Category Archives: Psychology & Psychiatry

New efforts to keep the mentally ill out of jail

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BrainBy Michael Ollove
Stateline

Paton Blough has served multiple jail terms as a result of mental illness.

He said his various offenses included brandishing a shotgun, reckless endangerment, destruction of civic property, spitting on a police officer, being a public nuisance and threatening a public official.

Never was he charged with being mentally ill. That isn’t a crime, after all. But there was no doubt about why he had ended up in jail.

Blough, 38, has had bipolar disorder since his late teens. At times delusions convinced him of a worldwide conspiracy against him involving police officers, former President George W. Bush and Nazi ghosts.

“Can you imagine if we had two million people locked up for having a heart condition? Well guess what? We have two million people locked up with a health condition called mental illness.”

“Can you imagine if we had two million people locked up for having a heart condition?” Blough, whose last arrest was six years ago, said in a telephone interview last week from his home in Greenville, South Carolina. “Well guess what? We have two million people locked up with a health condition called mental illness.”

In many places, police, judges and elected officials increasingly are pointing out that a high proportion of people in jail are mentally ill, and that in many cases they shouldn’t be there. In recent years, many cities and counties have tried to reduce those numbers by training police to deal with mental health crises, creating mobile mental health units to assist officers, and establishing mental health support centers as an alternative to jail, among other measures.

In King County, Washington, a combination of ACT teams, supportive housing and intensive community-based treatments has resulted in a 45 percent reduction in jail and prison bookings among those participating. 

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Helping the mentally ill stay out of hospitals

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By Christine Vestal
Stateline

NEW YORK – It is a busy Friday afternoon. Staff members check in guests at the front desk. Other employees lead visitors on tours of the upstairs bedrooms, or field calls from people considering future stays. Aromas of garlic and roasted chicken seep out of the kitchen.

Community Access is not a bed and breakfast, although it feels that way when you walk through its unmarked door off Second Avenue on Manhattan’s Lower East Side. Also known as Parachute NYC, this quiet seven-bedroom facility is one of four publicly funded mental health centers in New York City (located in Manhattan, Brooklyn, Queens and the Bronx) that provide an alternative to hospital stays for people on the verge of a mental health crisis.

Parachute’s respite centers have no medical staff, no medications, no locks or curfews and no mandatory activities. They are secure, welcoming places where people willingly go to escape pressure in their lives.

Parachute’s respite centers have no medical staff, no medications, no locks or curfews and no mandatory activities. They are secure, welcoming places where people willingly go to escape pressure in their lives and talk to trained “peer professionals” who can relate to what guests are going through because they are recovering from mental illness themselves.

Without places like this, New Yorkers who suffer from serious mental illness would have little choice but to check into a hospital or a hospital-like crisis center when their lives spin out of control. Some people need to be hospitalized for severe psychosis and depression, but many others end up in the hospital because they have no other options.

Relatively rare in the U.S., respite centers like this one cost a fraction of the price of a hospital stay, and can be far more effective at helping people avoid a psychotic break, severe mood swing or suicidal episode. Continue reading

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Psychiatrists unveil new resource for patients

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apa-understanding-mentalBy Lisa Gillespie
KHN

As mental health professionals, policy makers and advocates focus on taking steps to mend the fragmented mental health care system, the role of patients and their friends and families is sometimes overlooked.

That’s why the American Psychiatric Association is releasing a first-of-its-kind book to decode in plain English the Diagnostic and Statistical Manual of Mental Disorders – a guide for mental health providers that is also used to determine insurance coverage.

The resource, Understanding Mental Disorders: Your Guide To DSM-5, includes in-depth explanations of risk factors, symptoms and symptom management, treatment options and success stories.

This gets at one of APA’s reasons for releasing this volume — to help create a more accurate picture of what a particular illness or disorder might involve. Continue reading

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Most Common Drug Ingredient in the US Kills Emotions

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Three red and white capsulesCommonly found in pain relievers, acetaminophen gets rid of more than just physical agony – it also diminishes emotions.

“Rather than just being a pain reliever, acetaminophen can be seen as an all-purpose emotion reliever,” lead researcher said in a news release.

via Most Common Drug Ingredient in the US Kills Emotions.

