Linda Weinberg went where she wasn’t wanted and made a difference.

Suicide has been a major problem in Native American communities for decades. According to the Centers for Disease Control and Prevention (CDC) suicide rates among Native Americans have been more than double the general population. As recently as 2003, suicide was the second leading cause of violent death among Native Americans aged 19 or younger behind car accidents. In one tribe, three 12-year old girls committed suicide in a month.

“There are a lot of factors that can contribute to high Native American suicide rates,” Weinberg said. “There are problems with substance abuse, isolation, lack of employment, lack or resources, and the trouble of living in two worlds: Tribal and non-Tribal.”

Weinberg has been with Cenpatcio Arizona as Policy Developer for 3 ½ years. She knows and understands the problem suicide has been in the Tribes in her area and knew she had to help make a difference. “There was no prevention department,” Weinberg said. “There were no enrollment, and no diagnoses services in the tribal areas.”

Tribes can be very protective of their people and their lands. Outsiders aren’t always welcome or trusted; especially those who wish to discuss and help solve a very taboo problem like suicide. This is a fact not lost on Weinberg. “I had to be invited onto Native Lands,” she said. “I learned about each culture and made sure to be seen to prove that I could be trusted. People of any culture want to see that you want to learn and will keep your word. I had to learn who my supporters were and build upon those relationships.”

Weinberg was able to secure funds from the Arizona Department of Health Services (ADHS) for suicide prevention services for the Maricopa Ak-Chin and the San Carlos Apache Nations.

She identified the type of services the Maricopa Ak-Chin felt were needed and got permission to bring services in the form of Critical Incident Stress Management Training and Applied Suicide Intervention Skills Training. She went to Columbia University for training to be able to teach Teen Screen to behavioral health and school personnel so they could screen youth who may be at risk for suicide and trained personnel who worked with youth from each the Maricopa Ak-Chin, San Carlos Apache, and Gila River Pima Tribes.

At San Carlos, Weinberg works closely with the Wellness Center and the Vice Chair of Tribal Council to identify services to meet the Tribal needs and has contracted for training of school personnel, detention center staff, behavioral health, housing department and other Tribal Departments. She also contracts with the Tribe for a public education campaign, the training of caregivers (including all materials) and works with the Tribe on infrastructure development for more staff to be trained to conduct suicide prevention training and debriefing after a critical incident.

In part because of Weinberg’s work, Native American Suicide rates in Arizona dropped below the state mean for the first time in Arizona history. In September 2008 Weinberg was awarded for her works with the Native American Suicide Prevention/MBrace Life Award.

“Change takes a long time,” Weinberg said “When you see the stats and see the changes in a community … rewarding isn’t a big enough word to describe the feeling.”

This entry is filed under Close Up.

And you ask me what I want this year
And I try to make this kind and clear
Just a chance that maybe we’ll find better days
Cuz I don’t need boxes wrapped in strings
And desire and love and empty things
Just a chance that maybe we’ll find better days

-Lyrics from “Better Days” by the Goo Goo Dolls

I’m sure like many Americans, you have been reading about the decline in retail sales, and even the recent news that not only are we spending less, but actually, for the first time in about 50 years, paying down debt. I guess this is a mixed bag for our country. On the one hand, it is bad news since our economy is so driven by consumerism. But on the other hand, it is good news that maybe, just maybe, we are examining our attachment to things, our culture and an economy based on spending. It just cannot be a good thing to have a national economy based on buying stuff and, worse, doing so on borrowed money. I, too, have gotten caught up in buying more things, getting attached to things, and then like most Americans, ending up throwing these things away resulting in an added consequence to our environment.

I think we must all be waking up as if it were the next morning after a wonderful party which involved too much eating and drinking. We have fond memories of the good times but are shocked at how unwell we ended up feeling the next day. I know that times are grim for many Americans now, but I have such hope that our personal sober reflection of how we ended up in this mess will bring us back to what is truly important in life. As you look around at all that you have accumulated, no matter how much or little you think you have accumulated, I wonder if you have the same thoughts that I do lately. None of it is really important, and I could live happily with just about all of it gone. What I know I cannot live happily without is my health, my family and my friends.

What is the true meaning of the Christmas season? Hope and renewal, not gifts, not buying more things. It is an opportunity to reflect on our values as a society and hope that we will all find renewal as a nation next year.

From our employees and myself at Cenpatico, we are wishing you the very warmest and joyful holiday season.

And, here’s to better days for all of us in 2009!

This entry is filed under Blog.

There is no medicine like hope, no incentive so great, and no tonic so powerful as expectation of something better tomorrow.
– Orison Marden.

