Category Archives: Psychology & Psychiatry

Alzheimer’s support model could save states millions

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And younger man's hand holds an elderly man's handBy Lisa Gillespie

As states eye strategies to control the costs of caring for Alzheimer’s patients, a New York model is drawing interest, and findings from a study of Minnesota’s effort to replicate it shows it could lead to significant savings and improved services.  Continue reading

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Jails house 10 times more mentally ill than state hospitals, report

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Screen Shot 2014-04-08 at 7.26.27 AMBy Jenny Gold
KHN

April 8, 2014 – In 44 states and the District of Columbia, at least one prison or jail holds more people with serious mental illnesses than the largest state psychiatric hospital, according to a report released Tuesday by the Treatment Advocacy Center and the National Sheriffs’ Association. Continue reading

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Drug company agrees to pay $27.6 million to settle allegations involving Chicago psychiatrist

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ProPublica Logoby Kara Brandeisky
ProPublica, March 12, 2014

Teva Pharmaceutical Industries Ltd. has agreed to pay more than $27.6 million to settle state and federal allegations that it induced Chicago psychiatrist Michael Reinstein to overprescribe clozapine, a powerful antipsychotic drug.

Reinstein has twice figured into ProPublica investigations.

Four years ago, ProPublica and the Chicago Tribune spotlighted Reinstein’s prescribing pattern, findingthat in 2007 he had prescribed more clozapine to patients in Medicaid’s Illinois program than all of the doctors in the Medicaid programs of Texas, Florida and North Carolina combined. Continue reading

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Why hospitals are failing civilians who get PTSD

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Gunby Lois Beckett
ProPublica, March 4, 2014

More than 20 percent of civilians with traumatic injuries may develop PTSD. Trauma surgeons explain why many hospitals aren’t doing anything about it.

Undiagnosed post-traumatic stress disorder is having a major impact on injured civilians, particularly those with violent injuries, as Propublica detailed last month.

One national study of patients with traumatic injuries found that more than 20 percent of them developed PTSD.

But many hospitals still have no systematic approach to identifying patients with PTSD or helping them get treatment.

We surveyed 21 top-level trauma centers in cities with high rates of violence. The results show that trauma surgeons across the country see PTSD as a serious problem.  Continue reading

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Childhood trauma’s affect on health throughout life – Event Feb. 25

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Dr. Anda

Dr. Anda

A national expert on child abuse, Dr. Robert Anda, will discuss how childhood trauma can have effects that last throughout life at an event being held February 25th in Lynnwood.

The event is sponsored by Ryther, a provider of behavioral health services to children and their families, the Comprehensive Health Education Foundation and Coordinated Care.

Dr. Anda’s talk will be followed with a panel discussion. The event is free but registration is required.  Continue reading

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Men, minorities and the elderly not getting treated for depression

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And younger man's hand holds an elderly man's handBy Milly Dawson
HBNS Contributing Writer

A leading cause of disability, depression rates are increasing in the U.S. and under-treatment is widespread, especially among certain groups including men, the poor, the elderly and ethnic minorities, finds a new study in General Hospital PsychiatryContinue reading

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The PTSD crisis that’s being ignored: Americans wounded in their own neighborhoods

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GunBy Lois Beckett
ProPublica, Feb. 3, 2014

Chicago’s Cook County Hospital has one of the busiest trauma centers in the nation, treating about 2,000 patients a year for gunshots, stabbings and other violent injuries.

So when researchers started screening patients there for post-traumatic stress disorder in 2011, they assumed they would find cases.

They just didn’t know how many: Fully 43 percent of the patients they examined – and more than half of gunshot-wound victims – had signs of PTSD.  Continue reading

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Women’s Health — Week 22: Eating Disorders — Anorexia and Bulimia

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tacuin womenFrom the Office of Research on Women’s Health

Eating disorders are marked by extremes. An eating disorder can be an extreme reduction of food intake or extreme overeating, or feelings of extreme distress or concern about body weight or shape.

A person with an eating disorder may have started out just eating smaller or larger amounts of food than usual, but at some point, the urge to eat less or more spirals out of control.