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US proposes rule for providing mental health ‘parity’ in Medicaid program

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Photo courtesy of Sanja Gjenero

By Jenny Gold
KHN

A federal law that passed in 2008 was supposed to ensure that when patients had insurance benefits for mental health and addiction treatment, the coverage was on par with what they received for medical and surgical care.

But until now, the government had only spelled out how the law applied to commercial plans.

That changed Monday, when federal officials released a long-awaited rule proposing how the parity law should also protect low-income Americans insured through the government’s Medicaid managed care and the Children’s Health Insurance Program (CHIP) plans. The proposed regulation is similar to one released in November 2013 for private insurers.

“Whether private insurance, Medicaid, or CHIP, all Americans deserve access to quality mental health services and substance use disorder services,” said Vikki Wachino, acting director at the Center for Medicaid and CHIP Services.

Medicaid and CHIP programs are funded jointly by the federal and state governments.

Even if the state has carved out some benefits under a separate behavioral health plan, patients would be protected under the rule. Medicare patients are generally not affected by the regulation, nor are those in Medicaid fee-for-service plans .

But the rule does affect the majority of the 70 million people on Medicaid who are in managed care plans, and the 8 million children covered by CHIP plans.

Insurers, advocates and the general public will have a chance to comment on the proposed rule. The government will then release a final version.

Photo courtesy of Sanja Gjenero

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Wanting mental health treatment and not getting it

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Jigsaw puzzle with one piece to add

By Michael Ollove
Stateline

More than a half-million adults who said they wanted help with their serious mental conditions last year couldn’t get it because they lacked the resources and weren’t eligible for Medicaid to pay for treatment, a new study finds.

Those people — an estimated 568,886 adults ages 18 through 64 diagnosed with a serious mental illness, serious psychological stress or substance use disorder at the start of last year — lived in 24 states that didn’t expand Medicaid eligibility under the Affordable Care Act in 2014, according to a study published this week from the American Mental Health Counselors Association (AMHCA).

More than a half-million adults who said they wanted help with their serious mental conditions last year couldn’t get it.

In contrast, 351,506 adults with those same mental health problems got treatment paid for by Medicaid in the 26 states and the District of Columbia, which did expand coverage of the state-federal health insurance program to eligible adults living on low incomes.

The upshot, said Joel Miller, AMHCA’s executive director, is “the health of hundreds of thousands of people would be improved” if all states provided Medicaid coverage as they were given the option to under the Affordable Care Act (ACA).

Photo: Willi Heidelbach
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When Facebook friends become depressing – The Washington Post

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Facebook ThumbA few minutes browsing Facebook can be a welcome distraction for knowledge workers dog tired after punching their keyboards all morning. But what seems like a mental break can also be an opportunity for devastating self-analysis: Are my Facebook friends’ boyfriends more beautiful than my boyfriend? Are my Facebook friends’ children more beautiful than my child? Are my Facebook friends’ lives better than mine?

Those familiar with this paralyzing spiral of doubt and shame, take comfort: It’s not just you. New research has drawn a line between logging into Facebook and symptoms of depression.

via When Facebook friends become depressing – The Washington Post.

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Battle for mental health parity produces mixed results

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Illustration of the skull and brainBy Jenny Gold
KHN

By law, many U.S. insurance providers that offer mental health care are required to cover it just as they would cancer or diabetes treatment.

But advocates say achieving this mental health parity can be a challenge.

report released last week by the National Alliance on Mental Illness found that “health insurance plans are falling short in coverage of mental health and substance abuse conditions.”

Jenny Gold of Kaiser Health News spoke with NPR’s Arun Rath over the weekend about the issue.

Rath noted that many patients have trouble getting their mental health care covered, and she outlined some of the issues confronting both patients and the insurance industry. Here is an edited transcript of her comments.

Where does parity stand?