A common question in our field is why do some people with mental illness or substance use disorders recover, and others do not, even with the same support and treatment interventions. As a young man working on my Ph.D., I decided to tackle this very question in my dissertation by focusing specifically on the phenomenon of “hitting bottom” in alcoholism. What I found in my study, and find in almost all studies on this subject today, is that the difference between those who successfully began recovery from alcoholism and those who did not focused on two factors. One, relationships with peers who were successful in their recovery pointed to the fact that isolation often means death for those with mental illness/substance use disorders. Two, in specific, those relationships were people who could successfully help the person suffering begin to imagine for themselves a better future or outcome for their life.

In other words, Hope. “Inspiring hope” is not just some cute marketing line at Cenpatico. Those of us in the behavioral health field understand that if our consumers have hope for a better life, they can and will recover. It isn’t complicated at all, and it often takes very little. And isn’t hope for a new beginning the very message of this season?

I would like to hear from you. Tell me where you have seen the power of hope help someone recover?

This entry is filed under Blog.

Always around this time we hear in the media and other sources how the holiday season is so stressful and creates more depression and anxiety. With few exceptions, I see that the evidence is actually to the contrary, that the holiday season is actually one in which people smile more, socialize more, and, yes, even enjoy seeing their families. Many people believe that suicide rates are higher and depression is higher this time of year, but the data simply doesn’t support this. (I, personally, am a big fan of data.) On the contrary, in the behavioral health managed care industry we actually see utilization of all services begin a gradual decline from about mid-November through the month of December, and this year is no exception. Also, the suicide rate is actually quite low in comparison to the peak months of April and May.

So, don’t buy into the fact that you are supposed to be feeling stressed and blue. Keep in mind it is still, as with everything, all about your attitude and expectations regarding the season as to whether you have an enjoyable one or not. If your family always gets into a knock down drag out fight on Christmas Eve, why try to hope for it to go differently and be disappointed. Instead, plan on how you are going to do something different for yourself so you don’t get pulled into the predictable family dysfunction. Many people keep trying to compare this holiday season to those of the past. This is another bad move. Each holiday season is different and trying to recapture the past is again another set up for disappointment. For all you know, you are living, right now, the “good old days” which you will appreciate in the future.

So, there is nothing inherently stressful and depressing about the holidays. On the contrary, it is nice to have a time of year, every year, where we are reminded about the importance of such values as giving, of acknowledging that there are others in the world far less fortunate, of appreciating family/friends, and embracing the messages of the season of re-birth and forgiveness. I think everyone can buy into these values irrespective of religious belief.

Having written this, I do want to acknowledge that this season can be particularly hard on those who have suffered major losses recently, particularly the loss of a loved one, the loss of a job. The holiday season can be a painful reminder of an absence of someone we loved, and the economic consequences of the loss of a job can be felt as humiliation during a time of gift giving, especially to the children. We do need to be mindful of these people in our lives and to give them all the support we can.

This entry is filed under Blog.

Thanksgiving is my favorite holiday.  Their are really no huge expectations, no need to decorate, buy gifts;  it is just a nice time to be with others we care about and to reflect on our good fortune.  No matter what your circumstances, it is hard not to find things that you are grateful for.  In the rooms of Alcoholics Anonymous, sponsors will often have their sponsees work on an “Attitude of gratitude” by having them write a list of things they are grateful for each and every day.

Personally there is so much that I am grateful for.  As CEO of a managed care behavioral health organization, there are two things I am most grateful for:  My employees and our providers.  I am grateful to have a group of employees who believe in the mission of inspiring hope for our consumers, and each and every day go beyond to help the most disenfranchised in our society.  I am grateful to our providers who equally embrace the mission of trying to help our consumers find their voice and confidence that they can and will recover from their illness.  I can tell you that our providers did not go into the behavioral health or substance use field because of the fame and fortune associated with these jobs.  These are people truly motivated by doing the right thing.

So, there’s a lot to be grateful for.  I wish you, your friends and family a very nice Thanksgiving holiday.

This entry is filed under Blog.

Cenpatico Welcomes Dr. Bernard Engelberg

Cenpatico’s new Medical Director enjoys adventure. It’s that sense of adventure that helped Dr. Bernard T. Engelberg, M.D. decide to move his family from Albany, NY to Austin, TX. “I’d heard so many great things about Austin, but once I visited, I fell in love with it. It more than fit my imagination, even with the over 100 degree heat. If you can enjoy a city then, you know it’s a great city,” said Dr. Engelberg. The Doctor’s family; wife Ligaya, daughter Carina, and son Kevin, are also looking forward to the move. “They’re excited,” Dr. Engelberg said. “My son is even looking at possibly applying at the University of Texas or Rice.”

It’s also that sense of adventure that helped Dr. Engleberg decide to complete some of his studies in Europe where he lived for seven years including getting his Medical degree from Goettingen University in Germany. While there he got the chance to learn more about his family history. “My parents were German Jewish refugees and Holocaust survivors. I felt it was important to take the opportunity to see and learn more about where they came from.”