Continue reading

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Women’s health – Week 15: Depression and Anxiety

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Office of Research on Women’s Health

Everyone feels sad sometimes, but these feelings usually pass within a couple of days. But when a woman has a depressive disorder, it can interfere with daily life and cause pain for her and those who care about her. The good news is that the vast majority of people, even those with the most severe depression, can get better with treatment.

Your health care provider may conduct a complete medical and psychological evaluation and will recommend an appropriate treatment. The most proven treatment methods are certain antidepressant medications and kinds of psychotherapy.

Women with depressive illnesses may not all experience the same symptoms. The severity, frequency, and duration of symptoms will vary depending on the person and her particular illness.

The most common symptoms of depression can include:

  • Persistent sad, anxious, or “empty” feelings.
  • Feelings of hopelessness and/or pessimism (belief that things will not get better).
  • Loss of interest in activities or hobbies once pleasurable, including sex.
  • Insomnia, waking up during the night, or excessive sleeping.
  • Fatigue and decreased energy.
  • Irritability, restlessness, or anxiety.
  • Feelings of guilt, worthlessness, and/or helplessness.
  • Thoughts of suicide, suicide attempts.
Antidepressant medication and pregnancy and breastfeeding
Women can be depressed while pregnant, especially if they have a history of depression. Women also can develop depression during pregnancy and especially after giving birth. The decisions about how to treat depression during pregnancy are complex and should be made in consultation with your health care provider before becoming pregnant to develop the best treatment plan.Antidepressants are excreted in breast milk, usually in very small amounts. Health care providers have not noticed many problems among infants nursing from mothers who are taking antidepressants, but research into possible side effects is ongoing. Whether you are planning to get pregnant, or are now pregnant or breastfeeding, consult your health care provider about the risks and benefits to you and your baby when deciding whether to take an antidepressant during pregnancy or while breastfeeding.

Anxiety disorders

People with anxiety disorders feel extremely fearful and unsure. Most people feel anxious about something for a short time now and again. For people with anxiety disorders, the anxiety is so frequent and intense that it seriously disrupts daily activity and quality of life.

Examples of anxiety disorders include:

  • Panic disorder.
  • Obsessive-compulsive disorder (OCD).
  • Post-traumatic stress disorder (PTSD) (see Week 38 for more information).
  • Social phobia (or social anxiety disorder).
  • Specific phobias.
  • Generalized anxiety disorder (GAD).

Each anxiety disorder has different symptoms, but all the symptoms cluster around excessive, irrational fear and dread. There is help for people with anxiety disorders. The first step is to talk to your health care provider about your symptoms. Your health care provider will examine you to make sure that another physical problem is not causing the symptoms. He or she may refer you to a mental health specialist.

Health care providers may prescribe medication to help relieve your anxiety disorder, but it is important to know that some of these medicines may take a few weeks to start working. The kinds of medicines that have been found to be helpful for anxiety disorders include antidepressants, anti-anxiety medicines, and beta blockers.Many people get relief from their anxiety with certain kinds of psychotherapy. These treatments can help people feel less anxious and fearful. You may be referred to a social worker, psychologist, psychiatric nurse, or psychiatrist for psychotherapy.

For more information: www.nimh.nih.gov
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Mental health parity rule clarifies standards for treatment limits and coverage

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Jigsaw puzzle with one piece to add

Photo: Willi Heidelbach

By Michelle Andrews

The Mental Health Parity and Addiction Equity Act of 2008 required health plans that offer mental health and substance use disorder benefits to cover them to the same extent that they cover medical/surgical benefits.

Among other things, it prohibits having treatment limits or financial coverage requirements such as copayments or deductibles that are more restrictive than a plan’s medical coverage. Interim regulations issued in 2010 clarified some issues about implementing the law.

The final rules, issued last month by federal officials, spell out more specifics. I spoke with Jennifer Mathis, director of programs at the Judge David L. Bazelon Center for Mental Health Law in Washington, about the parity law and the new regulations. This transcript was condensed and edited for clarity.

Q. What issues does this final mental health parity rule address that will be important to consumers?

A. The rule offers a number of clarifications about the parity law. Some of these clarifications concern how parity requirements relate to the Affordable Care Act, and others relate to issues that were not addressed in the interim rule.

