-and-answer session.

Today we are joined by three people with extensive experience and knowledge about various prevention and holistic approaches to wellness.

Our first presenter is Prachi Patel. She’s the Public Affairs Specialist at the National Center for Complementary and Alternative Medicines or NCCAM at the National Institutes of Health. Prachi’s work includes creating educational awareness campaigns, managing NCCAM exhibits, and speaking at organizations about complementary and alternative medicine practices in the context of rigorous science.

Prachi will now give us an overview of complementary and alternative medicine. Prachi.

Prachi Patel: Hello. Good afternoon. My name is Prachi Patel. And I’m from the National Center for Complementary and Alternative Medicine or NCCAM at the National Institutes of Health. Thank you so much for joining today’s webinar.

I’m going to start today by giving you an overview of NCCAM and NIH and then briefly discuss complementary and alternative medicine statistics on use and costs.

And then we’ll go into NCCAM’s research portfolio and at this time I’ll provide specific examples of different clinical trials as related to today’s webinar on prevention and holistic approaches.

So let’s begin with just a little bit of background on the National Institutes of Health or NIH. NIH is the largest supporter of biomedical research in the world. It’s actually comprised of 27 different institutes and centers including NCCAM. We are part of the federal government and employ about 25,000 people. In total the organization invests about $31 billion in research throughout the world.

Now before we take a look at the specific role of NCCAM I just want to take a moment to define complementary and alternative medicine also known as CAM. CAM includes medical and healthcare practices that tend to fall outside the realm of conventional medicine. These are practices that have yet to be validated by scientific methods.

Complementary refers to practices that are used in conjunction with conventional medicine.

So for example a cancer patient who is getting chemotherapy may also schedule acupuncture treatments to help with the side effects of their cancer treatments.

Alternative means that therapies are used in place of conventional medicine. So for example a person may opt to use magnets for pain rather than turning to aspirin or a prescription pain medication.

So that’s essentially the definition of CAM in a nutshell. And from here we’ll go on to see what the mission of the National Center of Complementary and Alternative Medicine is. I think by understanding the mission of NCCAM you’ll be able to better grasp what we do at the organization and why we do it.

NCCAM was established just over ten years ago when Congress noted an upward trend in CAM usage among the American public. And they felt that the NIH ought to be funding more research to learn whether the therapies are safe and effective.

And this brings us in the first part of our three prong mission and that’s essentially to explore CAM practices using rigorous scientific methods and to develop the evidence base for safety and efficacy of CAM approaches.

This is a good time to point out that NCCAM like the rest of NIH is solely focused on research. And we are not involved in regulation.

The second part of the mission is to train researchers. This includes enticing conventional researchers to apply their expertise to the CAM research field as well as training researchers who are already CAM practitioners.

Finally we strive to be an authoritative source of credible information for health professionals and the public alike so that you may all make informed decisions about your healthcare.

And that is essentially what I’m here today to talk to you about. Now let’s take a quick look at different CAM statistics mainly who’s using it, what they’re using and why they’re using it.

In 2007 NCCAM partnered with the Centers for Disease Control and Prevention to conduct a supplement to the National Health Interview Survey, NHIS. This survey is an annual in-person survey of Americans regarding their health and illness related experiences. The CAM Section gathered information on more than 23,000 adults.

And today I’m just going to share with you some key data that was derived from that survey. As we can see from this slide approximately 40% of the American public uses some form of CAM. It’s widespread among all demographic groups but women do tend to use it more than men and geographically populations in the West and Midwest tend to use it more than those in the Northeast and the South.

CAM use is greater among people with higher education levels. And as far as cost goes CAM is largely paid for out-of-pocket. It accounts for about $34 billion or almost 1.5% of total healthcare expenditure.

So now that we definitely know that people are using CAM let’s quickly take a look at some of the—the main practices.

So as we can see from this list there’s non-vitamin, non-mineral, and natural products, there’s meditation and massage therapy, yoga, among many other things.

And we realize that people are using CAM and there’s a number of things that people use it for but the question for why people turn to CAM remains. Main reasons include to promote general health and wellbeing, to treat specific health conditions, and from the NHIS study I mentioned earlier the primary specific conditions include head pain, neck pain, back pain, chronic pain, anxiety and much more. And finally people turn to CAM to use it as an adjunct to conventional care.

So this is essentially an overview of CAM practices and from here we’re going to go on to take a look at the specific things that are studied at the National Center for Complementary and Alternative Medicine.

We’ll focus on three main areas including natural products, manipulative and body-based practices and mind-body medicine.

Natural products include vitamins and minerals as well as herbal products and supplements. Again from the NHIS study we found that the most commonly used forms of natural products include fish oil and Omega-3 fatty acids, glucosamine, Echinacea, ginseng, Gingko and even garlic.

So from here let’s take a look at two specific clinical trials involving natural products. The first is on St. John’s Wort and the second one will be on Gingko.

This study, specifically on St. John’s Wort and its effects on major depression, according to the National Institute of Mental Health mental depression affects about 10 million American adults age 18 and older in any given year. And this is the leading cause of disability in the United States.

Extracts from the herb St. John’s Wort are used in many countries especially Germany to treat depression. However the results from these clinical trials have been contradictory. And the effectiveness of St. John’s Wort for depression is still a bit questionable. Additionally major depression is often treated with antidepressant drugs which thus far have shown to only have modest effects over placebo in clinical trials.

So NCCAM teamed up with the National Institute of Mental Health and the Office of Dietary Supplements all components of the NIH in response to this growing use of St. John’s Wort especially in the United States.

This is a randomized double-blind clinical trial which compared the use of a standardized extract of St. John’s Wort to placebo for treating major depression of moderate severity. The trial also did compare an FDA-approved antidepressant drug to placebo as a way to measure how sensitive the trial itself was to detecting antidepressant effects.

This is a multisite trial and it involves more than 340 participants.

So as you can see from the slide the findings did not support the use of St. John’s Wort for major depression of moderate severity. And that without clear evidence of efficacy people should not substitute St. John’s Wort for standard clinical care of their condition.