Dr. Engelberg comes to Cenpatico from MVP Healthcare in New York where he served as Senior Medical Director.  A life-long New Yorker having spent his residency and his career there, Dr. Engelberg is a New York Yankees fan which he jokingly admits might get him in trouble with some of his new Texas neighbors. He also enjoys tennis and photography and is looking forward to taking advantage of Austin’s hike and bike trials. The main thing he admits he will miss about the east is the ocean. “I will miss the (Atlantic) ocean. It was always a great place to spend the weekend.”  Colleagues at Cenpatico might want to give Dr. Engelberg some travel tips on exploring our great Gulf Coast region.

Dr. Engelberg is very excited about his new position at Cenpatico. When asked about his first impressions: “The people were wonderful. In fact, it was the people that were the most important factor for me taking this job. They were sincere and knowledgeable.”

He’s also excited to take on the challenge of an expanding company. “I love psychiatry. I grew up loving it. I really am looking forward to bringing that love and knowledge and combine that with my managed care skills to create new products for programs such as foster care.”

Dr. Engelberg is also excited about working with Cenpatico’s providers. “I want to work collaboratively and build a report with them,” he says. “I have an open door policy with providers and will gladly make my number available to them if they feel the have a problem or would like me to help them in a consultative role. My job and my hope is to make sure care never gets to the point of denial.”

“The best care is efficient care,” Dr. Engelberg says. “I strive for Goal-Oriented Quality Care and want to bring that kind of enthusiasm to my new position.”

This entry is filed under Close Up.

“Mental illness is nothing to be ashamed of, but stigma and bias shame us all.”
- Former President Bill Clinton

I read a wonderful article this weekend about Army Major General David Blackledge who served our country in Iraq but came home suffering from post traumatic stress disorder (PTSD).* There is nothing unique about this; according to the article an estimate 20% of soldiers returning from Iraq and Afghanistan will return to the U.S. suffering from anxiety and major depression disorders. I don’t have the statistics, but I am certain the numbers for those coming home with substance use disorders will be high as well. But, what is unique about Maj. Gen. Blackledge is that he successfully underwent treatment and then has been openly talking about his successful treatment, as he did for this article in the Associated Press.

We are a culture that has a propensity to stigmatize and our greatest weapon against stigma around mental illness and substance use disorders is for people like Blackledge to openly talk to others about their experience. All the public service announcements, national walks and research I believe cannot do as much to fight this stigma as much as people willing to come forward and tell their story. So, as I write this on Veteran’s Day, I am grateful not only for the service by our brave men and women in the armed forces, but also grateful for this brave soldier. Let’s honor Blackledge not only for his service to our country, but also his service in helping all who suffer from mental illness to overcome their personal sense of shame. He is twice the hero in my book.

I would like to hear from you: What do you think we need to do to overcome stigma in this country?

*”General bucks culture of silence on mental health”; P. Jelinek, Associated Press, 11/8/2008

This entry is filed under Blog.

“Bad politicians are sent to Washington by good people who don’t vote.” - William E. Simon

I love elections and love the process, long and arduous as it might be. There is no greater opportunity to recognize and appreciate the fact that Americans really can choose the direction of their government. Every forecast is that today will result in the highest voter turnout in decades, possibly one for the record books. If you succumb to the apathy that many Americans do by telling yourself “my vote doesn’t matter”, then you have only helped to create a self-fulfilling prophecy.

I hope that you will make your voice heard and that as you consider your candidates of choice that you consider the following issues:

Where do the candidates stand on the issue of health care? What is their involvement and voting record?

Specifically, have the candidates you are considering been champions for fighting for the funding for research and treatment of mental illness and substance use disorders? A good place to start is to take a look at your candidates voting record on the recently passed “parity law” or the Mental Health Parity and Addiction Equity Act (H.R. 1424).

And another good question: what have the candidates done to fight the stigma surrounding mental illness and substance use disorders?

We all have our important issues that we consider when voting. Don’t forget to vote for candidates who support behavioral health recovery and wellness!

Get out and vote! No excuses. It is your responsibility if you are going to participate in a Democracy!

This entry is filed under Blog.

This great Nation will endure as it has endured, will revive and will prosper. So, first of all, let me assert my firm belief that the only thing we have to fear is fear itself-nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance. - March 3, 1933 Inaugural Address, Franklin D. Roosevelt

Keep Calm and Carry On.
Poster produced by the British Ministry of Information, 1939

Above are two of my favorite quotes that personally help me as I, like many Americans, listen to all the grim news about our economy.  Both of these speak to the fact that fear can be a very destructive force.  In fact, FDR was a great psychologist; he just didn’t know it.