Plans don’t have to cover mental health benefits, but if they do, they generally have to cover inpatient and outpatient services, emergency care and prescription drugs. This final rule says that within a category, such as outpatient care, plans can treat preferred providers differently than non-preferred providers.

So it might mean a consumer could have higher copays for non-preferred providers in their insurer’s network for mental health outpatient services than for preferred providers, for example.

The regulation also said that services some would label as intermediate-level mental health services, including residential treatment and intensive outpatient services, are within the scope of the parity law. The regulations say they should be covered at parity. That hadn’t been clear in the interim rules.

Q. The parity law doesn’t allow quantitative differences in coverage, such as fewer office visits or higher copayments for mental health services. But what about other limits that may be harder to measure?

A. The rule provides some clarification on that. These are things like requiring plan members to get prior authorization before receiving services and setting up protocols to determine whether treatment is medically necessary.

What the final rules say is that plans must use the same type of processes to determine what is medically necessary or to require prior authorization for both mental health and medical services. If they have a rigorous process for justifying prior authorization for medical services they must have a similarly rigorous process for mental health services prior authorization as well.

Q. What does it clarify about mental health coverage and the Affordable Care Act?

A. The ACA says plans can’t have annual or lifetime dollar limits on the 10 essential health benefits, one of which is mental health and substance use disorder treatment. Normally, under parity you can have those dollar limits as long as they’re at parity with medical service limits. This rule clarifies that the ACA trumps parity in this regard.

Q. Who’s affected by this rule, and by parity more broadly?

A. People who get counseling, psychotherapy, prescription drugs are likely to see the biggest benefit from these rules because those are the services that commercial health plans usually cover. And they already have benefited since the law passed in 2008. This is not a brand new set of rules, this is an update of the rules that already apply. They have benefited and will continue to benefit.

And people on the exchanges who previously had no insurance or bad insurance not only will be able to get insurance now but also insurance with mental health parity. 

The ACA also applies parity requirements to insurance plans in the states that adopt the new Medicaid expansion for adults with incomes up to 138 percent of the federal poverty level ($15,856 for an individual in 2013).

These regulations do not apply to those plans, but the government says that it will be issuing further guidance about how parity applies to those plans.

Parity is likely to be a very important requirement in those plans, which in many cases will cover more mental health services than are typically covered by commercial insurance plans, including services that are used by people with significant psychiatric disabilities.

Thus a wider variety of services, used by a wider group of people with mental health needs, will be subject to parity requirements.

Q. What types of health plans are covered by the rule?

A. It generally applies to both fully insured and self-funded large group plans as well as individual and small group plans sold on and off the health insurance exchanges.

Q. What if states have mandated mental health benefits of their own?

A. State parity laws that are more stringent than federal parity laws are not pre-empted. For example, some states’ parity laws require coverage of particular services or benefits on top of the federal requirements. Some states require autism coverage, for example.

Q. What about providers that don’t accept insurance. Does the parity law or this rule affect them?

A. No. That is an issue, certainly for psychiatric services. That’s becoming an increasing concern.

Q. Since the mental health parity law passed, is there any evidence that companies have dropped mental health benefits from their plans so as not to have to comply?

A. According to these regulations, a 2010 study sponsored by the department of Health and Human Services found that, since the 2010 parity regulations came out, only a small percentage of plans have dropped mental health or substance use coverage

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Women’s Health – Week 11: Chronic fatigue syndrome

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Office of Researcher on Women’s Health

Chronic fatigue syndrome (CFS) affects people of all age, racial, ethnic, and socioeconomic groups. CFS is a complex syndrome that is three times more common in women. People with CFS often function at considerably lower levels of activity than their pre-CFS ability.

CFS can be hard to diagnose because its symptoms can be mistaken for other illnesses. Some common symptoms of CFS include:

  • Severe fatigue that does not improve with bed rest (experienced as intense exhaustion and extremely low energy for 6 months or more).
  • Problems with concentration and short-term memory.
  • Flu-like symptoms such as pain in the joints and muscles, sleep that does not leave you feeling refreshed, tender lymph nodes, sore throat, and headaches.