But I would like you all to keep in mind that these results are still useful because when building an evidence base for safety and efficacy it’s important to know what does work but it is equally important to know what does not work.

And this is something you’ll see again as we move onto the next natural product trial on Ginkgo Biloba, approximately one-third to one-half of Americans over the age of 85 have some kind of dementia. Further Ginkgo is widely marketed and already being used to improve cognitive health in aging populations.

So this trial was essentially designed to determine whether Ginkgo Biloba slows the rate of cognitive decline in older adults. Trial participants were randomized into two groups, the Ginkgo group or the placebo group.

All participants either had normal cognition or mild cognitive impairment. It’s important to note at this point that people who did suffer from full onset dementia were excluded from participating.

The more than 3000 participants between the ages of 72 and 96 years old were assigned to receive two daily doses of either 120 mgs. of Ginkgo extract or an identical appearing placebo.

So again, as you look at this slide and see from the results Gingko compared to placebo showed no result in decreasing cognitive decline. Now this study like the previous one on St. John’s Wort did not show efficacy in the treatment. However as I mentioned earlier Ginkgo is one of the top ten natural products used by Americans.

And so this reminds us that it is still important to conduct these studies and to build the scientific evidence base regarding not only botanical supplements but also other treatments and doing this through rigorous research because people are clearly still using these treatments and therapies.

This concludes our look at natural product research. And we’re now just going to quickly move onto manipulative and body-based practices.

Manipulative and body-based practices including massage therapy and chiropractic care focus primarily on structures and systems of the body including the bones and joints, soft tissues and circulatory and lymphatic systems.

Today I’m actually going to specifically focus on massage therapy. It dates back thousands of years and includes different types of massage ranging from shiatsu and deep tissue to Swedish and trigger points. While there are different types of massage therapy they all involve manipulating muscles and other soft tissue. People turn to massage therapy for treating specific illnesses as well as just for general wellness.

So there’s one specific research trial we’ll discuss today. And that involves massage therapy in advanced cancer. People with advanced cancer often experience pain that causes physical and emotional distress which leads to a decrease in functional ability and quality of life.

There are already smaller studies that suggest that massage therapies may benefit people with advanced cancer. In this particular study researchers investigated the benefits of massage therapy versus simple touch therapy. And this basically refers to placing both hands on a specific site of the body.

This was a multisite study conducted at 15 hospices across the country. It included almost 400 participants with advanced cancer who were experiencing moderate to severe pain.

The participants were randomly assigned to receive six 30 minute treatment sessions of either massage or simple touch therapy over a two week period.

As the results on the slide in front of you show, both groups experienced statistically significant improvements in pain relief, physical and emotional distress and the quality of life.

However immediate improvement in pain and mood was greater with massage therapy over simple touch. It’s important also to note that the sustained effects of these therapies were not observed in this particular trial.

Researchers concluded that massage therapy may in fact provide some immediate relief for patients with advanced cancer. They did go on to suggest that simple touch therapy which can be provided by family members, caregivers or even volunteers may benefit these patients.

So now we finished discussing natural products and manipulative and body-based processes. I’m actually going to finish the research section of my discussion with mind-body medicine.

Mind-body medicine focuses on techniques which enhance an individual’s capacity for self knowledge and self care. And focus on the interactions among the brain, the mind, body and behavior with the overall intent of promoting health and wellness.

Techniques include but are not limited to meditation, yoga and Tai Chi.

The first trial I’ll discuss today is on long term yoga and women’s stress. Yoga combines physical postures, breathing techniques and meditation or relaxation.

In this particular trial researchers enrolled 50 women, 25 of them were identified as yoga experts, which meant they practiced yoga regularly once or twice a week for at least two years.

The other half of the participants were novices who participated in yoga classes or did at home yoga practice with videos for maybe 6 to 12 sessions.

The type of yoga they practiced in this trial is called Hatha Yoga. Hatha Yoga is the most commonly practiced form in the United States and it incorporates body postures, breath control and meditation.

The researchers assessed participant’s cardiovascular, inflammatory and endocrine responses before and after they took part in three different activities; yoga practice, slowly walking on a treadmill and passively watching the video.

They also measured participant’s psychological responses before and after certain stress events.

So the differences in inflammatory and endocrine responses were not unique to the yoga session but that was the case for cardiovascular differences.

Researchers found that the novice’s blood had 41% higher levels of a stress-related compound called IL6. IL6 is thought to play a role in certain conditions such as cardiovascular disease and Type 2 Diabetes.

In addition the novice’s levels of C-reactive protein which serves as a general marker for inflammation were nearly five times that of the yoga expert. Furthermore the yoga experts also have lower heart rates in response to stress events than the novices.

But overall regardless of novice or expert participants yoga was found to boost mood while the other two interventions, walking on a treadmill and watching a video did not.

Overall results show that women who practice Hatha Yoga regularly recover from stress faster than women who are considered yoga novices.

Researchers suggested that this study offers insight into how yoga may affect health. And they did say that performing yoga regularly may have health benefits but these benefits may only become evident after years of practice.

So the second technique, mind-body technique that we’ll discuss today is looking at the health benefits of Tai Chi and Qi Gong. Tai Chi and Qi Gong have origins in China and involve physical movement, mental focus and deep breathing. And because of these apparent similarities, researchers reviewed literature that I’m about to present to you on both practices together.

So researchers from the Institute of Integral Qi Gong and Tai Chi out of California, the Arizona State University and the University of North Carolina came together to analyze the results of 66 randomized controlled trials.

So as you would imagine with more than 6000 participants that were looked at there were many outcomes identified. But the most important was that the research suggests that the strongest and most consistent evidence of health benefits for Tai Chi or Qi Gong is for bone health, for cardio pulmonary fitness, for balance and factors associated with prevention falls and for overall quality of life.

From this review the literature of review itself reviewers concluded that the evidence is sufficient to suggest that Tai Chi and Qi Gong are viable alternatives to conventional forms of exercise.

Now this concludes the research portion of this presentation. And this is obviously just a small sampling of the clinical trials and the research results that NCCAM has to share. So I do encourage you all to visit our web site at nccam.nih.gov. And to obtain more information either about the topics that were discussed today or ones that may meet your own specific interest.

