Complete Health: Mental and Physical (A Most Important Resolution of Our First 100 Years)

We pray for refuat ha-nefesh u'refuat haguf, a healing of both soul and body, noting that there is a distinction between mental and physical health, we recognize that both are necessary for complete health. 

Issues

1. Barriers to the effective care of mental illness include stigmatization, lack of insurance coverage, and fragmented delivery systems for treatment.
    
2. The impact of bullying.
    
3. Lack of awareness in the Jewish community about inheritable diseases in the Ashkenazi population or of the availability of genetic testing.
    
4. The need for federal funding for embryonic stem cell research unlimited by the date of cell line development.

Background

Mental Illness

Millions of people across North America are affected by mental illness, which with the exception of heart disease causes disability and premature death more frequently than all other diseases. Mental illness knows no boundaries, touching people of all ages and backgrounds, reaching into our communities, congregations, and families. According to the 1999 report of the Surgeon General on mental health, "Tragic and devastating disorders such as schizophrenia, depression and bipolar disorder, Alzheimer's' disease, the mental and behavioral disorders suffered by children, and a range of other mental disorders affect nearly one in five Americans in any year." The Surgeon General's report also indicates that ten to twelve million persons in the United States suffer with "co-occurring mental and addictive disorders." In Canada it is believed that one in ten individuals suffer from mental disorders.

Cutting across the entire lifespan, mental illness is also prevalent among children, teenagers, and the elderly. Approximately 20% of children and adolescents suffer from a debilitating mental health disorder. Schizophrenia often first appears between the ages of 15 and 25. Moreover, each year 5000 young people in that age group commit suicide in the United States and a similar number do so in Canada. Older persons are faced with health problems, disabilities, and loss, but persistent and serious depression is considered a serious mental health problem. Depression contributes to the high suicide rates among the elderly.

Research has shown the general efficacy of mental illness treatments. Additionally, there are a variety of treatment options for most disorders. Nonetheless almost half of all persons with mental illness or mental health problems do not seek treatment. Several social and economic barriers limit access to treatment, one of which is stigma. Despite the enormous advances in medical research that have identified serious mental illness as a disease, it is often perceived by the individual, family, and community as personal failure rather than as a medical disorder. This stigma frequently leads mentally ill persons to deny or hide the disorder and stimulates reluctance to seeking treatment. They often resort to self-medication to feel better, leading to the abuse of prescription drugs, alcohol or street drugs. The stigma accruing to mental illness may also have limited the extent to which communities and our congregations reach out to support those with mental illness and their families, who are often their caregivers.

Stigma and discrimination may have also led to inequities in health insurance coverage for mental health services. In the United States legislation is under consideration regarding the need for parity in mental health insurance, a requirement that health plans provide the same benefits for mental health as they do for other health care needs. In addition, the 44 million people without health insurance in the United States are at a significant disadvantage in obtaining mental health services. Moreover, the existing mental health systems in both Canada and the United States are unable to keep pace with service delivery needs, leading to a lack of available mental health care in certain areas and for poverty populations.

The loss of housing and the shortage of affordable housing create homelessness, exacerbating the problems of the mentally ill. Treatment programs often lose contact with homeless clients. Lack of supportive living situations and lack of treatment may create problems of street drug and alcohol use as homeless people with mental illness attempt self-medication.

Criminal justice systems present serious issues requiring attention by those advocating for the mentally ill. Community facilities are needed so that the mentally ill are not incarcerated in local jails when they have a crisis. It is also imperative that those who are incarcerated and also mentally ill receive appropriate mental health treatment. In addition, over 50% of young people in juvenile detention facilities suffer from mental illness, half of whom also suffer from co-occurring substance abuse problems. Moreover, approximately 11,000 boys and 17,000 girls in detention attempt suicide. Yet 75% of juvenile facilities do not meet suicide prevention guidelines and many staff members have not been trained to recognize and respond appropriately to the symptoms of mental illness.

In most communities a major barrier to effective care is the fragmentation of treatment and supportive services needed by the mentally ill. Complex and fragmented mental health systems can be impossible to navigate by clients or their caregivers. This puts mentally ill persons at increased risk for loss of treatment or costly psychiatric services such as inpatient hospitalization and emergency-room care. The Assertive Community Treatment (ACT) program, developed in Madison, Wisconsin, twenty years ago, sought to address this fragmentation. The following are among the features that characterize the ACT program:

• Multidisciplinary treatment teams with a low client to case manager ratio 
   
• Shared caseloads among clinicians 
   
• 24-hour coverage, including emergencies 
   
• Close attention to illness management 
   
• Most services provided in the community, rather than at the clinic. 
   