Although no cure exists for CFS, your health care provider can work with you to manage symptoms, monitor activity levels, improve function, and conserve energy.

Symptoms that change in type and severity make treatments more complicated and affect patients’ ability to cope with the illness. Treatment can improve the quality of life for people with CFS. Medicines can be used to treat pain, sleep disorders, and other problems.

While CFS is hard to diagnose, if you think you may be experiencing some symptoms of CFS, do not hesitate to consult with your health care provider so that he or she may design a highly individualized treatment plan to help you feel better.

NIH and You
The Office of Research on Women’s Health and the Trans-NIH Working Group for Research on Chronic Fatigue Syndrome of the National Institutes of Health support and encourage CFS research through meetings, a website, and funding. The NIH supports ongoing studies to increase our knowledge about CFS and the potential for new treatments.

For more information: http://orwh.od.nih.gov

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Lack of eye contact in early infancy may be sign of autism, study

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From the National Institutes of Health

Eye contact during early infancy may be a key to early identification of autism, according to a study funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health.

Published this week in the journal Nature, the study reveals the earliest sign of developing autism ever observed — a steady decline in attention to others’ eyes within the first two to six months of life.

“Autism isn’t usually diagnosed until after age 2, when delays in a child’s social behavior and language skills become apparent. This study shows that children exhibit clear signs of autism at a much younger age,” said Thomas R. Insel, M.D., director of NIMH. “The sooner we are able to identify early markers for autism, the more effective our treatment interventions can be.”

autism eye

Decline in eye fixation reveals signs of autism present already within the first 6 months of life. Data from a 6-month-old infant later diagnosed with autism are plotted in red.

Data from a typically developing 6-month-old are plotted in blue. The data show where the infants were looking while watching a video of a caregiver. Source: Warren Jones, Ph.D., Marcus Autism Center, Children’s Healthcare of Atlanta, and Emory University School of Medicine.

Typically developing children begin to focus on human faces within the first few hours of life, and they learn to pick up social cues by paying special attention to other people’s eyes.

Children with autism, however, do not exhibit this sort of interest in eye-looking. In fact, a lack of eye contact is one of the diagnostic features of the disorder.

To find out how this deficit in eye-looking emerges in children with autism, Warren Jones, Ph.D., and Ami Klin, Ph.D., of the Marcus Autism Center, Children’s Healthcare of Atlanta, and Emory University School of Medicine followed infants from birth to age 3.

The infants were divided into two groups, based on their risk for developing an autism spectrum disorder. Those in the high risk group had an older sibling already diagnosed with autism; those in the low risk group did not.

Jones and Klin used eye-tracking equipment to measure each child’s eye movements as they watched video scenes of a caregiver. The researchers calculated the percentage of time each child fixated on the caregiver’s eyes, mouth, and body, as well as the non-human spaces in the images. Children were tested at 10 different times between 2 and 24 months of age.

By age 3, some of the children — nearly all from the high risk group — had received a clinical diagnosis of an autism spectrum disorder. The researchers then reviewed the eye-tracking data to determine what factors differed between those children who received an autism diagnosis and those who did not.

“In infants later diagnosed with autism, we see a steady decline in how much they look at mom’s eyes,” said Jones. This drop in eye-looking began between two and six months and continued throughout the course of the study.

By 24 months, the children later diagnosed with autism focused on the caregiver’s eyes only about half as long as did their typically developing counterparts.

This decline in attention to others’ eyes was somewhat surprising to the researchers. In opposition to a long-standing theory in the field — that social behaviors are entirely absent in children with autism — these results suggest that social engagement skills are intact shortly after birth in children with autism. If clinicians can identify this sort of marker for autism in a young infant, interventions may be better able to keep the child’s social development on track.

“This insight, the preservation of some early eye-looking, is important,” explained Jones. “In the future, if we were able to use similar technologies to identify early signs of social disability, we could then consider interventions to build on that early eye-looking and help reduce some of the associated disabilities that often accompany autism.”

The next step for Jones and Klin is to translate this finding into a viable tool for use in the clinic. With support from the NIH Autism Centers of Excellence program, the research team has already started to extend this research by enrolling many more babies and their families into related long-term studies.