And as you can see from this resources slide in addition to just the informative videos that we have online there’s also an A to Z listing of different therapies and conditions like the ones discussed today each of which have correlating fact sheets and backgrounders and links to a database of research results.

And on the web site you’ll also be able to find consumer friendly information on topics ranging from finding a CAM practitioner to paying for CAM treatment.

Again all of those can be accessed online or you can contact our clearinghouse at the toll-free number that you see on the screen.

NCCAM has electronic newsletters that you can sign up for as well as monthly research lectures that can be watched live online.

And again this is just a small amount of information but you’re certainly welcome to visit our web site to obtain more.

A few other resources that you can access include the Conklin Collaboration, CAM on PubMed and the International Bibliographic Information on Dietary Supplements.

As I conclude the presentation I just want to thank you all again for joining the webinar. And I do want to extend my thanks to SAMHSA for creating this platform with which NCCAM has had the opportunity to disseminate tangible information on complementary and alternative medicine.

Thank you.

Jane Tobler: Thank you Prachi for that important overview of complementary and alternative medicine.

Our next presenter is Ken Jue, Senior Executive of Monadnock Family Services in Keene, New Hampshire. He founded In SHAPE, a motivational health promotion and physical fitness program for adults with serious mental illness.

Ken has received numerous accolades throughout his career and the In SHAPE Program in particular received the 2008 Excellence and Innovation Award by the National Council for Community Behavioral Healthcare.

Ken joins us today to talk about key contributive factors to positive health status. Welcome Ken.

Ken Jue: Thank you very much Jane. What I wanted to do is rather than spend a great deal of time specifically on each of the slides is you’ll have those and you’ll be able to access them but what I would like to do is to really focus on the points, the key points I wanted to make.

Before I go any further I also wanted to thank SAMHSA for an opportunity to be able to talk with you all about wellness and how we’re doing with our program with In SHAPE.

I think you’re all well aware of the lifespan crisis that individuals with serious mental illness are experiencing. And I think that, you know, that there’s - we should feel compelled to act on this given the fact that the lifespan is - differences is so dramatic. And that we should feel I think for moral obligation to act.

And more recently we did have a consumer who died. And this was just about a month ago. And she was only 40 years old. And she died of a heart attack.

Now this was an individual that was really working extremely hard to—to create a life for her self and was moving forward with many aspects of her life. She had a college degree and was a math whiz. And so one of the things that she did was she found herself a job at a local college where she was a math tutor to college students.

And this was a paid position. She as a volunteer tutored high school students and she also more recently was the Chair of the Board of Directors of the local - of one of our local peer support agencies.

So here was a person who was striving to create a niche for herself in the community to fulfill her roles as a family member, as a citizen and yet she was - fell victim to the - one of the more critical comorbid conditions that so many of our - of consumers are experiencing.

The point I want to make is that wellness does work if one can get engaged in it and if - depending upon perhaps how we structure and provide wellness programming can move from an illness paradigm to a health paradigm. And that what wellness will do it helps us go beyond just simply keeping people out of the hospital.

Now some of the more critical factors that contribute to health I think are well-known to all of us. And I just think that if we think about it we can figure out a way to implement these kinds of factors. Physical activity for example and fitness is a very important contributing factor to health. Healthy eating which is something that is a real challenge for many of our consumers.

And the concept and issue of social inclusion which I will come back to and I’d like - because I’d like to say a little bit more about this and I will also later on, is a critical health contributory factor.

Recovery principles such as control of one’s own life where we’re certainly finding out in our programming that control is - adds considerable amount of degree of confidence and hope and motivation for people.

And then a highly obvious contributing factor to health of course is access to quality healthcare.

In terms of the healthcare issue and access to it, recently one of our In SHAPE Program participants and one of - and another—another agency that has adopted the program went to see a physician for the first time I believe it was probably in 10 to 12 years. And was very anxious about going to see the physician and went with the In SHAPE staff member.

And in the meeting the physician simply said to the individual well you’re just incredibly obese and you really need to do something about this and take this program that you just signed into seriously, and then left the office.

To say the least the In SHAPE staff member had quite a bit of work on her hands to try to help the participant with the - with how upset she was with that exchange in that healthcare experience.

So we have a long way to go in building this in as a contributing health factor to our own programming.

Now I said I’d come back to social inclusion. The European Union has done studies among their countries and they have reached the conclusion that a social exclusion or discrimination of people with disabilities for example and others where people are marginalized has and does continue to cost their various societies anywhere from 2 to 5% of their gross national product.

So they can quantify that. And being able to do that they then developed templates for national social inclusion policies and strategies and countries now within the European Union are beginning to adopt these policies and adapt the templates for strategies to their own societies.

And actually England which is not a member of the European Union was the first country to establish a center for social inclusion.

And it’s - and of course where they placed that national center on social inclusion was in their National Office of Health.

And the other - another aspect of social inclusion has to do with belonging. The concept of belonging is a healing process that helps people become members of their societies and can lead people to productive lives.

Now what we have done in taking these health factors we at my organization in 2003 created a pilot project called In SHAPE. What our ultimate aim is to really reduce that lifespan or eliminate that lifespan disparity.

And the components, the essential components of the In SHAPE Program include the physical fitness, healthy eating, smoking cessation, social inclusion strategies, implementation of recovery principles for example such as a person centered approach where each participant and we have 150 participants at any given time set their own goals and plans. They self manage them. And they control their own In SHAPE plans.

We use strategies of community engagement to create partnerships and I will expand more on that as well.

And we have an integration of health and mental health initiative within the In SHAPE project and the people who carry out the In SHAPE Program really are staff who are all certified as personal trainers.

And just to give you a sense of the flavor of how well wellness can work for people and for people with serious mental illnesses, I’ll give you a few stories about some of the participants.

Joanne is someone that had been suffering from serious major depression for decades. And she lived in a small apartment, was isolated and kept her shades drawn 24 hours a day. And eventually what - once we established this program her Case Manager was able to convince her to come out and at least take a look at In SHAPE and what it might do for her.

