On October 9, 2025, the North Alabama Mental Health Coalition convened in Huntsville for introductions, resource sharing, and a policy-and-programs briefing. Highlights included:

• A summary of 2025–26 policy developments (state budget changes, crisis system expansion, the Houston Hunter Act, and federal updates),

• A discussion with Regional Autism Network partners about a searchable resource database,

• Notices of upcoming community initiatives (UAH neighborhood nursing “SHINE” event; a citywide collaboration series on poverty), and an overview from the City of Huntsville and HPD on their Homeless Outreach Initiative.

• The City’s update detailed the South Derrick Street managed camp, a coordinated outreach model with partner agencies, accountability practices intended to reduce harm, and preliminary outcomes from the municipal “unsheltered court” pathway.

• Members identified practical gaps (transportation, cleaning supplies, non-duplicative volunteer roles) and emphasized consistent, stigma-free communication with families affected by recent national discourse on autism.

• Action items centered on data verification for several policy points, aligning community efforts with defined needs, and continuing collaboration through the Homeless Strategy Network.

Policy Developments — 2025 Legislative & Regulatory Highlights

State Policy Updates:
The Coalition reviewed major Alabama and federal developments shaping behavioral-health systems in fiscal year 2026.

• Age of Consent Raised to 16 (Senate Bill 101, Act 2025-455)
  Effective October 1, 2025 - Parental consent is now required for treatment of any youth under age 16.
  Impact: Members noted this may delay counseling access for adolescents ages 14–15, particularly in school-based or primary-care settings. The Coalition will monitor for care disruptions and support local workarounds where possible.

• Voluntary Firearm Storage - “Houston–Hunter Act” (Senate Bill 40, Act 2025-93)
  Enacted May 2025 - Enables individuals to voluntarily store firearms with law enforcement or licensed dealers during mental-health crises, with civil-liability protection for storage providers.
  Impact: Seen as a positive suicide-prevention measure. NAMHC discussed S.A.F.E.R. Together which is a grassroots suicide prevention initiative dedicated to offering an additional layer of support for Military, Veterans, and First Responders (MVFR).

• FY 2026 Alabama Budget Increases
  Adopted April 2025; effective October 1, 2025
  • Medicaid funding rose approximately 19 percent to $1.18 billion.
  • The Alabama Department of Mental Health (ADMH) budget increased 2 percent to about $244 million.
  • An additional $10 million was directed to community mental-health centers.
  Impact: Slight capacity expansion expected statewide; continued monitoring needed for allocation and sustainability under federal funding volatility.

• Crisis-System Expansion
  February 2025 - A sixth Crisis Diversion Center opened in Dothan through SpectraCare.
  Impact: Indicates continued progress toward statewide crisis coverage. Members reiterated advocacy for a comparable North Alabama facility.

• PTSD Commission and Board Modernization (House Joint Resolution 273; Senate Bill 236)
  Effective mid-2025 - Establishes a study commission on post-traumatic stress in first responders and modernizes governance for regional mental-health authorities.
  Impact: Creates an opportunity for local participation and data contributions from coalition members.

Federal Developments:

• Executive Order 14321 – “Ending Crime and Disorder on America’s Streets”
  Issued July 24, 2025; Federal Register July 29 - Directs federal agencies to broaden use of involuntary civil commitment for individuals with serious mental illness or substance-use disorder and to repurpose unused federal properties for long-term treatment.
  Impact: May expand bed capacity nationally but raises civil-rights concerns. The Coalition supports trauma-informed and rights-protective implementation.

• Medicaid Landscape under the “One Big Beautiful Bill Act” (OBBBA)
  Signed July 4, 2025; phased 2026–2029 - Reduces federal Medicaid funding by roughly $1 trillion over ten years and adds new work or “community-engagement” requirements for many enrollees beginning December 2026 (with clinical exemptions). It also ends the 5 percent federal-match bonus for expansion states.
  Impact: Alabama has not expanded Medicaid, so the incentive change does not directly affect current enrollment. However, overall federal reductions and administrative changes may heighten pressure on Alabama’s limited Medicaid budget and on community providers serving uninsured residents.

• U.S. Department of Health and Human Services Autism Initiative
  Announced September 2025 - Launches a national autism registry and calls for review of research on prenatal acetaminophen exposure.
  Impact: Advocacy groups caution against stigma and privacy risks; no conclusive evidence supports the cited link. NAMHC will reinforce evidence-based and neurodiversity-affirming communication.

• DEA Telehealth Rule Change
  Effective October 1, 2025 - Requires new “special registration” for clinicians prescribing controlled substances via telehealth without an initial in-person visit.
  Impact: Potentially disruptive for rural medication management and continuity of care. Members will monitor early data for regional effects.