It’s been a mixed bag so far. Insurance companies often used to have a separate deductible or a higher copay for mental health and substance abuse visits.  Right now, that usually isn’t the case. In that way, insurers really have complied. Continue reading

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Depression take its toll in the workplace, study

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RED # 18355 64-NA-193By Lisa Gillespie
KHN

For every dollar spent on treating depression, almost five dollars is spent on the treatment and workplace costs of related medical conditions like back and chest pain, sleep disorders and migraines – placing a greater financial burden on businesses and the health care system, according to new research measuring the economic impact of depression.

“The fact that they’re finding such greater costs with all these different [related conditions] underscores how the fragmented system is not helpful for our economy because people with mental illness are not getting the rounded health care they need,” said Lynn Bufka, assistant executive director of practice research and policy at the American Psychological Association, who was not affiliated with the study.

The average worker who had major depression disorder lost the productivity of about 32 workdays a year due to what’s known as “presenteeism.” That is a term for when an employee is at work but not completing daily tasks and responsibilities.

Among the study’s findings was that the total cost to the U.S. economy of major depressive disorder – a condition that results in having persistent depressive episodes – rose from $173.2 billion in 2005 to $210 billion in 2010, a 21.5 percent increase.

About half of that is for direct treatment and suicide-related services, but the rest is workplace costs. The rise is partially accounted for by the increase in population, but also because depression is being diagnosed and treated more often.

The incidence of major depressive disorder rose during this time period from 6.4 percent of the population to 6.8 percent.

In addition, some of this growth might have been caused by the nation’s 2008 economic downturn and tight job market, factors that combined to make it harder for those suffering from depression to retain their jobs and even more difficult for those with this condition who are job seekers to find work, according to Paul Greenberg, a study author and director of health economics at the Analysis Group, a consulting firm in Boston.

Meanwhile, the study also examined how depression plays out in the workplace.

Mental health experts and economists have long known that someone’s depression can have a significant cost on the workplace, Greenberg said.

For example, the study found that the average worker who had major depression disorder lost the productivity of about 32 workdays a year due to what’s known as “presenteeism.” That is a term for when an employee is at work but not completing daily tasks and responsibilities.

Experts say that, though this loss in productivity highlights the economic toll mental health issues have on the work place, small and medium-sized employers may not have the knowledge or tools to improve the situation. Continue reading

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States gear up to help Medicaid enrollees beat addictions

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CocaineBy Chrisine Vestal
Stateline

Under the Affordable Care Act, millions of low-income adults last year became eligible for Medicaid and subsidized health insurance for the first time.

Now states face a huge challenge: how to deal with an onslaught of able-bodied, 18- to 64-year olds who haven’t seen a doctor in years.

“It took a lot of time and effort to enroll everyone, particularly those who were new to the system,” said Matt Salo, director of the National Association of Medicaid Directors. “The next big step, and the biggest unknown, is finding out exactly how this newly insured population will use the health care system.”

In addition to increasing the number of people with health insurance, the Affordable Care Act for the first time made coverage of addiction services mandatory for all insurers, including Medicaid.

Until now, the vast majority of Medicaid beneficiaries were pregnant women, young children, and disabled and elderly adults. Relatively few able-bodied adults without children qualified, so states did not set up their Medicaid programs to treat them.

The newly insured, most of them young adults, have different needs. Though not as sick as existing Medicaid beneficiaries, the newcomers are more likely than the general population to have undiagnosed and untreated chronic illnesses such as diabetes and heart disease.

The starkest difference between the new population and the old one, however, is that the new enrollees have much higher rates of drug and alcohol addiction and mental illness.

The number of Medicaid enrollees receiving addiction services is expected to skyrocket over the next two years.

Of the estimated 18 million adults potentially eligible for Medicaid in all 50 states, at least 2.5 million have substance use disorders. Of the 19 million uninsured adults with slightly higher incomes who are eligible for subsidized exchange insurance, an estimated 2.8 million struggle with substance abuse, according to the most recent national survey by the U.S. Substance Abuse and Mental Health Services Administration.

In addition to increasing the number of people with health insurance, the ACA for the first time made coverage of addiction services and other behavioral health disorders mandatory for all insurers, including Medicaid. As a result, the number of Medicaid enrollees receiving addiction services is expected to skyrocket over the next two years.