They also plan to examine additional markers for autism in infancy in order to give clinicians more tools for the early identification and treatment of autism.

Grant: R01MH083727

About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and care. For more information, visit http://www.nimh.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health®

Reference

Jones W, Klin A. Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism. Nature, Nov. 6, 2013.

 

 

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Women’s Health – Week 9: Caregiving

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tacuin womenFrom Office of Reseach on Women’s Health

Caring for a loved one, while immensely challenging, can also be a rewarding and positive experience. Caregivers provide many kinds of help, from grocery shopping to helping with daily tasks such as eating and dressing.

Women provide the majority of long-term care in this country. Caregivers act as health care providers,  friends,  companions,  decision-makers,  and advocates,  often while working and caring for their children at the same time.

To be able to take care of others, you must also take care of yourself. Eating right,  staying active, and making sure your own emotional and physical needs are being met are important places to start. Caregivers often have high levels of depression,  anxiety,  and other mental health issues.

You should talk to a counselor,  psychologist,  or other mental health professional right away if the stress affects your daily life or leads you to physically or emotionally harm the person you are caring for.

As a caregiver, you already know that it is important to track financial and medical records. Planning ahead in case of an emergency can make all the difference. The person who you are caring for should give consent in advance for their health care provider or lawyer to talk with you as needed if there are questions about medical care, a bill, or a health insurance claim. Without consent, the caregiver may not be able to get needed information.

Respite care
Respite care is the provision of short-term, temporary relief to you if you are caring for family members who might otherwise require permanent placement in a facility outside the home. It provides you with the break you need, and also ensures that your loved one still receives the attention that he or she needs. Respite care can vary in time from part of a day to several weeks. For more information about respite care: www.ninr.nih.gov.
for more information: www.orwh.nih.gov
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Oregon experiment puts therapists on primary care teams

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dave-tyson-and-jennifer-engel

Tyler Engel with his parents, Dave and Jennifer. His doctor and therapist worked with the family to help Tyler recover from a concussion. (Photo by Kristian Foden-Vencil/OPB)

By Kristian Foden-Vencil, Oregon Public Broadcasting

The state of Oregon is trying some experiments to bring different kinds of medical professionals under the same roof.

Medicaid patients can see different kind of doctors in one visit, and the hope is it will provide better patient care, eventually at less cost to the state.

This can make sense in a primary care setting, where doctors often have to deal with stomach aches and migraines that end up stemming from mental, rather than physical, problems.

Before, primary care doctors typically would refer those patients to a psychologist. But very few patients actually go see the psychologist, says Robin Henderson, a psychologist with the St. Charles Health System in Bend, Ore.

They don’t want the stigma of seeing a psychologist, Henderson says, so they procrastinate and get sicker.

In an effort to solve the problem, St. Charles has been running a pilot project that puts psychologists in doctors’ offices.

“You’re sitting on the table, in comes your psychologist to sit next to you. It changes the stigma dynamic,” Henderson says.

Take the case of 17-year-old Tyson Engel.

Back in the spring of 2011, he was snowboarding on Mt. Batchelor when he fell so hard he cracked his helmet. His mom Jennifer Engel says she soon began to notice dramatic changes.

“Tyson talked about headaches for a while. He was always on the run, not eating very much, not sleeping very much,” she says.

Over a period of several months, she took him to the ER five times and tried several doctors around town. But the symptoms weren’t improving.

Eventually she ended up at the Mosaic Medical Clinic, where they saw Dr. Kristi Nix, a pediatrician, and Sandra Marshall, a clinical psychologist.

Nix treated Tyson for his physical brain injuries, while Marshall helped him with everyday coping skills to deal with symptoms like sensory overload and impulse control. For instance, Tyson’s mom remembers taking him to an appointment one day when he suddenly ran across a busy street to see a shiny new bike.

Marshall says it wasn’t just Tyson who needed help — his parents needed it too.

“Sometimes there would be too much talk,” says Marshall. “They would talk and talk and talk and he would get frustrated, and too fast. And it was ‘Okay, you guys have to stop talking too much.’ ”

Tyson says Marshall gave him coping strategies explained clearly enough that he could use them, as opposed to trying to recall some long in-depth family conversation.