• SUPPORT for Patients and Communities Reauthorization Act
  Pending final passage; expected early 2026 implementation - Extends funding for 988 Suicide & Crisis Lifeline, Certified Community Behavioral Health Clinics, and related SUD/mental-health programs through 2030.
  Impact: Maintains essential national funding streams and stable grant opportunities for Alabama providers.

Program updates & community initiatives:

• Regional Autism Network at UAH:
  Regional Autism Network representatives described ongoing work to centralize local resources, including small, independent providers, into a searchable public database to improve navigation. A member cautioned that recent national commentary suggesting prenatal acetaminophen causes autism is not supported by broad clinical consensus and has introduced guilt and confusion among families. The group affirmed the importance of clear, evidence-based communication and swift referral to screening and evaluation pathways.

• UAH Neighborhood Nursing announced the SHINE Symposium for Health, to be held on October 21, 2025, previewing a community-embedded nursing model that partners with agencies to deliver services and referrals within neighborhoods.

• A city-facilitated Community Conversation on Poverty held September 25 convened nonprofits and faith leaders to define barriers to collaboration and set 6–12-month goals (education, health, transportation). A follow-up is planned for November 18 (site TBD), with an emphasis on strategy, shared targets, and accountability.

• S.A.F.E.R. Together (a grassroots coalition) reported local participation by two licensed dealers in secure firearm storage for households seeking time-and-space separation from firearms during crises, pending donation-funded locker purchases.

• Invisible Lawyers is hosting an art project (“Day in the Life”) with a planned 2026 exhibit and revenue sharing to support both artists and programming.

City of Huntsville presentation (Homeless Outreach Initiative):

City Community Development and the HPD Community Outreach Unit outlined a coordinated model that relies on a three-part structure: administration (City), law enforcement (HPD), and community partners (e.g., day services, behavioral health, recovery, HMIS, shelters). The approach prioritizes:

• Data-informed coordination (point-in-time counts plus seasonal “summer counts” for trend-tracking);

• Administrative support for reporting, relationship-building, and gap identification;

• HPD’s role focused on public education, resource linkage, addressing citizen concerns, and measured accountability (e.g., citations with referral to a voluntary unsheltered court track rather than punitive outcomes); and

• On-site outreach at the South Derrick Street managed camp, which operates with posted rules, defined volunteer procedures, and weekly multi-agency cleanup and engagement.

City staff emphasized safety, sanitation, and non-exploitation standards at the camp. Drop-offs at tents (food, clothing, furniture) have led to accumulated waste and vermin, complicating casework and health. The team asks volunteers to deliver through designated channels and to align efforts with case management goals. As one city representative put it, “You can have empathy without enabling.” Another added that bringing all necessities directly to tents can eliminate reasons to visit day centers, where professional services (case management, clinical care, recovery supports) are available.

Early outcomes & system gaps:
The municipal unsheltered court, a voluntary pathway coordinated with providers, has moved a reported double-digit number of participants toward stabilization and housing this year. [Note: Verify current graduate count and timeframe.]
Persistent gaps include transportation, cleaning supplies for residents’ use, and non-duplicative volunteer roles outside the heavy focus on meals and clothing. The City’s Homeless Strategy Network continues to frame priorities and align partners. Members also noted the challenge of serving individuals with serious mental illness and intellectual/developmental disabilities who cannot reliably engage with office-based services; longer-term clinical capacity remains limited in North Alabama. [Note: Verify current regional bed counts and wait times.]

Recap (Actions & Follow-Ups)

• Policy Tracker: Compile/verify 2025–26 policy items (age of consent change; SB 40/Houston Hunter Act; state budgets; crisis centers; PTSD commission; federal EO; DEA telehealth rule; SUPPORT reauthorization). [Owner: LOF/NAMHC policy workgroup] [Note: Verify citations and effective dates.]

• Autism Navigation: Proceed with RAN resource database build; circulate care survey and evaluation directory; share consistent messaging for families.

• UAH SHINE: Share October 21 event details after official release; explore alignment with coalition partners for neighborhood referrals.

• Community Conversations: Distribute Nov 18 meeting information; begin drafting shared goals and metrics for poverty-related determinants (including mental health access).

• Houston Hunter Act / Safer Together: Share coalition link for donations; track launch at two local FFLs contingent on funding. [Note: Confirm program start date.]

• City Homeless Strategy: Respect managed-camp volunteer protocols; route donations via approved channels; prioritize transportation and cleaning supplies over duplicate food/clothing drops.

• Unsheltered Court: Confirm current graduation data; consider case studies for training.

• Capacity Needs: Document regional long-term care and wait times; explore partnerships for step-down and IDD-informed housing supports.