Our brains are primed and ready to protect us in the face of danger.  When we are facing danger, the brain, through powerful chemicals, produces all kinds of physical changes in our bodies to prepare us for “fight or flight.”  These chemicals released by our brains can produce changes in our body in less than half a second!  Evolution did an excellent job.  Think about it; primitive human beings didn’t have time to reason things out if they thought they saw, for example, a saber tooth tiger in the shadows ready to pounce.  Once the danger passed, either through successful flight from danger, or, perhaps in the case of a tiger jumping on you, fight, our brains should stop producing these chemicals allowing our bodies to relax.

The problem is today the dangers we think we face are much less immediate and life threatening.  In fact, as I once heard a woman at an Alcoholics Anonymous meeting state very eloquently, 90% of everything we fear is simply a waste of time.  Most of what we fear is not the immediate danger of any sort but rather what we imagine COULD happen, those images and thoughts in our heads.  Our brain doesn’t know the difference.  Whether we imagine it or hear it daily in the news, all our brain understands is DANGER.  This is where evolution has not caught up.  Our brains continue to react as if the tiger is about to pounce and the result is a continuous release of chemicals in our body to prepare us for fight or flight.  The continuous release of these chemicals from our brain is simply bad for our body over time: weakened immune system, insomnia, mood disorders, substance abuse, etc.  The result is what is commonly referred to as stress.

So FDR had it right long before the psychological research: fear is in itself a very damaging and destructive force on our brains and bodies.  I offer you following steps to combat the fear:

1. Silence the Alarm in your brain.  Remember, most of what we fear comes from thoughts and images in our head about what MIGHT happen.  Try to be aware of the stuff going through your head.  Instead, stay in the present.  Turn off the TV with its steady stream of bad news.  (Research studies in fact have shown that those who watch fewer hours of television are less anxious!)
2. Take action.  Physical activity and exercise.  Get together with your supports, your friends, family, and talk about your fears.  Avoid the impulse to withdraw. Don’t get paralyzed.
3. Develop a spiritual program.  Again, research demonstrates over and over that those who have a spiritual program cope much more effectively during stressful times.  This does not mean you have to believe in God or attend church.  To get in touch with one’s spiritual side means finding the answers to the fundamental questions of why we exist and what is the purpose of our life.
4. Above all, keep calm and carry on.

This entry is filed under Blog.

“Vision without action is a daydream. Action without vision is a nightmare.” -Japanese proverb

Welcome to my blog on our new, exciting web site! This is my first attempt at blogging anywhere and I hope that you will take this as an opportunity to post your reactions and comments to what I write. I’m looking forward as much to hearing your reactions and comments as I am to writing my entries.

I started with the proverb above to focus this first entry on what is commonly referred to as the “vision thing”. We are in the process of rolling out a tool, a campaign called “Inspiring Hope”, so that all of you understand the vision, mission and goal of Cenpatico. Our vision for this company is that Cenpatico will become the industry leader in recovery and resiliency based managed behavioral healthcare for the publically funded consumer.

Think of the vision statement above as the top of a triangle and moving down are the building blocks that support this statement which ultimately become a foundation, the actions we must take as a company. The vision answers the question WHERE we want to end up, but not the HOW and WHY. The “why” has to be answered by a strong mission that supports our vision. Our mission for this company is that together we inspire hope for a better life. That is why I get out of bed in the morning. Yes, increasing share holder value for Centene is critical and understood, however, that is true of every great company, and, I think you will agree, is hardly by itself an inspiring mission. I believe that every one of us has to understand that regardless of our role, each of us has the power to make a difference in our consumers’ lives; each of us can inspire hope!

So, we have the “where”, we have the “why”, and now for the “how”. Think about your favorite companies and what is it you love about them. Obviously they have to have a great product, but don’t they also have great customer service? And sometimes when the product falters, don’t these same companies also make it up to you, again, with great customer service? I still remember an American Airlines service agent when I showed up with 5 minutes to spare, grabbing me and my suitcase and escorting me down the ramp to the plane before they closed the door. Once on the plane, there was no overhead space, she then grabbed my bag and rushed it down the stairs outside to ensure that it made it into the plane’s baggage compartment. See, I still remember her and she reflected well for her airline.

Customer service is not a department. CSR’s are not just a specific group of employees. In our business we are all CSR’s. We can do most of what our competitors do, however, it is a crowded field and we have to stand out. I believe our employees set us apart from our competitors. If we are to get to our vision, we have to show the world we “walk the talk” with our mission. Cenpatico’s primary goal, the engine for the vision and mission, is customer service that consistently demonstrates Cenpatico’s value. Thus, our goal, the “how”: “Demonstrate value to our customers in everything you do”.

So there you have it. Our vision, mission, and goal (bolded above for your convenience) which answer the questions: Where is this company going — Why are we going there — How are we going to get there.

Sam Donaldson, Ph.D.
CEO & President
Cenpatico

This entry is filed under Blog.