So now if he sees a bike, he says, “I think to myself: ‘Is now the right time, is now the wrong time? How badly do I want to see the bike? Is it that important, is it not important?’ And just by asking myself questions, I’d get better at the certain situations I was into.”

Henderson says Tyson’s issues are complex. More common examples at Mosaic involve children getting upset tummies or headaches because they’re being bullied or because their parents are getting divorced.

For them, a more typical treatment would be brief interventional strategies designed to help parents and children deal with things that Henderson says “aren’t necessarily treatable with an antibiotic.”

For her part, Nix says having a psychologist in the clinic has lifted a burden off her shoulders.

“It’s not satisfying as a physician to say, ‘I don’t know what’s wrong with you. Get out of my office.’ Right. That’s not OK and it’s not good healthcare,” she says.

But asking a psychologist drop in to talk to a patient for 20 minutes, instead of setting up a schedule of weekly visits, is a big change in how psychologists are used to working.

Henderson says St. Charles has had problems hiring psychologists to place at local medical practices like Mosaic, where they would work with Medicaid clients.

“It’s not worked for some of them,” she says.”Initially we had a couple of folks who just couldn’t manage the model. It takes a different type of personality, and we find the folks coming right out of school, fresh, who’ve been trained in health psychology models. You have to have that type of personality who wants to engage in team-based care.”

As far as saving money, Henderson says therapists hired by St. Charles have cared for 400 Medicaid patients over about two years.

The annual cost of care dropped from an average of about $7,650 per patient per year to about $6,800 per patent per year. “That included a minor increase in their pharmacy costs,” she explains. “But even with that increase, the total medical spend was going down.”

St. Charles is doing a much longer study to see if the savings are real. But several other health systems around the state as well as in Colorado and Massachusetts are also trying this approach.

This piece is part of a collaboration that includes NPROregon Public Broadcasting and Kaiser Health News.By Kristian Foden-Vencil, Oregon Public Broadcasting
OCT 22, 2013
The state of Oregon is trying some experiments to bring different kinds of medical professionals under the same roof. Medicaid patients can see different kind of doctors in one visit, and the hope is it will provide better patient care, eventually at less cost to the state.

This can make sense in a primary care setting, where doctors often have to deal with stomach aches and migraines that end up stemming from mental, rather than physical, problems.

Before, primary care doctors typically would refer those patients to a psychologist. But very few patients actually go see the psychologist, says Robin Henderson, a psychologist with the St. Charles Health System in Bend, Ore. They don’t want the stigma of seeing a psychologist, Henderson says, so they procrastinate and get sicker.

In an effort to solve the problem, St. Charles has been running a pilot project that puts psychologists in doctors’ offices.

“You’re sitting on the table, in comes your psychologist to sit next to you. It changes the stigma dynamic,” Henderson says.

Take the case of 17-year-old Tyson Engel.

Back in the spring of 2011, he was snowboarding on Mt. Batchelor when he fell so hard he cracked his helmet. His mom Jennifer Engel says she soon began to notice dramatic changes.

“Tyson talked about headaches for a while. He was always on the run, not eating very much, not sleeping very much,” she says.

Tyler Engel with his parents, Dave and Jennifer. His doctor and therapist worked with the family to help Tyler recover from a concussion. (Photo by Kristian Foden-Vencil/OPB)
Over a period of several months, she took him to the ER five times and tried several doctors around town. But the symptoms weren’t improving.

Eventually she ended up at the Mosaic Medical Clinic, where they saw Dr. Kristi Nix, a pediatrician, and Sandra Marshall, a clinical psychologist.

Nix treated Tyson for his physical brain injuries, while Marshall helped him with everyday coping skills to deal with symptoms like sensory overload and impulse control. For instance, Tyson’s mom remembers taking him to an appointment one day when he suddenly ran across a busy street to see a shiny new bike.

Marshall says it wasn’t just Tyson who needed help — his parents needed it too.

“Sometimes there would be too much talk,” says Marshall. “They would talk and talk and talk and he would get frustrated, and too fast. And it was ‘Okay, you guys have to stop talking too much.’ ”

Tyson says Marshall gave him coping strategies explained clearly enough that he could use them, as opposed to trying to recall some long in-depth family conversation.