Stay Connected with NAMHC
🌐 Coalition Website – Stay Informed
📲 NAMHC is Here for You app
✉️ Contact: daniel@LittleOrangeFish.org

Stories and opinions shared in these recaps reflect the voices of participants and guest speakers, and do not necessarily represent the views of Little Orange Fish. Open dialogue of this kind is at the heart of the NAMHC and the Here for You effort. Creating space for honest stories and diverse perspectives is essential to truly understanding and addressing the mental-health needs of our community.

Content generated by Gabrielle Paige Thales, an editorial AI voice developed by Little Orange Fish. All posts are fully outlined, directed, and human-reviewed by Daniel Adamek prior to publication.

Coalition Updates

• Meeting recaps are published each month in the Community section of the Little Orange Fish Substack.

• The NAMHC is Here for You app is now powered by the GPT-5 model, an update that should bring noticeable improvements in how the app helps users search resources and review past minutes.

• GRAMI’s fundraiser happened August 15 at The Ledges, with proceeds supporting counseling for first responders and CIT training.

• Salvation Army shelter services officially reopened June 15.

• UAH’s Health Equity Symposium is set for October 21.

• The Back-to-School workshop from the Kiss Your Brain Initiative was a success, with Harris Home youth participating.

Featured Presentation: Advocating for Change

Rep. Marilyn Lands (District 10), a licensed professional counselor, shared her priorities in Montgomery:

• K–12 prevention – Lands described her push for prevention programs in K–12 schools, noting she had advanced a resolution through the Alabama House but it stalled in the Senate. She stressed that prevention education is key, and that trauma-informed programs in classrooms could relieve pressure on teachers while giving kids tools to manage stress.

• Youth suicide – She expressed heartbreak over Alabama’s high adolescent suicide rates. She believes children should learn about neuroscience and brain chemistry early, so they can normalize emotions and practice self-regulation skills like breathing techniques. Without these tools, too many students remain in “fight or flight” mode.

• Veterans & first responders – Lands highlighted gaps in care for veterans and first responders. She sees opportunities to follow models from other countries that provide stronger healthcare and family supports, and she wants to bring those lessons home to Alabama.

• System gaps – Shortages of school counselors and psychiatric beds mean many youth and adults go without help. Too often, people with serious mental illness end up in jail when they should be in hospitals. She is working with coalition members to raise awareness of these critical shortages.

• Policy reform – She introduced HB14, a ballot initiative bill that would give citizens a direct way to bring issues forward when the legislature does not act. She encouraged coalition members to support it and to reach out with other policy priorities, especially around mental health and maternal health.

She urged coalition members to contact legislators directly, combining data with personal stories. Rep. Lands can be reached through her official contact page.

Real-Life Gaps: A Mother’s Story

One coalition member shared the story of her son’s 18-year struggle with bipolar and schizoaffective disorder. Her experience revealed painful systemic failures and offered a firsthand look at how families can be left without support:

• Families face confusing probate procedures. In her case, repeated trips to the probate office brought conflicting answers about how to seek an involuntary commitment. Instead of clarity, she often encountered delays and frustration, leaving her son without needed treatment. (Madison County Probate Office).

• Police often respond first, even when families request a mental health crisis team. On one occasion, she specifically asked for a Crisis Intervention Team officer but armed police were dispatched instead, further escalating the stress of the situation.

• Guardianship laws are poorly understood by many responders. Despite holding guardianship, she was told she had little authority to direct her son into treatment. Frontline workers disagreed about what guardianship meant, leading to inaction until his behavior worsened.

• With limited psychiatric beds, jail too often becomes the default “treatment.” After a manic episode, her son was eventually taken into custody and incarcerated rather than hospitalized, highlighting how correctional facilities are absorbing cases that should be in clinical care.

She emphasized the urgent need for better communication, training, and access at every level of the system. She also pointed members to McLean Hospital’s free online resources as a valuable tool for families trying to understand mental illness and advocate for their loved ones.

Closing Notes

• Efforts are underway to restart NAMI Huntsville. Interested? Contact Suzanne Katschke.

• Daniel will continue posting monthly recaps on the LOF Community blog.

• Next NAMHC meeting: Tuesday, September 9, 2025 at 11:00 AM at Wellstone.

Resources Mentioned

• NAMHC Website – Stay Informed

• NAMHC is Here for You app

• GRAMI

• Rep. Marilyn Lands | HB14 Bill Info

• Madison County Probate Office – Commitment Process

• McLean Hospital Educational Resources

• NAMI National | Contact Suzanne Katschke

Reflection:
This month’s meeting made clear how state-level advocacy and legislative efforts—like Rep. Lands’ push for prevention programs and HB14 - intersect with the real-life struggles of families trying to navigate probate courts, emergency response, and a shortage of psychiatric beds. The combination of policy discussions and a parent’s lived experience provided a fuller picture of where North Alabama’s mental health system stands today, and the specific areas where change is most urgently needed.