• High frequency of contact with clients; and help in dealing with practical problems of daily living. 

Although the ACT program has been replicated and studied in a variety of settings, such programs have not been implemented in most communities in the United States and Canada.

In 1999, the National Alliance for the Mentally Ill (NAMI), in an effort to work towards establishing a more comprehensive system of care, launched an initiative designed to encourage state and provincial policy makers to replicate its model legislation, the Omnibus Mental Illness Recovery Act (OMIRA). NAMI believes that OMIRA would close the gap between what this country knows about treating severe mental illnesses and the discriminatory policies that dismiss individuals with such disorders as second-class citizens and abandon them to cruel and unnecessary suffering. The Surgeon General's 1999 report calls for a vision for the future that includes integrated community based services, continued research to build the science base for prevention and treatment, and overcoming stigma and other barriers to treatment.

Bullying Behavior

Serious concern is being focused on bullying as a mental health social policy issue. Children who bully or are the target of bullying behavior need mental health services and social skills counseling. Bullying includes threats, teasing, deliberately leaving individuals out of a social gathering or ignoring them. It can also involve serious assaults and abuse by individuals or groups. It is easy to underestimate the fear and anxiety that a bullied child feels. Young victims can become involved in blaming, ridiculing, shaming, and physically abusing others. It has been noted that some violent children and adolescents had been victims of bullying.

Social scientists who focus on the family suggest that adults who bully others, such as their children, aged parents or coworkers, may have experienced bullying as children. Although it is important to be aware of bullying behavior in our schools and playgrounds, we must also reevaluate bullying behavior in society, for example in contact sports such as hockey or football. Research is needed on the prevention and treatment of bullying.

Genetic Diseases Among Ashkenazi Jews

Nearly 10,000 genetic diseases afflict the world's population. However, in almost every ethnic, racial, or demographic group, certain genetic diseases occur at higher frequencies among their members than in the general population. This is the case for Ashkenazi Jews. Tragically, families and congregations are not aware of the genetic disorders possible in the Ashkenazi community, nor are they aware of the genetic testing and counseling options available to couples

When members of a population marry and reproduce almost entirely within the group, such as was true of the Jews of Central and Eastern Europe, the effects of random disease-producing alterations in genes are not diluted by the introduction of other genes from outside the community. Under these circumstances, these genes become entrenched in the population. It is estimated that Ashkenazi Jews carry five to fifty disease-producing genes, which are harmful if passed on to children by both mother and father. Many of the diseases are severely incapacitating and can be very debilitating, leading to death in infancy or early childhood. Tay-Sachs disease may be the most well known, but others, just as prevalent and just as devastating, also shatter the lives of Jewish families.

Most of the Jewish genetic diseases are transmitted as recessive traits. Recessive traits are those for which you need two copies of an altered gene, a copy originating from the male and another from the female, to cause the disease in the offspring. These genes also occur equally in men and women and can be transmitted by both. Thus a couple which has no history of a disease in either family may have a child with one of these disorders because each was carrying the recessive gene. Two carriers of the same trait have a 25% chance of having a child with that genetic disease and a 50% chance of having one that is a carrier of the syndrome. Among the Jewish genetic disorders are: Bloom Syndrome; Canavan Disease; Cystic Fibrosis; Familial Dysautonomia (Riley-Day Syndrome); Fanconi Anemia C; Gaucher Disease Type I; Mucolipidosis IV; Niemann-Pick Disease; and Tay-Sachs Disease.\

Genetic counseling is highly recommended for Ashkenazi Jewish couples planning to have a child. Genetic counselors are health professionals with specialized degrees and experience in the areas of medical genetics and counseling who can help couples become informed and make intelligent decisions with respect to childbearing. Recent research has made it possible for medical laboratories to identify most carriers of these diseases from a simple blood test, although this knowledge is not widespread in the medical community. The screening tests for Familial Dysautonomia and Mucolipidosis IV are so new that even many testing centers may not be aware of them. In addition, the new assisted reproductive technologies can help couples avoid the risk of these diseases. In some circumstances it is advisable to do a prenatal diagnostic procedure that can provide important information.

Until very recently, palliative care was the only treatment for these disorders. Researchers from the Mount Sinai School of Medicine and the University of Pittsburgh have recently reported on studies in genetic engineering that have enabled research and treatment teams to reverse the devastating symptoms of Fabry disease and even cure Gaucher disease, both of which are found among Ashkenazi Jews. These results are promising: much research remains to be done.