And since that time, 2003 was when Joanne joined. She joined our pilot project. She has participated in In SHAPE on an on and off basis. And on and off mainly because of significant physical issues that she has experienced which has required several major surgeries. But each time that Joanne had a major surgery she rejoined In SHAPE as soon as she could and included it in her recovery plan.

And something - the other things that Joanne has done for herself is she has become a volunteer, regular volunteer at the local hospital to visit patients particularly elderly patients and she also volunteers and tutors students at an elementary school and she recently did a - participated in a video for the local United Way Campaign.

And one of the more touching things that has happened for Joanne is that one of our service clubs in town, one of the rotary clubs awarded her an award that is normally reserved for rotary club members only.

And there was a ceremony that the club invited her to where they gave her the award.

Now Joanne’s life has changed. And she is an avid participant in her own wellness activities.

Luke is another participant who’s 38. Joanne was about 62. Luke is 38. Has a diagnosis of schizophrenia, was about 70 pounds overweight, smoked three packs a day, drank three liters of Coke every other day and had a terrible diet.

When Luke joined the - he decided to join the program about a year and a half ago and what Luke now does is he climbs Mt. Monadnock at least once a week, sometimes he’s able to do it twice a week. And able is only because of time because Luke has created a very busy life for himself.

He no longer smokes the cigarettes. He no longer drinks the liters of Coke. He drinks water. He’s steadily changing and improving his diet. He’s lost all that weight. And he found himself a job working behind a deli counter at one of the supermarkets where he interacts with people in fulfilling their orders.

And I asked Luke. I said, “Luke doesn’t-doesn’t your mental illness present a problem for you in terms of the voices that you’ve complained about for so many years and how it affects you?”

And he said basically that he now controls his life and those voices are his to manage and he says he does fine with them.

So those are two examples. There are others. And wellness also the other point I want to make beyond the issue of the obligation to deal with a lifespan crisis that wellness works is that wellness programming also can serve as a vehicle for mental health and community systems change.

And strategies that one can use to do that is through creating new partnerships so that what we can do as mental health providers is leverage the many other resources out there in the community. The In SHAPE Program itself is a project that had seven or eight funding partners including the Robert Wood Johnson Foundation and eight project partners. And we continue to have partners seven years later.

And there are other partnerships that we can engage in that would enhance other areas of community issues of community engagement and social inclusion that can bring in sort of the unusual and not the traditional partnerships that move the responsibility of dealing with issues regarding mental health and mental illness to a level of community organizations and the community a large taking responsibility.

I think that if we can engage our communities adequately and appropriately that that is one of the most important sustainability factors for our organizations.

And it would be important for us to think of the larger community really as the community mental health system.

So with that I think I’ll conclude for now and hopefully we’ll get a chance to talk more with question and answers.

Thank you very much.

Jane Tobler: Thanks Ken for those insights into the social determinants of health and wellness paradigm and challenges.

Our final presenter today is Sherry Jenkins Tucker, Executive Director of the Georgia Mental Health Consumer Network.

In addition to her extensive experience with the Consumer Survivor Movement Sherry who is a self-identified consumer of mental health services has a strong background with WRAP facilitation, leadership academy training, peer workforce development, advocacy and mind/body/spirit wellness.

She is a Certified Peer Specialist and holds the credentials of ITE for I’m the Evidence that Recovery Works.

Sherry will provide a spotlight on her Peer Wellness Initiative in Georgia.

Welcome Sherry.

Sherry Jenkins Tucker: Thank you so much for inviting me to be with you all today. It’s really such a pleasure to talk about our work and this wellness initiative that’s so important to all of us.

I wanted to first start to talk with you about our Peer Support and Wellness Center. It is coming up on its third birthday. We were able to create the Peer Support and Wellness Center through a contract with the State of Georgia and it’s a—an alternative to traditional psychiatric hospitalization for people.

It’s a trauma informed environment. It’s run by Certified Peer Specialists. It focuses on self-directed mind/body/spirit wellness and our motto is we are about wellness not illness.

I had the good fortune to go to New Hampshire a few years ago and actually visit Ken Jue and his In SHAPE Program and so we got to borrow some of the ideas that Ken created in his In SHAPE Program to bring to bear at the Peer Support and Wellness Center particularly with our daily wellness activities.

At the Peer Support and Wellness Center we have three respite beds that people can access for up to seven nights and to access them they do a proactive interview which is basically about creating a relationship and understanding what people need when they need 24/7 peer support. We have daily wellness activities some of which we have actually in the house at the Peer Support and Wellness Center.

And you can see the house there on the screen. And it’s in a lovely neighborhood. It blends in with every other house. It’s in a little wooded patch in the neighborhood and it’s got four bedrooms, three baths, three floors and we have room for activities as well as an office for the staff to do their paperwork and so on and then the respite beds and then we also have one of our CPS who actually lives in the house.

We also have a 24/7 warm line that is statewide. It’s run by the Certified Peer Specialist. And people can call who need peer support over the telephone.

We have a trained peer workforce in the form of our Certified Peer Specialist and our model is an intentional peer support model. And with the intentional peer support model we actually create a relationship that is focused on getting to understand a person’s world view.

And we’re—we support people with moving forward on the recovery journeys. With our daily wellness activities we have many of our activities outside of the Peer Support and Wellness Center in the community.

And we got the idea from the In SHAPE Program to work with supporting people with engaging and reengaging with their communities from a wellness orientation so instead of creating a little mini mental health center run by peers we’re creating a conduit to the community for people.

The - another one of our programs that is related to wellness is our Statewide Peer Wellness Initiative. We’ve been very lucky over the years to receive funding from SAMHSA Center for Mental Health Services in the form of the Statewide Consumer Networking Grants.

And our Statewide Peer Wellness Initiative was funded through a Statewide Consumer Networking Grant. And we focused on mind/body/spirit wellness training. We offered this training to peers including Certified Peer Specialists across the state and we engage with people around developing wellness plans.