Although Medicaid and other state and federal programs historically have provided care for people with serious mental illness, coverage of addiction treatments has been spotty. Optional under Medicaid until now, coverage in most states was limited, typically just for pregnant women and adolescents.

“It’s the biggest change in a generation for addiction services,” said Robert Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors. “Comprehensive addiction programs didn’t exist in Medicaid until now.” Continue reading

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Locking up firearms to prevent suicide

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GunBy Tony Gomez, BS, RS, Manager, Violence and Injury Prevention
Public Health — Seattle & King County

I’ve worked on Violence and Injury Prevention for over thirty years. I consistently notice in the media and in conversations about firearms that usually the discussion focuses on tragic homicides.

But, the truth is that most firearm deaths are suicides—often hidden from the public conversation. In King County, nearly 70% of firearm deaths being suicides, it’s crucial we come together despite different ideologies.

The truth is that most firearm deaths are suicides.

There are numerous entities including King County that have a deep commitment to suicide prevention and are working together to address this “silent” killer of our residents.

With firearm ownership so prevalent in King County (~25%) – and some estimated 30,000 households that keep at least one firearm loaded and unlocked – we can’t afford to wait any longer to get those easily stolen and accessed firearms locked up.

We know that impulsivity plays a significant role in suicide attempts; easy access to highly lethal means, such as firearms, increases risk.  Strong evidence exists, both in the United States and abroad, that restricting access to lethal means is an effective way to reduce suicide.

Suicide prevention efforts in King County and elsewhere in the United States now champion safe storage of firearms. Continue reading

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Some states retreat on mental health spending

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By Michael Ollove
Stateline

Fewer states increased their spending on mental health programs this year compared to last year, when a spate of horrific shootings by assailants with histories of mental illness prompted a greater focus on the shortcomings of the country’s mental health system.

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From State Mental Health Legislation 2014 Trends, Themes & Effective Practices – NAMI

Some states slashed their mental health budgets significantly this year. At the same time, however, a number of states adopted mental health measures in 2014 that won plaudits from behavioral health advocates.

survey of state spending published last week by the National Alliance on Mental Illness (NAMI) found that 29 states plus the District of Columbia increased their spending on mental health in fiscal year 2015. A year earlier, 37 states plus D.C. increased their mental health budgets.

NAMI warned that the momentum to improve state mental health services, which was especially powerful after the December 2012 Sandy Hook massacre in Connecticut, has slowed.

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Mental health report ranks Washington 48th in the US

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A report by Mental Health America, a mental health advocacy group, ranks Washington state the 48th in the nation because of its high prevalence of mental illness and poor access to mental health services.

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The report found that the states with the lowest prevalence of mental illness and highest rates of access to care include:

  • Massachusetts
  • Vermont
  • Maine
  • North Dakota
  • Delaware

States with the highest prevalence of mental illness and lowest rates of access to care include:

  • Arizona
  • Mississippi
  • Nevada
  • Washington
  • Louisiana

States that rank in the top ten are in the Northeast and Midwest, while states that rank in the bottom ten are in the South and the West.

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Health news headlines – October 24th

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Silhouettes of U.S. Soldiers at night in Iraq

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Kreidler calls for insurers to review mental health denials back to 2006

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MKreidlerPhotoFrom the Office of the Insurance Commissioner

Insurance Commissioner Mike Kreidler is directing all health insurers in Washington state to identify any policyholders who had mental health services denied because of a blanket or categorical exclusion since Jan. 1, 2006 and notify them of their right to have their claim re-evaluated.

The Washington State Supreme Court recently ruled that Washington’s Mental Health Parity Act prevents insurers from using blanket exclusions for mental health services that may be medically necessary.

Kreidler sent a letter to the insurers today (PDF, 371KB), outlining his expectations for how to implement the court’s decision and what steps he expects them to take on behalf of consumers.

“The court ruled decisively on behalf of Washington consumers, and I intend to see that insurers doing business in our state follow through on this decision,” Kreidler said.  “I expect the insurers to do a thorough review of all policyholders who may have current and past claims that may be impacted by this decision and to start the process immediately.” Continue reading

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