Stem Cell Research

In its 1995 resolution "Medical Research and Clinical Practice," Women of Reform Judaism called for "continuing fetal tissue research and its use in life saving and life enhancing procedures." Research on embryonic stem cells has even more potential to save and enhance lives because of their ability to develop into a variety of human tissues, such as heart, brain, kidney or over 200 other cells. Stem cell research has the potential to develop treatments for diseases, such as Juvenile Diabetes, Alzheimer's, and Parkinson's. Embryonic stem cells are derived from the human embryos resulting from in vitro fertilization (IVF), an infertility treatment. Estimates indicate that there are 25,000 frozen embryos in IVF clinics developed as part of fertility treatments that were in excess of need and will probably be destroyed.

On August 9, 2001, in an attempt to provide a middle ground between the proponents of stem cell research and its opponents, President Bush allowed the use of federal funding for stem cell research but limited it to research on cells that had already been extracted from embryos. Advocates for the life saving benefits of stem cell research and scientists contend that the existing cell lines developed from these cells might change over time, perhaps becoming inviable. A report issued by the National Academy of Sciences calls for the use of new cell lines "to replace those that become inviable." It also states that federal financing, and the government oversight that comes with it "offers the most efficient and responsible means of fulfilling the promise of stem cells."

Resolutions

Women of Reform Judaism has had long-standing positions on health care and has called for universal access to health care as a priority. In accordance with its commitment to health care for all, Women of Reform Judaism calls for action on the following health care concerns.

1. In accordance with the Jewish tradition regarding mental health as a fundamental part of total health, Women of Reform Judaism concurs with the provisions of the UAHC Proposed 2001 Resolution on Establishing a Comprehensive System of Care for Persons with Mental Illness and urges its affiliates to: 
    
   • Implement programming to destigmatize mental illness, increase awareness that mental disorders are medical concerns and strengthen responsiveness to signs of developing mental health problems from infancy through the senior years; 
      
   • Provide a welcoming and supportive atmosphere, as well as support services by Caring Community Committees, for individuals with mental illness and their caregivers; 
      
   • Advocate, with other like minded groups, community-based coordinated comprehensive systems of care for people with serious mental illness and those with co-occurring mental and addictive disorders including children and teenagers with mental health problems; 
      
   • Seek community support services and programming for caregivers; 
      
   • Participate in coalitions to urge local, state, and provincial governments to provide housing for the mentally ill that is integrated with community mental health services, with special outreach to those who are homeless; 
      
   • Urge the United States and Canadian governments to increase funding of programming for the treatment of mental illness and for research on its prevention and treatment; 
      
   • Call for legislation at the United States federal and state levels to require parity between physical and mental health insurance coverage, both public and private; 
      
   • Join with advocacy groups working to improve the conditions and treatment of mentally ill offenders within the criminal justice system; and 
      
   • Urge increased governmental attention to youth in the criminal justice system and the need for increased funding for community-based treatment programs. 
      
2. Support congregational efforts to develop programs to prevent bullying. 
    
   • Alert sisterhood as well as congregational leaders, and professionals to the need for recognition of bullying among religious and day school children; 
      
   • Inform sisterhood members and congregants about programs dealing with bullying which exist in their communities; 
      
   • Encourage the development of social skills training for bullies and their victims to promote mentally healthy responses to provocative situations; 
      
   • Refer young victims of abusive bullying for consultation with mental health professionals. 
      
3. Given the presence of genetic diseases in the Ashkenazi population, Women of Reform Judaism urges its affiliates worldwide to: 
    
   • Educate and inform sisterhood members, the congregation, and the Jewish and medical communities about genetic diseases among people of Ashkenazi descent and the availability of genetic counseling, testing and new treatments; 
      
   • Urge clergy to counsel Ashkenazi couples about the need for and availability of genetic counseling; 
      
   • Seek financial support for continued research on testing and treatment; and 
      
   • Support community programs to provide opportunities for genetic testing. 
      
4. Embryonic stem cell research has enormous life saving potential. Women of Reform Judaism is concerned that United States federal funding of such research is limited to existing cell lines. Therefore, Women of Reform Judaism calls for continued federal funding of responsible research involving stem cells derived from human embryos produced through in vitro fertilization, but without limitation by date of extraction, and with the limitation that researchers would only use embryos previously earmarked for destruction, which had been released with consent by donors.