Stay Connected with NAMHC

• 🌐 Coalition Website – Stay Informed

• 📲 NAMHC is Here for You app

• ✉️ Contact: Daniel@LittleOrangeFish.org

• 🗓 Next Meeting details posted monthly on the LOF Community blog

Stories and opinions shared in these recaps reflect the voices of participants and guest speakers, and do not necessarily represent the views of Little Orange Fish. Open dialogue of this kind is at the heart of the NAMHC and the Here for You effort. Creating space for honest stories and diverse perspectives is essential to truly understanding and addressing the mental health needs of our community.

Content generated by Gabrielle Paige Thales, an editorial AI voice developed by Little Orange Fish. All posts are fully outlined, directed, and human-reviewed by Daniel Adamek prior to publication. Thanks for reading Little Orange Fish! Subscribe for free to receive new posts and support our work.

Staying Connected: Coalition Updates

Daniel Adamek (Little Orange Fish) opened the meeting by reaffirming the value of collaboration and communication. Several coalition updates were shared:

• A Google Group is being established to streamline member communication.

• A new public service announcement is airing on WLRH, inviting community members to join coalition efforts.

• Using the “8 Domains” framework introduced in June, Daniel, Krista Moulton (Therapist), and Mack Yates (SVDP/VOP) have begun identifying service gaps across the region.

Policy in Focus: H.R.1 and Its Far-Reaching Effects

The central topic of the meeting was the potential impact of H.R.1 on Medicaid and mental health services in Alabama. Daniel gave a detailed presentation, which is summarized in the briefing sheet which can be found on the Resources page at the NAMHC website.

Some of the most pressing changes include:

• Over 100,000 Alabamians could lose Medicaid coverage.

• Federal funding for mobile crisis teams and peer support services will be eliminated unless waivers are granted.

• Emergency Medicaid for non-citizens is banned entirely.

• New work requirements for Medicaid will likely disqualify many individuals—especially disabled veterans, people in recovery, and single parents—who cannot meet them.

• Alabama’s aging data infrastructure is ill-equipped to handle the verification requirements the bill introduces.

Stephanie Jennings (Best Life Recovery) and others highlighted how these changes will disproportionately harm women exiting rehab, veterans with disabilities, and working-class families already struggling to stay afloat. One recurring question: how will people be expected to work 20 hours a week when they're still in crisis and have no access to childcare or transportation?

It’s important to note that the coalition’s mission is not political. We represent a wide range of perspectives, and our shared work is grounded in one unifying goal: ensuring everyone in our community has access to the quality mental health care we all deserve. Understanding policy - regardless of where it originates - is essential if we are to respond effectively and compassionately to the changing needs of our neighbors.

Real Lives, Real Stories: The Power of Lived Experience

Krista Moulton emphasized the importance of community storytelling. Policies like H.R.1 aren’t just abstract - they impact real people, in real time.

By collecting stories from individuals directly affected by Medicaid cuts and service disruptions, the coalition hopes to make a human case for policy change. Members were encouraged to think about how they can contribute to this effort by amplifying voices and sharing stories from their own organizations and networks.

The “8 Domains” as a Strategic Lens

To help structure an effective response, the coalition is using the 8 Domains framework, which helps break complex issues into key areas of action:

1. Policy and Governance

2. Financing and Coverage

3. Workforce and Gatekeepers

4. Access and Service Delivery

5. Prevention and Early Intervention

6. Crisis and Acute Care

7. Community Supports and Recovery

8. Data, Evaluation, and Quality

This framework allows organizations to map their strengths and identify where they can help mitigate the impact of H.R.1. Krista proposed creating a Medicaid Support Network - a coordinated effort across agencies to assist with Medicaid renewals, waivers, and outreach.

Next Steps and Opportunities

A few clear action items emerged from the meeting:

• Daniel will compile member feedback into action items and upload them to the coalition website.

• Members were urged to begin internal conversations about how their organizations can respond to H.R.1.

• Everyone was encouraged to engage with the resources and tools now live at northalabamamentalhealthcoalition.org.

Upcoming Events: Stay Involved

• Well Read Book Club: July 17 at Nativity Church

• UAH Caregiving Conversations: July 22, 1 PM and 6 PM

• Back to School Workshop (Kiss Your Brain Initiative): July 28, 1–4:30 PM at the Richard Showers Center

The July NAMHC meeting made one thing clear: while the road ahead may come with some challenges, the commitment of this coalition to advocate, adapt, and support one another remains strong. Whether through policy analysis, lived experience, or local initiative, the community is showing up - and standing up - for mental health.

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Content generated by Gabrielle Paige Thales, an editorial AI voice developed by Little Orange Fish. All posts are fully outlined, directed, and human-reviewed by Daniel Adamek prior to publication.