We started out the Statewide Peer Wellness Initiative Training by inviting peers to sign onto SAMHSA’s 10x10 Campaign. I’m sure that you all or many of you are familiar with that and it’s basically about decreasing the early mortality of consumers of mental health services that is currently at 25 years earlier than the general population, decrease that by 10 years within 10 years.

And I’m happy to say that the Georgia Mental Health Consumer Network was one of the first organizations to sign onto the 10x10 Campaign and we’re very proud to be part of that and to introduce it to consumers particularly in the State of Georgia.

In the Statewide Peer Wellness Initiative we reorient peers to the Wellness Recovery Action Plan, commonly called WRAP, and that’s something we’ve trained thousands of people in Georgia with. And we focus on assisting people with developing a wellness toolbox where they can actually create a toolbox that’s specifically their own, full of wellness tools that work for them.

Several of the wellness tools that we talk to people about and invite them to include in their wellness toolbox if it’s something that resonates with them is we introduce people to the Benson-Henry Institute, commonly called BHI, relaxation response. And it’s a way of a person inducing relaxation using, you know, dedicated breathing and calming oneself.

We focus on of course many of the usual things that one would think about with regard to wellness tools, a healthy diet, exercise, positive imaging, viewing the world and outcomes from hoping and projecting a positive image of an outcome.

Smoking cessation of course is one of the many wellness tools that we invite people to engage with. Many of us have been smokers. I think that Ken brought forward the statistics that we are, you know, high consumers of cigarettes. And I myself was a very dedicated cigarette smoker in my day.

And I must tell you that quitting smoking was probably a greater achievement for me than completing my Masters Degree. And I’m sure that it’s contributed more to my longevity and overall wellness than any of the formal education that I have partaken in.

The Statewide Peer Wellness Initiative also invites people to do action planning and we basically encourage people to set short term goals oriented towards success. And we introduce people to a technique of action planning that they can set their own goals for their wellness plans.

We talk to people about self-advocacy for whole health particularly in the arena of how to talk to their doctors around what their - what people - what a person’s personal goal, what personal goals. People’s personal goals are with regard to their wellness and their whole health. Talk about getting possible tests that they need and so on.

And we also talk to people about psychiatric advance directives so that people can plan for crisis, a possible crisis at a time when they’re feeling well.

The Statewide Peer Wellness Initiative also trained - we train 10% of our peer workforce, Certified Peer Specialists using the Peer Support Whole Health Training Model.

And the Peer Support Whole Health Training Model focus on peer supported whole health goal setting and support and it is being worked on as Medicaid reimbursable services. So not only can Certified Peer Specialists bill for their work in the arena of peer support or in with the sort of Community Treatment Teams or with community support individual work but that they could also bill for peer support whole health meaning that they work with consumers to support them with setting whole health goals and achieving those goals.

The latest project that we’re working on that has grown out of our recovery and wellness initiatives is our Peer Support Resiliency Project.

Again we’re very grateful to have another project that’s funded by the Statewide Consumer Networking Grant funding stream. We just were funded for this this year and so it’s our newest project. We’re going to develop and build a Consumer Controlled Resiliency Training Program for adults with mental health and addictive disease diagnoses. And it’ll be offered to peers and CPS's statewide. And we’re very delighted to be able to engage with this project.

The training will focus on principles of social supported networking. We again will call upon the work of the Benson-Henry Institute for Mind Body Medicine, their relaxation response. We’ll focus on altruism, cognitive skills and positive psychology and also with general wellness practices many of which I have already spoken with you about.

We’re going to do a little pilot study and collect a little data and tweak our curriculums depending on the outcomes of our pilot study. We’ll do the statewide training for peers including CPS’s.

And then for the sustainability piece we will actually do a trainer’s training for CPS’s so that they can continue this work when our grant is finished.

I wanted to share some resources with you. The Wellness Recovery Action Plan is something that has been a great tool for many of us with regard to developing our own personal wellness plans. And I’d like to invite you to go to www.mentalhealthrecovery.com. This is Mary Ellen Copeland’s site. She is the creator of the Wellness Recovery Action Plan. And you can find a lot of useful information there about WRAP and WRAP resources.

The Benson-Henry Institute for Mind Body Medicine is also another great tool, great institute and a tool for us and so I’d invite you to go to there to their web site and they’re with - connected to Harvard University.

And then the Collaborative Support Programs of New Jersey, they do some of the greatest work in wellness in our peer oriented world. And so I’d recommend to you that you visit their web site.

Thank you very much for this opportunity. I really enjoyed talking with you all today.

Jane Tobler: Thank you Sherry for that spotlight on a really great Peer Wellness Initiative in Georgia.

We’ve asked each of the presenters to share with us their vision.

Prachi, would you share NCCAM’s vision please?

Prachi Patel: Absolutely, thank you. So the vision of the National Center for Complementary and Alternative Medicine is essentially to facilitate integration of effective CAM strategies and conventional medicine into comprehensive care.

And this is care that recognizes the importance of compassion and caring, while encouraging individuals to participate in choices that will ultimately enhance the quality of their lives.

Thank you.

Jane Tobler: Thanks Prachi. Ken what is your vision?

Ken Jue: I think my vision would be to really eliminate the lifespan gap for individuals who have a serious mental illness. That would be at the top of my list.

The other second item would be to establish social inclusion policies and strategies at various levels of our communities from national to state and community levels and really use it to eliminate discrimination and stigma related to mental illness hopefully once and for all.

And then in dealing with social determinants economic resources at an individual level is really crucial. And so equal access to all employment opportunity, decent and affordable housing and quality healthcare that they would all become realities in the foreseeable future.

Jane Tobler: Excellent, thank you Ken. Sherry what is your vision?

Sherry Jenkins Tucker: My vision is I see a world in which consumers of state mental health services outlive the general population by 25 years. And by saying this I just mean that it would be lovely to see us be able to live long healthy lives full of recovery and wellness.

Jane Tobler: Great, thank you Sherry. We’ll take questions in just a moment.

On Slide 51 we’ve shared the presenters contact information, and Slide 52 through 54 have brief biographies of today’s excellent speakers.

We will now take questions from callers. To ask a question, please dial star 1 on your telephone keypad to be placed in the queue and give the Operator your name.

