Access Institute News

Access Institute Executive Director Bart Magee, Ph.D. and Access Institute faculty member Nancy Drooker, Ph.D. will participate in a panel at the upcoming International Association for Relational Psychoanalysis and Psychotherapy (IARPP) conference in San Francisco. Their presentation will focus on Access Institute's Elder Psychotherapy Program, and they will discuss developing the innovative training and treatment model- its challenges and its benefits-that provides on-site psychotherapy and internship training at the Bayview Hunter's Point Adult Day Health Center. The panel, moderated by Neil Altman, Ph.D., will include other professionals who work to provide services to disenfranchised and underserved communities. We hope you can attend.

IARPP Annual Conference
Expanding the Relational Context
Desire, Sexuality, Politics, Economics, Aesthetics, Technologies
Thursday through Sunday, February 25 - 28, The Fairmont Hotel

The theme of the 2010 International Association for Relational Psychoanalysis and Psychotherapy conference is to expand on relational theory and clinical work by exploring subjects that take psychoanalysis into social sphere: desire, sexuality, politics, economics, aesthetics, technologies. Besides the roundtable on Community-based Psychoanalysis, other highlights include five plenaries focused on the following: Desire and Consent, Transgendering, Economic Crisis/Relational Crisis, Birth Technologies and Subjectivity, and Collective Trauma and Reconciliation. In addition to pre-conference workshops on relational theory, adult onset trauma, and meditation in psychoanalysis, there are 35 paper sessions and featured panels that include: A Conversation between Steve Seligman, Erik Hesse, and Mary Main, Aesthetics, and Culture and the Transformation of Psychoanalysis.

San Francisco--December 18, 2009 We will look back on 2009 and recognize it as the year when Access Institute's research program began to take shape. This year Access Institute submitted proposals for therapy outcome research, became the new home for The Scales of Psychological Capacities and received an invitation to travel to the University of Uruguay to provide research training-events that together helped jumpstart our empirical research endeavor.

Researchers Denisse Dogmanas, Laura DeSouza and Rosa Zytner
with Bart Magee in Montevideo, Uruguay, Nov. 2009

Patients with complex mental disorders make up nearly half (45%) of those in the United States diagnosed with any mental disorder and make up the majority of patients treated at Access Institute's clinic. Evidence suggests that the kind of long-term psychoanalytic psychotherapy that Access Institute provides is effective for these patients, who often do not respond adequately to short-term interventions. In order to assess the effectiveness of longer term therapy and to contribute to a small but growing body of research in this area Access Institute has developed a research proposal that, if fully funded, will begin in the summer of 2010.

In a second important research development, Access Institute became the new custodian of The Scales of Psychological Capacities (SPC). The SPC is an interview-based instrument developed by Robert Wallerstein, M.D. and his colleagues designed to measure the structure of personality and the change in character organization that takes place though the psychotherapy process. What is unique about the SPC as a measure is its ability to tap into deeper psychological structures that self-report measures and symptom questionnaires cannot assess. By measuring structural and personality changes, the SPC can help us gauge the more enduring changes that psychodynamic therapy supports and help us analyze those changes over the long term.

The SPC has been used in psychotherapy research in Europe and the U.S., but is neither well known nor utilized to its potential. The developers of the measure have all retired and asked Access Institute to guard the data and the training protocols and to agree to promote the use of the measure and respond to any new requests for training.

The first request for training came from the Department of Psychology of the University of Uruguay, (Facultad de Psicologia, Universidad de la Republica) and Executive Director Bart Magee, Ph.D. agreed to travel to Montevideo in late November 2009 to train a group of faculty and graduate students in the SPC, to exchange clinical knowledge, and to explore the feasibility of joint projects, including research and educational exchanges. A group of nine enthusiastic psychology faculty and graduate students participated in the training that lasted for nine days. The group was assembled from a special center within the University devoted to clinical research (Centro de Investigacion Clinica en Psicologia, CIC-P). Dr. Magee gave the group training in the SPC including a thorough understanding of the 17 capacities (i.e. hope, zest for life, flexibility in thinking, commitment in relationships, self esteem, affect tolerance, impulse control, etc.), taught them the structured interview, and helped them learn to rate subjects on each capacity. In spite of having to learn the measure in English, the group picked up the concepts quickly. Now with the basic training under its belt, the group plans to translate the measure into Spanish and to utilize it in research in the University's public mental health clinic and in other settings throughout the country. Beyond gaining knowledge in the SPC and becoming the first Spanish-speaking country to employ the measure, the training was important for the University in realizing its goal to enhance empirical psychoanalytic research, provide more opportunities for doctoral student research and create vehicles for collaboration with other universities and research groups.

The trip and the new relationship forged in Uruguay benefits Access Institute and the University of Uruguay in a number of ways. Access Institute has a new international partner where multi-site research studies, faculty and student exchanges and other opportunities to develop and share knowledge can be pursued. Similar to the population Access Institute serves, patients at the public clinic in Montevideo are low income and suffer from complex and difficult to treat psychosocial problems. Similarly, both programs employ innovative methods of addressing the problems of specific groups (the elderly, children) and specific problems (suicide, psychological trauma) and can benefit from sharing resources and information. Like Access Institute, The University of Uruguay has a strong educational program where all bachelors and masters level students receive sophisticated training in psychoanalytic theory and technique and both institutions can benefit from sharing educational methods and resources. Also like Access Institute, the University is a small but determined institution that has developed a top-notch clinical program and with modest means seeks to create programs with the widest possible social impact. At both institutions much of the labor for research and clinical supervision is donated by a faculty who devote themselves to education, training and clinical practice. With so many common interests Access Institute and the University of Uruguay look forward to a lasting and valuable partnership.