So now if he sees a bike, he says, “I think to myself: ‘Is now the right time, is now the wrong time? How badly do I want to see the bike? Is it that important, is it not important?’ And just by asking myself questions, I’d get better at the certain situations I was into.”

Henderson says Tyson’s issues are complex. More common examples at Mosaic involve children getting upset tummies or headaches because they’re being bullied or because their parents are getting divorced.

For them, a more typical treatment would be brief interventional strategies designed to help parents and children deal with things that Henderson says “aren’t necessarily treatable with an antibiotic.”

For her part, Nix says having a psychologist in the clinic has lifted a burden off her shoulders.

“It’s not satisfying as a physician to say, ‘I don’t know what’s wrong with you. Get out of my office.’ Right. That’s not OK and it’s not good healthcare,” she says.

But asking a psychologist drop in to talk to a patient for 20 minutes, instead of setting up a schedule of weekly visits, is a big change in how psychologists are used to working.

Henderson says St. Charles has had problems hiring psychologists to place at local medical practices like Mosaic, where they would work with Medicaid clients.

“It’s not worked for some of them,” she says.”Initially we had a couple of folks who just couldn’t manage the model. It takes a different type of personality, and we find the folks coming right out of school, fresh, who’ve been trained in health psychology models. You have to have that type of personality who wants to engage in team-based care.”

As far as saving money, Henderson says therapists hired by St. Charles have cared for 400 Medicaid patients over about two years.

The annual cost of care dropped from an average of about $7,650 per patient per year to about $6,800 per patent per year. “That included a minor increase in their pharmacy costs,” she explains. “But even with that increase, the total medical spend was going down.”

St. Charles is doing a much longer study to see if the savings are real. But several other health systems around the state as well as in Colorado and Massachusetts are also trying this approach.

This piece is part of a collaboration that includes NPR, Oregon Public Broadcasting and Kaiser Health News

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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States bolster suicide prevention programs

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PrintBy Maggie Clark
Stateline Staff Writer

After three students took their own lives in one year at his children’s middle school, Utah state Rep. Steve Eliason wracked his brain for a response.

“One of the students came to me and said, ‘We know something is happening, but no one is talking about this.’ I talked to the principal and said there needed to be more dialogue,” recalled Eliason, a Republican.

The school scheduled a seminar for parents on teen mental health issues, sparking conversations between students and parents.

In the next week, two students were diagnosed with severe depression and hospitalized. The seminar idea turned into a model for state legislation and a passion for Eliason.

“It’s incumbent on legislators to address suicide, since it’s a public health problem,” Eliason said.

A growing number of state lawmakers are putting that view into practice.

Since 2007, Utah and 11 other states have approved versions of the Jason Flatt Act, which requires states to provide suicide awareness training to school employees, including teachers, nurses, counselors, school psychologists and administrators.

The law is named for a 16-year-old Tennessee student who took his own life in 1997.

Some state legislatures also are trying cut down on the rising number of adult suicides by encouraging stiffer gun safety measures and mandating more extensive training for social workers.

States Respond

Every day, more than 100 people commit suicide in the U.S.  Suicide is the second-leading cause of death for people between the ages of 25 and 34, and the third-leading cause of death among those between 15 and 24.

Between 2008 and 2010, there were twice as many suicides as homicides, according to the Suicide Prevention Resource Center. Still, in many areas of the country, suicide-prevention efforts are virtually nonexistent.

Clark Flatt, Jason Flatt’s father, started The Jason Foundation four months after his son’s death to advocate for youth suicide prevention training nationwide.

“We hear from teachers that they’re afraid of hearing that a student is having a hard time and not knowing how to help them,” Flatt said. “But once you empower a teacher to know that they’re competent to handle the situation, they are more assured about what to do.”

So far, more than 152,000 school employees nationwide have been exposed to the Jason Foundation’s training materials, Flatt said.

In Ohio, Rep. Marlene Anielski sponsored the Jason Flatt Act in honor of her son Joseph, who committed suicide three years ago. Anielski also worked to put locked mailboxes in schools where students can deposit anonymous notes alerting administrators to students who might be at risk.