If you do not wish your full name to be announced please only give her your first name.

After the conference Operator announces your name please ask your question. Once you’ve asked your question your line will be on mute so presenters have an opportunity to respond.

Operator, could we have our first question please?

Coordinator: Thank you. One moment, while I get the first name.

Karen you may ask your question.

Karen: Yes, my name is Karen as you know. And I’m kind of on both sides of the alternative, the CAM Movement on both in wellness for mental health with complementary and alternative and also I’m a practitioner.

My question is this. I understand that a lot of these modalities are not, you know, researched by science. And I wonder what pharmaceutical companies have to do with possibly squelching the benefits of these modalities.

Jane Tobler: That’s a great question. Prachi can you answer that?

Prachi Patel: So if I understood the question correctly, you’re asking what role pharmaceutical companies have in just the research that’s conducted at the National Center for Complementary and Alternative Medicine or in suggesting what things should be verified. Can you just clarify that for me?

Karen: No. What I’m asking is, you know, I really have a philosophy that, you know, pharmaceutical companies who have a lot of money squelch or put down alternative and complementary modalities which I think are fabulous.

And I’m wondering if because the pharmacies having so much money is that preventing people from having access to these techniques which I think are more or less (anti-work) for me?

Prachi Patel: Right. Okay, hopefully I can speak to your question and answer it correctly.

So I first want to say that, you know, NCCAM is a part of the federal government. And we focus on research in areas of interest of great promise including the use of CAM to manage troubling symptoms and enhancing overall health and wellness which is what we discussed today.

And, you know, we set our priorities by taking the most promising areas of research and investing sufficiently so that we can have enough evidence to impact the field.

And I guess as you had seen on my slide earlier CAM is certainly primarily paid for out-of-pocket at this time almost $34 billion and I think said more than 1% of overall health costs.

So access to care may come into consideration then when thinking that as of now people do pay for CAM out-of-pocket primarily.

Karen: No, I understand that. I understand that completely. What I’m saying is that, you know, speaking for myself I use it and I pay out of the pocket.

Prachi Patel: Right.

Karen: But a lot of people don’t know about things like, you know, complementary medicine, nutritional medication. I read and study a lot about nutritional medicine and it helps people even with schizophrenia, bipolar in extreme cases and people are not aware of this.

Prachi Patel: Right. And that’s a very important point to make. And, you know, NCCAM specifically is the one of the NIH’s 27 different institutes and centers that really does focus on Complementary and Alternative Medicine. And we have been around for ten years.

And part of our three prong mission is to disseminate information and I do understand the fact that our messages are still in the process of getting out there. And when we do have research and clinical data whether it proves to be efficacious or not we do try to take that information and put it out there whether it’s through the exhibits that we go through each year, whether it’s through our online communications tools.

And I think that’s something we strive to do daily in terms of trying to progress our mission and live up to it in terms of getting this information out there because I do agree that we have so much important content that can potentially positively affect the lives of all Americans.

And so, you know, that’s something we strive to do everyday. I don’t want to say that there are any organizations or companies out there that try to “Squash” our ability in doing this. It’s just a matter of us working daily to figure out which communication vehicles to use and to really penetrate as many audiences as possible in different ways.

Karen: Yeah.

Jane Tobler: Great, thank you Prachi. Another question came in via email.

Has there been any studies looking at the ability or frequency of people being able to decrease use of psychiatric medications by using CAM or healthy lifestyle practices such as exercise, yoga or massage?

Ken could you answer that question please? And again it’s around studies, looking at the ability of frequency of people being able to decrease psychiatric medications via using CAM or healthy lifestyle changes.

Ken Jue: I’m not aware of any formalized studies yet at this point especially for people with the more severe mental illness conditions. However what we’re seeing in our programming is that there are participants who are reducing the dosages of their medications and the types and extent of their medication, the numbers of medications that they’re taking.

One of the differences that we’ve seen - our programs are being researched by - through NIMH and CDC Grants in New Hampshire and in Boston; we’re going to be implementing In SHAPE in all the centers in New Hampshire over the next several years and now four of us have the program implemented. And there are various aspects that we’re studying.

What we are seeing is that there is some differences in some of the behaviors of how people go about assessing their medication regimen.

More participants seem to be more confident in directly discussing and raising issues and questions regarding their medications with staff, with particularly with nurses, and nursing staff and psychiatric staff and in many ways its people are not just unilaterally terminating their medications without some conversation with a medical professional.

But we have seen people actually stop taking medications or most of the medications over probably a period of a year. And not feeling that they really need them as much and still able to function very effectively.

But we have not really - that’s not part of the NIMH research studies that are being done. The researching entity is the Dartmouth Psychiatric Research Center and the Dartmouth Center for Healthy Living and Aging.

And I think there are probably more studies that are related to depressive states than there are related to some of the more serious conditions like schizophrenia or diagnoses related to psychosis of severe bipolar disorder.

Jane Tobler: Okay, thank you Ken. Operator next question please.

Coordinator: Yes, the next question is from Jim McKelly. Your line is open.

Jim McKelly: Hi. Can you hear me?

Ken Jue: Yes.

Jane Tobler: Yes we can Jim. Thanks.

Jim McKelly: Okay. Thank you. This is a question for NCCAM. I was curious about the study with the St. John’s Wort versus a placebo. And this is really sort of a two part question or a lead into a bigger question.

The initial question is was any of the study or the test subjects, was any of that used in conjunction with therapy. And the reason why I’m asking is in addressing this in a holistic way I feel like there’s a piece missing really bringing in the holistic aspect. It seems really more a study based on chemical or physical effects.

And I’m wondering if there was a measurement used for like EQ for Emotional Quotient and what was really the rest of the picture that would bring in the–the–the holistic sort of label.

Jane Tobler: Great, thank you. Prachi.

Prachi Patel: Sure, thank you for that question. So essentially this study had two prongs in it, one was the placebo and one with the extract of St. John’s Wort.

So the third prong that you’re referring to to test for emotional quality, i.e. therapy, was not included in this particular-- in this particular clinical trial.