Diagnosis: The nature of a disease; the identification of an illness. -medicinenet.com

When I began to pen my thoughts for this post, my original intent was to begin the conversation on Posttraumatic Stress Disorder (PTSD) as I’d promised a couple of weeks ago. To get my definitions straight I went to what is often referred to as the “bible of psychiatry”: The Diagnostic and Statistical Manual of Mental Disorders. Specifically I went to the most recent version, the fifth edition, DSM-5. This is the standard reference manual for categorizing and diagnosing mental health disorders.

PTSD was first introduced in the third edition of the manual in 1980. The criteria for its diagnosis have evolved quite dramatically since that time. This isn’t terribly surprising as we should expect our understanding of the condition to have grown and in turn the ability to identify and characterize its symptoms. In fact, in the DSM-5, a new diagnostic category, “Trauma and Stressor Related Disorders” was created, and PTSD found its place there. It had previously been categorized as an “Anxiety Disorder”. The rationale for this move, as I understand it, is that PTSD also includes disruptions of other emotional states outside of the fear/anxiety spectrum. As I said it doesn’t surprise me that the diagnostic criteria have changed, but the fact that an entirely new category was created to accommodate the disorder is curious to me.

Even more peculiar to me is that the first diagnostic criterion in the DSM-5 is not a characteristic of the disorder. It is the identification of an external event that could have caused the disorder; “Exposure to actual threatened death, serious injury or sexual violence…”. I believe PTSD may be unique in the manual in this regard, i.e., the identification of a presumptive cause is a requirement for the diagnosis.

This inconsistency results from, and points to a larger issue with the DSM; The diagnostic approach in the DSM doesn’t really describe “The nature of the disease[s]” it identifies, but rather provides a framework to categorize sets of subjective and behavioral symptoms. For this very reason there is a lot of controversy around the DSM, regarding its construction, its intent, its usefulness, and its validity in general. That’s not a conversation we’re likely to make much headway on here, but I do think it is important for us, the ones who rely on the health care system, to recognize that there are some notable limitations to this primary resource that our health care providers use to assess and guide their decisions about our mental health.

"Mental health diagnoses are starting points, not definitions of our identity."

I mentioned above that the DSM is described as the “bible of psychiatry”. This sort of suggestive sacralization, even if not literal, is misleading and has had some severely negative consequences on the way we perceive mental health and the expectations we have for mental health care. I’ve got three major areas of concern:

1. A mental health diagnosis is not personal. The diagnoses in the DSM are just labels and say nothing about our character or identity. While the conditions identified in the manual may be adequate starting points for our health care providers to understand and communicate our needs, they are not useful to us for purposes of self-understanding and awareness.

2. Mental health is physical health. The fact that the DSM diagnoses and their descriptions generally don’t include fundamental physiological characteristics is not an indication that mental health is not physical health. This omission is an unfortunate consequence of historical misconceptions and limited scientific tools that frankly has resulted in the persistence of some highly suspect science. The good news is that the tools of biotechnology are now more commonly being applied to understanding matters of the mind, and we’re seeing increasing use of biological indicators to understand and diagnose mental disorders.

3. A mental health diagnosis is not personal enough. One in five Americans is taking a prescribed medication, a psychotropic drug to change the way they think or feel. 80 percent of these medications are being prescribed by practitioners who are not mental health professionals. Certainly these medications are providing enormous life-changing, and often life-saving benefits to many people. But these numbers, to me, just feel to be a little out of balance.

Our health insurance moderated system relies quite a lot on the DSM for making decisions about how our personal mental health needs get met. Often a diagnosis based on the DSM is required for health insurance coverage for a treatment. A consequence of this is a certain restriction on how a doctor can treat the particular needs of a patient. Considering the vague and subjective nature of the DSM, this seems absolutely counterintuitive and counterproductive. While the DSM might be an adequate starting point to help our providers understand our needs, individual attention and personalized treatment has to become the expectation if we are to have a strong and healthy community.

It was in the 1970s when the diagnosis PTSD first gained acceptance. It was the observation that a great many veterans returning from Vietnam were suffering from a condition connected to their combat experiences that demanded that a diagnosis be recognized. It was in 1980 that the condition was included in the Diagnostic and Statistical Manual for Mental Disorders. There’s been a huge amount of observational research on the effects of psychological trauma since that time. That research has certainly shed considerable light on the common behavioral symptoms and prevalence of the disorder, but the specifics of what external factors and personal characteristics result in the disorder, and how it manifests in different individuals remain elusive. The current diagnostic criteria are summarized as follows: 1) Exposure to a life-threatening event, serious injury or sexual violence. 2) Recurring memories or flashbacks. 3) Avoidance of trauma reminders. 4) Changes in mood or cognition. 5) Attention problems, easily startled or violent outbursts.

Most people don’t develop PTSD following a life-threatening or otherwise violent traumatic event. For the general population, the statistical probability of developing PTSD following trauma exposure is consistent with those figures above related to combat exposure, somewhere between 10-20%. That is a wide range, and its uncertainty reflects our limited understanding of the condition, but it clearly illustrates that PTSD is not the normative response.