“Having blinders on and not talking about it does not help anyone,” Anielski said in an interview with the Sun News of Ohio.

At the federal level, the Garrett Lee Smith grant program provides $30 million a year to states and tribes for follow-up care for youth who have attempted suicide or to cover training for teachers, coaches, juvenile justice workers or other people who work closely with teens. More than 600,000 people have been trained through these programs, according to the Suicide Prevention Resource Center.

The U.S. Surgeon General has also developed a national suicide prevention strategy to guide public health agencies.  As a result, most states in the last 10 years have hired a statewide suicide prevention coordinator. Many states also have their own statewide suicide-prevention plan.

Reaching Suicidal Adults

Reaching suicidal adults is trickier than reaching students in school. Suicide rates among adults ages 35-64increased 28 percent from 1999 to 2010, according to the Centers for Disease Control and Prevention.

This year, Kentucky and Washington passed legislation that requires training for social workers and counselors to help them recognize suicidal tendencies, which can range from someone talking about wanting to die to displaying extreme mood swings.

And earlier this week, Maine Gov. Paul LePage issued an executive order directing state agencies to create a policy on suicide awareness and prevention for state employees.

Other states are focusing on guns. Of the more than 30,000 gun deaths in 2010, the most recent year that data is available, about 61 percent were suicides and 35 percent were homicides, according to the CDC (the rest were the result of accidents, police shootings, or unknown causes). In the U.S., more than half of all suicides are gun suicides.

In Utah, where more than 500 people killed themselves last year, Eliason is working on building support forlegislation to require gun-safety education for gun owners applying for concealed carry permits.

He also plans to provide free trigger locks and information pamphlets for doctors to give to their patients. “For instance, if a parent brings their child to a doctor because he or she is depressed, the doctor can say, ‘Here’s a trigger lock, go home and put this on your gun,’” Eliason said.

Guns are also the most lethal means of suicide, since there is no time for someone to reconsider their decision to take their own life.

In a study of youth suicides in 2001 and 2002 in Connecticut, Maine, Utah, Wisconsin, Allegheny County, Pa., and San Francisco, researchers from the Suicide Prevention Resource Center found that 82 percent of youths who committed suicide with a firearm used one belonging to a family member.

Another recent study from the Harvard Injury Control Research Center found that states with higher rates of gun ownership had higher rates of firearm suicide, but not non-firearm suicide.

The challenge is separating gun safety from the politically fraught issue of gun control, said Catherine Barber, one of the co-authors of the study.

“It’s really important to figure out an approach that sidesteps gun control issues, because the audience to reach is gun-owning families,” said Barber. “If they see their family member struggling, that’s when we want it to cross a gun owners minds to say, ‘Maybe it would be safer to ask my friend to hold onto my guns, or store them in a locker at the hunting lodge, or even ask the guy at the gun shop to hold onto them for a while.’”

This strategy has been successful in New Hampshire. Under the direction of the New Hampshire Safety Coalition and Harvard researchers, nearly half of all gun store owners in the state have voluntarily displayed educational fliers advising gun owners to keep their firearms locked away from anyone who might be suicidal. Tennessee is also rolling out a gun safety and suicide prevention campaign with gun store owners this year.

Comprehensive Approach

Restricting access to guns for suicidal people may well help to reduce suicides, said Dr. Richard McKeon, chief of the suicide prevention branch of the U.S. Substance Abuse and Mental Health Services Administration, but it’s not the only thing that can work.

“What’s needed is a comprehensive approach to suicide prevention using multiple interventions, not just one,” McKeon said.  That could include restricting weapons access, training or building general awareness, he said.

“It’s a multifaceted and complex issue,” Eliason said. “We’re doing pretty well at bringing down the number of violent crime deaths, even cancer death, but suicide rates continue to climb. It’s not like there’s going to be a polio vaccine to fix this.”

Suicide prevention experts urge that if you or someone you know exhibits any of these signs to seek help by calling that national suicide prevention lifeline at 1-800-273-TALK (8255) or visit suicidepreventionlifeline.org.
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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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