And I do understand what you’re saying but the researchers for this study solely focused on those two things. Because within this study the complementary and alternative therapy that was studied was specifically St. John’s Wort as a natural product.

And so as far as holistic and wellness goes this was a - this was specifically a CAM study looking at natural products research and particularly extracts of St. John’s Wort.

Jim McKelly: Okay. So then the approach was not specific toward defining holistic wellness in the sense of mental, emotional, spiritual; this was just strictly physical.

Prachi Patel: And primarily looking at, you know, the therapy of using an herbal product, an herbal remedy which in this case would be St. John’s Wort.

Jane Tobler: Okay, thank you. Our next question is an email question from Michael. Michael says I’m interested in mental health outcome in the peer led whole health program.

With cutbacks everywhere it seems that a focus on wellness could help us lower costs in mental health treatment. Is there any evidence to support this?

Sherry, could you answer that please?

Sherry Jenkins Tucker: With the work that we do we do - we collect data from people that we work with and people do indicate that they are feeling better, that they experience less hospitalization.

So in the work that we do we are collecting information and I’m sure that other places that are working on wellness there are people that are also collecting data from the people that they’re working with.

Ken Jue: Can I add something to that?

Sherry Jenkins Tucker: Sure.

Ken Jue: Part of the research that we’re doing is a Medicaid analysis by a health economist that is developing a study component of the impact on the use of a variety of healthcare services and connecting it to wellness activities.

But the - that’s just - that part of the research is just beginning in our projects.

Wilma Townsend: This is Wilma Townsend with SAMHSA. One of the things that we’re doing on a national level is trying to determine what are the outcomes that we should be looking at around wellness and in fact at the last Steering Committee Meeting we had a nice discussion about that.

So whoever just asked that question if you have some ideas, email them to us; what we’re planning on doing is going back to the original research and looking at some of those indicators.

But if you have some other things please let us know.

Jane Tobler: Great, thanks Wilma.

Woman: Yes, thank you.

Jane Tobler: Operator could we have our next question please?

Coordinator: Yes, Jenny Bailey your line is open.

Jenny Bailey: Hello. I am working in a 23 county region in Pennsylvania. And we are just starting a physical health, behavioral healthcare initiative.

And the presenter from New Hampshire mentioned the situation that an individual in service had with her physical healthcare doctor where, you know, he walked in and said, you know, you’re obese. Get with the program and walked out.

And I’m wondering what kind of ideas he might have for education and training for the physical healthcare providers especially the doctors in working with individuals with mental illness.

Jane Tobler: Thanks Jenny. Ken that sounds like it’s for you. What kind of education is available for them and training?

Ken Jue: What we are going to be doing in that agency particular where they have the In SHAPE program is- is some conversations that will need to occur I think from the administrative staff particularly our - we have a Medical Director with the medical leaders for that particular clinic that they were using on that day.

I think probably establishing working partnership at the beginning on the front-end is really important so that the training programs can be added in actually probably prior to the integration of efforts would be best.

And that’s how we did it here in Keene where my agency is is that we have spent quite a bit of time with physicians and we embedded some staff into the clinic and after working things out and reaching understandings with the administrative people, managerial people at the clinic and medical center.

And those staff then provided some training for physicians about better understanding mental health issues.

And it’s gone pretty well for us. And we’ve generally not encountered this - the same kinds of situations that we used to encounter years ago that were very similar to that incident that that particular person experienced in one of the other communities. That particular agency I think has some work that they are planning to do with that other medical service.

Did that answer the question or can I try - you want me to elaborate further?

Jenny Bailey: That does. Thank you.

Ken Jue: Okay.

Jane Tobler: Thanks Ken. Operator next question please.

Coordinator: Yes, Barbara Meyers your line is open.

Barbara Meyers: Yes. I have a question about whether you plan to do any work on the effect of faith or religious or spiritual lives and how that helps people in their recovery and their longevity.

I know that in California we recently had a study that showed that consumers felt that that was one - the number one thing that helped them to get well. So I was wondering to what extent you were looking at it.

Jane Tobler: Prachi do you want to say what NCCAM is doing around religion? And then I’d be interested also in Ken and Sherry you sharing the information you have about that. That’s a great question on faith and religion and its healing effects.

Prachi Patel: Sure. This is Prachi. Thank you for that question.

I actually want to reference the National Health Interview Survey again because I presented the data from the 2007, the most recent survey that took place.

And we did have another one in 2002 that took place that did reference some of the things that you’re talking about as far as faith and religion and prayer come into place.

But at this time and as I mentioned when NCCAM is setting its priority areas and gaining feedback from the public in terms of what they are looking at and what is sort of more of a priority setting, that is not something that we’re currently looking at in our next strategic plan although I’m not saying that that’s not something we will actually not discuss at all.

And in fact if you are interested in more specific information or studies that have taken place I’m happy to put you in touch with one of our program officers or specialists who may be able to shed more light on studies that have either already taken place or potentially down the pike.

But if you actually visit our NCCAM page and go to the Strategic Plan you’ll be able to see some of the priority setting on what’s come down the pike for the next five years. And that should probably provide more information on some of the newer things that are coming down the line in research and development.

Coordinator: Would you like to go to the next question?

Jane Tobler: No. I didn’t know if Ken or Sherry if you know of any studies around the religion with the wellness.

Sherry Jenkins Tucker: I don’t know of any studies but certainly in our network of people express that spirituality is important to them. We have a large annual conference where, you know, we have a Spirituality Workshop that’s always, you know, standing room, you know, only.

And we certainly support people at the Peer Support and Wellness Center with being able to have wellness activities around spirituality and related activities like yoga and other mind/body/spirit wellness activities that people feel support their recovery and wellness.

Jane Tobler: Thanks Sherry. Ken did you have anything to add?

Ken Jue: Just that and generally at my organization where there is an interest in spirituality or more specific religion our staff do try to support people in making the connections because we have a strong social inclusion value in the agency.

And we encourage people in all aspects of interest in their lives to pursue that and we will try to facilitate it.