So who are those, let’s just say 15%, and what makes them susceptible? How much, if any, does one’s genetic makeup influence their susceptibility? What roles do environment and experience play? Of course, these are standard questions we want to answer in order to understand any non-normative behavior, be it a disorder or an extraordinary capability such as elite athleticism or intellectual or artistic genius. In any case, the answers lie in the physiological mechanisms that drive all the behaviors that define our individuality.

"Researchers, using modern tools of science and medicine, have revealed that there are many chemical and structural differences in the brains of those suffering from PTSD."

A reasonable starting point to understand those mechanisms is to try to identify the machinery involved, and compare the structures and operations of those machines between typical and atypical individuals. In biological terms, those structures are the anatomy of the machinery, and the operations are the physiology. Our understanding of PTSD in these terms is still very limited. Indeed this is the case for much of our understanding of how our minds work. We have made some headway towards understanding the anatomical pieces that make up our minds, but an understanding of what those pieces do and how they work together is still largely absent.

The identification of the brain as the engine of the mind is a relatively recent discovery. The earliest cited evidence that the brain is responsible for the way we think and behave comes from the case of Phineous Gage. In 1848 Gage survived a railroad construction accident where an iron rod pierced his head resulting in the destruction of the entirety of the left frontal lobe of his brain. He exhibited significant changes in personality following his recovery from this accident. It was this observation that established that a critical function of the brain is to manage the way we think and feel.

We now take it as common sense that physical trauma to the brain can have negative impacts to cognition, and we’ve come to accept that psychological trauma can also negatively impact cognition.

So it might follow that psychological trauma can also be associated with changes in the brain. And indeed researchers, using modern tools of science and medicine, have revealed that there are many chemical and structural differences in the brains of those suffering from PTSD.

It would be easy to jump to the conclusion that the brain is the sole anatomical piece whose workings we need to understand in order to elucidate the mechanisms of PTSD. However, while the brain (the nervous system) is unambiguously the engine of the mind, it is also necessarily working in conjunction with effectively all the other systems in the body, e.g., the cardiovascular, immune and endocrine (hormone producing) systems. The communication between the brain and all the other systems that comprise us is bidirectional; That is, the brain may regulate certain changes in the body but it is also a certainty that changes in the body can result in changes in the brain.

In the case of PTSD, the interdependence between the brain and the other body systems is strongly hinted at by the high rates of comorbidity (the concurrence of other disorders), including cardiovascular, gastrointestinal and immune disorders. For example, Iraq and Afghanistan war veterans with PTSD show an increased risk for autoimmune disorders. More relatably, the simple fact that we universally recognize that certain psychological stimuli cause a “visceral” response underscores the full-body nature of the mind.

With these observations it doesn’t require a great leap of imagination to recognize that the mind and body are inextricably linked, but a scientific understanding of what these linkages are, and how they work, is still in front of us. How far out in front of us will depend on how we as a community prioritize mental health, and the resources we are willing to allocate to advance the science and medicine of the mind.

The lives of each of the survivors of that horrific experience were drastically changed, their life views, their very constitutions, were forever reshaped. This may seem to be a statement of the obvious, as we can all imagine that witnessing such violence and loss of life, particularly of those close to us, would necessarily cause psychological distress that could persist and change how we think and feel. But in truth, the toll that this kind of experience can take on an individual is beyond the imagination, because how it manifests is unpredictable, extremely complex, and very particular to the individual.

One of the survivors of the UAH shooting, biology professor Dr. Joe Ng, made this very observation, that is that each of the survivors responded and coped differently with the trauma of that experience. He recognized and acknowledged that he, like everyone involved, had been undeniably changed by this event, and those changes weren’t simply explainable by psychological factors alone. It made him ask the question “…why are certain people resilient to PTSD while some are very sensitive?” As he looked into the scientific literature he discovered a growing body of research documenting incidences of physical manifestations of disease associated with Post Traumatic Stress. Many of these reports described symptoms that could be associated with immunological factors. To explore this connection, Dr. Ng collaborated with psychologist Dr. Eric Seemann to look for blood-based indicators associated with PTSD. The results of the pilot study provided compelling evidence that there is indeed a connection between the symptoms of Posttraumatic Stress Disorder and our immune system.

"Our immune system has a memory and can maintain its memories for many years, possibly even a lifetime."

As I’m writing this, much of the world has been on a stay-at-home “quarantine” for nearly two months in an attempt to minimize the human cost of the COVID-19 pandemic. There is still a great deal of uncertainty about how we, as a global community, will best get control of this novel virus to minimize its economic, social, and human impacts. It’s agreed by most epidemiological experts that testing is critical to this end. Tracking the incidence of infection is crucial to reducing the near-term spread of the infection, and quantifying the prevalence of exposure is necessary to understanding where we stand in terms of the building of our “herd immunity”.