San Francisco--September 18, 2009 The school year has just begun and Access Institute has launched its second in-school therapy program at Hillcrest Elementary School in the Excelsior district of San Francisco.

At Hillcrest, using the same basic principles that succeeded at Access Institute’s first program Grattan School, the innovative project provides on-site individual therapy for the school’s most distressed students, facilitates Care Team meetings with school staff and teachers, and addresses the concerns of families by facilitating family interventions. Having mental health care available at the school removes a significant barrier for families who need the support of psychological services.

Like at Grattan all services at the school are provided free of charge.

Hillcrest school draws from the southern, underserved neighborhoods of San Francisco . Many families are immigrants, are headed by single parents, are lower-income and are coping with multiple environmental and social stresses. The school is unique due to its high level of need and its desire to build a “community school” which, according to Hillcrest Community School Coordinator, Stefanie Eldred, MSW, “is a place and a set of partnerships between the school and other community resources where there is an integrated focus on academics and family support, health and social services, and youth and community development leads to improved student learning, stronger families and healthier communities.” Community partnerships like these really make a difference and Access Institute is thrilled to participate.

You can participate as well, by joining us and our community partners at Spectrum on October 18^th.

Access Institute seeks to bridge the gap

San Francisco – September 14, 2009. Amid California’s economic crisis and mental health budget cuts, independent non-profit Access Institute is bridging the gap for San Francisco’s underserved community, while providing a training ground for future community-minded therapists.

Mental illness is the leading cause of adult disability, affecting over 57 million Americans in a given year and costing the U.S. over $100 billion annually. [1] It is the most underfunded disease in health care today, due to pervasive social stigma and lack of public awareness associated with mental and emotional disorders.

· California’s $60 billion budget gap – the largest in state history – has resulted in significant cuts to mental health and social service programs, which are critically important to the current and future well being of California’s most vulnerable citizens.

· Mental health care is among one of San Francisco’s most pressing issues, and it is becoming a fast growing need for residents facing the realities of today’s economic crisis.

· While the City is known for its sizeable homeless population, many of whom suffer from acute mental disease, there is a fast-growing population of San Franciscans suffering from the impact of job loss and insufficient health insurance, who desperately need low-cost psychological care.

· These are the people Access Institute has been dedicated to serving for the past 5 years, providing a lifeline to the underserved community by bridging the public funding gap.

An already stretched “safety net” of mental health services for low-income families in San Francisco is being made worse by California ’s economic crisis, which has resulted in a $60 billion budget gap – the largest in state history. As more San Franciscans in need of mental health services fail to get the care they need due to cutbacks or elimination of publicly-funded programs, the City will face more acute hospitalizations and increased homelessness, making the care that independent non-profit organizations such as Access Institute provide even more crucial.

· In late July, California ’s leaders amended the state’s 2009-10 budget to address a swelling budget shortfall due to a deepening depression. After passing $36 billion in cuts in February, state legislators cut another $24 billion in July, taken from virtually every program that receives General Fund support.

1. $64 million eliminating state support for the Mental Health Managed Care program. This program supports county provided in- and outpatient mental health services not covered by physical health care providers or by Medi-Cal fee-for-service providers.

2. $28 million reduction in the Early and Periodic Screening, Diagnosis and Treatment program, funded by counties using Mental health Services Act funds, and an additional $15.8 million in reductions for prior-year claims.

3. $52 million in deferred payments for mental health services to students with serious mental and emotional disorders enrolled in special education.

4. $4.1 million reduction in Caregiver Resource Center funding for services and support to families and caregivers of cognitively impaired individuals.

· Local impact: The 2009-10 state budget cutbacks result in $36.4 million in direct cuts to San Francisco – nearly all in health and human services, which includes $3 million to the City’s mental health and substance abuse funds.[3]

Access Institute expects the fallout from California’s slashed mental healthcare services and further rises in unemployment during a prolonged economic downturn will result in a continued rise in demand for services.

· California’s unemployment rate has climbed from 7.1 percent to 11.6 percent over the last year.

· More than one out of three people in California under the age of 65 went without health insurance for all or part of the two-year period 2007-2008. 80% of uninsured Californian’s are members of working families.[4]

· About 37% of veterans returning from Iraq and Afghanistan have mental health problems, a nearly 50% increase from the last time the prevalence was calculated, according to a new study analyzing national Department of Veterans Affairs data. [5]

Access Institute's innovative approach to mental health services

Founded in 2002, Access Institute for Psychological Services is an integral part of San Francisco's health services safety net. The organization is an independent non-profit funded by individuals and foundations who think that psychological services should be available to everyone. Some of Access Institute's accomplishments include:

· One of the only organizations in the City providing high quality, comprehensive, long-term outpatient psychological care to low-income, culturally diverse San Franciscans.

· Delivers affordable psychological services, serving as a mental health safety net for individuals and families who fall in the gap between those eligible for publicly-funded mental health programs and those with adequate insurance or financial means to afford high quality, potentially longer-term treatment.

· Meets our community’s need for comprehensive psychological care while providing clinical training and supervision to clinicians seeking licensure in a mental health discipline.

· Provides over 8,000 hours of therapy, medication and psychological services per year. Access Institute doubled its capacity in the last five years and has expanded services to include partnerships with community organizations supporting at risk youth and seniors.

Contacts:

[1] NAMI 2007 Fact Sheet

[2] California’s Full Budget Summary, July 2009

[3] Beyond Chron, “State Budget Cuts Leave San Francisco with Choices, “8/6/09.

[4] The Uninsured: A Closer Look, Families USA, March 2009

[5] National Alliance for the Mentally Ill