Now we have when the need - the interest arises we have done - taken groups of participants or consumers to meditative retreats. And we have located a particular retreat where we have used their facility probably over the last - I think we’ve been doing this for the last ten or more years. And our organization and our constituencies are - have been welcomed there and participants really enjoy the - it’s usually this three day sometimes a four day experience of a meditative retreat.

Wilma Townsend: This is Wilma. There were a number of studies that was done about ten years ago on spirituality, faith and its impact on persons with chronic physical illnesses.

And what they found was that those individuals who had a strong sense of faith and spirituality that they ended up where they live longer. And many of them went into recession. Most of this stuff around cancer and other physical illnesses like that.

I used to be able to give you the name of the studies but I can’t now. It’s been so long but I know if you Google studies on spirituality and physical health it’ll come up. There’s a strong correlation.

Jane Tobler: Thanks Wilma. Could we take - Operator could we take our next question please?

Coordinator: Yes ma’am. It is from Ann. Your line is open.

Ann: Hi. I actually have a comment and then two questions for Ken. And the comment is probably for Prachi.

The presentation seemed to give the impression that natural products didn’t have as much value as the other ones and maybe that’s just because the two studies found them to be ineffective although there are studies that some natural products are effective.

And then so that’s just my comment about that. So I don’t know if there’s other information that could be included on a positive note about natural products.

And then my questions to Ken are that are there any community and economic development efforts that are being added alongside with your kind of recovery and peer support to kind of prepare the community to be more inclusive?

Ken Jue: Yes. What I did is I individually approached the potential project partners or organizations I was hoping would be project partners. And it was over probably a year, year and a half. And our project partners are both nonprofit and for profit entities.

And what I did was I tried to, before I went out to really understand the mission and the values of those various organizations that I was visiting. So for example I went out to one of our ongoing partners, Keene State College which was not a usual partner for us.

But because of the issue of healthy eating I went to meet with people that were in charge of the academic programming dealing with health sciences and nutrition. And as it turned out what happened is that they expressed a need for internship for their nutrition students.

And so we just reached an understanding that gee that would be a great service for us and ever since that time the nutrition students have been an important part of the program as well as professors from that department. So they have been a great partner.

Another, a different approach that we took with another partner which is a dance movement company that was wanting to expand into creative arts and the visual arts. They wanted to establish a community art school.

And they - working with or engaging with individuals who might have a serious mental illness whether, you know, we’re talking about kids or adults, would be something new for them.

So we needed to establish a relationship then. So knowing that they wanted to develop an art school, community art school, I approached them and I offered to assist them into doing just that.

And so what I did was leverage some relationships that I had in the community and brought it to bear on the creation of the art school. We created the art school within about a year and got it structured and began to accept students into it.

And then we sat down and they asked me. They said, “Well gee, you helped us create this. Who owns it?”

And I said that, “Well you guys own it. We know nothing about running art schools and keeping enrollment up, etcetera, etcetera, leave alone how little we - our field would understand and appreciate art. It’s new for us.”

So and I said to them, “But I do have one request that what we - what I would ask you to do is forever and a day be receptive and to welcome into your art classes our adult constituencies and our children and youth constituencies.”

And they have honored that and are an active partner in our In SHAPE project not only with the art school but with all their dance and other kinds of activities. They offer yoga, et cetera.

And I approached a variety of other organizations. There was the YMCA is an active member and they - I convinced them that we fell well within their mission. And they agreed.

And I went to our cooperative extension office which is run out of the land grant college in New Hampshire is University of New Hampshire. And every state has a land grant college or university and probably has a cooperative extension service with it.

And they actually needed constituencies so they could continue to justify what they were trying to do.

And we came with a potential constituency that they were eager to serve so that they could justify their funding. And so again there was an intersection in our mission.

And that’s what I kept looking for with people is where our intersections and values came together.

So the project continues to have multiple partners. We - none of the activities that we provide through our In SHAPE Program are done at the Mental Health Center. They’re all done in community settings. And they’re integrated.

We also have a swimming pool that not only at the YMCA but we wanted an option to the YMCA so we negotiated a swimming pool access with a local motel. And they love having it. It’s great publicity for them. We’ve given them an award and it’s in their lobby. They gave us a great discounted rate for the use of the pool.

And they - we hold classes there. And the hotel guests participate in the classes. They advertise the classes among their hotel guests and so they’re integrated classes for our participants for In SHAPE and people who come to the motel.

So does that give you some idea?

Jane Tobler: Ken I thought that was great. And I think we have a question - time for just one more question.

Sherry this is for you. In the Statewide Peer Wellness Initiative what specifically is Medicaid reimbursable? And are you aware of other states that have Wellness Initiative or Peer Support Whole Health Training?

Sherry Jenkins Tucker: For the Statewide Peer Wellness Initiative it’s not Medicaid reimbursable because it’s funded by a Statewide Consumer Networking Grant. So it has its own funding stream.

Other than what I talked about which was the - what would be the work that would come from the training that we provided for the Certified Peer Specialist in the Peer Support Whole Health and with the Peer Support Whole Health Training Certified Peer Specialists are actually trained to engage with consumers around setting whole health goals and then supporting them with achieving those whole health goals. And then that is Medicaid reimbursable work.

Ken Jue: Could I add something to that?

Sherry Jenkins Tucker: Sure.

Ken Jue: The State of Michigan and the State of New Hampshire are allowing for some Medicaid reimbursement of activities within - functions within the In SHAPE Program.

And Michigan and New Hampshire have allowed this and permitted this for the past year. And it looks like in New Hampshire that will continue and well as in Michigan.

Jane Tobler: Excellent. Thank you very much.

We’ve come to the end of our time today. So if you have more question or would like to follow-up please email the SAMHSA 10x10 Wellness Campaign at 10x10@samhsa.hhs.gov or contact the speakers directly via their contact information on Slide 51.

Prachi, Ken and Sherry thank you so much for your work on this important subject and for sharing your insights today. Thanks also to all of our listeners for taking time out of your afternoon to learn more.

This conference has been recorded and the audio recording and transcription will be available in mid-January on the SAMHSA 10x10 Campaign web site.

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