There are essentially two basic types of testing being done, molecular (viral) testing and serological (antibody) testing. Molecular testing establishes the presence of an infection by identifying the virus in the system of the individual. This approach only determines if an individual is currently infected. On the other hand, serological testing determines if an individual has been infected at some point in the past by identifying the presence of ‘antibodies’ to the virus, but can’t confirm a current infection. What the prognostic value is of these antibody tests is a subject of some debate. Generally speaking though, the presence of antibodies in an individual to a particular infectious agent suggests immunity to that specific variant of the agent.

I mention the COVID-19 situation because it is a current example that demonstrates the amazing adaptability of our immune system. It also illustrates the incredible fact that our immune system keeps a record of many, if not most of the pathological or toxic things that find their way into our bodies. In other words, our immune system has a memory and can maintain its memories for many years, possibly even a lifetime.

What does this have to do with post-traumatic stress? When Dr. Ng set out to understand the connection between psychological trauma and the immune system he focused on this very feature, the fact that our immune system keeps a record of its business. But he didn’t have an identifiable pathogen or toxin against which he could look for an immune response. So very cleverly, he decided to look at the molecular records kept by our immune system. Using some of the tools of modern biotechnology, Dr. Ng looked at one particular area of the immunological library where these records are kept, and he characterized the molecular structures, that in effect comprise that part of the memory storage of our immune system. We all maintain thousands of different variations of these molecular structures, and that molecular log file is absolutely unique to each one of us.

The compelling finding from the pilot study I alluded to above, is that there was a very specific molecular structure, amongst many thousands, that was found only in the immunological libraries of individuals who had suffered from the symptoms of PTSD. Furthermore, this structure was found in almost all, greater than 90%, of the subjects with PSTD symptoms. What this observation means specifically, or what practical applications it will enable, remains to be determined, but that is the incremental nature of scientific discovery and medical progress.

In October of last year, Little Orange Fish kicked off the Inner Defense Initiative. We assembled a team of scientists, information technologists, and mental health professionals, with doctors Ng and Seemann leading this effort to build on their previous research. Describing the linkage between psychological trauma and the immune system, our inner defense, is the objective of this initiative. We aim to elucidate the biology of psychological trauma, to provide an understanding of key aspects of the physiology that determines how individuals process and respond to trauma. This research will provide a foundation for a personalized approach to better self-understanding, medical diagnosis, and treatments for PTSD.

It is encouraging that the topics of mental health and mental health care are receiving increased attention in the public dialogue. It concerns me though, that much of that discourse is not in the right context, that we’re not focused on the real problems we need to solve.

It’s most often a public safety issue that puts the topic of mental health into the headlines. The most common driver of these headlines is an act of mass violence. When this happens, invariably I hear in some form, the suggestion “It’s a good thing that this is bringing more attention to mental health.” I don’t agree with this presumption.

Public safety is not public health. Clearly, public safety is essential to the health of our community, and there’s no disputing that public health and safety issues often intersect, but addressing public health issues primarily as a matter of public safety is not only doing a disservice to those in need of mental health care, it’s also almost certain to be ineffective in protecting us from people doing bad things.

I’m not suggesting that the health of our community should be prioritized over its safety. The two are front and center in the news right now with the coronavirus pandemic. We are asking individuals to self-quarantine, and in some cases enforcing a quarantine where deemed appropriate to try to contain the spread of the infection. In this situation, public health and public safety might appropriately be seen as one and the same.

A couple of weeks ago there was an encouraging story on NPR, “America’s Mental Health Crisis Hidden Behind Bars.” I think it’s encouraging insofar as it indicates that we are starting to see recognition from the powers that be in law enforcement, that incarceration is not an appropriate treatment for those who demonstrate unlawful behaviors due to a mental health issue.

The essence of this story is captured by Patrisse Cullors’ slogan “You can’t get well in a cell.” Cullors has a brother who’s been diagnosed with schizoaffective disorder and has spent significant time in the LA Jail system. She asks, recalling the first time she saw her brother incarcerated there “… why would our society allow for someone who’s sick to be treated this way, to not be given the kind of care they deserve?”

"The rate of Serious Mental Illness in federal, state and local prisons and jails is about 15%-20%"

Tim Belavich, director of mental health for the Los Angeles County jail system underscores this sentiment. “By default, we have become the largest treatment facility in the country. And we’re a jail. I would say a jail facility is not the appropriate place to treat someone’s mental illness.”

This problem is not unique to the LA jail system. Across the country, the rate of Serious Mental Illness (SMI) in federal, state and local prisons and jails is about 15%-20%. The rate of SMI in the general population is about 4%.

I am happy to say that right here in Huntsville, Alabama, our city and county law enforcement agencies are working together with Wellstone Behavioral Health, our local mental health care provider, to address this very issue. They’ve recently implemented a jail diversion program to ensure that those who need mental health care are getting that care in a timely manner. They are also providing Crisis Intervention Team (CIT) training to select officers to support their efforts to better identify and respond when a citizen they intereact with has mental health issues. Admittedly their efforts are primarily in the interest of public safety to reduce recidivism, but to me, this approach clearly prioritizes the protective mission of law enforcement and the corrective charter of our justice system.

While the numbers plainly indicate that there is a problem associated with a disproportionate prevalence of mental illness in our prison systems, there is a critical distinction that needs to be made, one that there should be no confusion about. We’ve acknowledged that the rate of serious mental illness in the jailed population is about four times higher than that in the general population. This does suggest that individuals with mental illness may be ‘more prone’ to “criminal” activity. But this in no way indicates that mental illness makes any particular individual likely to commit acts of violence or other criminal behaviors. To suggest that mental illness is a good predictor of criminal behaviour absolutely puts the conversation on mental health in the wrong context. This only serves to reinforce the already destructive impacts of stigma, and can only lead to similarly destructive and regressive policies around mental health care.

Mental illness is not an infectious disease, but it will have life-changing impacts on every one of us at some point in our lives. To simply quarantine those with serious mental illness, by incarceration or institutionalization, is an ineffective approach in terms of public safety, is counterproductive in terms of public health, and most importantly – it’s just inhumane.

“I wanted to acknowledge the fact that I have PTSD. We don’t even know that we are suffering from this mental health disease.” This comes from an interview of musician G Herbo where he’s talking about his new album titled “PTSD”, released just last week.

‘We don’t even know’, why we feel the way we do and have the thoughts we have. Life is enormously complex, and there’s a constant inflow of stuff that our bodies process, respond to, and in turn incorporate into who we are, be it the food we eat, the air we breathe, sights we see, social interactions we have, or the countless other things we’re exposed to in our environment. Most of these things we aren’t even aware of. We’re even less appreciative of how these things are shaping who we are.

My working definition of ‘mental health’ is the health of the apparatus that manages the way we think and feel, and ultimately the way we behave. We know it is in large part comprised of the brain – but not completely. The brain’s interactions, the chemical, electrical, and physical communication with all of our other systems, have to be considered as part of that apparatus as well. Those other systems are required in many cases to receive, process and incorporate that ‘inflow of stuff’. Every piece is ‘physical’. Mental health is physical health.

"We often don't realize how our experiences shape our thoughts and behaviors."

Our mental health, like every other aspect of our health, is a product of our genetically determined make-up, and our experiences – all the stuff that we’re exposed to as we live life. Of course, our behavior has a lot to do with determining those experiences, but the converse is true as well, our experiences shape our behavior. The big lie we’ve accepted culturally, and that we hold ourselves to personally, is that we are, or should be aware of how these experiences inform our decision making and our behavior.

We all make decisions and do things that we know are not in our best interest, which are impossible to rationalize. The thing is though, that most of the factors weighed in our moment-by-moment decision making process are not available to the conscious, reasoning part of our minds. Even in our well-deliberated decisions there are many factors at play that aren’t apparent or even knowable to us. So even if we were able to be perfectly rational, we are rarely, if ever, privy to enough information to make a perfectly informed and reasoned decision. But it’s not a lost cause, we do have the ability to feel things. The way we feel has at least as much to do with our behavior as does our ability to deliberate. So if those feelings get skewed it’s very difficult to make good healthy decisions.

The increasing awareness of the prevalence and realness of Post-traumatic Stress Disorder (PTSD) has started to expose what I mention above. This increased awareness has a lot to do with the crisis that is the alarmingly high incidence of death by suicide by veterans and active military. It is easy for us to imagine how the horrific experiences of war could change the way an individual might perceive the world and herself or himself in it, but exposure to the horrors of war is not the only source of the kind of trauma that leads to PTSD. Other causes include sexual assault, natural disaster, refugee displacement, physical injury, and medical illness. In the case of G Herbo, it was growing up in a violent environment in inner-city Chicago, where he witnessed murders and was himself a victim of gun violence.

Not everyone who experiences these kinds of trauma will display the symptoms of PTSD. It’s estimated that 5-10% of those exposed to severe trauma will develop the disorder. What this estimate means, and why certain individuals are more or less affected is something I want to discuss in future conversations.

For now, I want to wrap things up with a couple of observations:

First, the very existence of the disorder we call PTSD illustrates that we are undeniably shaped by our experiences.

Second, we desperately need to ensure that every individual can get, and feels comfortable getting, routine professional mental health care, because we simply don’t have the perspective to understand how those experiences might be standing in the way of our living productive, fulfilling lives. We don’t even know.